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Unstable proximal femoral fractures and pathological lesions involving the trochanteric region in the elderly comprise an increasing workload for the trauma surgeon as the ageing population increases. This study aims to evaluate use of the Russell-Taylor reconstruction nail (RTRN) in this group with regard to mortality risk, complication rates and...
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Dynamic hip screw (DHS) has been the standard treatment for stable trochanteric fracture patterns, but complications of lag screw cut out from a superior aspect, due to inadequate bone anchorage, occur frequently in elderly osteoporotic patients. Polymethylmethacrylate (PMMA) has been used as an augmentation tool to facilitate fixation stability in...
Citations
... [3] had a mean age of 80 years showed mortality of 16%. [15] had a higher reoperation rate of 16.6% whereas in our study we had a reoperation rate of 8% only. [8] in a follow up of 100 patients had reoperation rate of 1%. ...
There is an increase in the incidence of the intertrochanteric fracture due to the rise in the life expectancy of the people. The intertrochanteric fracture is commonly surgically treated by either DHS or PFN. The hospital database was searched for all intertrochanteric fractures over three years (2015 through 2018). This is a retrospective study done in 100 patients with intertrochanteric fractures treated by PFN (66 patients) and DHS (34 patients). Both the devices were compared in terms of complications and outcomes. The various complications that occurred in patients with intertrochanteric fracture treated are bed sores(15%), shortening more than 1cm(10%), reoperation due to implant related complications(8%), varus collapse(5%), persistent hip pain(5%), restriction of hip movements(5%), deep vein thrombosis(3%), screw migration (3%), failure to achieve closed reduction(3%), compression lag screw cutout (3%), fracture of lateral cortex(2%), mortality(2%), post-operative wound infection(2%), periprosthetic fracture (1%), mean blood loss in DHS(300ml) whereas in PFN(200ml).
... Los clavos intramedulares han demostrado ser la mejor opción de tratamiento, pero ningún implante ha demostrado ser superior a otro. 1,3,5,6,7 Existen estudios que comparan el uso de clavos intramedulares en los que varía el punto de entrada para la inserción del clavo en el tratamiento de estas fracturas, pero no hemos encontrado estudios en la literatura que comparen dos clavos que usen el mismo punto de entrada femoral. Nuestro estudio pretende estudiar de forma retrospectiva los resultados obtenidos usando dos clavos intramedulares diferentes que utilizan un mismo punto de entrada para el tratamiento de fracturas subtrocantéreas en el paciente anciano. ...
... Estos estudios se basan en diferenciar clavos con diferentes puntos de entrada. 6,14 El Russel Taylor es un clavo recto que tiene su punto de entrada al nivel de la fosa piriforme, mientras que tanto los clavos Gamma3 www.medigraphic.org.mx como los nuevos clavos de reconstrucción T2 Recon, tienen su punto de inserción más lateral, justo en la punta del trocánter mayor. ...
Introduction:
Subtrochanteric fractures are associated with a high rate of complications. Intramedullary nails have proven to be the best choice for treatment, but no implant has been shown to be superior to another. We want to study the differences between treating subtrochanteric fractures in the elderly with two different types of nails: T2 Recon vs Gamma3 long.
Material and methods:
Comparative retrospective study between 2013 and 2015 with 54 patients with subtrochanteric fractures and more than 65 years. The average follow-up is 12 months; 26 patients were treated with T2 Recon, and 28 with Gamma3. The duration of surgery, need for transfusion, evolution and complications of fractures were compared in both groups.
Results:
The duration of surgery was significantly longer for T2 Recon (p = 0.035), while the need for transfusion and fracture evolution were similar in both groups. Three cases required another surgery to achieve the final consolidation of the fracture. Two of them due to a failure of the T2 Recon implant, which represents 7.69% of the patients in this group, while the other case belonged to the Gamma3 group and it was sufficient to perform a nail dynamization.
Conclusions:
We found no statistically significant differences, except for a longer surgical time in the T2 Recon group, being a surgeon-dependent variable that is not enough to prove that one nail is better than another.
... Los clavos intramedulares han demostrado ser la mejor opción de tratamiento, pero ningún implante ha demostrado ser superior a otro. 1,3,5,6,7 Existen estudios que comparan el uso de clavos intramedulares en los que varía el punto de entrada para la inserción del clavo en el tratamiento de estas fracturas, pero no hemos encontrado estudios en la literatura que comparen dos clavos que usen el mismo punto de entrada femoral. Nuestro estudio pretende estudiar de forma retrospectiva los resultados obtenidos usando dos clavos intramedulares diferentes que utilizan un mismo punto de entrada para el tratamiento de fracturas subtrocantéreas en el paciente anciano. ...
