Palmer Mobility Score Research Articles

The PFNA in treatment of intertrochanteric fractures with or without lateral wall fracture in elderly patients: a retrospective cohort study

BackgroundThere is no consensus about intertrochanteric fractures with lateral wall treated with intramedullary nail—proximal femoral nail antirotation (PFNA). The aim of the present study was to compare function outcomes between lateral wall and no lateral wall fractures after surgery by PFNA.MethodsThis retrospective study evaluated patients with or without lateral wall fractures who underwent PFNA between January 2015 and June 2018. The operative time, intraoperative blood loss, time to fracture healing, complications and functional outcomes qualified by Harris hip score and Parker − Palmer mobility score (PPMS) were compared between the two groups.ResultsTwo groups were comparable with regard to patient age, sexual distribution, mechanism of injury, fracture type, body mass index (BMI), Time to surgery, American Society of Anesthesiologists (ASA) score and quality of reduction. The incomplete group had a longer operation time (54.1 ± 8.74 min vs. 51.0 ± 9.86 min) and more intraoperative blood loss (228.4 ± 48.8 ml vs. 151.3 ± 43.5 ml) in comparison with the control group (P < 0.01). Regarding functional outcome, the HHSs of the two groups were 76.2 ± 11.6 vs 75.6 ± 12.5 at the 3 months (P = 0.603), 81.9 ± 9.4 vs 82.6 ± 8.7 at the six months (P = 0.224), 83.8 ± 6.6 vs 84.5 ± 6.0 at the twelve months 85.2 ± 5.5 vs 86.0 ± 5.8 at the twenty-four months (P > 0.05), respectively. Similar results were obtained about PPMS. We found no difference in Weight bearing time, Time of fracture healing, and Complications between incomplete group and intact group.ConclusionsThere is no substantial difference in functional results or complication rates for intertrochanteric fractures with lateral wall fractures, except from increased blood loss and operation time. We believe that an intramedullary nail will be sufficient to repair an intertrochanteric fracture with or without a lateral wall fracture.

Locking plate for periprosthetic femoral fractures according to Vancouver C: Outcome and radiological subanalysis of 40 patients.

Periprosthetic femoral fractures (PFF) according to type Vancouver C are less common and outcome is limited reported. Therefore, we conducted this retrospective single center study. We performed analysis of patients who underwent open reduction and internal fixation (ORIF) with locking plates for PPF occurring distally of a primary standard hip stem. Data on demographics, revisions, fracture patterns, and mortality were evaluated. At least two years after operation, we examined outcome using the Parker and Palmer mobility score. Primary aim of this study was revision, outcome and mortality. Secondary aim was evaluation of fracture subtypes within type Vancouver C fractures. Between 2008 and 2020, 383 patients with periprosthetic femoral fracture after hip replacement were surgically treated according to our database. Among them, 40 patients (10.4%) with type Vancouver C fractures were enrolled for this study. The mean patient age was 81.5years (59-94) at the time of fracture. Thirty-three patients were women, and 22 fractures were on the left side. Without exception, locking plates were used. The 1-year mortality rate for the sample was 27.5% (n = 11). Three revisions (7.5%) were performed for plate breakage. Rate of infection and non-union was zero. Three different fracture patterns were assessed: (1) transverse or oblique fractures below the tip of the stem (n = 9); (2) spiral-shaped fractures within the diaphysis (n = 19); and (3) burst fractures at the supracondylar region (n = 12). Demographic or outcome effects between fracture patterns were not found. On average of 4.2years (2.0-10.4) after treatment, the mean reported Parker score was 5.5 (1-9). ORIF with a single lateral locking plate is safe for type Vancouver C fractures with a well-fixed hip stem. Therefore, we do not recommend routinely revision arthroplasty or orthogonal double plating. Three subtypes of fractures within Vancouver C demonstrated no significant differences in baseline data and outcome.

Intramedullary Femur Nailing in Intertrochanteric Fractures: Postoperatively Do Helical Blades Migrate More Than Lag Screws? A Randomized Controlled Trial.

