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Prevention of Venous Thromboembolism in Patients Undergoing Hip Fracture Surgery: A Survey of the Korean Hip Society. 髋关节骨折手术患者静脉血栓栓塞的预防:韩国髋关节学会的调查。
Pub Date : 2023-09-01 Epub Date: 2023-09-06 DOI: 10.5371/hp.2023.35.3.200
Chang Hyun Kim, Je-Hyun Yoo, Young-Kyun Lee, Ye-Yeon Won, Jong-Seok Park

Purpose: The aim of this study was to assess the current status of venous thromboembolism (VTE) prevention in Korean patients with hip fractures.

Materials and methods: A survey using a questionnaire on the experiences and protocols of VTE prevention was conducted among 570 members of the Korean Hip Society.

Results: A total of 97 surgeons responded, with a response rate of 17.0%. Of the 97 participants, 61.9% answered that they had encountered one or more cases of symptomatic VTE in the past year. Mechanical prophylaxis was applied most often (30.9%) until the point of ambulation in standard-risk patients and most often (34.0%) extended until discharge in high-risk patients. Chemical prophylaxis was most often prescribed for a particular period of time rather than for recovery of walking ability (24.7% in standard-risk patients and 26.8% in high-risk patients). Dual prophylaxis was administered in the standard-risk group by 58.8% of the participants and in the high-risk group by 83.5%. Among the participants, 73.2% answered that they had been attentive to wound complications during chemical prophylaxis. More than half of the participants (59.8%) reported that they did not perform routine screening for VTE after surgery.

Conclusion: The results of our survey provided information regarding the current status of VTE prevention for patients undergoing surgery for treatment of hip fractures in Korea as well as a baseline for establishment of educational programs and guidelines in the future.

目的:本研究旨在评估韩国髋部骨折患者预防静脉血栓栓塞(VTE)的现状。材料和方法:对570名韩国髋关节学会成员进行了一项关于VTE预防经验和方案的问卷调查。结果:共有97名外科医生做出了回应,回应率为17.0%。在97名参与者中,61.9%的人回答说他们在过去一年中遇到过一例或多例有症状的VTE。在标准风险患者中,机械预防最常见(30.9%),直到活动点,在高危患者中,最常见(34.0%),直到出院。化学预防通常是在特定的一段时间内进行的,而不是为了恢复行走能力(标准风险患者为24.7%,高危患者为26.8%)。58.8%的参与者在标准风险组和83.5%的参与者中进行了双重预防。在参与者中,73.2%的人回答说,他们在化学预防期间注意到了伤口并发症。超过一半的参与者(59.8%)报告说,他们在手术后没有进行VTE的常规筛查。结论:我们的调查结果提供了有关韩国髋关节骨折手术患者VTE预防现状的信息,并为未来制定教育计划和指南提供了基线。
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引用次数: 0
Cut-Through versus Cut-Out: No Easy Way to Predict How Single Lag Screw Design Cephalomedullary Nails Used for Intertrochanteric Hip Fractures Will Fail? 切开与切开:没有简单的方法可以预测用于髋关节转子间骨折的单滞后螺钉设计头髓内钉会失败吗?
Pub Date : 2023-09-01 Epub Date: 2023-09-06 DOI: 10.5371/hp.2023.35.3.175
Garrett W Esper, Nina D Fisher, Utkarsh Anil, Abhishek Ganta, Sanjit R Konda, Kenneth A Egol

Purpose: This study aims to compare patients in whom fixation failure occurred via cut-out (CO) or cut-through (CT) in order to determine patient factors and radiographic parameters that may be predictive of each mechanism.

Materials and methods: This retrospective cohort study includes 18 patients with intertrochanteric (IT) hip fractures (AO/OTA classification 31A1.3) who underwent treatment using a single lag screw design intramedullary nail in whom fixation failure occurred within one year. All patients were reviewed for demographics and radiographic parameters including tip-to-apex distance (TAD), posteromedial calcar continuity, neck-shaft angle, lateral wall thickness, and others. Patients were grouped into cohorts based on the mechanism of failure, either lag screw CO or CT, and a comparison was performed.

Results: No differences in demographics, injury details, fracture classifications, or radiographic parameters were observed between CO/CT cohorts. Of note, a similar rate of post-reduction TAD>25 mm (P=0.936) was observed between groups. A higher rate of DEXA (dual energy X-ray absorptiometry) confirmed osteoporosis (25.0% vs. 60.0%) was observed in the CT group, but without significance.

