Treatment Of Unstable Intertrochanteric Fractures Research Articles

Effects of hemiarthroplasty with different hip prostheses on prognosis of unstable osteoporotic intertrochanteric fractures in elderly patients

Objective To investigate the effects of hemiarthroplasty with different hip prostheses on the prognosis of unstable osteoporotic intertrochanteric fractures in elderly patients. Methods A retrospective case series study was conducted on the clinical data of 556 elderly patients with unstable osteoporotic femoral intertrochanteric fractures treated with hemiarthroplasty from January 2008 to December 2014. There were 142 males and 414 females, aged (83.1±6.9) years (range, 75-103 years). The T value of bone mineral density was -3.5--2.5 SD [(-2.8±0.2)SD]. There were 306 cases of type A2.2 and 250 cases of type A2.3 according to AO classification. There were 296 cases of cement type and 260 biological type according to prosthesis type. Operation time, blood loss, time for ambulation, Harris hip score, and incidence of perioperative major complications were used to compare the therapeutic outcomes between the two types of prostheses. Results The operation time[(75.5±9.2)minutes], blood loss [(992.9±94.2)ml], and time for ambulation[(7.1±1.8)days] in cement type group were all less than those [(86.1±9.3)minutes, (1 139.5±96.0)ml, and (8.6±2.1)days] in biological type group, but the lung infection rate (19.9%), incidence of cardio-cerebrovascular complications (15.9%) and total death rate (7.1%) in cement type group were significantly greater than the those (13.5%, 8.8% and 1.9%) in biological type group (P 0.05). Conclusions In the treatment of unstable osteoporotic intertrochanteric fractures in elderly patients by hemiarthroplasty, the use of cement type prosthesis can reduce operation time, blood loss and bed rest time, but it will lead to significant increases of cardio-cerebrovascular complication and overall mortality. The prosthesis type has no significant effect on the improvement of hip function. Key words: Arthroplasty, replacement, hip; Aged; Osteoporotic fractures; Femoral fractures

Early results of primary bipolar hemi arthroplasty in treatment of unstable intertrochanteric fractures in elderly patients: A prospective study

Background and Objectives: Unstable intertrochanteric fracture in elderly is a challenging surgical condition with a high risk of morbidity and mortality. The aim of this study is to evaluate the results of bipolar arthroplasty as an alternative to the standard treatment of internal fixation. Methods: This prospective study was conducted at Department of Orthopedics, Government Medical College, Jammu from October 2014 to May 2017. Records of total 34 patients with unstable intertrochanteric fractures treated under our hospital's Orthopedic Department were analyzed. Results: Out of 34 patients enrolled in the study, 2 patients died during the study, hence the results of remaining 32 patients were analyzed with an average follow-up of 12 months. The average age of the patient was 79.35 years (range 70-94 years). The average surgery time was 82.53 min (range 62-110 min). The average intraoperative blood loss was 409.37 cc and average stay in the hospital was 14.53 days (range 5-21 days). At 1-year follow-up with help of Harris Hip Score, 8 patients (25%) were graded as excellent, 10 patients (31.25%) as good, 10 (31.25%) as fair, 2 (6.25%) as poor, and 2 (6.25%) as failed. Interpretation and Conclusion: Treatment of unstable intertrochanteric fractures in elderly patients with cemented bipolar hemi arthroplasty results in reduced complications of prolonged immobilization and easy rehabilitation along with rapid return to functional level.

Dynamic Hip Screw Versus Proximal Femoral Nail in Treatment of Unstable Intertrochanteric Fracture of Femur AO/OTA Types 31 A2 and 31A3 in Patients above Sixty Years Old. A Comparative Study

