Management Of Femoral Fractures Research Articles

SIMBA-A Single-Puncture Approach to Lower Limb Block.

Peripheral nerve blocks provide a safe and reliable alternative in the anesthetic management of femur fractures in elderly subpopulations associated with significant comorbidities. Single-Insertion Multiple Nerve Block Anesthesia (SIMBA) is a technique where a single needle insertion is used to block all four nerves that supply the femur shaft: the femoral nerve, obturator nerve, lateral femoral cutaneous nerve, and sciatic nerve. The authors performed this technique in 11 cardiac compromised geriatric patients with midshaft/distal femur fractures, and the surgery was conducted successfully without any significant hemodynamic change and good postoperative analgesia.

Effect of training program on the performance of orthopedic nurses regarding upper femoral fracture management by using the proximal femoral nailing technique

Abstract Introduction: Hip fractures pose a significant global health-care challenge due to the increasing number of older adults, necessitating accurate and comprehensive nursing care. Materials and Methods: Quasi-experimental design, purposive study was carried out at three teaching Hospitals in Mosul City in Iraq from the period of January 2022 to December 2022, forty nurses from orthopedic wards were the subject to this study, all nurses were evaluated according specialized checklist “Iraqi Ministry of Health guide for organizing nursing operations and practices inside the hospitals and medical departments” then they attended the training program. Results: Approximately 50% of the study sample had a poor level of performance in the initial evaluation preintervention of the program, then after implementing the training program, the performance and practices of the nursing staff have improved significantly. Conclusion: The study concluded that there is a significant and poor performance and practices of the nursing staff toward upper femoral fractures in the orthopedic wards, and that the training program greatly and successfully improve their performance and practices. The following core competencies are addressed in this article: Practice-based learning and improvement, Patient care and procedural skills, Interpersonal and communication skills.

Anesthetic Management of Femur Fracture in a Pediatric Patient with Osteogenesis Imperfecta

Anesthetic Management of Femur Fracture in a Pediatric Patient with Osteogenesis Imperfecta

A comparison of fascia iliaca compartment block with intravenous analgesia to improve pain control in patients with femoral fracture.

The most common approach to managing severe pain following femoral fracture is with intravenous systemic analgesics, such as opioid analgesics and non-steroidal anti-inflammatory drugs associated with side effects such as respiratory depression, nausea, and vomiting. These side effects might be intolerable in trauma patients and may result in under treatment of pain. Improving the quality of analgesia may reduce these intolerable side effects. Our study compared the efficacy of fascia iliaca compartment block (FICB) with intravenous analgesics for preoperative pain management of femoral fractures. The study was a quality improvement prospective randomised study, where 50 patients aged between 18 and 65 years, and American society of anesthesiologists I and II were recruited into two groups. Group A received FICB with a combination of 0.4 mL/kg of 0.5% plain bupivacaine and adrenaline 1:200,000 made up to 30 mL, while group B received placebo FICB using 30 mL normal saline. Also, group B received a combination of intravenous paracetamol 15 mg/kg not exceeding 900 mg and tramadol 1 mg/kg not exceeding 100 mg, while group A received an equal volume as normal saline intravenously. The study revealed no significant difference in age, gender, associated injuries, X-ray description of fractures, and mechanism of injuries; however, there was a significant difference in the NRS-pain score at 30 min, summed pain intensity difference for 4 h and patient satisfaction in the FICB group compared to the standard group. The study revealed that FICB results in better pain control compared to a combination of intravenous tramadol and paracetamol in patients with femoral fractures.

Closed reduction and intramedullary nails for acute completely displaced femoral diaphysis fracture in children aged 2-6.

