Salvage of failed dynamic hip screw fixation of intertrochanteric fractures
|
|
- Marybeth Terry
- 6 years ago
- Views:
Transcription
1 Injury, Int. J. Care Injured (2005) xxx, xxx xxx Salvage of failed dynamic hip screw fixation of intertrochanteric s G.Z. Said, O. Farouk *, A. El-Sayed, H.G. Said Department of Orthopaedic Surgery and Traumatology, Assiut University Hospitals, Assiut, Egypt Accepted 19 September 2005 KEYWORDS Failed DHS; Intertrochanteric ; Trochanteric nonunion Introduction Primary insertion of dynamic hip screw (DHS) for trochanteric s is not always successful, especially in unstable s. 3,6 Madsen et al. 9 reported significant secondary displacement in 34% of cases, leading to a varus malunion, * Corresponding author. Tel.: ; fax: address: osama_farouk@yahoo.com (O. Farouk) /$ see front matter # 2005 Published by Elsevier Ltd. doi: /j.injury Summary Twenty-six patients with failed dynamic hip screw fixation of intertrochanteric s were included in this study. The mean age of the patients was 61 years (range, years). Average limb shortening was 2.4 cm; 18 patients were treated with revision internal fixation and eight patients with prosthetic replacement. The decision depended on the physiological age of the patient, quality of bone, and condition of the femoral head and the acetabulum. The revision internal fixation group included DHS reinsertion in eight patients, and revision DHS fixation in six, while four patients were treated by and insertion of single-angled 1308 plate. The prosthetic replacement group included cemented Thompson endoprothesis in five patients and cemented total hip arthroplasty in three. The mean follow-up period was 31 months (range, months). All patients of revision internal fixation group achieved healing without bone grafting. Time to union averaged 17 weeks. Average gain in length was 2 cm Avascular necrosis of the femoral head occurred in one patient. Six patients of the prosthetic replacement group achieved good functional outcome and pain-free gait. The remaining two had unsatisfactory result. # 2005 Published by Elsevier Ltd. lag screw cutout, or excessive lag screw sliding with medialisation of the distal fragment. Buciuto et al. 2 reported significant technical failures in their series. Mechanical stability after internal fixation is dependent on the quality of bone, personality, quality of reduction and choice of the implant. Implant placement in the biomechanically ideal position, however, is probably the most important factor. 8 The aim of this study is to report on surgical salvage for failed DHS fixation of intertrochanteric s
2 2 G.Z. Said et al Patients and methods Between January 1998 and January 2004, twenty-six patients with failed DHS fixation of intertrochanteric were referred to our institution. All patients were preoperatively assessed, surgically treated and followed up by the authors. Inclusion criteria Early and late DHS failures with un-united intertrochanteric s in adults and elderly patients were included. The exclusion criteria were active infection and united s with accepted functional outcome. All patients were evaluated both clinically and radiologically. Fractures were classified according to the AO classification. 11 Causes of DHS failure were analyzed. Treatment groups The patients were sorted under four subgroups according to the method of surgical treatment applied (Table 1). In the revision internal fixation group, the implant was inserted to near the subchondral bone for good purchase. In one patient of group I, in addition to reinsertion of DHS, a narrow six-hole DCP was laterally mounted like a trochanteric stabilizing plate to prevent medialisation of the shaft (Fig. 1). In this case, a 1-cm shorter DHS screw was introduced deep into the neck to allow for the sliding mechanism inside the plate barrel. Bone grafting was not added in any patient. Assessment i. Fracture union in groups I and II was considered radiographically if callus formation was seen in three of four cortices on anteroposterior and lateral views. Clinical union was considered when there was painless hip range of movement and painless full weight bearing. ii. Functional assessment was done using subjective and objective information, based on pain, limb shortening, and walking ability. Results Details of the patients are shown in Table 2. The patients were aged years (mean 61 years) with a male to female ratio of The mean period of follow-up was 31 months (range, months). Eight s were stable type A1 and 18 were unstable (type A2 in 15 and type A3 in three) according to AO classification. DHS failure Time between initial surgery and DHS failure ranged between 2 and 52 weeks and averaged 22 weeks. Causes of DHS failure were inadequate placement of the DHS in eight patients, instability with secondary varus displacement in 10 patients and severe of the femoral head in eight patients. Fracture union All patients in groups I and II achieved union. The osteotomy also united in all patients of group II. The mean time to union was 17 weeks (range, weeks). Bone grafting was not needed in any case. All had satisfactory radiological result (Figs. 1 and 2) without any implant failure. Functional outcome 1. Pain: Twenty patients were pain free at the last follow up. Four patients from group II had occasional hip pain that did not interfere with their daily activities. The remaining two patients were from group III, and had persistent hip and anterior thigh pain. 2. Limb shortening: Preoperative average limb shortening measured 2.4 cm (range, 1 6 cm). Table 1 The four groups of patients according to the type of surgery Surgical group Number Indications I. Repeat DHS 8 Short screw, good bone stock II. Subtrochanteric 10 Varus neck DHS re-fixation 6 Good bone stock of femoral head Single angled 1308 plate 4 Good bone stock in infero-medial quadrant III. Haemiarthroplasty 5 Excavated femoral head IV. Total hip replacement 3 Osteoporosis, acetabular damage
3 Salvage of failed dynamic hip screw fixation 3 Figure 1 (a) A 38-year-old man (case no. 1) presented 8 months after DHS operation. Note translucency around the screw and barrel, excessive backing of the screw and medialisation. (b) Lateral view confirmed poor reduction and non-union. (c and d) The united after reduction of the fragments and reinsertion of DHS to near the subchondral bone. A narrow DCP was put as a trochanter-stabilizing plate.
