Trochanteric Femoral Fractures Research Articles

The impact of surgery for trochanteric femur fracture on sexuality in men and their female partners.

This study was aimed to investigate the effects of trochanteric femur fracture treatment methods on erectile functions of the patients and on sexual functions with their female partners. A total of 43 patients with trochanteric femur fracture who underwent proximal femoral nail (PFN) or proximal femur locking compression plate (PF-LCP) surgery were included in the study. The PFN implant was applied to group 1 ( n = 23) and the PF-LCP implant to group 2 ( n = 20). All the patients and their female partners completed the 5-item version of the International Index of Erectile Function (IIEF-5) and the Female Sexual Function Index (FSFI) preoperatively and at 1 year postoperatively after the rehabilitation period. The mean preoperative IIEF-5 and FSFI score was 21.910.9 and 21.911.1, 72.319.7 and 70.516.2 for the PFN and PF-LCP treatment groups, respectively, and at postoperative 1 year after rehabilitation, change in IIEF-5 score and FSFI score of each group was -6.512.1 versus -3.811.6, ( p < 0.001) and -16110.7 versus -6.314, ( p = 0.001), respectively. These data show that trochanteric femur fractures treated with PFN or PF-LCP had a negative impact on sexual function. PF-LCP had a greater negative effect than PFN on sexual function.

Cortical thickness in the intertrochanteric region may be relevant to hip fracture type

BackgroundThis study assessed the differences in femoral geometry and bone mineral density between femoral neck fragility fractures and trochanteric fractures.MethodsOne hundred and seventeen patients were divided into femoral neck and trochanteric fracture groups. There were 69 patients with femoral neck fractures, 20 men and 49 women with an average age of 75.1 ± 9.6 years and an average body mass index (BMI) value of 21.6 ± 4.1 kg/m2. The trochanteric group consisted of 48 patients, 16 men and 32 women with an average age of 78.1 ± 9.1 years and an average BMI value of 21.5 ± 4.3 kg/m2. All patients underwent dual-energy X-ray absorptiometry (DXA) of the contralateral hip; hip structural analysis (HSA) software was used to analyze the femoral geometry parameters, including hip axis length (HAL), neck-shaft angle (NSA), cross-sectional area (CSA), the cross-sectional moment of inertia (CSMI), the buckling ratio (BR), and cortical thickness.ResultsThe cortical thickness in the intertrochanteric region was reduced in the trochanteric fractures group compared to the femoral neck fracture group (P < 0.05). There were no statistically significant differences (P > 0.05) in gender, age, height, weight, or BMI between the two groups. In addition, no statistically significant differences (P > 0.05) were found in the CSA, CSMI, or BR of the femoral neck or the intertrochanteric region between the two groups. There were no statistically significant differences (P > 0.05) in femoral neck cortical thickness between the two groups.ConclusionsCortical thickness thinning in the intertrochanteric region may be one of the relevant factors causing different types of hip fractures, especially in elderly patients.

Posterior tibial spine avulsion fractures treated by open reduction and internal fixation through Burks and Schaffer approach – An outcome analysis

Trochanteric femoral fractures are among the most common injuries necessitating hospital admission. Regardless the type of fracture, trochanteric fractures can lead to substantial morbidity and mortality, especially in elderly patients [1, 2]. Surgery is the mainstay of the treatment for both displaced and non displaced trochanteric fractures, to allow early mobilization of the patient, depending on the stability of the reduction and fixation achieved [4]. Dynamic Hip Screw [DHS] as extramedullary and Proximal Femoral Nail [PFN] as intramedullary systems are established and standard in treatment of trochanteric femoral fractures [5, 6]. Aim: To compare the results of Dynamic Hip Screw and Proximal Femoral Nail in the treatment of intertrochanteric fractures. Materials & Methods: In our study we compared DHS with PFN in a group of 60 patients admitted in a tertiary care hospital between August 2013 – December 2016. Patients with intertrochanteric fractures without having concomitant shaft femur or neck femur fractures were included. The preoperative morbidity was evaluated using Parker’s mobility scale. Salvati and Wilson’s scoring helped in measuring overall functional outcome at 16 & 24 weeks between the two study groups. Results: The preoperative Parker’s mobility scale was comparable between two study groups. Salvati and Wilson’s score at 16 & 24 weeks was significantly better with PFN group. The functional outcome based on SWS score was Fair in 39% of patients operated with DHS at 16 weeks while for PFN it was Fair to Good in 79% of patients. At 24 weeks it was Fair to Good in 84% patients operated with DHS while in case of PFN the score was Fair to Good in 59% of the patients & Excellent in 38% of the patients. Conclusion: Our conclusion from this study supported the use of PFN for both stable and unstable pertrochanteric fractures over DHS due to its lesser operation time, lesser blood loss, early weight bearing, limited open reduction & better functional outcome.

