scholarly journals Interest of Surgical Treatment of Per-Trochanteric Fractures by Gamma Nail: About 100 Cases

2018 ◽  
Vol 25 (4) ◽  
Author(s):  
Omar Mourafiq ◽  
Youssef Benyias ◽  
Hicham Benomar ◽  
Valery Kamenan ◽  
Jalal Boukhriss ◽  
...  
Keyword(s):  
Trochanteric Fracture ◽  
Functional Results ◽  
The Elderly ◽  
Gamma Nail ◽  
Infectious Complications ◽  
Trochanteric Fractures ◽  
Male Predominance ◽  
Trochanteric Region ◽  
The Military ◽  
Consolidation Time

Gamma nail closed osteosynthesis has surpassed several methods previously used in the treatment of fractures in the trochanteric region.          The objective of the research was to carry out an epidemiological study and to assess the evolutionary profile of patients with per-trochanteric fracture treated with gamma nail.          Materials and methods. In this retrospective study, we report the experience of the Traumatology-Orthopedics Service II of the Military Teaching Hospital Mohamed V-Rabat, in the treatment of per-trochanteric fractures by gamma nail in 100 cases, collected between January 2011 and March 2016.          Results. The average age of our patients was 68 years, with a male predominance of 67%. The most reported etiology (92% of cases) was simple drop. Stable fractures were the most common (81%), with a predominance of simple per-trochanteric fractures. The average response time was 24 hours, the average duration of the surgical procedure was 45 minutes. The rate of infectious complications was 1%; the rate of mechanical complications was 1%. The functional results were excellent and good in 95% of cases. The average consolidation time was 8 weeks.          Conclusions. Trochanteric fracture is a delayed emergency which is seen primarily in the elderly. The gamma nail represents one of the latest improvements in implants for the treatment of these fractures. We report a series of 100 cases of trochanteric fractures treated surgically by gamma nail. The functional results were very encouraging compared to those reported in the literature.  

scholarly journals Breakage of a Third Generation Gamma Nail: A Case Report and Review of the Literature

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Takashi Iwakura ◽  
Takahiro Niikura ◽  
Sang Yang Lee ◽  
Yoshitada Sakai ◽  
Kotaro Nishida ◽  
...  
Keyword(s):  
Rare Complication ◽  
Trochanteric Fracture ◽  
High Strength ◽  
The Elderly ◽  
Gamma Nail ◽  
Bipolar Hemiarthroplasty ◽  
Third Generation ◽  
Trochanteric Fractures ◽  
Cemented Bipolar Hemiarthroplasty ◽  
Fractures Of The Femur

The use of intramedullary nails to treat trochanteric fractures of the femur has increased with the increasing size of the elderly population. The third generation Gamma nail is currently one of the most popular devices for the treatment of trochanteric fractures. Nail breakage is a rare complication, possibly resulting from fatigue fracture of the implant. We present the first reported case of breakage of a third generation Gamma nail that was not used to treat a pathological fracture. An 83-year-old woman with an unstable trochanteric fracture of the femur was treated using a third generation Gamma nail. She was referred to our hospital 14 months postoperatively with nail breakage at the opening for the lag screw. The breakage was secondary to nonunion, which was thought to be mainly due to insufficient reduction of the fracture. The broken nail was removed, and the patient underwent cemented bipolar hemiarthroplasty. At followup 18 months later, she was mobile with a walker and asymptomatic with no complications. This case shows that inadequate operation such as insufficient reduction of the trochanteric fracture may result in nonunion and implant breakage, even when using a high-strength, well-designed implant.

scholarly journals Fractures of the trochanteric region in children and young adolescents—a treatment algorithm for a rare injury

2020 ◽  
Author(s):  
Stephan Payr ◽  
Ellen Payr ◽  
Britta Chocholka ◽  
Manuela Jaindl ◽  
Monika Luxl ◽  
...  
Keyword(s):  
Children And Adolescents ◽  
Femoral Fractures ◽  
Trochanteric Fracture ◽  
High Energy ◽  
Fracture Reduction ◽  
Long Term Results ◽  
Harris Hip Score ◽  
Trochanteric Fractures ◽  
Fractures In Children ◽  
Trochanteric Region