The management of femoral fractures in children aged two to six years is still controversial. The purpose of this study was to assess the results of closed reduction and elastic stable intramedullary nail (ESIN) fixation in completely displaced fractures of the femoral diaphysis in children in this age group. A retrospective review of all children with acute completely displaced fractures of the femoral diaphysis in children aged 2-6 years treated from 2013 to 2020 was performed. A total of 34 patients were treated who met the inclusion criteria: Group 1: 21 fractures (transverse and short oblique); Group 2: 13 fractures (long oblique and spiral) that underwent closed reduction and elastic stable intramedullary nail (ESIN) fixation. No differences existed between the 2 groups with respect to age, extremity, sex, time to treatment, mechanism of injury, or fracture displacement. Demographic characteristics and radiographs were reviewed, and the following parameters were documented: surgery time, time to union, return to activities, range of motion of knee joints, and complications. Major complications were defined as those with presumptive long-term side effects or those requiring a reoperation. No major complications were observed in the two groups. All included fractures were treated by a single senior paediatric surgeon. The mean follow-up period was 28.4 months (range 24-45 months). The level of significance was set at p < 0.05. Thirty-four children with acute completely displaced fractures of the femoral diaphysis were included: Group 1: 21 fractures; Group 2: 13 fractures. The patients included 15 girls (44.1%) and 19 boys (55.9%), with an average age of 4.4 years (range 2.8 to 6.5 years). The mean follow-up period was 28.4 months (range 24.2-45.0 months). The demographic characteristics did not differ between the two groups of patients. Overall, successful closed reduction and elastic stable intramedullary nail (ESIN) fixation could be achieved in all 34 patients. The mean surgical time was 40.4 and 43.0 min in Group 1 and Group 2, respectively (p = 0.857). Fluoroscopy time was not significantly different between the two groups (37.0 vs. 36.1 s, respectively; p = 0.247). Cosmetic results were described as good and satisfactory by all patients. There were no refractures and no incidences of nonunion or growth arrest in the proximal epiphysis. Only two patients suffered from a superficial infection, which was resolved after the pins were shortened and oral antibiotics were administered. Closed reduction and elastic stable intramedullary nail (ESIN) fixation can be successfully used to treat completely displaced fractures of the femoral diaphysis in children aged two to six years. This technique is efficient and minimally invasive, and the results are satisfactory.

Trends in the Management of Femur Fractures in Young Children

Background: Femoral shaft fractures in young children are commonly treated with closed reduction and spica casting; however, there is increasing literature and interest focusing on internal fixation. This study aims to assess trends in the management of femoral shaft fractures in patients under the age of 6.Methods: This is a retrospective study utilizing the Pediatric Health Information System (PHIS) database. We queried for patients aged 1 to 6 years who had an isolated, closed femoral shaft fracture from October 2015 to December 2020. ICD10 procedure codes were used to determine treatment of the injury. Descriptive statistics and tests of trend were utilized in the analysis of this study.Results: We identified 4608 patients with a femoral shaft fracture during the study period. The majority of patients were treated with spica casting (n=3398, 73.7%), followed by intramedullary fixation (n=600, 13.0%) and plate osteosynthesis (n=449, 9.7%). In this cohort, 3236 patients were between the ages of 1-3 years, and 1372 patients were between the ages of 4-6 years. There was a significant difference in management between these two age groups with lower rates of spica casting in older patients (92.1% vs. 30.5%) and higher rates of intramedullary fixation (37.3% vs. 2.7%) and plate osteosynthesis (28.2% vs. 1.9%) (p<0.01). There was a significant correlation with increasing rates of intramedullary fixation and plate osteosynthesis from 2016 to 2020 (p=0.03 and 0.01, respectively), and a decrease in rate of spica casting over time (p=0.04).Conclusion: Femur fractures in young children are treated with spica casting, intramedullary nails, and plate osteosynthesis. There is a significant change in management over time, and children between the ages of 4 and 6 are more likely to be treated with intramedullary nails compared to younger children. Additional studies are needed to understand these trends as well as justify the increase in rates of intramedullary nails and plate osteosynthesis in young children.Level of Evidence: Level III; Retrospective Cohort Comparison using Large DatabaseKey Concepts•Historically, spica casting was the gold standard for femur fracture treatment in younger patients.•There has been recent interest in the utilization of internal fixation for treatment of femur fractures in young children.•The use of intramedullary nails and plate osteosynthesis in young patients with femur fractures has increased by 34% and 25%, respectively, from 2015 to 2020.•Spica casting has remained the main treatment option for patients aged 1-3.•Intramedullary nails and plate osteosynthesis have been used increasingly over time for patients aged 4-6.

