scholarly journals Clinical outcomes of intramedullary femoral nailing system to treat femoral fracture

2020 ◽  
Vol 6 (3) ◽  
pp. 618
Author(s):  
Pooja Rawat ◽  
Mohit Kumar ◽  
Gaurav Luthra
Keyword(s):  
Bone Fracture ◽  
Femoral Fractures ◽  
Gamma Nail ◽  
Fracture Site ◽  
Complication Rates ◽  
Non Union ◽  
Femoral Nailing ◽  
Operative Outcomes ◽  
Femoral Nail ◽  
American Society

<p class="abstract"><strong>Background:</strong> Femoral fractures are bone fracture involve femur, common injuries in adults. Intramedullary femoral nailing system is the recommended solution or treatment for fractures due to its high union rates.</p><p class="abstract"><strong>Methods:</strong> In this clinical inspection 30 patients were selected with bone fracture of femur, and treated by using intramedullary femoral nailing system (universal intramedullary cannulated femoral nail, expert femoral nail, gamma nail and retrograde femoral nail) manufactured by Auxein Medical Private Limited, Sonepat, Haryana, India. There are two types of patients used in this study, one is male (n=18) and another female (n=12). Patients physical fitness was also observed through American Society of Anesthesiologist.<strong></strong></p><p class="abstract"><strong>Results:</strong> Outcomes record from the patients using visual analog scale. Follow up of the patients were taken on 1<sup>st</sup> month, 6<sup>th</sup> month, and 12 months. Post-operative outcomes were good with none of the patients showing non-union of fracture site. There were no complications noticed related to intramedullary femoral nailing system in this study and hardware related complications were not encountered in this study also.</p><p class="abstract"><strong>Conclusions:</strong> Intramedullary nailing system provide excellent outcomes with high union and low complication rates in the management of bone fracture involve femoral in patients.</p>

scholarly journals Clinical outcomes in the treatment of femoral fracture by using intramedullary femur nailing system

2021 ◽  
Author(s):  
Shashank Mishra ◽  
Mohit Kumar ◽  
Prashant Kumar ◽  
Gaurav Luthra
Keyword(s):  
Clinical Outcomes ◽  
Femoral Fracture ◽  
Femoral Fractures ◽  
Ao Classification ◽  
Femoral Nailing ◽  
Femoral Nail ◽  
American Society ◽  
Hospital Group

<p><strong>Background: </strong>Femoral fractures are frequently occurring fractures that are caused due to large force impaction. The purpose of this study was to clinically evaluate the outcomes of treating femoral fractures with the use of the intramedullary femoral nailing system.</p><p><strong>Methods:</strong> This retrospective clinical trial consists of 32 patients with femoral fracture and are treated by using an intramedullary femoral nailing system which consists of retrograde femoral nail, gamma nails, expert femoral nail, universal intramedullary cannulated femoral nails that are manufactured by Auxein medical Pvt. Ltd. Sonipat, Haryana, India. There were 32 patients from two different hospitals i.e., first hospital group consist of 15 patients (8 male and 7 female) with mean age of 32 years and the second hospital group consist of 17 patients (9 male and 8 female). The fracture categorization was done on the basis of AO Classification of fracture and physical fitness was categorized by American society of anaesthesiologists. VAS score and HHS was used as a criterion for assessing the clinical outcomes of the patients.</p><p><strong>Results: </strong>There were 32 patients to whom surgery was performed and follow up time was 1 month, 3 months, 6 months and 12 months. After the final follow up no patient in any group complaint about the complications or any hardware related problem, there were perfect bone union in every patient. Radiological outcomes also showed proper union at 6 months follow up.</p><p><strong>Conclusions: </strong>For femoral fractures, intramedullary femoral nail gives a better result with high union rate and post-operative composure.</p>

scholarly journals 505 Failed Femoral Nail with Significant Operative Technical Difficulty: A Practical Solution to Achieve Metalwork Extraction Using Conical Screw Remover

