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Gupta SK, Esposito ER, Phillips R, Schwab PE, Leary EV, Hoernschemeyer DG. Effect of Antibiotic Prophylaxis on Infection Rates in Pediatric Supracondylar Humerus Fractures Treated with Closed Reduction and Percutaneous Pinning: A Prospective Double-Blinded Randomized Controlled Trial. J Am Acad Orthop Surg 2024; 32:410-416. [PMID: 38422496 DOI: 10.5435/jaaos-d-23-00795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 01/16/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Supracondylar humerus fractures (SCHFs) are the most common elbow fracture in the pediatric population. In the case of displaced fractures, closed reduction and percutaneous Kirschner wire pinning (CRPP) is commonly performed. Infection rates are between 0 and 7%; however, retrospective studies have shown no benefit of preoperative antibiotics. There continues to be notable variability in antibiotic usage based on surgeon preference and local institutional policy. We conducted a double-blinded, randomized controlled trial to evaluate whether antibiotic prophylaxis reduces the risk of infection in pediatric SCHF patients treated with CRPP. METHODS Pediatric patients with displaced SCHF who presented to a pediatric hospital were enrolled and randomized into two groups. Group I received one dose of prophylactic antibiotics (25 mg/kg cefazolin IV up to 1g or clindamycin 10 mg/kg up to 600 mg/kg IV in the case of cefazolin allergy). Group II received placebo (10-mL prefilled syringe of normal saline). All patients underwent CRPP and casting followed by pin removal 3 to 6 weeks after the initial procedure. The presence of pin-site infection, erythema, drainage, septic arthritis, and osteomyelitis was recorded. RESULTS One hundred sixty patients were enrolled in the study. Eighty-two patients were randomized to receive antibiotics, and 78 patients were randomized to placebo. No difference was seen in the rate of infection between the treatment groups (1.2% in the antibiotic group versus 1.3% in the placebo group; P = 1.00). Presence of purulent drainage (0.0% versus 1.3%; P = 0.49), septic arthritis (0.0% versus 0.0%; P = 1.00), and osteomyelitis (1.2% versus 0.0%; P = 1.00) was similar in both groups. No difference in the need for additional antibiotics (1.2% versus 1.3%; P = 1.00) or additional surgery (1.2% versus 0.0%; P = 1.00) was found between groups. DISCUSSION The use of antibiotic prophylaxis did not affect the risk of infection in pediatric patients who underwent CRPP for displaced SCHF. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov: NCT03261830. LEVEL OF EVIDENCE Therapeutic Level I.
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Affiliation(s)
- Sumit K Gupta
- From the Department of Orthopaedic Surgery, University of Missouri, Columbia, MO
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Cho WT, Jang JH, Park SR, Sohn HS. Radiographic outcomes and non-union factor analysis in fragmentary segmental femoral shaft fractures (AO/OTA 32C3) treated with reamed antegrade nailing. Sci Rep 2024; 14:8364. [PMID: 38600312 PMCID: PMC11006881 DOI: 10.1038/s41598-024-59136-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 04/08/2024] [Indexed: 04/12/2024] Open
Abstract
This study retrospectively assessed radiographic outcomes and risk factors associated with non-union in femoral shaft fragmentary segmental fractures (AO/OTA 32C3) treated with reamed antegrade intra-medullary nailing. Radiological outcomes, including union and alignment, were evaluated. The risk factors for non-union were investigated, including demographics and treatment-related characteristics, such as the number of interlocking screws, segmentation length, main third fragment length, distance of the main third fragment, width ratio and exposed nail length in one cortex from immediate post-operative radiographs. Multivariate logistic regression was used for statistical analysis. Among 2295 femoral shaft fracture patients from three level-1 trauma centers, 51 met the inclusion criteria. The radiological union was achieved in 37 patients (73%) with a mean union time of 10.7 ± 4.8 months. The acceptable axial alignment was observed in 30 patients (59%). Multiple logistic regression analysis identified only exposed nail length as a significant risk factor for non-union (odds ratio: 1.599, p = 0.003) and the cut-off value was 19.1 mm (sensitivity, 0.786; specificity, 0.811). The study revealed high rates of non-union (27%) and malalignment (41%). Therefore, patients who underwent intramedullary nailing with an exposed nail length greater than 19.1 mm or about twice the nail diameter should be cautioned of the potential non-union.
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Affiliation(s)
- Won-Tae Cho
- Department of Orthopaedic Surgery, School of Medicine, Ajou University Hospital, Suwon, Republic of Korea
| | - Jae Hoon Jang
- Department of Orthopaedic Surgery, Dong-eui Hospital, Busan, Republic of Korea
| | - Seung Ryeol Park
- Department of Orthopaedic Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, 162 Ilsan-dong, Wonju, 26426, Republic of Korea
| | - Hoon-Sang Sohn
- Department of Orthopaedic Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, 162 Ilsan-dong, Wonju, 26426, Republic of Korea.
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Gathen M, Burger C, Kasapovic A, Kabir K. Proximal Femur Fractures - How Decisive are Reduction and the Chosen Implant? Z Orthop Unfall 2024; 162:135-142. [PMID: 36167326 DOI: 10.1055/a-1904-8551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Proximal femoral fractures are frequent and complex injuries requiring prompt and targeted care. Numerous treatment strategies have been described, some of which have been assessed and clinically implemented clinically. The aim of surgical is always the restoration of a pain-free and stable extremity. Mostly elderly patients are affected and treatment is associated with high postoperative complications and mortality rates. With increasing numbers of patients, the topic is of great medical and economic relevance. In this work, the choice of implants for the osteosynthesis of proximal femoral fractures - as depending on the fracture type - will be examined, as based on a review of current literature. Standard care includes cannulated screws, sliding hips screws and cephalomedullary nails. In addition, the influence of implant positioning, fracture reduction and additional measures such as cement augmentation are evaluated and discussed. Careful fracture reduction and the quality of implant positioning are paramount in order to avoid complications.
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Affiliation(s)
- Martin Gathen
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn Chirurgisches Zentrum, Bonn, Deutschland
| | - Christof Burger
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn Chirurgisches Zentrum, Bonn, Deutschland
| | - Adnan Kasapovic
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn Chirurgisches Zentrum, Bonn, Deutschland
| | - Koroush Kabir
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn Chirurgisches Zentrum, Bonn, Deutschland
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Tsugeno H, Takegami Y, Tokutake K, Mishima K, Nakashima H, Kobayashi K, Imagama S. Comparing short vs. intermediate and long nails in elderly patients with unstable multifragmental femoral trochanteric fractures (AO type A2): Multicenter (TRON group) retrospective study. Injury 2024; 55:111420. [PMID: 38401233 DOI: 10.1016/j.injury.2024.111420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 01/31/2024] [Accepted: 02/06/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND Unstable femoral trochanteric fractures (FTFs), especially Arbeitsgemeinschaft für Osteosynthesefragen/ the Orthopedic Trauma Association (AO/OTA) 31-A2 fractures, which are multifragment fractures, occur in elderly individuals with osteoporosis and are associated with high mortality and complication rates due to prolonged immobilization. Longer nails (LNs) were developed to obtain superior fracture site stabilization in unstable FTFs. We hypothesized that the postoperative outcomes of elderly patients with unstable FTFs treated with LNs would be superior to those of patients treated with short nails (SNs), with fewer complications. METHODS This multicenter retrospective study aimed to compare the outcomes of SNs versus LNs in elderly patients with unstable FTFs. From the Trauma Research Group of our university (TRON) database, 1854 trochanteric fractures treated between January 2016 and December 2020 were extracted. A total of 174 patients>65 years of age with AO/OTA 31-A2 fractures were included in the present study. They were divided into the SN group and the LN group and matched for age and sex. Parameters such as operative time, blood loss, survival rate, Parker Mobility Score (PMS), and numerical rating scale (NRS) for pain, complications, and radiographic findings were analyzed. RESULTS Both groups included 67 patients with an average age of 87.32 years. The LN group had a longer operative time (76.52 min vs. 51.61 min, P < 0.001) and more blood loss (106.79 mL vs. 49.98 mL, P = 0.014) in comparison to the SN group. However, the 1-year survival rate, PMS, and NRS for pain did not differ to a statistically significant extent between the groups. The rates of complications, including screw cutout, nonunion, implant breakage, osteonecrosis of the femoral head, and surgical site infections, were comparable. The radiographic findings, including the nail/canal ratio, progression of varus, and sliding distance, were also similar. CONCLUSION Although LNs are associated with longer operative times and increased blood loss, the overall outcomes and complication rates are comparable to those of SNs in elderly patients with AO/OTA 31-A2 type unstable FTFs. The use of LNs did not confer any distinct advantages for this specific type of fracture.
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Affiliation(s)
- Hidetoshi Tsugeno
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuhiko Takegami
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Katsuhiro Tokutake
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenichi Mishima
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroaki Nakashima
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuyoshi Kobayashi
- Department of Orthopaedic Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Qiang H, Congming Z, Teng M, Kun Z, Chaofeng W. Plate augmentation and hybrid bone grafting are effective treatments for atrophic nonunion of the femur with the original intramedullary nail retained in situ. Sci Rep 2024; 14:7089. [PMID: 38528078 DOI: 10.1038/s41598-024-57809-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 03/21/2024] [Indexed: 03/27/2024] Open
Abstract
The purpose of this study is to evaluate the efficacy of plate augmentation and hybrid bone grafting for treating atrophic nonunion of the femur with original intramedullary nail retained in situ.In this study, 36 patients with atrophic nonunion of the femur who underwent surgery using the technique of plate augmentation and a hybrid bone grafting while retaining the original intramedullary nail in situ in Xi'an Honghui Hospital from January 2019 to December 2021 were enrolled. 28 patients who met the inclusion and exclusion criteria were ultimately included in the study. These 28 patients, consisting of 20 males and 8 females with a mean age of 38 years, were evaluated based on factors such as operation time, intraoperative blood loss, the average hospitalization days. Additionally, the results and function of these patients were evaluated by union time, Wu's scores of limb function and incidence of serious complications.All 28 patients achieved bone union at the 12 month follow-up, with an average follow-up time of 14.6 ± 4.2 months.The average operation time was 68.3 ± 11.2 min, and the average intraoperative blood loss was 140 ± 22.6 ml. Patients were hospitalized for an average of 5.8 ± 1.1 days. Full clinical and radiological bone union was achieved on average at 5.1 ± 1.9 months. The mean value of Wu's scores at the 12 month follow-up was significantly higher than before the operation. Limb function was excellent in 27 patients and good in one patient at the 12 month follow-up. However, five patients experienced the lower limb vein thrombosis, including one deep vein thrombosis and four lower limb intermuscular vein thromboses. One patient had a superficial infections of the surgical incision site, while three patients reported pain and numbness where their iliac bone graft was extracted at the 12 month follow-up. The technique of plate augmentation and hybrid bone grafting, combined with retaining the original intramedullary nail in situ has been shown to be a safe, effective, simply and standardizable practice for treating atrophic femoral nonunion with an intact original IMN fixation.
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Affiliation(s)
- Huang Qiang
- Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, No.76 Nanguo Road, Beilin District, Xi'an, 710054, Shaanxi, China
| | - Zhang Congming
- Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, No.76 Nanguo Road, Beilin District, Xi'an, 710054, Shaanxi, China
| | - Ma Teng
- Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, No.76 Nanguo Road, Beilin District, Xi'an, 710054, Shaanxi, China
| | - Zhang Kun
- Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, No.76 Nanguo Road, Beilin District, Xi'an, 710054, Shaanxi, China
| | - Wang Chaofeng
- Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, No.76 Nanguo Road, Beilin District, Xi'an, 710054, Shaanxi, China.
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Rehm A, Clegg R, Linardatou Novak P, Butt J, Hatzantoni K. Incidence, risk factors, and consequences of radiographic pin migration after pinning of pediatric supracondylar humeral fractures. J Pediatr Orthop B 2024; 33:198-199. [PMID: 38299641 DOI: 10.1097/bpb.0000000000001153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Affiliation(s)
- Andreas Rehm
- Department of Paediatric Orthopaedics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Kook I, Oh CW, Shon OJ, Kim JW, Kim JW, Hwang KT, Park KC. Comparing outcomes of plate augmentation, nail exchange, and nail exchange with plate augmentation in the treatment of atrophic femoral shaft nonunion after intramedullary nailing: a multicenter retrospective study. Arch Orthop Trauma Surg 2024; 144:1259-1268. [PMID: 38372763 DOI: 10.1007/s00402-023-05183-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 12/11/2023] [Indexed: 02/20/2024]
Abstract
INTRODUCTION Intramedullary (IM) nailing is the treatment of choice for femoral shaft fractures, but nonunion rates have been reported to be as high as 12%. Surgical interventions for nonunion involve exchange nailing or plate augmentation. Recently, a combined treatment of exchange nailing and plate augmentation has demonstrated good results, but its comparative effectiveness remains unclear. This study aimed to compare the clinical and radiographic outcomes of three different surgical interventions for atrophic femoral shaft nonunion, and investigate the factors that affect bone healing after reoperation. MATERIALS AND METHODS A retrospective study was conducted at five university hospitals involving 149 patients with aseptic atrophic nonunion after IM nailing. These patients underwent reoperation with plate augmentation, exchange nailing, or combined treatment. Clinical and radiographic outcomes were assessed and compared according to reoperation procedure. Logistic regression analysis was performed to identify factors affecting persistent nonunion after reoperation. RESULTS Of the cohort, 57 patients underwent plate augmentation, 64 underwent exchange nailing, and 28 received combined treatment. There were no significant differences in patient demographics among the groups. Exchange nailing produced a significantly lower union rate than did the combined treatment (82.8% vs. 100%, p = 0.016), whereas no significant difference was observed in the union rate and time to the union between plate augmentation and the combined treatment. Combined treatment showed the longest operative time and the greatest transfusion requirements. The risk factors for persistent nonunion included age, absence of autogenous bone grafts, and use of an exchange nailing technique. CONCLUSIONS Exchange nailing as a treatment for atrophic femoral shaft nonunion after IM nailing resulted in a lower union rate. The efficacy of the combined treatment requires further study, and persistent nonunion may be influenced by age, bone grafting, and surgical techniques. A comprehensive approach targeting both biological environment and mechanical stability is crucial in the treatment of atrophic femoral shaft nonunion.
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Affiliation(s)
- Incheol Kook
- Department of Orthopaedic Surgery, Hanyang University Hospital, Seoul, South Korea
| | - Chang-Wug Oh
- Department of Orthopaedic Surgery, Kyungpook National University Hospital, Daegu, South Korea
| | - Oog-Jin Shon
- Department of Orthopaedic Surgery, Yeungnam University Medical Center, Daegu, South Korea
| | - Joon-Woo Kim
- Department of Orthopaedic Surgery, Kyungpook National University Hospital, Daegu, South Korea
| | - Ji-Wan Kim
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Kyu Tae Hwang
- Department of Orthopaedic Surgery, Hanyang University Hospital, Seoul, South Korea
| | - Ki-Chul Park
- Department of Orthopaedic Surgery, Hanyang University Guri Hospital, 153, Gyeongchun-ro, Guri, Gyeonggi-do, 11923, South Korea.
