Treatment Of Intertrochanteric Fractures Research Articles

Evaluation of the results of intertrochanteric femur fractures fixation by dynamic hip screw versus gamma nail

Background: Femoral intertrochanteric fractures account for approximately half the hip fractures in elderly patients. The aim of this study is to evaluate the results of the treatment of intertrochanteric fractures in adults using Dynamic Hip Screw (DHS) and Gamma nail (GN) and evaluate radiologically the effect of these implants on normal proximal femoral morphology.Methods: This prospective randomized study was carried out on 40 patients ranged from 18 to70 years old (20 patients were managed by Dynamic Hip Screw (DHS) and 20 patients were managed by GN). Patients were subjected to: history taking, physical examination, mechanism of trauma, the harris hip score (HHS), radiographic evaluation.Results: There was significant difference regarding operative time, number of gauzes soaked with blood, number of C-arm shots and follow up time and insignificant difference Regarding gender, age or occupation, comorbid diseases and mechanism of injury or side of lesion, HHS score, postoperative complications, and postoperative changes of proximal femur, Conclusions: In femur fractures fixation, DHS and GN are useful in the treatment of trochanteric femoral fractures, although the results were slightly in favor of DHS fixation (in stable fractures), GN has shorter operative duration, less blood loss, earlier weight bearing despite of higher number of C-arm shots needed.

CLINICAL AND RADIOLOGICAL ASSESSMENT OF PATIENTS WITH INTERTROCHANTERIC FRACTURES MANAGED WITH PROXIMAL FEMORAL NAIL WITH HELICAL BLADE

Various treatment methods have been described for the treatment of intertrochanteric fractures. We present our experience with proximal femoral nail with helical blade in the management of intertrochanteric fractures at SGT Medical College Hospital and Research Institute, Gurugram. Methods: This study was conducted from October 2018 to April 2020 and included 30 patients above 18 years presenting with intertrochanteric fractures of femur managed by proximal femoral nail with helical blade. Clinical and Radiological evaluation of the patients was done at 6,12,18 and 24 weeks. Functional outcome was assessed according to Modied Harris Hip Score and was graded excellent, good, fair or pair as per the score. Results: The average age of patients in the present study was 58.16 years with slight male preponderance. The average operating time in the present study was 71.8 minutes. The average time of union was 18 weeks, with one case of implant failure and two cases of delayed union. average value of Neck-Shaft Angle in our study was 128.26 and the average Tip-Apex Distance (TAD) was 21.63mm. There was a case each of supercial infection and varus collapse. The average Modied Harris Hip score in present study was 90.5 with a range of 78-99, excellent in 63.33% patients, good in 26.66% of the patients and fair in 10% of the patients as per the Modied Harris Hip scoring system.

Meta-analysis of InterTan, PFNA and PFNA-II internal fixation for the treatment of unstable intertrochanteric fractures in elderly individuals.

Elderly individuals are often affected by osteoporosis and have poor stability after fracture reduction. Moreover, there is still controversy regarding the clinical effects of the treatment for unstable intertrochanteric fractures in the elderly. The Cochrane, Embase, PubMed, and other databases were searched, and a meta-analysis of the literature on the treatment of unstable intertrochanteric fractures of the elderly with InterTan, PFNA, and PFNA-II was conducted. Seven studies were screened, with a total of 1236 patients. Our meta-analysis results show that InterTan is not significantly different from PFNA in terms of operation and fluoroscopy times, but it takes longer than PFNA-II. In terms of postoperative screw cut, pain, femoral shaft fracture, and secondary operations, InterTan is superior to PFNA and PFNA-II. Conversely, in terms of intraoperative blood loss, hospital stay, and postoperative Harris score, there is no significant difference between InterTan and PFNA and PFNA-II. Compared to PFNA and PFNA-II, InterTan internal fixation has advantages in the treatment of unstable intertrochanteric fractures in elderly individuals in terms of screw cutting, femoral shaft fractures, and secondary operations. However, InterTan operation and fluoroscopy times take longer than PFNA and PFNA-II.

INTERTROCHANTERIC FEMUR FRACTURE

Introduction: Intertrochanteric fractures are a type of extracapsular fractures of the proximal femur occurring between the greater and lesser trochanter. They are frequently seen in the elderly because their incidence is higher as life expectancy increases. Objective: to describe the current information related to epidemiology, anatomy, presentation, classification, evaluation and management of intertrochanteric fractures. Methodology: a total of 35 articles were analyzed in this review, including review and original articles, as well as clinical cases, of which 27 bibliographies were used because the other articles were not relevant to this study. The sources of information were PubMed, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: transtrochanteric, intertrochanteric, femur, fracture, fratura. Results: Intertrochanteric fractures have a bimodal presentation. They have a female to male ratio ranging from 2:1 to 8:1, possibly due to changes in bone metabolism after menopause. They are frequently seen in the elderly because their incidence is higher as life expectancy increases. Plain radiographs are still the initial choice to complement the diagnosis in this type of fractures. It is preferable to take anteroposterior (AP), AP and lateral cross pelvis projections of the affected hip and full body radiographs of the affected femur. Surgical treatment is preferred over conservative treatment except in cases that contraindicate surgery or anesthesia. Conclusions: Intertrochanteric fractures are a type of extracapsular fractures of the proximal femur occurring between the greater and lesser trochanter. Femur fractures have several classifications, recently the classification of intertrochanteric fractures is based on the stability of this area. It is of vital importance to evaluate whether it is an open or closed fracture, in addition to assessing the neurovascular status. The surgical treatment has the mission of providing a stable internal fixation that allows early mobilization and full weight bearing. There are several tools and techniques to provide surgical treatment, however, in our current reality, intramedullary nails are the most used devices in the treatment of intertrochanteric fractures. Regardless of the therapeutic alternative chosen, the mortality risk is 20% to 30% in the first year after the fracture, with males being more affected than females. KEY WORDS: transtrochanteric, intertrochanteric, femur, fracture.

Treatment of irreducible intertrochanteric femoral fracture with a minimally invasive clamp reduction technique via the anterior approach

ObjectiveTo investigate the efficacy of the minimally invasive clamp reduction technique via the anterior approach in the treatment of irreducible intertrochanteric femoral fractures.MethodsFrom January 2015 to January 2021, 115 patients (48 males and 67 females) with irreducible intertrochanteric femoral fractures were treated. The average age of the patients was 78.7 (45–100 years old). The types of injuries were falls (91 cases), traffic accidents (12 cases), smashing (6 cases), and high falling (6 cases). The duration between injury and surgery ranged from 1 to 14 days, with an average of 3.9 days. The distribution of AO classification was as follows: 31-A1 in 15 cases, type 31-A2 in 67 cases and 31-A3 in 33 cases.ResultsAll patients achieved good reduction, with fracture reduction times ranging from 10 to 32 min (mean of 18 min), and were followed up for 12–27 months after surgery (mean of 17.9 months). Two patients with pronation displacement of the proximal fracture segment died of infection or hypostatic pneumonia after internal fixation failure; one patient with failed internal fixation switched to joint replacement. After internal fixation, the lateral wall of six reversed intertrochanteric femoral fractures showed repronation and abduction displacement, but all fractures achieved bony healing. The rest of the patients did not lose fracture reduction, and all fractures achieved bony healing with a healing time ranging from 3 to 9 months (mean of 5.7 months). While two patients died and one patient exhibited failed internal fixation and thus switched to joint replacement, 91 of the remaining 112 patients had an excellent Harris score of the hip joint function at the final follow-up, while 21 patients had a good Harris score.ConclusionThe minimally invasive clamp reduction technique via the anterior approach for the treatment of irreducible intertrochanteric femoral fractures is simple, effective and minimally invasive. In the case of irreducible intertrochanteric femoral fractures associated with lateral wall displacement, the lateral wall needs to be strengthened after clamp reduction and intramedullary nail fixation to avoid loss of reduction and failure of internal fixation.

Use of the Heracles straight blade in the treatment of intertrochanteric hip fractures: a prospective study with a 1-year follow-up.