Background and objectives: Intertrochanteric fracture of the femur is one of the common and challenging fractures in the orthopedic field, which mostly affect old osteoporotic patients. Different method of fixation used to treat inter- trochanteric fracture of femur, including dynamic hip screws and proximal femoral nail .We compared the dynamic hip screw and proximal femoral nail methods of fixation in unstable intertrochanteric fracture of femur (AO Types A2 and A3) with respect to duration of surgery, blood loss, intraoperative complications, union rate and functional return. Methods:A prospective randomized and comparative study was conducted on forty two patients, 26 males (61.9%), 16 females (38.1%), from March 2015 to March 2017. Out of 42 cases, 20 patients (47.6%) treated with dynamic hip screw (group A) and 22 patients (52.4%) with proximal femoral nail (group B). In this study, maximum age was 80 years and minimum was 60 years old with a mean age of 70.9 years. Results: Our study found that proximal femoral nail fixation had relatively lesser operative time (74.5+2.6 minutes in dynamic hip screw group and 57+2.3 minutes in proximal femoral nail group), less blood loss observed (150±10.7 ml in dynamic hip screw group and 90±6.7 ml in proximal femoral nail group) and the patients were capable of early mobilization and lesser rates of implant failures (2 cases in dynamic hip screw group with no case in proximal femoral nail group), however, dynamic hip screw patients showed faster fracture healing (12-16 weeks in dynamic hip screw group and 16-24 weeks in proximal femoral nail group). Conclusions:Proximal femoral nail provides more stable fixation for unstable intertrochanteric fractures spe- cially AO type 31A3 and has more favorable short-term outcomes with a shorter procedure duration, less blood loss and no implant failures.

Evaluation of the Functional and Clinical Outcome of Intramedullary Osteosynthesis with Gamma Nail in Treatment of Unstable Peritrochanteric Fractures

AbstractBackground: Peritrochanteric fractures of the femur rank among the most common fractures in elderly people. The Gamma Nail is one of the latest advances in the treatment of trochanteric fractures based on intramedullary nailing principles during closed procedures.Purpose: This paper is made to assess the Functional & clinical Outcome of closed intramedullary osteosynthesis with a gamma nail in the treatment of unstable peritrochanteric fractures.Material and Methods: The study was based on a total of 30 patients surgically treated for unstable peritrochanteric femoral fracture by gamma nail fixation in the period between June/2012 till February/2014, including 10 males and 20 females with the mean age is 67.63 (range 50 to 81). The right side was affected in 16 patients and left side was affected in 14.Results: There were 28 patients (93.33%) with good reductions while there was 2 cases with mild displacement (<8mm) in both AP & lateral views but considered accepted. The fracture had healed in all the patients with no significant varus displacement except in 2 patients where their fracture had healed with mild (<20) degrees varus angulations. No intraoperative complication were reported. Post operative fracture of femur midshaft had occurred in 1 patient after 10 weeks. Screw cutout had occurred also in 1 case while 3 cases sustained suerficial infection. Recovery situations of all patients were evaluated based on Harris scoring with an average of 87 points. There are indications and improved functional outcome in the treatment of unstable intertrochanter-ic fracture with Gamma 3 intramedullary nail.Conclusion: Various studies found favorable results with gamma nail in managing a greater variety of unstable hip fractures with a less invasive technique and with better results. Other studies have reported favorable results with GN in terms of shorter operation time, less blood loss, shorter hospital stay, decreased wound infection and reduced complication rate.

Comparison of Intra- and Extramedullary Implants in Treatment of Unstable Intertrochanteric Fractures

IntroductionComparison was made of the clinical and radiological results of the surgical treatments of proximal femoral nail (PFN), dynamic hip screw (DHS) or proximal femoral locking compression plate (PF-LCP) in patients with AO 31A2.2/2.3 unstable intertrochanteric femoral fracture(ITF). MethodsEvaluation was made of a total of 91 patients in respect of age, gender, time from fracture to surgery, operating time, amount of blood replacement, total hospitalisation, follow-up period, time to full weight-bearing, time to union, complications and Harris hip scores(HHS). ResultsA statistically significant difference was determined between the groups in respect of perioperative operating time, blood replacement and hospitalisation period with the values of the PFN group seen to be superior to those of the other two groups (p < 0.001). No significant difference was determined beween the DHS and PFN groups in respect of time to union and in the long-term HHS, both groups were seen to be superior to the PF-LCP group (p < 0.001). Full weight-bearing was statistically significantly earlier in the PFN group (p < 0.001). The numbers of implant failures was statistically significantly higher in the PF-LCP group (p < 0.001). ConclusionThe new generation intra-medullar nails are easy to apply and have more successful clinical results compared to extra-medullar implants in the treatment of A2 unstable ITF. Due to the high rates of implant failure, PF-LCP should not be preferred in these fractures.

