scholarly journals Treatment of Unstable Intertrochanteric Fractures in Elderly Patients Using a New Technique of Wire Tension Band Ventral Compression Wiring Combined With Artificial Femoral Head Replacement

2021 ◽  
Author(s):  
Jiajing Ye ◽  
Zhong Zhu ◽  
Lingjun Jiang ◽  
Haizhao Wu ◽  
Shouli Wang ◽  
...  
Keyword(s):  
Femoral Head ◽  
Elderly Patients ◽  
Tension Band ◽  
Fracture Line ◽  
Intertrochanteric Fractures ◽  
Greater Trochanter ◽  
Wire Tension ◽  
Different Types ◽  
Hip Function

Abstract Background: This study evaluates the effects of wire tension band ventral compression wiring technology paired with artificial femoral head replacement according to the different types of intertrochanteric fractures of the greater trochanter in elderly patients. Methods: Thirty-eight patients with unstable intertrochanteric fractures of the femur treated with artificial femoral head replacement between January 2015 and August 2019 were included. According to the fracture line of the greater trochanter, a new classification system was proposed. Type A fractures include transverse fractures from the greater trochanter tip to the base (2 patients). Type B fractures include oblique fractures from the greater trochanter tip to the base (according to the fracture line direction, type B was further divided into types B1 [4 patients], and B2 [24 patients]). the fracture line of type C fractures runs from the greater trochanter to near the femur end (8 patients). Different wire tension belt ventral compression wiring technologies were used for each fracture type. The Harris hip function score, Parker activity score, and hip pain were evaluated during the follow-up period. Fracture healing and prosthesis positioning, loosening, and dislocation were evaluated using radiographs. Results: The average follow-up period was 28.6 ± 5.8 months. Deep vein embolism was noted in one patient, heterotopic ossification in another, and steel wire fractures in another. All patients had satisfactory fracture healing and femoral prosthesis positioning and no chronic pain. The mean Harris hip function score was 7.21 ± 2.58 preoperatively and 84.74 ± 3.82 at the final follow-up (F = -48.13, P < 0.001).Conclusion: The use of different wire tension band ventral compression wiring technology based on different types of femoral rotation fractures combined with artificial femoral head replacement in elderly patients with unstable intertrochanteric fractures results in favorable clinical outcomes.

scholarly journals 3D printing-based Ganz approach for treatment of femoral head fractures: a prospective analysis

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Jinwu Wang ◽  
Leyi Cai ◽  
Linzhen Xie ◽  
Hua Chen ◽  
Xiaoshan Guo ◽  
...  
Keyword(s):  
Femoral Head ◽  
3D Printing ◽  
Blood Loss ◽  
Surgical Approach ◽  
Type I ◽  
Type Ii ◽  
Femoral Head Fracture ◽  
Hip Function ◽  
The Mean

