RESUMO
BACKGROUND: Distal femoral resection knee arthroplasty is a limb salvage procedure. The impact of distal femoral resection arthroplasty on patient function and health status is unknown. The aim of this study was to report knee function, quality of life, knee pain, and living conditions after distal femoral resection knee arthroplasty for non-tumor indications. METHODS: Of 52 patients (52 knees) undergoing distal femoral resection knee arthroplasty in a single institution between 2012 and 2021, 22 were excluded as 3 patients had ≤90 days follow-up, 6 had died, and 13 declined or were unable to participate for unrelated reasons. Thus, 30 patients were included and interviewed by telephone in March 2021 (mean follow-up 3.5 years after surgery). Patient completed the Oxford Knee Score (0-48, 48 best), EQ-5D-5L, and the Copenhagen Knee ROM, and information on pain and living conditions was obtained. RESULTS: The mean age was 67.9 years (SD 13.6), and 21 (70%) were female. Mean total Oxford Knee Score was 29.9 (SD 10.5), mean Copenhagen Knee ROM flexion was 116° (SD 21.6), and mean extension was - 2° (SD10.1). Mobility aids were used by 18 (60%) patients, i.e. a cane (30%), walker (26.7%) or wheelchair (3.3%). Mean EQ-5Dindex score was 0.70 (SD 0.22) and mean EQ-5D VAS score was 55.4 (SD 23.9). Nine (30%) patients used paracetamol or NSAID and 2 (6.7%) used opioids for knee pain. Mean VAS knee pain score was 1.30 (SD 2.2) at rest and 2.8 (SD 3.1) when walking. Most (90%) patients lived in their own home, with only 3 patients in nursing homes. Two-thirds (66.7%) required no home care, 5 (16.6%) received home care 1-2 times over 2 weeks, and 5 (16.6%) every day. CONCLUSION: Distal femoral resection knee arthroplasty appears to be a viable treatment option for non-tumor indications. Acceptable patient outcomes were achieved in terms of functional status and quality of life, especially considering treatment alternatives such as femoral amputation.
Assuntos
Artroplastia do Joelho , Osteoartrite do Joelho , Humanos , Feminino , Idoso , Masculino , Artroplastia do Joelho/efeitos adversos , Artroplastia do Joelho/métodos , Qualidade de Vida , Condições Sociais , Resultado do Tratamento , Articulação do Joelho/cirurgia , Dor , Osteoartrite do Joelho/cirurgiaRESUMO
BACKGROUND: Distal femoral resection knee arthroplasty may be a viable option for several indications other than bone tumors. Resection knee arthroplasty appears to be becoming more common, but patients requiring this type of surgery are often elderly and with high comorbidity. The aim of this study was to report in-hospital complications, readmissions, reoperations, and mortality after distal femoral resection knee arthroplasty for non-tumor indications. METHODS: We retrospectively identified a consecutive cohort of 45 knees (45 patients) treated with distal femoral resection knee arthroplasty in a single institution between 2012 and 2021. Indications for surgery were failure of osteosynthesis (8), primary fracture treatment (2), periprosthetic fracture (22), and revision arthroplasty with severe bone loss (13). A major reoperation was defined as a major component exchange procedure or amputation. Mean follow-up was 3.9 years. RESULTS: The mean age was 71.3 years (SD 12.3), and 64.4% were female; 8.9% were ASA I, 40% ASA II, and 51% ASA III. Median length of stay was 7 days (range 3-19) with no major in-hospital complications, but 55.6% (n = 25) required blood transfusion. The 90-day readmission rate was 17.8% (n = 8), of which 50% was prosthesis-related. Four patients (8.9%) underwent major reoperation due to infection (n = 2), mechanical failure (n = 1), or periprosthetic fracture (n = 1). The mortality rate was 0% ≤ 90 days and 2.2% ≤1 year. CONCLUSIONS: Distal femoral resection knee arthroplasty in this fragile patient population appears to be a viable and safe option considering that it is a limp salvage procedure most cases.