... Estos estudios se basan en diferenciar clavos con diferentes puntos de entrada. 6,14 El Russel Taylor es un clavo recto que tiene su punto de entrada al nivel de la fosa piriforme, mientras que tanto los clavos Gamma3 www.medigraphic.org.mx como los nuevos clavos de reconstrucción T2 Recon, tienen su punto de inserción más lateral, justo en la punta del trocánter mayor. ...
... Several studies in literature have similar result. Rethnam et al in 2007 studied the outcome of 42 patients above 60 years of age and found that most of them had poorer outcomes with higher complication rate [13] . Korkmaz et al in their study reported that HHS negatively correlated with ASA score and patient's age [6] . ...
... Longer antirotation screws increases the cutout risk because in this situation, the thinner screw assumes a load-bearing function. Domingo et al. [5] Rethnam et al. [13] Korkmaz et al. [6] Menezes et al. [15] Seo et al. [10] Simmermacher et al. [ ...
... In the present series 8 % complications were present. Alvarez et al. [11] reported two out of 42 cases that developed infection [12] . In our study, superficial infection was present in 1 patient, which respond to wound care and antibiotics with no sign of osteomyelitis at final Follow up. ...
... [4] However, complications such as migration of proximal screws and perforation of the femoral head, varus collapse, and cut-outs and fractures around the femoral nail have been observed after fixation of intertrochanteric femur fractures with PFN. [5,6] Prosthetic replacement is recommended for unstable intertrochanteric fractures because of the complications that may occur after internal fixation. [7][8][9] Unstable intertrochanteric femur fractures are defined as comminution of the posteromedial buttress with a simple fragment or extension of the fracture to the subtrochanteric region. ...
INTRODUCTION[|]There is a debate about the treatment of intertrochanteric femur fractures in the geriatric population. A proximal femoral nail (PFN), a sliding hip screw, and bipolar hip arthroplasty (BHA) are the most commonly used treatment modalities. The aim of this study was to compare the blood transfusion rate, duration of surgery, and clinical scores of elderly patients treated with cementless BHA and a PFN.[¤]METHODS[|]A total of 38 patients with intertrochanteric femur fractures treated with cementless BHA or a PFN between 2012–2016 were evaluated. In all, 20 patients had surgical treatment with cementless BHA and 18 had surgical treatment with a PFN. All of the patients were evaluated with the Harris Hip Score (HHS) at the last control visit. Blood transfusion rates and the duration of surgery were recorded and the values of both groups were compared statistically.[¤]RESULTS[|]The mean HHS was 81.4+-10.5 for the BHA group and 83.7+-13 for the PFN group. The mean blood transfusion volume was 1.45+-0.6 units for the BHA group and 0.33+-0.48 units for the group treated with a PFN. The mean duration of surgery for the BHA group was 95+-23.1 minutes. In the PFN group, the mean duration of the surgery was 61.8+-7.3 minutes.[¤]DISCUSSION AND CONCLUSION[|]There was a significant difference in the duration of surgery and the blood transfusion volume. The PFN procedure takes less time than BHA, and the blood transfusion volume is smaller. For these reasons, PFN seems to be a better option than BHA.[¤]
... The present study was further compared to a study conducted by Ulfin rethnam, James Cordell-smith, Thirumoolanathan M Kumar and Amit sinha at Department of orthopaedics, glan Clwyd Hospital, Bodelwyddan, U.K [7] . ...
