Complex Proximal Femoral Fractures Research Articles

Role of proximal femur locking plate in management of complex proximal femoral end fractures

Introduction: To study the role of proximal trochanteric contoured plate in management of complex proximal femur end fractures. Materials and Methods: A total of 30 cases 11 male and 19 female patients aged 19 to 90 years [Mean age 42] were included. Time duration of surgery, total amount of blood loss, hospital stay, mobilization and weight bearing, radiological assessment of union, complications and Harris Hip score were assessed at the end of 6 months. Results: Mean duration of surgery was 72.18 mins, average blood loss was 283.75ml, average hospital stay was 13.75 days. Mean time for radiological union was 16.8 wks and Harris hip score was 84.6. Abductor lurch occurred in 4 cases. Conclusion: Proximal Femoral Locking Compression Plate (PFLCP) provides stable fixation for fractures of proximal end of femur especially for lateral wall fracture because it provides stable fixation of lateral fragments and prevents lateral migration of proximal fragments. Keywords: Proximal femur fractures, Proximal femur locking plate, Harris Hip Score. MESH words: Proximal femur fracture, Internal fixation, Extramedullary devices

Functional outcome of proximal femoral nailing for unstable intertrochanteric fracture in elderly

<p class="abstract"><strong>Background:</strong> This study is intended to analyse the functional outcome of proximal femoral nailing (PFN) for unstable intertrochanteric fractures in elderly.</p><p class="abstract"><strong>Methods:</strong> The data was collected from the 35 patients with unstable intertrochanteric femur fracture who were subjected to PFN from 2015 to 2018. All patients were followed up at 3 months and 6 months after the operation to check the functional outcome based on harris hip score (HHS) and complication if any.</p><p class="abstract"><strong>Result:</strong> In 35 patients, 1 patient was lost to follow-up and 34 patients were followed-up at 3 months and 6 months. All patient’s union was achieved at 3 and 6 months follow up. The cause of fractures was trivial fall in all 35 patients. No incidence of non-union and delayed union was reported. Functional outcome was rated as per HHS, we got excellent results in 20 cases, good in 10, fair in 03 and poor in one patient at end of 6 months.</p><p class="abstract"><strong>Conclusions:</strong> PFN provides stable fixation and early post-operative mobilization with fracture union especially complex proximal femoral fractures which includes unstable, communited, reverse oblique fractures and fractures in osteoporotic bones. PFN has shown excellent results in our study.</p>

A CROSS SECTIONAL STUDY OF CLINICO-DEMOGRAPHIC PROFILE OF PATIENTS WITH COMPLEX PROXIMAL FEMORAL FRACTURES

Background: Fractures of femoral bone is very commonly seen in geriatric age group but is also getting common in young population up-to some extent. Such kind of fractures are a result of road traffic accidents or any kind of trauma in young and healthy individuals but in geriatric age group, most of them are due to a trivial fall but aggravated by osteoporosis.
 Aim: To study clinico-demographic profile of patients with complex proximal femoral fractures.
 Material and Methods: In our study, 40 cases with complex proximal femoral fractures with osteoporosis & communition were examined.
 Results: Majority of the cases were in the age group of 41-60 years & 61-80 years i.e., 16 patients each (40% each). Most of the patients were male i.e., 24 (60%) and 16 (40%) were female. The commonest mode of injury was road traffic accidents in 20 patients (50%) followed by fall from height in 14 (35%) patients. Both sides were equally affected.
 Conclusion: The complex proximal femoral fractures were more common in geriatric age and in case of females which could be attributed by underlying osteoporosis which is prevalent more in females.
 Keywords: road traffic accident, geriatric age group, osteoporosis, proximal femoral fracture.

Management of subtrochanteric fractures of femur: A narrative review

Subtrochanteric fractures constitute complex proximal femoral fractures. These fractures are often associated with complications related to fracture union, loss of reduction, and implant failure. Reduction and stable fixation have been implicated as the major predictors for favorable outcomes. This narrative review briefly discusses various aspects of the management of subtrochanteric fractures along with various technical tips, which are helpful in achieving a satisfactory reduction of these fractures.

