Pertrochanteric Femoral Fractures Research Articles

Impact of lateral cortical notching on biomechanical performance in cephalomedullary nailing for unstable pertrochanteric fractures.

In pertrochanteric femur fractures the risk for fracture healing complications increases with the complexity of the fracture. In addition to dynamization along the lag screw, successful fracture healing may also be facilitated by further dynamization along the shaft axis. The aim of this study was to investigate the mechanical stability of additional axial notch dynamization compared to the standard treatment in an unstable pertrochanteric femur fracture treated with cephalomedullary nailing. In 14 human cadaver femora, an unstable pertrochanteric fracture was stabilized with a cephalomedullary nail. Additional axial notch dynamization was enabled in half of the samples and compared against the standard treatment (n = 7). Interfragmentary motion, axial construct stiffness and load to failure were investigated in a stepwise increasing cyclic load protocol. Mean load to failure (1414 ± 234N vs. 1428 ± 149N, p = 0.89) and mean cycles to failure (197,129 ± 45,087 vs. 191,708 ± 30,490, p = 0.81) were equivalent for axial notch dynamization and standard treatment, respectively. Initial construct stiffness was comparable for both groups (axial notch dynamization 684 [593-775] N/mm, standard treatment 618 [497-740] N/mm, p = 0.44). In six out of seven specimens the additional axial dynamization facilitated interfragmentary compression, while maintaining its mechanical stability. After initial settling of the constructs, there were no statistically significant differences between the groups for either subsidence or rotation of the femoral head fragment (p ≤ 0.30). Axial notch dynamization provided equivalent mechanical stability compared to standard treatment in an unstable pertrochanteric fracture. Whether the interfragmentary compression generated by axial notch dynamization will promote fracture healing through improved fracture reduction needs to be evaluated clinically.

Effect of Primary Arthroplasty on Post Treatment Results among Elderly with Pertrochanteric Femur Fracture

Abstract Background With an increasing global incidence of hip fractures, designing ppropriate treatment strategies for hip fractures is fundamentally important to healthcare professionals. Evaluation of the role of 1ry arthroplasty in the setting of trauma for the acute treatment of hip fractures will be fulfilled. Aim of the Work to review the literature to know the best arthroplastic option for elderly people with pertrochantric fracture and compare between them as regard post-operative complications (infections, bed sores, pneumonia and other chest infections, dislocations), post-operative functional outcome, post-operative dislocation, rate of revision surgrey. Patients and Methods The included studies were randomized controlled trials, including cluster RCTs, controlled (non-randomized) clinical trials or cluster trials, prospective and retrospective comparative cohort studies, and case-control or nested case-control studies. The excluded studies were cross-sectional studies, case series, case reports and literature not in English. Results after extraction of non-compatible studies as regard our priciples, we setteled on 18 studies that compare different types of primary arthroplasty and their post operative outcome among elderly with pertrochanteric femur fracture. We found some heterogenty in the results of some studies but we overcome this problem by using other methods for comparison.Another problem is lack of studies that compare among interventios in some comparative points. Among these studies We found that, as regard postoperative functional outcome and harris hip scoring (HHS), dual mobility arthroplasty(DMA) is higher than Total Hip Arthroplasty (THA). Total hip arthroplasty (THA) is also higher than (BHA) in the score. Conclusion As the general population is getting older while staying active, faster and more complete rehabilitation as well as decreased complication rate must be achieved for these patients.

Outcome of Internal Fixation by Cephalomedullary Nail versus Outcome of Bipolar Hemiarthroplasty in the Treatment of Unstable Pertrochanteric Femoral Fractures in Elderly: Systematic Review and Meta-analysis

