Intramedullary femoral nailing is the gold standard for femoral shaft fixation but only in the past 27 years. Case competencies in orthopaedic surgery is a centralized, easyaccess guide to preparing for cases most commonly encountered during training. Numerous reduction techiques are available to achieve an anatomic. Baumgaertner thomas fishler introduction the number of hip fractures in the united states is estimated to be approximately 400,000 per year and will increase 50% by the year 2025.
A prospective, randomized study of one hundred patients. Zelle1 and guilherme boni2 abstract statically locked, reamed intramedullary nailing remains the standard treatment for displaced tibial shaft fractures. This type of repair generally involves a large surgical incision. These fractures typically occur in elderly osteoporotic females, with 90% of fractures occurring in patients older than 65. Patients who require a second hip surgery after initial fixation with an intramedullary implant for pertrochanteric hip fractures have significantly higher oneyear healthcare. The position of the screw is measured on the radiograph and is then reproduced in the operating room under fluoroscopy. Recently, suprapatellar nailing in the semiextended position has been suggested as a safe and effective surgical technique. An intramedullary rod is inserted into the top of the femur and guided down through the fracture site and into the bottom portion of the bone. When surgical intervention of a fifth metatarsal base fracture is required, authors have described numerous techniques including the use of intramedullary screw fixation, tension band wiring, plating and crossed kirschner wires. This rapid replacement of closed traction and cast techniques in north america was a controversial and contentious evolution in surgery. This chapter discusses indications, surgical technique and postoperative outcome of intramedullary fixation.
A total of 237 patients 45 male, 192 female were eligible for the assessment with an average age of 81. Novel intramedullary device for lengthening transfemoral. Hip screw dhs augmentation and on proximal femoral nail augmentation. Short versus long cephalomedullary nailing for the treatment of intertrochanteric hip fractures in patients over 65 years old. Preparation the patient is positioned so that the side of the thigh is clearly visible to the physician, and the area is. Kuntscher first described the technique of im nailing femur fractures in the german and later in the american. Femur fracture fixation with intramedullary rod overview this surgical procedure stabilizes severe fractures of the femur by placing a metal rod into the center of the femur. However, an intramedullary fixation with a sliding screw achieves. Intramedullary hip screw fixation for proximal femoral fractures. It is strongly recommended that the surgeon read the complete procedure for details, notes, and technique tips.
Femur fracture fixation with intramedullary rod arctic. Case competencies in orthopaedic surgery sciencedirect. The dynamic hip screw implant system softcover reprint of the original 1st ed. Stryker, now owns pohls company through a previous acquisition by howmedica, responsible for the grossekempf and gamma nails, continuing the heritage of nail improvements. The new subtrochanteric lag screw provides more clinical options. These devices combine the features of a sliding hip screw and intramedullary nail. Surgical management of femoral neck fractures statpearls ncbi. Fatigue strength of common tibial intramedullary nail. This book is now available for surgeons from the stryker. Intramedullary hip screws have recently been introduced for the treatment of pertrochanteric fractures. Download for offline reading, highlight, bookmark or take notes while you read intramedullary nailing. Zuckerman, md intramedullary hip screws have recently been introduced for the treatment of pertrochanteric fractures.
Intramedullary nail versus sliding hip screw inter. Lengthening of the femur with a remotecontrolled magnetic. This situation has resulted in terminologic and morphologic confusion that. Antegrade femoral nail afn surgical technique depuy synthes 5 reconstruction locking implants end cap 020 mm extension in 5 mm increments for diameters of 910, 1112, and 14 mm 6. Patients were positioned on the radiolucent or table in the supine position. Moreover, there is a continuum between these two groups.
In the second group, the term subtrochanteric fracture is used by most investigators for fractures occurring between the lesser trochanter and the isthmus of the femoral shaft i. This book is distributed under the terms of the creative commons attribution 4. There are smart toe implants fusing the right second and third interphalangeal joints. 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.
Fracture stability is the clinical most important determinant. A lateral longitudinal femoral osteotomy was used for the resection of the distorted nail. Written by expert author teams consisting of both attending surgeons and residents, it follows a techniquebased format and design that summarizes the surgical steps, from room setup to closure, of all cases relevant to the 15 categories of. Intramedullary nailing is surgery to repair a broken bone and keep it stable. An improved surgical technique to treat femoral shaft. The screw must allow enough room for the intramedullary nail to pass between the screw and the cortex. The compression hip screw is fixed to the outer side of the bone with bone screws and has a large secondary screw lag screw that is placed through the plate into the neck and head of.
