Pertrochanteric Femoral Fractures Research Articles

Anatomy-based MRI assessment of the iliopsoas muscle complex after pertrochanteric femoral fracture.

To evaluate the quality of the iliopsoas muscle complex after pertrochanteric femoral fracture, using MRI; to propose an anatomy-based evaluation of the iliopsoas muscle complex; and to determine the inter-reader reliability of two classifications of fatty muscle degeneration. We included adult patients with a displaced lesser trochanter following pertrochanteric femoral fracture. Muscle quality was evaluated using the Goutallier and Slabaugh classifications at three levels (L4/L5, L5/S1, and the anterior inferior iliac spine). Two radiologists independently reviewed the MRIs, and force measurement was performed on both hips. Linear mixed-effects models were used to determine the effect of fracture on muscle quality and strength, and Cohen's kappa statistic was used to assess inter-reader agreement. In the 18 patients included, the iliopsoas muscle complex showed higher grades of fatty muscle degeneration on the fractured side than on the non-fractured side. The mean difference between muscle strength on the fractured vs the non-fractured side was -12N (p > 0.05). Inter-reader agreement for the Goutallier and Slabaugh classifications was good and very good respectively (weighted K = 0.78 and 0.85 respectively). Fatty muscle degeneration of the iliopsoas muscle complex after pertrochanteric femoral fracture was evident using both classification systems; however, fatty muscle degeneration resulted in only a minimal reduction of muscle strength. To provide a thorough assessment of iliopsoas muscle complex quality, we suggest evaluating it at different anatomical levels. Regarding inter-reader agreement, the Slabaugh classification was superior to the Goutallier classification.

Clinical analysis using proximal femoral locking plate in the management of complex, comminuted pertrochanteric femoral fractures in adults: a prospective study

<p class="abstract"><strong>Background:</strong> Pertrochanteric fractures consume major part of orthopaedic injuries with high morbidity and cost factors. They affect almost all age groups. The treatment options vary a lot depending on the type of fracture and age. Despite marked improvement in implant design, surgical technique and patient care; pertrochanteric fractures continue to consume a substantial proportion of our health care resources.</p><p class="abstract"><strong>Methods:</strong> This prospective study consists of 20 adult patients of pertrochanteric fractures of femur, who were treated with internal fixation using PFLP. All patients were followed up at an interval of 4 to 6 weeks till fracture union and then once in 3 months till 1 year.<strong></strong></p><p class="abstract"><strong>Results:</strong> Anatomical results are noted as good or poor depending upon shortening, varus deformity, hip movements and knee movements and functional result as excellent, good, fair and poor depending upon the hip pain, ambulatory status, ability to squat, and sit cross leg. In the study 2 patients had shortening of l cm. None of the patients had any varus deformity. Overall excellent to good results were achieved in 85% cases.</p><p class="abstract"><strong>Conclusions:</strong> The potential advantages of the proximal femoral locking plate over intramedullary devices are better biomechanical design, ability to bear more stress due to, strong biomechanical stability shows that this technique holds considerable promise in complex, comminuted fractures in revision cases and in osteoporosis.</p>

Outcomes after unstable pertrochanteric femur fracture: intermediate versus long cephalomedullary nails.

Optimal cephalomedullary nail (CMN) length for unstable pertrochanteric femur fractures is controversial. Long CMNs (L-CMNs) are currently recommended; however, intermediate-length CMNs (I-CMNs) may provide stable fixation without the additional surgical steps required by L-CMNs. We analyzed outcomes after unstable pertrochanteric femur fractures treated with L-CMNs or I-CMNs to determine whether functional outcomes, perioperative measures, complications, and mortality and reoperation rates differ by CMN length. We retrospectively reviewed medical records at our institution for 100 patients who received surgical treatment for pertrochanteric femur fractures from June 2014 to June 2016. Data from 43 unstable pertrochanteric femur fractures treated with L-CMNs (n = 25) or I-CMNs (n = 18) were analyzed. We evaluated operative time, fluoroscopy time, intraoperative blood loss, blood transfusions, and perioperative complications; peri-implant fracture, malunion, reoperation, and death; and neck-shaft angle, tip-apex distance, and 6-month postoperative functional scores. We analyzed categorical data with Fisher exact tests and continuous data with Student t tests. P < 0.05 was considered significant. The I-CMN group had shorter operative time (68 versus 92min; P = 0.048), shorter fluoroscopy time (72 versus 110s; P = 0.019), and less intraoperative blood loss (80 versus 168mL; P < 0.001) than the L-CMN group. The groups were similar in rates of blood transfusion, perioperative complications, peri-implant fracture, malunion, reoperation, and death. Six-month postoperative functional scores were similar between groups (P > 0.05). We found operative advantages of I-CMNs over L-CMNs with no difference in treatment outcomes. Level IV, Retrospective case series study.

