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Abulsoud MI, Elmarghany M, Ibrahim MAA, Elsebaey IM, Gaber U, Elsherbiny EA. The "foothill" entry for cephalomedullary nailing in unstable proximal femoral fractures: a technical note with a review of the literature. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024:10.1007/s00590-024-04014-5. [PMID: 38922404 DOI: 10.1007/s00590-024-04014-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Accepted: 05/31/2024] [Indexed: 06/27/2024]
Abstract
Cephalomedullary nailing for unstable proximal femoral fractures is widely utilized, especially for geriatric osteoporotic fractures. There are two starting points for entry, namely trochanteric tip entry and pyriformis fossa entry, both have advantages and disadvantages, the tip of the greater trochanter seems that it is not the ideal starting point for trochanteric entry nails, the study presents the foothill entry point as a reproducible, technically feasible entry point to overcome the shortcoming of both standard starting points, and it could be easy executed with clear intraoperative fluoroscopic landmarks and lead to appropriate nail position without intraoperative complications.
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Affiliation(s)
- Mohamed I Abulsoud
- Department of Orthopedic Surgery, Faculty of Medicine, Al-Azhar University, Al Mokhayyam Al Dayem Street, Nasr City, Cairo, 11675, Egypt.
| | - Mohammed Elmarghany
- Department of Orthopedic Surgery, Faculty of Medicine, Al-Azhar University, Al Mokhayyam Al Dayem Street, Nasr City, Cairo, 11675, Egypt
| | - Mohamed A A Ibrahim
- Department of Orthopedic Surgery, Faculty of Medicine, Al-Azhar University, Al Mokhayyam Al Dayem Street, Nasr City, Cairo, 11675, Egypt
| | - Ibrahem M Elsebaey
- Department of Orthopedic Surgery, Faculty of Medicine, Al-Azhar University, Al Mokhayyam Al Dayem Street, Nasr City, Cairo, 11675, Egypt
| | - Usama Gaber
- Department of Orthopedic Surgery, Faculty of Medicine, Al-Azhar University, Al Mokhayyam Al Dayem Street, Nasr City, Cairo, 11675, Egypt
| | - Elsherbiny Ali Elsherbiny
- Department of Orthopedic Surgery, Faculty of Medicine, Al-Azhar University, Al Mokhayyam Al Dayem Street, Nasr City, Cairo, 11675, Egypt
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Takahiro F, Shigeharu T. Skeletal muscle tissue composition ratio in patients with hip fracture: Comparison of fractured side and non-fractured side. J Back Musculoskelet Rehabil 2022; 36:669-676. [PMID: 36530078 DOI: 10.3233/bmr-220083] [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] [Indexed: 12/15/2022]
Abstract
BACKGROUND The extent of asymmetry in the muscle tissue composition ratios with hip fractures has not been clarified. OBJECTIVE To determine whether there is a difference in the muscle tissue composition ratios between the fractured and non-fractured sides of the trunk and thighs immediate measurement. METHODS Forty-four patients (84.6 ± 7.0 years) were included. Computed tomography images were used for measurements. The muscle tissue composition ratio was measured using muscle cross-sectional area (CSA) and attenuation coefficient (Hounsfield units; HU). Defined each HU attenuation range as follows: low-density muscle (LDM), low-quality muscle tissue with fat infiltration, normal-density muscle (NDM), muscle contractor tissue, and intramuscular adipose tissue (IMAT), fat infiltration tissue. The CSA of each muscle tissue was expressed as a percentage: %LDM, %NDM, and %IMAT. A paired t-test was performed for comparison. RESULTS The %LDM on the fractured side was higher in the thigh and erector spinae. The %NDM on the fractured side was lower in the thigh. There was no significant difference in the %IMAT for all muscles. CONCLUSION The thigh on the fractured side showed asymmetry with low %NDM and high %LDM. This characteristic captures a characteristic of muscle tissue that may have importance in hip fracture etiology.
