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Zhao Y, Wang H, Liu Y, Shan L, Zhou J. Augmentation of intramedullary nail in unstable intertrochanteric fractures with plate or cable. Front Surg 2024; 11:1293049. [PMID: 38425376 PMCID: PMC10902109 DOI: 10.3389/fsurg.2024.1293049] [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] [Received: 09/12/2023] [Accepted: 01/03/2024] [Indexed: 03/02/2024] Open
Abstract
Backgrounds This study aims to evaluate the clinical outcome of intramedullary nail supplemented by buttress plate or cable in the treatment of intertrochanteric fracture with broken lateral wall. Methods From May 2015 to January 2022, patients with unstable intertrochanteric femoral fractures underwent intramedullary fixations strengthened with buttress plates or cables, which depended on the lateral femur wall fragment type. The clinical and radiographic results were compared between the two groups. The hip function was evaluated according to the Harris Hip Scoring (HHS) system. Results Forty-one patients who sustained intertrochanteric fracture + broken lateral wall were enrolled. Of these, thirty-four received a minimum of twelve months of follow-ups. No statistically significant differences in baseline and operative data were proved between these groups (p > 0.05). Three patients were observed fat liquefaction after surgery (plate group: 2 cases, cable group: 1 case). All patients could sustain partial/full weight-bearing and no case underwent subsequent operation. The HHS of the last follow-up presented 83.6 ± 4.9 points in the plate group and 83.8 ± 3.7 points in the cable group. Conclusions Intertrochanteric femoral fracture with broken lateral wall is an unstable injury type, the operative treatments of which have been challenging and controversial over the years. Augmentation of intramedullary nailing system using plate/cable contributes to reconstructing the lateral femur wall.
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Turabi RY, Wyatt D, Guerra S, O'Connell MDL, Khatun T, Sageer SA, Alhazmi A, Sheehan KJ. Barriers and facilitators of weight bearing after hip fracture surgery among older adults. A scoping review. Osteoporos Int 2023:10.1007/s00198-023-06735-5. [PMID: 37016146 DOI: 10.1007/s00198-023-06735-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/24/2023] [Indexed: 04/06/2023]
Abstract
PURPOSE This scoping review aimed to synthesise the available evidence on barriers and facilitators of weight bearing after hip fracture surgery in older adults. METHODS Published (Cochrane Central, MEDLINE, EMBASE, CINAHL, and PEDro) and unpublished (Global Health, EThOS, WorldCat dissertation and thesis, ClinicalTrials.gov , OpenAIRE, DART-Europe) evidence was electronically searched from database inception to 29 March 2022. Barriers and facilitators of weight bearing were extracted and synthesised into patient, process (non-surgical), process (surgical), and structure-related barriers/facilitators using a narrative review approach. RESULTS In total, 5594 were identified from the primary search strategy, 1314 duplicates were removed, 3769 were excluded on title and abstract screening, and 442 were excluded on full-text screening. In total, 69 studies (all from published literature sources) detailing 47 barriers and/or facilitators of weight bearing were included. Of barriers/facilitators identified, 27 were patient-, 8 non-surgical process-, 8 surgical process-, and 4 structure-related. Patient facilitators included anticoagulant, home discharge, and aid at discharge. Barriers included preoperative dementia and delirium, postoperative delirium, pressure sores, indoor falls, ventilator dependence, haematocrit < 36%, systemic sepsis, and acute renal failure. Non-surgical process facilitators included early surgery, early mobilisation, complete medical co-management, in-hospital rehabilitation, and patient-recorded nurses' notes. Barriers included increased operative time and standardised hip fracture care. Surgical process facilitators favoured intramedullary fixations and arthroplasty over extramedullary fixation. Structure facilitators favoured more recent years and different healthcare systems. Barriers included pre-holiday surgery and admissions in the first quarter of the year. CONCLUSION Most patient/surgery-related barriers/facilitators may inform future risk stratification. Future research should examine additional process/structure barriers and facilitators amenable to intervention. Furthermore, patient barriers/facilitators need to be investigated by replicating the studies identified and augmenting them with more specific details on weight bearing outcomes.
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Affiliation(s)
- R Y Turabi
- Department of Population Health Sciences, School of Life Course and Population Sciences, King's College London, London, UK.
