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1.
S. Y. Huang C. D. Grimsrud J. Provus M. Hararah M. Chandra B. Ettinger J. C. Lo 《Osteoporosis international》2012,23(2):743-750
Summary
Hospital diagnosis codes are useful for assessing hip fracture rates in large populations. However, these codes do not reliably differentiate hip fractures that occur in the subtrochanteric region. Identification of subtrochanteric fractures requires review of radiographic images to distinguish these fractures from the more commonly occurring trochanteric fractures. 相似文献2.
R. Rizzoli K. ?kesson M. Bouxsein J. A. Kanis N. Napoli S. Papapoulos J.-Y. Reginster C. Cooper 《Osteoporosis international》2011,22(2):373-390
Summary
This paper reviews the evidence for an association between atypical subtrochanteric fractures and long-term bisphosphonate use. Clinical case reports/reviews and case?Ccontrol studies report this association, but retrospective phase III trial analyses show no increased risk. Bisphosphonate use may be associated with atypical subtrochanteric fractures, but the case is yet unproven.Introduction
A Working Group of the European Society on Clinical and Economic Aspects of Osteoporosis and Osteoarthritis and the International Osteoporosis Foundation has reviewed the evidence for a causal association between subtrochanteric fractures and long-term treatment with bisphosphonates, with the aim of identifying areas for further research and providing recommendations for physicians.Methods
A PubMed search of literature from 1994 to May 2010 was performed using key search terms, and articles pertinent to subtrochanteric fractures following bisphosphonate use were analysed.Results
Several clinical case reports and case reviews report a possible association between atypical fractures at the subtrochanteric region of the femur in bisphosphonate-treated patients. Common features of these ??atypical?? fractures include prodromal pain, occurrence with minimal/no trauma, a thickened diaphyseal cortex and transverse fracture pattern. Some small case?Ccontrol studies report the same association, but a large register-based study and retrospective analyses of phase III trials of bisphosphonates do not show an increased risk of subtrochanteric fractures with bisphosphonate use. The number of atypical subtrochanteric fractures in association with bisphosphonates is an estimated one per 1,000 per year. It is recommended that physicians remain vigilant in assessing their patients treated with bisphosphonates for the treatment or prevention of osteoporosis and advise patients of the potential risks.Conclusions
Bisphosphonate use may be associated with atypical subtrochanteric fractures, but the case is unproven and requires further research. Were the case to be proven, the risk?Cbenefit ratio still remains favourable for use of bisphosphonates to prevent fractures. 相似文献3.
N. Nicolaou Y. Agrawal M. Padman J. A. Fernandes M. J. Bell 《Journal of children's orthopaedics》2012,6(1):21-27
Purpose
Osteogenesis imperfecta (OI) has been treated with bisphosphonates for many years, with some clear clinical benefits. In adults, there are reports of a new pattern of atraumatic subtrochanteric fractures with bisphosphonate treatment. This study assesses if bisphosphonate treatment leads to an altered pattern of femoral fractures. 相似文献4.
Chang-Wug Oh Jung-Jae Kim Young-Soo Byun Jong-Keon Oh Joon-Woo Kim Shin-Yoon Kim Byung-Chul Park Hyun-Joo Lee 《Archives of orthopaedic and trauma surgery》2009,129(12):1659-1665
Background
Intramedullary nailing is a mainstay in the treatment of subtrochanteric femoral fractures. But nailing is often unsuitable for difficult fracture patterns with comminution or when the medullary canal is narrow. The purpose of this study was to clarify the efficacy of minimally invasive plate osteosynthesis (MIPO) with locking compression plate in the treatment of subtrochanteric fractures. 相似文献5.
J. W. Nieves J. P. Bilezikian J. M. Lane T. A. Einhorn Y. Wang M. Steinbuch F. Cosman 《Osteoporosis international》2010,21(3):399-408
Summary
Using national discharge and medical claims data, we studied the epidemiology of femoral fractures from 1996 to 2006. The annual hip fracture incidence declined from 600/100,000 to 400/100,000, without decline in the more rare femur fractures. Incidence rates for subtrochanteric and femoral shaft fractures were each below 20 per 100,000. 相似文献6.
Priv.-Doz. Dr. Wolfgang Ertel Rudolf Schulz Klaus A. Siebenrock Reinhold Ganz 《Orthopedics and Traumatology》1999,7(4):277-287
Objectives
Stabilization of subtrochanteric fractures through indirect reduction to avoid significant devascularisation of the fragments. Balanced proximal and distal fixation with condylar blade plate. 相似文献7.
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9.
