Management Of Unstable Intertrochanteric Fractures Research Articles

Comparison of Twin Screw Derotation Type Versus Single Helical Blade Type Cephalomedullary Nail in the Management of Unstable Intertrochanteric Fractures.

The intertrochanteric fracture is a frequently occurring fracture, often attributed to osteoporosis in older populations. Recently, there has been a proposal to perform early surgical fixation on elderly patients to facilitate early rehabilitation. This approach has been shown to have a beneficial effect in lowering comorbidities. The study aims to compare the efficacy of the twin screw derotation type cephalomedullary nail with that of the single helical blade type cephalomedullary nail in the management of unstable intertrochanteric fractures. The research sample included patients from the orthopedic outpatient and emergency departments of Adesh Medical College and Hospital,Ambala Cantt, India, who were scheduled for surgery for unstable intertrochanteric femur fractures. The patients were categorized into two groups according to the kind of implant they were given: either a twin screw derotation cephalomedullary nail or a single helical blade cephalomedullary nail. The functional result was evaluated by comparing the modified Harris hip score (HHS). Patients with unstable intertrochanteric fractures, including reverse oblique fractures and fractures with posteromedial comminution, as well as patients who provided consent, were included in this study. Thirteen individuals received treatment with proximal femoral nail antirotation (PFNA2), whereas 19 individuals received treatment with proximal femoral nail (PFN). The mean age in the PFNA2 group was 69.51, whereas the mean age in the PFN group was 70.804. There were three patients in the PFNA2 group and five patients in the PFN group who had a tip apex distance of more than 25 mm. According to the Cleveland index, nine patients in the PFNA2 group and eight patients in the PFN group had an implant location that was not optimum. Four patients in the PFNA2 group and seven patients in the PFN group had a neck shaft angle difference of more than 10° between their undamaged and operated sides. The mean HHS was 74.55 for the PFNA2 group and 69.88 for the PFN group. The PFNA2 group exhibited four problems, whereas the PFN group had five issues. The study found that both implants offer similar functional outcomes, with adherence to specific radiological parameters optimizing results. While both face similar challenges with osteoporosis, there was no notable distinction between them. Notably, the PFNA2 group showed superior outcomes in perioperative morbidity.

THE RETROSPECTIVE ANALYSIS OF TRIGEN INTERTAN NAIL IN THE TREATMENT OF UNSTABLE INTERTROCHANTERIC FEMORAL FRACTURES AT HOSPITAL FOR TRAUMATOLOGY AND ORTHOPAEDICS.

Intertrochanteric fractures are highly prevalent among the elderly population, with approximately 90% occurring in individuals aged over 65. These geriatric fractures are associated with elevated mortality rates and significant functional impairment. Common treatment modalities for unstable intertrochanteric fractures include proximal femoral nail antirotation (PFNA) and the InterTan nail (IT). PFNA and IT are frequently employed due to their lower failure rates and favorable biomechanical properties, resulting in positive clinical outcomes for the management of unstable intertrochanteric fractures. The unique design of the IT nail, featuring two cephalocervical screws within an integrated mechanism, permits linear intraoperative compression and rotational stability of the neck and head fragment. In this study, we assess the clinical outcomes of IT nail utilization in the treatment of intertrochanteric fractures at the Hospital for Traumatology and Orthopedics. This study comprises a retrospective analysis and case series report. Between February 2021 and August 2021, we retrospectively evaluated 35 patients who underwent treatment with the IT nail for unstable intertrochanteric fractures. Epidemiological data, operative duration, intraoperative blood loss, intraoperative blood transfusion requirements, length of hospital stay, bone healing rates, and IT nail-related complications were recorded. The mean age of the patients was 70.97 ± 16.97 years, with a mean operative time of 60 minutes, mean intraoperative blood loss of 160.86 ± 72.8 ml, mean intraoperative blood transfusion volume of 203.43 ± 189.29 ml, and a mean hospital stay of 7 days. Bone healing was observed in 97.14% of cases. The treatment of unstable intertrochanteric fractures using the IT nail in elderly patients was successful. Our findings indicate favorable clinical outcomes in terms of surgical duration, intraoperative blood loss, hospitalization duration, and union rates for elderly patients. Further investigations are warranted to validate these early results.

