Cephalomedullary

Cephalomedullary refers to fixation devices that combine a proximal cephalic screw or blade with an intramedullary nail running through the medullary canal. The term is most often applied to devices for the proximal femur, where the cephalic element penetrates the femoral head and neck to fix the hip while the nail spans the femoral shaft.

Design and function: Inserted through a trochanteric or subtrochanteric entry. The proximal cephalic component engages the femoral head and neck to resist varus collapse and rotation. The nail is fixed distally with locking screws to control motion and bending.

Indications and use: Commonly for unstable intertrochanteric and subtrochanteric fractures, and select femoral neck fractures in adults, especially with osteoporosis. The approach can be minimally invasive and may permit early weight bearing, depending on fracture pattern and bone quality. Contraindications include non-reconstructible fractures or very poor bone stock.

Outcomes and complications: Benefits include preservation of soft tissue, alignment with the weight-bearing axis, and potential for rapid rehabilitation. Complications can include screw cutout, malreduction with varus collapse, nonunion or delayed union, hardware failure, infection, and avascular necrosis in certain femoral neck injuries. Careful patient selection and surgical technique are essential to minimize these risks.