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Liu D, Huang Q, Wang C, Ren C, Xu Y, He C, Zhang K, Zhou D, Zhang C, Ma T. Biomechanical evaluation of Gamma 3 nail with anti-rotation screw fixation for unstable femoral neck fractures: a biomechanical study. Sci Rep 2024; 14:19356. [PMID: 39169075 PMCID: PMC11339291 DOI: 10.1038/s41598-024-70346-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 08/14/2024] [Indexed: 08/23/2024] Open
Abstract
This study aims to evaluate the biomechanical performance of the Gamma 3 nail with an anti-rotation screw (GNS) and compare it to two established gold-standard methods for treating unstable femoral neck fractures (UFNFs). Synthetic bone models were prepared with Pauwels' type III osteotomy and an additional posterior wedge. Three different implant configurations were tested: three cannulated crews (3CS) in an inverted triangle configuration, a dynamic hip screw with an anti-rotation screw (DHSS), and GNS. Non-destructive cyclic axial loading was applied at 7° adduction, with 1000 cycles ranging from 100 to 1000 N. Subsequently, a construct failure test was conducted using progressive axial compression, and fracture reduction loss was recorded. The average axial stiffness was 321 ± 52 N/mm for 3CS, 430 ± 71 N/mm for DHSS, and 519 ± 104 N/mm for GNS. The average ultimate failure loads were 2699.3 N for 3CS, 3427.1 N for DHSS, and 3758.9 N for GNS. GNS demonstrated significantly greater axial stiffness compared to the other two groups (P < 0.05). Both DHSS and GNS exhibited similar failure loading, which were greater than those of 3CS (P < 0.05). GNS offers the advantages of a minimally invasive and intramedullary implant with comparable stability to the DHSS system. Moreover, GNS demonstrated superior biomechanical performance compared to 3 CS configuration.
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Affiliation(s)
- Deyin Liu
- Department of Severe and Poly Trauma, Xi'an Jiaotong University College of Medicine, Hong-Hui Hospital, Xi'an City, 710054, Shaanxi Province, China
| | - Qiang Huang
- Department of Severe and Poly Trauma, Xi'an Jiaotong University College of Medicine, Hong-Hui Hospital, Xi'an City, 710054, Shaanxi Province, China
| | - Chaofeng Wang
- Department of Severe and Poly Trauma, Xi'an Jiaotong University College of Medicine, Hong-Hui Hospital, Xi'an City, 710054, Shaanxi Province, China
| | - Cheng Ren
- Department of Severe and Poly Trauma, Xi'an Jiaotong University College of Medicine, Hong-Hui Hospital, Xi'an City, 710054, Shaanxi Province, China
| | - Yibo Xu
- Department of Severe and Poly Trauma, Xi'an Jiaotong University College of Medicine, Hong-Hui Hospital, Xi'an City, 710054, Shaanxi Province, China
| | - Changjun He
- Department of Severe and Poly Trauma, Xi'an Jiaotong University College of Medicine, Hong-Hui Hospital, Xi'an City, 710054, Shaanxi Province, China
| | - Kun Zhang
- Department of Severe and Poly Trauma, Xi'an Jiaotong University College of Medicine, Hong-Hui Hospital, Xi'an City, 710054, Shaanxi Province, China
| | - Dawei Zhou
- Department of Severe and Poly Trauma, Xi'an Jiaotong University College of Medicine, Hong-Hui Hospital, Xi'an City, 710054, Shaanxi Province, China
| | - Congming Zhang
- Department of Severe and Poly Trauma, Xi'an Jiaotong University College of Medicine, Hong-Hui Hospital, Xi'an City, 710054, Shaanxi Province, China.
| | - Teng Ma
- Department of Severe and Poly Trauma, Xi'an Jiaotong University College of Medicine, Hong-Hui Hospital, Xi'an City, 710054, Shaanxi Province, China.
