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Ramezani A, Babagoli M, Ghaseminejad-Raeini A, Golbakhsh M, Shafiei SH. Factors associated with postoperative quality of life in patients with intertrochanteric fracture. Ann Med Surg (Lond) 2024; 86:703-711. [PMID: 38333317 PMCID: PMC10849437 DOI: 10.1097/ms9.0000000000001608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/29/2023] [Indexed: 02/10/2024] Open
Abstract
Introduction Intertrochanteric fractures, which make up the majority of hip fractures, are a common and serious injury that can greatly impact quality of life. Treatment of such fractures comprises nearly half of the costs contributed to hip fractures. Identifying the factors affecting the functional outcomes of patients after intertrochanteric fracture can help to reduce burden of disease for the patient and healthcare system. The present study investigated the factors underlying the worsening of short form-36 score (SF-36) scores for intertrochanteric fracture patients. Materials and methods This retrospective cohort study was designed based on data from our clinic. All consecutive patients with intertrochanteric fractures from November 2016 to September 2020 were reviewed. The exclusion criteria included patients having a second injury or having had previous surgery related to the hip and those with incomplete data. Baseline characteristics of patients were extracted from annotated records. The lab data were acquired from the electronic hospital system. The outcomes were SF-36 scores obtained by phone contact with patients or their families. Statistical analysis was conducted in SPSS. Results A total of 310 patients were included in the current study. The female gender, advanced age, history of diabetes, thyroid malfunction, cancer, osteoporosis, anticoagulant use and blood transfusion were identified as risk factors for lower SF-36 scores. Low levels of haemoglobin before surgery, blood urea nitrogen (BUN), BUN/Creatinine, and white blood count values correlated with lower SF-36 scores. Conclusion Numerous contextual variables affected the functional outcomes of the patients. Consideration of these factors could be helpful in reducing costs and improving the quality of life for intertrochanteric fracture patients.
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Affiliation(s)
| | | | | | | | - Seyyed Hossein Shafiei
- Orthopedic Surgery Research Center (OSRC), Sina University Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Amer KM, Congiusta DV, Smith B, Jain K, Shaath MK, Dalcortivo RL, Ahmed IH, Vosbikian MM. Cephalomedullary Nailing has a Higher Reoperation Rate Compared to Sliding Hip Screw Fixation in the Treatment of Intertrochanteric Femur Fractures: A Systematic Literature Review and Meta-analysis. THE ARCHIVES OF BONE AND JOINT SURGERY 2023; 11:595-604. [PMID: 37873525 PMCID: PMC10590488 DOI: 10.22038/abjs.2023.64311.3088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 08/13/2023] [Indexed: 10/25/2023]
Abstract
Objectives Intertrochanteric hip fractures are a common orthopaedic injury in the United States. Complications of surgical treatment include nonunion, lag screw cutout, implant failure, post-operative pain, risk of refracture or reoperation, and infection. The purpose of this study was to compare the rate of complications of sliding hip screw fixation (SHS) compared to cephalomedullary nailing (CMN) for the treatment of closed intertrochanteric femur fractures in adult patients. Methods PubMed, CINAHL, and Cochrane Library databases were searched for studies comparing SHS to CMN in the treatment of closed intertrochanteric femur fractures in adults. Data were compiled to observe the rate of nonunion, cutout failure, infection, refracture, perioperative blood loss, reoperation, postoperative pain, pulmonary embolism/deep venous thrombosis (DVT), length of hospital stay, and mortality. Results Seventeen studies were included comprising 1,500 patients treated with SHS and 1,890 patients treated with CMN. Treatment of intertrochanteric femur fractures with SHS demonstrated significantly fewer refractures and reoperations. There was no significant difference in other variables between SHS and CMN treated groups. Conclusion This meta-analysis shows that the only notable difference in outcomes is patients treated with CMN have a higher rate of refracture and reoperation. With new advances in the development of both CMNs and SHS, further studies will be required to see if these differences persist in the coming years.
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Affiliation(s)
- Kamil M. Amer
- Rutgers New Jersey Medical School Department of Orthopaedics, Newark, USA
| | | | - Brendan Smith
- Rutgers New Jersey Medical School Department of Orthopaedics, Newark, USA
| | - Kunj Jain
- Rutgers New Jersey Medical School Department of Orthopaedics, Newark, USA
| | - M. Kareem Shaath
- Rutgers New Jersey Medical School Department of Orthopaedics, Newark, USA
| | | | - Irfan H. Ahmed
- Rutgers New Jersey Medical School Department of Orthopaedics, Newark, USA
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Costa GG, Franzese V, Cozzolino A, Rizzo M, Cerbasi S, Guarino A, Lepore S, Schiraldi M, Mariconda M. Gamma nail versus percutaneous compression plate for the treatment of intertrochanteric hip fractures: a multicenter pair-matched study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2022:10.1007/s00590-022-03441-6. [PMID: 36534367 DOI: 10.1007/s00590-022-03441-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 11/14/2022] [Indexed: 06/17/2023]
Abstract
PURPOSE To compare functional outcomes, complication rates, and survival in patients with intertrochanteric fracture treated with percutaneous compression plate (PCCP) or gamma nail (GN). METHODS A retrospective study of prospectively collected data of patients treated with PCCP or GN for AO/OTA 31.A1 or AO/OTA 31.A2 fractures was conducted. Sixty-eight consecutive patients treated with PCCP between 2018 and 2020 were enrolled and matched with 68 patients with comparable characteristics treated with GN. The activities of daily living (ADL) index and specific scales for walking ability and need for walking aids at 4 months and 1 year after fracture fixation were chosen as primary outcomes. Postoperative complications and one-year survival were recorded and compared between the two groups. RESULTS Walking ability and ADLs index decreased and the need for walking aids increased in both groups compared to the prefracture state at both follow-up intervals (p < 0.001), regardless of the treatment received. There was no difference between the two implants in the rate of implant-related complications. One-year survival rate was 78.9% (95% CI 67.0-86.9) and 82.4% (95% CI 71.0-89.5) in patients undergoing PCCP or GN, respectively, with no significant difference between the two groups. CONCLUSIONS Walking ability, ADLs, complication rate, and 1-year survival are not significantly different when patients undergoing PCCP or GN are compared. The choice of implant may not be decisive for the outcome of treatment of intertrochanteric fractures, provided that stable fixation is ensured.
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Affiliation(s)
- Giovan Giuseppe Costa
- Department of Orthopaedic and Trauma Surgery, "Michele e Pietro Ferrero" Hospital, Verduno, CN, Italy
| | - Vincenzo Franzese
- Department of Orthopaedic and Trauma Surgery, "Michele e Pietro Ferrero" Hospital, Verduno, CN, Italy
| | - Andrea Cozzolino
- Department of Public Health, Section of Orthopaedic and Trauma Surgery, Federico II" University, Via S. Pansini 5, Building 12, 80131, Naples, Italy
| | - Maria Rizzo
- Department of Public Health, Section of Orthopaedic and Trauma Surgery, Federico II" University, Via S. Pansini 5, Building 12, 80131, Naples, Italy
| | - Simone Cerbasi
- Department of Orthopaedic and Trauma Surgery, Ospedali Riuniti, Ancona, Italy
| | - Amedeo Guarino
- Department of Public Health, Section of Orthopaedic and Trauma Surgery, Federico II" University, Via S. Pansini 5, Building 12, 80131, Naples, Italy
| | - Stefano Lepore
- Department of Orthopaedic and Trauma Surgery, "A. Cardarelli" Hospital, Naples, Italy
| | - Marco Schiraldi
- Department of Orthopaedic and Trauma Surgery, "Michele e Pietro Ferrero" Hospital, Verduno, CN, Italy
| | - Massimo Mariconda
- Department of Public Health, Section of Orthopaedic and Trauma Surgery, Federico II" University, Via S. Pansini 5, Building 12, 80131, Naples, Italy.
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Dynamic hip screw with stabilization plate in unstable intertrochanteric fractures: a case series. CURRENT ORTHOPAEDIC PRACTICE 2022. [DOI: 10.1097/bco.0000000000001168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Comparative analysis of operation time and intraoperative fluoroscopy time in intramedullary and extramedullary fixation of trochanteric fractures. VOJNOSANIT PREGL 2022. [DOI: 10.2298/vsp200516094m] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background/Aim. Cephalomedullary and extramedullary methods are used for the internal fixation of trochanteric fractures. The usage of the third generation Gamma Nail (GN) is a gold standard in this kind of treatments. Self-dynamisable Internal Fixator (SIF) is an extramedullary implant for trochanteric fractures? treatment. The aim of this study was to compare these two methods regarding operation time and intraoperative fluoroscopy time. Methods. A total of 89 patients with a surgical treatment of a trochanteric fracture were included in this study. There were two groups of patients ? GN group (43 patients) and SIF group (46 patients). Results. Average operation times were 67.5 min (GN group) and 56.0 min (SIF group). Average intraoperative fluoroscopy times were 84.8 s (GN group) and 36.7 s (SIF group). The difference between the groups was statistically significant for both of the given parameters (p < 0.05). The correlation between operation time and intraoperative fluoroscopy time was confirmed in the SIF group (p < 0.05; r = 0.405), while it was not confirmed in the GN group (p > 0.05). There was a higher variability in the GN method than in the SIF method regarding the duration and type of repeated surgical maneuvers followed by X-ray checks. Conclusion. The number of planned surgical interventions per day could depend on the type of trochanteric fracture internal fixation (intramedullary or extramedullary). Certain additional analyses including radiation dose assessment are desirable to clarify if shorter intraoperative fluoroscopy time in the SIF method can have the influence regarding intraoperative X-ray protection clothing. If there is the need to activate dynamization in long femoral axis after initial static fixation in that axis, the SIF method provides its spontaneous activation several weeks after the surgery without the need neither for additional surgery nor for additional intraoperative fluoroscopy
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Akinyemi T, Mannan S, Ayeni F. Pertrochanteric hip fracture fixation with 3 hole and 4 hole dhs side plates - A retrospective patient record review. NIGERIAN JOURNAL OF MEDICINE 2022. [DOI: 10.4103/njm.njm_120_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Law GW, Wong YR, Gardner A, Ng YH. Intramedullary nailing confers an increased risk of medial migration compared to dynamic hip screw fixation in unstable intertrochanteric hip fractures. Injury 2021; 52:3440-3445. [PMID: 33551262 DOI: 10.1016/j.injury.2021.01.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/02/2021] [Accepted: 01/07/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Medial migration of the femoral neck element (FNE) superomedially against gravity with respect to the intramedullary component of the cephalomedullary nail is a complication increasingly recognized to cause femoral head cut-out in intramedullary nailing of pertrochanteric hip fractures. Although cut-outs are common to both intra- and extramedullary fixation, especially in unstable pertrochanteric hip fractures, FNE medial migration in sliding hip screws continues to remain sparse despite increased awareness of the phenomenon. This study aims to investigate whether intramedullary nailing is biomechanically predisposed to FNE medial migration compared to extramedullary fixation with sliding hip screws to account for the discrepancy in reported FNE medial migration rates. MATERIALS AND METHODS Twelve fourth-generation synthetic femurs (Sawbones) with unstable intertrochanteric fractures were divided into 2 groups (n=6 per group). Fracture fixation was performed using the Proximal Femoral Nail Antirotation (PFNA, Synthes) (n=6) in the first group, and the Dynamic Hip Screw (DHS, Synthes) (n=6) in the second group. Both groups were subjected to bidirectional cyclic loading (600N compression loading, 120N tensile loading) at 2 Hz for 5000 cycles. The medial migration distance (MMD) was recorded at the end of the testing cycles. RESULTS The mean MMD in the PFNA group was 4.56mm (SD 0.69mm) with consistent reproduction of medial migration across all constructs tested. This was significantly more compared to the MMD of 1.17mm (SD 0.69mm) in the DHS group (p<0.001). CONCLUSION Intramedullary nailing of unstable intertrochanteric hip fractures is inherently predisposed to FNE medial migration making it more susceptible to consequent cut-out compared to fixation with the DHS.
