Fixation Of Femoral Fractures Research Articles

Low reoperation rate after fixation of displaced femoral neck fractures with the femoral neck system (FNS).

Operative fixation of femoral neck fractures (FNFs) remains challenging. Complications are not infrequent, especially in displaced patterns. Numerous fixation techniques have been previously described in the literature; however, there remains a paucity of data regarding outcomes of these injuries treated with the femoral neck system (FNS). Patients with a displaced FNF (OTA/AO 31B) treated with the FNS at a single level 1 academic trauma center between 1/1/2019 and 1/1/2023 were identified. Radiographs were reviewed to assess fracture displacement, location, and characteristics. Patient records were further reviewed to assess for complications, reoperations, and osseous union. Forty-three patients (65% male) with 44 FNFs were identified with a mean age of 35.0years (range, 13-61years). Two patients developed a deep infection requiring surgical debridement, four patients underwent a total hip arthroplasty, and one patient underwent a valgus intertrochanteric osteotomy for nonunion. There were three cases of femoral head AVN. Mean follow-up was 482.5days among all patients, and 36 fractures had at least 6months of follow-up or reached bony union. Here, we present a series of patients treated with the FNS for internal fixation and report a 18% reoperation rate. This is lower than the average rate that has been previously reported in similar patient populations in the literature treated with alternative methods of internal fixation. Thus, the FNS appears to be a safe and effective option for treatment of these injuries.

CEPHALOMEDULLARY NAILING FOR SUBTROCHANTERIC FEMORAL SHAFT FRACTURES: A COMPARISON OF SINGLE LAG SCREW DEVICE WITH AN INTERCALATED DUAL SCREW DEVICE

Subtrochanteric femoral fractures are a subset of hip fractures generally treated with cephalomedullary nail fixation\[1\]. Single lag screw devices are most commonly-used, but integrated dual screw constructs have become increasingly popular\[2,3\]. The aim of this study was to compare outcomes of fixation of subtrochanteric femoral fractures using a single lag screw (Gamma3 nail, GN) with a dual screw device (InterTAN nail, IN). The primary outcome was mechanical failure, defined as lag screw cut-out, back-out, nail breakage or peri-implant fracture.Consecutive adult patients (18yrs) with subtrochanteric femoral fracture treated in a single centre were retrospectively identified using electronic records. Patients that underwent surgical fixation using either a long GN (2010–2017) or IN (2017–2022) were included. Medical records and radiographs were reviewed to identify complications of fixation. Cox regression analysis was used to determine the risk of mechanical failure and secondary outcomes by implant design. Multivariable regression models were used to identify predictors of mechanical failure.The study included 622 patients, 354 in the GN group (median age 82yrs, 72% female) and 268 in the IN group (median age 82yrs, 69% female). The risk of any mechanical failure was increased two-fold in the GN group (HR 2.44 \[95%CI 1.13 to 5.26\]; _p=0.024_). Mechanical failure comprising screw cut-out (_p=0.032_), back-out (_p=0.032_) and nail breakage (_p=0.26_) was only observed in the GN group. Technical predictors of failure included varus >5° for cut-out (OR 19.98 \[2.06 to 193.88\]; _p=0.01_), TAD;25mm for back-out (8.96 \[1.36 to 58.86\]; p=0.022) and shortening 1cm for peri-implant fracture (7.81 \[2.92 to 20.91\]; _p=<0.001_).Our results demonstrate that an intercalated screw construct is associated with a lower risk of mechanical failure compared with the a single lag screw device. Intercalated screw designs may reduce the risk of mechanical complications for patients with subtrochanteric femoral fractures.

Low avascular necrosis rates in femoral neck fractures: efficacy of cannulated screw fixation.

Cannulated screw fixation for femoral neck fractures is often limited by concerns of avascular necrosis (AVN) occurring, historically seen in 5-40% of fixed intracapsular fractures. This study aims to assess the outcomes, particularly the AVN rate, associated with current surgical techniques within our unit. We conducted a single-center cross-sectional study, manually searching operative records between July 14, 2014, and December 1, 2018, identifying patients with intracapsular fractured neck of femur fixed with cannulated screws, with a minimum of two years follow-up. Patient records and radiographs were reviewed for clinical and radiographic diagnoses of AVN, non-union, post-operative metalwork infection, and screw penetration of the head. Additionally, fracture pattern and displacement, screw configuration, reduction techniques, and adequacy of reduction were recorded, with radiographs independently analyzed by four orthopedic surgeons. Fifty-six patients were included; average age of 67 years (range 30-100). Forty-two patients (75%) sustained displaced fractures and 14 patients (25%) had undisplaced fractures. Two (4%) patients developed AVN, with no cases of non-union, post-operative metalwork infection or screw penetration of the head. Eight patients (14%) sustained a high-energy injury, though none of these patients developed AVN. All fractures required closed reduction; no open reductions performed. Twenty-seven (64%) of reductions were adequate. Our observed AVN rate is notably lower than the widely reported figures, even among a significant proportion of displaced fractures that were fixed. This study underscores that with adequate fixation, cannulated screws represent an excellent option for treating intracapsular neck of femur fractures, even in cases of displaced fracture patterns with imperfect reduction.

