Complication reporting and assessment is an important part of orthopaedic trials assessing new technologies. Because the reliability of the assessment by the treating surgeon compared to central review is still unknown, it was quantified in this study and possible patterns were identified. 176 patients with trochanteric fractures, treated with a trochanteric nail, were included in a prospective multicenter study. Surgeons were encouraged to report honestly every single potential complication, to rate severity, most likely cause, relation to implant, and to report the outcome of the complication. After 1-yr follow-up, 3 experienced orthopedic surgeons reassessed independently the same variables (agreement determined using kappa coefficient). Discrepancies were resolved by consensus.Introduction
Materials and methods
Tip apex distance (TAD) is reported as a predictor for cut outs of lag screws in the treatment of intertrochanteric fractures, and surgeons are adviced to strive for TAD within 20 mm. However the definition of neck axis and the limb position of lateral radiograph are not clearly described in the original literature. We propose the refined TAD by defining these factors. The objective of this study was to analyze the interobserver agreement of this refined TAD. X rays of 130 cases of unstable trochanteric fractures were used for the analysis of the refined TAD. In the refined TAD, neck axis was defined as the line between the center of femoral head and midpoint of narrowest part of the femoral neck, and lateral radiograph was taken with hip flexion 90 degrees and abduction 45 degrees. The refined TAD was independently measured by 2 experienced (observer 1,2) and 2 inexperienced (observer 3,4) orthopaedic surgeons who were trained with the new method before the measurement. Intraclass correlation coefficient (ICC [2,4]) was calculated to assess the interobserver agreement.Introduction
Materials and Method
When translating the principle of intramedullary nailing for trochanteric femoral fractures to Asian patients, design modifications made to adjust for anatomic differences resulted in an PFNA Asia. The primary endpoint of this study was the rate of complications attributable to fracture fixation. A prospective multicenter case series was performed; 176 patients with a median age of 84 with unstable trochanteric fractures treated with a PFNA Asia were included and followed for one year postoperatively. Complications were reviewed by a complication review board (CRB). Intra- and postoperative fracture fixation complications are presented according to type and incidence proportions (risk).Introduction
Material and methods
For the increasing number of frail elderly patients in Japan, mobility is crucial to stay independent and maintain quality of life. After failure reports with standard implants, a prospective multicentre study was performed to evaluate whether an implant designed for Asians enables rapid recovery after unstable trochanteric fractures. Patients with an AO 31A2 or A3 fracture sustained less than 7 days before fracture fixation with the Asian version of the Proximal Femoral Nail Antirotation. Those with severe dementia and bedridden or confined to a wheelchair were excluded. Outcome parameters were quality of life (SF36v2, EQ5D), mobility (Parker Mobility score PMS) and range of motion (ROM).Introduction
Materials and methods
Hip resurfacing has become a popular procedure for young active patients with osteonecrosis of the femoral head. However, it is not yet clear exactly how much osteonecrosis would permit this procedure and how much would be a contraindication. The aim of the present study was to analyze the resurfaced femoral head using finite element models and, in particular, to examine the influence of the extent of osteonecrosis and metaphysical stem shaft angles within the femoral head. We evaluated biomechanical changes at various extents of necrosis and implant alignments, using the finite element analysis method. We established three patterns of necrosis by depth from the surface of femoral head and five stem angles. Extension of necrosis as a quarter of femoral head diameter is type A, from a half is type B, and three-fourths is type C. We set five types of different stem angles from 125 to 145 degrees for the axis of femoral shaft. For these models, we evaluated biomechanical changes associated with the extent of necrosis and the stem alignment.Introduction
Methods
