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      Breakage of the Tail Portion of the Lag Screw during Removal of Proximal Femoral Zimmer Natural Nail: Report of Two Cases with Technical Notes

      case-report
      Author(s): , MD, , MD * , , MD, PhD * , , , MD, PhD *
      Publication date (Electronic):
      Journal: Hip & Pelvis
      Publisher: Korean Hip Society
      Keywords: Hip fractures, Zimmer Natural Nail, Lag screw, Breakage

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          Abstract

          Proximal femoral cephalomedullary nailing is one of the treatments of choice for intertrochanteric fracture. Zimmer Natural Nail® (ZNN; Zimmer) is one of the alternatives. We report two cases of broken tail portion of the ZNN lag screw during the removal procedure. This may be the first reported cases in scientific literature with this pattern of failure. We report these cases to highlight one of the possible problems that could occur during removal of this implant which can possibly prolong the operation time significantly if the required device is not prepared.

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          Treatment of extracapsular hip fractures with the proximal femoral nail (PFN): long term results in 45 patients.

          Minos Tyllianakis, Andreas Papadopoulos, Andreas Panagopoulos … (2004)
          The authors have retrospectively studied the results achieved with the AO/ASIF PFN system in the treatment of unstable intertrochanteric fractures of the proximal femur. Between June 1999 and February 2003, 51 patients with unstable intertrochanteric fractures of the proximal femur underwent intramedullary nailing with the PFN system. A total of 45 patients (28 women, 17 men, average age 72 years) with 46 unstable pertrochanteric fractures (21 31-A2, 25 31-A3,) were available for outcome analysis. Mean follow-up period was 20 months (range, 12 to 30). The Salvati and Wilson scale of hip function was used at the last follow-up clinical assessment. Intraoperative difficulties in the insertion of the nail or screws, fracture consolidation, technical or mechanical complications and delayed union, nonunion and avascular necrosis were registered as well. Solid union of the fracture was achieved in all patients except one who was revised to total hip arthroplasty because of avascular necrosis of the femoral head. Technical and mechanical complications were noted in 41.3% of the patients during the operation and in 30.4% at the follow-up period (2 cut-outs of the neck screw, 5 "Z effects" of the antirotational hip pin leading to femoral head protrusion in four of these cases, 1 case with reverse "Z-effect" and 2 implant failures, both revised to a long PFN implant). The overall rate of re-operation was 28.8%. The Salvati and Wilson score was > 25 in 27 (60%) of the patients. The PFN modifications might be responsible for the positive results in this study. Technical or mechanical complications seem to be related with the type of fracture, the operative technique and the time of weight bearing rather than the PFN system itself.
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            Comparative prospective study of proximal femoral nail and dynamic hip screw in treatment of intertrochanteric fracture femur.

            Ranjeetesh Kumar, R.N. Singh, B.N Singh (2012)
            The aim of this study was to compare the outcome of intertrochanteric fractures treated with Dynamic Hip Screw and Proximal Femoral nail.
            Article 0 comments Cited 15 times – based on 0 reviews     Review now
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              Breakage of a Third Generation Gamma Nail: A Case Report and Review of the Literature

              Takashi Iwakura, Takahiro Niikura, Sang Lee … (2013)
              The use of intramedullary nails to treat trochanteric fractures of the femur has increased with the increasing size of the elderly population. The third generation Gamma nail is currently one of the most popular devices for the treatment of trochanteric fractures. Nail breakage is a rare complication, possibly resulting from fatigue fracture of the implant. We present the first reported case of breakage of a third generation Gamma nail that was not used to treat a pathological fracture. An 83-year-old woman with an unstable trochanteric fracture of the femur was treated using a third generation Gamma nail. She was referred to our hospital 14 months postoperatively with nail breakage at the opening for the lag screw. The breakage was secondary to nonunion, which was thought to be mainly due to insufficient reduction of the fracture. The broken nail was removed, and the patient underwent cemented bipolar hemiarthroplasty. At followup 18 months later, she was mobile with a walker and asymptomatic with no complications. This case shows that inadequate operation such as insufficient reduction of the trochanteric fracture may result in nonunion and implant breakage, even when using a high-strength, well-designed implant.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Hip Pelvis
                Journal ID (iso-abbrev): Hip Pelvis
                Journal ID (publisher-id): HP
                Title: Hip & Pelvis
                Publisher: Korean Hip Society
                ISSN (Print): 2287-3260
                ISSN (Electronic): 2287-3279
                Publication date (Print): September 2017
                Publication date (Electronic): 06 September 2017
                Volume: 29
                Issue: 3
                Pages: 199-203
                Affiliations
                Department of Orthopaedic and Traumatology, Faculty of Medicine, Sebelas Maret University, Prof. Dr. R. Soeharso Orthopaedic Hospital, Solo, Indonesia.
                [* ]Department of Orthopedic Surgery, Center for Joint Disease, Chonnam National University Hwasun Hospital, Hwasun, Korea.
                Author notes
                Address reprint request to Kyung-Soon Park, MD, PhD. Department of Orthopedic Surgery, Center for Joint Disease, Chonnam National University Hwasun Hospital, 322 Seoyang-ro, Hwasun-eup, Hwasun 58128, Korea. TEL: +82-61-379-7677, 7676 FAX: +82-61-379-7681, chiasma@ 123456hanmail.net
                Article
                DOI: 10.5371/hp.2017.29.3.199
                PMC ID: 5612981
                PubMed ID: 28955687
                SO-VID: 6f5a44b0-fa1f-4b22-ac48-eb86f48077a2
                Copyright © Copyright © 2017 by Korean Hip Society
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 21 February 2017
                Date revision received : 11 April 2017
                Date accepted : 19 April 2017
                Categories
                Subject: Case Report

                Keywords: hip fractures,zimmer natural nail,lag screw,breakage
                Data availability:
                Keywords: hip fractures, zimmer natural nail, lag screw, breakage

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