Cephalomedullary Nail Indications and Techniques

Indications for CM Nail

The American Academy of Orthopaedic Surgeons recommends the use of cephalomedullary nails for unstable intertrochanteric fractures with posteromedial comminution or lesser trochanter involvement, as well as for subtrochanteric and reverse oblique fractures, due to high failure rates of sliding hip screws in these patterns 1, 2
The American College of Surgeons suggests that cephalomedullary devices are preferred for subtrochanteric fractures, with strong evidence supporting their use 1

The American Academy of Orthopaedic Surgeons advises against the use of preoperative traction, as it provides no benefit, and recommends administering prophylactic antibiotics within one hour of skin incision 2
Anatomic reduction must be achieved before nail insertion, with restoration of the medial cortical continuity and normal neck-shaft angle, to prevent malunion and hardware failure 2

Inadequate reduction before fixation can lead to malunion and hardware failure, emphasizing the importance of proper reduction techniques 2
Over-compression can cause fracture comminution in osteoporotic bone, highlighting the need for careful handling of fragile bone 2

The American College of Surgeons recommends immediate weight-bearing as tolerated, with adequate fixation, as well as DVT prophylaxis with fondaparinux or low molecular weight heparin for 4 weeks 2, 4
Regular paracetamol is recommended for pain management, with cautious opioid use, especially in patients with renal dysfunction 2, 4

The Journal of the American Academy of Orthopaedic Surgeons suggests that CM nails can be used for diaphyseal lesions in metastatic/pathologic fractures, but routine use is not advantageous, and failure to diagnose a femoral neck lesion before implanting increases risks of implant failure 3