Research Article
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Individualized fluoroscopic lateral femoral neck view for fixation of hip fractures in the lateral decubitus position

Year 2023, Volume: 6 Issue: 5, 1125 - 1132, 28.09.2023
https://doi.org/10.32322/jhsm.1348153

Abstract

Aims: The aim of this study is to evaluate whether displaced hip fractures can be reduced and nailed properly in the lateral decubitus position without using a traction table with Proximal Femoral Nail Antirotation as a fixation device with inlet flouroscopic view.
Methods: In this retrospective study, 58 patients with hip fractures who were treated with Proximal Femoral Nail Antirotation in a single center were evaluated to determine the efficacy of the inlet fluoroscopic image. The postoperative X-rays of the patients underwent a comprehensive evaluation including the tip-apex distance, the quality of fracture reduction, and the positioning of the screw. The length of hospital stay, postoperative, and total hospital stays were evaluated. We propose personalized fluoroscopy positioning method for the reduction and internal fixation of hip fractures, eliminating the need for a traction table.
Results: The mean age of the patients was 78.43±11.67 years. By inlet viewing of the hip the most common placement of the integrated compression screws on postoperative radiographs was found to be 63.8% in Cleveland zone 5 and an increase in the femoral neck angle mean was 133,6° resulted in a significant decrease in the postoperative hospital stay of which mean was 3.95 days . The tip-apex distance was 19 mm as a mean.
Conclusion: The nailing of proximal femoral fractures using a lateral decubitus position and neutral fluoroscopy view may not achieve optimal quadrant placement of the nail. However, by repositioning the C-arm fluoroscopy with a 45-degree inlet angulation from the initial reference point, aligned with the femur and considering individual adduction, an enhanced lateral visualization of the femoral neck can be achieved, which will also help reduce potential complications during surgery.

