Prediction of internal fixation failure of femoral trochanteric fracture by external wall morphology / 中国骨伤

OBJECTIVE@#To investigate the relationship between the shape of the lateral wall and the early failure of internal fixation in the fracture of the femoral trochanteric region(FFT).@*METHODS@#Total 295 patients with femoral trochanteric fracture underwent internal fixation from January 2015 to January 2020 were selected. The patients were divided into two groups according to whether there was early internal fixation failure after surgery, 19 patients in the failure group and 276 patients in the normal group. Gender, affected side, age, AO classification, body mass index(BMI), preoperative hemoglobin, X-ray measurement of lower lateral wall thickness, preoperative internal diseases, intraoperative blood loss, postoperative tip apex distance(TAD), postoperative neck shaft angle, operation time and other data were compared between two groups. The shape of the lateral wall was compared between two groups, and the correlation between the shape of the lateral wall and the early internal fixation failure of femoral trochanteric fracture was analyzed.@*RESULTS@#All patients were followed up for more than 1 year. There was no significant difference between two groups in terms of intraoperative blood loss, operation time, postoperative TAD, and postoperative neck shaft angle(P>0.05). At the latest follow-up, the visual anaglue scale (VAS) of the failure group was higher than that of the normal group(P<0.01), and the Harris score of the failure group was lower than that of normal group(P<0.05). The receiver operator characteristic (ROC) curve between shape of lateral wall and failure of early internal fixation of femoral trochanteric fracture was drawn. The critical value of the midpoint lateral wall thickness was 16.5 mm, and the area under the ROC curve was 0.845;The critical value of average sidewall thickness was 16.5 mm, and the area under ROC curve was 0.838;The critical value of the axial area of the sidewall was 7.5 mm, and the area under the ROC curve was 0.826.@*CONCLUSION@#The shape of the lateral femoral wall measured by CT could be used as a predictive factor for the early failure of internal fixation of femoral trochanteric fractures. For patients at risk, more reasonable surgical plans and postoperative preventive measures should be developed.

Compresión-distracción en el tratamiento de pseudoartrosis de tibia distal utilizando el aparato de Ilizarov: reporte de casos / Compression-distraction in the treatment of distal tibial no union using the Ilizarov apparatus: case report / Compressão-distração no tratamento da pseudoartrose distal da tibia com Ilizarov: relato de caso

El método de Ilizarov, con sus diferentes variantes y mediante la utilización de su aparato, desarrollado en la década del 50, continúa vigente, sobre todo en el tratamiento de las complicaciones de fracturas, principalmente aquellas vinculadas a la infección y a las dificultades de la consolidación. Reportamos 2 pacientes adultos con diagnóstico de pseudoartrosis hipertrófica, rígida, con deformidad, sin infección activa y sin dismetría, tratados mediante el método de distracción y compresión realizado con el aparato de Ilizarov. En ambos casos se logró la alineación y consolidación del miembro con escasas complicaciones.

The Ilizarov method, with its different variants and using its apparatus, developed in the 1950s, is still valid, especially in the treatment of fracture complications, mainly those linked to infection and consolidation difficulties. We report 2 adult patients with a diagnosis of hypertrophic, rigid nonunion, with deformity, without active infection and without dysmetria, treated by the distraction and compression method performed with the Ilizarov device. In both cases, the alignment and consolidation of the limb was achieved with few complications.

O método de Ilizarov, com suas diferentes variantes e pelo uso de seu aparato, desenvolvido na década de 1950, ainda é válido, principalmente no tratamento de complicações de fraturas, principalmente aquelas ligadas à infecção e dificuldades de consolidação. Relatamos 2 pacientes adultos com diagnóstico de pseudoartrose hipertrófica, rígida, com deformidade, sem infecção ativa e sem dismetria, tratados pelo método de distração e compressão realizado com o dispositivo de Ilizarov. Em ambos os casos, o alinhamento e a consolidação do membro foram alcançados com poucas complicações.

