Lambers Anton P, Rieger Bertram, Kop Alan, Pabbruwe Moreica B, Briffa Tom, Perring Jessica, D'Alessandro Peter, Yates Piers J
Medical School, Division of Surgery, The University of Western Australia, Perth, Western Australia, Australia.
ALTIUS Swiss Sportsmed Center, Rheinfelden, Switzerland.
JB JS Open Access. 2025 Apr 18;10(2). doi: 10.2106/JBJS.OA.24.00196. eCollection 2025 Apr-Jun.
Cephalomedullary nails are used for internal fixation of proximal femur fractures, pathological fractures, and for revision fixation in the case of failures. Nail breakages are rare, with published figures demonstrating a high variability with a previous benchmark set at less than 1.3%. The aim of this study was to use a large and geographically isolated patient cohort to better define and compare the proportion of implant breakages across a range of cephalomedullary nails.
Implantation data were collected from electronic theater records at all tertiary public orthopaedic hospitals in the state of Western Australia between 1 January, 2001, and 5 July, 2017, to capture a consecutive series of implant insertions across all indications. This was linked to Western Australia's Centre for Implant Technology and Retrieval Analysis (CITRA) nail repository records to identify broken nails received for analysis in the subsequent years until data collection ceased on 5 July, 2024.
Three thousand eight hundred eighty-two cephalomedullary nails were implanted. There were 18 nail breakages in this cohort recovered by CITRA, giving an overall breakage proportion of 0.5%. While breakages were rare, the Trochanteric Fixation Nail-Advanced (TFNA) demonstrated a 7-fold higher proportion of reported breakages (6/393; 1.5%) compared with its predecessor the proximal femoral nail antirotation (PFNA; 6/2,621; 0.2%, p = 0.002). The proportions of reported breakages in the Gamma3 and PFN prostheses were 0.6% (2/320) and 0.7% (4/548), respectively.
In this large consecutive sample of cephalomedullary nail patients, the TFNA appears to have a higher proportion of reported breakages than one of its predecessors, the PFNA, and this sits outside our previously defined benchmark. Breakages need to be considered in conjunction with other causes of failure and the index diagnosis when making decisions about implant choice in the management of proximal femur fractures. Further studies that are better able to deal with the many confounding variables of implant fatigue failure are required.
Therapeutic Level III (Retrospective Cohort Study). See Instructions for Authors for a complete description of levels of evidence.
股骨近端髓内钉用于股骨近端骨折、病理性骨折的内固定以及失败后的翻修固定。钉断裂很少见，已发表的数据显示差异很大，之前设定的基准低于1.3%。本研究的目的是使用一个规模大且地理位置相对孤立的患者队列，以更好地定义和比较一系列股骨近端髓内钉的植入物断裂比例。
收集了2001年1月1日至2017年7月5日期间西澳大利亚州所有三级公立骨科医院电子手术室记录中的植入数据，以获取所有适应症的连续一系列植入情况。这与西澳大利亚州植入技术与取出分析中心（CITRA）的髓内钉储存库记录相关联，以识别在后续年份收到用于分析的断裂髓内钉，直至2024年7月5日停止数据收集。
共植入3882枚股骨近端髓内钉。CITRA在该队列中回收了18例钉断裂，总体断裂比例为0.5%。虽然断裂很少见，但与它的前身股骨近端抗旋髓内钉（PFNA；6/2621；0.2%，p = 0.002）相比，股骨转子间固定高级髓内钉（TFNA）报告的断裂比例高出7倍（6/393；1.5%）。Gamma3和PFN假体报告的断裂比例分别为0.6%（2/320）和0.7%（4/548）。
在这个大型连续的股骨近端髓内钉患者样本中，TFNA报告的断裂比例似乎高于其前身之一PFNA，且超出了我们之前定义的基准。在决定股骨近端骨折治疗中的植入物选择时，需要结合其他失败原因和索引诊断来考虑断裂情况。需要进一步开展研究，以更好地处理植入物疲劳失效的众多混杂变量。
治疗性III级（回顾性队列研究）。有关证据水平的完整描述，请参阅作者指南。