The best intramedullary nail for the treatment of unstable aoota 31. Short versus long cephalomedullary nailing for the. This case demonstrates a softtissue sparing technique of humeral shaft fixation using a humeral intramedullary nail. Intramedullary hip screw how is intramedullary hip screw. Surgical technique treating femoral fractures with intramedullary rods is safe but tricky while antegrade nailing is best for most cases, retrograde nailing is beneficial for select patients. We assessed the cutout rate, the tad and caltad tip apex distance of three different implants. Anchorage strategies in geriatric hip fracture management in. Twentyfour consecutive adult patients who sustained a femoral shaft angular or rotational deformity, with or without significant shortening, were treated with skeletal traction of the femoral condyle, transverse femoral osteotomy, realignment of the shaft axis with or without lengthening, stable reamed intramedullary nail stabilization, and corticocancellous bone grafting. Most intertrochanteric fractures are managed with either a compression hip screw or an intramedullary nail, which also allows for impaction at the fracture site. Femur fracture fixation with intramedullary rod central.
Clinical orthopaedics and related research, 348, 8794 11 d. The intramedullary im lengthening device developed over the course of this study consists of three main components. In this paper, we present the management of a 40yearold man presented with a bent intramedullary nail due to secondary trauma. After the patient is in the correct position, the carm must be adjusted so that. Orthopedic hardware uw radiology university of washington. Surgery for hip fracture intramedullary nail insertion this leaflet aims to answer your questions about having surgery for a hip fracture. Tibial fractures are the most common long bone injury.
Intramedullary hip screw for intertrochanteric fractures wheeless. The technique is easy to perform and has significant benefits in minimizing surgical exposure, decreasing operative time and decreasing blood loss. Surgical technique of dhs fixation dhs remains the gold standard for trochanteric fractures, and is a rather quick surgery with assured and predictable results. Intertrochanteric fractures account for approximately half of all hip fractures in the elderly, with up to 60 percent of these fractures being classified as unstable. A small cortical screw goes through the second metatarsal neck, and there are k wires in the fourth and fifth toes. The femur was reconstructed with a new nail, and the fixation. It is an optional instrument in the extraction set.
The surgical technique comprises the closed reduction of the fracture on a. Statically locked, reamed intramedullary nailing remains the standard treatment for displaced tibial shaft fractures. Managing a problematic intramedullary screw in a patient. Surgical screws are inserted into the top end of the femur, through the rod and into the femoral head to secure the rod. Intramedullary nailing for hip fractures has become more popular in recent years.
Additional features include i a protective foam cover over the protruding parts. It will help you be able to put weight on the bone. The most common bones fixed by this procedure are the thigh, shin, hip, and upper arm. A drawback of the bouquet technique was the need for a proximal surgical incision and the relative technical dif. Extramedullary fixation for the treatment of intertrochanteric hip fractures. Establishing an appropriate starting point is a crucial part of the surgical procedure. Early rehabilitation following surgical fracture fixation restores function and. Trochanteric gamma nail and compression hip screw for. Either gamma3 intramedullary nail or slidingdynamic hip screw shs dhs depending on allocation by randomization system. Intramedullary hip screw fixation for proximal femoral. Intramedullary, spacer block and extramedullary techniques. With the frequency of intertrochanteric fractures, t mahmood, s sadiq and f arnaout set out to assess the efficacy of intramedullary hip screws in place of more outdated fixation methods introduction. We are never going to know the history, physical findings, surgical findings and.
A secondary highvelocity trauma to a previously stabilized femoral fracture with intramedullary nailing is rare. One screw placed in the distal part of the oblong hole and the other in the. While femoral intramedullary nailing, the fractured extremity usually needs to be positioned in full adduction during surgery for nail entry, reduction, and. Various methods of managing tibial fractures have been described in the literature over the years, ranging from plaster, functional bracing, compression plating external fixation and intramedullary im nailing 18.
Intracapsular fnfs account for approximately 50% of all hip fractures. Treating femoral fractures with intramedullary rods is. The following chapters describe the concept and design features of the drs, as well as the details of the surgical technique. Use of an intramedullary hipscrew compared with a compression hipscrew with a plate for intertrochanteric femoral fractures.