Stable Intertrochanteric Fractures Research Articles

A Novel Internal Fixation Design for the Treatment of AO/OTA-31A3.3 Intertrochanteric Fractures: Finite Element Analysis.

AO/OTA 31-A3.3 intertrochanteric fracture is the most unstable type of intertrochanteric fracture, with a high rate of postoperative complications and implant failure. We have designed a new intramedullary fixation, proximal femoral totally bionic nail (PFTBN), for the treatment of A3.3 intertrochanteric fracture. To test its biomechanical performance, we adopted the method of finite element analysis and compared PFTBN with proximal femoral nail antirotation (PFNA) and proximal femoral bionic nail (PFBN, another internal fixation we previously designed for stable intertrochanteric fractures). Mimics, 3-matic, ANSYS, and other software were used to construct a highly precise and realistic 3D digital model of the human femur. An AO/OTA 31-A3.3 intertrochanteric fracture of the femur was constructed according to the 2018 classification of AO/OTA, and then assembled with PFNA, PFBN and PFTBN models, respectively. The stress distribution and displacement distribution of the three groups of constructs were tested under three times the body weight load and one-foot standing configuration. In terms of maximum stress and maximum displacement, the PFTBN group outperforms the PFBN group, and the PFBN group, in turn, surpasses the PFNA group. The maximum stress of PFTBN group was 408.5 Mpa, that of PFBN group was 525.4 MPa, and that of PFNA group was 764.3 Mpa. Comparatively, the maximum stress in the PFTBN group was reduced by 46.6% when contrasted with the PFNA group. Moreover, the stress dispersion within the PFTBN group was more evenly distributed than PFNA group. Regarding maximum displacement, the PFTBN group displayed the least displacement at 5.15 mm, followed by the PFBN group at 7.32 mm, and the PFNA group at 7.73 mm. Notably, the maximum displacement of the PFTBN group was 33.4% less than that observed in the PFNA group. Additionally, the relative displacement between the fragment and implant at the tip of pressure screw or helical blade was 0.22 mm in the PFTBN group, 0.34 mm in the PFBN group, and substantially higher 0.51 mm in the PFNA group. The "lever-reconstruction-balance" theory provides a new perspective for us to understand the mechanical conduction of the proximal femur. Compared with PFNA, in treating A3.3 intertrochanteric fractures PFTBN can better reconstruct the function of lateral wall, restore physiological mechanical conduction, increase postoperative stability, and finally reduce the risk of postoperative cut-out and implant failure. It might be a better alternative for the treatment of A3.3 intertrochanteric fracture.

Lateral wall thickness is not associated with revision risk of medially stable intertrochanteric fractures fixed with a sliding hip screw.

This study aimed to determine whether lateral femoral wall thickness (LWT) < 20.5 mm was associated with increased revision risk of intertrochanteric fracture (ITF) of the hip following sliding hip screw (SHS) fixation when the medial calcar was intact. Additionally, the study assessed the association between LWT and patient mortality. This retrospective study included ITF patients aged 50 years and over treated with SHS fixation between 2019 and 2021 at a major trauma centre. Demographic information, fracture type, delirium status, American Society of Anesthesiologists grade, and length of stay were collected. LWT and tip apex distance were measured. Revision surgery and mortality were recorded at a mean follow-up of 19.5 months (1.6 to 48). Cox regression was performed to evaluate independent risk factors associated with revision surgery and mortality. The cohort consisted of 890 patients with a mean age of 82 years (SD 10.2). Mean LWT was 27.0 mm (SD 8.6), and there were 213 patients (23.9%) with LWT < 20.5 mm. Overall, 20 patients (2.2%) underwent a revision surgery following SHS fixation. Adjusting for covariates, LWT < 20.5 mm was not independently associated with an increased revision or mortality risk. However, factors that were significantly more prevalent in LWT < 20.5 mm group, which included residence in care home (hazard ratio (HR) 1.84; p < 0.001) or hospital (HR 1.65; p = 0.005), and delirium (HR 1.32; p = 0.026), were independently associated with an increased mortality risk. The only independent factor associated with increased risk of revision was older age (HR 1.07; p = 0.030). LWT was not associated with risk of revision surgery in patients with an ITF fixed with a SHS when the calcar was intact, after adjusting for the independent effect of age. Although LWT < 20.5 mm was not an independent risk factor for mortality, patients with LWT < 20.5 mm were more likely to be from care home or hospital and have delirium on admission, which were associated with a higher mortality rate.