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Affiliation(s)
- Gin Way Law
- National University Health System, Singapore.
| | | | | | - Yau Hong Ng
- National University Health System, Singapore; National University Health System, Singapore.
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Kalia A, Singh J, Garg S, Singh R. Proximal Femoral Non-unions with Implant In Situ Treated by Revision Osteosynthesis: A Real Challenge. J Orthop Case Rep 2020; 10:80-84. [PMID: 34169023 PMCID: PMC8046450 DOI: 10.13107/jocr.2020.v10.i09.1912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Proximal femur fractures non-union with implant failure creates a nightmare for both the surgeon and the patient. Meticulous surgical planning and the correct choice of the implant are essential to achieve success in the revision surgery. Materials and Methods: Eleven patients with ununited proximal femur fractures including both intertrochanteric and subtrochanteric fractures who had a failed previous implant were included in the study. Femoral neck nonunions and infected nonunions were excluded from the study. One patient was lost to follow-up. Results: One patient was lost to follow-up and out of the remaining ten patients, six were males and four were females. Mean age was 62.2 years (35–74). Union was achieved with mean union time of 10.1 months (9–14). Mean surgical time was 105 min (90–125) and mean blood loss during surgery was 600 ml (350–850). Mean time of revision surgery after the primary index surgery was 20 months (15–30). Mean duration of follow-up was 12.9 months (12-16). Conclusion: Revision osteosynthesis in proximal femoral nonunions with implant failure is a real test of surgeons expertise because of the many factors going against like osteoporosis, distorted proximal femur anatomy due to the already present implant resulting in poor bone stock availability. Judicious and appropriate selection of implants is an impeccable factor for fracture union and positive outcome.
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Affiliation(s)
- Anoop Kalia
- Department of Orthopaedics, Max Super Speciality Hospital, Mohali, Punjab. India
| | - Jagdeep Singh
- Department of Orthopaedics, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab. India
| | - Sorabh Garg
- Department of Orthopaedics, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab. India
| | - Rajdeep Singh
- Department of Orthopaedics, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab. India
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Ceynowa M, Zerdzicki K, Klosowski P, Pankowski R, Rocławski M, Mazurek T. The early failure of the gamma nail and the dynamic hip screw in femurs with a wide medullary canal. A biomechanical study of intertrochanteric fractures. Clin Biomech (Bristol, Avon) 2020; 71:201-207. [PMID: 31775090 DOI: 10.1016/j.clinbiomech.2019.11.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 10/28/2019] [Accepted: 11/11/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Intertrochanteric fractures may occur in a bone with a wide medullary canal that may lead to significant mobility of a intramedullary nail, contrary to an extramedullary device. This study evaluates the Dynamic Hip Screw and the gamma nail in AO 31.A2.1 fractures in these circumstances. METHODS Synthetic femora with canals drilled to 18 mm were used. Five fixation types were examined: a 2 - hole and a 4 - hole Dynamic Hip Screw with a 2 - hole plate, a standard gamma nail with dynamic and static distal locking and a long gamma nail. The specimens were tested with cyclic axial loading, from 500 N increasing of 50 N increments in each cycle. Force at failure, overall stiffness, stiffness at the fracture site, location and mode of failure were recorded. FINDINGS The short gamma nails dislocated into varus under preload because the nail migrated laterally. The Dynamic Hip Screw was initially stable, but some specimens rotated around the lag screw. The gamma nail was rotationally stable. Both implants failed through femur fracture. The long gamma nailed failed by screw cut - out at forces lower than the ultimate force of the short gamma nail. INTERPRETATION This study shows that the gamma nail is unstable in a large medullary canal but offers better rotational stability of the proximal fragment. A modification of the nail design or the operative technique may be considered.
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Affiliation(s)
- Marcin Ceynowa
- Department of Orthopedic Surgery, Medical University of Gdańsk, ul. Nowe Ogrody 1-6, 80-803 Gdańsk, Poland.
| | - Krzysztof Zerdzicki
- Faculty of Civil and Environmental Engineering, Gdansk University of Technology, Gabriela Narutowicza 11/12, 80-233 Gdańsk, Poland.
| | - Pawel Klosowski
- Faculty of Civil and Environmental Engineering, Gdansk University of Technology, Gabriela Narutowicza 11/12, 80-233 Gdańsk, Poland.
| | - Rafał Pankowski
- Department of Orthopedic Surgery, Medical University of Gdańsk, ul. Nowe Ogrody 1-6, 80-803 Gdańsk, Poland
| | - Marek Rocławski
- Department of Orthopedic Surgery, Medical University of Gdańsk, ul. Nowe Ogrody 1-6, 80-803 Gdańsk, Poland
| | - Tomasz Mazurek
- Department of Orthopedic Surgery, Medical University of Gdańsk, ul. Nowe Ogrody 1-6, 80-803 Gdańsk, Poland
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Oldani D, Maniscalco P. Preliminary experience with MEDGAL DHS for treatment of proximal femoral fractures. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:82-85. [PMID: 31821289 PMCID: PMC7233698 DOI: 10.23750/abm.v90i12-s.8960] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 11/07/2019] [Indexed: 11/23/2022]
Abstract
Background and aim of the study: The Authors report their implant’s analysis and preliminary experience with a new fixation device, the MEDGAL DHS for treatment of proximal femoral fractures, producted by MEDGAL Sp.z o.o, Niewodnicka, Poland. Materials: Between January 2019 and September 2019 in Orthopedics and Traumatology Department of Piacenza, 12 patients with stable pertrocanteric fractures were treated with the MEDGAL DHS. Results: No patients presented perioperative complications with low bleeding and mean surgical time of 40 minutes. Conclusions: DHS is an optimal implant for the treatment of stable pertrochanteric femural fractures. (www.actabiomedica.it)
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11
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Bonnaire F, Lein T, Fülling T, Bula P. Reduced complication rates for unstable trochanteric fractures managed with third-generation nails: Gamma 3 nail versus PFNA. Eur J Trauma Emerg Surg 2019; 46:955-962. [PMID: 31520157 DOI: 10.1007/s00068-019-01200-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 07/28/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Third-generation nails for the management of unstable trochanteric fractures were evaluated with regard to outcomes. PATIENTS AND METHODS A prospective observational study comparing the Gamma 3 nail and the Proximal Femoral Nail Antirotation (PFNA) in 106 unstable trochanteric fractures confirms the recently reported low intra- and postoperative complication rates from retrospective cohort studies. RESULTS Studies of same generations of both intramedullary nail systems did not reveal significant differences in intra- or postoperative complications. Intraoperative dislocation during nail insertion occurred 7 times for the Gamma nail and 9 times for the PFNA. The standard PFNA had to be exchanged intraoperatively for a shorter one on two occasions. Superficial wound healing disorders and hematoma requiring revision were observed in four patients in the Gamma 3 nail group and in three patients in the PFNA group. No deep infections were documented. Mechanical complications required revision in four patients (7.5%) after Gamma nailing and in two patients (3.8%) after PFNA. Postoperative rotation of the head-neck fragment was observed for the Gamma nail in three patients, not in the PFNA group. This was not statistically significant (p = 0.08). There were neither incidences of cut out without renewed trauma nor intraoperative fracture or postoperative femoral fracture. Nonunion affected 1 of 18 patients in late follow-up (p = 0.3) in the Gamma 3 nail group. DISCUSSION The Gamma 3 nail and the PFNA yielded comparable clinical results and significantly improved outcomes for unstable trochanteric fractures compared to older nail generations.
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Affiliation(s)
- Felix Bonnaire
- Städtisches Klinikum Dresden Standort Friedrichstadt, Friedrichstrasse 41, 01067, Dresden, Germany.
| | - Thomas Lein
- Städtisches Klinikum Dresden Standort Friedrichstadt, Friedrichstrasse 41, 01067, Dresden, Germany.,Diakonissenkrankenhaus Dresden, Holzhofgasse 29, 01099, Dresden, Germany
| | - Tim Fülling
- Städtisches Klinikum Dresden Standort Friedrichstadt, Friedrichstrasse 41, 01067, Dresden, Germany
| | - Philipp Bula
- Städtisches Klinikum Dresden Standort Friedrichstadt, Friedrichstrasse 41, 01067, Dresden, Germany.,Klinikum Gütersloh, Reckenberger Str. 19, 33332, Dresden, Germany
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Hierholzer C, Friederichs J, Augat P, Woltmann A, Trapp O, Bühren V, von Rüden C. [Evolution and principles of intramedullary locked nailing]. Unfallchirurg 2019; 121:239-255. [PMID: 29464295 DOI: 10.1007/s00113-018-0461-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Key factors for successful osteosynthetic fracture stabilization are anatomical fracture reduction, restoration of axis and torsion alignment as well as tissue-preserving operative techniques. In long bone fractures, the use of intramedullary long bridging nailing offers ideal conditions for bone healing, as axial and rotational stability is provided by canal-filling nails and locking screws. In addition, the tissue in the fracture region is protected as the intramedullary nail insertion is distant from the fracture. The indication spectrum for modern intramedullary locked nailing includes diaphyseal fractures of long bones, metaphyseal fractures and reconstructions, as well as treatment of nonunion, osteotomy and arthrodesis of the lower extremities. Continuous improvements in nail design and instrumentation as well as the introduction of anatomical reconstruction nails will optimize the spectrum and effectiveness of intramedullary osteosynthesis even further.
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Affiliation(s)
- C Hierholzer
- Abteilung Unfallchirurgie, BG Unfallklinik Murnau, Professor-Küntscher-Str. 8, 82418, Murnau, Deutschland
- Klinik für Traumatologie, Universitätsspital Zürich, Zürich, Schweiz
| | - J Friederichs
- Abteilung Unfallchirurgie, BG Unfallklinik Murnau, Professor-Küntscher-Str. 8, 82418, Murnau, Deutschland
| | - P Augat
- Universitätsinstitut für Biomechanik, Paracelsus Medizinische Privatuniversität, Salzburg, Österreich
- Institut für Biomechanik, BG Unfallklinik Murnau, Murnau, Deutschland
| | - A Woltmann
- Abteilung Unfallchirurgie, BG Unfallklinik Murnau, Professor-Küntscher-Str. 8, 82418, Murnau, Deutschland
| | - O Trapp
- Abteilung Unfallchirurgie, BG Unfallklinik Murnau, Professor-Küntscher-Str. 8, 82418, Murnau, Deutschland
| | - V Bühren
- Abteilung Unfallchirurgie, BG Unfallklinik Murnau, Professor-Küntscher-Str. 8, 82418, Murnau, Deutschland
| | - C von Rüden
- Abteilung Unfallchirurgie, BG Unfallklinik Murnau, Professor-Küntscher-Str. 8, 82418, Murnau, Deutschland.
- Universitätsinstitut für Biomechanik, Paracelsus Medizinische Privatuniversität, Salzburg, Österreich.
- Institut für Biomechanik, BG Unfallklinik Murnau, Murnau, Deutschland.
