Treatment Of Unstable Intertrochanteric Fractures Research Articles

Evaluation of the outcome of proximal femoral nail in the treatment of unstable Intertrochanteric fracture in adult

Background & Objectives: The incidence of intertrochanteric fractures among elderly patients is expected to be increased even further with the advancing age of the population, proximal femoral nail was introduced as a method of treatment for this fracture, which is currently the most effective surgical method. The goal is to find out the role of a proximal femoral nail in treating intertrochanteric fractures and assess the advantages and complications of this treatment method. Methods: This prospective study was conducted on seventy patients with unstable intertrochanteric fractures treated with Proximal femoral nails at Erbil teaching hospital. They were followed up for one year, from (May 2016 to May 2017). Patients were examined for the union of fracture and complications clinically and radiologically. The functional outcome was evaluated using the Harris Hip Score. Results: Total number of 70 patients were included in this study, 44 (62.85%) were females, and 26 (37.15%) were males. The mean operative time was (90.885 min. ±11.38SD). Infection developed in (1.42%) of the patients. The most common complication was Varus malalignment which was found in (5.7%) of the cases. Harris Hip Score-based findings were excellent-good in (85.7%) of patients Conclusion: Proximal femoral nail is a relatively effective treatment possibility for most unstable intertrochanteric fractures with good biological stabilization, better short-term outcomes, and minimal complications.

THE RETROSPECTIVE ANALYSIS OF TRIGEN INTERTAN NAIL IN THE TREATMENT OF UNSTABLE INTERTROCHANTERIC FEMORAL FRACTURES AT HOSPITAL FOR TRAUMATOLOGY AND ORTHOPAEDICS.

Intertrochanteric fractures are highly prevalent among the elderly population, with approximately 90% occurring in individuals aged over 65. These geriatric fractures are associated with elevated mortality rates and significant functional impairment. Common treatment modalities for unstable intertrochanteric fractures include proximal femoral nail antirotation (PFNA) and the InterTan nail (IT). PFNA and IT are frequently employed due to their lower failure rates and favorable biomechanical properties, resulting in positive clinical outcomes for the management of unstable intertrochanteric fractures. The unique design of the IT nail, featuring two cephalocervical screws within an integrated mechanism, permits linear intraoperative compression and rotational stability of the neck and head fragment. In this study, we assess the clinical outcomes of IT nail utilization in the treatment of intertrochanteric fractures at the Hospital for Traumatology and Orthopedics. This study comprises a retrospective analysis and case series report. Between February 2021 and August 2021, we retrospectively evaluated 35 patients who underwent treatment with the IT nail for unstable intertrochanteric fractures. Epidemiological data, operative duration, intraoperative blood loss, intraoperative blood transfusion requirements, length of hospital stay, bone healing rates, and IT nail-related complications were recorded. The mean age of the patients was 70.97 ± 16.97 years, with a mean operative time of 60 minutes, mean intraoperative blood loss of 160.86 ± 72.8 ml, mean intraoperative blood transfusion volume of 203.43 ± 189.29 ml, and a mean hospital stay of 7 days. Bone healing was observed in 97.14% of cases. The treatment of unstable intertrochanteric fractures using the IT nail in elderly patients was successful. Our findings indicate favorable clinical outcomes in terms of surgical duration, intraoperative blood loss, hospitalization duration, and union rates for elderly patients. Further investigations are warranted to validate these early results.

Cemented bipolar hemiarthroplasty for unstable intertrochanteric fracture in elderly patients over 70years: Boon or bane?