Intramedullary Nailing versus Dynamic Screw and Plate for Treatment of Trochanteric Fractures of the Femur

Background Trochanteric and intertrochanteric femur fractures are extracapsular fractures of the proximal femur at the level of the greater and lesser trochanter. Trochanteric fractures in adults mostly affect elderly subjects. Frequency is increasing with population aging despite the development of treatments for osteoporosis. The two most widely used types of internal fixation are intramedullary nailing and screw-plate fixation, often performed by trainee surgeons due to their frequency and reputed simplicity. Aim of the Work The aim of the study is to conduct a systematic review of literature and metaanalysis comparing between intramedullary nailing and dynamic plate and screw in treatment of trochanteric fractures of the femur according to: Length of mean operation time, time of radiation exposure (fluoroscopy time), Intraoperative blood loss, reoperation rate, fracture non-union and postoperative wound infection wither superficial or deep infection. Patients and Methods We followed the PRISMA statement guidelines during this study preparation and performed all steps according to the Cochrane handbook of systematic reviews of intervention. We searched PubMed, Scopus, Cochrane, and Web of Science, Embase, and Science Direct in June 2021 and updated the search in July 2021 using relevant Keywords. The eligibility inclusion criteria for studies inclusion were the following: (1) Adult patients above 18 years old (2) Double arm designs (3) Studies designs are limited to randomized control trial (RCT) (4) English studies (5) Any outcome is acceptable. The risk of bias was evaluated by the Cochrane handbook of systematic reviews of interventions 5.1.0. Regarding the data extraction, we obtained data from text, tables, figures (using graph grabber version 2.0), and supplementary data. We conducted this metaanalysis by using Review Manager software (RevMan version 5.4). Results Compared to the control group (Dynamic hip screw and plate technique), Intramedullary nailing (IMN) showed a significant improvement in length of operation time (MD = −9.27; 95% CI: [-18.07, -0.47]; P = 0.04) and perioperative blood loss(MD = -120; 95% CI: [-164.05, -77.89]; P &amp;lt; 0.00001) than dynamic hip screw with plate fixation technique. However, in the term of intraoperative radiation exposure time (Fluoroscopy time), dynamic hip screw (DHS) with plate fixation showed a significant lesser fluoroscopy time than IMN(MD = 0.61; 95% CI: [0.23, 0.99]; P = 0.002). Regarding the postoperative patient satisfaction (assessed by visual analogue scale), postoperative Fracture non-union, perioperative wound infection, femur shaft fracture, and hip prosthetic instability, they showed no significant difference between IMN and dynamic hip screw with plate fixation. Reoperation rate also showed no significant difference between IMN and DHS with plate fixation. Conclusion DHS with plate is not the preferred implant for stable intertrochanteric femur fractures. IMN showed a better result than DHS. We believe that the IMN is biologically superior to DHS for fixation of unstable inter-trochanteric fractures as it provides stable intramedullary fixation resistant to varus collapse and fixation failure, with relatively less operation time, and blood loss.

Comparison of Dynamic Hip Screw and Proximal Femoral Nailing Techniques in Stable Intertrochanteric Fractures

Comparison of Dynamic Hip Screw and Proximal Femoral Nailing Techniques in Stable Intertrochanteric Fractures

Site-Specific Differences in Bone Mineral Density of Proximal Femur Correlate with the Type of Hip Fracture.

The aim of this study was to investigate whether site-specific differences in bone mineral density (BMD) of proximal femur correlate with the type of hip fracture using quantitative computed tomography. Femoral neck (FN) fractures were classified as nondisplaced or displaced subtypes. Intertrochanteric (IT) fractures were classified as A1, A2, or A3. The severe hip fractures were identified as displaced FN fractures or unstable IT fractures (A2 and A3). In total, 404 FN fractures (89 nondisplaced and 317 displaced) and 189 IT fractures (76 A1, 90 A2, and 23 A3) were enrolled. Areal BMD (aBMD) and volumetric BMD (vBMD) were measured in the regions of total hip (TH), trochanter (TR), FN, and IT of the contralateral unfractured femur. IT fractures exhibited lower BMD than FN fractures (all p ≤ 0.01). However, unstable IT fractures had higher BMD compared with stable ones (p < 0.01). After adjusting for covariates, higher BMD in TH and IT were associated with IT A2 (A1 vs. A2: odds ratios (ORs) from 1.47 to 1.69, all p < 0.01). Low bone measurements were risk factors for stable IT fractures (IT A1 vs. FN fracture subtypes: ORs from 0.40 to 0.65, all p < 0.01). There are substantial site-specific differences in BMD between IT fractures A1 and displaced FN fractures. Higher bone density was associated with unstable IT fracture when compared with stable ones. The understanding of biomechanics of various fracture types could help to improve the clinical management of these patients.

