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Percutaneous compression plating versus gamma nail for the treatment of pertrochanteric hip fractures
Rinaldo Giancola,Guido Antonini,Giacomo Delle Rose,Cornelio Crippa
Strategies in Trauma and Limb Reconstruction , 2008, DOI: 10.1007/s11751-008-0032-1
Abstract: The objective of this study is to compare percutaneous compression plating (PCCP) device with standard gamma nail (GN). A sample was prospectively followed and compared to a historical cohort: 82 intertrochanteric hip fractures in 81 patients treated with PCCP in 2004 versus 51 hip fractures treated with GN in 2003 (AO type 31A1, 31 A2). The main outcome measures were: surgery times, blood loss (Hb serum level and transfusions), complication, costs, for a 1-year follow-up. The minimally invasive PCCP technique resulted in a lower blood loss and consequently lower transfusion need (statistically significant), fewer implant-related complications and comparable surgery times. Overall surgical costs were lower for a comparable outcome in terms of healing and surgical time.
The use of tibial Less Invasive Stabilization System (LISS) plate [AO-ASIF] for the treatment of paediatric supracondylar fracture of femur: a case report
Hoi Lam, Chun Lo, Kai Cheung
Journal of Orthopaedic Surgery and Research , 2010, DOI: 10.1186/1749-799x-5-10
Abstract: Paediatric supracondylar fractures of the femur are uncommon. There are different modalities of treatment depending on the age of child, the site and the fracture pattern. The use of traction, hip spicas in young children, external fixators, flexible intramedullary nails or even plating had been reported but each had its own limitations. The Less Invasive Stabilization System (LISS, Synthes) combines minimally invasive internal fixation with fixed-angle screws. To our knowledge, there has been no report about fixation of paediatric distal femur fractures with a LISS tibial plate. We report a case of an 11-year old boy who suffered from a displaced comminuted supracondylar fracture of the femur and was treated with close reduction and internal fixation with a LISS tibial plate.An 11-year old boy sustained a fall during a soccer game. He landed on his right knee and complained of severe right leg pain and swelling after the injury. There was no associated injury. Physical examination showed deformity with swelling over the right distal thigh. There was tenderness over the distal femur. There was no neurovascular deficit. X-ray of the right knee showed a displaced supracondylar fracture of the right distal femur with comminution both the medial and the lateral cortex. The fracture was classified as AO/ASIF (Arbeitsgemeinschaft Fur Osteosynthesefragen/Association for the Study of Internal Fixation) Type 33A [Figure 1a and 1b]. Closed reduction and fixation with tibia LISS plate was performed. (The reasons for choosing the LISS tibial plate were illustrated in the Discussion Section.) We performed lateral approach with incision over the right distal femur. After closed reduction of the fracture with satisfactory alignment, we inserted the tibial LISS plate in submuscular plane and temporarily fixated it with Kirschner wires. We then inserted the locking screws through the jag. Intra-operatively, we took a bone biopsy to exclude the possibility of a pathological fracture
Use of a modified IMHS for unstable intertrochanteric fractures
P. Maniscalco,C. Bertone,F. Rivera,S. Urgelli
Journal of Orthopaedics and Traumatology , 2002, DOI: 10.1007/s101950200017
Abstract: The treatment of unstable intertrochanteric fractures in elderly osteopenic patients, especially those who cannot follow limited weight bearing instructions, is controversial. Recent publications indicate concern with excessive sliding of telescoping nail or sliding screw devices when used in these unstable intertrochanteric fractures. In our experience with the use of intramedullary hip screw (IMHS) in these fracture patterns, we have observed excessive sliding and collapse of the fracture in some patients. We modified the keyed centering sleeve by threading its internal distal third and substituted the compression screw with a custom bolt to obtain restricted sliding or rigid fixation depending on the gap between the lag screw and custom bolt. We used this modified system in static configuration to treat five patients who had an unstable intertrochanteric fracture of the femur. The length of the involved limb measured at the time of consolidation showed no shortening. In view of these results, intertrochanteric hip fractures that are unstable in patients with poor bone-stock can be fixed using the modified IMHS in a static or controlled sliding configuration.
