Hip Fracture Nonunions: Diagnosis, Treatment, and Special Considerations in Elderly Patients

Babcock, Sharon; Kellam, James F

doi:10.1155/2018/1912762

Cited by 25 publications

(17 citation statements)

References 52 publications

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“…75 Common complications after treatment of intertrochanteric and subtrochanteric fractures include screw cutout, malalignment, implant failure, nonunion, infection, and trochanteric pain. 79,80 Most intramedullary implants used in the treat-ment of intertrochanteric fractures allow for a small amount of controlled collapse through the fracture site during healing. This can lead to prominence of the cephalomedullary screw base that may be symptomatic 79 (►Fig.…”

Section: Complicationsmentioning

confidence: 99%

Imaging of Pelvic and Femoral Fixation Hardware: Normal Findings and Hardware Failure

Sanal¹,

Boulton

Neyisci³

et al. 2019

Semin Musculoskelet Radiol

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Good outcomes following treatment of pelvic ring injuries, acetabular fractures, and femur fractures rely on restoration of native pelvic or limb alignment, anatomical reduction and rigid stability of articular fractures, and early postoperative mobilization. Multiple surgical approaches, reduction aids, and orthopaedic implants are available to stabilize these fractures. Despite best practices, complications including hardware failure, nonunions, malunions, and infections occur. This article discusses common fracture classification systems, implants, and imaging findings associated with unwanted complications in fractures of the pelvis, acetabulum, and femur.

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Section: Complicationsmentioning

confidence: 99%

Imaging of Pelvic and Femoral Fixation Hardware: Normal Findings and Hardware Failure

Sanal¹,

Boulton

Neyisci³

et al. 2019

Semin Musculoskelet Radiol

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“…For example, slowly healing patients could be prescribed altered physical therapy and activity regimes, ultrasound or electrical bone stimulation therapy, diagnostics for underlying metabolic therapies, bisphosphonates, or interventional revision before catastrophic failure. 6,7 In addition, a clearer knowledge of fracture stability could help with communication throughout the cycle of care and inform treatment of comorbidities with therapies that could otherwise affect healing. 7 With undiagnosed delayed fracture healing, the hardware continues to be loaded can be overloaded or fatigue and fail, requiring costly revision surgery with significant risk of morbidity and mortality.…”

Section: Introductionmentioning

confidence: 99%

“…6,7 In addition, a clearer knowledge of fracture stability could help with communication throughout the cycle of care and inform treatment of comorbidities with therapies that could otherwise affect healing. 7 With undiagnosed delayed fracture healing, the hardware continues to be loaded can be overloaded or fatigue and fail, requiring costly revision surgery with significant risk of morbidity and mortality. 9 A technique to quantitatively assess IT fracture stability through standard radiography could thus improve care management and communications using existing facilities.…”

Section: Introductionmentioning

confidence: 99%

“…6 Failure to recognize a nonunion and take appropriate interventional measures could result in catastrophic fixation failure and the need for emergency revision surgery. 7,8 Hip fracture patients are often frail and thus these revision surgeries are risky for them: the 1-year all-cause mortality rate for patients readmitted within 30 days of surgery is 56%, compared to 19% for those not readmitted. 9 The average hip fixation hardware failure rate is around 5%; however, this can increase to over 20% in patients with comorbidities such as osteoporosis, unstable fractures and poor initial fracture reduction.…”

Section: Introductionmentioning

confidence: 99%

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Measuring Intertrochanteric Fracture Stability with a Novel Strain-Sensing Sliding Hip Screw