Reason for failed fixation with dynamic hip screws for intertrochanteric fracture: analysis based on the lever-balance-reconstruction theory / 中华创伤骨科杂志

Objective:To study the reason for failed fixation with dynamic hip screws (DHS) and the indications for DHS fixation in the treatment of intertrochanteric fracture based on the lever-balance-reconstruction theory.Methods:A retrospective analysis was performed of the data of 32 patients with intertrochanteric fracture who had been treated by DHS fixation at Department of Orthopaedic Trauma, Peking University People's Hospital from January 1999 to December 2019. There were 22 males and 10 females, aged from 34 to 91 years (average, 67.7 years). By the AO classification, 15 fractures were type 31-A1, 13 ones type 31-A2, and 4 ones type 31-A3. According to the lever-balance-reconstruction theory, after the position of postoperative fulcrum was determined depending on the relationship between fracture line and internal fixation, the medial and lateral force arms were measured after internal fixation. The 32 patients were divided into 2 groups according to the position of fulcrum after internal fixation. In group A of 13 patients, the fulcrum was located in or within the center of the medullary cavity; in group B of 19 patients, the fulcrum was located outside the center of the medullary cavity. The incidence of internal fixation failure was compared between the 2 groups.Results:Internal fixation failure occurred in 15 of the 32 patients: cutting out of the head and neck screws without penetration in 2 cases, screw withdrawal in 8 cases, hip varus deformity in 10 cases, and femoral neck shortening in 15 cases. The 2 groups were comparable because there were no statistically significant differences in their preoperative general data or types of internal fixation between them except AO classification ( P>0.05). The length of medial force arm (power arm) averaged 51.12 mm (from 39.4 to 57.9 mm) and the length of lateral force arm (resistance arm) 23.37 mm (from 15.1 to 31.0 mm) in group A where 3 patients experienced internal fixation failure after operation; the length of medial force arm (power arm) averaged 63.71 mm (from 52.3 to 74.5 mm) and the length of lateral force arm (resistance arm) 9.94 mm (from 3.1 to 18.3 mm) in group B where 12 patients experienced internal fixation failure after operation. There was a significant difference between the 2 groups in internal fixation failure ( P=0.036). Conclusions:In the DHS fixation of intertrochanteric fracture, the postoperative fixation failure is associated with the fulcrum position after reconstruction. DHS is only indicated for intertrochanteric fractures whose fracture line (post-reconstruction fulcrum) is near and inside the center of the medullary cavity, but not for those whose fracture line (post-reconstruction fulcrum) is outside the medullary cavity.

Risk Factors Associated with Failure of Cephalomedullary Nail Fixation in the Treatment of Trochanteric Hip Fractures

BACKGROUND: Intramedullary (IM) nailing is widely performed in elderly patients with trochanteric fractures. Thus, it is important to identify causative factors associated with fixation failure. We investigated fixation failures after IM nailing in elderly patients with trochanteric fractures and compared the failure group with nonfailure group to identify risk factors of fixation failure.METHODS: A total of 396 patients aged 65 years or older underwent IM nailing for trochanteric fractures between January 2012 and August 2016 at our institution. Of those, 194 patients who were followed up for more than 12 months were enrolled in this study; 202 patients were excluded due to death during follow-up, bedridden status before injury, and loss to follow-up. All patients underwent plain radiography and preoperative computed tomography (CT).RESULTS: Fixation failure occurred in 11 patients (5.7%). Seven patients had stable fractures (AO/OTA); eight patients had basicervical fractures (confirmed by CT). Five patients had comminution in the greater trochanter (confirmed by CT). Regarding fracture reduction, eight patients showed discontinuity in the anterior cortex. The position of the lag screw on the lateral view was in the center in six patients and in a posterior area in the other five patients. On the basis of comparison with the 183 patients without fixation failure, risk factors of fixation failure were higher body mass index (BMI; p = 0.003), basicervical type of fracture (p = 0.037), posterior placement of the lag screw on the lateral view (p < 0.001), and inaccurate reduction of the anterior cortex (p = 0.011).CONCLUSIONS: Among the risk factors of fixation failure after IM nailing in elderly patients with trochanteric fractures, discontinuity of the anterior cortex and posterior position of the lag screw are modifiable surgeon factors, whereas higher BMI and basicervical type of fracture are nonmodifiable patient factors. Therefore, care should be taken to avoid fixation failure in IM nailing for patients with a basicervical type of fracture or higher BMI or both.

