We report on three cases of subtrochanteric femoral fractures during trochanteric intramedullary nailing for the treatment of femoral shaft fractures. Trochanteric intramedullary nails, which have a proximal lateral bend, are specifically designed for trochanteric insertion. When combined with the modified insertion technique, trochanteric intramedullary nails reduce iatrogenic fracture comminution and varus malalignment. We herein describe technical aspects of trochanteric intramedullary nailing for femoral shaft fractures to improve its application and prevent implant-derived complications.
Adult ; Aged ; Female ; Femoral Fractures/radiography/*surgery ; Fracture Fixation, Internal/*adverse effects/methods ; Hip Fractures/*etiology/radiography ; Humans ; Iatrogenic Disease ; Male ; Middle Aged

BACKGROUND: We evaluated the clinical and radiologic results of impacted femoral neck fractures treated with multiple pinning and determined the influence of the progression of impaction at the fracture site on clinical outcome. METHODS: There were 34 patients with a mean age of 65.5 years. The mean follow-up period was 3.4 years. Progression of fracture site impaction was measured using an articulo-trochanteric distance index and the percentage decrease in the articulo-trochanteric distance index between follow-up intervals. The failure of treatment was clarified as non-union and avascular necrosis. Other characteristics of the patients, including mean waiting time for surgery, preoperative Singh index score, and body mass index, were also measured to evaluate the influence on the clinical outcome of surgery. RESULTS: There were 6 fractures which were not treated successfully (3 non-union, 8.8% and 3 avascular necrosis, 8.8%). The mean percentage decrease of the articulo-trochanteric distance index within the first 6 weeks after surgery was 4.5% in the successful group and 25.1% in the failure group (p < 0.001). There was also a significant mean percentage decrease in the articulo-trochanteric distance index between 6 weeks and 3 months (p < 0.001). CONCLUSIONS: Primary stabilization with Knowles pins for impacted femoral neck fractures had a reasonable clinical outcome with low morbidity. Despite a significant difference of a mean percentage decrease in the articulo-trochanteric distance index between the successful group and the failure group, we could not verify it as a risk factor for failure of treatment because the odds ratio was not statistically significant.
Adult ; Aged ; Aged, 80 and over ; Bone Nails ; Female ; Femoral Neck Fractures/complications/radiography/*surgery ; Femur Head Necrosis/etiology/radiography ; Follow-Up Studies ; *Fracture Fixation, Internal ; Fractures, Ununited/radiography ; Hip Joint/*pathology/radiography ; Humans ; Male ; Middle Aged ; Odds Ratio ; Treatment Outcome

BACKGROUND: We evaluated the clinical and radiologic results of impacted femoral neck fractures treated with multiple pinning and determined the influence of the progression of impaction at the fracture site on clinical outcome. METHODS: There were 34 patients with a mean age of 65.5 years. The mean follow-up period was 3.4 years. Progression of fracture site impaction was measured using an articulo-trochanteric distance index and the percentage decrease in the articulo-trochanteric distance index between follow-up intervals. The failure of treatment was clarified as non-union and avascular necrosis. Other characteristics of the patients, including mean waiting time for surgery, preoperative Singh index score, and body mass index, were also measured to evaluate the influence on the clinical outcome of surgery. RESULTS: There were 6 fractures which were not treated successfully (3 non-union, 8.8% and 3 avascular necrosis, 8.8%). The mean percentage decrease of the articulo-trochanteric distance index within the first 6 weeks after surgery was 4.5% in the successful group and 25.1% in the failure group (p < 0.001). There was also a significant mean percentage decrease in the articulo-trochanteric distance index between 6 weeks and 3 months (p < 0.001). CONCLUSIONS: Primary stabilization with Knowles pins for impacted femoral neck fractures had a reasonable clinical outcome with low morbidity. Despite a significant difference of a mean percentage decrease in the articulo-trochanteric distance index between the successful group and the failure group, we could not verify it as a risk factor for failure of treatment because the odds ratio was not statistically significant.
Adult ; Aged ; Aged, 80 and over ; Bone Nails ; Female ; Femoral Neck Fractures/complications/radiography/*surgery ; Femur Head Necrosis/etiology/radiography ; Follow-Up Studies ; *Fracture Fixation, Internal ; Fractures, Ununited/radiography ; Hip Joint/*pathology/radiography ; Humans ; Male ; Middle Aged ; Odds Ratio ; Treatment Outcome

BACKGROUND: The osteosynthesis of the periprosthetic fractures following a total knee arthroplasty (TKA) can be technically difficult with the relatively small satisfactory outcomes and the high complication rates. The purpose of the study is to analyze the mid-term radiological and functional outcomes following the locked plating of the distal femur periprosthetic fractures after a TKA. METHODS: Records of 20 patients with a periprosthetic distal femur fracture following TKA treated by the locked plate osteosynthesis were retrospectively evaluated. The union rate, complications and functional outcome measures were analyzed. RESULTS: Successful union was achieved in 18 of the 19 patients available for the follow-up. The mean follow-up was 39 +/- 10 months. Significant reductions (p < 0.05) in the range of motion and Western Ontario and McMaster Universities Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores were evident in the follow-up. Secondary procedures were required in 5 patients to address the delay in union and the reduced knee range of motion. The osteosynthesis failed in 1 patient who underwent a revision TKA. CONCLUSIONS: The satisfactory union rates can be achieved with the locked plate osteosynthesis in the periprosthetic distal femur fractures after TKA. Prolonged rehabilitation coupled with the un-modifiable risk factors can decrease the activity and satisfaction levels, which can significantly alter the functional outcome.
Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Knee/*adverse effects ; Female ; Femoral Fractures/*etiology/radiography ; Fracture Fixation, Internal/*adverse effects ; Humans ; Male ; Osteoporosis/epidemiology ; Periprosthetic Fractures/*etiology/radiography ; Postoperative Complications/etiology ; Range of Motion, Articular ; Retrospective Studies ; Risk Factors ; Treatment Outcome

