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J.-f. Chabas - One of the best experts on this subject based on the ideXlab platform.
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A newly designed locked intramedullary nail for trochanteric hip fractures fixation: Results of the first 100 Trochanteric™ implantations
Orthopaedics & traumatology surgery & research : OTSR, 2009Co-Authors: F. Loubignac, J.-f. ChabasAbstract:INTRODUCTION: Internal fixation continues to be the surgical treatment of choice for trochanteric region hip fractures. Intramedullary nailing is the updated version of the Kuntscher Y nail and provides stable osteosynthesis of trochanteric hip fractures, classically achieved by Closed Reduction. MATERIAL AND METHODS: We report on our experience (which started in 2003), using a new fixation device featuring a metaphyseal antegrade nail locked with two cephalic screws and comprising a diaphyseal distal locking. Between April 2003 and September 2006, the first 100 patients who sustained an extracapsular intertrochanteric hip fracture and indicated for internal fixation were prospectively enrolled in this single-center study. RESULTS: Eighty-six patients (mean age 80.3) were reviewed at 6 months (nine had died, three had failure and two were lost to follow-up) and reported a satisfactory functional outcome (mean Merle d'Aubigne score was 16 and mean Harris Hip score was 90). Union was achieved within a mean delay of 3 months (median 102 days 1/2) in a good anatomical position (mean medialization was 1.86 - ranging from -16 to 0mm, and mean shortening was 1.72 mm - ranging from 0 to 24 mm). Functional recovery was satisfactory with a mean Parker score of 7.52. Total operating time was shortened and good fracture stabilization allowed early weight bearing. DISCUSSION: Classically, such intertrochanteric fractures can be managed either with a dynamic screw-plate type fixation or with an intramedullary nailing device locked through a single cephalic screw and finally, in rare cases, with a hip arthroplasty supplemented with some sort of fixation. Most published clinical studies of screw-plate fixations have generally reported satisfactory results except for unstable fractures associated with a calcar area lesion. Screw-nail fixations featuring a single cephalic screw should be used in these latter fracture patterns. We believe this new implant design will significantly enhance the anatomical result and functional outcome of these fractures; all this is expected to bring about an earlier recovery of patient's walking ability. CONCLUSION: This original intramedullary nailing system provides reliable internal fixation means for intertrochanteric fractures since it combines the advantage of a Closed Reduction Procedure with a more stable biomechanical construct.
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A newly designed locked intramedullary nail for trochanteric hip fractures fixation: results of the first 100 Trochanteric implantations.
Orthopaedics and Traumatology - Surgery and Research, 2009Co-Authors: F. Loubignac, J.-f. ChabasAbstract:INTRODUCTION: Internal fixation continues to be the surgical treatment of choice for trochanteric region hip fractures. Intramedullary nailing is the updated version of the Küntscher Y nail and provides stable osteosynthesis of trochanteric hip fractures, classically achieved by Closed Reduction. MATERIAL AND METHODS: We report on our experience (which started in 2003), using a new fixation device featuring a metaphyseal antegrade nail locked with two cephalic screws and comprising a diaphyseal distal locking. Between April 2003 and September 2006, the first 100 patients who sustained an extracapsular intertrochanteric hip fracture and indicated for internal fixation were prospectively enrolled in this single-center study. RESULTS: Eighty-six patients (mean age 80.3) were reviewed at 6 months (nine had died, three had failure and two were lost to follow-up) and reported a satisfactory functional outcome (mean Merle d'Aubigné score was 16 and mean Harris Hip score was 90). Union was achieved within a mean delay of 3 months (median 102 days 1/2) in a good anatomical position (mean medialization was 1.86 - ranging from -16 to 0mm, and mean shortening was 1.72 mm - ranging from 0 to 24 mm). Functional recovery was satisfactory with a mean Parker score of 7.52. Total operating time was shortened and good fracture stabilization allowed early weight bearing. DISCUSSION: Classically, such intertrochanteric fractures can be managed either with a dynamic screw-plate type fixation or with an intramedullary nailing device locked through a single cephalic screw and finally, in rare cases, with a hip arthroplasty supplemented with some sort of fixation. Most published clinical studies of screw-plate fixations have generally reported satisfactory results except for unstable fractures associated with a calcar area lesion. Screw-nail fixations featuring a single cephalic screw should be used in these latter fracture patterns. We believe this new implant design will significantly enhance the anatomical result and functional outcome of these fractures; all this is expected to bring about an earlier recovery of patient's walking ability. CONCLUSION: This original intramedullary nailing system provides reliable internal fixation means for intertrochanteric fractures since it combines the advantage of a Closed Reduction Procedure with a more stable biomechanical construct.
