Dislocation Precautions for Cephalomedullary Nail
No specific hip dislocation precautions are required for patients treated with cephalomedullary nails for femur fractures, as these intramedullary devices do not violate the hip joint capsule or alter hip stability. 1, 2
Why Dislocation Precautions Are Not Necessary
Cephalomedullary nails are intramedullary fixation devices that stabilize femur fractures from within the bone canal. Unlike hip arthroplasty procedures (hemiarthroplasty or total hip replacement), these nails do not disrupt the hip joint capsule, acetabular labrum, or surrounding soft tissue stabilizers of the hip. 3
The key distinction is that dislocation risk is specifically associated with arthroplasty procedures, not intramedullary nailing. 3
When Dislocation Risk Does Apply
Dislocation precautions become relevant only when arthroplasty is performed instead of intramedullary fixation:
- Hemiarthroplasty for displaced femoral neck fractures carries lower dislocation risk compared to total hip arthroplasty, though precautions are still warranted 3
- Total hip arthroplasty has higher dislocation rates but may offer improved long-term function in appropriate candidates 3
- Metastatic femoral lesions treated with arthroplasty have increased complication rates including dislocation 3
Postoperative Management for Cephalomedullary Nails
Instead of dislocation precautions, focus on these evidence-based protocols:
- Immediate weight-bearing as tolerated with adequate fixation 1, 2
- DVT prophylaxis with fondaparinux or low molecular weight heparin for 4 weeks 1, 2
- Pain management with regular paracetamol and cautious opioid use 1, 2
- Early mobilization protocols to reduce complications and improve outcomes 2
Critical Technical Considerations
The primary concerns with cephalomedullary nails relate to fixation quality, not joint stability: