Early mechanical complications following fixation of proximal femur fractures: From prevention to treatment

Ehlinger, Matthieu; Favreau, Henri; Eichler, David; Adam, P.; Bonnomet, F.

doi:10.1016/j.otsr.2019.02.027

Cited by 44 publications

(22 citation statements)

References 47 publications

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“…With MCS, the length as well as the diameter and position of the screw are important [ 15 , 16 ]. Lindequist reported that the screws must be located within 3 mm of the femoral head cortex to achieve cortical support [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Improved control over implant anchorage under the use of the femoral neck system for fixation of femoral neck fractures: a technical note

Cha

Song²,

Yoo

et al. 2021

BMC Musculoskelet Disord

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Background The depth of bolt in Femoral neck system (FNS, DePuy Synthes, Oberdorf, Switzerland) is difficult to finely control as the length of the bolt is in units of 5 mm. Thus, this study introduces a method to control the depth of FNS bolt in analogue scale in patients with femoral neck fracture. Methods By the technique of control of reaming and retraction of bolt, the tip of implant could be positioned close to subchondral bone without harming it. The position of implant tip in four cases in which the introduced technique was applied was compared to that of eight cases where the standard technique was performed. Results The average tip-apex distance measured in the cases that underwent surgery using the suggested technique in this study was statistically significantly shorter than that measured in the cases that underwent surgery under manufacturer guidelines. Conclusion Even though the bolt of FNS is manufactured in the unit of 5 mm, the technique proposed in this study helps surgeons to adjust the depth of bolt for the fixation of femoral neck fracture using FNS.

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Section: Discussionmentioning

confidence: 99%

Improved control over implant anchorage under the use of the femoral neck system for fixation of femoral neck fractures: a technical note

Cha

Song²,

Yoo

et al. 2021

BMC Musculoskelet Disord

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“…Significant fracture collapse was considered equal to or greater than 1 cm, as previously established by Zlowodzki [66] and Fang [21]. We have classified them as early mechanical complications (EMC) or late mechanical complications (LMC), depending on whether they occur within 6 months post-operatively or later, which is between the 3 months proposed by Bojan [7] and the first year indicated by Ehlinger [19].…”

Section: Methodsmentioning

confidence: 99%

Long-term outcomes of distal locking in extracapsular fractures treated with trochanteric Gamma3 nails

et al. 2021

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Background Few publications have assessed long-term results of distal locking of short endomedullary nails for extracapsular hip fracture. Virtually all of them focus on immediate differences. Criteria for the use of static or dynamic locking are unclear in most nailing systems, and use is advised in unstable fracture patterns or with risk of bell-clapper effect, but often influenced by the “orthopaedic school”. Materials and methods This is a historical cohort study on patients diagnosed and operated in 2014 and followed up until endpoint, considered as consolidation or major complication, plus evaluation of overall long-term survival. They were categorised as static distal locking (ST) or dynamic distal locking (DN). Both are comparable, except for all stable pre-operative classifications, Fracture Mobility Score (FMS) at discharge, and immediate post-operative loading, all of which were in favour of DN. Results Consolidation took place in > 95% of patients, with a non-statistically significant delay trend in ST. Less than 6% in both ST and DN had major complications, with no differences. Most cases suffered early cut-out. Significant fracture collapse was the most frequent minor complication. There were more statistically significant minor and total complications in ST. Infection, without differences, can precede cut-out. Lateral thigh pain was similar and could be related to back-out. In DN, 21.1% of cases were truly dynamised. We did not find differences in mobility or in long-term survival. Conclusions Any type of distal locking seems to be safe for consolidation, despite a slightly longer consolidation time in static locking. Early cut-out was the main complication, while others were very infrequent, which is an advantage over helical blade devices. There was a higher rate of minor and overall mechanical complications in ST, but infection and lateral thigh pain were similar. Most non-traumatic mechanical complications occurred around 5–6 weeks. About one in five of the DN truly dynamised, with all cases occurring before 8 weeks. Mobility until endpoint and overall long-term survival were not influenced by the locking mode used. Level of evidence Therapeutic study, level 2b.

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“…The gap between the implant tip and subchondral bone is important for stable fixation during femoral neck fracture surgery using MCS. 30,31 According to Rau et al, 32 the insertion of the DHS into the subchondral bone of the femoral head gave satisfactory clinical results. The tip-apex distance, determined by the length of the DHS during intertrochanteric fracture surgery, was also reported to be an important factor associated with fixation failure.…”

Section: Figmentioning

confidence: 99%

Mechanical effects of surgical variations in the femoral neck system on Pauwels type III femoral neck fracture

Jung

Cha

Yoon

et al. 2022

Bone & Joint Research

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Aims In this study, we aimed to explore surgical variations in the Femoral Neck System (FNS) used for stable fixation of Pauwels type III femoral neck fractures. Methods Finite element models were established with surgical variations in the distance between the implant tip and subchondral bone, the gap between the plate and lateral femoral cortex, and inferior implant positioning. The models were subjected to physiological load. Results Under a load of single-leg stance, Pauwels type III femoral neck fractures fixed with 10 mm shorter bolts revealed a 7% increase of the interfragmentary gap. The interfragmentary sliding, compressive, and shear stress remained similar to models with bolt tips positioned close to the subchondral bone. Inferior positioning of FNS provided a similar interfragmentary distance, but with 6% increase of the interfragmentary sliding distance compared to central positioning of bolts. Inferior positioning resulted in a one-third increase in interfragmentary compressive and shear stress. A 5 mm gap placed between the diaphysis and plate provided stability comparable to standard fixation, with a 7% decrease of interfragmentary gap and sliding distance, but similar compressive and shear stress. Conclusion Finite element analysis with FNS on Pauwels type III femoral neck fractures revealed that placement of the bolt tip close to subchondral bone provides increased stability. Inferior positioning of FNS bolt increased interfragmentary sliding distance, compressive, and shear stress. The comparable stability of the fixation model with the standard model suggests that a 5 mm gap placed between the plate and diaphysis could viably adjust the depth of the bolt. Cite this article: Bone Joint Res 2022;11(2):102–111.

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Early mechanical complications following fixation of proximal femur fractures: From prevention to treatment

Cited by 44 publications

References 47 publications

Improved control over implant anchorage under the use of the femoral neck system for fixation of femoral neck fractures: a technical note

Improved control over implant anchorage under the use of the femoral neck system for fixation of femoral neck fractures: a technical note

Long-term outcomes of distal locking in extracapsular fractures treated with trochanteric Gamma3 nails

Mechanical effects of surgical variations in the femoral neck system on Pauwels type III femoral neck fracture

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