Pertrochanteric Fractures Research Articles

Does the Instability of Pertrochanteric Fractures in the Elderly Correlate With Weakened Gluteal Muscles?

Does the Instability of Pertrochanteric Fractures in the Elderly Correlate With Weakened Gluteal Muscles?

Single-centre results of a randomised controlled trial comparing the Gamma3 nail and a sliding hip screw to treat AO type 31-A1 and 31-A2 trochanteric fractures.

The primary goal of this randomised controlled trial was to investigate whether there are differences in the outcome between the Gamma3 nail and a sliding hip screw (SHS) regarding quality of life 1 year after surgery. In a controlled randomised trial, we compared the Gamma3 nail (Stryker) and a SHS(Omega, Stryker) in the treatment of 193 patients with pertrochanteric fractures. The follow-up period was 12 months. The outcomes included the surgical duration, health-related quality of life measured with the EQ-5D Index and a Visual Analogue Scale (VAS), the living situation and use of walking aid before trauma and 52 weeks after surgery; the Parker Mobility Score; the Harris Hip Score; and the revision, complication and mortality rates. The Gamma3 group had a significantly shorter surgical duration than the SHS group (p < 0.0001). Implant-related complications were significantly lower in the Gamma3 group (p > 0.05). The revision rate was significantly lower in the Gamma3 group based on intention-to-treat (p = 0.0336) as well as as-treated (p = 0.0302) analyses. Otherwise, we did not find significant difference between the two groups regarding the EQ-5D Index and VAS scores, the Parker Mobility Score, the Harris Hip Score, the mortality rate, the use of walking aids and the living situation. There were no detectable differences between the groups in terms of quality of life and clinical scores 12 months after surgery. The surgical duration and revision rate were superior for the Gamma3 group.

7473 Mortality following Hip Fracture among Black and White Women in a Western US Healthcare System

Abstract Disclosure: J.C. Lo: None. M. Chandra: None. W. Yang: None. U. Ozomaro: None. M.D. Sharma: None. J.A. Darbinian: None. C. Lee: None. A.L. Wheeler: None. M.M. Khan: None. Background: Prior studies using US Medicare data demonstrate that Black women have higher mortality after hip fracture than White women. However, few studies have examined findings specific to the Western US. We previously found that 1-year mortality after hip fracture (in 2000-2010) was similar among Black and White women in a Western US healthcare system. We now examine 6-month and 1-year mortality in an expanded cohort of Black and White women with hip fracture in the same healthcare system. Methods: This retrospective study includes data from non-Hispanic White and Black women aged ≥65y in a Western US healthcare system who were hospitalized with hip fracture during 2000-2019. The outcome was all-cause mortality, within 6-months and 1-year after hip fracture. Covariates included age at hip fracture, femoral neck vs pertrochanteric (hip) fracture, year of fracture, prior clinical fracture (diagnosed in the prior 5 years), Charlson-Deyo Comorbidity index (CCI based on inpatient/outpatient data in the prior year and during hip fracture hospitalization) and diabetes (diagnosed in the prior 5 years or during hip fracture hospitalization). Modified Poisson regression was used to examine mortality after hip fracture (Black vs White women), adjusting for (a) age, fracture type, year and (b) age, fracture type, year, CCI, prior fracture and diabetes. Results: The cohort included 691 Black women (age 82.9 ± 8.0y; 43.4% age ≥85y) and 20,450 White women (age 82.8 ± 7.7y; 44.2% age ≥85y) with hip fracture in 2000-2019. Black women had a similar proportion with femoral neck fracture (58.2% vs 55.2%) but were more likely to have prior fracture (23.0% vs 33.5%), diabetes (35.2% vs 18.2%), and higher CCI vs White women. For Black vs White women, respectively, group differences in 6-month (18.4% [95% confidence interval 15.7-21.4%] vs 16.4% [15.9-16.9%], p=0.12) and 1-year mortality (23.2% [20.2-26.5%] vs 22.1% [21.4-22.6%], p=0.49) were not significant. In multivariable analyses, the relative risk of death at 1-year for Black (vs White) women was 1.03 [0.90-1.19] adjusting for age, year, fracture type and 0.97 [CI 0.84-1.11] adjusting for age, year, fracture type, CCI, prior fracture, and diabetes. The relative risk of death at 6-months for Black (vs White) women was 1.05 [0.89-1.23] adjusting for covariates. Conclusions: In a Western US healthcare system, differences in 6-month and 1-year mortality post-hip fracture were small and not significant for Black and White women aged ≥65y, after accounting for age and comorbidity burden. However, the number of Black women was small, and data on social factors, frailty, post-fracture morbidity, and other health factors were not available. Nonetheless, these results suggest that racial and ethnic differences in mortality after hip fracture may vary by geographic region. Hip fracture outcomes in larger populations of Black women in the Western US should be examined. Presentation: 6/3/2024

