1
|
Structure-mechanical analysis of various fixation constructs for basicervical fractures of the proximal femur and clinical implications; finite element analysis. Injury 2023; 54:370-378. [PMID: 36529550 DOI: 10.1016/j.injury.2022.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/14/2022] [Accepted: 12/03/2022] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This present study was conducted to determine the structural-mechanical stability of various fixation constructs through finite element (FE) analysis following simulation of a basicervical fracture and to introduce the clinical implications. MATERIALS AND METHODS We simulated fracture models by using a right synthetic femur (SAWBONES®). We imported the implant models into ANSYS® for placement in an optimal position. Five assembly models were constructed: (1) multiple cancellous screws (MCS), (2) FNS (femoral neck system®), (3) dynamic hip screw (DHS), (4) DHS with anti-rotation 7.0 screw (DHS + screw), and PFNA-II (Proximal Femoral Nail Antirotation-II®). The femur model's distal end was completely fixed and 7° abducted. We set the force vector at a 3° angle laterally and 15° posteriorly from the vertical ground. Analysis was done using Ansys® software with von Mises stress (VMS) in megapascals (MPa) and displacement (mm) RESULTS: The displacements of the proximal femur were 10.25 mm for MCS, 9.66 mm for DHS, 9.44 mm for DHS + screw, 9.86 mm for FNS, and 9.31 mm for PFNA-II. The maximum implant VMS was 148.94 MPa for MCS, 414.66 MPa for DHS, 385.59 MPa for DSH + screw, 464.07 MPa for FNS, and 505.07 MPa for PFNA-II. The maximum VMS at the fracture site was 621.13 MPa for MCS, 464.14 MPa for DHS, 64.51 MPa for DHS + screw, 344.54 MPa for FNS, and 647.49 MPa for PFNA-II. The maximum VMS at the fracture site was in the superior area with the high point around the posterior screw in the MCS, anterosuperior corner in the DHS, the posteroinferior site of the FNS, and posterosuperior site around the entry point in the PFNA-II. In the DHS + screw, the stresses were distributed evenly and disappeared at the maximum VMS fracture site. CONCLUSION Based on the fracture site and implant's stress distribution, the model receiving the optimal load was a DHS + screw construct, and the FNS implant could be applied to anatomically reduced fractures without comminution. Considering the high-stress concentration around the entry point, a PFNA-II fixation has a high probability of head-neck fragment rotational instability.
Collapse
|
2
|
Yamakawa Y, Yamamoto N, Tomita Y, Noda T, Inoue T, Matsumoto T, Kawasaki K, Ozaki T. Coronal shear fractures of the femoral neck: a comparison with basicervical fractures. Eur J Trauma Emerg Surg 2023; 49:419-430. [PMID: 35978044 DOI: 10.1007/s00068-022-02079-7] [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: 03/02/2022] [Accepted: 08/08/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE We propose coronal shear fracture of the femoral neck (CSFF) as a new type of fracture that differs from a basicervical fracture. This study aimed to present the incidence of CSFF and compare its clinical characteristics and outcomes with those of basicervical fractures. METHODS In this multicenter retrospective cohort study, 2207 patients with hip fractures were identified using computed tomography (CT), 17 and 27 patients were diagnosed with CSFF (CSFF group) and basicervical fractures (basicervical fracture group), respectively. The primary outcome was reoperation, while the secondary outcomes were postoperative radiographic findings, ambulatory ability, and 1-year mortality rate. These outcomes were compared between the two groups. We also conducted diagnostic reliability tests for these fractures using the Cohen's kappa coefficient. RESULTS The incidence of CSFF and basicervical fractures in the 2207 patients were 0.77% and 1.22%, respectively. The inter-and intra-observer agreements for the diagnosis were almost perfect. The comorbidity score was significantly higher in the CSFF group than in the basicervical fracture group. No reoperations occurred in both groups. There were no significant intergroup differences in the postoperative radiographic findings. The 1-year mortality rate was higher in the CSFF group than in the basicervical fracture group (38.5% vs. 5.3%; odds ratio: 11.9, 95% CI: 1.2-118.5; p = 0.025). CONCLUSION This study presents the definition and incidence of CSFF with a high diagnostic reliability. Patients with CSFF had similar reoperation rate postoperative radiographic outcomes to basicervical fractures, while 1-year mortality rate was high.
