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Ulusal Travma Ve Acil Cerrahi Dergisi =... Sep 2016The purpose of the present study was to evaluate safety and efficiency of the semi-sterile technique used in recent years in treatment of pediatric supracondylar humeral...
BACKGROUND
The purpose of the present study was to evaluate safety and efficiency of the semi-sterile technique used in recent years in treatment of pediatric supracondylar humeral fractures (SHF).
METHODS
Total of 712 patients who were treated for SHF via closed reduction and percutaneous fixation with semi-sterile technique were enrolled in present study. Patients were evaluated for postoperative infection and other complications. Clinical and radiological assessments were also made.
RESULTS
It was found that there were 52 (7.3%) pin tract infections, which responded to oral antibiotic administration and pin care without need for early pin removal (before 3 weeks). There were no deep infections. Loss of reduction was observed in 82 patients (11.5%). There were 59 iatrogenic nerve injuries (8.3%), of which 52 (7.3%) were ulnar palsy. Clinically apparent cubitus varus was observed in 29 (4.1%) patients.
CONCLUSION
Though semi-sterile technique is an effective treatment in closed percutaneous pinning of SHF, increased pin tract infection risk is a matter of concern.
Topics: Bone Nails; Child; Child, Preschool; Databases, Factual; Female; Fracture Fixation, Intramedullary; Humans; Humeral Fractures; Male; Range of Motion, Articular; Retrospective Studies; Surgical Wound Infection; Treatment Outcome; Turkey
PubMed: 27849325
DOI: 10.5505/tjtes.2016.31614 -
Journal of Orthopaedics and... Aug 2021To evaluate set screw fracture in the Trochanteric Femoral Nail Advanced implant (TFNa, Synthes, West Chester, PA) and to identify additional mechanisms of set screw...
OBJECTIVES
To evaluate set screw fracture in the Trochanteric Femoral Nail Advanced implant (TFNa, Synthes, West Chester, PA) and to identify additional mechanisms of set screw failure in the TFNa.
MATERIALS AND METHODS
Patients who had experienced failure after open reduction and internal fixation (ORIF) with the TFNa were identified. TFNa implants were explanted and inspected following revision surgery. Medical device reports (MDRs) and manufacturer's inspection reports describing similar failures for the TFNa in the United States Food and Drug Administration (FDA) Manufacturer and User Facility Device Experience (MAUDE) database were also reviewed.
RESULTS
Four set screw fractures that occurred at a level II trauma center were observed. Sixty-seven reported failures were identified in the MAUDE database for review. Twenty-eight failed implants were returned to the manufacturer for inspection with a published inspection report available for analysis. Set screw fractures can occur in the TFNa when the set screw is deployed prematurely into the proximal screw aperture prior to blade/screw insertion. The set screw can also bend and deform if it is advanced against a helical blade/lag screw that is not fully seated into position, thereby potentially compromising its function.
CONCLUSION
The TFNa set screw allows for potential fracture during implant insertion leading to uncontrolled collapse, early excessive proximal femoral shortening, and rotational instability of the helical blade/lag screw. Similar failures in the TFNa can be prevented by having the surgeon inspect the proximal screw aperture after attachment of the proximal aiming aim to ensure the set screw has not been deployed prematurely.
LEVEL OF EVIDENCE
Therapeutic Level III.
Topics: Bone Nails; Bone Screws; Femur; Fracture Fixation, Intramedullary; Hip Fractures; Humans; Reoperation
PubMed: 34346023
DOI: 10.1186/s10195-021-00594-8 -
Ulusal Travma Ve Acil Cerrahi Dergisi =... May 2022The aim of this study to compare three cephalomedullary nails (CMNs) with different designs in terms of complica-tion, reoperation, implant failure, mortality rates, and...
Functional and radiological comparison of three cephalomedullary nails with different designs used in the treatment of unstable intertrochanteric femur fractures of elderly.