A comparative study of treatment of unstable intertrochanteric fractures with PFN and cemented hemiarthroplasty

Aim: Aim of the study is to analyse and compare the functional outcomes and radiological results of two different surgical modalities, PFN and cemented hemiarthroplasty in the treatment of unstable intertrochanteric fractures in elderly patients. Background: Elderly patients with intertrochanteric fractures should be mobilized early to reduce the morbidity and mortality. While cemented hemiarthroplasty allows early weight bearing, the prolonged surgical time increase the blood loss and mortality, whereas with PFN once the fracture becomes stable allows early mobilization thus overcoming the problems of recumbency. PFN efficiently preserves the femoral head and the abductor mechanism and thus has the biomechanical advantage of increased range of hip joint movements and better functional outcome. Materials and methods: Sixty patients of age 60 years and above with comminuted intertrochanteric fractures treated by PFN or cemented hemiarthroplasty were taken up for the prospective study in our institute between january2013 and june 2015. 30 patients underwent PFN and 30 patients had hemiarthroplasty. Average period of follow up was 2 years. Post-operative complications and mortality rates were compared between the two groups. Functional results and the hip range of movements were assessed by Harris Hip Score (HHS). In the mean follow up period of 22months radiological examination was done to assess the results & complications. Results: The demographic and background data of the patients in the two groups are statistically similar. At 2 years follow up PFN group patients had a mean HHS of 85.89 and HA group had 78.11. Pain, severity and range of hip movements are better in PFN group than HA group. Radiologicaly 4 patients in HA group had stem loosening and 2 patients had screw cut out in the PFN group with subsequent pain in the final follow up. Conclusion: PFN is a better option for the treatment of elderly intertrochanteric fractures as the operative time is short, easier surgical procedure & has less mortality. PFN also gives a better functional outcome in the late follow up than hemiarthoplasty.

Role of Proximal Femoral Nail in the Treatment of Unstable Intertrochanteric Fractures

Role of Proximal Femoral Nail in the Treatment of Unstable Intertrochanteric Fractures

Study of effectiveness of coxofemoral bypass in comparison to proximal femoral nail in the treatment of unstable intertrochanteric fractures in the elderly

Background: Osteosynthesis of unstable intertrochanteric (IT) fractures in geriatric population needs prolonged bed rest to prevent implant failure, which in turn results in complications such as pressure sore and pulmonary infection. In literature, a newer approach, such as prosthetic replacement for unstable intertrochanteric fractures, has been described to allow earlier restoration of postoperative weight bearing. Our study aimed to evaluate the effectiveness of coxofemoral bypass in comparison to proximal femoral nail in the treatment of unstable intertrochanteric fractures in the elderly. Materials and Methods: Forty-two elderly patients with unstable IT femur fractures were included in this study, of which 21 patients underwent coxofemoral bypass with remaining 21 patients treated with proximal femoral nail. Both the groups were comparable with regard to demographic data and injury variables. The clinicoradiological evaluation was done at regular follow-up visits at 6 weeks, 3 months, and 6 months postoperatively. The functional outcome between the two techniques was evaluated using Harris hip score. Results: The complications such as pressure sore and pulmonary infection were higher in proximal femoral nail group compared to coxofemoral bypass group. There was statistically significant difference in functional outcome between two groups at the end of 6 weeks (P = 0.048) but not significant at the end of 6 months (P = 0.357, better in coxofemoral bypass group). Conclusion: Coxofemoral bypass is a better option than proximal femoral nail in the treatment of unstable IT fractures in the elderly as it provides stable, pain-free, mobile joint with earlier restoration of walking ability, less complications, and good functional outcome.

Comparison between Cementless and Cemented Bipolar Hemiarthroplasty for Treatment of Unstable Intertrochanteric Fractures: Systematic Review and Meta-analysis.

