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Salvage hip replacement after cut-out failure of cephalomedullary nail fixation for proximal femur fractures: a case series describing the technique and results

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Abstract

Background

Cut-out failure following proximal femoral fracture fixation is a compromising complication warranting surgical treatment. We describe 24 patients with cut-out failure after cephalomedullary nail fixation managed with salvage hip replacement.

Methods

Twenty-four consecutive patients who had sustained a proximal femoral fracture from December 2009 to December 2019, were managed with cephalomedullary nail fixation and experienced a cut-out failure were reviewed retrospectively. Data on demographics, comorbidities, injury characteristics, treatment, and post-operative course were analysed.

Results

Among 2802 proximal femoral fractures assessed, 28 fixations failed due to cut-out, with 24/28 patients subsequently undergoing salvage hip replacement. Intertrochanteric fractures (66.7%) managed with short nails predominated (79.2%). The median tip-to-apex distance (TAD) was 19 mm, but only two fractures had a good quality of reduction. Inverse correlations were identified between patient age and the time from fixation to cut-out (r =  − 0.57; p = 0.02), and between the time of nailing to failure among patients with a greater TAD (r =  − 0.43; p = 0.04). Most patients were managed via cemented hemiarthroplasty (66.7%). Surgical time was longer for total hip replacements (175.4 vs. 136.8 min; p < 0.01), but no bleeding or blood transfusion requirement differences were found. Two patients had orthopaedic complications, and three patients died within the first follow-up year.

Conclusion

In our series, 1% of the proximal femoral fractures managed with a cephalomedullary nail failed due to cut-out. Salvage hip replacement appeared to be a relatively safe and reliable procedure for managing this challenging complication in patients who typically are elderly and physically frail.

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Data availability

The data that support the findings of this study are available from the corresponding author, José Vicente Andrés Peiró, upon reasonable request.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Son Espases, Mallorca, Spain

    Sebastián Corró

  2. Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Vall d’Hebron, Barcelona, Spain

    Rafael Óleo-Taltavull, Jordi Teixidor-Serra, Jordi Tomàs-Hernández, Jordi Selga-Marsà, Ernesto Guerra-Farfán & José-Vicente Andrés-Peiró

  3. Department of Orthopaedic Surgery and Traumatology, Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain

    Jordi Teixidor-Serra, Jordi Tomàs-Hernández, Jordi Selga-Marsà, Yaiza García-Sánchez, Ernesto Guerra-Farfán & José-Vicente Andrés-Peiró

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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by SC, RÓT and JVAP. The first draft of the manuscript was written by JVAP and SCR, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to José-Vicente Andrés-Peiró.

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Ethics approval

This study was approved by our institutional review board (reference number PR(ATR)121/2021).

Consent to participate and consent for publication

This is a retrospective study. Its realization did not imply any risk for the participants, and all the collected data were de-identified. Therefore, IRB approved a full waiver of informed consent.

Competing interests

The authors have financial conflicts of interest to declare with Smith & Nephew, Zimmer-Biomet, Stryker and MBA Surgical Empowerment.

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Corró, S., Óleo-Taltavull, R., Teixidor-Serra, J. et al. Salvage hip replacement after cut-out failure of cephalomedullary nail fixation for proximal femur fractures: a case series describing the technique and results. International Orthopaedics (SICOT) 46, 2775–2783 (2022). https://doi.org/10.1007/s00264-022-05529-4

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