Fixation of Trochanteric Fragments in Cementless Bipolar Hemiarthroplasty of Unstable Intertrochanteric Fracture: Cerclage Wiring

Lee, Youngkyun; Park, Chan Ho; Koo, Kyung‐Hoi

doi:10.5371/hp.2017.29.4.262

Cited by 8 publications

(10 citation statements)

References 30 publications

(34 reference statements)

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“…Therefore, hemiarthroplasty is emerging as a viable alternative to internal fixation in recent decades. [1][2][3][4][5][6]8,[10][11][12] In this study, we retrospectively followed up 22 elderly patients of unstable intertrochanteric fractures treated by cemented bipolar hemiarthroplasty as the primary management plan. We observed that, hemiarthroplasty in the unstable fracture scenario is more challenging than the routine hemiarthroplasty surgeries for fractures of the neck of femur.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, some researchers turn to cemented or uncemented hemiarthroplasty as an option to achieve a stable hip joint suitable for early weight-bearing rehabilitation. 3,5,[10][11][12] In the current study, we present our mid-term experience of managing the unstable intertrochanteric fractures in the elderly by cemented bipolar hemiarthroplasty and early rehabilitation.…”

Section: Introductionmentioning

confidence: 99%

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Cemented hemi-arthroplasty for unstable intertrochanteric fractures in the elderly: a retrospective study

et al. 2020

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Background: Unstable intertrochanteric fractures belonging to 31A2 and A3 varieties are difficult challenges for orthopaedic surgeons, particularly in the elderly patients. Osteosynthesis by dynamic hip screw or proximal femoral nail are often plagued by complications like screw cut-out, excessive collapse and fixation failures due to osteoporotic bones. Because of these complications, patients are often kept confined to the bed which may increase the risks of pressure sores, venous thrombosis and pulmonary infections. So, it is desirable to mobilize these elderly patients as quickly as possible following surgery. In recent decades, primary hemi-arthroplasty has emerged as a valuable treatment option for mobilizing these patients early.Methods: We present our retrospective study on 27 patients above 60 years of age, who were managed with cemented bipolar hemi-arthroplasty after sustaining unstable intertrochanteric fractures. All the patients were operated through modified Hardinge approach. The fractured fragments were secured by stainless steel wiring, particularly the greater trochanter, wherever necessary.Results: Twenty-three patients (85%) were able to stand up with walkers by third post-operative day and were able to walk by fifth post-operative day. There was one case of hip dislocation; it was reduced under anaesthesia. No other complications were encountered at an average follow-up of 3.1 years. The Harris hip score was ‘good’ or ‘excellent’ in more than 60% patients.Conclusions: Cemented hemi-arthroplasty appears to be a reliable treatment method for unstable intertrochanteric fractures in the elderly and it allows early weight-bearing and rehabilitation in most patients following surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cemented hemi-arthroplasty for unstable intertrochanteric fractures in the elderly: a retrospective study

et al. 2020

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“…Then, the greater trochanteric and the medial fracture fragments were attached and fixed with two to three 16-gauge wires with the technique, which was described elsewhere. 16 Usually, the greater trochanter was fixed with one vertical wire, which was inserted through a hole drilled in the lateral femoral cortex below the abductor tubercle and a hole in the upper portion of the fractured greater trochanter. The medial fragment was fixed with one to two circumferential wires.…”

Section: Methodsmentioning

confidence: 99%

“…Thus, it was difficult to restore and adjust the leg length. To adjust the leg length, we used the method described by Lee et al 16 With the use of the trial components, the optimal stem size and head length were determined. If the size, stability, and leg length were satisfactory, the stem was inserted into the Journal of Orthopaedic Surgery 27 (2) femoral canal with a firm impaction from a gentle tapping to a press fit.…”

Section: Methodsmentioning

confidence: 99%

Bipolar hemiarthroplasty using microarc oxidation-coated cementless stem in patients with unstable intertrochanteric fracture

Lee

Won

Roa³

et al. 2019

J Orthop Surg (Hong Kong)

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Purpose: Treatment for an unstable intertrochanteric fracture in elderly patients is challenging. Bipolar hemiarthroplasty (HA) using microarc oxidation (MAO) coating has been a treatment option alternative to internal fixation. However, the outcome of bipolar HA using MAO-coated stem in these patients is unknown. Methods: From July 2007 to April 2016, 234 (older than 65 years) patients (234 hips) who were diagnosed as having unstable intertrochanteric fractures were treated with bipolar HA using a fully MAO-coated standard-length rectangular cementless stem. During the arthroplasty, the greater trochanteric and the medial fracture fragments were attached to the stem and fixed with two to three 16-gauge wires. Forty-eight patients (48 hips) died within postoperative 2 years. The remaining 186 patients (186 hips) were followed up for a mean of 4.3 (range 2–10) years. Results: With the exception of 4 patients who died during hospitalization, 176 of 230 ( 76.5%) patients could ambulate independently with or without an assistive device at the time of hospital discharge. Venous thromboembolism occurred in seven patients (3.0%). One hip dislocated due to a fall 1 month after the arthroplasty. Periprosthetic femoral fracture occurred in four patients and periprosthetic acetabular fracture in one patient. One patient had periprosthetic of acute pyelonephritis. There was no focal osteolysis around the femoral stem. Conclusion: The result of cementless HA using MAO-coated stem enabled early ambulation in most (76.5%) of elderly patients with unstable intertrochanteric fractures and the results were encouraging.

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“…However, it is not always possible for elderly patients with unstable fractures to have good outcomes after osteosynthesis (3,4). To address this problem, both improvement of surgical technique and advances in implant technology have been promoted (5)(6)(7)(8)(9). Therefore, intertrochanteric fractures need to be classified accurately to determine the most appropriate treatment method.…”

Section: Introductionmentioning

confidence: 99%

A novel three-dimensional classification system for intertrochanteric fractures based on computed tomography findings

et al. 2019

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A novel three-dimensional fragment-based classification system based on computed tomography findings was established to characterize femoral intertrochanteric fractures. The intertrochanteric bone fragments were defined as follows : neck, posterior portion of the greater trochanter, anterior portion of the greater trochanter, lesser trochanter, and shaft. Each type of fracture was classified as 2-, 3-, 4-, or 5-fragment according to the number of floating bone fragments. Following the description of the fracture type, each floating bone fragment was appended, with the exception of a fragment involving the shaft. Ninety-five intertrochanteric fractures were classified by the same surgeon. The fractures occurred in 14 men and 81 women with a mean age of 84.7 years. The frequency of each type of fracture was investigated. Thirty-one fractures (32.6%) were 2-fragment and 64 (67.4%) were ≥ 3-fragment. A fragment of the anterior portion of the greater trochanter, which cannot be classified using conventional systems, was included in 29 cases (30.5%). A 5-fragment fracture was detected in two cases (2.1%). Using this fragment-based classification system, intertrochanteric fractures can be evaluated in more detail than is possible using conventional classification systems.

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Fixation of Trochanteric Fragments in Cementless Bipolar Hemiarthroplasty of Unstable Intertrochanteric Fracture: Cerclage Wiring

Cited by 8 publications

References 30 publications

Cemented hemi-arthroplasty for unstable intertrochanteric fractures in the elderly: a retrospective study

Cemented hemi-arthroplasty for unstable intertrochanteric fractures in the elderly: a retrospective study

Bipolar hemiarthroplasty using microarc oxidation-coated cementless stem in patients with unstable intertrochanteric fracture

A novel three-dimensional classification system for intertrochanteric fractures based on computed tomography findings

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