Collapse
Affiliation(s)
- Yasuaki Yamakawa
- Department of Orthopedic Surgery, Kochi Health Sciences Center, Kochi, Japan
| | - Norio Yamamoto
- Department of Orthopedic Surgery, Kagawa Prefectural Central Hospital, 1-2-1, Asahi-machi, Takamatsu, Kagawa, 760-8557, Japan. .,Systematic Review Workshop Peer Support Group (SRWS-PSG), Osaka, Japan.
| | - Yosuke Tomita
- Department of Physical Therapy, Faculty of Health Care, Takasaki University of Health and Welfare, Gunma, Japan
| | - Tomoyuki Noda
- Department of Orthopaedic Surgery and Traumatology, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Tomoo Inoue
- Department of Orthopedic Surgery, Kagawa Prefectural Central Hospital, 1-2-1, Asahi-machi, Takamatsu, Kagawa, 760-8557, Japan
| | - Toshiyuki Matsumoto
- Department of Orthopedic Surgery, Kochi Health Sciences Center, Kochi, Japan
| | - Keisuke Kawasaki
- Department of Orthopedic Surgery, Kagawa Prefectural Central Hospital, 1-2-1, Asahi-machi, Takamatsu, Kagawa, 760-8557, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
| |
Collapse
|
3
|
Jiang QL, Li Y, Bai XW, Deng Y, Hong H, Li J, Cao Y, Peng XY. A novel computed tomography-based three-column MLP classification of intertrochanteric fracture. THE JOURNAL OF MEDICAL INVESTIGATION 2023; 70:524-529. [PMID: 37940544 DOI: 10.2152/jmi.70.524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
OBJECTIVES The aim of the present study was to introduce a novel three-dimensional computed tomography (3DCT)-based three-column classification (named "MLP classification system") of intertrochanteric fractures and evaluate its reproducibility and reliability. METHODS From September 2020 to September 2022, a total of 258 consecutive patients (60 male, 198 female;mean age 81.3 years) with intertrochanteric fractures were included in this study. The fracture in each case was assessed using a novel three-dimensional computed tomography-based three-column classification. Two examiners tested the intra and inter-observer reliability of this new classification system using kappa variance. RESULTS The intertrochanteric region was divided into the medial column, lateral column, and posterior column. Intertrochanteric fractures were documented as M0/1/2L0/1/2/3P0/1/2/3. All fractures were classifiable into the new classification system. The intra-observer kappa values were 0.91 and 0.89, while the inter-observer kappa value was 0.82, both indicating almost perfect reliability. CONCLUSION This novel 3DCT-based MLP classification system for intertrochanteric fractures is comprehensive, and reproducible with good agreement. It is based on proximal femur biomechanic characteristics and traumatic mechanism, contributing to formulating more reasonable treatment protocols involving various late-model internal fixation devices. J. Med. Invest. 70 : 524-529, August, 2023.
Collapse
Affiliation(s)
- Qi-Long Jiang
- Department of Orthopaedic Surgery, Chongqing Orthopedic Hospital Of Traditional Chinese Medicine, Chongqing, China
| | - Yan Li
- Central Sterile Supply Department, Chonggang General Hospital, Chongqing, China
| | - Xin-Wen Bai
- Department of Orthopaedic Surgery, Chongqing Orthopedic Hospital Of Traditional Chinese Medicine, Chongqing, China
| | - Yu Deng
- Department of Orthopaedic Surgery, Chongqing Orthopedic Hospital Of Traditional Chinese Medicine, Chongqing, China
| | - Hao Hong
- Department of Orthopaedic Surgery, Chongqing Orthopedic Hospital Of Traditional Chinese Medicine, Chongqing, China
| | - Jun Li
- Department of Orthopaedic Surgery, Chongqing Orthopedic Hospital Of Traditional Chinese Medicine, Chongqing, China
| | - Yong Cao
- Department of emergency, Chongqing Orthopedic Hospital Of Traditional Chinese Medicine, Chongqing, China
| | - Xiao-Yu Peng
- Department of emergency, Chongqing Orthopedic Hospital Of Traditional Chinese Medicine, Chongqing, China
| |
Collapse
|
4
|
Komatsu M, Iwami T, Kijima H, Kawano T, Miyakoshi N. What is the most fixable intramedullary implant for basicervical fracture and transcervical shear fracture? - A finite element study. J Clin Orthop Trauma 2022; 34:102015. [PMID: 36203783 PMCID: PMC9529975 DOI: 10.1016/j.jcot.2022.102015] [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: 01/24/2022] [Revised: 07/16/2022] [Accepted: 08/29/2022] [Indexed: 11/17/2022] Open
Abstract
Objective The objectives of this study are 1) to biomechanically compare six different intramedullary fixations for basicervical fracture (AO 31-B3, Type 2 in area classification) and transcervical shear fracture (AO 31-B2.3, Type 1-2 in area classification) using the finite element (FE) method, and 2) to investigate the effects of two different unstable fracture types on fixation. Methods FE models of two different types of proximal femoral fractures are constructed from CT scan images of a patient with osteoporosis. The fracture models are fixed with a short femoral nail with a single lag screw, short femoral nail with a single blade, and short femoral nail with double lag screws, and then fixed with long femoral nails for each of the three nail types. Subsequently, the maximum loads during walking and stair climbing, as well as the minimum principal strain and compressive failure elements are calculated to assess the fixation of each implant. Results In both fracture types, the long nail with double lag screws show the smallest volume of compressive failure elements (basicervical fracture, 2 mm3; transcervical shear fracture, 217 mm3). In all types of implants, the volume of the compressive failure elements is larger in the transcervical shear fracture than in the basicervical fracture. A similar trend is observed for the minimum principal strain (compressive strain). Conclusion The present study shows that a long nail with double lag screws is the most fixative intramedullary nail device for basicervical fracture and transcervical shear fracture in any condition. Furthermore, it is shown that transcervical shear fracture is considerably more unstable than basicervical fracture.
Collapse
Affiliation(s)
| | - Takehiro Iwami
- Graduate School of Engineering Science, Akita University, Japan
| | - Hiroaki Kijima
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
- Akita Hip Research Group (AHRG), Akita, Japan
| | - Tetsuya Kawano
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
- Akita Hip Research Group (AHRG), Akita, Japan
| | - Naohisa Miyakoshi
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
- Akita Hip Research Group (AHRG), Akita, Japan
| |
Collapse
|
5
|
Kacmaz IE, Turgut A, Basa CD, Bilgin E, Reisoglu A, Kalenderer O. Comparison of the Reliability of Three Scoring Systems Used to Decide Whether to Apply Cement in Hip Arthroplasty Among Fracture Patients and the Effect of Surgical Experience: The Spotorno, Dorr, and Canal Flare Indices. J Arthroplasty 2022; 37:1348-1353. [PMID: 35337947 DOI: 10.1016/j.arth.2022.03.062] [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: 02/09/2022] [Revised: 03/15/2022] [Accepted: 03/16/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND No consensus has been reached regarding the best index to decide whether to use cement during hip replacement surgery. Therefore, this study compared the reliability of three frequently used scoring systems. The secondary purpose was to evaluate the effect of surgical experience on the decision to use cement. METHODS Anteroposterior radiographs of 60 hips were assessed by four orthopedic surgeons and four orthopedic residents. The observers were asked to make measurements using the Spotorno criteria, the Dorr index, and the canal flare index, and to decide whether to use a cemented or cementless femoral stem. The same X-rays were sent to all participants, in a different order, 4 weeks later, for a second evaluation. The SPSS software (version 24.0) was used for the statistical analysis. Intraobserver agreement was determined for all observers via the intraclass correlation coefficient (ICC), and interobserver reliability was calculated using the weighted kappa (κ) statistic. RESULTS The average age of the patients were 73.1 ± 12.1 years. Thirty-three (55%) patients were female and thirty-two (53.3%) had fractures on the right side. Intraobserver agreement was "excellent" for all participants according to the Spotorno criteria. The canal flare index had the lowest intra-observer agreement. The highest interobserver agreement was found using the Spotorno criteria. CONCLUSION The intra- and interobserver reliabilities of the Spotorno criteria were higher than those of the Dorr index and the canal flare index. The Spotorno criteria was more useful for deciding between cemented and un-cemented hip arthroplasty.
Collapse
Affiliation(s)
- Ismail Eralp Kacmaz
- Department of Orthopaedics and Traumatology, Tepecik Training and Research Hospital, İzmir, Turkey
| | - Ali Turgut
- Department of Orthopaedics and Traumatology, Tepecik Training and Research Hospital, İzmir, Turkey
| | - Can Doruk Basa
- Department of Orthopaedics and Traumatology, Tepecik Training and Research Hospital, İzmir, Turkey
| | - Emre Bilgin
- Department of Orthopaedics and Traumatology, Tepecik Training and Research Hospital, İzmir, Turkey
| | - Ali Reisoglu
- Department of Orthopaedics and Traumatology, Tepecik Training and Research Hospital, İzmir, Turkey
| | - Onder Kalenderer
- Department of Orthopaedics and Traumatology, Tepecik Training and Research Hospital, İzmir, Turkey
| |
Collapse
|
6
|
Assink N, Reininga IHF, Ten Duis K, Doornberg JN, Hoekstra H, Kraeima J, Witjes MJH, de Vries JPPM, IJpma FFA. Does 3D-assisted surgery of tibial plateau fractures improve surgical and patient outcome? A systematic review of 1074 patients. Eur J Trauma Emerg Surg 2022; 48:1737-1749. [PMID: 34463771 PMCID: PMC9192447 DOI: 10.1007/s00068-021-01773-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 08/15/2021] [Indexed: 01/10/2023]
Abstract
PURPOSE The aim of this systematic review was to provide an overview of current applications of 3D technologies in surgical management of tibial plateau fractures and to assess whether 3D-assisted surgery results in improved clinical outcome as compared to surgery based on conventional imaging modalities. METHODS A literature search was performed in Pubmed and Embase for articles reporting on the use of 3D techniques in operative management of tibial plateau fractures. This systematic review was performed in concordance with the PRISMA-guidelines. Methodological quality and risk of bias was assessed according to the guidelines of the McMaster Critical Appraisal. Differences in terms of operation time, blood loss, fluoroscopy frequency, intra-operative revision rates and patient-reported outcomes between 3D-assisted and conventional surgery were assessed. Data were pooled using the inverse variance weighting method in RevMan. RESULTS Twenty articles evaluating 948 patients treated with 3D-assisted surgery and 126 patients with conventional surgery were included. Five different concepts of 3D-assisted surgery were identified: '3D virtual visualization', '3D printed hand-held fracture models', 'Pre-contouring of osteosynthesis plates', '3D printed surgical guides', and 'Intra-operative 3D imaging'. 3D-assisted surgery resulted in reduced operation time (104.7 vs. 126.4 min; P < 0.01), less blood loss (241 ml vs. 306 ml; P < 0.01), decreased frequency of fluoroscopy (5.8 vs. 9.1 times; P < 0.01). No differences in functional outcome was found (Hospital for Special Surgery Knee-Rating Scale: 88.6 vs. 82.8; P = 0.23). CONCLUSIONS Five concepts of 3D-assisted surgical management of tibial plateau fractures emerged over the last decade. These include 3D virtual fracture visualization, 3D-printed hand-held fracture models for surgical planning, 3D-printed models for pre-contouring of osteosynthesis plates, 3D-printed surgical guides, and intra-operative 3D imaging. 3D-assisted surgery may have a positive effect on operation time, blood loss, and fluoroscopy frequency.
Collapse
Affiliation(s)
- Nick Assink
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
- Department of Oral and Maxillofacial Surgery, 3D Lab, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Inge H F Reininga
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Kaj Ten Duis
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Job N Doornberg
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Harm Hoekstra
- Department of Traumatology, KU Leuven University Hospitals Leuven Gasthuisberg Campus, Leuven, Belgium
| | - Joep Kraeima
- Department of Oral and Maxillofacial Surgery, 3D Lab, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Max J H Witjes
- Department of Oral and Maxillofacial Surgery, 3D Lab, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Frank F A IJpma
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| |
Collapse
|
7
|
Ji Q, Wang F, He Q, Li Y, Ma Y. Effect of Low-Dose Dexmedetomidine Combined with Lumbosacral Plexus Block Guided by Ultrasound Imaging Based on Image Segmentation Algorithm in Fracture Surgery. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:8063874. [PMID: 35676952 PMCID: PMC9170447 DOI: 10.1155/2022/8063874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/25/2022] [Accepted: 05/06/2022] [Indexed: 11/18/2022]
Abstract
The aim of this study was to analyze the application of ultrasound-guided low-dose dexmedetomidine combined with lumbosacral plexus block based on artificial intelligence algorithm in the surgical treatment of proximal femoral fractures. 104 patients with proximal femoral fractures were divided into 52 cases in the experimental group (ultrasound-guided lumbosacral plexus block combined with dexmedetomidine based on local fitting image segmentation algorithm) and 52 cases in the routine group (endotracheal intubation and inhalation combined with general anesthesia). An image segmentation algorithm based on local fitting was constructed to enhance the ultrasound image. It was found that in the routine group, the heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) at the beginning of intravenous injection of dexmedetomidine, during skin incision, and half an hour after skin incision were significantly lower than those at admission (P < 0.05). The pressing times of patient-controlled intravenous analgesia (PCIA) in the conventional group (17.05 ± 6.85 times) were significantly higher than that in the experimental group (8.55 ± 4.12 times), and the difference was statistically significant (P < 0.05). The visual analogue scale (VAS) scores at 1, 5, 10, and 15 after operation in the routine group were significantly higher than those in the experimental group (P < 0.05). The number of dizziness, nausea, and vomiting, venous thrombosis of lower limbs, cardiovascular events, and pulmonary infection in the routine group on the 1st, 2nd, and 3rd days after operation were significantly higher than those in the experimental group (P < 0.05). In summary, the ultrasound-guided lumbar plexus-sacral plexus block combined with dexmedetomidine anesthesia based on image segmentation algorithm can effectively maintain the hemodynamic stability of patients, with remarkable analgesic effect and high safety.
