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Assi C, Otayek J, Mansour J, Daher J, Caton J, Samaha C, Yammine K. Outcomes of total hip arthroplasty using dual mobility cups following failed internal fixation of proximal femoral fractures at a mean follow-up of 6 years. SICOT J 2024; 10:3. [PMID: 38240729 PMCID: PMC10798229 DOI: 10.1051/sicotj/2023038] [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] [Received: 09/20/2023] [Accepted: 12/09/2023] [Indexed: 01/22/2024] Open
Abstract
INTRODUCTION Performing total hip arthroplasty (THA) after failed internal fixation of proximal femoral fractures (PFF) is known to be associated with high rates of complications. Dual mobility cups (DMC) are known to lower dislocation events in high-risk patients. Very few reports investigated the outcomes of THA using DMC following failure of internal fixation for PFF. METHODS This is a retrospective monocentric continuous study of 31 patients who underwent THA with DMC after failed internal fixation of PFF. The clinical assessment was based on the modified Harris hip score (mHHS) at the last follow-up. The complication rates and radiological analyses were recorded. RESULTS The mean follow-up period was 5.96 ± 4.2 years. At the last follow-up, the mean mHHS was 92.9 ± 9.1 with 71% of the patients describing their operated hip as a forgotten hip. No dislocation or aseptic loosening events were noted. One patient developed a septic loosening of the implant. No significant radiological changes were recorded. Sixteen stems (51.6%) were placed in a neutral position, 13 (42%) in valgus (2.74 ± 1.72°), and 2 (6.4%) in varus (6.94 ± 2.02°). CONCLUSION This study emphasizes the advantage of using DMC following failed internal fixation of PFF in reducing dislocation and complication events in this high-risk population.
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Affiliation(s)
- Chahine Assi
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine Beirut Lebanon
- Center of Evidence-based Anatomy, Sports & Orthopedic Research Beirut Lebanon
| | - Joeffroy Otayek
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine Beirut Lebanon
| | - Jad Mansour
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine Beirut Lebanon
| | - Jimmy Daher
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine Beirut Lebanon
| | | | - Camille Samaha
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine Beirut Lebanon
| | - Kaissar Yammine
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine Beirut Lebanon
- Institut de Chirurgie Orthopédique Lyon France
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Thalody HS, Post ZD, Lutz RW, Czymek M, Ong AC, Ponzio DY. Primary Cementless Femoral Stems in Conversion Hip Arthroplasty After Failed Fixation of Intertrochanteric Fractures. Orthopedics 2024; 47:e6-e12. [PMID: 37216568 DOI: 10.3928/01477447-20230517-04] [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: 05/24/2023]
Abstract
Salvage conversion hip arthroplasty is a viable solution to restore function and reduce pain after failed intertrochanteric hip fracture fixation. Our primary objective was to assess early outcomes achieved with primary cementless metaphyseal-engaging femoral stems for conversion hip arthroplasty compared with revision diaphyseal-engaging stems. This was a retrospective review of 70 patients with failed intertrochanteric hip fractures subsequently managed with conversion total hip arthroplasty or hemiarthroplasty. Thirty-five patients who underwent conversion using a primary cementless stem were compared with 35 patients who underwent conversion using a revision stem. The groups were similar regarding sex, body mass index, American Society of Anesthesiologists classification, preoperative diagnosis, and implants removed. Clinical and radiographic outcomes and complications were compared over a mean follow-up of 6 years. The primary stem cohort had a shorter mean hospital stay (3.03 vs 4.34 days, P=.028). There were no significant differences between the primary and revision cohorts regarding mean time to conversion (2.26 vs 1.75 years, P=.671), operative time (127 vs 131 minutes, P=.611), incidence of discharge to home (54.3% vs 37.1%, P=.23), postoperative complications (5.71% vs 5.71%, P=1.0), reoperations (5.71% vs 11.4%, P=.669), leg length discrepancy (5.33 vs 7.38 mm, P=.210), subsidence (20.0% vs 23.3%, P=.981), and Hip dysfunction and Osteoarthritis Outcome Score for Joint Replacement (78.6 vs 81.9, P=.723). We report comparable outcomes of conversion hip arthroplasty with the use of primary cementless and revision stems. Current primary cementless femoral stems may be considered for conversion hip arthroplasty for failed intertrochanteric fracture fixation. [Orthopedics. 2024;47(1):e6-e12.].
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Chen P, Fan Z, Xu N, Wang H. A biomechanical investigation of a novel intramedullary nail used to salvage failed internal fixations in intertrochanteric fractures. J Orthop Surg Res 2023; 18:632. [PMID: 37641046 PMCID: PMC10463605 DOI: 10.1186/s13018-023-04112-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 08/17/2023] [Indexed: 08/31/2023] Open
Abstract
PURPOSE The ideal approach for revision surgery following femoral head salvage treatments for an intertrochanteric fracture is still up for debate. A novel variety of proximal femoral bionic intramedullary nail (PFBN) has been created in clinical practice. We aimed to compare the biomechanical results of the novel implant to conventional intramedullary and extramedullary fixation in the treatment of intertrochanteric fracture following primary internal fixation failure. METHODS Using finite element analysis, we created a three-dimensional model of the intertrochanteric fracture's helical blade cut-out for this investigation. The PFBN 1 group, the PFBN 2 group, the PFNA group, and the DHS group were our four test groups. For each fracture group, the von Mises stress and displacements of the femur and internal fixation components were measured under 2100 N axial loads. RESULTS The values for the femoral displacement in the PFBN1 group, PFBN2 group, PFNA group, and DHS group were 6.802 mm, 6.716 mm, 8.080 mm, and 8.679 mm, respectively. The internal implant displacement values were 6.201 mm, 6.138 mm, 7.396 mm, and 8.075 mm in the PFBN1 group, PFBN2 group, PFNA group, and DHS group, respectively. The maximum von Mises Stress in the femoral was 187.2 MPa, 85.18 MPa, 106.6 MPa, and 386.2 MPa in the PFBN1 groups, PFBN2 groups, PFNA groups, and DHS groups, respectively. In the PFBN1 groups, PFBN2 groups, PFNA groups, and DHS groups, the maximum von Mises Stress in internal fixation was 586.7 MPa, 559.8 MPa, 370.7 MPa, and 928.4.8 MPa, respectively. CONCLUSION Our biomechanical research demonstrates that intramedullary fixation is more stable than extramedullary fixation when salvaging failed internal fixations in intertrochanteric fracture. Compared with PFNA and DHS, PFBN showed better biomechanical stability in the treatment of patients with revised intertrochanteric fractures. In light of this, we advocate PFBN fixation as the method of choice for intertrochanteric fracture revision. This result still has to be confirmed in more clinical research.
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Affiliation(s)
- Ping Chen
- The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine (Guangdong Provincial Hospital of Traditional Chinese Medicine), Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
| | - Zhirong Fan
- The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine (Guangdong Provincial Hospital of Traditional Chinese Medicine), Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
| | - Nengneng Xu
- Panyu Hospital of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, 511401, China
| | - Haizhou Wang
- The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine (Guangdong Provincial Hospital of Traditional Chinese Medicine), Guangzhou University of Chinese Medicine, Guangzhou, 510120, China.
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Halvachizadeh S, Martin DP, Pfeifer R, Jukema GN, Gueorguiev B, Pape HC, Berk T. Which non-infection related risk factors are associated with impaired proximal femur fracture healing in patients under the age of 70 years? BMC Musculoskelet Disord 2023; 24:405. [PMID: 37210475 DOI: 10.1186/s12891-023-06539-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 05/16/2023] [Indexed: 05/22/2023] Open
Abstract
BACKGROUND/PURPOSE Impaired healing is a feared complication with devastating outcomes for each patient. Most studies focus on geriatric fracture fixation and assess well known risk factors such as infections. However, risk factors, others than infections, and impaired healing of proximal femur fractures in non-geriatric adults are marginally assessed. Therefore, this study aimed to identify non-infection related risk factors for impaired fracture healing of proximal femur fractures in non-geriatric trauma patients. METHODS This study included non-geriatric patients (aged 69 years and younger) who were treated between 2013 and 2020 at one academic Level 1 trauma center due to a proximal femur fracture (PFF). Patients were stratified according to AO/OTA classification. Delayed union was defined as failed callus formation on 3 out of 4 cortices after 3 to 6 months. Nonunion was defined as lack of callus-formation after 6 months, material breakage, or requirement of revision surgery. Patient follow up was 12 months. RESULTS This study included 150 patients. Delayed union was observed in 32 (21.3%) patients and nonunion with subsequent revision surgery occurred in 14 (9.3%). With an increasing fracture classification (31 A1 up to 31 A3 type fractures), there was a significantly higher rate of delayed union. Additionally, open reduction and internal fixation (ORIF) (OR 6.17, (95% CI 1.54 to 24.70, p ≤ 0.01)) and diabetes mellitus type II (DM) (OR 5.74, (95% CI 1.39 to 23.72, p = 0.016)), were independent risk factors for delayed union. The rate of nonunion was independent of fracture morphology, patient's characteristics or comorbidities. CONCLUSION Increasing fracture complexity, ORIF and diabetes were found to be associated with delayed union of intertrochanteric femur fractures in non-geriatric patients. However, these factors were not associated with the development of nonunion.
