Augmented Fixation for Fractures of the Appendicular Skeleton

Marecek, Geoffrey S.; Centomo, Hugo

doi:10.5435/jaaos-d-18-00471

Cited by 10 publications

(8 citation statements)

References 61 publications

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“…However, inherent design aws associated with the implants and the complex biomechanical environment of the proximal femur still be remained, and this revision strategy has the similar potential risk of the surgical failure. [12][13]. Even when combined with a valgus osteotomy, single internal xation approaches have obvious disadvantages, including abnormal alignment and degeneration of the affected limb joints [14][15].…”

Section: Introductionmentioning

confidence: 99%

Is the reconstruction of medial support important for revision following failed treatment of femoral trochanteric fractures? A retrospective comparative study

Lin¹,

Zhang

CHANG³

et al. 2022

Preprint

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Background: Hip-preserving revision in patients with failed treatment of femoral trochanteric fracture is still a major challenge. Whether the medial support reconstruction could benefit the patients and improve the success rate of hip-preserving revision is still controversial. Hence, the purpose of this study was to evaluate the clinical significance and prognosis of medial support reconstruction during the hip-preserving revision of failed femoral trochanteric fracture treatment.Methods: Patients with failed femoral trochanteric fractures treatments addressed by hip-preserving revision at our hospital from January 2014 to December 2020 were analyzed retrospectively. 31 patients were included and divided into a medial support group (n=16) and a non-medial support group (n=15). The Oxford Hip Score (OHS) was the primary measurement. In addition, the differences in quality of life, fracture healing, surgical trauma, and complications were also evaluated.Results: The OHS (42.06 ± 4.12 vs. 30.93 ± 11.56, M ± SD), the mental component score of the 12-item Short-Form Survey (SF-12) (54.48 ± 5.38 vs. 47.90 ± 3.47, M ± SD), the fracture healing rate (100%, 16/16 vs. 66.67%, 10/15), and the fracture healing time [4 (3,5) vs. 6 (3.75,6) months, M (Q1, Q3)] were significantly better and the incidence of complications [0(0/16) vs. 40%(6/15)] was significantly lower in the medial support group than the non-medial support group (p<0.05). No significant differences in the physical component score of the SF-12, surgical trauma and reduction in collodiaphyseal angle of affected femur were observed between groups.Conclusions: The reconstruction of medial support seems important for revision following failed treatment of femoral trochanteric fractures. Due to the medial augmentation and improvement of the mechanical stability for proximal femur, the patients might benefit from functional and fracture healing prognosis.

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Section: Introductionmentioning

confidence: 99%

Is the reconstruction of medial support important for revision following failed treatment of femoral trochanteric fractures? A retrospective comparative study

Lin¹,

Zhang

CHANG³

et al. 2022

Preprint

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“…In such a scenario, vigilant management of osteoporosis, efficient surgical skills to handle the fragile bones during fracture reduction, and selection of suitable implants for fracture fixation are of paramount importance. There is a place for augmented fixation in osteoporotic bones such as structural bone graft and intramedullary fixation, to improve the outcome of fixation [ 4 ]. We present a case of neglected osteoporotic proximal humerus shaft fracture and share our challenges encountered in its management.…”

Section: Introductionmentioning

confidence: 99%

Complications and Difficulties Encountered in the Management of a Neglected Osteoporotic Proximal Humerus Fracture

