Enclavado Endomedular Trocantérico versus DHS por técnica mínimamente invasiva en el tratamiento de fracturas extracapsulares de fémur proximal / Intermediate Endomedullary Trochanteric versus DHS by minimally invasive technique in the treatment of extracapsular proximal femoral fractures

Las fracturas extracapsulares de cadera están asociadas a traumatismos de baja energía en ancianos y a traumatismos de alta energía, como los arrollamientos o heridas por arma de fuego, en pacientes jóvenes. El objetivo de este estudio fue comparar los resultados del tratamiento de las fracturas extracapsulares de cadera con dos métodos quirúrgicos. Se realizó un estudio experimental de tipo ensayo clínico controlado, conducido en un centro de IV nivel, diseñado para comparar la efectividad del enclavado endomedular trocantérico y el tornillo deslizante de cadera por técnica MIO en el tratamiento de fracturas extracapsulares de cadera. Se incluyeron pacientes de ambos géneros, mayores de 16 años. El tiempo promedio de seguimiento fue de 8,2 meses. Se incluyeron 120 pacientes, 60 para cada grupo. 65% de sexo femenino y 35% masculino. La edad promedio fue de 79,39 años. El tipo de fractura más frecuente fue la 31A2.1 en 34,16% y la 31A1.2 con 21,66%. El mecanismo de trauma más frecuente fue la caída simple en 85%. El enclavado endomedular trocantérico mostró mejores resultados en cuanto a sangrado operatorio, tiempo exposición al fluoroscopio, duración de la cirugía, y resultados en la escala de Harris y Montoya al final de la valoración (p<0,05). La tasa de complicaciones fue de 24,16%. El enclavado endomedular trocantérico demostró ser superior al tornillo deslizante de cadera por técnica MIO en el tratamiento de estas fracturas(AU)

Extracapsular hip fractures are associated with low-energy trauma in elderly and high-energy trauma, such as coils or gunshot wounds in young patients. The aim of this study was to compare the results of treatment of extracapsular hip fractures with two surgical methods. A controlled clinical trialexperimental study, conducted at a level IV center was made. Designed to compare the effectiveness of proximal femoral nail and sliding hip screw for MIO technique in the treatment of extracapsular hip fractures. Patients of both genders, aged 16 years, were included. The average follow-up time was 8.2 months. We study 120 patients, 60 for each group. 65% were female and 35% male. The average age was 79.39 years. The 31A2.1 and 31A1.2 type of fracture was the most common in 34.16% and 21.66% respectively. The most common mechanism of trauma was simply falling by 85%. The proximal femoral nail showed better results in terms of operative bleeding, fluoroscopy exposure time, duration of surgery, and results on the scale of Harris and Montoya at the end of following (p <0.05). The complication rate was 24.16%. The trochanteric nailing proved superior to the sliding hip screw for MIO technique in the treatment of these fractures(AU)

Treatment of Intertrochanteric Fractures of the Femur using Double Sliding Screws / 대한정형외과학회잡지

PURPOSE: To report the clinical and radiological results of intertrochanteric fractures of femur treated with double sliding screws. MATERIALS AND METHODS: Twenty-two intertrochanteric fractures of the femur in 22 patients who had at least one year follow-up were included in our study. The age at operation ranged from 25 to 90 years old (average 71.2 years). According to Jensen classification, unstable intertrochanteric fractures were 18 cases (82%). Radiologic assessments were composed of union time, neck-shaft angle, sliding length of lag screws and penetrating length into femoral head of lag screws. Clinical assessments were composed of operation time, amount of postoperative blood loss, length of skin incision and ambulatory ability at one year follow-up according to Koval classification. RESULTS: Mean fracture healing was done in 16.2 weeks. Postoperative change of neck-shaft angle was 136.3 degree to 134.4 degree. Mean sliding length of lag screw was 3.22 mm and mean penetrating length was 2.13 mm. Mean operation time was 112 minutes. Mean length of skin incision was 16.5 cm and average amount of blood loss counted by baro-vac was 264 mL. Ambulatory ability at one year follow-up was decreased compared to preinjury state. Three cases of reoperations were perfomed due to two cases of varus angulation (9%) and one case of penetration of lag screw into femoral head (4.5%). Two cases of trochanteric bursitis developed by prominent plate. CONCLUSION: The results of our study indicate that double sliding screw is a useful implant in treating intertrochanteric fractures of the femur. But this system needs more operation time, length of skin incision, postoperative blood loss and skill compared to conventional compression hip screw. So, it is rather the treatment of choice for unstable intertrochanteric fracture of the femur than a stable one.

A Clinical Analysis of Treatment of Intertrochanteric Fractures between the Fixation with Ender Nail and Sliding Screw Plate / 대한정형외과학회잡지

The incidence of the interochanteric fracture of femur is increasing and this increase is likely to continue for many years due to increase of traffic accident and old people. The primary goal in the treament of an elderly patient with an intertrochanteric fracture is to return the patient to his prefracture activity as soon as possible. Rapid mobilization of a pain free patient helps to prevent skin ulceration, pneumonia, urinarystasis, thromboembolic disease and other complications of confinement to bed in the eldery. For there reasons, treatment of intertrochanteric fractures by surgical methods has become the standard procedure. The authors treated 53 cases of intertrochanteric fractures from March 1978 to February 1985 with Ender nail or sliding screw plate. The results obtained as follows: l. In the 34 cases where sliding screw plates were used, the patients average age was 49.4 years old and in the 19 cases where Ender nails were used, the average in age was 63.2 and therefore, compared to the sliding screw plate, the patients using Ender nails were about 13.8 years older. 2. In the cases where Ender nails were used, the average operation hours took in the average of 55 minutes and whereby, in the cases where sliding dcrew plates were used, took in the average of 125 minutes, and during the operation time, the amout of hemorrhage in the cases of Ender nail was about 150ml and the sliding scew plate resulted in about 610ml. 3. The average weight bearing period in the cases which Ender nails were used took in the average of 2.5 weeks, where by the sliding scew plates took in the average of 9.8 weeks. 4. In the cases where Ender nails were used, the radiological bony union time was about 12.7 weeks and the sliding screw plate took about 16.1 weeks. 5. In the cases of Ender nail, if, in the geriatric age, the indication is chosen well, it will result in a benefial treatment method.