BACKGROUND
The aim of this study to compare three cephalomedullary nails (CMNs) with different designs in terms of complica-tion, reoperation, implant failure, mortality rates, and functional outcomes in the treatment of unstable intertrochanteric fractures (UIFs).
METHODS
This retrospective study included patients with UIFs (AO/OTA type 31-A2 and 31-A3) who were treated with one of these CMNs (74 patients with Talon-PFN, 70 patients with PFN-III, and 69 patients with Intertan) between October 2014 and October 2018.
RESULTS
A total of 213 patients (122 females and 91 males) with a mean age of 81.0±9.3 years have participated in this study. The mean follow-up time was 26.1±6.3 months. Malfixation was the most common complication and the most common reason of reop-eration for each type of CMN. Complication and reoperation rates, post-operative functional status, mean union times, and overall mortality rates were similar between groups. Mean operation/fluoroscopy time and mean blood loss were low in the Talon-PFN group, whereas the highest means of these parameters were in the PFN-III group. There were six (8.2%) implant failures in the Talon-PFN group and one (1.5%) in PFN-III group. No implant failure was seen in the Intertan group. The highest rate (58.6%) of anatomic reduc-tion was detected in PFN-III group.
CONCLUSION
Our study results showed that each implant type had its own advantages and disadvantages in the treatment of UIFs with similar functional and reoperation outcomes. Intertan was advantageous with its absence of implant failures. Talon-PFN decreased the operation/fluoroscopy time and intraoperative blood loss but had the highest implant failure rate. There was a need for more anatomic reduction to centralize two separate parallel lag screws in the femoral neck in PFN-III group, and that costs operation/fluo-roscopy time and blood loss. Malfixation, which was the most common cause of complications and reoperations, should be avoided.
Topics: Aged; Aged, 80 and over; Bone Nails; Female; Femur; Hip Fractures; Humans; Male; Nails; Radiography; Retrospective Studies
PubMed: 35485475
DOI: 10.14744/tjtes.2020.80733 -
Annals of the Royal College of Surgeons... Mar 2020Implant wastage is an under-reported issue in orthopaedics, yet it has been shown to have a significant cost burden on healthcare budgets. In a background of a perilous...
INTRODUCTION
Implant wastage is an under-reported issue in orthopaedics, yet it has been shown to have a significant cost burden on healthcare budgets. In a background of a perilous financial climate in the UK health service, our aim was to define the frequency and costs of implant wastage in orthopaedic trauma.
MATERIALS AND METHODS
The trauma theatre's implant logbook was retrospectively analysed between April 2017 and April 2018. Wasted implants were identified by the study authors independently. Patient demographics, implant details and costs were among the data collected. Product codes of wasted implants were used to identify implant costs through the manufacturer.
RESULTS
Implant wastage occurred in 25.1% of trauma procedures during the study period. Most wasted implants (91%) were screws. The total cost of implant wastage was £8,377.25 during the 12-month period, accounting for 2% of the total implant budget. Wasted intramedullary nails accounted for almost 50% of the total cost. More than 51% of affected procedures involved a trainee as the primary operator.
DISCUSSION
We report the first study of implant wastage in orthopaedics from the UK. Total implant wastage was higher than reported in most of the published literature, although it represented a small portion of the budget. Implant wastage is attributable to surgeons or operating theatre staff in most cases and is compounded by surgeons' limited understanding of implant costs. Initiatives to reduce implant wastage should include raising awareness of costs and departmental wastage to surgeons and operating theatre staff as well as employing preoperative planning techniques.
Topics: Bone Nails; Bone Screws; Humans; Musculoskeletal System; Orthopedic Procedures; Prostheses and Implants; Retrospective Studies; United Kingdom; Wounds and Injuries
PubMed: 31660763
DOI: 10.1308/rcsann.2019.0151 -
Zhongguo Xiu Fu Chong Jian Wai Ke Za... Mar 2022To compare the effectiveness of locking plate and intramedullary nail in treatment of Neer two- and three-part fractures of the proximal humerus in the elderly.
