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 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 Treatment of Intertrochanteric Femur Fractures with Hip Arthroplasty in Older Patients: A Narrative Review of Indications and Outcomes

Medicina ◽  
2021 ◽  
Vol 57 (8) ◽  
pp. 763
Author(s):  
Tiago Martinho ◽  
Karl Stoffel
Keyword(s):  
High Risk ◽  
Surgical Technique ◽  
Internal Fixation ◽  
Functional Outcome ◽  
Hip Arthroplasty ◽  
Older Patients ◽  
Bipolar Hemiarthroplasty ◽  
Intramedullary Nails ◽  
Fixation Failure ◽  
Femur Fractures

Intertrochanteric femur fractures are common in older patients and often have a significant impact on disability. The treatment aims to achieve a rapid return to the prior functional level with a low rate of complications and mortality. Surgical management by internal fixation is the mainstay of treatment for most of these fractures. Even when treated with intramedullary nails, the overall complication rates are high, especially for unstable or highly comminuted fractures or in the presence of poor bone quality. Hip arthroplasty is an alternative in older patients with intertrochanteric femur fractures at high risk of fixation failure or with concomitant intraarticular pathologies. Especially patients whose condition precludes prolonged bedrest and who are at risk of significant deterioration if their locomotor function cannot be restored rapidly are likely to benefit from hip arthroplasty. The choice of the surgical technique mainly depends on the surgeon’s preferences and the fracture characteristics. Bipolar hemiarthroplasty is the most common type of prosthesis used with primary or revision femoral stems. Compared with intramedullary nails, hip arthroplasty has a better early functional outcome and lower rates of surgical complications as well as reoperations. However, the functional outcome and the mortality rate in the longer term tend to favor intramedullary nails, even though the results are inconsistent, and a statistically significant difference cannot always be obtained. Currently, there are no guidelines that define the role of hip arthroplasty in the treatment of intertrochanteric femur fractures in older patients. The literature only offers an overview of the possibilities of the usage of hip arthroplasty, but methodological limitations are common, and evidence levels are low. Further studies are needed to identify the intertrochanteric fractures that are at high risk of internal fixation failure, the characteristics that determine which patients may benefit most from hip arthroplasty, and the optimal surgical technique.

scholarly journals Internal Fixation of Intertrochanteric Hip Fractures: A Clinical Comparison of Two Implant Designs

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Ran Tao ◽  
Yue Lu ◽  
Hua Xu ◽  
Zhen-Yu Zhou ◽  
You-Hua Wang ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Weight Bearing ◽  
Harris Hip Score ◽  
Femur Fractures ◽  
Fixation Devices ◽  
Duration Of Surgery ◽  
Envelope Method ◽  
Bony Healing ◽  
Proximal Femur Nail

Objective. To compare two internal fixation devices clinically in stabilisation of intertrochanteric femur fractures.Methods. Eighty-seven patients were randomised upon their admission to the hospital using a sealed envelope method. Forty-five were treated with proximal femur nail antirotation (PFNA) and 42 with reverse less invasive stabilisation system (LISS). The perioperative data were recorded and compared in relation to fracture type.Results. In each type of fractures, no significant differences were found with respect to the blood loss, the quality of reduction, the time to bony healing, and the Harris hip score between the 2 groups. The mean duration of surgery was significantly longer in reverse LISS group than in PFNA group.Conclusion. Both the PFNA and the reversed LISS are effective in the treatment of different types of intertrochanteric femur fractures. PFNA is superior to reverse LISS in terms of surgical time, weight-bearing, and perhaps fluoroscopy time.

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 Role of percutaneous cerclage wire in the management of subtrochanteric fractures treated with intramedullary nails

2018 ◽  
Vol 21 (1) ◽  
pp. 42-49 ◽  
Author(s):  
Vivek Trikha ◽  
Saubhik Das ◽  
Prabhat Agrawal ◽  
Arkesh M ◽  
Sunil Kumar Dhaka
Keyword(s):  
Intramedullary Nails ◽  
Cerclage Wire ◽  
Subtrochanteric Fractures

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.

scholarly journals Functional outcome of Subtrochanteric Fractures of femur fixed with Dynamic Condylar Screw (DCS).

2020 ◽  
Vol 27 (02) ◽  
pp. 225-229
Author(s):  
Masroor Ahmed ◽  
Ghulam Hussain ◽  
Mukesh Kumar ◽  
Nida ◽  
Rukhsana Hamid
Keyword(s):  
Functional Outcome ◽  
Road Traffic ◽  
Subtrochanteric Fracture ◽  
Female Ratio ◽  
Subtrochanteric Fractures ◽  
Femur Fractures ◽  
Dynamic Condylar Screw ◽  
Quasi Experimental ◽  
Subtrochanteric Femur Fractures ◽  
Male To Female

