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Robioneck MW, Pishnamaz M, Becker N, Bolierakis E, Hildebrand F, Horst K. Development of early complications after treatment of trochanteric fractures with an intramedullary sliding hip screw in a geriatric population. Eur J Trauma Emerg Surg 2024; 50:329-337. [PMID: 38081966 DOI: 10.1007/s00068-023-02404-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/12/2023] [Indexed: 04/23/2024]
Abstract
PURPOSE Although trochanteric fractures (TF) are a frequent event in the geriatric population, studies reporting on complication rates associated with surgical treatment are sparse. Thus, this study investigated the relevance of fracture-, implant-, and surgery-associated complications in TF. Furthermore, the role of possible risk factors for the before mentioned complications was investigated. METHODS A consecutive series of patients with TF treated by intramedullary nailing with a sliding screw device was evaluated. Data were sampled retrospectively from the hospital patient information system and anonymized at the source. Demographic data and information regarding fracture pattern, the treatment performed, hospital stay, and evaluation of operative and follow-up radiographs were analyzed. Intraoperative problems (i.e., technical problems with the implant, intraoperative fracture) and postoperative complications were investigated. RESULTS Postoperative surgical complications were noted in 11.7%. The most frequent surgical problem was a difficult fracture reduction (13%) and intraoperative fracture dislocation (3.6%). The most frequent postoperative complication was intra-hospital mortality (3.6%), delayed/non-union (2.7%), and a cut-out of the lag screw in the femoral head (2.3%). Implant failure (1,4%) was significantly associated with morbid obesity while cut-out (2,3%) correlated with a higher tip-apex distance (TAD). A complex fracture type and a suboptimal screw position significantly increased the cut-out rate to 5% (p = 0.018). CONCLUSION Complications after TF treatment occur frequently. While patient-associated variables such as morbid obesity cannot be influenced by the surgeon, correct fracture reduction and implant positioning remain to be of highest importance.
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Affiliation(s)
| | - Miguel Pishnamaz
- Department of Orthopaedic Trauma and Reconstructive Surgery, University Hospital RWTH, Aachen, Germany
| | - Nils Becker
- Department of Orthopaedic Trauma and Reconstructive Surgery, University Hospital RWTH, Aachen, Germany
| | - Eftychios Bolierakis
- Department of Orthopaedic Trauma and Reconstructive Surgery, University Hospital RWTH, Aachen, Germany
| | - Frank Hildebrand
- Department of Orthopaedic Trauma and Reconstructive Surgery, University Hospital RWTH, Aachen, Germany
| | - Klemens Horst
- Department of Orthopaedic Trauma and Reconstructive Surgery, University Hospital RWTH, Aachen, Germany
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Jagow DM, Yacoubian SV, McCrink EJ, Yacoubian SV. A novel technique for the fixation of inter-trochantieric hip fractures: A telescoping lag screw. J Orthop 2018; 15:690-694. [PMID: 29881222 DOI: 10.1016/j.jor.2018.05.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 05/06/2018] [Indexed: 10/17/2022] Open
Abstract
One-hundred and three patients with intertrochanteric hip fractures as classified by the OTA 2007 system underwent fixation using the telescoping AOS Galileo lag screw system and ES Nail (a long IM nail). Thirty-one patients (76%) were female and ten (24%) were male, with an average age of 75.70 ± 11.3 years at date of surgery. At final follow-up 21 (53%) patients returned to their pre-fracture ambulatory status, 20 (47%) had a reduction in ambulatory status, and no patients were confined to a wheel chair. The telescoping capability of the AOS Galileo lag screw allowed for a decrease in total length by 3.96 ± 3.04 mm during fracture healing. The TAD distance at final follow-up was 14.09 ± 4.69 mm. Lateral protrusion of the lag screw into soft tissue did not occur. There was one reported incidence of femoral head cutout, which occurred after the lag screw had telescoped its entire distance and began functioning as a rigid non-compressible lag screw. All other fractures healed uneventfully and no device failure occurred. The AOS Galileo telescoping lag screw has shown promise concerning IT fracture fixation and will continue to undergo further investigation.