BACKGROUND: Currently, an algorithmic approach for deciding treatment options according to the Vancouver classification is widely used for treatment of periprosthetic femoral fractures after hip arthroplasty. However, this treatment algorithm based on the Vancouver classification lacks consideration of patient physiology and surgeon's experience (judgment), which are also important for deciding treatment options. The purpose of this study was to assess the treatment results and discuss the treatment options using a case series. METHODS: Eighteen consecutive cases with periprosthetic femoral fractures after total hip arthroplasty and hemiarthroplasty were retrospectively reviewed. A locking compression plate system was used for osteosynthesis during the study period. The fracture type was determined by the Vancouver classification. The treatment algorithm based on the Vancouver classification was generally applied, but was modified in some cases according to the surgeon's judgment. The reasons for modification of the treatment algorithm were investigated. Mobility status, ambulatory status, and social status were assessed before the fracture and at the latest follow-up. Radiological results including bony union and stem stability were also evaluated. RESULTS: Thirteen cases were treated by osteosynthesis, two by revision arthroplasty and three by conservative treatment. Four cases of type B2 fractures with a loose stem, in which revision arthroplasty is recommended according to the Vancouver classification, were treated by other options. Of these, three were treated by osteosynthesis and one was treated conservatively. The reasons why the three cases were treated by osteosynthesis were technical difficulty associated with performance of revision arthroplasty owing to severe central migration of an Austin-Moore implant in one case and subsequent severe hip contracture and low activity in two cases. The reasons for the conservative treatment in the remaining case were low activity, low-grade pain, previous wiring around the fracture and light weight. All patients obtained primary bony union and almost fully regained their prior activities. CONCLUSIONS: We suggest reaching a decision regarding treatment methods of periprosthetic femoral fractures by following the algorithmic approach of the Vancouver classification in addition to the assessment of each patient's hip joint pathology, physical status and activity, especially for type B2 fractures. The customized treatments demonstrated favorable overall results.
Aged ; Aged, 80 and over ; Algorithms ; Arthroplasty, Replacement, Hip/*adverse effects ; Female ; Femoral Fractures/classification/etiology/radiography/*surgery ; Hemiarthroplasty/adverse effects ; Humans ; Male ; Middle Aged ; Periprosthetic Fractures/classification/etiology/radiography/*surgery ; Retrospective Studies

OBJECTIVETo determine whether bone density is related to osteoarthritis and to compare osteoarthritis with osteoporotic fracture of the femoral neck.

METHODSAll 165 femoral heads removed at joint replacement surgery were divided into 4 groups according to radiographic features of hip (osteophytes, subchondral sclerosis, cysts and femoral head deformity). The individual femoral head was divided into 5 zones histologically. Sections were studied histomorphologically, and quantitation was performed using the computer-assisted system to determine the bone density of the femoral head.

RESULTSThe values of bone density in weight-bearing, super lateral non weight-bearing (SL) and inferior medial non weight-bearing (IM) areas after femoral neck fracture in patients with osteoarthritis were lower than normal. The values of bone density in weight bearing area were increased in patients with osteoarthritis in all four groups but lower than normal in one group (I), and higher than normal in other 2 groups (III, IV). The values of bone density in SL and IM areas except IM area in group IV were lower than normal (P > 0.05). The values of bone density in the central area in the 4 groups were relatively consistent and normal. The density of Haversian canals was increased in the 4 groups indicating osteoporosis of the femoral head. The average age of patients with femoral neck fracture associated with OA (group I) was significantly higher than that of group II, III, IV (P < 0.05).

CONCLUSIONSBone density is different in the femoral head and neck. Dividing the weight bearing joint into distinct zones is a method for laboratory and clinical study. Femoral neck fracture associated with OA was caused by osteoporosis which is related to the age of the patient. The data of this study can be regarded as a potential indicator of implant/host bone relations with morphological, morphometric implications.

Adult ; Aged ; Aged, 80 and over ; Bone Density ; Female ; Femoral Neck Fractures ; etiology ; Femur Head ; diagnostic imaging ; pathology ; physiopathology ; Humans ; Male ; Middle Aged ; Osteoarthritis ; complications ; pathology ; physiopathology ; Osteoporosis ; complications ; physiopathology ; Radiography

Adult ; Bone and Bones ; diagnostic imaging ; injuries ; Femoral Fractures ; surgery ; therapy ; Foot Deformities, Acquired ; diagnosis ; etiology ; therapy ; Fracture Fixation, Intramedullary ; adverse effects ; methods ; Fractures, Ununited ; diagnostic imaging ; etiology ; surgery ; Humans ; Intra-Articular Fractures ; diagnostic imaging ; surgery ; Male ; Radiography ; methods ; Reoperation ; methods ; Treatment Outcome