Radiographic predictors of symptomatic screw removal after retrograde femoral nail insertion |
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| Institution: | 1. GRESPI/Thermomécanique, Université de Reims Champagne-Ardenne, Moulin de la Housse, BP 1039, 51687 Reims Cedex 2, France;2. CAMPA, route de Soissons, 51170 Fismes, France;3. LIMSI, CNRS, Université Paris-Saclay, Rue John Von Neumann, 91400 Orsay, France;4. Sorbonne Universités, UPMC Univ Paris 06, UFR d''Ingéniérie, 4 place Jussieu, 75005 Paris, France;1. Fondren Orthopedic Group, Texas Orthopedic Hospital, Houston, TX, USA;2. Laboratory of Integrated Physiology, University of Houston, Houston, TX, USA;1. University of California, Irvine, 101 The City Drive South Building 29A, Pavilion III – 2nd Floor Orange, Irvine, Orange, CA 92868, USA;2. University of Pennsylvania, Philadelphia, PA USA;1. Department of Orthopedic Surgery, Kurume University Medical Center, Fukuoka, Japan;2. Department of Orthopedic Surgery, Kurume University, Fukuoka, Japan;3. Division of Microscopic and Developmental Anatomy, Department of Anatomy, School of Medicine, Kurume University, Fukuoka, Japan;1. Department of Orthopedics, ChengDu Military General Hospital, 270 Tianhui Rd, Rongdu Ave., ChengDu 610083, People''s Republic of China;2. Pharmacy Department, Research Center, ChengDu Military General Hospital, 270 Tianhui Rd, Rongdu Ave., ChengDu 610083, People''s Republic of China;3. Department of Orthopedics, Spine Tumor Center, ChangZheng Hospital, Second Military Medical University, 415 Fengyang Rd, Shanghai 200003, People''s Republic of China;1. Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom;2. Royal National Throat, Nose and Ear Hospital, London, United Kingdom;3. Victor Horsley Department of Neurosurgery, National Hospital for Neurology & Neurosurgery, London, United Kingdom |
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| Abstract: | IntroductionRemoval of symptomatic implants is a common procedure performed by orthopaedic trauma surgeons. No guidance is available regarding which factors contribute to the likelihood of an implant becoming symptomatic. Our objective was to determine whether radiographic parameters associated with distal interlocks in retrograde femoral nails are associated with the rate of symptomatic screw removal.Patients and methodsWe conducted a retrospective review at a Level I trauma center. Study patients (n = 442) had femoral fractures treated with retrograde intramedullary nails from 2007 to 2014 and at least 1 year of follow-up. The main outcome measurement was symptomatic distal screw removal as predicted by radiographic parameters.ResultsSymptomatic screw removal occurred in 12% of the patients. Increased distance between the most distal screw and the articular surface of the femur significantly reduced likelihood of symptomatic screw removal. A cutoff of 40 mm from the articular block was predictive of removal (≥40 mm, 0% removal; <40 mm, 18% removal, p < 0.0001). In patients with distal screws placed within 40 mm of the articular surface of the femur, a ratio of screw length to distance between medial and lateral femoral cortices that was ≥1 was a strong predictor of symptomatic screw removal (area under Receiver Operating Characteristic curve, 0.75; p < 0.0001).ConclusionsMore distal screws and screws that radiographically extend to or beyond the medial cortex are more likely to cause pain and require removal in femoral fractures treated with retrograde intramedullary nails. We identified a specific distance from the joint (<40 mm) and a ratio of screw length to bone width (≥1) that significantly increased the likelihood of symptomatic screw removal. Clinicians can use these data to inform patients of the likely risk of implant removal and perhaps to better guide placement and length of screws when the clinical scenario allows some flexibility in location and length of screws. |
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| Keywords: | Retrograde femoral nail Symptomatic screw removal Distal screws Medial cortex |
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