Management Of Unstable Intertrochanteric Fractures Research Articles

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.

Primary bipolar hemiarthroplasty as a treatment option for unstable intertrochanteric fractures.

Management of unstable intertrochanteric fractures is challenging, especially in patients with osteoporosis. Comminuted unstable intertrochanteric fractures require postoperative immobilization. Several recent reports have recommended hemiarthroplasty for treatment of unstable intertrochanteric fractures to avoid various immobilization-associated complications. The purpose of this study was to evaluate the functional and clinical outcomes of bipolar hemiarthroplasty for unstable intertrochanteric fractures in older persons. Sixty patients aged over 75 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 standard posterolateral 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. Clinical evaluation was based on Harris Hip Scores. The cohort comprised 16 men and 44 women (aged 75-96 years). According to the Jensen classification, 24 fractures were type III, 14 type IV, and 22 type V. Cement was used in 24 patients. At 12 months follow-up, Harris Hip Scores were excellent in 18%, good in 42%, fair in 25%, and poor in 15%. No radiological abnormalities were detected. Primary bipolar hemiarthroplasty for treating unstable intertrochanteric fractures 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.

Primary bipolar replacement arthroplasty versus internal fixation in the management of unstable intertrochanteric fractures in the elderly

<p class="abstract"><strong>Background:</strong> Management of unstable intertrochanteric femur fracture in the elderly has been always a matter of debate. There has been always a dilemma between osteosynthesis and prosthesis.</p><p class="abstract"><strong>Methods:</strong> We retrospectively evaluated, 108 osteoporotic elderly patients with unstable intertrochanteric for internal fixation versus primary bipolar replacement arthroplasty in a span of 4 years.<strong></strong></p><p class="abstract"><strong>Results:</strong> Bipolar replacement arthroplasty gives better outcome as compared to internal fixation with sliding hip screw.</p><p class="abstract"><strong>Conclusions:</strong> It was found that cemented bipolar arthroplasty is the choice in freely mobile elderly osteoporotic comminuted displaced intertrochanteric fracture, though is a surgically demanding technique, it spares the postoperative complication of non-weight bearing after internal fixation of these fracture. The internal fixation is also compounded by osteoporosis, medical illness, difficulty to achieve and maintain reduction of comminuted and widely displaced unstable fractures, which restricts the mobilization and weight bearing and further increase the risk of morbidity and mortality in elderly in comparison to cemented bipolar replacement arthroplasty which allows early mobilization and weight bearing.</p>

Results of proximal femoral nail in unstable intertrochanteric fracture of femur

Introduction: Intertrochanteric Femur fractures comprise approximately half of all hip fracture caused by low energy mechanism. These hip fractures occur in characteristic population with risk factors including increasing age, female gender, osteoporosis, a history of fall and gait abnormality. In spite of great advances made in the field of trauma in last 50 years, management of this fracture has always remained subject of debate. There are several internal fixation options for managing these fractures that generally fall into two categories: some form of intramedullary fixation or some form of plating. Proximal Femoral Nailing is load bearing device with rotational stability and also short lever arm in addition to indirect fracture reduction. In this article we will discuss the role of proximal femoral nail in unstable intertrochanteric femur fracture.Materials & Methods: We have done a prospective study in 40 patients of unstable intertrochanteric femur fractures of femur operated with proximal femoral nailing at our institute with follow up of 5 – 24 months. All patients above 31 years of age with proximal femur fractures of femur admitted in tertiary center meeting the inclusion and the exclusion criteria during the study period were the subjects for the study. Patient were regularly followed up radiologically. Final outcome is measured with Harris Hip Score.Results: In the present study, 40 cases of unstable intertrochanteric fractures treated operatively with proximal femoral nail (PFN), and the results were analyzed. In this series, low velocity injury (Domestic fall) was the cause of fracture in the majority (70%), especially in the elderly female patients. The operations were completed within 2 hours in 98% of the patients. For PFN minimum duration was 40 minutes and maximum duration was 150 minutes and mean duration was 80 minutes. One patient had outward migration of screw, one patient had backout of derotation screw, 7 patient had varus collapse, five patient had abductor weakness on followup. On 6 month follow up thirty patient had separated lesser trochanter with union of fracture but there was no limitation of movement & any residual deformity. The functional result according to Harris Hip Score was found to be excellent in 54%, good in 26%, fair in 10% and poor in 10% of patients.Conclusion: Intertrochanteric fractures commonly occur in elderly persons, usually following minor trauma whereas in young patients a major trauma is needed to cause this fracture. Proximal femoral nail offer less invasive option for fixation of unstable intertrochanteric hip fractures. Unstable fractures can be fixed faster and with lesser soft tissue dissection. On basis of our study we have concluded that PFN should be considered for management of unstable intertrochanteric fractures in young as well as elderly patients who have multiple pre-existing illness.

