Subtrochanteric Femoral Fractures Research Articles

Radiation-induced pathological fractures of the proximal femur: a case series considering an endoprosthetic solution

ABSTRACT BACKGROUND: Radiation-induced pathological fractures of the proximal femur are difficult to treat due to frequent non-union and hardware failure using standard fracture fixation techniques. This case series investigates endoprosthetic replacement as a treatment option METHODS: A retrospective folder review from a private hospital in Cape Town, of patients who had sustained a radiation-induced pathological fracture, was reviewed using descriptive statistics. RESULTS: Six patients met the inclusion criteria. One patient was excluded as the minimum follow-up time of six months was not met. Of the Ave patients that were analysed, all Ave sustained transverse, subtrochanteric femur fractures. Prior to definitive treatment with a proximal femoral replacement, three patients were treated with standard trauma instrumentation prior to referral to the unit, and one patient was treated with a vascularised fibular graft as their initial treatment while at the unit. One patient was treated with an endoprosthetic replacement as their first procedure at the unit. Among the three patients treated with standard trauma fixation and the one patient treated with a vascularised fibular graft, there was a 100% failure rate. One standard trauma instrumentation patient had an ablation due to free musculocutaneous flap failure and periprosthetic infection after endoprosthetic replacement. This was the only complication of endoprosthetic replacement. At a median follow-up of 15 months (min 7, max 55) the median Musculoskeletal Tumour Society score was 74% (min 63%, max 93%. CONCLUSION: This case series seeks to highlight the high failure rates seen when treating this condition with standard trauma instrumentation or biological methods. Further research is needed, but endoprosthetic replacement may be a viable alternative solution Level of evidence: Level 4. Keywords: radiation-induced fracture, pathological fracture, endoprosthetic replacement

Evaluation of the Nature and Etiologies of Risk Factors for Diaphyseal Atypical Femoral Fractures

Objectives: Differences in mechanisms of subtrochanteric and diaphyseal atypical femoral fractures (AFFs) are speculated in studies that analyzed differences in the patients’ background. However, the etiologies of each type of AFF have not been studied in detail. This study aimed to investigate the nature and etiologies of the risk factors for diaphyseal AFFs. Materials and Methods: Eighty consecutive Japanese patients with 91 diaphyseal AFFs (AFF group) and 110 age-matched women with osteoporosis (non-AFF control group) were included. Their clinical data were compared; factors affecting AFFs were investigated, and the etiologies of the risk factors for diaphyseal AFFs were examined. Results: Multivariate analysis revealed that femoral serrated changes, bisphosphonate or denosumab usage, and lateral and anterior femoral curvatures were risk factors for diaphyseal AFFs (p < 0.0011, p = 0.0137, and p < 0.0001, respectively). Multivariate analyses revealed that serrated changes and low serum 25(OH)D levels affected the lateral curvature (p = 0.0088 and 0.0205, respectively), while serrated changes affected the anterior curvature (p = 0.0006), each significantly affected the femoral curvature. High serum calcium (Ca) levels, lateral femoral curvature, and anterior femoral curvature were predictors of serrated changes (p = 0.0146, 0.0002, and 0.0098, respectively). Conclusion: Risk factors for diaphyseal AFFs were bone resorption inhibitor usage, a strong femoral curvature, and serrated changes. Low serum 25(OH)D levels and serrated changes are risk factors for lateral curvature, while a high serum Ca level is a risk factor for serrated changes.

Role of mini-invasive bridge plate in the complex femoral fracture in school going children: A prospective clinical study of 30 cases.

Objective:Pediatric femoral fracture including supracondylar and subtrochanteric fracture constitutes 1.6% of all paediatric fracture. Elastic nails remain the standard treatment of choice in a midshaft transverse femoral fracture in children weighing less than 45 kg. But in subtrochanteric and spiral femoral fracture, the failure rate of elastic nails are quite high. Hence, in accordance with AAOS guidelines, we treated complex femoral fracture in children with submuscular mini-invasive bridge plate because of its advantage of minimal incision, early union with proper alignment and lower failure.Material and Methods:We retrospectively reviewed 30 complex femur fracture in children treated with Submuscular bridge plate by mini-invasive approach. Patients were analysed according to their age, type of fracture, time of union in weeks, complication and results were evaluated with modified Flynn's criteria.Result:Out of 30 patients 28 were boys and 2 were females, with an average age of 11.5 years in which Spiral fracture (n = 12), subtrochanteric fracture (n = 9), Complex Shaft fracture (n = 10). All fracture united well on an average of 11 weeks. And 29 patients has excellent results and in 1 patient there is Acceptable result. The single complication was 3 mm limb lengthening but it didn't change gait of the patient.Conclusion:Mini invasive bridge plating is an easy and soft tissue preserving procedure for managing complex femoral fracture in children. It has shown promising results in achieving union without any major complication. We strongly recommend the SBP in a complex femoral fracture in children.