The surgical management of intertrochanter femur fracture in elderly patient is still under debate. Various implants can be utilised but prosthetic replacement is gaining popularity. This study was performed to evaluate the functional and clinical outcomes of cemented bipolar arthroplasty as a primary treatment for unstable intertrochanteric fracture in elderly patients (> 70years). Thirty-seven patients with unstable intertrochanteric fracture in elderly patient (> 70years) who underwent cemented bipolar hemiarthroplasty. Intra-operative and post-operative complications were noted; functional outcomes were assessed using Harris hip score (HHS). All patients were followed up for a minimum of 12months. Overall 90% of patients has some minor or major intra or post-operative complication. One year mortality rate was 16% (6/37). Cardiopulmonary events were the most common life threatening incident. Mean fall in Haemoglobin was 1.6gm/dL. The average time for full weight bearing mobilisation with the help of walker was 2.8 ± 1.2days (1-8days). The average duration of surgery was 58 ± 6min (44-96min) with an average blood loss of 126 ± 24mL (90-380mL). HHS at the end of 12months was 77. The use of bipolar hemiarthroplasty in senile patient with unstable hemiarthroplasty gives an advantage of early weight bearing. However, it is associated with risk of significant intra or post-operative morbidity due to intra-operative trauma, surgical time and blood loss during the surgery. Although hemiarthroplasty can be a single-time solution to the complexities of intertrochanter fracture in elderly patients but should be performed in selected patients only.

Surgical Management of Unstable Trochanteric Fractures of the Femur Using Cemented Hemi-Prosthesis in Elderly Patients: A Prospective Study.

Background In the case of elderly patients suffering from osteoporosis, the primary objectives of addressing comminuted intertrochanteric fractures are centered upon the recuperation of the patients' pre-fracture levels of activity, the expeditious promotion of full weight-bearing capacity, and the minimization of the likelihood of further surgical interventions. The adoption of hemiarthroplasty as a method for comminuted intertrochanteric fractures is proven as a means of hastening the recovery process, enabling early weight-bearing and mitigating the problems associated with extended bed rest. The outcomes that resulted from the application of this technique will be evaluated and analyzed as part of this study's objectives. Methodology A prospective study was conducted over the course of one year at a tertiary care hospital in the northern part of India. The study comprised a total of 30 individuals; however, unfortunately, one of the patients could not be located for further analysis. Patients of either gender in the age group of over 60 years old and with unstable osteoporotic intertrochanteric fractures were included (AO Foundation/Orthopaedic Trauma Association type 31-A2.2, A2.3, or 31-A3 group). Patients were observed at one, three, and six months after the surgical operation. The Harris Hip Score (HHS) was used for the functional outcome evaluation. Results Throughout the course of our analysis, we saw an increase in the overall HHS that was statistically significant. The HHS exhibited a mean value of 34.33 during the period of discharge, with a range of 32 to 39. It increased to 55.34 (range = 52-59) after one month of follow-up, and it continued to rise to 85.03 (range = 63-89) after three months of follow-up. It is important to note that the mean HHS reached 95.24 (range = 63-98) by the sixth month of follow-up. The study showed a statistically significant upward trend in HHS scores across all time periods (p < 0.001). Conclusions Early postoperative ambulation was made possible with the use of cemented prostheses, which contributed to patients' overall improvements in their functional results. Cemented primary bipolar hemiarthroplasty has emerged as a promising alternative for the treatment of unstable intertrochanteric fractures. The enhanced functional outcomes measured by the HHS provide evidence of this. The transtrochanteric technique has shown advantages in retaining the anatomical integrity of external rotators, minimizing the necessity for their resection, and reducing the danger of sciatic nerve injury. These advantages were displayed by the transtrochanteric approach. Moreover, owing to the implementation of wiring techniques, the larger trochanter could be conserved, resulting in enhanced postoperative recovery and expediting the return to the preoperative condition. When compared with other techniques of internal fixation, the utilization of cemented bipolar hemiarthroplasty demonstrated much-reduced rates of complications, such as the need for further surgery and implant failure.

Application of lesser trochanteric reduction fixator in the treatment of unstable intertrochanteric fractures.

Closed reduction and internal fixation with intramedullary nails has been widely accepted for treating intertrochanteric fractures. To focus on how to avoid displacement of the lesser trochanter in unstable intertrochanteric fractures. We developed a lesser trochanteric reduction fixator for treating intertrochanteric fractures through fixing the lesser trochanter by combining the loop plate through the fixator after reduction by the reducer. Five patients with intertrochanteric fractures treated with the newly developed lesser trochanteric reduction fixator and loop plate combined with intramedullary nails, and 20 patients with intertrochanteric fractures treated with simple intramedullary nails were selected from December 2020 to March 2021. The postoperative Harris hip score was significantly higher in patients treated with the lesser trochanteric reduction fixator than in patients treated without the lesser trochanteric reduction fixator, which indicated that this lesser trochanteric reduction fixator had a positive impact on rehabilitation of the hip joint after surgery and could significantly improve the quality of life of patients. We fully realize the significance of trochanteric reduction and fixation, namely, reconstruction of structures under pressure, in the treatment of intertrochanteric fractures. As long as the general condition of patients is favorable and they are willing to undergo surgery, fixation of the main fracture end should be performed and the lesser trochanter should be reduced and fixed at the same time.

