„Cutting out“ bei pertrochantären Frakturen – ein Problem der Osteoporose?

Bonnaire, F.; Wéber, A.; Bösl, O.; Eckhardt, C.; Schwieger, Karsten; Linke, Berend

doi:10.1007/s00113-007-1248-0

Cited by 101 publications

(61 citation statements)

References 26 publications

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“…23,25 In our study there was no varus collapse accordance with the studies by Lee et al, Kim et al 25,26 Cement-augmented DHS have a different failure mode than screw cut-out in conventional DHS. Failures tended to be more related to delayed union, non-union and resultant side plate construct failure as concluded by Wu MH et al 27 In our study there were no cases of nonunion, the average time to union was 14.12 (12)(13)(14)(15)(16)(17) 28,29 They concluded no risk of thermal necrosis at the PMMA/bone interface or in the surrounding bone upto 6.0 cc PMMA. In a study by Lee et al using cement augmentation with DHS, with an average amount 13.7 ml of PMMA.…”

Section: Discussionsupporting

confidence: 68%

“…12 In the past, various methods such as valgus osteotomy, valgus reduction with tension-band wiring, lateral wall reconstruction, and a variety of other techniques have been developed, in an attempt to reduce the rate of complications in the management of these fractures. [13][14][15][16] However, none of these have been able to completely address the problem of implant failure in osteoporotic patients, due to a superior screw cut out.…”

mentioning

confidence: 99%

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Evaluation of osteoporotic trochanteric fractures treated with cement-augmented dynamic hip screw

et al. 2016

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Background: Dynamic hip screw (DHS) has been the standard treatment for stable trochanteric fracture patterns. However, primary stabilization with dynamic/sliding hip screw is not always successful, especially in osteoporotic fractures. Internal fixation in such a situation may achieve a satisfactory initial fracture site reduction, but late fracture collapse into varus during weight bearing, can lead to a high failure rate. Since 1975, polymethylmethacrylate (PMMA) cement-augmented DHS have been used as a solution in unstable ITFs by adding an anchoring ability to the lag screw.Methods: A series of 33 osteoporotic intertrochanteric fractures were operated with cement augmented dynamic hip screw. One patient lost to follow up. All patients were then allowed partial weight bearing walker aided ambulation under the guidance of physiotherapist on the second or third postoperative day. The patients were followed radio logically and clinically at regular intervals (1st month, than at 3rd month and then at 6th month interval after surgery). Results were graded as excellent (score >31), good (score 24-31), fair (score 16-23), and poor (score <16). Clinical result was given according to Salvati and Wilson scoring.Results: Total 33 patients were taken for the study they were followed for minimum 6 months and at 6 months the clinical outcome was rated as per the Salvati and Wilson scoring system. One patient lost to follow-up. Final clinical results as evaluated by Salvati and Wilson scoring were; excellent in 24 cases (75%), good in 7 cases (21.88%), fair in 1 case (3.12%) and poor in 0 cases (0%). There were no non-union, AVN, implant failure and screw cut-out in our study.Conclusions: The surgical management of intertrochanteric fractures with PMMA augmented DHS provide a stable fixation with moderate pain free early mobilisation and better outcome in osteoporotic patients without the complications of superior screw cut-out, sliding collapse, and with the appropriate placement of bone cement along with proper amount (4-5 ml) of cement we can also reduce the cement related complications such as delayed healing, nonunion, heat necrosis and avascular necrosis.

