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Grünewald D, Dolt A, Barzen S, Rehme-Röhrl J, von Rüden C, Hoffmann R, Schweigkofler U. [Is the 95°blade plate still important in the treatment of proximal femoral pseudarthrosis?]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2024; 127:589-596. [PMID: 38748217 DOI: 10.1007/s00113-024-01435-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/13/2024] [Indexed: 07/30/2024]
Abstract
Due to demographic changes, fractures and subsequently delayed fracture healing as well as pseudarthrosis of the proximal femur are on the increase. In the acute fracture situation, a load-stable treatment with an intramedullary implant (cephalomedullary nail) is generally sought. To date, there is no uniform consensus on the optimal treatment for complicated cases. The aim of this study was to evaluate the clinical and radiological outcome after revision of pseudarthrosis using a 95° blade plate in aseptic proximal femoral pseudarthrosis and to identify the specifications of blade plate treatment.The retrospective study design was used to evaluate data, some of which were prospectively collected. The study period covered January 2010 to December 2020 and 22 patients (10 women, 12 men) with an average age of 59 years were included in this single-center study. All patients showed pseudarthrosis after a femoral fracture type AO 31 A1-A3 or proximal femoral fracture type AO 32 A-C. Clinical and radiological follow-up were performed after 3, 6 and 12 months. Functional outcomes were assessed using the modified Harris hip score (mHHS), the numerical rating scale (NRS) and the short form health survey (SF-12).The postoperative radiological results after reosteosynthesis using a blade plate showed good results and 86.4% of the patient population were healed during the observation period. Pseudarthrosis persisted in four patients and was surgically revised.The functional results showed good results on average, albeit with a high dispersion of 17-91 points in the mHHS. The SF-12 averaged 42.6 (±10.4) points and the psychological score 49.4 (±9.6) points. The postoperative pain level was low both at rest and under stress.It was shown that reosteosynthesis with a blade plate is a surgically demanding but effective treatment option with a low potential for infection and safe bone consolidation, especially for the correction of high-grade axial deviation or varus malalignment.
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Affiliation(s)
- Dag Grünewald
- Department of Trauma and Orthopedic Surgery, BG Unfallklinik Frankfurt, Friedberger Landstraße 430, 60389, Frankfurt am Main, Deutschland.
| | - Annika Dolt
- Department of Trauma and Orthopedic Surgery, BG Unfallklinik Frankfurt, Friedberger Landstraße 430, 60389, Frankfurt am Main, Deutschland
| | - Stefan Barzen
- Department of Trauma and Orthopedic Surgery, BG Unfallklinik Frankfurt, Friedberger Landstraße 430, 60389, Frankfurt am Main, Deutschland
| | - Julia Rehme-Röhrl
- Department of Trauma Surgery, BG Unfallklinik Murnau, 82418, Murnau, Deutschland
| | - Christian von Rüden
- Department of Trauma Surgery, BG Unfallklinik Murnau, 82418, Murnau, Deutschland
- Klinik für Unfallchirurgie, Orthopädie und Handchirurgie, Klinikum Weiden, 92637, Weiden in der Oberpfalz, Deutschland
| | - Reinhard Hoffmann
- Department of Trauma and Orthopedic Surgery, BG Unfallklinik Frankfurt, Friedberger Landstraße 430, 60389, Frankfurt am Main, Deutschland
| | - Uwe Schweigkofler
- Department of Trauma and Orthopedic Surgery, BG Unfallklinik Frankfurt, Friedberger Landstraße 430, 60389, Frankfurt am Main, Deutschland
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Vicenti G, Solarino G, Bizzoca D, Simone F, Maccagnano G, Zavattini G, Ottaviani G, Carrozzo M, Buono C, Zaccari D, Moretti B. Use of the 95-degree angled blade plate with biological and mechanical augmentation to treat proximal femur non-unions: a case series. BMC Musculoskelet Disord 2022; 22:1067. [PMID: 35227245 PMCID: PMC8886749 DOI: 10.1186/s12891-022-05089-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 02/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intertrochanteric and subtrochanteric non-union are rare but challenging complications. In the present study, we investigate the use of a 95° blade, in association with biological and mechanical augmentation, in the management of intertrochanteric and subtrochanteric femoral non-unions. METHODS Between October 2015 and February 2021, a retrospective cohort study was conducted at our institution to investigate the use of a 95° blade, in association with biological and mechanical augmentation, in the management of intertrochanteric and subtrochanteric femoral non-unions, following the mechanical failure of the first device. All the patients underwent a clinical and radiographic follow-up at 6 weeks, 3, 6, 9, 12 and 18 months; at each follow-up, a plain radiograph of the femur was performed and patients were assessed using Harris Hip Score (HHS) and the Short Form-12 (SF-12) questionnaire. RESULTS From October 2015 and February 2021, 40 proximal femur non-unions were managed at our Institution. Fifteen patients out of forty (37.5%) met the inclusion criteria. The main data of the study are summarized in Table 1; patients' mean was 57 years old (range 19-83); 10 males and 5 females were included in the study. All the patients completely healed clinically and radiologically at an average of 6.1 months (range 4-13). All these patients returned to their pre-injury mobility status. During an average follow-up period of 25 months (range 8-60), the observed complications included wound dehiscence, which was treated with a superficial surgical debridement, a below-the-knee deep vein thrombosis, and a blade plate failure 3 months after the first revision surgery. CONCLUSIONS This study shows the treatment of inter-and sub-trochanteric non-unions with a 95° blade plate, medial strut allograft, and bone autograft obtained with RIA system, together with a varus malalignment correction, leads to a high percentage of bone healing, with a low incidence of complications and good clinical outcome.