Abstract Background Femoral head fractures are uncommon injuries. Open reduction and internal fixation (ORIF) of femoral head fracture is the preferred treatment for most patients. There are several surgical approaches and treatments for this difficult fracture. However, the optimal surgical approach for the treatment of femoral head fracture remains controversial. Meanwhile, the operation is difficult and the complications are numerous. We prospectively reviewed patients with femoral head fractures managed surgically through the 3D printing-based Ganz approach to define a better approach with the least morbidity. Patients and methods Between 2012 and 2017, a total of 17 patients were included in this study. An exact 1:1 3D printing model of the injured hip side was fabricated for each patient and simulated surgery was finished preoperative. The surgical approach was performed as described by Ganz. Functional assessment was performed using the modified Merle d’Aubigne scores. The reduction of the fracture was evaluated according to Matta’s criteria. The incidence of complications, such as heterotopic ossification (HO) and avascular necrosis (AVN), and the need for additional surgery were also documented. Results Twelve of 17 patients (four females and eight males) were available for 2 years follow-up. The mean follow-up was 35 months (25–48 months). Average age for the 12 patients was 39.9 ± 12.2 years. According to the Pipkin classification, four patients were type I fracture, three patients were type II fracture, and five patients were type IV fracture. The mean operative time was 124.2 ± 22.1 min, and the estimated blood loss was 437.5 ± 113.1 ml. According to Merle d’ Aubigne scores, excellent results were achieved in six of the 12 patients; four good and two poor results occurred in the rest of the patients. On the radiograph evaluation, fracture reduction was defined as anatomical in eight patients, and imperfect in four. Most patients had good outcomes and satisfactory hip function at last follow-up. Almost all great trochanteric osteectomy healed uneventfully. One patient developed symptomatic AVN of the femoral head and underwent THA at 3 years. After THA, she regained a good hip function with the ability to return to work and almost no reduction in sports activities. Heterotopic ossification was found in four cases (type I-1, type II-2, and type III-1). Conclusions The 3D printing-based Ganz approach provides a safe and reliable approach and satisfactory results of treatment in femoral head fractures. Using 3D printed model for the fracture of the femoral head, the fracture can be viewed in every direction to provide an accurate description of fracture characteristics, which contributes to make a reasonable surgical plan for patients. In addition, the 3D printing-based Ganz approach can obtain excellent surgical exposure and protection of the femoral head blood supply, reduce the operation time and intraoperative blood loss, make the precise osteotomy, anatomically fix the intra-articular fragments, and effectively reduce postoperative complications. Trial registration We register our research at http://www.researchregistry.com. The Unique Identifying Number (UIN) from the Research Registry of the study is researchregistry4847.

scholarly journals Traumatic Obturator Hip Dislocation with Marginal Femoral Head Fracture in a 15-Year-Old Adolescent: A High-Energy Trauma—A Case Report and a Review of the Literature

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Yoann Durand ◽  
Clémence Bruyère ◽  
Marco Saglini ◽  
Aurélien Michel-Traverso
Keyword(s):  
Femoral Head ◽  
Hip Dislocation ◽  
High Energy ◽  
Hip Pain ◽  
X Rays ◽  
Hip Function ◽  
One Year ◽  
High Level ◽  
Joint Limitation

We report the case of a 15-year-old boy brought to the emergency department after a bike accident, complaining of an isolated left hip pain. The X-rays showed an obturator hip dislocation treated by closed reduction under general anaesthesia, followed by 6 weeks of discharge. The follow-up MRI performed 6 weeks after the trauma showed an avascular femoral head necrosis, for which we performed multiple retrograde femoral head drilling, completed by the injection of autologue stem cells from the iliaq crest. One year later, the patient has no hip pain, no joint limitation, and can practice BMX at a high level again. The purpose of this report is to make the physicians aware of this rare problem that may be damaging for hip function, especially in young people.

Unstable trochanteric Fracture Fixation with P.F.N. augmented by T.B.W.

2021 ◽  
Vol 8 (1) ◽  
pp. 39-42
Author(s):  
Dr. Vijay Patil ◽  
Dr. Pandurang Daule ◽  
Dr. Deepak Naikwade
Keyword(s):  
Femoral Head ◽  
Trochanteric Fracture ◽  
Bony Union ◽  
Age Group ◽  
Lateral Migration ◽  
Trochanteric Fractures ◽  
Screw Breakage ◽  
Hip Function ◽  
The Stability

