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Al-Dahan T, Murhekar S, Patel N. Treatment Outcomes of Dynamic Hip Screws Versus Short Intramedullary Nails for Extra-capsular Fragility Hip Fractures and Their Coding Audit. Cureus 2024; 16:e68617. [PMID: 39233732 PMCID: PMC11372849 DOI: 10.7759/cureus.68617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2024] [Indexed: 09/06/2024] Open
Abstract
Introduction In the UK, hip fractures are a common reason for presentations to the emergency departments, which places significant pressure on NHS hospitals, appropriate choice of an implant to treat the hip fracture is one among many other factors that affect patients' outcomes. This audit aims to identify and compare the outcome difference between the dynamic hip screws (DHS) and short cephalomedullary nails in the treatment of extracapsular hip fractures. Methods In a retrospective study of 52 patients admitted as a result of hip fractures in one NHS trust, data collection was done from the patients' records using the trust's online system, we studied different variables to compare the outcome difference between DHS and short intramedullary (IM) nails, two senior authors interpreted the patients' X-rays and verified the coding and classification of the neck of femur fractures. Results This retrospective study examined 52 extracapsular hip fracture cases, including 37 females and 15 males. Forty-six (88%) of the included patients were ASA 3 and 4 (American Society of Anesthesiologists), and the average days to discharge from therapies were 8.4 (SD-+ 4) days compared to 11 (SD-+ 5.2) days for short IM nails and DHS, respectively (P= 0.03), the 30-day mortality rate for short nails was 7% (n= 4/52) patients and 6% (n= 3/52) for DHS (P =0.69). The mean operating times for the different implants were 58.11 (SD-+ 15.1) minutes for DHS and 58.03 (SD-+ 23.2) minutes for the short nail (P =0.98). Compliance with the national guidelines for providing an appropriate operation to treat hip fractures initially went from 63% (n=33/52) initially to 73% (n=38/52). This means that more patients who are appropriate for nailing are being treated with IM nails. Conclusion Short IM nails are associated with faster hospital discharge; this fact may be reflecting the lower postoperative pain as a result of avoiding soft tissue dissection associated with extramedullary devices. keeping in mind that IM devices have mechanical advantages over sliding hip screws; hence, they are more commonly used for more complex fracture patterns, leading to nearly similar outcomes when compared to extramedullary devices, this can be a source of bias in retrospective studies, larger randomized trials may lead to different outcomes.
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Affiliation(s)
- Tarik Al-Dahan
- Trauma and Orthopaedics, East Kent Hospitals University NHS Foundation Trust, Canterbury, GBR
| | - Siddhartha Murhekar
- Trauma and orthopaedics, East Kent Hospitals University NHS Foundation Trust, Canterbury, GBR
| | - Nimesh Patel
- Trauma and Orthopaedics, East Kent Hospitals University NHS Foundation Trust, Margate, GBR
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Lambers AP, D'Alessandro P, Yates P. Defining Cephalomedullary Nail Breakage Rates: A Systematic Review and Meta-Analysis. J Orthop Trauma 2023; 37:S33-S40. [PMID: 37710373 DOI: 10.1097/bot.0000000000002673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/11/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVE To establish the background rate of breakage of cephalomedullary nails. DATA SOURCES MEDLINE, PubMed, and Web of Science were searched on April 3, 2023. STUDY SELECTION All English-language studies that examined trochanteric with or without subtrochanteric fractures and identified cephalomedullary nail breakage as an outcome measure and a breakage rate could be derived were included. Implants captured were predominantly the TFNA, TFN, and PFN by DePuy Synthes, various versions of the Gamma nail by Stryker, the Zimmer Natural Nail by Zimmer Biomet, and the Intertan by Smith and Nephew. DATA EXTRACTION The author, year of publication, dates of implant insertion, study design, method of detection of breakages, implant used, number of implant breakages, number of implants inserted, breakage rate, and follow-up were extracted. DATA SYNTHESIS Meta-analysis of included studies used descriptive nonparametric statistics and a noncomparative proportion for the pooled result. Differences in results between study design types were compared using the mean breakage rate per study design. CONCLUSIONS Cephalomedullary nail breakage is a rare complication with a median reported rate of 0.6% and a pooled result rate of 0.4%. Ninety-five percent of studies had a breakage rate of 1.3% or less, which sets a benchmark from the reported literature for future studies. There is wide variability in rates of breakage reported between different types of study designs with single-center review studies reporting breakage rates nearly 4-fold greater than large-scale administrative database reviews. The rate of implant breakage should not be used in isolation to judge an implant's performance. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Anton Philip Lambers
