Bone Nails ; adverse effects ; Bone Plates ; adverse effects ; Hip Fractures ; physiopathology ; surgery ; therapy ; Humans ; Prostheses and Implants ; adverse effects

Compared with hip replacement, internal fixation in the treatment of the elderly femoral neck fracture, especially the application of cannulated screws, is minimally invasive, easy to operate and economical. In recent years, it becomes the research focus in the field of orthopedic clinical research. However, configuration of cannulated screws is still controversial. Most clinicians believe that three cannulated screws being placed in parallel in an inverted triangle configuration is better than that in a triangular configuration in biomechanics and clinical effect. Nonparallel strong oblique nailing technique allows the screws to share more weight to reduce postoperative complications, so that it is more suitable for elderly patients with osteoporosis. However, the related complications of internal fixation such as nonunion, femoral neck shortening and other problems are still the focus of domestic and foreign scholars. Issues about how to control the indication of internal fixation surgery, understand related factors of the complications, and prevent complications are required to be further explored.
Aged ; Bone Nails ; Femoral Neck Fractures ; surgery ; Fracture Fixation, Internal ; adverse effects ; methods ; Humans ; Internal Fixators

Subtrochanteric fractures pose a therapeutic challenge to the surgeons. With the advent of proximal femoral nails, most of the cases are treated with nailing. Newer nails like proximal femoral nail antirotation (PFNA) require the blade to be directly hammered into the bone compared to older nails where the screws are drilled and tapped before insertion. We report one such case in a middle aged female that had intraoperative lateral cortex blowout during PFNA blade insertion in a sclerotic bone. This occurrence to the best of our knowledge is unreported in literature. It is therefore imperative to consider the quality of bone before a decision is made on the implant chosen.
Bone Nails ; adverse effects ; Female ; Hip Fractures ; surgery ; Humans ; Middle Aged ; Rotation

OBJECTIVETo explore the curative effects and complications of elastic intramedullary nail in treating children's bilateral femoral shaft fractures.

METHODSForm February 2005 to March 2008, 7 patients with bilateral femoral shaft fractures were treated by closed reduction and internal fixation with elastic intramedullary nail. There were 5 males and 2 females. The age ranged from 3 to 13 years with the mean of 8.3 years. Six injuries caused by road accident and 1 injury caused by fall from high. Two cases associated with pulmonary contusion, 3 cases brain injuries, 1 case fracture of calcaneus and 1 case bladder injuries. All the cases were closed fractures without nerve and blood vessel injury. A cast external fixation had been used after operation for a month in two cases.

RESULTSAll the patients were followed up for 21-37 months with an average of 30.3 months. No infecton of incisional wound, displacement fracture, internal fixation fail, delayedunion and malunion were found. All fracture obtained healing for 7-12 weeks with an average of 8.7 weeks. Inequality of lower limb was found in 1 case (length differences was 5 mm). According to Flynn scoring,all fractures were excellent.

CONCLUSIONTreatment of femoral shaft fractures in children with elastic intramedullary nail according with biological principle. The method has little trauma, less complication, outstanding effect and it is a good way to treat bilateral femoral shaft fractures result from high-energy injuries.

Adolescent ; Bone Nails ; Child ; Child, Preschool ; Elasticity ; Female ; Femoral Fractures ; surgery ; Fracture Fixation, Intramedullary ; adverse effects ; methods ; Humans ; Male

OBJECTIVE: To explore the influencing factors of perioperative blood transfusion in the treatment of elderly femoral intertrochanteric fractures with proximal femoral nail antirotation(PFNA). METHODS: The clinical data of 109 elderly patients with intertrochanteric fractures who received PFNA treatment from July 2018 to January 2020 were retrospectively analyzed. Both pelvic hip X-rays and CT plain scans were performed before surgery. All patients were diagnosed by X-ray and CT plain scan of pelvis and hip before operation. Through the statistical analysis of the basic data of patients before and during operation, the risk factors of perioperative blood transfusion were explored. RESULTS: Logistic regression analysis showed that age ( CONCLUSION Age, fracture type, diabetes history, and preoperative hemoglobin are independent risk factors for perioperative blood transfusion in the treatment of elderly intertrochanteric fractures with PFNA. The older the patient, the history of diabetes, the more unstable the fracture, and the lower preoperative hemoglobin, the more likely it is to require a blood transfusion, which may provide a reference for clinical perioperative blood transfusion decisions.
Aged ; Blood Transfusion ; Bone Nails ; Fracture Fixation, Intramedullary/adverse effects* ; Hip Fractures/surgery* ; Humans ; Retrospective Studies ; Risk Factors ; Treatment Outcome