Multiple fluoroscopic views, including an external rotation-adduction view, are required to detect uncontained screws in the femoral neck

Introduction: Peripheral screws in the femoral neck are often used for fixation of femoral neck fractures. The posterior-cranial screw can violate the femoral head blood supply if it is extra-osseous, and can be difficult to image intraoperatively. The purpose of this study was to identify whether any specific radiographic views were superior at detecting an uncontained screw in the femoral neck. Additionally, the external rotation-adduction view was defined and its efficacy at detecting an unsafe posterior cranial screw assessed. Methods: A radiographic study using three-dimensional (3D) computed tomography scanswas performed at a single institution academic hospital. Forty-six patients with normal CT scans of the pelvis were included. Cannulated screws were digitally templated on 3D renderings of the femoral neck in an inverted triangle configuration. Each screw was systematically moved to a position where it was uncontained. Ghost images were created, and the pelvis rotated to simulate obtaining various iterations of a lateral view of the proximal femur. The ability of a given radiographic view to detect an uncontained screw was determined. Results: A flat-lateral view detected 72% of unsafe anterior screw, while a neck-shaft colinear view detected 98%. The flat lateral view detected 61% of unsafe posterior cranial screws, while a new external rotation-adduction view identified 100% of unsafe posterior cranial screws. Conclusions: Multiple radiographic views should be obtained to assess screw safety when treating femoral neck fractures with peripherally placed screws. The external rotation-adduction view may be useful for detection of uncontained posterior cranial screws. Level of evidence: III

Two big bones, one big decision: when to fix bilateral femur fractures

PurposeFor polytrauma patients with bilateral femoral shaft fractures (BFSF), there is currently no consensus on the optimal timing of surgery. This study assesses the impact of early (≤ 24 hours) versus delayed (>24 hours) definitive fixation on clinical outcomes, especially focusing on concomitant versus staged repair. We hypothesized that early definitive fixation leads to lower mortality and morbidity rates. MethodsThe 2017-2020 Trauma Quality Improvement Program was used to identify patients aged ≥16 years with BFSF who underwent definitive fixation. Early definitive fixation (EDF) was defined as fixation of both femoral shaft fractures within 24 hours, delayed definitive fixation (DDF) as fixation of both fractures after 24 hours, and early staged fixation (ESF) as fixation of one femur within 24 hours and the other femur after 24 hours. Propensity score matching and multilevel mixed effects regression models were used to compare groups. Results1,118 patients were included, of which 62.8% underwent EDF. Following propensity score matching, 279 balanced pairs were formed. EDF was associated with decreased overall morbidity (12.9% vs 22.6%, p=0.003), lower rate of deep venous thrombosis (2.2% vs 6.5%, p=0.012), a shorter ICU LOS (5 vs 7 days, p<0.001) and a shorter hospital LOS (10 vs 15 days, p<0.001). When compared to DDF, early staged fixation (ESF) was associated with lower rates of ventilator acquired pneumonia (0.0% vs 4.9%, p=0.007), but a longer ICU LOS (8 vs 6 days, p=0.004). Using regression analysis, every 24-hour delay to definitive fixation increased the odds of developing complications by 1.05, postoperative LOS by 10 hours and total hospital LOS by 27 hours. ConclusionEarly definitive fixation (≤ 24 hours) is preferred over delayed definitive fixation (>24 hours) for patients with bilateral femur shaft fractures when accounting for age, sex, injury characteristics, additional fractures and interventions, and hospital level. Although mortality does not differ, overall morbidity and deep venous thrombosis rates, and length of hospital and intensive care unit stay are significantly lower. When early definitive fixation is not possible, early staged repair seems preferable over delayed definitive fixation.

Contralateral Neck-shaft Angle Lower Than 130° Is Associated With Clinical Failure in Nongeriatric Individuals: Analysis of the National Femoral Neck Fracture Database of 1066 Patients.

