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Open Access 01-12-2011 | Short report

Failure of fixation of trochanteric femur fractures: Clinical recommendations for avoiding Z-effect and reverse Z-effect type complications

Authors: Robinson Esteves Santos Pires, Egídio Oliveira Santana Júnior, Leandro Emílio Nascimento Santos, Vincenzo Giordano, Daniel Balbachevsky, Fernando Baldy dos Reis

Published in: Patient Safety in Surgery | Issue 1/2011

Abstract

Background

Z-effect and reverse Z-effect are complications that arise from the surgical treatment of pertrochanteric fractures of the femur with proximal femoral nails (PFN) comprising two interlocking head screws. Such complications are induced by the migration of screws in opposite directions, which may lead to failure of the osteosynthesis.

Findings

The paper describes three cases of pertrochanteric fractures that were treated with PFN with two interlocking screws that evolved to either Z-effect or reverse Z-effect. Literature-based explanations for this phenomenon are provided together with recommendations of how to avoid such complications.

Conclusions

Although intramedullary fixation is an established method of treatment of femoral intertrochanteric and subtrochanteric fractures, the evolution of the procedure may include complications associated with the migration of the interlocking head screws. The occurrence of Z-effect and reverse Z-effect has not been completely elucidated, but the main causes of such complications are probably fracture fixation in varus position, severe medial comminution, inappropriate entry point of the nail and poor bone quality.

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Brunner A, Jöckel JA, Babst R: The PFNA proximal femoral nail in treatment of unstable proximal femur fractures - 3 cases of postoperative perforation of the helical blade into the hip joint. J Orthop Trauma. 2008, 22: 731-736. 10.1097/BOT.0b013e3181893b1b.CrossRefPubMed

Guimarães JAM, Guimarães ACA, Franco JS: Avaliação do emprego da haste femoral curta na fratura transtrocantérica instável do fêmur. Rev Bras Ortop. 2008, 43: 406-417.

Tyllianakis M, Panagopoulos A, Papadopoulos A, Papasmos S, Mousafiris : Treatment of extracapsular hip fractures with the proximal femoral nail (PFN): Long term results in 45 patients. Acta Orthop Belg. 2004, 70: 444-454.PubMed

Rethnam U, Cordell-Smith J, Kumar TM, Simha A: Complex proximal femoral fractures in the elderly managed by reconstruction nailing - complications and outcomes: a retrospective analysis. J Trauma Manag Outcomes. 2007, 1 (7): 1-7.

Davis TRC, Sher JL, Horsman A, Simpson M, Porter BB, Checketts RG: Intertrochanteric femoral fractures. Mechanical failure after internal fixation. J Bone Joint Surgery Br. 1990, 72: 26-31.

Heinz T, Vecsei V: Complications and errors in use of the gamma nail. Causes and prevention. Chirurg. 1994, 65: 943-952.PubMed

Megas P, Kaisidis A, Zouboulis P, Papas M, Panagopoulos A, Lambiris E: Comparative study of the treatment of pertrochanteric fractures - Trochanteric gamma nail vs. proximal femoral nail. Z Orthop Ihre Grenzgeb. 2005, 143: 252-257. 10.1055/s-2005-836453.CrossRefPubMed

Alvarez DB, Aparício JP, Fernandez ELA, Múgica IGB, Batalla DN, Jiménez JP: Implant breakage, a rare complication with gamma nail. A review of 843 fractures of the proximal femur treated with gamma nail. Acta Orthop Belg. 2004, 70: 435-443.PubMed

Werner-Tutschku W, Lajtai G, Schmiedhuber G, Lang G, Pirkl C, Orthner E: Intra-und perioperative Komplikationen bei der Stabilisierung von per-und subtrochantären Femurfrakturen mittels PFN. Unfallchirurg. 2002, 105: 881-885. 10.1007/s00113-002-0416-5.CrossRefPubMed

10.

Strauss EJ, Kummer FJ, Koval KJ, Egol KA: The "Z-effect" phenomenon defined: a laboratory study. J Orthop Res. 2007, 25: 1568-1573. 10.1002/jor.20457.CrossRefPubMed

11.

Al-yassari G, Langstaff RJ, Jones JW, Al-Lami M: The AO/ASIF proximal femoral nail (PFN) for the treatment of unstable trochanteric femoral fracture. Injury. 2002, 33: 395-399. 10.1016/S0020-1383(02)00008-6.CrossRefPubMed

Title: Failure of fixation of trochanteric femur fractures: Clinical recommendations for avoiding Z-effect and reverse Z-effect type complications
Authors: Robinson Esteves Santos Pires
Egídio Oliveira Santana Júnior
Leandro Emílio Nascimento Santos
Vincenzo Giordano
Daniel Balbachevsky
Fernando Baldy dos Reis
Publication date: 01-12-2011
Publisher: BioMed Central
Published in: Patient Safety in Surgery / Issue 1/2011
Electronic ISSN: 1754-9493
DOI: https://doi.org/10.1186/1754-9493-5-17

Keynote webinar | Spotlight on sleep in brain health

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Failure of fixation of trochanteric femur fractures: Clinical recommendations for avoiding Z-effect and reverse Z-effect type complications

Abstract

Background

Findings

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Findings

Conclusions

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