The treatment of intertrochanteric fractures in the elderly remains challenging for orthopedic surgeons, due to aging, comorbidities, and poor bone quality. The Heracles straight blade has proven a lower rate of cut-out and femoral head displacement in biomechanical studies; however, there are currently no published clinical studies using this nail. To analyze the clinical and radiological results of the Heracles nail with the straight cephalic Heracles blade as a device to treat osteoporotic intertrochanteric fractures of the proximal femur. A total of 136 patients with trochanteric hip fractures were operated on by the same surgeon, using the Heracles nail with a straight cephalic blade. However, only 86 patients completed the 1-year follow-up both clinically and radiologically. According to the Association of Osteosynthesis classification, 38 patients (44.1%) had 31-A1, 36 patients (41.6%) had 31-A2, and 12 patients (14.1%) had 31-A3. Functional outcomes were assessed according to the Katz and Barthel scores, finding that 58% of patients recovered their original functional level, According to Barthel score, a mean loss of 11.8 points was found. The mean hospital stay was 8.22 days (mean preoperative stay of 2.71 days). The mean tip-apex distance was 15.2 mm. During the follow-up, 6 complications (6.96%) were detected: 4 cut-out, 1 cut-in, and 1 nail breakage. According to the Katz score, 58% of the patients recovered their previous functional status and 20.58% needed an additional walking aid. The mean loss in the Barthel score was 11.8 points. The Heracles nail using a cephalic straight blade has proven to be a valid treatment of trochanteric fractures, due to the functional recovery of the patients and low level of complications.

Clinical and radiological outcome of the Chimaera short nailing system in inter- and subtrochanteric fractures.

cephalomedullary devices are popular treatment for femoral intertrochanteric or subtrochanteric fractures. Various complications include post-surgical lateral thigh pain and cut-out. To prevent those complications, a new concept cephalomedullary device system was designed (Chimaera, Orthofix®). This study aimed to evaluate the clinical and radiological outcomes in patients with femoral intertrochanteric or subtrochanteric fractures treated with the proximal femoral cephalomedullary device system. A prospective cohort study involved consecutive patients with Arbeitsgemeinschaft für Osteosynthesefragen/ Orthopaedic Trauma Association type 31-A1, 2, 3 fractures treated with the Chimaera short cephalomedullary device system from October 2016 to September 2017 at our level 1 trauma center. The Parker and Palmer mobility score and Jensen social function scores and post-surgical lateral thigh pain were assessed at 3 months post-operatively and compared to before surgery. Radiologic assessment consisted of controlling the position of the cephalic screw by using the tip-apex distance (TAD) and Cleveland zone as well as union and cut-out rates. We included 99 patients (79 women; 100 hips; one bilateral fracture 3 months after a first trochanteric fracture) with a mean follow-up of 2 years. The Parker and Palmer mobility score decreased by 22% at 3 months post-operatively as compared with the pre-fracture score (42/99 patients showed a return to their pre-injury level). The Jensen social function score increased by 16.5% at 3 months post-operatively as compared with the pre-fracture score (68/99 patients showed a return to their pre-injury level). No major intra-operative complication was recorded. Nine TAD scores were > 25mm. The mean TAD was 16.5mm (range 5-36), and the lag screw position was well positioned in most (95%) hips according to Cleveland zones. Three patients required revision surgery (one for cut-out of the lag screw, one for hip osteoarthritis and one for gluteus medius insufficiency). All patients but the one with the cut-out showed fracture union. The Chimaera short cephalomedullary device exhibited good mid-term functional and radiological outcomes.

Insufficient proximal medullary filling of cephalomedullary nails in intertrochanteric femur fractures predicts excessive postoperative sliding: a case–control study

ObjectiveExcessive postoperative sliding is a common complication of intramedullary nails in the treatment of intertrochanteric femur fractures. The aim of this study was to identify risk factors for excessive postoperative sliding in the intertrochanteric fractures treated with an intramedullary nail.MethodsA retrospective analysis of 369 patients with femoral intertrochanteric fractures treated with short intramedullary nails between February 2017 and September 2020 was performed. Patients were classified into an excessive sliding group (ES group) and a control group according to the sliding distance after 6 months of follow-up. The proximal medullary filling degree (MFD), fracture reduction patterns in the anteroposterior (AP) view and lateral view, and tip-apex distance (TAD) were evaluated and compared in each group.ResultsThirty-three cases were included in the ES group, and 336 cases were included in the control group. No significant differences in age, sex, fracture side, AO Foundation and Orthopaedic Trauma Association (AO/OTA) classification, Dorr classification, Singh Osteoporosis Index (SOI), American Society of Anesthesiologists classification (ASA), TAD or fracture reduction patterns in the AP view were noted between the two groups. The negative reduction pattern can strongly predict excessive postoperative sliding (OR 4.286, 95% CI 1.637–11.216, P = 0.003). The incidence of excessive postoperative sliding increased by 8.713-fold when the MFD decreased by 10% (OR 8.713, 95% CI 1.925–39.437, P = 0.005).ConclusionsA low medullary filling degree and negative fracture reduction pattern in the lateral view were both independent risk factors for excessive postoperative sliding.