Comparison of functional outcomes of pertrochanteric fractures of the femur managed with dynamic hip screw with a locking side plate versus proximal femoral nail

Background: In current practice, proximal femoral nail (PFN) and dynamic hip screw (DHS) with locking side plate are the implant of choice in stable trochanteric fractures. Most of the deficiencies of the standard DHS have been addressed by the introduction of the Locking side plate. There are plenty of studies comparing standard DHS and PFN. But studies comparing locking DHS and PFN are scarce in current literature. This study aimed to compare the outcomes of both implants in stable pertrochanteric fractures. Methods: The objective of this study was to assess and compare the clinical outcomes of using locking DHS and PFN for fixation in 40 patients who were admitted to SUT Academy of Medical Sciences between October 2017 and April 2019. The modified Harris hip score was used to evaluate the patients' progress, and regular follow-up was conducted to compare their outcomes. Results: Among the DHS group, the mean Harris hip score was 83.05, with excellent results observed in 2 patients (10%), good results in 12 patients (60%), fair results in 5 patients (25%), and poor results in 1 patient (5%). In comparison, the PFN group had a mean Harris hip score of 85.50, with excellent results seen in 6 patients (30%), good results in 10 patients (50%), fair results in 3 patients (5%), and poor results in 1 patient (5%). Conclusions: The DHS group had more patients with good and fair outcomes, while the PFN group had more patients with excellent and good outcomes. Based on these findings, we can conclude that both the PFN and DHS with locking side plate are similarly effective in treating stable intertrochanteric fractures.

Clinical and Radiological Results of Minimally Invasive Two-Hole Dynamic Hip Screw Fixation of Stable Intertrochanteric Fractures: A Prospective Study of 50 Patients

Background Intertrochanteric fractures are fractures of elderly population and are known for morbidity and mortality. Early stabilization with minimal surgical trauma is important for early mobilization to prevent recumbence-related complications. Methods This prospective study was conducted on 50 stable intertrochanteric fractures that were managed by fixation with a small two-hole dynamic hip screw –(DHS) side plate using a minimally invasive technique. The surgical time, intraoperative blood loss, length of the skin incision, duration of hospital stay, time to full weight bearing and fracture union, and complications were recorded. Results The mean age of the patients was 60.2 years with 64% belonging to male sex. The mean operative time, average blood loss, and mean incision length were 35.6 minutes, 68.4 mL, and 3.7 cm, respectively. Time to bone healing ranged from 10 to 16 weeks (mean 13 weeks). Two patients had hip screw backout but that did not interfere with failure of fixation. Conclusion Stabilization of stable intertrochanteric fractures with two-hole DHS using minimally invasive approach is a viable option with negligible complication rate related to failure of small DHS side plate.

Comparison of Treatment Results of Stable Intertrochanteric Femur Fractures with Dynamic Hip Screw and Proximal Femoral Nail

Comparison of Treatment Results of Stable Intertrochanteric Femur Fractures with Dynamic Hip Screw and Proximal Femoral Nail