Assuntos
Artroplastia do Joelho , Fraturas do Fêmur , Idoso , Artroplastia do Joelho/efeitos adversos , Artroplastia do Joelho/métodos , Estudos de Coortes , Feminino , Fraturas do Fêmur/cirurgia , Humanos , Articulação do Joelho/cirurgia , Masculino , Segurança do Paciente , Reoperação/efeitos adversos , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Background Following surgery, the standard regimen for fractures of the distal forearm includes radiographs taken 2-weeks postoperatively. However, it is unclear whether these radiographs have any therapeutic risks or benefits for patients. Objective The purpose of this study is to determine the importance of radiographs taken 2-weeks after surgery on distal forearm fractures, especially if it leads to further operations, and to establish whether this practice should be continued. Materials and Methods This is a retrospective cohort study of patients with a distal forearm fracture treated surgically with a volar locking plate at two university hospitals in Denmark. Standard aftercare at both departments is 2 weeks in a cast. Patients attend a 2-week follow-up, at which the cast is replaced with a removable orthosis and radiographs are taken. It was recorded whether these radiographs had resulted in any change of treatment in terms of further operations, prolonged immobilization, additional clinical follow-up, or additional diagnostic imaging. Results A total of 613 patients were included in the study. The radiographs led to a change of standard treatment for 3.1% of the patients. A second operation was required by 1.0%; 0.5% were treated with prolonged immobilization, and 1.6% had additional outpatient follow-up due to the findings on the radiographs. Additional diagnostic imaging was performed on 1.9% of the patients. Conclusion The radiographs taken at the 2-weeks follow-up resulted in a change of treatment in 3.1% of the cases. Given the low cost and minimal risk of radiographs of an extremity, we concluded that the benefits outweigh the costs of routine radiographs taken 2 weeks after surgical treatment of distal forearm fractures.
RESUMO
INTRODUCTION: The treatment of choice for unstable diaphyseal fractures in the tibia is reamed insertion of an intramedullary nail (IMN). The most common complication to this treatment is chronic knee pain with reported rates ranging from 10% to 87% with a mean of 47.4% in meta-analyses. METHODS: This study evaluates the long-term outcome after IMN insertion in adult patients with a tibial shaft fracture using the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire. The study includes patients operated on one of five Danish hospitals in a five-year period. The patients received a KOOS questionnaire with questions regarding knee-specific symptoms, stiffness, pain, function and quality of life. Data were subsequently compared to those of a reference population. RESULTS: A total of 391 patients were enrolled from the trauma centre's database search. 55 patients did not meet the inclusion criteria. Questionnaires were sent out to 336 patients and 223 (66%) responded. Mean age was 47.9 years at the time of surgery; 63% were men. The follow-up time ranged from 1.7 to 6.7 years. CONCLUSIONS: With a follow-up time of more than six years after receiving an IMN, patients in this study experienced more knee-specific symptoms, pain, limitations in sports and daily living than a reference population who had not undergone surgery. The study population also reported poorer quality of life outcomes than the reference population. FUNDING: none. TRIAL REGISTRATION: Approved by the Danish Data Protection Agency. Clinical trials: NCT03649360.
Assuntos
Pinos Ortopédicos , Fixação Intramedular de Fraturas , Articulação do Joelho/fisiopatologia , Dor/etiologia , Qualidade de Vida , Fraturas da Tíbia/cirurgia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Bases de Dados Factuais , Dinamarca , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória , Amplitude de Movimento Articular , Estudos Retrospectivos , Fatores Sexuais , Inquéritos e Questionários , Fraturas da Tíbia/complicações , Resultado do Tratamento , Adulto JovemRESUMO
It is increasingly recognised that individuals with non-0 blood groups may be at elevated risk of venous thromboembolism (VTE) compared with blood group 0 individuals. Multiple studies suggest that individuals with a non-0 blood group have an approximately twofold increased risk of VTE. The largest risk is seen in individuals with combined factor VLeiden mutation and non-0 blood group. In this review, we outline an overview of the existing literature regarding AB0 blood groups and the risk of VTE.
Assuntos
Antígenos de Grupos Sanguíneos , Tromboembolia Venosa , Humanos , Mutação , Fatores de Risco , Tromboembolia Venosa/etiologiaRESUMO
BACKGROUND: Tourniquets are commonly used in today's orthopaedic surgical practice, but little evidence is available regarding the links between the use of a tourniquet and the amount of post-operative pain and other complications. The aim of the study was to conduct a systematic review and meta-analysis comparing tourniquet versus non-tourniquet use during fracture surgery of the lower limb in adult patients. METHOD: A search was performed using the keyword "tourniquet" in EmBase and as a MeSH term in PubMed, and no limitations (including language) were applied. Available studies were screened using the Covidence software, and demographic as well as outcome data were extracted from the final studies. Critical appraisal was performed according to Cochrane Risk of Bias guidelines. Pooled data were assessed for heterogeneity using Chi-squared and I2 tests. RESULTS: Five studies were included, and no statistically significant difference was found in the amount of pain and post-operative complications between tourniquet and non-tourniquet groups. Length of in-hospital stay was longer in the tourniquet groups. An overall high risk of bias was found in the included studies. CONCLUSION: Although the validity and statistical strength of our results are not strong enough to suggest a change in practice in tourniquet use, the operating surgeon should still carefully consider his or her decision to use a tourniquet in lower limb fracture surgery, as there are indeed complications associated with it and no current evidence to support its continued use. LEVEL OF EVIDENCE: Level I, systematic review of randomized controlled trials.