Abstract Background Pertrochanteric femoral fractures are extracapsular metaphyseal fractures of proximal femur that involve the region between the femoral neck and shaft. Intertrochanteric femur fractures, the most common type of fragility fractures in the elderly, account for 55% of proximal femoral fractures. Intertrochanteric femur fractures have high fatality and disability rates, resulting in a huge burden on the economy and on society. Objective To compare the advantages and disadvantages of the PFN and BHA to provide reliable evidence for clinicians in selecting the optimal treatment for unstable pertrochanteric fractures. Patients and Methods This systematic review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Data Sources Medline databases (PubMed, Medscape, ScienceDirect. EMF-Portal) and all materials available in the Internet till 2022. Data Extraction Data were independently extracted by two reviewers and cross-checked. Results This study included 12 samples which recruited 1019 patients with unstable intertrochanteric fractures, form which 515 patients underwent bipolar hemiarthroplasty (BHA) and 504 patients underwent proximal femoral nail (PFN). No significant difference between BHA and PFN in operative time and post-operative hospital stay was found. Intra-operative blood loss and incidence of blood transfusion was higher in BHA compared with PFN. HHS was higher after PFN than after BHA. Patients underwent PFN required larger period for partial weight bearing compared with who underwent BHA. There were no statistically significant difference between both groups regarding postoperative mobility scores, reoperation rate, incidence of infection and limb length alteration. The overall mortality rate risk ratio revealed that the incidence of mortality was higher after BHA than PFN. Conclusion Both PFN and BHA can be used in managing fractures of the Intertrochanteric in elderly patients. PFN establishes itself as a better modality than BHA due to lower postoperative mortality and better functional outcomes. BHA should ideally be reserved for lower life expectancies and those requiring immediate weight bearing patients.

Treatment reality of distal radius fractures in a center

Distal radius fractures are the third most common type of fracture in Germany after fractures of the femoral neck and peritrochanteric femoral fractures. In 2019 a total of 72,087 cases were registered with an incidence of 106 cases per 100,000 inhabitants (81,570 fractures of the femoral neck, 73,785 peritrochanteric fractures). Many of these fractures are surgically treated also in this hospital but with controversial views on the optimal treatment. Against the background of the coronavirus disease 2019 (COVID-19) pandemic, disappearing personnel resources and the political pressure to form centers and a switch to outpatient treatment, the authors ask the question what the treatment reality in this hospital looks like and whether the general changes in the framework conditions also have an affect in this context. This is not a strictly scientific study but a stocktaking without any claims of completeness and the retrospective evaluation of a larger data pool with all its weaknesses. On the contrary, the data provide interesting aspects that are explained in detail in the individual sections.

Major low-energy trauma results in non-specific immunoglobulin generation without evidence for specific autoantibody production: A prospective cohort study.

Cellular debris resulting from large trauma might overwhelm the scavenger mechanisms and lead to autoimmune reactions. We analysed whether a major well-defined trauma in humans induces laboratory signs of transient autoimmunity in the months after the insult. We included 50 patients with pertrochanteric femur fracture undergoing intramedullary nail osteosynthesis in a prospective cohort study and followed them at 3-4 days, 6 weeks, 12 weeks and 12 months postoperatively. By standard techniques, we assessed levels of total immunoglobulins, anti-nuclear antibodies (ANA), anti-cardiolipin antibodies, anti-dsDNA antibodies and anti-C1q antibodies, as well as antibodies against cytomegalovirus (CMV) as a control. Blood leukocyte differential and lymphocyte subpopulations were determined at baseline and in the first two postoperative samples. The mean age of the patients reached 80.1 years, and 23 (46%) completed all visits. Serum concentrations of total IgG, IgM and IgA increased at all follow-up time points. The ANA fluorescence light intensity units increased at 12 weeks and 12 months postoperatively (p < 0.0001), but the proportion of ANA-positive patients did not change (35%). The values of anti-C1q mildly increased at all follow-up visits, but not the ratio to total IgG. Anti-dsDNA remained negative in all patients, and anti-cardiolipin IgG/IgM antibodies did not change. Anti-CMV IgG antibodies increased significantly at all follow-up visits, without change in the ratio to total IgG. Flow cytometry showed an increased proportion of B-cells 3-4 days postoperatively. In conclusion, major musculoskeletal trauma in elderly patients induces a generalized non-specific increase in immunoglobulin production without laboratory signs for enhanced systemic autoimmunity.

