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Schmidt NH, Birkelund L, Schønnemann JO. A retrospective cohort analysis of failure and potential causes after osteosynthesis of femoral fractures with VA-LCP Condylar plate 4.5/5.0, Depuy Synthes. J Orthop 2024; 55:69-73. [PMID: 38681826 PMCID: PMC11047189 DOI: 10.1016/j.jor.2024.04.004] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 04/02/2024] [Indexed: 05/01/2024] Open
Abstract
Background Since 2014, the VA-LCP Condylar Plate 4.5/5.0, Depuy Synthes, has been the preferred implant for these injuries at our institution, however, speculations have been made whether it is more prone to failure compared to other implants. Thus, the aim of the study was to describe the cohort treated with the VA-LCP Condylar Plate 4.5/5.0, Depuy Synthes, at our department from 2014 to 2020, including the number of failures. Secondary, whether specific outcome measures were significantly overrepresented in the failure group. Methods Patients were identified through the hospital database, and demographic data was extracted from patient files. X-rays were evaluated for injury type, osteosynthesis characteristics, and whether the construct failed during follow-up. Thanks to the national patient record database a minimum of patients was lost to follow-up. Results After exclusion 159 patients (165 osteosyntheses, descriptive part) and 108 patients (112 osteosyntheses, subgroup analysis) were eligible for inclusion. The VA-LCP Condylar Plate 4.5/5.0, Depuy Synthes, was used for most AO-type fractures and inserted as both neutralization, buttress, and bridging plates. Overall failure was seen in 8 % of osteosyntheses. Significantly more failures were seen in patients with increased Body Mass Index (BMI) (24 vs. 32, p = 0,046) and those treated for a periprosthetic fractures (41 % vs. 89 %, p = 0,005). We did not see an association between failure and plate length, bridge span, screw density or the degree of medial support. Conclusion The VA-LCP Condylar Plate 4.5/5.0, Depuy Synthes is a versatile plate with failure rates comparable to previously reported studies. This study confirmed that elevated BMI may be a risk factor for failure, while other previously reported risk factors were not associated with failure in this study.
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Affiliation(s)
- Nikolaj Hjort Schmidt
- Department of Orthopaedics, Hospital Sønderjylland, Kresten Philipsens vej 15, 6200, Aabenraa, Denmark
| | - Lasse Birkelund
- Department of Orthopaedics, Odense Univesity Hospital, J. B. Winsløws vej 4, 5000, Odense C, Denmark
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Van Nguyen L. Iatrogenic femoral artery injury due to cerclage wiring for diaphyseal femoral fracture: A case report and review the literature. Int J Surg Case Rep 2024; 119:109765. [PMID: 38759400 DOI: 10.1016/j.ijscr.2024.109765] [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: 04/09/2024] [Revised: 05/09/2024] [Accepted: 05/14/2024] [Indexed: 05/19/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE During femoral fracture osteosynthesis, the superficial femoral artery can be incarcerated in the cerclage wiring. We report a case that had an iatrogenic superficial femoral artery injury due to cerclage wiring during femoral osteosynthesis. CASE PRESENTATION I reported a 57-year-old patient presented with a fracture at the distal third of the left femur. He had undergone a femoral nailing and a cerclage wiring. Four hours postoperative, his left leg was colder, and his dorsalis pedis and posterior tibial pulse were absent. A CTA revealed his left superficial femoral artery entrapment by cerclage wire. After cerclage removal, the superficial femoral artery and vein had normal flow. The dorsalis pedis and posterior tibial pulse could be palpated. One day following, there was no compromising of blood flow, sensation, or motor-nerve function. CLINICAL DISCUSSION Cerclage wiring in the proximal half of the femur was less risk to the femoral artery than in the distal part. The SFA entrapment into a femoral cerclage wire requires an urgent diagnosis and treatment. A missed diagnosis could lead to necrosis of the lower extremity and even death. CONCLUSION Our case shows that the superficial femoral artery can be incarcerated in the cerclage wiring during osteosynthesis. Cerclage wiring in the proximal half of the femur was less risk to the femoral artery than in the distal part. We recommend using a suitable cerclage passer precautionary in any femur fracture, particularly in the distal third of the femur. LEVEL OF EVIDENCE A case report.
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Affiliation(s)
- Luong Van Nguyen
- Institute of Trauma and Orthopaedics, 108 Central Military Hospital, No. 01 Tran Hung Dao Street, Hanoi, Viet Nam.
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3
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Lippuner K, Kyuchukova M, Schwab P, Rizzoli R. Differences in femoral fracture localizations in men and women in Switzerland between 1998 and 2021-reversal of the secular trend? Osteoporos Int 2024; 35:893-902. [PMID: 38396306 PMCID: PMC11031489 DOI: 10.1007/s00198-024-07016-5] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 12/28/2023] [Indexed: 02/25/2024]
Abstract
Number and age-standardized incidences of femoral fractures by sex and localization were determined annually between 1998 and 2021 in subjects aged 45 years or older living in Switzerland. The number and incidences of femoral neck, pertrochanteric, subtrochanteric, and femoral shaft fractures followed distinct unexpected trend patterns. INTRODUCTION Long-term incidence trends for femoral fractures by individual localizations are unknown. METHODS Annual absolute number of hospitalizations and median age at hospital admission between 1998 and 2021 were extracted from the medical database of the Swiss Federal Office of Statistics by sex and 10-year age groups for the following 10th International Classification of Diseases (ICD-10) codes: femoral neck (ICD-10 S72.0), pertrochanteric (S72.1), subtrochanteric (S72.2), and femoral shaft fractures (S72.3). Age-standardized incidence rates (ASI) and corresponding trends were calculated. RESULTS Over 24 years, the number of femoral neck fractures increased in men (+ 45%) but decreased in women (- 7%) with ASI significantly decreasing by 20% and 37% (p < 0.001 for trend for both), respectively. By contrast, the number of pertrochanteric fractures increased by 67% and 45% in men and women, respectively, corresponding to a horizontal ASI-trend in men (n.s.) and a modest significant decreasing ASI-trend in women (p < 0.001). The number of subtrochanteric fractures increased in both sexes with corresponding modest significant reductions in ASI-trends (p = 0.015 and 0.002, respectively). Femoral shaft fractures almost doubled in men (+ 71%) and doubled in women (+ 100%) with corresponding significant increases in ASI-trends (p = 0.001 and p < 0.001, respectively). Age at admission increased for all fracture localizations, more so in men than in women and more so for subtrochanteric and shaft fractures than for "typical" hip fractures. CONCLUSION Incidence changes of pertrochanteric fractures and femoral shaft fractures deserve increased attention, especially in men. Pooling diagnostic codes for defining hip fractures may hide differing patterns by localization and sex.
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Affiliation(s)
- Kurt Lippuner
- Department of Osteoporosis, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Mariya Kyuchukova
- Department of Osteoporosis, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Patrick Schwab
- Swiss Federal Statistical Office, Neuchâtel, Switzerland
| | - René Rizzoli
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
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Jadib I, Rachidi HE, Abdennaji S, Messoudi A, Rafai M. A rare combination of sagittal fracture of the medial femoral condyle (Trélat fracture) with an ipsilateral femoral shaft fracture: A case report. Int J Surg Case Rep 2024; 119:109657. [PMID: 38718491 PMCID: PMC11098947 DOI: 10.1016/j.ijscr.2024.109657] [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: 02/03/2024] [Revised: 04/05/2024] [Accepted: 04/19/2024] [Indexed: 05/20/2024] Open
Abstract
INTRODUCTION Isolated unicondylar fractures of the distal femur are rare injuries, accounting for 3-6 % of adult femur fractures. The association with a femoral shaft fracture is very rare and, to our knowledge, has, never been described in the literature. CASE PRESENTATION In this article, we report the case of a 19-year-old motorcyclist involved in an accident, that resulted in both a midshaft transverse femoral fracture and an ipsilateral sagittal fracture of the medial femoral condyle (Trélat fracture). CLINICAL DISCUSSION The surgical intervention involved open reduction and internal fixation for both fractures, utilizing a dynamic compression plate for the femoral shaft fracture and screws for the medial condyle fracture. Postoperative results showed excellent fracture reduction, and the patient progressed well with rehabilitation. The choice of fixation method for the sagittal medial femoral condyle fracture considered the unique anatomical challenges posed by this rare combination, the emergency (fat embolism), and the fact we didn't have a retrograde nail in our structure. A dynamic compression plate was used for femoral shaft fracture and screw fixation for condyle fracture treatment. The traction table in anterograde femoral nailing, led to the recurvatum of the condylar fracture and difficulty accessing it with the medial subvastus approach. CONCLUSION This case report adds a description of a rare combination and valuable insight into the management of complex femoral fractures, emphasizing the importance of individualized treatment approaches.
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Affiliation(s)
- Imad Jadib
- Department of Orthopedics and Trauma-Surgery P32, University Hospital Center IBN Rochd - Casablanca, Faculty of Medicine and Pharmacy Hassan-II, Morocco.
| | - Houssam Eddine Rachidi
- Department of Orthopedics and Trauma-Surgery P32, University Hospital Center IBN Rochd - Casablanca, Faculty of Medicine and Pharmacy Hassan-II, Morocco
| | - Soufiane Abdennaji
- Department of Orthopedics and Trauma-Surgery P32, University Hospital Center IBN Rochd - Casablanca, Faculty of Medicine and Pharmacy Hassan-II, Morocco
| | - Abdeljebbar Messoudi
- Department of Orthopedics and Trauma-Surgery P32, University Hospital Center IBN Rochd - Casablanca, Faculty of Medicine and Pharmacy Hassan-II, Morocco
| | - Mohamed Rafai
- Department of Orthopedics and Trauma-Surgery P32, University Hospital Center IBN Rochd - Casablanca, Faculty of Medicine and Pharmacy Hassan-II, Morocco
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Rehm A, Linardatou Novak P, Kobezda T, Ong JCY, Thahir A, Ashby E. Resource implications of managing paediatric femoral fractures in a major trauma centre: Analysis of 98 cases. Injury 2024; 55:111250. [PMID: 38044161 DOI: 10.1016/j.injury.2023.111250] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 11/25/2023] [Indexed: 12/05/2023]
Affiliation(s)
- Andreas Rehm
- Consultant Paediatric Orthopaedic Surgeon, Department of Paediatric Orthopaedics, Paediatric Division, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.
| | - Pinelopi Linardatou Novak
- Higher Orthopaedic Trainee, Department of Paediatric Orthopaedics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Tamás Kobezda
- Higher Orthopaedic Trainee, Department of Paediatric Orthopaedics, Paediatric Division, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Joshua C Y Ong
- Higher Orthopaedic Trainee, Department of Paediatric Orthopaedics, Paediatric Division, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Azeem Thahir
- Higher Orthopaedic Trainee, Department of Paediatric Orthopaedics, Paediatric Division, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Elizabeth Ashby
- Consultant Paediatric Orthopaedic Surgeon, Department of Paediatric Orthopaedics, Paediatric Division, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
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Farhan-Alanie MM, Jonas SC, Gallacher D, Whitehouse MR, Chesser TJS. Fewer native and periprosthetic femoral fracture patients receive an orthogeriatric review and expedited surgery compared to hip fracture patients. Hip Int 2024; 34:281-289. [PMID: 37720960 PMCID: PMC10935621 DOI: 10.1177/11207000231198459] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 07/01/2023] [Indexed: 09/19/2023]
Abstract
INTRODUCTION Disproportionate emphasis has been attributed to hip fracture over other femoral fractures through implementation of Best Practice Tariff (BPT).This retrospective comparative observational cohort study aimed to evaluate the epidemiology of native and periprosthetic femoral fractures and establish any disparities in their management relative to hip fractures. METHODS All patients ⩾60 years admitted with a native or periprosthetic femoral fracture during July 2016-June 2018 were identified using our hospital database. Results were compared to National Hip Fracture Database data over the same period. RESULTS 58 native femoral, 87 periprosthetic and 1032 hip fractures were identified. (46/58) 79% and 76/87 (89%) of native and periprosthetic femoral fractures were managed operatively. Surgery was performed <36 hours for 34/46 (74%) of native femoral and 33/76 (43%) of periprosthetic fractures compared to 826/1032 (80%) for hips. Median time to surgery was longer in periprosthetic femoral than hip fracture patients (44.7 vs. 21.6 hours; p < 0.0001). Orthogeriatrician review occurred in 24/58 (41%) and 48/87 (55%) of native and periprosthetic fractures compared to 1017/1032 (99%) for hips (p < 0.0001). One year mortality was 35%, 20% and 26% for native femoral, periprosthetic and hip fracture patients. Cox proportional hazard ratio was higher for native femoral than hip fracture patients (1.75; 95% CI, 1.12-2.73). CONCLUSIONS This study demonstrates large disparities in management of other femoral and periprosthetic fractures compared to hip fractures, specifically time to surgery and orthogeriatrician review. This may have resulted in the comparatively higher mortality rate of native femoral fracture patients. Expansion of the BPT to include the whole femur is likely to improve outcomes.
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Affiliation(s)
| | - Sam C Jonas
- Cardiff and Vale Orthopaedic Centre, University Hospital Llandough, Penarth, UK
| | - Daniel Gallacher
- Warwick Medical School, University of Warwick, Coventry, CV4 7HL, UK
| | - Michael R Whitehouse
- Department of Trauma and Orthopaedics, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol, Bristol, UK
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Tim JS Chesser
- Department of Trauma and Orthopaedics, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
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Gilmore C, Mayne A, Goodland C, Cassidy R, MacDonnell L, Mogey P, Murphy L, Diamond O. Early surgery improves survival after femoral fractures in the elderly: A retrospective review of 502 fragility fractures. Injury 2024; 55:111275. [PMID: 38134490 DOI: 10.1016/j.injury.2023.111275] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 11/29/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023]
Abstract
AIMS Fragility fractures are a growing global healthcare burden; fragility fractures of the femur have been shown to occur in a highly comorbid patient group, with parallels to hip fracture patients. This study aimed to investigate if early surgery for femoral fractures, distal to the hip, resulted in a reduction in mortality in patients over 65 years of age. METHODS A retrospective review of prospectively collected data for all consecutive femoral fractures in patients aged over 65 years who underwent surgical management between January 2000 and December 2018. Data was extracted from the Fracture Outcomes Research Database (FORD) and analysed to assess if early surgery, defined as occurring within 48 h of hospital admission with a fragility femur fracture, had an effect on 30 day and 1 year mortality. RESULTS 502 eligible patients were included; median follow up time was 57 months. 24 patients (4.7%) died within 30 days of surgery and 105 patients (20.9%) had died within 1 year of surgery. Patients who underwent surgery within 48 h of admission had a significantly reduced chance of mortality within 1 year of surgery compared to patients who had surgery more than 48 h after admission (OR = 0.401, 95% CI 0.25-0.65, p<0.001). Following Multivariate Cox Regression analysis the hazard ratio of 1 year mortality following early surgery remained significantly reduced (HR = 0.57, 95% CI 0.36-0.92, p = 0.020). CONCLUSIONS This study demonstrates that fragility femoral fracture patients represent a similar cohort to hip fracture patients, with high mortality rates. We recommend that hip fracture management principles are also employed for fragility femoral fractures in patients over 65 years, with rapid pre-operative optimisation to ensure these patients undergo early surgical intervention.
