Stable Intertrochanteric Fractures Research Articles

Treatment of intertrochanteric femoral fracture with proximal femoral medial sustainable intramedullary nails: study protocol for a randomized controlled trial

Background: Conservative management of intertrochanteric femoral fracture often yields poor therapeutic outcomes, and surgical fixation is generally warranted. Biomechanical instability of intertrochanteric femoral fracture is a major cause of fixation failure. To increase the stability of intramedullary nails in intertrochanteric femoral fracture, it is critical to strengthen the support between the nail and the cortical bone. Our previously designed proximal femoral medial sustainable intramedullary nail has been proven to be able to provide this internal support and stabilization by finite element analysis. We aim to examine the efficacy and safety of internal fixation with this new type of intramedullary nail in the treatment of stable and unstable intertrochanteric femoral fractures. Methods/Design: This will be a single-center, two-arm, parallel, randomized controlled trial conducted at the Chinese PLA General Hospital, China. Seventy-two patients with stable or unstable intertrochanteric femoral fracture diagnosed according to AO/OTA Classification of Fractures and Dislocations will be randomly assigned to receive internal fixation either with proximal femoral medial sustainable intramedullary nails, or proximal femoral nail antirotation. The primary outcome measure will be bone healing condition 6 months postoperatively; secondary outcomes will be requirement for revision surgery, quality of life and complications 1 year postoperatively. Discussion: Our findings will provide an evidence base for the use of proximal femoral medial sustainable intramedullary nails for the treatment of intertrochanteric femoral fracture. Trial registration: ClinicalTrial.gov identifier: NCT01437176; registered on 1 September 2011. Ethics: This protocol was approved by Ethics Committee of Chinese PLA General Hospital of China (approval No. 07/06/2011) and will be performed in accordance with the Declaration of Helsinki formulated by the World Medical Association. Informed consent: Written informed consent will be obtained prior to involvement in the clinical trial.

Minimal Invasive Dynamic Hip Screw Fixation for Intertrochanteric Fractures of Femur

INTRODUCTION: Good results have been achieved consistently with compression hip screw fixation for stable intertrochanteric femur fractures by conventional method. Thus, this present study was conducted to find out the outcomes for such hip fracture fixation with minimal invasive technique. MATERIALS AND METHOD: This retrospective study was carried out by collecting the records of 66 adult patients with stable intertrochanteric femur fracture managed by Dynamic Hip Screw (DHS) fixation with minimal invasive technique under Spinal Anaesthesia and Epidural Analgesia in Universal College of Medical Sciences and Teaching Hospital (UCMSTH) over a period of 3 years. The patients were in follow up visits for 1 year postoperatively. Operating time, blood loss, decrease in haemoglobin level, analgesic demand, length of hospital stay, fracture union time, early and delayed complications and functional outcome were recorded. RESULTS: This study showed less operative time, less blood loss and less reduction in mean haemoglobin value postoperatively by only 1.53 gm/dl when compared with baseline values. Though complications like pain, stitch infection at surgical site and UTI was seen in few patients, all patients were mobilized within 2nd postoperative day with less rescue analgesic demand and shorter duration of hospital stay of only 8.23 days. However, plate breakage, nonunion, implant cut out, joint infection, delayed union and varus deformity was not observed in any of these patients. Moreover, Harris Hip Score showed good functional outcome. CONCLUSION: Fixation of DHS with minimal invasive technique for stable hip fracture has good functional outcome in cost effective way with fewer incidences of complications resulting in great advantage over the conventional method of fixation.

Calcar femorale grafting in the hemiarthroplasty of the hip for unstable inter trochanteric fractures.

Background:The sliding screw-plate devices and cephalo-medullary nail devices have performed well in stable inter-trochanteric fractures in patients with reasonably good quality of bone. However, their suboptimal performance in comminuted fractures in the presence of osteoporotic bone has prompted many surgeons to consider bipolar hemiarthroplasty as the primary modality of management of comminuted inter-trochanteric fractures in elderly patients. However, long term stability of the hemiarthroplasty implant also may be compromised due to the presence of postero-medial bone loss at the area of the calcar.Materials and Methods:We have presented a simple and effective technique of calcar grafting by harvesting cortical bone strut from the neck of the fractured femur. A total of 34 patients with inter-trochanteric fractures of the femur were treated with calcar grafting. The mean age was 79.2 years. The graft was harvested from the calcar region of the head and neck fragment of the femur and wedged between the medial femoral cortex and medial edge of the prosthesis. The mean followup period was 54.5 months.Results:In 32 of 34 (94%) patients in our series, the calcar graft healed well without dislodgement. There was graft resorption in two patients associated with subsidence of the implant and loosening.Conclusion:Calcar grafting using this technique provides stability to the implant in the presence of comminution and incorporates well in the majority of patients. Donor site morbidity of graft harvesting is also avoided.