Risk factors, classification, and operative choices of femur fractures at a Tertiary Hospital: first report from Somalia

A traumatic femur fracture is a significant cause of morbidity, affecting one to three million individuals annually. The present is the first study investigated the epidemiological characteristics, risk factors, classification, mechanisms of injury, and early management of femoral fractures in Somalia. This retrospective epidemiological study included all patients with a femur fracture who were admitted for four years between November 2018 and December 2022 to the orthopedic and trauma surgery department. We reviewed patient demographic characteristics, including age and gender, the mechanism of injury, injury characteristics, and the type of fixation performed. We reviewed the radiographs and classified the fracture using the AO/OTA classification system. During the study period, a total of 402 patients were treated for femur fractures; 256 (64%) were males, and 144 (36%) were females. The mean patient age was 47.7 ± 8.5 years. Regarding the anatomical location of femur fractures, the proximal (31A, 31B) was the most common, accounting for 50% of the patients. Femur neck fracture (31B) was the most common in the proximal femur fractures. Gunshot 82 (59.42%) was the leading cause of femur shaft fractures. Most patients with femur shaft fractures were males; 150 (86.20%) and 152 (64.47%) were young patients between 19 and 40 years old. Almost half of the patients (86) with femur shaft fractures had open fractures. The distribution of the mechanism of injury significantly differed according to age (p < 0.001). Younger patients (< 40 years) were predominantly injured due to gunshot injuries compared to elderly cases (> 60 years), where falls from standing height were the primary mechanism of injuries. There was a statistically significant difference between the mechanism of injury and gender categories (p < 0.001). Male patients were injured mainly by gunshots in about 40%, while 80% of fractures in female patients were due to falls from standing height. Female fractures occurred primarily in the proximal, while the males had an equal fracture rate for proximal and shaft fractures. Femur fracture causes significant morbidity and mortality. The study findings revealed that the most common femur fracture type was femur neck fracture, and low-energy injuries were the most common mode of injury in the elderly. Proximal femur fractures occur in older age and mainly in females. Gunshots were the most common cause of femur shaft fractures in Somalia, a country that has struggled with wars for over 30 years.

Management and Outcomes of Femur Fractures in Patients with Duchenne Muscular Dystrophy

Background: Duchenne muscular dystrophy (DMD) is a severe, progressive X-linked recessive neuromuscular disorder characterized by muscle weakness and atrophy. Additionally, patients with DMD have significant reductions in bone mineral density compared to age-matched controls, which is exacerbated by concomitant steroid use. These findings dramatically increase fracture risk, which may irreparably decrease functional status. The aim of this case series is to examine outcomes of operative versus nonoperative management of femur fractures in this patient population.Methods: An IRB-approved retrospective chart review was completed for patients with DMD treated at a single institution for a femur fracture between 2013-2022. Patients were excluded for incomplete documentation, treatment initiation at an outside hospital, or diagnosis of a different muscular dystrophy. Demographic variables, treatment information, functional status, and adverse events were collected for each patient. Descriptive statistics were used to summarize demographic and outcome variables.Results: A total of 10 patients with 11 femur fractures were included for analysis. All patients were male with an average age of 12.7 years and clinical follow-up of 286 days. Five fractures in five patients underwent operative fixation (Group A), and six fractures in five patients underwent nonoperative management (Group B). In Group A, three patients were short-distance ambulators prior to injury, and all patients regained a similar functional status postoperatively. All three patients were treated with a locked intramedullary nail. One patient in Group B was a short-distance ambulator prior to injury; the remainder were nonambulatory. All patients in Group B were primary wheelchair users at final follow-up. There were no adverse events as a result of treatment in either group.Conclusion: Nonoperative management with cast immobilization remains an acceptable option for nonambulatory patients and those with minimally displaced fractures not amenable to surgical intervention. Surgical intervention is recommended for higher-functioning patients with the goal of restoring ambulatory status. Regardless of treatment modality, patients should receive aggressive physical therapy directed at early weight-bearing, range of motion, and mobilization to preserve strength, muscle mass, and mobility.Level of Evidence: Level IV case series Key Concepts•Management of femur fractures in Duchenne muscular dystrophy should account for fracture morphology as well as patient functional status.•Surgical management is safe and effective in promoting fracture union and preserving functional status.•Nonoperative management is preferred in nonambulatory patients and for minimally displaced fractures.

