Extracapsular Proximal Femoral Fractures Research Articles

Full Reversal of Anticoagulants Prior to Cephalomedullary Fixation of Geriatric Hip Fractures May Not Be Necessary.

To examine the relationship between anticoagulant and antiplatelet drugs and surgical blood loss for geriatric patients undergoing cephalomedullary nail fixation of extracapsular proximal femur fractures. Multicenter retrospective cohort study using bivariate and multivariable regression analyses. Two level-1 trauma centers. 1442 geriatric (ages 60-105) patients undergoing isolated primary intramedullary fixation of non-pathologic extracapsular hip fractures from 2009 - 2018 including 657 taking an antiplatelet drug alone (including aspirin), 99 taking warfarin alone, 37 taking a direct oral anticoagulant (DOAC) alone, 59 taking an antiplatelet drug and an anticoagulant, and 590 taking neither. Cephalomedullary nail fixation. Blood transfusion and calculated blood loss. More patients taking antiplatelet drugs required a transfusion than controls (43% versus 33%, p < 0.001) whereas patients taking warfarin or DOACs did not (35% or 32% versus 33%). Median calculated blood loss was increased in patients taking antiplatelet drugs (1275 mL versus 1059 mL, p < 0.001) but not in patients taking warfarin or DOACs (913 mL or 859 mL versus 1059 mL). Antiplatelet drugs were independently associated with an odds ratio of transfusion of 1.45 (95% CI 1.1 - 1.9) in contrast with 0.76 (95% CI 0.5 - 1.2) for warfarin and 0.67 (95% CI 0.3 - 1.4) for DOACs. Geriatric patients taking warfarin (incompletely reversed) or DOACs lose less blood during cephalomedullary nail fixation of hip fractures than those taking aspirin. Delaying surgery to mitigate anticoagulant-related surgical blood loss may be unwarranted. Therapeutic level III. See Instructions for Authors for a complete description of levels of evidence.

Complications of standard versus long cephalomedullary nails in the treatment of unstable extracapsular proximal femoral fractures: A randomized controlled trial

AimsTo compare in a prospective randomized trial the mechanical complications in patients with unstable extracapsular proximal femur fractures without subtrochanteric extension (AO/OTA 31-A2 and 31-A3) MethodsWe prospectively studied 182 patients with unstable extracapsular proximal femur fractures without fractures lines extending more than 3 cm below the lesser trochanter, randomized to receive either a ‘standard’ (240 mm) nail or a long nail and followed them up for 1 year. ResultsWe found no difference in the incidence of mechanical or general complications between the two groups, no cut-outs, no fractures of the tip the implant, 1 cut-through and 2 malrotations in the LN group, 2 non-unions that were reoperated, one on each group. The commonest complication was blade lateral migration, 13 (14%) patients in SN and 6 (9%) in the LN. The operating time was shorter in the SN group 51 minutes compared to 67 minutes in the LN group (p=0.000075). The mortality at 1,3 and 12 months in the SN group was of 2%, 6%, 12% while in the LN group was 12%, 18% and 22%. These differences where significative at 1 (p=0.007) and 3 months (p=0.013), but not at 12 months (p=0.075). ConclusionsWe recommend the use of standard nails (240 mm) for this group of fractures, since it does not produce more mechanical complications, and it is faster, cheaper and easier to interlock distally.

General health and functional improvement among patients with unstable extracapsular proximal femoral fractures managed with proximal femoral nail by using SF-36 score

&lt;p&gt;&lt;strong&gt;Background&lt;/strong&gt;: Proximal femoral nail is emerging as the treatment of choice for unstable extra capsular proximal femoral fractures. This study comprises of functional evaluation of the treated patients by using SF 36 score.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods&lt;/strong&gt;: This was a prospective hospital-based study done on 54 patients with unstable proximal femoral fractures classified according to the AO/ASIF classification system and were treated by using PFN in the department of Orthopaedics DRPGMC, Tanda. Functional outcome was assessed by using SF-36 score on, 14th postoperative day, at three months and six months.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results&lt;/strong&gt;: Our study has mean scores of short form-36 subscales as physical function 70.6, role limitation due to physical health 68.1, role limitation due to emotional health 90, energy/fatigue 66, emotional wellbeing 78, social functioning 67.7, pain 75 and general health 73.3.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions&lt;/strong&gt;: The results of this study confirm that intramedullary nailing with the use of a PFN in unstable proximal femoral fractures is a safe method. A significant change was seen in quality of life postoperatively as evidenced by various scores used in present study. Weaknesses of this study include a short follow-up period and the inclusion of a small study group.&lt;/p&gt;

