Trochanteric Femoral Fractures Research Articles

Treatment of femoral trochanteric fractures with navigation system

Treatment of femoral trochanteric fractures with navigation system

Evaluation of perioperative bleeding and CRP level between PFNA and Multi-fix for femoral trochanteric fracture

Evaluation of perioperative bleeding and CRP level between PFNA and Multi-fix for femoral trochanteric fracture

Proximal Femoral Nail for Treatment of Trochanteric Femoral Fractures

To report outcomes of 87 consecutive patients treated with a proximal femoral nail (PFN) for trochanteric femoral fractures. 17 men and 70 women aged 58 to 95 (mean, 85) years with trochanteric femoral fractures underwent PFN fixation using an intramedullary nail, a lag screw, and a hip pin. Fractures were classified according to the AO system; the most common fracture type was A2 (n=45), followed by A1 (n=36) and A3 (n=6). The position of the lag screw within the femoral head was measured. The lateral slide of the lag screw after fracture consolidation was measured by comparing the immediate postoperative and final anteroposterior radiographs. 90% of lag screws were placed in an optimal position. The length of lateral slide of the lag screw in stable A1 fractures was significantly less than that in unstable A2 fractures; it was over 10 mm in 7 of 45 patients with A2 fractures. Cut-out of lag screw did not occur, suggesting that free sliding of the lag screw facilitates direct impaction between fragments. A PFN is useful for the treatment of trochanteric femoral fractures.

Encouraging Results of Treating Femoral Trochanteric Fractures With Specially Designed Double-Screw Nails

Conventional intramedullary nails for trochanteric fractures have the disadvantages of intraoperative splintering resulting from large proximal section and postoperative femoral fracture caused by stress concentration at the nail tip. The present study reports the experience of using a specially designed double-screw nail with a smaller proximal section to avoid intraoperative splintering and a longer nail shank to avoid postoperative femoral fracture. Between 2003 and 2005, 144 consecutive femoral trochanteric fractures in 143 patients with an average age of 78.2 years were treated with double-screw nails. The OTA fracture classification was 31-A1 in 51 cases, 31-A2 in 65 cases, and 31-A3 in 28 cases. Seventy-nine patients had more than one major medical disease. The operation was performed using fluoroscopic guide on the fracture table. A distal locking screw was applied in patients with 31-A2 and A3 fractures. At 1 year, 23 patients had died and 6 were lost to follow-up, leaving 114 fractures for functional evaluation. Patients with 31-A1 fractures tended to have better preoperative conditions than those with 31-A2 and A3 fractures had. The operation time and hospital stay were significantly shorter for those with 31-A1 fractures. Lag screw breakage occurred in four patients with 31-A2 and A3 fractures, and two of these also had screw backout. Another three patients had lag screw cutout. Among these seven patients, only one with screw cutout underwent revision of the fixation. All 114 fractures at 12 months had eventual union. Preoperative mobility was recovered in 35 (85%) patients with 31-A1 fractures and 45 (61%) with 31-A2 and A3 fractures. The functional recovery among patients with 31-A2 and A3 fractures was significantly worse than their preoperative condition and that of patients with 31-A1 fractures. The double-screw nail can yield acceptable treatment results for both 31-A1 and 31-A2 and A3 trochanteric fractures and is particularly useful in patients with a small proximal femur. Type 31-A1 and 31-A2 and A3 trochanteric fractures should be separately analyzed in terms of treatment planning or prognostic study.

Trochanteric fractures in the elderly: the influence of primary hip arthroplasty on 1-year mortality

