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European Journal of Trauma and Emergency Surgery

Erschienen in:

03.03.2017 | Original Article

The challenge of non-union in subtrochanteric fractures with breakage of intramedullary nail: evaluation of outcomes in surgery revision with angled blade plate and allograft bone strut

verfasst von: G. Rollo, N. Tartaglia, G. Falzarano, P. Pichierri, A. Stasi, A. Medici, L. Meccariello

Erschienen in: European Journal of Trauma and Emergency Surgery | Ausgabe 6/2017

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Abstract

Purpose

Subtrochanteric fractures have a bimodal age distribution. They usually require open reduction and internal fixation. Closed reduction and intramedullary nail fixation rate are increased for this type of fracture. As a result, the hardware breakage and non-union rate is high among such patients. Our purpose is to evaluate the outcomes of the role of blade plate and bone strut allograft in the management of subtrochanteric non-union by femoral nailing.

Materials and methods

We reported a group of 22 patients with subtrochanteric non-union, associated with breakage of the intramedullary nail with medial femoral allograft bone and lateral blade plate and wire (PS) s; and a group of 13 patients with subtrochanteric non-union, associated with breakage of the intramedullary nail treated with lateral blade plate and screws (CG). The chosen criteria to evaluate the two group during the clinical and radiological follow-up were the quality of life, measured by The Short Form (12) Health Survey (SF-12), the hip function and quality of life related to it, measured by the Harris Hip Score (HHS), bone healing, measured by Radiographic Union Score (RUS) by XR and CT at 1 year after the surgery, and postoperative complications. The evaluation endpoint was set at 12 months.

Results

The Bone healing measured by RUS occurred and also the full recovery before the first trauma measured by SF-12 and HHS are better in PS group. We only had three unimportant complications in PS while four breakage hardware in CG.

Conclusion

We conclude that in complicated non-unions, the use of blade plate and bone strut allograft has a definite positive role in the management of such cases.

Handoll HH, Parker MJ. Conservative versus operative treatment for hip fractures in adults. Cochrane Database Syst Rev 2008;(3):CD000337. doi: 10.1002/14651858.CD000337.pub2.

Lix LM, Quail J, Teare G, Acan B. Performance of comorbidity measures for predicting outcomes in population-based osteoporosis cohorts. Osteoporos Int. 2011;22(10):2633–43. doi: 10.1007/s00198-010-1516-7. CrossRefPubMed

Wee JL, Sathappan SS, Yeo MS, Low YP. Management of gamma nail breakage with bipolar hemi-arthroplasty. Singap Med J. 2009;50(1):e44–e7.

Lorich DG, Geller DS, Nielson JH. Osteoporotic pertrochanteric hip fractures: management and current controversies. Instr Course Lect. 2004;53:441–54. PubMed

Bernstein J, Ahn J: Provider factors associated with intramedullary nail use for intertrochanteric hip fractures. J Bone Joint Surg Am. 2010;92(15):2619. PubMed

Anglen JO, Weinstein JN, American Board of Orthopaedic Surgery Research Committee: Nail or plate fixation of intertrochanteric hip fractures: changing pattern of practice. A review of the American Board of Orthopaedic Surgery Database. J Bone Joint Surg Am. 2008;90(4):700–7. CrossRefPubMed

Maniscalco P, Rivera F, D’Ascola J, Del Vecchio EO. Failure of intertrochanteric nailing due to distal nail jamming. J Orthop Traumatol. 2013;14(1):71–4. CrossRefPubMed

Yeo I, Rhyu KH, Kim SM, Park YS, Lim SJ. High union rates of locking compression plating with cortical strut allograft for type B1 periprosthetic femoral fractures. Int Orthop. 2016. doi: 10.1007/s00264-015-3107-x.

Burnei C, Popescu G, Barbu D, Capraru F. Intramedullary osteosynthesis versus plate osteosynthesis in subtrochanteric fractures. J Med Life. 2011;14(4):324–9.

10.

Salomone C, Burastero G, Rita A, Felli L, Biasibetti A. Nonunions in diaphyseal fractures. Lo Scalpello. 2015;29:44–8. doi: 10.1007/s11639-015-0102-3. CrossRef

11.

Calori GM, Colombo M, Mazza EL, Mazzola S, Malagoli E, Marelli N, Corradi A. Validation of the Non-Union Scoring System in 300 long bone non-unions. Injury. 2014;45 (Suppl 6):S93–7. doi: 10.1016/j.injury.2014.10.030.

12.

Dettoni F, Pellegrino P, La Russa MR, Bonasia DE, Blonna D, Bruzzone M, Castoldi F, Rossi R. Validation and cross cultural adaptation of the Italian version of the Harris Hip Score. Hip Int. 2015;25(1):91–7. doi: 10.5301/hipint.5000184. CrossRefPubMed

13.

Litrenta J, Tornetta P 3rd, Mehta S, Jones C, OʼToole RV, Bhandari M, Kottmeier S, Ostrum R, Egol K, Ricci W, Schemitsch E, Horwitz D. Determination of radiographic healing: an assessment of consistency using RUST and modified RUST in metadiaphyseal fractures. J Orthop Trauma. 2015;29(11):516–20. doi: 10.1097/BOT.0000000000000390. CrossRefPubMed

14.