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A comparative study of proximal trochanteric contoured plate vs proximal femoral nail for unstable inter-trochanteric fracture of femur

Background: Unstable inter-trochanteric fractures of the femur remains one of the most challenging fractures faced by orthopaedic surgeons. This study was done to compare the proximal femoral nail and proximal femoral locking plate for the management of unstable inter-trochanteric fractures and their postoperative complications. Material and methods: This was a prospective study of 40 patients with unstable inter-trochanteric fractures of femur who were treated with PFN (20 cases) and PFLP (20 cases). The fractures were classified according to Boyds and Griffin classification. All patients were assessed functionally by Harris Hip Score. Results: Average duration of union was 14.75±3.52 weeks (range 14 to 16 weeks) in PFN cases and 17.70±2.00weeks (range 14 to 21 weeks) in PFLP cases, union was achieved in 100% cases except one case of PFN which goes to non union due to Z effect. Various complications were seen in both cases. As per Harris Hip score, excellent results were noted in 75%PFN and 40%PFLP cases, good in 15%PFN and 25%PFLP cases and fair in 5% PFN and 35% PFLP cases and poor in 5%PFN and 0%PFLP cases. Conclusion: Harris hip score comparison of study suggests that functional results were better in PFN than PFLP. Less Blood loss, less operative time, early weight bearing were other favouring factors in PFN. Though blood loss and operative time was more, rigidity of fixation was better in unstable fractures in PFLP group. We conclude that PFN is the better implant for unstable intertrochanteric fractures with lesser operative time and lesser blood loss. While PFLP can be a good alternative for unstable intertrochanteric fractures with better results with slightly longer operative time and more blood loss when compared with PFN.

Outcomes of primary bipolar hemiarthroplasty in the management of unstable inter-trochanteric fracture of femur among elderly

Aims and Objectives: To evaluate the results with regard to function, to restoring proper limb length after surgery and to study the associated complications in intertrochanteric fractures treated by cemented bipolar hemiarthroplasty in elderly.Methodology: This is a prospective study of 25 cases of Intertrochanteric fractures admitted to a tertiary care center between August 2016 and November 2018 treated with Bipolar Hemiarthroplasty for intertrochanteric fractures. Cases were taken according to inclusion and exclusion criteria. Results: In our study of 25 cases, there were 14 male and 11 female patients with mean age of 72.8 years. 80% of the cases admitted were due to trivial trauma, 20% due to RTA with left side being more common side affected. According to OTA classification Type 31A2.2 fractures accounted for 60% of cases & Type 31A2.3 accounted for 40 %. Mean duration of hospital stay was 13.2 days and mean time of full weight bearing was 4.7days in our patients. Excellent was seen in 24% cases Fair to Good results were seen in 72% of cases in our study according to Harris Hip Score.Conclusion: From our study we conclude that Cemented Bipolar Hemiarthroplasty for intertrochanteric fractures in elderly reduced the complications of prolonged immobilisation, prolonged rehabilitation, marked residual deformities and need for revision surgeries. The procedure offered, faster mobilization, rapid return to pre injury level, improved the quality of life.

