Trochanteric Femoral Fractures Research Articles

Comparison of sub trochanteric femur fracture treatment with intra medullary proximal femur nail versus proximal femur nail with trochanteric support plate

: Comparison of sub trochanteric femur fracture treatment with intramedullary proximal femur nail vs intramedullary proximal femur nail augmented with trochanteric support plate.: Two groups were divided from 50 patients to 25 in each and first were treated with PFN and the other with a combination of PFN plus trochanteric support plate.: At the end of 6 months all except 2 patient from group 1 mobilized unassisted while all the patient from group 2 got mobilized unassisted. Based on harries hip score.: Intramedullary fixation with intra medullary proximal femur nail plus trochanteric support plate.is feasible for the treatment of subtrochanteric femur fracture. Intraoperative reduction and surgical skill are important for the clinical outcome and the patients.

"Recurrent Upper Gastrointestinal Bleeding after Operation of Femoral Trochanteric Fracture in the Elderly: Report of one Case"

"Recurrent Upper Gastrointestinal Bleeding after Operation of Femoral Trochanteric Fracture in the Elderly: Report of one Case"

Comparison of Dynamic Hip Screw and Proximal Femoral Nail in Cases of Unstable Intertrochanteric Fractures of the Femur, in Terms of Blood Loss and Operative Time: Experience in a Tertiary Care Hospital

Objective: To compare Dynamic Hip Screw with Proximal Femoral Nail in unstable Inter Trochanteric femur fractures.
 Study Design: Quasi-experimental study.
 Place and Duration of Study: Department of Orthopaedic Surgery, Combined Military Hospital, Malir Pakistan, from Dec 2020 to Aug 2021.
 Methodology: This study comprised patients aged 40 to 80 years with unstable inter Trochanteric proximal femoral fractures (AO Classification 31A2, 31A3). These patients were randomised into two Groups. Group-A patients underwent Dynamic hip screw fixation, and Group-B patients were subjected to Proximal Femoral Nailing. Follow-up was done at 2,6,12 weeks postoperatively. Two variables, namely operative time and blood loss, were evaluated. 
 Result: Thirty patients were recruited in this study, with 18 patients in each Group. The average blood loss for Group-A Dynamic Hip Screw was measured to be 193.3±29.10 ml, and for Group-B Proximal Femoral Nail was 79.44±17.98 ml (p< 0.001). Group-A (DHS) scored an average operative time of 51.56±7.76 min, and Group-B Proximal Femoral Nail was 36.89±3.66 min (p<0.001).
 Conclusion: Proximal femoral nailing is a better choice in unstable proximal femoral fractures regarding operative time and blood loss.Keywords: Blood loss, Dynamic hip screw, Intertrochanteric fractures, Operative time, Proximal femoral nail.

Relation entre la densité minérale osseuse du fémur proximal et l’instabilité des fractures fémorales proximales : étude rétrospective

BackgroundProximal femoral fractures can occur in patients with osteoporosis. However, the relationship between bone mineral density (BMD) of the proximal femur and fracture type and instability remains unclear. This study aimed to determine whether there is a relationship between the site-specific BMD of the proximal femur and the instability of proximal femoral fracture. HypothesisThe instability of proximal femoral fractures is related to the site-specific BMD of the proximal femur. Patients and methodsUsing dual-energy X-ray absorptiometry (DEXA), the BMD on the non-fractured side was retrospectively examined in 252 women who underwent surgery for proximal femoral fracture at our hospital. The BMD was measured at three sites: the femoral neck (neck), trochanter (trochanter), and intertrochanteric region (inter). The BMD at several sites was compared between the femoral neck and trochanteric fractures. Femoral neck fractures were classified into the displaced and non-displaced types, and trochanteric fractures were classified into stable and unstable types. A comparative analysis was conducted for each proximal femur site and fracture type. ResultsBoth total and site-specific BMDs were lower in trochanteric fractures than in femoral neck fractures. No difference was observed between BMD and displaced or non-displaced femoral neck fractures. However, the BMD of the intertrochanteric region was lower in unstable trochanteric fractures (0.57±0.12g/cm2) than in stable trochanteric fractures (0.61±0.11g/cm2) [p<0.05]. DiscussionSeveral factors, including the patient's age and the bone component of each region, may influence the lower BMD in trochanteric fractures. In trochanteric fractures, the site-specific BMD of the proximal femur may predict the type of fracture and the degree of instability, especially in those with low BMD at the intertrochanteric site. The study findings suggest that a decrease in the BMD of the intertrochanteric region of femoral trochanteric fractures, which is thought to be involved in instability, is associated with fracture-type instability. Level of evidenceIII, retrospective study.

