Intracapsular Femoral Neck Fractures Research Articles

Treatment of Intracapsular Femoral Neck Fracture with Multiple Cannulated Lag Screws and Minimal Capsulotomy

Background: Intracapsular femoral neck fracture (ICFNF) was and still is a challenge for orthopedic surgeons; and among few accepted methods of treatment, the most widely used is multiple cannulated lag screws (CLS); but still there are some controversies in the accepted time lapse for operation and age limit of the patients. Objective: treatment of choice for (ICFNF) in wide variety age groups, and after different times since the fracture happened. Patients and Methods: from (Dec. 2014-Sep. 2017) 23 patients with (ICFNF) were selected from those admitted to the orthopedic surgery department in Azadi Teaching Hospital Kirkuk. The time lapse before the surgery ranged from 1/2-6 days; the patient's ages ranged from 14-62years. All were treated by fixation with multiple (CLS) and minimal capsulotomy. The outcomes studied monthly both clinically and radiologically in duration from 8 to 20 months. Results: Fourteen cases (61%) were rated as excellent, six cases (26%) as good, two cases (9 %) as fair, and one case (4%) was rated as poor; according to the pain, limp and range orded in four cases (17%) in the form of superficial infection in one case, malunion in two and both in the other. Conclusion: This method can be used successfully in treating (ICFNF) in wide age groups and even after a delay of up to 6 days.

SuperPath approach is a recommendable option in frail patients with femoral neck fractures: a case–control study

IntroductionThe treatment of intracapsular femoral neck fractures (FNFs) in the elderly is usually based on hip replacement, both total hip arthroplasty (THA) and hemiarthroplasty (HA). Recently, several tissue-sparing approaches for hip arthroplasty had been described with promising results in terms of hospitalization length, blood loss and dislocation rate. The aim of the present study was to compare the blood loss and the transfusion rate in a cohort of patients with FNF treated using an HA through both the SuperPath (SP) and the traditional posterolateral (PL) approaches.Materials and methodsWe retrospectively collected data from patients affected by FNFs between January 2018 and February 2020. All patients with intracapsular FNF treated with a single HA implant (Profemur L, MicroPort Orthopedics Inc., USA) via PL or SP approaches were included. Exclusion criteria were pathological fractures, polytrauma and preoperatively transfused patients.ResultsThirty-five patients were included and analysed in the present study. 17 patients were classified in the SP group, and 18 in the PL one. The rate of antithrombotic therapy was higher in the SP group compared with the PL group [10 (58, 82%) vs 4 (22, 2%)]. While the two groups did not differ in terms of preoperative haemoglobin (Hb), 48 h postoperative Hb and Hb reduction, a significative difference was observed in terms of blood transfusion rate (1 SP vs 9 PL, p = 0.0072).ConclusionsThe SuperPath approach in patients with FNF under antithrombotic therapy assures lower transfusion rate, potentially reducing complication rates and improving patients' outcomes.

Does Proximal Femoral Morphology Impact Morbidity and Mortality? A Cohort Study of Uncemented Hemiarthroplasties in the Treatment of Femoral Neck Fractures.

BackgroundTo assess outcomes after uncemented hemiarthroplasty stems in the treatment of intracapsular femoral neck fractures over an 11-year period. Mortality rates were assessed, and whether proximal femoral geometry and stem alignment were factors in intraoperative or postoperative periprosthetic fracture (PPF) needs to be identified.Materials and MethodsA retrospective single-center observational study was conducted of all patients who underwent intracapsular femoral neck fracture treatment using an uncemented prosthesis between January 2008 and December 2018. Primary endpoints included mortality rate, Dorr classification, prosthesis alignment, intraoperative fracture, and reoperation rate for any reason. Subanalysis on collared and uncollared implants was also conducted. Multivariate logistic regression was performed based on Dorr classification for stem alignment, fracture incidence, reoperation rate, implant sizing, and patient mortality.ResultsA total of 536 patients received an uncemented hemiarthroplasty in the study period. The mean patients age was 80.4 years, of which 71% were female. The 30-day mortality rate was 5.2%, with no deaths on day zero or day one. Twenty patients (3.7%) sustained an intraoperative calcar fracture, and 14 patients a PPF (2.6%) at a mean of 1.3 years from surgery. Dorr C type femurs were more likely to develop a PPF (P = .001), while valgus stem alignment was associated with PPF (P = .049).ConclusionsThis implant has low reoperation rates, low early postoperative mortality, and low 30-day mortality. This large single-center study provides up-to-date information using a contemporary stem in patients with multiple comorbidities. Dorr C femoral morphology and valgus stem malalignment were risk factors for postoperative fractures.

