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Reduction techniques for difficult subtrochanteric fractures

  • Zinon T. Kokkalis
  • Andreas F. MavrogenisEmail author
  • Dimitris I. Ntourantonis
  • Vasilios G. Igoumenou
  • Thekla Antoniadou
  • Renos Karamanis
  • Panayiotis D. Megaloikonomos
  • Georgios N. Panagopoulos
  • Dimitrios Giannoulis
  • Eleftheria Souliotis
  • Theodosis Saranteas
  • Panayiotis J. Papagelopoulos
  • Elias Panagiotopoulos
Technical Note • HIP - FRACTURES
  • 204 Downloads

Abstract

Subtrochanteric fractures can result from high-energy trauma in young patients or from a fall or minor trauma in the elderly. Intramedullary nails are currently the most commonly used implants for the stabilization of these fractures. However, the anesthetic procedure for the patients, the surgical reduction and osteosynthesis for the fractures are challenging. The anesthetic management of orthopedic trauma patients should be based upon various parameters that must be evaluated before the implementation of any anesthetic technique. Surgery- and patient-related characteristics and possible comorbidities must be considered during the pre-anesthetic evaluation. Adequate fracture reduction and proper nail entry point are critical. Understanding of the deforming forces acting on various fracture patterns and knowledge of surgical reduction techniques are essential in obtaining successful outcomes. This article discusses the intraoperative reduction techniques for subtrochanteric fractures in adults and summarizes tips and tricks that the readers may find useful and educative.

