PMD49 MECHANICAL COMPLICATIONS ASSOCIATED WITH INTRAMEDULLARY NAILING FOR TROCHANTERIC, INTERTROCHANTERIC AND SUBTROCHANTERIC FEMUR FRACTURES

Background: 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.Methods: 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.Results: 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.Conclusions: 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.

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Second Generation Intramedullary Nailing of Subtrochanteric Femur Fractures: A Biomechanical Study of Fracture Site Motion

Journal of Orthopaedic Trauma ◽

10.1097/00005131-200204000-00003 ◽

2002 ◽

Vol 16 (4) ◽

pp. 231-238 ◽

Cited By ~ 60

Author(s):

Craig S. Roberts ◽

Akbar Nawab ◽

Mei Wang ◽

Michael J. Voor ◽

David Seligson

Keyword(s):

Intramedullary Nailing ◽

Second Generation ◽

Fracture Site ◽

Biomechanical Study ◽

Femur Fractures ◽

Subtrochanteric Femur Fractures

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Reosteosintezių po šlaunikaulio diafizės lūžių analizė

Lietuvos chirurgija ◽

10.15388/lietchirur.2011.1.2091 ◽

2011 ◽

Vol 9 (1-2) ◽

pp. 0-0

Author(s):

Andrius Vaitiekus ◽

Mykolas Liubauskas ◽

Igoris Šatkauskas

Keyword(s):

Intramedullary Nailing ◽

Intramedullary Nail ◽

Dynamic Compression ◽

Femoral Shaft ◽

Femoral Diaphysis ◽

Emergency Hospital ◽

Mechanical Complications ◽

Femur Fractures ◽

Vilnius University ◽

Medical Histories

Andrius Vaitiekus, Mykolas Liubauskas, Igoris Šatkauskas Vilniaus universiteto Reumatologijos, traumatologijos-ortopedijos ir rekonstrukcinės chirurgijos klinika, Ortopedijos ir traumatologijos centras, Vilniaus greitosios pagalbos universitetinė ligoninė, Šiltnamių g. 29, LT-04130 VilniusEl. paštas: [email protected] Tikslas: Nustatyti reosteosintezių dažnį ir priežastis po šlaunikaulio diafizės vidurinio trečdalio osteosintezių. Ligoniai ir metodai: Retrospektyviai išanalizuotos 237 pirminės šlaunikaulių osteosintezės Vilniaus universitetinės greitosios pagalbos ligoninės (VGPUL) Ortopedijos ir traumatologijos centre nuo 2003 iki 2010 metų. Į galutinę analizę įtrauktos 229 osteosintezės. Visi ligoniai pagal taikytą osteosintezės metodą suskirstyti į grupes: osteosintezė DCP plokštele, intramedulinė osteosintezė vinimi (IMV) ir išorinė fiksacija AO aparatu (IF). Ieškota reosteosintezės priežasčių: mechaninių komplikacijų, pseudoartrozės, supūliavimo. Rezultatai: Pagal AO (32) klasifikacija A tipo lūžis diagnozuotas 133 (56,1 %) pacientams, B tipo – 67 (28,3 %), C tipo – 37 (15,6 %). DCP grupėje iš 150 pacientų 29 (19,3 %) peroperuoti dėl mechaninių komplikacijų, 17 (11,3 %) – dėl pseudoartrozės ir 4 (2,6 %) – dėl supūliavimo. IMV grupėje iš 52 operuotųjų nė vienas neperoperuotas dėl mechaninių komplikacijų, 3 (5,8 %) peroperuoti dėl pseudoartrozės ir 1 (1,9 %) – dėl supūliavimo. IF grupėje iš 27 operuotųjų 7 (26 %) peroperuoti dėl mechaninių komplikacijų, 10 (27 %) – dėl pseudoartrozės ir 10 (27 %) – dėl supūliavimo. Išvados: Osteosintezė intrameduline vinimi yra pranašesnis metodas už osteosintezę plokštele, nes pastarojoje grupėje reosteosintezių dažnis buvo didesnis. Rekomenduojame, jei įmanoma, šlaunikaulio diafizės lūžius gydyti osteosinteze intrameduline vinimi. Reikšminiai žodžiai: reosteosintezė plokštele, intramedulinė fiksacija, šlaunikaulio osteosintezės plokštele komplikacijos, pseudoartrozės. The analysis of reosteosynthesis after diaphyseal femur fractures Andrius Vaitiekus, Mykolas Liubauskas, Igoris Šatkauskas Vilnius Universitety, Clinic of Reumatology, Traumatology-Orthopedics and Reconstructive Surgery, Orthopedics and Traumatolgy Centre, Vilnius University Emergency Hospital,Šiltnamių Str. 29, LT-04130 Vilnius, LithuaniaE-mail: [email protected] Objective: To evaluate the rate of and reasons for reosteosynthesis after osteosynthesis of the middle third of the femoral diaphysis. Materials and Methods: Retrospectively, 237 medical histories of patients with diaphyseal femur fractures, who underwent primary femoral osteosynthesis in the Centre of Traumatology and Orthopaedics of the Vilnius University Emergency Hospital in 2003–2010 were analyzed; 229 osteosyntheses were enrolled into the final study. All patients, by the osteosynthesis method, were grouped into three groups: osteosynthesis with Dynamic Compression Plate (DCP), intramedullary nailing (IMN), and AO external fixation apparatus (EF). These groups were investigated for the reasons of reosteosynthesis (pseudarthrosis, mechanical complications, suppuration). Results: A fracture type (by AO classification) was diagnosed to 133 (56.1%), B type – 67 (28.3%), and C type to 37 patients (15.6%).In first group (DCP) there were 150 cases of osteosynthesis, from which 29 (19.3%) were reoperated on because of mechanical complications, 17 (11.3%) because of pseudarthrosis, and 4 (2.6%) because of suppuration. In the second group, there were 52 IM nailing cases, from which none were reoperated because of mechanical complications, altthough 3 (5.8%) had to be reoperated because of pseudarthrosis and one (1.9%) because of suppuration. In the third group, there were 27 external fixations of which 7 (26%), 10 (27%) and 10 (27%) were reoperated on because of mechanical complications, pseudarthrosis and suppuration, respectively. Conclusions: Osteosynthesis with intramedullary nail is a superior method to internal fixation with DCP, because the rate of reosteosynthesis after intramedullary nailing was lower. We recommend, when possible, to perform osteosynthesis with intramedullary nail for the treatment of diaphyseal femur fractures. Keywords: DCP plating, femoral shaft intramedullary nailing, femur plating complications, pseudoarthrosis.

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