Surgical Tips: Managing the Orthopedic Traction Table on Gritti-Stokes Amputated Patients

Introduction: Closed anatomical reduction of per-trochanteric fractures requires 3-axis control of the orthopedic traction table (OTT) which is challenging in patients having suffered a previous ipsilateral Gritti-Stokes amputation. Case Report: A 52-year-old man, known by Gritti-Stokes amputated (GSA) 10 years before, was admitted to our trauma center after a fall from his height. We describe a simple method for positioning a previously ipsilateral GSA patient in an OTT to reduce displaced a femoral per-trochanteric fracture site and to maintain it during surgery. The proposed method attaches non-adhesive bands to the stump, reinforced by the wire guide package to increase rigidity and allow 3-axis control of the OTT. Conclusion: This method can be performed in a standard trauma operating room, it only uses materials that were planned to be used during surgery, and consequently, it does not increase operative costs. Keywords: Gritti-Stokes amputation, per-trochanteric femoral fracture, patient positioning, orthopedic trauma, orthopedic traction table.

Perioperative peri-implant fracture after osteosynthesis for geriatric femoral pertrochanteric fracture with the linear compression integrated screw intramedullary nail system (INTERTAN™): a retrospective study

BackgroundOsteosynthesis for geriatric femoral pertrochanteric fractures using the linear compression integrated screw intramedullary nail system (INTERTAN™) has become popular. Nonetheless, cases of perioperative peri-implant fractures have been reported following this surgical technique. The factors responsible for this complication remain unclear. Therefore, we investigated perioperative peri-implant fracture risk factors and incidence, as well as overall outcomes, using the INTERTAN™ system for geriatric femoral pertrochanteric fractures.MethodsWe retrospectively reviewed 98 consecutive patients with geriatric femoral pertrochanteric fractures after INTERTAN™ fixation, with at least a 12-month follow-up period between May 2020 and April 2022 at a single medical institute. The patients’ demographic characteristics, fracture pattern, quality of reduction, quality of fixation, nail length, morphology of the femur, and perioperative complications were recorded and analyzed.ResultsAmong the 98 patients, 92 achieved union during follow-up. Twelve perioperative peri-implant fractures (12.2%) were recorded, all of which occurred during or within 1 month of osteosynthesis. Except for one patient who underwent re-osteosynthesis, the others underwent nonoperative treatment, and all achieved union. Multiple regression analysis revealed morphology of the femur with low-lesser trochanter width (odds ratio (OR) 0.532, 95% confidence interval (CI) 0.33–0.86, p = 0.01) to be the only factor contributing to perioperative peri-implant fractures. When the Youden index was used, the optimal cut-off value was 20.2 mm of low-lesser trochanter width. Low-lesser trochanter width < 20.2 mm was found to be a potential factor causing perioperative peri-implant fractures (OR 17.81, 95% CI 1.67–19.76, p = 0.017).ConclusionsMorphology of the femur with a low-lesser trochanter width smaller than 20.2 mm was found to be the only potential contributor to perioperative peri-implant fractures when using INTERTAN™ for geriatric femoral pertrochanteric fractures. Care should be taken during osteosynthesis, focusing not only on the fracture site but also on the femoral cortex around the implant. Although perioperative peri-implant fractures were observed within one month following osteosynthesis, the majority of these cases were effectively treated without surgical intervention.

Application of the Finite Element Method in Modeling Biological Systems in Traumatology and Orthopedics

Surgical treatment of fractures of the proximal femur is a problem due to the lack of a uniform treatment strategy. Of particular importance is the analysis of the processes occurring in bone tissue during the healing of fractures under dynamic conditions, especially the analysis of mechanical stresses. The finite element method is an effective method for mathematical modeling of complex objects and describing the stress-strain states of these objects. In order to improve the results of treatment of fractures of the proximal femur and pelvic bones, mathematical modeling was carried out using the finite element method of a pertrochanteric femur fracture under conditions of fixation with a dynamic pin and a pelvic fracture under various conditions of its submersible fixation

Impact of COVID-19 on Fracture Incidence in Germany: A Comparative Age and Gender Analysis of Pre- and Post-Outbreak Periods.

