Objectives. Bisphosphonates are widely used as first-line treatment for primary and secondary prevention of fragility fractures. Whilst they have proved effective in this role, there is growing concern over their long-term use, with much evidence linking bisphosphonate-related suppression of bone remodelling to an increased risk of atypical subtrochanteric
Internal fixation for supracondylar
Purpose: Treating
Aim: the aim of the study is to show that the supracon-dylar nail, for
Post-operative periprosthetic
Introduction: The amount of tension which surgeons apply to a two-side Dall-Miles cable during the fixation of periprosthetic fracture has not been reported. Current study is the first report that reveals the real cable tension data which was intraoperatively measured. Methods: In vivo data of tightening torque was measured intraoperatively during Dall-Miles cable fixation surgeries for periprosthetic
Introduction. Total hip arthroplasty (THA) using short design stem is surging with increasing movement of minimally invasive techniques. Short stems are easier to insert through small incisions preserving muscles. We have used these types of short stems since 2010. Almost all of the patients have shown good clinical results. However, two patients developed fatigue
Introduction. Long-term use of bisphosphonates has been known to induce femoral insufficiency fracture in osteoporotic patients. We followed patients who had femoral insufficiency fractures after a long-term use of bisphosphonates. Methods. Eleven patients (14 hips) were diagnosed as having an insufficiency
Introduction. Basicervical
Purpose of this study is to compare the two techniques, [sliding nail plate, or locking intramedullary nail type ã], and to estimate their results of the surgical treatment of the subtrochanteric
Purpose: To review the results of periprosthetic femoral fractures treated using cortical strut allograft and plate internal fixation. Material &
Methods: Between November 1996 and July 2006, 17 patients with periprosthetic
Purpose: Periprosthetic fractures around hip prostheses are difficult problems because these fractures range from the very simple (requiring no surgical intervention) to the complex (requiring major surgery). This paper evaluates the primary stability and restoration of femoral bone stock following treatment of Vancouver type B-2 periprosthetic
Introduction: Intraoperative femoral fractures occurring in cementless total hip replacement are not frequent. In a series of in 350 consecutive hip replacements 15 cases of fractures were recognized and included for this study. Materials and Methods: The fractures mainly occured during the femoral preparation rather than during the definitive stem impaction. Accurate reduction and stable internal fixation were considered necessary intraoperatively. Nevertheless in 4 cases the fixation of the stem was converted into a conventional cemented one. Postoperatively the patients were allowed to have an immediat full weight bearing on the operated side in 5 cases. The remainders (10 patients) had a delayed reloading on the lower limb. In this study the clinical and radiological results of the fracture group were compared to those of a control group of 15 patients. Results: One year after surgery the Harris Hip score was no significantly different between the groups. Postoperative complication rate (deep venous thrombosis, infection, dislocation) were not different between the groups. There was a significant increase of duration of the stay of the patient in the rehabilitation center (p=0.007) in the fracture group and the patient spend more time with the physiotherapist (p=0.001)as they left the center. The fracture rate was lower when the patients were operated by a senior surgeon (p=0.021). Discussion: These results are comparable to those of the literature. Nevertheless intraoperative
Gunshot-induced
Due to its popularity of intramedullary nails (IMN) high success rate, newer design (titanium) IMN system have been introduced to replace stainless steel system. However the stability provided by the titanium IMN may not be adequate, there by influencing the union rate. We aimed to compare the results of both IMN systems via prospective clinical study and biomechanical testing using RSA. This study was done in an experimental set-up which consisted of a physically simulated femoral shaft fractures models fixed with a stainless steel (Russell Taylor) or Titanium (Trigen) IM nailing system. Two common fracture configurations with stimulated weight bearing conditions were used and the axis of fragment movements recorded. The data on two groups of patients were collected as part of a prospective cohort study. Details of the implant, such as size of nail, cross screw lengths, screw thickness, etc. was collected. Patients were followed up for a minimum of 4 months and details of clinical complications recordedBiomechanical study
Clinical study
The femur is a common site for skeletal metastases. The Gamma2 nail has proved effective in relieving pain and restoring function. Little data exists on the use of the Gamma3 Long Nail (GLN) in this condition. Improved instrumentation is suggested to reduce operative time and facilitate minimally invasive surgery. This study reports a series of patients treated in a District General Hospital. A retrospective casenote review was performed of all patients treated with the GLN for femoral metastatic disease over a five year period. Patients were followed-up for a minimum of one year. Functional level was assessed using the Parker Mobility Score (PMS). 12 patients underwent 15 nailings. Mean age was 75.4 years (median 75.7, range 61-92). In bilateral cases, the operations were performed during the same hospital admission. There were seven prophylactic nailings for impending fracture from proximal femoral lesions, seven procedures for actual fractures distal to the intertrochanteric line, and one basicervical fracture associated with multiple femoral metastases. Primaries were four prostate, two breast, two lung, one bowel, one bladder, one renal, and one myeloma. Average anaesthetic time for all procedures was 134 mins (median 125, range 90-210). Average peri-operative drop in serum haemoglobin was 2.3g/dL (median 2.1, range 0.6-4.8). Five patients with actual fracture and one patient with impending fracture required blood transfusion, receiving 2.2 units on average. In-hospital mortality rate was 0.83%, with only one patient not surviving to discharge. One year mortality was 83.3%. Only two patients were alive one year post-operation. Of the remaining patients, average survival was 3.2 months (median 3, range 1-6). Patients spent an average of 17 days on an acute orthopaedic unit (median 14, range 4-80). Two patients required further convalescence in a rehabilitation unit. There were three surgical complications. Two impending fractures became complete, One intra-operatively and one post-operatively. In the case of basi-cervical fracture, the proximal screw cut out of the femoral head, requiring revision to a long-stem bipolar hemiarthroplasty. This was the only re-operation required in this series. Average pre-operative PMS was 5.2 (median 4, range 2-9). Average peri-operative drop in PMS was two points (median 1.5, range 0-6). Of the 11 patients who survived to discharge, 10 were independently mobile and returned to their pre-operation residence. Nine required a change in walking aids. Only one patient reported post-operative pain. This small patient series suggests that the Gamma3 Long Nail is a suitable treatment option for impending and actual metastatic femoral fractures in the District General setting. Length of stay, in-hospital mortality and re-operation rates compare favourably with published data on the Gamma2. There was a significant drop in Parker Mobility Score but all patients bar one were independently mobile and returned to their home. Anaesthetic time was not lower than with the Gamma2, suggesting little tangible benefit of the new instrumentation.
Case Report: Metastatic deposits in the proximal femur commonly result in pathological fracture. Conventionally these fractures are treated surgically, by internal fixation or arthroplasty. The emphasis in treating these fractures is on restoring stability to the proximal femur and relieving pain. We present two cases in which pathological
Chronic infection of bone with nonunion is traditionally treated by a 2-stage procedure involving initial debridement and antibiotic delivery and then definitive internal fixation. Alternatively, external fixators are used to provide stability. A technique with which single stage antibiotic cement-coated intramedullary nails are prepared in the operating room with the use of Kuntscher Nails and materials that generally are available is described herein. Although useful for all infected nonunions this technique is particularly useful for patients who are not ideal candidates for external fixation and for those who do not want to have an external fixator applied. We evaluated 10 cases treated with antibiotic cement-coated K nail with application of an additional unicortical plate in 7 cases. Autologous iliac crest bone grafting was done in all cases and additional bone substitutes used in 2 cases. 9 patients had stable union with complete control of infection. One patient had persistent infection at the time of last follow