Treatment Of Unstable Trochanteric Fractures Research Articles

A study of functional outcome in unstable intertrochanteric fractures treated by proximal femoral nailing in Bundelkhand region

Background: Intertrochanteric fractures are the most frequent fractures of the hip joint. This is attributed to the increase in the elderly population in our country, along with osteoporosis being prevalent in these populations. Aims and Objectives: The aim of the study is to prospectively analyze the functional outcome of unstable intertrochanteric fractures managed with “proximal femoral nail” (PFN). Materials and Methods: The prospective study was conducted on 48 cases of unstable intertrochanteric in Maharani Laxmi Bai Medical College, Jhansi, between June 2022 and December 2023. Results: In our study, the mean age of the patient is 36.16 and the most common age group is 41–60 years, 33.33%, and >60 years, 41.67%. In forty-eight cases, 37 (77.08%) were male patients, and 11 (22.92%) were female patients. The Harris hip score patients follow-up after 3 months 8 (16.67%) patients of excellent outcomes, 18 (37.50%) patients of good outcomes, 12 (25.00%) of fair outcomes, and 10 (20.83%) patients of poor outcomes. The Harris hip score patients follow-up after 6 months 24 (50%) patients of excellent outcomes, 20 (41.67%) patients of good outcomes, 2 (4.17%) of fair outcomes, and 2 (4.17%) patients of poor outcomes. Conclusion: In unstable proximal femur fractures, PFN is a significant advancement in the treatment of unstable trochanteric fractures which has the unique advantages of closed reduction, preservation of fracture hematoma, less tissue damage, early rehabilitation, and early return to work.

Anterior Cortical Impingement With 240 mm Cephalo-Medullary Nail (PFN and PFNA-2) in Intertrochanteric Femur Fracture Fixation in the Indian Population: A Problem Statement.

Trochanteric fractures are common in the elderly population, and their incidence increases twice every decade after age 50. Intramural fixation has achieved good clinical efficacy in the treatment of unstable trochanteric fractures, but there have been complications reported in the literature in the Asian population. Most complications arise from a mismatch between the increase in the anterior femoral bow with advancing age and the proximal femoral nails (PFN) on the market, which still have straight designs on the sagittal plane. The non-anatomic shapes of the PFNs sometimes make the surgeries difficult or may lead to an inadvertent intraoperative fracture around the tip of the nail, particularly if they impinge on the anterior cortex of the femur. The entry point on the greater trochanter was divided into three equal parts, i.e., anterior 1/3rd, middle 1/3rd, and posterior 1/3rd on the lateral X-rays. Patients with posterior 1/3rd entry were excluded from the study as it is known that posterior positioning of nail entry can cause an increased incidence of anterior nail impingement. The AI was measured using the best available preoperative lateral roentgenogram of the femur using the incidence cortex (AI cortex) angle. This angle was measured using two tangential lines drawn parallel to the anterior cortex of the femur, proximal and distal to the most bowed point of the femur. We recommend that there is a need to introduce anterior curvature in the sagittal plane corresponding to the femoral bow in a 240 mm cephalomedullary nail to decrease complications. We also consider the use of either a short (i.e., 180 mm) or a long cephalomedullary nail in the Indian population, as the height of the population is shorter as compared to the western population, and the role of a 240 mm cephalomedullary nail is doubtful in the Indian population.

Comparative Outcome of Short Proximal Femoral Nail Versus Proximal Femoral Locking Compression Plate in the Management of Unstable Trochanteric Fractures