References

  • Aguado-Maestro I, Escudero-Marcos R, García-García JM, et al. Resultados y complicaciones de la osteosíntesis de fracturas pertrocantéreas de fémur mediante clavo endomedular con espiral cefálica (clavo femoral proximal antirrotación) en 200 pacientes. Rev Esp Cir Ortop Traumatol. 2013;57(3):201-207. doi:10.1016/j.recot.2013.03.001
  • Frei HC, Hotz T, Cadosch D, Rudin M, Käch K. Central head perforation, or "cut through," caused by the helical blade of the proximal femoral nail antirotation. J Orthop Trauma. 2012;26(8):e102-e107. doi:10.1097/BOT.0b013e31822c53c1
  • Parker MJ, Handoll HH. Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures in adults. Cochrane Database Syst Rev. 2008;(3):CD000093. doi:10.1002/14651858.CD000093.pub4
  • Vaquero J, Munoz J, Prat S, et al. Proximal Femoral Nail Antirotation versus Gamma3 nail for intramedullary nailing of unstable trochanteric fractures. A randomised comparative study. Injury. 2012;43 Suppl 2:S47-S54. doi:10.1016/S0020-1383(13)70179-7
  • Brandt E, Verdonschot N. Biomechanical analysis of the sliding hip screw, cannulated screws and Targon1 FN in intracapsular hip fractures in cadaver femora. Injury. 2011;42(2):183-187. doi:10.1016/j.injury.2010.08.021
  • Erez O, Dougherty PJ. Early complications associated with cephalomedullary nail for intertrochanteric hip fractures. J Trauma Acute Care Surg. 2012;72(2):E101-E105. doi:10.1097/ta.0b013e31821c2ef2
  • Zhang J, Tang X. The application of the 150° oblique tangential fluoroscopic view to detect the posterosuperior femoral neck screw in-out-in intraoperatively. Sci Rep. 2022;12(1):12790. doi:10.1038/s41598-022-17221-z
  • Chen SY, Chang SM, Tuladhar R, et al. A new fluoroscopic view for evaluation of anteromedial cortex reduction quality during cephalomedullary nailing for intertrochanteric femur fractures: the 30° oblique tangential projection. BMC Musculoskelet Disord. 2020;21(1):719. doi:10.1186/s12891-020-03668-6
  • Turgut A, Kalenderer O, Gunaydin, B, Onvural B. Karapınar L, Agus H. İntertrokanterik femur kırıklarının proksimal femoral çivi antirotasyon (PFNA) ile lateral dekübit pozisyonda tespiti. Acta Orthop Traumatol Turc. 2014;48(5):513-520.
  • Flierl MA, Stahel PF, Hak DJ, Morgan SJ, Smith WR. Traction table-related complications in orthopaedic surgery. J Am Acad Orthop Surg. 2010;18(11):668-675. doi:10.5435/00124635-201011000-00004
  • 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. doi:10.1016/0020-1383(94)90276-3
  • 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):1450-1455.
  • Doğan N, Ertürk C, Gülabi D. Is proximal femoral nailing of unstable intertrochanteric fractures in the lateral decubitus position without a traction table as safe and effective as on a traction table?. Injury. 2022;53(2):555-560. doi:10.1016/j.injury.2021.11.017
  • Sonmez MM, Camur S, Erturer E, Ugurlar M, Kara A, Ozturk I. Strategies for proximal femoral nailing of unstable intertrochanteric fractures: lateral decubitus position or traction table. J Am Acad Orthop Surg. 2017;25(3):e37-e44. doi:10.5435/JAAOS-D-15-00691
  • Jong-Keon O, Jin-Ho H, Dipit S. Nailing of Intertrochanteric Fractures: Review on Pitfalls and Technical Tips. Journal of Orthopaedics, Trauma and Rehabilitation. 2010;14(2):3-7. doi:10.1016/j.jotr.2010.08.006
  • Liu W, Zhou D, Liu F, Weaver MJ, Vrahas MS. Mechanical complications of intertrochanteric hip fractures treated with trochanteric femoral nails. J Trauma Acute Care Surg. 2013;75(2):304-310. doi:10.1097/TA.0b013e31829a2c43
