Cases Of Proximal Femoral Fractures Research Articles

Preoperative predictors of mortality in fractures of the proximal femur

BACKGROUND: Age and comorbidities are considered independent preoperative predictors of mortality in proximal femoral fractures; however, their contribution remains debatable. AIM: To assess the prognostic significance of age and Charlson Comorbidity Index (CCI) of the survival of older people with proximal femoral fractures. MATERIALS AND METHODS: This retrospective prospective study included all cases of proximal femoral fractures that occurred between January 1, 2019, and December 31, 2019, in individuals over 50 years of age from the cities of Tver, Torzhok, Rzhev, VyshnyVolochek, and Kashin. ICD-10 codes: S72.0, S72.1, and S72.2. The CCI of each patient was calculated using an online calculator and clinical data obtained from patient and outpatient records. Statistical analysis. Survival was estimated using Kaplan–Meier curves and the average number of deaths per day per 1000 people. The follow-up interval was obtained in days from the time of injury to the event of death or last contact with the patient. The minimum observation period was 876 days, and the maximum was 1492 days. RESULTS: The survival rate of patients decreased from younger to older age groups, both among those operated on and those who were not. Patients aged ≥85 years were at greatest risk (median survival: 257 days; 95% CI: 36.6–478.3). CCI was significantly associated with survival: the risk of death with CCI 3 was 3–6 times higher than that with CCI 2–3, depending on the follow-up interval. CCI reflected health status more than age: within the same age group, there were patients with different CCIs. CONCLUSION: Using age and CCI simultaneously as predictors of mortality and more accurate indicators of health status will enable the planning of the utilization of additional medical and social resources in the preoperative and postoperative periods, thereby increasing survival.

Treatment of Unstable Trochanteric / Subtrocanteric Fractures with PFN, First Cases in University Hospital of Trauma & American Hospital. Results and Complications.

Aims and objectives: This study was done to evaluate the functional and radiographic outcome of PFN in treatment of proximal femoral fracture and more common technical, mechanical complications and intraoperative difficulties during the implant implementation.
 Materials & Methods: We conducted a retrospective study with ten cases of proximal femoral fractures treated between September 2017 and September 2018, which were accepted at the Department of Orthopedics, the University Hospital of Trauma and the American Hospital in Tirana. Fractures are classified according to classification AO and Boyd-Griffin. The age range of patients taking the study was 20-90 years. Ten cases were followed at regular intervals and the final assessment was made at the end of the 6 month period. In the result, functional clinical assessment according to Harris hip score was done .
 Results: In our study,mean age was 66 y.o, 7 male and 3 females. Mean of hospitalization time 6 days, mean operation time 120 min. In our study at 6 months follow up, union was achieved in 9 cases, open reduction was performed in 3 cases (10 cases). Technical and mechanical complications were noted in one case. Reoperation rate was 10 % (one case). According Harris hip scoring system excellent results were seen 40 % of cases (4 cases), good results in 50 % cases (5 cases), and poor results in 10% cases (1 case).
 Conclusions: In our study, in spite of low experience in proximal femoral nailing in cases with unstable trochanteric / subtrocanteric fractures, it was found that PFN is an attractive implant and suitable for proximal femoral fractures and its use in unstable trochanteric / subtrocanteric fractures is very encouraging. This study has also shown that this device can safely be used by an average surgeon to handle common but sometimes tough fractures. Operation is technically not difficult, but gradual learning and great patience is needed to make this method really minimal invasive.

