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Cannulated Cancellous Screw and Ender’s Nail Fixation in Stable Intertrochanteric Femur Fracture in Elderly Patient With Co-Morbid Condition

January 10, 2019/in Jan. - April 2019 | Volume 5 | Issue 1

Vol 5 | Issue 1 | Jan-April 2019 | page: 17-22 |Rohan R Memon, Drashtant Patel Author: Rohan R Memon[1], Drashtant Pate[l1] 1 Department of orthopaedics, VS General hospital,NHL Medical college. Ahmedabad Address of Correspondence Dr. Rohan Rafik Memon, Department of orthopaedics, VS General hospital,NHL Medical college. Ahmedabad Email: rhnmemon222@gmail.com Abstract Background: Intertrochanteric Femur fracture […]

Comparative study of operative treatment of distal femur fractures using retrograde intramedullary nail versus locking plate Retrospective study

January 10, 2019/in Jan. - April 2019 | Volume 5 | Issue 1

Vol 5 | Issue 1 | Jan-April 2019 | page:3-6 – Raviraj Shinde, Tanvi Shinde, Ajit Shinde Author: Raviraj Shinde[1], Tanvi Shinde[1], Ajit Shinde[2] 1Department of Orthopaedics, Grant Medical College and Sir.J.J. Group of Hospitals, Mumbai. 2Shree AnnasahebShindeMhaishalkar Charitable Trust, Post Graduate Institute, Ambedkar road, civil hospital chowk, sangli Address of Correspondence Dr Raviraj Ajit […]

Cannulated Cancellous Screw and Ender’s Nail Fixation in Stable Intertrochanteric Femur Fracture in Elderly Patient With Co-Morbid Condition

January 10, 2019/in Jan. - April 2019 | Volume 5 | Issue 1

Comparative study of operative treatment of distal femur fractures using retrograde intramedullary nail versus locking plate Retrospective study

January 10, 2019/in Jan. - April 2019 | Volume 5 | Issue 1

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Cannulated Cancellous Screw and Ender’s Nail Fixation in Stable Intertrochanteric Femur Fracture in Elderly Patient With Co-Morbid Condition

January 10, 2019/in Jan. - April 2019 | Volume 5 | Issue 1

Vol 5 | Issue 1 | Jan-April 2019 | page: 17-22 |Rohan R Memon, Drashtant Patel

Author: Rohan R Memon[1], Drashtant Pate[l1]

1 Department of orthopaedics, VS General hospital,NHL Medical college. Ahmedabad

Address of Correspondence
Dr. Rohan Rafik Memon,
Department of orthopaedics, VS General hospital,NHL Medical college. Ahmedabad
Email: rhnmemon222@gmail.com

Abstract

Background: Intertrochanteric Femur fracture is common in elderly patient with co-morbidity.Ender and Simon Weidner popularized the concept of closed condylocephlic nailing for intertrochanteric fractures in 1970. The clinical experience of authors revealed that Ender nailing alone cannot provide secure fixation in elderly patients with osteoporosis.
Aims and objectives; we conducted a study to evaluate the efficacy of a combined fixation procedure using Ender nails and a cannulated compression screw for intertrochanteric fractures.
Study Design: This is a prospective observational type of study
Place and duration of study: Department of orthopaedics, NHL medical college between January 2015 to June 2018
Methodology: 52 patients with intertrochanteric fractures were treated using intramedullary Ender nails and cannulated compression screw from January 2015 to june 2018. We included those patients having age ≥50 years, with multiple co- morbid conditions like diabetes, hypertension, COPD, Asthma, bleeding disorders and multiple fractures, and duration of the Intertrochanteric fracture ≤ two week. We exclude young active patients < 50 yrs age, fracture > 2 weeks duration, fracture with lateral wall comminution and open fractures. The two Ender nails of 4.5mm each were passed across the fracture site into the proximal neck. This was reinforced with a 6.5 mm cannulated compression screw passed from the sub trochanteric region, across the fracture into the head.
Results; All the fractures were united within an average period of 13 weeks with a range of 10 – 13 weeks. The functional assessment was done with modified Harris hip score(Table no 1,2) and the mean was 86.3 with a range from 73 to 95 , and 26 patients were excellent, 20 patients were good , 4 patients were fair and two patients were poor with respect to total score. The analysis of this study fulfils the objectives of good functional outcome
Conclusions: The Ender nailing combined with compression screw fixation in cases of intertrochanteric fractures in high risk elderly patients could achieve reliable fracture stability with minimal complications.
Keywords: Compression screw, Ender nails, osteoporosis, inter-trochanteric fracture

References

[1]. Rockwood and Green;s Fracture in adults, 8th edition: vol.2:2075-2130.

[2]. Hagino H, Furukawa K, Fujiwara S, et al. Recent trend in the incidence and lifetime risk of hip fractures in Tottori, Japan.Osteoporos Int. 2009;20(4):543-548.

[3]. Lawton JO, Baker MR, Dickson RA. Femoral neck fracture: two populations. Lancer 1983;2:70-72.

