Clin Orthop Surg.  2015 Jun;7(2):152-157. 10.4055/cios.2015.7.2.152.

Accurate and Easy Measurement of Sliding Distance of Intramedullary Nail in Trochanteric Fracture

• Chinzei N
• Hiranaka T
• Niikura T
• Fujishiro
• Hayashi S
• Kanzaki N
• Hashimoto
• Sakai Y
• Kuroda R
• Kurosaka M

• KMID: 2164538
• DOI: http://doi.org/10.4055/cios.2015.7.2.152

Abstract

BACKGROUND
In daily clinical practice, it is essential to properly evaluate the postoperative sliding distance of various femoral head fixation devices (HFD) for trochanteric fractures. Although it is necessary to develop an accurate and reproducible method that is unaffected by inconsistent postoperative limb position on radiography, few studies have examined which method is optimal. Therefore, the purpose of this study is to prospectively compare the accuracy and reproducibility of our four original methods in the measurement of sliding distance of the HFD.
METHODS
Radiographs of plastic simulated bone implanted with Japanese proximal femoral nail antirotation were taken in five limb postures: neutral, flexion, minute internal rotation, greater external rotation, and flexion with external rotation. Orthopedic surgeons performed five measurements of the sliding distance of the HFD in each of the flowing four methods: nail axis reference (NAR), modified NAR, inner edge reference, and nail tip reference. We also assessed two clinical cases by using these methods and evaluated the intraclass correlation coefficients.
RESULTS
The measured values were consistent in the NAR method regardless of limb posture, with an even smaller error when using the modified NAR method. The standard deviation (SD) was high in the nail tip reference method and extremely low in the modified NAR method. In the two clinical cases, the SD was the lowest in the modified NAR method, similar to the results using plastic simulated bone. The intraclass correlation coefficients showed the highest value in the modified NAR method.
CONCLUSIONS
We conclude that the modified NAR method should be the most recommended based on its accuracy, reproducibility, and usefulness.

Keyword

Hip fractures; Radiography; Intramedullary nailing

MeSH Terms

*Bone Nails
*Dimensional Measurement Accuracy
Fracture Fixation, Intramedullary/instrumentation/*methods
Hip Fractures/*surgery
Prospective Studies
Reproducibility of Results

Figure

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  Fig. 1 Plastic simulated bone after Japanese proximal femoral nail antirotation implantation.

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  Fig. 2 Radiographs showing five postures of intramedullary nailing: (A) neutral, (B) flexion, (C) minute internal rotation, (D) greater external rotation, and (E) flexion with external rotation.

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  Fig. 3 Methods for measurement of sliding distance. A: tip of head fixation device (HFD), B: base of HFD, C: intersection of proximal nail axis and AB, D: intersection of inner edge of nail and AB, E: intersection of proximal edge of nail and AB, P: intersection of inner edge of nail and lower edge of HFD, Q: intersection of outer edge of nail and upper edge of HFD, C': intersection of PQ and AB.

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  Fig. 4 Methods for measurement of sliding distance in detail. (A) Measurement of sliding distance by nail axis reference. Tip length of head fixation device (TLH) was defined as AC / AB × real head fixation device (HFD) length. (B) Measurement of sliding distance by modified nail axis reference. TLH was defined as AC' / AB × real HFD length. (C) Measurement of sliding distance by inner edge reference. TLH was defined as AD / AB × real HFD length. (D) Measurement of sliding distance by nail tip reference. TLH was defined as AE / AB × real HFD length.

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