Serum HMGB1 levels and its clinical significance in elderly patients with intertrochanteric fractures after intramedullary fixation surgery.

Intramedullary fixation is a valuable alternative for the treatment of intertrochanteric fractures. However, further development of new biomarkers to predict the prognosis of the patient is still needed for timely and effective treatment and intervention. The present study aimed to explore the serum high-mobility group box 1 (HMGB1) levels in the prognosis of intertrochanteric fracture patients and its correlation with clinical results. The present prospective cohort study recruited 115 intertrochanteric fracture patients who were admitted from January 2015 to December 2019. All patients were evaluated preoperatively and treated (proximal femoral nail antirotation or intramedullary proximal femoral nail) by the same team. The serum HMGB1, interleukin-6, interleukin-1β, tumor necrosis factor α, and C-reactive protein levels were measured by enzyme-linked immunosorbent assay. Demographic and clinical data of all patients were collected. Harris score was used to assess the prognosis of intertrochanteric fracture patients after 6 months of treatment. Statistical analysis was conducted using SPSS software with P < .05 as statistically different. The time of the operation and the amount of bleeding in intramedullary proximal femoral nail were remarkably elevated compared with the proximal femoral nail antirotation group (P < .05). The age, proportion of complications and visual analogue score VAS after 72 hours of surgery in the Harris score < 80 group were remarkably increased compared with Harris score ≥ 80 group (P < .05). In addition, we found that the serum HMGB1 levels in Harris score < 80 group were markedly elevated than the patients in Harris score ≥ 80 group at all time points (P < .05). The results showed that the serum HMGB1 levels at postoperative 48 hours had the highest predictive value for predicting poor prognosis in intertrochanteric fracture patients. It was found that HMGB1, age and VAS after 72 hours of surgery were the risk factors for poor prognosis of intertrochanteric fracture patients. This study showed that the serum HMGB1 levels was significantly decreased in intertrochanteric fracture patients with bad prognoses. This study may provide a new approach to screening intertrochanteric fracture patients with worse prognoses in advance.

Topical tranexamic acid in intramedullary nailing for the treatment of intertrochanteric fractures in the elderly: A protocol for systematic review and meta-analysis.

Numerous studies have demonstrated that the use of tranexamic acid (TXA) intravenously minimizes bleeding, lowers transfusion rates, and does not raise the risk of complications during major orthopedic surgery. Concerning the effectiveness of the topical application, there are, nevertheless, inconsistent findings. We aimed to develop a protocol for systematic review and meta-analysis on the benefits and safety of topical TXA in intramedullary nailing for the treatment of intertrochanteric fractures in the elderly. PubMed, Embase, and the Cochrane Library will all be searched for randomized controlled trials published from the database inception to October 15, 2022. The primary outcomes will be intraoperative blood loss, hidden blood loss, total blood loss, transfusion rate, transfusion units, operative time, thromboembolic events, and mortality. The risk of bias will be evaluated using the Cochrane risk of bias assessment tool. Review Manager 5.3 will be used for the analysis. The effects and safety of topical TXA in intramedullary nailing for the treatment of intertrochanteric fractures in the elderly will be quantified in this study. The study's findings will assist doctors in determining if topical TXA use is secure and efficient.

Comparison of clinical outcomes with proximal femoral nail anti-rotation versus dynamic hip screw for unstable intertrochanteric femoral fractures: A meta-analysis.