USE OF PROXIMAL FEMORAL NAIL IN PATIENTS WITH UNSTABLE EXTRACAPSULAR PROXIMAL FEMORAL FRACTURES: A CLINICAL OUTCOME STUDY

Introduction: Unstable trochanteric and subtrochanteric fractures are biomechanically unfavorable fractures and often associated with complications such as cut-out, excessive sliding or varus.The reoperation rate is approximately 10%. The forces that tend to displace the fracture must be neutralized by the implant. The proximal femoral nail is an intramedullary implant and associated with less blood loss and lower infection rate,and allows direct full weight bearing because of its favorable biomechanical properties. In the present study we have observed the functional outcome in unstable extra capsular proximal femoral fractures managed by proximal femoral nail using by ICF (International Classification of Functioning, Disability and Health) questionnaire. Material &amp; Method: It was a clinical outcome observation study carried out in eighty patients of unstable extracapsular proximal femoral fractures presented in the department of Orthopaedics DR. RPGMCH, Tanda over a period of one year from 1st April 2013 to 31st March 2014. Patients were assessed functionally by ICF (International Classification of Functioning, Disability and Health) questionnaire on one and half month, three month and sixth month of surgery. Results: There was female preponderance with female/male ratio being 46/34. Postoperative health assessment was done by using ICF method where we did the assessment of general, mental and emotional health. After 6 months of the surgery, a total of 66.6% patients rated their health as good to very good and 79 patients had mild to moderate impairment because of pain. In terms of functional assessment,sixty eight percent (68.52%) patients had no to mild impairment in the performance and the capacity and 31.48% patients had moderate impairment in performance and capacity for washing oneself.None of the patients observed with severe to very severe limitation after the surgery.Seventy percent (70.0%) patients had mild to moderate impairment in the performance and the capacity and 29.37% patients had severe impairment in performance and capacity for toileting and dressing. Conclusion: It is concluded that a significant change was seen in quality of life of patients postoperatively as evidenced by ICF questionnaire used in present study.

A prospective study to evaluate the clinical and functional outcomes in the management of unstable extracapsular proximal femoral fractures using proximal femoral nail with a helical blade construct (PFNA-II) at a tertiary care hospital

Background: Extracapsular proximal femoral fractures are one of the most common fractures of the hip especially in the elderly with osteoporotic bones, usually due to trivial trauma. Presently, unstable extracapsular proximal femoral fractures are treated commonly with intramedullary nailing devices. Various designs of intramedullary nail are introduced. The conventional design has given diverse outcome and complications have also been noted with this implant. Newer designs like Proximal Femoral Nail Antirotation-II have been introduced for Asian population. There is paucity of the prospective studies on the effectiveness of PFNA-II system. Most have been retrospective studies and there are not much evidences regarding the postoperative complications in a long term. So a prospective study is needed to evaluate the effectiveness and long term problems if any with PFNA-II system and to modify the design further if required.Aim and Objectives: To evaluate the clinical and functional outcomes in the management of unstable extracapsular proximal femoral fractures using proximal femoral nail with a helical blade construct (PFNA-II) at a tertiary care hospital.Materials and Methods: A prospective study was undertaken in a Tertiary Hospital from April 2018 to April 2019, 30 patients (age >18 yrs) with extracapsular proximal femoral fracture i.e.AO type 31-A2 and type 31-A3 operated with PFNA-II. The patients were followed up at 6th week, 12th week and 6 months from the date of surgery. Clinical and Functional assessment was done using Harris Hip Score during follow up. X-ray was done at 12 weeks to assess the fracture healing, position of the implant and any complication. Data collected of these 30 patients were statistically analysed using SPSS (Statistical Package for the Social Sciences) version 16.0, IBM Corporation; NY, USA for MS Windows.Results: The mean post-op (3 Months and 6 Months) Harris Hip score is significantly higher compared to the mean post-op (6 Weeks) Harris Hip Score (P-value