- Department of Physical Therapy, Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia.
| | - D Wyatt
- Department of Population Health Sciences, School of Life Course and Population Sciences, King's College London, London, UK
| | - S Guerra
- Department of Population Health Sciences, School of Life Course and Population Sciences, King's College London, London, UK
| | - M D L O'Connell
- Department of Population Health Sciences, School of Life Course and Population Sciences, King's College London, London, UK
| | - T Khatun
- Centre for Implementation Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - S A Sageer
- Department of Orthopaedic, Relief Hospital and Trauma Centre, Kerala, India
| | - A Alhazmi
- Department of Orthopaedic, King Fahad Central Hospital, Jazan, Saudi Arabia
| | - K J Sheehan
- Department of Population Health Sciences, School of Life Course and Population Sciences, King's College London, London, UK
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Nahouli H, Bassil D, Mailhac A, Der-Boghossian A, Tamim H, Al Taki M. Association of Hip Fracture With the Use of Walking Assistance Devices Post-surgery: A Retrospective Study Comparing Intertrochanteric and Subtrochanteric Hip Fractures. Cureus 2023; 15:e36706. [PMID: 37113370 PMCID: PMC10129033 DOI: 10.7759/cureus.36706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2023] [Indexed: 03/29/2023] Open
Abstract
Background Hip fractures, including intertrochanteric and subtrochanteric fractures, are among the most common types of fractures. The dynamic hip screw (DHS) and the cephalomedullary hip nail (CHN) are the two main techniques used for the fixation of these types of fractures. This study aims to explore the association of the fracture type with the use of walking assistance devices post-surgery, regardless of the fixation technique. Methodology This study is a retrospective study based on the review of de-identified patient data from the American College of Surgeons National Surgical Quality Improvement Program database. Patients aged 65 years old or above who underwent fixation procedures for intertrochanteric or subtrochanteric fractures using CHN or DHS techniques were included in this study. Results A total of 8,881 patients were included and divided into the following two groups: 876 (9.9%) patients treated for subtrochanteric fracture, and 8,005 (90.1%) patients treated for intertrochanteric fracture. No statistical significance was detected in the use of mobility aid postoperatively between the two groups. When compared to CHN, DHS was noted to be the most employed fixation technique among patients with intertrochanteric fractures. One main finding was that patients who underwent surgery using DHS for intertrochanteric fractures were more likely to use walking assistance devices postoperatively compared to those with subtrochanteric fractures treated with the same fixation technique. Conclusions Findings suggest that the use of walking assistance devices post-surgery is independent of the type of fracture and potentially dependent on the fixation technique employed. Future studies focused on the difference in the use of walking assistance devices based on fixation techniques for patients with distinctive sub-types of trochanteric fractures are highly encouraged.
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Jain S, Rohra S, Dawar H, Kushwah B, Agrawal A. Outcome of buttress plate-nail construct used for reconstruction of broken lateral wall in intertrochanteric fractures. Chin J Traumatol 2023:S1008-1275(23)00021-4. [PMID: 37076327 PMCID: PMC10388249 DOI: 10.1016/j.cjtee.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 01/18/2023] [Accepted: 02/27/2023] [Indexed: 04/21/2023] Open
Abstract
PURPOSE Intramedullary implants are well accepted fixation of all types of intertrochanteric (IT) fractures, both stable and unstable types. Intramedullary nails have an ability to effectively support the posteromedial part, but fail to buttress the broken lateral wall requiring lateral augmentation. The aim of this study was to evaluate the outcome of proximal femoral nail augmented with trochanteric buttress plate for broken lateral wall with IT fractures, which was fixed to the femur through hip screw and anti-rotation screw nail. METHODS Of 30 patients, 20 had Jensen-Evan type III and 10 had type V fractures. Patients with IT fracture of broken lateral wall and aged more than 18 years, in whom satisfactory reduction was achieved by closed methods, were included in the study. Patients with pathologic or open fractures, polytrauma, prior hip surgery, non-ambulatory prior to surgery, and those who refused to participate were excluded from the study. The operative time, blood loss, radiation exposure, quality of reduction, functional outcome and union time were evaluated. All data were coded and recorded in Microsoft Excel spread sheet program. SPSS 20.0 was used for data analysis and normality of the continuous data was checked using Kolmogorv Smirnov test. RESULTS The mean age of patients in the study was 60.3 years. The mean duration of surgery (min), mean intra-operative blood loss (mL) and mean number of exposures were 91.86 ± 12.8 (range 70 - 122), 144.8 ± 3.6 (range 116 - 208), and 56.6 (range 38 - 112), respectively. The mean union time was 11.6 weeks and the mean Harris hip score was 94.1. CONCLUSION Lateral trochanteric wall in IT fractures is significantly important, and needs to be reconstructed adequately. Nail-plate construct of trochanteric buttress plate fixed with hip screw and anti-rotation screw of proximal femoral nail can be successfully used to augment, fix or buttress the lateral trochanteric wall giving excellent to good results of early union and reduction.
