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Date: 2012-11-30 Session: Trauma: Hip I Time: 08:30 - 10:00 Room: Rashid D Abstract no.: 32897 IMPLANT SELECTION IN SUBTROCHANTERIC FRACTURES: STILL A DILEMMA Dinakar Rai B.K 1 , Chittaranjan KARUPPANAN 2 , Ramakrishna YELURI 3 1 PSG Institute of medical sciences and research, Coimbatore (INDIA), 2 PSG Insitute of medical sciences and research, Coimbatore (INDIA), 3 PSG Institute of medical siences and research, Coimbatore (INDIA) INTRODUCTION & PURPOSE: Subtrochanteric fractures are difficult to manage and associated with many complications. Various implants have been designed to address these fractures with variable success but the choice of implant in different fracture patterns have not been defined clearly. We suggest an algorithm for management of Subtrochanteric fractures. MATERIALS AND METHODS: We include 28 cases in the study. All the fractures were fixed with various implants based on fracture pattern, achievement of closed reduction and surgeon’s familiarity with the procedure. Out of the 28 cases, in 13 cases biological DCS fixation, in 2 cases open reduction and DCS fixation, 8 cases DHS fixation and in 5 cases RECONSTRUCTION NAIL fixation was done respectively. RESULTS: In 27 cases fracture union was achieved without bone grafting and in one case where open reduction and DCS fixation was done went for delayed union and failure. DISCUSSION: Subtrochanteric fractures of femur demand a special consideration in implant selection, achieving closed reduction and surgical technique. Among these we suggest an algorithm for choice of implant. We followed Seinsheimer’s classification. For type I, II and III fractures if closed reduction is achieved reconstruction nail is our choice of implant and if not, our choice is biological DCS fixation. In type IV and V fractures if closed reduction is achieved biological DCS is advised and if not biological DCS fixation and subperiosteal bone grafting is our choice.
Date: 2012-11-30 Session: Trauma: Hip I Time: 08:30 - 10:00 Room: Rashid D Abstract no.: 32076 CERCLAGES IN PERIIMPLANT FRACTURES ABOUT THE TIP OF GAMMA NAIL – AN ALTERNATIVE PROCEDURE? Gerrit MATTHES 1 , Christian IRMER 2 , Uli SCHMUCKER 3 , Michael WICH 4 , Axel EKKERNKAMP 5 1 Unfallkrankenhaus Berlin and University Greifswald, Berlin (GERMANY), 2 Achenbach-Krankenhaus, Königs Wusterhausen (GERMANY), 3 Unfallkrankenhaus Berlin, Berlin (GERMANY), 4 Unfallkrankenhaus Berlin and Achenbach-Krankenhaus, Berlin (GERMANY), 5 Unfallkrankenhaus Berlin and University Greifswald, Berlin (GERMANY) Background: Due to aging societies an increased frequency of periimplant fractures must be expected. Wire cerclages are occasionally used for fixation of oblique fractures at the implant site. The Titanium Compression Cerclage Gundolf (CCG) may provide greater primary stability. We set out to compare these two methods regarding their primary stability in fractures at the tip of a gamma nail. Materials and Methods: A biomechanical cadaver model was designed. Fracture was simulated by oblique osteotomy at the tip of an implanted gamma-nail. 3 CCGs (study group) vs. 3 stainless steel wires (control group) were mounted for fixation of the fracture. After that the cadaver femora were fixed in a servohydraulic testing maschine. Static loading (1000N, 30sec) and cyclic loading (1000N, 3Hz, 10.000/100.000 cycles) was applied. Third, a destructive test gave load to failure. Results: N=8 pairs of femurs were tested, N=7 pairs were included in the study. There was no significantly greater fracture dislocation and load to failure in the control group. Loosening or failure of devices was not seen in any study group or test. A trend towards a lower maximum fracture dislocation was seen in the group of the CCGs. Conclusion: Both, CCGs and steel wire cerclages proved to give sufficient primary stability for fractures at the tip of gamma nails. The described method might prove to be a less invasive method for fixing periimplant fractures.
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Date: 2012-11-30<br />
Session: Trauma: Hip I<br />
Time: 08:30 - 10:00<br />
Room: Rashid D<br />
Abstract no.: 32897<br />
IMPLANT SELECTION IN SUBTROCHANTERIC FRACTURES: STILL A<br />
DILEMMA<br />
Dinakar Rai B.K 1 , Chittaranjan KARUPPANAN 2 , Ramakrishna YELURI 3<br />
1 PSG Institute of medical sciences and research, Coimbatore (INDIA), 2 PSG<br />
Insitute of medical sciences and research, Coimbatore (INDIA), 3 PSG<br />
Institute of medical siences and research, Coimbatore (INDIA)<br />
INTRODUCTION & PURPOSE: Subtrochanteric fractures are difficult to manage and<br />
associated with many complications. Various implants have been designed to address<br />
these fractures with variable success but the choice of implant in different fracture patterns<br />
have not been defined clearly. We suggest an algorithm for management of<br />
Subtrochanteric fractures. MATERIALS AND METHODS: We include 28 cases in the<br />
study. All the fractures were fixed with various implants based on fracture pattern,<br />
achievement of closed reduction and surgeon’s familiarity with the procedure. Out of the<br />
28 cases, in 13 cases biological DCS fixation, in 2 cases open reduction and DCS fixation,<br />
8 cases DHS fixation and in 5 cases RECONSTRUCTION NAIL fixation was done<br />
respectively. RESULTS: In 27 cases fracture union was achieved without bone grafting<br />
and in one case where open reduction and DCS fixation was done went for delayed union<br />
and failure. DISCUSSION: Subtrochanteric fractures of femur demand a special<br />
consideration in implant selection, achieving closed reduction and surgical technique.<br />
Among these we suggest an algorithm for choice of implant. We followed Seinsheimer’s<br />
classification. For type I, II and III fractures if closed reduction is achieved reconstruction<br />
nail is our choice of implant and if not, our choice is biological DCS fixation. In type IV and<br />
V fractures if closed reduction is achieved biological DCS is advised and if not biological<br />
DCS fixation and subperiosteal bone grafting is our choice.
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