Scribd
Upload
12 views

Journal Club 24-09-24 (Bihs)

Uploaded by

OJAS YADAV
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
12 views

Journal Club 24-09-24 (Bihs)

Uploaded by

OJAS YADAV
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
You are on page 1/ 20

JOURNAL CLUB

CHAIRPERSON: DR. ARUNKUMAR. K


PRESENTER: OJAS YADAV
PYRAMID OF LEVELS OF EVIDENCE:
PK Sundar Raj et al
Department of Orthopaedics, Azeezia Medical College, Kollam, Kerala
Indian Journal of Orthopaedics
| March 2015 | Vol.49 | Issue 2 |

Level Of Evidence: II
INTRODUCTION:

 Femoral neck fractures are treated traditionally – Arthroplasty or Internal fixation.

 The goal of treatment is to restore the anatomical reduction, stable fixation and
union; as to achieve stability of the lower limb later to bear weight on it.

 Usually, cannulated screws are used for fixation of fracture neck of femur in young
active individuals. Controversy arises in the mode of treatment of fracture neck of
femur in the “young old” age (age between 55 and 65 with good physical activity)
GARDEN’S CLASSIFICATION OF FEMORAL NECK
FRACTURES

Type I (Valgus Impacted) Type II (Undisplaced)

Type IV (Completely Displaced)


Type III (Partially Displaced)
PAUWELS’ CLASSIFICATION OF FEMORAL NECK FRACTURES
 In treating femoral neck fracture, cannulated cancellous screws
are commonly used; ideally three screws. Some surgeons
replace one of the screws with fibular strut graft to stimulate bone
growth.

 Present understanding of biomechanical principles employ three


screws, each assigned a particular area of the neck of femur, and
this assumes an inverted triangular configuration. Since each of
the screws have a particular function to perform, if one of the
screws is replaced by fibular strut graft, the function assigned to
that particular screw will be lost and the construct becomes
unstable and the fracture tempts to displace lately leading to
delayed union and avascular necrosis
 This study uses an implant, Bone Impregnated Hip
Screw (BIHS), which combines the biomechanical
properties of the standard cancellous screws and as
well as providing provision for placing cancellous bone
grafts within the body of the screw.

 This retrospective study, presents the clinical and


radiological results of femoral neck fracture managed
with BIHS.
Materials and Methods:

 Similar to the conventional hip screws it has a structure that


retains the biomechanical stability, but also provides
provision for osteogenic potential.
 The BIHS has a thread diameter of 8.3 mm, shank diameter
of 6.5 mm and wall thickness of 2.2 mm. The screw has
provision for filling it with cancellous graft. Holes of
diameter 2 mm are placed in a staggered
fashion in the shaft.
 The yield strength was calculated using the Amsler universal testing machine. (Jayon Implants Private
Limited, Palakkad, Kerala, India). The holes in the screw allow blood vessels from the surroundings to
permeate into the graft.

 It was found during the course of biomechanical analysis that if the holes are 2 mm in diameter and
placed in a staggered way the yield strength is higher when compared to holes more than 2 mm and
placed in a linear arrangement.

 The inclusion criteria were unstable femoral neck fractures Gardens type III and type IV cases treated
with BIHS screw.

 The exclusion criteria were obese patients and old age patients (>60 years), were excluded from the
study
 Phase 1 pilot study: Phase 1 clinical trial was done in 15 patients.
All 15 patients volunteered themselves for the procedure and the
complications were explained in detail to them.
Study was done after getting a detailed “special informed consent” and
“Ethical Committee Clearance.”
Operative Procedure:

 Under C-arm, the fracture was reduced and the limb secured on an operating
fracture table. The reduction achieved was checked under image intensifier.

 Three guide wires were passed as per the standard biomechanical principles.

 The first screw should rest along the inferior cortex in the anteroposterior projection
and in center on the lateral projection. The second screw is placed parallel to the first
close to the posterior cortex and central on the anteroposterior image. The final
screw should be placed anteriorly on the lateral view and central on the
anteroposterior view.
 Cannulated drill bit and cannulated tap used thereafter and 6.5 mm cancellous
screw were inserted, again the position verified and also the exact length of screws
were determined.

 The exact size “BIHS” corresponding to the cannulated screws was selected and
filled fully with autogenous cancellous bone. The guide wires were removed as
there was already a well prepared tract. The BIHS screw was tightened. The whole
construct checked entirely again by AP, Lateral and oblique projections as per need.
Post-Operatively:

 Static quadriceps and hamstring exercise started early and as soon as


sutures were removed. Gentle knee flexion exercises were started after
the tenth postoperative day.

 Active assisted range of motions of the hip started at 3 weeks. Partial


weight bearing started at 12 weeks after visualizing early signs of union.

 Of the 15 patients, only one patient had nonunion which required


hemiarthroplasty.
 Phase 2 comparative clinical study: The phase 2 clinical
comparative study between cancellous screw group and BIHS group
was done between 2002 and 2011.

 Out of 78 patients, 44 patients were treated with BIHS and the rest with
cancellous screws. Early union was noticed in the BIHS patients. The
BIHS and cancellous groups differed significantly in the union rate
RESULTS:
DISCUSSION:

 The incidence of fracture neck of femur in between 50 and 70 years; the productive age group has
increased in Indian population and rest of the world. This population demands treatment with excellent
functional outcome, so that they can do manual work, able to squat and climb stairs.

 If any of the screws are replaced by a fibular strut graft, the function attributed to that particular screw
will be lost. The BIHS retains the fixation principle and also increases the osteogenic potential as the
screw itself has cancellous bone.

 The BIHS were of 2 mm in diameter holes and placed in a staggered way. The cannulated part filled
with cancellous graft. This structure of the screw resulted in a higher yield strength
 The rate of union was more in the BIHS group with lesser time. The BIHS group had Harris
hip score of excellent score in majority 90% with good flexion movement range.

 This procedure requires no special equipment other than the instruments used for standard
internal fixation. It is cost effective in Indian population. Patients can undergo
hemiarthroplasty or total arthroplasty with ease if this treatment modality fails.

 This implant is an innovation for the people who are “old,” but do not accept to be old and are
forced to work to earn for livelihood, or by their lifestyle, the desired term “young old.”
THANK YOU !!!

You might also like

pFad - Phonifier reborn

Pfad - The Proxy pFad of © 2024 Garber Painting. All rights reserved.

Note: This service is not intended for secure transactions such as banking, social media, email, or purchasing. Use at your own risk. We assume no liability whatsoever for broken pages.


Alternative Proxies:

Alternative Proxy

pFad Proxy

pFad v3 Proxy

pFad v4 Proxy