Is there a difference in the positioning of sliding screws between stable and unstable extracapsular fractures?

Labronici, Pedro José; Silva, Rodrigo Freitas da; Viana, Ana Maria Santos; Blunck, Saulo Santos; Franco, José Sergio; Neto, Sergio Ricardo; Pires, Robinson Esteves Santos; Canto, Roberto Sérgio Tavares

doi:10.1016/j.rboe.2015.02.002

Cited by 5 publications

(6 citation statements)

References 40 publications

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“…35 The TADs for all SHSs were ≤25 mm, 41 with the average of all 16 SHSs being 18.8 ± 3.3 mm representing a variation of 17.5%. Labronici et al 29 placed SHS implants into live human femora utilizing fluoroscopy and document a significantly greater TAD of 23.9 ± 8.4 mm, a variation of 35% or twice as much as this study.…”

Section: Discussionsupporting

confidence: 56%

“…Furthermore, clinical studies utilizing fluoroscopy for positioning SHSs report TAD of 23.9 ± 8.4 mm; this study sought to determine whether a radiation-free implantation method could yield improved accuracy. 29 As mentioned previously, one of the objectives of this study was to determine whether a more accurate and precise placement of hardware could be achieved without image guidance. 8 The custom guides described above were designed to position the hardware via clinically recommended guidelines (TAD < 25 mm, CSs which are <5 mm from adjacent subcortical bone; Figure 2).…”

Section: Methodsmentioning

confidence: 99%

“…4,7,8,25–28 Such guidelines dictate that SHSs be positioned with a tip-to-apex (TAD) distance of <25 mm, while CSs positioned inferior and posterior be <5 mm from adjacent subcortical bone in the femoral neck. 25–28 One exception is Labronici et al 29 who studied 117 human clinical cases of fracture treated with an SHS and report a TAD of 23.9 ± 8.4 mm (range 3–41 mm) achieved with intraoperative fluoroscopic guidance. These clinical data indicate that some of the TAD values exceeded 25 mm; in addition, the dispersion of 35% (ratio of standard deviation to mean) is not insignificant.…”

Section: Introductionmentioning

confidence: 99%

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A model to evaluate Pauwels type III femoral neck fractures

Magone

Owen

Kemker

et al. 2018

Proc Inst Mech Eng H

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While many femoral neck fractures can be reliably treated with surgical intervention, Pauwels III femoral neck fractures in the young adult population continue to be a challenging injury, and there is no consensus on optimal treatment. As such, there are past and ongoing biomechanical studies to evaluate the fixation provided by different constructs for this inherently unstable fracture. While many investigations rely on cadavers to evaluate the biomechanical performance of a construct, significant inter-subject variability can confound the analysis. Biomechanical femur analogs are being used more frequently due to more consistent mechanical properties; however, they have not been stringently evaluated for morphology or suitability for instrumentation. This study sought to determine the variability among composite femoral analogs as well as consistently create a Pauwels III injury and instrument the analogs without the need for fluoroscopic guidance. In total, 24 fourth-generation composite femoral analogs were evaluated for femoral height, neck-shaft angle, anteversion, and cortical thickness. A method was developed to simulate a Pauwels III fracture and to prepare three different constructs: an inverted triangle of cannulated screws, a sliding hip screw, and a hybrid inverted triangle with cannulated screws and a sliding hip screw. Radiographs were utilized to evaluate the variation in implant position. All but one of the morphological parameters varied by <1%. The tip-to-apex distance for all sliding hip screw hardware was 18.8 ± 3.3 mm, and all relevant cannulated screw distances were within 5 mm of the adjacent cortex. All screws were parallel, on average, within 1.5° on anterior-posterior and lateral films. Fourth-generation composite femora were found to be morphologically consistent, and it is possible to consistently instrument the analogs without the use of fluoroscopy. This analog and hardware implantation model could serve as a screening model for new fracture repair constructs without the need for cadaveric tissues or radiologic technology.

