scholarly journals Pitfalls and Remedial Technique of Intramedullary Nail for Subtrochanteric Femur Fractures: A Case Series

2021 ◽  
Author(s):  
Botao Chen ◽  
Xiaohong Fan
Keyword(s):  
Internal Fixation ◽  
Intramedullary Nailing ◽  
Intramedullary Nail ◽  
Locking Plate ◽  
Case Series ◽  
Trochanteric Fracture ◽  
Subtrochanteric Fracture ◽  
Chinese Patients ◽  
Good Reduction ◽  
Subtrochanteric Fractures

Abstract Background: Intraoperative technical complications are occasionally encountered while implanting intramedullary nails for subtrochanteric fractures. Surgeons must pay attention to the pitfalls and remedial technique of this operation.Methods: We report on three cases in which intraoperative difficulties occurred during the implantation of an intramedullary nail among Han Chinese patients from mainland China. In Case 1, during an operation on a 57-year-old man, a seinsheimer type V in a right subtrochanteric fracture was not fully realized, and the dislocation of intertrochanteric fracture was aggravated after reduction of the subtrochanteric fracture. The intramedullary nail fixation was completed with the aid of an additional anterolateral plate. Case 2 involved a transverse subtrochanteric fracture. The surgeon neglected the coronal dislocation when considering good sagittal reduction. Although an auxiliary reduction device was used during the operation, there was unacceptable coronal dislocation after the intramedullary nail was inserted. A temporary anterolateral locking plate fixation was used to complete the intramedullary nail fixation. Case 3 involved an old trochanteric fracture combined with a new subtrochanteric fracture in an 81-year-old woman. After reducing the subtrochanteric fractures, the intramedullary nail fixation was successfully completed by releasing the poorly healed intertrochanteric fractures and fixing the anterior lateral plate.Results: With the development of techniques, reliable results can be obtained with fewer complications. Of the various internal fixation methods, we favor using a trochanteric start intramedullary nail.Conclusions: The treatment of subtrochanteric fractures presents challenges. Good reduction and reliable temporary fixation are key to completing the intramedullary nailing. If percutaneous joysticks, finger reduction tools, blocking screws, clamps, and Schanz pins cannot be used for effective auxiliary reduction or temporary reliable fixation, reduction after intramedullary nailing will not be satisfactory. The temporary addition of a reconstruction locking plate can achieve good reduction and temporary stability, and an extra reconstruction locking plate should be retained when the temporary fixation device is removed to reduce the risk of internal fixation failure during fracture healing.

scholarly journals Reverse distal femoral locking plate for subtrochanter femur fracture

2018 ◽  
Vol 27 (2) ◽  
Author(s):  
Peter Giarso ◽  
Ismail H. Dilogo
Keyword(s):  
Distal Femur ◽  
Locking Plate ◽  
Femur Fracture ◽  
Case Series ◽  
Subtrochanteric Fracture ◽  
Locking Compression Plate ◽  
Non Union ◽  
Functional Scores ◽  
The Right ◽  
Subtrochanteric Femur Fracture

In these case series, we used titanium locking compression plate-distal femur (LCP-DF) plate (Synthes) 9–11 hole using less invasive stabilization system or open reduction technique. This case series aims to determine the functional scores on reverse distal femoral locking plate for subtrochanteric femur fracture. A 34-year-old male with closed subtrochanteric fracture of the right femur (Seinsheimer 2B) with Harris hip scores (HHS) of 17, 96, and 97 obtained consecutively in 0, 6, and 12 months, respectively. A 24-year-old male with closed comminuted subtrochanteric fracture of the right femur (Seinsheimer V) with HHS of 13, 93, and 97 at 0, 6, and 12 months respectively. A 39-year-old male with non-union, left subtrochanteric femur fracture (Seinsheimer 2C) yielded HHS of 38, 73, and 77 at 0, 6, and 12 months, respectively. A 35-year-old female with close subtrochanteric fracture of the right femur (Seinsheimer IIB) yielded HHS of 23, 40, and 73 at 0, 6, and 12 months, respectively. Mean initial HHS and scores at 6 and 12 months reached 22, 75, and 86, respectively.