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Affiliation(s)
- Catherine Gilmore
- Royal Victoria Hospital, 274 Grosvenor Road Belfast BT12 6BA, United Kingdom.
| | - Alistair Mayne
- Royal Victoria Hospital, 274 Grosvenor Road Belfast BT12 6BA, United Kingdom
| | | | - Roslyn Cassidy
- Outcomes Department, Musgrave Park Hospital, Stockman's Lane, Belfast BT9 7JB, United Kingdom
| | - Lisa MacDonnell
- Royal Victoria Hospital, 274 Grosvenor Road Belfast BT12 6BA, United Kingdom
| | - Paul Mogey
- Royal Victoria Hospital, 274 Grosvenor Road Belfast BT12 6BA, United Kingdom
| | - Lynn Murphy
- Royal Victoria Hospital, 274 Grosvenor Road Belfast BT12 6BA, United Kingdom
| | - Owen Diamond
- Royal Victoria Hospital, 274 Grosvenor Road Belfast BT12 6BA, United Kingdom; Outcomes Department, Musgrave Park Hospital, Stockman's Lane, Belfast BT9 7JB, United Kingdom
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Laitakari E, Koukkula T, Huttunen TT, Mattila VM, Salonen A. The incidence, trends, and costs of treatment of femoral shaft fractures among Finnish children aged 2-12 years between 1998 and 2016. J Child Orthop 2024; 18:49-53. [PMID: 38348435 PMCID: PMC10859116 DOI: 10.1177/18632521231217267] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 11/12/2023] [Indexed: 02/15/2024] Open
Abstract
Purpose The purpose of this study was to determine the incidence and trends of both hip spica casting and elastic stable intramedullary nailing in children aged 2-12 years who sustained femoral diaphyseal fracture between 1998 and 2016 in Finland. We also evaluated the actual hospital costs of both treatment methods as well as calculating the length of hospital stay. Methods This study included all 2- to 12-year-old children with femoral diaphyseal fracture who were treated in Finland between 1998 and 2016. Data were collected from the National Hospital Discharge Register of Finland. Children were classified by age into five groups. The annual incidences per 100,000 persons were calculated using annual mid-year population census data obtained from Statistics Finland. Data on the annual actual daily hospital costs were collected from the Finnish Institute for Health and Welfare. Results In total, 1064 patients aged 2-12 years who had sustained femoral diaphyseal fracture were treated with elastic stable intramedullary nailing or hip spica casting between 1998 and 2016. In children aged 4-5 years, the incidence of elastic stable intramedullary nailing increased during the study period from 5.4 per 100,000 persons in 1998 to 8.1 per 100,000 persons in 2016. Conclusions The length of hospitalization in patients treated with elastic stable intramedullary nailing was shorter and, therefore, the total costs of hospital treatment were lower than in those children treated with hip spica cast. Level of evidence level III.
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Affiliation(s)
- Elina Laitakari
- Department of Pediatric and Adolescent Surgery, Pediatric Clinic and Pediatric Research Centre, Tampere University Hospital, Tampere, Finland
| | - Topias Koukkula
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland
| | - Tuomas T Huttunen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Tampere University Heart Hospital, Tampere University Hospital, Tampere, Finland
| | - Ville M Mattila
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland
| | - Anne Salonen
- Department of Pediatric and Adolescent Surgery, Pediatric Clinic and Pediatric Research Centre, Tampere University Hospital, Tampere, Finland
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Howard A, Myatt A, Hodgson H, Naeem H, Pepple S, Perumal A, Panteli M, Kanakaris N, Giannoudis PV. Retrograde intramedullary nailing or locked plating for stabilisation of distal femoral fractures? A comparative study of 193 patients. Eur J Orthop Surg Traumatol 2024; 34:471-478. [PMID: 37612566 PMCID: PMC10771351 DOI: 10.1007/s00590-023-03650-7] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 07/15/2023] [Indexed: 08/25/2023]
Abstract
PURPOSE The aim of this study was to evaluate the results of distal femoral fracture fixation of two different methods, lateral locking plate (LP) or an Intra-medullary nail (IMN), in patients managed in our institution. More specifically, to assess: (a) if there was a difference in functional outcomes between the LP and IMN groups; (b) whether the rate of complications was different between the two groups. METHODS Between January 2009 and December 2018 adult patients with distal femoral fractures managed in our unit with either LP or IMN for extra and intra-articular fractures were eligible to participate. Demographic details, fracture type, procedures performed, time to union, complications and functional scores (Oxford Knee Score) were recorded and analysed. The mean follow up was 4 years (12-120 months). RESULTS Out of 193 patients who met the inclusion criteria, 93 received an IMN whereas 100 patients were treated with LP. Mean age was 64.2 (18-99) and 70.1 (18-100) for the IMN and LP groups respectively. Overall, the two groups had similar demographics and there was no significant difference in the type of fractures sustained (p > 0.05). The Oxford Knee Score was highest for patients fixed with LP, mean 37.3 (6-48, SD 7.3) versus 28.4 (3-48, SD 14.4), (p = < 0.02) compared to the IMN group. In terms of complications, the rate of non-union was higher in the LP group 8.6% versus 4% in those patients treated with an IMN, p value < 0.01. CONCLUSION While the rate of non-union was higher in the LP group and the functional results were superior in the plating group.
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Affiliation(s)
- Anthony Howard
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.
- Leeds General Infirmary University Hospital, Leeds, UK.
- NDORMS, Oxford University, Oxford, UK.
| | - A Myatt
- Leeds General Infirmary University Hospital, Leeds, UK
| | - H Hodgson
- Leeds General Infirmary University Hospital, Leeds, UK
| | - H Naeem
- Leeds General Infirmary University Hospital, Leeds, UK
| | - S Pepple
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - A Perumal
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - M Panteli
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- Leeds General Infirmary University Hospital, Leeds, UK
| | - N Kanakaris
- Leeds General Infirmary University Hospital, Leeds, UK
| | - P V Giannoudis
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- Leeds General Infirmary University Hospital, Leeds, UK
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Wall R, Syed F, Arastu M, Riemer B, Boutefnouchet T. Treatment of supracondylar periprosthetic femoral fractures with retrograde intramedullary nailing versus distal femoral plating: A systematic review and meta-analysis of current evidence. Orthop Traumatol Surg Res 2023; 109:103489. [PMID: 36442809 DOI: 10.1016/j.otsr.2022.103489] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 05/18/2022] [Accepted: 07/13/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Supracondylar periprosthetic fractures, when amenable to fixation, can be treated by either retrograde intramedullary nailing (RIMN) or plating. There is paucity of evidence regarding the superiority of one fixation method over the other. This review aims to determine which fixation method leads to better functional outcomes and perioperative complications. HYPOTHESIS Superiority of intramedullary nailing in terms of fracture healing and surgical complications when compared to distal femoral plating. MATERIALS AND METHODS Using PRISMA guidelines, a systematic search was performed. Studies which reported comparative outcome data following the two interventions were included. Qualitative data analysis and narrative synthesis were reported. Pooled comparisons were conducted when similar quantifiable outcomes were reported in a minimum of three studies. RESULTS A total of 151 records were generated by the search. Eight studies met the eligibility criteria so were included in the final analysis. The studies comprised a total of 407 cases, with a follow up period ranging from 1 to 15 years. 252 cases were treated with plate fixation and 155 with RIMN. All studies were mitigated by heterogeneity and methodological limitations. The review showed marked variation in descriptive fracture classifications. Narrative data synthesis was conducted. Although guarded by the methodological limitations of individual studies, outcomes showed that mean time to union was equivalent; 5.88 months for RIMN compared to 6.75 months in plating, standardised mean difference=0.28 (95% CI -0.02-0.58). Similarly, no statistically significant differences were reported between RIMN and plating for deep infection (OR:1.41 95%CI 0.40-5.00) and revision surgery (OR: 0.74, 95%CI 0.39-1.41). DISCUSSION Clinical outcomes showed a tendency that favours intramedullary nailing; however, generalisation of results was not possible. Future priority must be awarded to higher quality research in the form of a collaborative multicentre observational studies to delineate appropriate major diagnostic categories, ultimately informing a large comparative trial using condition specific validated outcome measures. LEVEL OF EVIDENCE III, meta-analysis.
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Affiliation(s)
- Rosemary Wall
- University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK.
| | - Farhan Syed
- University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - Mateen Arastu
- University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - Bryan Riemer
- University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK
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Mencia MM, Pattron R, Goalan R, Pong CY. Intramedullary reamer failure in orthopaedic surgery: Two case reports and practical recommendations for prevention. Trauma Case Rep 2023; 46:100860. [PMID: 37396114 PMCID: PMC10310905 DOI: 10.1016/j.tcr.2023.100860] [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] [Accepted: 06/03/2023] [Indexed: 07/04/2023] Open
Abstract
Intramedullary reaming has been proven to be a safe and effective method for enhancing the union rates of long bone fractures. However, there is a risk of equipment failure, which can lead to severe complications. We present two cases of reamer failure during femoral nailing which illustrate the rare occurrence of intraoperative instrument failure. Our report also underscores the importance of routinely inspecting reaming equipment and provides technical insights to reduce the risk of failure.
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Affiliation(s)
- Marlon M. Mencia
- Bungalow 5, Department of Clinical Surgical Sciences, University of the West Indies, Port of Spain General Hospital, Port of Spain, Trinidad and Tobago
| | - Rohini Pattron
- Department of Orthopaedics, Eric Williams Medical Sciences Complex, Champ Fleur, Trinidad and Tobago
| | - Raakesh Goalan
- Department of Orthopaedics, Sangre Grande Hospital, Sangre Grande, Trinidad and Tobago
| | - Curtis Young Pong
- Department of Orthopaedics, Eric Williams Medical Sciences Complex, Champ Fleur, Trinidad and Tobago
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Wang Q, Leng YK, Xia B. [Comparison of clinical effects of minimally invasive femoral head replacement and proximal femoral nail antirotation in the treatment of comminuted intertrochanteric fracture in the elderly]. Zhongguo Gu Shang 2023; 36:641-6. [PMID: 37475628 DOI: 10.12200/j.issn.1003-0034.2023.07.009] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
OBJECTIVE To analyze the clinical effect of minimally invasive femoral head replacement and proximal femoral nail antirotation(PFNA) internal fixation at the same time in the treatment of elderly patients with comminuted intertrochanteric fracture. METHODS From April 2020 to October 2020, 76 elderly patients with comminuted intertrochanteric fracture treated by minimally invasive femoral head replacement and PFNA were analyzed retrospectively. There were 35 patients in the prosthetic group, including 24 females and 11 males with an average age of (86.2±6.1) years old. There were 41 patients in PFNA group including 28 females and 13 males with an average age of (84.6±5.3) years old. The operation time, intraoperative blood loss, postoperative ambulation time, hospitalization time and complications were observed and compared between two groups. Harris hip score was performed at 1, 6 and 12 months after operation. RESULTS All patients were followed up for 13 to 17 months with an average of (14.3±1.4) months. The operation time of the prosthesis group was longer than that of the PFNA group (P<0.05);the amount of bleeding in PFNA group was less than that in prosthesis group (P>0.05);the time of ambulation in prosthetic group was earlier than that in PFNA group(P<0.05);the number of complications in the prosthesis group was less than that in the PFNA group(P<0.05); the Harris score of prosthesis group was significantly higher than that of PFNA group at 1 and 6 months after operation (P<0.05), but there was no significant difference in Harris score between two groups at 12 months after operation(P>0.05);the number of complications in the prosthesis group was less than that in the PFNA group (P<0.05). CONCLUSION Minimally invasive femoral head replacement is a good choice for the elderly patients with commuited intertrochanteric fracture. It can improve the quality of life and reduce the burden of family members and society.
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Affiliation(s)
- Qiang Wang
- Traditional Chinese Medicine Hospital of Jinhua, Jinhua 321017, Zhejiang, China
| | - Yan-Kui Leng
- Traditional Chinese Medicine Hospital of Jinhua, Jinhua 321017, Zhejiang, China
| | - Bing Xia
- Zhejiang Provincial People's Hospital, Hangzhou 310000, Zhejiang, China
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Wu L, Cheng B. A nomogram to predict postoperative deep vein thrombosis in patients with femoral fracture: a retrospective study. J Orthop Surg Res 2023; 18:463. [PMID: 37370139 DOI: 10.1186/s13018-023-03931-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
OBJECTIVE The implementation of more active anticoagulant prevention and treatment measures has indeed led to a significant reduction in the incidence of perioperative deep vein thrombosis (DVT) among patients with bone trauma. However, it is important to note that despite these efforts, the incidence of DVT still remains relatively high. According to the Caprini score, all patients undergoing major orthopedic surgery were defined as the high-risk group for DVT. Stratifying the risk further within high-risk groups for DVT continues to present challenges. As a result, the commonly used Caprini score during the perioperative period is not applicable to orthopedic patients. We attempt to establish a specialized model to predict postoperative DVT risk in patients with femoral fracture. METHODS We collected the clinical data of 513 patients undergoing femoral fracture surgery in our hospital from May 2018 to December 2019. According to the independent risk factors of DVT obtained by univariate and multivariate logistic regression analysis, the corresponding nomogram model was established and verified internally. The discriminative capacity of nomogram was evaluated by receiver operating characteristic (ROC) curve and area under the curve (AUC). The calibration curve used to verify model consistency was the fitted line between predicted and actual incidences. The clinical validity of the nomogram model was assessed using decision curve analysis (DCA) which could quantify the net benefit of different risk threshold probabilities. Bootstrap method was applied to the internal validation of the nomogram model. Furthermore, a comparison was made between the Caprini score and the developed nomogram model. RESULTS The Caprini scores of subjects ranged from 5 to 17 points. The incidence of DVT was not positively correlated with the Caprini score. The predictors of the nomogram model included 10 risk factors such as age, hypoalbuminemia, multiple trauma, perioperative red blood cell infusion, etc. Compared with the Caprini scale (AUC = 0.571, 95% CI 0.479-0.623), the calibration accuracy and identification ability of nomogram were higher (AUC = 0.865,95% CI 0.780-0.935). The decision curve analysis (DCA) indicated the clinical effectiveness of nomogram was higher than the Caprini score. CONCLUSIONS The nomogram was established to effectively predict postoperative DVT in patients with femoral fracture. To further reduce the incidence, more specialized risk assessment models for DVT should take into account the unique risk factors and characteristics associated with specific patient populations.