A clinical study to evaluate the effectiveness of the short proximal femoral nail in the management of unstable intertrochanteric fractures

<p class="abstract"><strong>Background:</strong> The objective was to study the effectiveness and drawbacks of short proximal femoral nail in the management of unstable intertrochanteric fractures.</p><p class="abstract"><strong>Methods:</strong> This prospective study was conducted in the department of orthopaedics Al-Ameen medical college, Vijayapura, Karnataka, India from July 2010 to June 2017. Total 175 patients (130 males and 45 females) aged between 41 to 80 years with unstable Intertrochantreric fracture (155 had type IV and 20 had type III according to Boyd and Griffin classification). All patients were operated using Short proximal femoral nail and followed at least for a minimum period of 6 months and were evaluated radiologically and clinically by Kyle’s Criteria.<strong></strong></p><p class="abstract"><strong>Results:</strong> Anatomical reduction was achieved in 125 patients, 105 (60%) had no complications post operatively. Complications included 5 cases of avascular necrosis and screw cut out, 5 cases of delayed union, 5 cases of Z-effect, 20 cases of varus malunion, 10 cases of antirotation screw breakage, 5 cases of distal bolt breakage and 15 cases with lateral thigh discomfort. 125 patients had No shortening and the average shortening was 0.34 cm, average time of union was 19.26 weeks (15-30 weeks) in 170 cases. At the end of 6 months, good to excellent results were seen in 71.5% of cases, 57% patients returned to their pre injury functional level.</p><p class="abstract"><strong>Conclusions:</strong> Short proximal femoral nail provides good fixation for unstable intertrochanteric fractures, if proper pre-operative planning, good reduction and surgical techniques are followed leading to high rate of bone union and minimal soft tissues damage especially for Asian patients with relatively small femora.</p>

Randomised comparative study in management of unstable intertrochanteric fracture with PFN V/S PFN A2 - functional and radiological out-come

A prospective, randomized, comparative study, this study was conducted in Institute Of Orthopaedic Research and Accident Surgery (IORAS) Devadoss Multispeciality Hospital, Madurai, Tamil Nadu. Study period of Two years from April 2016 – May 2017. Since this fracture is more common in the elderly patients, the aim of treatment is prevention of mal union and early mobilization, taking all the factors into consideration surgery by internal fixation of the fracture is ideal choice. A wide modalities of internal fixation are available for the management of these fractures, most commonly used implant is dynamic hip screw(DHS) with side plate, this is a controlled collapsible fixation device, unstable intertrochantric fracture are difficult to treat, so intramedullary devices such as proximal femoral nail(PFN) are biomechanically stronger and more rigid compared to extramedullary devices such as DHS, PFN also has showed more number of post operative complications like implant failure, screw cutout in case of unstable intertrochantric fractures, to improvise in 2009 AO/ASIF introduced Proximal femoral nail antirotation (PFN A2) which claimed better rotation and angular stability with helical blade and better functional outcome in treating unstable intertrochantric fractures when compared to PFN. So to evaluate and compare functional and radiological outcome of the patients having unstable intertrochantric fractures treated by two different methods of fixation with PFN and PFNA2. This study is taken up to find out the efficacy of newer implant PFN A2 over PFN.

