Femoral shaft medialisation and neck-shaft angle in unstable pertrochanteric femoral fractures

Pajarinen, Jukka; Lindahl, Jan; Savolainen, Vesa; Michelsson, Oliver; Hirvensalo, Eero

doi:10.1007/s00264-004-0590-x

Cited by 52 publications

(58 citation statements)

References 20 publications

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“…Unstable A2 fractures should be initially reduced to a slightly valgus position during PFN surgery, because the neck-shaft angle would decrease during the first 6 postoperative weeks. 19 The lag screw should be inserted into the femoral head as deeply as noted in the AP view, and centrally in the lateral view. 13 The tip of the lag screw should always be inferior to the centre of the femoral head.…”

Section: Discussionmentioning

confidence: 99%

Proximal Femoral Nail for Treatment of Trochanteric Femoral Fractures

Morihara

Arai

Tokugawa

et al. 2007

J Orthop Surg (Hong Kong)

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Purpose. To report outcomes of 87 consecutive patients treated with a proximal femoral nail (PFN) for trochanteric femoral fractures. Methods. 17 men and 70 women aged 58 to 95 (mean, 85) years with trochanteric femoral fractures underwent PFN fixation using an intramedullary nail, a lag screw, and a hip pin. Fractures were classified according to the AO system; the most common fracture type was A2 (n=45), followed by A1 (n=36) and A3 (n=6). The position of the lag screw within the femoral head was measured. The lateral slide of the lag screw after fracture consolidation was measured by comparing the immediate postoperative and final anteroposterior radiographs. Results. 90% of lag screws were placed in an optimal position. The length of lateral slide of the lag screw in stable A1 fractures was significantly less than that in unstable A2 fractures; it was over 10 mm in 7 of 45 patients with A2 fractures. Cut-out of lag screw did not occur, suggesting that free sliding of the lag screw facilitates direct impaction between fragments. Conclusion. A PFN is useful for the treatment of trochanteric femoral fractures.

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Section: Discussionmentioning

confidence: 99%

Proximal Femoral Nail for Treatment of Trochanteric Femoral Fractures

Morihara

Arai

Tokugawa

et al. 2007

J Orthop Surg (Hong Kong)

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“…So the choice of the implant is particularly critical in unstable fractures. This is reflected in the clinical situation where the failure rate in unstable fractures is significantly increased compared to stable fractures [1,21,29]. Although these complications in unstable fractures are largely related to the local mechanical situation at the fracture site, no standardized biomechanical model exists to study the mechanical characteristics of hip fracture osteosynthesis [12].…”

Section: Introductionmentioning

confidence: 99%

Type of Hip Fracture Determines Load Share in Intramedullary Osteosynthesis

Eberle

Gerber

Oldenburg

et al. 2009

Clinical Orthopaedics &Amp; Related Research

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The choice of the appropriate implant continues to be critical for fixation of unstable hip fractures. Therefore, the goal of this study was to develop a numerical model to investigate the mechanical performance of hip fracture osteosynthesis. We hypothesized that decreasing fracture stability results in increasing load share of the implant and therefore higher stress within the implant. We also investigated the relationship of interfragmentary movement to the fracture stability. A finite element model was developed for a cephalomedullary nail within a synthetic femur and simulated a pertrochanteric fracture, a lateral neck fracture, and a subtrochanteric fracture. The femur was loaded with a hip force and was constrained physiologically. The FE model was validated by mechanical experiments. All three fractures resulted in similar values for stiffness (462-528 N/mm). The subtrochanteric fracture resulted in the highest local stress (665 MPa), and the pertrochanteric fracture resulted in a lower stress (621 MPa) with even lower values for the lateral neck fracture (480 MPa). Thus, intramedullary implants can stabilize unstable hip fractures with almost the same amount of stiffness as seen in stable fractures, but they have to bear a higher load share, resulting in higher stresses in the implant.

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“…The most important finding of their series was that the mean NSA angle decreased in both treatment groups. This decrease was more distinct in the DHS group, but the difference in patients treated with the PFN was not significant [3] . In another study conducted by Barwar N et al showed that there is a high incidence of coxa vara or coxa valga in fixation with standard dynamic hip screw and restoration of NSA could often not be achieved.…”

Section: Discussionmentioning

confidence: 85%

Evaluation of the neck shaft angle achieved after surgical fixation of intertrochanteric fracture of femur

Bhandari¹,

Deane²

2018

Int. J. Orthop. Sci.

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Introduction: Femoral trochanteric fractures are the most common fractures of old age. Due to the fracture there is a change in the neck shaft angle which if not restored can lead to further disability. In this study we evaluated the immediate post-operative neck shaft angle achieved in surgically fixed intertrochantric fracture of femur using DHS and PFN and compared it with the normal side. Material & Method:This observational study was performed on 30 patients, with a mature skeleton, with an intertrochantric fracture of femur who got operated within a period of one year. AP view of Xray pelvis with bilateral hip in 15 degree internal rotation was done in the supine position after surgery. Morphometric measurements bilaterally on digital X-ray machine (CR system) using DIACOM software were done. All the data was analyzed for evaluation of neck shaft angle in non-fractured side and the restoration/change in neck shaft angle on the operated side after surgical fixation. Result: In our study the average neck shaft angle of normal side of femur was found to be 121.17±6.88 degrees and that of the operated side was found to be 125.32±10.12 degrees. Discussion: With DHS we were not able to restore the anatomical NSA due to the valgus reduction but with PFN we were able to restore.

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Femoral shaft medialisation and neck-shaft angle in unstable pertrochanteric femoral fractures

Cited by 52 publications

References 20 publications

Proximal Femoral Nail for Treatment of Trochanteric Femoral Fractures

Proximal Femoral Nail for Treatment of Trochanteric Femoral Fractures

Type of Hip Fracture Determines Load Share in Intramedullary Osteosynthesis

Evaluation of the neck shaft angle achieved after surgical fixation of intertrochanteric fracture of femur

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