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Gu A, Doe K, Bracey L, Agarwal A, Raffa T, Farley B, Fraychinaud T, Knapp B, Tabaie S, Debritz J, Sterling R. Increased 1-Year Revision Rates Among Left-Sided Intertrochanteric Femur Fractures. J Orthop Trauma 2024; 38:431-434. [PMID: 39007659 DOI: 10.1097/bot.0000000000002829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/26/2024] [Indexed: 07/16/2024]
Abstract
OBJECTIVES To compare 1-year revision rates among left-sided and right-sided intertrochanteric femur fractures. METHODS DESIGN Retrospective. SETTING 120+ contributing centers to multicentered database. PATIENT SELECTION CRITERIA Patients who sustained intertrochanteric femur fracture (ITFF) and had a cephalomedullary nail (CMN) from 2015 to 2022 were identified. Patients were then stratified based on left-sided or right-sided fracture. Patients were excluded if younger than 18 years with <1-year follow-up. The intervention investigated was CMN on left or right side. OUTCOME MEASURES AND COMPARISONS One-year revision surgery, comparing CMN performed on left or right side for ITFFs. RESULTS In total, 113,626 patients met inclusion criteria, with 55,295 in the right-sided cohort and 58,331 in the left-sided cohort. There was no difference between cohorts with respect to age, gender, diabetes, osteoporosis, chronic kidney disease, or congestive heart failure (P > 0.05 for all). Patients who sustained a left ITFF and treated with a CMN were more likely to have revision surgery at 1 year (Left: 1.24%, Right: 0.90%; OR: 1.24; 95% confidence interval [CI], 1.15-1.1.33) or develop a nonunion or malunion (Left: 1.30%, Right: 0.98%; OR: 1.31; 95% CI, 1.14-1.52). The most common revision surgery conducted for both cohorts was conversion total hip arthroplasty (Left: 70.4% and Right: 70.0%). CONCLUSIONS Patients who sustained a left intertrochanteric femur fracture and were treated with a CMN were more likely to undergo revision at 1 year due to nonunion. There were no differences in demographics and comorbidities between cohorts. Though left-sided versus right-sided confounding variables may exist, the difference in nonunion rate may be explained by clockwise torque of the lag screw used in most implants. Increased awareness, implant design, and improved technique during fracture reduction and fixation may help lower this disproportionate nonunion rate and its associated morbidity and financial impact. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Alex Gu
- Department of Orthopaedic Surgery, George Washington School of Medicine and Health Sciences, Washington, DC; and
| | - Keli Doe
- Department of Orthopaedic Surgery, George Washington School of Medicine and Health Sciences, Washington, DC; and
| | - Lauren Bracey
- Department of Orthopaedic Surgery, George Washington School of Medicine and Health Sciences, Washington, DC; and
| | - Amil Agarwal
- Department of Orthopaedic Surgery, George Washington School of Medicine and Health Sciences, Washington, DC; and
| | - Taylor Raffa
- Department of Orthopaedic Surgery, George Washington School of Medicine and Health Sciences, Washington, DC; and
| | - Benjamin Farley
- Department of Orthopaedic Surgery, George Washington School of Medicine and Health Sciences, Washington, DC; and
| | - Thomas Fraychinaud
- Department of Orthopaedic Surgery, George Washington School of Medicine and Health Sciences, Washington, DC; and
| | - Brock Knapp
- Department of Orthopaedic Surgery, George Washington School of Medicine and Health Sciences, Washington, DC; and
| | - Sean Tabaie
- Department of Orthopaedic Surgery, Children's National Hospital, Washington, DC
| | - James Debritz
- Department of Orthopaedic Surgery, George Washington School of Medicine and Health Sciences, Washington, DC; and
| | - Robert Sterling
- Department of Orthopaedic Surgery, George Washington School of Medicine and Health Sciences, Washington, DC; and
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Kaptein BL, Pijls B, Koster L, Kärrholm J, Hull M, Niesen A, Heesterbeek P, Callary S, Teeter M, Gascoyne T, Röhrl SM, Flivik G, Bragonzoni L, Laende E, Sandberg O, Solomon LB, Nelissen R, Stilling M. Guideline for RSA and CT-RSA implant migration measurements: an update of standardizations and recommendations. Acta Orthop 2024; 95:256-267. [PMID: 38819193 PMCID: PMC11141406 DOI: 10.2340/17453674.2024.40709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 04/08/2024] [Indexed: 06/01/2024] Open
Abstract
Opening remarks: These guidelines are the result of discussions within a diverse group of RSA researchers. They were approved in December 2023 by the board and selected members of the International Radiostereometry Society to update the guidelines by Valstar et al. [1]. By adhering to these guidelines, RSA studies will become more transparent and consistent in execution, presentation, reporting, and interpretation. Both authors and reviewers of scientific papers using RSA may use these guidelines, summarized in the Checklist, as a reference. Deviations from these guidelines should have the underlying rationale stated.
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Affiliation(s)
- Bart L Kaptein
- Department of Orthopedics, Leiden University Medical Center, Leiden, The Netherlands.
