Stable Trochanteric Fractures Research Articles

Three-Dimensional gait kinematics in older adults after stable trochanteric fracture

Three-Dimensional gait kinematics in older adults after stable trochanteric fracture

No benefit of the trochanteric stabilizing plate on loss of fracture reduction in AO/OTA 31-A2 trochanteric fractures.

Despite limited clinical scientific backing, an additional trochanteric stabilizing plate (TSP) has been advocated when treating unstable trochanteric fractures with a sliding hip screw (SHS). We aimed to explore whether the TSP would result in less post operative fracture motion, compared to SHS alone. Overall, 31 patients with AO/OTA 31-A2 trochanteric fractures were randomized to either a SHS alone or a SHS with an additional TSP. To compare postoperative fracture motion, radiostereometric analysis (RSA) was performed before and after weightbearing, and then at four, eight, 12, 26, and 52 weeks. With the "after weightbearing" images as baseline, we calculated translations and rotations, including shortening and medialization of the femoral shaft. Similar migration profiles were observed in all directions during the course of healing. At one year, eight patients in the SHS group and 12 patients in the TSP group were available for analysis, finding a clinically non-relevant, and statistically non-significant, difference in total translation of 1 mm (95% confidence interval -4.7 to 2.9) in favour of the TSP group. In line with the migration data, no significant differences in clinical outcomes were found. The TSP did not influence the course of healing or postoperative fracture motion compared to SHS alone. Based on our results, routine use of the TSP in AO/OTA 31-A2 trochanteric fractures cannot be recommended. The TSP has been shown, in biomechanical studies, to increase stability in sliding hip screw constructs in both unstable and intermediate stable trochanteric fractures, but the clinical evidence is limited. This study showed no advantage of the TSP in unstable (AO 31-A2) fractures in elderly patients when fracture movement was evaluated with radiostereometric analysis.

The increasing complexity of femoral fragility fractures: incidence, fracture patterns and management over a 10-year period.

The purpose of this study was to determine whether there have been changes in the numbers and complexity of femoral fragility fractures presenting to our department over a period of 10 years. Patients >60 years presenting with femoral fragility fractures to our institution in 2018-2019 (397 fractures) were compared with respect to demographic data, incidence rates, fracture classification and surgical management with a historical cohort from 2009-2010 (335 fractures). Pathological and high velocity fractures were excluded. The gender proportion and average age (83.1 vs. 82.7 years) was unchanged. The number of femoral fractures increased by 19% but the overall incidence in people >60 years fell by 6% (p = 0.41). The proportion of unstable trochanteric fractures (31A2 and A3) increased from 22% to 55% (p < 0.001). The proportion of displaced intracapsular fractures increased from 53% to 72% (p < 0.001). The incidence of stable trochanteric fractures fell from 12.4 to 7.3/10,000 patients>60 years (p = 0.0006) while the incidence of unstable trochanteric fractures (31A2 and 31A3) increased from 3.5 to 8.9/10,000 patients >60 years (p < 0.0001). The proportion of trochanteric fractures treated with an intramedullary (IM) nail increased from 9% to 35% (p = 0.0001). The number of shaft and distal femoral fractures increased by 41% although the incidence did not change significantly. Periprosthetic fractures comprised 70% of femoral shaft fractures in both cohorts. The increasing number and complexity of femoral fragility fractures, especially unstable trochanteric fractures and periprosthetic fractures, is likely to have an impact on implant use, theatre time and cost.

Relation entre la densité minérale osseuse du fémur proximal et l’instabilité des fractures fémorales proximales : étude rétrospective

