Reverse wedge effect following intramedullary nail fixation of trochanteric fracture, what does it imply?

Lag screw cut-out is the most common cause of fixation failure of trochanteric fractures. Intraoperative assessment of fracture reduction and fixation quality is vital to avoid fracture reduction and achieve good functional outcomes. In a recent study, Zhang et al. reported the occurrence of a rever...

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Bibliographic Details
Published in:BMC musculoskeletal disorders 2021-05, Vol.22 (1), p.1-497, Article 497
Main Authors: Hao, Wei, Fang, Long, Yin, Shuangshuang, Lin, Yongjie, Wang, Bingchen
Format: Article
Language:English
Subjects:
Basicervical
Classification
Complications
Complications and side effects
Computed tomography
Correspondence
Fractures
Hip joint
Internal fixation in fractures
Intraoperative
Literature reviews
Mechanism
Methods
Reverse wedge effect
Surgery
Trochanteric fracture
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Summary:Lag screw cut-out is the most common cause of fixation failure of trochanteric fractures. Intraoperative assessment of fracture reduction and fixation quality is vital to avoid fracture reduction and achieve good functional outcomes. In a recent study, Zhang et al. reported the occurrence of a reverse wedge effect after intraoperative nail insertion based on a new computed tomography(CT)-guided fracture classification system, which specifically happened to the basicervical facture type and resulted in valgus deformity with gapping at the medial inferior fracture line. Impingement between the reamer/nail and superolateral cortex of the femoral neck has been regarded as the main cause. Based on these findings, together with an extensive literature review, the practicality of the new fracture classification system, the definition of basicervical trochanteric fracture, and the mechanisms underlying the reverse wedge effect have been deeply discussed. More studies should be carried out in the future to analyse pre- and intraoperative related factors that could affect the intraoperative fragment migration effects and determine highly specific measures to address them.
ISSN:1471-2474
1471-2474
DOI:10.1186/s12891-021-04388-1