Subtrochanteric Fractures (Subscribe)

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A Critical Analysis of the Eccentric Starting Point for Trochanteric Intramedullary Femoral Nailing

OTA Poster 2004
The purpose of this study was to look at specific trochanteric entry sites to examine whether there is a "perfect" universal starting point. In addition, we examined the insertion angle, the trochanteric angle, the proximal bend, and the radius of curvature of four commonly used implants. Three different starting points were employed.

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Complex proximal femoral fractures in the elderly managed by reconstruction nailing

Conclusion Favourable fixation of unstable complex femoral fractures in the elderly population can be achieved with the Russell-Taylor reconstruction nail. However, use of this device in this frail population was associated with a high implant complication and mortality rate that undoubtedly reflected the severity of the injury sustained, co-morbidity within the group and the stress of a major surgical procedure.
Complex proximal femoral fractures in the elderly managed by reconstruction nailing – complications & outcomes: a retrospective analysis
Ulfin Rethnam, James Cordell-Smith, Thirumoolanathan M Kumar and Amit Sinha Journal of Trauma Management & Outcomes 2007, 1:7 Full text

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Revision of a nonunited subtrochanteric femoral fracture around a failed intramedullary nail

Case presentation We report the case of an 80-year-old Caucasian woman with a subtrochanteric fracture originally treated using a trochanteric gamma nail which failed, resulting in a nonunion and fracture of its proximal end. The nonunion was revised with the removal of the broken trochanteric gamma nail, application of a condylar blade plate, ipsilateral Reamer/Irrigator/Aspirator autografting, recombinant human bone morphogenetic protein-7 and injectable hydroxyapatite cement. The fracture united fully at ten months following revision surgery, with no signs of femoral head avascular necrosis at 18-month follow-up.
Conclusion The essential requirements for success when revising a nonunited fracture are to provide anatomical reduction, mechanical stability, bone defect augmentation and biological stimulation to achieve healing. Current advances in molecular biology, such as recombinant human bone morphogenetic protein-7, and biotechnology such as the Reamer/Irrigator/Aspirator system and hydroxyapatite injectable cement can improve patient outcomes over the use of our traditional revision techniques.
Revision of a nonunited subtrochanteric femoral fracture around a failed intramedullary nail with the use of RIA products, BMP-7 and hydroxyapatite: a case report Tzioupis C, Panteliadis P, Gamie Z, Tsiridis E Journal of Medical Case Reports 2011, 5:87 (full text)

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Subtrochanteric Femoral fractures

Subtrochanteric Femoral fractures: OTA Basic Fracture Course

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Subtrochanteric Fracture Wheeless

Wheel definition: - between lesser trochanter and 5 cm distal, even as far as center of isthmus of the femoral shaft; - technically starts below the lesser tuberosity; - medial and posteromedial cortex is a site of high compressive forces, while the lateral cortex experiences high tensile stress
Wheeless' Textbook of Orthopaedics

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Subtrochanteric Hip Fractures eMedicine Orthopedics

Lee & Ertl 2008
During the last 50 years, the treatment of subtrochanteric femur fractures has evolved with improved understanding of both fracture biology and biomechanics. Previously, nonsurgical treatment of these fractures was associated not only with significant shortening and malrotation but also with the morbidity and mortality of prolonged immobilization. Early techniques of surgical repair demonstrated unacceptably high rates of complications; however, the benefits of restoring the anatomy and encouraging early mobilization are recognized and have led to significant research and improvement in implants. Currently, the subtrochanteric fracture remains technically challenging, even to experienced fracture surgeons.

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