Treatment of femoral neck fractures in patients who are nongeriatric (≤ 60 years) is challenging because of high failure rates. Anatomic parameters influence the biomechanical environment for fracture healing, but their associations with clinical prognosis remains unclear. (1) Which anatomic parameter that is identifiable on pelvic radiographs shows a statistical correlation with a higher risk of clinical failure defined as nonunion, avascular necrosis (AVN), reoperation, and functional failure (decrease in Harris hip score reaching the minimum clinically important difference) in the screw fixation of femoral neck fractures among nongeriatric patients? (2) How does the influence of anatomic parameters on clinical prognosis manifest: directly or mediated by additional mechanisms? This retrospective, multicenter study used a nationwide database in China. Between January 2014 and December 2020, we evaluated 1066 patients with femoral neck fractures with a median age of 53 years (interquartile range 46 to 56) and median follow-up period of 62 months. Anatomic parameters including femoral neck-shaft angle (NSA), femoral head radius, femoral neck width, femoral offset, acetabular center-edge angle, and acetabular sharp angle were variables of interest. The primary outcome was clinical failure including nonunion, AVN, reoperation, and functional failure (decrease in Harris hip score reaching the minimum clinically important difference). Risk factors for failure were first filtered using the Bayesian information criterion and then assessed with multiple regression adjusting for confounders. The mediation effect was further explored using model-based causal mediation analysis with a quasi-Bayesian Monte Carlo method. Of all anatomic parameters we assessed, the contralateral NSA was associated with clinical failure, after adjusting for all potential covariates and confounding variables (adjusted odds ratio 0.92 [95% confidence interval 0.89 to 0.95]; p < 0.001). The optimal threshold for the NSA was 130°, with the highest Youden index of 0.27. Patients with an NSA < 130° (41% [441 of 1066]) demonstrated an increased occurrence of nonunion (15% [68 of 441] versus 5% [33 of 625]; p < 0.001), AVN (32% [141 of 441] versus 22% [136 of 625]; p < 0.001), functional failure (25% [110 of 441] versus 15% [93 of 625]), and reoperations (28% [122 of 441] versus 13% [79 of 625]). The impact of an NSA less than 130° on clinical failure was direct and substantially mediated by the type of displaced fracture (mediation proportion: 18.7%). In our study of screw fixations for femoral neck fractures among nongeriatric patients, we identified that a contralateral NSA < 130° correlates with an increased risk of clinical failure including nonunion, AVN, functional failure, and reoperation. The effect is either direct or mediated through displaced fracture types. This is important for surgeons in order to recognize the elevated rate of clinical failure and nature of the challenging biomechanical environment, which should guide them in refining surgical details and selecting appropriate fixation and rehabilitation plans. Approaches to managing these fractures require further validation with large-scale clinical trials. Level III, prognostic study.

Canal fitting and treatment outcomes of patients treated with sign fin nail at a Tertiary Hospital in Tanzania

Background: The Surgical Implant Generation Network (SIGN) Fin nail is a relatively newer design of intramedullary nails that eliminates the requirement for distal locking. While various factors influencing treatment outcomes with different nail designs have been extensively studied, limited research has focused on the specific implications of using the SIGN Fin nail. Objective: This study aimed to assess the relationship between Fin nail canal fitting and treatment outcomes in femur fractures treated with the SIGN Fin nail at Muhimbili Orthopaedics Institute. Methods: A cross-sectional study was conducted at a tertiary hospital in Tanzania. Patients who underwent femoral fracture fixation with SIGN Fin nails between January 2016 and December 2021 were recruited from the SIGN surgical database. Radiographic measurements were performed using radiant software, fracture union at one year was assessed using the mRUST score, and weight-bearing status at 6 weeks was obtained from patient records. Results: The mean canal diameter was 11.30±1.75 mm, and 82.2% had a canal fill of 80% or more. The reoperation rate was 5.9% (7/118). Although not statistically significant, patients with canal fill less than 80% had a higher rate of reoperation (p = 0.074). The union rate was 84.1% in this study, with a mean mRUST score of 9.4, and those patients with a canal fill of less than 80% were more likely to have nonunion at 1 year (p = 0.028). Pain on weight bearing at 6 weeks was reported by 42.9% (24/118) of participants, and this was significantly associated with canal fitting (p &lt; 0.001). Conclusion: The study found the degree of canal fitting of the Fin nail to be an important factor affecting the outcomes of femoral fractures treated with SIGN Fin nails. A higher degree of canal fill was associated with better pain outcomes and lower nonunion rates.

