title: Backout of the helical blade of proximal femoral nail antirotation and accompanying fracture nonunion.
abstract: This article describes a case of backout of the helical blade, a rare complication of proximal femoral nail antirotation. A 31-year-old man had sustained a trochanteric fracture of his right femur. Fracture fixation using proximal femoral nail antirotation and autologous bone grafting 7 months later were performed at another hospital. However, bony union was not obtained, and the patient's pain and limp persisted. Therefore, he presented to the current authors. A radiograph taken at presentation revealed backout of the helical blade and fracture nonunion. A radiograph taken 1 month later showed a more advanced backout of the helical blade. The authors performed exchange nailing supplemented with transplantation of peripheral blood CD34-positive cells and autologous bone grafting. The proximal femoral nail antirotation was revised to a long gamma 3 nail, and a U-lag screw was used to obtain better stability. The postoperative course was uneventful. The patient regained ambulation without pain or support at 12 weeks postoperatively. Radiographic bony union was completed 9 months postoperatively. At 1-year follow-up, he could run and stand on the previously injured leg and had returned to work. Backout of the helical blade should be considered as a possible complication of proximal femoral nail antirotation. Incomplete fixation of the helical blade is the possible reason for backout. The use of a helical blade in young patients may cause difficulty in insertion and result in incomplete fixation.
authors.affiliation: Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan. tniikura@med.kobe-u.ac.jp
authors.forename: Takahiro
authors.initials: T
authors.lastname: Niikura
authors.forename: Sang Yang
authors.initials: SY
authors.lastname: Lee
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Matsumoto
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Fukui
authors.forename: Yohei
authors.initials: Y
authors.lastname: Kawakami
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Akisue
authors.forename: Ryosuke
authors.initials: R
authors.lastname: Kuroda
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kurosaka
mesh_terms: D000328:Adult; D018952:Antigens, CD34 / Q000276:immunology; D001858:Bone Nails / Q000009:adverse effects*; D016025:Bone Transplantation; D018450:Disease Progression; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects* / Q000295:instrumentation*; D017102:Fracture Healing; D005599:Fractures, Ununited / Q000209:etiology / Q000601:surgery* / Q000628:therapy; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D006931:Hyperbaric Oxygenation; D007963:Leukocytes, Mononuclear / Q000276:immunology / Q000637:transplantation; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation; D014464:Ultrasonic Therapy
chemical_list: D018952:Antigens, CD34