Implants failure in Hip with Intarmedullary Devices
Complications arising from fixation of unstable proximal femur fracture with PFN having 2 screws .
1.Z-effect
lateral migration of caudal screw , varus collapse and perforation of femoral head by superior screw
2. Reverse Z-effect
lateral migration of superior screw , varus collapse and femoral head cut by inferior screw
Causes
varus fixation of fractures , severe medial communition , inappropriate entry point and poor bone
quality.
Intaoperative Procedures to stabilize unstable IT fractures
Osteotomies and fixed with nail plate
Design (Smith -Peterson nail plate )
e.g. 1. Dimon -Hughston medial displacement Osteotomy
2. Sarmiento Valgus Osteotomy
3. Wayne -County lateral displacement Osteotomy
No evidence are there to support these osteotomies combined with sliding hip screw fixation .
1.Z-effect
lateral migration of caudal screw , varus collapse and perforation of femoral head by superior screw
2. Reverse Z-effect
lateral migration of superior screw , varus collapse and femoral head cut by inferior screw
Causes
varus fixation of fractures , severe medial communition , inappropriate entry point and poor bone
quality.
Intaoperative Procedures to stabilize unstable IT fractures
Osteotomies and fixed with nail plate
Design (Smith -Peterson nail plate )
e.g. 1. Dimon -Hughston medial displacement Osteotomy
2. Sarmiento Valgus Osteotomy
3. Wayne -County lateral displacement Osteotomy
No evidence are there to support these osteotomies combined with sliding hip screw fixation .
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