Pro’s and Con’s of proximal femoral nail in Peri trochanteric fractures

Background: Fractures of the trochanteric region of femur can be difficult to treat. This anatomic region experiences the highest tensile and compressive stresses in the human skeleton. The proximal fragment is often quiet short, offering limited opportunity for internal fixation, which must withstand these substantial forces. In subtrochanteric fracture, the proximal fragment is flexed, abducted and externally rotated due to the Iliopsos, abductor muscles, and short external rotators muscle pull. Hence, it is useful to perform an open reduction of the fracture fragments and then stabilise the proximal fragment to restore anatomical position, prior to nail insertion. Methods: The present study consists of 20 adult patients with proximal femoral fractures of femur who were treated with PFN at Bims, Belgaum between Jan 2014 to March 2018. The fractures were classified according to Russell and Taylor classification. 20 cases were followed at regular intervals. This study was conducted with due emphasis for clinical observation and analysis of results after surgical management of peritrochanteric fractures of femur. Results: In our study of peritrochanteric fractures treated with PFN, we encountered intraoperative complications like iatrogenic fracture of lateral cortex in 2 cases (10%) due to selection of wrong entry point, failure to put derotation screw in 2 cases (10%) and guidewire breakage in 1 case (5%). Delayed complications like hip joint stiffness in 3 cases (15%), knee joint stiffness in I case (5%) and shortening of more than one cm in 1 case (5%) and delayed union in 2 cases (10%). Conclusions: Open reduction offer advantage in preventing malalignment of peritrochanteric fractures as compared to closed reduction. From our study we conclude that PFN is a reliable implant for peritrochanteric fractures, leading to high rate of bone union restoring the anatomical alignment and reduced chance of implant failure or deformities.

A study of surgical management of peritrochanteric fracture of femur with proximal femoral nail

Peritrochanteric fractures are devastating injuries that most commonly affect the elderly population and also the young. Peritrochanteric fracture is a leading cause of hospital admissions in elderly people. The number of such admissions is on a raise because of increasing life span and sedentary habits. Conservative methods of treatment results in malunion with shortening and limitation of hip movement as well as complications of prolonged immobilization. This study was done to analyze the surgical management of Peritrochanteric fractures using Proximal Femoral Nail. This is a retrospective study of 20 cases of trochanteric and subtrochanteric fractures admitted to R.L. Jalappa Hospital and Research Centre, S.D.U, M.C, Kolar, between July 2009 to October 2011. Patients with Peritrochanteric fracture above the age of 18yrs were included while pathological fractures and patients with associated co-morbidities posing a risk for surgery were excluded from the study. In our series of 20 cases, excellent results were seen in 50% cases, good in 33.3% cases, fair in 16.7% in trochanteric fractures. In subtrochanteric fractures, excellent results were seen in 64.3%, good in 21.4% cases and fair in 14.3%. From this sample study, we consider that PFN is an excellent implant for the treatment of Peritrochanteric fractures. The terms of successful outcome include a good understanding of fracture biomechanics, proper patient selection, good preoperative planning, accurate instrumentation, good image intensifier.

Functional and Radiological Results of Proximal Femoral Nail Antirotation (PFNA) Osteosynthesis in the Treatment of Unstable Pertrochanteric Fractures.