Evaluation of functional outcome of intracapsular fracture neck of femur with Austin Moore prosthesis at a tertiary care hospital in Srikakulam

Introduction: Fractures of the femoral neck are common injuries occurring in the elderly population due to osteoporosis. They present a significant challenge to Orthopaedic surgeons because of the high rate of complications like nonunion, avascular necrosis, and associated comorbidities. Historically, Austin Moores prosthesis has served as an exemplary implant over the years in the management of intracapsular fracture neck of femur in older individuals. Our aim of the study is to asses postoperative function in these population and to validate the use of AMP in current Orthopaedic practice. Methods & Materials: This is a hospital-based cohort study. We did this study in thirty patients who had the fractured neck of the femur using Austin Moore Prosthesis, who are admitted to the Department of Orthopaedics in Great Eastern Medical School & Hospital, Srikakulam from Dec 2017 to Dec 2019. All patients were followed for twelve months. It is a patient-reported outcome study based on a questionnaire using a Harris hip score. Results: Harris hip score, which is the gold standard in the assessment of postoperative function in hip surgeries was used in this study. We graded the patients as excellent, good, fair, and poor depending on the functional outcome based on each criterion in this scoring system. The functional results were excellent in 50%, good in 23.3%, fair in 23.3%, and poor in 3.3% of cases. The poor results are due to moderate hip pain after surgery. The complication rate was low. Conclusion: Hemiarthroplasty with Austin Moore Prosthesis proved to be a good choice for the management of fracture neck femur in the elderly population with limited physical demand and low economic background. The mortality and morbidity are low; the operative procedure is simple with satisfactory functional results and fewer complications.

APPRAISAL OF CLINICAL OUTCOME OF BIPLANE DOUBLE SUPPORTED SCREW FIXATIONS (BDSF) FOR FEMORAL NECK FRACTURES

Background: Over the years, primary hip arthroplasty has become a popular choice of management modality for intracapsular fracture neck of femur in geriatric hip. Although the complication of nonunion and avascular necrosis (AVN) is nullied by arthroplasty, the probability of re-operation and high surgical stress is substantially high as compare to osteosynthesis. The aim of this study was to determine the clinical outcome of biplane double supported screw xation (BDSF) for femoral neck fracture. Material And Methods: A total of 37 patients (15 males, 22 females) with a mean age of 75.97 years underwent BDSF for femoral neck fracture and were followed up for a period of 10-12 months. They were assessed on the basis of improvement in Harris Hip Score (HHS) and Garden Index. Results: After BDSF the union was achieved in 89.18% (33) patients.The mean HHS was 91.027 points and a garden index of 161-170 was achieved in 56.76% (21) patients at one year of follow up. The majority of patients had good to excellent functional outcomes. The average time of clinico-radiological union was 9.3 weeks. BDSF method used in femoral neck fracture Conclusion: xation has given very good results in this study. Though anatomical reduction is crucial, BDSF method ensures reliable xation, early rehabilitation and good functional outcome especially in elderly

Mortality Following Hip Fracture Surgery During COVID-19 Pandemic Compared to Pre-COVID-19 Period: A Case Matched Cohort Series.

