Objectives: To evaluate the need for reoperation of geriatric intertrochanteric hip fractures treated with 10-mm cephalomedullary nails versus those treated with nails larger than 10 mm.
Design:Retrospective review at a single institution.Setting: Level I trauma center.Patients/Participants: All patients age 60 and over treated with cephalomedullary fixation for an intertrochanteric femur fracture at a single institution.Intervention: Cephalomedullary fixation with variable nail diameters.Main Outcome Measurements: Reoperation rates of geriatric intertrochanteric fractures treated with a size 10-mm diameter cephalomedullary nail compared with patients treated with nails larger than 10 mm.Results: There were no significant differences in reoperation rates when the 10-mm cohort was compared with an aggregate cohort of all nails larger than 10 mm (P = 0.99). This result was true for both allcause reoperation and noninfectious reoperation. There was no difference between cohorts in regards to age, gender, or fracture pattern.Conclusions: A 10-mm cephalomedullary nail can be used in lieu of a larger diameter fixation in patients age 60 and older with intertrochanteric femur fractures while still maintaining a comparable rate of reoperation.
Background: Femoral head osteonecrosis (FHON) is a well-recognised complication in patients with human immunodeficiency virus (HIV) infection. Total hip arthroplasty (THA) is a reliable solution to FHON and has provided functional improvement and pain relief in these patients. Higher complication rates, in particular infections, have been reported in the series of THAs done in the HIV-positive patients. The purpose of this study was to evaluate the complication rate of THA for FHON in HIV-positive patients managed with the highly active antiretroviral therapy (HAART) protocols. Methods: A retrospective review was performed of HIV-positive patients with FHON who underwent THAs over a 10-year period at a single institution. Results: A total of 56 THAs (44 patients) met the inclusion criteria. The mean age at the time of THAs was 47 (range 34–60) years. Of the 44 patients, 39 (88.6%) were males. The mean follow-up was 6.6 (range 2.0–11.3) years. The overall complication rate was 12.5%, with 2 (3.6%) cases of deep periprosthetic infections. Conclusions: HIV-positive patients with FHON undergoing THAs do have a considerable complication rate (12.5%). The deep periprosthetic infection rate (3.6%) in these patients, however, has decreased with contemporary disease modification protocols.
Conversion total hip arthroplasty (THA) after previous intertrochanteric (IT) hip fracture is a unique operation that is different from the routine primary total hip arthroplasty (THA) done for osteoarthritis or femoral head necrosis. Conversion THAs are similar to revision THAs with regard to complexity, technical challenges, implant costs, and perioperative complications. A literature review was performed with specific focus on the surgical techniques, patient outcomes, and financial burdens of conversion THAs after IT fracture treatment with either a sliding compression hip screw with side plate (SSP), or a cephalomedullary nail (CMN). The reported data demonstrated similar technical challenges regardless of the method of the index treatment of the IT fracture. The surgeon must plan and be prepared for more difficult and extensile exposure, available instruments for the hardware removal, altered proximal femoral geometry, and available implant inventory for the reconstruction. The outcomes are consistent with higher rates of instability and infection in the conversion THAs compared with primary THAs. There is no significant difference in the clinical outcomes of conversion THAs following either SSP or CMN. Overall, conversion THAs pose greater technical challenges. The clinical outcomes of conversion THAs remain inferior to the primary THAs. The complications and patient functional outcomes are similar to those following revision THAs.
Purpose
This study reviewed the literature regarding the patient-reported treatment outcomes of using either open reduction and internal fixation (ORIF) with a plate and screw system or intramedullary nail (IMN) fixation for periprosthetic distal femur fractures around a total knee arthroplasty.
Methods
A total of 13 studies published in the last 20 years met the inclusion criteria. The studies included 347 patients who were allocated to ORIF (n = 249) and IMN (n = 98) groups according to the implants used. The primary outcome measures were the Knee Society Score or the Western Ontario and McMaster Universities osteoarthritis index. The secondary outcome measures included knee range of motion and the rates of complications, including non-union, malunion, infection, revision total knee arthroplasty, and reoperation. Statistical significance was set at P < 0.05.
Results
The mean Knee Society Scores of ORIF and IMN groups were 83 and 84, respectively; the mean postoperative range of motion of the knee were 99° and 100°, respectively (P < 0.05); the non-union rates were 9.4 and 3.8%, respectively (P > 0.05); the malunion rates were 1.8 and 7.5%, respectively (P < 0.05); surgical site infection rates were 2 and 1.3%, respectively (P > 0.05); the reoperation rates were 9.6 and 5.1%, respectively (P > 0.05); and revision rates of total knee arthroplasty were 2 and 1%, respectively (P > 0.05).
Conclusion
Based on the patient-reported outcome assessments, both ORIF with a plate and screw system and IMN fixation are well-accepted techniques for periprosthetic distal femur fractures around a TKA, and they produce similar functional outcomes.
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