4 Table 2 Summary of patients data, pre-operative clinical evaluation, surgical procedure and outcome of all patients Patients Initial DHS fixation Pre-operative clinical evaluation Fracture type (AO classification) Surgical procedure No. Age Sex Time to failure (weeks) Cause of failure Limb shortening (cm) Femoral head Acetabular state Complications Functional outcome 1 38 Male 32 Mal-placed DHS 1.5 Good Good A2 DHS reinsertion 2 55 Female 22 Unstable 3 Good Good A2 DHS reinsertion Female 16 Unstable 2.5 Good Good A2 DHS reinsertion + Occasional Without 4 40 Female 12 Mal-placed DHS 1.5 Good Good A3 DHS reinsertion 5 58 Male 18 Unstable 6 Good Good A2 DHS reinsertion Male 2 Mal-placed DHS 1 Good Good A2 DHS reinsertion 7 70 Female 24 Femoral head 1.5 Excavated Good A1 Thompson 8 60 Female 20 Unstable 3.5 Good Good A2 DHS reinsertion Female 20 Femoral head 2 Excavated Good A1 Thompson Free One-arm Male 16 Unstable 3 Good inferomedial Good A Plate + valgus quadrant osteotomy Male 12 Mal-placed DHS 1.5 Good Good A3 DHS reinsertion Female 32 Femoral head 2 Excavated Abraded A1 Total hip replacement Free One-arm Female 12 Mal-placed DHS 1.5 Good Good DHS reinsertion Female 40 Femoral head 2 Excavated Severe A1 Total hip replacement Free One-arm Female 16 Mal-placed DHS 1.5 Good Good A2 DHS reinsertion Male 24 Unstable 3 Good infero-medial Good A Plate + valgus quadrant osteotomy Female 14 Mal-placed DHS 2 Good Good A3 DHS reinsertion Pain Walking 4 G.Z. Said et al. DTD 5
5 18 72 Male 36 Femoral head 1.5 Excavated Osteoporosis A1 Thompson Persistent Indoor + walker Female 16 Mal-placed DHS 2 Good Good A2 DHS reinsertion Female 30 Femoral head 2 Excavated Osteoporosis A1 Thompson Free One-arm Female 28 Femoral head 3 Excavated Good A1 Thompson Periprosthetic Persistent Indoor + walker Male 20 Unstable 4 Good infero-medial Good A Plate + valgus Avascular necrosis Occasional Without quadrant osteotomy of femoral head Female 52 Femoral head 3 Excavated Severe A1 Total hip replacement DVT Free One-arm Female 24 Unstable 3 Good inferomedial Good A Plate + valgus Occasional Without quadrant osteotomy Female 16 Unstable 2.5 Good Good A2 DHS reinsertion + valgus Occasional Without osteotomy Male 20 Unstable 2.5 Good Good A2 DHS reinsertion + Salvage of failed dynamic hip screw fixation 5 DTD 5
6 6 G.Z. Said et al Figure 2 (a) A 58-year-old man (case no. 5) had DHS fixation for trochanteric. The DHS lag screw cutout. The DHS was removed. (b) The patient presented to our institution 6 weeks later with coxa vara, full external rotation and 6 cm shortening. (c) Reinsertion of DHS and was done after correction of external rotation and shortening. (d) Follow-up 10 months postoperatively with complete union of the. Average gain in length was 2 cm (range, 1 4 cm) postoperatively. Residual shortening of 2 cm remained in two patients. 3. Walking ability: All patients of groups I and II could walk without at the latest follow up. Two patients from group III were walking with one arm and one patient was able to walk without. The remaining two could walk indoors using walker with difficulty, and were listed for conversion to total joint replacement. The three patients of group IV could walk with one arm. Complications Two patients had post-operative complications. One had DVT and the other had a periprosthetic in the early postoperative period, which was treated successfully with plate fixation. Avascular necrosis of the femoral head occurred in one patient who had and 1308 plate fixation. The blade penetrated the femoral head gradually and became intra-articular. Hardware removal was done after complete union of and osteotomy site (Fig. 3)
7 Salvage of failed dynamic hip screw fixation 7 Figure 3 (a) A 66-year-old man (case no. 22) presented with non-union of basi-trochanteric and cutout of DHS lag screw. (b) DHS removal, and insertion of 1308 blade-plate were done. (c) Follow-up 8 months postoperatively; the blade penetrated the femoral head with radiological picture of avascular necrosis. (d) Good healing of the non-union and osteotomy sites after metal removal.
8 8 G.Z. Said et al Re-operations Two re-operations were reported. The first was plate fixation of a periprosthetic in the early postoperative period. The second was hardware removal after union because of intraarticular penetration of the implant. Discussion The results of salvage procedures after failed DHS fixation are few in the orthopaedic literature. Wu et al. 14 reported on 14 intertrochanteric s with failed DHS. All were treated by reinsertion of a lag screw inferiorly in the femoral head, cement augmentation and subtrochanteric. All healed at a mean of 5 months. Haidukewych and Berry 4 6 reported the largest series for salvage of trochanteric s after failed initial fixation using different types of implants in two retrospective studies over 20 years. They reported successful treatment of 20 patients with revision internal fixation and 60 patients with prosthetic replacement. In the current study we report on salvage procedures for failed DHS fixation of intertrochanteric s. The following points are to be discussed. DHS failure The result of DHS fixation depends on patient and surgeon factors. The patient related factors include: (1) stability, (2) bone quality, and (3) femoral neck shaft angle. Unstable s, with loss of medial calcar continuity, tend to fall into varus displacement when stabilized. Severe allows cutting of the lag screw through the hollow femoral head and loss of reduction. The neck shaft angle decreases gradually with age. The average neck-shaft angle was found to be 1258 in a population with an average age of 69.9 years. 12 To insert DHS of 1358 angle in that hip, the lag screw will take a superolateral position inside the femoral head facilitating its cutout. In these cases, it is preferable to insert the lag screw in the long axis of neck and head. The plate will stick out about 108 away from the shaft and of 108 below the hole of screw insertionshouldbedone.thesurgeonrelatedfactors to prevent DHS failure include: (1) adequate reduction with good contact of bone fragments, (2) correction of varus displacement, and (3) proper placement of the lag screw. Poor reduction with lack of good bone contact across the site or persistent varus position will lead to non-union and loss of fixation. The lag screw should be inserted in a central position inside the femoral head and should be advanced to near the subchondral bone for best purchase. 