Pertrochanteric Fractures Research Articles

Risk of shortening in operatively treated proximal femur fractures with cephalomedullary nails with dynamically versus statically locked helical blades

IntroductionCephalomedullary nails (CMN) have proven to be effective for the fixation of unstable pertrochanteric hip fractures, but limited data exists regarding the degree of shortening that occurs with nailing systems that offer “dynamically” versus “statically” locked helical blades. This study aimed to determine the incidence, timing, and amount of postoperative fracture shortening in patients with pertrochanteric hip fractures treated with “dynamically” versus “statically” locked helical blades. MethodsA retrospective review was performed on patients requiring operative fixation of pertrochanteric fractures. Inclusion criteria were patients aged 55 or older, low energy mechanism of injury, primary surgical open reduction and internal fixation of the injury, surgery performed by a fellowship-trained orthopaedic traumatologist, and radiographic follow up until healing or failure (minimum of 3 months). Quantification of fracture shortening was determined using the lateral screw protuberance method. Fracture shortening measurements were calculated from immediate post-operative films and subsequent radiographs at each follow-up visit. Results222 patients met inclusion criteria (123 using Depuy Synthes Trochanteric Fixation Nail proximal femoral nailing system (TFN) with static locking; 65 TFN with dynamic locking; 23 using Depuy Synthes Trochanteric Fixation Nail-Advanced proximal nailing system (TFNA) with static locking; and 11 TFNA with dynamic locking). When comparing the final screw protuberance, the TFN dynamic (10.31 mm), TFNA static (9.52 mm), and TFNA dynamic (7.02 mm) groups were found to be significantly less compared to the TFN static cohort (11.67 mm; p < 0.001). The distribution of fracture shortening was found to be significant (p < 0.01). Interval measurements of fracture shortening by repeated measures of ANOVA within groups showed statistically significant increases in screw protuberance for the TFN static (p < 0.001), TFN dynamic (p < 0.001), and TFNA static (p < 0.01) cohorts within the first 60 days postoperatively. The TFNA with dynamic locking group was found to have statistically significant increases until the first 100 days post-operatively (p < 0.02). DiscussionThe incidence of fracture shortening remains high even with the use of cephalomedullary nails, regardless of dynamization status. Current pertrochanteric fixation constructs continue to favor fracture healing at the direct expense of fracture shortening.

Mean Tip Apex Distance in Patients undergoing Dynamic Hip Screw Fixation for Pertrochanteric Fractures without using Traction Table: A Descriptive Cross-sectional Study.

Dynamic Hip Screw fixation has shown to be equally effective compared to cephalomedullary nailing. The effectiveness of dynamic hip screw fixation for pertrochanteric fractures without using traction table is not well investigated. This study aimed to find out the mean tip apex distance in patients undergoing dynamic hip screw fixation for pertrochanteric fractures without using traction table. A descriptive cross-sectional study was conducted among patients undergoing dynamic hip screw fixation for pertrochanteric fractures without using traction table between 1 September 2021 and 30 June 2022, after getting approval from institutional review committee (Reference number: IRC-2021-08-23-02). All patients undergoing dynamic hip screw fixation for pertrochanteric fractures without using traction table were included in the study. Patients with pre-existing ipsilateral or contralateral hip deformity, contra-lateral hip prosthesis, bilateral hip fractures, and history of prior ipsilateral hip surgeries were excluded. Point estimate and 95% confidence interval were calculated. Among 45 patients, the mean tip apex distance was 20.45±6.13 mm (18.66-22.24 mm, 95% Confidence Interval). Among 45 patients, 24 (53.33%) were males and 21 (46.66%) were females. The average age of the participants was 67.75±21.33 years. The mean tip apex distance in patients undergoing dynamic hip Screw fixation for pertrochanteric fractures without using traction table was similar to that reported in other international studies. fracture fixation; hip fractures; operating tables.