Our Experience in the Management of Subtrochanteric Femoral Fractures in Children

Our Experience in the Management of Subtrochanteric Femoral Fractures in Children

Is Dynamic Condylar Screw Better Than (95°) Blade Plate in Management of Subtrochanteric Fracture of Femur?

Background: Subtrochanteric fractures account for approximately 10-30% of all hip fractures, affecting persons of all ages and should be internally fixed to reduce the morbidity and mortality by early rehabilitation and mobilization. A dynamic condylar screw (DCS) and a 95° angle blade plate (BP) provide a good choice for fixation of subtrochanteric fractures so it is a matter of debate that which one is the best fixation in such fractures. Objective: To evaluate the surgical treatment of subtrochanteric fracture of femur using DCS versus a 95° BP. Methods: Prospective comparative study of 40 patients conducted in Al-Imamein Al-Kadhimein Medical City from November 2015 to November 2017. Twenty patients treated with open reduction and internal fixation by using DCS and other twenty patients treated with open reduction and internal fixation by using a 95° BP. The mode of injury, site and type of fracture, age of patients, operating time, and blood loss, union rate, complication of implants, functional results were compared between the groups. Results: Out of 40 patients, there were 26 (65%) male, right side affected in 24 (60%) patients. Mechanism of injury was trivial trauma observed in 28 (70%) patients. According to a Russell-Taylors classification, majority of fractures are type IB that observed in 16 (40%) patients. Majority of the patients, 27 (67.5%), started full weight bearing at 14 weeks. There was no significant mean age difference between the two groups (p=0.7). The mean operation time of DCS (83±4.3 min) was lower significantly than of 95° BP (p&lt;0.001). Mean blood loss from DCS variety (365±63 cc) was lower significantly than of 95° BP (p=0007). Infection occurred less frequently significantly in patients who treated by DCS than those treated by 95° BP (p=0.03). There was no association between types of open reduction and internal fixation treatment variety and functional result according to the modified Harris hip score (p=0.52). Conclusion: DCS better than 95ᵒ BP because of its technically easier, possibility to correct reduction even after insertion, less perioperative complication and earlier weight bearing. Keywords: Subtrochanteric fractures of femur, dynamic condylar screw, 95ᵒ BP Citation: Joda AI, Chhaily ZA, Abd Ali AS, Rahee LS. Is dynamic condylar screw better than (95°) blade plate in management of subtrochanteric fracture of femur? Iraqi JMS. 2020; 18(2): 123-129. doi: 10.22578/IJMS.18.2.6

Weight Bearing Protocols Following Subtrochanteric Fracture Fixation with Intramedullary Implants, a Retrospective Cohort Study

Aim: Subtrochanteric femur fractures are commonly managed with operative fixation. However, they have a high complication rate due to cortical comminution and stress concentration during stance. This study evaluates the effects of immediate weight bearing in the recovery of subtrochanteric femur fractures treated with intramedullary fixation when compared to a traditional, limited weight bearing protocol. Materials and Methods: 69 consecutive subtrochanteric femur fractures were retrospectively reviewed at two level-I trauma centers, evaluating for postoperative hospital length of stay in relation to their respective weight bearing rehabilitation protocol. All femur fractures were treated between August 2009 and November 2015. Results: Our study identifies a decreased length of stay in weight bearing as tolerated groups for both the overall sample (4.5 vs 5.9 days; p < 0.01) and those that experienced a high-energy injury (5.1 vs 7.0 days; p < 0.001), with no significant difference in postoperative complications (2 vs 3; p = 0.43). Conclusions: This study provides preliminary evidence for the adoption of immediate weight bearing as tolerated as a viable postoperative rehabilitation protocol in the setting of subtrochanteric femur fractures treated with intramedullary fixation.