The aim of this meta-analysis was to evaluate the advantages and disadvantages of proximal femoral nail anti-rotation (PFNA) versus dynamic hip screw (DHS) for the treatment of unstable intertrochanteric fractures, including the available evidence drawn from the literature. A systematic search was conducted to identify available and relevant randomized controlled trials and retrospective comparative observational studies regarding PFNA compared against DHS in treating unstable femoral intertrochanteric fractures in Embase, PubMed, Cochrane Library, Web of Science, and Scopus Online up to February 12, 2022. Data from the included studies were extracted independently by 2 reviewers and analyzed using RevMan 5.3, and the quality of the studies was assessed. Five randomized controlled trials and 12 observational studies were recruited and met the inclusion criteria, which consisted of 1332 patients with PFNA and 1271 patients with DHS. The results of the meta-analysis showed that, compared with the DHS, PFNA exhibited a beneficial role in postoperative Harris Hip Scores, operation time, intraoperative blood loss, length of hospital stay, fracture healing time and full weight-bearing time, limb shortening, cutout, reoperation, union problems, the varus collapse of the femoral head/neck, and infection; however, DHS was superior to PFNA in hidden blood loss (relative risk [RR] = 139.81, 95% confidence interval [CI] [136.18, 143.43], P < .00001), postoperation drainage (RR = -17.85, 95% CI [-30.10, -5.60], P = .004), total blood loss (RR = 50.34, 95% CI [42.99, 57.69], P < .00001), and femoral shaft fracture (RR = 4.72, 95% CI [1.15, 19.32], P = .03) treated by DHS were significantly decreased, compared with those by PFNA; however, no significant differences were observed in tip-apex distance, fixation failures, screw migration, or other complicants between the 2 surgical methods. Analysis of a large number of relevant clinical indicators available shows that PFNA has better clinical manifestation than DHS in treating unstable femoral intertrochanteric fractures.

PROSPECTIVE FUNCTIONAL OUTCOME STUDY OF PRIMARY CEMENTED HEMIARTHROPLASTY USED IN MANAGEMENT OF UNSTABLE INTERTROCHANTERIC FRACTURES IN THE ELDERLY PATIENTS

Introduction: Hip fractures are the most commonly occurring fracture which leads to substantial morbidity and mortality in elderly population. Conventional treatment with internal xation devices in osteoporotic bones leads to screw cutout,implant breakage, varus collapse of femoral head and shortening on early weight bearing. Aim of this study is to asses functional outcome of cemented bipolar hemiarthroplasty in treatment of unstable intertrochanteric fracture. This study includes 20 cases of comminuted, Material&amp;Method: unstable (AO/OTA type 31-A2.2 and type 31-A2.3) intertrochanteric fractures which had undergone cemented bipolar hemiarthroplasty and functional outcome was measured on sequential follow up on 3, 6 and 12 months post operatively with help of modied harris hip score. Bipol Results: ar hemiarthroplasty can be used as an alternative to conventional internal xation techniques as it provides stable xation and early weight bearing mobilisation, but is a technically demanding procedure so it requires more operative time, familiarity of surgeon to the technique along with incresed intraoperative blood loss. Conclusion: Bipolar hemiarthroplasty provides an effective alternative to internal xation techniques for treatment of unstable intertrochanteric fractures

Comparing the supine and lateral positions for proximal femoral nail use in the treatment of intertrochanteric femoral fractures