scholarly journals Treatment of subtrochanteric fracture femur by open reduction and internal fixation by long proximal femoral nailing

2019 ◽  
Vol 6 (1) ◽  
pp. 164
Author(s):  
Prabhu P. Munavalli ◽  
Gururaj N. G.
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Road Traffic ◽  
Weight Bearing ◽  
Subtrochanteric Fracture ◽  
High Rate ◽  
Full Weight Bearing ◽  
Subtrochanteric Fractures ◽  
Fractures In Children ◽  
Pathologic Fractures

<p class="abstract"><strong>Background:</strong> Subtrochanteric fractures are devasting injuries that most commonly affect the elderly population and also in young.</p><p class="abstract"><strong>Methods:</strong> This is a prospective study of 20 cases of subtrochanteric fracture admitted to KIMS, Huballi between November 2008 to August 2010 treated with left proximal femoral nail (LPFN) by open method. Cases were taken according to inclusion and exclusion criteria, i.e., fresh subtrochanteric fracture in adults. Pathologic fractures, multiple fractures, fractures in children, old neglected fractures were excluded from the study. Objectives of this study were to study subtrochanteric fractures and to determine effectiveness of LPFN in tretment of subtrochanteric fractures by open reduction and internal fixation (ORIF).<strong></strong></p><p class="abstract"><strong>Results:</strong> In our study of 20 cases, there were 16 male and 4 female patients with age ranging from 17 years to 75 years with most patients in between 21-40 years. 65% of the cases admitted were road traffic accidents, 25% due to fall from height and 10% due to trivial fall with right side being more common side affected. Russell and Taylor type IA fracture accounted for 40% of cases. Mean duration of hospital stay was 24 days and mean time of full weight bearing was 14 weeks in our patients. Good to excellent results were seen in 85% of cases in our study.</p><p class="abstract"><strong>Conclusions:</strong> Subtrochanteric fractures of femur can be successfully treated by ORIF by LPFN resulting in proper anatomical reduction and hence alignment and high rate of bone union.</p>

scholarly journals Bosworth Dislocation without Associated Fracture

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Austin D. Williams ◽  
Matthew Blue ◽  
Christian Douthit ◽  
Cyrus Caroom
Keyword(s):  
Intramedullary Nailing ◽  
Treatment Option ◽  
Intramedullary Nail ◽  
Closed Reduction ◽  
Open Reduction ◽  
Ankle Injuries ◽  
Fracture Dislocation ◽  
Good Reduction ◽  
Timely Manner ◽  
Distal Fibula

One of the rarest ankle injuries is the Bosworth fracture-dislocation, whereby the distal fibula fractures and is lodged behind the tibia and is often unable to be reduced in a closed fashion. Even more rarely, a Bosworth dislocation without any accompanying fractures may occur. In this case, a 19-year-old male presented with a Bosworth dislocation, with the ipsilateral tibia having previously undergone intramedullary nailing. After closed reduction was attempted, open reduction and fixation was performed, directly reducing the fibula and fixing the unstable syndesmosis with 2 quadricortical screws. Bosworth injuries are rare, yet severe, and should be treated in a timely manner. We were able to provide good reduction and fixation without requiring removal of the intramedullary nail, and we support the use of 2 quadricortical screws as a valid treatment option for the fixation of Bosworth dislocations.

scholarly journals Femoral trochanteric fracture: PFNA spiral blade placement with the aid of an angler

2019 ◽  
Vol 48 (3) ◽  
pp. 030006051989078
Author(s):  
Ye Yu ◽  
Keliang Pan ◽  
Gangxiang Wang
Keyword(s):  
Internal Fixation ◽  
Intramedullary Nailing ◽  
Group Versus ◽  
Trochanteric Fracture ◽  
Fixation Failure ◽  
Surgery Group ◽  
Bleeding Volume ◽  
Hip Function ◽  
Surgical Bleeding ◽  
Spiral Blade