Determination of the ideal plate for medial femoral condyle fracture fixation: an anatomical fit and biomechanical study

BackgroundThe aim of this study is to determine the best plate to use as a substitute to fix a medial femoral condyle fracture.Materials and methodsThe first part is to measure the best fit between several anatomical plates including the Proximal Tibia Anterolateral Plate (PT AL LCP), the Proximal Tibia Medial Plate (PT M LCP), the Distal Tibia Medial Locking Plate (DT M LCP) and the Proximal Humerus (PHILOS) plate against 28 freshly embalmed cadaveric distal femurs. Measurements such as plate offset and number of screws in the condyle and shaft shall be obtained. The subsequent part is to determine the compressive force at which the plate fails. After creating an iatrogenic medial condyle fracture, the cadavers will be fixed with the two plates with the best anatomical fit and subjected to a compression force using a hydraulic press.ResultsThe PT AL LCP offered the best anatomical fit whereas the PHILOS plate offered the maximal number of screws inserted. The force required to create 2 mm of fracture displacement between the two is not statistically significant (LCP 889 N, PHILOS 947 N, p = 0.39). The PT AL LCP can withstand a larger fracture displacement than the PHILOS (LCP 24.4 mm, PHILOS 17.4 mm, p = 0.004).Discussion and conclusionBoth the PT AL LCP and the PHILOS remain good options in fixing a medial femoral condyle fracture. Between the two, we would recommend the PT AL LCP as the slightly superior option.

Correlation between combined deflection angle classification adduction typing and complications after internal fixation of adduction femoral neck fracture

To analyze the correlation between postoperative complications and combined deflection angle classification adduction type (CDAC-ADT) of femoral neck fractures after cannulated screw internal fixation. The clinical data of 121 patients with CDAC-ADT femoral neck fracture admitted between January 2018 and December 2021 and met the selected criteria were retrospectively analyzed. There were 69 males and 52 females, the age ranged from 19 to 79 years (mean, 48.1 years). The causes of injury included 52 cases of traffic accident, 24 cases of falling from height, and 45 cases of fall. The time from injury to operation ranged from 2 to 12 days, with an average of 6.0 days. Among them, there were 18 cases of CDAC-ADT type Ⅰ, 46 cases of type Ⅱ, and 57 cases of type Ⅲ; 6 cases of Garden type Ⅱ, 103 cases of type Ⅲ, and 12 cases of type Ⅳ; and according to the location of the fracture line, there were 26 cases of subcapitate type, 88 cases of transcervical type, and 7 cases of basal type. All patients were treated with cannulated screw internal fixation. The occurrence of complications (including internal fixation failure, fracture nonunion, and osteonecrosis of the femoral head) was recorded, and the correlation between complications and CDAC-ADT typing, Garden typing, and fracture line location were analyzed. The patients were followed up 8-44 months, with a mean of 24.9 months. There were 10 cases of internal fixation failure, 7 cases of fracture nonunion, and 30 cases of osteonecrosis of the femoral head after operation. Correlation analysis showed that patients' CDAC-ADT typing was significantly correlated with the overall incidence of complication and the incidence of internal fixation failure, fracture nonunion, and osteonecrosis of the femoral head ( P<0.05), and the Pearson coefficient of contingency were 0.435, 0.251, 0.254, and 0.241, respectively. Garden typing did not correlate with the overall incidence of complication and the incidence of internal fixation failure and fracture nonunion ( P>0.05), but correlated with the incidence of osteonecrosis of the femoral head ( P<0.05), and the Pearson coefficient of contingency was 0.251. Fracture line position typing had no correlation with the overall incidence of complication and the incidence of internal fixation failure, fracture nonunion, and osteonecrosis of the femoral head ( P>0.05). CDAC-ADT typing has obvious correlation with postoperative complications of femoral neck fracture and can be used to predict complications of femoral neck fracture.

Titanium versus stainless steel alloy bridge plates for distal femur fractures: Does callus form earlier with titanium?