Clockwise torque results in higher reoperation rates in left-sided femur fractures

PurposeEffects of clockwise torque rotation onto proximal femoral fracture fixation have been subject of ongoing debate: fixated right-sided trochanteric fractures seem more rotationally stable than left-sided fractures in the biomechanical setting, but this theoretical advantage has not been demonstrated in the clinical setting to date. The purpose of this study was to identify a difference in early reoperation rate between patients undergoing surgery for left- versus right-sided proximal femur fractures using cephalomedullary nailing (CMN). Materials and methodsThe American College of Surgeons National Surgical Quality Improvement Program was queried from 2016-2019 to identify patients aged 50 years and older undergoing CMN for a proximal femoral fracture. The primary outcome was any unplanned reoperation within 30 days following surgery. The difference was calculated using a Chi-square test, and observed power calculated using post-hoc power analysis. ResultsIn total, of 20,122 patients undergoing CMN for proximal femoral fracture management, 1.8% (n=371) had to undergo an unplanned reoperation within 30 days after surgery. Overall, 208 (2.0%) were left-sided and 163 (1.7%) right-sided fractures (p=0.052, risk ratio [RR] 1.22, 95% confidence interval [CI] 1.00–1.50), odds ratio [OR] 1.23 (95%CI 1.00–1.51), power 49.2% (α=0.05). ConclusionThis study shows a higher risk of reoperation for left-sided compared to right-sided proximal femur fractures after CMN in a large sample size. Although results may be underpowered and statistically insignificant, this finding might substantiate the hypothesis that clockwise rotation during implant insertion and (postoperative) weightbearing may lead to higher reoperation rates. Level of evidenceTherapeutic level II.

Intrafracture Recombinant Platelet-Derived Growth Factor Improves Fracture Healing Process on Wistar Rat

Background: Femoral fracture is associated with high morbidity and mortality, especially in young adults with high-energy injuries. Abnormal fracture healing presents as a significant matter in management of femoral fracture. Platelet Derived Growth Factor (PDGFBB) is proposed as potential agent in fracture healing. Up to this point, PDGF has been scientifically studied improve wound healing by enhancing fibroblast proliferation, extracellular matrix synthesis, and revascularization. This study aims to evaluate role of PDGF on fractured bone healing.Subjects and Method: This was a randomized controlled trial conducted at Animal and Biomedical Laboratory of Udayana University, from March to September 2022. 36 male and healthy Wistar Rats at 34 months old and weighs 140160 grams were selected for this study. The dependent variables were Allen score, type I and type III collagen levels. The independent variable was administration of 10 mcg PDGFBB following femoral osteotomy and intramedullary wire fixation. Type I and III collagen levels are assessed using ELISA methods. Statistical analysis is performed using independent T-test in SPSS ver 25.0 software.Results: Allen score in the PDGFBB group (Mean= 3.89; SD= 1.40) was higher than control group (Mean= 2.28; SD= 1.48), with p=0.002. Type I collagen in the PDGFBB group (Mean= 4.97; SD= 0.54) was higher than control group (Mean= 4.41; SD= 0.74), with p=0.014. Type III collagen in the PDGFBB group (Mean= 12.1; SD= 2.49) was higher than control group (Mean= 10.01; SD= 1.61), with p=0.005.Conclusion: In comparison to the nonPDGFBB group, Wistar rats that had their femurs osteotomized and joined with intramedullary wire in the PDGFBB group has higher mean of Allen score, type I and type III collagen levels.Keywords: femoral fracture, allen score, type I collagen, type III collagen, PDGFBBCorrespondence: IGN Wien Aryana, Consultant of Sports Medicine, Dept. Orthopaedic and Traumatology, Prof IGNG Ngoerah General Hospital, Faculty of Medicine, Udayana University. Jl. Diponegoro, Dauh Puri Klod. Denpasar City, Bali 80113. Email: wienaryanaortho@gmail.com. Mobile: +62811385263.Indonesian Journal of Medicine (2023), 08(02): 136141https://doi.org/10.26911/theijmed.2023.08.02.02

Management of Femur Fractures during COVID-19 Pandemic Period: The Influence of Vaccination and Nosocomial COVID-19 Infection.