Bipolar Hemiarthroplasty in Unstable Intertrochanteric Fractures with an Effective Wiring Technique.

Bipolar hemiarthroplasty has recently been acknowledged as an effective option for treatment of unstable intertrochanteric fracture. Trochanteric fragment nonunion can cause postoperative weakness of the abductor muscle and dislocation; therefore, reduction and fixation of the fragment is essential. The purpose of this study was to perform an evaluation and analysis of the outcomes of bipolar hemiarthroplasty using a useful wiring technique for management of unstable intertrochanteric fractures. A total of 217 patients who underwent bipolar hemiarthroplasty using a cementless stem and a wiring technique for management of unstable intertrochanteric femoral fractures (AO/OTA classification 31-A2) at our hospital from January 2017 to December 2020 were included in this study. Evaluation of clinical outcomes was performed using the Harris hip score (HHS) and the ambulatory capacity reported by patients was classified according to Koval stage at six months postoperatively. Evaluation of radiologic outcomes for subsidence, breakage of wiring, and loosening was also performed using plain radiographs at six months postoperatively. Among 217 patients, five patients died during the follow-up period as a result of problems unrelated to the operation. The mean HHS was 75±12 and the mean Koval category before the injury was 2.5±1.8. A broken wire was detected around the greater trochanter and lesser trochanter in 25 patients (11.5%). The mean distance of stem subsidence was 2.2±1.7 mm. Our wiring fixation technique can be regarded as an effective additional surgical option for fixation of trochanteric fracture fragments during performance of bipolar hemiarthroplasty.

Comparison of Supine Position and Traction Table in the Surgical Treatment of Unstable Intertrochanteric Fractures with PFNA

Aim: Intertrochanteric femur fractures (IFF) are a major cause of morbidity and mortality in the elderly population. Proximal femoral nail-anti-rotation (PFNA) is one of the most preferred surgical treatment methods. This study aimed to compare the clinical and radiologic results of two different patient positions used during PFNA and to reveal the intraoperative advantages and disadvantages.&#x0D; Material and Method: Cases operated due to IFF between January 2020 and December 2022 were retrospectively analyzed. The study was conducted with 123 patients meeting the inclusion criteria. The minimum follow-up period was determined as one year. Two groups were formed: those operated on the traction table (opereted-TT) and those operated in supine lithotomy without traction table (operated-SP). The groups were compared regarding operative time, reduction quality, type-apex distance (calTAD), and radiologic and clinical results.&#x0D; Results: There were 76 patients in the operated-TT group and 47 in the operated-SP group. The mean age of the operated-TT group was 81.00±8.52 years, and the mean age of the operated-SP group was 79.30±8.12 years. (p=0.213) Gender, follow-up time, time from trauma to surgery, and fracture classification were similar for the groups. The mean operative time was 95.18±8.54 minutes in the operated-TT group and 88.23±7.12 minutes in the operated-SP group, and the operation was completed in a shorter time in the operated-SP group. (p=0.001) There were no differences between the groups in terms of reduction quality, calTAD, Harris Hip Score, VAS score, infection rates, and cut-out rates.&#x0D; Conclusion: Based on this study, the radiologic and clinical results of the cases operated with manual traction in the supine position and those operated using a traction table in treating IFF with PFNA are similar. In addition, it was concluded that shorter operation time was an advantage of the operated-SP group.

