Tips and tricks to avoid implant failure in proximal femur fractures treated with cephalomedullary nails: a review of the literature
Abstract. Objective:. To describe the surgical aspects potentially contributing to hardware failure of cephalomedullary nails. Data Sources:. A search of the Embase, PubMed (MEDLINE), Web of Science, and the Cochrane library for reports of hardware failures after intramedullary fixation of proximal...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer
2022-04-01
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| Series: | OTA International |
| Online Access: | http://journals.lww.com/10.1097/OI9.0000000000000191 |
| _version_ | 1811236835175694336 |
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| author | Joseph L. Petfield, MD Luke E. Visscher, MBBS Boyko Gueorguiev, PhD Karl Stoffel, MD Hans-Christoph Pape, MD |
| author_facet | Joseph L. Petfield, MD Luke E. Visscher, MBBS Boyko Gueorguiev, PhD Karl Stoffel, MD Hans-Christoph Pape, MD |
| author_sort | Joseph L. Petfield, MD |
| collection | DOAJ |
| description | Abstract. Objective:. To describe the surgical aspects potentially contributing to hardware failure of cephalomedullary nails.
Data Sources:. A search of the Embase, PubMed (MEDLINE), Web of Science, and the Cochrane library for reports of hardware failures after intramedullary fixation of proximal femur fractures. Issues of cut out and cut through phenomena related to technique were excluded. Expert opinion of 3 surgeons, each trained on several fixation systems at Level | trauma centers is reported.
Data Extraction:. Three authors extracted data using a predesigned form. Implant type, reported failure mechanism, and associated factors with implant failure were recorded as well as potential bias.
Results:. Of 2182 search results screened, 64 articles were deemed relevant for our research question and were included. The authors identified factors associated with implant failure: preoperative patient and fracture characteristics, intraoperative reduction, implant handling, and postoperative nonunion. Issues were identified as independent modifiable intraoperative risk factors: inadequate fracture reduction, varus position of femoral neck, direct damage of the cephalomedullary nail aperture by eccentric drilling related to guide sleeve handling, and implant design mechanism failures.
Conclusions:. Multiple factors associated with intraoperative handling can influence the healing of proximal femur fractures. Although many of these have been well described and are taught in fracture courses, surgeons should be aware of subtle intraoperative complications reported in the literature that can weaken implants and add to the likelihood of early failure.
Level of Evidence: IV |
| first_indexed | 2024-04-12T12:14:57Z |
| format | Article |
| id | doaj.art-bbfac8e3eabe42f386e8ce2459508d33 |
| institution | Directory Open Access Journal |
| issn | 2574-2167 |
| language | English |
| last_indexed | 2024-04-12T12:14:57Z |
| publishDate | 2022-04-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | OTA International |
| spelling | doaj.art-bbfac8e3eabe42f386e8ce2459508d332022-12-22T03:33:27ZengWolters KluwerOTA International2574-21672022-04-0152Se19110.1097/OI9.0000000000000191202204002-00001Tips and tricks to avoid implant failure in proximal femur fractures treated with cephalomedullary nails: a review of the literatureJoseph L. Petfield, MDLuke E. Visscher, MBBSBoyko Gueorguiev, PhDKarl Stoffel, MDHans-Christoph Pape, MDAbstract. Objective:. To describe the surgical aspects potentially contributing to hardware failure of cephalomedullary nails. Data Sources:. A search of the Embase, PubMed (MEDLINE), Web of Science, and the Cochrane library for reports of hardware failures after intramedullary fixation of proximal femur fractures. Issues of cut out and cut through phenomena related to technique were excluded. Expert opinion of 3 surgeons, each trained on several fixation systems at Level | trauma centers is reported. Data Extraction:. Three authors extracted data using a predesigned form. Implant type, reported failure mechanism, and associated factors with implant failure were recorded as well as potential bias. Results:. Of 2182 search results screened, 64 articles were deemed relevant for our research question and were included. The authors identified factors associated with implant failure: preoperative patient and fracture characteristics, intraoperative reduction, implant handling, and postoperative nonunion. Issues were identified as independent modifiable intraoperative risk factors: inadequate fracture reduction, varus position of femoral neck, direct damage of the cephalomedullary nail aperture by eccentric drilling related to guide sleeve handling, and implant design mechanism failures. Conclusions:. Multiple factors associated with intraoperative handling can influence the healing of proximal femur fractures. Although many of these have been well described and are taught in fracture courses, surgeons should be aware of subtle intraoperative complications reported in the literature that can weaken implants and add to the likelihood of early failure. Level of Evidence: IVhttp://journals.lww.com/10.1097/OI9.0000000000000191 |
| spellingShingle | Joseph L. Petfield, MD Luke E. Visscher, MBBS Boyko Gueorguiev, PhD Karl Stoffel, MD Hans-Christoph Pape, MD Tips and tricks to avoid implant failure in proximal femur fractures treated with cephalomedullary nails: a review of the literature OTA International |
| title | Tips and tricks to avoid implant failure in proximal femur fractures treated with cephalomedullary nails: a review of the literature |
| title_full | Tips and tricks to avoid implant failure in proximal femur fractures treated with cephalomedullary nails: a review of the literature |
| title_fullStr | Tips and tricks to avoid implant failure in proximal femur fractures treated with cephalomedullary nails: a review of the literature |
| title_full_unstemmed | Tips and tricks to avoid implant failure in proximal femur fractures treated with cephalomedullary nails: a review of the literature |
| title_short | Tips and tricks to avoid implant failure in proximal femur fractures treated with cephalomedullary nails: a review of the literature |
| title_sort | tips and tricks to avoid implant failure in proximal femur fractures treated with cephalomedullary nails a review of the literature |
| url | http://journals.lww.com/10.1097/OI9.0000000000000191 |
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