Treatment Of Subtrochanteric Fractures Research Articles

Subtrochanteric Femur Fractures: The Association Between Obesity and Perioperative, Clinical, and Radiographic Outcomes.

To evaluate the association between obesity and treatment approaches, perioperative factors, and clinical and radiographic outcomes following subtrochanteric fracture fixation. Retrospective Cohort. Academic Medical Center. Patients operatively treated for an AO/OTA 32Axa, 32Bxa, or 32Cxa subtrochanteric femur fracture. Injury characteristics, perioperative parameters, fixation information, postoperative complications, and clinical and radiographic outcomes. Univariate analyses were conducted between the obese (BMI ≥30 kg/m2) and the nonobese (BMI <30 kg/m2) cohorts. Regression analyses were performed to assess BMI as a continuous variable. Of 230 operatively treated subtrochanteric fracture patients identified, 49 (21%) were obese and 181 (79%) were nonobese. The average age of the obese cohort was 69.6 ± 17.2 years, with 16 (33%) male and 33 (77%) female. The average age of the nonobese cohort was 71.8 ± 19.2 years, with 60 (33%) male and 121 (77%) female. Aside from BMI, there were no significant differences in demographics between the obese and nonobese (age [P = 0.465], sex [P = 0.948], American Society of Anesthesiology Score [P = 0.739]). Both cohorts demonstrated similar injury characteristics including mechanism of injury, atypical fracture type, and AO/OTA fracture pattern (32A, 32B, 32C). Obese patients underwent more open reduction procedures (59% open obese, 11% open nonobese, P < 0.001), a finding further quantified by a 24% increased likelihood of open reduction for every 1 unit increase in BMI (OR: 1.2, 95% CI, 1.2-1.3, P < 0.001). There was no difference in average nail diameter, 1 versus 2-screw nail design, or number of locking screws placed. The obese cohort was operated more frequently on a fracture table (P < 0.001) when compared with the nonobese cohort that was operated more frequently on a flat table (P < 0.001). There were no significant differences (P > 0.050) in postoperative complications, mortality/readmission rates, hospital quality measures, fixation failure, or time to bone healing. The treatment of subtrochanteric fractures in obese patients is associated with a higher likelihood of surgeons opting for open fracture reduction and the use of different operating room table types, but no difference was observed in postoperative complications, mortality or readmission rates, or healing timeline when compared with nonobese patients. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Intramedullary nailing of subtrochanteric fractures in elderly patients: Comparative study of helical blade cephalomedullary nail versus reconstruction nail

IntroductionIntramedullary nailing (IMN), which is a common method for treating subtrochanteric fractures, is conducted as cephalomedullary (CMN) or reconstruction (RCN) nailing. Numerous studies have reported the effectiveness of CMN, which requires a shorter surgery time and provides stronger fixation strength with blade-type devices. However, the radiographic and clinical outcomes of the use of CMN and RCN in elderly patients aged ≥65 years have not been compared yet. This study aimed to investigate whether CMN offers superior outcomes over RCN in the treatment of subtrochanteric fractures in elderly patients. Materials and methodsThis retrospective study included 60 elderly patients (17 men and 43 women; mean age: 74.9 years) diagnosed with subtrochanteric fractures and treated with IMN with helical blade CMN (CMN group: 30 patients) or RCN (RCN group: 30 patients) between January 2013 and December 2018 with at least 1 year of follow-up period. Radiologic outcomes were evaluated based on the postoperative state of alignment and the achievement and timing of bony union at the final follow-up. Clinical outcomes were evaluated using the Merle d'Aubigné–Postel score. Radiologic and clinical outcomes in the two groups were compared and analyzed, and the occurrence of complications was examined. ResultsThe difference in malalignment between the two groups was not significant; however, the RCN group achieved more effective reduction. At the final follow-up, bony union was achieved within 18.9 weeks, on average, in 28 patients in the CMN group and within 21.6 weeks, on average, in 27 patients in the RCN group. Twenty patients in the CMN group and 26 in the RCN group showed good or better results according to the Merle d'Aubigné–Postel score. No significant differences were found for any of the parameters. ConclusionsIn the treatment of difficult subtrochanteric fractures in elderly patients, RCN can provide excellent reduction and strong fixation similar to CMN and can result in outstanding clinical and radiologic outcomes.

The Treatment of Subtrochanteric Fracture with Reversed Contralateral Distal Femoral Locking Compression Plate (DF-LCP) Using a Progressive and Intermittent Drilling Procedure in Three Osteopetrosis Patients.

ObjectiveTo describe the application of reversed contralateral distal femoral locking compression plate (DF‐LCP) inserted through a progressive and intermittent drilling procedure in the treatment of osteopetrotic subtrochanteric fracture (OSF).MethodsThree patients (one male and two females with an average age of 45.33 ± 11.09 years) with OSF hospitalized between September 2015 and September 2020, were included in this present study. Lateral approach was applied in all patients who accepted open reduction and internal fixation (ORIF) with a reversed contralateral DF‐LCP inserted through a progressive and intermittent drilling procedure. The operation time and intraoperative blood loss were recorded to evaluate the efficiency of this surgical method. Physical examination and imaging examination of the fracture site were used to evaluate the fracture union status, the position and stability of the implant, and the alignment of the injured limb at 1, 3, 6, and 12 months after operation, then a subsequent visit was conducted at least once a year. Harris Hip Score (HHS) was used to evaluate the hip joint function at 6 and 12 months after operation.ResultsThe average operation time was 140 ± 21.60 min (110, 160, and 150 min); The average intraoperative blood loss was about 333.33 ± 23.57 ml (300, 350, and 350 ml). The average follow‐up time was 22.33 ± 7.41 months (29, 26, and 12 months). All patients achieved bone union with an average time of 6.67 ± 0.94 months (6, 8, and 6 months). At the time of 6 months after operation, case 1 and 3 were almost pain‐free and could walk with full weight bearing while case 2 could walk only with partial weight bearing using a crutch. The HHS scores of cases 1, 2, and 3 were 84/100, 74/100, and 92/100, respectively. At the follow‐up at 12 months after operation, the HHS score improved to 91/100, 81/100, and 96/100, respectively. The contralateral incomplete old subtrochanteric fracture was deteriorated in case 1 at 26 months after operation. After 3 months of limited weight bearing using a crutch, bone union was verified in radiograph imaging. Fresh contralateral subtrochanteric fracture occurred in case 2 at 26 months after operation, which was treated using a similar surgical approach, and its clinical outcome is under follow‐up. Moreover, no perioperative complications including operation‐related death, vascular/nerve injury, deep venous thrombosis, pulmonary embolism, and incision infection, and long‐term complications involving malunion, nonunion, implant failure, ankylosis, heterotopic ossification, osteonecrosis, and osteomyelitis were identified.ConclusionThe application of reversed contralateral DF‐LCP in OSF is practicable and reliable. Progressive and intermittent drilling is a safe and efficient method for implant insertion in this complicated situation.

Management Of Subtrochanteric Femoral Fractures Using Proximal Femoral Nail

Background: Fractures of the proximal femur are a big challenge in traumatology. Rapid strides in implant and instrumentations in quest of ideal fixation of subtrochanteric femoral fractures have made various options available. Objective: The present study aims to study the role of standard proximal femoral nail (PFN) in the management of these fractures. This study aimed to evaluate the results of treatment of subtrochanteric femoral fractures using PFN. Patients and methods: This prospective study conducted at Orthopedic Department, Zagazig University Hospital, from November 2020 to July 2021. It included 24 patients, complaining of closed subtrochanteric fractures treated with PFN (Gamma intramedullary nail). The age ranged from 23 to 87 years (with mean54.21 years), 13 of them were males and 11 females. Road traffic accident (RTA) represented the most common mechanism of injury in 10 patients (41.7%) while fall down represented (37.5%) in 9 patients, and fall from height in 5 patients (20.8%). Results: there was statistically significant difference in HHS among patients with different age groups, mechanism of injury and presence of diabetes mellitus (DM) as associated condition. Statistically there was significant correlation between type of reduction and diabetes mellitus with Harris hip score. Conclusion: This study concluded that the Gamma nail is an excellent choice in treatment of subtrochanteric fractures as it has many advantages as allowing for early functional exercise and full weight-bearing of the affected limb, shortening the duration of operation, high rotation stability, small wounds and minimizing blood loss along with risk of infection

