Treatment of unstable intertrochanteric femoral fractures with locking gamma nail (LGN): A retrospective cohort study

Long vs short intramedullary nails for reverse pertrochanteric fractures: A biomechanical study

There is currently no definitive evidence for the implant of choice for the treatment of reverse pertrochanteric fractures. Here, we aimed to compare the stability provided by two implant options: long and short intramedullary nails. We performed finite element simulations of different patterns of reverse pertrochanteric fractures with varying bone quality, and compared the short vs long nail stabilization under physiological loads. For each variable combination, the micromotions at the fracture site, bone strain, and implant stress were computed. Mean micromotions at the fracture surface and absolute and relative fracture surface with micromotions >150 µm were slightly lower with the short nail (8%, 3%, and 3%, respectively). The distal fracture extension negatively affected the stability, with increasing micromotions on the medial side. Bone strain above 1 % was not affected by the nail length. Fatigue stresses were similar for both implants, and no volume was found above the yield and ultimate stress in the tested conditions. This simulation study shows no benefit of long nails for the investigated patterns of reverse pertrochanteric fractures, with similar micromotions at the fracture site, bone strain, and implant stress.

Proximal femoral bionic nail (PFBN)-an innovative surgical method for unstable femoral intertrochanteric fractures

PURPOSE

Intertrochanteric femoral fractures (IFF) are one of the most common traumatic conditions, but there are no established treatment methods for this condition due to implant failure and re-operation rates. The proximal femoral bionic nail (PFBN), which is a new design of the cephalomedullary nail, was developed by our team. The objective of this study was to assess the clinical and radiographic outcomes of PFBN in patients with unstable IFF.

METHODS

From October 2020 to August 2021, 12 patients diagnosed with unstable IFF (31-A2, 3) were treated with PFBN at the Third Hospital of Hebei Medical University. We evaluated the clinical therapeutic effects of this treatment by measuring peri-operative indicators and post-operative complications. Clinical outcomes, specific radiographic parameters, and post-operative complications were collected and analyzed within the first post-operative year.

RESULTS

The average age of the patients was 72.4 ± 16.1 years (five males and seven females). The mean operation time was 90.4 ± 16.0 min, whereas the operation time of 31-A2 fractures (83.1 ± 12.2 min) was shorter than that of 31-A3 fractures (105.0 ± 12.9 min) (p < 0.05). The blood loss was 175 ml (range: 50 to 500 ml), and the length of hospitalization was 10.0 ± 1.9 days. The prognosis evaluation was assessed at three, six and 12 months after the operation; for these time points, the Harris hip scores were 69.6 ± 4.1, 77.8 ± 3.8, and 82.6 ± 4.6, respectively, and the Parker-Palmer scores were 5.3 (5.0, 7.0), 6.3 (5.3, 7.0), and 7.8 (7.0, 8.0), respectively.

CONCLUSION

PFBN has shown advantages in the treatment of unstable IFF (particularly in geriatric patients) and possesses both stability and safety. This innovative method may provide a new option for treating unstable IFFs.

Comparison of perioperative hidden blood loss for intertrochanteric fractures in the elderly by different intramedullary fixations: A randomized controlled study protocol

BACKGROUND

Till date only a few studies have reported the clinical outcomes of intraoperative hidden blood loss of intertrochanteric fracture in the old people treated with various intramedullary immobilizations. The aim of the trial is to investigate the best choice for treating intertrochanteric fractures, as well as the hidden blood loss among different intramedullary fixations.

METHODS

This randomized, single-blind, superiority clinical trial was admitted by the Ethics Committee in our hospital (The 7th Medical Center of PLA, 20200602DM). The eligibility criteria were:Patients who met any of the following conditions would not be able to participate in the test: composite femoral fracture, under 65 years of ages, experience of femoral fractures, surgical contraindications, nonambulatory before the presenting injury, or presence of any other traumatic fractures. 120 participants with unstable intertrochanteric fractures, treated by Gammar nail, (n = 40), Proximal Femoral Nail Antirotation (n = 40) and Intertrochanteric Antegrade Nail (n = 40) instruments were enrolled in this research. The main outcome measures were total blood loss and hidden blood loss, which were evaluated based on the haematocrit change after the operation. The experimental data was analyzed and sorted out with SPSS program (ver.19; SPSS Inc., Chicago, IL).

RESULTS

This experiment had strict inclusive criteria and exclusive criteria and a well- regulated intervention.

CONCLUSIONS

The results of this trial will provide more evidence on which technique can better treat unstable intertrochanteric fracture.

TRIAL REGISTRATION

This study protocol was registered in Research Registry (researchregistry5788).

