{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T04:06:14Z","timestamp":1793851574417,"version":"4.6.1"},"reference-count":28,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,11,17]],"date-time":"2021-11-17T00:00:00Z","timestamp":1637107200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,11,17]],"date-time":"2021-11-17T00:00:00Z","timestamp":1637107200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Orthop Surg Res"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Objective<\/jats:title>\n                <jats:p>To reveal noteworthy characteristics of intramedullary (IM) nail breakage in pertrochanteric femur fractures.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Materials and methods<\/jats:title>\n                <jats:p>The data from 6 patients with IM nail breakage in our hospital between August 2008 and May 2018 were reviewed retrospectively. With an additional 64 cases reported in articles in the PubMed database prior to October 2019, a total of 70 cases were reviewed and analysed; epidemiological patient data and data on the initial trauma, fracture type, nail selected for the original surgery, time from surgery to breakage, mechanism and location of breakage, status of fracture healing, salvage treatment and prognosis were assessed.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Seventy patients with pertrochanteric fractures, including 2 stable fractures and 68 unstable fractures, experienced IM nail breakage at a mean of 9.4\u00a0months after the initial surgery. Among them, 9 (12.9%) occurred within 3\u00a0months, 23 (32.9%) between 3 and 6\u00a0months and 38 (54.3%) after 6\u00a0months. The mean age was 72.3\u00a0years, and 16 (22.9%) patients were younger than 65\u00a0years old. When nail breakage occurred, 66 fractures (94.3%) exhibited delayed union\/non-union. Self-dynamisation was found in 12 cases (17.1%). The salvage procedures included 4 partial\/total implant removal procedures, 17 hemi\/total hip arthroplasty procedures, 3 conservative treatment procedures, and 46 revised osteosyntheses, of which 7 cases (15.2%) sustained secondary implant failure. No significant differences were found between the failure rates of IM nails and extramedullary(EM) devices (odds ratio [OR], 3.429; 95% confidence interval [CI], 0.632\u201318.877; <jats:italic>p<\/jats:italic>\u2009=\u20090.330).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>IM nail breakage is a rare complication lack of time regularity and mostly occurs in unstable pertrochanteric fractures in the presence of delayed union\/non-union. Osteosynthesis revision can be conduct by a new IM nail or EM device but considerable secondary failure rate is noteworthy. Self-dynamisation may be a warning sign of nail breakage.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s13018-021-02826-3","type":"journal-article","created":{"date-parts":[[2021,11,17]],"date-time":"2021-11-17T12:10:01Z","timestamp":1637151001000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Characteristics of intramedullary nail breakage in pertrochanteric femur fractures: a summary of 70 cases"],"prefix":"10.1186","volume":"16","author":[{"given":"Pengfei","family":"Li","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhishan","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fang","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Lv","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Guo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yun","family":"Tian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,11,17]]},"reference":[{"key":"2826_CR1","doi-asserted-by":"publisher","first-page":"2053","DOI":"10.1056\/NEJMcp1611090","volume":"377","author":"M Bhandari","year":"2017","unstructured":"Bhandari M, Swiontkowski M. Management of acute