PROGRESS ON DISTAL INTERLOCKING SCREW OF CEPHALOMEDULLARY NAIL FOR INTERTROCHANTERIC FRACTURES_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIQing ,  ZHANGShimin

Department of Orthopedic Surgery, Yangpu Hospital, Tongji University, Shanghai, 200090, P. R. China;

Corresponding author：

ZHANGShimin, Email: shiminchang11@aliyun.com

Keywords：

Cephalomedullary nail; Distal interlocking screw; Intertrochanteric fracture

DOI：

10.7507/1002-1892.20140254

Video：

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Objective To summarize the progress on the distal interlocking screw of cephalomedullary nail for intertrochanteric fractures. Methods Related literature concerning the distal interlocking screw of cephalomedullary nail was reviewed and analyzed in terms of biomechanics, clinical application, operating difficulties, and complications. Results Distal interlocking screw can provide extra torsional stiffness in both short and long cephalomedullary nail. It is applied in most clinical cases. In long cephalomedullary nail, placing the distal interlocking screw increases the operative time for fixation and the amount of radiation exposure notably. In short cephalomedullary nail, placing the distal interlocking screw can cause adjacent vascular injury, stress concentration, and secondary fracture around the screw. Conclusion When the fracture is stable (type A1, type A2.1), it can be fixed solidly without the distal interlocking screw, but prefers to use a long nail. In unstable fracture, the distal interlocking screw should be used to prevent rotational displacement of the femur shaft and the failure of the nail.

Citation： LIQing, ZHANGShimin. PROGRESS ON DISTAL INTERLOCKING SCREW OF CEPHALOMEDULLARY NAIL FOR INTERTROCHANTERIC FRACTURES. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(9): 1177-1180. doi: 10.7507/1002-1892.20140254 Copy

