scholarly journals P25 AVN and complication rate following Intracapsular fracture Neck of Femur fixation in the under 60s. – Derby experience

BJS Open ◽  
2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
Ross Sian ◽  
Conal Keane ◽  
Amol Tambe ◽  
Ross Sian
Keyword(s):  
Complication Rate ◽  
Major Complication ◽  
Time Range ◽  
Fixation Time ◽  
Neck Of Femur ◽  
Factors Affecting ◽  
Non Union ◽  
Femur Fractures ◽  
Fixation Type ◽  
Hip Screw

Abstract Introduction Neck of femur fractures (NOF#) are common in Trauma and Orthopaedics and Avascular necrosis (AVN) is a major complication. Guidance advises fixation within 48 hours, with no separate guidance for under 60 years of age. We reviewed factors affecting the complication rate in intracapsular NOF#’s undergoing fixation under the age of 60. Methodology We retrospectively reviewed a 5 year cohort (2013-2017) of intracapsular NOF#’s with native femoral head retention. 49 patients were identified. The following were determined: • Time to fixation from presentation in ED - 0-6hrs, 6-12hrs, 12-18hrs, 18-24hrs, 24-48hrs, 48+hrs: • Fixation type - Cannulated screw (CS), Dynamic Hip Screw (DHS), DHS + CS: • Complications – AVN, Non-union: • Displaced/Undisplaced Results 31 were undisplaced, 18 displaced. 82% (N = 40) were treated with CS, 10% (N = 5) with DHS and 8% (N = 4) with DHS + CS. Overall 21% developed AVN and 10% developed non-union. After undisplaced fractures 19% developed AVN and 10% developed non-union. After displaced fractures 22% developed AVN and 11% developed non-union. 40 patients were fixed using CS, 20% developed AVN and 12.5% had non-union. AVN occurred in 20% of those fixed with a DHS and 25% fixed with DHS and CS. No AVN was identified in the 0-6 hr fracture fixation time range. Conclusion No patients receiving fixation in less than 6 hours went on to have AVN or non-union, with higher rates after this time. There was no difference in outcome regarding AVN when looking at different fixation methods. There was no difference in complications when comparing fracture displacement.

scholarly journals Implant removal associated complications after ESIN osteosynthesis in pediatric fractures

2021 ◽  
Author(s):  
Justus Lieber ◽  
Markus Dietzel ◽  
Simon Scherer ◽  
Jürgen F. Schäfer ◽  
Hans-Joachim Kirschner ◽  
...  
Keyword(s):  
Complication Rate ◽  
Metal Removal ◽  
Intraoperative Complications ◽  
Statistical Significance ◽  
Major Complication ◽  
Safe Procedure ◽  
Pediatric Fractures ◽  
Femur Fractures ◽  
Outlet Angle ◽  
Implant Length

Abstract Purpose ESIN (elastic stable intramedullary nailing) is considered the gold standard for various pediatric fractures. The aim of this study was to analyze the incidence and type of complications during or after TEN (titanium elastic nail) removal. Methods A retrospective data analysis was performed. Metal removal associated complications and preoperative extraosseous length/outlet angle of TENs as possible causes of complications were assessed. Results The complication rate in 384 TEN removals was 3.1% (n = 12). One major complication (rupture of M. extensor pollicis brevis) was documented. One refracture at the forearm occurred, however, remodeling prior TEN removal was completed. Ten minor complications were temporary or without irreversible restrictions (3 infections, 5 scaring/granuloma, 2 temporary paraesthesia). In 38 cases (16 forearms, 10 femora, 9 humeri, 3 lower legs), intra-operative fluoroscopy had to be used to locate the implants. In patients with forearm fractures, extraosseous implant length was relatively shorter than in cases without fluoroscopy (p = 0.01), but outlet angle of TENs was not significantly different in these two groups (28.5° vs 25.6°). In patients with femur fractures, extraosseous implant length and outlet angle were tendentially shorter, respectively, lower, but this did not reach statistical significance. Conclusion Removal of TENs after ESIN is a safe procedure with a low complication rate. Technically inaccurate TEN implantation makes removal more difficult and complicated. To prevent an untimely removal and patient discomfort, nail ends must be exactly positioned and cut. Intraoperative complications may be minimized with removal of TENs before signs of overgrowth. Evidence Level III, retrospective.

