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Critical factors in cut-out complication after gamma nail treatment of proximal femoral fractures

BACKGROUND: The most common mechanical failure in the internal fixation of trochanteric hip fractures is the cut-out of the sliding screw through the femoral head. Several factors that influence this complication have been suggested, but there is no consensus as to the relative importance of each fa...

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Autores principales: Bojan, Alicja J, Beimel, Claudia, Taglang, Gilbert, Collin, David, Ekholm, Carl, Jönsson, Anders
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3543839/
https://www.ncbi.nlm.nih.gov/pubmed/23281775
http://dx.doi.org/10.1186/1471-2474-14-1
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author Bojan, Alicja J
Beimel, Claudia
Taglang, Gilbert
Collin, David
Ekholm, Carl
Jönsson, Anders
author_facet Bojan, Alicja J
Beimel, Claudia
Taglang, Gilbert
Collin, David
Ekholm, Carl
Jönsson, Anders
author_sort Bojan, Alicja J
collection PubMed
description BACKGROUND: The most common mechanical failure in the internal fixation of trochanteric hip fractures is the cut-out of the sliding screw through the femoral head. Several factors that influence this complication have been suggested, but there is no consensus as to the relative importance of each factor. The purpose of this study was to analyse the cut-out complication with respect to the following variables: patients’ age, fracture type, fracture reduction, implant positioning and implant design. METHODS: 3066 consecutive patients were treated for trochanteric fractures with Gamma Nails between 1990 and 2002 at the Centre de Traumatologie et de l`Orthopedie (CTO), Strasbourg, France. Cut-out complications were identified by reviewing all available case notes and radiographs. Subsequently, the data were analysed by a single reviewer (AJB) with focus on the studied factors. RESULTS: Seventy-one cut-out complications were found (2.3%) of the 3066 trochanteric fractures. Cut-out failure associated with avascular head necrosis, pathologic fracture, deep infection or secondary to prior failure of other implants were excluded from the study (14 cases). The remaining 57 cases (1.85 %, median age 82.6, 79% females) were believed to have a biomechanical explanation for the cut-out failure. 41 patients had a basicervical or complex fracture type. A majority of cut-outs (43 hips, 75%) had a combination of the critical factors studied; non-anatomical reduction, non-optimal lag screw position and the characteristic fracture pattern found. CONCLUSIONS: The primary cut-out rate of 1.85% was low compared with the literature. A typical cut-out complication in our study is represented by an unstable fracture involving the trochanteric and cervical regions or the combination of both, non-anatomical reduction and non-optimal screw position. Surgeons confronted with proximal femoral fractures should carefully scrutinize preoperative radiographs to assess the primary fracture geometry and fracture classification. To reduce the risk of a cut-out it is important to achieve both anatomical reduction and optimal lag screw position as these are the only two factors that can be controlled by the surgeon.
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spelling pubmed-35438392013-01-14 Critical factors in cut-out complication after gamma nail treatment of proximal femoral fractures Bojan, Alicja J Beimel, Claudia Taglang, Gilbert Collin, David Ekholm, Carl Jönsson, Anders BMC Musculoskelet Disord Research Article BACKGROUND: The most common mechanical failure in the internal fixation of trochanteric hip fractures is the cut-out of the sliding screw through the femoral head. Several factors that influence this complication have been suggested, but there is no consensus as to the relative importance of each factor. The purpose of this study was to analyse the cut-out complication with respect to the following variables: patients’ age, fracture type, fracture reduction, implant positioning and implant design. METHODS: 3066 consecutive patients were treated for trochanteric fractures with Gamma Nails between 1990 and 2002 at the Centre de Traumatologie et de l`Orthopedie (CTO), Strasbourg, France. Cut-out complications were identified by reviewing all available case notes and radiographs. Subsequently, the data were analysed by a single reviewer (AJB) with focus on the studied factors. RESULTS: Seventy-one cut-out complications were found (2.3%) of the 3066 trochanteric fractures. Cut-out failure associated with avascular head necrosis, pathologic fracture, deep infection or secondary to prior failure of other implants were excluded from the study (14 cases). The remaining 57 cases (1.85 %, median age 82.6, 79% females) were believed to have a biomechanical explanation for the cut-out failure. 41 patients had a basicervical or complex fracture type. A majority of cut-outs (43 hips, 75%) had a combination of the critical factors studied; non-anatomical reduction, non-optimal lag screw position and the characteristic fracture pattern found. CONCLUSIONS: The primary cut-out rate of 1.85% was low compared with the literature. A typical cut-out complication in our study is represented by an unstable fracture involving the trochanteric and cervical regions or the combination of both, non-anatomical reduction and non-optimal screw position. Surgeons confronted with proximal femoral fractures should carefully scrutinize preoperative radiographs to assess the primary fracture geometry and fracture classification. To reduce the risk of a cut-out it is important to achieve both anatomical reduction and optimal lag screw position as these are the only two factors that can be controlled by the surgeon. BioMed Central 2013-01-02 /pmc/articles/PMC3543839/ /pubmed/23281775 http://dx.doi.org/10.1186/1471-2474-14-1 Text en Copyright ©2013 Bojan et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Bojan, Alicja J
Beimel, Claudia
Taglang, Gilbert
Collin, David
Ekholm, Carl
Jönsson, Anders
Critical factors in cut-out complication after gamma nail treatment of proximal femoral fractures
title Critical factors in cut-out complication after gamma nail treatment of proximal femoral fractures
title_full Critical factors in cut-out complication after gamma nail treatment of proximal femoral fractures
title_fullStr Critical factors in cut-out complication after gamma nail treatment of proximal femoral fractures
title_full_unstemmed Critical factors in cut-out complication after gamma nail treatment of proximal femoral fractures
title_short Critical factors in cut-out complication after gamma nail treatment of proximal femoral fractures
title_sort critical factors in cut-out complication after gamma nail treatment of proximal femoral fractures
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3543839/
https://www.ncbi.nlm.nih.gov/pubmed/23281775
http://dx.doi.org/10.1186/1471-2474-14-1
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