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A75 Intramedullary nailing and compression bolts in the management of type C distal femoral fractures
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Oral presentations / Injury, Int. J. Care Injured 42 (2011) S3, S1–S24
A72 The use of long gamma nail in fractures of subtrochanteric area S. Paraschou1 , H. Anastasopoulos1 , G. Chatziliadis1 , K. Veltsistas1 , A. Papapanos2 , J. Alexopoulos2 , A. Karanikolas1 . 1 A’ Orthopaedic Department-Kilkis General Hospital, 2 Orthopaedic Department-Agrinio General Hospital, Greece Aim: The aim of this study is to present the results of the use of long gamma-nail in difficult fractures of subtrochanteric area. Material and Methods: 26 patients with equal number of fractures treated surgically with long gamma-nail between 1998 and 2010 were reviewed. Mean patient age was 75 years whereas 15 of them were females. The cause was pathologic fracture due to metastatic tumor in peritrochanteric area in 5 patients, subtrochanteric fracture in 13 and, inter-subtrochanteric in 8 patients. In an averaged follow up of 68 months 5 patients with metastatic tumor died within the first 2 postoperative years. Results: All fractures except for one united within an average of 4.3 months(range 3–6 months). We did not observe any major or minor complications such as superficial or deep infections, malunion, delay union, or adjacent joints restriction of motion. There was observed one non union with breakage of nail and distal screw revised succesfully with a new long gamma nail of a larger diameter. Conclusions: We consider that long gamma-nail is an acceptable method of treatment for difficult fractures of subtrochanteric area with good functional results and low rate of complications. A73 Treatment of peritrochanteric fractures with the Veronail system M. Michaelidou, K. Christopoulos, A. Panagopoulos, A. Kouzelis, P. Megas. Orthopaedic Department, Patras University Hospital, Greece Aim: The retrospective evaluation of the Veronail system for the treatment of peri-trochanteric fractures of the proximal femur. Materials and methods: Between January 2006 and December 2010, 145 patients with an average age of 78 years underwent intramedullary nailing with the Veronail system. Minimal follo up period was 12 months. The Harris hip score was used at the last follow up for clinical assessment. Fracture consolidation, technical or mechanical complications and delayed union or nonunion were registered as well. Results: Twelve patients (8%) died from reasons unrelated to the implant. Solid union of the fracture was noted in 138 patients (95%) in a mean postoperative time of 11 weeks. Two fractures did not progress to union. Breakage of the implant was noted in one patient with Parkinson disease after accidental fall on the ground. Early complications included three (2%) superficial infections, one (0.6%) deep infection and six patients (4%) with varus deformity of the hip without significant functional impairment. The mean Harris hip score was over 80 points in 75.8% of the patients. Conclusion: Use of the Veronail system yielded good results in our study. Technical complications were mostly related to the operative technique and the type and preoperative reduction of the fracture, rather than the system itself. A74 Comparative study between dynamic condylar screw and retrograde intramedullary nail for the treatment of femoral supracondylar fractures S. Paraschou1 , H. Anastasopoulos1 , G. Chatziliadis1 , A. Papapanos2 , J. Alexopoulos2 , A. Karanikolas1 , K. Veltsistas1 . 1 A’Orthopaedic Clinic-Kilkis General Hospital, Kilkis, 2 Orthopaedic Clinic-Agrinio General Hospital, Agrinio, Greece Aim: The purpose of this study is to present our results of the treatment of supracondylar femoral fractures with Dynamic condylar plate and Retrograde intramedullary nail.
