Objective: The aim of this study was to assess outcomes of using the SIGN Hip Construct (SHC) to achieve hip fracture fixation without the use of an image intensifier. Design: Prospective case series. Setting: Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania. Outcome measures: Radiographic union, callus formation ...
Syed, Farhan; Eachempati, Krishna Kiran; Apsingi, Sunil
Intertrochanteric fractures are commonly seen in elderly population. 90% of these occur following a trivial fall. Dynamic hip screw fixation is one of the most common modality of treatment, although intramedullary fixation devices are gaining popularity in recent times, especially in unstable fractures. Dislocation of hip following a DHS fixation of hip is a very rare complication. There are only two case reports which describes dislocation of hip following DHS fixation of an intertrochanteric fracture. Here we present a case of anterior dislocation of hip following DHS fixation of an intertrochanteric fracture. We also discuss about the possible causes of this rare complication, its management and follow up.
Africa, and Latin America due to the aging population and the increasing prevalence of osteoporosis in these countries (2). Intertrochanteric fractures are defined as .... patients, inability to obtain transport (n=9) and death due to unrelated cause (n=3) were the reasons cited for missing the follow-up clinics. The remaining.
Femoral neck fractures commonly occur in elderly osteoporotic females, and include extra-capsular fractures (intertrochanteric and pertrochanteric), and usually treated with the Dynamic Hip Screw (DHS). This is based on tension band principle which allows the screw to slide within the barrel to enable compression of the ...
Baker, Joseph F
Periprosthetic fracture and infection are both challenges following hip arthroplasty. We report the case of an 87 year old female who underwent open reduction and internal fixation of a periprosthetic femoral fracture. Her post-operative course was complicated by infection with Clostridium perfringens. Early aggressive antibiotic treatment and surgical debridement were successful, and allowed retention of the original components.
Full Text Available Background: We reviewed the operative results of fibular bone graft with cannulated hip screw fixation in femoral neck fracture in young adults. Method: Sixteen young adults with femoral neck fracture were treated by fibular bone graft with cannulated hip screw fixation. All the fractures were more than 3 weeks old. Results: Results were assessed in 15 patients while one patient died due to complications not related to surgery. Union occurred in all 15 patients. One patient had intra-operative complication in the form of screw cut out with graft in the joint space. The average fallow up was 24.4 months. Out of 15 patients assessed clinico-radiologically 11 showed good results, 3 had fair while 1 had poor result. Conclusion: We conclude that this is a simple and cost effective procedure for late femoral fleck fracture in young adults with good results.
Taljanovic, Mihra S; Jones, Marci D; Ruth, John T; Benjamin, James B; Sheppard, Joseph E; Hunter, Tim B
The basic goal of fracture fixation is to stabilize the fractured bone, to enable fast healing of the injured bone, and to return early mobility and full function of the injured extremity. Fractures can be treated conservatively or with external and internal fixation. Conservative fracture treatment consists of closed reduction to restore the bone alignment. Subsequent stabilization is then achieved with traction or external splinting by slings, splints, or casts. Braces are used to limit range of motion of a joint. External fixators provide fracture fixation based on the principle of splinting. There are three basic types of external fixators: standard uniplanar fixator, ring fixator, and hybrid fixator. The numerous devices used for internal fixation are roughly divided into a few major categories: wires, pins and screws, plates, and intramedullary nails or rods. Staples and clamps are also used occasionally for osteotomy or fracture fixation. Autogenous bone grafts, allografts, and bone graft substitutes are frequently used for the treatment of bone defects of various causes. For infected fractures as well as for treatment of bone infections, antibiotic beads are frequently used. Copyright RSNA, 2003
Full Text Available Background: Over the years, there has been a tremendous increase in the use of fluoroscopy in orthopaedics. The risk of contracting cancer is significantly higher for an orthopedic surgeon. Hip and spine surgeries account for 99% of the total radiation dose. The amount of radiation to patients and operating surgeon depends on the position of the patient and the type of protection used during the surgery. A retrospective study to assess the influence of the radiation exposure of the operating surgeon during fluoroscopically assisted fixation of fractures of neck of femur (dynamic hip screw and ankle (Weber B was performed at a district general hospital in the United Kingdom. Materials and Methods: Sixty patients with undisplaced intertrochanteric fracture were included in the hip group, and 60 patients with isolated fracture of lateral malleolus without communition were included in the ankle group. The hip and ankle groups were further divided into subgroups of 20 patients each depending on the operative experience of the operating surgeon. All patients had fluoroscopically assisted fixation of fracture by the same approach and technique. The radiation dose and screening time of each group were recorded and analyzed. Results: The radiation dose and screening time during fluoroscopically assisted fixation of fracture neck of femur were significantly high with surgeons and trainees with less than 3 years of surgical experience in comparison with surgeons with more than 10 years of experience. The radiation dose and screening time during fluoroscopically assisted fixation of Weber B fracture of ankle were relatively independent of operating surgeon′s surgical experience. Conclusion: The experience of operating surgeon is one of the important factors affecting screening time and radiation dose during fluoroscopically assisted fixation of fracture neck of femur. The use of snapshot pulsed fluoroscopy and involvement of senior surgeons could
Botchu, Rajesh; Ravikumar, Kassetti
Over the years, there has been a tremendous increase in the use of fluoroscopy in orthopaedics. The risk of contracting cancer is significantly higher for an orthopedic surgeon. Hip and spine surgeries account for 99% of the total radiation dose. The amount of radiation to patients and operating surgeon depends on the position of the patient and the type of protection used during the surgery. A retrospective study to assess the influence of the radiation exposure of the operating surgeon during fluoroscopically assisted fixation of fractures of neck of femur (dynamic hip screw) and ankle (Weber B) was performed at a district general hospital in the United Kingdom. Sixty patients with undisplaced intertrochanteric fracture were included in the hip group, and 60 patients with isolated fracture of lateral malleolus without communition were included in the ankle group. The hip and ankle groups were further divided into subgroups of 20 patients each depending on the operative experience of the operating surgeon. All patients had fluoroscopically assisted fixation of fracture by the same approach and technique. The radiation dose and screening time of each group were recorded and analyzed. The radiation dose and screening time during fluoroscopically assisted fixation of fracture neck of femur were significantly high with surgeons and trainees with less than 3 years of surgical experience in comparison with surgeons with more than 10 years of experience. The radiation dose and screening time during fluoroscopically assisted fixation of Weber B fracture of ankle were relatively independent of operating surgeon's surgical experience. The experience of operating surgeon is one of the important factors affecting screening time and radiation dose during fluoroscopically assisted fixation of fracture neck of femur. The use of snapshot pulsed fluoroscopy and involvement of senior surgeons could significantly reduce the radiation dose and screening time.
Parker, M J; Pryor, G A
208 patients aged over 70 years with a displaced cervical hip fracture were admitted to a prospective randomised trial of internal fixation using 3 parallel cannulated screws or an uncemented Austin...
Blyth, P; Stott, N S; Anderson, I A
We report development of a PC-based virtual reality training system for hip fracture fixation that comprises a surgical simulator and an assessment component. The simulator allows hip fracture fixation to be performed on a virtual hip model using two-dimensional radiographic images to guide fracture reduction and implant placement. Ten operative scenarios with increasing complexities of fracture type are available. The face validity of the simulator was tested using a 26 item feedback questionnaire, with answers on a 5 cm visual analogue scale from 'disagree strongly' to 'agree strongly'. Ten study participants, aged 20-50, and with variable levels of surgical skills, each performed six operative scenarios on the simulator before completing the questionnaire. The results showed that the simulator had good face validity, with the majority of subjects stating it provided a realistic view of the operating environment (median score 8.2/10) and that the three-dimensional view provided was all that was required (median score 7.8/10). The subjects considered the simulator was able to test problem solving ability (median score 8.0/10). These results confirm that this simulator achieves good face validity without computationally intensive touch feedback (haptics). Overall, this study demonstrates that non-haptic simulators have a larger role to play in virtual simulation than is currently recognised.
Nauth, A. (Aaron); Creek, A.T. (Aaron T.); Zellar, A. (Abby); Lawendy, A.-R. (Abdel-Rahman); Dowrick, A. (Adam); Gupta, A. (Ajay); Dadi, A. (Akhil); A. van Kampen (A.); Yee, A. (Albert); A.C. de Vries (Alexander); de Mol van Otterloo, A. (Alexander); Garibaldi, A. (Alisha); Liew, A. (Allen); McIntyre, A.W. (Allison W.); Prasad, A.S. (Amal Shankar); Romero, A.W. (Amanda W.); Rangan, A. (Amar); Oatt, A. (Amber); Sanghavi, A. (Amir); Foley, A.L. (Amy L.); Karlsten, A. (Anders); Dolenc, A. (Andrea); Bucknill, A. (Andrew); Chia, A. (Andrew); Evans, A. (Andrew); Gong, A. (Andrew); Schmidt, A.H. (Andrew H.); Marcantonio, A.J. (Andrew J.); Jennings, A. (Andrew); Ward, A. (Angela); Khanna, A. (Angshuman); Rai, A. (Anil); Smits, A.B. (Anke B.); Horan, A.D. (Annamarie D.); Brekke, A.C. (Anne Christine); Flynn, A. (Annette); Duraikannan, A. (Aravin); Stødle, A. (Are); van Vugt, A.B. (Arie B.); Luther, A. (Arlene); Zurcher, A.W. (Arthur W.); Jain, A. (Arvind); Amundsen, A. (Asgeir); Moaveni, A. (Ash); Carr, A. (Ashley); Sharma, A. (Ateet); Hill, A.D. (Austin D.); Trommer, A. (Axel); Rai, B.S. (B. Sachidananda); Hileman, B. (Barbara); Schreurs, B. (Bart); Verhoeven, B. (Bart); Barden, B.B. (Benjamin B.); Flatøy, B. (Bernhard); B.I. Cleffken (Berry); Bøe, B. (Berthe); Perey, B. (Bertrand); Hanusch, B.C. (Birgit C.); Weening, B. (Brad); B. Fioole (Bram); Rijbroek, B. (Bram); Crist, B.D. (Brett D.); Halliday, B. (Brett); Peterson, B. (Brett); Mullis, B. (Brian); Richardson, C.G. (C. Glen); Clark, C. (Callum); Sagebien, C.A. (Carlos A.); C. van der Pol (Carmen); Bowler, C. (Carol); Humphrey, C.A. (Catherine A.); Coady, C. (Catherine); Koppert, C.L. (Cees L.); Coles, C. (Chad); Tannoury, C. (Chadi); DePaolo, C.J. (Charles J.); Gayton, C. (Chris); Herriott, C. (Chris); Reeves, C. (Christina); Tieszer, C. (Christina); Dobb, C. (Christine); Anderson, C.G. (Christopher G.); Sage, C. (Claire); Cuento, C. (Claudine); Jones, C.B. (Clifford B.); Bosman, C.H.R. (Coks H.R.); Linehan, C. (Colleen); C.P. van der Hart (Cor P.); Henderson, C. (Corey); Lewis, C.G. (Courtland G.); Davis, C.A. (Craig A.); Donohue, C. (Craig); Mauffrey, C. (Cyril); Sundaresh, D.C. (D. C.); Farrell, D.J. (Dana J.); Whelan, D.B. (Daniel B.); Horwitz, D. (Daniel); Stinner, D. (Daniel); Viskontas, D. (Darius); Roffey, D.M. (Darren M.); Alexander, D. (David); Karges, D.E. (David E.); Hak, D. (David); Johnston, D. (David); Love, D. (David); Wright, D.M. (David M.); Zamorano, D.P. (David P.); Goetz, D.R. (David R.); Sanders, D. (David); Stephen, D. (David); Yen, D. (David); Bardana, D. (Davide); Olakkengil, D.J. (Davy J); Lawson, D. (Deanna); Maddock, D. (Deborah); Sietsema, D.L. (Debra L.); Pourmand, D. (Deeba); D. den Hartog (Dennis); Donegan, D. (Derek); D. Heels-Ansdell (Diane); Nam, D. (Diane); Inman, D. (Dominic); Boyer, D. (Dory); Li, D. (Doug); Gibula, D. (Douglas); Price, D.M. (Dustin M.); Watson, D.J. (Dylan J.); Hammerberg, E.M. (E. Mark); Tan, E.T.C.H. (Edward T.C.H.); E.J.R. de Graaf (Eelco); Vesterhus, E.B. (Elise Berg); Roper, E. (Elizabeth); Edwards, E. (Elton); E.H. Schemitsch (Emil); E.R. Hammacher (Eric); Henderson, E.R. (Eric R.); Whatley, E. (Erica); Torres, E.T. (Erick T.); Vermeulen, E.G.J. (Erik G.J.); Finn, E. (Erin); E.M.M. van Lieshout (Esther); Wai, E.K. (Eugene K.); Bannister, E.R. (Evan R.); Kile, E. (Evelyn); Theunissen, E.B.M. (Evert B.M.); Ritchie, E.D. (Ewan D.); Khan, F. (Farah); Moola, F. (Farhad); Howells, F. (Fiona); F. de Nies (Frank); F.H.W.M. van der Heijden (Frank); de Meulemeester, F.R.A.J. (Frank R.A.J.); F. Frihagen (Frede); Nilsen, F. (Fredrik); Schmidt, G.B. (G. Ben); Albers, G.H.R. (G.H. Robert); Gudger, G.K. (Garland K.); Johnson, G. (Garth); Gruen, G. (Gary); Zohman, G. (Gary); Sharma, G. (Gaurav); Wood, G. (Gavin); G.W.M. Tetteroo (Geert); Hjorthaug, G. (Geir); Jomaas, G. (Geir); Donald, G. (Geoff); Rieser, G.R. (Geoffrey Ryan); Reardon, G. (Gerald); Slobogean, G.P. (Gerard P.); G.R. Roukema (Gert); Visser, G.A. (Gijs A.); Moatshe, G. (Gilbert); Horner, G. (Gillian); Rose, G. (Glynis); Guyatt, G. (Gordon); Chuter, G. (Graham); Etherington, G. (Greg); Rocca, G.J.D. (Gregory J. Della); Ekås, G. (Guri); Dobbin, G. (Gwendolyn); Lemke, H.M. (H. Michael); Curry, H. (Hamish); H. Boxma (Han); Gissel, H. (Hannah); Kreder, H. (Hans); Kuiken, H. (Hans); H.L.F. Brom; Pape, H.-C. (Hans-Christoph); H.M. van der Vis (Harm); Bedi, H. (Harvinder); Vallier, H.A. (Heather A.); Brien, H. (Heather); Silva, H. (Heather); Newman, H. (Heike); H. Viveiros (Helena); van der Hoeven, H. (Henk); Ahn, H. (Henry); Johal, H. (Herman); H. Rijna; Stockmann, H. (Heyn); Josaputra, H.A. (Hong A.); Carlisle, H. (Hope); van der Brand, I. (Igor); I. Dawson (Imro); Tarkin, I. (Ivan); Wong, I. (Ivan); Parr, J.A. (J. Andrew); Trenholm, J.A. (J. Andrew); J.C. Goslings (Carel); Amirault, J.D. (J. David); Broderick, J.S. (J. Scott); Snellen, J.P. (Jaap P.); Zijl, J.A.C. (Jacco A.C.); Ahn, J. (Jaimo); Ficke, J. (James); Irrgang, J. (James); Powell, J. (James); Ringler, J.R. (James R.); Shaer, J. (James); Monica, J.T. (James T.); J. Biert (Jan); Bosma, J. (Jan); Brattgjerd, J.E. (Jan Egil); J.P.M. Frölke (Jan Paul); J.C. Wille (Jan); Rajakumar, J. (Janakiraman); Walker, J.E. (Jane E.); Baker, J.K. (Janell K.); Ertl, J.P. (Janos P.); de Vries, J.P.P.M. (Jean Paul P.M.); Gardeniers, J.W.M. (Jean W.M.); May, J. (Jedediah); Yach, J. (Jeff); Hidy, J.T. (Jennifer T.); Westberg, J.R. (Jerald R.); Hall, J.A. (Jeremy A.); van Mulken, J. (Jeroen); McBeth, J.C. (Jessica Cooper); Hoogendoorn, J. (Jochem); Hoffman, J.M. (Jodi M.); Cherian, J.J. (Joe Joseph); Tanksley, J.A. (John A.); Clarke-Jenssen, J. (John); Adams, J.D. (John D.); Esterhai, J. (John); Tilzey, J.F. (John F.); Murnaghan, J. (John); Ketz, J.P. (John P.); Garfi, J.S. (John S.); Schwappach, J. (John); Gorczyca, J.T. (John T.); Wyrick, J. (John); Rydinge, J. (Jonas); Foret, J.L. (Jonathan L.); Gross, J.M. (Jonathan M.); Keeve, J.P. (Jonathan P.); Meijer, J. (Joost); J.J. Scheepers (Joris J.); Baele, J. (Joseph); O'Neil, J. (Joseph); Cass, J.R. (Joseph R.); Hsu, J.R. (Joseph R.); Dumais, J. (Jules); Lee, J. (Julia); Switzer, J.A. (Julie A.); Agel, J. (Julie); Richards, J.E. (Justin E.); Langan, J.W. (Justin W.); Turckan, K. (Kahn); Pecorella, K. (Kaili); Rai, K. (Kamal); Aurang, K. (Kamran); Shively, K. (Karl); K.J.P. van Wessem; Moon, K. (Karyn); Eke, K. (Kate); Erwin, K. (Katie); Milner, K. (Katrine); K.J. Ponsen (Kees-jan); Mills, K. (Kelli); Apostle, K. (Kelly); Johnston, K. (Kelly); Trask, K. (Kelly); Strohecker, K. (Kent); Stringfellow, K. (Kenya); Kruse, K.K. (Kevin K.); Tetsworth, K. (Kevin); Mitchell, K. (Khalis); Browner, K. (Kieran); Hemlock, K. (Kim); Carcary, K. (Kimberly); Jørgen Haug, K. (Knut); Noble, K. (Krista); Robbins, K. (Kristin); Payton, K. (Krystal); Jeray, K.J. (Kyle J.); Rubino, L.J. (L. Joseph); Nastoff, L.A. (Lauren A.); Leffler, L.C. (Lauren C.); L.P. Stassen (Laurents); O'Malley, L.K. (Lawrence K.); Specht, L.M. (Lawrence M.); L. Thabane (Lehana); Geeraedts, L.M.G. (Leo M.G.); Shell, L.E. (Leslie E.); Anderson, L.K. (Linda K.); Eickhoff, L.S. (Linda S.); Lyle, L. (Lindsey); Pilling, L. (Lindsey); Buckingham, L. (Lisa); Cannada, L.K. (Lisa K.); Wild, L.M. (Lisa M.); Dulaney-Cripe, L. (Liz); L.M.S.J. Poelhekke; Govaert, L. (Lonneke); Ton, L. (Lu); Kottam, L. (Lucksy); L.P.H. Leenen (Luke); Clipper, L. (Lydia); Jackson, L.T. (Lyle T.); Hampton, L. (Lynne); de Waal Malefijt, M.C. (Maarten C.); M.P. Simons; M. van der Elst (Maarten); M.W.G.A. Bronkhorst (Maarten); Bhatia, M. (Mahesh); M.F. Swiontkowski (Marc ); Lobo, M.J. (Margaret J.); Swinton, M. (Marilyn); Pirpiris, M. (Marinis); Molund, M. (Marius); Gichuru, M. (Mark); Glazebrook, M. (Mark); Harrison, M. (Mark); Jenkins, M. (Mark); MacLeod, M. (Mark); M.R. de Vries (Mark); Butler, M.S. (Mark S.); Nousiainen, M. (Markku); van ‘t Riet, M. (Martijne); Tynan, M.C. (Martin C.); Campo, M. (Martin); M.G. Eversdijk (Martin); M.J. Heetveld (Martin); Richardson, M. (Martin); Breslin, M. (Mary); Fan, M. (Mary); Edison, M. (Matt); Napierala, M. (Matthew); Knobe, M. (Matthias); Russ, M. (Matthias); Zomar, M. (Mauri); de Brauw, M. (Maurits); Esser, M. (Max); Hurley, M. (Meghan); Peters, M.E. (Melissa E.); Lorenzo, M. (Melissa); Li, M. (Mengnai); Archdeacon, M. (Michael); Biddulph, M. (Michael); Charlton, M. (Michael); McDonald, M.D. (Michael D.); McKee, M.D. (Michael D.); Dunbar, M. (Michael); Torchia, M.E. (Michael E.); Gross, M. (Michael); Hewitt, M. (Michael); Holt, M. (Michael); Prayson, M.J. (Michael J.); M.J.R. Edwards (Michael); Beckish, M.L. (Michael L.); Brennan, M.L. (Michael L.); Dohm, M.P. (Michael P.); Kain, M.S.H. (Michael S.H.); Vogt, M. (Michelle); Yu, M. (Michelle); M.H.J. Verhofstad (Michiel); Segers, M.J.M. (Michiel J.M.); M.J.M. Segers (Michiel); Siroen, M.P.C. (Michiel P.C.); M.R. Reed (Mike); Vicente, M.R. (Milena R.); M.M.M. Bruijninckx (Milko); Trivedi, M. (Mittal); M. Bhandari (Mohit); Moore, M.M. (Molly M.); Kunz, M. (Monica); Smedsrud, M. (Morten); Palla, N. (Naveen); Jain, N. (Neeraj); Out, N.J.M. (Nico J.M.); Simunovic, N. (Nicole); Simunovic, N. (Nicole); N.W.L. Schep (Niels); Müller, O. (Oliver); Guicherit, O.R. (Onno R.); O.J.F. van Waes (Oscar); Wang, O. (Otis); P. Doornebosch (Pascal); Seuffert, P. (Patricia); Hesketh, P.J. (Patrick J.); Weinrauch, P. (Patrick); Duffy, P. (Paul); Keller, P. (Paul); Lafferty, P.M. (Paul M.); Pincus, P. (Paul); P. Tornetta III (Paul); Zalzal, P. (Paul); McKay, P. (Paula); Cole, P.A. (Peter A.); de Rooij, P.D. (Peter D.); Hull, P. (Peter); Go, P.M.N.Y.M. (Peter M.N.Y.M.); P. Patka (Peter); Siska, P. (Peter); Weingarten, P. (Peter); Kregor, P. (Philip); Stahel, P. (Philip); Stull, P. (Philip); P. Wittich (Philippe); P.A.R. Rijcke (Piet); P.P. Oprel (Pim); Devereaux, P.J. (P. J.); Zhou, Q. (Qi); Lee Murphy, R. (R.); Alosky, R. (Rachel); Clarkson, R. (Rachel); Moon, R. (Raely); Logishetty, R. (Rajanikanth); Nanda, R. (Rajesh); Sullivan, R.J. (Raymond J.); Snider, R.G. (Rebecca G.); Buckley, R.E. (Richard E.); Iorio, R. (Richard); Farrugia, R.J. (Richard J); Jenkinson, R. (Richard); Laughlin, R. (Richard); R.P.R. Groenendijk (Richard); Gurich, R.W. (Richard W.); Worman, R. (Ripley); Silvis, R. (Rob); R. Haverlag (Robert); Teasdall, R.J. (Robert J.); Korley, R. (Robert); McCormack, R. (Robert); Probe, R. (Robert); Cantu, R.V. (Robert V.); Huff, R.B. (Roger B.); R.K.J. Simmermacher; Peters, R. (Rolf); Pfeifer, R. (Roman); Liem, R. (Ronald); Wessel, R.N. (Ronald N.); Verhagen, R. (Ronald); Vuylsteke, R. (Ronald); Leighton, R. (Ross); McKercher, R. (Ross); R.W. Poolman (Rudolf); Miller, R. (Russell); Bicknell, R. (Ryan); Finnan, R. (Ryan); Khan, R.M. (Ryan M.); Mehta, S. (Samir); Vang, S. (Sandy); Singh, S. (Sanjay); Anand, S. (Sanjeev); Anderson, S.A. (Sarah A.); Dawson, S.A. (Sarah A.); Marston, S.B. (Scott B.); Porter, S.E. (Scott E.); Watson, S.T. (Scott T.); S. Festen; Lieberman, S. (Shane); Puloski, S. (Shannon); Bielby, S.A. (Shea A.); Sprague, S. (Sheila); Hess, S. (Shelley); MacDonald, S. (Shelley); Evans, S. (Simone); Bzovsky, S. (Sofia); Hasselund, S. (Sondre); Lewis, S. (Sophie); Ugland, S. (Stein); Caminiti, S. (Stephanie); Tanner, S.L. (Stephanie L.); S.M. Zielinski (Stephanie); Shepard, S. (Stephanie); Sems, S.A. (Stephen A.); Walter, S.D. (Stephen D.); Doig, S. (Stephen); Finley, S.H. (Stephen H.); Kates, S. (Stephen); Lindenbaum, S. (Stephen); Kingwell, S.P. (Stephen P.); Csongvay, S. (Steve); Papp, S. (Steve); Buijk, S.E. (Steven E.); S. Rhemrev (Steven); Hollenbeck, S.M. (Steven M.); van Gaalen, S.M. (Steven M.); Yang, S. (Steven); Weinerman, S. (Stuart); Subash, (); Lambert, S. (Sue); Liew, S. (Susan); S.A.G. Meylaerts (Sven); Blokhuis, T.J. (Taco J.); de Vries Reilingh, T.S. (Tammo S.); Lona, T. (Tarjei); Scott, T. (Taryn); Swenson, T.K. (Teresa K.); Endres, T.J. (Terrence J.); Axelrod, T. (Terry); van Egmond, T. (Teun); Pace, T.B. (Thomas B.); Kibsgård, T. (Thomas); Schaller, T.M. (Thomas M.); Ly, T.V. (Thuan V.); Miller, T.J. (Timothy J.); Weber, T. (Timothy); Le, T. (Toan); Oliver, T.M. (Todd M.); T.M. Karsten (Thomas); Borch, T. (Tor); Hoseth, T.M. (Tor Magne); Nicolaisen, T. (Tor); Ianssen, T. (Torben); Rutherford, T. (Tori); Nanney, T. (Tracy); Gervais, T. (Trevor); Stone, T. (Trevor); Schrickel, T. (Tyson); Scrabeck, T. (Tyson); Ganguly, U. (Utsav); Naumetz, V. (V.); Frizzell, V. (Valda); Wadey, V. (Veronica); Jones, V. (Vicki); Avram, V. (Victoria); Mishra, V. (Vimlesh); Yadav, V. (Vineet); Arora, V. (Vinod); Tyagi, V. (Vivek); Borsella, V. (Vivian); W.J. Willems (Jaap); Hoffman, W.H. (W. H.); Gofton, W.T. (Wade T.); Lackey, W.G. (Wesley G.); Ghent, W. (Wesley); Obremskey, W. (William); Oxner, W. (William); Cross, W.W. (William W.); Murtha, Y.M. (Yvonne M.); Murdoch, Z. (Zoe)
textabstractBackground Reoperation rates are high after surgery for hip fractures. We investigated the effect of a sliding hip screw versus cancellous screws on the risk of reoperation and other key outcomes. Methods For this international, multicentre, allocation concealed randomised controlled
Nauth, Aaron; Creek, Aaron T.; Zellar, Abby; Lawendy, Abdel Rahman; Dowrick, Adam; Gupta, Ajay; Dadi, Akhil; van Kampen, Albert; Yee, Albert; de Vries, Alexander C.; de Mol van Otterloo, Alexander; Garibaldi, Alisha; Liew, Allen; McIntyre, Allison W.; Prasad, Amal Shankar; Romero, Amanda W.; Rangan, Amar; Oatt, Amber; Sanghavi, Amir; Foley, Amy L.; Karlsten, Anders; Dolenc, Andrea; Bucknill, Andrew; Chia, Andrew; Evans, Andrew; Gong, Andrew; Schmidt, Andrew H.; Marcantonio, Andrew J.; Jennings, Andrew; Ward, Angela; Khanna, Angshuman; Rai, Anil; Smits, Anke B; Horan, Annamarie D.; Brekke, Anne Christine; Flynn, Annette; Duraikannan, Aravin; Stødle, Are; van Vugt, Arie B.; Luther, Arlene; Zurcher, Arthur W.; Jain, Arvind; Amundsen, Asgeir; Moaveni, Ash; Carr, Ashley; Sharma, Ateet; Hill, Austin D.; Trommer, Axel; Rai, B. Sachidananda; Hileman, Barbara; Schreurs, Bart; Verhoeven, Bart A N; Barden, Benjamin B.; Flatøy, Bernhard; Cleffken, Berry I.; Bøe, Berthe; Perey, Bertrand; Hanusch, Birgit C.; Weening, Brad; Fioole, Bram; Rijbroek, Bram; Crist, Brett D.; Halliday, Brett; Peterson, Brett; Mullis, Brian; Richardson, C. Glen; Clark, Callum; Sagebien, Carlos A.; van der Pol, Carmen C.|info:eu-repo/dai/nl/41397006X; Bowler, Carol; Humphrey, Catherine A.; Coady, Catherine; Koppert, Cees L.; Coles, Chad; Tannoury, Chadi; DePaolo, Charles J.; Gayton, Chris; Herriott, Chris; Reeves, Christina; Tieszer, Christina; Dobb, Christine; Anderson, Christopher G.; Sage, Claire; Cuento, Claudine; Jones, Clifford B.; Bosman, Coks H.R.; Linehan, Colleen; van der Hart, Cor P.; Henderson, Corey; Lewis, Courtland G.; Davis, Craig A.; Donohue, Craig; Mauffrey, Cyril; Sundaresh, D. C.; Farrell, Dana J.; Whelan, Daniel B.; Horwitz, Daniel; Stinner, Daniel; Viskontas, Darius; Roffey, Darren M.; Alexander, David; Karges, David E.; Hak, David; Johnston, David; Love, David; Wright, David M.; Zamorano, David P.; Goetz, David R.; Sanders, David; Stephen, David; Yen, David; Bardana, Davide; Olakkengil, Davy J.; Lawson, Deanna; Maddock, Deborah; Sietsema, Debra L.; Pourmand, Deeba; Den Hartog, Dennis; Donegan, Derek; Heels-Ansdell, Diane; Nam, Diane; Inman, Dominic; Boyer, Dory; Li, Doug; Gibula, Douglas; Price, Dustin M.; Watson, Dylan J.; Hammerberg, E. Mark; Tan, Edward C T H; de Graaf, Eelco J.R.; Vesterhus, Elise Berg; Roper, Elizabeth; Edwards, Elton; Schemitsch, Emil H.; Hammacher, Eric R.; Henderson, Eric R.; Whatley, Erica; Torres, Erick T.; Vermeulen, Erik G.J.; Finn, Erin; Van Lieshout, Esther M M; Wai, Eugene K.; Bannister, Evan R.; Kile, Evelyn; Theunissen, Evert B.M.; Ritchie, Ewan D.; Khan, Farah; Moola, Farhad; Howells, Fiona; de Nies, Frank; van der Heijden, Frank H.W.M.; de Meulemeester, Frank R.A.J.; Frihagen, Frede; Nilsen, Fredrik; Schmidt, G. Ben; Albers, G. H.Robert; Gudger, Garland K.; Johnson, Garth; Gruen, Gary; Zohman, Gary; Sharma, Gaurav; Wood, Gavin; Tetteroo, Geert W.M.; Hjorthaug, Geir; Jomaas, Geir; Donald, Geoff; Rieser, Geoffrey Ryan; Reardon, Gerald; Slobogean, Gerard P.; Roukema, Gert R.; Visser, Gijs A.; Moatshe, Gilbert; Horner, Gillian; Rose, Glynis; Guyatt, Gordon; Chuter, Graham; Etherington, Greg; Rocca, Gregory J.Della; Ekås, Guri; Dobbin, Gwendolyn; Lemke, H. Michael; Curry, Hamish; Boxma, Han; Gissel, Hannah; Kreder, Hans; Kuiken, Hans; Brom, Hans L.F.; Pape, Hans Christoph; van der Vis, Harm M.; Bedi, Harvinder; Vallier, Heather A.; Brien, Heather; Silva, Heather; Newman, Heike; Viveiros, Helena; van der Hoeven, Henk; Ahn, Henry; Johal, Herman; Rijna, Herman; Stockmann, Heyn; Josaputra, Hong A.; Carlisle, Hope; van der Brand, Igor; Dawson, Imro; Tarkin, Ivan; Wong, Ivan; Parr, J. Andrew; Trenholm, J. Andrew; Goslings, J Carel; Amirault, J. David; Broderick, J. Scott; Snellen, Jaap P.; Zijl, Jacco A.C.; Ahn, Jaimo; Ficke, James; Irrgang, James; Powell, James; Ringler, James R.; Shaer, James; Monica, James T.; Biert, Jan; Bosma, Jan; Brattgjerd, Jan Egil; Frölke, Jan Paul M.; Wille, Jan; Rajakumar, Janakiraman; Walker, Jane E.; Baker, Janell K.; Ertl, Janos P.; De Vries, Jean-Paul P. M.; Gardeniers, Jean W.M.; May, Jedediah; Yach, Jeff; Hidy, Jennifer T.; Westberg, Jerald R.; Hall, Jeremy A.; van Mulken, Jeroen; McBeth, Jessica Cooper; Hoogendoorn, Jochem M; Hoffman, Jodi M.; Cherian, Joe Joseph; Tanksley, John A.; Clarke-Jenssen, John; Adams, John D.; Esterhai, John; Tilzey, John F.; Murnaghan, John; Ketz, John P.; Garfi, John S.; Schwappach, John; Gorczyca, John T.; Wyrick, John; Rydinge, Jonas; Foret, Jonathan L.; Gross, Jonathan M.; Keeve, Jonathan P.; Meijer, Joost; Scheepers, Joris J.G.; Baele, Joseph; O'Neil, Joseph; Cass, Joseph R.; Hsu, Joseph R.; Dumais, Jules; Lee, Julia; Switzer, Julie A.; Agel, Julie; Richards, Justin E.; Langan, Justin W.; Turckan, Kahn; Pecorella, Kaili; Rai, Kamal; Aurang, Kamran; Shively, Karl; van Wessem, Karlijn|info:eu-repo/dai/nl/337932077; Moon, Karyn; Eke, Kate; Erwin, Katie; Milner, Katrine; Ponsen, Kees Jan; Mills, Kelli; Apostle, Kelly; Johnston, Kelly; Trask, Kelly; Strohecker, Kent; Stringfellow, Kenya; Kruse, Kevin K.; Tetsworth, Kevin; Mitchell, Khalis; Browner, Kieran; Hemlock, Kim; Carcary, Kimberly; Jørgen Haug, Knut; Noble, Krista; Robbins, Kristin; Payton, Krystal; Jeray, Kyle J.; Rubino, L. Joseph; Nastoff, Lauren A.; Leffler, Lauren C.; Stassen, Laurents P.S.; O'Malley, Lawrence K.; Specht, Lawrence M.; Thabane, Lehana; Geeraedts, Leo M.G.; Shell, Leslie E.; Anderson, Linda K.; Eickhoff, Linda S.; Lyle, Lindsey; Pilling, Lindsey; Buckingham, Lisa; Cannada, Lisa K.; Wild, Lisa M.; Dulaney-Cripe, Liz; Poelhekke, Lodewijk M.S.J.; Govaert, Lonneke; Ton, Lu; Kottam, Lucksy; Leenen, Luke P.H.|info:eu-repo/dai/nl/071390596; Clipper, Lydia; Jackson, Lyle T.; Hampton, Lynne; de Waal Malefijt, Maarten C.; Simons, Maarten P.; van der Elst, Maarten; Bronkhorst, Maarten W.G.A.; Bhatia, Mahesh; Swiontkowski, Marc; Lobo, Margaret J.; Swinton, Marilyn; Pirpiris, Marinis; Molund, Marius; Gichuru, Mark; Glazebrook, Mark; Harrison, Mark; Jenkins, Mark; MacLeod, Mark; de Vries, Mark R.; Butler, Mark S.; Nousiainen, Markku; van ‘t Riet, Martijne; Tynan, Martin C.; Campo, Martin; Eversdijk, Martin G.; Heetveld, Martin J.; Richardson, Martin; Breslin, Mary; Fan, Mary; Edison, Matt; Napierala, Matthew; Knobe, Matthias; Russ, Matthias; Zomar, Mauri; de Brauw, Maurits; Esser, Max; Hurley, Meghan; Peters, Melissa E.; Lorenzo, Melissa; Li, Mengnai; Archdeacon, Michael; Biddulph, Michael; Charlton, Michael R; McDonald, Michael D.; McKee, Michael D.; Dunbar, Michael; Torchia, Michael E.; Gross, Michael; Hewitt, Michael; Holt, Michael; Prayson, Michael J.; Edwards, Michael J R; Beckish, Michael L.; Brennan, Michael L.; Dohm, Michael P.; Kain, Michael S.H.; Vogt, Michelle; Yu, Michelle; Verhofstad, Michiel H J; Segers, Michiel J M; Segers, Michiel J M; Siroen, Michiel P.C.; Reed, Mike; Vicente, Milena R.; Bruijninckx, Milko M.M.; Trivedi, Mittal; Bhandari, Mohit; Moore, Molly M.; Kunz, Monica; Smedsrud, Morten; Palla, Naveen; Jain, Neeraj; Out, Nico J.M.; Simunovic, Nicole; Simunovic, Nicole; Schep, Niels W. L.; Müller, Oliver; Guicherit, Onno R.; Van Waes, Oscar J.F.; Wang, Otis; Doornebosch, Pascal G.; Seuffert, Patricia; Hesketh, Patrick J.; Weinrauch, Patrick; Duffy, Paul; Keller, Paul; Lafferty, Paul M.; Pincus, Paul; Tornetta, Paul; Zalzal, Paul; McKay, Paula; Cole, Peter A.; de Rooij, Peter D.; Hull, Peter; Go, Peter M.N.Y.M.; Patka, Peter; Siska, Peter; Weingarten, Peter; Kregor, Philip; Stahel, Philip; Stull, Philip; Wittich, Philippe; de Rijcke, Piet A.R.; Oprel, Pim; Devereaux, P. J.; Zhou, Qi; Lee Murphy, R.; Alosky, Rachel; Clarkson, Rachel; Moon, Raely; Logishetty, Rajanikanth; Nanda, Rajesh; Sullivan, Raymond J.; Snider, Rebecca G.; Buckley, Richard E.; Iorio, Richard; Farrugia, Richard J.; Jenkinson, Richard; Laughlin, Richard; Groenendijk, Richard P R; Gurich, Richard W.; Worman, Ripley; Silvis, Rob; Haverlag, Robert; Teasdall, Robert J.; Korley, Robert; McCormack, Robert; Probe, Robert; Cantu, Robert V.; Huff, Roger B.; Simmermacher, Rogier K J; Peters, Rolf; Pfeifer, Roman; Liem, Ronald; Wessel, Ronald N.; Verhagen, Ronald; Vuylsteke, Ronald J C L M; Leighton, Ross; McKercher, Ross; Poolman, Rudolf W; Miller, Russell; Bicknell, Ryan; Finnan, Ryan; Khan, Ryan M.; Mehta, Samir; Vang, Sandy; Singh, Sanjay; Anand, Sanjeev; Anderson, Sarah A.; Dawson, Sarah A.; Marston, Scott B.; Porter, Scott E.; Watson, Scott T.; Festen, Sebastiaan; Lieberman, Shane; Puloski, Shannon; Bielby, Shea A.; Sprague, Sheila; Hess, Shelley; MacDonald, Shelley; Evans, Simone; Bzovsky, Sofia; Hasselund, Sondre; Lewis, Sophie; Ugland, Stein; Caminiti, Stephanie; Tanner, Stephanie L.; Zielinski, Stephanie M.; Shepard, Stephanie; Sems, Stephen A.; Walter, Stephen D.; Doig, Stephen; Finley, Stephen H.; Kates, Stephen; Lindenbaum, Stephen; Kingwell, Stephen P.; Csongvay, Steve; Papp, Steve; Buijk, Steven E.; Rhemrev, Steven J.; Hollenbeck, Steven M.; van Gaalen, Steven M.; Yang, Steven; Weinerman, Stuart; Lambert, Sue; Liew, Susan; Meylaerts, Sven A.G.; Blokhuis, Taco J.|info:eu-repo/dai/nl/231997841; de Vries Reilingh, Tammo S.; Lona, Tarjei; Scott, Taryn; Swenson, Teresa K.; Endres, Terrence J.; Axelrod, Terry; van Egmond, Teun; Pace, Thomas B.; Kibsgård, Thomas; Schaller, Thomas M.; Ly, Thuan V.; Miller, Timothy J.; Weber, Timothy; Le, Toan; Oliver, Todd M.; Karsten, Tom M.; Borch, Tor; Hoseth, Tor Magne; Nicolaisen, Tor; Ianssen, Torben; Rutherford, Tori; Nanney, Tracy; Gervais, Trevor; Stone, Trevor; Schrickel, Tyson; Scrabeck, Tyson; Ganguly, Utsav; Naumetz, V.; Frizzell, Valda; Wadey, Veronica; Jones, Vicki; Avram, Victoria; Mishra, Vimlesh; Yadav, Vineet; Arora, Vinod; Tyagi, Vivek; Borsella, Vivian; Willems, W. Jaap; Hoffman, W. H.; Gofton, Wade T.; Lackey, Wesley G.; Ghent, Wesley; Obremskey, William; Oxner, William; Cross, William W.; Murtha, Yvonne M.; Murdoch, Zoe
Background Reoperation rates are high after surgery for hip fractures. We investigated the effect of a sliding hip screw versus cancellous screws on the risk of reoperation and other key outcomes. Methods For this international, multicentre, allocation concealed randomised controlled trial, we
Full Text Available The Dynamic Hip Screw (DHS is currently the most frequently used implant for the treatment of pertrochanteric hip fractures. The Percutaneous Compression Plate (PCCP is a recently developed, alternative device that involves minimal invasive surgery. The objective of the present study was to compare functional recovery following these two surgical procedures. A total of 76 consecutive elderly subjects (mean age and standard deviation, 80.6 ± 5.5 following pertrochanteric hip fracture fixation were evaluated prospectively. Functional recovery was assessed 3 and 12 weeks and 2 years following surgery. Differences between groups 3 weeks postsurgery were found only in pain level during ambulation and in the weight-bearing capability of the operated extremity, which were both in favor of the PCCP. By 3 months, both groups had improved in all measures, but did not reach their preinjury level of independence. However, the PCCP group ambulated with fewer assistive devices and demonstrated better recovery of basic activities of daily living (BADL. While the majority of the subjects from both groups ambulated independently 2 years postsurgery, the PCCP group exhibited less pain during ambulation, was more independent in ADL, and required fewer assistive devices for ambulation. To summarize, the PCCP presents enhanced short- and long-term recovery of functional abilities in comparison to DHS. However, given the limited number of patients, further studies are necessary to substantiate these results.
Ramponi, Denise R; Kaufmann, Judith; Drahnak, Gwendolen
Hip fractures are associated with significant morbidity and mortality and a major health problem in the United States (). Eighty percent of hip fractures are experienced by 80-year-old women. Plain radiographs usually confirm the diagnosis, but if there is a high level of suspicion of an occult hip fracture, magnetic resonance imaging or bone scan is the next step to confirm the diagnosis. Areas of the hip bone have varied bone strength and blood supply, making the femoral neck one of the most vulnerable areas for fracture. A consultation to an orthopedic surgeon will determine surgical interventions.
Majernícek, Marek; Dungl, P; Kolman, J; Malkus, T; Vaculík, J
The treatment of femoral neck fractures shows a relatively high number of poor outcomes, usually due to late complications, such as avascular necrosis of the femoral head or pseudoarthrosis. The latter may develop when the osteosynthesis of osteoporotic bone fails. The aim of this retrospective study was to evaluate a group of patients treated by osteo- synthesis for intra-capsular femoral neck fractures at our department, and to verify indication criteria and identify the therapeutic procedures that are best suited to our conditions. In the 1997-2001 period, a total of 81 patients with intra-capsular femoral neck fractures were operated on. Of these, 64 treated by dynamic hip screw (DHS) fixation were followed up for at least 5 years. There were 33 women and 31 men; the average age was 21.5 years (range, 21 to 74 years). The Garden classification was used to evaluate the displacement of femoral neck fractures. Preferably, osteosynthesis was carried out by closed reduction; only exceptionally was an extension device for the operating table used. A 135-degree sliding hip screw, with a short thread, directed to the head centre and a two-hole side plate were used most often.The average follow-up was 6.9 years. Evaluated were: the occurrence of late complications in relation to the length of time between injury and surgery, quality of fracture reduction, use of an anti-rotation screw and necessity of repeat surgery. Garden I or II fractures were diagnosed in 13 patients, 51 had Garden III or Garden IV fractures. Bone union without complications was achieved in 73.4 % of the patients within 12 months of surgery. Late complications were found in 26.6 %; of these, only one had Garden I fracture and the rest were Garden III and IV fractures. An anti-rotation screw was used in 39 patients (60.9 %) and its use had no effect on the development of late complications. Of the seven patients who developed pseudoarthrosis, the screw was used in four (57.1%); out of the nine
Full Text Available Background. The purpose of this meta-analysis was to find out whether the proximal femoral nail was better than the dynamic hip screw in the treatment of trochanteric fractures with respect to operation time, blood transfusion, hospital stay, wound complications, number of reoperation, and mortality rate. Methods. All randomized controlled trials comparing proximal femoral nail and dynamic hip screw in the treatment of trochanteric fractures were included. Articles and conference data were extracted by two authors independently. Data was analyzed using RevMan 5.1 version. Eight trials involving 1348 fractures were retrieved. Results. Compared with DHS fixation, PFN fixation had similar operation time (95% CI: −15.28–2.40, P=0.15. Blood loss and transfusion during perioperative time were also comparable between the two fixations (95% CI: −301.39–28.11, P=0.10; 95% CI: −356.02–107.20, P=0.29, resp.. Outcomes of hospital stay (95% CI: −0.62–1.01, P=0.64, wound complication (95% CI: 0.66–1.67, P=0.82, mortality (95% CI: 0.83–1.30, P=0.72, and reoperation (95% CI: 0.61–1.54, P=0.90 were all similar between the two groups. Conclusion. PFN fixation shows the same effectiveness as DHS fixation in the parameters measured.
Ma, Jian-Xiong; Kuang, Ming-Jie; Xing, Fei; Zhao, Yun-Long; Chen, Heng-Ting; Zhang, Lu-Kai; Fan, Zheng-Rui; Han, Chao; Ma, Xin-Long
Femoral neck fracture is considered a difficult fracture to treat and often gives rise to unsatisfactory treatment results. Cannulated cancellous screws (CCS) or a sliding hip screw (SHS) are the mainstream internal fixations used for osteosynthesis of femoral neck fractures. There is a need to integrate existing data through a meta-analysis to investigate the safety and effectiveness of CCS and SHS in the treatment of femoral neck fractures. According to the Cochrane Handbook for Systematic Reviews of Interventions, we screened for the relevant studies by searching Google Scholar, the Cochrane Controlled Trials Register, the Cochrane Library, Web of Science, EMBASE, and PubMed. The PICOS criteria was used to make sure the included studies fulfilled the inclusion criteria. Pooled data showed that there were no significant differences between the SHS and CCS groups for the Harris Hip Score. Significant differences were found between the SHS and CCS groups in terms of union time, postoperative complications, blood loss, operation time, incision length and length of hospital stay. Although the SHS and CCS groups showed similar functional recovery in treatment of femoral neck fracture in terms of the Harris Hip Score, the SHS group showed fewer postoperative complications and faster union time for patients with femoral neck fractures. Therefore, compared with CCS, the use of SHS may be a more effective treatment of femoral neck fractures. Copyright © 2018. Published by Elsevier Ltd.
Kumar Shantanu Anand
Full Text Available BACKGROUND Neck of femur fracture is one of the commonest fracture seen at all ages. It comprises 20% of all the fractures and 50% of all intracapsular fractures, only 15% of all the neck of femur (NOF fracture is undisplaced, remaining 85% is displaced. Even in undisplaced neck of femur fractures, surgery is treatment of choice. Mechanism of injury in this is simple. Fall with force being transmitted to femoral neck via greater trochanter. There are other mechanism also. MATERIALS AND METHODS This is a prospective and retrospective study conducted at MGM Medical College, Kishanganj, in which 15 patients who is suffering from NOF fracture were selected randomly. All these patients were treated by closed reduction by Flynn method and internal fixation by three divergent cannulated screws with 10 mm distance from each other. Fixation was done under spinal or epidural anaesthesia. Preoperatively, optimal 3 kg surface traction was given in affected limb. RESULTS Out of 15 operated patients, 2 patients had implant failure due to fall and 3 patients did not turned up for surgery, hence these 5 patients were excluded from the study. Rest 10 patients were followed up at 4, 12, 24, 48 and 96 weeks. In 2 cases, there was nonunion. In 2 cases, fracture united after follow up of 14 months. A 2 years follow up was done for 6 patients in which there was no evidence of an avascular necrosis and all these cases had good healing. CONCLUSION In neck of femur fracture, our first intention injury of treatment is by internal fixation in young individuals as well as elderly population. We should never directly go for partial/full replacement in young individuals. We felt the most important thing, which should be kept in mind while operating is to do accurate reduction and rigid fixation with 3 parallel short headed cannulated screw.
Li, Kainan; Zheng, Yingjie
To retrospectively evaluated Gamma nail internal fixation in the treatment of elderly patients with post-stroke hemiplegia experiencing trochanteric hip fracture. The patients were obtained consecutively from January 2005 to December 2010 with inclusion criteria. The total number was 138 and allocated to two groups: treated with the Gamma nail (n=72,group A) and continuous skin traction (n=66,group B). Preoperative variables including patient age, gender, duration of cerebrovascular accident, duration of hypertension, ASA risk score, Harris hip score and fracture type were recorded and compared. After treatment, time of patients activity on the bed, ambulation time, Harris hip score, mortality, complications were recorded and used to compare the outcomes. (1) Follow-up was undertaken from 3 to 10 years, with an average of 5.8 years. (2) No statistical difference in preoperative variables was found between the 2 groups. (3) two groups had statistical significance (P=0.000) in the time of patients activity on the bed and ambulation time and group A can activities on the bed and ambulates earlier. (4) There were significant differences between 2 groups in Harris hip score at 1 and 3 years and group A was significantly higher than group B. (5) there were statistically significant differences in mortality of 3 years, 5 years and 10 years and the group B was significantly higher than the group A. (6) There was a statistical significance in complications between 2 groups and group B was higher than group A. Major complications in group A were pain, lag screw cut out, implant infection and distal femoral fractures caused by fall after the surgery. On elderly patients with trochanteric hip fracture on the hemiplegic lower side, Gamma nail internal fixation treatment can achieve better effect, patients can be early activity, fewer complications, and less mortality. Copyright © 2016 Elsevier Ltd. All rights reserved.
Waddell James P
Full Text Available Abstract Background A variety of techniques are available for fixation of femoral shaft fractures following total hip arthroplasty. The optimal surgical repair method still remains a point of controversy in the literature. However, few studies have quantified the performance of such repair constructs. This study biomechanically examined 3 different screw-plate and cable-plate systems for fixation of periprosthetic femoral fractures near the tip of a total hip arthroplasty. Methods Twelve pairs of human cadaveric femurs were utilized. Each left femur was prepared for the cemented insertion of the femoral component of a total hip implant. Femoral fractures were created in the femurs and subsequently repaired with Construct A (Zimmer Cable Ready System, Construct B (AO Cable-Plate System, or Construct C (Dall-Miles Cable Grip System. Right femora served as matched intact controls. Axial, torsional, and four-point bending tests were performed to obtain stiffness values. Results All repair systems showed 3.08 to 5.33 times greater axial stiffness over intact control specimens. Four-point normalized bending (0.69 to 0.85 and normalized torsional (0.55 to 0.69 stiffnesses were lower than intact controls for most comparisons. Screw-plates provided either greater or equal stiffness compared to cable-plates in almost all cases. There were no statistical differences between plating systems A, B, or C when compared to each other (p > 0.05. Conclusions Screw-plate systems provide more optimal mechanical stability than cable-plate systems for periprosthetic femur fractures near the tip of a total hip arthroplasty.
Full Text Available Background: At present, there is no consensus on an appropriate treatment modality for intertrochanteric fractures in the elderly with background diseases. The aim of the present study was to compare treatment outcomes of intertrochanteric fractures reduced with dynamic hip screws (DHS and bipolar hemiarthroplasty in elderly patients with background medical conditions. Methods: In this randomized clinical trial, 60 patients with intertrochanteric fractures, who were 45-60 years old, were randomly divided into DHS and bipolar groups. After treatment, the two groups were compared in relation to complications and mortality rates, functional status using the Harris Hip Score (HHS, range of movement and severity of pain using the visual analogue score (VAS. Results: HHS (86±9 vs. 75±7.6, range of flexion (105±11 degrees vs. 90±17 degrees and external rotation (35±7 degrees vs. 20±7 degrees were significantly higher in the bipolar group compared to the DHS group (P
Full Text Available The positioning of the patient on the fracture table is critical to the successful reduction and operative fixation of hip fractures which are fixed using the dynamic hip screw system (DHS. There is a standard setup which is commonly used with relative ease. Yet the positioning of patients with amputations either above or below knee of the affected side can pose a significant challenge. We describe a novel positioning technique used on a 51-year old patient with a right above knee amputation who sustained an intertrochanteric extracapsular hip fracture.
Inter-trochanteric fracture repair - discharge; Subtrochanteric fracture repair - discharge; Femoral neck fracture repair - discharge; Trochanteric fracture repair - discharge; Hip pinning surgery - ...
Atesok, Kivanc; Doral, M Nedim; Whipple, Terry; Mann, Gideon; Mei-Dan, Omer; Atay, O Ahmet; Beer, Yiftah; Lowe, Joseph; Soudry, Michael; Schemitsch, Emil H
the purpose of this article was to systematically analyze the results of published studies in the literature which evaluated the use of arthroscopically assisted techniques in intra-articular fracture fixation. published investigations to date were analyzed by classifying them according to joints that were involved with intra-articular fractures including: knee, ankle, hip, shoulder, elbow, and wrist joints. The results were studied to assess the feasibility, efficiency, and outcomes of arthroscopy-assisted fracture fixation. arthroscopy-assisted techniques have been used successfully for the treatment of fractures of the tibial plateau, tibial eminence, malleoli, pilon, calcaneus, femoral head, glenoid, greater tuberosity, distal clavicle, radial head, coronoid, distal radius, and scaphoid. The major advantages of arthroscopic fracture fixation over open methods are direct visualization of the intra-articular space, decreased invasiveness, and the possibility for multitask interventions through which fixation of the fracture, and repair of the soft tissues and the cartilage can be performed simultaneously. The time-consuming and technically demanding nature of the procedures with a prolonged learning curve and limited fixation alternatives are the main disadvantages of this technique. arthroscopic fixation is increasingly utilized for certain intra-articular fracture types due to the minimally invasive nature of the procedures and high accuracy. Randomized controlled trials are needed to justify wider use of arthroscopy-assisted techniques for treatment of intra-articular fractures.
Full Text Available Dynamic hip screw (DHS is a well-established conventional implant for treating intertrochanteric fracture. However, revision surgery sometimes still occurs due to the cutting out of implants. A helical blade instead of threaded screw (DHS blade was designed to improve the fixation power of the osteoporotic intertrochanteric fracture. In this study, the biomechanical properties of DHS blade compared to the conventional DHS were evaluated using an unstable AO/OTA 31-A2 intertrochanteric fracture model. Fifty synthetic proximal femoral bone models with such configuration were fixed with DHS and DHS blade in five different positions: centre-centre (CC, superior-centre (SC, inferior-center (IC, centre-anterior (CA, and centre-posterior (CP. All models had undergone mechanical compression test, and the vertical and rotational displacements were recorded. The results showed that DHS blade had less vertical or rotational displacement than the conventional DHS in CC, CA, and IC positions. The greatest vertical and rotational displacements were found at CP position in both groups. Overall speaking, DHS blade was superior in resisting vertical or rotational displacement in comparison to conventional DHS, and the centre-posterior position had the poorest performance in both groups.
Zhang, Yan; Fan, Xinbin; Liu, Yue; Shao, Jin; Tang, Jiang'an; Liu, Shuyi; Yang, Tieyi; Zhang, Changqing
To evaluate the effectiveness of limited open reduction and double plates internal fixation in the treatment of Vancouver type B1 periprosthetic femoral fracture after hip arthroplasty. A retrospective analysis was made on the clinical data of 12 patients with Vancouver type B1 periprosthetic femoral fracture after hip arthroplasty between May 2007 and October 2012, who underwent limited open reduction and double plates internal fixation. Of 12 patients, 4 were male and 8 were female, aged 76-85 years (mean, 81.6 years); the left side was involved in 5 patients and the right side in 7 patients. The cement prosthesis was used in 3 cases and cementless prosthesis in 9 cases; double acting head of hip arthroplasty was performed in 4 cases and total hip arthroplasty in 8 cases. The median time from first hip arthroplasty to re-fracture was 13 months (range, 5 months-5 years). The causes of injury were traffic accident in 2 cases and falling in 10 cases. Combined fractures included contralateral tibial and fibular fractures and ipsilateral distal humeral fracture (1 case), ipsilateral proximal humeral fracture (2 cases), ipsilateral distal radial fracture (1 case), and rib fracture (1 case). The time from injury to operation was 5.6 days on average (range, 3-10 days). The incisions all healed by first intention, and no infection or deep venous thrombosis of lower extremity occurred. Twelve cases were followed up 6-24 months (mean, 13.3 months). One female patient died of acute myocardial infarction at 16 months after operation. All the fractures were healed, with X-ray healing time of 12.5 weeks on average (range, 10-16 weeks). The time of full weight bearing was 13 weeks on average (range, 10-18 weeks). Ten cases could walk freely after operation, and 2 cases could walk by the aid of walking aid appliance. At last follow-up, the Harris score of hip function was 87.3 on average (range, 75-93). The method of limited open reduction and double plates internal fixation for
... neck fracture repair; Trochanteric fracture repair; Hip pinning surgery; Osteoarthritis - hip ... You may receive general anesthesia for this surgery. This means you ... spinal anesthesia . With this kind of anesthesia, medicine is ...
Conclusion: From this study it is inferred that the functional outcome of THR and quality of life in patients who had acetabular fractures and were initially managed by open reduction and internal fixation is good.