PurposeThis study was conducted to compare cemented and cementless bipolar hemiarthroplasty in elderly patients with unstable intertrochanteric fractures via meta-analysis and systematic review of relevant studies.Materials and MethodsSystematic review and meta-analysis were performed on 31 available clinical studies; 19 of these studies used cemented stems, 12 used cementless stems, one used both types of stems, and two studies involved a comparative analysis of both stem types.ResultsThere were statistically significant differences in rates of leg length discrepancy (LLD) greater than 1 cm between the cemented (event rate, 0.089) and cementless groups (event rate, 0.015 and 0.047; P=0.03).ConclusionCemented bipolar hemiarthroplasty and cementless bipolar hemiarthroplasty performed on elderly patients with unstable intertrochanteric fracture revealed similar mortality and complication rates; however, the rate of LLD greater than 1 cm was significantly higher in the cemented group compared with the cementless group.

Fixation of Trochanteric Fragments in Cementless Bipolar Hemiarthroplasty of Unstable Intertrochanteric Fracture: Cerclage Wiring.

PurposeBipolar hemiarthroplasty (HA) is an option for the treatment of unstable intertrochanteric fracture in elderly patients. There is a raising concern regarding cable-grip related complications for the fixation of trochanteric fragments. Therefore, the aim of this study was to evaluate outcome of cementless HA with fixation for the trochanteric fragments using monofilament wires in unstable intertrochanteric fracture.Materials and MethodsWe reviewed 92 cementless bipolar HAs using a grit-blasted long stem design for unstable intertrochanteric fractures in 91 elderly patients with a mean age of 81.7 years. During the arthroplasty, trochanteric fracture fragments were fixed using 1 or 2 vertical wires and transverse wires. We evaluated the clinical outcomes such as abductor power, ambulatory ability and wire-related complications, and radiologic outcomes including the union of the trochanteric fragment and subsidence of stem.ResultsSixty-two patients were followed for a minimum of 2 years (mean, 59 months) postoperatively. The mean abductor power and Koval category was 4.1 (range, 3 to 5) and 4.6 (range, 1 to 6). The wire was broken in 3 hips (4.8%) and the nonunion of the greater trochanter occurred in 1 hips (1.6%). Two stems subsided by 3 mm and 8 mm, respectively, during postoperative 6 weeks, after which the subsidence was not progressive.ConclusionCerclage wiring of the trochanter using monofilament wire leads to acceptable outcome in cementless HA for senile patients with unstable intertrochanteric fracture. Cerclage wiring using a monofilament wire is recommended for the fixation of trochanteric fragments.

Functional outcome of unstable intertrochanteric femur fracture in elderly osteoporotic patients treated by primary cemented bipolar hemiarthroplasty versus internal fixation with proximal femoral nailing

Backround: Intertrochanteric fractures in the elderly pose certain special problems and need to be addressed in a balanced way as on one hand senile osteoporosis requires prolonged immobilization, on the other hand rapid mobilization is required as they are generally medically compromised due to age and associated diseases. Despite several randomized trials and comparative studies treatment of unstable intertrochanteric fractures in elderly patients is still controversial, which we want to investigate in this set-up which caters to a vast rural population. Methods: A retrospective analysis of 54 patients, of which 27 each were operated with cemented bipolar hemiarthroplasty (BPA) and proximal femur nail (PFN) between January 2012 till July 2016 was done. Primary outcome was assessed in both groups using Harris hip score( HHS) at 4weeks, 6 weeks, 12weeks, 6months and 1 year on outpatient basis. The secondary outcome measures were intraoperative blood loss, transfusion rate, surgical time, bed to chair time, chair to walking time, limb length discrepancy at final follow up. All complications were noted at follow ups. Results: The HHS was significantly higher for BPA group at all follow ups, at 4 weeks of follow up was 77.81 for BPA and 71.18 for PFN (p-value = 0.001) and at 1 year of follow up was 85.55 for BPA and 77.03 for PFN (p-value = 0.001). Statistically significant differences were found between BPA and PFN groups with reference to intraoperative blood loss, transfusion rate, surgical time, bed to chair time, chair to walking time, limb length discrepancy at final follow up. Conclusion: The bipolar hemiarthroplasty group had fewer complications and earlier mobilization with better Harris hip score at all follow ups, which indicate bipolar hemiarthroplasty is a better option in the treatment of unstable intertrochanteric fractures in senile osteoporotic patients.