Risk factors for failed internal fixation with proximal femoral nail antirotation for reverse intertrochanteric hip fractures / 中华创伤骨科杂志

Objective@#To identify the risk factors for failure of internal fixation with proximal femoral nail antirotation (PFNA) for reverse intertrochanteric hip fractures.@*Methods@#A retrospective study was conducted of the 45 patients with reverse intertrochanteric hip fracture who had been treated with PFNA fixation from January 2006 through January 2018 at the Department of Traumatic Orthopaedics, The Third Affiliated Hospital to Peking University. They were 19 males and 26 females, aged from 19 to 97 years (average, 71.9 years). According to the AO/OTA classification, there were 7 cases of type 31-A3.1, 4 cases of type 31-A3.2 and 34 cases of type 31-A3.3. Fracture healing was judged according to the X-ray at the time of last follow-up. The patients were assigned into a healed group and a failed group. The 2 groups were compared in terms of gender, age, body mass index (BMI), mechanism of injury, AO classification, type of main fracture line, reduction method, reduction quality, status of lateral femoral wall and tip-apex distance. A multivariate logistic regression model was designed to analyse the dependent variable 'implant failure’ with a set of independent variables as risk factors.@*Results@#The 45 patients were followed up for 12 to 62 months (average, 28.4 months). Implant failure was observed in a total of 6 patients (13.3%), 3 of whom had helical blade perforation, 2 main screw breakage, and one cut-out of helical blade. The single factor analysis revealed significant differences in reduction quality and type of main fracture line between the patients with successful fixation and those with failed fixation (P<0.05). The multiple logistic regression analysis identified poor reduction quality (OR=30.809, 95%CI: 1.052~902.298, P=0.047) and a transverse fracture line (OR=25.639, 95%CI: 1.636~401.917, P=0.021) as risk factors for implant failure.@*Conclusion@#Poor reduction quality and a transverse fracture line may be predictors of implant failure in reverse intertrochanteric hip fractures treated with PFNA fixation.

Appication of individualized semi-shoulder prosthesis for proximal humerus reconstruction under assistance of 3D printing technology / 吉林大学学报(医学版)

Objective: To study the application of individualized semi-shoulder prosthesis under the assistance of 3D printing technology in the shoulder replacement surgery of one patient with bone defect caused by a complex proximal humerus fracture internal fixation failure, and to provide the basis for the repairment and reconstruction of articular bone defect. Methods: One patient was admitted to the hospital because of the internal fixation failure after open reduction and internal fixation for left proximal humeral fractures and proximal collapse and necrosis of humerus. The humerus CT data of this patient was collected and the three-dimensional reconstruction was conducted. The models of stereo lithography apparatus resin on healthy side and affected side of this patient were manufactured by 3D printing technology, and the length of osteotomy was designed preoperatively according to the bone destruction condition. The shape of customized prosthesis was designed on the basis of mirror image of the contralateral humerus head. The Ti6 Al4 V semi-shoulder prosthesis was manufactured by the means of Electron Beam Melting technology. The preoperative simulative operation was carried out, and the matching experiment of the customized prosthesis and residual humerus model was performed; the humerus osteotomy was performed in accordance with the preoperative design in operation. The customized prosthesis was implanted to the designed location. The patients were followed up at 1, 3, 6, and 12 months after operation. Results: The operation time was 150 min. The intraoperative blood loss was 290 ml. The postoperative humerus X-ray examination at 1, 3, 6, and 12 months after operation were performed and the results showed that the prosthesis was observed in good position without loosening. There were also no infection (ESR and C-reactive protein level were normal) as well as dislocation, nerve damage and periprosthetic fractures, etc. The UCLA scores were 13 points before and during operation, 15 points at 1 month after operation, 22 points at 3 months after operation, 28 points at 6 months after operation, and 30 points at 12 months after operation. The Constant-Murley scores were 21 points before and during operation, 28 points at 1 month after operation, 61 points at 3 months after operation, 65 points at 6 months after operation, and 70 points at 12 months after operation. The Disbility of Arm shoulder and Hand (DASH) scores were 100 points before and during operation, 63 points at 1 month after operation, 50 points at 3 months after operation, 44 points at 6 months after operation, 25 points at 12 months after operation. The rehabilitation of daily life ability of the affected shoulder of the patient after operation was satisfied. Conclusion: Individualized semi-shoulder joint prosthesis under assistance of 3D printing technology can achieve the perfect anatomy reconstruction and partial function restoration of shoulder joint and the curative effect of short-term follow-up of the patient isobvious.