Pertrochanteric femur fractures are considered amongst the most commonly encountered fractures in the geriatric age group. We evaluated radiographic and functional outcomes of patients with unstable pertrochanteric fractures treated with the proximal femur nail antirotation (PFNA). Between March 2013 and December 2015, fifty patients (28 male and 22 females with a mean age of 72.8 years (range, 20–94)) with unstable pertrochanteric fractures (AO 31.A2 and 31.A3) were fixed with the PFNA at our institution, and they were retrospectively evaluated. Forty one patients were treated with short PFNA and nine with long PFNA. Operative time ranged between 30 and 150 (average 73.60) min, blood loss ranged between 50 and 250 (average 80) milliliter and hospital stay ranged between 3 and 18 (6.86) days. The mean follow-up period was 18 months (range, 11–31). At final follow-up, solid union of all fractures had been achieved without any implant-related complications, the mean Harris Hip Score (HHS) was 79.34 ± 9.10 points and the mean neck-shaft angle was 127.2° ± 5.07°. No significant differences were encountered between the functional and radiographic outcomes of the PFNA with regards to the AO fracture classification and the implant version. PFNA is a recommended option for the treatment of unstable pertrochanteric fractures owing to its easy insertion, reduced blood loss, stable fixation and satisfactory functional and radiological outcomes.

An unusual neurological complication following internal fixation of pertrochanteric fracture neck of the femur.

Fracture of the femoral neck is a common injury in the elderly population and may be associated with significant morbidity. More than 25,000 patients per year in the UK receive treatment for femoral neck fractures. Neurological injury associated with pertrochanteric fracture of the neck of the femur is rare. Sciatic nerve injury following isolated pertrochanteric femoral neck fractures is very rare and has not previously been reported in the literature. We describe a case of foot drop secondary to sciatic nerve injury following fracture of neck of the femur, with recovery after surgical exploration and nerve release. (Hip International 2002; 4: 400-2).

Functional Outcome of Proximal Femoral Nail in Unstable Peritrochanteric Fractures of Femur

Functional Outcome of Proximal Femoral Nail in Unstable Peritrochanteric Fractures of Femur

A surgical management of pertrochanteric fractures of femur by dynamic hip screw and proximal femoral nail

The incidence of femoral fractures at hip region is increasing with advancement of age in population, globally. Surgical treatment with stable fixation reduces fracture associated complications and helps in regaining of mobility. Dynamic hip screw (DHS) and proximal femoral nail (PFN) are main types of fixations for trochanteric fractures. This study was designed to assess the efficacy of DHS and PFN in trochanteric fractures of femur. A total 50 patients with type I, II, III intertrochanteric and subtrochanteric fractures of femur as per Boyd and Griffin’s classification, Seinsheimer’s classification and Evans classification were included and were managed operatively by internal fixation with dynamic hip screw (DHS) and proximal femoral nail (PFN). 48% cases in DHS and 44% cases in PFN undergone with surgery within 5 days after injury. In PFN, the range of lag screw length was between 70mm to 95mm whereas in DHS, range was in between 65mm to 100mm. In intra operative complications of this study, there was ill fitting jig in 24% cases of PFN and in DHS method includes shattering of lateral cortex (8%) and difficulty in reduction (8%). Average time for fracture union in this study was between 14-17 weeks. In 12% cases varus deformity was observed in both groups and on an average 82% cases had good range of movement at hip joint in PFN and DHS groups. It was concluded that proximal femoral nail and dynamic hip screw were ideal treatment modalities to treat inter trochanteric and sub trochanteric fractures of the femur.

Uma análise retrospectiva de fraturas complexas do fêmur proximal tratadas cirurgicamente com placa de compressão bloqueada do fêmur proximal