This was a prospective, randomized controlled trial to test functional outcomes between a single lag screw and helical blade nails in the treatment of intertrochanteric fractures. 72 patients with intertrochanteric fractures between March 2019 to November 2020 were randomized into two groups and treated with a lag screw or a helical blade nail. Intraoperative parameters such as operative time, blood loss, and radiation exposure were calculated. Postoperatively, tip apex distance, neck length, neck-shaft angle, lateral impingement of implant, union rate, and the functional outcomes were measured at the end of 6month follow-up period. There was a significant decrease in tip apex distance (p = 0.03) and neck length(p-0.04) with significant lateral impingement of the implant (p = 0.04) in the helical blade group compared to the lag screw group. The functional outcome calculated using the modified Harris Hip score & Parker and Palmer mobility score, at the end of 6months, had no significant difference between the two groups. Both lag screw and helical blade devices can be used to successfully treat these fractures, although there is greater medial migration in the helical blade as compared to the lag screw.

Clinical and radiological outcome of the Chimaera short nailing system in inter- and subtrochanteric fractures.

cephalomedullary devices are popular treatment for femoral intertrochanteric or subtrochanteric fractures. Various complications include post-surgical lateral thigh pain and cut-out. To prevent those complications, a new concept cephalomedullary device system was designed (Chimaera, Orthofix®). This study aimed to evaluate the clinical and radiological outcomes in patients with femoral intertrochanteric or subtrochanteric fractures treated with the proximal femoral cephalomedullary device system. A prospective cohort study involved consecutive patients with Arbeitsgemeinschaft für Osteosynthesefragen/ Orthopaedic Trauma Association type 31-A1, 2, 3 fractures treated with the Chimaera short cephalomedullary device system from October 2016 to September 2017 at our level 1 trauma center. The Parker and Palmer mobility score and Jensen social function scores and post-surgical lateral thigh pain were assessed at 3 months post-operatively and compared to before surgery. Radiologic assessment consisted of controlling the position of the cephalic screw by using the tip-apex distance (TAD) and Cleveland zone as well as union and cut-out rates. We included 99 patients (79 women; 100 hips; one bilateral fracture 3 months after a first trochanteric fracture) with a mean follow-up of 2 years. The Parker and Palmer mobility score decreased by 22% at 3 months post-operatively as compared with the pre-fracture score (42/99 patients showed a return to their pre-injury level). The Jensen social function score increased by 16.5% at 3 months post-operatively as compared with the pre-fracture score (68/99 patients showed a return to their pre-injury level). No major intra-operative complication was recorded. Nine TAD scores were > 25mm. The mean TAD was 16.5mm (range 5-36), and the lag screw position was well positioned in most (95%) hips according to Cleveland zones. Three patients required revision surgery (one for cut-out of the lag screw, one for hip osteoarthritis and one for gluteus medius insufficiency). All patients but the one with the cut-out showed fracture union. The Chimaera short cephalomedullary device exhibited good mid-term functional and radiological outcomes.

The effect of rehabilitation support on male and female after intertrochanteric femoral fracture treatment

Aim: The aim of our study is to investigate the effect of rehabilitation support after intertrochanteric femur fractures on men and women. The results of the groups consisting of male and female patients who received and did not receive rehabilitation support were compared both between the same sexes and between different sexes.&#x0D; Material and Method: One hundred twenty four patients were evaluated under two groups according to whether they received rehabilitation support or not. First group (no rehabilitation support) consists of 42 females, and 29 males, and second group (rehabilitation support) consists of 30 females, and 23 males. While the patients in the first group performed the exercises themselves at home, the patients in the second group received rehabilitation support under the guidance of a physiotherapist. The patients in both groups were also evaluated under 2 subgroups as male and female.&#x0D; Results: There was no significant differences between both groups in terms of mean age, female male ratio, fracture type, mean follow-up time, Harris hip score, Barthel life index, Parker and Palmer Mobility Scale before fracture. There was also no significant difference between the subgroups of the both groups. Harris hip score, Barthel life index, and Parker and Palmer Mobility Score of males were better than females at the final follow-up in the first group. The results of females were worse than pre-fracture, but there was no difference in males at the final follow-up. Harris hip score, Barthel life index, and Parker and Palmer Mobility Score of males were better than females at the final follow-up in the second group as first group. While the results of females were not different compared to pre-fracture, the results were better in males at the final follow-up. When the female and male subgroups of both groups were compared with each other, it was determined that the results in male and female subgroups in the 2nd group were significantly better.&#x0D; Conclusion: The continuity of rehabilitation support after hospital discharge is very important. Although rehabilitation support positively affects the results in male and female, it is much more important for female than male.