Introduction:This study aims to report on clinical outcomes and 30-day mortality of patients with neck of femur fracture during COVID-19 pandemic and compare the outcomes in a cohort during the same period prior to the pandemic.Material and Methods:The study included 66 patients with hip fracture over the age of 60 years, presented between 1st March and 15th May 2020 and matched with the patients with hip fractures (75 patients) managed during the corresponding period in 2019 as control. Data was collected on demographics, comorbidities, COVID-19 status, procedures and mortality and complications.Results:Thirty-day mortality following hip surgery was 13.6% during COVID-19 pandemic with all the mortalities in patients with ASA Grade 3 and 4. Mortality was considerably high for intracapsular fracture (20%) but highest in cemented hemiarthroplasty (20%). One third of the hip fractures operated in COVID-19 designated theatre died within 30 days of surgery. Thirty-day mortality rate for COVID-19 positive hip fracture patients were 55.5%. There has been higher 30-day mortality for hip surgeries during COVID-19 pandemic with positive correlation between patient’s COVID-19 test status and 30-day mortality following hip surgeries.Conclusion:There is strong association between 30-day mortality and the designated theatre (Clean/COVID) where the patients were operated on with higher mortality for intracapsular neck of femur fractures with significant mortality associated with cemented hemiarthroplasty particularly among symptomatic or COVID-19 positive patients. Therefore, adoption of a multidisciplinary approach is recommended to optimally balance the risk-benefit ratio for planning of management of hip fractures while considering patient’s peri-operative outcomes.

Functional Outcome of Intracapsular Femoral Neck Fractures Treated by Bipolar Hemiarthroplasty

Aim: To evaluate the functional outcome of bipolar hemiarthroplasty in intracapsular fracture neck of femur. Study design: Descriptive cross sectional study. Place and duration of study: Department of Orthopaedic Surgery & Traumatology, Peoples Medical University Hospital, Shaheed Benazir Abad from 1st December 2017 to 31st December 2020. Methodology: Sixty six cases of intracapsular femoral neck fractures with age ranging from 50 year to 75 year of either gender who were ambulatory before injury were included; while basicervical, younger than 50 years, with neuromuscular disorder, unfit for surgery, open fracture, bilateral injuries, osteoarthritis of hip, Rheumatoid, Gouty, pathological fractures, bedridden & who did not give consent for study, were excluded from the study. Functional outcome assessed by Harris hip score & data analyzed by SPSS version 23. Results: Twenty six (59.09%) were male and 40 (40.91%) were female with mean age of 64.3±7.77 year. Average time from injury to hospital arrival was 14.7±6.8 hours. Average time from hospitalization to surgery was 4.67±2.23 days. Average time of surgery was 55.67±9.9 minutes. Average hospital stay was 9.7±4.3 days. The average time of follow-up was 18.45±7.63 months. Conclusion: Bipolar implant is safe, effective, reliable, stable and cost effective implant for intracpsular fracture of femoral neck in elderly populace. The 66.66% of patients have satisfactory Harris hip score in follow up duration of 18.45±7.63 months. Keywords: Functional, Outcome, Femoral neck fractures, FNF, Bipolar, Hemiarthroplasty, HHS

193 An Audit of Compliance for NICE Guidance of Management of Displaced Intracapsular Neck of Femur Fractures

Abstract Introduction The 2011 NICE guideline ‘CG124 Hip fracture: management’ covers the management of hip fractures in adults aged over 18. It was updated in 2017 to highlight the role of total hip replacement in intracapsular fracture management – Recommendations 1.6.2 and 1.6.3. The aim of this audit was to assess, and improve, the compliance of Torbay Hospital’s management of intracapsular neck of femur fractures. Method The study was split over the three cycles, using data from the National Hip Fracture Database, followed by a review of patient notes. The first audit of 2017 data assessed the compliance of the department. A first change was then implemented to operation note documentation and 2018 data analysed. A further change was then implemented to operation notes and 2019-2020 data analysed. Results The 2017 audit showed a compliance of 67.7% against statement 1 and 41.1% against statement 2. After the initial change, the 2018 re-audit showed a slight improvement to 76.0% and 54.9%. After the second change was made, compliance subsequently rose to 100% and 100%. Conclusions The initial compliance with NICE guidance was poor. Following changes to the documentation on the operation note, compliance rose to 100%.