Analysis of influencing factors of failure of internal fixation after closed reduction and internal fixation for intertrochanteric fractures in the elderly / 中国基层医药

Objective To explore the process of clinical treatment of senile intertrochanteric fractures in patients with closed reduction and internal fixation,to analyze the related factors leading to operation failure,and to lay the foundation for the clinical treatment in Department of Orthopedics.Methods 100 elderly patients with intertro-chanteric fracture were treated with closed reduction and internal fixation,and the related factors leading to the failure of the operation were analyzed.Results Through the statistics of all patients,7 cases were found in patients with internal fixation failure.The internal fixation failure rates of the patients with 4 ~6 class Singh index,basic diseases, TAD >25mm,and the using of hormone drugs were significantly higher than those of the patients with 1 -3 class Singh index,basic diseases,TAD≤25mm,and no using hormone drugs,the differences were statistically significant (χ2 =6.246,4.532,4.532,6.439,all P 25mm and Cleveland partition were internal fixation failure risk factors,the difference was statistically significant(all P 25mm and Cleveland partition can be used as the risk factors of internal fixation failure.

Risk factors for failed internal fixation in surgery of senile femoral intertrochanteric fractures / 中华创伤骨科杂志

Objective To analyze the risk factors for failures of intramedullary and extramedullary internal fixation in surgery of femoral intertrochanteric fractures in elderly patients.Methods A retrospective study was conducted of the 205 elderly patients with osteoporotic femoral intertrochanteric fracture who had accepted closed reduction together with intramedullary and extramedullary internal fixation between September 2005 and August 2014.They were 89 men and 116 women,from 65 to 98 year of age (average,78.8 years).By AO classification,137 cases were of types AI.1-A2.1 (stable fractures),and 68 of type A2.2-A3.3(unstable fractures).The incidence of internal fixation failure and Harris scores at the last follow-up were recorded.The factors possibly contributing to the failure were analyzed using the univariate analysis and multivariate logistic regression analysis.Results Of the patients,192 obtained a mean follow-up of 39 months (from 14 to 60 months),but 13 were lost after a 10-month follow-up.Of the 205 patients,internal fixation failure occurred in 12 (incidence of 5.9％).Five failed cases received DHS fixation and 7 accepted PENA fixation.At the last follow-up when the 13 cases were lost after 10-month follow-up,the mean Harris hip score was 81.6 (from 57 to 92),and the excellent to good rate was 84.9％ (29 excellent cases,145 good ones,10 fair ones and 21 poor ones).The multivariate regression analysis revealed that tip-apex distance (TAD) ＞ 25 mm(OR ＝ 333.33),severe osteoporosis (OR =267.44),AO types A2.2-A3.3 (OR ＝ 22.24),functional reduction of fracture (OR =20.79),and concomitant medical diseases (OR =4.59) were independent risk factors for failures of internal fixation.Conclusions DHS and PFNA fixations are effective treatments for elderly patients with femoral intertrochanteric fractures.TAD＞ 25 mm,severe osteoporosis,unstable factures,functional reduction of fracture,and concomitant medical diseases may lead to internal fixation failure in surgery of femoral intertrochanteric fractures in elderly patients.