F. Loubignac - One of the best experts on this subject based on the ideXlab platform.
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A newly designed locked intramedullary nail for trochanteric hip fractures fixation: Results of the first 100 Trochanteric™ implantations
Orthopaedics & traumatology surgery & research : OTSR, 2009Co-Authors: F. Loubignac, J.-f. ChabasAbstract:INTRODUCTION: Internal fixation continues to be the surgical treatment of choice for trochanteric region hip fractures. Intramedullary nailing is the updated version of the Kuntscher Y nail and provides stable osteosynthesis of trochanteric hip fractures, classically achieved by Closed Reduction. MATERIAL AND METHODS: We report on our experience (which started in 2003), using a new fixation device featuring a metaphyseal antegrade nail locked with two cephalic screws and comprising a diaphyseal distal locking. Between April 2003 and September 2006, the first 100 patients who sustained an extracapsular intertrochanteric hip fracture and indicated for internal fixation were prospectively enrolled in this single-center study. RESULTS: Eighty-six patients (mean age 80.3) were reviewed at 6 months (nine had died, three had failure and two were lost to follow-up) and reported a satisfactory functional outcome (mean Merle d'Aubigne score was 16 and mean Harris Hip score was 90). Union was achieved within a mean delay of 3 months (median 102 days 1/2) in a good anatomical position (mean medialization was 1.86 - ranging from -16 to 0mm, and mean shortening was 1.72 mm - ranging from 0 to 24 mm). Functional recovery was satisfactory with a mean Parker score of 7.52. Total operating time was shortened and good fracture stabilization allowed early weight bearing. DISCUSSION: Classically, such intertrochanteric fractures can be managed either with a dynamic screw-plate type fixation or with an intramedullary nailing device locked through a single cephalic screw and finally, in rare cases, with a hip arthroplasty supplemented with some sort of fixation. Most published clinical studies of screw-plate fixations have generally reported satisfactory results except for unstable fractures associated with a calcar area lesion. Screw-nail fixations featuring a single cephalic screw should be used in these latter fracture patterns. We believe this new implant design will significantly enhance the anatomical result and functional outcome of these fractures; all this is expected to bring about an earlier recovery of patient's walking ability. CONCLUSION: This original intramedullary nailing system provides reliable internal fixation means for intertrochanteric fractures since it combines the advantage of a Closed Reduction Procedure with a more stable biomechanical construct.
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A newly designed locked intramedullary nail for trochanteric hip fractures fixation: results of the first 100 Trochanteric implantations.
Orthopaedics and Traumatology - Surgery and Research, 2009Co-Authors: F. Loubignac, J.-f. ChabasAbstract:INTRODUCTION: Internal fixation continues to be the surgical treatment of choice for trochanteric region hip fractures. Intramedullary nailing is the updated version of the Küntscher Y nail and provides stable osteosynthesis of trochanteric hip fractures, classically achieved by Closed Reduction. MATERIAL AND METHODS: We report on our experience (which started in 2003), using a new fixation device featuring a metaphyseal antegrade nail locked with two cephalic screws and comprising a diaphyseal distal locking. Between April 2003 and September 2006, the first 100 patients who sustained an extracapsular intertrochanteric hip fracture and indicated for internal fixation were prospectively enrolled in this single-center study. RESULTS: Eighty-six patients (mean age 80.3) were reviewed at 6 months (nine had died, three had failure and two were lost to follow-up) and reported a satisfactory functional outcome (mean Merle d'Aubigné score was 16 and mean Harris Hip score was 90). Union was achieved within a mean delay of 3 months (median 102 days 1/2) in a good anatomical position (mean medialization was 1.86 - ranging from -16 to 0mm, and mean shortening was 1.72 mm - ranging from 0 to 24 mm). Functional recovery was satisfactory with a mean Parker score of 7.52. Total operating time was shortened and good fracture stabilization allowed early weight bearing. DISCUSSION: Classically, such intertrochanteric fractures can be managed either with a dynamic screw-plate type fixation or with an intramedullary nailing device locked through a single cephalic screw and finally, in rare cases, with a hip arthroplasty supplemented with some sort of fixation. Most published clinical studies of screw-plate fixations have generally reported satisfactory results except for unstable fractures associated with a calcar area lesion. Screw-nail fixations featuring a single cephalic screw should be used in these latter fracture patterns. We believe this new implant design will significantly enhance the anatomical result and functional outcome of these fractures; all this is expected to bring about an earlier recovery of patient's walking ability. CONCLUSION: This original intramedullary nailing system provides reliable internal fixation means for intertrochanteric fractures since it combines the advantage of a Closed Reduction Procedure with a more stable biomechanical construct.
