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“Revision of subtrochanteric femoral nonunions after intramedullary nailing with dynamic condylar screw”
BACKGROUND: Nonunions of the subtrochanteric region of the femur after previous intramedullary nailing can be difficult to address. Implant failure and bone defects around the implant significantly complicate the therapy, and complex surgical procedures with implant removal, extensive debridement of...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6303875/ https://www.ncbi.nlm.nih.gov/pubmed/30577781 http://dx.doi.org/10.1186/s12891-018-2372-4 |
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author | Lotzien, Sebastian Rausch, Valentin Schildhauer, Thomas Armin Gessmann, Jan |
author_facet | Lotzien, Sebastian Rausch, Valentin Schildhauer, Thomas Armin Gessmann, Jan |
author_sort | Lotzien, Sebastian |
collection | PubMed |
description | BACKGROUND: Nonunions of the subtrochanteric region of the femur after previous intramedullary nailing can be difficult to address. Implant failure and bone defects around the implant significantly complicate the therapy, and complex surgical procedures with implant removal, extensive debridement of the nonunion site, bone grafting and reosteosynthesis usually become necessary. The purpose of this study was to evaluate the records of a series of patients with subtrochanteric femoral nonunions who were treated with dynamic condylar screws (DCS) regarding their healing rate, subsequent revision surgeries and implant-related complications. METHODS: We conducted a retrospective chart review of patients with aseptic femoral subtrochanteric nonunions after failed intramedullary nailing. Nonunion treatment consisted of nail removal, debridement of the nonunion, and restoration of the neck shaft angle (CCD), followed by DCS plating. Supplemental bone grafting was performed in all atrophic nonunions. All patients were followed for at least six months after DCS plating. RESULTS: Between 2002 and 2017, we identified 40 patients with a mean age of 65.4 years (range 34–91 years) who met the inclusion criteria. At a mean follow-up period of 26.3 months (range 6–173), 37 of the 40 (92.5%) nonunions healed successfully (secondary procedures included). The mean healing time of the 37 patients was 11.63 months (± 12.4 months). A total of 13 of the 40 (32.5%) patients needed a secondary revision surgery; one patient had a persistent nonunion, nine patients had persistent nonunions leading to hardware failure, two patients had deep infections requiring revision surgery, and one patient had a peri-implant fracture due to low-energy trauma four days after the index surgery. CONCLUSIONS: The results indicate that revision surgery of subtrochanteric femoral nonunions after intramedullary nailing with dynamic condylar screws is a reliable treatment option overall. However, secondary revision surgery may be indicated before final healing of the nonunion. |
format | Online Article Text |
id | pubmed-6303875 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-63038752018-12-31 “Revision of subtrochanteric femoral nonunions after intramedullary nailing with dynamic condylar screw” Lotzien, Sebastian Rausch, Valentin Schildhauer, Thomas Armin Gessmann, Jan BMC Musculoskelet Disord Research Article BACKGROUND: Nonunions of the subtrochanteric region of the femur after previous intramedullary nailing can be difficult to address. Implant failure and bone defects around the implant significantly complicate the therapy, and complex surgical procedures with implant removal, extensive debridement of the nonunion site, bone grafting and reosteosynthesis usually become necessary. The purpose of this study was to evaluate the records of a series of patients with subtrochanteric femoral nonunions who were treated with dynamic condylar screws (DCS) regarding their healing rate, subsequent revision surgeries and implant-related complications. METHODS: We conducted a retrospective chart review of patients with aseptic femoral subtrochanteric nonunions after failed intramedullary nailing. Nonunion treatment consisted of nail removal, debridement of the nonunion, and restoration of the neck shaft angle (CCD), followed by DCS plating. Supplemental bone grafting was performed in all atrophic nonunions. All patients were followed for at least six months after DCS plating. RESULTS: Between 2002 and 2017, we identified 40 patients with a mean age of 65.4 years (range 34–91 years) who met the inclusion criteria. At a mean follow-up period of 26.3 months (range 6–173), 37 of the 40 (92.5%) nonunions healed successfully (secondary procedures included). The mean healing time of the 37 patients was 11.63 months (± 12.4 months). A total of 13 of the 40 (32.5%) patients needed a secondary revision surgery; one patient had a persistent nonunion, nine patients had persistent nonunions leading to hardware failure, two patients had deep infections requiring revision surgery, and one patient had a peri-implant fracture due to low-energy trauma four days after the index surgery. CONCLUSIONS: The results indicate that revision surgery of subtrochanteric femoral nonunions after intramedullary nailing with dynamic condylar screws is a reliable treatment option overall. However, secondary revision surgery may be indicated before final healing of the nonunion. BioMed Central 2018-12-21 /pmc/articles/PMC6303875/ /pubmed/30577781 http://dx.doi.org/10.1186/s12891-018-2372-4 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Lotzien, Sebastian Rausch, Valentin Schildhauer, Thomas Armin Gessmann, Jan “Revision of subtrochanteric femoral nonunions after intramedullary nailing with dynamic condylar screw” |
title | “Revision of subtrochanteric femoral nonunions after intramedullary nailing with dynamic condylar screw” |
title_full | “Revision of subtrochanteric femoral nonunions after intramedullary nailing with dynamic condylar screw” |
title_fullStr | “Revision of subtrochanteric femoral nonunions after intramedullary nailing with dynamic condylar screw” |
title_full_unstemmed | “Revision of subtrochanteric femoral nonunions after intramedullary nailing with dynamic condylar screw” |
title_short | “Revision of subtrochanteric femoral nonunions after intramedullary nailing with dynamic condylar screw” |
title_sort | “revision of subtrochanteric femoral nonunions after intramedullary nailing with dynamic condylar screw” |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6303875/ https://www.ncbi.nlm.nih.gov/pubmed/30577781 http://dx.doi.org/10.1186/s12891-018-2372-4 |
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