Extramedullary versus intramedullary fixation of stable trochanteric femoral fractures: a systematic review and meta-analysis.

This systematic review and meta-analysis compared extramedullary fixation and intramedullary fixation for stable two-part trochanteric femoral fractures (AO type 31-A1) with regards to functional outcomes, complications, and surgical outcomes. Embase, Medline, Web of Science, Cochrane Central Register of Controlled Trials, and Google Scholar were searched for randomized controlled trials (RCTs) and observational studies. Effect estimates were pooled across studies using random effects models. Results were presented as weighted risk ratio (RR) or weighted mean difference (MD) with corresponding 95% confidence interval (95% CI). Five RCTs (397 patients) and 14 observational studies (21,396 patients) were included. No significant differences in functional outcomes, complications, or surgical outcomes were found between extramedullary and intramedullary fixation devices, except for a difference in duration of surgery (MD 14.1min, CI 5.76-22.33, p < 0.001) and intra-operative blood loss (MD 92.30mL, CI 13.49-171.12, p = 0.02), favoring intramedullary fixation. Current literature shows no meaningful differences in complications, surgical, or functional outcomes between extramedullary and intramedullary fixation of stable two-part trochanteric femoral fractures. Both treatment options result in good outcomes. This study implicates that, costs should be taken into account when considering implants or comparing fixation methods in future research.

A biomechanical analysis of the effect of hydroxyapatite augmentation for trochanteric femoral fractures.

Hydroxyapatite (HA) augments are used to treat trochanteric femoral fractures. However, the efficacy of HA augmentation has not been fully described in trochanteric femoral fracture surgery. In total, 85 patients were enrolled in the present study; all had trochanteric femoral fractures between January 2016 and October 2020, 45 with HA (HA group) and 40 without HA (N group). The intraoperative lag screw insertion torque was directly measured and the amount of lag screw telescoping with and without HA augmentation after surgery was analyzed. Maximum lag screw insertion torque (max-torque), bone mineral density in the opposite femoral neck (n-BMD), tip apex distance (TAD) of the lag screw, radiographic findings including fracture union, the amounts of lag screw telescoping and occurrence of complications were evaluated. A total of 12 patients were excluded if they were aged under 60 years old, had ipsilateral surgery and disorders in the hip joint, TAD of the lag screw ≥26 mm on postoperative radiographs and had measurement errors. A total of 73 fractures could be analyzed: HA group (n=36) and N group (n=37). Max-torque/n-BMD ratios were higher in the HA group compared with in the N group (7.23±2.71 vs. 5.93±1.91 g/cm2·N·m; P=0.04). The amounts of lag screw telescoping in the HA group were smaller compared with the N group (1.41±2.00 vs. 2.58±2.34; P=0.05). Evaluation of screw insertion torque showed maximum screw insertion torque correlated well with n-BMD in both groups, HA (R=0.57; P<0.01) and N group (R=0.64; P<0.01). No correlation was found between maximum screw insertion torque and TAD in both groups, HA (R=-0.10; P=0.62) and N group (R=0.02; P=0.93). All fractures were radiographically united without any complications. These results support the effectiveness of HA augmentation, indicating higher resistance against rotational instability and reduced lag screw telescoping in trochanteric femoral fracture treatment.