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Affiliation(s)
- Linqin Wu
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Bo Cheng
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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Padgett AM, Kothari EA, Williams KA. Bilateral Femoral Shaft Fractures in a Young Child due to Nonaccidental Trauma: A Case Report and Literature Review. J Orthop Case Rep 2023; 13:110-114. [PMID: 37398517 PMCID: PMC10308972 DOI: 10.13107/jocr.2023.v13.i06.3716] [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: 03/28/2023] [Revised: 04/21/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction Bilateral femoral diaphyseal fractures in children due to nonaccidental trauma (NAT) are a rare occurrence, with no reported cases currently published in the literature. The authors present a case of an 8-month-old male who presented with bilateral femoral shaft fractures. History, physical examination, and radiographic findings support NAT as the cause of his injuries. Due to the patient's size and associated comorbidities, he was initially treated with Pavlik harness placement, rather than spica casting. The patient demonstrated appropriate radiographic evidence of fracture healing on follow-up. Case Report An 8-month-old male with a complex past medical history presents to the emergency department. Per the patient's mother, he has been demonstrating a progressive loss of movement and refusal to bear weight in his bilateral lower extremities over the preceding 1-2 weeks. Other injuries include facial bruising and lesions indicative of subconjunctival hemorrhages. After orthopedics was consulted, the decision was made to treat the patient's bilateral femoral shaft fractures with a Pavlik harness, rather than spica casting, due to his small size and associated past medical history. The patient was subsequently discharged under foster care. Follow-up visit demonstrates appropriate fracture healing in the bilateral femoral diaphyses. Conclusion Many cases of NAT in the pediatric population are initially missed. Orthopedic providers must maintain a high index of suspicion for NAT as many of these patients will present with musculoskeletal injuries. The authors report a rare case of NAT in a male child resulting in bilateral femoral diaphyseal fractures. The patient was successfully treated through Pavlik harness placement. Orthopedic providers should consider Pavlik harness placement as a viable option even for young children >6 months of age presenting with femoral shaft fractures if spica casting or open reduction internal fixation is not appropriate.
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Affiliation(s)
- Anthony M Padgett
- Department of Orthopaedic Surgery, University of Alabama, Birmingham, Alabama
| | - Ezan A Kothari
- Department of Orthopaedic Surgery, University of Alabama, Birmingham, Alabama
| | - Kevin A Williams
- Department of Orthopaedic Surgery, University of Alabama, Birmingham, Alabama
- Department of Orthopaedic Surgery, Children’s of Alabama, Division of Orthopedic Surgery, Birmingham, Alabama
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Walsh ME, Blake C, Walsh CD, Brent L, Sorensen J. Patient and hospital-level factors associated with time to surgery after hip fracture in Ireland: Analysis of national audit data 2016-2020. Injury 2023:S0020-1383(23)00371-6. [PMID: 37085350 DOI: 10.1016/j.injury.2023.04.038] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 04/03/2023] [Accepted: 04/14/2023] [Indexed: 04/23/2023]
Abstract
INTRODUCTION In hip fracture care, time to surgery (TTS) is a commonly used quality indicator associated with patient outcomes including mortality. This study aimed to identify patient and hospital-level characteristics associated with TTS in Ireland. METHODS National data from the Irish Hip Fracture Database (IHFD) (2016-2020) were analysed along with hospital-level characteristics obtained from a 2020 organisational survey. Generalised linear model regression was used to explore the association of TTS with case-mix, surgical details, hospital-level staffing and specific protocols recommended to expedite surgery. RESULTS A total of 14,951 patients with surgically treated hip fracture from 16 hospitals were included (Mean age= 80.6 years (SD=8.8), 70.4% female). Mean TTS was 40.9 h (SD=60.3 h). Case-mix factors associated with longer TTS were male sex and higher American Society of Anaesthesiologists (ASA) grade. Other factors found to be associated with longer TTS included low pre-morbid mobility, inter-hospital transfer, weekday presentation, pre-operative medical physician assessment, intracapsular fracture type, arthroplasty surgery, general anaesthesia, consultant grade of surgeon and lower hospital-level orthopaedic surgical capacity. The oldest age-group and pre-fracture nursing home residence were associated with shorter TTS when adjusted for other case-mix factors. None of four explored protocols for expediting surgery were associated with TTS. CONCLUSION Patients with more comorbidity experience longer surgical delay after hip fracture in Ireland, in line with international research. Low availability of senior orthopaedic surgeons in Ireland may be delaying hip fracture surgery. Pathway of presentation, including via inter-hospital transfer or hospital bypass, is an important factor that requires further exploration. Further research is required to identify successful system-level protocols and interventions that may expedite hip fracture surgery within this setting.
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Affiliation(s)
- Mary E Walsh
- School of Public Health Physiotherapy and Sports Science, University College Dublin, Dublin 4, Ireland.
| | - Catherine Blake
- School of Public Health Physiotherapy and Sports Science, University College Dublin, Dublin 4, Ireland
| | - Cathal D Walsh
- Department of Mathematics and Statistics, University of Limerick, Limerick, Ireland
| | - Louise Brent
- National Office of Clinical Audit, RCSI University of Medicine and Health Sciences, Dublin 2, Ireland
| | - Jan Sorensen
- Healthcare Outcomes Research Centre, RCSI University of Medicine and Health Sciences, Dublin 2, Ireland
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He YK, Wang YC, Li FF. Is the traction table necessary to treat femoral fractures with intramedullary nailing? A meta-analysis. J Orthop Surg Res 2023; 18:277. [PMID: 37020232 PMCID: PMC10074654 DOI: 10.1186/s13018-023-03659-y] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 02/28/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND The traction table is generally used in femoral intramedullary nailing surgery. Recently, some published studies have shown that the same or better treatment effects can be gotten without a traction table. It remains no consensus on this issue. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-analyses guideline was applied in this study. We searched PubMed, Embase, Web of Science, and Cochrane Library databases for eligible studies. The random-effect model was used to calculate the standardized mean difference (SMD) and risk ratios with 95% CIs. Trial sequential analysis (TSA) was performed to verify the results. RESULTS The pooled estimates of seven studies, including 266 cases each in the manual traction group and traction table group, indicated that manual traction could shorten operative time [SMD, - 0.77; 95% CI (- 0.98, - 0.55); P < 0.00001] and preoperative set-up time [SMD, - 2.37; 95% CI (- 3.90, - 0.84); P = 0.002], but it would not reduce intraoperative blood loss volume and fluoroscopy time. No statistical difference was found in their fracture healing time, postoperative Harris scores, and malunion rate. The use of a Traction repositor could reduce the set-up time [SMD, - 2.48; 95% CI (- 4.91, - 0.05); P < 0.00001]. CONCLUSIONS Compared with manual traction, the traction table in femoral intramedullary nailing surgery lengthened operative time and preoperative set-up time. At the same time, it did not show significant advantages in reducing blood loss volume and fluoroscopy time, or improving prognosis. In clinical practice, the optimal surgical plan must be made on a case-by-case basis to avoid unnecessary traction table use.
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Affiliation(s)
- Yu-Kun He
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510000, Guangdong, China
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, 9000, Ghent, Belgium
| | - Yi-Chong Wang
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510000, Guangdong, China
| | - Feng-Feng Li
- Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 210008, Nanjing, China.
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Walsh ME, Cunningham C, Brent L, Savin B, Fitzgerald M, Blake C. Long-term outcome collection after hip fracture in Ireland: a systematic review of traditional and grey literature. Osteoporos Int 2023:10.1007/s00198-023-06713-x. [PMID: 36869882 DOI: 10.1007/s00198-023-06713-x] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 02/20/2023] [Indexed: 03/05/2023]
Abstract
UNLABELLED This review aimed to describe the methods and results from recent Irish research about post-acute hip fracture outcomes. Meta-analyses estimate the 30-day and 1-year mortality rate at 5% and 24% respectively. There is a need for standardised recommendations about which data should be recorded to aid national and international comparisons. PURPOSE Over 3700 older adults experience hip fracture in Ireland annually. The Irish Hip Fracture Database national audit records acute hospital data but lacks longer-term outcomes. This systematic review aimed to summarise and appraise recent Irish studies that collected long-term hip fracture outcomes and to generate pooled estimates where appropriate. METHODS Electronic databases and grey literature were searched in April 2022 for articles, abstracts, and theses published from 2005 to 2022. Eligible studies were appraised by two authors and outcome collection details summarised. Meta-analyses of studies with common outcomes were conducted where the sample was generalisable to the broad hip fracture population. RESULTS In total, 84 studies were identified from 20 clinical sites. Outcomes commonly recorded were mortality (n = 48 studies; 57%), function (n = 24; 29%), residence (n = 20; 24%), bone-related outcomes (n = 20; 24%), and mobility (n = 17; 20%). One year post-fracture was the most frequent time point, and patient telephone contact was the most common collection method used. Most studies did not report follow-up rates. Two meta-analyses were performed. The pooled estimate for one-year mortality was 24.2% (95% CI = 19.1-29.8%, I2 = 93.8%, n = 12 studies, n = 4220 patients), and for 30-day mortality was 4.7% (95% CI = 3.6-5.9%, I2 = 31.3%, n = 7 studies, n = 2092 patients). Reports of non-mortality outcomes were deemed inappropriate for meta-analysis. CONCLUSION Hip fracture long-term outcomes collected in Irish research are broadly in line with international recommendations. Heterogeneity of measures and poor reporting of methods and findings limits collation of results. Recommendations for standard outcome definitions nationally are warranted. Further research should explore the feasibility of recording long-term outcomes during routine hip fracture care in Ireland to enhance national audit.
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Affiliation(s)
- Mary E Walsh
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin 4, Ireland.
| | - Caitriona Cunningham
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin 4, Ireland
| | - Louise Brent
- National Office of Clinical Audit, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | | | | | - Catherine Blake
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin 4, Ireland
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Chung J, Malayko G, Pagliaro T, Journeaux S. Elbow to digit measurements as a preoperative adjunct tool to aid intramedullary femoral nail selection - the rule of thumb. Injury 2023; 54:683-686. [PMID: 36529548 DOI: 10.1016/j.injury.2022.12.011] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 12/07/2022] [Accepted: 12/10/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Intramedullary femoral nails are measured intraoperatively using fluoroscopy. This study aims to investigate whether distance from the olecranon to fingertips can be used to estimate nail length preoperatively by evaluating agreement of the two measurements. Such preoperative measurements may provide a likely range of nails needed for theatre and serve as an adjunct to intraoperative measurements. METHODS In 70 patients, long leg radiographs were used to make linear measurements from the piriformis fossa and greater trochanter to the distal physeal scar of the femur. These were compared to measurements from the olecranon to the tip of each digit and Bland-Altman agreement analysis was performed. Train and Trial groups were formed to develop models for estimation and to then test their accuracy. RESULTS Bland-Altman analysis revealed a fixed bias, indicative of average difference between measurements, of 1.4 cm when comparing the elbow-thumb length to maximum femoral nail length for piriformis fossa entry and 3.5 cm using greater trochanter entry, informing the "rule of thumb". Elbow-thumb length plus 1.4 cm or 3.5 cm predicts nail length to a range of ± one nail increment. The rule can be used to preoperatively predict a range of three nails from which there is a 94-97% likelihood the appropriate intramedullary nail would be selected. CONCLUSIONS The "rule of thumb" may serve as a simple to use tool for preoperative planning and a technical check to assess the "reasonableness" of intraoperative measurements before implantation of the device. It has the potential to reduce operating time and nail wastage.
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Affiliation(s)
| | | | | | - Simon Journeaux
- University of Queensland, Brisbane, QLD, Australia; Mater Hospital, South Brisbane, QLD, Australia
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Choi BC, Min BW, Lee KJ. Femoral Shaft Fracture in Klippel-Trenaunay-Weber Syndrome Patients - What to Do to Reduce Bleeding Risk: A Case Report. Hip Pelvis 2022; 34:262-268. [PMID: 36601615 PMCID: PMC9763826 DOI: 10.5371/hp.2022.34.4.262] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 07/22/2022] [Accepted: 08/09/2022] [Indexed: 12/14/2022] Open
Abstract
A fracture of the affected extremity in patients with Klippel-Trenaunay-Weber syndrome can be fatal due to massive bleeding and show poor results. A 42-year-old male presented with an old fracture of the right femoral shaft with metal failure. We planned an operation to remove the previously fixed plate and to perform re-fixation using an intra-medullary nail. Preoperative angiography was performed and the arteriovenous malformations were embolized in order to reduce the risk of bleeding. After angiography, the previously fixed plate was removed. After the operation, a second angiography was performed immediately and the venous malformation was embolized. One week after the first operation, a second operation was performed in order to reduce the fracture and to perform re-fixation using an intramedullary nail. The patient is being followed without major complication over a period of seven years after surgery. We recommend careful planning of preoperative and postoperative angiography and embolization in order to reduce the risk of bleeding in patients with Klippel-Trenaunay-Weber syndrome.
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Affiliation(s)
- Byung-Chan Choi
- Department of Orthopedic Surgery, Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
| | - Byung-Woo Min
- Department of Orthopedic Surgery, Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
| | - Kyung-Jae Lee
- Department of Orthopedic Surgery, Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
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Pierret M, Favreau H, Bonnomet F, Elizondo Moreno D, Bahlouli N, Martz P, Ehlinger M. Comparison of five methods for locked-plate fixation of complex diaphyseal fractures. Orthop Traumatol Surg Res 2022; 108:103400. [PMID: 36096378 DOI: 10.1016/j.otsr.2022.103400] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 05/03/2022] [Accepted: 05/11/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Peri-prosthetic fractures (PPFs) are steadily rising in number due to population ageing and increased performance of joint replacement procedures. Although PPFs without implant loosening are usually managed by internal fixation, no consensus exists regarding the optimal construct. The primary objective of this study was to compare five constructs, and the secondary objective was to compare sub-groups of mono-cortical screw constructs, with the goal of identifying the method most appropriate for diaphyseal fracture fixation when prosthetic material is present within the intra-medullary canal. HYPOTHESIS The primary hypothesis was that fixation using bi-cortical screws, i.e., the current reference standard, was superior over other fixation methods. The secondary hypothesis was that adding double cerclage to mono-cortical screw fixation provided the greatest mechanical strength. MATERIALS AND METHODS Synthetic osteoporotic bone was used to compare five methods for locking-screw fixation of a femoral diaphyseal plate. One method involved bi-cortical screws and four methods mono-cortical screws, with no cerclage wire, a single cerclage wire on either side positioned near or at a distance from the fracture, and two cerclage wires on both sides of the fracture. A complex fracture was simulated by creating a 2-cm diaphyseal gap. Load-to-failure was determined by applying compression loading along the anatomical axis of the femur. RESULTS Bi-cortical screw fixation provided greater mechanical strength than did three of the four mono-cortical screw constructs. The exception was the mono-cortical-screw and double-cerclage construct, for which no significant difference was found compared to bi-cortical screw fixation. Thus, mono-cortical screw fixation with double cerclage may be the best alternative when presence of an implant in the intra-medullary canal precludes bi-cortical screw fixation. CONCLUSION The findings from this study have clear implications for clinical practice. The study hypotheses were partly confirmed. The absence of a significant difference between the reference-standard bi-cortical screw fixation method and mono-cortical screw fixation with double cerclage, combined with the results regarding the secondary objective, suggest that mono-cortical screws plus double cerclage deserve preference in patients with an intra-medullary implant. Clinical studies are needed to assess the results of this bench study. LEVEL OF EVIDENCE IV, bench study.