Background/Aim: The management of unstable intertrochanteric fractures (ITF), which are becoming more common, is still a significant issue for public healthcare systems. As a result, successful fracture therapy is becoming a more crucial aspect of orthopedic practice. To treat older patients who have an ITF, this study compared the therapeutic outcomes and side effects of proximal femoral nail anti-rotation (PFNA) conducted in lateral decubitus and supine postures. Methods: One-hundred twenty patients between the ages of 65 and 90 who underwent PFNA surgery as a result of an unstable femoral ITF brought on by low-energy trauma were included in the study, which was conducted as a retrospective cohort study. Two groups of patients were established: (1) Group L, consisting of patients who underwent surgery in the lateral decubitus position and (2) Group S, consisting of patients who underwent surgery in the supine position. Several patient characteristics were compared: (1) demographic information, (2) length of hospital stay, (3) length of surgery, (4) intra-operative blood loss, (5) incision length, (6) number of intra-operative fluoroscopies, (7) duration of activity outside of bed, (8) duration of clinical recovery of fracture, (9) surgical complications, (10) patient outcomes, and (11) Harris hip scores (HHS). Results: Group L (60 patients) consisted of patients who underwent surgery in the lateral decubitus position, while Group S (60 patients) underwent surgery in the supine position (60 patients). The average hospital stay for patients receiving PFNA was 8.2 days for those in the supine position compared to 8.0 days for those in the lateral decubitus position. The difference between the operative times was significant (P&lt;0.001) with 48.6 and 59.7 min in Groups L and S, respectively. Intra-operative blood losses in Groups L and S were 129.2 and 151.5 mL, respectively. Compared to Group S, Group L's mean incision length was much lower at 6 cm (as compared to 8 cm in Group S). The difference between the mean intra-operative radiation exposure times for Groups L and S was considerable at 9.38 versus 12.5 min. The mean times for fracture union and the HHS were not statistically different between the two groups after 12 weeks of treatment. Conclusion: ITFs in elderly patients can be successfully treated with PFNA in either the lateral decubitus or supine position. Surgical duration, blood loss, intra-operative X-ray exposure, and incision lengths were all reduced with PFNA performed in the lateral decubitus position. As a result, treatment of ITFs in older individuals may involve PFNA fixation in the lateral decubitus position. Particularly for people with a muscular gluteal region or obese patients, the lateral decubitus position is advised.

Comparison of Cephalomedullary Nails with Sliding Hip Screws in Surgical Treatment of Intertrochanteric Fractures: A Cumulative Meta-Analysis of Randomized Controlled Trials.

The primary objective of the present study was to compare surgical failures of intertrochanteric fractures of the femur through a meta-analysis of randomized controlled trials and to assess the change in surgical outcomes over time in a cumulative meta-analysis. To identify studies evaluating the surgical outcomes of internal fixation using sliding hip screws (SHS) or cephalomedullary (CM) nails for the treatment of intertrochanteric fractures of the femur, all records until August 2021 in the PubMed, Embase, and Cochrane Library databases were searched. Studies with the following characteristics were considered eligible: patients who had an intertrochanteric fracture of the femur (population); patients who received surgical treatment using a CM nail (intervention); patients who received surgical treatment using SHS (comparator); surgical failures that required reoperation, including cut-out or cut-through of lag screws, varus collapse or posterior angulation of proximal fragments, loosening of lag screws or helical blades, and fracture nonunion (outcomes); and two reviewers independently reviewed the titles and abstracts of the randomized controlled trials and selected relevant studies for a full-text review (study design). Twenty-one studies were included in the final analysis consisting of 1,777 cases in the SHS group and 1,804 cases in the CM nail group. The cumulative standard mean difference was 0.87, indicating that CM nails had no significant effect in improving the surgical outcomes. There was no significant difference in surgical failure between SHS and CM nails for all intertrochanteric fractures (odds ratio [OR], 1.07; 95% confidence interval [CI], 0.76-1.49). Pooled data showed no significant difference between the two groups in terms of surgical failure in unstable intertrochanteric fractures (OR, 0.80; 95% CI, 0.42-1.54). Although the use of CM nails has become a current trend in the treatment of intertrochanteric fractures, there is no literature supporting their clinical superiority when compared with SHS.

Cephalomedullary Nailing has a Higher Reoperation Rate Compared to Sliding Hip Screw Fixation in the Treatment of Intertrochanteric Femur Fractures: A Systematic Literature Review and Meta-analysis.

Intertrochanteric hip fractures are a common orthopaedic injury in the United States. Complications of surgical treatment include nonunion, lag screw cutout, implant failure, post-operative pain, risk of refracture or reoperation, and infection. The purpose of this study was to compare the rate of complications of sliding hip screw fixation (SHS) compared to cephalomedullary nailing (CMN) for the treatment of closed intertrochanteric femur fractures in adult patients. PubMed, CINAHL, and Cochrane Library databases were searched for studies comparing SHS to CMN in the treatment of closed intertrochanteric femur fractures in adults. Data were compiled to observe the rate of nonunion, cutout failure, infection, refracture, perioperative blood loss, reoperation, postoperative pain, pulmonary embolism/deep venous thrombosis (DVT), length of hospital stay, and mortality. Seventeen studies were included comprising 1,500 patients treated with SHS and 1,890 patients treated with CMN. Treatment of intertrochanteric femur fractures with SHS demonstrated significantly fewer refractures and reoperations. There was no significant difference in other variables between SHS and CMN treated groups. This meta-analysis shows that the only notable difference in outcomes is patients treated with CMN have a higher rate of refracture and reoperation. With new advances in the development of both CMNs and SHS, further studies will be required to see if these differences persist in the coming years.

