Management Of Intertrochanteric Fractures Research Articles

Trends in Medicare Utilization and Reimbursement for Intertrochanteric Femur Fractures: A 21-Year Review.

Sliding hip screw (SHS) and intramedullary (IMN) constructs are commonly utilized treatments for intertrochanteric (IT) femur fractures. The aim of this study was to assess the economic and utilization trends in the management of IT fractures among the Medicare population over the last 21years. A review of the publicly available Medicare Part B National Summary Data File for years 2000-2021 was performed. Collected data included true physician reimbursement and utilization numbers for all CPT codes pertaining to fixation of IT fractures with either SHS or IMN. A total of 1,361,112 IMN implants and 739,032 SHS implants were billed to Medicare for intertrochanteric femur fractures during the studied timeline. In this 21-year span, utilization of IMN increased 695% (9648-76,667), while utilization of SHS decreased by 96% (94,223-4224). After adjusting for inflation, the average physician reimbursement for SHS decreased by 34%, while IMN decreased by 41%. Absolute physician reimbursement was found to be $943.36 for SHS and $999.88 for IMN constructs. Intramedullary implants are being increasingly utilized while sliding hip screw, and intramedullary construct reimbursement continues to decrease for intertrochanteric femur fracture fixation. These trends suggest that opting for a sliding hip screw may be more cost-effective when the fracture pattern allows for either construct.

REVIEW OF A CLINICAL CASE OF TRANSTROCHANTERIC FRACTURE

Introduction: Intertrochanteric or transtrochanteric fractures are defined as extracapsular fractures of the proximal femur that occur between the greater and lesser trochanter. A clinical case is described below from the time of the initial incident to the final ambulatory control and updated notes on the management of intertrochanteric fractures are made. Objective: to describe this clinical case objectively and to make an analysis of the subject. Methodology: An objective description of the clinical case and a review with analysis of a total of 17 articles, including review and original articles, as well as cases and clinical trials, of which 9 bibliographies were used because the information collected was not sufficiently important to be included in this study. The sources of information were Cochrane, PubMed and Google Scholar; the terms used to search for information in Spanish, Portuguese and English were: transtrochanteric fracture, femur fracture, intertrochanteric fracture, femur osteosynthesis. Results: the use of cephalomedullary nails reduces fracture collapse in comparison with the screwed plate. Cephalomedullary nails have been more effective in intertrochanteric fractures with subtrochanteric extension and in fractures with a reverse obliquity pattern. The type of surgical treatment is based on the fracture pattern and its inherent stability, since the failure rate is highly correlated with the choice of implant and fracture pattern. Conclusions: it is of utmost importance to know the proper management of a fractured patient, especially when the fracture is severe and life-threatening. The management of proximal femoral fractures will depend on their classification and the condition of the affected individual. Therefore, a good imaging study is essential. When deciding on a surgical approach, the material to choose in the procedures has to be ordered with planning and caution, because this will vary according to the type of fracture, being usual to perform different types of surgeries in intertrochanteric fractures being more common the use of intramedullary nails compared to femoral neck fractures, where it is more common the use of cannulated screws, or prosthesis depending on the type of fracture trace. Our clinical case gives a brief view on the surgical management of the pathology, which has to be understood for the best performance of the patient. KEY WORDS: fracture, transtrochanteric, femur, intertrochanteric.

Cement Filling Technique to Prevent Greater Trochanter Displacement in Hip Arthroplasty for Femoral Intertrochanteric Fracture: A Technical Note.

With the increasing use of primary hip arthroplasty for management of intertrochanteric fractures, firm fixation and union of the greater trochanteric (GT) fragment are required during hip arthroplasty for management of intertrochanteric fractures. Various methods have been suggested to address this issue. However, displacement of the GT is a frequent occurrence. We have introduced a cement-filling technique for performance of hip arthroplasty of the proximal femur for achievement of immediate firm fixation of the GT. Cement filling during performance of hip arthroplasty for management of femoral intertrochanteric fractures is a valuable technique for preventing displacement of the GT and to encourage early mobilization.