Biomechanically Proximal Femoral Nail (PFN) is a better choice of implant. Still it is associated with screw breakage, cut out through femoral head,”Z” effect, reverse “Z” effect and lateral migration of screws. The purpose of this study is to evaluate the results of augmented PFN in terms of post operative complication and failure rates in unstable trochanteric fracture. Methodology: We did study of 21 unstable trochanteric fractures from Jan 2016 to Nov .2020. 14 patients were males & 7 patients were females. Age group between 25 to 80 was included in this group. There were 15 A0 A2 (2.2, 2.3) and 6 were A0 A3 (3.1, 3.2, 3.3). All fractures were fixed with 25cm, 1350 PFN mainly 11 mm, 12mm in diameter augmented with one or two 16 gauge tension band wire, strengthening lateral trochanteric wall and holding either communiated   fragments or lesser trochanteric fracture. Results: The bone healing was observed in all cases with mean period of 16 weeks. Two patients developed complication of TBW breakage; one developed lateral migration of screws. Patients were followed till # union. At the end of follow up the Salvati and Wilson hip function was 30 (out of 40) in 80% patients. Conclusion: The stabilization of lateral trochanteric wall fracture and communicated fragments with additional one or two TBW increases the stability of construct enhancing bony union & better results.

scholarly journals Errores de osteosíntesis en fracturas laterales de cadera tratadas con placa/tornillo deslizante [Osteosynthesis pitfalls in lateral hip fractures treated with plate / sliding screw system].

2019 ◽  
Vol 84 (4) ◽  
pp. 328-335
Author(s):  
César Ángel Pesciallo ◽  
Leonel Pérez Alamino ◽  
Germán Garabano ◽  
Hernán Del Sel
Keyword(s):  
Hip Fracture ◽  
Femoral Head ◽  
Failure Rate ◽  
Hip Fractures ◽  
Fixation Method ◽  
Intertrochanteric Fractures ◽  
Medial Migration ◽  
Significant Difference ◽  
Proximal Screw

Introducción: El uso de los sistemas placa/tornillo deslizante para fracturas intertrocantéricas ha demostrado ser un método de fijación eficaz, pero no está exento de fallas. El propósito de este estudio fue evaluar las causas de falla en los pacientes con fracturas laterales de cadera, tratados con placa/tornillo deslizante, puntualizando los defectos técnicos en la colocación.Materiales y Métodos: En nuestro centro, se trató a 177 pacientes por fractura lateral de cadera, a 151 de ellos se les practicó osteosíntesis con placa/tornillo deslizante. Se analizaron la adecuada reducción posoperatoria, la medición de la distancia punta a vértice, la posición del tornillo cefálico en la cabeza femoral y las posibles complicaciones.Resultados: La serie quedó conformada por 143 pacientes. El seguimiento promedio fue de 18 meses (rango 12-48). La tasa de fallas fue del 8,4% (n = 12): 7 (4,8%) por migración cefálica (cut-out) del tornillo proximal, 2 (1,4%) por migración medial (cut-through), 2 (1,4%) presentaron seudoartrosis y un caso (0,70%) de reducción inadecuada en varo. El porcentaje de una segunda operación fue del 7,7% (n = 11). La peor posición fue la superior/posterior con un 100% de migración (n = 4) (p <0,001, diferencia estadísticamente significativa).Conclusión: El posicionamiento superior/posterior del tornillo cefálico podría incrementar la posibilidad de migración y, en consecuencia, la tasa de falla del sistema. AbstractIntroduction: The use of Dynamic Hip/Sliding Screw (DHS) for intertrochanteric fractures has proven to be an effective fixation method, but it also has its failures.The purpose of this study was to evaluate the reason of failures in patients with lateral hip fractures that were treated with a DHS.Method:177 patients were treated in our center for lateral hip fracture. In 151 of them we used a DHS. The adequate postoperative reduction, the measurement of the tip-to-apex distance, the position of the cephalic screw in the femoral head and the possible complications were analyzed.Results: The series was made up of 143 patients. The average follow-up was 18 months (range 12-48). The failure rate was 8.4% (n = 12): 7 (4.8%) due to cephalic migration (cut-out) of the proximal screw, 2 (1.4%) due to medial migration (cut-through) , 2 (1.4%) presented pseudoarthrosis and one case (0.70%) of inadequate reduction in varus. The percentage of a second operation was 7.7% (n = 11). The worst position was the superior / posterior with 100% migration (n = 4) (p <0.001, statistically significant difference).Conclusion: The superior / posterior positioning of the head screw could increase the possibility of migration and, consequently, the failure rate of the system.