| | - Bart Pijls
- Department of Orthopedics, Leiden University Medical Center, Leiden, The Netherlands
| | - Lennard Koster
- Department of Orthopedics, Leiden University Medical Center, Leiden, The Netherlands
| | - Johan Kärrholm
- Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Maury Hull
- Orthopedic Surgery Department, University of California, Davis, United States
| | - Abby Niesen
- Orthopedic Surgery Department, University of California, Davis, United States
| | - Petra Heesterbeek
- Orthopedic Research Department, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Stuart Callary
- Department of Orthopedics and Trauma, Royal Adelaide Hospital, Adelaide, Australia
| | - Matthew Teeter
- Department of Medical Biophysics, Western University, London, Canada
| | | | - Stephan M Röhrl
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Gunnar Flivik
- Department of Orthopedics, Skane University Hospital, Lund, Sweden
| | | | - Elise Laende
- Department of Surgery, Dalhousie University, Halifax, Canada
| | | | - L Bogdan Solomon
- Department of Orthopedics and Trauma, Royal Adelaide Hospital, Adelaide, Australia
| | - Rob Nelissen
- Department of Orthopedics, Leiden University Medical Center, Leiden, The Netherlands
| | - Maiken Stilling
- Department of Orthopedics, Aarhus University Hospital, Aarhus, Denmark
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Alm CE, Karlsten A, Madsen JE, Nordsletten L, Brattgjerd JE, Pripp AH, Frihagen F, Röhrl SM. No benefit of the trochanteric stabilizing plate on loss of fracture reduction in AO/OTA 31-A2 trochanteric fractures. Bone Jt Open 2024; 5:37-45. [PMID: 38240179 PMCID: PMC10797560 DOI: 10.1302/2633-1462.51.bjo-2023-0082.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2024] Open
Abstract
Aims Despite limited clinical scientific backing, an additional trochanteric stabilizing plate (TSP) has been advocated when treating unstable trochanteric fractures with a sliding hip screw (SHS). We aimed to explore whether the TSP would result in less post operative fracture motion, compared to SHS alone. Methods Overall, 31 patients with AO/OTA 31-A2 trochanteric fractures were randomized to either a SHS alone or a SHS with an additional TSP. To compare postoperative fracture motion, radiostereometric analysis (RSA) was performed before and after weightbearing, and then at four, eight, 12, 26, and 52 weeks. With the "after weightbearing" images as baseline, we calculated translations and rotations, including shortening and medialization of the femoral shaft. Results Similar migration profiles were observed in all directions during the course of healing. At one year, eight patients in the SHS group and 12 patients in the TSP group were available for analysis, finding a clinically non-relevant, and statistically non-significant, difference in total translation of 1 mm (95% confidence interval -4.7 to 2.9) in favour of the TSP group. In line with the migration data, no significant differences in clinical outcomes were found. Conclusion The TSP did not influence the course of healing or postoperative fracture motion compared to SHS alone. Based on our results, routine use of the TSP in AO/OTA 31-A2 trochanteric fractures cannot be recommended. The TSP has been shown, in biomechanical studies, to increase stability in sliding hip screw constructs in both unstable and intermediate stable trochanteric fractures, but the clinical evidence is limited. This study showed no advantage of the TSP in unstable (AO 31-A2) fractures in elderly patients when fracture movement was evaluated with radiostereometric analysis.
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Affiliation(s)
- Carl E. Alm
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Jan E. Madsen
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Lars Nordsletten
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Jan E. Brattgjerd
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Are H. Pripp
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Oslo Centre of Biostatistics and Epidemiology, Research Support Services, Oslo, Norway
| | - Frede Frihagen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Orthopaedic Surgery, Østfold Hospital Trust, Grålum, Norway
| | - Stephan M. Röhrl
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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Krogh AC, Thillemann JK, Hansen TB, Holck K, Kristensen MT, Palm H, Stilling M. No effect of hydroxyapatite-coated sliding hip screw threads on screw migration in the femoral head/neck of pertrochanteric fractures: a randomized controlled trial using radiostereometric analysis. J Orthop Surg Res 2023; 18:686. [PMID: 37710269 PMCID: PMC10503211 DOI: 10.1186/s13018-023-04170-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 09/07/2023] [Indexed: 09/16/2023] Open
Abstract
INTRODUCTION Cut-out is the most frequently reported mechanical failure of internal fixation of pertrochanteric fractures. The purpose of this study was to examine if hydroxyapatite-coated screw thread on a sliding hip screw (SHS) could reduce screw migration within the femoral head in patients with stable pertrochanteric fractures. MATERIALS AND METHODS In a double-blinded randomized controlled study, 37 patients at mean age 78 (range 56-96), with pertrochanteric fracture (Evans I, II, IV) received surgery with a SHS with a hydroxyapatite-coated or a non-coated lag screw thread. Radiostereometry and standard radiographs were obtained 1 day, 6 weeks, 3- and 6 months post-operatively to evaluate screw and fracture migration and fracture reposition. The two groups were combined to describe fracture migration. RESULTS There was similar and small screw migration in the femoral head between the two groups at 6 weeks, 3- and 6 months (p > 0.12). Fracture migration occurred predominantly in the first 6 weeks, where fracture impaction was 5.95 mm (CI 95% 2.87 to 9.04) and anterior rotation of the femoral head was -2.94° (CI 95% - 5.22 to - 0.66). Migration of the fracture (total translation) correlated to the post-operative fracture reposition (p = 0.002), but not significantly to screw migration (p = 0.09). Neither screw total translation (rho 0.06, p = 0.79) nor fracture total translation (rho 0.04, p = 0.77) correlated with bone mineral density. CONCLUSION There was no clinical benefit of hydroxyapatite coating on lag screw migration in this patient cohort. Migration of the pertrochanteric fractures was higher with poor fracture reposition but fractures generally stabilized after 6 weeks follow-up. The study was registered at ClinicalTrials.gov (NCT05677061). LEVEL OF EVIDENCE II Patient-blinded prospective randomized study. Trial registration number The study was registered at ClinicalTrials.gov (NCT05677061).
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Affiliation(s)
- August Christoffer Krogh
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark.
- AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus N, Denmark.
- Department of Orthopedics, Palle Juul-Jensens Boulevard 165, Crossing J501, 8200, Aarhus N, Denmark.
| | - Janni Kjærgaard Thillemann
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
- AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus N, Denmark
- University Clinic for Hand, Hip and Knee Surgery, Gødstrup Regional Hospital, Herning, Denmark
| | - Torben Bæk Hansen
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
- University Clinic for Hand, Hip and Knee Surgery, Gødstrup Regional Hospital, Herning, Denmark
| | - Kim Holck
- Department of Orthopedics, Hvidovre Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Morten Tange Kristensen
- Department of Orthopedics, Hvidovre Hospital, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Physical and Occupational Therapy, Copenhagen University-Hospital, Bispebjerg-Frederiksberg, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Palm
- Department of Orthopedics, Hvidovre Hospital, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Orthopedics, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Maiken Stilling
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
- AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus N, Denmark
- University Clinic for Hand, Hip and Knee Surgery, Gødstrup Regional Hospital, Herning, Denmark
- Department of Orthopedics, Aarhus University Hospital, Aarhus N, Denmark
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Shariyate MJ, Kheir N, Caro D, Abbasian M, Rodriguez EK, Snyder BD, Nazarian A. Assessment of Bone Healing: Opportunities to Improve the Standard of Care. J Bone Joint Surg Am 2023; 105:1193-1202. [PMID: 37339171 DOI: 10.2106/jbjs.22.01224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
➤ Bone healing is commonly evaluated by clinical examination and serial radiographic evaluation. Physicians should be mindful that personal and cultural differences in pain perception may affect the clinical examination. Radiographic assessment, even with the Radiographic Union Score, is qualitative, with limited interobserver agreement.➤ Physicians may use serial clinical and radiographical examinations to assess bone healing in most patients, but in ambiguous and complicated cases, they may require other methods to provide assistance in decision-making.➤ In complicated instances, clinically available biomarkers, ultrasound, and magnetic resonance imaging may determine initial callus development. Quantitative computed tomography and finite element analysis can estimate bone strength in later callus consolidation phases.➤ As a future direction, quantitative rigidity assessments for bone healing may help patients to return to function earlier by increasing a clinician's confidence in successful progressive healing.