Effect of Implanting Prosthesis Combined with Internal Fixation for the Treatment of Unstable Intertrochanteric Fractures in the Elderly

Effect of Implanting Prosthesis Combined with Internal Fixation for the Treatment of Unstable Intertrochanteric Fractures in the Elderly

Proximal femur locking plate fixation for the treatment of unstable femoral intertrochanteric fractures in elderly patients

Objective To explore the efficacy of proximal femur locking plate(PFLP) for the treatment of unstable femoral intertrochanteric fractures in elderly patients. Methods Data of 120 cases of patients with unstable femoral intertrochanteric fractures who were treated by PFLP were retrospectively analyzed. There were 56 males and 64 were females, aging from 62 to 78 year-old (average, 69.4 year-old). 85 cases were left hip, and 35 cases right hip. According to AO fracture classification, there were 12 cases of A2.2, 23 A2.3, 34 A3.1, 29 A3.2, and 22 A3.3. According to Evans intertrochanteric fractures classification: there were 93 cases of type III, 19 type IV, and 8 type V. Operation time, length of hospital stay, fracture healing time, postoperative complications and hip joint Harris scores were recorded. Results All patients were followed up for 8-14 months (average, 12.4 months). Their operating time were 51-80 min (average, 63.1 min); X-ray exposure were 8-15 times (average, 11.6 times); intraoperative blood loss were 70-120 ml (average, 92.7 ml); postoperative drainage volume were 50-100 ml (average, 61.7 ml), and length of hospital stay were 7-14 d (average, 10.2 days). The healing time ranged from 12 to 32 weeks (20.4 weeks average). 14 cases had delayed union, and healing time was 8-10 months. In addition, 4 cases had deep vein thrombosis (after thrombolysis therapy the vein was recanalized); 2 had internal fixation broken, who were then treated with PFNA II, and bone healed after 6 months; 5 had hip varus, who were then treated via hip replacement, and no hip prosthesis fracture were found. No other complications occurred in the remaining patients. At the latest follow-up, according to Harris hip score: there were 38 cases with excellent results, 71 good, 9 fair, and 2 poor, and the rate of excellent and good was 90.8% (109/120). Conclusion PFLP for the treatment of unstable femoral intertrochanteric fractures has advantages of less invasion, less complication, reliable fixation and high fracture healing rate, thus it is suitable for unstable intertrochanteric fractures in elderly patients. Key words: Aged; Hip; Fractures, bone; Fracture fixation, internal

What Are the Determinants of Mortality After Cemented Bipolar Hemiarthroplasty for Unstable Intertrochanteric Fractures in Elderly Patients?

BackgroundPrimary hemiarthroplasty is proposed for the treatment of unstable intertrochanteric fractures in elderly patients with the advantages of early mobilization, acceptable functional results, and lower failure rates. The 1-year mortality rates demonstrated high variance in the literature, whereas, the factors related to 1-year mortality were not widely investigated. The main purpose of the present study was to determine predictive factors related to 1-year mortality after primary cemented calcar-replacement bipolar hemiarthroplasty performed for unstable intertrochanteric fracture. MethodsOne hundred six patients with the mean age of 80.7 years were included in this retrospective study. Age, gender, body mass index, comorbid diseases, American Society of Anesthesiologists score, total hospitalization time, time from injury to surgery, operation time, estimated blood loss, postoperative mobilization time, and decrease in Koval ambulatory categories were evaluated. Univariate and multivariate analyses were performed to determine major predictors of 1-year mortality. The Kaplan-Meier survival analysis was used to construct the cumulative survival rate. ResultsThree or more American Society of Anesthesiologists scores, presence of ≥3 comorbid diseases, and postoperative mobilization time of ≥2 days were significantly correlated with 1-year mortality. Presence of ≥3 comorbid systemic diseases was identified as the major predictive factor for 1-year mortality. The overall 5-year cumulative survival rate was 5.6%. ConclusionHaving three or more comorbid systemic diseases has been detected as the major determinant of 1-year mortality after primary cemented calcar-replacement bipolar hemiarthroplasty performed for unstable intertrochanteric fracture in elderly patients.