7,11 Improper placement of the lag screw may lead to loss of fixation and DHS failure. Patient selection The type of surgical treatment after failed DHS fixation depended on the physiological age of the patient, quality of bone, and condition of the femoral head and the acetabulum. The policy followed was that whenever the patient was young and fit, and there was still good bone stock in the femoral head, revision internal fixation was done. If the patient was fragile and the femoral head was found excavated from the previous internal fixation, replacement arthroplasty was decided. Implant selection The implant used for revision internal fixation was selected according to the quality and location of remaining bone stock in the femoral head. It was possible to reinsert a DHS when there was still good bone stock in the femoral head to hold the threads of another screw. A single-angled 1308 plate was inserted when there was good bone stock only in the infero-medial quadrant of the femoral head. Haemiarthroplasty was done, if the femoral head was excavated, but with healthy acetabulum. Total hip replacement was decided when the acetabulum was abraded by a protruding screw and in severe. Repositioning osteotomy A subtrochanteric was added to facilitate bringing the plate of the implant to the shaft of the femur. The osteotomy also helped in stabilization of the and correction of the shortening. 1,10,13,14 Müller 10 and Bartonicek et al. 1 used double-angled plate to fix the subtrochanteric. Single-angled 1308 plate was used in this series. Fixation of the subtrochanteric osteotomy by a single-angled plate allowed lateralization and normal orientation of the femoral shaft, to counteract the medialisation and the vertical orientation of the femoral shaft produced by the osteotomy. 13 Bone grafting Haidukewych and Berry 5 reported on open reduction and bone grafting in all their patients with
9 Salvage of failed dynamic hip screw fixation revision internal fixation. Bone grafting was not found necessary in any of our patients. We believe that the problem is mechanical rather than biological, as the intertrochanteric region of the femur is well vascularised and has excellent surrounding soft tissue coverage. The limitations of the current study include the retrospective design and the possible selection bias. However, the limitations do not undermine the conclusion that for salvage of failed DHS we can achieve union with revision internal fixation for physiologically younger patients with good remaining bone stock, while older patients with lowdemand activities and poor bone quality, or a damaged hip articular surface are treated with hip arthroplasty. References 1. Bartonicek J, Skala-Rosenbaum J, Dousa P. Valgus osteotomy for malunion and nonunion of trochanteric s. J Orthop Trauma 2003;17(9): Buciuto R, Uhlin B, Hammerby S, Hammer R. RAB-plate versus Richards CHS plate for unstable trochanteric hip s: a randomised study of 233 patients with 1-year follow-up. Acta Orthop Scand 1998;69: Ecker ML, Joyce III JJ, Kohl EJ. The treatment of trochanteric hip s using a compression screw. J Bone Joint Surg 1975;57(A): Haidukewych GJ, Berry DJ. Hip arthroplasty for salvage of failed treatment of intertrochanteric hip s. J Bone Joint Surg 2003;8(A): Haidukewych GJ, Berry DJ. Salvage of failed internal fixation of intertrochanteric hip s. Clin Orthop 2003;412: Haidukewych GJ, Berry DJ. Salvage of failed treatment of hip s. J Am Acad Orthop Surg 2005;13: Jacobs RR, McClain O, Armstrong HJ. Internal fixation of intertrochanteric hip s: a clinical and biomechanical study. Clin Orthop 1980;146: Kaufer H. Mechanics of the treatment of hip injuries. Clin Orthop 1980;146: Madsen JE, Naess L, Aune AK, et al. Dynamic hip screw with trochanteric stabilizing plate in the treatment of unstable proximal femoral s: a comparative study with the gamma nail and compression hip screw. J Orthop Trauma 1998;12(4): Müller ME. Intertrochanteric osteotomy: indication, preoperative planning, technique. In: Schatzker J, editor. The intertrochanteric osteotomy. Berlin: Springer-Verlag, Müller ME, Allgöwer M, Schneider R, Willenegger H. Manual of internal fixation: techniques recommended by the AO-ASIF group. Berlin: Springer-Verlag, Noble PC, Alexander JW, Lindhal LJ. The anatomical basis of femoral component design. Clin Orthop 1988;235: Said GZ, Gaballa MA, Said HZ, Elkady H. Subtrochanteric fixation by single or double angled plate. Pan Arab J Orthop Trauma 1999;3(2): Wu CC, Shih CH, Chen WJ, Tai CL. Treatment of cutout of a lag screw of a dynamic hip screw in an intertroch anteric. Arch Orthop Trauma Surg 1998;117:
Failed Subtrochanteric Fracture How I Decide What to Do?
Failed Subtrochanteric Fracture How I Decide What to Do? Gerald E. Wozasek Thomas M. Tiefenboeck 5 October 2016, Washington Medical University of Vienna, Department of Trauma Surgery ordination @wozasek.at
More informationValgus subtrochanteric osteotomy for malunited intertrochanteric fractures : Our experience in 5 cases
Original article : Valgus subtrochanteric osteotomy for malunited intertrochanteric fractures : Our experience in 5 cases Rajendraprasad Butala *, Sunirmal Mukherjee, Prakash Samant, Ravindra Khedekar
More informationTechnique Guide. DHS Blade. For osteoporotic bone.
Technique Guide DHS Blade. For osteoporotic bone. Table of Contents Introduction Features and Benefits 2 Indications and Contraindications 4 Clinical Cases 5 Surgical Technique Implantation 6 Implant
More informationJMSCR Vol. 03 Issue 08 Page August 2015
www.jmscr.igmpublication.org Impact Factor 3.79 Index Copernicus Value: 5.88 ISSN (e)-2347-176x ISSN (p) 2455-0450 DOI: http://dx.doi.org/10.18535/jmscr/v3i8.08 Study of Functional and Radiological Outcome
More informationTechnique Guide. LCP Proximal Femoral Hook Plate 4.5/5.0. Part of the LCP Periarticular Plating System.
Technique Guide LCP Proximal Femoral Hook Plate 4.5/5.0. Part of the LCP Periarticular Plating System. Table of Contents Introduction Features and Benefits 2 AO ASIF Principles 4 Indications 5 Surgical
More information9/24/2015. When Can I Use a SHS? When CAN T I Use a SHS? Sliding Hip Screw. Time proven. Technically simple. Cheap. Quick
When Can I Use a SHS? Frank A. Liporace, MD Associate Professor Director of Orthopaedic Trauma Research Director of Orthopaedic Trauma Jersey City Medical Center New York University / Hospital for Joint
More informationUse Of A Long Femoral Stem In The Treatment Of Proximal Femoral Fractures: A Report Of Four Cases
ISPUB.COM The Internet Journal of Orthopedic Surgery Volume 5 Number 1 Use Of A Long Femoral Stem In The Treatment Of Proximal Femoral Fractures: A Report Of Four Cases C Yu, V Singh Citation C Yu, V Singh..