- Division of Surgery, Medical School, The University of Western Australia, Perth, Western Australia, Australia
- Department of Traumatology and Orthopaedic Surgery, Fiona Stanley Hospital, Perth, Western Australia, Australia; and
| | - Peter D'Alessandro
- Division of Surgery, Medical School, The University of Western Australia, Perth, Western Australia, Australia
- Department of Traumatology and Orthopaedic Surgery, Fiona Stanley Hospital, Perth, Western Australia, Australia; and
- Orthopaedic Research Foundation Western Australia (ORFWA), Claremont, Western Australia, Australia
| | - Piers Yates
- Division of Surgery, Medical School, The University of Western Australia, Perth, Western Australia, Australia
- Department of Traumatology and Orthopaedic Surgery, Fiona Stanley Hospital, Perth, Western Australia, Australia; and
- Orthopaedic Research Foundation Western Australia (ORFWA), Claremont, Western Australia, Australia
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Grønhaug KML, Dybvik E, Matre K, Östman B, Gjertsen JE. Comparison of Intramedullary Nails in the Treatment of Trochanteric and Subtrochanteric Fractures: An Observational Study of 13,232 Fractures in the Norwegian Hip Fracture Register. J Bone Joint Surg Am 2023; 105:1227-1236. [PMID: 37418538 DOI: 10.2106/jbjs.22.01245] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/09/2023]
Abstract
BACKGROUND Intramedullary nails are commonly used in the treatment of trochanteric and subtrochanteric fractures. We aimed to compare intramedullary nails in widespread use in Norway on the basis of reoperation risk. METHODS We assessed data from 13,232 trochanteric or subtrochanteric fractures treated with an intramedullary nail and registered in the Norwegian Hip Fracture Register between 2007 and 2019. The primary outcome measure was the risk of reoperation for various types of short and long intramedullary nails. Secondly, we compared risk of reoperation for the selected nails with respect to fracture type (AO/OTA type A1, A2, A3, and subtrochanteric fractures). Cox regression analysis adjusted for sex, age, and American Society of Anesthesiologists class was used to estimate hazard rate ratios (HRRs) for reoperation. RESULTS The mean patient age was 82.9 years, and 72.8% of the nails were used in the treatment of female patients. We included 8,283 short and 4,949 long nails. A1 fractures accounted for 29.8%, A2 for 40.6%, A3 for 7.2%, and subtrochanteric fractures for 22.4%. When comparing short nails regardless of fracture type, the TRIGEN INTERTAN had an increased risk of reoperation at 1 year (HRR, 1.31 [95% confidence interval (CI), 1.03 to 1.66]; p = 0.028) and 3 years (HRR, 1.31 [95% CI, 1.07 to 1.61]; p = 0.011) postoperatively compared with the Gamma3. For individual fracture types, we found no significant differences in reoperation risk between the various types of short nails. When comparing long nails, the TRIGEN TAN/FAN had an increased risk of reoperation at 1 year (HRR, 3.05 [95% CI, 2.10 to 4.42]; p < 0.001) and 3 years (HRR, 2.54 [95% CI, 1.82 to 3.54]; p < 0.001) postoperatively compared with the long Gamma3. CONCLUSIONS This study may indicate a slightly increased risk of reoperation for the short TRIGEN INTERTAN compared with other short nails in widespread use in Norway. In analyses of long nails, the TRIGEN TAN/FAN nail was associated with a higher risk of reoperation in the treatment of trochanteric and subtrochanteric fractures. LEVEL OF EVIDENCE Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Kirsten Marie Larsen Grønhaug
- Department of Orthopedic Surgery, Østfold Hospital Trust, Sarpsborg, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Eva Dybvik
- Norwegian Hip Fracture Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Kjell Matre
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Norwegian Hip Fracture Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Bengt Östman
- Department of Orthopedic Surgery, Østfold Hospital Trust, Sarpsborg, Norway
| | - Jan-Erik Gjertsen
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Norwegian Hip Fracture Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway
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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] [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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Khadem M, Torkaman A, Pisoudeh K, Bahari M, Torkaman P. Clinical and radiological results of using proximal femoral locking compression plate and proximal femoral nail antirotation for subtrochanteric fractures. Eur J Transl Myol 2022; 32. [PMID: 35546727 PMCID: PMC9295174 DOI: 10.4081/ejtm.2022.10422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 02/24/2022] [Indexed: 11/23/2022] Open
Abstract
The aim of this study was to evaluate the results of treatment of subtrochanteric femoral fracture in the use of proximal femoral locking compression plate (PFLCP) and proximal femoral nail antirotation (PFNA). This retrospective study was performed on patients who referred to Firoozgar Hospital in 2017 with subtrochanteric fracture. During follow-up, control radiographs were obtained from patients and the Harris Hip Score questionnaire was completed. Finally, the data were entered into Spss version 22 and then analyzed. A total of 56 patients were included in the study. Patients were divided into two treatment groups of 28: including groups with locking plate and nailing treatment. The results showed that the treatment was not significantly different in patients with subtrochanteric fractures who were treated with either intramedullary nailing or plate placement. There is no difference between the two groups in any of the parameters. The two groups were similar in terms of fracture classification, and finally no significant difference was found in terms of union findings. This study showed that clinical and imaging findings are not significantly different between the two groups of patients with subtrochanteric fracture who are treated with nailing or plate placement.
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Affiliation(s)
- Mehryar Khadem
- Department of Orthopedics, Kurdistan University of Medical Science, Kosar Hospital, Sanandaj.
| | - Ali Torkaman
- Department of Orthopedics, Iran University of Medical Science, Firouzgar hospital, Tehran.
| | - Karim Pisoudeh
- Department of Orthopedics, Iran University of Medical Science, Firouzgar hospital, Tehran.
| | - Milad Bahari
- Department of Orthopedics, Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Science, Tehran.
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Grønhaug KML, Dybvik E, Matre K, Östman B, Gjertsen JE. Intramedullary nail versus sliding hip screw for stable and unstable trochanteric and subtrochanteric fractures : 17,341 patients from the Norwegian Hip Fracture Register. Bone Joint J 2022; 104-B:274-282. [PMID: 35094569 DOI: 10.1302/0301-620x.104b2.bjj-2021-1078.r1] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
AIMS The aim of this study was to investigate if there are differences in outcome between sliding hip screws (SHSs) and intramedullary nails (IMNs) with regard to fracture stability. METHODS We assessed data from 17,341 patients with trochanteric or subtrochanteric fractures treated with SHS or IMN in the Norwegian Hip Fracture Register from 2013 to 2019. Primary outcome measures were reoperations for stable fractures (AO Foundation/Orthopaedic Trauma Association (AO/OTA) type A1) and unstable fractures (AO/OTA type A2, A3, and subtrochanteric fractures). Secondary outcome measures were reoperations for A2, A3, and subtrochanteric fractures individually, one-year mortality, quality of life (EuroQol five-dimension three-level index score), pain (visual analogue scale (VAS)), and satisfaction (VAS) for stable and unstable fractures. Hazard rate ratios (HRRs) for reoperation were calculated using Cox regression analysis with adjustments for age, sex, and American Society of Anesthesiologists score. RESULTS Reoperation rate was lower after surgery with IMN for unstable fractures one year (HRR 0.82, 95% confidence interval (CI) 0.70 to 0.97; p = 0.022) and three years postoperatively (HRR 0.86, 95% CI 0.74 to 0.99; p = 0.036), compared with SHS. For individual fracture types, no clinically significant differences were found. Lower one-year mortality was found for IMN compared with SHS for stable fractures (HRR 0.87; 95% CI 0.78 to 0.96; p = 0.007), and unstable fractures (HRR 0.91, 95% CI 0.84 to 0.98; p = 0.014). CONCLUSION This national register-based study indicates a lower reoperation rate for IMN than SHS for unstable trochanteric and subtrochanteric fractures, but not for stable fractures or individual fracture types. The choice of implant may not be decisive to the outcome of treatment for stable trochanteric fractures in terms of reoperation rate. One-year mortality rate for unstable and stable fractures was lower in patients treated with IMN. Cite this article: Bone Joint J 2022;104-B(2):274-282.