Conclusion: The mechanism of CT failure during intramedullary nail fixation of an IT fracture did not show an association with clinical data including patient demographics, reduction accuracy, or radiographic parameters. As reported in previous biomechanical studies, the main predictive factor for patients in whom early failure might occur via the CT effect mechanism may be related to bone quality; however, conduct of larger studies will be required in order to determine whether there is a difference in bone quality.

目的:本研究旨在比较通过切开(CO)或切开(CT)发生固定失败的患者,以确定可能预测每种机制的患者因素和放射学参数。材料和方法:这项回顾性队列研究包括18名股骨粗隆间(IT)髋部骨折(AO/OTA分类31A1.3)患者,他们使用单拉力螺钉设计的髓内钉进行治疗,在一年内发生固定失败。对所有患者的人口统计学和放射学参数进行了审查,包括尖端到顶点的距离(TAD)、后内侧距连续性、颈轴角、侧壁厚度等。根据失败机制,将患者分组,无论是拉力螺钉CO还是CT,并进行比较。结果:CO/CT队列之间在人口统计学、损伤细节、骨折分类或放射学参数方面没有观察到差异。值得注意的是,在两组之间观察到类似的复位后TAD>25 mm的发生率(P=0.936)。在CT组中,DEXA(双能X射线吸收仪)证实骨质疏松症的比率较高(25.0%对60.0%),但无显著性。结论:IT骨折髓内钉固定过程中CT失败的机制与临床数据(包括患者人口统计学、复位准确性或放射学参数)无关。正如先前生物力学研究中所报道的,早期失败可能通过CT效应机制发生的患者的主要预测因素可能与骨质量有关;然而,为了确定骨质量是否存在差异,还需要进行更大规模的研究。
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引用次数: 0
Risk Factors Associated with Fixation Failure in Intertrochanteric Fracture Treated with Cephalomedullary Nail. 头髓内钉治疗股骨粗隆间骨折固定失败的危险因素。
Pub Date : 2023-09-01 Epub Date: 2023-09-06 DOI: 10.5371/hp.2023.35.3.193
Hyung-Gon Ryu, Dae Won Shin, Beom Su Han, Sang-Min Kim

Purpose: Cephalomedullary (CM) nailing is widely performed in treatment of elderly patients with femoral intertrochanteric fractures. However, in cases of fixation failure, re-operation is usually necessary, thus determining factors that may contribute to fixation failure is important. In this study, we examined factors affecting the occurrence of fixation failure, such as age or fracture stability, after CM nailing in elderly patients.

Materials and methods: This study was conducted retrospectively using registered data. From April 2011 to December 2018, CM nailing was performed in 378 cases diagnosed with femoral intertrochanteric fractures, and 201 cases were finally registered. Cases involving patients who were bed-ridden before injury, who died from causes unrelated to surgery, and those with a follow-up period less than six months were excluded.

Results: Fixation failure occurred in eight cases. Comparison of the surgical success and fixation failure group showed that the mean age was significantly higher in the fixation failure group compared with the control group (81.3±6.4 vs. 86.4±6.8; P=0.034). A significantly high proportion of unstable fractures was also observed (139/54 vs. 3/5; P=0.040), with a significantly high ratio of intramedullary reduction (176/17 vs. 5/3; P=0.034). A significantly higher ratio of unstable fractures compared with that of stable fractures was observed in the intramedullary reduction group (132/49 vs. 10/10; P=0.033).

Conclusion: Fixation failure of CM nailing is likely to occur in patients who are elderly or have unstable fracture patterns. Thus, care should be taken in order to avoid intramedullary reduction.

目的:头髓内钉广泛应用于治疗老年股骨粗隆间骨折。然而,在固定失败的情况下,通常需要再次手术,因此确定可能导致固定失败的因素很重要。在这项研究中,我们检查了影响老年患者CM钉扎后固定失败发生的因素,如年龄或骨折稳定性。材料和方法:本研究采用注册资料进行回顾性研究。2011年4月至2018年12月,对378例诊断为股骨粗隆间骨折的患者进行了CM内钉治疗,最终登记201例。排除了受伤前卧床不起、因与手术无关的原因死亡以及随访期不到六个月的患者。结果:8例发生固定失败。手术成功组和固定失败组的比较显示,固定失败组与对照组相比,平均年龄明显更高(81.3±6.4 vs.86.4±6.8;P=0.034)。不稳定骨折的比例也显著较高(139/54 vs.3/5;P=0.040),髓内复位率明显较高(176/17 vs.5/3;P=0.034)。髓内复位组不稳定骨折的发生率明显高于稳定骨折(132/49 vs.10/10;P=0.033)。因此,应注意避免髓内复位。
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引用次数: 0
Hip Function after Surgically Treated Isolated Traumatic Acetabular Fracture: A Prospective Series of Consecutive Cases. 手术治疗孤立的外伤性髋臼骨折后的髋关节功能:一系列前瞻性连续病例。
Pub Date : 2023-06-01 DOI: 10.5371/hp.2023.35.2.133
Indy Smits, Niek Koenders, Vincent Stirler, Erik Hermans

Purpose: Isolated acetabular fractures can occur as a result of a high energy impact on the hip joint. Surgery is required for most patients with an isolated acetabular fracture in order to alleviate pain, restore joint stability, and regain hip function. This study was conducted in order to examine the course of hip function in patients after surgical treatment of an isolated traumatic acetabular fracture.