A prospective study of functional outcome of intracapsular femoral neck fractures with delayed presentation in young adults

Objectives: To assess the functional and radiological outcome of intracapsular femoral neck fractures with delayed presentation in young adults treated with cannulated cancellous screws. Methods: A prospective study included 21 patients with intracapsular neck of femur fractures who presented after 24 hours of injury but within 3 weeks of injury for which closed reduction and fixation was done with cannulated cancellous screws in Sanjay Gandhi Institute of trauma and orthopedics, Bangalore from May 2018 to December 2019. Patients were followed up at 6 weeks, 3 months, 6 months and 12 months. Clinical outcome was assessed using Modified Harris hip score and radiological assessment was done using x rays. Results: In our study we analysed the following parameters especially age, fracture type according to Garden and Pauwel, time of presentation, timing of surgery. In our study we found that patients with Pauwels type 3 (23.81%) and Gardens type 4 (42.86%) had low hip scores compared to others. 85% patients were pain free, 80% had good mobility post surgery. Incidence of non union was 2 out of 21 cases. The Modified Harris Hip Score evaluated at maximum follow-up of our patients averaged 90.13 with the maximum score being 96 and the minimum score being 67.8. Overall, 10 patients (47.62%) achieved excellent result, 6 patients (28.57%) achieved good result, 3 patients (14.29%) achieved fair result and 2 patients (9.48%) achieved poor result. 76.19% of the patients achieved either excellent or good results. According to radiographic evaluation AP view xray of pelvis with hip in 15 degree internal rotation, radiological parameters such as fracture union, non union changes, avascular necrosis of head, arthritic changes in the joint were analysed. Fracture union was seen in 19 patients (90.48%) and non union in 2 patients (9.52%). AVN changes were seen in 3 patients (14.29%). Average time of union was less than 3 months in 8 patients (44.4%), 3 to 4 months in 5 patients (27.7%), 4to 5 months in 4 patients (22.2%) and in one patient (5.55%) union achieved at 6 months.Conclusion: We conclude that canulated cancellous screw fixation is a viable option of treatment for fractures of intracapsular neck of femur in young adults with delayed presentation, showing excellent to good functional outcome and early radiological union with minimal complications.

Patient outcomes in Tropical North Queensland after implementation of a dedicated orthopaedic trauma list.

To assess patient outcomes after the introduction of a regular orthopaedic-specific trauma list (OTL). A retrospective analysis of 422 trauma cases was performed comparing patient outcomes after the introduction of the OTL. Four common traumatic injuries requiring operative intervention were considered; closed tibial fractures, intra-capsular neck of femur fractures, displaced paediatric supracondylar humeral fractures and hand tendon injuries. The outcomes assessed included time from patient referral to theatre, time from admission to theatre, operative times, time of day operation commenced, consultant involvement, hospital length of stay (LOS), returns to theatre and mortality. Tibial fractures had an increased time from admission to theatre (0.46 days pre-OTL versus 1.21 days post-OTL, P=0.01), hand tendons injuries had an increase in time from referral to theatre (1.06 days pre-OTL versus 2.82 days post-OTL, P=0.001). Consultant involvement increased for supracondylar procedures (27% pre-OTL versus 61% post-OTL, P < 0.001) and tendinous hand injury repairs (5% pre-OTL versus 37% post-OTL, P < 0.001). There was a decrease in cases starting after 17:00 hours; however, no group reached statistical significance. There was a reduction in complications and shorter inpatient LOS, however; these were not statistically significant. There was no difference in overall operative times after OTL implementation; however, individual group differences existed between registrars and consultants. Implementing regular orthopaedic trauma lists resulted in greater consultant involvement and was associated with decreased after-hours operating. Delays to theatre increased from both time of referral and admission; however, this was not correlated with increases in significant harm.

