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Khan A, Kyeremateng DK, Khan ZA, Tariq MS, Khan M. Complex Pathological Femoral Fracture in a Multiple Myeloma Patient Undergoing Intertrochanteric Fixation: A Case Report. Cureus 2024; 16:e58224. [PMID: 38689668 PMCID: PMC11058735 DOI: 10.7759/cureus.58224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2024] [Indexed: 05/02/2024] Open
Abstract
Pathological fractures commonly occur in patients with metastatic bone diseases, particularly multiple myeloma. The current optimal management for metastatic pathological lesions affecting the proximal femur is surgical intervention. Surgical planning and appropriate use of imaging modalities are pivotal in the appropriate treatment of pathological fractures. Impending fractures create added layers of complexity in the decision-making process. The appropriateness of different surgical interventions involves a multi-disciplinary approach and the importance of holistic healthcare is paramount in these circumstances.
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Affiliation(s)
- Ameer Khan
- Cardiology, Tameside General Hospital, Ashton-under-Lyne, GBR
| | - Daniel K Kyeremateng
- Medicine, University of Leeds, Leeds, GBR
- Orthopaedics, Tameside General Hospital, Ashton-under-Lyne, GBR
| | - Zeeshan A Khan
- Orthopaedics and Trauma, North Manchester General Hospital, Manchester, GBR
- Orthopaedics and Trauma, Tameside General Hospital, Ashton-under-Lyne, GBR
| | - Muhammad S Tariq
- Internal Medicine, Tameside General Hospital, Ashton-under-Lyne, GBR
| | - Munir Khan
- Medicine, University of Leeds, Leeds, GBR
- Orthopedics and Traumatology, Tameside General Hospital, Ashton-under-Lyne, GBR
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Mohammed Hassan Elbahri H, Ali Aydrouce Ahmed M, Omer Elgaili Yousif Y, Mohammed Ali Abd-Elmaged H. Quality of Life After Proximal Femoral Fractures Treated With Gamma Nail in Sudan. Cureus 2024; 16:e55702. [PMID: 38586703 PMCID: PMC10998661 DOI: 10.7759/cureus.55702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2024] [Indexed: 04/09/2024] Open
Abstract
Background Hip fracture is a public health problem globally, and it poses one of the biggest challenges in healthcare due to its associated complications. Objectives The aim of this study is to investigate the quality of life in adult patients in Khartoum State, Sudan, after they have undergone treatment using a gamma nail for proximal femoral fractures. Methodology This cross-sectional descriptive hospital-based study was conducted at Ibrahim Malik, Omdurman, and Bahri Teaching Hospitals over six months, from April to October 2022. The data were collected using an interview questionnaire that covered relevant aspects of the study. The data were analyzed using IBM SPSS Statistics for Windows, V. 26.0 (IBM Corp., Armonk, NY). The study was approved by the Sudan Medical Specialization Board, and ethical clearance was obtained. Results The study included 37 patients. More than half of the patients (59.5%, n=22) were women. The mean age of cases was 66.7 years (standard deviation, ±15.6). The mean time from the time of the fracture to the time of surgery was eight days (±15). Twenty-three (62.2%, n=23) (JRB1) of the patients started weight bearing on the second postoperative day. Regarding the health-related quality of life, 21.6% of the patients had a good health-related quality of life, 67.6% had a fair health-related quality of life, and 10.8% had a poor health-related quality of life. None of the patients reported an excellent quality of life. Based on the Oxford Hip Score, 54.1% of the patients had satisfactory joint function, 29.7% had mild to moderate hip joint function, 13.5% had moderate to severe hip joint function disturbance, and one patient (2.7%) had severe hip joint function problems. Conclusion In this study, the vast majority of the patients who underwent gamma nail surgery for hip fracture had quality of life scores in the fair to good range afterward. The results indicate that nailing is associated with good outcomes regarding quality of life and is an acceptable option for femoral fracture surgeries in Sudan.