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Devendra A, Patra SK, Velmurugesan P, Zackariya M, Ramesh P, Arun Kamal C, Dheenadhayalan J, Rajasekaran S. Results of a simple treatment protocol for aseptic femoral shaft nonunion in 330 patients. Injury 2024; 55:111412. [PMID: 38341997 DOI: 10.1016/j.injury.2024.111412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/21/2024] [Accepted: 01/27/2024] [Indexed: 02/13/2024]
Abstract
INTRODUCTION Our primary aim of the study was to assess the results of a treatment protocol for aseptic femoral shaft nonunion treated by three techniques - Exchange Nailing (EN), Plate Augmentation (PA), and Exchange Nailing combined with Plate augmentation (NP). The secondary objective was to assess the radiological outcome, duration of surgery (DOS) and need for blood transfusion (BT) in all the three groups. MATERIALS AND METHODS We analyzed 330 patients treated for AFNU between Jan 2007 and Dec 2019. Using a simple treatment algorithm, EN, PA and NP were performed in 24,183 and 123 patients respectively. Patients in all the three groups were assessed for radiological-union (union rate and time to union), DOS and BT. RESULTS Of these 330 patients, 327 (99 %) patients achieved radiological union at a mean duration of 6.07 months. Union rate is highest with NP followed by PA and EN. The union rate in patients with NP, PA and EN were 100 %, 99.5 % and 91.7 % respectively (p < 0.01). Time to union was lowest for NP followed by PA and EN (p < 0.001).The mean time to union for NP, PA and EN were 3.76, 7.2and 9.21 months respectively (p < 0.001). The mean DOS in minutes for NP, EN and PA was 107, 94 and 82 respectively (p < 0.01). The mean need for BT in the form of packed red blood cells for NP, PA and EN were 1.95, 1.87 and 1.38 units respectively (p < 0.01). CONCLUSION Following a simple algorithm to decide treatment protocol on a case-to case basis helps to achieve good results in an optimal time period. When compared with EN and PA, NP is associated with 100 % union rate with least time to union making NP a reasonably effective procedure with a very high success rate. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Agraharam Devendra
- Department of Orthopaedics and Trauma, Ganga Medical Centre & Hospitals Pvt Ltd, Tamil Nadu, India.
| | - Sudipta Kumar Patra
- Department of Orthopaedics and Trauma, Ganga Medical Centre & Hospitals Pvt Ltd, Tamil Nadu, India
| | - P Velmurugesan
- Department of Orthopaedics and Trauma, Ganga Medical Centre & Hospitals Pvt Ltd, Tamil Nadu, India
| | - Mohd Zackariya
- Department of Orthopaedics and Trauma, Ganga Medical Centre & Hospitals Pvt Ltd, Tamil Nadu, India
| | - P Ramesh
- Department of Orthopaedics and Trauma, Ganga Medical Centre & Hospitals Pvt Ltd, Tamil Nadu, India
| | - Chandramohan Arun Kamal
- Department of Orthopaedics and Trauma, Ganga Medical Centre & Hospitals Pvt Ltd, Tamil Nadu, India
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Fernandez M, Du Bourg VM, David Y, Dubrana F, Letissier H, Di Francia R. Augmented versus non-augmented Trochanteric Fixation Nail-Advanced (TFNA) nails for treating trochanteric fractures in patients over sixty-five years of age. Int Orthop 2024; 48:831-840. [PMID: 38159137 DOI: 10.1007/s00264-023-06073-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 12/15/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE Intramedullary nailing is a common treatment for pertrochanteric fractures. However, implant-related mechanical failures, such as cut-out and cut-through, lead to higher rates of revision surgery, loss of autonomy, and mortality. Cemented augmentation enhances the bone-implant interface. This study compared the frequency of mechanical failures between augmented and non-augmented Trochanteric Fixation Nail-Advanced (TFNA) nails. METHODS This descriptive, retrospective study at a level 1 trauma centre included patients aged > 65 years with pertrochanteric fractures treated by a short augmented or non-augmented TFNA nail. The primary outcome was the comparison of cut-out or cut-through rates between groups at three and six months postoperatively. RESULTS Of the 181 patients analysed, 103 had augmented TFNA nails and 78 had non-augmented TFNA nails. There were no statistically significant differences between groups in terms of demographic characteristics, AO/OTA classification, or quality of reduction. The failure rate was significantly lower in the augmented group than in the non-augmented group: 1 (0.97%) versus 9 (11.54%) (p = 0.005). At six months postoperatively, there was no significant difference between the two groups concerning functional recovery, as measured by the Parker and EuroQoL 5-Dimensions scores. CONCLUSIONS For patients aged over 65 years, the use of the augmented TFNA nail may reduce the risk of fixation failures such as cut-out.
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Affiliation(s)
- Marie Fernandez
- Service d'Orthopédie Et de Traumatologie, CHRU Brest Cavale Blanche, Boulevard Tanguy Prigent, 29200, Brest, France
| | - Valentin Merle Du Bourg
- Service d'Orthopédie Et de Traumatologie, CHU Grenoble Alpes - Hôpital Sud, Avenue de Kimberley, 38130, Echirolles, France
| | - Yoann David
- Service d'Orthopédie Et de Traumatologie, CHRU Brest Cavale Blanche, Boulevard Tanguy Prigent, 29200, Brest, France
| | - Frédéric Dubrana
- Service d'Orthopédie Et de Traumatologie, CHRU Brest Cavale Blanche, Boulevard Tanguy Prigent, 29200, Brest, France
| | - Hoel Letissier
- Service d'Orthopédie Et de Traumatologie, CHRU Brest Cavale Blanche, Boulevard Tanguy Prigent, 29200, Brest, France
| | - Rémi Di Francia
- Service d'Orthopédie Et de Traumatologie, CHRU Brest Cavale Blanche, Boulevard Tanguy Prigent, 29200, Brest, France.
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Cho YH, Kim S, Koo J, Byun SE. Failure after intramedullary nailing for geriatric trochanteric fracture: does quality of fracture reduction on the AP and lateral planes show the same results? Arch Orthop Trauma Surg 2024; 144:1233-1241. [PMID: 38167750 DOI: 10.1007/s00402-023-05176-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 12/05/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE This study aimed to investigate the failure of trochanteric fracture fixation according to the quality of fracture reduction on the anteroposterior (AP) and lateral views. METHODS Data from 340 female and 152 male patients ≥ 60 years of age who underwent intramedullary nailing for a trochanteric fracture between 2016 and 2020 were analysed retrospectively. The quality of fracture reduction was classified as type A, type E, and type I on the AP view and type N, type A, and type P on the lateral view according to the relative position of the proximal and distal fragments. The failure rate was evaluated and compared according to the quality of fracture reduction. The risk factors of the fixation failure were investigated by comparison of variables between patients with and without failure and by regression analysis. RESULTS Patients with poor reduction, type I and type P had higher failure rates. However, a statistically significant difference was found only for patients with poor reduction (type P) on the lateral view (p < 0.001). Patients with failure showed significantly higher rates of poor reduction on the lateral view and AO/OTA type A3 fractures. The regression analysis also showed that poor reduction on the lateral view (odds ratio [OR] 12.70; 95% confidence interval [CI] 4.0-40.6; p < 0.001) and AO/OTA type A3 fractures (OR 5.40; 95% CI 1.24-23.49, p = 0.025) were risk factors for failure. CONCLUSION Poor reduction such as type P reduction was associated with failure after intramedullary nailing for trochanteric fractures. Surgeons should check the quality of fracture reduction carefully with the proper fluoroscopic view to prevent failure in geriatric patients with trochanteric fractures.
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Affiliation(s)
- Young-Ho Cho
- Department of Orthopaedic Surgery, Daegu Fatima Hospital, Daegu, Republic of Korea
| | - Sangwoo Kim
- Department of Orthopaedic Surgery, Daegu Fatima Hospital, Daegu, Republic of Korea
| | - Jaewook Koo
- Department of Orthopaedic Surgery, Daegu Fatima Hospital, Daegu, Republic of Korea
| | - Seong-Eun Byun
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University, 59 Yatap-Ro, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 13496, Republic of Korea.
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McAleese T, McLeod A, Keogh C, Harty JA. Mechanical outcomes of the TFNA, InterTAN and IMHS intramedullary nailing systems for the fixation of proximal femur fractures. Injury 2024; 55:111185. [PMID: 38070327 DOI: 10.1016/j.injury.2023.111185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 10/15/2023] [Accepted: 11/04/2023] [Indexed: 01/29/2024]
Abstract
INTRODUCTION Hip fractures have become a major public health priority due to their increasing incidence. Intramedullary (IM) nailing has gained popularity as a surgical technique for managing these fractures. However, comparative studies with extramedullary devices indicate potentially increased mechanical complications associated with IM nailing. Specifically, there have been recent reports of early implant fracture associated with the TFNA system. This study compares the rate of mechanical complications between 3 implants. Secondarily, we analysed the factors associated with implant fracture and all other mechanical complications. METHODS This retrospective study included 803 IM nails performed between 2008-2021 for the fixation of proximal femur fractures at a level 1 trauma centre. We recorded patient demographics, AO fracture classification, implant specification and intra-operative parameters such as tip-apex distance, Cleveland index, reduction quality, presence of medial calcar integrity, neck-shaft angle. The outcomes analysed included implant fracture, lag screw cut-out, >10 mm backing out, autodynamisation, periprosthetic fracture, non-union at 6 months and time to revision surgery. RESULTS The overall implant fracture rate was 3.1 % (25/803), with no statistically significant difference between the three devices (p = 0.51). The TFNA group included 183 patients with a median follow-up of 1.6 years. The TFNA fracture rate was 2.2 % (4/183) which occurred at 207 +/- 16.66 days post-operatively. The rate of all mechanical complications was 4.9 % in the TFNA group, 12.9 % in the InterTAN group and 17 % in the IMHS group. Non-union (p < 0.001) and increasing lag screw length (p < 0.02) were identified as risk factors for implant fracture and other mechanical complications. The reverse oblique fracture pattern (AO 31 A3.1) was associated with mechanical complications only (p < 0.01). The cumulative survival rates without revision for the TFNA, InterTAN, IMHS groups were 97.8 %, 95.5 % and 87.9 % respectively at 2.5 years. DISCUSSION The rates of implant fracture were comparable between the three nailing systems. The TFNA provides effective fixation for proximal femur fractures using a traditional screw without cement augmentation. The TFNA was associated with an overall reduction in mechanical complications compared to the InterTAN and IMHS. Previously reported mechanical complications associated with IM Nails may relate to older device designs.
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Affiliation(s)
- Timothy McAleese
- Department of Trauma and Orthopaedics, Cork University Hospital, Cork, Ireland.
| | - Andre McLeod
- Department of Trauma and Orthopaedics, Cork University Hospital, Cork, Ireland
| | - Cillian Keogh
- Department of Trauma and Orthopaedics, Cork University Hospital, Cork, Ireland
| | - James A Harty
- Department of Trauma and Orthopaedics, Cork University Hospital, Cork, Ireland
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12
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Steffann F, Rubens-Duval B, Huten D. Should trochanteric fractures in elderly patients be treated by arthroplasty or internal fixation? Orthop Traumatol Surg Res 2024; 110:103778. [PMID: 38040114 DOI: 10.1016/j.otsr.2023.103778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 03/27/2023] [Indexed: 12/03/2023]
Abstract
Most trochanteric fractures are treated by fixation, most often intramedullary. Nevertheless, the desire to have patients walk as soon as possible and the fear of fixation failure has driven some surgeons to carry out an arthroplasty instead, especially for unstable fractures and/or in patients with severe osteoporosis, in order to avoid the difficult conversion to arthroplasty later on if the fixation fails. The aim of this review was to specify the role, technique and results of performing arthroplasty in this context. In which fractures? Unstable fractures (A2.2, A2.3 and A3), especially in osteoporotic bone, which are the most difficult to reduce and fix, and in cases with associated osteoarthritis. For which patients? Arthroplasty should not be done in patients who have ASA≤3 due to greater blood loss and longer operative time. Since the postoperative Parker score often drops, arthroplasty should not be done in patients having a Parker score<6. What are the technical problems? Arthroplasty must be done by an experienced surgeon because of the lack of anatomical landmarks, although fracture fixation has its own demands (satisfactory reduction, appropriate length and position of cervicocephalic screw). What are the results and complications? Despite several comparative studies (randomized trials, meta-analysis and prospective studies), it is difficult to draw any conclusions. These studies show worse performance of dynamic hip screws relative to intramedullary nails. The complication and revision rates were higher for nails than arthroplasty, but not in every study, while the functional outcomes with nails (with or without immediate weightbearing) were better than those of arthroplasty beyond 6 months. What is the mortality rate? It was lower after nailing in a few studies but was mainly determined by the patient's comorbidities and preoperative Parker score. The best indication for arthroplasty may be self-sufficient patients over 70 years of age who have an unstable fracture with severe osteoporosis. Nevertheless, new studies should be done to compare arthroplasty to nailing with immediate return to weightbearing in patients having the same type of fracture, defined using 3D CT scan. Level of evidence: Expert advice.
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Affiliation(s)
- François Steffann
- Clinique des Cèdres, 5, rue des Tropiques, Parc sud Galaxie, 38130 Échirolles, France.
| | - Brice Rubens-Duval
- Service de chirurgie de l'arthrose et du sport, urgences traumatiques des membres, hôpital Sud, CHU de Grenoble-Alpes, avenue de Kimberley, 38130 Échirolles, France
| | - Denis Huten
- Service de chirurgie orthopédique et réparatrice, hôpital Pontchaillou, CHU de Rennes, 2, rue H.-Le-Guilloux, 35000 Rennes, France
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13
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George NE. CORR Insights®: Intramedullary Nailing of Intertrochanteric Femoral Fractures in a Level I Trauma Center in Finland: What Complications Can Be Expected? Clin Orthop Relat Res 2024; 482:289-290. [PMID: 37713264 PMCID: PMC10776149 DOI: 10.1097/corr.0000000000002858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 08/16/2023] [Indexed: 09/16/2023]
Affiliation(s)
- Nicole E. George
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD, USA
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14
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Tien D, Chang WC, Cheng MF, Hsu KH, Su YP. The role of postoperative piriformis fossa and greater trochanter tubercle distance to predict cutout failure after cephalomedullary nail fixation. J Chin Med Assoc 2024; 87:179-188. [PMID: 38095570 DOI: 10.1097/jcma.0000000000001035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND This study investigated the association between postoperative piriformis fossa and greater trochanter tubercle distance (distance from the deepest point of piriformis fossa to the most lateral greater trochanter tubercle [PG]) and cutout failure after cephalomedullary nail (CMN) osteosynthesis for intertrochanter fracture (ITF). A rotating femur model was designed to analyze PG variation during femur rotation. METHODS From 2005 to 2010, 311 patients diagnosed of ITF (Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association [AO/OTA] 31-A2 and A3) underwent CMN fixation at our institute were reviewed. Of these, 281 (90.3%) patients achieved union without complication, 21 (6.8%) had cutout failure, six (1.9%) had femoral head osteonecrosis, and three (1%) had nonunion during postoperative 2-year follow-up. The side difference of postoperative PG compared to contralateral uninjured hip (dPG) was analyzed between patients who had cutout failure and those who did not. In the rotating femur model, the PG was measured for every 2.5° increments of internal and external rotation from 0° to 50°. RESULTS The dPG was significantly higher in the failure group (10.2 ± 4.2 vs 6.6 ± 3.5 mm, p <0.001). The odds ratio for lag screw cutout was 6.35 (95% CI, 1.10-11.6, p =0.003) for every 1 mm dPG increment. dPG exhibited high diagnostic performance in predicting cutout failure according to receiver operating characteristic curve analysis. The area under the curve was 0.774 (95% CI, 0.711-0.837). dPG yielded the greatest sensitivity (78.4%) and specificity (78.4%) to predict lag screw cutout when cutoff value being 8.65 mm. In rotating femur model, PG change from baseline demonstrated significant ( p <0.001) positive and negative correlation with increased external and internal rotation, respectively. CONCLUSION Increased dPG is a risk factor of cutout failure for ITF osteosynthesis with CMN. In conjunction with tip-apex distance, fracture displacement, and reduction quality; dPG can help surgeons interpret postoperative radiograph and predict failure. However, it should be noticed that a proper and standard patient positioning is critical for accurate dPG measurement.