EFFECT OF BISPHOSPHONATES ON FRACTURE HEALING AMONG THE ELDERLY PEOPLE WITH INTERTROCHANTERIC FRACTURE

Background: Hip fractures in the elderly are commonly associated with osteoporosis, and the surgical outcome is therefore inuenced by its concurrent management. Understanding the role of the osteoporosis drug and its healing mechanism with the fracture is crucial for managing the fracture and osteoporosis properly. The purpose of our study is to determine whether bisphosphonate administration in stable intertrochanteric (IT) fractures helps in early fracture healing. Aim: The aim of the study is to assess the effect of bisphosphonates on intertrochanteric fracture among elderly people aged &gt;50 years in preoperatively conrmed osteoporotic patients. Methodology: This is a non-randomized study done in the Department of Orthopaedics at Assam Medical College, Dibrugarh for a period of 1 year, from May 2021 to April 2022. The total sample size attained was 50, consisting of 25 patients in each group. Demographic details like age, sex, mean bone mineral density of hip and spine, and mean body mass index were obtained. The collected data was entered into MS Excel and statistics were done with SPSS 16. Results: Among the study participants, the majority were female: 15(60%) in the bisphosphonate group and 19(76%) in the control group; the rest were males. The mean age of the study participants was 56±2.1 years. In both groups, xation of the fracture was done by intramedullary nailing. The mean time difference in fracture healing between the two groups was not found to be signicant. Conclusion:The mean healing time for the fracture healing was not found to be statistically signicant when compared with the placebo group

Comparison of Dynamic Hip Screw and Proximal Femoral Nailing Techniques in Stable Intertrochanteric Fractures.

Introduction Dynamic Hip Screw (DHS) and Proximal Femoral Nail (PFN) are two well-accepted modes of surgical treatments for intertrochanteric (IT) hip fractures. While studies have extensively explored the efficacy of one over the other in unstable fractures, the comparison is sparsely available for stable fractures. The main aim of this study is to compare DHS or PFN corrective surgeries in cases of stable IT fractures operated at the Hamad General Hospital, Doha, Qatar, between 2016 and 2018. Methods We conducted a retrospective data review of all stable IT fractures operated at the Hamad General Hospital, Doha, Qatar, between 2016 and 2018. Data were extracted from electronic medical CERNER records, including demographics, clinical notes, operative reports, radiographs, and imaging reports. Data review was followed by prospective data collection via phone about the current post-operative functional status of all cases. Data analysis was done on SPSS v.23. Study was approved by Medical Research Center (MRC) and Institutional Review Board (IRB) at Hamad Medical Corporation (HMC). Study Protocol ID: MRC-01-19-108 Results Out of 62 stable IT fractures operated at our center during the study period, 42 underwent DHS correction, while 20 had PFN. The mean age of the studied cohort was 66.56 years (± 15.95). Males were twice more than females. The mean duration of surgery was 83.73 minutes for DHS and 120.25 minutes for PFN. This difference was statistically significant (p < 0.001). Differences in intraoperative blood loss, duration between fracture and surgery, and length of hospital stay were all statistically insignificant. Patients who underwent PFN showed a higher frequency of return to ambulation (assisted and unassisted), while the number of patients with DHS was less for the functional outcome. Similarly, more post-PFN radiographs displayed union than post-DHS radiographs (55% and 38%, respectively). This difference was statistically insignificant. Conclusion Our study showed promising results for stable IT fractures treated with PFN. However, more data and prospective observational studies are required to establish more statistically significant results.

Prevalence of Intertrochanteric Fractures of the Femur and Comparison of Radiological Outcomes when Managed with Proximal Femoral Nail vs the Dynamic Hip Screw with Locking Side Plate in the Indian Population

Background: Currently, the preferred implants for stable trochanteric fractures are the Proximal Femoral Nail and the Dynamic Hip Screw with Locking Side Plate. The Locking side plate has resolved many of the limitations associated with the standard DHS. Although numerous studies have compared the standard DHS and PFN, there is a scarcity of literature on the prevalence of IT fractures in the Indian population and comparison of Locking DHS and PFN in term of radiological union times. The purpose of this study is to assess and compare the effectiveness of both implants in stable intertrochanteric fractures. Methods: The objective of this study was to assess the prevalence of intertrochanteric fractures in the Indian population and compare the radiological outcomes of using Locking DHS and PFN for fixation in 40 patients who were admitted to SUT Academy of Medical Sciences between October 2019 and April 2021. Serial x-rays were used to evaluate the patients' progress, and regular follow-up was conducted to compare their outcomes. Results: All 40 fractures united. The time to union ranged from 16 to 30 weeks, with an average of 22.0 weeks in the DHS group and 19.40 weeks in the PFN group. %). 3 complications were noted. 2 in the DHS group, namely malunion and superficial infection and 1 delayed union in the PFN group. Conclusions: The DHS group relatively took more time to achieve union while the PFN group achieved union faster. However our finding was not statistically significant. Based on these findings, we can conclude that both the Proximal Femoral Nail and Dynamic Hip Screw with Locking Side Plate are similarly effective in treating stable intertrochanteric fractures.

