Clinical Outcomes of Intermediate-Length Cephalomedullary Nails for Intertrochanteric Femur Fracture Repair in Older Adults

Introduction. Hip fracture is a major cause of morbidity and mortality in older adults. Intertrochanteric hip fractures often are treated surgically using cephalomedullary nails (CMN), in either a short or long length. Their outcomes are documented in the literature; however, outcomes of the intermediate-length CMN have not been well described. Methods. A retrospective review was conducted of older adults with intertrochanteric hip fractures that were treated with cephalomedullary nail fixation using an intermediate-length (235 mm Synthes Trochanteric Fixation® nail or 240 mm Stryker Gamma 3®) nail. Outcome data were collected during the inpatient stay and 16 months post-operatively. Results. Seventy-seven patients met inclusion criteria and were reviewed during inpatient stay; however, only 42 had documented post-operative outcomes. Of those, two patients died post-discharge and were not included in the 16-month follow-up. Comparison of results to published literature suggested that intermediate-length nails are comparable to short-length nails with regard to time in the operating room and estimated blood loss. The rate of blood transfusion was lower and length of hospital stay was shorter than in comparable studies of both short- and long-length nails. There were no post-operative periprosthetic fractures in the 16-month follow-up. This rate was lower than published rates for short and long nails. The hardware failure rate (3/42, 7.1%) of intermediate-length nails was higher than comparison studies of both short- and long-length nails. Conclusions. Patient outcomes for intermediate-length nails were similar to outcomes of shorter length nails. Utilization of the intermediate-length nail appears to be an effective treatment option for repair of intertrochanteric femur fractures. However, direct comparison is difficult since periprosthetic fracture rate may increase over time and nail length and hardware failure are not defined consistently in the literature. Further study is needed with a larger sample size followed over a longer period of time to confirm our findings.

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Role of cephalomedullary nail in proximal femur fractures

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20173154 ◽

2017 ◽

Vol 3 (5) ◽

pp. 929

Author(s):

Nishant Kumar ◽

Dhruv Sharma ◽

Kuljit Kumar

Keyword(s):

Hip Fractures ◽

Proximal Femur ◽

Femoral Fractures ◽

Public Health Problem ◽

Major Public Health Problem ◽

Cephalomedullary Nail ◽

Proximal Femur Fractures ◽

Femur Fractures ◽

Bending Loads ◽

Cephalomedullary Nails

Background: Hip fractures are recognized to be a major public health problem. Key determinants of hip fractures include age, osteoporosis, and falls. In these determinants socioeconomic status, have not been well explored. Under eccentric loading, high bending loads occur, leading to failure of the osteosynthetis anchorage at the center of the femoral head.The introduction of the reconstruction nail has broadened the indications for the intramedullary fixation of difficult femoral fractures. The operative technique is however complicated. Some technical difficulties encountered during its use are presented together with guidance to allow these problems to be avoided.Methods: This Study had included 47 cases which were operated by single surgeon and use of different implant (cephalomedullary nail) was randomized irrespective of fracture types and pattern. This study was done over a period of 12 months (October 2013 to October 2014) with 1 month, 3 months, 6 months, 12 months follow up. At every visit patient were assessed as per Oxford hip score. Type of implant used was PFNA, Intertan, Sirus Nail.Results: The mean age of the patients was 65.68 (±13.55) years. Severe pain was observed among majority of the patients at one month (70.2%) which became mild (40.4%) and moderate (34%) at 3 months. Very mild pain was found in 36.2% patients at 6 months and in 61.7% at 12 months. The limping was all the time among all the patients at one month. However, the limping was found often in 46.8% at 3 months and sometimes in 57.4% at 6 months and 53.2% at 12 months. The hip score was found to be severe among all the patients at one month. However, moderate to severe hip was in 46.8% patients at 3 months, mild to moderate was in 57.4% at 6 months and satisfactory joint function was in 68.1% at 12 months. The comparison of Hip score according to long or short nail at one 3, 6 and 12 months showed no difference. Conclusions: Cephalomedullary nails with adequate technique so that the lag screws by purchase in the centre-centre or posterior-inferior quadrant combines the benefit of sliding hip screw as well as intramedullary implants. So we recommend the use of cephalomedullary nails in proximal femur fractures especially the unstable fractures.