Correction of Torsional Deformity Following Nail Osteosynthesis of a Subtrochanteric Fracture.

Torsional deformity is a frequent complication following nail osteosynthesis of a subtrochanteric fracture. This complication is difficult to assess intraoperatively, but can cause major functional restrictions. The authors consider that a clinical assessment should be complemented by a postoperative radiological control standardised with torsion CT. Thus, torsion deformity can be recognised immediately and easily corrected if necessary. This can help to avoid long-term damage that requires considerable surgery. The video shows details of torsion correction after a ca. 5-week old subtrochanteric femoral fracture, which had been initially treated with a femur nail. Before torsion correction, the internal torsion on the right femur was 22° and the external torsion on the left femur was 2°. Thus, the total deformation of the external torsion on the left side was 24°. We note the indication for removal of the nail, torsion correction and reosteosynthesis with long PFNA. The postoperative CT control confirmed that the torsion correction was adequate with internal torsion of 25° on the operated left side.

Comparison of efficacy of extramedullary fixation devices and proximal femoral nail in the management of subtrochanteric fracture femur

Introduction: Hip is one of the important joint for locomotion in human beings. So fractures in and around hip joint are of great concern to treating surgeon and patient. We have made an attempt to evaluate these complex fractures and compared the efficacy of proximal femoral nail and extamedullary devices in treatment of subtrochanteric fracture femur. Materials and Methods: After informed consent was given, all 56 consecutive patients with subtrochanteric fracture of femur were randomized into two treatment groups. One group of patients were treated with dynamic hip screw or Dynamic condylar screw (Group I) and other group received proximal femoral nail (Group II). All procedures were performed by staff surgeons with patient supine on a fracture table. Result: The mean operative time in Group I (93.57 min) was significantly higher than in Group II (80 min) with a P value of Conclusion: We conclude that subtrochanteric fractures are difficult to understand and manage. We consider that the PFN is a good minimally invasive implant for unstable proximal femoral fractures when closed reduction is possible. In general, PFN afforded early return to physical activity, faster rehabilitation & walking ability, lesser blood loss and comparable success rate. Keywords: Extramedullary fixation, Proximal femoral nail, Subtrochanteric fracture femur, Dynamic condylar screw.

Comparative study of the clinical and radiological outcome of subtrochanteric fracture femur fixed by dynamic condylar screw (DCS) and long proximal femur nail (PFN)

Background: Subtrochanteric fractures are included among those injuries caused by severe high energy trauma in the younger population. However, in the older population, this particular hip injury is caused by trivial fall and osteoporotic bones in the elderly population. It is difficult to treat these kinds of fractures easily. In order to avoid major complication such as mortality, the early surgical treatment regime is required to be followed. Aim: To compare and study the clinical and radiological outcome of subtrochanteric fracture femur fixed by Dynamic Condylar Screw (DCS) and Long Proximal Femur Nail (PFN) Materials and Methods: Total of 30 patients was included in the study. Simple randomization technique was employed to categorized patients for either PFN treatment or DCS treatment. Fifteen patients out of 30 were treated using PFN, and the remaining 15 were treated using DCS using close reduction. The study period was from July 2017 to June 2019. All the patients with subtrochanteric femur fractures within two weeks of injury were included for the study. Patients’ follow-up was done at 6-weeks, 3-months, and 6 months. Results: The highest number of patients, i.e. 40%, was aged between 51 and 60 years with the mean age of 58.231.26 years. The number of male patients (66.66%) was higher as compared to female patients. The mode of treatment for 50% of patients was PFN while it was DCS for the remaining 50% of the patients. The highest number of patients, i.e., 50% had Type III femur fracture. The patients treated using PFN showed improved functional outcome as compared to the patients treated using DCS. The patients were able to bear full weight within five weeks of surgery. The mean union time for patients treated with PFN was 16 weeks, while the mean union time in patients treated with DCS was 19 weeks. Also, the mean Harris Hip Score for patients treated with PFN was 90 and for the patients treated with DCS was 85. Conclusion: In light of the above resul

The Sydney AFF Score: A Simple Tool to Distinguish Females Presenting With Atypical Femur Fractures Versus Typical Femur Fractures.