Introduction: Trochanteric fractures are mostly due to RTA and falls. Unstable trochanteric fractures include those with a reverse oblique fracture line, intertrochanteric comminution, big posteromedial fragment, subtrochanteric extension, a broken greater trochanter and lateral cortex breach. As per the AO Classification of intertrochanteric fractures, AO31-2.2, AO31-2.3, AO31-3.1, AO31-3.2 and AO31-3.3 fall under the category of unstable trochanteric fractures. Internal fixation is mandatory to provide early mobilization of patients with partial weight-bearing and prevent further compli&cations. Materials and Methods: 43 patients more than 18 years old with unstable trochanteric fractures, less than 3 weeks old trauma were included in the prospective study for 1 year period (1st June 2020 to 31st May 2021). 22 cases were treated with short Proximal Femoral Nail (PFN) and 21 cases were treated with Proximal Femoral Locking Compression Plate (PFLCP). Results: (P<0.05), mean duration of surgery, blood loss was less in the PFN group (67minutes; 80mL) than PFLCP group (99 minutes; 152 ml). Union and partial weight-bearing was seen earlier in PFN group (14.1weeks; 10.6weeks) than in PFLCP group (18.7 weeks; 15.8weeks) (P<0.05). Good-excellent outcome was seen in 100% cases in PFN group and 85.71% cases in PFLCP group. There were 3 cases of delayed union in PFLCP group and 1 in PFN group. 1 PFLCP case had malunion in varus deformity. Conclusion: Short PFN is the optimum implant in treatment of unstable trochanteric fractures as it is an intramedullary, load sharing device with short lever arm and hastens biological healing with early ambulation and minimal complications.

Clinical, functional and radiological outcome of unstable intertrochanteric femur fracture treated with proximal femur nail

Objective: To determine the clinical, functional and radiological outcome of unstable intertrochanteric femur fractures treated with proximal femur nailMethods: The study is a prospective study on 20 patients to analyse clinical, functional and radiological outcome of unstable intertrochanteric femur fractures treated with proximal femur nail conducted in the Department of Orthopedics at Stanley medical college, Chennai from June 2018 to August 2020. Functional outcome was assessed using Harris hip score.Results: 20 patients of unstable intertrochanteric fracture were treated surgically with proximal femur nail and the results were functionally and radiologically analysed. Patients were followed up from 11months to 22 months and mean follow up in months was 15.9 ± 2.73. Mean Harris hip space at 3months was 73.85 ± 3.4, Mean Harris hip score at 6months was 85.15 ± 2.66. Radiological Fracture union was noted between 12-16 weeks and mean time for union was 12.90 ± 1.4 weeksConclusion: Intramedullary nailing with the PFN has distinct advantages over DHS like shorter operating time and lesser blood loss for unstable trochanteric fractures. Early mobilization and weight bearing is allowed in patients treated with PFN thereby decreasing the incidence of bedsores, uraemia and hypostatic pneumonia. The incidence of pre-operative and postoperative planning and correct technique, adequate reaming of femoral canal, insertion by hand and meticulous placement of distal locking screws. PFN is a significant advancement in the treatment of unstable trochanteric fractures which has the unique advantage of closed reduction, preservation of fracture haematoma, less tissue damage during surgery, early rehabilitation and early return to work.

COMPARATIVE STUDY BETWEEN INTRAMEDULLARY FIXATION AND ARTHROPLASTY FOR THE MANAGEMENT OF UNSTABLE TROCHANTERIC FRACTURE IN ELDERLY

Background: Intertrochanteric fractures involve those occurring in the region extending from the extra capsular basilar neck region to the region along the lesser trochanter proximal to the development of the medullary canal, these fractures account for forty percent of proximal femoral fractures in elderly.Aim of the Work: is to compare intramedullary fixation and hip arthroplasty in treatment of unstable trochanteric fracture in elderly in terms of surgical techniques, clinical and radiological outcome, complications, functional outcome and patient satisfaction.Patients and Methods: The thesis is a prospective comparative randomized study between PFN and Hemiarthroplasty for the treatment of unstable trochanteric fractures in elderly. Patients were followed up at 1, 3, 6, 12 month postoperative, clinical and radiological data collected and documented starting from perioperative data (operative time, blood loss, transfusion).Results: We compared intramedullary fixation and hip arthroplasty in treatment of unstable, comminuted trochanteric fracture in elderly in terms of surgical techniques, clinical and radiological outcome, complications, functional outcome. We did our best to execute it in an objective unbiased scientific manner by allocating patients randomly into two groups using closed opaque envelops. This was confirmed by the mean personal data (Age, sex), side of the fracture, pre-existing comorbidities, and fracture type according to AO classification, both groups were comparable, with no significant difference. Comparison of operative data showed significant difference in operative time, mean operative time was [78.4 min for group 1 Vs 112.6 min for group 2], favoring group 1 as less operative time.Conclusion: Hemiarthroplasty could be valid option in management of unstable trochanteric fractures in elderly, giving the advantage of early full weight bearing, yet it is more technically demanding, require higher surgical experience.

