Treatment Of Pertrochanteric Fractures Research Articles

Proximal femoral nail anti-rotation (PFNA) to treat peritrochanteric fractures in elderly patients

The treatment of peritrochanteric fractures in elderly patients with osteoporosis due to the difficulty of obtaining and maintaining stable fixation. Although many implants have been developed to solve this problem, the choice of implant has been controversial. We present 71 consecutive peritrochanteric fractures treated with proximal femoral nail anti-rotation (PFNA). The average age of the patients was 80.75 ± 6.42 (71–96) years. The fractures were closely reduced and fixed with PFNA. All of the fractures healed in an average of 14 weeks. The mean operation time was 44.68 ± 8.44 (30–73) minutes, and the mean blood loss was 126.77 ± 49.04 (50–300) ml. One patient was reoperated because of a poor blade position. In three patients, a lateral cortex fracture was observed, and, in one patient, a greater trochanter fracture was observed. At the time of the final follow-up, 78.7% of the patients returned to their pre-injury activity levels. PFNA might be one treatment choice to solve the mechanical problems associated with these fractures because of its improved fixation strength, simpler technique, shorter operation time and reduced blood loss.

Technical errors and complications of gamma nail and other cephalocondylic intramedullary nails in the treatment of pertrochanteric fractures: Prevention and treatment

Study rationale: This study is aiming to illustrate the experience gained through a relatively satisfactory number of pertrochanteric fractures managed with gamma nail and other cephalocondylic intramedullary nails to mention the intraoperative pitfalls and their influence on the final result.

Management of osteoporotic pertrochanteric fractures with external fixation in elderly patients

We evaluated the results of osteosynthesis with external fixation for intertrochanteric hip fractures in elderly patients with a high anesthesia risk. Fourteen ASA 4 patients (5 men, 9 women; mean age 75 years; range 65 to 81 years) with intertrochanteric hip fractures were treated with a unilateral external fixator under epidural anesthesia combined with mild sedation. According to the AO/OTA classification, six fractures were A1.2, seven fractures were A2.2, and one fracture was A3.1. All were closed fractures. The mean preoperative Singh index of the contralateral hip was 3.1 (range 3 to 5). Eleven patients received an AO tubular external fixator, and three patients received a unilateral external fixator. Final evaluations were made using the Parker-Palmer mobility score and Harris hip score. The mean follow up was 12 months (range 9 to 17 months). The mean operation time was 37 min (range 25 to 44 min), the mean fluoroscopy time was 1.5 min (1 to 2 min), and the mean hospital stay was seven days (5 to 15 days). None of the patients required blood transfusion. Bone union was obtained in all the patients in a mean of 4.1 months (3 to 5 months). The mean femoral shaft-neck angles in the early postoperative period and at the latest follow-up were 133 degrees (127 degrees to 139 degrees ) and 132 degrees (126 degrees to 138 degrees ), respectively. Five patients (35.7%) developed grade I pin-tract infection. Medial displacement of the distal fragment, limb shortening, or fixator failure were not seen. Three patients (21.4%) died within the first postoperative year due to associated diseases. The mean final Harris hip score was 61 (range 45 to 80) and the mean Parker-Palmer mobility score was 6.6 (range 5 to 8). Osteosynthesis with an external fixator in elderly patients with a high anesthesia risk is a fast, minimally invasive procedure in the treatment of pertrochanteric fractures, resulting in fewer pre- and postoperative complications.

No advantages of Gamma nail over sliding hip screw in the management of peritrochanteric hip fractures: A meta-analysis of randomized controlled trials

Purpose. There is a lack of consensus regarding the best option for the operative treatment of peritrochanteric fractures. A meta-analysis was performed to assess the surgical outcomes of peritrochanteric fractures.Methods. Only prospective, randomized studies comparing Gamma nail and sliding hip screw (SHS) fixation in adults were included. Eleven studies met the inclusion criteria: the target population consisted of patients with peritrochanteric fractures, while subtrochanteric fractures were not included; the intervention was SHS compared with Gamma nail; the study was a published randomized trial. Each outcome measure tested was assessed for heterogeneity. If significant heterogeneity was present, data from the studies were not combined. If there was no significant heterogeneity, a combined relative risk was calculated using a fixed effects model and a Z-test was performed to test the overall effect.Results. A total of 1344 peritrochanteric fractures entered into the included studies. There were no differences of mortality, cut-out, non-union, re-operation, wound infection, intra-operative fractures of femur, blood loss or surgical time.Conclusions. It seemed that there were no obvious advantages of Gamma nail fixation over SHS fixation in treating peritrochanteric fractures.