BackgroundProximal femoral fractures can occur in patients with osteoporosis. However, the relationship between bone mineral density (BMD) of the proximal femur and fracture type and instability remains unclear. This study aimed to determine whether there is a relationship between the site-specific BMD of the proximal femur and the instability of proximal femoral fracture. HypothesisThe instability of proximal femoral fractures is related to the site-specific BMD of the proximal femur. Patients and methodsUsing dual-energy X-ray absorptiometry (DEXA), the BMD on the non-fractured side was retrospectively examined in 252 women who underwent surgery for proximal femoral fracture at our hospital. The BMD was measured at three sites: the femoral neck (neck), trochanter (trochanter), and intertrochanteric region (inter). The BMD at several sites was compared between the femoral neck and trochanteric fractures. Femoral neck fractures were classified into the displaced and non-displaced types, and trochanteric fractures were classified into stable and unstable types. A comparative analysis was conducted for each proximal femur site and fracture type. ResultsBoth total and site-specific BMDs were lower in trochanteric fractures than in femoral neck fractures. No difference was observed between BMD and displaced or non-displaced femoral neck fractures. However, the BMD of the intertrochanteric region was lower in unstable trochanteric fractures (0.57±0.12g/cm2) than in stable trochanteric fractures (0.61±0.11g/cm2) [p<0.05]. DiscussionSeveral factors, including the patient's age and the bone component of each region, may influence the lower BMD in trochanteric fractures. In trochanteric fractures, the site-specific BMD of the proximal femur may predict the type of fracture and the degree of instability, especially in those with low BMD at the intertrochanteric site. The study findings suggest that a decrease in the BMD of the intertrochanteric region of femoral trochanteric fractures, which is thought to be involved in instability, is associated with fracture-type instability. Level of evidenceIII, retrospective study.

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.

THE CHANGING FACE OF FEMORAL FRAGILITY FRACTURES: INCIDENCE; FRACTURE PATTERNS; AND MANAGEMENT

The purpose of this study was to determine whether there have been changes in the complexity of femoral fragility fractures presenting to our Dunedin Orthopaedic Department, New Zealand, over a period of ten years.Patients over the age of 60 presenting with femoral fragility fractures to Dunedin Hospital in 2009 −10 (335 fractures) were compared with respect to demographic data, incidence rates, fracture classification and treatment details to the period 2018-19 (311 fractures). Pathological and high velocity fractures were excluded.The gender proportion and average age (83.1 vs 83.0 years) was unchanged. The overall incidence of femoral fractures in people over 60 years in our region fell by 27% (p&lt;0.001). Intracapsular fractures (31 B1 and B2) fell by 29% (p=0.03) and stable trochanteric fractures by 56% (p&lt;0.001). The incidence of unstable trochanteric fractures (31A2 and 31A3) increased by 84.5% from 3.5 to 6.4/10,000 over 60 years (p = 0.04). The proportion of trochanteric fractures treated with an intramedullary (IM) nail increased from 8% to 37% (p &lt;0.001). Fewer intracapsular fractures were treated by internal fixation (p&lt;0.001) and the rate of acute total hip joint replacements increased from 13 to 21% (p=0.07). The incidence of femoral shaft fractures did not change significantly with periprosthetic fractures comprising 70% in both cohorts.While there has been little difference in the numbers there has been a decrease in the incidence of femoral fragility fractures likely due to the increasing use of bisphosphonates. However, the incidence of unstable trochanteric fractures is increasing. This has led to the increased use of IM nails which are increasingly used for stable fractures as well.The increasing complexity of femoral fragility fractures is likely to have an impact on implant use, theatre time and cost.

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.

Relationship between site-specific bone mineral density in the proximal femur and instability of proximal femoral fractures: A retrospective study

BackgroundProximal femoral fractures can occur in patients with osteoporosis. However, the relationship between bone mineral density (BMD) of the proximal femur and fracture type and instability remains unclear. This study aimed to determine whether there is a relationship between the site-specific BMD of the proximal femur and the instability of proximal femoral fracture. HypothesisThe instability of proximal femoral fractures is related to the site-specific BMD of the proximal femur. Patients and methodsUsing dual-energy X-ray absorptiometry (DEXA), the BMD on the non-fractured side was retrospectively examined in 252 women who underwent surgery for proximal femoral fracture at our hospital. The BMD was measured at three sites: the femoral neck (neck), trochanter (trochanter), and intertrochanteric region (inter). The BMD at several sites was compared between the femoral neck and trochanteric fractures. Femoral neck fractures were classified into the displaced and non-displaced types, and trochanteric fractures were classified into stable and unstable types. A comparative analysis was conducted for each proximal femur site and fracture type. ResultsBoth total and site-specific BMDs were lower in trochanteric fractures than in femoral neck fractures. No difference was observed between BMD and displaced or non-displaced femoral neck fractures. However, the BMD of the intertrochanteric region was lower in unstable trochanteric fractures (0.57±0.12g/cm2) than in stable trochanteric fractures (0.61±0.11g/cm2) [p<0.05]. DiscussionSeveral factors, including the patient's age and the bone component of each region, may influence the lower BMD in trochanteric fractures. In trochanteric fractures, the site-specific BMD of the proximal femur may predict the type of fracture and the degree of instability, especially in those with low BMD at the intertrochanteric site. The study findings suggest that a decrease in the BMD of the intertrochanteric region of femoral trochanteric fractures, which is thought to be involved in instability, is associated with fracture type instability. Level of evidenceIII, retrospective study.