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Affiliation(s)
- Derming Tien
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Wen-Chieh Chang
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Ming-Fai Cheng
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Kuei-Hsiang Hsu
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Yu-Ping Su
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
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15
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Lähdesmäki M, Ylitalo AAJ, Karjalainen L, Uimonen M, Mattila VM, Repo JP. Intramedullary Nailing of Intertrochanteric Femoral Fractures in a Level I Trauma Center in Finland: What Complications Can be Expected? Clin Orthop Relat Res 2024; 482:278-288. [PMID: 37582281 PMCID: PMC10776171 DOI: 10.1097/corr.0000000000002792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 06/29/2023] [Indexed: 08/17/2023]
Abstract
BACKGROUND Intertrochanteric hip fractures are one of the most common fractures in older people, and the number is estimated to increase. These fractures are often treated with intramedullary nailing; however, various complications have been reported. It is important to identify the potential complications and investigate whether the choice of implant and patient-related factors are associated with the risk of complications to develop better strategies for preventing them. QUESTIONS/PURPOSES (1) In the treatment of intertrochanteric fractures with intramedullary nailing, what are the risks of major complications and 30-day mortality? (2) Which implant types are associated with greater odds of major complications? (3) Which patient-related factors are associated with increased odds of major complications? METHODS In this retrospective, comparative study, we reviewed the health records of 2397 patients with a femoral fracture treated at one Level I trauma center between January 2014 and November 2020. Of those, we considered patients who were treated with intramedullary nailing for an intertrochanteric fracture after sustaining a low-energy injury as potentially eligible. Based on this criterion, 53% (1279) were eligible; a further 47% (1118) were excluded because the fixation method was other than intramedullary nailing, the fracture pattern was other than intertrochanteric fracture, or the fracture was caused by a high-energy injury mechanism. Another 4% (97) were excluded because they had incomplete datasets because of follow-up less than 12 months, leaving 49% (1182) for analysis. During the study period, intramedullary nails were generally used to treat nearly all intertrochanteric fractures at our hospital. The risk of complications was then assessed by chart review. Acute myocardial ischemia, cutout, nail breakage, pulmonary embolism, sepsis, stroke, and wound infection were defined as major complications. Cutout, nail breakage, and wound infection were defined as major complications leading to reoperation. To examine the association of implant type and major complications, a logistic regression analysis was performed. Additionally, the risks of major complications leading to reoperation were compared between implants. Finally, a univariable logistic regression analysis was performed to examine the association between patient-related factors and major complications. RESULTS The overall proportion of patients experiencing complications was 16% (183 of 1182), and the crude percentage of 30-day mortality was 9% (107 of 1182) based on the hospital`s medical records. After controlling for patient-related factors such as disease, age, and smoking, we found that nail type was not associated with odds of major complications leading to reoperation (Gamma3: OR 0.86 [95% CI 0.44 to 1.67]; p = 0.67; Trochanteric Fixation Nail: OR 0.61 [95% CI 0.2 to 1.53]; p = 0.33; Proximal Femoral Nail Antirotation: OR 0.55 [95% CI 0.16 to 1.49]; p = 0.29) compared with the Trochanteric Fixation Nail Advanced. Anticoagulation (OR 1.70 [95% CI 1.11 to 2.59]; p = 0.01), congestive heart failure (OR 1.91 [95% CI 1.13 to 3.11]; p = 0.01), and hypertension (OR 1.67 [95% CI 1.08 to 2.63]; p = 0.02) were associated with a major complication. Liver disease (OR 5.19 [95% CI 0.78 to 20.8]; p = 0.04) was associated with a major complication leading to reoperation. CONCLUSION This study provides a better understanding of the occurrence of surgical and medical complications after intramedullary nailing of intertrochanteric fractures. The new-generation nail types are comparable options based on the risk of reoperation. Anticoagulation, congestive heart failure, and hypertension were associated with major complications, highlighting the need for careful management and monitoring of these comorbidities during intramedullary nailing procedures.Level of Evidence Level III, therapeutic study.
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Affiliation(s)
- Miika Lähdesmäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Antti AJ Ylitalo
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland
| | - Leevi Karjalainen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Mikko Uimonen
- Department of Surgery, Hospital Nova of Central Finland, Jyväskylä, Finland
| | - Ville M. Mattila
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland
| | - Jussi P. Repo
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland
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16
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Vogt B, Laufer A, Gosheger G, Toporowski G, Antfang C, Rölfing JD, Rödl R, Frommer A. Evaluation of simultaneous bilateral femoral distraction osteogenesis with antegrade intramedullary lengthening nails in achondroplasia with rhizomelic short stature: a retrospective study of 15 patients with a minimum follow-up of 2 years. Acta Orthop 2024; 95:47-54. [PMID: 38287909 PMCID: PMC10825798 DOI: 10.2340/17453674.2024.35226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 11/07/2023] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND AND PURPOSE Bilateral femoral distraction osteogenesis in patients with achondroplasia is insufficiently reported. We aimed to perform the first study that exclusively analyzed simultaneous bilateral femoral distraction osteogenesis with motorized intramedullary lengthening nails via an antegrade approach in patients with achondroplasia focused on reliability, accuracy, precision, and the evolving complications. PATIENTS AND METHODS In this retrospective singlecenter study we analyzed patients with achondroplasia who underwent simultaneous bilateral femoral lengthening with antegrade intramedullary lengthening nails between October 2014 and April 2019. 15 patients (30 femoral segments) of median age 14 years (interquartile range [IQR] 12-15) were available for analysis. The median follow-up was 29 months (IQR 27-37) after nail implantation. RESULTS The median distraction length per segment was 49 mm (IQR 47-51) with a median distraction index of 1.0 mm/day (IQR 0.9-1.0), and a median consolidation index of 20 days/cm (IQR 17-23). Reliability of the lengthening nails was 97% and their calculated accuracy and precision were 96% and 95%, respectively. The most common complication was temporary restriction of knee range of motion during distraction in 10 of 30 of the lengthened segments. 1 patient was treated with 2 unplanned additional surgeries due to premature consolidation. CONCLUSION The method is reliable and accurate with few complications.
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Affiliation(s)
- Björn Vogt
- Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, Muenster University Hospital, Muenster, Germany; General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany.
| | - Andrea Laufer
- Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, Muenster University Hospital, Muenster, Germany; General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany
| | - Georg Gosheger
- General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany
| | - Gregor Toporowski
- Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, Muenster University Hospital, Muenster, Germany; General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany
| | - Carina Antfang
- Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, Muenster University Hospital, Muenster, Germany; General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany
| | - Jan Duedal Rölfing
- Children's Orthopedics and Reconstruction, Aarhus University Hospital, Aarhus, Denmark
| | - Robert Rödl
- Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, Muenster University Hospital, Muenster, Germany; General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany
| | - Adrien Frommer
- Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, Muenster University Hospital, Muenster, Germany; General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany
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17
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Kasai Y, Okabayashi R, Aoki K. Femoral Shaft Fracture Developed Late-Onset Infection in 27 Years after Intramedullary Nailing: A Case Report. J Long Term Eff Med Implants 2024; 34:13-17. [PMID: 38505888 DOI: 10.1615/jlongtermeffmedimplants.2023048585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
Postoperative late-onset infections more than 1 year after intramedullary nail surgery for femoral shaft fractures are very rare. We show an extremely rare case of developed late-onset infection 27 years after surgery, report on risk factors for late-onset infection, and infer why the infection occurred.
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Affiliation(s)
| | - Ryo Okabayashi
- Department of Orthopaedic Surgery, Aoyama General Hospital, Toyokawa City, Aichi Prefecture, Japan
| | - Kentaro Aoki
- Department of Orthopaedic Surgery, Aoyama General Hospital, Toyokawa City, Aichi Prefecture, Japan
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18
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Okwesili IC, Enweani UN, Muoghalu ON, Okwara BO, Ogbu DC, Anagor AA, Ekwedigwe HC. Nail-extraction device mismatch: an issue in developing countries intramedullary nail removal practice. Int Orthop 2024; 48:261-265. [PMID: 37938321 DOI: 10.1007/s00264-023-06025-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 10/23/2023] [Indexed: 11/09/2023]
Abstract
PURPOSE Intramedullary nail is the gold standard in the management of long bone diaphyseal fractures of tibia and femur. The jig of these nails has corresponding extraction device whose pitch for nail coupling come in various sizes. This unlike plate and screws may be difficult to predict preoperatively and may pose a problem during removal. Difficulties in removal may arise due to the proliferation of nail brands especially in developing countries. The study aims to identify the incidence of extraction device mismatch among orthopaedic surgeons in Nigeria as well as the indications and complications associated with intramedullary nail removal. METHODS A two-page questionnaire was administered to 87 orthopaedic surgeons attending the Annual General Meeting of the Nigerian Medical Association. The attitudes of the participants towards intramedullary nail were assessed. RESULTS All participants agree to asymptomatic removal. Patients wish was the leading indication for asymptomatic removal among the participants. Sixty-one percent of the surgeons have had the need to remove a nail different from the brand in the hospital their practice. The commonest indication for symptomatic removal was infections. Forty-seven percent of the participant encountered nail extraction-device mismatch. CONCLUSIONS The incidence of extraction device mismatch may portend a public health issue. There may be need for patient who had intra medullary nail insertion to be told their brand. We advocate for standardization of extraction device pitch for intramedullary nail.
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Affiliation(s)
- Ikechukwu C Okwesili
- Department of Surgery, College of Medicine University of Nigeria, Ituku Ozalla, Enugu, Nigeria.
- Department of Orthopaedics, University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu, Nigeria.
| | | | - Obiora N Muoghalu
- Department of Orthopaedics and Traumatology, National Orthopaedic Hospital, Enugu, Nigeria
| | - Blasius O Okwara
- Department of Orthopaedics, University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu, Nigeria
| | - Damian C Ogbu
- Department of Orthopaedics and Traumatology, National Orthopaedic Hospital, Enugu, Nigeria
| | - Anthony A Anagor
- Department of Orthopaedics, Alex Ekwueme Federal Teaching Hospital, Abakiliki, Ebonyi, Nigeria
| | - Henry C Ekwedigwe
- Department of Orthopaedics and Traumatology, National Orthopaedic Hospital, Enugu, Nigeria
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Deichsel A, Katthagen JC, Raschke MJ, Riesenbeck O. Medial migration of the helical blade with penetration into the acetabulum: a rare complication using the TFNA nail. Eur J Orthop Surg Traumatol 2024; 34:113-117. [PMID: 37351646 PMCID: PMC10771584 DOI: 10.1007/s00590-023-03615-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 06/04/2023] [Indexed: 06/24/2023]
Abstract
PURPOSE To determine the frequency and possible reasons of medial migration with penetration into the acetabulum (MMPA) of the helical blade when using the Trochanteric Fixation Nail Advanced (TFNA) is used for treatment of pertrochanteric fractures. METHODS All patients with pertrochanteric femoral fracture, treated by intramedullary femoral nailing with the TFNA, were retrospectively reviewed for MMPA of the helical blade. Epidemiological parameters, additional procedures, distance of medial migration, time from primary operation to revision as well as type of revision were assessed. RESULTS 4 of 153 patients treated with the TFNA developed an MMPA of the helical blade (risk = 2.6%), with a mean medial migration of the blade of 11.6 mm (SD 8.8). The mean time from initial operation to revision surgery was 70 days (SD 30). All patients were revised by conversion to cemented total hip arthroplasty. CONCLUSION MMPA of the helical blade is a rare but potentially hazardous complication of femoral nailing with the TFNA femoral nail, resulting in the necessity for revision surgery and total hip arthroplasty.
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Affiliation(s)
- Adrian Deichsel
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building W1, 48149, Münster, Germany.
| | - J Christoph Katthagen
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building W1, 48149, Münster, Germany
| | - Michael J Raschke
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building W1, 48149, Münster, Germany
| | - Oliver Riesenbeck
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building W1, 48149, Münster, Germany
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20
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Markowitz MI, Al-Hardan W, Constantinescu DS, Pretell-Mazzini J, Conway SA. Subtrochanteric nonunion after intramedullary nailing due to pathological fracture: proximal femoral replacement as a salvage approach. Eur J Orthop Surg Traumatol 2024; 34:167-173. [PMID: 37386190 DOI: 10.1007/s00590-023-03627-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 06/17/2023] [Indexed: 07/01/2023]
Abstract
PURPOSE To assess proximal femoral replacement as a treatment solution for nonunion of pathologic subtrochanteric fractures after cephalomedullary nailing in patients with pathological fracture and previously irradiated bone. METHODS Retrospective review of five patients with pathological subtrochanteric femoral fractures that were treated with cephalomedullary nailing and developed a nonunion, which was revised with conversion to a proximal endoprosthetic replacement. RESULTS All five patients had previously been treated with radiation. One patient had the latest follow-up at 2 months postoperatively. At that time, the patient was walking with a walker for assistance, with no evidence of hardware failure or loosening on imaging. The remaining four patients had the latest follow-up ranging from 9 to 20 months after surgery. At their latest follow-up, three of the four patients were ambulatory with no pain, using only a cane for assistance with longer distances. The other patient demonstrated pain in his affected thigh, utilizing a walker for assistance with ambulation at latest follow-up, but not requiring further surgical interventions. There were no hardware failures or implant loosening through the follow-up period. None of the patients required revision, and there were no postoperative complications observed at their last follow-up. CONCLUSIONS In patients with pathological fractures in the subtrochanteric region that is treated with cephalomedullary nailing and developed a nonunion, treatment with conversion to a proximal femoral replacement with a mega prosthesis is a valuable treatment with good functional results and low risk for complications. LEVEL OF EVIDENCE Therapeutic level IV.