The Effect of Synthetic Osteoconductive Bone Graft Material for Augmentation of Internally Fixed Unstable Trochanteric Fractures

This study aimed to evaluate whether the augmentation of CaP into the femoral head around the lag screw results in superior clinical and radiological outcomes of treatment of unstable trochanteric fractures using an intramedullary (IM) implant. Fifty-six consecutive patients with unstable trochanteric fractures who had been surgically treated with IM devices between 2014 and 2016 were prospectively reviewed and randomly divided into two groups based on the use of CaP degradable cements: 28 patients were assigned to the CaP group, while the other 28 patients were assigned to the control group (no use of CaP). Clinical evaluations and radiological analyses were conducted during a minimum of 2-year follow-up. No significant differences in the mean visual analogue scale for the hip pain scores and modified Harris Hip Scores were found between the CaP group and the controls at postoperative 2 months and 2 years. However, earlier walker ambulation was possible in the CaP group (10 ± 9 days) compared to the control group (13 ± 12 days) (P = 0.02). In radiological analysis, the CaP group showed significantly lower difference between tip-apex distance measured immediately after surgery and that measured at one-year follow-up compared to the control group (P = 0.012). No screw cut-out occurred in the CaP group, while one patient in the control group was reoperated for screw cut-out. The CaP augmentation into the femoral head around lag screw can reduce lag screw penetration, prevent screw cut-out beyond the femoral head, and facilitate early ambulation in elderly patients with unstable trochanteric fractures.

Functional outcome of unstable intertrochanteric fractures managed with proximal femoral nail: a prospective analysis

<p class="abstract"><strong>Background:</strong> Hip fractures are a growing concern for the orthopedic surgeons all over the world because the incidence of hip fractures is increasing dramatically and these fractures impose a significant challenge in their efficient management. The aim of the study was to prospectively analyze the functional outcome of unstable intertrochanteric fractures managed with ‘proximal femoral nail’.</p><p class="abstract"><strong>Methods:</strong> In our institution, we have selected 24 cases of unstable intertrochanteric fractures for this prospective study. All cases enrolled were managed with the proximal femoral nail. These cases were studied from the mechanism of injury, classification, and treatment with the proximal femoral nail and their surgical and functional outcome with or without residual comp.<strong></strong></p><p class="abstract"><strong>Results:</strong> Patients were followed up for an average period of 8.58 months. The mean Harris hip score was 88.75 at 6th month. The score was excellent in 12 patients, good in 10 patients, fair in 1 patient and poor in 1 patient. In our study of 24 patients with unstable intertrochanteric fracture, the average age incidence was 54.64 years. In the present study male: female was 5:3.</p><p class="abstract"><strong>Conclusions:</strong> In unstable proximal femur fractures, PFN is a significant advancement in the treatment of unstable trochanteric fractures which has the unique advantages of closed reduction, preservation of fracture hematoma, less tissue damage, early rehabilitation and early return to work.</p>

The Influence of Position of the Displaced Lesser Trochanter on Clinical Outcome of Unstable Trochanteric Femur Fractures in the Elderly.

Purpose This study aimed to evaluate whether position of the displaced lesser trochanter affected clinical outcome in the treatment of unstable trochanteric fractures with intramedullary fixation. Patients and Methods Patients with unstable trochanteric fractures and displaced lesser trochanter who received intramedullary fixation were retrospectively reviewed in this study. Based on displacement distance of the lesser trochanter and whether the lesser trochanter was reduced operatively, patients were divided into three groups: patients with the displaced lesser trochanter less than 1cm (Group A), those with the displaced lesser trochanter more than 1 cm without operative reduction (Group B), or those with operative reduction (Group C). The surgical time, reduction quality, Harris Hip Score (HHS), Visual Analog Score (VAS), and complication rate were reviewed. Results There were 42 patients in Group A, 33 in Group B, and 36 in Group C with comparable demographic characteristics. The surgical time was significantly longer in Group C (P=0.009), compared with Groups A and B. Fracture reduction quality was comparable with over 85% good reduction among the three groups. The VAS score was significantly higher in Group B (P=0.023) without significant difference between Groups A and B. The HHS score was slightly lower in Group B, but it did not reach significant difference. The complication rate was statistically higher in Group B (p=0.043) than Groups A and C. Conclusion The severe displaced lesser trochanter may increase postoperative complications and postoperative pain in the treatment of unstable trochanteric femur fractures. However, the displaced lesser trochanter may not affect hip function.