Materials and methods: This prospective series of consecutive cases included patients who underwent surgery for treatment of an isolated acetabular fracture in a European level one trauma center between 2016 and 2020. Patients with relevant concomitant injuries were excluded. Scoring of hip function was performed by a trauma surgeon using the Modified Merle d'Aubigné and Postel score at six-week, 12-week, six-month, and one-year follow-up. Scores between 3-11 indicate poor, 12-14 fair, 15-17 good, and 18 excellent hip function.

Results: Data on 46 patients were included. The mean score for hip function was 10 (95% confidence interval [CI] 7.09-12.91) at six-week follow-up (23 patients), 13.75 (95% CI 10.74-16.76) at 12-week follow-up (28 patients), 16 (95% CI 13.40-18.60) at six-month follow-up (25 patients), and 15.50 (95% CI 10.55-20.45) at one-year follow-up (17 patients). After one-year follow-up, the scores reflected an excellent outcome in 11 patients, good in five patients, and poor in one patient.

Conclusion: This study reports on the course of hip function in patients who have undergone surgical treatment for isolated acetabular fractures. Restoration of excellent hip function takes six months.

目的:孤立性髋臼骨折可因髋关节受到高能撞击而发生。大多数孤立性髋臼骨折患者需要手术以减轻疼痛,恢复关节稳定性和恢复髋关节功能。本研究旨在探讨创伤性孤立髋臼骨折手术治疗后患者髋关节功能的变化过程。材料和方法:该前瞻性系列连续病例包括2016年至2020年在欧洲一级创伤中心接受手术治疗孤立髋臼骨折的患者。排除有相关伴随损伤的患者。在6周、12周、6个月和1年的随访中,由创伤外科医生使用改良Merle d’aubign和Postel评分对髋关节功能进行评分。3-11分表示髋关节功能差,12-14分表示一般,15-17分表示良好,18分表示极好。结果:纳入46例患者的资料。6周随访(23例)髋关节功能平均评分为10分(95%可信区间[CI] 7.09-12.91), 12周随访(28例)为13.75分(95% CI 10.74-16.76), 6个月随访(25例)为16分(95% CI 13.40-18.60), 1年随访(17例)为15.50分(95% CI 10.55-20.45)。经过一年的随访,评分反映了11名患者的良好结果,5名患者为良好,1名患者为差。结论:本研究报道了孤立性髋臼骨折患者手术治疗后髋关节功能的变化过程。恢复良好的髋关节功能需要6个月。
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引用次数: 0
Periprosthetic Occult Femoral Fracture: An Unknown Side Effect of Press-Fit Fixation in Primary Cementless Total Hip Arthroplasty. 假体周围隐蔽性股骨骨折:首次无骨水泥全髋关节置换术加压固定的未知副作用。
Pub Date : 2023-06-01 DOI: 10.5371/hp.2023.35.2.88
Ho Hyun Yun, Woo Seung Lee, Young Bin Shin, Tae Hyuck Yoon

Purpose: The objectives of this study were to examine the prevalence and risk factors for development of periprosthetic occult femoral fractures during primary cementless total hip arthroplasty (THA) and to assess the clinical consequences of these fractures.

Materials and methods: A total of 199 hips were examined. Periprosthetic occult femoral fractures were defined as fractures not detected intraoperatively and on postoperative radiographs, but only observed on postoperative computed tomography (CT). Clinical, surgical, and radiographic analysis of variables was performed for identification of risk factors for periprosthetic occult femoral fractures. A comparison of stem subsidence, stem alignment, and thigh pain between the occult fracture group and the non-fracture group was also performed.

Results: Periprosthetic occult femoral fractures were detected during the operation in 21 (10.6%) of 199 hips. Of eight hips with periprosthetic occult femoral fractures that were detected around the lesser trochanter, concurrent periprosthetic occult femoral fractures located at different levels were detected in six hips (75.0%). Only the female sex showed significant association with an increased risk of periprosthetic occult femoral fractures (odds ratio for males, 0.38; 95% confidence interval, 0.15-1.01; P=0.04). A significant difference in the incidence of thigh pain was observed between the occult fracture group and the non-fracture group (P<0.05).