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Affiliation(s)
- Moses I Markowitz
- University of Miami Miller School of Medicine, 1120 NW 14th St, Miami, FL, 33136, USA.
| | - Waleed Al-Hardan
- Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, 1611 NW 12th Ave #303, Miami, FL, 33136, USA
| | - David S Constantinescu
- Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, 1611 NW 12th Ave #303, Miami, FL, 33136, USA
| | - Juan Pretell-Mazzini
- Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, 1611 NW 12th Ave #303, Miami, FL, 33136, USA
| | - Sheila A Conway
- Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, 1611 NW 12th Ave #303, Miami, FL, 33136, USA
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Howard A, Myatt A, Hodgson H, Naeem H, Pepple S, Perumal A, Panteli M, Kanakaris N, Giannoudis PV. Retrograde intramedullary nailing or locked plating for stabilisation of distal femoral fractures? A comparative study of 193 patients. Eur J Orthop Surg Traumatol 2024; 34:471-478. [PMID: 37612566 PMCID: PMC10771351 DOI: 10.1007/s00590-023-03650-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 07/15/2023] [Indexed: 08/25/2023]
Abstract
PURPOSE The aim of this study was to evaluate the results of distal femoral fracture fixation of two different methods, lateral locking plate (LP) or an Intra-medullary nail (IMN), in patients managed in our institution. More specifically, to assess: (a) if there was a difference in functional outcomes between the LP and IMN groups; (b) whether the rate of complications was different between the two groups. METHODS Between January 2009 and December 2018 adult patients with distal femoral fractures managed in our unit with either LP or IMN for extra and intra-articular fractures were eligible to participate. Demographic details, fracture type, procedures performed, time to union, complications and functional scores (Oxford Knee Score) were recorded and analysed. The mean follow up was 4 years (12-120 months). RESULTS Out of 193 patients who met the inclusion criteria, 93 received an IMN whereas 100 patients were treated with LP. Mean age was 64.2 (18-99) and 70.1 (18-100) for the IMN and LP groups respectively. Overall, the two groups had similar demographics and there was no significant difference in the type of fractures sustained (p > 0.05). The Oxford Knee Score was highest for patients fixed with LP, mean 37.3 (6-48, SD 7.3) versus 28.4 (3-48, SD 14.4), (p = < 0.02) compared to the IMN group. In terms of complications, the rate of non-union was higher in the LP group 8.6% versus 4% in those patients treated with an IMN, p value < 0.01. CONCLUSION While the rate of non-union was higher in the LP group and the functional results were superior in the plating group.
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Affiliation(s)
- Anthony Howard
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.
- Leeds General Infirmary University Hospital, Leeds, UK.
- NDORMS, Oxford University, Oxford, UK.
| | - A Myatt
- Leeds General Infirmary University Hospital, Leeds, UK
| | - H Hodgson
- Leeds General Infirmary University Hospital, Leeds, UK
| | - H Naeem
- Leeds General Infirmary University Hospital, Leeds, UK
| | - S Pepple
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - A Perumal
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - M Panteli
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- Leeds General Infirmary University Hospital, Leeds, UK
| | - N Kanakaris
- Leeds General Infirmary University Hospital, Leeds, UK
| | - P V Giannoudis
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- Leeds General Infirmary University Hospital, Leeds, UK
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Vakharia AM, Haase LR, Speybroeck J, Furdock R, Ina J, Ochenjele G. Utilization Trends, Patient-Demographics, and Comparison of Medical Complications of Sliding Hip Screw or Intramedullary Nail for Intertrochanteric Fractures: A Nationwide Analysis from 2005 to 2014 of the Medicare Population. Iowa Orthop J 2023; 43:163-171. [PMID: 38213845 PMCID: PMC10777688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
Background Studies demonstrate an increase incidence of intertrochanteric fractures within the United States. Matched studies evaluating intertrochanteric fractures managed with either sliding hip screw (SHS) or intramedullary nail (IMN) within the Medicare population are limited. The purpose of this study was to investigate: 1) annual utilization trends; 2) patient demographics; and 3) complications including mortality. Methods A retrospective query using a nationwide database was performed. Patients undergoing SHS or IMN for intertrochanteric fractures were identified. The query yielded a total of 37,929 patients utilizing SHS (n = 11,665) or IMN (n = 26,264). Patients were matched 1:1 based on comorbidities. Primary outcomes included: utilization trends, patient demographics, 90-day complications, and 90-day readmission rates. Linear regression analyses were used to compare utilization trends. Pearson's c2 analyses were used to compare patient-demographics, medical complications, and 90-day readmission rates. A p-value less than 0.05 was considered statistically significant. Results Linear regression analysis demonstrated a statistically significant decrease in utilization of SHS for IT fractures (p<0.0001); whereas utilization for IMN stayed consistent (p=0.36). IMN had significantly higher prevalence of comorbidities compared to SHS, notably, hyperlipidemia (70.6 vs. 62.6%; p<0.0001). Based on 1:1 match, IMN patients had significantly higher rates of 90-day medical complications, such as respiratory failure (11.0 vs. 8.1%; p<0.0001) and VTE (4.2 vs. 3.2%; p<0.001; however, there was not a statistical difference in postoperative infection (1.4 vs. 1.5%, p=0.06). There was no statistical difference in 90-day mortality between IMN and SHS cohorts (0.19 vs .13%, p = 0.249). Conclusion This analysis demonstrates a difference in utilization of SHS and IMN for patients with IT fractures. Patients with IMN had significantly higher prevalence of comorbid conditions and incidence of 90-day postoperative complications compared to SHS patients. The study can be utilized by orthopaedic surgeons to potentially anticipate healthcare utilization depending on implant selection. Level of Evidence: III.
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Affiliation(s)
- Ajit M. Vakharia
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Lucas R. Haase
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Jacob Speybroeck
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Ryan Furdock
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Jason Ina
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - George Ochenjele
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
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23
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Koob S, Plöger MM, Schmolling JS, Lehmann RP, Alex D, Kohlhof H. Intramedullary nailing versus plate compound osteosynthesis in subtrochanteric and diaphyseal pathologic femoral fractures: a retrospective cohort study. Eur J Orthop Surg Traumatol 2023; 33:3597-3601. [PMID: 37246990 PMCID: PMC10651703 DOI: 10.1007/s00590-023-03599-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 05/17/2023] [Indexed: 05/30/2023]
Abstract
PURPOSE Pathologic fractures of the extremities due to carcinoma metastases require individual and patient prognosis-related stabilization procedures. Quick remobilization of the patient to restore the quality of life is of high importance, especially in the case of subtrochanteric and diaphyseal femoral fractures. In our retrospective cohort study, we evaluated intraoperative blood loss, length of operation, complication rate, and regain of lower extremity function in plate compound osteosynthesis (PCO) versus intramedullary nailing (IM) for subtrochanteric and diaphyseal pathologic fractures of the femur. METHODS Between January 2010 and July 2021, we retrospectively reviewed 49 patients who were treated at our institution for pathologic fractures of the subtrochanteric and diaphyseal femurs for group differences in terms of blood loss, length of operation, implant survival, and Musculoskeletal Tumor Society (MSTS) score. RESULTS We included 49 stabilization procedures of the lower extremity due to pathologic fractures of the proximal or diaphyseal femur, with a mean follow-up of 17.7 months. IM (n = 29) had a significantly shorter operation time than PCO (n = 20) (112.4 ± 9.4 and 163.3 ± 15.96 min, respectively). We did not detect any significant differences in terms of blood loss, complication rate, implant survival, or MSTS score. CONCLUSION Based on our data, pathologic subtrochanteric and diaphyseal fractures of the femur can be stabilized with IM, which has a shorter operation time than PCO, but the complication rate, implant survival, and blood loss remain unaffected.
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Affiliation(s)
- Sebastian Koob
- Department of Orthopaedics and Trauma Surgery, University of Bonn, Venusberg Campus 1, 53127, Bonn, Germany.
| | - Milena Maria Plöger
- Department of Orthopaedics and Trauma Surgery, University of Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - Johanna Sophie Schmolling
- Department of Orthopaedics and Trauma Surgery, University of Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - Ramona Pia Lehmann
- Department of Orthopaedics and Trauma Surgery, University of Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - Dana Alex
- Department of Orthopaedics and Trauma Surgery, University of Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - Hendrik Kohlhof
- Department of Emergency, Hand and Orthopaedic Surgery, St. Antonius Hospital, Cologne, Germany
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Alsharef JF, Ghaddaf AA, AlQuhaibi MS, Shaheen EA, AboAljadiel LH, Alharbi AS, AlHidri BY, Alamri MK, Makhdom AM. External fixation versus intramedullary nailing for the management of open tibial fracture: meta-analysis of randomized controlled trials. Int Orthop 2023; 47:3077-3097. [PMID: 37491610 DOI: 10.1007/s00264-023-05879-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 06/24/2023] [Indexed: 07/27/2023]
Abstract
AIM Tibial shaft fractures are the most common type of long-bone fractures. External fixation (EF) and intramedullary nailing (IMN) are widely used surgical techniques for the definitive fixation of open tibial shaft fractures. The aim of this systematic review and meta-analysis was to compare EF to IMN for the definitive fixation of open tibial fractures. METHODS Medline, Embase, and CENTRAL databases were searched for eligible studies. We included randomized controlled trials (RCTs) that compared EF to IMN for skeletally mature adults with open tibial fracture (Gustilo I, II, and III). We evaluated the following outcomes: superficial infection, pin-track infection, deep infection, malunion, nonunion, delayed union, and implant/hardware failure. The risk ratio (RR) was used to represent the desired outcomes. The statistical analysis was performed using the random-effects model. RESULTS A total of 12 RCTs that enrolled 1090 participants were deemed eligible for the analysis. EF showed a significantly higher rate of superficial infection, pin track infection, and malunion compared to IMN (RR = 2.30, 95% confidence interval (CI): 1.34 to 3.95; RR = 13.52, 95% CI: 6.16 to 29.66; RR = 2.29, 95% CI 1.41 to 3.73, respectively). No substantial difference was found between EF and IMN in terms of deep infection, nonunion, delayed union, or implant/hardware failure (RR = 1.15, 95% CI 0.67 to 1.98; RR = 0.92, 95% CI 0.77 to 1.10; RR = 1.50, 95% CI 0.98 to 3.33; RR = 0.96, 95% CI 0.36 to 2.60, respectively). DISCUSSION The findings of our meta-analysis are consistent with the previous systematic reviews excepts for the implant/hardware failure which was found to be significant in favour of IMN by one of the previous reviews. CONCLUSION This meta-analysis confirms that IMN is better than EF with respect to clinical outcomes and complication rate for the definitive fixation of open tibial fracture.
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Affiliation(s)
- Jawaher F Alsharef
- College of Medicine, King Saud Bin Abdelaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Abdullah A Ghaddaf
- College of Medicine, King Saud Bin Abdelaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Mohammed S AlQuhaibi
- College of Medicine, King Saud Bin Abdelaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Esraa A Shaheen
- College of Medicine, King Saud Bin Abdelaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Lamar H AboAljadiel
- College of Medicine, King Saud Bin Abdelaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Abdullah S Alharbi
- College of Medicine, King Saud Bin Abdelaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Bashair Y AlHidri
- College of Medicine, King Saud Bin Abdelaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | | | - Asim M Makhdom
- College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
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Bleeker NJ, Doornberg JN, Ten Duis K, El Moumni M, Reininga IHF, Jaarsma RL, IJpma FFA. Intraoperative fluoroscopic protocol to avoid rotational malalignment after nailing of tibia shaft fractures: introduction of the 'C-Arm Rotational View (CARV)'. Eur J Trauma Emerg Surg 2023; 49:2329-2336. [PMID: 35907028 PMCID: PMC10728226 DOI: 10.1007/s00068-022-02038-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 06/26/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Rotational malalignment (≥ 10°) is a frequent pitfall of intramedullary-nailing of tibial shaft fractures. This study aimed to develop an intraoperative fluoroscopy protocol, coined 'C-Arm Rotational View (CARV)', to significantly reduce the risk for rotational malalignment and to test its clinical feasibility. METHODS A cadaver and clinical feasibility study was conducted to develop the CARV-technique, that included a standardized intraoperative fluoroscopy sequence of predefined landmarks on the uninjured and injured leg in which the rotation of the C-arm was used to verify for rotational alignment. A mid-shaft tibia fracture was simulated in a cadaver and an unlocked intramedullary-nail was inserted. Random degrees of rotational malalignment were applied using a hand-held goniometer via reference wires at the fracture site. Ten surgeons, blinded for the applied rotation, performed rotational corrections according to (1) current clinical practice after single-leg and dual-leg draping, and (2) according to the CARV-protocol. The primary outcome measure was the accuracy of the corrections relative to neutral tibial alignment. The CARV-protocol was tested in a small clinical cohort. RESULTS In total, 180 rotational corrections were performed by 10 surgeons. Correction according to clinical practice using single-leg and dual-leg draping resulted in a median difference of, respectively, 10.0° (IQR 5.0°) and 10.0° (IQR 5.0°) relative to neutral alignment. Single-leg and dual-leg draping resulted in malalignment (≥10°) in, respectively, 67% and 58% of the corrections. Standardized correction using the CARV resulted in a median difference of 5.0° (IQR 5.0°) relative to neutral alignment, with only 12% categorized as malalignment (≥10°). The incidence of rotational malalignment after application of the CARV decreased from 67% and 58% to 12% (p = <0.001). Both consultants and residents successfully applied the CARV-protocol. Finally, three clinical patients with a tibial shaft fracture were treated according to the CARV-protocol, resulting all in acceptable alignment (<10°) based on postoperative CT-measurements. CONCLUSION This study introduces an easy-to-use and clinically feasible standardized intraoperative fluoroscopy protocol coined 'C-arm rotational view (CARV)' to minimize the risk for rotational malalignment following intramedullary-nailing of tibial shaft fractures.
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Affiliation(s)
- Nils Jan Bleeker
- Department of Orthopaedic Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - Job N Doornberg
- Department of Orthopaedic Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Kaj Ten Duis
- Department of Orthopaedic Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Mostafa El Moumni
- Department of Orthopaedic Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Inge H F Reininga
- Department of Orthopaedic Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ruurd L Jaarsma
- Department of Orthopaedic Trauma Surgery, Flinders Medical Center and Flinders University, Adelaide, Australia
| | - Frank F A IJpma
- Department of Orthopaedic Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Büyükdoğan K, Öztürkmen Y, Goker B, Oral M, Atay T, Özkan K, Çağlar Ö, Ayvaz M. Early results of a novel modular knee arthrodesis implant after uncontrolled periprosthetic knee joint infection. BMC Musculoskelet Disord 2023; 24:889. [PMID: 37968710 PMCID: PMC10648648 DOI: 10.1186/s12891-023-07016-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 11/03/2023] [Indexed: 11/17/2023] Open
Abstract
AIM The aim of this study is to evaluate the functional outcomes and complications after non-fusion knee arthrodesis with a modular segmental intramedullary implant used for infected total knee arthroplasty revisions. METHODS A retrospective review of the patients who had been surgically treated with a modular intramedullary arthrodesis implant for recurrent infection after revision TKA between January 2016 and February 2020 were included. The indications for arthrodesis were failed infected TKA with massive bone loss, deficient extensor mechanism and poor soft tissue coverage that precluded joint reconstruction with revision TKA implants. Clinical outcomes were assesed with visual analogue scale for pain (pVAS), Oxford knee score (OKS) and 12-item short form survey (SF-12). Full-length radiographs were used to verify limb length discrepancies (LLD). RESULTS Fourteen patients (4 male and 10 female) patients with a mean age of 69.3 (range, 59 to 81) years at time of surgery were available for final follow-up at a mean of 28.8 months (range, 24-35 months). All clinical outcome scores improved at the final follow-up (pVAS, 8.5 to 2.6, p = .01; OKS, 12.6 to 33.8, p = .02; SF-12 physical, 22.9 to 32.1, p = .01 and SF-12 mental, 27.7 to 40.2, p = .01). The mean LLD was 1.0 cm (range, + 15 - 2.3 cm). Re-infection was detected in three patients (21.4%). Two patients were managed with suppressive antibiotic treatment and a third patient required repeat 2-stage revision procedure. In one patient, a periprosthetic femur fracture was observed and treated with plate osteosynthesis. CONCLUSION Uncontrolled infection after total knee arthroplasty can be effectively treated with arthrodesis using a modular intramedullary nail and satisfactory functional results can be obtained. LEVEL OF EVIDENCE Level 4, Retrospective cohort study.