A comparative study of fixation of pertrochanteric fractures with dynamic hip screw and proximal femoral nail

Trochanteric femoral fractures are among the most common injuries necessitating hospital admission. Regardless the type of fracture, trochanteric fractures can lead to substantial morbidity and mortality, especially in elderly patients [1, 2]. Surgery is the mainstay of the treatment for both displaced and non displaced trochanteric fractures, to allow early mobilization of the patient, depending on the stability of the reduction and fixation achieved [4]. Dynamic Hip Screw [DHS] as extramedullary and Proximal Femoral Nail [PFN] as intramedullary systems are established and standard in treatment of trochanteric femoral fractures [5, 6]. Aim: To compare the results of Dynamic Hip Screw and Proximal Femoral Nail in the treatment of intertrochanteric fractures. Materials & Methods: In our study we compared DHS with PFN in a group of 60 patients admitted in a tertiary care hospital between August 2013 – December 2016. Patients with intertrochanteric fractures without having concomitant shaft femur or neck femur fractures were included. The preoperative morbidity was evaluated using Parker’s mobility scale. Salvati and Wilson’s scoring helped in measuring overall functional outcome at 16 & 24 weeks between the two study groups. Results: The preoperative Parker’s mobility scale was comparable between two study groups. Salvati and Wilson’s score at 16 & 24 weeks was significantly better with PFN group. The functional outcome based on SWS score was Fair in 39% of patients operated with DHS at 16 weeks while for PFN it was Fair to Good in 79% of patients. At 24 weeks it was Fair to Good in 84% patients operated with DHS while in case of PFN the score was Fair to Good in 59% of the patients & Excellent in 38% of the patients. Conclusion: Our conclusion from this study supported the use of PFN for both stable and unstable pertrochanteric fractures over DHS due to its lesser operation time, lesser blood loss, early weight bearing, limited open reduction & better functional outcome.

Chronic haematogenous osteomyelitis of fibula diaphysis with pathological fracture and review of literature

Trochanteric femoral fractures are among the most common injuries necessitating hospital admission. Regardless the type of fracture, trochanteric fractures can lead to substantial morbidity and mortality, especially in elderly patients [1, 2]. Surgery is the mainstay of the treatment for both displaced and non displaced trochanteric fractures, to allow early mobilization of the patient, depending on the stability of the reduction and fixation achieved [4]. Dynamic Hip Screw [DHS] as extramedullary and Proximal Femoral Nail [PFN] as intramedullary systems are established and standard in treatment of trochanteric femoral fractures [5, 6]. Aim: To compare the results of Dynamic Hip Screw and Proximal Femoral Nail in the treatment of intertrochanteric fractures. Materials & Methods: In our study we compared DHS with PFN in a group of 60 patients admitted in a tertiary care hospital between August 2013 – December 2016. Patients with intertrochanteric fractures without having concomitant shaft femur or neck femur fractures were included. The preoperative morbidity was evaluated using Parker’s mobility scale. Salvati and Wilson’s scoring helped in measuring overall functional outcome at 16 & 24 weeks between the two study groups. Results: The preoperative Parker’s mobility scale was comparable between two study groups. Salvati and Wilson’s score at 16 & 24 weeks was significantly better with PFN group. The functional outcome based on SWS score was Fair in 39% of patients operated with DHS at 16 weeks while for PFN it was Fair to Good in 79% of patients. At 24 weeks it was Fair to Good in 84% patients operated with DHS while in case of PFN the score was Fair to Good in 59% of the patients & Excellent in 38% of the patients. Conclusion: Our conclusion from this study supported the use of PFN for both stable and unstable pertrochanteric fractures over DHS due to its lesser operation time, lesser blood loss, early weight bearing, limited open reduction & better functional outcome.