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Affiliation(s)
- Sascha Halvachizadeh
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Harald-Tscherne Laboratory for Orthopedic and Trauma Research, University of Zurich, Sternwartstrasse 14, 8091, Zurich, Switzerland
| | - David Paul Martin
- Department of Orthopedics and Rehabilitation, University of Wisconsin, 1685 Highland Ave, Madison, WI, 53705, USA
| | - Roman Pfeifer
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Harald-Tscherne Laboratory for Orthopedic and Trauma Research, University of Zurich, Sternwartstrasse 14, 8091, Zurich, Switzerland
| | - Gerrolt Nico Jukema
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Harald-Tscherne Laboratory for Orthopedic and Trauma Research, University of Zurich, Sternwartstrasse 14, 8091, Zurich, Switzerland
| | - Boyko Gueorguiev
- AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos, Switzerland
| | - Hans-Christoph Pape
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Harald-Tscherne Laboratory for Orthopedic and Trauma Research, University of Zurich, Sternwartstrasse 14, 8091, Zurich, Switzerland
| | - Till Berk
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
- Harald-Tscherne Laboratory for Orthopedic and Trauma Research, University of Zurich, Sternwartstrasse 14, 8091, Zurich, Switzerland.
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Qi L, Zhang W, Chang Z, Zuo Z, Li J, Li J, Chen H, Tang P. Is the reconstruction of medial support important for revision following failed treatment of femoral trochanteric fractures? a retrospective comparative study. BMC Musculoskelet Disord 2022; 23:1028. [PMID: 36447239 PMCID: PMC9707300 DOI: 10.1186/s12891-022-06004-2] [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] [Received: 05/26/2022] [Accepted: 11/18/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Hip-preserving revision in patients with failed treatment of femoral trochanteric fracture is still a major challenge. Whether the medial support reconstruction could benefit the patients and improve the success rate of hip-preserving revision is still controversial. Hence, the purpose of this study was to evaluate the clinical significance and prognosis of medial support reconstruction during the hip-preserving revision of failed femoral trochanteric fracture treatment. METHODS Patients with failed femoral trochanteric fractures treatments addressed by hip-preserving revision at our hospital from January 2014 to December 2020 were analyzed retrospectively. 31 patients were included and divided into a medial support group (n = 16) and a non-medial support group (n = 15). The fracture healing rate was the primary measurement. In addition, the differences in Oxford Hip Score (OHS), quality of life, surgical trauma, and complications were also evaluated. RESULTS The fracture healing rate (100%, 16/16 vs. 66.67%, 10/15), the OHS (42.06 ± 4.12 vs. 30.93 ± 11.56, M ± SD), and the mental component score of the 12-item Short-Form Survey (SF-12) (54.48 ± 5.38 vs. 47.90 ± 3.47, M ± SD), were significantly better and the incidence of complications [0(0/16) vs. 40%(6/15)] was significantly lower in the medial support group than the non-medial support group (p < 0.05). No significant differences in the physical component score of the SF-12, surgical trauma and reduction in collodiaphyseal angle of affected femur were observed between groups. CONCLUSIONS The reconstruction of medial support seems important for revision following failed treatment of femoral trochanteric fractures. Due to the medial augmentation and improvement of the mechanical stability for proximal femur, the patients might benefit from fracture healing prognosis and functional.
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Affiliation(s)
- Lin Qi
- grid.488137.10000 0001 2267 2324Chinese PLA Medical School, No.28 Fuxing Road, Haidian, Beijing, 100853 China ,grid.414252.40000 0004 1761 8894Department of Orthopaedics, the First Medical Center, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian, Beijing, 100853 China
| | - Wei Zhang
- grid.411614.70000 0001 2223 5394School of Sports Engineering, Beijing Sport University, No. 48 Information Road, Haidian District, Beijing, 100084 China
| | - Zuhao Chang
- grid.488137.10000 0001 2267 2324Chinese PLA Medical School, No.28 Fuxing Road, Haidian, Beijing, 100853 China ,grid.414252.40000 0004 1761 8894Department of Orthopaedics, the First Medical Center, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian, Beijing, 100853 China
| | - Zhaoxia Zuo
- National Clinical Center for Orthopedics, Sports Medicine & Rehabilitation, No.28 Fuxing Road, Haidian, Beijing, 100853 China
| | - Jiaqi Li
- grid.488137.10000 0001 2267 2324Chinese PLA Medical School, No.28 Fuxing Road, Haidian, Beijing, 100853 China ,grid.414252.40000 0004 1761 8894Department of Orthopaedics, the First Medical Center, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian, Beijing, 100853 China
| | - Jiantao Li
- grid.414252.40000 0004 1761 8894Department of Orthopaedics, the First Medical Center, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian, Beijing, 100853 China
| | - Hua Chen
- grid.414252.40000 0004 1761 8894Department of Orthopaedics, the First Medical Center, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian, Beijing, 100853 China
| | - Peifu Tang
- grid.414252.40000 0004 1761 8894Department of Orthopaedics, the First Medical Center, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian, Beijing, 100853 China
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Conversion of failed internal fixation in proximal femur fractures using calcar-guided short-stem total hip arthroplasty. J Orthop Traumatol 2022; 23:34. [PMID: 35876963 PMCID: PMC9310680 DOI: 10.1186/s10195-022-00655-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 07/11/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Reoperations for secondary osteoarthritis, osteonecrosis, or hardware failure following failed internal fixation after intertrochanteric fracture (ITF) or femoral neck fracture (FNF) are common. An effective salvage treatment often involves complete removal of the hardware followed by total hip arthroplasty (THA). Almost no data are available regarding conversion to short-stem THA. This study aimed to evaluate clinical and radiological outcomes, potential complications, and the survival rate of short-stem THA following revision surgery. METHODS We investigated 27 patients who underwent conversion THA using a calcar-guided short stem. Patient-reported outcome measurements were obtained, including the Harris hip score, the Western Ontario and McMaster Universities Osteoarthritis Index, as well as pain and satisfaction on the visual analogue scale. Radiological follow-up was also performed. RESULTS We identified 18 (66.7%) patients diagnosed with FNF and 9 (33.3%) patients with ITF. Clinical and radiological outcomes were satisfactory at the last follow-up (30.56 ± 11.62 months). One patient required early revision surgery due to dislocation and greater trochanter fracture. At the last follow-up, none of the short stems required revision. No other major complications occurred. CONCLUSION Given the low rate of complications and 100% survival, our findings indicate that short stems for conversion THA due to failed internal fixation may be considered an option in a properly selected patient population. However, it should not be considered a standard procedure and should only be performed by experienced surgeons.
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7
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Ma HH, Chou TFA, Tsai SW, Chen CF, Wu PK, Chen WM. Is there a role for cementless primary stem in hip arthroplasty for early or late fixation failures of intertrochanteric fractures? BMC Musculoskelet Disord 2022; 23:266. [PMID: 35303844 PMCID: PMC8933997 DOI: 10.1186/s12891-022-05223-x] [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: 10/11/2021] [Accepted: 03/14/2022] [Indexed: 11/24/2022] Open
Abstract
Background The choice of femur stems during the hip arthroplasty procedures for patients with treatment failure of intertrochanteric fractures (ITF) remains controversial. We aimed to compare the surgical complication and reoperation rates between cementless primary and revision stems in the early (≤3 months) and late (> 3 months) fixation failures of ITF. Methods This was a retrospective, cohort study conducted in a single, tertiary referral hospital of Taipei, Taiwan. We included hip arthroplasty procedures for failed ITF using cementless primary or revision stems. There were 40 and 35 patients who had early and late fixation failure of ITF, respectively. The patient demographics, time to fixation failure, surgical complications and medical complications were recorded for analysis. Results We included 75 patients that underwent hip arthroplasty procedure for failed ITF using cementless primary (n = 38) or revision (n = 37) stems. The mean age was 79.3 years and 56% of the patients were female. In the early fixation failure group, the complication rate was similar between the primary and revision stems (44% vs. 29%, p = 0.343). However, there was a trend toward a higher reoperation rate (31% vs. 8%, p = 0.061) of using the primary stem, compared with the revision stem. In the late fixation failure group, the rate of complication and reoperation was similar between the two stem types. Conclusion For early fixation failures of ITFs, we caution against the use of cementless primary stems due to a trend towards an increased risk of reoperations compared to the use of cementless revision stems. However, in late fixation failures of ITFs, there is a role for cementless primary stems. Level of evidence III, retrospective cohort study. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05223-x.