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Affiliation(s)
- Kadir Büyükdoğan
- Department of Orthopedic Surgery, Güven Hospital, Şimşek Sokak, No: 29, A.Ayrancı, Ankara, Turkey.
| | - Yusuf Öztürkmen
- Department of Orthopedics and Traumatology, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Barlas Goker
- Department of Orthopedics and Traumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Melih Oral
- Department of Orthopedics and Traumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Tolga Atay
- Department of Orthopedics and Traumatology, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey
| | - Korhan Özkan
- Orthopedics and Traumatology Department, Faculty of Medicine, Medeniyet University, Istanbul, Turkey
| | - Ömür Çağlar
- Department of Orthopedics and Traumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Mehmet Ayvaz
- Department of Orthopedics and Traumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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27
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Kotsarinis G, Wakefield SM, Kanakaris NK, Giannoudis PV. Stabilization of Tibial Fractures at Risk of Complications With the Bactiguard Intramedullary Nail: Early to Medium Results With a Novel Metal-Coated Device. J Orthop Trauma 2023; 37:S12-S17. [PMID: 37828696 DOI: 10.1097/bot.0000000000002688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/08/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVES The purpose of this study was to investigate the safety and early clinical results from the use of a novel, noble metal-coated titanium tibial nail for the definite stabilization of tibial shaft fractures at risk of developing complications. DESIGN This is a retrospective case series with prospectively collected data. SETTING Level I Trauma Centre in the United Kingdom. PATIENTS AND INTERVENTION Thirty-one patients who were managed with the Bactiguard-coated Natural Nail and achieved a minimum of a 12-month follow-up. MAIN OUTCOME MEASUREMENTS The main outcomes of this study were the incidence of adverse events (related to implant safety), complications (particularly infection), and reinterventions. RESULTS Thirty-one patients with a mean age of 41.6 years were included in this study. Active heavy smokers or intravenous drug users were 25.8% and 9.7% of them were diabetic. Five fractures were open while 13 had concomitant soft-tissue involvement (Tscherne grade 1 or 2). Twenty-seven patients healed with no further intervention in a mean time of 3.3 months. Three patients developed nonunion and required further intervention. The overall union rate was 96.7%. One patient developed deep infection after union (infection incidence 3.2%). Six patients (6/31; [19.3%]) required reinterventions [2 for the treatment of nonunion, 3 for removal of screws soft-tissue irritation, and 1 for the management of infection). CONCLUSIONS The management of tibial shaft fractures with a noble metal-coated titanium tibial nail demonstrates encouraging outcomes. Further studies are desirable to gather more evidence in the performance of this innovative implant. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Georgios Kotsarinis
- Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, United Kingdom; and
| | - Sophia M Wakefield
- Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, United Kingdom; and
| | - Nikolaos K Kanakaris
- Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, United Kingdom; and
| | - Peter V Giannoudis
- Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, United Kingdom; and
- NIHR Leeds Biomedical Research Center, Chapel Allerton Hospital, Leeds, United Kingdom
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Rincón-Hoyos JA, Gómez-Ramírez JF, Cuesta-Montoya JS, Lara-Garavito AM, Muñoz-Medina SE, Castro-Dangond AJ. Treatment of intertrochanteric fractures using cephalomedullary nail: One or two cephalic screws? Injury 2023; 54 Suppl 6:110625. [PMID: 38143146 DOI: 10.1016/j.injury.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 02/03/2023] [Indexed: 12/26/2023]
Abstract
OBJECTIVES To determine the incidence of cut-out, cut-in, cut-through, Z-effect, and reverse Z-effect in two cephalomedullary nail (CMN) systems: one with single cephalic screw fixation and the other with dual-screw fixation using a lag screw and an anti-rotation screw. METHODS A retrospective study from a cohort of patients was conducted between January 2017 and August 2019 in patients with intertrochanteric fractures treated with osteosynthesis using CMN. RESULTS One hundred ninety-six patients with intertrochanteric fractures who met the inclusion criteria were recruited. The median age was 81 years [interquartile range (IQR) 12]. Seventy-six percent had fractures classified as Orthopaedic Trauma Association/Arbeitsgemeinschaft für Osteosynthesefragen (OTA/AO) 31A2. Twenty-one mechanical complications occurred, 8.7% (17) was cut-out with a single cephalic screw CMN and 2% (4) was Z-effect with a dual-screw CMN non-integrated. The median tip-apex distance (TAD) was 19.4 mm (IQR 10.8) in patients who experienced cut-out and 19 mm (IQR 10) in those who experienced Z-effect. The median time to cut-out occurrence was 39,5 days (IQR 47,5), while the median time to Z-effect was 90 days (IQR 86). CONCLUSIONS The incidence of osteosynthesis failure using CMN is more frequent in patients treated with a single cephalic screw CMN. LEVEL OF EVIDENCE Therapeutic, Level III.
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Affiliation(s)
- Jairo Alonso Rincón-Hoyos
- Hip and orthopedic trauma surgeon, Clínica Universitaria Colombia, Carrera 21 No. 127D-39, Bogotá, 110121 Colombia
| | | | | | | | | | - Alfredo José Castro-Dangond
- Orthopedic trauma surgeon, Fundación Universitaria Sanitas, Clínica Universitaria Colombia, Bogotá, Colombia
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29
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Zuluaga M, Pérsico F, Medina J, Reina F, Jiménez N, Benedetti F. PRECICE nail for the management of posttraumatic bone defects with nonunion or malunion: Experience from a Latin American center. Injury 2023; 54 Suppl 6:110838. [PMID: 38143138 DOI: 10.1016/j.injury.2023.110838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/17/2023] [Accepted: 05/19/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND To evaluate the clinical outcomes using the PRECICE magnetic limb lengthening intramedullary nail for the correction of lower limb length discrepancies (LLD) in adults with posttraumatic nonunion or malunion defects in a Latin American center. METHODS A retrospective review of 25 adult patients with LLD associated with posttraumatic nonunion or malunion defects of femur or tibia treated with the PRECICE nail between January 2018 and December 2020. The primary outcomes considered were lengthening length achieved in mm, incidence of complications and quality of life (EQ-5D-3 L questionnaire). RESULTS Twenty-five cases (20 femoral and 5 tibial nails) were performed, with a median follow-up of 27 months (Interquartile range-IQR: 17.5 to 34.5). The average age was 36.5 ± 12.9 years; 10 cases were women. Fifteen cases had an LLD secondary to a malunion defect and 10 cases had an LLD secondary to a nonunion. PRECICE nails were inserted for the treatment of a median LLD of 40.0 mm (IQR: 30.2 to 74.2) in the femur and 30.0 mm (28.5 to 50.0) in the tibia. An accuracy of 100% was reported in 18 cases (Femur: 14 and tibia: 4) and consolidation was achieved in 22/25 cases with the PRECICE nail in situ. Complications were recorded in 9 (36%) cases (6/20 femur, 3/5 tibia), mainly related to the consolidation process (5/9). The median EQ-5D and EQ-VAS were 0.79 (IQR: 0.63 to 0.79) and 80.0 (IQR: 50.0 to 90.0), respectively. CONCLUSIONS The results of this study demonstrated that the PRECICE nail is an effective device for the management of posttraumatic LLD during the treatment of nonunion or malunion bone defects of femur and tibia, offering a reasonable quality of life, despite its postoperative complication risk.
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Affiliation(s)
- Mauricio Zuluaga
- Limb Lengthening and Reconstruction unit, Clínica Imbanaco Grupo QuirónSalud, Cali, Colombia; Faculty of Health Sciences, Pontificia Universidad Javeriana Cali, Colombia.
| | - Federico Pérsico
- Limb Lengthening and Reconstruction unit, Clínica Imbanaco Grupo QuirónSalud, Cali, Colombia
| | - Juan Medina
- Limb Lengthening and Reconstruction unit, Clínica Imbanaco Grupo QuirónSalud, Cali, Colombia; Faculty of Health Sciences, Pontificia Universidad Javeriana Cali, Colombia
| | - Federico Reina
- Limb Lengthening and Reconstruction unit, Clínica Imbanaco Grupo QuirónSalud, Cali, Colombia
| | - Nicolas Jiménez
- Limb Lengthening and Reconstruction unit, Clínica Imbanaco Grupo QuirónSalud, Cali, Colombia; Orthopedic surgery, Universidad del Rosario, Bogotá, Colombia
| | - Fernando Benedetti
- Limb Lengthening and Reconstruction unit, Clínica Imbanaco Grupo QuirónSalud, Cali, Colombia; Faculty of Health Sciences, Pontificia Universidad Javeriana Cali, Colombia
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Garcia-Barreiro G, Huespe I, Llano L, Dozo M, Benchimol JA, Rebecchi P, Taype D, Barla J, Sancineto C, Carabelli G. Patients with trochanteric hip fractures and pre-existing osteoarthritis can be treated with nailing osteosynthesis without significant decrease in functional status. Injury 2023; 54 Suppl 6:110735. [PMID: 38143114 DOI: 10.1016/j.injury.2023.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 03/25/2023] [Accepted: 04/12/2023] [Indexed: 12/26/2023]
Abstract
PURPOSE Functional outcome in patients after trochanteric fracture fixation with pre-existing radiographic osteoarthritis (OA) is unclear. Analyzing their function and independence, before and after fracture, could optimize their treatment and decrease the socioeconomic burden in this particular group. METHODS The influence of pre-existing radiographic hip OA on functional outcome was retrospectively analyzed with a cohort of patients undergoing proximal femoral nailing for trochanteric fracture. OA was graded according to the Tonnis classification. Functional outcome was assessed preoperatively and 12 months after surgery by the Parker Mobility Score (PMS). We consider a meaningful reduction a difference between preoperatively PMS and 12 months after surgery ≥ 2. In order to evaluate if OA is related to PMS reduction ≥ 2, we calculate the SubHazard ratio (SHR) performing a competing risk regression model considering death as a competing risk event, adjusting by confounders. Death, reoperations, readmissions, surgical time, and fracture reduction quality in patients with and without osteoarthritis were recorded. RESULTS 375 trochanteric hip fractures treated with cephalomedullary nails were included, from which 80 (21% CI95% 17%-21%) were classified as Tonnis 2 or 3. This group of patients with pre-existing OA was significantly older (mean age of 88.6 [SD 5.65] vs 85.5 years [SD 6.95]) than the group without OA. The preoperatively PMS score was 6.28 (2.71) in non-OA patients and 5.69 (2.67) in OA patients. The mean PMS reduction 12 months after surgery was 1.3 (SD 2.05) in OA patients and 1.07 (SD 2.2) in non-OA patients (p = 0.43). Competing risks analysis, adjusted by confounders had an SHR of 1.15 (IC95% 0.77 - 1.69). Death, readmission, reoperations, surgical time, and fracture reduction quality did not differ in both groups. CONCLUSIONS Patients with pre-existing radiographic OA treated with femoral nailing have a similar reduction in functional outcomes compared to the non-OA group at one-year follow-up. Further studies will be needed to compare the results of the functional outcome in arthroplasty with those of femoral nailing for the treatment of trochanteric femur fractures in patients with OA.
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Affiliation(s)
- Gonzalo Garcia-Barreiro
- Orthopaedic Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires C1199ABB, Argentina.
| | - Ivan Huespe
- Orthopaedic Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires C1199ABB, Argentina.
| | - Lionel Llano
- Orthopaedic Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires C1199ABB, Argentina.
| | - Marcelo Dozo
- Orthopaedic Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires C1199ABB, Argentina
| | - Javier Alberto Benchimol
- Orthopaedic Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires C1199ABB, Argentina
| | - Pilar Rebecchi
- Orthopaedic Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires C1199ABB, Argentina.
| | - Danilo Taype
- Orthopaedic Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires C1199ABB, Argentina.
| | - Jorge Barla
- Orthopaedic Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires C1199ABB, Argentina.
| | - Carlos Sancineto
- Orthopaedic Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires C1199ABB, Argentina.
| | - Guido Carabelli
- Orthopaedic Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires C1199ABB, Argentina.
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Badin D, Boustany M, Lee RJ, Varghese R, Sponseller PD. Incidence, risk factors, and consequences of radiographic pin migration after pinning of pediatric supracondylar humeral fractures. J Pediatr Orthop B 2023; 32:575-582. [PMID: 36892011 DOI: 10.1097/bpb.0000000000001069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
Current literature on pin migration is inconsistent and its significance is not understood. We aimed to investigate the incidence, magnitude, predictors, and consequences of radiographic pin migration after pediatric supracondylar humeral fractures (SCHF). We retrospectively reviewed pediatric patients treated with reduction and pinning of SCHF at our institution. Baseline and clinical data were collected. Pin migration was assessed by measuring the change in distance between pin tip and humeral cortex on sequential radiographs. Factors associated with pin migration and loss of reduction (LOR) were assessed. Six hundred forty-eight patients and 1506 pins were included; 21%, 5%, and 1% of patients had pin migration ≥5 mm, ≥10 mm, and ≥20 mm respectively. Mean migration in symptomatic patients was 20 mm compared to a migration of 5 mm in all patients with non-negligible migration ( P < 0.001). Pin migration > 10 mm was strongly associated with LOR [odds ratio (OR) = 6.91; confidence interval (CI), 2.70-17.68]. Factors associated with increased migration included increased days to pin removal ( β = 0.022; CI, 0.002-0.043), migration outwards versus inwards ( = 1.02; CI, 0.21-1.80), and BMI > 95th percentile (OR = 1.63; [1.06-2.50]). Factors not associated with migration included cross-pinning, number of pins, and fracture grade. In summary, we identified a 5% incidence of radiographic pin migration ≥ 10 mm and determined the factors associated with it. Pin migration became radiographically significant at >10 mm where it was strongly associated with LOR. Our findings contribute to the understanding of pin migration and suggest that interventions targeting pin migration may decrease the risk of LOR. Level of Evidence: Level III - Retrospective Cohort Study.
