ABSTRACT
@#Poliomyelitis is on the verge of eradication since the introduction of the vaccine in 1950. In developed countries, those afflicted with the disease are primarily in their sixth decade and beyond, usually with disabling complications. Due to the diminished muscle power coupled with the abnormal bony anatomy and joint contractures, patients with polio present unique surgical challenges when they sustain fragility fractures. We report an uncommon case of intertrochanteric hip fracture in a limb affected with polio and hip dysplasia, on a background of ipsilateral distal femur fracture with previous surgical fixation. We aim to outline the challenges encountered during the surgery and the preoperative planning to overcome these shortcomings.
ABSTRACT
PURPOSE: Proximal femur fractures are classified into intracapsular neck fractures and extracapsular trochanteric fractures, and several related treatment recommendations in elderly patients have already been introduced. Importantly, we have observed cases of combined intra and extracapsular fractures (i.e., ipsilateral neck and trochanter fractures). The purpose of this study is to report the outcomes of combined neck and trochanter fractures of the femur treated with cephalomedullary nail (CMN) in elderly patients. MATERIALS AND METHODS: From January 2010 to December 2014, 410 patients with proximal femoral fractures were fixed using CMN; among this group, 37 patients with combined neck and trochanter fractures were identified. Two of these patients died fewer than three months after injury and another two did not return for follow-up. Thirty-three patients were included and reviewed retrospectively in this study. RESULTS: All patients were injured by simple fall. Bone union was obtained in 28 of 33 patients. Of the five patients who failed treatment, three experienced implant penetration through head (cut-through and cut-out), one had breakage of CMN and the last one had a loosening of internal fixation device with persistent non-union at final follow-up. The former four patients underwent hip replacement surgery and the latter refused surgery because he had low demand in daily life and many medical problems. CONCLUSION: Eighty-five percent of elderly patients with combined neck and trochanter fractures of the femur treated with CMN achieved bone union; these complex fractures require more accurate reduction than usual extra-articular intertrochanteric fractures.
Subject(s)
Aged , Humans , Femoral Fractures , Femur , Follow-Up Studies , Head , Hip , Hip Fractures , Internal Fixators , Neck , Retrospective StudiesABSTRACT
Background: Intramedullary hip screw (IMHS) is a cephalomedullary nail used for surgical treatment of hip fracture for the past two decades but only a few studies have been reported. Aim of the study: To evaluate the effectiveness of IMHS for intertrochanteric fracture in Thammasat university hospital. Materials and methods: Ninety-two intertrochanteric fracture patients were retrospectively reviewed. Results: Mean operative time was 87 minutes (45-154 min) with an average blood loss of 150 ml (50- 300 ml). Intraoperative femoral shaft fracture was found in two cases which required the immediate exchange to long IMHS intraoperatively. One displaced large greater tuberosity fragment during nail insertion was treated by tension band wiring and five lateral cortex fractures were managed conservatively. Failed IMHS were found in 3 cases with two cases screw cut out the femoral head and one fracture extending from intertrochanter to the superior neck. All of these three cases were changed to hip prosthesis. Most of the patients stayed in the hospital for 3 weeks (61.4%), younger patients tend to have shorter hospital stay (<1 week) and preexisting medical complications may prolong hospitalization (>1 month). From this study, IMSH can safely treat a hip fracture patient and Sunyarn Niempoog, Sukanis Chumchuen, Chayanin Angthong, Krit Boontanapibul. Intramedullary Hip Screw (IMHS) for the Treatment of Intertrochanteric Hip Fracture: A Retrospective Study. IAIM, 2019; 6(8): 51-61. Page 52 its complications can be avoided by correct entry point, over-reaming and manually pushing the nail with use of a hammer and a centering sleeve.Conclusion: IMSH is a choice of treatment for hip fracture in Thais with a satisfactory outcome, and complications can be avoided by locating the correct entry point, over-reaming and manually push the nail while using a hammer and a centering sleeve
ABSTRACT
PURPOSE: Cephalomedullary nail (CM nail) in the treatment of femoral intertrochanteric fractures is in the lime light in recent years. The purpose of this study is to compare surgical outcomes between experienced surgeon and non-experienced surgeons in respect of CM nail for femoral intertrochanteric fractures. MATERIALS AND METHODS: The 129 patients underwent CM nail for femoral intertrochanteric fracture more than six months of follow-up from April 2011 to March 2014 in Seoul Medical Center (Seoul, Korea) were participated in this study. For this study, group A consisted of experienced surgeons who performed more than 500 times of CM nail, and group B consisted of non-experienced surgeons who performed less than 50 times of CM nail. Clinical and radiologic outcomes, complications and the need for reoperation between both groups were compared in the study. RESULTS: According to clinical result, both the mean operation time and transfusion volume were significantly longer and greater in group B (P<0.05). In the radiologic outcomes, adequacy of reduction, tip-apex distance and numbers of case placed in the Cleveland zones 5, 6 and 8; there was no statistical difference between both groups. Moreover, rate of complication and reoperation had same results as radiologic outcomes. CONCLUSION: There was no significant difference with statistical data in complications from CM nail for femoral intertrochanteric fractures between experienced surgeon and non-experienced surgeon. Although the operation time and transfusion volume were significantly longer and greater in the case of operation by non-experienced surgeon, satisfactory performance was seen in the complications and the need for reoperation.