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Affiliation(s)
- Hsuan-Hsiao Ma
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei, 112, Taiwan.,Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Te-Feng Arthur Chou
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei, 112, Taiwan.,Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shang-Wen Tsai
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei, 112, Taiwan. .,Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Cheng-Fong Chen
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei, 112, Taiwan.,Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Po-Kuei Wu
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei, 112, Taiwan.,Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wei-Ming Chen
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei, 112, Taiwan.,Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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8
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M Mares J, Hadeed MM, Parry JA. Treatment of intertrochanteric nonunion after sliding hip screw fixation with a short cephalomedullary nail. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:1415-1421. [PMID: 34477958 DOI: 10.1007/s00590-021-03108-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 08/25/2021] [Indexed: 11/29/2022]
Abstract
Intertrochanteric femur fracture nonunions are a rare complication that can be difficult to treat with limited evidence regarding treatment options. Revision fixation is typically reserved for well-aligned nonunions with sufficient femoral head bone stock. The most common implant used for revision fixation is a sliding hip screw implant. The use of a short cephalomedullary nail (CMN) for revision fixation has not been previously reported. This article presents a technique for reamed short CMN revision fixation of well-aligned nonunions with sufficient bone stock that is a simpler and potentially less morbid treatment option compared to open procedures with fixed-angle devices. For nonunions with poor femoral head bone stock and/or malaligned fractures, a fixed-angle implant, with or without a valgus osteotomy, may be necessary, while arthroplasty is reserved for nonunions with poor proximal femur bone stock that are not amenable to fixed-angle implant fixation.
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Affiliation(s)
- Joshua M Mares
- Department of Orthopaedics, Denver Health Medical Center, University of Colorado School of Medicine, 777 Bannock St, MC 0188, Denver, CO, 80204, USA
| | - Michael M Hadeed
- Department of Orthopaedics, Denver Health Medical Center, University of Colorado School of Medicine, 777 Bannock St, MC 0188, Denver, CO, 80204, USA
| | - Joshua A Parry
- Department of Orthopaedics, Denver Health Medical Center, University of Colorado School of Medicine, 777 Bannock St, MC 0188, Denver, CO, 80204, USA.
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9
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Innocenti M, Guido D, Cozzi Lepri A, Maritato E, Carulli C, Matassi F, Civinini R. Proximal femoral replacement: A salvage treatment of cephalomedullary nails' mechanical failures in the elderly population. Injury 2021; 52:1868-1874. [PMID: 33910684 DOI: 10.1016/j.injury.2021.04.038] [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: 01/06/2021] [Revised: 04/08/2021] [Accepted: 04/10/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The use of proximal femoral replacements (PFR) has been recently described for catastrophic internal fixation failures. PFR is an attractive treatment option because it is technically straightforward and allows for immediate mobilization of the patient. The aim of the study was to determine the survivorship, functional outcome and complications' rate in a group of elderly patients who underwent proximal femoral replacement as a salvage treatment after femur cephalomedullary nails' mechanical failures. METHODS We evaluated 21 patients who underwent salvage of a failed cephalomedullary nail by using a single design PFR at our institution between 2014-2017. A cemented stem was used in all cases. Radiographs were assessed for fractures, sign of loosening, presence of heterotopic ossification and leg length discrepancy. Functional evaluation was performed through Harris Hip Score (HHS), FIM™ and Time Up and Go test (TUG). Kaplan-Meier estimator was used to determine the overall implants' survival. RESULTS The average age at the time of surgery was 83years. The mean follow-up was 3.1years. We recorded 3 dislocations of which 2 required a revision. No case of septic or aseptic failure was reported. Two patients died respectively at 11 and 14 months after surgery. At the last follow-up the mean HHS, FIM™, and the TUG improved significantly (p<0.05). CONCLUSION Immediate weight bearing, good functional outcomes, low complications' and one-year mortality rate make the proximal femur replacement with megaprostheses a potential first line treatment of intertrochanteric/subtrochanteric fixations' failures among elderly, osteoporotic, frail patients. Dislocation is the most common complication to bear in mind within the first six months after surgery.
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Affiliation(s)
- Matteo Innocenti
- University of Florence, Orthopaedic Clinic CTO, Largo Palagi 1 50139 Florence, Italy.
| | - Davide Guido
- University of Florence, Orthopaedic Clinic CTO, Largo Palagi 1 50139 Florence, Italy
| | - Andrea Cozzi Lepri
- University of Florence, Orthopaedic Clinic CTO, Largo Palagi 1 50139 Florence, Italy
| | - Ernesto Maritato
- University of Florence, Orthopaedic Clinic CTO, Largo Palagi 1 50139 Florence, Italy
| | - Christian Carulli
- University of Florence, Orthopaedic Clinic CTO, Largo Palagi 1 50139 Florence, Italy.
| | - Fabrizio Matassi
- University of Florence, Orthopaedic Clinic CTO, Largo Palagi 1 50139 Florence, Italy
| | - Roberto Civinini
- University of Florence, Orthopaedic Clinic CTO, Largo Palagi 1 50139 Florence, Italy.
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10
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Zhong G, Teng L, Li HB, Huang FG, Xiang Z, Cen SQ. Surgical Treatment of Internal Fixation Failure of Femoral Peritrochanteric Fracture. Orthop Surg 2021; 13:1739-1747. [PMID: 34142451 PMCID: PMC8523769 DOI: 10.1111/os.13110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 05/20/2021] [Accepted: 05/23/2021] [Indexed: 02/05/2023] Open
Abstract
Objective To investigate the factors, surgical treatment methods and clinical effect of internal fixation failure of intertrochanteric and subtrochanteric fractures. Methods From June 2015 to May 2019, arthroplasty and internal fixation revision were used to treat 18 cases of internal fixation failure of intertrochanteric and subtrochanteric fractures. There were 10 males and eight females, with an average age of 67.3 years (38–92 years). The 16 cases of initial intertrochanteric fractures were classified according to AO/OTA:13 cases of A2 and 3 cases of A3, the other 2 cases were subtrochanteric fractures (Seinsheimer type IV). The internal fixation failure was treated with total hip arthroplasty (6 cases), bipolar hemiarthroplasty (4 cases), revision with proximal femoral lockingplate (4 cases) and extend intramedullary nail (4 cases). Results All patients were followed up for an average of 24.7 months (range, 12 to 36 months). The average operative time was 111.4 min (range, 72 to 146 min) and the average intraoperative blood loss was 403.6 mL (range, 200 to 650 mL). The average time of fracture union was 6.9 months (range, 5 to 9 months) for cases of internal fixation revision. The operative time of the arthroplasty group was shorter than the revision group (P < 0.001), and the intraoperative blood loss of the arthroplasty group was less than the revision group (P = 0.001). The affected limb shortening of postoperative (0.21 ± 0.19 cm) was better than preoperative (2.01 ± 0.60 cm) (P < 0.001), while the limb shortening of the arthroplasty group (0.11 ± 0.21 cm) was less than the revision group (0.33 ± 0.09 cm) (P = 0.015). At the last follow‐up, all injured limbs regained walking function, and the Harris hip score was 81.3 ± 9.4 points. The Harris score of postoperative was better than preoperative (33.4 ± 5.9 points) (P < 0.001), while there were no significant differences between the arthroplasty group and the revision group at 3 months (76.5 ± 8.5 vs 71.1 ± 10.6, P = 0.249), 6 months (80.9 ± 7.9 vs 78.9 ± 12.9,P = 0.687) postoperative and the last follow‐up (80.5 ± 8.3 vs 82.3 ± 11.7, P = 0.716) respectively. Conclusion For internal fixation failure of peritrochanteric fractures, young patients could accept internal fixation revision to restore normal anatomical structure, correct varus deformity and autograft; while elderly patients and patients with damaged femoral head could be treated with arthroplasty to restore walking function.
