RESUMO
BACKGROUND: Proximal femur fractures, including both intracapsular (femoral neck fractures) and extracapsular fractures (intertrochanteric femoral fractures, IFFs), affect around 1.5 million people per year worldwide. Mechanical failures of intertrochanteric nailing in IFFs could be managed with revision total hip arthroplasty (THA). AIM: To describe the surgical complexity and the procedure-related complication rates in patients with trochanteric nailing failure and treated with THA. METHODS: Patients referred to our level I trauma center between April 2012 and July 2018 with failed cephalomedullary nailing following trochanteric fractures were retrospectively recruited. All patients underwent a salvage surgical procedure, i.e., cephalomedullary nail removal and conversion to THA. The same surgical and anesthesiology team performed the surgical procedures under spinal anesthesia. All patients underwent clinical and radiographic follow-ups for at least 24 mo. Complications and re-operations were recorded. RESULTS: Seventy-four patients met the inclusion criteria (male: 29; female: 45; mean age: 73.8-years-old; range: 65-89) and were included in the current study. The average operative time was 117 min (76-192 min). The average blood loss was 585 mL (430-1720 mL). Among the 74 patients, 43 (58.1%) required transfusion of three or more blood units. Two patients died within the 4th d after surgery because of pulmonary embolism, and 1 patient died 9 mo after surgery due to ischemic myocardial infarction. The complication rate in the 71 patients who completed the minimum 24-mo follow-up was 22.5%. In 3 cases out of 71 (4.2%) periprosthetic acetabular fracture was observed during the follow-up. One of these periacetabular fractures occurred intraoperatively. An intraoperative periprosthetic femur fracture was observed in 5 patients out of 71 (7.0%). Four of these patients needed a re-operation to fix the fracture with plates and cerclages; in one of these patients, femoral stem revision was also necessary. In 4 patients out of 71 (5.6%), an early THA dislocation was observed, whereas in 1 case (1.4%) a late THA dislocation was observed. Three patients out of 71 (4.2%) developed a periprosthetic joint infection during the study follow-up. CONCLUSION: The present study demonstrated that salvage options for IFF fixation failure are complex procedures with a relevant intraoperative and postoperative complication rate.
RESUMO
The present study aims to depict the importance of gender-related factors in the subjective perception of spine deformity in adolescents undergoing posterior instrumented fusion for scoliosis. Patients undergoing posterior spinal instrumentation and fusion (PSF) for idiopathic adolescent scoliosis (AIS) were recruited. The following data were recorded: gender, age, parents' civil status, Tegner Activity Scale (TAS), body mass index (BMI), concomitant diseases, and history of neuropsychological disorders. Each patient underwent clinical and radiological evaluations according to the protocol used at our institution. All the patients were assessed before surgery using the following Patient-Reported Outcome Measures (PROMs): the Italian version of the revised Scoliosis Research Society-22 patient questionnaire (SRS-22R), the Quality-of-Life Profile for Spinal Deformities (QLPSDs) questionnaire, and the Spinal Appearance Questionnaire (SAQ). The present study recruited 80 patients (male: 19, female: 61). A significant correlation was observed between BMI, TAS, and subjective perception scores. A worse deformity perception was observed in female patients and patients with divorced parents. Gender-related factors impact the subjective perception of spine deformity in patients undergoing PSF for AIS. Specific assessment and correction are needed to improve postoperative outcomes in these patients.
