Treatment of reverse oblique trochanteric femoral fractures with proximal femoral nail

Orthopaedic and Traumatology Department, Goztepe Research and Training Hospital, Istanbul, Turkey.
International Orthopaedics (Impact Factor: 2.11). 03/2010; 35(4):595-8. DOI: 10.1007/s00264-010-1002-z
Source: PubMed


Treatment of reverse oblique trochanteric femoral fractures is still challenging. We present the results of our proximal nailing surgery performed for reverse obliquity intertrochanteric fractures using two lag screws and evaluated the quality of the reduction, operative time, complications and functional status of the patients. Fifteen patients with AO/OTA 31 A-A3 fractures were treated by proximal femoral nailing in our trauma centre. The mean Harris hip score was 74.66 (range 65-96) and the mean Barthel activity score was 15.71 (range 12-20). The mean duration of surgery was 48 minutes and the average consolidation time was 8.6 weeks. No intraoperative complications or postoperative technical failures and no stress shielding as evidenced by the lack of cortical hypertrophy at the level of the tip of the implant were detected. Intramedullary nailing with proximal femoral nails may be a good option in the treatment of reverse obliquity intertrochanteric fractures.

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Available from: Budak Akman, Apr 20, 2014
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    • "Due to aging of the population and the increasing number of elderly persons, the incidence of hip fractures is predicted to double over the next 15 to 20 years [1]. Since their introduction over 15 years ago and subsequent widespread adoption, the so-called cephalomedullary nails that incorporate fixation into the femoral head have become a standard treatment for these proximal femur fractures [2–7]. Despite their popularity, the technology associated with these nails has only been incrementally advanced over the last 10–15 years, with most of the design changes having been done to lessen the likelihood of intraoperative fracture of the femur and cutout of the lag screw [8, 9] Reports of the results of the stabilization of proximal femoral fractures with cephalomedullary nails indicate that more than 10% of cases demonstrate varus malreduction, with neck-shaft angles that are more than 10° of varus relative to the contralateral side [10, 11]. "
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    ABSTRACT: Ten percent of the 250,000 proximal femur fractures that occur in the United States each year are malreduced into a varus position after treatment. Currently, there is no cephalomedullary nail available that allows the physician to dynamically change the lag-screw-to-nail angle. The Variable Angle Nail (VAN) was designed to allow movement of the lag screw relative to the shaft of the nail. This study compared the characteristics of the VAN to the Gamma 3 nail via finite element analysis (FEA) in stiffness and fatigue. The results of the FEA model with the same loading parameters showed the Gamma 3 and the VAN with lag-screw-to-nail angle of 120° to have essentially the same stiffness values ranging from 350 to 382 N/mm. The VAN with lag-screw-to-nail angles of 120°, 130°, and 140° should be able to withstand more than 1,000,000 cycles from 1,400 N to 1,500 N loading of the tip of the lag screw. The Gamma 3 should be able to last more than 1,000,000 cycles at 1,400 N. In summary, the VAN is superior or equivalent in stiffness and fatigue when compared to the Gamma 3 using FEA.
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