1.	Zhou JQ, Chang SM.Failure of PFNA:helical blade perforation and tip-apex distance.Injury, 2012, 43(7):1227-1228.
2.	李双, 王栋, 张世民.尖顶距与股骨头内拉力螺钉切出的研究进展.中国矫形外科杂志, 2007, 15(19):1484-1485, 1491.
3.	李海丰, 张世民.股骨近端防旋髓内钉螺旋刀片向内穿出的研究进展.中华创伤骨科杂志, 2013, 15(5):442-444.
4.	Born CT, Karich B, Bauer C, et al.Hip screw migration testing:first results for hip screws and helical blades utilizing a new oscillating test method.J Orthop Res, 2011(29):760-766.
5.	Goffin JM, Pankaj P, Simpson AH, et al.Does bone compaction around the helical blade of a proximal femoral nail antirotation (PFNA) decrease the risk of cut-out? A subject-specific computational study.Bone Joint Res, 2013, 2(5):79-83.
6.	Nikoloski AN, Osbrough AL, Yates PJ.Should the tip-apex distance (TAD) rule be modified for the proximal femoral nail antirotation (PFNA)? A retrospective study.J Orthop Surg Res, 2013, 8:35.
7.	Bong MR, Kummer FJ, Koval KJ, et al.Intramedullary nailing of the lower extremity:biomechanics and biology.J Am Acad Orthop Surg, 2007, 15(2):97-106.
8.	Rosenblum SF, Zuckerman JD, Kummer FJ, et al.A biomechanical evaluationof the Gamma nail.J Bone Joint Surg (Br), 1992, 74(3):352-357.
9.	Bostrom MP, Lyden JP, Ernberg JJ, et al.A biomechanical evaluation of the long stem intramedullary hip screw.J Orthop Trauma, 1995, 9(1):45-52.
10.	Kane PM, Vopat B, Paller D, et al.Effect of distal interlock fixation in stable intertrochanteric fractures.Othopedics, 2013, 36(7):e859-864.
11.	Gallagher D, Adams B, El-Gendi H, et al.Is distal locking necessary? A biomechanical investigation of intramedullary nailing constructs for intertrochanteric fractures.J Orthop Trauma, 2013, 27(7):373-378.
12.	Efstahopoulos N, Nilolaou VS, Xypnitos FN, et al.Investigation on the distal screw of a trochanteric intramedullary implant (Fi-nail) using a simplified finite element model.Injury, 2010, 41(3):259-265.
13.	Ozkan K, Unay K, Demircay C, et al.Distal unlocked proximal femoral intramedullary nailing for intertrochantetic femur fractures.Int Orthop, 2009, 33(5):1397-1400.
14.	Whatling GM, Nokes LDM.Literature review of current techniques for the insertion of distal screws into intramedullary locking nails.Injury, 2006, 37(2):109-119.
15.	White NJ, Sorkin AT, Konopka G, et al.Static intramedullary nailing of the Femur and tibia without intraoperative fluoroscopy.Clin Orthop Relat Res, 2011, 469(12):3469-3476.
16.	Ogunlusi JD, St Rose RS, Davids T.Interlocking nailing without imaging:the challenges of locating distal slots and how to overcome then in SIGN intrameduallary nailing.Int Orthop, 2010, 34(6):891-895.
17.	Arlettaz Y, Dominguez A, Farron A, et al.Distal locking of femoral nails:evaluation of a new radiation-independent targeting system.J Orthop Trauma, 2012, 26(11):633-637.
18.	Negrin LL, Vecsei V.Is a Magnetic-manual targeting device an appealing alternative for distal locking of tibial intramedullary nails? Arch Trauma Res, 2013, 2(1):16-20.
19.	Moreschini O, Petrucci R, Cannata R.Insertion of diatal locking screws of tibial intramedullary nails:A comparison between the free-hand technique and the SUPESHOTTM distal targeting system.Injury, 2014, 45(2):405-407.
20.	Fordyce A.False aneurysm of the profunda femoris artery following nail and plate fixation of an intertrochanteric fracture.Report of a case.J Bone J Surg (Br), 1968, 50(1):141-143.
21.	Ebong WW.False aneurysm of the profunda femoris artery following internal fixation of an intertrochanteric femoral fracture.Injury, 1978, 9(3):249-251.
22.	DeCasas R, Lazaro FJG, Garcia-Rayo MR, et al.Arteriovenous fistula after interlocking nailing of the femur:a case report.J Trauma, 1995, 38(2):303-304.
23.	Karkos CD, Hughes R, Prasad V, et al.Thigh compartment syndrome as a result of a false aneurysm of the profunda femoris artery complicating fixation of an intertrochanteric fracture.J Trauma, 1999, 47(2):393-395.
24.	Grimaldi M, Courvoisier A, Tonetti J, et al.Superficial femoral artery injury resulting from intertrochanteric hip fracture fixation by a locked intramedullary nail.Orthop Traumatol Surg Res, 2009, 95(5):380-382.
25.	Bose D, Hauptfleisch J, Mcnally M.Delayed pseudoaneurysm caused by distal locking screw of a femoral intramedullary nail:a case report.J Orthop Trauma, 2006, 20(8):584-586.
26.	Riina J, Tornetta P 3rd, Ritter C, et al.Neurologic and vascular structures at risk during anterior-posterior locking of retrograde femoral nails.J Orthop Trauma, 1998, 12(6):379-381.
27.	Yang KH, Yoon CS, Park HW, et al.Position of the superficial femoral artery in closed hip nailing.Arch Orthop Trauma Surg, 2004, 124(3):169-172.
28.	Han CD, Lee YH, Yang KH, et al.Relationship between distal screws and femoral arteries in closed hip nailing on computed tomography angiography.Arch Orthop Trauma Surg, 2013, 133(3):361-366.