Cementless total hip arthroplasty for failed treatment of subtrochanteric fracture

BackgroundFailed treatment of subtrochanteric fractures commonly leads to pain, limping, and poor limb function. Cementless total hip arthroplasty (THA) could serve as an efficient salvage procedure in such cases. This study aimed to evaluate the outcomes and complications of salvage THA in failed subtrochanteric fracture fixation cases.MethodsFrom January 2001 to December 2017, cementless THA for failed treatment of subtrochanteric fractures was performed in 18 hips of 11 men and 7 women (average age, 74 years; age range, 57.0–89.0 years). Patients were followed up for clinical and radiological assessments in terms of implant survival and complications after a minimum follow-up of 2 years. The Wagner femoral stems (Zimmer, Warsaw, USA) were used in all 18 patients (100%), with the long-length stem (Wagner SL stem) and standard-length stem (Wagner cone stem) used in 11 and 7 patients, respectively.ResultsThe mean follow-up period was 5.2 years (range: 2.2–10.8 years). The mean Harris hip score (HHS) was 38.2 (range: 24–56) preoperatively and 85.4 (range: 79–92) at the last follow-up. The mean postoperative limb length discrepancy was 6.4 mm (range: 4–9 mm). Only one patient underwent revision due to bone in-growth failure of the femoral stem. One patient had an episode of postoperative dislocation and was treated with closed reduction without reoccurrence. Delayed union of the fracture site occurred in one patient. Patients who were previously treated with an intramedullary nail had a significantly shorter surgical duration, lesser intraoperative blood loss, and fewer blood transfusions than those who were previously treated with plate and screws. Kaplan–Meier survival rate with an endpoint of revision was 94.4% (95% confidence interval 72.7–99.9) at 5 years.ConclusionOur results indicate that cementless THA is a beneficial and effective procedure for salvaging the failed treatment of subtrochanteric fractures. The Wagner conical prosthesis has shown satisfactory function outcomes, stable fixation, and survival rate for these complex situations. However, attention should be paid to increased operation time, blood loss, and complications when performing THA for subtrochanteric fractures with failed fixation devices especially, plates and screws.

Comparison of third generation long Gamma nail and femur intramedullary nail for the treatment of femoral subtrochanteric fractures

Background/Aim: Internal fixation is the current gold standard procedure in treatment of subtrochanteric femur fractures. One of the most common causes of morbidity after subtrochanteric femoral fracture treatment is mechanical complications, such as implant failure. The aim of this study is to share our experience and compare the radiological and functional results of two different fixation implants in patients with subtrochanteric fractures. Methods: A cohort of 57 patients with a subtrochanteric fracture operated using a third generation Gamma nail (G3LN) or an anterograde intramedullary nail (AIMN) were prospectively followed up. Twenty-eight underwent fracture fixation with the Gamma nail while the other twenty-nine were operated using a conventional AIMN. All patients were followed up until union or, in case of a revision, healing and recovery. Their radiological findings were retrospectively analyzed, and the functional results were assessed using a Harris Hip Score. Results: Data regarding demographic properties such as sex, trauma mechanism and smoking were similar for the subgroups (P 0.05 for each). Compared to the AIMN group, whose reduction was mostly acceptable (48.28%), the majority of G3LN patients (57.14%) had an anatomical reduction on early follow up. Most fractures, regardless of the implant used, needed an open reduction. Both implants showed similar union time and had similar final HHS scores. None of the complication rates reached statistical significance between the two groups (P>0.05 for each). Conclusion: Both third-generation Gamma Nail implant and anterograde intramedullary nailing are viable means of fixation for subtrochanteric hip fractures. They lead to similar and few complications while providing a rigid and secure fixation. These findings lead us to believe that good reduction and adherence to the principles of internal fixation rather than implants used are the key to success in the treatment of subtrochanteric fractures.