Design innovation and rationale of the intramedullary implants for treating Intertrochanteric fractures: A review

Intertrochanteric fracture management require effective management strategies for early return to function and minimise complications. Intramedullary devices like proximal femoral nail have an biomechanical advantage, particularly in unstable intertrochanteric fractures. Such unstable injury patterns not only require precise reduction technique, but also right implant design to minimise the complications. Novel concepts of reduction like medial cortical support classification and antero-posterior reduction (Subtype classification system) refine the reduction strategies. Despite reporting of the reduction analysis, there has been continuing number of implant failures following proximal femoral nail implantation. Complications like ‘Z’ effect and reverse ‘Z’ effect are very well reported with the 2 screw Recon - Proximal femur nails. Analysis of failure and complications have constantly upgraded the designs of proximal femur nails. Design of the new generation intramedullary implants for treatment of intertrochanteric fractures like Gamma nail, PFNA-II (Proximal Femoral Nail Anterotation), Zimmer Natural Nail, Trigen Intertan nail and TFN – Advanced (Trochanteric Femoral Nail Advanced) are described in this review. While the new implant designs offer advancements, fundamental principles of reduction remains crucial for successful outcomes. Design rationale and instrumentation of each implant must be known at the time of application along with techniques of maintaining the reduction for a successful outcome.

Comparative Interrupted Time Series Analysis of Medical Expenses in Patients with Intertrochanteric Fracture Who Underwent Internal Fixation and Hemiarthroplasty.

The objective of this study was to assess postoperative direct medical expenses and medical utilization of elderly patients who underwent either hemiarthroplasty (HA) or internal fixation (IF) for treatment of a femoral intertrochanteric fracture and to analyze differences according to surgical methods and age groups. Data from the 2011 to 2018 Korean National Health Insurance Review & Assessment Service database were used. Risk-set matching was performed for selection of controls representing patients with the same sex, age, and year of surgery. A comparative interrupted time series analysis was performed for evaluation of differences in medical expenses and utilization between the two groups. A total of 10,405 patients who underwent IF surgery and 10,405 control patients who underwent HA surgery were included. Medical expenses were 18% lower in the IF group compared to the HA group during the first year after the fracture (difference-in-difference [DID] estimate ratio 0.82, 95% confidence interval [CI] 0.77-0.87, P<0.001), and 9% lower in the second year (DID estimate ratio 0.91, 95% CI 0.85-0.99, P=0.018). Length of hospital stay was significantly shorter in the IF group compared to the HA group during the first two years after time zero in the age ≥80 group. A noticeable increase in medical expenses was observed for patients who underwent HA for treatment of intertrochanteric fractures compared to those who underwent IF over a two-year period after surgery. Therefore, consideration of such findings is critical when designing healthcare policy support for management of intertrochanteric fractures.

The Role of Computed Tomography and Radiographs in the Management of Intertrochanteric Fractures.

The Intertrochanteric fracture is a common hip trauma encountered in elderly patients. There is a lack of general agreement regarding its surgical management and choice of implant. Purpose of this study to conclude the final decision matrix regarding surgical management of intertrochanteric fractures based on parameters assessed on plain radiographs and CT scan. We have retrospectively evaluated 55 patients with intertrochanteric fractures presented to our institute after informed consent with radiographs and CT scans between July 2017 to July 2018. Assessment of various parameters regarding fracture geometry and classification as well as measurement was done. Mean lateral wall thickness in present study was 20.76mm. Incidence of coronal fragments was 90.9% and absence of coronal fragment in 5 patients. We noted the cases with anterior comminution had also a posterior comminution rendered the fracture unstable in almost 20 % cases. Better understanding of fracture geometry by combined used of radiograph and CT scan enhanced preoperative planning, choice of suitable implant, helps in reduction manoeuvre and improving quality of osteosynthesis.

Long Versus Short Twin-Screw Integrated Cephalomedullary Nail (InterTAN) for the Surgical Management of Intertrochanteric Fractures of the Hip in Indians.