A Prospective Comparative Study of outcome of Management of unstable Intertrochanteric Fractures of Femur with Dynamic Hip Screw (DHS) and Proximal Femoral Nail Antirotation (PFNA)

A Prospective Comparative Study of outcome of Management of unstable Intertrochanteric Fractures of Femur with Dynamic Hip Screw (DHS) and Proximal Femoral Nail Antirotation (PFNA)

Dimon hughston osteotomy for unstable intertrochanteric fractures done on ordinary operation theatre table using newly developed imaging technique

Background: Intertrochanteric fracture make up 45% of all hip fractures. Trochanteric fractures almost invariably occur as a result of fall, involving both direct and indirect forces. Dimon Hughson Osteotomy procedure have a role in the management of unstable intertrochanteric fractures. Method: In the present study of 40 patients of unstable intertrochanteric fractures, 20 were operated in standard technique and 20 in modified technique. The data was assessed, analyzed, evaluated and following conclusions were made. Results: Intertrochanteric fractures common between 50-78 years. In young patients it was due to high velocity trauma. Fall from height being the common mechanism of injury. Slip and fall was common mechanism in elderly. It was more common in females due to post-menopausal osteoporosis. Associated injuries were more common in high velocity trauma. Early reduction and internal fixation increases patients comfort, facilitates nursing care, helps in early mobilization of patients and decreases hospital stay. Early mobilization can be begun in all the cases of Dimon Hughston osteotomy based on the pain bearing capacity with the help of a walker. In both the techniques complications can be avoided with proper patient selection and good preoperative planning, appropriate implant selection, good surgical technique, pre and post-operative physiotherapy and regular follow up. Conclusion: Dimon Hughston osteotomy is a viable option in unstable fractures with technical expertise. Can be performed on ordinary operation theatre table with comparative results.

Comparative study of unstable intertrochanteric fracture treatment by trochanteric femoral nail versus hip hemiarthroplasty

The management of unstable intertrochanteric fractures in elderly is challenging because of difficult anatomical reduction, poor bone quality, and sometimes a need to protect the fracture from stresses of weight bearing and the need for early mobilization. Internal fixation in these cases usually involves prolonged bed rest or limited ambulation, to prevent implant failure. This might result in higher chances of complications like pulmonary embolism, deep vein thrombosis, pneumonia, and decubitus ulcer. The purpose of this study to compare the results of trochanteric fixation nailing (TFN) and hip hemiarthroplasty in unstable intertrochanteric femur fractures in elderly patients. Out of 50 patients with unstable intertrochanteric fractures 25 patients were treated with primary cemented bipolar hemiarthroplasty and 25 were treated with trochanteric femoral nail. Follow up was done post operatively at 1 months, 3 months, 6 months. At each follow up visit patients were evaluated radiologically and clinically. Functional outcome was evaluated by Harris hip score. Out of 25 patients operated by hemiarthroplsty, 3 patients had excellent results and 12 patients had good results whereas 9 patients had fair and one patient had poor results. Out of 25 patients operated with TFN, one had excellent results and 8 patients had good results whereas 10 patients had fair and 6 had poor results. Two hemiarthroplasty patients and one TFN patient developed superficial infection whereas one dislocation was also observed in hemiarthroplasty patient. Screw cut out from head was seen in one TFN patient and one TFN patient also developed pulmonary embolism. The cornerstone of management of such fractures is early surgery, followed by mobilization. Hence Cemented bipolar hemiarthroplasty offers a modality of treatment that provides adequate fixation and early mobilization in these patients thus preventing postoperative complications such as pressure sores, chest infection and DVT, as compared to TFN where there was more chance of complication due to prolonged immobilization.

Management of unstable inter-trochanteric fractures by Dynamic Hip screw versus Proximal Femur Nailing- A Comparative Analysis

Management of unstable inter-trochanteric fractures by Dynamic Hip screw versus Proximal Femur Nailing- A Comparative Analysis

To Study the Functional Outcome of Primary Cemented Bipolar Hemiarthroplasty in the Management of Unstable Inter-Trochanteric Fracture of Femur among Elderly