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Duymus TM, Aydogmus S, Ulusoy İ, Kececi T, Adiyeke L, Dernek B, Mutlu S. Comparison of Intra- and Extramedullary Implants in Treatment of Unstable Intertrochanteric Fractures. J Clin Orthop Trauma 2019; 10:290-295. [PMID: 30828196 PMCID: PMC6383078 DOI: 10.1016/j.jcot.2018.04.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 02/07/2018] [Accepted: 04/07/2018] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Comparison was made of the clinical and radiological results of the surgical treatments of proximal femoral nail (PFN), dynamic hip screw (DHS) or proximal femoral locking compression plate (PF-LCP) in patients with AO 31A2.2/2.3 unstable intertrochanteric femoral fracture(ITF). METHODS Evaluation was made of a total of 91 patients in respect of age, gender, time from fracture to surgery, operating time, amount of blood replacement, total hospitalisation, follow-up period, time to full weight-bearing, time to union, complications and Harris hip scores(HHS). RESULTS A statistically significant difference was determined between the groups in respect of perioperative operating time, blood replacement and hospitalisation period with the values of the PFN group seen to be superior to those of the other two groups (p < 0.001). No significant difference was determined beween the DHS and PFN groups in respect of time to union and in the long-term HHS, both groups were seen to be superior to the PF-LCP group (p < 0.001). Full weight-bearing was statistically significantly earlier in the PFN group (p < 0.001). The numbers of implant failures was statistically significantly higher in the PF-LCP group (p < 0.001). CONCLUSION The new generation intra-medullar nails are easy to apply and have more successful clinical results compared to extra-medullar implants in the treatment of A2 unstable ITF. Due to the high rates of implant failure, PF-LCP should not be preferred in these fractures.
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Affiliation(s)
- Tahir Mutlu Duymus
- Department of Orthopedic Surgery and Traumatology, Haydarpaşa Numune Education and Research Hospital, 34668 Uskudar, Istanbul, Turkey,Corresponding author at: Department of Orthopaedics, Haydarpaşa Numune Training and Research Hospital, Atakent Mh., 1. Cd, 34303 Küçükçekmece, Istanbul, Turkey.
| | - Suavi Aydogmus
- Department of Orthopaedics, Maltepe State Hospital, Maltepe/Istanbul, Istanbul, Turkey
| | - İbrahim Ulusoy
- Fırat Universty, Department of Orthopaedics, Elazıg, Turkey
| | - Tolga Kececi
- Department of Orthopedic Surgery and Traumatology, Haydarpaşa Numune Education and Research Hospital, 34668 Uskudar, Istanbul, Turkey
| | - Levent Adiyeke
- Department of Orthopedic Surgery and Traumatology, Haydarpaşa Numune Education and Research Hospital, 34668 Uskudar, Istanbul, Turkey
| | - Bahar Dernek
- Department of Physical Therpy, Istanbul Kanuni Sultan Suleyman Training and Research Hospital, Atakent Mh., 1. Cd, 34303 Küçükçekmece, Istanbul, Turkey
| | - Serhat Mutlu
- Department of Orthopaedics, Istanbul Kanuni Sultan Suleyman Training and Research Hospital, Atakent Mh., 1. Cd, 34303 Küçükçekmece, Istanbul, Turkey
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Ding T, Zhang B, Tian S, Wang Y, Sun K. [Selection principles and application status of surgical methods for hip fracture in the elderly]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 32:1435-1440. [PMID: 30417620 PMCID: PMC8414111 DOI: 10.7507/1002-1892.201804084] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 10/08/2018] [Indexed: 11/03/2022]
Abstract
Objective To summarize the selection criteria and clinical application of surgical methods for hip fractures (femoral neck fracture and intertrochanteric fracture) in the elderly. Methods The related literature concerning the surgical methods for femoral neck fracture and intertrochanteric fracture in the elderly at home and abroad was extensively reviewed and summarized. Results Among the elderly patients with femoral neck fracture, the closed reduction and internal fixation or dynamic hip screw (DHS), and total hip arthroplasty are recommended for patients under 65 years old and 65-80 years old respectively and without special surgical contraindication; whereas hemiarthroplasty is recommended for patients with poor physical conditions. Among the patients with intertrochanteric fracture, DHS or the 3rd generation of Gamma nails is recommended for patients with stable fracture while the intramedullary fixation systems (e.g., proximal femoral nail anti-rotation, intertrochanteric antegrade nail) and the extramedullary fixation systems (e.g., proximal femoral locking compression plate and less invasive stabilization system) can be applied to the patients with unstable fracture according to the fracture type and bone conditions. Notably, hip arthroplasty is recommended for elderly patients with comminuted fracture. Conclusion The surgical method and internal fixator should be chosen according to the fracture type and bone condition in the elderly in order to improve the effectiveness and reduce the complication.
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Affiliation(s)
- Tao Ding
- Department of Articular Surgery, the Affiliated Hospital of Qingdao University, Qingdao Shandong, 266555, P.R.China
| | - Baokun Zhang
- Department of Trauma Orthopedics, Shanghai Sixth People's Hospital, Shanghai Jiaotong University, Shanghai, 200233, P.R.China
| | - Shaoqi Tian
- Department of Articular Surgery, the Affiliated Hospital of Qingdao University, Qingdao Shandong, 266555, P.R.China
| | - Yuanhe Wang
- Department of Articular Surgery, the Affiliated Hospital of Qingdao University, Qingdao Shandong, 266555, P.R.China
| | - Kang Sun
- Department of Articular Surgery, the Affiliated Hospital of Qingdao University, Qingdao Shandong, 266555,
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Unlocked versus dynamic and static distal locked femoral nails in stable and unstable intertrochanteric fractures. A prospective study. Injury 2018; 49 Suppl 3:S19-S25. [PMID: 30415664 DOI: 10.1016/j.injury.2018.09.063] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 09/29/2018] [Accepted: 09/30/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Few clinical studies have analyzed the utility of distal interlocking screws in stable and unstable intertrochanteric fractures treated with intramedullary devices. We performed a prospective analysis comparing short unlocked versus short dynamic and short static distal locked intramedullary nails. MATERIALS AND METHODS Nine level-II trauma centres were involved in the study. 240 patients over the age of 65 with a stable (AO/OTA 31-A1) or unstable intertrochanteric fracture (AO/OTA 31-A2) were prospectively investigated. The same type of nail was used in every patient. Patients were randomly divided into 3 groups according to the type of distal locking used. Intra-operative variables were examined and patients were followed clinically and radiographically at 1, 3, 6, 12 months postoperatively. All complications were recorded. RESULTS A total of 212 patients completed 1 year of follow-up visits. In the Unlocking Group (UG) the operation time, blood loss, fluoroscopy time, total length of incision were significantly decreased compared to both the Dynamic Group (DG) and the Static Group (SG) (p < 0.05). Conversely, no reliable differences in intraoperative variables were noted between the Dynamic Group and the Static Group (p > 0.05). In terms of time of fracture union we found no differences among the three Groups (p > 0.05). Moreover, no cases of limb shortening >1 cm or varus collapse were detected in any group. The 3 Groups were similar in terms of HHS, SF-12 and Barthel index results at 1-year follow-up (p > 0.05). Finally, no significant differences were demonstrated across the three Groups in terms of major complications. CONCLUSIONS This clinical study further confirms the hypothesis that short intramedullary nails do not need to be locked for stable and unstable intertrochanteric fractures.
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Ibrahim S, Meleppuram JJ. A retrospective analysis of surgically-treated complex proximal femur fractures with proximal femoral locking compression plate. Rev Bras Ortop 2017; 52:644-650. [PMID: 29234646 PMCID: PMC5720848 DOI: 10.1016/j.rboe.2016.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 10/03/2016] [Indexed: 11/30/2022] Open
Abstract
Objective Analyze the outcomes of proximal femoral locking compression plate (PF-LCP) in these complex fractures. Methods This study retrospectively analyzed 21 proximal femoral fractures treated with PF-LCP from June 2013 to February 2015. There were 15 females (71%) and six males (29%) with an average age of 61.4 years (range: 34–80 years). The peritrochanteric fractures constituted by intertrochanteric and subtrochanteric fractures were classified by the Boyd and Griffin classification and Seinshemier's classification, respectively. Among them, 16 cases (76%) were of intertrochanteric and five cases (24%) were of subtrochanteric fracture pattern. The functional outcome was assessed by Harris Hip Score and the Parker Palmer mobility score one year post-surgery. Results Among 21 patients, 19 patients obtained fracture union without further intervention; two patients required additional bone grafting. No cases of the hip screw cutting the femoral head were noted. There was no post-operative mortality in this study. The average Harris Hip Score was 84.5 (range: 83–94). The assessment by Parker and Palmar mobility score was 7.5 (range: 4–9). Conclusion The PF-LCP is a good, stable alternative in the treatment of peritrochanteric femoral fractures. It provides good-to-excellent bone healing with reduced complications.
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Affiliation(s)
- Syed Ibrahim
- Vinayaka Missions Medical College and Hospital, Department of Orthopaedics, Karaikal, Pondy India
| | - Jimmy Joseph Meleppuram
- Vinayaka Missions Medical College and Hospital, Department of Orthopaedics, Karaikal, Pondy India
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Ibrahim S, Meleppuram JJ. Uma análise retrospectiva de fraturas complexas do fêmur proximal tratadas cirurgicamente com placa de compressão bloqueada do fêmur proximal. Rev Bras Ortop 2017. [DOI: 10.1016/j.rbo.2016.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Hodel S, Beeres FJP, Babst R, Link BC. Complications following proximal femoral locking compression plating in unstable proximal femur fractures: medium-term follow-up. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2017; 27:1117-1124. [DOI: 10.1007/s00590-017-1981-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 05/16/2017] [Indexed: 11/28/2022]
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Arirachakaran A, Amphansap T, Thanindratarn P, Piyapittayanun P, Srisawat P, Kongtharvonskul J. Comparative outcome of PFNA, Gamma nails, PCCP, Medoff plate, LISS and dynamic hip screws for fixation in elderly trochanteric fractures: a systematic review and network meta-analysis of randomized controlled trials. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2017; 27:937-952. [PMID: 28434124 DOI: 10.1007/s00590-017-1964-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Accepted: 04/17/2017] [Indexed: 11/30/2022]
Abstract
The ideal implant for the treatment of an unstable intertrochanteric femoral fracture is still a matter of discussion. The aim of this systematic review is to conduct a network meta-analysis of randomized controlled trials (RCTs) comparing clinical outcomes between dynamic hip screws (DHS), Medoff sliding plating, percutaneous compression plating (PCCP), proximal femoral nails (PFN), Gamma nails and less invasive stabilization system fixation in femoral trochanteric fractures in the elderly. These clinical outcomes consist of total intra-operative time, intra-operative fluoroscopy time, intra-operative blood loss, blood component transfusion, length of hospital stay, postoperative general complications, wound complications, late complications and reoperation rates. This systematic review was conducted using PubMed and Scopus search engines for RCTs comparing clinical outcomes between treatments from inception to February 22, 2015. Thirty-six of 785 studies identified were eligible. Compared to the other implants, PCCP showed the lowest total operative time and units of blood transfusion with an unstandardized mean difference (UMD) of 29.27 min (95% CI 5.24, 53.50) and 0.89 units (95% CI 0.52, 1.25). The lowest incidence of general complications, wound complications and late complications of PCCP was 0.09 (95% CI 0.04, 0.18), 0.01 (95% CI 0.01, 0.04) and 0.05 (95% CI 0.02, 0.11), respectively, when compared to others. The lowest fluoroscopic time was with DHS with an UMD of 0.24 min (95% CI 0.16, 0.32), whereas the lowest blood loss and shortest hospital stay were with PFN with an UMD of 233.61 ml of blood loss (95% CI 153.17, 314.04) and 7.23 days of hospital stay (95% CI 7.15, 7.31) when compared to all other fixation methods. Reoperation rates of all implants had no statistically significant difference. The network meta-analysis suggested that fixation with PCCP significantly shortens operative time and decreases the units of blood transfusion required, while also lowering risks of general complications, wound complications and late complications when compared to fixation. Use of PFN showed the least intra-operative blood loss and shortest hospital stay. Multiple active treatment comparisons indicate that PCCP fixation in trochanteric fractures in the elderly is the treatment of choice in terms of intra-operative outcomes and postoperative complications.