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Affiliation(s)
- Daniel Badin
- Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, Maryland, USA
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Tosun HB, Serbest S, Yasar MM, Uludag A, Ersoz G. Comparison of the Locking Intramedullary Nailing, Single Plate and Double Plate Osteosynthesis in Treatment of Humerus Shaft Fractures. J Coll Physicians Surg Pak 2023; 33:1315-1320. [PMID: 37926888 DOI: 10.29271/jcpsp.2023.11.1315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 08/25/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE To compare the clinical and radiographic outcomes between patients treated with single plate osteosynthesis, double plate osteosynthesis, and antegrade locked intramedullary nailing (IMN) in treatment of humerus diaphyseal fractures. STUDY DESIGN Descriptive study. Place and Duration of the Study: Department of Orthopaedics and Traumatology, Adiyaman University Training and Research Hospital, Adiyaman, Turkey, between 2014 and 2020. METHODOLOGY A total of 99 patients with humerus diaphyseal fractures were retrospectively evaluated. Forty-six had been treated with single plating, 24 were treated with double plating, and 29 with IMN. The outcomes were evaluated in terms of the union time, union rate, complications, and Disabilities of the Arm, Shoulder, and Hand (DASH) functional scores. RESULTS The average union time was 17 weeks and nonunion rate was 6% of patients. There was no significant difference between the groups in terms of DASH functional score and nonunion (p >0.05). The surgical time and bleeding amount were significantly shorter in the IMN group compared to the other groups (p <0.05). A statistically significantly short union time was observed in both plating groups compared to IMN (p <0.05), but it was not different between single and dual plating (p >0.05). CONCLUSION Regardless of the implant used, good reduction and stable fixation, respect for the soft tissue and use of the implant in accordance with the surgical technique are sufficient to achieve union in the surgical treatment of humeral shaft fractures. KEY WORDS Humeral shaft fracture, Surgical treatment options, Comparison, Outcomes.
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Affiliation(s)
- Haci Bayram Tosun
- Department of Orthopaedics and Traumatology, Elazig Fethi Sekin Training and Research Hospital, Elazig, Turkey
| | - Sancar Serbest
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Kirikkale University, Kirikkale, Turkey
| | - Mehmet Mete Yasar
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey
| | - Abuzer Uludag
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey
| | - Galip Ersoz
- Department of Orthopaedics and Traumatology, Elazig Fethi Sekin Training and Research Hospital, Elazig, Turkey
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Testa EJ, Albright AJ, Morrissey P, Orman S, Clippert D, Antoci V. Local anesthetic with monitored anesthesia care in cephalomedullary nailing of proximal femur fractures. Orthop Traumatol Surg Res 2023; 109:103619. [PMID: 37044244 DOI: 10.1016/j.otsr.2023.103619] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 03/16/2023] [Accepted: 03/30/2023] [Indexed: 04/14/2023]
Abstract
INTRODUCTION Proximal femur fractures have high rates of morbidity, mortality, and perioperative complications. Limiting anesthesia, especially in the elderly population, is a priority from a medical perspective. The goal of the current study is to present a technique of using local anesthetic with monitored anesthesia care (MAC) for the fixation of intertrochanteric (IT) femur fractures with cephalomedullary nailing (CMN), provide early clinical results in a small series of patients, and evaluate the safety, efficiency, and anesthetic efficacy of our technique. HYPOTHESIS The use of only local anesthetic with MAC for the fixation of IT fractures is safe and leads to decreased operative times when compared to spinal and general anesthesia. MATERIALS AND METHODS Patients undergoing cephalomedullary nailing (CMN) with a long nail for IT femur fractures by a single surgeon from January 2020 to June 2021 were identified retrospectively from a prospectively-collected patient registry. Patient demographics, operative time, length of hospital stay, perioperative medication use, and complications were collected. Analysis of variance, Chi2, linear regression, and two-sampled T-tests were performed to analyze potential differences between the local anesthesia group and the general or spinal anesthesia group. RESULTS Thirty-seven patients were identified. Eleven patients underwent CMN using local anesthesia with MAC, 11 using spinal anesthesia, and 15 using general anesthesia. The local anesthesia group demonstrated significantly lower operating room times and anesthesia induction to incision time compared to other anesthesia techniques. The local anesthesia group also trended towards less need for vasopressors during surgery and less postoperative delirium. No differences were identified in intraoperative narcotic use, complications, patient mortality, or hospital readmissions. CONCLUSIONS Local anesthesia with MAC for the treatment of IT fractures with CMN was associated with decreased operating room times and had similar complication rates including blood transfusions, readmissions, and mortalities, when compared to spinal and general anesthesia. LEVEL OF EVIDENCE III, therapeutic.
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Affiliation(s)
- Edward J Testa
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI, USA.
| | - Alex J Albright
- Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Patrick Morrissey
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Sebastian Orman
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | | | - Valentin Antoci
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
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Zielli SO, Mazzotti A, Artioli E, Arceri A, Bonelli S, Ruffilli A, Faldini C. Retrograde intramedullary nail entry point for tibio-talo-calcaneal arthrodesis: a review of anatomical studies. Eur J Orthop Surg Traumatol 2023; 33:3185-3195. [PMID: 36906879 DOI: 10.1007/s00590-023-03512-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 02/26/2023] [Indexed: 03/13/2023]
Abstract
PURPOSE Tibio-talo-calcaneal arthrodesis (TTCA) is considered a safe and valuable option for end-stage tibiotalar and subtalar arthritis, and usually is performed with a retrograde intramedullary nail. Although the good results reported, potential complications may be related to retrograde nail entry point. Aim of this systematic review is to analyze in cadaveric studies the risk of iatrogenic injuries related to different entry points and different retrograde intramedullary nail design when performing TTCA. METHODS According to PRISMA, a systematic review of the literature was performed on PubMed, EMBASE and SCOPUS databases. A subgroup analysis comparing different entry point location (anatomical or fluoroscopic guided) and different nail design (straight vs. valgus curved nails) was performed. RESULTS Five studies were included, for a total of 40 specimens. Superiority of anatomical landmark-guided entry points was observed. Different nail designs did not seem to influence nor iatrogenic injuries neither hindfoot alignment. CONCLUSION Retrograde intramedullary nail entry point should be placed in the lateral half of the hindfoot in order to minimize the risk of iatrogenic injuries.
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Affiliation(s)
- Simone Ottavio Zielli
- 1st Orthopaedics and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy.
| | - Antonio Mazzotti
- 1st Orthopaedics and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Elena Artioli
- 1st Orthopaedics and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | - Alberto Arceri
- 1st Orthopaedics and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | - Simone Bonelli
- 1st Orthopaedics and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | - Alberto Ruffilli
- 1st Orthopaedics and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Cesare Faldini
- 1st Orthopaedics and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
- Sidney Kimmel Medical College of Thomas Jefferson University (SKMC), Philadelphia, PA, USA
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Nadar AC, Seligson D. Heterotopic ossification in the knee following retrograde nailing of a femur fracture. Eur J Orthop Surg Traumatol 2023; 33:3181-3184. [PMID: 36797500 DOI: 10.1007/s00590-023-03491-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 02/05/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND Heterotopic ossification (HO) is a pathologic bone formation in extra skeletal tissue and articular space. This was an objection to nailing of femur fractures across the knee; however, this has not been the case in many thousands of cases. Nonetheless, we present a patient in who placement of a retrograde nail resulted in calcification in the knee requiring excision. CASE PRESENTATION A 42-year-old male presented to the clinic complaining of pain, popping, clicking, and mocking in the right knee, especially in the patellar region. Nine months prior he suffered an ipsilateral femur fracture that was treated with a retrograde intramedullary nail. X-ray and CT scan were used to confirm the presentation of a heterotopic bone mass in the Hoffa area of the right knee. The patient underwent an arthrotomy for excision of the bone mass. The bone mass was excised, but bone in the ACL was not removed. The patient experienced pain relief and improved range of motion following excision. CONCLUSION Intraarticular heterotopic ossification is an infrequent event. We present a case of heterotopic ossification in the knee following retrograde nailing. The patient experienced improved symptoms and range of motion after excision of the intraarticular heterotopic bone mass.
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Affiliation(s)
- Arun C Nadar
- University of Louisville School of Medicine, 500 S. Preston St, Louisville, KY, 40202, USA
| | - David Seligson
- Department of Orthopaedic Surgery, University of Louisville, 550 S. Jackson St., 1st Floor ACB, Louisville, KY, 40202, USA.
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Wilkinson BG, Bangura A, Burke CE, O'Connor K, Gupta J, Demyanovich HK, Healey K, O'Hara NN, Schneiderman BA, Nascone JW, O'Toole RV. A deep surgical site infection risk score for patients with open tibial shaft fractures treated with intramedullary nail. Injury 2023; 54:110965. [PMID: 37572509 DOI: 10.1016/j.injury.2023.110965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 06/09/2023] [Accepted: 07/26/2023] [Indexed: 08/14/2023]
Abstract
OBJECTIVES To identify deep infection risk factors in patients with open tibial shaft fractures and to develop a scoring algorithm to predict the baseline deep infection risk in this patient population. METHODS A retrospective cohort study conducted at a single academic trauma center identified patients with open tibial shaft fractures treated with intramedullary nail fixation from December 2006 to October 2020. The primary outcome was a deep surgical site infection requiring surgical debridement. The outcome was identified by Current Procedural Terminology codes and confirmed with a medical chart review documenting evidence of a tibial draining wound or sinus tract. RESULTS Deep surgical site infection occurred in 13% of patients (97/769). Factors that predicted deep surgical site infection were identified. Gustilo-Anderson type IIIB or IIIC was the strongest predictor with a 12-fold increase in the odds of deep infection (OR 11.8, p < 0.001). Additional factors included age >40 years (OR 1.7, p = 0.03), American Society of Anesthesiologists score ≥3 (OR 1.9, p < 0.01), Gustilo-Anderson type IIIA vs. type I or II (OR 2.8, p = 0.004), and gunshot wounds (OR 2.9, p = 0.02). The risk scoring model predicted patients who would develop an infection with an acceptable level of accuracy (AUC 0.79). The risk score categorized patients from a low probability of deep infection 2%-6% with <10 points to high risk (58%-69%) with >40 points. CONCLUSIONS This risk score model predicts deep postoperative infection in patients with open tibial shaft fractures treated with intramedullary nails. The ability to accurately estimate deep infection risk at the time of presentation might aid patient expectation management and allow clinicians to focus infection prevention strategies on the high-risk subset of this population.
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Affiliation(s)
- Brandon G Wilkinson
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD, United States
| | - Abdulai Bangura
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD, United States
| | - Cynthia E Burke
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD, United States
| | - Katherine O'Connor
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD, United States
| | - Jayesh Gupta
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD, United States
| | - Haley K Demyanovich
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD, United States
| | - Kathleen Healey
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD, United States
| | - Nathan N O'Hara
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD, United States
| | - Brian A Schneiderman
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD, United States
| | - Jason W Nascone
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD, United States
| | - Robert V O'Toole
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD, United States.
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Burton MG, Moon JY, Roberts DW. Distal Femur Valgus Deformity After Rigid Intramedullary Nailing of Adolescent Femoral Shaft Fracture. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202310000-00002. [PMID: 37801646 PMCID: PMC10558226 DOI: 10.5435/jaaosglobal-d-22-00220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 07/21/2023] [Accepted: 07/25/2023] [Indexed: 10/08/2023]
Abstract
A 12-year-old girl developed a distal femoral shaft fracture treated with lateral trochanteric entry intramedullary nail fixation. The nail was retained after union because of a persistent nonossifying fibroma at the previous fracture site. At 16 months after surgery, marked valgus deformity was noted at the distal femur, with signs of implant haloing and loosening, suggesting repetitive motion and stress concentration of forces at the distal femur. Owing to recognition before skeletal maturity, the valgus was corrected with hemiepiphysiodesis. This finding illustrates the importance of follow-up up to skeletal maturity for pediatric femoral shaft fractures and consideration of routine removal of implants after fracture union to avoid this previously unreported complication.
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Affiliation(s)
- Michael G. Burton
- From the University of Illinois College of Medicine, Department of Orthopaedic Surgery, Chicago, IL (Dr. Burton and Dr. Moon); Department of Pediatric Orthopaedic Surgery and Scoliosis, Northshore University Health System, Chicago, IL (Dr. Roberts)
| | - John Y. Moon
- From the University of Illinois College of Medicine, Department of Orthopaedic Surgery, Chicago, IL (Dr. Burton and Dr. Moon); Department of Pediatric Orthopaedic Surgery and Scoliosis, Northshore University Health System, Chicago, IL (Dr. Roberts)
| | - David W. Roberts
- From the University of Illinois College of Medicine, Department of Orthopaedic Surgery, Chicago, IL (Dr. Burton and Dr. Moon); Department of Pediatric Orthopaedic Surgery and Scoliosis, Northshore University Health System, Chicago, IL (Dr. Roberts)
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Pectol RW, Kavolus MW, Kiefer A, Sneed CR, Womble T, Foster JA, Kinchelow DL, Hawk GS, Matuszewski PE, Landy DC, Aneja A. Comparison of post-op opioid use and pain between short and long cephalomedullary nails in elderly intertrochanteric fractures. Eur J Orthop Surg Traumatol 2023; 33:3135-3141. [PMID: 37052677 DOI: 10.1007/s00590-023-03553-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 04/10/2023] [Indexed: 04/14/2023]
Abstract
PURPOSE It remains unknown if cephalomedullary nail (CMN) length has an impact on pain and opioid use following fixation. Given the lack of level I evidence favoring a specific CMN length to prevent adverse surgical outcomes, we investigated if CMN length impacts acute postoperative pain and opioid use. The authors hypothesize that the use of longer CMNs results in increased pain scores and morphine milligram equivalents (MME) intake during the 0-24 h (h) and 24-36 h postoperative period. METHODS A retrospective chart review was performed from 2010 to 2020 of patients ≥ 65 years-old who underwent CMN for IT fractures and fractures with subtrochanteric extension (STE). We compared patients who received short and long CMNs using numeric rating scale (NRS) pain scores and MME intake at 0-24 h and 24-36 h postoperatively. RESULTS 330 patients receiving short (n = 155) and long (n = 175) CMNs met criteria. CMN length was found to not be associated with higher pain scores in the early postoperative phase. However, patients with long CMNs received higher MME from 0-24 h (25.4% estimated mean increase, p value = 0.02) and 24-36 h (22.3% estimated mean increase, p value = 0.04) postoperatively, even after adjusting for covariates, gender, and age. CONCLUSION Patients with long CMNs received greater MME postoperatively. Additionally, differences in pain and MME were not significantly different between patients with and without STE, suggesting our findings were not influenced by this pattern. These results suggest longer CMNs are associated with higher acute postoperative opioid intake among patients with IT fractures. LEVEL OF EVIDENCE Therapeutic level III.