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Submuscular plates versus flexible nails in preadolescent diaphyseal femur fractures

Journal of Children s Orthopaedics ◽

10.1302/1863-2548.12.180036 ◽

2018 ◽

Vol 12 (5) ◽

pp. 488-492 ◽

Cited By ~ 2

Author(s):

L.-K. Chen ◽

B. T. Sullivan ◽

P. D. Sponseller

Keyword(s):

Operative Time ◽

Length Of Hospital Stay ◽

Surgical Site Infections ◽

Patient Characteristics ◽

Level Of Evidence ◽

Femur Fractures ◽

Estimated Blood Loss ◽

Postoperative Length ◽

Flexible Nails

Purpose To compare patient characteristics, operative time, estimated blood loss (EBL), postoperative length of hospital stay (LOS) and complications after insertion and removal of submuscular plates (SMPs) versus flexible nails (FNs) for paediatric diaphyseal femur fractures. Methods We reviewed records of 58 children (mean age, 7.7 years SD 2.0) with diaphyseal femur fractures who underwent treatment with SMPs (n = 30) or FNs (n = 28) from 2005 to 2017 (mean follow-up, 22 months SD 28). Patients with pathological fractures or musculoskeletal comorbidities were excluded. Alpha = 0.05. Results Insertion of FNs was associated with shorter operative time (ß = –24 mins) and less EBL (ß = –38 mL) (both, p < 0.001) compared with insertion of SMPs, after adjusting for fracture type and time from beginning of study period. Removal of FNs was also associated with shorter operative time (ß = –15 min) compared with removal of SMPs (p < 0.001). EBL during removal was similar between groups (p = 0.080). The FN group had a shorter LOS after insertion (ß = –0.2 d) compared with the SMP group (p = 0.032). Four patients treated with SMPs and three treated with FNs developed surgical site infections. Two patients treated with SMPs and seven treated with FNs experienced implant irritation that resolved with removal. No other complications occurred. Conclusion Compared with SMPs, FNs were associated with shorter operative time (for insertion and removal), less EBL (for insertion) and shorter post-insertion LOS in patients with diaphyseal femur fractures. Level of Evidence: III

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Outcomes of Proximal Femoral Locking-plate Fixation for Pathological Fractures of the Proximal Femur

Siriraj Medical Journal ◽

10.33192/smj.2021.78 ◽

2021 ◽

Vol 73 (9) ◽

pp. 603-608

Author(s):

Kongkhet Riansuwan ◽

Somkiat Jivasomboonkul ◽

Rapin Phimolsarnti ◽

Chandhanarat Chandhanayingyong ◽

Apichat Asavamongkolkul

Keyword(s):

Proximal Femur ◽

Locking Plate ◽

Plate Fixation ◽

Clinical Results ◽

Assistive Device ◽

Locking Plate Fixation ◽

Pathological Fractures ◽

Hardware Failure ◽

Estimated Blood Loss

Objective: To study the treatment outcomes of proximal femoral locking-plate fixation of pathological fractures ofthe proximal femur relative to clinical results, implant failure, and surgical complications.Materials and Methods: From 2007 to 2018, 17 patients (18 femurs) with a diagnosis of impending or existingpathological fracture of the proximal femur were treated with proximal femoral locking-plate fixation. Data collectedincluded operative duration, estimated blood loss, ambulatory status, hardware failure events, and postoperativecomplications.Results: Of the 18 femurs that were included, 13 were existing pathological fractures and 5 were impending fractures.The mean age of patients was 53.7 years (range: 28-89), and 12 of them were female. The mean follow-up was 11.3months (range: 1-67). Ten of 17 patients (62.5%) had progressive lung disease from pulmonary metastasis or fromlung primary. No patient developed oxygen desaturation or cardiac arrest during the intraoperative or postoperativeperiod. Thirteen of 17 patients (76.5%) could walk with or without an assistive device at the time of final follow-up.Two patients required close postoperative monitoring in the intensive care unit due to poor preoperative status,and both of those patients died within one month after surgery from other medical problems. No hardware failureoccurred.Conclusion: For pathological fracture of the proximal femur, proximal femoral locking-plate fixation is a treatmentoption that results in fewer perioperative and postoperative cardiopulmonary events and surgical complications.Most patients can ambulate with or without an assistive device at the final follow-up.

