Trochanteric Femoral Fractures Research Articles

大腿骨転子部骨折に対するJapanese PFNA術後にcentral migrationおよびcutoutした症例の検討

大腿骨転子部骨折に対するJapanese PFNA術後にcentral migrationおよびcutoutした症例の検討

Rotationally Stable Screw-Anchor Versus Sliding Hip Screw Plate Systems in Stable Trochanteric Femur Fractures

The rotationally stable screw-anchor plate system (RoSA) is unique in using a novel screw-blade combination. This investigation tested the hypothesis whether RoSA is advantageous over the sliding hip screw plate system (SHS) with regard to stiffness, failure load, displacement, and migration in stable trochanteric femur fractures (OTA 31A1.1). Thirteen femur pairs (mean age = 79 years; range, 64-92 years) received implants of either the RoSA or SHS (Koenigsee Implants, Allendorf, Germany). Beginning with 300 N and under consecutive 300 N load-increase steps (2000 cycles, 0.5 Hz) the femurs were cycled until failure. Specimens were evaluated for fragment displacement in both frontal and rotational planes and for migration. A survival analysis was carried out. With regard to stiffness (526 ± 195 N/mm vs 358 ± 143 N/mm; P = 0.006) and the failure load (2838 ± 781 N vs 2262 ± 863 N; P = 0.012), the RoSA proved superior to the SHS. Furthermore, RoSA demonstrated higher rotational stability in comparison to the SHS (1800 N: 0 ± 0 degrees vs 1.1 ± 1.3 degrees; P = 0.015; failure point: 0 ± 0 degrees vs 2.3 ± 2.6 degrees; P = 0.008), measuring rotation about femoral neck axis over time. Whereas cutout occurred only in the RoSA system (n = 3; P = 0.110), the SHS underwent plastic deformation in 7 cases (n = 7; P = 0.003). In one case (7%), the insertion of the RoSA blade resulted in iatrogenic cut-through caused by a jamming of the screw and the blade. The fixation of stable trochanteric femur fractures with RoSA in cadavers led to greater primary stability under cyclic load, with significant advantages with regard to stiffness, failure load, and rotational stability, compared with the SHS. A detrimental effect was its migration tendency, which began at 1800 N and occurred in the cranial direction. A meticulous insertion technique was a prerequisite to avoid iatrogenic perforation of the femoral head. Our results will have to be substantiated by further biomechanical and clinical trials using an optimized RoSA system.

Indications for treatment of femoral trochanteric fractures with reversed less invasive stabilization system (LISS)

Objective To discuss outcomes of and indications for treatment of femoral trochanteric fractures with reversed less invasive stabilization system (LISS).Methods A retrospective study was performed for 72 consecutive patients with femoral trochanteric fracture who had been treated with reversed LISS at our institution between June 2005 and June 2011.They were 33 men and 39 women,with a mean age of 73.4 years (range,45 to 87 years).The operation time,intraoperative blood loss,intra-hospital complications and internal fixation-related complications at the last follow-up were analyzed.The fracture union was assessed by follow-up radiographs and hip functional recovery by Harris hip scoring.Results The operation time averaged 141.4 minutes and the intraoperative blood loss averaged 138.1 mL.The intra-hospital complications included deep venous thrombosis in 3 cases,pneumonia in one,gastrointestinal bleeding in one,postoperative delirium in one,and a death resulting from multiple organ failure.Sixty-five patients (90.3％) obtained a mean follow-up of 22.1 months (range,18 to 46 months).The fracture union was achieved after an average of 4.2 months (range,3 to 8 months).The mean Harris score at the last follow-up was 73.7 points (range,20 to 100 points).Eight patients were excellent,19 good,25 fair and 13 poor,giving an excellent to good rate of 41.5％.The internal fixation-related complications at the last follow-up were observed in 10 out of the 65 patients (15.4％),including 6 cases of screw breakage,one of nonunion,one of plate breakage,one of screw loosening and one of malunion.Conclusions Reversed LISS should not be a routine treatment for femoral trochanteric fractures because of its high rate of complications.We recommend its indications include fractures more complex than AO type 31A2.2,those with a narrow medullary canal,those with a severely bowed or deformed femur,pathologic and periprosthetic ones and those with multiple traumas and a priority of immediate trauma control. Key words: Hip fractures; Fracture fixation, internal; Bone plates; Surgical procedures,minimally invasive; Indication

Total Hip Replacement After Medullary Hip Screw Placement Is Frequently Complicated by Trochanteric Femoral Fracture

Total Hip Replacement After Medullary Hip Screw Placement Is Frequently Complicated by Trochanteric Femoral Fracture

