Acta chirurgiae orthopaedicae
et traumatologiae Čechoslovaca

Acta Chir Orthop Traumatol Cech. 2007; 74(1):37-46 | DOI: 10.55095/achot2007/005

Řešení intrakapsulárních zlomenin krčku femuru pomocí proximálního femorálního hřebuPůvodní práce

P. VIŠŇA^1,*, E. BEITL¹, Z. ŠMÍDL¹, J. KALVACH¹, J. PILNݲ

¹ Traumatologické oddělení, Chirurgická klinika 2. LF UK a FN Motol, Praha

² Ortopedické oddělení Krajské nemocnice, Pardubice

PURPOSE OF THE STUDY:
The management of intracapsular femoral neck fractures remains an unsolved issue of the present-day trauma surgery of the musculoskeletal system. These fractures are conventionally treated with the use of spongious screws or a dynamic hip screw combined with an antirotational spongious screw. The aim of this study was to evaluate the outcomes of surgical therapy using a different type of implant (proximal femoral nail) for intracapsular femoral neck fractures.

MATERIAL:
From January 2000 to March 2004, intracapsular fractures were treated with the use of a proximal femoral nail in 70 patients. In this retrospective study, 56 patients (28 men and 28 women) were evaluated at a minimum of 12 months after surgery. The average follow-up was 22.4 months. According to the AO classification, the fractures were categorized as 31-B1 in 20, 31-B2 in 12 and 31-B3 in 24 patients.

METHODS:
The implant used was a bi-axial proximal femoral nail (Targon PF, B. Braun Aesculap®, Germany) inserted by the standard surgical procedure.

RESULTS:
In 33.3 % of the patients the operative stabilization was performed early, within 6 hours of injury, in 51.8 % the operation was carried out within 24 hours, and 14.3 % of the patients underwent surgery later than 24 hours after injury.
At one year after injury, fracture union without complications was recorded in 45 patients (80 %). Complications included avascular necrosis of the femoral head in seven patients (12.5 %), pseudoarthrosis in two patients (3.6 %) and other serious complications in two patients (3.6 %). Reoperations were indicated in five patients, and these underwent total hip replacement. No refracture occurred in the vicinity of the implant.
No or little pain after the implantation procedure, as assessed at 12 months and later, was reported by 83 % of the patients.
The patients in whom fracture union was achieved without complications were allowed to walk with full weight-bearing at 13.8, 16.4 and 20.4 weeks, when their injury was 31-B1, 31-B2 and 31-B3, respectively.

CONCLUSIONS:
Our results show that the bi-axial proximal femoral nail (Targon PF, B. Braun Aesculap®, Germany) is useful for management of intracapsular femoral head fractures because of the following advantages:
* it eliminates the risk of lateral protrusion of the implant,
* it allows for even distribution of weight bearing and thus reduces the risk of pseudoarthrosis development,
* it has a low probability of the sliding screw getting jammed.

Klíčová slova: intracapsular femoral neck fracture, proximal femoral nail

Přijato: 6. září 2006; Zveřejněno: 1. únor 2007  Zobrazit citaci