Screw versus helical proximal femoral nail in the treatment of unstable trochanteric fractures in the elderly

PurposeComparison of clinical, radiological and functional outcomes of screw proximal femoral nail (PFN) and helical PFN in management of unstable trochanteric fractures. MethodsThis prospective randomised comparative study included 60 patients with closed unstable intertrochanteric fractures (AO classification-A2.2–A2.3 & A3.1–A3.3). Patients were randomised to 2 treatment groups using simple random sampling method utilizing computer based randomisation. Screw PFN and helical PFN were used for internal fixation with 30 patients in each group. ResultsBoth groups were similar in respect of age, gender, fracture classification, quality of fracture reduction, duration of hospitalization, post-operative complications, residual/late deformity as well as functional assessment. However, mean duration of surgery was significantly lower (23.1%) in helical PFN group as compared to screw PFN group (43.32 ± 8.20 min vs. 35.20 ± 6.03 min, p < 0.001). Furthermore, mean blood loss was not significant in either of the study groups but it was significantly lesser (30.1%) in helical PFN group as compared to screw PFN group (77.80 ± 17.39 ml vs. 59.80 ± 14.96 ml, p < 0.001). Also, mean number of images taken was significantly lower (58.7%) in helical PFN group as compared to screw PFN group (29.52 ± 4.85 no vs. 18.60 ± 3.12 no, t = 9.47; p < 0.001). ConclusionBoth screw PFN and helical PFN are equally effective implants in internal fixation of unstable trochanteric fractures with no statistically significant difference (p > 0.05) in any of the outcome measures. However, helical PFN group fared marginally better in terms of operative time, blood loss and imaging required.

Helical Blade or the Integrated Lag Screws: A Matched Pair Analysis of 100 Patients With Unstable Trochanteric Fractures

To compare the radiological and clinical results with PFNA-II and InterTan in the treatment of unstable trochanteric fractures in the elderly. Retrospective, multicenter, matched pair. Three tertiary level trauma centers. Hundred elderly patients who underwent intramedullary stabilization with either the PFNA-II or the InterTan for osteoporotic unstable trochanteric fractures. Fifty matched pairs consisting of OTA/AO-A2 and A3 fractures were created from a cohort of 290 patients who underwent internal fixation for unstable trochanteric fractures with the PFNA-II or InterTan nails. Radiological assessment was performed to compare union rates, varus collapse, medial or lateral screw/blade migration, and cut-out. Functional outcome at 1 year was assessed and compared using Harris hip score, Timed Up and Go test, and the mobility score. Union rates, fracture reduction, neck shaft angle, and tip-apex distance were similar in both groups. The PFNA-II group had a significantly higher degree of lateral sliding of the helical blade (P < 0.001). The InterTan group had a better Harris hip score, mobility score, Timed Up and Go test scores, and abductor strength (P < 0.05) at 1 year. The incidence of varus collapse and medial blade migration were higher in the PFNA-II group (P > 0.05). The need for repeat surgery to address surgery-related complications were significantly high in the PFNA-II group (P = 0.045). The InterTan may provide superior functional outcome and reduced complications than does the Proximal Femur Nail - Antirotation in elderly patients with unstable trochanteric fractures. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Intramedullary Fixation for Unstable Intertrochanteric fractures

Background: Intertrochanteric fractures of the hip are common fractures in the elderly. While the incidence of these fractures has actually decreased, the absolute increase in the elderly population has led to doubling the number of these fractures over the past three decades and this trend is expected to continue. Intramedullary fixation of these fractures gained popularity in the last few years because of its biomechanical superiority over extramedullary methods moreover less blood loss, operative time, x-ray exposure and hospital stay. Method: This study was performed on forty patients with unstable intertrochanteric fractures underwent fixation with intramedullary short Gamma nail generation three. Results: Functional outcome was assessed using Parker mobility score at 6 months and one year postoperative, 31(77.5%) patients had the same score as preoperative at 6 months and increased to 87.5% at one year. The most of cases 29(72.5%) had no complications. Conclusion: Our results recommend the use of intramedullary nail in the treatment of unstable trochanteric fracture after anatomical reduction.

