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1.
Summary We report a case of a subcapital fracture that occurred after reduction and fixation of an intertrochanteric fracture of the hip with a sliding screw. The subcapital fracture occurred 4 months after surgery for the intertrochanteric hip fracture. The subcapital fracture was undisplaced and occurred in an area supported by the screw without damaging the implant. This patient was treated conservatively with bedrest. 相似文献
2.
股骨粗隆间骨折内固定手术后并发症原因分析 总被引:33,自引:11,他引:33
目的:探讨动力髋螺钉(DHS)和股骨近端髓内固定(Gamma钉、PFN)治疗股骨粗隆间骨折产生手术后并发症的原因。方法:总结2000~2004年用DHS和髓内固定系统治疗的共94例股骨粗隆间骨折病例,对6例出现手术后并发症病例的原因进行了分析。结果:94例患者中6例出现术后并发症,并发症种类包括6类:术后股骨干骨折;内固定物股骨头颈内切割;髋内翻;股骨头坏死;头颈螺钉穿人髋关节;骨折不愈合。结论:内固定物选择不当是发生手术并发症的重要原因,而不稳定骨折、严重骨质疏松、骨折复位不良、头颈螺钉位置不良都将增加手术并发症的发生率。 相似文献
3.
动力加压髋螺钉取出后钉道内植骨的生物力学意义 总被引:5,自引:0,他引:5
目的:探讨动力加压髋螺钉(DHS)内固定治疗股骨上段骨折愈合后,取出DHS以后不处理的股骨上段、钉道植骨的股骨上段和完整的股骨上段的生物力学特性,为临床DHS取出术后进一步治疗提供理论依据。方法:收集16具新鲜尸体股骨标本进行实验应力分析,分别测定完整股骨上段,DHS取出后不处理的股骨上段和DHS取出后钉道内植骨股骨的股骨上段的力学特性,结果:DHS取出术后,不处理的股骨上段与完整股骨上段、DHS取出术后钉道植骨的股骨上段的力学特性相比,差异有显著性(P<0.01)。结论:股骨颈骨折DHS治疗骨折愈合取出固定后,应在股骨上段螺钉道内植骨补强,这有利于提高股骨上段的生物学性能,便于患者早期全负荷功能锻炼,防止再骨折和髋畸形等并发症的发生。 相似文献
4.
Yousaf Rashid Shah Santosh Nagammanavar Turab A. Syed Fauzia Zafar Martin H. Wetherill 《European journal of orthopaedic surgery & traumatology : orthopedie traumatologie》2008,18(8):591-593
Profunda femoris artery pseudo aneurysm is a rare occurrence following fractures of the proximal femur or their surgical fixation.
They usually present late because of the deep position of the artery. Patients present with a painful expansile mass in the
thigh with or without progressive anaemia. Modalities such as ultrasound scanning may aid in diagnosis but CT arteriography
is used mostly for accurate diagnosis and intervention. We report a case of delayed presentation of profunda femoris pseudo
aneurysm following dynamic hip screw fixation for intertrochanteric femur fracture. 相似文献
5.
Thomas Lang Jane A Cauley Frances Tylavsky Douglas Bauer Steven Cummings Tamara B Harris 《Journal of bone and mineral research》2010,25(3):513-519
Fatty infiltration of muscle, myosteatosis, increases with age and results in reduced muscle strength and function and increased fall risk. However, it is unknown if increased fatty infiltration of muscle predisposes to hip fracture. We measured the mean Hounsfield unit (HU) of the lean tissue within the midthigh muscle bundle (thigh muscle HU, an indicator of intramuscular fat), its cross‐sectional area (CSA, a measure of muscle mass) by computed tomography (CT), bone mineral density (BMD) of the hip and total‐body percent fat by dual X‐ray absorptiometry (DXA), isokinetic leg extensor strength, and the Short Physical Performance Battery (SPPB) in 2941 white and black women and men aged 70 to 79 years. Sixty‐three hip fractures were validated during 6.6 years of follow‐up. Proportional hazards regression analysis was used to assess the relative risk (RR) of hip fracture across variations in thigh muscle attenuation, CSA, muscle strength, and physical function for hip fracture. In models adjusted by age, race, gender, body mass index, and percentage fat, decreased thigh muscle HU resulted in increased risk of hip fracture [RR/SD = 1.58; 95% confidence interval (CI) 1.10–1.99], an association that continued to be significant after further adjustment for BMD. In models additionally adjusted by CSA, muscle strength, and SPPB score, decreased thigh muscle HU but none of the other muscle parameters continued to be associated with an increased risk of hip fracture (RR/SD = 1.42; 95% CI 1.03–1.97). Decreased thigh muscle HU, a measure of fatty infiltration of muscle, is associated with increased risk of hip fracture and appears to account for the association between reduced muscle strength, physical performance, and muscle mass and risk of hip fracture. This characteristic captures a physical characteristic of muscle tissue that may have importance in hip fracture etiology. © 2010 American Society for Bone and Mineral Research 相似文献
6.
