Internal fixation of 410 cervical hip fractures: A randomized comparison of a single nail versus two hook-pins

Totally, 410 patients with a cervical hip fracture were randomized between two methods of osteosynthesis: a single nail (Rydell) and two hook-pins (LIH). Seventy-five percent of the patients were women. Sixty-nine percent were alive after 2 years. The patients were followed up with clinical and radiographic examinations for 2 years postoperatively. No differences between the two groups were found regarding quality of reduction, early displacement within 3 months, extraction after healing, nonunion, late segmental collapse, or reoperation with a total hip arthroplasty. Nor did we find any differences between the two groups when selecting those alive after 2 years or when dividing the fractures in displaced and nondisplaced fractures.     

Fixation of femoral neck fractures. A four-flanged nail versus threaded pins in 200 cases

Two methods of internal fixation for cervical hip fractures were compared in a "randomized to surgeons" type of study. One hundred patients were treated with the Rydell four-flanged nail and 100 with the Gouffon pins. Redisplacement, nonunion, or segmental collapse occurred in 27 patients operated on with the Rydell nail and in 29 patients operated on with the Gouffon pins. According to the actuarial method of follow-up, the failure rates after 2 years were 31 and 33 percent in the two groups.     

Fixation of femoral neck fractures: A four-flanged nail versus threaded pins in 200 cases

Two methods of internal fixation for cervical hip fractures were compared in a “randomized to surgeons” type of study. One hundred patients were treated with the Rydell four-flanged nail and 100 with the Gouffon pins. Redisplacement, nonunion, or segmental collapse occurred in 27 patients operated on with the Rydell nail and in 29 patients operated on with the Gouffon pins. According to the actuarial method of follow-up, the failure rates after 2 years were 31 and 33 percent in the two groups.     

Fixation of 220 femoral neck fractures: A prospective comparison of the Rydell nail and the LIH hook pins

220 patients with femoral neck fractures were randomly treated with either a Rydell nail (n 110) or two LIH hook pins (n 110). The age, sex, and displacement patterns were similar in both group. All the patients were operated on by orthopedic specialists and followed clinically and radiographically for 2 years or until death. The mortality at 2 years was similar (28 percent) in both groups. Among 154 survivors, early redisplacement or nonunion was recorded in 19 percent of the Rydell-nailed fractures and 32 percent of the LIH-pinned fractures. In nondisplaced fractures, complications occurred in 8/30 Rydell cases compared with 3/16 in the LIH group. In displaced fractures, complications occurred in 21/48 Rydell cases compared with 28/60 in the LIH group.     

Fixation of 220 femoral neck fractures. A prospective comparison of the Rydell nail and the LIH hook pins

220 patients with femoral neck fractures were randomly treated with either a Rydell nail (n 110) or two LIH hook pins (n 110). The age, sex, and displacement patterns were similar in both group. All the patients were operated on by orthopedic specialists and followed clinically and radiographically for 2 years or until death. The mortality at 2 years was similar (28 percent) in both groups. Among 154 survivors, early redisplacement or nonunion was recorded in 19 percent of the Rydell-nailed fractures and 32 percent of the LIH-pinned fractures. In nondisplaced fractures, complications occurred in 8/30 Rydell cases compared with 3/16 in the LIH group. In displaced fractures, complications occurred in 21/48 Rydell cases compared with 28/60 in the LIH group.     

Changing methods of hip fracture osteosynthesis in Sweden: An epidemiological enquiry covering 46 900 cases

An enquiry covering all hospitals in Sweden operating on hip fractures was conducted in 1990. The results were compared with enquiries from 1982 and 1985. In cervical hip fractures the use of single nail has almost disappeared in favor of 2 LIH hook pins and, lately, the Uppsala subchondral screws. Primary hip prosthesis is the ultimate method of choice in Sweden. Among trochanteric hip fracture the Ender nail has almost totally been replaced by a sliding screw and plate device.     

Internal fixation of femoral neck fracture. No difference between the Rydell four-flanged nail and Gouffon's pins

Two methods of internal fixation of femoral neck fractures were compared in a prospective randomized study of 223 patients. Radiographic evidence of early redisplacement, nonunion, or late segmental collapse occurred in 45 of 122 patients operated on with the Rydell four-flanged hook nail and in 33 of 101 patients operated on with Gouffon pins. According to the actuarial method of follow-up, the failure rates after 2 years were respectively 41 and 35 percent in the nail and pin groups, which is a nonsignificant difference.     