ObjectiveAnalyze the outcomes of proximal femoral locking compression plate (PF‐LCP) in these complex fractures. MethodsThis study retrospectively analyzed 21 proximal femoral fractures treated with PF‐LCP from June 2013 to February 2015. There were 15 females (71%) and six males (29%) with an average age of 61.4 years (range: 34–80 years). The peritrochanteric fractures constituted by intertrochanteric and subtrochanteric fractures were classified by the Boyd and Griffin classification and Seinshemier's classification, respectively. Among them, 16 cases (76%) were of intertrochanteric and five cases (24%) were of subtrochanteric fracture pattern. The functional outcome was assessed by Harris Hip Score and the Parker Palmer mobility score one year post‐surgery. ResultsAmong 21 patients, 19 patients obtained fracture union without further intervention; two patients required additional bone grafting. No cases of the hip screw cutting the femoral head were noted. There was no post‐operative mortality in this study. The average Harris Hip Score was 84.5 (range: 83–94). The assessment by Parker and Palmar mobility score was 7.5 (range: 4–9). ConclusionThe PF‐LCP is a good, stable alternative in the treatment of peritrochanteric femoral fractures. It provides good‐to‐excellent bone healing with reduced complications.

Comparative study between DHS and PFN in the management of trochanteric and subtrochanteric femoral fractures

Introduction: The of aim treatment of these fractures is prevention of malunion and early mobilization. There are various treatment options available, the ideal choice of treatment is internal fixation. Most common used device used for fixation is DHS with side plate assemblies. The best suited implant for management is PFN.Aim and Objectives: (A) Comparative study of PFN AND DHS. (B) Evaluation of effectiveness and strength of PFN and DHS.Material and methods: The present study was carried out in PRH, Loni from 2016 to 2017.The study consisted of total 40 adult patients of peritrochanteric fractures of femur. Out of this 20 patients were treated with PFN and DHS 20.This was a comparative study. All the peritrochanteric fractures were considered except grade 4 type of intertrochanteric fracture as per Boyd and Griffins classification and grade 5 according to seinsheimer classification. Minimum of 6 months of follow up.Observation and Result: We have done follow up examination at the end of 6 weeks, 12 weeks, 18 weeks. Average time for which patients were admitted was 3 weeks i.e. 21 days. Average time of union in all our 40 patients was 18 weeks (range 12 to 20 weeks).Intraoperative details PFN is better treatment modality considering its biomechanical properties. The claimed advantage with PFN is that a smaller exposure is required than for a sliding screw it may therefore be associated with less blood loss, shorter operating time and less morbidity. Also in osteoporotic bone PFN fixation carries definitive advantage over DHS fixation device.

Proximal femoral nail: A boon for peritrochanteric fractures

Expected age of human race has increased, leading to increase in the number of geriatric people with osteoporotic bones and falls associated with them. In 1949, Boyd and Griffin classified fractures in the trochanteric region of femur into four types. Biomechanical studies have shown that intramedullary device with sliding screw is better. Its location & rotational stability provides better load transfer and hence provides biological fixation. This was a prospective study of 25 cases of peritrochanteric fractures of femur evaluated as per Harris Hip score. In our study, 60% of the patients had excellent to good functional score with 40% of patients had fair to poor functional score due to presence of comorbidity or affected by one of the complications mentioned further. In our study, the average Harris Hip Score was 82.12 with the range of 66.5-92.5.

Extent and Morbidity of Lateralization of a Trochanteric Fixation Nail Blade.

This study examined the incidence and risk factors associated with lateral helical blade migration and trochanteric pain with the trochanteric fixation nail. A retrospective review was performed of 141 cases of pertrochanteric femur fracture treated with a trochanteric fixation nail at a level I trauma center over a period of 42 months. Exclusion criteria included follow-up of less than 60 days, preexisting osteonecrosis of the femoral head, and prophylactic trochanteric fixation nail treatment. Patient demographics, operative findings, and radiographic findings were recorded. Medical records were reviewed to identify symptomatic hardware. Overall, 27 patients (19.1%) were symptomatic, and 3 (2.1%) required revision surgery for blade prominence. Of the patients, 42 (30%) had lateralization of greater than 1 cm, and 16 of these (38.1%) were symptomatic (P<.02). A risk factor for lateralization was AO classification, with 46.1% of type A2 fractures showing lateralization of greater than 1 cm. The quality of calcar reduction nearly reached statistical significance, and 44.8% of patients who had inadequate reduction had lateralization of greater than 1 cm compared with 26.4% of patients who had adequate reduction (P=.054). Lateralization of greater than 1 cm was directly associated with the presence of symptoms (P<.001) and removal of hardware because of trochanteric pain (P=.007). Multivariate analysis showed that increasing tip-apex distance, inadequate calcar reduction, and greater fracture severity were predictive of excessive lateralization of greater than 1 cm. Nearly 20% of patients had lateral hip pain associated with cephalomedullary fixation. Final lateralization of the helical blade of greater than 1 cm was a very strong predictor of symptoms. During preoperative counseling, surgeons should caution patients about this relatively frequent and likely underreported complication. [Orthopedics. 2017; 40(5):e886-e891.].