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Affiliation(s)
- Marie Pierret
- Service de Chirurgie Orthopédique et de Traumatologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 avenue Molière, 67098 Strasbourg cedex, France; Laboratoire ICube, Université de Strasbourg- CNRS, 2 rue Boussingault, 67000 Strasbourg, France
| | - Henri Favreau
- Service de Chirurgie Orthopédique et de Traumatologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 avenue Molière, 67098 Strasbourg cedex, France
| | - François Bonnomet
- Service de Chirurgie Orthopédique et de Traumatologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 avenue Molière, 67098 Strasbourg cedex, France
| | - Daniel Elizondo Moreno
- Laboratoire ICube, Université de Strasbourg- CNRS, 2 rue Boussingault, 67000 Strasbourg, France; Plateforme IRIS/ICube, Université de Strasbourg- CNRS, 1 place de l'hôpital, 67000 Strasbourg, France
| | - Nadia Bahlouli
- Laboratoire ICube, Université de Strasbourg- CNRS, 2 rue Boussingault, 67000 Strasbourg, France
| | - Pierre Martz
- CHU Dijon, service d'orthopédie traumatologie, 14 rue Paul Gaffarel, 21000 Dijon, France; Unité INSERM UMR CAPS U1093. UFR STAPS, - BP 27877, Campus Universitaire, 21078 Dijon Cedex, France
| | - 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, Université de Strasbourg- CNRS, 2 rue Boussingault, 67000 Strasbourg, France.
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Gao H, Liu Z, Bai X, Xu G, Chen W, Ma J, Wang Y, Wang J, Wang G, Wang B. Comparison of freehand technique and a novel laser guiding navigation in distal locking of femoral intramedullary nails: a randomized controlled trial. BMC Surg 2022; 22:363. [PMID: 36271356 PMCID: PMC9585874 DOI: 10.1186/s12893-022-01815-5] [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: 05/25/2022] [Accepted: 10/13/2022] [Indexed: 12/04/2022] Open
Abstract
Background Intramedullary nail (IMN) is one of the key essential minimally invasive “weapons” in orthopaedic trauma, while the distal locking is still challenging for surgeons. Although there are various inventions and technologies to improve the locking procedure, there are still problems such as inaccurate positioning, excessive radiation exposure, low first success rate and long learning curve. Therefore, a new laser guiding navigation device was designed and compared with the traditional freehand (FH) technique in the distal locking of femoral IMN. Methods This randomized controlled single-blind trial recruited patients with femoral diaphyseal fracture. The self-designed laser navigation device (laser group) and freehand technique (FH group) were used in the distal locking of the IMNs. The patients enrolled were randomized into FH group and laser group, all operations were performed by two surgeons of the same level. The differences between the two groups were compared in terms of radiation exposure time, operative time, first success rate, blood loss, visual analogue score (VAS), Harris score and healing time. Results 32 patients ended the study period and 16 patients in each group. The results showed that the laser group was better than the FH group in terms of distal locking time (10(9/11) vs 19.5 (17.25/21) min, Z = 4.83, P < 0.001), distal locking radiation exposure time (46.5 (41.25/51.75) vs 105 (88.25/140) s, Z = 4.807, P < 0.001), first success rate (30/32 vs 20/32, χ2 = 9.143, P = 0.002) and blood loss (60 (50–100) vs 150 (105–192.5) mL, Z = 3.610, P = 0.0003). There was no difference in Harris score, VAS score, or fracture healing time between the two groups. Conclusion Compared with the FH technique, the novel laser guiding navigation device for distal locking of femoral IMN has the advantages of shorter operative time, less radiation exposure and higher first success rate. Trial registration Chinese Clinical Trial Registry, ChiCTR2200060236. Registered 23 May 2022, https://www.chictr.org.cn/showprojen.aspx?proj=169130
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Affiliation(s)
- Hua Gao
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhenyu Liu
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xiaodong Bai
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Guoqiang Xu
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Wentao Chen
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Ji Ma
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yijun Wang
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jiatian Wang
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Gang Wang
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
| | - Baojun Wang
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
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Schaefer RO, Eberlein SC, Klenke FM, Bastian JD, Hecker A. Staged treatment of a comminuted femoral fracture with Masquelet technique and 3D printed reposition guides. Trauma Case Rep 2022; 42:100723. [PMID: 36303888 PMCID: PMC9593800 DOI: 10.1016/j.tcr.2022.100723] [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] [Accepted: 10/16/2022] [Indexed: 11/06/2022] Open
Abstract
Background Comminuted femoral fractures pose a challenge to the trauma surgeon due to the absence of bony references during surgery. Therefore, malalignment of length and axis can occur and necessitate revision surgery. During the last decade, 3D-planning has evolved as a surgical aid in difficult cases. Case report An 18-year-old male patient suffered a polytrauma following a motorcycle accident. This report is about the treatment of a 3rd degree open and comminuted fracture of the left distal femur. The fracture was treated with Masquelet's two-staged technique. With the intent of avoiding malalignment, the second stage surgery was performed with the aid of 3D-planned reduction guides. Despite complex fracture pattern, complete fracture union was achieved with acceptable final alignment (side-to-side comparison of length, axis and femoral torsion). Conclusion In this case, performing Masquelet's two-staged surgery with the aid of 3D-printed reposition guides yielded favorable results in regards to rotational malalignment. The malrotation of the femur was reduced after the second operation to a clinically acceptable side-to-side difference (10°). This technique remains technically challenging due to soft tissue tension and limited possibility of soft tissue release.
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Affiliation(s)
- Raymond O Schaefer
- Corresponding author at: Department of Orthopaedic Surgery and Traumatology, Bern University Hospital, Freiburgstrasse 4, 3010 Bern, Switzerland.
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de Ruijter M, Lucke J, Yuan J, Derksen R. Patient experience from a doctor's perspective: A case report concerning treatment, fracture healing and rehabilitation of multiple complex injuries due to a high energy motor vehicle collision. Trauma Case Rep 2022; 42:100699. [PMID: 36210916 PMCID: PMC9535306 DOI: 10.1016/j.tcr.2022.100699] [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] [Accepted: 10/02/2022] [Indexed: 11/24/2022] Open
Abstract
A 35-year old healthy male trauma surgery chief resident, suffered a high-speed motor vehicle collision. The patient sustained the following injuries: a Gustilo-Anderson grade 2 open comminuted intra-articular fracture of the left distal femur (AO 33C3.3), a Hawkins 1A neck fracture of the right talus (AO 81.2A), an undisplaced Lisfranc injury of the right foot comprising avulsion fractures at the base of the 1st, 2nd and 5th metatarsal as well as the cuboid bone suggesting ligament injury and 2nd to 5th carpometacarpal dislocations of the right (non-dominant) hand with comminuted fractures of the capitate, hamate, trapezoid and the base of the fifth metacarpal bone. A staged-treatment approach ensued. An external fixator (ex-fix) was placed over the left knee, followed by definitive fixation of the distal femoral fracture using a Qwix screw, Non-Contact Bridging (NCB) plate and Locking Compression Plate (LCP). An ex-fix was placed over the right wrist, followed by open reduction and k-wire fixation. The talar fracture of the right foot was treated with a single lag screw and the Lisfranc injury was treated non-operatively with four weeks of non-weight bearing cast immobilization. An intensive clinical rehabilitation program was started, including early use of Continuous Passive Motion (CPM), daily non-weightbearing swimming pool exercises, hand, physical and recreational therapy. One year after the injury the patient was rehabilitated and resumed his surgical residency. Two years after the injury, limited flexion and pain in the left leg remains, possibly related to partial union of the femoral fracture. Range of motion (ROM) of the right ankle and wrist remains limited, not causing significant functional impairment. Lessons learned from a patient experience combined with detailed descriptions of injuries, rehabilitation and long term outcomes can be used as a reference for treating patients with comparable injuries.
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Affiliation(s)
- M.A. de Ruijter
- Department of Traumasurgery, Zaandam Medical Centre, Zaandam, the Netherlands,Corresponding author at: Department of Traumasurgery, Zaandam Medical Centre, Koningin Julianaplein 58, 1502 DV Zaandam, the Netherlands.
| | - J.A. Lucke
- Department of Emergency Medicine, Spaarne Gasthuis, Haarlem, the Netherlands
| | - J.Z. Yuan
- Department of Traumasurgery, Zaandam Medical Centre, Zaandam, the Netherlands
| | - R.J. Derksen
- Department of Traumasurgery, Zaandam Medical Centre, Zaandam, the Netherlands
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Huang C, Fu Z, Wang Q, You R, Zhao F. Treatment of the Hoffa fracture of the lateral femoral condyle with cannulated screws in combination with an anti-gliding steel plate, a retrospective observational study. BMC Surg 2022; 22:354. [PMID: 36192727 PMCID: PMC9531427 DOI: 10.1186/s12893-022-01803-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 06/01/2022] [Accepted: 09/22/2022] [Indexed: 11/22/2022] Open
Abstract
Background The stability of the Hoffa fracture fixed with a cannulated screw is limited. In the present work, we adopted two cannulated screws from anterior to posterior and posteriorly anti-gliding plate to treat 12 cases with Hoffa fracture of the lateral femoral condyle. Methods Open reduction and internal fixation were performed in 12 patients with Hoffa fractures of the lateral femoral condyle. The Hoffa fracture end was fixed with an anti-gliding steel plate based on cannulated screw fixation in the rear of the distal femur. All patients were followed for 12–24 months, with a median of 15.3 ± 4.6 months. Results All fractures were bony union, with a healing time of 3–6 months (median, 4.5 months). The Letenneur evaluation system was used to assess efficacy. Four indexes were observed, including knee range of motion (ROM), stability, pain, and dependent ambulation. The results revealed that eight cases were excellent and four cases good, with a good rate of 100%. Conclusion The surgical treatment with cannulated screws in combination with an anti-gliding steel plate could fix the end of the Hoffa fracture, which could acquire strong internal fixation and a good curative effect.
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Affiliation(s)
- Chunfu Huang
- Department of Orthopaedics, No. 910 Hospital of PLA, Quanzhou, 362000, Fujian, China
| | - Zuchang Fu
- Department of Orthopaedics, No. 910 Hospital of PLA, Quanzhou, 362000, Fujian, China
| | - Qingkeng Wang
- Department of Orthopaedics, No. 910 Hospital of PLA, Quanzhou, 362000, Fujian, China
| | - Ruijin You
- Department of Orthopaedics, No. 910 Hospital of PLA, Quanzhou, 362000, Fujian, China.
| | - Feng Zhao
- Department of Orthopaedics, No. 910 Hospital of PLA, Quanzhou, 362000, Fujian, China
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Wang C, Sun L, Wang Q, Ma T, Zhang K, Li Z. The technique of "autologous bone grafting through channels" combined with double-plate fixation is effective treatment of femoral nonunion. Int Orthop 2022; 46:2385-2391. [PMID: 35849163 DOI: 10.1007/s00264-022-05519-6] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 07/12/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE The aims of this retrospective study were to evaluate the effective treatment of femoral nonunion using the technique of "autologous bone grafting through channels" combined with double-plate fixation. METHODS In this study, 186 patients with nonunion fracture of femur who underwent surgery using the technique of "autologous bone grafting through channels" combined with double-plate fixation in Hong Hui Hospital from May 2010 to July 2020 were enrolled. Totally, 122 males and 64 females with mean age of 44 years were evaluated. These patients were evaluated for the full clinical and radiological union time, duration of follow-up, levels of post-operative limb shortening, and range of motion of adjacent joints, and incidence of serious complications. RESULTS The mean follow-up time was 22 ± 6.2 months (range 12-44 months). Mean union time from surgery using our technique to full clinical and radiological union was 7.6 ± 1.2 months (range 4-9 months). All patients have achieved the union after one operation or two operations using the technique. The one-operation union rate is 98.4%. Post-operative severe complications were seen in seven patients which included deep vein thrombosis; the surgical site infection and the fracture nonunion. The range of motion in the adjacent joint of 17.7% (33/186) in all patients have an effect to the limb function. Six patients have the limb shortening more than 10 mm after surgery. CONCLUSION The technique of "autologous bone grafting through channels" combined with double-plate fixation is showed to be safe, effective, and easy to master and operate surgical option for treating the femoral nonunion.
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Affiliation(s)
- Chaofeng Wang
- Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, No. 76 Nanguo Road, Beilin District, Xi'an, 710054, Shaanxi Province, China.
| | - Liang Sun
- Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, No. 76 Nanguo Road, Beilin District, Xi'an, 710054, Shaanxi Province, China
| | - Qian Wang
- Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, No. 76 Nanguo Road, Beilin District, Xi'an, 710054, Shaanxi Province, China
| | - Teng Ma
- Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, No. 76 Nanguo Road, Beilin District, Xi'an, 710054, Shaanxi Province, China
| | - Kun Zhang
- Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, No. 76 Nanguo Road, Beilin District, Xi'an, 710054, Shaanxi Province, China.
| | - Zhong Li
- Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, No. 76 Nanguo Road, Beilin District, Xi'an, 710054, Shaanxi Province, China.
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Walsh ME, Sorensen J, Blake C, Johnsen SP, Kristensen PK. Geographic variation in hip fracture surgery rate, care quality and outcomes: a comparison between national registries in Ireland and Denmark. Arch Osteoporos 2022; 17:128. [PMID: 36161538 DOI: 10.1007/s11657-022-01169-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 05/17/2022] [Accepted: 09/12/2022] [Indexed: 02/03/2023]
Abstract
Ireland and Denmark have similar hip fracture surgery rates but differences in care quality indicators and patterns of intracapsular fracture repair. Very high variation in total hip arthroplasty rate within both countries and higher observed early mortality in Denmark require further investigation. PURPOSE To explore and compare geographic variation of hip fracture surgery rate, care quality and outcomes in Ireland and Denmark. METHODS Patients aged ≥ 65 years with surgically treated hip fracture were included from the Irish Hip Fracture Database (years = 2017-2020, n = 12,904) and the Danish Multidisciplinary Hip Fracture Registry (years = 2016-2017, n = 12,924). The age and sex standardised rate of hip fracture surgery and the proportion of patients with seven process quality indicators, three surgery types and four outcomes were calculated. Systematic components of variation (SCV) were calculated based on hospital area (6 Irish hospital groups, 5 Danish regions). RESULTS The age and sex standardised rate of hip fracture surgery per 1000 older population in 2017 was 4.7 (95% CI = 4.4-5.1) in Ireland and 5.3 (95% CI = 5.1-5.5) in Denmark. Ireland had lower rates of surgery within 36 h (59% versus 84%), nutritional assessment (27% versus 84%) and pre-discharge mobility recording (52% versus 92%). Patterns of intracapsular fracture repair also differed between countries (hemiarthroplasty: Ireland = 85%, Denmark = 52%). Both countries had very high variation for total hip arthroplasty (THA) provision (SCV Ireland = 10.6, Denmark = 97.9). Ireland had longer hospital stays (median 12 versus 7 days), but lower 7-day (1.0% versus 3.1%) and 14-day (2.0% versus 5.5%) mortality. CONCLUSION Ireland and Denmark have similar hip fracture surgery rates, but differences in care quality, surgery patterns and outcomes. High variation in THA provision and observed differences in mortality require further exploration. In Ireland, there is scope for improvement regarding early surgery, mobility, nutrition assessment and improved post-discharge follow-up.