Long vs short intramedullary nails for reverse pertrochanteric fractures: A biomechanical study

There is currently no definitive evidence for the implant of choice for the treatment of reverse pertrochanteric fractures. Here, we aimed to compare the stability provided by two implant options: long and short intramedullary nails.We performed finite element simulations of different patterns of reverse pertrochanteric fractures with varying bone quality, and compared the short vs long nail stabilization under physiological loads. For each variable combination, the micromotions at the fracture site, bone strain, and implant stress were computed.Mean micromotions at the fracture surface and absolute and relative fracture surface with micromotions >150 µm were slightly lower with the short nail (8%, 3%, and 3%, respectively). The distal fracture extension negatively affected the stability, with increasing micromotions on the medial side. Bone strain above 1 % was not affected by the nail length. Fatigue stresses were similar for both implants, and no volume was found above the yield and ultimate stress in the tested conditions.This simulation study shows no benefit of long nails for the investigated patterns of reverse pertrochanteric fractures, with similar micromotions at the fracture site, bone strain, and implant stress.

Postoperative Gait Performance Following Pertrochanteric Fractures Is Influenced by the Preoperative Condition of the Gluteal Muscles.

Introduction Amid an increasing number of patients with pertrochanteric fractures, early prediction of postoperative gait potential could reduce unnecessary rehabilitation and hospitalization. The relationship between preoperative gluteal muscle condition and postoperative gait outcomes remains unclear. The gluteal muscles are crucial for mobility, and their cross-sectional area (CSA) and fatty infiltration are indicators of physical function. Preoperative computed tomography (CT) provides quantitative data on muscle CSA and density, measured in Hounsfield Units (HU). This study aimed to identify which preoperative muscle index, CSA, BMI-adjusted CSA, or muscle density, best predicts postoperative gait ability. We hypothesized that a higher adjusted CSA and muscle density in the gluteus muscles would be associated with superior gait performance. Materials and methods Preoperative assessments included radiographs and CT scans. Patients under 75, with less than four weeks of follow-up, prior contralateral hip surgery, prefracture immobility, male patients, high-energy trauma, or conditions impairing physical performance were excluded. Gait performance was evaluated four weeks postoperatively, classifying patients into two groups: the 'parallel bar group,' requiring parallel bars, and the 'walker group,' walking independently. Patients underwent CM nailing. Preoperative CT scans measured the CSA and muscle density of the gluteus maximus and medius. Measurements were taken from the non-injured side to avoid interference from the fracture. Muscle borders were manually traced, and the CSA and muscle density in HU were calculated. Results Out of 81 patients, 49 met the inclusion criteria (mean age: 87). The patients were divided into the 'parallel bar group' (n=19) and the 'walker group' (n=30) based on postoperative gait performance. No significant differences in age, weight, height, or fracture laterality were observed between groups. The mean (and standard deviation (SD)) of CSA for the gluteus maximus in the 'parallel bar group'/in the 'walker group' was 2211.8 ± 469.8 mm²/2440.0 ± 586.2 mm², respectively (p=0.15), and for the gluteus medius, itwas 1751.7 ± 415.2mm²/1869.1 ± 448.3mm², respectively (p=0.36). The mean (and SD) muscle density for the gluteus maximus in the 'parallel bar group'/in the 'walker group' was 13.6 ± 12.7 HU / 20.6 ± 13.0 HU (p=0.07), and for the gluteus medius, it was 25.2 ± 8.4 HU/31.8 ± 10.1 HU, respectively (p=0.02). The ROC curve identified a 30.9 HU cut-off for gluteus medius density, with sensitivity and specificity of 60.7% and 78.9%. The mean (and SD) of BMI-adjusted CSA for the gluteus maximus in the 'parallel bar group'/ in the 'walker group' was 116.4 ± 26.8 m²/106 kg/124.3 ± 29.2 m²/106 kg, respectively (p=0.35), and for the gluteus medius, it was 93.3 ± 27.2 m²/106 kg/95.4 ± 21.3m²/106kg, respectively (p=0.78). Conclusion This study analyzed preoperative CT images of women aged 75 and older with pertrochanteric fractures, comparing gluteal muscle CSA and density with postoperative walking ability. The gluteus medius density was significantly higher in the superior gait group, with a cut-off value of 30.9 HU. However, no significant differences were found in the gluteus maximus density, CSA, or BMI-adjusted CSA. These findings partially support the hypothesis, emphasizing the importance of muscle evaluation in predicting postoperative gait performance.

