In this editorial,I present my comments on the article by Solarino et al.Conversion hip arthroplasty,which is an optional salvage procedure performed following unsuccessful fixation of intertrochanteric femur fracture...In this editorial,I present my comments on the article by Solarino et al.Conversion hip arthroplasty,which is an optional salvage procedure performed following unsuccessful fixation of intertrochanteric femur fractures in elderly pati-ents,entails more complex processes and higher rates of operative complications than primary arthroplasty.Hence,it is important to consider the appropriateness of the primary treatment choice,as well as the adequacy of nailing fixation for intertrochanteric fractures.This article briefly analyzes the possible factors contributing to the nailing failure of intertrochanteric fractures and attempts to find corresponding countermeasures to prevent fixation failures.It also analyzes the choice of treatment between nailing fixation and primary arthroplasty for intertrochanteric fractures.展开更多
Background: Fractures of humeral shaft in adults are common injuries. Humeral shafts non-union either from late presentation after initial treatment by traditional bone setters or failed non-operative orthodox care is...Background: Fractures of humeral shaft in adults are common injuries. Humeral shafts non-union either from late presentation after initial treatment by traditional bone setters or failed non-operative orthodox care is a major problem in this part of the world. This non-union is a major treatment challenge with increased cost of care and morbidity in this part of the world. Humeral shaft non-union can be treated with locked intra-medullary nailing (LIMN) or dynamic compression plating (DCP). Study on comparison of these methods of fixation in this part of the world is scarce in literature search, hence the reason for this study. Objective: The objectives of this study are: (1) to compare early clinical outcome following fixation of humeral shaft fracture nonunion with DCP versus LIMN;(2) to compare the time of radiologic fracture union of DCP with LIMN;(3) to compare complications following fixation of humeral shaft fracture nonunion with DCP versus LIMN. Patients and Methods: This was a randomized control study done for 2 years in which fifty adult patients with humeral shaft non-union were recruited. The patients were grouped into 2 (P = DCP & N = LIMN). Forty five of the patients completed the follow up periods of the study and then analyzed. The P group had ORIF with DCP while the N group had ORIF with LIMN. Both groups had grafting with cancellous bones. Each patient was followed up for a period of 6 months at the time which radiographic union is expected. Any patient without clinical and/or radiographic evidence of union after six months of surgery was diagnosed as having recurrent non-union. The data generated was analyzed using SPSS Version 23. The results were presented in charts and tables. The paired t-test was used while considering p value Result: Forty five patients completed follow up. There was a male preponderance (4:1), right humerus predominated (3:2). Motor vehicular accidents were the commonest cause of the fractures (62%). Most non-union fractures occurred at the level of the middle 3<sup>rd</sup> of the humeral shaft (60%). Failed TBS treatment was the commonest indication for the osteosynthesis (71%). More patients had plating (53%) compared to 47% who had LIMN. Most patients (93.4%) had union between 3 to 6 months irrespective of fixation type with no significant statistical difference between the union rate of DCP and LIMN (p value 0.06) with similar functional outcome and complication rates irrespective of the type of fixation. Conclusion: This study showed that the success rates in term of fracture union, outcome functional grades and complication rates were not directly dependent on the types of the fixation: plating or locked intra-medullary nailing.展开更多
BACKGROUND Proximal femur fractures,including both intracapsular(femoral neck fractures)and extracapsular fractures(intertrochanteric femoral fractures,IFFs),affect around 1.5 million people per year worldwide.Mechani...BACKGROUND Proximal femur fractures,including both intracapsular(femoral neck fractures)and extracapsular fractures(intertrochanteric femoral fractures,IFFs),affect around 1.5 million people per year worldwide.Mechanical failures of intertrochanteric nailing in IFFs could be managed with revision total hip arthroplasty(THA).AIM To describe the surgical complexity and the procedure-related complication rates in patients with trochanteric nailing failure and treated with THA.METHODS Patients referred to our level I trauma center between April 2012 and July 2018 with failed cephalomedullary nailing following trochanteric fractures were retrospectively recruited.All patients underwent a salvage surgical procedure,i.e.,cephalomedullary nail removal and conversion to THA.The same surgical and anesthesiology team performed the surgical procedures under spinal anesthesia.All patients underwent clinical and radiographic follow-ups for at least 24 mo.Complications and re-operations were recorded.RESULTS Seventy-four patients met the inclusion criteria(male:29;female:45;mean age:73.8-years-old;range:65-89)and were included in the current study.The average operative time was 117 min(76-192 min).The average blood loss was 585 mL(430-1720 mL).Among the 74 patients,43(58.1%)required transfusion of three or more blood units.Two patients died within the 4th d after surgery because of pulmonary embolism,and 1 patient died 9 mo after surgery due to ischemic myocardial infarction.The complication rate in the 71 patients who completed the minimum 24-mo follow-up was 22.5%.In 3 cases out of 71(4.2%)periprosthetic acetabular fracture was observed during the followup.One of these periacetabular fractures occurred intraoperatively.An intraoperative periprosthetic femur fracture was observed in 5 patients out of 71(7.0%).Four of these patients needed a re-operation to fix the fracture with plates and cerclages;in one of these patients,femoral stem revision was also necessary.In 4 patients out of 71(5.6%),an early THA dislocation was observed,whereas in 1 case(1.4%)a late THA dislocation was observed.Three patients out of 71(4.2%)developed a periprosthetic joint infection during the study follow-up.CONCLUSION The present study demonstrated that salvage options for IFF fixation failure are complex procedures with a relevant intraoperative and postoperative complication rate.展开更多
文摘In this editorial,I present my comments on the article by Solarino et al.Conversion hip arthroplasty,which is an optional salvage procedure performed following unsuccessful fixation of intertrochanteric femur fractures in elderly pati-ents,entails more complex processes and higher rates of operative complications than primary arthroplasty.Hence,it is important to consider the appropriateness of the primary treatment choice,as well as the adequacy of nailing fixation for intertrochanteric fractures.This article briefly analyzes the possible factors contributing to the nailing failure of intertrochanteric fractures and attempts to find corresponding countermeasures to prevent fixation failures.It also analyzes the choice of treatment between nailing fixation and primary arthroplasty for intertrochanteric fractures.