Biomechanical Comparisons of Trochanteric Hip Fracture Fixation Using Short-, Mid-, and Long-Length Proximal Femoral Nails.

IntroductionFor trochanteric hip fractures, proximal femoral nails (PFNs) have been frequently used for surgical treatment. No study has clarified whether length of the nail affected the wiper motion; the repetitive motion of the distal nail inside canal after surgery.MethodsThirty synthetic femora were used to biomechanically evaluate construct lateral angular movement of 3 different lengths of PFN [TFN-ADVANCED Proximal Femoral Nailing System (TFNA) 170 (short-length), 235 (mid-length), and 300 (long-length) mm] constructs for the fixation of stable pertrochanteric fractures. Cyclic testing and radiological evaluation were performed to investigate the loosening patterns in 3 different fixation constructs. Migration along the mechanical axis during the cyclic testing from 1-100th, 100-500th, 500-1000th, 1000-1500th, and 1500-2000th cycles was compared between TFNA lengths. Also, before and after cycling changes in tip to apex distance, angulation of fracture line, and lateral angular movement of the distal stem inside the canal were compared between TFNA lengths.ResultsMigration along the mechanical axis during cyclic loading, plus changes after cycling in tip to apex distance, and fracture line angulation did not differ between TFNA lengths for the fixation of stable intertrochanteric fracture model using synthetic femora. Conversely, one-way analysis of variance revealed a significant difference in lateral angular movement of the distal stem inside the canal after cyclic testing between groups (1.4 ± 1.6°, .21 ± .35°, and .26 ± .57° in 170-mm short nail, 235-mm middle nail, and 300-mm long nail, respectively; P = .026), and post-hoc analysis also revealed that middle nail yielded significantly less lateral angular movement compared with short nail (P = .047) but did not significantly differ from the long nail.ConclusionsMid-length TFNA for the fixation of stable trochanteric hip fracture model using synthetic femora resulted in significantly smaller lateral angular movement of the distal stem after cyclic loading.

Dynamic Hip Screw Technique in the Management of Trochanteric Fracture

Background: To study was conducted to find the results of dynamic hip screw in the management of trochanteric fracture&#x0D; Methods: 50 Individuals &gt;18 years, both genders who were diagnosed having a trochanteric type I and II Boyd and Griffin Stable fractures were included in the study. &#x0D; Results: As per the Kyle's criteria, 40.00% showed excellent response, followed by good by 48.00% members, fair by 8.00% members. Poor results were shown by 4.00% members.&#x0D; Conclusions: Dynamic hip screw is the operative treatment of choice for stable trochanteric fractures. However, studies on large sample for long time are recommended.&#x0D; Keywords: Femur, Fracture, Operative

Cephalomedullary nails versus extramedullary implants for extracapsular hip fractures in older adults.

Cephalomedullary nails versus extramedullary implants for extracapsular hip fractures in older adults.

A STUDY TO DETERMINE THE FUNCTIONAL OUTCOME IN THE MANAGEMENT OF STABLE PER TROCHANTERIC HIP FRACTURES WITH DYNAMIC HIP SCREW.