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Affiliation(s)
- Saurabh Jain
- Department of Orthopaedics, MGM Medical College and MY Hospital, Indore, M.P., 452009, India.
| | - Satish Rohra
- Department of Orthopaedics, MGM Medical College and MY Hospital, Indore, M.P., 452009, India
| | - Harshwardhan Dawar
- Department of Orthopaedics, MGM Medical College and MY Hospital, Indore, M.P., 452009, India
| | - Bhupendra Kushwah
- Department of Orthopaedics, MGM Medical College and MY Hospital, Indore, M.P., 452009, India
| | - Adit Agrawal
- Department of Orthopaedics, MGM Medical College and MY Hospital, Indore, M.P., 452009, India
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Yang AL, Mao W, Chang SM, Dong YH. Relative instability ratios of bone wall defects in trochanteric hip fractures: A finite element analysis. Front Bioeng Biotechnol 2023; 11:1082613. [PMID: 36815902 PMCID: PMC9935934 DOI: 10.3389/fbioe.2023.1082613] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 01/25/2023] [Indexed: 02/05/2023] Open
Abstract
Background: For decades, medial and lateral wall fragments of trochanteric hip fractures were considered two pivotal factors that could influence the stability of postoperative femur-implant complex. However, most studies seemed to misunderstand the concept of the posteromedial fragment and equated it with the medial wall, which overlooked vital roles of the anteromedial wall. Roles of the posterior coronal bone fragment were also highlighted in some research. However, influences of the bone walls above the trochanteric fracture instability are yet to be investigated and quantified by means of finite element analysis. Methods: Eight trochanteric fracture fixation models with different wall defects were constructed. Outcome indicators were the von Mises stress of the implant models, the maximum/minimum principal strain, the risky tensile/compressive volume and the volume ratios of the bone models, the femoral head vertex displacement, and the fracture surface gap. Based on these indicator values, the relative instability ratios were computed. Results: Outcome indicators, absolute values, and nephograms of all models showed the same upward and concentrating trends with exerted hip contact loads shifting from static walking to dynamic climbing. Similarly, these indicators also exhibited the same trends when the eight models were solved in sequence. Moreover, the relative instability ratio of the medial wall (100%), particularly the anteromedial part (78.7%), was higher than the figure for the lateral wall (36.6%). Conclusion: The anteromedial wall played relatively pivotal stabilizing roles in trochanteric hip fractures compared with the posteromedial wall and the lateral wall, which indicated that orthopedic surgeons should attach more importance to the anteromedial cortex support in an operating theatre.
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Affiliation(s)
- Ao-Lei Yang
- Department of Orthopedic Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China,Department of Orthopaedics, Fifth People’s Hospital of Shanghai, Fudan University, Shanghai, China
| | - Wei Mao
- Department of Orthopedic Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China,Department of Orthopaedics, Fifth People’s Hospital of Shanghai, Fudan University, Shanghai, China
| | - Shi-Min Chang
- Department of Orthopedic Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China,*Correspondence: Shi-Min Chang, ; You-Hai Dong,
| | - You-Hai Dong
- Department of Orthopaedics, Fifth People’s Hospital of Shanghai, Fudan University, Shanghai, China,*Correspondence: Shi-Min Chang, ; You-Hai Dong,
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Jain S, Dawar H, Khare H, Kumar M, Ajmera A. Does augmentation of intramedullary nails by a buttress plate effectively restore lateral wall integrity in intertrochanteric fractures. INTERNATIONAL ORTHOPAEDICS 2022; 46:2365-2371. [PMID: 35821118 DOI: 10.1007/s00264-022-05488-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 06/14/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Recent studies have proved the importance of intact lateral trochanteric wall, thus buttressing/fixing the broken lateral trochanteric wall irrespective of the implant, is likely to improve the alignment and outcome. We compared the outcome of lateral wall buttressing by trochanteric buttress plate (TBP) supplemented to proximal femoral nailing versus proximal femoral nailing alone in patients of broken lateral wall intertrochanteric fractures. MATERIAL AND METHOD Sixty patients of intertrochanteric factures (IT) of femur with broken lateral wall were randomized into group A or B and were treated with either proximal femoral nail (PFN) alone or proximal femoral nail augmented with trochanteric buttress plate (PFN + TBP), respectively. The