06 - Radiographic Anatomy of the Proximal Ulna to Avoid Inadvertent Intra-Articular Screw Placement
Year: 2019
Type: other
Abstract: PurposeClosed reduction and fixation using a cephalomedullary nail (CMN) represents the accepted management of unstable intertrochanteric fractures. Cut-through have been described as a complication associated to the treatment. Although a hip arthroplasty may be the most predictable revision method, a non prosthetic option can lead to similar results.The objective is to describe a non prosthetic revision procedure in cases of cut-through.MethodWe performed a retrospective analysis of our Institutional Registry for Hip Fractures in elderly patients (RIAFC) from January 2000 to June 2017 searching for cut-through as a failure after unstable intertrochanteric fracture treatment.Age, gender, fractures pattern, fracture reduction (Tip to Apex score/Gardenu2019s Angle/Cleveland classification), surgical blood loss, fracture healing during the last follow-up visit were analyzed.Revision procedure:A- Helical blade removal, introduction of structural bone graft (autologous or allograft) as a plug to obliterate the communication to the joint and a new blade insertion.B- Same as in A but augmenting the blade/head purchase with Poly(methyl methacrylate) (PMMA). Before the cement insertion, a radio opaque solution was instilled to assure lack of joint leakage. ResultsWe evaluated 1616 patients. Sixteen of them presented a cut-through complication (1 %). Ten of them were females with an average age for all of 84 years. In 14 cases the fracture were 31A2 and in 2, 31A3. Reduction: 6 patients had a Gardenu2019s angle associated to a bad reduction. Four patients had their blades inserted in a dangerous zone according to Clevelandu2019s. Blood loss had an average of 3.6 points of hematocrit declination.One patient denied an implant revision and opted for a total joint replacement. In four of the patients the procedure A was done, 2 of them had a new failure and an joint arthroplasty was performed. In the B group, only one patient needed a revision to a total hip. The other 10 patients healed uneventfully and did not need any further intervention.Cut-through revision after fixation of unstable intertrochanteric fractures treated with CMN by blocking of the joint communication and augmenting the head blade purchase with PMMA is a safe and minimal invasive procedure. Generates low blood loss and rate of complications and allows bone healing preserving the native joint.
Institution: Hospital Italiano de Buenos Aires
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W4212923889