scholarly journals Treatment of stable and unstable intertrochanteric fractures with selfdynamisable internal fixator (concept of double dynamisation)

2015 ◽  
Vol 72 (7) ◽  
pp. 576-582 ◽  
Author(s):  
Igor Kostic ◽  
Milan Mitkovic ◽  
Milorad Mitkovic
Keyword(s):  
Bone Fractures ◽  
Scoring Systems ◽  
Internal Fixator ◽  
Walking Ability ◽  
Intertrochanteric Fractures ◽  
Duration Of Surgery ◽  
Optimum Period ◽  
Fracture Types ◽  
Fractures Of The Femur

Bacground/Aim. Intertrochanteric fractures of the femur are the third most common fractures among all bone fractures. Today in everyday orthopedic practice a number of different methods of treatment of trochanteric fractures of the femur are applied. Despite the improvement in the development of new implants, the percentage of serious complications of the treatment of these fractures remains very high, varying from 10% to 20%. One of the most serious complications of internal fixation of intertrochanteric fractures is nonunion of fractures due to the lack of additional axial dynamisation of implants. The aim of this study was to determine the efficacy of double dynamisation in stable and unstable intertrochanteric fractures treatment using the self dynamisable internal fixator. Methods. During the period from 2000 to 2009 we analyzed the use of selfdynamisable internal fixator (SIF implant) in the treatment of 247 patients with stable and unstable intertrochanteric fractures. Fracture types were classified according to the AO Fracture Classification/Orthopaedic Trauma Association Scheme. Salvati and Wilson scoring systems were used for functional assessment considering pain, walking ability and hip movements of operated patients. Results. Of the total number of treated patients, 134 were males and 113 females, aged 19 to 90 (average 49.6) years. More than a half of the patients were older than 50 years. Monitoring of the patients after the operation was carried out clinically and radiographically for a period of three to six months in all the patients, whereas a 2-year follow-up was conducted in 176 (71.2%) patients. The average duration of surgery was 47 min, the average blood loss 145 mL, and the average fluoroscopy time was 16 sec (8-97 sec). The average time for union was 3.7 months (3-6.5 months). Double dynamisation (dynamisation along the neck and shaft of the femur) was observed in 85 (34.4%) patients, and was on average 4.3 mm (1.5-8 mm). All fractures managed with dynamisation implants healed completely within no later than six months after the surgery. In 17 cases there was a cut-out phenomenon of implant, while in seven cases there was mechanical implant failure. Complications were detected within 3 to 6 weeks after the surgery, and treated by the method of intramedullary fixation. During the study, there were no cases of infecton and thromboembolic complications detected. Conclusion. The concept of double dynamisation improves the fracture healing in the stable and unstable intertrochanteric fractures using the selfdynamisable internal fixator. This biological method of fixation provides healing of intertrochanteric fracture in the optimum period of time, significantly reducing the risk for mechanical failure.

scholarly journals Functional performance and safety of bone-anchored prostheses in persons with a transfemoral or transtibial amputation: a prospective one-year follow-up cohort study

2018 ◽  
Vol 33 (3) ◽  
pp. 450-464 ◽  
Author(s):  
Ruud A Leijendekkers ◽  
Gerben van Hinte ◽  
Jan Paul Frölke ◽  
Hendrik van de Meent ◽  
Femke Atsma ◽  
...  
Keyword(s):  
Cohort Study ◽  
Back Pain ◽  
Adverse Events ◽  
Functional Performance ◽  
Bone Fractures ◽  
Walking Distance ◽  
Dual Cone ◽  
Walking Ability ◽  
Timed Up And Go

Objectives: (1) To compare level of function, activity, health-related quality of life (HRQoL) and satisfaction in persons with a lower extremity amputation before surgery and 6- and 12-months after implantation of an osseointegration implant and (2) to report adverse events. Design: Prospective cohort study. Setting: University medical centre. Subjects: A total of 40 consecutive persons (median age: 56 years) who received a transfemoral (31) or transtibial (9) osseointegration implant, between April 2014 and March 2016. Intervention: Osseointegration implant surgery followed by a predefined rehabilitation programme. Main measures: Hip abductor strength, prosthetic use, back pain frequency, postoperative pain, mobility level (Timed-Up and Go (TUG) and wheelchair-boundedness), walking ability (6 minute walking test (6MWT) and walking distance in daily life), HRQoL, satisfaction regarding the prosthesis, and adverse events. Results: Strength, prosthetic use, walking distance, HRQoL, and satisfaction level increased significantly at 6- and 12-month follow-up compared to baseline ( P ⩽ 0.002). The TUG showed no change at 6-month follow-up ( P = 0.420) but improved significantly at 12-month follow-up compared to baseline ( P = 0.005). Wheelchair-boundedness decreased from 12/40 participants at baseline to 0 at follow-ups. The 6MWT ( P ⩾ 0.038) and back pain ( P ⩾ 0.437) did not change over time. Stump pain was present in 28/39 and 22/40 of the participants at 6-and 12-month follow-up, respectively. The major adverse events were managed successfully and included three dual-cone breakages and four bone fractures. An uneventful course was completed by 19/31 transfemoral and 4/9 transtibial bone-anchored prostheses users. Conclusion: Bone-anchored prostheses lead to improved performance and appear to be safe, so they might be considered for persons with socket-related problems.

