Abstract

To determine the outcome of subtrochanteric fractures treated by intramedullary (IM) nailing and identify causes for implant failure.

We performed a retrospective analysis of all subtrochanteric fractures treated by intramedullary nailing in Belfast trauma units between February 2006 and 2009. This subgroup of patients was identified using the Fractures Outcome Research Database (FORD). Demographic data, implant type, operative details, duration of surgery and level of operator were collected and presented. Post-operative X-rays were assessed for accuracy of reduction.

One hundred and twenty two (122) patients were identified as having a subtrochanteric fracture treated by IM nailing. There were 79 females and 43 males. Age range was 16 to 93 (mean 78). 95 (78%) cases were performed by training grades and 27 (22%) by consultants. Duration of surgery ranged from 73–129mins (mean 87mins). 47 patients (38.5%) were found to have a suboptimal reduction and 75 patients (61.5%) had an anatomical reduction on immediate post-operative x-ray. One year from surgery 73/122 patients were available for follow up. Of those patients with suboptimal reduction, 13/47 (27.7%) required further surgery. 8 required complete revision with bone grafting, and 5 underwent dynamisation. A further 6 patients had incomplete union. In the anatomical group, 4 patients underwent further surgery (5%). 3 required dynamisation and one had exchange nailing for an infected non-union. 3 patients had incomplete union at last follow up. 5/47 (10.6%) had open reduction in the suboptimal group compared to 25/75 (33.3%) in the anatomical group. Of the 27 cases performed by consultants, 13 (48%) were open reduction, compared to 17/93 (18%) by training grades.

This study has shown that inadequate reduction of subtrochanteric fractures, leads to increased rates of non union and ultimately implant failure. We recommend a low threshold for performing open reduction to ensure anatomical reduction is achieved in all cases.

Introduction

Dislocation is one of the most common complications following total hip arthroplasty. The literature suggests a frequency of 1–3% for primary total hip replacement (THR) and 7–10% for revision procedures. No definitive treatment algorithm exists for their management, with some surgeons attempting to constrain hip motion with casting or bracing initially. The evidence for this practice is limited. The purpose of this study was to determine the current practice for managing THR dislocation within our unit, and to determine the effectiveness of abduction bracing.

Introduction: Intracapsular femoral neck fractures in adults under 65 years old are associated with significant complications such as avascular necrosis of the femoral head and non-union. Timing of surgery remains controversial, with some studies suggesting that early surgical fixation reduces the rate of these complications. Presently the policy in this Fracture Unit remains early fixation (target less than twelve hours). The purpose of this study is to determine if this twelve hour target is being achieved and if not, where the delays are occurring.

Methods: A retrospective case-note and data analysis was performed on all patients aged under 65 who underwent internal fixation of displaced intracapsular femoral neck fractures (Garden III/IV) between 31/12/06 and 31/12/07. The following data was collected; time of injury to presentation at health service, time from presentation at health service to admission at treating hospital, time of admission at treating hospital to time of surgery and overall time from injury to surgery. The main causes of delay were also determined.

Results: In the one year period, there were 37 young adults with displaced intracapsular femoral neck fractures, with a mean age of 52.57 years. There were 23 females (62.2%) and 14 males (37.8%).

We also present the reasons for delay at each stage including transfer delays, medical delays and limited emergency theatre availability.

Discussion: Early operative fixation of young femoral neck fractures remains controversial. In this unit where it is advocated, the median time from injury to fixation is 22.18 hours. By reducing transfer times, increasing emergency theatre availability and improving efficiency of patient preparation for theatre at ward level, the twelve hour targets will be much more attainable.

Introduction: Intracapsular femoral neck fractures in adults under 65 years old are associated with significant complications such as avascular necrosis of the femoral head and non-union. Timing of surgery remains controversial, with some studies suggesting that early surgical fixation reduces the rate of these complications. Presently the policy in this Fracture Unit remains early fixation (target less than twelve hours). The purpose of this study is to determine if this twelve hour target is being achieved and if not, where the delays are occurring.

Methods: A retrospective case-note and data analysis was performed on all patients aged under 65 who underwent internal fixation of displaced intracapsular femoral neck fractures (Garden III/IV) between 31/12/06 and 31/12/07. The following data was collected; time of injury to presentation at health service, time from presentation at health service to admission at treating hospital, time of admission at treating hospital to time of surgery and overall time from injury to surgery. The main causes of delay were also determined.

Results: In the one year period, there were 37 young adults with displaced intracapsular femoral neck fractures, with a mean age of 52.57 years. There were 23 females (62.2%) and 14 males (37.8%).

We also present the reasons for delay at each stage including transfer delays, medical delays and limited emergency theatre availability.

Discussion: Early operative fixation of young femoral neck fractures remains controversial. In this unit where it is advocated, the median time from injury to fixation is 22.18 hours. By reducing transfer times, increasing emergency theatre availability and improving efficiency of patient preparation for theatre at ward level, the twelve hour targets will be much more attainable.