Tranexamic acid in pertrochanteric fractures: a retrospective analysis of perioperative outcomes after fixation with a proximal femoral nail

BackgroundTreatment of pertrochanteric femoral fractures is often associated with significant blood loss. It has already been demonstrated that the administration of tranexamic acid (TXA) for endoprosthetic procedures reduces blood losses and leads to a decreased frequency of postoperative complications. The aim of this study is to demonstrate whether the administration of TXA as part of osteosynthesis treatment for pertrochanteric fractures using a proximal femoral nail reduces perioperative blood losses and haemorrhage-related complications.MethodsIn a two-centre retrospective cohort study, 1 g TXA i.v. was administered preoperatively to 294 patients who had suffered from pertrochanteric femoral fractures. The subjects were compared clinically to a historical control group who did not receive TXA (nonTXA). Outcomes were evaluated on the basis of perioperative blood loss, transfusion requirement, and occurrence of complications.ResultsThe TXA group showed evidence of a reduction in blood loss (TXA = 0.97 ± 0.47 l; nonTXA = 1.06 ± 0.47 l; p = 0.004) and a lower frequency of transfusion (TXA = 20%; nonTXA = 31%; p = 0.032) as compared to the nonTXA group. However, evidence of this therapeutic effect could only be demonstrated at one of the centres on subgroup comparison between the two centres. At the second centre, the data did not show a significant difference. A trend could be seen towards a reduction in postoperative renal failure. No complications occurred resulting from the administration of tranexamic acid.ConclusionPreoperative administration of TXA does not lead to an increased rate of thromboembolic complications when applied for treatment of pertrochanteric femoral fractures. Evidence of a positive effect could be seen in principle in relation to the reduction in perioperative blood loss and the frequency of transfusion. The difference in effect between the two centres remains to be clarified: for this reason, it is possible to assume that further factors influencing the efficacy of TXA administration are at play which were not taken into account in this study.

OR01-1 Proximal Femur Fracture Incidence by Sex among Older US Asian/Pacific Islander Adults and non-Hispanic White Adults

Abstract Background The burden of proximal femur (hip) fractures is high in older adults and contributes to substantial mortality. Numerous studies also document racial/ethnic differences in hip fracture incidence, lower among US Asian compared to non-Hispanic White (NH-White) adults. These data have informed base population factors used for fracture risk calculation; for US Asian compared to NH-White populations, ratios of 0.50 and 0.64 have been used for women and men, respectively. In this study, we examined age-adjusted and age-specific incidences of hip fracture in a contemporary population of older US adults and compared findings in Asian and NH-White women and men. Methods Among adults age ≥50 years who were members of a large US healthcare system during 2010-2019, we identified Asian/Pacific Islander (Asian/PI) and NH-White adults based on self-reported race/ethnicity data. Incident hip fractures were identified during follow-up from 2010 to 2021 (censoring at hip fracture, death, or membership end) based on (1) initial principal/primary hospital diagnosis of femoral neck or pertrochanteric fracture or (2) secondary hospital diagnosis with hip fracture repair procedure(s). The incidence of hip fracture (per 100,000 person-years) by sex and age and overall age-standardized incidence (using the 2010 US Census) were reported with [95% confidence intervals]. To compare sex-specific fracture rates between Asian/PI and NH-White adults, Poisson models were fitted, adjusting for age (5-year age categories). Results Among 203,116 Asian/PI and 645,384 NH-White women, we identified 1,436 and 15,214 hip fractures, and among 174,594 Asian/PI and 573,693 NH-White men, we identified 582 and 7051 hip fractures during follow-up, respectively. The age-adjusted incidence of hip fracture was 136 [129-143] and 297 [292-302] per 100,000 person-years for Asian/PI and NH-White women and 54 [49-58] and 149 [145-153] per 100,000 person-years for Asian/PI and NH-White men, respectively. By 5-year age group, hip fracture incidence increased from 4, 40, to 1113 per 100,000 person-years for Asian/PI women and 7, 29, to 528 per 100,000 person-years for Asian/PI men ages 50-54, 65-69, to 85+ years, respectively. These estimates were lower than that observed in respective NH-White women (range 19, 140, to 2068 per 100,000 person-years) and NH-White men (range 22, 85, and 1381 per 100,000 person-years). The age-adjusted relative risk (risk ratio) of fracture comparing Asian/PI to NH-White women was 0.44 [0.41-0.46] and comparing Asian/PI to NH-White men was 0.35 [0.33-0.39]. Conclusion Hip fracture incidence in Asian/PI women and men is 56% and 65% lower than that observed in NH-White women and men. These findings indicate that racial/ethnic differences in proximal femur fracture persist in contemporary aggregate populations of older US Asian/PI adults compared to NH-White adults. However, given the known and increasing heterogeneity of the US Asian/PI population, future studies should examine whether these risk ratios vary by Asian/PI ethnic subgroups. Presentation: Saturday, June 11, 2022 11:30 a.m. - 11:45 a.m.