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Affiliation(s)
| | - Tanaka Shigeharu
- Division of Physical Therapy, School of Rehabilitation, Kanagawa University of Human Services, Kanagawa, Japan
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Yu S, Li C, Zhong Y, Zang J, Zhou Z, Wang S, Zhang Y. Risk factors for contralateral hip refractures in patients aged over 80 years with intertrochanteric femoral fractures. Front Surg 2022; 9:924585. [PMID: 36176341 PMCID: PMC9513157 DOI: 10.3389/fsurg.2022.924585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 08/22/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose The purpose of this study was to identify which of the risk factors would contribute to the contralateral fracture in very elderly patients after intramedullary nail fixation. Methods Clinical data of 227 intertrochanteric fracture patients aged 80 years or older were retrospectively reviewed. Intramedullary nails (IMNs) were used on all of the patients. Potential risk factors for contralateral hip refractures were determined using univariate and logistic regression analyses. Results Contralateral hip refractures occurred in 11 patients (4.84%). Univariate analysis revealed that age, gender, body mass index, fracture classification, hematocrit, D-dimer, and CRP level were not associated with contralateral fractures (P > 0.05). However, neurological diseases, cardiovascular disease, and visual impairments were significantly associated with contralateral fractures (P < 0.05). Multivariate analysis further revealed that neurological diseases (OR 4.25, P = 0.044) and visual impairments (OR 5.42, P = 0.015) were independent risk factors associated with contralateral refractures. Conclusion To prevent contralateral refractures, more attention should be paid to elderly intertrochanteric fracture patients with underlying neurological disease and visual impairments.
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Affiliation(s)
- Shujun Yu
- The First Department of Hip Traumatology, Tianjin Hospital, Tianjin, China
| | - Chen Li
- The First Department of Hip Traumatology, Tianjin Hospital, Tianjin, China
| | - Yuqiao Zhong
- Department of Radiology, Tianjin Hospital, Tianjin, China
| | - Jiacheng Zang
- The First Department of Hip Traumatology, Tianjin Hospital, Tianjin, China
| | - Zhanzhe Zhou
- Department of Orthopedics, Tianjin Xiqing Hospital, Tianjin, China
| | - Song Wang
- The First Department of Hip Traumatology, Tianjin Hospital, Tianjin, China
- Correspondence: Song Wang Yinguang Zhang
| | - Yinguang Zhang
- The First Department of Hip Traumatology, Tianjin Hospital, Tianjin, China
- Correspondence: Song Wang Yinguang Zhang
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Çölbe SA, Çiftdemir M, Ustabaşıoğlu FE, Özgür C. Iatrogenic gluteus medius muscle insertion injury while trochanteric entry nailing due to trochanteric fractures: a comparative study in forty patients with gray-scale ultrasound and shear-wave elastography. INTERNATIONAL ORTHOPAEDICS 2021; 45:3253-3261. [PMID: 34448922 DOI: 10.1007/s00264-021-05177-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 07/30/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Trochanteric entry nailing potentially causes damage to the gluteus medius (GM) tendon. The aim of this study is to determine the amount of iatrogenic damage to the tendon during reaming by measuring the thickness and stiffness of the GM muscle in patients with trochanteric fractures who are treated with trochanteric entry nails using gray-scale ultrasound (GSUS) and shear-wave elastography (SWE). METHODS Thickness and stiffness values of bilateral GM muscles in 40 patients with trochanteric fractures treated with PFN-A were measured using GSUS and SWE at post-operative sixth week or later. Harris Hip Scores and bilateral active hip abduction measurements of the patients were recorded. The data was analyzed using statistical methods to assess the extent and amount of iatrogenic injury that occurred during trochanteric entry. RESULTS Mean age of the patients was 70. Thirty-three fractures occurred with low-energy trauma. In the SWE evaluation, there was no statistically significant difference between ipsi- and contralateral GM muscle thickness measurements or ipsi- and contralateral GM muscle stiffness measurements. Also, the difference between the clinical evaluation results of the ipsi- and contralateral hip functions was not statistically significant. DISCUSSION In this study, we used the Harris Hip Score and hip abduction range of motion in addition to SWE and GSUS in order to assess the patients' functional status. There are studies in the literature that report significant injury to the GM tendon with cephalomedullary nailing. The majority of these studies are cadaver studies with only clinically irrelevant or uncertain evidence. In this study, we aimed to evaluate the potential negative effects of the iatrogenic damage to the bone-tendon junction during nailing, by measuring the stiffness (consistency) and atrophy of the GM muscle alongside the functional evaluation. CONCLUSION We have found no statistically significant difference between operated and intact side GM muscles in terms of stiffness, atrophy, and functional evaluation in patients with TFs treated using PFN-A. The results of our study should not be interpreted as trochanteric entry nailing does not cause any damage on the GM tendon.