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Affiliation(s)
- Kirsten M L Grønhaug
- Department of Orthopaedic Surgery, Østfold Hospital Trust, Grålum, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Eva Dybvik
- Norwegian Hip Fracture Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Kjell Matre
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Norwegian Hip Fracture Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Bengt Östman
- Department of Orthopaedic Surgery, Østfold Hospital Trust, Grålum, Norway
| | - Jan-Erik Gjertsen
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Norwegian Hip Fracture Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
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Biodegradable cement augmentation of gamma nail osteosynthesis reduces migration in pertrochanteric fractures, a biomechanical in vitro study. Clin Biomech (Bristol, Avon) 2021; 84:105327. [PMID: 33773169 DOI: 10.1016/j.clinbiomech.2021.105327] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 03/09/2021] [Accepted: 03/13/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Cut-out of gamma nail often results from poor primary bone stability, suboptimal reduction (varus) and excentric placement of the head element which may lead to "instability" and frequently requires revision. Various studies have shown that augmentation with polymethylmethacrylate cement increases the primary stability of osteosynthesis. However, it has not yet been widely used in fracture treatment due to certain disadvantages, e.g., the lack of osteointegration, the formation of an interface membrane or the presence of toxic monomers. Few studies show that biodegradable bone cements increase the stability of osteosynthesis in different anatomical regions and therefore could be an alternative to polymethylmethacrylate cement in the treatment of pertrochanteric fractures. METHODS Two biomechanical situations were simulated using 24 Sawbones (simple and multifragmentary pertrochanteric fractures; AO-classification 31-A1 and 31-A2. Both groups were stabilized using the Gamma3® nailing system with and without biodegradable bone cement. Sawbones underwent the same cyclic loading test, simulating 10.000 gait cycles loading the bones with three times body weight. Migration was determined by comparing computed tomography scans recorded before and after the mechanical testing. The three-dimensional migration of the lag screw was calculated, and the rotation of the head around the longitudinal axis was determined. FINDINGS Biodegradable cement reduced migration by approximately 35% in 31-A1 fractures (25.4% in 31-A2 fractures) and the rotation of the head around the lag screw by approximately 37% in 31-A1 fractures (17.8%, 31-A2). INTERPRETATION Use of biodegradable bone cement improved the primary stability of gamma nail osteosynthesis in the biomechanical model.
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Bhowmick K, Matthai T, Boopalan PRJ, Jepegnanam TS. Decision making in the management of malunion and nonunion of intertrochanteric fractures of the hip. Hip Int 2020; 30:793-798. [PMID: 31304795 DOI: 10.1177/1120700019863410] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
AIM Intertrochanteric fractures account for almost 50% of hip fractures.Nonunion and malunion of these fractures are relatively uncommon. This study reviews the outcome of 31 cases of intertrochanteric fracture failures. An algorithm for the management of these injuries is also proposed. METHODS 19 patients with intertrochanteric malunion and 12 patients with non-union were included in this study. Treatment of these injuries was initiated according to the algorithm proposed in this study. Treatment outcomes were evaluated by assessing union, pre and postoperative shortening and HSA (head-shaft angle). Functional outcomes were assessed by the Parker mobility scale and presence or absence of pain. RESULTS All the patients with intertrochanteric malunion with follow-up had united. The postoperative shortening in all patients were ⩽2.5 cms. Patients having intertrochanteric nonunion with follow-up, who underwent internal fixation had united with an acceptable Parker mobility scale score, except in 1 patient who sustained an ipsilateral distal femur fracture. The average HSA correction obtained was 21° (range 3-60°). CONCLUSION The algorithm proposed in this study helps streamline the treatment according to each case scenario.It helps in planning and managing patients with intertrochanteric fracture failures.