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Affiliation(s)
- Gang Zhong
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China
| | - Lin Teng
- Department of Orthopaedics, The First People's Hospital in Shuangliu Distract/West China Airport Hospital, Sichuan University, Chengdu, China
| | - Hai-Bo Li
- Department of Orthopaedics, The First People's Hospital in Shuangliu Distract/West China Airport Hospital, Sichuan University, Chengdu, China
| | - Fu-Guo Huang
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China
| | - Zhou Xiang
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China
| | - Shi-Qiang Cen
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China
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Evaluation and management of atypical femoral fractures: an update of current knowledge. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 31:825-840. [PMID: 33590316 DOI: 10.1007/s00590-021-02896-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 01/29/2021] [Indexed: 12/12/2022]
Abstract
Atypical femoral fractures are often attributed to the use of anti-resorptive medications such as bisphosphonates (BP). Whilst they have proven effects on fragility fracture prevention, clinical and laboratory evidence is evolving linking BP-related suppression of bone remodelling to the development of atypical stress-related sub-trochanteric fractures (Shane et al. in JBMR 29:1-23, 2014; Odvina et al. in JCEM 90:1294-301, 2005; Durchschlag et al. in JBMR 21(10):1581-1590, 2006; Donnelly et al. in JBMR 27:672-678, 2012; Mashiba et al. in Bone 28(5):524-531, 2001; Dell et al. in JBMR 27(12):2544-2550, 2012; Black et al. in Lancet 348:1535-1541, 1996; Black et al. in NEJM 356:1809-1822, 2007; Black et al. in JAMA 296:2927-2938, 2006; Schwartz et al. in JBMR 25:976-82, 2010). Injuries may present asymptomatically or with prodromal thigh pain and most can be successfully managed with cephalomedullary nailing and discontinuation of BP therapy. Such injuries exhibit a prolonged time to fracture union with high rates of non-union and metal-work failure when compared to typical subtrochanteric osteoporotic femoral fractures. Despite emerging literature on AFFs, their management continues to pose a challenge to the orthopaedic and extended multi-disciplinary team. The purpose of this review includes evaluation of the current evidence supporting the management of AFFs, clinical and radiological features associated with their presentation and a review of reported surgical strategies to treat and prevent these devastating injures.
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12
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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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Salvage treatment of failed internal fixation of intertrochanteric fractures: What factors determine the failure of treatment? Injury 2020; 51:367-371. [PMID: 31822345 DOI: 10.1016/j.injury.2019.12.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 10/28/2019] [Accepted: 12/03/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The purpose of this study is to evaluate the clinical and radiographic result in patients who got salvage treatment for the failed fixation of intertrochanteric fracture and to evaluate the factors that may affect healing of these treatment. PATIENTS AND METHODS Between 1997 and 2016, 39 patients who could be followed up for more than 1 year after treatment were enrolled. For determining of factor that may affect healing of treatment, the primary outcome was based on union. There were success group which achieved a restored union and failure group which had an additional revisional surgery because of another complication for analysis. And neck-shaft angle (NSA) was measured with a goniometer. RESULTS Fracture healing as a primary outcome (after revision surgery) was achieved 31 out of 39 patients (80%). There were no statistically significant differences between two groups in terms of age, sex, BMI and laterality. In the clinical outcomes, four categories of outcomes were compared between the success and failure groups and significant improvements were observed. In measurements at final follow-up, it the angle was 133.4° in the success group and 123.4° in the failure group. CONCLUSION The clinical and radiographic results of the salvage treatment for the failed fixation of intertrochanteric fracture were satisfactory in our study. Restoration of femoral neck-shaft angle of failed intertrochanteric fracture is key factors for obtaining successful results.
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Ehlinger M, Favreau H, Eichler D, Adam P, Bonnomet F. Early mechanical complications following fixation of proximal femur fractures: From prevention to treatment. Orthop Traumatol Surg Res 2020; 106:S79-S87. [PMID: 31680016 DOI: 10.1016/j.otsr.2019.02.027] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 02/13/2019] [Accepted: 02/13/2019] [Indexed: 02/02/2023]
Abstract
Proximal femur fractures have significant functional repercussions in both older adults (sometimes life-threatening) and younger adults (socioeconomic). This study will review the early mechanical complications (EMC) associated with the fixation of femoral neck (FNF) and trochanteric (TF) fractures. What is the nature of these complications? They consist of incorrect fracture fixation, secondary displacement and/or fixation failure (FNF: 3-10%; TF: 5-7%), and more rarely, secondary fractures distal to the implant. What are the risk factors and how can they be controlled? They are related to the patient (osteoporosis), to the type of fracture (FNF: posterior comminution, magnitude of displacement, vertical fracture line, fracture of calcar/TF: comminution of calcar, lesser trochanter fracture, metaphyseal comminution, lateral cortex fracture, greater trochanter comminution), to the chosen treatment (FNF: triple screw fixation or screw-plate are preferable/TF: all implants suitable for simple fractures, cervicomedullary implants for complex fractures), and to the surgical technique (quality of reduction, implant positioning). How should they be treated? Early revision of internal fixation can be difficult and increases the infection risk. Inter- or subtrochanteric valgus osteotomy leads to satisfactory results but is difficult to carry out. Secondary arthroplasty, which is the preferred option in older adults, leads to good outcomes but is technically more difficult, and has a higher complication rate in EMC of trochanteric fractures. LEVEL OF EVIDENCE: V.
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Affiliation(s)
- Matthieu Ehlinger
- Service de chirurgie orthopédique et de traumatologie, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France; Laboratoire ICube, CNRS UMR 7357, 30, boulevard Sébastien-Brant, 67400 Ilkirch, France.
| | - Henri Favreau
- Service de chirurgie orthopédique et de traumatologie, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - David Eichler
- Service de chirurgie orthopédique et de traumatologie, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - Philippe Adam
- Service de chirurgie orthopédique et de traumatologie, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France; Laboratoire ICube, CNRS UMR 7357, 30, boulevard Sébastien-Brant, 67400 Ilkirch, France
| | - François Bonnomet
- Service de chirurgie orthopédique et de traumatologie, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France
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Taheriazam A, Saeidinia A. Salvage of failed dynamic hip screw fixation of intertrochanteric fractures. Orthop Res Rev 2019; 11:93-98. [PMID: 31686921 PMCID: PMC6709790 DOI: 10.2147/orr.s215240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 07/23/2019] [Indexed: 11/28/2022] Open
Abstract
Background and aim Failure of intertrochanteric fracture fixation can occur in patients with poor bone quality, extreme osteoporosis, or unstable fracture arrangement. Although hip replacement is a commonly successful process, it includes technical problems, such as implant removal, bone loss, low bone quality, nonunion of trochanter, and difficult surgical exposure. The goal of this study was to restore total hip replacement for failed intertrochanteric fractures to assess the outcomes. Methods During April 2009 to October 2015, 203 patients (203 hips) underwent total hip arthroplasty through the direct lateral approach, as salvage of failed intertrochanteric fracture management by dynamic hip screw (DHS). The restoration process was done by a direct lateral approach (Hardinge) in all hips. The operation details, such as duration, blood transfusion volume, blood loss, and duration of hospital stay, were recorded. Modified Harris hip score (MHHS) was applied for assessment of clinical outcome before and after the operation, and during the follow-up. Results Overall, 112 patients were male (55.17%) and 91 patients (44.8%) were female and the mean of age was 72.58±10.60 years old. Average operation time was 93.96±10.72 minutes. The mean blood loss volume during the operation was 355.86±84.11 mL. The mean preoperative MHHS score was 39.55±6.74 (range: 30–50). The MHHS score improved to 90.55±2.24, 92.34±1.26, and 94.34±1.85 during the first, second, and final follow-up, respectively (P<0.0001). Infection was found in only two patients, who had undergone one stage revision and linear of the cup was exchanged. Total rate of complications during the follow-up was 4.92%. Conclusion The current research was a large population study and indicated that sufficient functional outcome could be obtained by total hip replacement in geriatrics with failed intertrochanteric fractures. Therefore, well-performed hip replacement could be a suitable choice for restoring failed DHS in unsuccessfully managed intertrochanteric fractures in the elderly.