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).
 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
 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%.
 Conclusion: Proximal Femoral Nail Antirotation (PFNA) is the biomechanically and biologically suitable implant for the management of intertrochanteric fracture of the femur.
 JCMCTA 2020 ; 31 (1) : 64-70

Bipolar Hemiarthroplasty in Unstable Intertrochanteric Fractures with an Effective Wiring Technique.

Bipolar hemiarthroplasty has recently been acknowledged as an effective option for treatment of unstable intertrochanteric fracture. Trochanteric fragment nonunion can cause postoperative weakness of the abductor muscle and dislocation; therefore, reduction and fixation of the fragment is essential. The purpose of this study was to perform an evaluation and analysis of the outcomes of bipolar hemiarthroplasty using a useful wiring technique for management of unstable intertrochanteric fractures. A total of 217 patients who underwent bipolar hemiarthroplasty using a cementless stem and a wiring technique for management of unstable intertrochanteric femoral fractures (AO/OTA classification 31-A2) at our hospital from January 2017 to December 2020 were included in this study. Evaluation of clinical outcomes was performed using the Harris hip score (HHS) and the ambulatory capacity reported by patients was classified according to Koval stage at six months postoperatively. Evaluation of radiologic outcomes for subsidence, breakage of wiring, and loosening was also performed using plain radiographs at six months postoperatively. Among 217 patients, five patients died during the follow-up period as a result of problems unrelated to the operation. The mean HHS was 75±12 and the mean Koval category before the injury was 2.5±1.8. A broken wire was detected around the greater trochanter and lesser trochanter in 25 patients (11.5%). The mean distance of stem subsidence was 2.2±1.7 mm. Our wiring fixation technique can be regarded as an effective additional surgical option for fixation of trochanteric fracture fragments during performance of bipolar hemiarthroplasty.

Comparing the supine and lateral positions for proximal femoral nail use in the treatment of intertrochanteric femoral fractures

Background/Aim: The management of unstable intertrochanteric fractures (ITF), which are becoming more common, is still a significant issue for public healthcare systems. As a result, successful fracture therapy is becoming a more crucial aspect of orthopedic practice. To treat older patients who have an ITF, this study compared the therapeutic outcomes and side effects of proximal femoral nail anti-rotation (PFNA) conducted in lateral decubitus and supine postures. Methods: One-hundred twenty patients between the ages of 65 and 90 who underwent PFNA surgery as a result of an unstable femoral ITF brought on by low-energy trauma were included in the study, which was conducted as a retrospective cohort study. Two groups of patients were established: (1) Group L, consisting of patients who underwent surgery in the lateral decubitus position and (2) Group S, consisting of patients who underwent surgery in the supine position. Several patient characteristics were compared: (1) demographic information, (2) length of hospital stay, (3) length of surgery, (4) intra-operative blood loss, (5) incision length, (6) number of intra-operative fluoroscopies, (7) duration of activity outside of bed, (8) duration of clinical recovery of fracture, (9) surgical complications, (10) patient outcomes, and (11) Harris hip scores (HHS). Results: Group L (60 patients) consisted of patients who underwent surgery in the lateral decubitus position, while Group S (60 patients) underwent surgery in the supine position (60 patients). The average hospital stay for patients receiving PFNA was 8.2 days for those in the supine position compared to 8.0 days for those in the lateral decubitus position. The difference between the operative times was significant (P<0.001) with 48.6 and 59.7 min in Groups L and S, respectively. Intra-operative blood losses in Groups L and S were 129.2 and 151.5 mL, respectively. Compared to Group S, Group L's mean incision length was much lower at 6 cm (as compared to 8 cm in Group S). The difference between the mean intra-operative radiation exposure times for Groups L and S was considerable at 9.38 versus 12.5 min. The mean times for fracture union and the HHS were not statistically different between the two groups after 12 weeks of treatment. Conclusion: ITFs in elderly patients can be successfully treated with PFNA in either the lateral decubitus or supine position. Surgical duration, blood loss, intra-operative X-ray exposure, and incision lengths were all reduced with PFNA performed in the lateral decubitus position. As a result, treatment of ITFs in older individuals may involve PFNA fixation in the lateral decubitus position. Particularly for people with a muscular gluteal region or obese patients, the lateral decubitus position is advised.