Functional outcome of Cemented Modular bipolar Hemiarthroplasty in Fracture Neck of Femur

Introduction: Intracapsular femoral neck fractures account for about 50% of all hip fractures. With increase in life expectancy, the incidence is increasing. Popular treatment is replacement of femoral head by bipolar prosthesis. Materials & methods: This study was done to assess the functional outcome of cemented bipolar hemiarthroplasty. Patients aged 50-80 years with intracapsular femoral neck fractures reporting to the orthopaedic department of the institute were considered for the study. 30 such patients were selected. All were operated by cemented modular bipolar hemiarthroplasty. It was a retrospective as well as prospective study. Regular clinical and radiological follow up was done for a minimum period of 6 months. Results were assessed using Harris Hip score. Results: Out of 30 patients assessed, 17 were females and 13 were males with average age was 68 years. At 6 months of follow up, out of 30 patients, excellent results were observed in 70% cases, good in 20% cases, average in 10% cases and poor in 0% cases. Conclusion: Most patients had good to excellent functional results post cemented modular bipolar hemiarthroplasty. Hence, Cemented Modular Bipolar Hemiarthroplasty is a safe and effective treatment modality in treating femoral neck fractures in middle aged to elderly individuals.

A radiological study of proximal femoral geometry and its relationship with hip fractures in Indian population

Context: In literature there is scarcity of documentation to test the relationship of radiological geometry of proximal femur with incidence and patterns of hip fractures especially in Indian population. In this study radiological parameters like Femoral Neck Length (FNL), Hip Axis Length (HAL), Neck Shaft Angle (NSA), Femoral Neck Diameter (FND) and Femoral Head Diameter (FHD) are measured in standardized digital pelvis radiograph of patients with hip fractures presented at a tertiary care hospital and efforts were made to establish a relationship of these parameters with the pattern of hip fractures in Indian population.Aims: The objective of the study is to investigate as to whether a particular type of proximal femoral morphology (viz. Femoral Neck Length, Hip Axis Length, Neck Shaft Angle, Femur head diameter and Femoral Neck diameter) determines and predicts the anatomical location of various types of hip fractures (1.Intracapsular (femoral neck) fractures – subtypes – subcapital; transcervical and basicervical neck femur fractures, 2. Extracapsular – subtyoes – intertrochanteric; intertrochanteric with subtrochanteric extension and subtrochanteric fractures). Settings and Design: Cross sectional observational studyMethods and Material: A cross sectional analysis was made in our hospital of a population of 100 patients with hip fractures (Intracapsular and Extracapsular). Study was conducted during 18/10/2019 to 30/09/2020. FNL, HAL, FND, FHD and NSA were measured on standardized digital pelvis radiograph by using an advanced computer software.Statistical analysis used: Independent sample t-test.Results: The sample size was divided into two age groups a younger age group (31-60years) and older age group (61-90years). For both age groups, means and standard deviations for all five parameters were calculated. We observed that for older age group, HAL is higher for extracapsular fractures than for intracapsular fractures. FNAL is increased for extracapsular fractures for the whole sample size as well as for older group. There was no significance for FHD, FND and NSA for any of the age groups for any type of fracture.Conclusions: In our study, we concluded that the HAL is significantly increased for extracapsular fractures than for intracapsular fractures in old age group of 61-90 years. FNAL is also found to be higher for extracapsular hip fractures in the same age group as well as the whole sample size. In our study, we could not establish any significant correlation between FHD, FND and NSA in any age group for any fracture type.

Total hip replacement for displaced intracapsular neck of femur fracture. Are current guidelines appropriate for all patients? Five-year retrospective analysis of 315 cases