scholarly journals Increased Fracture Collapse after Intertrochanteric Fractures Treated by the Dynamic Hip Screw Adversely Affects Walking Ability but Not Survival

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Christian Fang ◽  
Paata Gudushauri ◽  
Tak-Man Wong ◽  
Tak-Wing Lau ◽  
Terence Pun ◽  
...  
Keyword(s):  
Survival Data ◽  
Dynamic Contact ◽  
Dynamic Hip Screw ◽  
Walking Ability ◽  
Intertrochanteric Fractures ◽  
Term Survival ◽  
Kaplan Meier ◽  
Screw Position ◽  
Hip Screw

In osteoporotic hip fractures, fracture collapse is deliberately allowed by commonly used implants to improve dynamic contact and healing. The muscle lever arm is, however, compromised by shortening. We evaluated a cohort of 361 patients with AO/OTA 31.A1 or 31.A2 intertrochanteric fracture treated by the dynamic hip screw (DHS) who had a minimal follow-up of 3 months and an average follow-up of 14.6 months and long term survival data. The amount of fracture collapse and shortening due to sliding of the DHS was determined at the latest follow-up and graded as minimal (<1 cm), moderate (1-2 cm), or severe (>2 cm). With increased severity of collapse, more patients were unable to maintain their premorbid walking function (minimal collapse = 34.2%, moderate = 33.3%, severe = 62.8%, andp=0.028). Based on ordinal regression of risk factors, increased fracture collapse was significantly and independently related to increasing age (p=0.037), female sex (p=0.024), A2 fracture class (p=0.010), increased operative duration (p=0.011), poor reduction quality (p=0.000), and suboptimal tip-apex distance of >25 mm (p=0.050). Patients who had better outcome in terms of walking function were independently predicted by younger age (p=0.036), higher MMSE marks (p=0.000), higher MBI marks (p=0.010), better premorbid walking status (p=0.000), less fracture collapse (p=0.011), and optimal lag screw position in centre-centre or centre-inferior position (p=0.020). According to Kaplan-Meier analysis, fracture collapse had no association with mortality from 2.4 to 7.6 years after surgery. In conclusion, increased fracture collapse after fixation of geriatric intertrochanteric fractures adversely affected walking but not survival.

scholarly journals Zimmer Natural Nails in the Treatment of Unstable Intertrochanteric Fractures: A Longitudinal Study

2021 ◽  
Author(s):  
C Yashavanth Kumar ◽  
P Ashok Kumar ◽  
P Rahul ◽  
Harshad M Shah ◽  
Sandesh Patil ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Intertrochanteric Fractures ◽  
Chi Square ◽  
Female Ratio ◽  
Radiological Results ◽  
Significant Difference ◽  
Duration Of Surgery ◽  
Radiological Healing ◽  
Functional And Radiological Results

Introduction:Cephalomedullary nails are preferred over intramedullary nails for internal fixation of unstable intertrochanteric fractures; however, they are associated with complications as they do not match the anatomy of the proximal femur to a great extent. Aim: To investigate functional and radiological results of Zimmer natural nails in the management of unstable intertrochanteric fractures. Materials and Methods: A longitudinal prospective study of 99 patients with unstable intertrochanteric fractures was carried out. All patients underwent closed reduction and internal fixation with 180 mm short Zimmer natural nails. Follow-up visits were scheduled for six weeks, three months, and six months for radiological healing and mobility measurements using RUSH and Parker scores, respectively. Statistical analysis was performed using Chi-square and ANOVA. Results: Mean age of patients was 69.77±11.47 years with a male to female ratio of 1:1. A majority of patients had co-morbidities like diabetes mellitus and hypertension. Average duration of surgery was 58.38 minutes with no statistically significant difference among the different categories of unstable intertrochanteric fractures. Fixation of fractures with Zimmer natural nails increased Parker score and RUSH score consistently with each follow-up visit (p<0.05). There were no postoperative complications in 93.94% cases. Conclusion: This study emphasised good functional and radiological results of Zimmer natural nails in the treatment of unstable intertrochanteric fractures.