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A Paluch ◽  
A Clarke ◽  
S Smith ◽  
S Adams
Keyword(s):  
Revision Surgery ◽  
Femoral Fractures ◽  
Technical Difficulty ◽  
Distal Segment ◽  
Fracture Site ◽  
Practical Solution ◽  
Non Union ◽  
Femoral Nail ◽  
Operative Difficulty ◽  
Im Nailing

Abstract Introduction There is a greater risk of delayed healing and revision surgery in atypical femoral fractures (AFFs). Although non-union in reamed intra-medullary (IM) nailing is relatively uncommon, it can lead to fracture of the nail and present a considerable challenge to the treating surgeon. Case Report We present a case of AFF treated with IM nail fixation. Metalwork failure of the nail prompted removal of distal locking screws and plating of the fracture site at 8 months. Failure of the plate-bone interface 3 months later led to further revision surgery to remove the broken metalwork. We focus on the significant operative difficulty encountered during removal of the failed IM metalwork and provide a novel practical solution to overcome this particular challenge - insertion of a conical cannulated screw remover under fluoroscopy guidance to create an interference fit with the distal segment of the broken nail. Discussion This case is an example of significant and unexpected intra-operative technical difficulty, requiring improvisation and teamwork to manage. We introduce an accessible and uncomplicated alternative to the existing techniques for removal of a broken femoral nail and in doing so hope to benefit peers and colleagues should they encounter similar difficulties in the future.

Integrated dual lag screws versus single lag screw cephalomedullary nail constructs: a meta-analysis and systematic review

2021 ◽  
pp. 112070002098506
Author(s):  
James R Onggo ◽  
Mithun Nambiar ◽  
Jason D Onggo ◽  
Anuruban Ambikaipalan ◽  
Parminder J Singh ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Meta Analysis ◽  
Femoral Fractures ◽  
Harris Hip Score ◽  
Complication Rates ◽  
Non Union ◽  
Lag Screw ◽  
Significant Difference ◽  
Lower Complication ◽  
Cephalomedullary Nails

Background/Aim: This study aims to determine the safety and efficacy of integrated dual lag screw (IDL) cephalomedullary nails (CMN) when compared with single lag screw (SL) constructs, in the internal fixation of intertrochanteric femoral fractures. Methods: The Smith & Nephew InterTan IDL was compared with SL CMN group consisting of the Stryker Gamma-3 (G3) and Synthes Proximal Femoral Nail Antirotation (PFNA) CMN. A multi-database search was performed according to PRISMA guidelines. Data from studies assessing the clinical and radiological outcomes, complications and perioperative parameters of InterTan versus G3 or PFNA CMN in patients with intertrochanteric femoral fractures were extracted and analysed. Results: 15 studies were included in this meta-analysis, consisting of 2643 patients. InterTan was associated with lower complication rates in terms of all-cause revisions (OR 0.34; 95% CI, 0.22–0.51; p < 0.001), cut-outs (OR 0.30; 95% CI, 0.17–0.51; p < 0.001), medial or lateral screw migration (OR 0.19; 95% CI, 0.06–0.65; p = 0.008) as well as persistent hip and thigh pain (OR 0.65; 95% CI, 0.47–0.90; p = 0.008). In terms of perioperative parameters, InterTan is associated with longer operative times (MD 5.57 minutes; 95% CI, 0.37–10.78 minutes, p = 0.04) and fluoroscopy times (MD 38.89 seconds, 95% CI, 15.88–61.91 seconds; p < 0.001). There was no statistically significant difference in terms of clinical Harris Hip Score and radiological outcomes, non-union, haematoma, femoral fractures, varus collapse, length of stay and mean intraoperative blood loss between the 2 groups. Conclusions: Integrated dual lag screw cephalomedullary nails are associated with fewer revisions and complications. However, there is insufficient data to suggest that either nail construct is associated with better functional outcomes.

