Retrospective study of mechanical complications after cephalomedullary nail implantation from 2019 to 2024 following per-, sub- or intertrochanteric femur fractures

TL;DR

This study examines mechanical complications after a common hip fracture surgery and finds that precise implant placement and blood management can reduce risks.

Contribution

The study identifies specific predictors of mechanical complications after cephalomedullary nail implantation for femur fractures.

Findings

Mechanical complications occurred in 7% of patients after CMN implantation.

Increased tip-apex distance (TAD) and younger age were significant predictors of complications.

Postoperative blood transfusion requirements also correlated with higher complication risks.

Abstract

Cephalomedullary nail (CMN) fixation is commonly used to treat extracapsular femoral fractures but is associated with mechanical complications, including implant cut-out, cut-in, and material failure. Identifying clinical and radiographic predictors of these complications is critical for improving patient outcomes.

This retrospective cohort study analyzed 401 patients treated with CMN for per-, sub-, or intertrochanteric fractures between 2019 and 2024. Clinical, laboratory, and radiographic parameters were evaluated using logistic regression analyses to identify predictors of mechanical complications.

Mechanical complications occurred in 7% (n = 28) of patients. The most common complications were cut-out (n = 16, 57%) and cut-in (n = 7, 25%). Significant predictors included increased tip-apex distance (TAD), younger patient age, and the requirement for postoperative blood transfusions. A TAD greater than 37.2 mm substantially elevated the risk of complications.

Mechanical complications after CMN implantation can be significantly reduced by precise implant placement to minimize TAD and careful perioperative management of hemoglobin levels. Implementing these findings into clinical practice can potentially improve surgical outcomes and reduce patient morbidity.

The online version contains supplementary material available at 10.1007/s00402-026-06257-9.

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