Proximal femoral fractures are a common injury in elderly individuals and can have significant impacts on their mobility and overall quality of life. In many cases, surgical intervention is necessary to repair the fracture and restore function to the affected area. Implants are a crucial component of many surgical interventions for proximal femoral fractures and can greatly improve outcomes for patients. In this blog, we will discuss proximal femoral fractures and implants, including the types of implants used and the benefits they provide.
Proximal femoral fractures
The femur is the longest and strongest bone in the human body, and it connects the hip joint to the knee joint. The proximal femur refers to the upper part of the femur that is closest to the hip joint. Fractures in this area can occur due to trauma, falls, or weakened bones caused by conditions such as osteoporosis. These fractures are particularly common in elderly individuals, and they can cause significant pain and impair mobility.
There are several types of proximal femoral fractures, including intertrochanteric fractures, femoral neck fractures, and subtrochanteric fractures. Intertrochanteric fractures occur in the region between the greater and lesser trochanters of the femur, while femoral neck fractures occur in the area where the femoral head meets the femoral shaft. Subtrochanteric fractures occur in the area just below the lesser trochanter.
Surgical treatment
In many cases, surgical treatment is necessary to repair proximal femoral fractures. There are several different surgical approaches that can be used, including open reduction and internal fixation (ORIF), hemiarthroplasty, and total hip arthroplasty (THA). The choice of surgical approach depends on factors such as the type of fracture, the patient’s age and overall health, and the surgeon’s experience and preference.
Regardless of the surgical approach used, implants are a crucial component of many surgical interventions for proximal femoral fractures. Implants are used to stabilize the fractured bone and promote healing, and they can help to restore function to the affected area.
Implants for surgical treatment
There are several different types of implants that can be used for proximal femoral fractures, including screws, plates, nails, and prostheses. The choice of implant depends on factors such as the type of fracture and the patient’s age and overall health.
Screws
Screws and plates are often used for intertrochanteric fractures and are typically made of metal. The screws are inserted into the bone to hold the fracture in place, and the plates are placed over the bone and secured with screws. This helps to stabilize the fracture and promote healing.
Nails
Nails are often used for femoral neck fractures and are inserted into the femur to stabilize the fracture. The nails are typically made of metal and can be either intramedullary (inserted into the bone marrow) or extramedullary (inserted outside of the bone marrow). Nails can help to promote healing and restore function to the affected area.
Prostheses
Prostheses are used for more severe proximal femoral fractures, such as those that involve damage to the femoral head. Hemiarthroplasty involves replacing the femoral head with a prosthetic implant, while Total Hip Arthroplasty (THA) involves replacing both the femoral head and the acetabulum (socket) of the hip joint. Prostheses can help to restore function to the affected area and improve quality of life for patients.
Advantages of proximal femoral nail
Proximal femoral nail (PFN) is a type of implant commonly used in the treatment of proximal femoral fractures. Here are some advantages of PFN in the treatment of proximal femoral fractures:
- Efficient load transfer is facilitated by proximal femoral nails.
- Implant failure risk is reduced due to shorter lever arm and decreased tensile strain.
- Controlled fracture impaction is maintained by this technique.
- Buttress is provided to prevent shaft medialisation.
- Shorter operating time and lesser soft tissue dissection are the benefits of proximal femoral nails.
- Proximal screws offer improved resistance to varus collapse and rotational control of head and neck fragment.
- Length and rotational control is possible even in the absence of the lesser trochanter.
- Longitudinal slot throughout the nail accelerates the regeneration of endosteal bone.
- The nail has a flexible distal tip to prevent stress generation and refracture, and a 6° medio-lateral angle facilitates easy insertion.
Implant materials used in proximal femoral fractures
There are several implant materials that are commonly used in the treatment of proximal femoral fractures. The choice of implant material depends on various factors such as the fracture pattern, bone quality, patient age and activity level, and surgeon preference.
Here are some implant materials that are commonly used in the treatment of proximal femoral fractures:
Stainless steel
Stainless steel implants are commonly used in the treatment of proximal femoral fractures, especially in older patients with poor bone quality. Stainless steel is relatively inexpensive and provides adequate stability for most types of fractures.
Titanium
Titanium implants are commonly used in younger patients with good bone quality. Titanium is biocompatible and has a low risk of metal allergy. It is also stronger than stainless steel, which allows for the use of smaller implant sizes.
Cobalt-chromium alloys
Cobalt-chromium alloys are used in the treatment of complex proximal femoral fractures that require a higher degree of stability. These implants are stronger than stainless steel and provide better resistance to bending and torsional forces.
Polyethylene
Polyethylene implants are used in the treatment of hip fractures, especially in patients with poor bone quality. These implants are lightweight and biocompatible, and can be used in combination with metal implants to provide stability.
Calcium phosphate ceramics
Calcium phosphate ceramics are used in the treatment of proximal femoral fractures as a bone graft substitute. These materials are biocompatible and can be resorbed by the body over time, allowing for the regeneration of new bone.
Selection of the right implant for proximal femoral fractures
Proximal femoral fractures can be challenging to treat, and selecting the right implant is crucial for successful outcomes. The choice of implant depends on the fracture pattern, bone quality, patient age and activity level, and the surgeon’s experience and preference.
Here are some key considerations when selecting an implant for proximal femoral fractures:
Fracture pattern
The type and location of the fracture determine the appropriate implant. For example, unstable intertrochanteric fractures may require a dynamic hip screw or proximal femoral nail, while sub trochanteric fractures may need a long intramedullary nail.
Bone quality
Good bone quality allows for a stable implant, while poor bone quality may require augmentation with bone cement or screws. In cases of osteoporosis, implants with a larger diameter and longer screws may be necessary.
Patient age and activity level
Older patients with lower activity levels may require a less invasive implant, such as a sliding hip screw, while younger patients with higher activity levels may benefit from a more stable implant, such as a proximal femoral nail.
Surgeon experience and preference
Surgeons with more experience and training may prefer certain implants, based on their familiarity and success with them.
Conclusion
Proximal femoral fractures can be debilitating and severely impact a patient’s quality of life. The use of orthopedic implants has revolutionized the treatment of these fractures, providing improved support, stability, and mobility to the affected joint. We at Zealmax Ortho are committed to utilizing the latest advancements in orthopedic technology to produce implants that offer the highest level of care to patients. Our team of experts is dedicated to ensuring that every implant is manufactured to the highest standards of quality and performance, providing patients with the best possible chance of a successful outcome.