Fixation using alternative implants for the treatment of hip fractures (FAITH): design and rationale for a multi-centre randomized trial comparing sliding hip screws and cancellous screws on revision surgery rates and quality of life in the treatment of femoral neck fractures
McCormack, Robert; Apostle, Kelly; Boyer, Dory; Moola, Farhad; Perey, Bertrand; Stone, Trevor; Viskontas, Darius; Lemke, H. Michael; Zomar, Mauri; Moon, Karyn; Moon, Raely; Oatt, Amber; Buckley, Richard E.; Duffy, Paul; Korley, Robert; Puloski, Shannon; Johnston, Kelly; Powell, James; Carcary, Kimberly; Sanders, David; Lawendy, Abdel; Tieszer, Christina; Stephen, David; Kreder, Hans; Jenkinson, Richard; Nousiainen, Markku; Axelrod, Terry; Murnaghan, John; Nam, Diane; Wadey, Veronica; Yee, Albert; Milner, Katrine; Kunz, Monica; Schemitsch, Emil H.; Ahn, Henry; Hall, Jeremy A.; McKee, Michael D.; Whelan, Daniel B.; Nauth, Aaron; Vicente, Milena R.; Wild, Lisa M.; Khan, Ryan M.; Hidy, Jennifer T.; Coles, Chad; Leighton, Ross; Biddulph, Michael; Johnston, David; Glazebrook, Mark; Alexander, David; Coady, Cathy; Dunbar, Michael; Amirault, David; Gross, Michael; Oxner, William; Reardon, Gerald; Richardson, Glen; Trenholm, Andrew; Wong, Ivan; Trask, Kelly; MacDonald, Shelley; Dobbin, Gwen; Bicknell, Ryan; Yach, Jeff; Bardana, Davide; Wood, Gavin; Harrison, Mark; Yen, David; Lambert, Sue; Howells, Fiona; Ward, Angela; Zalzal, Paul; Brien, Heather; Naumetz, V.; Weening, Brad; Simunovic, Nicole; Wai, Eugene K.; Papp, Steve; Gofton, Wade T.; Liew, Allen; Kingwell, Stephen P.; Johnson, Garth; O'Neil, Joseph; Roffey, Darren M.; Borsella, Vivian; Avram, Victoria; Oliver, Todd M.; Jones, Vicki; Jones, Clifford B.; Ringler, James R.; Endres, Terrence J.; Sietsema, Debra L.; Jeray, Kyle J.; Broderick, J. Scott; Goetz, David R.; Pace, Thomas B.; Schaller, Thomas M.; Porter, Scott E.; Tanner, Stephanie L.; Snider, Rebecca G.; Nastoff, Lauren A.; Bielby, Shea A.; Switzer, Julie A.; Cole, Peter A.; Anderson, Sarah A.; Lafferty, Paul M.; Li, Mengnai; Ly, Thuan V.; Marston, Scott B.; Foley, Amy L.; Vang, Sandy; Wright, David M.; Marcantonio, Andrew J.; Kain, Michael S. H.; Iorio, Richard; Specht, Lawrence M.; Tilzey, John F.; Lobo, Margaret J.; Garfi, John S.; Vallier, Heather A.; Dolenc, Andrea; Robinson, Chalitha; Prayson, Michael J.; Laughlin, Richard; Rubino, L. Joseph; May, Jedediah; Rieser, Geoffrey R.; Dulaney-Cripe, Liz; Gayton, Chris; Shaer, James; Schrickel, Tyson; Hileman, Barbara; Gorczyca, John T.; Gross, Jonathan M.; Humphrey, Catherine A.; Kates, Stephen; Noble, Krista; McIntyre, Allison W.; Pecorella, Kaili; Davis, Craig A.; Weinerman, Stewart; Weingarten, Peter; Stull, Philip; Lindenbaum, Stephen; Hewitt, Michael; Schwappach, John; Baker, Janell K.; Rutherford, Tori; Newman, Heike; Lieberman, Shane; Finn, Erin; Robbins, Kristin; Hurley, Meghan; Lyle, Lindsey; Mitchell, Khalis; Browner, Kieran; Whatley, Erica; Payton, Krystal; Reeves, Christina; Cannada, Lisa K.; Karges, David; Hill, Leslie; Mehta, Samir; Esterhai, John; Ahn, Jaimo; Horan, Annamarie D.; McGinnis, Kelly; Kaminski, Christine A.; Kowalski, Brynn N.; Keeve, Jonathan P.; Anderson, Christopher G.; McDonald, Michael D.; Hoffman, Jodi M.; Tarkin, Ivan; Siska, Peter; Gruen, Gary; Evans, Andrew; Farrell, Dana J.; Irrgang, James; Luther, Arlene; Cross, William W.; Cass, Joseph R.; Sems, Stephen A.; Torchia, Michael E.; Scrabeck, Tyson; Jenkins, Mark; Dumais, Jules; Romero, Amanda W.; Sagebien, Carlos A.; Butler, Mark S.; Monica, James T.; Seuffert, Patricia; Hsu, Joseph R.; Ficke, James; Charlton, Michael; Napierala, Michael; Fan, Mary; Tornetta, Paul; Tannoury, Chadi; Carlisle, Hope; Silva, Heather; Archdeacon, Michael; Finnan, Ryan; Le, Toan; Wyrick, John; Hess, Shelley; Brennan, Michael L.; Probe, Robert; Kile, Evelyn; Mills, Kelli; Clipper, Lydia; Yu, Michelle; Erwin, Katie; Horwitz, Daniel; Strohecker, Kent; Swenson, Teresa K.; Schmidt, Andrew H.; Westberg, Jerald R.; Aurang, Kamran; Zohman, Gary; Peterson, Brett; Huff, Roger B.; Baele, Joseph; Weber, Timothy; Edison, Matt; McBeth, Jessica; Shively, Karl; Ertl, Janos P.; Mullis, Brian; Parr, J. Andrew; Worman, Ripley; Frizzell, Valda; Moore, Molly M.; Tobias, Erin; Thomas, Emily; DePaolo, Charles J.; Alosky, Rachel; Shell, Leslie E.; Hampton, Lynne; Shepard, Stephanie; Nanney, Tracy; Cuento, Claudine; Cantu, Robert V.; Henderson, Eric R.; Eickhoff, Linda S.; Hammerberg, E. Mark; Stahel, Philip; Hak, David; Mauffrey, Cyril; Gibula, Douglas; Gissel, Hannah; Henderson, Corey; Zamorano, David P.; Tynan, Martin C.; Pourmand, Deeba; Lawson, Deanna; Della Rocca, Gregory J.; Crist, Brett D.; Murtha, Yvonne M.; Anderson, Linda K.; Linehan, Colleen; Pilling, Lindsey; Lewis, Courtland G.; Caminiti, Stephanie; Sullivan, Raymond J.; Roper, Elizabeth; Obremskey, William; Kregor, Philip; Richards, Justin E.; Stringfellow, Kenya; Dohm, Michael P.; Zellar, Abby; Segers, Michiel J. M.; Zijl, Jacco A. C.; Verhoeven, Bart; Smits, Anke B.; de Vries, Jean Paul; Fioole, Bram; van der Hoeven, Henk; Theunissen, Evert B.; de Vries Reilingh, Tammo S.; Govaert, Lonneke; Wittich, Philippe; de Brauw, Maurits; Wille, Jan; Go, Peter M.; Ritchie, Ewan D.; Wessel, Ronald N.; Hammacher, Eric R.; Heetveld, Martin J.; Visser, Gijs A.; Stockmann, Heyn; Silvis, Rob; Snellen, Jaap P.; Rijbroek, Bram; Scheepers, Joris J. G.; Vermeulen, Erik G. J.; Siroen, Michiel P. C.; Vuylsteke, Ronald; Brom, Hans L. F.; Rijna, Herman; de Rijcke, Piet A. R.; Koppert, Cees L.; Buijk, Steven E.; Groenendijk, Richard P. R.; Dawson, Imro; Tetteroo, Geert W. M.; Bruijninckx, Milko M. M.; Doornebosch, Pascal G.; de Graaf, Eelco J. R.; van der Elst, Maarten; van der Pol, Carmen C.; van 't Riet, Martijne; Karsten, Tom M.; de Vries, Mark R.; Stassen, Laurents P. S.; Schep, Niels W. L.; Schmidt, G. Ben; Hoffman, W. H.; Poolman, Rudolf W.; Simons, Maarten P.; van der Heijden, Frank H. W. M.; Willems, W. Jaap; de Meulemeester, Frank R. A. J.; van der Hart, Cor P.; Turckan, Kahn; Festen, Sebastiaan; de Nies, Frank; Haverlag, Robert; Out, Nico J. M.; Bosma, Jan; van Kampen, Albert; Biert, Jan; van Vugt, Arie B.; Edwards, Michael J. R.; Blokhuis, Taco J.; Frolke, Jan Paul M.; Geeraedts, Leo M. G.; Gardeniers, Jean W. M.; Tan, Edward T. C. H.; Poelhekke, Lodewijk M. S. J.; de Waal Malefijt, Maarten C.; Schreurs, Bart; Roukema, Gert R.; Josaputra, Hong A.; Keller, Paul; de Rooij, Peter D.; Kuiken, Hans; Boxma, Han; Cleffken, Berry I.; Liem, Ronald; Rhemrev, Steven J.; Bosman, Coks H. R.; de Mol van Otterloo, Alexander; Hoogendoorn, Jochem; de Vries, Alexander C.; Meylaerts, Sven A. G.; Verhofstad, Michiel H. J.; Meijer, Joost; van Egmond, Teun; van der Brand, Igor; Patka, Peter; Eversdijk, Martin G.; Peters, Rolf; den Hartog, Dennis; van Waes, Oscar J. F.; Oprel, Pim; van der Vis, Harm M.; Campo, Martin; Verhagen, Ronald; Albers, G. H. Robert; Zurcher, Arthur W.; Simmermacher, Rogier K. J.; van Mulken, Jeroen; van Wessem, Karlijn; van Gaalen, Steven M.; Leenen, Luke P. H.; Bronkhorst, Maarten W. G. A.; Guicherit, Onno R.; Goslings, J. Carel; Ponsen, Kees Jan; Bhatia, Mahesh; Arora, Vinod; Tyagi, Vivek; Liew, Susan; Bedi, Harvinder; Carr, Ashley; Curry, Hamish; Chia, Andrew; Csongvay, Steve; Donohue, Craig; Doig, Stephen; Edwards, Elton; Etherington, Greg; Esser, Max; Gong, Andrew; Jain, Arvind; Li, Doug; Miller, Russell; Moaveni, Ash; Russ, Matthias; Ton, Lu; Wang, Otis; Dowrick, Adam; Murdoch, Zoe; Sage, Claire; Frihagen, Frede; Clarke-Jenssen, John; Hjorthaug, Geir; Ianssen, Torben; Amundsen, Asgeir; Brattgjerd, Jan Egil; Borch, Tor; Boe, Berthe; Flatoy, Bernhard; Hasselund, Sondre; Haug, Knut Jorgen; Hemlock, Kim; Hoseth, Tor Magne; Jomaas, Geir; Kibsgard, Thomas; Lona, Tarjei; Moatshe, Gilbert; Muller, Oliver; Molund, Marius; Nicolaisen, Tor; Nilsen, Fredrik; Rydinge, Jonas; Smedsrud, Morten; Stodle, Are; Trommer, Axel; Ugland, Stein; Karlsten, Anders; Ekas, Guri; Vesterhus, Elise Berg; Brekke, Anne Christine; Gupta, Ajay; Jain, Neeraj; Khan, Farah; Sharma, Ateet; Sanghavi, Amir; Trivedi, Mittal; Rai, Anil; Subash, N. N.; Rai, Kamal; Yadav, Vineet; Singh, Sanjay; Tetsworth, Kevin; Donald, Geoff; Weinrauch, Patrick; Pincus, Paul; yang, Steven; Halliday, Brett; Gervais, Trevor; Holt, Michael; Flynn, Annette; Prasad, Amal Shankar; Mishra, Vimlesh; Sundaresh, D. C.; Khanna, Angshuman; Cherian, Joe Joseph; Olakkengil, Davy J.; Sharma, Gaurav; Pirpiris, Marinis; Love, David; Bucknill, Andrew; Farrugia, Richard J.; Pape, Hans-Christoph; Knobe, Matthias; Pfeifer, Roman; Hull, Peter; Lewis, Sophie; Evans, Simone; Nanda, Rajesh; Logishetty, Rajanikanth; Anand, Sanjeev; Bowler, Carol; Dadi, Akhil; Palla, Naveen; Ganguly, Utsav; Rai, B. Sachidananda; Rajakumar, Janakiraman; Jennings, Andrew; Chuter, Graham; Rose, Glynis; Horner, Gillian; Clark, Callum; Eke, Kate; Reed, Mike; Herriott, Chris; Dobb, Christine; Bhandari, Mohit; Swiontkowski, Marc; Devereaux, P. J.; Jeray, Kyle; Thabane, Lehana; Walter, Stephen; Sprague, Sheila; Scott, Taryn; Guyatt, Gordon; Viveiros, Helena; McKay, Paula; Swinton, Marilyn; Truong, Victoria; Koo, Kaitlin; Heels-Ansdell, Diane; Zhou, Qi; Buckingham, Lisa; Duraikannan, Aravin; Maddock, Deborah; Agel, Julie; van Lieshout, Esther M. M.; Zielinski, Stephanie M.; Rangan, Amar; Hanusch, Birgit C.; Kottam, Lucksy; Clarkson, Rachel; Slobogean, Gerard; Katz, Jeffrey; Gillespie, Brenda; Greendale, Gail A.; Guy, Pierre; Hartman, Curtis; Rubin, Craig; Waddell, James
Hip fractures are a common type of fragility fracture that afflict 293,000 Americans (over 5,000 per week) and 35,000 Canadians (over 670 per week) annually. Despite the large population impact the optimal fixation technique for low energy femoral neck fractures remains controversial. The primary
Fixation using alternative implants for the treatment of hip fractures (FAITH): Design and rationale for a multi-centre randomized trial comparing sliding hip screws and cancellous screws on revision surgery rates and quality of life in the treatment of femoral neck fractures
textabstractBackground: Hip fractures are a common type of fragility fracture that afflict 293,000 Americans (over 5,000 per week) and 35,000 Canadians (over 670 per week) annually. Despite the large population impact the optimal fixation technique for low energy femoral neck fractures remains
Mulley, G.; Espley, A. J.
In a series of 57 hemiplegic patients who subsequently fractured their hips, it was found that hip fracture occurred significantly more often on the hemiplegic side. Hip fracture was equally common in right- and left-sided hemiplegia, and often occurred within one year of the stroke. Two factors seem to be important in the genesis of hip fractures in hemiplegic patients: the tendency of stroke patients to fall to the affected side as a result of impaired locomotor function, and the development of disuse osteoporosis in the hemiplegic limb. PMID:471862
... online training for health care providers. Learn More Hip Fractures Among Older Adults Recommend on Facebook Tweet Share ... get older. What You Can Do to Prevent Hip Fractures You can prevent hip fractures by taking steps ...
Superior variety of anterior dislocation of the hip is a rare injury. Its occurrence with acetabular fractures has been documented infrequently. We report a case of superior dislocation of the hip with anterior column acetabular fracture. Open reduction of the hip and internal fixation of the fracture was carried out using a twin ...
Pozzi, Antonio; Peck, Jeffrey N; Chao, Peini; Choate, Christina J; Barousse, Dan; Conrad, Bryan
To evaluate whether cerclage wire or a lateral plate increases the peak-torque load to failure, compared to femora without adjunctive fixation, in femora implanted with Zurich Cementless stems. In vitro biomechanical study. Paired femora from adult dogs (n = 24) weighing 28-35 kg. Pairs of femora were implanted with a stem and randomly assigned to 2 treatment groups: cerclage or plate. Within each pair, either 3 loop cerclage wires or a laterally applied 12-hole Advanced Locking Plate System 10-mm plate (ALPS 10) were implanted in a femur, whereas the contralateral femur acted as control with no adjunctive fixation. After application of a static axial load each specimen was loaded to failure in torsion. Peak torque load at failure was compared between femora with each adjunctive fixation and the control using a paired t-test; P plated group (P plates and with cerclage were 13.9% and 7.2% stronger in torsion than the femora without fixation, respectively. Adjunctive fixation with a laterally applied ALPS 10 may aid in the prevention of peri-prosthetic fractures associated with Zurich Cementless medium stems. © Copyright 2013 by The American College of Veterinary Surgeons.
... osteolysis. Symptoms The most common symptoms of periprosthetic hip fracture include: • Pain around the hip or thigh • Swelling ... o en very painful, someone with a periprosthetic hip fracture will most likely go directly to the emergency ...
This thesis, comprising 5 separate studies, is concerned with fixation of prosthetic components in total hip arthroplasty. The results and conclusions of the studies fol-low; The initial stability of femoral revision components, the long cementless PCA stem and the Exeter standard stem cemented in a bed of impacted bone graft, was com-pared in an experimental study. The PCA stem was more stable than the Exeter stem. However, for both stems initial stability may not be sufficient to allow bone...
Schmal, Hagen; Strohm, Peter C; Jaeger, Martin
, noncomminuted fractures. External fixation uses external bars for stabilization, whereas internal fixation is realized by subcutaneous placement of locking plates. Both of these "biologic" osteosynthesis methods allow a minimally invasive approach and do not compromise fracture hematoma and periosteal blood...... of articular fractures. They allow for subchondral stabilization using small-diameter angular stable screws as well as buttressing of the joint and the metaphyseal component of a fracture. Biomechanically, they can be far stiffer than external fixators, because subcutaneous plates are located much closer...... to the bone surface than external fixator bars. External fixators have the advantage of being less expensive, highly flexible, and technically less demanding. They remain an integral part of orthopaedic surgery for emergent stabilization, for pediatric fractures, for definitive osteosynthesis in certain...
Darwish, Fayeq M; Haddad, Walid
Female, 30. Intertrochanteric fracture under an arthrodesed hip. Developmental dysplasia of the hip. Pain • inability to walk. Open reduction and internal fixation. Orthopedics and traumatology. Rare disease, Unusual setting of medical care. An intertrochanteric fracture among elderly people is common, but it is rare to see such a fracture under a longstanding hip arthrodesis. Its surgical management represents a real challenge to orthopedic surgeons. A 30-year-old female teacher with long-standing hip arthrodesis was involved in a traffic accident. Clinical and radiological examination revealed the presence of a displaced intertrochanteric fracture under an arthrodesed hip and high neck shaft angle. Before embarking on surgery, we have to consider many factors such as patient personality (a young active and ambitious woman) and the mature of the fracture (a displaced fracture, coxa valga, and atrophied muscles). After a deep discussion and evaluation of the available devices, we selected a heavy duty locked plate and cannulated screws to fix the fracture. Because of the rarity of intertrochanteric fracture under an arthrodesis hip, the proper surgical treatment is controversial. Nevertheless, we were fortunate in successfully treating this unusual fracture using a locked plate and cannulated screws, which are implants that can be useful in treatment of such fractures.
Full Text Available There is an enormous humanitarian and socioeconomic need to improve the quality and effectiveness of care for patients with hip fracture. To reduce mechanical complications in the osteosynthesis of proximal femoral fractures, improved fixation techniques have been developed including blade or screw-anchor devices, locked minimally invasive or cement augmentation strategies. However, despite numerous innovations and advances regarding implant design and surgical techniques, systemic and mechanical complication rates remain high. Treatment success depends on secure implant fixation in often-osteoporotic bone as well as on patient-specific factors (fracture stability, bone quality, comorbidity, and gender and surgeon-related factors (experience, correct reduction, and optimal screw placement in the head/neck fragment. For fracture fixation, the anchorage of the lag screw within the femoral head plays a crucial role depending on the implant’s design. Meta-analyses and randomized controlled studies demonstrate that there is a strong trend towards arthroplasty treating geriatric femoral neck fractures. However, for young adults as well as older patients with less compromised bone quality, or in undisplaced fractures, head-preserving therapy is preferred as it is less invasive and associated with good functional results. This review summarizes the evidence for the internal fixation of femoral neck fractures and trochanteric femoral fractures in elderly patients. In addition, biomechanical considerations regarding implant anchorage in the femoral head including rotation, migration, and femoral neck shortening are made. Finally, cement augmentation strategies for hip fracture implants are evaluated critically.
Full Text Available We report the case of an 82-year-old woman who developed extensive proximal thigh swelling and persistent anaemia following internal fixation of an extracapsular neck of femur fracture with a dynamic hip screw (DHS. This was revealed to be a pseudoaneurysm of a branch of profunda femoris artery on angiography. Her case was further complicated by a concurrent pulmonary embolism (PE. She underwent endovascular coil embolisation of the pseudoaneurysm. An IVC filter was inserted and the patient was fully anticoagulated once it had been ensured that there was no active bleeding. In this case, we review the potential for anatomical variations in the blood supply to this region and discuss treatment options for a complicated patient. We recommend that a pseudoaneurysm should be part of a differential diagnosis for postoperative patients with anaemia refractory to blood transfusion so as not to miss this rare but potentially serious complication.
Johansson, T.; Risto, O.; Knutsson, A.; Wahlström, O.
One hundred hips in 99 patients of 75 years or older, with a displaced femoral neck fracture, were studied for heterotopic ossification (HO). The patients were randomized to either internal fixation or total hip arthroplasty (THA). In the THA group HO was found in 32 of 45 hips compared with 1 of 39 in the internal fixation group (P
Full Text Available Prasad Antapur, Nizar Mahomed, Rajiv GandhiToronto Western Hospital, Toronto, Ontario, CanadaAbstract: As the world’s population ages, hip fractures pose a significant health care problem. Hip fractures in the elderly are associated with impaired mobility, and increased morbidity and mortality. Associated conditions, such as osteoporosis, medical comorbidity, and dementia, pose a significant concern and determine optimal treatment. One-year mortality rates currently range from 14% to 36%, and care for these patients represents a major global economic burden. The incidence of hip fractures is bimodal in its distribution. Young adult hip fractures are the result of high energy trauma, and the larger peak seen in the elderly population is secondary to low-energy injuries. The predilection for the site of fracture at the neck of femur falls into two major subgroups. Pertrochanteric fractures occur when the injury is extracapsular and the blood supply to the head of femur is unaffected. The management of this group involves internal fixation through a sliding hip screw device or intramedullary fixation device, both of which have good results. The other group of patients who sustain an intracapsular fracture at the femoral neck are at increased risk of nonunion and osteonecrosis. Recent papers in the literature have shown better functional outcomes with a primary hip replacement over other treatment modalities. This article reviews the current literature and indications for a primary total hip replacement in these patients.Keywords: hip fractures, elderly, hip replacement
Prentice, Heather A; Paxton, Elizabeth W; Hunt, Jessica J; Grimsrud, Christopher D; Weiss, Jennifer M
Hip fracture registries offer an opportunity to identify and to monitor patients with rare conditions and outcomes, including hip fractures in pediatric patients. To report patient demographics and surgical outcomes of pediatric patients treated surgically for hip fractures in a large integrated health care system. Pediatric patients (fracture) with hip fractures were identified between 2009 and 2012 using our health care system's hip fracture registry. Patient characteristics, type of fracture, surgical treatment, and short-term complications. Among 39 patients identified, 31 (79.5%) were male, and the median age was 15 years old (interquartile range: 11-17 years). Most patients were Hispanic (n = 17, 43.6%) or white (n = 14, 35.9%). There were 8 patients (20.5%) with 15 comorbidities. Delbet Type IV (intertrochanteric) fractures were the most common fracture type (n = 22, 56.4%), and fixation method was equally distributed between intramedullary, screw and sideplate, and screws (n = 12, 30.8% for each). Most surgeries were performed by medium-volume surgeons (n = 22, 56.4%) at medium- and high-volume hospitals (n = 37, 94.9%). Three 90-day readmissions (7.7%), 1 infection (2.6%), 1 malunion (2.6%), and 1 revision (2.6%) were observed in this cohort during the study period. In our series using registry data, hip fractures younger than age 21 years were more common in boys and Hispanic patients. Intertrochanteric fractures (Delbet Type IV) were the most frequently observed type in our community-based hip fracture registry. Short-term complications were infrequent.
Ogunlade, S O; Alonge, T O; Idowu, O E
The pattern of hip fractures, treatment, outcome of treatment, and complications of forty-four consecutive patients treated over a five-year period were retrospectively studied. This represents 3.5% of the hospitalised patients in orthopaedic services. The male:female ratio was 1:1.3. Seventy percent of the fractures occurred in those over 65 years of age. The fractures were the result of low energy trauma in 81.8% of patients. Intracapsular (cervical) fractures accounted for 79.5% of the total cases. Only two patients had associated injuries on admission. Austin Moore hemiarthroplasty was the choice of hip replacement for intracapsular fractures, while ORIF (Open reduction and internal fixation using fixed angle blade plate) was done for patients with (extracapsular) trochanteric fractures. Anaesthesia (general or regional) was uneventful. Non-fatal pulmonary embolism occurred in one patient post-hemiarthroplasty while in the hospital. This study shows that hip fractures are not uncommon in our environment although far less common than what obtains in the Caucasians.
Harvey, N. C.; Hansen, L.; Judge, A.
Social inequality appears to be increasing in many countries. We explored whether risk of hip fracture was associated with markers of inequality and whether these relationships changed with time, using data from Danish Health Registries. Methods: All patients 60 years or older with a primary hip...
Chin, Yuin Cheng; Foo, Tun-Lin
We describe three steps to aid fracture assessment and fixation in the extensor block pin technique for mallet fractures. The first step is the use of fluoroscopy in the initial assessment to determine indication for fixation. Next is the use of supplementary extension block pin to control larger dorsal fragments. The third technique described details the steps of open reduction of nascently malunited fractures.
Conclusion: Percutaneous fixation of displaced tongue-type calcaneal fractures is an effective treatment with acceptable clinical outcome, short hospital stay, minimal skin complications, and quick recovery.
Griffiths, Frances; Mason, Victoria; Boardman, Felicity K.; Dennick, Kathryn J.; Haywood, Kirstie L.; Achten, Juul; Parsons, Nicholas R; Griffin, Xavier L.; Costa, Matthew L.
Objective: \\ud To explore what patients consider important when evaluating their recovery from hip fracture and to consider how these priorities could be used in the evaluation of the quality of hip fracture services.\\ud \\ud Design:\\ud Semistructured interviews exploring the experience of recovery from hip fracture at two time points—4 weeks and 4 months postoperative hip fixation. Two approaches to analysis: thematic analysis of data specifically related to recovery from hip fracture; summar...
Jangir, Rajat; Mishra, Diwakar
Injuries of the hip joint from pure hip dislocations to fracture dislocations have been described and classified by various authors. These descriptions do not include fracture dislocation of hip associated with fracture of the greater trochanter. We report an unusual case of fracture dislocation of hip in which posterior dislocation of hip was associated with fracture of acetabulum, femoral head, femoral neck, greater trochanter and ipsilateral shaft of tibia. The fracture dislocation was managed with open reduction and internal fixation. Such fracture dislocation has not been reported in literature to the best of our knowledge. We believe that fracture dislocations associate with fractures of greater trochanter should be included in current classification systems of fracture dislocations of hip.
Thien, T. M.; Chatziagorou, G.; Garellick, G.
BACKGROUND: We used the Nordic Arthroplasty Register Association database to evaluate whether age, sex, preoperative diagnosis, fixation, and implant design influence the risk of revision arthroplasty due to periprosthetic fracture within two years from operation of a primary total hip replacemen...
van der Elst, M.; Bramer, J. A.; Klein, C. P.; de Lange, E. S.; Patka, P.; Haarman, H. J.
Serious problems such as stress shielding, allergic reactions, and corrosion are associated with the use of metallic fracture fixation devices in fractured long bones. Metal implants often are removed during a second retrieval operation after fracture healing has completed. A biocompatible implant
Fokter, S. K.; Vengust, V.
We describe a case of displaced subcapital fracture of the hip in a woman in the third trimester of her first pregnancy. A pathological fracture occurred in a previously painful hip, and radiographs showed pronounced osteopenia of the femoral head and neck. Closed reduction and internal fixation was carried out 2 weeks after delivery when the osteopenia was still severe. Healing of the fracture followed with recovery of hip movements.
Full Text Available Bicondylar fractures of the tibia, representing the Schatzker V and VI fractures represent a challenging problem. Any treatment protocol should aim at restoring articular congruity and the metaphyseo-diaphsyeal dissociation (MDD-both of these are equally important to long-term outcome. Both internal and external fixations have their proponents, and each method of treatment is associated with its unique features and complications. We review the initial and definitive management of these injuries, and the advantages and disadvantages of each method of definitive fixation. We suggest the use of a protocol for definitive management, using either internal or external fixation as deemed appropriate. This protocol is based on the fracture configuration, local soft tissue status and patient condition. In a nutshell, if the fracture pattern and soft tissue status are amenable plate fixation (single or double is performed, otherwise limited open reduction and articular surface reconstruction with screws and circular frame is performed.
Mehra, Pushkar; Van Heukelom, Emily; Cottrell, David A
To evaluate the treatment outcomes of rigid internal fixation for the management of infected mandible fractures. A retrospective chart review of infected mandible fractures managed by a single oral and maxillofacial surgeon at a level I trauma center during a 7-year period was accomplished by independent examiners. All patients were treated with incision and drainage, culture and sensitivity testing, extraction of nonsalvageable teeth, placement of maxillomandibular fixation when possible, fracture reduction with bone debridement and decortication, rigid internal fixation of the mandible by an extraoral approach, and antibiotic therapy. The medical and social history was contributory in most patients. The analysis was stratified by the differentiation of the fractures into 2 groups: those with soft tissue infections in the fracture region versus those with hard tissue-infected fractures (biopsy-proven osteomyelitis). A total of 44 patients were included in this study, with an average follow-up of 18.2 months from the date of surgery (range 3 to 48). The treatment protocol was successful in all 18 patients (100%) with soft tissue infected mandibular fractures and 24 (92%) of 26 patients with hard tissue-infected fractures. A protocol consisting of concomitant incision and drainage, mandibular debridement, fracture reduction, and stabilization with rigid internal fixation can be effectively used for single-stage management of infected mandible fractures.
Colón-Emeric, Cathleen; Pieper, Carl F; Grubber, Janet; Van Scoyoc, Lynn; Schnell, Merritt L; Van Houtven, Courtney Harold; Pearson, Megan; Lafleur, Joanne; Lyles, Kenneth W; Adler, Robert A
With ethical requirements to the enrollment of lower risk subjects, osteoporosis trials are underpowered to detect reduction in hip fractures. Different skeletal sites have different levels of fracture risk and response to treatment. We sought to identify fracture sites which cluster with hip fracture at higher than expected frequency; if these sites respond to treatment similarly, then a composite fracture endpoint could provide a better estimate of hip fracture reduction. Cohort study using Veterans Affairs and Medicare administrative data. Male Veterans (n=5,036,536) aged 50-99 years receiving VA primary care between 1999 and 2009 were included. Fractures were ascertained using ICD9 and CPT codes and classified by skeletal site. Pearson correlation coefficients, logistic regression and kappa statistics were used to describe the correlation between each fracture type and hip fracture within individuals, without regard to the timing of the events. 595,579 (11.8%) men suffered 1 or more fractures and 179,597 (3.6%) suffered 2 or more fractures during the time under study. Of those with one or more fractures, the rib was the most common site (29%), followed by spine (22%), hip (21%) and femur (20%). The fracture types most highly correlated with hip fracture were pelvic/acetabular (Pearson correlation coefficient 0.25, pfractures cluster with hip fractures within individuals at greater than expected frequency. If we observe similar treatment risk reductions within that cluster, subsequent trials could consider the use of a composite endpoint to better estimate hip fracture risk. Published by Elsevier Inc.
Comparison of Femoral Head Rotation and Varus Collapse Between a Single Lag Screw and Integrated Dual Screw Intertrochanteric Hip Fracture Fixation Device Using a Cadaveric Hemi-Pelvis Biomechanical Model.
Santoni, Brandon G; Nayak, Aniruddh N; Cooper, Seth A; Smithson, Ian R; Cox, Jacob L; Marberry, Scott T; Sanders, Roy W
This study compared the stabilizing effect of 2 intertrochanteric (IT) fracture fixation devices in a cadaveric hemi-pelvis biomechanical model. Eleven pairs of cadaveric osteopenic female hemi-pelves with intact hip joint and capsular ligaments were used. An unstable IT fracture (OTA 31-A2) was created in each specimen and stabilized with a single lag screw device (Gamma 3) or an integrated dual screw (IDS) device (InterTAN). The hemi-pelves were inverted, coupled to a biaxial apparatus and subjected to 13.5 k cycles of loading (3 months) using controlled, oscillating pelvic rotation (0-90 degrees) plus cyclic axial femoral loading at a 2:1 body weight (BW) ratio. Femoral head rotation and varus collapse were monitored optoelectonically. For specimens surviving 3 months of loading, additional loading was performed in 0.25 × BW/250 cycle increments to a maximum of 4 × BW or failure. Femoral head rotation with IDS fixation was significantly less than the single lag screw construct after 3 months of simulated loading (P = 0.016). Maximum femoral head rotation at the end of 4 × BW loading was 7× less for the IDS construct (P = 0.006). Varus collapse was significantly less with the IDS construct over the entire loading cycle (P = 0.021). In this worst-case model of an osteopenic, unstable, IT fracture, the IDS construct, likely owing to its larger surface area, noncylindrical profile, and fracture compression, provided significantly greater stability and resistance to femoral head rotation and varus collapse.
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.
Arirachakaran, Alisara; Amphansap, Tanawat; Thanindratarn, Pichaya; Piyapittayanun, Peerapong; Srisawat, Phutsapong; Kongtharvonskul, Jatupon
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. This systematic review was conducted using PubMed and Scopus search engines for RCTs comparing clinical outcomes between treatments from inception to February 22, 2015. Thirty-six of 785 studies identified were eligible. Compared to the other implants, PCCP showed the lowest total operative time and units of blood transfusion with an unstandardized mean difference (UMD) of 29.27 min (95% CI 5.24, 53.50) and 0.89 units (95% CI 0.52, 1.25). The lowest incidence of general complications, wound complications and late complications of PCCP was 0.09 (95% CI 0.04, 0.18), 0.01 (95% CI 0.01, 0.04) and 0.05 (95% CI 0.02, 0.11), respectively, when compared to others. The lowest fluoroscopic time was with DHS with an UMD of 0.24 min (95% CI 0.16, 0.32), whereas the lowest blood loss and shortest hospital stay were with PFN with an UMD of 233.61 ml of blood loss (95% CI 153.17, 314.04) and 7.23 days of hospital stay (95% CI 7.15, 7.31) when compared to all other fixation methods. Reoperation rates of all implants had no statistically significant difference. The network meta-analysis suggested that fixation with PCCP significantly shortens operative time and decreases the units of blood transfusion required, while
Scott, C E H; MacDonald, D; Moran, M; White, T O; Patton, J T; Keating, J F
To evaluate the outcomes of cemented total hip arthroplasty (THA) following a fracture of the acetabulum, with evaluation of risk factors and comparison with a patient group with no history of fracture. Between 1992 and 2016, 49 patients (33 male) with mean age of 57 years (25 to 87) underwent cemented THA at a mean of 6.5 years (0.1 to 25) following acetabular fracture. A total of 38 had undergone surgical fixation and 11 had been treated non-operatively; 13 patients died at a mean of 10.2 years after THA (0.6 to 19). Patients were assessed pre-operatively, at one year and at final follow-up (mean 9.1 years, 0.5 to 23) using the Oxford Hip Score (OHS). Implant survivorship was assessed. An age and gender-matched cohort of THAs performed for non-traumatic osteoarthritis (OA) or avascular necrosis (AVN) (n = 98) were used to compare complications and patient-reported outcome measures (PROMs). The mean time from fracture to THA was significantly shorter for patients with AVN (2.2 years) or protrusio (2.2 years) than those with post-traumatic OA (9.4 years) or infection (8.0 years) (p = 0.03). Nine contained and four uncontained defects were managed with autograft (n = 11), bulk allograft (n = 1), or trabecular metal augment (n = 1). Initial fracture management (open reduction and internal fixation or non-operative), timing of THA (>// 10 mm) were significantly higher following acetabular fracture compared with atraumatic OA/AVN and OHSs were inferior: one-year OHS (35.7 v ersus 40.2, p = 0.026); and final follow-up OHS (33.6 v ersus 40.9, p = 0.008). Cemented THA is a reasonable option for the sequelae of acetabular fracture. Higher complication rates and poorer PROMs, compared with patients undergoing THA for atraumatic causes, reflects the complex nature of these cases. Cite this article: Bone Joint J 2017;99-B:1399-1408. ©2017 The British Editorial Society of Bone & Joint Surgery.
Schmal, Hagen; Strohm, Peter C; Jaeger, Martin; Südkamp, Norbert P
External and internal fixators use bone screws that are locked to a plate or bar to prevent periosteal compression and associated impairment of blood supply. Both osteosynthesis techniques rely on secondary bone healing with callus formation with the exception of compression plating of simple, noncomminuted fractures. External fixation uses external bars for stabilization, whereas internal fixation is realized by subcutaneous placement of locking plates. Both of these "biologic" osteosynthesis methods allow a minimally invasive approach and do not compromise fracture hematoma and periosteal blood supply. Despite these similarities, differences between the two fixation methods prevail. Locked plating "internal fixators" allow a combination of biomechanical principles such as buttressing and dynamic compression. Periarticular locking plates are anatomically contoured to facilitate fixation of articular fractures. They allow for subchondral stabilization using small-diameter angular stable screws as well as buttressing of the joint and the metaphyseal component of a fracture. Biomechanically, they can be far stiffer than external fixators, because subcutaneous plates are located much closer to the bone surface than external fixator bars. External fixators have the advantage of being less expensive, highly flexible, and technically less demanding. They remain an integral part of orthopaedic surgery for emergent stabilization, for pediatric fractures, for definitive osteosynthesis in certain indications such as distal radius fractures, and for callus distraction.
Conclusion: Concomitant hip and distal radius fractures were generally ipsilateral and involved the femoral neck after a backward fall. These patients were younger than and not more osteoporotic than the population with isolated hip fractures; however, the hospital stay was significantly increased. The functional outcome was not influenced by concomitant wrist fracture.
Embden, Daphne van
As the number of hip fracture patients has increased dramatically over the years, the need for high quality, multidisciplinary and patient centred fracture treatment continues to grow. The first aim of this thesis is to provide better understanding of fracture patterns and classification in hip
Ostrum, R F; Litsky, A S
A prospective study on tension band fixation of medial malleolus fractures was performed on 30 consecutive patients with 31 fractures from October 1987 until December 1990. All patients had at least a displaced medial malleolus fracture unreduced by closed methods. The fractures were classified into small, medium and large using a modified Lauge-Hansen classification. There were no nonunions or movements of wires postoperatively and only two patients had subjective complaints with reference to the wires that required hardware removal. There was one 2-mm malreduction and one patient with a wound slough and subsequent osteomyelitis. One fragment had 2 mm of displacement after fixation but went on to union. A biomechanical study was undertaken to compare fixation of the medial malleolus with K wires alone, K wires plus a tension band, and two cancellous screws. The tension band fixation provided the greatest resistance to pronation forces: for times stiffer than the two screws and 62% of the intact specimen. Tension band fixation of the medial malleolus is a biomechanically strong and clinically acceptable method of treatment for displaced medial malleolus fractures. This method of fixation may be especially useful for small fragments and in osteoporotic bone.
Heetveld, Martin J.; Raaymakers, Ernst L. F. B.; van Walsum, Ariaan D. P.; Barei, David P.; Steller, E. Philip
It is not known how the described methods of reduction and dynamic hip screw (DHS) fixation of displaced intracapsular femoral neck fractures translate into proper assessment of the postoperative radiographs. At teaching or evaluation sessions in daily practice, frequent discussion arises about
Tajeu, Gabriel S; Delzell, Elizabeth; Smith, Wilson; Arora, Tarun; Curtis, Jeffrey R; Saag, Kenneth G; Morrisey, Michael A; Yun, Huifeng; Kilgore, Meredith L
We examined the effects of hip fracture on mortality, entry into long-term institutional care, and new evidence of poverty. We estimate of the proportion of hip fracture patients who require not just short-term rehabilitation but who become dependent on long-term institutional care, and the risk of becoming newly dependent on Medicaid or eligible for low-income subsidies following hip fracture. We used data from 2005 through 2010 for a random 5% sample of Medicare beneficiaries (N = 3.1 million) to conduct a retrospective matched cohort study. We used high-dimensional propensity score matching to compare outcomes for patients who experienced a hip fracture with subjects who did not, but had similar propensity for suffering a hip fracture. We then compared the 1-year risk of death, debility, and destitution between groups. We matched 43,210 hip fracture patients to comparators without a hip fracture. Hip fractures were associated with more than a twofold increase in likelihood of mortality (incidence proportion ratio [IPR] of 2.27, 95% CI, 2.20-2.34), a fourfold increase in likelihood of requiring long-term nursing facility care (IPR, 3.96; 95% CI, 3.77-4.16), and a twofold increase in the probability of entering into low-income status (IPR, 2.14; 95% CI 1.99-2.31) within 1 year following hip fracture compared with subjects without a hip fracture. Hip fracture in elderly patients resulted in increased death, debility, and destitution. Initiatives that lead to improved treatment of osteoporosis could result in a decrease in incidence of fractures, subsequent death, debility, and destitution for older adults.
Santesso, Nancy; Carrasco-Labra, Alonso; Brignardello-Petersen, Romina
Older people living in nursing care facilities or older adults living at home are at high risk of falling and a hip fracture may occur after a fall. Hip protectors have been advocated as a means to reduce the risk of hip fracture. Hip protectors are plastic shields (hard) or foam pads (soft), usually fitted in pockets in specially designed underwear.This is an update of a Cochrane review first published in 1999, and updated several times, most recently in 2010. To determine if the provision of external hip protectors (sometimes referred to as hip pads or hip protector pads) reduces the risk of fracturing the hip in older people. We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (December 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 12), MEDLINE (1950 to week 3 November 2012), MEDLINE In-Process (18 December 2012), EMBASE (1988 to 2012 Week 50), CINAHL (1982 to December 2012), BioMed Central (January 2010), trial registers and reference lists of relevant articles. All randomised or quasi-randomised controlled trials comparing an intervention group provided with hip protectors with a control group not provided with hip protectors. Two review authors independently assessed risk of bias and extracted data. We sought additional information from trialists. Data were pooled using fixed-effect or random-effects models as appropriate. This review includes 19 studies, nine of which were cluster randomised. These included approximately 17,000 people (mean age range 78 to 86 years). Most studies were overall at low risk of bias for fracture outcomes. Trials tested hard or soft hip protectors enclosed in special underwear in 18 studies.Pooling of data from 14 studies (11,808 participants) conducted in nursing or residential care settings found moderate quality evidence for a small reduction in hip fracture risk (risk ratio (RR) 0.82, 95% confidence interval (CI) 0.67 to 1.00); the absolute
Tetsunaga, Tomonori; Fujiwara, Kazuo; Endo, Hirosuke; Noda, Tomoyuki; Tetsunaga, Tomoko; Sato, Toru; Shiota, Naofumi; Ozaki, Toshifumi
Total hip arthroplasty (THA) is a good option as a salvage procedure after failed treatment of proximal femur fracture. The anatomy of the proximal femur, however, makes this surgery complicated and challenging. The purpose of this study was to evaluate the radiographic and clinical outcomes of THA after failed treatment of proximal femur fractures. We retrospectively analysed 50 consecutive THAs (42 women, 8 men; mean age 77 years) after failed treatment of a proximal femur fracture. Mean postoperative follow-up was 58.1 months. Preoperative diagnoses were femoral neck fracture in 18 hips and trochanteric fracture in 32 hips, including three that were infected. Failure resulted from cutout in 22 cases, osteonecrosis in 12, non-union with failed fixation in nine, postoperative osteoarthritis in four, and infection in three. Factors compared included radiographic assessment, complication rate, visual analogue scale (VAS), and Harris Hip Scores (HHS). Radiographic variables included femoral neck anteversion and cup and stem alignment. Absolute values of the differences in femoral neck anteversion between the affected and healthy sides were 6.0° in the femoral neck fracture group and 19.2° in the trochanteric fracture group (p = 0.01). There were no significant differences in cup anteversion (p = 0.20) or stem anteversion (p = 0.08). The complication rate was significantly higher in the trochanteric fracture group than in the femoral neck fracture group (25 vs 0%, p fracture group included three periprosthetic fractures (9.4%), two dislocations (6.3%), two surgical-site infections (6.3%), and one stem penetration (3.1%). Although no significant differences between groups were seen in the VAS or HHS at final follow-up (p = 0.32, 0.09, respectively), these measures were significantly improved at final follow-up in both groups (p fractures requires consideration of complication risk and incorrect femoral neck anteversion.
Verettas, Dionysios-Alexandros; Chloropoulou, Pelagia-Paraskevi; Drosos, Georgios; Vogiatzaki, Theodosia; Tilkeridis, Konstantinos; Kazakos, Konstantinos
Patient: Female, 68 Final Diagnosis: Periprosthetic fractures of the acetabulum and femur after bipolar hip arthroplasty Symptoms: Inability to walk Medication: ? Clinical Procedure: Revision cup and internal fixation femur Specialty: Orhopedics and Traumatology Objective: Rare co-existance of disease or pathology Background: Although periprosthetic fractures of the femur are a recognized complication of total hip arthroplasty, periprosthetic fractures of the acetabulum are rare. Simultaneous...
Houwing, R. H.; Rozendaal, M; Wouters-Wesseling, W; Buskens, E.; Keller, P; Haalboom, JRE
Hip fracture patients have a high risk of pressure ulcers (PU). We followed 121 hip fracture patients for the development of pressure ulcers and evaluated a risk assessment tool for sensitivity and specificity. More than half of the patients presented with PU, mostly stage I. Risk factors for PU
V. V. Khominets
Full Text Available Periprosthetic fractures are one of the most serious complications after hip replacement. Nineteen periprosthetic femoral fractures operated on during the period 2011-2015 were followed-up retrospectively. Periprosthetic fractures were classified according to the Vancouver classification. The functional results were evaluated using Harrison scale. Bone healing and implant stability were evaluated clinically, on plain radiographs and computed tomography. The periprosthetic fractures in all patients occurred in the postoperative period. Time from operation until fracture varied from 2 weeks to 11 years. A wedge-shaped cemented or cementless stems were implanted during the first surgery: Versys ET, Spotorno, CPT (Zimmer, США: cementless fixation was performed in 16 (84,2% patients, hybrid -in 2 (10,5% and cemented fixation - in 1 (5,3% patient. The fractures of greater trochanter were diagnosed in all patients with type A periprosthetic fractures. In type B1 periprosthetic fracture (8 patients open reduction, cerclage wiring and internal plate osteosynthesis were applied. Loosening stems in 3 patients with type B2 fractures were replaced with Wagner cementless revision component (Wagner SL Revision Stem. Angle-stable plate osteosynthesis and cerclage wiring were also performed. Closed reduction and internal minimal invasive plate osteosynthesis were performed in patients with type C periprosthetic fractures. Bone consolidation was achieved in 18 (94,7% patients, the average term was 14,3±5,2 weeks. The average Harris hip score in all patients 3 months after treatment was 64,9±16,7 points, and in 12 patients (63,2% after a year - 86,5±15,9. Femoral periprosthetic fractures require a specialized approach to choosing the treatment tactic depending on the fracture type and quality of bone tissue. It is necessary to evaluate the femoral component stability, especially in differential diagnosis of type B1 and B2 periprosthetic fractures. Computed
Della Rocca, Gregory J; Uppal, Harmeeth S; Copeland, Marilyn E; Crist, Brett D; Volgas, David A
The objective of this study was to compare a cohort of geriatric patients with operatively managed isolated fractures below the hip to a cohort of geriatric patients with operatively managed isolated hip fractures. All patients greater than 59 years of age admitted to our institution for surgical care of an isolated lower extremity fracture during a 3-year period were included. Patients were divided into 2 cohorts: BTH (fracture below the subtrochanteric region of the femur) and HIP (proximal femoral fracture at subtrochanteric region or proximal). We identified 141 patients included in cohort BTH and 205 patients included in cohort HIP. HIP patients were older (P patients and of peripheral neuropathy (P = .014) in BTH patients. HIP patients were more likely to be under active antiosteoporotic medication management and were more likely to be receiving pharmacological anticoagulation at the time of admission. HIP patients and BTH patients were similar with regard to necessity of assistance with ambulation preinjury, but HIP patients were less likely to reside independently at home than were BTH patients (P patients were also less likely to be discharged directly home from the hospital (P Geriatric patients with fractures below the hip are medically similar to geriatric patients with hip fracture. Medical comanagement protocols have been extensively published that improve care of geriatric patients with hip fracture; consideration should be given to similar protocol-driven medical comanagement programs for geriatric patients with fractures below the hip.
Beyranvand, Mandana; Mohammadi, Goergee
SUMMARY: The aim of this study was to estimate the incidence of hip fracture in Kermanshah, Iran. 161 cases (88 men and 73 women) were recorded. The annual age-standardized incidence rates were 181.1/100,000 in men and 214.6/100,000 in women. Incidence rate of hip fracture was less than in Western countries. INTRODUCTION: Hip fracture is the most serious complication of osteoporosis, the most common metabolic bone disease worldwide. The incidence of hip fracture in the elderly patients varies in different areas. The aim of this study was to estimate the incidence rate of hip fracture in Kermanshah, Iran. MATERIALS AND METHODS: All cases of hip fracture patients who aged 50 years or more admitted in six referral orthopedic hospitals in Kermanshah from May 21, 2007 to May 21, 2008 were studied. The age- and sex-specific incidence rates of hip fracture per 100,000 persons were calculated using the population data from the last national census in Iran, 2007. RESULTS: A total of 161 cases of hip fracture (88 men and 73 women) were recorded. The annual age-standardized incidence rates were 181.1/100,000 in men and 214.6/100,000 in women. The female to male ratio of hip fracture incidence was 1.18. CONCLUSION: We found a relatively low incidence of hip fracture in Iran than in Western countries, which is mostly due to the lower rate in women. This is probably related to the different lifestyle factors in different societies.
Frisch, Nicholas B; Charters, Michael A; Sikora-Klak, Jakub; Banglmaier, Richard F; Oravec, Daniel J; Silverton, Craig D
Intraoperative periprosthetic femur fracture is a known complication of total hip arthroplasty (THA) and a variety of cerclage systems are available to manage these fractures. The purpose of this study was to examine the in situ biomechanical response of cerclage systems for fixation of periprosthetic femur fractures that occur during cementless THA. We compared cobalt chrome (CoCr) cables, synthetic cables, monofilament wires and hose clamps under axial compressive and torsional loading. Metallic constructs with a positive locking system performed the best, supporting the highest loads with minimal implant subsidence (both axial and angular) after loading. Overall, the CoCr cable and hose clamp had the highest construct stiffness and least reduction in stiffness with increased loading. They were not demonstrably different from each other. Copyright © 2015 Elsevier Inc. All rights reserved.
Burke, Neil G
Locking plates are increasingly used to surgically treat proximal humerus fractures. Knowledge of the bone quality of the proximal humerus is important. Studies have shown the medial and dorsal aspects of the proximal humeral head to have the highest bone strength, and this should be exploited by fixation techniques, particularly in elderly patients with osteoporosis. The goals of surgery for proximal humeral fractures should involve minimal soft tissue dissection and achieve anatomic reduction of the head complex with sufficient stability to allow for early shoulder mobilization. This article reviews various treatment options, in particular locking plate fixation. Locking plate fixation is associated with a high complication rate, such as avascular necrosis (7.9%), screw cutout (11.6%), and revision surgery (13.7%). These complications are frequently due to the varus deformation of the humeral head. Strategic screw placement in the humeral head would minimize the possibility of loss of fracture reduction and potential hardware complications. Locking plate fixation is a good surgical option for the management of proximal humerus fractures. Complications can be avoided by using better bone stock and by careful screw placement in the humeral head.
... 21 Food and Drugs 8 2010-04-01 2010-04-01 false External facial fracture fixation appliance. 878.3250 Section 878.3250 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... External facial fracture fixation appliance. (a) Identification. An external facial fracture fixation...
Berg, Andrew James; Bhatia, Chandra
While neck of femur fractures are common it is rare to see this injury in a bilateral leg amputee. Special consideration needs to be given to the management of these patients. We report the case of a 58-year-old man with bilateral leg amputation who presented to the emergency department with left hip pain following a fall. A fracture of the left neck of femur with extension into the femoral shaft was diagnosed. Internal fixation was planned with a dynamic hip screw. Standard fracture table setup, which allows for traction of the fractured limb and positioning of the contralateral limb such that anteroposterior and lateral X-rays can be obtained, was not possible in this case due to the amputations. We highlight considerations that need to be made in positioning a bilateral amputee for neck of femur fracture fixation and also highlight an improvised technique that can be utilised by other surgeons. PMID:24563044
Kanis, J A; McCloskey, E V
Hip fracture is the most serious complication of osteoporosis and the incidence is rising worldwide. Bone mineral density measurements can be used not only to diagnose osteoporosis at the hip, but also to give prognostic information on the lifetime risk of hip fracture. A number of additional risk factors enhance the ability of density measurements to assess risk. Candidates include markers of bone resorption, prior fragility fractures, hip axis length, and estimates of postural integrity, each of which improve prognostic value independently of bone mineral assessments. Their use in the stratification of risk will help define intervention thresholds for treatments and improve the design of population screening policies, particularly in elderly women in whom the burden of hip fracture is greatest.
Chang, Jun-Dong; Yoo, Je-Hyun; Reddy, Pradeep; Lee, Sang-Soo; Hwang, Ji-Hyo; Kim, Tae-Young
Contra-lateral hip fractures in elderly patients with a previous hip fracture increase the incidence of complications and socioeconomic burden. The purpose of this study was to identify the risk factors that contribute to the occurrence of contra-lateral hip fracture in elderly patients. Among 1093 patients treated for a hip fracture, 47 patients sustained a contra-lateral hip fracture. These patients were compared with 141 patients with a unilateral hip fracture (controls). The incidence of contra-lateral hip fracture was 4.3% among the 1093 patients treated for a hip fracture at our institute. A contra-lateral hip fracture occurred within 2 years of initial fracture in 66%, and subsequently, the annual incidence rate decreased. A similar fracture pattern was noted in 70% of patients who sustained an intertrochanteric fracture. In terms of preoperative factors, respiratory disease (OR 2.57, P=0.032) and visual impairment (OR 2.51, P=0.012) were higher in patients with a contra-lateral hip fracture than in controls, and for postoperative factors, the proportions of patients with postoperative delirium (OR 2.91, P=0.022), late onset of rehabilitation (OR 1.05, P=0.023), and poor ambulatory status at 3 months (OR 1.34, P=0.002) were also significantly higher in patients than in controls. Postoperative delirium and underlying visual impairment and respiratory disease could be risk factors of contra-lateral fracture in elderly patients. Early and active rehabilitation after surgery is important to prevent the occurrence of contra-lateral hip fracture in the elderly. Copyright © 2013 Elsevier Ltd. All rights reserved.
Beltran, Michael J; Collinge, Cory A; Gardner, Michael J
Stress modulation is the concept of manipulating bridge plate variables to provide a flexible fixation construct that allows callus formation through uneventful secondary bone healing. Obtaining absolute stability through the anatomic reduction of all fracture fragments comes at the expense of fracture biology, whereas intramedullary nailing, which is more advantageous for diaphyseal fractures of the lower extremity, is technically demanding and often may not be possible when stabilizing many metaphyseal fractures. Overly stiff plating constructs are associated with asymmetric callus formation, early implant failure, and fracture nonunion. Numerous surgeon-controlled variables can be manipulated to increase flexibility without sacrificing strength, including using longer plates with well-spaced screws, choosing titanium or stainless steel implants, and using locking or nonlocking screws. Axially dynamic emerging concepts, such as far cortical locking and near cortical overdrilling, provide further treatment options when bridge plating techniques are used.
Aggarwal Aditya K
Full Text Available 【Abstract】Femoral head fractures without dislocation or subluxation are extremely rare injuries. We report a neglected case of isolated comminuted fracture of femoral head without hip dislocation or subluxation of one year duration in a 36-year-old patient who sustained a high en- ergy trauma due to road traffic accident. He presented with painful right hip and inability to bear full weight on right lower limb with Harris hip score of 39. He received cementless total hip replacement. At latest follow-up of 2.3 years, functional outcome was excellent with Harris hip score of 95. Such isolated injuries have been described only once in the literature and have not been classified till now. The purpose of this report is to highlight the extreme rarity, possible mechanism involved and a novel classification system to classify such injuries. Key words: Femur head; Hip dislocation; Classification; Arthroplasty, replacement, hip
Su, Hsiu; Aharonoff, Gina B; Hiebert, Rudi; Zuckerman, Joseph D; Koval, Kenneth J
In this article, we examine rates of in-hospital mortality of elderly patients with femoral neck fracture treated with internal fixation or hemiarthroplasty. Data were analyzed for 51,003 patients (> or = 65 years old) admitted with femoral neck fractures to New York state hospitals between 1985 and 1996. The primary outcome examined was in-hospital mortality. Associations between type of surgical procedure and outcome were assessed using a multiple logistic regression model, adjusting for patient age, sex, race, number of comorbidities, and residence in a nursing facility before hip fracture. Approximately 30% of the study group had undergone open or closed reduction and internal fixation; the other 70% had undergone hemiarthroplasty. Forty-six percent of the internal fixation group and 56% of the hemiarthroplasty group were 85 years old or older (P femoral neck fracture were more likely to die during hospitalization than those who had undergone internal fixation.
Dinesh K Dhanwal
Full Text Available Osteoporosis is a major health problem, especially in elderly populations, and is associated with fragility fractures at the hip, spine, and wrist. Hip fracture contributes to both morbidity and mortality in the elderly. The demographics of world populations are set to change, with more elderly living in developing countries, and it has been estimated that by 2050 half of hip fractures will occur in Asia. This review conducted using the PubMed database describes the incidence of hip fracture in different regions of the world and discusses the possible causes of this wide geographic variation. The analysis of data from different studies show a wide geographic variation across the world, with higher hip fracture incidence reported from industrialized countries as compared to developing countries. The highest hip fracture rates are seen in North Europe and the US and lowest in Latin America and Africa. Asian countries such as Kuwait, Iran, China, and Hong Kong show intermediate hip fracture rates. There is also a north-south gradient seen in European studies, and more fractures are seen in the north of the US than in the south. The factors responsible of this variation are population demographics (with more elderly living in countries with higher incidence rates and the influence of ethnicity, latitude, and environmental factors. The understanding of this changing geographic variation will help policy makers to develop strategies to reduce the burden of hip fractures in developing countries such as India, which will face the brunt of this problem over the coming decades.
Full Text Available BACKGROUND Ninety percent of the hip fractures in the elderly result from a simple fall. More than fifty percent of the hip fractures in the elderly are intertrochanteric fractures. The goal of treatment of any intertrochanteric fracture in elderly is to restore mobility at the earliest and minimise the complications of prolonged bed rest. The Dynamic Hip Screw (DHS has been shown to produce good results, but complications are frequent, particularly in unstable intertrochanteric fractures. Intramedullary fixation is considered to provide a more biomechanically stable construct by reducing the distance between the hip joint and implant. MATERIALS AND METHODS The goal of this study is to compare the functional outcome of intertrochanteric fractures in elderly patients treated with Proximal Femoral Nail (PFN and Dynamic Hip Screw (DHS by analysing the clinical and radiological results to evaluate the advantages and disadvantages and possible complications associated with fixation of intertrochanteric fractures with PFN and DHS. 1 In our study, we included 106 intertrochanteric fractures, out of which 46 were treated with PFN and 60 with DHS. Ordinary fracture table was used in all cases and were followed up at regular intervals of 4, 8 and 12 weeks, 6 months and one year. RESULTS Functional results were assessed with modified Harris hip score. We observed significantly higher excellent results and less poor results in PFN compared to DHS. CONCLUSION Unstable intertrochanteric fractures treated with PFN have significantly better outcome than DHS. In unstable fractures, reduction loss, union in varus and limb shortening are significantly higher in DHS. Hence, the advantages of PFN are less surgical trauma, less blood loss and the possibility of early weightbearing even after very complex fractures.
Full Text Available Introduction: Posterior dislocation of the hip joint with associated acetabular and intertrochanteric fracture is a complex injury. Early recognition, prompt and stable reduction is needed of successful outcome. Case Report: 45 year old male patient presented with posterior dislocation of the hip with transverse fracture with posterior wall fracture of acetabulam and intertrochanteric fracture on the ipsilateral side. The complex fracture geometry was confirmed by CT scan. The patient was successfully managed by open reduction and internal fixation of intertrochanteric fracture was achieved with dynamic hip screw (DHS plate fixation followed by fixation of acetabular fracture with reconstruction plate. Conclusion: Hip dislocation combined with acetabular fracture is an uncommon injury; this article presents a unique case of posterior wall and transverse fractures of ipsilateral acetabulum with intertrochanteric fracture in a patient who sustained traumatic posterior hip dislocation. Early surgical intervention is important for satisfactory outcomes of such complex fracture-dislocation injuries. Keywords: Hip dislocation; acetabular fractures; intertrochanteric fracture; operative treatment.
Lü, Bo; Wang, Yue; Zhu, Jian-Xin; Huang, Chong-Xin; Liao, Tian-Cheng; Wang, An
To investigate the results of hip arthroplasty for the treatment of severe comminuted proximal femoral fracture with ipsilateral acetabulum fracture. From June 2007 to September 2013, 8 patients (8 hips) with severe comminuted proximal femoral fracture combined with ipsilateral acetabulum fracture were treated with hip arthroplasty. All patients were male and using biological prosthesis. Aged from 33 to 64 years old with an average of 41.9 years. According to Harris score in aspect of pain, function, range of motion to evaluate clinical effects. There was no untoward reaction in 8 patients. And bed rest at 3 months after operation, waiting for acetabulum fracture healed to out-of-bed activity. There was no complications such as pneumonia, bedsore and so on in the patients. Follow-up time was from 9 to 72 months with an average of 35.8 months, the wound healed, there was no the subsidence and loosening of prosthesis, no dislocation and infection. The mean of Harris score was 87.5 points after operation. The effect of the hip replacement in treating severe comminuted proximal femoral fracture with ipsilateral acetabulum fracture is confirmed. It can restore motor function and reduce traumatic complication, may serve as a substitute for internal fixation of difficult operation. The long-term efficacy is necessary to further observe.
Bitsch, M S; Foss, N B; Kristensen, B B
BACKGROUND: Patients undergoing hip fracture surgery often experience acute post-operative cognitive dysfunction (APOCD). The pathogenesis of APOCD is probably multifactorial, and no single intervention has been successful in its prevention. No studies have investigated the incidence of APOCD after...... hip fracture surgery in an optimized, multimodal, peri-operative rehabilitation regimen. METHODS: One hundred unselected hip fracture patients treated in a well-defined, optimized, multimodal, peri-operative rehabilitation regimen were included. Patients were tested upon admission and on the second...... without a concomitant medical complication, the only risk factors were cognitive level and regular anti-psychotic treatment. CONCLUSION: On the basis of current evidence, APOCD is prevalent amongst hip fracture patients despite multimodal intervention; future research should therefore focus on defining...
The advent and increasing use of joint replacement for various pathologies has led to a new group of fractures- the periprosthetic fractures. The hip joint is no exception to this group, a fair share of these fractures do occur around the hip joint. The management of these fractures is complex and usually needs application of ...
Pedersen, Tonny J; Lauritsen, Jens M
Background and purpose - Pre-fracture functional level has been shown to be a consistent predictor of rehabilitation outcomes in older hip fracture patients. We validated 4 overall pre-fracture functional level assessment instruments in patients aged 65 or more, used the prediction of outcome at 4...... months post-fracture, and assessed cutoff values for decision making in treatment and rehabilitation. Patients and methods - 165 consecutive patients with acute primary hip fracture were prospectively included in the study. Pre-fracture Barthel-20, Barthel-100, cumulated ambulation score, and new...... mobility score were scored immediately after admission. Outcome defined as mortality, residential status, and independent walking ability was assessed at 4 months. Results - 3 of the assessment instruments, namely Barthel-20, Barthel-100, and new mobility score, correlated with outcome at 4 months post-fracture...
Palm, Henrik; Krasheninnikoff, Michael; Holck, Kim
Background and purpose Treatment of hip fracture patients is controversial. We implemented a new operative and supervision algorithm (the Hvidovre algorithm) for surgical treatment of all hip fractures, primarily based on own previously published results. Methods 2,000 consecutive patients over 50...... years of age who were admitted and operated on because of a hip fracture were prospectively included. 1,000 of these patients were included after implementation of the algorithm. Demographic parameters, hospital treatment, and reoperations within the first postoperative year were assessed from patient...... 192 of 1,000 to 105 of 1,000 (p fractures and a decline of 13% to 7% for extracapsular fractures. The proportion of bed-days caused...
Iobst, Christopher A
Most tibia fractures in children can be treated nonoperatively. For fractures that do require surgery, however, the most common methods of management include plating or flexible nail insertion. Some fracture patterns, such as periphyseal fractures, fractures with bone and/or soft tissue loss, or fractures with delayed presentation, are not easily amenable to these techniques. Hexapod external fixators are especially helpful in these difficult cases. The purpose of this review is to discuss the principles of performing hexapod circular external fixation applied to pediatric tibia fractures. Some of the additional capabilities of the hexapod external fixator will also be highlighted.