Comparative study of dynamic hip screw and gamma nail in the treatment of stable intertrochanteric fracture

Comparative study of dynamic hip screw and gamma nail in the treatment of stable intertrochanteric fracture

A comparative analysis of distal locked and unlocked long proximal femoral nail antirotation (PFNA-II) in the fixation of stable intertrochanteric fractures

PurposeLong proximal femoral nail anti-rotation (PFNA-II) is a preferred implant in recent years for fixation of pertrochanteric fractures, especially in osteoporotic patients. The purpose of this study is to prospectively investigate the effect of distal locking in long PFNA-II fixation of stable intertrochanteric fractures. MethodsA total of 58 patients with isolated stable intertrochanteric fractures and treated in our hospital during the study period of 2017–2019 by distal locked or unlocked long PFNA-II fixation were included in this study. Patients who had multiple injuries or open fractures were excluded. There were 40 female and 18 male patients, with 33 affecting the left side and 25 the right side. Of them, 31 belonged to the distal locked group (group A) and 27 to the unlocked group (group B). Surgical procedures and implants used in both groups were similar except for the distal locking of the nails. General data (age, gender, fracture side, etc.) showed no significant difference between two groups (all p > 0.05). The intraoperative parameters like operative time, radiation exposure and follow-up parameters like functional and radiological outcomes were recorded and compared. Statistical tests like the independent samples t-test Fischer's exact and Chi-square test were used to analyze association. ResultsThe distribution of the fractures according to AO/OTA classification and 31A1.2 type of intertrochanteric fractures were most common in our study. All the included fractures united and the average functional outcome in both groups were good and comparable at the end of one year. The operative time (mL, 107.1 ± 12.6 vs. 77.0 ± 12.0, p < 0.001) and radiation exposure (s, 78.6 ± 11.0 vs. 40.3 ± 9.3, p < 0.001) were significantly less among the patients in group B. Fracture consolidation, three months after the operative procedures, was seen in a significantly greater proportion of patients in group B (92.6% vs. 67.7%, p = 0.025). Hardware irritation because of distal locking bolt was exclusively seen in group A, however this was not statistically significant (p = 0.241). ConclusionWe conclude that, in fixation of stable intertrochanteric fractures by long PFNA-II nail, distal locking not only increases the operative time and radiation exposure but also delays the fracture consolidation and increases the chances of hardware irritation, and hence is not required.

Association between fracture type and the risk of bleeding in intertrochanteric femur fractures

IntroductionThe current study aimed to determine the association between fracture type and pre-operative hemoglobin level decrease in intertrochanteric fractures. Further, the erythrocyte unit required in replacement therapy until discharge according to fracture type was evaluated. Patients and methodsWe retrospectively analyzed 194 patients diagnosed with intertrochanteric femur fracture who received proximal femoral nail implantation. Among them, 122 met the inclusion criteria, and they were divided into group 1 (stable fracture) and group 2 (unstable fracture) according to the Arbeitsgemeinschaft für Osteosynthesefragen classification. Data on age, sex, fracture side, surgical waiting time, pre- and post-operative hemoglobin levels, and total erythrocyte units required were assessed. Then, statistical analysis was performed. ResultsThe stable and unstable groups were similar in terms of age, sex, fracture side, and surgical waiting time (p > 0.05). The average erythrocyte units required in replacement therapy were 1.62 (total: 96) in group 2 and 0.91 (total: 57) in group 1. Moreover, group 2 was more likely to require eythrocyte replacement than group 1 (p = 0.001). The average hemoglobin level decreases were 1.70 g/dL in group 1 and 1.95 g/dL in group 2. The pre-operative hemoglobin level decrease had a similar distribution in both groups (p = 0.239). ConclusionsThe pre-operative blood loss volume was similar between unstable and stable intertrochanteric fractures. Moreover, at unstable group, the need for erythrocyte replacement therapy was high in the whole period until discharge.