BackgroundAccording to the National Hip Fracture Database (NHFD), in 2018 31.4% of patients with displaced intracapsular neck of femur (NOF) fracture who, National Institute for Health and Care Excellence (NICE) viewed eligible for total hip replacement (THR), received this operation.We aimed to identify the compliance of performing THR for those patients in our unit and identify the reasons for proceeding with the alternative type of surgery. MethodsA five-year retrospective review of eligible patients was conducted between January 2014 and Dec 2018. Statistical analysis was performed between groups who did or didn't receive THR. Reasons for not performing THR were identified from pre-operative ward rounds notes. ResultsIn 2018 our unit performed THR for 44% of eligible cases. This was the highest result over five-years and higher than the national average.Out of the 348 eligible cases, pathological or undisplaced intracapsular fractures were excluded. Reminder received THR (138), hip hemiarthroplasty (166) or internal fixation (11).The average age was 77. Younger patients were more likely to receive THR than 80 years or older (p<0.05). THR group scored 0.4 points higher on AMTS and 0.2 lower on ASA scale then non-THR group (9.8 vs. 9.4 and 2.7 vs. 2.5 respectively). Mean time to surgery was 1.24 days with no significant difference between THR and non-THR group (1.6 vs. 1.1) but a slight delay to surgery during the weekends was noted (1.3 vs 1.8 days).Reasons for not performing THR were well documented as a combination of mobility restrictions and serious medical comorbidities. Retrospectively we judged the surgical decision making to be correct in 95% of cases. ConclusionsAnnual NHFD report comments on poor national and individual hospital's compliance with NICE guidelines without allowing surgeons to justify their choice of the procedure undertaken.Surgical decisions are made in a highly specialised multi-disciplinary environment taking into consideration individual patient's frailty and potential morbidity. Details of those discussions should be collected in NHFD to allow further analysis of reasons why surgeons decide not to offer THR to a patient NHFD views as eligible for this procedure. This could help in understanding the complex factors impacting on decision making in those cases.Level of evidence:Level III

Effect of 4DryField\xae PH on blood loss in hip bipolar hemiarthroplasty following intracapsular femoral neck fracture \u2013 a randomized clinical trial

BackgroundOne of the most common complications of hip arthroplasty is excessive blood loss that could necessitate allogenic blood transfusion, which is further associated with other complications, such as infections, transfusion reactions or immunomodulation. In gynecology, 4DryField®PH, an absorbable polysaccharide-based formulation, is used for hemostasis and adhesion prophylaxis. In this study, we evaluated its hemostatic effect in patients undergoing hip bipolar hemiarthroplasty following intracapsular femoral neck fracture.MethodsWe studied 40 patients with intracapsular femoral neck fractures (Garden III or IV) admitted at our institution between July 2016 and November 2017. We included patients above 60 years with simple fracture and without pathologic fractures. Patients were randomized into intervention and control groups. The intervention group received 5 g of 4DryField® PH (subfascially and subcutaneously) during wound closure. Three drainages were inserted in a standardized manner (submuscular, subfascial, and subcutaneous) and drainage volume was measured immediately before extraction. Total blood loss was calculated using Mercuriali’s formula and standard hemograms upon admission and five days after surgery. Volume of postoperative hematoma was measured using point-of-care ultrasound seven days after surgery.ResultsVolume of the postoperative hematoma was reduced by 43.0 mL. However, significant reduction of total blood loss and drainage volume was not observed.ConclusionsWe observed that 4DryField® PH had a local hemostatic effect, thereby reducing volume of the postoperative hematoma. However, this reduction was small and had no effect on the total blood loss. Further studies are warranted to improve the application algorithm.Trial registrationDRKS, DRKS00017452, Registered 11 June 2019 – Retrospectively registered.

Radiological assessment of total hip arthroplasty in displaced neck of femur fracture: An observational study

Aim: Radiological assessment of Total Hip Arthroplasty in Displaced fracture Neck of femur. Materials and Methods: This observational study was carried out in the Department of Orthopaedics, American International Institute of Medical Sciences, Udaipur, Rajasthan, India. Total 110 patients were treated with total hip replacement. Plain X-ray pelvis with both hip joints and proximal femur - pre and post-operative - AP view, preoperative X-ray of affected hip- lateral view, X-ray of the operated hip with proximal 2/3rd of femur- AP and lateral view were evaluated. Results: Out of 110, 80 patients were male and 30 female. Most of the patients in this study were above 60 year, followed by 55-60 year. Patients scored 47.3% excellent, 27.3% good, 10.9% fair and 14.5% poor. The acetabular cup inclination 85 neutral, 15 vertical and 10 horizontal positions were seen. Femoral stem positions were central in 82 hips, valgus in 15 hips and varus in 13 hips. There were 2 subsidences and 1 migration. Class II heterotopic ossification was noted in 4 hips, i.e., 6% incidence that underwent THA. We had 2 cases of dislocation (1.8%). Conclusion: The result of this study shows that Total Hip Arthroplasty gave good results in Displaced Intracapsular Neck of femur fractures with radiological assessment.

