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A43 Long gamma nail with distal targeting system in the treatment of subtrochanteric fractures
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Oral presentations / Injury, Int. J. Care Injured 42 (2011) S3, S1–S24
sustained a pertrochanteric fracture. The mean age of these patients at the time of admission was 74 year old. All patients were treated surgically with internal fixation using short cephalocondylic nails. By the time of a standardised follow up visit at least 5 years after the operation, 30 of these patients had died. The remaining 216 patients were evaluated clinically and radiographically, using Harris Hip Score to assess postoperative functionality and standard x-ray check of the operated femur. Results: The mean Harris Hip Score was 84. All patients had good to excellent function except for 7 who were reported as being non ambulatory. Radiographic evidence of fracture consolidation was found in all cases. Conclusion: The results of intramedullary nailing of intertrochanteric fractures with the use of a short g-nail were very good at a minimum of 5 years. Our data suggest that surgical treatment of pertrochanteric fractures with this kind of fixation is secure. A43 Long gamma nail with distal targeting system in the treatment of subtrochanteric fractures N. Barbounakis, D. Nikolopoulos, C. Rossas, G. Karatzas, C. Aggelidis, I. Michos. D Orthopaedic Department, Asklepeion Voulas General Hospital, Greece Aim: The standard gamma nail is commonly used for the treatment of trochanteric fractures but cannot be used if the fracture lies at the level of the distal locking. The Long Gamma nail succeeded to overcome this inconvenience and could be used for all cases of subtrochanteric and trochanteric-shaft fractures; whereas the distal targeting system (DTS) minimizes the problems with the distal screws. Materials & Methods: Over a period of 11 /2 years, 12 patients (5 male, 7 female) of mean age 69.4 years old (range, 54–82) with subtrochanteric fractures, were treated with the Long Gamma nail with Distal Targeting system (LGNDTS). In order to evaluate the clinical and radiological outcomes, we reviewed the clinical and radiographic charts of these patients followed for a mean time of 10 months (range, 6–36 months). Results: Neither intra- or perioperative complications nor early or late infection were detected. Clinical and radiological union was achieved at a mean of 4.2 months (range 3–7 months). The distal locking screws were easily fixed without any complications. The mean duration of surgery was diminished to 50 min versus 70 min of the free hand technique. None of our patients required revision surgery. Weight-bearing with support was possible early after surgery in all patients who walked with crutches or a walker. Conclusions: The minimally invasive technique and simple application of the LGNDTS lead to a low percentage of complications in these difficult fractures, after a relatively short learning curve. The DTS minimizes the duration of surgery and decreases the complications with the distal locking screws. A44 Management of subtrochanteric femoral fractures with long gamma nails intramedullary fixation device A. Foukas, G. Konstantinidis, A. Adam, Th. Karagounis, St. Papastergiou. Orthopaedic Clinic of General Public Hospital “St. Paul”, Thessaloniki, Greece Aim: This retrospective study reports on the clinical results of a group of 18 patients with subtrochanteric femoral fractures using Long Gamma nail intramedullary device. Material & Methods: Between January 2008-January 2011, 18 patients (14 women, 4 men; average age 67.2 years old) with subtrochanteric femoral fractures were treated surgically. According to the AO/ASIF Classification, 5 (27.8%) fractures were type 32-A, 6 (33.3%) were type 32-B and 7 (38.9%) fractures were type 32-C. Of the 18 fractures 15 of them had been the result of an unexpected
fall, 2 were the result of a hight-energy trauma and 1 consisted of pathologic fracture. The mean follow-up time was 18 months. All the patients were treated by nailing the fracture with Long Gamma fixation Nail and they received clinical and radiological follow-ups at least until their fractures were consolidated. Results: The average operating time was 65 minutes (range, 45 to 90 minutes). The average blood loss was 250 mL (range, 125 to 350 mL). The average hospital stay was 12 days. Implant failure was not observed and union was achieved in all the patients. Deep infection occurred in one (5%) patient in the early postoperative period. Fracture union was achieved at a mean of 14 weeks. Varus malalignment less then 10 degree was noted in ten (11%) patients at the end of follow-up. Twelve patients were pain-free and six had mild pain. Conclusions: The Long Gamma nail is a safe and reliable intramedullary device for the treatment of subtrochanteric fractures of the femur. It provides a short operative time, low blood loss, spontaneous biaxial dynamisation and healing in an optimal period of time. Despite the improvement of implants and surgical techniques, failures due to complications are still considerable. Open reduction may be required so