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Cephalomedullary nails: factors associated with impingement of the anterior cortex of the femur in a Hispanic population

  • Trauma Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Impingement and penetration of the anterior cortex of the femur have been reported as complications after cephalomedullary nailing. The purpose of this study was to determine factors related to nail impingement in our population of Hispanic patients.

Materials and methods

A non-matched case–control study was carried out and 156 patients who underwent cephalomedullary nailing from 2010 and 2013 were included; 78 cases with anterior cortical impingement and 78 control cases without impingement were documented. Demographic variables and specifications of the nails such as manufacture and radius of curvature were recorded. The presence of impingement, angle of incidence on radiographs—indirect measurement of the femoral bow on the sagittal plane—and nail entry site were determined. Bivariate and multivariate logistic regression analyses were performed to identify the factors associated with cortical impingement.

Results

The distribution by sex corresponded to 87 females (56 %) and 69 males (44 %) with a mean age of 75 years [SD 18.2]. Cortical impingement was presented in 78 cases (50 %) and 6 (3.8 %) patients evidenced penetration of the anterior cortex of the femur. On the bivariate analysis the posterior nail start site is highlighted, which showed a positive association with impingement (OR 4.3; 95 % CI 1.1–36 and p = 0.04). After the multivariate analysis, the factors associated with anterior cortical impingement included female gender (OR 2.2; 95 % CI 1.1–4.6 and p ≤ 0.038), straight nails—short nails—(OR 4.9; 95 % CI 2.2–10 and p ≤ 0.001) and angle of incidence ≥7° (OR 4.9; 95 % CI 2.2–10 and p ≤ 0.001), the latter showing a likelihood of 57 % for impingement, increasing to 90 % with an angle of incidence of 11°.

Conclusions

Posterior entry site should be avoided and an anterior site should be used. Female gender, straight nails and greater angle of incidence of the femur were associated with cortical impingement. A specific intramedullary nail design is needed for the Hispanic population due to high impingement and anterior cortical penetration rates seen with conventional nails. Short curved nails and long nails with a lower radius of curvature are required.

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Acknowledgments

The authors thank Dr. Andrés González and Dr. Iván Flórez for the epidemiologic support, and Dr. Jaime Leal for contributions to the discussion of the results. Likewise, the authors acknowledge Dr. Alfredo M. López-Yunez, Dr. Julia Escandon and Dr. Anna Spector for editing and proofreading the manuscript.

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Authors and Affiliations

  1. Department of Orthopaedics and Traumatology, Hospital Universitario de La Samaritana, Carrera 8 No. 0-55 Sur, Third Floor, Bogotá, Colombia

    Omar R. Peña M.D., Amparo Gómez Gélvez M.D., Kristian A. Espinosa M.D. & José R. Cardona M.D.

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  1. Omar R. Peña M.D.
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  2. Amparo Gómez Gélvez M.D.
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  3. Kristian A. Espinosa M.D.
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Correspondence to Kristian A. Espinosa M.D..

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No external funding was used.

Ethical standards

(1) The study was approved by both the Institutional Medical Review Board and Ethics Committee of the Hospital Research Center and was performed in accordance with the ethical standards of the 1964 Declaration of Helsinki and its later amendments. (2) Since it was a retrospective study, the need for informed consent was waived by the Institutional Medical Review Board.

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The authors declare that they have no conflict of interest.

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Peña, O.R., Gómez Gélvez, A., Espinosa, K.A. et al. Cephalomedullary nails: factors associated with impingement of the anterior cortex of the femur in a Hispanic population. Arch Orthop Trauma Surg 135, 1533–1540 (2015). https://doi.org/10.1007/s00402-015-2313-8

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  • DOI: https://doi.org/10.1007/s00402-015-2313-8

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