With an increasing life expectancy, there has been an increase in the incidence of intertrochanteric fractures. These fractures in the elderly are disabling and have a tremendous impact on the healthcare system. Despite substantial improvements in implant design and surgical techniques, high failure rates have been observed, varying with the severity of the fracture and the type of fixation. Intramedullary nails have become popular in recent times, especially in unstable fractures. The purpose of the present study is to compare the functional outcomes and complications of long versus short InterTAN cephalomedullary nails(Smith & Nephew, Memphis, Tennessee) used for intertrochanteric fracture fixation. All patients who had intertrochanteric fractures classifiable as AO OTA (Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association) 31-A and were treated with either a short InterTAN nail (SIN) or long InterTAN nail (LIN) between March 2017 and March 2020 were retrospectively assessed. AO subtype A1 fractures are considered to be stable whereas subtype A3 fractures are considered unstable. The stability of subtype A2 fractures is variable depending on the amount of posteromedial comminution.Both stable and unstable fractures were included. Patients aged above 18 years, who had a normal pre-injury gait and were operated on within seven days of trauma as per the records were included in the study. Postoperatively, functional outcome recorded using the modified Harris hip score (mHHS) was compared. The minimum follow-up period was 24 months. A total of 89 patients fulfilling the inclusion criteria were included. The mean age was 67.5 ±8.92 years. Of the patients,72% were above 60 years of age and 68% of those were females. The mean follow-up period was 31 months (range: 24-54 months). Of the patients,84.27% sustained fractures after a trivial trauma due to slip and fall at home.All fractures had united at nine to 12 months, except one had a screw cut-out, which required revision surgery. The mean mHHS at three monthsand nine to 12 months postoperatively was 42.46 ±3.62 and 87.24 ±6.44, respectively. The patients who were treated with LIN had a significantly better functional outcome at three-month follow-up (p-value < 0.05); however, post one year, this effect plateaued and no significant difference was seen when comparing SIN with LIN.The resultsalso showed that there was no significant difference in complications among SIN and LIN. Both LIN and SIN are equally effective for the surgical management of intertrochanteric fractures, and have similar functional outcomes.SIN, however, has shorter surgical procedure time and lesser estimated blood loss. LIN allowed in early recovery evidenced by better Harris hip scores at three months duration, thus improving the quality of life in the initial months post surgery. The choice of implant should be individualized according to fracture anatomy, patients' needs and expectations, and surgeons' expertise.

Role of Proximal Femoral Nail Antirotation in Management of Unstable Intertrochanteric Fracture of Femur

Background: The aim of this study is to evaluate the management of intertrochanteric fracture of the femur using Proximal Femoral Nail Antirotation (PFNA).&#x0D; Materials and methods: Sixty patients of unstable pertrochanteric fractures were treated by closed reduction and internal fixation by proximal femoral nail antirotation from July 2015 to June 2017. Four patients were lost to follow-ups. The remaining 56 patients were followed for a mean period of 2 years. The results were evaluated by assessing the patients regarding their clinical and functional outcome at follow up as per kyle’s criteria&#x0D; Results: Peroperative failure to proximal head neck blade fixation (n-1) jamming of nail (n=2) and post operative lateral migration of head neck blade (n=1) and fracture related infection (n=1) were complications observed. End results were excellent in 46.34%, good in 36.58%, fair is 14.64% and poor in 2.43%.&#x0D; Conclusion: Proximal Femoral Nail Antirotation (PFNA) is the biomechanically and biologically suitable implant for the management of intertrochanteric fracture of the femur.&#x0D; JCMCTA 2020 ; 31 (1) : 64-70

Risk factors affecting the outcome of management of intertrochanteric fractures with dynamic hip screw in elderly patients: a retrospective, observational study