A prospective study of management of inter-trochanteric fractures of femur by modified intramedullary implant

Background: The best surgical strategy for extra-capsular proximal femoral fractures (PFFs) is controversial in the elderly. Poor bone quality and neck screw instability can adversely affect the results with currently available fixation devices, which predominantly consist in dynamic hip screw-plates and proximal reconstruction nails. Hypothesis: The lag screw of the modified intramedullary implant achieves better cancellous bone compaction in the femoral neck, thereby decreasing the risk of secondary displacement. Materials and Methods: We studied consecutive cases of modified intramedullary implant fixation performed between 2019 and 2021 in 20 patients (8 females and 12 males) with a mean age of 71.3 ± 9.02 years. All patients were operated on under hypotensive spinal-epidural anaesthesia in a supine position on a traction table. Patients were evaluated at pre-op and post-op follow-up periods with serial radiography and clinically by Harris Hip score (HHP) for pain and disability scoring. Results: Mean follow-up in the 20 patients was 12.3 ± 7.5 months (4–20 months). Fracture union was consistently achieved, after a mean of 12.25 ± 1.67 weeks. After the last follow-up, the mean Harris hip score was 86.8 ± 7.3 (range, 65–100); the score was excellent in 11 patients (55%), good in 5 (25%), fair in 2 (10%), and poor in 1 (5%). Conclusion: Modified intramedullary implant has the advantages of a simple operation, few complications, and clinical efficacy for the treatment of intertrochanteric fractures. However, evaluation of its long-term efficacy and risk of other complications requires a large-sample, multicenter observational study.

Outcome Analysis of Dual Implant Osteosynthesis for Ipsilateral Proximal and Shaft Femur Fractures: Do We Need Cephalomedullary Nails?

IntroductionMost surgeons prefer a single implant for segmental proximal and diaphyseal femur fractures, although results are controversial and still no consensus for proper management is present. This prospective study analyses the functional and radiological outcome of managing 17 patients with ipsilateral shaft and proximal femur fractures by dual implant osteosynthesis at our center.MethodsOver a two-year period, we managed 17 patients with a mean age of 35 years, with cancellous cannulated screws or dynamic hip screws for intracapsular femur fractures and improvised proximal femoral nail for extracapsular proximal femur fractures. Distal femoral locking plates or distal femoral nails were used for shaft femur fractures depending upon fracture morphology. The patients had a maximum follow-up of 18 months.ResultsA total of 80% of patients had a good functional outcome (using the Friedman-Wyman scoring system) while 60% had an excellent Harris Hip Score. The mean time taken for the bone union for proximal femur fractures was 4.75 months and for shaft femur fractures, it was 6 months.ConclusionWe had a satisfactory functional and clinical outcome of managing these fractures with two implants, one focusing biomechanically on each fracture. This principle of dual implant osteosynthesis can reliably be used in such difficult fracture patterns and it negates the use of the single cephalomedullary nail for fixating both fractures.

Fixation and Implant Retention of Extracapsular Femoral Neck Periprosthetic Fractures Around Hip Resurfacing Arthroplasty - A Case Series.

Background:Extracapsular femoral neck fractures in the presence of a resurfacing hip arthroplasty (RHA) appear to be independent of suboptimal technique during the initial implantation of the RHA and present with a similar etiology as native hip fractures – that is, a fragility fracture related to pathological or age-related osteoporosis, as a consequence of trauma. In the presence of a well-fixed and previously well-functioning RHA, the options for management include revision arthroplasty or open reduction and internal fixation (ORIF). In the absence of loosening through mechanisms of wear, infection, metallosis, or suboptimal prosthesis positioning, many authors have advocated ORIF with implant retention. However, there is often debate regarding the use of total hip arthroplasty in these casesCase Series:The authors conducted a thorough assessment of the literature followed by a retrospective review of outcomes for three patients treated by ORIF with implant retention for extracapsular femoral neck fractures around a RHA, using a standardized technique. All patients were independently mobile and active with well-fixed and well-functioning RHAs before the date of injury. All patients suffered low-energy trauma resulting in the fracture. There were no intraoperative or perioperative complications. All patients achieved full weight-bearing status and independent mobility. Two patients achieved radiographic union and returned to full range of movement and independent mobilization comparable to their preoperative state. One patient was lost to follow-up.Conclusion:The authors believe that fixation of extracapsular proximal femoral fractures distal to a well-fixed, well-functioning RHA is a good management option in an independent and active patient. A higher level of evidence is needed to investigate the surgical management options of these injuries comparing osteosynthesis with revision arthroplasty.