OBJECTIVE
To compare the effectiveness of locking plate and intramedullary nail in treatment of Neer two- and three-part fractures of the proximal humerus in the elderly.
METHODS
A retrospective analysis was conducted on 86 elderly patients with Neer two- and three-part fractures of the proximal humerus met the selection criteria between January 2015 and December 2018. Forty-six patients were treated with locking plate fixation (locking plate group), and 40 patients with intramedullary nail fixation (intramedullary nail group). There was no significant difference in gender, age, cause of injury, fracture side and type, time from injury to operation, and comorbidities between the two groups ( >0.05). Visual analogue scale (VAS) score, American Shoulder and Elbow Surgery (ASES) score, Constant-Murley score, and shoulder range of motion (forward flexion, abduction, and external rotation) were compared between the two groups. X-ray films were taken to assess the fracture healing, and the neck-shaft angle was measured at 2 days after operation and at last follow-up, and the difference between the two time points was calculated.
RESULTS
Patients in both groups were followed up 18-40 months, with an average of 30.4 months. There was no significant difference in follow-up time between the two groups ( =-0.986, =0.327). X-ray films reexamination showed that the fractures of two groups healed, and the healing time was (11.3±2.1) weeks in locking plate group and (10.3±2.0) weeks in intramedullary nail group, which had significant difference between the two groups ( =2.250, =0.027). The difference of neck-shaft angle was (7.63±7.01)° in locking plate group and (2.85±2.82)° in intramedullary nail group, which had significant difference between the two groups ( =4.032, <0.001). There was no significant difference in Constant-Murley score, ASES score, VAS score, and shoulder range of motion between the two groups at last follow-up ( >0.05). Complications occurred in 13 cases (28.3%) of locking plate group and in 4 cases (10.0%) of intramedullary nail group, and the difference between the two groups was significant ( =4.498, =0.034).
CONCLUSION
Both locking plates and intramedullary nails can be used for the treatment of Neer two- and three-part fractures of the proximal humerus in the elderly. The intramedullary nail fixation surgery is more minimally invasive, which has fewer postoperative complications and faster fracture healing.
Topics: Aged; Bone Nails; Humans; Humerus; Retrospective Studies; Shoulder; Shoulder Fractures; Treatment Outcome
PubMed: 35293166
DOI: 10.7507/1002-1892.202107003 -
Operative Orthopadie Und Traumatologie Feb 2021Minimally invasive, sufficiently stable for movement and partial weight bearing, osteosythesis of pertrochanteric femoral fractures in children < 6-8 years using... (Review)
Review
OBJECTIVE
Minimally invasive, sufficiently stable for movement and partial weight bearing, osteosythesis of pertrochanteric femoral fractures in children < 6-8 years using elastic, stable intramedullary nailing (ESIN).
INDICATIONS
Proximal, pertrochanteric femoral fractures Delbet type IV in children < 6 years.
CONTRAINDICATIONS
Comminuted fractures, femoral neck fractures.
SURGICAL TECHNIQUE
By inserting three elastic titanium nails (TEN), prebent in the proximal third, retrograde into the femur, a stable 3‑point support stabilizes the proximal fragment. For further improvement of stability, EndCaps can be used.
POSTOPERATIVE MANAGEMENT
Partial weight bearing (sole-contact) for 4-5 weeks. X‑ray controls immediately after surgery and after 4-5 weeks. No sports for 3 months.
RESULTS
In our patient population we have good experience with this technique for very rare pertrochanteric fractures in children younger than 6-8 years. With minimally invasive access, exercise-stable administration can be achieved without a pelvic leg cast.