Objective To investigate the effect of angler-assisted proximal femoral nail antirotation (PFNA) spiral blade fixation in treating femoral trochanteric fractures. Methods Patients who underwent angler-assisted PFNA screw blade fixation (angler-assisted group), or conventional internal fixation-intramedullary nailing (traditional surgery group) were included. Intraoperative indicators and treatment effects data were retrospectively analysed. Results Statistically significant differences were observed between the angler-assisted group ( n = 27) and traditional surgery group ( n = 28) regarding surgery duration (71.24 ± 8.01 min versus 81.50 ± 11.56 min), number of intraoperative fluoroscopy images (7.28 ± 0.91 versus 12.83 ± 1.55), and surgical bleeding volume (88.80 ± 7.98 ml versus 121.11 ± 27.21 ml). Rates of one-time intramedullary pin puncture for internal fixation in the angler-assisted and traditional surgery groups were 92.59% (25/27) and 32.14% (9/28), respectively. At 1 year following surgery, fractures in both groups had healed without internal fixation failure or fracture displacement failure. Harris hip function scores were 90.68 ± 4.23 (angler-assisted group) versus 81.69 ± 5.85 (traditional surgery group). Conclusions Angler-assisted intramedullary nailing with PFNA spiral blade provides good spiral blade positioning, low internal fixation failure rate, low fluoroscopy, short surgery time, and low bleeding volume. Hip function was well restored.

scholarly journals Finite Element Analysis of Proximal Femoral Nail Anti-Rotation Blade Combined with Cerclage Wire Fixation for Osteoporotic Subtrochanteric Fracture

2021 ◽  
Vol 4 (3) ◽  
Keyword(s):  
Internal Fixation ◽  
Weight Bearing ◽  
Bed Rest ◽  
Biological Properties ◽  
Subtrochanteric Fracture ◽  
Intramedullary Nails ◽  
Element Analysis ◽  
Cerclage Wire ◽  
Subtrochanteric Fractures ◽  
Femur Fractures

Osteoporosis is a type of systemic bone disease wherein the patient is highly vulnerable to bone fracture because of the decrease in bone density and quality, destruction of the bone microstructure, and an increase in the bone fragility. Most of the osteoporotic subtrochanteric fractures are unstable in nature, requiring the conservative treatment of a long-duration bed rest and traction; this condition is prone to complications resultant from extended bed rest, often leading to death. Presently, the preferred treatment is internal fixation, such as sliding hip screws, blade plates, locking compression plates, and femoral intramedullary nails [1-8]. Owing to its valuable biological properties, intramedullary nail can be used for the optimal fixation of subtrochanteric fractures [9-11]. Unless any contraindication exist, immediate tolerable weight-bearing activities may be allowed to patients with subtrochanteric femur fractures who have been treated with statically locked intramedullary nails [12]. Considering that the proximal femoral fracture occurs under the traction of the surrounding muscles, it is extremely challenging to perform precision reduction and fixation in the surgery. Inappropriate reduction and selection of internal fixation can easily lead to failure of internal fixation, resulting in complications such as lower limb shortening deformity, hip varus deformity, and nonunion of fracture. Presently, good outcomes have been reported with the use of PFNA combined with cerclage wire for the treatment of subtrochanteric fracture of the femur [13-15]. There are few studies to help decide whether PFNA should be combined with cerclage wire or used alone according the Seinsheimer classification of subtrochanteric fractures.

scholarly journals Cementless total hip arthroplasty for failed treatment of subtrochanteric fracture

2020 ◽  
Author(s):  
Sheng-Yu Jin ◽  
Jing-Yao Jin ◽  
Woo-Jong Kim ◽  
Taek-Rim Yoon ◽  
Kyung-Soon Park
Keyword(s):  
Total Hip Arthroplasty ◽  
Blood Loss ◽  
Hip Arthroplasty ◽  
Intramedullary Nail ◽  
Subtrochanteric Fracture ◽  
Subtrochanteric Fractures ◽  
Total Hip ◽  
Cementless Total Hip Arthroplasty ◽  
The Mean

