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Treatment with Locking Intramedullary Nailing for Intertrochanteric Fracture of the Femur Utilizing a New Awl with a Distal Positioner
Published on: June 6, 2025
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Does Stem Design for Conversion Total Hip Arthroplasty From Previous Short Intramedullary Nail Predispose to
Kevin F Purcell1, Taylor P Stauffer, Shawn Kaura
1From the Division of Orthopedic Surgery, Duke University (Dr. Purcell, Dr. Bolognesi, Dr. Wellman, Dr. Seyler, and Dr. Ryan), and the School of Medicine, Duke University, Durham, NC (Dr. Stauffer).
Summary
Conversion to total hip arthroplasty after short intramedullary nail (IMN) placement is common. This study found few fractures during conversion surgery, suggesting it is generally safe regardless of stem design.
Area of Science:
- Orthopedic Surgery
- Arthroplasty
- Trauma Surgery
Background:
- Conversion to total hip arthroplasty (THA) following short intramedullary nail (IMN) is a growing procedure.
- The potential for distal interlock screws to act as stress risers and cause fractures during conversion is unknown.
- The feasibility of using primary hip stems in femurs previously treated with IMN requires investigation.
Purpose of the Study:
- To evaluate the safety and outcomes of converting short IMN to THA.
- To determine if distal interlock screws contribute to perioperative fractures.
- To assess the suitability of primary hip stems in reamed and fractured femurs.
Main Methods:
- Retrospective review of 19 patients undergoing short IMN to THA conversion between 2013-2022.
- Data collected included patient demographics, stem design, intraoperative and postoperative complications (fractures, readmissions), and length of stay.
- Mean follow-up was 13 months; study level was III.
Main Results:
- Two intraoperative fractures (greater trochanteric) occurred in 19 patients; no postoperative fractures were observed.
- Diaphyseal-engaging revision stems were most common (13 cases), with metaphyseal press-fit (3) and cemented (3) stems also used.
- No significant differences in length of stay or procedure duration were noted between stem types.
Conclusions:
- Conversion to THA from short IMN is feasible with a low rate of fractures and no revisions.
- The distal interlock screw did not universally cause issues, though revision stems were often used.
- Further research is necessary to determine if primary arthroplasty stems can be safely utilized in this context.
