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1.
Jan Herzog Robert Wendlandt Sebastian Hillbricht Rainer Burgkart Arndt-Peter Schulz 《Injury》2019,50(3):744-751
Introduction
The annual incidence of proximal femoral fractures is 100–150/100,000 and continues to increase with an aging population. Cut-out of hip screws after fracture fixation has been quoted as 8% in the literature. The tip-apex distance (TAD) is the strongest predictor for cut-out after operative fracture stabilisation.The aim of this study was to evaluate the novel ADAPT system (Adaptive Positioning Technology, Stryker, USA), a navigation device for intramedullary nailing of trochanteric fractures and its effect on optimising the TAD. This is the first clinical study to evaluate this new technology.Methods
The study group of 36 consecutive patients with a pertrochanteric fracture underwent intramedullary nailing for fracture fixation using ADAPT technology, while the matched control group underwent conventional Gamma-3-nailing. Matching criteria included fracture classification, gender and age. We measured the operative time and the postoperative TAD in anteroposterior (AP) and lateral radiographs of the 72 patients.Results
The mean TAD using ADAPT was 16.9?mm (range 8.4–33.7?mm) compared with 24.9?mm (range 14.6–40.2?mm) in the reference group treated without ADAPT. Using the ADAPT system significantly improved (p?<?0.0005) the accuracy of lag screw placement but had no effect on operating time in fixation of femoral pertrochanteric fractures.Conclusion
Working with the novel ADAPT system for positioning the lag screw using the Gamma-3-nail led to a statistically highly significant reduction of the TAD compared to the reference group (p?<?0.001). The ADAPT system proved to be a very useful device in achieving higher surgical standards for the treatment of trochanteric fractures with intramedullary nailing. It enables higher accuracy in screw positioning and therefore better placement of the implant. 相似文献2.
Nam Hoon Moon Won Chul Shin Jung Shin Kim Seung Hun Woo Seung Min Son Kuen Tak Suh 《Injury》2019,50(3):713-719
Background
The aim of this study was to investigate the postoperative outcomes of cementless Total hip arthroplasty (THA) following failed internal fixation for femoral neck and intertrochanteric fractures.Method
Ninety-six cementless THAs for failed internal fixation after femoral neck fracture (59, group I) and intertrochanteric fracture (37, group II) with a minimum follow-up of 3 years were analyzed. Clinical and radiologic evaluations were performed on all patients.Results
The intraoperative blood loss and operating time were significantly increased in group II (p?=?0.001, p?=?0.001, respectively). Harris hip score at last follow-up was significantly improved in group I (p?=?0.007) but, there were no differences in hospital stay, Koval score at last follow-up, and perioperative complications between both groups. Long femoral stems for diaphyseal fitting were frequently used in group II (32/37, 86%) (p?=?0.001). Radiographically, none of the acetabular cups showed evidence of migration, loosening. All cases showed stable fixation of the femoral stem at last follow-up.Conclusions
Outcomes of cementless THA following failed internal fixation for femoral neck and intertrochanteric fractures were satisfactory; increased intraoperative blood loss, operating time, and requirement of long femoral stem should be considered in the latter type of fracture. 相似文献3.
Alvin K. Shieh Motasem Refaat Nasser Heyrani Tanya C. Garcia-Nolen Mark A. Lee Jonathan G. Eastman 《Injury》2019,50(3):703-707
Objectives
Prophylactic femoral neck fixation may be performed in the setting of geriatric diaphyseal femur fracture, pathologic or impending atypical femur fractures. Fixation constructs often utilize cephalomedullary implants with one or two proximal interlocking screws into the femoral head/neck. Variations in proximal femoral anatomy and implant design can interfere with the placement of two screws in the femoral head and neck. Our objective was to assess the strength of piriformis entry reconstruction implants with one versus two proximal interlock screws for prophylactic femoral neck fixation.Methods
Thirty fourth generation synthetic femur models were separated into 5 groups. The control group was an intact femur, and the second group was an intact femur with an entry hole in the piriformis fossa. The remaining groups had an intramedullary nail placed with either 0, 1, or 2 screws placed into the femoral head and neck. Each femur was mechanically loaded along the mechanical axis through the femoral head. Load to failure and failure displacement were recorded.Results
Mean load to failure was 5583?±?543?N in the intact femur. Constructs with 2 screws had a significantly higher mean load to failure (3223?±?474?N) compared to one screw constructs (2368?±?280?N). All of the experimental groups remained significantly lower than the intact femur model (p?<?0.05).Conclusion
Our results demonstrate that piriformis entry reconstruction implants have a significantly lower load to failure compared to an intact femur irrespective of screw construct. Further studies are needed to investigate this potential iatrogenic weakening. 相似文献4.