Conclusion: Occurrence of periprosthetic occult femoral fractures is relatively common during primary THA using tapered wedge stems. We recommend CT referral for female patients who report unexplained early postoperative thigh pain or developed periprosthetic intraoperative femoral fractures around the lesser trochanter during primary THA using tapered wedge stems.

目的:本研究的目的是研究原发性无骨水泥全髋关节置换术(THA)期间假体周围隐匿性股骨骨折的发生率和危险因素,并评估这些骨折的临床后果。材料和方法:共检查199个髋关节。股骨假体周围隐匿性骨折定义为术中和术后x线片未发现但仅在术后计算机断层扫描(CT)上观察到的骨折。通过临床、手术和影像学分析,确定假体周围隐匿性股骨骨折的危险因素。隐匿性骨折组和非骨折组的骨干下沉、骨干对齐和大腿疼痛也进行了比较。结果:术中发现股骨假体周围隐匿性骨折21例(10.6%)。在小粗隆周围发现股骨假体周围隐匿性骨折的8个髋中,6个髋(75.0%)同时发现位于不同水平的股骨假体周围隐匿性骨折。只有女性与假体周围隐匿性股骨骨折的风险增加有显著关联(男性优势比为0.38;95%置信区间为0.15-1.01;P = 0.04)。隐匿性骨折组与非骨折组在大腿疼痛发生率上有显著差异(p结论:采用锥形楔柄进行初级THA时,假体周围隐匿性股骨骨折的发生率相对较高。我们建议在使用锥形楔柄进行初级THA时,报告无法解释的术后早期大腿疼痛或术中股骨小粗隆周围发生假体周围骨折的女性患者转诊CT。
{"title":"Periprosthetic Occult Femoral Fracture: An Unknown Side Effect of Press-Fit Fixation in Primary Cementless Total Hip Arthroplasty.","authors":"Ho Hyun Yun,&nbsp;Woo Seung Lee,&nbsp;Young Bin Shin,&nbsp;Tae Hyuck Yoon","doi":"10.5371/hp.2023.35.2.88","DOIUrl":"https://doi.org/10.5371/hp.2023.35.2.88","url":null,"abstract":"<p><strong>Purpose: </strong>The objectives of this study were to examine the prevalence and risk factors for development of periprosthetic occult femoral fractures during primary cementless total hip arthroplasty (THA) and to assess the clinical consequences of these fractures.</p><p><strong>Materials and methods: </strong>A total of 199 hips were examined. Periprosthetic occult femoral fractures were defined as fractures not detected intraoperatively and on postoperative radiographs, but only observed on postoperative computed tomography (CT). Clinical, surgical, and radiographic analysis of variables was performed for identification of risk factors for periprosthetic occult femoral fractures. A comparison of stem subsidence, stem alignment, and thigh pain between the occult fracture group and the non-fracture group was also performed.</p><p><strong>Results: </strong>Periprosthetic occult femoral fractures were detected during the operation in 21 (10.6%) of 199 hips. Of eight hips with periprosthetic occult femoral fractures that were detected around the lesser trochanter, concurrent periprosthetic occult femoral fractures located at different levels were detected in six hips (75.0%). Only the female sex showed significant association with an increased risk of periprosthetic occult femoral fractures (odds ratio for males, 0.38; 95% confidence interval, 0.15-1.01; <i>P</i>=0.04). A significant difference in the incidence of thigh pain was observed between the occult fracture group and the non-fracture group (<i>P</i><0.05).</p><p><strong>Conclusion: </strong>Occurrence of periprosthetic occult femoral fractures is relatively common during primary THA using tapered wedge stems. We recommend CT referral for female patients who report unexplained early postoperative thigh pain or developed periprosthetic intraoperative femoral fractures around the lesser trochanter during primary THA using tapered wedge stems.</p>","PeriodicalId":73239,"journal":{"name":"Hip & pelvis","volume":"35 2","pages":"88-98"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/80/14/hp-35-88.PMC10264232.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9654868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Stenotrophomonas maltophilia Periprosthetic Joint Infection after Hip Revision Arthroplasty. 髋关节置换术后假体周围感染的嗜麦芽窄养单胞菌。
Pub Date : 2023-06-01 DOI: 10.5371/hp.2023.35.2.142
Valentino Latallade, Carlos Lucero, Pablo Slullitel, Martin Buttaro

Stenotrophomonas maltophilia, a well-established opportunistic bacterium, primarily impacts healthcare settings. Infection of the musculoskeletal system with this bacterium is rare. We report on the first known case of hip periprosthetic joint infection (PJI) caused by S. maltophilia. The potential for development of a PJI caused by this pathogen should be considered by orthopaedic surgeons, particularly in patients with multiple severe comorbidities.