Distal femur fractures account for 3-6% of all femur fractures. Internal fixation of most distal femur fractures with an anatomic lateral locking plate should permit some motion at the metaphyseal portion of the fracture when secondary bone healing is planned by the operating surgeon. While several studies have been performed evaluating union rates for distal femur fractures with stainless steel and titanium plates, the timing of callus formation between stainless steel and titanium implants used as bridge plates for distal femur fractures (AO/OTA 33-A and -C) has been investigated to a lesser extent. We hypothesize that callus will be visualized earlier with post-operative radiographs with titanium versus stainless steel bridge plates. We retrospectively reviewed a consecutive cohort of patients over 18 years of age with acute AO/OTA 33-A and 33-C fracture patterns treated with an isolated stainless steel or titanium lateral bridge plate within 4 weeks of injury by a single fellowship-trained orthopedic trauma surgeon from 2011 to 2020 at one academic Level 1 trauma center. An independent, fellowship-trained orthopedic trauma attending surgeon reviewed anterior-posterior (AP) and lateral radiographs from every available post-operative clinic visit and graded them using the Modified Radiographic Score for Tibia (mRUST). Twenty-five subjects were included in the study with 10 with stainless steel and 15 with titanium plates. There were no significant differences in demographics between both groups, including age, sex, BMI, injury classification, open versus closed, mechanism, and laterality. Statistically significant increased mRUST scores, indicating increased callus formation, were seen on 12-week radiographs (8.4 vs. 11.9, p = 0.02) when titanium bridge plates were used. There were no statistically significant differences in mRUST scores at 6 or 24-weeks, but scores in the titanium group were higher in at every timepoint. In conclusion, we observed greater callus formation at 12 weeks after internal fixation of 33-A and 33-C distal femur fractures treated with titanium locked lateral distal femoral bridge plates compared to stainless steel plates. Our data suggest that titanium metallurgy may have quicker callus formation compared to stainless steel if an isolated, lateral locked bridge plate is chosen for distal femur fracture fixation.

Factors associated with increased radiation exposure in the fixation of proximal femoral fractures.

When using radiation intraoperatively, a surgeon should aim to keep the radiation dose as low as is reasonably achievable to obtain the therapeutic goal. We aimed to investigate factors associated with increased radiation exposure in fixation of proximal femur fractures. We assessed 369 neck of femur fractures over a 1-year period in a district general hospital. All hip fracture subtypes that had undergone surgical fixation were included. We assessed the relationship between type of fracture, implants used and surgeon level of experience with the dose-area product (DAP; cGy/cm2) and screening time (dS). We also looked at the quality of reduction and fixation and its effect on the radiation exposure. A total of 184 patients were included in our analysis; 185 patients who were treated with hip arthroplasty were excluded. There was a significant association between higher DAP and fracture subtype (p = 0.001), fracture complexity (p < 0.001), if an additional implant was used (p = 0.001), if fixation was satisfactory (p = 0.002) and operative time (p < 0.001). DAP was higher with a proximal femoral nail than with a dynamic hip screw, especially when a long nail was used. There was some evidence of an association between the surgeon's level of experience and DAP exposure, although this was not statistically significant (p = 0.069). Increased radiation in proximal femur fractures is seen in the fixation of complex fractures, some subtypes, with certain types of implants used and if an additional implant was required. Surgeon seniority did not result in less radiation exposure, which is in contrast to other published studies.

Effectiveness of cannulated screw fixation for femoral neck fracture assisted by three-dimensional printing navigation template in middle-aged and elderly patients.

We sought to explore the effectiveness of cannulated screw fixation for femoral neck fractures in middle-aged and elderly patients assisted by a three-dimensional printing navigation template. A total of 98 middle-aged and elderly patients who underwent cannulated screw fixation for femoral neck fractures were retrospectively analyzed. They were allocated into two groups, each comprising 49 patients. Surgical indexes, hip function, and pain levels were compared between the two groups. The study group, assisted by the three-dimensional printing navigation template, exhibited significantly reduced nail insertion, fewer instances of C-arm fluoroscopy, shorter operation time, quicker time to bone union, earlier initiation of walking exercise, shorter time to weight-bearing walking, and reduced hospital stay than those in the control group (all p<0.001). However, the study group also experienced higher blood loss compared to the control group (p<0.001). Postoperatively, at 3 months and 12 months, the study group demonstrated significantly higher scores compared to the control group (both p<0.001) and reported significantly lower pain scores than that in the other group at 1 week and 12 months post-surgery (both p<0.001). Furthermore, the study group experienced significantly fewer postoperative complications than the control group (p=0.029). Cannulated screw fixation for femoral neck fractures assisted by a 3D printing navigation template is more effective and safer than traditional fixation methods. This approach represents a promising alternative for surgical management.