SIGNIFICANCE OF TIP APEX DISTANCE (TAD) IN PROXIMAL FEMORAL NAIL ANTIROTATION (PFNA) II SYSTEM USED IN TRAUMA CASES OF PROXIMAL FEMORAL FRACTURES

Introduction: Proximal femoral fractures of trochanteric region are common orthopaedic trauma in routine practice and the ideal implant for treatment is still not found. After the sliding hip screw and various intramedullary nails having been used for so long, newer implants like PFNA II (Asian version of PFNA) with helical blade are now available. But ideal position of helical blade in femoral head has been in debate till date. For sliding hip screw, concept of maintaining Tip Apex Distance (TAD) less than 25mm is well accepted. So, the purpose of this study is to determine the optimal TAD for PFNA II in trochanteric femoral fractures. Materials and methods:100 cases of proximal femoral fractures of trochanteric region which were treated with PFNA II between August 2015 to July 2019 at Geetanjali Medical College and hospital, Udaipur, Rajasthan, India were included in this study. TAD value and position of helical blade tip in femoral head was correlated with failure of fixation. 60 cases were studied retrospectively and 40 cases prospectively. Results: The mean TAD found in this study was 17.97 mm. The overall fixation failure in this study was 3 out of 100 cases (3%). TAD of more than 25 mm was seen in 7 cases out of which 1 case failed (14.28%). However, only 2 out of 93 cases (2.15%) failed in cases with TAD less than 25 mm. Position of helical blade tip in failed cases was superior-centre in 2 cases, while centre-posterior in 1 case. However, all 60 cases with centre-centre position healed successfully. Failed cases showed implant breakage in 2 cases and fracture collapse in 1 case. Conclusion: This study recommends that maintaining TAD less than 25 mm prevents fixation failure in treating trochanteric femoral fractures with PFNA II. Central position of helical blade tip shows most successful result. Also, helical blade of PFNA II provides better hold in osteoporotic bones. Keywords: trochanteric fractures, TAD (Tip Apex Distance), PFNA II, helical blade

Chronic hyponatremia in patients with proximal femoral fractures after low energy trauma: A retrospective study in a level-1 trauma center

IntroductionWe evaluated the prevalence and influence of chronic hyponatremia in patients with low energy trauma. We also investigated the influence of medication and diseases on hyponatremia. Material and methodsThis retrospective study included 314 cases of proximal femoral fracture due to low energy trauma. Patients were treated in the University Medical Center Goettingen within 3 years. Hyponatremia was defined as serum sodium <135 mmol/L at admission. ResultsOverall, 15.6% of patients in the low energy trauma group had hyponatremia. Among patients older than 80 years, women showed distinctly higher rates of hyponatremia (female: 16.4%; male: 5.9%). In contrast only 4.7% of patients who underwent elective hip arthroplasty showed hyponatremia. Patients on sartanes and aldosterone antagonists showed significantly higher rates of hyponatremia. Alcoholism was significantly associated with hyponatremia. ConclusionsWe confirmed a high prevalence of chronic hyponatremia in patients with fractures due to low energy trauma. Our data underscore chronic hyponatremia as a contributing factor to hip fractures. Women older than 80 have a higher risk of developing hyponatremia. Sartanes, aldosterone antagonists, and alcohol disease are associated with hyponatremia. Treating hyponatremia may decrease the risk of fracture after low energy trauma. Therefore, physicians of different specialties should focus on treatment of chronic hyponatremia to reduce the fracture rate associated with low energy trauma.

FUNCTIONAL OUTCOME OF SUB- TROCHANTRIC FRACTURE TREATED BY LONG PFN

Background: Hip fractures are a growing concern for the orthopedic surgeons all over the world because the incidence of hip fractures is increasing dramatically and these fractures impose a significant challenge in their efficient management.&#x0D; Methods: It was a prospective study on 50 cases of proximal femoral fractures. The fractures were classified according to Seinsheimer classification. Salvati and Wilson Score were used for functional assessment.&#x0D; Results: According to Salvati and Wilson scoring system excellent results were seen in 80% of cases (40 patients), good results in 16% cases (8 patients), fair result in 4% cases (2 patients) and poor results in (0% patients).&#x0D; Conclusions: PFN is safe, effective and patient friendly device useful for the treatment of all subtrochanteric fractures irrespective of their comminution.&#x0D; Keywords: Proximal femoral nail, Subtrochanteric fractures, Proximal femur fracture

Proximal femoral nailing-intra operative complications: A retrospective analysis of 200 cases of proximal femoral fractures

Background: Proximal femoral fractures are common in elderly and with high velocity trauma in younger age groups too. Nailing of proximal femoral fractures is technically demanding procedure which needs experience to tackle the difficulties. Detailed literature regarding the difficulties faced during the procedure is lacking. Methods: Analysis of the intra operative complications faced during closed and open proximal femoral intra-medullary nailing. Conclusions: Technical difficulties arise due to many reasons starting from improper positioning of the patient. With good instrumentation and with experience these problems can be minimized with attention to each surgical step.