Cristancho, P; Lenze, E J; Avidan, M S; Rawson, K S
Hip fracture is often complicated by depressive symptoms in older adults. We sought to characterize trajectories of depressive symptoms arising after hip fracture and examine their relationship with functional outcomes and walking ability. We also investigated clinical and psychosocial predictors of these trajectories. We enrolled 482 inpatients, aged ⩾60 years, who were admitted for hip fracture repair at eight St Louis, MO area hospitals between 2008 and 2012. Participants with current depression diagnosis and/or notable cognitive impairment were excluded. Depressive symptoms and functional recovery were assessed with the Montgomery-Asberg Depression Rating Scale and Functional Recovery Score, respectively, for 52 weeks after fracture. Health, cognitive, and psychosocial variables were gathered at baseline. We modeled depressive symptoms using group-based trajectory analysis and subsequently identified correlates of trajectory group membership. Three trajectories emerged according to the course of depressive symptoms, which we termed 'resilient', 'distressed', and 'depressed'. The depressed trajectory (10% of participants) experienced a persistently high level of depressive symptoms and a slower time to recover mobility than the other trajectory groups. Stressful life events prior to the fracture, current smoking, higher anxiety, less social support, antidepressant use, past depression, and type of implant predicted membership of the depressed trajectory. Depressive symptoms arising after hip fracture are associated with poorer functional status. Clinical and psychosocial variables predicted membership of the depression trajectory. Early identification and intervention of patients in a depressive trajectory may improve functional outcomes after hip fracture.
Fernando Manuel Bidolegui
Full Text Available The number of hip fractures in the elderly growth with the increase in life expectancy. Therefore meet with a femur fractured, distal to a previously implant fixation used in intertrochanteric femur fractures as dynamic hip screw or fixed angle plate, is not an uncommon scenario despite year mortality of hip fracture of 30 to 50%. Given this situation, we used a retrograde intramedullary nail associated with extracting screws percutaneously prior implant. We present 8 cases in patients with an average age of 85.6 years, 5 female and 3 male with a time from the proximal femur fixation to the new fracture average 3.5 years. Will we track 36 months and we evaluated postoperative mobility and pain getting a consolidation of the fracture in all cases. We found this technique effective; capable of achieving stable fixation without adding morbidity due to the possibility of overlapping two implants decreasing the possibility of potential new interimplantes fracture.
Full Text Available The outcome of bicondylar tibial plateau fractures treated with either external fixation (35 patients or internal fixation (24 patients was reviewed. Outcome measures included the Rasmussen score, clinical complications, development of osteoarthritis and the requirement for total knee replacement (TKR. Twenty-two (92% anatomical reductions were achieved in the internal fixation group compared to 27 (77% in the external fixation group. Infective complications were more common in the external fixation group (9 patients, 26% due to pin tract infection. There were no deep infections in the internal fixation group. The mean Rasmussen score was not significantly different (mean score 32 in external fixation and 29 in internal fixation between the two groups and the incidence of osteoarthritis was the same in both groups. Four patients in the external fixation group underwent a TKR compared to 5 patients in the internal fixation group. Bicondylar tibial plateau fractures have similar outcomes following external or internal fixation.
Fascia iliaca block associated only with deep sedation in high-risk patients, taking P2Y12 receptor inhibitors, for intramedullary femoral fixation in intertrochanteric hip fracture: a series of 3 cases.
Almeida, Carlos Rodrigues; Francisco, Emília Milheiro; Pinho-Oliveira, Vítor; Assunção, José Pedro
We present a series of 3 cases in which the impact in outcome was, first of all, related to the capacity to offer early and safer treatment to some hip fracture high-risk patients using a fascia iliaca block (FIB; ropivacaine 0,5% 20 cc and mepivacaine 1,3% 15 cc, given 30 minutes before incision) associated only with deep sedation, contributing to better practice and outcome. All elderly patients were American Society of Anesthesiologists IV patients, under P2Y12 receptor inhibitors, suffering from an intertrochanteric fracture, and purposed for intramedullary femoral fixation (IMF). All patients have been managed successfully through a deep sedation using a low-dose infusion of propofol and bolus of fentanyl without face mask ventilation, supraglottic device placement, or endotracheal intubation after an FIB. Bispectral index was always greater than 75, and no CO 2 retention or respiratory depression was present. No signs of pain or hemodynamic instability were observed. In these cases, surgery would be postponed if the choice was neuroaxial anesthesia, particularly because of P2Y12 receptor inhibitors' effect. FIB puncture site is distal to the fracture and incision site, but proximal local anesthetic migration through the interfascial planes allows for constant block of femoral nerve and lateral cutaneous of femur nerve and, less constantly, block of obturator. FIB may reduce the risk of perineural hematoma associated with several injections in nerve vicinity of different lumbar plexus branches. Frequently, indications for extramedullary or IMF are overlapping, but IMF is associated with less blood loss and may be managed using a low anesthetic depth if an FIB is done, increasing safety. This way, these less invasive surgical techniques combined with an adjusted anesthetic technique may have a crucial role in high-risk patients, particularly if taking P2Y12 receptor inhibitors. In these cases of IMF, surgical manipulation of sciatic and/or inferior subcostal
Background: Rib fractures and flail chests have traditionally been treated nonoperatively. Current literature suggests that it is not only safe and feasible but also desirable to perform fixation of severe rib fractures. Our unit in the Pietermaritzburg public sector adopted rib fracture fixation in 2014 and in this audit we assess its ...
A.H. Broekhuizen (Tom); B. van Linge
textabstractInternal fixation can be carried out in various ways. For femoral shaft fractures, an (interlocking) nail is becoming increasingly popular, instead of open realignment of the fracture. External fixation, which has become a generally accepted method of treating fractures of the lower
A.J.H. Vochteloo (Anne); W.E. Tuinebreijer (Wim); A.B. Maier (Andrea); R.G.H.H. Nelissen (Rob); R.M. Bloem (Rolf); P. Pilot (Peter)
textabstractPurpose This paper reports on the development and validity of a new instrument, called the discharge of hip fracture patients score (DHP), that predicts at admission the discharge location in patients living in their own home prior to hip fracture surgery. Methods A total of 310 patients
Lyles, Kenneth W; Colón-Emeric, Cathleen S; Magaziner, Jay S
BACKGROUND: Mortality is increased after a hip fracture, and strategies that improve outcomes are needed. METHODS: In this randomized, double-blind, placebo-controlled trial, 1065 patients were assigned to receive yearly intravenous zoledronic acid (at a dose of 5 mg), and 1062 patients were...... assigned to receive placebo. The infusions were first administered within 90 days after surgical repair of a hip fracture. All patients (mean age, 74.5 years) received supplemental vitamin D and calcium. The median follow-up was 1.9 years. The primary end point was a new clinical fracture. RESULTS...... in the two groups. CONCLUSIONS: An annual infusion of zoledronic acid within 90 days after repair of a low-trauma hip fracture was associated with a reduction in the rate of new clinical fractures and with improved survival. (ClinicalTrials.gov number, NCT00046254 [ClinicalTrials.gov].)....
Brand, Stephan; Klotz, Johannes; Hassel, Thomas; Petri, Maximilian; Haasper, Carl; Bach, Friedrich-Wilhelm; Krettek, Christian; Goesling, Thomas
AIM: To develop new fixation techniques for the treatment of periprosthetic fractures using intraprosthetic screw fixation with inserted threaded liners. METHODS: A Vancouver B1 periprosthetic fracture was simulated in femur prosthesis constructs using sawbones and cemented regular straight hip stems. Fixation was then performed with either unicortical locked-screw plating using the less invasive stabilization system-plate or with intraprosthetic screw fixation using inserted liners. Two experimental groups were formed using either prostheses made of titanium alloy or prostheses made of cobalt chrome alloy. Fixation stability was compared in an axial load-to-failure model. Drilling was performed using a specially invented prosthesis drill with constantly applied internal cooling. RESULTS: The intraprosthetic fixation model with titanium prostheses was superior to the unicortical locked-screw fixation in all tested devices. The intraprosthetic fixation model required 10 456 N ± 1892 N for failure and the unicortical locked-screw plating required 7649 N ± 653 N (P < 0.05). There was no significant difference between the second experimental group and the control group. CONCLUSION: Intraprosthetic screw anchorage with special threaded liners enhances the primary stability in treating periprosthetic fractures by internal fixation. PMID:23326763
Norris, Brent L; Lang, Gerald; Russell, Thomas A Toney; Rothberg, David L; Ricci, William M; Borrelli, Joseph
The goals of all orthopaedic surgeons treating fractures are, and will remain, obtaining union of the fracture with a well-aligned and functional limb while minimizing the risk of complications. This requires us to understand how the biomechanical environment of the fracture affects healing and to be able to discern which mechanical environment is preferred over another. Understanding the spectrum of stability imparted by our current surgical devices is paramount to giving our patients the best opportunity to heal and recover from their injury. Gone are the simplistic views of plates and screws being applied for absolute stability and nails and external fixators being applied for relative stability. This review sheds new light on how the use of different implants provides the appropriate stability to encourage fracture healing and limit the risk of complication and loss of function.
Full Text Available We present a rare clinical case of a 90-year-old female who sustained a proximal femoral neck fracture following long-standing hip arthrodesis. Since the fracture occurred relatively proximally and involved the pelvis, double-plate fixation was chosen to achieve rigid fixation. The reconstruction plate was placed at the posterior and anterior columns individually through single vertical incision. She was treated successfully, and she attained preinjury activity level. Proximal femoral fractures in arthrodesed hips need to be recognized as a fracture between the pelvis and femur. Rotational stress from the trunk and lower extremity requires rigid fixation to minimize the increase of displacement and the risk for nonunion.
Sáez López, Pilar; Sánchez Hernández, Natalia; Paniagua Tejo, Sonsoles; Valverde García, José Antonio; Montero Díaz, Margarita; Alonso García, Noelia; Freites Esteve, Alfonso
Hip fracture in the elderly often occurs in patients with high co-morbidity. Effective management requires a comprehensive and multidisciplinary approach. To evaluate the effect of a quality improvement intervention in the detection and treatment of complications in elderly patients admitted for hip fracture. A comparative study was conducted between two groups of patients admitted for hip fracture prior to 2010, and after a quality improvement intervention in 2013. The intervention consisted of implementing improved multidisciplinary measures in accordance with recent scientific evidence. The degree of compliance of the implemented measures was quantified. Patients admitted due to hip fracture in 2010 (216 patients) and 2013 (196 patients) were similar in age, sex, Barthel Index, and a reduced Charlson Index, although there were more comorbidities in 2013. After implementation of the protocols, the detection of delirium, malnutrition, anemia, and electrolyte disturbances increased. A larger number of patients in 2013 were precribed intravenous iron (24% more) and osteoporosis treatment (61.3% more). The average stay was reduced by 45.3% and surgical delay by 29.4%, achieving better functional efficiency. The implementation of a clinical pathway in geriatric patients with hip fracture is useful to detect and treat complications at an early stage, and to reduce pre-operative and overall stay, all without a negative clinical or functional impact. Copyright © 2014 SEGG. Published by Elsevier Espana. All rights reserved.
Sørensen, Holger J; Jensen, Signe O W; Nielsen, Jimmi
In a nationwide study using linkage of Danish hospital registers we examined predictors of hip fracture (ICD-10: S72) in 15,431 patients with schizophrenia (ICD-10: F20 or ICD-8: 295) and 3,807,597 population controls. Shorter education, disability pension, lifetime alcohol abuse, somatic co......-morbidity, antipsychotics (IRR=1.19; 95% CI 1.15-1.24), antidepressant (IRR=1.18; 95% CI 1.16-1.20), anticholinergics (IRR=1.29; 95% CI 1.22-1.36), benzodiazepines (IRR=1.06; 95% CI 1.04-1.08) and corticosteroids (IRR=1.44; 95% CI 1.36-1.53) were significant predictors. In 556 persons with schizophrenia and hip fracture...... (matched to 1:3 to schizophrenia controls without hip fracture), antipsychotic polypharmacy predicted hip fracture. Analyses among antipsychotic monotherapy patients showed no differential effect of individual antipsychotics. A dose-response relationship of hip fracture and lifetime antipsychotics...
Rocos, Brett; Whitehouse, Michael R; Kelly, Michael B
To evaluate the evidence for the resuscitation of patients with hip fracture in the preoperative or perioperative phase of their treatment and its impact on mortality. We searched MEDLINE, EMBASE, CENTRAL and PROSPERO databases using a systematic search strategy for randomised trials and observational studies investigating the fluid resuscitation of any patient with hip fracture. No language limits were applied to the search, which was complemented by manually screening the reference lists of appropriate studies. Mortality at 1 week, 30 days and 1 year following surgery. Two hundred and ninety-eight citations were identified, and 12 full manuscripts were reviewed; no studies satisfied the inclusion criteria. The background literature showed that the mortality for these patients at 30 days is approximately 8.5% and that bone cement implantation syndrome is insufficient to explain this. The literature was explored to define the need for an interventional investigation into the preoperative resuscitation of patients with hip fracture. Patients with hip fracture show similar physiological disturbance to major trauma patients. Nineteen per cent of patients presenting with hip fracture are hypoperfused and 50% show preoperative anaemia suggesting that under resuscitation is a common problem that has not been investigated. A properly conducted interventional trial could improve the outcome of these vulnerable patients. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
Brennan, Stephen A
Traumatic periprosthetic fractures adjacent a hip resurfacing prosthesis are rare. When proximal fractures are encountered the obvious surgical solution is to revise to a large head stemmed femoral component. A previously well functioning implant may however be retained as various non-operative and operative treatment options exist. This paper reports the case history of a traumatic periprosthetic fracture successfully treated with cannulated screw fixation and reviews the current literature.
Full Text Available Aim. To present the possibility of a successful use of external skeletal fixation in treating the open and closed tibial shaft fractures with Mitković’s external fixator. Methods. External fixation was used in 115 patients with 118 fresh tibial shaft fractures, 82 males (71.3% and 33 females (28.7%, average age 43.92 years (16−84. Open tibial shaft fractures were present in 37 (31.36%. All the fractures were treated with Mitković’s external fixator type M 20. Results. The results of external fixation were excellent or good in 94.07% of the cases, and bad in 5.08%. Pin tract infection appeared in 7 (5.93% patients. In only 3 cases an external fixator was removed and treatment continued with the functional braces. Nonunion occurred in 6 (5.08% patients, of which 4 were with open fractures (2 Gustilo type IIIB, 1 Gustilo type IIIA, 1 Gustilo type II and 2 with the segment fractures. Compartment syndrome was observed in 1 (0.85% patient with closed fracture. Malunion was found in 2 (1.69% patients. Conclusion. External fixation of tibial shaft fractures is a simple and effective method to enable the safe healing of fractures, early mobilization of the patients, early weight-bearing, as well as early rehabilitation. Fixation of tibial shaft fractures was unilateral with convergent pins orientation, and there was also a possibility of compression and distraction.
Miyamoto, Shuichi; Nakamura, Junichi; Iida, Satoshi; Suzuki, Chiho; Ohtori, Seiji; Orita, Sumihisa; Takahashi, Kazuhisa
Fracture of the femoral head and the acetabulum with traumatic dislocation of the hip is a severe injury representing various types and unfavorable outcome. We showed a 45-year-old man with Pipkin type-IV fracture and coxa valga. An immediate closed reduction was achieved followed by open reduction and internal fixation via a posterior approach 6 days later. However, dislocation occurred three times without traumatic events after three weeks. CT demonstrated no displacement of posterior fragm...
Sen Ramesh Kumar
Full Text Available 【Abstract】This paper discussed the injury mecha- nism and management of a patient who had concomitant ipsilateral hip and knee dislocations and contralateral open leg fracture. A 32-year-old man presented with ipsilateral fracture- dislocations of the left hip (Pipkin’s type IV and knee (Moore II joints and contralateral open fracture of the leg bones after a car accident. After emergency resuscitative measures, the hip joint was reduced and Pipkin’s fracture was fixed using Ganz approach with lag screws; knee joint was reduced closely and tibial plateau fracture was stabi- lized with lateral buttress plate and a transarticular span- ning fixator. The open fracture on the other leg was de- brided and fixed with an external fixator. There was no insta- bility in both joints after fixation when he was examined under anesthesia. The fractures united after 3 months and the patient had no residual instability of hip and knee. There was no clinical or radiological evidence of osteonecrosis in the hip joint after 6 months. At one-year follow-up, he had satisfactory functional outcome with almost normal range of motion at both joints. Ipsilateral hip and knee dislocations are rare injuries and more caution is needed for early diagnosis. A timely appro- priate intervention can provide good functional outcome to the patient in this situation. Key words: Hip dislocation; Knee dislocation; Fractures, bone
Zelent, Marek E; Neese, David J
We describe a man with an acute osteochondral defect in the lateral talar dome associated with a supination-adduction-type ankle fracture. The osteochondral defect was readily visible on plain film radiographs, and magnetic resonance imaging was ordered to determine the full extent of soft-tissue and articular injury. It was discovered that the patient had a stage IV lesion of the talar dome, with complete inversion of the fragment, and rupture of the anterior talofibular and calcaneofibular lateral ankle ligaments. Furthermore, the patient experienced an oblique fracture of the medial malleolus with comminution. The talar dome lesion was surgically reduced and fixated using bioabsorbable pins. Nine months after surgery, the patient was fully recovered from his injury and had no functional limitations.
Syed Shahid Noor
Full Text Available Osteoporosis is epidemic in Asian countries. It is a major cause of fractures that orthopaedic surgeons deal in Pakistan, though proper epidemiological data is not available. Habiba U et al found that 75.3% of post menopausal women of Pakistan were predisposed to Osteoporosis; whereas Baig L has described an average T - score of -1.833±0.65 on bone mineral density calculation of post menopausal females of Pakistan. Osteoporotic hip fractures constitute a major cause of elderly mortality worldwide and recent figures supporting the idea that these patients have survival rates comparable to breast and thyroid cancer patients. Pakistan is a developing country with large burden of hip fractures. Patients living in remote areas are the ones which suffer more because of inadequate awareness, fear of surgical treatment and lack of availability of standard treatment. These patients are dealt by surgeons of various expertise and levels of experience. Lack of facilities in hospitals is well known and usage of sub-standard implant is a major cause of failure. Therefore these patients either because of their bone fragility or mal-treatment suffer frequently from failure of hip fracture surgeries. Being in a tertiary care centre we come across these types of cases very frequently. Six to eight such cases present to outpatient department of Liaquat National Hospital every month being referred from every part of the country. These patients may have been operated once, twice or even multiple times. Special attention is required to acquire an informative history from these cases and perform a comprehensive examination. Moreover previous records and radiographs provide invaluable information regarding cause of failure and deciding course of further treatment. We herein discuss few of the cases of failure of hip fractures which were treated by hip arthroplasty.
Rao, Ganesh; Apfelbaum, Ronald I
Fractures of the odontoid process are common, accounting for 10% to 20% of all cervical spine fractures. Odontoid process fractures are classified into three types depending on the location of the fracture line. Various treatment options are available for each of these fracture types and include application of a cervical orthosis, direct anterior screw fixation, and posterior cervical fusion. If a patient requires surgical treatment of an odontoid process fracture, the timing of treatment may affect fusion rates, particularly if direct anterior odontoid screw fixation is selected as the treatment method. For example, type II odontoid fractures treated within the first 6 months of injury with direct anterior odontoid screw fixation have an 88% fusion rate, whereas fractures treated after 18 months have only a 25% fusion rate. In this review, we discuss the etiology, biomechanics, diagnosis, and treatment (including factors affecting fusion such as timing and fracture orientation) options available for odontoid process fractures.
Polesie, Sam; Sigurdsen, Ulf; Bjørgul, Kristian
Purpose: The aim of this study was to ascertain trends in the incidence of hip fracture in southeastern Norway by comparing the hip fracture incidence for the years 2008 to 2010 to that of a study from 1998...
Kuo, Feng-Chih; Kuo, Shu-Jui; Ko, Jih-Yang; Wong, To
Hip fractures account for coxa vara in 3 (13%) and coxa valga in 2 (9%). There was no nonunion. Poor outcomes were related to the development of osteonecrosis. The time to surgery (≤ 12 hours) and the quality of reduction significantly influenced the occurrence of osteonecrosis. The occurrence and severity of femoral head osteonecrosis significantly influenced the functional results (p < 0.001, and p < 0.048, respectively). Osteonecrosis is the most severe complication after hip fractures in children and is associated with poor functional results. The time to surgery and the quality of reduction were the significant predictors in our study.
Cloutier, Luc P; Laflamme, G Yves; Menard, Jeremie; Petit, Yvan
Greater trochanter fractures or osteotomies fixed with lateral plates still present high rates of complications. Unblocked greater trochanter anterior movement during hip extension might be a possible cause of failure. This study aimed to determine, under stair climbing conditions, the biomechanical behaviour of a greater trochanter fragment and the impact of an anterior locking plate on its migration. Eighteen femurs paired from nine fresh frozen cadaveric specimens were tested on a quasi-dynamic stair climbing cycling test bench. Left and right sides with greater trochanter fractures were randomly fixed either with an antero-lateral locking plate or with a lateral locking plate. Migrations, defined as the remaining movements of the unloaded greater trochanter fragment, were measured for all 18 femurs. During hip extension, multi-directional greater trochanter fragment movements occurred and showed a back-and-forth anterior rotation. The lateral locking plate failed due to greater trochanter fragment rotation around the superior axis and anterior translation. The antero-lateral locking plate significantly reduced greater trochanter anterior migration (-0.9 mm ± 1.6) compared to the lateral locking plate (9.6 mm ± 9.5). Hip extension provides a plausible explanation for the high rate of post-operative failures of greater trochanter fixations. An antero-lateral locking plate represents an efficient surgical alternative counteracting the multi-directional greater trochanter movements occurring during hip extension. Copyright © 2014 Elsevier Ltd. All rights reserved.
Marsland, Daniel; Mears, Simon C.
Periprosthetic fractures of the femur in association with total hip arthroplasty are increasingly common and often difficult to treat. Patients with periprosthetic fractures are typically elderly and frail and have osteoporosis. No clear consensus exists regarding the optimal management strategy because there is limited high-quality research. The Vancouver classification facilitates treatment decisions. In the presence of a stable prosthesis (type-B1 and -C fractures), most authors recommend surgical stabilization of the fracture with plates, strut grafts, or a combination thereof. In up to 20% of apparent Vancouver type-B1 fractures, the femoral stem is loose, which may explain the high failure rates associated with open reduction and internal fixation. Some authors recommend routine opening and dislocation of the hip to perform an intraoperative stem stability test to rule out a loose component. Advances in plating techniques and technology are improving the outcomes for these fractures. For fractures around a loose femoral prosthesis (types B2 and 3), revision using an extensively porous-coated uncemented long stem, with or without additional fracture fixation, appears to offer the most reliable outcome. Cement-in-cement revision using a long-stem prosthesis is feasible in elderly patients with a well-fixed cement mantle. It is essential to treat the osteoporosis to help fracture healing and to prevent further fractures. We provide an overview of the causes, classification, and management of periprosthetic femoral fractures around a total hip arthroplasty based on the current best available evidence. PMID:23569704
Full Text Available BACKGROUND Open fractures which occur close to any fracture need immobilisation for the soft tissues to heal. Some open fractures are even fixed with provisional fixations to maintain the alignment of the fractures. The provisional fixation needs to be augmented with external support, which can be given by spanning external fixators across a joint. MATERIALS AND METHODS Our study consists of 38 open fractures of the lower limbs, which are of Gustilo-Anderson’s type IIIB, an MT4 of AO-ASIF soft tissue injury classification essentially requiring open wound management as well as fracture fixation. Wound lavage and debridements are carried out till the soft tissues show granulations. The position in which joint is immobilised is functional and with access to open wound for dressings and inspection without any displacement of the fracture as well as creeping granulation tissue. RESULTS All the cases in our study are maintained with functional position till soft tissue cover is achieved and provisional fixation is done with definitive fixation after soft tissue cover with skin grafting. CONCLUSION Spanning external fixators are useful in maintaining functional positions as well as augmenting the provisional fixation of the compound fractures.
Rao Ganesh; Apfelbaum Ronald
Fractures of the odontoid process are common, accounting for 10% to 20% of all cervical spine fractures. Odontoid process fractures are classified into three types depending on the location of the fracture line. Various treatment options are available for each of these fracture types and include application of a cervical orthosis, direct anterior screw fixation, and posterior cervical fusion. If a patient requires surgical treatment of an odontoid process fracture, the timing of...
Higher incidence of hip fracture in newly diagnosed schizophrenic patients in Taiwan. Hip fracture is a major public health concern due to its poor outcome and serious socioeconomic burden in older people (1). Evidence has shown that many factors are related to increased risk of hip fracture, but psychiatric diseases are ...
Full Text Available The article deals with the problem of transverse acetabular fracture fixation using different plate attachment methods. A 3D model of pelvis and hip joint structure was created and the design of three different fixation plates using SolidWorks was made. The plates were fixed at distances of 10, 20 and 30 mm from the acetabulum. The model was meshed into finite elements, a static external load of 2500 N was added and the analysis of stress distribution in plates and fracture displacement was performed. The obtained results showed that fracture displacement was quite similar in all fixation methods. However, the maximal stress in the nearest from the acetabulum plate was higher than yield strength. Thus, this placement is not eligible. The plate fixed at a distance of 30 mm from the acetabulum appeared the most suitable because of the smallest and symmetrical stress distribution in the plate.
Pitto, R P; Kessler, M; Schikora, N; di Muria, G V
The bone-vacuum cementing technique is a promising method developed to obtain reliable fixation of the femoral component. Previous studies showed that intraoperative embolic complications, cardiopulmonary impairment, and deep venous thrombosis can be prevented when this technique is used. The specific aims of the present investigation were to provide additional treatment outcome information, to identify risk factors for poor results, and to define the need of surgical technique improvement by risk factor analysis. The first 118 consecutive patients (121 hips) who had primary total hip arthroplasty using the bone-vacuum cementing technique and an anatomical stem were followed-up for a mean of 2.5 years (1 to 4 years). The mean age of patients at index operation was 73 years. Current criteria were used for clinical and radiological assessment. At the time of the latest follow-up, 3 patients (3 hips, 2.5%) had been lost, and 9 patients (9 hips, 7.5%) had died. However, the status of the hip joint at the time of death could be verified in all patients. Thus, the clinical outcome of 115 patients (118 hips, 97.5%) was known. Radiographs were available for 102 patients (104 hips) who were alive for the entire follow-up period. The mean preoperative Harris Hip Score was rated 51, and it had improved to 92 at the time of follow-up. The score was good for 70 hips and excellent for 42 hips, so the rate of clinical success was 95%. Six patients (6 hips, 5%) had a fair result. Two of them had a fracture of the greater trochanter after the index operation, requiring internal fixation. Four hips with severe acetabular dysplasia had persistent limp and limited motion. The quality of the cement mantle was rated good (grade A and B) in 108 of 121 hips (89.5%). Nineteen of the 108 hips presented at least one small void in the cement mantle (grade C1). Insufficient thickness of the cement mantle (grade C2) was present in 10 hips (8%). Failure of cement to extend below the tip of the
Gutierres, Manuel; Lopes, M. Ascenção; Santos, J. Domingos; Cabral, A. T.; Pinto, R.
Introduction. Intertrochanteric hip fractures occur in the proximal femur. They are very common in the elderly and are responsible for high rates of morbidity and mortality. The authors hypothesized that adding an autologous bone marrow stem cells concentrate (ABMC) to a hydroxyapatite scaffold and placing it in the fracture site would improve the outcome after surgical fixation of intertrochanteric hip fractures. Material and Methods. 30 patients were randomly selected and divided into 2 groups of 15 patients, to receive either the scaffold enriched with the ABMC (Group A) during the surgical procedure, or fracture fixation alone (Group B). Results. There was a statistically significant difference in favor of group A at days 30, 60, and 90 for Harris Hip Scores (HHS), at days 30 and 60 for VAS pain scales, for bedridden period and time taken to start partial and total weight bearing (P hydroxyapatite scaffold result in better outcomes after surgical treatment of intertrochanteric hip fractures. PMID:24955356
Andrew J. Hotchen BMedSc (Hons, MBChB
Full Text Available Objectives: This study sought to assess the value of differing pre-operative measures in prediction of post-operative non-surgical site infection (NSSI and length of hospital stay following hip fracture surgery. Methods: All patients admitted during a one year period with a hip fracture to our department were included in the study (n=207. Primary outcome measures were ten independent risk factors correlated to the development of non-surgical site infection following surgery for hip fracture. Secondary outcome measures were duration of hospital stay and inpatient mortality. Results: The patients who had severe cognitive impairment had a 71.0% risk of developing non-surgical site infection. Patients who had multiple medical co-morbidities also had increased risk of developing non-surgical site infection at 59.1%. Patients who developed NSSI on average stayed in hospital 13.1 days longer than patients who did not (31.6 vs. 18.5, p < .001. Conclusions: This study demonstrates the importance of reducing post-operative infection in hip fracture patients in view of reducing morbidity, mortality and cost. These patients can be stratified by risk factors and interventions can be employed in view of reducing inpatient post-operative infection rates in this cohort.
Vochteloo, Anne; Tuinebreijer, Wim; Maier, Andrea; Nelissen, Rob; Bloem, Rolf; Pilot, Peter
textabstractPurpose This paper reports on the development and validity of a new instrument, called the discharge of hip fracture patients score (DHP), that predicts at admission the discharge location in patients living in their own home prior to hip fracture surgery. Methods A total of 310 patients aged 50 years and above were included. Risk factors for discharge to an alternative location (DAL) were analysed with a multivariable regression analysis taking the admission variables into accoun...
Nymark, T; Lauritsen, Jens; Ovesen, O
Hip fracture patients represent a frail group of elderly with increased morbidity and mortality. The aim of this study was to evaluate the occurrence and distribution of a second hip fracture in the time interval between the first and the second hip fracture....
Parker, Martyn J; Handoll, Helen H G
Two types of implants used for the surgical fixation of extracapsular hip fractures are cephalocondylic intramedullary nails, which are inserted into the femoral canal proximally to distally across the fracture, and extramedullary implants (e.g. the sliding hip screw). To compare cephalocondylic intramedullary nails with extramedullary implants for extracapsular hip fractures in adults. We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (June 2007), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2007, Issue 2), MEDLINE (1966 to June week 3 2007), EMBASE (1988 to 2007 Week 27), the UK National Research Register, orthopaedic journals, conference proceedings and reference lists of articles. All randomised and quasi-randomised controlled trials comparing cephalocondylic nails with extramedullary implants for extracapsular hip fractures. Both authors independently assessed trial quality and extracted data. Wherever appropriate, results were pooled. Predominantly older people with mainly trochanteric fractures were treated in the 36 included trials.Twenty-two trials (3871 participants) compared the Gamma nail with the sliding hip screw (SHS). The Gamma nail was associated with an increased risk of operative and later fracture of the femur and an increased reoperation rate. There were no major differences between implants in the wound infection, mortality or medical complications.Five trials (623 participants) compared the intramedullary hip screw (IMHS) with the SHS. Fracture fixation complications were more common in the IMHS group; all cases of operative and later fracture of the femur occurred in this group. Results for post-operative complications, mortality and functional outcomes were similar in the two groups. Three trials (394 participants) showed no difference in fracture fixation complications, reoperation, wound infection and length of hospital stay for proximal femoral nail (PFN) compared with the SHS
Fensky, F; Schäffler, A; Siebenlist, S; König, B; Stöckle, U
Insufficiency fractures of the sacrum are frequently overlooked injuries especially in postmenopausal women with an osteoporotic bone structure and without a history of significant trauma. Plain radiographs are frequently inadequate in showing insufficiency fractures of the sacrum. Regarding this a fracture of a pubic ramus combined with appropriate clinical symptoms should raise the suspicion of a concomitant sacral injury. Therefore, further investigations including a CT scan are necessary.The case of an osteoporotic female patient with bilateral insufficiency fractures of the sacrum and a fracture of the right superior and inferior pubic ramus 5 weeks after primary total hip arthroplasty and implantation of a pedestal cup due to an intraoperative fracture of the right acetabulum is presented. To ensure early mobilization as well as avoidance of further concomitant morbidities a percutaneous iliosacral screw fixation was performed. This approach has been established as an operative treatment for minimally or non-displaced insufficiency fractures of the sacrum.
Griffin, Justin W; Hopkinson, William J; Rud-Lassen, Michael
Thromboembolic disease is a common complication of hip fracture in the elderly. Anticoagulants represent a standard of care in preventing postoperative thrombotic complications following surgical fixation. We asked whether levels of antibody to heparin-platelet factor 4 (PF4) complex were differe...
Lyles, Kenneth W; Colón-Emeric, Cathleen S; Magaziner, Jay S
receiving zoledronic acid were pyrexia, myalgia, and bone and musculoskeletal pain. No cases of osteonecrosis of the jaw were reported, and no adverse effects on the healing of fractures were noted. The rates of renal and cardiovascular adverse events, including atrial fibrillation and stroke, were similar......BACKGROUND: Mortality is increased after a hip fracture, and strategies that improve outcomes are needed. METHODS: In this randomized, double-blind, placebo-controlled trial, 1065 patients were assigned to receive yearly intravenous zoledronic acid (at a dose of 5 mg), and 1062 patients were...... assigned to receive placebo. The infusions were first administered within 90 days after surgical repair of a hip fracture. All patients (mean age, 74.5 years) received supplemental vitamin D and calcium. The median follow-up was 1.9 years. The primary end point was a new clinical fracture. RESULTS...
Huegli, R.W.; Staedele, H.; Messmer, P.; Regazzoni, P.; Steinbrich, W.; Gross, T. [Univ. Hospital of Basel (Switzerland). Dept. of Radiology
The purpose of this study is to demonstrate the feasibility of computer-tomography-navigated closed reduction and percutaneous fixation (CRPF) in a patient with an externally rotated left acetabular fracture. After a follow-up of 18 months the patient was pain-free and had a normal range of motion in both hip joints. Radiologically, the fracture was fully consolidated, remodelled, and there were no signs of osteoarthritis. To our knowledge, CT-navigated CRPF of a rotated acetabular fracture has not been reported before. Further studies regarding the feasibility of the method are warranted(CRPF)
Rohde, Christine; Greives, Matthew R; Cetrulo, Curtis; Lerman, Oren Z; Levine, Jamie P; Hazen, Alexes
Gustilo IIIB fractures involve high-energy tibial fractures for which there is inadequate soft tissue coverage. In addition to orthopedic fixation, these injuries require soft tissue reconstruction, often in the form of a microvascular free flap. Although the majority of orthopedic literature favorably compares intramedullary rod fixation to external fixation in open tibial fractures, these studies have not focused on the role of either method of fixation in relation to the soft tissue reconstruction. Because we had noted numerous complications after providing free-flap coverage over intramedullary rodded fractures, we sought to investigate whether there were differences in outcomes between free flap-covered lower-extremity fractures which were fixated by external fixation versus intramedullary rods. A retrospective chart review was performed on all patients in our institution who had lower-extremity free flaps for coverage of Gustilo IIIB fractures from 1995-2005 in relation to the type of bony fixation. Of the 38 patients studied, 18 underwent external fixation of the tibial fracture, and 20 had intramedullary rodding. Overall flap survival was 95%, with 1 failure in each group. However, the intramedullary rod group had higher incidences of wound infection, osteomyelitis, and bony nonunion (25%, 25%, and 40%, respectively) than the external fixation group (6%, 11%, 17%, respectively). For Gustilo IIIB fractures that require free-flap coverage, the added bony and soft tissue manipulation required for intramedullary rodding may disrupt the surrounding blood supply and lead to higher rates of complications that threaten the overall success of the reconstruction. Plastic and orthopedic surgeons should discuss the optimal method of bony fixation for complex tibial fractures when a free flap will likely be needed for soft tissue coverage. This integrated team approach may help minimize complications.
Akinbo, Oluwaseun; Tyagi, Vineet
Acute hip pain following total hip arthroplasty (THA) could have numerous causes to include stress fracture of the pelvis. Stress fractures of the pelvis are rare and have been reported to involve the medial wall and the pubic ramus. A unique case is presented demonstrating the clinical presentation and management of an acute stress fracture of ilium and anterior column following a THA. A 72-year-old man underwent an uncomplicated right THA. He was noted to have femoral head resorption and thin osteoporotic bone intraoperatively. He initially did well postoperatively and ambulating without pain or assistive devices. Within 1 month of surgery, he returned with acute right hip pain without any traumatic event. Radiographs showed migration of the acetabular component and computed tomography scan confirmed a fracture through the ilium. The patient underwent revision surgery, where the fracture was reduced and internal fixation was achieved with a reconstruction plate and acetabular cage construct. At 9 months postoperatively, the patient remained pain-free with full weight bearing and with stable radiographs. Elderly patients who undergo THA may have low bone mineral density. These patients can develop stress fractures in their pelvis after surgery. These fractures may involve the medial wall, posterior column, or posterior wall. In patients who develop atraumatic pain postoperatively, it is important to consider for potential stress fractures of the ilium and evaluate appropriately with imaging. In these cases, revision surgery can be necessary to provide fixation of the stress fracture.
Gompa Parameswara Rao
Full Text Available BACKGROUND Postoperative patients of ankle fracture patients can be made weightbearing as tolerated immediately following surgery. Immediate Weightbearing As Tolerated (IWBAT allows patients to return to ambulation and activities of daily living faster and may facilitate rehabilitation. MATERIALS AND METHODS Retrospectively, patients were identified who have ORIF after unstable ankle injuries had treated by the senior author. Patients were excluded if they were not IWBAT based on specific criteria or if they did meet followup requirement. RESULTS After the study, it was seen that only 1/26 patients was noted to have loss of fixation. This was found at the 6-week followup and was attributed to a missed syndesmotic injury. At 2-weeks follow up, 2 patients had peri-incisional erythema that resolved with a short course of oral antibiotics. At 6-week follow up, 20 patients were wearing normal shoes and 6 patients continued to wear the Cam Boot for comfort. CONCLUSION It was seen that IWBAT in a certain subset of patients with stable osteosynthesis following an ankle fracture were at a safe alternative to a period of protected weightbearing.
Kazemian, Gholam Hossein; Emami, Mohammad; Manafi, Alireza; Najafi, Farideh; Najafi, Mohammad Amin
Hip fractures are one of the causes of disability amongst elderly patients. External fixator and skeletal traction are two modes of treatment. The aim of this study is to compare two different treatment modes for intertrochanteric fractures in elderly patients. Sixty elderly patients with intertrochanteric fractures were randomized for treatment with either skeletal traction (Group A) or an external fixation (Group B). In this study patients at least 60 years of age, with AO/OTA A1 or A2 type fracture and intertrochanteric fracture as a result of minor trauma, were enrolled. Acceptable reduction was achieved in eight and 26 patients of group A and B, respectively. The mean duration of hospitalization in Group A and Group B was 14.3 ± 1.1 and 2.2 ± 0.6 days, respectively. Significant differences between the two groups were observed, regarding acceptable reduction and duration of hospitalization. Less pain was observed in group B, at five days and twelve months after surgery; the average HHS was 57 and 66, in group A and B, respectively (P > 0.05). Treatment with an external fixator is an effective treatment modality for intertrochanteric fractures in elderly high-risk patients. The advantages include rapid and simple application, insignificant blood loss, less radiation exposure, adequate fixation, pain reduction, early discharge from the hospital, low cost and more favorable functional outcome.
P K Sundar Raj
Full Text Available Background: Femoral neck fractures are treated either by internal fixation or arthroplasty. Usually, cannulated cancellous screws are used for osteosynthesis of fracture neck of femur. The bone impregnated hip screw (BIHS is an alternative implant, where osteosyntehsis is required in femoral neck fracture. Materials and Methods: The BIHS is a hollow screw with thread diameter 8.3 mm, shank diameter 6.5 mm and wall thickness 2.2 mm and holes in the shaft of the screw with diameter 2 mm, placed in a staggered fashion. Biomechanical and animal experimental studies were done. Clinical study was done in two phases: Phase 1 in a group of volunteers, only with BIHS was used in a pilot study and phase 2 comparative study was done in a group with AO cannulated screws and the other group treated with BIHS. Results: In the phase 1 study, out of 15 patients, only one patient had delayed union. In phase 2, there were 78 patients, 44 patients in BIHS showed early union, compared to the rest 34 cases of AO cannulated screws Out of 44 patients with BIHS, 41 patients had an excellent outcome, 2 had nonunions and one implant breakage was noted. Conclusions: Bone impregnated hip screw has shown to provide early solid union since it incorporates the biomechanical principles and also increases the osteogenic potential and hence, found superior to conventional cannulated cancellous screw.
Maini, Lalit; Batra, Sahil; Arora, Sumit; Singh, Shailendra; Kumar, Santosh; Gautam, V K
To assess the outcome of open reduction and internal fixation combined with surgical dislocation of the hip for displaced acetabular fractures. 20 men and 2 women aged 20 to 55 (mean, 28) years underwent open reduction and internal fixation combined with surgical dislocation of the hip for displaced acetabular fracture. The most common fracture pattern was bicolumnar (n=12), followed by transverse (n=6) and T-type (n=4). Femoral head chondral lesions were classified as grade 0 (no defect) to grade 4 (osteochondral defect). Fracture fragments were fixed with titanium plates and screws, and the femoral head was redislocated to inspect for intraarticular screws. The association between functional status and acetabular fracture pattern and femoral head chondral lesions was explored. Nine patients had chondral lesions in the femoral head (mostly in the anterosuperior zone), but none in the acetabulum. All femoral heads were viable. Reduction was anatomic in 6 patients and satisfactory in 16. Functional outcome was very good in 6 patients, good in 13, medium in 2, and fair in one. No patient developed avascular necrosis of the femoral head. Four patients had iatrogenic sciatic nerve palsy. One patient developed early degenerative hip arthritis and underwent total hip arthroplasty 14 months later. Surgical dislocation of the hip facilitated anatomic reduction and inspection of any chondral lesions. It did not result in avascular necrosis of the femoral head.
Socci, A R; Casemyr, N E; Leslie, M P; Baumgaertner, M R
The aim of this paper is to review the evidence relating to the anatomy of the proximal femur, the geometry of the fracture and the characteristics of implants and methods of fixation of intertrochanteric fractures of the hip. Relevant papers were identified from appropriate clinical databases and a narrative review was undertaken. Stable, unstable, and subtrochanteric intertrochanteric fractures vary widely in their anatomical and biomechanical characteristics, as do the implants used for their fixation. The optimal choice of implant addresses the stability of the fracture and affects the outcome. The treatment of intertrochanteric fractures of the hip has evolved along with changes in the design of the implants used to fix them, but there remains conflicting evidence to guide the choice of implant. We advocate fixation of 31A1 fractures with a sliding hip screw and all others with an intramedullary device. Cite this article: Bone Joint J 2017;99-B:128-33. ©2017 The British Editorial Society of Bone & Joint Surgery.
Cahueque, Mario; Martínez, Marcos; Cobar, Andrés; Bregni, María
Acetabular fractures are complex high-energy injuries. Increasing in recent years with the increased use of high-speed motor vehicles. One of the most important complications of acetabular fracture is the post-traumatic hip osteoarthritis; this complication has been associated to poor fracture reduction, type of fracture and delay in the reduction and fixation of acetabular fracture (Timing surgery). The aims of this study were to determine the incidence of post-traumatic hip osteoarthritis after acetabulum fracture and demonstrate whether the delay surgery is associated to early post-traumatic hip osteoarthritis. Using the database of patients with acetabular fractures treated with open reduction and internal fixation (ORIF) over 3 years (2011-2014) with minimum of 2 years follow-up. Data was acquired and saved in a digital format. Demographic information was obtained from each patient with minimum of 2 years follow-up. Acetabular fracture was distributed according to the classification of Judet. The quality of reduction was classified in anatomic (0-1 mm) and non-anatomic (>1 mm) and the timing surgery, early (7 days). Clinical and radiographic follow-up was generally performed at six weeks, three months, one and two years after fracture fixation. Multivariate logistic regression analyses were performed to assess the strength of the covariates in relation to the development of post-traumatic hip osteoarthritis. 59 (48%) patients of 122, developed post-traumatic hip osteoarthritis before 2 years. Posterior wall fracture with or without transverse fracture was associated with higher post-traumatic hip osteoarthritis compared with other types of fractures (p osteoarthritis compared with those who had nonanatomic reduction (p osteoarthritis (p = 7092). According to our results, the anatomical reduction of the articular surface in acetabular fractures is the most important factor in hip osteoarthritis prevention. This factor is strongly associated with early
Zanker, Jesse; Duque, Gustavo
A comprehensive geriatric assessment, combined with a battery of imaging and blood tests, should be able to identify those hip fracture patients who are at higher risk of short- and long-term complications. This comprehensive assessment should be followed by the implementation of a comprehensive multidimensional care plan aimed to prevent negative outcomes in the postoperative period (short and long term), thus assuring a safe and prompt functional recovery while also preventing future falls and fractures. Copyright © 2017 Elsevier Inc. All rights reserved.
Conclusions: Intra-medullary crossed Rush pinning is an effective method of paediatric diaphyseal femur fracture fixation as compared to primary hip spica in terms of early weight bearing and restoration of normal anatomy.
Radulescu, R; Badila, A; Japie, I; Papuc, A; Manolescu, R
Dislocations of the hip usually occur following high energy trauma, the coxo-femoral joint being inherently stable, and can be associated with acetabular fractures or fractures of the head, neck or shaft of femur. However, the combination between the anterior hip dislocation and the ipsilateral intertrochanteric fracture is extremely rare, the literature offering only scarce information. We present the case of a patient, aged 44, victim of a trauma by precipitation from height (12m), diagnosed with left hip anterior dislocation and intertrochanteric fracture of the ipsilateral femur. An emergency surgical treatment was applied in less than 3 hours after trauma. The hip dislocation was reduced under general anesthesia and the intertrochanteric fracture was also reduced and internally fixed with a dynamic hip screw. Radiological and functional evaluation at 6 months after surgery, using the modified Merle D'Aubigne hip score was good. The clinical outcome of such a case depends on the quick evaluation and treatment. Providing a stable reduction of the dislocation and a stable internal fixation of the fracture as soon as possible (within the first 6 hours) will allow an early physical rehabilitation and decrease the risk of complications.
Kain, Michael S; Marcantonio, Andrew J; Iorio, Richard
Femoral neck fractures are a major public health problem. Multiple-screw fixation is the most commonly used surgical technique for the treatment of stable femoral neck fractures. We determined (1) the proportion of hips that had conversion surgery to THA, and (2) the proportion of hips that underwent repeat fracture surgery after percutaneous screw fixation of stable (Garden Stages I and II) femoral neck fractures in patients older than 65 years and the causes of these reoperations. We performed a retrospective study of all patients older than 65 years with stable femoral neck fractures secondary to low-energy trauma treated surgically at our institution between 2005 and 2008. We identified 121 fractures in 120 patients older than 65 years as stable (Garden Stage I or II); all were treated with percutaneous, cannulated screw fixation in an inverted triangle without performing a capsulotomy or aspiration of the fracture hematoma at the time of surgery. The average age of the patients at the time of fracture was 80 years (range, 65-100 years). Radiographs, operative reports, and medical records were reviewed. Fracture union, nonunion, osteonecrosis, intraarticular hardware, loss of fixation, and conversion to arthroplasty were noted. Followup averaged 11 months (range, 0-5 years) because all patients were included, including those who died. The mortality rate was 40% for all patients at the time of review. Twelve patients (10%) underwent conversion surgery to THA at a mean of 9 months after the index fracture repair (range, 2-24 months); the indications for conversion to THA included osteonecrosis, nonunion, and loss of fixation. Two others had periimplant subtrochanteric femur fractures treated by surgical repair with cephalomedullary nails and two patients had removal of hardware. Revision surgery after osteosynthesis for stable femoral neck fractures was more frequent in this series than previously has been reported. The reasons for this higher frequency
Rao, Ganesh; Apfelbaum, Ronald I
.... If a patient requires surgical treatment of an odontoid process fracture, the timing of treatment may affect fusion rates, particularly if direct anterior odontoid screw fixation is selected as the treatment method...
viii) The wound was closed over a drain. Adjuvant medical and supportive therapy included: (i) Prophylactic antibiotics- intraoperative followed by postop. for three days .... The hybrid fixation of this particular fracture with a locked hooking plate ...
Robstad, B.; Frihagen, F.; Nordsletten, L.
Summary We found no difference in the rate of radiological hip osteoarthritis in the injured hip when comparing 349 patients with proximal femoral fractures and 112 patients with hip contusion. There was, however, a tendency for more osteoarthritis in patients with trochanteric fractures than in patients with femoral neck fractures. Introduction Osteoarthritis (OA) and osteoporotic fractures are two age-related disorders associated with considerable morbidity. There is a clinical impression o...
Pletka, Joshua D; Marsland, Daniel; Belkoff, Stephen M; Mears, Simon C; Kates, Stephen L
Locking plates are commonly used to treat fractures around a well-fixed femoral component. The optimal construct should provide sufficient fixation while minimizing soft-tissue dissection. The purpose of the current study was to determine whether plate length, working length, or bone mineral density affects survival of locking plate fixation for Vancouver type B1 periprosthetic hip fractures. A transverse osteotomy was created just distal to cemented femoral prostheses in 9 pairs of cadaveric femurs. Fractures were stabilized with long (20-hole) or short (12-hole) locking plates that were secured proximally with cables and screws and distally with screws only. Specimens were then cycled 10 000 times at 2500 N of axial force and 15 Nm of torque to simulate full weightbearing. A motion capture system was used to record fracture displacement during cycling. Failure occurred in 5 long and 3 short plates, with no significant differences found in the number of cycles to failure. For the specimens that survived, there were no significant differences found between long and short plates for displacement or rotation observed at the fracture site. A shorter working length was not associated with increased failure rate. Lower bone mineral density was significantly associated with failure (P = .02). We concluded that long locked plates do not appear to offer a biomechanical advantage over short locking plates in terms of fixation survival, and that bone mineral density was a better predictor of failure than was the fixation construct type.
Mangram, Alicia; Moeser, Phillip; Corneille, Michael G; Prokuski, Laura J; Zhou, Nicolas; Sohn, Jacqueline; Chaliki, Shalini; Oguntodu, Olakunle F; Dzandu, James K
Background Annually in the US, there are over 300,000 hospital admissions due to hip fractures in geriatric patients. Consequently, there have been several large observational studies, which continue to provide new insights into differences in outcomes among hip fracture patients. However, few hip fracture studies have specifically examined the relationship between hip fracture patterns, sex, and short-term outcomes including hospital length of stay and discharge disposition in geriatric trau...
Yang, Xiaodong; Tang, Xueyang; Jiang, Xin; Liu, Lijun
To compare the effectiveness of locking compression plate and elastic intramedullary nail for the treatment of benign long bone pathological fractures in children, so as to provide the evidence for clinical treatment. Seventy-two children with long bone pathological fractures who accorded with the inclusion criteria between January 2005 and July 2013 were randomly divided into 2 groups. Fracture was fixed with elastic intramedullary nail in 33 cases (group A) and with locking compression plate in 39 cases (group B). There was no significant difference in sex, age, body mass index, primary lesion, location of fracture, side of fracture, and interval between injury and operation between 2 groups (P > 0.05). Group A had shorter operation time, less intraoperative blood loss, and less overall costs than group B, showing significant differences (P fracture healed after operation by X-ray film observation, and group A had faster fracture healing time than group B (P fracture was found in 1 patient with tibial bone cyst of group B after 3 months of operation, and healed after 1 year of open reduction and internal fixation. According to X-ray film and comprehensive function evaluation of shoulder, elbow, hip, knee, and ankle, the results were all excellent in 2 groups at last follow-up. Elastic intramedullary nail fixation should be the first choice, and locking compression plate should be the second choice for children with benign long bone pathological fractures.
Pedersen, Poul; Palm, Henrik; Ringsted, Charlotte
of an undisplaced femoral neck fracture: 2 hook-pins, 2 screws, and a sliding hip screw. All procedures were preformed on a trauma simulator. Performance scores for each procedure were obtained from the predefined metrics of the simulator. The inter-case reliability of the simulator metrics was explored......BACKGROUND AND PURPOSE: Internal fixation of hip fractures is a common and important procedure that orthopedic surgeons must master early in their career. Virtual-reality training could improve initial skills, and a simulation-based test would make it possible to ensure basic competency of junior...
Federico De Iure
Full Text Available We studied 122 patients with 163 fractures of the thoracic and lumbar spine undergoing the surgical treatment by percutaneous transpedicular fixation and stabilization with minimally invasive technique. Patient followup ranged from 6 to 72 months (mean 38 months, and the patients were assessed by clinical and radiographic evaluation. The results show that percutaneous transpedicular fixation and stabilization with minimally invasive technique is an adequate and satisfactory procedure to be used in specific type of the thoracolumbar and lumbar spine fractures.
L. Lokanadha Rao
Full Text Available Fractures of neck of femur have always presented great challenges to the orthopaedic surgeons. This remains, even today, an unsolved fracture as far as treatment and results are concerned. Results depend upon the extent of injury, timing of surgery and adequacy of reduction and fixation. Fixation with cannulated cancellous screws is usually adequate for femoral neck fractures. Lateral cortex plays a very important role in screw fixation. AIMS AND OBJECTIVES To study the effectiveness of cannulated cancellous screw fixation for treatment of fracture of neck of femur in adults. MATERIALS AND METHODS This study was conducted at Andhra Medical College, King George Hospital, Visakhapatnam, AP from Nov 2013 to Oct 2015. The patients with intracapsular fracture of neck of femur are evaluated with pre-operative X-rays of pelvis with both hips and X-ray of the concerned hip joint both in anteroposterior and lateral views and their outcome was evaluated postoperatively after fixation with cancellous screws. The outcome is evaluated in terms of pain relief, extent of ambulation achieved after surgery. The classifications we followed are Pauwel’s and Garden’s classification of fracture of neck of femur. The patients were followed up to one year to assess the functional outcome. OBSERVATION AND RESULTS A good result was obtained in 66.1% of the patients, excellent in 23.2%, fair in 3.8% and poor result in 6.9% of the patients. Complications such as Non-union & avascular necrosis in one case, Non-union and Extrusion of screws in one case, Cut through of screws into articular surface leading to painful joint in one case. Most of the cases of intracapsular neck of femur were in the age group of 31-40 years. There was male preponderance as shown in this study (69%. CONCLUSION By the usage of multiple cannulated cancellous lag screws, compression effect at the fracture site is achieved, it also avoids re-displacement and rotations. The implant occupies less
Full Text Available Introduction: The femoral neck fracture is a frequent pathology in the elderly population, with about of 100,000 cases per year in Brazil. The surgical treatment by internal fixation or arthroplastic hip replacement is advocated today. The non-surgical treatment is reserved for cases of exception. Objective: To compare the quality of patient postoperative life treated for femoral neck fracture by two different techniques: hip arthroplasty and internal fixation. Methods: Through the SF-36 questionnaire, we study the quality of life of 60 patients with more than 65 years, treated between 2004 and 2012 in our service. Half of the patients was submitted to internal fixation and the other half to the arthroplastic replacement. Results: Higher averages in the large majority of the parameters of the questionnaire were obtained by the group which was carried out by internal fixation, but without statistical significance in most of these differences. Some international reports indicate that patients who have suffered a fracture of the femoral neck and were treated with internal fixation may recover the quality of life they had before the fracture. Paradoxically, there is a growing trend among orthopedic surgeons to perform a hip replacement surgery in these cases. Conclusion: Further studies are needed to define which is the best surgical treatment option.
Hip fracture in the elderly is a serious condition associated with increased mortality. Survivors experience an increase in morbidity and disability that affect their independence and quality of life; the outcome for patients with dementia is particularly poor. Many hip fracture patients have signs of malnutrition already on admission and this patient group has been shown to have a lower body mass index (BMI) than aged-matched controls. A catabolic state develops following hip fracture, chara...
Kirschenbaum, D; Albert, M C; Robertson, W W; Davidson, R S
External fixation was used to treat complex femur fractures in 10 children. These injuries were associated with head trauma, cerebral palsy, epidermolysis bullosa, open wounds, and failed casting. The duration of external fixation averaged 8 weeks, and the mean follow-up was 5 years 8 months. At follow-up, one patient had 2.6 cm of residual shortening, and two had overgrowth. Complications included one refracture. Three children developed superficial pin site drainage. Although most femur fractures can be treated with traction or casting, external fixation may simplify overall care in children with multiple injuries and is effective in controlling unacceptable femoral shortening and angulation.
Klotch, D W; Gilliland, R
The purpose of this review is to evaluate internal fixation by means of AO miniplates compared to conventional therapy for the treatment of complicated midface fractures. A more precise division of midface fractures into functional units than that afforded by the Le Fort classification was employed to categorize the complexity of injury. The criteria of evaluation were ease of functional rehabilitation, incidence of complications, and results of surgery. The classification system was helpful in surgical planning and in subsequent analysis of results. Forty-nine of the 92 midface fractures treated by open repair between July 1980 and January 1986 were malar fractures, and 41 of these had associated orbital fractures. The remaining 43 had Le Fort II or more complicated midface fractures, only 15 of which could be adequately categorized by the Le Fort classification. Twenty-two of the 43 patients with complicated midface fractures were surgically treated with internal fixation utilizing 67 AO miniplates. The remaining 21 patients were treated with conventional therapy utilizing a combination of intermaxillary fixation (IMF), and/or interosseous wiring, and/or primary bone grafting. Among the problems encountered were a nonunion of the midface in a delayed repair of a severely comminuted midface fracture, which required secondary split rib grafting. Three plates were removed because of intraoral extrusion. There were no plate-related infections. One of the advantages of internal fixation is that the need for primary bone grafting and external fixation is eliminated. Another is that intermaxillary fixation is needed less frequently, allowing immediate access to the oral cavity for control of airway, care of intraoral wounds, and rapid return to normal alimentation with full mandibular function. Most patients with no associated GI problems tolerated a soft diet within 6 days. Tracheostomy tubes were removed within 3 days if no pulmonary failure was present. We can
Lauritzen, J B
with aging, but the time-trend in increasing age-specific incidence may not be a universal phenomenon. Postmenopausal women suffering earlier non-hip fractures have an increased risk of later hip fracture. The relative risk being highest within the first years following the fracture. Nursing home residents...... have a high risk of hip fracture (annual rate of 5-6%), and the incidence of falls is about 1,500 falls/1,000 persons/year. Most hip fractures are a result of a direct trauma against the hip. The incidence of falls on the hip among nursing home residents is about 290 falls/1,000 persons/year and about...... the hip may influence the risk of hip fracture, and being an important determinant for the development of hip fracture, maybe more important than bone strength. External hip protectors were developed and tested in an open randomised nursing home study. The rate of hip fractures was reduced by 50...
Kristiansen, Nina Sahlertz; Kristensen, Pia Kjær; Nørgård, Bente Mertz
OBJECTIVE: Higher risks of adverse outcomes have been reported for patients admitted acutely during off-hours. However, in relation to hip fracture, the evidence is inconsistent. We examined whether time of admission influenced compliance with performance measures, surgical delay and 30-day...... mortality in patients with hip fracture. DESIGN: Cohort study. SETTING: Data from The Danish Multidisciplinary Hip Fracture Registry linked with data from Danish National Registries. PARTICIPANTS: Danish patients undergoing hip fracture surgery, aged >65 years, admitted 1 March 2010 to 30 November 2013 (N...
A.J.H. Vochteloo (Anne); B.L. Borger van der Burg (Boudewijn); M.L. Röling (Maarten); D.H.-J. van Leeuwen (Diederik); P. van den Berg (Peter); A.H.P. Niggebrugge (Arthur); M.R. de Vries (Mark); W.E. Tuinebreijer (Wim); R.M. Bloem (Rolf); R.G.H.H. Nelissen (Rob); P. Pilot (Peter)
textabstractPurpose: To report risk factors, 1-year and overall risk for a contralateral hip and other osteoporosis-related fractures in a hip fracture population. Methods: An observational study on 1,229 consecutive patients of 50 years and older, who sustained a hip fracture between January 2005
Full Text Available Introduction. Open segmental fractures of the tibia are rare but severe injuries. In these fractures the wide zone of injury (damage of all structures of the lower leg creates very unsuitable biological conditions for healing of the fracture. Objective. The aim of our work was to present the results of treatment of patients with segmental open fractures of the tibia treated by external fixation. Methods. We analyzed treatment results of 21 patients with open segmental tibial fractures who were treated using the method of external fixation at the Clinical Center Niš from January 1, 1995 to July 31, 2010. The average age of the patients was 53 years; the youngest patient was 27 years and the oldest one 80 years. According to the Gustilo open fracture classification, there were 3 (14.3% type I, 6 (28.6% type II, 8 (38.1% type IIIA, and 4 (19.0% type IIIB. All the patients were treated by a unilateral type Mitković external fixator by Traffix Company. Results. Union was attained in 16 (76.2% fractures without severe complications (pseudoarthrosis, chronic osteitis and angular deformities of over 10 degrees. Among severe complications associated with open segmental tibial fractures, in two cases we registered septic pseudoarthrosis, in one aseptic pseudoarthrosis and in two large angular deformities of the tibia after union, with a valgus of over 10 degrees and extremity shortening of over 2 cm which required additional surgery. Conclusion. External fixation by the use of Mitković external fixator is one of the methods of choice in the treatment of open segmental tibial fractures, which incorporated with antibiotic therapy provides good biomehanical conditions for segmental fracture healing that enables good stability of the segmental tibial fracture and decreases the risk of deep infections. [Projekat Ministarstva nauke Republike Srbije, br. 41017: Virtuelni koštanozglobni sistem čoveka i njegova primena u pretkliničkoj i kliničkoj praksi
Lundin, H; Sääf, M; Strender, L-E; Nyren, S; Johansson, S-E; Salminen, H
A hip fracture results in a lower quality of life and a cost of £30,000. In this study, one-leg standing time (OLST) had a negative linear relationship to the risk of a hip fracture. OLST could be a useful tool to assess the need for fracture-preventive interventions. A hip fracture immobilizes, restricts autonomy, shortens life expectancy, and results in a cost of £30,000 in the UK health care system. However, effective preventive treatments can be offered to high-risk individuals. Impaired postural balance is an important risk factor for hip fractures, and the aim of this study was to evaluate whether OLST can predict hip fractures in elderly women. FRAX is the most established fracture risk assessment tool worldwide and a secondary aim was to relate the predictive ability of OLST to that of FRAX in this population. Three hundred fifty-one women aged between 69 and 79 years were timed standing on one leg up to 30 s with eyes open and assessed with FRAX. Fracture data was obtained from registers. The main outcome, a hip fracture, occurred in 40 of the 351 participants (11.4%). The age-adjusted risk of a hip fracture was 5% lower with 1 s longer OLST (Hazard ratio 0.95, 95% CI 0.927-0.978). The relation between OLST and hip fracture risk was linear. Harrell's c was 0.60 for FRAX and 0.68 for OLST adjusted for age. With 1 s longer OLST, the risk of a hip fracture decreased significantly by 5%. This risk reduction was not explained by differences in the classic fracture risk factors included in FRAX. OLST had a predictive ability similar to FRAX. OLST is an easily performed balance test which may prove to be valuable in the assessment of hip fracture risk.