Comparison of proximal femur locking compression plate and proximal femur nail in treatment of complex proximal femoral fractures

Background: Proximal femur fractures are common injuries that mostly affect the elderly population. In young and healthy individuals, the injury results from high energy trauma, whereas these fractures are common in the elderly persons due to low energy trauma like simple fall. Methods: 20 patients treated by proximal femoral locking compression plate and 20 patients treated by proximal femoral nailing which operated for complex proximal femoral fractures(AO31 A2.3 and A3.3) selected for this prospective study. Results: Average operating time in PF-LCP is 66.05 mins (range 55.72-76.58mins) and in PFN was 49 mins (range 39.46-58.54 mins). Average blood loss in PF-LCP was 361.50ml (range 303.98-419.02ml) and in PFN was 260.00ml (range 204.37-315.63 ml). 8(40.0%) patients treated by PF-LCP had postoperative complications in which 1 had early deep infection, 2 had proximal screw back out, 3 had varus collapse and 2 had shorting >1 cm. 4(20.0%) patients treated by PFN had postoperative complications in which 1 had screw back out 1 had varus collapse and 2 had shortening >1 cm. Radiological union was seen in all 40(100%) cases and Average Harris hip score in patients treated with PFN is 90.0 (range 83.79-96.21)) and in PF-LCP is 81.15(71.56-90.74). Conclusions: The Functional outcome was better for PFN then PF-LCP.

A study of results of long closed proximal femoral nailing in complex proximal femoral fractures

A study of results of long closed proximal femoral nailing in complex proximal femoral fractures

Proximal femur locking compression plate in complex proximal femoral fractures: a retrospective analysis

<p class="abstract"><strong>Background:</strong> Proximal femoral fractures are one of the most common fractures in old age patients. Fixation of these fractures is technically high demanding owing to the high risk of complications. The aim of our study is to analyze the outcomes of proximal femoral locking compression plate (PF-LCP) in these fractures.</p><p class="abstract"><strong>Methods:</strong> We retrospectively analyzed 18 proximal femoral fractures treated with PF-LCP from May 2012 to May 2015. There were 12 females (67%) and six males (33%) with an average age of 59.6 years (range, 32 to 84 years). The peritrochanteric fractures constituted by intertrochanteric and subtrochanteric fractures were classified by Boyd and Griffin classification along with Seinshemier’s classification, respectively. Among that, 14 cases (77%) were of intertrochanteric and four cases (23%) were of subtrochanteric fracture pattern. The functional outcome was evaluated by harris hip score and the parker palmer mobility score one year after surgery.<strong></strong></p><p class="abstract"><strong>Results:</strong> Among 18 patients, 16 patients obtained fracture union without further intervention; two patients required additional bone grafting. There were no cases of hip screw cutting the femoral head. There was no post-operative mortality in our study. The average harris hip score was 85.5 (83-94). The assessment by parker and palmar mobility score was 7.6 (range 4-9).</p><strong>Conclusions:</strong> The PF-LCP is a good stable alternative in the treatment of complex proximal femoral fractures. It provides good to excellent bone healing with limited complications.

Proximal femoral locking compression plate for proximal femoral fractures.

To review short-term outcomes of proximal femoral locking compression plate (PF-LCP) fixation for proximal femoral fractures in terms of postoperative complications and failure rates. Medical records of 21 men and 5 women aged 22 to 85 (mean, 49.7) years who underwent internal fixation with the PF-LCP for proximal femoral fractures were reviewed. Younger patients (mean age, 38.7 years) were more commonly involved in high-energy trauma with multiple musculoskeletal injuries, whereas older patients (mean age, 67.7 years) were more commonly involved in low-energy trauma. Fractures were classified into: multi-fragmentary pertrochanteric fractures (n=13), transtrochanteric fractures (n=6), and subtrochanteric/proximal diaphyseal fractures (n=7). Patients were followed up for a mean of 14.7 months. Seven patients developed complications including loosening of locking screws (n=4), delayed union (n=2), and infection (n=1); 4 of them required additional surgeries. The PF-LCP is appropriate for complex proximal femoral fractures with poor bone quality, revision surgeries, and multi-fragmentary subtrochanteric/proximal diaphyseal fractures. For intertrochanteric fractures, the sliding hip screw system should be used to avoid failure.