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Affiliation(s)
- Kaushik Bhowmick
- Department of Orthopaedics, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Thomas Matthai
- Department of Orthopaedics, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | | | - Thilak S Jepegnanam
- Department of Orthopaedics, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
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Buruian A, Silva Gomes F, Roseiro T, Vale C, Carvalho A, Seiça E, Mendes A, Pereira C. Distal interlocking for short trochanteric nails: static, dynamic or no locking? Review of the literature and decision algorithm. EFORT Open Rev 2020; 5:421-429. [PMID: 32818069 PMCID: PMC7407850 DOI: 10.1302/2058-5241.5.190045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Pertrochanteric hip fractures are among the most common and the use of short cephalomedullary nails as the treatment of choice is increasing. A systematic review regarding distal locking options for short cephalomedullary nails was undertaken using Medline/PubMed®, Embase® and Cochrane Library® in order to evaluate current indications, associated complications and to provide treatment recommendations. The results seem to support the use of distal static locking for unstable fractures, dynamic locking for length stable/rotational unstable fractures and no locking for stable fractures. Complications associated with distal locking include iatrogenic fractures, thigh pain, delayed union and nonunion, implant failure, screw loosening and breaking, drill bit breaking, soft tissue irritation, femoral artery branch injury, intramuscular haematoma and compartment syndrome. It is also associated with longer operative time and radiation exposure. In unlocked constructs, dorsomedial comminution and nail/medullary canal mismatch contribute to peri-implant fractures. Anterior cortical impingement is associated with cut-out and nonunion. Most studies comparing distally locked and unlocked nails report a short follow-up. Distal locking mode should be based on the fracture’s stability.
Cite this article: EFORT Open Rev 2020;5:421-429. DOI: 10.1302/2058-5241.5.190045
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Affiliation(s)
- Alexei Buruian
- Hospital Distrital da Figueira da Foz, Figueira Da Foz, Portugal
| | | | - Tiago Roseiro
- Hospital Distrital da Figueira da Foz, Figueira Da Foz, Portugal
| | - Claudia Vale
- Hospital Distrital da Figueira da Foz, Figueira Da Foz, Portugal
| | - André Carvalho
- Hospital Distrital da Figueira da Foz, Figueira Da Foz, Portugal
| | - Emanuel Seiça
- Hospital Distrital da Figueira da Foz, Figueira Da Foz, Portugal
| | - Antonio Mendes
- Hospital Distrital da Figueira da Foz, Figueira Da Foz, Portugal
| | - Carlos Pereira
- Hospital Distrital da Figueira da Foz, Figueira Da Foz, Portugal
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Chang SM, Hu SJ, Du SC. An alternative method to tighten the helical blade with impaired locking mechanism during operation of cephalomedullary nailing. Injury 2020; 51:1922-1924. [PMID: 32482421 DOI: 10.1016/j.injury.2020.04.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 04/25/2020] [Indexed: 02/02/2023]
Abstract
During the operation of proximal femoral nail antirotation (PFNA), surgeons may run across a rare problem that the helical blade fails to be tightened and locked by clockwise turning of the impactor handle. At this moment, three options can be taken: first, replace the unlocked helical blade and re-insert another new one; second, keep the unlocked helical blade in place, proceed and finish the operation as usual; and third, as we described, keep the first helical blade in situ and tighten and lock it by other instruments, such as the SW4.0 mm hexagonal screwdriver for the distal interlocking screw, which is already in the instrument box. The third option is the best, as it keeps the operation going and remains the fixation quality as usual.
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Affiliation(s)
- Shi-Min Chang
- Department of Orthopedic Surgery, Yangpu Hospital, Tongji University School of Medicine, 450 Tengyue Road, Shanghai 200090, PR China.