Kloen, Peter; Rubel, Iván F.; Lyden, John P.; Helfet, David L.
Subtrochanteric fractures after screw or pin fixation of femoral neck fractures are a recognized complication. No literature is available on this complication after fixation using the recently popularized cannulated screws. We present our experience in treating four of these complications. The
Introduction: The majority of the fifth metacarpal neck fractures can be treated conservatively. Nevertheless, surgical treatment is justified in certain cases. This retrospective study was designed to evaluate the clinical results of intramedullary Kirschner-wire fixation of these fractures. Material and methods: Between May 2005 ...
Schortinghuis, J; Bos, RRM; Vissink, A
Purpose: The aim of this retrospective study was to evaluate the complications of open reduction and internal fixation of maxillofacial fractures with microplates. Patients and Methods: In 44 patients with maxillofacial trauma, fractures of the maxillofacial skeleton were treated by open reduction
Wendt, Matthew C; Cass, Joseph R; Trousdale, Robert R
Cam-type femoral impingement is caused by structural abnormalities of the hip and is recognized as a cause of degenerative hip arthritis. Identifiable etiologies of this structural abnormality include congenital malformation, pediatric hip disease, and malunion of femoral neck fractures after internal fixation. The purpose of this study was to determine the prevalence of radiographic impingement in healed Orthopaedic Trauma Association (OTA) type 31B fractures treated with reduction and internal fixation. Seventy OTA 31B hip fractures treated with internal fixation were identified from our institutional trauma database and radiographs were retrospectively reviewed for signs of impingement. Mean follow-up was 53 months after fracture. Alpha angle, Mose templates, and femoral head retroversion were the measurements used to determine impingement. The overall prevalence of any sign of radiographic impingement was 75%. Alpha angle was elevated in 32 hips (46%), asphericity was present in 46 femoral heads (65%), and femoral head retroversion was present in 26 hips (37%). The rates were highest in displaced subcapital fractures (OTA 31B-3) with a 63% (13/19) prevalence of elevated alpha angle, 68% (14/19) prevalence of asphericity, and 47% (10/19) prevalence of retroversion. Prevalence of radiographic signs of impingement in this population is higher than expected based on population-based controls. Surgeons must be vigilant about reduction and fixation of femoral neck fractures. Malunion should be recognized as early intervention may be beneficial in improving long-term outcomes.
Kuiper, B W; Graybill, S; Tate, J M; Kaufman, N; Bersabe, D
Osteoporotic hip fractures can be life changing and can increase mortality. Treatment of osteoporosis following hip fracture is often delayed. We began offering osteoporosis medication during hospitalization for hip fracture, dramatically increasing the number of patients meeting standard of care. Osteoporotic hip fracture is a debilitating condition with major morbidity and mortality implications. Osteoporosis medication given within 90 days of hip fracture improves mortality and reduces risk of future fractures. The aim of this project was to improve rates of timely osteoporosis treatment following fragility hip fracture. This was a two-step intervention utilizing the Plan-Do-Study-Act cycle, beginning with resident-focused education in cycle 1. In cycle 2, we offered osteoporosis medication to inpatients for hip fracture with help from a new electronic order set. Prior to this intervention, 32% of patients received osteoporosis medication within 90 days of fragility hip fracture; this improved to 81% after intervention. Resident education and an electronic order set dramatically improved the percentage of patients meeting standard of care with osteoporosis pharmacotherapy following fragility fracture.
Handoll, Helen Hg; Queally, Joseph M; Parker, Martyn J
fixation failure. Three minor adverse effects (sensory disturbance and skin blisters) related to skin traction were reported.One of the above trials included both skin and skeletal traction groups. This trial and one other compared skeletal traction with skin traction and found no important differences between these two methods, although the initial application of skeletal traction was noted as being more painful and more costly. From the evidence available, the routine use of traction (either skin or skeletal) prior to surgery for a hip fracture does not appear to have any benefit. However, the evidence is also insufficient to rule out the potential advantages for traction, in particular for specific fracture types, or to confirm additional complications due to traction use.Given the increasing lack of evidence for the use of pre-operative traction, the onus should now be on clinicians who persist in using pre-operative traction to either stop using it or to use it only in the context of a well-designed randomised controlled trial.
Full Text Available Abstract Background There have been reports both supporting and refuting an inverse relationship between hip fracture and hip osteoarthritis (OA. We explore this relationship using a case-control study design. Methods Exclusion criteria were previous hip fracture (same side or contralateral side, age younger than 60 years, foreign nationality, pathological fracture, rheumatoid arthritis and cases were radiographic examinations were not found in the archives. We studied all subjects with hip fracture that remained after the exclusion process that were treated at Akureyri University Hospital, Iceland 1990-2008, n = 562 (74% women. Hip fracture cases were compared with a cohort of subjects with colon radiographs, n = 803 (54% women to determine expected population prevalence of hip OA. Presence of radiographic hip OA was defined as a minimum joint space of 2.5 mm or less on an anteroposterior radiograph, or Kellgren and Lawrence grade 2 or higher. Possible causes of secondary osteoporosis were identified by review of medical records. Results The age-adjusted odds ratio (OR for subjects with hip fracture having radiographic hip OA was 0.30 (95% confidence interval [95% CI] 0.12-0.74 for men and 0.33 (95% CI 0.19-0.58 for women, compared to controls. The probability for subjects with hip fracture and hip OA having a secondary cause of osteoporosis was three times higher than for subjects with hip fracture without hip OA. Conclusion The results of our study support an inverse relationship between hip fractures and hip OA.
Jöstl, Julian; Tiefenböck, Thomas Manfred; Hofbauer, Marcus; Winnisch, Markus; Lang, Nikolaus; Hajdu, Stefan; Sarahrudi, Kambiz
The purpose of this study was the comparison of the most commonly used surgical techniques (external fixation, intramedullary nailing, and plate fixation) for the treatment of distal tibial fractures (AO/OTA classification 42-A, B, C or 43-A, B1). A retrospective cohort study of patients who underwent surgical treatment for distal tibial fractures between 1992 and 2011 was performed. A total of 93 patients (52 male/41 female) met inclusion criteria. Statistically significant differences were found regarding the consolidation time of the intramedullary-nailing (147.32 ± 91.16 days) and the plate-fixation group (135.75 ± 110.75 days) versus the external-fixation group (163.12 ± 96.79 days; P = 0.001; P = 0.01). Significant differences were also observed in the range of motion (ROM) of the ankle joint in the intramedullary-nailing and plate-fixation group versus the ROM in the external-fixation group (P = 0.044; P = 0.025). The overall complication rate was 13/93 (14 %). Out of 66 patients treated with intramedullary nailing, 8 (12 %) suffered from complications. Out of the 15 patients treated with plate and 12 patients with external fixation, 2 (13 %) and 3 (25 %) showed complications, respectively. Our results demonstrate advantages in terms of shorter mobilization time and a better ROM of the ankle joint for intramedullary nailing and plate fixation compared with external fixation. Due to our results, we suggest internal fixation (intramedullary nailing or plate fixation) whenever patient's condition and the local fracture situation allow it.
Full Text Available Introduction. Intertrochanteric hip fractures occur in the proximal femur. They are very common in the elderly and are responsible for high rates of morbidity and mortality. The authors hypothesized that adding an autologous bone marrow stem cells concentrate (ABMC to a hydroxyapatite scaffold and placing it in the fracture site would improve the outcome after surgical fixation of intertrochanteric hip fractures. Material and Methods. 30 patients were randomly selected and divided into 2 groups of 15 patients, to receive either the scaffold enriched with the ABMC (Group A during the surgical procedure, or fracture fixation alone (Group B. Results. There was a statistically significant difference in favor of group A at days 30, 60, and 90 for Harris Hip Scores (HHS, at days 30 and 60 for VAS pain scales, for bedridden period and time taken to start partial and total weight bearing (P<0.05. Discussion. These results show a significant benefit of adding a bone marrow enriched scaffold to surgical fixation in intertrochanteric hip fractures, which can significantly reduce the associated morbidity and mortality rates. Conclusion. Bone marrow stem cells added to a hydroxyapatite scaffold result in better outcomes after surgical treatment of intertrochanteric hip fractures.
S.M. Zielinski (Stephanie)
markdownabstract__Abstract__ This thesis consists of three parts. Part 1 described aspects of the organization of trauma related trials. Part 2 analyzed the uniformity of current femoral neck fracture treatment and adherence to the Dutch guideline on hip fracture treatment. The implications of
An intracapsular femoral neck fracture in a young patient is a rare and difficult injury to manage. The occurrence of complications following fixation is multifactorial. Initial displacement and timing and accuracy of reduction are the key factors affecting outcome. The severities of the trauma to the hip and the impact of the intracapsular hematoma also play a role, the importance of which remains poorly understood. The purpose of this study was to evaluate the high incidence of femoral neck fractures treated in our institution over a 7-month period, to record the long-term outcome of these patients, all of whom were treated with contemporary methods of internal fixation, and to highlight the reasons for this injury being termed an "orthopedic emergency" and its differences from the same injury in the elderly population. We performed a retrospective analysis of 12 cases of intracapsular femur neck fracture in patients younger than 50 years treated over 7 months in a regional trauma center. All patients underwent satisfactory reduction and fixation. Nine of the 12 patients had a good outcome at a mean follow-up of 29 months. One patient developed a nonunion of the femoral head requiring total hip arthroplasty, one developed avascular necrosis of the femoral head, and one developed partial avascular necrosis. This compares favorably with other studies.
Page, Piers R J; Lord, Roxana; Jawad, Ahsin; Dawe, Edward; Stott, Philip; Rogers, Benedict; Gill, Richie
With an annual incidence greater than 65,000 in the United Kingdom, hip fractures are a common but debilitating injury predominantly affecting those over 65. Treatment is based on the anatomical location of the fracture relative to the capsule of the hip joint - fractures occurring within it are treated by arthroplasty, while extracapsular fractures are an indication for fixation. Intertrochanteric fractures are further grouped as stable (AO/OTA 31A1/A2) or unstable (31A3) which in turn governs in the current UK guidelines whether this fixation is achieved with a dynamic hip screw or intramedullary device. Anecdotally, some units are tending towards intramedullary devices for 31A2 fractures as well, a practice which from the evidence does not appear to confer benefit and carries an excess cost. We reviewed our data submitted to the National Hip Fracture Database over the last five years and identified all intertrochanteric fractures, from which cohort we identified all patients with 31A2 fractures by review of radiographs. The cohort comprised 370 patients. We then recorded age, gender, ASA grade, abbreviated mental test score, residence from where admitted, length of stay, destination on discharge and whether any further operations were required. There was no significant difference in the demographics of the groups, year-on-year, except gender mix. There was a significant, twenty-fold rise in the use of intramedullary devices between 2011 and 2015. Length of stay, length of overall episode of care, revision rates, mortality and destination on discharge were unchanged. This use is not supported by NICE guidelines and this study offers no evidence to contradict this position. We advocate all centres examine their practice to avoid a costly intervention without clinical benefit. Copyright © 2016 Elsevier Ltd. All rights reserved.
Key words: Femoral neck fractures, hip hemiarthroplasty, modified stracathro approach. DOI: 10.4103/2006- ... using the modified Stracathro approach following fracture of the neck of the femur and have been .... Superior rim of the acetabulum and remnant of the fractured neck and head; 2 = The distal end of the fractured ...
Mizrahi, Eliyahu H; Lubart, Emilia; Heymann, Anthony; Leibovitz, Arthur
Holocaust survivors report a much higher prevalence of osteoporosis and fracture in the hip joint compared to those who were not Holocaust survivors. To evaluate whether being a Holocaust survivor could affect the functional outcome of hip fracture in patients 64 years of age and older undergoing rehabilitation. A retrospective cohort study compromising 140 consecutive hip fracture patients was conducted in a geriatric and rehabilitation department of a university-affiliated hospital. Being a Holocaust survivor was based on registry data. Functional outcome was assessed by the Functional Independence Measure (FIM)TM at admission and discharge from the rehabilitation ward. Data were analyzed by t-test, chi-square test, and linear regression analysis. Total and motor FIM scores at admission (P = 0.004 and P = 0.006, respectively) and total and motor FIM gain scores at discharge (P = 0.008 and P = 0.004 respectively) were significantly higher in non-Holocaust survivors compared with Holocaust survivors. A linear regression analysis showed that being a Holocaust survivor was predictive of lower total FIM scores at discharge (β = -0.17, P = 0.004). Hip fracture in Holocaust survivors showed lower total, motor FIM and gain scores at discharge compared to non-Holocaust survivor patients. These results suggest that being a Holocaust survivor could adversely affect the rehabilitation outcome following fracture of the hip and internal fixation.
Davis, Adrian T; Moed, Berton R
% (16/28) and 47% (15/32), respectively. Orthopedic traumatologists expert in acetabular fracture care cannot adequately determine hip stability status for fractures involving 20%-50% of the posterior wall using plain radiographs, computed tomography, and the patient's hip dislocation status. If the diagnosis is in doubt, open reduction and internal fixation clearly is the much safer course than nonoperative treatment. Examination under anesthesia should be considered as a helpful addition to the surgeon's armamentarium in determining hip stability status for these fractures.
Visschedijk, Johannes Hermanus Maria (Jan)
FoF is possibly one of the most important factors in patients after hip fracture, with a substantial impact on the final results of the rehabilitation process. Moreover, patients with hip fracture who rehabilitate in a SNF with high rates of comorbidity and complications, may have even worse
Nymark, Tine; Lauritsen, Jens; Ovesen, Ole
Hip fracture incidence rates are high, and increase with increasing age. Previous studies have predicted a continued increase in both crude and age-standardized rates.......Hip fracture incidence rates are high, and increase with increasing age. Previous studies have predicted a continued increase in both crude and age-standardized rates....
Vochteloo, A.J.H.; Flikweert, E.R.; Tuinebreijer, W.E.; Maier, A.B.; Bloem, R.M.; Pilot, P.; Nelissen, R.G.H.H.
This paper reports the external validation of a recently developed instrument, the Discharge of Hip fracture Patients score (DHP) that predicts discharge location on admission in patients living in their own home prior to hip fracture surgery. The DHP (maximum score 100 points) was applied to 125
Overgaard, Jan; Kristensen, Morten T
To investigate the feasibility of a 6-wk progressive strength-training programme commenced shortly after hip fracture surgery in community-dwelling patients.......To investigate the feasibility of a 6-wk progressive strength-training programme commenced shortly after hip fracture surgery in community-dwelling patients....
Vochteloo, Anne J. H.; Flikweert, Elvira R.; Tuinebreijer, Wim E.; Maier, Andrea B.; Bloem, Rolf M.; Pilot, Peter; Nelissen, Rob G. H. H.
This paper reports the external validation of a recently developed instrument, the Discharge of Hip fracture Patients score (DHP) that predicts discharge location on admission in patients living in their own home prior to hip fracture surgery. The DHP (maximum score 100 points) was applied to 125
Full Text Available Calcaneal fracture, the most common tarsal bone fracture, occurs predominantly in manual labors and subsequently has got considerable socioeconomic implications. Treatment modality which can offer early weight bearing and early return to work is therefore needed for those patient s. We have used a biplanar percutaneous external fixator for treating calcaneal fractures per operative visualization of the fractures. We have treated 20 calcaneal fractures in 18 patients, 12 intra articular and five extra articular, with our percutaneou s external fixator system with under image intensifier and achieving the fracture reduction. Functional outcome was measured using the American Orthopaedic Foot and ankle society Hind foot score. All fractures united with a mean of 55 days. Partial weight bearing was possible in a mean of 1.8 days and full bearing was possible in a mean of 11.6 days. All the patients were returned to their original work within six weeks. Minor infectious complications occurred in 17.6 percent of cases. The average AOFAS sco re at six months follow up was 83.8. We conclude that our percutaneous external fixator technique for fracture calcaneum is an effective alternative to the currently available – surgical and conservative treatment modalities especially in lower socio econo mic labor population who need to return to their job as early as possible. Level of Evidence – IV Case series
crash and sustained a posterior hip dislocation of the right hip with an associated fracture of the neck of femur. This is a rare case but may occur in ... considered to be the most conservative yet functional mode of management(2). ... was thought to be a poor prognostic factor precluding. ORIF. A total hip athroplasty was our ...
García Pascual, E
Repairing hip fractures is one of the most common surgical procedures and has greater morbidity and mortality. This procedure is also a process that involves a greater need for blood products. Numerous factors influence morbidity, mortality and the use of blood products: patient age, concomitant diseases and drug treatments that change hemostasis and hemorrhaging (preoperative, intraoperative and postoperative), which are usually significant. On top of all this is the presence in a high percentage of cases of preoperative anemia, which can have one or more causes. It is therefore essential to establish an appropriate management of perioperative anemia and optimize the transfusion policy. The aim of this review is to briefly analyze the epidemiology of hip fractures as well as establish a basis for treating perioperative anemia and transfusion policies, proposing guidelines and recommendations for clinical management based on the most current studies. Copyright © 2015 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.
A number of different bone geometries have been reported to be correlated with osteoporosis, bone mineral density and fractures. Those correlations are used for diagnosis, treatment and prediction of fracture risk in osteoporosis cases. However there have been no studies of significant bone parameters predicting osteoporosis and hip fracture in Thailand To evaluate the correlation between geometric parameters of the proximal femur and both the Singh index and bone mineral density as well as to investigate the relationship between those two metrics and osteoporotic hip fracture in the Thai population. Forty-four Thai patients with osteoporotic hip fractures andforty-five healthy Thai people matched for age and gender were included in the present study. Bone mineral density and bone geometry from plain hip radiographs of non-fracture sites in the fracture group and proximal femur radiographs of the same site in the healthy group were measured That data were analyzed to determine levels of correlation. Bone geometries were also analyzed to determine hip fracture predictive capacity. Correlation between the Singh index and bone mineral density was significant (p hip fracture (p = 0.014 and p = 0.035, respectively). Each 1 mm reduction in the width of the femoral medial neck cortex increased the osteoporotic hip fracture risk by a factor of 2.7 (OR = 0.37, 95% CI = 0.15-0.93). In the Thai population, bone geometry from plain radiographs can help predict the risk of osteoporotic hip fracture. Osteoporosis is correlated with a low Singh index value. The width of the femoral medial neck cortex is a reliable predictor of hip fracture risk.
Foss, N.B.; Kristensen, M.T.; Kehlet, H.
BACKGROUND: the impact of anaemia on the outcome after a hip fracture surgery is controversial, but anaemia can potentially decrease the physical performance and thereby impede post-operative rehabilitation. We therefore conducted a prospective study to establish whether anaemia affected functional...... mobility in the early post-operative phase after a hip fracture surgery. PATIENTS AND METHODS: four hundred and eighty seven consecutive hip fracture patients, treated according to a well-defined multimodal rehabilitation programme with a uniform, liberal transfusion threshold, were studied. Hb...... mobility in the early post-operative phase after a hip fracture surgery and is an independent risk factor for patients not being able to walk post-operatively. The potential for a liberal transfusion policy to improve the rehabilitation potential in hip fracture patients with anaemia should be investigated...
Stenqvist, Charlotte; Madsen, Christian Medom; Riis, Troels
INTRODUCTION: Orthogeriatric service has been shown to improve outcomes in patients with hip fracture. The purpose of this study is to evaluate the effect of orthogeriatrics at Bispebjerg University Hospital, Denmark. The primary outcome is mortality inhospital and after 1, 3, and 12 months...... for patients with hip fracture. The secondary outcome is mortality for home dwellers and nursing home inhabitants. MATERIALS AND METHODS: This is a retrospective clinical cohort study with an historic control group including all patients with hip fracture admitted from 2007 to 2011. Patients with hip fracture...... = .009) after orthogeriatrics. However, when adjusting for age, gender, and American Society of Anaesthesiologists (ASA) score in a multivariate analysis, including all patients with hip fracture, we find significantly reduced mortality inhospital (odds ratio [OR] 0.35), after 30 [OR 0.66] and 90 days...
Wardak, Mohammed Ismail; Siawash, Abdul Razaqu; Hayda, Roman
Current fixation methods of patella fractures are associated with hardware prominence, infection, and failure of fixation. These complications necessitate repeat surgical treatment, increase costs, and limit function. We investigated whether a novel device can effectively treat patella fractures with few complications. A consecutive series of patients with displaced patella fractures with transverse and select other patterns were treated with the technique of compressive external fixation (CEF), a device based on an external tensioned wire construct. Patients were allowed unrestricted motion and weight bearing postoperatively. Patient outcomes were evaluated retrospectively. Eighty-four fractures (26 open) were treated with CEF with 23 performed percutaneously. All of the fractures attained union. The device was removed in the office at 6 weeks. Sixty-one patients regained excellent motion with a mean Insall knee score of 97 points, at an average follow-up of 4 years. Minor complications presented in 11% of patients but did not affect the overall outcome. Complications included minor wire irritation in 14 patients and one case of poor knee motion in a patient presenting with fibroankylosis of the joint. Treatment using the CEF technique is a safe and effective method of treatment of patella fractures with advantages over traditional forms of fixation particularly in cases with a poor soft tissue envelope, salvage situations, and in locations with limited resources. It allows for rapid recovery with minimal complications and no secondary surgery. Its use should be considered in the treatment of these injuries. V, therapeutic study.
Pollock, Frederic H.; Bethea, Audis; Samanta, Damayanti; Modak, Asmita; Maurer, James P.; Chumbe, Julton Tomanguillo
The Affordable Care Act currently requires hospitals to report 30-day readmission rates for certain medical conditions. It has been suggested that surveillance will expand to include hip and knee surgery-related readmissions in the future. To ensure quality of care and avoid penalties, readmissions related to hip fractures require further investigation. The goal of this study was to evaluate factors associated with 30-day hospital readmission after hip fracture at a level I trauma center. Thi...
Dislocations of the hip associated with fractures of the neck of femur are rare entities. We report a case of a 23 year old man involved in a road traffic crash and sustained a posterior hip dislocation of the right hip with an associated fracture of the neck of femur. This is a rare case but may occur in high energy injuries. He was ...
Full Text Available Abstract Introduction Associated with the increase in the aging population, there is an increase in the incidence of hip fractures worldwide. Outcome following such fractures is affected by age of the patient. This study aims to assess the incidence and early outcome of hip fractures, comparing between different age groups. Methods Data of hip fractures collected over a period of five years was analysed. Patients were divided into three groups, group A (patients under the age of 64, group B (patients between 65 and 84 years of age, and group C (patients over the age of 85. Results Of the 1177 patients included in the study, there were 90 patients in group A, 702 patients in group B and 385 patients in group C. There was a female preponderance across all age groups, and this increased as age advanced (p Conclusions Hip fractures are more common among females irrespective of age group. Older patients have a higher mortality and a greater deterioration of walking ability after such injuries. Internal fixation of intracapsular fractures have demonstrated satisfactory early outcome in the immediate period. This could be attributed to retention of native bone, better propioception and shorter operation time.
Grivas, TB; Magnissalis, E; Papadakis, S
During revision surgery of total hip arthroplasties, surgeons may come across the challenging complication of a proximally fractured femoral stem, which however maintains sufficient distal fixation. Such cases, although rare, are extremely demanding due to lack of available attachments that would assist surgical explantation of the broken implant. It is herein presented a metal sterilisable surgical tool designed for the removal of the femoral stem broken at the level of the “neck”. Hippokratia 2015; 19 (4): 352-355. PMID:27688701
Dombroski, Derek; Scolaro, John A; Pulos, Nicholas; Beingessner, Daphne M; Dunbar, Robert; Mehta, Samir
The tibia is the most commonly fractured long bone. Although the goals of fracture management are straightforward, methods for achieving anatomical alignment and stable fixation are limited. Type of management depends on fracture pattern, local soft-tissue involvement, and systemic patient factors. Tibial shaft fractures with concomitant fibula fractures, particularly those at the same level, may be difficult to manage because of their inherent instability. Typically, management of lower extremity fractures is focused on the tibia fixation, and the associated fibula fracture is managed without fixation. In this article, we describe a novel technique for intramedullary fixation of the fibula, using a humeral guide wire as an adjunct to tibia fixation in the setting of tibial shaft fracture. This technique aids in determining length, alignment, and rotation of the tibia fracture and may help support the lower extremity as whole by stabilizing the lateral column. In addition, this technique can be used to help maintain reduction of the fibula when there is concern about the soft tissues of the lower extremity secondary to swelling or injury. Our clinical case series demonstrates the safety, effectiveness, and cost-sensitivity of this technique in managing select concurrent fractures of the tibia and fibula.
Eichinger, Josef K; Balog, Todd P; Grassbaugh, Jason A
Historically, management of displaced midshaft clavicle fractures has consisted of nonsurgical treatment. However, recent literature has supported surgical repair of displaced and shortened clavicle fractures. Several options exist for surgical fixation, including plate and intramedullary (IM) fixation. IM fixation has the potential advantages of a smaller incision and decreased dissection and soft-tissue exposure. For the last two decades, the use of Rockwood and Hagie pins represented the most popular form of IM fixation, but concerns exist regarding stability and complications. The use of alternative IM implants, such as Kirschner wires, titanium elastic nails, and cannulated screws, also has been described in limited case series. However, concerns persist regarding the complications associated with the use of these implants, including implant failure, migration, skin complications, and construct stability. Second-generation IM implants have been developed to reduce the limitations of earlier IM devices. Although anatomic and clinical studies have supported IM fixation of midshaft clavicle fractures, further research is necessary to determine the optimal fixation method.
Li, Heng; Yang, Honghang; Wang, Dan; Xu, Yi; Min, Jikang; Xu, Xuchun; Li, Zhanchun; Yuan, Yongjian
Our aim was to evaluate the efficacy of the treatment method using internal fixation of parallel reconstruction plates for the posterior wall of the acetabulum fractures. Randomised, prospective. Level I trauma centre. 57 patients with posterior wall fractures of the acetabulum in our department from 2007 to 2010 were treated operatively using this technique. internal fixation of two parallel reconstruction plates was used in this study. One of the plates was near the border of acetabulum. The other was parallel to the former one and was located to stress concentrated area. The clinical outcome was evaluated using the clinical grading system and radiological outcome was evaluated according to the criteria described by Matta. In addition, complications were researched in this study. The percentages of the clinical excellent-to-good and fair-to-poor results were 93.0% and 7%, respectively. We found that clinical outcome had no correlation with age, operation time from injury to operation, nor had correlation with hip dislocation, comminuted fracture condition and marginal compression fracture. Anatomical reduction was significantly correlated with excellent-to-good clinical outcome. Necrosis of the femoral head and heterotopic ossification were prone to decline the outcome of acetabular fractures despite good fracture reduction. the internal fixation of two parallel reconstruction plates facilitated rigid fixation and avoided fracture fragment injury, was an effective and reliable alternative method to treat fractures of the posterior wall of the acetabulum. Copyright © 2013 Elsevier Ltd. All rights reserved.
Full Text Available Purpose. The Anatomic Fiber Metal plus stem (Zimmer is one of the anatomically designed cementless stems to achieve stable fixation by metaphyseal fit. We studied outcomes of cementless total hip arthroplasty using this stem and possible effects of metaphyseal fit on outcomes. Methods. The cementless total hip arthroplasty using this stem was performed for 155 hips. One hundred and thirty-seven hips of 122 patients were followed for 5 to 16 (mean, 9.7 years and entered into the study. The metaphyseal fit was defined as good or poor in an anteroposterior radiograph after surgery. We studied the fixation of the stem and bone reaction on an anteroposterior radiograph at the final followup. Results. Twelve hips had revision, six acetabular components and six acetabular liners. No stem was revised. The biological fixation of the stem was bone ingrown fixation for 136 hips and unstable for one. The metaphyseal fit was good for 83 hips and poor for 54 hips. There were no differences for stem fixation and bone reaction between the two groups. Conclusions. The fixation of the stem was stable at a mean followup of 9.7 years independently from metaphyseal fit.
Liu, Zhao-Jie; Jia, Jian; Zhang, Yin-Guang; Tian, Wei; Jin, Xin; Hu, Yong-Cheng
The purpose of this article is to evaluate the efficacy and feasibility of preoperative surgery with 3D printing-assisted internal fixation of complicated acetabular fractures. A retrospective case review was performed for the above surgical procedure. A 23-year-old man was confirmed by radiological examination to have fractures of multiple ribs, with hemopneumothorax and communicated fractures of the left acetabulum. According to the Letounel and Judet classification, T-shaped fracture involving posterior wall was diagnosed. A 3D printing pelvic model was established using CT digital imaging and communications in medicine (DICOM) data preoperatively, with which surgical procedures were simulated in preoperative surgery to confirm the sequence of the reduction and fixation as well as the position and length of the implants. Open reduction with internal fixation (ORIF) of the acetabular fracture using modified ilioinguinal and Kocher-Langenbeck approaches was performed 25 days after injury. Plates that had been pre-bent in the preoperative surgery were positioned and screws were tightened in the directions determined in the preoperative planning following satisfactory reduction. The duration of the operation was 170 min and blood loss was 900 mL. Postoperative X-rays showed that anatomical reduction of the acetabulum was achieved and the hip joint was congruous. The position and length of the implants were not different when compared with those in preoperative surgery on 3D printing models. We believe that preoperative surgery using 3D printing models is beneficial for confirming the reduction and fixation sequence, determining the reduction quality, shortening the operative time, minimizing preoperative difficulties, and predicting the prognosis for complicated fractures of acetabulam. © 2017 Chinese Orthopaedic Association and John Wiley & Sons Australia, Ltd.
Meselhy, Mohammed Anter; Singer, Mohamed Salah
External fixation can be performed in poor bone and soft tissue conditions, and can be used in patients with poor general conditions or multiple injuries as a rapid, mini-invasive procedure. The purpose of the current study was to evaluate the effectiveness and safety of the Ilizarov external fixator in the management of proximal humeral fractures. Between May 2011 and December 2013, 14 patients with displaced proximal humeral fractures were enrolled in the current study. Nine patients were males and five were females, with mean age 42.9 years (range 21-55). All fractures were acute. The mode of injury was road traffic accident in eight patients and fall in six patients. There were six patients with two-part fracture, one of them with fracture dislocation, and eight patients presented with three-part fracture, two of them with fracture dislocation. All fractures were fixed using the Ilizarov external fixation. The average operative time was about 67 min (range 50-90). The mean follow-up period was (18) months (range 12-28). Healing was obtained in all 14 patients in a mean of 10.4 weeks (range 8-14). At the final follow-up, the mean constant score was 73.1 points (range 60-97 points), the mean visual analog score (VAS) for pain 3.2 (range 1-5), the mean DASH score 31.8 points (range 10-55 points), and the mean satisfaction VAS 7.6 (range 4-10). The Ilizarov external fixation is an effective technique in managing proximal humeral fractures with good outcome and low complication rates. Level IV, case series.
Feng, Yongzeng; Yu, Yang; Shui, Xiaolong; Ying, Xiaozhou; Cai, Leyi; Hong, Jianjun
Open reduction and internal fixation has been widely used to treat displaced intra-articular calcaneus fractures in children. However, the complications of surgical trauma and the wound created through the extended lateral approach cannot be ignored. This study analyzed the outcomes of displaced intra-articular calcaneal fractures in children treated with closed reduction and percutaneous fixation. Medical records of pediatric patients who had displaced intra-articular calcaneus fractures and underwent closed reduction and percutaneous fixation at the study institution between January 2008 and January 2013 were reviewed. Preoperative radiographs and computed tomography scans were used to evaluate and classify the fractures. Clinical outcomes and radiographic findings were assessed at postoperative follow-up. The study included 14 displaced intra-articular calcaneal fractures in 11 patients (7 boys and 4 girls). Mean patient age was 11.18 years (range, 6-16 years), and average follow-up time was 42.8 months postoperatively (range, 12-72 months). There were 6 tongue-type fractures and 8 joint depression-type fractures, based on the Essex-Lopresti classification, and there were 11 type II and 3 type III fractures, based on the Sanders classification. Average Böhler angle was 8.00° (range, -5° to 18°) preoperatively and 30.79° (range, 26° to 40°) postoperatively (P<.001). Average subjective American Orthopaedic Foot and Ankle Society hindfoot score was 65.7 (range, 52-68). No patients had wound breakdown or infection. In the treatment of displaced intra-articular calcaneal fractures in pediatric patients, closed reduction and percutaneous fixation achieved good outcomes, with few complications. [Orthopedics. 2016; 39(4):e744-e748.]. Copyright 2016, SLACK Incorporated.
Yang, Lijuan; Liu, Chunming; Hua, Wenmei; Liu, Weidong; Wang, Xiguang; Wang, Kai; Zhang, Zhanle; Li, Meifang; Duan, Hainan
To explore the procedure and effectiveness of sequential reduction and fixation for zygomatic complex fractures. Between March 2004 and February 2012, 32 patients with zygomatic complex fractures were treated. There were 28 males and 4 females with a median age of 29 years (range, 17-55 years). Fractures were caused by traffic accident in 29 cases and by tumble in 3 cases. The time between injury and admission was 1-12 days (mean, 3 days) in 28 fresh fractures and 22-60 days (mean, 40 days) in 4 old fractures. All patients were diagnosed by clinical symptom and CT scan. Coronal scalp incision, lower eyelid aesthetic incision, and intraoral incision were used to expose the zygomatic bone segments. The sequence of fractures reduction and fixation was horizontal first, and then longitudinal. In horizontal orientation, reduction and simultaneous fixation started from the root of the zygoma, to zygomatic arch, body of the zygoma, and inferior orbital rim in turn. Longitudinally, fracture reduction of zygomatico-frontal suture and orbital posterolateral walls was done first, followed by fracture reduction of zygomaticomaxillary buttress. Primary healing of incision was obtained in all 32 cases, without complications of maxillary sinus fistula and infection. Eighteen patients were followed up 6 months to 6 years with a median time of 32 months. All the patients gained satisfactory results with normal zygomatic contour and symmetric midface. All patients restored normal mouth opening. No eye and vision damage occurred. Frontal disappearance and brow ptosis were observed in 2 cases. Hair loss (2-3 mm) was seen at the site of coronal scalp incision, without scar hyperplasia; there was no obvious scar at lower eyelid. CT and X-ray films showed bony healing at 6 months after operation. Sequential reduction and fixation is accord with the mechanical characters of complicated zygomatic fractures. It is very easy to achieve anatomic reduction of the bone segments and facial
Naranje, Sameer; Kotwal, P. P.; Shamshery, P.; Gupta, Vikas; Nag, H. L.
The aim of our study was to evaluate clinical, radiological and functional outcomes of selected cases of percutaneous fixation of scaphoid fractures via a dorsal approach. Percutaneous fixation by dorsal approach was done in 32 patients (mean age 32.2 years) involving both fresh and late scaphoid fracture presentations (mean 17 days). Fourteen cases of B1 type, ten cases of B2 and eight cases of C type (Herbert’s classification) were treated. The patients were prospectively followed up clinic...
Hung, Li-Wei; Hwang, Yi-Ting; Huang, Guey-Shiun; Liang, Cheng-Chih; Lin, Jinn
Abstract Hip fractures in older people requiring dialysis are associated with high mortality. Our study primarily aimed to evaluate the specific burden of dialysis on the mortality rate following hip fracture. The secondary aim was to clarify the effect of the fracture site on mortality. A retrospective cohort study was conducted using Taiwan's National Health Insurance Research Database to analyze nationwide health data regarding dialysis and non-dialysis patients ≥65 years who sustained a first fragility-related hip fracture during the period from 2001 to 2005. Each dialysis hip fracture patient was age- and sex-matched to 5 non-dialysis hip fracture patients to construct the matched cohort. Survival status of patients was followed-up until death or the end of 2011. Survival analyses using multivariate Cox proportional hazards models and the Kaplan-Meier estimator were performed to compare between-group survival and impact of hip fracture sites on mortality. A total of 61,346 hip fracture patients were included nationwide. Among them, 997 dialysis hip fracture patients were identified and matched to 4985 non-dialysis hip fracture patients. Mortality events were 155, 188, 464, and 103 in the dialysis group, and 314, 382, 1505, and 284 in the non-dialysis group, with adjusted hazard ratios (associated 95% confidence intervals) of 2.58 (2.13–3.13), 2.95 (2.48–3.51), 2.84 (2.55–3.15), and 2.39 (1.94–2.93) at 0 to 3 months, 3 months to 1 year, 1 to 6 years, and 6 to 10 years after the fracture, respectively. In the non-dialysis group, survival was consistently better for patients who sustained femoral neck fractures compared to trochanteric fractures (0–10 years’ log-rank test, P fractures was better than that of patients with trochanteric fractures only within the first 6 years post-fracture (0–6 years’ log-rank, P hip fracture patients. Survival outcome was better for non-dialysis patients with femoral neck fractures compared to those with
Dawei, Tian; Na, Liu; Jun, Lei; Wei, Jin; Lin, Cai
Although there were many different types of fixation techniques for sacroiliac dislocation fracture, the treat remained challenging in posterior pelvic ring injury. The purpose of this study was to evaluate the biomechanical effects of a novel fixation system we designed. 12 human cadavers (L3-pelvic-femora) were used to compare biomechanical stability after reconstruction on the same specimens in four conditions: (1) intact, (2) cable system, (3) plate-pedicle screw system, and (4) cable system and plate-pedicle screw combination system (combination system). Biomechanical testing was performed on a material testing machine for evaluating the stiffness of the pelvic fixation construct in compression and torsion. The cable system and plate-pedicle screw system alone may be insufficient to resist vertical shearing and rotational loads; however the combination system for unstable sacroiliac dislocation fractures provided significantly greater stability than single plate-pedicle or cable fixation system. The novel fixation system for unstable sacroiliac dislocation fractures produced sufficient stability in axial compression and axial rotation test in type C pelvic ring injuries. It may also offer a better solution for sacroiliac dislocation fractures. Copyright © 2012 Elsevier Ltd. All rights reserved.
J. Gómez; J. Albareda; L. Ezquerra
Introduction: Trochanteric hip fractures in elderly patients with osteoporosis are commonly caused by low energy trauma. The cardioversion therapy is an extremely rare cause of this type of fracture. Presentation of case: We report the case of a woman with hip fracture after cardioversion. Discussion: We discuss the production mechanism of this injury and the importance of the care of the osteoporotic bone under these therapies. Conclusion: The propofol sedation should be complemente...
Clinical studies do not allow a quantitative correlation between stability of fracture fixation and outcome of bone healing. This limits the biomechanical improvement of fracture fixation techniques. The most practical quantitative parameter to describe the stability of a fracture fixation is the stiffness. This can be determined for several types of fixation through biomechanical methods and in some clinical studies in vivo. By using numerical fracture healing models, it is now possible to use the tissue differentiation rules found in basic research to calculate optimal stiffness parameters for various fixation techniques. For a tibial fracture as an example the possibilities of a numerical fracture healing simulation have been demonstrated. The effects of the diameter of an intramedullary nail, type of fracture, fracture gap size and nail material on healing could be demonstrated. To circumvent complex and time consuming calculations for several fixations a map was calculated which shows the expected bone healing quality as a function of the axial stiffness and the shear stiffness of the fixation device. By comparing the stiffness of various fixation techniques with the stiffness map it becomes evident that the methods most often used (e.g. unreamed nail, plate and external fixator) have a low shear and/or rotational stiffness that is too low to achieve the optimal healing outcome. The high axial stiffness of plates next to the plate surface can lead to very low tissue strain directly adjacent to the plate and can delay the bone healing process at this location.
Sundh, D; Nilsson, A G; Nilsson, M; Johansson, L; Mellström, D; Lorentzon, M
Hip fractures cause increased mortality and disability and consume enormous healthcare resources. Only 46% of hip fracture patients have osteoporosis at the total hip according to dual-energy X-ray absorptiometry (DXA) measurement. Cortical porosity increases with ageing and is believed to be important for bone strength. To investigate whether older women with hip fracture have higher cortical porosity than controls, and if so whether this difference is independent of clinical risk factors and areal bone mineral density (aBMD). From an ongoing population-based study, we identified 46 women with a prevalent X-ray-verified hip fracture and 361 control subjects without any fractures. aBMD was measured with DXA. High-resolution peripheral quantitative computed tomography was used to measure bone microstructure at the standard (ultradistal) site and at 14% (distal) of the tibial length. Women with a previous hip fracture had lower aBMD at the femoral neck (-11.8%) and total hip (-14.6%) as well as higher cortical porosity at the ultradistal (32.1%) and distal (29.3%) tibia compared with controls. In multivariable logistic regression analysis, with adjustment for covariates (age, height, weight, smoking, calcium intake, physical activity, walk time, oral glucocorticoids, parental hip fracture, rheumatoid arthritis, previous fall, current bisphosphonate treatment and femoral neck aBMD), cortical porosity at the ultradistal [odds ratio per standard deviation increase (95% confidence interval) 2.61 (1.77-3.85)] and distal [1.57 (1.12-2.20)] sites was associated with prevalent hip fracture. Cortical porosity was associated with prevalent hip fracture in older women independently of femoral neck aBMD and clinical risk factors. © 2017 The Authors. Journal of Internal Medicine published by John Wiley & Sons Ltd on behalf of Association for Publication of The Journal of Internal Medicine.
Mazzucchelli, Ramón; Pérez-Fernández, Elia; Crespí, Natalia; García-Vadillo, Alberto; Rodriguez Caravaca, Gil; Gil de Miguel, Angel; Carmona, Loreto
Older persons who have suffered a hip fracture (HFx) are at increased risk of subsequent hip fractures. The cumulative incidence of a second hip fracture (SHFx) has been estimated in 8.4%; however, no studies have been carried out in our country, and the information on risk markers of SHFx is limited. The aim of this study was to estimate the incidence, explore trends, and examine predictors of SHFx in a suburban population of Spain. An observational longitudinal retrospective study was performed in a universal health coverage setting (Alcorcón, 1999-2011). Data were obtained from the area hospital discharge database. Annual incidence of HFx was estimated over 100,000 population (general and persons with HFx), and median time to SHFx by Kaplan-Meier tables. Cox regression was used for the analysis of association between SHFx and baseline predictors, measured by hazard ratio (HR). Among the 3430 patients who suffered a first HFx in the study period, 255 (7.4%) experienced a SHFx (4.5% of men and 8.5% of women). Median time between the first and second HFx was 3.7 years (SD 3.2). Annual incidence of HFx in population over 45 was 290.5 per 100,000 inhabitants (131.03 in men and 433.11 in women). Annual incidence of SHFx among persons with a HFx was 956.7 per 100,000 (1052.1 in women and 595.5 in men). There was a decline trend along the study period with an annual reduction of 10.4% (95% CI 7.7-13.0%; p < 0.001) in both sexes. The following associations were found: female sex (HR 1.41, 95% CI 0.97-2.02), age (HR 1.03, 95% CI 1.01-1.04), living in a nursing house (HR 1.46, 95% CI 1.10-1.94), and moderate to severe liver disease (HR 4.96, 95% CI 1.23-20.06). In our environment the occurrence of a SHFx is 7.4%, three-fold risk compared to no previous HFx. Being woman, elderly, living in a nursing home, and having severe to moderate liver disease may be important predictors of a SHFx. There seems to be adequate time between the first and the SHFx for interventions
Kang, Dai-Hun; Jung, Dong-Woo; Kim, Yong-Ha; Kim, Tae-Gon; Lee, JunHo
Background The Kirschner wire (K-wire) technique allows stable fixation of bone fragments without periosteal dissection, which often lead to bone segment scattering and loss. The authors used the K-wire fixation to simplify the treatment of laborious comminuted zygomatic bone fracture and report outcomes following the operation. Methods A single-institution retrospective review was performed for all patients with comminuted zygomatic bone fractures between January 2010 and December 2013. In each patient, the zygoma was reduced and fixed with K-wire, which was drilled from the cheek bone and into the contralateral nasal cavity. For severely displaced fractures, the zygomaticofrontal suture was first fixated with a microplate and the K-wire was used to increase the stability of fixation. Each wire was removed approximately 4 weeks after surgery. Surgical outcomes were evaluated for malar eminence, cheek symmetry, Kwire site scar, and complications (based on a 4-point scale from 0 to 3, where 0 point is 'poor' and 3 points is 'excellent'). Results The review identified 25 patients meeting inclusion criteria (21 men and 4 women). The mean age was 52 years (range, 15-73 years). The mean follow up duration was 6.2 months. The mean operation time was 21 minutes for K-wire alone (n=7) and 52 minutes for K-wire and plate fixation (n=18). Patients who had received K-wire only fixation had severe underlying diseases or accompanying injuries. The mean postoperative evaluation scores were 2.8 for malar contour and 2.7 for K-wire site scars. The mean patient satisfaction was 2.7. There was one case of inflammation due to the K-wire. Conclusion The use of K-wire technique was associated with high patient satisfaction in our review. K-wire fixation technique is useful in patient who require reduction of zygomatic bone fractures in a short operating time. PMID:28913236
Rubel, Ivan F.; Kloen, Peter; Helfet, David L. [Department of Orthopaedic Surgery, Weill Medical College of Cornell University, New York, NY (United States); Potter, Hollis G. [MRI Department, Diagnostic Radiology, Hospital for Special Surgery, New York (United States)
Traumatic hip dislocations associated with posterior wall fractures of the acetabulum in the pediatric population are in general a consequence of high-energy trauma. After expeditious reduction, instability mandates for further diagnosis and intervention. Plain radiographs or computerized tomography (CT) scans can misjudge the involvement of the posterior wall of the acetabulum due to the partially calcified nature of the pediatric bone. We present two cases of pediatric traumatic hip dislocation associated with posterior wall fractures of the acetabulum. In both cases, obvious postreduction instability was noted without conclusive findings of etiology on plain X-rays or CT scans. Magnetic resonance imaging (MRI) disclosed an extensive posterior wall traumatic involvement in both cases and helped to decide in favor of open reduction of the hip and internal fixation of the posterior wall fragment. (orig.)
Lee, Bong-Gun; Sung, Yoon-Kyoung; Kim, Dam; Choi, Yun Young; Kim, Hunchul; Kim, Yeesuk
The purpose was to evaluate the prevalence and location of simultaneous fracture using bone scans in patients with hip fracture and to determine the risk factors associated with simultaneous fracture. One hundred eighty two patients with hip fracture were reviewed for this study. Clinical parameters and bone mineral density (BMD) of the lumbar vertebra and femoral neck were investigated. To identify acute simultaneous fracture, a bone scan was performed at 15.4±4.1days after hip fracture. The prevalence and location of simultaneous fracture were evaluated, and multivariate logistic regression analysis was performed to determine the risk factors. Simultaneous fracture was observed in 102 of 182 patients, a prevalence of 56.0%. Rib fracture was the most common type of simultaneous fracture followed by rib with vertebral fracture. The BMD of the lumbar vertebra was significantly lower in patients with simultaneous fracture (p=0.044) and was identified as an independent risk factor (odds ratio: OR 0.05, 95% confidence interval: CI 0.01-0.57). The prevalence of simultaneous fracture was relatively high among patients with hip fracture, and BMD was significantly lower in patients with simultaneous fracture than in patients without it. Surgeons should be aware of the possibility of simultaneous fracture in patients with hip fracture. Copyright © 2016 Elsevier Ltd. All rights reserved.
Suneel B. Bhat
Full Text Available Background: Osteoporosis is a common condition among the elderly population, and is associated with an increased risk of fracture. One of the most common fragility fractures involve the distal radius, and are associated with risk of subsequent fragility fracture. Early treatment with bisphosphonates has been suggested to decrease the population hip fracture burden. However, there have been no prior economic evaluations of the routine treatment of distal radius fracture patients with bisphosphonates, or the implications on hip fracture rate reduction. Methods: Age specific distal radius fracture incidence, age specific hip fracture rates after distal radius fracture with and without risendronate treatment, cost of risendronate treatment, risk of atypical femur fracture with bisphosphonate treatment, and cost of hip fracture treatment were obtained from the literature. A unique stochastic Markov chain decision tree model was constructed from derived estimates. The results were evaluated with comparative statistics, and a one-way threshold analysis performed to identify the break-even cost of bisphosphonate treatment. Results: Routine treatment of the current population of all women over the age of 65 suffering a distal radius fracture with bisphosphonates would avoid 94,888 lifetime hip fractures at the cost of 19,464 atypical femur fractures and $19,502,834,240, or on average $2,186,617,527 annually, which translates to costs of $205,534 per hip fracture avoided. The breakeven price point of annual bisphosphonate therapy after distal radius fracture for prevention of hip fractures would be approximately $70 for therapy annually. Conclusion: Routine treatment of all women over 65 suffering distal radius fracture with bisphosphonates would result in a significant reduction in the overall hip fracture burden, however at a substantial cost of over a $2 billion dollars annually. To optimize efficiency of treatment either patients may be selectively
Zhang, Chun-qiang; Zheng, Hong-yu; Wang, Bing; Huang, He; He, Fei; Zhao, Xue-ling
To explore the clinical effects of external fixation associated with limited internal fixation on treatment of Gustilo grade III leg fractures. From July 2006 to December 2008, 40 cases of Gustilo grade III leg fractures were emergently treated in our unit with external fixation frames. Soft tissue injuries were grouped according to the Gustilo classification as IIIA in 17 cases, IIIB in 13 cases, and IIIC in 10 cases. All the patients were debrided within 8 hours, and then fracture reposition was preformed to reestablish the leg alignment. Limited internal fixation with plates and screws were performed on all the Gustilo IIIA cases and 10 Gustilo IIIB cases at the first operation. But all the Gustilo IIIC cases and 3 Gustilo IIIB cases who had severe soft tissue injuries and bone loss only received Vacuum-sealing drainage (VSD). Broad-spectrum antibiotics were regularly used and VSD must be especially maintained easy and smooth for one week or more after operation. Limited internal fixation and transplanted free skin flaps or adjacent musculocutaneous flaps were not used to close wounds until the conditions of the wounds had been improved. The first operations were completed within 90-210 minutes (170 minutes on average). The blood transfusions were from 400 ml to 1500 ml (those used for anti-shock preoperatively not included). All the 40 patients in this study were followed up for 6-28 months, 20.5 months on average. The lower limb function was evaluated according to the comprehensive evaluation standards of leg function one year after operation and the results of 28 cases were excellent, 9 were good and 3 were poor. External fixation associated with limited internal fixation to treat Gustilo grade III leg fractures can get satisfactory early clinical therapeutic effects.
Rasmussen, Birgit; Uhrenfeldt, Lisbeth
Background Older people's hip fracture (HF) may occur due to osteoporosis, impaired balance or other health problems. For the individual, the experience of changes in wellbeing and/or changes in a recent active everyday-life; new health problems such as dependency, pain and a fear of falling may...... add to the load of wellbeing-challenges after HF. Evidence-based knowledge in order to address the wellbeing of older people and the challenges they meet in changing times after HF is needed for professionals. Aim To explore the support older people with HF may need to optimize their wellbeing during...... by the philosophies of Heidegger and Gadamer to explore older people´s lived experiences through repeated interviews; and applying an existential framework of wellbeing where meaning and health can be understood as a balancing of mobility and dwelling. Results The systematic review reveals older peoples´ worries when...
Gordon, Katharina; Winkler, Martin; Hofstädter, Thomas; Dorn, Ulrich; Augat, Peter
With increasing life expectancy and number of total hip arthroplasties (THA), the need for revision surgery is increasing too. The aim of this study was to evaluate the optimal fracture treatment for a clinically characteristic Vancouver B1 fracture. We hypothesized that locking plate fixation has biomechanical advantages over fixation with a simple cerclage system. Additionally, we hypothesized that removal of the primary short stem and revision with a long stem would show biomechanical benefit. The biomechanical testing was performed with a static and a dynamic loading protocol on twenty 4th Generation sawbones. These were divided into four different groups (n = 5 each). In group 1, the primary uncemented short stem remained and the fracture was stabilized with a locking plate. In group 2, the primary stem remained and the fracture was stabilized with a cerclage stabilization system containing two stabilizers and four cerclages. In group 3, the primary stem was replaced by an uncemented long revision stem and the fracture was fixed with a locking plate. In group 4, the short stem was replaced by a long revision stem and the fracture was fixed with the cerclage system. Static testing revealed that the revision of the short stem with the long stem caused a 2-fold (p Vancouver B1 fractures can be sufficiently fixed by simple cerclage systems. Revision with a long replacement stem provides a superior mechanical stability regardless of type of osteosynthesis fixation and is therefore a viable method in Vancouver B1 cases. A disadvantage of the cerclage system compared to plating is that an increased subsidence of the short stem was observed. © 2016 Elsevier Ltd. All rights reserved.
James A. Browne, MD
Full Text Available The incidence of periprosthetic fractures of the acetabulum associated with a total hip arthroplasty is relatively low but may be increasing. Treatment options depend upon the stability of the prosthesis. In this case, we report an unusual fracture pattern where a large portion of posterior column remained osseointegrated to a displaced uncemented acetabular component and removal of the cup would have resulted in massive structural bone loss and potential pelvic discontinuity. A metal cutting burr was used to create additional screw holes in the cup to allow us to retain the original implant and also obtain fixation of the fracture. The patient had a good outcome at one year with a healed fracture, stable implant, and excellent function. To our knowledge, this technique has not been previously described and offers surgeons an approach to fix these challenging fractures.
Objective. The present paper examines pertinent literature sources published in the peer-reviewed English language between 1980 and November 1, 2010 concerning hip fractures. The aim was to highlight potential intervention points to offset the risk of incurring a hip fracture and its attendant disability. Methods. An in-depth search of the literature using the key terms: disability, epidemiology, hip fracture, prevention, and risk factors was conducted, along with data from the author's research base detailing the disability associated with selected hip fracture cases. All articles that dealt with these key topics were reviewed, and relevant data were tabulated and analyzed. Results. Hip fractures remain an important but potentially preventable public health problem. Among the many related remediable risk factors, low physical activity levels are especially important. Related determinants of suboptimal neuromuscular function also contribute significantly to hip fracture disability. Conclusion. Physical activity participation can help to reduce the prevalence and excess disability of hip fractures and should be encouraged. PMID:21584248
Full Text Available Background/Aim. Besides the conquasant fractures, open tibia shaft fractures belong to the group of the most severe fractures of tibia. Open tibia shaft fracture is one of the most common open fractures of long bones. They most frequently occur as a result of traffic accidents caused by the influence of a strong direct force. Methods. Within the period from January, 2000 to December 31, 2005. at the Clinic for Orthopaedics and Traumatology, Clinical Center Nis, 107 patients with open tibial fractures were treated. We analyzed 96 patients with open tibial fracture. In the series analyzed, the male sex was prevalent - there were 74 men (77.08%. The mean age was 47.3 years. The youngest patient was 17 years old, while the oldest patient was 79. According to the classification of the Gustilo et al. in the analysed group there were 30 (31.25% open tibial fractures of the I degree, 31 (32.29% of the II degree, 25 (26.05% of the III A degree, 8 (8.33% of the III B degree and 2 (2.08% of the III C degree. In 95 of the patients the treatment of open tibia shaft fractures consisted of the surgical treatment of wound and the external fixation of the fractured bone using "Mitkovic" type external fixator with a convergent method of pin applications. One primary amputations had been done in patients with grade IIIC open tibial fracture with large soft tissue defect. Results. Of the 96 open tibial fractures available for follow-up, 73 (76.04% healed without severe complications (osteitis, pseudoarthrosis, valgus malunion and amputation. Ther were nine (9.38% soft tissue pin track infections and six (6.25% superficial wound infections. The mean time of union was 21 (14-36 week. Among severe local complications associated with open tibial fractures, in eight patients (8.33% was registered osteitis, and in nine patients (9.38% fracture nonunion and the development of pseudoarthrosis. Three of the patients (3.13% had more than 10 degree valgus malunion. In one
SCHRODER, HM; Petersen, KK; ERLANDSEN, M
During a 16-year period, 256 second hip fractures were found in 3898 persons 40 years of age and older who had a previous hip fracture. Ninety-two percent of the second fractures were contra-lateral, and 68% of these were the same type as the first. Thus, 62% of the femoral neck and 72......% of the trochanteric fractures were preceded by a contra-lateral fracture of the same type. The mean interval between fractures was 3.3 years, and there was no significant difference between genders or among fracture types. The risk of the first fracture was 1.6 per 1000 men per year and 3.6 per 1000 women......, and for the second fracture 15 per 1000 men per year and 22 per 1000 women. This increase was highly significant for both genders, especially for men....
Ruhullah, Mohammad; Singh, Hare Ram; Shah, Sanjay; Shrestha, Dipak
Femoral fractures are common in children between 2 and 12 years of age and 75% of the lesions affect the femoral shaft. Traction followed by a plaster cast is universally accepted as conservative treatment. We compared primary hip spica with closed reduction and fixation with retrogradely passed crossed Rush pins for diaphyseal femur fracture in children. The hypothesis was that Rush pin might provide better treatment with good clinical results in comparison with primary hip spica. Fifty children with femoral fractures were evaluated; 25 of them underwent conservative treatment using immediate hip spica (group A) and 25 were treated with crossed retrograde Rush pins (group B). The patients ages ranged from 3 to 13 years (mean of 9 years). Mean duration of fracture union was 15 weeks in group A and 12 weeks in group B. Mean duration of weight bearing 14 weeks in group and 7 weeks in group B. Mean hospital stay was 4 days in group A and 8 days in group B. Mean followup period in group A was 16 months and group B was 17 months. Complications such as angulation, shortening, infection were compared. Closed reduction and internal fixation with crossed Rush pins was superior in terms of early weight bearing and restoration of normal anatomy.
Robles, María José; Formiga, Francesc; Vidán, M Teresa
The fracture of the proximal femur or hip fracture in the elderly usually happens after a fall and carries a high morbidity and mortality. One of the most common complications during hospitalization for hip fracture is the onset of delirium or acute confusional state that in elderly patients has a negative impact on the hospital stay, and prognosis, worsening functional ability, cognitive status and mortality. Also the development of delirium during hospitalization increases health care costs. Strategies to prevent and treat delirium during hospitalization for hip fracture have been less studied. In this context, this paper aims to conduct a review of the literature on strategies that exist in the prevention and treatment of delirium in elderly patients with hip fracture. Copyright © 2013 Elsevier España, S.L. All rights reserved.
Jain, Mohit J; Mavani, Kinjal J; Patel, Dhaval
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. To understand the technical difficulties involved in PFN and role of provisional fixation of fracture by Steinmann-pin. 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. All patients were followed-up for two years and final outcome assessment included shortening, neck shaft angle and Harris Hip Score was done. In all except one, neck shaft angle greater than 130° was achieved and also maintained in the final follow up (Mean 131.1°). All fractures were united with mean shortening of 3.6 mm and average Harris Hip Score of 91 after two years. There were five complications which included one shortening, two varus collapses, one backed out screws and one reverse Z effect. Though PFN is technically challenging, with proper technique, gives excellent results with negligible varus collapse even in unstable fractures. Three most important technical aspects are achieving good non-varus reduction, inserting nail correctly and accurate placement of lag screws. The technique of provisional fixation of fracture fragments by Steinmann-pin significantly helps in achieving these and reduces the risk of implant failure.
Background: Tension Band Wire(TBW) fixation of olecranon fracture is a commonly used technique by orthopaedic surgeons. However surgeons do not strictly adhere to the AO standard. Objectives: To determine the use and variability of this technique by surgeons at the hospital. Design: A hospital based retrospective ...
Background: Implant failure is traumatic for patient as it increases the cost of treatment and may negatively affect the confidence of patients in the superior outcome of operatively treated fractures. Hence the objectives for this study were to determine the proportion of implant fixations that fail, types and causes of implant ...
Background: In early 2006 during AO-scholarship training at Hadassah Hospital in Jerusalem, I witnessed patients being walked on the same day after fixation of ankle fractures. This was contrary to my original teaching of protected non-weight bearing for six weeks. Literature review in this subject was inconclusive.
Acetabular Fracture Fixation in an Adult with Fontan Physiology. A Case Report. D Olabumuyi, R Taib, S Nair, C F Chong. Abstract. No Abstract. Nigerian Journal of Orthopaedics and Trauma Vol. 6 (2) 2007: pp. 80-82. Full Text: EMAIL FULL TEXT EMAIL FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT.
Flynn criteria 34 had excellent and 6 had satisfactory results. No poor results were seen. Conclusion: Ender’s nail fixation can be preferred method of treatment for femoral shaft fractures in age group 5 -15 years as the results are excellent and satisfactory. It is technically simple and can be done in a closed manner. It spares the vascularity and growth plate.
Proximal femoral periprosthetic fracture fixation with a hooked locking plate: a Kenyan experience. ... The PDF file you selected should load here if your Web browser has a PDF reader plug-in installed (for example, a recent version of Adobe Acrobat Reader). If you would like more information about how to print, save, and ...
