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unstable trochanteric fracture

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https://www.readbyqxmd.com/read/29724590/cement-augmentation-of-the-proximal-femoral-nail-antirotation-pfna-a-multicentre-randomized-controlled-trial
#1
Christian Kammerlander, Einar S Hem, Tim Klopfer, Florian Gebhard, An Sermon, Michael Dietrich, Olaf Bach, Yoram Weil, Reto Babst, Michael Blauth
INTRODUCTION: New implant designs like the Proximal Femoral Nail Antirotation (PFNA) were developed to reduce failure rates in unstable pertrochanteric fractures in the elderly. Standardized implant augmentation with up to 6 mL of polymethylmethacrylate (PMMA) cement has been introduced to enhance implant anchorage by increasing the implant-bone interface in osteoporotic bone conditions. Biomechanically, loads to failure were significantly higher with augmentation. The primary objective of this study was to compare the mobility of patients with closed unstable trochanteric fractures treated by PFNA either with or without cement augmentation...
April 22, 2018: Injury
https://www.readbyqxmd.com/read/29549969/reliability-of-the-classification-of-proximal-femur-fractures-does-clinical-experience-matter
#2
Tom J Crijns, Stein J Janssen, Jacob T Davis, David Ring, Hugo B Sanchez
BACKGROUND: Radiographic fracture classification helps with research on prognosis and treatment. AO/OTA classification into fracture type has shown to be reliable, but further classification of fractures into subgroups reduces the interobserver agreement and takes a considerable amount of practice and experience in order to master. QUESTIONS/PURPOSES: We assessed: (1) differences between more and less experienced trauma surgeons based on hip fractures treated per year, years of experience, and the percentage of their time dedicated to trauma, (2) differences in the interobserver agreement between classification into fracture type, group, and subgroup, and (3) differences in the interobserver agreement when assessing fracture stability compared to classifying fractures into type, group and subgroup...
April 2018: Injury
https://www.readbyqxmd.com/read/29432318/helical-blade-or-the-integrated-lag-screws-a-matched-pair-analysis-of-100-patients-with-unstable-trochanteric-fractures
#3
Ashok S Gavaskar, Naveen C Tummala, Parthasarathy Srinivasan, Hitesh Gopalan, Bhupesh Karthik, S Santhosh
OBJECTIVES: To compare the radiological and clinical results with PFNA - II and InterTan in the treatment of unstable trochanteric fractures in the elderly DESIGN:: Retrospective, multi-center, matched pair SETTING:: 3 tertiary level trauma centres PATIENTS:: 100 elderly patients who underwent intramedullary stabilisation with either the PFNA - II or the InterTan for osteoporotic unstable trochanteric fractures. INTERVENTIONS: 50 matched pairs consisting of AO - A2 and A3 fractures were created from a cohort of 290 patients who underwent internal fixation for unstable trochanteric fractures with the PFNA - II or InterTan nails...
February 9, 2018: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/29397996/trochanteric-fracture-implant-motion-during-healing-a-radiostereometry-rsa-study
#4
Alicja J Bojan, Anders Jönsson, Hans Granhed, Carl Ekholm, Johan Kärrholm
Cut-out complication remains a major unsolved problem in the treatment of trochanteric hip fractures. A better understanding of the three-dimensional fracture-implant motions is needed to enable further development of clinical strategies and countermeasures. The aim of this clinical study was to characterise and quantify three-dimensional motions between the implant and the bone and between the lag screw and nail of the Gamma nail. Radiostereometry Analysis (RSA) analysis was applied in 20 patients with trochanteric hip fractures treated with an intramedullary nail...
March 2018: Injury
https://www.readbyqxmd.com/read/29318087/treatment-with-helical-blade-cephalomedullary-nail-for-two-part-basicervical-proximal-femoral-fracture-in-elderly-patients-a-retrospective-observational-study
#5
Ichiro Okano, Takatoshi Sawada, Nobumasa Kushima, Tetsuya Tachibana, Katsunori Inagaki
Background: Basicervical proximal femoral fracture is a known subtype of extracapsular fracture and is mechanically unstable, especially for the rotational direction, which may lead to implant failure. A cephalomedullary nail (CMN) is widely used for the fixation of unstable extracapsular fracture; however, its application for basicervical fracture remains controversial. Helical blade CMN is proven to have more rotational stability than traditional lag screw implants and potentially advantageous in the treatment of basicervical fracture...