Dynamic hip screw fixation of subtrochanteric femoral fractures

IntroductionA subtrochanteric proximal femur fracture occurs in the 5 cm of bone immediately distal to the lesser trochanter. UK national guidelines advise that adults with subtrochanteric fractures should be treated with an intramedullary nail (IMN). This study aims to compare peri-operative outcome measures of patients with subtrochanteric fractures treated with either an IMN or a dynamic hip screw (DHS) construct.Materials and MethodsWe retrospectively reviewed subtrochanteric fractures presenting at our institution over 4.5 years (October 2014–May 2019), classifying them into two treatment groups; IMN and DHS. These groups were compared on outcome measures including surgical time, blood loss, radiation dose area product (DAP), length of stay, re-operation rate and mortality.ResultsDuring the time period studied, 86 patients presented with a subtrochanteric fracture of the femur; with 74 patients (86%) receiving an IMN and 12 (14%) receiving a DHS. The comparative outcome measures reaching statistical significance were blood loss and radiation DAP. The DHS group showed a significantly lower mean blood loss of 776 ml compared to 1029 ml in the IMN group. Also, the DHS group showed a significantly lower mean DAP of 150.30 mGy cm2 compared to 288.86 mGy cm2 in the IMN group.ConclusionAlthough UK national guidelines recommend treating all subtrochanteric fractures with an IMN; the outcome measures assessed in our study did not show use of an IMN to be superior to a DHS. The DHS group showed a lower estimated blood loss and a reduced DAP. This, along with the reduced financial cost associated with a DHS, may support the use of DHS over IMN for certain subtrochanteric fractures of the femur. There may not be a single favourable implant for the treatment of subtrochanteric fractures as a whole; instead different subtypes of fracture may be amenable to a number of fixation devices. Choice of implant should be determined locally and based on existing and future clinical and health economic research.

Case series and finite element analysis of PFNA combined with cerclage wire for treatment of subtrochanteric fracture of femur

ObjectiveTo retrospectively analyze the clinical efficacy of PFNA combined with a cerclage wire in the treatment of 52 patients with unstable subtrochanteric fracture of the femur and to analyze the biomechanical effect of ligature on a fracture model.MethodsIn this study, 52 patients with unstable subtrochanteric fractures were treated in our orthopedic trauma center from June 2013 to July 2018. The Seinsheimer type IV fracture model was established using the patient’s CT data, and the joint surface of the distal femoral condyle and the external condyle were restrained. The femoral head was used as the loading point, and a force of 500 N was applied vertically along the long axis of the femoral shaft.ResultsAll 52 patients were followed up for 12 to 37 months, with an average of 18.07 ± 4.38 months. According to the Sanders hip function score, 28 cases were excellent (55–60 points), 22 cases were good (45–54 points), and 2 cases were poor (35–44 points), with an excellent and good rate of 96.15%. Postoperative deep vein thrombosis occurred in 3 cases, and fracture nonunion occurred in 1 case. No infection, loose fracture of internal fixation or hip varus deformity occurred. The finite element analysis indicated that the displacement of the whole model decreased slightly and the relative sliding of the fracture block decreased, but the maximum stress of the femur increased after the addition of the cerclage wire.ConclusionThe treatment of unstable subtrochanteric fracture of the femur with PFNA combined with cerclage wire has the advantages of simple operation, satisfactory reduction of fracture, stable fixation, and good recovery of limb function. The finite element analysis suggested that the biomechanical strength fixation was enhanced after the addition of cerclage wire. However, the local stress concentration of the tie may increase the risk of failure.

Does Cerclage wiring with Intramedullary Nailing in Subtrochanteric Fractures Improve the Final Outcome?

