Tips and Tricks in Extracapsular Hip Fracture Fixation

Aside from the decision-making in how to fix an extracapsular hip fracture, surgeons must be conversant with systems, implants and how to maximize their potential in the shortest operative time. We present a series of steps used in our unit when performing both DHS and intramedullary nail surgery to avoid the commonest problems and maximize our patients’ recovery potential.

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Fracture of pubic rami during hip fracture fixation: a rare case of traction table–related injury

BMJ Case Reports ◽

10.1136/bcr-2021-246581 ◽

2022 ◽

Vol 15 (1) ◽

pp. e246581

Author(s):

Austin Gomindes ◽

Mohammedabbas Remtulla ◽

Julian Cooper ◽

Anastasios P Nikolaides

Keyword(s):

Risk Factors ◽

Hip Fracture ◽

Intramedullary Nail ◽

Fracture Fixation ◽

Closed Reduction ◽

Rare Case ◽

Pubic Rami ◽

Reduction Techniques ◽

Morbidity Risk

We present a case of an elderly and comorbid patient who was scheduled to undergo a hip fracture fixation using an intramedullary nail. Unfortunately, this was delayed by 3 weeks as the patient was unfit to undergo this procedure. She was placed onto the traction table and intraoperatively sustained a superior and inferior pubic rami fracture while attempting reduction on the traction table. Closed-reduction techniques using traction tables and perineal posts are not without morbidity. Risk factors such as osteoporosis and delayed-fixation should be accounted for when managing this complex and often frail group of patients.

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Superficial femoral artery injury resulting from intertrochanteric hip fracture fixation by a locked intramedullary nail

Orthopaedics & Traumatology Surgery & Research ◽

10.1016/j.otsr.2009.04.014 ◽

2009 ◽

Vol 95 (5) ◽

pp. 380-382 ◽

Cited By ~ 33

Author(s):

M. Grimaldi ◽

A. Courvoisier ◽

J. Tonetti ◽

H. Vouaillat ◽

P. Merloz

Keyword(s):

Hip Fracture ◽

Femoral Artery ◽

Intramedullary Nail ◽

Superficial Femoral Artery ◽

Fracture Fixation ◽

Artery Injury ◽

Intertrochanteric Hip Fracture

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Laparoscopic resection of rectovaginal endometriosis involving segmental bowel resection and anastomosis: pre‐operative planning, intra‐operative decision making, description of technique, and tips and tricks for a successful outcome.

Colorectal Disease ◽

10.1111/codi.15737 ◽

2021 ◽

Author(s):

T Bainton ◽

V Celentano ◽

J Phillips ◽

O Warren ◽

R Richardson ◽

...

Keyword(s):

Decision Making ◽

Laparoscopic Resection ◽

Bowel Resection ◽

Successful Outcome ◽

Tips And Tricks ◽

Rectovaginal Endometriosis ◽

Segmental Bowel Resection ◽

Operative Planning ◽

Resection And Anastomosis

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Magnetic Targeting Systems for Endo-Bronchoscope Diagnosis and Intramedullary-Nail Surgery: A Review

IEEE Sensors Journal ◽

10.1109/jsen.2021.3059044 ◽

2021 ◽

pp. 1-1

Author(s):

Chin-Chung Chen ◽

Po-Chen Yeh ◽

Chih-Cheng Cheng ◽

Ching-Kai Lin ◽

Tze-Hong Wong ◽

...

Keyword(s):

Intramedullary Nail ◽

Magnetic Targeting ◽

Nail Surgery

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Association between preoperative evaluation with lung ultrasound and outcome in frail elderly patients undergoing orthopedic surgery for hip fractures: study protocol for an Italian multicenter observational prospective study (LUSHIP)

The Ultrasound Journal ◽

10.1186/s13089-021-00230-w ◽

2021 ◽

Vol 13 (1) ◽

Author(s):

Luigi Vetrugno ◽

Enrico Boero ◽

Elena Bignami ◽

Andrea Cortegiani ◽

Santi Maurizio Raineri ◽

...