Minimally Invasive Management of Unstable Proximal Femoral Extracapsular Fractures using Reverse LISS Femoral Locking Plates

The efficacy of the reverse Less Invasive Plating System in the management of unstable proximal femoral extracapsular fractures was retrospectively evaluated. Twenty-seven patients with complex proximal femoral fractures were identified. There were three open fractures. The mean age was 71 years (range; 65-79). The mean follow up was 24 months (range; 15-32). The main outcome measures were union, union time, requirement for secondary procedures, development of deep infection, pain, and functional impairment. Nonunion was observed in one patient. The average Harris hip score at the last assessment was 73 points (range 58-85). The outcome was adversely affected by concomitant medical problems, anatomical reduction and fixation of the plate. The use of this plate in the management of proximal femoral fractures of all types may be a safe and alternative method to other treatment options.

Complications Of Treatment Of The Subtrochanteric Fractures Of The Femur By Russell-Taylor Reconstruction Nail

Thirty cases of closed subtrochantric fractures were treated in adults by Russell –Taylor Reconstruction nail between March 2004 and September 2005. Complications of this modality of treatment are described. Complications were divided intointraoperative and postoperative complications. Difficulty in the placement of proximal locking screw was the most common complication in the first group followed by difficulty in close reduction of the fracture. Amongst the postoperative complication proximal thigh pain and limb length discrepancy were the main complications. None of these complications, however, contributed adversely to the final outcome of results. The findings of this study revealed that Russell-Taylor Reconstruction nail is the preferred treatment for complex proximal femoral fractures and complications associated are minor and do not significantly contribute towards the final outcome. Moreover these complications decline as the learning curve progresses.

Outcomes of modular proximal femoral replacement in the treatment of complex proximal femoral fractures: A case series

Background The treatment of complex femur fractures poses a significant challenge. Even with current advancements and the various implements available for the fixation of femoral fractures, results are often disappointing. This study sought to identify problems associated with and examine results of modular proximal femoral replacement. Outcomes were evaluated in two groups of patients: those receiving primary modular proximal femoral replacement for fractures and those treated with salvage arthroplasty for failed internal fixation. Methods Twelve patients who had received modular proximal femoral replacement as primary treatment for proximal femoral fractures were evaluated along with nine patients treated with salvage proximal femoral replacement for failed internal fixation. After the surgical procedure, patients were evaluated at regular follow-up intervals and contacted by phone at the conclusion of this study. Patient functional results were evaluated using the Merle D'Aubigne hip rating scale, which measures pain, motion and ambulatory status. Routine radiographs were also obtained at each patient visit. Results On average, patients who received modular proximal femoral replacement as the primary surgery for their femoral fractures enjoyed a high-level functional result and had few complications. Subjects who received salvage femoral replacement had a less optimal outcome and experienced more complications. Nonetheless, final post-operative MDA score was significantly increased from pre-operative levels. Conclusion Modular proximal femoral replacement is a viable option in the primary fracture or revision setting, and has been shown to have a reasonable outcome, especially when the nature of initial injury is taken into account.

Complex proximal femoral fractures in the elderly managed by reconstruction nailing – complications & outcomes: a retrospective analysis

BackgroundUnstable proximal femoral fractures and pathological lesions involving the trochanteric region in the elderly comprise an increasing workload for the trauma surgeon as the ageing population increases. This study aims to evaluate use of the Russell-Taylor reconstruction nail (RTRN) in this group with regard to mortality risk, complication rates and final outcome.MethodsRetrospective evaluation of 42 patients aged over 60 years who were treated by reconstruction nailing for proximal femoral fractures over a 4 year period.ResultsOver two-thirds of patients were high anaesthetic risk (ASA > 3) with ischemic heart disease the most common co-morbidity. 4 patients died within 30 days of surgery and 4 patients required further surgery for implant related failure. Majority of patients failed to regain their pre-injury mobility status and fewer than half the patients returned to their original domestic residence.ConclusionFavourable fixation of unstable complex femoral fractures in the elderly population can be achieved with the Russell-Taylor reconstruction nail. However, use of this device in this frail population was associated with a high implant complication and mortality rate that undoubtedly reflected the severity of the injury sustained, co-morbidity within the group and the stress of a major surgical procedure.