Conclusion: Anatomic reduction and internal fixation is the standard method for treatment of fractures by displacing radios and ulna in adults. According to results, it seems more intension to motions specially pronation and muscle strengthening foream after surgery will have affect on improving patients’ function specially pronation and Grip strength.
Apfelbaum, R I; Lonser, R R; Veres, R; Casey, A
The management of odontoid fractures remains controversial. Only direct anterior screw fixation provides immediate stabilization of the spine and may preserve normal C1-2 motion. To determine the indications, optimum timing, and results for direct anterior screw fixation of odontoid fractures, the authors reviewed the surgery-related outcome of patients who underwent this procedure at two institutions. One hundred forty-seven consecutive patients (98 males and 49 females) who underwent direct anterior screw fixation for recent ( or = 18 months postinjury [18 patients]) Type II (138 cases) or III (nine cases) odontoid fractures at the University of Utah (94 patients) and National Institute of Traumatology in Budapest, Hungary (53 patients) between 1986 and 1998 are included in this study (mean follow up 18.2 months). Data obtained from clinical examination, review of hospital charts, operative findings, and imaging studies were used to analyze the surgery-related results in these patients. In patients with recent fractures there was an overall bone fusion rate of 88%. The rate of anatomical bone fusion of recent fractures was significantly (p or = 0.05) of age, sex, number of screws placed (one or two), and the degree or the direction of odontoid displacement. In patients with remote fractures there was a significantly lower rate of bone fusion (25%). Overall, complications related to hardware failure occurred in 14 patients (10%) and those unrelated to hardware in three patients (2%). There was one death (1%) related to surgery. Direct anterior screw fixation is an effective and safe method for treating recent odontoid fractures ( or = 18 months postinjury) a significantly lower rate of fusion is found when using this technique, and these patients are believed to be poor candidates for this procedure.
Li, Yizhong; Lin, Jinkuang; Cai, Siqing; Yan, Lisheng; Pan, Yuancheng; Yao, Xuedong; Zhuang, Huafeng; Wang, Peiwen; Zeng, Yanjun
The aim of this study was to assess the influence of bone mineral density and hip geometry on the fragility fracture of femoral neck and trochanteric region. There were 95 menopausal females of age ≥ 50 years with fragility fracture of hip, including 55 cases of femoral neck fracture and 40 cases of trochanteric fracture. Another 63 non-fractured females with normal bone mineral density (BMD) were chosen as control. BMD, hip axis length, neck-shaft angle and structural parameters including cross surface area, cortical thickness and buckling ratio were detected and compared. Compared with control group, the patients with femoral neck fracture or trochanteric fractures had significantly lower BMD of femoral neck, as well as lower cross surface area and cortical thickness and higher buckling ratio in femoral neck and trochanteric region. There were no significant differences of BMD and structural parameters in the femoral neck fracture group and intertrochanteric fracture group. Hip axis length and neck-shaft angle were not significantly different among three groups. The significant changes of BMD and proximal femur geometry were present in the fragility fracture of femoral neck and trochanteric region. The different types of hip fractures cannot be explained by these changes.
Full Text Available Fracture of the femoral head and the acetabulum with traumatic dislocation of the hip is a severe injury representing various types and unfavorable outcome. We showed a 45-year-old man with Pipkin type-IV fracture and coxa valga. An immediate closed reduction was achieved followed by open reduction and internal fixation via a posterior approach 6 days later. However, dislocation occurred three times without traumatic events after three weeks. CT demonstrated no displacement of posterior fragments or implant failure. Femoral intertrochanteric varus osteotomy was performed to gain concentric stability and successfully resolved recurrent dislocation. Another 45-year-old woman with Pipkin type-IV fracture and coxa valga also underwent closed reduction initially and then continued conservative treatment. After eight weeks, when she started gait training, progressive pain became symptomatic. Persistent hip pain at weight bearing was not improved in spite of arthroscopic synovectomy and osteochondroplasty. Two years after injury, femoral intertrochanteric varus osteotomy was indicated and her refractory pain was resolved gradually. We suggest that femoral varus osteotomy should be considered for superolateral subluxation associated fracture dislocation of the hip in Pipkin type-IV and coxa valga.
Miyamoto, Shuichi; Nakamura, Junichi; Iida, Satoshi; Suzuki, Chiho; Ohtori, Seiji; Orita, Sumihisa; Takahashi, Kazuhisa
Fracture of the femoral head and the acetabulum with traumatic dislocation of the hip is a severe injury representing various types and unfavorable outcome. We showed a 45-year-old man with Pipkin type-IV fracture and coxa valga. An immediate closed reduction was achieved followed by open reduction and internal fixation via a posterior approach 6 days later. However, dislocation occurred three times without traumatic events after three weeks. CT demonstrated no displacement of posterior fragments or implant failure. Femoral intertrochanteric varus osteotomy was performed to gain concentric stability and successfully resolved recurrent dislocation. Another 45-year-old woman with Pipkin type-IV fracture and coxa valga also underwent closed reduction initially and then continued conservative treatment. After eight weeks, when she started gait training, progressive pain became symptomatic. Persistent hip pain at weight bearing was not improved in spite of arthroscopic synovectomy and osteochondroplasty. Two years after injury, femoral intertrochanteric varus osteotomy was indicated and her refractory pain was resolved gradually. We suggest that femoral varus osteotomy should be considered for superolateral subluxation associated fracture dislocation of the hip in Pipkin type-IV and coxa valga.
IHFD is a clinically led web-based audit. We summarize the data collected on hip fractures from April 2012 to March 2013 from 8 centres. Results. There were 843 patients with the majority being (70% female. The 80–89-year age group accounted for the majority of fractures (44%. Most (71% sustained a fall at home. Intertrochanteric fractures (40% were most common. Only 28% were admitted to an orthopaedic ward within 4 hours. The majority (97% underwent surgery with 44% having surgery within 36 hours. Medical optimization (35% and lack of theatre space (26% accounted for most of the surgical delay. While 29% were discharged home, 33% were discharged to a nursing home or other long-stay facilities. There was a 4% in-hospital mortality rate. Conclusions. Several key areas in both the database and aspects of patient care needing improvement have been highlighted. The implementation of similar databases has led to improved hip fracture care in other countries and we believe this can be replicated in Ireland.
stability, soft tissue cover, union of the fracture and above all prevent infection. Therefore various methods ... Also soft tissue cover should be done as soon as possible following the fix and flap-protocal (7) for open fractures ... and flap: the radical orthopaedic and plastic treatment of severe open fractures of the tibia.
Fractured neck of femur is a common problem seen in elderly osteoporotic females, mostly in Western countries, among which are the extra‑capsular fractures such as intertrochanteric and pertrochanteric fractures also known as peritrochanteric fractures, and commonly treated with dynamic hip screw (DHS) or compression ...
Miller, S D
Although the treatment of ankle fractures is often straightforward, several controversies remain. This article reviews the need for open reduction and internal fixation of the displaced supination-external rotation fracture, and contrasts the studies that mandate anatomic reduction with clinical results. The many issues surrounding syndesmosis fixation are also reviewed, including the need for fixation of distal fractures and the timing of screw fixation.
Full Text Available Aim: The aim of this study is to determine the state of osteoporosis and treatment in patients with osteoporotic hip fracture. Patients and Methods: 39 patients enrolled in this study that were above 50 years with an atraumatic hip fracture and operated in 1. and 2. Department of Orthopedics and Traumatology. Istanbul Training and Research Hospital, in our study (31 women, 8 men we investigate patients about risk factors of osteoporosis, before and after fracture severity of osteoporosis, treatment of osteoporosis. Patients who are younger than 50 years, and immobilized for long time, have pathological fracture, hip fracture is 2 cm distal than minor trochanter; are taken out from our study. Results: There is not significant difference between type of fracture, age, sex and risk factors. Before fractured 5 patients were diagnosed as osteoporosis and only 4 of them had been using antiresorptive, vitamin D, and calcium preparats. 36 patients that we studied never examined and treated for osteoporosis. All patients participating in study were informed about osteoporosis. Each patient was asked to apply for physical therapy and rehabilitation department with result of lumber and femoral bone mineral density measurement. Conclusion: Patients who had recent osteoporotic fractures must be treated to prevent new fracture. Orthopedic doctors should care osteoporosis and a new fracture risk as a serious important complication of osteoporotic hip fracture. (From the World of Osteoporosis 2007;13:11-4
Full Text Available Introduction. Open lower leg fractures are the most common open fractures of the locomotor system and their treatment is associated with a number of complications. Objective. The aim of the paper was to present the results of the treatment of 68 patients with open lower leg fractures, as well as the complications that accompany the treatment of these fractures. Methods. In the analyzed group, there were 45 (66.18% men and 23 (33.82% women. The majority of patients - 33 (48.53% of them - were injured in motor vehicle accidents, whereas 24 (35.29% patients sustained injuries due to falls from heights. In two (2.94% patients the cause of open tibial fractures was gunshot injuries. In the analyzed group, there were 18 (26.47% type I open fractures, 21 (30.88% type II open fractures, 19 (27.94% type IIIA open fractures, seven (10.29% type IIIB open fractures, and three (4.41% type IIIC open fractures. Results. The tibial shaft fracture healed without serious complications in 50 (73.53% patients, whereas in 18 (26.47% patients we observed some complications. Nonunion was found in 10 (14.71% patients, osteitis in four (5.88, malunion in two (2.94% patients. Milder complications such as soft tissue pin tract infection developed in 13 (19.12% patients, infection of the open fracture wound soft tissue was observed in four (5.88% patients. Conclusion. Basic principles in the treatment of open lower leg fractures in this study are thorough primary open fracture wound treatment followed by the delayed wound closure, stable fracture fixation using unilateral external skeletal device, proper antibiotic treatment and tetanus prophylaxis. The results correlate with similar studies. [Projekat Ministarstva nauke Republike Srbije, br. III 41017: Virtual Human Osteoarticular System and its Application in Preclinical and Clinical Practice
Full Text Available BACKGROUND The dynamic compression screw and plate is a gold standard device in the management of intertrochanteric fracture fixation. The problems of bedsores, DVT, lung complications, joint stiffness and malunion are very common with conservative management of IT fractures. Various modalities of devices are available for fracture fixation. The objective of the study is to analyse the treatment outcome of IT fractures by DHS. 1 MATERIALS AND METHODS This is a prospective study. 20 patients with fracture IT were treated with DHS. The average age of the patient was 52.25 years (range 41-60 years with mean follow-up of 2.1 years (range 1.5-2.0 years. The patients were assessed for fracture union, function and complications at regular follow-up interval. RESULTS The average age of the patient was 52.25 years (range 41-60 years with mean follow-up of 2.1 years (range 1.5-2.0 years. The patients were assessed for fracture union, function and complications at regular follow-up interval. CONCLUSION From this study, we conclude that dynamic hip screw is a reliable, versatile and effective device for the treatment of intertrochanteric fractures.
Ilyas S Aleem; Bhandari, Mohit; Elizalde, Sebastian Rodriguez
Introduction: Periprosthetic fractures of the femur after total hip arthroplasty are increasing in frequency. In the polytraumatized patient with long-bone fracture, an ongoing debate exists regarding early definitive stabilization versus initial damage control orthopaedics, followed by delayed fixation. It remains to be seen whether this rationale applies to the polytraumatized patient with periprosthetic fracture. Case presentation: We present the case of a 73-years old Caucasian woman who ...
Yu, Liang; Fenglin, Zhong
Whether external or plating fixation is more appropriate for high-energy tibial plateau fractures is still being disputed, our aim was to test the hypothesis whether external fixation can provide a fair outcome with fewer complications, when compared to the results with previously reported data of plating fixation for high-energy tibial plateau fractures. An Ovid of Medline, Embase, and Cochrane Library search was conducted for the relevant English orthopedic journals, and eligible studies, including twenty-four case series and one comparative study containing 885 patients associated with 892 fractures, were enrolled. The results showed there were a higher proportion of men, open fractures, malunion, knee instability, and posttraumatic arthritis occurred in external fixation group than those in plating group (P=0.007, P=0.000, P=0.024, P=0.006, P=0.000, respectively), while valgus deformity happened at a significantly higher rate in plate group (P=0.014). No significant differences were found between the two groups in terms of age, Schatzker type, follow-up, mean time to union, mean range of knee motion, and rate of reoperation. With regard to the functional and radiological outcome assessment, despite what assessment tools were used, most of these studies presented less than 90% good/excellent results in their high-energy fracture series. Besides, there was a trend for patients in plating group to have a higher risk than those in external fixation group in terms of heterotopic ossification and local irritation (1.23 vs 0.17%, 4 vs 1.94%, accordingly). Although lack of good quality randomized control trials, there are rather enough samples supporting the current available results. Meanwhile, future multicentered, randomized, controlled studies should be implemented to test these outcomes.
Miller, Matthew A; McDonald, Tyler C; Graves, Matthew L; Spitler, Clay A; Russell, George V; Jones, LaRita C; Replogle, William; Wise, Jeremy A; Hydrick, Josie; Bergin, Patrick F
We sought to define the rate of syndesmotic instability after anatomic reduction of the posterior malleolus when posterior stabilization of a trimalleolar or trimalleolar equivalent ankle fracture was chosen vs when a supine position and initially conservative management of the posterior elements was chosen. The types of syndesmotic and posterior malleolar fixation used to treat adult patients with ankle fractures involving the posterior malleolus at our level I trauma center were retrospectively assessed (N = 198). Specifically, both bimalleolar and trimalleolar fractures were included. Exclusion criteria included pilon fractures, trimalleolar fractures with Chaput fragments, and neurologic injury. Demographics, fracture classification, initial operative position, medial clear space, and posterior malleolar fragment size were recorded for each fracture. In total, 151 patients (76.3%) were initially positioned supine, 27.2% of whom had syndesmotic instability requiring operative stabilization. Almost 25% of supine patients also underwent posterior malleolar stabilization for posterior instability. Overall, 73 (48.3%) patients who were initially treated in the supine position needed some form of additional stabilization. Forty-seven patients (23.7%) were initially positioned prone. Syndesmotic stability was restored in 97.9% of these patients. This 2.1% rate of instability vastly differs from the 13-fold higher syndesmotic instability rate observed in the supine group ( P < .001). Our data demonstrate that the rate of syndesmotic instability was reduced in trimalleolar and trimalleolar equivalent fractures when prone positioning and direct fixation of the posterior malleolus were first performed. Using traditional preoperative estimates of posterior stability to determine the need for posterior malleolar fixation may be inadequate since almost a quarter of patients treated supine received posterior stabilization. Level III, retrospective comparative series.
Full Text Available Background/Aim. Osteoporotic fractures are a major cause of morbidity in the population. Therefore, fracture prevention strategies should be a major concern, and one of the priorities in the primary health care system. The aim of the study was to assess fracture and fall risk factors, and fracture risk level in patients with acute hip fracture, and to evaluate if there had been adequate osteoporosis treatment prior to fracture in this group of patients. Methods. Fracture and fall risk factors were assessed in 342 patients, ≥ 65 years old, hospitalized due to acute hip fracture at the Clinic for Orthopedic Surgery and Traumatology, Clinical Centre of Serbia in a 12-month period. Fall risk factors were assessed with the Fracture Risk Assessment (FRAX® algorithm, and patients were classified in respect to fracture risk level. Results. Hip fracture occurred in the majority of the patients in the high risk group (74.2%, where no additional bone mineral density testing was needed. Less than 10% of the patients had a diagnosis of osteoporosis before injury, while less than 2% were treated. Cognitive impairment (95.3%, visual impairment (58.2%, lower index of daily activities (51.8%, and depression (47.1% were the most frequently observed fall risk factors. Conclusion. The results of our investigation reveal insufficient identification of clinical fracture risk factors in the primary care setting, inadequate treatment of osteoporosis and, consequently, ineffective prevention of hip fractures in the geriatric population. The introduction of FRAX® into clinical practice enables more effective acknowledgment of patients with elevated fracture risk, even if bone density measurement is not available. The results of this study have a special significance for everyday clinical practice, because they impose a need for reviewing the existing approaches to osteoporosis prevention, and precise definiment of hip prevention strategies.
Mahecha-Toro, M; Vergara-Amador, E; González Ramírez, M
Diaphyseal fractures of the forearm comprise 6%-10% of all fractures in children. The treatment depends on the age and type of displacement, and conservative and surgical management with fixation of intramedullary nails, among other techniques, is valid. The aim is to show the radiological and functional outcomes, and complications of intramedullary fixation with Kirschner nails in children. A retrospective descriptive case series of patients treated with intramedullary fixation of forearm fractures. The radiological and functional results, and complications are correlated. Of the 117 patients operated, 59 met the inclusion criteria. The average age was 10 years. Eighty-four point seven percent were males and the left side was the most affected (62.7%). In 88.1% both bones were fractured and 11 cases had open fractures. An open reduction was performed in 72.8% of the cases, the main indications for this being instability, failed reduction and refracture. There were 52 excellent outcomes, 2 good, and 4 regular and 1 bad. There were 13.5% minor complications. This study shows that intramedullary fixation with Kirschner nails in radius and ulna diaphysis fractures in children is a safe, low-cost procedure and offers adequate short and medium term functional outcomes, with a low prevalence of serious complications with only 6 cases of non-consolidation and refracture. Larger preoperative angulations in the anteroposterior and lateral planes, and lateral postoperative angulations, could be considered predictors of less satisfactory functional results. Copyright © 2017 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.
Griffiths, Frances; Mason, Victoria; Boardman, Felicity; Dennick, Katherine; Haywood, Kirstie; Achten, Juul; Parsons, Nicholas; Griffin, Xavier; Costa, Matthew
To explore what patients consider important when evaluating their recovery from hip fracture and to consider how these priorities could be used in the evaluation of the quality of hip fracture services. Semistructured interviews exploring the experience of recovery from hip fracture at two time points-4 weeks and 4 months postoperative hip fixation. Two approaches to analysis: thematic analysis of data specifically related to recovery from hip fracture; summarising the participant's experience overall. 31 participants were recruited, of whom 20 were women and 12 were cognitively impaired. Mean age was 81.5 years. Interviews were provided by 19 patients, 14 carers and 8 patient/carer dyad; 10 participants were interviewed twice. Single major trauma centre in the West Midlands of the UK. Stable mobility (without falls or fear of falls) for valued activities was considered most important by participants who had some prefracture mobility and were able to articulate what they valued during recovery. Mobility was important for managing personal care, for day-to-day activities such as shopping and gardening, and for maintenance of mental well-being. Some participants used assistive mobility devices or adapted to their limitations. Others maintained their previous limited function through increased care provision. Many participants were unable to articulate what they valued as hip fracture was perceived as part of their decline with age. The fracture and problems from other health conditions were an inseparable part of one health experience. Prefracture mobility, adaptations to reduced mobility before or after fracture, and whether or not patients perceive themselves to be declining with age influence what patients consider important during recovery from hip fracture. No single patient-reported outcome measure could evaluate quality of care for all patients following hip fracture. General health-related quality of life tools may provide useful information within
Florescu, Vlad-Andrei; Kofod, Thomas; Pinholt, E. M.
Purpose The aim of the present retrospective study was to investigate the morbidity of screws used for intermaxillary fixation (IMF) in the treatment of mandibular fractures. A review of the published data was also performed for a comparison of outcomes. Our hypothesis was that the use of screws...... for IMF of mandibular fractures would result in minimal morbidity. Materials and Methods Patients treated for mandibular fractures from 2007 to 2013, using screws for IMF, using the international diagnosis code for mandibular fracture, DS026, were anonymously selected (Department of Oral and Maxillofacial...... retrospective study have shown that the use of screws is a valid choice for IMF in mandibular fracture treatment with minimal morbidity. The 793 screws used for IMF resulted in a negligible amount of central and peripheral tooth root trauma. © 2016 American Association of Oral and Maxillofacial Surgeons...
Full Text Available Acetabular fracture is usually treated with osteosynthesis. However, in the case of an intra-articular fracture, osteosynthesis can result in arthropathy of the hip joint and poor long-term results, hence, total hip arthroplasty is required. However, in total hip arthroplasty for postoperative acetabular fracture, sciatic nerve palsy tends to develop more commonly than after primary total hip arthroplasty. This is a case report of a 57-year-old Japanese male who had internal skeletal fixation for a left acetabular fracture that had occurred 2 years earlier. One year later, he developed coxarthrosis and severe pain of the hip joint and total hip arthroplasty was performed. After the second surgery, he experienced pain along the distribution of the sciatic nerve and weakness of the muscles innervated by the peroneal nerve, indicating sciatic nerve palsy. We performed a third operation, and divided adhesions around the sciatic nerve. Postoperatively, the anterior hip joint pain and the buttocks pain when the hip was flexed were improved. Abduction of the fifth toe was also improved. However, the footdrop and sensory disturbance were not improved. A year after the third operation, sensory disturbance was slightly improved but the footdrop was not improved. We believe the sciatic nerve palsy developed when we dislocated the hip joint as the sciatic nerve was excessively extended as the hip joint flexed and internally rotated. Sciatic nerve adhesion can occur easily in total hip replacement for postoperative acetabular fracture; hence, adhesiotomy should be conducted before performing hip dislocation to prevent injury caused by nerve tension. The patient agreed that the details of this case could be submitted for publication. The work has been reported in line with the CARE criteria and cite.
Feb 16, 1991 ... a satisfactory reduction by conservative means, severe soft.- tissue injury with or without vascular trauma, long-standing neurological disorder with incapacity and contractures, mal- union, and delayed union. Although long-bone diaphyseal fractures in children are generally managed non-operatively,.
Ohishi, Masanobu; Nakashima, Yasuharu; Yamamoto, Takuaki; Motomura, Goro; Fukushi, Jun-ichi; Hamai, Satoshi; Kohno, Yusuke; Iwamoto, Yukihide
Femur deformities can make stem fixation difficult in total hip arthroplasty (THA). We report the clinical results of cementless THA using a press-fit stem in patients who had previously undergone femoral osteotomy for hip...
Hulsbæk, Signe; Larsen, Rikke Faebo; Troelsen, Anders
PURPOSE: Regaining basic mobility after hip fracture surgery is a milestone in the in-hospital rehabilitation. The aims were to investigate predictors for not regaining basic mobility at the fifth post-operative day and at discharge after undergoing hip fracture surgery. METHOD: In a prospective...... cohort study 274 hip fracture patients were included. Patients with compromised ability to exercise were excluded leaving 167 patients for analysis. Patient demographics, functional level, method of operation, post-operative hemoglobin and the completion of physiotherapy was registered. Basic mobility...... on first post-operative day (OR = 3.3) (p values: 0.009-hip fracture surgery, who are not able to complete physiotherapy on first post-operative day, are at a greater risk of not regaining basic mobility during hospitalization...
Panula, J; Pihlajamäki, H; Sävelä, M; Jaatinen, P. T; Vahlberg, T; Aarnio, P; Kivelä, S.-L
Background and Aims: Our aim was to describe the incidence of cervical hip fractures and to describe the relationships between selected background variables and mortality at 30 days, 6 months, and 3 years postoperatively...
Panula, J; Pihlajamäki, H; Sävelä, M; Jaatinen, P T; Vahlberg, T; Aarnio, P; Kivelä, S L
Our aim was to describe the incidence of cervical hip fractures and to describe the relationships between selected background variables and mortality at 30 days, 6 months, and 3 years postoperatively...
Dodd, A C; Bulka, C; Jahangir, A; Mir, H R; Obremskey, W T; Sethi, M K
.... Though the 30-day mortality is considered a highly effective tool in measuring hospital performance, little data actually exists that explores the rate and risk factors for trauma-related hip and pelvis fractures...
Chiavaras, Mary M. [McMaster University, Department of Radiology, Hamilton, Ontario (Canada); Hamilton General Hospital, Department of Diagnostic Imaging, Hamilton, Ontario (Canada); Bains, Simrit [University of Western Ontario Medical School, London, Ontario (Canada); Choudur, Hema; Parasu, Naveen [McMaster University, Department of Radiology, Hamilton, Ontario (Canada); Jacobson, Jon [University of Michigan, Department of Radiology, Ann Arbor, MI (United States); Ayeni, Olufemi; Petrisor, Brad; Sprague, Sheila; Bhandari, Mohit [McMaster University, Department of Orthopedic Surgery, Hamilton, Ontario (Canada); Chakravertty, Rajesh [University of Toronto, Department of Orthopedic Surgery, Toronto, Ontario (Canada)
The assessment of fracture healing following intertrochanteric fracture fixation is highly variable with no validated standards. Agreement with respect to fracture healing following surgery is important for optimal patient management. The purpose of this study was to (1) assess reliability of intertrochanteric fracture healing assessment and (2) determine if a novel radiographic scoring system for hip fractures improves agreement between radiologists and orthopedic surgeons. A panel of three radiologists and three orthopedic surgeons assessed fracture healing in 150 cases of intertrochanteric fractures at two separate time points to determine inter-rater and intra-rater agreement. Reviewers, blinded to the time after injury, first subjectively assessed overall healing using frontal and lateral radiographs for each patient at a single time point. Reviewers then scored each fracture using a Radiographic Union Score for Hip (RUSH) form to determine whether this improves agreement regarding hip fracture healing. Inter-rater agreement for the overall subjective impression of fracture healing between reviewer groups was only fair (intraclass coefficient [ICC] = 0.34, 95 % CI: 0.11-0.52). Use of the RUSH score improved overall agreement between groups to substantial (ICC = 0.66, 95 % CI: 0.53-0.75). Across reviewers, healing of the medial cortex and overall RUSH score itself demonstrated high correlations with overall perceptions of healing (r = 0.53 and r = 0.72, respectively).??The RUSH score improves agreement of fracture healing assessment between orthopedic surgeons and radiologists, offers a systematic approach to evaluating intertrochanteric hip fracture radiographs, and may ultimately provide prognostic information that could predict healing outcomes in patients with femoral neck fractures. (orig.)
Full Text Available 【Abstract】Objective: Intertrochanteric femur fracture is a common injury in elderly patients. The dynamic hip screw (DHS has served as the standard choice for fixation; however it has several drawbacks. Studies of the percutaneous compression plate (PCCP are still inconclusive in regards to its effi cacy and safety. By comparing the two methods, we assessed their clinical therapeutic outcome. Methods: A total of 121 elderly patients with intertrochanteric femur fractures (type AO/OTA 31.A1- A2, Evans type 1 were divided randomly into two groups undergoing either a minimally invasive PCCP procedure or a conventional DHS fi xation. Results: The mean operation duration was signifi cantly shorter in the PCCP group (55.2 min versus 88.5 min, P<0.01. The blood loss was 156.5 ml±18.3 ml in the PCCP group and 513.2 ml±66.2 ml in the DHSgroup (P<0.01. Among the patients treated with PCCP, 3.1% needed blood transfusions, compared with 44.6% of those that had DHS surgery (P<0.01. The PCCP group displayed less postoperative complications (P<0.05. The mean American Society of Anesthesiologists score and Harris hip score in the PCCP group were better than those in the DHS group. There were no signifi cant differences in the mean hospital stay, mortality rates, or fracture healing. Conclusion: Due to several advantages, PCCP has the potential to become the ideal choice for treating intertrochanteric fractures (type AO/OTA 31.A1-A2, Evans type 1, particularly in the elderly. Key words: Hip fractures; Osteoporotic fractures; Surgical procedures, minimally invasive; Fracture fixation, internal
Poole, Kenneth E S; Skingle, Linda; Gee, Andrew H; Turmezei, Thomas D; Johannesdottir, Fjola; Blesic, Karen; Rose, Collette; Vindlacheruvu, Madhavi; Donell, Simon; Vaculik, Jan; Dungl, Pavel; Horak, Martin; Stepan, Jan J; Reeve, Jonathan; Treece, Graham M
Hip fractures are mainly caused by accidental falls and trips, which magnify forces in well-defined areas of the proximal femur. Unfortunately, the same areas are at risk of rapid bone loss with ageing, since they are relatively stress-shielded during walking and sitting. Focal osteoporosis in those areas may contribute to fracture, and targeted 3D measurements might enhance hip fracture prediction. In the FEMCO case-control clinical study, Cortical Bone Mapping (CBM) was applied to clinical computed tomography (CT) scans to define 3D cortical and trabecular bone defects in patients with acute hip fracture compared to controls. Direct measurements of trabecular bone volume were then made in biopsies of target regions removed at operation. The sample consisted of CT scans from 313 female and 40 male volunteers (158 with proximal femoral fracture, 145 age-matched controls and 50 fallers without hip fracture). Detailed Cortical Bone Maps (c.5580 measurement points on the unfractured hip) were created before registering each hip to an average femur shape to facilitate statistical parametric mapping (SPM). Areas where cortical and trabecular bone differed from controls were visualised in 3D for location, magnitude and statistical significance. Measures from the novel regions created by the SPM process were then tested for their ability to classify fracture versus control by comparison with traditional CT measures of areal Bone Mineral Density (aBMD). In women we used the surgical classification of fracture location ('femoral neck' or 'trochanteric') to discover whether focal osteoporosis was specific to fracture type. To explore whether the focal areas were osteoporotic by histological criteria, we used micro CT to measure trabecular bone parameters in targeted biopsies taken from the femoral heads of 14 cases. Hip fracture patients had distinct patterns of focal osteoporosis that determined fracture type, and CBM measures classified fracture type better than a
Kemler, Marius A; de Vries, Mattijs; van der Tol, Anno
An unknown percentage of patients who have internal fixation for hip fractures have sciatic neuropathy develop. In most cases, the cause for this complication is unknown. We retrospectively reviewed 2202 consecutive patients treated in our hospital for hip fractures to ascertain whether there was any relationship between duration of preoperative traction and postoperative sciatic neuropathy, and to determine the incidence of sciatic neuropathy after surgery for hip fractures. All patients had preoperative skin traction. Patients with and without sciatic neuropathy were compared using nonparametric tests. The median duration of traction was 2.6 days in the group that had sciatic neuropathy develop and 0.9 days in the group that did not. Also, patients in the group that had sciatic palsy develop were older. There seemed to be no other difference between the groups for any of the studied variables. Sixteen patients (0.7 %) had postoperative sciatic neuropathy. Our data suggest sciatic neuropathy after surgery for hip fractures may be related to the duration of preoperative traction. Some investigators have reported that there seems to be no evidence of benefit from skeletal or skin traction. A potential for damage to the sciatic nerve may be an argument to stop routine use of preoperative traction. Diagnostic study, Level III (study of nonconsecutive patients; without consistently applied reference "gold" standard).
Gibson-Smith, D.; Klop, C.; Elders, P.J.M.; Welsing, P.M.J.; van Schoor, N.M.; Leufkens, H.G.M.; Harvey, N.C.; van Staa, TP; de Vries, F.
Introduction: Hip fractures are associated with subsequent fractures, particularly in the year following initial fracture. Age-adjusted hip fracture rates have stabilised in many developed countries, but secular trends in subsequent fracture remain poorly documented. We thus evaluated secular trends
Guay, Joanne; Parker, Martyn J; Gajendragadkar, Pushpaj R; Kopp, Sandra
The majority of people with hip fracture are treated surgically, requiring anaesthesia. The main focus of this review is the comparison of regional versus general anaesthesia for hip (proximal femoral) fracture repair in adults. We did not consider supplementary regional blocks in this review as they have been studied in another review. We searched the Cochrane Central Register of Controlled Trials (CENTRAL; the Cochrane Library; 2014, Issue 3), MEDLINE (Ovid SP, 2003 to March 2014) and EMBASE (Ovid SP, 2003 to March 2014). We included randomized trials comparing different methods of anaesthesia for hip fracture surgery in adults. The primary focus of this review was the comparison of regional anaesthesia versus general anaesthesia. The use of nerve blocks preoperatively or in conjunction with general anaesthesia is evaluated in another review. The main outcomes were mortality, pneumonia, myocardial infarction, cerebrovascular accident, acute confusional state, deep vein thrombosis and return of patient to their own home. Two reviewers independently assessed trial quality and extracted data. We analysed data with fixed-effect (I(2) anaesthesia. Based on 11 studies that included 2152 participants, we did not find a difference between the two anaesthetic techniques for mortality at one month: risk ratio (RR) 0.78, 95% confidence interval (CI) 0.57 to 1.06; I(2) = 24% (fixed-effect model). Based on six studies that included 761 participants, we did not find a difference in the risk of pneumonia: RR 0.77, 95% CI 0.45 to 1.31; I(2) = 0%. Based on four studies that included 559 participants, we did not find a difference in the risk of myocardial infarction: RR 0.89, 95% CI 0.22 to 3.65; I(2) = 0%. Based on six studies that included 729 participants, we did not find a difference in the risk of cerebrovascular accident: RR 1.48, 95% CI 0.46 to 4.83; I(2) = 0%. Based on six studies that included 624 participants, we did not find a difference in the risk of acute confusional
Foss, N B; Christensen, D S; Krasheninnikoff, M
Efforts to optimize the peri-operative care of hip fracture patients through multidisciplinary intervention have focused on orthopaedic-geriatric liaisons, which have not resulted in significant outcome changes. The early phase of rehabilitation could potentially be optimized through a multidisci......Efforts to optimize the peri-operative care of hip fracture patients through multidisciplinary intervention have focused on orthopaedic-geriatric liaisons, which have not resulted in significant outcome changes. The early phase of rehabilitation could potentially be optimized through...
Rocos, Brett; Whitehouse, Michael R.; Kelly, Michael B
To evaluate the evidence for the resuscitation of patients with hip fracture in the preoperative or perioperative phase of their treatment and its impact on mortality.DESIGN: We searched MEDLINE, EMBASE, CENTRAL and PROSPERO databases using a systematic search strategy for randomised trials and observational studies investigating the fluid resuscitation of any patient with hip fracture. No language limits were applied to the search, which was complemented by manually screening the reference l...
Ami Hommel; Marie-Louise Kock; Jeanette Persson; Elisabeth Werntoft
Background: The pathway for patients with a hip fracture described in this study is a fast track. Many studies have focused on prevention of various complications but, so far, the patient's view of nursing care has not been highlighted. Aim: The aim of the study is to illuminate the patient's view on nursing care when treated for a hip fracture. Method: Ten patients were interviewed. A content analysis design was conducted. Findings. From the analysis, four m...
Full Text Available INTRODUCTION Treating a proximal humerus fracture remained a challenging problem until proximal humeral internal locking system has been developed. Our study aims at evaluating the functional outcome of 30 consecutive patients with proximal humeral fracture treated by Philos plate fixation; 30 patients with proximal humeral fractures who attended our hospital between December 2013 and December 2015 were included in the study; 18 women and 12 men with a mean age of 47.5years (30-60 years are included. Data was collected prospectively and outcomes were assessed using constant shoulder score. The mean follow-up period was 12 months (6-18 months. Mean union time of all the fractures was 11.4 weeks (8-20 weeks. The mean constant shoulder score at final review was 70.5 (52-92. Philos plate provides stable fracture fixation for proximal humerus fracture in both young and elderly patients, which enables for early mobilisation and achieves acceptable functional results.
Arzi, Boaz; Verstraete, Frank J M
To describe internal fixation for maxillofacial fractures using titanium miniplates and report outcome in 7 dogs. Prospective case series. Skeletally mature dogs (n = 7) with maxillofacial fractures. After CT evaluation of fracture configuration, using a combination of extraoral and intraoral approaches as needed, non-locking titanium miniplates were contoured to match the normal anatomy of the fractured bones. Plates were secured using non-locking titanium screws and then covered with a soft-tissue envelope followed by routine intraoral and extraoral closure. Fractures healed rapidly after reconstruction with immediate return to normal function and occlusion. Follow-up time of up to 94 months indicated excellent long-term function and general lack of complications. One dog developed nasal aspergillosis 1.5 years after surgery and the miniplates were removed without adverse consequences. Internal fixation for maxillofacial reconstruction using titanium miniplates is an excellent solution for the treatment of comminuted and displaced maxillofacial fractures in dogs. © Copyright 2014 by The American College of Veterinary Surgeons.
Beishuizen, Sara J. E.; van Munster, Barbara C.; de Jonghe, Annemarieke; Abu-Hanna, Ameen; Buurman, Bianca M.; de Rooij, Sophia E.
ObjectivesChange in cognitive functioning is often observed after hip fracture. Different patterns, with both improvement and decline, are expected, depending on premorbid cognitive functioning and events that occur during hospitalization. These patterns are unknown and important for older hip
Traumatic anterior dislocation of the hip is rare even in children. Very uncommon also is the perineal variant of the inferior type of anterior dislocation with concomitant avulsion fracture of the greater trochanter. We report such a case highlighting the peculiarity of its management. No similar case of triumvirate injury of the hip ...
Mangram, Alicia; Moeser, Phillip; Corneille, Michael G; Prokuski, Laura J; Zhou, Nicolas; Sohn, Jacqueline; Chaliki, Shalini; Oguntodu, Olakunle F; Dzandu, James K
Annually in the US, there are over 300,000 hospital admissions due to hip fractures in geriatric patients. Consequently, there have been several large observational studies, which continue to provide new insights into differences in outcomes among hip fracture patients. However, few hip fracture studies have specifically examined the relationship between hip fracture patterns, sex, and short-term outcomes including hospital length of stay and discharge disposition in geriatric trauma patients. We performed a retrospective study of hip fractures in geriatric trauma patients. Hip fracture patterns were based on ICD -9 CM diagnostic codes for hip fractures (820.00-820.9). Patient variables were patient demographics, mechanism of injury, injury severity score, hospital and ICU length of stay, co-morbidities, injury location, discharge disposition, and in-patient mortality. A total of 325 patient records met the inclusion criteria. The mean age of the patients was 82.2 years, and the majority of the patients were white (94%) and female (70%). Hip fractures patterns were categorized as two fracture classes and three fracture types. We observed a difference in the proportion of males to females within each fracture class (Femoral neck fractures Z-score = -8.86, p fractures Z-score = -5.63, p fractures were fixed based on fracture pattern and patient characteristics. Hip fracture class or fracture type did not predict short-term outcomes such as in-hospital or ICU length of stay, death, or patient discharge disposition. The majority of patients (73%) were injured at home. However, 84% of the patients were discharged to skilled nursing facility, rehabilitation, or long-term care while only 16% were discharged home. There was no evidence of significant association between fracture pattern, injury severity score, diabetes mellitus, hypertension or dementia. Hip fracture patterns differ between geriatric male and female trauma patients. However, there was no
Nakahara, Ichiro; Takao, Masaki; Bandoh, Shunichi; Bertollo, Nicky; Walsh, William R; Sugano, Nobuhiko
Carbon fiber-reinforced polyetheretherketone (CFR/PEEK) is theoretically suitable as a material for use in hip prostheses, offering excellent biocompatibility, mechanical properties, and the absence of metal ions. To evaluate in vivo fixation methods of CFR/PEEK hip prostheses in bone, we examined radiographic and histological results for cementless or cemented CFR/PEEK hip prostheses in an ovine model with implantation up to 52 weeks. CFR/PEEK cups and stems with rough-textured surfaces plus hydroxyapatite (HA) coatings for cementless fixation and CFR/PEEK cups and stems without HA coating for cement fixation were manufactured based on ovine computed tomography (CT) data. Unilateral total hip arthroplasty was performed using cementless or cemented CFR/PEEK hip prostheses. Five cementless cups and stems and six cemented cups and stems were evaluated. On the femoral side, all cementless stems demonstrated bony ongrowth fixation and all cemented stems demonstrated stable fixation without any gaps at both the bone-cement and cement-stem interfaces. All cementless cases and four of the six cemented cases showed minimal stress shielding. On the acetabular side, two of the five cementless cups demonstrated bony ongrowth fixation. Our results suggest that both cementless and cemented CFR/PEEK stems work well for fixation. Cup fixation may be difficult for both cementless and cemented types in this ovine model, but bone ongrowth fixation on the cup was first seen in two cementless cases. Cementless fixation can be achieved using HA-coated CFR/PEEK implants, even under load-bearing conditions. Copyright © 2012 Orthopaedic Research Society.
Rogmark, Cecilia; Carlsson, Ake; Johnell, Olof; Sembo, Ingemar
We included in a prospective, randomized study 68 patients aged 70 years or older, with displaced cervical hip fractures. The patients were randomized to internal fixation with hook-pins (36) or primary arthroplasty (32) (total or hemiarthroplasty due to their prefracture status) and followed for 2 years. Patients with rheumatoid arthritis, mental confusion and/or residence in an institution were excluded. The postoperative stay in hospital, rehabilitation wards or nursing homes were recorded as well as complications and the costs of surgery. The aim of this study was to compare the accumulated costs of each method, during the first 2 years after the fracture. In the internal fixation group, 15/36 were considered failures, as compared to 1/32 in the arthroplasty group. As regards primary treatment of the fracture, the durations of surgery and hospital stay were shorter after internal fixation, but the total need for hospitalization/institutionalization was somewhat longer in these patients. The mean 2-year cost for a patient with internal fixation was USD 21,000 and of one with primary arthroplasty USD 15,000. We conclude that primary arthroplasty is a cost-efficient treatment. Considering the very much higher failure rate after internal fixation--leading to increased suffering for these patients--primary arthroplasty stands out as the best method for displaced fractures of the femoral neck.
Fang, Christian; Gudushauri, Paata; Wong, Tak-Man; Lau, Tak-Wing; Pun, Terence; Leung, Frankie
In osteoporotic hip fractures, fracture collapse is deliberately allowed by commonly used implants to improve dynamic contact and healing. The muscle lever arm is, however, compromised by shortening. We evaluated a cohort of 361 patients with AO/OTA 31.A1 or 31.A2 intertrochanteric fracture treated by the dynamic hip screw (DHS) who had a minimal follow-up of 3 months and an average follow-up of 14.6 months and long term survival data. The amount of fracture collapse and shortening due to sliding of the DHS was determined at the latest follow-up and graded as minimal (2 cm). With increased severity of collapse, more patients were unable to maintain their premorbid walking function (minimal collapse = 34.2%, moderate = 33.3%, severe = 62.8%, and p = 0.028). Based on ordinal regression of risk factors, increased fracture collapse was significantly and independently related to increasing age (p = 0.037), female sex (p = 0.024), A2 fracture class (p = 0.010), increased operative duration (p = 0.011), poor reduction quality (p = 0.000), and suboptimal tip-apex distance of >25 mm (p = 0.050). Patients who had better outcome in terms of walking function were independently predicted by younger age (p = 0.036), higher MMSE marks (p = 0.000), higher MBI marks (p = 0.010), better premorbid walking status (p = 0.000), less fracture collapse (p = 0.011), and optimal lag screw position in centre-centre or centre-inferior position (p = 0.020). According to Kaplan-Meier analysis, fracture collapse had no association with mortality from 2.4 to 7.6 years after surgery. In conclusion, increased fracture collapse after fixation of geriatric intertrochanteric fractures adversely affected walking but not survival.
Full Text Available Objective: The most prevailing surgical procedure in the treatment of thoracolumbar burst fractures, Short Segment Fixation (SSF, is often followed by loss of correction or hardware failure which may be significant enough to require another surgical intervention. In order to take advantage of its benefits but to avoid or diminish the risk and impact of associated drawbacks, some other alternatives have been lately developed among which we refer to short segment fixation with intermediate screws (SSF+IS. This article provides a comparative picture over the effectiveness of the two above-mentioned surgical treatments, focusing on their potential to prevent the loss of correction.
Johansson, H; Hongslo Vala, C; Odén, A; Lorentzon, M; McCloskey, E; Kanis, J A; Harvey, N C; Ohlsson, C; Stefan Lohmander, L; Kärrholm, J; Mellström, D
We aimed to study the risk of hip fracture and risk of hip arthroplasty among farmers in Sweden. Our results indicate that farming, representing an occupation with high physical activity, in men is associated with a lower risk of hip fracture but an increased risk of hip arthroplasty. The risks of hip fracture and hip arthroplasty are influenced by factors including socioeconomic status, education, urbanization, latitude of residence, and physical activity. Farming is an occupation encompassing rural living and high level of physical activity. Therefore, we aimed to study the risk of hip fracture and risk of hip arthroplasty among farmers in Sweden. We studied the risk of hip fracture, and hip arthroplasty due to primary osteoarthritis, in all men and women aged 35 years or more in Sweden between 1987 and 2002. Documented occupations were available in 3.5 million individuals, of whom 97,136 were farmers. The effects of age, sex, income, education, location of residence, and occupation on risk of hip fracture or hip arthroplasty were examined using a modification of Poisson regression. A total of 4027 farmers and 93,109 individuals with other occupations sustained a hip fracture, while 5349 farmers and 63,473 others underwent a hip arthroplasty. Risk of hip fracture was higher with greater age, lower income, lower education, higher latitude, and urban area for all men and women. Compared to all other occupations, male farmers had a 20% lower age-adjusted risk of hip fracture (hazard ratio (HR) 0.80, 95%CI 0.77-0.84), an effect that was not seen in female farmers (HR 0.96, 95% CI 0.91-1.01). Both male and female farmers had a higher age-adjusted risk for hip arthroplasty. Our results indicate that farming, representing an occupation with high physical activity, in men is associated with a lower risk of hip fracture but an increased risk of hip arthroplasty.
Ercin, Ersin; Bilgili, M Gokhan; Sari, Cihangir; Basaran, S Hakan; Tanriverdi, Bulent; Edipoglu, Erdem; Celen, K Mumtaz; Cetingok, Halil; Kural, Cemal
Only a little is known about whether type of surgical intervention has an effect on mortality of these patients. Our primary objective was to assess whether different type of surgical procedures has an effect on mortality among elderly patients with hip fracture. A secondary objective was to examine factors that are related to mortality in our patient population. Our hypothesis is that type of surgical procedure, especially external fixation, should have an influence on mortality outcomes. We included 785 patients age 65 years or older, with hip fractures. Operative treatment consisted of external fixation, internal fixation, total hip arthroplasty and hip hemiarthroplasty. Age, gender, type of fracture, type of surgery performed, American Society of Anesthesiology (ASA) grade, clinical comorbidities, anesthesia type, blood transfusion requirement, time to surgery, intensive care unit requirement, operation length and length of hospital stay and number of comorbidities were documented. During the study period, 785 patients (262 male, 523 female) were included to study, Overall mortality rate was 37.2 % (292/785). Their age ranged between 65 and 100 years (mean 81). Surgery type Kaplan-Meier cumulative mortality curves suggested no significant difference between four different types of surgery groups (p = 0.064). Transfusion requirement was significantly lower in external fixation group comparing to other groups (p = 0.014). Cox regression analysis showed the number of comorbidities 2 and ≥ 3 (p = 0.0027, p = 0.015), transfusion requirement (p = 0.0001), ASA 4 (p = 0.016) to be significant predictors of mortality. Transfusion requirement, ASA grade 4 and having more than two comorbidities are risk factors for mortality in geriatric hip fractures. Type of surgical intervention and fracture type had similar mortality rates in our patient population.
Hip fractures are common and serious consequence of osteoporosis. Bone mineral density (BMD) measurement and the World Health Organization (WHO) fracture risk assessment tool are considered to predict the hip osteoporotic fractures. In this study, their sensitivities in hip fracture cases are evaluated. BMD and WHO probability of fracture risk were determined in 71 hip fractures ≥ 50 years of old. Totally, 65% of patients had ≤-2.5 BMD T score. 81% of patients had above the upper interventional threshold of WHO fracture risk probability model. Sensitivities were low in 50-59 year age group with progression in older age groups. Results of BMD T score and fracture risk probabilities were not significant between men and women. There were 23% and 49% sensitivities of less than or equal to -2.5 T score in the 50-59 and 60-69 year age groups with a 31% sensitivity of greater than 3% probability of hip fracture risk in the 50-59 year age group, both of which were not valid for predicting hip fracture risk.
Vidović, Dinko; Elabjer, Esmat; Muškardin, I V A; Milosevic, Milan; Bekic, Marijo; Bakota, Bore
The aim of this study was to compare reduction quality and functional outcome of posterior malleolus fractures treated with indirect reduction and anteroposterior (AP) fixation or with direct reduction via a posterolateral approach and posteroanterior (PA) fixation. Forty-eight patients with trimalleolar fracture were enrolled in the study. Patients were randomised in two groups: indirect reduction and AP fixation (AP group) and direct reduction and PA fixation (PA group). Inclusion criteria were: posterior fragment involving more than 25% of the articular surface, displacement over 2mm and ankle instability. The quality of reduction was evaluated using postoperative plain radiographs. Residual displacement of the posterior fragment, articular step-off and/or articular surface gap were analysed. The reduction was considered excellent (2mm). Range of motion (ROM) was measured bilaterally, and the difference in dorsiflexion between the injured and uninjured side was considered as dorsiflexion restriction. Demographic data (age, sex), type of fracture (AO/ASIF classification) and complications were noted. Forty-six patients completed all follow-up examinations. There was no statistically significant difference in age (p = 0.41), sex (p = 0.29) or specific type of fracture (p = 0.83) distribution between the AP and PA groups. All fractures completely healed within 3 months. The overall complication rate was 8.7%. There was no statistically significant difference in complication rate between the two groups (p = 0.71). Radiological evaluation of the ankle showed there was significantly better quality of reduction with direct reduction via a posterolateral approach in the PA group. Excellent reduction was achieved in 79.2% and 45.5% of the PA and AP groups, respectively. The quality of reduction was significantly higher in the PA group compared with the AP group (p = 0.04). The mean restriction of dorsiflexion was lower in the PA group (5.96 ± 0.65°) compared with the
Full Text Available Background: The treatment of displaced intracapsular femoral neck fracture is still an unsolved problem. Non-union and avascular necrosis are the two main complications of this fracture, especially if patient presents late. Muscle pedicle bone grafting has been advocated to provide additional blood supply. We present analysis of our 32 cases of displaced femoral neck fracture treated by internal fixation and quadratus femoris based muscle pedicle bone grafting. Materials and Methods: Open reduction and internal fixation with muscle pedicle grafting was done in 32 patients. The age of patients varied from 14-62 years (average age 45 years with male to female ratio of 13:3. Twenty-nine fractures were more than three weeks old. All the cases were treated by Meyers′ procedure. The fracture was internally fixed after open reduction and then a muscle pedicle graft was applied. It was supplemented by cancellous bone graft in seven cases. Fixation was done by parallel cancellous lag screws ( n = 19, crossed Garden′s screws ( n = 7, parallel Asnis screws ( n = 5 and Moore′s pin ( n = 1.Quadratus femoris muscle pedicle graft was used in 32 cases. In the initial 12 cases the graft was fixed with circumferential proline sutures, but later, to provide a secure fixation, the graft was fixed with a cancellous screw ( n = 20. Postoperative full weight bearing was deferred to an average of 10 weeks. Results: Union was achieved in 26/29 (89.65% cases which could be followed for an average period of 3.4 years, (2-8.5 years with good functional results and had the ability to squat and sit cross-legged. Results were based on hip rating system given by Salvatti and Wilson. The results were excellent in 15 cases, good in four cases, fair in four cases and poor in six cases. Complications were avascular necrosis ( n = 2, transient foot drop ( n = 2, coxa-vara ( n = 1 and temporary loss of scrotal sensation ( n = 1. Conclusion: Muscle pedicle bone grafting with
Abrahamsen, B; van Staa, T; Ariely, R
the need for interventions to reduce this risk.Patients experiencing hip fracture after low-impact trauma are at considerable risk for subsequent osteoporotic fractures and premature death. We conducted a systematic review of the literature to identify all studies that reported unadjusted and excess...
Hip fracture is a common injury that predominantly affects older people. Pain following fracture of the neck of the femur is present throughout the illness trajectory, including the preoperative and postoperative periods. This article describes how nurses at one trust implemented an innovative nurse-administered femoral nerve block service.
Kristensen, M T
Having a hip fracture is considered one of the most fatal fractures for elderly people, resulting in impaired function, and increased morbidity and mortality. This challenges clinicians in identifying patients at risk of worse outcome, in order to optimise and intensify treatment in these patient...
Full Text Available CASE:: We present an elderly lady with an intertrochanteric fracture of a previously fused hip. A 3D printed model of her pelvis and femur was used for implant templating before surgery. Minimal invasive fixation was performed with a spanning reversed distal femur locking plate without the need for removal of the previous implant. Multiple long locking screws were placed in the supra-acetabular region. The patient had union in 4 months, return to function and no complication. Conclusion:: The technique allowed us to optimize implant selection and insert screws safely at difficult trajectories using minimal invasive surgery. Keywords: Hip fusion, Fracture, Plating, Minimal invasive, 3D printing
Christie, J; Howie, C R; Armour, P C
One hundred and twenty-seven consecutive patients with displaced subcapital fractures of the femoral neck (Garden Grade III or IV) all under 80 years of age and independently mobile, were randomly allocated to fixation with either double divergent pins or a single sliding screw-plate device. The incidence of non-union and infection in the sliding screw-plate group was significantly higher, and we believe that when internal fixation is considered appropriate multiple pinning should be used. Mobility after treatment was disappointing in about half of the patients, and we feel that internal fixation can only be justified in patients who are physiologically well preserved and who maintain a high level of activity.
Aleem, Ilyas S; Bhandari, Mohit; Elizalde, Sebastian Rodriguez
Periprosthetic fractures of the femur after total hip arthroplasty are increasing in frequency. In the polytraumatized patient with long-bone fracture, an ongoing debate exists regarding early definitive stabilization versus initial damage control orthopaedics, followed by delayed fixation. It remains to be seen whether this rationale applies to the polytraumatized patient with periprosthetic fracture. We present the case of a 73-years old Caucasian woman who sustained bilateral Gustillo-Anderson grade III open femur fractures; the fracture on the right was a Vancouver C open periprosthetic fracture after cemented total hip arthroplasty. After massive fluid resuscitation in the trauma bay she was taken to the intensive care unit in a hemodynamically unstable condition. She was subsequently operated and underwent early definitive fixation of both femurs with the rationale of potentially reducing pulmonary complications and promoting early mobilization. Early definitive stabilization versus delayed fixation in the polytraumatized patient with an open periprosthetic femur fracture is reviewed. Although several treatment algorithms based on fracture classification and implant stability exist, further study is required to delineate the preferred method and timeline of fixation for this growing cohort of patients.
Zhuang, Yan; Zhang, Kun; Wang, Hu; Wei, Xing; Liu, Ping; Wang, Peng-Fei; Cong, Yu-Xuan; Lei, Jin-Lai; Kandemir, Utku
The goal of this study was to evaluate the safety and efficacy of a new technique for posterior column fixation through the standard ilioinguinal approach. We conducted a retrospective review involving 33 consecutive patients with complex acetabular fractures treated using a short buttress plate fixation of posterior column through single ilioinguinal approach. Radiographic evaluation was performed using criteria described by Matta. Functional outcome was assessed using modified Postel Merle D'Aubigné score. Between 2008 and 2013, 33 adult patients with mean age of 46 years and mean follow up of 37.5 months were enrolled. Anatomic reduction was obtained in 61 % of cases, imperfect reduction in 24 % of cases and poor reduction in 15 % of cases. The average modified Merle d'Aubigné score was 15: categorized as excellent in seven, good in 18, fair in three, and poor in four. One patient died at 15 days because of pulmonary embolism. Four patients sustained temporary lateral femoral cutaneous palsy. At final follow up, two patients had severe post-traumatic arthritis; one of them underwent a total hip arthroplasty at 93 months. None of the patients had loss of reduction. A short buttress plate fixation of posterior column through single ilioinguinal approach for complex acetabular fractures is a safe and effective method.
Foss, Nicolai; Kristensen, Morten Tange; Palm, H
BACKGROUND: Hip fracture patients experience high pain levels during postoperative rehabilitation. The role of surgical technique on postoperative pain has not been evaluated previously. METHODS: One hundred and seventeen hip fracture patients were included in a descriptive prospective study. All.......001) and walking (r=-0.36, P=0.004). CONCLUSIONS: Postoperative pain levels after surgery for hip fracture are dependent on the surgical procedure, which should be taken into account in future studies of analgesia and rehabilitation....... patients received continuous epidural analgesia and were treated according to a standardized perioperative rehabilitation programme. Resting pain, pain on hip flexion, and walking were measured during daily physiotherapy sessions on a verbal five-point rating scale during the first four postoperative days...
Foss, N B; Kehlet, H
Our aim was to determine the total blood loss associated with surgery for fracture of the hip and to identify risk factors for increased blood loss. We prospectively studied 546 patients with hip fracture. The total blood loss was calculated on the basis of the haemoglobin difference, the number...... with aspirin, intra-operative hypotension and gastro-intestinal bleeding or ulceration were all independent predictors of blood loss. We conclude that total blood loss after surgery for hip fracture is much greater than that observed intra-operatively. Frequent post-operative measurements of haemoglobin...... of transfusions and the estimated blood volume. The hidden blood loss, in excess of that observed during surgery, varied from 547 ml (screws/ pins) to 1473 ml (intramedullary hip nail and screw) and was significantly associated with medical complications and increased hospital stay. The type of surgery, treatment...
Foss, Nicolai Bang; Kehlet, H
Our aim was to determine the total blood loss associated with surgery for fracture of the hip and to identify risk factors for increased blood loss. We prospectively studied 546 patients with hip fracture. The total blood loss was calculated on the basis of the haemoglobin difference, the number...... of transfusions and the estimated blood volume. The hidden blood loss, in excess of that observed during surgery, varied from 547 ml (screws/ pins) to 1473 ml (intramedullary hip nail and screw) and was significantly associated with medical complications and increased hospital stay. The type of surgery, treatment...... with aspirin, intra-operative hypotension and gastro-intestinal bleeding or ulceration were all independent predictors of blood loss. We conclude that total blood loss after surgery for hip fracture is much greater than that observed intra-operatively. Frequent post-operative measurements of haemoglobin...
Busel, Gennadiy A; Watson, J Tracy; Israel, Heidi
Comminuted fibular fractures can occur with pilon fractures as a result of valgus stress. Transverse fibular fractures can occur with varus deformation. No definitive guide for determining the proper location of tibial fixation exists. The purpose of this study was to identify optimal plate location for fixation of pilon fractures based on the orientation of the fibular fracture. One hundred two patients with 103 pilon fractures were identified who were definitively treated at our institution from 2004 to 2013. Pilon fractures were classified using the AO/OTA classification and included 43-A through 43-C fractures. Inclusion criteria were age of at least 18 years, associated fibular fracture, and definitive tibial plating. Patients were grouped based on the fibular component fracture type (comminuted vs transverse), and the location of plate fixation (medial vs lateral) was noted. Radiographic outcomes were assessed for mechanical failures. Forty fractures were a result of varus force as evidenced by transverse fracture of the fibula and 63 were due to valgus force with a comminuted fibula. For the transverse fibula group, 14.3% mechanical complications were noted for medially placed plate vs 80% for lateral plating ( P = .006). For the comminuted fibular group, 36.4% of medially placed plates demonstrated mechanical complications vs 16.7% for laterally based plates ( P = .156). Time to weight bearing as tolerated was also noted to be significant between groups plated medially and laterally for the comminuted group ( P = .013). Correctly assessing the fibular component for pilon fractures provides valuable information regarding deforming forces. To limit mechanical complications, tibial plates should be applied in such a way as to resist the original deforming forces. Level of Evidence Level III, comparative study.
Khoo, B C C; Lewis, J R; Brown, K; Prince, R L
Many attempts have been made to improve the predictive ability of areal bone mineral density (aBMD) which integrates bone mass and area. The addition of an extra variable derived from the hip dual-energy X-ray (DXA) image TR_σ, which describes distribution of mass within the scanned area of the trochanter, improved prediction of 15-year hip fracture probability in elderly women. Two-dimensional DXA imaging of the proximal femur to produce an aBMD is a clinically useful predictor of future fracture risk. Further analysis of the DXA image to produce an eight-variable hip structure analysis (Beck HSA) has been developed to improve understanding of structural factors determining hip bone strength at each of three proximal femur sites, the narrow femoral neck (NN), intertrochanter (TR) and shaft (S). Recently, data on four measurements derived from the currently used eight Beck HSA variables were used to capture population variation in bone structure at each site. These include two previously used variables, the localised aBMD and the sub-periosteal width (W) applying to 5-mm sections (at each sites), and two new variables, standard deviation of normalised mineral-mass projection profile distribution (σ), and displacement between centre-of-mineral mass and geometric centre-of-mineral mass of projection profile (δ). Using a cohort of 1159 women, mean baseline age 75, who sustained 139 hip fractures over 15 years, we determined whether these measures significantly improved 15-year hip fracture prediction compared to current approach utilising age and total hip aBMD. To describe the most parsimonious model for hip fracture risk prediction, the 12 base measures (4 from each site), total hip aBMD and age were evaluated in stepwise logistic regression models. The final model included TR_σ, total hip aBMD and age and provided improved utility for hip fracture prediction compared to total hip aBMD and age alone (C-statistic 0.73 vs. 0.69, P = 0.009 and net
Buijze, G.A.; Blankevoort, L.; Tuijthof, G.J.M.; Sierevelt, I.N.; Kloen, P.
New concepts in plate fixation have led to an evolution in plate design for olecranon fractures. The purpose of this study was to compare the stiffness and strength of locking compression plate (LCP) fixation to one-third tubular plate fixation in a cadaveric comminuted olecranon fracture model with
Jun 21, 2012 ... Abstract. Superior variety of anterior dislocation of the hip is a rare injury. Its occurrence with acetabular fractures has been documented infrequently. We report a case of superior dislocation of the hip with anterior column acetabular fracture. Open reduction of the hip and internal fixation of the fracture was ...