In March 2020, Germany imposed a nationwide lockdown to curb the spread of COVID-19, prompting questions about the impact on the incidence of common fractures. This study examined 15 fracture types in pre-outbreak (2010-2019) and post-outbreak (2020-2021) periods, using data categorized by age (18-64 years, >65 years) and sex (male, female). Linear regression assessed annual growth rates, and mean fracture numbers were compared across periods for significant differences. Results indicated a positive correlation between fracture incidence rates and time for various types, such as cervical, thoracic, lumbar, and pelvic spine fractures, rib fractures, femoral neck, pertrochanteric femur, femoral shaft, and ankle fractures. Frequencies of proximal humerus, distal radius, femoral neck, pertrochanteric femur, femoral shaft, and ankle fractures in 2020 and 2021 were within predicted ranges from previous years. However, rib fractures and spinal fractures (cervical, thoracic, lumbar, and pelvic spine) occurred less frequently during this time. Notably, this study found a consistent decline in most fracture types for individuals aged 18-64 after the pandemic's onset, while the fracture incidence of hip fractures, often referred to as fragility fractures, for those over 65 remained unchanged. Fibula fractures showed the most considerable decrease in both age groups. In conclusion, the COVID-19 pandemic substantially impacted fracture incidence, with lower rates among individuals under 65 and unchanged fragility fractures in the elderly population.

Effect of zoledronic acid on functional outcome in cases of pertrochanteric femoral fractures in elderly patients operated with proximal femoral nailing

Background: Osteoporosis is a very common problem in geriatric population and postmenopausal women. Zoledronic acid injection is a very convenient and effective treatment option available for osteoporosis. Our study aimed to study the effect of zoledronic acid on functional outcome and fracture related complications in elderly patients with low energy pertrochanteric femoral fractures who were operated with proximal femoral nail. Methods: This was a case control study. Elderly patients who underwent surgery in the form of proximal femoral nailing for low energy pertrochanteric femoral fractures were included. Injection zoledronic acid was given to every alternate patient who underwent surgery. Radiological healing was evaluated at six weekly intervals for six months and then 12 weekly intervals for one year. The Harris hip score was used to measure the functional outcome of the patient. Results: Effective study population consisted of total 49 patients (25 cases and 24 controls). The mean union time in the cases and the control was 8.76±9.12 weeks and 7.04±1.57 weeks respectively. The mean Harris hip score was 86.742±7.55 in the cases and 84.339±11.20 in the control group. The p value was 0.3815. This study concluded that the two groups had no statistically significant difference between functional outcome and fracture related complications. Conclusions: Zoledronic acid in patients admitted for surgery with osteoporotic fracture does not improve the functional outcome of the patients. It does not affect the mortality of the patients.

Medial migration of the helical blade with penetration into the acetabulum: a rare complication using the TFNA nail

PurposeTo determine the frequency and possible reasons of medial migration with penetration into the acetabulum (MMPA) of the helical blade when using the Trochanteric Fixation Nail Advanced (TFNA) is used for treatment of pertrochanteric fractures.MethodsAll patients with pertrochanteric femoral fracture, treated by intramedullary femoral nailing with the TFNA, were retrospectively reviewed for MMPA of the helical blade. Epidemiological parameters, additional procedures, distance of medial migration, time from primary operation to revision as well as type of revision were assessed.Results4 of 153 patients treated with the TFNA developed an MMPA of the helical blade (risk = 2.6%), with a mean medial migration of the blade of 11.6 mm (SD 8.8). The mean time from initial operation to revision surgery was 70 days (SD 30). All patients were revised by conversion to cemented total hip arthroplasty.ConclusionMMPA of the helical blade is a rare but potentially hazardous complication of femoral nailing with the TFNA femoral nail, resulting in the necessity for revision surgery and total hip arthroplasty.