A comparative study of intertan nail versus proximal femoral nail antirotation in the treatment of peritrochanteric fractures

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Over the past decades the incidence of intertrochanteric fractures has increased and there is a universal agreement about the intramedullary nail being the preferred implant of fixation for these fractures.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; In this study we have attempted to assess and compare the results and immediate as well as long term outcome of fractures managed by proximal femoral nail anti rotation and the intertan nail. We included 102 patients in our study, half in the group managed by proximal femoral nail anti rotation group and half in the group managed by intertan nail. Over a period of almost one and half years we evaluated the patients in immediate and late post op period for the union of the fracture, functional outcomes and the short- and long-term complications.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The results were evaluated in the terms of intraoperative variables like fluoroscopy time, mean blood loss and reduction achieved and postoperatively in terms of superficial wound infections and Harris hip score and mobility score of paper and palmer which were comparable for both groups of patients with slight differences in some variables.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; We concluded that the intertan nail is a good option for fracture fixation in patients with unstable intertrochanteric fractures and though associated with a steeper learning curve it has lesser complications and slightly better functional outcomes as compared to the proximal femoral nail anti rotation.&lt;/p&gt;

Biomechanical comparison of screw vs. cerclage refixation in orthogeriatric lesser trochanteric fractures: a cadaveric study

PurposeOsteoporosis-related proximal femur fractures continue to increase significantly due to demographic change. This study was designed to evaluate the biomechanical stability of two different fixation methods (cerclage vs. screw) for refixation of a trochanter minor fragment in the pertrochanteric fractures in cadaveric bones.MethodsArtificial bones (n = 14) and human bones (n = 16) were treated with a DHS and the trochanter minor fragment was reduced by cerclage wiring or direct screw fixation. After preloading the simulated iliopsoas with 10 N, a tensile test was performed, ending with either a 70% loss of strength or avulsion of the fragment. The mean values of the avulsion force and the surface strain were recorded.ResultsAll tensile tests showed no significant differences between refixation using a direct screw or wire cerclage, for both artificial bones and human specimens. Absolute values showed higher avulsion forces after direct screw fixation than refixation with a wire cerclage. The surface tension of specimens treated with direct screw fixation was lower than that of specimens treated with wire cerclage. An opposite effect was seen in artificial bones. Both effects were not statistically significant.ConclusionBased on the equal stability after lag screw placement compared to cerclage wiring, we promote the placement of a lag screw into the lesser trochanter fragment in pertrochanteric femur fractures when using a dynamic hip screw.Level of evidenceLevel III.

Comparison of the dynamic HIP screw to PFN (proximal femoral nail) for unstable peri trochanteric femur fracture

Introduction: One of the most common fractures in the elderly is inter-trochanteric fractures where surgical management allows better functional and rehabilitation outcomes making it a treatment of choice. Aim: To compare radiological, functional, and clinical outcomes following treatment of unstable intertrochanteric femur fractures using dynamic hip screw (DHS) or proximal femur nail (PFN). Methods: The study assessed 120 subjects with unstable intertrochanteric femur fractures where 60 were treated with DHS and the other 60 with PFN. For assessment of the outcomes, Harris hip scores were used. Results: Most surgeries were done in 56-70 minutes in 30% (n=18) subjects and 37% (n=22) subjects in DHS and PFN group respectively which was statistically non-significant with p=0.86. Most common complication was lateral cortex shattering in 16.6% (n=10) study subjects followed by ill-fitting jig in 13.3% (n=8) study subjects and distal locking difficulty in 10% (n=6) study subjects respectively. Mean Harris hip score was higher in PFN group (83.5±2.38) compared to DHS group (82.1±2.32).