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Affiliation(s)
- Mohammad Javad Shariyate
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Nadim Kheir
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Daniela Caro
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Mohammadreza Abbasian
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Edward K Rodriguez
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Brian D Snyder
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ara Nazarian
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Department of Orthopaedic Surgery, Yerevan State Medical University Yerevan, Armenia
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6
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Oosterhoff JHF, Dijkstra H, Karhade AV, Poolman RW, Schipper IB, Nelissen RGHH, van Embden D, Jaarsma RL, Schwab JH, Doornberg JN, Heng M, Jadav B. Clockwise torque results in higher reoperation rates in left-sided femur fractures. Injury 2023:S0020-1383(23)00386-8. [PMID: 37164900 DOI: 10.1016/j.injury.2023.04.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 04/11/2023] [Accepted: 04/23/2023] [Indexed: 05/12/2023]
Abstract
PURPOSE Effects of clockwise torque rotation onto proximal femoral fracture fixation have been subject of ongoing debate: fixated right-sided trochanteric fractures seem more rotationally stable than left-sided fractures in the biomechanical setting, but this theoretical advantage has not been demonstrated in the clinical setting to date. The purpose of this study was to identify a difference in early reoperation rate between patients undergoing surgery for left- versus right-sided proximal femur fractures using cephalomedullary nailing (CMN). MATERIALS AND METHODS The American College of Surgeons National Surgical Quality Improvement Program was queried from 2016-2019 to identify patients aged 50 years and older undergoing CMN for a proximal femoral fracture. The primary outcome was any unplanned reoperation within 30 days following surgery. The difference was calculated using a Chi-square test, and observed power calculated using post-hoc power analysis. RESULTS In total, of 20,122 patients undergoing CMN for proximal femoral fracture management, 1.8% (n=371) had to undergo an unplanned reoperation within 30 days after surgery. Overall, 208 (2.0%) were left-sided and 163 (1.7%) right-sided fractures (p=0.052, risk ratio [RR] 1.22, 95% confidence interval [CI] 1.00-1.50), odds ratio [OR] 1.23 (95%CI 1.00-1.51), power 49.2% (α=0.05). CONCLUSION This study shows a higher risk of reoperation for left-sided compared to right-sided proximal femur fractures after CMN in a large sample size. Although results may be underpowered and statistically insignificant, this finding might substantiate the hypothesis that clockwise rotation during implant insertion and (postoperative) weightbearing may lead to higher reoperation rates. LEVEL OF EVIDENCE Therapeutic level II.
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Affiliation(s)
- Jacobien H F Oosterhoff
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Engineering Systems and Services, Faculty Technology Policy Management, Delft University of Technology, Delft, the Netherlands
| | - Hidde Dijkstra
- Department of Orthopaedic Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; Department of Geriatric Medicine, University Medical Center of Groningen, University of Groningen, Groningen, the Netherlands.
| | - Aditya V Karhade
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Rudolf W Poolman
- Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Inger B Schipper
- Department of Surgery, Trauma Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Rob G H H Nelissen
- Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Daphne van Embden
- Department of Trauma Surgery, Amsterdam University Medical Centers, the Netherlands
| | - Ruurd L Jaarsma
- Department of Orthopaedics & Trauma Surgery, Flinders Medical Centre and Flinders University, Adelaide, SA, Australia
| | - Joseph H Schwab
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Job N Doornberg
- Department of Orthopaedic Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; Department of Orthopaedics & Trauma Surgery, Flinders Medical Centre and Flinders University, Adelaide, SA, Australia
| | - Marilyn Heng
- Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Bhavin Jadav
- Department of Orthopaedics & Trauma Surgery, Flinders Medical Centre and Flinders University, Adelaide, SA, Australia
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7
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Mechanical Complications After Intramedullary Fixation of Extracapsular Hip Fractures. J Am Acad Orthop Surg 2022; 30:e1550-e1562. [PMID: 36476463 DOI: 10.5435/jaaos-d-22-00213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 06/26/2022] [Indexed: 12/13/2022] Open
Abstract
Extracapsular hip fractures occur frequently in the elderly as a result of low-energy trauma. Achieving stable fixation in osteoporotic bone to allow early weight bearing is a key objective in the treatment of these injuries. Many of the intraoperative decisions facing surgeons are directed by first determining fracture stability. Unstable fracture patterns should be fixated with intramedullary nails, aiming to control motion around the implant and at the fracture site. Torsion control devices provide additional stability and control, although their exact indications are not precisely defined. Complications that arise as a result of the early loading can be avoided with a good surgical reduction, meticulous technique, and proper implant selection. Mechanical complications include cutout, inordinate proximal femoral shortening, delayed union, early implant fracture, nail toggle, and cut through/medial migration.
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You J, Wang F, Li F, Wu Y, Wang Y, Chen Z. The impact of the union of lesser trochanter fragments after intramedullary fixation of trochanteric femoral fractures: an X-ray based study. BMC Musculoskelet Disord 2022; 23:601. [PMID: 35733116 PMCID: PMC9215053 DOI: 10.1186/s12891-022-05534-z] [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: 02/17/2022] [Accepted: 06/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Displacement of the lesser trochanter (LT) is not uncommon after managing intertrochanteric femoral fractures and the influence of nonunion of the LT-fragment on clinical outcomes remains controversial. This study aimed to investigate the relationship between the displacement distance and union of the LT-fragment and evaluate the influence of LT-fragment nonunion on hip function and complications. METHODS This retrospective study included patients with intertrochanteric fractures and displaced LT treated with intramedullary fixation at Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine from June 2015 to July 2017. The patients were grouped as union and nonunion of the LT-fragment at 1 year. The LT-fragment displacement distance of LT was measured by the anterior-posterior radiographs. RESULTS Thirty-one and 22 patients showed union and nonunion at 1 year, respectively. The nonunion group had a higher postoperative complication rate than the union group (59% vs. 29%, P = 0.047), especially mechanical complications (45% vs. 6%, P = 0.001). There was no significant difference in hip function between the two groups (P > 0.05). The receiver operating characteristic (ROC) curve revealed an area under the curve of 0.933 of displacement ratio. Patients with a displacement ratio > 0.35 were more likely to have nonunion of the LT-fragment. CONCLUSIONS The displacement ratio might be a reliable predictor of LT-fragment union. The incidence of postoperative complications might increase with LT-fragment nonunion.