Atypical femur fractures (AFF) are a rare but serious complication of long-term bisphosphonate use. Although clearly defined by ASBMR criteria, a proportion of patients with AFFs may go unrecognized and the use of qualitative fracture criteria may lead to uncertainty in AFF diagnosis, with significant therapeutic implications. A score that rapidly and accurately identifies AFFs among subtrochanteric femur fractures using quantitative, measurable parameters is needed. In a retrospective cohort of 110 female patients presenting with AFFs or typical femur fractures (TFFs), multiple logistic regression and decision tree analysis were used to develop the Sydney AFF score. This score, based on demographic and femoral geometry variables, uses three dichotomized independent predictors and adds one point for each: (age ≤80 years) + (femoral neck width <37 mm) + (lateral cortical width at lesser trochanter ≥5 mm), (score, 0 to 3). In an independent validation set of 53 female patients at a different centre in Sydney, a score ≥2 demonstrated 73.3% sensitivity and 69.6% specificity for AFF (area under the receiver-operating characteristic curve [AUC] 0.775, SE 0.063) and remained independently associated with AFF after adjustment for bisphosphonate use. The Sydney AFF score provides a quantitative means of flagging female patients with atraumatic femur fractures who have sustained an AFF as opposed to a TFF. This distinction has clear management implications and may augment current ASBMR diagnostic criteria. © 2021 American Society for Bone and Mineral Research (ASBMR).

Clinical effect of titanium cable assisted fixation combined with lengthened Gamma nail in the treatment of subtrochanteric fracture of femur

To investigate the clinical effect of titanium cable assisted fixation combined with lengthened Gamma nail in the treatment of subtrochanteric fracture of femur. From January 2010 to January 2018, 45 patients with long subtrochanteric fractures were retrospectively analyzed, and they were divided into two groups according to the operation plan. There were 24 cases of titanium cable assisted fixation combined with lengthened Gamma nail (observation group), including 14 males and 10 females, with an age of (54.2±12.8) years; 21 patients (control group) were treated with simple lengthened Gamma nail (control group), including 12 males and 9 females, with an age of (51.4±15.9) years. The operation time, intraoperative blood loss, hospital stay, hemoglobin decrease and fracture healing time were observed and recorded in the two groups. Harris hip function score was used to evaluate the postoperative curative effect, and the occurrence of complications was observed. All patients were followed up for 14 to 36 months. There was significant difference in operation time, intraoperative blood loss, hospital stay between two groups(P<0.05). Three months after operation, the fracture healing rate of the observation group was 79.1%(19 / 24), which was higher than that of the control group 52.4%(11 / 21)(P<0.05). There was no significant difference in Harris hip function score 1 year after operation and fracture healing rate at 6 and 12 months after operation between the two groups (P>0.05). There were no complications such as deep infection, fracture of internal fixation and deep vein thrombosis of lower limbs in the two groups, and delayed healing occurred in 1 case in the control group. Lengthened Gamma nail fixation is reliable in the treatment of subtrochanteric fracture. Limited incision titanium cable assisted fixation can improve the reduction rate and fixation strength of long segment fracture, which is conducive to early functional exercise.

Analysis of the Influence of Osteosynthesis Technique and Patient-specific Factors on the Outcome of Subtrochanteric Fracture Treatment

Objective:The number of subtrochanteric femoral fractures will continue to grow on account of demographic developments. The treatment of choice is reduction and surgical stabilisation. Intramedullary (IO) and extramedullary (EO) techniques are available for this purpose. A final assessment has not been made of which technique is superior with regard to treatment outcome, complication rates, and revision rates. The objective of this retrospective study was to compare surgical procedures with regard to weight bearing, length of hospital stay, the occurrence of complications, and the necessity of surgical revisions.Methods:This retrospective study included 77 patients (74.9 ± 14.9 years; 42.9% male). Associations between surgical procedures and treatment outcomes, complications and revision rates were calculated by linear and logistic regression analysis. To investigate the effect of surgical procedure within patients with fracture type 2 B according to Russel-Taylor classification, a subgroup analysis was performed.Results:In case of fracture type 2 B, according to Russell-Taylor classification, EO took 80 minutes longer on average than the intramedullary technique (p = 0.001), although surgeon experience plays an important role. Common complications were more frequently associated with IO than with EO. Surgical revisions were required more often in the extramedullary group (OR 4.5; 95% CI: 0.87 – 23.19). Patients in the intramedullary group were discharged 3.4 days earlier from the hospital (p = 0.024). Older patients had a higher risk for the occurrence of complications, but BMI and the experience of the surgeon did not. Patients with intramedullary stabilisation frequently showed better postoperative weight-bearing stability.Conclusion:The intramedullary technique offers advantages to both patients and hospitals with regard to outcome, duration of surgery, and length of stay in the hospital. Although, extramedullary implants are less expensive, this advantage is clearly reduced by the longer duration of surgery and hospital stays.