Proximal femoral nail- outcome and complications: a prospective study of 125 cases of proximal femoral fractures

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Fractures of the proximal femur are relatively common injuries in adults and common source of morbidity and mortality among the elderly. Fractures of the proximal femur include trochantric and subtrochantric fractures. The present study was designed to evaluate and analyze the role of proximal femoral nail (PFN) in the treatment of proximal femoral fractures.&lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;It was a prospective study on 125 cases of proximal femoral fractures. The fractures were classified according to AO classification. Salvati and Wilson Score were used for functional assessment&lt;/span&gt;.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;In this study at 6 months follow up, union was achieved in 123 cases, open reduction was performed in 11% of cases (14 cases). Technical and mechanical complications were noted in 21% cases (27 cases). Reoperation rate was 4% (Five cases). According to Salvati and Wilson scoring system excellent results were seen in 36% of cases (45 cases), good results in 46% cases (58 cases), fair result in 13% cases (16 cases) and poor results in 5% cases (6 cases)&lt;/span&gt;&lt;span lang="EN-IN"&gt;. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;It is concluded from our study that proximal femoral nailing is an attractive and suitable implant for Proximal Femoral Fractures and its use in unstable intertrochantric fractures is very encouraging&lt;/span&gt;&lt;span lang="EN-IN"&gt;.&lt;/span&gt;&lt;/p&gt;

Clinical efficacy of lengthened proximal femoral nail antirotation versus Gamma nail in treatment of proximal femoral fractures combined with femoral shaft fractures

Objective To investigate the clinical efficacy of lengthened proximal femoral nail antirotation (PFNA) and Gamma nail treatment of proximal femoral fractures (including the intertrochanteric and inferior intertrochanteric area) combined with ipsilateral femoral shaft fractures. Methods A retrospective case control study was made on 68 cases of proximal femoral fractures combined with ipsilateral femoral shaft fractures received from January 2013 to October 2014. According to the operation mode, the patients were assigned to PFNA group (30 cases) and Gamma nail group (38 cases). Between-group differences were compared in aspects of surgical condition, treatment effect, Visual Analogue Scale (VAS), postoperative hip function (Harris score) and living ability (Barthel index). Postoperative complications were recorded as well. Results Duration of follow-up was 12-24 months [(20.8±1.9)months]. Incision length in PFNA group was (5.4±1.2)cm versus (7.3±1.7)cm in Gamma nail group (P 0.05). Conclusion In treatment of proximal femoral fractures combined with ipsilateral femoral shaft fractures, the lengthened PFNA fixation has advantages over Gamma nail in terms of minor trauma, rapid postoperative recovery and significant effect. Key words: Femoral fractures; Fracture fixation, internal; Proximal femoral nail antirotation

MOD-Centaur® stemを用いて手術を行った大腿骨近位部骨折の2例

MOD-Centaur® stemを用いて手術を行った大腿骨近位部骨折の2例

Treatment of Periprosthetic Fractures Around Hip Resurfacings With Cephalomedullary Nails

We describe 2 cases of proximal femoral fractures, 1 intertrochanteric and 1 subtrochanteric, distal to hip resurfacing implants that were managed successfully via internal fixation with trochanteric start point cephalomedullary nails. Both patients had pain-free, well-functioning implants with radiographically healed fractures at their 1-year follow-up. This novel approach offers several advantages over previously described techniques for these rare and difficult-to-treat fractures.