TBP plate used was primarily fixed to proximal femur via 8 mm hip screw and 6.4 mm antirotation screw of the PFN. Operative time, blood loss, radiation exposure, quality of reduction, functional outcome, union time, and complications were compared. RESULT The mean age was 60.03 + 7.60 (range 42 to 70 years), with male to female ratio of 4:1 and left to right ratio of approximately 1:1. The mean follow up in the series was 16.2 months (range 13 to 36 months). Mean duration of surgery, mean intra-operative blood loss, and mean number of exposures in group A (PFN alone) were 64.88 + 12.24 min (48 to 88), 93 + 1.18 ml (60 to 120), and 32.13 (24 to 46) and in group B (PFN with TBP plate) were 91.86 + 12.78 min (70 to 122 min), 144.8 + 3.6 ml (116 to 208 ml), and 56.6 (38 to 112), respectively. Twenty-five patients and 28 patients in groups A and B respectively achieved score of 4 Chang quality reduction. Mean union time was 13.4 weeks in group A whereas in group B was 11.6 weeks. Mean HHS score in group A was 87.86 with 90% patients in comparison to 94.13 and 97% cases having excellent to good results in group B. In group A, 24 patients, while 29 patients in group B, had excellent to good results. Four patients had hip pain, four had impingement of screws, two had screw migration, three had Z/reverse effect, and four patients had shortening of more than 1 cm in group A. In group B, only one patient had impingement and none of the patient had hip pain, infection, implant failure, Z effect, or shortening. CONCLUSION The lateral trochanteric wall in IT fractures is significantly important, and when the lateral wall is broken, it can lead to poor results. TBP plate which is applied laterally on femur along with nail and fixing the plate with hip screw and antirotational screw provides faster union, early weight bearing, better reduction, and so better hip functions. TBP can be used successfully to augment, fix, or buttress the lateral trochanteric wall giving excellent to good results but at the cost of surgical time, blood loss, and radiation exposure.
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Affiliation(s)
- Saurabh Jain
- Department of Orthopaedics, MGM Medical College and MY Hospital, 2-A, Scheme no. 71, Sector C, Footi Kothi Chouraha, Ring Road, Indore, M.P, 452009, India.
| | - Harshwardhan Dawar
- Department of Orthopaedics, MGM Medical College and MY Hospital, 2-A, Scheme no. 71, Sector C, Footi Kothi Chouraha, Ring Road, Indore, M.P, 452009, India
| | - Harshit Khare
- Department of Orthopaedics, MGM Medical College and MY Hospital, 2-A, Scheme no. 71, Sector C, Footi Kothi Chouraha, Ring Road, Indore, M.P, 452009, India
| | - Malay Kumar
- Department of Orthopaedics, MGM Medical College and MY Hospital, 2-A, Scheme no. 71, Sector C, Footi Kothi Chouraha, Ring Road, Indore, M.P, 452009, India
| | - Anand Ajmera
- Department of Orthopaedics, MGM Medical College and MY Hospital, 2-A, Scheme no. 71, Sector C, Footi Kothi Chouraha, Ring Road, Indore, M.P, 452009, India
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Yang AL, Mao W, Wu JG, He YQ, Ni HF, Li HL, Dong YH. When to Reduce and Fix Displaced Lesser Trochanter in Treatment of Trochanteric Fracture: A Systematic Review. Front Surg 2022; 9:855851. [PMID: 35402493 PMCID: PMC8992837 DOI: 10.3389/fsurg.2022.855851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 02/21/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose To systematically evaluate the benefits of reducing and fixing displaced lesser trochanter (LT) of trochanteric fractures and when this procedure is worth the effect. Methods From database establishment through March 2021, four online databases (PubMed, Cochrane, Embase, and Web of Science) were searched for relevant literature that investigated reduction and fixation for displaced LT of trochanteric fractures. The papers were then screened by two reviewers independently and in duplicate according to prior inclusion and exclusion criteria. Demographic data as well as data on fracture types, surgical protocols, and surgical outcomes were recorded, analyzed, and interpreted. Results Total 10 clinical studies with 928 patients were included, in which 48 cases had intact LT and 880 cases involved the displaced LT, of which 196 (22.27%) cases underwent reduction and fixation for LT while the rest of 684 (77.73%) cases not. In these studies, complications were evaluated as a more applicable predictive parameter for operation than postoperative hip function. Conclusion It was beneficial to reduce and fix the displaced LT when one of the conditions below occurred: displacement distance of LT ≥2 cm, quantity of comminuted LT fragments ≥2, and range of LT fragments in medial wall ≥75%; the fracture line of LT fragments reaching or exceeding the midline of the posterior wall.