Dynamic hip screw with locking side plate: a viable treatment option for intertrochanteric fracture

ObjectiveDynamic hip screw (DHS) is recommended for the fixation of stable intertrochanteric fractures. Its postoperative cut-out rate ranges from 1% to 6%. In osteoporotic bone, normal screws in DHS blade provide less anchorage compared to locking screws. This study aims to compare DHS with locking side plate and conventional side plate. MethodsFifty consecutive patients with intertrochanteric fractures were randomly allocated for fixation with a standard DHS (group A) and locking DHS (Combi plate, group B). We compared the clinical and radiological outcomes for the conventional DHS and locking DHS in intertrochanteric fractures. Functional outcome was evaluated using the Parker mobility score. ResultsCoxa valga was found more frequently in group A than in group B (12% vs. 0%, P=0.42). Coxa vara showed the same trend (12% vs. 8%, P=0.81). Rate of restoration of postoperative neck-shaft angle within 20° of sound side was higher in group B (8% cases) than in group A (4% cases, P=0.98). The rate of anteversion angle restoration within 10° of sound side was also higher in group B (100% vs. 88%, s=0.85). The average lag screw slippage in group A and group B was 3.2mm and 4.2mm, the average fracture union duration was 17.1 weeks and 16.4 weeks, and the mean Parker score was 5.6 and 5.8 respectively. Screw cut-out was seen in one patient in group A. No cut-out was seen in any of the patient in group B. No patient developed deep infection, avascular necrosis, deep vein thrombosis or any other significant complications. ConclusionThe present study demonstrated that treating intertrochanteric fracture with a locking DHS allows sound bone healing and is not associated with any major complications. Although this report is promising, it should be interpreted with caution because only a prospective study with a large sample size would allow definitive conclusion.

A biomechanical comparison of proximal femoral nails and locking proximal anatomic femoral plates in femoral fracture fixation: A study on synthetic bones.

Background:The incidence of fractures in the trochanteric area has risen with the increasing numbers of elderly people with osteoporosis. Although dynamic hip screw fixation is the gold standard for the treatment of stable intertrochanteric femur fractures, treatment of unstable intertrochanteric femur fractures still remains controversial. Intramedullary devices such as Gamma nail or proximal femoral nail and proximal anatomic femur plates are in use for the treatment of intertrochanteric femur fractures. There are still many investigations to find the optimal implant to treat these fractures with minimum complications. For this reason, we aimed to perform a biomechanical comparison of the proximal femoral nail and the locking proximal anatomic femoral plate in the treatment of unstable intertrochanteric fractures.Materials and Methods:Twenty synthetic, third generation human femur models, obtained for this purpose, were divided into two groups of 10 bones each. Femurs were provided as a standard representation of AO/Orthopedic Trauma Associationtype 31-A2 unstable fractures. Two types of implantations were inserted: the proximal femoral intramedullary nail in the first group and the locking anatomic femoral plate in the second group. Axial load was applied to the fracture models through the femoral head using a material testing machine, and the biomechanical properties of the implant types were compared.Result:Nail and plate models were locked distally at the same level. Axial steady load with a 5 mm/m velocity was applied through the mechanical axis of femur bone models. Axial loading in the proximal femoral intramedullary nail group was 1.78-fold greater compared to the plate group. All bones that had the plate applied were fractured in the portion containing the distal locking screw.Conclusion:The proximal femoral intramedullary nail provides more stability and allows for earlier weight bearing than the locking plate when used for the treatment of unstable intertrochanteric fractures of the femur. Clinicians should be cautious for early weight bearing with locking plate for unstable intertrochanteric femur fractures.

What makes an intertrochanteric fracture unstable in 2015? Does the lateral wall play a role in the decision matrix?