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Affiliation(s)
- Süleyman Alp Çölbe
- Department of Orthopedics and Traumatology, Faculty of Medicine, Trakya University, Balkan Yerleşkesi, 22030, Edirne, Turkey
| | - Mert Çiftdemir
- Department of Orthopedics and Traumatology, Faculty of Medicine, Trakya University, Balkan Yerleşkesi, 22030, Edirne, Turkey.
| | - Fethi Emre Ustabaşıoğlu
- Department of Radiology, Faculty of Medicine, Trakya University, Balkan Yerleşkesi, 22030, Edirne, Turkey
| | - Cihan Özgür
- Department of Radiology, Faculty of Medicine, Trakya University, Balkan Yerleşkesi, 22030, Edirne, Turkey
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Is gluteus medius injured in patients treated with a trochanter tip entry intramedullary nail? Clinical, electrophysiological and functional outcomes. Jt Dis Relat Surg 2020; 31:312-319. [PMID: 32584731 PMCID: PMC7489166 DOI: 10.5606/ehc.2020.74801] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 04/29/2020] [Indexed: 12/26/2022] Open
Abstract
Objectives
This study aims to assess the functional outcomes, static-dynamic postural stability of patients and evaluate electromyographic activity of gluteus medius (GMed) muscle during gait and spatiotemporal parameters of gait in patients after antegrade intramedullary nailing (IMN) of femoral shaft fractures with trochanter tip entry. Patients and methods
Sixteen patients (15 males, 1 female; mean age 34.8±15.2 years; range, 18 to 58 years) who were treated with an antegrade trochanteric IMN between January 2009 and July 2013 and eight healthy male controls (mean age 39.3±9.8 years; range, 27 to 57 years) were included in this retrospective study. Muscle strength, static and dynamic postural stability and fall risk were evaluated. In addition, spatiotemporal parameters of gait were assessed using a validated wireless inertial sensing device and a wireless electromyography (EMG) device was used to measure electromyographic activity of GMed muscle in both groups. Results
There were significant differences in muscle strength, functional and dynamic balance test scores between operated and intact sides (one-leg hop test score p=0.009, balance test scores p<0.001-0.033). There were significant differences in functional and quality of life physical function test scores between groups (one-leg hop test score p=0.014). However, no significant differences were found in EMG results, dynamics balance, and statics postural stability test scores between groups (p>0.05). Conclusion After isolated femur fracture, patients treated with antegrade trochanteric IMN demonstrated good static and dynamic stability and poor functional outcomes compared to controls. In conclusion, patients with antegrade trochanteric IMN have good balance but poor functional performance; however, further studies are needed to find out the primary reason for these results.
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Chinzei N, Noda M, Matsushita T, Inui A, Osawa S, Okimura K, Takahashi M, Saegusa Y. Does the duration to bipolar hip arthroplasty for femoral neck fracture influence on postoperative muscular strength? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 30:251-256. [PMID: 31493025 DOI: 10.1007/s00590-019-02545-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 09/03/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND The primary purpose of this study was to compare the postoperative muscular strength and functional performance between early versus late bipolar hip arthroplasty (BHA) intervention for femoral neck fracture classified by the duration from the onset to surgery. METHODS Twenty-one patients who could walk at 12 months or more after BHA were enrolled into this study. We examined the muscular strength of hip flexion, extension, abduction, and knee extension of these patients. Time of one-leg standing, timed up and go test, pain grade by visual analog scale, and Barthel index were also evaluated as functional indices. We classified these patients into two groups by the duration from the onset to surgery, namely: within 3 days until BHA (early OP) and more than 4 days (late OP) to compare these indices at the latest follow-up. RESULTS The mean days until operation were 2.3 days in the early-OP group and 5.9 days in the late-OP group, showing a significant difference between the two groups. Muscular strength and other functional indices were also found to have no significant differences between these two groups. CONCLUSION Our study suggests that the delay to operate might not severely compromise the muscular strength around the hip joint for least 1.5 years among ambulatory patients.
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Affiliation(s)
- Nobuaki Chinzei
- Department of Orthopaedic Surgery, Konan Hospital, Kobe, 658-0064, Japan
| | - Mitsuaki Noda
- Department of Orthopaedic Surgery, Nishi Hospital, Kobe, 657-0037, Japan.
| | - Takehiko Matsushita
- Department of Orthopaedic Surgery, Nishi Hospital, Kobe, 657-0037, Japan.,Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, 650-0017, Japan
| | - Atsuyuki Inui
- Department of Orthopaedic Surgery, Nishi Hospital, Kobe, 657-0037, Japan.,Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, 650-0017, Japan
| | - Shin Osawa
- Department of Orthopaedic Surgery, Konan Hospital, Kobe, 658-0064, Japan
| | - Kenjiro Okimura
- Department of Orthopaedic Surgery, Konan Hospital, Kobe, 658-0064, Japan
| | - Masayasu Takahashi
- Department of Orthopaedic Surgery, Konan Hospital, Kobe, 658-0064, Japan
| | - Yasuhiro Saegusa
- Department of Orthopaedic Surgery, Konan Hospital, Kobe, 658-0064, Japan
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