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Affiliation(s)
- Mary E Walsh
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin 4, Ireland.
| | - Jan Sorensen
- Healthcare Outcomes Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Catherine Blake
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin 4, Ireland
| | - Søren Paaske Johnsen
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Pia Kjær Kristensen
- The Department of Clinical Medicine, Orthopaedic, Aarhus University, Aarhus, Denmark
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Yuan H, Yu H, Zhu Y, Xiang L, Wang H. Effect of Age on the Patterns of Traumatic Femoral Fractures: Seven Years of Experience at a Regional Tertiary Hospital. Orthop Surg 2022; 14:2132-2140. [PMID: 35929600 PMCID: PMC9483057 DOI: 10.1111/os.13410] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 06/11/2022] [Accepted: 06/26/2022] [Indexed: 11/29/2022] Open
Abstract
Objective Femoral fractures are a common cause of mortality and functional loss, mainly among older people, and there are few studies about the age in relation to traumatic femoral fractures. The aim of this study was to investigate the effect of age on the patterns of traumatic femoral fractures in patients presenting to our regional tertiary hospital. Methods The records of 2020 patients who presented with traumatic femoral fractures between 2013 and 2019 were retrospectively reviewed. The patients' clinical and radiographic records were reviewed. Univariate and multivariable logistic regression were used to identify independent risk factors for associated injuries and complications. Results The patients were divided into a child group (CH group, n = 342) aged under 18 years, a young adult group (YA group, n = 484) aged 18–60 years, and an older people group (OP group, n = 1194) aged 60 years and over. There were significant differences among the three groups in several indexes, such as sex ratio (χ2 = 301.699, p < 0.001), osteoporosis (χ2 = 375.463, p < 0.001), injury time of day (χ2 = 114.913, p < 0.001), injury cause (χ2 = 748.187, p < 0.001), injury location (χ2 = 490.153, p < 0.001), fracture side (χ2 = 57.000, p < 0.001), fracture site (χ2 = 806.650, p < 0.001), associated injuries (χ2 = 322.921, p < 0.001), coma after injury (χ2 = 147.814, p < 0.001), non‐surgery‐related complications (χ2 = 7.895, p = 0.019), and surgery‐related complications (χ2 = 82.186, p < 0.001). The YA group had a significantly higher percentage of patients with surgery‐related complications than the OP group. The OP group had a higher frequency of non‐surgery‐related complications than the YA group and CH group. The most common non‐surgery‐related complications were pneumonia (7.1%) in the OP group and deep venous thrombosis (6.4%) in the YA group. Multivariable logistic regression showed that young adults, high‐energy injury, outdoors, coma after injury, and fracture sites except for the proximal region were independent risk factors for associated injuries. Older age, male, and fracture site except for the proximal region were independent risk factors for complications. Conclusions Traumatic femoral fractures are mostly the result of low‐energy trauma and predominantly affect the proximal site of the femur among older people. A higher rate of shaft fractures, fractures occurring outdoors, and associated injuries were observed among young adults and children than among older people.
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Affiliation(s)
- Hong Yuan
- Department of Orthopaedics, General Hospital of Northern Theater Command of Chinese PLA, Shenyang, China
| | - Hailong Yu
- Department of Orthopaedics, General Hospital of Northern Theater Command of Chinese PLA, Shenyang, China
| | - Yunpeng Zhu
- Department of Orthopedics, Hong Hui Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Liangbi Xiang
- Department of Orthopaedics, General Hospital of Northern Theater Command of Chinese PLA, Shenyang, China
| | - Hongwei Wang
- Department of Orthopaedics, General Hospital of Northern Theater Command of Chinese PLA, Shenyang, China
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Huang X, Chen Y, Chen B, Zheng K, Lin C, Lin F, Luo X. Reamed versus unreamed intramedullary nailing for the treatment of femoral shaft fractures among adults: A meta-analysis of randomized controlled trials. J Orthop Sci 2022; 27:850-858. [PMID: 34303590 DOI: 10.1016/j.jos.2021.03.022] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 02/03/2021] [Accepted: 03/17/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The purpose of this meta-analysis is to compare the merits and drawbacks between reamed intramedullary nailing (RIN) and unreamed intramedullary nailing (URIN) among adults. METHODS We comprehensively searched PubMed, MEDLINE database through the PubMed search engine, Google Scholar, Cochrane Library, Embase, VIPI (Database for Chinese Technical Periodicals), and CNKI (China National Knowledge Infrastructure) from inception to March 2020. Outcomes of interest included nonunion rates, implant failure rates, secondary procedure rates, blood loss, acute respiratory distress syndrome (ARDS) rates, and pulmonary complications rates. RESULTS Eight randomized controlled trials were included. The result of nonunion rates shows that the nonunion rate is significantly lower in the RIN group (RR = 0.20, 95% CI = 0.09-0.48, Z = 3.63, P = 0.0003). There were no significant differences for the risk of implant failure rates (RR = 0.55, 95% CI = 0.18-1.69, Z = 1.04, P = 0.30). The secondary procedure rates were significantly lower in the RIN group (RR = 0.28, 95% CI = 0.12-0.66, Z = 2.91, P = 0.004). The result shows that the blood loss of URIN group is significantly lower (RR = 145.52, 95% CI = 39.68-251.36, Z = 2.69, P = 0.007). The result shows that there was no significant difference in the ARDS rates (RR = 1.53, 95% CI = 0.37-6.29, Z = 0.59, P = 0.55) and the pulmonary complications rates between RIN group and URIN group (RR = 1.59, 95% CI = 0.61-4.17, Z = 0.94, P = 0.35). CONCLUSIONS Reamed intramedullary nailing would lead to lower nonunion rate, secondary procedure rate and more blood loss. Unreamed intramedullary nailing is related to a higher nonunion rate, secondary procedure rate and less blood loss. No significant difference is found in implant failure rate, ARDS rate and pulmonary complication rate between the two groups.
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Affiliation(s)
- Xu'an Huang
- School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Yifan Chen
- Department of Orthopedic Surgery, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
| | - Bin Chen
- Department of Orthopedic Surgery, Fuzhou Second Hospital Affiliated to Xiamen University, The Teaching Hospital of Fujian Medical University, Fuzhou, Fujian, China; Department of Orthopedic Surgery, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
| | - Ke Zheng
- Department of Orthopedic Surgery, Fuzhou Second Hospital Affiliated to Xiamen University, The Teaching Hospital of Fujian Medical University, Fuzhou, Fujian, China; Department of Orthopedic Surgery, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
| | - Chaohui Lin
- Department of Orthopedic Surgery, Fuzhou Second Hospital Affiliated to Xiamen University, The Teaching Hospital of Fujian Medical University, Fuzhou, Fujian, China; Department of Orthopedic Surgery, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
| | - Fengfei Lin
- Department of Orthopedic Surgery, Fuzhou Second Hospital Affiliated to Xiamen University, The Teaching Hospital of Fujian Medical University, Fuzhou, Fujian, China; Department of Orthopedic Surgery, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China.
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Tehrany PM, Kumar S. Comment on "Risk factors for excessive postoperative sliding of femoral trochanteric fracture in elderly patients: A retrospective multicenter study". Injury 2022; 53:2695. [PMID: 35410739 DOI: 10.1016/j.injury.2022.03.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 03/23/2022] [Indexed: 02/02/2023]
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Tang MT, Liu CF, Liu JL, Saijilafu, Wang Z. Multiple stress fractures of unilateral femur: A case report. World J Clin Cases 2022; 10:4280-4287. [PMID: 35665126 PMCID: PMC9131223 DOI: 10.12998/wjcc.v10.i13.4280] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 02/07/2022] [Accepted: 03/16/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Stress fractures of the femoral neck are not common in clinical practice, and simultaneous stress fractures of the femoral neck and proximal femur of the unilateral femur are even more rare. We introduce a case of this type of fracture that was treated in our department, analyze the causes, and review similar stress fractures reported in the literature to provide references for the diagnosis and treatment of such conditions.
CASE SUMMARY A 62-year-old female, with a free medical history, was admitted to the hospital mainly due to pain in the right hip and worsening pain in the right thigh. The patient had no obvious history of trauma. X-ray and computed tomography showed fracture of the femoral neck and proximal femur. The patient had undergone surgery 1 year prior to address a fracture of the left proximal femur that had occurred in a traffic accident. Our first consideration was stress fracture of the femoral neck; however, simultaneous stress fractures of the femoral neck and proximal femur of the unilateral femur were seen. The femoral neck stress fracture was a tension fracture, with obvious displacement and varus deformity of the hip. Considering that the patient was an elderly female, we performed total hip arthroplasty. Follow-up X-rays showed that the stress fracture of the proximal femur had mostly healed after 3 mo.
CONCLUSION Muscle fatigue and hip varus deformity provide an anatomical basis for the occurrence of femoral neck stress fractures.
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Affiliation(s)
- Mao-Ting Tang
- Department of Orthopaedics, Suzhou Kowloon Hospital Shanghai Jiao Tong University School of Medicine, Suzhou 215028, Jiangsu Province, China
| | - Chun-Feng Liu
- Department of Orthopaedics, Suzhou Kowloon Hospital Shanghai Jiao Tong University School of Medicine, Suzhou 215028, Jiangsu Province, China
| | - Jin-Lian Liu
- Department of Orthopaedics, Suzhou Kowloon Hospital Shanghai Jiao Tong University School of Medicine, Suzhou 215028, Jiangsu Province, China
| | - Saijilafu
- Orthopaedic Institute, Medical College, Soochow University, Suzhou 215007, Jiangsu Province, China
| | - Zhen Wang
- Department of Orthopaedics, Suzhou Kowloon Hospital Shanghai Jiao Tong University School of Medicine, Suzhou 215028, Jiangsu Province, China
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Grewal MUS, Bawale MR, Singh PB, Sandiford MA, Samsani MS. The use of Nottingham Hip Fracture score as a predictor of 1-year mortality risk for periprosthetic hip fractures. Injury 2022; 53:610-614. [PMID: 34986978 DOI: 10.1016/j.injury.2021.12.027] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 12/17/2021] [Indexed: 02/02/2023]
Abstract
AIMS The primary aim was to determine if the Nottingham Hip Fracture Score (NHFS) could be used to stratify 1-year mortality risk amongst periprosthetic hip fracture patients. The secondary aim was to identify 1year mortality rates amongst surgically managed periprosthetic hip fractures. METHODS Our electronic fracture database was interrogated for all Vancouver B or C periprosthetic fractures between September 2009 to April 2019; 83 patients were identified. All available data was then collected from radiographic, electronic and paper notes. The NHFS was retrospectively calculated for each patient. Statistical analysis was performed to identify factors significantly affecting 12month mortality using Akaike's information criterion corrected for small sample sizes (AICc), binomial logistic regression was performed using each variable; the p-values presented are for the coefficients of the regressor. RESULTS Periprosthetic fractures have a 1year mortality risk of 26.5%, 30 day mortality was 4.82%. The NHFS was found to be highly predictive of 1-year mortality amongst this patient cohort (p = 0.0001). We find that each unit increase in the NHFS is correlated with a 2.7times increase in mortality rate. There was no evidence that time lag from presentation to surgery led to an increased mortality (p = 0.455). CONCLUSION The NHFS can be used to stratify the 1-year mortality risk amongst patients who have periprosthetic hip fracture; this is a new finding not previously published to our knowledge. Given that time to surgery does not correlate with mortality, patients should be risk stratified on admission with NHFS. Time is then available to conduct a multi-disciplinary approach to optimize the patient, personnel and equipment. The introduction of a parallel multidisciplinary pathway to neck of femur fractures is long overdue and must be expedited.
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Affiliation(s)
- Mr Urpinder Singh Grewal
- Medway Maritime Hospital, Medway Foundation Trust, Windmill Road, Gillingham, Kent, ME7 5NY, United Kingdom.
| | - Mr Rajesh Bawale
- Medway Maritime Hospital, Medway Foundation Trust, Windmill Road, Gillingham, Kent, ME7 5NY, United Kingdom
| | - Professor Bijayendra Singh
- Medway Maritime Hospital, Medway Foundation Trust, Windmill Road, Gillingham, Kent, ME7 5NY, United Kingdom
| | | | - Mr Srinivas Samsani
- Medway Maritime Hospital, Medway Foundation Trust, Windmill Road, Gillingham, Kent, ME7 5NY, United Kingdom
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Townsend O, Jain S, Lamb JN, Scott CEH, Dunlop DG, Pandit HG. Periprosthetic femoral fracture type and location are influenced by the presence of an ipsilateral knee arthroplasty implant: A case-control study of 84 interprosthetic femoral fractures. Injury 2022; 53:645-652. [PMID: 34893307 DOI: 10.1016/j.injury.2021.11.047] [Citation(s) in RCA: 1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 11/13/2021] [Accepted: 11/21/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND This multicentre case-control study compares Vancouver Classification System (VCS) grade and Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) fracture type in interprosthetic femoral fractures (IPFFs) between primary total hip arthroplasty (THA) and ipsilateral total knee arthroplasty (TKA) to periprosthetic femoral fracture (PFF) without ipsilateral TKA. METHODS Data were collected following institutional approval. Eighty-four IPFFs were assessed for VCS grade and AO/OTA type. Each IPFF case (84) was matched to five PFF controls (360) by age, gender and stem fixation philosophy (SMD<0.1). VCS grade and AO/OTA type were compared between the IPFF and PFF groups using weighted proportions and medians. RESULTS Median (IQR) age of IPFF patients was 81.75 (76.57-85.33) years and 61 (72.6%) were female. The commonest VCS grade was B1 (34, 40.5%). The commonest AO/OTA type was spiral (51.8% of VCS B fractures; 50.0% of VCS C fractures). A greater proportion of fractures occurred distal to the stem in IPFF patients versus PFF patients (33.3% versus 18.2%, p = 0.003). VCS grade was significantly different between groups (p = 0.015). For VCS C fractures, twice as many AO/OTA transverse and wedge fractures occurred in the IPFF group compared to the PFF group (25.0% versus 12.6% and 7.1% versus 3.3%, respectively) although the overall difference was not statistically significant (p = 0.407). CONCLUSION The presence of an ipsilateral TKA affects the location of PFF with more fractures occurring distal to the stem. A greater proportion of bending type fractures occurred when an ipsilateral TKA was present. These unstable fractures often require more complex surgery.