scholarly journals X-Bolt unforeseen placement complication: case report

2017 ◽  
Vol 99 (8) ◽  
pp. e227-e229
Author(s):  
AD Clarke ◽  
JBT Herron ◽  
JL McVie
Keyword(s):  
Clinical Trial ◽  
Case Report ◽  
Gold Standard ◽  
The Novel ◽  
Sliding Hip Screw ◽  
Neck Of Femur ◽  
Femur Fractures ◽  
The World ◽  
Hip Screw ◽  
Hip Trauma

With the introduction of the World Hip Trauma Evaluation Four clinical trial, fixation of pertrochanteric neck of femur fractures is becoming a hot topic. In this trial, the novel X-Bolt expanding bolt implant is being compared with the current gold standard of a sliding hip screw. We present a previously undescribed complication when inserting the bolt into the femoral head, where the expandable wings penetrate the femoral neck due to misplacement of the bone crusher or the X-Bolt prosthesis. This unforeseen complication required the introduction of several additional corrective intraoperative steps.

scholarly journals Functional and radiological outcome of valgus osteotomy (abduction osteotomy of Pauwel) and fixation with dynamic hip screw in neglected fracture neck of femur

2020 ◽  
Vol 6 (5) ◽  
pp. 920
Author(s):  
Venugopal S. M. ◽  
Naveen Babu ◽  
Naresh Odnala ◽  
Gudaru Jagadesh
Keyword(s):  
Femoral Neck ◽  
Young Patients ◽  
Dynamic Hip Screw ◽  
Harris Hip Score ◽  
Osteotomy Site ◽  
Valgus Osteotomy ◽  
Neck Of Femur ◽  
Non Union ◽  
Fracture Neck Of Femur ◽  
Hip Screw

<p class="abstract"><strong>Background:</strong> Despite improvements in the techniques of surgery and internal fixation devices, non-union is still reported in one-third of cases of femoral neck fracture with displacement. Valgus intertrochanteric osteotomy alters the biomechanical environment of the fracture site and restores limb length.</p><p class="abstract"><strong>Methods:</strong> This was a prospective study on functional outcome of valgus osteotomy and fixation with dynamic hip screw (DHS) in neglected fracture neck of femur in Balaji Institute of Surgery, Research and Rehabilitation for the Disabled (BIRRD), Tirupati. 28 patients were enrolled between December 2017 to December 2019. Patients less than 60 years of age with fracture neck of femur of more than or equal to 3 weeks since injury and with failed primary fixation were included. Patients &gt;60 years of age, patients with avascular necrosis (AVN), and with resorption of femoral neck were excluded.<strong></strong></p><p class="abstract"><strong>Results:</strong> Among 28 patients 12 had union within 6 months and another 12 within 12 months. 4 patients were lost for follow-up hence considered as non-union. Osteotomy site united by 6 months in 22 patients and by 12 months in 2. Harris hip score was fair to excellent in 24 patients and poor in 4.</p><p class="abstract"><strong>Conclusions:</strong> Valgus osteotomy and DHS fixation is often a definitive one-time surgical procedure to achieve union in neglected and ununited fracture neck femur in young patients. It is simple and biological. In this study because of the delay in presentation and the young age of patients, Pauwels’ osteotomy was performed as the head-salvaging procedure. Union was achieved in 86% of this study patients.</p>

The Adjunctive Use of Half-Pin (Type I) External Skeletal Fixators in Combination with Intramedullary Pins for Femoral Fracture Fixation

1991 ◽  
Vol 4 (03) ◽  
pp. 77-85 ◽  
Author(s):  
P. D. Schwarz ◽  
M. D. Salman ◽  
Melissa Foland
Keyword(s):  
Complication Rate ◽  
Femoral Fracture ◽  
Major Complication ◽  
Bony Union ◽  
Type I ◽  
Femur Fractures ◽  
Impaired Limb ◽  
Lower Complication ◽  
Lower Complication Rate ◽  
One Year

SummaryA half-pin (type I) external skeletal fixator was used in conjunction with an intramedullary pin(s) for management of 29 femur fractures in 15 dogs and 14 cats. Eighty percent of the dogs and 100% of the cats achieved bony union using this combination of implants. However, because of the development of major complications which permanently impaired limb function (e.g. quadriceps tie-down), only 67% of the dogs and 93% of the cats were considered to have successful outcomes. The overall complication rate was 87% for dogs and 43% for cats. Dogs weighing <6.8 kg had a significantly lower complication rate than dogs weighing ≥6.8 kg. Dogs < one year of age were significantly more likely to develop a major complication resulting in an unsuccessful outcome, than dogs ≥ one year of age. A significant association was not established between any of the study variables and the complication incidence in cats.

scholarly journals To derotate or not? The impact of a permanent derotation screw on the revision rate of dynamic hip screw fixation for intracapsular neck of femur fractures.