Material and Methods: Fiftythree patients with supracondylar femoral fracture were treated between 1998 and 2007. Thirtyfive of them were females and 18 males with a mean age of 68.3 years (range 37–83 years). RIN was used in 26 patients and DCS in 27 patients. In the group of patients treated with DCS the mean operation time was 133 min and the mean blood loss 257cc whereas in RIN group 97 min and 135cc respectively (p < 0.001). The average follow up period was 3 years (range 2.5–4.5 years). Results: The Schatzker and Lambert criteria were used for the patients evaluation. In RIN group excellent result was recorded in 13 patients, good in 6, moderate in 2 and poor in 2 whereas in DCS group excellent in 14, good in 7, moderate in 3 and poor in 3 patients. The complications that were observed in RIN group were nonunion in 1 patient, knee stiffness in 2 and varus deformity in 2 patients whereas in DCS group knee stiffness in 3 patients and nonunions in 2 and varus deformity in 1 patient. Conclusions: Although the two methods seem to be equivalent with high rate of union and low incidence of complications.RIN compared with DCS has lower blood loss and shorter operative time. A75 Intramedullary nailing and compression bolts in the management of type C distal femoral fractures C. Garnavos, N. Lasanianos, E. Charalambidis, P. Papagiannopoulos, P. Boudouris, I. Akrivos. Athens General Infirmary “Evangelismos”, Greece Aim: To investigate the role of intramedullary nailing in combination with compression bolts in the management of intraarticular fractures of the distal femur (type C according to AO classification). Material and Methods: Within a period of 4 years, 17 patients (aged from 26 to 85 years) with 18 inter-supracondylar distal femoral fractures were treated with minimal invasive technique utilizing intramedullary nailing and compression bolts. According to the AO classification all fractures were of C type. The nails used were the Supracondylar Nail (SCN – Stryker) and the T2 supracondylar nail (Stryker). In all cases the condylar bolts were inserted on the coronal plane, either through or outside the nail. Results: There were not any neurovascular complications or infections recorded. One of the patients sustained a new femoral fracture at the level of the proximal screws, 4 weeks postoperatively. He was treated with a revision nailing procedure with a longer nail. All the other fractures healed without any complications between 3.5–5.5 months. All patients regained an excellent range of knee motion (0°–5° extension and 110°–130° flexion) apart from a multi-injured patient with serious co-morbidities who did not follow a proper rehabilitation program and ended up with knee stiffness. The rest of the patients returned to their pre injury level of activities. Conclusions: The combination of intramedullary nailing and condylar bolts creates a stable osteosynthesis and enhances the good results of intramedullary nailing by allowing immediate mobilisation of the knee joint and earlier weight bearing of the lower limb. A76 Retrograde intramedullary nailing vs. plating in treatment of extrarticular distal femoral fractures: a comparative study C. Rossas, D. Nikolopoulos, S. Liarokapis, I. Platanitis, G. Karatzas, C. Aggelidis, I. Michos. 4th Orthopaedic Department, Asklepeion Voula General Hospital, Athens, Greece Aim: The presentation of our experience in treating extrarticular fractures of distal femur, by using either retrograde intramedullary nail (rIN) or plate (comparative study) Material & Methods: Between 01/2005 and 01/2010, 27 patients (10 male, 17 female), aged 64–91 years old (average 78.6 years),
Oral presentations / Injury, Int. J. Care Injured 42 (2011) S3, S1–S24
A72 The use of long gamma nail in fractures of subtrochanteric area S. Paraschou1 , H. Anastasopoulos1 , G. Chatziliadis1 , K. Veltsistas1 , A. Papapanos2 , J. Alexopoulos2 , A. Karanikolas1 . 1 A’ Orthopaedic Department-Kilkis General Hospital, 2 Orthopaedic Department-Agrinio General Hospital, Greece Aim: The aim of this study is to present the results of the use of long gamma-nail in difficult fractures of subtrochanteric area. Material and Methods: 26 patients with equal number of fractures treated surgically with long gamma-nail between 1998 and 2010 were reviewed. Mean patient age was 75 years whereas 15 of them were females. The cause was pathologic fracture due to metastatic tumor in peritrochanteric area in 5 patients, subtrochanteric fracture in 13 and, inter-subtrochanteric in 8 patients. In an averaged follow up of 68 months 5 patients with metastatic tumor died within the first 2 postoperative years. Results: All fractures except for one united within an average of 4.3 months(range 3–6 months). We did not observe any major or minor complications such as superficial or deep infections, malunion, delay union, or adjacent joints restriction of motion. There was observed one non union with breakage of nail and distal screw revised succesfully with a new long gamma nail of a larger diameter. Conclusions: We consider that long gamma-nail is an acceptable method of treatment for difficult fractures of subtrochanteric area with good functional results and low rate of complications. A73 Treatment of peritrochanteric fractures with the Veronail system M. Michaelidou, K. Christopoulos, A. Panagopoulos, A. Kouzelis, P. Megas. Orthopaedic Department, Patras University Hospital, Greece Aim: The retrospective evaluation of the Veronail system for the treatment of peri-trochanteric fractures of the proximal femur. Materials and methods: Between January 2006 and December 2010, 145 patients with an average age of 78 years underwent intramedullary nailing with the Veronail system. Minimal follo up period was 12 months. The Harris hip score was used at the last follow up for clinical assessment. Fracture consolidation, technical or mechanical complications and delayed union or nonunion were registered as well. Results: Twelve patients (8%) died from reasons unrelated to the implant. Solid union of the fracture was noted in 138 patients (95%) in a mean postoperative time of 11 weeks. Two fractures did not progress to union. Breakage of the implant was noted in one patient with Parkinson disease after accidental fall on the ground. Early complications included three (2%) superficial infections, one (0.6%) deep infection and six patients (4%) with varus deformity of the hip without significant functional impairment. The mean Harris hip score was over 80 points in 75.8% of the patients. Conclusion: Use of the Veronail system yielded good results in our study. Technical complications were mostly related to the operative technique and the type and preoperative reduction of the fracture, rather than the system itself. A74 Comparative study between dynamic condylar screw and retrograde intramedullary nail for the treatment of femoral supracondylar fractures S. Paraschou1 , H. Anastasopoulos1 , G. Chatziliadis1 , A. Papapanos2 , J. Alexopoulos2 , A. Karanikolas1 , K. Veltsistas1 . 1 A’Orthopaedic Clinic-Kilkis General Hospital, Kilkis, 2 Orthopaedic Clinic-Agrinio General Hospital, Agrinio, Greece Aim: The purpose of this study is to present our results of the treatment of supracondylar femoral fractures with Dynamic condylar plate and Retrograde intramedullary nail.