The purpose of this study is to compare the results of compression screw fixation and Ender's rods in the treatment of intertrochanteric fractures of the hip. A retrospective analysis of 77 cases of both unstable and stable cases of intertrochanteric fractures showed a higher incidence of complications in the Ender's group; these included backing out, distal femur fracture, need for a secondary procedure, external rotation deformity, and knee pain. Indications for the use of Ender's rods may be found among patients with burns, soft-tissue injuries of the proximal thigh, and patients refusing blood transfusions. Wiring of the distal ends of Ender's rods prevents backing out of the rods. Dacron tape has also been successfully used to prevent the distal ends of the rods from backing out in the last six of the 77 cases. The compression hip screw is a preferred treatment of choice in both stable and unstable intertrochanteric fractures. 相似文献
7.
Hitesh Lal Deepak Kumar Sharma Deepak Mittal 《Journal of Clinical Orthopaedics and Trauma》2012,3(1):48-53
A 40-year-male treated with hip screw for unstable inter trochanteric fracture femur, had an implant failure after an aggressive therapy session .The Dynamic Condylar Screw was removed and fracture was fixed with Proximal Femoral Nail. The nail also failed to achieve its goal of fracture union, as a result of a unique type of reverse Z effect, in contradiction to expected Z effect resulting in intrapelvic migration of proximal hip lag screw of the proximal femoral nail. 相似文献
8.
Traumatic Inferior dislocation of hip in adult is an extremely rare occurrence. We report a case of an inferior hip dislocation associated with an intertrochanteric fracture. Treatment consisted of an initial closed manipulative reduction of the dislocation with the aid of a Schanz screw inserted in a T handle universal chuck and using C-arm imaging. A dynamic hip screw was then used to fix the intertrochanteric fracture. At 2.5 years after the injury, the patient has symmetrical range of motion versus his contra lateral normal hip. Radiographs of the hip show normal anatomy without signs of avascular necrosis of the femoral head. To our knowledge, this is the first reported case of an adult with an inferior hip dislocation with a trochanteric fracture. 相似文献
9.
A case of fracture through the femoral shaft at the site of the lower Garden screw, three months after operation is described. The purpose of this paper is to draw attention to the treatment of this fracture by replacing the lower Garden screw with an AO Dynamic hip screw and a five-hole plate, resulting in satisfactory healing of both fractures. 相似文献
10.
85岁以上老年人髋部骨折围手术期治疗 总被引:1,自引:0,他引:1
目的:探讨老年人髋部骨折围手术期治疗。方法:1999年9月-2006年1月治疗85岁以上老年人髋部骨折68例,男31例,女37例;年龄85~93岁,平均87岁;左髋31例,右髋37例。有60例存在一种以上的并存症。人工股骨头置换术28例,加压空心钉固定21例,动力髋固定19例。术前应积极治疗并存疾病,手术采用硬膜外麻醉,尽力缩短手术时间,术后加强护理。结果:68例中术中休克1例,术后由于消化道出血死亡1例,所有患者围手术期切口无感染。结论:对于85岁以上老年患者髋部骨折,只要术前准备充分,术中尽力缩短手术时间,术后加强护理,是能度过围手术期的。 相似文献
11.