Müller T Topp T Kühne CA Gebhart G Ruchholtz S Zettl R 《International orthopaedics》2011,35(8):1237-1243
Purpose
Reduction and intramedullary fixation of subtrochanteric fractures is often challenging. Osteosynthesis frequently fails and a higher rate of non-unions is found. The aim of this study was to evaluate the benefit of an additional cerclage to anatomically reduce and support the medial hinge. The application is based on the experience of the surgeon; as yet no biomechanical data are available. 相似文献10.
Ivan D. Micic Milorad B. Mitkovic Il-Hyung Park Desimir B. Mladenovic Predrag M. Stojiljkovic Zoran B. Golubovic In-Ho Jeon 《Clinics in Orthopedic Surgery》2010,2(4):227-231
Background
Surgical treatment is the preferred method for treating subtrochanteric femoral fractures and the variety of extramedullary and intramedullary implants continues to evolve. The purpose of our study was to retrospectively evaluate the clinical and radiological results of subtrochanteric fractures that are treated with the Selfdynamisable internal fixator.Methods
From January 2000 to January 2004, we treated 49 consecutive patients who had subtrochanteric fractures. According to the AO classification, 8 (16.3%) fractures were type 32-A, 16 (32.7%) were type 32-B and 25 (51%) fractures were type 32-C. The mean follow-up time was 22.3 months.Results
The average operating time was 45 minutes (range, 32 to 90 minutes). The average blood loss was 250 mL (range, 125 to 350 mL). The average hospital stay was 10 days (range, 7 to 59 days). Implant failure was not observed and union was achieved in all the patients. Deep infection occurred in one (2%) patient in the early postoperative period. Fracture union was achieved at a mean of 14 weeks. Varus malalignment less then 10 degree was noted in three (6.1%) patients at the end of follow-up. Thirty-five patients were pain-free and 14 had mild pain.Conclusions
The selfdynamisable internal fixator was successfully used for subtrochanteric fracture. It provides a short operative time, low blood loss, spontaneous biaxial dynamisation and healing in an optimal period of time without the need for secondary intervention. 相似文献11.
Background
The conflict between the anatomist and biologist surgeons is exemplified by the debate about subtrochanteric hip fractures. Closed intramedullary nailing is biologically friendly but may result in prolonged procedures and malunion. By contrast, accurate anatomical open reduction may disturb the biological composition of the fracture environment.Methods
There were 17 patients at our institution over a 2-year period whose long oblique subtrochanteric fractures would not reduce perfectly in an anatomical fashion using closed methods. All these patients had their fractures treated identically using a new policy at our unit. This strategy involved reduction of the fracture through an open approach, and then employing cerclage cables to stabilise the fracture in an anatomical position before finally inserting a cephalomedullary nail. These patients were retrospectively reviewed at an average of 18 months postoperatively, to assess their progressive functional and radiological outcome up to that point.Results
One patient had nonunion and required a secondary procedure. One patient died 8 days postoperatively from a medical complication. The remaining 15 healed within 6 months and all returned to independent living.Conclusions
The results demonstrate that judicious use of cerclage cables to augment fixation of subtrochanteric femur fractures does not have a deleterious effect on healing. One should endeavour, however, to minimise the number of cables used. The basic science literature underpinning our approach to these unstable fractures is also discussed. 相似文献12.
Nishikant Kumar Himanshu Kataria Chandrashekhar Yadav Bharath S. Gadagoli Rishi Raj 《Journal of Clinical Orthopaedics and Trauma》2014,5(3):137-145
Background
Stable trochanteric femur fractures can be treated successfully with conventional implants such as sliding hip screw, cephalomedullary nails, angular blade plates. However comminuted and unstable inter or subtrochanteric fractures with or without osteoporosis are challenging & prone to complications. The PF-LCP is a new implant that allows angular stability by creating fixed angle block for treatment of complex, comminuted proximal femoral fractures.Method
We reviewed 30 patients with unstable inter or subtrochanteric fractures, which were stabilized with PF-LCP. Mean age of patient was 65 years, and average operative time was 80 min. Patients were followed up for a period of 3 years (June 2010–June 2013). Patients were examined regularly at 3 weekly interval for signs of union (radiological & clinical), varus collapse (neck-shaft angle), limb shortening, and hardware failure.Result
All patients showed signs of union at an average of 9 weeks (8–10 weeks), with minimum varus collapse (<10°), & no limb shortening and hardware failure. Results were analysed using IOWA (Larson) hip scoring. Average IOWA hip score was 77.5.Conclusion
PF-LCP represents a feasible alternative for treatment of unstable inter- or subtrochanteric fractures. 相似文献13.
