Acetabular Migration of Lag Screw of Intramedullary Nail Used as Treatment for Intertrochanteric Fracture. Case Study

Most trochanteric fractures of the femur are classified as low-energy fractures as they are seen in people with decreased mechanical properties of bone tissue. The treatment is assumed to provide biomechanical fixation with the possibility of dynamization between bony fragments to stimulate the biological processes of bone union. The aim of the study was to analyze a complication presenting as migration of the cervical screw of an intra­medullary nail towards the hip joint acetabulum and present the therapeutic management of this complication. The case report concerned a 74-year-old patient with an AO/OTA type 31 A2.2 fracture of the trochanteric massif of the right femur treated with the Gamma3 intramedullary nail. An assessment of changes over time of the radiological appearances on A-P images after the surgery showed migration of the cervical screw towards the acetabulum and displacement of the major trochanter fracture. Extensive destruction of the acetabular fossa made biologic restorative treatment impossible. A total hip joint prosthesis with a modular stem and MDM articulation was implan­ted and the trochanter was fixed with a "hook" plate with a "cable system". The postoperative course was uneventful. Failure to perform axial radiographs in the preoperative and postoperative period made it impossible to objectively determine the type of fracture and the quality of screw insertion into the femoral neck, and assessment limited to A-P images turned out to be deceptive. The wandering of the screw towards the acetabulum led to extensive destruction of the acetabular fossa. The decision to stop biological treatment, which, if properly performed, stimulates bone union, and perform the mechanical procedure of endoprosthesoplasty was fully prognostically justified. The early and late postoperative course was not complicated.

Cementless Hemiarthroplasty Without Femoral Calcar Reconstruction Versus Cemented Hemiarthroplasty for Unstable Intertrochanteric Fractures in octogenarians

Background The aim of this study was to compare the mid-term outcomes of cementless hemiarthroplasty without femoral calcar reconstruction with cemented hemiarthroplasty in patients aged 80 years or more. Methods From January 2015 to December 2017, 135 patients with unstable intertrochanteric fractures were retrospectively investigated, 70 patients were treated with the cemented hemiarthroplasty while 65 patients were treated with a modular long-stem cementless hemiarthroplasty without rebuilding calcar. Clinical and radiological results were analyzed. Results The 106 alive patients were followed for 62.1 ± 8.3 months, and 29 patients died during the follow-up period. No significant differences were found in terms of demographic and clinical characters of patients, weight training time, postoperative hospital stay length, postoperative ambulatory status and Harris hip score. Patients treated with cementless hemiarthroplasty had a shorter operative time, less estimated blood loss, less amount of blood transfusion and a lower one-year mortality compared with patients treated with cemented hemiarthroplasty. Conclusions Compared with cemented hemiarthroplasty, cementless hemiarthroplasty using a long modular stem without reconstruction of femoral calcar was a good choice for octogenarians with unstable intertrochanteric fractures.

Dual Modular Titanium Alloy Femoral Stem Failure Mechanisms and Suggested Clinical Approaches

Titanium (Ti) alloys have been proven to be one of the most suitable materials for orthopaedic implants. Dual modular stems have been introduced to primary total hip arthroplasty (THA) to enable better control of the femoral offset, leg length, and hip stability. This systematic review highlights information acquired for dual modular Ti stem complications published in the last 12 years and offers a conclusive discussion of the gathered knowledge. Articles referring to dual modular stem usage, survivorship, and complications in English were searched from 2009 to the present day. A qualitative synthesis of literature was carried out, excluding articles referring solely to other types of junctions or problems with cobalt-chromium alloys in detail. In total, 515 records were identified through database searching and 78 journal articles or conference proceedings were found. The reasons for a modular neck fracture of a Ti alloy are multifactorial. Even though dual modular stems have not shown any clinical benefits for patients and have been associated with worse results regarding durability than monolithic stems, some designs are still marketed worldwide. Orthopaedic surgeons should use Ti6Al4V dual modular stem designs for primary THA in special cases only.

Modular stem in total hip arthroplasty for patients with trochanter valgus deformity: surgical technique and case series

Background: Trochanter valgus deformity (TVD) is a rare condition of total hip arthroplasty (THA). Femoral osteotomy could be required in correcting the deformity to implant femoral stem in severe TVD. In this study, we described one unpublished technique of reverse sleeve of S-ROM to get through the complex situation. This study aimed to summarize and evaluate its technical challenges, safety and effectiveness.Methods: From January 2006 to December 2014, we enrolled patients whose sleeves were implanted towards the great trochanter in THA with TVD. Their demographics, perioperative and postoperative information were recorded. To explore its indication, we measured and analyzed the ratio of greater trochanter/lesser trochanter (G/L ratio) and trochanter valgus angle (TVA).Results: Twelve patients (1 male and 11 female, average age 42.30±10.23) had mean follow-up of 6 years. Among them, only two patients had intraoperative femoral fracture. The survivorship of femoral prosthesis was 100%. The Harris hip score (HHS) increased from preoperative 34.31±14.43 to postoperative 84.12±11.33. All patients’ G/L ratio were larger than 1.50.Conclusions: The reverse sleeve of S-ROM was a reliable method for the patients with severe TVD, which brought satisfying clinical outcomes in mid-term follow-up.Keywords: cementless modular stem; reverse sleeve; total hip arthroplasty; trochanter valgus deformity.