Medicine and Medical Sciences

Trochanteric fractures usually occur in elderly patients with associated comorbidities or in case of  low energy trauma. The trochanteric fractures  represent a challenging pathology with many possible complications. The usual treatment issurgical with either intramedullary nail or dynamic hip screw (DHS).Most of the complications are due to the severe osteoporosis or implant malpositioning. Due to the complications encountered during practice, we decided to make an adequate assessment of our complicated cases and a study of the intramedullary nails used in our surgical treatment of the trochanteric fractures. In the study were included twenty-three  patients, of which thirteen followed a fast recovery program with early walking (FWB group). The other ten  patients were not allowed full weight bearing up to 6 weeks (NFWB group). All the patients were diagnosed with osteoporosis pre-operative. The T-score  was determined post-operativefor all the cases.  The T-score on your bone density report shows how much your bone mass differs from the bone mass of an average healthy adult. A bone density test is like any other medical test or measurement. The results for the entire population will be distributed around an average score (the mean). The stress testing of the implant was done in another centre and we measured the tolerances of the material. The average T-score was 2.5 for the patients that followed the fast recovery program and 2.7 for the patients from non-full weight bearing. The average age of patients was 70 years old with a Body mass index (BMI) between 26-31 and no septic post-operative complications were recorded. Four patients, one from the NFWB group and  three from FWB group, presented a screw cut-out. We also presented three particular cases with very serious post-operative complications. One of the cases is a patient with a failed dynamic hip screw implant fixed in another hospital centre, where we decided to remove and use an intramedullary nail. Even though the screw position was optimal, the nail broke in the proximal part after 6 months due to the insufficient bone healing and high stress shielding forces. The patient underwent revision surgery for the implant and the broken nail was sent for metallurgic testing and electronic microscopic examination. We found that the errors of the guiding instruments may create dents or scratches on the coating or on the inside proximal hole that may lead to a reduced resistance to the high number of cycles of stress forces. Even though such an event is not frequent, it must be avoided, especially in patients with osteoporosis, which have an increased risk of implant failure.. Despite the reported postoperative complications, the gamma nail remains one of the main solutions for the treatment of pertrochanteric fractures.

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