High reliability of an algorithm for choice of implants in hip fracture patients

Palm, Henrik; Posner, Eva; Ahler-Toftehøj, Hans-Ulrik; Siesing, Peter Christian; Gylvin, Silas Hinsch; Aasvang, Tobias Kvanner; Holck, Kim; Holtz, Kenneth Brian

doi:10.1007/s00264-013-1831-7

Cited by 24 publications

(20 citation statements)

References 13 publications

(44 reference statements)

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“… Surgical incision lines, as well as other reference lines were marked bilaterally on the skin with a UV pen (see Figure for specification of the surgical incision lines). An orthopaedic surgeon marked the surgical incision lines representing the most commonly used surgical approaches for hip surgery With the subject in the upright sitting position, the investigator assessed the ultrasonographic visibility (15‐6 MHz linear transducer, SonoSite X‐Porte, FUJIFILM Sonosite) of the subcostal nerve at three locations (Figures and ).…”

Section: Methodsmentioning

confidence: 99%

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Cutaneous anaesthesia of hip surgery incisions with iliohypogastric and subcostal nerve blockade: A randomised trial

Nielsen

Moriggl

Barckman

et al. 2018

Acta Anaesthesiol Scand

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Cutaneous anaesthesia of hip surgery incisions with iliohypogastric and subcostal nerve blockade: A randomised trial

Nielsen

Moriggl

Barckman

et al. 2018

Acta Anaesthesiol Scand

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“…An orthopedic surgeon marked the surgical incision lines (J.B.), which are representative of the most commonly used surgical incisional approaches for hip surgery. 28,29 (2) Prior to nerve blockade, bilateral baseline knee extensor muscle strength was recorded as the average of 3 measurements of maximum voluntary isometric contraction (MVIC), using a handheld dynamometer (Commander Muscle Tester; JTECH Medical, Midvale, Utah). 30 (3) Bilateral SI-FIC nerve blocks were then performed in order to anesthetize the LFC nerve in its intrapelvic trajectory prior to any LFC nerve branching.…”

Section: Trial Day 1: Bilateral Assessment Of Maximum Area Of Anesthesiamentioning

confidence: 99%

“…28,29 The assessment of anesthesia of each surgical incision line suggests that the LFC nerve block does not anesthetize the surgical incision of the anterior approach or the surgical incision for the entry point of the IM nail. Furthermore, the anterolateral, the direct lateral, and the posterolateral incision lines were only partially included in the anesthetized area, suggesting that the LFC nerve block is required but not sufficient to anesthetize the area intersected by these surgical incisional approaches.…”

Section: Clinical Trialmentioning

confidence: 99%

The Lateral Femoral Cutaneous Nerve

Nielsen

Moriggl

Barckman

et al. 2018

Regional Anesthesia and Pain Medicine

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Background and ObjectivesNerve blockade of the lateral femoral cutaneous (LFC) nerve provides some analgesia after hip surgery. However, knowledge is lacking about the extent of the cutaneous area anesthetized by established LFC nerve block techniques, as well as the success rate of anesthetic coverage of various surgical incisions. Nerve block techniques that rely on ultrasonographic identification of the LFC nerve distal to the inguinal ligament can be technically challenging. Furthermore, the branching of the LFC nerve is variable, and it is unknown if proximal LFC nerve branches are anesthetized using the current techniques. The primary aim of this study was to investigate a novel ultrasound-guided LFC nerve block technique based on injection into the fat-filled flat tunnel (FFFT), which is a duplicature of the fascia lata between the sartorius and the tensor fasciae latae muscle, in order to assess the success rate of anesthetizing the proximal LFC nerve branches and covering of the different surgical incisions used for hip surgery.MethodsFirst, a cadaveric study was conducted in order to identify an FFFT injection technique that would provide adequate injectate spread to the proximal LFC nerve branches. Second, a clinical study was conducted in a group of 20 healthy volunteers over 2 consecutive days. On trial day 1, successful complete anesthesia of the LFC nerve was defined by performing a suprainguinal fascia iliaca block bilaterally in each subject. On trial day 2, a triple-blind randomized controlled trial compared the effect of the novel ultrasound-guided LFC nerve block technique for bupivacaine versus placebo. The primary end point was the success rate of anesthesia of the proximal cutaneous area innervated by the LFC nerve for the FFFT injection with bupivacaine versus placebo.ResultsAdequate spread of injectate to the proximal LFC nerve branches in cadavers was obtained by injecting 10 mL with dynamic needle-tip tracking in the FFFT. Application of this technique in the randomized controlled trial provided anesthesia of the lateral thigh with a success rate of 95% (95% confidence interval, 73.9%–99.8%) for the active side and 0% for placebo (P < 0.001). The proximal branches were anesthetized with a success rate of 68% (95% confidence interval, 43.4%–87.4%) on the active side. The proximal extent of the anesthetized cutaneous area was on average 7.9 cm distal to the greater trochanter.ConclusionsThis novel LFC nerve block technique is easy and quick and reliably produces anesthesia of the lateral thigh. The greater trochanter is rarely included in the area of anesthesia, which reduces the coverage of each specific surgical incision. The success rate of 68% in anesthetizing the proximal nerve branches must be further evaluated by future research.