More informationAssessment of Prognosis of Patients with Intertrochanteric Fractures Undergoing Treatment with PFN: An Observational Study
Original article: Assessment of Prognosis of Patients with Intertrochanteric Fractures Undergoing Treatment with PFN: An Observational Study Gajraj Singh 1, Sandhya Gautam 2 1Assistant Professor, Department
More informationDISLOCATION AND FRACTURES OF THE HIP. Dr Károly Fekete
DISLOCATION AND FRACTURES OF THE HIP Dr Károly Fekete 1 OUTLINE Epidemiology Incidence Anatomy Patient s examination, clinical symptons Diagnosis Classification Management Special complications 2 EPIDEMIOLOGY,
More informationTypes of Plates 1. New Dynamic Compression Plate: Diaphyseal fracture: Radius, Ulna, Humerus, Rarely tibia
Types of Plates 1. New Dynamic Compression Plate: DCP Diaphyseal fracture: Radius, Ulna, Humerus, Rarely tibia 1. Undercut adjacent to the holes low contact: less stress shield 2. Undercut at the undersurface
More informationJournal of Orthopaedic Surgery and Research 2010, 5:62
Journal of Orthopaedic Surgery and Research This Provisional PDF corresponds to the article as it appeared upon acceptance. Fully formatted PDF and full text (HTML) versions will be made available soon.
More informationThe Lateral Trochanteric Wall A Key Element in the Reconstruction of Unstable Pertrochanteric Hip Fractures
CLINICAL ORTHOPAEDICS AND RELATED RESEARCH Number 425, pp. 82 86 2004 Lippincott Williams & Wilkins The Lateral Trochanteric Wall A Key Element in the Reconstruction of Unstable Pertrochanteric Hip Fractures
More informationComparitive Study between Proximal Femoral Nailing and Dynamic Hip Screw in Intertrochanteric Fracture of Femur *
Open Journal of Orthopedics, 2013, 3, 291-295 Published Online November 2013 (http://www.scirp.org/journal/ojo) http://dx.doi.org/10.4236/ojo.2013.37053 291 Comparitive Study between Proximal Femoral Nailing
More informationThe Journal of the Korean Society of Fractures Vol.16, No.1, January, 2003
The Journal of the Korean Society of Fractures Vol16, No1, January, 2003 : 351 ( )463-712 TEL: (031) 780-5270/5271 FAX : (031) 708-3578 E-mail: bskima@netsgocom 16,, ( > 20mm ) 5, ) 20 % 1 ), 6,, 3 8 8
More informationA comparative study of 30 cases of trochanteric fracture femur treated with dynamic hip screw and proximal femoral nailing
Original Article A comparative study of 30 cases of trochanteric fracture femur treated with dynamic hip screw and proximal femoral nailing Jaswinder Pal Singh Walia *, Himanshu Tailor**, H S Mann ***,
More informationPage Proof 1 of 5. Fig. E1-A The INTERTAN nail was short or long.
Page 1 of 5 Fig. E1-A The INTERTAN nail was short or long. Fig. E1-B The sliding hip screw comes in different lengths, and is used with or without a trochanteric stabilizing plate. Page Proof 1 of 5 Page
More informationIpsilateral femoral neck and shaft fractures: a retrospective analysis of two treatment methods
J Orthopaed Traumatol (2008) 9:141 147 DOI 10.1007/s10195-008-0025-3 ORIGINAL ARTICLE Ipsilateral femoral neck and shaft fractures: a retrospective analysis of two treatment methods Roop Singh Æ Rajesh
More informationPre-Operative Planning. Positioning of the Patient
Surgical Technique Pre-Operative Planning Decide upon the size and angle of the barrel plate to be used from measuring the x-rays. To maximise the sliding action when using shorter lag screws, the Short
More informationProvision of Rotational Stability: Prevention of Collapse: Closed Fracture Reduction: Minimally Invasive Surgery with no Exposure of the Fracture:
INTRODUCTION Percutaneous Compression Plating was developed by considering each of the stages in the surgical procedure for pertrochanteric fractures and the ways in which these might be improved. Primary
More informationDistal femoral fracture with subsequent ipsilateral proximal femoral fracture
Distal femoral fracture with subsequent ipsilateral proximal femoral fracture by M Agarwal, MS FRCS, AA Syed, FRCSI, PV Giannoudis (!), BSc,MB,MD,EEC(Orth) Dept. of Orthopaedics and Trauma, St.James University
More informationNon-Anatomical Surgical Solutions for Difficult Non-Unions: Case Series
KOWSAR Non-Anatomical Surgical Solutions for Difficult Non-Unions: Case Series Galal Zaki Said 1, *, Osama Ahmed Farouk 1, Hatem Galal Said 1, Mohamed Mostafa Mohamed El-Sharkawi 1 1 Department of Orthopedic
More informationWe compared 54 patients treated by a Medoff
Femoral shortening in intertrochanteric fractures A COMPARISON BETWEEN THE MEDOFF SLIDING PLATE AND THE COMPRESSION HIP SCREW O. Olsson, L. Ceder, A. Hauggaard From Helsingborg Hospital, Helsingborg, Sweden
More informationClinical outcomes of muscle pedicle bone grafting (Meyer's Procedure) in cases of old displaced femur neck fractures: A Study Of 20 Cases
ISPUB.COM The Internet Journal of Orthopedic Surgery Volume 10 Number 1 Clinical outcomes of muscle pedicle bone grafting (Meyer's Procedure) in cases of old displaced femur neck fractures: A Study Of
More informationImportance of screw position in intertrochanteric femoral fractures treated by dynamic hip screw
Orthopaedics & Traumatology: Surgery & Research (2010) 96, 21 27 ORIGINAL ARTICLE Importance of screw position in intertrochanteric femoral fractures treated by dynamic hip screw M. Güven a,, U. Yavuz
More informationLong-stem revision prosthesis for salvage of failed fixation of extracapsular proximal femoral fractures
Acta Orthop. Belg., 2009, 75, 340-345 ORIGINAL STUDY Long-stem revision prosthesis for salvage of failed fixation of extracapsular proximal femoral fractures Rory J. SHARVILL, Nicholas A. FERRAN, Huw G.