Treatment of Complex Femoral Fractures with the Long Intramedullary Gamma Nail

The purpose of the current study was to present the authors’ experiences with the long intramedullary Gamma nail in the treatment of patients with complex femoral fractures. Th is retrospective study included 48 patients with complex femoral fractures. All patients had received fracture fixation treatments with long intramedullary Gamma nails from January 2007 to December 2015. The complex fractures of all patients were classified into 3 types, according to the anatomical locations of the fractures. Type I included combined fractures of the shaft and the proximal femur. Type II included segmental fractures. Type III included combined fractures of the shaft and distal femur. According to the Harris Hip Score, 85.4% of our patients had excellent and very good functional outcomes of the operative procedure. Complications occurred in 7 (14.58%) patients. The most common complications occurred in patients with combined fractures of the shaft and distal femur (50%). Based on the findings of this study, we conclude that the clinical and radiological results after the treatment of complex femoral fractures with the long intramedullary Gamma nail show good outcomes, with a high rate of bone union and minimal soft tissue damage. Experience with this procedure is important to prevent and minimise technical complications.

Preliminary experience with MEDGAL DHS for treatment of proximal femoral fractures

Background and aim of the study: The Authors report their implant’s analysis and preliminary experience with a new fixation device, the MEDGAL DHS for treatment of proximal femoral fractures, producted by MEDGAL Sp.z o.o, Niewodnicka, Poland. Materials: Between January 2019 and September 2019 in Orthopedics and Traumatology Department of Piacenza, 12 patients with stable pertrocanteric fractures were treated with the MEDGAL DHS. Results: No patients presented perioperative complications with low bleeding and mean surgical time of 40 minutes. Conclusions: DHS is an optimal implant for the treatment of stable pertrochanteric femural fractures. (www.actabiomedica.it)

Controlled study on Gamma nail and proximal femoral locking plate for unstable intertrochanteric femoral fractures with broken lateral wall

The gamma nail and proximal femoral locking plate (PFLP) are both used for fractures. A controlled study was performed to determine the optimal implant. To assess and analyze the clinical effects of gamma nails and PFLPs for patients with unstable intertrochanteric femoral fractures, specifically with broken lateral walls. Thirty-six patients with unstable intertrochanteric femoral fractures and broken lateral walls were treated with gamma nails or PFLPs and retrospectively studied. The clinical data were compared. Duration of surgery and early full weight-bearing time were significantly longer in the PFLP group compared to the gamma nail group (P < 0.05). However, intraoperative fluoroscopy frequency and total blood loss in the PFLP group were significantly less than those in the gamma nail group (P < 0.05). No significant differences were found in hospitalized days, Parker Palmer mobility scores, Harris hip scores, and complications between the two groups. No difference in hip-functional recovery was found between the gamma nail group and the PFLP group, indicating that both the gamma nail and PFLP were effective for unstable intertrochanteric femoral fractures with a broken lateral wall. However, early weight bearing on the fractures was not encouraged in patients treated with PFLP.

Joint-preserving palliative surgery using self-locking screws of intramedullary nail and percutaneous cementoplasty for proximal humeral metastasis in the advanced cancer patients

BACKGROUND

We introduced a palliative joint-preserving surgery using proximal self-locking screws of intramedullary (IM) nail and percutaneous cementoplasty (PC) in patients with proximal humeral metastases, including the head and neck, and evaluated the outcome of the surgical method.

METHODS

Twenty-three patients (mean age = 63.0 ± 11.8 years, M:F = 14:9) had IM nailing with a self-locking screw system and PC for the treatment of humeral head and neck metastases. Usually, three proximal locking screws were inserted after IM nailing, and 20.9 ± 8.0 ml of polymethylmethacrylate (PMMA) bone cement was injected in the perimetal osteolytic area.

RESULTS

Regional anesthesia with interscalene block was performed in 87.0% (20/23), and the duration of surgery (from anesthesia to awakening) was approximately 40-55 min. Red blood cell was not transfused intra- and/or postoperatively in 65.2% (15/23). The localized preoperative pain (visual analog scale (VAS), 8.2 ± 3.1) was gradually decreased at postoperative 1 week (VAS, 4.9 ± 2.1) and at 6 weeks (VAS, 2.9 ± 2.1) (P < 0.001). Among nine patients who underwent F-18-FDG PET/CT, the proximal humeral metastasis around PC showed improved, stable, and aggravated states in five (55.6%), three (33.3%), and one patient (11.1%), respectively. Meanwhile, 88.8% (8/9) of patients showed aggravation at the naive bone metastasis area.

CONCLUSION

The selection of the self-locking screw type of the IM nail and PC was helpful in preventing fixation failure for joint-preserving palliative surgery in the proximal humeral metastasis.