Inca Vilar-Sastre1, Sebastián Corró2, Jordi Tomàs-Hernández1,3, Jordi Teixidor-Serra1,3, Jordi Selga-Marsà1,3, Carlos-Alberto Piedra-Calle1,3, Vicente Molero-García1,3, Yaiza García-Sánchez3, José-Vicente Andrés-Peiró4,5. 1. Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain. 2. Department of Orthopaedic Surgery and Traumatology, Hospital de Manacor, Manacor, Spain. 3. Department of Orthopaedic Surgery and Traumatology, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain. 4. Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain. jose.andres@vhebron.net. 5. Department of Orthopaedic Surgery and Traumatology, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain. jose.andres@vhebron.net.
Abstract
PURPOSES: Femoral implant related fractures (IRF) are a growing pathology in an increasingly elderly and frail population. A series of IRF after cephalomedullary nail (CMN) fixation of a femoral fracture is analyzed and an algorithm described to guide the management of such fractures. METHODS: All eligible patients operated on for IRF fixation after CMN were reviewed regarding their demographics, comorbidities, injury pattern, and treatment. Primary outcomes were mortality and local complications. Secondary outcomes were time to consolidation, time to weight-bearing initiation, length of hospitalization, and discharge destination. RESULTS: The incidence of IRF requiring fixation was 1.3% after 3401 CMN implantation procedures. Elderly women with comorbidities and plate fixation predominated. One-year mortality was 18.6%, being higher for patients presenting with infection and those unable to walk at the end of follow-up. Local complications occurred in 25.6%. Median time to weight-bearing was 9.1 weeks, but longer for patients with plate fixation or complications. Patients presenting with an infection and those discharged to nursing facilities had more comorbidity. CONCLUSIONS: Following an algorithm presented here, patients were treated either with nail exchange or lateral locking plate fixation, permitting straightforward evaluations and acceptable results in a very high-risk population.
PURPOSES: Femoral implant related fractures (IRF) are a growing pathology in an increasingly elderly and frail population. A series of IRF after cephalomedullary nail (CMN) fixation of a femoral fracture is analyzed and an algorithm described to guide the management of such fractures. METHODS: All eligible patients operated on for IRF fixation after CMN were reviewed regarding their demographics, comorbidities, injury pattern, and treatment. Primary outcomes were mortality and local complications. Secondary outcomes were time to consolidation, time to weight-bearing initiation, length of hospitalization, and discharge destination. RESULTS: The incidence of IRF requiring fixation was 1.3% after 3401 CMN implantation procedures. Elderly women with comorbidities and plate fixation predominated. One-year mortality was 18.6%, being higher for patients presenting with infection and those unable to walk at the end of follow-up. Local complications occurred in 25.6%. Median time to weight-bearing was 9.1 weeks, but longer for patients with plate fixation or complications. Patients presenting with an infection and those discharged to nursing facilities had more comorbidity. CONCLUSIONS: Following an algorithm presented here, patients were treated either with nail exchange or lateral locking plate fixation, permitting straightforward evaluations and acceptable results in a very high-risk population.
Authors: Lester W M Chan; Antony W Gardner; Merng Koon Wong; Kenon Chua; Ernest B K Kwek Journal: Arch Orthop Trauma Surg Date: 2018-03-12 Impact factor: 3.067
Authors: Kenneth A Egol; Kurtis D Carlock; Erin A Kelly; Abhijit Seetharam; Brian H Mullis; Andrew J Marcantonio; Kasey J Bramlett; Corbyn M Nchako; J Tracy Watson; Lisa K Cannada; Sanjit R Konda Journal: J Orthop Trauma Date: 2019-09 Impact factor: 2.512