Factors Affecting Time to Bony Union of Femoral Subtrochanteric Fractures Treated with Intramedullary Devices

Choi, Jung-Yoon; Sung, Yerl-Bo; Yoo, Jinhee; Chung, Sung‐Jae

doi:10.5371/hp.2014.26.2.107

Cited by 19 publications

(21 citation statements)

References 25 publications

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“…However, use of IMN remains technically demanding and requires proper reduction and correct positioning of the implant [34]. Malreduction in either the coronal (comminution of the medial cortex) or sagittal plane leads to prolonged time to union for subtrochanteric fractures [10, 35, 36]. Percutaneous reduction maneuvers and minimally invasive techniques can be useful in obtaining proper reduction [3].…”

Section: Discussionmentioning

confidence: 99%

“Revision of subtrochanteric femoral nonunions after intramedullary nailing with dynamic condylar screw”

Lotzien

Rausch

Schildhauer

et al. 2018

BMC Musculoskelet Disord

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BackgroundNonunions of the subtrochanteric region of the femur after previous intramedullary nailing can be difficult to address. Implant failure and bone defects around the implant significantly complicate the therapy, and complex surgical procedures with implant removal, extensive debridement of the nonunion site, bone grafting and reosteosynthesis usually become necessary. The purpose of this study was to evaluate the records of a series of patients with subtrochanteric femoral nonunions who were treated with dynamic condylar screws (DCS) regarding their healing rate, subsequent revision surgeries and implant-related complications.MethodsWe conducted a retrospective chart review of patients with aseptic femoral subtrochanteric nonunions after failed intramedullary nailing. Nonunion treatment consisted of nail removal, debridement of the nonunion, and restoration of the neck shaft angle (CCD), followed by DCS plating. Supplemental bone grafting was performed in all atrophic nonunions. All patients were followed for at least six months after DCS plating.ResultsBetween 2002 and 2017, we identified 40 patients with a mean age of 65.4 years (range 34–91 years) who met the inclusion criteria. At a mean follow-up period of 26.3 months (range 6–173), 37 of the 40 (92.5%) nonunions healed successfully (secondary procedures included). The mean healing time of the 37 patients was 11.63 months (± 12.4 months). A total of 13 of the 40 (32.5%) patients needed a secondary revision surgery; one patient had a persistent nonunion, nine patients had persistent nonunions leading to hardware failure, two patients had deep infections requiring revision surgery, and one patient had a peri-implant fracture due to low-energy trauma four days after the index surgery.ConclusionsThe results indicate that revision surgery of subtrochanteric femoral nonunions after intramedullary nailing with dynamic condylar screws is a reliable treatment option overall. However, secondary revision surgery may be indicated before final healing of the nonunion.

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Section: Discussionmentioning

confidence: 99%

“Revision of subtrochanteric femoral nonunions after intramedullary nailing with dynamic condylar screw”

Lotzien

Rausch

Schildhauer

et al. 2018

BMC Musculoskelet Disord

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“…The radiological follow-up included anterior–posterior (AP) and lateral radiographs after 6 weeks, 12 weeks, 6 months and additionally 12 months if necessary. Clinically, nonunion was defined as persistent pain at the fracture site during weight bearing after 6 months [3, 10, 21]. Radiologically, nonunion was defined as lack of cortical bridging after 6 months on at least three cortices [3, 4, 12, 21].…”

Section: Methodsmentioning

confidence: 99%

Risk factors for nonunion after intramedullary nailing of subtrochanteric femoral fractures