T Abel - One of the best experts on this subject based on the ideXlab platform.
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Outcome of 51 cases of unilateral locked cervical facets: interspinous braided cable for lateral mass plate fusion compared with interspinous wire and facet wiring with iliac crest.
Journal of neurosurgery, 1999Co-Authors: S Shapiro, W Snyder, K Kaufman, T AbelAbstract:To increase knowledge about unilateral facet dislocation, including presentation, radiological findings, management, and outcome, the authors reviewed the cases of 51 consecutive patients with unilateral locked facets of the cervical spine who underwent treatment over an 11-year period. With the development of internal fixation devices, the authors compared the Procedure of using interspinous wire and facet wiring of iliac crest to fix unilateral locked facets with that in which interspinous braided cable and lateral mass plates were used. Thirty-seven patients (73%) presented with radiculopathy, eight (16%) with neck pain only, and six (12%) with spinal cord injuries (SCIs). Plain x-ray films demonstrated subluxation in only 44 (86%) of 51 cases. All patients underwent cervical computerized tomography (CT) scanning, and in all patients with SCI, a magnetic resonance (MR) image was obtained. Fracture in addition to facet locking was seen on 24 (47%) of 51 CT scans. Disc disruption with cord compression was seen in five cases (10%). Based on CT and/or MR imaging findings, a Closed Reduction Procedure was believed to be contraindicated in 11 cases (22%). Of the remaining 40 patients, 13 (33%) underwent Closed Reduction Procedures. Two patients who underwent a Closed Reduction Procedure were placed in a halo brace but experienced resubluxation. Thus, all cases were surgically treated. Forty-six patients underwent posterior Reduction and/or internal fixation alone (in 24 cases spinous process fixation with facet wiring was connected to struts of iliac crest, and in 22 cases interspinous braided cable for lateral mass plating was used). Initial surgery, regardless of technique, was successful in 45 (98%) of 46 cases. One patient experienced a resubluxation and underwent reoperation in which anterior cervical fusion and plating were performed. Four of six patients with SCI underwent an emergency combined anterior-posterior decompressive Procedure in which internal fixation was performed, and the patients experienced immediate neurological improvement. Overall there were no cases of neurological worsening or death, and there were three cases of wound infection. At 1 year postsurgery, all deficits had improved. Of 37 cases of radiculopathy, three patients (8%) experienced persistent 4/5 weakness, and the remaining patients were normal, including four patients in whom diagnosis was delayed. The six patients with SCI all improved significantly by 1 year. Persistent neck pain was seen in nine cases (18%). Although the lateral mass plates and interspinous cable are stronger, easier to place, and significantly lessened the amount of resultant kyphosis (p < 0.02), the results of chi-square analysis demonstrated only a slight trend for improved clinical outcome compared with the use of wire and iliac crest (p = 0.1). Cervical CT and MR imaging provide information that aids in the diagnosis and management of patients with unilateral locked facets of the cervical spine. The authors' experience strongly suggests that a Reduction Procedure in which internal fixation and bone fusion are performed will be the most successful treatment for this injury.
Ziming Zhang - One of the best experts on this subject based on the ideXlab platform.
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Timing for Closed Reduction Procedure for developmental dysplasia of the hip and its failure analysis.
