Pertrochanteric Femoral Fractures Research Articles

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.

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

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

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

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

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

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

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

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

Results of cementless and cemented bipolar hemiarthroplasty in proximal femur fractures with Dorr type B morphology

Aim: Surgical outcomes of patients, who had Dorr type B femoral morphology, were operated on with bipolar hemiarthroplasty for hip fracture were compared. Materials And Methods: This retrospective study included 352 patients with at least five years of follow-up. The patients were divided into two groups: cementless (Group 1; n = 136) and cemented (Group 2; n = 216). The study focused on the following parameters: admission cost, fracture type, gender, need for blood transfusion, Harris hip score (HHS), additional fracture, use of cement, mortality rate, revision surgery, the time between trauma and operation, duration of hospital stays, and surgery time. Results: The mean age of the patients in Group 2 was higher. Group 2 had a significantly longer duration of surgery and a higher need for blood transfusion than Group 1. The mean hemoglobin values of the patients in Group 2 was lower. The pertrochanteric femur fractures was more common than the neck of femur fractures in Group 2. The two groups did not differ by the parameters of the time between trauma and operation, mortality rate, revision surgery, duration of hospital stay, cost, and additional fracture. Conclusion: In this study, patients with femoral neck fractures were mainly operated on with cementless bipolar hemiarthroplasty, while patients with pertrochanteric femur fractures were primarily treated with cemented bipolar hemiarthroplasty.

In Silico Finite Element Modeling of Stress Distribution in Osteosynthesis after Pertrochanteric Fractures.

A stabilization method of pertrochanteric femur fractures is a contentious issue. Here, we assess the feasibility of rapid in silico 2D finite element modeling (FEM) to predict the distribution of stresses arising during the two most often used stabilization methods: gamma nail fixation (GNF) and dynamic hip screw (DHS). The modeling was based on standard pre-surgery radiographs of hip joints of 15 patients with pertrochanteric fractures of type A1, A2, and A3 according to the AO/OTA classification. The FEM showed that the stresses were similar for both GNF and DHS, with the medians ranging between 53–60 MPa and consistently lower for A1 than A3 fractures. Stresses also appeared in the fixation materials being about two-fold higher for GNF. Given similar bone stresses caused by both GNF and DHS but shorter surgery time, less extensive dissection, and faster patient mobilization, we submit that the GNF stabilization appears to be the most optimal system for pertrochanteric fractures. In silico FEM appears a viable perioperative method that helps predict the distribution of compressive stresses after osteosynthesis of pertrochanteric fractures. The promptness of modeling fits well into the rigid time framework of hip fracture surgery and may help optimize the fixation procedure for the best outcome. The study extends the use of FEM in complex orthopedic management. However, further datasets are required to firmly position the FEM in the treatment of pertrochanteric fractures.

Calcar fracture gapping: a reliable predictor of anteromedial cortical support failure after cephalomedullary nailing for pertrochanteric femur fractures

BackgroundMaintaining anteromedial cortical support is essential for controlling sliding and decreasing postoperative implant-related complications. However, adequate fracture reduction with cortical support in immediate postoperative fluoroscopy is not invariable in postoperative follow-ups. This study was conducted to investigate the risk factors leading to anteromedial cortical support failure in follow up for pertrochanteric femur fractures treated with cephalomedullary nails.MethodsThis retrospective study enrolled 159 patients with pertrochanteric fractures (AO/OTA- 31A1 and 31A2) that fixed with cephalomedullary nails. All patients were evaluated as adequate fracture reduction in immediate postoperative fluoroscopy before leaving the operation theater. The patients were separated into two groups based on the condition of the anteromedial cortex in the postoperative 3D CT with full-range observation: those with calcar support maintained in Group 1 and those with calcar support lost in Group 2. Demographic information, fracture classification, TAD (tip-apex distance), Cal-TAD, Parker ratio, NSA (neck-shaft angle), reduction quality score, and calcar fracture gapping were collected and compared. Logistic regression analysis was conducted to explore the risk factors leading to anteromedial cortex change.ResultsAnteromedial cortical support failure was noted in 46 cases (29%). There was no significant difference between the two groups concerning age, sex, side injury, TAD, Cal-TAD, Parker ratio, or NSA. There was a significant difference in the AO/OTA fracture classification in univariate analysis but no difference in the multivariable analysis. The reduction quality score, calcar fracture gapping in the AP (anteroposterior), and lateral views were significantly associated with anteromedial cortical support failure in follow-up after cephalomedullary nailing in the multivariable analysis. The threshold value of calcar fracture gapping for the risk of loss was 4.2 mm in the AP and 3.8 mm in the lateral fluoroscopies. Mechanical complications (lateral sliding and varus) were frequently observed in the negative anteromedial cortical support group.ConclusionsGood reduction quality was a protective factor, and larger calcar fracture gapping in the AP and lateral views were risk factors leading to the postoperative loss of anteromedial cortical support. Therefore, we should pay close attention to fracture reduction and minimize the calcar fracture gap during surgery.