Assuntos
Fraturas Ósseas/cirurgia , Dor Pós-Operatória/etiologia , Torniquetes/efeitos adversos , Viés , Perda Sanguínea Cirúrgica/prevenção & controle , Humanos , Tempo de Internação , Extremidade Inferior , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
BACKGROUND: The purpose of this study was to compare two methods of stabilization for proximal tibia fractures (AO 41) with a complete metaphyseal component, external fixation with the Ilizarov wire frame, and internal fixation with locking plates. METHODS: Patients from two level 1 trauma centers treated between 2009 and 2015 were included in a retrospective comparing cohort study. The first center stabilized the non-pathological, proximal tibia fractures exclusively with external fixation and the second with internal plating. Combined clinically and radiologically evaluated, bone healing was the primary outcome. The secondary outcomes included complications, range of motion (ROM) and axial alignment of the knee, the reoperation rate within 6 months, heterotopic ossifications (HTO), and signs of posttraumatic osteoarthritis (PTOA). A logistic regression analysis corrected for uneven distributed parameters. RESULTS: The 62 patients treated with Ilizarov frame and the 68 patients treated with plate fixation were comparable regarding epidemiological parameters, injury characteristics, and comorbidity except for injury severity score (ISS) and smoking behavior. The time of healing was shorter in the group undergoing plate fixation (p = 0.041); however, the incidence of non-unions was equal. Furthermore, there was no difference regarding the rate of deep infections, thrombosis, alignment, reoperations, PTOA, and ROM. Heterotopic ossifications were more prevalent following plate fixation (13.2 vs 1.6%, p = .013). External fixation was associated with a higher rate of superficial infections (40.4 vs 2.9%, p = .000). The initial displacement, the incidence of deep infections, and the classification significantly influenced the incidence of non-unions in both groups (p < 0.02). CONCLUSIONS: Fixation of proximal tibia fractures with plates resulted in a slightly shorter healing time compared to Ilizarov frame stabilization. Furthermore, the complication profiles differ with more heterotopic ossifications and less superficial infections following internal plating. TRIAL REGISTRATION: DRKS, DRKS00013275 , Registered 11/2/2017, Retrospectively registered.
Assuntos
Placas Ósseas/normas , Técnica de Ilizarov/normas , Fraturas da Tíbia/diagnóstico por imagem , Fraturas da Tíbia/cirurgia , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Fixação de Fratura/métodos , Fixação de Fratura/normas , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fraturas da Tíbia/epidemiologiaRESUMO
BACKGROUND: We hypothesized that undergoing surgery as soon as possible reduces early mortality in patients with a proximal femoral fracture. Our aim was to evaluate the association between surgical delay and early mortality in these patients. METHODS: We performed a retrospective analysis of prospectively collected data from the Danish Fracture Database and the Civil Registration System on patients who were fifty years of age or older and had undergone surgery for a proximal femoral fracture. Femoral head fracture (classified as OTA/AO 31C per the OTA/AO classification system), high-energy trauma, pathological fractures, multiple fractures, and surgeries performed with implants not commonly used were excluded. End points were adjusted odds ratios for thirty-day and ninety-day mortality. RESULTS: For the 3517 surgeries included in this study, the median patient age was 82.0 years (range, fifty-one to 107 years), 2458 patients (70%) were female, and 1720 surgeries (49%) were performed because of a trochanteric fracture. Within twelve hours, 722 of the surgeries (21%) had been performed; within twenty-four hours, 2482 surgeries (71%); within thirty-six hours, 3024 surgeries (86%); within forty-eight hours, 3242 surgeries (92%); and within seventy-two hours, 3353 surgeries (95%). Unsupervised surgeons with an education level below that of an attending surgeon performed the surgery in 1807 (51%) of all cases. The thirty-day mortality was 380 (10.8%) and the ninety-day mortality was 612 (17.4%). The risk of thirty-day mortality increased with a surgical delay of more than twelve hours (odds ratio, 1.45; p = 0.02), more than twenty-four hours (odds ratio, 1.34; p = 0.02), and more than forty-eight hours (odds ratio, 1.56; p = 0.02); the risk of ninety-day mortality increased with a surgical delay of more than twenty-four hours (odds ratio, 1.23; p = 0.04). An education level of the surgeon below that of an attending surgeon increased the risk of thirty-day mortality (odds ratio, 1.28; p = 0.035) and ninety-day mortality (odds ratio, 1.26; p = 0.016). Increasing American Society of Anesthesiologists score and male sex significantly increased both thirty-day and ninety-day mortality. CONCLUSIONS: In this study, a surgical delay of more than twelve hours significantly increased the adjusted risk of thirty-day mortality and a surgical delay of more than twenty-four hours significantly increased the adjusted risk of ninety-day mortality. The adjusted risk of both thirty-day and ninety-day mortality increased significantly when the education level of the surgeon was below that of an attending surgeon. The study findings challenge orthopaedic departments to facilitate fast surgical treatment supported by attending orthopaedic surgeons.