A prospective, comparative study between the use of the proximal femoral nail and trochanteric support plate for management of pertrochanteric hip fracture

Introduction: The proximal femoral nail (PFN) and dynamic hip screw with trochanteric support plate are two implants used in the management of pertrochanteric hip fracture. In this study, we try to find out if one implant is better than the other. Materials and Methods: A total of 40 patients were included with 20 each in both the groups between August 2016 and February 2018 in this prospective observational study. All patients were recorded and analyzed for the length of incision (LoI), period of hospitalization (PoH), blood loss, time of union (ToU), duration of surgery (DoS), Parker and Palmer mobility score (PPMS), and Harris hip score (HHS). Results: PFN was found to have a statistical advantage over TFN in terms of LoI (6.4 vs. 14.7 cm.), DoS (70.65 vs. 105.25 min), blood loss (97.25 vs. 294.0 ml), ToU (14.9 vs. 17 days), and PoH (18.1 vs. 21.6 days). While PPMS (7.05 vs. 6.5) was comparable in both groups, HHS (90.25 vs. 81.6) was better in the PFN group. Conclusions: PFN was found to be a better minimally invasive implant for pertrochanteric fractures when closed reduction is possible in terms of LoI, PoH, ToU, DoS, blood loss, and HHS but not for PPMS.

Outcomes of Wedge Wing in the Lag Screw for Unstable Intertrochanteric Fractures in Elderly Patients.

PurposeTo evaluate clinical-functional and radiologic outcomes of elderly patients with an unstable intertrochanteric femur fracture treated with a wedge wing in the lag screw.Materials and MethodsForty-eight patients treated with the Dyna Locking Trochanteric nail (DLT nail) to resolve an unstable intertrochanteric femur fracture were reviewed retrospectively. Based on AO/OTA classification, Fracture 31-A2 (34 cases) and 31-A3 (14 cases) were included in the analysis. We measured the femoral neck-shaft angle, tip-apex distance (TAD), Cleveland index, sliding distance of the lag screw, and time to the fracture union. The Harris Hip Score and Paker and Palmer's mobility score for clinical evaluation were used.ResultsThe mean follow-up period was 21.4 months (range, 12–34 months). The postoperative state of reduction was good in 28 cases and acceptable in 20 cases. The mean TAD was 20.5 mm. The position of the lag screw was center-center in 30 cases and center-inferior in 18 cases. The mean sliding distance of the lag screw was 3.4 mm at the last follow-up. The mean union time was 4.5 months. Two cases had complications which included a cut-out (1 case) and non-union (1 case). The mean Harris Hip Score was 86.5±8.3 (range, 76–90). Walking ability in 34 of the cases (70.8%) at last follow-up was similar to that prior to fracture.ConclusionFunctional and radiological outcomes are satisfactory using the DLT nail in the treatment of elderly patients with unstable intertrochanteric fractures; however, wedge wing in the lag screw does not prevent implant-related complications.

Above–the–knee amputation versus knee arthrodesis for revision of infected total knee arthroplasty: Recurrent infection rates and functional outcomes of 43 patients at a mean follow-up of 6.7 years

IntroductionIn cases of repeated treatment failure of periprosthetic joint infections (PJI) of the knee, above–the–knee amputation (AKA) or knee arthrodesis can be proposed to reduce the risk of recurrent infection, especially in cases with major bone defects or irreparable damage to the extensor mechanism of the knee. Since AKA versus knee arthrodesis results have been rarely assessed for these indications, we conducted a retrospective case-control study to compare both the rates of recurrent infection and functional outcomes.Hypothesis Patients who underwent AKA had fewer recurrent infections than those who had arthrodesis. Materials and methodsTwenty patients who underwent AKA and 23 patients who had knee arthrodesis, between 2003 and 2019, were retrospectively included in this study. These two groups were comparable in age (73.8 versus 77.7 years (p=.31)) and sex (10 women and 10 men versus 16 women and seven men (p=.19)). Each group was analyzed individually and then compared in terms of survival (recurrent infection) and functional outcomes using clinical assessment scores (visual analog scale (VAS), French neuropathic pain questionnaire (DN4), Parker and Palmer mobility score and the 36-item short-form survey (SF–36)). ResultsThe rate of recurrent infection was 10% (two out of 20 patients) for the AKA group and 21.75% (five out of 23 patients) for the arthrodesis group (p=.69). The mean follow-up for the AKA group was 4.18 years (1.2-11.8) and 9.7 years (1.1-14.33) for the arthrodesis group (p=.002). The number of previous revisions (three (1.5-4) for AKA and two (2-3) for arthrodesis) and the time between the primary arthroplasty and surgical procedure were significantly greater in the AKA group (48.0 (12.0-102.0) months) than the arthrodesis group (48.0 (24.0-87.0) months) (p<001). The AKA group had significantly better clinical results for VAS (2.7±2.2 vs. 3.1±3.3), DN4 (1.5±2.1 vs. 2.6±2.9), Parker and Palmer (5.2±1.7 vs. 4.6±1.4), and SF–36 (30.9±15.6 vs. 26.9±17.0) (p<001). ConclusionAbove–the–knee amputation and knee arthrodesis showed no differences in the rate of recurrent sepsis. However, the comparison of the two groups demonstrated that patients who underwent an AKA had less pain, were more autonomous and had a better quality of life. Level of EvidenceIII; retrospective case–control.