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Moldovan F, Ivanescu AD, Fodor P, Moldovan L, Bataga T. Correlation between Inflammatory Systemic Biomarkers and Surgical Trauma in Elderly Patients with Hip Fractures. J Clin Med 2023; 12:5147. [PMID: 37568549 PMCID: PMC10419519 DOI: 10.3390/jcm12155147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 07/29/2023] [Accepted: 08/04/2023] [Indexed: 08/13/2023] Open
Abstract
The treatment for hip fractures consists of a wide variety of orthopedic implants ranging from prosthesis to intramedullary nails. The purpose of this study is to determine the correlation between blood-count-derived biomarkers such as the neutrophil-to-lymphocyte ratio (NLR), the platelet-to-lymphocyte ratio (PLR), the monocyte-to-lymphocyte ratio (MLR) and the systemic immune-inflammation index (SII) and the level of aggression sustained by elderly patients during these surgical procedures. A total of 129 patients aged over 70 and diagnosed with acute hip fractures who underwent surgical treatment between November 2021 and February 2023 were included in our observational retrospective cohort study. Two groups were formed depending on the anatomic location of the fracture for statistical comparison: group 1 with extracapsular fractures, who received a closed reduction internal fixation (CRIF) with a gamma nail (GN) as treatment, and group 2 with intracapsular fractures, who received a bipolar hemiarthroplasty (BHA) as treatment. The length of hospital stay (LHS), duration of surgery, preoperative days, pre- and postoperative red blood count (RBC) and hemoglobin (HGB) levels and postoperative NLR, PLR and SII were significantly different between the two groups (p < 0.05). Furthermore, the multivariate analysis indicated that the postoperative NLR (p = 0.029), PLR (p = 0.009), SII (p = 0.001) and duration of surgery (p < 0.0001) were independently related to the invasiveness of the procedures. The ROC curve analysis demonstrated that a postoperative SII > 1564.74 is a more reliable predictor of surgical trauma in terms of specificity (58.1%) and sensitivity (56.7%). Postoperative SII as a biomarker appears to be closely correlated with surgical trauma sustained by an older population with hip fractures.
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Affiliation(s)
- Flaviu Moldovan
- Orthopedics—Traumatology Department, Faculty of Medicine, “George Emil Palade” University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania; (A.D.I.); (P.F.); (T.B.)
- Department of Training, Technological Innovation, and Research in Orthopedics-Traumatology, “George Emil Palade” University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Adrian Dumitru Ivanescu
- Orthopedics—Traumatology Department, Faculty of Medicine, “George Emil Palade” University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania; (A.D.I.); (P.F.); (T.B.)
| | - Pal Fodor
- Orthopedics—Traumatology Department, Faculty of Medicine, “George Emil Palade” University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania; (A.D.I.); (P.F.); (T.B.)
| | - Liviu Moldovan
- Faculty of Engineering and Information Technology, “George Emil Palade” University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania;
| | - Tiberiu Bataga
- Orthopedics—Traumatology Department, Faculty of Medicine, “George Emil Palade” University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania; (A.D.I.); (P.F.); (T.B.)
- Department of Training, Technological Innovation, and Research in Orthopedics-Traumatology, “George Emil Palade” University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania
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Mariscal G, Lorente R, Barrios C. U-blade gamma 3 vs. gamma 3 nails for intertrochanteric hip fracture: Meta-analysis. Front Surg 2022; 9:1015554. [PMID: 36504573 PMCID: PMC9727099 DOI: 10.3389/fsurg.2022.1015554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/13/2022] [Indexed: 11/24/2022] Open
Abstract
Background and Objective Intertrochanteric fracture is a growing problem in the traumatology department. The use of intramedullary devices has increased, representing the first treatment option in intertrochanteric fractures. U-Blade devices appeared to avoid rotation of the femoral head over the femoral neck. The aim of this study was to conduct a meta-analysis of the surgical treatment of intertrochanteric fractures comparing in terms of safety and efficacy the U-Blade Gamma 3 nail vs. the conventional Gamma 3 nail. Methods A literature search for intertrochanteric fracture 31A1-31A3 according to the AO foundation/orthopaedic trauma association (AO/OTA) classification was performed. Baseline characteristics of each article were obtained; radiological outcomes were tip apex distance (TAD), sliding distance (mm), cut-out rate, and lateralization rate. Surgery time (min) was also recorded. A meta-analysis was performed with ReviewManager 5.4. Results Five retrospective studies (n = 993 patients) were included. With respect to TAD and sliding distance, there were no differences between two groups [mean difference (MD) 0.47, 95% confidence interval (CI), -0.46 to 1.40] and (MD 0.39, 95% CI, 0.13-0.66). The cut-out rate and lateralization rate did not show differences between two groups (p > 0.05). Finally, surgery time was significantly higher in the U-Blade Gamma 3 group (MD -4.84, 95% CI, -7.22 to -2.46). Conclusions The use of U-Blade Gamma 3 did not show significant differences in the radiological results compared with the conventional Gamma 3 nail.