The COVID-19 pandemic management has led to a significant change in orthopedic surgical activity. During the pandemic, femur fractures in patients over 65 years of age have maintained a constant incidence. Our study will focus on this fragile population, analyzing the incidence of SARS-CoV-2 infection during hospital stays and the clinical and radiographic orthopedic outcomes. We also evaluated the va\riation of COVID-19 infection after health professionals' vaccinations, and the influence of inter-hospital transfers caused by logistical and organizational aspects of the pandemic. Material and Methods: This is a descriptive and prospective study from 13 October 2020 to 15 March 2021. Participants were patients over 65 years of age with diagnoses of proximal femoral fractures with r surgical treatments indicated. We compared the SARS-CoV-2 infected patients during the stay with non-infected cases. A second evaluation was carried out dividing the patients into those who underwent inter-hospital transfers and a group without transfers. We subdivided the study period into two, according to the percentage of healthcare workers vaccinated against SARS-CoV-2. The reported clinical variables included the Parker and Palmer Score, the Nottingham Hip Fracture Score, the Harris Hip Score, mortality, the Rush Score, and evaluation of reduction in radio-lucent lines in prosthetic implants. Results: Ninety-three patients were studied. The whole positive COVID cohort (11.83%) was hospitalized during the period when less than 80% of health workers were vaccinated (p = 0.02). The COVID cohort and the patients transferred before surgery had longer stays in the Emergency Room (p = 0.019; p = 0.00007) and longer lengths of stay compared to the other patients (p = 0.00001; p = 0.001). Mortality was higher both in the infected group and in the patients who underwent a transfer before the surgical procedure (18.18% vs. 1.22 %; p = 0.003. 25% vs. 6.85%; p = 0.02). In terms of orthopedic outcomes measured through the third month of follow-up, we found worse score results in functional and radiographic outcomes in the COVID positive cohort and in the transferred patients' cohort. Conclusions: The impact of the COVID-19 pandemic on patients treated for proximal femur fracture was statistically significant. Patients with Coronavirus during hospitalization obtained poor short-term radiographic and functional results and increased peri-operative mortality. The incidence of intra-hospital infection was high during the period in which health professionals were not yet covered by the anti-COVID vaccination cycle. Patients who were transferred between two hospitals due to pandemic-related management issues also achieved reduced outcomes compared to non-transferred cases, with increased mortality.

Therapy preference of 131 parents confronted with a pediatric femoral fracture

BackgroundThe management of femoral fractures in children between 3 and 5 years of age is still vividly debated. Therefore, we aimed to assess the basic attitude of parents if confronted with a hypothetical femoral fracture of their toddler.Materials and methodsParents of children aged between 12 and 36 months were asked for their preference after receiving detailed information on conservative and surgical treatment of femoral shaft fractures. Furthermore, we obtained information regarding the parents’ gender, marital status, medical background, highest level of education and profession in a leading or non-leading position and if any of their children already had undergone any operations. The Freiburg Personality Inventory (FPI-R) questionnaire was used to assess parents’ personality traits.ResultsIn total, 131 participants were included in this study. The vast majority (n = 116, 88.5%) preferred surgical treatment. The most frequently mentioned reasons for this decision were lack of acceptance, followed by faster reconvalescence, shorter hospital stay, less deformity or growth disorders and less stress on the child. The only reason stated against surgical treatment was the need of general anesthesia. A significantly higher rate of conservative procedures was noticed in self-employed participants and stress was found to significantly influence the treatment decision of the parents toward conservative treatment.ConclusionThe majority of parents confronted with a hypothetical femoral fracture of their child questioned in this study opted for a surgical approach with elastic stable intramedullary nailing (ESIN). This corresponds with trends toward surgery in these cases in major trauma centers in Europe.

The Butterfly Fragment in Wedge-Shaped Femoral Shaft Fracture: Comparison of Two Different Surgical Methods.

ObjectiveOur study compared the results of wedge‐shaped femoral shaft fracture following intramedullary (IM) nailing with or without fixation of the third fragment.MethodsWe retrospectively reviewed patients presenting with femoral shaft fracture with AO/OTA type 32‐B from 2011 to 2016. Patients were divided into two groups: closed reduction without touching the third fragment and open reduction with fixation of the third fragment. The fragment ratio, fragment length, nail size, dynamization or not, mRUST scores, union rate, and union time were compared between the two groups. Risk factors of non‐union were also investigated, including sex, age, fracture pattern, fracture location, dynamization, nail size, fragment ratio, fragment size, and postoperative fragment displacement.ResultsA total of 80 patients met inclusion criteria, 20 patients with wedge‐shaped shaft femoral fracture were managed with IM nailing and open reduction with fixation of the third fragment. Sixty patients were treated with IM nail without touching the third fragment. The union rate for the fixation and non‐fixation groups were 60.0% and 81.7%, respectively. The mean union time for the fixation group was 19 months vs 14 months for the non‐fixation group. Multi‐regression analysis showed larger nail size (odds ratio: 2.26) and fixation of the third fragment (odds ratio: 0.18) influenced fracture healing.ConclusionsFixation of the third fragment in wedge‐shaped shaft femoral fracture results in a longer union time and lower union rate. In the management of femoral fracture with a third fragment, a larger nail size is recommended and fixation should be performed in a closed manner. Fixation of the fragment may achieve better fracture reduction. However, disruption of the vasculature and surrounding structures may further result in nonunion of the fracture site.