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Affiliation(s)
- Ao-Lei Yang
- Department of Orthopedics, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
| | - Wei Mao
- Department of Orthopedics, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China.,Department of Orthopedic Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jun-Guo Wu
- Department of Orthopedics, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
| | - Yi-Qun He
- Department of Orthopedics, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
| | - Hao-Fei Ni
- Department of Orthopedics, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
| | - Hai-Long Li
- Department of Orthopedics, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
| | - You-Hai Dong
- Department of Orthopedics, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
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Medial support nail and proximal femoral nail antirotation in the treatment of reverse obliquity inter-trochanteric fractures (Arbeitsgemeinschaft fur Osteosynthesfrogen/Orthopedic Trauma Association 31-A3.1): a finite-element analysis. Chin Med J (Engl) 2020; 133:2682-2687. [PMID: 32889910 PMCID: PMC7647506 DOI: 10.1097/cm9.0000000000001031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The reverse obliquity inter-trochanteric fracture is a distinct fracture pattern that is mechanically different from most inter-trochanteric fractures and the optional treatment of it is still controversial. The purpose of this study was to compare differences in the efficacy of a novel nail (medial support nail [MSN-II]) and proximal femoral nail anti-rotation (PFNA-II) in the treatment of reverse obliquity inter-trochanteric fractures (Arbeitsgemeinschaft fur Osteosynthesfrogen/Orthopedic Trauma Association [AO/OTA] 31-A3.1) using finite-element analysis. METHODS Modeling software was used to establish a three-dimensional model of MSN-II and PFNA-II and an A3.1 inter-trochanteric fracture model. Abaqus software was used to implement different force loads to compare finite-element biomechanical parameters such as the maximum stress in implant and the displacement of fracture site. RESULTS The femoral stress, implant stress and fracture site displacement of MSN-II was less than that of PFNA-II. The results indicated that the maximal femoral stress was 581 MPa for PFNA-II and 443 MPa for the MSN-II. The maximum stress values in the PFNA-II and MSN-II models were 291 and 241 MPa, respectively. The maximal displacements of the fracture site were 1.47 and 1.16 mm in the PFNA-II and MSN-II models, respectively. CONCLUSION Compared with PFNA-II for inter-trochanteric fracture (AO/OTA 31-A3.1), MSN-II which was designed with a triangular stability structure can provide better biomechanical stability. The MSN-II may be a feasible option for the treatment of reverse obliquity inter-trochanteric fracture.
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Liu P, Jin D, Zhang C, Gao Y. Revision surgery due to failed internal fixation of intertrochanteric femoral fracture: current state-of-the-art. BMC Musculoskelet Disord 2020; 21:573. [PMID: 32828132 PMCID: PMC7443291 DOI: 10.1186/s12891-020-03593-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 08/17/2020] [Indexed: 12/12/2022] Open
Abstract
Failed treatment of intertrochanteric (IT) femoral fractures leads to remarkable disability and pain, and revision surgery is frequently accompanied by higher complication and reoperation rates than primary internal fixation or primary hip arthroplasty. There is an urgent need to establish a profound strategy for the effective surgical management of these fragile patients. Salvage options are determined according to patient physiological age, functional level, life expectancy, nonunion anatomical site, fracture pattern, remaining bone quality, bone stock, and hip joint competency. In physiologically young patients, care should be taken to preserve the vitality of the femoral head with salvage internal fixation; however, for the elderly population, conversion arthroplasty can result in early weight bearing and ambulation and eliminates the risks of delayed fracture healing. Technical challenges include a difficult surgical exposure, removal of broken implants, deformity correction, critical bone defects, poor bone quality, high perioperative fracture risk, and prolonged immobilization. Overall, the salvage of failed internal fixations of IT fractures with properly selected implants and profound techniques can lead to the formulation of valuable surgical strategies and provide patients with satisfactory clinical outcomes.
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Affiliation(s)
- Pei Liu
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Xuhui, Shanghai, 200233, China
| | - Dongxu Jin
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Xuhui, Shanghai, 200233, China
| | - Changqing Zhang
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Xuhui, Shanghai, 200233, China.
| | - Youshui Gao
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Xuhui, Shanghai, 200233, China.
