Periprosthetic femoral fractures treated with intramedullary nail knee retrograde, and plate osteosynthesis: comparison of results in the medium to long term
| Autor: | Navarro Carmona, Francisco Javier, Serrano Montilla, José, Montañez Heredia, Elvira |
|---|---|
| Přispěvatelé: | Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Virgen de la Victoria, Málaga, Spain. |
| Jazyk: | Spanish; Castilian |
| Rok vydání: | 2012 |
| Předmět: |
Diseases::Pathological Conditions
Signs and Symptoms::Pathologic Processes::Postoperative Complications [Medical Subject Headings] Fibrosarcoma Anciano Diseases::Wounds and Injuries::Fractures Bone::Periprosthetic Fractures [Medical Subject Headings] Analytical Diagnostic and Therapeutic Techniques and Equipment::Equipment and Supplies::Prostheses and Implants::Bone Nails [Medical Subject Headings] Anatomy::Musculoskeletal System::Skeleton::Joints::Knee Joint [Medical Subject Headings] Acromioplastia Articulación de la Rodilla Diseases::Wounds and Injuries::Fractures Bone::Femoral Fractures [Medical Subject Headings] Analytical Diagnostic and Therapeutic Techniques and Equipment::Surgical Procedures Operative::Orthopedic Procedures::Fracture Fixation::Fracture Fixation Internal::Fracture Fixation Intramedullary [Medical Subject Headings] Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans [Medical Subject Headings] Analytical Diagnostic and Therapeutic Techniques and Equipment::Surgical Procedures Operative::Prosthesis Implantation::Arthroplasty Replacement::Arthroplasty Replacement Knee [Medical Subject Headings] Artroplastia de Reemplazo de Rodilla Fracturas Periprotésicas Analytical Diagnostic and Therapeutic Techniques and Equipment::Equipment and Supplies::Prostheses and Implants::Bone Plates [Medical Subject Headings] Complicaciones Postoperatorias Fijación Intramedular de Fracturas UCLA Síndrome Subacromial Braquiorradialis Manguito Named Groups::Persons::Age Groups::Adult::Aged [Medical Subject Headings] PRGF Fracturas del Fémur |
| Popis: | INTRODUCTION: The femoral periprosthetic fracture of the knee is one of the most feared complications because of its repercussions. Incidence are more and more likely due to the increase of total implanted arthroplasty of the knee, due to the increasing lifespan among the general population. The objective of this study is to analyze some of the perioperative aspects of the treatment of these fractures, comparing the use of osteosynthesis with plates and the retrograde nailing in those patients with femoral periprosthetic knee fractures with a stable implant. MATERIAL AND METODS: The study retrospectively examines 18 cases treated consecutively in our hospital (3 men and 15 women, average age of 72.7 years) between the years of 2000 and 2009. All fractures were located in the distal femur and on a stable implant. Eight were treated through retrograde nailing (Group I) and ten with plates (Group II). The cases are analyzed through the tests of the University of Mann-Withney and the exact Fischer test, with significant values of p≤0.05, the variables of median hospital stay, necessity of transfusion indicated with values of hemoglobin less than 8 mg/ml, preoperative radiological alignment and postoperative alignment of the total knee prosthesis (TKR), measured following the anatomical tibiofemoral axis, time of consolidation and incidence of localized complications in both groups. RESULTS: We did not find any statistically significant differences between the two groups in any of the variables analyzed. Localized complications are more frequent in Group I (62.5 percent of patients) than in Group II (10 percent of patients). The need for transfusion is greater in Group II (40 percent) than in Group I (12.5 percent). CONCLUSIONS: The type of implant used in treatment of femoral periprosthetic knee fracture does not significantly influence perioperative factors. The treatment for this type of fractures should be individually chosen in relation to the type of fracture, characteristics of the patient and stability and prosthesis model of the primary knee. Yes INTRODUCCIÓN: La fractura periprotésica femoral de rodilla constituye una de las complicaciones mas temidas por sus repercusiones. Su incidencia aumenta debido tanto al mayor número de artroplastias totales de rodilla (ATR) implantadas como al aumento de la esperanza de vida de la población. El objetivo del estudio es analizar algunos aspectos perioperatorios del tratamiento de estas fracturas comparando el uso de osteosíntesis con placas y el enclavado retrógrado en los pacientes con fracturas femorales periprotésicas de rodilla con implante estable. MATERIAL Y MÉTODOS: Se estudian retrospectivamente 18 casos tratados consecutivamente en nuestro hospital (3 hombres y 15 mujeres; edad media, 72.7 años) entre los años 2000 y 2009. Todas las fracturas asentaban en fémur distal y sobre implante estable. Fueron tratados mediante enclavado retrógrado 8 (Grupo I) y 10 con placas (Grupo II). Se analizan mediante el test de la U de Mann-Withney y el test exacto de Fisher, con valores significativos de p£0.05, las variables: estancia media hospitalaria, necesidad de transfusión indicada con cifras de hemoglobina menor a 8mg/ml, alineación radiológica preoperatoria y postoperatoria de la ATR, medida según el eje anatómico tibiofemoral, tiempo de consolidación e incidencia de complicaciones locales en ambos grupos. RESULTADOS: No hemos encontrado diferencias estadísticamente significativas entre ambos grupos para ninguna de las variables analizadas. Las complicaciones locales son más frecuentes en el Grupo I (75% pacientes) que en el Grupo II (50% pacientes). La necesidad de transfusión es mayor en el Grupo II (40%) que en el Grupo I (12.5%). CONClUSIONES: El tipo de implante utilizado en el tratamiento de las fracturas femorales periprotésicas no influye de forma significativa en los aspectos Perioperatorios. El tratamiento para este tipo de fracturas debe ser elegido de forma individualizada en función de tipo de fractura, características del paciente y estabilidad y modelo de prótesis de rodilla primaria. |
| Databáze: | OpenAIRE |
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