MOREL-LAVALLÉE LESION INDUCED BY DYNAMIC HIP SCREW (DHS) CUT OUT: A CASE REPORT AND LITERATURE REVIEW

A Morel-Lavallee lesion (MLL) is a benign cystic lesion that occurs due to injury to the soft-tissue envelope's perforating vascular and lymphatic systems, resulting in a distinctive hemolymphatic fluid accumulation between the tissue layers. The MLL has the potential to make a significant impact on the treatment of orthopaedic injuries.A 79-year-old male patient community ambulatory with assisting aid (cane) known case of Diabetes mellitus, hypertension, bronchial asthma and ischemic heart disease. He was brought to the Emergency, complaining of right hip discomfort and burning sensation for the last 5 days with no history of recent trauma at all. Patient had history of right trochanteric femur fracture 3 years ago, treated with DHS in a privet service. Clinical and Radiological assessment showed that the patient mostly has acute MLL due to lag screw cut out. We offered the patient the surgical intervention, but he refused despite explaining the risks of complications if not treated and preferred to receive the conservative treatment. Compression therapy management explained to him including biker's shorts (instructed to be worn full-time a day) and regular follow up in clinic. Symptom's improvement was reported by the patient in the subsequent visits.In the polytrauma patient, a delayed diagnosis of these lesions is conceivable due to the presence of more visible injuries. It's located over the greater trochanter more commonly, but sometimes in other areas such as the lower lumbar region, the thigh, or the calf. Incorrect or delayed diagnosis and care can have unfavorable outcomes such as infection, pseudocyst development, and cosmetologically deformity. Magnetic resonance imaging (MRI) and ultrasound will aid in MLL diagnosis. However, the effectiveness of MLL therapy remains debatable.We strongly believe that the MLL caused due to tangential shear forces applied to the soft tissue leads to accumulation of the blood and/or lymph between the subcutaneous and overlying fascia and it often misdiagnosed due to other distracting injuries. Nontheless, in our case we reported MLL occur due to internal pressure on the fascia caused by cut out of DHS lag screw.

A RELIABLE PREDICTOR OF SECONDARY LATERAL WALL FRACTURE FOLLOWING TROCHANTERIC FRACTURES: AN UPDATE

The lateral wall thickness (LWT) in trochanteric femoral fractures is a known predictive factor for postoperative fracture stability. Currently, the AO/OTA classification uses a patient non-specific measure to assess the absolute LWT (aLWT) and distinguish stable A1.3 from unstable A2.1 fractures based on a threshold of 20.5 mm. This approach potentially results in interpatient deviations due to different bone morphologies and consequently variations in fracture stability. Therefore, the aim of this study was to explore whether a patient-specific measure for assessment of the relative LWT (rLWT) results in a more precise threshold for prediction of unstable fractures.Part 1 of the study evaluated 146 pelvic radiographs to assess left-right symmetry with regard to caput-collum-angle (CCD) and total trochanteric thickness (TTT), and used the results to establish the rLWT measurement technique. Part 2 reevaluated 202 patients from a previous study cohort to analyze their rLWT versus aLWT for optimization purposes.Findings in Part 1 demonstrated a bilateral symmetry of the femur regarding both CCD and TTT (p ≥ 0.827) allowing to mirror bone's morphology and geometry from the contralateral intact to the fractured femur. Outcomes in Part 2 resulted in an increased accuracy for the new determined rLWT threshold (50.5%) versus the standard 20.5 mm aLWT threshold, with sensitivity of 83.7% versus 82.7% and specificity 81.3% versus 77.8%, respectively.The novel patient-specific rLWT measure can be based on the contralateral femur anatomy and is a more accurate predictor of a secondary lateral wall fracture in comparison to the conventional aLWT. This study established the threshold of 50.5% rLWT as a reference value for prediction of fracture stability and selection of an appropriate implant for fixation of trochanteric femoral fractures.

Prediction of internal fixation failure of femoral trochanteric fracture by external wall morphology

