Modified Candy-Package technique vs Cerclage technique for refixation of the lesser trochanteric fragment in pertrochanteric femoral fractures. A biomechanical comparison of 10 specimens

Schopper, CO; Faschingbauer, M.; Moeller, Richard-Tobias; Gebhard, Florian; Duerselen, Lutz; Seitz, Alexander

doi:10.1016/j.injury.2020.06.008

Cited by 7 publications

(5 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Initial biomechanical studies were able to demonstrate increased primary stability after cerclage wiring of the lesser trochanter fragment in osteoporotic pertrochanteric fractures after intramedullary osteosynthesis [22]. Consecutive studies showed similar results regarding stability with a modified candy-package cerclage technique using two cerclage wires placed above and below the apex of the lesser trochanter [26].…”

Section: Discussionmentioning

confidence: 98%

Biomechanical comparison of screw vs. cerclage refixation in orthogeriatric lesser trochanteric fractures: a cadaveric study

Linhart¹,

Kistler²,

Woiczinski³

et al. 2022

Eur J Trauma Emerg Surg

View full text Add to dashboard Cite

Purpose Osteoporosis-related proximal femur fractures continue to increase significantly due to demographic change. This study was designed to evaluate the biomechanical stability of two different fixation methods (cerclage vs. screw) for refixation of a trochanter minor fragment in the pertrochanteric fractures in cadaveric bones. Methods Artificial bones (n = 14) and human bones (n = 16) were treated with a DHS and the trochanter minor fragment was reduced by cerclage wiring or direct screw fixation. After preloading the simulated iliopsoas with 10 N, a tensile test was performed, ending with either a 70% loss of strength or avulsion of the fragment. The mean values of the avulsion force and the surface strain were recorded. Results All tensile tests showed no significant differences between refixation using a direct screw or wire cerclage, for both artificial bones and human specimens. Absolute values showed higher avulsion forces after direct screw fixation than refixation with a wire cerclage. The surface tension of specimens treated with direct screw fixation was lower than that of specimens treated with wire cerclage. An opposite effect was seen in artificial bones. Both effects were not statistically significant. Conclusion Based on the equal stability after lag screw placement compared to cerclage wiring, we promote the placement of a lag screw into the lesser trochanter fragment in pertrochanteric femur fractures when using a dynamic hip screw. Level of evidence Level III.

show abstract

Section: Discussionmentioning

confidence: 98%

Biomechanical comparison of screw vs. cerclage refixation in orthogeriatric lesser trochanteric fractures: a cadaveric study

Linhart¹,

Kistler²,

Woiczinski³

et al. 2022

Eur J Trauma Emerg Surg

View full text Add to dashboard Cite

show abstract

“…Therefore, the value of lateral wall status (intact, incompetent, or broken) on fracture stability is decreased. On the other hand, the other two parameters, the distal cortical extension of the lesser trochanter fragment, and the anterior extension of the posterior coronal fracture line to the entry portal of headneck implant are recognized again as predictors for postoperative un-stability after short cephalomedullary nailing (20)(21)(22).…”

Section: In the Time Of Cephalomedullary Nailmentioning

confidence: 99%

A sophisticated fracture classification system of the proximal femur trochanteric region (AO/OTA-31A) based on 3D-CT images

et al. 2022

View full text Add to dashboard Cite

ObjectiveFracture classification evolves dynamically with new and enhanced imaging modalities. This paper aims to introduce a novel hypothesis of a sophisticated fracture classification system for the proximal femur trochanteric region (AO/OTA-31A) based on 3D-CT images and accommodate the clinical requirement of the worldwide outbreak of geriatric hip fractures with large amounts of surgical operations.MethodsIn the current practice of widely preoperative 3D-CT application and cephalomedullary nailing, we attempt to propose a new comprehensive classification system to describe the fracture characteristics in a more detailed and sophisticated architecture, and pay the most important concern to the parameters that contribute to fracture stability reconstruction in osteosynthesis.ResultsThe new four-by-four comprehensive classification system, followed the structure of the AO/OTA system, incorporates many fracture characteristics as dividing indexes into multiple grade levels, such as fracture line direction, the number of fragments, the lesser trochanter fragment and its distal extension (>2 cm), the posterior coronal fragment and its anterior expansion (to the entry portal of head–neck implant at the lateral cortex), the lateral wall and anterior cortex fracture, and the anteromedial inferior corner comminution. From a panoramic perspective, there are four types and each type has four subtypes. A1 is simple two-part fractures (20%), A2 is characterized by lesser trochanter fragment and posterior coronal fractures (62.5%), A3 is reverse obliquity and transverse fractures with complete lateral wall broken (15.5%), and A4 is medial wall comminution which further lacks anteromedial cortex transmission of compression force (2%). For subtypes, A2.2 is with a banana-like posterior coronal fragment, A2.4 is with distal cortex extension >2 cm of the lesser trochanter and anterior expansion of the posterior coronal fragment(s) to the entry portal of head–neck implants, A3.4 is a primary pantrochanteric fracture, and A4.4 is a concomitant ipsilateral segmental fracture of the neck and trochanter region.ConclusionClassification represents diversity under consistency. The four-by-four sophisticated classification system delineates fracture characteristics in more detail. It is applicable in the time of rapid outbreak of trochanteric fractures in the older population, the large amounts of surgical operations, and incorporates various rare and/or more complicated subtypes which is unclassifiable before.