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Affiliation(s)
- Richard W Pectol
- Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, 780 Rose St., MN508, Lexington, KY, 40536, USA
| | - Matthew W Kavolus
- Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, 780 Rose St., MN508, Lexington, KY, 40536, USA
| | - Axel Kiefer
- Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, 780 Rose St., MN508, Lexington, KY, 40536, USA
| | - Chandler R Sneed
- Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, 780 Rose St., MN508, Lexington, KY, 40536, USA
| | - Tanner Womble
- Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, 780 Rose St., MN508, Lexington, KY, 40536, USA
| | - Jeffrey A Foster
- Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, 780 Rose St., MN508, Lexington, KY, 40536, USA.
| | - Daria L Kinchelow
- Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, 780 Rose St., MN508, Lexington, KY, 40536, USA
| | - Gregory S Hawk
- Department of Statistics, University of Kentucky, Lexington, KY, USA
| | - Paul E Matuszewski
- Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, 780 Rose St., MN508, Lexington, KY, 40536, USA
| | - David C Landy
- Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, 780 Rose St., MN508, Lexington, KY, 40536, USA
| | - Arun Aneja
- Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, 780 Rose St., MN508, Lexington, KY, 40536, USA
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Sharma P, Baghel A. Outcome of intramedullary nail coated with antibiotic-impregnated cement in chronic osteomyelitis. Ann Afr Med 2023; 22:434-439. [PMID: 38358142 PMCID: PMC10775937 DOI: 10.4103/aam.aam_185_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/11/2023] [Accepted: 01/17/2023] [Indexed: 02/16/2024] Open
Abstract
Introduction Chronic osteomyelitis (Chr OM) may result as a sequel of acute hematogenous infection or following open fractures or orthopedic surgeries. Among various osteoarticular infections, Chr OM is one of the most challenging in terms of treatment. In the present study, we evaluate the outcome of antibiotic cement-coated nails in the treatment of chronic pyogenic osteomyelitis and also discuss the future innovations in field of antibiotic-compatible biomaterials for coating the implants. Materials and Methods Twelve cases of Chr OM (5 hematogenous and 7 exogenous following trauma or surgery) were operated by intramedullary nail coated with antibiotic-impregnated bone cement from September 2018 to January 2021. All the cases had bacteriological confirmation of infection by deep curettage and its subsequent culture sensitivity. K nail was used in 10 cases and elastic stable intramedullary nails were used in 2 cases. Results Out of 12 cases, 8 were male and 4 were female. The average duration of follow-up was 13 months. Infection was controlled in all the cases (two cases required repeat antibiotic-coated nailing), and there was no incidence of relapse in any case. The control of infection was assessed by clinical assessment and laboratory parameters. Conclusion Antibiotic cement-coated nails are an effective method in local control of infection in Chr OM without any systemic side effect.
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Affiliation(s)
- Pulak Sharma
- Department of Orthopaedics, Apex Trauma Center, SGPGI, Lucknow, Uttar Pradesh, India
| | - Anurag Baghel
- Department of Orthopaedics, Apex Trauma Center, SGPGI, Lucknow, Uttar Pradesh, India
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Kulakoglu B, Ozdemir G, Bingol O, Karlidag T, Halit Keskin O, Durgal A. A new scoring system for predicting cut-out risk in patients with intertrochanteric femur fractures treated with proximal femoral nail anti-rotation. Acta Orthop Traumatol Turc 2023; 57:258-266. [PMID: 37909683 PMCID: PMC10724802 DOI: 10.5152/j.aott.2023.23018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 09/28/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE The objectives of this study were to: (1) determine all the potential risk factors defined in the literature for cut-out after proximal femoral nail anti-rotation in managing intertrochanteric fractures and (2) make a reliable prediction about the likelihood of cut-out by developing a quantitative scoring system. METHODS Four hundred eighty patients who were operated on for an intertrochanteric femur fracture were included in the study. The patients were evaluated retrospectively. Radiological parameters known to affect cut-out, including tip apex distance (TAD), calcarreferenced TAD (CalTAD), and reduction quality, were also used to evaluate the patients. Additionally, the classification of the fracture according to the cortical thickness index for osteoporosis, the Charlson comorbidity index for additional comorbidities, and the Arbeitsgemeinschaft Für Osteosynthesefragen classification were evaluated. RESULTS The cut-out rate among all patients was 7.2%. Cut-out risk could be predicted by gender, TAD, CalTAD, and reduction quality. Female gender, TAD > 29.45, CalTAD > 31.75, and acceptable or poor reduction quality significantly increased the cut-out risk. Based on the chi-square analysis, it was determined that there was a significant relationship between the cut-out risk and the variables of TAD, CalTAD, reduction quality, gender, and fracture type (P=.000, P=.000, P=.000, P=.008, P=.016, respectively). Logistic regression analysis showed a strong correlation between the newly developed scoring system and the risk of cut-out. The risk of cut-out increased 8.1 times in individuals with a score of more than 2 (P < .001). CONCLUSION Female gender, TAD > 29.45, CalTAD > 31.75, and acceptable or poor reduction quality are the parameters found to be significant in determining the cut-out risk. With the newly developed scoring system, risks can be calculated for all situations that may occur according to the scores obtained by the patients. The cut-out risk increases significantly in patients with a score above 2 points. LEVEL OF EVIDENCE Level III, Diagnostic Study.
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Affiliation(s)
- Burak Kulakoglu
- Department of Orthopaedics and Traumatology, Kilis State Hospital, Kilis, Turkey
| | - Guzelali Ozdemir
- Department of Orthopaedics and Traumatology, Ankara City Hospital, Ankara, Turkey
| | - Olgun Bingol
- Department of Orthopaedics and Traumatology, Ankara City Hospital, Ankara, Turkey
| | - Taner Karlidag
- Department of Orthopaedics and Traumatology, Ankara City Hospital, Ankara, Turkey
| | - Omer Halit Keskin
- Department of Orthopaedics and Traumatology, Ankara City Hospital, Ankara, Turkey
| | - Atahan Durgal
- Department of Orthopaedics and Traumatology, Ankara City Hospital, Ankara, Turkey
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Schneider F, Geir F, Koidl C, Gehrer L, Runer A, Arora R. Retrospective evaluation of radiological and clinical outcomes after surgical treatment of proximal femur fractures utilizing TFNA. Arch Orthop Trauma Surg 2023; 143:4165-4171. [PMID: 36456766 PMCID: PMC10293328 DOI: 10.1007/s00402-022-04704-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 11/15/2022] [Indexed: 12/03/2022]
Abstract
INTRODUCTION The aim of this study was to evaluate the clinical and radiological outcomes of patients treated with the TFN-Advanced™ Proximal Femoral Nailing system (TFNA¸ DePuy Synthes, West Chester, PA) including intra- and postoperative complications. MATERIALS AND METHODS All patients with an acute proximal femur fracture consequently treated with a TFNA between September 2014 and December 2018 were evaluated. Clinical and radiological data were assessed for intra- and postoperative complications, including treatment failure. In addition, intra- and postoperative X-rays were used to determine the position of the implant, and any migration, via tip-apex-distance (TAD) and the caput-collum-diaphyseal angle (CCD). The accuracy of the fracture reduction was rated by both observers according to Baumgartners criteria. RESULTS 275 consecutive patients (mean age 77.5 ± 14.1; 70.2% female) were included. The predominant OTA/AO fracture classification was 31A2 (140 cases, 50.7%). The average surgical time was 69 min (± 39.8). The reduction quality was good in 253 cases (92.0%) and acceptable in 22 cases (8.0%). In 18 cases, a pre-defined primary outcome parameter (6.5%) was recorded after a mean of 8.2 ± 8.0 months. During the observational period, 19 patients (6.9%) required a total of 23 additional surgeries. Implant removal was not considered a failure in the absence of pain. Significant group differences were observed with younger age (p = 0.001), lower Charlson Comorbidity Index (CCI)-score (p = 0.041) and lower rate of osteoporosis (p = 0.015) in the failure group. There were no cases of cut-out or cut-through among the patients who underwent augmentation as part of osteosynthesis. CONCLUSIONS Proximal femur fractures treated with the TFNA show low complication rates and high levels of radiological healing. Implant-related complications might be more common in patients with younger age, a lower CCI-score and lower frequency of osteoporosis. Usage of cement augmentation could potentially be beneficial to reduce postoperative cut-through and cut-out.
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Affiliation(s)
- Friedemann Schneider
- University Hospital for Orthopaedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria.
| | - Fabian Geir
- Medical University of Innsbruck, Innsbruck, Austria
| | - Christian Koidl
- University Hospital for Orthopaedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Luise Gehrer
- Medical University of Innsbruck, Innsbruck, Austria
| | - Armin Runer
- University Hospital for Orthopaedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria
- Department of Sports Orthopaedics, Technical University of Munich, Munich, Germany
| | - Rohit Arora
- University Hospital for Orthopaedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria
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Park K, Cardin S, Fan B, Toledano J, Birnbaum M, Herrera-Soto JA. Can Rigid Femoral Nailing Be Used for Pediatric Femoral Shaft Fracture in Children 8 to 10 Years? Use of RIN in Patients With Femoral Shaft Fracture. J Pediatr Orthop 2023; 43:362-367. [PMID: 36922002 DOI: 10.1097/bpo.0000000000002395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
BACKGROUND The treatment modalities for pediatric femoral shaft fractures are determined by their age, weight, and fracture pattern. Rigid intramedullary nailing (RIN) is usually recommended for patients >11 years of age, and elastic intramedullary nailing (EIN) has been used for patients under 10 years. However, little is known about the use of RIN in patients aged 8 to 10 years. We examined the differences in patients with femoral shaft fractures who were treated with EIN or RIN in terms of (1) fracture healing; (2) changes of anatomic parameters; and (3) related complications. METHODS We retrospectively reviewed 54 patients between 8 and 10 years of age, with femoral shaft fractures, who were treated with either EIN or RIN between 2011 and 2020. Lateral trochanteric entry was used for RIN procedure. The mean follow-up period was 26.4 months (range, 6 to 113 mo). There were 17 patients in the EIN group and 37 patients in the RIN group. The mean age at the time of surgery was 1 year younger in the EIN group ( P <0.01). The mean weight of the patient was significantly heavier in the RIN group compared with the EIN group. RESULTS Complete union of the fracture was achieved slightly faster in the RIN group at 3.4 months compared with 3.7 months in the EIN group ( P =0.04). There were no clinically significant changes of the anatomic parameters in either group, including neck shaft angle and articulotrochanteric distance. There was no evidence of avascular necrosis at the time of final follow-up for either group. There were no significant differences in postoperative complications between the groups. CONCLUSION RIN using lateral trochanteric entry is a feasible surgical option for femoral shaft fractures in patients 8 to 10 years of age that are heavier than 40 kg or with unstable fracture patterns. LEVEL OF EVIDENCE Level III, retrospective cohort study. See the Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Kwangwon Park
- Center for Orthopaedics at the Arnold Palmer Hospital for Children, 1222 S. Orange Avenue, Orlando, FL, 32806
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Engler ID, Sinz NJ, McIntyre JA, Finch DJ, Ryan SP. Impingement and perforation of the anterior femoral cortex in cephalomedullary nailing: Systematic review and surgical techniques. Orthop Traumatol Surg Res 2023; 109:103505. [PMID: 36496157 DOI: 10.1016/j.otsr.2022.103505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/25/2022] [Accepted: 06/22/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Anterior femoral cortical impingement and perforation are known risks of cephalomedullary nailing. The incidence of and risk factors for these findings have not been fully established in the literature. The purpose of this review was to answer: (1) What is the incidence of anterior femoral cortical impingement and perforation associated with cephalomedullary nailing of proximal femur fractures? (2) How does incidence vary by nail radius of curvature (ROC)? (3) What populations are at increased risk of impingement and perforation? (4) What surgical techniques prevent their occurrence? HYPOTHESIS Our hypothesis was that impingement would be a relatively common finding following cephalomedullary nailing, and perforation would be much less frequent but still an appreciable risk. Secondarily, nails with a larger ROC would have a higher rate of impingement. PATIENTS AND METHODS In this systematic review, PubMed, MEDLINE, and Cochrane databases were searched for articles from 1990-2020 written in English using the terms "cephalomedullary nail" or "femoral nail" and "perforation" or "impingement", and similar words. Inclusion criteria were studies discussing the complication of anterior femoral cortical impingement or perforation associated with the use of a cephalomedullary nail. Fourteen studies met inclusion criteria. Rates of anterior femoral cortical impingement or perforation, patient demographics, nail type, and ROC were extracted. Surgical techniques to prevent perforation were qualitatively reviewed. RESULTS The rate of anterior cortical impingement with long cephalomedullary nails was 17.2% (192/1117 patients) and with short nails was 29.2% (176/602). The rate of anterior cortical perforation with long nails was 1.0% (11/1116) and with short nails was 0% (0/234). Long nails with ROC>150cm showed an impingement rate of 10.9% (62/567) and perforation rate of 1.1% (7/617 patients). Nails with ROC 150cm or 100cm had an impingement rate of 1.1% (1/93) and perforation rate of 0% (0/93). DISCUSSION Impingement and perforation of the anterior femoral cortex during cephalomedullary nailing are appreciable risks that surgeons should anticipate and avoid, especially in certain populations and with nails with larger ROC. Surgeons may consider use of long nails with ROC 150cm and below, given a nearly 10-fold lower incidence of impingement and no reported perforations. LEVEL OF EVIDENCE Therapeutic, level IV.
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Affiliation(s)
- Ian D Engler
- Tufts Medical Center, Department of Orthopaedics, 800 Washington Street, Boston, MA, 02111, United States; Central Maine Medical Center, 690, Minot avenue, Auburn, ME, 04210, United States.
| | - Nathan J Sinz
- Tufts Medical Center, Department of Orthopaedics, 800 Washington Street, Boston, MA, 02111, United States
| | - J Alexander McIntyre
- Tufts Medical Center, Department of Orthopaedics, 800 Washington Street, Boston, MA, 02111, United States
| | - Daniel J Finch
- Tufts University School of Medicine, 145 Harrison avenue, Boston, MA, 02111, United States
| | - Scott P Ryan
- Tufts Medical Center, Department of Orthopaedics, 800 Washington Street, Boston, MA, 02111, United States
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Martí-Garín D, Fillat-Gomà F, Marcano-Fernández FA, Balaguer-Castro M, Murias Álvarez J, Pellejero R, Sánchez Fernández J, Torner P, Muñoz Vives JM. Complications of standard versus long cephalomedullary nails in the treatment of unstable extracapsular proximal femoral fractures: A randomized controlled trial. Injury 2023; 54:661-668. [PMID: 36411103 DOI: 10.1016/j.injury.2022.11.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 11/06/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022]
Abstract
AIMS To compare in a prospective randomized trial the mechanical complications in patients with unstable extracapsular proximal femur fractures without subtrochanteric extension (AO/OTA 31-A2 and 31-A3) METHODS: We prospectively studied 182 patients with unstable extracapsular proximal femur fractures without fractures lines extending more than 3 cm below the lesser trochanter, randomized to receive either a 'standard' (240 mm) nail or a long nail and followed them up for 1 year. RESULTS We found no difference in the incidence of mechanical or general complications between the two groups, no cut-outs, no fractures of the tip the implant, 1 cut-through and 2 malrotations in the LN group, 2 non-unions that were reoperated, one on each group. The commonest complication was blade lateral migration, 13 (14%) patients in SN and 6 (9%) in the LN. The operating time was shorter in the SN group 51 minutes compared to 67 minutes in the LN group (p=0.000075). The mortality at 1,3 and 12 months in the SN group was of 2%, 6%, 12% while in the LN group was 12%, 18% and 22%. These differences where significative at 1 (p=0.007) and 3 months (p=0.013), but not at 12 months (p=0.075). CONCLUSIONS We recommend the use of standard nails (240 mm) for this group of fractures, since it does not produce more mechanical complications, and it is faster, cheaper and easier to interlock distally.
