{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T06:43:42Z","timestamp":1787985822152,"version":"build-2784847793"},"reference-count":48,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2020,10,20]],"date-time":"2020-10-20T00:00:00Z","timestamp":1603152000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Surgery"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>At present, cephalomedullary nail is the most frequently used implant in the management of intertrochanteric fractures around the world. The implant design and fixation techniques of the cephalomedullary nail have been continuously improved to ensure uncomplicated bone union during the past decade. However, a degree of reduction loss during bone healing is still not rare in clinical work. Many attributed this complication to misoperation during the surgery and hold that a series of techniques and tips could help to avoid the loss of reduction. However, until now there has been no research to explore whether the reduction loss after the operation can be fully prevented in the best cases. The purposes of the study are as follows: (i) to evaluate the efficiency of the current established CMN techniques; (ii) to quantify the loss of reduction under an appropriately implanted CMN to anatomically realigned intertrochanteric fractures; and (iii) to explore the possible underlying causes for the inevitable loss of reduction.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In the retrospective study, 163 consecutive cases with the intertrochanteric fractures fixed with standard cephalomedullary nail technique were reviewed. The anatomical reduction and optimal positioning of the nail were confirmed by postoperative imaging. The fracture types ranged from 31\u2010A1.1\u20132.3 according to the OTA\/AO fracture classification. One hundred and fifteen cases with stable fracture types (31A1.1\u20132.1) were allocated to Group A, and 48 cases with unstable 31A2.2\u20132.3 fracture types were allocated to Group B. The radiological measurements included femoral neck shortening, loss of the neck\u2010shaft angle, cutout, and cut\u2010through of the blade. The outcomes between postoperative and 1\u2009year after the operation were evaluated and compared.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The patients consisted of 66 males and 97 females with an average age of 69.4 (range: 46\u201378, SD: 14.6) years. At the 1\u2010year follow\u2010up, no fixation failure or nonunion was observed in each group. The mean femoral neck shortening and loss of the neck\u2010shaft angle were 4.47\u2009mm (range: 0.43\u201317.68, SD: 3.71) and 5.4\u00b0 (range: 0.51\u201319.10, SD: 3.58) separately. The mean cutout and cut\u2010through were 1.84\u2009mm (range: 0.24\u201311.30, SD: 2.33) and 1.25\u2009mm (range: 0.51\u201310.29, SD: 1.74). The average femoral neck shortening and loss of the neck\u2010shaft angle were higher in Group B than Group A. Among the 23 cases with the femoral neck shortening more than 10\u2009mm, 19 cases (16.5%) were from Group A and four cases (8.3%) were from Group B. There were nine (7.8%) cases with the loss of the neck\u2010shaft angle more than 10\u00b0 in Group A and six (12.5%) cases in Group B.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Current established CMN techniques are efficient in treating intertrochanteric femoral fracture. However, even with currently consensual techniques of cephalomedullary nail, the process of fracture healing still risks the loss of reduction, although the migration of the blade could be minimized. This situation may associate with the intrinsic design of the CMN and further improvement is still needed.<\/jats:p><\/jats:sec>","DOI":"10.1111\/os.12828","type":"journal-article","created":{"date-parts":[[2020,10,21]],"date-time":"2020-10-21T03:13:14Z","timestamp":1603249994000},"page":"1998-2003","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Loss of Reduction after Cephalomedullary Nail Fixation of Intertrochanteric Femoral Fracture: A Brief Report"],"prefix":"10.1111","volume":"12","author":[{"given":"Yao","family":"Pang","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery Hangzhou Hospital Affiliated to Nanjing Medical University (Hangzhou First People's Hospital)  Nanjing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0301-1832","authenticated-orcid":false,"given":"Qi\u2010fang","family":"He","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Hangzhou Hospital Affiliated to Nanjing Medical University (Hangzhou First People's Hospital)  Nanjing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liu\u2010long","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Hangzhou First People's Hospital  Hangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhen\u2010yu","family":"Bian","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Hangzhou First People's Hospital  Hangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mao\u2010qiang","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Hangzhou First People's Hospital  Hangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,10,20]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF01623184"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2018.01.029"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-010-1263-2"},{"key":"e_1_2_7_5_1","doi-asserted-by":"crossref","first-page":"67","DOI":"10.5812\/traumamon.10436","article-title":"Fixation of intertrochanteric fractures: dynamic hip screw versus locking compression plate","volume":"18","author":"Mardani\u2010Kivi M","year":"2013","journal-title":"Trauma Mon"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/os.12512"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00590-017-1964-2"},{"key":"e_1_2_7_8_1","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1177\/0954411914568693","article-title":"Sliding of the load carrier in third\u2010generation intramedullary nails for proximal femur fractures: an in vitro mechanical comparison study","volume":"229","author":"Konstantinidis L","year":"2015","journal-title":"Proc Inst Mech Eng H"},{"key":"e_1_2_7_9_1","first-page":"1","article-title":"PFNA vs. DHS helical blade for elderly patients with osteoporotic femoral intertrochanteric fractures","volume":"22","author":"Li H","year":"2018","journal-title":"Eur Rev Med Pharmacol Sci"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otsr.2014.07.023"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.99B1.BJJ-2016-0134.R1"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.bot.0000151819.95075.ad"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/os.12396"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/00003086-200208000-00024"},{"key":"e_1_2_7_15_1","first-page":"824","article-title":"Comparison of PFNA and DHS for the treatment of elderly unstable intertrochanteric fractures of femur","volume":"32","author":"Lu JF","year":"2019","journal-title":"Zhongguo Gu Shang"},{"key":"e_1_2_7_16_1","first-page":"306","article-title":"Unstable pertrochanteric femur fractures. 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