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Dynamic Hip Screw with Trochanter-Stabilizing Plate Compared with Proximal Femoral Nail Antirotation as a Treatment for Unstable AO/OTA 31-A2 and 31-A3 Intertrochanteric Fractures. BIOMED RESEARCH INTERNATIONAL 2020; 2020:1896935. [PMID: 32923477 PMCID: PMC7453265 DOI: 10.1155/2020/1896935] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 08/05/2020] [Indexed: 11/18/2022]
Abstract
Background The dynamic hip screw (DHS) with the addition of an angular stable trochanter-stabilizing plate (TSP) has been considered the ideal treatment for the unstable intertrochanteric fracture type. However, there have been few comparisons between DHS+TSP augmentation with intramedullary (IM) nailing. The aim of this retrospectively registered study was to compare the clinical outcomes of patients with the unstable type of intertrochanteric fractures treated with DHS+TSP or IM nailing (proximal femoral nail antirotation (PFNA)). Methods From June 2013 to April 2018, 358 patients with proximal femur fracture AO/OTA type 31A2 and 31A3 treated with PFNA or DHS+TSP and followed for ≥10 months postoperatively were included. The surgical-dependent outcome evaluation included the operation time, intraoperative blood loss, postoperative decrease in hemoglobin, and blood transfusion amount. Functional status was also measured. Radiographic findings and postoperative complications were recorded and analyzed. Result The operation time was significantly shorter in the DHS+TSP group than that in the PFNA group for both A2 and A3 fractures (A2 type: 84.0 vs.96.4 min; p < 0.05; A3 type: 102.4 vs.116.1 min; p < 0.05). Postoperative decrease in hemoglobin was more significant in the PFNA group than that in the DHS+TSP group for both fracture types (A2 type: −1.88 vs. −1.29 (mg/dL); p < 0.05; A3 type: −1.63 vs. −1.04 (mg/dL); p < 0.05). However, the patients treated with DHS+TSP had significantly more residual pain than those treated with PFNA during the final follow-up (Visual Analog Scale score, A2 type: 28.4 vs.23.2; p < 0.05; A3 type: 27.5 vs.23.6; p < 0.05) and complained of greater implant irritation. Conclusion We found that DHS+TSP was associated with less operation time and less postoperative decrease in hemoglobin but more residual pain and implant irritation than those of PFNA. As a treatment for unstable intertrochanteric fracture, DHS+TSP provided ideal surgical outcomes which were not inferior to the PFNA.
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Ren H, Ao R, Wu L, Jian Z, Jiang X, Yu B. Effect of lesser trochanter posteromedial wall defect on the stability of femoral intertrochanteric fracture using 3D simulation. J Orthop Surg Res 2020; 15:242. [PMID: 32620138 PMCID: PMC7333289 DOI: 10.1186/s13018-020-01763-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 06/26/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND This study investigated the effects of posteromedial fracture fragments on the postoperative stability of intertrochanteric fractures of the femur by analyzing the quantity and range of fragments in CT 3D reconstruction. MATERIALS AND METHODS Patients diagnosed with femoral lesser trochanter fractures were collected from September 2015 to February 2018. CT 3D reconstruction was applied to evaluate the quantity and extension of posteromedial fragments and the presence of isolated medial fragments. The stability of postoperative fracture was evaluated by comparing the changes of "neck-shaft angle" and "telescoping" from 1 week to 1 year after operation. RESULTS A total of 143 patients were finally confirmed, in which 63 patients contained isolated fragments on the medial side, and the average number of fragments in the posteromedial side was 1.93 ± 0.34, which accounted for an average of about 86.11% ± 8.20% in the whole posteromedial wall. When the number of posteromedial fragments was > 2 and the range of posteromedial fragments was > 75%, then the changes in the neck-shaft angle and "telescoping" showed statistical significance (12.27 ± 4.18 mm and 10.13 ± 6.17°, respectively), and when there were isolated medial isolated fragments, then the change in the neck-shaft angle was 10.66 ± 4.27°, showing statistical significance. CONCLUSIONS These findings revealed a certain correlation between the quantity and the range of posteromedial fragments and the postoperative "shortening" and "collapse" of femoral intertrochanteric fractures.