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Affiliation(s)
- Afshin Taheriazam
- Department of Orthopedics Surgery, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran
| | - Amin Saeidinia
- Faculty of Medicine, Guilan University of Medical Sciences, Rasht, Iran.,Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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The utility of the angled blade plate in hip fracture nonunion treatment: A report of three cases and review of the literature. OTA Int 2019; 2:e041. [PMID: 33937669 PMCID: PMC7997124 DOI: 10.1097/oi9.0000000000000041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 06/04/2019] [Indexed: 01/05/2023]
Abstract
Objectives: We report the radiographic and clinical outcome of patients treated with an angled blade plate (ABP) for hip fracture nonunion. We also provide a review of the literature on joint preserving treatment approaches to hip fracture nonunions. Design: Retrospective, case series. Setting: Tertiary academic hospital. Patients/Participants: Three. Intervention: We treated three patients with varied hip fracture nonunions using a joint preserving approach with an ABP. Main outcome measurements: Radiographic union and clinical outcome. Results: All three patients achieved radiographic union, and were ambulating without pain at final follow-up. Conclusions: The treatment approach to hip fracture nonunions is either restorative (joint preserving) or reconstructive (joint replacing). The primary restorative approach to nonunions around the hip consists of revision open reduction and internal fixation with or without bone grafting. Though a variety of implants and treatment techniques have demonstrated excellent success in this setting, revision open reduction and internal fixation with an ABP remains an efficacious implant selection in hip nonunion surgery.
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Babcock S, Kellam JF. Hip Fracture Nonunions: Diagnosis, Treatment, and Special Considerations in Elderly Patients. Adv Orthop 2018; 2018:1912762. [PMID: 30595922 PMCID: PMC6286768 DOI: 10.1155/2018/1912762] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 10/11/2018] [Accepted: 10/22/2018] [Indexed: 12/19/2022] Open
Abstract
In the United States, more than 300,000 hip fractures occur annually in the elderly population with associated significant morbidity and mortality. Both intracapsular and extracapsular hip fractures have inherent treatment challenges and therefore are at risk of nonunion complications. A systematic assessment including radiographic, metabolic, and infectious evaluations should be completed for all patients suspected of nonunion. Failed internal fixation of intracapsular hip fractures is typically treated with arthroplasty, while extracapsular proximal femur nonunions may be amenable to revision internal fixation or arthroplasty. While not a classic hip fracture, bisphosphate associated subtrochanteric femur fractures affect a similar patient population and are historically difficult to treat. Atypical subtrochanteric femur fractures are at increased risk of nonunion given the altered biologic environment secondary to bisphosphonate use; therefore adjuvant therapies may be beneficial in setting of revision fixation. Having a thorough understanding of nonunion risks, recognition, evaluation, and treatment is necessary for appropriate patient care.
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Affiliation(s)
- Sharon Babcock
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - James F. Kellam
- Department of Orthopaedic Surgery, UT Health Science Center at Houston, Houston, TX, USA
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Morice A, Ducellier F, Bizot P. Total hip arthroplasty after failed fixation of a proximal femur fracture: Analysis of 59 cases of intra- and extra-capsular fractures. Orthop Traumatol Surg Res 2018; 104:681-686. [PMID: 29908356 DOI: 10.1016/j.otsr.2018.04.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 04/06/2018] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The indications for total hip arthroplasty (THA) after failed internal fixation of a proximal femur fracture vary. Published studies on this topic are broad-ranging and do not distinguish between intracapsular and extracapsular fractures. This led us to conduct a retrospective analysis comparing the clinical outcomes, radiological outcomes, technical problems and complications between these two types of fractures. HYPOTHESIS The functional outcomes of THA after an extracapsular fracture will be worse than the ones after an intracapsular fracture. MATERIAL AND METHODS This was a retrospective, single-center study of 59 THA cases performed after internal fixation of a proximal femur fracture. These procedures were performed between 2002 and 2013 in 58 patients (22 men, 36 women). There were 40 intracapsular fractures and 19 extracapsular fractures. The initial fracture fixation involved a screw-plate (n=50), intramedullary nail (n=6) or screws (n=3). The mean patient age at the time of THA was 67 years [22-94]. The THA was performed an average of 2.8 years [0.2-28] after the fracture. The posterolateral approach was used in 55 cases (93%). Ten patients (17%) had the fixation hardware removed before the THA procedure, on average at 30 months [1-240] after the fracture. During the THA procedure, a cemented stem was used in 31 cases (53%) and a cementless stem in 28 cases (47%). A cementless press-fit cup was used in 56 cases (95%), of which 35 were dual mobility cups (60%), and a cemented cup was used in the other 3 cases (5%). All patients were reviewed by a physician not involved in the surgical procedures who performed a clinical and radiological examination. RESULTS No patients were lost to follow-up; two patients died. Ten patients suffered an intraoperative femur fracture (17%) and four suffered a dislocation (2 early, 2 late) (6.8%). Nine hips had to be reoperated (15%), of which five required an implant change (8.5%). There were significantly more intraoperative fractures and postoperative complications in the THA cases after extracapsular fracture. With a mean follow-up of 38 months [12-149], the mean PMA and Harris scores were 14.6 [3-18] and 74 [10-100], respectively; these scores were significantly lower in the THA cases after extracapsular fracture (p<0.05). With an endpoint of revision with implant change, the overall 40-month survival was 94% (95% CI: 0.25-0.55); it was 97% (95% CI: 0.62-0.85) for the intracapsular fracture cases and 84% (95% CI: 0.39-0.75) for the extracapsular fracture cases (p<0.05). CONCLUSION Secondary THA after failed fixation of proximal femur fractures has more complications than primary THA. Subgroup analysis identified more technical problems in the THA cases after extracapsular fracture and a higher number of complications, particularly dislocation and periprosthetic fractures. LEVEL OF EVIDENCE IV - Retrospective study.
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Affiliation(s)
- Antoine Morice
- Service de chirurgie orthopédique et traumatologique, centre hospitalier d'Agen-Nerac, Route de Villeneuves sur Lot, 47923 Agen, France.
| | - Florian Ducellier
- Service de chirurgie orthopédique et traumatologique, CHU d'Angers, 4, rue Larrey, 49100 Angers, France
| | - Pascal Bizot
- Service de chirurgie orthopédique et traumatologique, CHU de Lariboisière, université Paris-Diderot, AP-HP, 2, rue Ambroise-Paré, 75475 Paris, France
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- SOO - Société d'orthopédie de l'ouest, 18, rue de Bellinière, 49800 Trélazé, France
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Gao YS. Commentary on "Better Prognosis of Senile Patients with Intertrochanteric Femoral Fracture by Treatment with Open Reduction Internal Fixation than by Hip Arthroplasty". J INVEST SURG 2017; 31:438-439. [PMID: 28708942 DOI: 10.1080/08941939.2017.1341574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- You-Shui Gao
- a Department of Orthopedic Surgery , Shanghai Jiao Tong University Affiliated Sixth People's Hospital , Shanghai , China
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Sun Q, Fan G, Li X, Gong J, Ge W, Cai M. Relationship Between Femur and Femoral Arteries for Identifying Risk Factors for Vascular Injury. Med Sci Monit 2017; 23:1733-1740. [PMID: 28392552 PMCID: PMC5399797 DOI: 10.12659/msm.900252] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background This study aimed to identify risk factors for vascular injury in proximal femoral fracture through identifying frequency and distances between femur and femoral arteries with computed tomography angiography and 3-dimensional reconstruction. Material/Methods In a series of 400 participants, based on measurement results regarding the distribution of femoral arteries in the medial femur, the femoral portion covering that part was divided into levels A–E. The center region, margin region, and risky area in the medial femur were defined. The frequency of femoral arteries and interested shortest distance between the outer femur and superficial, deep, and perforating femoral arteries (SFAs, DFAs, and PFAs) in the center region, margin region, and risky area at each level were recorded. Results There were 173 males and 227 females (average age: 63.61±19.18 years) in this study. The starting point and end point for femoral arteries in the medial femur were from 22.55±4.23% to 54.56±8.39% of the whole femur. The femoral arteries in the medial femur mainly were distributed at levels B (88.2%), C (65.9%), and D (40.6%). The femoral arteries in center regions in the risky area, most of which were DFAs and PFAs, were mainly concentrated at levels B (26.93%) and C (11.81%). Conclusions The mid-shaft level was the most risky level, and the DFAs and PFAs were easier to injure than the SFAs when performing internal fixation of proximal femoral fracture. We recommended that great attention be paid to drill and screw insertion around the mid-shaft level for prevention of iatrogenic vascular injury.