Cemented modular bipolar hemiarthroplasty of hip in treatment of unstable intertrochanteric fractures in elderly patients

Aim: The aim of this study is to find out this treatment option can lead to the best clinical and functional outcomes. Patients and Methods: Twenty patients admitted to Hospital between Jan 2013 and Dec 2015 with a diagnosis of unstable intertrochanteric fractures of femur were selected. Preoperative and operative data was retrieved from inpatient hospital files. Postoperative radio clinical data at follow up visits was collected from outpatient department files. Functional outcomes were assessed with use of Harris hip score. The main clinical measures were early postoperative full weight bearing, postoperative complications and functional outcome. Results: The time to full weight bearing, the rate of postoperative complications, and the functional outcomes were significantly better in the cemented bipolar modular hemiarthroplasty group. Conclusion: According to our results, we believe that cemented modular bipolar hemiarthroplasty is of choice in freely mobile elderly patients above seventy years of age with an unstable intertrochanteric femoral fracture.

Strategies for Proximal Femoral Nailing of Unstable Intertrochanteric Fractures: Lateral Decubitus Position or Traction Table.

The aim of this prospective randomized study was to compare the traction table and lateral decubitus position techniques in the management of unstable intertrochanteric fractures. Eighty-two patients with unstable intertrochanteric fractures between 2011 and 2013 were included in this study. All patients were treated surgically with the Proximal Femoral Nail Antirotation implant (DePuy Synthes). Patients were randomized to undergo the procedure in the lateral decubitus position (42 patients) or with the use of a traction table (40 patients). Patients whose procedure was not performed entirely with a semi-invasive method or who required the use of additional fixation materials, such as cables, were excluded from the study. The groups were compared on the basis of the setup time, surgical time, fluoroscopic exposure time, tip-to-apex distance, collodiaphyseal angle, and modified Baumgaertner criteria for radiologic reduction. The setup time, surgical time, and fluoroscopic exposure time were lower and the differences were statistically significant in the lateral decubitus group compared with the traction table group. The collodiaphyseal angles were significantly different between the groups in favor of the lateral decubitus method. The tip-to-apex distance and the classification of reduction according to the modified Baumgaertner criteria did not demonstrate a statistically significant difference between the groups. The lateral decubitus position is used for most open procedures of the hip. We found that this position facilitates exposure for the surgical treatment of unstable intertrochanteric fractures and has advantages over the traction table in terms of set up time, surgical time and fluoroscopic exposure time.

Steinmenn pins used to assist reduction in treatment of unstable intertrochanteric fractures with proximal femoral nail antirotation

Objective To evaluate application of Steinmenn pins to assist reduction in the treatment of unstable intertrochanteric fractures with proximal femoral nail antirotation(PFNA). Methods From February 2010 to June 2013, 38 unstable intertrochanteric fractures were treated by us. There were 23 men and 15 women, aged from 32 to 69 years. By Evans-Jensen classification, 18 cases were type Ⅲ, 13 type Ⅳ and 7 type V. They were divided into 2 groups (n=19). Group A received reduction on a traction bed assisted by Steinmenn pins plus PFNA fixation while group B received reduction only on a traction bed plus PFNA fixation. The 2 groups were compared in terms of fracture reduction, operation time, intro-operative blood loss, fracture healing time, and Harris scores one year postoperation. Results According to the evaluation system modified by Baumgaetner et al., the postoperative quality of fracture reduction was fine in 15 cases and fair in 4 in group A while it was fine in 9 cases, fair in 8 and poor in 2 in group B, showing a significant difference between the 2 groups (P 0.05). No cases of refracture, delayed union, nonunion, or avascular necrosis of the femoral head were reported. Conclusion In the treatment of unstable intertrochanteric fractures, compared with reduction only on a traction bed plus PFNA fixation, application of Steinmenn pins to assist reduction on a traction bed plus PFNA fixation may lead to better curative efficacy due to its limited invasion, simplicity and beneficial assistance in reduction. Key words: Hip fractures; Fracture fixation, intramedullary; Bone nails; Reduction; Steinmenn pins

Treatment for unstable intertrochanteric fractures with proximal femoral locking plate in elderly patients