A comparison study of proximal femoral nail and dynamic hip screw devices in unstable trochanteric fractures

Background Trochanteric fracture of the femur is a common orthopedic injury in the geriatric population, and the use of extramedullary dynamic hip screw (DHS) is still more superior with fewer complication rates in stable trochanteric fractures. On the contrary, proximal femoral nail (PFN) may have some advantages in fractures at the level of lesser trochanter, reversed obliquity fractures and in subtrochanteric fracture, although the evidence is yet insufficient. Aim The aim of this study was to compare the results of treatment of unstable trochanteric fracture of femur in 40 patients treated by either PFN or DHS regarding primary outcomes: early mobilization, pain improvement, radiological assessment for fracture reduction and fixation and secondary outcome. Patients and methods This study was conducted on 40 patients with unstable pertrochanteric fractures treated surgically, where 20 patients were treated by DHS and 20 patients were treated by PFN. All were planned for follow-up examination for a period of 8 months from the date of operation. Full workup including the age, sex, medical history, type of fracture, mechanism of injury, and plain radiographs was carried out on admission. Results In this study, the duration of union in the whole study population ranged from 1.5 to 8 months, whereas in the group of patients with trochanteric fractures, it ranged from 2 to 8 months. Conclusion We recommend to conduct larger studies to further evaluate the DHS and PFN in the management of unstable trochanteric fractures, with a longer follow-up duration.

Functional and radiological outcome of proximal femoral locking compression plates in the treatment of unstable trochanteric fractures

Introduction Intertrochanteric femoral fracture is extracapsular fracture of the proximal femur between the greater and lesser trochanters. They represent about 50% of all hip fractures. Considerable complications such as pulmonary embolism, deep venous thrombosis, and pneumonia are frequently seen with these fractures mainly due to prolonged immobilization and specifically in elderly patients. These fractures can be categorized into stable and unstable according to the bony construct displacement after a fracture. Approximately 35–40% will be classified as unstable three-part and four-part fractures; unstable fractures are difficult to manage with dynamic hip screw alone and are technically much more challenging and the treatment is more controversial. Patients and methods During the period from 1 July 2016 till 1 February 2017, 44 patients with unstable trochanteric fractures AO A2 and A3 who were admitted in the Causality Department in Kasralainy Hospital, Cairo University were randomly selected in our study to be treated by fixation with proximal femoral locking compression plate according to the standardized protocol. Results Patient demographics: 28 women and 16 men were included with a mean age of 61.75 years (SD 8.7); eight patients were diabetic; four patients were hypertensive, and three were cardiac. The total hospital stay was a mean of 8.95 days, mean preoperative period was 4.44 days, and the mean postoperative period was a mean of 4.73 days (SD 1.16).The mean operative time was 106 min; the mean blood loss intraoperative was 308 ml; postoperative infection was three (6.8%) cases; and all of them resolved with a single session of debridement. One case of deep venous thrombosis (DVT) was treated by conservative measures and four cases of varus malunion with no functional deficit. The mean time for fracture union was 17.9 weeks and the mean time till weight-bearing was 12 weeks. Mean harris hip score (HHS) at 6 months was 62.3 which is fair and 81.2 at 12 months which is good. Conclusion Proximal femoral locking compression plate was an effective treatment for unstable trochanteric fracture in terms of time to full weight-bearing. It can be used in these fractures with good functional outcomes and low complication rates. Level of Evidence: Level II randomized, prospective trial.

Functional outcome of patients treated with proximal femoral nail for unstable trochanteric fractures

Introduction: Proximal Femoral Nail has become a popular method of stabilization of unstable trochanteric fracture in adults. The aim of our study was to assess functional outcome, radiological result and complications in patient treated with Proximal Femoral Nail in unstable trochanteric fracture. Material& Method: 30 patients were treated with PFN for unstable trochanteric of femur. Patients were selected on the basis of inclusion and exclusion criteria. Final outcome assessment included fracture union, implant cutout, Z effect, reverse Z effect, loss of reduction in varus, nonunion, broken locking screw/PFN and Modified Harris Hip Score. Result: This study included 25 male and 5 female above 18 years of age Major cause of injury was Road Traffic accident followed by fall at home. Modified Harris hip score was excellent in 19 patient, good in 7 patient fair in 3 and poor in 1 patient. Conclusion: Proximal Femoral Nail is effective device in the treatment of unstable trochanteric fractures.

