Successful Revision with INTERTAN for a Blade Cut Through in PFNA Fixation: A Case Report
Open Access
- 29 January 2023
- journal article
- research article
- Published by Wiley in Orthopaedic Surgery
- Vol. 15 (3), 906-911
- https://doi.org/10.1111/os.13656
Abstract
BackgroundImplant cut-out or cut-through remains a common cause of cephalomedullary nail failure and patient morbidity following surgical treatment of intertrochanteric femur fractures. In patients not suitable for conversion to total hip arthroplasty, which can involve long operation times and substantial blood loss, as well as a higher risk of periprosthetic fracture and dislocation postoperatively, revision with another internal fixation is an alternative option. If the femoral head can be preserved as much as possible to avoid eventual joint replacement while the internal fixation failure is solved, the quality of life of patients will be significantly improved. Case PresentationThis current case describes a successful clinical use of a salvage procedure that allows the surgeon to avoid joint arthroplasty using INTERTAN to solve internal fixation failure caused by cut-through of Proximal Femoral Nail Antirotation-II (PFNA-II). Four years after closed reduction and internal fixation of the right femur, the patient had immobilizing right hip pain and mobility disorder. X-ray examination revealed contraction of the neck of the right femur and cut-through of the helical blade of the PFNA-II. After the revision operation, he recovered well and presented no grown pain or discomfort in weight-bearing. Conventional radiographs at 1-year follow-up showed a healed fracture, with no implant migration. ConclusionMain nail exchange and revision with INTERTAN can be considered a salvage procedure in selected cases to revise a failed fixation with PFNA, which solves internal fixation failure as well as preserves the femoral head.Keywords
This publication has 17 references indexed in Scilit:
- Helical Blade Versus Screw Fixation in the Treatment of Hip Fractures With Cephalomedullary Devices: Incidence of Failure and Atypical “Medial Cutout”Journal of Orthopaedic Trauma, 2018
- AO principles of fracture managementActa Chirurgica Belgica, 2018
- Management of Acute Hip FractureThe New England Journal of Medicine, 2017
- Fracture fixation in the operative management of hip fractures (FAITH): an international, multicentre, randomised controlled trialThe Lancet, 2017
- What is the optimal salvage procedure for cut-out after surgical fixation of trochanteric fractures with the PFNA or TFN?Injury, 2015
- Helical blade versus sliding hip screw for treatment of unstable intertrochanteric hip fractures: A biomechanical evaluationInjury, 2006
- Salvage of Failed Internal Fixation of Intertrochanteric Hip FracturesClinical Orthopaedics and Related Research, 2003
- The value of the tip-apex distance in predicting failure of fixation of peritrochanteric fractures of the hip.The Journal of Bone & Joint Surgery, 1995
- Analysis of six hundred and twenty-two intertrochanteric hip fractures.The Journal of Bone & Joint Surgery, 1979
- A Ten-Year Analysis of Intertrochanteric Fractures of the FemurThe Journal of Bone & Joint Surgery, 1959