scholarly journals Midterm outcome analysis of bipolar hemiarthroplasty for unstable intertrochanteric femur fractures: A retrospective study

2020 ◽  
Author(s):  
Hongman CHO ◽  
Sun Do Kim ◽  
JiYeon Park ◽  
KiHyun Kwon ◽  
Young Lee
Keyword(s):  
Cortical Bone ◽  
Femoral Stem ◽  
Harris Hip Score ◽  
Walking Ability ◽  
Intertrochanteric Fractures ◽  
Hip Hemiarthroplasty ◽  
Vas Scores ◽  
Group B ◽  
Selection Of

Abstract Background: Recent advances in medical systems and technologies have resulted in increased survival after intertrochanteric fractures of the femur, requiring the selection of appropriate femoral stems considering mid- to long-term durations. We performed hip hemiarthroplasty for unstable intertrochanteric fractures using a Wagner cone femoral stem (Group A) and double tapering right angled femoral stem (C2 stem, Group B), and evaluated the clinical imaging results. Methods From January 2004 to December 2013, 79 patients (79 hips) who underwent hip hemiarthroplasty with a cone stem (36 cases) and C2 stem (43 cases) were included. During the follow-up period, clinically, changes in pain (visual analog scale [VAS] score), walking ability, and Harris Hip score were examined. Radiologically, changes in the proximal femur were observed. We also reviewed the complications that occurred. Results Patients’ mean ages were 77.2 (70-83) years and 78.6 (70-84) years, and mean follow-up periods were 84.7 (60-108) months and 85.4 (60-96) years in Groups A and B, respectively. Postoperative pain (VAS score) and the Harris hip score were not significantly different between the groups until 24 months and 36 months, respectively. However, VAS scores from 36 months postoperatively and Harris hip scores from 48 months postoperatively indicated that Group B patients had significantly higher VAS scores and lower Harris hip scores. There was no significant difference in walking ability between the groups; however, in Group B, walking ability was reduced by one grade in 13 patients and by two grades in nine. Cortical bone osteoporosis occurred in four and 14 cases in Groups A and B, respectively. In Group B, five patients developed cortical bone resorption, and four of them had nonunion of trochanteric fracture fragments. Conclusions Hip hemiarthroplasty using a cementless femoral stem for unstable intertrochanteric fractures requires careful selection of the stem, considering the remaining life of the patient. When using a 3C stem for unstable intertrochanteric fractures, it is thought that the firm fixation of fractured trochanteric fragments is necessary, and for a reverse oblique fracture, it is better to use the 3B stem with a suitable length.

Effect of Osteoplasty with Bioactive Glass (S53P4) in Bone Healing - In vivo Experiment on Common European Rabbits (Oryctolagus cuniculus)

2018 ◽  
Vol 69 (2) ◽  
pp. 429-433
Author(s):  
Solyom Arpad ◽  
Cristian Trambitas ◽  
Ecaterina Matei ◽  
Eugeniu Vasile ◽  
Fodor Pal ◽  
...  
Keyword(s):  
Bioactive Glass ◽  
Bone Fractures ◽  
Healing Process ◽  
Bone Grafts ◽  
Bone Substitutes ◽  
Native Bone ◽  
European Rabbits ◽  
Autologous Bone Grafts ◽  
Fracture Types

Osteoplasty, is a procedure mostly applied in complicated bone fractures. Nowadays this method is widely used in primary fracture treatment while the native bone graft is progressively replaced with various synthetic bone substitutes. From the numerous bone grafts we�d like to mention a representative of ceramics, the S53P4 bioactive glass. (BonAlive�). The aim of this study was to investigate the healing process of different fracture types generated on rabbit femurs. During this experiment we used seven common European rabbits. We separated these animals into two groups; in the first group we surgically generated a total fracture in the middle 1/3 of the femur, while in the second group, we produced only a bone defect on the femur. The osteoplasty was carried out with bioactive glass and autologous bone grafts. The radiographic follow-up was immediate after the operation and after 3, 6 and 7 weeks. The animals were euthanized after 19, 20 and 21 weeks, for histomorphometric examination of the femur. It was also studied the ionic release from the used bioactive glass at physiological pH and the etching of the glass was studied by Scanning Electron Microscopy.