Can proximal femoral nailing of unstable trochanteric fractures help to regain pre-injury functional status in Indian rural patients? A prospective study of functional outcome of unstable intertrochanteric fractures with proximal femoral nailing

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; In view of the high incidence of implant failure and varus collapse seen in unstable inter trochanteric femur fractures treated with dynamic hip screw (DHS), proximal femoral nailing (PFN) has gained popularity.&lt;sup&gt;1,2&lt;/sup&gt; However there is limited literature regarding functional outcome following PFN especially in Indian patients. In this study, our aim was to assess functional outcome following PFN of unstable inter trochanteric femur fractures which includes the ability to sit cross leg and squat.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This prospective observational study was done at the associated hospitals of KMC Mangalore, spanning a time period of around 2 years, from October 2014 to July 2016. All patients who presented with isolated closed unstable inter-trochanteric fractures were included in the study. Patients were treated with proximal femoral nailing and followed up for a minimum period of 6 months. Outcome measures included Harris hip score, walking status and ability to sit cross leg and squat.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; 40 consecutive patients (Mean age 61 years, range 25-95) were included in the study, all fractures united within 6 months. As per Harris hip score, 25 patients (62.5%) had excellent or good results, 8 patients (20%) had fair and 7 patients (17.5%) had poor results. 74% (20 out of 27) regained their gainful working status. 80% (24 out of 30) were able to squat easily or with some difficulty and 74% (20 out of 27) patients were able to sit crossed leg with or without difficulty. 82% (23 out of 28) regained their unassisted walking status.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; For unstable inter trochanteric femur fracture PFN gives good results in terms of union, walking ability and majority of the patients regained their pre injury activity status including squatting and cross leg sitting. &lt;/p&gt;

A comparison of two fixation methods for femoral trochanteric fractures: a new generation intramedullary system vs sliding hip screw.

Trochanteric fractures are frequent and generally associated with bone fragility. There is still debate on the best fixation device to treat stable or rather stable trochanteric fractures: we report our clinical and radiological results of fixation with Proximal Femoral Nail "antirotation" (PFNa) in a population of patients compared to a control group treated by Sliding Hip Screw (SHS). A prospective study was conducted in 71 consecutive patients treated by PFNa (group A), and 69 by a SHS (group B), with a mean age of 81.6 and 83.4 years respectively. Short Form 12 was administered to check postoperative results, and the following parameters were evaluated: range of motion, evaluation of pain, gait ability, X-rays, and Tip Apex Distance Index. A minimum follow-up was conducted in 128 patients: 66 subjects belonging to the PFNa group and 62 to the DHS group. All patients in the group A were able to reach partial or full weight-bearing on the operated leg before leaving the hospital. Forty-four patients (63.8%) of the group B were able to walk with partial weight-bearing before discharge. We recorded 17 complications with a final overall percentage of 17.2% on the overall study population with one single case of failure in both the two groups. A statistical significance (p<0.01) of superiority for PFNa was demonstrated regarding surgical time, amplioscope time, intraoperative blood loss, hospital stay, recovery of weight-bearing before discharge. Less significant results (p<0.05) were found for walking ability at the three-months follow-up and patients' satisfaction 6 months after surgery. PFNa may be considered an useful choice for the treatment of stable or rather stable trochanteric fractures as well as DHS. The light superiority of PFNa may be principally related to its mechanical advantages.

The influence of acetabular morphology on prediction of proximal femur fractures types in an elderly population.

The role of proximal femur morphology to the development of certain proximal femur fracture types both femoral neck and trochanteric fractures has been observed. However, the relavance of acetabular morphology to the development of proximal femur fractures is not extensively questioned. Therefore the aim of the study was to determine whether there is a correlation between acetabular morphology and pathogenesis of 2 different hip fracture types after low energy trauma. This retrospective study includes 60 cases (41 women, 19 men) with a proximal femoral fracture after a low energy trauma between July 2012 and December 2014. Acetabular depth and acetabular index were measured on pelvic radiographs. Neck shaft angle, hip axis length and cortical index were measured on pelvic computed tomography scans. All measurements were performed on the contralateral hip. Mean age was 77.56 ± 8.99 years (range 61-92 years). No statistically significant difference was found with regard to neck shaft angle, acetabular depth or cortical index measurements between patients with femoral neck fracture and patients with trochanteric femoral fractures (p>0.05). Acetabular index measurement was higher (p = 0.001) and hip axis length measurement was lower (p = 0.001) in trochanteric fracture group as compared to femoral neck fracture. The rate of trochanteric femur fractures is higher in patients with high acetabular index, whereas the rate of femoral neck fractures is higher in patients with increased hip axis length.