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Zhao Y, Li J, Liu Y, Cui G, Li Z. Comparison of reconstruction nails versus dual implants in the treatment of ipsilateral femoral neck and shaft fractures in adults: a meta-analysis and systematic review. BMC Musculoskelet Disord 2023; 24:800. [PMID: 37814281 PMCID: PMC10561477 DOI: 10.1186/s12891-023-06933-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 10/01/2023] [Indexed: 10/11/2023] Open
Abstract
OBJECTIVE There is no consensus on the optimal treatment for ipsilateral femoral neck and shaft fractures. This meta-analysis aims to assess the effectiveness of reconstruction nails and dual implants in treating ipsilateral femoral neck and shaft fractures to provide a basis for decision-making when selecting the optimal approach. METHODS Relevant articles were retrieved from Pubmed, Embase, and Cochrane databases using the keywords "neck of femur", "shaft" and "fracture fixation" from inception until November 17, 2022. The screening process of the studies was conducted independently by two assessors, who assessed each study's eligibility and two assessors assessed the quality. Then compared differences in outcome measures using RevMan 5.3 software. RESULTS A total of ten retrospective cohort studies were included. There were no significant differences in union time, union rate, union-related complications (malunion, nonunion, delayed union) of femoral neck and shaft fractures, osteonecrosis of the femoral head, and functional outcomes (Friedman-Wyman scoring system) (P > 0.05). CONCLUSION Our pooled estimates indicated that reconstruction nails and dual implants for ipsilateral femoral neck and shaft fractures could yield satisfactory surgical results, and that there is no difference between the two treatment methods. TRIAL REGISTRATION This meta-analysis was registered on the PROSPERO website (registration number: CRD42022379606).
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Affiliation(s)
- Yongchao Zhao
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, Jilin Province, China
| | - Jian Li
- Department of Emergency and Critical Care, The Second Hospital of Jilin University, Changchun, China
| | - Yadong Liu
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, Jilin Province, China
| | - Guanlu Cui
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, Jilin Province, China
| | - Zhengwei Li
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, Jilin Province, China.
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Cnossen JD, Van Lieshout EMM, Verhofstad MHJ. Surgical management of bifocal femoral fractures: a systematic review and pooled analysis of treatment with a single implant versus double implants. Arch Orthop Trauma Surg 2023; 143:6229-6241. [PMID: 37405462 PMCID: PMC10491515 DOI: 10.1007/s00402-023-04950-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 06/13/2023] [Indexed: 07/06/2023]
Abstract
INTRODUCTION Fractures of the proximal femur accompanied by a fracture of the femoral shaft are relatively rare, with a reported prevalence between 1 and 12%. Multiple surgical options are available, consisting of treatment with a single implant or with double implants. Controversy exists about the optimal management. A systematic review and pooled analysis were performed to assess the most reliable treatment for bifocal femoral fractures of the femur. MATERIALS AND METHODS A literature search was conducted on July 15, 2022. Selected studies were screened on title and abstract by two researchers independently, and full texts were read by both authors. Emphasis was put on adverse events such as postoperative infection, healing complications, malalignment, and functional outcome using either a single implant or double implants. RESULTS For the proximal femoral fractures, no significant difference could be confirmed for avascular necrosis of the femoral neck (5.1% for single implant and 3.8% for double implants), nonunion (6.4% for single implant and 7.8% for double implants), or varus malalignment (6.6% for single implant and 10.9% for double implants). This study also suggests that the number of implants is irrelevant for complications of the femoral shaft regarding the rates of postoperative infection and healing complications. Pooled rates of bone healing complications were 1.6-2.7-fold higher when patients were treated with a single implant, but statistical significance could not be confirmed. For hardware failure, revision surgery, leg length discrepancy, and functional outcome, no difference between the two groups was found either. CONCLUSIONS The pooled proportions of all postoperative complications had overlapping confidence intervals; thus, no inference about a statistically significant difference on the number of implants used for treating ipsilateral fractures of the femur can be made. Both treatment groups showed a similar functional outcome at the last moment of follow-up, with more than 75% of the patients reporting a good outcome.