Abstract For femoral fractures of the trochanteric region in children and adolescents, only two mechanisms have been identified to cause a fracture of the proximal femur: high-energy trauma or predisposing bone pathologies with inadequate trauma (e.g., simple fall, movement). We identified 20 patients between 1993 and 2018 with a trochanteric fracture under the age of 18 (12 males; 8 females; mean age, 12 years; range, 4–17 years) who were treated operatively at our department. The mean follow-up of all patients was 50.06 months. All 20 patients were treated operatively. Complications occurred after a mean time of 6.27 months (range, 0.47 to 12.07 months) in two patients. Harris Hip Score was evaluated in all patients with a mean score of 94.16 (range 11 to 100). Eighty-five percent of the patients reached an excellent clinical outcome after treatment. Trochanteric femoral fractures in children and adolescents are very rare accounting for only 1% of all trochanteric fractures. Excellent long-term results can be achieved with an adequate fracture reduction. Conclusion: Physicians treating pediatric trauma have to be aware of other predisponding diseases when low-energy trauma leads to a trochanteric fracture as in this study, 50% of the trochanteric fractures were associated with bone pathologies. What is Known:• Trochanteric femoral fractures in children and adolescents are very rare• In all patients with trochanteric femoral fractures, malignancies have to be ruled outWhat is New:• Awareness of an underlying bone pathology in a high number of cases• Awareness for necessity of a good fracture reduction leading to highly satisfactory results

scholarly journals Treatment of trochanteric fractures using the Gamma nail

2015 ◽  
Vol 21 (1) ◽  
pp. 52-56
Author(s):  
V. Botnaru ◽  
Al. O. Șerban ◽  
Al. Valcu ◽  
B. Obadă
Keyword(s):  
Retrospective Study ◽  
Weight Bearing ◽  
Gamma Nail ◽  
Fracture Reduction ◽  
Trochanteric Fractures ◽  
Surgical Indications ◽  
Septic Complications ◽  
Female Sex ◽  
Reduction Stability ◽  
Consolidation Time

Abstract A retrospective study on 2 years and 4 months (April 2012 - August 2014) on 430 patients admitted with trochanteric fractures in our Clinic. The surgical indications depended on the patients age, degree of osteoporosis, level activity, associated pathologies and the anatomo-clinical particularity of the fractures. The fractures were operated with gamma nail. The surgery was done in the first 24-72 hours, patients were followed clinically and radiographically at 2, 4, 6 months postoperative. The age of the patients were between 28-95 years, female sex was predominant in 65% of case. It was reported a case of a fracture produced intraoperatory during progression of the nail, 11 bronhopulmonary complications, 5 phlebitis, 7 cases of hematoma after surgery, a case of pseudarthrosis with loosening of implant and 4 dead. There were no septic complications. Fractures consolidate within 12- 14 weeks. The results were appreciated according to fracture reduction, stability of implant, consolidation time and possibility of walking and weight bearing on operated limb.

scholarly journals A Evaluation of Initial Treatment of Trochanteric Fractures using Gamma Nails

10.3823/2619 ◽  
2020 ◽  
Vol 13 ◽  
Author(s):  
Quang-Tri LE ◽  
Minh-Hoang Nguyen
Keyword(s):  
Range Of Motion ◽  
Initial Treatment ◽  
Treatment Effectiveness ◽  
Trochanteric Fracture ◽  
The Elderly ◽  
Bone Union ◽  
Military Hospital ◽  
Trochanteric Fractures ◽  
Functional Rehabilitation ◽  
Neck Shaft Angle

Background: Trochanteric fractures are extra-joint fractures, account for 55% of femoral proximal fractures. They often happen in the elderly with increased frequency due to age. Treatment experiences at 7A Military Hospital showed increased trochanteric fracture cases. To properly assess treatment effectiveness and select proper treatment methods, the study of “Evaluation of initial treatment of trochanteric fractures using gamma nails at 7A Military Hospital and made the conclusions of indications and applied techniques” was carried out. The study objectives are evaluating the initial treatment of trochanteric fractures using gamma nails at 7A Military Hospital and made the conclusions of indications and applied techniques. Methods and findings: nineteen patients diagnosed with traumatic trochanteric fractures and surgically treated with Gamma nails were monitored and evaluated for bone fusion, bone union, range of motion, limb shortening, and functional rehabilitation according to Merle D'Aubigné scale. Fourteen patients (82.35%) achieved proper bone union with the femoral neck-shaft angle of 1250 - 1300, three patients (17.65%) got slightly deviated bone union. Amongst patients aged under 60, 14/17 cases (82.35%) achieved “good” and “very good” functional rehabilitation, scored over 15 points according to Merle D΄aubigne Index; 3/17 cases (17.65%) got “average” recovery. Hip range of motion in 14 cases (82.35%) achieved “very good” (normal movement) or “good” (over 10% movement limitation) outcome, 3 cases had “average” movement (17.65%). Limb shortening of below 1cm took place in 10 patients (58.82%), 1 – 2 cm in 4 patients (23,53%) and over 3 cm in 3 patients (17.65%). Conclusions: The surgical treatment of trochanteric fractures using gamma nails yielded positive outcomes. Keywords: Gamma nails, trochanteric fractures, elderly, extra-joint.

