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Structures at Risk With Intrapelvic Guide Wire Migration During Cephalomedullary Fixation of Hip Fractures: CT-Based

Arman Vahabi1, Yusuf Kerem Limon2, Çağatay Öncel1

  • 1Ege University School of Medicine, Department of Orthopedics and Traumatology, İzmir, Turkey.

Journal of Orthopaedic Trauma
|September 19, 2025
PubMed
Summary

Guide wire migration during cephalomedullary nail fixation risks serious intrapelvic injury, especially with deeper penetration. This study quantifies these risks to pelvic structures, highlighting areas for improved surgical safety.

Keywords:
cephalomedullary nailhip fractureiatrogenic damagek-wireneurovascular injurypelvic organpenetrationproximal femoral nail

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Area of Science:

  • Orthopaedic surgery
  • Trauma surgery
  • Anatomy

Background:

  • Cephalomedullary nail fixation is common for hip fractures.
  • Guide wire misplacement can lead to intrapelvic injuries.
  • Understanding at-risk structures is crucial for patient safety.

Purpose of the Study:

  • To identify intrapelvic structures at risk from guide wire migration during cephalomedullary nail fixation.
  • To quantify the risk based on guide wire penetration depth and trajectory.
  • To compare risks between sexes and laterality.

Main Methods:

  • Retrospective review of patients undergoing cephalomedullary nail fixation.
  • Contrast-enhanced computed tomography (CT) analysis.
  • Six simulation scenarios with varying penetration depths (2 cm, 5 cm) and sagittal angles (neutral, anteversion, retroversion).

Main Results:

  • Guide wire contact with pelvic structures occurred in 78% of cases at 2 cm and 98% at 5 cm penetration in neutral trajectory.
  • Most frequent injuries involved external iliac vessels, small intestine, and colon.
  • Males had significantly higher rates of external iliac vessel injury and smaller safe distances.

Conclusions:

  • Intrapelvic guide wire mispositioning during cephalomedullary nail fixation presents a significant risk of iatrogenic injury.
  • Risk increases with deeper penetration.
  • Clinical implications of these injuries require further investigation.