A biomechanical study comparing proximal femur nail and proximal femur locking compression plate in fixation of reverse oblique proximal femur fractures

BackgroundThe reverse oblique trochanteric fractures are common fractures and its treatment poses a challenge. The purpose of this study was to compare the biomechanical parameters of the construct using proximal femoral nail (PFN) and proximal femoral locking compression plates (PFLCP) in these fractures using cadaveric specimens. Materials and MethodsTwenty freshly harvested cadaveric femoral specimens were randomly assigned to two groups after measuring bone mineral density, ten of which were implanted with PFN and the other ten with PFLCP. The constructs were made unstable to simulate reverse oblique trochanteric fracture (AO type 31A3.3) by removing a standard size posteromedial wedge. These constructs were tested in a computer controlled cyclic compressive loading with 200kg at a frequency of 1 cycle/s (1Hz) and test was observed for 50,000 cycles or until implant failure, whichever occurred earlier. Peak displacements were measured and analysis was done to determine axial stiffness and subsidence in axial loading. ResultsAll the specimens in PFN group completed 50,000 cycles and in PFLCP group, seven specimens completed 50,000 cycles. Average subsidence in PFN group was 1.24±0.22mm and in PFLCP group was 1.48±0.38mm. The average stiffness of PFN group (72.6±6.8N/mm) was significantly higher than of PFLCP group (62.4±4.9N/mm) (P=0.04). The average number of cycles sustained by PFLCP was 46634 and for PFN group was 50,000 (P=0.06). ConclusionThe PFN is biomechanically superior to PFLCP in terms of axial stiffness, subsidence and number of specimens failed for the fixation of reverse oblique trochanteric fractures of femur.

Comparative study between dynamic hip screw and plate with proximal femoral nailing in trochanteric fractures of femur

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Incidence of intertrochanteric fractures has increased significantly during recent years and&lt;strong&gt; &lt;/strong&gt;it will probably continue to rise in near future due to increased longevity of life. Closed methods of treatment for intertrochanteric fractures have increased mortality rates &amp;amp; have largely been abandoned. Rigid internal fixation and early mobilization has been the standard protocol of treatment nowadays. This study was intended to compare the results of Intertrochanteric fractures treated by dynamic hip screw (DHS) over proximal femoral nailing (PFN)&lt;/span&gt;&lt;span lang="EN-IN"&gt;.&lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;This is a randomized prospective study of 102 cases of intertrochanteric fractures,&lt;strong&gt; &lt;/strong&gt;admitted to Mysore Medical College &amp;amp; Hospital, Mysore and ESIC medical college and hospital Kalaburagi and Kamareddy Ortho &amp;amp; Trauma care Hospital Kalaburagi; treated with proximal femoral nailing and DHS. The patients were divided randomly into two groups, each of 51 patients, 51 were treated by Dynamic Hip Screw &amp;amp; 51 were treated with proximal femoral nail (PFN).All patients were followed up for one year&lt;/span&gt;.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;In our series of 102 patients of Intertrochanteric fractures, 51 were treated with sliding hip screw with&lt;strong&gt; &lt;/strong&gt;plate and 51 were treated by an intra-medullary hip screw. Most of the patients were between 51 to 80 years. Slip and trivial fall accounted for 70% cases. Right side was more common accounted for 58.34% of cases&lt;/span&gt;&lt;span lang="EN-IN"&gt;. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;From our study, we consider PFN as better alternative to DHS in more unstable fractures with technically difficulty and require more experience. Sliding hip screw remains the implant of choice for stable type fractures. We noticed less operative time, less blood loss, fewer intra-op complications in PFN group. The quality of the reduction achieved &amp;amp; proper positioning of the implant are important to achieve the best post-operative outcome&lt;/span&gt;&lt;span lang="EN-IN"&gt;.&lt;/span&gt;&lt;/p&gt;

A study of management of trochanteric fracture of femur treated with dynamic sliding hip screw-plate device vs. proximal femoral nail