文摘Background: Fractures of humeral shaft in adults are common injuries. Humeral shafts non-union either from late presentation after initial treatment by traditional bone setters or failed non-operative orthodox care is a major problem in this part of the world. This non-union is a major treatment challenge with increased cost of care and morbidity in this part of the world. Humeral shaft non-union can be treated with locked intra-medullary nailing (LIMN) or dynamic compression plating (DCP). Study on comparison of these methods of fixation in this part of the world is scarce in literature search, hence the reason for this study. Objective: The objectives of this study are: (1) to compare early clinical outcome following fixation of humeral shaft fracture nonunion with DCP versus LIMN;(2) to compare the time of radiologic fracture union of DCP with LIMN;(3) to compare complications following fixation of humeral shaft fracture nonunion with DCP versus LIMN. Patients and Methods: This was a randomized control study done for 2 years in which fifty adult patients with humeral shaft non-union were recruited. The patients were grouped into 2 (P = DCP & N = LIMN). Forty five of the patients completed the follow up periods of the study and then analyzed. The P group had ORIF with DCP while the N group had ORIF with LIMN. Both groups had grafting with cancellous bones. Each patient was followed up for a period of 6 months at the time which radiographic union is expected. Any patient without clinical and/or radiographic evidence of union after six months of surgery was diagnosed as having recurrent non-union. The data generated was analyzed using SPSS Version 23. The results were presented in charts and tables. The paired t-test was used while considering p value Result: Forty five patients completed follow up. There was a male preponderance (4:1), right humerus predominated (3:2). Motor vehicular accidents were the commonest cause of the fractures (62%). Most non-union fractures occurred at the level of the middle 3<sup>rd</sup> of the humeral shaft (60%). Failed TBS treatment was the commonest indication for the osteosynthesis (71%). More patients had plating (53%) compared to 47% who had LIMN. Most patients (93.4%) had union between 3 to 6 months irrespective of fixation type with no significant statistical difference between the union rate of DCP and LIMN (p value 0.06) with similar functional outcome and complication rates irrespective of the type of fixation. Conclusion: This study showed that the success rates in term of fracture union, outcome functional grades and complication rates were not directly dependent on the types of the fixation: plating or locked intra-medullary nailing.
文摘BACKGROUND Proximal femur fractures,including both intracapsular(femoral neck fractures)and extracapsular fractures(intertrochanteric femoral fractures,IFFs),affect around 1.5 million people per year worldwide.Mechanical failures of intertrochanteric nailing in IFFs could be managed with revision total hip arthroplasty(THA).AIM To describe the surgical complexity and the procedure-related complication rates in patients with trochanteric nailing failure and treated with THA.METHODS Patients referred to our level I trauma center between April 2012 and July 2018 with failed cephalomedullary nailing following trochanteric fractures were retrospectively recruited.All patients underwent a salvage surgical procedure,i.e.,cephalomedullary nail removal and conversion to THA.The same surgical and anesthesiology team performed the surgical procedures under spinal anesthesia.All patients underwent clinical and radiographic follow-ups for at least 24 mo.Complications and re-operations were recorded.RESULTS Seventy-four patients met the inclusion criteria(male:29;female:45;mean age:73.8-years-old;range:65-89)and were included in the current study.The average operative time was 117 min(76-192 min).The average blood loss was 585 mL(430-1720 mL).Among the 74 patients,43(58.1%)required transfusion of three or more blood units.Two patients died within the 4th d after surgery because of pulmonary embolism,and 1 patient died 9 mo after surgery due to ischemic myocardial infarction.The complication rate in the 71 patients who completed the minimum 24-mo follow-up was 22.5%.In 3 cases out of 71(4.2%)periprosthetic acetabular fracture was observed during the followup.One of these periacetabular fractures occurred intraoperatively.An intraoperative periprosthetic femur fracture was observed in 5 patients out of 71(7.0%).Four of these patients needed a re-operation to fix the fracture with plates and cerclages;in one of these patients,femoral stem revision was also necessary.In 4 patients out of 71(5.6%),an early THA dislocation was observed,whereas in 1 case(1.4%)a late THA dislocation was observed.Three patients out of 71(4.2%)developed a periprosthetic joint infection during the study follow-up.CONCLUSION The present study demonstrated that salvage options for IFF fixation failure are complex procedures with a relevant intraoperative and postoperative complication rate.