show abstract

“…It is di cult to x an intertrochanteric fracture with a steel wire, even if the reduction of the subtrochanteric fracture is aided by small incision. The candy-package technique is a complicated operation to perform, [20] and the stability of Kirschner wire in maintaining reduction is poor. As in case 1, temporary reduction and xation with auxiliary reconstruction locking plate can not only reduce distal subsidence by tightening the steel wire on the plate but can also increase the stability between the fractures, thus facilitating temporary reduction and xation.…”

Section: Selection Of Needle Entry Pointmentioning

confidence: 99%

Pitfalls and Remedial Technique of Intramedullary Nail for Subtrochanteric Femur Fractures: A Case Series

Chen

Fan

2021

Preprint

View full text Add to dashboard Cite

Background: Intraoperative technical complications are occasionally encountered while implanting intramedullary nails for subtrochanteric fractures. Surgeons must pay attention to the pitfalls and remedial technique of this operation.Methods: We report on three cases in which intraoperative difficulties occurred during the implantation of an intramedullary nail among Han Chinese patients from mainland China. In Case 1, during an operation on a 57-year-old man, a seinsheimer type V in a right subtrochanteric fracture was not fully realized, and the dislocation of intertrochanteric fracture was aggravated after reduction of the subtrochanteric fracture. The intramedullary nail fixation was completed with the aid of an additional anterolateral plate. Case 2 involved a transverse subtrochanteric fracture. The surgeon neglected the coronal dislocation when considering good sagittal reduction. Although an auxiliary reduction device was used during the operation, there was unacceptable coronal dislocation after the intramedullary nail was inserted. A temporary anterolateral locking plate fixation was used to complete the intramedullary nail fixation. Case 3 involved an old trochanteric fracture combined with a new subtrochanteric fracture in an 81-year-old woman. After reducing the subtrochanteric fractures, the intramedullary nail fixation was successfully completed by releasing the poorly healed intertrochanteric fractures and fixing the anterior lateral plate.Results: With the development of techniques, reliable results can be obtained with fewer complications. Of the various internal fixation methods, we favor using a trochanteric start intramedullary nail.Conclusions: The treatment of subtrochanteric fractures presents challenges. Good reduction and reliable temporary fixation are key to completing the intramedullary nailing. If percutaneous joysticks, finger reduction tools, blocking screws, clamps, and Schanz pins cannot be used for effective auxiliary reduction or temporary reliable fixation, reduction after intramedullary nailing will not be satisfactory. The temporary addition of a reconstruction locking plate can achieve good reduction and temporary stability, and an extra reconstruction locking plate should be retained when the temporary fixation device is removed to reduce the risk of internal fixation failure during fracture healing.

show abstract

Modified Candy-Package technique vs Cerclage technique for refixation of the lesser trochanteric fragment in pertrochanteric femoral fractures. A biomechanical comparison of 10 specimens

Cited by 7 publications

References 21 publications

Biomechanical comparison of screw vs. cerclage refixation in orthogeriatric lesser trochanteric fractures: a cadaveric study

Biomechanical comparison of screw vs. cerclage refixation in orthogeriatric lesser trochanteric fractures: a cadaveric study

A sophisticated fracture classification system of the proximal femur trochanteric region (AO/OTA-31A) based on 3D-CT images

Pitfalls and Remedial Technique of Intramedullary Nail for Subtrochanteric Femur Fractures: A Case Series

Contact Info

Product

Resources

About