ReviewEFORT open reviews2026
Considerations for removal of cephalomedullary screws and blades following intertrochanteric femoral fracture healing: a narrative review.
Review in EFORT open reviews, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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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.
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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.
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Who cites it
0 citing papers in PubMed.
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Authors and funding
2 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: Cephalomedullary fixation using intramedullary nails combined with proximal lag screws or helical blades is widely accepted as the standard surgical treatment for unstable intertrochanteric femoral fractures. Although fracture union is reliably achieved in most patients, management of retained implants after healing remains controversial. Despite limited evidence supporting clinical benefit, elective implant removal continues to be performed in routine practice. Purpose: This review synthesizes biomechanical, clinical, and health-economic evidence regarding the removal of cephalomedullary screws and helical blades after intertrochanteric fracture union. Particular emphasis is placed on mechanism-based structural failure, femoral head collapse, and age-dependent risk-benefit profiles. Methods: A narrative literature review was conducted, incorporating biomechanical experiments, finite-element analyses, cadaveric studies, clinical case series, cohort studies, registry-based investigations, and health-economic analyses related to implant removal after intertrochanteric fracture fixation. Results: Removal of proximal cephalic components produces a residual bone defect within the femoral head and neck, resulting in stress concentration and reduced structural integrity. Clinical studies report femoral neck fracture, varus collapse, and femoral head insufficiency, often occurring shortly after removal and frequently without significant trauma. These complications disproportionately affect elderly patients with osteoporotic bone. In contrast, symptomatic improvement after implant removal, particularly pain relief, is inconsistent and unpredictable. Conclusion: Routine removal of cephalomedullary screws or helical blades after intertrochanteric fracture union is not supported by current evidence. Implant retention should be considered the default strategy, particularly in elderly patients, while selective removal may be considered only in carefully selected younger individuals with preserved bone quality and clear indications.
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