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Castellanos-Alonso S, Tomás-Hernández J, Teixidor-Serra J, Selga-Marsà J, Piedra-Calle CA, Andrés-Peiró JV. Non-prosthetic implant-related femur fractures in post-polio patients. Trauma Case Rep 2023; 46:100843. [PMID: 37251433 PMCID: PMC10213328 DOI: 10.1016/j.tcr.2023.100843] [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] [Accepted: 05/15/2023] [Indexed: 05/31/2023] Open
Abstract
The overall societal impact of poliomyelitis worldwide is decreasing, rendering it almost absent in most developed countries. However, even there, patients are still seen who contracted it in endemic areas or developed polio before vaccinations became widely available. Post-polio syndrome (PPS) causes skeletal and neurological changes that increase affected individuals' likelihood of fractures, including fractures requiring complex surgical treatment. The existence of previous internal fixation creates a particularly difficult challenge. We present here the surgical management of four post-polio patients who suffered non-prosthetic implant-related femoral fractures. Injuries occurred at earlier ages than implant-related fractures in non-polio patients and three of the four fractures occurred around plates, a phenomenon which is usually rare. The treatment of implant-related fractures in patients with post-polio syndrome poses significant technical challenges, often creating problematic functional sequelae for patients and high costs for healthcare systems.
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Affiliation(s)
- Sara Castellanos-Alonso
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Jordi Tomás-Hernández
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department of Orthopaedic Surgery and Traumatology, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Jordi Teixidor-Serra
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department of Orthopaedic Surgery and Traumatology, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Jordi Selga-Marsà
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department of Orthopaedic Surgery and Traumatology, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Carlos Alberto Piedra-Calle
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department of Orthopaedic Surgery and Traumatology, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - José Vicente Andrés-Peiró
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department of Orthopaedic Surgery and Traumatology, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
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2
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Gupta A, Saurabh S, Trikha T, Karpe A, Mittal S. Femoral Shaft Fracture in Post-polio Syndrome Patients: Case Series from a Level-I Trauma Center and Review of Literature. Indian J Orthop 2022; 56:1339-1346. [PMID: 35928657 PMCID: PMC9283591 DOI: 10.1007/s43465-022-00683-8] [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: 01/17/2022] [Accepted: 06/06/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Femoral shaft fracture in patients of post-polio syndrome (PPS) represents an uncommon yet complex injury pattern. Poorly developed soft-tissue envelope, decreased muscle bulk, reduced vascularity, regional osteopenia, joint contractures, and altered bony anatomy impose significant surgical challenges. Thorough pre-operative planning is imperative as each case requires individualized approach and method of fixation. The aim of the study was to analyze the clinical outcomes in such patients following fracture fixation and to assess the surgical challenges encountered and provide solutions. MATERIALS AND METHODS A retrospective case series of 33 patients with femoral shaft fracture in PPS limbs was undertaken. Mode of injury, method of fixation, surgical time, intra-operative blood loss, union time, and complications were recorded. RESULTS Low-energy fall was the most common mechanism of injury (73%). Thirty-three patients underwent fixation with intramedullary nailing being the most common mode (79%). Femoral canal diameter, femoral bow, fracture location and morphology and clinical deformities of the patients are key governing factors that determine the choice of implant. Locking plates, pre-contoured anatomical plates, and titanium elastic nailing system offer an alternative in patients unsuitable for nailing. With no difference between various implants, average time for bone healing was 13.8 ± 4.4 weeks. All patients resumed full weight-bearing mobilization and returned to pre-injury activity status at the end of 6 months post-surgery. CONCLUSION With detailed pre-operative work-up, contemplating intra-operative difficulties, individualized surgical plan, careful handling of soft tissues, and availability of back-up implants, good clinical outcomes can be achieved in femur fractures in PPS patients.
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Affiliation(s)
- Anupam Gupta
- Department of Orthopaedics, All India Institute of Medical Sciences, JPNATC, AIIMS, New Delhi, India
| | - Suman Saurabh
- Department of Orthopaedics, All India Institute of Medical Sciences, JPNATC, AIIMS, New Delhi, India
| | - Tanya Trikha
- Mahatma Gandhi Mission Medical College and Hospital, Aurangabad, India
| | | | - Samarth Mittal
- Department of Orthopaedics, All India Institute of Medical Sciences, JPNATC, AIIMS, New Delhi, India
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3
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Pires RE, Yoon RS, Liporace FA, Balbachevsky D, Bitar RC, Giordano V, Wajnsztejn A, Kfuri M. Expanding the horizons of clinical applications of proximal humerus locking plates in the lower extremities: A technical note. Chin J Traumatol 2020; 23:331-335. [PMID: 32855044 PMCID: PMC7718511 DOI: 10.1016/j.cjtee.2020.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 06/29/2020] [Accepted: 07/28/2020] [Indexed: 02/04/2023] Open
Abstract
Pre-contoured anatomical locking plates were designed to address the clinical need of fixing small epiphyseal segments with a larger number of screws. Those plates match the contour and shape of a variety of bones allowing for optimal buttress properties. The aim of this manuscript is to highlight the benefits of applying proximal humerus locking plates in the fixation of lower extremity bones. Although designed for the proximal humerus, the low-profile plate shape and anatomic contour also provides versatile use in certain areas of the lower extremity. This technical narrative highlights the versatile and reliable use of this plate for other anatomical areas than the one to which it has been originally conceived.
