Pertrochanteric Femoral Fractures Research Articles

Combined lumbar plexus-sciatic nerve block in the emergency surgery for pertrochanteric fracture: an alternative technique in patients at high risk of anaesthetic complications

Introductionl’anesthésie pour la chirurgie urgente de la fracture pertrochantérienne (FPT) chez les patients à haut risque anesthésique représente souvent un véritable challenge pour les praticiens en vue du risque periopératoire majeur. Nous rapportons notre expérience avec le bibloc ou bloc combiné lombaire et sciatique plexique (BCLS) comme technique anesthésique alternative face à ce type de situation.Méthodesune étude transversale, descriptive, monocentrique, a été menée sur une période de 3 ans, incluant les patients à haut risque anesthésique présentant une FPT récente. Les deux blocs nerveux étaient réalisés au niveau plexique selon la technique classique de neurostimulation. Un mélange de 20ml de lidocaine 2% et de bupivacaine 0,5% (50/50) a été injecté au niveau de chaque bloc. Le critère d’évaluation principal était l’efficacité du BCLS apprécié par l’incidence d’échecs de la technique anesthésique, définie par la nécessité de convertir en anesthésie générale (AG). Les critères d’évaluation secondaires étaient: 1) les données techniques de la procédure anesthésique, 2) les retentissements hémodynamiques, respiratoires et neurologiques periopératoires, et 3) les résultats et les complications éventuelles en postopératoire.Résultatstrente patients ont été colligés. L’âge moyen était de 74 ± 10 ans. Le délai moyen d’admission aux urgences-intervention était de 12(5-36) heures. La durée moyenne pour la réalisation de la procédure était de 15,20 ± 3,45 minutes. Aucune conversion en AG n’a été nécessaire. Il n’y avait pas de différences statistiquement significatives entre les différentes valeurs enregistrées des paramètres hémodynamiques et respiratoires periopératoires (PAM, FC, SpO2) (p > 0,05). La durée de l’intervention était de 46 ± 5 minutes. La satisfaction des chirurgiens était de 9,7 ± 0,1. La première demande en antalgiques postopératoires était après 8(1-24) heures. Tous les patients avaient une récupération sensitivomotrice complète.Conclusionle BCLS est une alternative anesthésique pour les interventions urgentes de FPT chez les patients à haut risque anesthésique: délais opératoires réduits, efficacité anesthésique, stabilité hémodynamique et respiratoire periopératoire, absence de complications inhérentes aux autres techniques anesthésiques, passage rapide en salle de surveillance post-interventionnelle (SSPI), et analgésie postopératoire de qualité.

A prospective study of the comparison between PFN (proximal femur nail) and PFNA (proximal femur nail antirotation) in the treatment of Intertrochanteric fracture femur: Union rates and functional outcome

The Proximal femur nail is an essential intramedullary device in the internal fixation of Peritrochanteric fractures of the femur. The evolution of the implant has proceeded from extramedullary plates to intramedullary nails which provide stable fixation of peritrochanteric femur fractures.

Intramedullary nailing for pertrochanteric fractures of proximal femur: a consecutive series of 323 patients treated with two devices