The Treatment of Peritrochanteric Fracture of Femur with Proximal Femoral Nail: Comparative Study with Dynamic Hip Screw

The Treatment of Peritrochanteric Fracture of Femur with Proximal Femoral Nail: Comparative Study with Dynamic Hip Screw

Dislocation of the hip following valgus fixation of unstable pertrochanteric hip fractures: A complication

As the age of the population increases, hip fractures will become an increasingly common cause for presentation to accident/emergency and orthopaedic departments. Pertrochanteric fractures of the hip account for almost half of all fractures of the proximal femur. The surgical treatment of pertrochanteric fractures has been a contentious issue but the basic principles of fracture management (fracture reduction, fracture immobilisation and rehabilitation) must guide treatment. The most commonly used management technique used in the UK is reduction of the fracture on a fracture table and fixation using a sliding hip screw and plate (first introduced in the 1950s). The stable reduction and fixation of pertrochanteric fractures often presents difficulty to orthopaedic surgeons as many have inherent instability due to their configuration. One benefit of the hip screw and plate technique is that even if a fully stable reduction is not achieved, the ‘sliding’ apparatus of the

Complications of an Expandable Hip Nail

Currently, the most common treatment of peritrochanteric fractures is surgical stabilization with use of either a compression hip screw or an intramedullary hip screw and early mobilization of the patient1-3. The compression hip screw provides secure fixation and controlled impaction of the fracture, but use of this device in the treatment of fractures with posteromedial comminution and subtrochanteric extension can be problematic4,5. Cephalomedullary nails combine the advantages of intramedullary fixation with those of a sliding screw. Such devices are load-sharing and offer a decreased bending strain, because the moment arm is reduced. These devices may also offer a biological advantage by combining a closed surgical technique with limited periosteal disruption6. Some of the problems encountered with intramedullary devices have been fracture propagation, difficulties with interlocking, stress mismatch, and jamming of the compression screw within the nail. If there is no sliding, the implant essentially functions as a fixed-angle device. This may result in screw migration, cutout, or failure2,7. Fig. 1 A photograph of the damage to the nail after the errant passing of the reamer. It could not be noted intraoperatively that the guide pin was anterior to the nail, and the nature of the instrumentation made it hard to tell that reaming was not progressing properly. Recently, a new device that allows a metal rod to expand inside the bone has been developed. This device is purported to provide rotational stability with use of rails that act as flutes. Because it is a thin-walled implant and is inserted at a diameter that is smaller than the medullary canal, it is also purported to be less likely to cause fracture propagation. Furthermore, it eliminates the need for screws and interlocking8. The use of this technology in …

Osteoporotic Pertrochanteric Fractures Can Be Successfully Treated with External Fixation

H ip fractures are the most severe of all fragility fractures. It has been calculated that more deaths are caused by hip fractures than by other common severe diseases such as cancer of the stomach or the pancreas1. Furthermore, regardless of the quality of surgical treatment, hip fractures remain a major cause of disability. The economic implications are clear. In the United States, hip fracture management already costs approximately $13.8 billion per year2. In Europe, the average acute hospital cost is approximately €25,000 per fracture and the total care cost is as much as 2.5 times higher3. Approximately 200,000 pertrochanteric fractures (AO/OTA fracture type A1 and A2) per annum occur in the United States alone4. It has been calculated by the United States Census Bureau that, by the year 2020, the average life expectancy will be eighty-two years for women and seventy-four years for men5. This longer life expectancy will be associated with a dramatic increase in the number of pertrochanteric fractures. The functional results of treatment of pertrochanteric fractures are often unsatisfactory. The mortality rate has been reported to be 18% in the first year following operative treatment6. The results are influenced by the inability of the implant to remain well fixed in osteoporotic bone during the time required for fracture-healing. Implant failure and loss of reduction, which often lead to fracture malunion, are frequent complications of osteoporotic pertrochanteric fractures. Because fracture stability is crucial for bone repair, poor bone quality remains a concern that must be given priority when the type of implant is being chosen7. The primary aim of surgical treatment is to obtain good fracture reduction and to maintain this reduction until sufficient stability is provided by the fracture callus. If stable …

Complications which occur in treatment of femoral peritrochanteric fractures by Gamma nail and DHS

Objective To analyze the complications which occur in the treatm en t of femoral peritrochanteric fractures by Gamma nail and DHS. Methods 152 patie nts with femoral peritrochanteric fractures, 15 of whom had complications, were treated from April 1997 to December 2002. 23 of them, 10 male and 13 female, wer e treated by Gamma nail. Their Evans types: 2 Type Ⅰ, 6 Type Ⅱ, 10 Type Ⅲ, an d 5 Type Ⅳ. 129 of them, 57 male and 72 female, were treated by DHS. Their Evan s types: 18 Type Ⅰ, 27 Type Ⅱ, 53 Type Ⅲ, 31 Type Ⅳ. AO method was adopted i n DHS Group, and Grosse method was adopted in Gamma nail Group. Results 136 pati ents were followed up. In DHS Group, 6 patients had hip varus, 2 patients tensio n screw protrusion, 1 patient perineum bedsore, 1 patient tension screw dislocat ion, and 1 patient died. In Gamma nail Group, 2 patient suffered hip varus, 1 pa tient tension screw protrusion, and 1 patient femoral net base fracture. The rat e of fine joint function was 87.2%and 89.3%respectively for the two groups. Co nclusions The methods of Gamma nail and DHS result in satisfactory functional re covery in treatment of femoral peritrochanteric fractures. In order to reduce th e complications, we should choose the proper fixation method according to bone q uality, shapes of the fragments, reduction, the design and position of the inter nal fixation, as well as the operation equipment.