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Affiliation(s)
- Hanru Ren
- Department of Orthopaedics, Shanghai Pudong Hospital, Fudan University, Pudong Medical Center, No. 2800, Gongwei Road, Shanghai, 201399 China
| | - Rongguang Ao
- Department of Orthopaedics, Shanghai Pudong Hospital, Fudan University, Pudong Medical Center, No. 2800, Gongwei Road, Shanghai, 201399 China
| | - Lianghao Wu
- Department of Orthopaedics, Shanghai Pudong Hospital, Fudan University, Pudong Medical Center, No. 2800, Gongwei Road, Shanghai, 201399 China
| | - Zheng Jian
- Department of Orthopaedics, Shanghai Pudong Hospital, Fudan University, Pudong Medical Center, No. 2800, Gongwei Road, Shanghai, 201399 China
| | - Xinhua Jiang
- Department of Orthopaedics, Shanghai Pudong Hospital, Fudan University, Pudong Medical Center, No. 2800, Gongwei Road, Shanghai, 201399 China
| | - Baoqing Yu
- Department of Orthopaedics, Shanghai Pudong Hospital, Fudan University, Pudong Medical Center, No. 2800, Gongwei Road, Shanghai, 201399 China
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Ye KF, Xing Y, Sun C, Cui ZY, Zhou F, Ji HQ, Guo Y, Lyu Y, Yang ZW, Hou GJ, Tian Y, Zhang ZS. Loss of the posteromedial support: a risk factor for implant failure after fixation of AO 31-A2 intertrochanteric fractures. Chin Med J (Engl) 2020; 133:41-48. [PMID: 31923103 PMCID: PMC7028211 DOI: 10.1097/cm9.0000000000000587] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The purpose of this study was to analyze cases of AO31-A2 intertrochanteric fractures (ITFs) and to identify the relationship between the loss of the posteromedial support and implant failure. METHODS Three hundred ninety-four patients who underwent operative treatment for ITF from January 2003 to December 2017 were enrolled. Focusing on posteromedial support, the A2 ITFs were divided into two groups, namely, those with (Group A, n = 153) or without (Group B, n = 241) posteromedial support post-operatively, and the failure rates were compared. Based on the final outcomes (failed or not), we allocated all of the patients into two groups: failed (Group C, n = 66) and normal (Group D, n = 328). We separately analyzed each dataset to identify the factors that exhibited statistically significant differences between the groups. In addition, a logistic regression was conducted to identify whether the loss of posteromedial support of A2 ITFs was an independent risk factor for fixation failure. The basic factors were age, sex, American Society of Anesthesiologists (ASA) score, side of affected limb, fixation method (intramedullary or extramedullary), time from injury to operation, blood loss, operative time and length of stay. RESULTS The failure rate of group B (58, 24.07%) was significantly higher than that of group A (8, 5.23%) (χ = 23.814, P < 0.001). Regarding Groups C and D, the comparisons of the fixation method (P = 0.005), operative time (P = 0.001), blood loss (P = 0.002) and length of stay (P = 0.033) showed that the differences were significant. The logistic regression revealed that the loss of posteromedial support was an independent risk factor for implant failure (OR = 5.986, 95% CI: 2.667-13.432) (P < 0.001). CONCLUSIONS For AO31-A2 ITFs, the loss of posteromedial support was an independent risk factor for fixation failure. Therefore, posteromedial wall reconstruction might be necessary for the effective treatment of A2 fractures that lose posteromedial support.
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Affiliation(s)
- Kai-Feng Ye
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China
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Müller F, Doblinger M, Kottmann T, Füchtmeier B. PFNA and DHS for AO/OTA 31-A2 fractures: radiographic measurements, morbidity and mortality. Eur J Trauma Emerg Surg 2019; 46:947-953. [PMID: 31673714 DOI: 10.1007/s00068-019-01251-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 10/22/2019] [Indexed: 12/18/2022]
Abstract
PURPOSE For this retrospective cohort study, we assessed pertrochanteric fracture types AO/OTA 31-A2. PFNA and DHS were the devices used. We determined both devices in relation to peri-operative variables, postoperative radiographic measurements, implant-related complications and mortality up to 2 years. The null hypothesis was no effect between the two devices. METHODS This single-centre study was conducted based on our computerized data. The treatment period ranged from 2006 to 2015. Only patients with type AO/OTA 31-A2 fractures and an age ≥ 65 years were included. Apart from descriptive variables, the following measurements were assessed: (1) duration of surgery, (2) blood loss, (3) transfusion, (4) hospitalization, (5) tip-apex distance (TAD), (6) fracture reduction, (7) screw position, (8) implant-related complications, and (9) mortality. The follow-up was 2 years for each living patient. Missing data were evaluated by telephone call. RESULTS A total of 375 consecutive patients were enrolled into three groups: (1) 75 patients treated with DHS and antirotation screw (ARS); (2); 100 patients treated with DHS + ARS + TSP (trochanteric stabilization plate); and (3) 200 patients treated with PFNA. Apart from dementia, the descriptive data (e.g., age and BMI) demonstrated no effects between the three groups. Compared to PFNA, DHS with or without TSP was adversely affected by a longer operation time, higher blood loss, increase in transfusion, and more implant-related complications including cut-out, infection and failure. The rate of cut-out was significantly higher in TAD ≥ 25 mm (p = 0.005), and PFNA demonstrated significantly better TAD measurements (p = 0.001), better fracture reduction (0.002), more central-central screw positions (p = 0.014), and less poor screw placement (p = 0.001). The mortality rate was without effect between the three groups (log rank 0.698). CONCLUSIONS DHS with or without TSP was associated with significantly higher rates of implant-related complications based on inferior radiographic measurements. Therefore, we only recommend PFNA for the treatment of proximal type AO/OTA 31-A2 femoral fractures. LEVEL OF EVIDENCE Therapeutic level III.