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Affiliation(s)
| | | | - Pichaya Thanindratarn
- Department of Orthopedic Surgery, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | | | - Phutsapong Srisawat
- Department of Orthopedic Surgery, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
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Gadegone WM, Shivashankar B, Lokhande V, Salphale Y. Augmentation of proximal femoral nail in unstable trochanteric fractures. SICOT J 2017; 3:12. [PMID: 28186871 PMCID: PMC5302881 DOI: 10.1051/sicotj/2016052] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 12/09/2016] [Indexed: 12/02/2022] Open
Abstract
Introduction: Biomechanically proximal femoral nail (PFN) is a better choice of implant, still it is associated with screw breakage, cut out of screw through femoral head, Z effect, reverse Z effect, and lateral migration of screws. The purpose of this study is to evaluate the results of augmented PFN in terms of prevention of postoperative complications and failure rates in unstable trochanteric fractures. Material and methods: We carried out a prospective study of 82 cases with unstable trochanteric femoral fractures from April 2010 to December 2015. Forty-two females and 40 males in the age group between 58 and 81 years were included in this study. There were 45 cases of AO 31 A2 (2.2, 2.3) and 37 cases of AO 31 A3 (3.1, 3.2, 3.3). Fractures were fixed by PFN with augmentation by an additional screw from trochanter to inferior quadrant of femoral head or cerclage wire to strengthen the lateral trochanteric wall. Results: The bone healing is observed in all the cases in the mean period of 14.2 weeks. Nine patients developed complications, including lateral migration of neck screws (n = 5), Z effect (n = 1), infection (n = 2), and breakage of distal interlocking bolt in one case. Removal of screws was required in five cases. Patients were followed up for a mean of 8.4 months. At the end of follow-up the Salvati and Wilson hip function was 32 (out of 40) in 88% of patients. Conclusion: The stabilization of lateral trochanteric wall with additional screw or cerclage wire increases the stability of construct.
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Affiliation(s)
- Wasudeo M Gadegone
- Department of Orthopaedic and Traumatology, Associate Professor of Orthopaedics, GMC, 442402 Chandrapur, Maharashtra, India
| | | | - Vijayanad Lokhande
- Department of Orthopaedic and Traumatology, Assistant Professor of Orthopaedics, Smt. Kashibai Nawale Medical college, Maharashtra, India
| | - Yogesh Salphale
- Department of Orthopaedic and Traumatology, Assistant Professor of Orthopaedics, Smt. Kashibai Nawale Medical college, Maharashtra, India
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Dumbre Patil SS, Karkamkar SS, Dumbre Patil VS, Patil SS, Ranaware AS. Author's reply. Indian J Orthop 2017; 51:348-349. [PMID: 28566792 PMCID: PMC5439326 DOI: 10.4103/ortho.ijortho_435_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Sampat S Dumbre Patil
- Department of Orthopaedics, Noble Hospital, Pune, Maharashtra, India,Address for correspondence: Dr. Sampat S Dumbre Patil, Department of Orthopaedics, Noble Hospital, 153, Magarpatta City Road, Hadapsar, Pune - 411 013, Maharashtra, India. E-mail:
| | | | | | - Shailesh S Patil
- Department of Orthopaedics, Noble Hospital, Pune, Maharashtra, India
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Shah MD, Kapoor CS, Soni RJ, Patwa JJ, Golwala PP. Evaluation of outcome of proximal femur locking compression plate (PFLCP) in unstable proximal femur fractures. J Clin Orthop Trauma 2017; 8:308-312. [PMID: 29062210 PMCID: PMC5647620 DOI: 10.1016/j.jcot.2016.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 09/02/2016] [Accepted: 11/11/2016] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Pertrochanteric fractures are most frequent factures of the proximal femur, accounts for nearly 50% of all proximal femur fractures and are most devastating and also a major cause of disability in elderly. The aim and objective of this study was to evaluate the role of proximal femoral locking compression plate in unstable proximal femur fractures. MATERIAL AND METHOD A total of 20 cases were included in our study (M:F - 16:4), who suffered proximal femur fracture due to various modalities and all of them were operated using proximal femoral locking compression plate. This proximal femoral fractures included unstable - intertrochanteric with subtrochanteric extension and subtrochanteric with intertrochanteric extensions as well as one case with intertrochanteric, subtrochanteric and neck of femur fracture. Patients were followed up regularly and minimum follow-up period was 12 months. Patients were given physiotherapy and partial weight bearing was started after 6 weeks postoperatively or after union was achieved. The outcome was evaluated as per Harris Hip Score and radiological union. RESULT Among 20 cases with average age of 55.3 ± 17.9 years, treated with PF-LCP, the average time of union 18.75 ± 3.67 weeks was achieved. We got 10 excellent, 3 good, 3 fair and 4 poor result with average Harris Hip Score of 80.2 ± 28.54 with 65% good to excellent result with average Post-operative Neck Shaft Angle of 124.150 ± 17.880 and with 45% rate of complication which included four cases of superficial infection and two cases of deep infection and late complications like four cases of non-union, deformity - three cases of coxa vara and 2 cases of coxa valga, with patients having more than one complication in them. CONCLUSION PF-LCP is not recommended as a definitive implant but can be used as an alternative for the treatment of unstable proximal femoral fractures when there is no option available for other routinely used implants. Despite of its complications, PF-LCP is used where all implants fail.
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Affiliation(s)
| | - Chirag S. Kapoor
- Corresponding author at: 541, Ramdarsh Bungalow, Bank of India Lane, Opposite Manusmruti Hospital, Adjacent Gayatri Flats, Subhanpura, Vadodara, Gujarat 390023, India.541, Ramdarsh Bungalow, Bank of India Lane, Opposite Manusmruti Hospital, Adjacent Gayatri Flats, SubhanpuraVadodaraGujarat390023India
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Abstract
Intramedullary devices are used increasingly to treat intertrochanteric femur fractures, especially those with unstable patterns. In spite of the considerable use of nails in the management of these fractures, opinions differ about the correct length of intramedullary nail. Long nails were developed to address the risk of diaphyseal fracture associated with earlier short nail designs and to extend the indications for use to include diaphyseal and subtrochanteric fractures. Several recent studies, however, have found no differences between modern short nails and long nails with regard to union and complication rates. In the absence of existing guidelines, the treating surgeon's preference and fracture characteristics continue to influence the decision of whether to use short nails or long nails. The surgeon needs to consider the fracture configuration and related factors, including whether osteoporosis is present and the cost and risk of revision surgery, when selecting the appropriate nail length.
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Effectiveness of treatment of transtrochanteric fractures with Dynamic Hip Screws using minimally invasive access. Rev Bras Ortop 2016; 51:138-42. [PMID: 27069880 PMCID: PMC4811999 DOI: 10.1016/j.rboe.2016.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 04/24/2015] [Indexed: 11/20/2022] Open
Abstract
Objective To analyze the short-term results from treating unstable intertrochanteric fractures with Dynamic Hip Screws (DHS), using a minimally invasive route, focusing on the functional aspects and complication and mortality rates of the method. Methods This was a prospective longitudinal study on 140 patients who underwent fixation of transtrochanteric fractures with the DHS system with a lateral minimally invasive access in the hip, between January and December 2013. The patients were evaluated pre and postoperatively (after six months of follow-up) by means of the Parker and Palmer mobility score. Women comprised 65.7% of the sample, and 54.3% of the fractures were on the right side. The patients’ mean age was 80 years, ranging from 60 to 93 years. Results We observed an overall decrease in the mobility score and an increase in the degree of dependence over the short term. However, we encountered only two deaths in the study sample and there were no cases of infection or nonunion. Conclusion Despite the efficacy of the treatment with DHS, with high rates of fracture consolidation and a low mortality rate, we noted that the patients still showed significant functional limitation at the follow-up six months after the operation.
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Skála-Rosenbaum J, Džupa V, Bartoška R, Douša P, Waldauf P, Krbec M. Distal locking in short hip nails: Cause or prevention of peri-implant fractures? Injury 2016; 47:887-92. [PMID: 26961434 DOI: 10.1016/j.injury.2016.02.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 02/14/2016] [Accepted: 02/16/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The most common cause of femoral fractures after osteosynthesis of trochanteric fractures with short nails is weakening of the femoral cortex via distal locking and stress concentrations at the tip of the nail. The aim of the study was to verify whether the incidence of peri-implant fractures is dependent upon the distal locking technique. METHODS We prospectively analysed a group of 849 pertrochanteric fractures (AO/ASIF 31-A1+2) managed with short nails from 2009 to 2013. Unlocked nailing was performed in 70.1% and distal dynamic locking was performed in 29.9%. The mean age was 82.0 years. Peri-implant fractures were divided into 3 groups according to the height of the fracture in relation to the tip of the nail. RESULTS In total 17 fractures (2.0%) were detected. One peri-implant fracture occurred after locked nailing, whereas 16 cases occurred after unlocked nailing (p=0.037). Patients without distal locking had an 85.7% greater risk of peri-implant fracture. Fractures of the proximal femur (Type I) occurred significantly earlier than fractures at the tip of the nail (Type II) (p=0.028). CONCLUSION Unlocked nails do not guarantee sufficient stability. Distal locking serves to prevent postoperative femoral fractures. We recommend the routine use of distal locking when utilizing short nails.
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Affiliation(s)
- Jiří Skála-Rosenbaum
- Department of Orthopedics and Traumatology, Charles University 3rd Faculty of Medicine and Kralovske Vinohrady Teaching Hospital, Šrobárova 50, 10034 Prague, Czech Republic.
| | - Valér Džupa
- Department of Orthopedics and Traumatology, Charles University 3rd Faculty of Medicine and Kralovske Vinohrady Teaching Hospital, Šrobárova 50, 10034 Prague, Czech Republic
| | - Radek Bartoška
- Department of Orthopedics and Traumatology, Charles University 3rd Faculty of Medicine and Kralovske Vinohrady Teaching Hospital, Šrobárova 50, 10034 Prague, Czech Republic
| | - Pavel Douša
- Department of Orthopedics and Traumatology, Charles University 3rd Faculty of Medicine and Kralovske Vinohrady Teaching Hospital, Šrobárova 50, 10034 Prague, Czech Republic
| | - Petr Waldauf
- Department of Orthopedics and Traumatology, Charles University 3rd Faculty of Medicine and Kralovske Vinohrady Teaching Hospital, Šrobárova 50, 10034 Prague, Czech Republic
| | - Martin Krbec
- Department of Orthopedics and Traumatology, Charles University 3rd Faculty of Medicine and Kralovske Vinohrady Teaching Hospital, Šrobárova 50, 10034 Prague, Czech Republic
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Sambandam SN, Chandrasekharan J, Mounasamy V, Mauffrey C. Intertrochanteric fractures: a review of fixation methods. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2016; 26:339-53. [PMID: 27028746 DOI: 10.1007/s00590-016-1757-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 02/25/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Senthil Nathan Sambandam
- Department of Orthopaedics, K.G. Hospital and Postgraduate Medical Institute, Arts College Road, Coimbatore, Tamil Nadu, 641018, India
| | - Jayadev Chandrasekharan
- Department of Orthopaedics, K.G. Hospital and Postgraduate Medical Institute, Arts College Road, Coimbatore, Tamil Nadu, 641018, India
| | - Varatharaj Mounasamy
- VCU Medical Center, Ambulatory Care Center, 417 North 11th Street, Richmond, VA, USA.