Mohanty¹,

Patro²,

Behera³

et al. 2022

JOCR

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Introduction: Osteoporosis is a known complication of prolonged steroid therapy. Osteoporotic fracture is common in such a scenario and poses several challenges in its management. We present a case of neglected proximal humerus fracture in a 57-year-old osteoporotic female and the difficulties encountered in its management. Case Report: A 57- year-old female, rheumatoid arthritis patient, is on steroids for the past ten years. Four years back, she sustained a fracture of the left humerus neck following a trivial trauma. The fracture was not managed by an orthopaedician and was treated by a general practitioner. She presented to us in a state of painless displaced non-union of fragments with severe osteoporosis. DEXA scan revealed severe osteoporosis. She was started on oral calcium, magnesium, and vitamin D supplementation. Along with oral supplementation, the patient was advised 20 mcg of Teriparatide subcutaneously once daily and single dose of Denosumab 60 mg subcutaneously. Non -vascularized free fibular graft was harvested from the ipsilateral lower limb. A five-hole PHILOS plate was used to fix the fracture. Intra-operatively, the humeral head appeared too indistinct under fluoroscopy leading to difficulty in estimating screw length. An indirect method was used to assess the screw length. The post-operative radiograph was satisfactory but radiograph after two weeks showed an un-displaced fracture adjacent to the distal end of the plate. It was decided to continue with conservative management by a “‘U”’ cast. A follow- up radiograph at three3 months showed complete union of the stress fracture at the distal end of the plate end and progressive union of the fracture at the primary site. But En- block pull-out of the locking plate was noticed in the distal fragment of the fracture in the follow-up radiograph at 9 months from surgery. The limb was further immobilized in an arm sling for more four weeks. At one year from operation, there was good union of fracture with acceptable shoulder movement. Conclusion: Osteoporotic fractures are often difficult to treat. Careful pre-operative planning, active osteoporosis management, good implant selection, careful bone handling, and judicious rehabilitation are key to avoid complications and achieve good functional outcome.

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“…However, inherent design flaws associated with the implants and the complex biomechanical environment of the proximal femur still be remained, and this revision strategy has the similar potential risk of the surgical failure. [ 10 , 11 ]. Even when combined with a valgus osteotomy, single internal fixation approaches have obvious disadvantages, including abnormal alignment and degeneration of the affected limb joints [ 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

Is the reconstruction of medial support important for revision following failed treatment of femoral trochanteric fractures? a retrospective comparative study

Lin

Zhang

Chang

et al. 2022

BMC Musculoskelet Disord

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Background Hip-preserving revision in patients with failed treatment of femoral trochanteric fracture is still a major challenge. Whether the medial support reconstruction could benefit the patients and improve the success rate of hip-preserving revision is still controversial. Hence, the purpose of this study was to evaluate the clinical significance and prognosis of medial support reconstruction during the hip-preserving revision of failed femoral trochanteric fracture treatment. Methods Patients with failed femoral trochanteric fractures treatments addressed by hip-preserving revision at our hospital from January 2014 to December 2020 were analyzed retrospectively. 31 patients were included and divided into a medial support group (n = 16) and a non-medial support group (n = 15). The fracture healing rate was the primary measurement. In addition, the differences in Oxford Hip Score (OHS), quality of life, surgical trauma, and complications were also evaluated. Results The fracture healing rate (100%, 16/16 vs. 66.67%, 10/15), the OHS (42.06 ± 4.12 vs. 30.93 ± 11.56, M ± SD), and the mental component score of the 12-item Short-Form Survey (SF-12) (54.48 ± 5.38 vs. 47.90 ± 3.47, M ± SD), were significantly better and the incidence of complications [0(0/16) vs. 40%(6/15)] was significantly lower in the medial support group than the non-medial support group (p < 0.05). No significant differences in the physical component score of the SF-12, surgical trauma and reduction in collodiaphyseal angle of affected femur were observed between groups. Conclusions The reconstruction of medial support seems important for revision following failed treatment of femoral trochanteric fractures. Due to the medial augmentation and improvement of the mechanical stability for proximal femur, the patients might benefit from fracture healing prognosis and functional.

show abstract

Augmented Fixation for Fractures of the Appendicular Skeleton

Cited by 10 publications

References 61 publications

Is the reconstruction of medial support important for revision following failed treatment of femoral trochanteric fractures? A retrospective comparative study

Is the reconstruction of medial support important for revision following failed treatment of femoral trochanteric fractures? A retrospective comparative study

Complications and Difficulties Encountered in the Management of a Neglected Osteoporotic Proximal Humerus Fracture

Is the reconstruction of medial support important for revision following failed treatment of femoral trochanteric fractures? a retrospective comparative study

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