Internal fixation of femoral neck fracture: No difference between the Rydell four-flanged nail and Gouffon's pins

Two methods of internal fixation of femoral neck fractures were compared in a prospective randomized study of 223 patients. Radiographic evidence of early redisplacement, nonunion, or late segmental collapse occurred in 45 of 122 patients operated on with the Rydell four-flanged hook nail and in 33 of 101 patients operated on with Gouffon pins. According to the actuarial method of follow-up, the failure rates after 2 years were respectively 41 and 35 percent in the nail and pin groups, which is a nonsignificant difference.     

Fixation of femoral neck fracture: A randomized 2-year follow-up study of hook pins and sliding screw plate in 222 patients

We compared fixation with hook pins or sliding screw plate in a prospective randomized study of 222 patients with a cervical hip fracture. Radiographic evidence of early redisplacement, nonunion, or late segmental collapse was found in 43 of 122 patients operated on with two hook pins and in 40 of 100 patients operated on with the sliding screw plate. According to the actuarial method, the failure rate after 2 years was 38% with hook pins and 46% with screw plates, which not is a significant difference.

Due to early redisplacement, reoperation with an endoprosthesis was performed within 0.5 (2) years in 11 (22) patients in the hook-pin group and in 4 (17) patients in the sliding-screw plate group.     

髋关节置换术治疗股骨转子间骨折内固定失败

 目的 回顾性分析采用髋关节置换术治疗股骨转子间骨折内固定失败的临床效果。方法2004年7月至2006年6月,采用髋关节置换术治疗32例股骨转子间骨折内固定失败患者,男24例,女8例;行关节置换时的年龄为57～81,平均71岁;从骨折到行关节置换的时间为5～70个月,平均40个月。骨折内固定方式包括：滑动髋螺钉15例,髓内钉10例,钢板5例,多枚螺钉2例。失败原因：拉力螺钉切出股骨头8例,骨折不愈合9例,股骨头缺血性坏死7例,创伤性关节炎8例。采用全髋关节置换术28例（全部为生物型髋臼）,双极人工股骨头置换术4例。骨水泥型股骨柄12例,非骨水泥型股骨柄20例。标准股骨假体25例,长柄股骨假体7例。结果术后28例患者获得随访,随访时间4～6年,平均5年。28例患者术前H arris评分平均37分（32～45分）,末次随访时平均88分（84～95分）;优6例,良14例,可7例,差1例。末次随访时X线片显示假体位置正常,髋臼平均外展角为44°（42°～48°）,髋臼假体无松动。根据Harris标准评价骨水泥型股骨假体固定,1例为A级,9例为C级。根据Engh等标准评价非骨水泥型股骨假体的固定,18例均评价为骨长入。3例髋关节术后6个月复查时发现异位骨化,BrookerⅡ级2例,Ⅲ级1例。结论髋关节置换术是老年患者股骨转子间骨折内固定治疗失败后的一种有效挽救选择。     

Operative treatment of hip fracture in haemodialysed patients

PURPOSE: To study operative treatment and postoperative clinical outcomes of hip fracture in haemodialysed patients. METHODS: In 12 patients (8 men and 4 women) undergoing haemodialysis, 14 hip fractures were treated. Of these, 8 hips were treated with bipolar hip arthroplasty, one hip with total hip arthroplasty, 4 hips with a compression hip screw, and one hip with a gamma nail. The mean duration of dialysis treatment until fracture was 7 years. During a mean postoperative follow-up period of 17 months (range, 1-44 months), the patients' renal condition, type of fracture, and level of activities of daily living before and after surgery were assessed. RESULTS: Of the 7 patients who died during a mean follow-up period of 17 months, 2 died from myocardial infarction, 2 from sepsis, and one each from gastric cancer, pulmonary oedema, and liver failure. Five of the 8 patients with diabetic nephropathy died, whereas 6 of the 8 patients who underwent bipolar hip arthroplasty or total hip arthroplasty died. Most of the patients had declined level of activities of daily living postoperatively. CONCLUSION: For haemodialysed patients with fractures, it is essential to select the most suitable operating method and to conduct vigilant management before and after the operation.     