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Affiliation(s)
- Gonzalo Mariscal
- Institute for Research on Musculoskeletal Disorders, Valencia Catholic University, Valencia, Spain,Correspondence: Gonzalo Mariscal
| | - Rafael Lorente
- Department of Orthopedic Surgery, University Hospital of Badajoz, Badajoz, Spain
| | - Carlos Barrios
- Institute for Research on Musculoskeletal Disorders, Valencia Catholic University, Valencia, Spain
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Lorkowski J, Pokorski M. In Silico Finite Element Modeling of Stress Distribution in Osteosynthesis after Pertrochanteric Fractures. J Clin Med 2022; 11:1885. [PMID: 35407491 DOI: 10.3390/jcm11071885] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/15/2022] [Accepted: 03/25/2022] [Indexed: 12/13/2022] Open
Abstract
A stabilization method of pertrochanteric femur fractures is a contentious issue. Here, we assess the feasibility of rapid in silico 2D finite element modeling (FEM) to predict the distribution of stresses arising during the two most often used stabilization methods: gamma nail fixation (GNF) and dynamic hip screw (DHS). The modeling was based on standard pre-surgery radiographs of hip joints of 15 patients with pertrochanteric fractures of type A1, A2, and A3 according to the AO/OTA classification. The FEM showed that the stresses were similar for both GNF and DHS, with the medians ranging between 53-60 MPa and consistently lower for A1 than A3 fractures. Stresses also appeared in the fixation materials being about two-fold higher for GNF. Given similar bone stresses caused by both GNF and DHS but shorter surgery time, less extensive dissection, and faster patient mobilization, we submit that the GNF stabilization appears to be the most optimal system for pertrochanteric fractures. In silico FEM appears a viable perioperative method that helps predict the distribution of compressive stresses after osteosynthesis of pertrochanteric fractures. The promptness of modeling fits well into the rigid time framework of hip fracture surgery and may help optimize the fixation procedure for the best outcome. The study extends the use of FEM in complex orthopedic management. However, further datasets are required to firmly position the FEM in the treatment of pertrochanteric fractures.
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Kang JS, Kwon YT, Suh YJ, Lee TJ, Ryu DJ. Outcomes of U-Blade Lag Screw for Cephalomedullary Fixation of Unstable Trochanteric Femur Fractures: A Case Control Study. Geriatr Orthop Surg Rehabil 2020; 11:2151459320979975. [PMID: 33403152 PMCID: PMC7739078 DOI: 10.1177/2151459320979975] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/03/2020] [Accepted: 11/18/2020] [Indexed: 11/17/2022] Open
Abstract
Background: Unstable trochanteric femur fractures in elderly patients with osteoporosis are still challenging. Gamma3 nail with the U-blade lag screw (U-blade gamma nail) has been developed to improve mechanical stability of proximal femoral fragment. This study aimed to compare the clinical and radiologic outcomes of U-blade gamma nail to proximal femoral nail antirotation (PFNA), and standard Gamma3 nail (gamma nail) for unstable trochanteric femur fractures. Methods: A retrospective matched-pair case study was performed with U-blade gamma nail, PFNA, and gamma nail. During 2012-2018, 970 patients with unstable trochanteric femur fractures were reviewed. Matching criteria were set as follows: 1) sex; 2) age (± 3 years); 3) body mass index (± 2 kg/m2); 4) bone mineral density (± 1 T-score in femur neck). Finally, a total of 159 patients were enrolled. We assessed the tip-apex distance (TAD), neck shaft angle, and hip screw sliding distance using plain radiographs. Also, we evaluated the clinical outcomes with Koval’s grade and fixation failure during 2 years. Results: The mean postoperative TAD was not significantly different among the 3 groups (p = 0.519). However, the change in the TAD at 1 year (p = 0.027) and 2 years (p = 0.008) after surgery was significantly smaller in U-blade gamma nail group compared with PFNA and gamma nail group. The hip screw sliding distance at 1 year (p = 0.004) and 2 years (p = 0.001) after surgery was significantly smaller in U-blade gamma nail group compared with PFNA and gamma nail group. However, there was no significant difference of Koval’s grade and fixation failure among the 3 groups (p = 0.535). Conclusion: U-blade gamma nail showed favorable radiologic results in terms of the change in the hip screw position. However, U-blade gamma nail was not superior to PFNA and gamma nail in clinical outcomes.