Comparison of Unstable Per-Trochanteric Fractures Fixed with Proximal Femoral Nail Versus Dynamic Hip Screw Using Harris Hip Score

Objective: To compare the frequency of a good functional outcome in unstable per-trochanteric fractures fixed with a dynamic hip screw and proximal femoral nail using the Harris Hip Score. Methodology: A comparative study was conducted at the Department of Orthopaedic Surgery, Pakistan Institute of Medical Sciences, Islamabad, from June to December 2021. A total of 80 patients with per-trochanteric femur fractures were selected and divided into two groups based on the surgical procedure performed: dynamic hip screw or proximal femoral nail. A comprehensive history and thorough examination were performed for all patients during scheduled follow-up visits. Patients were called in for follow-up assessments at 1 month and 3 months to evaluate the functional outcomes using the Harris Hip Score. Results: The mean age of all patients was 58.73±6.78 years. At the 3-month follow-up, the mean Harris Hip Score was significantly higher in the proximal femoral nail group compared to the dynamic hip screw group (84.64±7.05 vs. 73.9±12.53; p = 0.005). The proportion of patients with good functional outcomes (Harris Hip Score ≥ 70 points) was significantly higher in the proximal femoral nail group compared to the dynamic hip screw group (97.5% vs. 72.5%, p = 0.002). Conclusion: In this study, the proximal femoral nail group demonstrated superior functional outcomes compared to the dynamic hip screw group. The use of proximal femoral nail fixation can provide better outcomes and facilitate an earlier return to pre-injury status for patients.

Predictors of mortality for patients with hip fracture: a study of the nationwide 1-year records of 24,950 fractures in Romania

The aim of our study was to assess incidence rates for a revision-calibration of the Romanian FRAX tool and to evaluate particularities of hip fracture cases to determine patient- and hospital-related variables affecting mortality. We conducted a retrospective study using hospital reports of hip fracture codes to the National School of Statistics (NSS) from January 1, 2019, until December 31, 2019. The study population included 24,950 patients presenting to Romanian public hospitals in all 41 counties: ≥ the age of 40 with diagnostic ICD 10 codes: S72.0 femoral neck fracture, S72.1 pertrochanteric femoral fracture, and S72.2 subtrochanteric femoral fracture and procedure codes: O11104 (trochanteric/sub capital internal fixation), O12101 (hemiarthroplasty), O11808 (closed femoral reduction with internal fixation), O12103 (partial arthroplasty), O12104 (total arthroplasty). Hospital length of stay (LoS) was classified as follows: < 6, 6-9, 10-14, and ≥ 15days. Incidence of hip fractures was 248/100,000 among those aged 50 + and 184/100,000 within the 40 + age category. Average age of the patients was 77years (80 for females, 71 for males); 83.7% of the patients were 65 + with equivalent urban-rural distributions. Males had a 1.7 times higher mortality risk. Each year increase in age added a mortality risk of 6.9%. In-hospital mortality was 1.34 times higher among patients living in urban areas. Hemiarthroplasty and partial/total unilateral/bilateral arthroplasty had a lower risk of mortality than trochanteric/sub capital internal fixation (p < 0.02, p < 0.033). Gender, age, residence, and procedure type had significant impact on mortality. Updated incidence rates will allow the revision of Romania's FRAX model.

Predictive Value of Prognostic Nutritional Index for Early Postoperative Mobility in Elderly Patients with Pertrochanteric Fracture Treated with Intramedullary Nail Osteosynthesis