Assuntos
Causas de Morte , Fixação Intramedular de Fraturas/mortalidade , Fraturas do Quadril/mortalidade , Fraturas do Quadril/cirurgia , Tempo para o Tratamento , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Bases de Dados Factuais , Dinamarca , Feminino , Seguimentos , Fixação Intramedular de Fraturas/métodos , Fraturas do Quadril/diagnóstico por imagem , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Prospectivos , Radiografia , Estudos Retrospectivos , Medição de Risco , Taxa de Sobrevida , Fatores de Tempo , Resultado do TratamentoRESUMO
INTRODUCTION: The importance of supervision and of surgeons' level of experience in relation to patient outcome have been demonstrated in both hip fracture and arthroplasty surgery. The aim of this study was to describe the surgeons' experience level and the extent of supervision for: 1) fracture-related surgery in general; 2) the three most frequent primary operations and reoperations; and 3) primary operations during and outside regular working hours. MATERIAL AND METHODS: A total of 9,767 surgical procedures were identified from the Danish Fracture Database (DFDB). Procedures were grouped based on the surgeons' level of experience, extent of supervision, type (primary, planned secondary or reoperation), classification (AO Müller), and whether they were performed during or outside regular hours. RESULTS: Interns and junior residents combined performed 46% of all procedures. A total of 90% of surgeries by interns were performed under supervision, whereas 32% of operations by junior residents were unsupervised. Supervision was absent in 14-16% and 22-33% of the three most frequent primary procedures and reoperations when performed by interns and junior residents, respectively. The proportion of unsupervised procedures by junior residents grew from 30% during to 40% (p < 0.001) outside regular hours. CONCLUSION: Interns and junior residents together performed almost half of all fracture-related surgery. The extent of supervision was generally high; however, a third of the primary procedures performed by junior residents were unsupervised. The extent of unsupervised surgery performed by junior residents was significantly higher outside regular hours. FUNDING: not relevant. TRIAL REGISTRATION: The Danish Fracture Database ("Dansk Frakturdatabase") was approved by the Danish Data Protection Agency ID: 01321.
Assuntos
Plantão Médico/normas , Competência Clínica/normas , Fraturas Ósseas/cirurgia , Internato e Residência/normas , Procedimentos Ortopédicos/normas , Ortopedia/normas , Plantão Médico/organização & administração , Plantão Médico/estatística & dados numéricos , Bases de Dados Factuais , Humanos , Internato e Residência/organização & administração , Internato e Residência/estatística & dados numéricos , Procedimentos Ortopédicos/estatística & dados numéricos , Ortopedia/organização & administração , Ortopedia/estatística & dados numéricos , Avaliação de Processos em Cuidados de Saúde , ReoperaçãoRESUMO
INTRODUCTION: The Danish Fracture Database (DFDB) was established in 2011 to establish nationwide prospective quality assessment of all fracture-related surgery. In this paper, we describe the DFDB's setup, present preliminary data from the first annual report and discuss its future potential. MATERIAL AND METHODS: The DFDB collaboration includes 13 hospitals and covers a population of 3.7 million. Data registration is performed online by the surgeon following surgery, and it includes patient-, trauma- and surgery-related data. Primary procedures, reoperations and planned secondary procedures are registered. Indication for reoperation is also recorded. The reoperation rate and the one-year mortality are the primary indicators of quality. RESULTS: Approximately 10,000 fracture-related surgical procedures were registered in the database at the time of presentation of the first annual DFDB report (currently 15,000). 85% of all procedures were performed on adult fractures and 15% on paediatric fractures. Proximal femur (33%), distal radius (15%) and malleolar fractures (12%) were the three most common primary adult fractures. Pain and discomfort from orthopaedic hardware, infection and failure of osteosynthesis were the three most common indications for reoperation and accounted for 34%, 14% and 13%, respectively. CONCLUSION: The DFDB is an online database for registration of fracture-related surgery that allows for basic quality assessment of surgical fracture treatment and large-scale observational research by registering primary surgery, reoperations and planned secondary procedures. FUNDING: not relevant. TRIAL REGISTRATION: not relevant.
