Reamed femoral nailing in patients with multiple injuries. Adverse effects of tourniquet use.

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Abstract

[Indexed for MEDLINE] 20. Arch Orthop Trauma Surg. 2015 Oct;135(10):1343-7. doi: 10.1007/s00402-015-2280-0. Epub 2015 Jul 19. Wedge effect following intramedullary hip screw fixation of intertrochanteric proximal femur fracture. O'Malley MJ(1), Kang KK(2), Azer E(3), Siska PA(4), Farrell DJ(5), Tarkin IS(6). Author information: (1)Department of Orthopaedic Surgery, Division of Orthopaedic Trauma, University of Pittsburgh Medical Center, Kaufmann Building, Suite 911, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA. omalleymj@upmc.edu. (2)Department of Orthopaedic Surgery, Division of Orthopaedic Trauma, University of Pittsburgh Medical Center, Kaufmann Building, Suite 911, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA. kevinkang@gmail.com. (3)Department of Orthopaedic Surgery, Upstate University Hospital, Suite 100, 6620 Fly Road, East Syracuse, NY, 13057, USA. azere@upstate.edu. (4)Department of Orthopaedic Surgery, Division of Orthopaedic Trauma, University of Pittsburgh Medical Center, Kaufmann Building, Suite 911, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA. siskapa@upmc.edu. (5)Department of Orthopaedic Surgery, Division of Orthopaedic Trauma, University of Pittsburgh Medical Center, Kaufmann Building, Suite 911, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA. farrelldj@upmc.edu. (6)Department of Orthopaedic Surgery, Division of Orthopaedic Trauma, University of Pittsburgh Medical Center, Kaufmann Building, Suite 911, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA. tarkinis@upmc.edu. INTRODUCTION: The aim of the current study was to determine whether application of an intramedullary hip screw for definitive management of intertrochanteric fracture was associated with post-operative deformity. Specifically this study investigated whether nail insertion would cause a "wedge effect" of the intertrochanteric fracture manifesting as lateralization of the femoral shaft and varus malalignment. MATERIALS AND METHODS: The trauma database at the University of Pittsburgh Medical Center was investigated to identify all intertrochanteric fractures (AO/OTA 31A) over the past 3 years treated with an IMHS. Fractures eligible for inclusion were performed under the supervision of a fellowship trained orthopedic trauma surgeon. All fractures were reduced in optimal alignment using percutaneous or mini-open strategies during the reaming process and nail insertion. The entry portal was over-reamed by at least 1.5 mm. Cases selected for review of the "wedge effect" had optimal post-operative imaging allowing for assessment of discrepancy between the operative and normal hip. RESULTS: Forty six patients with an average age of 77 years were included for study. Fifty percent were classified as unstable patterns. Shaft lateralization following IMHS fixation of the fractured hip was found to be an average of 7 mm greater than the contralateral intact hip (p  0.05) (Table 2). There was no difference in post-operative deformity among techniques used for maintenance of reduction during reaming and nail insertion (p > 0.05). Despite deformity, all cases demonstrated radiographic radiographic fracture union. CONCLUSION: Despite attention to detail, the application of an intramedullary hip screw for intertrochanteric fracture has the tendency to lateralize the shaft relative to the head/neck segment (The "wedge effect"). DOI: 10.1007/s00402-015-2280-0