Intertrochanteric fractures have become a severe public health problem in elderly patients. Proximal femoral nail anti-rotation (PFNA) is a commonly used intramedullary fixation device for unstable intertrochanteric fractures. Pelvic perforation by cephalic screw is a rare complication. We reported an 84-year-old female who fell at home and sustained an intertrochanteric fracture. The patient underwent surgery with PFNA as the intramedullary fixation device. Routine postoperative examination revealed medial migration of the helical blade that eventually caused pelvic perforation. We performed a cemented total hip arthroplasty as the savage procedure. At the latest follow-up of 12 months after total hip arthroplasty, the patient had no pain or loosening of the prosthesis in the left hip. Pelvic perforation should be considered when choosing PFNA as the intramedullary fixation device, especially in patients with severe osteoporosis wherein the helical blade can be easily inserted during the operation. The lack of devices to avoid oversliding of the helical blade in PFNA is an unreported cause of this complication and should be considered in such cases.
Aged ; Aged, 80 and over ; Bone Nails/adverse effects* ; Female ; Femur ; Fracture Fixation, Intramedullary/adverse effects* ; Hip Fractures/surgery* ; Humans ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo investigate the reasonable methods of treatment for aged intertrochanteric fractures through the comparison and analysis about the clinical data and follow-up results of three kinds of treatment method of elderly intertrochanteric fractures.

METHODSFrom June 2004 to June 2010,131 patients with intertrochanteric fractures were treated and reviewed retrospectively. Among them, 72 patients were treated with dynamic hip screw (DHS) included 20 males and 52 females with an average age of (72.5 +/- 5.5) years, 43 patients were treated with proximal femoral nail antirotation (PFNA) included 12 males and 31 females with an average age of (72.8 +/- 4.9) years and 16 patients were treated with hemiarthroplasty included 4 males and 12 females with an average age of (76.0 +/- 5.0) years. The three groups of patients were statistically analyzed and compared on surgical trauma including operation time, blood loss, incision length, X-ray exposure, and on postoperative recovery including non-weight-bearing walking time, the hospitalization time, the healing time, the recovery of joint function and complications.

RESULTSAll patients were followed-up from 6 months to 3 years (means 18.2 months). In surgical trauma: the results of length of incision,operation time and blood loss was DHS>hemiarthroplasty>PFNA. PFNA group had the most X-ray exposure, hemiarthroplasty group had the least. In postoperative recovery: the results of in non-weight-bearing walking time, hospitalization time and healing time was DHS>PFNA>hemiarthroplasty. Harris scores at 12 weeks after operation in hemiarthroplasty was higher than that of DHS and PFNA, but there was no statistical difference between DHS and PFNA. The incidence of postoperative complications in DHS group was more than that of PFNA group, but there were not significant differences among three groups.

CONCLUSIONPFNA is prepered in the treatment of senile intertrochanteric fractures. DHS fixation is more suitable for primary hospital and AI-type fracture and the fracture near the entry point of PFNA. The hemiarthroplasty is one of the best ways to treat unstable comminuted and/or severe osteoporosis of elderly intertrochanteric fracture. However,it isn't generally considered.

Aged ; Bone Nails ; Bone Screws ; Female ; Fracture Fixation, Internal ; adverse effects ; instrumentation ; methods ; Hip Fractures ; physiopathology ; surgery ; Humans ; Male ; Postoperative Complications ; etiology ; Recovery of Function ; Retrospective Studies ; Time Factors

OBJECTIVETo prospectively evaluate the clinical result of Cable-Pin system in the treatment of olecranon fractures and compare with tension band wiring (TBW) method.

METHODSFrom March 2008 to June 2010,65 patients with olecranon fractures were divided into two groups: 32 patients in Cable-Pin group were treated with Cable-Pin system, including 18 males and 14 females, ranging in age from 21 to 69 years, with an average of (53.69 +/- 13.42) years; 33 patients in TBW group were treated with Kirschner tension bend, including 20 males and 13 females, ranging in age from 20 to 70 years, with an average of (53.18 +/- 13.36) years. The incision length, operation time, the amounts of hemoglobin after operation, fracture healing time, complications and HSS elbow scores were recorded and analyzed statistically. The follow-up period ranged from 12 to 24 months, with an average period of 18.4 months.