| | - Sun-Jun Hu
- Department of Orthopedic Surgery, Yangpu Hospital, Tongji University School of Medicine, 450 Tengyue Road, Shanghai 200090, PR China
| | - Shou-Chao Du
- Department of Orthopedic Surgery, Yangpu Hospital, Tongji University School of Medicine, 450 Tengyue Road, Shanghai 200090, PR China
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Soylemez MS, Uygur E, Poyanli O. Effectiveness of distally slotted proximal femoral nails on prevention of femur fractures during and after intertrochanteric femur fracture surgery. Injury 2019; 50:2022-2029. [PMID: 31375272 DOI: 10.1016/j.injury.2019.07.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 07/20/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Intra- and post-operative femoral shaft fractures related with nailing remain of concern. Although manufacturers have sought to solve the problem by providing distally slotted nails, it is not clear that these implants reduce fractures. We compare two distally slotted proximal femoral nails [trochanteric nail (TRON) and proximal femur intramedullary nail (PROFIN)]. PATIENTS AND METHODS The medical records of 195 hips treated with TRONs (distally slotted in four places in the sagittal and coronal planes) and 583 hips treated with PROFINs (distally slotted in two places in the coronal plane) in two institutes were retrospectively evaluated. The inclusion criteria were follow-up for at least 6 months; pertrochanteric fractures and age over 55 years. RESULTS In total, 161 hips in the TRON group and 512 hips in the PROFIN group were included. The mean follow-up time was 28.5 (range: 6-84) months in whole group. The demographic characteristics of the groups were similar. Only 2 intraoperative shaft and 3 proximal lateral cortex fracture was detected in PROFIN group, there wasn't any postoperative fracture. Four proximal lateral cortex and 2 femur shaft fractures were detected in TRON group (one during operation and one at postoperative 8th month after a fall at pedestrian way). CONCLUSIONS Distal cephalomedullary nail slotting prevented intra- and post-operative femoral fractures. A distal slot 50 mm in length may increase nail elasticity and reduce nail tip stress to a greater extent than a 30-mm slot. Distal slotting in both the sagittal and coronal planes afforded no advantage compared to coronal slotting only. LEVEL OF EVIDENCE Level III retrospective study.
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Affiliation(s)
- Mehmet Salih Soylemez
- Ümraniye Training and Research Hospital, Department of Orthopaedics and Traumatology, Istanbul, Turkey.
| | - Esat Uygur
- Istanbul Medeniyet University, Göztepe Training and Research Hospital, Department of Orthopaedics and Traumatology, Istanbul, Turkey.
| | - Oguz Poyanli
- Istanbul Medeniyet University, Göztepe Training and Research Hospital, Department of Orthopaedics and Traumatology, Istanbul, Turkey.
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Braun BJ, Osche D, Rollmann M, Orth M, Mörsdorf P, Histing T, Pohlemann T, Herath SC. Increased therapy demand and impending loss of previous residence status after proximal femur fractures can be determined by continuous gait analysis - A clinical feasibility study. Injury 2019; 50:1329-1332. [PMID: 31178148 DOI: 10.1016/j.injury.2019.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 05/17/2019] [Indexed: 02/02/2023]
Abstract
Proximal femur fractures account for increased healthcare costs whenever patients are unable to return to their previous state of residence. Studies suggest that patients benefit from early weight-bearing, yet compliance to weight-bearing regimes is poorly investigated. Aim of the study was thus to show the clinical feasibility of a new measurement tool able to determine continuous weight-bearing behavior after intramedullary nail osteosynthesis of intertrochanteric femur fractures, assess the influence of weight-bearing on clinical outcome and determine rehabilitation demand based on early postoperative gait performance. In an observational study, gait data of 22 patients with intertrochanteric femur fractures were evaluated. During the inpatient stay patients were continuously monitored with a gait analysis insole. Primary outcome was the amount of weight-bearing reached. Short-term functional outcome, as well as return to the previous state of living were evaluated in relation to weight-bearing and activity during the inpatient stay. With the presented technique continuous gait data of all patients during postoperative mobilization could be obtained. Only 13 patients reached full weight-bearing. The technique was feasible to determine correlations between weight-bearing and outcome, as well as between gait activity and outcome. Significant gait differences between patients able to return to their previous state of living and those who could not were seen. Dynamic insole measurements are feasible to continuously determine the postoperative gait performance. Their postoperative use showed, that the continuous compliance to permissive weight-bearing after intertrochanteric fractures is low. The presented measurement technique has the potential to identify patients at risk for reduced outcome and impending loss of previous residence status. Further studies will have to investigate the effects of technology assisted "patient at risk" identification and adapted therapy on clinical outcome.