New Proximal Femoral Compaction Blade Provides Strong Antirotation Stability of the Femoral Head.

This study investigated the mechanical properties of a new rectangular compaction blade and compared this blade with other types of nail. Three types of nail were tested: the Magnum lag screw (Robert Reid Inc, Tokyo, Japan), proximal femoral nail, and Magnum Fid blade (Robert Reid Inc). The nails were inserted into solid rigid polyurethane foam, and the torsional moments were loaded with an Instron testing machine (Instron, Kanagawa, Japan). The force curve was recorded, and the average maximum torque was calculated from this curve. A simulation study was performed with finite element models to determine the mechanism underlying differences in rotational stability. Mechanical testing showed that the new compaction blade had stronger resistance against rotational force than the helical blade and lag screw implants. Finite element analysis also showed that the new compaction blade had stronger resistance to migration of the polyurethane foam cylinder than the other implant types. In addition, the new compaction blade had strong rotational stability. This implant should be useful for the treatment of unstable trochanteric fracture in patients with osteoporosis. [Orthopedics. 2017; 40(3):e491-e494.].

Randomized comparative study to evaluate the role of proximal femoral nail and dynamic hip screw in unstable trochanteric fractures

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Treatment of unstable trochanteric fracture is much more challenging than stable fracture. These fractures require stable fixation to minimize the fracture and implant related complications. Need of this study is to assess the suitable implant for stable fixation of unstable trochanteric fracture with less intra and postoperative complications and good functional outcome.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; In this prospective randomized comparative study, 64 patients were distributed into two groups. Group A consisted of patients treated by proximal femoral nail (PFN) (n=32) and group B treated by dynamic hip screw (DHS) (n=32). All the patients were evaluated preoperatively and surgery was done according to the group they were allotted. Post-operative follow up was done at 6 weeks, 3, 6 and 12 months.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Average age of the patients in this study was 51.26±10.24 year. In this study patients were followed up for an average of 10.87±2.61 month. The duration of surgery was shorter in PFN group. Weight bearing was earlier in PFN group than DHS group. Mean functional ability score was better in PFN group with significant gain in function earlier as compared to DHS group.&lt;/p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; PFN is a better implant for internal fixation of unstable trochanteric fractures which allows early mobilization and has got better functional outcome score in early postoperative period than DHS

Comparison of clinical outcomes with three different intramedullary nailing devices in the treatment of unstable trochanteric fractures.

The aim of this study was toreport our experience regarding the use of three different methods for intramedullary nailing in the treatment of intertrochanteric fractures. Patients with A2 and A3 type fractures operated on for unstable trochanteric fractures were included into this retrospective cohort study. Patients were divided into three groups based on the technique used; Talon distal fix nail/lag screw (n=78; mean age, 78.5±6.6), PFNA nail (n=96; mean age, 77.2±6.8) or InterTan nails (n=102; mean age, 76.8±6.7). Harris hip scores were recorded at the last outpatient visit and survival information was obtained by phone interview and civil registry database. Baseline characteristics were similar among groups. Operation time, fluoroscopy time and blood loss were significantly higher in InterTan group. Screw cut-out occurred in eight patients in PFNA group. In-hospital mortality occurred in nine (3.2%) patients. Length of hospital stay and postoperative tip-apex distance was not different among groups. At follow-up, healing time and Harris hip scores were also similar among groups. One-year survival rate was 83.1±4.5% in Talon distal fix nail/lag screw, 84.0±3.8% in PFNA group and 84.4±3.7% in InterTan group (p=0.33). New Talon distal fix nail/lag screw was associated with lower cut-out rates than PFNA and shorter operative times than InterTan. Further study is warranted to clearly establish the potential advantages of Talon distal fix over any other technique described herein.