IntroductionPertrochanteric fractures (PFs) frequently affect the lower limb of osteoporotic patients and represent an important cause of morbidity and mortality in the elderly. In this prospective randomized controlled trial, we have compared functional and radiological results and complications of patients affected by PFs treated with two intramedullary proximal femoral nails.MaterialsWe enrolled 323 subjects with PFs, classified according to AO/OTA system as 31.A1 (pertrochanteric simple) and 31.A2 (pertrochanteric multifragmentary). Patients were divided into two groups according to the osteosynthesis devices: group A, Elos-Intrauma® nail (155 cases) and group B, Gamma 3-Stryker® nail (168 cases). Pre-operatively, the baseline characteristics of each patient (gender, age, weight and BMI) were collected. Intraoperative blood loss, subjective pain by visual analogue scale (VAS), esthetic satisfaction, functional scores of the hip by Harris Hip Score (HHS), and Western Ontario and McMaster Universities Arthritis Index (WOMAC) were noted. The post-operative degree of fracture reduction was assessed. Each patient had a minimum follow-up of 12 months.ResultsThe study group was composed of 106 male and 217 female with an average age of 85.4 (range, 65–90, standard deviation (SD) 5.95) years. No statistical differences about sex and age distribution were noted between the two groups. Group A reported lower intraoperative blood loss, 45 ml vs 51 ml, respectively (p < 0.001). There was not any statistical difference about operative time. Group A had a better reduction of fracture (p = 0.0347). The greatest difference was detectable comparing subgroups 31.A2 (p = 0.032). There were no statistical differences about complication frequency and the overall rate was 25% (80 cases). Finally, there was no difference in terms of VAS, HHS, and WOMAC score between the two groups on each follow-up. Patients of group A showed a higher subjective satisfaction index at 1 post-operative year, 7.42 (SD 1.19) vs 6.45 (SD 1.35) of group B (p < 0.001).ConclusionElos® nail is a reliable device on a short-term follow-up and represents an alternative choice to the Gamma 3® nail, a well-known and appreciated system for over 25 years.

The effect of surgery type on mortality in elderly patients with pertrochanteric femoral fracture: A Korean nationwide cohort study

The purpose of this study is to analyze the effect of surgical methods on mortality and the relative risk of patients who underwent internal fixation (IF) or hemiarthroplasty (HA) after being diagnosed as a pertrochanteric fracture over 65 years old in a Korean nationwide cohort with a single insurance medical system. The Korean National Health Insurance Service-Senior cohort (NHIS-Senior, NHIS-2018-2-111) was used in this study. The eligibility criteria for incident hip fracture patients were the following: (1) first-time admission to acute care hospitals (index admission) with pertrochanteric fracture (ICD-10 S721), (2) three years of hip fracture-free period, (3) recipients of typical surgeries including IF, HA, (4) age between 65 and 99. a total of 7223 patients were enrolled in the cohort. There were 1662 patients (23%) in the HA group and 5561 patients (77%) in the IF group. Mortality rates of the IF group and HA group were 13.46 and 17.94 cases per 100 person-years, respectively. In the multivariable-adjusted Cox proportional hazard model, the HA group had 1.22 times more hazard of all-cause mortality than IF group (aHR 1.22, 95% CI 1.13-1.32). In subgroup analysis, aged 65-79 and female patients showed a prominent association between surgery type and mortality (aHR 1.52, 95% CI 1.29-1.79). In patients with pertrochanter fracture over 65 years, 1.22-fold mortality rate was observed when HA was performed compared to that of IF, and the difference in mortality was particularly prominent within 1-year after surgery.

Evaluation of peritrochanteric fractures of femur with proximal femoral nail: A prospective study

Peritrochanteric fractures of femur are most commonly encountered fractures in orthopaedic practice which can be treated by various modalities of management each having its own advantages and disadvantages. With advent of PFN we are able to overcome most of the complications associated with other modalities. The aim of the study is to analyze clinical, functional & radiological outcomes of peritrochanteric fractures of femur managed with proximal femoral nail and were followed up until complete fracture union. The patients were assessed periodically with HARRIS HIP SCORE. 12 patients had excellent results, 28 patients had good results, 5 patients had fair results and 5 patients had poor. Based on our study we found PFN is an ideal modality of management of peritrochanteric fractures of femur.

Treatment of Peritrochanteric Femur Fractures With Proximal Femur Locked Plating

To report on our results using a proximal femoral locking plate for the treatment of peritrochanteric femur fractures. Retrospective study. Level I Academic Medical Center. Sixty-eight patients with 68 fractures. Demographics, fracture morphology, preoperative imaging, rationale against nailing, and outcomes were collected. Outcomes were grouped into no complication, minor complication, or major complication. Minor complications included healed fractures with implant failure or change in alignment from immediate postoperative radiographs, which did not require intervention or elective implant removal. Major complications included any case that required revision for nonunion or implant failure. Nine patients were lost to follow-up. Of the 59 fractures, 16 had complications (27%): 9 minor and 7 major. Active tobacco use (P = 0.020) and fractures with an associated intracapsular femoral neck component (P = 0.006) correlated with complications. Proximal femoral locking plates continue to be associated with a high complication rate. However, based on our experience, proximal femoral locking plates may be considered in highly selected cases when absolutely no other implant is deemed appropriate, based on the degree of comminution and the complexity of the fracture pattern. Patients must be informed about the possibility of revision surgery based on the inherent limitations of these devices. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