Improving Care Transitions in Healthcare: A Human Factors/Ergonomics (HFE) Approach

2018 ◽  
Vol 62 (1) ◽  
pp. 551-555 ◽  
Author(s):  
Patrick Waterson ◽  
Abigail Wooldridge ◽  
Abigail Wooldridge ◽  
Mary Sesto ◽  
Ayse Gurses ◽  
...  
Keyword(s):  
Patient Safety ◽  
Elderly Patients ◽  
Medication Management ◽  
Care Transitions ◽  
Pediatric Trauma ◽  
Marrow Transplant ◽  
Different Types ◽  
Hospital To Home ◽  
Orthopedic Patients

Delivering safe healthcare often involves multi-disciplinary teams working across multiple locations. Care transitions are required to provide continuity of care and are often fail due to this type of complexity. Care transitions occur in numerous settings, for example: during shift changes, transfer between wards, or during discharge to the patient’s home (WHO Collaborating Centre for Patient Safety Solutions 2007). The aim of the panel will be to discuss different types of care transitions and how HFE can assist in improving patient safety and efficiency of the process. The panel will discuss and share lessons learnt from a range of projects involving care transitions for pediatric trauma care (Woolridge), and barriers and facilitators to follow-up care for bone marrow transplant survivors (Sesto). In addition, the work system elements for care transitions for elective orthopedic patients (Carman), elderly patients after heart failure hospitalization (Holden) and risks to elderly patients’ safe medication management (Gurses) when transitioning from hospital to home will be discussed.

scholarly journals One-stage simultaneous hip-preserving surgeries for the management of bilateral femoral head osteonecrosis: a mean 7.0-year follow-up

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Wenjun Feng ◽  
Pengcheng Ye ◽  
Shihao Ni ◽  
Peng Deng ◽  
Lu Lu ◽  
...  
Keyword(s):  
Femoral Head ◽  
Group Analysis ◽  
Harris Hip Score ◽  
Greater Trochanter ◽  
One Stage ◽  
Femoral Head Osteonecrosis ◽  
Group A ◽  
Impaction Allografting ◽  
Group B

Abstract Background A retrospective study was conducted to evaluate and compare the clinical and radiological outcomes of one-stage fibular impaction allografting and vascularized greater trochanter flap autografting for the treatment of bilateral osteonecrosis of the femoral head (ONFH). Methods Patients who underwent one-stage aforementioned hip-preserving surgeries due to bilateral ONFH were retrospectively reviewed from January 2008 to December 2013. Sixty-nine patients (138 hips) with a mean age of 31.5 years and mean follow-up of 7.0 years were included. Hips that underwent fibular impaction allografting and vascularized greater trochanter flap autografting were assigned as group A and group B, respectively. Harris Hip Score (HHS) and Visual Analogue Scale (VAS) were used for clinical evaluation, and a series of X-ray images were used for radiological assessment. For inter-group analysis, the paired t test was used for continuous data, and the Wilcoxon rank sum test was used for non-parametric data, while the Mann-Whitney U test was used for intra-group analysis. Results The HHS and VAS in both groups A and B had a substantial advancement when compared with the preoperative level (p < 0.01). Fibular impaction allografting can achieve more pain relief (p < 0.01), though no clinical difference was found in terms of minimal clinically important difference (MCID < 10 points). Group A showed better radiological results than group B (p = 0.04). It was discovered that the appropriate indication for each procedure was patients with Association for Research on Osseous Circulation (ARCO) stages II and III, respectively. Conclusion One-stage hip-preserving surgeries for the management of bilateral ONFH could obtain good medium and long-term outcomes. It was recommended that fibular impaction allografting is more suitable for patients in ARCO stage II, while for patients in ARCO stage III, vascularized greater trochanter flap autografting is a better preference. Trial registration Retrospectively registered.

Sign in / Sign up

Export Citation Format

Share Document