The management of displaced intracapsular femoral neck fractures at a Sub-Saharan Academic Hospital.

Background: Femoral neck fractures (FNFs) remain “the unsolved fracture” and optimal management is still controversial. The outcomes of hemiarthroplasty (HA) and total hip arthroplasty (THA) in the treatment of FNFs are inconsistent. As demand for management of FNFs continues to grow globally, evaluation of the appropriateness of treatment remains essential, particularly in resource-constrained settings. Methods: We conducted a retrospective chart review of all patients presenting with isolated low energy intracapsular FNFs to an orthopaedic academic unit in Sub-Saharan Africa from January 2016 to April 2019. The decision regarding HA or THA was largely based upon the Sernbo score and ASA classification. The majority of patients with a Sernbo score of ≥15 and ASA class III or better received THA. Results: There were 117 patients (33 male/84 female) 72 years (33–97 years) with FNFs who underwent 56 THA and 61 HA between January 2016 and April 2019. The mean Sernbo score was 15.99 overall (range 8–20) and was 18.95 (11–20) for THA patients compared to 14.46 (8–20) for HA patients (p = 0.042). Time taken from admission to the theatre was 8–19 days (1–22) and 7–61 days (2–31) for HA and THA respectively. The average length of stay (LOS) was 16.04 days and the main reason for same-day cancellations was the lack of post ICU/High Care beds. The 30-day mortality rates were 1.78% and 4.91% for THA and HA patients, respectively (p = 0.07). The mortality rate for patients with a Sernbo score < 15 was 15.38% overall, 8.93% for THA patients, and 21.31% for HA patients, respectively (p = 0.021). Conclusion: The 30-day mortality rate was comparable with published rates from developed countries. There were significant delays in time to theatre, high rates of same-day surgical cancellations, and increased LOS for both HA and THA. These factors play a cumulative role in inflating costs on a strained healthcare system in a developing country. A multidisciplinary approach including the care provision of a specialized geriatric unit is recommended.Retrospective Study, Level III evidence

Cannulated cancellous screws versus dynamic hip screw in femoral neck fractures: a comparison in productive age group at tertiary care hospital of North India

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Since intracapsular fracture neck femur was recognized by Ambrose Pare almost 4 centuries back, the management of intracapsular neck femur fracture has undergone many changes. The multitude of various implants designed and techniques available for its treatment themselves indicate the inadequacy of the various methods of treatment. Objective was to compare cannulated cancellous screws (CCS) versus dynamic hip screw (DHS) in femoral neck fractures in productive age group.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This observational study with both prospective and retrospective data analysis of patients operated by different surgeons in same hospital setup has been conducted from March, 2018 to February, 2020 at the department of Orthopedics, Government Medical College (GMC), Jammu. 105 cases satisfying the inclusion criteria admitted in GMC Jammu were included clinically and radiologically. Total number of patients included in the study was 97 patients as 8 patients were lost to follow-up. Functional outcome was evaluated by using Harris hip scoring.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; In our study 8 CCS cases were lost to follow up. Total 97 of cases were followed up till one year both radiologically and clinically after a given time intervals and final assessment done on the basis of Harris hip score. Among 97 cases 71 were males most of them in age group of 41-45 years and 26 were females with 46-50 years age group predominance. 47.42% fractures were classified as type III in garden’s staging. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; DHS is a better implant than CCS in hands of doctors who lack of expertise and precision i.e. required for CCS in fracture neck femur in young adult patients.&lt;/p&gt;

Management of neglected femur neck fractures treated with non vascularised fibular graft

