Sat., 10/18/08 Femur, Paper #50, 9:46 am OTA-2008
Proximal Locking Screws for the Antegrade Nailing of Femoral Shaft Fractures: Should Cephalomedullary Screws Be the Standard?
Cory A. Collinge, MD1 (a-Foundation for Orthopedic Trauma; c-Biomet; c,e-Smith + Nephew);
Frank A. Liporace, MD2 (e-Stryker); Alexander Guyott, BS3 (n); George T. Gilbert, PhD4 (n);
1Harris Methodist Hospital-Fort Worth, John Peter Smith Orthopedic Surgery Residency, Fort Worth, Texas, USA;
2University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA;
3Orthopedic Specialty Associates, Fort Worth, Texas, USA;
4Texas Christian University, Fort Worth, Texas, USA
Purpose: The purpose of this study is to determine whether there are significant risks to patients treated for femoral shaft fractures with intramedullary nailing using cephalomedullary proximal locking screws and to make an actuarial estimate of the number of “missed” associated femoral neck fractures and late hip fractures that might be prophylactically treated with this modified treatment method.
Methods: 72 patients were treated by 2 surgeons at 2 trauma centers for femoral shaft fracture using antegrade femoral nailing with cephalomedullary proximal locking screws. Patient and injury data, radiographic analysis, and complications of treatment were assessed at ≥ 6 months. Actuarial analysis was performed using statistics from the U.S. National Center for Injury Prevention and Control (www.cdc.gov/ncipc) and the International Osteoporosis Foundation (www.osteofound.org/press).
Results: 52 of 72 patients (72%) were followed for ≥6 months and until healed. There were no complications relating to the cephalomedullary screws or the hip. Using a femoral shaft fracture risk rate of 1.15 per 10,000 with males at 3× the risk of females, and a hip fracture risk rate of 8 per 10,000 with females 2× the risk of males, and both rates increasing exponentially with age, the probability that a femoral shaft fracture patient will later experience an ipsilateral fracture of the hip is 7% (5% risk for men and 9% risk for women). Thus, one would expect some 2000 individuals fracturing a femur this year in the U.S. to fracture the corresponding hip at some point during their lives. Assuming a 5% incidence of associated femoral neck fracture with a femoral shaft fracture and a 5% rate of missed femoral neck fractures in these cases, 750 associated femoral neck fractures will be missed this year in the U.S.
Conclusion and Significance: Inserting cephalomedullary proximal locking screws during the antegrade femoral nailing of femoral shaft fractures caused no complications. This modification of standard femoral nailing offers potential advantages over traditional locking options including the fixation of any “missed” femoral neck fractures and the prevention of potential late hip fractures that might occur above the nail as the patient ages. Based on this actuarial analysis, of the 72 patients treated in this series, 3 likely would have a “missed” femoral neck fracture prophylactically treated and 6 would avoid a later hip fracture above the intramedullary implant.
If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.