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Calcar femorale grafting in the hemiarthroplasty of the hip for unstable inter trochanteric fractures

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Indian Journal of Orthopaedics Aims and scope Submit manuscript

Abstract

Background

The sliding screw–plate devices and cephalo–medullary nail devices have performed well in stable inter–trochanteric fractures in patients with reasonably good quality of bone. However, their suboptimal performance in comminuted fractures in the presence of osteoporotic bone has prompted many surgeons to consider bipolar hemiarthroplasty as the primary modality of management of comminuted inter–trochanteric fractures in elderly patients. However, long term stability of the hemiarthroplasty implant also may be compromised due to the presence of postero–medial bone loss at the area of the calcar.

Materials and Methods

We have presented a simple and effective technique of calcar grafting by harvesting cortical bone strut from the neck of the fractured femur. A total of 34 patients with inter–trochanteric fractures of the femur were treated with calcar grafting. The mean age was 79.2 years. The graft was harvested from the calcar region of the head and neck fragment of the femur and wedged between the medial femoral cortex and medial edge of the prosthesis. The mean followup period was 54.5 months.

Results

In 32 of 34 (94%) patients in our series, the calcar graft healed well without dislodgement. There was graft resorption in two patients associated with subsidence of the implant and loosening.

Conclusion

Calcar grafting using this technique provides stability to the implant in the presence of comminution and incorporates well in the majority of patients. Donor site morbidity of graft harvesting is also avoided.

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Authors and Affiliations

  1. Department of Orthopaedics, Johns Hopkins Hospital, Baltimore, USA

    Savyasachi Thakkar

  2. Department of Orthopaedics, HOSMAT Hospital, Bengaluru, Karnataka, India

    Rajshekhar T. Kathalgere & Malhar N. Kumar

  3. Department of Orthopaedics, Breach Candy Hospital, Mumbai, Maharashtra, India

    Chandrashekar J. Thakkar

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  1. Chandrashekar J. Thakkar
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Correspondence to Chandrashekar J. Thakkar.

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Thakkar, C.J., Thakkar, S., Kathalgere, R.T. et al. Calcar femorale grafting in the hemiarthroplasty of the hip for unstable inter trochanteric fractures. IJOO 49, 602–609 (2015). https://doi.org/10.4103/0019-5413.168762

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