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Affiliation(s)
- Joon Soon Kang
- Department of Orthopaedic Surgery, Inha University Hospital, Incheon, Republic of Korea
| | - Yong Tak Kwon
- Department of Orthopaedic Surgery, Inha University Hospital, Incheon, Republic of Korea
| | - Young Ju Suh
- Department of Biomedical Sciences, College of Medicine, Inha University, Incheon, South Korea
| | - Tong Joo Lee
- Department of Orthopaedic Surgery, Inha University Hospital, Incheon, Republic of Korea
| | - Dong Jin Ryu
- Department of Orthopaedic Surgery, Inha University Hospital, Incheon, Republic of Korea
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Herzog J, Wendlandt R, Hillbricht S, Burgkart R, Schulz AP. Optimising the tip-apex-distance in trochanteric femoral fracture fixation using the ADAPT-navigated technique, a longitudinal matched cohort study. Injury 2019; 50:744-751. [PMID: 30782395 DOI: 10.1016/j.injury.2019.02.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 01/14/2019] [Accepted: 02/12/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The annual incidence of proximal femoral fractures is 100-150/100,000 and continues to increase with an aging population. Cut-out of hip screws after fracture fixation has been quoted as 8% in the literature. The tip-apex distance (TAD) is the strongest predictor for cut-out after operative fracture stabilisation. The aim of this study was to evaluate the novel ADAPT system (Adaptive Positioning Technology, Stryker, USA), a navigation device for intramedullary nailing of trochanteric fractures and its effect on optimising the TAD. This is the first clinical study to evaluate this new technology. METHODS The study group of 36 consecutive patients with a pertrochanteric fracture underwent intramedullary nailing for fracture fixation using ADAPT technology, while the matched control group underwent conventional Gamma-3-nailing. Matching criteria included fracture classification, gender and age. We measured the operative time and the postoperative TAD in anteroposterior (AP) and lateral radiographs of the 72 patients. RESULTS The mean TAD using ADAPT was 16.9 mm (range 8.4-33.7 mm) compared with 24.9 mm (range 14.6-40.2 mm) in the reference group treated without ADAPT. Using the ADAPT system significantly improved (p < 0.0005) the accuracy of lag screw placement but had no effect on operating time in fixation of femoral pertrochanteric fractures. CONCLUSION Working with the novel ADAPT system for positioning the lag screw using the Gamma-3-nail led to a statistically highly significant reduction of the TAD compared to the reference group (p < 0.001). The ADAPT system proved to be a very useful device in achieving higher surgical standards for the treatment of trochanteric fractures with intramedullary nailing. It enables higher accuracy in screw positioning and therefore better placement of the implant.
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Affiliation(s)
- Jan Herzog
- Royal National Orthopaedic Hospital, Stanmore, United Kingdom, Department of Orthopaedics, Brockley Hill, Stanmore, Middlesex, HA7 4LP, United Kingdom.
| | - Robert Wendlandt
- Biomechanics Laboratory, University Medical Centre Lübeck, Germany
| | | | - Rainer Burgkart
- Dept. for Orthopaedics and Sportorthopaedics, Klinikum rechts der Isar, Technische Universität München, Germany
| | - Arndt-Peter Schulz
- Dept. for Trauma, Orthopaedics and Sportsmedicine, BG Clinic Hamburg and Dept. for Trauma and Orthopaedics, University Medical Centre Lübeck, Germany
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Wang HH, Shu WB, Lan GH, Zhang XB, Jiang ZQ, Xu DH, Bao XX, Li AB. Network meta-analysis of surgical treatment for unstable femoral intertrochanteric fractures. Oncotarget 2018; 9:24168-77. [PMID: 29844880 DOI: 10.18632/oncotarget.24202] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 12/05/2017] [Indexed: 01/22/2023] Open
Abstract
In this network meta-analysis, we determined the optimal surgical method for treating unstable femoral intertrochanteric fractures. We searched the EMBASE, Cochrane Library and Medline databases for studies evaluating sliding hip screws (SHS), gamma nail (GN) or proximal femoral nail antirotation (PFNA) methods, and included nine randomized controlled trials that met the inclusion criteria. Our analysis showed no differences in the rates of complications between SHS and PFNA relative to GN (p > 0.05). However, the surface under the cumulative ranking curve (SUCRA) score for PFNA (77.6%) was higher than the SUCRA scores for GN (65%) and SHS (7.5%). This suggests PFNA is the better surgical method than GN or SHS for unstable femoral intertrochanteric fractures.