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Affiliation(s)
- Robinson E. Pires
- Departamento do Aparelho Locomotor – Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil,Corresponding author.
| | - Richard S. Yoon
- Division of Orthopedic Trauma & Adult Reconstruction, Department of Orthopedic Surgery, Jersey City Medical Center – RWJ Barnabas Health Jersey City, NJ, United States
| | - Frank A. Liporace
- Division of Orthopedic Trauma & Adult Reconstruction, Department of Orthopedic Surgery, Jersey City Medical Center – RWJ Barnabas Health Jersey City, NJ, United States
| | - Daniel Balbachevsky
- Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Rogério C. Bitar
- Departamento de Ortopedia e Anestesiologia, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Vincenzo Giordano
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rio de Janeiro, RJ, Brazil
| | - André Wajnsztejn
- Serviço de Ortopedia e Traumatologia, Hospital Israelita Albert Einstein Hospital, São Paulo, SP, Brazil
| | - Mauricio Kfuri
- Missouri Orthopaedic Institute, University of Missouri, Columbia, United States
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Distefano M, Bettuzzi C, Salvatori G, Cristella G, Abati CN, Lampasi M. Flexible intramedullary nailing for supracondylar femoral fractures in children with Duchenne muscular dystrophy. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e924460. [PMID: 33173022 PMCID: PMC7669953 DOI: 10.12659/ajcr.924460] [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] [Indexed: 11/28/2022]
Abstract
Case series Patients: 11-year-old • 12-year-old Final Diagnosis: Duchenne muscular dystrophy Symptoms: Fracture Medication: — Clinical Procedure: — Specialty: Orthopedics and Traumatology
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Affiliation(s)
- Marco Distefano
- Orthopaedic Clinic, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Camilla Bettuzzi
- Department of Paediatric Orthopaedics and Traumatology, Anna Meyer Children's Hospital, Florence, Italy.,OrtoPediatria, Center for Education, Research and Patient Care in Paediatric Orthopaedics, Bologna, Italy
| | - Giada Salvatori
- Department of Paediatric Orthopaedics and Traumatology, Anna Meyer Children's Hospital, Florence, Italy.,OrtoPediatria, Center for Education, Research and Patient Care in Paediatric Orthopaedics, Bologna, Italy
| | - Giovanna Cristella
- Unit of Children Rehabilitation, IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Caterina Novella Abati
- Department of Paediatric Orthopaedics and Traumatology, Anna Meyer Children's Hospital, Florence, Italy
| | - Manuele Lampasi
- Department of Paediatric Orthopaedics and Traumatology, Anna Meyer Children's Hospital, Florence, Italy.,OrtoPediatria, Center for Education, Research and Patient Care in Paediatric Orthopaedics, Bologna, Italy
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Garceau SP, Igbokwe EN, Warschawski Y, Neufeld ME, Safir OA, Wade JP, Guy P, Wolfstadt JI. Management Options and Outcomes for Patients with Femoral Fractures with Post-Polio Syndrome of the Lower Extremity: A Critical Analysis Review. JBJS Rev 2020; 8:e0146. [PMID: 32487976 DOI: 10.2106/jbjs.rvw.19.00146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Post-polio syndrome is characterized by a late functional deterioration (usually after >=15 years from the initial infection) in patients with a history of paralytic poliomyelitis infection, and it is defined by the March of Dimes criteria. Patients with post-polio syndrome are at increased risk for falls and associated hip and femoral fractures as a result of lower bone mineral density, decreased lean muscle mass, and musculoskeletal deformities.
Current evidence suggests that treatment modalities for femoral fractures should emphasize fixation that allows early progressive weight-bearing and ambulation to optimize functional outcomes. Good results after hip arthroplasty have been described with both cemented and uncemented implants in patients who have been treated for osteoarthritis, but there has been little evidence guiding hip fracture management. Anatomic challenges that are encountered are osteoporotic bone, a valgus neck-shaft angle, increased femoral anteversion, and a small femoral canal diameter.