scholarly journals Assessment of Functions of the Autonomic Nervous System in the Elderly with Different Comorbid Factors

2020 ◽  
Author(s):  
Sushma S. ◽  
Medha Y Rao ◽  
Shaikh Mohammed Aslam
Keyword(s):  
Elderly Patients ◽  
Predictive Value ◽  
The Elderly ◽  
Common Symptom ◽  
Deep Breathing ◽  
Isometric Handgrip ◽  
Male Predominance ◽  
Healthy Elderly ◽  
Sensitivity Specificity ◽  
Deep Breathing Test

Abstract Background Studies in healthy elderly patients have shown the prevalence of autonomic dysfunction (AD) in the range of 20 to 30%. However, there is paucity in data pertaining to AD in the elderly in the Indian context. Objective To assess the prevalence of AD in the elderly irrespective of their comorbidity status. Methods A total of 141 elderly patients with or without comorbidities/symptoms of AD were included. Demographic and clinical details of the patients were recorded. Autonomic function tests (AFTs) such as deep breathing test, Valsalva ratio, orthostatic heart rate (OHR), isometric handgrip test, and orthostatic blood pressure were performed based on Ewing’s battery of tests. The sensitivity, specificity, positive predictive value, negative predictive value, and the accuracy of AFTs were evaluated. Results Most patients (n = 85) were aged between 60 and 69 years, with a male predominance (58.87%). Hypertension and diabetes mellitus were the most common comorbidities. Postural hypotension was the most common symptom of AD. With advancing age, symptoms of AD manifested significantly more. Overall, 73.8% of patients had AD, of whom 45.4% had early AD. Number of AD symptoms, glycated hemoglobin (HbA1c) level, and comorbid factors (diabetes and hypertension) were significantly associated with the results of AFTs (p < 0.05). AFTs were highly significant with respect to the results obtained (p < 0.001). Deep breathing test, abnormal in majority of study patients, has a sensitivity of 93.3% and OHR has a specificity of 81.1% to determine AD. Conclusion The study concludes that age itself is an independent predictor of AD, which increases in severity if associated with comorbidities.

scholarly journals Hip fractures among the elderly in Kyoto, Japan: a 10-year study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Maki Asada ◽  
Motoyuki Horii ◽  
Kazuya Ikoma ◽  
Tsuyoshi Goto ◽  
Naoki Okubo ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Femoral Neck ◽  
Incidence Rate ◽  
Acute Care ◽  
Hip Fractures ◽  
Age Groups ◽  
The Elderly ◽  
Femoral Neck Fractures ◽  
Age Group ◽  
Trochanteric Fractures

Abstract Summary In Kyoto Prefecture, Japan, the number of hip fractures increased during 2013–2017 compared to 2008–2012. However, the estimated overall incidence rate increased only in femoral neck fractures in men aged ≥75 and women aged ≥85. Purpose The incidence rate of hip fractures in Japan has plateaued or decreased. We investigated the annual hip fracture occurrences in Kyoto Prefecture, Japan, from 2008 to 2017. Methods Patients aged 65 years and above who sustained hip fractures between 2008 and 2017 and were treated at one of the participating 11 hospitals were included. The total number of beds in these institutions was 3701, accounting for 21.5% of the 17,242 acute-care beds in Kyoto Prefecture. The change in incidence rate was estimated utilizing the population according to the national census conducted in 2010 and 2015. Results The total number of hip fractures was 10,060, with 47.5% femoral neck fractures and 52.5% trochanteric fractures. A decrease in number was seen only in trochanteric fractures in the group of 75- to 84-year-old women. The population-adjusted numbers of femoral neck fractures showed a significant increase in all age groups in men, whereas in women, there was an increase in femoral neck fractures in the ≥85 group and trochanteric fractures in the age group 65–74, and a decrease in trochanteric fractures in the age group 75–84. The estimated change in incidence rate showed an increase in femoral neck fractures in men aged ≥75 and women aged ≥85. Conclusion In Kyoto Prefecture, the number of hip fractures increased in the second half of the study period (2013–2017) compared to the first half (2008–2012). However, the incidence rate had not increased, except in femoral neck fractures in men aged ≥75 and women aged ≥85.