Anticoagulants and fracture morphology have a significant influence on total blood loss after proximal femur fractures

IntroductionBlood loss after proximal femoral fractures is an important risk factor for postoperative outcome and recovery. The purpose of our study was to investigate the total blood loss depending on fracture type and additional risks, such as anticoagulant use, to be able to recognize vulnerable patients depending on planned surgery and underlying comorbidities.Materials and methodsA retrospective single center study including 1478 patients treated operatively for a proximal femoral fracture between January 2016 and June 2020 at a level I trauma center. Patient data, surgical procedure, time to surgery, complications and mortality were assessed. Lab data including hemoglobin and transfusion rates were collected. The Mercuriali formula was implemented to calculate total blood loss. Linear regression was performed to identify influencing factors.ResultsOne thousand four hundred seventy-eight mainly female patients were included in the study (mean age: 79.8 years) comprising 667 femoral neck fractures, 704 pertrochanteric- and 107 subtrochanteric fractures. Nearly 50% of the cohort were on anticoagulants or anti- platelet therapy. At time of admission average hemoglobin was 12.1 g/l. Linear regression proved fracture morphology, age, BMI, in-house mortality and anticoagulant use to have crucial influence on postoperative blood loss. Femoral neck fractures had a blood loss of 1227.5 ml (SD 740.4 ml), pertrochanteric fractures lost 1,474.2 ml (SD 830 ml) and subtrochanteric femoral fractures lost 1902.2 ml (SD 1,058 ml).ConclusionsHidden blood loss is underestimated. Anticoagulant use, fracture type, gender and BMI influence the total blood loss. Hemoglobin levels should be monitored closely. Within 48 h there was no increased mortality, so adequate time should be given to reduce anticoagulant levels and safely perform surgery.

Management of Unstable Per-trochanteric Fracture in Old Patient by Primary Prosthetic Replacement

Background: Peritrochanteric fractures are frequent of the proximal femur and represents about half of all proximal femur fractures. They are associated with disability, mainly in elder patients. Its management aiming to achieve immediate ambulation and to regain the pre-operative ambulation.&#x0D; Aim and objectives; to evaluate and assess the functional and radiological outcomes of primary prosthetic replacement in old age cases of unstable per-trochanteric femur fractures,&#x0D; Subjects and methods: The current work was an interrupted time series clinical trial (quasi experimental), included 15 patients suffering from unstable per-trochanteric fracture presented to us within a week of sustaining injury. They were clinically assessed and checked for fitness for surgery. Then and after surgery, they were followed by for functional outcome by Harris Hip Scale and any complications were recorded.&#x0D; Results: Patients age ranged between 61 and 94 years. Females were more affected than males (80.0% vs 20.0%). Associated comorbidities were hypertension, diabetes and both conditions among 33.3%, 6.7% and 33.3%, successively. Falling was the commonest mode of injury (60.0%), and the left side was more affected than the right (60.0% vs 40.0%). Associated injuries were 1(6.7%) fracture surgical neck hummers, 1(6.7%) contralateral both bone leg fracture, 1(6.7%) had fracture mid shaft ulna. Regarding outcome, all cases were free from postoperative complications. However, blood loss was reported among 11(73.3%). Twelve (80%) patients had an excellent, 2 (13.3%) had good and 1(6.7%) had fair functional outcome. There was significant association between functional outcome and patients, gender, associated comorbid medical conditions, mode of trauma, side of trauma, or blood loss.&#x0D; Conclusion: Primary prosthetic replacement is a valid surgical option in management of unstable trochanteric fractures in elderly. The main advantages are the safety, effectiveness and early full weight bearing.

