TITLE

Clamp-Assisted Reduction of High Subtrochanteric Fractures of the Femur

AUTHOR(S)
Afsari, Alan; Liporace, Frank; Lindvall, Eric; Infante Jr., Anthony; Sagi, Henry C.; Haidukewych, George J.
PUB. DATE
September 2010
SOURCE
Journal of Bone & Joint Surgery, American Volume;Sep2010 Supplement, p217
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
BACKGROUND: Subtrochanteric fractures can be a treatment challenge. The substantial forces that this region experiences and the fact that the proximal fragment is frequently displaced make accurate reduction and internal fixation difficult. The purpose of this study was to evaluate a series of patients who had undergone clamp-assisted reduction and intramedullary nail fixation to determine the impact of this technique on fracture union rates and reduction quality. METHODS: Between December 2003 and January 2007, fifty-five consecutive patients with a displaced high subtrochanteric femoral fracture were treated with clamp-assisted reduction and intramedullary nail fixation at two level-I trauma centers. Two patients died, and nine were lost to follow-up. The remaining forty-four patients were followed until union or a minimum of six months. There were twenty-seven male and seventeen female patients with a mean age of fifty-five years. All were treated with an antegrade statically locked nail implanted with a reaming technique as well as the assistance of a reduction clamp placed through a small lateral incision. Nine patients were treated with a single supplemental cerclage cable. Radiographs were evaluated for the quality of the reduction and fracture union. RESULTS: Forty-three of the forty-four fractures united. All reductions were within 5° of the anatomic position in both the frontal and the sagittal plane. Thirty-eight (86%) of the forty-four reductions were anatomic. Six fractures had a minor varus deformity of the proximal fragment (between 2° and 5°). There were no complications. DISCUSSION: Surgical treatment of subtrochanteric femoral fractures with clamp-assisted reduction and intramedullary nail fixation techniques with judicious use of a cerclage cable can result in excellent reductions and a high union rate. Careful attention to detail is important to perform these maneuvers with minimal additional soft-tissue disruption. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.
ACCESSION #
53993788

 

Related Articles

  • INDUSTRY NEWS.  // Orthopedics Today;Sep2010, Vol. 30 Issue 9, p68 

    This section offers news briefs related to the orthopedics industry including the first implantation of the Zimmer NCB (Non-Contact Bridging) Periprosthetic Plating System Zimmer Holdings Inc., a warning letter issued by the U.S. Food and Drug Administration (FDA) to Biomet, and a 510(k)...

  • Cementless bipolar hemiarthroplasty in femoral neck fractures in elderly. Marya, S. K. S.; Thukral, R.; Hasan, R.; Tripathi, M. // Indian Journal of Orthopaedics;May/Jun2011, Vol. 45 Issue 3, p236 

    Background: Cemented hip arthroplasty is an established treatment for femoral neck fracture in the mobile elderly. Cement pressurization raises intramedullary pressure and may lead to fat embolization, resulting in fatal bone cement implantation syndrome, particularly in patients with multiple...

  • Hoffa fracture: fixation using headless compression screws. Borse, V.; Hahnel, J.; Cohen, A. // European Journal of Trauma & Emergency Surgery;Oct2010, Vol. 36 Issue 5, p477 

    Introduction: Hoffa fractures are uni- or bicondylar fractures of the distal femur in a coronal tangential plane. Case Presentation: We report the case of an isolated, low energy, closed, displaced, lateral femoral condyle Hoffa fracture in a 54 year old Caucasian man. This was treated by open...

  • Primary hemiarthroplasty for unstable osteoporotic intertrochanteric fractures in the elderly. Aadala, Raviraj; Anand, Ashish; Sancheti, K. H.; Sancheti, P. K.; Shyam, A. K.; Patil, S.; Dhariwal, Q.; Joshi, R. // Indian Journal of Orthopaedics;Jul/Aug2011, Vol. 45 Issue 4, p380 

    A letter to the editor is presented in response to the article "Primary hemiarthroplasty for unstable osteoporotic intertrochanteric fractures in the elderly: A retrospective case series," by K. H. Sancheti et al, in the 2010 volume 44 issue, along with the response of the authors.

  • A subtle intra-operative complication of the IMHS that may go unnoticed. Sprenger De Rover, W.; Alazzawi, S.; Patel, A.; Walton, N. // European Journal of Orthopaedic Surgery & Traumatology;Jul2011, Vol. 21 Issue 5, p353 

    We present two cases with intra-operative complications during the placement of intra-medullary hip screw (IMHS). In both occasions, the implant accidentally breached the anterior cortex of the distal femur. Lateral view with image intensifier confirmed the perforation. This intra-operative...

  • Study does not recommend THR for older patients with femoral neck fractures. Brockenbrough, Gina; Owens, Colleen // Orthopedics Today;Nov2010, Vol. 30 Issue 11, p8 

    The article presents research which does not support the use of total hip replacement in treating patients older than 70 years who maintain femoral neck displaced intracapsular fractures.

  • Ipsilateral femoral neck and trochanter fracture. Raviraj, A.; Anand, Ashish; Neogi, Devdatta S.; K. V., Ajay Kumar; Trikha, Vivek; Yadav, Chandra S. // Indian Journal of Orthopaedics;May/Jun2011, Vol. 45 Issue 3, p284 

    A letter to the editor is presented in response to the article "Ipsilateral femoral neck and trochanter fracture," by D. S. Neogi and colleagues in a 2011 issue.

  • Internal Fixation of Type-C Distal Femoral Fractures in Osteoporotic Bone. Wähnert, Dirk; Hoffmeier, Konrad L.; von Oldenburg, Geert; Fräber, Rosemarie; Hofmann, Gunther O.; Mückley, Thomas // Journal of Bone & Joint Surgery, American Volume;Jun2010, Vol. 92-A Issue 6, p1442 

    Background: Fixation of distal femoral fractures remains a challenge, especially in osteoporotic bone. This study was performed to investigate the biomechanical stability of four different fixation devices for the treatment of comminuted distal femoral fractures in osteoporotic bone. Methods:...

  • Passive Pneumatic Stabilization Device for Assisting in Reduction of Femoral Shaft Fractures. Matthews, Felix; Neuhaus, Valentin; Schmucki, Daniel; Schwyn, Ronald; Gross, Thomas; Regazzoni, Pietro; Trentz, Otmar; Messmer, Peter // European Journal of Trauma;Dec2005, Vol. 31 Issue 6, p568 

    During treatment of femoral shaft fractures, not only the actual fracture reduction but also the retention of the achieved reduction is essential. Substantial forces may apply to the bone fragments, due to multidirectional muscular contraction. Furthermore, forces from manipulation of one bone...

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics