Gamma 3 Long Nail for Complex Sub-Trochanteric Fractures: A Ten-Year Retrospective Study

Urso R;  ; Milani L; Ortolan A; Martucci A; Berti M; Pascarella R; Tigani D;  ;  ;  ;  ;  ;

doi:10.26420/austinjmusculoskeletdisord.2021.1060

Gamma 3 Long Nail for Complex Sub-Trochanteric Fractures: A Ten-Year Retrospective Study

Austin Journal of Musculoskeletal Disorders ◽

10.26420/austinjmusculoskeletdisord.2021.1060 ◽

2021 ◽

Vol 8 (1) ◽

Author(s):

Urso R ◽

◽

Milani L ◽

Ortolan A ◽

Martucci A ◽

...

Keyword(s):

External Rotation ◽

Weight Bearing ◽

Femoral Fractures ◽

The Elderly ◽

Gamma Nail ◽

Trauma Centre ◽

High Rate ◽

Full Weight Bearing ◽

Coxa Vara ◽

X Rays

Cephalomedullary nailing is considered the treatment of choice for trochanteric and subtrochanteric femoral fractures. The aim of this study was to report postoperative outcomes of one of the widely used trochanteric nail device, the Gamma 3 long nail. We retrospectively assessed 405 patients treated with Gamma 3 long nail in a single Level One Trauma Centre between 2010 and 2018. We finally included 261 ambulant patients with 65 years or older, a lowenergy trauma and a closed trochanteric or subtrochanteric femoral fracture. Clinical outcomes were evaluated using the Hip Fracture Functional Recovery Score (FRS), while radiological complications and failures were assessed on postoperative x-rays. More than two-thirds of patients had completed fracture consolidation within 4 months after surgery. Immediate full weight bearing was allowed postoperatively in 64.0% of patients. We reported a mortality of 24.5% at one year postoperatively. The leading clinical postoperative complication was anemia (69.3%), followed by deep venous thrombosis (7.7%). Coxa vara was observed in 73 patients (28%), followed by malreduction in flexion-external rotation of the proximal femoral fragment (26.8%). No case of lag screw cutout was reported. Our study indicated that last generation of Long Gamma nail is a reliable implant for trochanteric and subtrochanteric femoral fractures in the elderly patients, leading to high rate of bone union and reduced incidence of related complications. An excellent fracture reduction and prevention of postoperative varus malalignment are the main factors that can avoid the major postoperative complications and failures after Gamma 3 long nailing.

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Finite element analysis of double‐plate fixation using reversed locking compression‐distal femoral plates for Vancouver B1 periprosthetic femoral fractures

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04152-5 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Daisuke Takahashi ◽

Yoshihiro Noyama ◽

Tsuyoshi Asano ◽

Tomohiro Shimizu ◽

Tohru Irie ◽

...

Keyword(s):

Finite Element Analysis ◽

Finite Element ◽

Plate Fixation ◽

Weight Bearing ◽

Femoral Fractures ◽

Full Weight Bearing ◽

Loading Test ◽

Lateral Plate ◽

Element Analysis ◽

Periprosthetic Femoral Fractures

Abstract Background Internal fixation is recommended for treating Vancouver B1 periprosthetic femoral fractures. Although several fixation procedures have been developed with high fixation stability and union rates, long-term weight-bearing constructs are still lacking. Therefore, the aim of the present study was to evaluate the stability of a double-plate procedure using reversed contralateral locking compression-distal femoral plates for fixation of Vancouver B1 periprosthetic femoral fractures under full weight-bearing. Methods Single- and double-plate fixation procedures for locking compression-distal femoral plates were analysed under an axial load of 1,500 N by finite element analysis and biomechanical loading tests. A vertical loading test was performed to the prosthetic head, and the displacements and strains were calculated based on load-displacement and load-strain curves generated by the static compression tests. Results The finite element analysis revealed that double-plate fixation significantly reduced stress concentration at the lateral plate place on the fracture site. Under full weight-bearing, the maximum von Mises stress in the lateral plate was 268 MPa. On the other hand, the maximum stress in the single-plating method occurred at the defect level of the femur with a maximum stress value of 1,303 MPa. The principal strains of single- and double-plate fixation were 0.63 % and 0.058 %, respectively. Consistently, in the axial loading test, the strain values at a 1,500 N loading of the single- and double-plate fixation methods were 1,274.60 ± 11.53 and 317.33 ± 8.03 (× 10− 6), respectively. Conclusions The present study suggests that dual-plate fixation with reversed locking compression-distal femoral plates may be an excellent treatment procedure for patients with Vancouver B1 fractures, allowing for full weight-bearing in the early postoperative period.

