Osteosynthese ipsilateraler Frakturen des Femurschaftes und des proximalen Femurs mit dem langen proximalen Femurnagel (PFN-long)

Pavelka, Tomáš; Lihart, M.; Matĕjka, J; Vyskocil, Vaclav

doi:10.1055/s-2005-836368

Cited by 8 publications

(6 citation statements)

References 4 publications

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“…They found results do not differ from those reported by other authors. Our results corroborate with those of Pavleka et al 26. 63.9% good, 30.6 % fair, and 5.5% poor.…”

Section: Discussionsupporting

confidence: 93%

Long proximal femoral nail in ipsilateral fractures proximal femur and shaft of femur

Gadegone¹,

Lokhande²,

Salphale³

et al. 2013

IJOO

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Background:Ipsilateral fractures of the proximal femur and femoral shaft are extremely uncommon injuries which occur in young adults who sustain a high energy trauma. A variety of management modalities have been tried to treat this complex fracture pattern ranging from conservative approach to recently introduced reconstruction nails. All these approaches have their own difficulties. We studied the outcome of long proximal femoral nail (LPFN) in the management of concomitant ipsilateral fracture of the proximal femur and femoral shaft.Materials and Methods:We analysed the prospective data of 36 consecutive patients who had sustained a high energy trauma (30 closed fractures and 6 open shaft fractures) who had concomitant ipsilateral fractures of the femoral shaft associated with proximal femur fractures treated with LPFN between December 2005 and December 2011. The mean age was 39 years (range 28-64 years). Twenty nine males and seven females were enrolled for this study.Results:The patients were followed up at three, six, twelve, and eighteen months. The mean healing time for the neck fractures was 4.8 months and for the shaft fractures was 6.2 months. The greater trochanter was splintered and widened in two cases which eventually consolidated. Two patients had superficial infection, two patients had lateral migration of the screws with coxa vara which was due to severe osteoporosis detected during the followup. We had two cases of nonunion of shaft fracture and one case of nonunion of neck fracture. Two cases of avascular necrosis of femoral head were detected after 2 years of followup. No cases of implant failure were noted. Limb shortening of less than 2 cms was noted in four of our patients. The functional assessment system of Friedman and Wyman was used for evaluating the results. In our series 59.9% (n = 23) were rated as good, 30.6% (n = 11) as fair, and 5.5% (n = 2) as poor.Conclusion:Long PFN is a reliable option for concomitant ipsilateral diaphyseal and proximal femur fractures.

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“…They found results do not differ from those reported by other authors. Our results corroborate with those of Pavleka et al 26. 63.9% good, 30.6 % fair, and 5.5% poor.…”

Section: Discussionsupporting

confidence: 93%

Long proximal femoral nail in ipsilateral fractures proximal femur and shaft of femur

Gadegone¹,

Lokhande²,

Salphale³

et al. 2013

IJOO

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“… Kakkar et al (2005) [ 43 ] May 1999–April 2002 7 (7) N.A N.A 7 (100%) FN 0 (0%) 7 0 3.7 (3.2–4.6) 4.6 (3.7–5.1) N.A. Khallaf et al (2005) [ 24 ] March 1996–June 2002 17 (17) 15 (88%) 37 (20–60) 17 (100%) FN 0 (0%) 2 15 4.0 (2.5–5) 5.4 (4–9) 43.2 (24–72) Pavelka et al (2005) [ 44 ] January 1998–February 2003 19 (19) 14 (74%) 48 (19–79) 15 (79%) FN + TF N.A. 19 0 N.A.…”

Section: Resultsmentioning

confidence: 99%

“…Nonunion of the femur neck was noted in 6.4% (95% CI 3.9–9.4%) when treated with a single implant and in 8.2% (95% CI 5.3–11.6%) when treated with a separate device for each fracture [ 3 – 5 , 7 – 9 , 12 , 18 , 21 , 25 , 26 , 28 , 32 , 33 , 43 , 45 – 50 , 55 , 56 , 61 ]. Varus malunion was noted in 6.6% of the patients in the single implant group (95% CI 3.9–10.1%) and in 10.9% in the double implant group (95% CI 6.6–16.2%) [ 3 – 5 , 7 , 9 , 21 , 24 – 27 , 38 , 41 , 42 , 44 , 46 , 49 , 52 , 55 , 57 , 61 , 63 ]. The pooled rates were higher for the double implant group but the overlapping confidence intervals suggest that nonunion and varus malunion of the femur neck are unrelated to the number of implants used.…”