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Section: Discussionsupporting

confidence: 56%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A model to evaluate Pauwels type III femoral neck fractures

Magone

Owen

Kemker

et al. 2018

Proc Inst Mech Eng H

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“…The intramedullary location of PFN prevents significant shortening at fracture site and its buttressing effect prevents medialization of the femoral shaft. 5,22 In our study most of the fractures occurred at home from a simple fall in elderly females. In our study, A2 (52%) was the most common type of fracture followed by A3 (48%).…”

Section: Discussionmentioning

confidence: 57%

Osteosynthesis of intertrochanteric fractures by PFN and DHS – A prospective randomized comparative study

Das

Singh

Lenka

et al. 2020

Journal of Orthopaedics, Trauma and Rehabilitation

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Introduction: As the geriatric population increases, the incidence of intertrochanteric fractures (ITF) has also increased significantly. There are various modalities to treat these fractures. In this study our aim is to analyse outcomes of Proximal Femoral Nail (PFN) in comparison to those of Dynamic Hip Screw (DHS) for the treatment of ITF. Materials and Methods: This study was carried out during 2017–20. 150 patients of unstable ITF (AO type 31-A2, 31-A3) in elderly were randomly divided into two groups of 75 each and were treated either by DHS or PFN and were followed up regularly. Results: The results were compared between the groups and statistical analyses were performed. The results were assessed with Harris Hip Score(HHS) & Parker Palmer mobility score (PPMS) which were better in PFN group. Conclusion: PFN is a better fixation device for unstable ITF (31 A2 and 31 A3) in elderly patients.

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“…Several studies have failed to show that IM implants are superior to the SHS, since both are associated with similar results in most trochanteric fracture patterns [ 9 - 11 ]. Nevertheless, the use of IM implants has grown in recent years, even in stable trochanteric fractures, mainly among younger American orthopedic surgeons.…”

Section: Introductionmentioning

confidence: 99%

A Survey of Current Practices and Preferences for Internal Fixation of Trochanteric Fractures of the Femur in Brazil

Giordano¹,

Ribeiro²,

Tinoco³

et al. 2018

Cureus

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ObjectiveThe primary aim of this study was to survey current practices and preferences behind internal fixation of trochanteric femoral fractures among Brazilian orthopedic surgeons. The secondary aim was to identify the main reason for these preferences.MethodsA survey containing 20 images of trochanteric fractures of the femur was presented to a group of 62 orthopedists, all members of the Brazilian Society of Orthopedics and Traumatology (SBOT). The first part of the questionnaire was created to identify the surgeons’ degree of professional experience, type of practice, and areas of greatest interest and performance within the specialty. The second part of the questionnaire contained options for fixating different trochanteric fracture patterns in the femur for participants to choose, along with the main reason for their decision. Statistical analysis was descriptive and profiled the surgeons’ major area of interest, treatment option, and the main reason for their therapeutic decision.ResultsOf the 62 orthopedists who participated in the study, 10 (16.0%) stated that their area of greatest interest was orthopedic trauma and 52 (83.9%) reported greater interest in another area of the specialty; these two groups were classified as the Trauma Group and Orthopedics Group, respectively. To treat AO 31A1 type fractures, the trauma group selected the sliding hip screw (SHS) in 66.7% of cases, while the orthopedics group chose the SHS in 65.8% of cases. For 31A2 type fractures, the trauma group chose the intramedullary (IM) nail in 64.0% of the cases, while the orthopedics group chose the IM nail in 76.7% of the cases. For 31A3 type fractures, the trauma group opted for the IM nail in 70.0% of the cases, while the orthopedics group selected the IM nail in 88.0% of the cases. The two most important factors in implant selection for the three types of fracture were fracture pattern and implant availability.ConclusionThe sliding hip screw is preferred by most Brazilian orthopedic surgeons for fixation of 31A1 type trochanteric femoral fractures. For 31A2 and 31A3 type fractures, the IM nail is preferred.

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Is there a difference in the positioning of sliding screws between stable and unstable extracapsular fractures?

Cited by 5 publications

References 40 publications

A model to evaluate Pauwels type III femoral neck fractures

A model to evaluate Pauwels type III femoral neck fractures

Osteosynthesis of intertrochanteric fractures by PFN and DHS – A prospective randomized comparative study

A Survey of Current Practices and Preferences for Internal Fixation of Trochanteric Fractures of the Femur in Brazil

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