Prospective Comparative Study Between Proximal Femoral Nail vs. Screw Augmented Proximal Femoral Nail in Unstable Intertrochanteric Fractures of Femur.

Introduction The proximal femoral nail (PFN) is a widely accepted fixation method for the management of unstable intertrochanteric fractures. Reconstructing the lateral trochanteric wall and ensuring the stability of the trochanteric fragments are considered to be essential for enhancing the prognosis of unstable intertrochanteric fractures. The aim of this study is to evaluate and compare the results of the management of unstable intertrochanteric fracture of the femur using PFN and the screw-augmented PFN (aPFN). Methods This prospectivecomparative study was undertaken from January 2020 to July 2021 and included 60 patients presenting with unstable intertrochanteric fractures (AO/OTA type 31-A2.2 and 31-A2.3) at a tertiary care teaching institute in northern India. The enrolled patients were randomly divided into two groups(group 1 and group 2)andwere managed with screw-augmented PFN and PFN, respectively. Functional outcome was evaluated using the Salvati and Wilson score at the 12-month follow-up. SPSS version 24.0 (IBM Corp., Armonk, NY, USA) was used for statistical analysis. A p-value less than 0.05 was regarded as significant. Results The average time to union of the fractures in group 1 was 12.66 ± 1.68 weeks, while it was 13.47 ± 1.47 weeks in group 2 (p = 0.055). At the 12-month follow-up, the average functional outcome, as evaluated by Salvati and Wilson score,was 34 ± 2.40 in group 1, whereas it was 31.58 ± 4.4 in group 2; and the difference was observed to bestatistically significant (p = 0.011). Group 1 had 28 patients (93.33%) with excellent to good results, while group 2 had 25 patients (83.33%) with excellent to good results. One patient in group 1 and five patients in group 2 had poor outcomes at the 12-month follow-up. Conclusion Screw-augmented PFN has better functional outcomes as compared to PFN alone for the management of unstable intertrochanteric fractures. Hence, in our opinion, screw augmentation of PFN may be the better fixation technique for most unstable intertrochanteric femur fractures.

Functional Outcome of Hemiarthroplasty of the Hip for Unstable Intertrochanteric Fractures of the Femur in Elderly Patients: A Prospective Study.

Introduction It is frequently challenging to treat an unstable intertrochanteric fracture in elderly people by internal fixation because of difficult anatomical reduction, poor bone quality, the need for prolonged bed rest and restricted ambulation. As an alternative to internal fixation, cemented bipolar hemiarthroplasty has been used as a treatment for unstable intertrochanteric fractures to avoid the postoperative immobilization-related complications. The aim of this study was to evaluate the functional and clinical outcomes of primary cemented bipolar hemiarthroplasty for elderly patients with unstable intertrochanteric fractures. Methodology A prospective study was conducted that included 30 patients who were admitted to the apex trauma center at a tertiary care centerfrom January 2019 to August 2020 with unstable intertrochanteric fractures (Association for Osteosynthesis/Orthopaedic Trauma Association, or AO/OTA, types 31-A2.2 and 31-A2.3); patients treated with cemented bipolar hemiarthroplasty, with at least one year of follow-up were included in the study. Basic descriptive statistics were used and the results were presented in frequencies, percentages for categorical variables and means and standard deviations for continuous variables. Results According to the Harris Hip Score, at the end of 12 months, 9 patients (30%) had excellent results, 14 patients (46.67%) had good results, 5 patients (16.67) had fair results, and 2 cases (6.67) had poor results. With cemented hemiarthroplasty, 87.7% of older patients with unstable intertrochanteric fractures were able to walk sooner, and the results were good. Conclusion Hemiarthroplasty of the hip with a cemented bipolar prosthesis appears to be a reliable treatment method for the management of unstable intertrochanteric fractures in elderly patients with osteoporosis; it allows for early ambulation and leads to a favorable functional outcome in most patients following surgery.