Intertrochanteric (IT) fractures pose a tremendous burden to the healthcare system. Although consistently good results are obtained while treating stable IT fractures, treatment failure rates with unstable fractures are much higher, and hence, it is imperative to identify unstable patterns. Presently, the conventionally classified unstable configurations (fracture with posteromedial comminution, reverse oblique, IT with subtrochanteric extension) and the recently added fracture patterns (IT fractures with avulsed greater trochanter and lateral wall breach) qualify as unstable IT fractures; however, the list is certainly not exhaustive. Disruption of lateral wall converts an IT fracture into a reverse oblique fracture equivalent and should be given a strong consideration in the decision matrix.

English

BACKGROUND: Proximal femoral nail is commonly recommended as treatment of choice for unstable and reverse oblique intertrochanteric fracture in view of superior biomechanics and prevention of varus collapse associated with Dynamic hip screw. Although in stable fracture types DHS is still being preferred as the treatment modality of choice. Proximal femoral nail owing to better biomechanics, less complications can still be used as the method of choice in stable fracture pattern as well. The aim of this study is to evaluate the results of PFN nail in stable intertrochanteric fracture and include evaluation of the mean operative time, amount of blood loss, complications and functional status of the patient. MATERIALS AND METHODS: In this study 30 patients presented to Orthopedics Department Hamidia Hospital Bhopal with stable intertrochanteric fracture were treated with proximal femoral nail. All patients were followed up for a period of 1 year and functional outcome assessment including amount of shortening, neck-shaft angle, Harris hip score was noted. RESULTS: At the time of final follow-up, all 30 patients showed union with average Harris hip score of 86.6 (range 62-94).14 patients had excellent score, 9 patients had good score, 5 patients had fair score and 2 patients had poor outcome. Mean neck shaft angle achieved post-reduction was 131.4 degrees and at final follow-up was 128.4 degrees. Limb length discrepancy was assessed in the final follow-up with average shortening of 5 mm and 4 patients had shortening above 1.5 cm. Average blood loss was 80 ml, the mean operative time was 65 minutes. Complications were seen in 3 cases with one case of local wound infection, one of screw cut-out and one of screw penetration. CONCLUSION: With proper technique PFN gives excellent results with less blood loss and shorter incision with less soft tissue trauma are added advantages which ultimately lead to less morbidity and early mobilisation of the patient and early return to normal routine activities. Most of the complications can be avoided by proper placement of the screw and maintaining proper neck-shaft

Outcome of intertrochanteric fractures treated with short femoral nail

Aim: To study the functional and anatomical outcome of Inter trochanteric fractures of femur treated with Short femoral nail. Method: This was retrospective study carried out in which 60 patients (50 Male & 10 Female) of 5th to 8th decade of life who underwent Short femoral nail fixation for both Stable & unstable Inter Trochanteric fractures. From the records each patient data was assessed for time required for mobilization, average fracture healing time, degree and grade of hip range of movements, complications, anatomical reduction achieved using Short femoral nail fixation. Results: 55 cases achieved Anatomical reduction. Good to Excellent Hip range of Motion was in 55 (90 %) cases. Fracture union was seen in all cases. No evidence of Z Effect, AVN of femoral head, Implant failure, Fracture of femoral shaft below the Nail tip was seen in any case, However Reverse Z Effect was seen in 4 & shortening of less than 2 cm was seen in 2 cases, External rotation of 10 degree was seen in1 case. Average fracture Union time was 14 weeks. Conclusion: Short femoral nail appears to be better implant for fixation of both Stable & unstable Inter Trochanteric fractures as it fulfills the biomechanical demands being minimally invasive, less blood loss , it prevents excessive varus collapse at fracture site, produces less stress riser effect below the nail tip, Short operative time, Facilitates early mobilization & functional recovery of patients. But Anatomical fracture reduction & optimal implant placement are absolutely must for better results.

Level of Recovery after Stable and Unstable Intertrochanteric Hip Fractures

Level of Recovery after Stable and Unstable Intertrochanteric Hip Fractures

Is Distal Locking Constantly Necessary When Intertrochanteric Femur Fracture Is Stably Fixed in the Distal Area with Intramedullary Hip Nail?