IMHS clinical experience in the treatment of peritrochanteric fractures: The results of a multicentric Italian study of 981 cases

This retrospective study evaluates the results obtained in five Italian departments of traumatology in the treatment of peritrochanteric (pertrochanteric and subtrochanteric) fractures by the intramedullary hip screw (IMHS; Smith & Nephew Richards, Memphis, TN, USA) nail. One thousand two hundred and seventy-three patients were treated with the IMHS nail between March 1992 and February 2000. The results of these operations were evaluated clinically and radiological in 981 patients. The 90.3% of patients could walk unaided or with simple support. Because of the low complication rate requiring re-operation (postoperative shaft fractures, screw penetrated the acetabulum, cut out and non-union) (1.7%), we think that this device is an advance in the treatment of peritrochanteric fractures.

Treatment of Pertrochanteric Fracture with Femoral Neck Fracture

Treatment of Pertrochanteric Fracture with Femoral Neck Fracture

Free Play of 3 Different Nail Designs Used for Fixation of Subtrochanteric Femoral Fractures

A subtrochanteric fracture is defined by its major portion of at least 2/3 which must be situated underneath the mid-part of the trochanter minor. Stabilization of subtrochanteric fractures technically does not differ from treatment of pertrochanteric fractures. The intramedullary device used for treatment is usually sufficient to bear strains occurring during the mobilization period. There is a major difference between these fracture types, though.

Clinical and Finite Element Analysis of a Modular Femoral Prosthesis Consisting of a Head and Stem Component in the Treatment of Pertrochanteric Fractures

To determine the biomechanical characteristics and potential clinical efficacy of a cementless modular femoral prosthesis consisting of a variable head (50 to 80 millimeters) and stem (length 120 to 280 millimeters, diameter 10 to 20 millimeters) component in patients with pertrochanteric femoral fracture. Finite element analysis (FEA) of different lengths and diameters of prosthesis components and first clinical prospective study in pertrochanteric femoral fracture. Using a 3D-CAD program, a model of femoral cortical bone with a pertrochanteric fracture was created and combined with a model of the prosthesis. This model was transferred into an FEA program. After applying a torsion-bending load of 2,000 N (25 degrees, 45 degrees) on the prosthesis, stress distribution in the cortical bone was determined for different lengths (160 to 240 millimeters) and diameters (10 and 12 millimeters) of stem. Twenty-eight patients with pertrochanteric fractures (very unstable or osteoarthritis) were treated with a modular hip arthroplasty. Complications, fracture healing, and results at first follow-up (average 13 months) were determined. FEA analysis indicated that reduction in stress was less when a prosthesis with a short stem was used. Shear stress in the interface bone/prosthesis was not affected by stem length. Prostheses with thin stems produced higher sheer stresses than those with thick stems. Results of FEA were used as the basis for clinical application of the device. None of the patients died, and all patients were able to walk, although some needed a cane or walker after surgery. There was no increase in thigh pain compared with reported pretrauma levels. Radiographs showed subsidence of up to 5 millimeters in 20 percent of patients. However, all but one prosthesis was stable at follow-up. Fracture healing was achieved in all patients. If proximal fixation of a femoral uncemented stem cannot be achieved, stem diameter should provide maximum cortical contact to reduce sheer stress. Longer stems do not necessarily provide additional stability. By using this prosthesis and selection method, a good outcome at first follow-up was observed.

大腿骨頚部外側骨折に対するつば付きＣＨＳの使用経験

大腿骨頚部外側骨折に対するつば付きＣＨＳの使用経験

Clinical Application of Gamma-Locking nail in the Treatment of Pertrochanteric Fracture

Clinical Application of Gamma-Locking nail in the Treatment of Pertrochanteric Fracture

Antibiotic Prophylaxis in the Surgical Treatment of Peritrochanteric Fractures: A Comparative Trial between Two Cephalosporins

In a study of 200 patients scheduled for orthopedic surgery, prophylaxis with either ceftriaxone or cefotaxime was equally effective. No patient developed bacterial infection, either systemic or local, during the first 10 postoperative days. In the 1-year follow-up period, 2 patients developed deep wound infection (1 from each group). Ceftriaxone 1 g was given once only as a single preoperative dose, whereas cefotaxime was, in addition to the preoperative dose, also given postoperatively every 8 h for 3 days (totally 9 doses of 1 g). Emphasis is placed on the practical advantage of the single dose of ceftriaxone, which facilitates nursing of the patient.