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Affiliation(s)
- Benedikt J Braun
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University Hospital, Building 57, Kirrbergerstr. 1, 66421 Homburg, Germany.
| | - David Osche
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University Hospital, Building 57, Kirrbergerstr. 1, 66421 Homburg, Germany
| | - Mika Rollmann
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University Hospital, Building 57, Kirrbergerstr. 1, 66421 Homburg, Germany
| | - Marcel Orth
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University Hospital, Building 57, Kirrbergerstr. 1, 66421 Homburg, Germany
| | - Philipp Mörsdorf
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University Hospital, Building 57, Kirrbergerstr. 1, 66421 Homburg, Germany
| | - Tina Histing
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University Hospital, Building 57, Kirrbergerstr. 1, 66421 Homburg, Germany
| | - Tim Pohlemann
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University Hospital, Building 57, Kirrbergerstr. 1, 66421 Homburg, Germany
| | - Steven C Herath
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University Hospital, Building 57, Kirrbergerstr. 1, 66421 Homburg, Germany
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Zhang C, Xu B, Liang G, Zeng X, Zeng D, Chen D, Ge Z, Yu W, Zhang X. Optimizing stability in AO/OTA 31-A2 intertrochanteric fracture fixation in older patients with osteoporosis. J Int Med Res 2018. [PMID: 29517952 PMCID: PMC5991238 DOI: 10.1177/0300060518761504] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Objectives To compare the functional and radiographic outcomes of InterTAN nail (IT) and proximal femoral nail anti-rotation (PFNA) for managing primary AO/OTA 31-A2 intertrochanteric hip fractures (IHFs) in older osteoporotic patients. Methods Patients aged 60 years or older who received surgical treatment for IHFs (AO/OTA 3.1A2.1-A2.3) with IT or PFNA were retrospectively evaluated. The primary outcome was the postoperative treatment failure rate. The secondary outcome was the Harris Hip Score (HHS). Results A total of 326 osteoporotic cases (326 hips: IT, n = 162; PFNA, n = 164) were assessed with a mean follow-up of 43.5 months (range, 38–48 months). For the entire cohort, the incidence of postoperative treatment failure (periprosthetic fracture and reoperation) was 29/326 (8.9%); the IT-treated cohort (7/162, 4.3%) had a significantly lower rate compared with the PFNA-treated cohort (22/165, 13.3%). The incidence of postoperative periprosthetic fractures was significantly lower in the IT-treated cohort than in the PFNA-treated cohort (2.5% vs 7.9%). The postoperative HHS at the final follow-up was not significantly different between the groups. Conclusion IT might show a better outcome in managing osteoporotic AO/OTA 31-A2 IHFs in terms of periprosthetic fracture and reoperation compared with PFNA.
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Affiliation(s)
- Chi Zhang
- 1 Department of Joint Surgery, The Third Affiliated Hospital of Guangzhou Medical University, Liwan District, Guangzhou, Guangdong, China
| | - Bo Xu
- 2 Department of Thoracic Surgery, The First Affiliated Hospital of Sun Yat-sen University, Huangpu District, Guangzhou, Guangdong, China
| | - Guanzhao Liang
- 3 Emergency Department, The First Affiliated Hospital of Sun Yat-sen University, Huangpu District, Guangzhou, Guangdong, China
| | - Xianshang Zeng
- 4 Department of Orthopaedics, The First Affiliated Hospital of Sun Yat-sen University, Huangpu District, Guangzhou, Guangdong, China
| | - Dan Zeng
- 5 Ultrasonography Department, The First Affiliated Hospital of Sun Yat-sen University, Huangpu District, Guangzhou, Guangdong, China
| | - Deng Chen
- 6 Department of Joint Surgery, The First People's Hospital of Jingmen, Hubei, Dongbao District, Jingmen, Hubei, China
| | - Zhe Ge
- 7 Department of Orthopaedics, Jinshan Hospital, Fudan University, Jinshan District, Shanghai City, China
| | - Weiguang Yu
- 4 Department of Orthopaedics, The First Affiliated Hospital of Sun Yat-sen University, Huangpu District, Guangzhou, Guangdong, China
| | - Xinchao Zhang
- 7 Department of Orthopaedics, Jinshan Hospital, Fudan University, Jinshan District, Shanghai City, China
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15
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Abstract
The incidence of trochanteric fractures is rising because of increasing number of senior citizens with osteoporosis. There are various modalities for reduction and internal fixation. However, the incidence of complications remains high. In the herein article we discuss issues that influence the fixation and outcomes of unstable trochanteric fractures. Moreover, the results of a prospective, randomised, cohort, time bound, hospital based, comparative study is presented.
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Affiliation(s)
- Sushrut Babhulkar
- Sushrut Institute of Medical Sciences, Research Centre & Post-Graduate Institute of Orthopedics, Central Bazar Road, Ramdaspeth, Nagpur, 440 010, India.
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