A prospective study to evaluate the complications in extracapsular proximal femur fractures treated with proximal femoral nail in a tertiary care centre, south India

Background: Fractures of the proximal femur of the hip are relatively common injuries in adults. Several epidemiological studies show that the incidence of fractures of the proximal femur is increasing. Dissatisfaction with use of a sliding hip screw in unstable fracture patterns led to the development of intramedullary hip screw devices. This design offers potential advantages like more efficient load transfer, decrease tensile strength on the implant, controlled fracture impaction, reduces amount of sliding and therefore limits limb shortening and deformity.Objectives: study to evaluate the complications related to proximal femur fractures treated with Proximal Femur Nail.Methods: This is a prospective study of 30 cases of fresh intertrochanteric and subtrochantric fractures admitted to a tertiary care center. Cases were taken according to inclusion and exclusion criteria. Results were evaluated by fracture union on X ray and descriptive statistics were used to analyze the data.Results: In our series of 30 cases there were 23 males and 7 females, most of the patients were between 41 to 60 years. Mean age of 57.7 years, of cases were admitted due to slip and fall and with predominance of right side. A total of 11 (36.7%) cases had intraoperative complications. Around 6.6% had superficial wound infection as immediate postoperative complication. A total of 7 (23.3%) had delayed complications (delayed union, varus malunion, shortening of more than 1cm, knee joint stiffness).Conclusion: From this study, we consider that Proximal Femoral Nail as a reliable implant for the treatment of intertrochanteric and subtrochantric fractures. This implant found to have minimal intraoperative complications, immediate post-operative complications and delayed complications in intertrochanteric and subtrochantric fractures. PFN remains the implant of choice in the management of extracapsular proximal femur fractures

Key factors influencing clinical and functional outcomes in extracapsular proximal femur fractures: the role of early weight-bearing - one-year follow-up cohort of 495 patients.

Aim To establish a correlation between immediate post-surgical weight bearing in extracapsular hip fractures and final functional outcome as well as to study the correlation between immediate post-surgical weight bearing and morbidity and mortality during the first year. Methods Retrospective observational cohort study including 495 consecutive patients ≥75 years old operated of extracapsular proximal femur fracture. Medical records were reviewed and information of demographic data, radiological evolution, time to weight-bearing, mortality rate, medical and surgical complications and final ambulation status were recorded. Results Patients' mean age was 87 years; 378 (76.4%) were females. One-year mortality rate was 21.2%. Immediate weight bearing was associated with: decreased hospital stays (7.5 days vs. 9.2 days; p=0.001) and decreased medical complications (78.3% vs. 82.3 %; p=0.02). Surgical complications prevalence was comparable (4.4% vs. 7.8 %; p=0.43) within the groups. Despite mortality rate was lower in patients with immediate weight bearing (21%) compared with delayed weight bearing (21.4%), the difference was not statistically significant (p=0.9). Conclusion Immediate weight bearing was associated with shorter hospital stay and fewer medical complications, improving functional outcome. Also, no correlation was found between immediate weight bearing and increased surgical complications or mortality rate during first year after surgery.

