Anatomical Reduction Is Not Necessary in Treating Non-Porotic Unstable Intertrochanteric Fracture: A Biomechanical Study of Porcine Model

2003 ◽  
Author(s):  
Shi-Wei Lin ◽  
Jaw-Lin Wang
Keyword(s):  
Soft Tissues ◽  
Porcine Model ◽  
Intertrochanteric Fracture ◽  
Weight Bearing ◽  
The United States ◽  
Anatomical Reduction ◽  
Fixation Failure ◽  
Cerclage Wire ◽  
Unstable Intertrochanteric Fracture ◽  
Cerclage Wiring

Intertrochanteric fracture occurred more than 200,000 cases each year in the United States, with mortality rate up to 20 percents. Evans classified the intertrochanteric fracture pattern to stable and unstable group. Most of the complications occurred in the unstable group. It is speculated that in the unstable intertrochanteric fracture, the lag screw migrates easily into the porotic femur head and than causing fixation failure. So the treatment of porotic unstable femoral intertrochanteric fracture depends on the bone quality, severity of comminution, anatomical reduction and methods of fixation. An abundant of studies had been focused on how to reinforce the porotic unstable intertrochanteric fracture including osteotomies, cement augmentation, anatomical reduction, and different implant applications. Among the many techniques, the anatomical reduction using cerclage wiring was widely used to enhance the stability of osteoporotic fractured femur. However, in the young adult, the application of cerclage wiring is controversial. The current study compares the mechanical properties of two anatomical reduction techniques of unstable intertrochanteric fracture reconstructed by a compression hip screw. Four porcine femurs of 10 months-old were used to simulate the non-porotic human bone. The specimens were stripped of all soft tissues. Each femur was prepared with four holes for dynamic hip screws following the standard surgical procedure. The anatomical reduction was achieved by a cerclage wiring and without cerclage wiring. The results reveal that in the non-porotic porcine model, there is no statistically difference in stiffness, plate strain and medial bone strain per load. No matter the unstable intertrochanteric fracture is reduced with cerclage wire or not. The non-porotic unstable intertrochanteric fracture anatomical reduction is not necessary if protective weight bearing is obeyed. However, whether the cerclage wiring is necessary or not for the osteoporotic unstable femur fracture needs further study.

Common Modes of Fixation Failure with a Sliding Hip Screw encountered Unstable Intertrochanteric Fracture

2003 ◽  
Vol 16 (1) ◽  
pp. 15 ◽  
Author(s):  
Byung Soon Kim ◽  
Duck Yun Cho ◽  
Hyung Ku Yoon ◽  
Dong Eun Sin ◽  
Soo Hong Han ◽  
...  
Keyword(s):  
Intertrochanteric Fracture ◽  
Sliding Hip Screw ◽  
Fixation Failure ◽  
Unstable Intertrochanteric Fracture ◽  
Hip Screw

scholarly journals Combined Lag Screw and Cerclage Wire Fixation for Calcaneal Tuberosity Avulsion Fractures

2018 ◽  
Vol 2018 ◽  
pp. 1-6
Author(s):  
Vincenzo Giordano ◽  
Alexandre Leme Godoy-Santos ◽  
Felipe Serrão de Souza ◽  
Hilton Augusto Koch ◽  
Cesar de Cesar Netto ◽  
...  
Keyword(s):  
Soft Tissues ◽  
Plantar Flexion ◽  
Weight Bearing ◽  
Large Diameter ◽  
Minor Trauma ◽  
Cannulated Screws ◽  
Avulsion Fractures ◽  
Cerclage Wire ◽  
Plantar Aspect ◽  
Calcaneal Tuberosity