IntroductionThe aim of the study was to compare the mortality risk and complication rate after operative treatment of pertrochanteric fractures with primary arthroplasty, dynamic hip screw (DHS) or proximal femoral nail (PFN).Patients and methodsClinical records including X-rays of all patients with trochanteric femoral fractures, except pathologic fractures and a minimum age of 60 years, which were treated between 1992 and 2005 were entered in this retrospective study. Of these 283 patients, 132 were treated by primary arthroplasty, 109 with a DHS and 42 with a PFN. Survival after 1 year and complications, which had to be treated within this period were our main outcome measurement. Influencing cofactors such as age, gender and comorbidities were reduced by multivariate logistic regression analysis.ResultsMortality was significantly influenced by age, gender and amount of comorbidities but not by fracture classification. Primary hip arthroplasty did not bear a higher 1-year mortality risk than osteosynthesis in a multiple regression analysis. The main complication with DHS and PFN were cutting out of the hip screw and non-union with a revision rate of 12.8%. With the introduction of hemiarthroplasty, the postoperative dislocation rate decreased from 12 to 0%.ConclusionFor stable fractures a dynamic hip screw (DHS) and for unstable fractures a short proximal femoral nail (PFN) can be recommended. The mortality risk of primary cemented arthroplasty did not differ significantly from the other treatment groups and because of its low complication rate it is a viable treatment option for trochanteric fractures if osteoporosis prevents from full weight bearing or if osteoarthritis makes further operations likely. Primary total hip replacement should be handled with care due to its significantly higher dislocation rate compared with hemiarthroplasty especially in unstable fractures.

AS hip screwを用いた大腿骨転子部骨折に対する最小侵襲骨接合術100例の治療経験

AS hip screwを用いた大腿骨転子部骨折に対する最小侵襲骨接合術100例の治療経験

大腿骨転子部骨折に対するTargon PFとDYAX-A nailによる治療成績の比較検討

大腿骨転子部骨折に対するTargon PFとDYAX-A nailによる治療成績の比較検討

Treatment of trochanteric femoral fractures with double dynamic internal fixation

Trochanteric fractures are extracapsular fractures of the proximal femur. The increasing number of trochanteric fractures is a great sociomedical problem. These fractures usually occur in elderly people (older than 65 years) with osteoporosis. Lateral and frontal falls are the most frequent cause of trochanteric fractures in the elderly. The aim of this paper is to present our results of applying the Mitković selfdynamisable internal fixator (SIF). From January 2001 to December 2005, 238 patients with trochanteric femoral fractures were treated operatively using the Mitković selfdynamisable internal fixator at the Clinic of Orthopeadics and Traumatology in Nis. The average patient age was 69, 11 years (range 17 to 88). In the analyzed group there were 152 (64%) female and 86 (36%) male patients, whereas patients in the eighth 101 (43%) and seventh 65 (27%) decade of life prevailed. Excellent results in the treatment of trochanteric femoral fractures with a Mitković dynamic internal fixator were achieved in 143 (60%) patients, good in 49 (21%) patients, poor in 41 (17%) and unsatisfactory in 5 (2%) patients. The treatment of trochanteric fractures may be operative and nonoperative. The aim of the operative treatment, considered to be the "gold standard" for these fractures, is to restore the patient's pretraumatic activity level and to reduce life-threatening complications. The operative stabilization is performed using various types of implants. Surgical treatment by using dynamic implants is a method of choice in the treatment of trochanteric fractures. Internal fixation using the Mitković selfdynamisable internal fixator is a method of choice in the treatment of trochanteric femoral fractures, providing dynamization and compression of the fracture site in two axes (axis of the femoral neck and femoral diaphyseal axis) and balanced biomechanical 3D.

Evaluation of perioperative bleeding between PFNA and Multi-fix for femoral trochanteric fracture

Evaluation of perioperative bleeding between PFNA and Multi-fix for femoral trochanteric fracture

Prognosis and outcomes of hip fractures

In elderly patients with fractures, local complications at fracture sites of are relatively infrequent, whereas systemic complications commonly occur. There is a marked difference in anatomical features between femoral neck fractures and trochanteric fractures; neck fractures is an intracapsular fracture while trochanteric fractures are extracapsular fractures. In patients with a femoral neck fracture, bone strength at the site may diminish, leading to a compression crush of the bone, usually at least 1 year after the fracture. A survey performed in 10,992 Japanese patients with hip fractures has shown that 51% of these patients had been normal in daily living activities before suffering a fracture and this percentage decreased by 24% 1 year after the fracture. Mortality within 1 year after the fracture was 10%. The following prognostic predictive factors showed significant differences: dementia, pre-injury ambulatory capability, age, baseline serum albumin, baseline total protein, and baseline hemoglobin.

