THE ROLE OF DISTAL LOCKING IN INTRAMEDULLARY NAILS FOR HIP FRACTURE FIXATION: A REVIEW OF CURRENT LITERATURE

Area of Science:

• Orthopedic Surgery
• Trauma Management
• Biomechanical Engineering

Background:

• Intra-medullary fixation for extra-capsular hip fractures traditionally mandates both proximal and distal locking for stability.
• Emerging evidence questions the universal necessity of distal locking, particularly in specific fracture patterns.

Approach:

• Review of recent literature examining the role and impact of distal locking in intra-medullary hip fracture fixation.
• Analysis of fracture characteristics influencing the need for distal locking, focusing on stability parameters.
• Evaluation of potential complications associated with distal locking.

Key Points:

• Distal locking is crucial for managing unstable fractures, including comminuted intertrochanteric, subtrochanteric extensions, and those with broad medullary canals.
• Stable pertrochanteric fractures, where the lag screw engages the distal fragment's lateral cortex, may not require distal locking.
• Potential complications of distal locking include soft tissue irritation, increased operative time, radiation exposure, blood loss, and implant-related issues.

Conclusions:

• The necessity of distal locking in intra-medullary hip fracture fixation is fracture-pattern dependent.
• Distal locking is indispensable for unstable fracture configurations to ensure longitudinal and rotational stability.
• Omitting distal locking in stable pertrochanteric fractures may be a viable option, potentially mitigating associated risks and complications.