scholarly journals Clinical outcomes of treatment with locking compression plates for distal femoral fractures in a retrospective cohort

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Masahiro Kiyono ◽  
Tomoyuki Noda ◽  
Hiroshi Nagano ◽  
Takashi Maehara ◽  
Yasuaki Yamakawa ◽  
...  
Keyword(s):  
Bone Fracture ◽  
Distal Femur ◽  
Femoral Fractures ◽  
Bone Union ◽  
Span Length ◽  
Union Rate ◽  
Non Union ◽  
Distal Femoral Fractures ◽  
Bridge Span ◽  
Comminuted Fractures

Abstract Background Plate fixation is one of the standard surgical treatments for distal femoral fractures. There are few reports on the relationship between the screw position and bone union when fixing by the bridging plate (relative stability) method. Methods This retrospective study included 71 distal femoral fractures of 70 patients who were treated with the locking compression plate for distal femur (DePuy Synthes Co., Ltd, New Brunswick, CA, USA). The following measurements were evaluated and analyzed: (1) bone union rate, (2) bridge span length (distance between screws across the fracture), (3) plate span ratio (plate length/bone fracture length), (4) number of empty holes (number of screw holes not inserted around the fracture), and (5) medial fracture distance (bone fracture distance on the medial side of the distal femur). Patient demographics (age), comorbidities (smoking, diabetes, chronic steroid use, dialysis), and injury characteristics (AO type, open fracture, infection) were obtained for all participants. Univariate analysis was performed on them. Results Of 71 fractures, 26 fractures were simple fractures, 45 fractures were comminuted fractures, and 7 fractures resulted in non-union. Non-union rate was significantly higher in comminuted fractures with bone medial fracture distance exceeding 5 mm. Non-union was founded in simple fractures with bone medial fracture distance exceeding 2 mm, but not significant (p = 0.06). In cases with simple fractures, one non-union case had one empty hole and one non-union case had four empty holes, whereas in cases with comminuted fractures, five non-union cases had two more empty holes. Conclusions We concluded that bone fragment distance between fracture fragments is more important than bridge span length of the fracture site and the number of empty holes. Smoking and medial fracture distance are prognostic risk factors of nonunion in distal femoral fractures treated with LCP as bridging plate.

scholarly journals Prospective study of managing long bone fracture nonunion: is bone graft needed in every case?

2018 ◽  
Vol 4 (4) ◽  
pp. 556
Author(s):  
Srinivas Balagani
Keyword(s):  
Prospective Study ◽  
Bone Graft ◽  
Bone Fracture ◽  
Fracture Site ◽  
Long Bone ◽  
Segmental Defect ◽  
Long Bones ◽  
Non Union ◽  
Number Of Patients ◽  
Long Bone Fracture

<p class="abstract"><strong>Background:</strong> Increased road traffic accidents lead to increased incidence of fracture of long bones. It has a tendency of non-union. Infection is very common in these cases which are an important cause of nonunion of long bone fractures. The objective of the study was to study the incidence and patterns of non-union of long bone fracture.</p><p class="abstract"><strong>Methods:</strong> Hospital based prospective study was carried out at Department of Orthopedics, from June 2017 to March 2018. Patients admitted to wards of Department of Orthopedics with nonunion of long bones were included. During the study period a total of 20 cases were eligible for the present study as per the inclusion and exclusion criteria.<strong></strong></p><p class="abstract"><strong>Results:</strong> Males were more affected than females. Most commonly affected age group was 41-50 years and 61-70 years (25% each). Most commonly affected long bone was femur in 35% of the cases. Most common type of non-union was hypertrophic (50%). Most common cause of non-union was broken implant in 35% of the cases. Maximum number of patients had union in 4-6 months in 60% of the cases after surgery of previous non-union of long bones. Only four patients developed complications like shortening of the limb or persistent non-union.</p><p class="abstract"><strong>Conclusions:</strong> Hypertrophic non unions doesn’t require bone graft, they require only stable fixation. For removal of broken implant in hypertrophic non-union if we open the fracture site, then even the gap after debridement of fracture site shows partial segmental defect it doesn’t require bone grafting.</p>

scholarly journals Complications following Treatment of Trochanteric Fractures with the Gamma3 Nail: Is the Latest Version of Gamma Nail Superior to Its Predecessor?