Aims and Objectives: To evaluate the results with regard to function, to restoring proper limb length after surgery and to study the associated complications in intertrochanteric fractures treated by cemented bipolar hemiarthroplasty in elderly. Methodology: This is a prospective study of 25 cases of Intertrochanteric fractures admitted to a tertiary care center between August 2013 and November 2015 treated with Cemented Bipolar Hemiarthroplasty for intertrochanteric fractures. Cases were taken according to inclusion and exclusion criteria. Results: In our study of 25 cases, there were 14 male and 11 female patients with mean age of 72.8 years. 80% of the cases admitted were due to trivial trauma, 20% due to RTA with left side being more common side affected. According to OTA classification Type 31A2.2 fractures accounted for 60% of cases & Type 31A2.3 accounted for 40 %.. Mean duration of hospital stay was 13.2 days and mean time of full weight bearing was 4.7days in our patients. Excellent was seen in 24% cases Fair to Good results were seen in 72% of cases in our study according to Harris Hip Score. Conclusion: From our study we conclude that Cemented Bipolar Hemiarthroplasty for intertrochanteric fractures in elderly reduced the complications of prolonged immobilisation, prolonged rehabilitation, marked residual deformities and need for revision surgeries. The procedure offered, faster mobilization, rapid return to pre injury level, improved the quality of life.

Strategies for Proximal Femoral Nailing of Unstable Intertrochanteric Fractures: Lateral Decubitus Position or Traction Table.

The aim of this prospective randomized study was to compare the traction table and lateral decubitus position techniques in the management of unstable intertrochanteric fractures. Eighty-two patients with unstable intertrochanteric fractures between 2011 and 2013 were included in this study. All patients were treated surgically with the Proximal Femoral Nail Antirotation implant (DePuy Synthes). Patients were randomized to undergo the procedure in the lateral decubitus position (42 patients) or with the use of a traction table (40 patients). Patients whose procedure was not performed entirely with a semi-invasive method or who required the use of additional fixation materials, such as cables, were excluded from the study. The groups were compared on the basis of the setup time, surgical time, fluoroscopic exposure time, tip-to-apex distance, collodiaphyseal angle, and modified Baumgaertner criteria for radiologic reduction. The setup time, surgical time, and fluoroscopic exposure time were lower and the differences were statistically significant in the lateral decubitus group compared with the traction table group. The collodiaphyseal angles were significantly different between the groups in favor of the lateral decubitus method. The tip-to-apex distance and the classification of reduction according to the modified Baumgaertner criteria did not demonstrate a statistically significant difference between the groups. The lateral decubitus position is used for most open procedures of the hip. We found that this position facilitates exposure for the surgical treatment of unstable intertrochanteric fractures and has advantages over the traction table in terms of set up time, surgical time and fluoroscopic exposure time.

Functional Outcome of Unstable Intertrochanteric Femur Fracture Patients Treated with Trochanteric Fixation Nail

Introduction: Intertrochanteric fractures are disabling injuries that most commonly affect the elderly population. These fractures have a tremendous impact on both the health-care system and society in general. These fractures can be managed by conservative methods, but mal-union and complications of prolonged immobilization are the result. Thus, surgery by internal fixation is the ideal choice. Dynamic hip screw was the gold standard treatment for intertrochanteric fractures before intramedullary devices were developed. These devices have the advantage of being an intramedullary fixation device, shorter lever arm of devices causing less tensile strain on the implant, controlled fracture impaction due to the incorporation of sliding hip screw, shorter operative duration, and less soft tissue dissection. In view of these consideration, this study of management of unstable intertrochanteric fractures using trochanteric fixation nail (TFN) is taken up to assess the outcome in terms of adequacy of fixation and results. Methods: In a retrospective controlled study, 40 patients of unstable intertrochanteric fracture were treated by TFN. Mean age group of the patient was 61.78 years. 26 cases showed union at 3 months, 13 cases showed union at 4 months, and 1 case showed union at 5 months duration. Results: Functional results were assessed in the 40 cases available for follow-up. Excellent results were noted in 10 cases, good in 27 cases, fair in 3 cases, and none had poor result. Anatomical results were assessed by presence or absence of shortening and range of movements. 37 cases had good results and 3 had poor result. Conclusion: At present, we consider that the TFN is a good minimally invasive implant for unstable intertrochanteric fracture when closed reduction is possible. Technical and mechanical complications were mostly related to the operative technique and the type of fracture and pre-operative reduction of the fracture. Keywords: Shortening, trochanteric fixation nail, unstable intertrochanteric fractures.