Early surgical treatment using regional clinical pathways to reduce the length of postoperative hospital stay in hip fracture patients: A retrospective analysis using the Japanese Diagnosis Procedure Combination database.

Hip fracture is a common injury in older adults; however, the optimal timing of surgical treatment remains undetermined in Japan. Therefore, this retrospective study aimed to ascertain the rate of early surgery among hip fracture patients and investigate its effectiveness, along with "regional clinical pathways" (patient plan of care devised by Japanese clinicians), in reducing the length of hospital stay (LOS) postoperatively. We hypothesized that performing early surgery along with a regional clinical pathway is effective to reduce the postoperative LOS and complications among hip fracture patients. We examined the data of patients diagnosed with femoral neck and peritrochanteric fractures retrieved from the Japanese Diagnosis Procedure Combination database between April 2016 and March 2018. Patients were divided into the early (43,928, 34%; surgery within 2 days of admission) and delayed (84,237, 66%; surgery after 2 days of admission) surgery groups. The difference in postoperative LOS between the two groups was 3 days (early vs. delayed: 29 days vs. 32 days). The early surgery group had more cases of intertrochanteric fractures (57% vs. 43%) and internal fixation (74% vs. 55%) than did the delayed surgery group. In contrast, the delayed surgery group had more cases of femoral neck fractures (43% vs. 57%) and bipolar hip arthroplasty (25% vs. 42%) or total hip arthroplasty (1.2% vs. 3.0%). Moreover, the early surgery group showed a lower incidence of complications, except anemia (12% vs. 8.8%). Logistic regression analysis using the adjusted model revealed that early surgery and implementation of regional clinical pathways reduced LOS by 2.58 and 8.06 days, respectively (p<0.001). Early surgery and implementation of regional clinical pathways for hip fracture patients are effective in reducing postoperative LOS, allowing regional clinical pathways to have a greater impact. These findings will help acute care providers when treating hip fracture patients.

Artificial Hip Replacement Combined with Proximal Femoral Locking Plate in The Treatment of Intertrochanteric Femur Fracture with Peritrochanteric Fracture

Artificial Hip Replacement Combined with Proximal Femoral Locking Plate in The Treatment of Intertrochanteric Femur Fracture with Peritrochanteric Fracture

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.

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.

The Functional Outcome of Proximal Femoral Nail Antirotation-2 (PFNA-2) in Peritrochanteric Fractures of the Femur.

Introduction Peritrochanteric fractures are defined as extra-articular fractures involving the trochanter and frequent extension into the subtrochanteric region. These fractures exhibit a bimodal distribution in terms of age. These fractures commonly happen in young individuals who experience high-energy trauma, often in combination with other injuries. In contrast, elderly individuals with osteopenia are more prone to fractures caused by low-energy trauma. Methods This study is a prospective investigation that was carried out over 30 months. The study focused on peritrochanteric fractures that were treated using proximal femoral nail antirotation-2 (PFNA-2) as a fixation device. A range of criteria were examined and documented, encompassing the mean duration of surgical procedures, blood loss, the duration of hospitalization, mobility, and any potential post-operative problems. Subsequent assessments were conducted at fixed intervals of two weeks, six weeks, three months, six months, and two years. The functional outcome analysis for all patients involved the utilization of the modified Harris hip score (HHS). Results The study involved 60 cases of peritrochanteric fractures. The average age was 56 years.The most common mode of trauma was trivial fall/slip (46.66%), followed by road traffic accidents (RTA) (31.66%) and falls from height (21.66%). The average operating time was 53.03±5.66 minutes. The average modified Harris hip score was 84.78 with 26.66% excellent,70% good, and 3.33% fair results. Complications included superficial wound infection (5%), knee stiffness (11.66%), hip pain (8.33%), and shortening (1.66%). Conclusion PFNA-2 is a safe and easy implant option for treating peritrochanteric fractures as it preserves periosteal covering, minimizes blood loss, has a short operative time, and helps in early mobilization. PFNA-2 provides excellent outcomes in patients with peritrochanteric fractures with minimum complication rates compared to all other open methods and is highly recommendable.