Azagra, Rafael; López-Expósito, Francisco; Martin-Sánchez, Juan Carlos; Aguyé-Batista, Amada; Gabriel-Escoda, Paula; Zwart, Marta; Díaz-Herrera, Miguel Angel; Pujol-Salud, Jesús; Iglesias-Martínez, Milagros; Puchol-Ruiz, Núria
To analyse differences in the incidence of hip fracture in people older than 65 years in the 17 autonomous communities (AA. CC.) (regions) of the Spanish state in the 1997-2010 period. Ecological, observational and retrospective study that includes people≥65 year old who have suffered a hip fracture in Spain over 14 years. These records are taken from the minimum basic data set of patients treated in all hospitals of Spain. The analysis include 534,043 hip fractures in≥65 year olds (414,518 women and 119,525 men). A percentage of 85.4 of hip fractures occurred in people≥75 years (86.7% women; 80.7% men). The adjusted hip fracture rate/100,000/year was 722.6 in women and 284.8 in men. AA. CC. with women above the average of the country were 7, including Catalonia, Comunidad Valenciana and Castilla-La Mancha. Six AA. CC. had patients below the average, including Canary Islands and Galicia. In AA. CC. with highest and lowest adjusted hip fracture rate/100,000/year, the difference was 44% lower in women (Canary vs. Castilla-La Mancha) and 50% lower in men (Galicia vs. Catalonia). The analysis of the incidence of hip fracture in Spain in people≥65 year old shows a significant variability between AA. CC. Except in Canary Islands, this variability is difficult to explain only by factors such as population age, sun exposure or north-south gradient. Additional studies are needed to analyse the causes of these important differences between Spanish AA. CC. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.
Full Text Available Introduction. Femoral neck fractures are very rare in young patients and are frequently complicated by femoral head osteonecrosis and femoral neck nonunion. Case Outline. A 19-year-old girl with hip dislocation following the treatment of the femoral neck fracture is presented. The femoral neck fracture was initially treated by open reduction and three-screw fixation. After detecting the nonunion of femoral neck, valgus osteotomy was done. Secondary, iatrogenic, hip dislocation appeared. The patient had pains, and in clinical findings a shorter leg and limited range of motion in the hip - altogether 40 degrees. She was then successfully treated by open reduction, together with Chiari pelvic osteotomy and joint transfixation. Transfixation pin was removed three weeks following the operation. After that, the patient was put into the abduction device and physical therapy was started. The mentioned regimen lasted four months after the surgery, then the abduction device was removed and walking started. Full weight bearing was allowed eight months after surgery. Conclusion. As we have not found the literature data concerning the above mentioned problem, we solved it in the way that we usually do for the treatment of developmental dislocation of the hip in adolescence.
Morwood, Michael P; Ruch, David S; Leversedge, Fraser J; Mithani, Suhail K; Kamal, Robin N; Richard, Marc J
To assess the results of olecranon fractures with an intra-articular sagittal plane fracture managed by orthogonal fixation constructs. A retrospective chart review was performed and 14 proximal ulna fractures with intra-articular comminution resulting in separate medial and lateral fragments were identified. All fractures were classified according to the Schatzker, Mayo, and AO classification systems. Postoperative functional assessment, Disabilities of the Arm, Shoulder, and Hand (DASH) score, time to union, and complications were recorded. Eleven patients were treated with both dorsal and lateral plates. Three patients were managed with a single dorsal plate and cerclage wires. All fractures healed. Mean length of follow-up was 15 months (range, 4-72 mo). Mean range of motion at final follow-up was a flexion-extension arc of 24° to 129° with 89° and 79° of pronation and supination, respectively. The most common complication was symptomatic hardware, leading to removal of hardware in 5 of 14 (36%) patients. Average postoperative Disabilities of the Arm, Shoulder, and Hand score was 7. Two patients developed heterotopic ossification and 1 patient required a local pedicled flap for soft-tissue coverage. Identification of this subset of fractures is critical to successful management. A supplemental lateral plate or cerclage wires can successfully manage these difficult fractures and achieve good outcomes. Therapeutic IV. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
Stevens, J A; Olson, S
Fall-related injuries are the leading cause of injury deaths and disabilities among older adults (i.e., persons aged > or = 65 years). The most serious fall injury is hip fracture; one half of all older adults hospitalized for hip fracture never regain their former level of function. In 1996, a total of 340,000 hospitalizations for hip fracture occurred among persons aged > or = 65 years, and 80% of these admissions occurred among women. From 1988 to 1996, hip fracture hospitalization rates for women aged > or = 65 years increased 23%. Risk factors for falls include increasing age, muscle weakness, functional limitations, environmental hazards, use of psychoactive medications, and a history of falls. Age is also a risk factor for hip fracture. Women aged > or = 85 years are nearly eight times more likely than women aged 65-74 years to be hospitalized for hip fracture. White women aged > or = 65 years are at higher risk for hip fracture than black women. Other riskfactors for hip fracture include lack of physical activity, osteoporosis, low body mass index, and a previous hip fracture. Because approximately 95% of hip fractures result from falls, minimizing fall risk is a practical approach to reducing these serious injuries. Research demonstrates that effective fall prevention strategies require a multifaceted approach with both behavioral and environmental components. Important elements include education and skill building to increase knowledge about fall risk factors, exercise to improve strength and balance, home modifications to reduce fall hazards, and medication assessment to minimize side effects (e.g., dizziness and grogginess). Coordination needs to be improved among the diverse Federal, state, and local organizations that conduct fall prevention activities. The effectiveness of existing fall prevention programs among specific groups of women (e.g., those aged > or = 85 years or living with functional limitations) needs careful evaluation. New primary fall
Hansen, Louise; Vestergaard, Peter; Petersen, Karin Dam
BACKGROUND: Osteoporotic fractures are characterized as fractures of the hip, spine, and forearm resulting from low energy trauma. In Denmark, hip fracture is the second most prevalent fracture in persons above 50 years of age, with an estimated incidence of 5 per 1000 inhabitants in 2011. Patients...... experience a 19% increased mortality within the first year following hip fractures. Furthermore, studies have shown that within 10 years after first hip fracture 40% will experience another hip fracture. The risk for second hip fracture is markedly increased, initiating at a relative risk of 11.8 within...... the first month after fracture and does not normalise until 15 years later. Fracture prevention programs have focused on identifying patients at risk of secondary low energy trauma fractures. The secondary prevention programs for fractures begin immediately after the first fracture, through identification...
Gibson-Smith, D; Klop, C; Elders, P J M; Welsing, P M J; van Schoor, N; Leufkens, H G M; Harvey, N C; van Staa, T P; de Vries, F
UNLABELLED: The risk of a subsequent major or any fracture after a hip fracture and secular trends herein were examined. Within 1 year, 2.7 and 8.4% of patients sustained a major or any (non-hip) fracture, which increased to 14.7 and 32.5% after 5 years. Subsequent fracture rates increased during
Zielinski, S M; Bouwmans, C A M; Heetveld, M J; Bhandari, M; Patka, P; Van Lieshout, E M M
The study rationale was to provide a detailed overview of the costs for femoral neck fracture treatment with internal fixation in the Netherlands. Mean total costs per patient at 2-years follow-up were 19,425. Costs were higher for older, less healthy patients. Results are comparable to internationally published costs. The aim of this study was to provide a detailed overview of the cost and healthcare consumption of patients treated for a hip fracture with internal fixation. A secondary aim was to compare costs of patients who underwent a revision surgery with patients who did not. The study was performed alongside the Dutch sample of an international randomized controlled trial, concerning femoral neck fracture patients treated with internal fixation. Patient characteristics and healthcare consumption were collected. Total follow-up was 2 years. A societal perspective was adopted. Costs included hospital costs during primary stay and follow-up, and costs related to rehabilitation and changes in living situation. Costs were compared between non-revision surgery patients, implant removal patients, and revision arthroplasty patients. A total of 248 patients were included (mean age 71 years). Mean total costs per patient at 2-years follow-up were 19,425. In the non-revision surgery patients total costs were 17,405 (N = 137), in the implant removal patients 10,066 (N = 38), and in the revision arthroplasty patients 26,733 (N = 67). The main contributing costs were related to the primary surgery, admission days, physical therapy, and revision surgeries. The main determinant was the costs of admission to a rehabilitation center/nursing home. Costs were specifically high in elderly with comorbidity, who were less independent pre-fracture, and have a longer admission to the hospital and/or a nursing home. Costs were also higher in revision surgery patients. The 2-years follow-up costs in our study were comparable to published costs in other Western societies.
Mazzola, Paolo; Rea, Federico; Merlino, Luca; Bellelli, Giuseppe; Dubner, Lauren; Corrao, Giovanni; Pasinetti, Giulio M; Annoni, Giorgio
Hip fracture (HF) is increasingly frequent with advancing age. Studies describing the HF incidence rate and survival after surgery in centenarians are scanty. To fill this gap, we performed a large population-based investigation on Lombardy centenarians (Italy). Retrospective observational cohort study based on information from the Healthcare Utilization Database. Among the cohort of 7,830 residents that reached 100 years of age between 2004 and 2011, incidence rate of HF was calculated. Two hundred fifty-nine patients were discharged alive from a hospital after HF and surgical repair (HF cohort). For each HF cohort member, a control was randomly selected from the initial cohort to be matched for gender and date of birth, and who did not experience HF from the date of their hundredth birthday until the date of hospital discharge of the corresponding HF cohort member. The survival curves and the hazard functions of HF and control cohort were calculated within 2 years. Over a mean follow-up of 1.85 years, HF incidence rate was 23.1 per 1,000 centenarians per year. Survival probability was significantly lower in HF cohort than in control cohort (31.5 vs 48.1%, p < .001). Hazard functions showed an increased risk of death in HF cohort than in control cohort, especially in the 3 months after surgery. Survival analysis exhibited an excess mortality in the first 3 months among HF cohort members, but not beyond this period. Every effort to counteract HF is warranted, including prevention of falls and high quality of care, especially in the early postsurgical time. © The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: firstname.lastname@example.org.
Altay, Murat; Aktekin, Cem Nuri; Ozkurt, Bülent; Birinci, Bariş; Ozturk, Akif Muhtar; Tabak, A Yalçin
Displaced fractures of the diaphyseal forearm in children are often treated conservatively, but there is relatively high incidence of redisplacement, malunion and consequent limitation of function. This retrospective study was performed to determine means for minimalising the complications of intramedullary Kirschner (K)-wire fixation used in the treatment of unstable, diaphyseal forearm fractures by pointing out those which most frequently occur with this treatment choice. This treatment method was applied in 48 children with a mean age of 10.3 (range, 5-14) years. A limited open reduction to one or both bones was necessary for insertion of the intramedullary wire in 20 (40%) patients. Although 24 complications, such as pin site infection, loss of forearm rotation, superficial branch of radial nerve palsy, delayed union, nonunion, hardware migration, and K-wire penetration to the opposite cortex, were recorded in 18 patients, 46 patients (96%) had excellent or good, 1 patient (2%) had fair and 1 patient (2%) had poor outcome using the grading scheme adapted by Price. Except for the patient in whom the fracture was not united, the average union time was 6.3 weeks in children less than 10 years and 7.8 weeks in those above 10 years of age. Despite these minor complications, percutaneous intramedullary fixation with K-wires and proper technique is an appropriate, effective and safe operation for unstable diaphyseal fractures of the forearm in children who cannot be treated by closed manipulation.
Ong, Terence; Anand, Varun; Tan, Wei; Quah, Edmund; Moran, Chris; Sahota, Opinder
A proportion of patients sustaining hip fractures present with a concomitant fracture. We aimed to evaluate the relationship between patient characteristics and clinical outcomes, in those with a hip and concomitant fracture compared with those sustaining a hip fracture alone from a clinical service registry. Cross-sectional study using data obtained from a clinical service registry (Nottingham Hip Fracture Database) on patients aged 50 and above who suffered a hip fracture between 1/1/2003 and 31/12/2012. Data was collected on patient demographics, fracture information and healthcare outcomes. 7338 patients of which 75 % were female (mean age 82 (SD 9.4), had a hip fracture with 334 (4.6 %) patients having a concomitant fracture. The majority (58 %) were distal radius or proximal humeral fractures. Only females (p = 0.002), those taking three or fewer medications (p = 0.018) and those on long term steroids (p = 0.048) were more likely to suffer a concomitant fracture. There was no difference in mortality, rates of postoperative complication, intensive care unit or care home admission between both groups. Patients with a concomitant fracture have a 16 % longer average length of stay in hospital (mean difference 1.16; 95 % CI 1.07-1.25, p fractures have similar patient characteristics, except gender, polypharmacy and long term steroid use; and outcomes to those presenting with hip fracture alone, except a longer average inpatient stay.
Full Text Available Objective: To retrospectively evaluate the open reduction internal fixation and total hip arthroplasty directions, results and complications associated with internal fixation in managing these fractures. Methods: In 8 years at 4 centers, 61 patients with associated acetabular fractures (Letournel classification were treated. The patients were divided into two groups. The total hip arthoplasty (THA group consisted of 30 patients, while the open reduction internal fixation group had 31 patients. The average age of the patients was 74.7 years. The following parameters were compared: the duration of surgery and hospitalization, the international unit of red blood cell concentrate transfusion, the time for the verticalization of the patient, perioperative complications, Harris hip score, and the short form (12 health survey. The clinical and radiographic follow-up was performed at 1 month, 3 months, 6 months and 12 months and annually thereafter. Patients with post-traumatic osteoarthritis formed the third comparison group. P ≤ 0.05 was considered statistically significant according to the analytical Student’s t-test. Results: The P < 0.05 in favor of the THA group was: surgical time, length of stay, number of the international unit of red blood cell concentrate transfusions, verticalization, quality of life and hip function, a reduction of perioperative complications and reinterventions. Conclusions: Our experience shows that the THA treatment for acetabular fractures in the elderly is to be preferred.
de Palma, L; Santucci, A; Verdenelli, A; Bugatti, M G; Meco, L; Marinelli, M
Traumatic hip dislocation with fracture of the posterior acetabular wall is associated with high rates of residual invalidity. The records of patients who underwent surgical treatment of traumatic dislocation of the hip associated with an isolated fracture of the posterior acetabular wall from 1999 to 2009 were reviewed. There were 30 men and 12 women, who at the time of the trauma had a mean age of 42 years (range 21-65). Mean follow-up duration was 5 years (range 2-10). Pre-operative fracture evaluation was based on the classification of Judet et al. which divided this fractures into three types: type 1 is characterized by a single fracture line separating a single bone fragment from the remaining part of the posterior wall; type 2 fracture involves several fragments of the posterior wall and in type 3, a type 1 or type 2 fracture is associated with a sunk cancellous area in the acetabular wall medial to the fracture line but not affected by it, due to the shear impact of the femoral head at the time of dislocation. Clinical evaluation of the outcome was according to the criteria of Merle D'Aubigné and Postel as modified by Matta. Outcomes were divided into excellent/good and fair/poor. Since treatment was standard, data were further analyzed to assess the relative importance of age, sex, follow-up duration, sciatic nerve lesion on admission and mechanism of injury, using the Chi-square test. Full clinical recovery without sequelae or radiographic abnormalities was achieved by 10 patients, 8 with type 1 fracture and 2 with type 2 fracture. A good outcome was seen in 13 patients, 3 with type 1 fracture, 9 with type 2 fracture and 1 with type 3 fracture. Eight patients, 3 with type 2 fracture and 5 with type 3 fracture, had a fair outcome. Only follow-up ≥6 years influenced outcome significantly (p > 0.005). Our conclusions in light of our experience are that in type 1 lesions, anatomical reduction and stabilization achieve excellent outcomes, both clinical
Ríha, Daniel; Bartonícek, Jan
Pertrochanteric fracture in a group of 41 patients was internally fixed using a DHS with a two-hole side-plate. There were 20 male and 21 female patients with a mean age of 74 years. Thirty-two patients were followed up for more than one year and their final results were evaluated. There were 30 stable (31A1) and only two unstable (31A2) fractures. The average surgical time was 28 minutes, the average length of incision was 5.5 cm. All the patients, with one exception, healed without complications in anatomical position with good function of the hip joint. The only complication was caused by pulling-out of the plate from the femur in the fourth postoperative week when the patient (31A2 fracture) fell out of bed. A DHS with a four-hole side-plate was used at reoperation; subsequently the fracture had healed. Based on the results in this series of patients, the authors recommend fixation of stable pertrochanteric fractures with DHS and a two-hole side-plate. As proven by the authors, the benefit of DHS with a two-hole side-plate as compared to DHS with a four-hole side-plate is a shorter surgical time (28 and 36 minutes, respectively).
Background: Operative fixation of ankle fractures is becoming popular in developing countries. The concern however is the outcome of care. The objective was to evaluate the results of open reduction and internal fixation (ORIF) of fractures of the ankle in our hospital. Methods: All cases ORIF of fractures of the ankle at the ...
Rasmussen, Birgit; Uhrenfeldt, Lisbeth
Background: Dependency and limited functional ability is common when older people fracture their hip. Experiences of well-being seem to be important during recovery and when living with a hip fracture as a balancing of suffering. Evidence exists that self-confidence is important during rehabilita......Background: Dependency and limited functional ability is common when older people fracture their hip. Experiences of well-being seem to be important during recovery and when living with a hip fracture as a balancing of suffering. Evidence exists that self-confidence is important during...... qualitative studies of lived experiences of well-being and suffering within one year after discharge with hip fracture. Method: Following the methodology of the Joanna Briggs Institute, a three-step literature search strategy was developed. Initially, a structured search was performed in the databases CINAHL...... five steps of meaning condensation was performed. Results: 30 studies were critically appraised, leaving 29 studies for inclusion in the analysis. Two main categories emerged, each containing three sub-categories. “Balancing a new life” described how participants strived to regain well-being through...
Full Text Available Risk factors for hip fracture in Japanese older populations are understudied compared with Western countries arguably due to the relatively lower prevalence rates in Japan. Nationally representative data from the Nihon University Japanese Longitudinal Study of Aging were analyzed using logistic regression to examine possible risk factors of hip fractures, separately for older women (n = 2,859 and older men (n = 2,108. Results showed that older Japanese women with difficulty bending their knees (OR = 1.9, with diabetes (OR = 1.7 times, and/or with more activity of daily living limitations (OR = 1.1 had higher risks of hip fracture. Older Japanese men with difficulty bending their knees (OR = 2.6, who use more external prescription drugs (OR = 1.9, and with cancer (OR = 2.0 times had higher risks of hip fracture. Further considerations of gender- and culture-specific factors along with the identified risk factors may provide insights into future intervention programs for hip fracture in Japanese older populations.
Hambright, Dustin S; Walley, Kempland C; Hall, Amber; Appleton, Paul T; Rodriguez, Edward K
Patella fractures with comminution, osteoporotic bone, and/or previously failed fixation are exceedingly difficult to reduce and fix. Moreover, the risk of symptomatic constructs and patients who are poorly compliant with postoperative activity restrictions can make these complex fracture patterns an even more challenging scenario. Although there is an array of techniques described for comminuted patella fractures, there lacks an accepted surgical technique for these difficult cases. In this clinical series, we describe an enhancement to the traditional tension band construct that uses additional wires and multiple tension bands to gather and fix comminuted fracture patterns in nontransverse planes, bolster osteoporotic bone, and secure fractures in patients undergoing a revision and/or have potential to be poorly compliant with postoperative activity restrictions. The clinical outcomes of 27 patients demonstrate high rates of bony union, functional range of motion, and low rates of both infection and failure. In conclusion, using the basic principles of tension band wiring remains highly versatile, useful, and economical in approaching difficult patella fractures.
Owen, Janice; Stephens, Derek; Wright, James G
The purpose of this study was to determine the interrater reliability of the assessment of range of motion of the hip joint through goniometry. We included children aged 4 to 10 years with a femoral shaft fracture, from 4 study sites, who had had either an early hip spica cast or an external fixator. An assessor blind to treatment received at each site measured range of hip joints motion, using a standardized goniometric technique at 15 and 24 months postfracture. The intraclass correlation coefficient (ICC) was used to quantify concordance or agreement. Most ICCs for the different aspects of hip range were between 0.2 and 0.5, indicating only slight agreement. The most reliable measure was hip flexion, with an ICC of 0.48 (95% confidence interval 0.29-0.63). Goniometric measurement, using standardized protocols for the hip, has low reliability. Only when differences in rotation exceed at least 30 degrees and in flexion-extension exceed 50 degrees should clinicians conclude that true change has occurred.
Ha, Yong-Chan; Baek, Ji-Hoon; Ko, Young-Bong; Park, Sang-Min; Song, Sang-Heon
Although vertebral fracture in patients is a predictor of subsequent hip fracture, no study has assessed the mortality and functional outcome in hip fracture patients with previous vertebral fracture. Between September 2009 and December 2012, we evaluated 246 patients over 50-years-of-age diagnosed with femoral neck or intertrochanteric fractures who underwent surgery. The patients were categorized into two groups and two subgroups. Group Ia comprised 150 patients with previous vertebral fracture at the time of hip fracture. Group Ib comprised 96 patients with no vertebral fracture. Group IIa consisted of 76 patients fracture. Group IIb comprised 69 patients fracture. The mortality rate and functional outcome of osteoporotic hip fracture patients with and without vertebral fractures were compared. The cumulative mortality rate at 6 and 12 months post-fracture was 19 and 23 % in Group Ia and 6 and 7 % in Group Ib, respectively. In subgroup analysis, the cumulative mortality rate at 6 and 12 months was 13 and 17 % in Group IIa and 3 and 4 % in Group IIb, respectively. Shut-in patients at the final follow-up included 51 of 103 (49.5 %) patients in Group Ia and 19 of 83 (22.9 %) patients in Group Ib. In subgroup analysis, the shut-in patients included 18 of 58 (31.0 %) patients in Group IIa and 10 of 62 (16.1 %) patients in Group IIb. Previous vertebral fracture was associated with a poor functional outcome and increased mortality in patients with hip fracture.
Troelsen, Anders; Malchau, Erik; Sillesen, Nanna Hylleholt
and to analyze age-stratified risk of revision comparing cemented, hybrid, and uncemented fixation as reported by national hip arthroplasty registries. METHODS: Data were extracted from the annual reports of seven national hip arthroplasty registries; we included all national registries for which annual reports...... were available in English or a Scandinavian language, if the registry had a history of more than 5 years of data collection. RESULTS: Current use of uncemented fixation in primary THAs varies between 15% in Sweden and 82% in Canada. From 2006 to 2010 the registries of all countries reported overall...... increases in the use of uncemented fixation; Sweden reported the smallest absolute increase (from 10% to 15%), and Denmark reported the greatest absolute increase (from 47% to 68%). Looking only at the oldest age groups, use of uncemented fixation also was increasing during the period. In the oldest age...
Alexandre H. Nehme
Full Text Available We present the case of a 13-year-old boy who sustained a locked central fracture dislocation of the right acetabulum following a bicycle fall. Immediate external reduction maneuvers under general anesthesia were unsuccessful due to intrapelvic entrapment of the femoral head. Open reduction internal fixation was achieved 48 hours later. After an initial satisfactory postoperative course, the patient ended up developing severe hip osteoarthritis 16 months after the procedure. The rarity of this injury in children is discussed, with its possible implications on joint congruity and potential growth injury.
Cobar, Andrés; Bregni, María; Altamirano, Marco
Abstract Bilateral traumatic hip dislocations are extremely rare. Most of these are related to acetabular or proximal femoral fractures, consisting of complex lesions, and are rarely pure ligamentous injuries. Posterior dislocation is the most frequent. Some dislocations are accompanied by sciatic nerve palsy. The present case is a posterior bilateral hip dislocation with no other associated lesions, there are very few reports published with this clinical setting. The patient had good functional outcome. PMID:28560017
Koso, Riikka E; Sheets, Charles; Richardson, William J; Galanos, Anthony N
Hip fracture in the elderly patients is associated with increased morbidity and mortality. There is great need for advance care planning should a patient fail to rehabilitate or experience an adverse event during or after recovery. This study was performed to evaluate for palliative care consultation and changes in code status and/or advance directives in elderly patients with hip fracture. We performed a retrospective review of 186 consecutive patients aged 65 years and older with a hip fracture due to a low-energy fall who underwent surgery at a large academic institution between August 1, 2013, and September 1, 2014. Risk factors assessed were patient demographics, home status, mobility, code status, comorbidities, medications, and hospitalizations prior to injury. Outcomes of interest included palliative care consultation, complications, mortality, and most recent code status, mobility, and home. About 186 patients with hip fractures were included. Three patients died, and 12 (6.5%) sustained major complications during admission. Nearly one-third (51 patients) died upon final follow-up approximately 1.5 years after surgery. Of the patients who died, palliative care consulted on 6 (11.8%) during initial admission. Eleven (21.6%) were full code at death. Three patients underwent cardiopulmonary resuscitation (CPR) and 1 underwent massive transfusion and extracorporeal membrane oxygenation prior to changing their code status to do not attempt resuscitation. Hip fracture in elderly patients is an important opportunity to reassess the patient's personal health-care priorities. Advance directives, goals of care, and code status documentation should be updated in all elderly patients with hip fracture, should the patient's health decompensate.
Lauritzen, J B; Lund, B
In a follow-up study during 1976-1984, the risk of a subsequent hip fracture was investigated in women aged 60-99 years, hospitalized for the following fractures: lumbar spine (n 70), olecranon (n 52), knee (n 129) and ankle (n 200). Follow-up ranged from 0 to 9 years. Observation time of the 4...... different fractures were 241, 180, 469, and 779, person-years, respectively. In women aged 60-79 years with one of the following fractures the relative risk of a subsequent hip fracture was increased by 4.8 (lumbar spine), 4.1 (olecranon), 3.5 (knee) and 1.5 (ankle). The relative risk of hip fracture showed...... a tendency to level off 3 years after the primary fracture....
Full Text Available Background: Fracture of the posterior wall is the most common pattern in acetabular fractures. The anatomical reduction and stable fixation of this articular fracture is a prerequisite for a favorable functional outcome but it is not enough in itself. In some patients, even physical therapy with initial passive motion and continued active exercises without weight bearing could lead to excessive loading on the injured cartilage and, in some cases, even to dislocation of fragments and early post-traumatic osteoarthritis. Our biomechanical studies demonstrated high loading of the acetabulum even during standard physical therapy.Case report: This article describes, using these mathematical models, a patient in whom a secondary dislocation of the fragments of the posterior wall occurred due to involuntary fast movements of the hip after surgical fixation. We have found that absolute values of hip joint reaction force and peak contact hip stress depend on the speed of movement and the angle of abductin and are significantly higher than during full weight bearing.Conclusions: We recommends to avoid fast movements and isometric exercises in early postoperative period.
Beaupre, Lauren A; Binder, Ellen F; Cameron, Ian D; Jones, C Allyson; Orwig, Denise; Sherrington, Cathie; Magaziner, Jay
This review discusses factors affecting recovery following hip fracture in frail older people as well as interventions associated with improved functional recovery. Prefracture function, cognitive status, co-morbidities, depression, nutrition and social support impact recovery and may interact to affect post-fracture outcome. There is mounting evidence that exercise is beneficial following hip fracture with higher-intensity/duration programmes showing more promising outcomes. Pharmacologic management for osteoporosis has benefits in preventing further fractures, and interest is growing in pharmacologic treatments for post-fracture loss of muscle mass and strength. A growing body of evidence suggests that sub-populations - those with cognitive impairment, residing in nursing homes or males - also benefit from rehabilitation after hip fracture. Optimal post-fracture care may entail the use of multiple interventions; however, more work is needed to determine optimal exercise components, duration and intensity as well as exploring the impact of multimodal interventions that combine exercise, pharmacology, nutrition and other interventions. Copyright © 2014 Elsevier Ltd. All rights reserved.
Beaupre, Lauren A.; Binder, Ellen F.; Cameron, Ian D.; Jones, C. Allyson; Orwig, Denise; Sherrington, Cathie; Magaziner, Jay
This review discusses factors affecting recovery following hip fracture in frail older people as well as interventions associated with improved functional recovery. Prefracture function, cognitive status, co-morbidities, depression, nutrition and social support impact recovery and may interact to affect post-fracture outcome. There is mounting evidence that exercise is beneficial following hip fracture with higher-intensity/duration programmes showing more promising outcomes. Pharmacologic management for osteoporosis has benefits in preventing further fractures, and interest is growing in pharmacologic treatments for post-fracture loss of muscle mass and strength. A growing body of evidence suggests that sub-populations – those with cognitive impairment, residing in nursing homes or males – also benefit from rehabilitation after hip fracture. Optimal post-fracture care may entail the use of multiple interventions; however, more work is needed to determine optimal exercise components, duration and intensity as well as exploring the impact of multimodal interventions that combine exercise, pharmacology, nutrition and other interventions. PMID:24836335
T.J. van der Steenhoven; B. Staffhorst (Bas); S.K. van de Velde (Samuel); R.G.H.H. Nelissen (Rob); M.H.J. Verhofstad (Michiel)
markdownabstractAbstract Purpose To determine patient and hip fracture characteristics, early postoperative complication rate and need for institutionalization at time of discharge from the hospital in patients treated for a second, contralateral hip fracture. Methods During a
Cyril Jonnes; Shishir Suranigi; Syed Najimudeen
Background: Intertrochanteric fracture is one of the most common fractures of the hip especially in the elderly with osteoporotic bones, usually due to low-energy trauma like simple falls. Dynamic Hip Screw (DHS...
Lee, Sang Ki; Kim, Kap Jung; Park, Ju Sang; Choy, Won Sik
The significance of distal ulna fractures is often undermined, which can result in inadequate treatment compared with fractures of the radius, the ulna's larger counterpart. However, little guidance exists in the current literature on how to manage distal ulna head or neck fractures and intra-articular ulna head fractures. Therefore, the purpose of this retrospective study was to evaluate the outcomes of distal ulna hook plate fixation for the treatment of an unstable distal ulna fracture associated with a distal radius fracture. Twenty-five patients with unstable distal ulna fractures who underwent stable fixation for an associated distal radius fracture were included in the study. All patients achieved satisfactory reduction and bony union. Average final motion was as follows: wrist flexion, 72° (range, 60°-85°); extension, 69° (range, 65°-80°); pronation, 77° (range, 55°-95°); supination, 82° (range, 65°-90°); ulnar deviation, 35° (range, 15°-50°); and radial deviation, 24° (range, 10°-40°). Average postoperative grip strength was 28 kg (range, 22-30 kg) and was 91% (range, 71%-100%) in the cases in which the dominant hand was injured and 80% (range, 65%-100%) in the cases in which the nondominant hand was injured. Average postoperative modified Mayo wrist score and Disabilities of the Arm, Shoulder and Hand score was 87 points (range, 65-100 points) and 14 points (range, 0-54 points), respectively. Chronic instability of the distal radioulnar joint was not encountered in any patient. Thus, the study demonstrated that distal ulna hook plate fixation for the treatment of unstable distal ulna fractures can achieve healing with good alignment, satisfactory function, and minimal transient morbidity. Copyright 2012, SLACK Incorporated.
Giesinger, Karlmeinrad; Ebneter, Lukas; Day, Robert E; Stoffel, Karl K; Yates, Piers J; Kuster, Markus S
Periprosthetic femoral fractures (PFF) are a serious complication after total hip arthroplasty. Plate fixation with screws perforating the cement mantle is a common treatment option. The study objective was to investigate hip stem stability and cement mantle integrity under dynamic loading. A cemented hip stem was implanted in 17 composite femur models. Nine bone models were osteotomised just distal to the stem and fixed with a polyaxial locking plate the other eight constructs served as the control group. All specimens were tested in a bi-axial material testing machine (100000 cycles). There were no statistically significant differences in axial nor in medial (varus) stem migration. No cement cracks were detected in both groups. Plate fixation of a PFF with a stable, cemented prosthesis did not lead to cement mantle failure in this in vitro study. Copyright © 2014 Elsevier Inc. All rights reserved.
Marcelo Alfonso Lugones
Full Text Available Background Acetabular fractures are a common cause of degenerative hip arthritis. The incidence of post-traumatic osteoarthritis has been reported between 12% and 57% and avascular necrosis of the femoral head may occur in 2% to 40% after posterior fracture dislocation. The fracture is often caused by major trauma in road accidents, at work or during sports, and patients usually present for total hip replacement (THR at an earlier age than the general arthritic population. We describe and analyze our patients with uncemented acetabular reconstruction in post-traumatic arthritis and compare them with THR in non-traumatic arthritis. Methods We retrospectively evaluated 19 patients who underwent uncemented acetabular reconstruction due to post-traumatic arthritis secondary to acetabular fracture. Results The average age at the time of arthroplasty was 52.2 years (19-83. The age at the time of fracture was 47.9 years (16-81. The average time between the acetabular fracture and THR was 52.4 months (4-360. The average follow-up was 4.25 years. No acetabular component loosening or infections were seen in either group. The Harris Hip Score at an average follow-up of 4.25 years was 89.3 (57-99. The follow-up in the control group with non-traumatic arthritis was 4.9 years, and the Harris Hip Score was 94.1 points (78-100. There were no significant difference in the Harris Hip Score between groups (p = 0.24. Conclusion Uncemented acetabular reconstruction in post-traumatic arthritis secondary to acetabular fracture is a more difficult procedure than routine arthroplasty in patient with non-traumatic arthritis. In the short-term there are no clinical or radiographic differences in THR with uncemented acetabular cups in post-traumatic arthritis patients compared to patients with non-traumatic arthritis.
Bukva, Bojan; Abramović, Dušan; Vrgoč, Goran; Marinović, Marin; Bakota, Bore; Dučić, Siniša; Miškulin, Mladen; Brdar, Radivoj; Čoklo, Miran; Gulan, Gordan
Femoral neck fractures in children are very rare and account for about 1% of all paediatric fractures. The aim of this retrospective study was to analyse the clinical and radiographic outcome in paediatric femoral neck fracture and to review the role of early decompression of the hip in the final outcome. The study was performed at the Department of Paediatric Orthopaedics and Traumatology, University Children's Hospital in Belgrade, Serbia from January 1996 to January 2010. The study included 28 patients, 12 female and 16 male, aged 4-14 years. Patients who were aged over 14 years or who had pathological femoral neck fractures or metabolic disturbances were excluded from the study. The type of neck fracture was determined according to the Delbet and Colonna classification. The patients were treated using different surgical procedures: closed reduction and cast immobilisation, closed reduction and percutaneous fixation with Kirschner wires (K-wires), closed reduction and fixation with cannulated screws and open reduction with Wagner plate stabilisation. The final outcome was evaluated using the clinical outcome (based on the Howorth-Ferguson scale), radiographic outcome and occurrence of complications. The median age of patients included in the study was 10.75 years and the average follow up was 9 years. According to the Delbet classification, there was one patient with type I, eight patients with type II, 16 patients with type III and three patients with type IV femoral neck fracture. Based on the Colonna classification, there were 23 displaced and five non-displaced femoral neck fractures. Decompression of the hip was performed in 21 patients. Avascular necrosis (AVN) developed as the main complication in 11 patients. The final outcome was excellent in 14 patients, good in four patients and poor in 14 patients. Our study unequivocally confirms the positive effect of urgent treatment on the incidence of AVN as well as on the outcome. We have established a 12-hour
Fiatarone Singh, Maria A
Lifestyle factors play a role in both the genesis and recovery from fragility fracture. The purpose of this review is to summarize recent evidence for exercise and nutrition in the management of hip fracture. Recent randomized controlled trials of exercise have primarily consisted of isolated resistance training or multimodal home-based programs. More robust, long-term, or supervised training is generally associated with greater clinical benefits, including muscle strength, mobility, and function. Recent nutritional interventions have included multinutrient supplements, nutritional counseling and support, and vitamin D/calcium supplementation. Isolated nutritional interventions have not consistently shown significant impact on long-term outcomes after hip fracture, although improvements in body weight, biochemical indices, complication rates, and mobility have been reported. Overall, there is marked heterogeneity in the robustness of responses seen to hip fracture treatment studies. Few large, long-term, multicomponent interventions with clinically relevant outcomes of functional independence, need for residential care, mortality, and quality of life have been reported. Evidence-based approaches to hip fracture should include comprehensive risk-factor assessment and treatment for sarcopenia/dynapenia, balance impairment, undernutrition of protein, energy, vitamin D and calcium, depression, cognitive impairment, sensory impairment, social isolation, and comorbid illness with exercise, nutrition and other modalities.
Full Text Available This study aims to evaluate the biomechanical mechanism of fixation systems in the most frequent T-shaped acetabular fracture using finite element method. The treatment of acetabular fractures was based on extensive clinical experience. Three commonly accepted rigid fixation methods (double column reconstruction plates (P × 2, anterior column plate combined with posterior column screws (P + PS, and anterior column plate combined with quadrilateral area screws (P + QS were chosen for evaluation. On the basis of the finite element model, the biomechanics of these fixation systems were assessed through effective stiffness levels, stress distributions, force transfers, and displacements along the fracture lines. All three fixation systems can be used to obtain effective functional outcomes. The third fixation system (P + QS was the optimal method for T-shaped acetabular fracture. This fixation system may reduce many of the risks and limitations associated with other fixation systems.
Daugaard, Cecilie Laubjerg; Jørgensen, Henrik L; Riis, Troels
Hip fractures are associated with high mortality, but the cause of this is still not entirely clear. We investigated the effect of surgical delay, weekends, holidays, and time of day admission on mortality in hip fracture patients.......Hip fractures are associated with high mortality, but the cause of this is still not entirely clear. We investigated the effect of surgical delay, weekends, holidays, and time of day admission on mortality in hip fracture patients....
Viberg, Bjarke; Overgaard, Søren; Lauritsen, Jens
Background and purpose Elderly patients with displaced femoral neck fractures are commonly treated with a hemiarthroplasty (HA), but little is known about the long-term failure of this treatment. We compared reoperation rates for patients aged at least 75 years with displaced femoral neck fractures...... treated with either internal fixation (IF), cemented HA, or uncemented HA (with or without hydroxyapatite coating), after 12-19 years of follow-up. Methods 4 hospitals with clearly defined guidelines for the treatment of 75+ year-old patients with a displaced femoral neck fracture were included. Cohort 1......%). Interpretation Cemented HA has a superior long-term hip survival rate compared to IF and uncemented HA (with and without hydroxyapatite coating) in patients aged 75 years or more with displaced femoral neck fractures....
Michael Pitta, MD
Full Text Available This report describes a patient with ankylosing spondylitis (AS who underwent total hip arthroplasty (THA by the direct anterior approach and sustained a L4-5 extension fracture dislocation with neural deficits. A magnetic resonance imaging revealed an epidural hematoma at the site of the fracture causing critical stenosis. The patient was taken to the operating room for a L3-S1 posterior decompression with L2-pelvis posterior spinal fusion. AS and diffuse idiopathic skeletal hyperostosis create a stiff spine that predisposes to fractures because of the larger moment arms experienced than normal spines. The arthroplasty surgeon performing THA should be aware and take precautions to reduce stress on the spine. Keywords: Direct anterior total hip arthroplasty, Ankylosing spondylitis, Specialized table, Lumbar chance fracture, Complication
Holstein, J H; Becker, S C; Fiedler, M; Scheuer, C; Garcia, P; Histing, T; Klein, M; Menger, M D; Pohlemann, T
The aim of the present study was to evaluate the systemic biological effect of increased exercise on bone repair after stable fracture fixation. Two groups of SKH-1h mice were studied. Animals of the first group (n=36) were housed in cages supplied with a running wheel, while mice of the second group (n=37) were housed in standard cages for control. Using a closed femur fracture model, bone repair was analysed by histomorphometry and biomechanical testing at 2 and 5 weeks. At 2 weeks, we additionally evaluated the expression of the proliferation marker PCNA (proliferating cell nuclear antigen) and the angiogenic and osteogenic growth factor VEGF (vascular endothelial growth factor). To standardise the mechanical conditions in the fracture gap, we used an intramedullary compression screw for stable fracture fixation. Each mouse of the exercise group run a mean total distance of 23.5 km after 2 weeks and 104.3 km after 5 weeks. Histomorphometric analysis of the size and tissue composition of the callus could not reveal significant differences between mice undergoing exercise and controls. Accordingly, biomechanical testing showed a comparable torsional stiffness, peak rotation angle, and load at failure of the healing bones in the two groups. The expression of PCNA and VEGF did also not differ between mice of the exercise group and controls. We conclude that increased exercise does not affect bone repair after stable fracture fixation. Copyright © 2012 Elsevier Ltd. All rights reserved.
Dombroski, Derek; Scolaro, John A; Pulos, Nicholas; Beingessner, Daphne M; Dunbar, Robert; Mehta, Samir
We present a novel technique of intramedullary fixation of the fibula using a humeral guide wire as an adjunct to tibial fixation, in the setting of tibial shaft fracture. Not only does this technique aid in determining length, alignment, and rotation of the tibial fracture, but it may also help the support of the lower extremity as whole by stabilizing the lateral column. In addition, this technique can be used to help maintain reduction of the fibula when there is concern for the soft tissues of the lower extremity secondary to swelling or injury. Our clinical case series demonstrates this safe, effective, and cost-sensitive technique to be used in the treatment of select concurrent fractures of the tibia and fibula.
Lyles, Kenneth W; Colón-Emeric, Cathleen S; Magaziner, Jay S
BACKGROUND: Mortality is increased after a hip fracture, and strategies that improve outcomes are needed. METHODS: In this randomized, double-blind, placebo-controlled trial, 1065 patients were assigned to receive yearly intravenous zoledronic acid (at a dose of 5 mg), and 1062 patients were...... assigned to receive placebo. The infusions were first administered within 90 days after surgical repair of a hip fracture. All patients received supplemental vitamin D and calcium. The median follow-up was 1.9 years. The primary end point was a new clinical fracture. RESULTS: The rates of any new clinical...... infusion of zoledronic acid within 90 days after repair of a low-trauma hip fracture was associated with a reduction in the rate of new clinical fractures and improved survival. (ClinicalTrials.gov number, NCT00046254.)....
Bodzay, Tamás; Sztrinkai, Gergely; Pajor, Sándor; Gál, Tamás; Jónás, Zoltán; Erdös, Péter; Váradi, Károly
This study aims to investigate whether surgical treatment of pubic rami fractures increases the stability of the posterior pelvis. A finite element pelvic model with improved geometric and material characteristics was analyzed. By imitating a standing position, a type I Denis sacrum fracture and a unilateral pubis fracture, we measured the differences in tension and displacement. The posterior injury was treated with a direct plate synthesis or transsacral plate synthesis, while the pubis fracture was left without fixation or fixed with either a retrograde pubic screw or plate synthesis. The operative fixation of pubic rami fractures decreased the movement in the fracture gap not only at the site of the pubis fracture, but also at the site of the fixed sacrum fracture. The plate synthesis provided greater stability of the anterior fracture than the retrograde screw. The tensions in the implants were below the allowed values. We concluded that surgically fixation of pubic fracture increases the stability of the operated posterior pelvis.
Full Text Available We report here a case of posterior dislocation of hip with fracture of posterior lip of acetabulum, with retained fracture fragments after a successful closed reduction. The fractured fragments were removed by arthroscopy of the hip. The technique of hip arthroscopy used in removing the fragments is discussed.
Sanz-Reig, J; Salvador Marín, J; Ferrández Martínez, J; Orozco Beltrán, D; Martínez López, J F
To identify pre-operative risk factors for surgical delay of more than 2 days after admission in patients older than 65 years with a hip fracture. A prospective observational study was conducted on 180 hip fractures in patients older than 65 years of age admitted to our hospital from January 2015 to April 2016. The data recorded included, patient demographics, day of admission, pre-fracture comorbidities, mental state, level of mobility and physical function, type of fracture, antiaggregant and anticoagulant medication, pre-operative haemoglobin value, type of treatment, and surgical delay. The mean age of the patients was 83.7 years. The mean Charlson Index was 2.8. The pre-fracture baseline co-morbidities were equal or greater than 2 in 70% of cases. Mean timing of surgery was 3.1 days. At the time of admission, 122 (67.7%) patients were fit for surgery, of which 80 (44.4%) underwent surgery within 2 days. A Charlson index greater than 2, anticoagulant therapy, and admission on Thursday to Saturday, were independently associated with a surgical delay greater than 2 days. The rate of hip fracture patients undergoing surgery within 2 days is low. Risk factors associated to surgical delay are non-modifiable. However, their knowledge should allow the development of protocols that can reduce surgical delay in this group of patients. Copyright © 2017 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.
Sanz-Reig, J; Salvador Marín, J; Pérez Alba, J M; Ferrández Martínez, J; Orozco Beltrán, D; Martínez López, J F
To identify and quantify the risk factors for in-hospital mortality in patients older than 65 years with a hip fracture. Retrospective review of prospectively collected data. We studied a cohort of 331 hip fracture patients older than 65 years of age admitted to our hospital from 2011 to 2014. Patients demographics, type of residence, physical function, mobility, prefracture comorbidities data, cognitive status, anti-aggregant and anticoagulant medication, preoperative haemoglobin value, type of fracture, type of treatment, surgical delay, and complications, were recorded. The average age was 83, 73% female, and 57% had sustained a subcapital fracture. In 62.8% pre-fracture baseline co-morbidities were equal or greater than 2. The in-hospital mortality rate was 11.4%. In univariate analysis, age over 90, male gender, haemoglobin ≤ 10g/dl, no antiplatelet agents, orthopaedic treatment, number of co-morbidities≥2, Charlson index≥2, age-adjusted Charlson index≥6, congestive heart failure, asthma, rheumatologic disease, were associated with in-hospital mortality. Preoperative patient-related factors have a strong relationship with in-hospital mortality in a hip fracture patients aged older than 65 years. These factors are non-modifiable; we recommend the development of protocols to reduce in-hospital mortality in this group of patients. Copyright © 2017 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.
Full Text Available 【Abstract】Fractures of the proximal humerus are uncommon in young patients. Although bilateral fracture of proximal humerus itself is rare, association with epilepsy and electrocution is frequent. Only one case of traumatic bilateral proximal humerus fracture has been reported in the literature. We report a rare case of bilateral traumatic dis- placed proximal humerus fractures in a 40 years old male patient, which was treated by means of open reduction and internal fixation with proximal humerus locked pates on both sides and obtained a good functional outcome. Key words: Humeral fractures; Shoulder fractures; Fracture fixation, internal
Cumming, R G; Klineberg, R J
To determine whether psychotropic medications increase, and thiazide diuretics decrease, the risk of hip fractures in elderly Australians. Population-based case-control study. The population aged 65 years and over living in a defined area in western Sydney, Australia, during 1990-1991. Cases (n = 209) were recruited from hospitals and controls (n = 207) were selected by an area probability sampling method, with additional sampling from nursing homes. Response rates were 96% for cases and 84% for controls. Data were collected directly from subjects by questionnaire; a proxy respondent was required for 27% of subjects. In addition to medication use, information was also collected on potential confounders: alcohol consumption, body mass index, cognitive status, dairy product consumption, health status, physical activity, smoking history and type of residence. The use of temazepam, a short-acting benzodiazepine, was associated with an increase in the risk of hip fracture--odds ratio, adjusted for age, gender and residence is 3.78; 95% confidence interval (CI), 1.60-8.92. After adjusting for multiple potential confounders by logistic regression, the odds ratio for temazepam use was 3.52. There was a non-significant (P > 0.05) increase in hip fracture risk associated with the use of antidepressants and antipsychotics. Thiazide diuretics were not associated with a risk of hip fracture--the multivariate-adjusted odds ratio was 0.98 (95% CI, 0.49-1.99). Temazepam may increase the risk of hip fracture in elderly people. The effect of thiazide diuretics on fracture risk should be assessed in a large randomised trial.
Amelot, Aymeric; Cristini, Joseph; Moles, Alexis; Salaud, Celine; Hamel, Olivier; Bord, Eric; Buffenoir, Kevin
Burst fractures not associated with any neurological deficits are frequent but not therapeutic agreement on their management is available to date. This case-control study was conducted to try to help guide therapeutic decision in the treatment of such fractures. This case-control study includes consecutive retrospective evaluation of 25 case-patients treated by posterior short-segment fixation associated with kyphoplasty (SFK) in the treatment of A3 thoracolumbar unstable fractures, as compared to a control-group composed of 82 patients treated by long-segment (LF) pedicle screws. SFK patients bled significantly less than the LF patients (p=0.04). Assessment of deformation progression, vertebral height restoration and reduction of the regional kyphotic angle in the SFK and LF groups revealed no statistically significant superiority of one approach on another. In contrast, the height of endplates was significantly increased in the SFK group (p=0.006). The patients' pain levels were significantly improved in the SFK group (p=0.002). However, patients from the SFK group stood earlier postoperatively (1.7 vs 3.7days, p=0.001). We believe that SFK in vertebral fractures is as efficient as LF for bone consolidation and spine stabilization. In addition, SFK patients may use fewer analgesics. Copyright © 2017 Elsevier Ltd. All rights reserved.
Full Text Available Objectives. To determine the minimum lateral bone coverage required for securing stable fixation of the porous-coated acetabular components (cups in hip dysplasia. Methods. In total, 215 primary total hip arthroplasties in 199 patients were reviewed. The average follow-up period was 49 months (range: 24–77 months. The lateral bone coverage of the cups was assessed by determining the cup center-edge (cup-CE angle and the bone coverage index (BCI from anteroposterior pelvic radiographs. Further, cup fixation was determined using the modified DeLee and Charnley classification system. Results. All cups were judged to show stable fixation by bone ingrowth. The cup-CE angle was less than 0° in 7 hips (3.3% and the minimum cup-CE angle was −9.2° (BCI: 48.8%. Thin radiolucent lines were observed in 5 hips (2.3%, which were not associated with decreased lateral bone coverage. Loosening, osteolysis, dislocation, or revision was not observed in any of the cases during the follow-up period. Conclusion. A cup-CE angle greater than −10° (BCI > 50% was acceptable for stable bony fixation of the cup. Considering possible errors in manual implantation, we recommend that the cup position be planned such that the cup-CE angle is greater than 0° (BCI > 60%.
Jazini, Ehsan; Klocke, Noelle; Tannous, Oliver; Johal, Herman S; Hao, John; Salloum, Kanaan; Gelb, Daniel E; Nascone, Jason W; Belin, Eric; Hoshino, C Max; Hussain, Mir; OʼToole, Robert V; Bucklen, Brandon; Ludwig, Steven C
We sought to determine the role of lumbopelvic fixation (LPF) in the treatment of zone II sacral fractures with varying levels of sacral comminution combined with anterior pelvic ring (PR) instability. We also sought to determine the proximal extent of LPF necessary for adequate stabilization and the role of LPF in complex sacral fractures when only 1 transiliac-transsacral (TI-TS) screw is feasible. Fifteen L4 to pelvis fresh-frozen cadaveric specimens were tested intact in flexion-extension (FE) and axial rotation (AR) in a bilateral stance gliding hip model. Two comminution severities were simulated through the sacral foramen using an oscillating saw, with either a single vertical fracture (small gap, 1 mm) or 2 vertical fractures 10 mm apart with the intermediary bone removed (large gap). We assessed sacral fracture zone (SZ), PR, and total lumbopelvic (TL) stability during FE and AR. The following variables were tested: (1) presence of transverse cross-connector, (2) presence of anterior plate, (3) extent of LPF (L4 vs. L5), (4) fracture gap size (small vs. large), (5) number of TI-TS screws (1 vs. 2). The transverse cross-connector and anterior plate significantly increased PR stability during AR (P = 0.02 and P = 0.01, respectively). Increased sacral comminution significantly affected SZ stability during FE (P = 0.01). Two versus 1 TI-TS screw in a large-gap model significantly affected TL stability (P = 0.04) and trended toward increased SZ stabilization during FE (P = 0.08). Addition of LPF (L4 and L5) significantly improved SZ and TL stability during AR and FE (P < 0.05). LPF in combination with TI-TS screws resulted in the least amount of motion across all 3 zones (SZ, PR, and TL) compared with all other constructs in both small-gap and large-gap models. The role of LPF in the treatment of complex sacral fractures is supported, especially in the setting of sacral comminution. LPF with proximal fixation at L4 in a hybrid approach might be needed in highly
Joestl, Julian; Hofbauer, Marcus; Lang, Nikolaus; Tiefenboeck, Thomas; Hajdu, Stefan
Revision arthroplasty is currently the recommended treatment for periprosthetic femoral fractures after primary total hip arthroplasty (THA) and stem loosening (Vancouver B2). However, open reduction and internal fixation (ORIF) utilizing locking compression plate (LCP) might be an effective treatment with a reduced surgical time and less complex procedure in a typically elderly patient collective with multiple comorbidities. The purpose of this study was to compare the functional and radiographic outcomes in two cohorts with Vancouver B2 periprosthetic femoral fractures after primary THA, treated either by ORIF with LCP fixation, or by revision arthroplasty utilizing a non-cemented long femoral stem. 36 patients with Vancouver B2 periprosthetic femoral fractures following THA, who had been treated between 2000 and 2014, were reviewed. Eight fractures were treated with LCP fixation, fourteen fractures with the first-generation revision prosthesis (Helios), and fourteen fractures with the second-generation revision prosthesis (Hyperion). The patients were assessed clinically with the Parker mobility score and radiographically. A total of ten males and 26 females formed the basis of this report with an average age of 81 years (range, 64 to 96 years). All fractures treated with LCP fixation alone healed uneventfully and there were no signs of secondary stem migration, malalignement or plate breakage. The average surgical time was shorter in the ORIF cohort; however, the results were not statistically significant. The postoperative Parker mobility score at latest follow-up showed no difference between the groups. According to the results of the current study, we conclude that the use of LCP fixation can be a sufficient option for the treatment of Vancouver B2 periprosthetic femoral fractures correspondingly with femoral stem loosening. Copyright © 2016 Elsevier Ltd. All rights reserved.
Ruzbarsky, Joseph J; Gausden, Elizabeth B; Goldwyn, Elan M; Lowenwirt, Isaac P; Kotlyar, Vitaly
Early surgical intervention for hip fractures in the elderly has proven efficacious. However, surgical delays commonly occur in this patient population due to comorbid conditions that put these patients at a high risk for hypotension-related complications of general or neuraxial anesthesia or anticoagulants that delay the safe use of neuraxial anesthesia. The questions/purposes of this study are (1) to investigate if a fascia iliaca block in conjunction with light to moderate sedation could provide adequate analgesia throughout open surgery for intertrochanteric hip fractures (AO/OTA 31-1) without requiring conversion to general anesthesia with airway support and (2) to assess its perioperative complication profile. A retrospective chart review was conducted to identify patients with intertrochanteric hip fractures who underwent anesthesia with a fascia iliaca block over a 1.5-year period. In the six patients identified, there were no intraoperative conversions to general anesthesia requiring airway support. Additionally, there were no intraoperative complications, no mortalities within 30 days, 2 patients on anticoagulation who required a blood transfusion, and a single patient who developed a postoperative hospital-acquired pneumonia that resolved with an antibiotic course. In this series of patients, we demonstrate that a fascia iliaca block can reliably be utilized as the primary anesthetic for patients undergoing surgical fixation of intertrochanteric hip fractures, with an acceptable perioperative complication profile. Although concomitant sedation was provided with the block, this anesthesia strategy has the potential to reduce preoperative delays and minimize the overall burden of sedative and anesthetic medications in a geriatric population. These initial findings may serve as a basis for future, higher-quality prospective and comparative studies.
Goslings, J C; Schafroth, M U; de Rooij, S E J A; Jansen, S.; Koster, R.W.; de Lange, F.J.; van der Velde, N
BACKGROUND: Several risk factors for falls and hip fractures have been recognised, but controversy still exists regarding the importance of rhythm and conduction abnormalities as potentially modifiable risk factors for recurrent falls. The aim of this study was to determine the prevalence of
Mosk, C.A. (Christina A.); Mus, M. (Marnix); Vroemen, J.P.A.M. (Jos P. A. M.); T. van der Ploeg (Tjeerd); D.I. Vos (Dagmar); Elmans, L.H.G.J. (Leon H. G. J.); L. van der Laan (Lyckle)
textabstractBackground: Delirium in hip fractured patients is a frequent complication. Dementia is an important risk factor for delirium and is common in frail elderly. This study aimed to extend the previous knowledge on risk factors for delirium and the consequences. Special attention was given to
Full Text Available Hip fractures are associated with a high rate of mortality and profound temporary and sometimes permanent impairment of quality of life. Current guidelines indicate that surgeons should perform surgery for a hip fracture within 24 hours of injury because earlier surgery is associated with better functional outcome and lower rates of perioperative complications and mortality. Proponents of early treatment argue that this approach minimizes the length of time a patient is confined to bed rest, thereby reducing the risk for associated complications, such as pressure sores, deep vein thrombosis, and urinary tract infections. Those favoring delaying surgery beyond the guideline recommendations believe that this approach is required to medically optimize patients, and therefore decrease the risk for perioperative complications. Further challenges to resolving this debate is the lack of an accepted definition of what should constitute an "unacceptable delay" for hip fracture surgery and the fact that outcomes associated with surgical delay are based on observational data alone (i.e., not randomized controlled trials. The effect of preoperative timing on mortality and other patient-important outcomes across various age groups remains controversial and warrants a large randomized controlled trial to offer clear insights into the effects associated with early versus delayed surgery among hip fracture patients.
In spite of the soft tissue contractures and osteoporosis associated with late presentation, there was no case of intraoperative fractures. The patients had good hip abduction postoperatively. In addition, there was no intraoperative nerve or vascular injury. Conclusion: The short-term results in this group of patients showed ...
Rupprecht, Martin; Grossterlinden, Lars; Sellenschloh, Kai; Hoffmann, Michael; Püschel, Klaus; Morlock, Michael; Rueger, Johannes M; Lehmann, Wolfgang
Internal fixation is a therapeutic mainstay for treatment of undisplaced femoral neck fractures and fractures without posterior comminution. The best treatment for unstable and comminuted fractures, however, remains controversial, especially in older patients. The present study was designed to assess the utility of the Intertan Nail® (IT) for stabilization of comminuted Pauwels type III fractures compared to dynamic hips screw (DHS). Randomized on the basis of bone mineral density, 32 human femurs were assigned to four groups. Pauwels type III fractures were osteomized with a custom-made saw guide. In 16 specimens the posteromedial support was removed and all femurs were instrumented with an IT or a DHS. All constructs were tested with nondestructive axial loading to 700N, cyclical compression to 1,400N (10,000 cycles), and loading to failure. Outcome measures included number of survived cycles, mechanical stiffness, head displacement and load to failure. Postoperative mechanical stiffness and stiffness after cyclical loading were significantly reduced in all constructs regardless of the presence of a comminution defect (p = 0.02). Specimens stabilized with the IT had a lower construct displacement (IT, 8.5 ± 0.5 mm vs. DHS, 14.5 ± 2.2 mm; p = 0.007) and sustained higher failure loads (IT, 4929 ± 419 N vs. DHS, 3505 ± 453 N; p = 0.036) than the DHS constructs. In comminuted Pauwels type III fractures, the fixation with the IT provided sufficient postoperative mechanical strength, comparable rate of femoral head displacement, and a similar tolerance of physiological loads compared to fractures without comminution. The absence of the posteromedial support in comminuted fractures tended to reduce the failure load regardless of the fixation method.
Moore, J; Carmody, O; Carey, B; Harty, J A; Reidy, D
Centenarians are the fastest rising age group in Ireland. Hip fractures most commonly affect older adults and are associated with significant morbidity and mortality, as well as the financial cost of healthcare resources. Despite this, very little is known regarding hip fractures in centenarians. The aim of this study was to investigate our experience with hip fractures in this group and to record the cost of treating these fractures to identify both the social and economic impact these injuries impose on the health system. The study was a retrospective data review at a major trauma centre. Nine proximal femoral fractures from June 2010-2016 were identified through a stepwise analysis of theatre data and patient notes. Time of death was recorded directly from patient records or by contacting the patient's general practitioner. With the assistance of the hospital finance department, individual inpatient costs were calculated using length of stay, theatre time and implant costs. Over the 7-year period we examined nine patients over 100 years of age were managed operatively for hip fractures with an average inpatient cost of €14,898. The mean age at the time of fracture was 101 years and 7 months. Eight of the patients were female and there was one male. Our inpatient, 30-day and 1-year mortality rate were 22, 22, and 71%. The 1-year mortality rate of any person aged 100 years or older is thought to be 67% for men and 59% for women. This suggests that the 1-year mortality rate of 71% in this current study is only slightly worse than the usual life expectancy of a person older than 100 years of age. Our data suggest that the extreme elderly should be offered operative management.
Goslings, J. C.; Ferguson, S. J.; Perren, R. A.; Tepic, S.
Several dynamic external fixation devices have been introduced to permit early functional treatment of unstable distal radial fractures. An intact cadaver wrist was spanned by a dynamic external fixator. Forces between the fixator and the radius were recorded during passive motion using a single,
Papakostidis, Costas; Panagiotopoulos, Andreas; Piccioli, Andrea; Giannoudis, Peter V
The aim of the present study was to evaluate the effect of timing of internal fixation of intracapsular fractures of the neck of femur on the development of late complications, particularly osteonecrosis of femoral head (ONFH) and non-union. We undertook a systematic review of the literature adhering to the PRISMA guidelines. There were 7 eligible reports for the final analysis. The methodological quality of component studies was assessed with the Coleman Methodology Score (CMS). Each included study was assigned a score independently by the two reviewers. The final score of each individual study constituted the average value of the scores given by the two reviewers. The agreement between the two assessors was tested with intraclass correlation coefficient (ICC). The CMS ranged from 37 to 64 within component studies (mean: 46.5, SD: 10.8, median: 41). The ICC was 0.94 (95% CI: 0.69-0.99), implying a nearly perfect agreement between the two assessors. Based on the available data regarding the timing of operative fixation of the femoral neck fractures, 4 discreet pairs of comparison groups could be created: (1) fractures fixed within 6h from injury versus fractures fixed after 6h from injury; (2) fractures fixed within 12h versus after 12h; (3) fractures fixed within 24h versus after 24h; and (4) fractures fixed within 6h versus after 24h. Outcome measures were analyzed within each one of the above pairs of treatment groups. The following subgroups analyses were a priori decided: (1) initial fracture displacement (displaced vs. undisplaced fractures); (2) fixation method (cannulated screws vs. sliding hip screw); (3) quality of reduction (anatomic vs non-anatomic reduction). This study failed to prove any essential association between timing of NOF fracture internal fixation and incidence of AVN. With respect to non-union though, it indicated that delay of internal fixation of more than 24h could increase substantially the odds of non-union. Copyright © 2015 Elsevier
Holloway, K L; Henry, M J; Brennan-Olsen, S L; Bucki-Smith, G; Nicholson, G C; Korn, S; Sanders, K M; Pasco, J A; Kotowicz, M A
Non-hip, non-vertebral fractures (NHNVF) were compared with hip, vertebral and controls. NHNVF were younger and heavier than controls and hip/vertebral fractures in both men and women, respectively. Falls and prior fractures were less common in NHNVF than hip fractures. Glucocorticoid use was lower in NHNVF compared to vertebral fracture (VF) in men. Although hip fracture (HF) and vertebral fractures (VF) receive the most attention in the literature and are the targeted sites for fracture prevention, non-hip, non-vertebral fracture (NHNVF) sites account for a greater proportion of fractures than the hip or vertebrae. This study aimed to assess risk factors for NHNVF and compare them with those for HF, VF and controls. Incident fractures during 2005-2007 for men and 1994-1996 for women were identified using computerised keyword searches of radiological reports, and controls were selected at random from electoral rolls for participation in the Geelong Osteoporosis Study. Participants aged 60+ years were included in this study. Compared to controls, men and women with NHNVF were younger (ORs, 0.90, 95% CI 0.86-0.94; and 0.96, 0.93-0.98, respectively) and had a lower femoral neck bone mineral density (BMD) T-score (age-adjusted; difference [men] 0.383, P = 0.002; [women] 0.287, P = 0.001). Compared to HF, men and women with NHNVF were heavier (difference [men] 9.0 kg, P = 0.01; [women] 7.6 kg, P fractures (0.38, 0.15-0.98) were less common compared to HF; and glucocorticoid use was less common for NHNVF (0.30, 0.11-0.85) compared to VF. Given the high numbers of NHNVF sustained by men and women in this study, fracture prevention strategies should focus on individuals with high risk of sustaining these types of fractures, as well as on individuals who are more likely to sustain a HF or VF.