Objectives: To determine functional outcome of Subtrochanteric femur fractures fixed with dynamic condylar screw. Study Design: Single group quasi experimental study. Setting: Orthopedic Surgery, creek general hospital, united medical and dental college and KVSS SITE hospital Karachi. Period: 15th February 2015 to 30th November 2016. Material & Methods: All the patients with Type 32A (A1, A2 and A3) subtrochanteric fractures of femur presenting within two weeks of injury were included in the study. Functional outcome was assessed by modified Schatzker and Lambert Criteria. Results: 79 patients with closed subtrochanteric fractures were included in study. The mean age of the patients was 41.2±12.98 years, mean duration of fracture was 4.58±1.25 days. Male to female ratio was 2.04 to 1, 42(53.16%) were injured in road traffic accident and 37(46.84%) were due to fall, right side were effected in 40.51% cases and left side effected in 59.49% cases. Acceptable functional outcome achieved in 82.28% (65/79) of cases. Conclusion: We conclude that open reduction and internal fixation are the best procedure to treat difficult fractures like subtrochanteric fractures and to avoid complications like implant failure, nonunion, and mal-union. In our study we attained satisfactory results by the use of dynamic condylar screw in patients with subtrochanteric fracture of femur.

scholarly journals Minimally invasive plate osteosynthesis of lower end of femur fractures using locking compression plating: a prospective study

2017 ◽  
Vol 3 (5) ◽  
pp. 1043 ◽  
Author(s):  
Raghu Kumar J. ◽  
Prasanna Anaberu ◽  
Vinit M. Oswal
Keyword(s):  
Minimally Invasive ◽  
Internal Fixation ◽  
Closed Reduction ◽  
Distal Femur ◽  
Tissue Injury ◽  
Plate Osteosynthesis ◽  
Weight Bearing ◽  
Soft Tissue Injury ◽  
Minimally Invasive Plate Osteosynthesis ◽  
Femur Fractures

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">The treatment of distal femur fractures has recently evolved towards indirect reduction and minimally invasive techniques. The goal is to strike a balance between the mechanical stability of the fragments and the biological viability. Pre-contoured Locking compression plates (LCPs) have shown to give best results in terms of recovery, fracture union, return to work and functional outcome. Advent of MIPO technique has reduced the amount of soft tissue injury, delayed healing, tissue necrosis and infections.</span>The objective was <span lang="EN-IN">to study the functional result of fracture distal femur treated by closed reduction with LCP by minimally invasive plate osteosynthesis (MIPO).</span></p><p class="abstract"><strong>Methods:</strong> 20 cases of fracture distal end of femur were treated by closed reduction and internal fixation using LCP by MIPO between 1st October 2013 to 30th September 2015 at our centre. The patients were evaluated clinically and radiologically for functional outcomes. All patients were followed up for an average of 12 months. Outcome was assessed using NEER’s score.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">8 of my patients were male and 12 were female. All of them were closed injuries and fresh cases. The mean age was 51.8 years (21-68 yrs). 13 patients sustained RTA and 7 patients had accidental fall. 8 patients had right sided distal femur fracture and 12 had left sided injury. According to NEER’s score 50% had excellent results, 35% had good results and 15% had fair results. Gait and weight bearing after union was satisfactory. Range of motion of knee joint in majority of patients was within acceptable limits. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">Closed reduction and internal fixation of fracture lower end of femur by MIPO using LCP is one of the best modalities of treatment for good results.</span></p>

STUDY OF PROXIMAL FEMORAL NAILING IN THE MANAGEMENT OF SUBTROCHANTERIC FRACTURES OF FEMUR

2021 ◽  
pp. 77-79
Author(s):  
Nilabh Kumar ◽  
Laljee Chaudhary ◽  
Debarshi Jana
Keyword(s):  
Early Mobilization ◽  
Subtrochanteric Fracture ◽  
Harris Hip Score ◽  
Subtrochanteric Fractures ◽  
Femur Fractures ◽  
Intramedullary Device ◽  
Fracture Table ◽  
Nail Insertion ◽  
Subtrochanteric Femur Fractures ◽  
Proximal Femoral Nailing

Background:The proximal femoral nail (PFN) used as an intramedullary device for the treatment of fractures. Objectives: Study was taken to analyse the union of the subtrochanteric fracture, internally xed with PFN. Materials and Methods: Study was conducted in the Department of Orthopaedics, DMCH, Laheriasarai, Bihar from June 2019 to November 2019. Individuals with acute subtrochanteric femur fractures >18 years were included in the study. The patient was positioned supine on the fracture table under spinal or epidural or general anesthesia as the condition of the patient permitted. Pre-operatively one dose of antibiotic was also administered. The fracture was reduced by longitudinal traction on fracture table and the limb was placed in neutral or slight adduction to facilitate nail insertion through the greater trochanter ; P <0.05 was considered statistically signicant. Results: At the end of ve months, all except three patients could mobilise independently; statistically there was signicant difference (P<0.05). Based on Harris Hip score obtained 3 patients outcome was excellent, 18 patients were good and 4 patients had fair outcome. Conclusion: Minimal exposure, better stability and early mobilization are the advantages with PFN. Fractures united in all cases and postoperative functional outcome was satisfactory. PFN could be a preferred implant of choice in treating subtrochanteric fractures especially in elderly.

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