Background: Among the different fixation procedures for intertrochanteric fractures, dynamic hip screw fixation is the most used therapy. Present study evaluated the risk factors affecting the outcome of intertrochanteric fractures managed by dynamic hip screw fixation. Methods: This was an observational retrospective study conducted between March 2021 and February 2022. Patients with intertrochanteric fractures aged &gt;60 years presenting within a week after incurring the fractures were enrolled. Evan’s and AO/OTA classification were used to categorize patients. “Failed” surgery was considered based on one of the following radiographic criteria. Functional outcomes were assessed at 6-months by Harris hip score (HHS). Results: 40 patients were enrolled, majority being females (n=22, 55%) with mean age of 67.79±4.76 years. Commonest mode of injury was fall while standing (n=32, 80%). Based on Evans classification, majority cases were stable fractures (n=25, 62.5%). By the AO/OTA classification, majority patients were under A2 class (n=22, 55%). The 30 cases (75%) had outstanding to good outcomes based on HHS assessment. 8 patients (20%) had “failed” surgical outcomes of which commonest presentations were &gt;20 mm lag screw pull-out (n=4, 10%) and mal union (n=2, 5%). Mean age, and number of obese patients were found to be significantly greater in the “failed fracture” subgroup, versus “united fracture” subgroup (p&lt;0.05). Significantly greater number of cases in “failed fracture” subgroup belonged to Evans’ class IV or V, and to A3 class of AO/OTA classification (p&lt;0.05). Conclusions: Patient factors like greater age, obesity and intertrochanteric unstable fractures as indicated by Evans’ and AO/OTA classification were risk factors affecting the outcome of intertrochanteric fractures, managed with dynamic hip screw.

CLINICAL AND RADIOLOGICAL ASSESSMENT OF PATIENTS WITH INTERTROCHANTERIC FRACTURES MANAGED WITH PROXIMAL FEMORAL NAIL WITH HELICAL BLADE

Various treatment methods have been described for the treatment of intertrochanteric fractures. We present our experience with proximal femoral nail with helical blade in the management of intertrochanteric fractures at SGT Medical College Hospital and Research Institute, Gurugram. Methods: This study was conducted from October 2018 to April 2020 and included 30 patients above 18 years presenting with intertrochanteric fractures of femur managed by proximal femoral nail with helical blade. Clinical and Radiological evaluation of the patients was done at 6,12,18 and 24 weeks. Functional outcome was assessed according to Modied Harris Hip Score and was graded excellent, good, fair or pair as per the score. Results: The average age of patients in the present study was 58.16 years with slight male preponderance. The average operating time in the present study was 71.8 minutes. The average time of union was 18 weeks, with one case of implant failure and two cases of delayed union. average value of Neck-Shaft Angle in our study was 128.26 and the average Tip-Apex Distance (TAD) was 21.63mm. There was a case each of supercial infection and varus collapse. The average Modied Harris Hip score in present study was 90.5 with a range of 78-99, excellent in 63.33% patients, good in 26.66% of the patients and fair in 10% of the patients as per the Modied Harris Hip scoring system.

INTERTROCHANTERIC FEMUR FRACTURE

Introduction: Intertrochanteric fractures are a type of extracapsular fractures of the proximal femur occurring between the greater and lesser trochanter. They are frequently seen in the elderly because their incidence is higher as life expectancy increases. Objective: to describe the current information related to epidemiology, anatomy, presentation, classification, evaluation and management of intertrochanteric fractures. Methodology: a total of 35 articles were analyzed in this review, including review and original articles, as well as clinical cases, of which 27 bibliographies were used because the other articles were not relevant to this study. The sources of information were PubMed, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: transtrochanteric, intertrochanteric, femur, fracture, fratura. Results: Intertrochanteric fractures have a bimodal presentation. They have a female to male ratio ranging from 2:1 to 8:1, possibly due to changes in bone metabolism after menopause. They are frequently seen in the elderly because their incidence is higher as life expectancy increases. Plain radiographs are still the initial choice to complement the diagnosis in this type of fractures. It is preferable to take anteroposterior (AP), AP and lateral cross pelvis projections of the affected hip and full body radiographs of the affected femur. Surgical treatment is preferred over conservative treatment except in cases that contraindicate surgery or anesthesia. Conclusions: Intertrochanteric fractures are a type of extracapsular fractures of the proximal femur occurring between the greater and lesser trochanter. Femur fractures have several classifications, recently the classification of intertrochanteric fractures is based on the stability of this area. It is of vital importance to evaluate whether it is an open or closed fracture, in addition to assessing the neurovascular status. The surgical treatment has the mission of providing a stable internal fixation that allows early mobilization and full weight bearing. There are several tools and techniques to provide surgical treatment, however, in our current reality, intramedullary nails are the most used devices in the treatment of intertrochanteric fractures. Regardless of the therapeutic alternative chosen, the mortality risk is 20% to 30% in the first year after the fracture, with males being more affected than females. KEY WORDS: transtrochanteric, intertrochanteric, femur, fracture.