Distally-fixed non-modular monoblock fluted long-stem hemiarthroplasty versus proximal femoral nailing for elderly patients with an osteoporotic intertrochanteric fracture: a retrospective comparative study.

The treatment of Intertrochanteric fractures in the elderly osteoporotic patient is still controversial. The aim of this study was to compare the outcomes of proximal femoral nailing (PFN) and a distally-fixed non-modular monoblock fluted long-stem hemiarthroplasty (HA) in elderly patients with an osteoporotic intertrochanteric fracture. This retrospective study included patients who had undergone surgery for an unstable intertrochanteric fracture. The patients were separated into PFN and HA groups. The demographic features of the 2 groups were compared. All patients were evaluated using the Singh index, ASA score, AO/OTA classification, Harris Hip Score (HHS), and Parker and Palmer mobility score. The most common complications were nonunion (12.0%) and cut-out of the screw (10.7%) in the PFN group, and dislocation of the prosthesis (6.7%) and wound infection (5.7%) in the HA group. Overall, the 2-year mortality rate was 29.3%. Mortality, particularly within the first 3 months, was 2.4 times higher in the PFN Group than in the HA group (40% vs. 19.75%). Although the HHS was significantly higher in the first year for the HA group, no significant difference was seen between the 2 groups at 24 months. Although PFN and HA have similar good outcomes at 2 years, HA allows earlier mobilisation and has fewer complications and a lower mortality rate.

Outcome of femoral fractures in poliomyelitis patients.

As patients who were afflicted with poliomyelitis during the outbreaks in the past are aging, lower extremity osteoporotic fractures are becoming more frequent. Fixation in deformed, porotic bone, coupled with muscle weakness and imbalance creates a unique challenge when treating these fractures as does their reduced rehabilitation potential. The aim of this study was to investigate the outcome of femoral fractures in surviving poliomyelitis patients. Sixty-five patients with 74 femoral fractures were treated between 1990 and 2014. Clinical outcome was assessed using the Parkland and Palmer mobility score, and quality-of-life was assessed using the SF-12® score. Some 84% of the fractures were a result of low-energy mechanisms and occurred in the polio-affected limbs, but nonaffected limbs were also injured owing to low-energy mechanisms in all cases. Fifty-seven fractures were treated operatively. There were nine re-operations (16%), including implant removals, nonunion, peri-implant fractures, and malunion. Some 60% of the patients did not regain their previous ambulatory capacity. Post-operative weight-bearing status did not correlate with the final functional outcome. Polio patients with femoral fractures have a guarded prognosis for regaining their pre-injury ambulatory capacity. A higher re-operation rate than that with "normal" osteoporotic fractures is expected.

Effect of teriparatide in fracture healing of intertrochanteric fracture: a prospective study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Intertrochanteric fracture is a relatively common and serious medical issue in geriatric trauma result in serious health problems and decrease health related quality of life. Faster time-to-union is important for early return to daily activities and reduction of complications. Teriparatide has been shown to accelerate fracture-healing. The purpose of the present prospective, randomized, controlled study was to evaluate the effect of teriparatide on the course of intertrochanteric fracture-healing.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Forty patients of intertrochanteric fractures who underwent surgical intervention between June 2016 and May 2017 were enrolled in this prospective study and followed for minimum of six months. Group A included patients who received only calcium supplementation; patients in Group B received teriparatide along with calcium supplementation postoperatively.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The mean time to fracture healing was between 8-12 weeks for the treatment group, compared with 12-16 weeks for the control group. There was also significant effectiveness with regards to Parker and Palmer mobility score at 6 months.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Postoperative use of teriparatide for 6 months appears to be an effective adjunct therapy in the treatment of patients with intertrochanteric fractures. However, because of the limited power of the study a large-scale cohort study is still required for determining the efficacy of teriparatide.&lt;/p&gt;

