Treatment Of Trochanteric Fractures Research Articles

Femoral Shortening After Surgical Treatment of Trochanteric Fractures in Nongeriatric Patients

Femoral shortening is a well-known clinical finding after surgical treatment of per- and intertrochanteric fractures. Particularly, in geriatric patients with poor bone quality and unstable fracture types, secondary compression of these fractures often leads to length inequality of the lower limbs. In younger patients with good bone quality and mobilization with delayed weight bearing, limb length shortening is expected to be a rare complication. The purpose of this study was to analyze incidence and degree of femoral shortening in patients younger than 60 years of age after fixation of different types of per- and intertrochanteric fractures. In addition, we compared the results of two different implants, which were used for operative treatment. Ninety-five patients, younger than 60 years of age, were evaluated for femoral shortening after surgical treatment of per- and intertrochanteric fractures between 1997 and 2002. Follow-up examinations took place at an average of 3.2 years (2-5 years) after trauma. Fractures were classified by the AO/OTA system and divided into sub-types 31 A1, 31 A2, and 31 A3. Two different implants (dynamic hip screw and cephalomedullary nail) were used for operative treatment, mainly depending on type and stability of the fracture. Femoral shortening was analyzed by standardized lower extremity radiographs measuring the distance from the top of the femoral head to the center of a line drawn between the most distal part of the medial and lateral femoral condyles. Fifty-seven patients were treated by a cephalomedullary nail, 38 by dynamic hip screw. Femoral shortening was seen in 46 patients (48%) with a mean value of 11 mm. Twenty-two patients had a femoral inequality of less than 10 mm, 17 patients an inequality between 10 mm and 20 mm, and 7 patients a shortening of more than 20 mm. Statistical analysis revealed that fracture type and implant had a significant influence on the shortening: In patients with fracture types 31 A2 and A3 femoral shortening was found to be more severe than in patients with fracture type 31 A1. Additionally, in unstable fracture types (31 A2 and A3) femoral shortening was significantly larger, if patients were treated by dynamic hip screw than by a cephalomedullary nail. Femoral shortening after operative treatment of per- and intertrochanteric fractures was found to be a common clinical finding in nongeriatric patients. Nearly half of them showed a lower limb length inequality after fracture fixation. The degree of the shortening was rather low and depended mainly on the fracture type. Comparing the two different implants used for operative treatment, a cephalomedullary nail was more successful in preventing limb length discrepancy in unstable fracture types than dynamic hip screw.

Evaluation of the cases associated with cut out of lag screw after the treatment of trochanteric fracture

Evaluation of the cases associated with cut out of lag screw after the treatment of trochanteric fracture

The Hansson Twin Hook is adequate for fixation of trochanteric fractures: 2 fixation failures in a series of 157 prospectively followed patients

Background and purpose The Hansson Twin Hook (HTH) is an alternative to the lag screw in the treatment of trochanteric fractures. In osteoporotic bone, mechanical tests have indicated that the HTH has better fixation properties than the lag screw. We evaluated the fixation stability of the HTH in a large series of elderly patients with trochanteric fractures. Many surgeons were involved in assessment of whether the device was user-friendly.Patients and methods In a prospective bicentric study, 55 surgeons used the HTH and a standard plate in 157 consecutive patients with trochanteric fractures, 83% of which were unstable. The mean age of the patients was 83 (43–98) years. They were followed regularly clinically and radiographically for at least 4 months, with a radiographic file search at 2 years.Results Technical errors occurred intraoperatively in 7 cases. The reduction of the fracture was inaccurate in these patients; thus, the HTH had not been placed centrally in the femoral head. One of these errors was immediately and easily corrected without interference with the standard plate, and caused no further problems. 2 of the remaining 6 intraoperative errors developed into failures of fixation during the 2-year period.Interpretation The HTH gives adequate fixation in the bone of elderly patients with trochanteric fractures and has a low failure rate. It is also easy to use.

Treatment for Trochanteric Fractures of the Femur with a New Nailing System

Treatment for Trochanteric Fractures of the Femur with a New Nailing System

Clinical result of surgical treatment for trochanteric fractures in elderly patients

Clinical result of surgical treatment for trochanteric fractures in elderly patients

A comparison of the sliding properties between a cylindrical screw and a H-shaped blade in surgical treatment for trochanteric fractures

A comparison of the sliding properties between a cylindrical screw and a H-shaped blade in surgical treatment for trochanteric fractures

Subcapital Femoral Neck Fracture following Successful Trochanteric Fracture Treatment with a Dynamic Hip Screw: A Report of Five Cases

A subcapital femoral neck fracture complicating a healed trochanteric fracture is rare. Such cases are managed in a rather heterogeneous manner, i.e. there exists a mixture of cases treated by either fixed angle devices or dynamic compression screws. We describe 5 patients who developed subcapital femoral neck fractures after healed trochanteric fractures treated with dynamic compression screws. The subjects' clinical data, operative records, and radiographs have been studied retrospectively and the literature reviewed. The risk factors for such a complication include being of advanced age, female, osteoporotic, and having a small femoral head and neck, and a basicervical type of fracture.

Treatment of trochanteric femoral fractures with double dynamic internal fixation

Trochanteric fractures are extracapsular fractures of the proximal femur. The increasing number of trochanteric fractures is a great sociomedical problem. These fractures usually occur in elderly people (older than 65 years) with osteoporosis. Lateral and frontal falls are the most frequent cause of trochanteric fractures in the elderly. The aim of this paper is to present our results of applying the Mitković selfdynamisable internal fixator (SIF). From January 2001 to December 2005, 238 patients with trochanteric femoral fractures were treated operatively using the Mitković selfdynamisable internal fixator at the Clinic of Orthopeadics and Traumatology in Nis. The average patient age was 69, 11 years (range 17 to 88). In the analyzed group there were 152 (64%) female and 86 (36%) male patients, whereas patients in the eighth 101 (43%) and seventh 65 (27%) decade of life prevailed. Excellent results in the treatment of trochanteric femoral fractures with a Mitković dynamic internal fixator were achieved in 143 (60%) patients, good in 49 (21%) patients, poor in 41 (17%) and unsatisfactory in 5 (2%) patients. The treatment of trochanteric fractures may be operative and nonoperative. The aim of the operative treatment, considered to be the "gold standard" for these fractures, is to restore the patient's pretraumatic activity level and to reduce life-threatening complications. The operative stabilization is performed using various types of implants. Surgical treatment by using dynamic implants is a method of choice in the treatment of trochanteric fractures. Internal fixation using the Mitković selfdynamisable internal fixator is a method of choice in the treatment of trochanteric femoral fractures, providing dynamization and compression of the fracture site in two axes (axis of the femoral neck and femoral diaphyseal axis) and balanced biomechanical 3D.

Outcome after treatment of complications of Gamma nailing: A prospective study of 554 trochanteric fractures

Background A high reoperation rate has been the main reason why Gamma nailing should not be recommended for routine use in the treatment of trochanteric fractures. We compared the outcome after reoperation to the outcome after primary surgery with Gamma nailing.Methods In a series of 554 patients, we compared the outcome in 52 patients who were reoperated with that in 502 patients who had no reoperations. We assessed mortality, pain, walking ability and habitat at follow-up.Results The most common reason for reoperation was new fracture around the implant (17), local pain after healed fracture (11), nonunion (9) and cut-out (8). A second reoperation was required in 9/52 patients. The mortality was significantly lower in the reoperated cases at 30 days and at 1–5 years, but not at 120 days, and there were no significant differences in the other outcome parameters.Interpretation Reoperation did not lead to a worse clinical outcome, nor to increased mortality.

Surgical treatment of trochanteric fractures: An Ivorian experience

Background: Trochanteric fractures have become a major focus of orthopaedic interest. Surgical management is the best option for treating such fractures. Objective: To present our experience with the surgical treatment of trochanteric fractures with special attention to short-term results. Design: A retrospective study performed between 1993 and 2002. Setting: Department of orthopaedics surgery, Yopougon teaching hospital, Abidjan, Côte d'Ivoire. Patients and methods: There were 48 men and 17 women with a mean age of 44 years at the moment of the injury. Road traffic accident was the main cause of fractures accounting for 42 cases. Mean preoperative delay was 22 days. Surgical implants used were the Judet screw plate and Küntscher nail. Results: Postoperative death occurred in three cases. Fracture healing was achieved in 57 patients at an average of four months. Malunion and displacement into varus was noticed in 11.7% of patients. Infection occurred in seven patients, wound hematoma in eight and decubital ulcer in five. Conclusions: Trochanteric fractures in our environment are caused by severe trauma. These injuries could be managed surgically with simple methods that are readily available with immediate satisfactory outcome. Keywords: trochanteric fractures, surgical care Judet screw plate, Küntscher nail, complications Nigerian Journal of Surgical Research Vol. 7(1&2) 2005: 187–190

Surgical treatment of trochanteric fractures

Surgical treatment of trochanteric fractures

Treatment of trochanteric fractures of femur with PFNA

Treatment of trochanteric fractures of femur with PFNA

Is the Proximal Femoral Nail a Suitable Implant for Treatment of All Trochanteric Fractures?

We reviewed 155 consecutive patients who were treated with a proximal femoral nail from 1997 to 2001 to determine the rate of implant specific complications. Results were stratified according to fracture type and surgeon experience to determine which problems occurred in these groups. One year postoperative followup was available for 129 of 132 surviving patients (98%). Failure of fixation occurred in three patients (2%), and a femoral shaft fracture occurred in one patient (0.7%). Fixation failures included one cutout, one delayed fracture healing, and one lateral displacement of the antirotation screw. The total reoperation rate was high (12%) mainly because of hardware removals, which occurred in 13 patients (8.6%). Stratification of results showed that hematomas and iliotibial tract irritation occurred more commonly with lesser surgical experience. General complications and intraoperative problems were seen more often with subtrochanteric fractures. Because the high reoperation rate with the proximal femoral nail is a concern, extramedullary devices continue to be the preferred implants for treatment of stable trochanteric fractures. The low rates of femoral shaft fractures and failure of fixation suggest the proximal femoral nail is useful for treatment of unstable trochanteric and subtrochanteric fractures.