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Affiliation(s)
- Jiongming You
- Department of Orthopedic, Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine, WenZhou, 325000, ZheJiang, China
| | - Feng Wang
- Department of Orthopedic, Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine, WenZhou, 325000, ZheJiang, China
| | - Feng Li
- Department of Orthopedic, Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine, WenZhou, 325000, ZheJiang, China
| | - Yinsheng Wu
- Department of Orthopedic, Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine, WenZhou, 325000, ZheJiang, China
| | - Yong Wang
- Department of Orthopedic, Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine, WenZhou, 325000, ZheJiang, China
| | - Zifei Chen
- Department of Operation Room, The Second Affiliated Hospital and Yuying Children's Hospital of WenZhou Medical University, WenZhou, 325000, ZheJiang, China.
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9
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Cost-effectiveness analysis of routine follow-up for hip fracture patients after dynamic hip screw and intramedullary nail fixation. SURGERY IN PRACTICE AND SCIENCE 2022. [DOI: 10.1016/j.sipas.2022.100069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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10
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Yamamoto N, Imaizumi T, Noda T, Inoue T, Kawasaki K, Ozaki T. Postoperative computed tomography assessment of anteromedial cortex reduction is a predictor for reoperation after intramedullary nail fixation for pertrochanteric fractures. Eur J Trauma Emerg Surg 2021; 48:1437-1444. [PMID: 34057554 DOI: 10.1007/s00068-021-01718-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 05/26/2021] [Indexed: 12/20/2022]
Abstract
PURPOSE Postoperative radiographs are routinely used to assess fracture reduction following intramedullary nail fixation for pertrochanteric fractures, even though computed tomography (CT) is a superior modality. We aimed to determine the association between reduction quality assessed by CT and rates of reoperation and to evaluate the association of reoperation and reduction quality according to the assessment modality (plain radiographs vs. CT). METHODS A retrospective analysis of 299 consecutive patients treated with intramedullary nail fixation for pertrochanteric fractures was conducted. Fracture reduction measured by postoperative radiographs and CT was categorized as anatomical type, extramedullary type, or intramedullary type. Postoperative data for analysis included reduction status, tip-apex distance (TAD), screw position in the femoral head, sliding distance, and conditions associated with reoperation. RESULTS Of the 299 patients included with a mean age of 83.1 ± 8.2 years, there were six patients who required reoperation (2.0%). According to the CT assessments, there were 42 intramedullary reductions (14.0%). Patients with a non-intramedullary reduction based on postoperative CT images were significantly more likely to have proper placement of the screw, a reduced TAD, a reduced sliding distance, and a lower reoperation rate than those with an intramedullary reduction (P < 0.05). The reduction quality assessed by postoperative CT was significantly associated with reoperation (95% CI, 1.45-29.31). CONCLUSIONS Intramedullary reduction assessed by CT was associated with reoperation. The reduction quality based on CT findings was more predictive for reoperation than that from plain radiographs.
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Affiliation(s)
- Norio Yamamoto
- Department of Orthopedic Surgery, Kagawa Prefectural Central Hospital, 1-2-1, Asahi-machi, Takamatsu, Kagawa, 760-8557, Japan.
| | - Takahiro Imaizumi
- Department of Orthopedic Surgery, Kagawa Prefectural Central Hospital, 1-2-1, Asahi-machi, Takamatsu, Kagawa, 760-8557, Japan
| | - Tomoyuki Noda
- Department of Orthopedic Surgery, Kagawa Prefectural Central Hospital, 1-2-1, Asahi-machi, Takamatsu, Kagawa, 760-8557, Japan
| | - Tomoo Inoue
- Department of Orthopedic Surgery, Kagawa Prefectural Central Hospital, 1-2-1, Asahi-machi, Takamatsu, Kagawa, 760-8557, 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 Orthopedic Surgery, Kagawa Prefectural Central Hospital, 1-2-1, Asahi-machi, Takamatsu, Kagawa, 760-8557, Japan
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Reorienting the tibial baseplate improves the registration accuracy of model-based radiostereometric analysis. J Biomech 2020; 113:110078. [DOI: 10.1016/j.jbiomech.2020.110078] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 10/04/2020] [Accepted: 10/16/2020] [Indexed: 11/19/2022]
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Bizzoca D, Vicenti G, Caiaffa V, Abate A, De Carolis O, Carrozzo M, Solarino G, Moretti B. Assessment of fracture healing in orthopaedic trauma. Injury 2020; 54 Suppl 1:S46-S52. [PMID: 33234266 DOI: 10.1016/j.injury.2020.11.014] [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] [Received: 08/29/2020] [Accepted: 11/05/2020] [Indexed: 02/02/2023]
Abstract
Fracture healing is a complex physiologic process, relying on the crucial interplay between biological and mechanical factors. It is generally assessed using imaging modalities, including conventional radiology, CT, MRI and ultrasound (US), based on the fracture and patient features. Although these techniques are routinely used in orthopaedic clinical practice, unfortunately, they do not provide any information about the biomechanical status of the fracture site. Therefore, in recent years, several non-invasive techniques have been proposed to assess bone healing using ultrasonic wave propagation, changes in electrical properties of bones and callus stiffness measurement. Moreover, different research groups are currently developing smart orthopaedic implants (plates, intramedullary nails and external fixators), able to provide information about the fracture healing process. These devices could significantly improve orthopaedic and trauma clinical practice in the future and, at the same time, reduce patients' exposure to X-rays. This study aims to define the role of traditional imaging techniques and emerging technologies in the assessment of the fracture healing process.