Analysis of the Fixation Failure in Intertrochanteric Hip Fractures Treated with Hip Nailing

PURPOSE: To analyze the patterns of and risk factors for fixation failure after hip nailing in intertrochanteric (IT) hip fractures. MATERIALS AND METHODS: Fourteen patients who sustained a fixation failure after hip nailing for IT hip fractures were enrolled in this study. The mean age at the index surgery was 74.5 years and the mean time to the fixation failure was 6.6 weeks. All of the serial radiographs up to the fixation failure and pre-operative 3-D computed tomography were analyzed. RESULTS: According to AO classification, there were 7 stable fractures and 7 unstable ones. Of the total of 14 cases, 10 showed a comminution of the greater trochanter tip and incomplete anatomical reduction of the medial and anterior cortex at the fracture site. Of the 10 cases with appropriate position of the lag screw within the femoral head, 9 showed a high pertrochanteric fracture (HPF) pattern. The mechanism of the fixation failure was rotation of the femoral head in 7 of 9 cases with HPF and varus collapse of the proximal fragment in 4 of the other 5 cases. CONCLUSION: The HPF pattern, the comminution of the greater trochanter tip, and incomplete reduction of the medial and anterior cortex may be additional risk factors of fixation failure after treating IT hip fractures with hip nailing in.

Analysis of the Factors Involved in Failed Fixation in Elderly Intertrochanteric Femoral Fracture

PURPOSE: To analyze the causes of internal fixation failure in elderly intertrochanteric femoral fractures. MATERIALS AND METHODS: We retrospectively analyzed 93 intertrochanteric femoral fractures that were treated by internal fixation. The follow-up period was at least 24 months. The mean age was 73 years. We analyzed the classification of the fracture, screw position, reduction state of the fracture, and neck-shaft angle. RESULTS: Internal fixation failure occurred in 12 cases (12.9%). The causes of internal fixation failure were one case (1.0%) of head perforation, 7 cases (7.5%) of excessive slippage of a screw, and 4 cases (4.3%) of varus deformity. Significant factors infixation failure were displacement of the posterolateral fragment more than 8 mm in anteroposterior radiograph, anterior displacement of a fragment, or more than 20-degree angulation in lateral radiography. Thirty-three cases had a screw in the middle position and 4 of these cases (12.1%) had fixation failure. Notably, 14 cases had a screw in the posteromedial position and 6 of these cases had fixation failure (42.8%). CONCLUSION: Accurate reduction of the posteromedial fragment is essential in unstable intertrochanteric fracture and anterior displacement or angulation should be avoided to prevent fixation failure. The tip apex distance of the screw and central location of the screw in the femoral head is also an important factor.

Fixation Failure of Proximal Femoral Nail Anti-rotation in Femoral Intertrochanteric Fracture / 대한고관절학회지

PURPOSE: The aim of this study was to identify the causes of fixation failure and evaluate prophylactic methods in femoral intertrochanteric fractures treated with proximal femoral nail anti-rotation. MATERIALS AND METHODS: Between 2006 and 2010, this study evaluated 80 cases(20 men and 60 women) of femoral intertrochanteric fracture treated with proximal femoral nail anti-rotation after a minimum follow-up of 1 year. The mean age and follow-up period was 72.6 years and 2.1 years, respectively. The factors that could affect fixation failure, such as osteoporosis, fracture pattern, reduction status and position of helical blade on the femoral head, were analyzed retrospectively. RESULTS: Six cases of fixation failure were encountered: 4 cases of cut out of the helical blade, 1 case of excessive varus union and 1 case of hip joint pain due to the excessive sliding of helical blade. The reduction status and position of the helical blade on the femoral head showed a significant association with the fixation failure, and there were 2 cases of osteonecrosis of the femoral head at the latest follow-up. CONCLUSION: Fixation failure was increased significantly in the case of non-anatomical reduction or superior position of helical blade in the femoral head. Therefore, the concerns related to the precise anatomical reduction and central location of the helical blade will need to be solved to reduce fixation failure.