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Affiliation(s)
- Oliver Townsend
- University Hospital Southampton, Tremona Road, Southampton SO16 6YD, UK.
| | - Sameer Jain
- University of Leeds, Woodhouse, Leeds LS2 9JT, UK; Chapel Allerton Hospital, Chapeltown Rd, Leeds LS7 4SA, UK
| | - Jonathan N Lamb
- University of Leeds, Woodhouse, Leeds LS2 9JT, UK; Chapel Allerton Hospital, Chapeltown Rd, Leeds LS7 4SA, UK
| | - Chloe E H Scott
- Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Rd, Edinburgh EH16 4SA, Scotland, UK
| | - Douglas G Dunlop
- University Hospital Southampton, Tremona Road, Southampton SO16 6YD, UK; University of Southampton, University Rd, Highfield, Southampton SO17 1BJ, UK
| | - Hemant G Pandit
- University of Leeds, Woodhouse, Leeds LS2 9JT, UK; Chapel Allerton Hospital, Chapeltown Rd, Leeds LS7 4SA, UK
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Rick Hatch GF, Bolia IK, Lindsay A, Haratian A, Hasan LK, Cohen L, Weber AE. Supracondylar femur fracture following multiligament knee reconstruction with Internal Brace® augmentation: A case report. Trauma Case Rep 2022; 37:100584. [PMID: 35036510 PMCID: PMC8743244 DOI: 10.1016/j.tcr.2021.100584] [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] [Accepted: 12/18/2021] [Indexed: 11/28/2022] Open
Abstract
This a case report of a 40-year-old male with left knee dislocation Type III and associated peroneal nerve palsy underwent delayed allograft reconstruction of his multiligament knee injury (MKI) with Internal Brace augmentation. The patient returned to work at 6 months postoperatively. He then fell and sustained a displaced supracondylar left femur fracture at the site of the internal brace augmentation of his lateral collateral ligament (LCL) reconstruction for which he underwent placement of a retrograde femoral nail. At 2 years of follow-up the patient had no evidence of knee instability. Level of evidence: V.
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Affiliation(s)
- George F Rick Hatch
- Investigation was performed at the USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, United States of America
| | - Ioanna K Bolia
- Investigation was performed at the USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, United States of America
| | - Adam Lindsay
- Investigation was performed at the USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, United States of America
| | - Aryan Haratian
- Investigation was performed at the USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, United States of America
| | - Laith K Hasan
- Investigation was performed at the USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, United States of America
| | - Landon Cohen
- Investigation was performed at the USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, United States of America
| | - Alexander E Weber
- Investigation was performed at the USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, United States of America
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Curtelin C, Delille E, Bailly C, Equy V, Hoffmann P, Courvoisier A, Riethmuller D. Femoral fracture during breech vaginal delivery: A case report. J Gynecol Obstet Hum Reprod 2022; 51:102310. [PMID: 34998975 DOI: 10.1016/j.jogoh.2022.102310] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/24/2021] [Accepted: 01/04/2022] [Indexed: 11/17/2022]
Abstract
Femoral fracture is a rare but significant foetal injury, more frequent and likely to happen when the foetus is malpositioned or in a breech presentation. Cesarian section does not appear to be protective and all recent publications report cases occurring during cesarian section. We report a case that occurred in a vaginal delivery of a single footling breech presentation. This complication allows us to remind that femur fracture is a complication of breech delivery whatever the modality. The prognosis is good with early diagnosis.
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Affiliation(s)
- C Curtelin
- University Grenoble-Alpes, Grenoble, France; Department of Gynecology-Obstetrics and Reproductive Medicine, Grenoble Alpes University Hospital, Grenoble, France
| | - E Delille
- University Grenoble-Alpes, Grenoble, France; Department of Gynecology-Obstetrics and Reproductive Medicine, Grenoble Alpes University Hospital, Grenoble, France
| | - C Bailly
- University Grenoble-Alpes, Grenoble, France; Department of Gynecology-Obstetrics and Reproductive Medicine, Grenoble Alpes University Hospital, Grenoble, France
| | - V Equy
- University Grenoble-Alpes, Grenoble, France; Department of Gynecology-Obstetrics and Reproductive Medicine, Grenoble Alpes University Hospital, Grenoble, France
| | - P Hoffmann
- University Grenoble-Alpes, Grenoble, France; Department of Gynecology-Obstetrics and Reproductive Medicine, Grenoble Alpes University Hospital, Grenoble, France
| | - A Courvoisier
- University Grenoble-Alpes, Grenoble, France; Department of Paediatric Orthopaedic Surgery, Grenoble Alpes University Hospital, Grenoble, France
| | - D Riethmuller
- University Grenoble-Alpes, Grenoble, France; Department of Gynecology-Obstetrics and Reproductive Medicine, Grenoble Alpes University Hospital, Grenoble, France.
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Hemmann P, Schmidutz F, Ahrend MD, Yan SG, Stöckle U, Schreiner AJ. Single-stage total hip arthroplasty after failed fixation of proximal femoral fractures: an increased risk for periprosthetic joint infections? Arch Orthop Trauma Surg 2022; 142:2911-7. [PMID: 34453205 DOI: 10.1007/s00402-021-04119-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 08/09/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Higher complication rates have been reported for total hip arthroplasty (THA) after osteosynthesis of proximal femur fractures (PFF). This study evaluated the infection risk for conversion of internal fixation of PFF to THA by a single-staged procedure in the absence of clear infection signs. METHODS Patients undergoing a one-staged conversion to THA (2013-2018) after prior internal fixation of the proximal femur were included. Preoperative diagnostics with laboratory results, hip aspirations as well as intraoperative microbiology and sonication were assessed. Postoperative complications were recorded as well as patient demographics, duration between initial and conversion to THA, explanted osteosynthesis and implanted THA. RESULTS Fifty-eight patients (24 male/34 female, 62.8 ± 14.5 years) were included with a mean time of 3.8 ± 7.5 years between internal fixation and conversion to THA (45 cementless, 3 cemented, 3 hybrid and 7 hybrid inverse THAs). Preoperative mean blood level CRP was 8.36 ± 14 mg/l (reference value < 5 mg/l) and leukocyte count was 7.11 ± 1.84^3/µl (4.5-10.000^3/µl). Fifty patients had intraoperative microbiological diagnostics, with either swabs in 86.2% and/or sonication in 29.3%. Positive microbiological results were recorded in 10% (5 of 50 patients), with pathogens identified being mainly Staphylococcus. Complications after conversion occurred in 9.6% including a postoperative low-grade infection rate of 5.8% after a mean of 2.5 years. CONCLUSION This study found a positive microbiological test result in 10% of a one-stage conversion of PFF fixation to THA. Moreover, we found a high infection rate (5.8%) for early postoperative periprosthetic joint infection. Interestingly, CRP has not been proven to be an adequate parameter for low-grade infections or occult colonized implants. Therefore, we recommend a comprehensive pre- and intraoperative diagnostic including hip aspiration, swabs and sonication when considering one-staged revision.
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He M, Fan Q, Zhu Y, Liu D, Liu X, Xu S, Peng J, Zhu Z. The need for nutritional assessment and interventions based on the prognostic nutritional index for patients with femoral fractures: a retrospective study. Perioper Med (Lond) 2021; 10:61. [PMID: 34930445 PMCID: PMC8686570 DOI: 10.1186/s13741-021-00232-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 04/21/2021] [Accepted: 11/19/2021] [Indexed: 02/07/2023] Open
Abstract
Background The incidence of adverse perioperative outcomes in surgery for femoral fractures is high and associated with malnutrition. Here, we identified independent factors and assessed the predictive value of the prognostic nutritional index (PNI) for perioperative adverse outcomes in patients with femoral fractures. Methods This retrospective study included 343 patients who underwent surgery for a single femur fracture. Demographic characteristics, surgery and anaesthesia records and blood test results at admission, 1 day postoperatively and before discharge were evaluated using logistic regression analysis. The discriminatory ability of the independent factors was assessed using the receiver operating characteristic curve analysis, and DeLong’s test was used to compare the area under the curve (AUC). Results Overall, 159 patients (46.4%) experienced adverse perioperative outcomes. Amongst these, 123 (35.9%) had lower limb vein thrombus, 68 (19.8%) had hospital-acquired pneumonia, 6 (1.7%) were transferred to the postoperative intensive care unit, 4 (1.2%) had pulmonary embolism, 3 (0.9%) died during hospitalisation and 9 (2.6%) had other adverse outcomes, including incision disunion, renal and liver function impairment, acute heart failure, acute cerebral infarction and stress gastroenteritis. The PNI at admission, age, postoperative hospital stay, time to admission, hypertension, combined injures and surgery type were independent factors for adverse perioperative outcomes. Based on the AUC (PNI at admission: 0.772 [0.723–0.821], P < 0.001; age: 0.678 [0.622–0.734], P < 0.001; postoperative hospital stay: 0.608 [0.548–0.668], P = 0.001; time to admission: 0.585 [0.525–0.646], P = 0.006), the PNI at admission had optimal discrimination ability, indicating its superiority over other independent factors (age vs. PNI at admission, P = 0.002; postoperative hospital stay vs. PNI at admission, P < 0.001; time to admission vs. PNI at admission, P < 0.001). Conclusions Patients with femoral fractures require a nutritional assessment and appropriate nutritional intervention at admission, and that the PNI value at admission may be a good nutritional assessment indicator.
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Affiliation(s)
- Miao He
- Medical College of Soochow University, Suzhou, Jiangsu, China.,Department of Anesthesiology, Affiliated Hospital of Zunyi Medical University, 149 Da Lian Road, Hui Chuan District, Zunyi, 563003, China.,Department of Anesthesiology, Clinical Medical College and Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Qinghong Fan
- Medical College of Soochow University, Suzhou, Jiangsu, China.,Department of Orthopedics, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Yuhang Zhu
- Department of Anesthesiology, Affiliated Hospital of Zunyi Medical University, 149 Da Lian Road, Hui Chuan District, Zunyi, 563003, China
| | - Dexing Liu
- Department of Anesthesiology, Affiliated Hospital of Zunyi Medical University, 149 Da Lian Road, Hui Chuan District, Zunyi, 563003, China
| | - Xingxing Liu
- Department of Anesthesiology, Affiliated Hospital of Zunyi Medical University, 149 Da Lian Road, Hui Chuan District, Zunyi, 563003, China
| | - Shan Xu
- Department of Anesthesiology, Affiliated Hospital of Zunyi Medical University, 149 Da Lian Road, Hui Chuan District, Zunyi, 563003, China
| | - Jiachen Peng
- Department of Orthopedics, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Zhaoqiong Zhu
- Medical College of Soochow University, Suzhou, Jiangsu, China. .,Department of Anesthesiology, Affiliated Hospital of Zunyi Medical University, 149 Da Lian Road, Hui Chuan District, Zunyi, 563003, China.
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Pasveer EH, Willems SA, Beetz I. Open lateral femoral condyle fracture concomitant with a vertical patella fracture in an adolescent: A case report. Trauma Case Rep 2021; 37:100575. [PMID: 34917741 PMCID: PMC8669457 DOI: 10.1016/j.tcr.2021.100575] [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] [Accepted: 12/05/2021] [Indexed: 11/28/2022] Open
Abstract
We present the rare case of an open femoral condyle fracture (Gustilla IIIA) combined with a vertical patella fracture due to sharp injury after a traffic collision in a 17-year-old female. During subsequent operation, a locking compression plate was used for definitive fixation of the distal femur and the patella was reduced and fixated with two screws. Four months after surgery, the patient had practically full range of motion again and no secondary complications occurred. On control X-ray, there was consolidation of the fracture.
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Affiliation(s)
- E H Pasveer
- Department of Surgery, Haga Teaching Hospital, The Hague, the Netherlands
| | - S A Willems
- Department of Surgery, Haga Teaching Hospital, The Hague, the Netherlands
| | - I Beetz
- Department of Surgery, Haga Teaching Hospital, The Hague, the Netherlands
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Pflüger P, Bolierakis E, Wurm M, Horst K, Hildebrand F, Biberthaler P. Revision rate is higher in patients with periprosthetic femur fractures following revision arthroplasty in comparison with ORIF following our algorithm: a two-center 1 analysis of 129 patients. Eur J Trauma Emerg Surg 2021; 48:1913-1918. [PMID: 34767064 PMCID: PMC9192397 DOI: 10.1007/s00068-021-01832-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 11/01/2021] [Indexed: 11/29/2022]
Abstract
Purpose Effective therapy of periprosthetic femur fractures of the hip (PPF) are challenging due to patients’ frailty and complexity of fracture patterns. The aim of this cohort study was to analyze the radiological and functional outcome following PPF. Methods A retrospective, multicenter study in the period 2009–2019 of patients with PPF at two level I trauma centers in Germany was performed. PPF were classified according to the Vancouver classification system. Demographic data, American Society of Anesthesiologists (ASA) classification, type of surgery, complications, and reoperation rate were obtained from patient records. The functional outcome was assessed by the modified Harris-Hip Score (mHHS), general health using the EQ-5D, and radiological outcome by Beals & Tower (B&T) criteria. Results A total of 129 patients with a mean age of 79 years (range 43–102) were included. 70% of all patients were female and 68% of the patients had an ASA score ≥ 3. 20 patients suffered from a Vancouver A, 90 from a Vancouver B and 19 from a Vancouver C fracture. 14% of the patients died within the first 2 years after surgery. The reoperation rate after open reduction and internal fixation (ORIF) (n = 60) was 8% and after revision arthroplasty (RA) (n = 47) 30% (OR 3.4, 95% CI [1.21–10.2]). Mean mHHS (n = 32) was 53 ± 19.4 and EQ-VAS was 50 ± 24.6. According to B&T criteria, 82% of patients treated with ORIF (n = 17) and 62% after RA (n = 13) showed an excellent outcome. Conclusion Patients with a PPF of the hip are elderly and at increased operative risk. In cases with a stable prosthesis, ORIF provides good radiological outcome with low reoperation rates. In case of RA, the risk for revision surgery is higher.
