Treatment of pertrochanteric fractures in elderly patients: is dynamic fixation so important?

Abstract. Introduction The problem of complications after surgical treatment of pertrochanteric fractures in elderly patients is relevant and far from a solution. Materials and methods The retrospective study was based on the analysis of the results of treatment of 129 patients with pertrochanteric femoral fractures (average age 76 years). All fractures in the early time from trauma were fixed with two types of cephalomedullary nails, either dynamic or static. All patients could not limit the load on the operated limb after surgery because of different reasons. Results The results of treatment were evaluated in 109 patients after one year. In dynamic cephalomedullary fixator group (59 patients), there were 7 orthopedic complications with a functional Harris scale result of 68 points (range, 26 to 94 points). In static cephalomedullary fixator group (50 patients), there were 14 orthopedic complications with a functional Harris score of 56.5 points (range, 15 to 92 points). Discussion Higher results of treatment in the group of dynamic fixator in the condition of full-weight bearing on the operated limb may be associated with the possibility of dynamization of the part of fixator in response to bone resorption in the contact area of bone fragments. The use of dynamic cephalomedullary fixators instead of static ones for treatment of pertrochanteric femoral fractures in elderly patients exercising full weight-bearing leads to a decrease in orthopedic complications (from 28 to 11.9 %) and improves the functional results of treatment.

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Results of Extraosseous Osteosynthesis with Extra Stabilization of Plate by Tightening Clamps

N.N. Priorov Journal of Traumatology and Orthopedics ◽

10.17816/vto201118411-14 ◽

2011 ◽

Vol 18 (4) ◽

pp. 11-14

Author(s):

Valentina Afanas'evna Kopysova ◽

V A Kaplun ◽

A N Svetashov ◽

V A Kopysova ◽

V A Kaploon ◽

...

Keyword(s):

Shape Memory ◽

Femoral Fractures ◽

Lower Extremities ◽

Functional Results ◽

Main Group ◽

Control Group ◽

Long Bones ◽

Correct Position ◽

Results Of Treatment ◽

Bone Fragments

Results of extraosseous osteosynthesis in 160 patients with fractures and pseudarthroses of lower extremities long bones were analyzed. In 80 patients from the main group the plate was additionally fixed to the bone with ring-shaped tightening clamp with shape memory to prevent screw migration.. In 65 (81.3%) patients from control group consolidation of bone fragments with excellent results was achieved in 66.3% of cases. In 15 (18.7%) patients with mainly peri- and intraarticular femoral fractures the migration of screws and plate destruction were noted. In main group the fractures consolidated in anatomically correct position in 76 (95.0%) and good functional results of treatment were achieved.

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Finite element analysis of double‐plate fixation using reversed locking compression‐distal femoral plates for Vancouver B1 periprosthetic femoral fractures

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04152-5 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Daisuke Takahashi ◽

Yoshihiro Noyama ◽

Tsuyoshi Asano ◽

Tomohiro Shimizu ◽

Tohru Irie ◽

...

Keyword(s):