嗜麦芽窄养单胞菌是一种公认的机会性细菌,主要影响医疗保健环境。肌肉骨骼系统感染这种细菌是罕见的。我们报告了第一例由嗜麦芽葡萄球菌引起的髋关节假体周围关节感染(PJI)。骨科医生应考虑由该病原体引起的PJI发展的可能性,特别是在患有多种严重合并症的患者中。
{"title":"<i>Stenotrophomonas maltophilia</i> Periprosthetic Joint Infection after Hip Revision Arthroplasty.","authors":"Valentino Latallade,&nbsp;Carlos Lucero,&nbsp;Pablo Slullitel,&nbsp;Martin Buttaro","doi":"10.5371/hp.2023.35.2.142","DOIUrl":"https://doi.org/10.5371/hp.2023.35.2.142","url":null,"abstract":"<p><p><i>Stenotrophomonas maltophilia</i>, a well-established opportunistic bacterium, primarily impacts healthcare settings. Infection of the musculoskeletal system with this bacterium is rare. We report on the first known case of hip periprosthetic joint infection (PJI) caused by <i>S. maltophilia</i>. The potential for development of a PJI caused by this pathogen should be considered by orthopaedic surgeons, particularly in patients with multiple severe comorbidities.</p>","PeriodicalId":73239,"journal":{"name":"Hip & pelvis","volume":"35 2","pages":"142-146"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/9c/06/hp-35-142.PMC10264233.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10028768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Primary Arthroplasty for Unstable and Failed Intertrochanteric Fractures: Role of Multi-Planar Trochanteric Wiring Technique. 不稳定和失败的转子间骨折的初次关节置换术:多平面转子连接技术的作用。
Pub Date : 2023-06-01 DOI: 10.5371/hp.2023.35.2.108
Javahir A Pachore, Vikram Indrajit Shah, Sachin Upadhyay, Shrikunj Babulal Patel

Purpose: The primary objective of the current study is to demonstrate the trochanteric wiring technique. A secondary objective is to evaluate the clinico-radiological outcomes of use of the wiring technique during primary arthroplasty for treatment of unstable and failed intertrochanteric fractures.

Materials and methods: A prospective study including follow-up of 127 patients with unstable and failed intertrochanteric fractures who underwent primary hip arthroplasty using novel multi-planar trochanteric wiring was conducted. The average follow-up period was 17.8±4.7 months. Clinical assessment was performed using the Harris hip score (HHS). Radiographic evaluation was performed for assessment of union of the trochanter and any mechanical failure. P<0.05 was considered statistically significant.

Results: At the latest follow-up, the mean HHS showed significant improvement from 79.9±1.8 (at three months) to 91.6±5.1 (P<0.05). In addition, no significant difference in the HHS was observed between male and female patients (P=0.29) and between fresh and failed intertrochanteric fractures (P=0.08). Union was achieved in all cases of fractured trochanter, except one. Wire breakage was observed in three patients. There were five cases of limb length discrepancy, three cases of lurch, and three cases of wire-related bursitis. There were no cases of dislocation or infection. Radiographs showed stable prosthesis in situ with no evidence of subsidence.

Conclusion: Use of the proposed wiring technique was helpful in restoring the abductor level arm and multi-planar stability, which enabled better rehabilitation and resulted in excellent clinical and radiological outcomes with minimal risk of mechanical failure.