One and two femoral neck screws with intramedullary nails for unstable trochanteric fractures of femur in the elderly— Randomised clinical trial

Intramedullary nailing has been the gold standard in the management of lower limb fractures by virtue of advantage of early joint mobilisation and weight bearing. They are being increasingly used in the peri-trochanteric fractures of femur. Biomechanical studies have proved the supremacy of single femoral neck screw construct over two femoral neck screws along with the intramedullary nails in osteoporotic bones due to lower incidence of complications. This randomised clinical trial was conducted to study the clinico-radiological outcome of single and two-femoral neck screw construct in the management of unstable trochanteric fractures in the elderly osteoporotic bones. Although there was no significant difference in the clinical outcome in the two groups, less sliding of the femoral neck screws was noted with two-femoral neck screw configuration. The tip-apex distance was also significantly lower in the two-screw construct compared to that of the single screw construct. This study to our knowledge is the first randomised control clinical trial evaluating the effectiveness of one and two femoral neck screw configuration of intra-medullary nails in the management of unstable trochanteric fractures.

2cmの皮切によるAS hip screwを用いた大腿骨転子部骨折に対する骨接合術（2cm小皮切法と標準皮切法との比較）

2cmの皮切によるAS hip screwを用いた大腿骨転子部骨折に対する骨接合術（2cm小皮切法と標準皮切法との比較）

Postoperative treatment using compression hip screw for the patients with trochanteric fractures of femur

Postoperative treatment using compression hip screw for the patients with trochanteric fractures of femur

Experience of Fluoro-navigation system for trochanteric fractures of femur

Experience of Fluoro-navigation system for trochanteric fractures of femur

Clinical result of DYAX-A nail for trochanteric fracture of femur

Clinical result of DYAX-A nail for trochanteric fracture of femur

Result of the treatment by PFNA for trochanteric fractures of femur

Result of the treatment by PFNA for trochanteric fractures of femur

Treatment of trochanteric fractures of femur with PFNA

Treatment of trochanteric fractures of femur with PFNA

THE CLASSIC: Complete Replacement Arthroplasty of the Hip by the Ring Prosthesis

THE CLASSIC: Complete Replacement Arthroplasty of the Hip by the Ring Prosthesis

Trochanteric Gamma Nail and Compression Hip Screw for Trochanteric Fractures

To compare the results between a new intramedullary Gamma nail and a compression hip screw in the treatment of trochanteric fractures. Prospective randomized. Level 1 trauma center. Two hundred ten consecutive patients older than 65 years with trochanteric femoral fractures. Treatment with a compression hip screw or a new design of the Trochanteric Gamma nail (180 mm in length with a mediolateral angle of 4 degrees and available only with a proximal diameter of 17 mm and distal diameter of 11 mm). Operative and fluoroscopy times, blood loss, functional outcome, complication rate, and failure of fixation. The Trochanteric Gamma nail was used in 104 patients and the compression hip screw in 106. The 2 groups were similar in terms of their preoperative data, with a median follow-up of 13.6 months (range 12-30). The results show no difference in operating time (P = 0.21), but the Trochanteric Gamma nail group had a significantly shorter fluoroscopy time (P = 0.006), and the number of patients transfused and the mean of units of blood transfused were significantly less in the Trochanteric Gamma nail group (P = 0.013, 0.046, respectively). Mortality within 12 months was similar in both groups (P = 0.83). All fractures were radiographically healed at the last visit. There was no difference in intraoperative and postoperative complications or rate of fixation failure between the 2 groups, and no case of secondary shaft fracture of the femur was encountered in this study. In the entire series, there was no difference in the functional outcome (P = 0.74), but the postoperative walking ability was better in those patients with unstable fractures who were treated with the Trochanteric Gamma nail (P = 0.017). The new Trochanteric Gamma nail is an effective method for the treatment of trochanteric femoral fractures in elderly patients. The indication for either Trochanteric Gamma nail or compression hip screw is similar in stable fractures, but we recommend the use of the Trochanteric Gamma nail for unstable trochanteric fractures.

Differences in exposure to stimulatory and inhibitory components of the insulin-like growth factor (IGF) system in patients with femoral neck versus trochanteric fracture

SIR—Bone loss, the major determinant of hip fracture risk in the elderly [1], results from an increased rate of bone turnover [2] that will amplify the imbalance at the level of the individual remodelling unit. However, while the increase in bone turnover in elderly women results in part from secondary hyperparathyroidism [3], the mechanisms responsible for the age-related decline in bone formation have not yet been identified.