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Mechanical complications of intertrochanteric hip fractures treated with trochanteric femoral nails.
MedLine Citation:
PMID:  23887564     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
BACKGROUND: The Trochanteric Fixation Nail System (TFN) was designed with a helical blade to improve resistance to cutout. We evaluated the incidence, modes, and predictors of failure for intertrochanteric hip fractures treated with this device.
METHODS: A retrospective review of 341 intertrochanteric hip fractures treated with the TFN was conducted. Fractures were classified from the injury films using the Arbeitsgemeinschaft für Osteosynthesefragen/Orthopedic Trauma Association (AO/OTA) classification, and quality of reduction and hardware placement was evaluated on the initial postoperative films.
RESULTS: Two hundred twenty-three patients met inclusion criteria. The overall rate of mechanical complications was 20.5%. Twenty-one patients (9.4%) had excessive lateral migration of the helical blade (≥10 mm). Fifteen patients (6.7%) had blade migration in the head, including 7 patients (3.1%) with typical cutout and 8 patients (3.6%) with medial perforation without loss of reduction. Three patients (1.3%) sustained a femoral shaft fracture at the tip of the nail. The quality of calcar reduction was significantly predictive of all modes of failure (p < 0.05), except femoral shaft fracture at the nail tip.
CONCLUSION: The most common mechanical complication was lateral migration of the helical blade; however, this rarely led to a clinical problem. Medial migration of the blade in the head without loss of reduction was the second most frequent complication. We have identified a new complication associated with the TFN, that is, medial perforation without loss of reduction. Blade migration in the head was less frequent when blades were placed inferiorly with a tip-apex distance of at least 15 mm.
LEVEL OF EVIDENCE: Therapeutic study, level IV.
Authors:
Wanjun Liu; Dongsheng Zhou; Fang Liu; Michael J Weaver; Mark S Vrahas
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The journal of trauma and acute care surgery     Volume:  75     ISSN:  2163-0763     ISO Abbreviation:  J Trauma Acute Care Surg     Publication Date:  2013 Aug 
Date Detail:
Created Date:  2013-07-26     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101570622     Medline TA:  J Trauma Acute Care Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  304-10     Citation Subset:  AIM; IM    
Affiliation:
From the Department of Orthopaedics (W.L.), Shanghai Sixth People's Hospital, Shanghai; and Department of Orthopaedics (D,Z,), Shandong University Affiliated Shandong Provincial Hospital, Jinan, China; and Bioengineering Laboratory (F.L.), Department of Orthopaedic Srugery, Massachusetts General Hospital; and Harvard Orthopaedic Trauma (M.J.W.), Brigham and Women's Hospital, Boston, Massachusetts.
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