A six-year retrospective analysis of cut-out risk predictors in cephalomedullary nailing for pertrochanteric fractures: Can the tip-apex distance (TAD) still be considered the best parameter?

ObjectivesIntramedullary fixation is considered the most stable treatment for pertrochanteric fractures of the proximal femur and cut-out is one of the most frequent mechanical complications. In order to determine the role of clinical variables and radiological parameters in predicting the risk of this complication, we analysed the data pertaining to a group of patients recruited over the course of six years.MethodsA total of 571 patients were included in this study, which analysed the incidence of cut-out in relation to several clinical variables: age; gender; the AO Foundation and Orthopaedic Trauma Association classification system (AO/OTA); type of nail; cervical-diaphyseal angle; surgical wait times; anti-osteoporotic medication; complete post-operative weight bearing; and radiological parameters (namely the lag-screw position with respect to the femoral head, the Cleveland system, the tip-apex distance (TAD), and the calcar-referenced tip-apex distance (CalTAD)).ResultsThe incidence of cut-out across the sample was 5.6%, with a higher incidence in female patients. A significantly higher risk of this complication was correlated with lag-screw tip positioning in the upper part of the femoral head in the anteroposterior radiological view, posterior in the latero-lateral radiological view, and in the Cleveland peripheral zones. The tip-apex distance and the calcar-referenced tip-apex distance were found to be highly significant predictors of the risk of cut-out at cut-offs of 30.7 mm and 37.3 mm, respectively, but the former appeared more reliable than the latter in predicting the occurrence of this complication.ConclusionThe tip-apex distance remains the most accurate predictor of cut-out, which is significantly greater above a cut-off of 30.7 mm.Cite this article: G. Caruso, M. Bonomo, G. Valpiani, G. Salvatori, A. Gildone, V. Lorusso, L. Massari. A six-year retrospective analysis of cut-out risk predictors in cephalomedullary nailing for pertrochanteric fractures: Can the tip-apex distance (TAD) still be considered the best parameter?. Bone Joint Res 2017;6:481–488. DOI: 10.1302/2046-3758.68.BJR-2016-0299.R1.

A systematic review of short versus long intramedullary fixation in the management of pertrochanteric fractures

Introduction The aim was to determine whether there is a significant difference in clinical outcomes when using short vs. long nails for pertrochanteric femur fractures. Methods A systematic literature search was undertaken of Pubmed and Embase in April 2016. All papers published in English reporting studies comparing long vs. short nails for pertrochanteric femur fractures were studied. Data were pooled for blood loss and transfusion requirement, operative time, length of stay, incidence of delayed or non-union, incidence of avascular necrosis or infection, fracture or metalware failure and was analysed to examine the differences between long and short nails. Results From 90 potential studies, nine were considered to be eligible for inclusion. The short nail resulted in a statistically significant benefit when looking at transfusion requirement (p = 0.02); however, blood loss was not statistically different (p = 0.33) Operative time was also quicker with the short nail (p = 0.004), but the length of stay was no different (p = 0.41). When examining complications and fixation outcomes, there was no difference in delayed union rates (p = 0.29) and non-union rates (p = 0.19) nor when looking at metalware failure (p = 0.41) and fracture (p = 0.14). Discussion The use of short intramedullary nails for pertrochanteric femur fractures appeared to be beneficial when looking at transfusion requirements and operative time. When looking at complications such as fracture and metalware failure, despite there being a slightly higher incidence of these in the short nail group, it is not statistically significant. This study advocates that both devices are safe to use, however, the short nail may have some perceived benefits in reducing transfusion requirements and have cost benefits with a shorter operative time.