[4]. Atkin JM. Relavance of osteoporosis in women with fractures of the femoral neck. Br Med J 1984;288’:597-601.Pogrund H, Makin M, Robin G, et al. Osteoporosis in patients with fractured femoral neck in Jerusalem. Clin Orthop 1977;124:165-172.

[5]. Ender J, Simon-Weidner R. Die Fixierung der trochantener bruche mit runden elastischen Kondylennageln. Acta Chir Austria1970;1:40.

[6]. Bonnaire F, Weber A, Bosl O, Eckhardt C, Schweiger, Linke B. “Cutting out” in pertrochanteric fractures – problem of osteoporosis. Unfallchirurg. 2007;110:425–32.

[7]. Beidle SH, Patel AD, Bircher M, Calvert PT. Fixation of intertrochanteric fractures femur – randomized prospective comparison of gamma nail and dynamic hip screw. JBJS Br. 1991;73:330–4.

[8]. Nordin S, Zulkifil O, Faisham WI. Mechanical failure of DHS fixation in intertochanteric fracture femur. Med J Malaysia. 2001;56:12–7.

[9]. Fogognolo F, Kfuri M, Jr, Paccola CA. Intramedullary fixation of pertrochanteric hip fractures with PFN. Arch Orthop Trauma surgery. 2004;124:31–7.

[10]. Wojcik B, Tokarowski A, Swieboda A, Kaleta M, Nowak R. Endernails in the stabilization of trochanteric fracture in elderly. Chir Narzadow Ruchu Ortop Pol. 1999;64:279–83.

[11]. Raughstad TS, Moister A, Haukeland W, Hestenes O, Olerud S. Treatment of petrochanteric and subtrochanteric fractures of the femur by the Ender metod. Clin Orthop. 1970;138:321.

[12]. Pankovich AM, Tarabiski IE. Ender nailing of intertrochanteric fractures of femur. J Bone Joint Surg. 1980;62A:635.

[13].Cobelli NJ, Sadler AH. Ender rod versus compressive screw: fixation of hip fracture. Clin Orthop. 1970;138:321

[14]. Moon MS, Woo YK, Kim ST. A clinical study of trochanteric fractures of the femur: Outcome of the treatment in regard to osteoporosis and type of the treatment. I Korean Orthop Assoc. 1991;26:1693–702.

[15]. Russian LA, Sonni A. Treatment of intertrochanteric and subtrochanteric fractures with Ender intramedullary rods. Clin Orthop. 1980;148:203–12.

[16]. Kuderna H, Bohler N, Colby AJ. Treatment of intertrochanteric and subtrochanteric fracture of the hip by the Ender method. J Bone Joint Surg. 1976;58:604–11.

[17]. Hall LG. Comparison of nail-plate fixation Ender’s nailing for intertrochanteric fractures. J Bone Joint Surg. 1981;63-B:24–8.

[18]. Parker MJ, Handoll HH, Bhonsle S, Gillespie WJ. Condylocephalic nails versus extramedullary implants for extracapsular hip fractures. Cochrane Database Syst Rev. 2000;2:CD000338.

How to Cite this article: Memon R R, Patel D. Cannulated Cancellous Screw and Ender’s Nail Fixation in Stable Intertrochanteric Femur Fracture in Elderly Patient With Co-Morbid Condition. Journal of Bone and Joint Diseases Jan – Apr 2019;5(1):17-22.

(Abstract)(Full Text HTML) (Download PDF)

Cannulated Cancellous Screw and Ender’s Nail Fixation in
Stable Intertrochanteric Femur Fracture in Elderly Patient
With Co-Morbid Condition

Comparative study of operative treatment of distal femur fractures using retrograde intramedullary nail versus locking plate Retrospective study

January 10, 2019/in Jan. - April 2019 | Volume 5 | Issue 1

Vol 5 | Issue 1 | Jan-April 2019 | page:3-6 – Raviraj Shinde, Tanvi Shinde, Ajit Shinde

Author: Raviraj Shinde[1], Tanvi Shinde[1], Ajit Shinde[2]

1Department of Orthopaedics, Grant Medical College and Sir.J.J. Group of Hospitals, Mumbai.
2Shree AnnasahebShindeMhaishalkar Charitable Trust, Post Graduate Institute, Ambedkar road, civil hospital chowk, sangli

Address of Correspondence
Dr Raviraj Ajit shinde
Department of Orthopaedics, Grant Medical College and Sir.J.J. Group of Hospitals, Mumbai
Email Id : drravirajshinde@gmail.com

