Inaccuracy of the AO Expert Lateral Femoral Nail recon jig: A case series

Abstract

IntroductionIntra-medullary nail fixation is a standard treatment for many proximal femoral fractures. The AO Expert Lateral Femoral Nail (ELFN) is a typical example of such a device and uses a jig to assist the surgeon accurately place the proximal screws. We present a series of six cases where this jig allowed the screws to miss the nail. This serious complication can easily be missed even with intra-operative radiography. Our series highlights the need for accurate radiography and vigilance when using jigs in femoral nails. MethodsBetween November 2011 and August 2012, the AO ELFN was used for eleven patients in a level II trauma centre. In nine cases the indication was a subtrochanteric fracture with two cases of prophylactic nailing for metastatic disease.We retrospectively reviewed the notes of patients identified from our theatre register. Data recorded included – mechanism of injury, indication, grade of operating surgeon and whether or not there was consultant supervision. The radiographic records were also assessed. The cases included seven different surgeons with four different consultants present. More than one ELFN jig was used. ResultsThe Aiming arm for the proximal (recon) screws was found to have missed the nail in six cases (54.5%). All of these cases were discovered during intra-operative radiography. This inaccuracy was only visible on true lateral X-ray screening. AP radiographs appeared normal. ConclusionsIn our series the Aiming arm for the proximal screws of the ELFN was inaccurate in a high proportion of cases. This serious complication can easily be missed even by experienced surgeons. The operating surgeon must recognize the potential for jigs to be inaccurate even for proximal screws. Meticulous bi-planar imaging and experience with this particular implant are important for precise and safe insertion.