Proximal Femur Fractures
Conditions
Keywords
femoral neck fracture, pertrochanteric fracture, internal osteosynthesis, mechanical complications
Brief summary
Osteosyntheses employed in treating fractures at the upper end of the femur play a critical role in facilitating a swift recovery by minimizing immobilization periods and enabling early rehabilitation of the affected joints, thereby promoting a speedy return to normal walking function. Osteosynthesis alters the mechanical dynamics of the bone segment, which undergoes continual changes during the consolidation and mobilization phases of recovery. Throughout these stages, a range of mechanical complications may arise, posing challenges despite the successful prevention of infections. Non-infectious complications associated with the presence of osteosynthesis materials, especially in weight-bearing areas like the lower limb, remain a concern. In light of these considerations, surgeons must exercise meticulous care in selecting synthetic materials to mitigate the risk of osteosynthesis failures. In cases where internal fixation fails, the standard recourse often involves converting to total hip arthroplasty (THA). However, it is essential to note that THA subsequent to complications arising from proximal femur osteosynthesis presents a higher incidence of both intraoperative and postoperative complications compared to the implantation of primary total hip prostheses. Thus, while osteosynthesis remains a valuable intervention for femur fractures, careful attention to material selection and postoperative management is crucial in optimizing patient outcomes and minimizing complications.
Detailed description
The aim was to identify the causes of mechanical failures of osteosynthesis in order to prevent them. Methods: We present the experience of the Department of Surgical Orthopedic Surgery, concerning 35 cases summarized after failure of surgical treatment of a fracture of the proximal end of the femur for a period spreading between January 2015 and December 2021. . The literature already found evidence of the greater complexity of this type of procedure compared to a first-line total hip prosthesis. Accordingly, all this, Prevention is better than cure these stiffnesses through good preoperative planning. Other factors related to the terrain or to untimely loading of the implant are more difficult to control. Whatever the cause, the surgeon remains by the rigor in these indications, the choice of the synthetic material the essential element in the prevention of osteosynthesis failures.
Interventions
PROCEDUREtotal hip arthroplasty
Sponsors
Ibn Jazzar Hospital
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Healthy volunteers
No
Inclusion criteria
* • Diagnosis of a fracture of the proximal end of the femur. * Subsequent surgical intervention(s) due to failure of initial surgical treatment
Exclusion criteria
* • Those initially treated with total hip arthroplasty. * Patients lost to follow-up, not consistently monitored, or untreated after diagnosis of the complication. * Cases with incomplete medical records
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Anesthesia | from enrollment to the of treatment 6 years | type of anesthesia |
| Type of Surgical Revision | from enrollment to the of treatment 6 years | material implanted for revision |
| Types of Prosthesis | from enrollment to the of treatment 6 years | prothesis used |
| Surgical Approach | from enrollment to the of treatment 6 years | type of approach |
| Preparation of the Patient | from enrollment to the of treatment 6 years | type of preparation |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Distribution by Sex | from enrollment to the end of treatment 6 years | Females represented a slight majority in the study, accounting for 57% (20 women), while males comprised 43% (15 men). |
| Distribution According to Affected Side | from enrollment to the end of treatment 6 years | The right side was affected in 60% (21 cases), while the left side was affected in 40% (14 cases). |
| Distribution According to Circumstances of Trauma | from enrollment to the end of treatment 6 years | Fractures were predominantly due to minimal trauma, with rare occurrences related to road accidents or domestic falls, attributed to bone fragility and muscle atrophy. One case of a pathological fracture was observed in a patient with dislocation of an intermediate hip prosthesis due to ovarian cancer. |
| Age Distribution | from enrollment to the end of treatment 6 years | The average age of patients experiencing therapeutic failure after surgical treatment of proximal femur fractures was 66 years, with ages ranging from 28 to 94 years. The age group 50-90 years constituted 68.59% of cases. |
Countries
Tunisia
Outcome results
None listed