Key result
Differences in the anteroposterior bow between the femoral diaphyseal canal and intramedullary nails contribute to distal femoral anterior cortex penetration during subtrochanteric fracture nailing.
Case Report (n=3)
The mismatch in radius of curvature between intramedullary nails and the femoral canal can lead to anterior cortex penetration during subtrochanteric fracture fixation.
May prompt femoral bow assessment before nailing; leaves open whether anatomic implants reduce penetration risk.
Three cases of anterior distal femoral cortex penetration during intramedullary nailing for subtrochanteric fractures are documented. Case 1 involved a Zimmer (Warsaw, IN) M/DN antegrade femoral nail, case 2 a Howmedica (Allendale, NJ) long-stem Gamma nail, and case 3 a Synthes (Paoli, PA) titanium femoral nail with spiral blade locking. The anterior Zimmer nail penetration resulted in a displaced supracondylar fracture, which subsequently required revision. The Gamma nail as well as the Synthes nail were left impaled through the distal femoral cortex, and the subtrochanteric fractures went on to union. The anteroposterior radius of curvature for the Zimmer, the long Gamma, and the Synthes nail are 257 cm, 300 cm, and 150 cm, respectively. It has been estimated that the radius of curvature of the femoral diaphyseal canal is 114 to 120 cm. It appears that the difference in femoral anteroposterior bow between the bone and the implant is a contributing factor to distal femoral anterior cortex penetration in intramedullary nailing of subtrochanteric fractures.
No takes yet. Share an insight, caveat, or question.
Ostrum et al. (2005) conducted a case report in Subtrochanteric fractures (n=3). Intramedullary nailing was evaluated on Anterior distal femoral cortex penetration. Differences in the anteroposterior bow between the femoral diaphyseal canal and intramedullary nails contribute to distal femoral anterior cortex penetration during subtrochanteric fracture nailing.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: