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Case report: unique failure of a Synthes TFNA fenestrated lag screw in a peritrochanteric nonunion. OTA Int 2022; 5:e203. [PMID: 35919107 PMCID: PMC9278917 DOI: 10.1097/oi9.0000000000000203] [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] [Received: 08/25/2021] [Accepted: 02/05/2022] [Indexed: 11/25/2022]
Abstract
Background: Intertrochanteric femur fractures are a common orthopaedic injury that are often treated surgically. Cephalomedullary nails (CMN) are frequently the implant of choice for intertrochanteric femur fractures, resulting in low complication rates. Implant failure is a rare but reported complication. Common locations of failure include the proximal nail aperture, distal screw holes, and implant shaft. In this case report, we describe a CMN failure pattern through fenestrated cephalic screw holes. Case: A 70-year-old female sustained an OTA 31A-2.2 peritrochanteric fracture during a motor vehicle collision. She was treated the following day with a Synthes Trochanteric Fixation Nail—Advanced CMN utilizing a fenestrated cephalic screw. There were no intraoperative complications. She was made non-weight bearing for 8 weeks after the procedure due to ipsilateral foot fractures. At 6 months follow-up she was noted to have a delayed union. 11 months postoperatively she suffered a ground level fall and the cephalic lag screw failed through its fenestrations, resulting in varus collapse of her fracture at the femoral neck. The patient then underwent nail extraction and salvage total hip arthroplasty. Conclusion: Cephalomedullary nail implant failure is presented with implant fracture propagation through a fenestrated cephalic screw. Cephalomedullary lag screw failure is rare and can be difficult to manage. It is important to monitor new implants for unique failure mechanisms.
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Li P, Zhang Z, Zhou F, Lv Y, Guo Y, Tian Y. Characteristics of intramedullary nail breakage in pertrochanteric femur fractures: a summary of 70 cases. J Orthop Surg Res 2021; 16:676. [PMID: 34789313 PMCID: PMC8597261 DOI: 10.1186/s13018-021-02826-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 11/01/2021] [Indexed: 11/21/2022] Open
Abstract
Objective To reveal noteworthy characteristics of intramedullary (IM) nail breakage in pertrochanteric femur fractures. Materials and methods The data from 6 patients with IM nail breakage in our hospital between August 2008 and May 2018 were reviewed retrospectively. With an additional 64 cases reported in articles in the PubMed database prior to October 2019, a total of 70 cases were reviewed and analysed; epidemiological patient data and data on the initial trauma, fracture type, nail selected for the original surgery, time from surgery to breakage, mechanism and location of breakage, status of fracture healing, salvage treatment and prognosis were assessed. Results Seventy patients with pertrochanteric fractures, including 2 stable fractures and 68 unstable fractures, experienced IM nail breakage at a mean of 9.4 months after the initial surgery. Among them, 9 (12.9%) occurred within 3 months, 23 (32.9%) between 3 and 6 months and 38 (54.3%) after 6 months. The mean age was 72.3 years, and 16 (22.9%) patients were younger than 65 years old. When nail breakage occurred, 66 fractures (94.3%) exhibited delayed union/non-union. Self-dynamisation was found in 12 cases (17.1%). The salvage procedures included 4 partial/total implant removal procedures, 17 hemi/total hip arthroplasty procedures, 3 conservative treatment procedures, and 46 revised osteosyntheses, of which 7 cases (15.2%) sustained secondary implant failure. No significant differences were found between the failure rates of IM nails and extramedullary(EM) devices (odds ratio [OR], 3.429; 95% confidence interval [CI], 0.632–18.877; p = 0.330). Conclusion IM nail breakage is a rare complication lack of time regularity and mostly occurs in unstable pertrochanteric fractures in the presence of delayed union/non-union. Osteosynthesis revision can be conduct by a new IM nail or EM device but considerable secondary failure rate is noteworthy. Self-dynamisation may be a warning sign of nail breakage.
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Affiliation(s)
- Pengfei Li
- Department of Orthopaedics, Peking University Third Hospital, No. 49 North Huayuan Road, Haidian District, Beijing, 100191, People's Republic of China.,Center of Foot and Ankle Surgery, Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaomin Lane, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Zhishan Zhang
- Department of Orthopaedics, Peking University Third Hospital, No. 49 North Huayuan Road, Haidian District, Beijing, 100191, People's Republic of China.
| | - Fang Zhou
- Department of Orthopaedics, Peking University Third Hospital, No. 49 North Huayuan Road, Haidian District, Beijing, 100191, People's Republic of China.
| | - Yang Lv
- Department of Orthopaedics, Peking University Third Hospital, No. 49 North Huayuan Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Yan Guo
- Department of Orthopaedics, Peking University Third Hospital, No. 49 North Huayuan Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Yun Tian
- Department of Orthopaedics, Peking University Third Hospital, No. 49 North Huayuan Road, Haidian District, Beijing, 100191, People's Republic of China
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Chitnis AS, Ray B, Sparks C, Grebenyuk Y, Vanderkarr M, Holy CE. Intramedullary Nail Breakage and Mechanical Displacement in Patients with Proximal Femoral Fractures: A Commercial and Medicare Supplemental Claims Database Analysis. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2021; 14:15-25. [PMID: 33603504 PMCID: PMC7881791 DOI: 10.2147/mder.s288188] [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: 10/29/2020] [Accepted: 12/16/2020] [Indexed: 12/05/2022] Open
Abstract
Objective This study evaluated the rates and patterns of intramedullary nail (IMN) breakage and mechanical displacement for proximal femur fractures and the factors associated with their occurrence. Patients and Methods Patients with subtrochanteric, intertrochanteric, or basicervical femoral neck fractures treated with IMN from 2016 to 2019 were identified from commercial and Medicare supplemental claims databases and were followed for up to two years. Kaplan–Meier analysis estimated the cumulative incidence of and patterns of breakage/mechanical displacement. Multivariable Cox regression models evaluated the factors associated with breakage/mechanical displacement. Results A total of 11,128 patients had IMN fixation for subtrochanteric, intertrochanteric, or basicervical femoral neck fractures: (mean SD) age 75.6 (16.4) years, 66.2% female, 74.3% Medicare supplemental vs 26.7% commercial insurance. Comorbidities included hypertension (62.9%), osteoporosis (27.3%), cardiac arrhythmia (23.1%), diabetes (30.7%), and chronic pulmonary disease (16.3%). Most fractures were closed (97.2%), intertrochanteric or basicervical femoral neck (80.1%), and not pathological (91.0%). The cumulative incidence of nail breakage over two years was 0.66% overall, 1.44% for combination fractures, 1.16% for subtrochanteric fractures, and 0.49% for intertrochanteric or basicervical fractures. The cumulative incidence of mechanical displacement was 0.37% overall, 0.43% for subtrochanteric fractures, 0.42% for combination fractures, and 0.36% for intertrochanteric or basicervical femoral neck fractures. Half of the breakages occurred within five months after surgery and half of the mechanical displacements occurred within 75 days. Age 50–64 (vs 75+) and subtrochanteric or pathological fracture were more commonly associated with nail breakage. Complicated hypertension was more commonly associated with mechanical displacement. Conclusion The incidence of IMN breakage and mechanical displacement in US commercial and Medicare supplemental patients with proximal femur fractures from 2016 to 2019 was low (0.66% and 0.37%, respectively up to two years). Age 50–64 (vs 75+) and subtrochanteric or pathological fracture were more commonly associated with breakage. Complicated hypertension was associated with mechanical displacement.
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Affiliation(s)
- Abhishek S Chitnis
- Real World Data Sciences, Medical Device Epidemiology, Johnson & Johnson, New Brunswick, NJ, USA
| | | | | | - Yuriy Grebenyuk
- Health Economics and Market Access, DePuy Synthes, West Chester, PA, USA
| | - Mollie Vanderkarr
- Health Economics and Market Access, DePuy Synthes, West Chester, PA, USA
| | - Chantal E Holy
- Real World Data Sciences, Medical Device Epidemiology, Johnson & Johnson, New Brunswick, NJ, USA
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4
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Dragosloveanu Ş, Dragosloveanu CDM, Stanca HT, Cotor DC, Dragosloveanu CI, Stoica CI. A new perspective towards failure of gamma nail systems. Exp Ther Med 2020; 20:216. [PMID: 33149780 PMCID: PMC7604752 DOI: 10.3892/etm.2020.9346] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 10/05/2020] [Indexed: 12/14/2022] Open
Abstract
Uncommon causes of nail failures and surgical reinterventions were determined. The study included 23 osteoporotic patients, 13 of whom followed a fast recovery program with early walking (FWB group). The other 10 patients were not allowed full weight bearing until 6 weeks (NFWB group). The T-score was determined before surgery for all cases. A case with a nail breakage after a failed DCS implant fixed in another clinic was also analyzed. The nail was revised and the broken implant underwent a metallurgic and microscopic examination. The average T-score was 2.5 for the patients that followed the fast recovery program and 2.7 for the patients from non-full weight bearing. Four patients, 1 from the NFWB group and 3 from FWB group, presented a screw cut-out. It was found that the errors of the guiding instruments may create dents, scratches or micro-fractures on the titanium coating that lead to an early implant failure. Imperfect reduction leads to incorrect implant placement and a high incidence of failure. Damaging the titanium protective coating, in a low force, high cycles scenario can cause structural failure. Delays in fracture healing and material fatigue are the most common causes of nail failure and can lead to catastrophic complications.
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Affiliation(s)
- Şerban Dragosloveanu
- Department of Orthopedics, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Department of Orthopedic Surgery, 'Foişor' Orthopedics‑Traumatology and Osteoarticular TB Hospital, 030167 Bucharest
| | | | - Horia T Stanca
- Department of Ophthalmology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Dragoş C Cotor
- Department of Ophthalmology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Călin I Dragosloveanu
- Department of Ophthalmology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Cristian I Stoica
- Department of Orthopedics, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Department of Orthopedic Surgery, 'Foişor' Orthopedics‑Traumatology and Osteoarticular TB Hospital, 030167 Bucharest
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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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6
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Management of subtrochanteric fractures by nail osteosynthesis: a review of tips and tricks. INTERNATIONAL ORTHOPAEDICS 2019; 44:645-653. [DOI: 10.1007/s00264-019-04404-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 08/27/2019] [Indexed: 10/26/2022]
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Lang NW, Breuer R, Beiglboeck H, Munteanu A, Hajdu S, Windhager R, Widhalm HK. Migration of the Lag Screw after Intramedullary Treatment of AO/OTA 31.A2.1-3 Pertrochanteric Fractures Does Not Result in Higher Incidence of Cut-Outs, Regardless of Which Implant Was Used: A Comparison of Gamma Nail with and without U-Blade (RC) Lag Screw and Proximal Femur Nail Antirotation (PFNA). J Clin Med 2019; 8:jcm8050615. [PMID: 31067639 PMCID: PMC6571935 DOI: 10.3390/jcm8050615] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 04/18/2019] [Accepted: 04/22/2019] [Indexed: 11/16/2022] Open
Abstract
The best intramedullary nail for the treatment of unstable AO/OTA 31.A2.1-3 fractures remains uncertain. A total of 237 patients (45 male, 192 female) were eligible for the assessment with an average age of 81.9 ± 10.5 years and a minimum follow-up of six months. We assessed the cut-out rate, the TAD and calTAD (Tip Apex distance) of three different implants. An overall cut-out rate of 2.5% (n = 6) was observed. The cut-out rate was 1.2% (n = 1) in the Proximal Femur Nail Antirotation (PFNA) group, 3.7% (n = 3) in the Gamma Nail group and 2.9% (n = 2) in the Gamma3® with a U-Blade (RC) lag-screw group. The TAD and calTAD differed between the cut-out and non-cut group-20.0 mm vs. 18.5 mm and 13.1 mm vs. 15.3 mm, respectively. A significantly higher TAD of 32.5 mm could be seen in the cut-out after PFNA (p < 0.0001). The only significant change in follow-up using Parker's ratio was observed in the PFNA group (p < 0.0001). The rate of patients requiring surgery after complications was 8.4% (n = 20) without any significant difference between the three groups. The PFNA blade showed significant migration within the femoral head, however the cut-out rate remained the smallest compared to Gamma3 with or without additional U-Blade (RC) lag screw.
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Affiliation(s)
- Nikolaus Wilhelm Lang
- Department of Orthopedics and Traumatology, Clinical Division of Traumatology, Medical University of Vienna, 1090 Vienna, Austria.
| | - Robert Breuer
- Department of Orthopedics and Traumatology, Clinical Division of Traumatology, Medical University of Vienna, 1090 Vienna, Austria.
| | - Hannes Beiglboeck
- Department of Orthopedics and Traumatology, Clinical Division of Traumatology, Medical University of Vienna, 1090 Vienna, Austria.
| | - Alexandru Munteanu
- Department: Medical School, University College London, London WC1E 6BT, UK.
| | - Stefan Hajdu
- Department of Orthopedics and Traumatology, Clinical Division of Traumatology, Medical University of Vienna, 1090 Vienna, Austria.
| | - Reinhard Windhager
- Department of Orthopedics and Traumatology, Clinical Division of Orthopedics, Medical University of Vienna, 1090 Vienna, Austria.
| | - Harald Kurt Widhalm
- Department of Orthopedics and Traumatology, Clinical Division of Traumatology, Medical University of Vienna, 1090 Vienna, Austria.
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Breakage in Two Points of a Short and Undersized "Affixus" Cephalomedullary Nail in a Very Active Elderly Female: A Case Report and Review of the Literature. Case Rep Orthop 2018; 2018:9580190. [PMID: 30302297 PMCID: PMC6158977 DOI: 10.1155/2018/9580190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 08/27/2018] [Indexed: 11/24/2022] Open
Abstract
Introduction Trochanteric fractures of the femur are common in elderly individuals with osteoporosis. The use of cephalomedullary nails is increasing, and they are now the most commonly used fixation devices, especially for the treatment of unstable trochanteric fractures. The nail breakage is not the most common complication of intramedullary nailing. Many scientific papers report nail breakage in a specific location: through the lag screw hole, the nail shaft, or the distal locking hole. Materials and Methods We present a case of an 84-year-old patient treated with modular revision hip arthroplasty due to the breakage in two points of a cephalomedullary nail implanted 3 years earlier for a subtrochanteric fracture. Results After modular revision hip arthroplasty, the functional results and quality of life have been excellent. Conclusions As far as we could determine, this appears to be the first case of a breakage of a cephalomedullary nail in two points after nonunion in a very active elderly female.
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9
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Tomás-Hernández J, Núñez-Camarena J, Teixidor-Serra J, Guerra-Farfan E, Selga J, Antonio Porcel J, Andrés-Peiró JV, Molero V. Salvage for intramedullary nailing breakage after operative treatment of trochanteric fractures. Injury 2018; 49 Suppl 2:S44-S50. [PMID: 30219147 DOI: 10.1016/j.injury.2018.07.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 07/08/2018] [Accepted: 07/23/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Trochanteric fractures are one of the most common fractures in elderly people. The use of intramedullary nails is an option for their treatment, especially in unstable patterns. Nail breakage is a rarely reported complication. The aim of this study was to determine the prevalence of nail breakage in our center. Secondary objectives are to show the management of this complication in our institution as well as the technical problems, complications and final outcomes of these patients in our hands. MATERIAL AND METHODS In a retrospective case series review between 2010 and 2015, we analyzed 1481 patients with trochanteric and subtrochanteric fractures who had been treated by cephalomedullary nailing in our centre. 13 patients with nail breakage were identified. RESULTS The percentage failure rate in our institution is 0.87%. 9 (69.2%) patients were women and 4 (3.8%) were men, with a mean age of 74.6 years (range 47-90). In all cases the mechanism of injury was a simple fall from standing height. Initial fracture types were: 1 case of AO/OTA 31A1, 6 cases of AO/OTA 31A2 and 6 cases of AO/OTA 31A3. Only 3 cases had a good overall reduction with a correct TAD, an optimal femoral neck-shaft angle and absence of fracture gaps >5 mm after surgery. The average time from the first surgery to the diagnosis of implant breakage was 333 days (range 70-1460), 11 months. Breakage occurred at the nail junction with the lag screw in 11 cases and in the distal nail aperture in 2 cases. CONCLUSIONS An insufficient reduction with varus and fracture gaps >5 mm, the use of short nails in unstable patterns with subtrochanteric involvement and patients with certain comorbidities are facts observed that can contribute to the development of delayed or nonunion with subsequent nail breakage. Different salvage treatments, conversion to hip arthroplasty or revision osteosynthesis, may be considered but we think that prevention has to be the best treatment.
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Affiliation(s)
- Jordi Tomás-Hernández
- Trauma Unit of the Department of Traumatology and Orthopaedic Surgery of Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona (UAB), Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain.
| | - Jorge Núñez-Camarena
- Trauma Unit of the Department of Traumatology and Orthopaedic Surgery of Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona (UAB), Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Jordi Teixidor-Serra
- Trauma Unit of the Department of Traumatology and Orthopaedic Surgery of Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona (UAB), Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Ernesto Guerra-Farfan
- Trauma Unit of the Department of Traumatology and Orthopaedic Surgery of Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona (UAB), Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Jordi Selga
- Trauma Unit of the Department of Traumatology and Orthopaedic Surgery of Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona (UAB), Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Juan Antonio Porcel
- Trauma Unit of the Department of Traumatology and Orthopaedic Surgery of Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona (UAB), Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - José Vicente Andrés-Peiró
- Trauma Unit of the Department of Traumatology and Orthopaedic Surgery of Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona (UAB), Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Vicente Molero
- Trauma Unit of the Department of Traumatology and Orthopaedic Surgery of Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona (UAB), Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
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10
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Choi K, Kim Y, Zhou S, Hwang J. Failure of a Rotation Control Gamma 3 Lag Screw Used to Treat a Trochanteric Fracture. Hip Pelvis 2018; 30:129-133. [PMID: 29896464 PMCID: PMC5990529 DOI: 10.5371/hp.2018.30.2.129] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 01/08/2018] [Accepted: 01/22/2018] [Indexed: 11/24/2022] Open
Abstract
Gamma 3 rotation control lag screws (U-blade) are particularly useful when treating rotational and unstable fractures of the proximal femur. A 93-year-old woman who underwent closed reduction of a trochanteric fracture and internal fixation with a Gamma 3 nail rotation control lag screw. The patient presented with metal failure and U-blade bending following a fall occurring 4 weeks after surgery. Here, we present a case report summarizing removal of the failed lag screw.
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Affiliation(s)
- Kyungho Choi
- Department of Orthopaedic Surgery, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Yongtae Kim
- Department of Orthopaedic Surgery, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Shicheng Zhou
- Department of Orthopaedic Surgery, The Second Hospital of Jilin University, Ziqiang, China
| | - Jihyo Hwang
- Department of Orthopaedic Surgery, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
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11
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Tucker A, Warnock M, McDonald S, Cusick L, Foster AP. Fatigue failure of the cephalomedullary nail: revision options, outcomes and review of the literature. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2017; 28:511-520. [PMID: 29043506 DOI: 10.1007/s00590-017-2059-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Accepted: 10/08/2017] [Indexed: 12/29/2022]
Abstract
Cephalomedullary nail (CMN) failure is a rare entity following hip fracture treatment. However, it poses significant challenges for revision surgery, both mechanically and biologically. Nail failure rates have been reported at < 2%; however, no published studies have reported revision surgery procedures and their respective outcomes. We present a regional experience, with outcomes, of the revision options. We identified 20 fatigued CMNs that underwent four different revision procedures. Mean age was 73 ± 15.24 years, with a 3:1 female preponderance, and a median ASA grade of 3. Post-operative CMN radiographs demonstrated a significant number of fractures were fixed in varus, with reductions in neck-shaft angles post-operatively. A "poor" quality of reduction resulted in significantly earlier nail failure, compared to "adequate" and "good" (p = 0.027). Tip-Apex Distance (TAD) mean was 23.2 ± 8.3 mm, and an adequate TAD with three-point fixation was seen in only 35% of cases. Mean time to failure was 401.0 ± 237.2 days, with mean age at failure of 74.0 ± 14.8 years. Options after failure included revision CMN nail, proximal femoral locking plate (PFLP), long-stem or restoration arthroplasty, or femoral endoprosthesis. Barthel Functional Index scores showed no significant difference at 3 and 12 months post-operatively, nor any difference between treatment groups. Mean 12-month mortality was 30%, akin to a primary hip fracture mortality risk according to NICE guidelines. Mortality rates were lowest in revision nails. Subsequent revision rates were higher in the PFLP group. There is no reported evidence on the best surgical technique for managing the failed CMN, with no clear functional benefit in the options above. Good surgical technique at the time of primary CMN surgery is critical in minimising fatigue failure. After revision, overall mortality rates were equivalent to reported primary hip fracture mortality rates. Further multicentre evaluations are required to assess which technique convey the best functional outcomes without compromising 12-month mortality rates.
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Affiliation(s)
- Adam Tucker
- Altnagelvin Area Hospital, Glenshane Road, Londonderry, BT47 6SB, Northern Ireland, UK.
| | - Michael Warnock
- Altnagelvin Area Hospital, Glenshane Road, Londonderry, BT47 6SB, Northern Ireland, UK
| | - Sinead McDonald
- Fracture Outcomes and Research Department, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BA, Northern Ireland, UK
| | - Laurence Cusick
- Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BA, Northern Ireland, UK
| | - Andrew P Foster
- Altnagelvin Area Hospital, Glenshane Road, Londonderry, BT47 6SB, Northern Ireland, UK
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12
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Santoso A, Choi IS, Park KS, Yoon TR. Breakage of the Tail Portion of the Lag Screw during Removal of Proximal Femoral Zimmer Natural Nail: Report of Two Cases with Technical Notes. Hip Pelvis 2017; 29:199-203. [PMID: 28955687 PMCID: PMC5612981 DOI: 10.5371/hp.2017.29.3.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 04/11/2017] [Accepted: 04/19/2017] [Indexed: 11/24/2022] Open
Abstract
Proximal femoral cephalomedullary nailing is one of the treatments of choice for intertrochanteric fracture. Zimmer Natural Nail® (ZNN; Zimmer) is one of the alternatives. We report two cases of broken tail portion of the ZNN lag screw during the removal procedure. This may be the first reported cases in scientific literature with this pattern of failure. We report these cases to highlight one of the possible problems that could occur during removal of this implant which can possibly prolong the operation time significantly if the required device is not prepared.
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Affiliation(s)
- Asep Santoso
- Department of Orthopaedic and Traumatology, Faculty of Medicine, Sebelas Maret University, Prof. Dr. R. Soeharso Orthopaedic Hospital, Solo, Indonesia
| | - Ik-Sun Choi
- Department of Orthopedic Surgery, Center for Joint Disease, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Kyung-Soon Park
- Department of Orthopedic Surgery, Center for Joint Disease, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Taek-Rim Yoon
- Department of Orthopedic Surgery, Center for Joint Disease, Chonnam National University Hwasun Hospital, Hwasun, Korea
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13
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Rollo G, Tartaglia N, Falzarano G, Pichierri P, Stasi A, Medici A, Meccariello L. The challenge of non-union in subtrochanteric fractures with breakage of intramedullary nail: evaluation of outcomes in surgery revision with angled blade plate and allograft bone strut. Eur J Trauma Emerg Surg 2017; 43:853-861. [PMID: 28258285 DOI: 10.1007/s00068-016-0755-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 12/23/2016] [Indexed: 12/01/2022]
Abstract
PURPOSE Subtrochanteric fractures have a bimodal age distribution. They usually require open reduction and internal fixation. Closed reduction and intramedullary nail fixation rate are increased for this type of fracture. As a result, the hardware breakage and non-union rate is high among such patients. Our purpose is to evaluate the outcomes of the role of blade plate and bone strut allograft in the management of subtrochanteric non-union by femoral nailing. MATERIALS AND METHODS We reported a group of 22 patients with subtrochanteric non-union, associated with breakage of the intramedullary nail with medial femoral allograft bone and lateral blade plate and wire (PS) s; and a group of 13 patients with subtrochanteric non-union, associated with breakage of the intramedullary nail treated with lateral blade plate and screws (CG). The chosen criteria to evaluate the two group during the clinical and radiological follow-up were the quality of life, measured by The Short Form (12) Health Survey (SF-12), the hip function and quality of life related to it, measured by the Harris Hip Score (HHS), bone healing, measured by Radiographic Union Score (RUS) by XR and CT at 1 year after the surgery, and postoperative complications. The evaluation endpoint was set at 12 months. RESULTS The Bone healing measured by RUS occurred and also the full recovery before the first trauma measured by SF-12 and HHS are better in PS group. We only had three unimportant complications in PS while four breakage hardware in CG. CONCLUSION We conclude that in complicated non-unions, the use of blade plate and bone strut allograft has a definite positive role in the management of such cases.
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Affiliation(s)
- G Rollo
- U.O.C. Orthopedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy
| | - N Tartaglia
- U.O.C. Orthopedics and Traumatology, Hospital Miulli, Acqua Viva delle Fonti, Italy
| | - G Falzarano
- U.O.C. Orthopedics and Traumatology, Department of Emergency, Azienda Ospedaliera Gaetano Rummo, Via dell'Angelo 1, Benevento, Italy
| | - P Pichierri
- U.O.C. Orthopedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy
| | - A Stasi
- U.O.C. Orthopedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy
| | - A Medici
- U.O.C. Orthopedics and Traumatology, Department of Emergency, Azienda Ospedaliera Gaetano Rummo, Via dell'Angelo 1, Benevento, Italy
| | - L Meccariello
- U.O.C. Orthopedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy.