hip fracture. N Engl J Med. 2017;377:2053\u201362.","journal-title":"N Engl J Med"},{"key":"2826_CR2","doi-asserted-by":"publisher","first-page":"138","DOI":"10.5435\/JAAOS-D-14-00433","volume":"23","author":"KC Roberts","year":"2015","unstructured":"Roberts KC, Brox WT. AAOS clinical practice guideline: management of hip fractures in the elderly. J Am Acad Orthop Surg. 2015;23:138\u201340.","journal-title":"J Am Acad Orthop Surg"},{"key":"2826_CR3","first-page":"e108","volume":"39","author":"AF Mavrogenis","year":"2016","unstructured":"Mavrogenis AF, Panagopoulos GN, Megaloikonomos PD, Igoumenou VG, Galanopoulos I, Vottis CT, et al. Complications after hip nailing for fractures. Orthopedics. 2016;39:e108\u201316.","journal-title":"Orthopedics"},{"key":"2826_CR4","doi-asserted-by":"publisher","first-page":"804","DOI":"10.2106\/JBJS.18.00997","volume":"101","author":"A Lambers","year":"2019","unstructured":"Lambers A, Rieger B, Kop A, D\u2019Alessandro P, Yates P. Implant fracture analysis of the TFNA proximal femoral nail. J Bone Joint Surg Am. 2019;101:804\u201311.","journal-title":"J Bone Joint Surg Am"},{"key":"2826_CR5","first-page":"9580190","volume":"2018","author":"G Rollo","year":"2018","unstructured":"Rollo G, Rinonapoli G, Pichierri P, Bisaccia M, Caraffa A, Meccariello L. Breakage in two points of a short and undersized \u201caffixus\u201d cephalomedullary nail in a very active elderly female: a case report and review of the literature. Case Rep Orthop. 2018;2018:9580190.","journal-title":"Case Rep Orthop"},{"key":"2826_CR6","doi-asserted-by":"publisher","first-page":"S1","DOI":"10.1097\/00005131-200711101-00001","volume":"21","author":"JL Marsh","year":"2007","unstructured":"Marsh JL, Slongo TF, Agel J, Broderick JS, Creevey W, DeCoster TA, et al. Fracture and dislocation classification compendium\u20142007: orthopaedic trauma association classification, database and outcomes committee. J Orthop Trauma. 2007;21:S1-133.","journal-title":"J Orthop Trauma"},{"issue":"Suppl 2","key":"2826_CR7","doi-asserted-by":"publisher","first-page":"S44","DOI":"10.1016\/j.injury.2018.07.018","volume":"49","author":"J Tomas-Hernandez","year":"2018","unstructured":"Tomas-Hernandez J, Nunez-Camarena J, Teixidor-Serra J, Guerra-Farfan E, Selga J, Antonio Porcel J, et al. Salvage for intramedullary nailing breakage after operative treatment of trochanteric fractures. Injury. 2018;49(Suppl 2):S44-s50.","journal-title":"Injury"},{"key":"2826_CR8","doi-asserted-by":"publisher","first-page":"557","DOI":"10.1016\/j.injury.2016.12.014","volume":"48","author":"XL Zheng","year":"2017","unstructured":"Zheng XL, Park YC, Kim S, An H, Yang KH. Removal of a broken trigen intertan intertrochanteric antegrade nail. Injury. 2017;48:557\u20139.","journal-title":"Injury"},{"key":"2826_CR9","first-page":"57","volume":"23","author":"M Sbiyaa","year":"2016","unstructured":"Sbiyaa M, El Alaoui A, Admi M, Lahrach K, Marzouki A, Boutayeb F. Intertrochanteric fracture non-unions with implant failure of the gamma nail. Pan Afr Med J. 2016;23:57.","journal-title":"Pan Afr Med J"},{"key":"2826_CR10","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1007\/s00402-014-2121-6","volume":"135","author":"C von Ruden","year":"2015","unstructured":"von Ruden C, Hungerer S, Augat P, Trapp O, Buhren V, Hierholzer C. Breakage of cephalomedullary nailing in operative treatment of trochanteric and subtrochanteric femoral fractures. Arch Orthop Trauma Surg. 2015;135:179\u201385.","journal-title":"Arch Orthop Trauma Surg"},{"key":"2826_CR11","doi-asserted-by":"publisher","first-page":"729","DOI":"10.1016\/j.injury.2014.12.003","volume":"46","author":"M Cruz-Sanchez","year":"2015","unstructured":"Cruz-Sanchez M, Torres-Claramunt R, Alier-Fabrego A, Martinez-Diaz S. Salvage for nail breakage in femoral intramedullary nailing. Injury. 