Proximal femoral fractures: Principles of management and review of literature

PurposeTo evaluate the clinical and radiological outcomes of using fibular strut grafts as a fixation device for non-united femoral neck fractures in children with or without subtrochanteric valgus osteotomy.MethodsA total of 12 children with non-united femoral neck fractures (nine males and three females) with an average age of 8.2 years (5 to 12) were managed, and functional results evaluated, between July 2013 and July 2015. The mechanisms of injury were fall from a height in ten patients and road traffic accident in two cases. Nine cases of femoral neck nonunion followed failed internal fixation and three cases were neglected fractures. Six cases were treated by fibular strut graft and subtrochanteric valgus osteotomy with contoured plate and six cases were treated by fibular strut graft and hip spica.ResultsThe mean follow-up period was 20.4 months (12 to 36). Union was achieved in all 12 cases by a mean of 3.5 months (2.5 to 6). All patients were satisfied at five months. For final analysis of clinical and radiographic results, the Ratliff’s classification was used. We classed 11 cases as good results and one case as fair.ConclusionsFibular strut grafts are a reliable option for treatment of pseudo-arthrosis in femoral neck fracture nonunion in children. It is successful in restoration of femoral neck length in children with non-united femoral neck fractures.

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“…18 The quality of reduction and rigidity of fixation are the major determinants of the outcome in terms of bone union and AVN. 19,20 …”

Section: Discussionmentioning

confidence: 99%

“…They range from the use of vascularised muscle pedicle, vascularised iliac crest or vascularised fibula to non-vascularised cortical tibial or free fibular strut graft (single or double). 19,20,26 …”

Section: Discussionmentioning

confidence: 99%

Fibular strut graft for nonunited femoral neck fractures in children

Elgeidi

El-Negery

2017

Journal of Children's Orthopaedics

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“…The associated morbidity and mortality with hip fracture is significant [8] . The general consensus in the literature is that primary goal of treatment should be to obtain a stable fixation of the fracture that will allow early mobilization, restoring the function of limb [9] Current evidence support use of sliding hip screw for fixing the stable trochanteric fractures [7] . Historically, to provide satisfactory outcome in unstable trochanteric fractures, various implant have been developed ranging from extramedullary to intramedullary implant.…”

Section: Discussionmentioning

confidence: 99%

Functional outcome of patients treated with proximal femoral nail for unstable trochanteric fractures

Ranjan¹,

Kumar²,

Singh³

2017

Int. J. Orthop. Sci.

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Introduction: Proximal Femoral Nail has become a popular method of stabilization of unstable trochanteric fracture in adults. The aim of our study was to assess functional outcome, radiological result and complications in patient treated with Proximal Femoral Nail in unstable trochanteric fracture. Material& Method: 30 patients were treated with PFN for unstable trochanteric of femur. Patients were selected on the basis of inclusion and exclusion criteria. Final outcome assessment included fracture union, implant cutout, Z effect, reverse Z effect, loss of reduction in varus, nonunion, broken locking screw/PFN and Modified Harris Hip Score. Result: This study included 25 male and 5 female above 18 years of age Major cause of injury was Road Traffic accident followed by fall at home. Modified Harris hip score was excellent in 19 patient, good in 7 patient fair in 3 and poor in 1 patient. Conclusion: Proximal Femoral Nail is effective device in the treatment of unstable trochanteric fractures.

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“…[14][15][16][17] Nowadays, proximal femur fracture is labeled as stable, if the posteromedial cortex is intact and valgus angulation is maintained. 18 The optimal fixation device is still controversial at present. Many authors compared the intramedullary nail (IMN), which involved gamma nail, intramedullary hip screw (IMHS), and PFN, with sliding hip screw (SHS) for treatment of extracapsular proximal femoral fractures and concluded no statistically significant difference in the cut-out rate while total failure rate and re-operation rate were greater with IMN.…”

Section: -12mentioning

confidence: 99%

Role of cephalomedullary nail in proximal femur fractures

2017

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Background: Hip fractures are recognized to be a major public health problem. Key determinants of hip fractures include age, osteoporosis, and falls. In these determinants socioeconomic status, have not been well explored. Under eccentric loading, high bending loads occur, leading to failure of the osteosynthetis anchorage at the center of the femoral head.The introduction of the reconstruction nail has broadened the indications for the intramedullary fixation of difficult femoral fractures. The operative technique is however complicated. Some technical difficulties encountered during its use are presented together with guidance to allow these problems to be avoided.Methods: This Study had included 47 cases which were operated by single surgeon and use of different implant (cephalomedullary nail) was randomized irrespective of fracture types and pattern. This study was done over a period of 12 months (October 2013 to October 2014) with 1 month, 3 months, 6 months, 12 months follow up. At every visit patient were assessed as per Oxford hip score. Type of implant used was PFNA, Intertan, Sirus Nail.Results: The mean age of the patients was 65.68 (±13.55) years. Severe pain was observed among majority of the patients at one month (70.2%) which became mild (40.4%) and moderate (34%) at 3 months. Very mild pain was found in 36.2% patients at 6 months and in 61.7% at 12 months. The limping was all the time among all the patients at one month. However, the limping was found often in 46.8% at 3 months and sometimes in 57.4% at 6 months and 53.2% at 12 months. The hip score was found to be severe among all the patients at one month. However, moderate to severe hip was in 46.8% patients at 3 months, mild to moderate was in 57.4% at 6 months and satisfactory joint function was in 68.1% at 12 months. The comparison of Hip score according to long or short nail at one 3, 6 and 12 months showed no difference. Conclusions: Cephalomedullary nails with adequate technique so that the lag screws by purchase in the centre-centre or posterior-inferior quadrant combines the benefit of sliding hip screw as well as intramedullary implants. So we recommend the use of cephalomedullary nails in proximal femur fractures especially the unstable fractures.

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Proximal femoral fractures: Principles of management and review of literature

Cited by 90 publications

References 70 publications

Fibular strut graft for nonunited femoral neck fractures in children

Fibular strut graft for nonunited femoral neck fractures in children

Functional outcome of patients treated with proximal femoral nail for unstable trochanteric fractures

Role of cephalomedullary nail in proximal femur fractures

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