目的:本研究的主要目的是演示转子连接技术。第二个目的是评估在初次关节置换术中使用钢丝技术治疗不稳定和失败的转子间骨折的临床放射学结果。材料和方法:对127例不稳定和失败的转子间骨折患者行新型多平面转子钢丝置换术进行前瞻性随访研究。平均随访时间17.8±4.7个月。临床评估采用Harris髋关节评分(HHS)。影像学检查评估股骨粗隆愈合和任何机械故障。结果:最新随访时,HHS平均值由79.9±1.8(3个月时)提高至91.6±5.1 (PP=0.29),新鲜骨折与失败骨折之间的差异有统计学意义(P=0.08)。除1例外,所有股骨粗隆骨折病例均愈合。3例患者出现钢丝断裂。其中肢体长度不一致5例,跛行3例,钢丝相关性滑囊炎3例。无脱位或感染病例。x线片显示假体原位稳定,无下沉迹象。结论:采用所提出的内固定技术有助于恢复外展水平臂和多平面稳定性,使康复效果更好,临床和放射学结果良好,机械故障风险最小。
{"title":"Primary Arthroplasty for Unstable and Failed Intertrochanteric Fractures: Role of Multi-Planar Trochanteric Wiring Technique.","authors":"Javahir A Pachore,&nbsp;Vikram Indrajit Shah,&nbsp;Sachin Upadhyay,&nbsp;Shrikunj Babulal Patel","doi":"10.5371/hp.2023.35.2.108","DOIUrl":"https://doi.org/10.5371/hp.2023.35.2.108","url":null,"abstract":"<p><strong>Purpose: </strong>The primary objective of the current study is to demonstrate the trochanteric wiring technique. A secondary objective is to evaluate the clinico-radiological outcomes of use of the wiring technique during primary arthroplasty for treatment of unstable and failed intertrochanteric fractures.</p><p><strong>Materials and methods: </strong>A prospective study including follow-up of 127 patients with unstable and failed intertrochanteric fractures who underwent primary hip arthroplasty using novel multi-planar trochanteric wiring was conducted. The average follow-up period was 17.8±4.7 months. Clinical assessment was performed using the Harris hip score (HHS). Radiographic evaluation was performed for assessment of union of the trochanter and any mechanical failure. <i>P</i><0.05 was considered statistically significant.</p><p><strong>Results: </strong>At the latest follow-up, the mean HHS showed significant improvement from 79.9±1.8 (at three months) to 91.6±5.1 (<i>P</i><0.05). In addition, no significant difference in the HHS was observed between male and female patients (<i>P</i>=0.29) and between fresh and failed intertrochanteric fractures (<i>P</i>=0.08). Union was achieved in all cases of fractured trochanter, except one. Wire breakage was observed in three patients. There were five cases of limb length discrepancy, three cases of lurch, and three cases of wire-related bursitis. There were no cases of dislocation or infection. Radiographs showed stable prosthesis in situ with no evidence of subsidence.</p><p><strong>Conclusion: </strong>Use of the proposed wiring technique was helpful in restoring the abductor level arm and multi-planar stability, which enabled better rehabilitation and resulted in excellent clinical and radiological outcomes with minimal risk of mechanical failure.</p>","PeriodicalId":73239,"journal":{"name":"Hip & pelvis","volume":"35 2","pages":"108-121"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/73/15/hp-35-108.PMC10264227.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10028772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Bipolar Hemiarthroplasty in Unstable Intertrochanteric Fractures with an Effective Wiring Technique. 双极半关节置换术治疗不稳定转子间骨折的疗效观察。
Pub Date : 2023-06-01 DOI: 10.5371/hp.2023.35.2.99
Jae-Hwi Nho, Gi-Won Seo, Tae Wook Kang, Byung-Woong Jang, Jong-Seok Park, You-Sung Suh

Purpose: Bipolar hemiarthroplasty has recently been acknowledged as an effective option for treatment of unstable intertrochanteric fracture. Trochanteric fragment nonunion can cause postoperative weakness of the abductor muscle and dislocation; therefore, reduction and fixation of the fragment is essential. The purpose of this study was to perform an evaluation and analysis of the outcomes of bipolar hemiarthroplasty using a useful wiring technique for management of unstable intertrochanteric fractures.

Materials and methods: A total of 217 patients who underwent bipolar hemiarthroplasty using a cementless stem and a wiring technique for management of unstable intertrochanteric femoral fractures (AO/OTA classification 31-A2) at our hospital from January 2017 to December 2020 were included in this study. Evaluation of clinical outcomes was performed using the Harris hip score (HHS) and the ambulatory capacity reported by patients was classified according to Koval stage at six months postoperatively. Evaluation of radiologic outcomes for subsidence, breakage of wiring, and loosening was also performed using plain radiographs at six months postoperatively.

Results: Among 217 patients, five patients died during the follow-up period as a result of problems unrelated to the operation. The mean HHS was 75±12 and the mean Koval category before the injury was 2.5±1.8. A broken wire was detected around the greater trochanter and lesser trochanter in 25 patients (11.5%). The mean distance of stem subsidence was 2.2±1.7 mm.

Conclusion: Our wiring fixation technique can be regarded as an effective additional surgical option for fixation of trochanteric fracture fragments during performance of bipolar hemiarthroplasty.