Sa1.7 Proximal femoral nail for treatment of trochanteric femoral fractures – treatment with Veronail

Sa1.7 Proximal femoral nail for treatment of trochanteric femoral fractures – treatment with Veronail

Sa1.10 Precise placement of lag screws in treatment of trochanteric femoral fractures with a new guide system and trochanteric nail

Sa1.10 Precise placement of lag screws in treatment of trochanteric femoral fractures with a new guide system and trochanteric nail

Intraoperative Comminution of the Lateral Wall When Treating Trochanteric Proximal Femoral Fractures May Not Adversely Affect Outcome

Intraoperative Comminution of the Lateral Wall When Treating Trochanteric Proximal Femoral Fractures May Not Adversely Affect Outcome

The Sinking of the Intramedullary Nail in Femoral Trochanteric Fracture

The Sinking of the Intramedullary Nail in Femoral Trochanteric Fracture

The relation between reduced position and sliding in unstable femoral trochanteric fracture

The relation between reduced position and sliding in unstable femoral trochanteric fracture

Decreasing time trend in SSI incidence for orthopaedic procedures: surveillance matters!

Infection is the most common reason for early revision after hip and knee arthroplasty, and the revision rate is increasing. Surgical site infection (SSI) surveillance data are important to assess the true infection rate. There is little information regarding the potential time trend in SSI incidence following orthopaedic surgery. To evaluate whether a time trend exists in SSI incidence due to surveillance following orthopaedic surgery. The SSI rates after hip and knee replacements and osteosynthesis of trochanteric femoral fractures and ankle fractures were recorded prospectively from May 1998 to October 2008 according to the criteria of the US Centers for Disease Control and Prevention. In total, 4177 procedures were analysed, 65.8% of which were performed on female patients. Linear regression was used to analyse trends in SSI rates. SSI incidence decreased significantly from 7% in the first year to 3% in the last year; a 57% relative reduction. The duration of surgery was the only significant predictor for infection (P < 0.001) in a logistic regression model that also included age, American Society of Anesthesiologists' score and level of emergency. Surveillance following orthopaedic procedures showed a significant decrease in SSI incidence over the 11-year surveillance period. The causality between surveillance and SSI incidence is difficult to prove, but surveillance with feedback probably influences several procedures that affect the quality of health care, even if duration of surgery is the only significant predictor of this effect.

L-F5.4 Z-effect after intramedullary nailing systems for trochanteric femur fractures

L-F5.4 Z-effect after intramedullary nailing systems for trochanteric femur fractures

Proximal femoral nail antirotation versus Gamma nail in treatment of femoral trochanteric fractures

Background Two osteosynthesis methods, proximal femoral nail antirotation (PFNA) and gamma nail (GN), were used in the management of femoral trochanteric fractures to prevent the complications of long-term confinement to bed for the elderly. This study evaluated the clinical results of PFNA and GN in treatment of femoral trochanteric fractures. Methods This is a retrospective study of patients with femoral trochanteric fractures who had procedures with GN or PFNA from January, 2005 to December, 2008. Two-hundred sixty-three patients initially fulfilled the study criteria, and 55 patients were lost to follow-up. Of the remaining 208 patients available for analysis, 96 had GN (46 men and 50 women) and 112 had PFNA (52 men and 60 women). Clinical and radiographic outcomes were measured and compared between the two groups. Results The surgery was successfully performed in all patients, and no intraoperative deaths occurred. The operating time for GN was longer than PFNA. All fractures in the PFNA group and 82 cases in the GN group united between 3 and 4 months, and 14 patients with GN had delayed union (5–9 months). The Parker's score evaluations were significantly in favor of PFNA (P<0.05). No significant differences were noted in the fracture reduction quality, but significant differences were noted in the screw position between the two groups (P<0.05). Conclusions PFNA had the advantages of antirotation and antivarus collapse compared with GN, which led to the good screw position, faster union and better functional results.

Comparison of cutout resistance of dynamic condylar screw and proximal femoral nail in reverse oblique trochanteric fractures: A biomechanical study

Background:Reverse oblique trochanteric fracture of femur is a distinct fracture pattern. 95° Dynamic condylar screw (DCS) and proximal femoral nail (PFN) are currently the most commonly used implants for its fixation. This study aims to biomechanically compare the cutout resistance as well as modes of failure of DCS and PFN in reverse oblique trochanteric fractures.Materials and Methods:Sixteen freshly harvested cadaveric proximal femoral specimens were randomly assigned to three mean bone mineral density matched groups, eight of which were implanted with 95° DCS and the other eight with PFN. The constructs were made unstable to resemble a reverse oblique trochanteric fracture by removing a standard size posteromedial wedge. These constructs were subjected to computer controlled cyclic compressive loading with 200 kg at a frequency of 1 cycle/second (1 Hz) and end points of both the groups were analyzed.Results:The bending moment of the PFN group was approximately 50% less than that of the DCS group (P<0.0001). The PFN group resisted more number of cycles than the DCS group (P=0.03) and showed lesser number of component failures as compared with the DCS group (P=0.003).Conclusions:The PFN is biomechanically superior to DCS for the fixation of reverse oblique trochanteric fractures of femur.