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Affiliation(s)
- J D Cnossen
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Esther M M Van Lieshout
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Michael H J Verhofstad
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
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Oh CW, Kim JW, Oh JK, Apivatthakakul T, Park KH, Hong W. "Reverse miss-a-nail technique" of reconstruction nailing for successful fixation of the ipsilateral femoral neck and shaft fracture. Arch Orthop Trauma Surg 2021; 141:959-969. [PMID: 33040209 DOI: 10.1007/s00402-020-03620-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 09/30/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Although reconstruction nails have an advantage of single-construct fixation in ipsilateral femoral neck and shaft fractures, they have not been used widely due to the technical challenges associated with their placement. Reduction is particularly demanding in patients with displaced neck fractures after nailing of the shaft fracture, and can be resulted in nonunion, malunion, and osteonecrosis. We report a new technique of reconstruction nailing after the provisional reduction and fixation of a neck fracture to achieve successful healing of this injury. MATERIALS AND METHODS Osteosynthesis using a reconstruction nail was performed in ten consecutive patients with displaced femoral neck and shaft fracture. After closed reduction of the displaced neck fracture, the femoral neck was provisionally fixed with pins in an anterolateral-to-medial direction. While maintaining reduction of the neck fracture, a nail was inserted and passed into the medullary canal posterior to the provisionally fixed pins with indirect reduction of the shaft fracture. After two reconstruction locking screws were fixed for proximal interlocking, the provisional pins were removed once distal interlocking was achieved. The radiologic outcomes included quality of reduction, healing rate, and time to the union were appraised, and the functional outcomes were assessed with Friedman and Wyman's criteria. RESULTS This novel technique provided satisfactory reduction of both the femoral neck and shaft fractures with no malunion. All fractures achieved primary union, except for one case of nonunion of femoral shaft. Eight of ten patients experienced good results in functional outcome, whereas the remaining two patients reported moderate limitations in activities of daily living. At the latest follow-up, all patients had excellent range of motion in hip and knee joints. CONCLUSIONS Provisional fixation after reduction of a femoral neck fracture may facilitate successful reconstruction nailing in the ipsilateral fractures of the femoral neck and shaft. This "Reverse Miss-a-Nail Technique" may minimize complications and maximize the radiologic and functional outcomes of patients who experience this injury.
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Affiliation(s)
- Chang-Wug Oh
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130, Dongduk-ro, Jung-gu, Daegu, 41944, Republic of Korea
| | - Joon-Woo Kim
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130, Dongduk-ro, Jung-gu, Daegu, 41944, Republic of Korea.