Purpose: The purpose of this study is to investigate the constant necessity of distal locking when intertrochanteric fracture was treated with an intramedullary hip nail. Materials and Methods: From April 2010 to June 2013, 47 stable intertrochanteric fractures (AO/OTA 31-A1) were treated with second generation intramedullary hip nailing. They were followed-up for more than 12 months. In the first group of 18 cases distal locking was used, and in the second group of 29 cases, distal locking was not used. We compared the radiologic and clinical results of the two groups. Results: Comparison of the two groups of patients showed no difference in terms of radiological and functional results. Postoperative thigh pain developed in eight cases (17%). A statistically difference was observed between isthmic diameter and used nail diameter (Fisher exact test, p=0.01) for postoperative thigh pain. In logistic regression analysis, the difference between isthmic diameter and used nail diameter was the most statistically significant factor in development of postoperative thigh pain (p=0.04, odd ratio=27.75). Conclusion: Our results suggested that the second generation intramedullary hip nail may be successfully implanted without distal interlocking in 31-A1 intertrochanteric femur fracture when the reduction status was satisfactory and stable fixation of the distal area was estimated by less than 3 mm difference between isthmic diameter and used nail diameter.

Minimally Invasive Dynamic Hip Screw Fixation for the treatment of stable Intertrochanteric Fractures of femur

Background: Trochanteric fracture is the commonest fracture in elderly people. These fractures carry risks associated with prolonged immobility. Early fracture fixation allowing early mobilization of the patients is the aim of the treatment. Dynamic hip screw and plate remains the most common method for treating stable intertrochanteric fractures. Minimal invasive technique has advantages of less blood loss, minimal soft tissue dissection, early mobilization, lesser requirement of analgesics and shorter hospital stay.Objectives: The study was done to evaluate the amount of intraoperative blood loss, reduction of post operative haemoglobin, requirement of post-operative analgesics and days of postoperative hospital stay in the patients of stable intertrochanteric femur fracture treated with minimal invasive dynamic hip screw (MIDHS).Methods: Twenty-five cases of stable intertrochanteric fractures of femur were treated with minimal invasive Dynamichip screw technique. Average blood loss during surgery, reduction of postoperative haemoglobin, requirement of post-operative analgesics and total days of postoperative hospital stay were studied.Results: Mean intraoperative blood loss was 53 ml, mean reduction of postoperative haemoglobin was 0.9 gm/dl. Average wound size was of five cm. Postoperative analgesic requirement was twice a day in an average and for five days. Mean hospital stay after surgery was five days.Conclusion: Minimal invasive Dynamic hip screw is a safe technique having advantages of less blood loss, minimal soft tissue dissection, lesser requirement of post-operative analgesics and shorter hospital stay in treating stable intertrochanteric fractures.DOI: http://dx.doi.org/10.3126/jkmc.v2i4.11739 Journal of Kathmandu Medical CollegeVol. 2, No. 4, Issue 6, Oct.-Dec., 2013Page: 170-174

A biomechanical comparison of locked and unlocked long cephalomedullary nails in a stable intertrochanteric fracture model.

This study compared the torsional properties of stable intertrochanteric femur fractures in a cadaveric bone model using 2 different distal fixation strategies: unlocked long cephalomedullary nailing versus dynamically locked nailing. Fourteen matched pairs of cadaveric femora were randomly assigned to 1 of 2 distal fixation treatment groups: a single distal interlock screw placed in the dynamic orientation or no distal screw fixation. A stable 2-part intertrochanteric fracture was produced. Specimens were potted and mounted in a double gimbal fixture, facilitating unconstrained motion in the sagittal and coronal planes. Specimens were cyclically loaded dynamically in both internal and external rotation. Range of motion, internal and external rotation stiffness, torsion stiffness, torsion yield, and ultimate torsion magnitude were calculated. The samples instrumented with a distal locking screw reported statistically significantly greater internal (1.54 ± 0.81 N·m per degree vs. 1.08 ± 0.35 N·m per degree; P = 0.026) and external rotational stiffness (1.42 ± 0.72 N·m per degree vs. 0.86 ± 0.36 N·m per degree; P = 0.009). Samples with locked distal fixation were statistically stiffer and displayed statistically less displacement at the yield and peak torque. The yield torque was statistically significantly higher in the samples without distal fixation (14.2 ± 3.3 N·m per degree vs. 10.6 ± 3.8 N·m per degree; P = 0.037). The peak torque was comparable between locked and unlocked samples (15.0 ± 4.6 N·m per degree vs. 16.2 ± 4.2 N·m per degree; P = 0.492). Distal locking of femoral intramedullary nails increases the stiffness of the nail-femur construct. Unlocked samples displayed statistically significant higher yield torque while maintaining comparable peak torque as the locked samples. This study indicates that treating stable intertrochanteric fractures with unlocked long intramedullary nails may be an acceptable option, although further clinical study will be needed to test this assertion.

