Prospective Randomized Comparison Between a Dynamic Hip Screw and a Mini-invasive Static Nail in Fractures of the Trochanteric Area: Preliminary Results

Dujardin, F.; Benez, C; Polle, G.; Alain, J. L.; Biga, N.; Thomine, J M

doi:10.1097/00005131-200108000-00004

Cited by 56 publications

(17 citation statements)

References 32 publications

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“…The literature comparing blood loss in intertrochanteric hip fractures treated with intramedullary nail or DHS is inconclusive. Authors have reported reduced blood loss, [25][26][27] increased blood loss 28 and no difference 29,30 in patients with intertrochanteric fractures treated with an intramedullary nail. The variability among studies may be related to differences in fracture severity, as patients with more displaced fractures are generally more likely to be treated with an intramedullary device.…”

Section: Discussionmentioning

confidence: 99%

Factors affecting transfusion requirement after hip fracture: Can we reduce the need for blood?

et al. 2014

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Background: Hip fractures are common injuries that result in blood loss and frequently require the transfusion of blood products. We sought to identify risk factors leading to increased blood transfusion in patients presenting with hip fractures, especially those factors that are modifiable. Methods:We retrospectively reviewed the cases of all patients who had fixation of their hip fractures between October 2005 and February 2010. The need for transfusion was correlated with potential risk factors, including age, sex, preoperative hemoglobin, fracture type, fixation method and more.Results: A total of 835 patients had fixation of their hip fractures during the study period; 631 met the inclusion criteria and 249 of them (39.5%) were transfused. We found an association between need for blood transfusion and female sex (p = 0.018), lower preoperative hemoglobin (p < 0.001), fracture type (p < 0.001) and fixation method (p < 0.001). Compared with femoral neck fractures, there was a 2.37 times greater risk of blood transfusion in patients with intertrochanteric fractures (p < 0.001) and a 4.03 times greater risk in those with subtrochanteric fractures (p < 0.001). Dynamic hip screw (DHS) fixation decreased the risk of transfusion by about half compared with intramedullary nail or hemiarthroplasty. We found no association with age, delay to operation (p = 0.17) or duration of surgery (p = 0.30). Conclusion:The only modifiable risk factor identified was fixation method. When considering blood transfusion requirements in isolation, we suggest a potential benefit in using a DHS for intertrochanteric and femoral neck fractures amenable to DHS fixation.Contexte : La fracture de la hanche est un traumatisme fréquent, qui cause une perte sanguine et nécessite souvent la transfusion de produits sanguins. Nous avons tenté d'identifier les facteurs de risque associés à une hausse du nombre des transfusions sanguines chez des patients ayant subi une fracture de la hanche, en particulier les facteurs modifiables.Méthodes : Au cours d'une étude rétrospective, on a revu les cas de tous les patients chez qui on avait pratiqué une ostéosynthèse pour une fracture de la hanche survenue entre octobre 2005 et février 2010. La nécessité d'une transfusion sanguine a été associée à d'éventuels facteurs de risque, dont l'âge, le sexe, le taux d'hémoglobine préopéra-toire, le type de fracture, la technique d'ostéosynthèse, et d'autres facteurs encore.Résultats : Au total, 835 patients avaient subi une ostéosynthèse pour fracture de la hanche au cours de la période à l'étude; 631 satisfaisaient les critères d'inclusion à l'étude et parmi eux, 249 (39,5 %) ont reçu une transfusion sanguine. On a observé l'existence d'un lien entre la nécessité d'une transfusion sanguine et le sexe féminin (p = 0,018), une plus faible concentration d'hémoglobine préopératoire (p < 0,001), le type de fracture (p < 0,001) et la technique d'ostéosynthèse (p < 0,001). Par rapport aux fractures du col fémoral, le risque de transfusion sanguine était 2,37 fois plus é...

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Section: Discussionmentioning

confidence: 99%

Factors affecting transfusion requirement after hip fracture: Can we reduce the need for blood?

et al. 2014

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“…Using American Board of Orthopaedic Surgery (ABOS) Part II data, Anglen and Weinstein reported that use of IM fixation increased from 3% in 1999 to 67% of cases in 2006 [3]. Numerous studies have been published comparing sliding compression hip screw and side plate with IM fixation [2,12,16,17,29,31,32]. However, results have been contradictory in terms of outcomes [2,12,16,17,29,31,32] with the only consistent differences reported between the two fixation techniques being increased complications (particularly intraoperative and postoperative fractures) and a higher reoperation rate with IMN [4,10,16,29].…”

Section: Discussionmentioning

confidence: 99%

“…Historically, a sliding hip screw (SHS) has been the preferred implant to stabilize these fractures [5,13,18,21,24,25,35]. However, intramedullary hip screw devices have gained popularity for stabilizing this fracture type [2,4,7,8,10,12,16,17,29,31,32].…”

Section: Introductionmentioning

confidence: 99%

“…Many of the published studies comparing SHS and IMN for stabilization of intertrochanteric fractures have involved a small number of patients and looked at a limited number of outcomes such as mortality and need for revision surgery [2,4,7,8,10,12,16,17,29,31,32]. Our study, using a large cohort of Medicare beneficiaries, was performed to determine whether patients who sustain an intertrochanteric fracture have better outcomes when stabilized with a SHS or an IMN.…”

Section: Introductionmentioning

confidence: 99%

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Is a Sliding Hip Screw or IM Nail the Preferred Implant for Intertrochanteric Fracture Fixation?