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Affiliation(s)
- Davide Bizzoca
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
| | - Giovanni Vicenti
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy.
| | - Vincenzo Caiaffa
- Orthopaedic and Traumatology Unit, "Di Venere" Hospital, Bari, Italy
| | - Antonella Abate
- Orthopaedic and Traumatology Unit, "Di Venere" Hospital, Bari, Italy
| | - Oronzo De Carolis
- Orthopaedic and Traumatology Unit, "Di Venere" Hospital, Bari, Italy
| | - Massimiliano Carrozzo
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
| | - Giuseppe Solarino
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
| | - Biagio Moretti
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
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Clockwise Torque of Sliding Hip Screws: Is There a Right Side? J Orthop Trauma 2020; 34 Suppl 3:S76-S80. [PMID: 33027170 DOI: 10.1097/bot.0000000000001934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES This study evaluated whether patients with a left-sided femoral neck fracture (FNF) treated with a sliding hip screw (SHS) had a higher implant failure rate than patients treated for a right-sided FNF. This was performed to determine the clinical relevance of the clockwise rotational torque of the femoral neck lag screw in a SHS, in relation to the rotational stability of left and right-sided FNFs after fixation. METHODS Data were derived from the FAITH trial and Dutch Hip Fracture Audit (DHFA). Patients with a FNF, aged ≥50, treated with a SHS, with at least 3-month follow-up data available, were included. Implant failure was analyzed in a multivariable logistic regression model adjusted for age, sex, fracture displacement, prefracture living setting and functional mobility, and American Society for Anesthesiologists Class. RESULTS One thousand seven hundred fifty patients were included, of which 944 (53.9%) had a left-sided and 806 (46.1%) a right-sided FNF. Implant failure occurred in 60 cases (3.4%), of which 31 were left-sided and 29 right-sided. No association between fracture side and implant failure was found [odds ratio (OR) for left vs. right 0.89, 95% confidence interval (CI) 0.52-1.52]. Female sex (OR 3.02, CI: 1.62-6.10), using a mobility aid (OR 2.02, CI 1.01-3.96) and a displaced fracture (OR 2.51, CI: 1.44-4.42), were associated with implant failure. CONCLUSIONS This study could not substantiate the hypothesis that the biomechanics of the clockwise screw rotation of the SHS contributes to an increased risk of implant failure in left-sided FNFs compared with right-sided fractures. LEVEL OF EVIDENCE Therapeutic Level II.See Instructions for Authors for a complete description of levels of evidence.
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Abstract
PURPOSE OF REVIEW This review discusses imaging modalities for fracture repair assessment, with an emphasis on pragmatic clinical and translational use, best practices for implementation, and challenges and opportunities for continuing research. RECENT FINDINGS Semiquantitative radiographic union scoring remains the clinical gold standard, but has questionable reliability as a surrogate indicator of structural bone healing, particularly in early-stage, complex, or compromised healing scenarios. Alternatively, computed tomography (CT) scanning enables quantitative assessment of callus morphometry and mechanics through the use of patient-specific finite-element models. Dual-energy X-ray absorptiometry (DXA) scanning and radiostereometric analysis (RSA) are also quantitative, but technically challenging. Nonionizing magnetic resonance (MR) and ultrasound imaging are of high interest, but require development to enable quantification of 3D mineralized structures. Emerging image-based methods for quantitative assessment of bone healing may transform clinical research design by displacing binary outcomes classification (union/nonunion) and ultimately enhance clinical care by enabling early nonunion detection.
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Affiliation(s)
- Peter Schwarzenberg
- Department of Mechanical Engineering & Mechanics, Lehigh University, Bethlehem, PA, USA
| | - Salim Darwiche
- Musculoskeletal Research Unit (MSRU), Vetsuisse Faculty, University of Zürich, Zürich, Switzerland
- Center for Applied Biotechnology and Molecular Medicine (CABMM), University of Zürich, Zürich, Switzerland
| | - Richard S Yoon
- Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, Jersey City Medical Center - RWJBarnabas Health, Jersey City, NJ, USA
| | - Hannah L Dailey
- Department of Mechanical Engineering & Mechanics, Lehigh University, Bethlehem, PA, USA.
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Radiostereometric Analysis of Stability and Inducible Micromotion After Locked Lateral Plating of Distal Femur Fractures. J Orthop Trauma 2020; 34:e60-e66. [PMID: 31794438 DOI: 10.1097/bot.0000000000001684] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To evaluate interfragmentary motion over 1 year after distal femoral fracture fixation using radiostereometric analysis (RSA). The secondary aim was to assess whether RSA data are consistent with diagnoses of nonunion. DESIGN Prospective cohort study. SETTING Level I urban trauma center. PATIENTS Sixteen patients between 22 and 89 years of age with distal femoral fracture (OTA/AO type 33). INTERVENTION All fractures were treated with a lateral locking plate, and tantalum markers were inserted into the main proximal and distal fracture fragments. RSA was performed at 2, 6, 12, 18, and 52 weeks postoperatively. Both unloaded and loaded RSA measurements were performed. MAIN OUTCOME MEASUREMENTS Unloaded fracture migration over time and inducible micromotion at the fracture site in the coronal plane were determined at each follow-up interval. RESULTS RSA precision in the coronal plane of interfragmentary motion over time and inducible micromotion were 1.2 and 0.9 mm in the coronal plane, respectively. Two cases required revision surgery for nonunion 1 year postoperatively. For cases of union, unloaded fracture migration stopped being detectable between 12 and 18 weeks, and inducible micromotion was no longer detectable by the 12-week visit. For cases of nonunion, both unloaded migration and inducible micromotion were detected throughout the study period. CONCLUSIONS RSA may be used to reliably assess distal femoral fracture healing. RSA revealed differences in cases of union and nonunion by 3 months and more consistently than traditional x-rays. LEVEL OF EVIDENCE Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Kokoroghiannis C, Vasilakos D, Zisis K, Dimitriou G, Pappa E, Evangelopoulos D. Is rotation the mode of failure in pertrochanteric fractures fixed with nails? Theoretical approach and illustrative cases. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 30:199-205. [PMID: 31538272 DOI: 10.1007/s00590-019-02557-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 09/16/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE The present article reviews data from biomechanical and clinical studies which indicate that rotational instability can cause failure of fixation due to the particular characteristics of the fracture, the mechanical properties of the chosen implant or flaws in surgical technique. METHODS Although radiographs give a similar impression in failure of fractures fixed with cephalomedullary nails, different mechanisms involving rotation of the femoral head may play a key role. RESULTS The incidence of failure in pertrochanteric fracture fixation is decreasing as implants continue to evolve. It is possible that currently reported low failure rates do not apply equally to all subtypes of this diverse group of fractures. Since the introduction of sliding hip screws, "cut-out" due to varus collapse of the proximal fracture fragment has been the only reported mode of failure. CONCLUSION Excessive rotation leading to eventual "cut-out" has not been adequately studied, and thus, available evidence is not sufficient to definitely prove this theoretical approach. As nailing is gradually overtaking extramedullary fixation as the treatment of choice, especially for comminuted pertrochanteric fractures which can be rotationally unstable, further research is warranted to improve our understanding of the pathogenetic mechanisms of failure.