Conclusions: Constrained and unconstrained exercises has similar effects after open reduction and internal fixation of proximal phalangeal fracture. Registration: Australian New Zealand Clinical Trials Registry (ACTRN12610000294055. [Miller L, Crosbie J, Wajon A, Ada L (2016 No difference between two types of exercise after proximal phalangeal fracture fixation: a randomised trial. Journal of Physiotherapy 62: 12–19
Leslie, William D; Lix, Lisa M; Morin, Suzanne N; Johansson, Helena; Odén, Anders; McCloskey, Eugene V; Kanis, John A
Bone mineral density (BMD) measurement from dual-energy X-ray absorptiometry (DXA) is widely used to assess skeletal strength in clinical practice, but DXA instruments can also measure biomechanical parameters related to skeletal shape. The objective of the study was to determine whether DXA-derived hip geometry measures provide information on fracture prediction that is independent of hip fracture probability determined from the fracture risk assessment tool (FRAX) algorithm. This was a retrospective registry study using BMD results for Manitoba, Canada. Women aged 40 years and older with baseline hip DXA, derived hip geometry measures, and FRAX scores (n = 50 420) participated in the study. Hospitalized hip fracture (n = 1020) diagnosed during 319 137 person-years of follow-up (median 6.4 y) was measured. Among the hip geometry measures, hip axis length (HAL) showed a consistent association with hip fracture risk when adjusted for age [hazard ratio (HR) 1.30 per SD increase, 95% confidence interval (CI) 1.22-1.38], and this was unaffected by further adjustment for BMD or FRAX score. Adjusted for FRAX score with BMD, there was a significant effect of increasing HAL quintile on hip fracture risk (linear trend P women (FRAX adjusted HR 1.70 per SD increase, 95% CI 1.48-1.94). DXA-derived hip geometry measurements are associated with incident hip fracture risk, but many do not confer significant independent predictive information. HAL was found to predict hip fractures when adjusted for BMD or FRAX score and may be of clinical value in refining hip fracture risk.
Coomber, Ross; Alshameeri, Zeiad; Masia, Antonio Francesco; Mela, Federico; Parker, Martyn J
There are no specific guidelines for treating Parkinson's disease patients who present with a hip fracture. Here we present a large cohort of patients with Parkinson's disease who suffered hip fractures. Our aim was to assess for differences between a Parkinson's disease population and a non-Parkinson's disease population with hip fractures and make recommendations on management guidelines. We performed a comprehensive analysis of prospectively collected data on all patients with hip fracture who were admitted into our department over a period of 29 years. In total 9225 patients with hip fractures were included in this study, 452 (4.9%) patients had Parkinson's disease. The mobility scores were worse pre- and post-operatively in the Parkinson's group as were mini-mental scores and ASA grade. Post-operative complications were similar between the two groups, with no difference in dislocation rate or wound complications. However, other outcomes including mobility and mortality rate at 1year were worse in the Parkinson's group. These patients also had a longer hospital stay and were more likely to be immobile and discharged to an institution. We recommend that Parkinson's disease patients should be assessed more thoroughly in the peri-operative period and arrangement for rehab and discharge planning should commence as soon as possible following admission. The consent process should reflect longer hospital stays, worse mobility, higher mortality and increased likelihood of discharge to institution but concern over increased complications, specifically dislocation was not evident in our data. Copyright © 2017 Elsevier Ltd. All rights reserved.
Zullo, Andrew R; Zhang, Tingting; Beaudoin, Francesca L; Lee, Yoojin; McConeghy, Kevin W; Kiel, Douglas P; Daiello, Lori A; Mor, Vincent; Berry, Sarah D
To examine the association between use of opioids versus other analgesics with death and functioning after hip fracture in older nursing home (NH) residents. Retrospective cohort using national Medicare fee-for-service claims linked to the Minimum Data Set. US NHs. NH residents aged ≥65 years who became a long-stay resident (>100 days in the NH) between January 2008 and December 2009, had a hospitalized hip fracture, and returned to the NH. New use of opioid versus nonopioid analgesics (acetaminophen or nonsteroidal anti-inflammatory drugs) within 14 days post hip fracture. Follow-up began on the index date and continued until the first occurrence of death, significant functional decline (3-point increase on MDS Activities of Daily Living scale), or 120 days of follow-up. Odds ratios (ORs) with 95% confidence intervals (CIs) for outcomes were estimated using inverse probability of treatment-weighted multinomial logistic regression models. Among the 2755 NH residents with a hip fracture included in our study, 1155 (41.9%) were opioid users, and 1600 (58.1%) were nonopioid analgesic users. The mean age was 86.3 years, 73.8% were female, and 86.0% were white. Opioid use was associated with a significantly lower likelihood of death (OR = 0.47, 95% CI 0.39-0.56) and a nonsignificant decrease in functional decline (OR = 0.77, 95% CI 0.58-1.03). A rigorous study that addresses the limitations of this study is critical to validate our preliminary findings and provide evidence about the effect of using opioid versus nonopioid analgesics to optimize acute pain in NH residents with a hip fracture. Published by Elsevier Inc.
Poss, Jeff; Cook, Richard J.; Byrne, Kerry; Hirdes, John P.
Background Little information is available on hip fracture risks among community-dwelling persons receiving home care. Our aim was to identify risk factors for hip fracture from health information routinely collected for older home care clients. Methods This was a cohort study involving secondary analysis of data on 40,279 long-stay (>60 days) home care clients aged 65 and older in Ontario, Canada; occurrence of hip fracture as well as potential risk factor information were measured using the Resident Assessment Instrument (RAI)/Minimum Data Set–Home Care assessment instrument. Results In all, 1,003 clients (2.5%) had hip fracture on follow-up assessment. Older (85+ vs 65–74, relative risk [95% confidence interval]: 0.52 [0.43–0.64]) clients are at increased risk; males are at reduced risk [0.60 (0.51–0.70)]. Other risk factors include osteoporosis (1.19 [1.03–1.36]), falls (1.31 [1.15–1.49]), unsteady gait (1.18 [1.03–1.36]), use of ambulation aide (1.39 [1.21–1.59]), tobacco use (1.42, [1.13–1.80]), severe malnutrition (2.61 [1.67–4.08]), and cognitive impairment (1.30 [1.12–1.51]). Arthritis (0.86 [0.76–0.98]) and morbid obesity (0.34 [0.16–0.72]) were associated with reduced risk. Males and females demonstrated different risk profiles. Conclusions Important risk factors for hip fracture can be identified from routinely collected data; these could be used to identify at-risk clients for further investigation and prevention strategies . PMID:19196903
Pedersen, Susanne Juhl; Moltke, Finn Borgbjerg; Schousboe, B.
OBJECTIVES: To evaluate the rate of postoperative complications, length of stay, and 1-year mortality before and after introduction of a comprehensive Multidisciplinary fast-track treatment and care program for hip fracture patients (the optimized program). DESIGN: Retrospective chart review...... community dwellers before the fracture and 159 (29.7%) were admitted from nursing homes. INTERVENTION: The fast-track treatment and care program included a switch from systemic opiates to a local femoral nerve catheter block; an earlier assessment by the anesthesiologist; and more-systematic approach...... group (P = .02). Overall 12-month mortality was 29% in the control group and 23% in the intervention group (P = .2). CONCLUSION: The optimized hip fracture program reduced the rate of in-hospital postoperative complications and mortality. Randomized clinical trials are needed to confirm these results...
Rakesh Kumar Gupta
Full Text Available Background: 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 cadaveric femora for biomechanical studies and in pathological fractures. However, there are very few reports on the utilization of PMMA cement to prevent these complications in fresh intertrochanteric fractures. A prospective study was conducted to evaluate the outcome and efficacy of PMMA augmented DHS in elderly osteoporotic patients with intertrochanteric fractures. Materials and Methods: The study included 64 patients (AO type31-A2.1 in eight, A2.2 in 29, A2.3 in 17 patients, and 31-A3.1 in five, A3.2 in three, and A3.3 in two patients with an average age of 72 years (60 − 94 years of which 60 were available for final followup. PMMA augmentation of DHS was performed in all cases by injecting PMMA cement into the femoral head with a custommade gun designed by the authors. The clinical outcome was rated as per the Salvati and Wilson scoring system at the time of final followup of one year. Results were graded as excellent (score > 31, good (score 24 − 31, fair (score 16 − 23, and poor (score < 16. Results: Fracture united in all patients and the average time to union was 13.8 weeks (range 12 − 16 weeks. At an average followup of 18 months (range 12 − 24 months, no incidence of varus collapse or superior screw cut out was observed in any of the patients in spite of weightbearing ambulation from the early postoperative period. There was no incidence of avascular necrosis (AVN or cement penetration into the joint in our series. Most of the patients were able to regain their prefracture mobility status with a mean hip pain score of 8.6. Conclusion: Cement augmentation of DHS appears
Kammerlander, Christian; Gosch, Markus; Kammerlander-Knauer, Ursula; Luger, Thomas J; Blauth, Michael; Roth, Tobias
Fragility fractures are a major health care problem worldwide. The proportion of the geriatric population and the overall life expectancy will increase. Hip fractures are the most common fragility fractures needing surgery and nowadays treatment concepts are changing. We studied the long-term functional outcome and their influencing factors in patients treated without any interdisciplinary aspects. A retrospective cohort study with functional long-term follow-up examination was carried out in a level one trauma centre on hip fracture patients 80 years old and above treated without any formalized interdisciplinary aspects ("usual care"). Of 281 consecutive patients who were treated 2005 and 2006 with usual care, 246 patients with a mean age of 86.8 years met our inclusion criteria. 69.1% died within the study period of 4.9 years. On the remaining patients, the residential status, the Barthel Index and the Parker Score were assessed. The mean Barthel Index was 49.6 and the mean Parker Score was 2.7. More than one-fourth of the survivors were found to be bedridden and 45% were not able to walk outside. 88% are bound to one floor and only 8% are able to walk unaided. Patients with more comorbidities and patients with subsequent fractures had significant higher mortality rates. Patients with trochanteric fractures had significant better functional outcome scores compared to patients with femoral neck fractures. Nursing home residents showed significant higher mortality rates and lower functional outcome scores. Patients who were transferred to a nearby acute geriatric hospital for further treatment had significantly higher functional outcome scores. This paper shows the frustrating long-term outcome of geriatric hip fracture patients but it also suggests that an early geriatric intervention may lead to better function.
Mohammad H Taraz Jamshidi
Full Text Available Hip dislocation occurs when the femur does not break and the force is transmitted towards the hip joint leading to a posterior dislocation of the femoral head with or without posterior acetabular fracture. We present the case of a 26 year old patient involved in motor vehicle accident. Clinical and imaging (radiography, CT examination revealed an intertrochanteric fracture associated with ipsilateral posterior hip dislocation and posterior acetabular wall fracture simultaneously with epsilateraal tibial and fibular fractures. Such associations is very rare and can be explained by an extremely powerful force generated the three lesions simultaneously. This case is important not only because of its extreme rarity but also because of treatment method.
Nijmeijer, W. S.; Folbert, E. C.; Vermeer, M.; Slaets, J. P.; Hegeman, J. H.
Background: Hip fractures are common in the elderly and have a high risk of early mortality. Identification of patients at high risk of early mortality could contribute to enhanced quality of care. A simple scoring system is essential for preoperative identification of patients at high risk of early
Wölfle-Roos, Julia V; Urlaub, Stefanie; Reichel, Heiko; Taurman, Rita
There is an ongoing debate on which fixation technique should be preferred for the prophylactic fixation of the asymptomatic contralateral hip in slipped capital femoral epiphysis (SCFE). In the case of Kirschner-wire (K-wire) fixation, there is a possibility of secondary loss of fixation because of longitudinal growth of the physis, whereas in screw fixation, physeal growth of the femoral neck might be impaired. The aim of this matched-pair study was to compare the longitudinal growth of the femoral neck in screw fixation versus K-wire fixation of the asymptomatic contralateral hip in SCFE. All 18 patients (female:male=3:15), who had undergone screw fixation of the asymptomatic contralateral hip between 9/2001 and 9/2011, were matched according to age, bone age, sex, and time to follow-up to another 18 patients with K-wire fixation. The length of the femoral neck of the contralateral hip was measured in parallel to either screw or K-wire from the apex of the femoral head to the opposite cortical bone. The ratio of the femoral neck length measured directly after surgery and on follow-up was defined as femoral neck growth. There was no significant difference between groups with respect to age, modified Oxford Bone age score, and time to follow-up. We found a significant difference in femoral neck growth between patients with screw fixation (5.5 ± 4.3%) compared with K-wire fixation (8.9 ± 5.7%, P = 0.048 matched Wilcoxon test). The difference in femoral neck growth of patients with K-wire or screw fixation of the contralateral asymptomatic hip in SCFE was small, but statistically significant. Thus, despite high rates of secondary loss of fixation, K-wire fixation should still be considered, especially in very young patients.
Background The zygoma plays an important role in the facial contour for both cosmetic and functional reasons; therefore zygomatic bone injuries should be properly diagnosed and adequately treated. Comparison of various surgical approaches and their complications can only be done objectively using outcome measurements which in turn require protocol management and long-term follow up. The preference for open reduction and internal fixation of zygomatic fractures at three points has continued to grow in response to observations of inadequate results from two point and one point fixation techniques. The objectives of this study were to compare the efficacy of zygomatic bone after treatment with ORIF using 2 point fixation and ORIF using 3 point fixation and compare the outcome of two procedures. Methods 100 patients were randomly divided equally into two groups. In group A, 50 patients were treated by ORIF using two point fixation by miniplates and in group B, 50 patients were treated by ORIF using three point fixation by miniplates. They were evaluated for their complications during and after surgery with their advantages and disadvantages and the difference between the two groups was observed. Results A total of 100 fractures were sustained. We found that postoperative complication like decreased malar height and vertical dystopia was more common in those patients who were treated by two point fixation than those who were treated with three point fixation. Conclusions Based on this study open reduction and internal fixation using three point fixation by miniplates is the best available method for the treatment zygomatic bone fractures. PMID:22497773
Buckens, Constantinus F; de Jong, Pim A; Mali, Willem P; Verhaar, Harald J; van der Graaf, Yolanda; Verkooijen, Helena M
Subclinical or undiagnosed vertebral fractures on routine chest computed tomography (CT) may be useful for detecting patients at increased risk of future hip fractures who might benefit from preventive interventions. We investigated whether prevalent vertebral fractures on routine chest CT are associated with future hip fractures. From a source population of 5679 patients ≥40 years old undergoing chest CT in one of three Dutch hospitals between 2002 and 2005, patients hospitalized for hip fractures (n = 149) during a median follow-up of 4.4 years were identified. Following a case-cohort design, a random sample of 576 patients was drawn from the source population and added to the cases. In this group, the presence and severity of vertebral fractures was determined using semiquantitative vertebral fracture assessment and multivariate case-cohort appropriate Cox modeling. We found that cases were older (69 versus 63 years) and more often female (48% versus 38%) than the source population. Compared with those with no fracture, patients with any vertebral fracture had triple the risk of future hip fracture (age- and gender-adjusted hazard ratio [HR] = 3.1, 95% confidence interval [CI] 2.1-4.7). This HR rose to 3.8 (CI 2.6-5.6) if mild fractures were discounted. Future fracture risk increased significantly with increasing severity of vertebral fracture status: from mild (HR = 2.4, CI 1.5-3.7) and moderate (HR = 4.8, CI 2.5-9.2) to severe (HR = 6.7, CI 2.9-15.5). The same was true for having higher cumulative fracture grades: 1 to 3 (HR = 2.7, CI 1.8-4.1), 4 to 6 (HR = 4.8, CI 2.2-10.5), or ≥7 (HR = 11.2, CI 3.7-34.6). In conclusion, prevalent vertebral fractures on routine clinical chest CT are associated with future hip fracture risk. © 2014 American Society for Bone and Mineral Research.
Drew, S; Judge, A; Cooper, C; Javaid, M K; Farmer, A; Gooberman-Hill, R
There is variation in how services to prevent secondary fractures after hip fracture are delivered and no consensus on best models of care. This study identifies healthcare professionals' views on effective care for the prevention of these fractures. It is hoped this will provide information on how to develop services. Hip fracture patients are at high risk of subsequent osteoporotic fractures. Whilst fracture prevention services are recommended, there is variation in delivery and no consensus on best models of care. This study aims to identify healthcare professionals' views on effective care for prevention of secondary fracture after hip fracture. Forty-three semi-structured interviews were undertaken with healthcare professionals involved in delivering fracture prevention across 11 hospitals in one English region. Interviews explored views on four components of care: (1) case finding, (2) osteoporosis assessment, (3) treatment initiation, and (4) monitoring and coordination. Interviews were audio-recorded, transcribed, anonymised and coded using NVivo software. Case finding: a number of approaches were discussed. Multiple methods ensured there was a 'backstop' if patients were overlooked. Osteoporosis assessment: there was no consensus on who should conduct this. The location of the dual energy X-ray absorptiometry (DXA) scanner influenced the likelihood of patients receiving a scan. Treatment initiation: it was felt this was best done in inpatients rather request initiation in the post-discharge/outpatients period. Monitoring (adherence): adherence was a major concern, and participants felt more monitoring could be conducted by secondary care. Coordination of care: participants advocated using dedicated coordinators and formal and informal methods of communication. A gap between primary and secondary care was identified and strategies suggested for addressing this. A number of ways of organising effective fracture prevention services after hip fracture were
Lee, Young-Kyun; Kim, Jin Woo; Lee, Myung Ho; Moon, Kyung Ho; Koo, Kyung-Hoi
The incidence of hip fractures has been reported to vary geographically, and its trend has also varied widely. However, the trend in the age-adjusted incidence of hip fractures has not been well studied in Korea. After we identified eligible studies presenting multiple age-adjusted incidences of hip fractures in the Korean population in PubMed, we evaluated changes in the absolute number of occurrence and calculated the annual percentage change (APC) of age-adjusted incidences of hip fractures. We have searched PubMed for the original and English-language literature on the incidence of hip fractures in the Korean population published since 2000. The studies presenting multiple age-adjusted incidences of hip fractures were selected. We evaluated the change in the absolute number of hip fractures and calculated the APC of age-adjusted incidences of hip fractures for each study. Three eligible articles were identified. The absolute number of hip fractures for both genders increased over time in all three studies although the operational definition of hip fracture differed from one another. The APC of the age-adjusted incidence of hip fractures was positive for women and negative for men. However, the change was not statistically significant in both genders during each study period (2001-2004, 2005-2008, and 2006-2010, respectively). The age-adjusted incidence of hip fractures was stable among men and women, while the absolute number of hip fractures increased for both genders in Korea. Further studies with longer study periods on age-adjusted incidences are required to better determine the trend in the incidence of hip fractures in Korea.
Yao, Kai-Ping Grace; Lee, Hsin-Yi; Tsauo, Jau-Yih
Researchers measure the significance of hip fracture by the patient's impairment. The patient's quality of life (QOL) is usually also substantially affected. However, there is no specific quality of life (QOL) questionnaire for patients with hip fractures. This study was designed to determine whether adding a new set of specific questions about…
Chen, Xiaobing; Zhang, Jianzheng; Wang, Xiinling; Ren, Jixin; Liu, Zhi
BACKGROUND To study the incidence of and factors influencing "neck shortening" in elderly patients treated for femoral neck fractures using multiple cancellous screws. MATERIAL AND METHODS Of the 197 femoral neck fracture cases treated via closed reduction and cancellous screws fixation from January 2006 to February 2010, 110 were followed up. Patient age, gender, operative time, implantation method, reduction quality, fracture type, bone mineral density, loading time, length of hospital stay, and Harris hip score 12 months after operation were recorded. The patients were divided into two groups (shortening and non-shortening) based on their X-ray performance during follow-up. The healing rates and Harris hip scores of the two groups were compared, and the influencing factors of femoral neck shortening were analyzed. RESULTS Of the 110 cases followed up, 94.5% (104/110) were healed and neck shortening occurred in 41.8% (46/110) within 12.5 months (mean) after treatment. The Harris hip score of the shortening group was lower than that of the non-shortening group (78±17 vs. 86±23, p=0.048). The fracture healing rates of the two groups were not significantly different (p=0.068). The factors influencing neck shortening were significantly correlated with bone mineral density, patient age, gender, and type of fracture. CONCLUSIONS The incidence of neck shortening in elderly patients treated for femoral neck fracture using cancellous screws was high. Bone mineral density, patient age, gender, and type of fracture were the influencing factors of neck shortening.
Full Text Available We present a case report of a 45-year old man who sustained a central dislocation of the hip secondary to an insufficiency fracture of the acetabulum. At the time of presentation he was on alendronate therapy for osteoporosis which had been previously investigated. CT scanning of the pelvis was useful for pre-operative planning which confirmed collapse of the femoral head but no discontinuity of the pelvis. The femoral head was morcellized and used as bone graft for the acetabular defect and an uncemented total hip replacement was performed.
Ronga, Mario; Bonzini, Daniele; Valoroso, Marco; La Barbera, Giuseppe; Tamini, Jacopo; Cherubino, Mario; Cherubino, Paolo
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. To evaluate the blood loss in patients that had their trochanteric fracture stabilized with dynamic hip screw (DHS) or Gamma nail. Multivariate analysis of different variables that can influence blood loss was carried out (type of fracture, antiaggregant or anticoagulant therapy, time to surgery). The hypothesis was that there is no difference in terms of blood loss in patients with trochanteric fracture treated with DHS or Gamma nail considering all these variables. Perioperative blood loss was evaluated in 417 consecutive patients treated for trochanteric fracture with DHS or Gamma nail between January 2010 and March 2013. The perioperative blood loss was calculated using the Lisander formula modified by Foss-Kehlet based on pre- and post-operative haemoglobin values and transfusion rates. Univariate and multivariate analysis were performed integrating the following variables: type of fracture (A1 vs A2), antiaggregant/anticoagulant therapy vs no therapy, time to surgery (24 hours from trauma), type of implant (DHS vs Gamma nail). A significant blood loss (p 24 hours from trauma (1584.4ml vs 1323.9ml), DHS and Gamma nail (894.7ml vs 1720.6ml). At multivariate analysis, in the A1 fracture groups the DHS showed a significant lower blood loss compared to Gamma nail (p loss, DHS should be used in A1 fractures while Gamma nail can be taking in account for the unstable A2 fractures. © 2017 Elsevier Ltd. All rights reserved.
Conclusion: For the treatment of calcaneal fractures, percutaneous poking reduction and fixation is superior to open reduction and fixation in terms of the incidence of postoperative complications. But both techniques can obtain satisfactory clinical function.
Shenoy Ravikiran; Eranki Vivek; Pillai Anand; Hadidi Mahar
Abstract Introduction Associated with the increase in the aging population, there is an increase in the incidence of hip fractures worldwide. Outcome following such fractures is affected by age of the patient. This study aims to assess the incidence and early outcome of hip fractures, comparing between different age groups. Methods Data of hip fractures collected over a period of five years was analysed. Patients were divided into three groups, group A (patients under the age of 64), group B ...
R. W. Jordan
Full Text Available Introduction. Patients suffering a distal femoral fracture are at a high risk of morbidity and mortality. Currently this cohort is not afforded the same resources as those with hip fractures. This study aims to compare their mortality rates and assess whether surgical intervention improves either outcome or mortality following distal femoral fractures. Methods. Patients over sixty-five admitted with a distal femoral fracture between June 2007 and 2012 were retrospectively identified. Patients mobility was categorised as unaided, walking aid, zimmer frame, or immobile. The 30-day, six-month, and one-year mortality rates were recorded for this group as well as for hip fractures during the same period. Results. 68 patients were included in the study. The mortality rate for all patients with distal femoral fractures was 7% at 30 days, 26% at six months, and 38% at one year, higher than hip fractures during the same period by 8%, 13%, and 18%, respectively. Patients managed surgically had lower mortality rates and higher mobility levels. Conclusion. Patients suffering a distal femoral fracture have a high mortality rate and surgical intervention seems to improve both mobility and mortality.
Katonis Pavlos G
Full Text Available Abstract Background Lag screw cut-out failure following fixation of unstable intertrochanteric fractures in osteoporotic bone remains an unsolved challenge. This study tested if resistance to cut-out failure can be improved by using a dual lag screw implant in place of a single lag screw implant. Migration behavior and cut-out resistance of a single and a dual lag screw implant were comparatively evaluated in surrogate specimens using an established laboratory model of hip screw cut-out failure. Methods Five dual lag screw implants (Endovis, Citieffe and five single lag screw implants (DHS, Synthes were tested in the Hip Implant Performance Simulator (HIPS of the Legacy Biomechanics Laboratory. This model simulated osteoporotic bone, an unstable fracture, and biaxial rocking motion representative of hip loading during normal gait. All constructs were loaded up to 20,000 cycles of 1.45 kN peak magnitude under biaxial rocking motion. The migration kinematics was continuously monitored with 6-degrees of freedom motion tracking system and the number of cycles to implant cut-out was recorded. Results The dual lag screw implant exhibited significantly less migration and sustained more loading cycles in comparison to the DHS single lag screw. All DHS constructs failed before 20,000 cycles, on average at 6,638 ± 2,837 cycles either by cut-out or permanent screw bending. At failure, DHS constructs exhibited 10.8 ± 2.3° varus collapse and 15.5 ± 9.5° rotation around the lag screw axis. Four out of five dual screws constructs sustained 20,000 loading cycles. One dual screw specimens sustained cut-out by medial migration of the distal screw after 10,054 cycles. At test end, varus collapse and neck rotation in dual screws implants advanced to 3.7 ± 1.7° and 1.6 ± 1.0°, respectively. Conclusion The single and double lag screw implants demonstrated a significantly different migration resistance in surrogate specimens under gait loading simulation with
Klit, Jakob; Gosvig, Kasper; Magnussen, Erland
Background and purpose - Slipped capital femoral epiphysis is thought to result in cam deformity and femoroacetabular impingement. We examined: (1) cam-type deformity, (2) labral degeneration, chondrolabral damage, and osteoarthritic development, and (3) the clinical and patient-reported outcome...... after fixation of slipped capital femoral epiphysis (SCFE). Methods - We identified 28 patients who were treated with fixation of SCFE from 1991 to 1998. 17 patients with 24 affected hips were willing to participate and were evaluated 10-17 years postoperatively. Median age at surgery was 12 (10...
Omsland, Tone K; Eisman, John A; Naess, Øyvind; Center, Jacqueline R; Gjesdal, Clara G; Tell, Grethe S; Emaus, Nina; Meyer, Haakon E; Søgaard, Anne Johanne; Holvik, Kristin; Schei, Berit; Forsmo, Siri; Magnus, Jeanette H
Hip fractures are associated with high excess mortality. Education is an important determinant of health, but little is known about educational inequalities in post-hip fracture mortality. Our objective was to investigate educational inequalities in post-hip fracture mortality and to examine whether comorbidity or family composition could explain any association. We conducted a register-based population study of Norwegians aged 50 years and older from 2002 to 2010. We measured total mortality according to educational attainment in 56,269 hip fracture patients (NORHip) and in the general Norwegian population. Both absolute and relative educational inequalities in mortality in people with and without hip fracture were compared. There was an educational gradient in post-hip fracture mortality in both sexes. Compared with those with primary education only, the age-adjusted relative risk (RR) of mortality in hip fracture patients with tertiary education was 0.82 (95% confidence interval [CI] 0.77-0.87) in men and 0.79 (95% CI 0.75-0.84) in women. Additional adjustments for Charlson comorbidity index, marital status, and number of children did not materially change the estimates. Regardless of educational attainment, the 1-year age-adjusted mortality was three- to fivefold higher in hip fracture patients compared with peers in the general population without fracture. The absolute differences in 1-year mortality according to educational attainment were considerably larger in hip fracture patients than in the population without hip fracture. Absolute educational inequalities in mortality were higher after hip fracture compared with the general population without hip fracture and were not mediated by comorbidity or family composition. Investigation of other possible mediating factors might help to identify new targets for interventions, based on lower educational attainment, to reduce post-hip fracture mortality. © 2015 American Society for Bone and Mineral Research.
Oliveri, Hadrien; Boudissa, Mehdi; Tonetti, Jerome; Chabanas, Matthieu
Acetabular fractures are a challenge in orthopedic surgery. Computer-aided solutions were proposed to segment bone fragments, simulate the fracture reduction or design the osteosynthesis fixation plates. This paper addresses the simulation part, which is usually carried out by freely moving bone fragments with six degrees of freedom to reproduce the pre-fracture state. Instead we propose a different paradigm, closer to actual surgeon's requirements: to simulate the surgical procedure itself rather than the desired result. A simple, patient-specific, biomechanical multibody model is proposed, integrating the main ligaments and muscles of the hip joint while accounting for contacts between bone fragments. Main surgical tools and actions can be simulated, such as clamps, Schanz screws or traction of the femur. Simulations are computed interactively, which enables clinicians to evaluate different strategies for an optimal surgical planning. Six retrospective cases were studied, with simple and complex fracture patterns. After interactively building the models from preoperative CT, gestures from the surgical reports were reproduced. Results of the simulations could then be compared with postoperative CT data. A qualitative study shows the model behavior is excellent and the simulated reductions fit the observed data. A more quantitative analysis is currently being completed. Two cases are particularly significant, for which the surgical reduction actually failed. Simulations show it was indeed not possible to reduce these fractures with the chosen approach. Had our simulator being used, a better planning may have avoided a second surgery to these patients.
Sakai, Rina; Kikuchi, Aki; Morita, Towa; Takahira, Naonobu; Uchiyama, Katsufumi; Yamamoto, Takeaki; Moriya, Mistutoshi; Uchida, Kentaro; Fukushima, Kensuke; Tanaka, Kensei; Takaso, Masashi; Itoman, Moritoshi; Mabuchi, Kiyoshi
Adequate fixation at the time of cementless stem implantation depends on the operator's experience. An objective evaluation method to determine whether the stem has been appropriately implanted may be helpful. We studied the relationship between the hammering sound frequency during stem implantation and internal stress in a femoral model, and evaluated the possible usefulness of hammering sound frequency analysis for preventing intraoperative fracture. Three types of cementless stem (BiCONTACT®, SL-PLUS®, and AI-Hip®) were used. Surgeons performed stem insertion using a procedure similar to that employed in a routine operation. Stress was estimated by finite element analysis, the hammering force was measured, and frequency analysis of hammering sound data obtained using a microphone. Finite element analysis showed a decrease in the hammering sound frequency with an increase in the estimated maximum stress. When a decrease in frequency was observed, adequate hammering had occurred, and the continuation of hammering risked fracture. Based on the relationship between stress and frequency, the evaluation of changes in frequency may be useful for preventing the development of intraoperative fractures. Using our method, when a decrease in frequency is observed, the hammering force should be reduced. Hammering sound frequency analysis may allow the prediction of bone fractures that can be visually confirmed, and may be a useful objective evaluation method for the prevention of intraoperative periprosthetic fractures during stem insertion.
Sawada, Hideyoshi; Shinohara, Takaaki; Natsume, Tadahiro; Hirata, Hitoshi
Ulnar styloid fractures are often associated with distal radius fractures. However, controversy exists regarding whether to treat ulnar styloid fractures. This study aimed to evaluate clinical effects of internal fixation for ulnar styloid fractures after distal radius fractures were treated with the volar locking plate system. We used prospectively collected data of distal radius fractures. 111 patients were enrolled in this study. A matched case-control study design was used. We selected patients who underwent fixation for ulnar styloid fractures (case group). Three control patients for each patient of the case group were matched on the basis of age, sex, and fracture type of distal radius fractures from among patients who did not undergo fixation for ulnar styloid fractures (control group). The case group included 16 patients (7 men, 9 women; mean age: 52.6 years; classification of ulnar styloid fractures: center, 3; base, 11; and proximal, 2). The control group included 48 patients (15 men, 33 women; mean age: 61.1 years; classification of ulnar styloid fractures: center, 10; base, 31; and proximal, 7). For radiographic examination, the volar tilt angle, radial inclination angle, and ulnar variance length were measured, and the union of ulnar styloid fractures was judged. For clinical examination, the range of motions, grip strength, Hand20 score, and Numeric Rating Scale score were evaluated. There was little correction loss for each radiological parameter of fracture reduction, and these parameters were not significantly different between the groups. The bone-healing rate of ulnar styloid fractures was significantly higher in the case group than in the control group, but the clinical results were not significantly different. We revealed that there was no need to fix ulnar styloid fractures when distal radius fractures were treated via open reduction and internal fixation with a volar locking plate system. Copyright © 2016 The Japanese Orthopaedic Association
Hwang, Jung-Taek; Lee, Woo-Yong; Kang, Chan; Hwang, Deuk-Soo; Kim, Dong-Yeol; Zheng, Long
Painful hip following hip dislocation or acetabular fracture can be an important signal for early degeneration and progression to osteoarthritis due to intraarticular pathology. However, there is limited literature discussing the use of arthroscopy for the treatment of painful hip. The purpose of this retrospective study was to analyze the effectiveness and benefit of arthroscopic treatment for patients with a painful hip after major trauma. From July 2003 to February 2013, we reviewed 13 patients who underwent arthroscopic treatment after acetabular fracture or hip dislocation and were followed up for a minimum of 2 postoperative years. The degree of osteoarthritis based on the Tonnis classification pre- and postoperatively at final follow-up was determined. Clinical outcomes were evaluated using visual analogue scale for pain (VAS) and modified Harris hip score (MHHS), and range of motion (ROM) of the hip pre- and postoperatively at final follow-up. There were nine male and four female patients with a mean age at surgery of 28 years (range, 20 to 50 years). The mean follow-up period of the patients was 59.8 months (range, 24 to 115 months), and the mean interval between initial trauma and arthroscopic treatment was 40.8 months (range, 1 to 144 months). At the final follow-up, VAS and MHHS improved significantly from 6.3 and 53.4 to 3.0 and 88.3, respectively (p = 0.002 and p hip flexion, abduction, adduction, external rotation, and internal rotation as minor improvements from 113.1°, 38.5°, 28.5°, 36.5°, and 22.7° to 118.5°, 39.0°, 29.2°, 38.9°, and 26.5° were observed, respectively (p = 0.070, p = 0.414, p = 0.317, p = 0.084, and p = 0.136, respectively). None of the patients exhibited progression of osteoarthritis of the hip at the final follow-up. Arthroscopic treatment after acetabular fracture or hip dislocation is effective and delays the progression of traumatic osteoarthritis.
Full Text Available Abstract Background Aseptic loosening is one of the greatest problems in hip replacement surgery. The rotation center of the hip is believed to influence the longevity of fixation. The aim of this study was to compare the influence of cemented and cementless cup fixation techniques on the position of the center of rotation because cemented cup fixation requires the removal of more bone for solid fixation than the cementless technique. Methods We retrospectively compared pre- and post-operative positions of the hip rotation center in 25 and 68 patients who underwent artificial hip replacements in our department in 2007 using cemented or cementless cup fixation, respectively, with digital radiographic image analysis. Results The mean horizontal and vertical distances between the rotation center and the acetabular teardrop were compared in radiographic images taken pre- and post-operatively. The mean horizontal difference was −2.63 mm (range: -11.00 mm to 10.46 mm, standard deviation 4.23 mm for patients who underwent cementless fixation, and −2.84 mm (range: -10.87 to 5.30 mm, standard deviation 4.59 mm for patients who underwent cemented fixation. The mean vertical difference was 0.60 mm (range: -20.15 mm to 10.00 mm, standard deviation 3.93 mm and 0.41 mm (range: -9.26 mm to 6.54 mm, standard deviation 3.58 mm for the cementless and cemented fixation groups, respectively. The two fixation techniques had no significant difference on the position of the hip rotation center in the 93 patients in this study. Conclusions The hip rotation center was similarly restored using either the cemented or cementless fixation techniques in this patient cohort, indicating that the fixation technique itself does not interfere with the position of the center of rotation. To completely answer this question further studies with more patients are needed.
Full Text Available Nine patients with open fractures of the proximal humerus were treated using an external fixation device. All of them had grade III open fractures resulting from high-velocity missile and explosive injuries with massive foreign body contamination. Radial nerve injury was present in five and two multiply injuried patients with thoracic wall and abdominal viscera were present. There were no major arterial injuries. Chronic osteitis with fistula and sequestra developed in one. There were no nonunions and no refractures. Minor painless limitation of shoulder and elbow motion presented in all patient. Upper-third humeral open fractures due to firearms are a unique type of open fractures. They are usually highly comminuted therefore, stable fixation is difficult or impossible to achieve. On the other hand, the risk of infection is high following plate fixation. External fixation allows adequate management of the soft tissue wounds, provides stable bone fixation and allows early mobilization of the shoulder and elbow.
Lüthje, Peter; Helkamaa, Teemu; Kaukonen, Juha-Pekka; Nurmi-Lüthje, Ilona; Kataja, Matti
To analyze the type and effect of prior and subsequent fractures in a hip fracture cohort. Hip fracture patients (n=221) were followed for a mean of 8 years and all prior and subsequent fractures were studied. Incidence of the first fracture and subsequent fractures according to sex, age group, and time between the first and the index hip fracture were measured. The absolute fracture risk was measured in the study subjects and in the age groups hip fracture patients had sustained previous fractures. In men, these were mostly ankle or hip fractures, and in women, wrist fractures. Of the subjects, 24% suffered a subsequent fracture, which in both sexes was usually a second hip fracture. At the end of the 8-year follow-up, 74% of the patients had died. The observed absolute fracture risk was 7% at one year and 24% at 5 years. In women, excess mortality was lowest during the first 4.8 years after the index hip fracture among patients with one fracture. However, it was highest among women with two fractures. In men, excess mortality was lowest among those with two fractures and highest among those with ≥3 fractures. There were no differences between the genders in sustaining subsequent fractures. The fracture risk subsequent to hip fracture was similar in both genders. Patients with prior hip fractures had the worst survival rate. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.
Kok, Laura M.; van der Steenhoven, Tim J.; Nelissen, Rob G. H. H.
The aim of this study was the evaluation of contralateral hip fractures after a previous hip fracture. For this retrospective analysis patients were selected from the database of the LUMC, a teaching hospital in the south-west of the Netherlands. We analyzed all patients with a second fracture of a hip between 1992 and 2007. The exclusion criteria were high impact trauma and patients with diseases or medication known to have a negative effect on bone metabolism. A total of 1,604 hip fractures...
Conclusion: While total hip BMD is the strongest predictor of hip fracture, increasing awareness of osteoporosis prevention by educating people about good lifestyle habits and how to maintain BMD is prioritized for preventing the first-incident hip fracture in Taiwanese women.
Moruf Babatunde Yusuf
Full Text Available Patella fracture is uncommon in pediatric age group and their patella is better preserved in any class of patella fracture. We reported a case of a 13-year-old male with right patella fracture nonunion. He had open reduction and internal fixation using tension band wire device. Fracture union was monitored with serial radiographs and he was followed up for 60 weeks. There was articular surface step after surgical fixation of the patella fracture. At 34 weeks postoperative, there was complete remodeling of the articular surface with good knee function after removal of the tension band wire. Children have good capacity of bone remodeling after fracture. Little retropatella step in a child after patella fracture surgical fixation will remodel with healing.
Tarantino, Umberto; Rao, Cecilia; Tempesta, Valerio; Gasbarra, Elena; Feola, Maurizio
Osteoporosis is characterised by poor bone quality arising from alterations to trabecular bone. However, recent studies have also described an important role of alterations to cortical bone in the physiopathology of osteoporosis. Although dual-energy X-ray absorptiometry (DXA) is a valid method to assess bone mineral density (BMD), real bone fragility in the presence of comorbidities cannot be evaluated with this method. The aim of this study was to evaluate if cortical thickness could be a good parameter to detect bone fragility in patients with hip fracture, independent of BMD. A retrospective study was conducted on 100 patients with hip fragility fractures. Cortical index was calculated on fractured femur (femoral cortical index [FCI]) and, when possible, on proximal humerus (humeral cortical index [HCI]). All patients underwent densitometric evaluation by DXA. Average value of FCI was 0.43 and of HCI was 0.25. Low values of FCI were found in 21 patients with normal or osteopenic values of BMD, while low values of HCI were found in three patients with non-osteoporotic values of BMD. Cortical thinning measured from X-Ray of the femur identifies 21% additional fracture cases over that identified by a T-score fracture risk even in patients with normal and osteopenic BMD. Copyright © 2016 Elsevier Ltd. All rights reserved.
Lakstein, Dror; Bachar, Ira; Debi, Ronen; Lubovsky, Omri; Cohen, Ornit; Tan, Zachary; Atoun, Ehud
The purpose of this study was to evaluate the use of pre-operative digital templating to minimize complications including limb length discrepancy (LLD), intraoperative fractures and early dislocations in patients with intracapsular femoral neck fractures. We retrospectively compared 23 patients undergoing total hip arthroplasty (THA) for intracapsular femoral fractures with pre-operative digital templating and 48 patients without templating. The mean post-operative LLD was significantly lower in patients who had pre-operative templating than in the control group (6.7 vs. 11.5 mm, p = 0.023). Only three patients (13 %) with templating had LLD greater than 1.5 cm, compared to the 15 patients (31 %) without templating (p = 0.17). In eight cases the final femoral stem size matched the templated size, while 19 patients were within two size increments. Complications included one dislocation and one intra-operative fracture in the control group. The present study demonstrated that careful pre-operative planning may reduce LLD in patients undergoing THA due to intracapsular hip fractures.
Zhu, Kang-xiang; Yin, Shan-qing
To explore optimal choice of surgical treatment for subtrochanteric fractures in older children. A retrospective study of 36 older children with subtrochanteric fractures was performed between January 2010 and January 2012. Among them, 18 patients (11 males and 7 females) aged from 7 to 13 years old with an average of 9.4 were treated with titanic elastic nail (TEN) fixation, 4 cases were Type II A, 3 cases were II B, 2 cases were II C, 4 cases were III A, 3 cases were III B according to Seinsheimer classification. Eighteen patients (10 males and 8 females) aged was from 8 to 13 years with an average of 9.6 were treated with locking compression pine (LCP) fixation, and 3 cases were Type II A, 4 cases were II B, 3 cases were II C, 4 cases were IIIA, 2 cases were III B. Fracture healing time, postoperative complications (including wound infection, failure and breakage of internal fixtion, deformities of angular on the sagittal view, deformities of coxa vara) and recovery of hip joint function were observed and recorded. All children were followed up from 15 to 36 months with an average of 21. Fracture were all healed, the time ranged from 7 to 16 weeks (mean 9.5). Three cases in TEN group occurred mild deformities of angular on the sagittal view, 3 cases occurred deformities of coxa vara and 2 cases occurred limb shortening; while 1 case occurred mild deformities of angular on the sagittal view, and no deformities of coxa vara and limb shortening occurred in LCP group. No early close of epiphyseal injury, avascular necrosis of femoral head occurred. Clinical efficacy were evaluated by Sanders standard, 14 cases got excellent results, 3 cases were moderate in LCP group, while 9 cases in excellent, 4 in moderate in TEN group. There were no significant differences between two group in recovery of hip joint function and complications. For the treatment of subtrochanteric fractures in older children,the efficacy of LCP fixation is better than that of TFN fixation, which
Leslie, William D; Lix, Lisa M; Majumdar, Sumit R; Morin, Suzanne N; Johansson, Helena; Odén, Anders; McCloskey, Eugene V; Kanis, John A
Areal bone mineral density (BMD) measurements are confounded by skeletal size. Hip BMD is an input to the FRAX® tool (Centre for Metabolic Bone Diseases, University of Sheffield, United Kingdom), but it is unknown whether performance is affected by hip area. To examine whether fracture prediction by FRAX® is affected by hip area. Cohort study using a population-based BMD registry. A total of 58,108 white women aged ≥40 years. Incident major osteoporotic fracture (MOF; n = 4913) and hip fracture (n = 1369), stratified by total hip area quintile, before and after adjustment for hip axis length (HAL). Smaller hip area was associated with younger age and lower FRAX® scores, whereas incident fractures were greater in those with larger hip area (P for trend hip area quintile increased risk for MOF and hip fracture when adjusted for FRAX® score with BMD (P for trend hip area was associated with greater risk for incident MOF [adjusted hazard ratio (HR), 1.08; 95% confidence interval (CI), 1.05 to 1.11] and hip fracture (HR, 1.16; 95% CI, 1.11 to 1.21), but not after adjustment for HAL. FRAX® with BMD underestimated MOF risk in the largest hip area quintile and underestimated hip fracture risk in the three largest hip area quintiles. In Canadian white women, skeletal size based on hip area affects fracture risk assessment based on FRAX® score with BMD, with risk underestimated in those with larger hip areas. Including HAL in the risk assessment compensates for this confounding by skeletal size and provides for more accurate assessment of fracture risk.
Full Text Available We believe that a certain subset of surgical ankle fracture patients can be made weight-bearing as tolerated immediately following surgery. Immediate weight-bearing as tolerated (IWBAT allows patients to return to ambulation and activities of daily living faster and may facilitate rehabilitation. A prospectively gathered orthopaedic trauma database at a Level 1 trauma center was reviewed retrospectively to identify patients who had ORIF after unstable ankle injuries treated by the senior author. Patients were excluded if they were not IWBAT based on specific criteria or if they did meet followup requirement. Only 1/26 patients was noted to have loss of fixation. This was found at the 6-week followup and was attributed to a missed syndesmotic injury. At 2-week followup, 2 patients had peri-incisional erythema that resolved with a short course of oral antibiotics. At 6-week followup, 20 patients were wearing normal shoes and 6 patients continued to wear the CAM Boot for comfort. To conclude, IWBAT in a certain subset of patients with stable osteosynthesis following an ankle fracture could potentially be a safe alternative to a period of protected weight-bearing.
Brian J. Gates
Full Text Available Osteoporosis is a significant concern for postmenopausal women and is a critical factor in hip fracture. Examining evidence for osteoporosis medications in hip fracture is important for optimizing treatment. Purpose Review risedronate's role for hip fracture in postmenopausal women. Methods A literature search was conducted using Medline and Web of Science. The search was limited using the terms “risedronate” and “hip fracture,” and to studies that included women. Similar articles linked to the search and pertinent articles in bibliographies were also examined. Results Risedronate has demonstrated efficacy and cost effectiveness for hip fracture, but may not be beneficial for patients with low fracture risk. Risedronate is generally well tolerated, but may cause side effects in some patient populations. Conclusion Risedronate has benefit for hip fracture, but patients should be carefully screened to determine the appropriateness of risedronate before starting treatment.
Modarres, Reza; Ouarda, Taha B. M. J.; Vanasse, Alain; Orzanco, Maria Gabriela; Gosselin, Pierre
Changes in extreme meteorological variables and the demographic shift towards an older population have made it important to investigate the association of climate variables and hip fracture by advanced methods in order to determine the climate variables that most affect hip fracture incidence. The nonlinear autoregressive moving average with exogenous variable-generalized autoregressive conditional heteroscedasticity (ARMA X-GARCH) and multivariate GARCH (MGARCH) time series approaches were applied to investigate the nonlinear association between hip fracture rate in female and male patients aged 40-74 and 75+ years and climate variables in the period of 1993-2004, in Montreal, Canada. The models describe 50-56 % of daily variation in hip fracture rate and identify snow depth, air temperature, day length and air pressure as the influencing variables on the time-varying mean and variance of the hip fracture rate. The conditional covariance between climate variables and hip fracture rate is increasing exponentially, showing that the effect of climate variables on hip fracture rate is most acute when rates are high and climate conditions are at their worst. In Montreal, climate variables, particularly snow depth and air temperature, appear to be important predictors of hip fracture incidence. The association of climate variables and hip fracture does not seem to change linearly with time, but increases exponentially under harsh climate conditions. The results of this study can be used to provide an adaptive climate-related public health program and ti guide allocation of services for avoiding hip fracture risk.
Modarres, Reza; Ouarda, Taha B M J; Vanasse, Alain; Orzanco, Maria Gabriela; Gosselin, Pierre
Changes in extreme meteorological variables and the demographic shift towards an older population have made it important to investigate the association of climate variables and hip fracture by advanced methods in order to determine the climate variables that most affect hip fracture incidence. The nonlinear autoregressive moving average with exogenous variable-generalized autoregressive conditional heteroscedasticity (ARMAX-GARCH) and multivariate GARCH (MGARCH) time series approaches were applied to investigate the nonlinear association between hip fracture rate in female and male patients aged 40-74 and 75+ years and climate variables in the period of 1993-2004, in Montreal, Canada. The models describe 50-56% of daily variation in hip fracture rate and identify snow depth, air temperature, day length and air pressure as the influencing variables on the time-varying mean and variance of the hip fracture rate. The conditional covariance between climate variables and hip fracture rate is increasing exponentially, showing that the effect of climate variables on hip fracture rate is most acute when rates are high and climate conditions are at their worst. In Montreal, climate variables, particularly snow depth and air temperature, appear to be important predictors of hip fracture incidence. The association of climate variables and hip fracture does not seem to change linearly with time, but increases exponentially under harsh climate conditions. The results of this study can be used to provide an adaptive climate-related public health program and ti guide allocation of services for avoiding hip fracture risk.
Choo, Suk Kyu; Park, Hyung Jun; Oh, Hyoung-Keun; Kang, Yoo Kyung; Kim, Youngwoo
Acute cholecystitis is a medical complication that can develop in the postoperative period after hip surgery. However, few studies have examined this complication in elderly patients. Our aim was therefore to evaluate the incidence and clinical manifestations of acute cholecystitis after hip fracture in elderly patients. Medical records and radiological studies of patients aged older than 65 years who underwent hip surgery for femoral neck or intertrochanteric fractures at a single hospital from April 2003 to March 2013 were reviewed retrospectively. We analyzed the type of cholecystitis (acalculous or calculous), clinical manifestations, fracture type (neck or trochanteric fracture), age, sex, body mass index, type of surgery, time to surgery, time from surgery to onset of acute cholecystitis and the timing of ambulation in acute cholecystitis cases. There were nine confirmed acute cholecystitis cases among 1211 hip fractures; thus, the incidence of acute cholecystitis within 2 months after hip fracture surgery was 0.74%. The incidence of acute cholecystitis was higher than we expected, and this condition can lead to more serious problems if overlooked. Acute cholecystitis as a medical complication after hip fracture was underestimated in previous studies. Furthermore, acute cholecystitis should be considered as a complication of hip fracture, not hip surgery, in the elderly. The present study does not imply that hip fracture causes acute cholecystitis, although elderly hip fracture patients are in an extremely debilitated state and are prone to developing acute cholecystitis. © 2015 Japan Geriatrics Society.
Fink, B; Oremek, D
To evaluate the hypothesis that failed osteosynthesis of periprosthetic Vancouver type B1 fractures can be treated successfully with stem revision using a transfemoral approach and a cementless, modular, tapered revision stem with reproducible rates of fracture healing, stability of the revision stem, and clinically good results. A total of 14 patients (11 women, three men) with a mean age of 72.4 years (65 to 90) undergoing revision hip arthroplasty after failed osteosynthesis of periprosthetic fractures of Vancouver type B1 were treated using a transfemoral approach to remove the well-fixed stem before insertion of a modular, fluted titanium stem which obtained distal fixation. These patients were clinically and radiologically followed up for a mean 52.2 months (24 to 144). After a mean of 15.5 weeks (standard deviation (sd) 5.7) all fractures had healed. No stems subsided and bony-ingrowth fixation had occurred according to the classification of Engh et al. The mean Harris Hip Score increased from a pre-operative score of 22.2 points (sd 9.7) to 81.5 points (sd 16.8) 24 months post-operatively. All hips had obtained an excellent result according to the classification of Beals and Tower. The technique described here for stem revision provides reproducibly good results in the treatment of failed osteosynthesis for Vancouver types B1 periprosthetic fractures of the hip. Cite this article: Bone Joint J 2017;99-B(4 Supple B):11-16. ©2017 Fink et al.
Flikweert, E R; Wendt, K W; Diercks, R L; Izaks, G J; Landsheer, D; Stevens, M; Reininga, I H F
Surgery for hip fractures is frequently followed by complications that hinder the rehabilitation of patients. The aim of this study was to describe the incidence rate and type of complications, including mortality, after hip fracture surgery, and to identify the risk factors of these complications that may be amenable to prevention. Prospective cohort study of all consecutive patients aged ≥60 treated for a hip fracture at University Medical Center Groningen between July 2009 and June 2013. All patients were treated in a comprehensive multidisciplinary care pathway. Logistic regression analyses were used to investigate which variables were significant risk factors for the occurrence of complications. Additional analyses were conducted to investigate whether the independent variables were significant risk factors for several specific complications and mortality. The study population consisted of 479 patients with a mean age of 78.4 (SD 9.5) years; 33% were men. The overall complication rate was 75%. Delirium was the complication seen most frequently (19%); the incidence of surgical complications was 9%. Most risk factors for complications were not preventable (high comorbidity rate, high age and dependent living situation). However, general anesthesia (OR 1.51; 95% CI 0.97-2.35) and delay in surgery (OR 3.16; 95% CI 1.43-6.97) may be risk factors that can potentially be prevented. Overall, the mortality risk was not higher in patients with a complication, but delirium and pneumonia were risk factors for mortality. The overall complication rate after hip fracture surgery was high. Only few complications were potentially preventable.
Klit, Jakob; Gosvig, Kasper; Magnussen, Erland; Gelineck, John; Kallemose, Thomas; Søballe, Kjeld; Troelsen, Anders
Slipped capital femoral epiphysis is thought to result in cam deformity and femoroacetabular impingement. We examined: (1) cam-type deformity, (2) labral degeneration, chondrolabral damage, and osteoarthritic development, and (3) the clinical and patient-reported outcome after fixation of slipped capital femoral epiphysis (SCFE). We identified 28 patients who were treated with fixation of SCFE from 1991 to 1998. 17 patients with 24 affected hips were willing to participate and were evaluated 10-17 years postoperatively. Median age at surgery was 12 (10-14) years. Clinical examination, WOMAC, SF-36 measuring physical and mental function, a structured interview, radiography, and MRI examination were conducted at follow-up. Median preoperative Southwick angle was 22o (IQR: 12-27). Follow-up radiographs showed cam deformity in 14 of the 24 affected hips and a Tönnis grade>1 in 1 affected hip. MRI showed pathological alpha angles in 15 affected hips, labral degeneration in 13, and chondrolabral damage in 4. Median SF-36 physical score was 54 (IQR: 49-56) and median mental score was 56 (IQR: 54-58). These scores were comparable to those of a Danish population-based cohort of similar age and sex distribution. Median WOMAC score was 100 (IQR: 84-100). In 17 patients (24 affected hips), we found signs of cam deformity in 18 hips and early stages of joint degeneration in 10 hips. Our observations support the emerging consensus that SCFE is a precursor of cam deformity, FAI, and joint degeneration. Neither clinical examination nor SF-36 or WOMAC scores indicated physical compromise.
Azagra, R.; López-Expósito, F.; Martin-Sánchez, JC.; Aguyé, A.; Moreno, N.; Cooper, C.; Díez-Pérez, A.; Dennison, EM.
Summary Temporal trends in hip fracture incidence have recently been reported in some developed countries. Such data in Spain has previously been incomplete; this study reports the stratified incidence of hip fractures in people over 65 in Spain during the last 14 years. Introduction The main objective is to establish whether temporal trends in hip fracture incidence in Spain exist. Methods Ecological study with data from hospital discharges nationwide. The study includes patients aged ≥ 65 years during a 14-year period (1997-2010). The analysis compares two periods of four years: 1997-2000 (P1) and 2007-2010 (P2). Results There were 119,857 fractures in men and 415,421 in women. Comparing periods (P1 vs P2), over ten years the crude incidence rate/100,000 inhabitant/year increased an average of 2.3%/year in men and 1.4% in women. After adjustment, the rate increased an average of 0.4%/year in men (p<0.0001), but decreased 0.2%/year in women (p<0.0001). In men younger than 85, the decrease was not significant except in 70-74 years and from 80 years the adjusted rate increases significantly (p<0.0001). In women under 80 years of age, the decrease in adjusted rate was significant, there was no change in 80-84 years and the adjusted rate increased significantly in individuals 85 years and older (p<0.0001). Mortality rates declined by 22% in both sexes and the index of overaging population rises 30.1% in men and 25.2% in women. Conclusions This study supports other international studies by showing changes in the incidence of hip fractures after age-population adjustment, which denotes a decrease in the younger age groups and among women and shows an increase in both groups over 85 years. The increase in the crude incidence rate of hip fracture in Spain reflects changes in population structure. PMID:24322478
Hung, Li-Wei; Hwang, Yi-Ting; Huang, Guey-Shiun; Liang, Cheng-Chih; Lin, Jinn
Hip fractures in older people requiring dialysis are associated with high mortality. Our study primarily aimed to evaluate the specific burden of dialysis on the mortality rate following hip fracture. The secondary aim was to clarify the effect of the fracture site on mortality. A retrospective cohort study was conducted using Taiwan's National Health Insurance Research Database to analyze nationwide health data regarding dialysis and non-dialysis patients ≥65 years who sustained a first fragility-related hip fracture during the period from 2001 to 2005. Each dialysis hip fracture patient was age- and sex-matched to 5 non-dialysis hip fracture patients to construct the matched cohort. Survival status of patients was followed-up until death or the end of 2011. Survival analyses using multivariate Cox proportional hazards models and the Kaplan-Meier estimator were performed to compare between-group survival and impact of hip fracture sites on mortality. A total of 61,346 hip fracture patients were included nationwide. Among them, 997 dialysis hip fracture patients were identified and matched to 4985 non-dialysis hip fracture patients. Mortality events were 155, 188, 464, and 103 in the dialysis group, and 314, 382, 1505, and 284 in the non-dialysis group, with adjusted hazard ratios (associated 95% confidence intervals) of 2.58 (2.13-3.13), 2.95 (2.48-3.51), 2.84 (2.55-3.15), and 2.39 (1.94-2.93) at 0 to 3 months, 3 months to 1 year, 1 to 6 years, and 6 to 10 years after the fracture, respectively. In the non-dialysis group, survival was consistently better for patients who sustained femoral neck fractures compared to trochanteric fractures (0-10 years' log-rank test, P dialysis group, survival of patients with femoral neck fractures was better than that of patients with trochanteric fractures only within the first 6 years post-fracture (0-6 years' log-rank, P Dialysis was a significant risk factor of mortality in geriatric hip fracture patients. Survival
Danish, national cross-sectional observational study on the prevalence of prior major osteoporotic fractures in adults presenting with hip fracture—limitations and scope for fracture liaison services in prevention of hip fracture
Frederiksen, A.; Abrahamsen, B.; Johansen, P. B.
. Identification of vertebral fractures in particular is lacking. Introduction: The purpose of this study was to examine the prevalence of prior major osteoporotic fractures (MOF) in the prior 10 years preceding hip fracture in order to provide information about the potential for prevention of hip fractures...... if occurring more than 6 months before the present fracture. Results: A total of 28% of hip fracture patients (32% of women and 19% of men) had at least one recognized MOF in the preceding 10 years. Forearm and humerus fractures constituted > 70% of prior MOF. In both genders, vertebral fractures only...... represented a small percentage (2.6%) of previously recognized MOF. Men were less likely than women to have experienced a prior MOF, chiefly due to fewer forearm and humerus fractures. Conclusion: The majority of hip fractures—and in particular hip fractures in men—occur without a previously treated MOF...
Conclusion: Better functional and clinical results were obtained for patients with complex fractures associated with joint of radius distal-end fractures compared with the group treated with an external fixator. At further stages, there was no difference in terms of arthritic changes between the two fixation methods. This result shows that according to AO classification, in the case of type C radius distal-end fractures, except for very distal fractures not amenable to plate fixation, locked volar plating provides a safe and stable fixation and hence why it is the preferred method. [Hand Microsurg 2017; 6(1.000: 15-20
Johansson, Inger; Athlin, Elsy; Frykholm, Lillemor; Bolinder, Helen; Larsson, Gerry
Nursing staff identified postoperative urinary tract infection (UTI) in patients with hip fracture as an increasing problem. A quality improvement project was carried out to investigate the problem and to reduce the incidence. The aim of the study was to describe the occurrence of UTI among patients with hip fracture before and after surgery, to assess whether the decision to use intermittent catheters instead of indwelling catheters was adopted and to test the hypothesis that hospital stay is significantly longer for patients with UTI than for those without infection. One hundred and forty-four patients were investigated for bacteriuria before the first catheterization and 1 week after the last catheterization. Positive urine cultures on admission to hospital were found in 38% of patients. Among those free from bacteria on admission, 61% had a positive urine culture after indwelling catheterization compared with 32% in the group treated with intermittent catetherization. A significantly longer hospital stay (P = 0.05) was found among patients with UTI. The reason for using an indwelling catheter was not found in any medical or nursing documentation for 29% of the patients. The study points to the necessity for systematic assessment to detect and prevent UTI among older patients with hip fracture.