Evaluation of functional outcome in Extracapsular proximal femur fractures treated with proximal femoral nail in a tertiary care centre, South India

Background: Fractures of the proximal femur of the hip are relatively common injuries in adults. Several epidemiological studies show that the incidence of fractures of the proximal femur is increasing. Dissatisfaction with use of a sliding hip screw in unstable fracture patterns led to the development of intramedullary hip screw devices. This design offers potential advantages like more efficient load transfer, decrease tensile strength on the implant, controlled fracture impaction, reduces amount of sliding and therefore limits limb shortening and deformity. Objectives: assess the clinical and functional outcome post operatively and during follow ups in proximal femur fractures by using Proximal Femur Nail. Methods: This is a prospective study of 30 cases of fresh intertrochanteric and subtrochantric fractures admitted to a tertiary care center. Cases were taken according to inclusion and exclusion criteria. Results were evaluated by fracture union on X ray and Harris hip score and descriptive statistics were used to analyze the data. Results: In our series of 30 cases there were 23 males and 7 females, most of the patients were between 41 to 60 years. Mean age of 57.7 years, of cases were admitted due to slip and fall and with predominance of right side. About 50% showed excellent and 50% showed good functional outcome in intertrochanteric and intertrochanteric fractures respectively as per Harris Hip scoring system (Modified). Conclusion: From this study, we consider that Proximal Femoral Nail as a reliable implant for the treatment of intertrochanteric and subtrochantric fractures. This implant also gives very good functional outcome in intertrochanteric and subtrochantric fractures.

Outcomes of Cephalomedullary Nailing in The Treatment of Extracapsular Proximal Femur Fractures and Factors Affecting it

Indroduction: Cephalomedullary nailing (CMN) has become popular in treatment of extracapsular proximal femur fractures due to its mechanical advantages. This study aims to analyse the functional outcomes of the same and factors affecting it. Material and Methods: 140 prospective cases of extracapsular proximal femur fractures were treated with CMN between October 2016 and October 2017 with a minimum follow-up period of 12 months. Patients were clinically assessed with range of motion, weight bearing status, Harris hip score (HHS) and Short form (SF)-36 score. Radiologically, fracture reduction, change in neck shaft angle (NSA) and neck length ratio in comparison to unaffected hip. Results: 140 patients, 52 had excellent while 88 had good HHS. Patient in age group 20-40 had an average HHS of 87.79, 40-60 age group had an average HHS of 87.41, while patients in age group &gt; 60 years had an average HHS of 87.63. Patients achieved average full weight bearing at 9.94 ± 2.76 weeks (p-value 0.578). Change in the neck shaft angle (NSA) was statistically significant in the immediate post-operative and at 1-year radiographs (p-value &lt;0.001). Comparison of neck length ratio between affected and unaffected hip showed no statistical difference. There was no significant difference in function, range of motion and HHS in males (88.51 ± 2.72) compared with females (87.61 ± 2.98) (p-value 0.082). There was no significant association between occurrence of limp with change in NSA and neck length ratio (all p values &gt;0.05). 6 complications occurred (1 peri-implant fracture, 2 surgical site infections and 3 cases of helical blade migration). Conclusion: CMN gives excellent functional outcomes in all AO types A1, A2, A3 irrespective of age and sex with early mobilisation, full weight bearing and better functional range of movement. Limp occurred independant of change in NSA and neck length ratio. Keywords: Extracapsular proximal femur fractures; Cephalomedullary nailing; Unstable intertrochanteric fractures; Reverse oblique fractures..

Short term results of modular bipolar hemiarthroplasty for the treatment of neglected trochanteric femur fracture in the elderly

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; In rural India because of native practitioner culture people tend to neglect orthopaedic injuries and often present late to the hospitals. Bipolar hemiarthroplasty for neglected intertrochanteric fractures of the femur in the elderly yields good clinical results in terms of early postoperative ambulation. This will have a direct effect on the general condition and postoperative rehabilitation.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Sixteen patients with proximal extracapsular femoral fractures presented average 10.4 weeks late from the day of injury, were treated with modular bipolar hemiarthroplasty. There were 11 men and 5 women, with mean age of 72.8 years (range: 65–83 years). Primary cemented bipolar hemiarthroplasty was performed using the Hardinge lateral approach in a lateral decubitus position. Harris hip score was used for the clinical evaluation of the patients.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Clinically, the Harris hip score at the last follow-up ranged from 92 to 59, with a mean value of 81.7. Postoperative radiographs showed a good position in all patients. 1 patient developed complication during cementing and 1 case came with dislocation. No case of infection, acetabular erosion, periprostheic fracture or implant loosening was reported in this study.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Primary cemented bipolar hemiarthroplasty is a good choice in elderly patients with neglected intertrochanteric fractures of the femur.&lt;/p&gt;