A study of results of fixation of pertrochanteric femur fractures with dynamic hip screw (DHS) & comparision with past studies

Background and Objectives: Trochanteric fracture is a leading cause of hospital admissions in elderly people. The number of such admissions is a rise because of increasing life span & sedentary habits. Conservative methods of treatment result in malunion with shortening and limitation of hip movement as well as complications of prolonged immobilization like bed sores DVT and respiratory infections. This study is done to analyze the surgical management and traumatic fractures using Dynamic Hip screw.Methods: This is a prospective study of 20 cases of fresh trochanteric fractures admitted to Tertiary care Hospital, Surat, from November 2016 to February 2018. Cases were taken according to inclusion and exclusion criteria i.e., patients with trochanteric fracture above the age of 18yrs. Medically unsuitable and old malunited trochanteric fractures were excluded from the study. Operation was done keeping the Tip Apex Distance (TAD) into consideration.Results: The study shows sex ratio of 7:3 (M:F) with maximum presentation between 66 to 80yrs with an average of 63 yrs. Mode of injury was more due to fall, 11(55%); followed by RTA, 9(45%). Left side was slightly more than right side. L: R = 11:9. 30% of patients had associated injury. Type II fractures were maximum with 11 cases followed by 9 cases Type I&II. Post-operative results were found to be excellent in 3(15%), Good in 10(50%), Fair in 6(30%) and poor in 1(5%).Conclusion and Interpretation: This study shows that trochanteric fracture is common in elderly population with male preponderance mainly occurring between 66 to 80yrs. Common mode of injury being trivial fall, Left side being slightly more involved in injury. Early operative intervention with Dynamic hip screw with 1350 side plate with barrel gives good results, helps early mobilization of elderly patients decreasing morbidity & mortality and achieves rigid fixation even in osteoporotic bone. From our study we concluded that DHS still is implant of choice by many surgeons and have stood against test of time. Results are similar to past studies.

A solution to z effect and lateral wall comminution in nailing of per trochanteric fractures: A retrospective study of 54 cases

Background: Pertrochanteric femur fractures are fractures which extends from extra capsular basilar neck of the femur to the lesser trochanter. Since this region bears the maximum mechanical stress as compared to other parts of the femur it’s a site for comminuted fractures, and accounts for 10% to 34% of all hip fractures with the incidence estimated to double by 2040. In the quest for perfect implant in pertrochanteric femur fractures we have been using hip fracture nail since past 2 years for all pertrochanteric fractures in our institution. Methods: This is a retrospective study of 54 cases of pertrochanteric femur fractures operated using hip fracture nail from 2017 to 2019 in our institute. All the patients were above 55 years of age with an average age group of 67 years. We analyzed rate of union, complications and functional outcome. All the patients were followed up at 3 months interval up to 1 year. Results: Average modified Harris hip score were satisfactory in 48 patients. Average time taken for fracture union was 9 months. Conclusion: We concluded that hip fracture nail solves many a problem of earlier generation nailing systems for unstable pertrochanteric femur fractures. Our study suggests that a twin screw integrated cephalo-medullary nail system effectively prevents the z effect and provides a solution to the lateral wall comminution which is the key predictor for a revision surgery after an unstable intertrochanteric femur fracture.