| | - Jong-Keon Oh
- Department of Orthopaedic Surgery, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Theerachai Apivatthakakul
- Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, 10, Suthep road, T Suthep, A Muang, Chiang Mai, 50200, Thailand
| | - Kyeong-Hyeon Park
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130, Dongduk-ro, Jung-gu, Daegu, 41944, Republic of Korea
| | - Wonki Hong
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130, Dongduk-ro, Jung-gu, Daegu, 41944, Republic of Korea
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Jitprapaikulsarn S, Chantarapanich N, Gromprasit A, Mahaisavariya C, Patamamongkonchai C. Single lag screw and reverse distal femur locking compression plate for concurrent cervicotrochanteric and shaft fractures of the femur: biomechanical study validated with a clinical series. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 31:1179-1192. [PMID: 33417049 DOI: 10.1007/s00590-020-02868-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 12/29/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The optimal surgical management of concurrent cervicotrochanteric and shaft fractures of the femur has not been consensual. The authors investigated the reliability of combined single lag screw and reverse distal femur locking compression plate (LCP-DF) by finite element (FE) study and retrospectively described the present technique for these dual fractures. METHOD Intact femurs were derived from CT data, and the implant models were created by using CAD software. The fractured femur and implant models were virtually aligned based on the surgical techniques before converting to the FE model. In the FE model, applied boundary conditions included body weight, muscle forces, and constraint of the joints. Regarding clinical series, three patients with these dual fractures of the femur and 2 with cervicotrochanteric fractures with subtrochanteric extension were operated on by the proposed technique. The collected data include operative time, postoperative complications, union times, and clinical outcomes. RESULTS Equivalent von Mises stress exhibited on dynamic hip screws with an anti-rotational screw was higher than the other techniques, close to the yield stress of the material. Multiple screw fixation produced better stability for transcervical fractures whereas the proposed technique of combined single lag screw and reverse LCP-DF provided better stability for intertrochanteric fractures. No significant difference in cortical bone stress was found between multiple screw construct and the proposed technique. The proposed technique presented a lower risk of secondary fractures, as the strain energy density (SED) in cancellous bone was lower than multiple screw construct. Regarding clinical series, all fractures were united with a mean union time of-16.1 weeks (range 12-20). There were no any postoperative complications. Regarding the Harris score, 1 was determined to be excellent value, and 4 to be good. CONCLUSION By the FE results, a combination of a single lag screw and reverse LCP-DF is an effective technique for fixation of cervicotrochanteric fractures. Empowered by the clinical results, this proposed technique could be an alternative for concurrent cervicotrochanteric and shaft fractures of the femur especially when either single-system or dual-system devices seem not to be suitable.
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Affiliation(s)
| | - Nattapon Chantarapanich
- Department of Mechanical Engineering, Faculty of Engineering at Sriracha, Kasetsart University, Sriracha, Chonburi, Thailand.
| | - Arthit Gromprasit
- Department of Orthopedics, Buddhachinaraj Hospital, Phitsanulok, Thailand
| | - Chantas Mahaisavariya
- Golden Jubilee Medical Center, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Hierholzer C, Friederichs J, Augat P, Woltmann A, Trapp O, Bühren V, von Rüden C. [Evolution and principles of intramedullary locked nailing]. Unfallchirurg 2019; 121:239-255. [PMID: 29464295 DOI: 10.1007/s00113-018-0461-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Key factors for successful osteosynthetic fracture stabilization are anatomical fracture reduction, restoration of axis and torsion alignment as well as tissue-preserving operative techniques. In long bone fractures, the use of intramedullary long bridging nailing offers ideal conditions for bone healing, as axial and rotational stability is provided by canal-filling nails and locking screws. In addition, the tissue in the fracture region is protected as the intramedullary nail insertion is distant from the fracture. The indication spectrum for modern intramedullary locked nailing includes diaphyseal fractures of long bones, metaphyseal fractures and reconstructions, as well as treatment of nonunion, osteotomy and arthrodesis of the lower extremities. Continuous improvements in nail design and instrumentation as well as the introduction of anatomical reconstruction nails will optimize the spectrum and effectiveness of intramedullary osteosynthesis even further.
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Affiliation(s)
- C Hierholzer
- Abteilung Unfallchirurgie, BG Unfallklinik Murnau, Professor-Küntscher-Str. 8, 82418, Murnau, Deutschland
- Klinik für Traumatologie, Universitätsspital Zürich, Zürich, Schweiz
| | - J Friederichs
- Abteilung Unfallchirurgie, BG Unfallklinik Murnau, Professor-Küntscher-Str. 8, 82418, Murnau, Deutschland
| | - P Augat
- Universitätsinstitut für Biomechanik, Paracelsus Medizinische Privatuniversität, Salzburg, Österreich
- Institut für Biomechanik, BG Unfallklinik Murnau, Murnau, Deutschland
| | - A Woltmann
- Abteilung Unfallchirurgie, BG Unfallklinik Murnau, Professor-Küntscher-Str. 8, 82418, Murnau, Deutschland
| | - O Trapp
- Abteilung Unfallchirurgie, BG Unfallklinik Murnau, Professor-Küntscher-Str. 8, 82418, Murnau, Deutschland
| | - V Bühren
- Abteilung Unfallchirurgie, BG Unfallklinik Murnau, Professor-Küntscher-Str. 8, 82418, Murnau, Deutschland
| | - C von Rüden
- Abteilung Unfallchirurgie, BG Unfallklinik Murnau, Professor-Küntscher-Str. 8, 82418, Murnau, Deutschland.