Management of unstable intertrochanteric fracture by proximal femoral nailing with trochanteric buttress plating

Aim: The aim of the study is to evaluate the anatomical reduction and augmenting the lateral wall with trochanteric buttress plating along with PFN in an unstable IT fractures with broken lateral wall. Background: Unstable IT fractures have poor contact between fragments, loss of posteromedial support, reverse oblique type, severe comminution and has subtrochanteric extension. Unstable IT fracture with coronal split presents a great challenges to an orthopaedic surgeon. This study evaluates augmenting the lateral wall with trochanteric buttress plating along with PFN for unstable IT fractures with a broken lateral wall.Design: Prospective study.Materials and Methods: Totally 20 patients of unstable intertrochanteric fractures treated in Rajah Muthiah Medical College and Hospital were studied during the study period August 2020 to November 2022.Result: In our study the patients were followed up for 1 year. Modified Haris Hip Score was excellent in 60% of the patients with the mean value of 87.25. Mean duration of surgery 99.25 min. Mean blood loss 330ml.Mean time of union 15.15 weeks.Conclusion: Although reconstruction of calcar is a main predictor of successful trochanteric fracture fixation, augmenting the lateral wall with Trochanteric buttress plate along with PFN is also a Major factor for successful fixation of unstable IT fractures.

Proximal femoral nail antirotation versus external fixation for unstable intertrochanteric fractures in elderly patients: A randomized controlled trial.

This study aimed to compare the clinical and radiographic outcomes of the proximal femoral nail antirotation (PFNA) and external fixation in the management of unstable intertrochanteric fractures in elderly patients. Eighty-seven of 114 patients with unstable intertrochanteric fractures were included in this study between January 2015 and June 2019, 46 were fixed with PFNA implant and 41 with external fixator. Patient baseline characteristics, functional and radiographic results, and postoperative complication were documented and compared between the 2 groups. Prolonged operation duration, increased fluoroscopy time, and excess blood loss occurred in PFNA group. The functional results scores seemed higher in the PFNA than external fixation group in the first semester, and thereafter, there was no significant difference between groups. On early postoperative radiographs, better femur neck-shaft angle was acquired in the external fixators device, but the difference did not continue at final visit. The incidence rate of overall complications was 43.5% for the group PFNA and 100% for the group external fixation. Fewer postoperative complications occurred in PFNA than external fixator group when unstable intertrochanteric fractures were treated. Nevertheless, there was no significant difference detected in final functional and radiographic outcome between the 2 groups.

Intertrochanteric fractures treated by diaphyseal support arthroplasty with hook plate vs cerclage wires only: A retrospective cohort study

BackgroundThe treatment of unstable fractures of the intertrochanteric region of the hip in the elderly is controversial. Conventionally, internal fixation with intramedullary nail or a dynamic hip screw is the treatment of choice in intertrochanteric fractures. Nowadays, some authors encouraged the use hip arthroplasty for management of these fractures with good outcome. The aim of this study is to compare total hip arthroplasty with hook plate against total hip arthroplasty with cerclage cables in the management of unstable intertrochanteric fractures. Materials and methodsOut of 100 admitted patients to a central university hospital in Beirut between 2013 and 2019 with a diagnosis of unstable intertrochanteric fracture of the hip, only 64 (36 hook plate vs 28 cerclage) patients were selected. This is a retrospective study, patients were excluded if lost to follow up, or if follow up less than one year is available. The data were retrieved from inpatient and outpatient hospital files. Functional outcomes were assessed according to ambulatory capacity. The main clinical measures were early postoperative full weight bearing, postoperative complications, functional outcome and radiologic assessment done by a radiologist in addition to measuring the dysfunction via the Harris Hip Score. ResultsThe time to full weight bearing, the rate of postoperative complications, radiologic outcome and the functional outcomes were more satisfactory in the hook - plate group than in the cerclage - cable group. ConclusionAccording to the results, total hip arthroplasty with hook plate is considered the preferred modality of treatment in mobile elderly patients above sixty-five years of age with an unstable intertrochanteric femoral fracture, despite being a bulky foreign material that can lead to trochanteric bursitis.