  • Turgut A, Kalenderer Ö, Karapınar L, Kumbaracı M, Akkan HA, Ağuş H. Which factor is most important for occurrence of cutout complications in patients treated with proximal femoral nail antirotation? Retrospective analysis of 298 patients. Arch Orthop Trauma Surg. 2016;136(5):623-630. doi:10.1007/s00402-016-2410-3
  • Kristan A, Benulič Č, Jaklič M. Reduction of trochanteric fractures in lateral view is significant predictor for radiological and functional result after six months. Injury. 2021;52(10):3036-3041. doi:10.1016/j.injury.2021.02.038
  • Campbell SE. Radiography of the hip: lines, signs, and patterns of disease. Semin Roentgenol. 2005;40(3):290-319. doi:10.1053/j.ro.2005.01.016
  • Lim SJ, Park YS. Plain radiography of the hip: a review of radiographic techniques and image features. Hip Pelvis. 2015;27(3):125-134. doi:10.5371/hp.2015.27.3.125
  • Herman A, Landau Y, Gutman G, Ougortsin V, Chechick A, Shazar N. Radiological evaluation of intertrochanteric fracture fixation by the proximal femoral nail. Injury. 2012;43(6):856-863. doi:10.1016/j.injury.2011.10.030
  • Ciufo DJ, Zaruta DA, Lipof JS, Judd KT, Gorczyca JT, Ketz JP. Risk factors associated with cephalomedullary nail cutout in the treatment of trochanteric hip fractures. J Orthop Trauma. 2017;31(11):583-588. doi:10.1097/BOT.0000000000000961
  • Aibinder WR, Yuan BJ, Cross WW 3rd, Parry JA. Sequential fluoroscopic rollover images reliably identify "in-out-in" posterosuperior screws during percutaneous fixation of femoral neck fractures. Eur J Orthopaedic Surg Traumatol. 2020 Aug;30(6):1061-1065. DOI: 10.1007/s00590-020-02668-5.
  • Schep NW, van Walsum T, De Graaf JS, Broeders IA, van der Werken C. Validation of fluoroscopy-based navigation in the hip region: what you see is what you get?. Comput Aided Surg. 2002;7(5):279-283. doi:10.1002/igs.10051
  • Bishop JA, Rodriguez EK. Closed intramedullary nailing of the femur in the lateral decubitus position. J Trauma. 2010;68(1):231-235. doi:10.1097/TA.0b013e3181c488d8
  • Nikoloski AN, Osbrough AL, Yates PJ. Should the tip-apex distance (TAD) rule be modified for the proximal femoral nail antirotation (PFNA)? A retrospective study. J Orthop Surg Res. 2013;8:35. doi:10.1186/1749-799X-8-35
  • Sadic S, Custovic S, Jasarevuc M, Fazlic M, Krupic F. Proximal femoral nail antirotation in treatment of intertrochanteric hip fractures: a retrospective study in 113 patients. Med Arch. 2015;69(6):352-6. doi: 10.5455/medarh.2015.69.353-356.
  • Cleveland M, Bosworth DM, Thompson FR, Wilson HJ Jr, Ishizuka T. A ten-year analysis of intertrochanteric fractures of the femur. J Bone Joint Surg Am. 1959;41-A:1399-1408.
  • Hwang JH, Garg AK, Oh JK, et al. A biomechanical evaluation of proximal femoral nail antirotation with respect to helical blade position in femoral head: A cadaveric study. Indian J Orthop. 2012;46(6):627-632. doi:10.4103/0019-5413.104186
  • Parker MJ. Cutting-out of the dynamic hip screw related to its position. J Bone Joint Surg Br. 1992;74(4):625. doi:10.1302/0301-620X.74B4.1624529
  • Hengg C, Mayrhofer P, Euler S, Wambacher M, Blauth M, Kralinger F. The relevance of neutral arm positioning for true ap-view X-ray to provide true projection of the humeral head shaft angle. Arch Orthop Trauma Surg. 2016;136(2):213-221. doi:10.1007/s00402-015-2368-6
  • Moshina N, Bjørnson EW, Holen ÅS, et al. Standardised or individualised X-ray tube angle for mediolateral oblique projection in digital mammography?. Radiography (Lond). 2022;28(3):772-778. doi:10.1016/j.radi.2022.03.002
  • Tan W, Ong YS, Ng CYQ, Kwok KY, Tan CYY, Sng LH. Anatomical tilt lateral wrist X-ray - Not always 22°. Radiography (Lond). 2023;29(4):807-811. doi:10.1016/j.radi.2023.05.010
Year 2023, Volume: 6 Issue: 5, 1125 - 1132, 28.09.2023
https://doi.org/10.32322/jhsm.1348153