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Affiliation(s)
- Devin M Jagow
- Orthopaedic Surgery Specialists, 2625 West Alameda Avenue, Suite 116, Burbank, CA 91505, United States
| | - Shahan V Yacoubian
- Orthopaedic Surgery Specialists, 2625 West Alameda Avenue, Suite 116, Burbank, CA 91505, United States.,Department of Orthopaedic Surgery, Providence St Joseph Medical Center, 501 S Buena Vista St, Burbank, CA 91505, United States
| | - Edward J McCrink
- Orthopaedic Surgery Specialists, 2625 West Alameda Avenue, Suite 116, Burbank, CA 91505, United States
| | - Stephan V Yacoubian
- Orthopaedic Surgery Specialists, 2625 West Alameda Avenue, Suite 116, Burbank, CA 91505, United States.,Department of Orthopaedic Surgery, Providence St Joseph Medical Center, 501 S Buena Vista St, Burbank, CA 91505, United States
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Norris R, Bhattacharjee D, Parker MJ. Occurrence of secondary fracture around intramedullary nails used for trochanteric hip fractures: a systematic review of 13,568 patients. Injury 2012; 43:706-11. [PMID: 22142841 DOI: 10.1016/j.injury.2011.10.027] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Revised: 09/06/2011] [Accepted: 10/23/2011] [Indexed: 02/02/2023]
Abstract
INTRODUCTION A sliding hip screw (SHS) is currently the treatment of choice for trochanteric hip fractures, largely due to the low incidence of complications. An alternative treatment is the use of intramedullary proximal femoral nails. Unfortunately these implants have been associated with a risk of later fracture around the implant. The aim of this study was to see if any improvements have been made to the current intramedullary nails, to reduce the incidence of secondary fracture around the distal tip of the nail. METHODS We analysed data related to 13,568 patients from 89 studies, focusing on the incidence of post operative secondary femoral shaft fracture following the use of intramedullary nails in the fixation of trochanteric hip fractures. RESULTS The overall reported incidence of secondary fracture around the nail was 1.7%. The incidence of fracture has reduced in the 3rd generation Gamma nails when compared to the older Gamma nail (1.7% versus 2.6%, p value 0.03). However, the incidence of secondary fracture in the 3rd generation Gamma nails is still significantly higher than the other brands of short nail (1.7% versus 0.7%, p value 0.0005). Long nails had a slight tendency towards a lower risk of fracture although the difference was not statistically significant (1.1% versus 1.7%, p value 0.28). There was a significantly lower risk of fracture for those nails with a biaxial fixation as opposed to uniaxial fixation (0.6% versus 1.9%, p value <0.0001). CONCLUSION Secondary fracture around a proximal femoral nail is one of the most significant of fracture healing complications, and this study suggests that continuing design changes to this method of fixation has reduced the risk of this complication occurring.
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Affiliation(s)
- Rory Norris
- Peterborough District Hospital, Thorpe Road, Peterborough PE3 6DA, UK.
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Early complications associated with cephalomedullary nail for intertrochanteric hip fractures. J Trauma Acute Care Surg 2012; 72:E101-5. [DOI: 10.1097/ta.0b013e31821c2ef2] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Little NJ, Verma V, Fernando C, Elliott DS, Khaleel A. A prospective trial comparing the Holland nail with the dynamic hip screw in the treatment of intertrochanteric fractures of the hip. ACTA ACUST UNITED AC 2008; 90:1073-8. [PMID: 18669966 DOI: 10.1302/0301-620x.90b8.20825] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We compared the outcome of patients treated for an intertrochanteric fracture of the femoral neck with a locked, long intramedullary nail with those treated with a dynamic hip screw (DHS) in a prospective randomised study. Each patient who presented with an extra-capsular hip fracture was randomised to operative stabilisation with either a long intramedullary Holland nail or a DHS. We treated 92 patients with a Holland nail and 98 with a DHS. Pre-operative variables included the Mini Mental test score, patient mobility, fracture pattern and American Society of Anesthesiologists grading. Peri-operative variables were anaesthetic time, operating time, radiation time and blood loss. Post-operative variables were time to mobilising with a frame, wound infection, time to discharge, time to fracture union, and mortality. We found no significant difference in the pre-operative variables. The mean anaesthetic and operation times were shorter in the DHS group than in the Holland nail group (29.7 vs 40.4 minutes, p < 0.001; and 40.3 vs 54 minutes, p < 0.001, respectively). There was an increased mean blood loss within the DHS group versus the Holland nail group (160 ml vs 78 ml, respectively, p < 0.001). The mean time to mobilisation with a frame was shorter in the Holland nail group (DHS 4.3 days, Holland nail 3.6 days, p = 0.012). More patients needed a post-operative blood transfusion in the DHS group (23 vs seven, p = 0.003) and the mean radiation time was shorter in this group (DHS 0.9 minutes vs Holland nail 1.56 minutes, p < 0.001). The screw of the DHS cut out in two patients, one of whom underwent revision to a Holland nail. There were no revisions in the Holland nail group. All fractures in both groups were united when followed up after one year. We conclude that the DHS can be implanted more quickly and with less exposure to radiation than the Holland nail. However, the resultant blood loss and need for transfusion is greater. The Holland nail allows patients to mobilise faster and to a greater extent. We have therefore adopted the Holland nail as our preferred method of treating intertrochanteric fractures of the hip.
