Traverso Aurélien, Ngo Trieu-Hoai-Nam, Fernandez Gil Guillem, Lannes Xavier, Steinmetz Sylvain, Moerenhout Kevin
Department of Orthopaedics and Traumatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
Department of Orthopaedics and Traumatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
Injury. 2023 Mar;54(3):970-975. doi: 10.1016/j.injury.2023.01.027. Epub 2023 Jan 11.
cephalomedullary devices are popular treatment for femoral intertrochanteric or subtrochanteric fractures. Various complications include post-surgical lateral thigh pain and cut-out. To prevent those complications, a new concept cephalomedullary device system was designed (Chimaera, Orthofix®). This study aimed to evaluate the clinical and radiological outcomes in patients with femoral intertrochanteric or subtrochanteric fractures treated with the proximal femoral cephalomedullary device system.
A prospective cohort study involved consecutive patients with Arbeitsgemeinschaft für Osteosynthesefragen/ Orthopaedic Trauma Association type 31-A1, 2, 3 fractures treated with the Chimaera short cephalomedullary device system from October 2016 to September 2017 at our level 1 trauma center. The Parker and Palmer mobility score and Jensen social function scores and post-surgical lateral thigh pain were assessed at 3 months post-operatively and compared to before surgery. Radiologic assessment consisted of controlling the position of the cephalic screw by using the tip-apex distance (TAD) and Cleveland zone as well as union and cut-out rates.
We included 99 patients (79 women; 100 hips; one bilateral fracture 3 months after a first trochanteric fracture) with a mean follow-up of 2 years. The Parker and Palmer mobility score decreased by 22% at 3 months post-operatively as compared with the pre-fracture score (42/99 patients showed a return to their pre-injury level). The Jensen social function score increased by 16.5% at 3 months post-operatively as compared with the pre-fracture score (68/99 patients showed a return to their pre-injury level). No major intra-operative complication was recorded. Nine TAD scores were > 25 mm. The mean TAD was 16.5 mm (range 5-36), and the lag screw position was well positioned in most (95%) hips according to Cleveland zones. Three patients required revision surgery (one for cut-out of the lag screw, one for hip osteoarthritis and one for gluteus medius insufficiency). All patients but the one with the cut-out showed fracture union.
The Chimaera short cephalomedullary device exhibited good mid-term functional and radiological outcomes.
髓内固定装置是治疗股骨转子间或转子下骨折的常用方法。各种并发症包括术后大腿外侧疼痛和内固定物穿出。为预防这些并发症，设计了一种新的概念性髓内固定装置系统（Chimaera，奥索公司®）。本研究旨在评估采用股骨近端髓内固定装置系统治疗的股骨转子间或转子下骨折患者的临床和影像学结果。
一项前瞻性队列研究纳入了2016年10月至2017年9月在我们的一级创伤中心连续接受Chimaera短髓内固定装置系统治疗的 Arbeitsgemeinschaft für Osteosynthesefragen/骨科创伤协会31-A1、2、3型骨折患者。在术后3个月评估帕克和帕尔默活动度评分、詹森社会功能评分以及术后大腿外侧疼痛情况，并与术前进行比较。影像学评估包括通过尖顶距（TAD）和克利夫兰分区控制头钉位置以及骨折愈合和内固定物穿出率。
我们纳入了99例患者（79例女性；100髋；1例双侧骨折，为首次转子间骨折3个月后发生），平均随访2年。与骨折前评分相比，术后3个月帕克和帕尔默活动度评分下降了22%（42/99例患者恢复到受伤前水平）。与骨折前评分相比，术后3个月詹森社会功能评分提高了16.5%（68/99例患者恢复到受伤前水平）。未记录到重大术中并发症。9个TAD评分>25 mm。平均TAD为16.5 mm（范围5 - 36），根据克利夫兰分区，大多数（95%）髋部的拉力螺钉位置良好。3例患者需要翻修手术（1例因拉力螺钉穿出，1例因髋骨关节炎，1例因臀中肌功能不全）。除1例内固定物穿出患者外，所有患者均实现骨折愈合。
Chimaera短髓内固定装置在中期显示出良好的功能和影像学结果。
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