Influence of the timing of surgery on mortality and activity of hip fracture in elderly patients

BackgroundExisting reports describe the decline of the mortality rate by conducting surgery for hip fractures within 24 h; however, the theory is still controversial. We have compared the perioperative mortality rate, improvement of mobility, and duration of hospital stay for early surgery (within 24 h) and delayed surgery (beyond 24 h) between two groups. MethodsWe studied 536 cases of proximal femoral fracture in patients >60 years who were treated between September 2003 and December 2006. There were 91 men and 445 women, who had a total of 257 femoral neck fractures and 279 trochanteric fractures. In all, 270 patients were operated on within 24 h after injury and were defined as the early group; 266 patients were treated surgically more than 24 hours after injury and were defined as the delayed group. Based on admission laboratory tests, co-morbidity, dementia, preoperative mobility, and residential environment before injury, we compared the duration of hospital stay, mobility at discharge, and mortality rates between the early group and the delayed group. ResultsThere was no significant difference in duration of hospital stay between the two groups. improvement of mobility was 52% in the early group and 41% in the delayed group, with the difference being significant (P < 0.05). Inpatient mortality rate was 5.6% in the early group and 2.6% in the delayed group, but the difference was not significant. in the early group, men with co-morbidity, dementia, and abnormal laboratory values upon admission showed a significantly higher mortality rate. ConclusionsEarly surgery was useful for improving mobility, but it showed a higher mortality rate in patients with a compromised somatic condition at the time of the injury. For independent patients with a stabilized somatic condition, surgery should be performed within 24 h. For unstable cases, we believe it is better to provide early surgery after stabilizing the patient’s condition to the greatest possible extent.

Clinical results of inoperable cases of proximal femoral fracture

Clinical results of inoperable cases of proximal femoral fracture

Proximal femoral nail – an analysis of 100 cases of proximal femoral fractures with an average follow up of 1 year

Numerous variations of intramedullary nails have been devised to achieve a stable fixation and early mobilisation of pertrochanteric fracture, among which is the proximal femoral nail (PFN). We report here the results of a prospective study carried out at our institute on 100 consecutive patients who had suffered a pertrochanteric, intertrochanteric or high subtrochanteric fracture, or a combination of fractures, between December 2002 and December 2005 and were subsequently treated with a PFN. Close to anatomical reduction of the fracture fragments was achieved in 12 patients, while limited open reduction was required in 14 patients. During the follow-up period of 1 year complications occurred in 12 patients. Our results indicate the necessity of a careful surgical technique and modifications that are specific to the individual fracture pattern in order to reduce complications. Osteosynthesis with the PFN offers the advantages of high rotational stability of the head-neck fragment, an unreamed implantation technique and the possibility of static or dynamic distal locking.

大腿骨近位部骨折の骨接合術における術前危険度評価システムの検討

The estimation of physiologic ability and surgical stress (E-PASS) scoring system is comprised of a preoperative risk score (PRS), surgical stress score (SSS), and comprehensive risk score (CRS) determined by both the PRS and SSS. E-PASS predicts postsurgical risks by quantification of the patient's reserve and surgical stress, and was previously reported in relation to postoperative complications and the costs of hospital stay in elective gastrointestinal operations.We evaluated the usefulness of this scoring system for 119 consecutive patients who underwent surgery with osteosynthesis for proximal femoral fractures. The postoperative morbidity rates linearly increased as the PRS and CRS increased, and correlated significantly with both the PRS (ρ=0.4, P<0.01)and CRS (ρ=0.4, P=0.02). The costs of hospital stay also related significantly to the PRS (r=0.2, P=0.01) and CRS (r=0.27, P=0.006). These results suggest that E-PASS may be useful for predicting postsurgical risk, estimating medical expenses, and comparing surgical quality for surgical cases of proximal femoral fractures.

Thompson hemiarthroplasty through a trochanteric osteotomy approach

The case histories and radiographs of 100 patients treated with a cemented Thompson prosthesis for displaced subcapital fracture were reviewed. All had been operated on through a lateral approach to the hip joint, combined with trochanteric osteotomy. Twenty patients had an unsound trochanteric reattachment at follow-up; only six were symptomatic. There were no cases of proximal femoral fracture or perforation, and only one dislocation. Infection rate and para-articular ossification did not occur more frequently than in other series.