Cost-effectiveness analysis of fixation options for intertrochanteric hip fractures.

Intertrochanteric hip fractures are a major source of morbidity and financial burden, accounting for 7% of osteoporotic fractures and costing nearly $6 billion annually in the United States. Traditionally, "stable" fracture patterns have been treated with an extramedullary sliding hip screw whereas "unstable" patterns have been treated with the more expensive intramedullary nail. The purpose of this study was to identify parameters to guide cost-effective implant choices with use of decision-analysis techniques to model these common clinical scenarios. An expected-value decision-analysis model was constructed to estimate the total costs and health utility based on the choice of a sliding hip screw or an intramedullary nail for fixation of an intertrochanteric hip fracture. Values for critical parameters, such as fixation failure rate, were derived from the literature. Three scenarios were evaluated: (1) a clearly stable fracture (AO type 31-A1), (2) a clearly unstable fracture (A3), or (3) a fracture with questionable stability (A2). Sensitivity analysis was performed to test the validity of the model. The fixation failure rate and implant cost were the most important factors in determining implant choice. When the incremental cost for the intramedullary nail was set at the median value ($1200), intramedullary nailing had an incremental cost-effectiveness ratio of $50,000/quality-adjusted life year when the incremental failure rate of sliding hip screws was 1.9%. When the incremental failure rate of sliding hip screws was >5.0%, intramedullary nails dominated with lower cost and better health outcomes. The sliding hip screw was always more cost-effective for A1 fractures, and the intramedullary nail always dominated for A3 fractures. As for A2 fractures, the sliding hip screw was cost-effective in 70% of the cases, although this was highly sensitive to the failure rate. Sliding hip screw fixation is likely more cost-effective for stable intertrochanteric fractures (A1) or those with questionable stability (A2), whereas intramedullary nail fixation is more cost-effective for reverse obliquity fractures (A3). These conclusions are highly sensitive to the fixation failure rate, which was the major influence on the model results.

Étude comparative des plaques verrouillées à compression de fémur proximal avec les vis plaques dynamiques de hanche (DHS) dans le traitement des fractures fémorales proximales extracapsulaires

IntroductionThe potential value of proximal femoral locking compression plate (PFLCP) for extracapsular femoral fractures has been discussed in several case reports; however, clinical control studies are lacking. Therefore, we performed a case control study to assess: 1) If PFLCP offers better functional results and fewer complications than dynamic hip screws (DHS)? 2) Which kind of extracapsular femoral fractures would benefit from PFLCP fixation? HypothesisThe PFLCP fixation offers better functional results and fewer complications than the DHS for the treatment of extracapsular fractures. Patients and methodsA total of 83 patients with extracapsular femoral fractures were recruited. Forty-one patients underwent PFLCP fixation, and 42 patients underwent DHS fixation. Patient information, operative time, blood loss, functional level (as assessed by Sanders’ traumatic hip rating scale), bone union, and implant complications were compared for the two treatment groups. ResultsPatients with stable intertrochanteric fractures who underwent PFLCP fixation demonstrated shorter bone union time than the DHS fixation group (3.3±0.2 vs. 4.3±0.1 month; P<0.0001); however, both groups had 100% bone union and good to excellent scores on Sanders’ traumatic hip rating scale (P=1.000). Patients with unstable intertrochanteric fractures who underwent PFLCP fixation experienced greater blood loss (619.0±23.9 vs. 474.1±19.8ml; P<0.0001), which was mainly due to the need for open reduction (64.3% vs. 12.5%; P=0.003), compared to the DHS fixation group. No differences were identified with respect to bony union, functional level, or complications. Patients with subtrochanteric fractures who underwent PFLCP fixation demonstrated significantly shorter operative times (82.1±4.3 vs 102.2±2.2min; P<0.0001), less blood loss (751.8±25.4 vs. 987.6±32.0ml; P<0.0001), shorter bone union times (5.2±0.4 vs. 8.8±1.0 month; P=0.006), more good to excellent Sanders’ traumatic hip rating scale scores (92.9% vs. 55.5%; P=0.009), and fewer complications (14.2% vs. 66.6%; P=0.005) than the DHS fixation group. ConclusionPFLCP fixation offers better functional outcomes and fewer complications for subtrochanteric femoral fractures but not for intertrochanteric femoral fractures. Levels of evidenceCase control study, level III.

