Abstract
Clinical Problem: The proximal femour ist he highest loaded part of the skeleton,on the other side the bone density is reduced in elderly patients. Therefore the cut out of the femour head and neck component is the most severe complication in the management of these farctures.
Material and Methods: To avoide cut out but also other complications a proximal femour nail with a I beam profile of the femur neck component was constructed: the gliding nail (GN) and small GN (SGNS).
Results: Experimental examination: an I beam plate (16x10mm) used in the Gliding nail, a single screw (12mm) fixation of the Gamma Nail and a double screw fixation (11 and 6mm) used in the Proximal Femour Nail were tested. For testing 9 sowbone femura and 3 pair of corps femura were used. A2 type of osteotomy and tests of 1000 cycles alternating load at 1000N and 1500N in the sowbons and 6000 cycles up to 3.500N were performed. Results: in the sowbones the I beam profile plate shows a total deformation of 1mm after 1000N and 2mm after 1500N test. For the 12mm screw the corresponding values were 2,5mm and 5.6mm. The double scew fixation showed a total cut out at 1000N in one femur and at 1500N in both others. In the corpse femura the differences were similar.
Clinical examination: Material and methods: in a five year period 03.1996-03.2001 501 patients all patients with trochanteric and subtrochanteric fractures were evaluated. Reexamination was performed at least 6 months after therapy. All patients with no additional injury of the same leg were allowed full weight bearing immediately(98%). 70% were female, mean age 76,2years,median 80 years.82% had risk factors, 11.2% were in a nursing home. 95% were treated in the first 36 houres by 23 surgeons.
Results: Eearly lokal complicationes occurred in 2,5%. Only wound revisiones for haematoma (11 cases with 5 times positive bacteriology) occurred but the general rate of complicationes was 28,5% especially urinary and pulmonary infections. Hospital mortality was 3.9%. Whereas the mortality in patients without risk factors the mortality was 2.4% when 4 risk factors were present mortality was 90%. Osteoporosis and Diabetes had no influence as risk factor. Late local complicationes were 3.3%. The 3 months mortality was 14.9%15.3% were in a nursing home.
Conclusion: The results show that the event of a trochanteric fracture is still a serious risk but local complicationes especially cut out of the implant and severe impaction of the fracture can be avoided by using the GN.
Theses abstracts were prepared by Professor Roger Lemaire. Correspondence should be addressed to EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