Strategies in the management of femoral fractures in post-polio limb a retrospective analysis of 10 patients with 3-year follow-up

Background: Out of 10–20 million people in the world with post-polio sequelae, around 6.5 million of them are in India. Due to its eradication, survivors have lived through their life and crossed 40–50 years of age. Falls and subsequent fractures are common in these patients, which are difficult to manage and cause considerable morbidity. We conducted this study to analyze the various strategies used in the management of fractures in a post-polio limb. Methods: This is a retrospective study analyzing a total of 10 adult patients with post-polio sequelae complicating the fractured limb, which was managed with varied treatment options such as locking compression plate, dynamic hip screw, and hemiarthroplasty. The functional status of the patient was evaluated with Vignos grade of disability. Results: All the patients (mean age of 34 ±12 years ) were treated with extramedullary internal fixation devices such as locking compression plating in 6 patients, dynamic hip screw fixation in 1 patient, cancellous screw fixation in 2 patients, and total hip replacement in one patient. Of the 10 cases, 8 were fresh fractures, and 2 presented with a failed fixation for repeated fracture sustained later on. The mean follow-up period was 37.8 ±16.4 months. Bony union was attained at a mean duration of 3.5 ±1.4 months in all the patients undergoing fracture fixation. None of the included had secondary implant failure or other complications. Conclusion: Patients with limbs involving post-polio sequelae are more prone to fractures and are difficult to manage using the standard treatment protocols. Extramedullary internal fixation device provides effective stability for bony union and optimal functional results without major complications in these small, deformed, osteoporotic, and hypo-vascularized femurs.

Evaluation of String of Pearls (SOP) locking plate system for management of femur fractures in dogs

Evaluation of String of Pearls (SOP) locking plate system for management of femur fractures in dogs

Advanced Physiotherapy of Supracondylar Femur Fracture with Implant In situ: A Case Report

Patient main concerns were restriction of movements of right knee and pus discharge from wound over right knee. In this case, the main clinical findings were a substantial loss in range of motion at right knee joints. There was also fixed flexion deformity seen over right knee. Diagnosis of the case was non united operated infected case of supracondylar femur fracture right side with implant in situ. In these types of circumstances, therapeutic approaches have been demonstrated to be useful. A 35-year-old male visited the orthopaedics who referred department of physiotherapy with complaints of restriction of movement of right knee and pus discharge from wound over right knee. Patient was examine in standing and supine position .On inspection, patient keeps right hip in flexion, knee in flexion patella pointing upwards and foot in equinus. According to the research, starting weight-bearing too soon can lead to failure of implant and mal-union. Supracondylar femoral fracture is a challenging condition to deal with and is associated with many secondary complications. An important role is played by physiotherapist in rehabilitation and supracondylar femur fracture management.

940 Neck of Femur Fracture Management and Outcomes during COVID-19: Overview of the Results from a District General Hospital in Wales

IntroductionThe COVID-19 pandemic has delivered significant challenges to the Orthopaedic community. Our study aims to assess the impact of COVID-19 on the management and outcomes of patient’s presenting with Hip Fractures to our DGH.MethodRetrospective data analysis was performed on a cohort of hip fracture patients who presented to our DGH before the COVID-19 pandemic (23/03/2019 to 05/05/2019) and were compared to those who presented during the COVID-19 pandemic (23/03/2020 to 05/05/2020). Minimum follow up was 30 days postoperatively.Results38 patients with hip fractures presented to our unit in the pre-COVID-19 period compared to 27 patients in the COVID-19 period. Total time from presentation to discharge, during COVID-19, demonstrated a 70.23% decrease when compared to the pre-COVID cohort. 30-day Mortality rates were higher in the COVID-19 cohort.ConclusionsDuring the COVID-19 pandemic our time to theatre and discharge of hip fractures has seen an improvement, with time to discharge decreasing by 70.23%. Comparison of our mortality rates has seen a fourfold increase likely influenced by the detrimental effects of COVID-19. Further work and larger numbers are required to see the true impact of COVID-19 on the management and outcomes of hip fractures in our DGH.