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Affiliation(s)
- Patrick Pflüger
- Department of Trauma Surgery, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Eftychios Bolierakis
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Markus Wurm
- Department of Trauma Surgery, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Klemens Horst
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Frank Hildebrand
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Peter Biberthaler
- Department of Trauma Surgery, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
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Ben-Haim G, Zabatani A, Orion D, Leshem E, Irony A, Katorza E. The Pandemic's impacts on patients without Covid-19 on multidisciplinary aspects in emergency medicine care. Intern Emerg Med 2021; 16:2261-2268. [PMID: 33650082 PMCID: PMC7920545 DOI: 10.1007/s11739-021-02680-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 02/16/2021] [Indexed: 12/23/2022]
Abstract
The emergence of Covid-19 has caused a pandemic and is a major public health concern. Covid-19 has fundamentally challenged the global health care system in all aspects. However, there is a growing concern for the subsequent detrimental effects of continuing delays or adjustments on time-dependent treatments for Covid-19 negative patients. Patients arriving to the ED with STEMIs and acute CVA are currently presumed to have delays due to Covid-19 related concerns. The objective of this paper is to evaluate the implications of the Covid-19 pandemic on non-Covid19 patients in emergency care settings. We conducted a retrospective study from February 2020 to April 2020 and compared this to a parallel period in 2019 to assess the impact of the Covid-19 pandemic on three distinct non-Covid-19 ED diagnosis that require immediate intervention. Our primary outcome measures were time to primary PCI in acute STEMI, time to fibrinolysis in acute CVA, and time to femoral hip fracture correction surgery. Our secondary outcome measure included a composite outcome of length of stay in hospital and mortality. From 1 February 2020 to 30 April 2020, the total referrals to ED diagnosed with STEMI, Hip fracture and CVA of which required intervention were 197 within Covid-19 group 2020 compared to 250 in the control group 2019. Mean duration to intervention (PCI, surgery and tPA, respectively) did not differ between COVID-19 group and 2019 group. Among femoral hip fracture patients', the referral numbers to ED were significantly lower in Covid-19 era (p = 0.040) and the hospitalization stay was significantly shorter (p = 0.003). Among CVA patients', we found statistical differences among the number of referrals and the patients' age. Coping with the Covid-19 pandemic presents a challenge for the general healthcare system. Our results suggest that with proper management, despite the obstacles of isolation policies and social distancing, any negative impact on the quality of health care for the non-Covid-19 patients can be minimized in the emergency department setting.
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Affiliation(s)
- Gal Ben-Haim
- Department of Emergency Medicine, Chaim Sheba Medical Center, 52621, Ramat-Gan, Tel Hashomer, Israel.
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Amit Zabatani
- Department of Orthopedics, Sheba Medical Center, Ramat-Gan, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - David Orion
- Acute Stroke and Neuro-Endovascular/Neuro-Interventional Unit and Stroke Center, Sheba Medical Center, Ramat-Gan, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Eyal Leshem
- The Center for Geographic Medicine and Tropical Diseases, Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Avinoah Irony
- Department of Emergency Medicine, Chaim Sheba Medical Center, 52621, Ramat-Gan, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Eldad Katorza
- Department of Medical Management, Sheba Medical Center, Ramat-Gan, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Curtis W, Pannier S, Gall O, Zentar MS, Angoulvant F, Cheron G. Efficacy of fascia iliaca nerve block in daily routine for children with femoral fractures in a pediatric emergency department. Arch Pediatr 2021; 28:544-7. [PMID: 34593294 DOI: 10.1016/j.arcped.2021.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 04/13/2021] [Accepted: 08/09/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES We aimed to evaluate the efficacy of fascia iliaca nerve block (FINB), routinely used for children with femoral fractures, in a pediatric emergency department (PED). METHODS This retrospective, single-center, observational study examined FINB using ropivacaine and a 1% lidocaine hydrochloride solution, in all patients under 18 years of age admitted with a femoral fracture from January 2012 to December 2016. Pain was assessed using two validated pediatric pain scales: EVENDOL or a visual analog scale. A level of ≥ 4 on either scale indicates the need for an analgesic. The primary outcome was the percentage of patients who were pain free after the FINB procedure defined by a pain score of < 4. Secondary outcomes were the time spent between PED admission and FINB, the need of additional analgesics, side effects, and the success rate of FINB. RESULTS Of 161 patients screened, 144 were included. The median age was 3.2 years (range 2 months to 16 years) and 74% were boys. The number of children determined to be pain free (pain score < 4) increased from 36 (25%) before the FINB to 123 (85%) after the FINB (absolute risk difference 60%, 95% CI: 51%-70%). Overall, 21 children (15%) required a second analgesic after the FINB. CONCLUSION The routine use of FINB with ropivacaine and lidocaine by pediatric ED physicians provided effective pain relief for children admitted for a femoral fracture in the emergency department. Our data support the efficiency and feasibility of FINB for the antalgic management of children with femoral fracture.
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Cech A, Rieussec C, Kerschbaumer G, Seurat O, Corbet C, Vibert B, Tronc C, Ruatti S, Bouzat P, Tonetti J, Boudissa M. Complications and outcomes in 69 consecutive patients with floating hip. Orthop Traumatol Surg Res 2021; 107:102998. [PMID: 34214653 DOI: 10.1016/j.otsr.2021.102998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 05/14/2020] [Revised: 01/07/2021] [Accepted: 02/01/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Floating hip is a rare and potentially serious injury. The objective of this study was to evaluate our management strategy for patients with floating hip. HYPOTHESIS A standardized strategy with specialised multidisciplinary management is associated with a low mortality rate. METHODS Consecutive patients who had surgery to treat floating hip between January 2010 and December 2019 were included in this single-centre retrospective study. Epidemiological, clinical, and radiological data were collected and analysed. Patients were managed according to a standardised strategy adapted to the haemodynamic status and type of floating hip (type A, femoral and pelvic ring fractures; type B, femoral and acetabular fractures; and type C, femoral, acetabular, and pelvic ring fractures). The clinical outcome at last follow-up was determined by a telephone interview, based on the Majeed and Oxford scores, sports resumption, and work resumption. To assess the radiological outcomes, we applied Matta's criteria for the acetabulum and Tornetta's criteria for the pelvic ring. RESULTS We included 69 patients with a mean age of 38.5 years. Among them, 39 (57%) had haemodynamic instability requiring embolisation (n=15, 22%) or multiple blood transfusions (n=24, 35%). Type A injuries predominated (n=57, 83%). The need for multiple blood transfusions was significantly associated with type C floating hip, underlining the risk of heavy bleeding with this injury. Two (3%) patients died. When management was complete, the reduction was anatomical or satisfactory for 76% (13/17) of the acetabula according to Matta's criteria (maximum residual displacement <3mm) and for 85% (56/66) of the pelvic rings according to Tornetta's criteria (maximum residual displacement <10mm). One or more complications occurred in 45 (65%) patients. After a mean follow-up of 5 years, the mean Oxford Hip Score in patients with acetabular fractures was 35.5 and the mean Majeed score in patients with pelvic ring fractures was 71.5. Only 30% of patients were able to resume physical activities at the former level and to return to their former professional activities. CONCLUSION Type C floating hip, which combines fractures of the pelvic ring and acetabulum, carries a high risk of bleeding. Special attention should be directed to the reduction of pelvic ring fractures, to avoid malunion. Acetabular fractures that are complex in the Letournel classification carry a risk of imperfect reduction. The results of this study confirm the severity of these rare injuries and the need for specialised multidisciplinary management according to a standardised strategy that is appropriate for the haemodynamic status and type of floating hip (A, B, or C). LEVEL OF EVIDENCE IV; retrospective study.
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Affiliation(s)
- Alexandre Cech
- Service de chirurgie orthopédique et traumatologique, Centre Hospitalier Universitaire de Grenoble, Université Grenoble Alpes, 38700 La Tronche, France
| | - Clémentine Rieussec
- Service de chirurgie orthopédique et traumatologique, Centre Hospitalier Universitaire de Grenoble, Université Grenoble Alpes, 38700 La Tronche, France
| | - Gaël Kerschbaumer
- Service de chirurgie orthopédique et traumatologique, Centre Hospitalier Universitaire de Grenoble, Université Grenoble Alpes, 38700 La Tronche, France
| | - Olivier Seurat
- Service de chirurgie orthopédique et traumatologique, Centre Hospitalier Universitaire de Grenoble, Université Grenoble Alpes, 38700 La Tronche, France
| | - Clémentine Corbet
- Service de chirurgie orthopédique et traumatologique, Centre Hospitalier Universitaire de Grenoble, Université Grenoble Alpes, 38700 La Tronche, France
| | - Benoît Vibert
- Service de chirurgie orthopédique et traumatologique, Centre Hospitalier Universitaire de Grenoble, Université Grenoble Alpes, 38700 La Tronche, France
| | - Camille Tronc
- Service de chirurgie orthopédique et traumatologique, Centre Hospitalier Universitaire de Grenoble, Université Grenoble Alpes, 38700 La Tronche, France
| | - Sébastien Ruatti
- Service de chirurgie orthopédique et traumatologique, Centre Hospitalier Universitaire de Grenoble, Université Grenoble Alpes, 38700 La Tronche, France
| | - Pierre Bouzat
- Service de réanimation et déchocage, Centre Hospitalier Universitaire de Grenoble, Université Grenoble Alpes, 38700 La Tronche, France
| | - Jérôme Tonetti
- Service de chirurgie orthopédique et traumatologique, Centre Hospitalier Universitaire de Grenoble, Université Grenoble Alpes, 38700 La Tronche, France; TIMC-IMAG lab, University Grenoble Alpes, CNRS UMR 5525, 38700 La Tronche, France
| | - Mehdi Boudissa
- Service de chirurgie orthopédique et traumatologique, Centre Hospitalier Universitaire de Grenoble, Université Grenoble Alpes, 38700 La Tronche, France; TIMC-IMAG lab, University Grenoble Alpes, CNRS UMR 5525, 38700 La Tronche, France.
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Yang J, Cui ZN, Dong JN, Lin WB, Jin JT, Tang XJ, Guo XB, Cui SB, Sun M, Ji CC. Early acute fat embolism syndrome caused by femoral fracture: A case report. World J Clin Cases 2021; 9:8260-8267. [PMID: 34621889 PMCID: PMC8462216 DOI: 10.12998/wjcc.v9.i27.8260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/23/2021] [Accepted: 08/05/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Fat embolism syndrome (FES) is a rare complication caused by the presence of fat particles in the microcirculation, which usually occurs within 12-72 h after trauma. At present, there have been few cases of fat embolism presenting within 3 h after trauma. Here, we report a case of femoral fracture complicated with an acute fat embolism caused by a car accident.
CASE SUMMARY A 29-year-old woman with pain, swelling and limited movement of her left lower limb after a car accident was taken by ambulance to our hospital. X-ray examination showed fracture of the middle and lower part of the left femur and fracture of the base of the left fifth metatarsal bone. She was hospitalized and admitted to the orthopedic ward. After the attending doctor performed tibial tubercle bone traction, the patient became confused, followed by respiratory distress. Finally, she was transferred to the intensive care unit. After nearly a month of treatment in the intensive care unit, the patient's cognitive function gradually recovered over 6 mo.
CONCLUSION For patients with early traumatic fractures, young emergency physicians and orthopedics should be aware of the possibility of FES.
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Affiliation(s)
- Jia Yang
- Department of Orthopaedic, Jincheng General Hospital, Jincheng 048006, Shanxi Province, China
| | - Zhong-Ning Cui
- Department of Orthopaedic, Jincheng General Hospital, Jincheng 048006, Shanxi Province, China
| | - Jia-Nan Dong
- Department of Gynecology, Gaoping People’s Hospital, Jincheng 048400, Shanxi Province, China
| | - Wen-Bo Lin
- Department of Orthopaedic, Shanghai Changzheng Hospital, Shanghai 200001, China
| | - Jiang-Tao Jin
- Department of Orthopaedic, Jincheng General Hospital, Jincheng 048006, Shanxi Province, China
| | - Xiao-Jie Tang
- Department of Spinal Surgery, The Yantai Affiliated Hospital of Binzhou Medical University, Yantai 264000, Shandong Province, China
| | - Xiao-Bo Guo
- Department of Orthopaedic, Jincheng General Hospital, Jincheng 048006, Shanxi Province, China
| | - Shao-Bo Cui
- Department of Critical Care Medicine, Jincheng General Hospital, Jincheng 048006, Shanxi Province, China
| | - Ming Sun
- Department of Emergency, Jincheng General Hospital, Jincheng 048006, Shanxi Province, China
| | - Chen-Chen Ji
- Department of Critical Care Medicine, Jincheng General Hospital, Jincheng 048006, Shanxi Province, China
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43
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Chloros GD, Giannoudis VP, Giannoudis PV. Iatrogenic sciatic nerve injury secondary to clamp placement around the femoral neck during proximal femoral fracture intramedullary nailing. Trauma Case Rep 2021; 35:100532. [PMID: 34541277 DOI: 10.1016/j.tcr.2021.100532] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 07/03/2021] [Revised: 08/27/2021] [Accepted: 08/28/2021] [Indexed: 11/21/2022] Open
Abstract
- 20-year-old male road-traffic accident - Sustained right acetabulum fracture, left proximal femur fracture, right patella fracture and pulmonary contusions - Had fixation within 4 days of his left proximal femur fracture and his right acetabulum:-Following fixation of his left femur fracture, developed symptoms of complete left sciatic nerve palsy.-At the time of surgery, a heygroves clamp around the neck of the femur was used to assist in the reduction of the fracture.-Subsequent exploration of the sciatic nerve showed several clamp indentations on it but fascicles in continuity. - Nerve conduction studies at 4 months post-operatively confirmed a high sciatic nerve injury. - The patient has still not recovered any function 1 year post-operatively.
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Nie Z, Ma W, Hu J. Models to predict the probability for intraoperative RBC transfusion during lumbar spinal stenosis and femoral fracture surgeries in aged patients. Transfus Apher Sci 2021; 60:103277. [PMID: 34563458 DOI: 10.1016/j.transci.2021.103277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 07/08/2021] [Revised: 09/06/2021] [Accepted: 09/09/2021] [Indexed: 01/28/2023]
Abstract
OBJECTIVE The goal of this study was to predict the probability of transfusion of red blood cells and the volume of blood consumption based on the clinical characteristics of patients before surgery. METHODS The medical records of 565 patients over 65 years old who underwent posterior lumbar surgery and 586 patients over 65 years old receiving femoral fracture surgery were reviewed. The clinical characteristics of the patients were subjected to multivariate regression analysis. The scores of these factors' influences on intraoperative red blood cells infusion were based on the odds ratio of each multivariate risk factor. Non-linear regression was performed to predict the probability of intraoperative blood transfusion and the volume of blood used for patients with different scores. RESULTS The factors that significantly influenced blood use during lumbar spinal stenosis and femoral fracture surgery in aged patients(P < 0.05) included age, body mass index, abnormal coagulation function, preoperative hemoglobin, administration of antithrombotic drugs, multisegmental lesions of the lumbar spine, femoral shaft fracture, secondary lumbar surgery and the time from fracture to surgery exceeding 48 h. According to our risk scoring system, patients of posterior lumbar surgery scored 0-10 and patients of femoral fracture had a score of 0-12. More than 50 % of patients receiving an intraoperative red blood cells transfusion during surgery scored>1. CONCLUSION The scoring system can be used as a predictive model for the probability of red blood cells transfusion and the blood volume in aged patients undergoing lumbar spinal stenosis and femoral fracture surgeries.