14.
Joon-Woo Kim Ki-Chul Park Jong-Keon Oh Chang-Wug Oh Yong-Cheol Yoon Hyo-Won Chang 《Archives of orthopaedic and trauma surgery》2014,134(9):1227-1235
Background
Although intramedullary nailing is an ideal treatment for subtrochanteric femoral fractures, it is technically challenging in fractures extending into the nail entry area and/or involving the lesser trochanter. Although the application of circumferential wire may facilitate reduction in these situations, its use remains controversial due to possible blood supply disturbances to underlying bone. In the present study, we evaluated complex subtrochanteric fractures treated by percutaneous cerclage wiring followed by intramedullary (IM) nailing for anatomical fracture reduction and union.Methods
Twelve patients (mean age 48.3 years) with an unstable subtrochanteric fracture were prospectively treated. Indications of percutaneous cerclage wiring followed by IM nailing were a fracture extending proximally into the nail entry area deemed difficult to treat by anatomical reconstruction by IM nailing or a fracture with long oblique or spiral component. One or two cerclage wires were percutaneously applied for the temporary reduction of main fragments, and then, a cephalo-medullary or a reconstruction nail was fixed. We assessed radiologic results (union time, alignment), functional results, and complications.Results
All 12 cases healed, without a bone graft, at an average of 19.1 weeks after surgery (range 16–24). In 11 cases, acceptable alignment was achieved (mean, valgus 0.3° extension 0.6°) with minimal leg-length discrepancy; the other exhibited 1 cm of shortening. All patients were able to return to pre-injury activity levels, and median Merle d’Aubigne score was 16.9 (15–18). No infection or implant-related complication was encountered to latest follow-up (minimum 12 months postoperatively).Conclusion
Temporary reduction by percutaneous wiring offers a means of satisfactory nailing in difficult subtrochanteric femoral fractures, and affords anatomical reconstruction and favorable bony union. 相似文献15.
Association of low-energy femoral fractures with prolonged bisphosphonate use: a case--control study
S. D. Vasikaran 《Osteoporosis international》2009,20(8):1457-1458
Summary Recent evidence has linked long-term bisphosphonate use with insufficiency fractures of the femur in postmenopausal women.
In this case–control study, we have identified a significant association between a unique fracture of the femoral shaft, a
transverse fracture in an area of thickened cortices, and long-term bisphosphonate use. Further studies are warranted.
Introduction Although clinical trials confirm the anti-fracture efficacy of bisphosphonates over 3–5 years, the long-term effects of bisphosphonate
use on bone metabolism are unknown. Femoral insufficiency factures in patients on prolonged treatment have been reported.
Methods We performed a retrospective case–control study of postmenopausal women who presented with low-energy femoral fractures from
2000 to 2007. Forty-one subtrochanteric and femoral shaft fracture cases were identified and matched by age, race, and body
mass index to one intertrochanteric and femoral neck fracture each.
Results Bisphosphonate use was observed in 15 of the 41 subtrochanteric/shaft cases, compared to nine of the 82 intertrochanteric/femoral
neck controls (Mantel–Haenszel odds ratio (OR), 4.44 [95% confidence interval (CI) 1.77–11.35]; P = 0.002). A common X-ray pattern was identified in ten of the 15 subtrochanteric/shaft cases on a bisphosphonate. This X-ray
pattern was highly associated with bisphosphonate use (OR, 15.33 [95% CI 3.06–76.90]; P < 0.001). Duration of bisphosphonate use was longer in subtrochanteric/shaft cases compared to both hip fracture controls
groups (P = 0.001).
Conclusions We found a significantly greater proportion of patients with subtrochanteric/shaft fractures to be on long-term bisphosphonates
than intertrochanteric/femoral neck fractures. Bisphosphonate use was highly associated with a unique X-ray pattern. Further
studies are warranted. 相似文献
16.
17.
