1. 7 YEARS FOLLOW UP OF
TRANSCERVICAL
OSTEOTOMY IN FRACTURE
NECK FEMUR- A NEW
CONCEPT
Dr. A. Latif
Associate Professor,dept. of orthopaedics
Midnapore Medical Collage & Hospital
West Bengal
2. INTRODUCTION
For
neglected and nonunited fracture neck
femur, t/t options for patients below 60-65
Yrs.fixation
with osteotomy
or/with bone grafting
All have some significant drawbacks
James A Dickson-it seemed desirable that a
suitable operation be devised which would combine
the advantages of corrected mechanics, obtained by
osteotomy, with that of the improved osteogenesis,
produced by a bone graft.
3. ACTUALLY TRANSTROCHANTERIC-TRANSCERVICAL
OSTEOTOMY
COMBINES THE ADVANTAGES OF DISPLACEMENT OF MCMURRY,
VALGUS ANGULATION OF POWELS AND BONE GRAFTING OF MPBG.
OSTEOTOMY AT THE LEVEL OF VASTUS RIDGE- ALONG NECK
FEMUR WITHIN FEW mm OF INFERIOR BORDER OF NECK UPTO
FRACTURE SITE.
4. AFTER OSTEOTOMY,EXTRA TRACTION MEDIAL DISPLACEMENT UP TO PERIP
OF ARTCULAR SURFACE ABDUCTION OF 45 – 60 DEGREE
EXTRA TRAC
AFTER DISPLACEMENT
5. FIXED WITH MODIFIED TUPMAN PLATE
LONG CONTINUOUS HOLE IN PROXIMAL,MIDDLE &DISTAL LIMB
VARIABLE LENGTH OF MIDDLE LIMB0.5cm
1cm
1.5cm
6. AFTER FIXATION WITH
oTWO 6.5 CC, SCREWS FOR FRACTURE
FIXATION
o2/3 CORTICAL SCREWS FOR FIXATION
OF SHAFT TO PLATE
o1 CORTICAL/ CANCELLOUS SCREW
FOR
FIXATION OF GR. TROCHANTERIC
FRAGMENT (AFTER PULLING IT
DISTALLY
WITH A POINTED REDUCTION FORCEPS
TO PREVENT SHORTENING OF
ABDUCTOR
LEVER ARM)
7. INDICATIONS
NON UNION FRACTURE NECK FEMUR
<6O-65YRS.OF AGE.POWELS GR III/GARDEN III/IV FRACTURE
NECK FEMUR
WITH>2-3 WKS DURATION.
VERTICAL
SHEAR FRACTURE/ POWELS III .
(IN FRESH FRACTURE)(A.O.PRINCIPLES
OF FRACTURE MANAGEMENT,
2nd EXPANDED EDITION,VOLUME 2)
8. RESULT
FROM2007-2013
50 PATIENTS
INFORMED CONSENT
POST OP- BED REST FOR 6-8 WKS
AXILLARY CRUTCH WALKING FOR 6-8 WKS
ELBOW CRUTCH FOR 4-6 WKS
FULL WEIGHT BEARING AFTER 16-18 WKS
NONUNION- 1 PATIENT
AVN- 1 PATIENT
CUT OUT- 2 PATIENTS
SHORTENING >1 CM-5 PATIENTS
ALL UNITED EXCEPT 4 CAN WALK WITHOUT SUPPORT WITH
MINIMUM PAIN
ALL UNITED CAN SQUAT BUT 50% WITH DIFFICULTY
21. DISCUSSION
ADV. OF TRANSCERVICAL OSTEOTOMY
COMBINED THE PRINCIPLES OF
MCMURRY, POWELS & MPBG
OSTEOTOMY IS STABLE
UNION IS ENSURED
NO OR MINIMAL SHORTENING
CHANCE OF AVN IS LESS
A) AS # FRACTURE-HAEMATOMA DRAINED OUT
B) DISTAL OSTEOTOMY FRAGMENT ACTS LIKE
MPBG
C)MAXIMUM MEDULLA TO MEDULLA CONTACT—
INCREASED CHANCES OF REVASCULARISATION
22. CONCLUSION
IN FRACTURE NECK FEMUR : UNION RATE IN NON UNITED FRACTURE NECK FEMUR WITH
ABDUCTION OSTEOTOMY 80-90%
NON UNION 10-20% (CAMPBELL)AVN 20-40%
SHORTENING>5mm=66%VARUS>5 DEGREE=39% [JBJS(Br)90;14871494,2008]
IDEAL FIXATION DEVICE REMAINS UNDEFINED FOR POWELS III
VERTICAL FRACTURE NECK FEMUR.[JBJS(AM)90;1654-1659,2008]
IN YOUNG PATIENTS,RATE OF AVN AND NON UNION IS HIGHER
IN THIS CONTEXT, THIS OSTEOTOMY, WITH LOW RATES OF COMPLICATIONS,
MAY BE SUGGESTED TO DECREASE NON UNION, SHORTENING,VARUS & AVN
OF THE UNSOLVED FRACTURE OF NECK FEMUR.
MAY I SUGGEST THIS AS A GOOD ALTERNATIVE FOR USE IN FRESH
DISPLACED FRACTURE NECK FEMUR ?