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Affiliation(s)
- C Kokoroghiannis
- 5th Department of Orthopaedics, "KAT" General Hospital of Athens, Nikis 2 Str, Athens, Greece
| | - D Vasilakos
- 5th Department of Orthopaedics, "KAT" General Hospital of Athens, Nikis 2 Str, Athens, Greece
| | - K Zisis
- 5th Department of Orthopaedics, "KAT" General Hospital of Athens, Nikis 2 Str, Athens, Greece
| | - G Dimitriou
- 5th Department of Orthopaedics, "KAT" General Hospital of Athens, Nikis 2 Str, Athens, Greece
| | - E Pappa
- 5th Department of Orthopaedics, "KAT" General Hospital of Athens, Nikis 2 Str, Athens, Greece.
| | - D Evangelopoulos
- 5th Department of Orthopaedics, "KAT" General Hospital of Athens, Nikis 2 Str, Athens, Greece
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Finnilä S, Moritz N, Strandberg N, Alm JJ, Aro HT. Radiostereometric analysis of the initial stability of internally fixed femoral neck fractures under differential loading. J Orthop Res 2019; 37:239-247. [PMID: 30273993 PMCID: PMC6587786 DOI: 10.1002/jor.24150] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 09/24/2018] [Indexed: 02/04/2023]
Abstract
We examined the feasibility of radiostereometric analysis (RSA) in the assessment of the initial stability of internally fixed femoral neck fractures. The study included 16 patients (mean age 73 years). During surgery, multiple RSA-beads were inserted on both sides of the fracture. Radiographs for RSA were taken in the supine position within the first 3 days and 6, 12, 24, and 52 weeks after surgery. To detect any inducible motion at the fracture-site, radiographs for RSA were taken with the patient resting or applying a load through the fracture. Fracture loading was achieved by the patient pressing the ipsilateral foot as much as tolerated on a force plate while providing a counterforce through both hands. Micromotion exceeding the precision values of RSA (≥0.3 mm for the translation vector and/or ≥1.2 degrees for the rotation vector) was considered significant. Permanent three-dimensional fracture-site displacement was also recorded. Voluntary loading induced fracture-site micromotion, which exhibited a dichotomous distribution. In patients with uncomplicated fracture union, inducible micromotion was detectable only at baseline-if at all. Conversely, fractures that developed a nonunion were characterized by the continuation of inducible micromotion beyond baseline. Permanent fracture-site displacement was, on average, nearly an order of magnitude greater than the inducible micromotion. Fracture unions were characterized by the cessation of permanent fracture-site displacement by 12 weeks. Nonunions presented as outliers in permanent fracture-site displacement. Large-scale studies are warranted to evaluate whether the detection of inducible micromotion beyond baseline could serve as an indicator of insufficient fixation stability. © 2018 The Authors. Journal of Orthopaedic Research® Published by Wiley Periodicals, Inc. on behalf of the Orthopaedic Research Society.
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Affiliation(s)
- Sami Finnilä
- Orthopedic Research Unit, Department of Orthopedic Surgery and TraumatologyTurku University Hospital and University of TurkuTurkuFinland
| | - Niko Moritz
- Orthopedic Research Unit, Department of Orthopedic Surgery and TraumatologyTurku University Hospital and University of TurkuTurkuFinland
| | - Niko Strandberg
- Orthopedic Research Unit, Department of Orthopedic Surgery and TraumatologyTurku University Hospital and University of TurkuTurkuFinland
| | - Jessica J. Alm
- Orthopedic Research Unit, Department of Orthopedic Surgery and TraumatologyTurku University Hospital and University of TurkuTurkuFinland
| | - Hannu T. Aro
- Orthopedic Research Unit, Department of Orthopedic Surgery and TraumatologyTurku University Hospital and University of TurkuTurkuFinland
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Segal D, Palmanovich E, Faour A, Marom E, Feldman V, Yaacobi E, Slevin O, Kish B, Brin YS. Routine early post-operative X-ray following internal fixation of intertrochanteric femoral fractures is unjustified: a quality improvement study. J Orthop Surg Res 2018; 13:189. [PMID: 30064462 PMCID: PMC6069722 DOI: 10.1186/s13018-018-0896-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 07/17/2018] [Indexed: 01/21/2023] Open
Abstract
Background There is no consensus regarding the proper radiographic protocol following closed or open reduction and internal fixation for intertrochanteric femoral fractures. The objective of this study was to assess the role of early postoperative imaging studies when deciding about weight bear limitations and reoperations. Methods A prospective cohort study of 100 patients (26 men and 74 women, at a mean age of 79.8 years) treated by closed or open reduction and internal fixation for AO31A fractures was conducted. According to the AO classification, there were 25 cases of 31A1, 54 cases of 31A2, and 21 cases of 31A3. For every patient, the intraoperative fluoroscopy studies were recorded and post-operative radiograms were taken during the first week. Excluded were patients for whom the early X-rays were clinically indicated. The intraoperative AP and axial fluoroscopy studies were compared with the radiograms taken during the first post-operative week. The investigators compared the decisions regarding weight-bearing limitations and the need for re-operation before and after conducting the radiograms. Results The early post-operative imaging studies did not change weight-bearing limitations nor did they lead to consecutive surgical treatments. Conclusions Unless indicated by physical examination, there is no value to routine post-operative radiograms within the first few days after closed reduction and internal fixation of intertrochanteric femoral fractures with regard to weight-bearing limitations and re-operation decisions. Trial registration Identifier: NCT02868125.