Krappinger

Waldenfels

Dammerer

et al. 2019

Arch Orthop Trauma Surg

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Introduction Nonunion is a common complication after intramedullary nailing of subtrochanteric femoral fractures. A more detailed knowledge, particularly of avoidable risk factors for subtrochanteric fracture nonunion, is thus desired to develop strategies for reducing nonunion rates. The aim of the present study therefore was to analyse a wide range of parameters as potential risk factors for nonunion after intramedullary nailing of subtrochanteric fractures. Materials and methods Seventy-four patients who sustained a subtrochanteric fracture and were treated by femoral intramedullary nailing at a single level 1 trauma centre within a 6-year period were included in this study. A total of 15 patient-related, fracture-related, surgery-related, mechanical and biological parameters were analysed as potential risk factors for nonunion. Furthermore, the accuracy of each of these parameters to predict nonunion was calculated. Results Nonunion occurred in 17 of 74 patients (23.0%). Of the 15 potential risk factors analysed, only 3 were found to have a significant effect on the nonunion rate ( p < 0.05): postoperative varus malalignment, postoperative lack of medial cortical support and autodynamisation of the nail within the first 12 weeks post-surgery. Accuracy of each of these 3 parameters to predict nonunion was > 0.70. Furthermore, the nonunion rate significantly increased with the number of risk factors (no risk factor: 2.9%, one risk factor: 23.8%, two risk factors: 52.9%, and three risk factors: 100% [Chi-square test, p = 0.001)]. Conclusions Our study indicates that intraoperative correction of varus malalignment and restoration of the medial cortical support are the most critical factors to prevent nonunion after intramedullary nailing of subtrochanteric femoral fractures. In addition, autodynamisation of the nail within the first 3 months post-surgery is a strong predictor for failure and should result in revision surgery.

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“…13 Therefore, maintenance of the continuity of the medial cortex and the reduction of all possible fracture fragments is recommended. 14 Riehl JT et al 5 showed malreduction greater than or equal to 10 in any plane and Choi JY et al 6 recommended the comminution of the medial cortex and the degree of the postoperative displacement of fractures contributed to fracture non-union. When fracture displacement degree increased, the medial buttress lost more seriously.…”

Section: Discussionmentioning

confidence: 99%

“…Riehl JT et al 5 found there was a statistically significant higher rate of delayed or nonunion when postoperative radiographs showed malreduction greater than or equal to 10 in any plane. Choi JY et al 6 recommended the comminution of the medial cortex and the degree of the postoperative displacement of fractures contributed to the delayed time of union. However, there was no further research about fracture non-union with fracture displacement degree in current studies.…”

Section: Introductionmentioning

confidence: 99%

What is the fracture displacement influence to fracture non-union in intramedullary nail treatment in subtrochanteric fracture?

Jiang

Zheng

Pan

2018

Journal of Clinical Orthopaedics and Trauma

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Introduction: The fracture displacement in intramedullary nail in femoral subtrochanteric fracture may cause fracture non-union. We retrospectively analysed our recent experience to clear the influence about fracture displacement in intramedullary nail in femoral subtrochanteric fracture. Materials and methods: This study includes 36 patients in the intramedullary nail group followed up for more than 12 months; these patients suffered from femoral subtrochanteric fracture from 2009.1-2014.12 in our hospital. The operation time, amount of bleeding, length of hospital stay, fracture healing time, Harris function score of hip joint, fracture displacement, TAD and postoperative complications were summarized. Results: The average follow up time was 20.2 months, average operation time was 126 min, average amount of bleeding was 258 ml, average hospitalization was 13.1 days, average fracture healing time was 6.8 months, average fracture displacement was 1.23 cm, average TAD was 19.7 mm and average hip Harris function score was 82.5 points. Five cases suffered non-union. Only the fracture displacement degree made significant correlation with fracture non-union. All union patients had a fracture displacement less than 2.2 cm and all non-union patients had a fracture displacement more than 2.5 cm. Conclusion: Intramedullary nail treatment must focus on fracture reduction and recovery of femoral medial support with assisted incision technique or closed cerclage wire technique when necessary. In our opinions, only the fracture displacement degree made significant correlation with bone non-union and all cases achieved bone union when it less than 2.2 cm according to our statistics. But it still need further research to find out the displacement of fracture fragments could be tolerant.

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Factors Affecting Time to Bony Union of Femoral Subtrochanteric Fractures Treated with Intramedullary Devices

Cited by 19 publications

References 25 publications

“Revision of subtrochanteric femoral nonunions after intramedullary nailing with dynamic condylar screw”

“Revision of subtrochanteric femoral nonunions after intramedullary nailing with dynamic condylar screw”

Risk factors for nonunion after intramedullary nailing of subtrochanteric femoral fractures

What is the fracture displacement influence to fracture non-union in intramedullary nail treatment in subtrochanteric fracture?

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