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;The incidence of intertrochanteric fractures has been increasing significantly due to the rising age of modern human populations. Generally, intramedullary fixation [proximal femoral nail (PFN) and gamma nail] and extra-medullary fixation [dynamic hip screw (DHS)] are the 2 primary options for treatment of such fractures. &lt;/span&gt;&lt;span lang="EN-IN"&gt; &lt;/span&gt;&lt;span lang="EN-IN"&gt;Objectives: The goal of this study is to compare the clinical and radiographical results of DHS and PFN for the treatment of trochanteric hip fractures. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Patients with trochanteric fractures were treated either with DHS or PFN in the Department of Orthopaedics, M.G.M. Medical College and L.S.K Hospital, Kishanganj, Bihar from October 2010 to October 2012 were included for this study&lt;/span&gt;.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Forty three patients (24 male and 19 female, ratio of M:F 1.26:1) surgically treated for trochanteric fractures were divided into two groups. Group 1: 25 hips treated with DHS and group 2: 18 hips treated with PFN. The outcome for each group was analyzed, and total operative time, time to union, complications (early and late), and mortality were recorded. The results were statistically compared. Out of 25 cases of DHS, majority cases (13) took between 1 hour 36 minutes to 2 hours. Whereas, out of 18 cases of PFN, majority (8) took 1 hour to 1 hour 30 minutes. The mean time to union for group 1 was 2.09 months and 1.69 months for group 2. Early and late complication rates between treatment groups revealed no statistically significant differences. Total duration of surgery was significantly lower for PFN than it was for DHS. A comparison of time to union and overall mortality demonstrated no statistically significant differences. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;We detected no differences between the two treatment groups in regard to early versus late complications, time to union, and overall mortality; however, with its shorter operative period, PFN is a good alternative to the DHS.&lt;/span&gt;&lt;/p&gt;

Comparative outcome of PFNA, Gamma nails, PCCP, Medoff plate, LISS and dynamic hip screws for fixation in elderly trochanteric fractures: a systematic review and network meta-analysis of randomized controlled trials.

The ideal implant for the treatment of an unstable intertrochanteric femoral fracture is still a matter of discussion. The aim of this systematic review is to conduct a network meta-analysis of randomized controlled trials (RCTs) comparing clinical outcomes between dynamic hip screws (DHS), Medoff sliding plating, percutaneous compression plating (PCCP), proximal femoral nails (PFN), Gamma nails and less invasive stabilization system fixation in femoral trochanteric fractures in the elderly. These clinical outcomes consist of total intra-operative time, intra-operative fluoroscopy time, intra-operative blood loss, blood component transfusion, length of hospital stay, postoperative general complications, wound complications, late complications and reoperation rates. This systematic review was conducted using PubMed and Scopus search engines for RCTs comparing clinical outcomes between treatments from inception to February 22, 2015. Thirty-six of 785 studies identified were eligible. Compared to the other implants, PCCP showed the lowest total operative time and units of blood transfusion with an unstandardized mean difference (UMD) of 29.27min (95% CI 5.24, 53.50) and 0.89 units (95% CI 0.52, 1.25). The lowest incidence of general complications, wound complications and late complications of PCCP was 0.09 (95% CI 0.04, 0.18), 0.01 (95% CI 0.01, 0.04) and 0.05 (95% CI 0.02, 0.11), respectively, when compared to others. The lowest fluoroscopic time was with DHS with an UMD of 0.24min (95% CI 0.16, 0.32), whereas the lowest blood loss and shortest hospital stay were with PFN with an UMD of 233.61ml of blood loss (95% CI 153.17, 314.04) and 7.23days of hospital stay (95% CI 7.15, 7.31) when compared to all other fixation methods. Reoperation rates of all implants had no statistically significant difference. The network meta-analysis suggested that fixation with PCCP significantly shortens operative time and decreases the units of blood transfusion required, while also lowering risks of general complications, wound complications and late complications when compared to fixation. Use of PFN showed the least intra-operative blood loss and shortest hospital stay. Multiple active treatment comparisons indicate that PCCP fixation in trochanteric fractures in the elderly is the treatment of choice in terms of intra-operative outcomes and postoperative complications.

Functional outcome of proximal femoral nailing in inter trochanteric fractures of femur: A prospective study

Background: The study was conducted to analyse the functional outcome of Proximal Femoral Nailing in Inter-Trochanteric Fractures of Femur. Methods: Over two years, after obtaining written consent, this prospective study was conducted among 22 patients (age group>18 years) who had Inter-trochanderic fracture treated with Proximal Femoral Nailing. The X-ray of the operated hip was taken whenever it was felt necessary and on 4th week, 8th week, 12th week and at 6th month. Functional outcome measures was done by using Harris Hip Scoring System (Modified) at the end of 6 months. Results: The present series includes, 14 males and 8 females in the age group of 47-82 years with the mean age of 62.09 years. Unstable inter-trochanteric fractures were commonly seen. Excellent results were see in 13 patients. Intraoperative and post-operative complications was seen in 9 patients. Conclusion: From this study, we consider that PFN is an excellent implant for the treatment of trochanteric fractures. With a proper technique, PFN gives excellent clinical results with almost negligible varus collapse even in unstable Inter trochanteric fractures.