Nuances and Management of Hilar Submandibular Sialoliths With Combined Transoral Robotic Surgery–Assisted Sialolithotomy and Sialendoscopy

2020 ◽  
pp. 019459982097323
Author(s):  
Christopher Z. Wen ◽  
Jennifer E. Douglas ◽  
Mohamed Elrakhawy ◽  
Ellen A. Paul ◽  
Christopher H. Rassekh
Keyword(s):  
Robotic Surgery ◽  
Submandibular Gland ◽  
Academic Medical Center ◽  
Transoral Robotic Surgery ◽  
Symptom Improvement ◽  
Stone Size ◽  
Duration Of Surgery ◽  
Tissue Manipulation ◽  
Preservation Rate

Objective To describe the management, technical nuances, and success rates of transoral robotic surgery (TORS)–assisted sialolithotomy. Study Design Retrospective database review. Setting Quaternary academic medical center. Methods Between the months of January 2015 and May 2019, patients with hilar submandibular gland stones underwent 2 main variations of TORS-assisted sialolithotomy and sialendoscopy: (1) TORS followed by sialendoscopy for patients with palpable predominantly single stones and (2) either sialendoscopy followed by TORS and sialendoscopy or sialendoscopy followed by TORS only for patients with nonpalpable or multiple stones. Clinical charts were reviewed to collect data, including stone size (imaging review, intraoperative measurement), palpability, duration of operation, TORS variation, operative challenges, symptom improvement, gland preservation rate, and complications. Results Thirty-seven patients were identified. Patients were 26 to 80 years old (mean, 57.2 years), and 40.5% were female. Twenty-four patients (64.9%) underwent TORS followed by sialendoscopy; 10 (27.0%), sialendoscopy followed by TORS and sialendoscopy; and 3 (8.1%), sialendoscopy followed by TORS only. The mean stone size was 12.4 mm (range, 4-28 mm). Eleven patients had multiple stones with a mean 4 stones per patient (range, 2-9). Procedural success was 91.9% (34/37) at a mean follow-up of 34.2 weeks (range, 1.4-262.1), and the gland preservation rate was 97.3% (36/37). No patients reported symptoms of lingual nerve injury at 3-month follow-up. Conclusion TORS combined with sialendoscopy for hilar submandibular gland sialolithiasis allows for improved visualization of critical anatomy, tissue manipulation, and operative flexibility. In our experience, the operative success rate is high, and duration of surgery compares favorably with conventional combined hilar approaches.

scholarly journals Open Versus Endoscopic Osteotomy of Posterosuperior Calcaneal Tuberosity for Haglund Syndrome: A Retrospective Cohort Study

2021 ◽  
Vol 9 (4) ◽  
pp. 232596712110010
Author(s):  
Yanbin Pi ◽  
Yuelin Hu ◽  
Qinwei Guo ◽  
Dong Jiang ◽  
Xin Xie ◽  
...  
Keyword(s):  
Cohort Study ◽  
Learning Curve ◽  
Endoscopic Surgery ◽  
Extent Of Resection ◽  
Endoscopic Procedure ◽  
Postoperative Outcomes ◽  
Open Procedure ◽  
Surgery Group ◽  
Duration Of Surgery

Background: Although endoscopic calcaneoplasty and retrocalcaneal debridement have been extensively applied to treat Haglund syndrome, evidence of the value of the endoscopic procedure remains to be fully established. Purpose/Hypothesis: The purpose of this study was to compare the postoperative outcomes and the amount of osteotomy between open and endoscopic surgery for the treatment of Haglund syndrome. It was hypothesized that endoscopic calcaneoplasty would lead to higher patient satisfaction and lower complication rates compared with open surgical techniques. Study Design: Cohort study; Level of evidence, 3. Methods: The following postoperative outcomes were compared between the open surgery group (n = 20) and the endoscopic surgery group (n = 27): visual analog scale for pain, American Orthopaedic Foot & Ankle Society ankle-hindfoot scale, Foot Function Index, Tegner score, Ankle Activity Score, and 36-Item Short Form Health Survey; postoperative complications; and duration of surgery. To determine the extent of resection, the authors compared the calcaneal height ratio, calcaneal resection ratio, calcaneal resection angle, pitch line, and Haglund deformity height between groups. The learning curve for endoscopic calcaneoplasty was also calculated. Results: There were no significant differences between the open and endoscopic groups on any outcome score. Two patients in the open group reported temporary paresthesia around the incisional site, indicating sural nerve injuries; no complication was reported in the endoscopy group. None of the parameters for extent of resection were statistically significant between the groups. The duration of surgery was 44.90 ± 10.52 and 65.39 ± 11.12 minutes in the open and endoscopy groups, respectively ( P = .001). Regarding the learning curve for endoscopic calcaneoplasty (6 surgeons; 27 follow-up patients; 9 patients lost to follow-up), the duration of surgery reached a steady point of 55.68 ± 4.19 minutes after the fourth operation. Conclusion: The results of this study indicated that the endoscopy procedure was as effective as the open procedure. The endoscopic procedure required significantly more time than the open procedure, and the duration of the endoscopic procedure was shortened only after the fourth operation, suggesting that it requires high technical skills and familiarity with the anatomic relationships.

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