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Affiliation(s)
- Qi Sun
- Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, China (mainland)
| | - GuoXin Fan
- Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, China (mainland)
| | - XiFan Li
- Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, China (mainland)
| | - JinPeng Gong
- Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, China (mainland)
| | - Wei Ge
- Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, China (mainland)
| | - Ming Cai
- Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, China (mainland)
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Reverse polyaxial less invasive stabilization systems for treatment of femoral intertrochanteric fractures of the distal femur. Arch Orthop Trauma Surg 2016; 136:1531-1537. [PMID: 27511196 DOI: 10.1007/s00402-016-2542-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The reverse less invasive stabilization system (LISS) for the distal femur remains generally regarded as a safe and satisfactory option for the treatment of unstable proximal femoral fractures. The polyaxial LISS provides a reverse plating technique that leverages the advantages of proximal screws by allowing the adjustable locking screw to be better positioned and providing more reliable fixation on the proximal femur compared with the standard axial LISS. To assess this fixation method, a detailed evaluation of institutional outcomes of femoral intertrochanteric fractures treated with reverse polyaxial LISS was performed. MATERIALS AND METHODS A total of 29 patients presenting with femoral intertrochanteric fractures were treated with the reverse polyaxial LISS system between January 2010 and March 2011. Patients were classified into stable and unstable fracture groups according to the Orthopaedic Trauma Association's (OTA) classification. Clinical data, including operative time, blood loss, radiological records and complications, Harris Hip scores and Parker scores, were collected and analyzed. RESULTS There were no significant between-group differences in age, sex, or American Society of Anesthesiologists score. Operative time and blood loss were significantly higher in the unstable fracture group compared with the stable fracture group. Four cases of fixation failure, consisting of one case of A2.3, one case of A3.2 and two cases of A3.3, occurred 4-7 m postoperatively. CONCLUSIONS Treatment of femoral intertrochanteric fractures with unstable pattern using polyaxial reverse LISS results in high failure rates; therefore, it should not be recommended as a routine alternative method for the treatment of femoral intertrochanteric fractures with unstable pattern.
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Varghese VD, Livingston A, Boopalan PR, Jepegnanam TS. Valgus osteotomy for nonunion and neglected neck of femur fractures. World J Orthop 2016; 7:301-307. [PMID: 27190758 PMCID: PMC4865720 DOI: 10.5312/wjo.v7.i5.301] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 01/27/2016] [Accepted: 02/24/2016] [Indexed: 02/06/2023] Open
Abstract
Nonunion neck of femur can be a difficult problem to treat, particularly in the young, and is associated with high complication rates of avascular necrosis due to the precarious blood supply and poor biomechanics. The various treatment options that have been described can be broadly divided according to the aim of improving either biology or biomechanics. Surgeries aimed at improving the biology, such as vascularized fibula grafting, have good success rates but require high levels of expertise and substantial resources. A popular surgical treatment aimed at improving the biomechanics-valgus intertrochanteric osteotomy-optimizes conditions for fracture healing by converting shear forces across the fracture site into compressive forces. Numerous variations of this surgical procedure have been developed and successfully applied in clinical practice. As a result, the proximal femoral orientation for obtaining a good functional outcome has evolved over the years, and the present concept of altering the proximal femoral anatomy as little as possible has arisen. This technical objective supports attaining union as well as a good functional outcome, since excessive valgus can lead to increased joint reaction forces. This review summarizes the historical and current literature on valgus intertrochanteric osteotomy treatment of nonunion neck of femur, with a focus on factors predictive of good functional outcome and potential pitfalls to be avoided as well as controversies surrounding this procedure.
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Tsai SW, Chen CF, Wu PK, Huang CK, Chen WM, Chang MC. Does Implant Selection Impact Postoperative Complications Following Hip Arthroplasty for Failed Intertrochanteric Fractures? A Retrospective Comparative Study. Artif Organs 2016; 40:798-804. [DOI: 10.1111/aor.12676] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Shang-Wen Tsai
- Taipei Veterans General Hospital-Orthopaedics and Traumatology; Taipei Taiwan
- Department of Orthopedics; School of Medicine; National Yang-Ming University; Taipei Taiwan
| | - Cheng-Fong Chen
- Taipei Veterans General Hospital-Orthopaedics and Traumatology; Taipei Taiwan
- Department of Orthopedics; School of Medicine; National Yang-Ming University; Taipei Taiwan
| | - Po-Kuei Wu
- Taipei Veterans General Hospital-Orthopaedics and Traumatology; Taipei Taiwan
- Department of Orthopedics; School of Medicine; National Yang-Ming University; Taipei Taiwan
| | - Ching-Kuei Huang
- Taipei Veterans General Hospital-Orthopaedics and Traumatology; Taipei Taiwan
- Department of Orthopedics; School of Medicine; National Yang-Ming University; Taipei Taiwan
| | - Wei-Ming Chen
- Taipei Veterans General Hospital-Orthopaedics and Traumatology; Taipei Taiwan
- Department of Orthopedics; School of Medicine; National Yang-Ming University; Taipei Taiwan
| | - Ming-Chau Chang
- Taipei Veterans General Hospital-Orthopaedics and Traumatology; Taipei Taiwan
- Department of Orthopedics; School of Medicine; National Yang-Ming University; Taipei Taiwan
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Considerations with failed intertrochanteric and subtrochanteric femur fractures: how to treat, revise, and replace. J Orthop Trauma 2015; 29 Suppl 4:S17-21. [PMID: 25756822 DOI: 10.1097/bot.0000000000000289] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
With the increasing number of intertrochanteric and subtrochanteric femur fractures, there will be an increasing need for surgical intervention. As a result, there will be an increasing number of failures and the need for revision surgery. The following outlines some of the pitfalls related to these complex fractures and options for revision surgery.
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Lee WT, Murphy D, Kagda FHY, Thambiah J. Proximal femoral locking compression plate for proximal femoral fractures. J Orthop Surg (Hong Kong) 2014; 22:287-93. [PMID: 25550004 DOI: 10.1177/230949901402200304] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To review short-term outcomes of proximal femoral locking compression plate (PF-LCP) fixation for proximal femoral fractures in terms of postoperative complications and failure rates. METHODS Medical records of 21 men and 5 women aged 22 to 85 (mean, 49.7) years who underwent internal fixation with the PF-LCP for proximal femoral fractures were reviewed. Younger patients (mean age, 38.7 years) were more commonly involved in high-energy trauma with multiple musculoskeletal injuries, whereas older patients (mean age, 67.7 years) were more commonly involved in low-energy trauma. Fractures were classified into: multi-fragmentary pertrochanteric fractures (n=13), transtrochanteric fractures (n=6), and subtrochanteric/proximal diaphyseal fractures (n=7). RESULTS Patients were followed up for a mean of 14.7 months. Seven patients developed complications including loosening of locking screws (n=4), delayed union (n=2), and infection (n=1); 4 of them required additional surgeries. CONCLUSION The PF-LCP is appropriate for complex proximal femoral fractures with poor bone quality, revision surgeries, and multi-fragmentary subtrochanteric/proximal diaphyseal fractures. For intertrochanteric fractures, the sliding hip screw system should be used to avoid failure.
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Affiliation(s)
- Wei Ting Lee
- Department of Orthopaedic Surgery, National University Hospital, Singapore
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Treatment and displacement affect the reoperation rate for femoral neck fracture. Clin Orthop Relat Res 2013; 471:2691-702. [PMID: 23640205 PMCID: PMC3705035 DOI: 10.1007/s11999-013-3020-9] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 04/22/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Femoral neck fractures (FNFs) comprise 50% of geriatric hip fractures. Appropriate management requires surgeons to balance potential risks and associated healthcare costs with surgical treatment. Treatment complications can lead to reoperation resulting in increased patient risks and costs. Understanding etiologies of treatment failure and the population at risk may decrease reoperation rates. QUESTIONS/PURPOSES We therefore (1) determined if treatment modality and/or displacement affected reoperation rates after FNF; and (2) identified factors associated with increased reoperation and timing and reasons for reoperation. METHODS We reviewed 1411 records of patients older than 60 years treated for FNF with internal fixation or hemiarthroplasty between 1998 and 2009. We extracted patient age, sex, fracture classification, treatment modality and date, occurrence of and reasons for reoperation, comorbid conditions at the time of each surgery, and dates of death or last contact. Minimum followup was 12 months (median, 45 months; range, 12-157 months). RESULTS Internal fixation (hazard ratio [HR], 6.38) and displacement (HR, 2.92) were independently associated with increased reoperation rates. The reoperation rate for nondisplaced fractures treated with fixation was 15% and for displaced fractures 38% after fixation and 7% after hemiarthroplasty. Most fractures treated with fixation underwent reoperation within 1 year primarily for nonunion. Most fractures treated with hemiarthroplasty underwent reoperation within 3 months, primarily for infection. CONCLUSIONS Overall, hemiarthroplasty resulted in fewer reoperations versus internal fixation and displaced fractures underwent reoperation more than nondisplaced. Our data suggest there are fewer reoperations when treating elderly patients with displaced FNFs with hemiarthroplasty than with internal fixation.
