Subtrochanteric fractures: Current management options

Craig, Niall; Maffulli, Nicola

doi:10.1080/09638280500055545

Cited by 45 publications

(45 citation statements)

References 61 publications

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“…The minimally invasive DHS requires less operating time, reduces the amount of intraoperative blood loss, and allows patients to be discharged earlier. This may carry benefit to the patients, and has significant financial implications to the hospital [7,9,10,14,18,19,21].…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive dynamic hip screw for fixation of hip fractures

Garau

Walley

et al. 2008

International Orthopaedics (SICOT)

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We compared a minimally invasive surgical technique to the conventional (open approach) surgical technique used in fixation of hip fractures with the dynamic hip screw (DHS) device. Using a case-control design (44 cases and 44 controls), we tested the null hypothesis that there is no difference between the two techniques in the following outcome measures: duration of surgery, time to mobilisation and weight bearing postoperatively, length of hospital stay, mean difference of pre-and postoperative haemoglobin levels, position of the lag screw of the DHS device in the femoral head, and the tip-apex distance. The minimally invasive DHS technique had significantly shorter duration of surgery and length of hospital stay. There was also less blood loss in the minimally invasive DHS technique. The minimally invasive DHS technique produces better outcome measures in the operating time, length of hospital stay, and blood loss compared to the conventional approach while maintaining equal fixation stability.Résumé Ce travail a pour but de comparer les techniques de fixation de fractures de la hanche par voie mini-invasive ou par voie d'abord conventionnelle avec utilisation de matériel de type DHS. Nous avons pour cette étude regroupé les patients en deux groupes, 44 cas par voie mini-invasive et 44 cas contrôle. Nous avons voulu tester l'hypothèse suivante: existe-t-il une différence entre ces deux techniques, sur la durée d'intervention, de reprise de l'appui post-opératoire; de durée moyenne de séjour des pertes sanguines notamment et enfin, en ce qui concerne la position de la vis céphalique dans la tête fémorale et sa distance par rapport à l'interligne. La technique mini-invasive entraîne de façon significative un temps chirurgical diminué et une diminution de la durée moyenne de séjour. Ceci est également vrai pour les pertes sanguines. Cette technique est pour nous supérieure en ce qui concerne ces items si on la compare à l'abord de type conventionnel en sachant que les problèmes de stabilité du matériel sont identiques quelle que soit la technique utilisée.

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Section: Discussionmentioning

confidence: 99%

Minimally invasive dynamic hip screw for fixation of hip fractures

Garau

Walley

et al. 2008

International Orthopaedics (SICOT)

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“…4,5 Such fractures are associated with high complication rates, and include non-union and implant failure, which occur regardless of the fixation method, because of the unique anatomical and biomechanical features of the subtrochanter. 2,3 Its cortex is thinner than the rest of the femoral shaft; it starts with the cancellous bone at the distal end of the intertrochanteric region and extends into the thick cortical bone of the proximal diaphysis. 6,7 High compressive medial stresses and tensile lateral stresses were placed on fracture fixation devices.…”

Section: Introductionmentioning

confidence: 99%

Intramedullary Nailing versus Fixed Angle Blade Plating for Subtrochanteric Femoral Fractures: A Prospective Randomised Controlled Trial

Rahme

Harris

2007

J Orthop Surg (Hong Kong)

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Purpose. To compare closed intramedullary nailingto open reduction and internal fixation using a fixed angle blade plate for the management of subtrochanteric femoral fractures. Methods. 58 patients were equally randomised to undergo either an intramedullary nailing (IN) or fixed angle blade plating (BP). Results. There were no significant differences between the 2 groups with regard to age, time to surgery, operating time, receipt of blood transfusions, duration of hospital stay, or fracture classification. The revision rate was 28% (8/29) in the BP group and none in the IN group; the difference was statistically significant. Conclusion. Internal fixation using a fixed angle blade plate for subtrochanteric femoral fractures has higher implant failure and revision rates, compared to closed intramedullary nailing.

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“…Stable subtrochanteric fracture can be treated successfully with conventional implants, such as cephalomedullary nails, sliding hip screws and angular blade plates. However, comminuted and unstable subtrochanteric fractures are challenging injuries that are prone to complications [1] . Intramedullary device showed increased fracture stability when compared to extramedullary devices [7] .…”

Section: Discussionmentioning

confidence: 99%

“…Subtrochanteric fractures account for 10-34% of all hip fractures [1] . Surgical treatment is the preferred method for subtrochanteric femoral fractures and a variety of implants are used.…”

Section: Introductionmentioning

confidence: 99%

“…Intramedullary fixation is associated with short operative time and minimal blood loss and has better biomechanical properties when compared with extramedullary fixation. However, they have their own technical difficulties and complications [1,2] . Extramedullary devices such as dynamic condylar screws and 95° condylar blade-plates provide strong fixation in the cancellous bone of the neck and head with considerable rotational stability.…”

Section: Introductionmentioning

confidence: 99%

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