Biomechanical Comparisons of Trochanteric Hip Fracture Fixation Using Short-, Mid-, and Long-Length Proximal Femoral Nails.

IntroductionFor trochanteric hip fractures, proximal femoral nails (PFNs) have been frequently used for surgical treatment. No study has clarified whether length of the nail affected the wiper motion; the repetitive motion of the distal nail inside canal after surgery.MethodsThirty synthetic femora were used to biomechanically evaluate construct lateral angular movement of 3 different lengths of PFN [TFN-ADVANCED Proximal Femoral Nailing System (TFNA) 170 (short-length), 235 (mid-length), and 300 (long-length) mm] constructs for the fixation of stable pertrochanteric fractures. Cyclic testing and radiological evaluation were performed to investigate the loosening patterns in 3 different fixation constructs. Migration along the mechanical axis during the cyclic testing from 1-100th, 100-500th, 500-1000th, 1000-1500th, and 1500-2000th cycles was compared between TFNA lengths. Also, before and after cycling changes in tip to apex distance, angulation of fracture line, and lateral angular movement of the distal stem inside the canal were compared between TFNA lengths.ResultsMigration along the mechanical axis during cyclic loading, plus changes after cycling in tip to apex distance, and fracture line angulation did not differ between TFNA lengths for the fixation of stable intertrochanteric fracture model using synthetic femora. Conversely, one-way analysis of variance revealed a significant difference in lateral angular movement of the distal stem inside the canal after cyclic testing between groups (1.4 ± 1.6°, .21 ± .35°, and .26 ± .57° in 170-mm short nail, 235-mm middle nail, and 300-mm long nail, respectively; P = .026), and post-hoc analysis also revealed that middle nail yielded significantly less lateral angular movement compared with short nail (P = .047) but did not significantly differ from the long nail.ConclusionsMid-length TFNA for the fixation of stable trochanteric hip fracture model using synthetic femora resulted in significantly smaller lateral angular movement of the distal stem after cyclic loading.

Age and Sex difference in pertrochanteric fracture femur in rural central India-Retrospective study

Age and Sex difference in pertrochanteric fracture femur in rural central India-Retrospective study

A prospective study comparing the efficacy of proximal femoral nail antirotation device with dynamic hip screw fixation in management of unstable pertrochanteric fractures

Background: Pertrochanteric femoral fracture is the most common fractures of the hip especially in the elderly patients with osteoporotic bone, usually due to low-energy trauma like simple falls. Dynamic hip screw (DHS) is still considered the gold standard for treating such factures. Not many studies compare DHS with Proximal Femoral Nail Antirotation (PFNA). We try to compare the efficacy of PFNA with DHS in management of unstable pertrochanteric factors. Aims and Objectives: We aimed to evaluate and compare the clinical and functional outcomes of DHS and PFNA treatment of unstable pertrochanteric femoral fractures in elderly patients. Materials and Methods: This study was a prospective study which included total of 39 patients, 25 patients treated with PFNA and 14 patients with DHS. The study was conducted in Manipal Teaching Hospital from March 1, 2019, to August 1, 2021. All the patients were clinically evaluated and detail history was obtained. After the anesthesia clearance, the patients were operated. Length of skin incision, operating time, intraoperative blood loss, and complications were noted. Postoperatively, the duration of hospital stay, time of partial and full weight-bearing, time for radiological union, and complications were noted. Functional outcome was assessed using Harris hip score at 3 months and 6 months follow-up. Results: The mean age of the patient in this study was 74.68 years for PFNA and 75.57 years for DHS. The average time to complete the surgery was 71 min for PFNA and 92.86 min for DHS. The average blood loss was 162 ml for PFNA and 403 ml for DHS which was found to be statically significant. Partial weight-bearing on axillary crutches was started at the mean time of 3.7 weeks for PFNA and 8.1 weeks for DHS, whereas full weight-bearing was done at the mean of 8.2 weeks for PFNA and 12.1 weeks for DHS. Radiological union was seen at the average of 18.72 weeks for PFNA and 20.14 weeks for DHS which was not statically significant. The mean Harris Hip score at 3 months and 6 months follow-up was 63.84 and 88 for PFNA and 48.50 and 81.43 for DHS, respectively, which showed significantly better result with PFNA. Conclusion: Compared to DHS treatment, PFNA treatment in unstable pertrochanteric femoral fracture is associated with reduced blood loss, shorter operative time, and hospital stay with few intraoperative and post-operative complication. Post-operative rehabilitation with the early mobilization and return to pre-injury status was better with PFNA.

