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Femoral Anteversion
Published in Benjamin Joseph, Selvadurai Nayagam, Randall T Loder, Anjali Benjamin Daniel, Essential Paediatric Orthopaedic Decision Making, 2022
Femoral de-rotation osteotomy using: Blade plateIntramedullary nail
Musculoskeletal Trauma
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
In the event of slow fracture healing, general measures such as stopping smoking will help. Surgical manoeuvres such as bone grafting or exchanging the intramedullary nail may be necessary. In extreme cases, bone ends may be non-viable and may need to be excised and the limb shortened to allow healing to commence. Limb-lengthening techniques can then be employed to restore the correct length.
Management of osteoporotic proximal intertrochanteric/subtrochanteric femoral fractures
Published in Peter V. Giannoudis, Thomas A. Einhorn, Surgical and Medical Treatment of Osteoporosis, 2020
Avadhoot Kantak, George Tselentakis
In stable intertrochanteric fractures, a standard sliding hip screw fixation is satisfactory. Subtrochanteric fractures require intramedullary nailing with a Recon option available for proximal locking. It is of paramount importance to obtain anatomical reduction or at least a stable reduction prior to nailing. In case of the unstable intertrochanteric fractures and the reverse oblique fractures, an intramedullary nail is a better biomechanical device with less chance of failure.
Use of the PRECICE nail for distraction osteogenesis after tumor resection
Published in Expert Review of Medical Devices, 2022
Nelson Merchan, Raed I. Narvel, I. Leah Gitajn, Eric R. Henderson
One barrier to the use of an internal lengthening nail may be habit-based. Some surgeons may be reluctant to use an ‘intramedullary’ device in the setting of a primary bone cancer. The use of intramedullary nails is strongly discouraged for in managing bone defects in patients who may have a primary bone cancer – due to the potential to spread tumor throughout the bone and induce metastases – and therefore an intramedullary device may be interpreted as harmful for the patient. The difference in this case is that the PRECICE nail is being employed following tumor resection, and therefore the introduction of the nail is analogous to the use of intramedullary endoprosthesis stems, which are used routinely for patients with primary bone cancers. Our practice currently is to delay reconstruction if postoperative (adjuvant) chemotherapy is to be given (this may vary based on type of tumor, treatment, and patient overall status), which is the case for most patients with primary bone malignancies. In this way, the majority of patients will receive temporary reconstructions (cement spacers), providing plenty of time for permanent section histopathological review of the resection specimen prior to proceeding with final reconstruction with the PRECICE device.
Complications common in motorized intramedullary bone transport for non-infected segmental defects: a retrospective review of 15 patients
Published in Acta Orthopaedica, 2021
Mindaugas Mikužis, Ole Rahbek, Knud Christensen, Søren Kold
Our current approach for treating segmental defects differs between the femur and the tibia. All femoral cases are treated by nails to avoid final treatment with external fixators. In cases of clinical infection or compromised soft tissues, extensive debridement is followed by temporal external fixation converted to an intramedullary nail within 2 weeks. Acute shortening is well tolerated on the femur, and segmental defects up to 4–6 cm are treated with a staged protocol. Acute shortening, autologous bone grafting, and standard intramedullary nailing allow for crucial early functional rehabilitation. When union has been obtained, the LLD is corrected at a second stage by standard intramedullary lengthening nail. Larger femoral defects of more than 4–6 cm are treated by femoral bone transport nails.
Low-molecular-weight heparin for hip fracture patients treated with osteosynthesis: should thromboprophylaxis start before or after surgery? An observational study of 45,913 hip fractures reported to the Norwegian Hip Fracture Register
Published in Acta Orthopaedica, 2018
Sunniva Leer-Salvesen, Eva Dybvik, Lars B Engesaeter, Ola E Dahl, Jan-Erik Gjertsen
Extracapsular hip fractures may be treated with hip compression screw or intramedullary nail. The complexity of the fracture will affect the risks of infection, bleeding, and reoperation. Intramedullary nails are increasingly used for complex trochanteric and subtrochanteric fractures. Postoperative start of LMWH compared with preoperative start increased the risk of reoperations due to infection after intramedullary nails. Hip fractures with time-consuming intramedullary nailing (more than 84 minutes, upper quartile) had a more than 8 times increased risk of reoperation due to infection after postoperative start of LMWH compared with preoperative start. A possible explanation could be that preoperative start of thromboprophylaxis induces bleeding earlier, which allows hemostasis or hematoma evacuation during surgery. Contrariwise, postoperative start of thromboprophylaxis LMWH may postpone traumatic bleeding and produce a late hematoma, which predispose to infection. A longer duration of surgery is often related to complex fractures, other concurrent intraoperative complications, or less experienced surgeons. These factors may also influence the risk of infection and potentiate the protective effect of a preoperative LMWH. However, due to limited number of patients in the sub-studies the results may be interpreted with caution.