Factors affecting Fixation Failure in Treatment of Intertrochanteric Fracture of the Femur by Dynamic Compression Hip Screw

PURPOSE: The purpose of this study was to analyze the factors affecting fixation failures of intertrochanteric fractures of the femur treated by dynamic compression hip screw in elderly patients. MATERIALS AND METHODS: Between March 1999 and February 2005, we evaluated 164 cases of intertrochanteric fractures of the femur treated by dynamic compression hip screw. The failure group (group 1) contained 14 cases, and the control group (group 2) contained 150 cases. We compared the fracture pattern, type of reduction, method of fixation, tip-apex distance, location of screw within head, and presence of lateral trochanteric wall fracture between the two groups. The average patient age was 76.1 years (range 63-92) in group 1 and 75.0 years (range 63-93) in group 2. RESULTS: The mode of fixation failure in group 1 included 6 cases of nonunion, 5 cases of varus and cutting-out, 2 cases of excessive sliding of lag screw, and 1 case of plate debonding. There was a significant relationship between the fracture pattern, tip-apex distance, position of lag screw (especially the posterior location), and presence of lateral wall fracture when compared against postoperative fixation failure (P<0.05). The use of bone cement augmentation and the central location of lag screw within the head correlated with the avoidance of cutting-out of lag screw through the head. However, there was no relationship between the type of reduction, the use of additional fixation with a screw, or greater trochanter stabilizing plate when compared against fixation failure. CONCLUSION: The structural integrity of lateral wall support is thought to be an essential factor in successful treatment of unstable intertrochanteric fractures of the femur. Furthermore, methods such as concentric screw placement in the head, minimal tip-apex distance, and cement augmentation may be useful for preventing cutting-out through obtaining secure purchase of the lag screw in the head.

Analysis and Management of Failed Intertrochanteric Fracture Fixation

PURPOSE: We wanted to analyze the causes of fixation failure after performing compression hip screw fixation for intertrochanteric fracture and we wanted to evaluate the methods to mange this type of failure. MATERIALS AND METHODS: From January 1999 to August 2005, 15 patients who underwent operation due to fixation failure after compression hip screw fixation for intertrochanteric fracture were evaluated, with at least 1 year follow up, for the fracture type, the status of the reduction, the aspects of failure, the causes of the failure and the clinical and radiologic results after operation. RESULTS: There were 7 cases of cut out by the hip screw, 1 case of hip screw breakage, 1 case of dislodging the hip screw, 2 cases of excessive sliding of the hip screw, 2 cases of plate breakage and 2 cases of fixation loss of the plate. The failure of cases was due to incorrect choice of the implants, and that of 9 cases was due to technical error. The Harris Hip score was an average of 67.8 for 10 cases of failed arthroplasty at the last follow up and 88.4 for 4 cases of re-fixation with a 95 degree angled blade plate, and bone union was achieved at a minimum of 5 months. CONCLUSION: It is important to choose an adequate implant and a precise technique to achieve a successful result for fixation of unstable intertrochanteric fracture, and refixation with a 95 degree angled blade plate could be considered for the management of failed intertrochanteric fracture with arthroplasty.

Causes and strategies of internal fixation failure in senile fracture of tibial plateau after operation / 中国矫形外科杂志

5?,dislocation of joint,instability of screws and plates and penetration of the screws into the joint surface.[Conclusion]Incorrect preoperative evaluation of the injury severity,incorrect judgement of the fracture type,improper operation indications,improper selection of internal fixation methods,nonstandard technique of bone graft and failure to reach anatomic reduction are the main causes of internal fixation failure.