Functional Outcome of Distal Femur Pre-Contour Locking Plate

OBJECTIVE: To evaluate the effectiveness and functional outcome of distal femur fractures fixation withpre-contoured locking compression plate while using knee society score.METHODOLOGY: This Descriptive Case Series was conducted at Trauma Orthopedic Clinic (T.O Clinic)Karachi from January 2016 to December 2019. A simple random sampling technique was used to selectthe study participants. After written and informed consent, 100 patients were enrolled in the study.Patients between the age of 40 and 60 years, either sex presented with extra and intraarticular distalfemur fracture due to trauma that required surgical treatment were included. The functional outcomewas assessed in the 6th month by using the structured questionnaire of Knee Society Score. Agoniometer was used to assess knee flexion and extension range of motion.RESULTS: The mean age of participants was 52.18±6.06 years. The majority of 60(60%) patients were >50 years patients. Union was achieved in all cases which is evident on a radiograph in the majority ofcases (68%) between 17-23 weeks and the mean duration to achieve union was 21 weeks. The meanknee society score (functional) was 82.35±13.35, with a range of 48(52-100). The knee society score(knee) was 81.12±13.04, with a range of 48(50-98). 53 had excellent grades, 31 had good grades, 11 hadfair grades, and 5 had poor grades.CONCLUSION: Pre-contour locking compression plate gives excellent and good functional outcome fordistal femur fracture management with early recovery. KEYWORDS: Functional Outcome, Internal Fixation, Distal Femur Fracture, Knee Society Score

Comparison of Titanium Elastic Nailing and End-threaded Intramedullary Pinning for Distal Femoral Fractures in Young Dogs

Background: Femur fractures are common in immature dogs. As compared to stainless steel, titanium implants are lighter and allow controlled micro-motion at the site of fracture that stimulates early callus formation by limiting stress shielding. Cited literature reports successful clinical use of titanium elastic nails for the stabilization of long bone fractures in young human patients; however, there is paucity of information on this technique is dogs. This study was planned with an objective to compare titanium elastic nails (TENS) and single end-threaded pin for the management of femoral fractures in young dogs. Methods: The study included 20 clinical cases (10 male and 10 female) of dogs suffering from distal femoral fracture with a mean ± SD age of 5.70 ± 5.60 month, body weight 11.09 ± 4.48 Kg since 3.05 ± 2.35 days. The cases were divided into 2 groups; using TENS (n=10; group 1) and stainless steel end-threaded intramedullary pin (n=10; group 2). Result: Group 1 dogs demonstrated better fracture reduction score, early and uniform callus and better implant stability as compared to group 2, radiographically. Early weight bearing and minimum postoperative complications with better functional outcome including joint mobility was reported in group 1. In conclusions, TENS is superior fracture fixation technique for the repair of supracondylar or distal third femur fractures in young dogs with better functional outcome, minimal stiffness of stifle joint and early weight bearing, in comparison to single end threaded intramedullary pin.

Management of intertrochanteric femoral fractures at Level 1 trauma center in Leningrad Region

Relevance. An in-house Protocol for proximal femoral fracture management was developed at Vsevolozhsk Clinical Interdistrict Hospital of Leningrad Region.Intention To demonstrate possible practical application of preliminary federal clinical guidelines at Level 1 trauma center in Leningrad Region including comparative analysis of its efficacy when treating intertrochanteric femoral fractures.Methodology. Post-surgery outcomes were retrospectively assessed in 86 patients of Vsevolozhsk Clinical Interdistrict Hospital (Group 1, per Protocol) and 28 patients of Tosno Clinical Interdistrict Hospital (Group 2, w/o Protocol) with intertrochanteric femoral fractures (31A by Arbeitsgemeinschaft für Osteosynthesefragen classification and S72.1 by ICD-10).Results and Discussion. There were no significant differences in patients’ age, methods of anesthesia and osteosynthesis between the groups. Group 1 demonstrated statistically significant decrease in preoperative bed-days, time to sitting up in bed after surgery, ambulation with walkers and duration of hospitalization. Group 1 patients needed less assistance from other health-care professionals, less intensive therapy and blood transfusions.Conclusion. Adoption of in-house protocols, optimization of supply and staffing as well as involvement of multidisciplinary teams will improve management of proximal femoral fractures.