Section of Orthopaedic Trauma, Department of Orthopaedic Surgery, ProMedica Toledo Hospital, Toledo, OH.
Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH.
J Orthop Trauma. 2019 Nov;33(11):553-558. doi: 10.1097/BOT.0000000000001577.
To retrospectively review a large population of long cephalomedullary nails with special attention to distal implant position in the sagittal plane and assess the ability to avoid anterior cortical contact (ACC) by bending the distal tip of the nail intraoperatively.
Retrospective review of single surgeon experience.
Single Level 1 trauma center.
Radiographic position of the cephalomedullary nail with respect to the anterior femoral cortex and the effects of intraoperative bending of the distal tip of the nail.
A total of 215 patients who underwent long cephalomedullary nailing for peritrochanteric hip fractures between 2007 and 2017 were reviewed.
In the period between 2007 and October 2013, ACC of the distal portion of the nail in the sagittal plane was a common finding. Its incidence significantly decreased after intraoperative bending of long cephalomedullary nails was incorporated into practice in cases where sagittal plane impingement was detected (P < 0.0001). ACC was more prevalent if the final nail position was proximal to the level of the patella.
Careful attention should be paid to sagittal plane anatomy and distal ACC during insertion of a long cephalomedullary nail. One strategy to prevent anterior impingement or perforation may be intraoperative bending of the distal end of the nail.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
回顾大量使用长髓内钉的病例，特别关注矢状面远端植入物的位置，并评估术中弯曲钉远端以避免前方皮质接触（ACC）的能力。
回顾单外科医生的经验。
单一级创伤中心。
髓内钉相对于股骨前皮质的放射学位置以及术中弯曲钉远端的效果。
2007 年至 2017 年间共 215 例经股骨转子间骨折行长髓内钉治疗的患者进行了回顾。
在 2007 年至 2013 年 10 月期间，矢状面中钉的远端发生 ACC 是一种常见的发现。在发现矢状面撞击时将长髓内钉术中弯曲纳入实践后，ACC 的发生率显著降低（P < 0.0001）。如果最终的钉位接近髌骨水平，ACC 更为常见。
在插入长髓内钉时，应仔细注意矢状面解剖结构和远端 ACC。预防前方撞击或穿孔的一种策略可能是术中弯曲钉的远端。
治疗性 III 级。请参阅作者说明以获取证据水平的完整描述。