Keyword(s):

Hip Fracture ◽

Postoperative Complications ◽

Observational Study ◽

Elderly Patients ◽

Fracture Fixation ◽

Frail Elderly ◽

Statistical Power ◽

Lung Ultrasound ◽

Preoperative Evaluation ◽

Cardiac Complications

Abstract Background Hip fracture is one of the most common orthopedic causes of hospital admission in frail elderly patients. Hip fracture fixation in this class of patients is considered a high-risk procedure. Preoperative physical examination, plasma natriuretic peptide levels (BNP, Pro-BNP), and cardiovascular scoring systems (ASA-PS, RCRI, NSQIP-MICA) have all been demonstrated to underestimate the risk of postoperative complications. We designed a prospective multicenter observational study to assess whether preoperative lung ultrasound examination can predict better postoperative events thanks to the additional information they provide in the form of “indirect” and “direct” cardiac and pulmonary lung ultrasound signs. Methods LUSHIP is an Italian multicenter prospective observational study. Patients will be recruited on a nation-wide scale in the 12 participating centers. Patients aged > 65 years undergoing spinal anesthesia for hip fracture fixation will be enrolled. A lung ultrasound score (LUS) will be generated based on the examination of six areas of each lung and ascribing to each area one of the four recognized aeration patterns—each of which is assigned a subscore of 0, 1, 2, or 3. Thus, the total score will have the potential to range from a minimum of 0 to a maximum of 36. The association between 30-day postoperative complications of cardiac and/or pulmonary origin and the overall mortality will be studied. Considering the fact that cardiac complications in patients undergoing hip surgery occur in approx. 30% of cases, to achieve 80% statistical power, we will need a sample size of 877 patients considering a relative risk of 1.5. Conclusions Lung ultrasound (LU), as a tool within the anesthesiologist’s armamentarium, is becoming increasingly widespread, and its use in the preoperative setting is also starting to become more common. Should the study demonstrate the ability of LU to predict postoperative cardiac and pulmonary complications in hip fracture patients, a randomized clinical trial will be designed with the scope of improving patient outcome. Trial registration ClinicalTrials.gov, NCT04074876. Registered on August 30, 2019.

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Is implant sonication useful when screening for infection in conversion of prior hip fracture fixation to total hip arthroplasty?

Journal of International Medical Research ◽

10.1177/03000605211028123 ◽

2021 ◽

Vol 49 (9) ◽

pp. 030006052110281

Author(s):

Yannick Palmowski ◽

Matthias Pumberger ◽

Carsten Perka ◽

Sebastian Hardt ◽

Christian Hipfl

Keyword(s):

Treatment Outcome ◽

Hip Fracture ◽

Total Hip Arthroplasty ◽

Internal Fixation ◽

Hip Arthroplasty ◽

Fracture Fixation ◽

Microbiological Analysis ◽

Total Hip ◽

Osteosynthesis Material ◽

Cutibacterium Acnes

Objective To examine sonication results in presumed aseptic conversion total hip arthroplasty (THA) after hip fracture fixation and to evaluate its implications on the treatment outcome. Methods This retrospective cohort study reviewed the data from presumed aseptic patients that underwent conversion of prior internal fixation of proximal femoral fractures to THA between 2012 and 2018. Microbiological analysis was performed using sonication of osteosynthesis material and tissue samples. Treatment outcome including the occurrence of periprosthetic joint infection (PJI) was recorded. Results A total of 32 patients were included in the study. Of these, five patients (15.6%) had positive intraoperative cultures. The mean follow-up following conversion THA was 43.0 months (range, 19.0–91.5 months). Sonication was positive in three patients (9.4%), all of whom were deemed contaminated and did not develop PJI. Tissue cultures were positive in two patients (6.3%). One patient with Enterococcus faecalis received antibiotic treatment and did not develop PJI. Another patient with growth of Cutibacterium acnes that was initially classified as a contaminant later developed acute PJI caused by the same pathogen. Overall, PJI occurred in two patients (6.3%) after conversion THA. Conclusion Sonication of internal fixation devices did not add diagnostic value in clinically aseptic conversion THA. Further studies are needed to better understand the relevance of unexpected positive cultures, and to develop diagnostic criteria for the management of these patients.

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