The Problem of Fracture Fixation Augmentation and Description of a Novel Technique and Implant for Femoral Neck Stabilization

An evaluation of endoprosthesis and pertrochanteric external fixator results in elderly intertrochanteric femoral fractures

Objective: In this study, 14-month clinical outcomes of the endoprosthesis and pertrochanteric external fixator application are retrospectively evaluated in elderly patients with pertrochanteric fractures. Patients and Method: A total of 45 patients of 65 years old and older (25 females and 20 males) with a mean age of 78.1, who were treated due to intertrochanteric femur fracture between November 2013 and December 2014 and whose controls could be made were included in this study. The deaths that occurred within the postoperative 1 year were not included in the study. 28 patients with endoprosthesis as Group I, and 17 patients with pertrochanteric external fixator as Group II were evaluated. Results: Table 2 shows the clinical evaluation results of the patients according to different criteria by the groups. The mean operation time was 45 min in Group I and 20 min in Group II. The external fixator application time is significantly shorter. The mean hospital stay was 14 days for Group I and 10 days for Group II. The hospital stay period of the external fixator group is 4 days shorter. While 7 patients were taken into the intensive care unit in Group I postoperatively, only 1 patient was taken into the same unit in Group II. This difference was significantly in favor of the external fixator group. While 14 patients in Group I needed a preoperative and postoperative blood transfusion, no patient needed blood transfusions in Group II. External fixator application is significantly more advantageous in terms of patient hemodynamics. The mean time to postoperatively move the extremity independently in the bed was 24 hours in Group I and 36 hours in Group II. All patients were exposed to the Harris hip scoring in the postoperative 12. month (the fixator was removed for the external fixator group). Conclusion: In addition to internal fixation options and endoprosthesis applications in elderly intertrochanteric femoral fractures, an external fixator may also be a good treatment alternative with appropriate patient selection and proper application in accordance with the technique thanks to its short surgical time, less blood loss and easy applicability.

Bone Substitute Materials and Minimally Invasive Surgery: A Convergence of Fracture Treatment for Compromised Bone

This article focuses on the understanding of the biochemistry and surgical application of bone substitute materials (BSMs) and particularly the newer calcium phosphate materials that can form a structural orthobiologic matrix within the metaphyseal components of the periarticular bone. Six characteristics of BSMs are detailed that can be used as a guide for the proper selection and application of the optimal BSM type for periarticular fracture repair. These 6 characteristics of BSMs are divided into 2 pillars. One pillar details the 3 biochemical features of BSMs and the other pillar details the 3 surgical application properties.

Femoral neck collapse after internal fixation of an intracapsular hip fracture: Does it indicate a poor outcome?

The degree of femoral neck collapse that occurred after 519 patients with an intracapsular hip fracture treated by internal fixation with a Targon FN implant was measured. Mean femoral neck collapse was 8.0mm and this was increased for displaced fractures in comparison to undisplaced fractures (9.5mm versus 5.9mm, p<0.0001) and for those patients that subsequently developed fracture healing complications (11.6mm versus 7.1mm, p<0.0001). At one year from injury femoral neck collapse in excess of 15mm was associated with an increase in the degree of residual pain (p=0.01). A clear relationship between increased collapse and increased loss of mobility was demonstrated (P<0.0001). This study confirms previous smaller studies that excessive femoral neck collapse (of more than 15mm) is more common for displaced fractures and presents new data to demonstrate that excessive femoral neck collapse is associated with an increased risk of fracture healing complications and increased loss of function. Future studies are now justified that consider methods to reduce fracture collapse.

Hot Topics in Biomechanics: Hip Fracture Fixation

Geriatric hip fractures continue to increase in frequency as the population ages, and intertrochanteric femur fractures are a significant part of these injuries. Plate fixation for intertrochanteric fractures of the proximal femur has been in use for many years, and application of the sliding hip screw has also been a mainstay of treatment. Recent data suggest there may be a benefit to using implants that add rotational stability to the proximal intertrochanteric fragment. Although preliminary data are promising, there is need for improved investigation to demonstrate the benefit of these new implant designs. In this era of increasing emphasis on cost, quality, and value, better data are needed to help clinicians determine the best therapy for their patients.

Optimizing Stability in Femoral Neck Fracture Fixation

Optimizing stability of femoral neck fracture fixation is important in obtaining a successful outcome. The mechanical problems and strategies for achieving optimal stability differ depending on patients' age and degree of osteoporosis. Femoral neck fractures in younger adults usually result from high-energy trauma and have a vertical fracture pattern. Strategies for optimizing fixation stability in this group include placing additional screws at right angles to the fracture plane and medial buttress plate augmentation. In elderly patients, screw position relative to the intact cortical femoral neck bone is of critical importance. Additional strategies for optimizing fixation stability in this group include the concept of length stable fixation, use of adjunctive calcium phosphate cement, and use of novel fixed angle fixation implants.