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Affiliation(s)
- Giovanni Vicenti
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro", AOU Consorziale Policlinico, Orthopaedic & Trauma Unit, Bari, Italy
| | - Giuseppe Solarino
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro", AOU Consorziale Policlinico, Orthopaedic & Trauma Unit, Bari, Italy
| | - Davide Bizzoca
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro", AOU Consorziale Policlinico, Orthopaedic & Trauma Unit, Bari, Italy.
- University of Bari "Aldo Moro, PhD course in Public Health, Clinical Medicine, and Oncology, Piazza Giulio Cesare 11, 70100, Bari, Italy.
| | - Filippo Simone
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro", AOU Consorziale Policlinico, Orthopaedic & Trauma Unit, Bari, Italy
| | | | - Giacomo Zavattini
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro", AOU Consorziale Policlinico, Orthopaedic & Trauma Unit, Bari, Italy
| | - Guglielmo Ottaviani
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro", AOU Consorziale Policlinico, Orthopaedic & Trauma Unit, Bari, Italy
| | - Massimiliano Carrozzo
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro", AOU Consorziale Policlinico, Orthopaedic & Trauma Unit, Bari, Italy
| | - Claudio Buono
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro", AOU Consorziale Policlinico, Orthopaedic & Trauma Unit, Bari, Italy
| | - Domenico Zaccari
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro", AOU Consorziale Policlinico, Orthopaedic & Trauma Unit, Bari, Italy
| | - Biagio Moretti
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro", AOU Consorziale Policlinico, Orthopaedic & Trauma Unit, Bari, Italy
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Evaluation and management of atypical femoral fractures: an update of current knowledge. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 31:825-840. [PMID: 33590316 DOI: 10.1007/s00590-021-02896-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 01/29/2021] [Indexed: 12/12/2022]
Abstract
Atypical femoral fractures are often attributed to the use of anti-resorptive medications such as bisphosphonates (BP). Whilst they have proven effects on fragility fracture prevention, clinical and laboratory evidence is evolving linking BP-related suppression of bone remodelling to the development of atypical stress-related sub-trochanteric fractures (Shane et al. in JBMR 29:1-23, 2014; Odvina et al. in JCEM 90:1294-301, 2005; Durchschlag et al. in JBMR 21(10):1581-1590, 2006; Donnelly et al. in JBMR 27:672-678, 2012; Mashiba et al. in Bone 28(5):524-531, 2001; Dell et al. in JBMR 27(12):2544-2550, 2012; Black et al. in Lancet 348:1535-1541, 1996; Black et al. in NEJM 356:1809-1822, 2007; Black et al. in JAMA 296:2927-2938, 2006; Schwartz et al. in JBMR 25:976-82, 2010). Injuries may present asymptomatically or with prodromal thigh pain and most can be successfully managed with cephalomedullary nailing and discontinuation of BP therapy. Such injuries exhibit a prolonged time to fracture union with high rates of non-union and metal-work failure when compared to typical subtrochanteric osteoporotic femoral fractures. Despite emerging literature on AFFs, their management continues to pose a challenge to the orthopaedic and extended multi-disciplinary team. The purpose of this review includes evaluation of the current evidence supporting the management of AFFs, clinical and radiological features associated with their presentation and a review of reported surgical strategies to treat and prevent these devastating injures.
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