Comparison of levobupivacaine and bupivacaine in fascia iliaca compartment block (FICB) for postoperative pain management in surgeries for fractures of neck of femur

Background and aims: Hip fractures are painful and usually affects elderly patients. If left untreated or under-treated, post-operative pain may increase the length of hospital stay and delayed ambulation. The use of peripheral nerve blocks in this population can significantly reduce the associated mortality and morbidity, without the side effects of systemic analgesics. We conducted this study to compare the use of levobupivacaine with bupivacaine in fascia iliaca compartment block (FICB) for postoperative pain management in surgeries for fractures of neck of femurMethodology: This prospective, randomised, double blind study was carried out after approval from the ethical committee and obtaining written informed consent. We enrolled 45 patients undergoing surgery under spinal anesthesia for extracapsular fractures of proximal femur and divided into 3 groups (15 each). Group L: received FICB with 30 ml of levobupivacaine 0.25% (75 mg). Group B: received FICB with 30 ml of bupivacaine 0.25% (75 mg). Group T: no block given. After 30 min patients were shifted to operating room and administered spinal anesthesia in sitting position. Primary outcome was total analgesic consumption in 24 h. Secondary outcomes- patient comfort during positioning for spinal, sensory onset time, postoperative VAS, and time to first analgesic request were registeredResults: Cumulative analgesic consumption was significantly lower in Groups L (93.33 ± 59.362 mg) and B (126.67 ± 45.774 mg) as compared to Group T (273.33 ± 79.881 mg); no significant difference was found between Groups L and B. The time to first analgesicrequest in Group L was 877.33 ± 355.673 min, Group B was 845.33 ± 379.997 min and Group T was 202.67 ± 142.351 min. Patient comfort on positioning was lowest in Group T.Conclusion: Administration of FICB in patients undergoing surgery for fractures of proximal femur led to a significant reduction in postoperative pain as compared to systemic analgesics alone. The use of equal concentration of levobupivacaine as compared to bupivacaine provided no added advantage.Background and aims: Hip fractures are painful and usually affects elderly patients. If left untreated or under-treated, post-operative pain may increase the length of hospital stay and delayed ambulation. The use of peripheral nerve blocks in this population can significantly reduce the associated mortality and morbidity, without the side effects of systemic analgesics. We conducted this study to compare the use of levobupivacaine with bupivacaine in fascia iliaca compartment block (FICB) for postoperative pain management in surgeries for fractures of neck of femurMethodology: This prospective, randomised, double blind study was carried out after approval from the ethical committee and obtaining written informed consent. We enrolled 45 patients undergoing surgery under spinal anesthesia for extracapsular fractures of proximal femur and divided into 3 groups (15 each). Group L: received FICB with 30 ml of levobupivacaine 0.25% (75 mg). Group B: received FICB with 30 ml of bupivacaine 0.25% (75 mg). Group T: no block given. After 30 min patients were shifted to operating room and administered spinal anesthesia in sitting position. Primary outcome was total analgesic consumption in 24 h. Secondary outcomes- patient comfort during positioning for spinal, sensory onset time, postoperative VAS, and time to first analgesic request were registeredResults: Cumulative analgesic consumption was significantly lower in Groups L (93.33 ± 59.362 mg) and B (126.67 ± 45.774 mg) as compared to Group T (273.33 ± 79.881 mg); no significant difference was found between Groups L and B. The time to first analgesic request in Group L was 877.33 ± 355.673 min, Group B was 845.33 ± 379.997 min and Group T was 202.67 ± 142.351 min. Patient comfort on positioning was lowest in Group T.Conclusion: Administration of FICB in patients undergoing surgery for fractures of proximal femur led to a significant reduction in postoperative pain as compared to systemic analgesics alone. The use of equal concentration of levobupivacaine as compared to bupivacaine provided no added advantage.Citation: Raiger LK, Gehlot RK, Bedi V, Betkeker SA. Comparison of levobupivacaine and bupivacaine in fascia iliaca compartment block (FICB) for postoperative pain management in surgeries for fractures of neck of femur. Anaesth pain &amp; intensive care 2019;23(3):284-289