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Johnson NA, Uzoigwe C, Venkatesan M, Burgula V, Kulkarni A, Davison JN, Ashford RU. Risk factors for intramedullary nail breakage in proximal femoral fractures: a 10-year retrospective review. Ann R Coll Surg Engl 2016; 99:145-150. [PMID: 27659368 DOI: 10.1308/rcsann.2016.0297] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Intramedullary nailing is a common treatment for proximal femoral fractures. Fracture of the nail is a rare but devastating complication that exposes often frail patients to complex revision surgery. We investigated which risk factors predict nail failure. METHODS We reviewed all cases of nail breakage seen over a 10-year period in a single busy trauma unit; 22 nail fractures were seen in 19 patients. Comparison was made with a group of 209 consecutive patients who underwent intramedullary fixation of a proximal femur fracture with no nail breakage over a 2-year period. RESULTS In the fractured nail group, mean age was 70.4 years (range 55-88 years).The mean time to fracture was 10 months (range 2.5-23 months). Logistical regression was used to show that low American Society of Anesthesiologists (ASA) score, subtrochanteric fracture and pathological fracture were independent risk factors for nail fracture. CONCLUSIONS Young patients with a low ASA score are at highest risk of nail breakage. We advise close follow-up of patients with these risk factors until bony union has been achieved. In addition, there may be merit in considering other treatment options, such as proximal femoral replacement, especially for those with pathological fracture with a good prognosis.
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Affiliation(s)
| | - C Uzoigwe
- Leicester Royal Infirmary , Leicester , UK
| | | | - V Burgula
- Leicester Royal Infirmary , Leicester , UK
| | - A Kulkarni
- Leicester Royal Infirmary , Leicester , UK
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15
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Sambandam SN, Chandrasekharan J, Mounasamy V, Mauffrey C. Intertrochanteric fractures: a review of fixation methods. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2016; 26:339-53. [PMID: 27028746 DOI: 10.1007/s00590-016-1757-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 02/25/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Senthil Nathan Sambandam
- Department of Orthopaedics, K.G. Hospital and Postgraduate Medical Institute, Arts College Road, Coimbatore, Tamil Nadu, 641018, India
| | - Jayadev Chandrasekharan
- Department of Orthopaedics, K.G. Hospital and Postgraduate Medical Institute, Arts College Road, Coimbatore, Tamil Nadu, 641018, India
| | - Varatharaj Mounasamy
- VCU Medical Center, Ambulatory Care Center, 417 North 11th Street, Richmond, VA, USA.
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16
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How evolution of the nailing system improves results and reduces orthopedic complications: more than 2000 cases of trochanteric fractures treated with the Gamma Nail System. Musculoskelet Surg 2015; 100:1-8. [PMID: 26667625 DOI: 10.1007/s12306-015-0391-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Accepted: 11/21/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE The incidence of trochanteric fractures has increased significantly during the last few decades, especially in elderly patients with osteoporosis. The dynamic/sliding hip screw and the cephalomedullary nail are the most commonly used fixation methods to treat trochanteric fractures. The improvements in the Gamma Nail System (GNS) associated with a correct surgical technique reduced the postoperative orthopedic complications. The purpose of this study was to compare the results of the different Gamma Nails. METHODS The present study is a retrospective analysis of 2144 patients treated with GNS between January 1997 and December 2011 for trochanteric fractures, classified according to AO classification method. The patients were divided into three groups according to the nailing system: 525 were treated with Standard Gamma Nail (SGN), 422 with Trochanteric Gamma Nail (TGN) and 1197 with Gamma3 Nail. RESULTS The overall incidence of intra-operative complications was 1.21 %; the incidence of intra-operative complications for each group was 1.71 % for SGN group, 0.47 % for TGN group and 1.25 % for Gamma3 Nail group. The overall incidence of postoperative complications was 5.48 %, and the incidence for each group was 10.73 % for SGN group, 9.92 % for TGN group and 2.92 % for Gamma3 Nail group. CONCLUSION The GNS is a safe device with a low rate of intra-operative complications. The evolution of this nail system reduces postoperative complications, thus improving the results at follow-up and confirming that the Gamma3 Nail is a safe and predictable device to fix trochanteric fracture.