December 2017: Geriatric Orthopaedic Surgery & Rehabilitation
https://www.readbyqxmd.com/read/29250501/fixation-of-trochanteric-fragments-in-cementless-bipolar-hemiarthroplasty-of-unstable-intertrochanteric-fracture-cerclage-wiring
#6
Young-Kyun Lee, Chan Ho Park, Kyung-Hoi Koo
Purpose: Bipolar hemiarthroplasty (HA) is an option for the treatment of unstable intertrochanteric fracture in elderly patients. There is a raising concern regarding cable-grip related complications for the fixation of trochanteric fragments. Therefore, the aim of this study was to evaluate outcome of cementless HA with fixation for the trochanteric fragments using monofilament wires in unstable intertrochanteric fracture. Materials and Methods: We reviewed 92 cementless bipolar HAs using a grit-blasted long stem design for unstable intertrochanteric fractures in 91 elderly patients with a mean age of 81...
December 2017: Hip & Pelvis
https://www.readbyqxmd.com/read/29221656/z-effect-after-intramedullary-nailing-systems-for-trochanteric-femur-fractures
#7
S J M Smeets, G Kuijt, P V van Eerten
PURPOSE: The aim of this study was to investigate the incidence of Z-effect after dual lag screw intramedullary nailing systems and risk factors contributing to this effect. We hypothesized that long nails provide more neck strength due to a longer lever than short nails and are therefore less likely to develop a misbalance of a higher head compressive strength than neck compressive strength. METHODS: In this retrospective cohort study 103 patients treated operatively with a dual lag screw intramedullary nailing device for (sub)trochanteric hip fracture were included...
December 2017: Chinese Journal of Traumatology, Zhonghua Chuang Shang za Zhi
https://www.readbyqxmd.com/read/29173962/intraoperative-lateral-wall-fractures-during-dynamic-hip-screw-fixation-for-intertrochanteric-fractures-incidence-causative-factors-and-clinical-outcome
#8
Annur R Pradeep, Addala KiranKumar, Jayaramaraju Dheenadhayalan, Shanmuganathan Rajasekaran
INTRODUCTION: The intact lateral wall plays a key role in stabilization of trochanteric fracture. Hence extreme precaution should be taken to prevent lateral wall damage during DHS fixation. Present study is aimed at evaluating the determinants of lateral wall fracture and its effect on outcome in intertrochanteric fracture femur treated with DHS. MATERIAL AND METHODS: This is a prospective study involving intertrochanteric fractures treated with DHS fixation from July 2013 to June 2014...
February 2018: Injury
https://www.readbyqxmd.com/read/29040233/is-the-best-plate-a-nail-a-review-of-3230-unstable-intertrochanteric-fractures-of-the-proximal-femur
#9
Adam Tucker, Kevin J Donnelly, Clare Rowan, Sinead McDonald, Andrew P Foster
OBJECTIVES: To evaluate the functional outcomes, revision, and mortality rates of 3 implants used for unstable intertrochanteric hip fractures; the sliding hip screw (SHS), with or without a trochanteric stabilization plate (TSP); and a cephalomedullary nail (CMN). DESIGN: Multicentre National Prospective Cohort Study. SETTING: Northern Ireland. PATIENT/PARTICIPANTS: Patients were identified from a prospective database...
February 2018: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/29025609/blood-loss-in-trochanteric-fractures-multivariate-analysis-comparing-dynamic-hip-screw-and-gamma-nail
#10
Mario Ronga, Daniele Bonzini, Marco Valoroso, Giuseppe La Barbera, Jacopo Tamini, Mario Cherubino, Paolo Cherubino
INTRODUCTION: Anaemia in patients with trochanteric fracture is associated with increased morbidity and mortality and it is an independent risk factor for functional mobility of patients. Several authors have reported the blood loss following operative treatment comparing different fixation systems but few authors have evaluated many associated variables that could influence the perioperative blood loss. PURPOSE: To evaluate the blood loss in patients that had their trochanteric fracture stabilized with dynamic hip screw (DHS) or Gamma nail...