Fixation of Intertrochanteric Fractures: Dynamic Hip Screw versus Locking Compression Plate
Mohsen Mardani-Kivi,Ahmadreza Mirbolook,Sina Khajeh Jahromi,Melina Rouhi Rad
Trauma Monthly , 2013, DOI: 10.5812/traumamon.10436
Abstract: Background: According to the existing literature, the Dynamic Hip Screw (DHS) is the preferred standard for the treatment of intertrochanteric fractures. However, some surgeons use other devices such as the Locking Compression Plate (LCP).Objectives: In this study, we compared the outcome of using DHS or LCP in intertrochanteric fractures.Materials and Methods: This cross-sectional study was carried out on 104 patients who were referred to Pursina Hospital in Rasht, Iran with intertrochanteric fractures of the femur treated with either the DHS or LCP devices. Demographic features, existence or nonexistence of stability and operating time were obtained from questionnaires. During a 6-month follow-up after surgery, patients were interviewed to record variables such as Harris Hip Scores and complications. The patients were also interviewed on their final visit (between 9 and 31 postoperative months). The collected data was analyzed using SPSS.Results: We discovered that the number of incidences of limb shortening and device failure was higher for patients treated with the LCP device (P = 0.048 and P = 0.014). Patients treated with the DHS device had higher Harris Hip scores for both the 6-month postoperative and the final evaluation visits (P = 0.01 and P = 0.018).Conclusions: Despite the complications of fixation with the DHS device, it remains the most successful for treatment of intertrochanteric fractures.
A study of the role of osteotomy in unstable intertrochanteric fractures.  [cached]
Kumar M,Sudhakar G,Shah D,Pathak R
Journal of Postgraduate Medicine , 1996,
Abstract: Osteotomy has been used in treatment of unstable intertrochanteric hip fractures in an attempt to increase the stability of the fracture fragments. We have assessed this stability in a randomised prospective study on 138 patients, all having been fixed by dynamic hip screen, comparing anatomical reduction with medialisation osteotomy. The groups were similar in terms of age, gender and fracture configuration. There was no difference in final results in both groups except that operation time was longer in osteotomy group and the blood loss was more. We found no clear benefit from osteotomy and therefore recommend anatomical reduction and fixation by a sliding hip screw in most cases. Rarely, a fracture configuration which does not allow anatomical reduction may benefit from an osteotomy.
Primary Bipolar Arthroplasty in Unstable Intertrochanteric Fractures in Elderly  [PDF]
Ahmed Elmorsy, Mahmoud Saied, Mahmoud Zaied, Mahmoud Hafez
Open Journal of Orthopedics (OJO) , 2012, DOI: 10.4236/ojo.2012.21003
Abstract: Unstable intertrochanteric fracture in elderly is a challenging surgical condition with a high risk of morbidity and mortality. The aim of this study is to evaluate the results of bipolar arthroplasty as an alternative to the standard treatment of internal fixation. Materials and methods: 41 patients (22 females and 19 males) who had bipolar arthroplasty for unstable intertrochanteric fractures were prospectively evaluated. Modified lateral approach was used in all patients. Clinical evaluation was done using Harris Hip Score (HHS) and radiological follow up was done using plain X-rays. All the patients were 65 years of age or above. Follow up period ranged from (12 - 24) months. Results: During the last follow up, the Harris Hip Score ranged from 93 to 51 with a mean value 78.19. Four cases (9.76%) were excellent (91 - 100), 16 cases (39.02%) good (81 - 90), 16 cases (39.02%) fair (71 - 80) and 5 cases (12.02%) poor (= or < 70). Six cases had complications; infection (1), dislocation (1), stem loosening and subsidence (2), bleeding peptic ulcer (1) and intra-operative crack of the femur while preparing the femoral canal for implant insertion (1). Five patients died within the first year (12.19%). Four patients had revision surgery. Conclusion: Bipolar hemiarthroplasty for the unstable intertrochanteric fractures of the femur in elderly has a reasonable clinical outcome at 2 years. It is to be considered as one of the treatment options for such injury speciality in case of fragility fractures.
Short barrel DHS plates for the treatment of intertrochanteric hip fractures in Indian population  [cached]
Agrawala Sanjay,Kohli Amit,Bhagwat Abhijit
Indian Journal of Orthopaedics , 2006,
Abstract: Background : The dynamic hip screw has appeared to be a reliable answer for intertrochanteric fractures. Intertrochanteric fractures are composed of different anatomic patterns that vary in their degree of stability. However insufficient impaction allowed by the implant may have an adverse effect on fracture healing. Methods : One hundred and four patients were divided in two groups and followed up for one year, mean age was 78.2 years. The ninety patients in group I were fixed with short barrel plate and screws of 75mm or less while fourteen patients in group II were treated with standard barrel plate and screws of 80mm or more. Results : In patients treated with short barrel DHS four out of 90 fractures in group 1 did not heal while in group 2 one out of fourteen did not heal due to failure of standard barrel plate to accommodate the collapse of the fracture fragments. We observed a healing rate of 100% at 3 months. Conclusion : The DHS is reliable for intertrochanteric fractures. However the results of our study support the use of short barrel plates rather than standard barrel plates in Indian population with shorter femoral head and neck length to allow sufficient slide when using dynamic screws of 75 mm or less.