Assuntos
Bases de Dados Factuais/estatística & dados numéricos , Fraturas Ósseas/cirurgia , Procedimentos Ortopédicos/estatística & dados numéricos , Procedimentos Ortopédicos/normas , Avaliação de Processos e Resultados em Cuidados de Saúde , Sistema de Registros/estatística & dados numéricos , Dinamarca , Fraturas Ósseas/etiologia , Humanos , Internet , Próteses e Implantes , Reoperação , Taxa de Sobrevida , Tempo para o TratamentoRESUMO
OBJECTIVES: Reoperations are common after surgical treatment of hip fractures but may be reduced by optimal choice of implant based on fracture classification. We hypothesized that implementing a surgical treatment algorithm was possible in our hospital and would result in a reduced reoperation rate. DESIGN: Retrospective comparative study. SETTING: Provincial level III trauma center. PATIENTS: The evidence-based "Hvidovre Algorithm" for treatment of hip fractures was adopted and implemented at our provincial institution in September 2008. Three hundred eighty-six consecutive patients older than 50 years admitted with a hip fracture in the first year after implementation were prospectively included and compared with 417 retrospectively included similar patients admitted within the last year before implementation. INTERVENTION: Implementation of an evidence-based treatment algorithm for hip fracture surgery. RESULTS: Eighty-five percent (330 of 386) patients were operated according to the algorithm after implementation, compared with 67% (280 of 417) of procedures before implementation (P < 0.001). After implementation, the overall reoperation rate showed a tendency toward a reduction to 8% (32 of 386) from 12% (48 of 417) (P = 0.1). Among all the 803 included patients, the reoperation rate was lower if procedures had been performed according to the algorithm recommendations: 9% (53 of 610) versus 14% (27 of 193) (P = 0.009). CONCLUSIONS: The algorithm for hip fracture surgery was easily implemented, and our results support that using it facilitates a low reoperation rate. The reoperation rate may be further reduced with higher adherence to algorithm recommendation. LEVEL OF EVIDENCE: Therapeutic level III. See instructions for authors for a complete description of levels of evidence.
Assuntos
Fixação Interna de Fraturas/normas , Fraturas do Quadril/cirurgia , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Protocolos Clínicos , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/instrumentação , Implementação de Plano de Saúde , Fraturas do Quadril/classificação , Fraturas do Quadril/diagnóstico por imagem , Humanos , Fixadores Internos , Masculino , Complicações Pós-Operatórias/prevenção & controle , Guias de Prática Clínica como Assunto , Estudos Prospectivos , Radiografia , Reoperação , Estudos RetrospectivosRESUMO
INTRODUCTION: Fracture-related surgery is among the most common orthopaedic procedures. However, to our knowledge, register-based quality assessment of fracture-related surgery has not previously been conducted. The Danish Fracture Database (DFDB) has been developed for the purpose of web-based quality assessment, but its properties as a valid data source have not previously been explored. We therefore investigated: 1) the completeness of data in the DFDB, and 2) if the entered data are valid data sources for future quality assessment. MATERIAL AND METHODS: We have developed the internet-based DFDB in which data entry is performed by the surgeon. Data collection includes primary fracture surgery and reoperations. After full implementation of the database at two orthopaedic departments, we assessed the completeness and validity of the entered data for 322 patients operated during a one-month period. Validity was calculated as observed agreement. RESULTS: We recorded 83% completeness for all types of data entry, with 88% completeness for primary fracture surgery and 77% for reoperations, respectively. Patient- and trauma-related data were 82-100% valid. Surgery-related data included method of osteosynthesis and was valid in 89-99% of the cases. CONCLUSION: The DFDB is an easy to use web-based database for registration of fracture-related surgery. Shortly after its implementation, we recorded satisfactory completeness and high data validity, which makes the DFDB a valuable tool with potential for nationwide quality assessment of fracture-related surgery.