More informationFixation with cancellous screws and fibular strut grafts for neglected femoral neck fractures
Journal of Orthopaedic Surgery 2014;22(2):181-5 Fixation with cancellous screws and fibular strut grafts for neglected femoral neck fractures Chandra Prakash Pal, 1 Binod Kumar, 2 Karuna Shankar Dinkar,
More informationJOURNALOF ORTHOPAEDIC TRAUMA
JOT Special Case Report Series CASE REPORTS www.jorthotrauma.com JOURNALOF ORTHOPAEDIC TRAUMA OFFICIAL JOURNAL OF Orthopaedic Trauma Association Belgian Orthopaedic Trauma Association Canadian Orthopaedic
More informationPFN in trochanteric fractures: Clinico radiological outcome study
2018; 4(2): 943-947 ISSN: 2395-1958 IJOS 2018; 4(2): 943-947 2018 IJOS www.orthopaper.com Received: 14-02-2018 Accepted: 15-03-2018 R Amarnath Senior Asst. Professor, Department of Orthopaedic Surgery,
More informationCase Report. Antegrade Femur Lengthening with the PRECICE Limb Lengthening Technology
Case Report Antegrade Femur Lengthening with the PRECICE Limb Lengthening Technology S. Robert Rozbruch, MD Hospital for Special Surgery New York, NY, USA ABSTRACT This is a case illustrating a 4.5 cm
More informationICUC Paper. The treatment of trochanteric fractures revisited: Pietro Regazzoni, Alberto Fernandez, Dominik Heim, Stephan M. Perren.
The treatment of trochanteric fractures revisited: Pietro Regazzoni, Alberto Fernandez, Dominik Heim, Stephan M. Perren September 2016 An optimal treatment of hip fractures is crucial because of the great
More informationTechnique Guide. 3.5 mm LCP Low Bend Medial Distal Tibia Plates. Part of the Synthes locking compression plate (LCP) system.
Technique Guide 3.5 mm LCP Low Bend Medial Distal Tibia Plates. Part of the Synthes locking compression plate (LCP) system. Table of Contents Introduction 3.5 mm LCP Low Bend Medial Distal Tibia Plates
More informationORIGINAL ARTICLE. INTER TROCHANTERIC # NECK FEMUR FIXATION WITH TFN 250 CASES. Prasad Vijaykumar Joshi, Chandrashekar Yadav.
INTER TROCHANTERIC # NECK FEMUR FIXATION WITH TFN 250 CASES. Prasad Vijaykumar Joshi, Chandrashekar Yadav. 1. Assistant Professor. Department of Orthopaedics, Joshi Hospital Pvt. Ltd. Phaltan, Maharashtra.
More informationmomentum arm The Journal of the Korean Society of Fractures Vol.15, No.1, January, 2002 : 62
The Journal of the Korean Society of Fractures Vol15 No1 January 2002 momentum arm 7 : 62 TEL : 02-3779-1192 FAX : 02-783-0252 E-mail : cmcos@cmccukackr * 2001 66 6 17 10-16 % 6 Fig 1 Anteroposterior radiograph
More informationRandomized comparative study to evaluate the role of proximal femoral nail and dynamic hip screw in unstable trochanteric fractures
International Journal of Research in Orthopaedics Mayi SC et al. Int J Res Orthop. 2016 Sep;2(3):75-79 http://www.ijoro.org Research Article DOI: http://dx.doi.org/10.18203/issn.2455-4510.intjresorthop20162618
More informationTechnique Guide. 2.4 mm Variable Angle LCP Distal Radius System. For fragment-specific fracture fixation with variable angle locking technology.
Technique Guide 2.4 mm Variable Angle LCP Distal Radius System. For fragment-specific fracture fixation with variable angle locking technology. Table of Contents Introduction 2.4 mm Variable Angle LCP
More informationInternal fixation of femoral neck fractures
Acta Orthop Scand 55, 423-429, 1984 Internal fixation of femoral neck fractures Compression screw compared with nail plate fixation In a prospective, randomized study of femoral neck fracture operations,
More informationPeritroch Hip Fractures. Robert M Harris MD. Hip Fractures. Factors Influencing Construct Strength: Uncontrolled factors 4/28/2016
Peritroch Hip Fractures Should be treated with an IMHS Robert M Harris MD Hip Fractures General principles Approximately 250,000 hip fractures/ year Cost approximately $8.7 billion annually The number
More informationANGLED BLADE PLATES FOR ADULTS
ANGLED BLADE PLATES FOR ADULTS Instruments and implants approved by the AO Foundation. This publication is not intended for distribution in the USA. SURGICAL TECHNIQUE Image intensifier control This description
More informationCannulated Pediatric Osteotomy System (CAPOS)
A Single System of Osteotomy Blade Plates and Cannulated Instrumentation Cannulated Pediatric Osteotomy System (CAPOS) Surgical Technique Table of Contents Introduction Cannulated Pediatric Osteotomy System
More informationLCP Medial Proximal Tibial Plate 3.5. Part of the Synthes small fragment Locking Compression Plate (LCP) system.
LCP Medial Proximal Tibial Plate 3.5. Part of the Synthes small fragment Locking Compression Plate (LCP) system. Technique Guide This publication is not intended for distribution in the USA. Instruments
More informationTechnique Guide. 3.5 mm LCP Proximal Tibia Plate. Part of the Synthes Small Fragment LCP System.