Порівняльна характеристика ефективності оперативного лікування хворих із черезвертлюжними переломами стегнової кістки з використанням інтрамедулярних блокованих стрижней і тотального ендопротезування кульшового суглоба

З метою визначення оптимальної тактики оперативного втручання у хворих із черезвертлюжними переломами виконано комплексне клінічне дослідження. Матеріалом дослідження став аналіз історій хвороб, рентгенограм і клінічне обстеження 100 хворих із черезвертлюжними переломами стегнової кістки. Всі хворі були розподілені на дві групи залежно від використаного методу оперативного втручання. Першу групу становили хворі, яким проводилось тотальне ендопротезування кульшового суглоба. До другої групи увійшли хворі, яким проводили блокований інтрамедулярний остеосинтез. Переважно мінімально інвазивне оперативне втручання у групі хворих, яким виконувався інтрамедулярний блокований остеосинтез, дозволило знизити порівняно з групою, де хворим виконувалось тотальне ендопротезування кульшового суглоба, у 4 рази кількість післяопераційних гнійних ускладнень, у 5 разів — летальність і в 5,5 раза зменшити кількість негативних результатів оперативного втручання. Виконання ендопротезування у хворих із черезвертлюжними переломами стегнової кістки повинно виконуватись за чіткими абсолютними показаннями, до яких належить супутня IV стадія коксартрозу у травмованих осіб. Інтрамедулярний блокований остеосинтез може бути рекомендований як основний метод оперативного лікування хворих із черезвертлюжними переломами стегнової кістки.

The quality of life of the elderly is negatively affected by pertrochanteric femoral fractures: a comparative study

Objectives: Limited data is available regarding the quality of life of hip fracture patients following surgery. This study examined the mid-term quality of life of hip fracture patients and compared these patients with healthy elderly patients devoid of hip fractures. Methods: A total of 103 patients (aged > 65 years) with pertrochanteric femoral fractures were treated with proximal femoral nail surgery in our clinic between January 2012 and December 2016. A healthy control group (n = 100) was demographically matched to the patients. The final follow-up visit included their Harris Hip Score and completion of a Short Form-36. The eight sub-parameters from the Short Form-36 form were also assessed. Results: The mean follow-up time for the patients was 36.4 ± 12.3 (range, 24-72) months. The mean Charlson comorbidity score for the patient group was 4.4 ± 2.1 and the mean Harris Hip Score was 77.24 ± 10.2. The comparison of the Short Form-36 sub-parameters revealed that the quality of life of the patient group was found to be lower than that of the control group for the following parameters physical function, physical roles, vitality, and social function (p < 0.05). Conclusions: Even if the fracture had healed of patients with hip fractures, QoL related to physical and social functions was not improved accordingly, new healthcare policies should be developed for these patients based on the premise that their physical capacity may not be fully regained. Moreover, the importance of hip fracture prevention was demonstrated by this study.

The Effect of Hospital and Surgeon Volumes on Complication Rates After Fixation of Peritrochanteric Hip Fractures.

This study evaluates the relationship between hospital and surgeon volumes of peritrochanteric hip fracture fixation and complication rates. Adults (60 years of age or older) who underwent surgical fixation for closed peritrochanteric fractures from 2009 to 2015 were identified using International Classification of Diseases 9 and 10 Clinical Modification and Procedural codes in the New York Statewide Planning and Research Cooperative System database. Readmission, reoperations, in-hospital mortality, and other adverse events were compared across surgeon and facility volumes. Statistical significance was set at P < 0.05. A total of 29,656 patients were included in the study. Low-volume (LV) facilities had higher rates of readmission [hazard ratio (HR) 1.07, 95% confidence interval (CI), 1.05-1.17], pneumonia (HR 1.36, 95% CI, 1.22-1.51), wound complications (HR 1.24, 95% CI, 1.03-1.49), and mortality (HR 1.15, 95% CI, 1.04-1.27) but lower rates of acute renal failure (HR 0.90, 95% CI, 0.83-0.98), deep vein thrombosis (HR 0.66, 95% CI, 0.55-0.78), and acute respiratory failure (HR 0.77, 95% CI, 0.62-0.95) than high-volume (HV) facilities. Patients treated by LV surgeons had lower rates of readmission (HR 0.92, 95% CI, 0.87-0.97) and deep vein thrombosis (HR 0.78, 95% CI, 0.66-0.94) but higher rates of acute renal failure (HR 1.13, 95% CI, 1.04-1.22) than those treated by HV surgeons. There are increased rates of mortality, readmission, and certain complications when peritrochanteric femur fractures are surgically managed at LV hospitals compared with those managed at HV hospitals. Thus, the benefit of a high-volume surgical facility is apparent in mortality and readmissions but not all complications. There was no significant decrease in complications if fixation was performed by HV surgeons relative to LV surgeons. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Comparison of the short-term result of PFNA and UNICORN nail for pertrochanteric femoral fracture with posterolateral fragment