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SIMULTANEOUS INSUFFICIENCY FRACTURE OF BILATERAL NECK OF FEMUR WITH COXA VARA

10.36106/ijsr/3801776 ◽

2020 ◽

pp. 41-42

Author(s):

Rishabh Surana ◽

Saurabh Singh ◽

Alok Rai

Keyword(s):

Weight Bearing ◽

Insufficiency Fracture ◽

Young Female ◽

Full Weight Bearing ◽

Coxa Vara ◽

Neck Of Femur ◽

Femur Neck ◽

Femur Neck Fracture ◽

Neck Fracture

Simultaneous insufficiency fracture of bilateral neck of femur with displacement and coxa vara is very uncommon , and very challenging. Osteomalacia is a known cause of insufficiency fracture. We present a case of a young female with non traumatic simultaneous bilateral femur neck fracture. On radiological and laboratory investigation fracture was diagnosed as insufficiency fracture due to osteomalacia with coxa vara. Treatment was done by intertrochanteric valgus osteotomy and fixation by dynamic condylar screw with a prebend plate along with oral and parentral vitamin D therapy. On six month follow up both side fractures were well united and patient was able to walk without pain with full weight bearing and with normal gait .Her lab investigations also returned to normal during follow up.

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Stress vs. Non-Stress Radiographs in Subtle Syndesmotic Injuries

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00296 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0029

Author(s):

Nicola Krähenbühl ◽

Travis Bailey ◽

Nathan Davidson ◽

Heath Henninger ◽

Charles Saltzman ◽

...

Keyword(s):