A retrospective analysis of surgically-treated complex proximal femur fractures with proximal femoral locking compression plate

ObjectiveAnalyze the outcomes of proximal femoral locking compression plate (PF-LCP) in these complex fractures. MethodsThis study retrospectively analyzed 21 proximal femoral fractures treated with PF-LCP from June 2013 to February 2015. There were 15 females (71%) and six males (29%) with an average age of 61.4 years (range: 34–80 years). The peritrochanteric fractures constituted by intertrochanteric and subtrochanteric fractures were classified by the Boyd and Griffin classification and Seinshemier's classification, respectively. Among them, 16 cases (76%) were of intertrochanteric and five cases (24%) were of subtrochanteric fracture pattern. The functional outcome was assessed by Harris Hip Score and the Parker Palmer mobility score one year post-surgery. ResultsAmong 21 patients, 19 patients obtained fracture union without further intervention; two patients required additional bone grafting. No cases of the hip screw cutting the femoral head were noted. There was no post-operative mortality in this study. The average Harris Hip Score was 84.5 (range: 83–94). The assessment by Parker and Palmar mobility score was 7.5 (range: 4–9). ConclusionThe PF-LCP is a good, stable alternative in the treatment of peritrochanteric femoral fractures. It provides good-to-excellent bone healing with reduced complications.

Primary hemiarthroplasty for treatment of unstable pertrochanteric femoral fractures (AO/OTA Type 31 A2.3) in elderly osteoporotic patients

Introduction: The aim of this study was to prospectively analyze the role of primary hemiarthroplasty in unstable osteoporotic pertrochanteric fractures (AO/OTA Type 31 A2.3), with emphasis given to postoperative Functional Independent Measure (FIM) and Harris Hip Score (HHS). Methods: Fifty-six consecutive patients (average age 78.25 ± 5.45), out of which 24 males (79.29 ± 4.99) and 32 females (77.47 ± 5.72), with unstable pertrochanteric femoral fractures, operated with primary hemiarthroplasty procedure from 2012 to 2014 were included in this prospective study with a follow-up of two years. Primary outcomes were FIM and HHS. Secondary outcomes included duration of surgery, estimated intraoperative blood loss, time to first postoperative full weight-bearing, time to walking ability with and without crutches, average hospital stay, postoperative complications, and mortality. Results: The FIM score at 3 months was 85.9 ± 5.7. HHS at two years was excellent for 41 patients (73, 2%), good for eight (14.3%), fair for four (7.1%), and poor for three (5.4%). The mean duration of surgery was 62.6 min, estimated intraoperative blood loss 175.5 mL, time to first postoperative full weight-bearing 2.2 ± 0.4 days, ability to walk with crutches 6.3 ± 1.8 days and without crutches 44.2 ± 12.7 days, and the average hospital stay was 9.6 ± 2.7 days. Conclusion: This study highlighted good clinical postoperative outcome scores for primary hemiarthroplasty for the treatment of unstable pertrochanteric femoral fractures in elderly osteoporotic patients. This procedure seems to be secure and effective, and offers a good quality of life in terms of FIM and HHS.

Reamed versus unreamed intramedullary nailing in the treatment of elderly pertrochanteric femoral fractures: evaluation of the systemic inflammatory response and organ dysfunction.

Background: Currently, the most widely used technique of osteosynthesis in the treatment of proximal femur fractures is the intramedullary nailing and canal reaming. However, intramedullary canal reaming causes a significant release of IL-6 and an important systemic inflammatory reaction. A surgical variant technique is the introduction of the nail with no canal reaming in order to reduce the trauma produced, to simplify and speed up the process of osteosynthesis and, presumably, to reduce the systemic inflammatory response produced by the reaming procedure.The purpose of the study is the comparative evaluation between the reamed and unreamed surgical techniques in terms of increased biochemical markers of organ damage and inflammation. Material and methods: The retrospective observational study was conducted between March 2014 and October 2015 on a sample of 199 patients. The following values were recorded: D-dimer, Troponin, alkaline phosphatase(ALP), ESR, CRP, LDH at admission, at 1st and 4th postoperative days, and the percentage change was calculated between the values of the fourth postoperative day, and those at admission. The Mann-Whitney test was administered for the significance of differences, with p-value