Topics: Bone Nails; Child; Femoral Fractures; Fracture Fixation, Intramedullary; Fracture Healing; Humans; Treatment Outcome
PubMed: 33501513
DOI: 10.1007/s00064-020-00696-2 -
Journal of Orthopaedic Surgery (Hong... 2021This study aims to systematically review the literature comparing surgical treatments options and respective failure rates for basicervical hip fractures.
PURPOSE
This study aims to systematically review the literature comparing surgical treatments options and respective failure rates for basicervical hip fractures.
METHODS
A comprehensive search of databases, including MEDLINE, Embase, Web of Science, and Cochrane Central for studies published in English on or before June 21, 2019 was performed. Selected search terms included "basicervical," "basi cervical," "AO/OTA type 31-B," "femoral neck fracture" AND "bone nails," "bone screws," "fracture fixation," "internal fixation," "arthroplasty," "cephalomedullary," "sliding hip screw," "ORIF," and "treatment outcome." We included studies that assessed outcomes of basicervical fracture fixation using open reduction internal fixation or arthroplasty. Two authors extracted the following data from each paper: study design, country, cohort year, definition of basicervical, intervention type, sample size, patient demographics, follow-up length, percent of fractures that required revision, and the percent of implants that failed.
RESULTS
Sixteen articles encompassing 910 patients were included. The main outcome was the percent of implants that required revision. The total revision rates were 8% (8 studies, 157 patients, range 0%-55%) for cephalomedullary nails, 7% (10 studies, 584 patients, range 0%-18%) for sliding hip screws, 23% (3 studies, 40 patients, range 16%-50%) for cannulated screws, 0% (1 study, 6 patients) for total hip arthroplasty, and 8% (2 studies, 13 patients, range 0%-11%) for hemiarthroplasty.
CONCLUSION
Management of basicervical fractures with SHS and CMN produces similar failure and re-operation rates. Limited evidence is available on the use of cannulated screws and arthroplasty, but available studies suggest that cannulated screws have an unacceptable revision rate (23%) while arthroplasty may be acceptable. Future studies examining the comparative efficacy of various fixation methods would benefit from strict definition of fracture type as well as consistent reporting of functional outcomes, re-operation rates, and mortality.
Topics: Aged; Aged, 80 and over; Bone Nails; Bone Screws; Female; Femoral Neck Fractures; Fracture Fixation, Internal; Hip Fractures; Humans; Male; Open Fracture Reduction; Postoperative Complications; Prognosis; Reoperation; Treatment Outcome
PubMed: 33779387
DOI: 10.1177/23094990211003344 -
Acta Orthopaedica Et Traumatologica... Aug 2021Application rate of cephalomedullary nails in treatment of pertrochanteric fractures has been increased. Although cephalomedullary nail breakage is rare, the occurrence... (Review)
Review
Application rate of cephalomedullary nails in treatment of pertrochanteric fractures has been increased. Although cephalomedullary nail breakage is rare, the occurrence is catastrophic and removingdistal fragment of the broken nail is always a challenging issue. Many techniques have been described for extracting broken nails, but most of them are used for conventional femoral nails. Furthermore, many of these techniques require specific extraction devices. Herein, we introduce a simple technique to remove the distal fragment of broken cephalomedullary nail with the least equipment requirements.
Topics: Bone Nails; Femoral Fractures; Femur; Fracture Fixation, Intramedullary; Humans
PubMed: 34464314
DOI: 10.5152/j.aott.2021.20282 -
BMC Musculoskeletal Disorders Jul 2020The aim of this study was to investigate the feasibility of an individual navigation template for the deep pin position on the iliac crest, based on digital design and...
BACKGROUND
The aim of this study was to investigate the feasibility of an individual navigation template for the deep pin position on the iliac crest, based on digital design and 3D printing technology.
METHODS
The preoperative CT images of 8 patients with pelvic fractures were collected. The data were reconstructed using a 3D imaging reconstruction workstation. An individual navigation template for the deep pin position on the iliac crest was designed on a virtual 3D model. The individual drill template and the solid pelvic model were produced using the 3D printing technology. The individual drill template was used for intraoperative deep pin position on the iliac crest after the preoperative simulation was completed.