Ankle Instability ◽

External Rotation ◽

Paired Comparison ◽

Weight Bearing ◽

Deltoid Ligament ◽

Ankle Sprains ◽

X Rays ◽

Syndesmotic Injury ◽

Stress Radiographs ◽

Clear Space

Category: Sports Introduction/Purpose: Between 1-18% of all ankle sprains and 23% of all ankle fractures involve injury to the distal tibio-fibular syndesmosis. Syndesmotic injuries can create a substantial diagnostic and therapeutic challenge for orthopaedic surgeons. While acute injuries can be assessed using conventional radiographs, subtle syndesmotic injuries may be misdiagnosed using X-rays. Misdiagnoses may result in chronic ankle instability, pain and post-traumatic osteoarthritis of the tibio-talar joint. The purpose of this study was to investigate whether syndesmotic injury was more easily diagnosed with stress vs. non-stress radiographs.radiographs.sed with stress vs. non-stress radiographs. Methods: Five pairs of cadavers (tibia plateau to toe-tip, mean 61 years, range 52-70 years) were scanned with weight-bearing CT (170 lb, w/ and w/o 10 Nm static external rotation torque). Digitally reconstructed radiographs (DRRs), which are comparable to conventional radiographs, were reconstructed from the 3D CT data. The following conditions were tested: First, intact ankles (Native) were tested. Second, one specimen from each pair underwent AITFL resection, while the contralateral underwent deltoid resection (Condition 1). Third, the remaining intact deltoid ligament or AITFL was resected in each ankle (Condition 2). Finally, the interosseous membrane (IOM) was resected in all ankles (Condition 3). Condition 3 was defined as acute syndesmotic injury. Using antero-posterior (AP) views, the tibio-fibular clear space (TFCS), tibiofibular overlap (TFO) and medial clear space (MCS) were assessed. Statistical analysis was performed using paired (comparison within groups) and unpaired (comparison between groups) t-test where p=0.05 was considered significant. Results: Regarding the TFCS, Native vs. Condition 3 in 10 Nm stress radiographs was significantly different in the deltoid group (p=0.021). Using TFO in stress and non-stressed radiographs, Native vs. Condition 2 and 3 was significantly different for the deltoid group (p=0.043), and Native vs. Condition 3 in the syndesmotic group (p=0.027). Regarding the MCS in non-stress radiographs, Native vs. Condition 3 was significantly different in the deltoid group (p=0.007), while in stress views, Native vs. Condition 2 was significant different in the syndesmotic (p=0.026) and Native vs. Condition 3 in the deltoid group (p=0.030). No differences were found comparing the conditions of the AITFL with the same conditions of the deltoid group. Conclusion: The TFCS cannot be used to assess subtle or acute syndesmotic injuries in stress and non-stress radiographs. The TFO can be used to assess a combined injury to the AITFL and deltoid ligament in stress and non-stress radiographs. The MCS can be used to assess acute syndesmotic injuries in stress and non-stress radiographs. Radiographs (stress or non-stress) cannot be used to distinguish between injuries to the AITFL or deltoid ligament. Therefore, stress and non-stress radiographs are not useful in assessment of subtle syndesmotic injuries. Stress-radiographs are not superior compared to non-stress radiographs in assessment of acute syndesmotic injuries.

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Is cemented revision total hip arthroplasty a reasonable treatment option in an elderly population?

Orthopedic Reviews ◽

10.4081/or.2019.8263 ◽

2019 ◽

Vol 11 (3) ◽

Author(s):

Philipp Born ◽

Isabella Manzoni ◽

Thomas Ilchmann ◽

Martin Clauss

Keyword(s):

Aseptic Loosening ◽

Elderly Population ◽

Weight Bearing ◽

The Elderly ◽

Full Weight Bearing ◽

Septic Loosening ◽

Term Survival ◽

Press Fit ◽

Revision Tha

Revision THA is increasingly performed especially in the elderly population. The surgeon’s challenge is to provide a solution that supports immediate full weight-bearing, despite poor bone quality. Shape-closed revision stems facilitate that by combining cement fixation with additional press-fit anchoring. The design tolerates varying cement mantle thickness and inconsistent cancellous bone lining of the femoral canal. Following that philosophy, we present our mid-term results using a long version of a cemented Charnley- Kerboull type stem. From 2010 to 2017, 38 long Charnley-Kerboull revision stems (Centris®, Mathys European Orthopaedics, Bettlach, Switzerland) were implanted and followed prospectively. Surgery was performed via a Hardinge approach in supine position with a third generation cementing technique. Patients were mobilized using full-weight bearing as early as possible. Survival was determined for stem revision for aseptic loosening and stem and/or cup revision for any reason. 20 stems had a minimum follow-up (f/u) of 2 years and were included for further radiological analysis. Detailed subsidence analysis as an early predictor for later aseptic loosening was performed using EBRA-FCA software. Further, the presence of osteolysis and cement debonding was evaluated. Mean follow- up was 4 years. No patient was lost to f/u.18 died of causes unrelated to THA. Stem survival was 100%. Survival for any re-operation was 82.2% (two early infections, one soft-tissue debridement, one cup exchange for recurrent dislocations). None of the cases revised for septic loosening showed signs of persistent infection at final f/u. EBRA-FCA revealed two oligosymptomatic cases of subsidence of 5mm and 6mm over a course of 2 and 12 months, respectively, with stable implants thereafter. Neither required revision. There was no development of osteolysis or debonding. The stem provides a reliable early fullweight bearing solution for revision THA with excellent mid-term survival in an elderly population. Even in two cases where subsidence was present, mobility was not impaired and re-revision could be avoided.