Abstract

References

  • Aguado-Maestro I, Escudero-Marcos R, García-García JM, et al. Resultados y complicaciones de la osteosíntesis de fracturas pertrocantéreas de fémur mediante clavo endomedular con espiral cefálica (clavo femoral proximal antirrotación) en 200 pacientes. Rev Esp Cir Ortop Traumatol. 2013;57(3):201-207. doi:10.1016/j.recot.2013.03.001
  • Frei HC, Hotz T, Cadosch D, Rudin M, Käch K. Central head perforation, or "cut through," caused by the helical blade of the proximal femoral nail antirotation. J Orthop Trauma. 2012;26(8):e102-e107. doi:10.1097/BOT.0b013e31822c53c1
  • Parker MJ, Handoll HH. Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures in adults. Cochrane Database Syst Rev. 2008;(3):CD000093. doi:10.1002/14651858.CD000093.pub4
  • Vaquero J, Munoz J, Prat S, et al. Proximal Femoral Nail Antirotation versus Gamma3 nail for intramedullary nailing of unstable trochanteric fractures. A randomised comparative study. Injury. 2012;43 Suppl 2:S47-S54. doi:10.1016/S0020-1383(13)70179-7
  • Brandt E, Verdonschot N. Biomechanical analysis of the sliding hip screw, cannulated screws and Targon1 FN in intracapsular hip fractures in cadaver femora. Injury. 2011;42(2):183-187. doi:10.1016/j.injury.2010.08.021
  • Erez O, Dougherty PJ. Early complications associated with cephalomedullary nail for intertrochanteric hip fractures. J Trauma Acute Care Surg. 2012;72(2):E101-E105. doi:10.1097/ta.0b013e31821c2ef2
  • Zhang J, Tang X. The application of the 150° oblique tangential fluoroscopic view to detect the posterosuperior femoral neck screw in-out-in intraoperatively. Sci Rep. 2022;12(1):12790. doi:10.1038/s41598-022-17221-z
  • Chen SY, Chang SM, Tuladhar R, et al. A new fluoroscopic view for evaluation of anteromedial cortex reduction quality during cephalomedullary nailing for intertrochanteric femur fractures: the 30° oblique tangential projection. BMC Musculoskelet Disord. 2020;21(1):719. doi:10.1186/s12891-020-03668-6
  • Turgut A, Kalenderer O, Gunaydin, B, Onvural B. Karapınar L, Agus H. İntertrokanterik femur kırıklarının proksimal femoral çivi antirotasyon (PFNA) ile lateral dekübit pozisyonda tespiti. Acta Orthop Traumatol Turc. 2014;48(5):513-520.
  • Flierl MA, Stahel PF, Hak DJ, Morgan SJ, Smith WR. Traction table-related complications in orthopaedic surgery. J Am Acad Orthop Surg. 2010;18(11):668-675. doi:10.5435/00124635-201011000-00004
  • 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. doi:10.1016/0020-1383(94)90276-3
  • 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):1450-1455.
  • Doğan N, Ertürk C, Gülabi D. Is proximal femoral nailing of unstable intertrochanteric fractures in the lateral decubitus position without a traction table as safe and effective as on a traction table?. Injury. 2022;53(2):555-560. doi:10.1016/j.injury.2021.11.017
  • Sonmez MM, Camur S, Erturer E, Ugurlar M, Kara A, Ozturk I. Strategies for proximal femoral nailing of unstable intertrochanteric fractures: lateral decubitus position or traction table. J Am Acad Orthop Surg. 2017;25(3):e37-e44. doi:10.5435/JAAOS-D-15-00691
  • Jong-Keon O, Jin-Ho H, Dipit S. Nailing of Intertrochanteric Fractures: Review on Pitfalls and Technical Tips. Journal of Orthopaedics, Trauma and Rehabilitation. 2010;14(2):3-7. doi:10.1016/j.jotr.2010.08.006
  • Liu W, Zhou D, Liu F, Weaver MJ, Vrahas MS. Mechanical complications of intertrochanteric hip fractures treated with trochanteric femoral nails. J Trauma Acute Care Surg. 2013;75(2):304-310. doi:10.1097/TA.0b013e31829a2c43
  • Turgut A, Kalenderer Ö, Karapınar L, Kumbaracı M, Akkan HA, Ağuş H. Which factor is most important for occurrence of cutout complications in patients treated with proximal femoral nail antirotation? Retrospective analysis of 298 patients. Arch Orthop Trauma Surg. 2016;136(5):623-630. doi:10.1007/s00402-016-2410-3