Intramedullary nailing of hip and femoral fractures can be challenging due to the small femoral canal diameter that frequently is encountered. Alternative methods of fixation have shown promising results. These include the use of sliding hip screws for hip fracture management and fixed-angle locking plates for hip and femoral fracture management.
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Affiliation(s)
- Simon P Garceau
- Division of Orthopaedics, Joseph and Wolf Lebovic Health Complex, Mount Sinai Hospital, Toronto, Ontario, Canada
| | | | - Yaniv Warschawski
- Division of Orthopaedics, Joseph and Wolf Lebovic Health Complex, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Michael E Neufeld
- Division of Orthopaedics, Department of Adult Joint Reconstruction, Western University, London, Ontario, Canada
| | - Oleg A Safir
- Division of Orthopaedics, Joseph and Wolf Lebovic Health Complex, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - John P Wade
- Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Pierre Guy
- Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jesse I Wolfstadt
- Division of Orthopaedics, Joseph and Wolf Lebovic Health Complex, Mount Sinai Hospital, Toronto, Ontario, Canada
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Checa Betegón P, Valle Cruz J, García Coiradas J, Rodríguez González A, González Pérez A, Torrecilla Cifuentes E, Marco F. Fractures in patients with poliomyelitis: Past or current challenge? Injury 2020; 51 Suppl 1:S48-S54. [PMID: 32111460 DOI: 10.1016/j.injury.2020.02.029] [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: 12/02/2019] [Accepted: 02/08/2020] [Indexed: 02/02/2023]
Abstract
Fractures in poliomyelitic limbs are a challenge to surgeons, due to polio's sequelae and morphological disorders, which make conventional osteosynthesis difficult. We present a retrospective study of 62 patients and 73 non-simultaneous fractures in their lower limbs. Average age was 61,7 years and 53,2% were females. We analyzed the preinjury functional level, etiology of the fracture, fracture pattern, treatment used (be conservative or surgical), and implant used in surgical cases. We treated 85,1% of them surgically and 37,9% of them maintained the same functional situation as before the fracture. 55,4% of them experienced the need to add some mechanical aids after the lesion and 6,8% lost the ability to walk. Most of the surgical treatments employed were similar as the ones used in non-poliomyelitic patients, although some cases required atypical implants, such as a Multiloc (® DePuy Synthes) humeral nail for a tibial shaft fracture, due to narrow bone. Mortality along the 1st year was 2.7%. We found similar functional and radiological results as those described in non-poliomyelitic limbs.
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Affiliation(s)
- P Checa Betegón
- Department of Traumatology and Orthopaedic Surgery, Hospital Clínico Universitario San Carlos, Madrid, Spain.
| | - J Valle Cruz
- Department of Traumatology and Orthopaedic Surgery, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - J García Coiradas
- Department of Traumatology and Orthopaedic Surgery, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - A Rodríguez González
- Department of Traumatology and Orthopaedic Surgery, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - A González Pérez
- Department of Traumatology and Orthopaedic Surgery, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - E Torrecilla Cifuentes
- Department of Traumatology and Orthopaedic Surgery, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - F Marco
- Department of Traumatology and Orthopaedic Surgery, Hospital Clínico Universitario San Carlos, Madrid, Spain
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7
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Outcome of femoral fractures in poliomyelitis patients. INTERNATIONAL ORTHOPAEDICS 2019; 43:2607-2612. [DOI: 10.1007/s00264-019-04285-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 01/02/2019] [Indexed: 11/26/2022]
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8
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Mingo-Robinet J, Alonso J, Moreno-Barrero M, González-García L, Garcia-Virto V, Aguado H. Technical aspects and complications in the surgical treatment of poliomyelitis-affected lower limb fractures. Rev Esp Cir Ortop Traumatol (Engl Ed) 2018. [DOI: 10.1016/j.recote.2018.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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9
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Mingo-Robinet J, Alonso JA, Moreno-Barrero M, González-García L, Garcia-Virto V, Aguado HJ. Technical aspects and complications in the surgical treatment of poliomyelitis-affected lower limb fractures. Rev Esp Cir Ortop Traumatol (Engl Ed) 2018; 62:257-266. [PMID: 29605559 DOI: 10.1016/j.recot.2018.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 09/21/2017] [Accepted: 01/18/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Post-polio patients present problems such as small and deformed bones, with narrow intramedullary canal and osteoporosis, affecting surgical treatment. The aim of this article is to describe the main preoperative and intraoperative complications of the surgical treatment of fractures in this population. MATERIAL AND METHODS A retrospective analysis was conducted between 1995 and 2014. Data obtained from the medical records included patient age, fracture pattern (AO/OTA), device used, technical aspects of the surgery that changed compared to a standard procedure, and the presence of intraoperative skeletal complications. RESULTS Sixty-four patients with 78 fractures were included in the study. Forty-seven percent of the fractures were at the proximal femur. The main complications of hip arthroplasty (14 patients) were absent hip abductors and intraoperative instability (3), bad cup fixation (3) and intraoperative periprosthetic fracture (2). The main problems of intramedullary nailing were due to a narrow canal and previous bone deformity. Main problems reported when plating included difficulty to fit a precontoured plate, and oversized hardware. CONCLUSION Given the large number of intraoperative complications, in preoperative planning we must include nails of small diameter and length, locking plates and external fixators, and, in the case of hip arthroplasty, long and thin stems and restrictive or dual mobility acetabular systems.