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Dimitrios Georgiannos ◽  
Vasilios Lampridis ◽  
Ilias Bisbinas
Keyword(s):  
Postoperative Complications ◽  
Femoral Fractures ◽  
Reoperation Rate ◽  
Gamma Nail ◽  
Complication Rates ◽  
Trochanteric Fractures ◽  
Historical Cohort ◽  
Pertrochanteric Fractures ◽  
Gamma3 Nail ◽  
Trochanteric Gamma Nail

Gamma nail is a cephalomedullary implant that was developed for the treatment of pertrochanteric hip fractures and has been successfully used for over 20 years. During this period, modifications of design and instrumentation have occurred to combat the intra- and postoperative complications that were associated with the use of early designs. The purpose of this study was to compare the complications observed with the use of the Gamma3 nail (G3N) with those seen following use of the previous trochanteric gamma nail (TGN). This study prospectively recorded the intra- and postoperative complications of 175 patients treated with the Gamma3 nail and compared them with those of a historical cohort of 192 patients treated with the trochanteric gamma nail. We encountered less intra- and postoperative complications with the use of Gamma3 nail. Femoral fractures and lag screw cutout were significantly lower. The reoperation rate was significantly higher in the TGN group. Gamma3 nail has proved to be a safe and efficient implant for the treatment of pertrochanteric fractures. The improvement of the biomechanical characteristics has led to a significant decrease in complication rates, demonstrating superiority over its predecessor.

scholarly journals Atypical Femoral Fractures due to long-term bisphosphonates therapy

2019 ◽  
Vol 2 (1) ◽  
pp. 23-27
Author(s):  
Ioan Mihai Japie ◽  
Radu Rădulescu ◽  
Adrian Bădilă ◽  
Ecaterina-Maria Japie ◽  
Alexandru Papuc ◽  
...  
Keyword(s):  
Intramedullary Nail ◽  
Femoral Fractures ◽  
Gamma Nail ◽  
Atypical Femoral Fractures ◽  
Non Union ◽  
Female Patients ◽  
Number Of Patients ◽  
Long Term Treatment

AbstractIntroduction. Bisphosphonates (BPs) represent the main therapy in patients with osteoporosis, although a long-term treatment can lead to atypical fractures.Material and methods. We conducted a retrospective study between 2008 and 2017 and included 23 female patients with atypical femoral fractures (AFFs). The mean period of BPs therapy administration was 5.2 years. We included 7 subtrochanteric fractures and 18 femoral shaft fractures. Two of the total patients presented bilateral femoral fractures. 18 patients presented prodromal symptoms from 2 to 18 months before the diagnosis of fractures, all of them following low energy trauma. All the patients included in our study underwent surgery with intramedullary nail or gamma nail. The postoperative mean follow-up was 2 years. Results. Of all 23 female patients with a total of 25 fractures – 10 underwent osteosynthesis with gamma nail and 15 underwent osteosynthesis with intramedullary nail. From the total number of patients: 13 patients achieved complete union, 6 presented delayed union and 3 non-union (2 intramedullary nail and one gamma nail), whereas in one patient treated previously with gamma nail we observed implant failure.Conclusion. The treatment of AFFs after BPs therapy administration represents a challenge for orthopaedic surgeons regarding both surgical technique and postoperative follow-up.

scholarly journals Functional outcome of proximal femoral nailing for unstable intertrochanteric fracture in elderly