Finite Element Analysis ◽

Finite Element ◽

Plate Fixation ◽

Weight Bearing ◽

Femoral Fractures ◽

Full Weight Bearing ◽

Loading Test ◽

Lateral Plate ◽

Element Analysis ◽

Periprosthetic Femoral Fractures

Abstract Background Internal fixation is recommended for treating Vancouver B1 periprosthetic femoral fractures. Although several fixation procedures have been developed with high fixation stability and union rates, long-term weight-bearing constructs are still lacking. Therefore, the aim of the present study was to evaluate the stability of a double-plate procedure using reversed contralateral locking compression-distal femoral plates for fixation of Vancouver B1 periprosthetic femoral fractures under full weight-bearing. Methods Single- and double-plate fixation procedures for locking compression-distal femoral plates were analysed under an axial load of 1,500 N by finite element analysis and biomechanical loading tests. A vertical loading test was performed to the prosthetic head, and the displacements and strains were calculated based on load-displacement and load-strain curves generated by the static compression tests. Results The finite element analysis revealed that double-plate fixation significantly reduced stress concentration at the lateral plate place on the fracture site. Under full weight-bearing, the maximum von Mises stress in the lateral plate was 268 MPa. On the other hand, the maximum stress in the single-plating method occurred at the defect level of the femur with a maximum stress value of 1,303 MPa. The principal strains of single- and double-plate fixation were 0.63 % and 0.058 %, respectively. Consistently, in the axial loading test, the strain values at a 1,500 N loading of the single- and double-plate fixation methods were 1,274.60 ± 11.53 and 317.33 ± 8.03 (× 10− 6), respectively. Conclusions The present study suggests that dual-plate fixation with reversed locking compression-distal femoral plates may be an excellent treatment procedure for patients with Vancouver B1 fractures, allowing for full weight-bearing in the early postoperative period.

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Functional outcome of fixation of distal femoral fractures with DF-LCP: a prospective study

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20164000 ◽

2016 ◽

Vol 2 (4) ◽

pp. 291 ◽

Cited By ~ 1

Author(s):

Shafeed T. P. ◽

Bijo Paul

Keyword(s):

Tissue Injury ◽

Weight Bearing ◽

Soft Tissue Injury ◽

Femoral Fractures ◽

Early Mobilization ◽

Type A ◽

Full Weight Bearing ◽

Supracondylar Fractures ◽

Range Of Movement ◽

Locked Plating

Background: Management of supracondylar fractures is a real challenge to the orthopaedician due to its extensive soft tissue injury, boneloss, comminution, articular extention and instability. Open reduction and internal fixation with anatomical distal femoral locking plate permits early mobilization. Stable anatomical fixation is necessary to avoid complications and disability.Methods: 25 patients with Type A and Type C closed supracondylar femoral fractures were followed up from November 2013 to November 2015. All the patients underwent ORIF with DF-LCP. Clinical and radiological follow up were recorded for 24 months.Results: Mean time for fracture union was 4.02 months. Average duration for full weight bearing was 122 days (range 90-180days). The average range of movement for Type A fractures was 105.71 degrees, for C fractures average ROM was 93.64 degrees. Average ROM for patients <50 was 103 degree and for patients>50 ROM was 98.66 degree. Conclusions: Locked plating of DF fractures permits stable fixation and early mobilization which avoids disability and ensures good joint function.

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Cross-Sectional Study to Assess the Functional Outcome of Neglected Bimalleolar Fracture

Foot & Ankle Specialist ◽

10.1177/1938640016685149 ◽

2016 ◽

Vol 10 (6) ◽

pp. 509-512

Author(s):

Rajeev Shukla ◽

Ravi Kant Jain ◽

Shravan Patidar ◽

Nikhil Jain ◽

Pranav Mahajan

Keyword(s):

Internal Fixation ◽

Functional Outcome ◽

Open Reduction ◽

Rating Scale ◽

Weight Bearing ◽

Functional Results ◽

Cross Sectional Study ◽

Cross Sectional ◽

Results Of Treatment ◽

Trimalleolar Fractures

Introduction. Ankle fracture is the most common intra-articular fracture of a weight-bearing joint and accounts for 9% of all fractures. Ankle fractures are classified into 3 subgroups: unimalleolar, bimalleolar, and trimalleolar fractures. Accurate reduction and stable internal fixation is necessary in bimalleolar fractures; otherwise, it may lead to posttraumatic painful restriction of movements or osteoarthritis. The purpose of this study is to assess the functional outcome and results of treatment of neglected bimalleolar fracture. Materials and Methods. Seventeen neglected bimalleolar fracture patients were treated with open reduction and internal fixation. Patients were followed-up at 1, 2, and 5 years and functional ability was assessed by using the modified Weber Rating Scale. Results. The mean age of patients was 41.4 ± 13.28 years. After 2 year of surgery, 13 out of 17 patients showed excellent results and 4 patients had fair results. Conclusion. Good to excellent functional results were observed after long-term follow-up in neglected bimalleolar fracture treated with open reduction and internal fixation, and we advise surgical intervention in all such patients. Levels of Evidence: Therapeutic, Level III: Retrospective Cohort study