Objective
Symptomatic distal interlocking screws in retrograde femoral nailing are common due the difficulties of imaging the trapezoidal femur. Screws appearing to have appropriate length on imaging may possibly be prominent, creating symptoms. Screw trajectory may influence the degree of this radiographic error. We hypothesize that external rotation of screw trajectory will increase measurement error of screw length.Design
Retrospective.Setting
Urban Level I Tertiary Trauma Center.Participants
283 patients with Computer Tomography (CT) scans of the native knee were retrospectively identified. Simulation was done of the trajectory of an interlock at 20?mm and 40?mm proximal to the nail entry point, which represent common screw positions associated/not associated respectively, with removal. The distance between the radiographic medial cortex and the tip of the transverse screw was calculated (D). The angle (Ψ) between the transverse trajectory and a modified trajectory aimed at the most medial cortex to avoid radiographic measurement error was calculated. Geometric modeling was utilized to calculate the measurement error (D) in the event of accidental external rotation. The angle of the medial slope was also measured (Θ).Intervention
Review of CT imaging of normal distal femora.Main Outcome Measurements
CT measurements of distal femora.Results
The mean distance (D) at 20/40?mm was 4.21 [95%CI 4.02–4.402] and 2.03?mm [95%CI 1.78–2.83], respectively (p?<?0.0001). The mean angle (Ψ) between the transverse and modified trajectory at 20/40?mm was 12° [95%CI 11.5–12.5] and 9.60° [95%CI 9–10.2], respectively (p?<?0.0001). External rotation by a similar amount nearly triples the measured difference (D). The measured medial slope was significantly increased as screws were placed more proximal (Θ20 mm 46.5 vs Θ40 mm: 48.7?°, p?<?0.00001).Conclusion
The distance between the perceived medial cortex and the tip of the most transverse screw is 4.21?mm and could account for painfully prominent screws. In more proximal screws this distance is decreased. Internal rotation of the screw trajectory 12° can reduce this distance (D), which has implications in nail design. External rotation, amplifies this difference nearly three-fold. Surgeons should avoid external rotation of the aiming arm to prevent prominent screws. 相似文献5.
Matthias Knobe Sebastian Bettag Christian Kammerlander Simon Altgassen Klaus-Jürgen Maier Sven Nebelung Andreas Prescher Klemens Horst Miguel Pishnamaz Christian Herren Marion Mundt Marcus Stoffel Bernd Markert Boyko Gueorguiev 《Injury》2019,50(2):292-300
Objectives
Improved fixation techniques with optional use of bone cements for implant augmentation have been developed to enhance stability and reduce complication rates after osteosynthesis of femoral neck fractures. This biomechanical study aimed to evaluate the effect of cement augmentation on implant anchorage and overall performance of screw-anchor fixation systems in unstable femoral neck fractures.Methods
Ten pairs of human cadaveric femora were used to create standardized femoral neck fractures (Pauwels type 3 fractures; AO/OTA 31-B2) with comminution and were fixed by means of a rotationally stable screw-anchor (RoSA) system. The specimens were assigned pairwise to two groups and either augmented with PMMA-based cement (Group 1, augmented) or left without such augmentation (Group 2, control).Biomechanical testing, simulating physiological loading at four distinct load levels, was performed over 10.000 cycles for each level with the use of a multidimensional force-transducer system. Data was analysed by means of motion tracking.Results
Stiffness, femoral head rotation, implant migration, femoral neck shortening, and failure load did not differ significantly between the two groups (p?≥?.10). For both groups, the main failure type was dislocation in the frontal plane with consecutive varus collapse). In the cement-augmented specimens, implant migration and femoral neck shortening were significantly dependent on bone mineral density (BMD), with higher values in osteoporotic bones. There was a correlation between failure load and BMD in cement-augmented specimens.Conclusion
In screw-anchor fixation of unstable femoral neck fractures, bone-cement augmentation seems to show no additional advantages in regard to stiffness, rotational stability, implant migration, resistance to fracture displacement, femoral neck shortening or failure load. 相似文献6.