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Bousbaa H, Bennani M, Elghoul N, Ouahidi M, Louaste J, Amhaji L. [Pertrochanterian fracture revealing multiple myeloma: how is it treated?]. Pan Afr Med J 2017; 27:155. [PMID: 28904683 PMCID: PMC5567931 DOI: 10.11604/pamj.2017.27.155.12069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 06/12/2017] [Indexed: 11/15/2022] Open
Abstract
L’atteinte squelettique est la complication clinique majeure au cours des myélomes multiples avec une part non négligeable pour les fractures pathologiques. Les fractures du fémur proximal sont très fréquentes au cours de l’évolution du myélome multiple et elles compromettent sérieusement la survie ainsi que la qualité de vie du patient cancéreux. Un traitement chirurgical précoce permet l’amélioration de la mortalité et la morbidité. L’ostéosynthèse par clou cervicomédullaire verrouillé de type clou gamma constitue un moyen stable, efficace et durable qui permet la levée précoce et une amélioration de la survie du malade. Cependant, une survie prolongée impose une surveillance régulière de l’ostéosynthèse pour dépister et traiter une faillite de matériel.Il faut en dernier lieu ne pas perdre de vue que le regain de l’autonomie après une fracture pertrochantérienne hypothèque même le contrôle du myélome par la possibilité ou non de réaliser l’autogreffe de la moelle osseuse.
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Affiliation(s)
- Hicham Bousbaa
- Service d'Orthopédie-Traumatologie, Hôpital Militaire Moulay Ismail, BP S 15, 50000 Meknès, Maroc
| | - Mourad Bennani
- Service d'Orthopédie-Traumatologie, Hôpital Militaire Moulay Ismail, BP S 15, 50000 Meknès, Maroc
| | - Naoufal Elghoul
- Service d'Orthopédie-Traumatologie, Hôpital Militaire Moulay Ismail, BP S 15, 50000 Meknès, Maroc
| | - Mohammed Ouahidi
- Service d'Orthopédie-Traumatologie, Hôpital Militaire Moulay Ismail, BP S 15, 50000 Meknès, Maroc
| | - Jamal Louaste
- Service d'Orthopédie-Traumatologie, Hôpital Militaire Moulay Ismail, BP S 15, 50000 Meknès, Maroc
| | - Laarbi Amhaji
- Service d'Orthopédie-Traumatologie, Hôpital Militaire Moulay Ismail, BP S 15, 50000 Meknès, Maroc
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Boukhris J, Boussouga M, Jaafar A, Chagar B. [Interest of the surgical treatment of fractures of the trochanteric mass by gamma nail, about 84 cases]. Pan Afr Med J 2015; 19:6. [PMID: 25574335 PMCID: PMC4282869 DOI: 10.11604/pamj.2014.19.6.3190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Accepted: 04/14/2014] [Indexed: 11/17/2022] Open
Abstract
La fracture trochantérienne est une urgence différée qui se voit essentiellement chez le sujet âgé, dont les processus physiologique sont en déclin progressif. Chez le sujet jeune, elle est rare et souvent consécutive à un traumatisme violent. Ces fractures ont bénéficié de l’évolution constante des moyens et des techniques thérapeutiques, visant à améliorer l'ostéosynthèse, assurant ainsi un lever et un appui précoces. Nous rapportons une série de 84 cas de fractures du massif trochantérien traités chirurgicalement par clou gamma. Les résultats fonctionnels sont très encourageants en les comparants à ceux rapportés dans la littérature.