A Comparison of the Clinico-Radiological Outcomes with Proximal Femoral Nail (PFN) and Proximal Femoral Nail Antirotation (PFNA) in Fixation of Unstable Intertrochanteric Fractures.

Management of unstable intertrochanteric fractures poses challenges in terms of obtaining stable fixation and good postoperative outcomes. There is a paucity of clinical data comparing the commonly used Proximal Femoral Nail (PFN) and Proximal Femoral Nail Antirotation (PFNA) implants, especially in relation to osteoporosis. To assess comparative performance of PFN and PFNA in the setting of osteoporosis. Patients presenting with unstable intertrochanteric fractures (AO 31.A2 and 31.A3) were included and treated with either PFN or PFNA. Preoperative radiographs of normal side were used to grade osteoporosis by Singh's index. Grade 3 or less was considered significant. Postoperative radiographs were assessed for tip-apex distance, Cleveland index and quality of reduction. Patients were followed up for a minimum of nine months and any complications noted. Comparison of functional outcomes was done using the Harris Hip Score and Parker-Palmer mobility score at final follow up. Statistical analysis was done using the unpaired t-test/Mann-Whitney U test and Chi-square test/Fisher's-exact test. A p-value of < 0.05 was considered significant. The study included 48 patients with unstable intertrochanteric fractures, of which 23 were treated with PFN and 25 with PFNA. Average age of PFN group was 60.78 years and of PFNA group was 74.12 years. In PFN group 8 patients (38.09%) and in PFNA group 13 patients (54.1%) had Singh's osteoporotic index of ≤ 3. The average Harris Hip Score was 75.37 and 78.85 in PFN and PFNA groups (p=0.54) respectively. From PFN and PFNA groups, 35% and 32% patients respectively were able to return to pre-injury mobility status as assessed by the Parker-Palmer mobility score (p=0.83). Out of eight implant related complications; seven were in patients treated with PFN (p=0.02). Among patients with Singh's grade ≤ 3, 3 (37.5%) in PFN group suffered from implant failure whereas all 13 patients in PFNA group had successful outcome (p=0.04). Although functional outcomes achieved with both implants are similar (p=0.83), number of implant related complications were fewer with PFNA (p=0.02), even in osteoporotic group (p=0.04). We recommend use of the PFNA in unstable fractures, especially in the elderly osteoporotic population.

Three different interlocking intramedullary nails for unstable reverse oblique inter-trochanteric fractures: a bio-mechanical comparative study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Biomechanical testing, intramedullary devices have proven advantageous over the extramedullary devices in the management of unstable intertrochanteric fractures. Reverse oblique type of intertrochanteric fractures are highly unstable and intramedullary nails are currently the method of internal fixation. The currently available nails seems to provide rotational, axial and angular stability, but biomechanical analysis of the strain pattern in the bone and implant in this fractures are lacking. The aim of this experimental study was to analyse the strain in three different long femoral nail-bone units under physiological loading when implanted in Saw bone model after creating a reverse oblique intertrochanteric fracture.&lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A total of 12 sawbones were divided in to 4 equal groups. Group 1 was intact saw bones and were used as controls. Group 2, Group 3 and Group 4 were implanted with Depuy, Stryker and Synthes nails respectively after creating a reverse oblique intertrochanteric fracture. All the four groups were axially loaded with 100 N increments until physiological loads. The strain patterns were measured at the posteromedial cortex and the peak strains were extracted at partial weight bearing i.e. 500 N and full weight bearing physiological loads i.e. 1000 N.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;There was no significant difference in peak strains among the groups at partial loads. However at 1000 N loads the peak strain in the DePuy nail-bone unit was significantly high compared to the other two nail-bone units and the controls. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; These results question the safety of immediate full weight bearing following surgery when treating the reverse oblique unstable fractures with DePuy intramedullary nails. A period of partial weight bearing following fixation of reverse oblique fractures would be wise when using DePuy nails&lt;span lang="EN-IN"&gt;.&lt;/span&gt;&lt;/p&gt;

