Salvage hip replacement after cut-out failure of cephalomedullary nail fixation for proximal femur fractures: a case series describing the technique and results

Background Cut-out failure following proximal femoral fracture fixation is a compromising complication warranting surgical treatment. We describe 24 patients with cut-out failure after cephalomedullary nail fixation managed with salvage hip replacement. Methods Twenty-four consecutive patients who h...

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Published in:International orthopaedics 2022-12, Vol.46 (12), p.2775-2783
Main Authors: Corró, Sebastián, Óleo-Taltavull, Rafael, Teixidor-Serra, Jordi, Tomàs-Hernández, Jordi, Selga-Marsà, Jordi, García-Sánchez, Yaiza, Guerra-Farfán, Ernesto, Andrés-Peiró, José-Vicente
Format: Article
Language:English
Subjects:
Aged
Arthroplasty, Replacement, Hip - adverse effects
Bone Nails - adverse effects
Femoral Fractures - complications
Femoral Fractures - surgery
Femur - surgery
Humans
Medicine
Medicine & Public Health
Nails - surgery
Original Paper
Orthopedics
Retrospective Studies
Treatment Outcome
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Summary:Background Cut-out failure following proximal femoral fracture fixation is a compromising complication warranting surgical treatment. We describe 24 patients with cut-out failure after cephalomedullary nail fixation managed with salvage hip replacement. Methods Twenty-four consecutive patients who had sustained a proximal femoral fracture from December 2009 to December 2019, were managed with cephalomedullary nail fixation and experienced a cut-out failure were reviewed retrospectively. Data on demographics, comorbidities, injury characteristics, treatment, and post-operative course were analysed. Results Among 2802 proximal femoral fractures assessed, 28 fixations failed due to cut-out, with 24/28 patients subsequently undergoing salvage hip replacement. Intertrochanteric fractures (66.7%) managed with short nails predominated (79.2%). The median tip-to-apex distance (TAD) was 19 mm, but only two fractures had a good quality of reduction. Inverse correlations were identified between patient age and the time from fixation to cut-out ( r  =  − 0.57; p  = 0.02), and between the time of nailing to failure among patients with a greater TAD ( r  =  − 0.43; p  = 0.04). Most patients were managed via cemented hemiarthroplasty (66.7%). Surgical time was longer for total hip replacements (175.4 vs. 136.8 min; p  
ISSN:0341-2695
1432-5195
DOI:10.1007/s00264-022-05529-4