A Comparative Study of Proximal Femoral Nail and Dynamic Hip Screw in the Treatment of Intertrochanteric Fractures of Femur

Aim: The aim of this analysis is the comparison of the functional and radiological results of stable intertrochanteric femoral fractures managed with the dynamic hip screw (DHS) and proximal femoral nail (PFN). Study Design: A Randomized, controlled study. Place and Duration: In the Orthopaedics department of Capital Hospital (CDA), Islamabad for two years duration from January 2020 to December 2021. Methods: All patients with stable intertrochanteric fractures who met the criteria of selection were randomly allocated to group A (DHS) and B (PFN). There were 80 total patients alienated into group A and B. Patients were x-rayed for union evaluation and functional evaluation was done with Harris Hip Score (HHS) was performed, rated as poor (score &lt;70), good (80 to 90), fair (70 to 80) and excellent (90 to 100). The comparison of the results in the two groups was made at the third, sixth and twelfth months, and the P value was calculated using the chi-square test and the independent sample t-test. P &lt;0.05 was measured significant. Results: There were 80 total patients. They were divided equally and randomly into groups A and B of 40 patients each. The PFN group had a shorter operative time, smaller incision and minimum blood loss intraoperatively than the DHS group (p &lt;0.05). The group A mean age was 60.10±4.48 years, and of group B was 59.20±5.71 years. There were 25 men (62.5%) in A group and 23 (57.5%) in B group. Women were 15 (37.5%) in A group and 17 (42.5%) in B group. Mean time of radiological union was 14.2±4 weeks in group A and 12.8±6 weeks in group B (P&gt; 0.05). During the 3-month follow-up period, the Harris Hip Score (HHS) was 54.20 ± 4.20 (poor) and 35.03 ± 4.11 (poor) in Groups A and B, correspondingly (P &lt;0.05). HHS in group A was 90.27 ± 3.80 (good) and in B group, it was 82.27 ± 3.65 (good) (P &lt;0.05) at 6 months and HHS 94.61 ± 2.08 (excellent) and 93.27 ± 2.18 (excellent) 1 year in the group A and B (P&gt; 0.05). Conclusions: Both DHS and PFN gave similar results in terms of radiological union in stable intertrochanteric fractures. The short-term functional score was poor and good for both DHS and PFN at 3 and 6 months, although DHS scored statistically better than PFN. After one year of follow-up, both DHS and PFN had similar excellent functional scores, but had no statistically significant difference in score. Keywords: Harris hip Score, Proximal femoral nail, Dynamic hip screw and Intertrochanteric fracture.

Early mobilisation after pain relief for conservative management for intertrochanteric fractures: a pandemic enforced innovation and its results.

The COVID pandemic challenged the orthopaedic mind on several fronts. 1 of them was in the management of intertrochanteric fractures. A subset of these patients refused surgical intervention during the pandemic for related reasons. Faced with the goal of early verticalisation, the senior author used pain relief as a method to facilitate early mobilisation in 23 patients with peritrochanteric fractures. 23 patients with stable intertrochanteric fractures received a β 6 distal sodium channel block (DSCB) and were allowed to walk from day 1 without surgery, traction or spica. The goal was to prevent complications of recumbency in this subset of patients. The basic idea of immediate mobilisation from the time of fracture was based on Sarmiento's sausage theory. All the fractures united. There were no major complications. No shortening was seen in more than 50% cases and the shortening did not exceed 2 cm in any case. All patients were satisfied with the outcome and had good to excellent Harris Hip Scores. The block and walk method is a surprisingly satisfactory method of treatment for stable intertrochanteric fractures. It circumvents the risks of surgery whilst allowing immediate mobilisation preventing complications associated with the other modalities of fracture management.

Keyhole Sliding Hip Screw Fixation for Stable Intertrochanteric Hip Fractures: A Novel Technique.

Intertrochanteric hip fractures are common orthopaedic injuries and the incidence is growing with increasing life expectancy. Several randomized controlled studies have shown the advantages of intramedullary devices over hip screw fixation in unstable intertrochanteric fractures. However, the proven advantage of the intramedullary device in stable intertrochanteric fractures, OTA (Orthopaedic Trauma Association) classification 31-A1 and some 31-A2 fractures are in less blood loss compared with standard hip screw fixation. In the current technical note, we describe a novel minimally invasive technique of hip screw fixation that use a keyhole size incision to fix stable intertrochanteric fractures using sliding hip screw. The less invasive nature and potentially reduced blood loss makes this technique an attractive option for stabilizing stable intertrochanteric hip fractures.

Dynamic Hip Screw Plate Length in Stable Intertrochanteric Fracture Neck of Femur: A Systematic Review.

