Critical factors in cut-out complication after gamma nail treatment of proximal femoral fractures
Identifieur interne : 001043 ( Ncbi/Merge ); précédent : 001042; suivant : 001044Critical factors in cut-out complication after gamma nail treatment of proximal femoral fractures
Auteurs : Alicja J. Bojan [Suède] ; Claudia Beimel [Allemagne] ; Gilbert Taglang [France] ; David Collin [Suède] ; Carl Ekholm [Suède] ; Anders Jönsson [Suède]Source :
- BMC Musculoskeletal Disorders [ 1471-2474 ] ; 2013.
Abstract
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.
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.
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.
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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DOI: 10.1186/1471-2474-14-1
PubMed: 23281775
PubMed Central: 3543839
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Bojan</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden</nlm:aff><country xml:lang="fr">Suède</country><wicri:regionArea>Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, Gothenburg University, Gothenburg</wicri:regionArea><wicri:noRegion>Gothenburg</wicri:noRegion></affiliation></author><author><name sortKey="Beimel, Claudia" sort="Beimel, Claudia" uniqKey="Beimel C" first="Claudia" last="Beimel">Claudia Beimel</name><affiliation wicri:level="1"><nlm:aff id="I2">Stryker Osteosynthesis, Schönkirchen, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Stryker Osteosynthesis, Schönkirchen</wicri:regionArea><wicri:noRegion>Schönkirchen</wicri:noRegion><wicri:noRegion>Schönkirchen</wicri:noRegion><wicri:noRegion>Schönkirchen</wicri:noRegion></affiliation></author><author><name sortKey="Taglang, Gilbert" sort="Taglang, Gilbert" uniqKey="Taglang G" first="Gilbert" last="Taglang">Gilbert Taglang</name><affiliation wicri:level="3"><nlm:aff id="I3">Trauma Unit University Hospital of Strasbourg, Strasbourg, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Trauma Unit University Hospital of Strasbourg, Strasbourg</wicri:regionArea><placeName><region type="region">Grand Est</region><region type="old region">Alsace (région administrative)</region><settlement type="city">Strasbourg</settlement></placeName></affiliation></author><author><name sortKey="Collin, David" sort="Collin, David" uniqKey="Collin D" first="David" last="Collin">David Collin</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden</nlm:aff><country xml:lang="fr">Suède</country><wicri:regionArea>Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, Gothenburg University, Gothenburg</wicri:regionArea><wicri:noRegion>Gothenburg</wicri:noRegion></affiliation></author><author><name sortKey="Ekholm, Carl" sort="Ekholm, Carl" uniqKey="Ekholm C" first="Carl" last="Ekholm">Carl Ekholm</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden</nlm:aff><country xml:lang="fr">Suède</country><wicri:regionArea>Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, Gothenburg University, Gothenburg</wicri:regionArea><wicri:noRegion>Gothenburg</wicri:noRegion></affiliation></author><author><name sortKey="Jonsson, Anders" sort="Jonsson, Anders" uniqKey="Jonsson A" first="Anders" last="Jönsson">Anders Jönsson</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden</nlm:aff><country xml:lang="fr">Suède</country><wicri:regionArea>Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, Gothenburg University, Gothenburg</wicri:regionArea><wicri:noRegion>Gothenburg</wicri:noRegion></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">23281775</idno><idno type="pmc">3543839</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3543839</idno><idno type="RBID">PMC:3543839</idno><idno type="doi">10.1186/1471-2474-14-1</idno><date when="2013">2013</date><idno type="wicri:Area/Pmc/Corpus">000405</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000405</idno><idno type="wicri:Area/Pmc/Curation">000402</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000402</idno><idno type="wicri:Area/Pmc/Checkpoint">000522</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">000522</idno><idno type="wicri:Area/Ncbi/Merge">001043</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Critical factors in cut-out complication after gamma nail treatment of proximal femoral fractures</title><author><name sortKey="Bojan, Alicja J" sort="Bojan, Alicja J" uniqKey="Bojan A" first="Alicja J" last="Bojan">Alicja J. Bojan</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden</nlm:aff><country