Dr A. C. Mageza. Dept of Orthopaedics and Trauma Surgery. MBChB(UZ); FCS Orth(ECSA) Orthopaedic Surgeon

Transcription

1 Management of Ipsilateral Neck and shaft of femur fractures using SIGN intramedullary locked system and lag screws. A case series of patients managed at Parirenyatwa hospital between March 2013 and December Mageza Akimu. C 1 ; Paketh Brian 2 ; Mandizvidza Valentine 3 ; Gova Max F 4 1,2 Department of Surgery Parirenyatwa Group of Hospitals Box CY198 Causeway Harare; 3,4 Department of Surgery University of Zimbabwe, College of Health Sciences Box A178 Avondale Harare. Dr A. C. Mageza MBChB(UZ); FCS Orth(ECSA) Orthopaedic Surgeon Dept of Orthopaedics and Trauma Surgery Parirenyatwa Group of Hospitals dramageza@gmail.com; dramageza@icloud.com

2 No Disclosures 2

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4 AVAILABLE LITERATURE Russell Taylor nails in 11 cases. Ostermann et al. Modified Grosse-Kempf nail in 27 cases. Alho et al. Reconstruction nails in 27. Randelli et al. 23 cases with recon nails - complications in 56%. Reconstruction nailing technically difficult. Jain et al. Good results with LPFN in 19 cases. Pavelka et al. Neck frx could be well treated with miss-a-nail screws. Shetty et al. 4

5 INTRODUCTION Incidence 1 10%. High velocity. 19% to 50% missed. Management controversial. Numerous methods. eg. Cephalo-medullary nails. 1. Watson TJ corr 2002; 2. Ming-Chian Tsai, et al Chang Gung Med J 2009; 3. Alho A, Acta 1996; Yang JBJS 1998; bennett Corr 1993; 4. Shao-Hung Hung Injury2004; Y. Liu et al. Injury 2010,

6 LOCAL EXPERIENCE Local data unknown. Various methods used SIGN nail introduced % excellent and good on femur frx. Ipsilateral neck and shaft fractures. Unpublished data M. F. Gova, A. C. Mageza

7 OBJECTIVES Determine the Incidence Aetiology Outcome Effect of timing of Sx. 7

8 METHODOLOGY Retrospective analysis of prospectively collected data SIGN database Excel spreadsheet SIGN surgical technique Lag screw under fluoroscopy Feibel and Zirkle Jr. Techniques in Orthopaedics Volume 24, Number 4,

9 METHODOLOGY 15 cases out of a total of 207 Incidence of 7%. 14 cases managed by SIGN nail +/- lag screws One pt not recorded in the SOSD 13 cases included in this study 12 males 1 female Median age 34yrs.

10 METHODOLOGY Antegrade vs Retrograde nail 11: 2 All pts victims of MVC Right: left = 10:3 Majority (85%) < 40yrs Intra vs extra capsular frxs 8:5 Winquist type 1=2; type 2=1; type 3=6; type 4= 4 Associated injuries 61% 10

11 CASE EXAMPLE 1 K N 34 male MVC Winquist 1 mid shaft femur frx Garden 1 basicervical Antegrade SIGN nail + 2 lag screws

12 Post operative images

13 Follow up 10 week review Angle 130 o Neck frx union Shaft no union Telephone interview 1yr 6mo Can squat and smile No pain full flexion ext mvnts

14 CASE EXAMPLE 2 O.C 53years male MVC Winquist 4 distal 1/3 Garden 3 basicervical Comminuted tibia plateau frx ipsilateral Blunt chest trauma 14

15 POST OP Referral was delayed Surgery done 9 weeks post injury Retrograde nailing + 2 lag screws in the neck ORIF tibia plateau Knee ROM limited post op 15

16 FOLLOW UP Neck shaft angle 95 o Knee stiffness ROM 0 30 o Mobilising with crutches Ankle pain Shortening 4cm Screw cut out 16

17 CASE 3 D N 33years Male MVC Winquist 2 mid shaft Displaced intertroch Rib frx Head injury, blunt chest trauma Antegrade SIGN nail 1 lag screw

18 Post operative images

19 Follow up

20 OUTCOME FAIR 18% POOR 18% GOOD 18% EXCELL ENT 45% 63% Good to excellent 20

21 RESULTS Incidence 7% of all femur fractures MVC. Infection 1 case Varus deformity in delayed cases. Poor outcome with associated injuries. Inadequate reduction - poor outcome. Varus deformity if no lag screw is used. No difference with number of lag screws. No diff btwn intra and extra capsular frx. 21

22 CONCLUSION Not uncommon. High velocity injuries Associated with other injuries. Young individuals. SIGN nail and Lag screws comparable. Lag screws necessary to stabilise the neck fracture. Early surgery is associated with a better outcome

23 IMPORTANT TO NOTE 23

24 REFERENCES 1. Watson T.J Corr 2002; 2. Ming-Chian Tsai, et al Chang Gung Med J 2009; 3. Alho A, Acta 1996; Yang JBJS 1998; bennett Corr 1993; 4. Shao-Hung Hung Injury 2004; Y. Liu et al. Injury Vidyadhara S, Rao S. K, Injury, Int. J. Care Injured 40 (2009) 6. Canale. S. T; Beaty J. H Campbell textbook of orthopaedic Surgery, 12th ed 7. Winquist RA. Locked femoral nailing. J Am Acad Orthop Surg Mageza A. C; Gova M. F; B. Paketh Unpublished data 9. Feibel and Zirkle Jr. Techniques in Orthopaedics Volume 24, Number 4, Thoresen et al 24