Treatment of subtrochanteric fractures is challenging due to anatomical and biomechanical factors. Many methods have been suggested to achieve and maintain fracture reduction during operative fixation for subtrochanteric fractures. Open reduction and intramedullary fixation, clamp assisted reduction without cerclage wires and fracture reduction cables are suggested methods. We conducted a retrospective study to look for the results of subtrochanteric fractures managed by intramedullary fixation with or without cerclage wires. We reviewed all cases of subtrochanteric fractures operated with intramedullary fixation with long proximal femoral nail with or without cerclage wire fixation. All available data from patient’s records available in medical records department were retrieved and evaluated. Statistical analysis were performed using SPSS software (v16). There were 86 cases of subtrochanteric fractures operated with intramedullary fixation at our Hospitals over a period of 5 years. Quality of fracture reduction of fractures are assessed good reduction was seen more often in cerclage group 64%. Cerclage wiring was done in 14 cases. Nonunion was seen in 8 cases overall, 3 in cerclage group and 5 in non Cerclage group. Implant failure was seen in 3 cases in no cerclage group and 2 cases of cerclage group. We conclude that anatomical reduction is the key factor for successful outcomes. Closed reduction with good to acceptable reduction had better results. Cerclage wiring should be considered in selected cases where reduction is poor after open reduction.

Treatment of subtrochanteric fracture in children:Titanium elastic nails versus plate and screws

Treatment of subtrochanteric fracture in children:Titanium elastic nails versus plate and screws

Natural reduction at prone position in treatment of femoral subtrochanteric fractures with intramedullary nailing

Objective To evaluate natural reduction at prone position in the treatment of femoral subtrochanteric fractures with intramedullary nailing. Methods The clinical data of 7 patients with subtrochanteric fracture were retrospectively analyzed who had been treated at Orthopaedic Department, Beijing Tsinghua Changgung Hospital from August 2016 to April 2018. They were 4 males and 3 females, aged from 31 to 87 years (average, 55.6 years). Their fractures happened on the left side in 3 patients and on the right side in 4. By the Seinsheimer classification, there were 3 cases of type Ⅱ, 2 cases of type Ⅲ and 2 cases of type Ⅴ. The time from injury to surgery ranged from 9 to 44 hours, averaging 26 hours. All patients were treated by intramedullary nailing after natural reduction at prone position. Their preoperative preparation time, time required for reduction, total operation time, fluoroscopic frequency for guide pin insertion, fluoroscopic frequency for reduction, reduction quality, complications and curative effect were recorded. Results Closed reduction and intramedullary nail fixation were completed uneventfully in all the 7 cases. Their preoperative preparation time averaged 29.4 min (from 21 to 42 min), reduction time 6.3 min (from 3 to 10 min), and total operation time 157 min (from 82 to 275 min). Their fluoroscopic frequency averaged 37 times (from 14 to 96 times) for guide pin insertion and 23 times (from 10 to 49 times) for reduction, totaling 244 times (from 121 to 360 times). According to the modified Baumgaetner criteria, the fracture reduction was evaluated as excellent in 6 cases and as fair in one. The 7 patients were followed up for 12 to 34 months (mean, 20.1 months). A drill broke at the interlocking nail hole during operation in one patient, deep venous thrombosis occurred at a lower extremity in another during hospitalization, and fracture nonunion was observed after operation in another, but no complications related to the prone position were observed. The curative effect evaluated by Harris hip score at the last follow-up was excellent in 4 cases, as good in 2 cases and as fair in one. Conclusion In the treatment of femoral subtrochanteric fractures with intramedullary nailing, the prone position benefits natural reduction and maintenance of reduction and allows convenient fluoroscopy and nail placement during operation, especially for obese patients. Key words: Hip fractures; Fracture fixation, intramedullary; Bone nails; Reduction; Prone position

Complications involved in treatment of sub trochanteric fractures by ORIF with long PFN

Complications involved in treatment of sub trochanteric fractures by ORIF with long PFN

To compare the clinicoradiological outcome of various operative techniques and fixation devices in treatment of subtrochanteric fractures