Collapse
Affiliation(s)
- Qiang Ji
- Department of Anesthesiology, Hebei Gucheng Hospital, Hengshui 253800, Hebei, China
| | - Feng Wang
- Department of Anesthesiology, Hebei Gucheng Hospital, Hengshui 253800, Hebei, China
| | - Qiang He
- Operation Room, Hebei Gucheng Hospital, Hengshui 253800, Hebei, China
| | - Yanhui Li
- Department of Pain, Hebei Gucheng Hospital, Hengshui 253800, Hebei, China
| | - Yan Ma
- Department of Anesthesiology, Hebei Gucheng Hospital, Hengshui 253800, Hebei, China
| |
Collapse
|
8
|
Effect of Ultrasound-Guided Fascia Iliac Compartment Block on Serum NLRP3 and Inflammatory Factors in Patients with Femoral Intertrochanteric Fracture. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:1944659. [PMID: 35620203 PMCID: PMC9129941 DOI: 10.1155/2022/1944659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/18/2022] [Accepted: 04/26/2022] [Indexed: 12/04/2022]
Abstract
Objective To investigate the effects of ultrasound-guided fascia iliac compartment block (FICB) on patients' postoperative pain and inflammatory factors as well as nucleotide-binding domain and leucine-rich repeat (NLR) family, pyrin domain-containing 3 (NLRP3) in femoral intertrochanteric fracture. Methods This single-blind randomized controlled study included 231 patients with femoral intertrochanteric fracture treated in our hospital from January 2017 to December 2020. All patients were randomized into two groups, the FICB group (n = 116) and the general anesthesia group (control group, n = 115). The serum NLRP3 levels and inflammatory factors were evaluated. The heart rate (HR), mean arterial pressure (MAP), and SpO2 values were recorded. Pain condition was measured by the visual analogue scale (VAS) score. Harris score was performed for positive hip function. Results The values of HR and MAP were significantly lower after anesthesia induction in FICB groups compared with the control group. However, no significant difference was found for SpO2. Compared with the control group, the VAS scores within 72 h after surgery were all markedly lower in the FICB group than in the control group and showed no significant difference at 1 week after surgery. The levels of NLRP3 and interleukin 6 (IL-6) were significantly lower in FICB patients at 1 h, 6 h, 24 h, 48 h, and 72 h after surgery compared with the control group. Tumor necrosis factor-α (TNF-α) showed a significant lower level in the FICB group at 1 h and 6 h after surgery, and significant lower levels of C-reactive protein (CRP) were found at 1 h and 24 h after surgery compared with the control group. Positive correlation was found between NLRP3 and IL-6, as well as CRP and VAS scores after 1 h of the surgery. No significant difference was found for both Harris score and postoperative complications between the two groups. Conclusion Fascia iliac compartment block could reduce the postoperative pain, which might be associated with the decrease of the serum levels of NLRP3, CRP, IL-6, and TNF-α in femoral intertrochanteric fracture patients.
Collapse
|
9
|
Risk factors for over-telescoping in reverse oblique intertrochanteric fractures. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2022; 33:1101-1107. [PMID: 35403907 DOI: 10.1007/s00590-022-03263-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 03/28/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Postoperative over-telescoping (OT) with lag screws is often observed in reverse oblique intertrochanteric fractures. This study aimed to clarify the risk factors of OT in patients with reverse oblique intertrochanteric fractures. METHODS Electronic medical records of patients diagnosed with reverse oblique intertrochanteric fractures using plain radiography who underwent operative fixation with an intramedullary nail between August 2013 and December 2019 were reviewed. Patients were classified into two groups according to the Futamura classification: lateral wall pattern (LW) and reverse oblique pattern (RO). The incidence of OT in the LW and RO groups was compared. Also, we compared the incidence of OT for each reduction type in the LW group. RESULTS Twenty patients had LW, and nine had RO. OT was observed in eight fractures (42.1%) in the LW group but not in the RO group. The incidence of OT was significantly higher in the LW group than in the RO group (P = 0.0261). Among the 19 fractures with LW, OT was observed in 7 of 10 and 1 of 9 fractures with postoperative reduction in the intramedullary and extramedullary or anatomical types, respectively. In the LW group, the incidence of OT was significantly higher in fractures with postoperative reduction in the intramedullary type than in those of the extramedullary or anatomical type (P = 0.0198). CONCLUSION Our study showed that the incidence of OT was significantly higher in LW than in RO and that postoperative reduction in the intramedullary type in LW was a risk factor for OT.