Early postoperative mobilization is essential for orthogeriatric patients. The prognostic nutritional index (PNI) is widely used to evaluate nutritional status. This study sought to investigate the predictive value of PNI for early postoperative mobility in patients with pertrochanteric femur fractures. This study included 156 geriatric patients with pertrochanteric femur fractures treated with TFN-Advance™ (DePuy Synthes, Raynham, MA, USA). Mobility was evaluated on the third postoperative day and by discharge. Stepwise logistic regression analyses were performed to evaluate the association significance of PNI with postoperative mobility together with comorbidities. The optimal PNI cut-off value for mobility was analyzed using the receiver operating characteristic (ROC) curve. Three days postoperatively, PNI was an independent predictor of mobility (OR: 1.14, 95% CI: 1.07-1.23, p < 0.01). By discharge, it was found that PNI (OR: 1.18, 95% CI: 1.08-1.30, p < 0.01) and dementia (OR: 0.17, 95% CI: 0.07-0.40, p < 0.001) were significant predictors. PNI correlated weakly with age (r = -0.27, p < 0.001). The PNI cut-off value for mobility on the third postoperative day was 38.1 (specificity = 78.5%, sensitivity = 63.6%). Our findings indicate that PNI is an independent predictor of early postoperative mobility in geriatric patients with pertrochanteric femur fractures treated with TFNA™.

Two-Part Intertrochanteric Femur Fractures with Bisection of the Lesser Trochanter: An Irreducible Fracture Pattern.

To introduce the clinical features of and surgical techniques for a rare type of irreducible pertrochanteric femur fracture pattern with bisection of the lesser trochanter. From January 2017 to December 2019, 357 patients with per/intertrochanteric femur fractures underwent surgery by closed reduction and internal fixation, of whom 12 patients were identified with rare preoperative imaging features, the lesser trochanter was almost equally bisected. The main fracture pathoanatomy of these cases included: The anterior fracture line passed along the intertrochanteric line to the medial lesser trochanter and bisected it into 2 equal parts from mid-level of the lesser trochanteric protrusion. The proximal part of the lesser trochanter connected to the head-neck fragment and attached by the psoas major tendon, while the distal part of the lesser trochanter connected to the femoral shaft and attached by the tendon of the iliac muscle. These fractures were irreducible by a closed maneuver and were reduced with limited assistance by some devices, and short intramedullary nails were used for fixation of these fractures. All patients were followed up for an average of 14.2 ± 2.1months. Clinical fracture union occurred at an average of 10.8 ± 1.5weeks, while radiographic union occurred at an average of 12.7 ± 1.2weeks. No cut out of the helical blade was visible on radiographs. The average Parker-Palmer score was 6.9 ± 1.3 (range, 5-9) at the last follow up, including 8 cases rated as excellent, 2 as good and 2 as fair. Two-part pertrochanteric femur fractures with bisection of the lesser trochanter have an irreducible fracture pattern with cortical locking and soft tissue incarceration. Soft tissue release and short cephalomedullary nail fixation for this fracture pattern provide stable fixation and allow early exercise. This treatment appears to have excellent outcomes in the short and medium terms.

A Demographic Survey of Pertrochanteric Fractures Based on the Revised Arbeitsgemeinschaft für Osteosynthesefragen/Orthopedic Trauma Association (AO/OTA) Classification Using 3D CT Scan Images.