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Affiliation(s)
- J Mingo-Robinet
- Servicio de Cirugía Ortopédica y Traumatología, Complejo Asistencial Universitario de Palencia, Palencia, España.
| | - J A Alonso
- FRCS (Tr & Orth), Servicio de Cirugía Ortopédica y Traumatología, Complejo Asistencial de Segovia, Segovia, España
| | - M Moreno-Barrero
- Servicio de Radiología, Complejo Asistencial Universitario de Palencia, Palencia, España
| | - L González-García
- Servicio de Cirugía Ortopédica y Traumatología, Complejo Asistencial Universitario de Palencia, Palencia, España
| | - V Garcia-Virto
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - H J Aguado
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico Universitario de Valladolid, Valladolid, España
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Gupta M, Jain VK, Upadhyaya GK, Arya RK. Comprehensive review of challenges associated with management of lower limb fractures in poliomyelitis patients. J Clin Orthop Trauma 2016; 7:276-281. [PMID: 27857503 PMCID: PMC5106482 DOI: 10.1016/j.jcot.2016.08.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 05/08/2016] [Accepted: 08/18/2016] [Indexed: 01/13/2023] Open
Abstract
Poliomyelitis is on the verge of eradication. But the survivors of polio are still living with its consequences in different parts of the world and so will continue to be seen for almost a century. Fractures in the polio-affected limb are a common entity in these patients and are difficult to manage using the common fracture management protocols. This article gives a comprehensive review of the challenges faced in fixation of fractures in polio affected limbs and possible solutions to overcome them. Knowledge of treating these fractures is important to a trauma surgeon as such scenarios are not uncommon in daily practice.
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Affiliation(s)
| | - Vijay Kumar Jain
- Corresponding author at: Department of Orthopedics, PGIMER Dr Ram Manohar Lohia Hospital, New Delhi 110001, India.Department of Orthopedics, PGIMER Dr Ram Manohar Lohia HospitalNew Delhi110001India
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11
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Biber R, Stedtfeld HW, Bail HJ. The Targon PH(®) nail for distal femoral fracture fixation in disabled children. A report of three cases. Orthop Traumatol Surg Res 2014; 100:699-702. [PMID: 24970711 DOI: 10.1016/j.otsr.2014.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2013] [Revised: 03/06/2014] [Accepted: 05/07/2014] [Indexed: 02/02/2023]
Abstract
UNLABELLED Recommendations for distal femoral fracture treatment in children with neuromuscular disease are various, including conservative, plating, nailing, and ESIN. All methods have disadvantages. Retrograde femoral intramedullary nailing using a statically interlocked Targon PH nail was performed in three cases. A right nail was used for a right femur (and vice versa). A short nail was used for supracondylar fractures, a long nail for distal femoral shaft fractures. Closed reduction was performed in all cases. Despite osteopenia, small bone dimensions and muscle dystrophy, no intraoperative or postoperative complications occurred. All cases achieved primary stability, allowing immediate rehabilitation. Bone healing occurred uneventfully within four months. No deterioration of functional status or range of motion was seen. There were no peri-implant fractures or hardware removal need over a two-year-period. Retrograde femoral nailing with the Targon PH nail seems to be a reasonable treatment concept for these rare and demanding cases. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- R Biber
- Department of Trauma and Orthopaedic Surgery, Klinikum Nürnberg Sued, Breslauer Strasse 201, 90471 Nuernberg, Germany.
| | - H-W Stedtfeld
- Department of Trauma and Orthopaedic Surgery, Klinikum Nürnberg Sued, Breslauer Strasse 201, 90471 Nuernberg, Germany.
| | - H J Bail
- Department of Trauma and Orthopaedic Surgery, Klinikum Nürnberg Sued, Breslauer Strasse 201, 90471 Nuernberg, Germany.
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