2015;46:729\u201333.","journal-title":"Injury"},{"key":"2826_CR12","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1007\/s10195-012-0183-1","volume":"14","author":"P Maniscalco","year":"2013","unstructured":"Maniscalco P, Rivera F, D\u2019Ascola J, Del Vecchio EO. Failure of intertrochanteric nailing due to distal nail jamming. J Orthop Traumatol. 2013;14:71\u20134.","journal-title":"J Orthop Traumatol"},{"key":"2826_CR13","first-page":"172352","volume":"2013","author":"T Iwakura","year":"2013","unstructured":"Iwakura T, Niikura T, Lee SY, Sakai Y, Nishida K, Kuroda R, et al. Breakage of a third generation gamma nail: a case report and review of the literature. Case Rep Orthop. 2013;2013:172352.","journal-title":"Case Rep Orthop"},{"issue":"Suppl 1","key":"2826_CR14","doi-asserted-by":"publisher","first-page":"S76","DOI":"10.1016\/S0020-1383(13)70017-2","volume":"44","author":"PV Giannoudis","year":"2013","unstructured":"Giannoudis PV, Ahmad MA, Mineo GV, Tosounidis TI, Calori GM, Kanakaris NK. Subtrochanteric fracture non-unions with implant failure managed with the \u201cDiamond\u201d concept. Injury. 2013;44(Suppl 1):S76-81.","journal-title":"Injury"},{"key":"2826_CR15","first-page":"e44","volume":"50","author":"JL Wee","year":"2009","unstructured":"Wee JL, Sathappan SS, Yeo MS, Low YP. Management of gamma nail breakage with bipolar hemi-arthroplasty. Singap Med J. 2009;50:e44\u20137.","journal-title":"Singap Med J"},{"key":"2826_CR16","doi-asserted-by":"publisher","first-page":"368","DOI":"10.1177\/230949900701500326","volume":"15","author":"GB Kasimatis","year":"2007","unstructured":"Kasimatis GB, Lambiris E, Tyllianakis M, Giannikas D, Mouzakis D, Panagiotopoulos E. Gamma nail breakage: a report of four cases. J Orthop Surg (Hong Kong). 2007;15:368\u201372.","journal-title":"J Orthop Surg (Hong Kong)"},{"key":"2826_CR17","doi-asserted-by":"publisher","first-page":"638","DOI":"10.1007\/s00776-006-1068-z","volume":"11","author":"N Yoshino","year":"2006","unstructured":"Yoshino N, Watanabe Y, Takenaka N, Watanabe N, Fukuda Y, Fujita N, et al. Implant failure of long Gamma nail in a patient with intertrochanteric-subtrochanteric fracture. J Orthop Sci. 2006;11:638\u201343.","journal-title":"J Orthop Sci"},{"key":"2826_CR18","doi-asserted-by":"publisher","first-page":"986","DOI":"10.1080\/17453670610013330","volume":"77","author":"AH Karladani","year":"2006","unstructured":"Karladani AH. Removal of a broken nail using a guide wire and a screw. Acta Orthop. 2006;77:986\u20138.","journal-title":"Acta Orthop"},{"key":"2826_CR19","first-page":"435","volume":"70","author":"DB Alvarez","year":"2004","unstructured":"Alvarez DB, Aparicio JP, Fernandez EL, Mugica IG, Batalla DN, Jimenez JP. Implant breakage, a rare complication with the Gamma nail: a review of 843 fractures of the proximal femur treated with a Gamma nail. Acta Orthop Belg. 2004;70:435\u201343.","journal-title":"Acta Orthop Belg"},{"key":"2826_CR20","doi-asserted-by":"publisher","first-page":"183","DOI":"10.3928\/0147-7447-20020201-25","volume":"25","author":"GE Wozasek","year":"2002","unstructured":"Wozasek GE, Radler C, Vecsei V. Multiple gamma nail failure. Orthopedics. 2002;25:183\u20134.","journal-title":"Orthopedics"},{"key":"2826_CR21","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1007\/s00068-001-1126-3","volume":"27","author":"G Rappold","year":"2001","unstructured":"Rappold G, Hertz H, Spitaler R. Implant breakage of the proximal femoral nail (PFN)reasons and case reports. Eur J Trauma. 2001;27:333\u20137.","journal-title":"Eur J Trauma"},{"key":"2826_CR22","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1016\/S0020-1383(98)00215-0","volume":"30","author":"C Gaebler","year":"1999","unstructured":"Gaebler C, Stanzl-Tschegg S, Tschegg EK, Kukla C, Menth-Chiari WA, Wozasek GE, et al. Implant failure of the gamma nail. Injury. 