Ease of doing proximal femoral nailing in lateral position in the management of peri-trochanteric femoral fractures in adults: A prospective study

Introduction: Intertrochanteric fractures are among the most common pei-trochanteric fractures encountered in orthopaedic practice. Most of the hip fractures are managed in supine position on a fracture table with foot attached to foot plates and biplanar fluoroscopy supervision under c-arm. But this procedure has its own difficulties in managing especially comminuted peri-trochanteric fractures, where in different fragments and segments are being pulled by strong muscles around hip, and getting good reduction and satisfactory alignment is difficult due to displaced bony fragments being held in traction on fracture table and cannot be manipulated easily. This leads to prolonged operative time, opening of fracture site, increased bleeding, and increased chances of infection and over all increased anaesthesia time adding up to risk factors. The purpose of this study was to demonstrate the technique of surgery as well as to report how these difficulties can be overcome by using long Proximal Femoral Nail in complex comminuted unstable trochanteric fractures in lateral position on an ordinary radiolucent top table without fracture table. Materials and Methods: 30 cases of peri-trochanteric fractures with or without comminution were operated in lateral position on simple ordinary radioluscent top table with lesser attachments and adjustments to operating table during the study duration were included in the study. We used long Proximal Femur Nail (PFN) (length more than 25cms 34, 36, 38, 40cms long) to fix these fractures. Results: In the present study, age group of patients was 60yrs to 78yrs. Male patients (60%) were more than female patients (40%) An average of less than 150 ml in closed surgery and 350 ml in Open reduction cases. The average operative time for all cases was 80 minutes. Union time varied from 14 weeks in simple fractures to 26 weeks in comminuted fractures. Clinical function of hip and knee was excellent with full range of movements. Overall excellent to good results were achieved in 90% cases. Conclusions: The lateral decubitus position provides easy identification of entry point, a shorter operation time, less of hospital stay, blood loss, number of intraoperative X-ray, incision length and out-of-bed activity time Reduction and fixation of proximal femoral fractures in the lateral position with fluoroscopy in the anteroposterior view for small set ups and rural hospitals that lack a fracture table or advanced fluoroscopic devices may be executable and probably safe.

The Frequency of Occult Intertrochanteric Fractures among Individuals with Isolated Greater Trochanteric Fractures.

PurposeIsolated greater trochanteric (GT) fractures are often identified using plain radiography of patients with post-traumatic hip pain. In many cases, the fracture extends to form an occult intertrochanteric fracture. We conducted a study to determine the frequency of occult intertrochanteric fractures in patients diagnosed with isolated GT fractures using plain radiographs.Materials and MethodsAmong 3,017 individuals who visited our emergency department with a trauma-induced pertrochanteric femur fracture between July 2004 and March 2018, 100 patients diagnosed with isolated GT fractures using plain radiographs were retrospectively analyzed. Patients were divided into two groups, those with: i) isolated GT fractures (group A) and ii) occult intertrochanteric fractures (group B). In addition, plain radiographs, magnetic resonance imaging results, and treatment methods were further analyzed in each group. If surgery treatment was needed, it was performed by one surgeon, and in all cases, a 2-hole dynamic hip screw was used.ResultsAmong the 100 cases of isolated GT fractures diagnosed using plain radiograph, additional examinations revealed that 10 (10.0%) were suffering from isolated GT fractures alone, while the remaining 90 (90.0%) were further diagnosed with occult intertrochanteric fracture. Gender, age, mechanism of injury, and bone mineral density did not correlate with fracture type.ConclusionIn our analysis, 90% of injuries initially diagnosed as isolated GT fractures were found to extend into occult intertrochanteric fractures upon further examination with additional imaging modalities. Therefore, additional evaluation should be performed to test for the potential presence of occult intertrochanteric fractures and to establish appropriate treatment plans.

Optimising the tip-apex-distance in trochanteric femoral fracture fixation using the ADAPT-navigated technique, a longitudinal matched cohort study