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Pediatric septic arthritis of the hip: the benefit of hip arthroscopy by extracapsular (outside-in) approach

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00011 ◽

2020 ◽

Vol 8 (2_suppl) ◽

pp. 2325967120S0001

Author(s):

Nicolas Jan ◽

Julien Pietrzak ◽

Matthieu Baudoux ◽

Arnaud Kaba

Keyword(s):

Septic Arthritis ◽

Hip Arthroscopy ◽

Weight Bearing ◽

Needle Aspiration ◽

High Rate ◽

Peripheral Compartment ◽

X Rays ◽

Quick Method ◽

Emergency Situations ◽

Tensor Fasciae Latae

Background: Pediatric septic arthritis of the hip is a surgical emergency. Facing a hip flexum and fever, surgeons can use comparative ultrasound to confirm the diagnosis and to establish the surgical indication. While needle aspiration-irrigation is a simple and quick method, it gives rise to a high rate of recurrence. The purpose of our study was to demonstrate that hip arthroscopy by extracapsular approach is an effective and accessible alternative applicable in emergency situations. Methods: This is a report of 2 cases (7 years-135 cm; 13 years-143 cm) of needle aspiration-irrigation failure subsequently treated by hip arthroscopy. The X-ray and arthroscopy-assisted extracapsular technique was performed on a conventional orthopedic table, using a 30 degree arthroscope and a 3.5mm diameter motorized knife. Minimally invasive anterior longitudinal capsulotomy was performed by 2 anterolateral approaches via the proximal and distal tensor Fasciae Latae muscle, without dedicated instrumentation, followed by sampling, irrigation, removal of false membranes, synovial biopsies, partial synovectomy, cartilage assessment of the central then peripheral compartment and placement of a drainage. Results: In both cases, effusion completely disappeared and the inflammatory process gradually normalized with antibiotic therapy without any repeat procedure or complications related to the approach. Weight bearing was resumed in 3 weeks. Postoperatively, in 6 months and 15 months respectively, after resumption of sports activities hip examination was painless and no damage was noted on x-rays in either case. Conclusion: In our experience, hip arthroscopy by extracapsular approach can effectively address cases of failed needle aspiration-irrigation in pediatric septic arthritis of the hip. It could be provided as first-line emergency treatment in the event of purulent septic arthritis or late management, as a replacement for arthrotomy.

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Functional outcome of fixation of distal femoral fractures with DF-LCP: a prospective study

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20164000 ◽

2016 ◽

Vol 2 (4) ◽

pp. 291 ◽

Cited By ~ 1

Author(s):

Shafeed T. P. ◽

Bijo Paul

Keyword(s):

Tissue Injury ◽

Weight Bearing ◽

Soft Tissue Injury ◽

Femoral Fractures ◽

Early Mobilization ◽

Type A ◽

Full Weight Bearing ◽

Supracondylar Fractures ◽

Range Of Movement ◽

Locked Plating

Background: Management of supracondylar fractures is a real challenge to the orthopaedician due to its extensive soft tissue injury, boneloss, comminution, articular extention and instability. Open reduction and internal fixation with anatomical distal femoral locking plate permits early mobilization. Stable anatomical fixation is necessary to avoid complications and disability.Methods: 25 patients with Type A and Type C closed supracondylar femoral fractures were followed up from November 2013 to November 2015. All the patients underwent ORIF with DF-LCP. Clinical and radiological follow up were recorded for 24 months.Results: Mean time for fracture union was 4.02 months. Average duration for full weight bearing was 122 days (range 90-180days). The average range of movement for Type A fractures was 105.71 degrees, for C fractures average ROM was 93.64 degrees. Average ROM for patients <50 was 103 degree and for patients>50 ROM was 98.66 degree. Conclusions: Locked plating of DF fractures permits stable fixation and early mobilization which avoids disability and ensures good joint function.