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Affiliation(s)
- David Martí-Garín
- Consorci Corporació Sanitària Parc Taulí, Department of Orthopaedic Surgery and Traumatology, Sabadell, Catalunya, ES; Institut d'Investigació i Innovació Parc Tauli, Sabadell, Catalunya, ES; Universitat Autònoma de Barcelona, Barcelona, Catalunya, ES
| | - Ferran Fillat-Gomà
- Consorci Corporació Sanitària Parc Taulí, Department of Orthopaedic Surgery and Traumatology, Sabadell, Catalunya, ES; Institut d'Investigació i Innovació Parc Tauli, Sabadell, Catalunya, ES; Universitat Autònoma de Barcelona, Barcelona, Catalunya, ES
| | - Francesc Antoni Marcano-Fernández
- Consorci Corporació Sanitària Parc Taulí, Department of Orthopaedic Surgery and Traumatology, Sabadell, Catalunya, ES; Institut d'Investigació i Innovació Parc Tauli, Sabadell, Catalunya, ES; Universitat Autònoma de Barcelona, Barcelona, Catalunya, ES
| | | | - Juan Murias Álvarez
- Consorci Corporació Sanitària Parc Taulí, Department of Orthopaedic Surgery and Traumatology, Sabadell, Catalunya, ES; Institut d'Investigació i Innovació Parc Tauli, Sabadell, Catalunya, ES; Universitat Autònoma de Barcelona, Barcelona, Catalunya, ES
| | - Raul Pellejero
- Consorci Corporació Sanitària Parc Taulí, Department of Orthopaedic Surgery and Traumatology, Sabadell, Catalunya, ES; Institut d'Investigació i Innovació Parc Tauli, Sabadell, Catalunya, ES; Universitat Autònoma de Barcelona, Barcelona, Catalunya, ES
| | - Joël Sánchez Fernández
- Consorci Corporació Sanitària Parc Taulí, Department of Orthopaedic Surgery and Traumatology, Sabadell, Catalunya, ES; Institut d'Investigació i Innovació Parc Tauli, Sabadell, Catalunya, ES; Universitat Autònoma de Barcelona, Barcelona, Catalunya, ES
| | - Pere Torner
- Hospital Clínic de Barcelona, Orthopaedic Department, Barcelona, Catalunya, ES
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Alpan B, Eralp L, Sungur M, Valiyev N, Özger H. Femoral Discrepancy After Childhood Bone Sarcoma Surgery Can Be Treated With Magnetic Intramedullary Nails. Orthopedics 2023; 46:27-34. [PMID: 36314876 DOI: 10.3928/01477447-20221024-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
This study aims to determine whether femoral lengthening with a magnetic motorized intramedullary nail (PRECICE; NuVasive) is safe and effective in patients with discrepancy due to limb salvage performed for bone sarcomas before skeletal maturity. Six patients (male, 4; female, 2) with a mean age of 9.3 years (range, 4.8-12.8 years) at the time of index limb salvage surgery were retrospectively analyzed. Four patients had undergone biological reconstruction with liquid-nitrogen recycled frozen autograft shell and inlaid vascular fibula combination and 2 had undergone nonbiological reconstruction with distal femur modular tumor endoprosthesis. The mean age at PRECICE operation was 16.1 years (range, 13.4-20.1 years). The mean prelengthening femoral discrepancy was measured as 60 mm (range, 39-80 mm). Lengthening was achieved in 5 of these 6 patients. Although the PRECICE nail was successfully implanted in the sixth patient, lengthening could never be performed owing to failure to overcome the chronic diaphyseal nonunion first, as intended with compressive use of the nail. For the other 5 patients, in whom lengthening was performed, the mean lengthening was 45 mm (range, 35-52 mm), the mean ratio of achieved to planned lengthening was 93% (range, 74%-100%), and the mean bone-healing index was 41 days per cm (range, 24-69 days per cm). Mean Musculoskeletal Tumor Society score improved from 25.6 to 27.2 after lengthening. No major complications occurred. The outcomes of this study demonstrate that the PRECICE implant can safely and effectively correct femoral length discrepancy caused by limb salvage performed for osteosarcoma before skeletal maturity. [Orthopedics. 2023;46(1):27-34.].
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Dyutin AO, Shakiryanov RA, Semenova AS, Kyarunts KD, Osipov VA. [Risk factors of adverse long-term consequences of tibial shaft fractures in children]. Khirurgiia (Mosk) 2023:33-41. [PMID: 37850892 DOI: 10.17116/hirurgia202304133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
OBJECTIVE To analyze leg length discrepancy and overgrowth after tibial shaft fractures in children. MATERIAL AND METHODS We analyzed medical records of 103 patients younger 14 years old with tibial shaft fractures between January 2003 and November 2018. Treatment included plastering and insertion of titanium elastic nail. To identify the risk factors of leg length discrepancy ≥1 cm and overgrowth ≥1 cm, we performed logistic regression analysis. Statistical analysis was carried out using the SPSS software for Windows. RESULTS Gender (p=0.014) and treatment methods (p=0.011) are the most significant predictors of leg length discrepancy and overgrowth. In boys, the risk of leg length discrepancy ≥1 cm was 7.4 times higher than in girls. The risk of leg length discrepancy ≥1 cm was 4.3 times higher after insertion of titanium elastic nail compared to plastering. The risk of overgrowth ≥1 cm was 5.4 times higher in boys than in girls. The risk of overgrowth ≥1 cm was 4.7 times higher after insertion of titanium elastic nail compared to plastering. CONCLUSION One should consider the risk of leg length discrepancy and overgrowth in children with tibial shaft fractures. This is especially true for boys undergoing insertion of titanium elastic nail.
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Affiliation(s)
- A O Dyutin
- Ulyanov Chuvash State University, Cheboksary, Russia
| | | | - A S Semenova
- Ulyanov Chuvash State University, Cheboksary, Russia
| | - K D Kyarunts
- Ulyanov Chuvash State University, Cheboksary, Russia
| | - V A Osipov
- Ulyanov Chuvash State University, Cheboksary, Russia
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Luo TD, Hussaini SH, Andring NA, Kelly EA, Carroll EA, Halvorson JJ. Comparison of Lateral versus Medial Entry Femoral Traction Pin Complication Rates. J Surg Orthop Adv 2023; 32:259-262. [PMID: 38551235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Distal femoral skeletal traction is a common procedure for the stabilization of fractures of the pelvis, acetabulum, and femur following trauma. Femoral traction pins are traditionally inserted via medial-to-lateral (MTL) entry to accurately direct the pin away from the medial neurovascular bundle. Alternatively, cadaveric studies have demonstrated low risk to the neurovascular bundle using a lateral-to-medial (LTM) approach. The purpose of this study was to compare the incidence of complications of LTM and MTL femoral traction pin placement at a single institution. This was a retrospective review of patients from the orthopaedic consult registry at a academic Level I Trauma Center. We identified 233 LTM femoral traction pin procedures in 231 patients and 29 MTL pin procedures in 29 patients. The two pin placement techniques were compared with respect to complications, specifically the incidence of neurovascular injury, cellulitis, septic arthritis, osteomyelitis, and heterotopic ossification after femoral traction pin placement. Two complications were reported. One patient developed heterotopic ossification along the pin tract after LTM traction pin placement. Another patient developed septic arthritis after LTM pin placement, likely attributable to retrograde intramedullary nailing of his open femur fracture rather than his traction pin. There were no reports of neurovascular injury, cellulitis, or osteomyelitis associated with pin placement. The complication rate was 0.9% for LTM group and 0.0% for MTL group (p = 0.616). LTM femoral traction pin placement is a safe procedure with a similarly low complication rate compared with traditional MTL placement when the limb is positioned in neutral alignment. (Journal of Surgical Orthopaedic Advances 32(4):259-262, 2023).
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Affiliation(s)
- T David Luo
- Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | | | | | - Erin A Kelly
- Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Eben A Carroll
- Wake Forest Baptist Medical Center, Winston-Salem, North Carolina; Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Jason J Halvorson
- Wake Forest Baptist Medical Center, Winston-Salem, North Carolina; Wake Forest University School of Medicine, Winston-Salem, North Carolina
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Halonen LM, Stenroos A, Vasara H, Kosola J. Peri-implant fracture: a rare complication after intramedullary fixation of trochanteric femoral fracture. Arch Orthop Trauma Surg 2022; 142:3715-3720. [PMID: 34618190 PMCID: PMC9596516 DOI: 10.1007/s00402-021-04193-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 09/25/2021] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Trochanteric femoral fractures are among the most common operatively treated fractures. Intramedullary fixation has become the treatment of choice in many centers around the world. Nevertheless, the knowledge of rare complications of these fractures is limited. In this study, the incidence and treatment strategies for peri-implant fractures (PIF) were assessed. MATERIALS AND METHODS A single-center retrospective cohort study was done on 987 consecutive operatively treated trochanteric fractures. PFNA cephalomedullary nail was used as a fixation method. All patients were followed up from patient records for peri-implant fractures. Plain radiographs as well as different salvage methods were analyzed and compared. RESULTS The total rate of peri-implant fractures was 1.4% (n = 14). The rate of PIF for patients treated with short (200 mm) nails, intermediate-length (240 mm) nails, and long nails was 2.7% (n = 2), 1.5% (n = 11), and 0.7% (n = 1), respectively (ns, p > 0.05 for difference). Treatment of choice for PIF was either ORIF with locking plate (57%, n = 8) or exchange nailing (43%, n = 6). None of the PIF patients needed additional surgeries for non-union, malunion, or delayed union. CONCLUSIONS A PIF is a rare complication of intramedullary fixation of trochanteric fractures. It can be treated with either locking plates or exchange nailing with sufficient results. There are no grounds for favoring long nails to avoid PIFs.
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Affiliation(s)
- Lauri M Halonen
- Department of Orthopedics and Traumatology, South Karelia Central Hospital, University of Helsinki, Valto Käkelän katu 3, 53130, Lappeenranta, Finland.
| | - Antti Stenroos
- Department of Orthopedics and Traumatology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Henri Vasara
- Department of Orthopedics and Traumatology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Jussi Kosola
- Department of Orthopedics and Traumatology, Kanta-Häme Central Hospital, Hämeenlinna, Finland
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Galal S, Shin J, Principe P, Khabyeh-Hasbani N, Mehta R, Hamilton A, Rozbruch SR, Fragomen AT. STRYDE versus PRECICE magnetic internal lengthening nail for femur lengthening. Arch Orthop Trauma Surg 2022; 142:3555-3561. [PMID: 33983528 PMCID: PMC9596511 DOI: 10.1007/s00402-021-03943-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 05/03/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Magnetic internal lengthening nails (MILNs) have been used for femoral lengthening to avoid complications associated with external fixation. The titanium version of the MILN (PRECICE®) has been in use since 2011 but had limitations (50-75 lb) in post-operative weight bearing. A new stainless-steel version of the MILN (STRYDE®) allows 150-250 lb of post-operative weight bearing. The aim is to compare the outcomes of using these two different MILNs for both unilateral and bilateral femoral lengthening. METHODS A single-center, retrospective cohort study was conducted in which patients' records were reviewed from the period from January 2017 to March 2020. A total of 66 femoral lengthening procedures were included in the study and were divided into two groups: STRYDE® group (30 femora) and PRECICE® group (36 femora). Outcomes assessed were the 6-months post-operative Limb Deformity-Scoliosis Research Society (LD-SRS) Score, adjacent joint range of motion (ROM), average distraction rate, bone healing index (BHI), and complications. RESULTS No statistically significant difference was found between the two groups in regard to the (LD-SRS) score, hip ROM, or knee ROM. Statistically significant differences were found between the two groups in regard to BHI (average of 0.84 months/cm and 0.67 months/cm for STRYDE® and PRECICE®, respectively) and distraction rate (average of 0.6 mm/day and 0.9 mm/day for STRYDE® and PRECICE®, respectively). No mechanical nail complications were reported in the STRYDE® group compared to three events of nail failure in the PRECICE® group. One femur in the PRECICE® group needed BMAC injection for delayed healing compared to four femurs in the STRYDE® group. CONCLUSION The STRYDE® MILN yields comparable functional results to those of PRECICE® MILN and shows fewer mechanical nail complications. However, STRYDE® MILN requires a slower distraction rate and yields slower healing (larger BHI). LEVEL OF EVIDENCE Level III, Therapeutic study.
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Affiliation(s)
- Sherif Galal
- Limb Lengthening and Complex Reconstruction Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College Cornell University, New York, NY USA
- Department of Orthopaedic Surgery, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt
| | - Jonggu Shin
- Limb Lengthening and Complex Reconstruction Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College Cornell University, New York, NY USA
| | - Peter Principe
- Limb Lengthening and Complex Reconstruction Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College Cornell University, New York, NY USA
| | - Nathan Khabyeh-Hasbani
- Limb Lengthening and Complex Reconstruction Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College Cornell University, New York, NY USA
| | - Rena Mehta
- Limb Lengthening and Complex Reconstruction Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College Cornell University, New York, NY USA
| | - Amber Hamilton
- Limb Lengthening and Complex Reconstruction Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College Cornell University, New York, NY USA
| | - S. Robert Rozbruch
- Limb Lengthening and Complex Reconstruction Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College Cornell University, New York, NY USA
| | - Austin T. Fragomen
- Limb Lengthening and Complex Reconstruction Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College Cornell University, New York, NY USA
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Garabano G, Crossa JI, Cullari M, Pérez-Alamino L, Pesciallo CA. [Impact of the nail diameter on consolidation of tibial diaphyseal fractures. Retrospective analysis of 96 patients]. Acta Ortop Mex 2022; 36:346-351. [PMID: 37669653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
INTRODUCTION the gold standard for tibial diaphyseal fracture treatment is represented by the intramedullary nail (IMN). This study aimed to assess the relevance of nail diameter in bone healing of tibial diaphyseal fractures. MATERIAL AND METHODS a retrospective study was conducted analyzing patients with closed 42 OTA/AO tibial fractures, treated with a reamed and locked IMN between January 2014 and December 2020. The variables assessed were gender, age, comorbidities, number of bolts used, canal/nail index (difference between the diameter of the medullary canal and nail), nail/canal ratio (ratio between nail diameter and medullary canal), related to consolidation and failure rates (delay and non-union). RESULTS 96 patients were included. The consolidation rate was 91.7% (n = 88). Patients with consolidation had a significantly larger nail diameter than those who failed (p = 0.0014), increasing the chance of consolidation 5.30 (p = 0.04) times for each millimeter that the nail increased its diameter. Using a nail > 10 mm increased the chance of consolidation 13.56 times (p = 0.018). A nail/canal ratio 0.80 increased the chance of consolidation 23.33 times (p = 0.005). CONCLUSION our findings suggested that reamed and locked IMN in tibial diaphyseal fractures should be implanted with the largest possible diameter (> 10 mm and with a nail-to-canal ratio 0.80) to promote bone healing.
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Affiliation(s)
- G Garabano
- Servicio de Ortopedia y Traumatología del Hospital Británico de Buenos Aires, Argentina
| | - J I Crossa
- Servicio de Ortopedia y Traumatología del Hospital Británico de Buenos Aires, Argentina
| | - M Cullari
- Servicio de Ortopedia y Traumatología del Hospital Británico de Buenos Aires, Argentina
| | - L Pérez-Alamino
- Servicio de Ortopedia y Traumatología del Hospital Británico de Buenos Aires, Argentina
| | - C A Pesciallo
- Servicio de Ortopedia y Traumatología del Hospital Británico de Buenos Aires, Argentina
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