October 2017: Injury
https://www.readbyqxmd.com/read/28951636/management-of-unstable-pertrochanteric-fractures-with-proximal-femoral-locking-compression-plates-and-affect-of-neck-shaft-angle-on-functional-outcomes
#11
Emrah Kovalak, Cenk Ermutlu, Tolga Atay, Özgür Başal
BACKGROUND: Management of unstable pertrochanteric fractures remains a challenge with various implant choices. Intramedullary devices are usually preferred for the management of the unstable fractures. When nailing is unsuitable for the configuration of the fracture extra medullary procedures are preferred. PFLCP is a contact limited implant that allows multiple angularly stable fixations with preserving more bone stock after implantation as an extramedullary implant. There are only a few reports in the literature about the osteosynthesis of unstable trochanteric fractures with proximal femoral locking compression plates and their results are conflicting...
July 2017: Journal of Clinical Orthopaedics and Trauma
https://www.readbyqxmd.com/read/28836973/comparison-and-analysis-of-reoperations-in-two-different-treatment-protocols-for-trochanteric-hip-fractures-postoperative-technical-complications-with-dynamic-hip-screw-intramedullary-nail-and-medoff-sliding-plate
#12
Johnny Paulsson, Josefine Corin Stig, Ola Olsson
BACKGROUND: In treatment of unstable trochanteric fractures dynamic hip screw and Medoff sliding plate devices are designed to allow secondary fracture impaction, whereas intramedullary nails aim to maintain fracture alignment. Different treatment protocols are used by two similar Swedish regional emergency care hospitals. Dynamic hip screw is used for fractures considered as stable within the respective treatment protocol, whereas one treatment protocol (Medoff sliding plate/dynamic hip screw) uses biaxial Medoff sliding plate for unstable pertrochanteric fractures and uniaxial Medoff sliding plate for subtrochanteric fractures, the second (intramedullary nail/dynamic hip screw) uses intramedullary nail for subtrochanteric fractures and for pertrochanteric fractures with intertrochanteric comminution or subtrochanteric extension...
August 24, 2017: BMC Musculoskeletal Disorders
https://www.readbyqxmd.com/read/28827502/risk-factors-associated-with-cephalomedullary-nail-cutout-in-the-treatment-of-trochanteric-hip-fractures
#13
David J Ciufo, Douglas A Zaruta, Jason S Lipof, Kyle T Judd, John T Gorczyca, John P Ketz
OBJECTIVES: To evaluate the association of cephalomedullary nail cutout in trochanteric femur fractures with the presence of the following radiographic variables: lateral wall fracture, posteromedial fragment, angular malreduction, residual basicervical fracture gapping, screw placement, and tip-apex distance. DESIGN: Retrospective review. SETTING: Academic medical center. PATIENTS: A total of 362 patients were included in the study...
November 2017: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/28802425/outcomes-of-dynamic-hip-screw-augmented-with-trochanteric-wiring-for-treatment-of-unstable-type-a2-intertrochanteric-femur-fractures
#14
Chetan Puram, Chetan Pradhan, Atul Patil, Vivek Sodhai, Parag Sancheti, Ashok Shyam
BACKGROUND: Posteromedial and greater trochanteric fragments are a major cause of telescoping and medialization of the femoral shaft in an unstable intertrochanteric fracture. This leads to significant limb shortening, fracture collapse in varus position and implant failure, which can be prevented by trochanteric wiring in addition to dynamic hip screw (DHS) fixation. The purpose of our study is to assess the outcomes of DHS augmented with trochanteric wiring in unstable type A2 intertrochanteric fractures...
August 2017: Injury
https://www.readbyqxmd.com/read/28802415/augmentation-of-intramedullary-nailing-in-unstable-intertrochanteric-fractures-using-cerclage-wire-and-lag-screws-a-comparative-study
#15
Sunil Govind Kulkarni, Sushrut Sudhir Babhulkar, Sujay Milind Kulkarni, Govind Shivram Kulkarni, Madhura Sujay Kulkarni, Raviraj Patil
BACKGROUND: Unstable intertrochanteric fractures present a challenge to orthopaedic surgeons, with varied geometry of the fractures and a wide choice of implants and techniques. The patients are usually osteoporotic, with multiple co-morbidities and poor tolerance for complications and re-operations. Lateral wall reconstruction and stability of the trochanteric fragments are considered important in providing a better outcome of these difficult injuries. We present a technique of lateral wall and trochanteric reconstruction using Cerclage wires and lag screws in the greater trochanter in addition to intramedullary nailing, and the radiological and functional outcome of this technique of augmentation...
