“Kissing Nail Technique” for the exchange of intramedullary implants in adjacent peri-implant fractures
One third of the people aged 65 years and over fall every year, and 1–5% of these falls result in a fracture. For these people, history of fracture and surgery become a risk factor for recurrent falls. In osteoporotic patients, repeated fractures often require several osteosynthetic procedures withi...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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AVES
2017-12-01
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| Series: | Acta Orthopaedica et Traumatologica Turcica |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1017995X16302796 |
| _version_ | 1797909064896741376 |
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| author | Carolin Melcher Patrick R. Delhey Christof Birkenmaier Peter H. Thaller |
| author_facet | Carolin Melcher Patrick R. Delhey Christof Birkenmaier Peter H. Thaller |
| author_sort | Carolin Melcher |
| collection | DOAJ |
| description | One third of the people aged 65 years and over fall every year, and 1–5% of these falls result in a fracture. For these people, history of fracture and surgery become a risk factor for recurrent falls. In osteoporotic patients, repeated fractures often require several osteosynthetic procedures within a short time frame. Despite the lack of biomechanical studies, clinical experience suggests that additional fractures adjacent to implants occur because of the difference in stiffness between the metallic implant and the osteoporotic bone. This requires customized fixation techniques to ensure stability.The technique was first performed in an 81-year old female patient presenting with a dislocated proximal femoral fracture at the tip of a previously implanted distal femoral nail (DFN), and non-union of the old fracture. For this technique, the DFN was advanced until it passed the proximal fracture, thereby reducing both fractures, while a lateral femoral nail (LFN), extra-long and 3 mm thicker than the DFN, was introduced and advanced distally. The LFN was implanted in a “kissing nail technique,” meaning the tips of the two nails were touching each other, and all fracture fragments were held in functional reduction. The DFN was slowly pulled backwards and fragment stability was maintained, while both nails passed the distal non-union.The Kissing Nail Technique allows simple, safe and fast reduction of all instable fragments, precise and easy positioning of the proximal entry point by the retrograde guide wire, a minimally invasive procedure, and stable fixation of a periprosthetic fracture.We found this new customized procedure accommodating to the unique anatomical features of a single patient, that can be applied as a strategy especially for osteoporotic patients with periprosthetic fractures. Keywords: Management, Adjacent fracture, Osteoporosis, Elderly, Exchange nailing |
| first_indexed | 2024-04-10T11:02:34Z |
| format | Article |
| id | doaj.art-d79d1d07726e4ae0a21c53c90b7e0939 |
| institution | Directory Open Access Journal |
| issn | 1017-995X |
| language | English |
| last_indexed | 2024-04-10T11:02:34Z |
| publishDate | 2017-12-01 |
| publisher | AVES |
| record_format | Article |
| series | Acta Orthopaedica et Traumatologica Turcica |
| spelling | doaj.art-d79d1d07726e4ae0a21c53c90b7e09392023-02-15T16:19:36ZengAVESActa Orthopaedica et Traumatologica Turcica1017-995X2017-12-01516488491“Kissing Nail Technique” for the exchange of intramedullary implants in adjacent peri-implant fracturesCarolin Melcher0Patrick R. Delhey1Christof Birkenmaier2Peter H. Thaller3Department of Orthopaedic Surgery, Ludwig-Maximilians-University, Campus Großhadern, Munich, Germany; Corresponding author. University Hospital Munich, Department of Orthopaedic Surgery, Marchioninistr. 15, 81377 Munich, Germany. Fax: +49 89 7095 5614.Department of Surgery, Ludwig-Maximilians-University, Campus Innenstadt, Munich, GermanyDepartment of Orthopaedic Surgery, Ludwig-Maximilians-University, Campus Großhadern, Munich, GermanyDepartment of Surgery, Ludwig-Maximilians-University, Campus Innenstadt, Munich, GermanyOne third of the people aged 65 years and over fall every year, and 1–5% of these falls result in a fracture. For these people, history of fracture and surgery become a risk factor for recurrent falls. In osteoporotic patients, repeated fractures often require several osteosynthetic procedures within a short time frame. Despite the lack of biomechanical studies, clinical experience suggests that additional fractures adjacent to implants occur because of the difference in stiffness between the metallic implant and the osteoporotic bone. This requires customized fixation techniques to ensure stability.The technique was first performed in an 81-year old female patient presenting with a dislocated proximal femoral fracture at the tip of a previously implanted distal femoral nail (DFN), and non-union of the old fracture. For this technique, the DFN was advanced until it passed the proximal fracture, thereby reducing both fractures, while a lateral femoral nail (LFN), extra-long and 3 mm thicker than the DFN, was introduced and advanced distally. The LFN was implanted in a “kissing nail technique,” meaning the tips of the two nails were touching each other, and all fracture fragments were held in functional reduction. The DFN was slowly pulled backwards and fragment stability was maintained, while both nails passed the distal non-union.The Kissing Nail Technique allows simple, safe and fast reduction of all instable fragments, precise and easy positioning of the proximal entry point by the retrograde guide wire, a minimally invasive procedure, and stable fixation of a periprosthetic fracture.We found this new customized procedure accommodating to the unique anatomical features of a single patient, that can be applied as a strategy especially for osteoporotic patients with periprosthetic fractures. Keywords: Management, Adjacent fracture, Osteoporosis, Elderly, Exchange nailinghttp://www.sciencedirect.com/science/article/pii/S1017995X16302796 |
| spellingShingle | Carolin Melcher Patrick R. Delhey Christof Birkenmaier Peter H. Thaller “Kissing Nail Technique” for the exchange of intramedullary implants in adjacent peri-implant fractures Acta Orthopaedica et Traumatologica Turcica |
| title | “Kissing Nail Technique” for the exchange of intramedullary implants in adjacent peri-implant fractures |
| title_full | “Kissing Nail Technique” for the exchange of intramedullary implants in adjacent peri-implant fractures |
| title_fullStr | “Kissing Nail Technique” for the exchange of intramedullary implants in adjacent peri-implant fractures |
| title_full_unstemmed | “Kissing Nail Technique” for the exchange of intramedullary implants in adjacent peri-implant fractures |
| title_short | “Kissing Nail Technique” for the exchange of intramedullary implants in adjacent peri-implant fractures |
| title_sort | kissing nail technique for the exchange of intramedullary implants in adjacent peri implant fractures |
| url | http://www.sciencedirect.com/science/article/pii/S1017995X16302796 |
| work_keys_str_mv | AT carolinmelcher kissingnailtechniquefortheexchangeofintramedullaryimplantsinadjacentperiimplantfractures AT patrickrdelhey kissingnailtechniquefortheexchangeofintramedullaryimplantsinadjacentperiimplantfractures AT christofbirkenmaier kissingnailtechniquefortheexchangeofintramedullaryimplantsinadjacentperiimplantfractures AT peterhthaller kissingnailtechniquefortheexchangeofintramedullaryimplantsinadjacentperiimplantfractures |