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Eficácia do tratamento das fraturas transtrocanterianas com Dynamic Hip Screw com acesso minimamente invasivo. Rev Bras Ortop 2016. [DOI: 10.1016/j.rbo.2015.04.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Nyholm AM, Palm H, Malchau H, Troelsen A, Gromov K. Lacking evidence for performance of implants used for proximal femoral fractures - A systematic review. Injury 2016; 47:586-94. [PMID: 26803696 DOI: 10.1016/j.injury.2016.01.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 01/04/2016] [Accepted: 01/06/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Evaluation of the long-term performance of implants used in trauma surgery relies on post-marked clinical studies since no registry based implant assessment exists. The purpose of this study was to evaluate the evidence of performance of implants currently used for treating proximal femoral fractures (PFF) in Denmark. METHOD PubMed was searched for clinical studies on primary PFF with follow-up ≥12 months, reporting implant-related failure and evaluating one of following: DHS, CHS, HipLoc, Gamma3, IMHS, InterTan, PFN, PFNA or PTN. LIMITS English language and publication date after 1st of January 1990. RESULTS All studies were evidence level II or III. 30 publications for SHS were found: 13 of CHS, 15 of DHS and 2 of HipLoc. In total CHS was evaluated in 1110 patients (900 prospectively), DHS in 2486 (567 prospectively) and HipLoc in 251 (all prospectively). Fifty-four publications for nails were found: 13 of Gamma3, 7 of IMHS, 5 of InterTan, 10 of PFN, 24 of PFNA and 0 of PTN. In total Gamma3 was evaluated in 1088 patients (829 prospectively), IMHS in 1543 (210 prospectively), InterTan in 595 (585 prospectively), PFN in 716 (557 prospectively), PFNA in 1762 (1018 prospectively) and PTN in 0. CONCLUSIONS The clinical evidence behind the current implants used for proximal femoral fractures is weak considering the number of implants used worldwide. Sporadic evaluation is not sufficient to identify long term problems. A systematic post market surveillance of implants used for fracture treatment, preferable by a national register, is necessary in the future.
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Affiliation(s)
- Anne Marie Nyholm
- Clinical Orthopaedic Research Hvidovre, Department of Orthopaedics, Copenhagen University Hospital Hvidovre, Kettegaard Alle 30, DK-2650 Hvidovre, Denmark.
| | - Henrik Palm
- Clinical Orthopaedic Research Hvidovre, Department of Orthopaedics, Copenhagen University Hospital Hvidovre, Kettegaard Alle 30, DK-2650 Hvidovre, Denmark
| | - Henrik Malchau
- Orthopedic Department, Massachusetts General Hospital, 55 Fruit Street, GRJ 1126, Boston, MA, United States
| | - Anders Troelsen
- Clinical Orthopaedic Research Hvidovre, Department of Orthopaedics, Copenhagen University Hospital Hvidovre, Kettegaard Alle 30, DK-2650 Hvidovre, Denmark
| | - Kirill Gromov
- Clinical Orthopaedic Research Hvidovre, Department of Orthopaedics, Copenhagen University Hospital Hvidovre, Kettegaard Alle 30, DK-2650 Hvidovre, Denmark
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Dumbre Patil SS, Karkamkar SS, Patil VSD, Patil SS, Ranaware AS. Reverse distal femoral locking compression plate a salvage option in nonunion of proximal femoral fractures. Indian J Orthop 2016; 50:374-8. [PMID: 27512218 PMCID: PMC4964769 DOI: 10.4103/0019-5413.185598] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND When primary fixation of proximal femoral fractures with implants fails, revision osteosynthesis may be challenging. Tracts of previous implants and remaining insufficient bone stock in the proximal femur pose unique problems for the treatment. Intramedullary implants like proximal femoral nail (PFN) or surface implants like Dynamic Condylar Screw (DCS) are few of the described implants for revision surgery. There is no evidence in the literature to choose one implant over the other. We used the reverse distal femur locking compression plate (LCP) of the contralateral side in such cases undergoing revision surgery. This implant has multiple options of fixation in proximal femur and its curvature along the length matches the anterior bow of the femur. We aimed to evaluate the efficacy of this implant in salvage situations. MATERIALS AND METHODS Twenty patients of failed primary proximal femoral fractures who underwent revision surgery with reverse distal femoral locking plate from February 2009 to November 2012 were included in this retrospective study. There were 18 subtrochanteric fractures and two ipsilateral femoral neck and shaft fractures, which exhibited delayed union or nonunion. The study included 14 males and six females. The mean patient age was 43.6 years (range 22-65 years) and mean followup period was 52.1 months (range 27-72 months). Delayed union was considered when clinical and radiological signs of union failed to progress at the end of four months from initial surgery. RESULTS All fractures exhibited union without any complications. Union was assessed clinically and radiologically. One case of ipsilateral femoral neck and shaft fracture required bone grafting at the second stage for delayed union of the femoral shaft fracture. CONCLUSIONS Reverse distal femoral LCP of the contralateral side can be used as a salvage option for failed fixation of proximal femoral fractures exhibiting nonunion.
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Affiliation(s)
- Sampat S Dumbre Patil
- Department of Orthopaedics, Noble Hospital, Hadapsar, Pune, Maharashtra, India,Address for correspondence: Dr. Sampat S Dumbre Patil, Department of Orthopaedics, Noble Hospital, 153, Magarpatta City Road, Hadapsar, Pune - 411 013, Maharashtra, India. E-mail:
| | - Sachin S Karkamkar
- Department of Orthopaedics, Noble Hospital, Hadapsar, Pune, Maharashtra, India
| | | | - Shailesh S Patil
- Department of Orthopaedics, Noble Hospital, Hadapsar, Pune, Maharashtra, India
| | - Abhijeet S Ranaware
- Department of Orthopaedics, Noble Hospital, Hadapsar, Pune, Maharashtra, India
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Asif N, Ahmad S, Qureshi OA, Jilani LZ, Hamesh T, Jameel T. Unstable Intertrochanteric Fracture Fixation - Is Proximal Femoral Locked Compression Plate Better Than Dynamic Hip Screw. J Clin Diagn Res 2016; 10:RC09-13. [PMID: 26894134 DOI: 10.7860/jcdr/2016/11179.7084] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 06/23/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Intertrochanteric fractures are one of the most common fractures encountered in our practice. Most of them need operative intervention and union is achieved. As per the literature dynamic hip screw (DHS) is the gold standard for the treatment of these fractures, however problem arises with maintenance of neck shaft angle and proper reduction in unstable intertrochanteric fractures. The situation gets more complex when "cut out" of femoral head screw occurs either alone or in combination with varus collapse when they are treated with DHS. Here we are giving results of unstable intertrochanteric fractures treated with Proximal Femoral Locked Compression Plate (PFLCP) as compared with similar patients treated with Dynamic Hip Screw (DHS). MATERIALS AND METHODS The study included a total of 27 patients (17 males, 10 females) with unstable intertrochanteric fractures who were subjected to PFLCP treatment from March 2011 to November 2012 in one group. Another was a similar group of 35 patients treated with DHS from March 2008 to February 2010. Results of group 1 were compared with group 2. Detailed clinical conditions of all patients, duration of surgery, blood loss, length of incision and duration of image intensifier use were recorded. Patients were revisited at 6 weeks, 3 months, 6 months and 1 year after operation. Results were evaluated clinically by Harris hip Score and radiologically for fracture union. Progress of union and complications (limb shortening, varus collapse, cut out of femoral head screw and medialization of distal fragment) were recorded. RESULTS Among 27 patients treated with PFLCP, one patient expired 6 week postoperatively and one patient lost to follow up, so 25 patients were evaluated for final outcome of which 23 (92%) showed union at follow up of 12 months. One patient developed bending of proximal screws and three developed varus collapse. Among the group treated with DHS, eight patients developed varus collapse, seven developed medialization and three had femoral head screw cut out. According to Harris hip Score 88% cases had good to excellent result in PFLCP group whereas only 60% cases in the DHS group had good to excellent result. CONCLUSION Treatment of unstable intertrochanteric fractures with proximal femoral locked plate (PFLCP) can give good healing, with a limited occurrence of complication.
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Affiliation(s)
- Naiyer Asif
- Associate Professor, Department of Orthopaedics, Surgery, J. N. Medical College, A.M.U. , Aligarh, Uttar Pradesh, India
| | - Sohail Ahmad
- Assistant Professor, Department of Orthopaedics, Surgery, J. N. Medical College, A.M.U. , Aligarh, Uttar Pradesh, India
| | - Owais Ahmad Qureshi
- Assistant Professorr, Department of Orthopaedics, Surgery, J. N. Medical College, A.M.U. , Aligarh, Uttar Pradesh, India
| | - Latif Zafar Jilani
- Assistant Professor, Department of Orthopaedics, Surgery, J. N. Medical College, A.M.U. , Aligarh, Uttar Pradesh, India
| | - Tajdar Hamesh
- Senior Resident, Department of Orthopaedics Surgery, J. N. Medical College, A.M.U. , Aligarh, Uttar Pradesh, India
| | - Tariq Jameel
- Junior Resident, Department of Orthopaedics Surgery, J. N. Medical College, A.M.U. , Aligarh, Uttar Pradesh, India
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Zhang L, Shen J, Chen S, Wu Z, Huang Z, He S, Ying Z, Liu D, Wang Y. Treatment of unstable intertrochanteric femoral fractures with locking gamma nail (LGN): A retrospective cohort study. Int J Surg 2015; 26:12-7. [PMID: 26718612 DOI: 10.1016/j.ijsu.2015.12.064] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Revised: 11/23/2015] [Accepted: 12/19/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Intertrochanteric femoral fractures remain a challenge to orthopedists. Although technologies and instruments have been continuously improved, fixation failure still poses a problem in the treatment of unstable intertrochanteric femoral fractures. The objective of the present study was to evaluate the clinical efficacy of a new type of intramedullary fixing device--locking gamma nail (LGN)--in treating unstable intertrochanteric femoral fractures. METHODS From March 2009 to March 2012, 88 patients with unstable intertrochanteric femoral fractures were treated at our department with LGNs. Twelve patients were excluded from the study. The clinical and radiographic results of the remaining 76 patients were retrospectively analyzed. RESULTS The mean duration of operation, volume of blood loss, and hospital stay was 50 min, 85 mL, and 8.5 days, respectively. No perioperative complications. Seven patients died 1 year after surgery. The other 69 patients received a mean 23-month follow-up. The mean fracture healing time was 16 weeks. Nine patients felt pain in their hips. Ten patients experienced delayed fracture healing. No other complications. Sixty-one patients had recovered to preoperative levels of function, with a mean Harris hip score of 86.6 and a mean Parker-Palmer mobility score of 7.42. Patients with malreduction were more likely to sustain pain complications (p = 0.002). Older patients were more likely to experience delayed fracture healing (p = 0.045). CONCLUSIONS LGN is a simple and safe treatment for unstable intertrochanteric femoral fractures with satisfactory clinical efficacy and may be considered a new, minimally invasive operative method for treating unstable intertrochanteric femoral fractures.