Role of proximal femoral nail anti-rotation in extracapsular proximal femoral fractures

Background: Peritrochanteric fractures are devastating injuries involving young and adult population and needs surgical fixation. But there are many complications related to fixation devices & quality of bone. In view of this surgical management of peritrochanteric fractures by other better device is taken up. Material & Method: Twenty five patients with peritrochanteric fracture were included as per inclusion & exclusion criteria. Radiographic & functional outcomes of PFNA II along with its intra & post- operative complications is evaluated. Result: Out of 25 cases there were 13 males and 12 females with age ranging from 22- 95 yrs. Mean duration of hospital stay, operative time & blood loss was 6.28±3.4 days, 54.60±11.71 min & 102.80±15.41 ml respectively. Radiologically ideal implant position in 88% cases & good/ acceptable reduction in 92 % patients was achieved. Good to excellent functional results of operated hip were seen in 62 % cases of peritrochanteric fractures. Intraoperative complications like fracture of lateral cortex & greater trochanter along with fixation of fracture in varus angulation in one case & failure to get anatomical reduction resulting in varus angulation in other case. Postoperatively two patients had deep vein thrombosis & two patients had shortening >4 CMS. Conclusion: PFNA II is very effective & good fixation implant for unstable peritrochanteric fractures.

Retrospective critical analysis of treatment of closed extra capsular proximal Femur fractures with proximal femur nail at rural teaching setup

Background: For extracapsular proximal femur fractures, the treatment options are innumerous, though the implant choice is debatable. In our institute we use proximal femoral nail for the treatment of extracapsular proximal femur fractures. Choosing most suitable implant for such fractures specially in old aged osteoporotic patients till date puts the surgeons in great dilemma. Aim & Objective: To study the clinical results and functional outcome of proximal femoral nail in extracapsular proximal femur fractures routinely used in our institute and to review the available literature. Material & Methods: This study consists of 60 patients who had undergone treatment of proximal femur fractures. Males constituted 70% of the study and 43.6% of the patients were more than 60 years old. Clinical outcome and functional results were evaluated by using Harris Hip scoring system. Results: Mean duration of surgery was 93 min.Post-operative complication rate was 6.7% which was superficial infection. Average time of union is 11.7 weeks. One patient had shortening of 2 cms and 2 patients had shortening of 1 cm. According to the Harris Hip Score we got excellent result in 70% and good result in 20%. Conclusion: Proximal femur fracture is common in elderly due to osteoporosis and mostly occurs due to trivial fall. PFN being a closed procedure, the amount of blood loss and duration of surgery was lesser. PFN is technically easier, with least complications even on follow up. PFN achieved the best clinical results and highest functional scores. Hence we conclude that PFN is the treatment of choice in proximal femur fracture.

Delay of Surgery does not Increase Transfusion Rates in Extracapsular Proximal Femur Fractures Stabilized with Intramedullary Implants

Scope: Aim of the study was to determine whether the delay of surgery increased transfusion requirements in extracapsular proximal femur fractures stabilized with intramedullary implants. Materials and Methods: We performed an internal audit (retrospective analysis of prospectively collected data) on blood transfusion requirements for hip fractures. Into this study were included 151 consecutive extracapsular proximal femur fractures in patients older than 55 years operated in our clinic over 9 months. Results: About the 126 patients operated using a short intramedullary implant, the time from admission to surgery did not correlate with transfusion needs (p=0.650). Patient’s age was positively correlated with the number of the received transfusions (p=0.125). Patient’s hemoglobin at admission was inversely correlated (p<0.001), whereas the duration of surgery was positively correlated with the number of transfusions (p=0.091). For 25 patients operated using a long intramedullary implant, the preoperative hemoglobin was the only significant influence for transfusion (p=0.005). Patients operated in the day of admission needed fewer transfusions compared to patients with delayed intervention: differences not statistically significant (p=0.222). Patients with sub trochanteric fractures required significantly more red blood cell mass (1.1 ± 1.1 versus 1.6 ± 1.0 units, p=0.024) and fresh frozen plasma (0.5 ± 1.3 versus 1.2 ± 1.4 units, p=0.014) spending nearly twice as long to operate (64.0 ± 21.8 versus 123.4 ± 45.7 minutes, p<0.001). Conclusions: The postponement of surgery did not increase the need of allogenic blood. Nonetheless, the older patients with lower baseline hemoglobin at admission undergoing to longer surgeries, did not require more perioperative transfusions.