1. Zhou JQ, Chang SM.Failure of PFNA:helical blade perforation and tip-apex distance.Injury, 2012, 43(7):1227-1228.
2. 李双, 王栋, 张世民.尖顶距与股骨头内拉力螺钉切出的研究进展.中国矫形外科杂志, 2007, 15(19):1484-1485, 1491.
3. 李海丰, 张世民.股骨近端防旋髓内钉螺旋刀片向内穿出的研究进展.中华创伤骨科杂志, 2013, 15(5):442-444.
4. Born CT, Karich B, Bauer C, et al.Hip screw migration testing:first results for hip screws and helical blades utilizing a new oscillating test method.J Orthop Res, 2011(29):760-766.
5. Goffin JM, Pankaj P, Simpson AH, et al.Does bone compaction around the helical blade of a proximal femoral nail antirotation (PFNA) decrease the risk of cut-out? A subject-specific computational study.Bone Joint Res, 2013, 2(5):79-83.
6. Nikoloski AN, Osbrough AL, Yates PJ.Should the tip-apex distance (TAD) rule be modified for the proximal femoral nail antirotation (PFNA)? A retrospective study.J Orthop Surg Res, 2013, 8:35.
7. Bong MR, Kummer FJ, Koval KJ, et al.Intramedullary nailing of the lower extremity:biomechanics and biology.J Am Acad Orthop Surg, 2007, 15(2):97-106.
8. Rosenblum SF, Zuckerman JD, Kummer FJ, et al.A biomechanical evaluationof the Gamma nail.J Bone Joint Surg (Br), 1992, 74(3):352-357.
9. Bostrom MP, Lyden JP, Ernberg JJ, et al.A biomechanical evaluation of the long stem intramedullary hip screw.J Orthop Trauma, 1995, 9(1):45-52.
10. Kane PM, Vopat B, Paller D, et al.Effect of distal interlock fixation in stable intertrochanteric fractures.Othopedics, 2013, 36(7):e859-864.
11. Gallagher D, Adams B, El-Gendi H, et al.Is distal locking necessary? A biomechanical investigation of intramedullary nailing constructs for intertrochanteric fractures.J Orthop Trauma, 2013, 27(7):373-378.
12. Efstahopoulos N, Nilolaou VS, Xypnitos FN, et al.Investigation on the distal screw of a trochanteric intramedullary implant (Fi-nail) using a simplified finite element model.Injury, 2010, 41(3):259-265.
13. Ozkan K, Unay K, Demircay C, et al.Distal unlocked proximal femoral intramedullary nailing for intertrochantetic femur fractures.Int Orthop, 2009, 33(5):1397-1400.
14. Whatling GM, Nokes LDM.Literature review of current techniques for the insertion of distal screws into intramedullary locking nails.Injury, 2006, 37(2):109-119.
15. White NJ, Sorkin AT, Konopka G, et al.Static intramedullary nailing of the Femur and tibia without intraoperative fluoroscopy.Clin Orthop Relat Res, 2011, 469(12):3469-3476.
16. Ogunlusi JD, St Rose RS, Davids T.Interlocking nailing without imaging:the challenges of locating distal slots and how to overcome then in SIGN intrameduallary nailing.Int Orthop, 2010, 34(6):891-895.
17. Arlettaz Y, Dominguez A, Farron A, et al.Distal locking of femoral nails:evaluation of a new radiation-independent targeting system.J Orthop Trauma, 2012, 26(11):633-637.
18. Negrin LL, Vecsei V.Is a Magnetic-manual targeting device an appealing alternative for distal locking of tibial intramedullary nails? Arch Trauma Res, 2013, 2(1):16-20.
19. Moreschini O, Petrucci R, Cannata R.Insertion of diatal locking screws of tibial intramedullary nails:A comparison between the free-hand technique and the SUPESHOTTM distal targeting system.Injury, 2014, 45(2):405-407.
20. Fordyce A.False aneurysm of the profunda femoris artery following nail and plate fixation of an intertrochanteric fracture.Report of a case.J Bone J Surg (Br), 1968, 50(1):141-143.
21. Ebong WW.False aneurysm of the profunda femoris artery following internal fixation of an intertrochanteric femoral fracture.Injury, 1978, 9(3):249-251.
22. DeCasas R, Lazaro FJG, Garcia-Rayo MR, et al.Arteriovenous fistula after interlocking nailing of the femur:a case report.J Trauma, 1995, 38(2):303-304.
23. Karkos CD, Hughes R, Prasad V, et al.Thigh compartment syndrome as a result of a false aneurysm of the profunda femoris artery complicating fixation of an intertrochanteric fracture.J Trauma, 1999, 47(2):393-395.
24. Grimaldi M, Courvoisier A, Tonetti J, et al.Superficial femoral artery injury resulting from intertrochanteric hip fracture fixation by a locked intramedullary nail.Orthop Traumatol Surg Res, 2009, 95(5):380-382.
25. Bose D, Hauptfleisch J, Mcnally M.Delayed pseudoaneurysm caused by distal locking screw of a femoral intramedullary nail:a case report.J Orthop Trauma, 2006, 20(8):584-586.
26. Riina J, Tornetta P 3rd, Ritter C, et al.Neurologic and vascular structures at risk during anterior-posterior locking of retrograde femoral nails.J Orthop Trauma, 1998, 12(6):379-381.
27. Yang KH, Yoon CS, Park HW, et al.Position of the superficial femoral artery in closed hip nailing.Arch Orthop Trauma Surg, 2004, 124(3):169-172.
28. Han CD, Lee YH, Yang KH, et al.Relationship between distal screws and femoral arteries in closed hip nailing on computed tomography angiography.Arch Orthop Trauma Surg, 2013, 133(3):361-366.

Chinese Journal of Reparative and Reconstructive Surgery

PROGRESS ON DISTAL INTERLOCKING SCREW OF CEPHALOMEDULLARY NAIL FOR INTERTROCHANTERIC FRACTURES

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