Femoral neck fracture in an arthrodesed hip treated by a supracondylar intramedullary locked nail

We describe a case of a femoral neck fracture occurring 51 years after a hip arthrodesis. This rare lesion in an obese woman was treated with a straight supracondylar nail with proximal and distal locking inserted retrograde from the subtrochanteric area into the ileum. Full weight bearing was achieved within 1 week postoperatively, and union was present 3 months following the operation.     

Postoperative improvement of walking capacity in patients with trochanteric hip fracture: a prospective analysis 3 and 6 months after surgery

Between 1982-1985, 149 patients with trochanteric fractures were randomly selected for treatment with either Ender nails or a sliding nail plate. Ninety-two patients were able to perform walkway tests on an electronic walkway and were considered the best prospects for rehabilitation. Thirty-seven patients' fractures were stabilized with Ender nails and 55 with a sliding nail plate. Gait analyses were made at 3 and 6 months after surgery. Change in walking capacity based on four parameters (walking aids, walking distance, maximal vertical force, and single limb support) was compared to changes in clinical and radiographic parameters at 3 and 6 months after surgery. In all, less than half of the patients had achieved their preoperative status 3 months after surgery. Between 3 and 6 months postoperatively, 42 patients experienced less pain, 23 improved in range of hip motion, and 12 improved in strength. According to multivariate regression analysis, the significant factors associated with improvement in walking capacity during this period were an unstable fracture type (p = 0.003), improvement of hip strength (p = 0.006), and improvement of pain (p = 0.03). In conclusion, rehabilitation of patients with trochanteric fractures, particularly in those patients with unstable fractures, should be continued for more than 3 months after surgery.     

PFNA-Ⅱ髓内钉内固定治疗股骨粗隆问骨折

目的评价应用PFNA-Ⅱ髓内钉内固定治疗股骨粗隆间骨折的临床结果。方法对20例股骨粗隆间骨折采用PFNA-Ⅱ髓内钉内固定．其中18例采用闭合复位,2例采用切开复位。随访术后3个月患者的临床和放射学结果。结果所有骨折在术后平均12周愈合。未发生机械性并发症。12例恢复到损伤前水平。放射学结果和功能结果之间没有直接相关性。结论PFNA-Ⅱ髓内钉内固定治疗股骨粗隆间骨折可以采用微创方法,但对于一些骨折闭合复位不理想,行有限切开复位是必须的。由于设计改进,使得髓内钉插钉更容易。对外侧壁应力减小,同时钉尾和尾帽切迹变低,减少了软组织刺激。术后多数患者可恢复到损伤前功能状态。     

经皮加压钢板和短重建钉治疗股骨转子间骨折的对照研究

目的 比较研究用于微创治疗股骨转子间骨折的同直径双主钉的髓内和髓外设计的两种内固定系统的临床治疗效果.方法 选择2005至2008年同期进行的两组股骨转子间骨折病例,均为AO/OTA分型A1和A2型骨折,其中髓外固定使用经皮加压钢板(percutaneous compression plating,PCCP)36例,髓内固定使用Trigen短重建钉48例,分别进行平均(16.3±3.2)个月随访.随访中临床评估包括术后1周,1、3、6个月和1年的疼痛视觉模拟评分(visual ahalogue scale,VAS)和1年后Harris髋功能评分;放射学评估包括骨折愈合时间、内固定主钉位置及骨折端加压短缩尺度,并记录并发症发生情况.结果 两组病例在手术时间和临床失血量方面差异并无统计学意义.PCCP组早期疼痛的缓解效果优于Trigen短重建钉组,主要表现在术后前3个月内,此后两组疼痛评分差异无统计学意义.PCCP组的骨折愈合时间和Harris评分均优于Trigen短重建钉组,差异有统计学意义.同时,PCCP组显示出更大尺度主钉回退和骨折端加压短缩情况.Trigen短重建钉组术后出现1例大转子劈裂、3例股骨干部骨折,其中1例进行翻修;而PCCP组无内固定周围骨折发生,但存在1例早期主钉切割移位.结论 PCCP和Trigen短重建钉均可满意地用于A1和A2型转子间骨折的微创治疗,其中髓外应用的PCCP具有疼痛缓解早、固定位置好、愈合时间短和并发症少等优点.     