To investigate the relationship between the shape of the lateral wall and the early failure of internal fixation in the fracture of the femoral trochanteric region(FFT). Total 295 patients with femoral trochanteric fracture underwent internal fixation from January 2015 to January 2020 were selected. The patients were divided into two groups according to whether there was early internal fixation failure after surgery, 19 patients in the failure group and 276 patients in the normal group. Gender, affected side, age, AO classification, body mass index(BMI), preoperative hemoglobin, X-ray measurement of lower lateral wall thickness, preoperative internal diseases, intraoperative blood loss, postoperative tip apex distance(TAD), postoperative neck shaft angle, operation time and other data were compared between two groups. The shape of the lateral wall was compared between two groups, and the correlation between the shape of the lateral wall and the early internal fixation failure of femoral trochanteric fracture was analyzed. All patients were followed up for more than 1 year. There was no significant difference between two groups in terms of intraoperative blood loss, operation time, postoperative TAD, and postoperative neck shaft angle(P>0.05). At the latest follow-up, the visual anaglue scale (VAS) of the failure group was higher than that of the normal group(P<0.01), and the Harris score of the failure group was lower than that of normal group(P<0.05). The receiver operator characteristic (ROC) curve between shape of lateral wall and failure of early internal fixation of femoral trochanteric fracture was drawn. The critical value of the midpoint lateral wall thickness was 16.5 mm, and the area under the ROC curve was 0.845;The critical value of average sidewall thickness was 16.5 mm, and the area under ROC curve was 0.838;The critical value of the axial area of the sidewall was 7.5 mm, and the area under the ROC curve was 0.826. The shape of the lateral femoral wall measured by CT could be used as a predictive factor for the early failure of internal fixation of femoral trochanteric fractures. For patients at risk, more reasonable surgical plans and postoperative preventive measures should be developed.

Risk Factors for Complications in Trochanteric Femur Fractures Treated with Dyna Locking Trochanteric Nail

Risk Factors for Complications in Trochanteric Femur Fractures Treated with Dyna Locking Trochanteric Nail

Trochanteric and subtrochanteric fractures irreducible by closed reduction: a retrospective study

AimTo explore the preoperative radiographic features and reduction methods of irreducible trochanteric and subtrochanteric fractures of the femur and to compare the perioperative characteristics and prognoses of irreducible and reducible fractures.MethodsThe data of 1235 patients with femoral trochanteric fractures surgically treated in our hospital between January 2010 and January 2021 were retrospectively analyzed. According to the inclusion criteria and exclusion criteria, 1163 cases of femoral trochanteric and subtrochanteric fractures were included in this study. Fractures in which good or acceptable reduction could not be reached by closed manipulation were defined as irreducible fractures. The preoperative radiographic features, fracture displacement patterns after closed manipulation and intraoperative reduction methods used to treat irreducible fractures were analyzed, and the perioperative characteristics and prognoses of irreducible fractures and reducible fractures were compared.ResultsThere were 224 patients in the irreducible group and 939 patients in the reducible group. According to the radiographic features of fractures, irreducible fractures could be divided into four types: those with interlocking of the fracture, sagging of the femoral shaft, splitting of the lateral wall or medial wall, and comminution of the subtrochanteric area. Various kinds of reduction techniques were needed for different types.ConclusionsThe incidence of irreducible trochanteric fractures was 15.4%, while the incidence of irreducible subtrochanteric fractures was 84.6%. According to the radiographic features of fractures, they can be divided into four types. It is important to identify irreducible fractures preoperatively and make comprehensive plans to the greatest extent possible to shorten the operation time, reduce intraoperative blood loss, and reduce the incidence of complications.

A study on greater trochanter reconstruction in unstable inter trochanteric fracture of femur

Background: A study on greater trochanter reconstruction in unstable intertrochanteric femur fracture. Methods: The 2019 to 2022, Patients were randomly divided into two groups with the help of computer-generated coded envelopes; Group A (unstable intertrochanteric femur fracture patients treated by hemi-arthroplasty or PFN with greater trochanter reconstruction) and Group B (unstable intertrochanteric femur fracture Patients Treated by hemi-arthroplasty or PFN with no greater trochanter reconstruction) with 20 patients in each group Outcomes were evaluated based on Harris hip score calculated at 2 weeks 6 weeks 3 months and 6 months. Results: Most common surgery in study groups performed were PFN, on radiology as non-union and union, most common study participants show union, on follow up at 2,6 weeks,3 months and 6 months Harris hip score was calculated and it was found to be statistically significant suggestive of improved quality of life, on radiological evaluation all cases shows non-displacement of GT position but in follow-ups at 6 weeks, 3 months and 6 months one case each reported displaced implant. Conclusions: The result of our study shows that there is improved quality of life and significant improvement in Harris hip score after reconstruction of greater trochanter in unstable intertrochanteric femur fracture.