Aros¹,

Tosteson

Gottlieb

et al. 2008

Clinical Orthopaedics &Amp; Related Research

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“…Intramedullary nails for stabilizing unstable fractures have been available since the early 1980s [3][4][5]. The nails are inserted percutaneously and allow the surgeon to minimize soft tissue dissection and bone damage, thereby reducing surgical trauma and wound complications and preserving the fracture hematoma that is essential for fracture healing [6][7][8]. Limping and abduction weakness as a result of damage to the nerves, abductor muscles, or change in neck shaft angle are important complications after hip surgery.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the Superior Gluteal Nerve During Proximal Femoral Nailing

S�nmez¹

2017

Ann Clin Anal Med

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ÖzetAmaç: Kalça cerrahisi sırasında süperior gluteal sinir etkilenebilir. Bu çalışma-da stabil olmayan trokanterik kırıklar nedeni ile proksimal femoral çivileme uygulanan hastalar, süperior gluteal sinir hasarı mevcutdiyetini ve bunun klinik bulgularını değerlendirmek amacıyla retrospektif olarak değerlendirilmiş-tir. Gereç ve Yöntem: Bu çalışmaya 25 hasta dahil edilmiştir (14 kadın, 11 erkek). Çalışmaya Hastanemiz Ortopedi Bölümü'ne başvuran proksimal femoral çivileme uygunana hastalar dahil edilmiştir. Kırık fiksasyonu için aynı dizayna sahip iki ayrı çivi ve aynı cerrahi teknik uygulanmıştır. Serebrovasküler hastalık hikayesi olan, polinöropatinin elektromyografik bulguları olan veya dejeneratif vertabral hastalığı bulunanan hastalar çalışmadan çıkartılmıştır. Hastalar klinik ve radyolojik olarak değerlendirilmiştir. Gluteus maksimus kasında akut denervasyon ile ilişkili bulgular ve motor ünite aksyon potansiyelindeki değişiklikler superior gluteal sinir hasarı bulguları olarak kabul edilmişir. Bulgular: Sekiz hasta yürüme sırasında destek kullanmıştır, bu hastaların üçün-de pozitif Trendelenburg belirtisi mevcttur ancak yalnızca bir hastada süpe-rior gluteal sinirde akut denervasyon bulguları saptanmıştır. Tartışma: Bu ça-lışmaya göre iyatrojenik sinir hasarı insidansı proksimal femoral çivilemenin nadir görülen bir komplikasyonudur. Yaşlı hastalarda sinir hasarından bağım-sız olarak, aksama ve destek kullanma ihtiyacı meydana gelebilir. Anahtar KelimelerHasar; Elektromyografi; Proksimal Femoral Çivileme; Süperior Gluteal Sinir Abstract Aim: The superior gluteal nerve may be compromised during hip surgery. We retrospectively evaluated the patients who underwent proximal femoral nailing for unstable trochanteric fractures in order to investigate the presence of superior gluteal nerve injury and its clinical findings. Material and Method: Twenty five patients (14 women, 11 men) were included in the study who had femoral nailing between January 2004 and March 2010 at Hamidiye Sisli Etfal Training and Research Hospital Department of Orthopaedics. Two different types of nails which have similar designs and surgical techniques were used for fracture fixation. Patients who had a history of cerebrovascular disease, electromyography findings of polyneuropathy, or degenerative vertebral disease were excluded from the study. Patients were evaluated clinically and radiologically. Findings related to acute denervation in the gluteus medius muscle and motor unit action potential changes were accepted as signs of superior gluteal nerve injury. Results: Eight patients were using support during walking and three of these patients had positive Trendelenburg sign, but only one patient had acute denervation signs of the superior gluteal nerve. Discussion: Based on the present study the incidence of iatrogenic nerve injury is a rare complication of proximal femoral nailing. Elderly patients, regardless of whether they have nerve injury, may limp and need to use a walking support.

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Prospective Randomized Comparison Between a Dynamic Hip Screw and a Mini-invasive Static Nail in Fractures of the Trochanteric Area: Preliminary Results

Abstract: This preliminary clinical study has shown the advantages of this mini-invasive technique. It could not evaluate all the possible disadvantages inherent in the method. These points will be evaluated in a multicenter study justified by these preliminary results.

Cited by 56 publications

References 32 publications

Factors affecting transfusion requirement after hip fracture: Can we reduce the need for blood?

Factors affecting transfusion requirement after hip fracture: Can we reduce the need for blood?

Is a Sliding Hip Screw or IM Nail the Preferred Implant for Intertrochanteric Fracture Fixation?

Evaluation of the Superior Gluteal Nerve During Proximal Femoral Nailing

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