- Universitätsinstitut für Biomechanik, Paracelsus Medizinische Privatuniversität, Salzburg, Österreich.
- Institut für Biomechanik, BG Unfallklinik Murnau, Murnau, Deutschland.
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Kim BS, Cho JW, Yeo DH, Oh JK. Surgical Treatment of Ipsilateral Multi-Level Femoral Fracture Treated Using Antegrade Intramedullary Nail. JOURNAL OF TRAUMA AND INJURY 2018. [DOI: 10.20408/jti.2018.31.2.96] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Beom-Soo Kim
- Department of Orthopedic Surgery, Korea University Guro Hospital, Korea University Medical Center, Seoul, Korea
| | - Jae-Woo Cho
- Department of Orthopedic Surgery, Korea University Guro Hospital, Korea University Medical Center, Seoul, Korea
| | - Do-Hyun Yeo
- Department of Orthopedic Surgery, Korea University Guro Hospital, Korea University Medical Center, Seoul, Korea
| | - Jong-Keon Oh
- Department of Orthopedic Surgery, Korea University Guro Hospital, Korea University Medical Center, Seoul, Korea
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Labza S, Fassola I, Kunz B, Ertel W, Krasnici S. Delayed recognition of an ipsilateral femoral neck and shaft fracture leading to preventable subsequent complications: a case report. Patient Saf Surg 2017; 11:20. [PMID: 28702088 PMCID: PMC5504794 DOI: 10.1186/s13037-017-0134-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 06/21/2017] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Ipsilateral femoral shaft and neck fractures are rare injuries, affecting mostly young patients who sustained high-energy traumas. In 19-50% of cases, the femoral fracture is misdiagnosed or overlooked at the initial presentation, with reportedly increased risk of complications such as non-union and avascular necrosis. We present a case of an ipsilateral femoral neck and shaft fracture, which was missed at initial presentation despite radiographic and computed tomography (CT) scan evaluation. CASE PRESENTATION A 56-year old female was admitted to our institution following a high-energy trauma (fall from 6 m). Initial radiographic and CT scan evaluation revealed a displaced femoral shaft fracture but no other femoral fractures were detected. Closed reduction and external fixation of the femoral shaft fracture was performed in the emergency setting. Follow-up radiologic evaluations revealed an ipsilateral laterally displaced femoral neck fracture. Despite cephalomedullary nail fixation of both fractures performed on the third day from the initial injury, the patient developed a non-union of the femoral neck fracture, which led to cut-out of the lag screw with associated varus failure of the femoral neck fracture requiring surgical revision and implant of a bipolar hemiarthroplasty at one year follow up. The postoperative course was uneventful and the patient had a full long-term recovery. CONCLUSION This case report exemplifies the need to maintain the highest level of suspiciousness for the concomitant presence of an ipsilateral femoral neck fracture when treating polytraumatized patients who sustained a femoral shaft fracture as a consequence of a high-energy trauma. Furthermore, the pre-operative standardized radiological evaluation (plain x-ray and CT scan) might not always help in ruling out these fractures. It is therefore necessary to adopt additional standardized radiographic protocols not only in the pre-operative but also in the intra-operative and immediate post-operative settings.