Outcome of intertrochanteric fracture managed with proximal femoral nail antirotation 2

Background: Intertrochanteric fracture is a common condition seen in elderly population which is managed with operative procedure in the department of orthopedics. The proximal femoral nail antirotation (PFNA) system was developed by the AO/ASIF in 2004 for this fracture that provides optimal anchoring and stability when the implant is inserted into the osteoporotic bone. The main characteristic of the implant is the use of a single blade with a large surface area and insertion of the blade compacts the cancellous bone. Aims and Objectives: The aim of the study was to study the functional outcome of intertrochanteric fracture managed with PFNA2. Materials and Methods: The prospective and observational study was conducted in patients diagnosed with intertrochanteric fracture admitted in orthopedic ward, Western Regional Hospital, Pokhara. Pre- and post-operative fracture alignment, Harris hip score (HHS), post-operative complications were taken into account. Results: Out of 55 cases taken into study, 36 (65.45%) were male and 19 (34.55%) were female. Maximum number of patients allocated in our study falls in 71–80 years group (29%) with least number in age group of 90 years or more (1.9%). Right-sided intertrochanteric fracture were 27 (49%) and left side involved were 28 (51%). Twenty-eight (51%) falls in Type II and 27 (49%) falls in Type III Boyd and Griffin intertrochanteric fractures. There was a marked improvement in fracture alignment after the operation with various parameters taken into consideration. Pre-operative HHS was 5.52±5.38 (Poor) and immediately after the procedure, it was 30.41±3.04 (Poor), 89.86±3.59 (Good) at 6 months, and 95.56±1.257 (Excellent) at 12 months. One case had blade cut out at immediate post-operative period, eight cases had surgical site infection, and five cases had GT fracture. Conclusion: This study showed that PFNA2 is an effective operative procedure in management of intertrochanteric fractures by achieving better fixation through bone impaction especially in osteoporotic bone.

Comparative Study between Short and Long Proximal femoral Nailing in Management of Intertrochanteric Fracture in Elderly Patients

Comparative Study between Short and Long Proximal femoral Nailing in Management of Intertrochanteric Fracture in Elderly Patients

Comparative study of the management of inter-trochanteric fractures in the elderly: Trochantric femoral nail vs dynamic hip screw

Introduction: Trochanteric fractures are among the most common injuries necessitating hospital admission. Regardless the type of fracture, trochanteric fractures can lead to substantial morbidity and mortality, especially in elderly patients. Surgery has been the mainstay of the treatment for these fractures to allow early mobilization of the patient. Among the surgical treatment, dynamic hip screw (DHS) as extramedullary power transmission system and trochanteric fixation nail (TFN) as the means of intramedullary stabilization are the established and standard in the treatment of trochanteric femoral fractures, particulary in elderly patients. AIM: The present study was designed to compare the results of TFN and DHS in treatment of intertrochanteric fracture femur. Material and methods: After fulfilling the mentioned criteria, patients were screened for medical fitness and then further randomized in group I and II. Group I-Patients treated with TFN (n=30). Group II-Patients treated with DHS (n=30). The clinical assessment was done according to the “Salvati and Wilson Function Score (SWS Score)”. Blood loss measurement and complications were also studied and compared. Results: Thirty patients were included in the study in each group. Salvati and Wilson Function Score (SWS) Score was used to evaluate the results at follow up. Mean ± SD of SWS at 16 weeks & 24 weeks was 18.93±3.34 & 28.80±5.33 respectively in group I whereas in group II, the value was 15.13±2.18 & 21.67±5.14 respectively. P-value was significant (< .01) Complications were observed in follow ups and the most frequent was varus displacement. It was observed that out of 30 subjects of Group 2, maximum i.e. 8 (26.67%) subjects had varus deformity whereas out of 30 subjects of group 1, only 1 (3.33%) subject had varus deformity Other complications include Non Union and Implant failure. Conclusion: We conclude that the advantage with Trochanteric fixation nail is that a smaller exposure is required than for a sliding screw, it may therefore be associated with lesser blood loss, shorter operating time and less morbidity.