Introduction A demographic survey of femoral pertrochanteric fractures provides several important information for the healthcare system of a country since this fracture is commonly seen in the elderly and has a poor postoperative functional prognosis that is a burden on society. The importance of accurately classifying pertrochanteric fractures as stable or unstable cannot be understated. However, the use of plain radiograph images alone is known to underestimate fracture severity with low inter- or intra-observer agreement. Computedtomography (CT) images offer information for a more accurate classification of pertrochanteric fractures. With this three-dimensional (3D) CT-based study using the revised Arbeitsgemeinschaft für Osteosynthesefragen/Orthopedic Trauma Association (AO/OTA) classification, the purpose of this study is to elucidate the epidemiological demography of patients with pertrochanteric fractures. Material and methods We retrospectively collected 808 patients from five hospitals, classified into two groups: stable (A1) or unstable (A2). Age, gender, fracture laterality, and surgerytiming were identified as epidemiological variables. Patients with both preoperative plain radiographs and 3D CT scans were included in the study. The exclusion criteria were AO/OTA A3 type fractures, pathological fractures, previous ipsilateral surgery, 60 years old or younger, and conservatively treated patients. The primary outcome involved detailing the total number of fractures based on classification (A1 or A2) and variables. The secondary outcome involved a comparison between the A1 and A2 groups. Results The mean age of patients at the time of surgery was 85 years (range: 61-103 years). There were 637 female and 171 male patients. There were 463 left-sided fractures and 345 right-sided fractures. Of the 808 patients, 371 (45.9%) were classified to have A1 fractures, and 437 (54.1%) had A2 fractures. The age at surgery, gender, fracture laterality, and surgerytiming between the A1 and A2 groups were compared. The mean and standard deviation of the age at surgery for patients in the A1 and A2 groups were 84.9±7.7 and 86.9±6.8, respectively. The number of patients for each age distribution of 61-69, 70-74, 75-79, 80-84, 85-89, 90-94, and 95 or older for the A1 and A2 groups was 18 and 7, 18 and 12, 43 and 44, 76 and 82, 107 and 132, 79 and 110, and 30 and 50, respectively, showing that the difference in categorial distribution was statistically significant (p=0.002). Overall, 278 females and 93 males were classified to have A1 fractures compared with 359 females and 78 males with A2 fractures (p=0.01). There were 166 right-sided and 205 left-sided stable A1 fractures and 179 right-sidedand 258 left-sided A2 fractures (not significant (NS)). Among the total number of A1 and A2 surgeries by month, the most were in December with 77 surgeries(37 and 40, respectively), and the least was in June with 37 (18 and 19, respectively). The seasonal classification for A1 and A2 surgeries is as follows: spring with 172 (74 and 98, respectively), summer with 150 (70 and 80, respectively), autumn with 193 (90 and 103, respectively), and winter with 208 (97 and 111, respectively) (NS). Conclusion In this demographic study of 808 patients with pertrochanteric fractures classified by 3D CT images, 371 had A1 fractures and 437 had A2 fractures. A2 fractures were significantly more in females with an age peak of 85-89 years.

Comparative Study of Functional and Radiological Outcome of Pertrochanteric Fracture Fixation by Proximal Femoral Nail Antirotation 2 and Old Proximal Femoral Nail

Abstract Context: Pertrochanteric fractures include the fractures in the region which extend from the extracapsular basilar neck region to the region along the lesser trochanter of femur. Pertrochanteric femur fracture accounts for the most common hip fracture. Most of pertrochanteric fractures, in younger as well as in the elderly patients, are unstable and slightly or partially displaced and require operative intervention. There are different types of fixation for pertrochanteric femur fracture such as proximal femoral nail (PFN), proximal femoral nail antirotation-2 (PFNA-2), Dynamic hip screw (DHS), Dynamic condylar screw (DCS), and angled blade plate. The PFNA-2 has been introduced to reduce implant-related complications, operative time, and intraoperative blood loss, especially in elderly osteoporotic individuals. This study was done with the belief that unstable pertrochanteric fractures can be better reconstructed with PFNA-2 designed specifically for the Asian population than with PFN and thereby enhance the functional outcome. Materials and Methods: A total of 40 patients were selected randomly. The fracture pattern included for the study was pertrochanteric fracture of the femur. The selection was based on performed inclusion and exclusion criteria. The functional outcomes and clinical results of the patients were evaluated and graded using the Harris hip score. Statistical Analysis Used: Statistical package for the social sciences software version 22.0 (IBM software package) was used for statistical analysis. Results: In our study, there were 20 (50%) patients who were treated with PFN and 20 (50%) were treated PFN-A2. The mean age in the PFN group was 43.90 ± 16.88 years and in the PFNA-2 group was 47.80 ± 17.25 years. In the PFNA-2 group, the average time of surgery was 67.00 min, and with PFN, the average time of surgery was 90.25 min. Mean intraoperative blood loss, in the PFNA-2 group was 68.25 ± 5.20 mL and in the PFN Group, it was 86.50 ± 10.37 mL. The group with PFN-A2 had a better hip score when compared with the PFN group. The complication rates were significantly lower in the PFN-A2 group. Conclusions: The newer alternative PFNA-2 was found to be much better than PFN in terms of lesser surgical time, small incision resulting in lesser blood loss, lesser number of image intensifier shoots, lesser duration of surgery, and advantage of compression mechanism at fracture site and lesser chances of biomechanical failure compared to PFN.