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Gadegone WM, Ramteke AA, Lokhande V, Salphade Y. Valgus intertrochanteric osteotomy and fibular strut graft in the management of neglected femoral neck fracture. Injury 2013; 44:763-8. [PMID: 23063702 DOI: 10.1016/j.injury.2012.09.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2012] [Revised: 09/07/2012] [Accepted: 09/19/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE A prospective study of neglected femoral neck fractures in mostly young patients was conducted to evaluate whether our technique of valgus intertrochanteric osteotomy with fibular strut grafting and osteosynthesis with dynamic hip screw and double-angle side plate can facilitate union with consistent satisfactory clinical outcomes. METHODS Forty-one consecutive patients (27 males, 14 females) of neglected femoral neck fractures treated between April 2002 and December 2009 were studied. The average age of patients was 45.41 years (±11.67, range 20-62 years). The average interval since injury was 14 weeks (±10.21, range 4-44 weeks). The cases were evaluated radiographically and clinically. RESULTS The average follow-up period was 32.5 months (±8, range 24-54 months). Radiographically union was seen in 39 patients at the nonunion site. The average time to radiographic union was 16.82 weeks (±3 weeks, range 12-24 weeks). Average Harris Hip Score (HHS) was 19.9 (±7.9, range 10-35) preoperatively and 90.9 (±10.35, range 62-100) at the latest follow-up. At that time clinical outcomes were excellent in 31, good in four, fair in three and poor in three patients. CONCLUSION Our mechanobiological surgical technique is reproducible with radiographic union achieved in 95.12% cases (39 patients) at the nonunion site and consistent excellent or good functional outcome in 85% of patients over a 32-month average follow-up. We recommend this procedure for neglected femoral neck fractures.
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Affiliation(s)
- Wasudeo M Gadegone
- Department of Orthopaedics & Traumatology, Chandrapur Multispeciality Hospital, Mul Road, Chandrapur, India.
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Gavaskar AS, Chowdary NT. Valgus sliding subtrochanteric osteotomy for neglected fractures of the proximal femur; surgical technique and a retrospective case series. J Orthop Surg Res 2013; 8:4. [PMID: 23497534 PMCID: PMC3643861 DOI: 10.1186/1749-799x-8-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2011] [Accepted: 03/05/2013] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Conventional technique of valgus osteotomy of the proximal femur involves removal of a partial or full thickness lateral based wedge from the peritrochanteric region. The purpose of this article is to describe a novel technique of valgus subtrochanteric osteotomy for proximal femur nonunion. METHODS 11 patients with proximal femur nonunions {intracapsular fractures--7, extracapsular fractures--4} were treated using a new technique of sliding subtrochanteric osteotomy and DHS fixation. Outcomes analysed include radiological outcome in terms of improvement in Pauwel's angle, neck-shaft angle and evidence of radiological union at the nonunion site and osteotomy site. Other outcomes analysed include, measurement of limb length discrepancy and functional outcome assessment with Oxford hip score. RESULTS Union at the nonunion site and the osteotomy site was achieved in all patients. There were significant improvements in the postoperative Pauwel's angle, neck shaft angle and Oxford hip score. Limb length discrepancy improved to less than 1 cm in all patients. There was no x ray evidence of avascular necrosis of the femoral head at one year follow-up. CONCLUSIONS The sliding osteotomy technique is simple, does not need extensive pre operative planning or removal of bone from the proximal femur.
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Abouelela AAKH. Salvage of failed trochanteric fracture fixation using the Revitan curved cementless modular hip arthroplasty. J Arthroplasty 2012; 27:1382-8. [PMID: 22146383 DOI: 10.1016/j.arth.2011.10.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2011] [Accepted: 10/19/2011] [Indexed: 02/01/2023] Open
Abstract
Failed internal fixation of an intertrochanteric or subtrochanteric fracture often leads to persistent pain and diminished function. This study evaluated 16 patients treated with Revitan curved cementless modular stem (Zimmer GmbH, Winterthur, Switzerland). At a mean follow-up period of 60 months, all patients demonstrated clinically significant pain relief and return to ambulation after salvage total hip arthroplasty. Mean Harris Hip Score improved from 17.8 to 87.7 points postoperatively. Radiographic follow-up demonstrated stable stem and bony ingrowth in 16 patients without evidence of subsidence. Eight patients had slight awareness of lateral trochanteric pain with no compromise of activities, and 1 patient had nonunion of the greater trochanter. Revitan curved cementless modular stem represents a useful treatment option in salvage total hip arthroplasty of failed pertrochanteric fixation.
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Affiliation(s)
- Amr A K H Abouelela
- Department of Orthopedic Surgery and Traumatology, Ain Shams University Hospitals, Cairo, Egypt
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Kapoor A, Deety LV, John VZ, Devadoss S, Devadoss A. Management of neglected femoral neck fractures and nonunions using a novel triple surgery combination: an Indian experience. INT J LOW EXTR WOUND 2012; 11:49-58. [PMID: 22334596 DOI: 10.1177/1534734612438056] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study describes a 2- to 13-year follow-up of a novel technique for osteosynthesis of neglected femoral neck fractures and nonunions that combines internal fixation with the benefits of fibular grafting and valgus angulation osteotomy. Twenty-three patients were treated by the "3-in-1" surgery, which consisted of osteosynthesis with a dynamic hip screw, nonvascularized fibular grafting, and valgus osteotomy, between January 1996 and June 2009. Union was achieved in all patients at an average of 5.4 months. The average shortening was 0.9 cm. Although avascular necrosis was seen in 4 patients, 2 of them still had good functional scores. Excellent and good hip functional scores were seen in 18 patients. Well-executed surgeries combining biomechanics and biology can ensure union in neglected femoral neck fractures and nonunions provided an adequate length of the neck and proximal fragment is present and there is no subchondral collapse.
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Affiliation(s)
- Amit Kapoor
- Institute of Orthopedic Research and Accident Surgery, Madurai, India
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Konstantinidis L, Papaioannou C, Mehlhorn A, Hirschmüller A, Südkamp NP, Helwig P. Salvage procedures for trochanteric femoral fractures after internal fixation failure: Biomechanical comparison of a plate fixator and the dynamic condylar screw. Proc Inst Mech Eng H 2011; 225:710-7. [DOI: 10.1177/0954411911402133] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study was the biomechanical evaluation of the reversed less invasive stabilization system (LISS) internal fixation as a joint-preserving salvage procedure for trochanteric fractures. Five LISS plates and five dynamic condylar screws (DCS) were tested using synthetic femora (Sawbones®) with an osteotomy model similar to a type-A2.3 pertrochanteric fracture. The constructs were subjected to axial loading up to 1000 N for five cycles. Then, the force was continuously increased until fixation failure. For the evaluation of the biomechanical behaviour, the stiffness levels were recorded and the osteotomy gap displacement was mapped three-dimensionally. The average stiffness for the constructs with LISS plates was 412 N/mm (with a standard deviation (SD) of 103N/mm) and 572 N/mm (SD of 116 N/mm) for the DCS constructs ( p = 0.051). Local displacement at the osteotomy gap did not yield any significant differences. The LISS constructs failed at a mean axial compression of 2103 N (SD of 519 N) and the DCS constructs at a mean of 2572 N (SD of 372 N) ( p = 0.14). It is concluded that the LISS plate offers a reliable fixation alternative for salvage procedures.
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Affiliation(s)
- L Konstantinidis
- Albert-Ludwig-University Freiburg, Department of Orthopedic and Trauma Surgery, Freiburg, Germany
| | - C Papaioannou
- Albert-Ludwig-University Freiburg, Department of Orthopedic and Trauma Surgery, Freiburg, Germany
| | - A Mehlhorn
- Albert-Ludwig-University Freiburg, Department of Orthopedic and Trauma Surgery, Freiburg, Germany
| | - A Hirschmüller
- Albert-Ludwig-University Freiburg, Department of Orthopedic and Trauma Surgery, Freiburg, Germany
| | - N P Südkamp
- Albert-Ludwig-University Freiburg, Department of Orthopedic and Trauma Surgery, Freiburg, Germany
| | - P Helwig
- Albert-Ludwig-University Freiburg, Department of Orthopedic and Trauma Surgery, Freiburg, Germany
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Siddique K, Athanatos L, Housden P. Spontaneous bilateral neck of femur fractures and shoulder dislocation. BMJ Case Rep 2011; 2011:2011/jan20_1/bcr0520103034. [PMID: 22715262 DOI: 10.1136/bcr.05.2010.3034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Non-traumatic fractures mostly present a diagnostic dilemma. Fracture risk is less reported in non-epileptic seizures. Various metabolic conditions leading to a decrease in bone mineral density may also cause fractures. The authors report the case of non-traumatic fracture of an old woman who presented with fever, shortness of breath and right shoulder pain without any history of epilepsy. Episode of seizures was noted prior to admission. The patient had poorly controlled diabetes mellitus and severe hypoglycaemia was noted at the time of admission. She was admitted to a medical ward for a severe chest infection. Non-traumatic fracture dislocation of the right shoulder was also noted upon admission and treated conservatively. Bilateral hip fractures were not diagnosed till the fourth day. Patient had multiple comorbidities making the management very difficult. Here the authors will discuss the possible aetiology of this pattern of pathologies and the multidisciplinary management of such a rare case in detail.