Abstract Background Failed treatment of subtrochanteric fractures commonly leads to pain, limping, and poor function. Cementless total hip arthroplasty (THA) could be an option as a salvage procedure in such cases. This study was to evaluate the clinical and radiological results and complications of this treatment in our hospital. Method Eighteen cementless THAs for failed treatment of subtrochanteric fractures were performed at our institution between January 2001 to December 2017. There were eleven males and seven females, and the average age was 74 years (range 57.0-89.0). Eight patients were previously operated with an intramedullary nail, six patients were treated with a dynamic hip screw, two patients were treated with an angled blade plate, one patient was treated with a proximal femur locking plate, and one patient was treated with a dynamic compression plate. Results The mean follow-up was 5.2 years (range 2.2-10.8). The mean duration of the operation was 98.0 minutes (standard deviation [SD],15.4; range 70-135). The mean total blood loss was 992.2 mL (SD,171.2; range 640-1260 mL), and the amount of transfusion was 2.2 units (SD, 0.8, range 1-4). The mean Harris hip score (HHS) was 38.2 (SD, 9.3; range, 24-56) preoperatively and 85.4 (SD, 4.9; range, 79-92) at the last follow-up. Compared to the patients treated with plate-screws, those treated with an intramedullary nail had significantly shorter surgical duration, fewer blood transfusions, and less intraoperative blood loss. Kaplan-Meier survivorship with an endpoint of revision was 94.4% (95% confidence interval 72.7-99.9) at five years. Conclusion Cementless THA is one of the acceptable procedures for failed treatment of the subtrochanteric fracture with fewer complications.

scholarly journals Operation time and intraoperative fluoroscopy time in different internal fixation methods for subtrochanteric fractures treatment

2018 ◽  
Vol 146 (9-10) ◽  
pp. 543-548
Author(s):  
Milan Mitkovic ◽  
Sasa Milenkovic ◽  
Ivan Micic ◽  
Igor Kostic ◽  
Predrag Stojiljkovic ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Guide Wire ◽  
Operation Time ◽  
Subtrochanteric Fracture ◽  
Fluoroscopy Time ◽  
Subtrochanteric Fractures ◽  
Fixation Methods ◽  
Blade Plate ◽  
Intraoperative Fluoroscopy ◽  
Im Nailing

Introduction/Objective. Subtrochanteric fractures are unstable, tending to a varus, antecurvatum, and shortening deformity. The aim of this paper was to compare operation time and fluoroscopy time between different internal fixation methods in the treatment of subtrochanteric fractures. Method. The prospective study of the group of 27 patients with a subtrochanteric fracture treated by the SIF (selfdynamisable internal fixator with a trochanteric unit) method had been done. Operation time and fluoroscopy time values from this group were compared to the same parameters data from the literature for intramedullary (IM) nails, proximal femur locking plates (PF-LCP), dynamic condylar screws (DCS), and the 95?-angled blade plate. Results. In the SIF group, operation time was 62.2 (25?140) minutes and fluoroscopy time was 43 (20?95) s. Average operation time from the literature data was: 102.1 (43?181) minutes for IM nail, 94.2 (75?129) minutes for PF-LCP, 105.3 (70?166) minutes for DCS and 221.5 (171?272) minutes for blade plate. Average fluoroscopy time from the literature data was: 109.6 (34?250) seconds for IM nail, 102.3 (47?180) seconds for PF-LCP, 238 seconds for DCS. Operation time and intraoperative fluoroscopy time were higher in IM nail, PF-LCP, DCS and blade plate comparing to SIF method (p < 0.05). Conclusion. The above mentioned difference could be explained by a degree of required accuracy in the initial operative technique maneuvers, by used number of screws and by the type of the fracture reduction performance in different fixation methods. Operation time during IM nailing of subtrochanteric fractures sometimes can be shorter than average operation time in SIF method, what could be explained by the skill of the surgeon to perform as fast closed reduction for insertion of guide wire.

Sign in / Sign up

Export Citation Format

Share Document