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Affiliation(s)
- David Segal
- Orthopedic Department, Meir Medical Center, 59 Tschernihovsky St., 44281, Kfar Saba, Israel.
| | - Ezequiel Palmanovich
- Orthopedic Department, Meir Medical Center, 59 Tschernihovsky St., 44281, Kfar Saba, Israel
| | - Ali Faour
- Orthopedic Department, Meir Medical Center, 59 Tschernihovsky St., 44281, Kfar Saba, Israel
| | - Elad Marom
- Orthopedic Department, Meir Medical Center, 59 Tschernihovsky St., 44281, Kfar Saba, Israel
| | - Viktor Feldman
- Orthopedic Department, Meir Medical Center, 59 Tschernihovsky St., 44281, Kfar Saba, Israel
| | - Eyal Yaacobi
- Orthopedic Department, Meir Medical Center, 59 Tschernihovsky St., 44281, Kfar Saba, Israel
| | - Omer Slevin
- Orthopedic Department, Meir Medical Center, 59 Tschernihovsky St., 44281, Kfar Saba, Israel
| | - Benjamin Kish
- Orthopedic Department, Meir Medical Center, 59 Tschernihovsky St., 44281, Kfar Saba, Israel
| | - Yaron S Brin
- Orthopedic Department, Meir Medical Center, 59 Tschernihovsky St., 44281, Kfar Saba, Israel
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Bojan AJ, Jönsson A, Granhed H, Ekholm C, Kärrholm J. Trochanteric fracture-implant motion during healing - A radiostereometry (RSA) study. Injury 2018; 49:673-679. [PMID: 29397996 DOI: 10.1016/j.injury.2018.01.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 12/13/2017] [Accepted: 01/06/2018] [Indexed: 02/02/2023]
Abstract
Cut-out complication remains a major unsolved problem in the treatment of trochanteric hip fractures. A better understanding of the three-dimensional fracture-implant motions is needed to enable further development of clinical strategies and countermeasures. The aim of this clinical study was to characterise and quantify three-dimensional motions between the implant and the bone and between the lag screw and nail of the Gamma nail. Radiostereometry Analysis (RSA) analysis was applied in 20 patients with trochanteric hip fractures treated with an intramedullary nail. The following three-dimensional motions were measured postoperatively, at 1 week, 3, 6 and 12 months: translations of the tip of the lag screw in the femoral head, motions of the lag screw in the nail, femoral head motions relative to the nail and nail movements in the femoral shaft. Cranial migration of the tip of the lag screw dominated over the other two translation components in the femoral head. In all fractures the lag screw slid laterally in the nail and the femoral head moved both laterally and inferiorly towards the nail. All femoral heads translated posteriorly relative to the nail, and rotations occurred in both directions with median values close to zero. The nail tended to retrovert in the femoral shaft. Adverse fracture-implant motions were detected in stable trochanteric hip fractures treated with intramedullary nails with high resolution. Therefore, RSA method can be used to evaluate new implant designs and clinical strategies, which aim to reduce cut-out complications. Future RSA studies should aim at more unstable fractures as these are more likely to fail with cut-out.
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Affiliation(s)
- Alicja J Bojan
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, Gothenburg University, Sweden.
| | - Anders Jönsson
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, Gothenburg University, Sweden
| | - Hans Granhed
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, Gothenburg University, Sweden
| | - Carl Ekholm
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, Gothenburg University, Sweden
| | - Johan Kärrholm
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, Gothenburg University, Sweden
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Stentz-Olesen K, Nielsen ET, De Raedt S, Jørgensen PB, Sørensen OG, Kaptein BL, Andersen MS, Stilling M. Validation of static and dynamic radiostereometric analysis of the knee joint using bone models from CT data. Bone Joint Res 2017; 6:376-384. [PMID: 28600383 PMCID: PMC5492337 DOI: 10.1302/2046-3758.66.bjr-2016-0113.r3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 03/13/2017] [Indexed: 11/05/2022] Open
Abstract
Objectives Static radiostereometric analysis (RSA) using implanted markers is considered the most accurate system for the evaluation of prosthesis migration. By using CT bone models instead of markers, combined with a dynamic RSA system, a non-invasive measurement of joint movement is enabled. This method is more accurate than current 3D skin marker-based tracking systems. The purpose of this study was to evaluate the accuracy of the CT model method for measuring knee joint kinematics in static and dynamic RSA using the marker method as the benchmark. Methods Bone models were created from CT scans, and tantalum beads were implanted into the tibia and femur of eight human cadaver knees. Each specimen was secured in a fixture, static and dynamic stereoradiographs were recorded, and the bone models and marker models were fitted to the stereoradiographs. Results Results showed a mean difference between the two methods in all six degrees of freedom for static RSA to be within -0.10 mm/° and 0.08 mm/° with a 95% limit of agreement (LoA) ranging from ± 0.49 to 1.26. Dynamic RSA had a slightly larger range in mean difference of -0.23 mm/° to 0.16 mm/° with LoA ranging from ± 0.75 to 1.50. Conclusions In a laboratory-controlled setting, the CT model method combined with dynamic RSA may be an alternative to previous marker-based methods for kinematic analyses. Cite this article: K. Stentz-Olesen, E. T. Nielsen, S. De Raedt, P. B. Jørgensen, O. G. Sørensen, B. L. Kaptein, M. S. Andersen, M. Stilling. Validation of static and dynamic radiostereometric analysis of the knee joint using bone models from CT data. Bone Joint Res 2017;6:376–384. DOI: 10.1302/2046-3758.66.BJR-2016-0113.R3.