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Affiliation(s)
- Lei Zhang
- Department of Orthopaedics, The 118th PLA Hospital, Wenzhou, Zhejiang, 325000, China.
| | - Jie Shen
- National & Regional United Engineering Laboratory of Tissue Engineering, Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China
| | - Sixu Chen
- Department of Orthopaedics, The 118th PLA Hospital, Wenzhou, Zhejiang, 325000, China
| | - Zhendong Wu
- Department of Orthopaedics, The 118th PLA Hospital, Wenzhou, Zhejiang, 325000, China
| | - Zaiyu Huang
- Department of Orthopaedics, The 118th PLA Hospital, Wenzhou, Zhejiang, 325000, China
| | - Shuai He
- Department of Stomatology, The 118th PLA Hospital, Wenzhou, Zhejiang, 325000, China
| | - Zhihao Ying
- Department of Orthopaedics, The 118th PLA Hospital, Wenzhou, Zhejiang, 325000, China
| | - Dan Liu
- Department of Orthopaedics, The 118th PLA Hospital, Wenzhou, Zhejiang, 325000, China
| | - Yong Wang
- Department of Orthopaedics, Integrated Traditional Chinese and Western Medicine Hospital of Wenzhou, Wenzhou, Zhejiang, 325000, China.
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Labronici PJ, da Silva RF, Viana AMS, Blunck SS, Franco JS, Neto SR, Pires RES, Canto R. Is there a difference in the positioning of sliding screws between stable and unstable extracapsular fractures? Rev Bras Ortop 2015; 50:30-7. [PMID: 26229893 PMCID: PMC4519572 DOI: 10.1016/j.rboe.2015.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 02/27/2014] [Indexed: 11/29/2022] Open
Abstract
Objective To analyze the tip–apex distance (TAD), cervicodiaphyseal angle and Garden angle in stable and unstable extracapsular fractures of the femur treated with a plate and sliding screw. Method Hip radiographs in anteroposterior (AP) and lateral view on 117 patients were evaluated. The fractures were classified as stable or unstable, using the AO classification, and the reduction achieved was assessed in accordance with the following criteria: TAD > 3 cm; Garden alignment index (AP) < 160°; and AP cervicodiaphyseal varus angle < 125°. When two or more criteria were present, the quality of the osteosynthesis was classified as “not ideal”. Results The patients with unstable fractures presented AP cervicodiaphyseal angles that were significantly greater (p = 0.05) than in those with stable fractures. The patients with unstable fractures presented lateral cervicodiaphyseal angles that were significantly smaller (p = 0.05) than in those with stable fractures. There were no significant differences in the remainder of the criteria evaluated. Conclusion This study did not find any significant differences in the measurements evaluated, except in relation to the cervicodiaphyseal angle. Satisfactory reduction was achieved both for the stable and for the unstable fractures, when we used a plate and sliding screw to treat proximal extracapsular fractures of the femur.
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Affiliation(s)
- Pedro José Labronici
- Prof. Dr. Donato D'Ângelo Orthopedics and Traumatology Service, Hospital Santa Teresa, Petrópolis, RJ, Brazil
| | - Rodrigo Freitas da Silva
- Prof. Dr. Donato D'Ângelo Orthopedics and Traumatology Service, Hospital Santa Teresa, Petrópolis, RJ, Brazil
| | - Ana Maria Santos Viana
- Prof. Dr. Donato D'Ângelo Orthopedics and Traumatology Service, Hospital Santa Teresa, Petrópolis, RJ, Brazil
| | - Saulo Santos Blunck
- Prof. Dr. Donato D'Ângelo Orthopedics and Traumatology Service, Hospital Santa Teresa, Petrópolis, RJ, Brazil
| | - José Sergio Franco
- Department of Orthopedics and Traumatology, School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Sergio Ricardo Neto
- Prof. Dr. Donato D'Ângelo Orthopedics and Traumatology Service, Hospital Santa Teresa, Petrópolis, RJ, Brazil
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Gordon M, Berntsson PO, Sjölund E, Demir Y, Hedbeck CJ, Stark A, Sköldenberg O. Loss of offset after pertrochanteric hip fractures affects hip function one year after surgery with a short intramedullary nail. A prospective cohort study. INTERNATIONAL ORTHOPAEDICS 2015; 40:799-806. [DOI: 10.1007/s00264-015-2815-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 05/09/2015] [Indexed: 10/23/2022]
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Shen J, Luo F, Sun D, Huang Q, Xu J, Dong S, Xie Z. Mid-term results after treatment of intertrochanteric femoral fractures with percutaneous compression plate (PCCP). Injury 2015; 46:347-57. [PMID: 24880886 DOI: 10.1016/j.injury.2014.04.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 03/10/2014] [Accepted: 04/20/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND With the ageing of the population, intertrochanteric femoral fracture is associated with increased morbidity. There is continuing controversy over the best treatment for the injury, and the choice of internal fixation method has been a focus of dispute. The purpose of this study was to evaluate the results of these fractures being treated with the percutaneous compression plate (PCCP) technique. METHODS From March 2009 to May 2012, 154 patients with intertrochanteric femoral fractures were treated using the PCCP method. Forty-one patients were excluded from the study. According to the AO classification, the remaining 113 fractures were classified as 35 cases of 31A1 fractures, 59 cases of 31A2 fractures, and 19 cases of 31A3 fractures. The clinical data and imaging results were retrospectively analysed. RESULTS The mean operation time was 42.0 (range, 25-82) min, the mean intraoperative blood loss was 40.5 (range, 10-100) ml, and the mean hospital stay was 8.6 (range, 3-18) days. One patient died of renal failure in the perioperative period. Twelve patients died during the 12 months after surgery. The remaining 100 patients were followed-up for 12-36 months and healed their fractures except one, whose neck screw cut out from the femoral neck after 1 postoperative month and resulting in a revision to a hemiarthroplasty. The mean time to bone healing was 12.6 (range, 6-23) weeks. Sixteen patients had pain. There were 13 major device-related complications, including 5 cases of coxa vara, 4 cases of fracture collapse, 2 cases of head penetration, and 2 cases of fracture collapse combined with head penetration. At the time of the last follow-up, 81 patients had regained a pre-injury level of function. The median Harris hip score was 89 points. The median Parker-Palmer score was 7 points. Patients with poor quality of reduction and bad positioning of neck screw were more likely to suffer complications (p<0.05). CONCLUSION The results suggest that the PCCP is an effective and safe method in the treatment of all types of intertrochanteric femoral fractures, but good fracture reduction and ideal positioning of the neck screw are prerequisites for the success of the device.
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Affiliation(s)
- Jie Shen
- National & Regional United Engineering Laboratory of Tissue Engineering, Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Fei Luo
- National & Regional United Engineering Laboratory of Tissue Engineering, Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Dong Sun
- National & Regional United Engineering Laboratory of Tissue Engineering, Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Qiang Huang
- National & Regional United Engineering Laboratory of Tissue Engineering, Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Jianzhong Xu
- National & Regional United Engineering Laboratory of Tissue Engineering, Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Shiwu Dong
- Department of Biomedical Materials Science, College of Biomedical Engineering, Third Military Medical University, Chongqing 400038, China
| | - Zhao Xie
- National & Regional United Engineering Laboratory of Tissue Engineering, Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing 400038, China.
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von Rüden C, Hungerer S, Augat P, Trapp O, Bühren V, Hierholzer C. Breakage of cephalomedullary nailing in operative treatment of trochanteric and subtrochanteric femoral fractures. Arch Orthop Trauma Surg 2015; 135:179-185. [PMID: 25466724 DOI: 10.1007/s00402-014-2121-6] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Mechanical breakage of cephalomedullary nail osteosynthesis is a rare complication attributed to delayed fracture union or nonunion. This study presents a series of cases of breakage and secondary lag screw dislocation after cephalomedullary nailing. The aim of this study was to identify factors that contribute to cephalomedullary nail breakage. MATERIALS AND METHODS In a retrospective case series review between 02/2005 and 12/2013, we analyzed 453 patients with trochanteric and subtrochanteric fracture who had been treated by cephalomedullary nailing. Fractures were classified according to AO/OTA classification. 13 patients with cephalomedullary nail breakage were included (failure rate 2.9 %). RESULTS Seven patients were women, and six men with a mean age of 72 years (range 35-94). Implant breakage occurred 6 months postoperatively (range 1-19 months). In ten cases, breakage was secondary to delayed or nonunion, which was thought to be mainly due to insufficient reduction of the fracture, and in two cases due to loss of the lag screw because of missing set screw. In one case, breakage was apparent during elective metal removal following complete fracture healing. Short-term outcome was evaluated 6 months after operative revision using Harris hip score in 11 out of 13 patients showing a mean score of 84 %. Complete radiological fracture healing has been found in 11 patients available for follow-up within 6 months after revision surgery. DISCUSSION Breakage of cephalomedullary nail osteosynthesis of trochanteric fractures is a severe complication. The results of our study demonstrate that revision surgery provides good clinical and radiological short-term results. Predominately, failures of trochanteric fractures are related to lack of surgeon performance. Therefore, application of the implant requires accurate preoperative planning, advanced surgical experience to evaluate the patient and the fracture classification, and precise surgical technique including attention to detail and anatomical reduction of the fracture fragments.
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Affiliation(s)
- Christian von Rüden
- Department of Trauma Surgery, Trauma Center Murnau, Professor-Küntscher-Str. 8, 82418, Murnau, Germany.
| | - Sven Hungerer
- Department of Trauma Surgery, Trauma Center Murnau, Professor-Küntscher-Str. 8, 82418, Murnau, Germany
| | - Peter Augat
- Institute of Biomechanics, Trauma Center Murnau, Murnau, Germany
| | - Oliver Trapp
- Department of Trauma Surgery, Trauma Center Murnau, Professor-Küntscher-Str. 8, 82418, Murnau, Germany.,Institute of Biomechanics, Trauma Center Murnau, Murnau, Germany
| | - Volker Bühren
- Department of Trauma Surgery, Trauma Center Murnau, Professor-Küntscher-Str. 8, 82418, Murnau, Germany
| | - Christian Hierholzer
- Department of Trauma Surgery, Trauma Center Murnau, Professor-Küntscher-Str. 8, 82418, Murnau, Germany
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A C U, E W, B K, C J, A P S. Treatment of trochanteric fractures with the gamma3 nail - methodology and early results of a prospective consecutive monitored clinical case series. Open Orthop J 2015; 8:466-73. [PMID: 25621082 PMCID: PMC4300511 DOI: 10.2174/1874325001408010466] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 11/18/2014] [Accepted: 11/23/2014] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES There is only sparse data on clinical results and complications of the third-generation Gamma nailing system (Gamma3, Stryker). Therefore, we started a large multi-centre case series in 2008. The aim of this paper is to present the study design and early results of a single arm of a prospective, consecutive, monitored, post-market follow-up evaluation of Gamma3 nails. METHODS From September 2009 to January 2012, 154 consecutive patients with an average age of 80 ± 1.43 years (50-99 years) and a trochanteric femoral fracture were included in the local arm of the trial. All patients that fulfilled the inclusion criteria were treated with a Gamma3 nail. Preoperative variables included age, gender, fracture classification, walking ability (Merle d'Aubigné score), daily activity level (retrospective Zuckerman score), ASA rating of operative risk, waiting time for operation, use of walker or crutches and body mass index (BMI). Skin-to-skin time, fluoroscopy time, blood loss, intraoperative complications and device information were recorded for each patient. Follow-up postoperative assessment was undertaken at 4, 12 and 24 months. Hip range of motion, pain around the hip and the tight, walking ability (Merle d'Aubigné score, Sahlgrenska mobility score) and management of daily life (Zuckerman score) were used to evaluate the outcome. RESULTS The descriptive data of age, gender, BMI, ASA classification, fracture type and skin-to-skin time is similar to other studies. Median fluoroscopy time was 62 seconds (range: 4-225 seconds) and significantly shorter in closed reductions. No intraoperative implant-related complication was recorded. A cut-out of the leg-screw during assessment period occurred in 2.6% patients (n = 4). At the 12-month assessment two (1.8%) non-unions were identified and two patients (1.8%) had broken the femoral shaft below the 180 mm nail after a fall. Analysis of the scores showed significantly declined mobility and activity in daily life four months after operation which increased significantly from four to 12 months and increased slightly between 12 and 24 months after fracture. CONCLUSION A low implant-associated complication rate was achieved in geriatric patients with trochanteric femoral fractures using the Gamma3 nail. A better outcome concerning mobility, activity in daily life and complications compared to the Gamma2 nail could not be found in comparison to historic data.
