Sunil Govind Kulkarni1, Sushrut Sudhir Babhulkar2, Sujay Milind Kulkarni3, Govind Shivram Kulkarni1, Madhura Sujay Kulkarni1, Raviraj Patil1. 1. Department of Orthopaedics and Trauma, Swasthiyog Pratisthan Fracture and Orthopaedic Hospital, Miraj 416410, India. 2. Sushrut Institute of Medical Sciences, Research Centre & Post-Graduate Institute of Orthopedics, Nagpur 400010, India. 3. Department of Orthopaedics and Trauma, Swasthiyog Pratisthan Fracture and Orthopaedic Hospital, Miraj 416410, India. Electronic address: jay2712@gmail.com.
Abstract
BACKGROUND: Unstable intertrochanteric fractures present a challenge to orthopaedic surgeons, with varied geometry of the fractures and a wide choice of implants and techniques. The patients are usually osteoporotic, with multiple co-morbidities and poor tolerance for complications and re-operations. Lateral wall reconstruction and stability of the trochanteric fragments are considered important in providing a better outcome of these difficult injuries. We present a technique of lateral wall and trochanteric reconstruction using Cerclage wires and lag screws in the greater trochanter in addition to intramedullary nailing, and the radiological and functional outcome of this technique of augmentation. MATERIALS AND METHODS: This prospective study includes 154 patients from 2010 to 2015 presenting to the institute with an unstable intertrochanteric fracture. They were sequentially operated with intramedullary nailing (IMN) and augmentation with cerclage wire and/or Anteroposterior screw in greater trochanter, and 77 patients with IMN only. Operating time and need for blood transfusion post-surgery were documented. Patients were followed up for minimum of 12 months and radiological union time, complications and functional outcome using Harris Hip Score were noted at 1 year. Statistical analysis was performed to compare the results in both groups RESULTS: The mean union was 3.6 months in group A and 4.1 months in group B, with no statistically significant difference. The operating time needed for augmentation was 10 minutes more than IMN only. Blood transfusion was not required in any case. The incidence of complications like screw cut out, back out and non-union was lower in augmented group, and good functional outcome was greater in the augmented group which was statistically significant. The reoperation rate was lower in augmented group. CONCLUSIONS: This new technique of augmentation of fixation of intramedullary nail in unstable trochanteric fractures using cerclage wires and lag screws for lateral wall reconstruction is useful in reducing complications of the procedure and provides good radiological and functional outcome. It requires little additional operating time with minimal blood loss and soft tissue injury.
BACKGROUND: Unstable intertrochanteric fractures present a challenge to orthopaedic surgeons, with varied geometry of the fractures and a wide choice of implants and techniques. The patients are usually osteoporotic, with multiple co-morbidities and poor tolerance for complications and re-operations. Lateral wall reconstruction and stability of the trochanteric fragments are considered important in providing a better outcome of these difficult injuries. We present a technique of lateral wall and trochanteric reconstruction using Cerclage wires and lag screws in the greater trochanter in addition to intramedullary nailing, and the radiological and functional outcome of this technique of augmentation. MATERIALS AND METHODS: This prospective study includes 154 patients from 2010 to 2015 presenting to the institute with an unstable intertrochanteric fracture. They were sequentially operated with intramedullary nailing (IMN) and augmentation with cerclage wire and/or Anteroposterior screw in greater trochanter, and 77 patients with IMN only. Operating time and need for blood transfusion post-surgery were documented. Patients were followed up for minimum of 12 months and radiological union time, complications and functional outcome using Harris Hip Score were noted at 1 year. Statistical analysis was performed to compare the results in both groups RESULTS: The mean union was 3.6 months in group A and 4.1 months in group B, with no statistically significant difference. The operating time needed for augmentation was 10 minutes more than IMN only. Blood transfusion was not required in any case. The incidence of complications like screw cut out, back out and non-union was lower in augmented group, and good functional outcome was greater in the augmented group which was statistically significant. The reoperation rate was lower in augmented group. CONCLUSIONS: This new technique of augmentation of fixation of intramedullary nail in unstable trochanteric fractures using cerclage wires and lag screws for lateral wall reconstruction is useful in reducing complications of the procedure and provides good radiological and functional outcome. It requires little additional operating time with minimal blood loss and soft tissue injury.
Authors: Xavier Lizano-Díez; Marius Johann Baptist Keel; Klaus Arno Siebenrock; Marc Tey; Johannes Dominik Bastian Journal: Eur J Trauma Emerg Surg Date: 2020-01-03 Impact factor: 3.693