AP3×ML3 reduction quality classification for femoral trochanteric fractures: validation for reliability focusing on positive medial cortical support

IntroductionThis study evaluated the validity of the AP3 × ML3 reduction quality classification, which applies the concept of positive medial cortical support.MethodsA total of 120 trochanteric fractures classified as AO Foundation/Orthopedic Trauma Association 31A1 and A2 were retrospectively analyzed. The validity of the AP3 × ML3 classification was evaluated by comparison with the Baumgaertner reduction quality criteria. When using the AP3 × ML3 classification, reduction quality was divided into three classes based on the degree of anterior cortical contact between the proximal and distal fragments. Reduction quality was also divided into three classes when using the Baumgaertner criteria. The frequency of mechanical complications, including cut­out, delayed union, and excessive migration of the lag screw, was retrospectively assessed. Intra-observer and inter-observer reliability was assessed using the intraclass correlation coefficient (ICC).ResultsMechanical complications included 4 cases of cutout (3.3%) and 1 of delayed union (0.8%). Mechanical complications occurred for all levels of reduction quality in both classifications, except for the acceptable of the Baumgaertner criteria. When reduction quality was rated as good, acceptable, and poor the incidence of mechanical complications was 2.5%, 5.7%, and 16%, respectively, under the AP3 × ML3 classification and 3.3%, 0%, and 15.0%, respectively, under the Baumgaertner criteria. The ICC was 0.80 for intra-observer reliability and 0.57 for inter-observer reliability when using the AP3 × ML3 classification and 0.85 and 0.34, respectively, when using the Baumgaertner criteria.ConclusionThe AP3 × ML3 classification was reliable and easy to use compared with the widely used Baumgaertner reduction quality criteria.Level of evidence 4

回復期リハビリテーション病棟における大腿骨転子部骨折患者の実績指数に影響を与える要因について

[Purpose] To identify factors affecting the performance index of trochanteric femoral fracture patients. [Participants and Methods] The participants were 117 patients with a trochanteric femoral fracture who underwent convalescent rehabilitation treatment. The relationships between the motor Functional Independence Measure (FIM) gain, length of a stay in the convalescent rehabilitation ward, and nine variables available at the time of admission to the convalescent rehabilitation ward were examined using Spearman’s rank correlation coefficient and multiple regression analysis using the stepwise method. [Results] The motor FIM score, the cognitive FIM score at the time of admission to the convalescent rehabilitation ward and pre-injury walking ability influenced motor FIM gain. No significant correlation was found for length of a stay in the convalescent rehabilitation ward. [Conclusion] The higher the three variables described above as influencing motor FIM gains were, the higher the FIM gains were, especially those of bathtub transfers and movement on stairs.

Comparative study of the management of inter-trochanteric fractures in the elderly: Trochantric femoral nail vs dynamic hip screw

Introduction: Trochanteric 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. Surgery has been the mainstay of the treatment for these fractures to allow early mobilization of the patient. Among the surgical treatment, dynamic hip screw (DHS) as extramedullary power transmission system and trochanteric fixation nail (TFN) as the means of intramedullary stabilization are the established and standard in the treatment of trochanteric femoral fractures, particulary in elderly patients. AIM: The present study was designed to compare the results of TFN and DHS in treatment of intertrochanteric fracture femur. Material and methods: After fulfilling the mentioned criteria, patients were screened for medical fitness and then further randomized in group I and II. Group I-Patients treated with TFN (n=30). Group II-Patients treated with DHS (n=30). The clinical assessment was done according to the “Salvati and Wilson Function Score (SWS Score)”. Blood loss measurement and complications were also studied and compared. Results: Thirty patients were included in the study in each group. Salvati and Wilson Function Score (SWS) Score was used to evaluate the results at follow up. Mean ± SD of SWS at 16 weeks & 24 weeks was 18.93±3.34 & 28.80±5.33 respectively in group I whereas in group II, the value was 15.13±2.18 & 21.67±5.14 respectively. P-value was significant (< .01) Complications were observed in follow ups and the most frequent was varus displacement. It was observed that out of 30 subjects of Group 2, maximum i.e. 8 (26.67%) subjects had varus deformity whereas out of 30 subjects of group 1, only 1 (3.33%) subject had varus deformity Other complications include Non Union and Implant failure. Conclusion: We conclude that the advantage with Trochanteric fixation nail is that a smaller exposure is required than for a sliding screw, it may therefore be associated with lesser blood loss, shorter operating time and less morbidity.