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Calcaneal BMD Obtained by Dual X-Ray and Laser Predicts Future Hip Fractures—A Prospective Study on 4 398 Swedish Women

Journal of Osteoporosis ◽

10.4061/2010/875647 ◽

2010 ◽

Vol 2010 ◽

pp. 1-6 ◽

Cited By ~ 9

Author(s):

Torkel B. Brismar ◽

Imre Janszky ◽

L. I. M. Toft

Keyword(s):

Hip Fracture ◽

Hip Fractures ◽

Area Under Curve ◽

Fracture Rate ◽

X Ray ◽

T Score ◽

National Patient Register ◽

National Patient ◽

A Prospective Study

The predictive value of dual X-ray and laser (DXL) calcaneal BMD (BMDDXL) on hip fractures was prospectively studied in 4,398 females aged 55 to 99 years. The average follow-up period was 3 years and 11 months with a total of 17,270 person years. Fractures were identified from the national patient register. After inclusion, 130 females sustained a hip fracture. The age adjusted hazard ratio for T-score <−2.5 versus >−2.5 was 2.64. Of all patients who sustained a hip fracture 78% had a T-score of −2.5 or below. The annual hip fracture rate was 0.26% at T-scores ≥−2, but 1.5% at T-scores ≤−2.5. The area under curve for the model including calcanealBMDDXL, follow-up time, and age to prospectively predict hip fractures was 0.84.Conclusions. CalcanealBMDDXLobtained by DXL Calscan predicts hip fractures and may therefore be suitable for diagnosing osteoporosis and for predicting fracture risk.

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The pre-loaded set-screw in InterTAN nail: should it be tightened or not tightened in pertrochanteric hip fractures

10.21203/rs.3.rs-56746/v1 ◽

2020 ◽

Author(s):

Shou-Chao Du ◽

Xiu-Hui Wang ◽

Shi-Min Chang

Keyword(s):

Femoral Neck ◽

Hip Fractures ◽

Cephalomedullary Nail ◽

Compression Screw ◽

Femur Fractures ◽

Fracture Nonunion ◽

Pertrochanteric Femur Fractures ◽

Walking Stick ◽

Intertan Nail

Abstract Background: InterTan is a specific type of cephalomedullary nail with a twin interlocking de-rotation and compression screw, which has inherent ability of anti-rotation. Whether to tighten or not to tighten the preloaded setscrew in InterTan nail is controversial in clinical practice.Methods: We retrospectively collected four nonunion cases of unstable pertrochanteric femur fractures (AO/OTA-31A2), all were treated with InterTan nail and the preloaded setscrew was tightened in order to prevent further sliding and femoral neck shortening. Results: After 6 months to 2 years follow-up, the fractures showed nonunion in radiography and the patients complained slight to middle degrees of pain, and had to use walking stick assistant in activities of daily life. Tightening the pre-loaded setscrew to prevent postoperative secondary sliding as static constructs might keep the femoral neck length, but lose the opportunity of telescoping for fracture impaction, and take the risk of healing complications, such as fracture nonunion, femoral head cutout or nail breakage.Conclusions: As the harm outweighs benefit, we advocate the preloaded setscrew in InterTan nail should not be tightened in pertrochanteric hip fractures (AO/OTA-31A1 and A2).

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Fracture liaison services: do they reduce fracture rates?

Therapeutic Advances in Musculoskeletal Disease ◽

10.1177/1759720x17706464 ◽

2017 ◽

Vol 9 (7) ◽

pp. 157-164 ◽

Cited By ~ 12

Author(s):

Irma J. A. de Bruin ◽

Caroline E. Wyers ◽

Joop P. W. van den Bergh ◽

Piet P. M. M. Geusens

Keyword(s):