BACKGROUND: The use of a dynamic hip screw (DHS) for stable as well as unstable intertrochanteric hip fracture xation has been successfully applied in fracture healing for more than 25years. DHS xation on unstable trochanteric fractures still has a more failure rate compared to stable fractures, mostly due to osteoporosis in patients. Thus, this study is aimed to investigate the biomechanical property of the DHS system to provide the stable xation in intertrochanteric A1 and A2 fractures1. MATERIAL AND METHODS: This is a retrospective study of 54 patients with trochanteric fractures of the femur that were treated with DHS (Dynamic hip screw) during the period of two years from April 2019 to March 2021 in a tertiary care hospital. All surgeries were performed under spinal and epidural anaesthesia. Surgery done was an internal xation with DHS plate. Results: Among 54 cases, 55.5% were A1, and 44.4% were A2 pertrochanter fractures. The clinical and functional outcomes of the procedure were excellent in 25 patients (46.29%), good in 19 patients (35.18%), fair in 8 patients (14.81%), and 2 (3.7%) of the patients had poor results. CONCLUSIONS: Intertrochanteric fractures are essentially fractures of the elderly, which demand prompt treatment and early ambulation. The dynamic hip screw is the operative treatment of choice for stable trochanteric fractures

Comparison of long vs short proximal femoral nailing with Intertan in stable intertrochanteric fractures

Aim: A comparative evaluation of the surgical treatment and outcome of patients with stable intertrochanteric fractures treated with long versus short INTERTAN nail. Objectives: Inter-trochanteric fractures of femur are among the most common orthopedic injury in elderly age group. Proximal femoral nailing with INTERTAN has become a popular method of stabilization of inter-trochanteric fractures in adults. stable trochanteric fractures can be treated using the conventional proximal femoral nailing method or the newly deviced proximal femoral nailing with INTERTAN nail. The present study was conducted to assess and evaluate the outcomes following treatment of stable inter-trochanteric fracture femur with long INTERTAN nail vs short INTERTAN nail.

English

BACKGROUND Trochanteric fractures are commonly encountered in elderly patients, and the outcome may be bad, if not intervened early. Dynamic hip screw (DHS) fixation is the most common treatment in stable trochanteric fracture. In unstable trochanteric fractures, there is high incidence of failure in view of excessive collapse seen with dynamic hip screw. In order to limit the collapse, we have done a modification on dynamic hip screw implant. Here we have assessed fracture healing, collapse and implant failure, in unstable trochanteric fractures (Evan’s unstable fractures) treated by modified dynamic hip screw fixation. METHODS The present retrospective case record analysis was conducted among 31 patients with unstable trochanteric fracture classified according to Evan’s classification who were operated with modified DHS in a tertiary care hospital. The details about fracture healing, collapse of fracture fragments, implant failure were assessed in a structured checklist through the case record analysis. RESULTS Out of 31 patients in this study, 29 patients showed fracture healing (93.5 %) with or without minimal collapse and 2 patients had non-union (6.5 %) at the end of 5 months follow up. Ultimately, all fractures united at the end of 1-year follow-up. Out of 31 patients in this study, at first month follow-up, 26 patients showed no implant failure (83.9 %), 5 patient had implant migration not breaching cortex (16.1 %), at third month follow-up, out of 5 patients who had implant migration, two patients had implant migration not breaching cortex (6.4 %), 3 patients had implant migration breaching cortex (11.0 %), at fifth month follow-up, two patients had implant migration not breaching cortex (6.4 %), 3 patients who had implant migration breaching cortex underwent revision surgery (11.0 %). CONCLUSIONS Modified dynamic hip screw has shown improved results as compared to normal dynamic hip screw in treating unstable trochanteric fracture, which limits the collapse at fracture site. KEYWORDS Unstable Trochanteric Fractures, Collapse, Modified Dynamic Hip Screw

High risks of failure observed for A1 trochanteric femoral fractures treated with a DHS compared to the PFNA in a prospective observational cohort study