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Section: Discussionsupporting

confidence: 68%

mentioning

confidence: 99%

Evaluation of osteoporotic trochanteric fractures treated with cement-augmented dynamic hip screw

et al. 2016

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“…After evaluating the relationship between osteoporosis and the incidence of dynamic hip screw, gamma nail, and PFN postoperative cutting, Bonnaire et al (2007) found that a bone mineral density of less than 0.6 g/cm 3 has a high fixation failure rate. Therefore, if the preoperative and postoperative procedures do not involve the systemic treatment of osteoporosis, postoperative functional exercise would not be appropriate.…”

Section: Discussionmentioning

confidence: 99%

Reason and treatment of failure of proximal femoral nail antirotation internal fixation for femoral intertrochanteric fractures of senile patients

et al. 2014

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ABSTRACT. The cause of postoperative failure after the treatment of femoral intertrochanteric fracture with proximal femoral nail antirotation (PFNA) was analyzed, and the reoperative methods were examined. Nine failures of 308 femoral intertrochanteric fracture patients with PFNA were treated with femoral prosthesis total hip replacement (THR) and reoperative internal fixation. All nine patients were analyzed to determine the cause of failure. The causes of failed internal fixation in the intertrochanteric-fractured patients included perforation of the helical blade into the hip joint in three cases, cuttingout of the helical blade exit outside in two cases, and hip varus as a result of cutting-out the helical blade in two cases. Seven patients with failed internal fixation were treated with THR. Two patients who had femoral shaft fractures at the end of the nail were treated with longer PFNA. Faulty operative procedures, unsatisfactory reductions, serious osteoporosis, and incorrect positioning of the helical blade were the most important factors responsible for the failed internal fixation. Satisfactory results were achieved with THR and refixation relative to the causes of the failed internal fixation.

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“…Fakat yaşlı hasta gurubunda instabil kırığa osteoporozun eşlik etmesi yüzünde rijid tesbit yön-temlerinin uygulama güçlükleri ve ameliyat sonrası implant sorunları ile karşılaşılabilmesi nedeni ile bu kırıkların tedavisinde hemiartroplastinin halen önemli bir yeri vardır. [4][5][6] Çalışmamızda, ileri yaş grubu intertrokanterik femur kırık-larının cerrahi tedavisinde proksimal femoral nail (PFN) ve hemiartroplasti uyguladığımız hastalarımızı ameliyat süresi ve kanama miktarı, erken ve geç dönem komplikasyonları, hastanede kalış süresi ve fonksiyonel sonuçları açısından değerlendirdik. Grup I' deki olgular kaynamama ve kötü kaynama, redüksi-yon kaybı-implant yetmezliği bakımından araştırıldı.…”

Section: Introductionunclassified

The clinical outcomes of hemiarthroplasty and proximal femoral nail (PFN) fixation of unstable intertrochanteric femoral fractures in patients over 70 years old

İnanmaz¹,

Köse²,

Cebesoy³

et al. 2011

Sakarya Med J

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Aim: To evaluate the clinical outcomes of proximal femoral nail and hemiarthroplasty in terms of functional results, morbidity and complications in patients over 70 years old who had unstable intertrochanteric femur fractures. Material and Methods: Twety five patients operated between 2007-2011 in three institutions were included in this study. Twelve underwent PFN fixation and 13 had hemiarthroplasty. The mean follow-up was 23 months. There were 14 men and 121 women. Both groups were compared in terms of operation time, blood loss, early and late complications, length of hospital stay (LOS) and Haris hip scores. Findings: Operation time was less in the hemiarthroplasty group but the blood loss was lower in the PFN group. (p<0.05) LOS was similar in both groups. (p>0.05). The only early PFN complication was fixation loss. The late complication in the hemiarthroplasty group was osteolysis. The Harris hip scores were better in favor of the hemiarthroplasty group. Conclusion: PFN fixation without anatomic reduction causes more complications and secondary operations in this population. Anatomically reduced PFN fixation and hemiarthroplasty gives comparable clinical and functional results.

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„Cutting out“ bei pertrochantären Frakturen – ein Problem der Osteoporose?

Cited by 101 publications

References 26 publications

Evaluation of osteoporotic trochanteric fractures treated with cement-augmented dynamic hip screw

Evaluation of osteoporotic trochanteric fractures treated with cement-augmented dynamic hip screw

Reason and treatment of failure of proximal femoral nail antirotation internal fixation for femoral intertrochanteric fractures of senile patients

The clinical outcomes of hemiarthroplasty and proximal femoral nail (PFN) fixation of unstable intertrochanteric femoral fractures in patients over 70 years old

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