Far cortical locking constructs for fixation of distal femur fractures in an Asian population: A prospective observational study

BackgroundThe stiffness of locked plates suppresses healing process, prompting the introduction of far cortical locking to address this issue. This study aimed to demonstrate the clinical efficacy of far cortical locking constructs in treating distal femoral fractures in an Asian population. MethodsThis multicenter prospective observational study was conducted at four university hospitals between February 2018 and February 2021. Demographic data, the presence of metaphyseal comminution, and surgical fixation details were recorded. Clinical outcomes, including single-leg standing, EQ-5D, and EQ-VAS scores, and radiologic outcomes, including the RUST score of each cortex, were evaluated and compared according to the presence of metaphyseal comminution. ResultsThere were 37 patients (14 men and 23 women) with a mean age of 67.3 ± 11.8 years. Twenty-two patients had metaphyseal comminution (59%), and 15 presented simple fractures in metaphyseal areas. Four patients (13%) could stand on one leg > 10s at 6 weeks, and 24 patients (92%) at 1 year. EQ-5D increased from 0.022 ± 0.388 to 0.692 ± 0.347, and the mean EQ-VAS 51.1 ± 13.1 to 74.1 ± 24.1 between discharge (n = 37) and post-operative 1 year (n = 33), respectively. RUST score presented increment for time, from 6.2 ± 1.8 at 6 week to 11.6 ± 1.1 at 1 year. Radiological healing demonstrated rapid increase from week 6 (16/28, 43%) to month 3 (27/31, 87%), with no obvious increase was observed in 6 months (23/26, 89%) or 12 months (25/28, 89%). Simple metaphyseal fractures presented significantly higher RUST scores at 6 weeks and 3 months, but there was no difference in RUST scores at 6 months or 1 year according to metaphyseal comminution. ConclusionsPlate constructs with far cortical locking screws provided safe and effective fixation for distal femoral fractures, with consistent radiological and clinical results, regardless of metaphyseal comminution.

Techniques for abductor reattachment in proximal femoral replacement for non-oncological reconstructions: a narrative review.

Proximal femoral replacement due to revision hip arthroplasty or catastrophic proximal femur fracture fixation failures with considerable proximal femur bone loss can lead to a substantial loss of function of the soft tissue around the hip and the abductor muscles in particular. Surgical techniques of gluteus medius repair and/or abductor mechanism reattachment/reconstruction are widely debated in the literature, but it is quite rarely dealt with in the context of megaprosthesis and femoral reconstruction, particularly in non-oncologic patients. The aim of this study is to present a narrative review of the literature on techniques for abductor reattachment in proximal femoral replacement for non-oncological reconstructions. MEDLINE, Embase, and Cochrane databases were searched by two researchers independently from inception until February 1st, 2023 (923 for MEDLINE and 963 for Embase; Cochrane is a composite of multiple databases and thus does not report a standard inception date). Articles examining proximal femoral reconstruction with megaprosthesis or allograft prosthesis were included. Studies concerning cadaver and oncologic patients were excluded. If the researchers failed to find an agreement on whether to include a study, the senior researcher would make a final decision in such cases. Data were extracted and stored, and qualitative synthesis was performed. A total of 1,157 articles from MEDLINE, 11,187 articles from Embase, and 0 articles from Cochrane were identified. Of 12,344 articles, the structured screening process revealed 10 eligible trials. Four different types of abductor musculature reconstruction/reinsertion were identified. Multiple and complex revision hip arthroplasties as well as multiple surgical procedures for proximal femur fracture fixations failures may have a great impact on proximal femur bone stock condition and soft tissue preservation requiring the use of a proximal femur megaprosthesis. In such cases, the abductor mechanism reconstruction and/or reattachment is achievable with different techniques that can be resumed in four different groups: direct suture to the prosthesis, trochanteric sleeve osteotomy, muscle-to-muscle suture, and synthetic tube augmentation suture.

Outcomes of conversion total hip arthroplasty for failed fixation of intertrochanteric fractures with monoblock distal-loading reconstruction stem.

The aim of our study was to analyze the clinical and radiological outcomes of conversion total hip arthroplasty (THA) for failed fixation of proximal femur fractures with monoblock grit-blasted titanium reconstruction stem (Wagner self-locking stem, Zimmer). Thirty-nine patients were included in this retrospective analysis undergoing conversion THA for failed cephalomedullary nail or dynamic hip screw fixation for intertrochanteric fractures from January 2017 to January 2022. The clinical evaluation was done using Harris hip score. The radiological outcomes measured were subsidence, level of osteointegration, stem-canal fill ratio and heterotopic bone formation. The complications were noted postoperatively and during the follow-up. The mean follow-up at the end of the study was 27.8months (range, 14-72months). There was a significant improvement in the Harris hip score over serial follow-ups (p < 0.001), but after 2years, there was no statistically significant difference (p = 0.46). According to Engh's criteria, stable ingrowth was noted in 35 stems, fibrous stable ingrowth was noted in 4 stems and no patients had progressive subsidence and unstable stem. The mean stem-canal fill percentages were 91.8 ± 5.4% at the mid-stem and 80.3 ± 11.5% at the stem tip. Heterotopic ossification Brooker grade 2 was noted in 8 patients, and no patients had grade 3 or 4 heterotopic ossification. There were 7 (17.9%) intraoperative periprosthetic fractures, and greater trochanteric avulsion was noted in 2 patients in the follow-up. Conversion THA using monoblock tapered distal loading stems bypasses the calcar deficiency and gives stable fixation in failed fixation of intertrochanteric fractures. It gives good radiological outcome and significant improvement in the clinical outcomes compared to the preoperative disability. However, caution should be noted for risk of intraoperative periprosthetic fractures in this subgroup of patients.