Avulsion fractures of the calcaneal tuberosity represent a rare injury pattern that is caused by a powerful tension force from the Achilles tendon and is usually seen following minor trauma, especially in elderly patients. The objective of this study is to describe a surgical technique using cerclage wiring through cannulated screws in the treatment of extra- and intra-articular avulsion fractures of the calcaneal tuberosity and to present our results in a small patient’s cohort. Through a 5.0 cm longitudinal skin incision over the posterolateral aspect of the calcaneus, after adequate debridement of the fracture fragments and while keeping the ankle in plantarflexion, the calcaneal tuberosity is anatomically reduced with the help of a periarticular reduction clamp and an accessory plantar longitudinal approach. Provisionally fixation is performed with K-wires. Definitive fixation is achieved with two parallel partially threaded 7.0 cannulated screws, which are positioned from the superior and posterior aspect of the tuberosity to the inferior and anterior aspect of the plantar surface of the calcaneus, and 1.5 mm cerclage wires that are pulled epiperiosteally to the plantar aspect of the calcaneus to avoid damage to local soft tissues. Alternatively, for smaller fracture fragments, two 3.5 mm partially threaded cannulated screws and 1.25 mm cerclage wires can be used. We also report the results of the procedure in a small cohort of four patients. All fractures healed in an anatomic position. There was no failure of fixation, loss of reduction, or need for secondary surgery, including hardware removal. At final follow-up, all patients had regained full plantar flexion range of motion and strength, with no gait or weight-bearing restrictions. In conclusion, the combination of cerclage wire and large diameter cannulated screws represents a promising option in the treatment of avulsion fractures of the calcaneal tuberosity, demonstrating good functional and radiographic results in our cohort of patients.

Fixation Failure of Compression Hip Screw in Unstable Intertrochanteric Fracture of Femur

2003 ◽  
Vol 16 (4) ◽  
pp. 600 ◽  
Author(s):  
Deuk Soo Hwang ◽  
Sang Goo Kwak ◽  
Young Mo Kim ◽  
Dae Chul Nam ◽  
Ui Pyo Hong
Keyword(s):  
Intertrochanteric Fracture ◽  
Fixation Failure ◽  
Unstable Intertrochanteric Fracture ◽  
Hip Screw

scholarly journals Efficacy of proximal femoral nail augmentation in unstable intertrochanteric fracture

2020 ◽  
Vol 6 (5) ◽  
pp. 1043
Author(s):  
Purushotham V. J. ◽  
M. Ayyub Khan ◽  
Navneeth Kumar
Keyword(s):  
Intertrochanteric Fracture ◽  
Femoral Fractures ◽  
Proximal Femoral Nail ◽  
Harris Hip Score ◽  
Cerclage Wire ◽  
Femoral Nail ◽  
Unstable Intertrochanteric Fracture ◽  
Male Patients ◽  
Modified Harris Hip Score ◽  
A Prospective Study

<p class="abstract"><strong><span lang="EN-US">Background: </span></strong><span lang="EN-US">To assess the short term functional and radiological outcome of unstable intertrochanteric fracture fixation using proximal femoral nail with augmentation using Cannulated Cancellous (CC) screw or Stainless Steel (SS) wiring.</span></p><p class="abstract"><strong><span lang="EN-US">Methods: </span></strong><span lang="EN-US">A prospective study was conducted with 20 cases of unstable intertrochanteric femoral fractures from May 2017 to March 2019. Six females and fourteen male patients in the age group between 40 and 80 years were included in this study. There were 8 cases of AO31A2 and 12 cases of AO31 A3. Fracture were fixed by proximal femoral nail with augmentation by an additional CC screw or encirclage with SS wires to strengthen the lateral trochanteric wall.</span></p><p class="abstract"><strong><span lang="EN-US">Results: </span></strong><span lang="EN-US">Fracture union was achieved in all cases with a mean period of 15.4 weeks. Patients were followed up for a period of 6 months. At the end of follow up the Modified Harris Hip Score was found to be more than 90 % in 16 cases.</span></p><p class="abstract"><strong><span lang="EN-US">Conclusion:</span></strong><span lang="EN-US"> Augmentation of proximal femoral nail in unstable intertrochanteric fracture with additional screw or cerclage wire increases the efficacy and stability of construct, aiding union and expedition of time to union.</span></p>

Primary Long Distal Fitting Bipolar Hemiarthroplasty for Unstable Intertrochanteric Fracture in Elderly Patients

