Unit:
Τομέας ΧειρουργικήςLibrary of the School of Health Sciences
Author:
Galanopoulos Ioannis
Dissertation committee:
Ανδρέας Φ. Μαυρογένης, Επίκουρος Καθηγητής, Ιατρική, ΕΚΠΑ
Παναγιώτης Κουλουβάρης, Επίκουρος Καθηγητής, Ιατρική, ΕΚΠΑ
Παναγιώτης Ι. Παπαγγελόπουλος, Καθηγητής, Ιατρική, ΕΚΠΑ
Όλγα Σαββίδου, Αναπληρώτρια Καθηγήτρια, Ιατρική, ΕΚΠΑ
Δημήτριος Φιλιππιάδης, Επίκουρος Καθηγητής, Ιατρική, ΕΚΠΑ
Ολυμπία Παπακωνσταντίνου, Αναπληρώτρια Καθηγήτρια, Ιατρική, ΕΚΠΑ
Βασίλειος Κοντογεωργάκος, Επίκουρος Καθηγητής, Ιατρική, ΕΚΠΑ
Original Title:
Κλινική και εμβιομηχανική μελέτη των ανάστροφα λοξών καταγμάτων του ισχίου
Translated title:
Clinical and biomechanical study of the reverse oblique hip fractures
Summary:
Aim
The clinical study and evaluation of the patients suffered by reverse obliquity pertrochanteric fracture who were treated with intramedullary nailing (short or long nail). Our purpose is to clarify if there is any difference between the two treatment methods, the advantages and disadvantages of each method. Furthermore, to note if there is any difference between those two methods of treatment with respect of the postoperative physical activity of the patients.
Material and methods
1st part: We studied 80 patients with reverse obliquity pertrochanteric fracture after a low energy injury. Patients with neuromuscular diseases, contralateral operated hip and pathological fracture as well as younger patients with similar fracture pattern after high energy injury were excluded. We divided the patients into two groups, group A (40 patients with mean age 81 yo) and group B (40 patients with mean age 79 yo) according to their treatment. The patients of group A were operated with intramedullary nailing with short nail in contrast with the patients of group B who were operated with long intramedullary nail. The mean postoperative follow up was 2 years and the patients gave written permission in order to participate to the study. The study was also approved by the scientific council of the “ATTIKON” general university hospital. All patients underwent the necessary preoperative workup and also were setup for any medical comorbidities. In group A, the Affixus intramedullary nailing system was used (Affixus Hip Fracture Nail System® (Zimmer BIOMET, Warsaw, IN, USA) in contrast with group B, where the Orthofix Veronail system was used [Orthofix VeroNail Trochanteric Nail® (Orthofix, Verona, Italy)]. Factors as the patient’s ability for painless walking with a single crutch or a cane, possible leg length discrepancy and Trendelenburg gait as indication of abductor muscles insufficiency were clinically evaluated. The radiologic evaluation was about fracture healing, the possible loss of reduction in varus/valgus on AP views and additionally for group A, the measurement of the distance between the distal fracture line and the distal locking screw of the nail. The clinical and radiological data was compared between the two groups via Student’s t test.
2nd part: We studied 60 patients separated in two groups in relation to the treatment they underwent (short vs long intramedullary nail). Detailed medical history, BMI, socioeconomic level, possible mental disabilities as well as the level of the postoperative homecare were registered. Two months postoperatively, a step counter was hanged on each patient for 48 hours and the physical activity was also registered.
Results
1st part: The mean operative time in group A was 41 min and in group B was 54 min. The difference is statistically significant. The functional healing evaluation highlighted similar results for both groups (p=0.910). The mean time of painless weight bearing with the use of a single crutch or a cane was
7.85 weeks for group A and 7.31 weeks for group B. The gait evaluation in 3 and 12 months postoperatively registered abductor muscles insufficiency in 12 and 6 patients respectively in group A and in group B 10 patients suffered by Trendelenburg gait in 3 months and 5 patients in 12 months postoperatively. 5 patients of group A and 3 patients of group B presented leg length discrepancy less than 1 cm postoperatively. Full healing achieved in all patients of both groups with similar healing time (11 weeks, p=0.44). Loss of reduction in varus or valgus was not reported in any patient of both groups. The distance between the distal fracture line and the distal locking screw of the nail was measured only in group A and the average was 7.2cm. With respect of complications, no statistical significant difference was registered between the two groups. Only one patient of group A with a periprosthetic fracture and one case of group B with z-effect were registered.
2nd part: Similar comorbidity rates were reported for both groups. The mean BMI was 21,.62 in group A and 26.06 in group B. The mean family income per person, the education level and the postoperative home care level didn’t have statistically significant difference between the patients of the two groups. The mean duration of hospitalization was 9 days for group A and 10 days for group B (p=0.24). This difference is not statistically significant. The complications which were reported were the DVT and non-usual postoperative bleeding without difference between the two groups (p=0.74). The Mini Mental State Examination (MMSE) scores were similar between the two groups. In group A the score was 24.1/30 and in group B was 24.3/30. In the two months follow up, patients of group A were performing average 97.5 steps per day and patients of group B average 115.11 steps per day. The comparison of the two groups highlighted statistically non-significant difference with p value =0.82 (>0.05).
Conclusion
The treatment of the reverse obliquity pertrochanteric hip fractures with short intramedullary nail has similar results with the treatment with long intramedullary nail but significantly shorter operative time. In addition, the postoperative physical activity of these patients seems not to be differentiated in relation to the treatment method followed.
Main subject category:
Health Sciences
Keywords:
Hip fracture, Reverse oblique, Intramedullary nailing, Biomechanics
File:
File access is restricted only to the intranet of UoA.
Galanopoulos Ioannis Phd.pdf
1 MB
File access is restricted only to the intranet of UoA.
