Abstract
Objectives: Due to ongoing concern about femur anatomy-implant mismatches, this cross-sectional study aimed to create a geometric femur profile and used it to identify and quantify possible mismatches between femur anatomy and cephalomedullary nail dimensions. The work further aimed to assess whether patient demographics affect anatomy-implant coherence. Methods: One hundred skeletally mature complete femur computer tomography (CT) scans were collected and exported to software enabling landmark placement and measures with multiplanar reconstruction techniques. Results: Clinically relevant anatomy-implant discrepancies included the femur neck and shaft axis offset 6.1 ± 1.7 mm (95% CI [5.7–6.4]), femur radius of curvature 1.2 ± 0.3 m (95% CI [1.1–1.2]), femur anteversion 18.8 ± 9.2 (95% CI [16.9–20.6]). The implants reviewed in this study did not compensate for the femur neck and shaft axis offset and had a larger radius of curvature than the studied population. Clinically significant demographic geometry differences were not identified. Conclusion: There were discrepancies between femur anatomy and cephalomedullary nail implant design; however, no clinically significant femur feature inconsistency was identified among the demographic subgroups. Due to the identified anatomy-implant discrepancies, including the femur neck and shaft axis offset, we suggest that these measurements be considered for future implant design and surgical technique.
Highlights
Proximal femur fracture incidence rises due to aging populations and increased trauma events [1, 2]
Sampled cephalomedullary nail (CMN) lag screw length ranged from 75 to 130 mm and encompassed the measured femur neck axis length of 94.1 mm ± 7.4
This study identified that the femur neck and shaft axis offset (FNSAO), the radius of curvature, and femoral anteversion did not overlap the ranges offered by the sampled CMNs
Summary
Proximal femur fracture incidence rises due to aging populations and increased trauma events [1, 2]. Reconstruction of proximal femur anatomy and accurate implant placement remains paramount to negate fixation failure [3, 4]. Contemporary cephalomedullary nail (CMN) designs rely on the concept of anatomy coherence and an intersecting femur shaft and neck axis for a secure fit between the nail and the cephalic lag screw [5, 6]. Despite the multiple intraoperative implant dimension choices, various discrepancies between anatomy and modern implants remain a challenge to successful surgery [3]. Recent computer tomography (CT) three-dimensional image interpretation techniques have facilitated recognition and anticipation of complex anatomy-implant mismatches [7]. Such studies have generally compared measurement methods or investigated a single measurement rather than exploring the interplay of dimensions that impact fixation [3, 7]
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