当院における大腿骨転子部骨折に対するCHS, gamma nailの治療成績

当院における大腿骨転子部骨折に対するCHS, gamma nailの治療成績

Correct Lag-Screw Positioning for the Gamma Nail: Development of the Targeting Device for Insertion

Proper lag-screw positioning in the femoral head is the most important factor in a successful Gamma nailing, in order to minimize the postoperative complications originating from the standard surgical technique. We now introduce a new targeting device for the correct insertion of the lag screw of the Gamma nail into the femoral head in the treatment of trochanteric fractures.

Complications following the treatment of trochanteric fractures with the gamma nail

The treatment of trochanteric fractures with the use of gamma nails has become an established method. Despite the good and reliable results, some typical failures and complications may occur. It was our purpose to analyse the most common complications and their treatment options. A total of 498 patients were treated with a gamma nail from January 1992 until December 2001. There were 77% pertrochanteric, 10% subtrochanteric, 11% reversed pertrochanteric and 2% lateral femoral neck fractures. The patients' mean age was 78.6 years (ranging from 29 to 98 years). There were a total of 78 general complications (16%) and implant-related complications in 8% (n=42). The most common complication was trochanteric pain necessitating removal of the gamma nail (n=30). Four patients fell after removal of the nail and sustained a neck fracture on the same side. Cut-out of the screw occurred in 19 patients. Sixteen of them had to be converted to a total hip replacement. Another 5 patients were converted to a total hip replacement because of pseudoarthrosis. During conversion to total hip replacements, the trochanter major refixation and length adjustment were the most problematic steps (intra- or postoperative dislocations necessitating anti-dislocation rings in three cases). Furthermore, cement extrusion at the femur and acetabulum occurred in 13 cases. Infections occurred in 3 patients. Five patients with a short gamma nail needed a conversion to a long gamma nail due to pseudoarthrosis (n=2) or femur fracture at the distal interlocking bolt (n=3). In addition, 7 patients sustained a distal femur fracture through the distal bolt, necessitating a plate osteosynthesis. Most complications after gamma nail fixation can be prevented by following certain rules. The other inevitable problems can be dealt with either through a conversion to a total hip replacement, a re-osteosynthesis with a long gamma nail or an additional condylar plate. Conversion to total hip replacement may be a demanding operation with a higher than normal complication rate. Removal of the gamma nail should be performed cautiously as re-fractures can occur.

Treatment of femoral intertrochanteric fractures with dynamic hip screw

目的 评价动力髋螺钉(DHS)治疗股骨转子间骨折的临床效果.方法1996年3月～2002年3月用DHS共治疗患者29例.骨折按Evans分型,本组Evans ⅠA 2例,Evans ⅠB 10例,EvansⅡA 3例,EvansⅡB12例,EvansⅢ2例.结果29例患者均获随访,随访12～48个月,平均26个月,根据Harris髋关节评分:优16例,良9例,中3例,差1例.结论如能及时手术良好复位,DHS是治疗股骨转子间骨折的较好选择。

The treatment of trochanteric fractures with the gliding nail-Our first 13 cases

The treatment of trochanteric fractures with the gliding nail-Our first 13 cases

Proximal Femoral Nail (PFN) for the Treatment of the Femoral Trochanteric Fracture

목 적: 최근 개발된 근위 대퇴정을 이용한 대퇴 전자부 골절의 치료 결과에 대해 보고하고자 한다. 대상 및 방법: 2001년 6월부터 2002년 8월까지 대퇴 전자부 골절에 대하여 근위 대퇴정을 이용하여 치료한 27예 중 24예를 대상으로 하였으 며, 급성신부전 및 호흡기 합병증으로 사망한 1예, 3개월 미만 추시 2예는 제외하였다. 평균 연령은 69.6세, 평균 추시 기간은 12개월이었다. 결 과: 술 후 방사선 사진상 내측 피질골의 내외측 전이는 평균 4.6 mm, 전방 피질골의 전후방 전이는 평균 4.1 mm였고, 술 후 대비 최종 추시 방사선 사진상 지연 나사의 활강 정도는 1.2 mm, 대퇴골 경간각의 변화는 술 후 평균 131.1°에서 최종 추시 127.8°로 평균 3.3° 내반 변형을 보였다. 체중 부하 시기는 평균 1주였고, 골유합 시기는 10주였고, 전 예에서 최종 추시 현재 골유합 소견을 보였고, 지연유합, 불유합은 없었다. 결 론: 고령의 대퇴 전자부 골절에 있어서 근위 대퇴정의 사용은 수술 시간의 감소 및 견고한 내고정을 통하여 조기 보행을 가능하게 하였고, 추시 관찰상 좋은 골유합과 합병증이 적어 만족스러운 치료 결과를 얻었다.

Roentgenological study about a treatment of trochanteric fractures of the femur with Gamma nail

Roentgenological study about a treatment of trochanteric fractures of the femur with Gamma nail