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A study on clinical outcomes of complex subtrochanteric femoral fractures with cephalomedullary nail

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20214188 ◽

2021 ◽

Vol 7 (6) ◽

pp. 1194

Author(s):

S. F. Kammar ◽

Karthik B. ◽

V. K. Bhasme ◽

Suryakanth Kalluraya

Keyword(s):

Clinical Outcomes ◽

Road Traffic ◽

Weight Bearing ◽

Femoral Fractures ◽

Lateral View ◽

Successful Outcome ◽

Harris Hip Score ◽

Full Weight Bearing ◽

Subtrochanteric Fractures ◽

The Mean

Background: The aim of the study was to evaluate the clinical outcomes of complex subtrochanteric fractures treated by using cephalomedulary nail.Methods: This is a prospective observational study of 30 cases of complex subtrochanteric femoral fractures admitted to our hospital from January 2018 to June 2019. Cases were taken according to the inclusion and exclusion criteria i.e. type IV, type V Seinsheimer’s classification, above 18 years and those who are willing to participate in the study has been included and pathological fractures, open fractures were excluded. All the patients are followed up on 2 post-operative day, after 4 weeks, 8 weeks, 12 weeks and 6months. X-ray hip with thigh anteroposterior (AP) and lateral view taken during each follow up. Out comes was assessed using modified Harris hip score.Results: In our study of 30 cases there are 22 males and 8 females and the mean age of 43.7 years. 73.3% patients are due to Road traffic accidents predominance of right side. In our study 66% had type 4 Seinsheimers and 34% cases had type 5 Seinsheimers fracture. The mean duration of hospital stay was 17 days. Mean time for full weight bearing is 12 weeks. Good to excellent results are seen in 80% of type 4 subtrochanteric fractures and 75% of cases of type 5 subtrochanteric fractures. 4 cases had surgical site infection, 3 cases had varus, 1 case had developed implant failure, and 1 case had reverse Z effect.Conclusions: From this study, we conclude that proximal femoral nail is an excellent implant in the treatment of complex subtrochanteric femoral fractures the terms of successful outcome include a good understanding of fracture biomechanics, good preoperative planning and accurate instrumentation.

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BONE-CEREBRAL CHANNEL REAMING IN THE TREATMENT OF LIMBS BONE FRACTURES

ScienceRise ◽

10.21303/2313-8416.2020.001559 ◽

2020 ◽

pp. 40-50

Author(s):

Asif Baglar ogly Mansyrov ◽

Viktor Lytovchenko ◽

Yevgeniy Garyachiy ◽

Andriy Lytovchenko

Keyword(s):

Bone Marrow ◽

Bone Fractures ◽

Functional Results ◽

Surgical Technology ◽

Results Of Treatment ◽

Bone Fragments ◽

Product Technology ◽

Scientific Results ◽

Technological Product

The object of the study: clinical effect of intramedullary blocking osteosynthesis of fractures of the bones of the extremities without reaming of the bone marrow canal. The problem to be solved: determination of the influence of surgical technology of intramedullary blocking osteosynthesis of bone fractures without reaming of the bone marrow canal on the qualitative and anatomical and functional results of treatment. Main scientific results. The term of fusion of bone fragments in complete groups (including all localizations) in the group of patients who underwent surgery with reaming of the bone marrow canal was 4.21±0.46 months, while in the group without reaming of the canal it was much shorter – 3.47±0.51 months Faster functional recovery of the limbs was also observed in cases that precluded bone marrow reaming – 96 % of good and 4 % satisfactory scores were obtained (80 % good and 20 % satisfactory in bone marrow reaming). The technology of closed intramedullary blocking osteosynthesis without reaming of the bone marrow can optimize the time of fusion of bone fragments and get 91 % good and 9 % satisfactory results. Its effectiveness is to reduce the number of satisfactory treatment results by 19 %, the absence of unsatisfactory and increase the share of good results by 23 %. The area of practical use of research results: clinics of traumatological profile of different levels, in which surgical treatment of fractures of the bones of the extremities are done. An innovative technological product: technology of closed intramedullary blocking osteosynthesis without reaming of the bone marrow canal. The area of application of an innovative technological product: clinical practice of using the technology of closed intramedullary blocking osteosynthesis without reaming of the bone marrow canal.