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Affiliation(s)
- Unger A C
- University Hospital SH, Campus Luebeck, Department of Trauma and Orthopaedics, Germany
| | - Wilde E
- University Hospital SH, Campus Luebeck, Department of Trauma and Orthopaedics, Germany
| | | | - Jürgens C
- University Hospital SH, Campus Luebeck, Department of Trauma and Orthopaedics, Germany ; BG Trauma Hospital Hamburg, Germany
| | - Schulz A P
- University Hospital SH, Campus Luebeck, Department of Trauma and Orthopaedics, Germany ; BG Trauma Hospital Hamburg, Germany
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Labronici PJ, Silva RFD, Viana AMS, Blunck SS, Franco JS, Neto SR, Santos Pires RE, Canto R. Existe diferença no posicionamento do parafuso deslizante entre as fraturas extracapsulares estáveis e instáveis? Rev Bras Ortop 2015. [DOI: 10.1016/j.rbo.2014.02.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Guerra MTE, Pasqualin S, Souza MP, Lenz R. Functional recovery of elderly patients with surgically-treated intertrochanteric fractures: preliminary results of a randomised trial comparing the dynamic hip screw and proximal femoral nail techniques. Injury 2014; 45 Suppl 5:S26-31. [PMID: 25528621 DOI: 10.1016/s0020-1383(14)70017-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Intertrochanteric fractures of the femur are prevalent in the elderly, and leave patients with functional restrictions after surgical treatment. The aim of this study was to compare the functional recovery at 1-year follow-up of elderly patients with intertrochanteric fractures treated surgically with the dynamic hip screw (DHS) or proximal femoral nail (PFN) fixation techniques. MATERIAL AND METHODS This prospective, randomised, blinded trial included patients aged over 65 years with intertrochanteric fractures classified as AO group 31.A1 or 31.A2. The patients were allocated into one of two treatment groups: one treated with DHS and the other with PFN. Data on functional recovery were obtained using the Functional Recovery Score developed by Zuckerman for elderly patients with hip fracture. Variables were described as means and standard deviations, and the non-parametric Kolmogorov-Smirnov test was used to verify the normality of data distribution. Non-normally distributed variables were compared using the non-parametric Friedman and Mann-Whitney U tests. Data processing and analysis were carried out in SPSS 10.0. Results were deemed significant at the 5% level (p ≤ 0.05). RESULTS There were no significant between-group differences in age (p=0.152), sex (p=0.363), or American Society of Anaesthesiologists (ASA) score (p=0.579). Functional recovery scores in the DHS group at 3 and 6 months after surgery were significantly reduced from preoperative baseline scores (p=0.007) compared with in the PFN group. However, there were no statistically significant differences between the two groups in functional recovery scores at baseline (p=0.346) or at 3 months (p=0.880), 6 months (p=0.699), and 12 months (p=0.468) after surgery. There was no between-group difference in mortality (p=0.140). CONCLUSION At 1-year follow-up, functional recovery scores were similar in elderly patients treated with the DHS and PFN techniques. However, DHS-treated patients exhibited significant loss of function in the first 6 months after surgery, which did not occur in the PFN-treated group.
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Affiliation(s)
- Marcelo T E Guerra
- Hospital Universitário de Canoas, Canoas, RS, Brazil; Universidade Luterana do Brasil (ULBRA), Porto Alegre, RS, Brazil.
| | | | | | - Renata Lenz
- Hospital Universitário de Canoas, Canoas, RS, Brazil
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Zhang K, Zhang S, Yang J, Dong W, Wang S, Cheng Y, Al-Qwbani M, Wang Q, Yu B. Proximal femoral nail vs. dynamic hip screw in treatment of intertrochanteric fractures: a meta-analysis. Med Sci Monit 2014; 20:1628-33. [PMID: 25213190 PMCID: PMC4170652 DOI: 10.12659/msm.890962] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background The aim of this meta-analysis was to compare the outcomes of proximal femoral nail (PFN) and dynamic hip screw (DHS) in treatment of intertrochanteric fractures. Material/Methods Relevant randomized or quasi-randomized controlled studies comparing the effects of PFN and DHS were searched for following the requirements of the Cochrane Library Handbook. Six eligible studies involving 669 fractures were included. Their methodological quality was assessed and data were extracted independently for meta-analysis. Results The results showed that the PFN group had significantly less operative time (WMD: −21.15, 95% CI: −34.91 – −7.39, P=0.003), intraoperative blood loss (WMD: −139.81, 95% CI: −210.39 – −69.22, P=0.0001), and length of incision (WMD: −6.97, 95% CI: −9.19 – −4.74, P<0.00001) than the DHS group. No significant differences were found between the 2 groups regarding postoperative infection rate, lag screw cut-out rate, or reoperation rate. Conclusions The current evidence indicates that PFN may be a better choice than DHS in the treatment of intertrochanteric fractures.
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Affiliation(s)
- Kairui Zhang
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, China (mainland)
| | - Sheng Zhang
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, China (mainland)
| | - Jun Yang
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, China (mainland)
| | - Weiqiang Dong
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, China (mainland)
| | - Shengnan Wang
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, China (mainland)
| | - Yirong Cheng
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, China (mainland)
| | - Mohammed Al-Qwbani
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, China (mainland)
| | - Qiang Wang
- Department of Orthopaedics, Subei People's Hospital of Jiangsu Province (Clinical Medical College of Yangzhou University), Yangzhou, China (mainland)
| | - Bin Yu
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, China (mainland)
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Audigé L, Cagienard F, Sprecher CM, Suhm N, Müller MA. Radiographic quantification of dynamic hip screw migration. INTERNATIONAL ORTHOPAEDICS 2014; 38:839-45. [PMID: 24146176 PMCID: PMC3971271 DOI: 10.1007/s00264-013-2146-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Accepted: 09/25/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE This study aimed to propose a technique to quantify dynamic hip screw (DHS®) migration on serial anteroposterior (AP) radiographs by accounting for femoral rotation and flexion. METHODS Femoral rotation and flexion were estimated using radiographic projections of the DHS® plate thickness and length, respectively. The method accuracy was evaluated using a synthetic femur fixed with a DHS® and positioned at pre-defined rotation and flexion settings. Standardised measurements of DHS® migration were trigonometrically adjusted for femoral rotation and flexion, and compared with unadjusted estimates in 34 patients. RESULTS The mean difference between the estimated and true femoral rotation and flexion values was 1.3° (95% CI 0.9-1.7°) and -3.0° (95% CI - 4.2° to -1.9°), respectively. Adjusted measurements of DHS® migration were significantly larger than unadjusted measurements (p = 0.045). CONCLUSION The presented method allows quantification of DHS® migration with adequate bias correction due to femoral rotation and flexion.
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Affiliation(s)
- Laurent Audigé
- />AO Clinical Investigation and Documentation, AO Foundation, Duebendorf, Switzerland
| | - Flurin Cagienard
- />Department of Orthopaedic Surgery and Traumatology, University Hospital of Basel, Spitalstrasse 21, CH-4031 Basel, Switzerland
| | | | - Norbert Suhm
- />Department of Orthopaedic Surgery and Traumatology, University Hospital of Basel, Spitalstrasse 21, CH-4031 Basel, Switzerland
| | - Marc Andreas Müller
- />Department of Orthopaedic Surgery and Traumatology, University Hospital of Basel, Spitalstrasse 21, CH-4031 Basel, Switzerland
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Zhang L, Shen J, Yu S, Huang Q, Xie Z. Percutaneous compression plate versus dynamic hip screw for treatment of intertrochanteric Hip fractures: a meta-analyse of five randomized controlled trials. ScientificWorldJournal 2014; 2014:512512. [PMID: 24737975 PMCID: PMC3967693 DOI: 10.1155/2014/512512] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Accepted: 12/11/2013] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Percutaneous compression plating (PCCP) has been advocated to reduce blood loss, relieve pain, and lead to faster rehabilitation for the treatment of intertrochanteric fractures. The purpose of this meta-analysis was to estimate the outcomes and complications of the PCCP versus dynamic hip screw (DHS) fixation for intertrochanteric fractures. METHODS All randomized controlled trials (RCT) that compared PCCP with DHS in treating adult patients with intertrochanteric fractures were included. Main outcomes were collected and analysed using the RevMan 5.1 version. RESULTS Five trials met the inclusion criteria. Compared with DHS, PCCP had similar operation time (95% CI: -26.01~4.05, P = 0.15), length of hospitalization (95% CI: -1.79~1.25, P = 0.73), mortality (95% CI: 0.37~1.02, P = 0.06), incidence of implant-related complications (95% CI: 0.29~1.82, P = 0.49), and reoperation rate (95% CI: 0.41~3.05, P = 0.83). But blood loss (95% CI: -173.84~-4.81, P = 0.04) and transfusion need (95% CI: -0.53~-0.07, P = 0.01) significantly favored the PCCP. CONCLUSIONS The PCCP was associated with reduced blood loss and less transfusion need, but similar to DHS in other respects. Owing to the limitations of this systematic review, more high-quality RCTs are still needed to assess the clinical efficiency of PCCP.