Comparative analysis of the economic costs of treating patients with non-infectious diseases of internal osteosynthesis

2020 ◽  
Vol 22 (4) ◽  
pp. 156-160
Author(s):  
V. V. Khominets ◽  
V. Yu. Tegza ◽  
I. V. Foos ◽  
E. M. Pugaev
Keyword(s):  
Comparative Analysis ◽  
Indirect Costs ◽  
Infectious Complications ◽  
Long Bones ◽  
Economic Costs ◽  
Direct And Indirect Costs ◽  
Military Medical Academy ◽  
Limb Fractures ◽  
Primary Osteosynthesis ◽  
The Military

A comparative analysis of the economic costs of revision surgical treatment of 121 patients with non-infectious complications of internal osteosynthesis and 59 patients who underwent primary osteosynthesis for fractures of the long bones of the limbs with an uncomplicated course was carried out. General economic costs include direct and indirect costs. It was found that the total costs for the treatment of patients suffering from non-infectious complications of internal osteosynthesis of the long bones of the extremities, who are in the clinic of military traumatology and orthopedics. G.I. Turner of the Military Medical Academy in the period from 2007 to 2018 revision surgery was performed, amounted to 279637238 rubles, which corresponds to 2311051,55 rubles per patient. At the same time, the total costs for the treatment of patients with fractures of the long bones of the extremities without complications amounted to 44960873 rubles (762048,69 rubles per patient). The total cost per patient with a non-infectious complication of internal osteosynthesis of the femur was 2540499,54 rubles (483824,85 straight, 2056674,69 indirect), of the leg bones 2333762,17 rubles (474501,47 straight, 1859260,70 indirect), the humerus 1830362,75 rubles (399942 straight, 1430420,75 indirect), the bones of the forearm 1804664,6 rubles (339700 straight, 1464964,6 indirect). It was revealed that due to failures after primary osteosynthesis of limb fractures and complications, the costs associated with the direct and indirect costs of their treatment increase. In this regard, further research is needed to improve the treatment of complications of internal osteosynthesis and to develop a set of measures for their prevention. This is important both for the patient and for the health care system as a whole.

Morbidity and Mortality of the Elderly after Early Operation for Trochanteric Fractures

2013 ◽  
Vol 26 (3) ◽  
pp. 199 ◽  
Author(s):  
Se-Ang Jang ◽  
Young-Ho Cho ◽  
Young-Soo Byun ◽  
Ki-Hong Park ◽  
Hyun-Seong Yoo ◽  
...  
Keyword(s):  
The Elderly ◽  
Morbidity And Mortality ◽  
Early Operation ◽  
Trochanteric Fractures

scholarly journals RESULTADOS CLINICOS Y RADIOLOGICOS POSTERIORES AL TRATAMIENTO QUIRURGICO DE FRACTURA DE MESETA TIBIAL EN PACIENTES MILITARES EN ACTIVO DEL CENTRO MEDICO NAVAL DE MEXICO

2021 ◽  
Vol 9 (11) ◽  
pp. 1089-1094
Author(s):  
Camargo-Garcia R. ◽  
◽  
Diaz-De Jesus B. ◽  
Keyword(s):  
Surgical Approach ◽  
Tibial Plateau ◽  
Tibial Plateau Fracture ◽  
Medical Center ◽  
Functional Results ◽  
Daily Activities ◽  
Joint Fractures ◽  
Plateau Fracture ◽  
Military Patients ◽  
The Military

Objective: To lay foundations in the population of theNavy Secretary from Mexico on the frequency, surgical approach, and recovery time of tibial plateau fractures, which would help in the future to develop more efficient protocols for the treatment of these patients and achieve their faster recovery, incorporating into their daily activities of high impact without complications. Materials and methods: We evaluated the functional and radiographic recovery of 20 active military patients with tibial plateau fracture undergoing surgical treatment at the Naval Medical Center of Mexico (CEMENAV) during the period from 2018 to 2021. Results: Of the patients evaluated in this study, it was found that 70% were men, in addition, it was observed that the most frequent tibial plateau fracture was type III, based on the Schatzker scale. Highlighting that the surgical approach most frequently was the previous one >80% of patients. In addition, 45% of patients showed excellent functional recovery, but 15% were poor. However, 90% of the patients had a very good radiographic recovery. Conclusion: The management of proximal tibial joint fractures that occur in the military, which are treated surgically at the Naval Medical Center of Mexico, show favorable functional results accompanied by an adequate radiological evaluation.

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