Subject(s)
Humans , Femur , Follow-Up Studies , Hip Fractures , Reoperation , Seoul , SurgeonsABSTRACT
Internal fixation using a cephalomedullary nail as treatment for proximal femur fracture has recently been popular for early ambulation and rehabilitation. However metal breakage at the lag screw insertion site was reported due to non-union, delayed-union, and early weight bearing. In our orthopedic department, we experienced 2 cases of nail breakage at the lag screw insertion site, therefore we report on evaluation of the cause of metal failure and prevention of complications with literature review.
Subject(s)
Early Ambulation , Femur , Orthopedics , Rehabilitation , Weight-BearingABSTRACT
Fazer uma avaliação radiográfica retrospectiva da redução e posição do implante na cabeça femoral em pacientes com fraturas pertrocantéricas tratados com haste cefalomedular em decúbito lateral e fatores que possam interferir na qualidade da redução da fratura e posição do implante no uso dessa técnica. MÉTODOS: Foram avaliados retrospectivamente 19 pacientes com diagnóstico de fratura pertrocantérica do fêmur tratados com haste cefalomedular em decúbito lateral. Para avaliação radiográfica ambulatorial usamos as incidências anteroposterior da pelve e o perfil do lado afetado. Aferimos o ângulo cervicodiafisário, o TAD, a posição espacial do elemento cefáfilo em relação à cabeça e o diâmetro biespinhal. Para avaliação antropométrica usamos índice de massa corporal. Foram criados dois grupos de pacientes, um com todos os critérios normais (TAD < 25 mm, ângulo cervicodiafisário entre 130° e 135° e a posição do implante cefálico na cabeça femoral no quadrante central-central) e outro com alteração em algum dos critérios de melhor prognóstico. RESULTADOS: Houve predomínio do sexo feminino (57,9%), com idade média de 60 anos. Sete pacientes ficaram com a posição do implante cefálico na posição central-central, um apresentou ângulo cervicodiafisário > 135° e o TAD máximo foi de 32 mm. Consequentemente, 12 pacientes apresentaram algum dos critérios alterados (63,2%). Nenhuma das características avaliadas diferiu ou mostrou associação estatisticamente significativa entre pacientes com todos os critérios normais e algum critério alterado (p > 0,05). CONCLUSÃO: A técnica descrita permite uma boa redução e um bom posicionamento do implante, independentemente dos índices antropométricos e do tipo de fratura.
To perform a retrospective radiographic evaluation on the fracture reduction and implant position in the femoral head among patients with pertrochanteric fractures who had been treated using a cephalomedullary nail in lateral decubitus; and to assess factors that might interfere with the quality of the fracture reduction and with the implant position in using this technique. METHODS: Nineteen patients with a diagnosis of pertrochanteric fractures of the femur who had been treated using cephalomedullary nails in lateral decubitus were evaluated. For outpatient radiographic evaluations, we used the anteroposterior view of the pelvis and lateral view of the side affected. We measured the cervicodiaphyseal angle, tip-apex distance (TAD), spatial position of the cephalic element in relation to the head, and the bispinal diameter. To make an anthropometric assessment, we used the body mass index. Two groups of patients were created: one in which all the criteria were normal (TAD ≤25 mm, cervicodiaphyseal angle between 130° and 135° and cephalic implant position in the femoral head in the central-central quadrant); and another group presenting alterations in some of the criteria for best prognosis. RESULTS: Female patients predominated (57.9%) and the mean age was 60 years. Seven patients presented a central-central cephalic implant position. One patient present a cervicodiaphyseal angle >135° and the maximum TAD was 32 mm; consequently, 12 patients presented some altered criteria (63.2%). None of the characteristics evaluated differed between the patients with all their criteria normal and those with some altered criteria, or showed any statistically significant association among them ( p> 0.05). CONCLUSION: The technique described here enabled good reduction and good positioning of the implant, independent of the anthropometric indices and type of fracture.
Subject(s)
Humans , Male , Female , Femoral Fractures/surgery , Femoral Fractures/therapy , Hip FracturesABSTRACT
PURPOSE: To evaluate the radiographic results of patients with subtrochanteric femoral fracture using minimal incision and cephalomedullary nail technique. MATERIALS AND METHODS: This study was performed on 54 patients, 54 cases of hip, recruited among patients who underwent minimal incision and Cephalomedullary nail from September 2005 to August 2008 and were available for 1-year or longer follow up. The gender ratio was 37 males and 17 females, and the mean age at the time of surgery was 57.4 years (range; 16~81 years). According to injury mechanism, traffic accident was 29 cases, fall down form high height was 18 cases, slip down was 7 cases. In classification by Seinsheimer, type II was 23 cases (m/c), type III was 18 cases, type IV was 13 cases. Average follow up period was 14 months (12~18). Radiographic evaluation was performed for time taking union, mal-union and complication. RESULTS: 53 of the 54 cases united. 39 of 54 reductions were anatomic. 19 fractures had a monir varus deformity of proximal fragment (between 2degrees and 5degrees). There was no varus deformity of more than 5degrees. 1 case that had been treated with PFN had nail breakage without trauma. There were no other complications. CONCLUSION: Surgical treatment of subtrochanteric fractures with minimal incision and Cephalomedullary nail technique can reslut in excellent reduction without complications including inflammation & malunion. Careful attention to detail for using Lowman clamp is demanding to decrease soft tissue injury.