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Affiliation(s)
- Lei Zhang
- National & Regional United Engineering Laboratory of Tissue Engineering, Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
- Department of Orthopaedics, The 118th Hospital of PLA, No. 15 Jiafusi Xiang, Wenzhou, Zhejiang 325000, China
| | - Jie Shen
- National & Regional United Engineering Laboratory of Tissue Engineering, Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Shengpeng Yu
- National & Regional United Engineering Laboratory of Tissue Engineering, Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Qiang Huang
- National & Regional United Engineering Laboratory of Tissue Engineering, Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Zhao Xie
- National & Regional United Engineering Laboratory of Tissue Engineering, Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
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Strike SA, Sieber FE, Gottschalk A, Mears SC. Role of fracture and repair type on pain and opioid use after hip fracture in the elderly. Geriatr Orthop Surg Rehabil 2014; 4:103-8. [PMID: 24600530 DOI: 10.1177/2151458513518343] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND PURPOSE Pain after hip fracture repair is related to worse functional outcomes and higher fracture care costs than that for patients with no or less pain. However, to our knowledge, few studies have examined the roles of hip fracture type or surgical procedure as factors influencing postoperative pain or opioid analgesic requirements. Our goal was to determine whether the type of hip fracture or hip fracture repair affects postoperative pain or opioid analgesic requirements in the elderly patient. METHODS We conducted a retrospective review of 231 patients ≥65 years old admitted to a hip fracture center for surgical repair. Fracture patterns were classified into femoral neck (FN) versus intertrochanteric (IT), stable versus unstable, and type of surgical repair. Demographic and intraoperative variables, postoperative pain scores, and opioid analgesic use data were collected and analyzed according to the type of hip fracture and type of surgical repair. RESULTS There were no differences in postoperative pain when comparing FN versus IT fractures, stable versus unstable fractures, or type of surgical repair. Patients with FN fractures had higher analgesic requirements on postoperative days 1, 2, and 3. There was no difference in postoperative analgesic requirements among patients with stable versus unstable fractures or type of surgical repair. Otherwise, there were no differences in postoperative pain or opioid analgesic use based on the surgical repair or fracture type. Overall, patients with hip fracture experienced low levels of pain.
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Affiliation(s)
- Sophia A Strike
- Department of Orthopaedic Surgery, The Johns Hopkins University/Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Frederick E Sieber
- Department of Anesthesiology, The Johns Hopkins University/Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Allan Gottschalk
- Department of Anesthesiology, The Johns Hopkins University, Baltimore, MD, USA
| | - Simon C Mears
- Department of Orthopaedic Surgery, The Johns Hopkins University/Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
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Complications following Treatment of Trochanteric Fractures with the Gamma3 Nail: Is the Latest Version of Gamma Nail Superior to Its Predecessor? Surg Res Pract 2014; 2014:143598. [PMID: 25374946 PMCID: PMC4208494 DOI: 10.1155/2014/143598] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 12/30/2013] [Indexed: 11/17/2022] Open
Abstract
Gamma nail is a cephalomedullary implant that was developed for the treatment of pertrochanteric hip fractures and has been successfully used for over 20 years. During this period, modifications of design and instrumentation have occurred to combat the intra- and postoperative complications that were associated with the use of early designs. The purpose of this study was to compare the complications observed with the use of the Gamma3 nail (G3N) with those seen following use of the previous trochanteric gamma nail (TGN). This study prospectively recorded the intra- and postoperative complications of 175 patients treated with the Gamma3 nail and compared them with those of a historical cohort of 192 patients treated with the trochanteric gamma nail. We encountered less intra- and postoperative complications with the use of Gamma3 nail. Femoral fractures and lag screw cutout were significantly lower. The reoperation rate was significantly higher in the TGN group. Gamma3 nail has proved to be a safe and efficient implant for the treatment of pertrochanteric fractures. The improvement of the biomechanical characteristics has led to a significant decrease in complication rates, demonstrating superiority over its predecessor.
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Hu SJ, Yu GR, Zhang SM. Surgical treatment of basicervical intertrochanteric fractures of the proximal femur with cephalomeduallary hip nails. Orthop Surg 2013; 5:124-9. [PMID: 23658048 DOI: 10.1111/os.12038] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Accepted: 01/27/2013] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To study the outcome of basicervical intertrochanteric fractures of the proximal femur treated with cephalomeduallary hip nails. METHODS The clinical outcomes of 32 cases of basicervical intertrochanteric fractures treated with cephalomeduallary hip nails from January 2008 to June 2010 were retrospectively reviewed and the progress of fracture healing and occurrence of complications recorded. The function of the hip joints was evaluated by the Harris social index 2 years postoperatively. RESULTS Thirty patients were followed up until fracture union for at least 24 months. Twenty-seven fractures had healed with no loss of position by 12 months postoperatively; the remaining three had mild varus deformity of the hip joint. No patient had evidence of avascular necrosis of the femoral head. No cut out of the helical blade was visible on radiographs. The mean Harris score was 86.5 (75-96) two years postoperatively, 11 patients having excellent scores, 15 good and 4 fair. CONCLUSION Closed reduction and proximal femur intramedullary nail fixation for basicervical intertrochanteric fractures provides stable fixation and allows early exercise. It appears to have excellent outcomes in the short and medium term.
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Affiliation(s)
- Sun-jun Hu
- Department of Orthopaedics, Tongji Hospital of Tongji University, Shanghai, China
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Georgiannos D, Bisbinas I. Gamma-3 nail mechanical failure. A report of two cases and a comprehensive review of literature. ACTA ACUST UNITED AC 2013. [DOI: 10.1007/s12570-013-0233-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Mechanical complications of intertrochanteric hip fractures treated with trochanteric femoral nails. J Trauma Acute Care Surg 2013; 75:304-10. [DOI: 10.1097/ta.0b013e31829a2c43] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Comparison of proximal femoral nail antirotation (PFNA) with AO dynamic condylar screws (DCS) for the treatment for unstable peritrochanteric femoral fractures. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2013; 24:347-52. [PMID: 23443746 PMCID: PMC3958814 DOI: 10.1007/s00590-013-1195-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 02/13/2013] [Indexed: 12/02/2022]
Abstract
Purpose The aim of this study was to compare the results of intramedullary fixation with those of plate-screw fixation for peritrochanteric femoral fracture patients older than 60 years old. Methods This article reports on a retrospective review of patients who had peritrochanteric femoral fractures and were treated with a 95° fixed-angle screw plate (DCS) or an intramedullary nailing system (PFNA). Patients with 79 fractures were enrolled in the study; 47 of them were treated with the PFNA system and 37 with the DCS. Followed for at least 1 year, the treatment groups were compared by taking into consideration all demographic and trauma variables. Results No significant differences were discovered between the two groups with regard to side of injury, mechanism of trauma, associated comorbidities, AO fracture classification, average follow-up duration, mortality, and fracture reduction quality at the 1-year follow-up. The average surgical time was significantly lower in the PFNA group (57 min.) compared to the DCS group (87 min.). Longer operative time was needed in the DCS group, and thus, greater blood loss occurred compared to the PFNA group. The functional results of the PFNA group were found to be significantly better than those of the DCS group. Conclusions Owing to some advantages, such as minimal exposure, reduced operative blood loss, and the achievement of biological fixation, PFNA is a better choice for the treatment for unstable peritrochanteric fractures.
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Leung F, Gudushauri P, Yuen G, Lau TW, Fang C, Chow SP. Dynamic hip screw blade fixation for intertrochanteric hip fractures. J Orthop Surg (Hong Kong) 2012; 20:302-6. [PMID: 23255634 DOI: 10.1177/230949901202000307] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To assess the one-year outcome of a dynamic hip screw (DHS) blade in the treatment of AO/OTA 31-A1 and 31-A2 intertrochanteric hip fractures. METHODS 35 men and 65 women aged 47 to 100 (mean, 83) years underwent fixation with a DHS blade for A1 (n=47) and A2 (n=53) intertrochanteric hip fractures after a low-energy injury. Patients were operated on within 48 hours of admission. Anteroposterior and lateral radiographs were examined for the tip-apex distance and femoral shortening. Potential complications were looked for, including implant migration, cut-out, loosening, or breakage. Functional outcome was based on the Parker mobility score. RESULTS The 30-day and one-year mortality rates were 5% and 20%, respectively. At the one-year follow-up, 81 patients were available, and all fractures had healed without varus deformity. The mean tip-apex distance was 14.1 (range, 5.7-31.1; SD, 4.3) mm. The mean femoral shortening was 4.9 (range, 0-20.2; SD, 4.8) mm. The mean Parker score decreased to 3.8 at one-year follow-up from 5.9 before injury (p<0.001). There was one loss of fixation secondary to a non-traumatic subcapital fracture at 3 months, for which a bipolar hemiarthroplasty was performed. CONCLUSION; The DHS blade system is effective in treating AO/OTA 31-A1 and 31-A2 intertrochanteric hip fractures and results in a low complication rate.
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Affiliation(s)
- Frankie Leung
- Department of Orthopaedics and Truamatology, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
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Hu SJ, Zhang SM, Yu GR. Treatment of femoral subtrochanteric fractures with proximal lateral femur locking plates. ACTA ORTOPEDICA BRASILEIRA 2012; 20:329-33. [PMID: 24453626 PMCID: PMC3861956 DOI: 10.1590/s1413-78522012000600003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Accepted: 03/26/2012] [Indexed: 01/02/2023]
Abstract
OBJECTIVE: To study the outcome of subtrochanteric hip fractures treated with proximal lateral femur locking plate. METHOD: We retrospectively reviewed the clinical results of 48 cases of femoral subtrochanteric fractures treated with proximal lateral femur locking plates from January 2008 to May 2010. The progress of fracture healing, as well as the occurrence of complications, was recorded. The function of the hip joint was evaluated by the Harris social index and the Parker and Palmer mobility score one year after the operation. RESULT: 45 patients were followed up until fracture union or a revision surgery. Among the 45 patients, 43 patients obtained fracture union without further intervention. Thirty-eight fractures healed with no loss of position at 1-year follow-up. There were no cases of hip screw cutting through the femoral head. The mean score of the Harris social index was 86.5±9.8 (73~95). The mean Parker and Palmer mobility score was 7.4±2.1 (3~9). CONCLUSION: The proximal lateral femur locking plate is the kind of stable and effective internal fixation for treating subtrochanteric hip fractures which has the advantage of stable fixation especially for the lateral femoral wall fracture. Level of Evidence IV, Case Series.
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Affiliation(s)
- Sun-Jun Hu
- Tongji University, República Popular da China
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Giessauf C, Glehr M, Bernhardt GA, Seibert FJ, Gruber K, Sadoghi P, Leithner A, Gruber G. Quality of life after pertrochanteric femoral fractures treated with a γ nail: a single center study of 62 patients. BMC Musculoskelet Disord 2012; 13:214. [PMID: 23110648 PMCID: PMC3518197 DOI: 10.1186/1471-2474-13-214] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Accepted: 10/17/2012] [Indexed: 11/16/2022] Open
Abstract
Background Intramedullary nailing of pertrochanteric femoral fractures has grown in popularity over the past 2 decades likely because this procedure is associated with a low risk for postoperative morbidity and a fast recovery of function. The evaluation of outcomes associated with pertrochanteric nailing has mainly been based on objective measures. The purpose of the present study is to correlate patients’ health-related quality of life results after intramedullary nailing of pertrochanteric fractures with objective outcome measures. Methods We conducted a single-center study including 62 patients (mean age 80 ± 10 years) with pertrochanteric fractures treated with a Gamma 3 Nail. Health related quality of life was measured using the Short Form-36. These results were compared to both US and Austrian age and sex-adjusted population norms. The objective outcome measures studied at one year postoperatively included Harris Hip Score, range of motion, leg length, body mass index, neck-shaft angle and grade of osteoarthritis. Results According to the Harris Hip Score 43 patients (67%) had excellent or good results. There was no significant difference in the average neck-shaft angle comparing affected hip to non-affected hip at 12 months postoperatively. The average osteoarthritis score, for both the injured and uninjured hip, did not differ significantly. We found significant differences between the bodily pain, social functioning and mental health subscales and two summary scores of the Short-Form 36 in comparison to Austrian population norms. Complication rate was 8%. Conclusions The results of this study confirm that intramedullary nailing with the use of a Gamma Nail is a safe treatment option for stable and unstable pertrochanteric fractures. Despite good functional and radiographic results we noticed a substantial fall off in patients’ quality of life up to 12 months after operation.
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