Prospective randomised controlled trial of an intramedullary nail versus a sliding hip screw for intertrochanteric fractures of the femur

Purpose

The purpose of this prospective randomised trial was to assess whether an intramedullary nail is superior to a sliding hip screw in the treatment of multifragmentary intertrochanteric fractures

Methods

Eighty patients with a 31-A2.2 or A2.3 Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) intertrochanteric fracture were randomly allocated to fixation with either the Gamma nail or the AMBI sliding hip screw device.

Results

All patients were followed up at one, three, six and 12 months postoperatively, except for nine who died. There was no statistical difference in Parker mobility score between groups. The Gamma nail group had significantly higher Barthel Index and EuroQol-5D (EQ-5D) scores than the AMBI group at 12 months. At the same time, the EQ-5D score had returned to its pre-operative values in the Gamma nail group but not in the AMBI group. There were no differences in mortality, radiation time and hospital stay. Duration of the operation, incision length and hip pain occurrence were significantly less in the Gamma nail group.

Conclusions

Few failures occur when unstable 31-A2.2 and A2.3 AO/OTA fractures are fixed with a sliding hip screw. Nevertheless, an intramedullary nail seems superior in reconstituting patients to their pre-operative state.     

Biomechanical evaluation of the Ender's pins, the Harris nail, and the dynamic hip screw for the unstable intertrochanteric fracture

While intramedullary fixation may have less operative morbidity than sliding plate systems, there also may be a loss of stability and strength of the fixation. In a biomechanical study with simulated unstable intertrochanteric fractures in cadaver femurs, multiple Ender's pins were 18% stronger than the single Harris nail. Compression hip screws were three times stronger than the Harris nail and two and one-half times stronger than Ender's pins. The compression hip screw was five times more rigid than either condylocephalic system.     

Experimental study on internal fixation of femoral neck fractures.

The relative strength and the failure mode of internal fixation by multiple pinning and nailing was investigated on 35 specimens. Internal fixation consisted of 3, 5 and 7 Knowles pins, a Smith-Petersen nail or a sliding nail plate. The strength of a specimen with a triflanged nail is only half of that with multiple Knowles pins. There is no significant difference in strength of 3, 5, or 7 pin specimens. The strength of an internal fixation with a sliding nail plate is not superior to the strength of multiple pinning. The mode of failure for the different types of internal fixation is primarily a crush fracture of the supporting trabecular bone at the femoral neck with downward and outward migration of the pins or nail. Except with the fixation with 3 pins where an initial bending could be observed, failure is not a plastic deformation of the internal fixation device.     

Risk factors of fixation failure in basicervical femoral neck fracture: Which device is optimal for fixation?

BackgroundBasicervical femur neck fracture (FNF) is a rare type of fracture, and is associated with increased risk of fixation failure due to its inherent instability. The purpose of this study was (1) to investigate the incidence of fixation failure and (2) to determine risk factors for fixation failure in basicervical FNF after internal fixation.MethodsTo identify basicervical FNF with a minimum of 12 months follow-up, we retrospectively reviewed records of 3217 patients who underwent hip fracture surgery from May 2003 to March 2016. Among the identified 77 patients with basicervical FNF, 69 patients were followed up for at least 12 months. We evaluated the rate of collapse of fracture site and reoperation due to fixation failure. We performed a multivariable analysis to determine risk factors associated with fracture site collapse and fixation failure.ResultsAmong the 69 patients with basicervical FNF, 17 (24.6%) showed collapse of fracture site, and 6 (8.6%) underwent conversion to arthroplasty because of fixation failure. In the multivariable analysis, use of extramedullary plating with a sliding hip screw was an independent significant risk factor for both collapse of fracture site (odds ratio 6.84; 95% confidence interval 1.91–24.5, p = 0.003) and fixation failure (odds ratio 12.2; 95% confidence interval 1.08–137.7, p = 0.042).ConclusionsBasicervical FNF treated with extramedullary plate with a sliding hip screw is more likely to fail than that treated with intramedullary nail with a helical blade. Our results suggested that intramedullary nail with a helical blade is more recommended for basicervical FNF compared with extramedullary plate with a sliding hip screw.Level of evidenceIII, Retrospective cohort study.