August 2017: Injury
https://www.readbyqxmd.com/read/28801202/a-biomechanical-study-comparing-proximal-femur-nail-and-proximal-femur-locking-compression-plate-in-fixation-of-reverse-oblique-proximal-femur-fractures
#16
Ashutosh Kumar Singh, N Narsaria, R K Gupta
BACKGROUND: The reverse oblique trochanteric fractures are common fractures and its treatment poses a challenge. The purpose of this study was to compare the biomechanical parameters of the construct using proximal femoral nail (PFN) and proximal femoral locking compression plates (PFLCP) in these fractures using cadaveric specimens. MATERIALS AND METHODS: Twenty freshly harvested cadaveric femoral specimens were randomly assigned to two groups after measuring bone mineral density, ten of which were implanted with PFN and the other ten with PFLCP...
May 22, 2017: Injury
https://www.readbyqxmd.com/read/28764254/role-of-provisional-fixation-of-fracture-fragments-by-steinmann-pin-and-technical-tips-in-proximal-femoral-nailing-for-intertrochanteric-fracture
#17
Mohit J Jain, Kinjal J Mavani, Dhaval Patel
INTRODUCTION: Proximal Femoral Nailing (PFN) in Intertrochanteric Fractures (IF) is becoming the choice of implant due to better biomechanics and prevention of varus collapse associated with Dynamic Hip Screw (DHS). Technical difficulties and implant related complications are yet to be addressed. AIM: To understand the technical difficulties involved in PFN and role of provisional fixation of fracture by Steinmann-pin. MATERIALS AND METHODS: In this study, 55 patients presented to a tertiary trauma center in India with trochanteric fractures from April 2010 to March 2012 were included and treated with PFN...
June 2017: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/28437506/treatment-of-unstable-trochanteric-femur-fractures-proximal-femur-nail-versus-proximal-femur-locking-compression-plate
#18
RANDOMIZED CONTROLLED TRIAL
Ashutosh Kumar Singh, Nidi Narsaria, Arun G R, Vivek Srivastava
Unstable trochanteric femur fractures are common fractures that are difficult to manage. We conducted a prospective study to compare functional outcomes and complications of 2 different implant designs, proximal femur nail (PFN) and proximal femur locking compression plate (PFLCP), used in internal fixation of unstable trochanteric femur fractures. On hospital admission, 48 patients with unstable trochanteric fractures were randomly assigned (using a sealed envelope method) to treatment with either PFN (24 patients) or PFLCP (24 patients)...
March 2017: American Journal of Orthopedics
https://www.readbyqxmd.com/read/28434124/comparative-outcome-of-pfna-gamma-nails-pccp-medoff-plate-liss-and-dynamic-hip-screws-for-fixation-in-elderly-trochanteric-fractures-a-systematic-review-and-network-meta-analysis-of-randomized-controlled-trials
#19
Alisara Arirachakaran, Tanawat Amphansap, Pichaya Thanindratarn, Peerapong Piyapittayanun, Phutsapong Srisawat, Jatupon Kongtharvonskul
The ideal implant for the treatment of an unstable intertrochanteric femoral fracture is still a matter of discussion. The aim of this systematic review is to conduct a network meta-analysis of randomized controlled trials (RCTs) comparing clinical outcomes between dynamic hip screws (DHS), Medoff sliding plating, percutaneous compression plating (PCCP), proximal femoral nails (PFN), Gamma nails and less invasive stabilization system fixation in femoral trochanteric fractures in the elderly. These clinical outcomes consist of total intra-operative time, intra-operative fluoroscopy time, intra-operative blood loss, blood component transfusion, length of hospital stay, postoperative general complications, wound complications, late complications and reoperation rates...
October 2017: European Journal of Orthopaedic Surgery & Traumatology: Orthopédie Traumatologie
https://www.readbyqxmd.com/read/28404548/the-tip-apex-distance-in-the-x-bolt-dynamic-plating-system
#20
M A Fernandez, A Aquilina, J Achten, N Parsons, M L Costa, X L Griffin
OBJECTIVES: The Sliding Hip Screw (SHS) is commonly used to treat trochanteric hip fractures. Fixation failure is a devastating complication requiring complex revision surgery. One mode of fixation failure is lag screw cut-out which is greatest in unstable fracture patterns and when the tip-apex distance of the lag screw is > 25 mm. The X-Bolt Dynamic Hip Plating System (X-Bolt Orthopaedics, Dublin, Ireland) is a new device which aims to reduce this risk of cut-out. However, some surgeons have reported difficulty minimising the tip-apex distance with subsequent concerns that this may lead to an increased risk of cut-out...
April 2017: Bone & Joint Research
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