Comparison of the Effects of Injectable Enoxaparin With Oral Rivaroxaban in Deep Vein Thrombotic Prophylaxis in Patients With Femoral Peritrochanteric Fracture: A Randomized Clinical Trial

Objectives: The prevalence of deep vein thrombosis (DVT) following orthopedic major surgery, such as peritrochanteric femoral fracture, is high. Also, there is a lack of accurate information about the results of using rivaroxaban in Iran. This study aimed to compare the effects of injectable enoxaparin with oral rivaroxaban in DVT prophylaxis in patients with femoral peritrochanteric fracture. Materials and Methods: This randomized single-blind clinical trial included 88 patients with femoral peritrochanteric fracture in Shohada Hospital of Tabriz, Iran from January 2019 to December 2019. The participants were randomly allocated into two equal groups (n=44 each) receiving enoxaparin (40 mg subcutaneously once daily for 28 days) and rivaroxaban (10 mg orally once daily for 28 days). Using independent t test in SPSS version 20, the results of clinical examinations and ultrasonography for the diagnosis of DVT at the end of intervention were compared between the two groups. A P value less than 0.05 was considered as statistically significant. Results: No significant differences were observed in laboratory results and DVT-related symptoms between the two groups, as well as before and after the intervention (intragroup). Also, the prevalence of DVT at the end of the study was zero. Conclusions: According to our results, there was no difference in the prevalence of DVT and short-term (one-month) complications between the two groups receiving rivaroxaban and enoxaparin after the peritrochanteric femur fracture.

Correlations of hospital length of stay and mortality with the osteoporotic hip-fracture type, treatment, the sociodemographic and hospital variables

Abstract Introduction: Diseases related to the elderly, including osteoporosis and the resulting fractures have a high incidence and are characterized by a high risk of early death. Most hip fractures are treated surgically. Its cost projections vary widely depending on the region, the level of institutional care, and the surgical solutions used. Material and method: We performed a retrospective study using hospital data from 2018-2019. The study included patients whose main diagnosis was: S72.0 - femoral neck fracture, S72.1 - pertrochanteric fracture, S72.2 - subtrochanteric fracture. We used hospital data from seven Romanian counties, Arad, Arges, Bucharest, Szilágy, Temes, Tulcea and Vaslui. Results: Women were significantly more affected (68.3%) than men, however the risk of mortality was 1.7 times higher among men. The average age was 77.2 years, 86% of the patients were over 65 years old. Most patients (69.3% ) were urban residents, but they were also characterized by a higher LOS and mortality. Discussion: Fracture types, gender distribution and correlation with urbanization of the fractures are consistent with international epidemiological data. Regression analysis shows a significant correlation between the length of hospital stay and the following variables: gender, environment, age, diagnosis, type of hospital and death. Regarding the average time of hospital stay, the shortest duration of hospitalization was in Vaslui and Tulcea (9.59 and 9.79 days), while the longest (13.42 and 14.61 days) were in Arad and Arges counties. Conclusions: On average, the patient hospitalization time in the examined counties is higher (13 days) than the Romanian average (11 days). Mortality is significantly higher among men, urban residents and those who suffer subtrochanteric fractures. Regarding the costs per patient of fractures, it can be said that Arad is the most economical, while Salaj county is the least cost-effective.