目的:双极半关节置换术最近被认为是治疗不稳定转子间骨折的有效选择。转子碎片不愈合可引起术后外展肌无力和脱位;因此,复位和固定碎片是必不可少的。本研究的目的是评估和分析双极半关节置换术对不稳定转子间骨折的治疗效果。材料和方法:本研究纳入2017年1月至2020年12月在我院行双相半关节置换术治疗不稳定股骨粗隆间骨折(AO/OTA分类31-A2)的217例患者。使用Harris髋关节评分(HHS)评估临床结果,并根据术后6个月的Koval分期对患者报告的活动能力进行分类。术后6个月用平片评估沉陷、钢丝断裂和松动的放射学结果。结果:217例患者中,5例患者在随访期间因与手术无关的问题死亡。HHS平均值为75±12,伤前Koval评分平均值为2.5±1.8。25例患者(11.5%)在大转子和小转子周围发现断线。结论:我们的钢丝固定技术可作为双极半关节成形术中转子骨折碎片固定的一种有效的附加手术选择。
{"title":"Bipolar Hemiarthroplasty in Unstable Intertrochanteric Fractures with an Effective Wiring Technique.","authors":"Jae-Hwi Nho,&nbsp;Gi-Won Seo,&nbsp;Tae Wook Kang,&nbsp;Byung-Woong Jang,&nbsp;Jong-Seok Park,&nbsp;You-Sung Suh","doi":"10.5371/hp.2023.35.2.99","DOIUrl":"https://doi.org/10.5371/hp.2023.35.2.99","url":null,"abstract":"<p><strong>Purpose: </strong>Bipolar hemiarthroplasty has recently been acknowledged as an effective option for treatment of unstable intertrochanteric fracture. Trochanteric fragment nonunion can cause postoperative weakness of the abductor muscle and dislocation; therefore, reduction and fixation of the fragment is essential. The purpose of this study was to perform an evaluation and analysis of the outcomes of bipolar hemiarthroplasty using a useful wiring technique for management of unstable intertrochanteric fractures.</p><p><strong>Materials and methods: </strong>A total of 217 patients who underwent bipolar hemiarthroplasty using a cementless stem and a wiring technique for management of unstable intertrochanteric femoral fractures (AO/OTA classification 31-A2) at our hospital from January 2017 to December 2020 were included in this study. Evaluation of clinical outcomes was performed using the Harris hip score (HHS) and the ambulatory capacity reported by patients was classified according to Koval stage at six months postoperatively. Evaluation of radiologic outcomes for subsidence, breakage of wiring, and loosening was also performed using plain radiographs at six months postoperatively.</p><p><strong>Results: </strong>Among 217 patients, five patients died during the follow-up period as a result of problems unrelated to the operation. The mean HHS was 75±12 and the mean Koval category before the injury was 2.5±1.8. A broken wire was detected around the greater trochanter and lesser trochanter in 25 patients (11.5%). The mean distance of stem subsidence was 2.2±1.7 mm.</p><p><strong>Conclusion: </strong>Our wiring fixation technique can be regarded as an effective additional surgical option for fixation of trochanteric fracture fragments during performance of bipolar hemiarthroplasty.</p>","PeriodicalId":73239,"journal":{"name":"Hip & pelvis","volume":"35 2","pages":"99-107"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/9f/da/hp-35-99.PMC10264230.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9654862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Comparison of Various Joint Decompression Techniques in Septic Arthritis of the Hip in Children: A Systematic Review and Meta-Analysis. 各种关节减压技术在儿童感染性髋关节关节炎中的比较:系统回顾和荟萃分析。
Pub Date : 2023-06-01 DOI: 10.5371/hp.2023.35.2.73
Sitanshu Barik, Vikash Raj, Sant Guru Prasad, Richa, Varun Garg, Vivek Singh

The aim of this review is to conduct an analysis of existing literature on outcomes of application of various methods of joint decompression in management of septic arthritis of the hip in children. A search of literature in PubMed, Embase, and Google Scholar was conducted for identification of studies reporting on the outcomes of intervention for septic arthritis of the hip in children. Of the 17 articles selected, four were comparative studies; two of these were randomized controlled trials while the rest were single arm studies. Statistical difference was observed between the proportion of excellent clinical and radiological outcomes in arthrotomy (90%, 95% confidence interval [CI] 81-98%; 89%, 95% CI 80-98%), arthroscopy (95%, 95% CI 91-100%; 95%, 95% CI 90-99%), and arthrocentesis (98%, 95% CI 97-100%; 99%, 95% CI 97-100%), respectively. The highest overall rate of additional unplanned procedures was observed in the arthrocentesis group (24/207, 11.6%). Patients who underwent arthrocentesis had a statistically greater chance of excellent clinical and radiological outcomes, although the highest level of need for additional unplanned surgical intervention was observed in the arthrocentesis group, followed by the arthroscopy group and the arthrotomy group. Future conduct of a prospective multicentric study focusing on the developed and developing world, along with acquisition of data. such as delay of treatment and severity of disease will enable assessment of the efficacy of one technique over the other by surgeons worldwide.