Do All Pediatric Femoral Shaft Fractures Need a Computed Tomography Scan of the Ipsilateral Femoral Neck? Calculating the Incidence of Concomitant Femoral Neck and Shaft Fractures

In adults, the incidence of ipsilateral femoral neck fractures in the setting of femoral shaft fractures is reported to be as high as 9%; however, scant literature exists on the same clinical scenario in pediatric/adolescent populations. Therefore, the purpose of this study was to investigate the incidence of ipsilateral femoral neck fracture in the setting of femoral shaft fractures in children and adolescents treated in pediatric hospitals across the United States. The Pediatric Health Information System database was queried for patients aged 18 years or younger who were treated for a femoral neck, femoral shaft, and pertrochanteric femur fractures through an emergency department, inpatient, ambulatory surgery, or observation visit. Patients were identified using ICD-9 and ICD-10 diagnosis codes. Data from 49 pediatric hospitals between the years 2002 and 2020 were included. Incidence was calculated as the number of cases including the event divided by the total number of cases. A total of 90,146 records were identified from a cohort of 55,733,855 (0.16%). Distal femur fractures, pathologic fractures, and periprosthetic fractures were excluded, resulting in 65,651 unique cases. Of the 65,651 cases, 7104 (11%) were identified as isolated neck fractures. The combined incidence of femoral neck or pertrochanteric femur fractures in the setting of a femoral shaft fracture was 82.3 per 10,000 cases (0.82%). Only 283 cases of concomitant femoral neck and shaft fractures were found among 55,169 femoral shaft fractures (0.5%). The incidence of ipsilateral femoral neck or pertrochanteric femur fractures in the setting of a femoral shaft fracture is 82.3 per 10,000 patients (0.82%) based on data from Pediatric Health Information System-participating institutions. The incidence of femoral neck/pertrochanteric femur fractures and femoral shaft fractures in children and adolescents is more than 10 times lower than reported for adults; therefore, the routine use of advanced diagnostic imaging in pediatric patients with femoral shaft fractures should be considered cautiously. Level IV; cross-sectional analysis.

Changes in the anatomical position of the superficial and deep femoral arteries during internal fixation of intertrochanteric fractures

Fixation for intertrochanteric proximal femoral fractures are increasing globally, one of the risks with surgical treatment is injury to the deep and superficial femoral arteries (DFA and SFA, respectively). The anatomic path of these vessels has been previously described, though the effect of reduction techniques, such as traction over a perineal post has not been well defined. This study addresses the question of: do closed reduction maneuvers on an orthopaedic trauma traction table affect the anatomical relationship of superficial and deep femoral arteries to the proximal femur in intertrochanteric proximal femoral fractures? Prospective observational single centre study of seventeen patients with pertrochanteric femoral fractures examined before and after applying traction for closed reduction. Doppler ultrasound was used to determine the proximity of these arteries to the proximal medial femoral cortex at three different levels. Our data demonstrates that internal rotation of the injured limb during reduction draws the arteries statistically closer to the medial cortex of the proximal femoral shaft at 3.5cm and 10.5cm distal to the lesser trochanter (SFA: 3.5cm - 38.0mm vs 34.7mm p 0.004, 10.5cm – 30.4mm vs 21.0mm p 0.02; DFA: 3.5cm – 26.4mm vs 22.3mm p 0.003, 10.5cm - 21.5mm vs 14.1mm p 0.007). No significant change in the artery position was noted in patients who did not require internal rotation to achieve fracture reduction. Surgeons performing these internal fixation procedures need to be aware of the anatomical changes to ensure patient safety and avoid complications including intramuscular haematomas and pseudoaneurysms. • Internal rotation laterally displaces the femoral artery during fixation on an orthopaedic traction table. • Care should be taken to avoid drill plunge beyond the medial femoral cortex. • Deep femoral artery is most ‘at risk’ of injury when using plate or distal locked nail constructs.

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.