Comparison of the short-term result of PFNA and UNICORN nail for pertrochanteric femoral fracture with posterolateral fragment

Evaluation of the Risk Factors for Mechanical Failure of Intertrochanteric Femoral Fracture Treated with Intramedullary Nailing

Aim: The aim of this study was to evaluate the radiological and clinical risk factors predisposing the proximal lag screw to mechanical failure in patients with pertrochanteric femur fractures treated with intramedullary nailing. Material and Methods: All intertrochanteric fracture cases were evaluated retrospectively and 298 patients (24 had mechanical failure) were included in this study. The patients were compared in terms of demographic data, Singh index, reduction quality according to the Baumgaertner scale, proximal lag screw position according to Cleveland-Bosworth quadrants and the Parker ratio, and the calcar femorale restoration and tip-apex distance. Results: There was no statistically significant difference in terms of gender (p=0.745), age (p=0.848), American Society of Anesthesiology scores (p=0.725), body mass index (p=0.648) and Singh index (p=0.119) between the two groups. There were statistically significant differences between the two groups in terms of the following variables; number of patients with unstable fracture (p&amp;lt;0.001), poor reduction quality (p&amp;lt;0.001), calcar femorale discontinuity (p&amp;lt;0.001), center-center/center-inferior lag screw position (p&amp;lt;0.001), and Parker ratio on the lateral view (p=0.002). The center-center/center-inferior lag screw position, good reduction quality and calcar femorale restoration were found to be parameters predicting superior outcomes according to logistic regression analyses. Conclusion: From the results of this study, it was concluded that although the preoperative reduction of the fracture and tip-apex distance are mandatory to prevent failure of the proximal lag screw, posteromedial discontinuity and lag screw position have a vital role in the treatment of interochanteric femur fracture fixed with intramedullary nailing.

Pertrochanteric Fracture Neck of the Femur Presenting as Avascular Necrosis with Gait Abnormality - A Case Report

The pertrochanteric femoral fracture is a highly common kind of femoral fracture. It is generally the consequence of a fall. A high-energy mechanism, such as a motor vehicle accident, is more likely to cause Pertrochanteric fractures in 16-30 year age group people. A 45year old man had a history of a bike crash that resulted in a pertrochanteric fracture of the right hip 2 years back, for which he was operated. The patient right now came to the AVBRH with the complaint of right hip discomfort and edema after surgery and was referred for physiotherapy. Avascular necrosis of the femoral head is a pathological condition that occurs when the blood supply to the bone is cut off, and it is a common consequence of fractures, dislocations, and other injuries and especially occurs in adult post road traffic accidents.

Mobility improvement in the first 6 postoperative weeks in orthogeriatric fracture patients

BackgroundPhysical activity is a relevant outcome parameter in orthopedic surgery, that can be objectively assessed. Until now, there is little information regarding objective gait parameters in the orthogeriatric population. This study focuses on the first 6 weeks of postoperative rehabilitation, and delivers objective data about gait speed and step length in typical orthogeriatric fracture patterns.MethodsThirty-one orthogeriatric fracture patients [pertrochanteric femur fractures (PFF), femoral neck (FN), and proximal humerus fractures (PHF)] were consecutively enrolled in a maximum care hospital in a prospective study design. All patients wore an accelerometer placed at the waist during the postoperative stay (24 h/d) and at 6-week follow-up, to measure real gait speed and step length. In addition, self-assessment of mobility (Parker mobility score) and activities of daily living (Barthel index) were collected at baseline, during the inpatient stay, and at 6-week follow-up.ResultsDuring postoperative hospitalization, significantly higher gait speed (m/s) was observed in the PHF group (0.52 ± 0.27) compared with the FN group (0.36 ± 0.28) and PFF group (0.19 ± 0.28) (p < 0.05). Six weeks postoperatively, gait speed improved significantly in all groups (PHF 0.90 ± 0.41; FN 0.72 ± 0.13; PFF 0.60 ± 0.23). Similarly, step length (m) differed between groups postoperatively [FN 0.16 ± 0.13; PFF 0.12 ± 0.15; PHF 0.31 ± 0.05 (p < 0.005)] and improved over time significantly (FN 0.47 ± 0.01; 0.39 ± 0.19; 0.50 ± 0.18). Self-assessment scores indicate that the majority of the patients had minor restrictions in mobility before the fracture. These values decreased immediately postoperatively and improved in the first 6 weeks, but did not reach the initial level.ConclusionsGait speed, step length, and self-assessment in terms of mobility and activities of daily living improve significantly in the first 6 postoperative weeks in orthogeriatric fracture patients. As very low postoperative mobility during hospitalization was observed, this collective shows great potential in postoperative rehabilitation regardless of their fracture pattern. For this reason, specific aftercare concepts similar to the “fast track” concepts in primary arthroplasty are crucial for orthogeriatric patients in clinical practice.Level of evidenceProspective cohort study, 2.