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Affiliation(s)
- Jalal Boukhris
- Service de Traumatologie Orthopedie II- HMIMV, Rabat, Maroc
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Ouchrif Y, Elouakili I. [Rare complication of gamma nail: cervical screw migration in contact with iliac vessels]. Pan Afr Med J 2014; 18:188. [PMID: 25419315 PMCID: PMC4237561 DOI: 10.11604/pamj.2014.18.188.4877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 06/30/2014] [Indexed: 11/30/2022] Open
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Todor A, Pojar A, Lucaciu D. Minimally invasive treatment of trochanteric fractures with intramedullary nails. Technique and results. Clujul Med 2013; 86:40-2. [PMID: 26527914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Accepted: 12/12/2012] [Indexed: 11/25/2022]
Abstract
UNLABELLED The aim of the study was to evaluate the results of minimally invasive treatment of trochanteric fractures with the use of intramedullary nails. PATIENTS AND METHODS From September 2010 to September 2012 we treated 21 patients with pertrochanteric fractures by a minimally invasive technique using the Gamma 3 (Stryker, Howmedica) nail. There were 13 females and 8 men with a mean age of 74.1 years, ranging from 58 to 88 years. Fractures were classified as being stable (AO type 31-A1) in 5 cases and unstable (AO type 31-A2 and A3) in the rest of 16 cases. Patients were reviewed at 6 weeks and 3 months postoperatively. RESULTS Mean surgery time was 46.8 minutes and mean hospital stay was 14.9 days. No patients required blood transfusions. During the hospital stay all the patients were mobilized with weight bearing as tolerated. All patients were available for review at 6 weeks, and 2 were lost to the 3 months follow up. 16 patients regained the previous level of activity. CONCLUSIONS This minimally invasive technique using a gamma nail device for pertrochanteric fractures gives reliable good results with excellent preservation of hip function.
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Zhu Y, Meili S, Zhang C, Luo C, Zeng BF. Is the lag screw sliding effective in the intramedullary nailing in A1 and A2 AO-OTA intertrochanteric fractures? A prospective study of Sliding and None-sliding lag screw in Gamma-III nail. Scand J Trauma Resusc Emerg Med 2012; 20:60. [PMID: 22938031 PMCID: PMC3518244 DOI: 10.1186/1757-7241-20-60] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2012] [Accepted: 08/28/2012] [Indexed: 11/10/2022] Open
Abstract
OBJECT To compare the Sliding with Non-sliding lag screw of a gamma nail in the treatment of A1 and A2 AO-OTA intertrochanteric fractures. MATERIALS AND METHODS 80 patients were prospectively collected. In each group, AO/OTA 31-A were classified into group A. AO/OTA 31-A2.1 was classified as group B. We classified the A2.2 and A2.3 as group C. According to the set-screw locking formation of Gamma-III, the cases were randomly allocated to Sliding subgroup and Non-sliding subgroup in A, B and C groups. Follow-ups were performed 1, 3, 6 and 12 months postoperatively. RESULTS In the Sliding group, the bone healing rate 3, 6, 12 months postoperatively reached 85.00%, 97.50%, 100% in group A, B and C. Meanwhile, in Non-sliding group, postoperatively, bone healing rate were 90.00%, 95.00% and 97.50% in group A, B and C, respectively. Both differences were not significant. Lower limb discrepancy between Sliding and Non-sliding pattern was significantly different in group C which represent fracture types of AO/OTA 31-A2.2 and A2.3 (0.573 ± 0.019 mm in Non-sliding group, 0.955 mm ± 0.024 mm in Sliding group, P < 0.001 ). Difference of sliding distance among the three groups was significant among group A, B and C: 0.48 mm ± 0.04 mm, 0.62 mm ± 0.07 mm and 0.92 mm ± 0.04 mm (P < 0.001). Differences in average healing time and Harris scores also presented no significance in the three groups. CONCLUSIONS As a result, we can conclude that the sliding distance is minimal in Gamma nails and it is related to the comminuted extent of the intertrochanteric area in A1 and A2 AO-OTA intertrochanteric fractures. For treating these kinds of fractures, the sliding of the lag screw of an Gamma nail does not improve any clinical results and in certain cases, such as highly comminuted A1 and A2 fractures, can therefore even benefit from a locked lag screw by tightening the set-screw.
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Affiliation(s)
- Yi Zhu
- Department of Orthopaedics, Shanghai Sixth People’s Hospital, Shanghai Jiaotong University, No.600, YiShan Road, Xuhui District, Shanghai, 200233, China
| | - Severin Meili
- Fellow of Trauma, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Changqing Zhang
- Department of Orthopaedics, Shanghai Sixth People’s Hospital, Shanghai Jiaotong University, No.600, YiShan Road, Xuhui District, Shanghai, 200233, China
| | - Congfeng Luo
- Department of Orthopaedics, Shanghai Sixth People’s Hospital, Shanghai Jiaotong University, No.600, YiShan Road, Xuhui District, Shanghai, 200233, China
| | - Bing-fang Zeng
- Department of Orthopaedics, Shanghai Sixth People’s Hospital, Shanghai Jiaotong University, No.600, YiShan Road, Xuhui District, Shanghai, 200233, China
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