Successful Revision with INTERTAN for a Blade Cut Through in PFNA Fixation: A Case Report. Issue 3 (29th January 2023)

• Record Type: Journal Article
• Authors: Zhang, Hengyan; Mu, Xuemeng; Zhang, Jia
• Is Part Of: Orthopaedic surgery. Volume 15:Issue 3(2023)
• Page Start: 906
• Page End: 911
• Publication Date: 2023-01-29
• Subjects: Implant cut‐through -- INTERTAN -- PFNA‐II -- Revision; Orthopedic surgery -- Periodicals; Orthopedics -- Periodicals; Musculoskeletal system -- Wounds and injuries -- Periodicals; 617.47005
• DOI: 10.1111/os.13656
• Languages: English
• ISSNs: 1757-7853

Abstract

Abstract : Background: Implant cut‐out or cut‐through remains a common cause of cephalomedullary nail failure and patient morbidity following surgical treatment of intertrochanteric femur fractures. In patients not suitable for conversion to total hip arthroplasty, which can involve long operation times and substantial blood loss, as well as a higher risk of periprosthetic fracture and dislocation postoperatively, revision with another internal fixation is an alternative option. If the femoral head can be preserved as much as possible to avoid eventual joint replacement while the internal fixation failure is solved, the quality of life of patients will be significantly improved. Case Presentation: This current case describes a successful clinical use of a salvage procedure that allows the surgeon to avoid joint arthroplasty using INTERTAN to solve internal fixation failure caused by cut‐through of Proximal Femoral Nail Antirotation‐II (PFNA‐II). Four years after closed reduction and internal fixation of the right femur, the patient had immobilizing right hip pain and mobility disorder. X‐ray examination revealed contraction of the neck of the right femur and cut‐through of the helical blade of the PFNA‐II. After the revision operation, he recovered well and presented no grown pain or discomfort in weight‐bearing. Conventional radiographs at 1‐year follow‐up showed a healed fracture, with no implant migration. Conclusion: Main nail exchange and revision with INTERTAN can be considered a salvage procedure in selected cases to revise a failed fixation with PFNA, which solves internal fixation failure as well as preserves the femoral head. Abstract : Implant cut‐through remains a common cause of patient morbidity following surgical treatment of intertrochanteric femur fractures. Total hip arthroplasty, the most common revision method, may face high risk of periprosthetic fracture and dislocation postoperatively. Main nail exchange and revision with INTERTAN can be considered a salvage procedure in selected cases to revise a failed fixation with PFNA, which solved internal fixation failure as well as preserved the femoral head.