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Tips and Pearls

Aid to Femoral Head Removal

Medlock, Gareth MBChB; Hamilton, Steven FRCS, MBChB

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Techniques in Orthopaedics: March 2014 - Volume 29 - Issue 1 - p e1-e2
doi: 10.1097/BTO.0b013e3182908d9b
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Abstract

BACKGROUND

The proximal femoral fractures occurring annually in the United Kingdom range from 70,000 to 75,000.1 Fifty percent of these are intracapsular hip fractures and in most elderly patients, these are usually treated with either a hemiarthroplasty or a total hip replacement depending on the demand. Both require removal of the femoral head from the acetabulum. A corkscrew is used for this task, requiring a high torque for insertion into cancellous bone. Control of the femoral head, that is, preventing it from spinning, is difficult and some methods such as hammering and K-wire fixation can potentially cause harm to the patient and the surgeon. We have modified the equipment, which stabilizes the femoral head apposing the torque and improving the control of the corkscrew.

TECHNIQUE

A plate tamper (candlestick) used in compression hip screw plate insertion was modified at one end to have 2 points to engage with the fracture surface of the femoral head (Fig. 1). This plastic candlestick is cannulated and the corkscrew can be placed down the center (Fig. 2). By grasping the candlestick and applying firm pressure against the femoral head, not only is the torque of the corkscrew apposed, greater control is obtained, facilitating safe corkscrew insertion (Fig. 3).

FIGURE 1
FIGURE 1:
Modification made to the end of the candlestick to engage with femoral head.
FIGURE 2
FIGURE 2:
Cork screw placed down the centre of candlestick.
FIGURE 3
FIGURE 3:
Engagement of the corkscrew into the femoral head fracture site facilitates safe and effective cork screw insertion.

DISCUSSION

This simple addition to our instrumentation for hip arthroplasty has not only improved patient and surgeon safety, but it could also reduce the operative time important in the elderly population this fracture occurs in.

REFERENCE

1. British Orthopaedic Association. The Care of Patients With Fragility Fractures. British Orthopaedic Association; 2007. Available at: http://www.boa.ac.uk.
Keywords:

hip fractures; hemiarthroplasty; arthroplasty; total hip replacement; intracapsular hip fracture; corkscrew; fragility fractures

© 2014 by Lippincott Williams & Wilkins