Background: There are various operative techniques and fixation devices in treatment of subtrochanteric fractures. The objective of treatment is restoration of optimal functions in the shortest possible time by the safest and most dependable method of treatment. Aim: To compare the clinicoradiological outcome of various operative techniques and fixation devices in treatment of subtrochanteric fractures and its variants. To compare the efficacy of various operative techniques in management of subtrochanteric fractures and its variants. To assess efficiency of various fixation devices in different (A-O) types of subtrochanteric fractrues and to compare our results with those available in literature. Methods: This prospective study was conducted in department of orthopedic surgery, in a span of two years. 38 Cases of subtrochanteric fractures and two types of extensions of subtrochanteric fractures admitted in orthopedics wards and treated by various operative methods were included in the study. Results: Malunion was seen in 3 cases and infection in 2 cases. Excellent and good results were seen in most of the cases fixed with intramedullary devices 35% &amp; 39% respectively) and these using closed techniques (38% &amp; 43% respectively). Majority of excellent result (52%) were seen in cases fixed with Proximal Femoral Nail. Most of the cases fixed using Dynamic Condylar Screw and Dynamic Hip Screw had fair to good results. Conclusion: Successful management of a case of subtrochanteric fracture is an exercise in balancing mechanical and biological consideration in maximize the likelihood of rapid healing and full restoration of function with minimal risk of complications at the least cost to the patient and society

A comparative study between proximal femoral nail and proximal femoral locking plate in subtrochanteric femoral fractures: A prospective analysis of 36 cases

Background: Subtrochanteric fractures constitute 10-30% of the hip fractures. Various implants were used to fix the fractures. Proximal femoral locking plate (PFLP) allows either direct anatomic reduction or indirect reduction and bridge plating techniques. Due to biomechnical advantage proximal femoral nails (PFN) have found superior to other implants.Objectives: To compare the Radiological and Functional Outcome of Subtrochanteric Fractures treated with proximal femoral nail (PFN) and Proximal femoral locking plate (PFLP) and to find out the more appropriate implant for the specific fracture pattern.Methods: 36 patients with Subtrochanteric femur fracture were operated and fixed by proximal femoral nail and proximal femoral locking plate (18 in each group). Follow up done for 24 months. Outcome was assessed by Harris Hip Score (HHS) and radiologically.Results: The patients treated by proximal femoral nailing required significantly less time for full weight bearing (16.06 weeks) as compared to the patients treated by proximal femoral locking plate (21.41 weeks).Radiological union was significantly delayed in the patients treated by proximal femoral locking plate (mean time 21.41 weeks) as compared to the patients treated by proximal femoral nailing (16.39 weeks). Nailing group had slightly better average HHS (93) than in the plating group (89.44).Conclusion: PFN have the advantage by taking less operative time, high rate of union, minimal soft tissue damage, less infection rate and early postoperative rehabilitation. In our study we found that both PFN & PFLP can be satisfactorily used in the treatment of Subtrochanteric fractures. There was significantly no major difference between implants with respect to anatomical alignment, limb length discrepancy, postoperative infection and most importantly the final outcome measured by Harris Hip Score.

Comparison of Proximal Femur Locking Compression Plate and Intramedullary Nailing in the Treatment of Sub-Trochanteric Fractures

Comparison of Proximal Femur Locking Compression Plate and Intramedullary Nailing in the Treatment of Sub-Trochanteric Fractures

Lateral decubitus intramedullary nailing for femoral subtrochanteric fractures

Objective To investigate the efficacy of lateral decubitus intramedullary nailing for treatment of subtrochanteric fractures of the femur. Methods From January 2012 to December 2015, 23 patients with simple femoral subtrochanteric fracture were treated at Department of Orthopedic Trauma, Changhai Hospital. They were 15 males and 8 females, aged from 19 to 77 years (average, 48.3 years). According to the Seinsheimer classification, there were 6 cases of type ⅡB, 8 cases of type ⅡC, 6 cases of type ⅢA, and 3 cases of type ⅢB. Their injuries were caused by traffic accident in 10 cases, falling from a height in 5 cases, and sprain in 8 cases. All patients were treated by closed reduction and anterograde intramedullary nailing at lateral decubitus. Their operative time, bleeding volume, fluoroscopic frequency, fracture healing time, functional recovery and complications were recorded and analyzed. Results Their operative time ranged from 55 to 80 min, averaging 65.7 min; their bleeding volumes ranged from 240 to 420 mL, averaging 304.3 mL; their fluoroscopic frequency ranged from 30 to 60 times, averaging 42.7 times. This cohort was followed up for 12 to28 months (average, 17.9 months). Their fracture healing time ranged from 4 to 10 months, averaging 5.5 months. Nonunion occurred in one patient but was cured by secondary operation. The HSS evaluation at the final follow-ups showed 17 excellent cases and 6 good ones, yielding an excellent to good rate of 100%. All the wounds healed by the first intention. No infection, deep vein thrombosis or implant failure was observed. Conclusion As lateral decubitus intramedullary nailing can achieve satisfactory clinical efficacy for subtrochanteric fractures of the femur, the body position of lateral decubitus may be a good alternative. Key words: Posture; Fracture fixation, intramedullary; Bone nail; Lateral decubitus; Subtrochanteric fracture

