ArticlePatient safety in surgery2011
Failure of fixation of trochanteric femur fractures: Clinical recommendations for avoiding Z-effect and reverse Z-effect type complications.
Article in Patient safety in surgery, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
26 citing papers in PubMed, 2 syntheses or guidelines pooled it, 51 citations in OpenAlex.
- Proximal femoral nail vs. dynamic hip screw in treatment of intertrochanteric fractures: a meta-analysis.Medical science monitor : international medical journal of experimental and clinical research · 2014Pooled it
- Proximal femoral nail versus dynamic hip screw fixation for trochanteric fractures: a meta-analysis of randomized controlled trials.TheScientificWorldJournal · 2013Pooled it
- Implant Design and Its Applications in the Fixation of Osteoporotic Bones: Newer Technologies in Nails, Plates and External Fixators.Indian journal of orthopaedics · 2025Review
- Healing Against the Odds: Successful Bone Union in Intertrochanteric Femur Fracture Despite Z-Effect and Implant Failure.Journal of orthopaedic case reports · 2025Article
- Effectiveness of the Dorr index in predicting implant failure before proximal femoral nail application.Joint diseases and related surgery · 2025Article
- Biomechanical evaluation of the triangular support structure of the proximal femoral bionic nail compared to conventional long intramedullary nails for subtrochanteric fractures.Frontiers in bioengineering and biotechnology · 2025Article
- Design innovation and rationale of the intramedullary implants for treating Intertrochanteric fractures: A review.Journal of clinical orthopaedics and trauma · 2024Article
- Does Fracture Severity of Intertrochanteric Fracture in Elderly Caused by Low-Energy Trauma Affected by Gluteus Muscle Volume?Hip & pelvis · 2022Article
- Article
- TFNA Implant Failure with Helical Blade Cut-out.Journal of orthopaedic case reports · 2020Article
- Biomechanical comparison of medial sustainable nail and proximal femoral nail antirotation in the treatment of an unstable intertrochanteric fracture.Bone & joint research · 2020Article
- Tip-apex distance and other predictors of outcome in cephalomedullary nailing of unstable trochanteric fractures.Journal of clinical orthopaedics and trauma · 2019Article
- Disengagement and intrapelvic migration of a dynamic helical hip screw.Radiology case reports · 2019Article
- Fragility fractures of the proximal femur: review and update for radiologists.Skeletal radiology · 2019Review
- "Revision of subtrochanteric femoral nonunions after intramedullary nailing with dynamic condylar screw".BMC musculoskeletal disorders · 2018Article
- Z-effect after intramedullary nailing systems for trochanteric femur fractures.Chinese journal of traumatology = Zhonghua chuang shang za zhi · 2017Article
- Role of Provisional Fixation of Fracture Fragments By Steinmann-Pin and Technical Tips in Proximal Femoral Nailing for Intertrochanteric Fracture.Journal of clinical and diagnostic research : JCDR · 2017Article
- Biomechanical Evaluation of Four Methods for Internal Fixation of Comminuted Subtrochanteric Fractures.Medicine · 2016Article
- Intertrochanteric fractures: a review of fixation methods.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2016Review
- [Pertrochanteric femoral fractures in the elderly].Der Unfallchirurg · 2015Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundZ-effect and reverse Z-effect are complications that arise from the surgical treatment of pertrochanteric fractures of the femur with proximal femoral nails (PFN) comprising two interlocking head screws. Such complications are induced by the migration of screws in opposite directions, which may lead to failure of the osteosynthesis.
findingsThe paper describes three cases of pertrochanteric fractures that were treated with PFN with two interlocking screws that evolved to either Z-effect or reverse Z-effect. Literature-based explanations for this phenomenon are provided together with recommendations of how to avoid such complications.
conclusionsAlthough intramedullary fixation is an established method of treatment of femoral intertrochanteric and subtrochanteric fractures, the evolution of the procedure may include complications associated with the migration of the interlocking head screws. The occurrence of Z-effect and reverse Z-effect has not been completely elucidated, but the main causes of such complications are probably fracture fixation in varus position, severe medial comminution, inappropriate entry point of the nail and poor bone quality.
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.