2020 ◽  
Vol 6 (6) ◽  
pp. 1186
Author(s):  
Ankit Jose ◽  
Edward Nazareth ◽  
Vivian Roshan D. A. ◽  
Mohan Kumar C. R.
Keyword(s):  
Functional Outcome ◽  
Femoral Fractures ◽  
Delayed Union ◽  
Harris Hip Score ◽  
Non Union ◽  
Femoral Nailing ◽  
Unstable Intertrochanteric Fracture ◽  
Intertrochanteric Femur Fracture ◽  
Proximal Femoral Nailing

<p class="abstract"><strong>Background:</strong> This study is intended to analyse the functional outcome of proximal femoral nailing (PFN) for unstable intertrochanteric fractures in elderly.</p><p class="abstract"><strong>Methods:</strong> The data was collected from the 35 patients with unstable intertrochanteric femur fracture who were subjected to PFN from 2015 to 2018. All patients were followed up at 3 months and 6 months after the operation to check the functional outcome based on harris hip score (HHS) and complication if any.</p><p class="abstract"><strong>Result:</strong> In 35 patients, 1 patient was lost to follow-up and 34 patients were followed-up at 3 months and 6 months. All patient’s union was achieved at 3 and 6 months follow up. The cause of fractures was trivial fall in all 35 patients. No incidence of non-union and delayed union was reported. Functional outcome was rated as per HHS, we got excellent results in 20 cases, good in 10, fair in 03 and poor in one patient at end of 6 months.</p><p class="abstract"><strong>Conclusions:</strong> PFN provides stable fixation and early post-operative mobilization with fracture union especially complex proximal femoral fractures which includes unstable, communited, reverse oblique fractures and fractures in osteoporotic bones. PFN has shown excellent results in our study.</p>

scholarly journals Primary total hip arthroplasty outcomes in octogenarians

2021 ◽  
Vol 2 (7) ◽  
pp. 535-539
Author(s):  
Stephen Gerard Zak ◽  
Katherine Lygrisse ◽  
Alex Tang ◽  
Morteza Meftah ◽  
William J. Long ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Patient Reported Outcome ◽  
Complication Rates ◽  
Total Hip ◽  
Joint Infections ◽  
Operative Outcomes ◽  
Patient Reported ◽  
American Society ◽  
One Year

Aims As our population ages, the number of octogenarians who will require a total hip arthroplasty (THA) rises. In a value-based system where operative outcomes are linked to hospital payments, it is necessary to assess the outcomes in this population. The purpose of this study was to compare outcomes of elective, primary THA in patients ≥ 80 years old to those aged < 80. Methods A retrospective review of 10,251 consecutive THA cases from 2011 to 2019 was conducted. Patient-reported outcome (PRO) scores (Hip disability and Osteoarthritis Outcome Score (HOOS)), as well as demographic, readmission, and complication data, were collected. Results On average, the younger cohort (YC, n = 10,251) was a mean 61.60 years old (SD 10.71), while the older cohort (OC, n = 609) was 84.25 years old (SD 3.02) (p < 0.001). The OC had greater surgical risk based on their higher mean American Society of Anesthesiologists (ASA) scores (2.74 (SD 0.63) vs 2.30 (SD 0.63); p < 0.001) and Charlson Comorbidity Index (CCI) scores (6.26 (SD 1.71) vs 3.87 (SD 1.98); p < 0.001). While the OC stayed in the hospital longer than the YC (mean 3.5 vs 2.5 days; p < 0.001), there were no differences in 90-day emergency visits (p = 0.083), myocardial infarctions (p = 0.993), periprosthetic joint infections (p = 0.214), dislocations (p = 0.993), or aseptic failure (p = 0.993). The YC was more likely to be readmitted within 90 days (3.88% vs 2.18%, Β = 0.57; p = 0.048). There were no observed differences in 12-week (p = 0.518) or one-year (p = 0.511) HOOS scores. Conclusion Although patients ≥ 80 years old have a greater number of comorbidities than younger patients, they had equivalent perioperative complication rates and PRO scores. This study demonstrates the safety and success of elective THA in octogenarians. Cite this article: Bone Jt Open 2021;2(7):535–539.

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