Reoperations of long bone fractures with interlocking intramedullary nails and limited open reductions / 中国矫形外科杂志

[Objective] To investigate the causes of failures of long bone fractures with internal fixations and to study the treatments and effects of reoperations of long bone fractures with inter-locking intramedullary nail and limited open reduction.[Method]Twenty-four patients of failures of long bone fractures with internal fixations were retreated with inter-locking intramedullary nail and limited open reduction.There were 15 cases of femoral fracture,7 cases of tibial fracture and 2 cases of humerus shaft fracture.Of the femoral fracture,there were 14 cases of fractures of shafts of femurs and 1 case of supracondylar fracture of femur;11 male,4 female;7 left cases,8 right cases;1 case complicated with bending of bone plate and screw,6 cases with breakages of plate;1 case with bending of common intramedullary nail,2 cases with breakages of common intramedullary nails,1 case of screw and wire lock fixation complicated with pseudoarticulation formation,4 cases with nonunion of fracture.Of the cases of tibial shaft fracture,there were 6 male,l female;3 left cases,4 righe cases;3 cases complicated with breakages of bone plate and screw,1 case with failure of external fixator,3 cases with nonunion of fracture.Of the cases of humerus shaft fracture,there were 2 cases of male and left ones;1 case complicated with breakage of bone plate and screw,1 case with breakage of common intramedullary nail.The ages of patients ranged from 18 to 68 years old with mean ages 43.7 years old.All fixation failure cases were retreated with inter-locking intramedullary nails and limited open reductions with autogenous iliac bone grafts or bone allografts.[Result]The average follow-up time was 25 months(12～35 months).All cases were cured with bone unions.Complications with submerge,breakages and bending of intramedullary nails did not occur.In the reoperating cases of femoral and filial fractures,the knee function were excellent in 18 cases,good 2 cases,fair 1 case and poor 1 case according to Karlstrom scale.Among the reoperating cases of humeral fractures,there were 1 case excellent and 1 good of shoulder function according to HAN score.[Conclusion]Reoperations with inter-locking intramedullary nail and limited open reduction are effective methods for treatment of internal fixation failure of long bone fracture.

Fixation Failure of LCP during the Treatment of Proximal Humerus Fractures

PURPOSE: To evaluate the causative factors in the catastrophic failure of LCP in the proximal humerus fracture. MATERIALS AND METHODS: Six patients (6 cases) were collected between October 2003 and July 2005. The mean age was 55.6 years (range: 38~70). The cause of injury was road traffic accident in four, fall down in one and slip down in one. According to the Neer classification, four were 2 part fractures, each one in 3 part fracture and 4 part fracture. RESULTS: Fixation failure occurred due to back-out of the plate and screw in five and plate breakage in one. Analysis of the preoperative radiographs revealed medial cortical defect in all and no bone graft and tension band wiring in the greater tuberosity fragment were carried out. Postoperative radiographs showed the anatomical reduction in three and non-anatomical in three. CONCLUSION: Non-anatomical reduction, insufficient medial bony buttress, inadequate screw length to the head and the neglect for the greater tuberosity fragment were the contributing factors to the failure of LCP. Knowledge of these factors will enable the surgeon to avoid failure of the LCP. Augmentation fixation and bone graft procedures with careful preoperative planning are necessary for successful fixation of LCP.

Analysis of Affecting Factors of Fixation Failure of Femoral Neck Fractures Using Internal Fixation