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Affiliation(s)
- Khurram Siddique
- Department of Trauma and Orthopaedics, East Kent Hospitals NHS Trust, Ashford, UK.
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Eberle S, Gerber C, von Oldenburg G, Högel F, Augat P. A Biomechanical Evaluation of Orthopaedic Implants for Hip Fractures by Finite Element Analysis and In-Vitro Tests. Proc Inst Mech Eng H 2010; 224:1141-52. [PMID: 21138232 DOI: 10.1243/09544119jeim799] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The aim of this study was to test the hypothesis that a reinforced gamma nail for the fixation of subtrochanteric fractures would experience less stress during loading compared with a common gamma nail. The issue of whether the use of the stronger implant would result in more stress shielding in the surrounding bone was also addressed. A finite element analysis (FEA) of a synthetic bone was employed to calculate the stress distribution in implant and bone for two fracture types (AO 31-A3.1 and AO 31-A3.3). The FEA was validated by mechanical tests on six synthetic femurs. To test the hypothesis in vitro, mechanical tests on six pairs of fresh-frozen human femurs were conducted. The femurs were supplied with a common or a reinforced gamma nail in a cross-over study design. Strains were measured on the nail shaft to quantify the loading of the nail. The FEA resulted in 3—51 per cent lower stresses for the reinforced gamma nail. No increase in stress shielding could be observed. In the in-vitro tests, the reinforced gamma nail experienced less strain during loading ( p < 0.016). The study demonstrated the benefit of a reinforced gamma nail in subtrochanteric fractures. It experienced less stress but did not result in more stress shielding.
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Affiliation(s)
- S Eberle
- Institute of Biomechanics, Trauma Center Murnau, Murnau, Germany
| | - C Gerber
- Stryker Osteosynthesis, Schoenkirchen/Kiel, Germany
| | | | - F Högel
- Institute of Biomechanics, Trauma Center Murnau, Murnau, Germany
| | - P Augat
- Institute of Biomechanics, Trauma Center Murnau, Murnau, Germany
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Abstract
Nonunion of fractures about the femoral neck and intertrochanteric hip regions is uncommon. Patients who develop nonunions of these fractures typically exhibit marked pain and disability, thereby presenting a treatment challenge to the orthopaedic surgeon. Factors that guide the choice of salvage treatment include the anatomic site of the nonunion, the quality of the remaining proximal bone and articular surface, and patient factors (such as age and activity level). In the younger patients with a well-preserved hip joint, treatment typically involves revision internal fixation with or without osteotomy or bone grafting. However, in older patients, it is more common to encounter poor remaining proximal bone stock or a badly damaged hip joint from hardware cutout. As such, conversion to hip arthroplasty is intended to help effectively restore function and relieve pain. With respect to salvage procedures for the femoral head, the major challenges in decision making include the choice of both internal fixation device and accurate preoperative planning. The challenges involved in planning to convert to hip arthroplasty include the need for acetabular resurfacing, selecting the femoral implant, and managing discontinuity of the greater trochanter. Furthermore, there are additional technical challenges that may be encountered, such as broken hardware, deformity, and femoral bone defects. Overall, salvage of nonunions of femoral neck and intertrochanteric hip fractures in properly selected patients can provide patients with good to excellent results.
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Schoenfeld AJ, Leeson MC, Vrabec GA, Scaglione J, Stonestreet MJ. Outcomes of modular proximal femoral replacement in the treatment of complex proximal femoral fractures: a case series. Int J Surg 2008; 6:140-6. [PMID: 18337199 DOI: 10.1016/j.ijsu.2008.01.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2007] [Revised: 01/10/2008] [Accepted: 01/30/2008] [Indexed: 11/25/2022]
Abstract
BACKGROUND The treatment of complex femur fractures poses a significant challenge. Even with current advancements and the various implements available for the fixation of femoral fractures, results are often disappointing. This study sought to identify problems associated with and examine results of modular proximal femoral replacement. Outcomes were evaluated in two groups of patients: those receiving primary modular proximal femoral replacement for fractures and those treated with salvage arthroplasty for failed internal fixation. METHODS Twelve patients who had received modular proximal femoral replacement as primary treatment for proximal femoral fractures were evaluated along with nine patients treated with salvage proximal femoral replacement for failed internal fixation. After the surgical procedure, patients were evaluated at regular follow-up intervals and contacted by phone at the conclusion of this study. Patient functional results were evaluated using the Merle D'Aubigne hip rating scale, which measures pain, motion and ambulatory status. Routine radiographs were also obtained at each patient visit. RESULTS On average, patients who received modular proximal femoral replacement as the primary surgery for their femoral fractures enjoyed a high-level functional result and had few complications. Subjects who received salvage femoral replacement had a less optimal outcome and experienced more complications. Nonetheless, final post-operative MDA score was significantly increased from pre-operative levels. CONCLUSION Modular proximal femoral replacement is a viable option in the primary fracture or revision setting, and has been shown to have a reasonable outcome, especially when the nature of initial injury is taken into account.
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Affiliation(s)
- Andrew J Schoenfeld
- Department of Orthopaedic Surgery, Northeastern Ohio Universities College of Medicine, Akron, OH 44302, USA.
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Schoenfeld AJ, Vrabec GA. Valgus osteotomy of the proximal femur with sliding hip screw for the treatment of femoral neck nonunions: the technique, a case series, and literature review. J Orthop Trauma 2006; 20:485-91. [PMID: 16891940 DOI: 10.1097/00005131-200608000-00006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Femoral neck nonunions are a difficult complication in the treatment of femoral neck fractures and have traditionally been managed using an intertrochanteric valgus osteotomy and blade plate. We propose an alternative method, a proximal femoral valgus osteotomy using a sliding hip screw instead of a blade plate. This technique eliminates many of the difficulties experienced with the valgus osteotomy and blade plate by employing a device and instrumentation that is more familiar to orthopedic surgeons. The technique is reproducible and has been used successfully in a series of 4 patients.
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Affiliation(s)
- Andrew J Schoenfeld
- Department of Orthopaedic Surgery, Akron General Medical Center, Northeastern Ohio, Universities College of Medicine, Tallmadge, 44278, USA.
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Said GZ, Farouk O, El-Sayed A, Said HG. Salvage of failed dynamic hip screw fixation of intertrochanteric fractures. Injury 2006; 37:194-202. [PMID: 16378609 DOI: 10.1016/j.injury.2005.09.011] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2005] [Revised: 09/01/2005] [Accepted: 09/19/2005] [Indexed: 02/02/2023]
Abstract
Twenty-six patients with failed dynamic hip screw fixation of intertrochanteric fractures were included in this study. The mean age of the patients was 61 years (range, 38-84 years). Average limb shortening was 2.4 cm; 18 patients were treated with revision internal fixation and eight patients with prosthetic replacement. The decision depended on the physiological age of the patient, quality of bone, and condition of the femoral head and the acetabulum. The revision internal fixation group included DHS reinsertion in eight patients, valgus osteotomy and revision DHS fixation in six, while four patients were treated by valgus osteotomy and insertion of single-angled 130 degrees plate. The prosthetic replacement group included cemented Thompson endoprothesis in five patients and cemented total hip arthroplasty in three. The mean follow-up period was 31 months (range, 15-72 months). All patients of revision internal fixation group achieved fracture healing without bone grafting. Time to union averaged 17 weeks. Average gain in length was 2 cm Avascular necrosis of the femoral head occurred in one patient. Six patients of the prosthetic replacement group achieved good functional outcome and pain-free gait. The remaining two had unsatisfactory result.
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Affiliation(s)
- G Z Said
- Department of Orthopaedic Surgery and Traumatology, Assiut University Hospitals, 71516 Assiut, Egypt
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