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Femoral neck fracture following intramedullary nailing with misplacement of an end cup: report of two cases.

Grala P, Mańkowski B, Kierzynka G - J Orthop Traumatol (2008)

Bottom Line: We report on two cases of femoral neck fractures attributed to misplacement of an end cup and subsequent invasive maneuvers in an effort to remove it.Authors associate it with many possible technical mistakes performed during the procedure, yet no complications after missed end cup placement were noted.We suggest that the fractures described below were a consequence of injury to the vascular supply and bone stock of the initially intact femoral neck.

View Article: PubMed Central - PubMed

Affiliation: Department of Trauma, Burns and Plastic Surgery, Karol Marcinkowski Medical University, Poznan, Poland, pawel.grala@aoalumni.org.

ABSTRACT
Femoral neck fracture is an unusual complication of intramedullary fixation of a broken femur. We report on two cases of femoral neck fractures attributed to misplacement of an end cup and subsequent invasive maneuvers in an effort to remove it. Iatrogenic fractures of the femoral neck during or after intramedullary nailing are reported in the medical literature. Authors associate it with many possible technical mistakes performed during the procedure, yet no complications after missed end cup placement were noted. We suggest that the fractures described below were a consequence of injury to the vascular supply and bone stock of the initially intact femoral neck.

No MeSH data available.


Related in: MedlinePlus

Case 1: ZESPOL internal fixator after removal of an infected plate. Proximal fragment periosteal elevation (black arrow) suggesting an inflammatory reaction
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Fig1: Case 1: ZESPOL internal fixator after removal of an infected plate. Proximal fragment periosteal elevation (black arrow) suggesting an inflammatory reaction

Mentions: A 76-year-old obese woman (BMI 32) was referred to our department after infected destabilization of a plate fixation of the left femoral shaft. On the next day she underwent removal of the implant with debridement and fixation of the bone with ZESPOL internal fixator—a Polish harbinger for the locked plates (Fig. 1). On the third postoperative day she sustained another fracture of the left femur while the wound dressings were changed. During an operation carried out on the next day, the fixator was lengthened proximally to incorporate the proximal fragment (Fig. 2). After three months, despite non-weight-bearing, recurrent destabilization occurred without any microbiological symptoms of infection. The implant was removed and open intramedullary nailing was performed. During this procedure significant bone fragility was evident, and the end cup was misplaced behind the femoral neck. Multiple efforts to remove it (using a finger and vascular clamps under the image intensifier) failed. After two weeks, during the first follow-up visit, a FNF (AO 31-B2) was diagnosed but the patient refused the proposed operative treatment. She came back after three months with significant shortening of the left femur and nonunions of both the neck and diaphysis (Fig. 3). During another operative intervention the end cup was replaced, and fixation of the femoral neck was attempted with two screws, one cortical interlocking through the dynamic slot of the nail and another cancellous with the “miss a nail technique.” We were not able to place additional screws due to the width of the proximal nail. The soft bone of the proximal fragment did not cause any noticeable resistance during screw placement. After three days of bed rest, the screws redisplaced and were removed. The patient remains severely disabled, walking around the house with a walker and occasionally using a Thomas splint based on her pelvis.Fig. 1


Femoral neck fracture following intramedullary nailing with misplacement of an end cup: report of two cases.

Grala P, Mańkowski B, Kierzynka G - J Orthop Traumatol (2008)

Case 1: ZESPOL internal fixator after removal of an infected plate. Proximal fragment periosteal elevation (black arrow) suggesting an inflammatory reaction
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2657352&req=5

Fig1: Case 1: ZESPOL internal fixator after removal of an infected plate. Proximal fragment periosteal elevation (black arrow) suggesting an inflammatory reaction
Mentions: A 76-year-old obese woman (BMI 32) was referred to our department after infected destabilization of a plate fixation of the left femoral shaft. On the next day she underwent removal of the implant with debridement and fixation of the bone with ZESPOL internal fixator—a Polish harbinger for the locked plates (Fig. 1). On the third postoperative day she sustained another fracture of the left femur while the wound dressings were changed. During an operation carried out on the next day, the fixator was lengthened proximally to incorporate the proximal fragment (Fig. 2). After three months, despite non-weight-bearing, recurrent destabilization occurred without any microbiological symptoms of infection. The implant was removed and open intramedullary nailing was performed. During this procedure significant bone fragility was evident, and the end cup was misplaced behind the femoral neck. Multiple efforts to remove it (using a finger and vascular clamps under the image intensifier) failed. After two weeks, during the first follow-up visit, a FNF (AO 31-B2) was diagnosed but the patient refused the proposed operative treatment. She came back after three months with significant shortening of the left femur and nonunions of both the neck and diaphysis (Fig. 3). During another operative intervention the end cup was replaced, and fixation of the femoral neck was attempted with two screws, one cortical interlocking through the dynamic slot of the nail and another cancellous with the “miss a nail technique.” We were not able to place additional screws due to the width of the proximal nail. The soft bone of the proximal fragment did not cause any noticeable resistance during screw placement. After three days of bed rest, the screws redisplaced and were removed. The patient remains severely disabled, walking around the house with a walker and occasionally using a Thomas splint based on her pelvis.Fig. 1

Bottom Line: We report on two cases of femoral neck fractures attributed to misplacement of an end cup and subsequent invasive maneuvers in an effort to remove it.Authors associate it with many possible technical mistakes performed during the procedure, yet no complications after missed end cup placement were noted.We suggest that the fractures described below were a consequence of injury to the vascular supply and bone stock of the initially intact femoral neck.

View Article: PubMed Central - PubMed

Affiliation: Department of Trauma, Burns and Plastic Surgery, Karol Marcinkowski Medical University, Poznan, Poland, pawel.grala@aoalumni.org.

ABSTRACT
Femoral neck fracture is an unusual complication of intramedullary fixation of a broken femur. We report on two cases of femoral neck fractures attributed to misplacement of an end cup and subsequent invasive maneuvers in an effort to remove it. Iatrogenic fractures of the femoral neck during or after intramedullary nailing are reported in the medical literature. Authors associate it with many possible technical mistakes performed during the procedure, yet no complications after missed end cup placement were noted. We suggest that the fractures described below were a consequence of injury to the vascular supply and bone stock of the initially intact femoral neck.

No MeSH data available.


Related in: MedlinePlus