Collapse
|
10
|
Yoon JY, Park S, Kim T, Im GI. Cut-out risk factor analysis after intramedullary nailing for the treatment of extracapsular fractures of the proximal femur: a retrospective study. BMC Musculoskelet Disord 2022; 23:107. [PMID: 35105349 PMCID: PMC8809036 DOI: 10.1186/s12891-022-05054-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 01/20/2022] [Indexed: 11/26/2022] Open
Abstract
Backgrounds The basic method of surgical treatment for extracapsular hip fractures (ECFs), including intertrochanteric fracture and basicervical fracture (BCF), is osteosynthesis. Intramedullary nails are among the most commonly used fixation devices for these fractures. Our study aimed to report the clinical outcomes of ECF treatment with two different nail devices and to analyze the risk factors associated with screw cut-out. Methods We retrospectively reviewed the medical records of 273 patients (300 cases) from a single institution who underwent surgical treatment for ECF between January 2013 and October 2018. Overall, 138 patients were eligible for the study and were divided into two groups according to the osteosynthesis device used. We evaluated the clinical outcomes of fracture surgery and performed univariate and multivariate regression analyses to identify risk factors associated with screw cut-out in each group. Results We used proximal femoral nails (group 1) to treat 83 patients and cephalomedullary nails (group 2) to treat 55 patients. Nine cut-outs (group 1, 6 cases; group 2, 3 cases) occurred during follow-up. The patients’ high body mass index (BMI) (p = 0.019), BCFs (p = 0.007), non-extramedullary reduction in the anteroposterior and lateral planes (p = 0.032 and p = 0.043, respectively), and anti-rotation screw pull-outs (p = 0.041) showed a positive correlation to screw cut-out in the univariate analysis of group 1. In group 2, only BCFs was positively correlated (p = 0.020). In the multivariate analysis of group 1, the patients’ BMIs (p = 0.024) and BCFs (p = 0.024) showed a positive correlation with cut-out. Meanwhile, the multivariate analysis of group 2 did not identify any factors associated with cut-out. Conclusions The cut-out risk was significantly higher in the BCF cases, regardless of the nail design used. Considerable attention should be paid to treating such unstable fractures. We expect that new-generation nails using a helical blade, or interlocking derotation and interlocking screws may improve surgical outcomes.
Collapse
Affiliation(s)
- Jae Youn Yoon
- Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, 10326, Goyang, Republic of Korea
| | - Sehan Park
- Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, 10326, Goyang, Republic of Korea
| | - Taehyun Kim
- Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, 10326, Goyang, Republic of Korea
| | - Gun-Il Im
- Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, 10326, Goyang, Republic of Korea.
| |
Collapse
|
11
|
Dündar A, Ipek D, Zehir S. Treatment of Basicervical Femoral Fracture With Retractable Talon Hip Compression Screw. Cureus 2022; 14:e20951. [PMID: 35154931 PMCID: PMC8815325 DOI: 10.7759/cureus.20951] [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] [Accepted: 01/05/2022] [Indexed: 11/17/2022] Open
Abstract
Background Basicervical femoral fractures (BFFs) are rare and biomechanically unstable. The goal of this study was to evaluate the effectiveness of the Talon™ DistalFix™ (Orthopedic Designs North America, Inc., Tampa, FL, USA) nail for the treatment of BFFs with a novel design. Methodology In this retrospective study, 25 patients with BFFs were analyzed between January 2016 and March 2020 at our institute. All patients were treated with the Talon™ DistalFix™ nail. Patients over the age of 60 years with basicervical fractures caused by low-energy trauma were included in this study. For inclusion into the study, the minimum follow-up time had to be longer than six months. The postoperative radiographic bone union, operative time, tip-apex distance (TAD), sliding distance of the lag screw, quality of fracture reduction, and major complications such as cut-out, non-union of the fracture, femoral head collapse, and cut-through were recorded. The Harris Hip Score was used to evaluate hip function at the end of the follow-up period. Results The mean follow-up period was 22 months (range, 16-28 months), and the mean age was 77.8 years (range, 61-91 years). The average sliding distance of the lag screw was 5.7 mm (range, 0.2-13.1 mm). The mean TAD of immediate postoperative view was 20.8 mm (range, 18.7-23.7 mm), and the TAD was <25 mm in all cases. Radiographic union was confirmed in most cases, and the average time for radiographic union was 18.8 weeks (range, 12-25 weeks). Most fractures (90.5%) had healed with no postoperative mechanical complications (cut-out, cut-thorough, or lateral wall fracture) at the final follow-up, except for two patients. One of the two patients had no evidence of union at six months, and mild varus reduction was observed in the other patient who had shortening of >10 mm. Conclusions According to the clinical and radiological findings of this study, treatment with the Talon™ DistalFix™ nail showed satisfactory results. Hence, it can be a suitable option in the treatment of BFFs.
