Complications after nailing of the pertrochanteric fractures with IMHS nail - influence of the »learning curve«
Abstract
Background: Intramedullary hip nails, which combine the advantages of intramedullary fixation with those of a sliding screw, should diminish the incidence of complications after osteosynthesis of the pertrochanteric fractures. Despite less mechanical failures, this has not happened. However, some new specific complications have occured. In this retrospective study of the pertrochanteric fractures treated with IMHS nail, the author is analysing the importance of experience and the impact of »learning curve« on incidence of complications.
Methods and results: Between March 1996 and July 1999 65 patients with 65 non-pathologic pertrochanteric fractures were operated with IMHS nail. Thirty-one were operated in 1996/97 (Group I), thirty-four later on (Group II). Between the groups there were no differences in demographic characteristics, types of fractures, used material or outcome. Twelve out of 65 patients (eight from Group I, four from Group II) had at least one complication. In five patients there was a crack of femoral diaphisis. In two reduction of the fracture was insufficient. In another two the hip screw protruded into the joint. One fracture dislocated secondarely. Three patients had infection. One non-union of the femoral neck showed after removal of the nail 2.5 years postinjury. Stratified statistical analysis showed that Group I had signifficantly more mechanical complications (insufficient reduction, hip screw protrusion, secondary dislocation), whereas differences between the groups in femur cracks, infection and non-union were insignificant.
Conclusions: This comparative study has shown frequent complications after nailing of the pertrochanteric fractures and that with growing experience the incidence of complications decreases.All this points to an important »learning curve«.
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References
Kyle R. Fractures of the proximal femur. J Bone Joint Surg 1994; 76A: 924–50.
Babst R, Martinet O, Renner N, Rosso R, Bodoky A, Heberer M, Regazzoni P. Die DHS-Abstutzplatte für die Versorgung der instabilen proximalen Femurfrakturen. Schweiz Med W Schr 1993; 123: 566–8.
Schlemminger R, Kniess T, Schleef J, Stanković P. Ergebnisse nach Winkelplattenosteosynthese der per- und subtrochantaeren Brueche beim alten Menschen. Akt Traumat 1992; 22: 149–56.
Butt MS, Krikler SJ, Nafie S, Ali MS. Comparison of dynamic hip screw and gamma nail: a prospective, randomized, controlled trial. Injury 1995; 26: 615–8.
Calvert PT. The gamma nail – a significant advance or passing fashion? J Bone Joint Surg 1992; 74B: 329–31.
Parker MJ, Pryor GA. Gamma versus DHS nailing for extracapsular femoral fractures. Meta-analysis of ten randomised trials. International Orthopaedics 1996; 20: 163–8.
Mueller ME, Nazarian S, Koch P, Schatzker J. The Comprehensiveclassification of fractures of long bones. Berlin: Springer-Verlag; 1999.
Lacroix H, Arwert H, Snijders CJ, Fontijne WPJ. Prevention of fracture at the distal locking site of the Gamma nail. J Bone Joint Surg 1995; 77B: 274–6.
Hardy DC, Descamps P, Krallis P, Fabeck L, Smets P, Bertens C, Delince PE. Use of intramedullary hip-screw compared with compression hip-screw with a plate for intertrochanteric femoral fractures. J Bone Joint Surg 1998; 80A: 618–30.
Wagner R, Blattert TR, Weckbach A. Problem Loesung der extraarticulaeren, koxalen Femurfraktur durch das »GleitschraubenNagel-Princip«. Ergebnise zwier verschiedene Systeme (classic nail und γ-Nagel). Unfallchirurg 1998; 101: 894–900.
Hoffman R, Schmidmaier G, Schuetz R, Schuetz M, Suedkamp NP. Classic-Nagel vs. dynamische Hueftschraube (DHS). Unfallchirurg 1999; 102: 182–90.
Schwab E, Hoentzsch D, Weise K. Die Versorgung instabiler perund subtrochantaerer Femurfrakturen mit proximalen Femurnagel (PFN). Akt Traumatol 1998; 28: 56–60.
Simmermacher RKJ, Bosch AM, Van der Werken Chr. The AO/ ASIF-proximal femoral nail (PFN): a new device for the treatment of unstable proximal femoral fractures. Injury 1999; 30: 327–32.
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