Table 1.
Meta-analyses of other nail breakages compared with our experience.
| Author | Total cases | Cases of broken nails | Nail type | Breakage site | Time in months | Cause of breakage |
|---|---|---|---|---|---|---|
| Valverde et al. [13] | 223 | 1 (0.4%) | 1st GN | Proximal | N/A | N/A |
| Boriani et al. [14] | 1181 | 5 (0.4%) | 1st GN | N/A | N/A | N/A |
| Gaebler et al. [15] | 839 | 2 (0.2%) | 1st GN | Distal | 4 | Direct trauma |
| 1st GN | Distal | 5 | Nonunion | |||
| Docquier et al. [16] | 439 | 1 (0.2%) | 1st or 2nd GN | N/A | N/A | Delayed union |
| Iwakura et al. [10] | N/A | N/A | Short 3GN | Proximal | 14 | Insufficient reduction |
| Pervez and Parker [17] | 35 | 2 (5.7%) | Long GN | Middle | 3 | Delayed union |
| Long GN | N/A | 5 | Delayed union (PF) | |||
| Van Doorn and Stapert [18] | 101 | 2 (2.0%) | Long GN | Proximal | 7 | Nonunion (PF) |
| Long GN | Middle | 9 | Nonunion (PF) | |||
| Sehat et al. [19] | 100 | 1 (1.0%) | Long GN | Middle | N/A | Insufficient reduction |
| 1st GN | Proximal | 7 | Nonunion | |||
| 1st GN | Distal | 7 | Nonunion | |||
| Alvarez et al. [20] | 843 | 5 (0.6%) | 2nd GN | Proximal | 7 | Nonunion |
| Long GN | Middle | 10 | Nonunion | |||
| Long GN | Proximal | 8 | Nonunion | |||
| Rappold et al. [21] | 61 | 2 (3.28%) | PFN | Proximal | 12 | Nonunion |
| PFN | Proximal | 24 | Insufficient reduction | |||
| Erez and Dougherty [23] | 100 | 1 (1%) | TN | Proximal | 6 | Second fall |
| Maniscalco et al. [24] | N/A | N/A | EN | Proximal | 6 | Nonunion, distal jamming |
| Liu et al. [25] | 341 | 2 (0.59%) | TFN | Proximal | N/A | Nonunion, fatigue |
| TFN | Proximal | NA | ||||
| Johnson et al. [26] | 221 | 20 (9.05%) | All HIS | All proximal | Range 25–23 | Nonunion, fatigue |
| 2 (0.90%) | AFF | All proximal | ||||
| Rollo et al. (PD) | 242 | 3 (1.24%) | 1GN | All proximal | Range 6–12 | Nonunion, fatigue |
| Rollo et al. (PD) | 286 | 4 (1.3%) | 2GN | All proximal | Range 6–12 | Nonunion, fatigue |
| Rollo et al. (PD) | 346 | 1 (0.29%) | 3GN (180 mm) | All proximal | Range 4–16 | Nonunion, fatigue |
| Rollo et al. (PD) | 189 | 2 (1.1%) | 3GN (200 mm) | All proximal | Range 3–18 | Nonunion, fatigue |
| Rollo et al. (PD) | 138 | 0 | Long GN | All proximal | Range 6–15 | Nonunion, fatigue |
| Rollo et al. (PD) | 150 | 2 (1.3%) | AFF | All proximal | Range 6–15 | Nonunion, fatigue |
1st GN: the first-generation Gamma nail; 2nd GN: the second-generation Gamma nail; 3rd GN: the third-generation Gamma nail; PFN: Proximal Femoral Nail® (DePuy Synthes, Raynham, Massachusetts, USA); TN: InterTAN® (Smith & Nephew™, Memphis, Tennessee, USA); EN: EndoViS® (Citieffe™, Calderara di Reno, Bologna, Italy); IMHS: Intramedullary Hip Screw® (Smith & Nephew™, Tennessee, USA); AFF: Affixus® (Zimmer Biomet™, Warsaw, Indiana, USA); long: long nail; proximal: the opening for the lag screw; middle: nail midshaft; distal: the opening for the distal locking screw; N/A: not available in the literature; PD: personal database; PF: pathological fracture.