Results of hip replacement in elderly patients with trochanteric femoral fractures

Fractures of the femur in the trochanteric zone in elder peo­ple dramatically change the life stereotype. This disruption of adaptation mechanisms often leads to a rapid exacerbation of concomitant chronic diseases. Current trends are reduced to the early surgical treatment of patients with femoral fractures in the trochanteric zone, which is due to better prognostic re­sults for the health and life of patients. Objective: to investigate and analyze the long-term results of hip arthroplasty in people of the older age group with trochanteric and intertrochanteric femoral fractures. Methods: clinical and radiologic examination of 47 patients (40 women, 7 men, mean age (74.2 ± 5.1) years) was performed with total cement, monopolar or bipolar hip arthroplasty. The choice of method of treatment depended on the degree of compensation of concomitant diseases. Long- term results (at least 1 year) of surgical treatment were analyzed using the Harris score. Results: excellent and good re­sults were obtained in 39 patients (82.94 %), satisfactory ones — in 7 (14.94 %), unsatisfactory ones — in 1 (2.12 %). The best long-term results were obtained by us in cases of using single-pole bipolar implants. All patients, regardless of age and before the operational functional state, quickly enough (up to 1 month) restored the previous level of efficiency and motor activity. Con­clusions: hip arthroplasty in femur fractures in the trochanteric is the method of choice for eldery people, since it provides early mobilization of patients and rapid recovery of the activity level.

A comparative study of 70 cases of inter-trochanteric fracture femur treated with dynamic hip screw and proximal femoral nailing

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Inter-trochanteric fracture femur is a common and grievous injury, mostly suffered in elderly people. It accounts for approximately half of hip fractures in elderly and out of this, more than 50% of fractures are unstable. In old age, it occurs mostly due to trivial trauma. Various procedures of internal fixation had been proposed as a treatment. DHS considered to be the standard procedure for comparison of outcomes. The advantage of proximal femur nailing fixation is that it provides a more biomechanically stable construct by reducing the distance between hip joint and implant. The goal of this study is to compare the clinical and radio-graphical results of the DHS and PFN for the treatment of Intertrochanteric hip fractures (load bearing vs. load sharing).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Seventy patients (more than 55 years old) presented to Adesh Hospital from March 2015 to November 2015 with trochanteric fracture femur. Patients were treated with osteosynthesis with dynamic hip screw (DHS) and proximal femoral nailing (PFN). The clinical results were compared between the dynamic hip screw and proximal femoral nailing groups of 35 patients each. All surgeries done on traction table and were followed up at regular intervals of 4 weeks, 6 weeks, 8 weeks, 10 weeks, 12 weeks, 6 months and at 1 year.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; We observed no statistically significant difference between two groups in view of late &amp;amp; early complications and time to union. We observed significantly better outcomes in PFN group for unstable inter-trochanteric fractures and in unstable fractures reduction loss is significantly lower in PFN group.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; We concluded that PFN may be the better fixation device for most unstable inter-trochanteric fractures. &lt;/p&gt;

Factors influencing period from surgery to discharge in patients with femoral trochanteric fractures.

[Purpose] The purpose of this study was to investigate factors influencing the period from surgery to discharge in patients with femoral trochanteric fractures. [Subjects and Methods] Sixty patients with femoral trochanteric fractures were investigated retrospectively. Based on the mean period from surgery to discharge (85.6 ± 26.6 days), the patients were divided into two groups: an under-85-day group (range, 29–78 days) and an over-85-day group (87–128 days). Age, gender, fracture type, presence of lesser trochanteric displacement, discharge destination, and walking ability were investigated. The relationship between these factors and the period from surgery to discharge was analyzed with logistic regression analysis. [Results] Age and lesser trochanteric displacement were significantly higher in the over-85-day group, and walking ability before fracture and at discharge were significantly lower in the over-85-day group. Logistic regression analysis showed that lesser trochanteric displacement and age were predictors of the length from surgery to discharge. Lesser trochanteric displacement were observed in 87.5% of these. Immediate displacement after surgery occurred in 57.8% of lesser trochanteric fractures, while 26.3% displaced 1 to 3 weeks after surgery. [Conclusion] This study revealed that lesser trochanteric displacement, higher age, and lower walking ability before fracture and at discharge were associated with longer hospitalizations in patients with femoral trochanteric fractures. Lesser trochanteric displacement were observed in 87.5% of lesser trochanteric fractures. These displacements occurred within 3 weeks after surgery in 84.1% of cases.