Functional outcome of pertrochanteric fractures undergoing Dynamic Hip Screw versus Proximal Femoral Nail Anti-Rotation Techniques at a Tertiary care hospital of Karachi.

Objective: To find out the functional outcomes as per Harris hip score (HHS) among patients of pertrochanteric fractures undergoing dynamic hip screw (DHS) versus proximal femoral nail anti-rotation (PFNA) at a Tertiary care hospital. Study Design: Non-randomized Controlled Trial. Setting: Orthopedic Section, Department of Surgery, Agha Khan University Hospital, Karachi, Pakistan. Period: 1st August 2023 to 30th January 2023. Methods: A total of 40 patients of age 18 and older with confirmed pertrochanteric fractures were non-randomly allocated to ether fixation with DHS or PFNA. Intra-opeative blood loss and duration of surgery were recorded. The functional outcome assessment was assessed using HHS. Results: In a total of 40 patients, 31 (77.5%) were female. The mean age was 67.63±15.13 years (ranging between 23 to 89 years). The most common mechanism of fall was tipped over loose carpet, noted in 17 (42.5%) patients. The mean intra-operative blood loss in DHS and PFNA groups were 73.75±20.06 ml, and 72.75±23.14 ml, respectively (p=0.885). The mean duration of surgery were 76.6±14.7 minutes, and 115.1±18.3 minutes in DHS and PFNA groups, respectively (p&lt;0.001). Excellent, good, fair, poor, and failed outcomes were reported in 3 (7.5%), 17 (42.5%), 6 (15.0%), 10 (25.0%), and 4 (10.0%) patients respectively. When both groups were compared for outcomes, no statistically significant differences were observed (p=0.339). The mean HHS in DHS, and PFNA groups were 75.26±11.41, and 73.46±14.57, respectively (p=0.666). Conclusion: Functional outcomes as per HHS were relatively similar with DHS and PFNA approaches in patients with pertrochanteric fractures.

Pertrochanteric fractures treated with long proximal femur nail: a prospective study at a tertiary hospital

Pertrochanteric fractures treated with long proximal femur nail: a prospective study at a tertiary hospital

Relationship Between Surgery Timing and Hidden Blood Loss in Proximal Femoral Nailing of Pertrochanteric Fractures in Elderly Patients: A Cross-Sectional Study

Relationship Between Surgery Timing and Hidden Blood Loss in Proximal Femoral Nailing of Pertrochanteric Fractures in Elderly Patients: A Cross-Sectional Study

Effects of Continuous Analgesic Titrated Spinal Anesthesia in Elderly Patients Undergoing Hip Fracture Surgery

Background and Objectives: Anesthetizing elderly patients with hip fractures poses a significant challenge in emergency settings, particularly given the aging population both in Algeria and worldwide. With a high prevalence of comorbidities and polypharmacy, effective anesthetic management becomes paramount. Continuous titrated spinal anesthesia (CTSA) has emerged as a promising technique for addressing these complexities by proposing lower doses of local anesthetic (LA) in this patient population. Methods: This retrospective study involved 40 elderly patients (&gt;65 years) undergoing hip fracture repair. Patients received intermittent dosing of a local anesthetic solution via an intrathecal catheter, utilizing 0.25 ml increments of 0.5% isobaric bupivacaine and 0.25 ml of fentanyl (12.5 μg). Evaluation criteria included hemodynamic stability, incidence of hypotension, extent of sensory and motor blockade, total ephedrine consumption, and patient and surgeon satisfaction. Results: A female predominance was noted, with a mean age of 75 years, and 72% classified as ASA ≥ III. Pertrochanteric fractures accounted for 47% of cases, followed by femoral neck fractures at 53%. Nearly all patients achieved a sensory level ≥ D10, with a failure rate of only 2%. Sedation supplementation was required in 20% of cases, with conversion to general anesthesia in one patient. Complications were minimal, including arterial hypotension (3%), vasoconstrictor use (2%), and bradycardia (0.8%). Overall, both patients and surgeons reported high levels of satisfaction. Conclusions: Our findings demonstrate that CTSA is an effective technique for elderly patients undergoing hip fracture repair, offering the advantages of reduced LA doses, excellent hemodynamic stability, and minimal side effects. Its simplicity and cost-effectiveness further enhance its appeal in clinical practice.

Nailing intertrochanteric fractures in geriatric population: Do we know it all?

