In the absence of interlocking screws, the implant transfers axial compaction motion along the longitudinal axis of the nail to the bone. J Bone Joint Surg 1995;77A(7):1058-1064. In general, and until any future contradicting evidence, long nails are preferable when longer working length is needed, that is, in comminuted fractures with extension to the subtrochanteric region, or when protection of the whole femoral shaft is necessary, that is, severe osteoporosis, known metastatic lesions, or suspected femoral pathology. This fracture type is called the reverse oblique pattern. A four-part fracture has several fracture lines. The proximal diameter of the nail is 15 mm and length is 18cm. 2 Afb. Pajarinen J, Lindahl J, Michelsson O, et al.. Pertrochanteric femoral fractures treated with a dynamic hip screw or a proximal femoral nail. Intertrochanteric Fractures Intertrochanteric fractures are breaks of the femur between the greater and the lesser trochanters. II: intertrochanteric fractures. Kleweno et al24 compared retrospectively four nail types used in 559 patients with all types of intertrochanteric fractures. 3 Afb. Please enable scripts and reload this page. All rights reserved. Methods of Hip Fracture Confirmation In the elderly, hip pain is usually indicative of a fracture. Unstable fractures are those in which the femur is broken into four parts or the fracture is of the reverse oblique pattern. 56. Technically, distal locking for long nails continues to be a topic, despite the development of numerous devices and techniques (free hand with fluoroscopy, mechanical jigs, nail-mounted mechanical jigs, assisted targeting devices).48 The increased radiation exposure intraoperatively, the prolonged operative time, and the creation of stress risers after mistargeting, or the eccentric insertion of locking screws predisposing to their fatigue failure constitute contemporary concerns relevant to distal interlocking of intertrochanteric fractures.49–51. The TFN System consists of a series of cannulated nails, cannulated helical blades, cannulated end caps, and locking bolts and screws. For immediate assistance, contact Customer Service: intramedullary nail carries the risk of fixation failure. Introduction .. Oscillating Saw Attachment II (Crescentic Technique). After surgery for a hip fracture, weightbearing should be allowed as tolerated. • Endo Y, Aharonoff GB, Zuckerman JD, Egol KA, Koval KJ. At the same time, the primary target of a proximal femoral fracture fixation, especially for the frail elderly patients, is mobilization and full weight-bearing as soon as possible after the surgery. In most cases, surgery is recommended because this fracture can take a long time to heal on its own. J Bone Joint Surg Am. Based on the low periprosthetic fracture rate (0.5%), the authors suggested an individualized approach to the management of these injuries based on the patient's anatomy and surgeon's expertise. A femoral neck fracture is intracapsular, that is within the hip joint and beneath the fibrous joint capsule. There was no difference between the short and long nail groups in the length-of-surgery, reoperation, blade penetration, superficial/deep wound infection, malunion, length-of-hospital stay, mortality, Harris-hip-score, or Parker and Palmer mobility score. Gamma3 Long Nail is intended for fixation of stable and unstable femoral fractures occurring from the base of the femoral neck extending distally to a point approximately 10cm proximal to the intracondylar notch including fractures of the basilar neck, intertrochanteric fractures, peritrochanteric fractures, subtrochanteric fractures and femoral shaft fractures. The femoral neck is the region of the femur bounded by the femoral head proximally and the greater and lesser trochanters distally (shown below). Hou Z, Bowen TR, Irgit KS, et al.. A cross-table lateral radiograph should also be obtained by flexing the unaffected hip and knee and pointing the x-ray beam at the groin of the affected side. The more pieces, the less stable is the fracture pattern. Trochanteric fixation nail (TFN): This intramedullary device consists of a Cannulated nail, Cannulated hip screws 8 mm lag screw and 6.4 mm derotation screw, distal locking bolts of 4.9 millimeters. Hip fracture. All registration fields are required. Gamma-nagel Bij deze ingreep is het bovenste deel van het dijbeen gebroken en de heupkop volledig intact. The authors suggested that locked distal constructs may fatigue and break earlier when subjected to torsional loading in the clinical setting.33,34 This mode of failure was also described in a clinical series for unstable 33.A3 fractures as an indicator of delayed union or nonunion, often leading to implant failure and revision surgery.38, Lately, the concept of angle stable nailing with toggle-free distal interlocking screws has been introduced to clinical practice.39 Conventionally, toggle of distal interlocking is allowed through the slight intentional oversizing of nail holes of approximately 0.13 mm to limit binding of the screw to the nail hole during screw insertion. Lindsey RW, Teal P, Probe RA, et al.. J Am Acad Orthop Surg 1994;2(3):141-149. The most common treatment for intertrochanteric fractures is surgery. The length of such a nail initially was short finishing above the level of the femoral isthmus. Clin Orthop Relat Res. Especially for unstable fractures or those with reverse obliquity (33.A3), it is our belief that there is no adequate evidence to support any deviation from the current practice, which is consistent with the use of a long statically locked nail. Lacroix H, Arwert H, Snijders CJ, et al.. Prevention of fracture at the distal locking site of the gamma nail. 42. Fatigue performance of angle-stable tibial nail interlocking screws. The nail extends throughout the shaft, protecting the rest of the bone from future fracture. 29. Registered users can save articles, searches, and manage email alerts. 53. Wolters Kluwer Health, Inc. and/or its subsidiaries. A recent Cochrane Systematic Review detected limited high-quality evidence with mainly inconclusive results pertaining to the use of intramedullary nailing for the management of extracapsular hip fractures.15 Moreover, no conclusive evidence exists on the specific characteristics of intramedullary fixation of these fractures. J Bone Joint Surg Am. 16. Injury. A well-designed, large-series randomized trial comparing long versus short nails with or without distal interlocking for the management of intertrochanteric fractures would be beneficial to the clinicians to balance meaningfully their decision making. 2014;28(suppl 8):S25–S28. 2009;40:663–668. Aguado d E. Moreno e M.D. By continuing to use this website you are giving consent to cookies being used. Mathematical analysis of the appropriate targeting range. (Posted Feb. 17), Patient Care Options | Visitor Guidelines | Coronavirus Information | Self-Checker | Get Email Alerts. Kanakaris, Nikolaos K. MD, PhD; Tosounidis, Theodoros H. MD, PhD; Giannoudis, Peter V. BSc, MD, FRCS. Treatment for a failed total hip replacement is a revision arthroplasty. 12. 43. Icks A, Haastert B, Wildner M, et al.. Hip fractures and area level socioeconomic conditions: a population-based study. Orthop Traumatol Surg Res. Positioning of the guide wire. 2007;89:470–475. 2009;23:460–464. 39. Aune AK, Ekeland A, Odegaard B, et al.. Gamma nail vs compression screw for trochanteric femoral fractures. The gamma nail consists of a large screw placed in the 30 mins. This article attempts to summarize the contemporary understanding of the existing biomechanical and clinical evidence on intramedullary nailing of intertrochanteric fractures, as to whether they should be short or long nails, and the use or not of distal locking screws. Lenz M, Gueorguiev B, Richards RG, et al.. Forte ML, Virnig BA, Kane RL, et al.. Grimaldi M, Courvoisier A, Tonetti J, et al.. Superficial femoral artery injury resulting from intertrochanteric hip fracture fixation by a locked intramedullary nail.
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