Minimally invasive clamp-assisted reduction and cephalomedullary nailing without cerclage cables for subtrochanteric femur fractures in the elderly: Surgical technique and results

Injury ◽  
2015 ◽  
Vol 46 (6) ◽  
pp. 1036-1041 ◽  
Author(s):  
Juan Mingo-Robinet ◽  
Miguel Torres-Torres ◽  
María Moreno-Barrero ◽  
Juan Antonio Alonso ◽  
Sara García-González
Keyword(s):  
Surgical Technique ◽  
Minimally Invasive ◽  
The Elderly ◽  
Femur Fractures ◽  
Cephalomedullary Nailing ◽  
Subtrochanteric Femur Fractures

scholarly journals Evaluation of outcome following clamp assisted mini open reduction and internal fixation with intramedullary nailing of subtrochanteric femoral fractures

2019 ◽  
Vol 5 (6) ◽  
pp. 1126
Author(s):  
Chirag G. Prajapati ◽  
Rasik B. Dabhi ◽  
Nikunj D. Maru
Keyword(s):  
Intramedullary Nailing ◽  
Femoral Fractures ◽  
The Elderly ◽  
High Energy ◽  
High Rate ◽  
Excellent Outcome ◽  
Subtrochanteric Fractures ◽  
Femur Fractures ◽  
Subtrochanteric Femur Fractures

<p class="abstract"><strong>Background:</strong> Subtrochanteric fractures of the proximal femur have been defined as the fractures extending from lesser trochanter distally for 5 cm. These fractures usually occur in two age distributions. In the elderly osteopenic population resulting from trivial trauma as fall from standing height or in the younger ones as a result of high energy trauma. Incidence has been on the rise and they comprise about 7 to 10% hip fractures and could lead quickly to large amount of blood loss and other complications.</p><p class="abstract"><strong>Methods:</strong> This is a multicentric prospective prognostic study level 1 consisting of 25 patients admitted in government civil hospital, Ahmedabad during April 2013 to May 2015 having high subtrochanteric femur fractures treated by clamp assisted reduction and intramedullary nailing. Out of these, 20 patients (80%) came for final follow up with average follow up of 11.5 months and evaluated for union, complication and functional outcome.<strong></strong></p><p class="abstract"><strong>Results:</strong> In our study final outcome is assessed based on hip outcome score (modified) based on which 85% had excellent outcome, 10% had good outcome and 5% had fair outcome with none of the patient having poor outcome.</p><p><strong>Conclusions:</strong> We found that clamp-assisted reduction and intramedullary nail fixation provides excellent reduction quality, high rate of fracture union, with no apparent increase in complications in subtrochanteric fractures of the femur. </p>

scholarly journals Hip Fracture Nonunions: Diagnosis, Treatment, and Special Considerations in Elderly Patients

2018 ◽  
Vol 2018 ◽  
pp. 1-11 ◽  
Author(s):  
Sharon Babcock ◽  
James F. Kellam
Keyword(s):  
Hip Fracture ◽  
Internal Fixation ◽  
Hip Fractures ◽  
The Elderly ◽  
The United States ◽  
Systematic Assessment ◽  
Femur Fractures ◽  
Increased Risk ◽  
Similar Patient ◽  
Subtrochanteric Femur Fractures

In the United States, more than 300,000 hip fractures occur annually in the elderly population with associated significant morbidity and mortality. Both intracapsular and extracapsular hip fractures have inherent treatment challenges and therefore are at risk of nonunion complications. A systematic assessment including radiographic, metabolic, and infectious evaluations should be completed for all patients suspected of nonunion. Failed internal fixation of intracapsular hip fractures is typically treated with arthroplasty, while extracapsular proximal femur nonunions may be amenable to revision internal fixation or arthroplasty. While not a classic hip fracture, bisphosphate associated subtrochanteric femur fractures affect a similar patient population and are historically difficult to treat. Atypical subtrochanteric femur fractures are at increased risk of nonunion given the altered biologic environment secondary to bisphosphonate use; therefore adjuvant therapies may be beneficial in setting of revision fixation. Having a thorough understanding of nonunion risks, recognition, evaluation, and treatment is necessary for appropriate patient care.