Unstable Intertrochanteric Fracture Management by Proximal Femoral Locking Plate

Unstable Intertrochanteric Fracture Management by Proximal Femoral Locking Plate

Comparative Study between Dynamic Hip Screw versus Proximal Femoral Nail Devices in the Management of Intertrochanteric Fractures

Objective: To compare the dynamic hip screw versus proximal femoral nail devices in the management of intertrochanteric fractures Design of the Study: It was a cross-sectional survey. Place and Duration of Study: This study was carried at the Department of Orthopaedic and Spine Surgery, Sahara Medical College (Sughra Shafi Medical Complex), Narowal from April 2022 to September 2022. Patients and Methods: In this study, 70 patients of both sexes, ranging in age from 40 to 70, had intertrochanteric fracture surgery. Two treatment groups were created by randomly dividing these patients; Group-A (n=35) patients got proximal femoral nailing while Group-B (n=35) patients underwent fracture fixation with DHS. The outcome variables that were used to compare the two groups were the frequency of infection (diagnosed clinically upon appearance of any two of the following signs within 4 weeks after surgery: redness around the wound, serosangious discharge, and fever &gt;100oF). Every participant's signed informed permission was obtained. Results of the Study: The age of the patients ranged from 40 years to 70 years with a mean of 54.96±8.34 years. There were 28 (40%) male and 42 (60%) female patients. 46 (65.7%) patients had Type-I and 24 (34.3%) patients had Type-II fracture according to Evan’s Classification. The frequency of infection was significantly higher in the DHS group (31.4% vs. 0.0%; p=0.000) as compared to PFN group. Conclusion: In patients with intertrochanteric fractures, proximal femoral nail was found to be superior to DHS in terms of a significantly reduced risk of infection, regardless of the patient's age or gender. This supports the preferred use of proximal femoral nail in future practise, provided the necessary hardware and surgical skills are available. Keywords: Dynamic Hip Screw, Proximal Femoral Nail, Intertrochanteric Fractures, Infection, Evan’s Classification

Outcomes of Intertrochanteric Fractures in Patients Managed with Proximal Femoral Nail Antirotation

Background: The older population is quite susceptible to intertrochanteric fractures. These fractures generally affect elderly patients with several medical conditions and eventually result in the patient losing their functional independence. Different treatment modalities are used for the management of proximal femoral fractures.s Objective: Outcomes of intertrochanteric fractures in patients managed with Proximal Femoral Nail Antirotation Methodology: The current study was descriptive study carried out at the orthopedic department, Qazi Hussain Ahmad Medical College, Nowshera from June 2021 to June 2022. All the enrolled patients were operated under an image intensifier by Proximal Femoral Nail Antirotation. Consultations after surgery were planned every two weeks for the first month, and then every month for the next six months. Radiographs were used to evaluate the radiological union at each visit. The functional outcome was determined with Harris Hip Score. SPSS version 23 was used to enter and analyze all of the data. Results: In the current study, totally 40 patients with intertrochanteric fractures were enrolled. The male participants in this study were 12 (30%) while female patients were 28 (70%). In all of our enrolled patients, radiological union occurs in a mean (SD) duration of 14.9 (2) weeks. The functional outcome in our study, based on Harris Hip Score was excellent in 12 (30%) patients, good in 18 (45%), fair in 8 (20%) patients and poor in 2 (5%) patients. Conclusion: Our study concludes that management of intertrochanteric fractures with proximal femoral nail antirotation is an effective procedure for excellent and good functional outcomes and less post-operative complication. Keywords: intertrochanteric fractures; Proximal Femoral Nail Antirotation; functional outcomes