Abstract

Introduction: The overall incidence of distal femur fractures is approximately 37 per 100,000 person-years.1 These fractures are either caused by high energy trauma in younger group or low energy falls in elderly population typically older women. As these fractures can lead to long term disability managing them is challenging task. Operative treatment for fracture fixation is recommended for optimal outcome. Although different modes of fracture fixation has evolved and no single method is uniformly successful. In our study we have compared fixation of distal femur fracture using locking plate and intramedullary nail.
Materials and Methods: Retrospectively collected data of operated distal femur fracture of 60 patients was included. Out of these 30 patients were operated with retrograde distal femoral nail and 30 were operated with locking distal femur plate. Patients were assessed with plain radiographs and CT scan was done for complex and intra articular fractures. AO ( Muller) classification was used to classify the fracture type. Postoperative functional results were evaluated using Schatzker and Lambert critera at 1 year follow up.
Results: Mean age of the patients in the study was 45 yrs. with 73.33 % male and 26.67 % female patients. There were 41 extra articular fractures (type A) while 19 were intrarticular fractures (type C). 22 type A and 8 type C fractures were treated with retrograde nailing while 19 type A fractures and 11 type C fractures were treated with locking plate. In LCP group 28.57% cases had excellent result while 42.86% cases had good result while in retrograde supracondylar nail 13.33% had excellent result and 23.33 % had good result. There were 2 cases of infection, one in each group and 3 cases of malunion, which were managed with nail. Delayed union was encountered in 3 patients, two of them were managed with LCP.
Conclusion: Open reduction and internal fixation of distal femur has achieved excellent to good functional results with locking plate construct in all types of fractures while retrograde supracondylar nail can achieve comparable results when used in simple extraarticular fractures.For other fractures it is difficult to maintain length, alignment and rotation with retrograde nail.
Keywords: distal femur fracture, Retrograde intramedullary nail, locking distal femur plate, minimally invasive plating technique, Schatzker and Lambert criteria

References

1. J Arneson, T & Melton, Joel & G Lewallen, D & M O’Fallon, W. (1988). Epidemiology of diaphyseal and distal femoral fractures in
Rochester, Minnesota, 1965-1984. Clinical orthopaedics and related research. 234. 188-94.
2. Kolmert L, Wulff K. Epidemiology and treatment of distal femoral fractures in adults.ActaOrthop Scand. 1982 Dec;53(6):957-62.
3. Elsoe R, Ceccotti AA, Larsen P. Population-based epidemiology and incidence of distal femur fractures.IntOrthop. 2018 Jan; 42(1):191- 196. doi: 10.1007/s00264-017-3665-1. Epub 2017 Nov 7.
4. Cambell’s operative orthopedics,11th edition, Vol.3,pg-2805.
5. Schatzker J. Lambert DC: Supradondylar fracture of the femur; Clin. Orthop 138: 77, 1979.
6. Krishna C et al : Current concept of management of supracondylar femur fracture: retrograde femoral nail or distal femoral locking plate IntSurg J. 2016 Aug;3(3):1356-1359
7. El Moumni M, Schraven P, ten Duis HJ, Wendt K: Persistent knee complaints after retrograde unreamed nailing of femoral shaft fractures. ActaOrthopBelg 2010;76:219–225.
8. Ricci WM, Loftus T, Cox C, Borrelli J. Locked plates combined with minimally invasive insertion technique for the treatment of periprosthetic supracondylar femur fractures above a total knee arthroplasty. J Orthop Trauma 2006 ; 20 : 190-196.
9. Krishna C et al : Current concept of management of supracondylar femur fracture: retrograde femoral nail or distal femoral locking plate IntSurg J. 2016 Aug;3(3):1356-1359
10. Gupta SKV, Govindappa CVS, Yalamanchili RK. Outcome of retrograde intramedullary nailing and locking compression plating of distal femoral fractures in adults. OA Orthopaedics 2013 Nov 01;1(3):23.
11. Hierholzer C, von Ruden C, Potzel T, Woltmann A, BuhrenV:Outcome analysis of retrograde nailing and less invasive stabilization system in distal femoral fracture: a retrospective analysis. Indian J Orthop. 2011;45:243-50.

How to Cite this article: Shinde R, Shinde T, Shinde A. Comparative study of operative treatment of distal femur fractures using retrograde intramedullary nail versus locking plate; Retrospective study. Trauma International Jan-Apr 2019;5(1):3-6

Half Sized Blog Element (Single Author Style)

Half Sized Blog Element (Multi Author Style)

Cannulated Cancellous Screw and Ender’s Nail Fixation in Stable Intertrochanteric Femur Fracture in Elderly Patient With Co-Morbid Condition

Comparative study of operative treatment of distal femur fractures using retrograde intramedullary nail versus locking plate Retrospective study

Cannulated Cancellous Screw and Ender’s Nail Fixation in Stable Intertrochanteric Femur Fracture in Elderly Patient With Co-Morbid Condition

Comparative study of operative treatment of distal femur fractures using retrograde intramedullary nail versus locking plate Retrospective study

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Cannulated Cancellous Screw and Ender’s Nail Fixation in Stable Intertrochanteric Femur Fracture in Elderly Patient With Co-Morbid Condition

Author: Rohan R Memon[1], Drashtant Pate[l1]

Abstract

References

(Abstract)(Full Text HTML) (Download PDF)

Comparative study of operative treatment of distal femur fractures using retrograde intramedullary nail versus locking plate Retrospective study

Author: Raviraj Shinde[1], Tanvi Shinde[1], Ajit Shinde[2]

Abstract

References

(Abstract)(Full Text HTML) (Download PDF)

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