Assessment of Usefulness of CT Scan in AO Classification of Intertrochanteric Fractures: A Prospective Observational Study.

The sliding hip screw (SHS) is the gold standard for the management of stable intertrochanteric (IT) fractures. However, intramedullary implants are now being increasingly used for management of unstable IT fractures especially those with a compromised or vulnerable lateral wall. Therefore, accurate classification of fracture is important to ensure proper surgical planning and choice of implant. The AO classification for IT fractures is based on plain radiographs alone and many authors have reported it to have poor inter- and intra-observer agreement. Therefore, the objectives of the study were to assess the improvement in inter- and intra-observer agreement of the AO classification after addition of CT scan to plain radiographs, to assess the change in pattern of AO classification on addition of CT scan to plain radiographs and to assess percentage of times, stable lateral wall seen on plain radiographs is classified as unstable or broken on CT scans. Fifty-four patients of intertrochanteric fracture were included in study. Plain radiographs of patients were shown to three orthopedic surgeons. They were asked to document the AO classification of the fracture, and comment on the integrity of the lateral wall. Then, CT scans with 3D reconstructions of the same patients were provided along with the radiographs and they were asked to classify the fracture again. Inter- and intra-observer agreement of the AO classification based on plain radiographs alone and once CT scan with 3D reconstruction was added to the plain radiographs was determined using Kappa coefficients. Pattern of change in classification on addition of CT scan to plain radiographs was also assessed. The mean kappa value for inter- and intra-observer agreement for AO classification on plain radiographs alone were 0.58 (moderate) and 0.66 (substantial), respectively. Upon addition of CT scan to plain radiographs, both improved to 0.70 (substantial) and 0.77 (substantial), respectively. The AO classification of the fracture changed 28.70% times (93 of 324 observations) upon addition of CT scan to plain radiographs. 96.77% times (90 of 93 observations) the classification was upgraded to higher group, while it was downgraded in only 3.22% times (3 of 93). 55.91% times this change was observed in AO 31 A 2 group (52 of 93 observations). In 17.59% cases (57 of 324 observations), fractures which were classified as stable (A1.1-A2.1) on radiographs alone, were reclassified as unstable (A2.2-3.3) upon addition of CT scan to plain radiographs. In 11.4% cases (37 of 324 observations), the lateral wall was classified as vulnerable or broken on CT scans where it was classified intact on plain radiographs. Addition of CT scans with 3D reconstructions to plain radiographs improves the intra- and inter-observer agreement of the AO classification. Addition of CT scan results in change in classification of the fracture in about one out of three cases. This most commonly happens in the AO 31 A 2 group. Most of the times, this results in the classification of fracture being upgraded. Many fractures which are initially classified as stable (A1.1-A2.1) on radiographs are reclassified as unstable (A2.2-3.3) on addition of CT scans. The lateral wall is also classified as vulnerable or broken more number of times on CT scans than plain radiographs alone. Therefore, we conclude that CT scan with 3 D reconstructions definitely helps in better pre-operative classification of intertrochanteric fractures especially in select group of fractures (AO 31 A 2) where stability and integrity of lateral wall is difficult to assess.

Salvage procedure for cut-through after surgical fixation of trochanteric fractures with TFN.

Closed reduction and fixation using a cephalomedullary nail represents the accepted management of unstable intertrochanteric fractures. Cut-through has been described as a complication associated with the treatment. Although a hip arthroplasty may be the most predictable revision method, a non-prosthetic option can lead to similar results. The objective is to describe a non-prosthetic revision procedure in cases of cut-through. We performed a retrospective analysis of our Institutional Registry for Hip Fractures in elderly patients (RIAFC) from January 2010 to June 2018 searching for cut-through as a failure after unstable intertrochanteric fracture treatment. REVISION PROCEDURE: (A) Helical blade removal, introduction of structural bone graft (autologous or allograft) as a plug to obliterate the communication to the joint and a new blade insertion. (B) Same as in A but augmenting the blade/head purchase with poly(methyl methacrylate) (PMMA). Before the cement insertion, a radio-opaque solution was instilled to assure lack of joint leakage. We evaluated 1616 patients. Sixteen of them presented a cut-through complication (1%). Ten of them were females with an average age for all of 84years. One patient denied an implant revision and opted for a total joint replacement. In four of the patients, the procedure A was done, 2 of them had a new failure, and an joint arthroplasty was performed. In the B group, only one patient needed a revision to a total hip. The other 10 patients healed uneventfully and did not need any further intervention. Cut-through revision after fixation of unstable intertrochanteric fractures treated with cephalomedullary nail by blocking of the joint communication and augmenting the head blade purchase with PMMA is a safe and minimal invasive procedure, generates low blood loss and rate of complications and allows bone healing preserving the native joint. Nil.

A clinical study of functional outcome of unstable intertrochanteric fractures treated with proximal femur nail anti rotation system II

Introduction: Unstable, Comminuted intertrochanteric fractures continue to pose a challenge to the orthopaedic surgeon because of severe osteoporosis and medical disorders that increase the risks associated with surgery and anaesthesia. To overcome problems like lateral wall impingement and prominence of the proximal end of the nail, the PFNA-II was introduced in 2008. The PFNA II design modifications include the flat lateral shape of the proximal portion and a decrease in the mediolateral bending angle from 60 to 50. The purpose of the study is to confirm that the PFNA II eliminates the problem of lateral wall impingement experienced with previous intramedullary nailing systems and provides stable fracture fixation with positive functional outcome.Materials and methods: This study was conducted on 52 patient of which 32 were available till follow up of 6 months. All patients we were diagnosed with unstable intertrochanteric fracture of femur and underwent closed reduction internal fixation with proximal femoral nail anti-rotation system II. Functional outcome was assessed with Modified Haris Hip Score and radiological outcome was assessed with TAD score and implant related complications. Results: Fracture union was appreciated on an average 4 months of postoperative period. 4 patient had superficial infection while 1 patient had deep infection. Only 1 patient had cut off of helical blade. According to modified Harris hip score, excellent to good outcome was noted in more than 80% of patient. Conclusion: From our study, we conclude that PFNA II can be a reliable and implant of choice for the management of unstable intertrochanteric fracture with high rates of union, restoring the anatomical alignment with less chances of implant failure and reduced chance of implant failure.

Comparison between Gamma Nail and Proximal Femoral Nail in Management of Unstable Intertrochanteric Fractures

Background: Proximal femoral fractures have been on the rise with the increase in life expectancy and osteoporosis in the elderly population and road traffic accidents among the younger counterparts. Aim of the Work: To evaluate and compare the outcome f using Gamma nail and Proximal femoral nail in internal fixation of unstable intertrochanteric fractures regarding preoperative parameters, intraoperative variables, postoperative complications. Patient and Methodology: A prospective study on 30 cases suffering from unstable intertrochanteric fractures managed using either Gamma Nail or Proximal femoral nail to assess the functional and radiological results. Results: There was a significant difference found between the two groups regarding intraoperative blood loss (ml). There was no significant difference found between the two groups regarding DVT, Infection, Implant failure, and non-union. There was a significant difference found between the two groups regarding the Time of union (months). Conclusion: Our study showed that both gamma nail and proximal femoral nail are trusted implants for the surgical management of unstable trochanteric fractures in patients with a high rate of union but with differences in the time of union, less intraoperative blood loss, and fewer postoperative complications rate.