PURPOSE: To evaluate the factors which influence on the fixation failure after internal fixation using multiple cannulated screws in the patients with femoral neck fracture. MATERIALS AND METHODS: Ninty-six patients (male: 63, female: 33) who underwent closed reduction and internal fixation of femoral neck fracture between Feb. 1994 and Jun. 2002 with use of multiple cannulated screws. The mean age was 68 years (17~90) and mean follow-up period was average 50 months (36 months~6 years). The fixation failure was defined by change in fracture position above 10 mm, change in each screws position above 5%, backing above 20 mm, or perforation of the head, respectively. They were evaluated with the age, gender, fracture type, accuracy of reduction, placement of screws, posterior comminution and also studied the risk factors which influenced nonunion and the development of avascular necrosis. RESULTS: Twenty-four patients out of 96 patients had radiographic signs of fixation failure. The incidence of nonunion in the fixation failure group was 41% (10/24) and AVN was 33% (8/24). There were statistically significant correlations between fixation failure and nonunion and that posterior comminution, poor reduction and improper placement of the screws were the major factors contributing to nonunion. CONCLUSION: In case of femoral neck fracture of internal fixation using multiple cannulated screws, posterior comminution, poor reduction and improper placement of the screws were the major factors contributing to nonunion and fixation failure.

Fixation Failure of Unstable Intertrochanteric Fracture of the Femur Using Compression Hip Screw

PURPOSE: To investigate the factors which influence on the fixation failure after the compression hip screw fixation for unstable intertrochanteric fractures. MATERIALS AND METHODS: Eighty-two patients of unstable intertrochanteric fracture of A2 and A3 type who had underwent operation with compression hip screw were evaluated at least 1 year follow-up in regard to the age, degree of osteoporosis, fracture type, diastasis of fragment, sliding of lag screw, position of lag screw and status of reduction. RESULTS: 73 patients out of 82 patients had the union and 9 patients showed fixation failure. The results of fixation failure were 6 cases of migration of lag screw and 3 cases of cut-out of lag screw. There were statistically significant correlations between fixation failure and A2.3 and A3 type. The fixation failure group showed increased medial migration of medial cortex of proximal and distal fragment, which is significantly correlated with fixation failure. There were little statistical significant correlations between age, degree of osteoporosis, status of reduction, position of lag screw, sliding of lag screw and fixation failure. CONCLUSION: Another alternative fixation method and technique have to be considered for unstable A2-3 or A3 type because compression hip screw fixation only is very insufficient with high failure rate.

Analysis of the failed internal fixations for thoracolumbar fractures / 中华创伤骨科杂志

Objective To discuss the common causes for postoperative complications after treatment of spinal fractures and their preventive measures.Methods To analyze the 32 failed eases who received internal fixation for their thoracolumbar fractures between July 1998 and April 2005 in our department.Their preoperative and postoperative results of X-ray,CT and MIR examinations were reviewed to find out the causes for failure.Three of them were treated through anterior approach and 29 through posterior approach.Eighteen screws broke in eight eases, the rods got loosened in eight cases and broken in four cases,15 pedicte screws were mis-located in eight cases and the implants got loosened in three cases.Results Thirty patients had to get a reoperation.Two were cured through non-surgical treatment.The causes for failure were found to be as follows:1,incorrect operation approach;2,in- stability of the front-middle colunm;3,unskillful operation;4,ignorance or the lesion to the adjacent vertebral discs; 5,flaws in pedicle screw design.Conclusion To prevent postoperative complications after internal fixation for spinal fractures,surgeons should strictly stick to the indications before operation,choose a proper approach and method for internal fixation,try to stabilize the front-middle column by the first intention,and have a good command of anatomy and operation skills.

Fixation Failure after internal Fixation in Intertrochanteric Fractures / 대한정형외과학회잡지

Fixation failure is a major complication of intertrochanteric fracture. The causes of fixation failure were assessed in a series of 80 patients with intertrochanteric fractures, which had been internally fixed with either a sliding hip screw or a Gamma interlocking nail. The overall rate of fixation failure was 16.3%, in which the cutting-out of the implant from the femoral head was the only cause of the instance. The cutting-out rate was influenced by the accuracy of fracture reduction, the position of implant placement within the femoral head, and the bone mineral density. Anatomical reduction and the central placement of implant within the femoral head showed the most excellent results compared to other treatment modalities. Age, gender, fracture type and a kind of fixation implant had no significant effect. Our results showed that the intertrochanteric fractures should be reduced as anatomically as possible and it is essential that the central placement of the implant within the femoral head be obtained.