The epidemiology and functional outcomes of operative fixation of extracapsular proximal femoral fractures (AO 31-A) in young adults.

Proximal femoral fractures in adults under 50years are not as common as in the elderly, but may have just as significant an impact. There is little in the literature describing the functional outcomes of fixation in this age group. Our aim was to assess the clinical and functional outcomes of operative management of extracapsular proximal femoral fractures (AO 31-A) in the young adult (<50years). Consecutive skeletally mature patients <50years undergoing operative fixation of these fractures were obtained from a prospective database over a 12-year period. Complications and mortality data were obtained from this database and case note review. Outcome scores were obtained via postal questionnaires. Eighty-eight patients were included in the study of which 74 (84%) had fixation with the dynamic hip screw. The mean age was 39years (range 17-50) with a male preponderance (73.8%). Mean hospital stay was 14days (range 2-94). Seventeen (19.3%) patients had died at a mean of 40months from their operation date. The 1-year mortality was 4.5%. There were five complications (5.7%). SF-36 and EuroQol 5D scores showed that 5-10% had severe problems with a 20% decrease in quality of life compared to population norms. The biggest differences were in the physical function modalities. One-third had fair to poor hip function as assessed by the Oxford Hip Score. Though these injuries are relatively rare in this age group, they do have significant mortality and functional impairment reflecting a higher energy of injury rather than the frailty seen in the elderly.

Efficacy of proximal femoral locking compression plate in the management of unstable extracapsular proximal femur fractures

Introduction: The proximal femur fractures are devastating injuries that most commonly affect the elderly population. The purpose of this study was to assess the efficacy of proximal femoral locking compression plate in the management of unstable extracapsular proximal femur fractures. Materials and methods: The proposed study is a hospital based prospective study. It was done between 2012 and 2014. During this period 32 cases of adult patients with unstable proximal femur fractures were selected according to inclusion criteria. The fractures were classified according to AO classification and Seinsheimers classification. 32 cases presenting to orthopaedic emergency and outpatient department were treated and were followed at regular intervals. Results: At the end of 3 months, 30 (93.75%) had no significant residual pain, 28 (87.5%) could squat, 31 (98.87%) could sit cross legged, 32 (100%) could walk up and down stairs unaided. According to modified Harris hip score results were excellent (40.6%), good (59.6%), fair (00%) and poor (00%). Average time of returning to work was 105.9 days. N = number of cases.

Bipolar hemiarthroplasty for the treatment of unstable trochanteric fracture femur in the elderly

Background Hemiarthroplasty using bipolar prostheses for unstable intertrochanteric fractures of the femur in the elderly yields good clinical results in terms of early postoperative ambulation. This will have a direct effect on the general condition and postoperative rehabilitation. Patients and methods Thirty patients with unstable proximal extracapsular femoral fractures were treated with bipolar hemiarthroplasty. There were 22 men and eight women, with mean age of 60 years (range: 55–70 years). Primary cemented bipolar hemiarthroplasty was performed using the Hardinge lateral approach in a lateral decubitus position. Harris hip score was used for the clinical evaluation of the patients. Results Clinically, the Harris hip score at the last follow-up ranged from 93 to 54, with a mean value of 79.5. Postoperative radiographs showed a good position in all patients. According to the Gruen scoring for cementation, 15 (50%) cases scored A, eight (26.66%) cases scored B, three (10%) cases scored C1, two (6.66%) cases scored C2, and two (6.66%) cases scored D. Four cases developed complications in this study: infection (two patients), loosening (one patient), and acetabular wear (one patient). Revision was performed in one patient because of loosening. Conclusion Primary cemented bipolar hemiarthroplasty is a good choice in elderly patients with unstable intertrochanteric fractures of the femur, and it saves time as well as cost, with little significant complications.