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

PURPOSE: 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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.