Keywords

Hip fractures Subtrochanteric Reduction techniques Anesthesia 

Notes

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Sambandam SN, Chandrasekharan J, Mounasamy V, Mauffrey C (2016) Intertrochanteric fractures: a review of fixation methods. Eur J Orthop Surg Traumatol 26(4):339–353.  https://doi.org/10.1007/s00590-016-1757-z CrossRefGoogle Scholar
  2. 2.
    Bellabarba C, Herscovici D Jr, Ricci WM (2000) Percutaneous treatment of peritrochanteric fractures using the Gamma nail. Clin Orthop Relat Res 375:30–42CrossRefGoogle Scholar
  3. 3.
    Curtis MJ, Jinnah RH, Wilson V, Cunningham BW (1994) Proximal femoral fractures: a biomechanical study to compare intramedullary and extramedullary fixation. Injury 25(2):99–104CrossRefGoogle Scholar
  4. 4.
    Saudan M, Lubbeke A, Sadowski C, Riand N, Stern R, Hoffmeyer P (2002) Pertrochanteric fractures: is there an advantage to an intramedullary nail?: a randomized, prospective study of 206 patients comparing the dynamic hip screw and proximal femoral nail. J Orthop Trauma 16(6):386–393CrossRefGoogle Scholar
  5. 5.
    Simmermacher RK, Bosch AM, Van der Werken C (1999) The AO/ASIF-proximal femoral nail (PFN): a new device for the treatment of unstable proximal femoral fractures. Injury 30(5):327–332CrossRefGoogle Scholar
  6. 6.
    Utrilla AL, Reig JS, Munoz FM, Tufanisco CB (2005) Trochanteric gamma nail and compression hip screw for trochanteric fractures: a randomized, prospective, comparative study in 210 elderly patients with a new design of the gamma nail. J Orthop Trauma 19(4):229–233CrossRefGoogle Scholar
  7. 7.
    Schipper IB, Marti RK, van der Werken C (2004) Unstable trochanteric femoral fractures: extramedullary or intramedullary fixation. Review of literature. Injury 35(2):142–151CrossRefGoogle Scholar
  8. 8.
    Streubel PN, Moustoukas M, Obremskey WT (2016) Locked plating versus cephalomedullary nailing of unstable intertrochanteric femur fractures. Eur J Orthop Surg Traumatol 26(4):385–390.  https://doi.org/10.1007/s00590-016-1743-5 CrossRefGoogle Scholar
  9. 9.
    Hoffmann R, Haas NP (2000) Femur: proximal. In: AO Publishing (ed) AO principles of fracture management. Thieme, Stuttgart, New York, pp 441–454.  https://doi.org/10.1308/003588409x432419f Google Scholar
  10. 10.
    Pape HC, Tarkin IS (2009) Intraoperative reduction techniques for difficult femoral fractures. J Orthop Trauma 23(5 Suppl):S6–S11.  https://doi.org/10.1097/BOT.0b013e31819f2754 CrossRefGoogle Scholar
  11. 11.
    Haidukewych GJ (2009) Intertrochanteric fractures: ten tips to improve results. J Bone Joint Surg Am 91(3):712–719Google Scholar
  12. 12.
    Schatzker J (2005) subtrochanteric fractures of the femur. In: Schroder G (ed) The rationale of operative fracture care, 3rd edn. Springer, Berlin, Heideberg, New York, pp 367–385.  https://doi.org/10.1007/3-540-27708-0 CrossRefGoogle Scholar
  13. 13.
    Lundy DW (2007) Subtrochanteric femoral fractures. J Am Acad Orthop Surg 15(11):663–671CrossRefGoogle Scholar
  14. 14.
    Tomas J, Teixidor J, Batalla L, Pacha D, Cortina J (2013) Subtrochanteric fractures: treatment with cerclage wire and long intramedullary nail. J Orthop Trauma 27(7):e157–e160.  https://doi.org/10.1097/BOT.0b013e31826fc03f CrossRefGoogle Scholar
  15. 15.
    Russel TA (2006) Subtrochanteric femur fractures: reconstruction nailing. In: Hurley R, LePlante M (eds) Master techniques in orthopaedic surgery: fractures, 2nd edn. Lippincot Williams & Wilkins, Philadelphia, pp 291–322Google Scholar
  16. 16.
    Winquist RA (1993) Locked femoral nailing. J Am Acad Orthop Surg 1(2):95–105CrossRefGoogle Scholar
  17. 17.
    Ostrum RF, Marcantonio A, Marburger R (2005) A critical analysis of the eccentric starting point for trochanteric intramedullary femoral nailing. J Orthop Trauma 19(10):681–686CrossRefGoogle Scholar
  18. 18.
    Farrar MJ, Binns MS (1996) Percutaneous reduction for closed nailing of femoral shaft fractures. J R Coll Surg Edinb 41(4):267–268Google Scholar
  19. 19.
    Georgiadis GM, Burgar AM (2001) Percutaneous skeletal joysticks for closed reduction of femoral shaft fractures during intramedullary nailing. J Orthop Trauma 15(8):570–571CrossRefGoogle Scholar
  20. 20.
    Moeller TB, Reif E (2007) Lower extremity. In: Verlagsgruppe (ed) Pocket atlas of sectional anatomy: computed tomography and magnetic resonance imaging. Thieme, Stuttgart, New York, pp 116–140Google Scholar
  21. 21.
    Angelini A, Battiato C (2015) Past and present of the use of cerclage wires in orthopedics. Eur J Orthop Surg Traumatol 25(4):623–635.  https://doi.org/10.1007/s00590-014-1520-2 CrossRefGoogle Scholar
  22. 22.
    Angelini A, Battiato C (2016) Combination of low-contact cerclage wiring and osteosynthesis in the treatment of femoral fractures. Eur J Orthop Surg Traumatol 26(4):397–406.  https://doi.org/10.1007/s00590-016-1761-3 CrossRefGoogle Scholar
  23. 23.
    Afsari A, Liporace F, Lindvall E, Infante A Jr, Sagi HC, Haidukewych GJ (2010) Clamp-assisted reduction of high subtrochanteric fractures of the femur: surgical technique. J Bone Joint Surg Am 92(Suppl 1 Pt 2):217–225.  https://doi.org/10.2106/JBJS.J.00158 CrossRefGoogle Scholar