Assuntos
Fraturas Ósseas/cirurgia , Sistema de Registros , Dinamarca , Fraturas Expostas/cirurgia , Fraturas Espontâneas/cirurgia , Humanos , Internet , Qualidade da Assistência à Saúde , Sistema de Registros/normasRESUMO
BACKGROUND AND PURPOSE: Historically, the treatment of periprosthetic femoral fractures (PFFs) has been associated with a high frequency of complications and reoperations. The preferred treatment is internal fixation, a revision of the femoral stem, or a combination of both. An improved understanding of plate use during internal fixation, and the introduction of locking-plate osteosynthesis may lead to improved outcome. We evaluated the outcome of Vancouver type B1 and C PFFs treated by locking-plate osteosynthesis, by assessing rates of fracture union and reoperations and by analyzing failure cases. PATIENTS AND METHODS: From 2002 through 2011, 58 consecutive patients (60 fractures) with low-energy PFF around or below a stable femoral stem, i.e. Vancouver type B1 and C fractures, underwent osteosynthesis with a locking plate. All patients had a total hip replacement (THR). They were followed up clinically and radiographically, with 6 weeks between visits, until fracture union or until death. Fracture union was evaluated 6 months postoperatively. RESULTS: At a median follow-up time of 23 (0-121) months after PFF, 8 patients (8 fractures) had been reoperated due either to infection (n = 4), failure of fixation (n = 3), or loosening of the femoral stem (n = 1). All the patients who had been followed up for at least 6 months-and who did not undergo reoperation or die-went on to fracture union (n = 43). INTERPRETATION: Locking-plate osteosynthesis of periprosthetic Vancouver type B1 and C fractures gives good results regarding fracture union. It appears that spanning of the prosthesis to avoid stress-rising areas is important for successful treatment. Infection is the major cause of failure.
Assuntos
Artroplastia de Quadril/efeitos adversos , Placas Ósseas , Fraturas do Fêmur/cirurgia , Fixação Interna de Fraturas/instrumentação , Fraturas Periprotéticas/cirurgia , Amplitude de Movimento Articular/fisiologia , Idoso de 80 Anos ou mais , Artroplastia de Quadril/métodos , Estudos de Coortes , Intervalos de Confiança , Feminino , Fraturas do Fêmur/diagnóstico por imagem , Fraturas do Fêmur/etiologia , Seguimentos , Fixação Interna de Fraturas/métodos , Consolidação da Fratura/fisiologia , Prótese de Quadril , Humanos , Masculino , Pessoa de Meia-Idade , Fraturas Periprotéticas/diagnóstico por imagem , Radiografia , Recuperação de Função Fisiológica , Reoperação/métodos , Estudos Retrospectivos , Medição de Risco , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND AND PURPOSE: Fixation of unstable trochanteric fractures is challenging. Application of a circumferential wire may facilitate bone contact and avoid postoperative fracture displacement. However, the use of circumferential wires remains controversial due to possible disturbance of the blood supply to the underlying bone. We evaluated the results of applied circumferential wires, concentrating mainly on complications and reoperations. PATIENTS AND METHODS: 60 patients with unstable trochanteric fractures and use of circumferential wires (1 or more) and an intramedullary nail were included from 2 centers. We retrospectively assessed complications and reoperation rates within the first postoperative year. RESULTS: In 37 of the 60 patients, 2 or more circumferential wires were used. Anatomic reduction was achieved in 24 of the patients and a total cortical displacement of ≤ 10 mm was achieved in 26 other patients. 6 of the 43 patients with radiographic audit after 12 weeks sustained a subsequent fracture displacement of more than 5 mm. 4 patients underwent reoperation: 1 due to deep infection, 1 due to technical failure during osteosynthesis, 1 had a screw cut out, and 1 sustained a new fracture following a new fall. INTERPRETATION: Application of circumferential wires as a supplement to intramedullary nails in unstable trochanteric fractures is an option as it provides good primary reduction which, in most patients, is maintained over time-with no apparent increase in reoperation rate. Based on our results and on other reports, the use of circumferential wires does not appear to be harmful as sometimes claimed.