Barwar, Nilesh; Meena, Sanjay; Aggarwal, Shashi Kant; Garhwal, Prashant
Dynamic hip screw (DHS) is recommended for the fixation of stable intertrochanteric fractures. Its postoperative cut-out rate ranges from 1% to 6%. In osteoporotic bone, normal screws in DHS blade provide less anchorage compared to locking screws. This study aims to compare DHS with locking side plate and conventional side plate. Fifty consecutive patients with intertrochanteric fractures were randomly allocated for fixation with a standard DHS (group A) and locking DHS (Combi plate, group B). We compared the clinical and radiological outcomes for the conventional DHS and locking DHS in intertrochanteric fractures. Functional outcome was evaluated using the Parker mobility score. Coxa valga was found more frequently in group A than in group B (12% vs. 0%, P=0.42). Coxa vara showed the same trend (12% vs. 8%, P=0.81). Rate of restoration of postoperative neck-shaft angle within 20° of sound side was higher in group B (8% cases) than in group A (4% cases, P=0.98). The rate of anteversion angle restoration within 10° of sound side was also higher in group B (100% vs. 88%, P=0.85). The average lag screw slippage in group A and group B was 3.2 mm and 4.2 mm, the average fracture union duration was 17.1 weeks and 16.4 weeks, and the mean Parker score was 5.6 and 5.8 respectively. Screw cut-out was seen in one patient in group A. No cut-out was seen in any of the patient in group B. No patient developed deep infection, avascular necrosis, deep vein thrombosis or any other significant complications. The present study demonstrated that treating intertrochanteric fracture with a locking DHS allows sound bone healing and is not associated with any major complications. Although this report is promising, it should be interpreted with caution because only a prospective study with a large sample size would allow definitive conclusion.
Lorich, Dean G; Warner, Stephen J; Schottel, Patrick C; Shaffer, Andre D; Lazaro, Lionel E; Helfet, David L
Patella fractures are challenging orthopaedic injuries. Many commonly used fixation techniques can be ineffective and lead to poor clinical outcomes even with satisfactory reductions and fracture healing. In this investigation, we present the technique of cage plate fixation of patella fractures and the clinical outcomes of 9 initial patients surgically treated at our institution. This technique allows direct visualization of the articular reduction, provides multiplanar fixation, effectively stabilizes inferior pole comminution, and reduces the risk of patella vascular disruption. Using this technique, we have achieved excellent functional and radiographic outcomes.
Sharma, Gaurav; Chadha, Manish; Pankaj, Amite
Traumatic posterior hip dislocation associated with a fracture of the femoral neck is a rare injury. The combination of posterior dislocation of the femoral head with ipsilateral femoral neck and shaft fractures is even rarer, with only one such case reported in literature. We present the case of a 50-year-old man, with traumatic posterior dislocation of the hip, and fractures of the femoral neck and shaft, in addition to an undisplaced superior pubic ramus fracture of the acetabulum. Osteosynthesis of the femoral shaft fracture followed by open reduction of the femoral head and fixation of the neck was undertaken, while taking care not to damage the intact retinaculum on the posterosuperior aspect of the femoral neck. The radiographs revealed union of all fractures without evidence of avascular necrosis of the femoral head at final follow-up of two years. This case is of particular interest as it highlights some of the important factors in deciding between head preservation versus arthroplasty for this complex fracture-dislocation.
Fraenkel, M; Yitshak-Sade, M; Beacher, L; Carmeli, M; Mandelboim, M; Siris, E; Novack, V
Osteoporotic hip fractures in 4344 patients were more common during winter. Lower temperatures were associated with higher rates of fracture only in those not vaccinated for influenza. Influenza outbreaks increased the risk of hip fractures. Further studies are needed to assess whether influenza vaccination can prevent hip fractures. Winter seasonality of osteoporotic hip fracture incidence has been demonstrated, yet the explanation for the association is lacking. We hypothesize that the seasonality of osteoporotic hip fracture can be explained by an association between hip fractures and seasonal influenza outbreaks. This retrospective cohort study included all patients admitted to Soroka University Medical Center with a diagnosis of osteoporotic hip fracture (ICD-9 code 820) between the years 2001 and 2013. Patients with malignancies, trauma, and age under 50 were excluded. In a time series analysis, we examined the association between hip fracture incidence and seasonality adjusted for meteorological factors, and population rates of influenza infection and vaccination using Poisson models. Four thousand three hundred forty-four patients with a hip fracture were included (69% females, mean age 78). Daily fracture rates were significantly higher in winter (1.1 fractures/day) compared to summer, fall, and spring (0.79, 0.90, and 0.91; p risk only in those not vaccinated for influenza (n = 2939, for every decrease of 5 °C, RR 1.08, CI 1.02-1.16; p risk for hip fracture, adjusted for seasons and temperature, was 1.26 2 weeks following a week with high infection burden (CI 1.05;1.51 p = 0.01), while the temperature was not significantly associated with the fracture risk. Under dry and warm desert climate, winter hip fracture incidence increase might be associated with influenza infection, and this effect can be negated by influenza vaccination.
Full Text Available Objective: The aim of this observational study, promoted by the Health Authorities of the Regione Veneto (Italy, is to assess the prevalence of the most relevant environmental and individual risk factors in subjects with a recent hip fracture. Methods: Patients aged more than 60 years of both genders with a recent hip fracture not associated with malignancies, were administered questionnaires on dietary habits, sun exposure, and disability score. A complete family, pharmacological and pathology history was collected together with information on previous falls, details of the fracture index, and anthropometric data. In all subjects, blood was taken for the measurement of serum 25 hydroxy-vitamin D (25OHD. Results: The study included 704 patients (573 women and 131 men. Mean age was 81±8 years (range 60-102. Severe pre-fracture disability was a common feature (58% associated with multiple co-morbidities (84%, more frequently cardio- vascular and neurological diseases, and specific medications. In a large proportion (86% of the patients, environmental or individual risk factors for falling were found. Vitamin D insufficiency (serum 25OHD levels <75 nmol/l was quite common (70%, particularly in the regional Health Districts were strategies for preventing vitamin D deficiency were not implemented (91%. Only a small proportion (17% of the study population had been evaluated and treated for osteoporosis. Conclusions: In senile patients with a recent hip fracture, pre-existing disability, multiple co-morbidities, high risk of falling and inadequate intake of calcium and vitamin D is relatively common. Community and case-finding interventions aimed at selecting subjects at high risk of osteoporosis, preventing vitamin D and dietary calcium deficiency, and increasing awareness on the environmental risks of falling are highly warranted.
Lenz, Mark; Stoffel, Karl; Gueorguiev, Boyko; Klos, Kajetan; Kielstein, Heike; Hofmann, Gunther O
Orthogonal plate osteosynthesis enhances fixation stability in periprosthetic femur fractures. Another option are locking attachment plates (LAP) allowing bicortical locking screw placement lateral to the prosthesis stem. Stability of lateral plate osteosynthesis with two LAP (2LAP) was compared to anterolateral orthogonal plate osteosynthesis (OP) with one LAP in a periprosthetic femur fracture model. In six pairs of fresh frozen human femora with cemented Charnley hip prosthesis, a transverse osteotomy was set distal to the tip of the prosthesis simulating a Vancouver type B1 fracture. Each pair was instrumented using a plate tensioner with either one lateral plate and two LAP, or two orthogonal anterolateral plates and one LAP. Stiffness was determined in a four-point-bending test prior to cyclic testing (2Hz) with physiologic profile and progressively increasing load up to catastrophic construct failure. Paired t-test and Wilcoxon-signed-rank test were used for statistical evaluation at a level of significance p = 0.05. The OP construct exhibited a significantly higher number of cycles and load to failure (39,627 cycles ± 4,056; 4,463 N ± 906) compared to the 2LAP construct (32,927 cycles ± 3,487; 3,793 N ± 849), p < 0.01. Mediolateral bending and torsional stiffness of the OP (1610 N/mm ± 249; 16.9 Nm/mm ± 6.3) were significantly higher compared to 2 LAP (1077 N/mm ± 189; 12.1 Nm/mm ± 3.9), p = 0.03 for both comparisons. Orthogonal plate osteosynthesis is a valuable option in periprosthetic fracture surgery, offering increased stability compared to a single lateral plate fixed with two LAP. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.
Full Text Available Periprosthetic fractures after hip resurfacings are rare occurrences that can pose a challenge to orthopaedic surgeons. With hip resurfacings becoming more common, the prevalence of these fractures is likely to increase because these patients are usually younger and more active. We report a case of traumatic periprosthetic proximal femur fracture treated with a reconstruction intramedullary nail technique.
Palm, Henrik; Posner, Eva; Ahler-Toftehøj, Hans-Ulrik
Hip fracture treatment is controversial, with high complication rates. An algorithm for hip fracture surgery has shown reduced reoperation rates, but choice of implant is based on the commonly used fracture classifications, which were previously evaluated to be unreliable. The purpose of this study...
Shen, Jia-Zuo; Yao, Jian-Fei; Lin, Da-Sheng; Lian, Ke-Jian; Ding, Zhen-Qi; Lin, Bin; Guo, Zhi-Min; Zhang, Ming-Hua; Li, Qiang; Li, Lin; Qi, Peng
Delayed bone union, nonunion or osteonecrosis often occur after femoral neck fractures in young adults. Secondary bone healing requires strong internal fixation, intramedullary pressure reduction and early functional exercise. To compare bone healing of femoral neck fractures treated with hollow-bone-graft dynamic hip screws (Hb-DHS) and standard dynamic hip screws (DHS) in an animal model. Testing of specifically designed fixation devices in a pig animal model. We designed Hb-DHS and DHS devices appropriate to the femoral neck and head of experimental animals and used them in eight pigs (4-month-old, male or female, 30-40 kg/each). Under anesthesia, we induced medium neck type, Garden III type femoral neck fractures in each pig with fracture gaps of 0.5 mm and then fixed each left femur with Hb-DHS and each right femur with DHS. We assessed the animals radiographically and by postmortem visual appraisal of evidence of bone healing 8 and 16 weeks postoperatively. There were significant differences in radiographic and general findings between the Hb-DHS and DHS groups at weeks 8 and 16 postoperatively. We found statistically significant differences between the Hb-DHS and DHS groups in bone healing scores, trabecular bone volume percentage and bone mineral density as assessed on plain radiographs and computed tomography images (P femoral neck bone union, stimulates trabecular bone formation, increases BMD and has advantages over DHS for internal fixation of femoral neck fractures. This animal experiment will contribute to developing optimal treatment for femoral neck fractures in young adults.
Egol, Kenneth; Howard, Daniel; Monroy, Alexa; Crespo, Alexander; Tejwani, Nirmal; Davidovitch, Roy
Operative fixation of displaced inferior pole patella fractures has now become the standard of care. This study aims to quantify clinical, radiographic and functional outcomes, as well as identify complications in a cohort of patients treated with non-absorbable braided suture fixation for inferior pole patellar fractures. These patients were then compared to a control group of patients treated for mid-pole fractures with K-wires or cannulated screws with tension band wiring. In this IRB approved study, we identified a cohort of patients who were diagnosed and treated surgically for a displaced patella fracture. Demographic, injury, and surgical information were recorded. All patients were treated with a standard surgical technique utilizing non-absorbable braided suture woven through the patellar tendon and placed through drill holes to achieve reduction and fracture fixation. All patients were treated with a similar post-operative protocol and followed up at standard intervals. Data were collected concurrently at follow up visits. For purpose of comparison, we identified a control cohort with middle third patella fractures treated with either k-wires or cannulated screws and tension band technique. Patients were followed by the treating surgeon at regular follow-up intervals. Outcomes included self-reported function and knee range of motion compared to the uninjured side. Forty-nine patients with 49 patella fractures identified retrospectively were treated over 9 years. This cohort consisted of 31 females (63.3%) and 18 males (36.7%) with an average age of 57.1 years (range 26-88 years). Patients had an average BMI of 26.48 (range 19-44.08). Thirteen patients with inferior pole fractures underwent suture fixation and 36 patients with mid-pole fractures underwent tension band fixation (K-wire or cannulated screws with tension band). In the suture cohort, one fracture failed open repair (7.6%), which was revised again with sutures and progressed to union. Of the 36
Leslie, William D; Lix, Lisa M; Morin, Suzanne N; Johansson, Helena; Odén, Anders; McCloskey, Eugene V; Kanis, John A
Most studies report that longer hip axis length (HAL) is associated with increased hip fracture risk in women, but comparable data in men are sparse. Using a registry of all dual-energy X-ray absorptiometry (DXA) results for Manitoba, Canada, we identified 4738 men and 50,420 women aged 40 yr and older with baseline hip DXA results, HAL measurements, and Fracture Risk Assessment Tool (FRAX) hip fracture probability computed with femoral neck bone mineral density (BMD). Population-based health service records were assessed for a subsequent hospitalization with a primary diagnosis of hip fracture. During mean 6.2 yr of follow-up, 70 men and 1020 women developed incident hip fractures. Mean HAL was significantly greater in those with vs without incident hip fractures (men 123.0 ± 7.6 vs 121.3 ± 7.4 mm, p = 0.050; women 106.9 ± 6.2 vs 104.6 ± 6.2 mm, p hip fracture risk by 3.6% in men (p = 0.022) and 4.6% in women (p hip fracture probability, each millimeter increase in HAL increased hip fracture risk by 3.4% in men (p = 0.031) and 4.8% in women (p hip fracture probability 4.7% for every millimeter that HAL is above the sex-specific average, relative decrease in hip fracture probability 3.8% for every millimeter that HAL is below the sex-specific average. We concluded that greater DXA-derived HAL is associated with increased incident hip fracture risk in both men and women, and this risk is independent of BMD and FRAX probability. Copyright © 2016 The International Society for Clinical Densitometry. Published by Elsevier Inc. All rights reserved.
Ferrari, Serge; Reginster, Jean-Yves; Brandi, Maria Luisa; Kanis, John A; Devogelaer, Jean-Pierre; Kaufman, Jean-Marc; Féron, Jean-Marc; Kurth, Andreas; Rizzoli, René
This review provides a critical analysis of currently available approaches to increase bone mass, structure and strength through drug therapy and of possible direct intra-osseous interventions for the management of patients at imminent risk of hip fracture. Osteoporotic hip fractures represent a particularly high burden in morbidity-, mortality- and health care-related costs. There are challenges and unmet needs in the early prevention of hip fractures, opening the perspective of new developments for the management of osteoporotic patients at imminent and/or at very high risk of hip fracture. Amongst them, preventive surgical intervention needs to be considered. A European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO)/International Osteoporosis Foundation (IOF) working group reviewed the presently available intervention modalities including preventive surgical options for hip fragility. This paper represents a summary of the discussions. Prevention of hip fracture is currently based on regular physical activity; prevention of falls; correction of nutritional deficiencies, including vitamin D repletion; and pharmacological intervention. However, efficacy of these various measures to reduce hip fractures is at most 50% and may need months or years before becoming effective. To face the challenges of early prevention of hip fractures for osteoporotic patients at imminent and/or at very high risk of hip fracture, preventive surgical intervention needs further investigation. Preventive surgical intervention needs to be appraised for osteoporotic patients at imminent and/or at very high risk of hip fracture.
Ding, Haoliang; Qin, Hui; An, Zhiquan
Minimally invasive plate osteosynthesis(MIPO) has been considered as an alternative for fracture treatment. Previous study has demonstrated that MIPO technique has the advantage of less soft tissue injury compared with open reduction internal fixation (ORIF). However, the comparison of callus formation and mineralization between two plate osteosynthesis methods remains unknown. In this experiment, ulna fracture model was established in 42 beagle dogs. The fractures underwent reduction and internal fixation with MIPO or ORIF. Sequential fluorescent labeling and radiographs were applied to determine new callus formation and mineralization in two groups after operation. At 4, 8 and 12 weeks postoperatively, the animals were selected to be sacrificed and the ulna specimens were analyzed by Micro-CT. The sections were also treated with Masson staining for histological evaluation. More callus formation was observed in MIPO group in early stage of fracture healing. The fracture union rate has no significant difference between two groups. The results indicate that excessive soft tissue stripping may impact early callus formation. As MIPO technique can effectively reduce soft tissue injury with little incision, it is considered to be a promising alternative for fracture fixation. PMID:26444295
Full Text Available BACKGROUND: Intertrochanteric fractures are a major cause of morbidity and mortality in geriatric population. Osteoporosis contributes significantly to the comminution and instability in such fractures. Internal fixations in unstable intertrochanteric fractures are a ssociated with high rates of implant failures and gross restriction of hip movements. This study was undertaken to evaluate the efficacy of cemented bipolar hemiart h roplasty in elderly patients with osteoporotic, unstable intertrochanteric fractures. PATIE NTS AND METHODS: 52 patients aged above 60 years with unstable, comminuted intertrochanteric fractures with Singh’s index < 4 were operated with primary cemented bipolar hemireplacement arthroplasty. All the patients were mobilized early with full weight b earing in the post - operative period as permitted. 50 patients were evaluated for the functional outcome with Harris Hip score. RESULTS: The average age of patients was 65 years with female predominance (64%. Left side (56% was commonly involved and the c ommonest mode of injury was due to a trivial fall at home. Hypertension (30% was the commonest co - morbid condition. Limb shortening was the commonest complication (8%. The mean ± S.D. of the Harris Hip score was 85.6 ± 10.59 with a range from 56 to 96. Resul ts were excellent in 62%, good in 22%, fair in 12% and poor in 4% of cases. CONCLUSION: Elderly osteoporotic patients with comminuted, unstable intertrochanteric fractures have an increased prevalence of unsatisfactory functional results with conventional internal fixation devices. Primary cemented bipolar hemiarthroplasty with anatomical reconstruction of the trochanters allows early mobilization, improved functional outcome with relatively low incidence of associated complications.
Egemen, Onur; Özkaya, Özay; Aksan, Tolga; Bingöl, Derya; Akan, Mithat
Frontal sinus fractures constitute 5% to 15% of maxillofacial fractures, and isolated anterior table injuries account for 33% of frontal sinus fractures. The treatment strategy of frontal sinus fractures should be individualized according to the extent of the injury. Endoscope-assisted repair without any fixation method for the treatment of mildly and moderately displaced (1-5 mm) and closed isolated anterior table frontal sinus fractures is a good alternative technique for treatment.Between April 2010 and December 2011, 5 patients with mildly and moderately displaced isolated anterior table fractures were treated. There were no lacerations in forehead skin of the patients. Preoperatively, the patients showed forehead depression at the fracture site, and computed tomography scan was taken to determine the extent of the frontal sinus fracture. Endoscope-assisted closed reduction treatment was applied to all patients.All fractures were reduced successfully. None of the patients needed to undergo conversion to traditional incision techniques. No patients required fixation materials. Cosmetic deformity was corrected in all patients perfectly.In the standard treatment modality of frontal sinus fractures, repair is best performed by a coronal approach. However, bicoronal incision has many disadvantages. Several authors have recently described some endoscopic and closed approaches to these injuries. The main disadvantages of these methods are poor visualization or fixation requirement with exogenous materials.Endoscopic reduction of mildly and moderately displaced closed isolated anterior table frontal sinus fractures without fixation is feasible. It results in a good clinical outcome in selected cases.
Höch, Andreas; Schimpf, Richard; Hammer, Niels; Schleifenbaum, Stefan; Werner, Michael; Josten, Christoph; Böhme, Jörg
Cement augmentation of pedicle screws is the gold standard for the stabilization of osteoporotic fractures of the spine. In-screw cement augmentation, in which cement is injected through the cannula, is another option for fracture stabilization of fragility fractures of the sacrum. However, biomechanical superiority of this technique compared to conventional sacroiliac screw fixation has not been tested. The present study compares the stability of cement-augmented and non-cement-augmented sacroiliac screw fixation in osteoporotic sacrum fractures under cyclic loading. Eight human donor pelvises with intact ligaments and 5th lumbar vertebra were dissected. A vertical shear fracture was created as a combination of a sacrum fracture and cutting of the symphysis. Both sides were tested in a single-limb-stance setup with 10,000 loading cycles applied. Stiffness of the pelvis and displacement of the fracture were measured using a hydraulic testing machine and a 3D image correlation system. The augmented screw fixation failed in two of eight pelvises, and the non-augmented screws failed in three of eight pelvises. CT scans showed no leakage of cement. In-screw polymethylmethacrylate (PMMA) augmentation showed no advantage based on measured displacement of the sacrum fractures or stiffness for sacroiliac screw fixation of fragility fractures of the sacrum.
Çelik, Talip; Mutlu, İbrahim; Özkan, Arif; Kişioğlu, Yasin
This study presents the numerical analysis of stem fixation in hip surgery using with/without cement methods since the use of cement is still controversial based on the clinical studies in the literature. Many different factors such as stress shielding, aseptic loosening, material properties of the stem, surgeon experiences etc. play an important role in the failure of the stem fixations. The stem fixation methods, cemented and uncemented, were evaluated in terms of mechanical failure aspects using computerized finite element method. For the modeling processes, three dimensional (3D) femur model was generated from computerized tomography (CT) images taken from a patient using the MIMICS Software. The design of the stem was also generated as 3D CAD model using the design parameters taken from the manufacturer catalogue. These 3D CAD models were generated and combined with/without cement considering the surgical procedure using SolidWorks program and then imported into ANSYS Workbench Software. Two different material properties, CoCrMo and Ti6Al4V, for the stem model and Poly Methyl Methacrylate (PMMA) for the cement were assigned. The material properties of the femur were described according to a density calculated from the CT images. Body weight and muscle forces were applied on the femur and the distal femur was fixed for the boundary conditions. The calculations of the stress distributions of the models including cement and relative movements of the contacts examined to evaluate the effects of the cement and different stem material usage on the failure of stem fixation. According to the results, the use of cement for the stem fixation reduces the stress shielding but increases the aseptic loosening depending on the cement crack formations. Additionally, using the stiffer material for the stem reduces the cement stress but increases the stress shielding. Based on the results obtained in the study, even when taking the disadvantages into account, the cement usage
Jürisson, M; Vorobjov, S; Kallikorm, R; Lember, M; Uusküla, A
The incidence of hip fractures among individuals aged over 50 in Estonia and trends over time were assessed for 2005-2012. The incidence among women is relatively low, with the declining trend, but the rate among men is among the highest in Eastern and Central Europe. The aim of this study was to assess the incidence and trends of hip fractures among individuals over 50 years in Estonia in 2005-2012 and to increase understanding of the incidence of hip fractures in Eastern Europe. We identified all patients aged 50 years or older with hip fracture (ICD-10 codes S72.0, S72.1 and S72.2) in 2005-2012 using medical claims data from the Estonian Health Insurance Fund. Crude and age-specific incidence rates were calculated for men and women using the population of Estonia in 2005-2012. To adjust for age differences in the population, standardized incidence rates (SIR) were estimated. The SIR per 100,000 for the entire observation period was 209.2 (95% CI 204.2 to 214.2) in women and 215.6 (95%CI 208.2 to 223.1) in men, resulting in a female to male rate ratio of 0.97 (95% CI 0.84 to 1.11). Over the period of 2005-2012 the estimated SIR/100,000 ranged from 211.5 (95% CI 196.8-226.3) in 2005 to 183.7 (95% CI 170.8-196.7) in 2012 in women, and from 238.5 (95% CI 215.4-261.7) in 2005 to 187.9 (95% CI 169.0-206.8) in 2012, in men. For women, the decrease in SIR for the study period approached statistical significance (p = 0.058), and for the period of 2009-2012, we observed an accelerated 16% decrease (p = 0.008). The incidence of hip fractures among Estonian women is relatively low, whereas the rate among men is among the highest in Eastern and Central Europe. In line with many countries, we found a recent decline in incidence among women.
Full Text Available Christina A Mosk,1 Marnix Mus,1 Jos PAM Vroemen,1 Tjeerd van der Ploeg,2 Dagmar I Vos,1 Leon HGJ Elmans,3 Lijckle van der Laan1 1Department of Surgery, Amphia Hospital, Breda, 2Department of Public Health, Erasmus MC–University Medical Center, Rotterdam, 3Department of Orthopedic Surgery, Amphia Hospital, Breda, the Netherlands Background: Delirium in hip fractured patients is a frequent complication. Dementia is an important risk factor for delirium and is common in frail elderly. This study aimed to extend the previous knowledge on risk factors for delirium and the consequences. Special attention was given to patients with dementia and delirium.Methods: This is a retrospective cohort study performed in the Amphia Hospital, Breda, the Netherlands. A full electronic patient file system (Hyperspace Version IU4: Epic, Inc., Verona, WI, USA was used to assess data between January 2014 and September 2015. All patients presented were aged ≥70 years with a hip fracture, who underwent surgery with osteosynthesis or arthroplasty. Patients were excluded in case of a pathological or a periprosthetic hip fracture, multiple traumatic injuries, and high-energy trauma. Patient and surgical characteristics were documented. Postoperative outcomes were noted. Delirium was screened using Delirium Observation Screening Scale and dementia was assessed from medical notes.Results: Of a total of 566 included patients, 75% were females. The median age was 84 years (interquartile range: 9. Delirium was observed in 35%. Significant risk factors for delirium were a high American Society of Anesthesiology score, delirium in medical history, functional dependency, preoperative institutionalization, low hemoglobin level, and high amount of blood transfusion. Delirium was correlated with a longer hospital stay (P=0.001, increased association with complications (P<0.001, institutionalization (P<0.001, and 6-month mortality (P<0.001. Patients with dementia (N=168 had a
fractures of the proximal femur. Two groups of patients were studied: duration of surgery, duration of osteosynthesis, complications, and outcomes (in terms of one year after the dismantling clips using the modified scale Luboshyce — Mattis — Schwartzberg. Results. Fracture repair was achieved in 40 patients (62,5% of the 1st group. The following complications were observed in this group: non-union and pseudarthrosis — in 21 (32,8% case; aseptic necrosis of the femoral head in 3 (4,7% cases; hip ankyloses — in one (1,6% case, breakage and migration of wires into the joint cavity and smaller pelvis — 3 (4,7% patients and cutting out of wires from the femoral head was observed in 3 (4,7% cases. Totally 61 complication were revealed. In the second group of the patients non-union was found in one patient (64 years old. Complications were observed in 6 patients of this group — pint-tract infection, moderate secondary displacement of the fragments (the patient fell down on the operated limb and wire breakage. Conclusion. The efficiency of the femoral neck osteosynthesis with application of elaborated monolateral wire- and half-pin fixator made up 95,7% of the positive outcomes (in osteosynthesis using bunch of wires with llizarov frame fixation the same 60,9% of the positive outcomes.
Geusens, Piet; van Geel, Tineke; van den Bergh, Joop
The etiology of hip fractures is multifactorial and includes bone and fall-related factors. Low bone mineral density (BMD) and BMD-related and BMD-independent geometric components of bone strength, evaluated by hip strength analysis (HSA) and finite element analysis analyses on dual-energy X-ray absorptiometry (DXA) images, and ultrasound parameters are related to the presence and incidence of hip fracture. In addition, clinical risk factors contribute to the risk of hip fractures, independent of BMD. They are included in the fracture risk assessment tool (FRAX) case finding algorithm to estimate in the individual patient the 10-year risk of hip fracture, with and without BMD. Fall risks are not included in FRAX, but are included in other case finding tools, such as the Garvan algorithm, to predict the 5- and 10-year hip fracture risk. Hormones, cytokines, growth factors, markers of bone resorption and genetic background have been related to hip fracture risk. Vitamin D deficiency is endemic worldwide and low serum levels of 25-hydroxyvitamin D [25(OH)D] predict hip fracture risk. In the context of hip fracture prevention calculation of absolute fracture risk using clinical risks, BMD, bone geometry and fall-related risks is feasible, but needs further refinement by integrating bone and fall-related risk factors into a single case finding algorithm for clinical use. PMID:22870438
Fuchs, M; Perka, C; von Roth, P
Periprosthetic fractures following hip and knee arthroplasty are potentially severe complications. As a fundament in diagnostic and therapeutic procedures, specific classification systems are necessary to ensure an optimal individualized treatment of these sometimes complicated fractures. This review article summarizes the epidemiological aspects, risk factors and diagnostics of periprosthetic hip and knee fractures. The most frequently used location related fracture classifications systems are explained. In addition, the recently introduced unified classification system (UCS), which is applicable to any location of periprosthetic fractures, is described in detail. Initial studies have shown a reliable applicability of the UCS to periprosthetic hip and knee fractures.
Barbour, Kamil E; Lui, Li-Yung; Ensrud, Kristine E; Hillier, Teresa A; LeBlanc, Erin S; Ing, Steven W; Hochberg, Marc C; Cauley, Jane A
Hip fractures are the most devastating consequence of osteoporosis and impact 1 in 6 white women leading to a two- to threefold increased mortality risk in the first year. Despite evidence of inflammatory markers in the pathogenesis of osteoporosis, few studies have examined their effect on hip fracture. To determine if high levels of inflammation increase hip fracture risk and to explore mediation pathways, a case-cohort design nested in a cohort of 4709 white women from the Study of Osteoporotic Fractures was used. A random sample of 1171 women was selected as the subcohort (mean age 80.1 ± 4.2 years) plus the first 300 women with incident hip fracture. Inflammatory markers interleukin-6 (IL-6) and soluble receptors (SR) for IL-6 (IL-6 SR) and tumor necrosis factor (TNF SR1 and TNF SR2) were measured, and participants were followed for a median (interquartile range) of 6.3 (3.7, 6.9) years. In multivariable models, the hazard ratio (HR) of hip fracture for women in the highest inflammatory marker level (quartile 4) was 1.64 (95% confidence interval [CI], 1.09-2.48, p trend = 0.03) for IL-6 and 2.05 (95% CI, 1.35-3.12, p trend hip fracture was 1.51 (95% CI, 1.07-2.14) and 1.42 (95% CI, 0.87-2.31) compared with women with zero to one marker(s) in the highest quartile (p trend = 0.03). After individually adjusting for seven potential mediators, cystatin-C (a biomarker of renal function) and bone mineral density (BMD) attenuated HRs among women with the highest inflammatory burden by 64% and 50%, respectively, suggesting a potential mediating role. Older white women with high inflammatory burden are at increased risk of hip fracture in part due to poor renal function and low BMD. © 2014 American Society for Bone and Mineral Research.
Sobky, Kareem; Baldini, Todd; Thomas, Kenneth; Bach, Joel; Williams, Allison; Wolf, Jennifer Moriatis
The purpose of this study was to compare the biomechanical properties of four volar fixed-angle fracture fixation plate designs in a novel sawbones model as well as in cadavers. Four volar fixed angle plating systems (Hand Innovations DVR-A, Avanta SCS/V, Wright Medical Lo-Con VLS, and Synthes stainless volar locking) were tested on sawbones models using an osteotomy gap model to simulate a distal radius fracture. Based on a power analysis, six plates from each system were tested to failure in axial compression. To simulate loads with physiologic wrist motion, six plates of each type were then tested to failure following 10,000 cycles applying 100N of compression. To compare plate failure behavior, two plates of each type were implanted in cadaver wrists and similar testing applied. All plate constructs were loaded to failure. All failed with in apex volar angulation. The Hand Innovations DVR-A plate demonstrated significantly more strength in peak load to failure and failure after fatigue cycling (p value biomechanical testing and indicates that volar fixation of unstable distal radius fractures with a fixed angle device is a reliable means of stabilization.
Angthong, Chayanin; Angthong, Wirana; Harnroongroj, Thos; Naito, Masatoshi; Harnroongroj, Thossart
Survival rates are poorer after a second hip fracture than after a first hip fracture. Previous survival studies have included in-hospital mortality. Excluding in-hospital deaths from the analysis allows survival times to be evaluated in community-based patients. There is still a lack of data regarding the effects of subsequent fractures on survival times after hospital discharge following an initial hip fracture. This study compared the survival times of community-dwelling patients with hip fracture who had or did not have a subsequent major long-bone fracture. Hazard ratios and risk factors for subsequent fractures and mortality rates with and without subsequent fractures were calculated. Of 844 patients with hip fracture from 2000 through 2008, 71 had a subsequent major long-bone fracture and 773 did not. Patients who died of other causes, such as perioperative complications, during hospitalization were excluded. Such exclusion allowed us to determine the effect of subsequent fracture on the survival of community-dwelling individuals after hospital discharge or after the time of the fracture if they did not need hospitalization. Demographic data, causes of death, and mortality rates were recorded. Differences in mortality rates between the patient groups and hazard ratios were calculated. Mortality rates during the first year and from 1 to 5 years after the most recent fracture were 5.6% and 1.4%, respectively, in patients with subsequent fractures, and 4.7% and 1.4%, respectively, in patients without subsequent fractures. These rates did not differ significantly between the groups. Cox regression analysis and calculation of hazard ratios did not show significant differences between patients with subsequent fractures and those without. On univariate and multivariate analyses, age fracture. This study found that survival times did not differ significantly between patients with and without subsequent major long-bone fractures after hip fracture. Therefore, all
Rosengren, B E; Björk, J; Cooper, C
born thereafter however seem to have a higher hip fracture risk, and we expect a reversal of the present decline in rates, with increasing hip fracture rates in both Denmark and Sweden during the upcoming decade. CONCLUSIONS: Time trends, cohort, and period effects were different in SE and DK. This may......This study used nationwide hip fracture data from Denmark and Sweden during 1987-2010 to examine effects of (birth) cohort and period. We found that time trends, cohort, and period effects were different in the two countries. Results also indicated that hip fracture rates may increase in the not so...... far future. INTRODUCTION: The reasons for the downturn in hip fracture rates remain largely unclear but circumstances earlier in life seem important. METHODS: We ascertained hip fractures in the populations ≥50 years in Denmark and Sweden in national discharge registers. Country- and sex-specific age...
Sanjeev Kumar Kare
Full Text Available BACKGROUND Fracture of the distal radius (‘broken wrist’ is a common clinical problem. It can be treated conservatively usually involving wrist immobilisation in a plaster cast or surgically. A key method of surgical fixation is external fixation. MATERIALS AND METHODS A prospective study was carried out on 66 patients admitted between June 2014 to May 2016 for evaluation of conservative and surgical management of distal radius fractures. RESULTS Excellent, fair or good result was noticed in around 85% of cases managed conservatively and in above 90% of cases managed by external fixator. CONCLUSION There is some evidence to support the use of external fixation for dorsally displaced fractures of the distal radius in adults. Though, there is insufficient evidence to confirm a better functional outcome, external fixation reduces redisplacement gives improved anatomical results and most of the excess surgically-related complications are minor.
Gold, Aviram; Sever, Ronen; Lerman, Yaffa; Salai, Moshe; Justo, Dan
We sought to determine if low ANSS, usually associated with high pressure ulcer risk, are also associated with postoperative complications and in-hospital mortality following hip fracture surgery in the elderly. This was a retrospective cross-sectional study conducted in a tertiary medical center. The medical charts of consecutive elderly (≥ 65 years) patients admitted for hip fracture surgery were studied for the following measurements: ANSS, demographic data, co-morbidities, postoperative complications, the need for revision procedures, and in-hospital mortality. Except for pressure ulcers, postoperative complications included: acute coronary syndrome, acute renal failure, confusion, pneumonia, urinary tract infection, venous thromboembolism, and wound infection. The final cohort included 269 patients: 198 (73.6%) females and 71 (26.4%) males. Mean age for the entire cohort was 82.8 ± 0.4 years. Most patients underwent an internal fixation (n=146; 54.3%) or hemiarthroplasty (n=92; 34.2%). Overall, 110 (40.9%) patients had low (<15) ANSS. Patients with low ANSS had significantly more postoperative complications relative to patients with high ANSS (0.77 ± 0.09 vs. 0.23 ± 0.04; p<0.0001). Among all postoperative complications, urinary tract infection was independently associated with low ANSS (p<0.0001). ANSS were independently associated with postoperative complications (p<0.0001), the need for revision procedures (p=0.019), and in-hospital mortality (p=0.016). We conclude that the Norton scoring system may be used for predicting postoperative complications and in-hospital mortality following hip fracture surgery in the elderly. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.
Ovesen, Ole; Emmeluth, Claus; Hofbauer, Christian
After 2 to 7 years we reviewed 125 prosthetic hip arthroplasty stem revisions using a modular tapered stem with distal fixation. Median age of these patients was 68 (33-92) years. Baseline and follow-up data were registered prospectively according to the Danish Hip Arthroplasty Registry. Survival...
Pollock, Frederic H; Bethea, Audis; Samanta, Damayanti; Modak, Asmita; Maurer, James P; Chumbe, Julton Tomanguillo
The Affordable Care Act currently requires hospitals to report 30-day readmission rates for certain medical conditions. It has been suggested that surveillance will expand to include hip and knee surgery-related readmissions in the future. To ensure quality of care and avoid penalties, readmissions related to hip fractures require further investigation. The goal of this study was to evaluate factors associated with 30-day hospital readmission after hip fracture at a level I trauma center. This retrospective cohort study included 1486 patients who were 65 years or older and had a surgical procedure performed to treat a femoral neck, intertrochanteric, and/or subtrochanteric hip fracture during an 8-year period. Analysis of these patients showed a 30-day readmission rate of 9.35% (n=139). Patients in the readmission group had a significantly higher rate of pre-existing diabetes and pulmonary disease and a longer initial hospital length of stay. Readmissions were primarily the result of medical complications, with only one-fourth occurring secondary to orthopedic surgical failure. Pre-existing pulmonary disease (odds ratio [OR], 1.885; 95% confidence interval [CI], 1.305-2.724), initial hospitalization of 8 days or longer (OR, 1.853; 95% CI, 1.223-2.807), and discharge to a skilled nursing facility (OR, 1.586; 95% CI, 1.043-2.413) were determined to be predictors of readmission. Accordingly, patient management should be consistently geared toward optimizing chronic disease states while concomitantly working to minimize the duration of initial hospitalization and decrease readmission rates Copyright 2015, SLACK Incorporated.
Colón-Emeric, C; Nordsletten, L; Olson, S
evident effect on fracture healing, even when the drug is infused in the immediate postoperative period. INTRODUCTION: Intravenous zoledronic acid 5 mg (ZOL) given after a hip fracture reduces secondary fracture rates and mortality. It has been postulated that bisphosphonates may affect healing if given...... soon after a fracture. We sought to determine whether the timing of ZOL infusion affected the risk of delayed hip fracture healing. METHODS: In the HORIZON Recurrent Fracture Trial, patients were randomized within 90 days of a low-trauma hip fracture to receive either once-yearly ZOL (n¿=¿1......¿=¿0.44). There was no interaction by timing of infusion, and nonunion rates were similar even when ZOL was given within 2 weeks of hip fracture repair. NSAID use was significantly associated with delayed fracture healing (OR, 2.55; 95% CI, 1.49-4.39; p¿
Gómez-Álvarez, J; González-Escobar, S; Gil-Garay, E
Some patients with a hip fracture also present a concomitant upper limb fracture. We want to know whether these patients have a worse functional level and whether they have any differences in various clinical parameters compared with patients with an isolated hip fracture. We retrospectively reviewed 1061 discharge reports from the Orthogeriatrics Unit. We collected information on several clinical parameters of the fractures. Subsequently, we performed a statistical analysis of the data by comparing the associated fracture group with the isolated fracture group. We detected 44 patients with associated upper limb fracture, 90.9% were women (40) and the average age was 84.45years. Eighty-one point eight percent of the upper limb fractures were distal radius or proximal humerus. Pertrochanteric fractures were the most common (none of them were subtrochanteric fractures). Surgical delay was 2.60days and the average hospital stay was 12.30days. Sixty-four point three percent were nail surgery and 31% arthroplasty. The mean Barthel index score was 84.88 (P=.021). Fifty-two point 5 percent of the patients in the study group were referred to a functional support unit (P=.03). The in-hospital mortality rate was 4.2%, with no differences between groups. Patients with an associated fracture have a higher previous functional capacity and they are more independent. Nevertheless, after the fracture they need more help from the healthcare system for optimal functional recovery. Copyright © 2017 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.
Kristensen, Morten Tange
patients (20 men and 35 women; ages 75.8 ± 10 years), 33 with a cervical hip fracture and 22 with an intertrochanteric hip fracture, all of whom were allowed to bear full weight after surgery. METHODS: All patients were evaluated upon discharge from the hospital to their own homes at a mean of 10 ± 6 days......OBJECTIVE: To examine whether functional performance upon hospital discharge is influenced by pain in the region of the hip fracture or related to the fracture type. DESIGN: Prospective observational study. SETTING: A 20-bed orthopedic hip fracture unit. PATIENTS: Fifty-five cognitively intact.......7 seconds to perform the TUG. No significant differences were observed in baseline characteristics or pain medication given for patients with a cervical versus an intertrochanteric fracture (P ≥ .22), but patients with an intertrochanteric fracture presented more often with moderate to severe pain during...
Full Text Available Objective: Dynamic hip screw (DHS is recommended for the fixation of stable intertrochanteric fractures. Its postoperative cut-out rate ranges from 1% to 6%. In osteoporotic bone, normal screws in DHS blade provide less anchorage compared to locking screws. This study aims to compare DHS with locking side plate and conventional side plate. Methods:Fifty consecutive patients with intertrochanteric fractures were randomly allocated for fixation with a standard DHS (group A and locking DHS (Combi plate, group B. We compared the clinical and radiological outcomes for the conventional DHS and locking DHS in intertrochanteric fractures. Functional outcome was evaluated using the Parker mobility score. Results:Coxa valga was found more frequently in group A than in group B (12% vs. 0%, P=0.42. Coxa vara showed the same trend (12% vs. 8%, P=0.81. Rate of restoration of postoperative neck-shaft angle within 20° of sound side was higher in group B (8% cases than in group A (4% cases, P=0.98. The rate of anteversion angle restoration within 10° of sound side was also higher in group B (100% vs. 88%, P=0.85. The average lag screw slippage in group A and group B was 3.2 mm and 4.2 mm, the average fracture union duration was 17.1 weeks and 16.4 weeks, and the mean Parker score was 5.6 and 5.8 respectively. Screw cut-out was seen in one patient in group A. No cut-out was seen in any of the patient in group B. No patient developed deep infection, avascular necrosis, deep vein thrombosis or any other significant complications. Conclusion:The present study demonstrated that treating intertrochanteric fracture with a locking DHS allows sound bone healing and is not associated with any major complications. Although this report is promising, it should be interpreted with caution because only a prospective study with a large sample size would allow definitive conclusion. Key words: Hip fractures; Bone screws; Bone plates
Bates, Brent D; Walmsley, David W; Vicente, Milena R; Kuzyk, Paul R; Nauth, Aaron; Waddell, James P; McKee, Michael D; Schemitsch, Emil H
The incidence of periprosthetic femoral fractures around total hip arthroplasties is increasing. Fractures around a stable implant stem (Vancouver type B1) are among the most common of these fractures. Various fixation strategies for Vancouver type B1 periprosthetic fractures have been reported in the literature; however, little high-level evidence exists. This study was designed to determine the current management strategies and opinions among orthopaedic surgeons treating Vancouver type B1 periprosthetic femoral fractures, and to evaluate the need for a large prospective randomized controlled trial for the management of these injuries. Orthopaedic surgeon members of the Orthopaedic Trauma Association (OTA), the Canadian Orthopaedic Association (COA), and the Hip Society were invited to participate in a 51-item web-based survey surrounding the management of periprosthetic femoral fractures around total hip replacements, as well as the perceived need for future research in this area. Responses were summarized using proportions, and further stratified by practice type, case volume, surgeon age, and fellowship training. For Vancouver type B1 fractures, open reduction and internal fixation (ORIF) with locked plating was favoured slightly over ORIF with cable plating ± cortical strut allograft (51.1% versus 45.5%). When compared to cable plating with cortical strut allograft, respondents believed that isolated locked plating resulted in lower nonunion and reoperation rates, but similar infection and malunion rates. Subgroup analyses revealed that practice type, surgeon age, case volume, and fellowship training influenced surgeons' management of periprosthetic femoral fractures and beliefs regarding complications. There is high demand for a large prospective randomized controlled trial for Vancouver type B1 fracture fixation. Consensus surrounding the management of Vancouver type B1 periprosthetic femoral fractures is lacking, and there is a perceived need among
Craig R Lareau
Full Text Available Unstable ankle fractures and impacted tibial pilon fractures often benefit from provisional external fixation as a temporizing measure prior to definitive fixation. Benefits of external fixation include improved articular alignment, decreased articular impaction, and soft tissue rest. Uniplanar external fixator placement in the Emergency Department (ED ex-fix is a reliable and safe technique for achieving ankle reduction and stability while awaiting definitive fixation. This procedure involves placing transverse proximal tibial and calcaneal traction pins and connecting the pins with two external fixator rods. This technique is particularly useful in austere environments or when the operating room is not immediately available. Additionally, this bedside intervention prevents the patient from requiring general anesthesia and may be a cost-effective strategy for decreasing valuable operating time. The ED ex-fix is an especially valuable procedure in busy trauma centers and during mass casualty events, in which resources may be limited.
Ban, Ilija; Birkelund, Lasse; Palm, Henrik
Fixation of unstable trochanteric fractures is challenging. Application of a circumferential wire may facilitate bone contact and avoid postoperative fracture displacement. However, the use of circumferential wires remains controversial due to possible disturbance of the blood supply to the under...
Miu, Ka Ying Doris; Lam, Pui Shan
Objective To identify the prevalence of malnutrition in elderly hip fracture and to investigate the relationship between hip fracture patients and malnutrition on functional recovery and mortality. Methods All hip fracture patients age >65 years admitted to a rehabilitation unit were recruited from July 2015 to June 2016. Nutritional status was assessed by Mini-Nutritional Assessment Short-Form (MNA-SF) within 72 hours of admission. Patients were reassessed at 6 months for functional status a...
Full Text Available Ray MarksCity University of New York and Columbia University, New York, NY, USAAbstract: Hip fractures – which commonly lead to premature death, high rates of morbidity, or reduced life quality – have been the target of a voluminous amount of research for many years. But has the lifetime risk of incurring a hip fracture decreased sufficiently over the last decade or are high numbers of incident cases continuing to prevail, despite a large body of knowledge and a variety of contemporary preventive and refined surgical approaches? This review examines the extensive hip fracture literature published in the English language between 1980 and 2009 concerning hip fracture prevalence trends, and injury mechanisms. It also highlights the contemporary data concerning the personal and economic impact of the injury, plus potentially remediable risk factors underpinning the injury and ensuing disability. The goal was to examine if there is a continuing need to elucidate upon intervention points that might minimize the risk of incurring a hip fracture and its attendant consequences. Based on this information, it appears hip fractures remain a serious global health issue, despite some declines in the incidence rate of hip fractures among some women. Research also shows widespread regional, ethnic and diagnostic variations in hip fracture incidence trends. Key determinants of hip fractures include age, osteoporosis, and falls, but some determinants such as socioeconomic status, have not been well explored. It is concluded that while more research is needed, well-designed primary, secondary, and tertiary preventive efforts applied in both affluent as well as developing countries are desirable to reduce the present and future burden associated with hip fracture injuries. In this context, and in recognition of the considerable variation in manifestation and distribution, as well as risk factors underpinning hip fractures, well-crafted comprehensive, rather
Gorman, Erin; Chudyk, Anna M.; Hoppmann, Christiane A.; Hanson, Heather M.; Guy, Pierre; Sims-Gould, Joanie; Ashe, Maureen C.
Purpose: To identify exercise patterns and perceived barriers, enablers, and motivators to engaging in exercise for older adults following hip fracture. Method: Telephone interviews were conducted with older adults (aged 62–97 y) within 1 year after hip fracture. Participants were asked about basic demographic information; level of mobility before hip fracture; current level of mobility; and barriers, enablers, and motivators to participating in exercise. Results: A total of 32 older adults s...
Resnick, Barbara; D’Adamo, Christopher; Shardell, Michelle; Orwig, Denise; Hawkes, William; Hebel, J. Richard; Golden, Justine; Magaziner, Jay; Zimmerman, Sheryl; Yu-Yahiro, Janet
The purpose of this study was to evaluate adherence to home-based exercise interventions among older women post hip fracture that were randomized to one of three exercise intervention groups or a routine care group. A total of 157 female hip fracture patients provided data for the intervention analysis. Factors evaluated baseline, 2, 6, and 12 months post hip fracture included demographic variables, adherence to treatment visits, self-efficacy, outcome expectations, stage of change for exerci...
Li, Ji; Yu, Yang; Liu, Chunhui; Su, Xiangzheng; Liao, Weixiong; Li, Zhongli
To compare biomechanical outcomes of 4 different arthroscopic techniques for fixation of tibial eminence fractures. Twenty-four skeletally mature, fresh-frozen cadaveric knees were divided into 4 comparison groups based on the fixation method: screw fixation (group A), traditional sutures fixation with 2 FiberWire sutures (group B), a modified suture technique with 2 FiberWire sutures that created neckwear knots to firmly trap the fracture fragment (group C), or suture anchors which was based on the suture bridge technique primarily used in the shoulder for repair of rotator cuff tears and greater tuberosity fractures (group D). A tibial eminence fracture was created in each knee for subsequent fixation. After fixation, each knee underwent cyclic loading of 100 N to assess the displacement change after 500 cycles of the fixation construct. Afterward, a single tensile failure test load was performed to assess the ultimate failure load, stiffness, and failure mode for each specimen. All specimens survived cyclic testing and were subsequently loaded to failure. Group C had the highest ultimate failure load (P Suture fixation using the neckwear knots technique provides superior fixation with regard to higher ultimate failure load, and absorbable suture anchor fixation with the suture bridge technique provides less displacement under cyclic loading conditions. Both techniques exhibited superior biomechanical properties compared with traditional screw and suture fixation. The new techniques showed satisfactory biomechanical properties and provided more choice for surgeons in the treatment of tibial eminence fractures. Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
Saket Jati; Dev Padia
BACKGROUND There are always difference of opinion in the importance of Bohler’s angle in evaluating the severity of displaced intra-articular calcaneal fractures and predicting the functional outcome following surgical fixation...
Ong, J C Y
The goal of this study was to determine differences in fracture stability and functional outcome between synthetic bone graft and natural bone graft with internal fixation of tibia plateau metaphyseal defects.
Wong, M K; Arjandas; Ching, L K; Lim, S L; Lo, N N
Little data are available on costs and outcome associated with osteoporotic hip fractures in Singapore. A retrospective study was carried out on 280 consecutive hip fractures in patients older than 60 years admitted over a 3-year period. The mean age of patients was 80 years. Sixty-eight per cent were female and 58% were intertrochanteric fractures. Two hundred and sixty-four patients (95%) were operated upon. The mean total hospitalisation period was 17 days. Seventy-six per cent were staying in their own homes prior to the hip fracture while 22% were admitted from nursing homes. After surgery, 63% of patients returned to their homes while 26% needed nursing home care. The index admission mortality rate was 5.7%. Mortality was 26% at 1 year. Of those alive at 1 year, ambulatory status was: 28% were walking without aids, 39% were walking with aids, 24% were wheelchair bound and 9% were bedridden. Poor ambulatory function at discharge was related to increased mortality at 1 year. The average cost incurred was S$7367. The average government subsidy amounted to 82%. Ninety-one per cent of patients were warded in subsidized beds. Breakdown of cost was as follows: hospital stay, 42.6%; surgery, 36.5%; ward treatment, fee 9%; laboratory and X-ray investigations, 4.4%; implant costs, 3.5%; drugs, 1.6% and rehabilitation, 1.1%. Multivariate analysis showed that the cost is significantly related to days spent awaiting surgery, preoperative sepsis, operative complications and cerebrovascular accidents. Young age, good American Society of Anesthetists (ASA) status and endoprosthesis replacement were factors that allowed for early ambulation and lower costs. The mortality rates and functional outcome are not very different from published studies in the West. More of our patients returned to their own homes after hospitalisation. Early surgery, close involvement of the medical social worker and intensive physiotherapy or provision of outpatient therapy facilities may help cut
Shen, H P; Zhou, J G; Shen, Y; Huang, L J
To investigate the clinical effect of zygomatic complex (ZC) fracture via infraorbital incision and rigid fixation. To clinically classify 65 cases with ZC fractures,which treated with open reduction and minor titanium-plate internal fixation. (1) The operated area can be widely exposed via infraorbital incision. (2) ZC fractures can be reducted timely and correctly. (3) The fragments can be fixed rigidly with minor Ti-plaets. No injury to the facial nerve.The satisfactory rate of recovery was 95.4% (63/65). Operation through infraorbital incision is suitable to ZC fractures.
Kronborg, Lise; Bandholm, Thomas; Palm, Henrik
IMPORTANCE: Patients with a hip fracture lose more than 50% knee-extension strength in the fractured limb within one week of surgery. Hence, immediate progressive strength training following hip fracture surgery may be rational, but the feasibility unknown. OBJECTIVE: To examine the feasibility...... of in-hospital progressive strength training implemented in the acute ward following hip fracture surgery, based on pre-specified criteria for feasibility. DESIGN, SETTING AND PATIENTS: A prospective cohort study conducted in an acute orthopedic hip fracture unit at a university hospital. A consecutive...... sample of 36 patients, 18 with a cervical and 18 with a trochanteric hip fracture (27 women and 9 men, mean (SD) age of 79.4 (8.3) years) were included between June and December 2012. INTERVENTION: A daily (on weekdays) program of progressive knee-extension strength training for the fractured limb, using...
Izadi, Ebrahim; Anwar, Rahij; Phillips, Sarah; Kavarthapu, Venu
Displaced osteochondral fractures of the body of talus quite often require a malleolar osteotomy to gain access to the fracture fragment during internal fixation. We describe a case report in which access to a displaced osteochondral fracture of the lateral talar dome was achieved using an arthroscopy-assisted fibular tunnel approach. This technique resulted in satisfactory fracture healing and a satisfactory clinical outcome. Copyright © 2017 The American College of Foot and Ankle Surgeons. All rights reserved.
Full Text Available 【Abstract】Objective: Surgical management op-tions for femoral shaft fracture and ipsilateral proximal fe-mur fracture vary from single-implant to double-implant fixation. Cephalomedullary fixation in such fractures has rela-tive advantages over other techniques especially because of less soft tissue dissection and immediate postoperative weight bearing with accelerated rehabilitation. However, the surgery is technically demanding and there is a paucity of literature describing the surgical techniques for this fixation. The aim of the study was to describe the surgical technique of cephalomedullary fixation for femoral shaft fracture and ipsilateral proximal femur fracture. Methods: Sixteen cases (10 males and 6 females with a mean age of 41.8 years of ipsilateral proximal femur and shaft fractures were treated by single-stage cephalomedullary fixa-tion at tertiary level trauma center in northern India. The fractures were classified according to AO classification. An intraoperative record of duration of surgery as well as tech-nical challenges unique to each fracture pattern was kept for all the patients. Results: The most common proximal femoral pattern was AO B2.1 observed in 9 of our patients. The AO B2.3 fractures were seen in 4 patients while the AO A1.2 fractures in 3 patients. Four of the AO B2.1 and 2 of the AO B2.3 frac-tures required open reduction with Watson-Jones approach. The mean operative time was around 78 minutes, which tended to decrease as the surgical experience increased. There was only one case of malreduction, which required revision surgery. Conclusion: Combination of ipsilateral femoral shaft fracture and neck/intertrochanteric fracture is a difficult frac-ture pattern for trauma surgeons. Cephalomedullary nail is an excellent implant for such fractures but it requires careful insertion to avoid complications. Surgery is technically de-manding with a definite learning curve. Nevertheless, a ma-jority of these
Full Text Available Main point in this contribution is the design of external fixators applied in traumatology and orthopaedics. These fixators can be used in the treatment of open and unstable (i.e. complicated fractures of pelvis and its acetabulum. Numerical modelling (i.e. Finite Element Method, together with CAD modelling, experiments, material engineering, and nanotechnology are presented as a support for developing of a new design of external fixators.
Tams, J; Otten, Egbert; van Loon, JP; Bos, RRM
Purpose: This computer-based study was done to determine whether a small biodegradable plate system was suitable for internal fixation of mandibular fractures. Materials and Methods: In a three-dimensional computer model of the mandible, fracture mobility and plate strain were calculated for bite
Foss, Nicolai Bang; Kristensen, Morten Tange; Kehlet, Henrik
OBJECTIVE: To validate the cumulated ambulation score as an early postoperative predictor of short-term outcome in hip fracture patients. DESIGN: Prospective, descriptive study. SETTING: An orthopaedic hip fracture unit in a university hospital. PATIENTS: Four hundred and twenty-six consecutive hip...... of short-term postoperative outcome after hip fracture surgery....... fracture patients with an independent walking function admitted from their own home. Rehabilitation followed a well-defined multimodal rehabilitation regimen and discharge criteria. MAIN OUTCOME MEASURE: Admission tests with a new mobility score to assess prefracture functional mobility and a short mental...
Frihagen, Frede; Waaler, Gudrun M; Madsen, Jan Erik; Nordsletten, Lars; Aspaas, Silje; Aas, Eline
Background and purpose There is very little information on the cost of different treatments for femoral neck fractures. We assessed whether total hospital and societal costs of treatment of elderly patients with displaced femoral neck fractures differ between patients operated with internal fixation or hemiarthroplasty. Methods 222 patients (mean age 83 years, 165 women (74%)) who had been randomized to internal fixation or hemiarthroplasty were followed for 2 years. Resource use in hospital,...
Conclusions: This case series demonstrates that an “internal fixator technique” is an acceptable alternative to the management of open fractures of the femur or tibia in adult patients. The NC-LP method provided opportunities to achieve a stable fixation with noncontact between the implant and the bone tissues, and the fractures were sufficiently stabilized to allow union with a low complication rate.
Smrke, Dragica; Biscević, Mirza; Smrke, Barbara U R; Zupan, Blaz
The implantation of a bipolar partial hip endoprosthesis is a treatment of choice for displaced medial femoral neck fracture. We present an experimental study which asses and compare biomechanical and clinical status through period before and after hip fracture and implantation of bipolar partial hip endoprosthesis. This study encompassed 75 patients who suffered from an acute medial femoral neck fracture and were treated with the implantation of a bipolar partial hip endoprosthesis. Their biomechanical status (stress distribution on the hip joint weight bearing area) and clinical status (Harris Hip Score) were estimated for the time prior to the injury and assessed at the follow-up examination that was, on average, carried out 40 months after the operation. Despite ageing, the observed Harris Hip Score at the follow-up examination was higher than that estimated prior to the injury (77.9 > 69.6; p = 0.006). Similarly, the hip stress distribution was reduced (2.7 MPa endoprosthesis for patients with displaced medial femoral neck fractures improves the biomechanical and clinical features of the hip, what should have on mind during making decision about treatment.
Arsoy, Diren; Huddleston, James I; Amanatullah, Derek F; Giori, Nicholas J; Maloney, William J; Goodman, Stuart B
Opioids have been the mainstay of treatment in the physiologically young geriatric hip fracture patient undergoing total hip arthroplasty (THA). However opioid-related side effects increase morbidity. Regional anesthesia may provide better analgesia, while decreasing opioid-related side effects. The goal of this study was to examine the effect of perioperative continuous femoral nerve blockade with regards to pain scores, opioid-related side effects and posthospital disposition in hip fracture patients undergoing THA. Twenty-nine consecutive geriatric hip fracture patients (22 women/7 men) underwent THA. Average follow-up was 8.3 months (6 weeks-39 months). Fifteen patients were treated with standard analgesia (SA). Fourteen patients received an ultrasound-guided insertion of a femoral nerve catheter after radiographic confirmation of a hip fracture. All complications and readmissions that occurred within 6 weeks of surgery were noted. Continuous femoral nerve catheter (CFNC) patients were discharged home more frequently than SA patients (43% for CFNC vs 7% for SA; P = .023). CFNC patients reported lower average pain scores preoperatively (P home more frequently. Use of a CFNC decreased daily average patient-reported pain scores, preoperative opioid usage, and opioid-related side effects after THA for hip fracture. Based on these data, we recommend routine use of perioperative CFNC in hip fracture patients undergoing THA. Copyright © 2017 Elsevier Inc. All rights reserved.
Full Text Available 【Abstract】Hip trauma has been a leading cause of death in senile patients for more than a centenary. Although the mortality decreased due to the advanced technique in medication, surgery and nursing, the increasing mortality should not be neglected in elders after orthopedic opera-tion nowadays. Many factors are considered to influence the causes of death after trauma, such as age, gender, per-sonal customs, comorbidities, types of fracture, timing of surgery, procedure, anesthesia, complications, medical treatment, activity of daily living, or even marriage status. This article reviews these causes from the aspects of patient’s own factors, iatrogenic factors, medical treatment and other factors and provides some clues for further clini-cal application according to the recent foreign and domes-tic researches. According to the present research, it is es-sential for surgeons to perform a comprehensive estimation for patients suffering from hip trauma. Key words: Hip fractures; Aged; Cause of death; Review
Full Text Available In dieser Studie wird das Hüftfraktur-Risiko bei postmenopausalen Frauen untersucht, indem die Frauen in verschiedene Subgruppen hinsichtlich dieses Risikos klassifiziert werden. Frauen in einer gemeinsamen Subgruppe haben ein ähnliches Risiko, hingegen in verschiedenen Subgruppen ein unterschiedliches Hüftfraktur-Risiko. Die Subgruppen wurden mittels der Tree Structured Survival Analysis (TSSA aus den Daten von 7.665 Frauen der SOF (Study of Osteoporosis Fracture