Fracture Risk ◽

Hip Fractures ◽

Fracture Prevention ◽

Fracture Liaison Service ◽

Fracture Rate ◽

Secondary Fracture ◽

Subsequent Fracture ◽

Significant Difference ◽

Fracture Liaison

The fracture liaison service (FLS) care is considered the most appropriate organizational approach for secondary fracture prevention. We performed a literature search to evaluate to what extent the introduction of a FLS reduced subsequent fracture rates. We identified five studies that compared subsequent fracture rates. These studies varied in study design, proportion of women, baseline and subsequent fracture type [vertebral fracture (VF), non-VF (NVF) or hip fractures], duration of follow-up, response rates of attending the FLS, as well as variables included in adjusted analyses (age, sex, baseline fracture, time dependency). In two studies comparing hospitals with and without a FLS, the adjusted hazard ratio (HR) for subsequent fractures was significantly lower in the FLS hospitals (HR: 0.84 during the first year, 0.44 during the second year for subsequent NVFs after baseline NVF, and 0.67 during the third year for subsequent VFs + NVFs after baseline VFs + NVFs). When comparing fracture rates before (pre-FLS) and after (post-FLS) introduction of a FLS, the adjusted HR for subsequent NVFs after baseline NVF was significantly lower in the post-FLS group after 2 years in one study (HR = 0.65) and nonsignificant in another study for subsequent hip fractures after baseline hip fracture. One study comparing pre-FLS and post-FLS with a follow-up of less than a year did not demonstrate a significant difference in subsequent fracture risk. In conclusion, only five FLS studies with heterogeneous study designs are available, three of them reported a lower subsequent fracture rate related to FLS care. Larger and long-term studies will be needed to further quantify the effect of FLS care on subsequent fracture risk.

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Effect of fractures on overall survival in cancer patients: The NHANES database.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e23024 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e23024-e23024

Author(s):

Beatrice Jara-Almonte Edwards ◽

Xiaotao Zhang

Keyword(s):

Older Adults ◽

Overall Survival ◽

Cancer Patients ◽

Solid Tumors ◽

Hip Fractures ◽

Functional Impairment ◽

Hematologic Malignancies ◽

Spine Fractures ◽

Increased Risk

e23024 Background: Fractures are a significant cause of morbidity, institutionalization and mortality in older adults who are cancer-free. We evaluated the effect of fractures on overall survival in older patients with cancer. Methods: The National Health and Nutrition Study (NHANES) assessed the health and nutritional status of the U.S. The NHANES database is publicly available, and this study was exempt from approval by an institutional review board. All participants provided informed consents both before the interview and examination stages. A total of 62,160 individuals participated in NHANES during 1999-2010. We restricted our analyses to older adults (65 years of age and older) with self-reported cancer diagnosis, with a follow-up till 2011. Results: In total, 1,718 older adults with cancer and with available follow up were included for final analysis. There were 303 participants with fractures (17.6%) and 581 deaths (33.8%) that occurred over a median follow up 4.3 years (range 0.1-12.8 years). Mean age was 74.8 ± 0.2, with females 49.6%. Cancer types included solid tumors and hematologic malignancies. Among solid tumors, colorectal 9.0%, breast cancer 17.4%, prostate cancer 17.7%, lung 3.0%. Among hematologic malignancies, lymphoma 1.6%, myeloma 7.2%, CLL 1.2%. Hip fractures were associated with advanced age, obesity, diabetes, stroke, functional impairment, and mortality. Spine fractures were associated with advanced age, cardiovascular disease, functional impairment and mortality. Univariate analysis for factors associated with overall survival in older adults in NHANES revealed an increased risk with spine fractures H.R. = 1.89, (95% CI 1.11, 3.2, p = 0.02) and hip fractures H.R. = 2.66, (95% CI 1.41, 5.02, p < 0.01). Conclusions: In older cancer patients vertebral and hip fractures were associated with an increased risk for mortality.

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What Are the Factors Contributing to the Delay in Hip Fracture Repair?

10.28971/532017pk82 ◽

2017 ◽

Author(s):

Karen Padraic

Keyword(s):

Older Adults ◽

Hip Fracture ◽

Hip Fractures ◽

Fracture Repair ◽

Early Surgery ◽

Patient Specific ◽

Critical Element ◽

Improvement Project ◽

Surgery Patient ◽

Specific Barriers

Hip fracture injuries are identified as one of the most serious healthcare problems affecting older adults (CDC). The prognosis after hip fracture is unfavorable and approximately 25% of elderly patients will die within one year after the event. Surgical repair is a critical element in the management of a hip fracture. Delay of surgery prolongs hospital stay and increases the risk of medical complications. Despite evidence showing early time to surgery reduces morbidity and mortality for patients with hip fractures, time delays to surgery still exist. The purpose of this quality improvement project was to explore patient- and hospital-specific barriers to early surgery for older adults with hip fractures in a community hospital. Kathleen Stevens’ ACE Star Model was used as a conceptual framework to guide this project. A retrospective chart review was conducted with a total of 62 charts consisting of 55 females and 8 males who experienced a hip fracture. Data collected included age, gender, time from emergency room arrival to admission, time from admission to operative intervention, current medications on admission, current use of tobacco and alcohol, type of surgical intervention, and length of stay. Average length of time from admission to surgery was 29 hours. Eight charts were identified with a delay of greater than 48 hours to surgery. Patient-specific barriers were identified. Further research is indicated to determine hospital-specific barriers to early surgery.