English

BACKGROUND: The following prospective consecutive case series was done to evaluate indications, technical pearls and functional outcomes of minimally invasive sliding hip screw in the fixation of stable intertrochanteric fractures of femur. These fractures carry risks associated with prolonged immobilization for which, early fracture fixation and early ambulation of the patient is necessary. Sliding hip screw remains the most common method for the treatment of stable intertrochanteric fractures of femur. METHODS: A total of 80 patients (48 males, 32 females) with stable intertrochanteric fractures of femur were treated with minimally invasive sliding hip screw technique. Average age of the patients was 73 year. Average blood loss during surgery, reduction of postoperative haemoglobin, requirement of post-operative analgesics and total days of postoperative hospital stay were studied. RESULTS: Length of incision, operation time, blood loss and duration of hospital stay were significantly less. Mean operating time was 50 minutes. Mean intra-operative blood loss was 53 ml. Mean reduction of postoperative haemoglobin was 0.9 gm/dl. Average wound size was of 5 cm. The average follow-up was 17 months. The average postoperative analgesic requirement was twice daily for 5 days. Mean hospital stay after surgery was 5 days. CONCLUSION: Minimally invasive sliding hip screw is a novel and advantageous technique that can be used comfortably for the treatment of stable intertrochanteric fractures of femur, thus providing rigid fracture fixation and early mobilization of the patients. Thus, the judicial use of this technique significantly reduces the amount of blood loss, soft tissue dissection, requirement of post-operative analgesics and also the length of stay in the hospital.

A comparison of proximal femoral locking compression plates with dynamic hip screws in extracapsular femoral fractures

IntroductionThe potential value of proximal femoral locking compression plate (PFLCP) for extracapsular femoral fractures has been discussed in several case reports; however, clinical control studies are lacking. Therefore, we performed a case control study to assess: (1) If PFLCP offers better functional results and fewer complications than dynamic hip screws (DHS)? (2) Which kind of extracapsular femoral fractures would benefit from PFLCP fixation? HypothesisThe PFLCP fixation offers better functional results and fewer complications than the DHS for the treatment of extracapsular fractures. Patients and methodsA total of 83 patients with extracapsular femoral fractures were recruited. Forty-one patients underwent PFLCP fixation, and 42 patients underwent DHS fixation. Patient information, operative time, blood loss, functional level (as assessed by Sanders’ traumatic hip rating scale), bone union, and implant complications were compared for the two treatment groups. ResultsPatients with stable intertrochanteric fractures who underwent PFLCP fixation demonstrated shorter bone union time than the DHS fixation group (3.3±0.2 vs. 4.3±0.1 month; P<0.0001); however, both groups had 100% bone union and good to excellent scores on Sanders’ traumatic hip rating scale (P=1.000). Patients with unstable intertrochanteric fractures who underwent PFLCP fixation experienced greater blood loss (619.0±23.9 vs. 474.1±19.8ml; P<0.0001), which was mainly due to the need for open reduction (64.3% vs. 12.5%; P=0.003), compared to the DHS fixation group. No differences were identified with respect to bony union, functional level, or complications. Patients with subtrochanteric fractures who underwent PFLCP fixation demonstrated significantly shorter operative times (82.1±4.3 vs. 102.2±2.2minutes; P<0.0001), less blood loss (751.8±25.4 vs. 987.6±32.0ml; P<0.0001), shorter bone union times (5.2±0.4 vs. 8.8±1.0 month; P=0.006), more good to excellent Sanders’ traumatic hip rating scale scores (92.9% vs. 55.5%; P=0.009), and fewer complications (14.2% vs. 66.6%; P=0.005) than the DHS fixation group. ConclusionPFLCP fixation offers better functional outcomes and fewer complications for subtrochanteric femoral fractures but not for intertrochanteric femoral fractures. Levels of evidenceCase control study, level III.