1999;30:91\u20139.","journal-title":"Injury"},{"key":"2826_CR23","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1097\/00005131-199502000-00008","volume":"9","author":"WA van den Brink","year":"1995","unstructured":"van den Brink WA, Janssen IM. Failure of the gamma nail in a highly unstable proximal femur fracture: report of four cases encountered in The Netherlands. J Orthop Trauma. 1995;9:53\u20136.","journal-title":"J Orthop Trauma"},{"key":"2826_CR24","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1308\/rcsann.2016.0297","volume":"99","author":"NA Johnson","year":"2017","unstructured":"Johnson NA, Uzoigwe C, Venkatesan M, Burgula V, Kulkarni A, Davison JN, et al. Risk factors for intramedullary nail breakage in proximal femoral fractures: a 10-year retrospective review. Ann R Coll Surg Engl. 2017;99:145\u201350.","journal-title":"Ann R Coll Surg Engl"},{"key":"2826_CR25","doi-asserted-by":"publisher","first-page":"480","DOI":"10.1097\/BOT.0000000000001553","volume":"33","author":"SF Shannon","year":"2019","unstructured":"Shannon SF, Yuan BJ, Cross WW 3rd, Barlow JD, Torchia ME, Holte PK, et al. Short versus long cephalomedullary nails for pertrochanteric hip fractures: a randomized prospective study. J Orthop Trauma. 2019;33:480\u20136.","journal-title":"J Orthop Trauma"},{"key":"2826_CR26","doi-asserted-by":"publisher","first-page":"1445","DOI":"10.1016\/j.injury.2018.06.028","volume":"49","author":"C Rogmark","year":"2018","unstructured":"Rogmark C, Kristensen MT, Viberg B, R\u00f6nnquist SS, Overgaard S, Palm H. Hip fractures in the non-elderly-Who, why and whither? Injury. 2018;49:1445\u201350.","journal-title":"Injury"},{"key":"2826_CR27","doi-asserted-by":"publisher","first-page":"e293-e9","DOI":"10.3928\/01477447-20161128-04","volume":"40","author":"MH Amini","year":"2017","unstructured":"Amini MH, Feldman JJ, Weinlein JC. High complication rate in young patients with high-energy intertrochanteric femoral fractures. Orthopedics. 2017;40:e293\u20139.","journal-title":"Orthopedics"},{"key":"2826_CR28","doi-asserted-by":"publisher","first-page":"72","DOI":"10.1590\/1413-785220182601148079","volume":"26","author":"CH Man","year":"2018","unstructured":"Man CH, Bae MW. Method for removing broken proximal femoral nails using existing screw hole. Acta Ortop Bras. 2018;26:72\u20134.","journal-title":"Acta Ortop Bras"}],"container-title":["Journal of Orthopaedic Surgery and Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13018-021-02826-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13018-021-02826-3\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13018-021-02826-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,11,17]],"date-time":"2021-11-17T12:22:58Z","timestamp":1637151778000},"score":1,"resource":{"primary":{"URL":"https:\/\/josr-online.biomedcentral.com\/articles\/10.1186\/s13018-021-02826-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,17]]},"references-count":28,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["2826"],"URL":"https:\/\/doi.org\/10.1186\/s13018-021-02826-3","relation":{},"ISSN":["1749-799X"],"issn-type":[{"value":"1749-799X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11,17]]},"assertion":[{"value":"18 July 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 November 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 November 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was approved by Peking University Third Hospital Medical Science Research Ethics Committee (IRB00006761-M2019076), and the need for informed consent was waived with the agreement of the Ethics Committee.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"676"}}