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7.
Objective
Surgical management of bicondylar tibial plateau fractures, which is frequently associate with high wound complication rates and functional impairment, remains a challenge for orthopedic surgeons. Recently, the emergence of three-dimension(3D) printing provided orthopedic surgeons with a new technology which has revolutionary impacts on surgical planning, operative guidance and custom-made implants manufacture. The aim of this study is to explore the clinical feasibility and application value of 3D printing in the surgical management of bicondylar tibial plateau fractures.Method
Data of this retrospective study was collected from 11 patients suffering bicondylar tibial plateau fracture from October 2015 to August 2016. All of them underwent surgical treatment with the assistance of 3D printing technology. Real-size solid models and screw guide templates were printed for preoperative planning, surgical simulation and intraoperative guidance. Patients’ Demographics, surgery duration, intraoperative blood loss, the accuracy of preoperative planning were recorded and evaluated.Result
The 3D printed models successfully provided the omni-directional exhibition of the fracture morphology. Model-based surgical simulation procedures and pre-selection of implants were generally consistent with the results of actual surgeries. There were no significant differences between the length of the osteosynthesis screws and that of actual surgeries (59.43?±?11.13?mm vs 60.14?±?12.05?mm). Beyond that, other parameters, such as surgical duration, intraoperative blood loss and HSS scores was satisfactory according to the surgical records and follow-up.Conclusions
According to our experience, the assistance of 3D printing technology in the surgical management of bicondylar tibial plateau fractures provides a comprehensive understanding of fracture features, an accurate patient-specific preoperative planning and an intraoperative guidance for real surgeries, thus leading to the optimization of clinical outcomes. 相似文献8.
Joey P. Johnson Justin Kleiner Avi D. Goodman Joseph A. Gil Alan H. Daniels Roman A. Hayda 《Injury》2019,50(3):708-712
Introduction
Young patients with femoral neck fractures are optimally treated with reduction and stable fixation, while patients over the age of sixty-five are often treated with arthroplasty. This study analyzes in-hospital outcomes associated with total hip arthroplasty, hip hemiarthroplasty and internal fixation for treatment of femoral neck fractures in patients aged 45–64.Methods
Records of patients between the ages of 45–64, from 2002 to 2014, sustaining femoral neck fractures and treated with internal fixation, hip hemiarthroplasty or total hip arthroplasty were obtained from the Nationwide Inpatient Sample (NIS). Examined variables were age, sex and Charlson Comorbidity Index (CCI). Outcome measures included hospital length of stay (LOS), complications, and inpatient hospitalization charge.Results
From 2002–2014 74,678 femoral neck fractures were available for analysis. THA use increased from 5.3% of operatively managed fractures in 2002 to 22.3% of operatively managed fractures in 2014 (p?<?0.0001). Patients undergoing THA had higher hospital cost, higher in hospital complication rates and longer length of stay than patients undergoing internal fixation (p?<?0.0001). The in-hospital mortality for patients undergoing a hip hemiarthroplasty was higher (1.2%) than either total hip arthroplasty (0.2%) or internal fixation (0.5%) (P?=?0.007).Conclusion
This study demonstrates that the use of total hip arthroplasty in treatment of femoral neck fractures in patients from the age of 45–64 increased 4.2-fold over the study period. This treatment is associated with increased hospital cost, length of stay and complications. Additionally, as age increased in our study population, there was a stepwise increase in the use of arthroplasty, and it appears that hemiarthroplasty is being used with a different patient population. 相似文献9.
