scholarly journals Risk Factor of Breakage After Proximal Femoral Nail Antirotation in Intertrochanteric Fractures

2020 ◽  
Author(s):  
Young-Kyun Lee ◽  
Jung-Taek Kim ◽  
Chan Ho Park ◽  
Ji-Ung Song ◽  
Tae-Young Kim ◽  
...  
Keyword(s):  
Intertrochanteric Fracture ◽  
Mechanical Failure ◽  
Proximal Femoral Nail ◽  
Pertrochanteric Fracture ◽  
Horizontal Distance ◽  
Lever Arm ◽  
Femoral Nail ◽  
Increased Risk ◽  
Helical Blade ◽  
Proximal Femoral Nail Antirotation

Abstract Background: Breakage of the intramedullary nail is a rare complication after proximal femoral nail antirotation (PFNA) in intertrochanteric fracture treatment. The purpose of this study was (1) to investigate the frequency of nail breakage among the patients who were treated for mechanical failure after PFNA for intertrochanteric/ pertrochanteric fracture, and (2) to determine the risk factors for nail breakage in PFNA treatment of intertrochanteric fracture.Methods: To identify mechanical failure after internal fixation using PFNA, we retrospectively reviewed the data of 35 patients (35 hips) who required reoperation after PFNA with a helical blade for intertrochanteric/ pertrochanteric fracture between June 2005 and June 2018. We evaluated the frequency of breakage of PFNA and compared the demographic and radiologic parameters between the breakage and control (non-breakage) groups. We also compared the lever arm for the load of stress from the fulcrum according to the centrum-collum-diaphyseal (CCD) angle of blade by using reverse design technique.Results: Among the 25 patients with mechanical failure after PFNA except 10 patients with peri-implant infection and osteonecrosis, 7 (28.0%) showed breakage of PFNA at average of 8 months (range, 5 to 13 months) after index surgery. A larger horizontal offset (the horizontal distance from the lateral surface of the IM nail and the medial tip of helical blade) was associated with an increased risk of nail breakage. A CCD angle of 130° has a shorter lever arm for the load of stress from the fulcrum, meaning a higher stress for nail breakage, although there was no association between centrum-collum-diaphyseal (CCD) angle and breakage of the nail.Conclusions: Our study suggested that higher horizontal offset and a higher CCD angle can increase the risk of breakage of the PFNA nail at the aperture for the helical blade.Levels of Evidence: Level III

scholarly journals Finite element analysis of two cephalomedullary nails in treatment of elderly reverse obliquity intertrochanteric fractures: zimmer natural nail and proximal femoral nail antirotation-ΙΙ

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Jian Chen ◽  
Jian-xiong Ma ◽  
Ying Wang ◽  
Hao-hao Bai ◽  
Lei Sun ◽  
...  
Keyword(s):  
Finite Element Analysis ◽  
Finite Element ◽  
Internal Fixation ◽  
Intertrochanteric Fracture ◽  
Proximal Femoral Nail ◽  
Intertrochanteric Fractures ◽  
Element Analysis ◽  
Femoral Nail ◽  
Unstable Intertrochanteric Fracture ◽  
Proximal Femoral Nail Antirotation

Abstract Background More elderly patients are suffering from intertrochanteric fractures. However, the choice of internal fixation is still controversial, especially in the treatment of unstable intertrochanteric fracture; thus, previous implants continue to be improved, and new ones are being developed. The purpose of our study was to compare the biomechanical advantages between the zimmer natural nail (ZNN) and proximal femoral nail antirotation-II (PFNA-II) in the treatment of elderly reverse obliquity intertrochanteric fractures. Methods A three-dimensional finite element was applied for reverse obliquity intertrochanteric fracture models (AO31-A3.1) fixed with the ZNN or PFNA-II. The distribution, peak value and position of the von Mises stress and the displacement were the criteria for comparison between the two groups. Results The stresses of the internal fixation and femur in the ZNN model were smaller than those in the PFNA-II model, and the peak values of the two groups were 364.8 MPa and 171.8 MPa (ZNN) and 832.3 MPa and 1795.0 MPa (PFNA-II). The maximum amount of displacement of the two groups was similar, and their locations were the same, i.e., in the femoral head vertex (3.768 mm in the ZNN model and 3.713 mm in the PFNA-II model). Conclusions The displacement in the two models was similar, but the stresses in the implant and bone were reduced with the ZNN. Therefore, the ZNN implant may provide biomechanical advantages over PFNA-II in reverse obliquity intertrochanteric fractures, as shown through the finite element analysis. These findings from our study may provide a reference for the perioperative selection of internal fixations.

scholarly journals Pseudoaneurysm of the internal iliac artery caused by proximal femoral nail antirotation following intertrochanteric fracture: a case report

2019 ◽  
pp. 030006051989238
Author(s):  
Cheng Ren ◽  
Qian Wang ◽  
Teng Ma ◽  
Zhong Li ◽  
Huijun Yuan ◽  
...  
Keyword(s):  
Iliac Artery ◽  
Intertrochanteric Fracture ◽  
Internal Iliac Artery ◽  
Rare Complication ◽  
Proximal Femoral Nail ◽  
Intense Pain ◽  
Left Femur ◽  
Femoral Nail ◽  
Internal Iliac ◽  
Proximal Femoral Nail Antirotation

Pseudoaneurysm of the internal iliac artery is a very rare complication of intertrochanteric fracture. Here, the case of an 88-year-old female patient, who presented with intense pain following surgery for intertrochanteric fracture of the femur, is reported. Radiography revealed intertrochanteric fracture of the left femur fixed by proximal femoral nail antirotation (PFNA). The PFNA was found to have disassembled, and the screw had penetrated through the acetabulum. As computed tomography (CT) revealed a haematoma behind the acetabulum, CT angiography was immediately performed. A pseudoaneurysm of the internal iliac artery caused by PFNA was revealed. Percutaneous endovascular treatment of the pseudoaneurysm was undertaken on an urgent basis. Three days later, the PFNA was removed, and the fracture was reduced and fixed with locking proximal femoral plate. The patient’s pain was significantly reduced following this corrective surgery. This case illustrates that substandard PFNA surgery for intertrochanteric fracture may result in pseudoaneurysm of the internal iliac artery.

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