"Kissing Nail Technique" for the exchange of intramedullary implants in adjacent peri-implant fractures

Abstract

One third of the people aged 65 years and over fall every year, and 1e5% of these falls result in a fracture.For these people, history of fracture and surgery become a risk factor for recurrent falls. In osteoporoticpatients, repeated fractures often require several osteosynthetic procedures within a short time frame.Despite the lack of biomechanical studies, clinical experience suggests that additional fractures adjacentto implants occur because of the difference in stiffness between the metallic implant and the osteoporotic bone. This requires customizedŞxation techniques to ensure stability.The technique wasŞrst performed in an 81-year old female patient presenting with a dislocatedproximal femoral fracture at the tip of a previously implanted distal femoral nail (DFN), and non-union ofthe old fracture. For this technique, the DFN was advanced until it passed the proximal fracture, therebyreducing both fractures, while a lateral femoral nail (LFN), extra-long and 3 mm thicker than the DFN,was introduced and advanced distally. The LFN was implanted in a"kissing nail technique," meaning thetips of the two nails were touching each other, and all fracture fragments were held in functionalreduction. The DFN was slowly pulled backwards and fragment stability was maintained, while both nailspassed the distal non-union.The Kissing Nail Technique allows simple, safe and fast reduction of all instable fragments, precise andeasy positioning of the proximal entry point by the retrograde guide wire, a minimally invasive procedure, and stableŞxation of a periprosthetic fracture.We found this new customized procedure accommodating to the unique anatomical features of asingle patient, that can be applied as a strategy especially for osteoporotic patients with periprostheticfractures.