Surgical management of pertrochanteric fractures with proximal lateral femur locking compression plate

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Pertrochanteric femoral fractures are of intense interest globally. Pertrochanteric fracture is a one of the most serious cause of mortality and morbidity in elderly people. The number of such admissions is on a raise because of increasing life span, sedentary habits and increased road traffic accidents. Pertrochanteric region is a high stress area. Hence delayed union, implant failures, varus collapse and non-union are common complications. Choice of implant was also a tough decision for surgeons in this area. Hence this study was intended to evaluate the functional outcome of proximal femur fractures treated with proximal femur locking compression plate (PFLCP) in terms of union of fracture, patient compliance and complications.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This prospective study was conducted at the department of orthopaedics, Narayana Medical College and Hospital, Nellore from December 2014 to June 2016. The complete data was collected from all the patients by taking history of illness and by doing detailed clinical examination and relevant investigations. Finally after the diagnosis, the patients were selected for the study depending on the inclusion and exclusion criteria. Postoperatively all the cases were followed for the minimum period of 6 months to maximum period of 1 year.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In this study 22 patients were involved. There were 14 males and 8 females, with a mean age of 46 years. 19 cases were admitted due to slip and fall and with slight predominance of right side. Mean duration of hospital stay was 20 days and mean time of full weight bearing is 10 weeks. Out of 22 cases 2 cases lost follow up before first follow up time of 6 weeks. Out of 20, remaining cases 8 were type 3 and 12 were type 4. Functional results were graded by Harris hip scoring system. Good to excellent results were seen in 87% cases of type 3 fractures and 83% cases in type 4 fractures.&lt;/p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Treatment with a PFLCP can provide good-to-excellent healing for proximal femur fractures, with a limited occurrence of complications especially for severe comminuted fracture and osteoporosis.

PMS39 - Direct Medical Resource Utilization For Reoperation After Intramedullary Fixation of Pertrochanteric HIP Fractures

To assess patient survival, reoperation rates, and direct medical resource utilization after reoperation subsequent to intramedullary fixation for patients with pertrochanteric femur fractures. This study used a retrospective cohort design with the United States Centers for Medicare and Medicaid (CMS) Standard Analytic File (5%) sample. Patients aged 65+ who received an ORIF with intramedullary fixation in 2013 were included in the cohort. Overall survival, reoperation events, and direct medical resource utilization (claim payments) across multiple settings of care were explored for the 90-day period after index hospitalization and for the subset of patients who underwent reoperation. Patient survival through 365 days of index surgery was analyzed using Kaplan-meier methods with stratification for baseline Charlson Comorbidity Index (CCI). 3,175 patients underwent index surgery during 2013. Patients had mean (SD) age of 83.4 (7.7), 74.1% were female, and 85.2% had a primary International Classification of Disease, 9th revision (ICD-9-CM) diagnosis code of 820.21: Closed fracture of intertrochanteric section of neck of femur. A total of 131 patients (4.1%) had a second hip surgery within 365 days after their index procedure: 51 (38.9%) contralateral, 35 (26.7%) ipsilateral and 45 (34.3%) of unknown laterality. Overall survival among the full cohort was 72.8% at 365 days, and differed across baseline CCI categories: 0-1: 83.2%; 2-3: 75.7%; 4-5: 69.5%; 6+: 58.3% (log-rank test; p <0001). For patients with ipsilateral hip reoperation, mean (SD) Medicare payments from index through the 90-day window totaled $46,577 ($26,607), and comprised the following: index hospitalization-$14,785 ($4,542); physician-$5,159 ($3,925); durable medical equipment-$203 ($536); home health-$2,936 ($3,802); skilled nursing facility-$12,002 ($11,656); inpatient rehab-$4,206 ($11,904); hospice-$326 ($1,365); and other inpatient admissions- $6,960 ($15,127). Mortality for patients with intramedullary fixation varies inversely with baseline CCI, and post-acute care accounts for nearly 60% of 90-day episode costs for patients requiring reoperation.