Introduction. Four parts inter trochanteric fracture of femur are commonest in elderly people.
Unstable intertrochanteric fractures may be treated by several types of implants, most frequently by dynamic sliding hip screw or some form of intramedullary implant. Intramedullary implants began to be used in cases with an expectation of further improvement of osteosynthesis stability. A need to determine the advantages of single implants for selected types of fractures in randomized trials was defined. In addition to biomechanical principles, bone quality is considered, together with increasing possibilities in recent years of further improving density measurements, especially qCT with respect to local specificity. A series of 86 patients (24 men, 62 women, average age 77,6 years) was operated on from September 6, 2005 to June 30, 2009 for unstable intertrochanteric fracture (31 A2.1, A2.2, A2.3), either by
Introduction. The sliding hip screw is the implant of choice for the operative treatment of stable trochanteric femur fractures. Surgeons have been using widely the four-hole side plate
The aim of the present study was to compare the amount of blood loss between Gamma nail and
Purpose: Numerous implants used in repairing a trochanteric fracture of the hip are currently available. The purpose of this prospective study was to determine the complications and results of the percutaneous compression plate (PCCP), a relatively new device versus the conventional dynamic hip screw (DHS). Materials and Methods: Between 2001–2003, 110 consecutive patients with trochanteric fractures were treated in our department. Fifty-five fractures were stabilized using the PCCP and 55 fractures were treated with the
Dynamic Hip Screw fixation for intertrochanteric fracture of femur is one of the most common operations in the trauma list of any DGH. The operation is commonly performed by the registrar or senior house officer as it is considered to be a relatively simple procedure. However the reality is slightly different as we audit our results of
Hip fractures are a major challenge and impose high demand on orthopaedic services.
Introduction: Hip fractures affects more than 65,000 people in the UK each year and this number is increasing. The standard treatment is insertion of either a dynamic hip screw or hemiarthroplasty depending on fracture configuration. Because of their advanced age, associated co-morbid factors as well as having had an implant inserted, hip fracture patients are at increased risk of developing post-operative wound infections. The infection rate for hip fracture surgery is quoted at 0.6 – 3.6%. 1. . Methods: We carried out a retrospective study of the readmission rate due to wound infection following treatment of their fractured neck of femur. 20 patients (16 females and 4 males) were identified over a 24 month period out of a total 1786 femoral neck fractures treated (1.1%). Results: 11 patients re-admitted with a wound infection had had a hemiarthroplasty fixation, 9 following insertion of a
Introduction:- We reviewed 69 patients with subcapital fracture neck of femur treated with two hole plate
Aims: Our purpose was to determine if
Introduction. The objective of this study was to determine if a synthetic bone
substitute would provide results similar to bone from osteoporotic
femoral heads during in vitro testing with orthopaedic
implants. If the synthetic material could produce results similar
to those of the osteoporotic bone, it could reduce or eliminate
the need for testing of implants on bone. Methods. Pushout studies were performed with the dynamic hip screw (DHS)
and the
The principle of the sliding hip screw is to provide a controlled collapse at the fracture site. It is during the screw insertion that clockwise rotational torque is imparted to the head and neck In right-sided fractures the screw causes the head fragment to rotate clockwise leading to apposition or flexed position of the fracture site. In Left sided fractures the clockwise rotation leads to the head and neck fragment into extension of the fracture site leading to a potentially unstable construct. All intertrochanteric fractures treated over a 12-month period were assessed. 75 fractures were included in the study. The fractures were classified according to Tronzo’s classification (Grades I &
II – stable; Grades III &
IV – unstable). Intraoperative and postoperative films were assessed for rotational abnormalities in the form of an anterior spike of the proximal fragment in left-sided fractures and a flexed position of reduction in right-sided fractures. There were 39 Left sided fractures and 36 Right sided fractures. A rotational abnormality was seen in 11 Left sided fractures compared with none on the right side. All 11 abnormalities were seen in Grade III and IV fractures (2 and 9 respectively). Analysis of results using the Chi-Square test revealed a significant difference (p <