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The clinical outcomes of early internal fixation for undisplaced femoral neck fractures and early full weight-bearing in elderly patients

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-014-2003-y ◽

2014 ◽

Vol 134 (7) ◽

pp. 941-946 ◽

Cited By ~ 18

Author(s):

Ji Wan Kim ◽

Seong-Eun Byun ◽

Jae Suk Chang

Keyword(s):

Femoral Neck ◽

Elderly Patients ◽

Internal Fixation ◽

Clinical Outcomes ◽

Weight Bearing ◽

Femoral Neck Fractures ◽

Full Weight Bearing

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A comparative study of surgical management of subtrochanteric fractures in children

Bangladesh Journal of Medical Science ◽

10.3329/bjms.v11i2.9664 ◽

2012 ◽

Vol 11 (2) ◽

pp. 91-97

Author(s):

Ramji Lal Sahu ◽

Pratiksha Gupta

Keyword(s):

Femoral Fracture ◽

Weight Bearing ◽

Medical Science ◽

Femoral Fractures ◽

Long Bone ◽

Full Weight Bearing ◽

Entry Site ◽

Early Weight Bearing ◽

Fractures In Children ◽

Mean Time

Introduction: Subtrochateric femoral fracture is a major cause of morbidity and mortality in patients with lower extremity injuries. There have been no studies that have specifically looked at the management of subtrochanteric femoral fractures in skeletally immature adolescents. It was the purpose of this study to investigate the treatment of this injury in this unique patient population. Methods: This study was conducted in the Department of Orthopaedic surgery in M. M. Medical College from July 2006 to November 2008. Thirty-four patients were recruited from Emergency and out patient department having closed subtrochanteric femoral fracture. All patients were operated under general or spinal anesthesia. All patients were followed for twelve months. Results: All children achieved union in a mean time of 10 weeks (range from 6 - 16 weeks) depending on the type of long bone. Full weight bearing was possible in a mean time of 8.8 weeks. Mean duration of hospital stay was 9.8 days. The mean follow-up period was 28 months (17-48 months). Complications were recorded in 4 (11.77%) patients and included: two entry site skin irritations, one protrusion of the wires through the skin and one delayed union. The results were excellent in 97.06% and good in 2.97% patients. Conclusions: We conclude that Rigid and close interlocking nailing between the age of 9-16 years offered excellent fracture stability allowing early mobilization (early weight bearing) and joint motion in comparisons to the other groups and between the age of 6-8 years titanium elastic nail and bridging plate offered excellent result.DOI: http://dx.doi.org/10.3329/bjms.v11i2.9664 Bangladesh Journal of Medical Science Vol. 11 No. 02 April 2012: 91-97

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Interprosthetic Femoral Fractures Surgical Treatment in Geriatric Patients

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/21514593211013790 ◽

2021 ◽

Vol 12 ◽

pp. 215145932110137

Author(s):

Marios Loucas ◽

Rafael Loucas ◽

Nico Safa Akhavan ◽

Patrick Fries ◽

Michael Dietrich

Keyword(s):