Introduction
Distal femoral fractures have many of the same challenges as hip fractures, but there has been limited research into outcomes following these. The aim of this study was to assess 30 day mortality following distal femoral fractures in comparison to hip fractures presenting to a single institution Secondary outcomes included risk factors for mortality, post-operative complications and union.Methods
A retrospective case series of all distal femoral fragility fractures in patients over 65, and hip fractures over a 5?year period at a single institution.Results
88 distal femoral fractures and 2837 hip fractures fulfilled the inclusion criteria. In the distal femoral fractures there were 80 females and 8 males with a mean age of 82.4 (range 65–103). The mean age of the hip fractures was 83.7 (range 65–106) and there were 2066 females and 771 males.The overall 30 day mortality for hip fractures was 7.7% and was 9.1% for distal femoral fractures. The risk ratio was 1.1777(95% CI 0.6009–2.3080) (p?=?0.6338). There was no significant difference in 30 day mortality between the two fracture types.Of the 88 distal femoral fractures 75 (85.2%) underwent open reduction internal fixation, 5 (5.7%) intramedullary nail and 8 (9.1%) conservative treatment. 11.4% suffered a medical complication. 9.1% patients required at least 1 further surgical procedure. The union rate was 94.3%. The 1?year mortality was 34.1%.Conclusions
There is no significant difference in 30 day mortality between distal femoral and hip fractures. Distal femoral fractures occur in a complex group of patients that is similar to hip fractures. They have high mortality and complication rates. 相似文献10.
Michael M. Hadeed Cody L. Evans Brian C. Werner Wendy M. Novicoff David B. Weiss 《Injury》2019,50(2):503-507
Introduction
Tibial pilon fractures are often treated with initial external fixation followed by delayed definitive fixation. It has been postulated that the external fixator pin site may correlate with infection risk. The purpose of this study was to determine whether external fixator pin-site distance from definitive implants impacts the risk of deep infection in pilon fractures.Materials and methods
A retrospective cohort study was completed at a single level 1 trauma center. All patients ages 15–65 who underwent open reduction and internal fixation (ORIF) of a distal tibial fracture (AO/OTA Classification 43) from 2007 to 2013 were included. The final study population was 133 patients. The impact of external fixation pin location (relative to the definitive implant location) on postoperative infection was measured.Results
As a continuous variable, the distance between the closest pin site and plate was 62.1 ± 44.1?mm in the infected cohort and 62.2 ± 49.7?mm in the non-infected cohort (p?=?0.991). Further analysis was performed by grouping the distances into less than 0?mm (i.e. overlapping), >0.0 – 25.0?mm, >25.0 – 50.0?mm, >50.0 – 75.0?mm, >75.0 – 100.0?mm, and >100.0?mm of separation. No significant differences were noted with regards to the risk for infection.Conclusions
Staged care has been shown to be an effective treatment strategy for AO/OTA type 43 fractures. There are many variables to consider when placing an external fixator construct. In this cohort, pin site distance from definitive implant location was not associated with an increase in deep infections.Level of evidence
Level III. 相似文献11.
Joscelyn M. Tatro Lisa K. Schroder Beth A. Molitor Emily D. Parker Peter A. Cole 《Injury》2019,50(2):376-381
Background
This 10?year retrospective study of the NTDB is the first to describe trends in scapula fracture diagnosis frequency, epidemiology, injury mechanisms and the type of hospital where the condition is treated.Methods
Demographics, ISS scores, hospital data, mechanism of injury, complications, and hospital length of stay were recorded for patients with diagnosed scapula fractures (ICD-9, 811.0) recorded in the NTDB, v7.2 (2002–2012). Mean and standard deviation for continuous variables and proportions for binary variables are calculated.Results
The prevalence of scapula fractures in all patients submitted to the NTDB (2002–2012) was 1.74%. Between 2006–2007, the reported incidence doubled from 1% to 2.2%. There was a predominance of injury to white males (75% and 78% respectively). Forty-one percent were treated at a Level 1 trauma center and had a mean ISS of 20.1 (SD-11.8). Scapula fracture rates declined in patients 0–19 years and increased in the 60–79 and 80+ age groups. The increasing incidence of the aged population is also reflected in the increase of falls as the mechanism of injury in the elderly population.Conclusion
This study is the first to describe a full decade of scapula fracture epidemiology on a national scale. The number of diagnosed scapula fractures increased substantially in the NTDB between 2002-2012. Scapula fractures diagnosed in the geriatric demographic and fractures resulting from falls are both on the rise, whereas the reported incidence is decreasing in the younger demographic. Additionally, fractures as a result of motor vehicle accidents also decreased precipitously during the reported decade. 相似文献12.