Reliability and Usefulness of Radiographic Union Score (RUS) for Fracture Healing Assessment in Subtrochanteric Femoral Fractures

Background: The fracture healing assessment in subtrochanteric femoral fracture (SFF) is essential due to a high rate of implant failure and non-union. It requires an effective diagnostic tool for determining fracture union status. However, significant disagreement exists among clinicians for SFF union diagnosis, and no standardized method is available. Previous studies showed that radiographic union score (RUS) is reliable and highly correlated with fracture healing status. Objective: To evaluate the reliability and diagnostic accuracy of the RUS method for assessing the fracture healing status in the treatment of SFFs. Materials and Methods: The present study was a retrospective review study conducted on 44 SFFs. A panel of seven reviewers, which included five orthopedic surgeons and two musculoskeletal radiologists, assessed the radiographic healing of SFF based on both the RUS method and the physician impression method. The interobserver and intraobserver reliabilities were calculated using the intraclass correlation coefficient (ICC) and Cohen’s kappa coefficient. The correlation and diagnostic accuracy between RUS and the clinical union were also evaluated. Results: The RUS method resulted in higher intraobserver and interobserver agreement compared to the physician impression method. Inter-rater agreements of the RUS method and physician impression method were moderate (ICC=0.60) and minimal (kappa=0.37), respectively. The RUS method had a higher correlation with clinical union outcome compared to the physician impression method in SFFs (AUC 0.908 versus 0.640). A RUS of 7 or more at 12 weeks had 88% sensitivity and 63% specificity for predicting clinical union outcome. Conclusion: The application of the RUS method is reliable for determining the fracture healing status in SFFs and has better correlation with clinical union than the physician impression method. The RUS method may also be useful for predicting clinical union in SFFs. These results support the use of the radiographic scoring system for fracture healing assessment in SFFs. Keywords: Hip fracture, Subtrochanteric fracture, Fracture healing assessment, Radiographic union, Clinical union, Physician impression

The Functional Outcome of the Treatment of Subtrochanteric Fracture of Femur Fixed by Proximal Femoral Nail (PFN)

The Functional Outcome of the Treatment of Subtrochanteric Fracture of Femur Fixed by Proximal Femoral Nail (PFN)

Nontraumatic bilateral atypical femoral fractures associated with long-term alendronate therapy

Alendronate is a bisphosphonate commonly used in the treatment of post-menopausal and steroid-associated osteoporosis. Bisphosphonates have an evidence base for reducing the occurrence of typical osteoporotic fractures. However, there has been growing recognition of a correlation with the use of long-term therapy with bisphosphonates, and rare occurrence of atypical femoral fractures (AFFs). This report describes a 72-year-old caucasian woman presenting with evolving groin and thigh pains of two weeks duration. Plain X-rays noted features compatible with bilateral impending femoral subtrochanteric fractures. She had been taking oral alendronate 70mg weekly for ten consecutive years as treatment for osteoporosis. Based on the medication history, the absence of preceding trauma or a fall, and the presence of supportive radiological findings, the diagnosis was made of impending bilateral proximal femur fractures secondary to long-term bisphosphonate therapy. The alendronate was discontinued, and the patient managed with two planned successive surgeries involving the insertion of intertrochanteric antegrade nails (inter-TAN) to both femurs. Following a period of rehabilitation, she was successfully discharged home. Some pharmacokinetic and pharmacodynamic considerations of bisphosphonates are discussed. The write-up presents a brief literature review of AFFs. The index report is further reviewed in relation to the American society for bone and mineral research (ASBMR) task force’s recommended case definition of what constitutes AFFs. The discussion concludes with the application of two previously validated causality assessment systems (CAS). In this instance, both CAS indicated a ‘probable’ classification for the adverse drug reaction (ADR) to prolonged usage of oral alendronate.