本综述的目的是对现有文献中应用各种关节减压方法治疗儿童脓毒性髋关节关节炎的结果进行分析。在PubMed, Embase和Google Scholar中检索文献,以确定关于儿童脓毒性髋关节关节炎干预结果的研究报告。在入选的17篇文章中,有4篇是比较研究;其中两项为随机对照试验,其余为单组研究。在关节切开术中,临床和影像学预后良好的比例有统计学差异(90%,95%可信区间[CI] 81-98%;89%, 95% CI 80-98%),关节镜检查(95%,95% CI 91-100%;95%, 95% CI 90-99%)和关节穿刺(98%,95% CI 97-100%;99%, 95% CI 97-100%)。关节穿刺组的额外计划外手术总体发生率最高(24/207,11.6%)。接受关节穿刺的患者在统计学上有更大的机会获得良好的临床和放射学结果,尽管在关节穿刺组观察到的额外计划外手术干预的需求最高,其次是关节镜组和关节切开术组。未来开展一项以发达国家和发展中国家为重点的前瞻性多中心研究,同时收集数据。诸如治疗的延迟和疾病的严重程度将使全世界的外科医生能够评估一种技术优于另一种技术的功效。
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引用次数: 1
Efficacy of Pericapsular Nerve Group Block for Pain Reduction and Opioid Consumption after Total Hip Arthroplasty: A Meta-Analysis of Randomized Controlled Trials. 全髋关节置换术后囊包神经阻滞对疼痛减轻和阿片类药物消耗的疗效:一项随机对照试验的荟萃分析。
Pub Date : 2023-06-01 DOI: 10.5371/hp.2023.35.2.63
Eunsoo Kim, Won Chul Shin, Sang Min Lee, Min Jun Choi, Nam Hoon Moon

The aim of this study was to conduct a meta-analysis of randomized controlled trials (RCTs) for comparison of the effectiveness of pericapsular nerve group (PENG) block with that of other analgesic techniques for reduction of postoperative pain and consumption of opioids after total hip arthroplasty (THA). A search of records in the PubMed, Embase, and Cochrane Library, and ClinicalTrials.gov databases was conducted in order to identify studies comparing the effect of the PENG block with that of other analgesics on reduction of postoperative pain and consumption of opioids after THA. Determination of eligibility was based on the PICOS (participants, intervention, comparator, outcomes, and study design) criteria as follows: (1) Participants: patients who underwent THA. (2) Intervention: patients who received a PENG block for management of postoperative pain. (3) Comparator: patients who received other analgesics. (4) Outcomes: numerical rating scale (NRS) score and opioid consumption during different periods. (5) Study design: clinical RCTs. Five RCTs were finally included in the current meta-analysis. Significantly lower postoperative opioid consumption at 24 hours after THA was observed in the group of patients who received the PENG block compared with the control group (standard mean difference=-0.36, 95% confidence interval -0.64 to -0.08). However, no significant reduction in NRS score at 12, 24, and 48 hours after surgery and opioid consumption at 48 hours after THA was observed. The PENG block showed better results for opioid consumption at 24 hours after THA compared with other analgesics.

本研究的目的是对随机对照试验(RCTs)进行荟萃分析,比较包膜神经阻滞(PENG)与其他镇痛技术在减少全髋关节置换术(THA)术后疼痛和阿片类药物消耗方面的有效性。检索PubMed、Embase、Cochrane图书馆和ClinicalTrials.gov数据库的记录,以确定比较彭阻滞与其他镇痛药在减少THA术后疼痛和阿片类药物消耗方面的作用的研究。资格的确定基于PICOS(参与者,干预,比较者,结果和研究设计)标准如下:(1)参与者:接受THA的患者。(2)干预:采用PENG阻滞治疗术后疼痛的患者。(3)比较组:使用其他镇痛药的患者。(4)结局:数值评定量表(NRS)评分和不同时期阿片类药物使用情况。(5)研究设计:临床随机对照试验。目前的荟萃分析最终纳入了5项随机对照试验。与对照组相比,接受PENG阻滞的患者在THA后24小时的阿片类药物消耗显著降低(标准平均差=-0.36,95%置信区间为-0.64至-0.08)。然而,术后12小时、24小时和48小时的NRS评分和THA后48小时的阿片类药物消耗均未观察到显著降低。与其他镇痛药相比,彭阻滞在THA后24小时对阿片类药物的消耗效果更好。
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引用次数: 1
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Hip & pelvis
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