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Analytic study of functional outcome of retrograde intramedullary nailing for distal femoral fractures in adults

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20212430 ◽

2021 ◽

Vol 7 (4) ◽

pp. 824

Author(s):

Srujith Kommera ◽

Pradeep Reddy ◽

Saba Khaleel

Keyword(s):

Range Of Motion ◽

Functional Outcome ◽

Intramedullary Nailing ◽

Weight Bearing ◽

Femoral Fractures ◽

X Rays ◽

Fracture Union ◽

Distal Femoral Fractures ◽

Retrograde Intramedullary Nailing ◽

Articular Fractures

Background: The purpose of this Study was to evaluate the clinical and functional outcome of retrograde intramedullary nailing for distal femur fractures.Methods: This 2 years observational study was done between December 2018 to January 2021, 60 patients with distal femoral fractures were surgically treated at our hospital using retrograde intramedullary nail. The patient was placed supine on fracture table with affected limb flexed to 60 degrees. Through a Transpatellar approach, the nail was introduced in retrograde method after serial reaming. Postoperatively knee range of motion was started immediately and weight bearing was progressed after signs of fracture union were noted on x-rays. The outcome was evaluated for time taken for fracture union, complications and functional outcome with various types of fractures.Results: All the fractures in the present study healed at an average of 13 weeks. However 25 to 40% of these patients underwent bone grafting primarily with reports of delayed union and non-union. Shortening occurred in two patients (3.33%) did affect the final functional outcome. average range of motion is 120 deg. for all fractures, 119 deg. for extra-articular fractures and 118 deg. for intra-articular fractures. Infection rates are low (0% to 8%).Conclusions: The study shows distal femoral fractures were common due to high velocity injuries, retrograde nailing is an excellent technique for management of distal femoral fractures as it promotes high rate of fracture union with less complications.

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A study on clinical outcomes of complex subtrochanteric femoral fractures with cephalomedullary nail

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20214188 ◽

2021 ◽

Vol 7 (6) ◽

pp. 1194

Author(s):

S. F. Kammar ◽

Karthik B. ◽

V. K. Bhasme ◽

Suryakanth Kalluraya

Keyword(s):

Clinical Outcomes ◽

Road Traffic ◽

Weight Bearing ◽

Femoral Fractures ◽

Lateral View ◽

Successful Outcome ◽

Harris Hip Score ◽

Full Weight Bearing ◽

Subtrochanteric Fractures ◽

The Mean

Background: The aim of the study was to evaluate the clinical outcomes of complex subtrochanteric fractures treated by using cephalomedulary nail.Methods: This is a prospective observational study of 30 cases of complex subtrochanteric femoral fractures admitted to our hospital from January 2018 to June 2019. Cases were taken according to the inclusion and exclusion criteria i.e. type IV, type V Seinsheimer’s classification, above 18 years and those who are willing to participate in the study has been included and pathological fractures, open fractures were excluded. All the patients are followed up on 2 post-operative day, after 4 weeks, 8 weeks, 12 weeks and 6months. X-ray hip with thigh anteroposterior (AP) and lateral view taken during each follow up. Out comes was assessed using modified Harris hip score.Results: In our study of 30 cases there are 22 males and 8 females and the mean age of 43.7 years. 73.3% patients are due to Road traffic accidents predominance of right side. In our study 66% had type 4 Seinsheimers and 34% cases had type 5 Seinsheimers fracture. The mean duration of hospital stay was 17 days. Mean time for full weight bearing is 12 weeks. Good to excellent results are seen in 80% of type 4 subtrochanteric fractures and 75% of cases of type 5 subtrochanteric fractures. 4 cases had surgical site infection, 3 cases had varus, 1 case had developed implant failure, and 1 case had reverse Z effect.Conclusions: From this study, we conclude that proximal femoral nail is an excellent implant in the treatment of complex subtrochanteric femoral fractures the terms of successful outcome include a good understanding of fracture biomechanics, good preoperative planning and accurate instrumentation.