Results of extensively coated femoral stem in revision hip replacement

Introduction: Revision hip replacement following failed previous hip arthroplasty or internal fixation (dynamic hip screw for intertrochanteric fractures) presents a major surgical challenge. Proximal fitting revision stems do not achieve adequate fixation. Distal fixation with long-stemmed extensively coated cementless implants (like the Solution™ system) affords a suitable alternative. We present our results of 25 patients treated with extensively coated cementless revision stems. Materials and Methods: Twenty five patients with severely compromised proximal femora following either failed hip arthroplasty or failed internal fixation (dynamic hip screw fixation for intertrochanteric fractures) were operated by the senior author over a two-year period. six patients had aseptic loosening of their femoral stems following cemented hip replacements, with severe thinning of their proximal cortices and impending stress fractures. Ten patients had secondary hip arthritis following failure of implants for comminuted intertrochanteric or subtrochanteric femoral fractures. Nine patients had peri-implant fracture following previous primary hip replacement. All patients were treated by removal of implant (cemented or uncemented stems/DHS implants) and insertion of long-stemmed extensively coated cementless revision (‘Solution™ DePuy, Warsaw (IN), US’) stems along with press-fit acetabular component (Duraloc Cup, DePuy, Warsaw (IN), US). Nine patient with peri-implant fracture and five having compromised proximal femora after inter trochanteric fracture needed osteotomy and undergone encerclage wiring. One patient had protrusion of acetabular cup with deficient acetabular wall in which anti protrusion cage was used. Results: All patients were primarily kept in bed on physiotherapy for six weeks and then gradually progressed to weight-bearing walking over the next six to eight weeks. The Harris Hip Scores and patient satisfaction were used for final evaluation. We achieved good results in the two years duration of study. Out of 25 patients, cerclage wiring was done for peri-implant fractures and osteotomy in 14 patients. One patient had a intraoperative fracture extending into subtrochantric area while hammering in the stem. Post cerclage wiring, she was put on a long knee brace and her mobilization was delayed to 12 weeks. Conclusions: The extensively coated cementless (‘Solution™’) femoral stem provides a reasonable ‘solution’ to the deficient femur in hip revision. The proximal femoral deficiences can be relatively easily adressed and distal fixation can be achieved with this stem. Extreme care needs to be taken to avoid fractures and penetration of the femoral shaft, which can, however, be managed by cerclage wiring. successful outcome can be assured by preservation of the functional continuity of the abduction apparatus, care to recognize and prevent distal extension of fracture while inserting the stem and supervised gradual rehabilitation post operatively.

Management of Subtrochanteric Femur Fracture Using Proximal Femoral Nail

Injuries to the femur, the longest bone in the body presents a challenging situationto the orthopedic surgeon. The proximal femoral intramedullary devices are useful for the treatmentof isolated pathological lesions in the subtrochanteric region. Biomechanically, the nail can withstandbetween 3to 5 times body weight. Hence the present study was planned to study the managementof these fractures with the proximal femoral nail. Materials and Methods: A total of 44 patientswith proximal femoral fractures of the subtrochanteric region admitted in the department wereincluded in the study. Patients age more than 25 years and diagnosed with subtrochanteric femurfracture were included in the study. Results: The age of the patients was more than 25 years. Therewere 34 males and 10 females included in the study. In the clinical evaluation as per the functionalGrading of the patient as per Kyle’s Criteria excellent and good results were considered satisfactory,whereas fair and poor results were considered unsatisfactory. In this series 92%, satisfactory resultswere obtained. Conclusion: Proximal femur nail (PFN) is an effective device in the management ofcomplex femoral fractures. The use of PFN in such fractures provides various advantages: Closedprocedure, Minimal soft tissue damage. It offers superior stabilization than other currently usedmethods of internal fixation. The use of PFN is technically demanding and needs expertise.Complications can be avoided by proper operative techniques. Early postoperative mobilization andphysiotherapy improve the results of PFN.

