# The accumulation of technical errors exponentially increases the risk of screw cut-out in femoral intramedullary nailing

## TL;DR

This study shows that small technical errors during femoral nailing can greatly increase the risk of screw failure in elderly patients with hip fractures.

## Contribution

The study identifies how the accumulation of technical errors increases the risk of screw cut-out in femoral nailing.

## Key findings

- A 5.6% mechanical failure rate was observed in patients undergoing short trochanteric intramedullary nailing.
- Anterior screw position, tip-apex distance >25 mm, and intra-focal entry point were linked to screw cut-out.
- Accumulation of technical errors significantly increases the risk of osteosynthesis failure.

## Abstract

Proximal femur fractures primarily affect the elderly, with significant morbidity, mortality, and socioeconomic impact. The main complication of short trochanteric intramedullary nailing is the cut-out of the cervicocapital screw through the femoral head. The objective of this study was to analyze the influence of technical errors in short trochanteric intramedullary nailing for the treatment of trochanteric femur fractures on the mechanical failure of osteosynthesis.

A total of 540 patients who underwent surgery for a trochanteric femur fracture using short trochanteric intramedullary nailing were included in a single-center, retrospective study conducted between February 2012 and July 2018.

Thirty patients (5.6%) experienced mechanical failure of the osteosynthesis at the 3-month follow-up. An anterior position of the cervicocapital screw, accumulation of technical errors, a tip-apex distance > 25 mm, and an intra-focal entry point were significantly associated with cervicocapital screw cut-out.

The mechanical failure rate is 5.6%. Short trochanteric intramedullary nailing requires precise execution to reduce the risk of cervicocapital screw cut-out, which is a source of osteosynthesis failure.