Functional Outcome of Long Proximal Femoral Nail Versus Short Proximal Femoral Nail in Peri-Trochanteric Fractures in Elderly Patient

Background: Intertrochanteric fractures account for 5% of all hip fractures and 35–40% of these fractures are unstable three or four part fractures. Operative treatment is the best option in most of the trochanteric fractures. Evolution of intramedullary devices is a result of dissatisfaction with the extra medullary devices in intertrochanteric unstable fractures. Intramedullary nailing, with less operative time and less operative blood loss allows early weight bearing with less resultant shortening on long term follow up. Our main aim was to compare the effectiveness and drawbacks of short proximal femoral nail (PFN) versus long PFN in the management of peri-trochanteric fractures. Materials and Methods: This study was randomized, time bound, hospital based study conducted in a tertiary hospital, between April 2019 to April 2022. The study included 41 cases of unstable peri-trochanteric fractures divided into two groups. Patients of Group-I were operated with Short PFN and Group-II were operated with Long PFN by standard technique. Intraoperative parameters, post-operative data and events were noted. During follow-ups, patients were assessed by clinico-radiological evaluation and Harris hip score. Results: Total of 41 patients of peri-trochanteric fracture have been included in study out of which 24 belonged to Group-I and were operated with short PFN and rest 17 were of Group-II operated with long PFN. Though there was no significant difference in results of two Groups but use of Long PFN was found to be advantages over Short PFN in terms of the less postoperative complications, less mean time of union and better lower extremity functional scores. Conclusion: In our short term results, it was evident that the use of Long PFN has advantages over Short PFN in terms of the less postoperative complications, less mean time of union and better lower extremity functional scores. A study with a larger sample size would have made a better assessment of this surgical intervention.

From Orthopaedic Museum

Orthopaedics in India is developed by many stalwarts by the dint of their inventions and innovations. Sen’s nail is one of them that were invented by Prof. (Dr.) Biswajit Sen from Kolkata, India, in 1973 as a solution to deal with peritrochanteric fractures in elderly. Though the “Sen’s nail” is not in use now a days (because of the advent of newer and better implant and technology for such fractures), it is absolutely imperative to convey to posterity about this lifetime work and obsession of Prof. (Dr.) Biswajit Sen.

Comment on "Comparison of systemic inflammatory responses of proximal femoral nail versus dynamic hip screw after treatment of patients with pertrochanteric fractures: A prospective comparative study".

Comment on "Comparison of systemic inflammatory responses of proximal femoral nail versus dynamic hip screw after treatment of patients with pertrochanteric fractures: A prospective comparative study".

Quality differences in multifragmentary pertrochanteric fractures [OTA 31A2.2 and 31A2.3] treated with short and long cephalomedullary nails

ObjectivesThis study compares demographics, outcomes, and costs of patients with similar multifragmentary pertrochanteric (MP) fracture patterns treated with either a short or long cephalomedullary nail (CMN) to determine treatment efficacy and value during hospital admission. DesignRetrospective cohort study. SettingLevel-1 trauma center. Patients384 patients who presented with a MP fracture [AO/OTA 31A2.2 and 31A2.3] at 1 of 3 hospitals within a single academic medical center. InterventionSurgical treatment with either short or long CMNMain outcome measurements: Operative time, in-hospital complications, discharge disposition, procedural and total costs of admission. ResultsSixty-nine (18.0%) patients were treated with long CMNs compared to 315 patients treated with short CMNs. Patients treated with long CMNs had increased rates of transfusions of allogenic packed red blood cells (52.2% vs 34.0%, p = 0.005), discharge to rehabilitation facilities (91.3% vs 80.3%, p = 0.030), and had costlier hospital stays ($28,632.50 vs $23,024.86, p = 0.014) with longer (74.9 vs 52.3 min, p <0.001), costlier procedures and implants ($12,090.31 vs $9,647.41, p = 0.014) compared to patients treated with short CMNs. There were no differences in timing of radiographic healing, rates of readmission, nonunion, screw cut out, fixation failure, or peri‑implant fracture. ConclusionsShort and long CMNs are equally suitable implants for the most unstable intertrochanteric fracture patterns. Short CMNs correlate with reduced operative time and costs with non-inferior in-hospital complication rates, hospital quality measures, and less frequent rehabilitation facility discharges. Given the similar long-term outcomes demonstrated here and in the literature, this data suggests nail length selection should be driven more by cost and discharge considerations for MP fractures. Level of evidencelevel III.

