ArticleJournal of orthopaedic surgery and research2022
Low filling ratio of the distal nail segment to the medullary canal is a risk factor for loss of anteromedial cortical support: a case control study.
Article in Journal of orthopaedic surgery and research, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 1 of them a synthesis that pooled it.
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16 citing papers in PubMed, 1 synthesis or guideline pooled it, 15 citations in OpenAlex.
- Implants for fixation of intertrochanteric femoral fracture: a systematic review and network meta-analysis of randomized controlled trials.BMC musculoskeletal disorders · 2025Pooled it
- Association of Long Versus Standard-Length Cephalomedullary Nail Constructs with Posterior Sagging in Intertrochanteric Fractures with Posteromedial Comminution: A Retrospective Comparative Study.Journal of clinical medicine · 2026Article
- From classification to anteromedial cortical contact: an integrative review of the Japanese and international literature on trochanteric fracture reduction and fixation.International orthopaedics · 2026Review
- Impact of limited intramedullary reaming versus unreamed technique in short proximal femoral nail anti-rotation for intertrochanteric fractures: a matched retrospective study.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2026Article
- Effect of intramedullary nail length on the biomechanical performance of internal fixation for subtrochanteric femoral fractures.BMC musculoskeletal disorders · 2026Article
- The Femoral Neck-Shaft Offset: A Key Element in the Reconstruction of Intertrochanteric Fracture.Orthopaedic surgery · 2025Article
- Anterior Redisplacement After Intramedullary Nail Fixation for Trochanteric Femoral Fractures: Incidence and Risk Factors in 598 Older Patients.Journal of clinical medicine · 2025Article
- Incidence, Impact, and Complications of Short Cephalomedullary Nail Toggling in Patients with Wide Femoral Medullary Canal.Journal of clinical medicine · 2025Article
- Risk factors of excessive sliding in elderly patients with intertrochanteric fractures treated with PFNA-II: a retrospective observational study.BMC musculoskeletal disorders · 2025Observational
- [Characteristics of posterior coronal banana-shaped fragments and its research progress in treatment of intertrochanteric femoral fracture with cephalomedullary nail].Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery · 2024Review
- [Research progress on distal interlocking screws of cephalomedullary nails in intertrochanteric fractures].Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery · 2024Article
- Biomechanical evaluation of three implants for treating unstable femoral intertrochanteric fractures: finite element analysis in axial, bending and torsion loads.Frontiers in bioengineering and biotechnology · 2023Article
- Finite-Element Analysis of a Novel Cephalomedullary Nail for Restricted Sliding to Reduce Risk of Implant Failure in Unstable Intertrochanteric Fractures.Orthopaedic surgery · 2022Article
- [Proposal of a novel comprehensive classification for femoral intertrochanteric fractures].Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery · 2022Review
- A sophisticated fracture classification system of the proximal femur trochanteric region (AO/OTA-31A) based on 3D-CT images.Frontiers in surgery · 2022Article
- What is the importance of distal nail diameter in the treatment of intertrochanteric femur fractures?Joint diseases and related surgery · 2022Article
Corrections and comments
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Authors and funding
4 authors at 1 institution in 1 country.
Funding
Abstract
backgroundAnteromedial cortical support apposition (positive and/or neutral cortical relations) is crucial for surgical stability reconstruction in the treatment of trochanteric femur fractures. However, the loss of fracture reduction is frequent in follow-ups after cephalomedullary nail fixation. This paper aimed to investigate the possible predictive risk factors for postoperative loss of anteromedial cortex buttress after nail fixation.
methodsA retrospective analysis of 122 patients with AO/OTA 31A1 and A2 trochanteric femur fractures treated with cephalomedullary nails between January 2017 and December 2019 was performed. The patients were classified into two groups according to the postoperative status of the anteromedial cortical apposition in 3D CT images: Group 1 with contact "yes" (positive or anatomic) and Group 2 with contact "No" (negative, loss of contact). The fracture reduction quality score, tip-apex distance (TAD), calcar-referenced TAD (Cal-TAD), Parker ratio, neck-shaft angle (NSA), and the filling ratio of the distal nail segment to medullary canal diameter in anteroposterior (AP) and lateral fluoroscopies (taken immediately after the operation) were examined in univariate and multivariate analyses. Mechanical complications were measured and compared in follow-up radiographs.
resultsAccording to the postoperative 3D CT, 84 individuals (69%) were categorized into Group 1, and 38 individuals (31%) were classified as Group 2. The multivariate logistic regression analysis showed that the poor fracture reduction quality score (P < 0.001) and decreasing filling ratio in the lateral view (P < 0.001) were significant risk factors for the loss of anteromedial cortical contact. The threshold value for the distal nail filling ratio in lateral fluoroscopy predicting fracture reduction re-displacement was found to be 53%, with 89.3% sensitivity and 78.9% specificity. The mechanical complication (varus and over lateral sliding) rate was higher in Group 2.
conclusionsThe fracture reduction quality score and the decreasing filling ratio of the distal nail to the medullary canal in the lateral view (a novel parameter causing pendulum-like movement of the nail) were possible risk factors for postoperative loss of anteromedial cortical support.
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