Fixation Failure of Proximal Femoral Nail Anti-rotation in Femoral Intertrochanteric Fracture

Kyung-Jae Lee

doi:10.5371/hp.2012.24.4.302

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Lee: Fixation Failure of Proximal Femoral Nail Anti-rotation in Femoral Intertrochanteric Fracture

Original Article

Hip & Pelvis

Hip & Pelvis 2012; 24(4): 302-308.

Published online: 31 December 2012

DOI: https://doi.org/10.5371/hp.2012.24.4.302

Fixation Failure of Proximal Femoral Nail Anti-rotation in Femoral Intertrochanteric Fracture

Kyung-Jae Lee, MD

Department of Orthopedic Surgery, School of Medicine, Keimyung University, Daegu, Korea.

Address reprint request to Kyung-Jae Lee, MD. Department of Orthopedic Surgery, School of Medicine, Keimyung University, 194 Dongsan-dong, Jung-gu, Daegu 700-712, Korea. TEL: +82-53-250-8161, FAX: +82-53-250-7205, oslee@dsmc.or.kr

Received 21 November 2012 Revised 12 December 2012 Accepted 12 December 2012

(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/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The aim of this study was to identify the causes of fixation failure and evaluate prophylactic methods in femoral intertrochanteric fractures treated with proximal femoral nail anti-rotation.

Materials and Methods

Between 2006 and 2010, this study evaluated 80 cases(20 men and 60 women) of femoral intertrochanteric fracture treated with proximal femoral nail anti-rotation after a minimum follow-up of 1 year. The mean age and follow-up period was 72.6 years and 2.1 years, respectively. The factors that could affect fixation failure, such as osteoporosis, fracture pattern, reduction status and position of helical blade on the femoral head, were analyzed retrospectively.

Results

Six cases of fixation failure were encountered: 4 cases of cut out of the helical blade, 1 case of excessive varus union and 1 case of hip joint pain due to the excessive sliding of helical blade. The reduction status and position of the helical blade on the femoral head showed a significant association with the fixation failure, and there were 2 cases of osteonecrosis of the femoral head at the latest follow-up.

Conclusion

Fixation failure was increased significantly in the case of non-anatomical reduction or superior position of helical blade in the femoral head. Therefore, the concerns related to the precise anatomical reduction and central location of the helical blade will need to be solved to reduce fixation failure.

Keywords: Femur, Intertrochanteric fracture, Proximal femoral nail anti-rotation, Fixation failure

Figures and Tables

Fig. 1

(A) Immediate postoperative radiographs show anatomical reduction and acceptable position of blade in unstable fracture. (B) Radiographs obtained at 18 months after surgery show stable fixation of implant and firm union of fracture site.

Fig. 2

(A) Postoperative radiographs show loss of medial and anterior cortical continouity. (B) Radiographs obtained at 4 months after operation show femoral head was penetrated by helical blade.

Fig. 3

The frequency of fixation failure in relation with the position of the helical blade in the femoral head.

^*number of fixation failure.

Fig. 4

(A) Anteroposterior radiographs of the right hip show displaced intertrochanteric fracture with femoral neck fracture component (arrow). (B) Immediate postoperative radiographs show anatomical reduction and acceptable position of blade. (C) Radiographs obtained at 2 years after surgery show union of the fracture with osteonecrosis of the femoral head.

Table 1

Age and Sex Distribution

Table 2

Relationship between Parameters (Degrees of Osteoporosis, Fracture Type and Postoperative Reduction Status) and Fixation Failure

^*Modification of Parker18).

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