Outcome of Titanium Elastic Nailing System in Diaphyseal Femoral Fractures of Children in the Age Group of 4-12 years

Background: Femoral shaft fractures are the most common major pediatric injuries treated by orthopedic surgeons. Management of femoral diaphyseal fracture in the age group of 4-12 years is controversial. The purpose of this study is to demonstrate the effectiveness of intramedullary fixation of femoral shaft fractures by using Titanium Elastic Nailing System (TENS). Methodology: Twenty-six (26) children in the range of 4-12 years with recent (&lt;3 days) femoral shaft fracture (24 closed, 02 Grade-I compound) were stabilized with Titanium Elastic Nail (TEN), between January 2019 and June 2022 in Eastern Medical College Hospital, Cumilla and Cumilla Trauma Centre. The diameter of the individual nail was selected as per Flynn’s formula and the results were evaluated by Flynn’s criteria. All patients were followed radiologically as well as clinically until fractures healed and for any complications. Results: Among the twenty-six (26) cases 18 were boys and 8 were girls. Twenty-three (23) cases were managed by closed reduction while three (3) cases required open reduction. The time duration of surgery ranged 20-45 minutes. The hospital stay ranged between 5 to 8 days (mean 6.5 days). The mean duration of follow-up was 21 months (range: 3 - 39 months). All fractures were radiologically united at 8-12 weeks (mean 10 weeks) and full weight bearing was possible in a meantime of 9.5 weeks. According to Flynn’s criteria, excellent results were found in 24 (92.3%) cases and satisfactory in 2 (7.7%) cases. Limb lengthening was noticed in 6 cases and rotational mal alignment was seen in 1 case. Conclusion: Intramedullary fixation with Titanium Elastic Nail may be the preferred method for the treatment of femoral fractures in children aged 4-12 years. As it is a safe, minimally invasive, surgeon-friendly technique and shows very good functional and cosmetic results. Eastern Med Coll J. July 2023; 8 (2): 1-6

Biomechanical Evaluation of Cannulated Screw Optimization for Stabilization of Pauwels Type Femoral Neck Fractures

Triangular screw configuration (TSC) fixation is widely used in clinics for femoral neck fractures, and the appropriate positions of TSC fixation have not been fully described in the literature. This study investigated the optimal fixation of femoral neck fractures with TSC fixation under nonstandard Pauwels angles to determine the ideal position. To determine the optimal fracture line angle and cannulated screw positions, the Pauwels angle and Rotation and Translate variables were parametrically defined in the fracture line and cannulated screw positions. Considering the equivalent stresses on the fracture surfaces, the effectiveness values of the Rotation and Translate 1, 2 and 3 variables are weak, whereas the effectiveness value of the Pauwels angle is high. Considering the equivalent stress on the screws and that the variable value of Translates 1, 2 and 3 is 7 mm, it can be seen that the reverse triangulation configuration is better, and the Pauwels angle is approximately 54°. Among the parameters examined in the study, Pauwels angle was found to have the highest level of effectiveness on femoral neck fracture surfaces and screws. The findings in this study provide a solid basis for future research; however, further clinical research is warranted.