Section: Resultsmentioning

confidence: 99%

“…Hardware failure was noted in 11.4% (95% CI 4.9–20.2%) of patients treated with a single implant versus 9.9% (95% CI 4.9–17.5%) in patients treated with a double implant [ 4 , 7 , 20 , 23 , 24 , 27 , 42 , 45 , 46 , 50 , 53 , 57 ]. The reoperation rate was 18.4% (95% CI 11.6–26.4%) versus 17.0% (95% CI 12.2–22.5%), respectively, for single implants and for double implants [ 3 , 7 , 9 , 18 – 21 , 24 , 27 , 32 , 34 , 38 , 41 , 42 , 44 , 45 , 47 , 49 , 50 , 53 – 56 ]. The overlapping confidence intervals suggested no relationship between these complications and the number of implants.…”

Section: Resultsmentioning

confidence: 99%

“…Leg length discrepancy was found in 12.4% (95% CI 8.5–17.3%) of the patients treated with a single implant and in 8.8% (95% CI 2.9–17.4%) of the patients treated with a double implant [ 4 , 7 , 20 , 27 , 38 , 44 – 46 , 49 , 50 , 53 , 55 , 56 ] (Table 4 ).…”

Section: Resultsmentioning

confidence: 99%

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Surgical management of bifocal femoral fractures: a systematic review and pooled analysis of treatment with a single implant versus double implants

Lieshout

Verhofstad

2023

Arch Orthop Trauma Surg

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Introduction Fractures of the proximal femur accompanied by a fracture of the femoral shaft are relatively rare, with a reported prevalence between 1 and 12%. Multiple surgical options are available, consisting of treatment with a single implant or with double implants. Controversy exists about the optimal management. A systematic review and pooled analysis were performed to assess the most reliable treatment for bifocal femoral fractures of the femur. Materials and methods A literature search was conducted on July 15, 2022. Selected studies were screened on title and abstract by two researchers independently, and full texts were read by both authors. Emphasis was put on adverse events such as postoperative infection, healing complications, malalignment, and functional outcome using either a single implant or double implants. Results For the proximal femoral fractures, no significant difference could be confirmed for avascular necrosis of the femoral neck (5.1% for single implant and 3.8% for double implants), nonunion (6.4% for single implant and 7.8% for double implants), or varus malalignment (6.6% for single implant and 10.9% for double implants). This study also suggests that the number of implants is irrelevant for complications of the femoral shaft regarding the rates of postoperative infection and healing complications. Pooled rates of bone healing complications were 1.6–2.7-fold higher when patients were treated with a single implant, but statistical significance could not be confirmed. For hardware failure, revision surgery, leg length discrepancy, and functional outcome, no difference between the two groups was found either. Conclusions The pooled proportions of all postoperative complications had overlapping confidence intervals; thus, no inference about a statistically significant difference on the number of implants used for treating ipsilateral fractures of the femur can be made. Both treatment groups showed a similar functional outcome at the last moment of follow-up, with more than 75% of the patients reporting a good outcome.

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Management of ipsilateral femoral neck and shaft fractures

et al. 2008

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Treatment of ipsilateral femoral neck and shaft fractures is still demanding, but diagnosis has improved with regular use of CT body scans in the management of multiply injured patients. Furthermore, possibilities for operative treatment have been advanced by the introduction of the long proximal femoral nail and the antegrade femoral nail, two implants supporting stabilization of these fracture entities.

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Osteosynthese ipsilateraler Frakturen des Femurschaftes und des proximalen Femurs mit dem langen proximalen Femurnagel (PFN-long)

Abstract: Long PFN is a quality implant which extends our options in the treatment of ipsilateral hip and femoral shaft fractures. It is one of the most beneficial implants in the category of reconstruction nails. The availability of only 3 nail lengths and 1 diameter presents a certain drawback.

Cited by 8 publications

References 4 publications

Long proximal femoral nail in ipsilateral fractures proximal femur and shaft of femur

Long proximal femoral nail in ipsilateral fractures proximal femur and shaft of femur

Surgical management of bifocal femoral fractures: a systematic review and pooled analysis of treatment with a single implant versus double implants

Management of ipsilateral femoral neck and shaft fractures

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