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Surgical Technique for Subtrochanteric Fracture of Femur.

ABSTRACT: A 56-year-old woman had fell over herself 4?h prior to her presentation to our hospital. The diagnosis was a subtrochanteric fracture of the right femur (AO-32-A3). The patient was placed in a supine position was set up on a fracture traction table after general anesthesia. The right leg was placed in abduction while the left leg was positioned so that there was flexion of the knee and hip joint. The C-arm was placed on the left side. The surgical field was sterilized and draped. Deformity and external rotation are always present for this type of fracture, so the first step was to place a joystick in the proximal fragment to correct the external rotation. Then the perfect entry point could be defined by K wire. After inserting guide wire into the canal dreaming was followed. An appropriate nail was selected and inserted. The distal tip of the nail should be located in the cancellous bone. Before inserting the proximal lag screws into the femoral head, the external rotation of the proximal fragment must be corrected by the joystick. The traction was loosened and the distal fragment was pushed towards the proximal side so that the gap between the fragments disappeared. The affected leg was maintained in perfect alignment. Meanwhile, the distal locking screws were inserted using the free hand perfect circle technique.

SUBMITTER: Wang PC

PROVIDER: S-EPMC6584163 | biostudies-literature | 2016 Nov

REPOSITORIES: biostudies-literature

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Surgical Technique for Subtrochanteric Fracture of Femur.

Wang Peng-Cheng PC Ren Dong D Song Chao-Hui CH Zhou Bing B

Orthopaedic surgery 20161101 4

A 56-year-old woman had fell over herself 4 h prior to her presentation to our hospital. The diagnosis was a subtrochanteric fracture of the right femur (AO-32-A3). The patient was placed in a supine position was set up on a fracture traction table after general anesthesia. The right leg was placed in abduction while the left leg was positioned so that there was flexion of the knee and hip joint. The C-arm was placed on the left side. The surgical field was sterilized and draped. Deformity and e ...[more]

PMID: 28032707

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Project description:BackgroundHip fractures are a common and costly health problem, resulting in significant morbidity and mortality, as well as high costs for healthcare systems, especially for the elderly. Implementing surgical preventive strategies has the potential to improve the quality of life and reduce the burden on healthcare resources, particularly in the long term. However, there are currently limited guidelines for standardizing hip fracture prophylaxis practices.MethodsThis study used a cost-effectiveness analysis with a finite-state Markov model and cohort simulation to evaluate the primary and secondary surgical prevention of hip fractures in the elderly. Patients aged 60 to 90 years were simulated in two different models (A and B) to assess prevention at different levels. Model A assumed prophylaxis was performed during the fracture operation on the contralateral side, while Model B included individuals with high fracture risk factors. Costs were obtained from the Centers for Medicare & Medicaid Services, and transition probabilities and health state utilities were derived from available literature. The baseline assumption was a 10% reduction in fracture risk after prophylaxis. A sensitivity analysis was also conducted to assess the reliability and variability of the results.ResultsWith a 10% fracture risk reduction, model A costs between $8,850 and $46,940 per quality-adjusted life-year ($/QALY). Additionally, it proved most cost-effective in the age range between 61 and 81 years. The sensitivity analysis established that a reduction of ≥ 2.8% is needed for prophylaxis to be definitely cost-effective. The cost-effectiveness at the secondary prevention level was most sensitive to the cost of the contralateral side's prophylaxis, the patient's age, and fracture treatment cost. For high-risk patients with no fracture history, the cost-effectiveness of a preventive strategy depends on their risk profile. In the baseline analysis, the incremental cost-effectiveness ratio at the primary prevention level varied between $11,000/QALY and $74,000/QALY, which is below the defined willingness to pay threshold.ConclusionDue to the high cost of hip fracture treatment and its increased morbidity, surgical prophylaxis strategies have demonstrated that they can significantly relieve the healthcare system. Various key assumptions facilitated the modeling, allowing for adequate room for uncertainty. Further research is needed to evaluate health-state-associated risks.

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Surgical Technique for Subtrochanteric Fracture of Femur.

Publications

Surgical Technique for Subtrochanteric Fracture of Femur.

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