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The Pre-Loaded Set-Screw in InterTAN Nail: Should It Be Tightened or Not Tightened in Pertrochanteric Hip Fractures

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/2151459321990640 ◽

2021 ◽

Vol 12 ◽

pp. 215145932199064

Author(s):

Shou-Chao Du ◽

Xiu-Hui Wang ◽

Shi-Min Chang

Keyword(s):

Femoral Neck ◽

Hip Fractures ◽

Cephalomedullary Nail ◽

Compression Screw ◽

Femur Fractures ◽

Fracture Nonunion ◽

Pertrochanteric Femur Fractures ◽

Walking Stick ◽

Intertan Nail

Background: InterTAN is a specific type of cephalomedullary nail with a twin interlocking de-rotation and compression screw, which has inherent ability of anti-rotation. Whether to tighten or not to tighten the preloaded setscrew to allow or not allow secondary sliding in InterTan nail is controversial in clinical practice. Methods: We retrospectively collected 4 nonunion cases of unstable pertrochanteric femur fractures (AO/OTA-31A2), all were treated with InterTan nail and the preloaded setscrew was tightened in order to prevent further secondary sliding and femoral neck shortening. Results: After 6 months to 2 years follow-up, the fractures showed nonunion in radiography and the patients complained slight to middle degrees of pain, and had to use walking stick assistant in activities of daily life. Tightening the pre-loaded setscrew to prevent postoperative secondary sliding as static constructs might keep the femoral neck length, but lose the opportunity of telescoping for fracture impaction, and take the risk of healing complications, such as fracture nonunion, femoral head cutout or nail breakage. Conclusions: As the harm outweighs benefit, we advocate the preloaded setscrew in InterTan nail should not be tightened in standard-obliquity pertrochanteric hip fractures (AO/OTA-31A1 and A2).

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Mid-term outcome after endovascular therapy in the superficial femoral and popliteal artery using long stents

VASA ◽

10.1024/0301-1526/a000163 ◽

2012 ◽

Vol 41 (1) ◽

pp. 49-56 ◽

Cited By ~ 10

Author(s):

Schoenefeld ◽

P. Donas ◽

Schönefeld ◽

Osada ◽

Austermann ◽

...

Keyword(s):

Endovascular Treatment ◽

Popliteal Artery ◽

Primary Patency ◽

Stent Fracture ◽

Fracture Rate ◽

Term Outcome ◽

Technical Success Rate ◽

Endovascular Interventions ◽

Artery Disease

Background: Peripheral artery disease (PAD) affecting the femoropopliteal artery is treated by endovascular interventions [2, 5, 13] increasingly. Aim of the study was to evaluate mid-term efficacy and patency of long stents in the superficial femoral and popliteal artery. Patients and methods: Between September 2006 and September 2007 103 patients received 128 stents for endovascular treatment of femoropopliteal vascular stenosis or occlusion. Clinical and hemodynamic parameters were collected. Risk factors, popliteal involvement and TASC classification, were documented and evaluated. Results: Immediate outcome was satisfactory with a technical success rate of 100 %. After a mean follow-up period of 21 months, primary patency was 83.6 %. Potential risk factor analysis for restenosis and fracture demonstrated hypertension to have borderline significance (P = 0.06). In normotensive patients no restenosis occurred. Further pre-conditions, e.g. smoking, metabolic syndrome, age, gender and previous intervention did not show any influence on restenosis or stent fracture. TASC C and D lesion had similar patency rates compared to TASC A and B lesions. Most of the restenoses (13 out of 16) were observed within the first six months of follow-up. Six stent fracture were observed (4.7 %). Conclusions: Long stents had convincing results after endovascular treatment of the femoropopliteal PAD. The used stent was an efficacious endovascular tool for long athersclerotic lesions in the superficial femoral and popliteal artery. Fracture rate was low with an incidence of 4.7 %. Most restenoses occurred within the first six months so that careful follow-up would be necessary.

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