xml:lang="fr">Suède</country><wicri:regionArea>Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, Gothenburg University, Gothenburg</wicri:regionArea><wicri:noRegion>Gothenburg</wicri:noRegion></affiliation></author><author><name sortKey="Beimel, Claudia" sort="Beimel, Claudia" uniqKey="Beimel C" first="Claudia" last="Beimel">Claudia Beimel</name><affiliation wicri:level="1"><nlm:aff id="I2">Stryker Osteosynthesis, Schönkirchen, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Stryker Osteosynthesis, Schönkirchen</wicri:regionArea><wicri:noRegion>Schönkirchen</wicri:noRegion><wicri:noRegion>Schönkirchen</wicri:noRegion><wicri:noRegion>Schönkirchen</wicri:noRegion></affiliation></author><author><name sortKey="Taglang, Gilbert" sort="Taglang, Gilbert" uniqKey="Taglang G" first="Gilbert" last="Taglang">Gilbert Taglang</name><affiliation wicri:level="3"><nlm:aff id="I3">Trauma Unit University Hospital of Strasbourg, Strasbourg, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Trauma Unit University Hospital of Strasbourg, Strasbourg</wicri:regionArea><placeName><region type="region">Grand Est</region><region type="old region">Alsace (région administrative)</region><settlement type="city">Strasbourg</settlement></placeName></affiliation></author><author><name sortKey="Collin, David" sort="Collin, David" uniqKey="Collin D" first="David" last="Collin">David Collin</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden</nlm:aff><country xml:lang="fr">Suède</country><wicri:regionArea>Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, Gothenburg University, Gothenburg</wicri:regionArea><wicri:noRegion>Gothenburg</wicri:noRegion></affiliation></author><author><name sortKey="Ekholm, Carl" sort="Ekholm, Carl" uniqKey="Ekholm C" first="Carl" last="Ekholm">Carl Ekholm</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden</nlm:aff><country xml:lang="fr">Suède</country><wicri:regionArea>Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, Gothenburg University, Gothenburg</wicri:regionArea><wicri:noRegion>Gothenburg</wicri:noRegion></affiliation></author><author><name sortKey="Jonsson, Anders" sort="Jonsson, Anders" uniqKey="Jonsson A" first="Anders" last="Jönsson">Anders Jönsson</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden</nlm:aff><country xml:lang="fr">Suède</country><wicri:regionArea>Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, Gothenburg University, Gothenburg</wicri:regionArea><wicri:noRegion>Gothenburg</wicri:noRegion></affiliation></author></analytic><series><title level="j">BMC Musculoskeletal Disorders</title><idno type="eISSN">1471-2474</idno><imprint><date when="2013">2013</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>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.</p><p>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.</p></sec><sec><title>Methods</title><p>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.</p></sec><sec><title>Results</title><p>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.</p></sec><sec><title>Conclusions</title><p>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.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Baumgaertner, Mr" uniqKey="Baumgaertner M">MR Baumgaertner</name></author><author><name sortKey="Curtin, Sl" uniqKey="Curtin S">SL Curtin</name></author><author><name sortKey="Lindskog, Dm" uniqKey="Lindskog D">DM Lindskog</name></author><author><name sortKey="Keggi, Jm" uniqKey="Keggi J">JM Keggi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Nordin, S" uniqKey="Nordin S">S Nordin</name></author><author><name sortKey="Zulkifli, O" uniqKey="Zulkifli O">O Zulkifli</name></author><author><name sortKey="Faisham, Wi" uniqKey="Faisham W">WI Faisham</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Davis, Tr" uniqKey="Davis 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<front><journal-meta><journal-id journal-id-type="nlm-ta">BMC Musculoskelet Disord</journal-id><journal-id journal-id-type="iso-abbrev">BMC Musculoskelet Disord</journal-id><journal-title-group><journal-title>BMC Musculoskeletal Disorders</journal-title></journal-title-group><issn pub-type="epub">1471-2474</issn><publisher><publisher-name>BioMed Central</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">23281775</article-id><article-id pub-id-type="pmc">3543839</article-id><article-id pub-id-type="publisher-id">1471-2474-14-1</article-id><article-id