Titanium elastic nailing versus locking compression plating in school-aged pediatric subtrochanteric femur fractures

The treatment of children between 5 and 12 years of age suffering from subtrochanteric femoral fracture is challenging. The optimal choice of internal fixation for these patients is controversial. The purpose of this study is to compare the outcomes and complications of titanium elastic nail and open reduction with plate fixation of subtrochanteric femur fractures in school-aged children.A total of 67 children aged 5 to 12 years with subtrochanteric femur fractures treated with titanium elastic nails or open plating were identified at our institution from January 2007 to December 2017. We retrospectively compared 39 children treated with titanium elastic nails with 28 children treated with open reduction and plate fixation. The data included age, sex, body weight, fracture pattern, operation time, blood loss, and length of hospitalization. The follow-up investigations included radiograph of pelvis, bilateral hip range of motion, bilateral femoral neck shaft angle, and length of lower extremity. The outcomes were classified according to Flynn classification as excellent, satisfactory, or poor. All the demographic characteristics were compared with statistical analyses.All 67 fractures united properly. No major postoperative complications were noted in both groups. No significant difference was found between the titanium elastic nail and open plating groups in terms of sex, fracture pattern, and length of hospitalization. We noted a significant difference between 2 groups in terms of age, weight, operation time, and blood loss. In total, we observed 24 excellent and 15 satisfactory results in the titanium elastic nail group, and 19 excellent results and 9 satisfactory results in the open plating group. There was no significant statistical difference between involved and uninvolved side of hip regarding range of motion and femoral neck shaft angle in both groups.Titanium elastic nail and pediatric hip plate fixation represent safe and effective methods in the treatment of subtrochanteric fractures in school-aged children. Titanium elastic nail internal fixation is a minimal invasive and simpler technique and suitable for young children of lower body weight. Open plate fixation is a more rigid fixation associated with a lower complication rate.

INTRAMEDULLARY NAILING VERSUS FIXED ANGLED BLADE PLATING FOR TREATMENT OF SUBTROCHANTERIC FEMORAL FRACTURE

Background: The subtrochanteric fractures represent 7-44% of the fractures of proximal femur caused by low energy trauma in elderly patients or high energy trauma in younger age group. Different surgical options used to treat and fix this fractures that could be Intramedullary devices like intramedullary nail or extramedullary devices like fixed angle blade plate. Objective: Comparing the result of close reduction and internal fixation with intramedullary nail to the open reduction and internal fixation with 95-angled blade plate for treatment of subtrochanteric fractures. Methods: Prospective multicenter study was done in Al-Imamein Al-kadhimein Medical City and Al-Wasity Teaching Hospital for thirty patients with close and open (Gustilo type-1) subtrochanteric femoral fractures between December-2014 and September-2016. Eighteen patients (8 closed + 10 open fractures) treated with Intramedullary nail (IMN) were compared to twelve patients (9 closed + 3 open fractures) treated with open reduction and 95-angled blade plate fixation (BP). Results: There were significant statistical differences between the two groups. The IMN group show better outcome regarding the mean union rate time (IMN were 16 weeks while in the BP were 22 weeks). Mean hospitalization stay (IMN were 82 hours while in BP were 110 hours) and rate of infection (IMN 0% while in BP were 16%), but no statistical difference regarding the mean operation time (IMN were 1.59 hour while in BP were 1.43 hour) and functional outcome (HHS in IMN were 82 while in BP were 79). Conclusion: Closed reduction and internal fixation with Intramedullary Nail is preferable (for Close and Open Gustilo’s type-1 Subtrochanteric fractures) when compared to the open reduction and Internal Fixation with 95-angled Blade Plate. Keywords:Subtrochanteric femur fractures, closed reduction intramedullary nail fixation, open reduction internal fixation, fixed angle blade plate. Citation: Joda AI, Aldookhi AA, Abd Ali AS. Intramedullary nailing versus fixed angled blade plating for treatment of subtrochanteric femoral fracture. Iraqi JMS. 2018; 16(2): 125-132. doi: 10.22578/IJMS.16.2.3

