Análise do emprego do parafuso antirrotacional nos dispositivos cefalomedulares nas fraturas do fêmur proximal

Takano, Marcelo Itiro; Moraes, Ramon Candeloro Pedroso de; Almeida, Luis Gustavo Morato Pinto de; Queiroz, Roberto Dantas

doi:10.1016/j.rbo.2013.05.006

Cited by 5 publications

(5 citation statements)

References 23 publications

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“…In the presented case series, 35% of the evaluated patients had a femoral neck diameter within the recommended range (> 34 mm) for the correct positioning of the used implant (Targon PF ® ), with the sliding screw associated with the use of the anti-rotational device in the mid-axis of the neck. The concurrent use of the anti-rotational device tends to position the sliding screw in a lower location in relation to the midline of the femoral neck, particularly in patients with a short femoral neck and head [20,21]. In consolidated fractures, the inferior dislocation of the sliding hip screw in relation to the mid-axis of the neck was 3.43mm.…”

Section: Discussionmentioning

confidence: 99%

“…The proximal femur's anatomical characteristics have shown importance in the positioning of the sliding screw or anti-rotational device in the femoral neck [21]. In the presented case series, 35% of the evaluated patients had a femoral neck diameter within the recommended range (> 34 mm) for the correct positioning of the used implant (Targon PF ® ), with the sliding screw associated with the use of the anti-rotational device in the mid-axis of the neck.…”

Section: Discussionmentioning

confidence: 99%

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Analysis of the use of the Anti-Rotational Device in Cephalomedullary Nail and its Implications in Fractures of the Proximal Femur

França¹,

Teixeira²,

Rigolino³

et al. 2023

Act Scie Ortho

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Objective: Evaluate the influence in the position of the anti-rotational device in cephalomedullary nails and its influences on the consolidation of trochanteric fractures. Methods:Retrospective case series comprising 58 patients with unstable trochanteric fractures that underwent osteosynthesis with cephalomedullary nail and anti-rotational device. Were analyzed the radiographs of the pelvis and ipsilateral hip osteosynthesis with 6 months postoperatively and compared to initial. The radiographic parameters used were tip-apex index (TAD), the positioning of the sliding screw in relation to the central axis of the femoral neck, the angle of reduction and fracture healing.Results: From the 58 patients selected for initial postoperative examination, 15 (26%) died, 6 (10%) lost the thread of the treatment and 37 (64%) were reassessed. Most of them were female patients, beteween the ninth and tenth decade of life. It was observed that 31 (84%) fractures were consolidated, while 6 (16%) patients had their fractures not yet consolidated. The reduction angle in healed fractures was 129o and in non-healed were 136o. In these, the position of the sliding screw was far from the central axis of femoral neck. Conclusion:The fixation of trochanteric fractures with cephalomedullary nail with anti-rotational device is safe. The reduced fractures with valgus above 135 ° showed higher rates of nonunion. In these cases the position of the sliding screw was lower than ideal to fit the anti-rotational device, which may have affected negatively the fracture healing.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Analysis of the use of the Anti-Rotational Device in Cephalomedullary Nail and its Implications in Fractures of the Proximal Femur

França¹,

Teixeira²,

Rigolino³

et al. 2023

Act Scie Ortho

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“…[11] However, the anti-rotational device was related to early complications arising from its position, and later, like as a "Z effect." [5,12] Z-effect, defined as a complication results from the collapse of the proximal fracture fragment that lead to a medial migration of the superior lag screw and lateral migration of the inferior lag screw. [5] In a previous study, [3] we have achieved successful results using a composite of DHS with derotation screw (DHS/DRS composite) for the fixation of a group of fractures, which were assigned as rotationally unstable.…”

Section: Introductionmentioning

confidence: 99%

Fixation of rotationally unstable extracapsular proximal femoral fractures

Massoud¹

2018

Ulus Travma Acil Cerrahi Derg

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BACKGROUND: It was thought that the AO types A1.2 and A1.3 fractures are rotationally stable; however, it revealed instability when fixed using the dynamic hip screw. Therefore, we hypothesized that these fractures should be treated as rotationally unstable. METHODS: A series of 83 fractures of the AO types A1, A2, and B2.1 were treated using dynamic hip screw with derotation screw (DHS/DRS) composite and then prospectively followed for 24 months. Adequacy of reduction and fixation were immediately assessed after surgery, and fracture collapse was assessed at six months or when fractures healed. To investigate the feasibility of our hypothesis, fractures were classified into two groups: 1) the inevitably unstable group (IUG) included the AO types A1.1, A2.1, A2.2, A2.3, and B2.1 fractures and 2) the potentially unstable group (PUG) included the AO types A1.2 and A1.3 fractures. The results were statistically analyzed. RESULTS: Adequate reduction was achieved in 77 and adequate fixation in 71 fractures. All fractures healed in a mean time of 13.5 weeks, and the amount of the fracture collapse averaged 5.8 mm. Equalization of the lower limbs was achieved in 66 patients, and hip motion range equalized the healthy contralateral in 80 patients. Re-operation was performed in one case with AO type A1.2. Comparison of IUG and PUG using the outcomes revealed insignificant differences. CONCLUSION: Using the DHS/DRS composite, anatomical features of the proximal femoral end were restored and maintained during the follow-up period. Insignificant differences between outcomes of IGU and PGU render the addition of the AO types A1.2 and A1.3 to the rotationally unstable fractures reasonable.

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“…Fractures of the femoral neck have osteosynthesis as treatment option, partial or total hip arthroplasty, being the late mortality rate the same for any of the treatments [10,11]. The treatment is predominantly surgical, unless exceptionally in patients with comorbidities that contraindicate anesthesia, surgery or both [10,11].…”

mentioning

confidence: 99%

“…The treatment is predominantly surgical, unless exceptionally in patients with comorbidities that contraindicate anesthesia, surgery or both [10,11].…”

mentioning

confidence: 99%