Technique Guide 3.5 mm LCP Proximal Tibia Plate. Part of the Synthes Small Fragment LCP System. Table of Contents AO ASIF Principles of Internal Fixation 4 Indications/Contraindications 5 Surgical Technique
More informationThe Orthopaedic Enigma: A Simplified Classification
ISPUB.COM The Internet Journal of Orthopedic Surgery Volume 3 Number 2 The Orthopaedic Enigma: A Simplified Classification D Iyer Citation D Iyer. The Orthopaedic Enigma: A Simplified Classification. The
More informationTrochanter Stabilization Plate for DHS Implants
Extends DHS Plate Construct to Help Stabilize Greater Trochanter Trochanter Stabilization Plate for DHS Implants Surgical Technique Table of Contents Introduction Trochanter Stabilization Plate for DHS
More informationElbow Fractures ORIF VS Arthroplasty
Elbow Fractures ORIF VS Arthroplasty Oke Anakwenze, M.D. Olympus Orthopedics No disclosures Disclosures Distal humerus fractures 0.5-0.7% of all fractures 30% of all elbow fractures Bimodal etiology Young
More informationDynamic Hip Screw Compared to Condylar Blade Plate in the Treatment of Unstable Fragility Intertrochanteric Fractures
Dynamic Hip Screw Compared to Condylar Blade Plate in the Treatment of Unstable Fragility Intertrochanteric Fractures CK Yong, MS Ortho, CN Tan*, MS Ortho, R Penafort**, MS Ortho, DA Singh, MS Ortho, MV
More informationAesculap Targon FN. Head Preserving Solution for Medial Femoral Neck Fractures. Aesculap Orthopaedics
Aesculap Targon FN Head Preserving Solution for Medial Femoral Neck Fractures Aesculap Orthopaedics Targon FN Operating Technique Indications for Targon FN AO 3 B. AO 3 B.2 AO 3 B.3 Undisplaced intracapsular
More informationComparison of two modality of fixation in unstable trochantric fractures in elderly patients
Original article Comparison of two modality of fixation in unstable trochantric fractures in elderly patients 1Dr. Vipin Garg, 2 Dr. Anjul Agarwal 1MS Orhtopaedics, Assistant professor, Department of orthopaedics,
More informationOutcome of Cloverleaf Locking Plate Fixation for Femoral Neck Fractures in Young Adults
http://dx.doi.org/10.5704/moj.1203.010 Outcome of Cloverleaf Locking Plate Fixation for Femoral Neck Fractures in Young Adults Ismail HD, Ph.D, Phedy*, MD, Oktavian Irawadi Purba*, MD, Bambang Gunawan,
More informationCASE REPORT. Bone transport utilizing the PRECICE Intramedullary Nail for an infected nonunion in the distal femur
PRODUCTS CASE REPORT Bone transport utilizing the PRECICE Intramedullary Nail for an infected nonunion in the distal femur Robert D. Fitch, M.D. Duke University Health System 1 1 CONDITION Infected nonunion
More informationHip arthroplasty after failed fixation of trochanteric and subtrochanteric
Acta Orthopaedica 2012; 83 (5): 493 498 493 Hip arthroplasty after failed fixation of trochanteric and subtrochanteric fractures A cohort study with 5 11 year follow-up of 88 consecutive patients Anders
More informationINTERTROCHANTERIC FEMORAL FRACTURES TREATED BY DYNAMIC HIP SCREW
29 INTERTROCHANTERIC FEMORAL FRACTURES TREATED BY DYNAMIC HIP SCREW Muhammad Ayoub Laghari, Asadullah Makhdoom, Pir Abdul latif Qureshi, Abbass Memon, Faheem Ahmed Memon, Professor Khaleeque Ahmed Siddiqui
More informationTechnique Guide. LCP Pediatric Hip Plate 3.5/5.0 for varus osteotomies.
Technique Guide LCP Pediatric Hip Plate 3.5/5.0 for varus osteotomies. Image intensifier control Warning This description alone does not provide sufficient background for direct use of the product. Instruction
More informationPFNA-II. Proximal Femoral Nail Antirotation.
PFNA-II. Proximal Femoral Nail Antirotation. Surgical Technique This publication is not intended for distribution in the USA. Instruments and implants approved by the AO Foundation. PFNA-II. Proximal Femoral
More informationPediatric LCP Hip Plate. For osteotomy and trauma applications in the proximal femur.
Pediatric LCP Hip Plate. For osteotomy and trauma applications in the proximal femur. Angular stability Intraoperative correction and flexibility Universal design Pediatric LCP Hip Plate The Pediatric
More informationHOW TO CITE THIS ARTICLE:
A COMPARATIVE STUDY OF FUNCTIONAL OUTCOME BETWEEN DYNAMIC HIP SCREW AND PROXIMAL FEMORAL NAIL IN SURGICAL MANAGEMENT OF PER-TROCHANTERIC FRACTURES Umesh M. Shivanna 1, Girish H. Rudrappa 2 HOW TO CITE
More information*smith&nephew CONTOUR
Surgical Technique *smith&nephew CONTOUR Acetabular Rings CONTOUR Acetabular Rings Surgical technique completed in conjunction with Joseph Schatzker MD, BSc (Med.), FRCS (C) Allan E. Gross, MD, FRCS (C)
More informationOPERATIVE TREATMENT OF THE INTERCONDYLAR FRACTURE OF THE FEMUR
OPERATIVE TREATMENT OF THE INTERCONDYLAR FRACTURE OF THE FEMUR S G Chee, K S Lam, B K Tay, N Balachandran SYNOPSIS Operative treatment of 28 intercondylar fractures of femur were done from 98 to 985. The
More informationOptimum implant geometry
Surgical Technique Optimum implant geometry Extending proven Tri-Lock heritage The original Tri-Lock was introduced in 1981. This implant was the first proximally coated tapered-wedge hip stem available
More informationLCP Anterolateral Distal Tibia Plate 3.5. The low profile anatomic fixation system with optimal plate placement and angular stability.
LCP Anterolateral Distal Tibia Plate 3.5. The low profile anatomic fixation system with optimal plate placement and angular stability. Technique Guide LCP Small Fragment System Table of Contents Introduction
More informationPreoperative Planning. The primary objectives of preoperative planning are to:
Preoperative Planning The primary objectives of preoperative planning are to: - Determine preoperative leg length discrepancy. - Assess acetabular component size and placement. - Determine femoral component
More informationFunctional evaluation of proximal femoral fractures managed with cephalomedullary nailing by oxford hip score - A prospective study
2017; 3(3): 980-985 ISSN: 2395-1958 IJOS 2017; 3(3): 980-985 2017 IJOS www.orthopaper.com Received: 13-05-2017 Accepted: 14-06-2017 Pranav Kothiyal Senior Resident, Department of Orthopaedics, SGRRIMHS,
More informationLCP Condylar Plate 4.5/5.0. Part of the LCP Periarticular Plating System.
LCP Condylar Plate 4.5/5.0. Part of the LCP Periarticular Plating System. Surgical Technique This publication is not intended for distribution in the USA. Instruments and implants approved by the AO Foundation.