Christina Marie Joseph Chandrasekaran Gunasekaran Abel Livingston Hepsy Chelliah Thilak Samuel Jepegnanam P.R.J.V.C. Boopalan 《Injury》2019,50(3):784-789
Background
Contrary to acute posterior cruciate ligament (PCL) bony tibial avulsions, surgical management of chronic injuries is technically challenging and appears to be controversial. We sought to assess the outcome of a novel screw post augmentation technique in neglected cases.Methods
16 patients were followed up in a tertiary single-center retrospective study. The bony fragment was fixed using a lag screw with a spiked washer and an additional screw post through an open posterior approach. The pre- and postoperative knee range of movement (ROM), laxity, and modified Tegner–Lysholm (TL) scores were compared.Results
The median time from injury to surgery was 10 weeks (range, 3–260). The mean clinical follow-up time was 24.25?±?9.21 months. At the final follow-up, the mean knee ROM flexion was 130°?±?11.55° with no extension lag. 3 patients had grade 1 laxity. The TL grade was predominantly excellent, and the overall median score improved from 76 preoperatively to 95 postoperatively (p?<?0.0004). Bony union was achieved in all cases.Conclusion
The described screw post fixation technique results in an excellent outcome for these rare injuries.Level of evidence
Level IV, case series. 相似文献13.
Aim
Comparison of unfixed, CRIF, and ORIF of the posterior malleolus fragment (PMF) regarding the frequency of trans-syndesmotic fixation and quality of reduction in trimalleolar (equivalent) fractures.Material and Methods
Retrospective registry study. Patients with a trimalleolar (equivalent) ankle fractures were identified within the departments’ fracture database. General demographics, treatment details, and fracture specific details (CT-scans) were assessed. Patients were grouped per the PMF treatment: not addressed, CRIF, ORIF.Results
236 patients (53.0?±?18.3 (range: 18–100) years), 58.1% female were eligible. The mean size of the PMF was 21.4?±?10.4% (range: 2.7–55.9%), 71.6% were ≤25% of the tibial plafond. PMF fixation: Untreated 48.3%, CRIF 18.6%, ORIF 33.1%. ORIF of the PMF significantly (p?<?0.001) reduced the frequency of trans-syndesmotic fixation (25%) compared to CRIF (61%) or untreated PMF (63%) with no significant influence of the PMF size (≤25%/>25%). ORIF resulted in a significantly (p?<?0.001) better quality of reduction (1.2?±?1.1?mm (range: 0–5?mm)) compared to CRIF (2.5?±?2.1?mm (range: 0–8?mm)) and untreated PMF (2.5?±?2.3?mm (range: 0–20?mm)). Neither the frequency of trans-syndesmotic fixation nor the quality of reduction differed significantly between untreated PMF and CRIF.Conclusion
All posterior malleolus fragments, independent of their size, should be treated by ORIF, as this restores syndesmotic stability significantly more often than untreated PMF or CRIF. 相似文献14.
Objectives
The purpose of this study is to analyze posteromedial fragment morphology using two-dimensional computed tomography fracture mapping and to compare posteromedial fragment morphology in various Schatzker type tibial plateau fractures.Materials & methods
One hundred twenty-seven consecutive AO/OTA B- and C-type tibial plateau fractures were retrospectively analyzed using 2DCT fracture mapping. The posteromedial articular fracture angle and articular surface areas of all fractures with posteromedial fragments were calculated. Based on biomechanical studies, posteromedial fragments with coronal fracture angles >68° were considered amenable for anterolateral stabilization with standardized plating. Kruskall-Wallis non-parametric test was used for statistical comparison of morphological features of posteromedial fragments between the various Schatzker types.Results
Forty-seven out of 127 tibial plateau fractures included a posteromedial fragment. The mean posteromedial articular fracture angle was 44° (range: 2°-90o, standard deviation: 23°). Forty fragments (85%) had a fracture angle of <68°, increasing the risk for insufficient stabilization with standardized anterolateral plating. The mean articular surface area was 34% of the entire tibial plateau (range: 7%–53%, SD: 12%). There were no significant differences in posteromedial fragment morphology between Schatzker type IV, V, and VI fractures.Discussion and conclusion
Posteromedial fragments commonly occur not only in Schatzker type V and VI, but also in Schatzker type IV tibial plateau fractures. Eighty-five percent of tibial plateau fractures with a posteromedial fragment may benefit from non-standard customized lateral plating, or may require an additional medial or posterior surgical approach for fracture-specific fixation to optimize screw purchase and biomechanical stability. 相似文献15.