Surgical Treatment ◽

Geriatric Patients ◽

Standard Procedure ◽

Weight Bearing ◽

Case Series ◽

Femoral Fractures ◽

Full Weight Bearing ◽

Level Of Evidence ◽

Type Iv ◽

Case Series Study

Background: Total hip (THA) and total knee arthroplasty (TKA) are becoming an increasingly standard procedure in the whole world. In conjunction with an aging population and increased prevalence of osteoporosis, proper management of periprosthetic, and interprosthetic fractures is of great interest to orthopedic surgeons. This study aims to report the clinical and radiographic outcomes, complications and reoperations of IFFs in geriatric patients. Methods: A retrospective single-institution case series study was conducted. Between 2011 and 2019, 83 patients underwent surgical treatment for periprosthetic femoral fractures. Thirteen fractures were identified as IFFs. Patient demographics and comorbidities were collected preoperatively, and fractures were classified with the Vancouver and AO unified classification system (AO-UCS). Results: We included 12 patients (13 hips) with IFFs (AO-UCS type IV.3 B (2/13) type IV.3 C (3/13), type IV.3 D (8/13)). The average patient age was 86.54 (range, 79-89) years. There were 10 females and 2 males. Perioperative morbidity has been identified in 10 of the 12 patients, and the 3-month and 1-year mortality were reported in 2 and 3 patients, respectively. Cerclage cables were used in 9 of 12 patients. One of 12 patients showed a local complication, with no documented implant failure or revision. Patients achieved complete union and returned to their preoperative ambulatory status, and full weight-bearing at an average of 5 (range, 2 to 7) months later. Conclusion: Management of IFF can be challenging because these fractures require extensive surgical expertise. Locking plate seems to be a valuable treatment option for geriatric patients with IFFs. Despite the complexity of this type of fracture, the overall complication and revision rate, as well as the radiographic outcome are good to excellent. Level of Evidence: Level III, Therapeutic study.

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Gamma 3 Long Nail for Complex Sub-Trochanteric Fractures: A Ten-Year Retrospective Study

Austin Journal of Musculoskeletal Disorders ◽

10.26420/austinjmusculoskeletdisord.2021.1060 ◽

2021 ◽

Vol 8 (1) ◽

Author(s):

Urso R ◽

◽

Milani L ◽

Ortolan A ◽

Martucci A ◽

...

Keyword(s):

External Rotation ◽

Weight Bearing ◽

Femoral Fractures ◽

The Elderly ◽

Gamma Nail ◽

Trauma Centre ◽

High Rate ◽

Full Weight Bearing ◽

Coxa Vara ◽

X Rays

Cephalomedullary nailing is considered the treatment of choice for trochanteric and subtrochanteric femoral fractures. The aim of this study was to report postoperative outcomes of one of the widely used trochanteric nail device, the Gamma 3 long nail. We retrospectively assessed 405 patients treated with Gamma 3 long nail in a single Level One Trauma Centre between 2010 and 2018. We finally included 261 ambulant patients with 65 years or older, a lowenergy trauma and a closed trochanteric or subtrochanteric femoral fracture. Clinical outcomes were evaluated using the Hip Fracture Functional Recovery Score (FRS), while radiological complications and failures were assessed on postoperative x-rays. More than two-thirds of patients had completed fracture consolidation within 4 months after surgery. Immediate full weight bearing was allowed postoperatively in 64.0% of patients. We reported a mortality of 24.5% at one year postoperatively. The leading clinical postoperative complication was anemia (69.3%), followed by deep venous thrombosis (7.7%). Coxa vara was observed in 73 patients (28%), followed by malreduction in flexion-external rotation of the proximal femoral fragment (26.8%). No case of lag screw cutout was reported. Our study indicated that last generation of Long Gamma nail is a reliable implant for trochanteric and subtrochanteric femoral fractures in the elderly patients, leading to high rate of bone union and reduced incidence of related complications. An excellent fracture reduction and prevention of postoperative varus malalignment are the main factors that can avoid the major postoperative complications and failures after Gamma 3 long nailing.

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