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17
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Tantigate D, Riansuwan K, Mahaisavariya B, Sukjaitham K. Breakage of a Lag Screw of Cephalomedullary Nail: A Technique of Removal. Clin Orthop Surg 2015. [PMID: 26217475 PMCID: PMC4515469 DOI: 10.4055/cios.2015.7.2.261] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A broken lag screw of the cephalomedullary nail is a rare condition. Removal of the retained lag screw from the femoral head is also very challenging. This article describes a surgical technique and the modified instrument that was available in the operating room for removing the broken implant by closed technique.
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Affiliation(s)
- Direk Tantigate
- Department of Orthopaedic Surgery and Rehabilitation, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kongkhet Riansuwan
- Department of Orthopaedic Surgery and Rehabilitation, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Banchong Mahaisavariya
- Department of Orthopaedic Surgery and Rehabilitation, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kitichai Sukjaitham
- Department of Orthopaedic Surgery and Rehabilitation, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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18
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Sonntag R, Reinders J, Gibmeier J, Kretzer JP. Fatigue performance of medical Ti6Al4V alloy after mechanical surface treatments. PLoS One 2015; 10:e0121963. [PMID: 25823001 PMCID: PMC4379149 DOI: 10.1371/journal.pone.0121963] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 02/05/2015] [Indexed: 11/19/2022] Open
Abstract
Mechanical surface treatments have a long history in traditional engineering disciplines, such as the automotive or aerospace industries. Today, they are widely applied to metal components to increase the mechanical performance of these. However, their application in the medical field is rather rare. The present study aims to compare the potential of relevant mechanical surface treatments on the high cycle fatigue (R = 0.1 for a maximum of 10 million cycles) performance of a Ti6Al4V standard alloy for orthopedic, spinal, dental and trauma surgical implants: shot peening, deep rolling, ultrasonic shot peening and laser shock peening. Hour-glass shaped Ti6Al4V specimens were treated and analyzed with regard to the material’s microstructure, microhardness, residual stress depth profiles and the mechanical behavior during fatigue testing. All treatments introduced substantial compressive residual stresses and exhibited considerable potential for increasing fatigue performance from 10% to 17.2% after laser shock peening compared to non-treated samples. It is assumed that final mechanical surface treatments may also increase fretting wear resistance in the modular connection of total hip and knee replacements.
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Affiliation(s)
- Robert Sonntag
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany
| | - Jörn Reinders
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany
| | - Jens Gibmeier
- Institute of Applied Materials, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - J. Philippe Kretzer
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany
- * E-mail:
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Hirai T, Inaba Y, Kobayashi N, Takakagawa S, Yukizawa Y, Ike H, Saito T. Late-Onset Screw Migration into Iliac Vessels 21 years after Hip Arthrodesis. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2014; 7:123-5. [PMID: 25336996 PMCID: PMC4197906 DOI: 10.4137/ccrep.s16159] [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: 04/16/2014] [Revised: 07/25/2014] [Accepted: 08/06/2014] [Indexed: 12/02/2022]
Abstract
Iatrogenic injuries to the vascular system are a rare but serious complication of hip surgery. We report a case of an 83-year-old man who presented with intrapelvic migration of a screw into the space between the external iliac artery and vein 21 years after hip arthrodesis. The patient was treated with laparotomy, and the damaged artery was excised and sutured. This is the first case of a late vascular complication secondary to screw migration after hip arthrodesis.
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Affiliation(s)
- Taishi Hirai
- Department of Orthopaedic Surgery, Yokohama City University Graduate School of Medicine, Kanazawa-ku, Yokohama, Japan
| | - Yutaka Inaba
- Department of Orthopaedic Surgery, Yokohama City University Graduate School of Medicine, Kanazawa-ku, Yokohama, Japan
| | - Naomi Kobayashi
- Department of Orthopaedic Surgery, Yokohama City University Graduate School of Medicine, Kanazawa-ku, Yokohama, Japan
| | - Shu Takakagawa
- Department of Orthopaedic Surgery, Yokohama City University Graduate School of Medicine, Kanazawa-ku, Yokohama, Japan
| | - Yohei Yukizawa
- Department of Orthopaedic Surgery, Yokohama City University Graduate School of Medicine, Kanazawa-ku, Yokohama, Japan
| | - Hiroyuki Ike
- Department of Orthopaedic Surgery, Yokohama City University Graduate School of Medicine, Kanazawa-ku, Yokohama, Japan
| | - Tomoyuki Saito
- Department of Orthopaedic Surgery, Yokohama City University Graduate School of Medicine, Kanazawa-ku, Yokohama, Japan
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