F1000Research ◽  
2017 ◽  
Vol 6 ◽  
pp. 678
Author(s):  
Simon Woods ◽  
Richard Pilling ◽  
Ivan Vidakovic ◽  
Alloush Al-Mothenna ◽  
Reza Mayahi
Keyword(s):  
Randomized Trials ◽  
Revision Rate ◽  
Number Needed To Treat ◽  
Neck Of Femur ◽  
Patient Demographics ◽  
Femur Fractures ◽  
Hip Screw ◽  
The Mean ◽  
The Impact ◽  
Robust Evidence

Background: In this retrospective study, we examine the impact that employing a permanent derotation screw (DRS) has on the rate of revision for 2-hole dynamic hip screws (DHS, a.k.a. sliding hip screws), used for internal fixation of intracapsular neck of femur (NOF) fractures. To the best of our knowledge, we are the first to examine the impact of using a derotation screw on DHS revision rate. Methods: We obtained a list of 64 patients suffering intracapsular NOF fracture treated with 2-hole DHS over a 5-year period, 28 of these were also treated with a DRS, forming our DRS group, 36 were not (non-DRS group). Fracture severity and patient demographics between the groups were compared to ensure homogeneity. The rate of revision to arthroplasty (total or hemi) of the two groups were compared. Results: The mean age in the DRS group was 70.79 years, 1.77 years lower than the non-DRS group (p=0.570). The DRS group had a rate of revision of 14%, in comparison with 39% in the non-DRS group (p=0.0299), corresponding with a number needed to treat of 4.06 derotation screws to prevent a single failure. Conclusions: In this study, employing a permanent derotation screw alongside a 2-hole DHS was associated with a significantly lower rate of revision to arthroplasty than using a 2-hole DHS alone. We would recommend this be further investigated with prospective randomized trials, to provide robust evidence and make clinical recommendations.

scholarly journals Correction to: Hemiarthroplasty for neck of femur fractures: to cement or not? A systematic review of literature and meta-analysis

2019 ◽  
Vol 29 (8) ◽  
pp. 1835-1836
Author(s):  
Prasoon Kumar ◽  
Rajesh Kumar Rajnish ◽  
Deepak Neradi ◽  
Vishal Kumar ◽  
Saurabh Agarwal ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Review Of Literature ◽  
Neck Of Femur ◽  
Femur Fractures

scholarly journals The Assessment of Early Complications and Risk Factors Affecting Their Occurrence in Breast Reconstructive Procedures

2021 ◽  
Author(s):  
Justyna Jończyk ◽  
Jerzy Jankau
Keyword(s):  
Risk Factors ◽  
Postoperative Complications ◽  
Breast Reconstruction ◽  
Complication Rate ◽  
Clinical Factors ◽  
Early Complications ◽  
Reconstructive Procedures ◽  
Factors Affecting ◽  
Rehospitalization Rate ◽  
Early Postoperative Complications

AbstractThe presence of postoperative complications may have a significant impact on the outcome of the breast reconstruction. The aim of this study was to investigate early postoperative complications and the risk factors for their occurrence. A prospective analysis was carried out to evaluate surgical outcomes after breast reconstructive surgeries performed over a 2-year period. Procedures included expander/implant (TE/IMP), pedicle transverse rectus abdominis musculocutaneous (pTRAM), and latissimus dorsi (LD) techniques. All adverse events which occurred within 6 weeks of surgery were ranked according to severity based on the contracted Accordion grading system. Outcomes were assessed for their association with surgical, demographic, and clinical variables. Sixty-one consecutive breast reconstruction procedures were analyzed. The overall complication rate was 60.7% (n = 37), and 8 patients (13.1%) required reoperation. The lowest complication rate was observed in implant-based reconstructions (TE/IMP, 18.8%; pTRAM, 72.7%; LD, 78.3%; p = 0.008). Mild complications occurred significantly more often after LD reconstructions (LD, 60.9%; pTRAM, 22.7%; TE/IMP, 12.5%; p = 0.031), while severe complications were significantly more frequent after the pTRAM procedures (pTRAM, 27.3%; TE/IMP, 6.2%; LD, 8.7%; p = 0.047). Severe complications were associated with higher rehospitalization rate (p = 0.010) and longer hospital stay. Study revealed a significant impact of the operative method on the incidence and severity of early complications after breast reconstruction procedures with little effect from other demographic and clinical factors.

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