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Affiliation(s)
- Zhiyang Nie
- Transfusion Department, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, China.
| | - Wanru Ma
- Transfusion Department, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, China.
| | - Junhua Hu
- Transfusion Department, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, China.
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Camacho-Carrasco P, Renau-Cerrillo M, Campuzano-Bitterling B, Martinez-de-la-Mata J, Vives-Barquiel M. A modified cable wiring technique with C-shaped passer through a mini-open approach to assist reduction in femoral fractures. Eur J Orthop Surg Traumatol 2021; 32:1407-1413. [PMID: 34532756 DOI: 10.1007/s00590-021-03119-5] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 09/07/2021] [Indexed: 11/26/2022]
Abstract
Femur fractures reduction can be technically challenging due to the deforming forces exerted by the muscles causing displacement of the fracture fragments. Cerclage wiring is one of the reduction techniques frequently performed, allowing anatomical reduction of the fragments and a more stable fixation when an accurate closed reduction is not possible. We describe a modified cerclage wiring through a minimally invasive technique, using a conventional cannulated C-shaped passer.
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Affiliation(s)
- Pilar Camacho-Carrasco
- Orthopaedic and Traumatology Department, Hospital Clínic de Barcelona, Calle Villarroel 170, 08036, Barcelona, Catalonia, Spain
| | - Marina Renau-Cerrillo
- Orthopaedic and Traumatology Department, Hospital Clínic de Barcelona, Calle Villarroel 170, 08036, Barcelona, Catalonia, Spain
| | - Borja Campuzano-Bitterling
- Orthopaedic and Traumatology Department, Hospital Clínic de Barcelona, Calle Villarroel 170, 08036, Barcelona, Catalonia, Spain
| | | | - Marian Vives-Barquiel
- Orthopaedic and Traumatology Department, Hospital Clínic de Barcelona, Calle Villarroel 170, 08036, Barcelona, Catalonia, Spain.
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Rehm A, Ngu A, Thahir A. Pediatric Femoral Shaft Fracture: An Age-Based Treatment Algorithm. Liau GZQ, Lin HY, Wang Y, Nistala KRY, Cheong CK, Hui JHP. Indian J Orthop. 2020 Oct 10;55(1):55-67. doi:10.1007/s43465-020-00281-6. eCollection 2021 Feb. Indian J Orthop 2022; 56:517-8. [PMID: 35251518 DOI: 10.1007/s43465-021-00453-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 06/27/2021] [Indexed: 02/04/2023]
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Jadzic J, Milovanovic P, Cvetkovic D, Ivovic M, Tomanovic N, Bracanovic M, Zivkovic V, Nikolic S, Djuric M, Djonic D. Mechano-structural alteration in proximal femora of individuals with alcoholic liver disease: Implications for increased bone fragility. Bone 2021; 150:116020. [PMID: 34044170 DOI: 10.1016/j.bone.2021.116020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/14/2021] [Accepted: 05/19/2021] [Indexed: 02/06/2023]
Abstract
Although increased hip fracture risk is noted in patients with alcoholic liver disease (ALD), their femoral microstructural and mechanical properties were not investigated previously. The present study aimed to analyze the associations between subregional deteriorations in femoral mechano-structural properties and clinical imaging findings to explain increased femoral fracture risk among ALD patients. This study analyzed proximal femora of 33 male cadaveric donors, divided into ALD (n = 13, 57 ± 13 years) and age-matched control group (n = 20, 54 ± 13 years). After pathohistological verification of ALD stage, DXA and HSA measurements of the proximal femora were performed, followed by micro-CT and Vickers microindentation of the superolateral neck, inferomedial neck, and intertrochanteric region. Bone mineral density and cross sectional area of the femoral neck were deteriorated in ALD donors, compared with healthy controls (p < 0.05). Significant ALD-induced degradation of trabecular and cortical microstructure and Vickers microhardness reduction were noted in the analyzed femoral regions (p < 0.05). Still, the most prominent ALD-induced mechano-structural deterioration was noted in intertrochanteric region. Additionally, more severe bone alterations were observed in individuals with an irreversible stage of ALD, alcoholic liver cirrhosis (ALC), than in those with an initial ALD stage, fatty liver disease. Observed osteodensitometric and mechano-structural changes illuminate the basis for increased femoral fracture risk in ALD patients. Additionally, our data suggest bone strength reduction that may result in increased susceptibility to intertrochanteric femoral fracture in men with ALD. Thus, femoral fracture risk assessment should be advised for all ALD patients, especially in those with ALC.
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Affiliation(s)
- Jelena Jadzic
- Laboratory for Anthropology and Skeletal biology, Institute for Anatomy, Faculty of Medicine, University of Belgrade, Dr. Subotica no. 4/2, Belgrade, Serbia
| | - Petar Milovanovic
- Laboratory for Anthropology and Skeletal biology, Institute for Anatomy, Faculty of Medicine, University of Belgrade, Dr. Subotica no. 4/2, Belgrade, Serbia
| | - Danica Cvetkovic
- Institute of Forensic Medicine, Faculty of Medicine, University of Belgrade, Deligradska no. 31a, Belgrade, Serbia
| | - Miomira Ivovic
- Institute for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Dr. Subotica no. 13, Belgrade, Serbia
| | - Nada Tomanovic
- Institute of Pathology, Faculty of Medicine, University of Belgrade, Dr. Subotica no. 1, Belgrade, Serbia
| | - Milos Bracanovic
- Clinic for Emergency Surgery, Clinical Center of Serbia, Pasterova no. 2, Belgrade, Serbia
| | - Vladimir Zivkovic
- Institute of Forensic Medicine, Faculty of Medicine, University of Belgrade, Deligradska no. 31a, Belgrade, Serbia
| | - Slobodan Nikolic
- Institute of Forensic Medicine, Faculty of Medicine, University of Belgrade, Deligradska no. 31a, Belgrade, Serbia
| | - Marija Djuric
- Laboratory for Anthropology and Skeletal biology, Institute for Anatomy, Faculty of Medicine, University of Belgrade, Dr. Subotica no. 4/2, Belgrade, Serbia
| | - Danijela Djonic
- Laboratory for Anthropology and Skeletal biology, Institute for Anatomy, Faculty of Medicine, University of Belgrade, Dr. Subotica no. 4/2, Belgrade, Serbia.
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Hohenberger GM, Schwarz AM, Grechenig P, Clement B, Staresinic M, Bakota B. Medial minimally invasive helical plate osteosynthesis of the distal femur - a new technique. Injury 2021; 52 Suppl 5:S27-S31. [PMID: 32067767 DOI: 10.1016/j.injury.2020.02.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 01/16/2020] [Accepted: 02/09/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The goal of this study was to evaluate distal femoral minimally invasive plate osteosynthesis (MIPO) from a distal medial approach by use of a pre-bent helical implant. MATERIAL & METHODS A total of 18 lower extremities was evaluated. A 29.6 cm steel plate was constructed and pre-bent on bone specimens with a torsion of 55.7° A 5 cm incision was performed from the tip of the medial epicondyle alongside its centre in a proximal direction. The medial border of the vastus medialis was retracted anteriorly. The level of the proximal skin incision was determined using the length of the pre-bent plates. The proximal incision was performed at a length of 4 cm at the described height at a line between the lateral epicondyle and the tip of the greater trochanter. A raspatory was advanced beneath the vastus medialis in a proximal direction to create an extraperiosteal tunnel for plate insertion. The plate was fixed to the bone at its proximal and distal portion via screws. Following dissection, the distance between the nearest perforator to the proximal plate end was evaluated. The vertical distances between the medial border of the plate and the femoral artery and femoral nerve were measured at the level of the proximal plate end and at the level of the proximal margin of the vastoadductor membrane. RESULTS The most proximal perforating artery was located at a mean distance of 20.15 mm starting from the proximal plate margin. The mean interval between the medial border of the plate at the level of its proximal tip and the femoral artery was 51.9 mm. The average distance between the femoral nerve and the medial border of the proximal part of the plate was 42.3 mm. Regarding the interval between the medial border of the plate and the femoral artery, this was at a mean of 40.5 mm at the level of the proximal margin of the vastoadductor membrane. During dissection, none of the specimens showed any lesions of the adjacent anatomical characteristics. CONCLUSION Our results indicate MIPO of the distal femur from a medial approach as a safe technique.
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Affiliation(s)
- G M Hohenberger
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria.
| | - A M Schwarz
- AUVA Trauma Hospital Styria, Göstinger Straße 24, 8020 Graz, Austria
| | - P Grechenig
- Chair of Macroscopic and Clinical Anatomy, Medical University of Graz, Harrachgasse 21, 8010 Graz, Austria
| | - B Clement
- Department of Dental Medicine and Oral Health, Medical University of Graz, Billrothgasse 4, 8010 Graz, Austria
| | - Mario Staresinic
- Trauma and Orthopaedics Department, University Hospital Merkur, Zagreb, Croatia
| | - Bore Bakota
- Trauma and Orthopaedics Department, Medical University Hospital LKH Graz, Austria
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Abstract
AIMS To achieve the functional benefits of the direct anterior (DA) approach and the fixation benefits of cemented replacement, this study combined the two techniques posing the following questions: does the limited access of the DA approach adversely affect the cement technique?; and does such a cementing technique reduce the incidence of cementless complications? METHODS A consecutive series of 341 patients (360 hips) receiving the DA approach between 2016 and 2018 were reviewed. There were 203 cementless stems and 157 cemented stems. Mean age was 75 years (70 to 86) in the cementless group and 76 years (52 to 94) in the cemented group, with 239 (70%) females in the whole series. Femoral complications were compared between the two groups. Mean follow-up was 1.5 years (0.1 to 4.4) for patients in the cementless group and 1.3 years (0.0 to 3.9) for patients in the cemented group. RESULTS The cementless group had a higher rate of femoral complications (8 vs 0; p = 0.011). There were two loose stems and six fractures, all requiring revision. Fractures occurred a mean 14.5 days (2 to 31) postoperatively and loosening at 189 days and 422 days postoperatively. Femoral cementing can be done using the DA approach safely and reduces the number of complications compared with a contemporary cementless series. CONCLUSION A higher rate of early fractures and loosening occurred with cementless stems. This was not observed in our cemented stem cohort and cementing was safely accomplished through the DA approach. The modern femoral cementing process with the DA approach does not add to surgical complexity or time, has fewer early complications, and is a safer option for older patients compared to cementless femoral arthroplasties. Cite this article: Bone Joint J 2021;103-B(7 Supple B):33-37.
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Affiliation(s)
- Kwame A Ennin
- Texas Center for Joint Replacement, Plano, Texas, USA
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50
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Albareda-Albareda J, Gabarre-Raso S, Rosell-Pradas J, Puértolas-Broto S, Ibarz-Montaner E, Redondo-Trasobares B, Gómez-Vallejo J, Blanco-Rubio N, Sánchez-Gimeno M, Herrera-Rodríguez A, Gracia-Villa L. Biomechanical behavior of retrograde intramedullary nails in distal femoral fractures. Injury 2021; 52 Suppl 4:S76-S86. [PMID: 33642084 DOI: 10.1016/j.injury.2021.01.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/13/2020] [Accepted: 01/25/2021] [Indexed: 02/02/2023]
Abstract
Fractures of the distal femur affect three different groups of individuals: younger people suffering high-energy trauma, elderly people with fragile bones and people with periprosthetic fractures around previous total knee arthroplasty. Main indications of intramedullary nailing are for supracondylar fractures type A or type C of the AO classification. The main objective of the present work is to analyze, by means of FE simulation, the influence of retrograde nail length, considering different blocking configurations and fracture gaps, on the biomechanical behavior of supracondylar fractures of A type. A three dimensional (3D) finite element model of the femur from 55-year-old male donor was developed, and then a stability analysis was performed for the fixation provided by the retrograde nail at a distal fracture with different fracture gaps: 0.5 mm, 3 mm y 20 mm, respectively. Besides, for each gap, three nail lengths were studied with a general extent (320 mm, 280 mm and 240 mm), considering two transversal screws (M/L) at the distal part and different screw combinations above the fracture. The study was focused on the immediately post-operative stage, without any biological healing process. In view of the obtained results, it has been demonstrated new possibilities of blocking configuration in addition to the usual ones, which allows establishing recommendations for nail design and clinical practice, avoiding excessive stress concentrations both in screws, with the problem of rupture and loss of blocking, and in the contact of nail tip with cortical bone, with the problem of a new stress fracture.
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Affiliation(s)
- J Albareda-Albareda
- Department of Surgery, University of Zaragoza. Zaragoza, Spain; Aragón Health Research Institute. Zaragoza, Spain; Department of Orthopaedic Surgery and Traumatology, Lozano Blesa University Hospital, Spain
| | | | - J Rosell-Pradas
- Department of Mechanical Engineering, University of Zaragoza. Zaragoza, Spain
| | - S Puértolas-Broto
- Department of Mechanical Engineering, University of Zaragoza. Zaragoza, Spain; Aragón Institute for Engineering Research. Zaragoza, Spain
| | - E Ibarz-Montaner
- Department of Mechanical Engineering, University of Zaragoza. Zaragoza, Spain; Aragón Institute for Engineering Research. Zaragoza, Spain
| | - B Redondo-Trasobares
- Aragón Health Research Institute. Zaragoza, Spain; Department of Orthopaedic Surgery and Traumatology, Lozano Blesa University Hospital, Spain.
| | - J Gómez-Vallejo
- Department of Surgery, University of Zaragoza. Zaragoza, Spain; Aragón Health Research Institute. Zaragoza, Spain; Department of Orthopaedic Surgery and Traumatology, Lozano Blesa University Hospital, Spain
| | - N Blanco-Rubio
- Department of Surgery, University of Zaragoza. Zaragoza, Spain; Aragón Health Research Institute. Zaragoza, Spain; Department of Orthopaedic Surgery and Traumatology, Lozano Blesa University Hospital, Spain
| | - M Sánchez-Gimeno
- Department of Surgery, University of Zaragoza. Zaragoza, Spain; Aragón Health Research Institute. Zaragoza, Spain; Department of Orthopaedic Surgery and Traumatology, Lozano Blesa University Hospital, Spain
| | - A Herrera-Rodríguez
- Department of Surgery, University of Zaragoza. Zaragoza, Spain; Aragón Health Research Institute. Zaragoza, Spain; Aragón Institute for Engineering Research. Zaragoza, Spain
| | - L Gracia-Villa
- Department of Mechanical Engineering, University of Zaragoza. Zaragoza, Spain; Aragón Institute for Engineering Research. Zaragoza, Spain
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