Management of Unstable Intertrochanteric Fractures with Proximal Femoral Locking Plate- A Prospective Study of 30 Patients

Intertrochanteric fractures are quite common in the elderly age group due to the osteoporotic nature of the bone. Unstable fracture patterns are challenging to treat and would require an implant which would address the requirements. This study was performed to evaluate the functional outcome following management of these fractures with PFLP (Proximal femoral locking plate). Thirty patients with unstable intertrochanteric fractures who presented between January 2012 to January 2015 were managed by ORIF (Open reduction and internal fixation) with PFLP and were followed up for three years. Functional assessment was performed using the Harris hip score. There was a female preponderance seen in our study with the left side being more commonly affected. The most common mode of injury was slip and fall, and Boyd and Griffin type 3 was the most common fracture type seen. The mean Harris hip score was 83.6(82-95). We were able to achieve a 100% union rate in our series with minimal complications.ORIF with PFLP is a good treatment option in the management of unstable intertrochanteric fractures and gives good rates of union and functional outcomes.

Evaluation of Dynamic Hip Screw with Trochanteric Stabilization Plate in management of Unstable Inter-Trochanteric Fractures

The goal of this study is to gauge the radiological results and therefore the functional outcomes consistent with Parker mobility score of the patients after using of Dynamic hip screw with trochanteric stabilizing plate in fixation of unstable trochanteric fractures and assess the complication. Twenty patients (ages ranged from 51 to 70 with an average age of 64.20 ± 6.338 years, 12 of them (60%) were females and 8 (40%) were males) with unstable trochanteric fracture were treated with Dynamic Hip Screw with Trochanteric Stabilization Plate between first of September 2019 to end of March 2020 at Beni-Suef University Hospital. Most of the operations were done in the first week 16 (80%) and only 4 (20%) patients had intraoperative complication and the same percent had post-operative complications. Parkers score was higher in non-diabetic patients p value (p value 0.041).The ASIA score was higher in patients with good bone quality and without intraoperative complication and this difference was statistically significant significantly (p-value, 0.011). DHS with TSP fixation of unstable intertrochanteric fractures of femur is an effective technique and has excellent functional and radiological outcomes with minimal complications and early rehabilitations rates.

Proximal femoral nail anti-rotation-2 in intertrochanteric fractures: Experience from the Kingdom of Saudi Arabia

Proximal femoral nail anti-rotation (PFNA)-2 is an intramedullary implant designed specifically for the Asian population for managing intertrochanteric (IT) fractures among the elderly. We presented this cases series with an objective to use and document the effectiveness of PFNA-2 for the management of unstable IT fracture among patients aged 60 years and above in the Kingdom of Saudi Arabia. Four females were treated above 65 years with severe pain in the hip region after a trivial fall on the ground over a period of 2 years (2018–2020), diagnosed with T3 and T4 unstable IT fracture. All the patients were hypertensive, with two having diabetes. It was decided to manage the fracture site by PFNA-II implant following baseline clinical and biochemical investigations. The duration of surgery took around 70–75 min with a blood loss of 100–150 ml, and there was no intraoperative complication. Early mobilisation and toe touch walking was achieved within 2 days postoperatively. Harris hip score was 'good' for all patients within 3 months, which became 'excellent' after 6 months for all except one. Union was achieved in all the cases with a full weight-bearing period ranging from 9 to 11 weeks. The usage of PFNA-2 for IT fractures among elderly having co-morbidities such diabetes and hypertension is perfectly promising good results for such reason we strongly recommend it. However, future prospective clinical trials using sufficient sample size, comparing PFNA-2 with PFN and dynamic hip screws are needed for better decision-making.

Functional outcome of hemiarthoplasty as a treatment option for trochanteric fractures

Objectives: Management of unstable intertrochanteric fractures in elderly patients is challenging due to osteoporosis. Comminuted unstable intertrochanteric fractures require early postoperative immobilization. Most of the recent reports have recommended Hemiarthroplasty for treatment of unstable intertrochanteric fractures to avoid various immobilization-associated complications like bed sore, pneumonia, urinary infection. The purpose of this study was to evaluate the functional and clinical outcomes of bipolar hemiarthroplasty for intertrochanteric fractures. Methods: Fifteen patients aged over 60 years underwent hemiarthroplasty to treat unstable intertrochanteric fractures and were followed up over 12 months. All surgeries were performed by the same surgical team using the Hardinge (lateral) approach. Wires, cables, and plates were used as required. Use of cemented protheses was considered when the lesser trochanter had been displaced. All patients were allowed full weight-bearing as tolerated as soon as possible. Clinical evaluation was based on Harris Hip Scores. Results: In our study, there were 6 male and 9 female patients with mean age of 70.26 years. 86.67% of the cases admitted were due to trivial trauma, 13.33% due to RTA with right side being more common side affected. In all patient partial weight bearing was started within 5 days. Good to excellent results were seen in 92.85% cases & Fair results were seen in 7.15% of cases in our study according to Harris Hip Score.Conclusions: Primary bipolar hemiarthroplasty for treating unstable intertrochanteric fractures provide a stable, pain free and mobile joint. It also eliminates the need for prolonged immobilization and permits early ambulation. As reported by others, hip hemiarthroplasty is an effective treatment choice for unstable intertrochanteric femoral fracture in older patients.

Zimmer Natural Nails in the Treatment of Unstable Intertrochanteric Fractures: A Longitudinal Study

Introduction:Cephalomedullary nails are preferred over intramedullary nails for internal fixation of unstable intertrochanteric fractures; however, they are associated with complications as they do not match the anatomy of the proximal femur to a great extent. Aim: To investigate functional and radiological results of Zimmer natural nails in the management of unstable intertrochanteric fractures. Materials and Methods: A longitudinal prospective study of 99 patients with unstable intertrochanteric fractures was carried out. All patients underwent closed reduction and internal fixation with 180 mm short Zimmer natural nails. Follow-up visits were scheduled for six weeks, three months, and six months for radiological healing and mobility measurements using RUSH and Parker scores, respectively. Statistical analysis was performed using Chi-square and ANOVA. Results: Mean age of patients was 69.77±11.47 years with a male to female ratio of 1:1. A majority of patients had co-morbidities like diabetes mellitus and hypertension. Average duration of surgery was 58.38 minutes with no statistically significant difference among the different categories of unstable intertrochanteric fractures. Fixation of fractures with Zimmer natural nails increased Parker score and RUSH score consistently with each follow-up visit (p<0.05). There were no postoperative complications in 93.94% cases. Conclusion: This study emphasised good functional and radiological results of Zimmer natural nails in the treatment of unstable intertrochanteric fractures.

Clinical study of fixation of unstable inter-trochanteric femoral fractures with 95⁰ angle blade plate

Background: Inter-Trochanteric hip fractures account for approximately half of the hip fractures in the elderly. By definition, these are extra-capsular fractures occurring between greater and lesser trochanters of the proximal femur, occasionally extending into sub-trochanteric region. These fractures present in bimodal age distribution. In older females these osteoporotic low energy fractures, while in young patients, usually males are affected with high energy injuries. Intertrochanteric fractures unite with conservative management also, but not without high rate of complications. Therefore, Stable reduction and rigid internal fixation is the treatment of choice for these fractures. In the present study, attempt has been made to evaluate the results of surgical management of unstable inter-trochanteric fractures with a 95 degrees angle blade plate. Materials and Methods: This study is a hospital based prospective study centered in Department of Orthopaedics at R.L Jalappa Hospital and Research Centre, Kolar, from October 2012 to October 2014 in which 30 patients with Unstable inter-trochanteric fractures are treated with open reduction and internal fixation with 95 degrees angle blade plate. Results: Patients were regularly followed-up post-operatively. Thirty cases were available for follow up. Excellent results were seen in 21 patients, good results in 7 patients, fair results in 2 patients and poor results in none. Conclusion: This study has shown that the 95 degrees angle blade plate fixation is a reliable and effective treatment of trochanteric fractures. This plate can be used for both stable and unstable intertrochanteric fractures. The final result is dependent on various other factors such as the type of fractures, lateral wall comminution and stability of the medial wall post reduction. The operative technique and final implant position also influenced the results. Over-all results also were dependent on co-morbidities of the patients. The ideal position of the implant is to keep the tip of the blade in the lower half of the femoral head and the blade should pass below the superior cortex of the neck. The 95 degrees angle blade plate is found to be a stable and acceptable implant for the fixation of intertrochanteric fractures.