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Affiliation(s)
- K Stentz-Olesen
- Orthopaedic Research Group, Department of Orthopaedic Surgery, Aarhus University Hospital, Tage-Hansens Gade 2, Building 10A, Office 15, 8000 Aarhus C, Denmark
| | - E T Nielsen
- Orthopaedic Research Group, Department of Orthopaedic Surgery, Aarhus University Hospital, Tage-Hansens Gade 2, Building 10A, Office 15, 8000 Aarhus C, Denmark
| | - S De Raedt
- Nordisk Røntgen Teknik, Birkegårdsvej 16, 8361 Hesselager, Denmark
| | - P B Jørgensen
- Orthopaedic Research Group, Department of Orthopaedic Surgery, Aarhus University Hospital, Tage-Hansens Gade 2, Building 9A, 8000 Aarhus C, Denmark
| | - O G Sørensen
- Orthopaedic Research Group, Department of Orthopaedic Surgery, Aarhus University Hospital, Tage-Hansens Gade 2, Building 10A, Office 15, 8000 Aarhus C, Denmark
| | - B L Kaptein
- Biomechanics and Imaging Group, Department of Orthopaedic Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherland
| | - M S Andersen
- Department of Mechanical Engineering and Manufacturing, Aalborg University, Fibigerstræde 16, 9220 Aalborg East, Denmark
| | - M Stilling
- Orthopaedic Research Group, Departments of Orthopaedic Surgery and Clinical Medicine, Aarhus University Hospital, University of Aarhus, Tage-Hansens Gade 2, Building 10A, 8000 Aarhus C, Denmark
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Gosiewski JD, Holsgrove TP, Gill HS. The efficacy of rotational control designs in promoting torsional stability of hip fracture fixation. Bone Joint Res 2017; 6:270-276. [PMID: 28473334 PMCID: PMC5457639 DOI: 10.1302/2046-3758.65.bjr-2017-0287.r1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 02/16/2017] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Fractures of the proximal femur are a common clinical problem, and a number of orthopaedic devices are available for the treatment of such fractures. The objective of this study was to assess the rotational stability, a common failure predictor, of three different rotational control design philosophies: a screw, a helical blade and a deployable crucifix. METHODS Devices were compared in terms of the mechanical work (W) required to rotate the implant by 6° in a bone substitute material. The substitute material used was Sawbones polyurethane foam of three different densities (0.08 g/cm3, 0.16 g/cm3 and 0.24 g/cm3). Each torsion test comprised a steady ramp of 1°/minute up to an angular displacement of 10°. RESULTS The deployable crucifix design (X-Bolt), was more torsionally stable, compared to both the dynamic hip screw (DHS, p = 0.008) and helical blade (DHS Blade, p= 0.008) designs in bone substitute material representative of osteoporotic bone (0.16 g/cm3 polyurethane foam). In 0.08 g/cm3 density substrate, the crucifix design (X-Bolt) had a higher resistance to torsion than the screw (DHS, p = 0.008). There were no significant differences (p = 0.101) between the implants in 0.24 g/cm3 density bone substitute. CONCLUSIONS Our findings indicate that the clinical standard proximal fracture fixator design, the screw (DHS), was the least effective at resisting torsional load, and a novel crucifix design (X-Bolt), was the most effective design in resisting torsional load in bone substitute material with density representative of osteoporotic bone. At other densities the torsional stability was also higher for the X-Bolt, although not consistently significant by statistical analysis.Cite this article: J. D. Gosiewski, T. P. Holsgrove, H. S. Gill. The efficacy of rotational control designs in promoting torsional stability of hip fracture fixation. Bone Joint Res 2017;6:270-276. DOI: 10.1302/2046-3758.65.BJR-2017-0287.R1.
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Affiliation(s)
- J D Gosiewski
- Department of Mechanical Engineering, University of Bath, Claverton Down Rd, Bath, Somerset BA2 7AY, UK
| | - T P Holsgrove
- Department of Engineering, College of Engineering, Mathematics & Physical Sciences, University of Exeter, and Department of Mechanical Engineering, University of Bath (visiting academic), University of Exeter, College of Engineering, Mathematics & Physical Sciences, Harrison Building, Streatham Campus, University of Exeter, EX4 4QF, UK
| | - H S Gill
- Department of Mechanical Engineering, University of Bath, Claverton Down Rd, Bath, Somerset BA2 7AY, UK
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The Role of Radiographs and Office Visits in the Follow-Up of Healed Intertrochanteric Hip Fractures: An Economic Analysis. J Orthop Trauma 2016; 30:687-690. [PMID: 27763962 DOI: 10.1097/bot.0000000000000682] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The purpose of this study was to evaluate the role and the necessity of radiographs and office visits obtained during follow-up of intertrochanteric hip injuries. DESIGN Retrospective study. SETTING Two level I trauma centers. PATIENTS Four hundred sixty-five elderly patients who were surgically treated for an intertrochanteric fracture of the femur at 2 level I trauma centers between January 2009 and August 2014 were retrospectively identified from orthopaedic trauma databases. INTERVENTION Analysis of all healed intertrochanteric hip fractures, including demographic characteristics, quality of reduction, time of healing, number of office visits, number of radiographs obtained, and each radiograph for fracture alignment, implant position or any pathological changes. RESULTS The surgical fixation of 465 fractures included 155 short nails (33%), 232 long nails (50%), 69 sliding hip screw devices (15%), 7 trochanteric stabilizing plates (1.5%), and 2 proximal femur locking plates (0.5%). The average fracture healing time was 12.8 weeks and the average follow-up was 81.2 weeks. Radiographs of any patient obtained after the fracture had healed did not reveal any changes, including fracture alignment or implant position and hardware failure. In 9 patients, pathological changes, including arthritis (3), avascular necrosis (3), and ectopic ossification (3) were noted. The average number of elective office visits and radiographs obtained after the fracture had healed were 2.8 (range: 1-8) and 2.6 (range: 1-8), respectively. According to Medicare payments to the institution, these radiographs and office visits account for a direct cost of $360.81 and $192, respectively, per patient. CONCLUSION The current study strongly suggests that there is a negligible role for radiographs and office visits during the follow-up of a well-healed hip fracture when there is documented evidence of radiographic and clinical healing with acceptable fracture alignment and implant position. Implementation of this simple measure will help in reducing the cost of care and inconvenience to elderly patients. LEVEL OF EVIDENCE Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Crosby JM, Parker MJ. Femoral neck collapse after internal fixation of an intracapsular hip fracture: Does it indicate a poor outcome? Injury 2016; 47:2760-2763. [PMID: 28340943 DOI: 10.1016/j.injury.2016.10.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 10/14/2016] [Accepted: 10/17/2016] [Indexed: 02/02/2023]
Abstract
The degree of femoral neck collapse that occurred after 519 patients with an intracapsular hip fracture treated by internal fixation with a Targon FN implant was measured. Mean femoral neck collapse was 8.0mm and this was increased for displaced fractures in comparison to undisplaced fractures (9.5mm versus 5.9mm, p<0.0001) and for those patients that subsequently developed fracture healing complications (11.6mm versus 7.1mm, p<0.0001). At one year from injury femoral neck collapse in excess of 15mm was associated with an increase in the degree of residual pain (p=0.01). A clear relationship between increased collapse and increased loss of mobility was demonstrated (P<0.0001). This study confirms previous smaller studies that excessive femoral neck collapse (of more than 15mm) is more common for displaced fractures and presents new data to demonstrate that excessive femoral neck collapse is associated with an increased risk of fracture healing complications and increased loss of function. Future studies are now justified that consider methods to reduce fracture collapse.
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Affiliation(s)
- Jonathan M Crosby
- Peterborough and Stamford Hospital NHS Foundation Trust, Department of Orthopaedics, Peterborough City Hospital, CBU PO Box 211, Core C, Bretton Gate, Peterborough PE3 9GZ, England, United Kingdom
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- Peterborough and Stamford Hospital NHS Foundation Trust, Department of Orthopaedics, Peterborough City Hospital, CBU PO Box 211, Core C, Bretton Gate, Peterborough PE3 9GZ, England, United Kingdom.
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