as to obtain a correct alignment of the fracture. A45 Intramedullary stem lengthening in situ in the treatment of periprosthetic fractures of the femur A.N. Chelnokov, I.M. Piven. Ural Scientific Institute of Traumatology and Orthopaedics named after V.D. Chaklin, Ekaterinburg, Russia Purpose/Aim: Conventional management of preiprosthetic femoral fracture fixation includes plating, cerclage and cortical struts, and results with high complication rate and 21% reoperations within first postoperative year (Zuurmond R. et al., 2007). Aim of our study was to design a technique of less invasive fixation in periprostethic fractures of the femoral shaft to provide primary stability of the stem and the femur. Material and Methods: Motivated by a case of plate failure in periprosthtic femoral fracture we designed and used a modification of an industrial solid titanium femoral locked nail. Its design provides tight fit of the distal part of the femoral stem. 13 patients were treated in 2007–2011 with the technique. There were 7/13 Vancouver B1, 3/10 B2 fractures, and 3/10 B3. Fixator-assisted nailing was used with small wire external distractor for acute or gradual reduction. The nails were individually custom-made to fit the particular stem design and size. The inserted nail was locked distally with two or three 6 mm screws. Results: Less invasive surgery and stable fixation provided fast recovery. Immediate weight-bearing as tolerated was recommended in most cases. Unassisted walking occurred at 2 month in 6/13 patients, and at 3 month in 12/13. 10 patients were available for follow-up in 1 year – all fractures healed. Major complications (2/13) include one case of deep infection resulted with two stage revision to a standard cementless stem 1.5 year after the surgery, and one case of extremely slim stem breakage at the level of junction revised to a long stem in three month after the surgery. Conclusion. Since 2007 few publications appeared (Zuurmond R.G. et al., 2007; Meyer C. et al., 2007) presenting similar approach with good results in series of 18–25 cases. We conclude that the technique can be an effective solution in problematic cases of failed plating after periprosthetic fractures. For elderly patients with severe comorbities the technique offers less inavsive treatment option with quick recovery. Immediate unrestricted weight-bearing appears safe in majority of cases. Some aspects of the technique concerning indications, possible stress-shielding, need of nail dynamization, implant removal require further research. Reference(s) [1] Zuurmond RG, Pilot P, Verburg AD. Retrograde bridging nailing of periprosthetic femoral fractures. Injury. 2007 Aug;38(8):958–64.
Oral presentations / Injury, Int. J. Care Injured 42 (2011) S3, S1–S24
sustained a pertrochanteric fracture. The mean age of these patients at the time of admission was 74 year old. All patients were treated surgically with internal fixation using short cephalocondylic nails. By the time of a standardised follow up visit at least 5 years after the operation, 30 of these patients had died. The remaining 216 patients were evaluated clinically and radiographically, using Harris Hip Score to assess postoperative functionality and standard x-ray check of the operated femur. Results: The mean Harris Hip Score was 84. All patients had good to excellent function except for 7 who were reported as being non ambulatory. Radiographic evidence of fracture consolidation was found in all cases. Conclusion: The results of intramedullary nailing of intertrochanteric fractures with the use of a short g-nail were very good at a minimum of 5 years. Our data suggest that surgical treatment of pertrochanteric fractures with this kind of fixation is secure. A43 Long gamma nail with distal targeting system in the treatment of subtrochanteric fractures N. Barbounakis, D. Nikolopoulos, C. Rossas, G. Karatzas, C. Aggelidis, I. Michos. D Orthopaedic Department, Asklepeion Voulas General Hospital, Greece Aim: The standard gamma nail is commonly used for the treatment of trochanteric fractures but cannot be used if the fracture lies at the level of the distal locking. The Long Gamma nail succeeded to overcome this inconvenience and could be used for all cases of subtrochanteric and trochanteric-shaft fractures; whereas the distal targeting system (DTS) minimizes the problems with the distal screws. Materials & Methods: Over a period of 11 /2 years, 12 patients (5 male, 7 female) of mean age 69.4 years old (range, 54–82) with subtrochanteric fractures, were treated with the Long Gamma nail with Distal Targeting system (LGNDTS). In order to evaluate the clinical and radiological outcomes, we reviewed the clinical and radiographic charts of these patients followed for a mean time of 10 months (range, 6–36 months). Results: Neither intra- or perioperative complications nor early or late infection were detected. Clinical and radiological union was achieved at a mean of 4.2 months (range 3–7 months). The distal locking screws were easily fixed without any complications. The mean duration of surgery was diminished to 50 min versus 70 min of the free hand technique. None of our patients required revision