ARTICULAR FEMORAL HEAD FRACTURE MANAGEMENT: A COMPREHENSIVE SYSTEMATIC REVIEW

Background: Femoral head fractures (FHFs) are relatively rare injuries usually caused by high-energy trauma. They typically occur after a posterior dislocation, and approximately 5 to 15 of posterior hip dislocations involve FHFs. FHFs may also occur simultaneously with acetabular fractures, with an estimated incidence of 29.2 In addition, the incidence of ipsilateral femoral head and neck fractures (iFHNF) is low. However, iFHNFs, as a special type of fracture, have the worst prognosis among all FHFs The aim: The aim of this study to show about articular femoral head fracture management. Methods: By comparing itself to the standards set by the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020, this study was able to show that it met all of the requirements. So, the experts were able to make sure that the study was as up-to-date as it was possible to be. For this search approach, publications that came out between 2014 and 2024 were taken into account. Several different online reference sources, like Pubmed and SagePub, were used to do this. It was decided not to take into account review pieces, works that had already been published, or works that were only half done. Result: In the PubMed database, the results of our search get 17 articles, whereas the results of our search on SagePub get 489 articles, on Google Scholar 8050 articles. Records remove before screening are 5860, so we get 2696 articles fos screening. After we screened based on record exclude, we compiled a total of 12 papers. We included five research that met the criteria. Conclusion: Open reduction and internal fixation of femoral head fracture using surgical hip dislocation through Ganz approach is a viable treatment option and provides satisfactory results with low complication rates.

Comparison of young femoral neck fractures treated by femoral neck system, multiple cancellous screws and dynamic hip screws: a retrospectively comparison study

BackgroundImplant choice for the fixation of femoral neck fracture is one of the most important management controversies. This study aims to evaluate and compare the short-term outcomes associated with the use of the Femoral Neck System (FNS), Multiple Cancellous Screws (MCS), and Dynamic Hip Screws (DHS) in treating femoral neck fractures in a young patient population.MethodsFrom June 2018 to June 2021, a total of 120 surgeries for a primary femoral neck fracture were retrospectively analyzed. This review encompassed demographic details of the patients and the mechanisms behind the injuries. Key surgical parameters such as operation duration, intraoperative blood loss, fluoroscopy duration, and hospital stay were meticulously documented. The employed surgical technique was described. All patients were followed up at 6 weeks, 3 months, 6 months, and 12 months postoperatively. Avascular necrosis of the femoral head (AVN), nonunion, malreduction, implant failure or other complications were noted. The functional status at the last follow-up was assessed using the Harris functional scoring criteria.ResultsThere were 90 males and 30 females, with a mean age of 40.4 years. As to patient characteristics, there were no significant differences between the three groups. DHS group showed longer operation time(52.15 ± 4.80 min), more blood loss(59.05 ± 5.87 ml) and longer time of hospitalization(7.6 ± 0.90 d) than FNS group (39.65 ± 2.84 min, 45.33 ± 9.63 ml and 4.87 ± 0.48 d) and MCS group (39.45 ± 3.10 min, 48.15 ± 7.88 ml and 5.04 ± 0.49 d) (p < 0.05). In addition, the time of fluoroscopy in FNS group (15.45 ± 3.67) was less than that in MCS group (26.3 ± 4.76) and DHS group (27.1 ± 5.67) (p < 0.05). The cost of FNS group(44.51 ± 2.99 thousand RMB) was significantly higher than the MCS and DHS groups. The FNS, MCS and DHS groups showed a similar mean length of femoral neck shortening (LFNS) and Harris score. The FNS, MCS and DHS groups showed a similar mean rate of AVN and internal fixation failure.ConclusionsFollowing successful fracture reduction, FNS, MCS, and DHS are effective for in the young femoral neck fractures. No difference was found in complications between the three groups. However, the reduced fluoroscopy time associated with FNS contributes to shorter operation durations. The adoption of minimally invasive techniques correlates with decreased blood loss and shorter hospital stays. Nevertheless, these advantages may be offset by the potential economic burden they impose.

Management of floating hip injury: a review of the literature.

The aim of this study was to provide a comprehensive overview of floating hip injury and attempt to provide a management algorithm. PubMed was searched using the terms 'Floating hip' or 'acetabular fracture' and 'Ipsilateral femoral fracture' or 'pelvic fracture' and 'Ipsilateral femoral fracture'. One author performed a preliminary review of the abstracts and references of the retrieved articles. The mean injury severe score reported was higher than 20. Chest and abdominal injuries, as well as fractures at other sites, were the most common associated injuries. Despite the high disability rate, surgery remained the preferred option for managing these injuries. The surgical timing varied from a few hours to several days and was subjected to the principles of damage control orthopedics. Although, in most cases, fixation of femoral fractures took precedence over pelvic or acetabular fractures, there was still a need to consider the impact of damage control orthopedics, associated injuries, and surgeon's considerations and preferences. Posttraumatic arthritis, neurological deficits, heterotopic ossification, femoral head necrosis, femoral nonunion, and limb inequality were common complications of the floating hip injury. The severity of such injuries often exceeds that of an isolated injury and often requires specialized multidisciplinary treatment. In the management of these complex cases, the complexity and severity of the injury should be fully assessed, and an appropriate surgical plan should be developed to perform definitive surgery as early as possible, with attention to prevention of complications during the perioperative period.