Introduction and objectivesPertrochanteric fractures constitute an important part of the daily activity of the orthopedic surgeon. The aim of this study was to carry out an analysis of pre-, intra- and post-operative radiographic parameters and to analyze the results of stable and unstable intertrochanteric fractures treated with short nails with dynamic distal locking. Materials and methodsRetrospective study in our center, between the years 2017–2021 of patients over 65 years of age with pertrochanteric fracture. We included 272 patients treated with Gamma3 Nail (Stryker®) with dynamic distal locking. As variables, we recorded: age, medical comorbidities, fracture pattern according to AO/OTA, osteopenia according to Singh's classification, pre-operative (such as diaphyseal extension), intra-operative (such as tip-to-the-apex or medial cortical support) and post-operative radiographic parameters (such as time to consolidation or loss of reduction), pre- and post-operative Barthel, quality of life and complications and reinterventions, such as non-union or cut-out. ResultsThe mean age was 83.28 years (65–102). Two hundred four cases were women (75%). The average follow-up was 18.2 months (12–24). The distribution according to AO/OTA classification was 85.7% 31.A1; 12.5% 31.A2; 1.9% 31.A3. Radiographic consolidation was obtained in 97.4% of cases. Tip to apex distance was less than 25mm in 95.6% of cases. Medial cortical support was positive or neutral in 88.6% of cases. Sixty cases (22.1%) of screw back-out were recorded. Eight reinterventions (2.9%) were performed, corresponding to three cut-outs (1.1%), three non-unions (1.1%), one avascular necrosis (0.4%) and one secondary hip osteoarthritis (0.4%). ConclusionsShort nail with dynamic distal locking offers good clinical, radiological and functional results in all types of AO/OTA patterns, without increasing the complication rate, as long as there is an appropriate tip-to-the-apex distance and good medial cortical support.

Factors Associated With Failure of Synthesis in the Treatment of Proximal Femur Fractures With Cephalomedullary Nails.

Proximal femur fractures are common in older patients and typically require surgical treatment, with cephalomedullary nails being the gold standard device for this approach. This study aimed to identify the factors associated with the failure of cephalomedullary nailing. We retrospectively evaluated 380 patients treated with a cephalomedullary nail between August 2021 and August 2022 in a trauma referral center in Brazil. A total of 221 (58.1%) patients were included in the study after applying specific eligibility criteria. Data were collected and rates were determined by reviewing patients' medical records and radiographs. Of 221 patients, 14 (6.3%) had nail failures A significant association was found between post-fixation cervico-diaphyseal angle and the occurrence of nail failure (p<0.001). Furthermore, calcar-referenced tip-apex distance (CalTAD) and tip-apex distance (TAD) values were higher in cases with nail failure than in those without nail failure. Cutoff points were established for TAD and CalTAD to measure the correspondence with nail failures. The present study supports previous evidence that varus reduction potentially causes collapse and nail failure in pertrochanteric fractures treated with cephalomedullary nailing and that high TAD and CalTAD values contribute to the incidence of cut-out.

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.

Exploring Quality of Life and Mortality in Pertrochanteric Fragility Hip Fractures in Northern Greece: A Single Tertiary Center Study.

Background: Fragility-related pertrochanteric fractures have become a significant public health concern, with a rising incidence attributed to the expanding elderly demographic. Assessing patient-reported health-related quality of life (HRQoL), mortality, and factors correlated with them serves as a crucial metric in evaluating the effectiveness of hip fracture surgery. Methods: In a single-center retrospective study, 259 patients underwent surgical treatment with a cephalomedullary nail, with a mean follow-up of 21.7 months. Health-related quality of life (HRQoL) was assessed using SF-12 (12-item Short Form) and EQ-5D (EuroQoL-5 Dimensions) questionnaires. Mobility status was measured by the Crude Mobility Index (CMI). Surveys were administered during hospitalization and six months postoperatively. Statistical analysis involved descriptive statistics, non-parametric controls (Kendall, Mann-Whitney, and Wilcoxon), and Spearman correlation and logistic regression analysis, which were conducted using IBM SPSS version 28. Results: A statistically significant decrease was observed in the mean EQ-5D and SF-12 scores at 6 months post-op compared to the pre-fracture status. The ASA (American Society of Anaesthesiologists) score showed a significant correlation with the decrease in HRQoL measured by the SF-12 questionnaire. The 30-day post-operative mortality rate was 9.3%, increasing to 32.4% at 1 year. Notably, the 30-day mortality significantly rose during the pandemic era (5.0% vs. 12.0%; p = 0.003). Conclusions: Pertrochanteric hip fractures cause a lasting decline in quality of life. Annual mortality is high, and further investigations are needed to formulate policies that prevent hip fractures and reduce mortality rates.