  24. 24.
    Saranteas T, Igoumenou VG, Megaloikonomos PD, Mavrogenis AF (2018) Ultrasonography in trauma: physics, practice, and training. JBJS Rev 6(4):e12.  https://doi.org/10.2106/JBJS.RVW.17.00132 CrossRefGoogle Scholar
  25. 25.
    Mavrogenis AF, Igoumenou VG, Kostroglou A, Kostopanagiotou K, Saranteas T (2018) The ABC and pain in trauma. Eur J Orthop Surg Traumatol 28(4):545–550.  https://doi.org/10.1007/s00590-018-2123-0 CrossRefGoogle Scholar
  26. 26.
    Saranteas T, Mavrogenis AF, Poularas J, Kostroglou A, Mandila C, Panou F (2018) Cardiovascular ultrasonography detection of embolic sources in trauma. J Crit Care 45:215–219.  https://doi.org/10.1016/j.jcrc.2018.03.017 CrossRefGoogle Scholar
  27. 27.
    Birnbaum K, Prescher A, Hessler S, Heller KD (1997) The sensory innervation of the hip joint—an anatomical study. Surg Radiol Anat 19(6):371–375CrossRefGoogle Scholar
  28. 28.
    Tran DQ, Tiyaprasertkul W, González AP (2013) Analgesia for clavicular fracture and surgery: a call for evidence. Reg Anesth Pain Med 38(6):539–543CrossRefGoogle Scholar
  29. 29.
    Qiu C, Chan PH, Zohman GL, Prentice HA, Hunt JJ, LaPlace DC, Nguyen VT, Diekmann GR, Maletis GB, Desai V (2018) Impact of anesthesia on hospital mortality and morbidities in geriatric patients following emergency hip fracture surgery. J Orthop Trauma 32(3):116–123CrossRefGoogle Scholar
  30. 30.
    McIsaac DI, Wijeysundera DN, Huang A, Bryson GL, van Walraven C (2018) Association of hospital-level neuraxial anesthesia use for hip fracture surgery with outcomes: a population-based cohort study. Anesthesiology 128(3):480–491.  https://doi.org/10.1097/ALN.0000000000001899 CrossRefGoogle Scholar
  31. 31.
    Scurrah A, Shiner CT, Stevens JA, Faux SG (2018) Regional nerve blockade for early analgesic management of elderly patients with hip fracture—a narrative review. Anaesthesia 73(6):769–783CrossRefGoogle Scholar
  32. 32.
    Kacha NJ, Jadeja CA, Patel PJ, Chaudhari HB, Jivani JR, Pithadia VS (2018) Comparative study for evaluating efficacy of fascia iliaca compartment block for alleviating pain of positioning for spinal anesthesia in patients with hip and proximal femur fractures. Indian J Orthop 52(2):147–153CrossRefGoogle Scholar
  33. 33.
    Amin NH, West JA, Farmer T, Basmajian HG (2017) Nerve blocks in the geriatric patient with hip fracture: a review of the current literature and relevant neuroanatomy. Geriatr Orthop Surg Rehabil 8(4):268–275CrossRefGoogle Scholar
  34. 34.
    Morin AM, Kratz CD, Eberhart LH, Dinges G, Heider E, Schwarz N, Eisenhardt G, Geldner G, Wulf H (2005) Postoperative analgesia and functional recovery after total-knee replacement: comparison of a continuous posterior lumbar plexus (psoas compartment) block, a continuous femoral nerve block, and the combination of a continuous femoral and sciatic nerve block. Reg Anesth Pain Med 30(5):434–445Google Scholar
  35. 35.
    Schipper IB, Steyerberg EW, Castelein RM, van der Heijden FH, den Hoed PT, Kerver AJ, van Vugt AB (2004) Treatment of unstable trochanteric fractures. Randomised comparison of the gamma nail and the proximal femoral nail. J Bone Joint Surg Br 86(1):86–94CrossRefGoogle Scholar
  36. 36.
    Mavrogenis AF, Panagopoulos GN, Megaloikonomos PD, Igoumenou VG, Galanopoulos I, Vottis CT, Karabinas P, Koulouvaris P, Kontogeorgakos VA, Vlamis J, Papagelopoulos PJ (2016) Complications after hip nailing for fractures. Orthopedics 39(1):e108–e116.  https://doi.org/10.3928/01477447-20151222-11 CrossRefGoogle Scholar
  37. 37.
    Tucker A, Warnock M, McDonald S, Cusick L, Foster AP (2018) Fatigue failure of the cephalomedullary nail: revision options, outcomes and review of the literature. Eur J Orthop Surg Traumatol 28(3):511–520.  https://doi.org/10.1007/s00590-017-2059-9 CrossRefGoogle Scholar
  38. 38.
    Vaughn J, Cohen E, Vopat BG, Kane P, Abbood E, Born C (2015) Complications of short versus long cephalomedullary nail for intertrochanteric femur fractures, minimum 1 year follow-up. Eur J Orthop Surg Traumatol 25(4):665–670.  https://doi.org/10.1007/s00590-014-1557-2 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  • Zinon T. Kokkalis
    • 1
  • Andreas F. Mavrogenis
    • 3
    Email author
  • Dimitris I. Ntourantonis
    • 1
  • Vasilios G. Igoumenou
    • 3
  • Thekla Antoniadou
    • 3
  • Renos Karamanis
    • 3
  • Panayiotis D. Megaloikonomos
    • 3
  • Georgios N. Panagopoulos
    • 3
  • Dimitrios Giannoulis
    • 2
  • Eleftheria Souliotis
    • 2
  • Theodosis Saranteas
    • 2
  • Panayiotis J. Papagelopoulos
    • 3
  • Elias Panagiotopoulos
    • 1
  1. 1.Department of OrthopaedicsUniversity of Patras, School of MedicineRio-PatrasGreece
  2. 2.Second Department of AnesthesiologyNational and Kapodistrian University of Athens, School of MedicineAthensGreece
  3. 3.First Department of OrthopaedicsNational and Kapodistrian University of Athens, School of MedicineAthensGreece

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