Material and Methods: Fiftythree patients with supracondylar femoral fracture were treated between 1998 and 2007. Thirtyfive of them were females and 18 males with a mean age of 68.3 years (range 37–83 years). RIN was used in 26 patients and DCS in 27 patients. In the group of patients treated with DCS the mean operation time was 133 min and the mean blood loss 257cc whereas in RIN group 97 min and 135cc respectively (p < 0.001). The average follow up period was 3 years (range 2.5–4.5 years). Results: The Schatzker and Lambert criteria were used for the patients evaluation. In RIN group excellent result was recorded in 13 patients, good in 6, moderate in 2 and poor in 2 whereas in DCS group excellent in 14, good in 7, moderate in 3 and poor in 3 patients. The complications that were observed in RIN group were nonunion in 1 patient, knee stiffness in 2 and varus deformity in 2 patients whereas in DCS group knee stiffness in 3 patients and nonunions in 2 and varus deformity in 1 patient. Conclusions: Although the two methods seem to be equivalent with high rate of union and low incidence of complications.RIN compared with DCS has lower blood loss and shorter operative time. A75 Intramedullary nailing and compression bolts in the management of type C distal femoral fractures C. Garnavos, N. Lasanianos, E. Charalambidis, P. Papagiannopoulos, P. Boudouris, I. Akrivos. Athens General Infirmary “Evangelismos”, Greece Aim: To investigate the role of intramedullary nailing in combination with compression bolts in the management of intraarticular fractures of the distal femur (type C according to AO classification). Material and Methods: Within a period of 4 years, 17 patients (aged from 26 to 85 years) with 18 inter-supracondylar distal femoral fractures were treated with minimal invasive technique utilizing intramedullary nailing and compression bolts. According to the AO classification all fractures were of C type. The nails used were the Supracondylar Nail (SCN – Stryker) and the T2 supracondylar nail (Stryker). In all cases the condylar bolts were inserted on the coronal plane, either through or outside the nail. Results: There were not any neurovascular complications or infections recorded. One of the patients sustained a new femoral fracture at the level of the proximal screws, 4 weeks postoperatively. He was treated with a revision nailing procedure with a longer nail. All the other fractures healed without any complications between 3.5–5.5 months. All patients regained an excellent range of knee motion (0°–5° extension and 110°–130° flexion) apart from a multi-injured patient with serious co-morbidities who did not follow a proper rehabilitation program and ended up with knee stiffness. The rest of the patients returned to their pre injury level of activities. Conclusions: The combination of intramedullary nailing and condylar bolts creates a stable osteosynthesis and enhances the good results of intramedullary nailing by allowing immediate mobilisation of the knee joint and earlier weight bearing of the lower limb. A76 Retrograde intramedullary nailing vs. plating in treatment of extrarticular distal femoral fractures: a comparative study C. Rossas, D. Nikolopoulos, S. Liarokapis, I. Platanitis, G. Karatzas, C. Aggelidis, I. Michos. 4th Orthopaedic Department, Asklepeion Voula General Hospital, Athens, Greece Aim: The presentation of our experience in treating extrarticular fractures of distal femur, by using either retrograde intramedullary nail (rIN) or plate (comparative study) Material & Methods: Between 01/2005 and 01/2010, 27 patients (10 male, 17 female), aged 64–91 years old (average 78.6 years),