Management of intertrochanteric femur fracture by proximal femoral nail and its functional outcome: A prospective study

Background: Intertrochanteric fractures are commonly encountered in orthopedics practice. Achieving early mobilization in patients with intertrochanteric fractures is the cornerstone of management. Proximal femoral nailing (PFN) is gaining popularity because of better tolerance of this procedure as well as minimal complication rates. We conducted this study to find out the functional outcome of patients with intertrochanteric fractures treated by PFN. Aims and Objectives: The objectives are as follows: (1) To find out the functional outcome of patients with intertrochanteric fractures treated by PFN. (2) To find out complications in patients treated by PFN. Materials and Methods: 60 patients with intertrochanteric fracture were included in this prospective study on the basis of a predefined inclusion and exclusion criteria. Under spinal anesthesia closed reduction and internal fixation by PFN were done. Open reduction was done in cases where closed reduction was not possible. Functional outcome as assessed by Harris hip score. Statistical analysis was done using SSPS 21.0 Software and P&lt;0.05 was taken as statistically significant. Results: Out of 60 studied cases there were 37 (61.67%) males and 23 (38.33%) females with a M: F ratio of 1:0.62. The most common type of fracture was AO A3.2 (simple transverse fracture) which was seen in 28 (46.67%) patients followed by AO A3.1 (Simple Oblique fracture) and AO A3.3 (wedge fracture or multi-fragmentary fracture). Functional outcome was excellent to good in 41 (68.33%) patients whereas fair and poor outcome was seen in 12 (20%) and 5 (8.33%) patients, respectively. Very poor outcome was seen in 2 (3.33%) patients. Conclusion: PFN is an excellent technique for management of intertrochanteric fractures. It is associated with excellent outcome in majority of the cases and is associated with minimal complications.

Surgical management of intertrochanteric fractures of femur with Proximal Fixation Nail Anti-Rotation-II

Background: Intertrochanteric Femur Fractures are usually complicated withassociated co-morbidities like osteoporosis, diabetes, hypertension, renal failure. In suchcircumstances, nonoperative treatment is mainly reserved for poor medical candidates and non-ambulantpatients with minimal discomfort after fracture. Objective: To study the management of intertrochanteric fractures with proximal femoral nail anti-rotation-II. Material and Methods: Present study was conducted on the patients admitted in at BTGH attached to MR medical college, Kalburgi &amp;Shri B M Patil Medical College Hospital and Research Centre, Vijayapura,with diagnosis of intertrochanteric fractures from October 2017 to April 2019. A total of 21 cases were taken in our study. Results: Majority of the cases i.e., 12(60%) were in the age group of 61- 80 years, followed by 3 cases in the age group 41-60 years. The mean age was 69years. Majority of the patients were males 13 (65%) and 7 (35%) were females. We took less number of exposures time in case of comminuted fractures where reduction was not a problem. Blood loss was more in open reductions. The HARRIS HIP SCORE grading was done and 2 patients were graded excellent, 16 as good, 2 as fair and none as poor.

Investigation into the problems of Proximal Femoral Nails (PFN) in the management of intertrochanteric fractures

Aim: An investigation into the problems of proximal femoral nails in the management of intertrochanteric fractures. Methods: This research comprised 50 patients with intertrochanteric fractures who received intramedullary fixation with PFN. The limb was adducted and held in traction. Under C-arm guidance, the entry location was seen, and a guide wire was passed over the fracture site. To repair the fracture, a short PFN with proximal and distal locking was inserted under C-arm guidance. Results: There were 33 men and 17 women. In 28 cases, the right side was implicated, whereas the left side was engaged in 22 patient. The average period of follow-up was 13 months. Closed reduction was used in 40 patients, whereas open reduction was used in 10 patients. Complications occurred in 15 of 50 individuals. All were early issues, and the causes of failure were investigated. Complications include a broken nail at the distal locking screw level (2%), screw back out (2%), perioperative proximal femur fracture (4%), inadequate fracture reduction (2%), varus distortion (4%), improper positioning of the distal locking screw (2%), placement of a single screw in the neck (4%), abductor lurch (4%), and Infection on the surface (4%).