Healing of Atypical Subtrochanteric Femur Fractures After Cephalomedullary Nailing

2017 ◽  
Vol 31 (3) ◽  
pp. 138-145 ◽  
Author(s):  
Jae-Woo Cho ◽  
Chang-Wug Oh ◽  
Frankie Leung ◽  
Ki-Chul Park ◽  
Merng Koon Wong ◽  
...  
Keyword(s):  
Femur Fractures ◽  
Cephalomedullary Nailing ◽  
Subtrochanteric Femur Fractures

Complication Rate after Radical Cystectomy Depends on the Surgical Technique and Patient’s Clinical Status

2021 ◽  
pp. 1-8
Author(s):  
Przemysław Adamczyk ◽  
Paweł Pobłocki ◽  
Mateusz Kadlubowski ◽  
Adam Ostrowski ◽  
Witold Mikołajczak ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Minimally Invasive ◽  
Radical Cystectomy ◽  
Urinary Diversion ◽  
Complication Rate ◽  
Tnm Stage ◽  
Complication Rates ◽  
Open Approach ◽  
Invasive Approach ◽  
Asa Score

<b><i>Purpose:</i></b> This study aimed to explore the complication rates of radical cystectomy in patients with muscle-invasive bladder cancer and identify potential risk factors. <b><i>Methods:</i></b> A total of 553 patients were included: 131 were operated on via an open approach (ORC), 242 patients via a laparoscopic method (LRC), and 180 by a robot-assisted procedure (RARC). Patient age, gender, American Society of Anesthesiologists (ASA) score, urinary diversion type, preoperative albumin level, body mass index (BMI), pathological (TNM) stage, and surgical times were collected. The severity of complications was classified according to the Clavien-Dindo scale (Grades 1–5). <b><i>Results:</i></b> The surgical technique was significantly related to the number of complications (<i>p</i> &#x3c; 0.00005). Grade 1 complications were observed most frequently following LRC (52.5%) and RARC (51.1%), whereas mostly Grade 2 complications were detected after ORC (78.6%). Those with less severe complications had significantly higher albumin levels than those with more severe complications (<i>p</i> &#x3c; 0.05). Patients with an elevated BMI had fewer complications if a minimally invasive approach was used rather than ORC. The patient’s general condition (ASA score) did not impact the number of complications, and urinary diversion type did not affect the severity of the complications. Mean surgical time differed according to the urinary diversion type in patients with a similar TNM stage (<i>p</i> &#x3c; 0.005); however, no difference was found in those with more locally advanced disease. Longer operation time and lower protein concentration were associated with higher probability of complication rate, that is, Clavien-Dindo score 3–5. <b><i>Conclusions:</i></b> The risk of complications after RC is not related to the type of urinary diversion, and can be reduced by using a minimally invasive surgical technique, especially in patients with high BMI.

scholarly journals Treatment of Intertrochanteric Femur Fractures with Hip Arthroplasty in Older Patients: A Narrative Review of Indications and Outcomes

Medicina ◽  
2021 ◽  
Vol 57 (8) ◽  
pp. 763
Author(s):  
Tiago Martinho ◽  
Karl Stoffel
Keyword(s):  
High Risk ◽  
Surgical Technique ◽  
Internal Fixation ◽  
Functional Outcome ◽  
Hip Arthroplasty ◽  
Older Patients ◽  
Bipolar Hemiarthroplasty ◽  
Intramedullary Nails ◽  
Fixation Failure ◽  
Femur Fractures

Intertrochanteric femur fractures are common in older patients and often have a significant impact on disability. The treatment aims to achieve a rapid return to the prior functional level with a low rate of complications and mortality. Surgical management by internal fixation is the mainstay of treatment for most of these fractures. Even when treated with intramedullary nails, the overall complication rates are high, especially for unstable or highly comminuted fractures or in the presence of poor bone quality. Hip arthroplasty is an alternative in older patients with intertrochanteric femur fractures at high risk of fixation failure or with concomitant intraarticular pathologies. Especially patients whose condition precludes prolonged bedrest and who are at risk of significant deterioration if their locomotor function cannot be restored rapidly are likely to benefit from hip arthroplasty. The choice of the surgical technique mainly depends on the surgeon’s preferences and the fracture characteristics. Bipolar hemiarthroplasty is the most common type of prosthesis used with primary or revision femoral stems. Compared with intramedullary nails, hip arthroplasty has a better early functional outcome and lower rates of surgical complications as well as reoperations. However, the functional outcome and the mortality rate in the longer term tend to favor intramedullary nails, even though the results are inconsistent, and a statistically significant difference cannot always be obtained. Currently, there are no guidelines that define the role of hip arthroplasty in the treatment of intertrochanteric femur fractures in older patients. The literature only offers an overview of the possibilities of the usage of hip arthroplasty, but methodological limitations are common, and evidence levels are low. Further studies are needed to identify the intertrochanteric fractures that are at high risk of internal fixation failure, the characteristics that determine which patients may benefit most from hip arthroplasty, and the optimal surgical technique.

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