Современная система интрамедуллярной фиксации вертельных переломов бедренной кости: Обзор литературы

The problem of treating patients with trochanteric fractures of the femur is relevant, due to the high incidence of fractures among the elderly due to increased life expectancy along with osteoporosis and the difficulty in choosing implants for osteosynthesis. Implants for intramedullary osteosynthesis are the method of choice for fixing such fractures. The purpose of this review: to study the advantages of implants for intramedullary osteosynthesis of trochanteric femoral fractures.The article provides an analysis of literature sources indexed in the Scopus, PubMed, Google Scholar, Lilacs and Cuiden databases, devoted to the study of the method of intramedullary osteosynthesis of trochanteric femoral fractures. The results made it possible to establish that modern intramedullary implants provide stable fixation of fragments even in osteoporosis, minimal blood loss during surgery, shortening of surgery time, early postoperative load and are safe and effective.The modern system of intramedullary fracture fixation is recognized as a highly effective method, especially in unstable trochanteric and subtrochanteric fractures of the femur, provides high antirotational stability of structures, overcomes the “Z” effect, medial migration of the cervical screw and minimally invasive intervention. Further research allows us to note the promising directions of the surgical method of treating patients with trochanteric fractures of the femur. Optimization of implants for intramedullary osteosynthesis of trochanteric fractures is a promising direction in traumatology and orthopedics.Key words: trochanteric fracture, femur, osteosynthesis, intramedullary osteosynthesis, metal structures, osteoporosis.

Is the proximal femoral nail a favourable option for trochanteric femur fractures in osteopenic elderly patients?

Primary aim of this study to evaluate the functional results and complications of the patients aged 70 and over whom are treated with proximal femoral nail (PFN) because of hip fracture. 128 patients out of 223 patients were included in the study, who were aged 70 and over, to whom treated with proximal femoral nail because of hip fracture in our clinic between 2006 and 2014. Since 26 of these 128 patients who were included in this study passed away before the follow up period of 1 year, they were excluded from the study. Fractures were evaluated by AO/OTA classification. Their Singh index and morphological cortical indexes were calculated from the pre-surgery radiographies. The functional situations of the patients were evaluated by Harris hip score. Average age of the evaluated 102 patients was 81.13 (70-98), 44 of them were male, 58 of them were female. According to AO/OTA fracture classification 48 of them were 31-A1, 25 of them were 31-A2, 29 of them were 31-A3. 54 fractures were on the left hip, 48 fractures were on the right hip. Average Singh index was 2.72 (1-5), average morphological cortical index was 2.94 (2.1-3.7), average Harris hip score was 74.3 (49-88). 4 patients have had complications after surgery and revised with other treatment modalities. Since the functional results are on a satisfactory level, in our opinion as well, proximal femoral nail should be considered among the surgical treatments in the elderly patients with hip fracture.

Measurement of Lag-Screw Anteversion With an iPhone During Trochanteric Fracture Surgery.

Introduction A useful way to easily evaluate femoral rotation during surgery for trochanteric fractures is not known. Hence, this pilot study aimed to develop an intraoperative indicator to evaluate anteversion in femoral trochanteric fractures. Material and methods Prospectively, from June 2021 to January 2022, all patients with femoral trochanteric fractures (Orthopaedic Trauma Association classification: 31A1-3) treated using a cephalo-medullary nail with a lag-screw neck-shaft angle of 125° were included in this study. During surgery, lag-screw anteversion (LS-AV) was measured using the goniometer application in an iPhone with the fractured femur table-top-plane level with the traction table floor. Accuracy was analyzed by comparing axial-projected lag-screw anteversion (AxP-LS-AV) and three-dimensional computed tomography lag-screw anteversion (3DCT-LS-AV) measurements after surgery. Results Fifty patients (14 males and 36 females) were included in the study. The mean age was 87 (range; 69-98) years; the Orthopaedic Trauma Association classifications were A1 (28 patients), A2 (18 patients), and A3 (4 patients). The mean LS-AV was 10.7° ± 6.9°, the mean AxP-LS-AV was 12.8° ± 8.3°, and the mean 3DCT-LS-AV was 13.1° ± 8.6°. The median difference between AxP-LS-AV and 3DCT-LS-AV was 3.0° (range: 0°-12°), and 40 (80%) patients had differences of ≤5° (Bland-Altman plot: inside of limit of agreement = 86%, paired t-test p = 0.7, Pearson correlation coefficient r = 0.817, p <0.001). Conclusion Femur malrotation is defined as a deformity of >15° relative to the normal contralateral limb. Intraoperative LS-AV iPhone measurement on table-top-plane standard had sufficient accuracy as an indicator of anteversion in femoral trochanteric fractures.