Functional Outcome of Unstable Intertrochanteric femur fracture treated with intramedullary nailing

Background: Femoral pertrochanteric fracture is one of the most frequently occurring fractures in the elderly, usually following trivial trauma. In the younger age group of people, it occurs almost always due to high velocity trauma. Objectives: This study aimed to study the functional outcome of operative management of unstable intertrochanteric fracture treated by intra medullary nailing. The results have been studied in depth with a view to outline guideline for better management of this fracture. Material & Methods: A prospective study of 75 cases of unstable intertrochanteric femur fracture treated by intra medullary nailing, minimum 6 months of follow up. All cases are evaluated according to Modified Harris Hip Score on residual effects on clinical ground at final examination. Pain & functional capacity are the two basic considerations for this scoring system. Points are given for pain, function, range of motion & absence of deformity. Result: Functional result according to Modified Harris Hip score was found to be excellent in 43(57.33%) patients, good in 19(25.33%) patients, fair in 3(44%) patients & poor in 10(13.33%) patients. poor outcome occurs due to development of complications and old age & medical illness. Conclusion: Modified Harris Hip Score is good score to evaluate functional outcome of the unstable intertrochanteric fracture treated with intramedullary nailing. Unstable intertrochanteric fracture treated with intramedullary nailing gives Excellent to Good (82.66%) functional results. Key words: Unstable intertrochanteric fracture, Modified Harris Hip score, Proximal Femoral Nail.

Dynamic Hip Screw with Trochanteric Stablization Plate Fixation of Unstable Inter-Trochanteric Fractures: A Prospective Study of Functional and Radiological Outcomes.

Management of unstable intertrochanteric fractures have posed a unique challenge to orthopaedicians over years. Several surgical techniques and implants have been developed for the same. Fractures of the lateral wall have been considered as the major cause of femoral medialization after fixation by Dynamic Hip Screw (DHS). Studies have shown that supplementation of trochanteric stabilization plate reduces the incidence of femoral medialization. To assess the radiological union and hip function after fixation of unstable intertrochanteric fractures with DHS and Trochanteric Stabilization Plate (TSP). A prospective study was conducted with a total of 32 patients between age groups of 30-70 years with Evan Jensen unstable and very unstable type of intertrochanteric fractures, between August 2013 to March 2015 in the Department of Orthopaedics ARS Hospital, Tirupur, Tamil Nadu, India. They underwent open reduction and DHS and TSP fixation. They were started on full weight bearing mobilization on post op day three. They were reviewed at post-op weeks 3,6,12 and 24. Hip mobilization and rehabilitation exercises were instituted during course of reviews. Radiographs were taken to assess fracture union and hip function was evaluated during follow-ups. At the end of 24 weeks, degree of radiographic union was scored as per Radiological Union Score for Hip (RUSH). Hip function was scored with Harris hip score. Analyses were done using frequency and proportions. Chi-square tests were used to assess the test of association. Fifteen patients had RUSH scores between 10-20 and 17 patients had scores between 20-30 points. RUSH score had mean of 21.03+/- 2.132 points. 9 of 32 patients had excellent results as per Harris hip score, 10 had good, nine had fair and four had poor. On comparison of Harris hip score with RUSH score: Interval between 10-20 points, of 15 patients; two had excellent results, five had good, five had fair and three had poor. Of 17 patients between 20-30 points, seven had excellent, five had good, four had fair and one had poor results. DHS and TSP fixation of unstable intertrochanteric fractures is an effective technique with good radiological and functional outcome.