IntroductionBoth the DHS and the PFNA are common and well-studied treatment options for stable trochanteric fractures. The aim of the current study was to compare the implant failure rates of these two implants in 31A1 type trochanteric femoral fractures.Materials and methodsA single-centre observational cohort study was conducted in the Hip Fracture Unit of a multicentre level 1 trauma teaching hospital between December 2016 and October 2018. Patients with an AO/OTA type 31A1 fracture were included. Pathological fractures, bilateral fractures, high-energy traumas and patients younger than 18 years of age were excluded. Surgery was performed using either a DHS or PFNA. Both were used routinely for stable trochanteric fractures, and allocation was decided by the surgeon performing the operation. The primary outcome of this study was the implant failure rate in the first postoperative year. Secondary outcomes included the reoperation rate, functional recovery, pain and morphine use.ResultsData were available from 126 patients treated with a DHS (n = 32, 25.4%) or PFNA (n = 95, 74.6%). Minor differences were observed in the patient characteristics including the prevalence of cognitive impairment (18.8% vs 40.2%; P = 0.028), prefracture independence in activities of daily living (87.1% vs 67.4%; P = 0.034) and prefracture mobility (independently without aides: 61.3% vs 40.4%; P = 0.033). Fractures treated with a DHS showed 25% implant failures, compared to 1.1% for fractures treated with a PFNA (P = 0.004). No differences were observed in any of the secondary outcomes.ConclusionsSignificantly more implant failures were observed for the DHS compared the PFNA within 1 year after surgery. Despite the fact that this did not result in differences in revision surgery, we conclude that the PFNA, considering the minimal number of implant-related fractures is a viable implant for A1 type trochanteric fractures.

Comparison of long vs short proximal femoral nailing with PFNA2 in intertrochanteric fractures

Aim: A comparative evaluation of the surgical treatment and outcome of patients with stable intertrochanteric fractures treated with long versus short PFNA2. Objectives: Inter-trochanteric fractures of femur are among the most common orthopedic injury in elderly age group. Proximal femoral nailing with A2 screws has recently become a popular method of stabilization of inter-trochanteric fractures in adults. Stable trochanteric fractures can be treated using the conventional proximal femoral nailing method or the newly deviced proximal femoral nailing with A2 screws. The present study was conducted to assess and evaluate the outcomes following treatment of stable inter-trochanteric fracture femur with proximal femoral nail A2 long vs short proximal femoral nail A2.

Hip fracture treatment in Norway: deviation from evidence-based treatment guidelines: data from the Norwegian Hip Fracture Register, 2014 to 2018.

AimsThe aim of this study was to describe variation in hip fracture treatment in Norway expressed as adherence to international and national evidence-based treatment guidelines, to study factors influencing deviation from guidelines, and to analyze consequences of non-adherence.MethodsInternational and national guidelines were identified and treatment recommendations extracted. All 43 hospitals routinely treating hip fractures in Norway were characterized. From the Norwegian Hip Fracture Register (NHFR), hip fracture patients aged > 65 years and operated in the period January 2014 to December 2018 for fractures with conclusive treatment guidelines were included (n = 29,613: femoral neck fractures (n = 21,325), stable trochanteric fractures (n = 5,546), inter- and subtrochanteric fractures (n = 2,742)). Adherence to treatment recommendations and a composite indicator of best practice were analyzed. Patient survival and reoperations were evaluated for each recommendation.ResultsMedian age of the patients was 84 (IQR 77 to 89) years and 69% (20,427/29,613) were women. Overall, 79% (23,390/29,613) were treated within 48 hours, and 80% (23,635/29,613) by a surgeon with more than three years’ experience. Adherence to guidelines varied substantially but was markedly better in 2018 than in 2014. Having a dedicated hip fracture unit (OR 1.06, 95%CI 1.01 to 1.11) and a hospital hip fracture programme (OR 1.16, 95% CI 1.06 to 1.27) increased the probability of treatment according to best practice. Surgery after 48 hours increased one-year mortality significantly (OR 1.13, 95% CI 1.05 to 1.22; p = 0.001). Alternative treatment to arthroplasty for displaced femoral neck fractures (FNFs) increased mortality after 30 days (OR 1.29, 95% CI 1.03 to 1.62)) and one year (OR 1.45, 95% CI 1.22 to 1.72), and also increased the number of reoperations (OR 4.61, 95% CI 3.73 to 5.71). An uncemented stem increased the risk of reoperation significantly (OR 1.23, 95% CI 1.02 to 1.48; p = 0.030).ConclusionOur study demonstrates a substantial variation between hospitals in adherence to evidence-based guidelines for treatment of hip fractures in Norway. Non-adherence can be ascribed to in-hospital factors. Poor adherence has significant negative consequences for patients in the form of increased mortality rates at 30 and 365 days post-treatment and in reoperation rates.Cite this article: Bone Joint Open 2020;1-10:644–653.