Intracapsular femoral neck fractures are seen commonly in elderly people following a low energy trauma. 2-3% of all femoral neck fractures occurs in adults younger than 50 years and is often the result of high-energy trauma. Femoral neck fracture continues to be considered as an unsolved fracture in view of poor prognosis and variable outcome reported after different procedures. In developing countries the fracture often remains untreated as the patients do not seek treatment due to non availability of treatment facility or may be treated primarily by osteopaths or operated under suboptimal theatre conditions with poor quality implants. We prospectively studied the outcome of 54 patients managed with non vascularised fibular graft and cancellous screws between 2010-2015. ANOVA test was used as a test of significance and functional results were assessed by Modified Askin and Bryan criteria. To conclude, in patients younger than 60 years of age with neglected femoral neck fracture, non vascularised fibular graft acts as a reliable biological implant for revascularisation and gives excellent functional outcome. Keywords: Neglected neck, Femur fracture.

To evaluate efficacy and complications of suction drains in hemiarthroplasty cases

Introduction: Intracapsular fracture of neck femur usually present with severe swelling, difficulty in walking reduced length of affected limb. The most common Risk factors are old age, osteoporosis, taking excessive medications, alcohol, smoking and cancer. Diagnosis can be done by using X-rays, CT scan and MRI. Materials and Methods: It is a prospective study consists of all the patients admitted to JSS hospital with intracapsular fracture neck femur treated with unipolar or bipolar endoprosthesis. Results: The selected patients were randomized and divided into two groups, Group one (I) and Group two (II). Patients were suction tube is used are categorized into Group I and in those were suction tube is not used are categorized into Group II. These two groups were studied and observed for the following, fall in haemoglobin and PCV at 48 hours post-operatively. Complications are Persistent discharge, serous discharge from the wound for more than 10 days. Discussion: When the doctors are in doubt, then they need to insert a drain was countered by Halsted (1898). Now days in orthopedic cases, closed suction drains are being commonly used to decrease the complications. Blood accumulation in and around the tissue site will raise the tissue tension and thereby reduces tissue perfusion in and around the surgical wound site. Conclusion: We consider that there is ample evidence that closed suction drains is of no benefit in primary uncomplicated hemiarthroplasty. The advantage of the drains in orthopaedic surgeries should be debated as non use of drains drastically reduces anemia and requirement of blood transfusion after surgery. In a developing and under-developing countries, the cost increases because of the blood transfusion needs and costs of drain device which will outweigh any advantages of putting a drain. Keywords: Persistent discharge, Dressing reinforcements, Superficial surgical site infections, Blood transfusion.

Risk factors for intraoperative greater trochanteric fractures in hemiarthroplasty for intracapsular femoral neck fractures

PurposeHemiarthroplasty is widely accepted as the treatment of choice in elderly patients with a displaced intracapsular femoral neck fracture. Intraoperative greater trochanteric fractures thwart this successful procedure, resulting in prolonged recovery, inferior outcome, and increased risk of revision surgery. Hence, this study analyzed factors potentially associated with an increased risk for intraoperative greater trochanteric fracture.MethodsThis retrospective study included 512 hemiarthroplasties in 496 patients with a geriatric intracapsular femoral neck fracture from July 2010 to March 2020. All patients received the same implant type of which 90.4% were cemented and 9.6% non-cemented. Intra- and postoperative radiographs and reports were reviewed and particularly screened for greater trochanteric fractures.ResultsFemale patients accounted for 74% and mean age of the patients was 82.3 (± 8.7) years. 34 (6.6%) intraoperative greater trochanteric fractures were identified. In relation to patient-specific factors, only a shorter prothrombin time was found to be significantly associated with increased risk of intraoperative greater trochanteric fracture (median 96%, IQR 82–106% vs. median 86.5%, IQR 68.8–101.5%; p = 0.046). Other factors associated with greater trochanteric fracture were a shorter preoperative waiting time and changes in perioperative settings. Outcome of patients with greater trochanteric fracture was worse with significantly more surgical site infection requiring revision surgery (17.6% vs. 4.2%, p = 0.005).ConclusionProlonged prothrombin time, a shorter preoperative waiting time, and implementing new procedural standards and surgeons may be associated with an increased risk of a greater trochanteric fracture. Addressing these risk factors may reduce early periprosthetic infection which is strongly related to greater trochanteric fractures.