Intramedullary osteosynthesis of complex proximal femoral fractures with the Targon PF nail

We evaluated the performance of the Targon PF nailing system in the treatment of complex proximal femoral fractures with a retrospective analysis of prospectively collected data for 94 patients with a complex proximal femoral fracture (subtrochanteric fracture or fracture with reversed fracture line pattern) treated with a Targon PF nail. There were no intra-operative femoral fractures. Late complications requiring reoperation were one femoral fracture and one fracture around the nail secondary to tumour. Seven nails had to be dynamised and a further six 'self-dynamised' at the site of the distal locking screw. One patient required revision of the distal locking. Only one other patient required secondary surgery for a wound haematoma. There were no cases of implant cut-out or non-union. The Targon PF nail represents a progressive development in the design of intramedullary nails for proximal femoral fractures and the results compare favourably with other intramedullary systems used to treat complex proximal femoral fractures.

Complications after Intramedullary Stabilization of Proximal Femur Fractures: a Retrospective Analysis of 178 Patients.

Secondary dislocation, non-union, re-fracture and implant failure are generally known complications after intramedullary fixation of proximal femur fractures with the PFN(®) (Synthes GmbH, Solothurn, Switzerland). The goal of our study was to assess the impact of patient- and treatment-specific risk factors on these complications. Complex fracture type and poor bone quality were defined as patient-specific risk factors. Inadequate fracture reduction and implant position were defined as treatment-specific risk factors. One hundred and seventy-eight cases were retrospectively analyzed. All patients had at least one clinical and radiological follow-up examination 3-6 months after the operation. Fifty percent of the patients were available for one more follow-up at least 1 year after the operation. All patients without patient-specific risk factors had a good outcome, irrespective of whether treatmentspecific risk factors were present or absent. In 153 of the 178 cases, patients had a complex type of fracture and/or poor bone quality. Of these patients, 27 (15.2%) had a poor result. Twenty-four of these patients needed re-operation within 6 months. Complication rate in these patients highly depended on treatment-specific risk factors. We conclude that the PFN is a secure implant for the stabilization of simple cases. Stabilization of complex proximal femoral fractures with the PFN, however, has a relevant complication rate and should therefore be considered a challenge.

The less invasive stabilization system in treatment of complex proximal femoral fractures

目的 探讨微创内固定系统(LISS)治疗复杂股骨转子部骨折的可行性、手术技术及指征,并总结其近期临床治疗效果.方法 自2005年6月～2006年5月,应用LISS治疗复杂股骨转子部骨折12例.骨折采用AO分类法,其中转子间骨折5例:31-A2.2型2例,31-A2.3型2例,31-A3.3型1例;转子下骨折7例:32-A3.1型1例,32-B1.1型3例,32-B2.1型1例,32-B3.1型2例.记录手术时间、术中出血量、术后住院时间,术后观察有无感染、下肢深静脉血栓、心肺疾患、应激性溃疡等并发症.术后1、2、3、6、12个月时常规随访.结果 手术时间50～90 min,平均65 min;出血量50～400 mL,平均142 mL,术后住院时间6～15 d,平均9.3 d.无死亡病例,所有患者均未出现切口感染、下肢深静脉血栓、术后心肺疾患、应激性溃疡等并发症.12例均获得3～14个月(平均7.2个月)随访.10例在术后3个月复查骨折时达到临床愈合,1例假体周围骨折术后4个月、1例病理性骨折术后6个月达到临床愈合.所有患者在最后一次随访时均无骨折再移位、髋内翻畸形、内固定切出、内固定失败及股骨头坏死.结论 微创反向使用股骨LISS从生物力学和解剖结构上都能满足股骨近端骨折内固定要求,并具有创伤小、操作简便、固定可靠、安全性高、并发症少的特点,尤其适用于老年人合并内科疾病、骨质疏松较重的转子间骨折及复杂的股骨近端骨折.熟练掌握间接复位技术,正确放置A孔导针,避免过早负重是手术成功的关键。