Background and purpose
The treatment of paediatric distal radius diaphyseal metaphyseal junction (DRDMJ) fractures is a challenge. The purpose of this study was to introduce a new operative approach at the proximal “safe zone” of the posterior interosseous nerve (PIN) to treat paediatric DRDMJ fractures and analyse the safety and efficacy of antegrade elastic stable intramedullary nail (ESIN) fixation.Methods
Thirty paediatric patients with unstable and displaced DRDMJ fractures were treated by antegrade ESIN fixation from November 2015 to September 2017. We created the entrance site at the posterolateral side of the proximal radius and 2?4?cm distal to the articular surface of the radius, using the ESIN to immobilise the fractures. In the study, we reviewed patient demographics, complications, time until removal, and intraoperative time for hardware removal.Results
Complete fracture healing was achieved between 6 and 12 weeks after surgery. Except for 3 patients presenting with irritation of the skin, we did not observe any complications. Radiologically, no secondary displacement, nail migration, loss of fixation, consolidation delay, non-union, or refracture was noted.Conclusions
The antegrade ESIN fixation is a minimally invasive, easy-to-learn, alternative operative method to treat paediatric DRDMJ fractures.Level of evidence
Therapeutic Level IV. 相似文献16.
Paolo Schiavi Francesco Pogliacomi Massimiliano Colombo Andrea Amarossi Francesco Ceccarelli Enrico Vaienti 《Injury》2019,50(2):420-423
Introduction
Femoral neck fractures are the most frequent fractures in the elderly and hemiarthroplasty is the treatment of choice. The objective of this multicenter study is to identify predictive factors of acetabular erosion after bipolar hemiarthroplasty (surgery between 1997 and 2007) in a mobile independent population during a follow-up of ten years.Materials and methods
Data were prospectively collected and retrospectively analyzed. Inclusion criteria were: age >60 and <85 years, BMI?<?35, normal Abbreviated MiniMental Test score, ability to walk 0.8?km and live independently, non-pathological fracture, hip with no or minimal osteoarthritic changes, and availability of clinical and radiological follow-up. For each Patient were recorded: demographic data, comorbidities, time from fracture to surgery, characteristics of the implant, duration of surgery. Patients included underwent clinical and radiological follow-up.Results
Overall, 209 Patients met inclusion criteria. A press-fit implant was performed in 172 subjects; in contrast a cemented prosthesis was implanted in 37 patients. Nineteen patients underwent implant revision to total hip arthroplasty for acetabular erosion and pain. Classification of X-ray using Baker criteria showed a grade 0 in 54.5%, a grade 1 in 19.6%, a grade 2 in 18.1% and a grade 3 in 7.6%. Multivariate analysis revealed that the size of the femoral head (FH) was the only predictive factor of a higher risk of acetabular erosion. The Kaplan-Meier survival curve verified the risk of implant revision in Group 1 (FH sized >48?mm) and Group 2 (FH sized <48?mm). The probability of implant revision for acetabular erosion at ten years from surgery were 5.5% in Group 1 and 15.6% in Group 2.Conclusion
In bipolar hemiarthroplasty smaller head size lead to a polar wear implying a higher risk of acetabular erosion and migration; in our population this risk was consistent with the use of implant head <48?mm diameter. Considering the absolute risk of a smaller FH size, the surgeon must evaluate the accuracy of measurement of the caliber, since the size can be significantly underestimated. 相似文献17.
Anton A. Semenistyy Elena A. Litvina EA Anna G. Fedotova Chukwuweike Gwam Andrey N. Mironov 《Injury》2019,50(2):515-520
Background
Intramedullary nailing is considered a “gold standard” for treatment of tibial shaft fractures. However, some types of fractures are typically considered as “difficult for nailing”. This group includes the periarticular fractures, fractures of both bones at the same level, comminuted and segmental fractures of the tibia. Fixator-assisted nailing (FAN) is an effective method treatment of these types of fractures. The main requirements for the ideal reduction device are an ease of its installation and an ability of multiplanar fracture reduction. Fixator-assisted nailing (FAN) with the use of two perpendicular to each other monolateral tubular frames perfectly meets these requirements. In this study we present this new surgical technique and the analysis of first 30 cases.Methods
A prospective analysis was conducted for 30 patients with “difficult for nailing” tibial fractures treated with fixator-assisted nailing in our institution between September 1st, 2017, and March 1st, 2018. The duration of surgery and its different stages, the time of fluoroscopy, difficulties encountered during surgery, were analyzed. Clinical and radiological methods were used to evaluated reduction quality.Results
In all 30 cases the acceptable reduction was achieved. The mean duration of the surgical procedure was 73.7?±?3?min. The mean duration of fluoroscopy 85.9?±?4.8?s. In 7 cases we faced with technical difficulties, which were successfully addressed.Conclusion
The described technique of FAN is an effective method for the treatment of “difficult for nailing” tibial fractures. Future multi-centered studies with a larger number of patients are needed to validate our results. 相似文献18.