Mortality and functional consequences after revision osteosynthesis for peritrochanteric fractures treated by intramedullary nail: A retrospective study of 312 patients

IntroductionOsteosynthesis of peritrochanteric fractures by intramedullary nail is associated with a 3 to 15% rate of complications requiring revision surgery. The objective of our study was to compare mortality and autonomy between patients who required revision surgery after osteosynthesis, and patients without revision surgery. HypothesesPatients who underwent revision surgery after osteosynthesis of a peritrochanteric fracture by intramedullary nail did not exhibit excess mortality or loss of autonomy compared to those who did not undergo revision surgery. MethodsBetween January 2017 and October 2019, 312 consecutive patients were operated on for a peritrochanteric fracture by intramedullary nail. Among them, 23 patients (7.4%) required revision surgery (change, nail removal, total hip arthroplasty). Mortality at 90 days and at one year was evaluated and compared between the group of “revision” patients and “no revision” patients. The level of autonomy was assessed by the Parker and Palmer score, one year postoperatively and compared between the 2 groups. ResultsThe patients requiring revision surgery were younger: 73 years old vs. 86 years old (p<0.011). The overall mortality was 7.25% at 90 days after surgery and 15% at one year. Mortality was zero at 90 days, and at 1 year, postoperatively for patients requiring revision surgery. There was no significant difference for the mortality at 90 days (p=0.39) between the 2 groups, however at 1 year, it was significantly less for the revision patients (0% vs. 17%, p=0.032). There was no significant difference for the Parker score between the “revision” group; 5 (4–9) and the “no revision” group; 4 (3–7), at one year postoperatively (p=0.24). ConclusionThis study did not show any excess mortality, nor loss of autonomy at 1 year postoperatively, for patients who required osteosynthesis for a trochanteric fracture, and who presented with a complication requiring revision surgery. Level of evidenceIII, comparative retrospective study.

Functional and Radiological Outcomes of Unstable Proximal Femur Fractures Fixed With Anatomical Proximal Locking Compression Plate.

IntroductionPeritrochanteric fractures are the most frequent fractures of the proximal femur that accounts for nearly half of all proximal femur fractures. They are a major cause of disability in the elderly. The aim is to study the functional and radiological outcome of unstable proximal femur fractures fixed with proximal femur locking compression plate (PF-LCP) and its complications. Unstable proximal femur fracture patients operated with proximal femur locking compression plate were followed up functionally by Harris Hip Score and radiologically by neck-shaft angle measure.Materials and methodsA retrospective analysis of 30 patients with unstable peritrochanteric fractures treated with PF-LCP in the first-level trauma center was conducted between 2015 and 2019. Stable peritrochanteric, pediatric and open fractures, and polytrauma were excluded. As a mid-term follow-up, functional and radiological outcomes were assessed at six weeks, three months, six months, and 12 months. Data was analyzed using a chi-square test, and results were compared with available western literature. ResultsThirty patients with unstable peritrochanteric fractures operated between 2015 and 2019, complying with our inclusion criteria, were analyzed. All patients were operated by the same surgeon and were available for a mid-term follow-up (12 months). Mean radiological union time was 12.5+/-2 weeks, with 24 patients achieving union between 10-15 weeks, three patients had union little more than 15 weeks. Two patients had non-union and required re-surgery. Functional results were assessed in the 30 patients available for follow-up using Harris Hip Score. Excellent results were seen in 17, good in seven, fair in three, and poor in three patients.ConclusionsThe choice of implant used to manage unstable peritrochanteric fractures has always been a debatable subject in our orthopedic fraternity. In our study, we used the anatomic, fixed-angle plates in peritrochanteric fractures and obtained significant functional and radiological outcomes over a midterm follow-up. We recommend PF-LCP as a good, stable alternative in the treatment of peritrochanteric femoral fractures. We consider that fracture pattern and extent in the proximal femur have a definite influence in determining the implant of choice. It provides good-to-excellent bone healing with reduced complications and better biomechanical stability.