... The results reported here can aid patients and their surgeons in the decision for operative treatment. (43) 12 (17) 0 (0) 0 (0) Sorensen et al. [87] EPR 105 --0 (0) 0 (0) 0 (0) 0 (0) 105 (100) Weiss et al. [47] EPR 82 --0 (0) 0 (0) 82 (100) 0 (0) 0 (0) Harvey et al. [48] EPR 113 70 (62) 113 (100) 0 (0) 0 (0) 0 (0) 0 (0) 113 (100) Steensma et al. [46] EPR 197 80 (41) 197 (100) 0 (0) 115 (58) 82 (42) 0 (0) 0 (0) Hattori et al. [41] EPR 16 13 (81) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 16 (100) Parker et al. [44] EPR 54 54 (100) 29 (54) 0 (0) 0 (0) 0 (0) 0 (0) 54 (100) Zacherl et al. [55] EPR 13 13 (100) 13 (100) 0 (0) 0 (0) 0 (0) 0 (0) 13 (100) Potter et al. [45] EPR 39 16 (41) 39 (100) 0 (0) 0 (0) 0 (0) 0 (0) 39 (100) Sarahrudi et al. [36] EPR 23 23 (100) 23 (100) 0 (0) 0 (0) 0 (0) 0 (0) 23 (100) Chandrasekar et al. [ (25) 0 (0) 0 (0) 0 (0) 0 (0) 12 (100) Weiss et al. [47] IMN 108 --0 (0) 0 (0) 108 (100) 0 (0) 0 (0) Harvey et al. [48] IMN 46 21 (46) -0 (0) 0 (0) 0 (0) 0 (0) 46 (100) Steensma et al. [46] IMN 82 27 (33) 31 (38) 0 (0) 7 (9) 75 (91) 0 (0) 0 (0) Parker et al. [44] IMN 40 40 (100) -0 (0) 0 (0) 0 (0) 0 (0) 40 (100) Zacherl et al. [55] IMN 37 37 (100) 4 (11) 0 (0) 8 (22) 14 (38) 10 (27) 5 (14) Rethnam et al. [84] IMN 11 9 (82) -0 (0) 0 (0) 0 (0) 0 (0) 11 (100) ...
Endoprosthetic reconstruction, intramedullary nailing, and open reduction internal fixation (ORIF) are the most commonly practiced surgical strategies for treatment of metastatic proximal femoral fractures. This review describes functional outcome, local, and systemic complications. All three surgical strategies result in reasonable function on average; however, wide ranges indicate that both poor and good functional levels are obtained. We found that the overall reoperation rate was comparable for endoprosthesis and intramedullary nailing, but was higher for ORIF. J. Surg. Oncol. © 2016 Wiley Periodicals, Inc.
... Established risk factors for decreased mobility in patients are osteoporosis, decreased bone density, prolonged consumption of corticosteroids, aging and central obesity. Several studies have shown direct relation between BMI and mortality rate in patients with the noted fractures (7,8). ...
... A multicentre study by Simmermacher et al. [10] suggests that, by controlling the metaphyseal impaction, the helical blade may prevent penetration through the femoral head and allow full weight-bearing in over three-quarters of patients with unstable fractures. Our results are comparable to those reported with the gamma nail in terms of operating time (30 to 90 min on ave- rage [10,15,25,34]), functional score declines after 3 and 6 months [34] , and mortality in the immediate postoperative period and after 6 months [2,24,34] . Blade backout was rarely associated with complications, because the cause was femoral head impaction, allowed by the device. ...
The best surgical strategy for extra-capsular proximal femoral fractures (PFFs) is controversial in the elderly. Poor bone quality and neck screw instability can adversely affect the results with currently available fixation devices, which predominantly consist in dynamic hip screw-plates and proximal reconstruction nails.
The helical blade of the proximal femoral nail antirotation (PFN-A™) achieves better cancellous bone compaction in the femoral neck, thereby decreasing the risk of secondary displacement.
We retrospectively reviewed consecutive cases of PFN-A™ fixation performed between 2006 and 2008 in 102 patients (75 females and 27 males) with a mean age of 84.9 ± 9.5 years (range, 70-100 years). Functional outcomes were assessed using the Parker Mobility Score.
Mean follow-up in the 102 patients was 21.3 ± 17.5 months (4-51 months). Fracture distribution in the AO classification scheme was A1, n=45; A2, n=41; and A3, n=16. At last follow-up, Parker Mobility Score values in the 65 survivors were 0-3, n=35; 4-6, n=11; and 7-9, n=19. Fracture union was consistently achieved, after a mean of 10.3 ± 3 weeks. Blade back-out allowed by the device design occurred in 16 (15.7%) patients but caused pain due to screw impingement on the fascia lata in only five patients (of whom two underwent reoperation). Cephalic blade cut-out was noted in three (2.9%) patients, of whom one required reoperation because of acetabular penetration. Two hardware-related fractures were recorded.
The new PFN-A™ device ensures reliable fixation with low mechanical complication rates. Although our data do not constitute proof that a helical blade is superior over a neck screw, they suggest a decreased rate of construct failure and may serve as a basis for a comparative study.