IntroductionThe annual incidence of proximal femoral fractures is 100–150/100,000 and continues to increase with an aging population. Cut-out of hip screws after fracture fixation has been quoted as 8% in the literature. The tip-apex distance (TAD) is the strongest predictor for cut-out after operative fracture stabilisation.The aim of this study was to evaluate the novel ADAPT system (Adaptive Positioning Technology, Stryker, USA), a navigation device for intramedullary nailing of trochanteric fractures and its effect on optimising the TAD. This is the first clinical study to evaluate this new technology. MethodsThe study group of 36 consecutive patients with a pertrochanteric fracture underwent intramedullary nailing for fracture fixation using ADAPT technology, while the matched control group underwent conventional Gamma-3-nailing. Matching criteria included fracture classification, gender and age. We measured the operative time and the postoperative TAD in anteroposterior (AP) and lateral radiographs of the 72 patients. ResultsThe mean TAD using ADAPT was 16.9 mm (range 8.4–33.7 mm) compared with 24.9 mm (range 14.6–40.2 mm) in the reference group treated without ADAPT. Using the ADAPT system significantly improved (p < 0.0005) the accuracy of lag screw placement but had no effect on operating time in fixation of femoral pertrochanteric fractures. ConclusionWorking with the novel ADAPT system for positioning the lag screw using the Gamma-3-nail led to a statistically highly significant reduction of the TAD compared to the reference group (p < 0.001). The ADAPT system proved to be a very useful device in achieving higher surgical standards for the treatment of trochanteric fractures with intramedullary nailing. It enables higher accuracy in screw positioning and therefore better placement of the implant.

A prospective study of treatment of intertrochanteric fractures of femur by fixation with dynamic hip screw or proximal femur nailing

Purpose: Fractures of the proximal femur are more than ever, an important challenge in the field of traumatology. An anatomical reduction obtained at the expense of total devascularisation of the fracture is not a well-planned or well-executed procedure. One must always remember that any form of fixation is at best a splinting device with a definite life span and there is always a race between fracture union and failure of implant. Aims & Objectives: The aim is to study the clinical and radiological outcomes in case of reduction and stabilization of intertrochanteric femur fractures through DHS or PFN. The objectives are to study the advantages and principles of reduction and stabilization methods by DHS or PFN fixation for the treatment of intertrochanteric fractures of femur, to study the range of motion of hip and knee joints and functional outcome, to study complications of the technique. Material &Methods: After ethics committee clearance, subject recruitment procedure was followed. The sample size is total 100 cases with age between 18 to 100 years. The inclusion criteria include 1.Unstable intertrochanteric fractures with posteromedial comminution. 2. Patients with co-morbid conditions like diabetes, hypertension and ischemic heart disease. 3. All patients were ambulatory before the injury. The exclusion criteria include fractures other than intertrochanteric femur and non-ambulatory patients. Standard lateral approach was followed for the fixation of intertrochanteric femur fractures using dynamic hip screw or proximal femur nailing. Results: Out of 100 patients (48 males and 52 females), we have follow up of 67 patients with intertrochanteric femur fracture between July 2013 to May 2016. Majority of the patients in our series were male (53.7%) compared to females (46.3%). The average of male patient was 56 years and that of female patients was 69.9 years. Discussion: The mean Harris Hip Score of DHS is 89.07 and PFN is 89.00. Thus, there was no statistical significance for using DHS or PFN in per-trochanteric femur fractures. Conclusion: Implant selection for the patients must be based on the ability of the implant to withstand long term cyclical loading, the implant should splint the entire femur to bridge other potential areas of unrecognized or future metastatic disease. One must develop mastery over the usage of the implant in a particular fracture and then one can convert that implant as Gold standard for that fracture.

Examining implant superiority in the treatment of simple pertrochanteric fractures of the proximal femur in elderly patients.

The aim of this study was to compare the clinical and radiological results of the proximal femoral nail antirotation (PFNA) with those of the dynamic hip screw (DHS) and percutaneous compression plate (PCCP) in the treatment of simple pertrochanteric fractures. A total of 203 patients were included in the study. PFNA fixations were performed in 73 patients (PFNA group), DHS in 68 patients (DHS group), and PCCP in 62 patients (PCCP group). The main outcome measurements were perioperative properties, the Harris hip score, changes in the neck-shaft angle, and loss of the abductor muscle strength. Data were compared between the groups. The mean estimated total blood loss and the number of patients receiving the blood transfusion rate in the PFNA group were statistically significantly lower. The mean operation and fluoroscopy times in the PCCP group were statistically significantly higher. The mean loss of the abductor muscle strength and changes in the neck-shaft angle in the PFNA group were statistically significantly higher. The mean Harris hip scores were similar. Our findings demonstrated that although PFNA was superior with regard to the perioperative data, DHS and PCCP were superior in maintaining the reduction and the abductor muscle strenght. All three implants were similar and had satisfactory functional outcomes.