Impact of Rehabilitation in a Complex Case of Intertrochanteric Fracture in Geriatric – A Case Report

Peri-trochanteric femoral fractures are among the most prevalent fractures in the aged population. Injury and trauma are the leading causes of intertrochanteric fractures. The intertrochanteric aspect of the femur is made up of dense trabecular bone and lies between the greater and lesser trochanters. The female to male ratio for sustaining these fractures is seen between 2:1 and 8:1.Patients with femoral neck fractures are usually in geriatric age group. The dynamic screw approach is used to treat intertrochanteric fractures surgically. An 88year old male patient with left intertrochanteric fracture, diagnosed on x-ray after a fall in toilet was operated and was referred immediately for physical therapy, which included strengthening exercises, balance retrainig, and breathing exercises. According to the case study, a physiotherapy treatment technique resulted in considerable and gradual improvement of functional goals.

Outcomes and Cost Comparison Between Generic and Conventional Cephalomedullary Nails in the Treatment of Peritrochanteric Femur Fractures.

Although generic orthopaedic implants have been available for several years, there has been slow adoption of this cost-saving option. We hypothesize equivalent outcomes between generic and conventional cephalomedullary nails (CMN) in the treatment of peritrochanteric femur fractures. We evaluated 419 patients undergoing CMN for peritrochanteric femur fracture with a minimum 6-month follow-up. Demographic data, radiographic assessment, and clinical outcomes were compared. Ninety patients were treated with generic implants and 329 patients with conventional implants. The overall complication rate was 7.0%, with a revision surgery rate of 5.4%. No significant differences were seen in demographic variables or surgical factors. Although there was an increased incidence of postoperative infections with conventional nails (P = 0.045), no significant differences were seen in other complications. At our institution, generic nails cost approximately 38% less than their conventional counterparts. There seems to be no increased rate of implant-associated complications with the use of generic CMNs, although allowing for notable cost savings.

English

BACKGROUND Pertrochanteric fractures in the elderly are highly unstable and osteoporotic. Comminution of fragments and distraction fragments make union difficult owing to forces acting on the proximal hip joint. The internal fixation in these cases leads to prolonged bed rest and immobilization to prevent implant failure. The purpose of this study was to analyse the role of bipolar hemiarthroplasty in cases of unstable pertrochanteric femur fractures as bypassing forces transmission through the proximal femur. METHODS 30 patients with pertrochanteric fractures were randomized and operated on as bipolar hemiarthroplasty using the indigenous bipolar prosthesis between July 2017 and July 2021. The inclusion criteria were patients more than 65 years of age, Type 4 intertrochanteric fracture (As per Evans classification) AO/ OTA type 31A2.3, 31A3.2, 31A3.3. Patients with polytrauma, compound injuries, pathological fractures and medically unfit patients were excluded from the study. RESULTS The mean age was 67 ± 5 years. The most common mechanism of injury was domestic fall comprising 80 %. The average duration of surgery from the time of injury was 3.5 ± 1.5 days. The average surgical duration was 85.5 mins. The average duration of stay in the hospital was 8.5 ± 1.5 days. Final results were calculated using the Harris Hip score with 33.3 % cases as excellent, 56.6 % cases as good and 10 % cases had fair results respectively. Follow-up was done at 6 weeks, 3, 6, 12 and 24 months. CONCLUSIONS Bipolar hemiarthroplasty in pertrochanteric femur fractures has the advantage of stable adequate fixation with early return to activities of daily living, thus preventing serious life-threatening complications. KEY WORDS Intertrochanteric Fractures, Hemiarthroplasty, Femur, Harris Hip Score