Breakage of Cephalomedullary Nail Used in the Treatment of Proximal Femur Fractures: Case Report

Seok Hyun Kweon; Chang Hyun Shin; Jin Sung Park; Byoung San Choi

doi:10.12671/jkfs.2016.29.1.42

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Kweon, Shin, Park, and Choi: Breakage of Cephalomedullary Nail Used in the Treatment of Proximal Femur Fractures: Case Report

Case Report

Journal of the Korean Fracture Society 2016; 29(1): 42-49.

Published online: 19 January 2016

DOI: https://doi.org/10.12671/jkfs.2016.29.1.42

Breakage of Cephalomedullary Nail Used in the Treatment of Proximal Femur Fractures: Case Report

Seok Hyun Kweon, M.D., Chang Hyun Shin, M.D., Jin Sung Park, M.D., Byoung San Choi, M.D.^*

Department of Orthopaedic Surgery, Wonkwang University School of Medicine, Iksan, Korea.

^*Department of Orthopaedic Surgery, Presbyterian Medical Center, Seonam University School of Medicine, Jeonju, Korea.

Address reprint requests to: Byoung San Choi, M.D. Department of Orthopaedic Surgery, Presbyterian Medical Center, Seonam University School of Medicine, 365 Seowon-ro, Wansangu, Jeonju 54987, Korea. Tel: 82-63-230-1430, Fax: 82-63-230-1439, bhinder@naver.com

Received 17 August 2015 Revised 2 September 2015 Accepted 7 November 2015

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Internal fixation using a cephalomedullary nail as treatment for proximal femur fracture has recently been popular for early ambulation and rehabilitation. However metal breakage at the lag screw insertion site was reported due to non-union, delayed-union, and early weight bearing. In our orthopedic department, we experienced 2 cases of nail breakage at the lag screw insertion site, therefore we report on evaluation of the cause of metal failure and prevention of complications with literature review.

Keywords: Proximal femur, Fracture, Breakage, Cephalomedullary nail

Figures and Tables

Fig. 1

Radiographs showed an AO/OTA classification 31-A3.3, Seinsheimer classification type IIIa, Russel-Taylor classification type II-B subtrochanteric fracture of the left femur. (A) Anteroposterior view. (B) Axial view.

Fig. 2

Postoperative radiographs showed long gamma nail insertion state. (A) Anteroposterior view. (B) Axial view.

Fig. 3

Failure of the long gamma nail through the insertion point of the lag screw at 8-month postoperative followup. (A) Anteroposterior view. (B) Axial view.

Fig. 4

Radiographs taken at the last follow-up 1 year and 7 months postoperative, showing metal removed, and union state of the left femur. (A) Anteroposterior view. (B) Axial view.

Fig. 5

Radiographs showed an AO/OTA classification 31-A2.1, Boyd-Griffin classification type II intertrochanteric fracture of the right femur. (A) Anteroposterior view. (B) Axial view.

Fig. 6

Postoperative radiographs showed proximal femoral nail antirotation insertion state. (A) Anteroposterior view. (B) Axial view.

Fig. 7

Failure of the proximal femoral nail antirotation through the insertion point of the lag screw at 4-month postoperative follow-up. (A) Anteroposterior view. (B) Axial view.

Fig. 8

Radiographs taken at the last follow-up 1 year and 2 months postoperative, showing metal removed, and bone union state of the right femur. (A) Anteroposterior view. (B) Axial view.

Fig. 9

Scanning electron microscopic study (SEM) showed the implant horizontal fracture surface in the Case 2 patient. (A, B) SEM images showed a tough fracture surface indicating that a primary crack occurred by continuous stress and the final fracture was due to traumatic force from sometimes (×100).

Notes

^{Financial support} This study was supported by research fund from Wonkwang University, 2013.

^{Conflict of interest} None.

References

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