Collapse
|
12
|
Dekhne MS, Thomas HM, Haider T, Mortensen S, Rodriguez EK, Weaver MJ, von Keudell A. Treatment and outcomes of basicervical femoral neck fractures: A systematic review. J Orthop Surg (Hong Kong) 2021; 29:23094990211003344. [PMID: 33779387 DOI: 10.1177/23094990211003344] [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] [Indexed: 11/16/2022] Open
Abstract
PURPOSE This study aims to systematically review the literature comparing surgical treatments options and respective failure rates for basicervical hip fractures. METHODS A comprehensive search of databases, including MEDLINE, Embase, Web of Science, and Cochrane Central for studies published in English on or before June 21, 2019 was performed. Selected search terms included "basicervical," "basi cervical," "AO/OTA type 31-B," "femoral neck fracture" AND "bone nails," "bone screws," "fracture fixation," "internal fixation," "arthroplasty," "cephalomedullary," "sliding hip screw," "ORIF," and "treatment outcome." We included studies that assessed outcomes of basicervical fracture fixation using open reduction internal fixation or arthroplasty. Two authors extracted the following data from each paper: study design, country, cohort year, definition of basicervical, intervention type, sample size, patient demographics, follow-up length, percent of fractures that required revision, and the percent of implants that failed. RESULTS Sixteen articles encompassing 910 patients were included. The main outcome was the percent of implants that required revision. The total revision rates were 8% (8 studies, 157 patients, range 0%-55%) for cephalomedullary nails, 7% (10 studies, 584 patients, range 0%-18%) for sliding hip screws, 23% (3 studies, 40 patients, range 16%-50%) for cannulated screws, 0% (1 study, 6 patients) for total hip arthroplasty, and 8% (2 studies, 13 patients, range 0%-11%) for hemiarthroplasty. CONCLUSION Management of basicervical fractures with SHS and CMN produces similar failure and re-operation rates. Limited evidence is available on the use of cannulated screws and arthroplasty, but available studies suggest that cannulated screws have an unacceptable revision rate (23%) while arthroplasty may be acceptable. Future studies examining the comparative efficacy of various fixation methods would benefit from strict definition of fracture type as well as consistent reporting of functional outcomes, re-operation rates, and mortality.
Collapse
Affiliation(s)
- Mihir S Dekhne
- Harvard Orthopaedic Trauma Initative, 1811Harvard Medical School, Boston, Massachusetts, USA
| | - Hannah M Thomas
- Harvard Orthopaedic Trauma Initative, 1811Harvard Medical School, Boston, Massachusetts, USA
| | - Thomas Haider
- Department of Orthopaedics and Trauma Surgery, 27271Medical University of Vienna, Waehringer Guertel 18-20,1090, Vienna, Austria
| | - Sharri Mortensen
- Center for Advanced Orthopaedic Studies, 1859Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Edward K Rodriguez
- Harvard Orthopaedic Trauma Initative, 1811Harvard Medical School, Boston, Massachusetts, USA.,Department of Orthopaedic Surgery, 1859Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Michael J Weaver
- Harvard Orthopaedic Trauma Initative, 1811Harvard Medical School, Boston, Massachusetts, USA.,Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Arvind von Keudell
- Harvard Orthopaedic Trauma Initative, 1811Harvard Medical School, Boston, Massachusetts, USA.,Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Center for Surgery and Public Health, 1811Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
13
|
Hu S, Du S, Xiong W, Chen S, Song H, Chang S. [Effectiveness of proximal femoral nail anti-rotation for high plane intertrochanteric femur fractures]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:307-311. [PMID: 33719238 DOI: 10.7507/1002-1892.202007114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To evaluate the effectiveness of proximal femoral nail anti-rotation (PFNA) in treatment of high plane intertrochanteric femur fractures. Methods A retrospective analysis was performed on 33 patients who underwent closed reduction and PFNA fixation for high plane intertrochanteric femur fracture between January 2016 and June 2019. There were 12 males and 21 females with an average age of 75.1 years (mean, 47-89 years). The fractures were caused by falling from height in 21 cases, by traffic accident in 7 cases, and by other injuries in 5 cases. Fractures were classified as type A in 14 cases and type B in 19 cases according to self-defined fracture classification criteria; and as type 31-A1.2 in 14 cases and as type 31-A2.2 in 19 cases according to AO/Orthopedic Trauma Association (AO/OTA) classification criteria. The time from injury to operation was 2-5 days (mean, 2.7 days). The operation time, intraoperative blood loss, hospital stay, fracture reduction quality, fracture healing time, internal fixation failure, and Parker-Palmer score were recorded. Results The operation time was 40-75 minutes (mean, 55 minutes). The intraoperative blood loss was 50-150 mL (mean, 64 mL). The hospital stay was 5-15 days (mean, 8.7 days). All incisions healed by first intention. Twenty-eight patients were followed up 12-18 months with an average of 13.6 months. The fracture reduction quality was rated as excellent in 9 cases (32.1%), good in 17 cases (60.7%), and poor in 2 cases (7.1%) by Chang's criteria. Parker-Palmer score was 6-9 (mean, 7.9) at last follow-up. Conclusion High plane intertrochanteric femur fracture is a special type of intertrochanteric fracture, which can be diagnosed by imaging examination. PFNA fixation can achieve satisfactory results and prevent the occurrence of internal fixation failure effectively.
