International Orthopaedics

, Volume 37, Issue 7, pp 1363–1368

How to prevent cut-out and cut-through in biaxial proximal femoral nails: is there anything beyond lag screw positioning and tip–apex distance?

  • Birgit Zirngibl
  • Roland Biber
  • Hermann Josef Bail
Original Paper

Abstract

Purpose

Hip perforation is a major complication in proximal femoral nailing. For biaxial nails, knowledge of their biomechanics is limited. Besides re-evaluation of accepted risk factors like the tip–apex distance (TAD), we analysed the influence of anti-rotational pin length.

Methods

We compared 22 hip perforation cases to 50 randomly chosen controls. TAD, lag-screw position, angle between lag-screw and femoral neck axis, lag-screw gliding capacity, displacement and anti-rotational pin length were investigated.

Results

Hip perforation was associated with a higher angle of deviation between lag-screw and femoral neck axis (p = 0.001), a lower telescoping capacity of the lag screw (p = 0.02), and higher TAD (p = 0.048). If the anti-rotational pin exceeded a line connecting the tip of the nail and the lag screw (NS line), hip perforation incidence was increased (p = 0.009). Inadequate pin length resulted in an odds ratio of 10.8 for hip perforation (p = 0.001).

Conclusions

In biaxial nails anti-rotational element positioning is underestimated, however, crucial.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Birgit Zirngibl
    • 1
  • Roland Biber
    • 1
    • 2
  • Hermann Josef Bail
    • 1
  1. 1.Department of Trauma and Orthopaedic SurgeryKlinikum NuernbergNuernbergGermany
  2. 2.Institute for Biomedicine of AgingFriedrich-Alexander University Erlangen-NuernbergNürnbergGermany

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