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Treatment of subtrochanteric fracture femur by open reduction and internal fixation by long proximal femoral nailing

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20195811 ◽

2019 ◽

Vol 6 (1) ◽

pp. 164

Author(s):

Prabhu P. Munavalli ◽

Gururaj N. G.

Keyword(s):

Internal Fixation ◽

Open Reduction ◽

Road Traffic ◽

Weight Bearing ◽

Subtrochanteric Fracture ◽

High Rate ◽

Full Weight Bearing ◽

Subtrochanteric Fractures ◽

Fractures In Children ◽

Pathologic Fractures

Background: Subtrochanteric fractures are devasting injuries that most commonly affect the elderly population and also in young.Methods: This is a prospective study of 20 cases of subtrochanteric fracture admitted to KIMS, Huballi between November 2008 to August 2010 treated with left proximal femoral nail (LPFN) by open method. Cases were taken according to inclusion and exclusion criteria, i.e., fresh subtrochanteric fracture in adults. Pathologic fractures, multiple fractures, fractures in children, old neglected fractures were excluded from the study. Objectives of this study were to study subtrochanteric fractures and to determine effectiveness of LPFN in tretment of subtrochanteric fractures by open reduction and internal fixation (ORIF).Results: In our study of 20 cases, there were 16 male and 4 female patients with age ranging from 17 years to 75 years with most patients in between 21-40 years. 65% of the cases admitted were road traffic accidents, 25% due to fall from height and 10% due to trivial fall with right side being more common side affected. Russell and Taylor type IA fracture accounted for 40% of cases. Mean duration of hospital stay was 24 days and mean time of full weight bearing was 14 weeks in our patients. Good to excellent results were seen in 85% of cases in our study.Conclusions: Subtrochanteric fractures of femur can be successfully treated by ORIF by LPFN resulting in proper anatomical reduction and hence alignment and high rate of bone union.

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Treatment of pertrochanteric fractures in elderly patients: is dynamic fixation so important?

Genij Ortopedii ◽

10.18019/1028-4427-2021-27-5-502-507 ◽

2021 ◽

Vol 27 (5) ◽

pp. 502-507

Author(s):

I.M. Shcherbakov ◽

◽

V.E. Dubrov ◽

A.S. Shkoda ◽

Yu.S. Zlobina ◽

...

Keyword(s):

Elderly Patients ◽

Weight Bearing ◽

Femoral Fractures ◽

Early Time ◽

Functional Results ◽

Full Weight Bearing ◽

Pertrochanteric Fractures ◽

Results Of Treatment ◽

Bone Fragments ◽

One Year

Abstract. Introduction The problem of complications after surgical treatment of pertrochanteric fractures in elderly patients is relevant and far from a solution. Materials and methods The retrospective study was based on the analysis of the results of treatment of 129 patients with pertrochanteric femoral fractures (average age 76 years). All fractures in the early time from trauma were fixed with two types of cephalomedullary nails, either dynamic or static. All patients could not limit the load on the operated limb after surgery because of different reasons. Results The results of treatment were evaluated in 109 patients after one year. In dynamic cephalomedullary fixator group (59 patients), there were 7 orthopedic complications with a functional Harris scale result of 68 points (range, 26 to 94 points). In static cephalomedullary fixator group (50 patients), there were 14 orthopedic complications with a functional Harris score of 56.5 points (range, 15 to 92 points). Discussion Higher results of treatment in the group of dynamic fixator in the condition of full-weight bearing on the operated limb may be associated with the possibility of dynamization of the part of fixator in response to bone resorption in the contact area of bone fragments. The use of dynamic cephalomedullary fixators instead of static ones for treatment of pertrochanteric femoral fractures in elderly patients exercising full weight-bearing leads to a decrease in orthopedic complications (from 28 to 11.9 %) and improves the functional results of treatment.

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