External fixation of “intertrochanteric” fractures
Naseem ul Gani,Khursheed Ahmed Kangoo,Arshad Bashir,Rahil Muzzafer
Orthopedic Reviews , 2009, DOI: 10.4081/or.2009.e18
Abstract: In developing countries, due to limited availability of modern anesthesia and overcrowding of the hospitals with patients who need surgery, high-risk patients with “intertro-chanteric” fractures remain unsuitable for open reduction and internal fixation. The aim of this study was to analyze the results of external fixation of “intertro-chanteric” fractures in high-risk geriatric patients in a developing country. The results of 62 ambulatory high-risk geriatric patients with a mean age of 70 years (range 58-90 years) with “intertrochanteric” fractures, in whom external fixation was performed, are reported. Eight patients died during follow-up due to medical causes unrelated to the surgical procedure. So only 54 patients were available for final assessment. Procedure is simple, performed under local anesthesia, requires less time for surgery and is associated with less blood loss. Good fixation and early ambulation was achieved in most of the patients. Average time to union was 14 weeks. Thirty-one patients developed superficial pin tract infection and 28 patients had average shortening of 15 mm due to impaction and varus angulation. Functional outcome was assessed using Judet’s point system. Good to excellent results were achieved in 44 patients. This study demonstrated that external fixation of “intertrochantric” fractures performed under local anesthesia offers significant advantage in ambulatory high-risk geriatric patients especially in a developing country.
Biological Plating in Comminuted Subtrochanteric Fractures
S Mehrpour,M Tavvafi,R Sorbi,MR Aghamirsalim
Tehran University Medical Journal , 2012,
Abstract: Background: Comminuted subtrochanteric fractures have been a challenge for orthopedic surgeons in terms of appropriate reduction and stable fixation. Numerous methods have been used for the fixation of comminuted subtrochanteric fractures among which some are accompanied with technical difficulties and complications of their own. Regarding the results of previous studies, we decided to evaluate the biological fixation method in comminuted subtrochanteric fractures. Methods: In this prospective study, we evaluated 20 men with comminuted subtrochanteric femoral fractures. The patients underwent indirect reduction with dynamic hip screw (DHS) or dynamic condylar screw (DCS) fixation within one week of injury. The patients were evaluated clinically for pain, hip and knee range of motion, leg-length discrepancy and angular and rotational deformities, in addition the radiographic assessment of the union. Results: According to Seinsheimer's classification of subtrochanteric fractures, four patients had type III, nine had type IV and seven had type V fractures. Fracture fixation was performed by DCS in eight and by DHS in 12 cases. The average time of the operations was 79.4 (ranging from 60-125) minutes. Mean blood loss was 634 (ranging from 340-1160) milliliters. Uneventfully, union occurred in all patients with no clinical pain or dysfunction. Conclusion: Submuscular plating with either DCS or DHS is a viable option to treat comminuted subtrochanteric fractures. The results of this study highly suggest use of submuscular plating in the treatment of comminuted subtrochanteric fractures, especially in the third world countries.
Concomitant ipsilateral subcapital and intertrochanteric fractures of the femur: a case report
George Loupasis, Panagiotis G Ntagiopoulos, Antonios Asimakopoulos
Journal of Medical Case Reports , 2010, DOI: 10.1186/1752-1947-4-363
Abstract: A 36-year-old Caucasian man was admitted with this rare fracture combination, and was managed with closed fracture reduction and fixation with a dynamic hip screw combined with an anti-rotational cannulated screw. We found four similar cases on reviewing the literature from 1989 to 2009, but these were reports of older patients after low energy injury.We found that segmental fracture of the femoral neck region is an extremely rare and uncategorized hip injury that can occur not only in older people but also in young non-osteoporotic patients, and should be considered for inclusion in femoral fracture classification systems.Subcapital femoral fractures secondarily complicating internal fixation of previous united intertrochanteric fractures have been infrequently reported in the literature [1-4]. Simultaneous presentation of ipsilateral neck and intertrochanteric femoral fractures are extremely rare, with only four such cases being reported in the literature during the period 1989 to 2009 [5-8]. All these cases occurred in older patients after a low energy injury.We report a case of simultaneous ipsilateral subcapital and intertrochanteric fractures in a 36-year old man after a high-energy trauma from a road traffic accident. Based on our clinical experience, the small number of previously published similar cases, the lack of such a fracture pattern in any classification scheme, and a meticulous survey of orthopaedic textbook knowledge, we consider that this is an extremely rare fracture combination, and in terms of patient age, mechanism of injury and the treatment followed, it is to the best of our knowledge, the first such report in the literature.A 36-year-old and otherwise healthy Caucasian man of Greek extraction was admitted to the hospital after been involved in a road traffic accident. Our patient was riding his motorcycle at an approximate speed of 70 mph. He collided head-on with a car, which caused him to be thrown from the motorcycle, landing forcefully
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