Retracted: Treatment of Elderly Femoral Intertrochanteric Fracture by InterTan Intramedullary Nail and PFNA.

[This retracts the article DOI: 10.1155/2022/5020960.].

Retracted: Treatment of Coronal Plane Femoral Intertrochanteric Fractures with a Microexternal Fixator Combined with Proximal Femoral Nail Antirotation.

[This retracts the article DOI: 10.1155/2022/1735603.].

FUNCTIONAL OUTCOME OF INTERTROCHANTERIC FRACTURES TREATED BY PROXIMAL FEMORAL NAIL ANTIROTATION

INTROCUCTION Intertrochanteric fractures are commonly encountered in elderly population. Nearly half of the fractures are unstable. Surgical fixation is mostly preferred due to early mobilization and to avoid complications of conservative treatment. Unsatisfactory results with extramedullary fixation led to the rise of intramedullary devices. Our aim in this study is to analyze the effectiveness and pitfalls of Proximal Femoral Nail Antirotation (PFNA) in the treatment of unstable intertrochanteric fractures. METHODS This prospective study was conducted during October 2017 to January 2019 in our hospital. A total of 20 patients (13 males, 7 females) above 50 years of age having unstable intertrochanteric fracture were treated with Proximal Femoral Nail Antirotation. About 75% of injuries occurred due to trivial fall. Mean interval between trauma and surgery was 3.95 days. All patients were treated by closed reduction. The study participants were followed up for a minimum duration of six months and were assesed using Harris Hip Score. RESULTS Anatomical reduction was achieved in 16 patients. Post operative complications include superficial infection, lag screw back out, delayed union in one case. The average time of union was 14.6 weeks. By the end of six months, good to excellent results were seen in 80% of patients. 75% patients returned to pre injury functional level. CONCLUSION PFNA gives optimal fixation for Intertrochanteric fractures, with good preoperative planning and intraoperative reduction. It’s the ideal implant for osteoporotic elderly population as it provides good cancellous bone compaction, less operative time and blood loss when compared to other fixation methods.

Long PFNA-II versus Dynamic Hip Screw for Treatment of Unstable Intertrochanteric Femur Fracture

Background: Intertrochanteric femur fractures are one amongst the most common hip fracture presenting to our centre. Clinical efficacy and safety of PFNA and DHS in the treatment of unstable intertrochanteric fractures in elderly patients and found that compared with the control group (DHS), the observation group (PFNA) experienced shorter operation time and fracture healing time and less intraoperative blood loss, and suffered a shorter incision. The purpose of this study was to compare the functional outcomes and related complications between DHS and PFNA in treatment of unstable intertrochanteric femur fracture. Methodology: Total of 60 patients having unstable intertrochanteric femur fracture were included in this study and was equally divided into two groups. Group-P included patients with unstable intertrochanteric femur fracture managed by PFN-A II while Group-D patients managed by DHS. The result was analysed using descriptive statistics and making comparisons among various groups. Categorial data were summarized as in proportions and percentage (%) while discrete as mean ± SD. Results: At final follow-up; it was found that 72.4% of the cases of PFNA have achieved excellent union as compared to 44.4% for DHS group, 24.1% cases of PFNA have good union as compared to 51.9% in DHS group and the difference of mean DHS was significantly higher for PFNA group (p=0.001). Conclusion: PFNA-II have benefits like minimally invasive procedure, less soft tissue dissection, less amount of blood loss and provides better result in terms of union. Therefore PFNA-II is recommended as a better choice as compared to DHS in management of unstable intertrochanteric fractures in terms of functional outcome.

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

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