Background
The main purpose of this study is to introduce our surgical technique and report surgical outcomes for percutaneous cable fixation in the treatment of subtrochanteric femoral fractures.Methods
Between May 2013 and April 2017, 51 patients with subtrochanteric femoral fractures treated with closed intramedullary nailing and percutaneous cable fixation were enrolled in this study. Postoperative angulation, union rate, time from injury to union, and femoral shortening were also evaluated to assess radiologic outcomes. Clinical outcomes, including range of hip flexion, walking ability, and Harris hip score at the last follow-up were evaluated.Results
Average coronal and sagittal angulation after surgery were 0.9 (range 0–5) and 0.3 (range 0–5), respectively. There was no postoperative angulation of more than 5°. Average shortening of the femur at 1-year follow-up was 2.7?mm (range 0–15). Bone union was achieved in 50 patients (98.0%) and average time to union was 18.6 weeks (range 12–48). Hip flexion, walking ability and Harris hip score at the last follow up were 115.6° (90–120), 7.9 (5–9), and 88.3 (65–100), respectively.Conclusion
Percutaneous cerclage cable fixation can provide a greater likelihood of achieving anatomical reduction and increased stability of fracture, while preserving biology around the fracture site. Thus, percutaneous cerclage cable fixation can be an effective surgical technique for the treatment of complex subtrochanteric fractures. 相似文献18.
Purpose: Cerclage wire application has emerged as a potential therapeutic adjunct to intramedullary nailing for subtrochanteric fractures. But its popularity is plagued by the concern of possible negative effect on fracture zone biology. This study was intended to analyze the clinico-radiological outcome and complications associated with cerclage wire application.
Methods: Retrospective analysis was performed on all the subtrochanteric fractures operated with intramedullary nailing between January 2012 and January 2016. After exclusion, 48 patients were available with an average follow-up of 20.8 months. Long oblique, spiral, spiral wedge or comminuted fracture configurations with butterfly fragments were particularly considered for cerclage wire application, which was employed by percutaneous cerclage passer in 21 patients. Assessment was done in terms of operation time, blood loss, quality of reduction, neck-shaft angle, follow-up redisplacement, union time, complications, and final functional evaluation by Merle d’Aubigne''-Postel score.
Results: Average operation time and blood loss were significantly higher in cerclage group (p < 0.05). However, cerclage use substantially improved quality of reduction in terms of maximum cortical displacement (p = 0.003) and fracture angulation (p = 0.045); anatomical reduction was achieved in 95.23% of cases as compared to 74.07% without cerclage. Union time was shorter, although not statistically different (p = 0.208), in cerclage group. Four patients in non-cerclage group developed non-union, 2 of them had nail breakage. No infection or any other implant related complications were reported with
cerclage use.
Conclusion: Minimally-invasive cerclage wire application has proved to be beneficial for anatomical reconstruction in difficult subtrochanteric fractures, whenever applicable, without any harmful effect on fracture biology. 相似文献
19.
Background
The subtrochanteric fracture constitutes approximately 5-10% of all hip fractures. This particular fracture type, owing to its configuration and instability, poses significant challenges to the fixation method, especially in elderly patients with varying degrees of osteoporosis. There has been a gradual change in the operative techniques used to stabilise these fractures leading to the current widespread use of cephalomedullary nails. In contrast to the field of research on patients with the more common femoral neck and trochanteric fractures, few studies have evaluated the health-related quality of life (HRQoL) in patients with subtrochanteric fractures.Objective
To report the long-term outcome for patients with subtrochanteric fractures treated with a cephalomedullary nail with special regard to the HRQoL.Setting
Four university hospitals.Design
A prospective cohort study with a 2-year follow-up.Patients and methods
Eighty-seven consecutive elderly patients with a subtrochanteric fracture treated with a cephalomedullary nail. Main outcome measurements were mortality rate, reoperation rate, pain at the hip, walking ability, activities of daily living (ADL) function and HRQoL assessed with the EQ-5D (EQ-5Dindex score).Results
The EQ-5Dindex score decreased from 0.73 before fracture to 0.53 at 4 and 12 months and to 0.52 at 24 months. At the final follow-up 80% of the patients reported no or only limited pain at the hip, 46% had regained their prefracture walking ability, 48% their prefracture level of ADL function and 71% had living conditions similar to those before the fracture. The reoperation rate was 8%. The mortality rate was 8% at 4 months, 14% at 12 months and 25% at 24 months.Conclusions
A subtrochanteric fracture in elderly patients had a substantial negative effect on both their short and long-term HRQoL. Although pain at the hip was not a major problem there was an obvious deterioration in walking ability and ADL function. However, the rate of revision surgery was comparatively low which confirms that the cephalomedullary nail constitutes a safe treatment for elderly patients with a subtrochanteric fracture. The data on HRQoL obtained in this study can be used in future healthcare evaluations and to calculate quality-adjusted life-years (QALYs). 相似文献20.
P. M. Guyver M. J. H. McCarthy Neil P. M. Jain R. J. Poulter C. J. P. McAllen J. Keenan 《European journal of orthopaedic surgery & traumatology : orthopedie traumatologie》2014,24(4):513-518