Proposal of new classification of femoral trochanteric fracture by three-dimensional computed tomography and relationship to usual plain X-ray classification.

Classification of femoral trochanteric fractures is usually based on plain X-ray findings using the Evans, Jensen, or AO/OTA classification. However, complications such as nonunion and cut out of the lag screw or blade are seen even in stable fracture. This may be due to the difficulty of exact diagnosis of fracture pattern in plain X-ray. Computed tomography (CT) may provide more information about the fracture pattern, but such data are scarce. In the present study, it was performed to propose a classification system for femoral trochanteric fractures using three-dimensional CT (3D-CT) and investigate the relationship between this classification and conventional plain X-ray classification. Using three-dimensional (3D)-CT, fractures were classified as two, three, or four parts using combinations of the head, greater trochanter, lesser trochanter, and shaft. We identified five subgroups of three-part fractures according to the fracture pattern involving the greater and lesser trochanters. In total, 239 femoral trochanteric fractures (45 men, 194 women; average age, 84.4 years) treated in four hospitals were classified using our 3D-CT classification. The relationship between this 3D-CT classification and the AO/OTA, Evans, and Jensen X-ray classifications was investigated. In the 3D-CT classification, many fractures exhibited a large oblique fragment of the greater trochanter including the lesser trochanter. This fracture type was recognized as unstable in the 3D-CT classification but was often classified as stable in each X-ray classification. It is difficult to evaluate fracture patterns involving the greater trochanter, especially large oblique fragments including the lesser trochanter, using plain X-rays. The 3D-CT shows the fracture line very clearly, making it easy to classify the fracture pattern.

Dynamic Hip Screw and Proximal Femoral Locking Compression Plate as a Surgical Treatment of Trochanteric Fracture of Femur a Comparative Study

Dynamic Hip Screw and Proximal Femoral Locking Compression Plate as a Surgical Treatment of Trochanteric Fracture of Femur a Comparative Study

Augmentation of proximal femoral nail in unstable trochanteric fractures.

Introduction: Biomechanically proximal femoral nail (PFN) is a better choice of implant, still it is associated with screw breakage, cut out of screw through femoral head, Z effect, reverse Z effect, and lateral migration of screws. The purpose of this study is to evaluate the results of augmented PFN in terms of prevention of postoperative complications and failure rates in unstable trochanteric fractures. Material and methods: We carried out a prospective study of 82 cases with unstable trochanteric femoral fractures from April 2010 to December 2015. Forty-two females and 40 males in the age group between 58 and 81 years were included in this study. There were 45 cases of AO 31 A2 (2.2, 2.3) and 37 cases of AO 31 A3 (3.1, 3.2, 3.3). Fractures were fixed by PFN with augmentation by an additional screw from trochanter to inferior quadrant of femoral head or cerclage wire to strengthen the lateral trochanteric wall. Results: The bone healing is observed in all the cases in the mean period of 14.2 weeks. Nine patients developed complications, including lateral migration of neck screws (n = 5), Z effect (n = 1), infection (n = 2), and breakage of distal interlocking bolt in one case. Removal of screws was required in five cases. Patients were followed up for a mean of 8.4 months. At the end of follow-up the Salvati and Wilson hip function was 32 (out of 40) in 88% of patients. Conclusion: The stabilization of lateral trochanteric wall with additional screw or cerclage wire increases the stability of construct.

Trochanteric femoral fractures treated by proximal femoral nail, a review of 110 cases

Intertrochanteric fractures are one of the most common fractures in osteoporotic individual. It is associated with high rates of morbidity and mortality. Management of Intertrochanteric fractures causes more burden to the any orthopaedics center across the country and its create a great surgical dilemma for orthopaedician. The treatment options have evolved over time from conservative management of such kind of fractures to use of cephalomedullary nails (PFN). This study was conducted to study outcome of Trochanteric femoral fractures treated by Proximal Femoral Nail. 110 patients were included in the study.