Objective To explore the clinical outcomes of treating unstable intertrochanteric fractures with proximal femoral locking plate (PFLP) in the elderly patients. Methods From January 2010 to June 2015, 380 elderly patients with unstable intertrochanteric fracture were treated with PFLP and successfully followed up at our department. They were 171 men and 209 women, from 60 to 89 years of age (average, 68.7 years). By AO classification, there were 58 cases of AO31-A2.2, 87 ones of 31-A2.3, 130 ones of 31-A3.1, 63 ones of 31-A3.2, and 42 ones of 31-A3.3. Operation time, incision length, length of hospital stay, fracture healing time, postoperative complications and hip joint Harris scores were recorded. Results This cohort was followed up for an average of 13.3 months (range, from 8 to 21 months). Their operation time averaged 53.2 min, X-ray exposure 12.2 times, intraoperative blood loss 92.7 mL, incision length 12.6 cm, postoperative drainage volume 54.7 mL, and length of hospital stay 9.2 days. Pulmonary infection was observed in 3 cases, fixation loosening in 8, fixation breakage in 2, hip varus in 9, and fracture nonunion in 4, yielding a total complication rate of 6.8% (26/380). No operative incision infection was observed. The average fracture healing time was 11.8 weeks (range, from 7 to 48 weeks) after operation. The average Harris score one year postoperation for the 380 patients was 86.3±6.1, significantly higher than the preoperative value (43.6±4.4) (P< 0.05). There were 96 excellent, 231 good, 42 fair and 11 poor cases, giving an excellent to good rate of 86.1%. Conclusion Since PFLP has advantages of limited invasion, blood loss and complications, a high rate of fracture healing, and good functional recovery of the hip, it may be a good treatment for unstable intertrochanteric fractures in the elderly patients. Key words: Hip fractures; Fracture fixation, internal; Bone plates; Surgical procedures, minimally invasive

Treatment of Unstable Intertrochanteric Femoral Fractures by Dynamic Hip Screw Vs Proximal Femoral Nailing

Background : Inter trochanteric fractures are increasing as the incidence of contributing conditions like osteoporosis, old age and trauma increases. Unstable fractures pose a challenge in management of these fractures. Multiple options for fixation are available but the more commonly used DHS has its own pros and cons. Intra medullary devices offer more stable construct and a good functional outcome. Method : A prospective study was done on 40 cases of unstable intertrochanteric fractures. They were randomly allocated to two groups. Group A was treated with DHS and group B with PFN. Post operatively the cases were followed up for a period of 2 years at regular intervals. Comparison between the two groups in terms of intra operative and post-operative advantages was done . Results : Intra operative parameters like operative time and blood loss were more in DHS group whereas radiation exposure was more in PFN group. Post-operative parameters like duration of stay in hospital, early weight bearing, union rate, infection rate, implant failure was favourable in PFN group. Conclusion : In treatment of Unstable Intertrochanteric Fractures PFN is better than DHS.

A Comparative study of the Dynamic Hip Screw, the Cemented Bipolar Hemiarthroplasty and the Proximal Femoral Nail for the Treatment of Unstable Intertrochanteric Fractures.

Fractures of the Intertrochanteric (IT) region are some of the most common fractures encountered by an orthopedic surgeon in his lifetime. With increase in life expectancy, the incidence of these fractures is also increasing. By 2040, the incidence of these fractures is expected to double. Unstable IT fractures are a major cause of concern in the elderly due to the associated increase in morbidity and mortality. The purpose of this study was to compare the intraoperative and postoperative parameters using the Dynamic Hip Screw (DHS), the Cemented Bipolar Hemiarthroplasty (BH) and the Proximal Femoral Nail (PFN) for the management of unstable IT fractures. Fifty patients, having unstable IT fractures with age more than 60 years were randomly selected and were followed up averagely for 19 months (12- 30 months). The type of implant for a particular patient and a particular type of fracture was randomly selected and the same surgical team treated all patients. Total number of 19 patients were operated using the DHS (Group-1), 13 using the BH (Group-2) and 18 using the PFN (Group-3). All patients in the three groups were compared in terms of preoperative, intraoperative and postoperative parameters and functionally assessed using the Harris hip score and the mobility score of Parker and Palmer. Patients operated using the PFN had significantly lower mean blood loss as compared to the other two groups. The mean days to unaided Full Weight Bearing (FWB) was significantly higher in patients treated by the DHS as compared to the other two groups. All three groups were comparable in terms of functional assessment. Treatment of unstable IT fracture of femur is a matter open to debate. IT fractures of elderly must be treated with considering the age of the patient, mental status, bone quality, and the type of fracture. Level of Evidence according to OCEBM Levels of Evidence Working Group - Level 2.