More informationTreatment of Comminuted Subtrochanteric Fractures by Dynamic Hip Screw
Treatment of Comminuted Subtrochanteric Fractures by Dynamic Hip Screw Pages with reference to book, From 212 To 215 Modood Ali ( Department of Surgery, College of Medicine, King Saud University, P.O.
More informationA 42-year-old patient presenting with femoral
Kanda et al. Journal of Medical Case Reports 2015, 9:17 JOURNAL OF MEDICAL CASE REPORTS CASE REPORT Open Access A 42-year-old patient presenting with femoral head migration after hemiarthroplasty performed
More informationLCP Anterolateral Distal Tibia Plate 3.5. The low profile anatomic fixation system with optimal plate placement and angular stability.
LCP Anterolateral Distal Tibia Plate 3.5. The low profile anatomic fixation system with optimal plate placement and angular stability. Technique Guide LCP Small Fragment System Table of Contents Introduction
More informationHip Fractures. Anatomy. Causes. Symptoms
Hip Fractures A hip fracture is a break in the upper quarter of the femur (thigh) bone. The extent of the break depends on the forces that are involved. The type of surgery used to treat a hip fracture
More information28 Surgical Technique
Surgical Technique 10 12 14 16 18 20 22 24 28 26 Technique described by James L. Guyton, MD Campbell Clinic Memphis, Tennessee James W. Harkess, MD Campbell Clinic Memphis, Tennessee David G. LaVelle,
More informationLCP Medial Proximal Tibial Plate 4.5/5.0. Part of the Synthes LCP periarticular plating system.
LCP Medial Proximal Tibial Plate 4.5/5.0. Part of the Synthes LCP periarticular plating system. Technique Guide This publication is not intended for distribution in the USA. Instruments and implants approved
More informationCannulated Pediatric Osteotomy System (CAPOS). A single system of osteotomy blade plates and cannulated instrumentation.
Cannulated Pediatric Osteotomy System (CAPOS). A single system of osteotomy blade plates and cannulated instrumentation. Surgical Technique This publication is not intended for distribution in the USA.
More information76 F: Plays tennis, lives independently, told she has weak bone
Femoral Neck Fractures In the ELDERLY What to do, when and why Frank Liporace, MD Chairman & VP, Dept of Orthopaedics Chief of Trauma & Adult Reconstruction Jersey City Medical Center / RWJ Barnabas Health
More informationStandard intramedullary (IM) nails are usually used
67 Effect of Piriformis Versus Trochanteric Starting Point on Fixation Stability of Short Intramedullary Reconstruction Nails Edward T. Su MD Hargovind DeWal MD Roy Sanders MD Frederick J. Kummer PhD Mohammed
More informationNonunion of the Femur Treated with Conventional Osteosynthesis Combined with Autogenous and Strut Allogeneic Bone Grafts
Original Article 268 Nonunion of the Femur Treated with Conventional Osteosynthesis Combined with Autogenous and Strut Allogeneic Bone Grafts Lin-Hsiu Weng, MD; Jun-Wen Wang, MD Background: In this study,
More informationThe Mechanical Properties Of Fixing Greater Trochanter Or Lesser Trochanter In Complex Four Part Intertrochanteric Fractures
The Mechanical Properties Of Fixing Greater Trochanter Or Lesser Trochanter In Complex Four Part Intertrochanteric Fractures Chih-Hui Chen 1, Kui-Chou Huang 2, Cheng-Kung Cheng, PhD 3, Hung-Chan Kao 4.
More informationManagement of Hip Fractures
Management of Hip Fractures in the Elderly Patient David A. Brown MD COL U.S. Army Ret. The Center for Orthopedics and Neurosurgery Optimizing Management of Hip Fractures in the Elderly Patient Optimizing
More informationElbow System Anatomy:
Elbow System Elbow System Anatomy: Olecranon Fossa Medial Lateral Ulna Olecranon Radius 2 Elbow System AO-classification of distal humerus fractures 3 3 3 Elbow System Case example Transkondylar elbow
More informationPelvis injuries Fractures of the femur (proximal,shaft) Dr Tamás Bodzay
Pelvis injuries Fractures of the femur (proximal,shaft) Dr Tamás Bodzay Pelvis anatomy Pelvis function - axial load bearing - protection: abdominal, pelvic structures Pelvic injury mechanism Falling from
More informationCrossed Steinmann Pin Fixation In Supracondylar Femur Fractures In Adults A Case Series
Article ID: WMC005027 ISSN 2046-1690 Crossed Steinmann Pin Fixation In Supracondylar Femur Fractures In Adults A Case Series Peer review status: No Corresponding Author: Dr. Mohit K Jindal, Senior Resident,
More informationLISS DF and LISS PLT. Less Invasive Stabilization Systems for Distal Femur and Proximal Lateral Tibia.
LISS DF and LISS PLT. Less Invasive Stabilization Systems for Distal Femur and Proximal Lateral Tibia. LISS DF and LISS PLT. Less Invasive Stabilization Systems for Distal Femur and Proximal Lateral Tibia.
More informationTechnique Guide. 3.5 mm LCP Periarticular Proximal Humerus Plate. Part of the Synthes locking compression plate (LCP) system.
Technique Guide 3.5 mm LCP Periarticular Proximal Humerus Plate. Part of the Synthes locking compression plate (LCP) system. Table of Contents Introduction 3.5 mm LCP Proximal Humerus Plate 2 AO Principles
More informationMRIMS Journal of Health Sciences 2016;4(1) pissn: , eissn:
MRIMS Journal of Health Sciences 216;4(1) pissn: 2321-76, eissn: 2321-7294 http://www.mrimsjournal.com/ Original Article A comparative study of proximal femoral nailing and dynamic hip screw in the management
More informationTechnique Guide. 3.5 mm LCP Olecranon Plates. Part of the Synthes locking compression plate (LCP) system.
Technique Guide 3.5 mm LCP Olecranon Plates. Part of the Synthes locking compression plate (LCP) system. Table of Contents Introduction 3.5 mm LCP Olecranon Plates 2 AO Principles 3 Indications 3 Clinical
More informationLCP Medial Distal Tibia Plate, without Tab. The Low Profile Anatomic Fixation System with Angular Stability and Optimal Screw Orientation.