Is distal locking of long nails for intertrochanteric fractures necessary? A clinical study.

Few clinical studies have examined the utility of distal interlocking nails when fixing intertrochanteric fractures with intramedullary devices. In this study we performed a retrospective analysis comparing fixation method of intertrochanteric fractures with either a long unlocked cephalomedullary nail versus a long locked cephalomedullary nail. Our hypothesis was there would be no difference in device related failures or complications in stable intertrochanteric fractures treated with long locked or long unlocked cephalomedullary nails. A retrospective chart review was performed of all stable intertrochanteric fractures treated with a long cephalomedullary nail between 2006 and 2012 at our institution. Clinical history as well as perioperative radiography was carefully reviewed for all subjects. AO classification, the use of locked or unlocked technique, and failure status was recorded. Overall, a device related failure rate of 1.8% (2/107) was observed for stable intertrochanteric fractures treated with long cephalomedullary nails. No statistical difference in failure rate was found between locked and unlocked nails within our studied population (0% long locked (0/56) versus 3.9% long unlocked (2/51), p=0.224). This clinical study supports our hypothesis that long cephalomedullary nails do not need to be locked for stable intertrochanteric fractures. We found no difference in failure rates between the two approaches across 107 patients.

Long Gamma nail versus short Gamma nail in the treatment of stable intertrochanteric fractures

Long Gamma nail versus short Gamma nail in the treatment of stable intertrochanteric fractures

Comparison of functional recovery in the very early period after surgery between plate and nail fixation for correction of stable femoral intertrochanteric fractures: a controlled clinical trial of 18 patients.

This study aimed to compare the differences in functional recovery between patients undergoing plate and nail fixation in the very early period after surgery. This study was designed as a controlled clinical trial that included 18 patients who were surgically treated with either dynamic hip screw as plate fixation or proximal femoral nail as nail fixation for stable intertrochanteric fractures. In particular, all patients selected for the study reported walking completely independently without the use of walking aids prior to sustaining their initial fracture. In all, 8 patients (mean age, 73.8 years; range, 65-89 years) were treated with plate fixation (group plate) and 10 patients (mean age, 79.7 years; range, 70-90 years) were treated with nail fixation (group nail). Functional evaluations were assessed every week after surgery using the Japanese Orthopaedic Association (JOA) hip functional scores and active range of motion (ROM) of the hip joint. The recovery of activities of daily living (ADLs) according to JOA hip functional scores at week 4 after surgery was significantly better in group nail than in group plate (P = .03), whereas active ROM of hip flexion improved significantly in group plate than in group nail at weeks 3 and 4 after surgery (P = .04 and P = .02, respectively). The results suggested that nail fixation may provide a more rapid recovery of ADLs than that of plate fixation in the very early period after surgery. However, plate fixation may provide better ROM of hip flexion than that of nail fixation.

Closed reduction and internal fixation for intertrochanteric femoral fractures is safer and more efficient using two fluoroscopes simultaneously

The purpose of the study was to assess whether using two fluoroscopes simultaneously in closed reduction and internal fixation of a stable intertrochanteric fracture reduces radiation and operation time.Patients who sustained a stable intertrochanteric femoral fracture were operated in our institution with closed reduction and internal fixation. They were randomly allocated to be operated with the assistance of one or two fluoroscopes. With one device, the radiology technician controlled and moved it to the desired anterior–posterior or axial view. With two fluoroscopes, one was positioned in the anterior–posterior view and the other in the axial view, both controlled by the surgeon. Total radiation and operation time were collected for all patients and compared between the two groups. A total of 27 patients participated in the study. One fluoroscope was used for 13 surgeries and two in 14. Total radiation time was shorter with two fluoroscopes compared to the use of one (36.6±8.6s versus 51.2±18.9s, respectively; p<0.02), as was total operation time (24.3±4.2min and 34.7±11.9min, respectively; p<0.01). Working simultaneously with two fluoroscopic devices is safer for the medical team in the operating theatre, because it decreases the patient's radiation exposure, wound exposure time, and anaesthesia time. It saves operating room time and fluoroscopy personnel during the operation. When operating on hip fractures that are planned to be reduced and fixated, we recommend working with two fluoroscopes simultaneously.