Comparison of treatment of unstable intertrochanteric fractures by intramedullary and extramedullary implants

Background To achieve union and restore the normal biomechanics of the hip region after unstable trochanteric fractures, surgical intervention is necessary. There are two options for internal fixation: extramedullary and intramedullary. Dynamic hip screw (DHS) as extramedullary fixation was and is still widely used to surgically treat intertrochanteric fractures. However, it sometimes fails to give good results. Intramedullary fixation methods include gamma nail placement, which is considered by some surgeons to be a better choice as it can avoid complications occurring with extramedullary fixation. Our study aimed to conclude which is better to be used to manage unstable intertrochanteric fractures by either DHS or gamma nail regarding the operation requirements (hospital stay, need for blood transfusion, wound complications, and soft tissue damage) and later on evaluate which is better regarding the fracture healing radiologically and functionally. Patients and methods This is a retrospective study of 52 patients with recent unstable intertrochanteric fractures between January 2020 and December 2020. A total of 40 patients continued the study till the last follow-up, where 20 of them were fixed by intramedullary gamma nails as a group I and the other 20 patients were fixed by extramedullary DHS as a group II. The mean age for the group I was 50.05 (20–83) years and the mean age for group II was 60.5 (22–91) years. A total of 14 patients from group I were males and 12 from group II were males. All fractures were classified according to Evan’s classification to be unstable (Evan’s types III, IV, and V). Results Overall, 19 (95%) patients of group I achieved full union and one patient had nonunion with nail breakage. No patients in group I had malunion. A total of 17 (85%) patients of group II achieved good union with one patient having nonunion with implant failure. Moreover, two (10%) patients of group II had femoral shaft medialization and varus malunion. Conclusion This study supported the previous series in the literature, which proved that unstable intertrochanteric fractures can be fixed by intramedullary gamma nails or extramedullary DHS but intramedullary fixation gives better results than extramedullary fixation.

Functional Outcome of Unstable Intertrochanteric fracture Treated with Proximal Femoral Nail Anti-Rotation

Background: Intertrochanteric fractures are one of the most disabling injuries, most commonly observed among the elderly, and shows a challenging problem for orthopedic surgeons. Nowadays, intertrochanteric fractures are being treated with different extramedullary and intramedullary devices. Among them, intramedullary fixations show the best outcome, and are widely used for different treatment of unstable intertrochanteric fractures (type 31A2, 31A3). A new device designed by AO/ASIF, the Proximal Femoral Nail Anti-Rotation (PFNA) represents a unique intramedullary nail system for improved management, with decrease in the number of complications. Material Methods: This prospective hospital based clinical trial was conducted at the Department of Orthopaedic Surgery, Chittagong Medical College Hospital, Chattogram, Bangladesh. The study duration was 2 years, from January 2018 to December 2019. During this period, a total of 48 patients who were admitted in the study place with unstable intertrochanteric fracture of femur were included in the study. Patients were followed up for 24 weeks, and overall outcome was measured using Kyle’s Criteria. Results: 48 patients were treated for unstable intertrochanteric fractures. The majority were between 50-80 years old (62.5%), with a mean age of 58.38. Gender distribution was even, with 50% male and 50% female. 75% of fractures were caused by a fall from height and 25% by a road traffic accident. 68.75% of fractures were type 31A3 and 31.25% were type 31A2. 68.75% of patients did not have comorbidities. The mean time interval for fixation was 12.6 days, and the majority of operations lasted between 45-90 minutes. 87.5% had a closed reduction and 12.5% had an open reduction. 64.58% of patients had radiation time between 2.5-3.3 minutes. At 2 weeks follow-up, 21.28% had poor functional outcome, 78.72% had fair functional outcome, and none had good or excellent outcomes. At 6 months follow-up, 2.17% had poor outcomes, 8.70% had fair outcomes, 34.78% had good outcomes, and 54.35% had excellent outcomes. 16.67% of patients experienced complications such as infection, varus, delayed union, and lateral migration. Conclusion: Most patients achieved good to excellent functional outcomes after treatment, with minimal complications.

