Management of Hip Fractures in Lateral Position without a Fracture Table

Document Type : RESEARCH PAPER

Authors

1 Trauma Research center, Shahid sadoughi University of Medical Sciences-Yazd, Iran

2 Shahid sadoughi University of Medical Sciences-Yazd, Iran

3 Department of orthopedics, Shahid sadoughi University of Medical Sciences-Yazd, Iran

4 Department of biostatistics and epidemiology, Shahid sadoughi University of Medical Sciences-Yazd, Iran

Abstract

Background:
 Hip fracture Management in supine position on a fracture table with biplane fluoroscopic views has some difficulties which leads to prolongation of surgery and increasing x- rays’ dosage. The purpose of this study was to report the results and complications of hip fracture management in lateral position on a conventional operating table with just anteroposterior fluoroscopic view.
 Methods:
 40 hip fractures (31 trochanteric and 9 femoral neck fractures) were operated in lateral position between Feb 2006 and Oct 2012. Age, gender, fracture classification, operation time, intra-operation blood loss, reduction quality, and complications were extracted from patients’ medical records. The mean follow-up time was 30.78±22.73 months (range 4-83).
Results:
The mean operation time was 76.50 ± 16.88 min (range 50 – 120 min).The mean intra-operative blood loss was 628.75 ± 275.00 ml (range 250-1300ml). Anatomic and acceptable reduction was observed in 95%of cases. The most important complications were malunion (one case in trochanteric group), avascular necrosis of oral head and nonunion (each one case in femoral neck group).
 Conclusions:
 It sounds that reduction and fixation of hip fractures in lateral position with fluoroscopy in just anteroposterior view for small rural hospitals may be executable and probably safe.

Keywords

References

  1. Nork SE, Reilly MC. Subtrochanteric fractures of the femur. Skeletal Trauma, 4th ed Philadelphia, PA: WB Saunders; 2008:1977-2034.

  2. Egol K, Koval KJ, Zuckerman JD. Handbook of fractures: Lippincott Williams & Wilkins; 2010.

  3. Canale ST,  Beaty JH. Campbell’s Operative Orthopedics. 12th ed. Canada: Elsevier Mosby; 2013.

  4. Smith-Petersen MN, Cave EF, Vangorder GW. Intracapsular fractures of the neck of the femur: treatment by internal fixation. Archives of Surgery. 1931;23(5):715.

  5. Caldwell JA. Subtrochanteric fractures of the femur: An operative approach for open fixation. The American Journal of Surgery. 1943; 59(2):370-82.

  6. Horwitz T. The posterolateral approach in the surgical management of basilar neck, intertrochanteric and subtrochanteric fractures of the femur; a report of its use in 36 acute fractures. Surgery, gynecology & obstetrics. 1952; 95(1):45-50.

  7. Davis PH, Frymoyer JW. The lateral position in the surgical management of intertrochanteric and subtrochanteric fractures of the femur. J Bone Joint Surg Am. 1969;51(6):1128-34.

  8. Ozkan K, Cift H, Akan K, Sahin A, Eceviz E, Ugutmen E. Proximal femoral nailing without a fracture table. European Journal of Orthopaedic Surgery & Traumatology. 2010;20(3):229-31.

  9. Connelly CL, Archdeacon MT. The Lateral Decubitus Approach for Complex Proximal Femur Fractures: Anatomic Reduction and Locking Plate Neutralization: A Technical Trick. Journal of orthopaedic trauma. 2012;26(4):252.

  10. Callanan I, Choudhry V, Smith H. Perineal sloughing as a result of pressure necrosis from the traction post during prolonged bilateral femoral nailing. Injury. 1994;25(7):472.

  11. Kao JT, Burton D, Comstock C, McClellan RT, Carragee E. Pudendal nerve palsy after femoral intramedullary nailing. J Orthop Trauma. 1993;7(1):58-63.

  12. Brumback RJ, Ellison TS, Molligan H, Molligan DJ, Mahaffey S, Schmidhauser C. Pudendal nerve palsy complicating intramedullary nailing of the femur. J Bone Joint Surg Am. 1992;74(10):1450-5.

  13. Carr JB, Williams D, Richards M. Lateral decubitus positioning for intramedullary nailing of the femur without the use of a fracture table. Orthopedics. 2009;32(10).

  14. Winquist R, Hansen S, Clawson D. Closed intramedullary nailing of femoral fractures. A report of five. J Bone Joint Surg Am. 1984;66:529-39.

  15. Müller M. CCF—Comprehensive Classification of Fractures I & II. MEM üller Foundation. Bern: MAO/ASIF Documentation Center; 1996.

  16. Lin J. Encouraging results of treating femoral trochanteric fractures with specially designed double-screw nails. The Journal of trauma. 2007; 63(4):866-74.

The Archives of Bone and Joint Surgery
Volume 2, Issue 3 - Serial Number 3
September 2014
Pages 168-173

Files

History

  • Receive Date: 28 April 2014
  • Revise Date: 03 September 2014
  • Accept Date: 27 August 2014

Share

How to cite

Statistics