BMC musculoskeletal disorders, 2020Co-Authors: Zhiqiang Zhang, Ziming ZhangAbstract:BACKGROUND It remains controversial whether the older age to perform Closed Reduction (CR) Procedure for developmental dysplasia of the hip (DDH), the higher incidence of complications. The aim of this study is to evaluate the midterm outcome of CR for DDH among different age groups, and to analyze and identify risk factors for the failure of this Procedure. METHODS Clinical data of 107 DDH patients, who received CR, were retrospectively reviewed. Data were divided into three groups according to initial treatment age (Group I: younger than 12 months; Group II: 12 months to less or equal to18 months; Group III: older than 18 months). The presence of avascular necrosis (AVN), residual acetabular dysplasia (RAD), re-dislocation, and further surgeries (FS) were observed. The risk factors were identified for those outcomes aforementioned using univariable logistic regression models. For identified risk factor age, pre-op acetabular index (AI) and post-op AI, their prediction of CR failure were evaluated by receiver operating characteristics curve (ROC). RESULTS A total of 107 patients (156 hips) undergoing CR Procedure were evaluated with a median age at initial Reduction of 13.0 ± 5.4 months (range, 4 to 28 mo). Mean follow-up time in this study was 6.7 ± 0.8 years (range, 3-8 years). The incidence of AVN, RAD and re-dislocation was 15.4% (24/156), 17.3% (27/156) and 14.7% (23/156) respectively. For AVN, RAD and re-dislocation, the significant risk factors are pre-op IHDI IV (p = 0.033), age ≥ 18 months (p = 0.012), and pre-op IHDI IV (p = 0.004) and walking (p = 0.011), respectively. The areas under the ROC curve of each type of failures were 0.841 (post-op AI), 0.688 (pre-op AI) and 0.650 (age). CONCLUSIONS Severe DDH patients older than 18 months with CR Procedure may result in a high risk of RAD complication. Re-dislocation is significantly associated with pre-op IHDI IV and walking. Patients, who are older than 12.5 months or have a pre-op AI of 38.7° or a post-op AI of 26.4°, are also more likely to fail of CR Procedure.
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Timing for Closed Reduction Procedure for Developmental Dysplasia of the Hip and its Failure Analysis
2020Co-Authors: Zhiqiang Zhang, Ziming ZhangAbstract:Abstract Background It remains controversial whether the older age to perform Closed Reduction (CR) Procedure for developmental dysplasia of the hip (DDH), the higher incidence of complications. The aim of this study is to evaluate the midterm outcome of CR for DDH among difference age groups, and to analyze and identify risk factors for the failure of this Procedure. Methods Clinical data of 107 DDH patients, who received CR, were retrospectively reviewed. Data were divided into three groups according to initial treatment age (Group I: younger than 12 months; Group II: 12 months to less or equal to18 months; Group III: older than 18 months). The presence of avascular necrosis (AVN), residual acetabular dysplasia (RAD), re-dislocation, and further surgeries (FS) were observed. The risk factors were identified for those outcomes aforementioned using univariable logistic regression models. For identified risk factor age, pre-op acetabular index (AI) and post-op AI, their prediction of CR failure were evaluated by receiver operating characteristics curve (ROC).Results A total of 107 patients (156 hips) undergoing CR Procedure were evaluated with a median age at initial Reduction of 13.0±5.4 months (range, 4 to 28 mo). Mean follow-up time in this study was 6.7±0.8 years (range, 3-8 years). The incidence of AVN, RAD and re-dislocation was 15.4% (24/156), 17.3% (27/156) and 14.7% (23/156) respectively. For AVN, RAD and re-dislocation, the significant risk factors are pre-op IHDI IV (p=0.033), age≥18 months (p=0.012), and pre-op IHDI IV (p=0.004) and walking (p=0.011), respectively. The areas under the ROC curve of each type of failures were 0.841 (post-op AI), 0.688 (pre-op AI) and 0.650 (age).Conclusions Severe DDH patients older than 18 months with CR Procedure may result in a high risk of RAD complication. Re-dislocation is significantly associated with pre-op IHDI IV and walking. Patients, who are older than 12.5 months or have a pre-op AI of 38.7° or a post-op AI of 26.4°, are also more likely to fail of CR Procedure.
Andrzej Ciszewski - One of the best experts on this subject based on the ideXlab platform.
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Post-Traumatic Palsy of Three Nerves of the Upper Limb Accompanied with Vascular Deficiency in the Supracondylar Humerus Fracture - Results of the Treatment: Case Report
Translational Medicine, 2018Co-Authors: Lukasz Matuszewski, Jarosław Kałakucki, Andrzej CiszewskiAbstract:We present a case report of a patient who at the age of 8 suffered an injury to the left elbow joint and admitted to the Department of Pediatric Orthopedics and Rehabilitation in Lublin / Poland due to a supracondylar humerus fracture in extension mechanism. As a result of the injury, in addition to the damage to the musculoskeletal system, the sensory and motor functions of the three nerves were also disturbed. A Closed Reduction Procedure was performed within two hours after admittance, with transverse fracture pinning with K-wires. On the third day after the injury, the left elbow joint was inspected, with the release of the brachial artery and the median nerve and removal of the K-wire conflicting with the ulnar nerve. After a multimodal rehabilitation, the child regained the full function of the left upper limb.