Early failure of spiral blade using with an unreamed femoral nail: a case report

Fixation principles in metaphyseal bone--a patent based review

Osteoporotic changes start in cancellous bone due to the underlying pathophysiology. Consequently, the metaphyses are at a higher risk of "osteoporotic" fracture than the diaphysis. Furthermore, implant purchase to fix these fractures is also affected by the poor bone quality. In general, researchers and developers have worked on three different approaches to address the problem of fractures to osteoporotic bone: adapted anchoring techniques, improved load distribution as well as transfer with angular stable screws, and augmentation techniques using bone substitutes. A patent-based review was performed to evaluate which ideas were utilized to improve fixation in osteoporotic, metaphyseal bone, especially in the proximal femur, and to analyze whether the concept had entered clinical use. Anchoring devices that are either extramedullary or intramedullary have a long clinical history. However, demanding surgical techniques and complications, especially in poor quality bone, are justification that such implants and their corresponding surgical techniques need to be improved upon. Expanding elements have been evaluated in the laboratory. The results are promising and the potential of this approach has yet to be fully exploited in the clinics. Internal fixators with angular stable screws open the door for many new anchorage ideas and have great potential for further optimization of load distribution and transfer. Augmentation techniques may improve anchorage in osteoporotic bone. However, the properties of bone substitute materials will need to be modified and improved upon in order to meet the demanding requirements. If we summarise the development process and the clinical use of implants to date, we have to clearly state that more factors than simply biomechanical advantage will determine the clinical success of a new fixation principle or a new implant. Instead, fracture treatment of patients with osteoporosis really needs an interdisciplinary approach!

Unreamed femoral nail with spiral blade in subtrochanteric fractures: experience of 55 cases

OBJECTIVE

To evaluate the use of the unreamed femoral nail with spiral blade (UFN-SB) in the treatment of subtrochanteric femoral fractures.

DESIGN

A retrospective review of a consecutive series of 55 fractures. Fourteen patients had metastatic disease (four had prophylactic nailing).

RESULTS

In five fractures, the UFN-SB failed: there was migration in three cases and breakage of the spiral blade in two cases, with breakage of the nail in two cases. Revision surgery was necessary in four cases. Five out of seven complications related to the spiral blade were seen in patients with a Seinsheimer fracture Type IIC or V. All other fractures healed within 1 year including those that needed revision surgery. In two cases the end result was THR.

CONCLUSIONS

No complication was observed in pathological fractures, which may be because of a high mortality in the first 4 months after surgery due to co morbidity. The main advantage of the nail seems to be its ease of use. It can be inserted through a small incision. The options in spiral blade angle insertion make it a very versatile implant. The implant should probably not be used in Type IIC or V (Seinsheimer) fractures.