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“…Those were elderly patients who presented with a posterior tilt of the femoral head of at least 20° measured on the preoperative lateral radiograph [ 1 – 3 ]. Primary arthroplasty could thus be a better alternative for this subgroup of elderly patients [ 4 , 5 ]. Two studies suggested that elderly patients with Garden-I and Garden-II FNFs with a posterior tilt of ≥ 20° could benefit from arthroplasty, whereas patients with a posterior tilt of < 20° may be treated with internal fixation [ 1 , 3 ].…”

Section: Introductionmentioning

confidence: 99%

Eight orthopedic surgeons achieved moderate to excellent reliability measuring the preoperative posterior tilt angle in 50 Garden-I and Garden-II femoral neck fractures

Dolatowski

Hoelsbrekken²

2017

J Orthop Surg Res

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BackgroundStudies of elderly patients with Garden-I and Garden-II femoral neck fractures (FNFs) suggest that a preoperative posterior tilt of the femoral head of at least 20° increases the risk of fixation failure. A recently published treatment algorithm recommended hemiarthroplasty over internal fixation for elderly patients with Garden-I and Garden-II FNFs and a preoperative posterior tilt of at least 20°. However, the reliability of the method used to measure the posterior tilt has not been assessed according to recommended standards for reliability trials.MethodsFour orthopedic registrars and four consultants measured the posterior tilt angle in 50 preoperative lateral radiographs at two occasions six weeks apart. We estimated inter- and intrarater reliability by intraclass correlation coefficient (ICC). We also assessed repeatability by the repeatability coefficient (RC) and agreement by the minimal detectable change (MDC). Based on the suggested cutoff value of 20°, we reported the overall percentage and specific agreement for the choice of implant.ResultsInter- and intrarater reliability for all raters was excellent with an ICC (95% CI) of 0.77 (0.69–0.85) and 0.77 (0.67–0.86), respectively. The RC was 13.9 and the MDC 14.1. Specific agreement for choosing arthroplasty was 61.3 and 54.6% for the first and second test occasion, respectively.ConclusionsEight orthopedic surgeons measured the posterior tilt in 50 Garden-I and Garden-II FNFs and achieved excellent inter- and intrarater reliability. However, variations in repeated measurements and variations in measurements made by different raters, as assessed by the RC and the MDC respectively, ranged from 13.9° to 14.1°. The variations in posterior tilt measurements should be taken into account when choosing the type of implant for elderly patients with Garden-I and Garden-II femoral neck fractures.

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High reliability of an algorithm for choice of implants in hip fracture patients

Cited by 24 publications

References 13 publications

Cutaneous anaesthesia of hip surgery incisions with iliohypogastric and subcostal nerve blockade: A randomised trial

Cutaneous anaesthesia of hip surgery incisions with iliohypogastric and subcostal nerve blockade: A randomised trial

The Lateral Femoral Cutaneous Nerve

Eight orthopedic surgeons achieved moderate to excellent reliability measuring the preoperative posterior tilt angle in 50 Garden-I and Garden-II femoral neck fractures

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