Proximal femur locking compression plate in complex proximal femoral fractures: a retrospective analysis

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Proximal femoral fractures are one of the most common fractures in old age patients. Fixation of these fractures is technically high demanding owing to the high risk of complications. The aim of our study is to analyze the outcomes of proximal femoral locking compression plate (PF-LCP) in these fractures.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; We retrospectively analyzed 18 proximal femoral fractures treated with PF-LCP from May 2012 to May 2015. There were 12 females (67%) and six males (33%) with an average age of 59.6 years (range, 32 to 84 years). The peritrochanteric fractures constituted by intertrochanteric and subtrochanteric fractures were classified by Boyd and Griffin classification along with Seinshemier’s classification, respectively. Among that, 14 cases (77%) were of intertrochanteric and four cases (23%) were of subtrochanteric fracture pattern. The functional outcome was evaluated by harris hip score and the parker palmer mobility score one year after surgery.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Among 18 patients, 16 patients obtained fracture union without further intervention; two patients required additional bone grafting. There were no cases of hip screw cutting the femoral head. There was no post-operative mortality in our study. The average harris hip score was 85.5 (83-94). The assessment by parker and palmar mobility score was 7.6 (range 4-9).&lt;/p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The PF-LCP is a good stable alternative in the treatment of complex proximal femoral fractures. It provides good to excellent bone healing with limited complications.

Effectiveness of treatment of transtrochanteric fractures with Dynamic Hip Screws using minimally invasive access

ObjectiveTo analyze the short-term results from treating unstable intertrochanteric fractures with Dynamic Hip Screws (DHS), using a minimally invasive route, focusing on the functional aspects and complication and mortality rates of the method. MethodsThis was a prospective longitudinal study on 140 patients who underwent fixation of transtrochanteric fractures with the DHS system with a lateral minimally invasive access in the hip, between January and December 2013. The patients were evaluated pre and postoperatively (after six months of follow-up) by means of the Parker and Palmer mobility score. Women comprised 65.7% of the sample, and 54.3% of the fractures were on the right side. The patients’ mean age was 80 years, ranging from 60 to 93 years. ResultsWe observed an overall decrease in the mobility score and an increase in the degree of dependence over the short term. However, we encountered only two deaths in the study sample and there were no cases of infection or nonunion. ConclusionDespite the efficacy of the treatment with DHS, with high rates of fracture consolidation and a low mortality rate, we noted that the patients still showed significant functional limitation at the follow-up six months after the operation.

Treatment of unstable intertrochanteric femoral fractures with locking gamma nail (LGN): A retrospective cohort study

IntroductionIntertrochanteric femoral fractures remain a challenge to orthopedists. Although technologies and instruments have been continuously improved, fixation failure still poses a problem in the treatment of unstable intertrochanteric femoral fractures. The objective of the present study was to evaluate the clinical efficacy of a new type of intramedullary fixing device – locking gamma nail (LGN) – in treating unstable intertrochanteric femoral fractures. MethodsFrom March 2009 to March 2012, 88 patients with unstable intertrochanteric femoral fractures were treated at our department with LGNs. Twelve patients were excluded from the study. The clinical and radiographic results of the remaining 76 patients were retrospectively analyzed. ResultsThe mean duration of operation, volume of blood loss, and hospital stay was 50 min, 85 mL, and 8.5 days, respectively. No perioperative complications. Seven patients died 1 year after surgery. The other 69 patients received a mean 23-month follow-up. The mean fracture healing time was 16 weeks. Nine patients felt pain in their hips. Ten patients experienced delayed fracture healing. No other complications. Sixty-one patients had recovered to preoperative levels of function, with a mean Harris hip score of 86.6 and a mean Parker–Palmer mobility score of 7.42. Patients with malreduction were more likely to sustain pain complications (p = 0.002). Older patients were more likely to experience delayed fracture healing (p = 0.045). ConclusionsLGN is a simple and safe treatment for unstable intertrochanteric femoral fractures with satisfactory clinical efficacy and may be considered a new, minimally invasive operative method for treating unstable intertrochanteric femoral fractures.