Outcome of treatment of Unstable Intertrochanteric Fracture by Proximal Femoral Nail (PFN)

Background: Proximal Femoral Nail (PFN) is a surgical technique used to treat unstable intertrochanteric fractures, which are fractures that occur in the upper portion of the thigh bone (femur). The procedure involves using a nail-like device that is inserted into the femur and secured in place with screws to stabilize the fracture and promote healing. It is a commonly used treatment option for this type of fracture and can lead to good outcomes in most cases. The aim of the study was to observe the outcome of Unstable Intertrochanteric fracture by Proximal Femoral Nail (PFN). Material Methods: This prospective observational study was conducted at the Department of Orthopedics, National Institute of Traumatology and Orthopedic Rehabilitation (NITOR), Dhaka, Bangladesh. The study duration was 2 years, from July 2017 to June 2019. A total of 34 cases were included in the study sing purposive sampling (non-randomized) according to availability of the patients and considering inclusion and exclusion criteria. Results: The participants’ age range was 16-90, with a mean of 56.91 ± 17.76. Most (35.29%) were 61-75 years old. 61.76% were female and 38.24% were male. 50% were housewives, 14.71% ex-service holders, 14.71% service holders, 11.76% businessmen, 5.88% students, and 2.94% farmers. The leading cause of injury was falls on slippery ground (55.88%), followed by motor vehicle injuries (44.12%). 70.59% of injuries occurred on the right side and 29.41% on the left. 76% had Kyle Type III fractures, 24% had type IV. 85.29% had open reduction, 14.71% had closed reduction. The mean duration of injury to operation was 15.59 days and the mean hospital stay was 19.15 days. 70.59% had no complications and 55.88% reported no pain at last follow-up. 58.82% had a good Harris hip score and 58.82% had excellent outcomes by final follow-up. Conclusion: The majority of patients in this study were in the 61-75 age range and female, with the most common cause of injury being falls on slippery ground. The most common fracture type was Kyle type IV, with a major portion of cases requiring open reduction. The rate of complications was relatively low, and the functional outcomes were acceptable and comparable to other studies. The duration of injury to operation and hospital stay were slightly longer than other studies, likely due to the busy nature of the study location. Overall, the Proximal Femoral Nail is a safe and effective treatment option for unstable proximal femoral fractures.

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.

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

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.

Proximal Femoral Nail Causes Lower Systemic Immunoinflammatory Response Compared to Hemiarthroplasty in the Treatment of Unstable Intertrochanteric Fractures

Introduction: This study aimed to compare the surgical stress and immunoinflammatory response caused by proximal femoral nail and hemiarthroplasty in patients with unstable intertrochanteric fractures. Materials and Methods: We retrospectively evaluated 344 patients who had undergone surgery for intertrochanteric fractures. Inclusion criteria were defined as being between the ages of 65 and 80, having an American Society of Anesthesiology physical status classification system score of 3, and the time between fracture formation and surgery being less than 72 hours. Proximal femoral nail was performed in 42 of the patients whereas hemiarthroplasty was performed in 40 patients. Data of age, gender, pre-operative waiting and operation times, length of hospital stay, change in haemoglobin levels, and erythrocyte suspension need were recorded. Venous blood samples were collected from all the patients at the first admission to the emergency department, 6 hours after the operation, and 3 days after the operation. Neutrophil-lymphocyte ratio and systemic immune-inflammation index were compared between the two procedures at three different time. Results: The operation and hospitalisation duration, erythrocyte suspension use were significantly higher (p&lt;0.05) in the hemiarthroplasty group than in the proximal femoral nail group. In both groups, neutrophil-lymphocyte ratio and systemic immune-inflamation index values increased significantly (p&lt;0.05) between the day 0 and the 3rd postoperative day. The postoperative day 0 neutrophil-lymphocyte ratio and systemic immune-inflammation index values in the hemiarthroplasty group were significantly higher than in the proximal femoral nail group (p&lt;0.05). Conclusions: We conclude that the proximal femoral nail procedure causes less surgical stress than hemiarthroplasty; therefore, it is a safer procedure.