RESULTS
Thirty-two external fixator pins were inserted using the individual drill template. The average depth of pins was 84.82 mm. The trajectories were appropriate based on the postoperative X-ray and CT scan. No significant difference in the entry point, convergence angle, and caudal angle of the pins were noted before and after the operation (all P > 0.05). Finite element analysis indicated that the deep external fixator pin position could more reasonably distribute the stress in the cortical and spongy bones in the pelvis. All patients could perform partial weight-bearing activity 6 weeks postoperatively. No loosening and rupture of the pin, infection, and no damage of blood vessels and nervous tissue were found during the entire follow-up period.
CONCLUSIONS
The individual drill template technique is an improvement of the traditional technique, which could increase precision and the depth of pin position. In addition, good mechanical stability and low risk of pin-related complications occurred due to the individual drill template, which makes the external fixation technique a potential alternative.
Topics: Bone Nails; External Fixators; Feasibility Studies; Humans; Ilium; Pelvic Bones; Printing, Three-Dimensional
PubMed: 32693799
DOI: 10.1186/s12891-020-03509-6 -
The Iowa Orthopaedic Journal Dec 2023Studies demonstrate an increase incidence of intertrochanteric fractures within the United States. Matched studies evaluating intertrochanteric fractures managed with...
Utilization Trends, Patient-Demographics, and Comparison of Medical Complications of Sliding Hip Screw or Intramedullary Nail for Intertrochanteric Fractures: A Nationwide Analysis from 2005 to 2014 of the Medicare Population.
BACKGROUND
Studies demonstrate an increase incidence of intertrochanteric fractures within the United States. Matched studies evaluating intertrochanteric fractures managed with either sliding hip screw (SHS) or intramedullary nail (IMN) within the Medicare population are limited. The purpose of this study was to investigate: 1) annual utilization trends; 2) patient demographics; and 3) complications including mortality.
METHODS
A retrospective query using a nationwide database was performed. Patients undergoing SHS or IMN for intertrochanteric fractures were identified. The query yielded a total of 37,929 patients utilizing SHS (n = 11,665) or IMN (n = 26,264). Patients were matched 1:1 based on comorbidities. Primary outcomes included: utilization trends, patient demographics, 90-day complications, and 90-day readmission rates. Linear regression analyses were used to compare utilization trends. Pearson's c2 analyses were used to compare patient-demographics, medical complications, and 90-day readmission rates. A p-value less than 0.05 was considered statistically significant.
RESULTS
Linear regression analysis demonstrated a statistically significant decrease in utilization of SHS for IT fractures (p<0.0001); whereas utilization for IMN stayed consistent (p=0.36). IMN had significantly higher prevalence of comorbidities compared to SHS, notably, hyperlipidemia (70.6 vs. 62.6%; p<0.0001). Based on 1:1 match, IMN patients had significantly higher rates of 90-day medical complications, such as respiratory failure (11.0 vs. 8.1%; p<0.0001) and VTE (4.2 vs. 3.2%; p<0.001; however, there was not a statistical difference in postoperative infection (1.4 vs. 1.5%, p=0.06). There was no statistical difference in 90-day mortality between IMN and SHS cohorts (0.19 vs .13%, p = 0.249).
CONCLUSION
This analysis demonstrates a difference in utilization of SHS and IMN for patients with IT fractures. Patients with IMN had significantly higher prevalence of comorbid conditions and incidence of 90-day postoperative complications compared to SHS patients. The study can be utilized by orthopaedic surgeons to potentially anticipate healthcare utilization depending on implant selection. .
Topics: Humans; Bone Nails; Fracture Fixation, Internal; Fracture Fixation, Intramedullary; Retrospective Studies; Bone Screws; Hip Fractures; Postoperative Complications; Demography
PubMed: 38213845
DOI: No ID Found