Intrapelvic migration of hip lag screw of proximal femoral nail-sequele to a paradoxical reverse Z effect and their critical analysis.

A 40-year-male treated with hip screw for unstable inter trochanteric fracture femur, had an implant failure after an aggressive therapy session .The Dynamic Condylar Screw was removed and fracture was fixed with Proximal Femoral Nail. The nail also failed to achieve its goal of fracture union, as a result of a unique type of reverse Z effect, in contradiction to expected Z effect resulting in intrapelvic migration of proximal hip lag screw of the proximal femoral nail.

Tip Apex Distance: a useful method to assess extra-capsular neck of femur fixation?

Introduction: Fixation of trochanteric femoral neck fractures can be problematic. The tip apex distance (TAD) is a simple measurement that predicts screw cut-out in the femoral head from fractures treated with a fixed angle sliding hip screw device. By assessing whether the measurements in our centre were comparable to published results, we wanted to assess our proficiency in fixing these injuries as well as the general usefulness of this measurement in day to day practice. Methods: A retrospective review was conducted of 102 consecutively treated trochanteric fractures over a 12 month period, with 11 patients excluded. Three observers (n=3) used a standardised method to measure the TAD (from 2 orthogonal projections with a correction for magnification). The stability of the fracture patterns with the accuracy of reduction were measured according to published criteria. Results: 91 fractures were sustained in 90 patients, with one patient being treated for bilateral hip fractures. The mean tip apex distance was 19.06 mm ±0.77 mm (±95% CI). Assessing the inter-observer variability, the standard deviation between the 3 observers was 1.99mm, equivalent to 10% of the mean TAD. 12 out of 91 sliding hip screw devices (13.1%) had a TAD greater then 25mm, predictive of a higher extrusion rate. Conclusions: Measurement of the TAD can provide a reliable method to examine the adequacy of screw placement in the femoral head. Our results compare favourably to those published and we have found a similar level of inter-observer variability, confirming the usefulness of this measurement in assessing the quality of fixation and its reproducibility. By determining which patients have an increased risk of failure of fixation by screw cut-out we have been able to offer targeted surveillance rather than routinely following up all patients: bringing back those with a high TAD for x-ray follow up.

大腿骨転子部骨折に対する準緊急骨接合術の試み

大腿骨転子部骨折に対する準緊急骨接合術の試み

A study of the case of the femoral trochanteric fracture with PFNA fully backed out

A study of the case of the femoral trochanteric fracture with PFNA fully backed out

Japanese PFNAを用いた大腿骨転子部骨折に対する治療 —Blade挿入は骨頭中心をめざす—

Japanese PFNAを用いた大腿骨転子部骨折に対する治療 —Blade挿入は骨頭中心をめざす—

A femoral model with all relevant muscles and hip capsule ligaments

In order to evaluate stabilisation systems in trochanteric femoral fractures with finite element (FE) analysis, a realistic model is required. For this purpose, a new model of a femur with all the relevant muscles and the hip capsule ligaments is set up. The pelvic and tibial bones are modelled as rigid bodies so as to take all the muscles attached to the femur into account. Fracture zones in the proximal femur are defined. Following the modelling of the geometry, the isotropic material behaviour and the load application, a numerical calculation of the femur is carried out. The static iterated FE simulation shows good agreement with in vivo data for the one-leg-stance phase during walking and Pauwels' one-leg stance regarding the displacement of the femoral head (2.9 and 5.2 mm, respectively) and the resulting hip force (253% and 294% bodyweight, respectively). In the modelled fracture zones without osteosynthesis, shear is higher than axial strain. The reduction of shear among others could be a criterion for judging the quality of a stabilisation implant.

A Case Report of Unique Complications of PFNA Penetration of the Blade into the Hip Joint

The proximal femoral nail anti-rotation (PFNA) is a useful device to fix trochanteric fractures of the proximal femur. We report a case of postoperative penetration of the helical blade through the femoral head into the hip joint without any sign of rotational or varus instability in the fracture.