Geriatric Intertrochanteric Fractures: What Is the Optimal Follow-Up Period?

OBJECTIVE: Evaluate patients with intertrochanteric fractures who were treated operatively to determine optimal follow-up to ensure complete fracture healing and recognize complications. DESIGN: Retrospective review. SETTING: Academic Level 1 trauma center. PATIENTS/PARTICIPANTS: Inclusion criteria included isolated intertroch fractures (not pathologic) and complete radiographic and clinical data, with at least 1-year follow-up. Four hundred ninety-seven patients were identified. Two hundred forty-nine patients met inclusion criteria with 194 patients studied. INTERVENTION: Operative fixation with either CMN or SHS. MAIN OUTCOME MEASUREMENTS: Radiographic parameters included time to union, neck-shaft angle, tip apex distance, and femoral neck screw telescoping (shortening) for both CMS and SHS combined. Postoperative complications were recorded. RESULTS: Union was achieved at a mean of 64.8 ± 30.7 days. Mortality (n = 12), infection (n = 4), and implant failure (n = 5) occurred within 3 months. Neck-shaft angle was changed before 3 months. Significant neck shortening for both CMN and SHS occurred within 6 weeks ( P =<0.001). Major complications occurred early, within 3 months. CONCLUSIONS: Most fractures healed by 3 months and the remainder by 6 months. Routine follow-up for 6 months is more than sufficient for most of these fractures. LEVEL OF EVIDENCE: Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Generic Preoperative Planning for Proximal Femoral Osteotomy in the Treatment of Nonunion of the Femoral Neck.

Despite improvements in surgical technique and overall patient care, failed treatment of fractures of the femoral neck persists. For the physiologically young patient, joint preservation is the preferred method of treatment. Unfortunately, the best treatment option, proximal femoral osteotomy, is fast becoming a lost art. Preoperative planning is critical in this regard. The described preoperative planning work flow is a reliable method for obtaining the desired deformity correction for a variety of proximal femoral malunions and nonunion. Revisiting the classic Pauwels osteotomy for femoral neck nonunion is an appropriate vehicle to supply the first link in resurrecting this treatment modality by providing a standardized preoperative planning protocol.

Complete medial dislocation of the tarsal navicular without fracture: report of a rare injury.

Complete dislocation of the tarsal navicular, without fracture of the navicular, is an uncommon injury. A review of the published data revealed only 15 previous reported cases. The rarity of this injury can be attributed to the rigid bony and ligamentous support surrounding the navicular, which usually undergoes fracture and dislocation rather than pure dislocation of the navicular. The mechanism and appropriate treatment of this injury remains unclear. In the present report, we describe the case of a 29-year-old male who sustained complete dislocation of the tarsal navicular, without fracture of the navicular, along with fractures of the cuboid and calcaneus, when he was involved in a motor vehicle collision. The proposed mechanism of injury in this case was that of a pronation-abduction force applied to the midfoot, resulting in a transient midtarsal dislocation and disruption of the ligamentous support of the navicular, with medial dislocation of the navicular when the midtarsal dislocation was reduced. The anterolateral calcaneus and cuboid fractures were likely from an avulsion injury through the bifurcate ligament. The patient was treated successfully with closed reduction and Kirschner wire fixation of the navicular combined with application of a spanning external fixator. The pins and external fixator were removed at 7 weeks postoperatively, and the navicular was stable at that time. The patient was lost to follow-up shortly thereafter.