Carrington

Millhouse

Behrend³

et al. 2020

Preprint

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Background: Bone healing after internal fixation of intertrochanteric hip fractures is difficult to monitor with radiography, particularly with internal fixation implants such as the sliding hip screw (SHS). In this study, we evaluate a robust, user-friendly device to non-invasively determine the loading on the screw implant. This will allow clinicians to better monitor the status of bone healing and take preventative steps if complications occur. Methods: A novel strain-sensing sliding hip screw (SS-SHS) was designed and refined using a finite element model of a simple intertrochanteric fracture and a standard SHS implant. The SS-SHS houses an internally fixed indicator rod, whose position relative to the screw body can be viewed on plain film radiographs to measure screw bending. Screw bending was assessed in an intact femur and an unstable A1 intertrochanteric fracture using a finite element computational model and compared with experimental axial loading of a femoral Sawbones composite and human cadaveric femur specimens. Indicator rod position relative to the screw was visually tracked using plain radiographs at each load state. Results: The indicator rod was found to displace linearly in response to implant strain in the unstable fracture. This movement was consistently visible and measurable using radiography throughout loading cycles across the mechanical and cadaveric fracture models. Sensor movement was not detected in healed fracture models. The slope of the curve was approximately equal in the computations, composite and cadaveric models (0.08 μm/N, 1.0 μm/N, 0.08 μm/N, respectively). The noise level was approximately 25 N in the composite model and 63 N in the cadaveric specimen and this was sufficient to see 1/10th of body weight or more for an 80 kg patient which is likely good enough to track fracture healing. Conclusions: In current practice, clinicians must carefully monitor their patients for signs of implant failure after surgery. However, by the time signs of failure are apparent, it is often too late to avoid revision surgery. This device enables clinicians to quantitatively track fracture healing, and better communicate the process to the patient. Clinicians can also take preventive measures with at-risk patients before revision surgery is needed, thus reducing mortality risks. Clinical Relevance: By augmenting an existing SHS system with an indicator rod, crucial information on the status of fracture healing can be ascertained from follow-up radiographs already taken with no additional risk to the patient.

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“…[3] In intra-capsular proximal femoral fractures, the most common complications are avascular necrosis and nonunion. [4,5] In a meta-analysis including only controlled trials, weighted-mean revision rates after internal xation were 18.5% for nonunion and 9.5% for osteonecrosis of the femoral head (ONFH). [6] Both intra-capsular and extra-capsular nonunion, malunion, and xation failure can be managed by corrective valgus osteotomy of the proximal femur.…”

Section: Introductionmentioning

confidence: 99%

Valgus Intertrochanteric Osteotomy for Salvage of Failed Femoral Cervicotrochanteric Fracture Fixation

Odeh¹,

et al. 2020

Preprint

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BackgroundFemoral cervicotrochanteric fracture fixation failure often requires a salvage procedure to preserve the hip. To understand its limitations, this study investigated the use of intertrochanteric osteotomy for this purpose and analyzed causes of failure.MethodsDuring 2001 − 2017, 21 patients (males:females = 12:9; 47 ± 17 years) with failed femur cervicotrochanteric fracture fixation were treated with intertrochanteric osteotomy. All patients were followed-up using functional assessment according to the Harris hip score (HHS) and radiological assessment. The clinical end-point was conversion to hip arthroplasty for any reason or acquiring a symptomatic hip with a HHS < 80.ResultsWith a follow-up duration of 124 ± 63 months, success was achieved in 16 patients, whereas 5 patients developed fixation failure. Early failure was associated with fixation loss in 2 hips with subcapital fractures, while late failure was related to progression of pre-existing osteonecrosis of the femoral head (ONFH) in 3 hips. Aside from the 2 early failure hips, the osteotomy healed uneventfully in all cases, and the original fracture sites healed within 17.2 ± 6.3 weeks. Of the 5 hips converted to arthroplasty, standard femoral implants were used without the need to re-perform an osteotomy to align the medullary canal. At the final follow-up, significant improvements in limb-length discrepancy (LLD), neck-shaft angle (NSA), and HHS were observed. The valgus osteotomy angle for correction was 21.9° ± 8.4°, and this was maintained at 21.1° ± 10.5° during follow-up.ConclusionsIntertrochanteric osteotomy is a useful operation and can promote fracture-healing in cases of failed cervicotrochanteric fracture fixation. Subcapital fracture with limited bone to enable secure purchase of the fixation device and pre-existing ONFH were associated with high failure rates. In such cases, salvage should not be attempted using this procedure alone, and arthroplasty or other salvage procedures may be necessary.

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Hip Fracture Nonunions: Diagnosis, Treatment, and Special Considerations in Elderly Patients

Cited by 25 publications

References 52 publications

Imaging of Pelvic and Femoral Fixation Hardware: Normal Findings and Hardware Failure

Imaging of Pelvic and Femoral Fixation Hardware: Normal Findings and Hardware Failure

Measuring Intertrochanteric Fracture Stability with a Novel Strain-Sensing Sliding Hip Screw

Valgus Intertrochanteric Osteotomy for Salvage of Failed Femoral Cervicotrochanteric Fracture Fixation

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