Treatment of Seinsheimer type III subtrochanteric femoral fractures with prolonged Gamma3 nails and titanium wire fixation in the aged patients

Objective To investigate the treatment of subtrochanteric femoral fractures of Seinsheimer type Ⅲ with prolonged Gamma3 nails and titanium wire fixation in the aged patients. Methods From October 2014 to December 2015, 23 old patients with subtrochanteric femoral fracture were treated with prolonged Gamma3 nails and titanium wire fixation. They were 7 men and 16 women, aged from 62 to 78 years (69.3 years on average). By Seinsheimer classification, 14 cases were type ⅢA and 9 type ⅢB. The time from injury to surgery averaged 3.4 days (from 2 to 6 days). Their operation time, intraoperative bleeding, hospital stay, fracture union time and hip function at the final follow-up were documented. Results Their operation time averaged 1.3 hours (from 1.0 to 1.6 hours), intraoperative bleeding 161 mL (from 115 to 215 mL), and hospital stay 10.7 days (from 9 to 12 days). They obtained follow-ups from 5 to 12 months (9.3 months on average). All the fractures achieved bony union after an average of 15.4 weeks (from 12 to 20 weeks). The function of the affected hip assessed at the final follow-up according to the Harris scoring was excellent in 15 cases, good in 5 and fair in 3, resulting in an excellent to good rate of 87.0%. Their follow-ups revealed no deep venous thrombosis of lower limb, fat embolism, coxa vara, refracture, cut-in of the femoral head by the lag screw, or implant breakage. Conclusions In the treatment of senile subtrochanteric femoral fractures of Seinsheimer type Ⅲ, prolonged Gamma3 nails and titanium wire fixation exhibits advantages of limited operative trauma, rigid fixation, a high rate of union and limited complications. Additionally, this treatment can increase the accuracy of inserting distal locking nails, shorten operation time and improve functional recovery. Key words: Femoral fractures; Fracture fixation, internal; Bone nails; Titanium wire

Functional and radiological outcome of subtrochanteric fracture treated with proximal femoral nail

Subtrochanteric fractures are one of the common fractures encountered in general population following a fall due to high velocity injury warranting immediate and active intervention. The main benefit of Proximal Femoral Nailing is being a closed technique offering an excellent reduction at the fracture site and adequate strength for weight bearing even in unstable hip fractures. This intramedullary device is proven to be biomechanically superior to DHS which is an extramedullary device in the treatment of subtrochanteric fractures. The objective of this study is to analyse and evaluate the functional and radiological outcome of subtrochanteric fracture treated with proximal femoral nail. A study population was selected and was carried out with a total of 25 patients (male: 20, female: 5) treated with proximal femoral nail from the year 2015-2016. All the patients were selected based on inclusion criteria such as closed fractures of less than 3 weeks and age above 25. The appropriate selected patients were assessed both clinically and radiologically at regular intervals of 4wks, 8wks, 12wks, 16wks and 20wks. The functional outcome was assessed using Harris Hip score. From our selected study sample we found majority of the patients were unstable fractures (70%) and others were stable fractures (30%). Based on the union, 50% of patients showed full union by 10 to 15 weeks and 35% showed full union by 16 to 20 weeks. We had 95% of the patients with good anatomical results and 50% of the patients with excellent functional results. PFN is a quite safe, well tolerated and effective instrumentation useful in the treatment of all subtrochanteric fractures. Being a closed intramedullary procedure early mobilization and rehabilitation is possible with early restoration of premorbid functions.