0.001). 3 out the 11 fractures with rotational anterior spike had an implant cut out which needed revision surgery. Compared to stable fractures, the accuracy of reduction determines the final stability in unstable fractures. In these fractures the rotational torque imparted to the proximal head and neck fragment can cause loss of reduction leading to potential failures of fixation. This appears to be greater in left sided fractures where the rotational torque causes the anterior spike which when not butressed inferiorly and medially can lead to a state where the implant cannot control the shear forces at the fracture site. This can then lead to failure of fixation. In right-sided fractures the rotational torque often causes compression of the head and neck fragment into the distal fragment with the creation of an infero- medial butress. The methods of overcoming this problem are with modifications in the technique. Untwisting the last few threads of the screw after insertion could reduce the anterior spike. The application of digital pressure along the anterior neck or the application of a reduction clamp at screw insertion provides counter rotation. The results of this study confirm that the problem of torque at the fracture site is not of considerable importance in stable fractures but is significantly so in unstable left sided fractures. This results in a greater predisposition for potential failure of fixation
Fractures of the proximal femur are a common clinical problem, and a number of orthopaedic devices are available for the treatment of such fractures. The objective of this study was to assess the rotational stability, a common failure predictor, of three different rotational control design philosophies: a screw, a helical blade and a deployable crucifix. Devices were compared in terms of the mechanical work (W) required to rotate the implant by 6° in a bone substitute material. The substitute material used was Sawbones polyurethane foam of three different densities (0.08 g/cm3, 0.16 g/cm3 and 0.24 g/cm3). Each torsion test comprised a steady ramp of 1°/minute up to an angular displacement of 10°.Objectives
Methods
Aims. To evaluate if, for orthopaedic trainees, additional cadaveric simulation training or standard training alone yields superior radiological and clinical outcomes in patients undergoing dynamic hip screw (DHS) fixation or hemiarthroplasty for hip fracture. Methods. This was a preliminary, pragmatic, multicentre, parallel group randomized controlled trial in nine secondary and tertiary NHS hospitals in England. Researchers were blinded to group allocation. Overall, 40 trainees in the West Midlands were eligible: 33 agreed to take part and were randomized, five withdrew after randomization, 13 were allocated cadaveric training, and 15 were allocated standard training. The intervention was an additional two-day cadaveric simulation course. The control group received standard on-the-job training. Primary outcome was implant position on the postoperative radiograph: tip-apex distance (mm) (DHS) and leg length discrepancy (mm) (hemiarthroplasty). Secondary clinical outcomes were procedure time, length of hospital stay, acute postoperative complication rate, and 12-month mortality. Procedure-specific secondary outcomes were intraoperative radiation dose (for DHS) and postoperative blood transfusion requirement (hemiarthroplasty). Results. Eight female (29%) and 20 male trainees (71%), mean age 29.4 years, performed 317
The incidence of hip fractures in the elderly is increasing. Minimally displaced and un-displaced hip fractures can be treated with either internal fixation or hemiarthroplasty. The aim was identifying the revision rate of internal fixation and hemiarthroplasty in patients 60 years or older with Garden I or II hip fractures and to identify risk factors associated with each method. A retrospective analysis was conducted from 2 Major Trauma Centres and 9 Trauma Units between 01/01/2015 and 31/12/2020. Patients managed conservatively, treated with a total hip replacement and missing data were excluded from the study. 1273 patients were included of which 26.2% (n=334) had cannulated hip fixation (CHF), 19.4% (n=247) had a dynamic hip screw (DHS) and 54.7% (n=692) had a hemiarthroplasty. 66 patients in total (5.2%) required revision surgery. The revision rates for CHF,
Aims. To develop a core outcome set of measurements from postoperative radiographs that can be used to assess technical skill in performing dynamic hip screw (DHS) and hemiarthroplasty, and to validate these against Van der Vleuten’s criteria for effective assessment. Methods. A Delphi exercise was undertaken at a regional major trauma centre to identify candidate measurement items. The feasibility of taking these measurements was tested by two of the authors (HKJ, GTRP). Validity and reliability were examined using the radiographs of operations performed by orthopaedic resident participants (n = 28) of a multicentre randomized controlled educational trial (ISRCTN20431944). Trainees were divided into novice and intermediate groups, defined as having performed < ten or ≥ ten cases each for
The aim of this study is to analyse the radiological outcomes and predictors of avascular necrosis following 2-hole
Background. Dynamic Hip Screw (DHS) is the most frequently used implant in management of intertrochanteric femoral fractures. There is a known statistical relationship between a tip-apex distance (TAD) >25mm and higher rate of implant failure. Our aim was to analyse all
Abstract. Background. The aim of this study is to analyse the radiological outcomes and predictors of avascular necrosis following 2-hole
A number of techniques have been developed to improve the immediate mechanical anchorage of implants for enhancing implant longevity. This issue becomes even more relevant in patients with osteoporosis who have fragile bone. We have previously shown that a dynamic hip screw (DHS) can be augmented with a calcium sulphate/hydroxyapatite (CaS/HA) based injectable biomaterial to increase the immediate mechanical anchorage of the