surgery. Weight-bearing with support was possible early after surgery in all patients who walked with crutches or a walker. Conclusions: The minimally invasive technique and simple application of the LGNDTS lead to a low percentage of complications in these difficult fractures, after a relatively short learning curve. The DTS minimizes the duration of surgery and decreases the complications with the distal locking screws. A44 Management of subtrochanteric femoral fractures with long gamma nails intramedullary fixation device A. Foukas, G. Konstantinidis, A. Adam, Th. Karagounis, St. Papastergiou. Orthopaedic Clinic of General Public Hospital “St. Paul”, Thessaloniki, Greece Aim: This retrospective study reports on the clinical results of a group of 18 patients with subtrochanteric femoral fractures using Long Gamma nail intramedullary device. Material & Methods: Between January 2008-January 2011, 18 patients (14 women, 4 men; average age 67.2 years old) with subtrochanteric femoral fractures were treated surgically. According to the AO/ASIF Classification, 5 (27.8%) fractures were type 32-A, 6 (33.3%) were type 32-B and 7 (38.9%) fractures were type 32-C. Of the 18 fractures 15 of them had been the result of an unexpected
fall, 2 were the result of a hight-energy trauma and 1 consisted of pathologic fracture. The mean follow-up time was 18 months. All the patients were treated by nailing the fracture with Long Gamma fixation Nail and they received clinical and radiological follow-ups at least until their fractures were consolidated. Results: The average operating time was 65 minutes (range, 45 to 90 minutes). The average blood loss was 250 mL (range, 125 to 350 mL). The average hospital stay was 12 days. Implant failure was not observed and union was achieved in all the patients. Deep infection occurred in one (5%) patient in the early postoperative period. Fracture union was achieved at a mean of 14 weeks. Varus malalignment less then 10 degree was noted in ten (11%) patients at the end of follow-up. Twelve patients were pain-free and six had mild pain. Conclusions: The Long Gamma nail is a safe and reliable intramedullary device for the treatment of subtrochanteric fractures of the femur. It provides a short operative time, low blood loss, spontaneous biaxial dynamisation and healing in an optimal period of time. Despite the improvement of implants and surgical techniques, failures due to complications are still considerable. Open reduction may be required so as to obtain a correct alignment of the fracture. A45 Intramedullary stem lengthening in situ in the treatment of periprosthetic fractures of the femur A.N. Chelnokov, I.M. Piven. Ural Scientific Institute of Traumatology and Orthopaedics named after V.D. Chaklin, Ekaterinburg, Russia Purpose/Aim: Conventional management of preiprosthetic femoral fracture fixation includes plating, cerclage and cortical struts, and results with high complication rate and 21% reoperations within first postoperative year (Zuurmond R. et al., 2007). Aim of our study was to design a technique of less invasive fixation in periprostethic fractures of the femoral shaft to provide primary stability of the stem and the femur. Material and Methods: Motivated by a case of plate failure in periprosthtic femoral fracture we designed and used a modification of an industrial solid titanium femoral locked nail. Its design provides tight fit of the distal part of the femoral stem. 13 patients were treated in 2007–2011 with the technique. There were 7/13 Vancouver B1, 3/10 B2 fractures, and 3/10 B3. Fixator-assisted nailing was used with small wire external distractor for acute or gradual reduction. The nails were individually custom-made to fit the particular stem design and size. The inserted nail was locked distally with two or three 6 mm screws. Results: Less invasive surgery and stable fixation provided fast recovery. Immediate weight-bearing as tolerated was recommended in most cases. Unassisted walking occurred at 2 month in 6/13 patients, and at 3 month in 12/13. 10 patients were available for follow-up in 1 year – all fractures healed. Major complications (2/13) include one case of deep infection resulted with two stage revision to a standard cementless stem 1.5 year after the surgery, and one case of extremely slim stem breakage at the level of junction revised to a long stem in three month after the surgery. Conclusion. Since 2007 few publications appeared (Zuurmond R.G. et al., 2007; Meyer C. et al., 2007) presenting similar approach with good results in series of 18–25 cases. We conclude that the technique can be an effective solution in problematic cases of failed plating after periprosthetic fractures. For elderly patients with severe comorbities the technique offers less inavsive treatment option with quick recovery. Immediate unrestricted weight-bearing appears safe in majority of cases. Some aspects of the technique concerning indications, possible stress-shielding, need of nail dynamization, implant removal require further research. Reference(s) [1] Zuurmond RG, Pilot P, Verburg AD. Retrograde bridging nailing of periprosthetic femoral fractures. Injury. 2007 Aug;38(8):958–64.