Extensive emphysema after intramedullary nailing of apertrochanteric fracture : Life-threatening infection or benign complication

The development of emphysema after intramedullary nailing can represent an easily manageable complication but in the differential diagnostics it could, however, be alife-threatening infection with Clostridium perfringens. This is a report about the case of an extensive subcutaneous and retroperitoneal emphysema, which developed after intramedullary nailing of apertrochanteric femoral fracture and where such an infection was suspected.

The fake unlocked femoral nail: A configuration to avoid in stable pertrochanteric femur fractures

BackgroundIntramedullary unlocked nailing is a safe and used treatment for stable pertrocantheric fractures. Due to the femoral anterior bow of the shaft or a wrong entry point, the distal tip of the nail can be impinging the anterior cortex. This type of situation can compromise the function of the nail, leading to nonunion of the fracture, and cut-out.The aim of this study was to assess the relationship between nail impingement of the anterior cortex of the femur and cut-out and nonunion incidence in patients with pertrochanteric stable fracture treated with an IM nail in an unlocked configuration. Material and methodsA retrospective study based on medical records and imaging from the archives of our Level I academic medical center was conducted.The study included patients with proximal femoral fractures treated with short cephalomedullary nails between January 2012 and May 2015. The data collected were analyzed to a possible correlation with the healing time and occurrence of nonunion and cut-out. ResultsThe study population counted 429 cases. Applying the inclusion criteria the final series was composed of 169 patients: 112 females (66.73%) and 57 males (33.27%), with a mean age of 81.23 years (range: 67–93 years). Distal tip impingement was observed in 22 cases (13.02%). In total 16 (9.47%) postoperative complications were recorded: 8 non-union and 7 cut-outs. Consolidation was registered in 153 cases and the fracture healing time averaged 14.4 ± 3.8 weeks (range, 11–24 weeks).The cortical impingement was correlated with nonunion and cut-out (p < 0.001) Logistic regression analysis revealed jamming sign significantly affected the fracture healing time (p < 0.001). ConclusionThe occurrence of cut-out and nonunion after cephalomedullary nailing of stable pertrochanteric fractures appear to be correlated to the presence of the cortical impingement. For this reason, the fake unlocked femoral nail with the cortical impingement is a configuration to avoid in stable pertrochanteric femur fractures.

Validation of Neck-Shaft Angle Correction After Cephalomedullary Nail Fixation.

To validate a neck-shaft angle (NSA) correction formula using the known angle between the medullary nail and lag screw of an indwelling cephalomedullary nail (CMN). Pertrochanteric femur fractures were created in 7 synthetic femurs and reconstructed with a CMN. Anteroposterior x-rays were taken with the proximal femur in 0, 15, 30, and 45 degrees of internal/external rotation and 10 and 20 degrees of flexion with neutral rotation. The femoral NSA and the nail angle were measured on anteroposterior x-rays. The corrected NSA was obtained by multiplying the known nail angle by the quotient of the measured NSA over the measured nail angle. With increasing degrees of internal or external rotation, the difference between the actual and the measured NSA increased. After correction using the known angle of the nail, the measured NSA was reduced to within 3 degrees of the actual NSA over all degrees of rotation. At neutral rotation, 15 degrees of external rotation, and 10 and 20 degrees of hip flexion, there was minimal difference between the actual NSA and the measured NSA, negating the effect of the correction formula. The measured NSA after CMN of intertrochanteric fractures is altered by hip rotation. This study validates the correction formula, which determines this difference by using the known angle between the lag screw and the nail.

Classifications in Brief: The Russell-Taylor Classification of Subtrochanteric Hip Fracture.

Classifications in Brief: The Russell-Taylor Classification of Subtrochanteric Hip Fracture.

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

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; 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.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 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.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; 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.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; 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.&lt;/p&gt;

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.