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Affiliation(s)
- Franz Müller
- Clinic for Trauma, Orthopaedic and Sports Medicine, Hospital Barmherzige Brüder, Prüfeninger Str. 86, 93049, Regensburg, Germany.
| | - Matthias Doblinger
- Clinic for Trauma, Orthopaedic and Sports Medicine, Hospital Barmherzige Brüder, Prüfeninger Str. 86, 93049, Regensburg, Germany
| | | | - Bernd Füchtmeier
- Clinic for Trauma, Orthopaedic and Sports Medicine, Hospital Barmherzige Brüder, Prüfeninger Str. 86, 93049, Regensburg, Germany
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Cho SH. Outcomes of dynamic hip screw augmented with trochanteric wiring for treatment of unstable type A2 intertrochanteric femur fractures. Injury 2019; 50:816. [PMID: 30670319 DOI: 10.1016/j.injury.2019.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 01/12/2019] [Indexed: 02/02/2023]
Affiliation(s)
- Su-Hyun Cho
- Department of Orthopaedic Surgery, Andong General Hospital, Kyoung-Book, Ang-silro 11 Soo-Sang-Dong, 36715, South Korea.
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Imerci A, Aydogan NH, Gemci C. Letter to the editor concerning "Intraoperative lateral wall fractures during Dynamic Hip Screw fixation for intertrochanteric fractures-Incidence, causative factors and clinical outcome". Injury 2018; 49:732-733. [PMID: 29397995 DOI: 10.1016/j.injury.2018.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 01/16/2018] [Indexed: 02/02/2023]
Affiliation(s)
- Ahmet Imerci
- Mugla Sitki Kocman University, Faculty of Medicine, Department of Orthopaedics and Traumatology, Mugla, Turkey.
| | - Nevres Hurriyet Aydogan
- Mugla Sitki Kocman University, Faculty of Medicine, Department of Orthopaedics and Traumatology, Mugla, Turkey.
| | - Cagatay Gemci
- Mugla Sitki Kocman University, Faculty of Medicine, Department of Orthopaedics and Traumatology, Mugla, Turkey.
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Wang W, Yu J. Tranexamic acid reduces blood loss in intertrochanteric fractures: A meta-analysis from randomized controlled trials. Medicine (Baltimore) 2017; 96:e9396. [PMID: 29384916 PMCID: PMC6392608 DOI: 10.1097/md.0000000000009396] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND This meta-analysis aims to assess the efficacy and safety of tranexamic acid for reducing blood loss and transfusion requirements in patients with intertrochanteric fractures. METHODS We conduct electronic searches of Medline (1966-2017.09), PubMed (1966-2017.09), Embase (1980-2017.09), ScienceDirect (1985-2017.09), and the Cochrane Library. Only randomized controlled trials (RCTs) are included. The quality assessments are performed according to the Cochrane systematic review method. Fixed/random-effect model is used according to the heterogeneity tested by I statistic. Meta-analysis is performed using Stata 11.0 software. RESULTS A total of 4 RCTs are retrieved involving 514 participants. The present meta-analysis indicated that there were significant differences between groups in terms of total blood loss (weighted mean differences = -131.49, 95% confidence interval (CI): -163.63 to -99.35, P = .00), hemoglobin decline (weighted mean differences = -0.31, 95% CI, -0.44 to -0.19, P = .00), and transfusion rate (risk differences = -1.11, 95% CI, -0.19 to -0.04, P = .00). In addition, no increased risk of adverse effects was identified in both groups. CONCLUSION Local administration of tranexamic acid is associated with a reduced total blood loss, postoperative hemoglobin decline, and transfusion requirements in patients with intertrochanteric fractures. High-quality RCTs are still required for further investigation.
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