Trochanteric fracture pattern is associated with increased risk for nonunion independent of open or closed reduction technique

PurposeSoft tissue injury and soft tissue injury as risk factors for nonunion following trochanteric femur fractures (TFF) are marginally investigated. The aim of this study was to identify risk factors for impaired fracture healing in geriatric trauma patients with TFF following surgical treatment with a femoral nail.MethodsThis retrospective cohort study included geriatric trauma patients (aged > 70 years) with TFF who were treated with femoral nailing. Fractures were classified according to AO/OTA. Nonunion was defined as lack of callus-formation after 6 months, material breakage, and requirement of revision surgery. Risk factors for nonunion included variables of clinical interest (injury pattern, demographics, comorbidities), as well as type of approach (open versus closed) and were assessed with uni- and multivariate regression analyses.ResultsThis study included 225 geriatric trauma patients. Nonunion was significantly more frequently following AO/OTA 31A3 fractures (N = 10, 23.3%) compared with AO/OTA type 31A2 (N = 6, 6.9%) or AO/OTA 31A1 (N = 3, 3.2%, p < 0.001). Type 31A3 fractures had an increased risk for nonunion compared with type 31A1 (OR 10.3 95%CI 2.2 to 48.9, p = 0.003). Open reduction was not associated with increased risk for nonunion (OR 0.9, 95%CI 0.1 to 6.1. p = 0.942) as was not the use of cerclage (OR 1.0, 95%CI 0.2 to 6.5, p = 0.995). Factors such as osteoporosis, polytrauma or diabetes were not associated with delayed union or nonunion.ConclusionThe fracture morphology of TFF is an independent risk factor for nonunion in geriatric patients. The reduction technique is not associated with increased risk for nonunion, despite increased soft tissue damage following open reduction.

Complications Patients Faces while Fixation, in Terms of Pain Relief, Walking, Sitting

Background: The fracture of the trochanteric area of the femur is one of the most frequent and challenging complications orthopedic surgeons deal daily. In virtually all instances, fractures develop through the highly vascular cancellous bone and heal within 8 to 12 weeks, independent of therapy. Malunion and varus angulations are prevalent. Due to the demands placed on the patient, nursing staff, and length of hospitalization, conservative therapy is no longer acceptable. Seventy percent of intertrochanteric fractures are considered unstable. During regular exercises, the proximal femoral loading has been calculated to reach up to three times the body weight. Muscle attachments apply force vectors in several directions, hence contributing to a trend for fracture displacement. This fracture is typically accompanied by severe comminution and osteopenia. Objective: The main objective of this study is to find thecomplications patients faces while fixation, in terms of pain relief, walking, witting. Materials and Methods: Descriptive study conducted at Department of Orthopedic Surgery, Chittagong Medical College Hospital, Chittagong, with the sample size of 36 patients aged above 50 years admitted to the Chittagong Medical College Hospital with closed trochanteric fracture. The aim of the study is to find out the Effectiveness of dynamic hip screw in fixation of trochanteric fractures of femur in elderly patients. Results: The patients' ages ranged from 52 to 95 years. The majority of patients were 70-79 years old (36.1 percent), followed by 80-89 years (25 percent), 60-69 years (22.2 percent), 50-59 years (11.1 percent), and 90-99 years (5.6 percent). The mean (±SD) age of the total study patients (n=36) was 72.± 1.20 years, male (n=21) was 75.05±12.62 years and female (n=15) were 68.07±7.46 years. There are considerable disparities between the age groups of 70-79 and 90-99.Males made up the majority of patients (58.3 percent), while females made up 41.7 percent. ....