Study of the immediate short term clinical and radiological outcome of intertrochanteric neck of femur fractures treated with primary bipolar hemiarthroplasty in geriatric population in a tertiary care centre

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Intertrochanteric fracture in elderly patient is a frequent problem and is becoming more common as the proportion of elderly people in the population increases. Unstable intertrochanteric fracture in the elderly patient is associated with a high rate of mortality as much as 20 percent during the first postoperative year. The treatment of such unstable intertrochanteric fracture is still controversial. So as to allow for earlier postoperative weight-bearing, primary hemiarthroplasty was proposed by some authors. The purpose of this study is to evaluate the functional and clinical outcomes of cemented bipolar arthroplasty as a primary treatment for unstable intertrochanteric fracture in the elderly patient.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; It was an observational retrospective plus prospective study design over a period of 18 months in a tertiary care setting with a sample size of 41. Patients fulfilling the inclusion criteria were assessed clinically using Harris hip score and radiologically were operated for bipolar hemiarthroplasty. They were assessed intraoperatively, immediate postoperatively and after 4 weeks for functional outcome using Harris hip score and assessed radiologically. Patients were also be evaluated for intraoperative and postoperative complications if any. The outcome was analysed statistically to comment on functional outcome of bipolar hemiarthroplasty.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; In our study majority of the patients 70% (29) had excellent and good outcomes at the end of 1 month. Out of the rest 22% more had fair outcome at the end of month. Thus 93% patients had favorable outcomes at the end of 1 month while 7% (3 cases) had poor outcome when measured using Harris hip score.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Primary cemented bipolar hemiarthroplasty is a viable option that leads to good functional outcomes and allows early mobilization and weight bearing.&lt;/p&gt;

Functional Outcome of Hemiarthroplasty of the Hip for Unstable Intertrochanteric Fractures of the Femur in Elderly Patients: A Prospective Study.

Introduction It is frequently challenging to treat an unstable intertrochanteric fracture in elderly people by internal fixation because of difficult anatomical reduction, poor bone quality, the need for prolonged bed rest and restricted ambulation. As an alternative to internal fixation, cemented bipolar hemiarthroplasty has been used as a treatment for unstable intertrochanteric fractures to avoid the postoperative immobilization-related complications. The aim of this study was to evaluate the functional and clinical outcomes of primary cemented bipolar hemiarthroplasty for elderly patients with unstable intertrochanteric fractures. Methodology A prospective study was conducted that included 30 patients who were admitted to the apex trauma center at a tertiary care centerfrom January 2019 to August 2020 with unstable intertrochanteric fractures (Association for Osteosynthesis/Orthopaedic Trauma Association, or AO/OTA, types 31-A2.2 and 31-A2.3); patients treated with cemented bipolar hemiarthroplasty, with at least one year of follow-up were included in the study. Basic descriptive statistics were used and the results were presented in frequencies, percentages for categorical variables and means and standard deviations for continuous variables. Results According to the Harris Hip Score, at the end of 12 months, 9 patients (30%) had excellent results, 14 patients (46.67%) had good results, 5 patients (16.67) had fair results, and 2 cases (6.67) had poor results. With cemented hemiarthroplasty, 87.7% of older patients with unstable intertrochanteric fractures were able to walk sooner, and the results were good. Conclusion Hemiarthroplasty of the hip with a cemented bipolar prosthesis appears to be a reliable treatment method for the management of unstable intertrochanteric fractures in elderly patients with osteoporosis; it allows for early ambulation and leads to a favorable functional outcome in most patients following surgery.

A bone-conserving revision stem for unstable intertrochanteric fractures of the geriatric osteoporotic population

PurposePrimary hemiarthroplasty is gaining popularity for the treatment of unstable intertrochanteric fractures in geriatric patients with severe osteoporosis. This study evaluated early clinical and radiographic outcomes by using a bone-conserving revision stem for unstable intertrochanteric fractures in the geriatric osteoporotic population.MethodsA retrospective study involving 31 patients with unstable intertrochanteric fractures was conducted. The patients were aged 82.1 years on average. All patients underwent primary hemiarthroplasty using bone-conserving, fully porous-coated revision stem. The operative time, intraoperative blood loss, length of hospitalization, and need for blood transfusion were noted during the hospital stay. Postoperative complications, including dislocations, deep venous thrombosis, infections, peri-prosthetic fractures, and frontal thigh pain were also recorded. Koval's category was used to quantify activity level, and Harris hip score (HHS) was used for functional assessment. Radiographic outcomes, including osteolysis, bone ingrowth, subsidence of the femoral component, lower limb length discrepancy, and heterotopic ossification, were collected at each follow-up.ResultsThe 31 patients were followed for an average time of 23 months postoperatively. The average operative time lasted for 74.2 min, while the mean intraoperative blood loss was 200.1 ml, with an average hemoglobin decrease of 11.1 g/L after the procedure. The mean visual analog scale (VAS) score for pain dropped from 7.4 preoperatively to 2.4 at the 4-week follow-up. At the latest follow-up, the mean Harris hip score was 82.1, and the VAS was 1.7. No intraoperative or postoperative peri-prosthetic fractures were noted. Postoperative complications included one case of thrombosis formation in the posterior tibial vein and one case of congestive heart failure. Both patients were discharged uneventfully after treatment. Radiographically, none of the hips had evidence of stem loosening or osteolysis. Within the follow-up period of 23 months, the mortality rate was 3.2% (1/31), and no revision surgeries were required.ConclusionPrimary hemiarthroplasty using a bone-conserving, cementless revision stem could serve as a reliable alternative for the treatment of unstable intertrochanteric fractures in the geriatric population with osteoporosis.