pub-id-type="doi">10.1186/1471-2474-14-1</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group></article-categories><title-group><article-title>Critical factors in cut-out complication after gamma nail treatment of proximal femoral fractures</article-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes" id="A1"><name><surname>Bojan</surname><given-names>Alicja J</given-names></name><xref ref-type="aff" rid="I1">1</xref><email>alicja.bojan@vgregion.se</email></contrib><contrib contrib-type="author" id="A2"><name><surname>Beimel</surname><given-names>Claudia</given-names></name><xref ref-type="aff" rid="I2">2</xref><email>claudia.beimel@stryker.com</email></contrib><contrib contrib-type="author" id="A3"><name><surname>Taglang</surname><given-names>Gilbert</given-names></name><xref ref-type="aff" rid="I3">3</xref><email>gtaglang@wanadoo.fr</email></contrib><contrib contrib-type="author" id="A4"><name><surname>Collin</surname><given-names>David</given-names></name><xref ref-type="aff" rid="I1">1</xref><email>david.collin@vgregion.se</email></contrib><contrib contrib-type="author" id="A5"><name><surname>Ekholm</surname><given-names>Carl</given-names></name><xref ref-type="aff" rid="I1">1</xref><email>carl.ekholm@vgregion.se</email></contrib><contrib contrib-type="author" id="A6"><name><surname>Jönsson</surname><given-names>Anders</given-names></name><xref ref-type="aff" rid="I1">1</xref><email>anders.k.jonsson@vgregion.se</email></contrib></contrib-group><aff id="I1"><label>1</label>Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden</aff><aff id="I2"><label>2</label>Stryker Osteosynthesis, Schönkirchen, Germany</aff><aff id="I3"><label>3</label>Trauma Unit University Hospital of Strasbourg, Strasbourg, France</aff><pub-date pub-type="collection"><year>2013</year></pub-date><pub-date pub-type="epub"><day>2</day><month>1</month><year>2013</year></pub-date><volume>14</volume><fpage>1</fpage><lpage>1</lpage><history><date date-type="received"><day>12</day><month>8</month><year>2012</year></date><date date-type="accepted"><day>19</day><month>12</month><year>2012</year></date></history><permissions><copyright-statement>Copyright ©2013 Bojan et al.; licensee BioMed Central Ltd.</copyright-statement><copyright-year>2013</copyright-year><copyright-holder>Bojan et al.; licensee BioMed Central Ltd.</copyright-holder><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by/2.0"><license-p>This is an Open Access article distributed under the terms of the Creative Commons Attribution License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/2.0">http://creativecommons.org/licenses/by/2.0</ext-link>), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><self-uri xlink:href="http://www.biomedcentral.com/1471-2474/14/1"></self-uri><abstract><sec><title>Background</title><p>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.</p><p>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.</p></sec><sec><title>Methods</title><p>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.</p></sec><sec><title>Results</title><p>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.</p></sec><sec><title>Conclusions</title><p>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.</p></sec></abstract></article-meta></front></pmc><affiliations><list><country><li>Allemagne</li><li>France</li><li>Suède</li></country><region><li>Alsace (région administrative)</li><li>Grand Est</li></region><settlement><li>Strasbourg</li></settlement></list><tree><country name="Suède"><noRegion><name sortKey="Bojan, Alicja J" sort="Bojan, Alicja J" uniqKey="Bojan A" first="Alicja J" last="Bojan">Alicja J. Bojan</name></noRegion><name sortKey="Collin, David" sort="Collin, David" uniqKey="Collin D" first="David" last="Collin">David Collin</name><name sortKey="Ekholm, Carl" sort="Ekholm, Carl" uniqKey="Ekholm C" first="Carl" last="Ekholm">Carl Ekholm</name><name sortKey="Jonsson, Anders" sort="Jonsson, Anders" uniqKey="Jonsson A" first="Anders" last="Jönsson">Anders Jönsson</name></country><country name="Allemagne"><noRegion><name sortKey="Beimel, Claudia" sort="Beimel, Claudia" uniqKey="Beimel C" first="Claudia" last="Beimel">Claudia Beimel</name></noRegion></country><country name="France"><region name="Grand Est"><name sortKey="Taglang, Gilbert" sort="Taglang, Gilbert" uniqKey="Taglang G" first="Gilbert" last="Taglang">Gilbert Taglang</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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