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Central head perforation, or "cut through," caused by the helical blade of the proximal femoral nail antirotation


Frei, Hans-Curd; Hotz, Thomas; Cadosch, Dieter; Rudin, Mark; Käch, Kurt (2012). Central head perforation, or "cut through," caused by the helical blade of the proximal femoral nail antirotation. Journal of Orthopaedic Trauma, 26(8):e102-e107.

Abstract

OBJECTIVE: : This study was designed to investigate the specific type and incidence of implant failure in patients with a proximal femur fracture treated with a proximal femoral nail antirotation. This device has a helical-shaped blade as a neck-head holding device, instead of the lag screw used in other intramedullary nails. The advantage of the blade is believed to originate from bone impaction and a larger bone-implant interface in comparison with the lag screw design, with consequential greater mechanical resistance to torsion in the cancellous bone.
PATIENTS AND METHODS: : This is a retrospective cohort study conducted at the state hospital of Winterthur, Switzerland. From December 2006 until November 2008, 210 consecutive patients were treated with a pertrochanteric femur fracture (OTA type 31-A1, 31-A2, and 31-A3) using a proximal femoral nail antirotation. One hundred and twelve patients were followed up clinically for a minimum of 12 months after discharge. Clinical and radiologic assessment of fracture healing and/or implant failure was investigated.
RESULTS: : We report 7 cases of implant failure with a "Cut Through," defined as a postoperative central perforation of the spiral blade into the hip joint, without any displacement of the neck-head fragment.
CONCLUSIONS: : Cut through needs to be distinguished from the well-known anterocranial perforation combined with a varus displacement of the neck-head fragment, known as "Cut Out," seen with intramedullary nails utilizing lag screws.
LEVEL OF EVIDENCE: : Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Abstract

OBJECTIVE: : This study was designed to investigate the specific type and incidence of implant failure in patients with a proximal femur fracture treated with a proximal femoral nail antirotation. This device has a helical-shaped blade as a neck-head holding device, instead of the lag screw used in other intramedullary nails. The advantage of the blade is believed to originate from bone impaction and a larger bone-implant interface in comparison with the lag screw design, with consequential greater mechanical resistance to torsion in the cancellous bone.
PATIENTS AND METHODS: : This is a retrospective cohort study conducted at the state hospital of Winterthur, Switzerland. From December 2006 until November 2008, 210 consecutive patients were treated with a pertrochanteric femur fracture (OTA type 31-A1, 31-A2, and 31-A3) using a proximal femoral nail antirotation. One hundred and twelve patients were followed up clinically for a minimum of 12 months after discharge. Clinical and radiologic assessment of fracture healing and/or implant failure was investigated.
RESULTS: : We report 7 cases of implant failure with a "Cut Through," defined as a postoperative central perforation of the spiral blade into the hip joint, without any displacement of the neck-head fragment.
CONCLUSIONS: : Cut through needs to be distinguished from the well-known anterocranial perforation combined with a varus displacement of the neck-head fragment, known as "Cut Out," seen with intramedullary nails utilizing lag screws.
LEVEL OF EVIDENCE: : Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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23 citations in Scopus®
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Additional indexing

Contributors:Department of Surgery, Kantonsspital Winterthur, Winterthur, Switzerland †University Hospital of Zurich, Clinic of Trauma Surgery, Zürich, Switzerland
Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Department of Trauma Surgery
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:August 2012
Deposited On:17 Sep 2012 15:44
Last Modified:07 Dec 2017 15:01
Publisher:Lippincott Wiliams & Wilkins
ISSN:0890-5339
Publisher DOI:https://doi.org/10.1097/BOT.0b013e31822c53c1
PubMed ID:22357090

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