Role of Anteromedial Cortical Support for Unstable Intertrochanteric Fractures Being Treated With Cephalomedullary Nails.

Reduction quality is of paramount importance for an optimal outcome in unstable pertrochanteric fractures. The non-anatomical functional anteromedial buttress is proposed to prevent impending mechanical complications. We aimed to evaluate the role of anteromedial cortical support in preventing mechanical complications following fixation with the cephalomedullary nail. A prospective, single-arm interventional study was conducted in the Orthopaedics Department of a Combined Military Hospital (CMH) in Rawalpindi. The duration of the study was 24 months. Patients were recruited by the purposive sampling technique as per inclusion/exclusion criteria. Preoperatively, the reduction was categorized as per Baumgartner's and Chang's criteria. Post-operatively, weight bearing as tolerated was advised. Radiographs prior to discharge for loss of reduction were evaluated. Follow-up radiographic measurements of neck length, neck shaft angle, and their loss as per protocol were done at three and six months. A total of 202 patients were operated on from October 21 until August 23. Mortality at six months in 39 patients (19.3%) and loss to follow-up in 31 patients (15.3%) resulted in 132 patients with complete follow-up and having developed complications in 12 patients (9.09%). The mean age was 76.3 ± 7.98 years; males were 105 (79.5%), and females were 27 (20.5%). Closed reduction was 58 (43.9%), and additional manoeuvres were required in 74 (56.1%). The mean tip apex distance (TAD) was 24.56 ± 2.76, and the Calcar gap was 5.16 ± 1.27. Cleveland zone centre-centre in 54 (40.9%), inferior-centre in 65 (49.2%), and inferior-posterior (9.9%) were statistically significant for mechanical complications (p≤0.001). There was a significant association between the grading of Chang's and Baumgartner's poor groups for the development of mechanical complications (p≤0.001). The mean time to full weight bearing without support was 21 ± 1.22 weeks. The mean Hip Harris score at six months was 69.27 ± 7.68. Results suggest that anteromedial cortical support can lead to fewer potential mechanical complications at six months. A higher Chang's grade drives surgeons to engage in additional manoeuvres. Anteromedial cortical support is worth consideration for unstable pertrochanteric fractures.

Effectiveness of Proximal Femur Nail in the Management of Unstable Per-Trochanteric Fractures: A Retrospective Cohort Study.

Background Intertrochanteric (IT) fractures in the elderly demand surgical intervention for optimal recovery. While dynamic hip screw (DHS) is standard for stable fractures, its use in unstable cases is debated. Proximal femur nail (PFN) addresses unstable per-trochanteric fractures, boasting biomechanical advantages. Many studies favor PFN over DHS, despite concerns like screw migration. In resource-constrained developing nations, the choice of implant is pivotal. This research assesses proximal femur nailing outcomes for unstable fractures, providing insights for regional orthopedic protocols and contributing to tailored treatment guidelines in contexts with limited resources. Objective To assess the clinical and radiological outcomes in patients undergoing proximal femur nailing for unstable per-trochanteric fractures. Material and Methods This retrospective single-arm cohort study was conducted from January 2020 to July 2022. All the consecutive patients who underwent PFN for unstable per-trochanteric fractures were included in this study. Harris Hip Score (HHS) and ambulation status were recorded to evaluate functional outcomes. In contrast, the radiological outcome was assessedby calculating Radiographic Union Score for Hip (RUSH) scores at six weeks, three months, and six months post-operatively. Results A total of 48 patients were included in this study with equal gender distribution and a mean age of 66 years. The functional outcome was recorded with 2.1% (1), 33.3% (16), and 50% (24) of patients achieving full weight bearing (FWB) without pain at six weeks, three months, and six months respectively while 14.6% (7) of the patients never achieved FWB. The radiological outcome was assessed by calculating RUSH score with 6.3% (3), 43.8% (21), and 50% (24) of the patients achieving complete union at the end of six weeks, three months, and six months respectively. One patient (2.1%) experienced malunion. Conclusion PFN remains an optimal treatment modality for the fixation of unstable per-trochanteric fractures yielding promisingfunctional and radiological outcomes.