The use of the long gamma nail in proximal femoral fractures

The results of 100 'Long Gamma Nails' (LGN) inserted in 97 patients, for the treatment of complex proximal femoral fractures and pathological lesions, are reported. The mean patient age was 74 (16-98). Seven significant complications occurred; four lag screws cut out, one broken nail, one infected non-union and one peri-prosthetic fracture. Five patients underwent revision either to total hip arthroplasty or exchange nailing. Seventy patients had follow-up of greater than 2 months (mean 10.8 months). Success was defined as stability of the fracture until union or death; this was achieved in 85% of cases. The mortality was 10% at 30 days and 25% at 1 year. The complication rate fell with increasing experience. Complex proximal femoral fractures are difficult to treat with all implants demonstrating high complication rates. The long gamma nail allowed early weight bearing and was effective in 85% of cases. Malpositioning of the implant should be avoided, as this was the leading cause of failure. Surgeon experience is an important factor but training of surgeons does not adversely affect outcome.

Role of Russell - Taylor delta reconstruction nail in the management of complex proximal femoral fractures

Background: Complex proximal femoral fractures are challenging problem. Methods: Forty-one patients had Russell- Taylor Delta reconstruction nailing done during the period from March 1992 to December 1996. 38 patients could be followed both clinically and radiologically either up to the fracture union or death. Clinical outcome was assessed by Kyle's criteria. Out of 13 patients with high-energy comminuted fractures, 12 were rated excellent or good. There was one death due to poly trauma. Results: Out of six elderly subtrochanteric fractures, 4 had excellent or good results. There was one poor result and one death. Out of 11 elderly interochanteric fractures with subtrochanteric extension, 8 had excellent or good results. There was 1 fair, 1 poor result and 1 death. In the elderly groups, the poor results were due to poor pre- existing medical conditions of the patients. In all the seven cases of pathological lesions, excellent or good results were achieved either till fracture union or death because of their malignant pathology. Conclusion: Russell- Taylor Delta reconstruction nail is a very useful device in high-energy comminuted proximal femoral fractures, in elderly low energy proximal femoral fractures and also in pathological lesions. The implant provides bio-mechanically stable fixation. The relatively high complication rate in elderly patients is because of their poor medical condition. In cases of pathological lesions, it is always preferable to fix the bone at the stage of impending fracture.

Results of the long Gamma nail for complex proximal femoral fractures

The results for a series of 35 patients with complex proximal femoral fractures treated with the long Gamma nail are presented. Fracture healing occurred in all surviving patients, but there were four technical problems associated with the implant. Two nails broke associated with delayed union of the fracture necessitating revision of the implant, one fracture of femur at the site of distal locking occurred during surgery and there was one later fracture at the tip of the nail. All but one failures of fixation were revised with another Gamma nail and healed uneventfully. Overall the number of fracture healing complications compares favourably to contemporary implants and improvements in the design and strength of the nail may further improve results.

Modified Transverse Locking Nail Fixation of Proximal Femoral Fractures

It was hypothesized that transverse locking screws of intramedullary nails, seated above the lesser trochanter, provide equal strength to that of reconstruction nails, and that screws placed through the medial cortex of the femoral neck do not have adverse biomechanical effects during physiologic loading. Synthetic femurs (n = 10) and paired anatomic specimen femurs (n = 14) were tested intact and with an intramedullary device in place. Intact specimens were loaded nondestructively, then a segmental subtrochanteric defect was created and either a high seated transverse locking nail or a reconstruction nail was inserted and statistically locked. Axial and torsional stiffness were determined followed by axial failure testing. Mechanical parameters evaluated were stiffness, displacement, and energy. The implanted specimens did not show any statistically significant difference between transverse or reconstruction screw constructs with any of the measured parameters (stiffness, displacement, and energy). Failure tests in implanted specimens also did not show any statistically significant difference in yield load, yield displacement, or energy to failure between implant constructs. All anatomic specimens failed, with fractures of the proximal fragment involving medial and lateral cortices. Synthetic specimens did not fracture but showed failure with implant deformation at the level of the skeletal defect. The use of high seated transverse locking nails for complex proximal femoral fractures is a viable option and has comparable in vitro mechanical performance with reconstruction nails. Although not shown to be a problem in the present study, clinical evaluation of screws through the medial femoral neck cortex is required.

The results of reconstruction femoral nailing for complex proximal femoral fractures and metastatic deposits

The results of reconstruction femoral nailing for complex proximal femoral fractures and metastatic deposits