Pseudoaneurysm of the profunda femoris artery due to intertrochanteric fracture of the hip 总被引:3,自引:3,他引:0
Murphy PG Geoghegan JG Austin O More-O'Ferrall R Quinlan WR Keaveny TV 《Archives of orthopaedic and trauma surgery》1999,119(1-2):117-118
Arterial injury caused by hip fracture is a rare event. We report a case of pseudoaneurysm of the profunda femoris artery
that presented 4 weeks after correction of an intertrochanteric hip fracture with a dynamic hip screw. The diagnosis was confirmed
by Duplex ultrasound scanning, and it was treated by ligation of the profunda femoris artery at the level of the pseudoaneurysm.
Received: 5 March 1996 相似文献
12.
Unstable intertrochanteric hip fractures in the elderly 总被引:6,自引:0,他引:6
Lindskog DM Baumgaertner MR 《The Journal of the American Academy of Orthopaedic Surgeons》2004,12(3):179-190
Unstable intertrochanteric hip fractures account for approximately one quarter of all hip fractures in the elderly and are increasing in frequency. Treatment goals include immediate mobilization while limiting complications. Preoperatively, medical comorbidities should be identified and managed. For stable intertrochanteric hip fractures, consistently good results have been achieved with compression hip screw fixation. However, with more unstable fracture patterns, problems with compression hip screw fixation, such as excessive fracture collapse and implant cutout, increase. For these fractures, adding a trochanteric stabilizing plate or using an axial compression hip screw or intramedullary hip screw is warranted. Surgical care should maximize the patient's chance of a successful outcome by realigning the fracture with minimal additional surgical insult, selecting the appropriate implant, and positioning it properly. 相似文献
13.
153 patients with a trochanteric hip fracture were operated on with a compression hip screw (CHS) and followed for 4 months. They were randomized into 2 groups, with or without a key and compression of the lag screw. Greater sliding of the lag screw was noted in cases where the compression screw and the key were used, especially in women over 80 years of age and in patients with a previous fracture indicating osteoporotic bone. Use of a key and compression of the lag screw gave no advantage, and we do not recommend this for treatment of trochanteric hip fractures. 相似文献
14.
A case of subcapital femoral neck fracture following osteosynthesis of a trochanteric fracture is described. The implant used was the dynamic hip screw. This kind of fracture is very rare, and has to our knowledge never been described with the use of the dynamic hip screw. 相似文献
15.
Helical blade versus sliding hip screw for treatment of unstable intertrochanteric hip fractures: a biomechanical evaluation 总被引:7,自引:0,他引:7
OBJECTIVE: To compare the fixation stability in the femoral head with sliding hip screw versus helical blade designs for unstable, intertrochanteric hip fractures. METHODS: A simulated, unstable intertrochanteric hip fracture was created in six pairs of cadaveric femurs. One of each pair was treated using an intramedullary nail with a sliding hip screw (ITST) for femoral head fixation and the other was treated with a nail with a helical blade (TFN). Each specimen was cyclically loaded with 750N vertical loads applied for 10, 100, 1000 and 10,000 cycles. Measurements for femoral head displacement, fracture fragment opening and sliding were made. Specimens were then loaded to failure. RESULTS: There was significantly more permanent inferior femoral head displacement in the ITST samples compared to the TFN samples after each cyclic loading (all p values<0.05). There was significantly more permanent fracture site opening and inferior displacement in the ITST group compared with the TFN group at 1000 and 10,000 cycles (p<0.05). Final loads to failure were not significantly different (p=0.51) between the two treatment groups. Nine specimens demonstrated fracture extension into the anteromedial cortex and subtrochanteric region and three specimens, which had an ITST implant, demonstrated a splitting fracture of the femoral head. CONCLUSION: This study demonstrated that fixation of the femoral head with a helical blade was biomechanically superior to fixation with a standard sliding hip screw in a cadaveric, unstable intertrochanteric hip fracture model. 相似文献
16.
Kühling J Schmidt J Dahn T Niebergall U Bogusch G 《Zeitschrift für Orthop?die und ihre Grenzgebiete》2005,143(4):412-418
AIM: With the growing number of elderly people in the population and the increasing incidence of proximal hip fractures the question of how to manage the medial hip head fracture is of increasing importance. Especially in Hungary and the Scandinavian countries surgeons prefer hip head-conserving therapy although the redislocation of this fracture and necrosis of the hip head opposes this point of view. METHOD: Encouraged by two theoretical and mathematical calculations, we tested two different possibilities to screw hip head fractures. RESULTS: Our results show that the hip head-conserving therapy with two cranial screws and a three-point-supported screw at Adam's arc has essential biomechanical advantages compared with the situation after conventional osteosynthesis. CONCLUSION: This result encourages us to prefer the minimally invasive head-conserving therapy of medial hip head fractures, especially for treatment of Pauwell's I and II injuries. 相似文献
17.