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Affiliation(s)
- N J Little
- Orthopaedic and Trauma Unit, Waikato Hospital, Pembroke Street, Hamilton, New Zealand.
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Corella Montoya F, Montoya Adarraga J, García Martín A, Villa A, Casteleiro González R, Vaquero Martín J, Riquelme Arias G. Correlación entre la biometría femoral de pacientes españoles y la osteosíntesis de fémur con clavo Gamma largo. Rev Esp Cir Ortop Traumatol (Engl Ed) 2008. [DOI: 10.1016/s1888-4415(08)74813-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Corella Montoya F, Montoya Adarraga J, García Martín A, Villa A, Casteleiro González R, Vaquero Martín J, Riquelme Arias G. Correlation between the Spanish patient's femoral biometrics and osteosynthesis with a long Gamma nail. Rev Esp Cir Ortop Traumatol (Engl Ed) 2008. [DOI: 10.1016/s1988-8856(08)70088-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Inglis MRB, Jaarsma RL. Intramedullary hip screw fixation of reverse oblique and transverse trochanteric femur fractures. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2008. [DOI: 10.1007/s00590-008-0309-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Shukla S, Johnston P, Ahmad MA, Wynn-Jones H, Patel AD, Walton NP. Outcome of traumatic subtrochanteric femoral fractures fixed using cephalo-medullary nails. Injury 2007; 38:1286-93. [PMID: 17981282 DOI: 10.1016/j.injury.2007.05.013] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2006] [Revised: 04/22/2007] [Accepted: 05/14/2007] [Indexed: 02/02/2023]
Abstract
We performed a retrospective review of 101 patients sustaining 102 traumatic, non-pathological subtrochanteric fractures treated with cephalo-medullary nailing over a period of 6 years from 1999 to 2005. Mean follow up was 24 weeks (range: 6-96). Twenty patients were lost to follow up and 21 died, whilst 57 of 60 fractures were followed to union. There were 19 fractures fixed in varus, as defined as a varus angulation of greater than 10 degrees at the fracture site. Implant failure, 9 of the 10 malunions and all 3 of the non-unions occurred in the varus group whilst only 1 malunion occurred in the satisfactory reduction group. This difference in outcome is statistically significant (p<0.0001). Twenty four of the 60 patients had undergone open reduction at the time of fixation. There were three malunions and one non-union in the open reduction group compared with six and two, respectively in the closed group (p>0.05). Post-operative recovery rates, infection rates and other complications were similar for both groups. We therefore advocate the use of open reduction where necessary to avoid varus malreduction to avoid such complications, particularly as open reduction was not associated with a higher complication rate in this series. The study supports the use of cephalo-medullary nailing for subtrochanteric fractures with a union rate of 95%.
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Affiliation(s)
- Sourav Shukla
- Leicester Royal Infirmary, Infirmary square, Leicester, LE1 5WW, United Kingdom.
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Sehat K, Baker RP, Pattison G, Price R, Harries WJ, Chesser TJS. The use of the long gamma nail in proximal femoral fractures. Injury 2005; 36:1350-4. [PMID: 16054630 DOI: 10.1016/j.injury.2005.03.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2005] [Revised: 03/10/2005] [Accepted: 03/10/2005] [Indexed: 02/02/2023]
Abstract
The results of 100 'Long Gamma Nails' (LGN) inserted in 97 patients, for the treatment of complex proximal femoral fractures and pathological lesions, are reported. The mean patient age was 74 (16-98). Seven significant complications occurred; four lag screws cut out, one broken nail, one infected non-union and one peri-prosthetic fracture. Five patients underwent revision either to total hip arthroplasty or exchange nailing. Seventy patients had follow-up of greater than 2 months (mean 10.8 months). Success was defined as stability of the fracture until union or death; this was achieved in 85% of cases. The mortality was 10% at 30 days and 25% at 1 year. The complication rate fell with increasing experience. Complex proximal femoral fractures are difficult to treat with all implants demonstrating high complication rates. The long gamma nail allowed early weight bearing and was effective in 85% of cases. Malpositioning of the implant should be avoided, as this was the leading cause of failure. Surgeon experience is an important factor but training of surgeons does not adversely affect outcome.
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Affiliation(s)
- K Sehat
- Department of Orthopaedics, Frenchay Hospital, North Bristol NHS Trust, Bristol BS16 1LE, UK
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