Injury
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Case Reports
A technique for extraction of the distal segment of a broken femoral nail using a flexible reamer.
Extraction of broken femoral nails in peri-implant fractures is becoming an increasingly common problem faced by orthopaedic surgeons. Different closed and open techniques for removal of broken nails have been previously described but due to variations in equipment and fracture configurations these methods are not always easily reproducible. We describe an open surgical technique using simple equipment that can be utilised when other methods of extraction have failed. ⋯ Broken femoral nail extraction can be technically challenging and when other closed methods have failed we believe our technique offers a simple alternative that can be added to the armamentarium of solutions.
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Non-union of neck femur is a common but difficult situation to manage especially in young adults. There are two main options of arthroplasty or osteotomy. The aim of this study was to assess the results of intertrochanteric valgus osteotomy in non-union femoral neck fractures. ⋯ Valgus intertrochanteric osteotomy achieved good union rates and good functional outcome with minimal complications.
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Challenges to the surgeon in managing cases of resistant non-union of the distal femur include poor bone stock, disuse osteopenia and joint contractures. Procedures varying from simple bone grafting to megaprosthesis revision have been described. We successfully managed such cases using our technique of combining cortical allograft struts to augment the defect in the femoral condyle coupled with autogenous iliac crest bone grafting and locking plate osteosynthesis. ⋯ Combing a locking plate fixation with the bone grafting technique of using an allograft strut to support the metaphyseal medial bone defect and autografts gives a good union and a good functional outcome in the management of resistant non-unions of the distal femur by enhancing the biology and providing a good structural support to the distal femur.
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The proximal femur nail anti-rotation (PFNA-II) (Synthes GmbH, Oberdorf, Switzerland) is the most commonly used implant for intramedullary nailing of unstable intertrochanteric fractures in our centre. However, mechanical failure of the bone with respect to the implant is a cause of concern due to its significant morbidity especially in the elderly. To date, factors for fixation failures are not well defined in the literature. This study aims to evaluate the factors that predispose to cut out of the PFNA implant and to provide a guide for surgical fixation. ⋯ To avoid cut out, one should aim for a tip apex distance of not more than 27mm and preserve a neck shaft angle of more than 128°. Risk stratification of the patient allows the surgeon to take greater caution in the post-operative period to detect early cut out.
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Review Meta Analysis Comparative Study
A meta-analysis of the efficacy of whole-body computed tomography imaging in the management of trauma and injury.
Traumatic injury is the third leading cause of death overall. To optimize the outcomes in these patients, hospitals employ whole-body computed tomography (WBCT) imaging due to the high diagnostic yield and potential to identify missed injuries. However, this delays time-critical interventions. Currently, there is an absence of any high-level evidence to support or refute either view. We present a meta-analysis of the available literature to elucidate the efficacy of WBCT in improving the outcomes of trauma, specifically the mortality rate. ⋯ The analysis shows that WBCT is associated with better outcomes, including a lower overall and 24h mortality rate, however the included studies are mostly observational and show considerable heterogeneity. Further work is required to make definitive clinical recommendations for a tailored algorithm in managing trauma patients.