Manicom O Karoubi M Mseddi M Demoura A Hernigou P 《Revue de chirurgie orthopédique et réparatrice de l'appareil moteur》2006,92(6):602-605
Although no cases have been reported to date, fracture of a sliding hip screw on a screw-plate fixation is a real entity since material watch registries have revealed two non-published cases. We report an illustrative case. A 67-year-old man was hospitalized for a right intertrochanteric fracture. The patient was treated with a sliding hip screw plate fixation (short cannon, 105 mm screw). On the eighth postoperative day, fracture impaction was present with complete loss of impaction reserve associated with secondary discrete divergence in the cannon-screw alignment. Weight-bearing was postponed until the 45th postoperative day. At three months, bone healing had not been achieved. A clear image was also visible at the plate end of the cannon. The patient complained of persistent pain but there were no signs of infection. At the fifth month, the patient fell from the standing position and standard x-rays visualized the nonunion of the intertrochanteric fracture plus a infratrochanteric diaphyseal fracture line in addition to a fracture of the sliding hip screw. The plate screws were intact. The patient underwent revision osteosynthesis with a Medoff plate. Fracture of a sliding hip screw is a rare event. In the present case, the mechanism involved an insufficient impaction reserve and use of a short cannon. Treatment requires extraction of the distal fragment of the screw and a new cemented osteosynthesis. 相似文献
18.
19.
Shailendra Singh Sumit Arora Ankit Thora Ram Mohan Sumit Sural Anil Dhal 《中华创伤杂志(英文版)》2013,16(4):233-236
Dynamic hip screw fixation is a commonly performed procedure for internal fixation of intertrochanteric femoral fractures.Arterial injury following the operative fixation is a rare but serious event.We... 相似文献
20.
The Medoff sliding plate and a standard sliding hip screw for unstable intertrochanteric fractures: A mechanical comparison in cadaver femurs 总被引:4,自引:0,他引:4
Ola Olsson Frederick J. Kummer Leif Ceder Kenneth J. Koval Sune Larsson Joseph D. Zuckerman 《Acta orthopaedica》1998,69(3):266-272
The Medoff sliding plate has a dual side capability along both the femoral shaft and neck to increase theoretically interfragmentary compression and load-sharing in hip fractures. We studied intertrochanteric fracture fixation in cadaveric bone to determine whether this device has a mechanical advantage over a standard sliding hip screw.
2-part and 4-part fractures were created in 12 cadaver femurs. The fractures were fixated and sequentially destabilized; bone and plate strains and fragment displacements were determined during testing, as a function of applied physiological loads before and after short-term cycling.
The Medoff sliding plate imposed a higher mean medial cortex strain than the sliding hip screw in all fracture models and at all loading levels, and the difference was statistically significant in the 2-part and in the unstable 4-part fracture models. The loading of the medial cortex region after cycling was approximately 50% higher in the Medoff samples than in the sliding hip screw samples. There were no significant differences in plate strains, fracture displacements or load to failure between the 2 devices.
These observations favor the dual sliding principle as regards providing fracture compression and load-sharing, which may explain low failure rates in clinical series of unstable intertrochanteric fractures, treated with the Medoff sliding plate. 相似文献
2-part and 4-part fractures were created in 12 cadaver femurs. The fractures were fixated and sequentially destabilized; bone and plate strains and fragment displacements were determined during testing, as a function of applied physiological loads before and after short-term cycling.
The Medoff sliding plate imposed a higher mean medial cortex strain than the sliding hip screw in all fracture models and at all loading levels, and the difference was statistically significant in the 2-part and in the unstable 4-part fracture models. The loading of the medial cortex region after cycling was approximately 50% higher in the Medoff samples than in the sliding hip screw samples. There were no significant differences in plate strains, fracture displacements or load to failure between the 2 devices.
These observations favor the dual sliding principle as regards providing fracture compression and load-sharing, which may explain low failure rates in clinical series of unstable intertrochanteric fractures, treated with the Medoff sliding plate. 相似文献