There has always been a debate between the use of four and two-hole plate for the fixation of stable intertrochanteric fractures. The choice is usually influenced by the general practice of the particular institution and the surgeon’s preference. While the dynamic hip screw (DHS) is the implant of choice for stable intertrochanteric fractures of the femur, the length of the side plate to be chosen for optimal results has no clear consensus and previous studies regarding the same have been inconclusive. In our systematic review, we aimed to review the evidence available on the selection of the optimal length of the side plate and bridge the glaring gap that exists in the literature.Our systematic review included a thorough search of databases like PubMed, Embase, MEDLINE, CINAHL, and the Cochrane Library, using the Preferred Reporting for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We included both clinical and biomechanical studies satisfying our search criteria on two- and four-hole DHS implants.A total of 4556 results were obtained from the above databases, sorting out led to final 15 studies on the topic. It was found that the two-hole DHS implant was inferior in terms of lab-controlled biomechanical properties, while only having a slight advantage in terms of real-life postoperative blood transfusions and operative time. At the same time, the two-hole plate was similar to the four-hole plate in other clinical parameters.In this study, the two-hole plate while appearing promising in a few areas did fall short in other aspects like biomechanical studies, and the use should be reserved for cases where a four-hole plate cannot be used until further randomised control trials are carried out.

Comparison of Extramedullary and Intramedullary Implants for Stable Intertrochanteric Fractures: Have We Swung the Pendulum Too Far the Other Way?

Although intramedullary implants are commonly used to treat stable intertrochanteric (IT) fractures, there is a lack of evidence to demonstrate their superiority over extramedullary implants in treating these fractures. The purpose of this study was to compare short-term outcomes (<30 days) between intramedullary and extramedullary implants in patients with closed nondisplaced stable IT fractures. Patients with closed nondisplaced stable IT fractures were identified from the American College of Surgeons National Surgical Quality Improvement Program database between 2016 and 2019. Patients who either underwent extramedullary implant or intramedullary implant fixation were selected for this analysis. Postoperative outcomes included transfusion, surgical complications (stroke, myocardial infarction, venous thromboembolism, pneumonia, renal failure/insufficiency, surgical site infection, urinary tract infections, and sepsis), weight-bearing on postoperative day 1, discharge destination, place of residence at 30 days after the operation, days from operation to discharge, readmission related to the index procedure, any readmission, revision surgery, and mortality. Of the 3,244 cases identified for the study, 2,521 (77.7%) underwent intramedullary nailing (IMN). Based on adjusted multivariable analysis, surgical complications between the two intervention groups were not statistically significantly (odds ratio [OR] 1.142; confidence interval [CI], 0.838 to 1.558; P = 0.4). However, patients who underwent IMN were associated with higher rates of blood transfusions (OR, 1.35, CI, 1.042 to 1.748, P = 0.023), more likely discharged to a place other than home (OR, 1.372, CI, 1.106 to 1.700, P = 0.004), and more likely to get readmitted (OR, 1.783, CI, 1.157 to 2.75, P = 0.009). Patients treated with IMN were associated with lower postoperative length of stay (OR 0.982, CI 0.967 to 0.998, P = 0.030). Our study found that extramedullary implants were associated with lower transfusions rates, lower readmissions, and better patient disposition. We recommend surgeons to consider extramedullary implants when treating stable IT fractures, especially if the patient is anemic or at high risk for hospital readmission. Level III. Retrospective cohort study.

Minimally invasive versus conventional fixation of stable intertrochanteric fracture by dynamic hip screw – A prospective study comparing the two techniques

Background: Intertrochanteric fractures of femur are one of the most common fractures encountered in the elderly population. Dynamic hip screw (DHS) with a side plate is the standard modality of treatment especially in the case of stable fractures because it creates a controlled collapse at fracture site, leading to union. A comparative study between minimally invasive surgical technique with the conventional surgical technique for the fixation of intertrochanteric fractures with the DHS device was done. Methods: Thirty patients with stable intertrochanteric fractures (31A1.1, 31A1.2, and 31A1.3) were treated with the conventional open technique and another thirty with a new minimally invasive technique. Patients in both groups were followed up for at least 9 months. Results: There was less preoperative and postoperative blood loss, less soft-tissue destruction, less pain postoperatively, shorter hospital stays, and early mobilization and faster union with the minimally invasive technique. Conclusion: The study concludes that minimally invasive technique is superior to conventional (open) DHS in stable fractures.