RESULTSThere were statistical differences (P<0.05) in fracture healing time (t= 2.588, P=0.012), complication rate (chi2=4.534, P=0.033) and HSS elbow joint scores (Z=-2.039, P=0.041) between two groups, which all were superior to TBW in Cable-Pin group. There was no statistical differences (P>0.05) in the length of incision (t= 0.416, P=0.679), operation time (t=0.816, P=0.417) and the postoperative amounts of hemoglobin (t=-0.553, P=0.294) between two groups.

CONCLUSIONCable-Pin system is an easy and reliable method for the treatment of olecranon fractures with less complications and better functions than TBW.

Adult ; Aged ; Bone Nails ; Bone Wires ; Case-Control Studies ; Female ; Fracture Fixation, Internal ; adverse effects ; methods ; Fracture Healing ; Humans ; Male ; Middle Aged ; Olecranon Process ; injuries ; Prospective Studies

OBJECTIVETo compare the clinical effects of three internal fixations as follows:dynamic hip screw (DHS), proximal femoral nail-A (PFNA) and InterTAN, for intertrochanteric femoral fractures in elderly patients.

METHODSFrom February 2007 to May 2012,136 elderly patients with intertrochanteric fractures (including 71 males and 65 females, ranging in age from 60 to 88 years old with an average of 69 years old) were treated with DHS (group A, 80 cases), PFNA (group B, 36 cases) and InterTAN (group C, 20 cases). Statistical analysis were applied to compare the 3 groups in operative time, blood loss, fracture healing time, intrraoperative complications and functional outcome (Harris hip score).

RESULTSThe average follow-up was 4.1 months (from 2.5 to 14 months). Compared with group A,groups B and C showed significant advantages in operative time, blood loss, fracture healing time, and intrraoperative complications, functional outcome (Harris scores) (P < 0.05). Compared with group B, group C had significant fewer intrraoperative complications (P < 0.05). There were no significant differences in all the indexes except intrraoperative complications between groups B and C (P > 0.05).

CONCLUSIONThe PFNA and InterTAN appear to be more reliable than DHS for the treatment of intertrochanteric femoral fractures in the elderly, but InterTAN appear to be more reliable in comminuted and complex intertrochanteric femoral fractures in the elderly than PFNA.

Aged ; Aged, 80 and over ; Bone Nails ; Bone Screws ; Female ; Fracture Fixation, Internal ; adverse effects ; methods ; Fracture Healing ; Hip Fractures ; surgery ; Humans ; Male ; Middle Aged

OBJECTIVETo investigate the effect of augmentative locking compression plate combined with bone graft in treating aseptic femoral shaft nonunion after intramedullary nailing.

METHODSTwenty-one cases with aseptic femoral shaft nonunion after intramedullary nailing from January 2007 to January 2013 were treated,including 18 males and 3 females with a mean age of 37.7 years (ranged from 23 to 64 years). The mean period of nonunion after surgery was 23.9 months (ranged from 9 to 62 months). According to Weber-Cech classification,10 of those 21 cases were hypertrophic nonunion,7 were atrophic, and 4 had oligotrophic fracture nonunion. All patients retained the original intramedullary nail, and applied with augmentation plating of 6 to 8 holes locking compression plate, unicortical fixation with 2 to 3 locking screws in the proximal or distal end, with simultaneous autologous iliac bone grafting. After treatment,all patients were allowed to partial weight-bearing until full weight-bearing according to the radiological results. All patients were followed up and were evaluated with clinical and imaging results.

RESULTSAll patients were followed up from 8 to 24 months, averaged (13.5±3.5) months,which showed clinical union at 4 to 8 months, averaged (6.0±1.0) months and radiological solid union at 7 to 12 months, averaged (9.1±1.5) months. No such complications as infection,hardware loosening or breaking were found.

CONCLUSIONAugmentative locking compression plate(LCP) combined with bone graft for aseptic femoral shaft nonunion after intramedullary nail has a satisfied clinical efficacy. It's an useful and simple method.

Adult ; Bone Nails ; adverse effects ; Bone Plates ; Bone Transplantation ; Female ; Femoral Fractures ; complications ; surgery ; Follow-Up Studies ; Fracture Fixation, Intramedullary ; adverse effects ; Fractures, Ununited ; complications ; surgery ; Humans ; Male ; Middle Aged ; Postoperative Complications ; etiology ; surgery ; Treatment Outcome ; Young Adult