A Comparison of Intramedullary and Extramedullary Fixation Devices in Unstable Trochanteric Fractures

Objectives: The main objective of the study was to compare functional outcome and complications associated with a proximal femoral nail, an intramedullary device with those of a traditional extramedullary device, the dynamic hip screw, in patients with unstable trochanteric fracture. Method: In this prospective, randomized study, total of 86 patients were randomized to the intramedullary group [Group A ( n = 40)] or the extrmedullary group [Group B ( n = 46)]. All relevant perioperative information and complications were recorded, and assessments of functional outcome were made. Results: The extramedullary group required a longer operative time (p value 0.001) and was associated with greater blood loss (p value 0.002) than the intramedullary group. The re-operation rate as well, was lower in the group A compared with the group B, although there were no statistically significant difference in the overall complication rate between the two groups (p value 0.221). There were no significant differences in functional outcome between both groups. Conclusions: The intramedullary device is useful in the treatment of unstable trochanteric fractures.

Primary versus secondary calcar replacement hip arthoplasty for treatment of unstable trochanteric fractures

Background Harris and Allen had modified and described a calcar replacement femoral component, which is necessary for the conventional femoral components, as a part of total hip replacement to address many problems related to proximal femoral deficiency. The aim of this study was to compare the clinical and radiological outcomes of a primary salvage calcar replacement hip arthroplasty with secondary salvage calcar replacement hip arthroplasty for treatment of new (group 1, prospective) or failed osteosynthesis or end prosthesis treatment (group 2, retrospective) of unstable trochanteric fractures. Patients and methods Fifteen patients were included in each group, with a mean age of 67.3 years for group 1 patients and 65.8 years for group 2 patients. The female-to-male ratio was 8 : 7 in group 1 and 10 : 5 in group 2. Incidence of preoperative comorbidities was 2.2 per patient in group 1 and 2.0 per patient in group 2. The mean time from the initial unstable trochanteric fracture to the time of calcar replacement hip arthroplasty was 4.2 days and 12.4 months in group 1 and group 2, respectively. The posterolateral approach using the posteriorKocher–Langenbeck proximally and the posterolateral approach distally for the proximal femur without trochanteric osteotomy. All patients were followed up clinically and radiologically, and at the end of the follow-up period (1–3 years) the Merle d’Aubigne and Postel score was used for functional evaluation. Results The mean operative time was 105 and 155 min, the mean amount of blood loss was 550 and 850 ml, and the mean period of hospital stay was 11 and 21 days for group 1 and group 2 patients, respectively. Two patients in group 2 had required postoperative ICU admission. Postoperative complication(s) were reported in one patient (6.6%) in group 1 and in five patients in group 2. Postoperative psychological problems and mortality during the first year were reported in three patients (20%). The Merle d’Aubigne and Postel functional outcome score by the end of the first year was found to be satisfactory (above 14 points) in 100 and 93.3% of patients in group 1 and group 2, respectively. After 3 years of follow-up it was satisfactory in 83.3 and 66.7% of patients in group 1 and group 2, respectively. Conclusion Primary cemented calcar replacement hip arthroplasty for treatment of unstable trochanteric fractures is associated with lesser pain, better walking ability without mortality or psychological problems, and with measurable better overall functional outcomes compared with salvage calcar replacement hip arthroplasty.

Retracted: Outcome of Short Proximal Femoral Nail Antirotation and Dynamic Hip Screw for Fixation of Unstable Trochanteric Fractures. A Randomised Prospective Comparative Trial

A prospective, randomised, controlled trial was performed to compare the outcome of treatment of unstable trochanteric fractures with either a short proximal femoral nail antirotation (PFNA) or dynamic hip screw (DHS). Eighty one patients with unstable fracture of the proximal part of the femur were randomised, at the time of admission, for fixation with either a short PFNA (n=42) or DHS (n= 39). The primary outcome measure was reoperation within the first postoperative year and mortality at the end of one year. Operative time, fluoroscopy time, blood loss, and any intra-operative complication were recorded for each patient. Clinical and radiological follow-up was undertaken for a minimum of 36 months. Any changes in the position of the implant or fixation failure were recorded. Hip range of motion, pain in the hip or thigh and return to work were used to compare the outcomes. There was no significant difference between 1 year mortality rates for the two groups. The mean operative time was significantly less in PFNA group (25 min) than in the DHS group (38 min). Patients treated with a PFNA experienced a shorter fluoroscopy time and less blood loss. Six patients in DHS group had implant failure while none experienced this in PFNA group. The PFNA group had a better functional outcome than the DHS group.