Eficácia do tratamento das fraturas transtrocanterianas com Dynamic Hip Screw com acesso minimamente invasivo

ObjectiveTo analyze the short‐term results from treating unstable intertrochanteric fractures with dynamic hip screws (DHS), using a minimally invasive route, focusing on the functional aspects and complication and mortality rates of the method. MethodsThis was a prospective longitudinal study on 140 patients who underwent fixation of transtrochanteric fractures with the DHS system with a lateral minimally invasive access in the hip, between January and December 2013. The patients were evaluated pre and postoperatively (after six months of follow‐up) by means of the Parker and Palmer mobility score. Women comprised 65.7% of the sample, and 54.3% of the fractures were on the right side. The patients’ mean age was 80 years, ranging from 60 to 93 years. ResultsWe observed an overall decrease in the mobility score and an increase in the degree of dependence over the short term. However, we encountered only two deaths in the study sample and there were no cases of infection or nonunion. ConclusionDespite the efficacy of the treatment with DHS, with high rates of fracture consolidation and a low mortality rate, we noted that the patients still showed significant functional limitation at the follow‐up six months after the operation.

Tratamento das fraturas femorais subtrocantéricas com placas de bloqueio lateral da parte proximal do fêmur

OBJECTIVE: To study the outcome of subtrochanteric hip fractures treated with proximal lateral femur locking plate. METHOD: We retrospectively reviewed the clinical results of 48 cases of femoral subtrochanteric fractures treated with proximal lateral femur locking plates from January 2008 to May 2010. The progress of fracture healing, as well as the occurrence of complications, was recorded. The function of the hip joint was evaluated by the Harris social index and the Parker and Palmer mobility score one year after the operation. RESULT: 45 patients were followed up until fracture union or a revision surgery. Among the 45 patients, 43 patients obtained fracture union without further intervention. Thirty-eight fractures healed with no loss of position at 1-year follow-up. There were no cases of hip screw cutting through the femoral head. The mean score of the Harris social index was 86.5±9.8 (73~95). The mean Parker and Palmer mobility score was 7.4±2.1 (3~9). CONCLUSION: The proximal lateral femur locking plate is the kind of stable and effective internal fixation for treating subtrochanteric hip fractures which has the advantage of stable fixation especially for the lateral femoral wall fracture. Level of Evidence IV, Case Series.

Comparison of proximal femoral nail antirotation blade and reverse less invasive stabilization system‐distal femur systems in the treatment of proximal femoral fractures

To compare the effects of proximal femoral nail antirotation blade (PFNA) and reverse less invasive stabilization system-distal femur (Liss-DF) systems in the treatment of proximal femoral fractures. Between June 2007 and October 2009, 41 proximal femoral fractures were treated, 22 with PFNA (group A) and 19 with reverse LISS-DF plates (group B). The time to starting full weight-bearing, fracture healing time, functional recovery (Parker and Palmer mobility score), neck-shaft angle discrepancies with the intact contralateral hip, preoperative American Society of Anesthesiologists (ASA) scores, the operation durations and amount of intraoperative bleeding were recorded and compared. The mean follow-up period was 11.2 months (range, 10-12 months). Compared with Group A, Group B showed a statistically longer mean time to bear full body weight and heal their fractures, but a smaller neck-shaft angle discrepancy (all P < 0.05). The groups were similar in ASA score, operation duration, amount of intraoperative bleeding and Parker and Palmer mobility score. Both PFNA and reverse Liss-DF were satisfactory for the treatment of proximal femoral fractures, but had different advantages. PFNA allowed earlier weight-bearing and accelerated fracture healing. Reverse Liss-DF more effectively avoided coxa vara and may be indicated for patients with very severe osteoporosis.

