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Anchorage strategies in geriatric hip fracture management

There is an enormous humanitarian and socioeconomic need to improve the quality and effectiveness of care for patients with hip fracture. To reduce mechanical complications in the osteosynthesis of proximal femoral fractures, improved fixation techniques have been developed including blade or screw-...

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Autores principales: Knobe, Matthias, Pape, Hans-Christoph
Formato: Online Artículo Texto
Lenguaje:English
Publicado: De Gruyter 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6753995/
https://www.ncbi.nlm.nih.gov/pubmed/31579722
http://dx.doi.org/10.1515/iss-2016-0034
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author Knobe, Matthias
Pape, Hans-Christoph
author_facet Knobe, Matthias
Pape, Hans-Christoph
author_sort Knobe, Matthias
collection PubMed
description There is an enormous humanitarian and socioeconomic need to improve the quality and effectiveness of care for patients with hip fracture. To reduce mechanical complications in the osteosynthesis of proximal femoral fractures, improved fixation techniques have been developed including blade or screw-anchor devices, locked minimally invasive or cement augmentation strategies. However, despite numerous innovations and advances regarding implant design and surgical techniques, systemic and mechanical complication rates remain high. Treatment success depends on secure implant fixation in often-osteoporotic bone as well as on patient-specific factors (fracture stability, bone quality, comorbidity, and gender) and surgeon-related factors (experience, correct reduction, and optimal screw placement in the head/neck fragment). For fracture fixation, the anchorage of the lag screw within the femoral head plays a crucial role depending on the implant’s design. Meta-analyses and randomized controlled studies demonstrate that there is a strong trend towards arthroplasty treating geriatric femoral neck fractures. However, for young adults as well as older patients with less compromised bone quality, or in undisplaced fractures, head-preserving therapy is preferred as it is less invasive and associated with good functional results. This review summarizes the evidence for the internal fixation of femoral neck fractures and trochanteric femoral fractures in elderly patients. In addition, biomechanical considerations regarding implant anchorage in the femoral head including rotation, migration, and femoral neck shortening are made. Finally, cement augmentation strategies for hip fracture implants are evaluated critically.
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spelling pubmed-67539952019-10-02 Anchorage strategies in geriatric hip fracture management Knobe, Matthias Pape, Hans-Christoph Innov Surg Sci Review There is an enormous humanitarian and socioeconomic need to improve the quality and effectiveness of care for patients with hip fracture. To reduce mechanical complications in the osteosynthesis of proximal femoral fractures, improved fixation techniques have been developed including blade or screw-anchor devices, locked minimally invasive or cement augmentation strategies. However, despite numerous innovations and advances regarding implant design and surgical techniques, systemic and mechanical complication rates remain high. Treatment success depends on secure implant fixation in often-osteoporotic bone as well as on patient-specific factors (fracture stability, bone quality, comorbidity, and gender) and surgeon-related factors (experience, correct reduction, and optimal screw placement in the head/neck fragment). For fracture fixation, the anchorage of the lag screw within the femoral head plays a crucial role depending on the implant’s design. Meta-analyses and randomized controlled studies demonstrate that there is a strong trend towards arthroplasty treating geriatric femoral neck fractures. However, for young adults as well as older patients with less compromised bone quality, or in undisplaced fractures, head-preserving therapy is preferred as it is less invasive and associated with good functional results. This review summarizes the evidence for the internal fixation of femoral neck fractures and trochanteric femoral fractures in elderly patients. In addition, biomechanical considerations regarding implant anchorage in the femoral head including rotation, migration, and femoral neck shortening are made. Finally, cement augmentation strategies for hip fracture implants are evaluated critically. De Gruyter 2016-12-22 /pmc/articles/PMC6753995/ /pubmed/31579722 http://dx.doi.org/10.1515/iss-2016-0034 Text en ©2016 Knobe M., Pape H.-C., published by De Gruyter, Berlin/Boston http://creativecommons.org/licenses/by-nc-nd/4.0 This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.
spellingShingle Review
Knobe, Matthias
Pape, Hans-Christoph
Anchorage strategies in geriatric hip fracture management
title Anchorage strategies in geriatric hip fracture management
title_full Anchorage strategies in geriatric hip fracture management
title_fullStr Anchorage strategies in geriatric hip fracture management
title_full_unstemmed Anchorage strategies in geriatric hip fracture management
title_short Anchorage strategies in geriatric hip fracture management
title_sort anchorage strategies in geriatric hip fracture management
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6753995/
https://www.ncbi.nlm.nih.gov/pubmed/31579722
http://dx.doi.org/10.1515/iss-2016-0034
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