Analysis of clinical, radiological and functional outcome of proximal femoral nail antirotation II in the treatment of unstable inter-trochanteric fracture

Purpose: To study the clinical, radiological and functional outcome of patients with IT fractures treated with pfn AII methods - An Hospital based Observational study was done at A J Institute of Medical Sciences and Research Centre, Mangalore. During the period June 2019 to April 2021, on 36 patients who underwent PFN AII fixation for Intertrochanteric fracture. Patient had regular follow ups at 1, 3, 6 and 9 month. Clinico-radiological outcome was assessed at the end of 9 months. Functional outcome was assessed using Harris Hip Score. Results: Among 36 patients with Intertrochanteric fracture meeting Inclusion criteria, patients studied, the mean time of union is 10.88 weeks. 2 patients presented with minor complications such as superficial skin infection treated conservatively. All fractures United uneventfully, no patients underwent re-surgery. Conclusion: PFN A-II is a significant advancement in the treatment of trochanteric fractures which has the unique advantage of closed reduction, preservation of fracture hematoma, minimal soft tissue damage during surgery, early rehabilitation and early return to work.

Finite-Element Analysis of a Novel Cephalomedullary Nail for Restricted Sliding to Reduce Risk of Implant Failure in Unstable Intertrochanteric Fractures.

How to restrict sliding of cephalomedullary nail and rigid reconstruct medial support for unstable intertrochanteric fractures remains a challenge. This study aims to explore the feasibility of a novel cephalomedullary nail for restriction sliding and reconstruction of medial femoral support to prevent failure in unstable trochanteric fractures through finite element analysis. The DICOM files of a unilateral femur spiral computed tomography (CT) scans from a elderly female were converted into STL files, and the most common clinical trochanteric fracture model with the absence of medial support, AO/OTA 31-A2.3 was simulated by removing the posterior medial femur. The model of a novel medial sustain nail (MSN-II) and a widely used nail (proximal femoral nail anti-rotation PFNA-II) were modeled according to the manufacturer-provided engineering drawing. Different loads were applied to the femoral head to simulate the postoperative weight bearing gait. The sliding distance of helical blade in femoral neck, maximum stress of femur and nail, displacement of proximal fragment were analyzed to revealing the mechanical stability of unstable trochanteric fracture stabilized by different implant. The sliding distance of helical blade in the femoral neck, the maximum stress on the femur and nail, the displacement of proximal fragment in MSN-II under 2100N axial load were 0.65 mm, 689 MPa, 1271 MPa, 16.84 mm respectively, while that were 1.43 mm, 720.8 MPa, 1444 MPa, 18.18 mm, respectively in PFNA-II. The difference between the two groups was statistically significant (P < 0.05) and the stress was mainly distributed in medial distal side of nail but helical blade and the proximal aperture for the nail in MSN-II. Compared to PFNA-II, MSN-II demonstrates biomechanical merit against femur medialization, cut-out and coax varus. The sliding distance of helical blade in femoral neck, the maximum stress on the femur and nail, and the displacement of proximal fragment of MSN-II were less than those of PFNA-II in the treatment of unstable intertrochanteric fractures. Therefore MSN-II has better stability than PFNA-II and it may have the potential to avoid femur medialization and cut out. It might be an option in unstable trochanteric fracture because of its superiority in restricted sliding and medial support reconstruction.