2020 ◽  
Author(s):  
Reza Zandi ◽  
Amin Karimi ◽  
Mehrdad Sadighi ◽  
Mohammadreza Minator-Sajjadi ◽  
Mohammad Ali Okhovatpour ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Femoral Fracture ◽  
Intertrochanteric Fracture ◽  
Weight Bearing ◽  
Operation Time ◽  
Harris Hip Score ◽  
Bipolar Hemiarthroplasty ◽  
Intertrochanteric Femoral Fracture ◽  
Estimated Blood Loss ◽  
Unstable Intertrochanteric Fracture

Background: Intertrochanteric fracture in elderly patients is a frequent problem and is becoming more prominent as the proportion of this injury increases. The ideal treatment for an unstable intertrochanteric femoral fracture in senile osteoporotic patients remains controversial. Methods: Seventy-five patients (over 70 years of age) with unstable intertrochanteric fractures were randomized into three groups and treated with three different procedures including long-stem bipolar hemiarthroplasty, proximal femoral nail (PFN), and dynamic hip screw (DHS). Estimated blood loss, duration of the operation, time of full weight-bearing, and Harris Hip Score (HHS) were determined for each patient. Results: Surgical time was longer in hemiarthroplasty group, but the HHS and time from surgery to mobilization in these patients were significantly superior to the two other groups. PFN group had the lowest bleeding volume during surgery. Revision surgery was lower in hemiarthroplasty compared to the internal fixation, although it was not statistically significant. Conclusions: In elderly patients with an unstable intertrochanteric femoral fracture who cannot tolerate long immobilization time, primary long distal fitting bipolar hemiarthroplasty is a valid treatment option for faster mobilization, good clinical efficacy, and satisfactory functional outcome.

Fixation Failure of Unstable Intertrochanteric Fracture of the Femur Using Compression Hip Screw

2005 ◽  
Vol 18 (1) ◽  
pp. 1
Author(s):  
Sang Won Park ◽  
Soon Hyuck Lee ◽  
Jong Ryoon Baek ◽  
Sung Jun Park ◽  
Jong Won Chung
Keyword(s):  
Intertrochanteric Fracture ◽  
Fixation Failure ◽  
Unstable Intertrochanteric Fracture ◽  
Hip Screw

Computerized Tomography: A Perspective in the Pediatric Patient

PEDIATRICS ◽  
1977 ◽  
Vol 59 (2) ◽  
pp. 305-308
Author(s):  
Derek Harwood-Nash ◽  
Herman Grossman ◽  
Alvin Felman ◽  
John Kirkpatrick ◽  
Leonard Swischuk
Keyword(s):  
Computerized Tomography ◽  
Soft Tissues ◽  
Conventional Radiography ◽  
The United States ◽  
The Body ◽  
Whole Body ◽  
Central Research ◽  
X Ray ◽  
Whole Body Ct

Computerized tomography (CT), a technique conceptualized by Oldendorf in 19611 and developed by Hounsfield2 of EMI-Tronics Inc. (EMI) Central Research Laboratories, has proven to be a successful innovation in neuroradiology. Reviews by Ambrose3 in England and by Baker et al.4 and by New et al.5 in the United States have clearly demonstrated the value of this new modality in neuroradiological diagnosis. In 1975 Houser et al.6 and Harwood-Nash et al.7 provided the initial clinical and radiological data about CT in infants and children. More recently this technique has been extended to the study of tissues and organs in the body other than those in the head. This has been accomplished by modification of the original machine into a whole-body CT system. Early reviews by Ledley et al.8 and by Alfidi et al.9 suggest a significant potential for diagnosis of lesions in the abdomen, pelvis, and thorax. The advantages of CT are that it is less invasive than standard special diagnostic radiological procedures and that for the first time it provides in vivo information regarding the content and the characteristics of tissue composing organs and masses. DESCRIPTION OF EQUIPMENT In conventional radiography an image is made on radiographic film by an attenuated X-ray beam. In passing through a core of tissue, each ray of the beam is attenuated as it is absorbed and scattered by the tissue in its path. The intensity of the transmitted ray depends on the sum total of X-ray attenuation by all the different soft tissues in its path.

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