  • Kristan A, Benulič Č, Jaklič M. Reduction of trochanteric fractures in lateral view is significant predictor for radiological and functional result after six months. Injury. 2021;52(10):3036-3041. doi:10.1016/j.injury.2021.02.038
  • Campbell SE. Radiography of the hip: lines, signs, and patterns of disease. Semin Roentgenol. 2005;40(3):290-319. doi:10.1053/j.ro.2005.01.016
  • Lim SJ, Park YS. Plain radiography of the hip: a review of radiographic techniques and image features. Hip Pelvis. 2015;27(3):125-134. doi:10.5371/hp.2015.27.3.125
  • Herman A, Landau Y, Gutman G, Ougortsin V, Chechick A, Shazar N. Radiological evaluation of intertrochanteric fracture fixation by the proximal femoral nail. Injury. 2012;43(6):856-863. doi:10.1016/j.injury.2011.10.030
  • Ciufo DJ, Zaruta DA, Lipof JS, Judd KT, Gorczyca JT, Ketz JP. Risk factors associated with cephalomedullary nail cutout in the treatment of trochanteric hip fractures. J Orthop Trauma. 2017;31(11):583-588. doi:10.1097/BOT.0000000000000961
  • Aibinder WR, Yuan BJ, Cross WW 3rd, Parry JA. Sequential fluoroscopic rollover images reliably identify "in-out-in" posterosuperior screws during percutaneous fixation of femoral neck fractures. Eur J Orthopaedic Surg Traumatol. 2020 Aug;30(6):1061-1065. DOI: 10.1007/s00590-020-02668-5.
  • Schep NW, van Walsum T, De Graaf JS, Broeders IA, van der Werken C. Validation of fluoroscopy-based navigation in the hip region: what you see is what you get?. Comput Aided Surg. 2002;7(5):279-283. doi:10.1002/igs.10051
  • Bishop JA, Rodriguez EK. Closed intramedullary nailing of the femur in the lateral decubitus position. J Trauma. 2010;68(1):231-235. doi:10.1097/TA.0b013e3181c488d8
  • Nikoloski AN, Osbrough AL, Yates PJ. Should the tip-apex distance (TAD) rule be modified for the proximal femoral nail antirotation (PFNA)? A retrospective study. J Orthop Surg Res. 2013;8:35. doi:10.1186/1749-799X-8-35
  • Sadic S, Custovic S, Jasarevuc M, Fazlic M, Krupic F. Proximal femoral nail antirotation in treatment of intertrochanteric hip fractures: a retrospective study in 113 patients. Med Arch. 2015;69(6):352-6. doi: 10.5455/medarh.2015.69.353-356.
  • Cleveland M, Bosworth DM, Thompson FR, Wilson HJ Jr, Ishizuka T. A ten-year analysis of intertrochanteric fractures of the femur. J Bone Joint Surg Am. 1959;41-A:1399-1408.
  • Hwang JH, Garg AK, Oh JK, et al. A biomechanical evaluation of proximal femoral nail antirotation with respect to helical blade position in femoral head: A cadaveric study. Indian J Orthop. 2012;46(6):627-632. doi:10.4103/0019-5413.104186
  • Parker MJ. Cutting-out of the dynamic hip screw related to its position. J Bone Joint Surg Br. 1992;74(4):625. doi:10.1302/0301-620X.74B4.1624529
  • Hengg C, Mayrhofer P, Euler S, Wambacher M, Blauth M, Kralinger F. The relevance of neutral arm positioning for true ap-view X-ray to provide true projection of the humeral head shaft angle. Arch Orthop Trauma Surg. 2016;136(2):213-221. doi:10.1007/s00402-015-2368-6
  • Moshina N, Bjørnson EW, Holen ÅS, et al. Standardised or individualised X-ray tube angle for mediolateral oblique projection in digital mammography?. Radiography (Lond). 2022;28(3):772-778. doi:10.1016/j.radi.2022.03.002
  • Tan W, Ong YS, Ng CYQ, Kwok KY, Tan CYY, Sng LH. Anatomical tilt lateral wrist X-ray - Not always 22°. Radiography (Lond). 2023;29(4):807-811. doi:10.1016/j.radi.2023.05.010
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Details

Primary Language English
Subjects Orthopaedics
Journal Section Original Article
Authors

Fatih Uğur 0000-0001-6109-8425

Early Pub Date September 26, 2023
Publication Date September 28, 2023
Published in Issue Year 2023 Volume: 6 Issue: 5

Cite

AMA Uğur F. Individualized fluoroscopic lateral femoral neck view for fixation of hip fractures in the lateral decubitus position. J Health Sci Med / JHSM. September 2023;6(5):1125-1132. doi:10.32322/jhsm.1348153

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