OWL: OCOSH Classification/Trauma/Fractures/Femur Fractures/Hip Fractures/IT Fractures

Comment on Hip arthroplasty for salvage of failed treatment of intertrochanteric hip fractures.

Callahan — 2006-12-17 00:01:23 GMT

Commentary & Perspective on "Hip Arthroplasty for Salvage of Failed Treatment of Intertrochanteric Hip Fractures" by George J. Haidukewych, MD, and Daniel J. Berry, MD by John J. Callaghan, MD*, Department of Orthopaedic Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA In summary, this article is helpful to the surgeon performing hip arthroplasty in patients with previous intertrochanteric femoral fractures and to the patients and families of the patients considering this operation. For the patient disabled by the failure of internal fixation of an intertrochanteric femoral fracture, hip arthroplasty can provide durable fixation and pain relief (although the surgeon should explain to the patients that they may have some residual pain in the greater trochanter). Addressing the patients� preoperative and postoperative medical problems are paramount, as long operative times and large amounts of blood loss are not uncommon with this procedure. Trochanteric osteotomy may be required to provide adequate exposure, and hardware should probably be removed after dislocating the hip to prevent fractures of the femoral shaft. The surgeon should compensate for proximal bone loss with a calcar-replacement implant and bypass any screw-holes in the femoral shaft with use of a long-stem prosthesis. If acetabular cartilage is preserved, a bipolar replacement may aid hip stability. If a total hip arthroplasty is chosen, and hip stability is problematic, a constrained implant can be used (because of low patient demands), especially if the abductor musculature is compromised. Postoperative prophylaxis against thromboembolism should be utilized. If these principles, outlined by Haidukewych and Berry, are followed, satisfying results of salvage hip arthroplasty in patients who have had failed treatment of an intertrochanteric fracture can be obtained.

Dynamic Hip Screw Failure: Should We Blame The Surgeon Or The Patient?

Arshad Bhatti, FRCSEd et al — 2006-12-16 00:01:23 GMT

Abstract Aims: To examine the roles of fracture stability, anatomical reduction and screw position on cut through failure of Dynamic Hip Screw (DHS) implants. Methods: This is a retrospective study of consecutive patients treated with a DHS implant following intertrochanteric fractures of the proximal femur. Fracture stability was assessed from fracture configuration in the initial presentation films. Adequacy of reduction and screw position within the head and neck were recorded using standardized measurements on AP and lateral radiographs taken intra-operatively and post-operatively. Outcome of surgical fracture fixation was assessed at a minimum of 12 months post-operatively. Results: 135 patients were treated during the study period but 40 had died by 12 months and radiographic records were incomplete in 8 patients.87 patients were included in the final analysis. 32 fractures were incompletely reduced. In 6 cases (6.9%) out of 32,fracture fixation was seen to have failed by way of the screw cutting out of the femoral head.Analysis of screw position in this group showed a 5.4% failure of screws placed centrally and 8.0% failure of screws placed off centre. Conclusions: Incomplete reduction is a strong predictor of implant failure by cut out (p=0.0018). Full Text Citation: Arshad Bhatti, Sohail Quraishi, Simon Tan, D.M. Power: Dynamic Hip Screw Failure: Should We Blame The Surgeon Or The Patient?. The Internet Journal of Orthopedic Surgery. 2004. Volume 2 Number 1.

Femoral Fractures

Michael Kelly MD — 2005-09-04 00:01:23 GMT

Medscape 2000 Report from the Vail Orthopaedics Symposium features
1. Indirect Reduction of the Femur
2. Retrograde and antegrade nailing
3. Supracondylar Femur Fractures
4. Current Treatment of Femoral Neck Fractures
5. Current Technique: Use of Hemiarthroplasty in Femoral Neck Fractures
6. Classification and Treatment of Intertrochanteric Fractures

Hip Arthroplasty for Salvage of Failed Treatment of Intertochanteric Hip Fractures

Haidukewich & Berry — 2006-12-17 00:01:23 GMT

Full text J Bone Joint Surg Am. 2003 May;85-A(5):899-904

Intertrochanteric Fractures Sliding Screw Placement in Femoral Head and Neck Wheeless

C.R.Wheeless — 2002-02-04 00:01:23 GMT

Anatomical Considerations:
- osseous anatomy of proximal femur dictates where internal fixation device should be placed for maximum purchase in femoral head;
- maximum bone density is found in the area where compression & tension trabeculae coalesce in the center of the head;
- in 1838, int. trabecular system of femoral head was described by Ward;
- maximum bone density is found in area where compression & tension trabeculae coalesce in the center of the head;
- when these trabeculae are absent, surgeon can expect higher rate of failure with use of device;
- most important aspect of device insertion is secure placement of screw within the proximal fragment;
- hence, insert screw centrally to within 1 cm of the subchondral bone;
- this placement ensures adequate purchase in femoral head & solid fixation of femoral head and neck fragment to shaft fragment;
Wheeless' Textbook of Orthopaedics

Intertrochanteric Fractures Wheeless

C.R.Wheeless — 2002-02-04 00:01:23 GMT

Wheeless' Textbook of Orthopaedics Extensive menu on this topic includes -
Classification, Radiography, Work-up, Treatment

Intertrochanteric Hip Fractures

Michael R. Baumgaertner, MD — 2002-04-27 00:01:23 GMT

Intertrochanteric Hip Fractures: OTA Basic Fracture Course

Intertrochanteric Hip Fractures eMedicine Orthopedics

Goodman — 2008-03-19 00:01:23 GMT

Author: Richard S Goodman, MD. 2006
An intertrochanteric hip fracture occurs between the greater trochanter, where the gluteus medius and minimus muscles (hip extensors and abductors) attach, and the lesser trochanter, where the iliopsoas muscle (hip flexor) attaches (Netter, 1987).

Outcomes of Gamma Nail Fixation for pertrochanteric fractures

Ziran et al — 2005-07-13 00:01:23 GMT

Archived 2003. UPMC. The introduction of the intramedullary hip screw (IMHS) was hailed as a solution for the treatment of complex intertrochanteric (IT) and subtrochanteric (ST) femur fractures. In fixation with the IMHS benefits of intramedullary shaft stabilization are combined with the advantages of sliding hip screw fixation. Fixation with the IMHS is in the canal versus on the lateral cortex with the Dynamic Hip Screw (DHS). This effect decreases the lever arm of the implant and reduces the bending strain on the implant. This biomechanical advantage enables more rigid fixation of complex fractures, and, thus, allows for earlier mobilization. The insertion technique of the IMHS also limits soft tissue disruption, which provides for a theoretical decreased blood loss and fewer problems with wound and fracture healing. One type of intramedullary sliding hip screw, the Gamma Nail (GN) (Howmedica, Rutherford, NJ) was first used in the U.S. in the late 1980ճ. Several studies indicated high rates of complications with use of the GN such as periprosthetic femur fracture (reported to range from 4% to 10%). Other anecdotal complications reported include intraoperative fracture, malunion, and lag screw cut out. The present observational study reports our experience with the GN for all surgeons at the authorճ institution.