Effect of types of proximal femoral fractures on physical function such as lower limb function and Activities of Daily Living

This study aimed to assess physical function such as lower limb function and Activities of Daily Living after surgery for proximal femoral fractures ( unstable medial femoral neck fracture and trochanteric fracture). This study enrolled 68 patients with proximal femoral fractures. Isometric knee extension strength (IKES), the Japanese Orthopedic Association (JOA) hip score, and the number of days required to develop straight leg raising, transfer, and T-caneassisted gait abilities to become independent were assessed. Patients were classified based on the types of proximal femoral fractures, namely unstable medial femoral neck fracture (bipolar hip arthroplasty [BHA] group), stable trochanteric fracture (S group), and unstable trochanteric fracture (US group). IKES and the JOA hip score were significantly better in the BHA group than in the S and US groups. IKES and the JOA hip score were significantly worse in the US group than in the BHA and S groups. Both transfer and T-cane-assisted gait abilities of patients in the BHA and S groups were indifferent. However, all physical functions were significantly worse in the US group. Our study results suggested that physical therapists plan the different rehabilitation program for the patients with proximal femoral fractures who were classified into three types, namely unstable medial femoral neck fracture, stable trochanteric fracture, and unstable trochanteric fracture, instead of two types.

Study of surgical management of trochanteric fracture of the femur with dynamic hip screw

Background: The use of a dynamic hip screw (DHS) for stable trochanteric hip fracture fixation has been successfully applied in fracture healing for more than 20 years. DHS fixation on unstable trochanteric fractures still has a more failure rate, particularly in osteoporosis patients. Thus, this study is aimed to investigate the biomechanical property of the DHS system to provide the lesser trochanter fragment stable fixation. Material and methods: This cross-sectional, observational, and follow-up study was conducted in the Department of Orthopedics, GSL Medical College and General Hospital, Rajamahendravaram with a total of 40 cases of trochanteric fractures. All surgeries were performed under spinal anesthesia. Surgery done was an internal fixation with DHS and 135-degree angled blade plate. Results: Among 40 cases, 32.5% were Type I, and 67.5% were Type II Trochanteric fractures. 40% cases had grade 3 osteoporosis and 30% had grade4-osteoporosis rest of the patients were having grade 2 (20%), grade 5 (7.5%), grade 6 (2.5%) and grade1 (0%), according to Singh’s index. The clinical and functional outcomes of the procedure were excellent in 10 hips (25%), Good in 20 hips (50%), Fair in 6 hips (15%), and 4 (10%) of the patients had poor results. Conclusions: Trochanteric fractures are essentially fractured of the elderly, with osteoporotic bones. The dynamic hip screw is the operative treatment of choice for stable trochanteric fractures.

Description of a minimally invasive technique with a modified instrument for the osteosynthesis of proximal femoral fractures using the standard DHS and case series

ABSTRACT Introduction: the number of hip fractures is estimated to increase from 1.66 million in 1990 to 6.26 million by 2050. Internal fixation is the most common surgical treatment for intertrochanteric fractures. Objectives: the objective of the present research is to describe a minimally invasive technique with a modified instrument for the treatment of stable proximal femoral trochanteric fractures using the standard DHS, classified as Tronzo types 1 and 2 (AO 31A1.2), and presenting a case series. Methods: a case was selected to present the technique. Patients operated by this technique undergo a clinical evaluation and preoperative preparation as routine. The criteria for inclusion in the study were the presence of stable fracture of the proximal femur verified by two hip specialist orthopedists, and operated by the minimally invasive technique with a modified instrument using a standard DHS. Exclusion criteria were cases of patients operated for unstable fractures, and the use of other surgical techniques. A case series of 98 patients was performed and discussed. Results: minimally invasive technique with a modified instrument using the standard DHS device can reduce bleeding, it decreases soft tissue injuries, surgical time, and hospital stay, as any other MIPO procedures. Ninety-eight patients underwent the operation (Tronzo types I and II), 59 female and 39 male, ages from 50 to 85 years old. Immediate post-operative complications were shortening of the lower limb, loss of fracture reduction, and death by clinical complications. Conclusion: the present study describes a minimally invasive surgical technique using a modified instrument to perform proximal femoral osteosynthesis for stable trochanteric fractures, using the standard DHS.