Additional Fixations for Sliding Hip Screws in Treating Unstable Pertrochanteric Femoral Fractures (AO Type 31-A2): Short-Term Clinical Results

BackgroundTo evaluate the utility of additional fixation methods and to suggest a method of reduction in the treatment of unstable pertrochanteric femur fractures with a sliding hip screw (SHS).MethodsA retrospective study was performed on thirty patients with unstable pertrochanteric femur fractures, who were operated on with a SHS between September 2004 and September 2009 and were followed up for at least 6 months. The additional fixation devices were as follows; antirotation screw (21 cases), fixation of displaced fractures of the posteromedial bone fragment (cerclage wiring, 21 cases and screw, 2 cases) and trochanter stabilizing plate (27 cases). Clinically, the Palmer's mobility score and Jensen's social function group were used. Radiologically, alignment and displacement were observed. The tip-apex distance (TAD) and sliding of the lag screw were measured, and the position of the lag screw within the femoral head was also examined.ResultsThe mean age at the time of surgery was 76 years (range, 56 to 89 years) and the average follow-up period was 25 months (range, 6 to 48 months). At the last follow-up, the average mobility and social function score was 6.2 (± 3.5) and 2.3 (± 1.5). Postoperatively, the alignment and displacement indices were adequate in almost all the cases. The mean amount of lag screw sliding and the mean TAD was 5.1 mm (range, 2 to 16 mm) and 6 mm (range, 3 to 11 mm) respectively. The lag screws were located in the center-center zone in 21 cases. The average period to union was 18.7 weeks without any cases of nonunion or malunion. Mechanical failure was noted in one case with breakage of the lag screw and clinical failure was noted in another case with persistent hip pain related to excessive sliding (16 mm).ConclusionsWith additional fixations, the unstable pertrochanteric femur fractures could be well stabilized by SHS until bone union.

Reverse LISS plates for unstable proximal femoral fractures

The best treatment for unstable proximal femoral fractures is controversial. In this prospective study, we assessed the outcomes of reverse less invasive stabilisation system (LISS) plates for treatment of unstable proximal femoral fractures that are expected to be difficult to nail. From April 2004 to January 2007, 20 patients with unstable proximal femoral fractures that were assessed to be difficult to nail were managed with reverse less invasive stabilisation system–distal femur (LISS–DF) plates, which included (1) subtrochanteric fractures with extension into the piriform fossa, (2) short skeletons with narrow femoral canals, (3) adolescents with open physes and (4) severely bowed or deformed femurs. These patients were enrolled in this study. There were 11 females and nine males, with a median age of 58 years (range, 14–95 years). The average follow-up period was 24 (range, 12–32) months. Functional recovery (Parker and Palmer mobility score), pain, bony union, varus deformity, implant failure and leg length discrepancy were assessed. The fractures united at a median of 7 months (range, 3–15 months) postoperatively. Parker and Palmer mobility scores were 9 points for 17 patients and 6 points for three patients. Pain was absent in 15, mild in three, and moderate in two patients. Patients with poor quality of reduction were more likely to have pain results ( p = 0.009). Although patients with advanced age were not more likely to have pain results, they were more likely to have ‘delayed union’ radiographic results ( p = 0.033). Two limbs were shortened by 1.5 and 2 cm, respectively. Reverse LISS plate fixation led to complete union of unstable proximal femoral fractures without additional procedures. The surgical technique was simple and safe. We recommend considering the use of this locked-plate device as the alternative management of unstable proximal femoral fractures that are unsuitable for nailing procedures.

The Treatment of Unstable Reverse Oblique Intertrochanteric Fractures with Proximal Femoral Nail (PFN)

Purpose: To investigate the results of treatment of unstable reverse oblique intertrochanteric fractures with proximal femoral nail (PFN). Materials and Methods: We reviewed the results of 16 cases of AO 31-A3.3 intertrochanteric fracture treated with PFN from September 2000 to February 2004 which could be followed up for more than six months and untill bone union. The mean age was 60.2 years old. We investigated the union time and amount of sliding of two screws (neck screw and anti-rotational hip pin) and complications such as fixation failure and nonunion. Functional results were evaluated by the Parker and Palmer mobility score and Jensen social-function score. Results: All fractures were united and the mean union time were 6.9 months. The amount of sliding of the neck screws and anti-rotational hip pin was 4.8 mm and 3.8 mm on average in 14 cases, respectively. Fixation failure and excessive migration of the screws occurred in two cases; One case showed so-called Z-effect of two screws (reciprocal movement of two screws) and nonunion. The other case showed proximal migration and cutout of the neck screw. There was one femoral shaft fracture at the nail tip caused by a slip. Eight cases (50%) and eleven cases (68.8%) were fully recovered according to Parker and Palmer mobility score and Jensen social-function score, respectively. Conclusion: We consider that PFN is a suitable implant for treatment of unstable reverse oblique intertrochanteric fractures. However, the revision of implant design is recommended to prevent the excessive migration of the femoral neck screw and anti-rotational hip pin.