Outcome of intramedullary nail for fixation of osteoporotic femoral shaft fractures in the elderly above 60

Elbarbary, Ahmed Naser; Hassen, Soliman; Badr, Ismail Tawfeek

doi:10.1016/j.injury.2020.10.012

Cited by 12 publications

(7 citation statements)

References 14 publications

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“…Compression Splints. Concerning the indications for the plate for femoral stem fractures, the plate is suitable for children or for patients who are not suitable for intramedullary pinning and intramedullary pinning of femoral stem fractures should be the preferred option [2,11,12]. Intramedullary fixation should be the preferred option.…”

Section: Improper Application and Manipulation Of Lockingmentioning

confidence: 99%

Clinical Outcomes of Treatment Strategies for Postoperative Plate Fracture and In Situ Fracture of the Femoral Shaft

Jiang

et al. 2022

BioMed Research International

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Objective. To investigate the treatment and clinical efficacy of postoperative plate fracture and in situ fracture of the femoral stem. Methods. We have retrospectively analyzed the clinical data, revised surgery information, and clinical efficacy of patients with postoperative plate fracture of the femoral stem in our hospital. A total of 33 cases were included whose original fractures were located in the upper and cadaveric femur and treated with paralleling intramedullary pins for revision surgery, as well as patients whose original fractures were located in the lower femur which were fixed with retrograde intramedullary nailing or anatomical locking and compression splints in the distal femur. For the selection of bone grafting, the original fracture site with Fernadez-Esteve scab grades I and II was treated with an autologous iliac bone graft. Postoperatively, patients were evaluated for fracture healing time, the clinical outcome of the affected limb, and complications in the iliac bone donor area. Results. All patients were followed up until fracture healing, and all patients achieved clinical healing with a healing rate of 100% and a mean healing time of 6.3 months. No internal fixation failure such as rebreakage or loosening of the internal fixation occurred in all patients during the follow-up period. According to the Tohner-Wrnch criteria, 23 cases were excellent, 10 cases were good, and 0 cases were poor, with an excellent rate of 100%. Complications in the autologous iliac bone donor area amounted to 36.7%. Conclusion. For patients with original fractures located in the upper femoral segment or cadre, it is recommended to perform revision surgery with a paralleling intramedullary pin, while patients with original fractures located in the lower femoral segment are fixed with the retrograde intramedullary nailing or an anatomical type of distal femoral locking and compression splint. Patients with postoperative plate fractures of the femoral stem do not require routine autologous bone grafting for revision surgery.

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Section: Improper Application and Manipulation Of Lockingmentioning

confidence: 99%

Clinical Outcomes of Treatment Strategies for Postoperative Plate Fracture and In Situ Fracture of the Femoral Shaft

Jiang

et al. 2022

BioMed Research International

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“…Elbarbary, et al showed that intramedullary nailing in femoral shaft fractures in osteoporotic bones has a good outcome with no major complications [13]. This was the first line of treatment offered to our patient when she initially presented with a fracture of her distal femoral shaft.…”

Section: Therapeutic Interventionmentioning

confidence: 64%

Hybrid Fixation of Failed Internally Fixed Distal Femoral Fracture with an Extramedullary Locking Plate and an Intramedullary Cortical Strut Allograft Construct- A Case Report

Vatsal¹,

Narendra²

2022

J Orthop Surg Tech

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Introduction: Osteoporotic bone fractures present a surgical challenge for fixation and are associated with significant morbidity. Case presentation:We present a case of failed internal fixation of fracture shaft femur in a 74-year-old patient with osteoporosis. Fracture fixation was done using an extra medullary locking plate with an intramedullary cortical strut graft as a hybrid fixation technique, a Locking Plate Allograft Construct.Discussion: Bone grafts are often used to support the native bone. By using a hybrid technique, the locking plate allograft construct achieves a higher stability of fracture fixation compared to plate alone, thus improving the outcome of surgery in osteoporotic bone fractures. Conclusion:Hybrid fixation using locking plate allograft constructs are relatively easy to perform and provide superior fixation to routine methods in osteoporotic bone fractures.

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“…Diaphyseal AFFs may be related to age >65 years, more lateral bowing, Asian female patient, and lower BMD [12,13,[34][35][36]. Unexpected iatrogenic fractures can occur during IM nailing in the diaphyseal region of the femur in patients with osteoporosis [37]. Therefore, as the severity of the osteoporosis increases, the probability of developing an iatrogenic fracture during IM nailing in diaphyseal AFFs becomes higher.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors Associated with Intraoperative Iatrogenic Fracture in Patients Undergoing Intramedullary Nailing for Diaphyseal Atypical Femoral Fractures

Joo¹,

Chung²,

Jeon³

et al. 2021

Preprint

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Introduction: Iatrogenic fractures remain a complication during intramedullary (IM) nailing for atypical femoral fractures (AFFs). The risk factors for iatrogenic fractures remain unclear, although excessive femoral bowing and osteoporosis are hypothesized to be contributing factors. The present study aimed to determine risk factors for iatrogenic fracture occurrence during IM nailing in patients with diaphyseal AFFs.Patients and methods: This retrospective cross-sectional study investigated 95 diaphyseal AFF patients (all female; age range, 49–87 years) who underwent IM nailing between June 2008 and December 2017. The patients were divided into two groups: group I (with iatrogenic fracture; n = 20) and group II (without iatrogenic fracture; n = 75). Background characteristics were collected from medical records and radiographic measurements were taken. Univariate and multivariate logistic regression analyses were performed to identify risk factors for intraoperative iatrogenic fracture occurrence. A receiver operating curve (ROC) analysis was carried out to determine a cutoff value for prediction of iatrogenic fracture occurrence.Results: Iatrogenic fractures occurred in 20 patients (21.1%). The two groups did not differ significantly in age and other background characteristics. Group I had significantly lower mean femoral bone mineral density (BMD) and significantly greater mean lateral and anterior femoral bowing angles than group II (all p < 0.05). There were no significant differences in diaphyseal AFF location, nonunion, and IM nail diameter, length, or nail entry point between the two groups. In the univariate analyses, femoral BMD and lateral bowing of the femur differed significantly between the two groups. On multivariate analysis, only lateral bowing of the femur remained significantly associated with iatrogenic fracture occurrence. The ROC analysis determined a cutoff value of 9.3° in lateral bowing of the femur for prediction of iatrogenic fracture occurrence during IM nailing for diaphyseal AFF treatment.Conclusions: Lateral bowing angle of the femur is an important predictive factor for intraoperative iatrogenic fracture occurrence in patients undergoing IM nailing for diaphyseal AFF treatment. Level of evidence: III, retrospective comparative study.

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Outcome of intramedullary nail for fixation of osteoporotic femoral shaft fractures in the elderly above 60

Cited by 12 publications

References 14 publications

Clinical Outcomes of Treatment Strategies for Postoperative Plate Fracture and In Situ Fracture of the Femoral Shaft

Clinical Outcomes of Treatment Strategies for Postoperative Plate Fracture and In Situ Fracture of the Femoral Shaft

Hybrid Fixation of Failed Internally Fixed Distal Femoral Fracture with an Extramedullary Locking Plate and an Intramedullary Cortical Strut Allograft Construct- A Case Report

Risk Factors Associated with Intraoperative Iatrogenic Fracture in Patients Undergoing Intramedullary Nailing for Diaphyseal Atypical Femoral Fractures

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