Akira Hara Toshiya Kudo Satoshi Ichihara Hideaki Iwase Masashi Nagao Yuichiro Maruyama Kazuo Kaneko 《Injury》2019,50(2):256-262
Introduction
Intra-articular distal humeral fractures involving both columns require double-plate fixation. In orthogonal plate fixation, screws from the medial plate reach the radial column, while screws from the dorsolateral plate run posterior–anterior, not creating interdigitation. The Synthes LCP-DHP system has an orthogonal plate configuration that enables dorsolateral plating with support, as the radial and ulnar columns are linked via interdigitation of the distal screws. We hypothesized that the transcondylar screw from the posterolateral plate, which interdigitates with screws from the medial plate, enables more rigid stabilization of orthogonal plating in distal humeral AO type C fractures.Methods
A previous study reported the biomechanical properties of orthogonal plate fixation using an AO type 13-C2.3 intra-articular fracture model with a 1-cm supracondylar gap using artificial bones (Kudo et al., Injury, 2016). We performed a biomechanical study of the dorsolateral plate with support, and inserted one 2.7-mm locking screw through the support in the lateral-to-medial direction, creating interdigitation of the distal screws. A 0–200?N axial load was applied separately to the radial and ulnar columns. We calculated the stiffness of both columns, and the anterior displacement of the condylar fragment. We compared the biomechanical properties of orthogonal plating with versus without interdigitation.Results
There were no significant differences between the two groups in radial or ulnar axial compression. The ulnar column was stiffer than the radial column in both groups. There were no significant differences between groups in the angular displacements of the capitellum or trochlea. The capitellum moved more anteriorly than the trochlea during axial compression in both groups.Discussion
The radial and ulnar columns were linked via interdigitation of the distal screws by adding one transcondylar screw from the dorsolateral plate, which did not affect radial column stiffness or capitellar anterior movement under axial compression. In the orthogonal configuration, axial compression induced more anterior displacement of the capitellum than the trochlea, which may induce secondary fragment or screw dislocation on the dorsolateral plate or nonunion at the supracondylar level.Conclusions
The transcondylar screw from the dorsolateral plate did not affect axial compression of the radial column or capitellar anterior displacement. 相似文献19.
Matthew R. Walker Ashraf N. El Naga Omar H. Atassi Christopher H. Perkins Scott A. Mitchell 《Injury》2019,50(3):686-689
Objectives
Hip dislocations are highly morbid injuries necessitating prompt reduction and post-reduction assessment for fracture and incarcerated fragments. Recent literature has questioned the need for initial pelvic radiographs for acute trauma patients, resulting in computed tomography (CT) scans as the initial evaluation. This study investigates the relationship between choice of pre-reduction imaging and treatment of acute hip dislocations.Design
Retrospective Case-Control.Setting
Single Academic Level I Trauma Center.Methods
All acute hip dislocations from 2011 to 2016 were reviewed. Exclusion criteria were diagnosis of dislocation at another facility, death prior to reduction, emergent surgical or ICU intervention, and periprosthetic dislocation. Patients were grouped by those with only a radiograph prior to reduction, Group I, versus those with a pre-reduction CT scan, Group II. The primary outcomes were time to reduction and the acquisition of a second CT scan.Results
Of the 123 hip dislocations identified, 35 patients were excluded, mostly for transfer with a known dislocation. Group I included 29 patients and Group II included 59 patients. The mean time to reduction was 74?min in Group I and 129?min in Group II for a difference of 55?min (p?<?0.001). The rate of repeat CT scan was 0 in Group I versus 48 (81%) in Group II (p?<?0.001).Conclusion
Initial trauma pelvic radiography prior to CT is still important in the setting of suspected hip pathology to decrease time to hip reduction and unnecessary radiation exposure.Level of evidence
Prognostic Level III. 相似文献20.