Subtrochanteric fracture of femur treated with proximal femoral nails – its functional outcome

Background: Using proximal femoral nailing for sub-trochanteric fractures of femur by orthopedicains showed a mixed response in terms of functional outcome such as stability and anchoring and long term studies had also showed that it helps in preventing the recurrence of fractures. Aim: To assess the operational outcome of subtrochanteric femur fractures those are treated with proximal femoral nails in terms of function. Methodology: A prospective study was conducted for a period of one year among patients with subtrochanteric hip fracture and a total of 62 patients were included as our study subjects. Proximal femoral nail was inserted through the tip of greater trochanter exactly at the midway between its anterior and posterior extent. Based on the type of fracture distal interlocking was done either statically or dynamically to fix the fracture and the fracture fixation was confirmed through C-arm. Post-operatively all patients were followed up for a period of one year at an interval of 3 months and during each follow-up visit for the functional outcome was assessed in the form of walking, squatting, sitting and rising from chair. Results: Function outcome was almost 100% at the end of 12 months and for walking for 15 meters nearly 98% was able to perform even at 6 months and 92% performed in 6 weeks post-operatively, whereas for raising from chair and squatting 55-60% of the patients were able to perform at the end of 6 months and for squatting and raising from chair it was 20% and 45% respectively at the end of 6 weeks. Conclusion: Proximal Femoral Nailing is a good implant technique for patients with subtrochanteric fracture of the femur as it is almost like a closed technique with better stability and early mobilisation. Keywords: Proximal femoral nail, Fracture femur, Functional outcome.

Immediate weight bearing as tolerated (WBAT) correlates with a decreased length of stay post intramedullary fixation for subtrochanteric fractures: a multicenter retrospective cohort study.

Subtrochanteric femur fractures associate with a relatively high complication rate and are traditionally treated operatively with a period of limited weight bearing. Transitioning from extramedullary to intramedullary implants, there are increasing biomechanical and clinical data to support early weight bearing. This multicenter retrospective study examines the effect of postoperative weight bearing as tolerated (WBAT) for subtrochanteric femur fractures. We hypothesize that WBAT will result in a decreased length of stay (LOS) without increasing the incidence of re-operation. This study assesses total LOS and postoperative LOS after intramedullary fixation for subtrochanteric fractures between postoperative weight bearing protocols across 6 level I trauma centers (n = 441). Analysis techniques consisted of multivariable linear regression and nonparametric comparative tests. Additional subanalyses were performed, targeting mechanism of injury (MOI), Winquist-Hansen fracture comminution, 20-year age strata, and injury severity score (ISS). Total LOS was shorter in WBAT protocol within the overall sample (7.4 vs 9.7days; p < 0.01). Rates of re-operation were similar between the two groups (10.6% vs 10.5%; p = 0.99). Stratified analysis identified patients between ages 41-80, WH comminution 2-3, high MOI, and ISS between 6-15 and 21-25 to demonstrate a significant reduction in LOS as a response to WBAT. Animmediate postoperative weight bearing as tolerated protocol in patients with subtrochanteric fractures reduced length of hospital stay with no significant difference in reoperation and complication rates. If no contraindication exists, immediate weight bearing as tolerated should be considered for patients with subtrochanteric femur fractures treated with statically locked intramedullary nails. Therapeutic Level III.

A hybrid treatment modality of a subtrochanteric femoral fracture in a patient with osteoporosis due to a renal Fanconi syndrome: a case report.

A 24-year-old male with an idiopathic renal Fanconi syndrome presented to our ER after a low-energetic fall. Conventional imaging revealed a right subtrochanteric femoral fracture, severely decreased bone quality and cannulated collum femoris screws on the contralateral side. Regular plate-screw osteosynthesis or cephalomedullary implantation was deemed insufficient, due to a high iatrogenic and periprosthetic fracture probability. The decision was made to perform a plate-screw osteosynthesis combined with an intramedullary polymer bone enhancement (IlluminOss), to minimize this risk. No complications occurred perioperatively. The patient was able to walk independently two months postoperatively. This case shows that use of polymer implant as an enhancement of osteosynthesis in repair of fractures in the Fanconi syndrome is a safe and possible useful treatment method.