Collapse
Affiliation(s)
- Sunjun Hu
- Department of Orthopedics, Yangpu Hospital, Tongji University, Shanghai, 200090, P.R.China
| | - Shouchao Du
- Department of Orthopedics, Yangpu Hospital, Tongji University, Shanghai, 200090, P.R.China
| | - Wenfeng Xiong
- Department of Orthopedics, Yangpu Hospital, Tongji University, Shanghai, 200090, P.R.China
| | - Shiyi Chen
- Department of Orthopedics, Yangpu Hospital, Tongji University, Shanghai, 200090, P.R.China
| | - Hui Song
- Department of Orthopedics, Yangpu Hospital, Tongji University, Shanghai, 200090, P.R.China
| | - Shimin Chang
- Department of Orthopedics, Yangpu Hospital, Tongji University, Shanghai, 200090, P.R.China
| |
Collapse
|
14
|
Reverse Z-effect phenomenon in a basicervical femoral fracture using cephalomedullary nail with two superior antirotation screws: A case report and procedure evaluation. Trauma Case Rep 2020; 31:100384. [PMID: 33376768 PMCID: PMC7758364 DOI: 10.1016/j.tcr.2020.100384] [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: 12/06/2020] [Indexed: 11/21/2022] Open
Abstract
We present a case of reverse Z-effect phenomenon in a basicervical femoral fracture using a cephalomedullary nail together with two superior antirotation screws and evaluate the procedure. An 86-year-old woman fell in her home and could not stand due to right hip joint pain. X-ray and CT imaging showed a right basicervical femoral fracture (AO/OTA classification; 31B3), and open reduction and internal fixation (OR/IF) was performed with a cephalomedullary nail and two superior antirotation screws (TES Nail, HOMS, Tokyo, Japan). Two months later, X-ray showed penetration of the femoral head by the inferior lag screw with lateral migration of the two superior antirotation screws; the so-called "reverse Z-effect"; without any trauma. We performed the exchange of a shorter inferior lag screw for the longer one, and replaced the sliding type end cap with one of rocking type. The reverse Z-effect has been reported in cases with two lag screws, i.e. one inferior and one superior, in the past; however, to our knowledge, there has been no case reported in the literature using two superior antirotation screws together with one inferior lag screw.
Collapse
|
15
|
Yoo JI, Cha Y, Kwak J, Kim HY, Choy WS. Review on Basicervical Femoral Neck Fracture: Definition, Treatments, and Failures. Hip Pelvis 2020; 32:170-181. [PMID: 33335865 PMCID: PMC7724026 DOI: 10.5371/hp.2020.32.4.170] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/13/2020] [Accepted: 05/15/2020] [Indexed: 01/11/2023] Open
Abstract
Basicervical femoral neck fracture is an uncommon fracture that accounts for only 1.8% of all proximal femoral fractures. Previous studies have recommended that the choice of implant to treat this fracture should be similar to that of intertrochanteric fracture. However, in previous studies on basicervical fractures, the definition and treatment results of these fractures were different, and there were also debates on the implant that had to be used. Therefore, the purpose of this study was to review the studies that performed surgical treatment of basicervical femoral fractures and to assess the definition of basicervical fracture, the use of implants, and failure rates and clinical results. Study selection was based on the following inclusion criteria: (1) treatment outcome for basicervical femoral neck fracture was reported; and (2) dynamic hip screw, proximal femoral nail, or multiple screw fixation was used as treatment. PubMed Central, OVID MEDLINE, Cochrane Collaboration Library, Web of Science, EMBASE, and AHRQ databases were searched to identify relevant studies published up to March, 2020 with English language restriction. A total of 15 studies were included in this study. Differences were found in the definition of basicervical fracture, treatment results, rehabilitation protocol, and fixation failure rate. Definitions and treatment methods for basicervical fractures varied, and treatment outcomes also differed among the enrolled studies. Further research is needed that would be restricted to those fractures that conform to the definition of basicervical fracture.
Collapse
Affiliation(s)
- Jun-Il Yoo
- Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Jinju, Korea
| | - Yonghan Cha
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, Korea
| | - Joonhyeok Kwak
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, Korea
| | - Ha-Yong Kim
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, Korea
| | - Won-Sik Choy
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, Korea
| |
Collapse
|