Iwakura T, Niikura T, Lee SY, Sakai Y, Nishida K, Kuroda R, Kurosaka M. Breakage of a third generation gamma nail: a case report and review of the literature. Case Rep Orthop. 2013;2013:172352. doi: 10.1155/2013/172352. PubMedPubMedCentral

15.

Liu P, Wu X, Shi H, Liu R, Shu H, Gong J, Yang Y, Sun Q, Wu J, Nie X, Cai M. Intramedullary versus extramedullary fixation in the management of subtrochanteric femur fractures: a meta-analysis. Clin Interv Aging. 2015;10:803–11. doi: 10.2147/CIA.S82119. PubMedPubMedCentral

16.

Liu W, Zhou D, Liu F, Weaver MJ, Vrahas MS. Mechanical complications of intertrochanteric hip fractures treated with trochanteric femoral nails. J Trauma Acute Care Surg. 2013;75(2):304–10. doi: 10.1097/TA.0b013e31829a2c43. CrossRefPubMed

17.

Chang SM, Zhang YQ, Ma Z, Li Q, Dargel J, Eysel P. Fracture reduction with positive medial cortical support: a key element in stability reconstruction for the unstable pertrochanteric hip fractures. Arch Orthop Trauma Surg. 2015;135(6):811–8. doi: 10.1007/s00402-015-2206-x. CrossRefPubMedPubMedCentral

18.

Barquet A. The treatment of subtrochanteric nonunions with the long gamma nail: twenty-six patients with a minimum 2-year follow-up. J Orthop Trauma. 2005;19(4):294. CrossRefPubMed

19.

Wirtz C, Abbassi F, Evangelopoulos DS, Kohl S, Siebenrock KA, Krüger A. High failure rate of trochanteric fracture osteosynthesis with proximal femoral locking compression plate. Injury. 2013;44(6):751–6. doi: 10.1016/j.injury.2013.02.020. CrossRefPubMed

20.

Saini P, Kumar R, Shekhawat V, Joshi N, Bansal M, Kumar S. Biological fixation of comminuted subtrochanteric fractures with proximal femur locking compression plate. Injury. 2013;44(2):226–31. doi: 10.1016/j.injury.2012.10.037. CrossRefPubMed

21.

D’Arrigo C, Perugia D, Carcangiu A, Monaco E, Speranza A, Ferretti A. Hip arthroplasty for failed treatment of proximal femoral fractures. Int Orthop. 2010;34(7):939–42. CrossRefPubMed

22.

Tomás Hernández J, Holck K. Periprosthetic femoral fractures: When I use strut grafts and why? Injury. 2015;46(Suppl 5):S43–6. doi: 10.1016/j.injury.2015.08.012. CrossRefPubMed

23.

Peters CL, Bachus KN, Davitt JS. Fixation of periprosthetic femur fractures: a biomechanical analysis comparing cortical strut allograft plates and conventional metal plates. Orthopedics. 2003;26(7):695–9. PubMed

24.

Choi JK, Gardner TR, Yoon E, Morrison TA, Macaulay WB, Geller JA. The effect of fixation technique on the stiffness of comminuted Vancouver B1 periprosthetic femur fractures. J Arthroplasty. 2010;25(6 Suppl):124–8. CrossRefPubMed

25.

Carta S, Fortina M, Riva A, Meccariello L, Manzi M, Di Giovanni A, Paolo Ferrata. The biological metallic versus metallic solution in treating periprosthetic femoral fractures: outcome assessment. Adv Med. 2016. doi: 10.1155/2016/2918735. PubMedPubMedCentral

26.

Wang J-W, Wang C-J. Supracondylar fractures of the femur above total knee arthroplasties with cortical allograft struts. J Arthroplasty. 2002;17(3):365–72. CrossRefPubMed

27.

Pelet S, Arlettaz Y, Chevalley F. Osteosynthesis of per- and subtrochanteric fractures by blade plate versus gamma nail. A randomized prospective study. Swiss Surg. 2001;7(3):126–33. CrossRefPubMed

28.

Bartonicek J, Skala-Rosenbaum J, Dousa P. Valgus intertrochanteric osteotomy for malunion and nonunion of trochanteric fractures. J Orthop Trauma. 2003;17(9):606–12. CrossRefPubMed

Titel: The challenge of non-union in subtrochanteric fractures with breakage of intramedullary nail: evaluation of outcomes in surgery revision with angled blade plate and allograft bone strut
verfasst von: G. Rollo
N. Tartaglia
G. Falzarano
P. Pichierri
A. Stasi
A. Medici
L. Meccariello
Publikationsdatum: 03.03.2017
Verlag: Springer Berlin Heidelberg
Erschienen in: European Journal of Trauma and Emergency Surgery / Ausgabe 6/2017
Print ISSN: 1863-9933
Elektronische ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-016-0755-5

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The challenge of non-union in subtrochanteric fractures with breakage of intramedullary nail: evaluation of outcomes in surgery revision with angled blade plate and allograft bone strut

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Purpose

Materials and methods

Results

Conclusion

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Springer Medizin

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Materials and methods

Results

Conclusion

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