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Affiliation(s)
- Sönke Labza
- Klinik für Unfallchirurgie und Orthopädie, DRK Kliniken Berlin
- Westend, Berlin, 14050 Germany
| | - Isabella Fassola
- Klinik für orthopädische und Unfallchirurgie, CHARITÉ - Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany
| | - Benedict Kunz
- Klinik für orthopädische und Unfallchirurgie, CHARITÉ - Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany
| | - Wolfgang Ertel
- Klinik für orthopädische und Unfallchirurgie, CHARITÉ - Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany
| | - Senat Krasnici
- Klinik für orthopädische und Unfallchirurgie, CHARITÉ - Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany
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A case of acute bilateral femur fracture with vascular injury. JOURNAL OF ACUTE DISEASE 2016. [DOI: 10.1016/j.joad.2015.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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von Rüden C, Tauber M, Woltmann A, Friederichs J, Hackl S, Bühren V, Hierholzer C. Surgical treatment of ipsilateral multi-level femoral fractures. J Orthop Surg Res 2015; 10:7. [PMID: 25616698 PMCID: PMC4335365 DOI: 10.1186/s13018-014-0149-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 12/26/2014] [Indexed: 11/23/2022] Open
Abstract
Background Concurrent ipsilateral fractures of the proximal and shaft of the femur are rare complex fracture combinations. In this prospective cohort study, we evaluated clinical and radiological long-term results after operative treatment using several surgical strategies: the so-called “rendezvous” surgical technique, e.g., the combination of retrograde intramedullary nailing and dynamic hip screw (DHS) osteosynthesis, or the all-in-one device technique, e.g., long cephalomedullary nail, compared with two non-overlapping implants (e.g., conventional technique). Methods In a 10-year-period from 2004 to 2013, we treated 65 patients with complex ipsilateral multi-level femoral fractures. Median age was 45 years (range 19–90 years). Fractures were classified according to the AO/OTA classification. Four patients died during intensive care unit treatment due to multi-organ failure prior to definitive osteosynthesis. Clinical long-term outcome using the functional system of Friedman/Wyman as well as radiological outcome was evaluated 2 years after trauma (range 13–42 months). Results All-in-one device was used in 36 patients, “rendezvous” technique in 9 patients, and the conventional technique in the remaining 16 patients. Two years after trauma, complete fracture healing was found in 57 out of 61 patients (“rendezvous”: 9, all-in-one device: 33, conventional: 15; p-value: 0.66). There was no significant difference regarding the complication rate in the cohort groups (“rendezvous”: 3, all-in-one device: 13, conventional: 5; p-value: 0.94). Using the functional assessment system of Friedman/Wyman 2 years after trauma, a good clinical result was found in 77.7% in the “rendezvous” group, in 77.8% in the all-in-one device group, and in 75% in the conventional group. Conclusion The indication for operative stabilization of ipsilateral multi-level femoral fractures is considered an urgent and emergency procedure. Based on the successful long-term results of this study, we prefer the “rendezvous” technique with fracture stabilization from distally to proximally. Both fracture components require stable fixation. It is advisable to stabilize the shaft fracture primarily using external fixation (damage control orthopedics) and the proximal femoral fracture using early definitive internal fixation. In a second and staged operation, the external fixator is removed and the shaft fracture is stabilized using retrograde nail osteosynthesis with overlapping of the DHS and nail implants.
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Affiliation(s)
| | - Markus Tauber
- Department of Trauma Surgery, Trauma Center Murnau, 82418, Murnau, Germany.
| | - Alexander Woltmann
- Department of Trauma Surgery, Trauma Center Murnau, 82418, Murnau, Germany.
| | - Jan Friederichs
- Department of Trauma Surgery, Trauma Center Murnau, 82418, Murnau, Germany.
| | - Simon Hackl
- Department of Trauma Surgery, Trauma Center Murnau, 82418, Murnau, Germany.
| | - Volker Bühren
- Department of Trauma Surgery, Trauma Center Murnau, 82418, Murnau, Germany.
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