LCP Medial Distal Tibia Plate, without Tab. The Low Profile Anatomic Fixation System with Angular Stability and Optimal Screw Orientation. Technique Guide LCP Small Fragment System Table of Contents Introduction
More informationTechnique Guide. TomoFix Osteotomy System. A comprehensive plating system for stable fixation of osteotomies around the knee.
Technique Guide TomoFix Osteotomy System. A comprehensive plating system for stable fixation of osteotomies around the knee. Table of Contents Introduction TomoFix Osteotomy System 2 AO Principles 4 Indications
More informationSurgical Technique. Cannulated Angled Blade Plate 3.5 and 4.5, 90
Surgical Technique Cannulated Angled Blade Plate 3.5 and 4.5, 90 Cannulated Angled Blade Plate 3.5 and 4.5, 90 Table of contents Indications/Contraindications 2 Implants 3 Surgical technique 5 Implant
More informationCementless Tapered Femoral Stem Surgical technique
Cementless Tapered Femoral Stem Surgical technique Contents Operative summary 4 Pre-operative planning 5 Femoral neck osteotomy 5 Femoral canal preparation 5 Intra-medullary (IM) reamer 6 Sequential rasping
More informationSurgical Technique. Hip System
Surgical Technique Hip System INDICATIONS FOR USE The TaperSet Hip System is designed for total or partial hip arthroplasty and is intended to be used with compatible components of the Consensus Hip System.
More informationINTERTAN Nails Geared for Stability
Geared for stability The TRIGEN INTERTAN nail brings advanced TRIGEN nail technology to hip fractures. With a unique integrated, interlocking screw construct, TRIGEN INTERTAN nail provides all the benefits
More informationCannulated Pediatric Osteotomy System (CAPOS). A single system of osteotomy blade plates and cannulated instrumentation.
Cannulated Pediatric Osteotomy System (CAPOS). A single system of osteotomy blade plates and cannulated instrumentation. Technique Guide This publication is not intended for distribution in the USA. Instruments
More informationTechnique Guide. 3.5 mm LCP Low Bend Medial Distal Tibia Plate Aiming Instruments. Part of the 3.5 mm LCP Percutaneous Instrument System.
Technique Guide 3.5 mm LCP Low Bend Medial Distal Tibia Plate Aiming Instruments. Part of the 3.5 mm LCP Percutaneous Instrument System. Table of Contents Introduction 3.5 mm LCP Low Bend Medial Distal
More informationClinical Outcome Following Treatment of Stable and Unstable Intertrochanteric Fractures with Dynamic Hip Screw
Original Article Outcomes of vs IT Fractures Treated with DHS Tony Setiobudi et al 48 Clinical Outcome Following Treatment of and Intertrochanteric Fractures with Dynamic Hip Screw Tony Setiobudi, MBBS,
More informationComparative Study of Fixation Devices for Intertrochanteric Fractures
Comparative Study of Fixation Devices for Intertrochanteric Fractures C. Sticlaru * A. Davidescu Politehnica University of Timişoara Politehnica University of Timişoara Timişoara, România Timişoara, România
More informationSurgical Care at the District Hospital. EMERGENCY & ESSENTIAL SURGICAL CARE
Surgical Care at the District Hospital 1 18 Orthopedic Trauma Key Points 2 18.1 Upper Extremity Injuries Clavicle Fractures Diagnose fractures from the history and by physical examination Treat with a
More informationIntramedullary Nailing: History & Rationale
Intramedullary Nailing: History & Rationale Overview 1. What is IM Nailing? 2. History 3. Design Rationale & Evolution 4. Modern IM Nails 5. The Future What is IM Nailing? Method of internal fixation in
More informationResults of Surgical Treatment of Coxa Vara in Children: Valgus Osteotomy with Angle Blade Plate Fixation
Results of Surgical Treatment of Coxa Vara in Children: Valgus Osteotomy with Angle Blade Plate Fixation Chatupon Chotigavanichaya MD*, Duangjai Leeprakobboon MD*, Perajit Eamsobhana MD*, Kamolporn Kaewpornsawan
More informationCONGENITAL HIP DISEASE IN YOUNG ADULTS CLASSIFICATION AND TREATMENT WITH THA. Th. KARACHALIOS, MD, DSc PROF IN ORTHOPAEDICS
CONGENITAL HIP DISEASE IN YOUNG ADULTS CLASSIFICATION AND TREATMENT WITH THA Th. KARACHALIOS, MD, DSc PROF IN ORTHOPAEDICS EDITOR IN CHIEF HIP INTERNATIONAL UNIVERSITY OF THESSALIA, LARISA HELLENIC REPUBLIC
More informationCAUTION: Ceramic liners are not approved for use in the United States.
Total Hip Prostheses, Self-Centering Hip Prostheses and Hemi-Hip Prostheses IMPORTANT: This essential product information sheet does not include all of the information necessary for selection and use of
More informationSURGICAL TECHNIQUE CEMENTED & PRESS-FIT UNIFIED INSTRUMENTATION INTRAOPERATIVE FLEXIBILITY PROVEN BIOMECHANICS
SURGICAL TECHNIQUE CEMENTED & PRESS-FIT UNIFIED INSTRUMENTATION INTRAOPERATIVE FLEXIBILITY PROVEN BIOMECHANICS INTRODUCTION The Summit Tapered Hip System s comprehensive set of implants and instruments
More informationTechnique Guide. DHS/DCS System. Including LCP DHS and DHS Blade.
Technique Guide DHS/DCS System. Including LCP DHS and DHS Blade. Table of Contents Introduction System Overview 2 Features and Benefits 4 Indications and Contraindications 6 Clinical Cases 8 Surgical
More informationHarsukh Educational Charitable Society International Journal of Community Health and Medical Research
Harsukh Educational Charitable Society International Journal of Community Health and Medical Research Journal home page: www.ijchmr.com doi: 10.21276/ijchmr Official Publication of Harsukh Educational
More informationVasu Pai FRACS, MCh, MS, Nat Board Ortho Surgeon Gisborne
Vasu Pai FRACS, MCh, MS, Nat Board Ortho Surgeon Gisborne FRACTURE MANAGEMENT I Simple closed fracture : Complete or Incomplete Stable or unstable II Open fracture III Multiple fracture IV Polytrauma Fractures
More information