Trochanteric Fractures Research Articles

Use of the Heracles straight blade in the treatment of intertrochanteric hip fractures: a prospective study with a 1-year follow-up.

The treatment of intertrochanteric fractures in the elderly remains challenging for orthopedic surgeons, due to aging, comorbidities, and poor bone quality. The Heracles straight blade has proven a lower rate of cut-out and femoral head displacement in biomechanical studies; however, there are currently no published clinical studies using this nail. To analyze the clinical and radiological results of the Heracles nail with the straight cephalic Heracles blade as a device to treat osteoporotic intertrochanteric fractures of the proximal femur. A total of 136 patients with trochanteric hip fractures were operated on by the same surgeon, using the Heracles nail with a straight cephalic blade. However, only 86 patients completed the 1-year follow-up both clinically and radiologically. According to the Association of Osteosynthesis classification, 38 patients (44.1%) had 31-A1, 36 patients (41.6%) had 31-A2, and 12 patients (14.1%) had 31-A3. Functional outcomes were assessed according to the Katz and Barthel scores, finding that 58% of patients recovered their original functional level, According to Barthel score, a mean loss of 11.8 points was found. The mean hospital stay was 8.22 days (mean preoperative stay of 2.71 days). The mean tip-apex distance was 15.2 mm. During the follow-up, 6 complications (6.96%) were detected: 4 cut-out, 1 cut-in, and 1 nail breakage. According to the Katz score, 58% of the patients recovered their previous functional status and 20.58% needed an additional walking aid. The mean loss in the Barthel score was 11.8 points. The Heracles nail using a cephalic straight blade has proven to be a valid treatment of trochanteric fractures, due to the functional recovery of the patients and low level of complications.

Clinical and radiological outcome of the Chimaera short nailing system in inter- and subtrochanteric fractures.

cephalomedullary devices are popular treatment for femoral intertrochanteric or subtrochanteric fractures. Various complications include post-surgical lateral thigh pain and cut-out. To prevent those complications, a new concept cephalomedullary device system was designed (Chimaera, Orthofix®). This study aimed to evaluate the clinical and radiological outcomes in patients with femoral intertrochanteric or subtrochanteric fractures treated with the proximal femoral cephalomedullary device system. A prospective cohort study involved consecutive patients with Arbeitsgemeinschaft für Osteosynthesefragen/ Orthopaedic Trauma Association type 31-A1, 2, 3 fractures treated with the Chimaera short cephalomedullary device system from October 2016 to September 2017 at our level 1 trauma center. The Parker and Palmer mobility score and Jensen social function scores and post-surgical lateral thigh pain were assessed at 3 months post-operatively and compared to before surgery. Radiologic assessment consisted of controlling the position of the cephalic screw by using the tip-apex distance (TAD) and Cleveland zone as well as union and cut-out rates. We included 99 patients (79 women; 100 hips; one bilateral fracture 3 months after a first trochanteric fracture) with a mean follow-up of 2 years. The Parker and Palmer mobility score decreased by 22% at 3 months post-operatively as compared with the pre-fracture score (42/99 patients showed a return to their pre-injury level). The Jensen social function score increased by 16.5% at 3 months post-operatively as compared with the pre-fracture score (68/99 patients showed a return to their pre-injury level). No major intra-operative complication was recorded. Nine TAD scores were > 25mm. The mean TAD was 16.5mm (range 5-36), and the lag screw position was well positioned in most (95%) hips according to Cleveland zones. Three patients required revision surgery (one for cut-out of the lag screw, one for hip osteoarthritis and one for gluteus medius insufficiency). All patients but the one with the cut-out showed fracture union. The Chimaera short cephalomedullary device exhibited good mid-term functional and radiological outcomes.

Effect of Postoperative Non-Weight-Bearing in Trochanteric Fracture of the Femur: A Retrospective Cohort Study Using Propensity Score Matching.

The effects of postoperative early weight-bearing (WB) on walking ability, muscle mass, and sarcopenia have been investigated. Postoperative WB restriction is also reportedly associated with pneumonia and prolonged hospitalization; however, its effect on surgical failures has not been studied. This study aimed to assess whether WB restriction after surgery for trochanteric fracture of the femur (TFF) is useful in preventing surgical failure, considering the unstable fracture type, quality of intraoperative reduction, and tip-apex distance. This retrospective analysis included 301 patients admitted to a single institution between January 2010 and December 2021, diagnosed with TFF, and who underwent femoral nail surgery. Eight patients were excluded, and finally 293 patients were included in the study. Propensity score (PS) matching yielded 123 cases; 41 patients in the non-WB (NWB) group and 82 patients in the WB group were included in the final analysis. The primary outcome was surgical failure (cutout, nonunion, osteonecrosis, and implant failure). The secondary outcomes were medical complications (pneumonia, urinary tract infection, stroke, and heart failure), change in walking ability, period of hospitalization, and sliding distance of the lag screw. Five surgical complications occurred in the NWB group and two in the WB group, with significantly more surgical complications in the NWB group (P = .041). Cutout occurred in two cases, each in the NWB and WB groups. Two cases of nonunion and one case of implant failure occurred in the NWB group, but not in the WB group. Osteonecrosis did not occur in both groups. The secondary outcomes were not significantly different between the two groups. The results of this retrospective cohort study using a PS matching approach showed that WB restriction after TFF surgery could not decrease the incidence of surgical failures.

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.

Outcomes of osteosynthesis of periprosthetic fractures of the greater trochanter with an anatomic claw plate

BackgroundThe treatment of periprosthetic trochanteric fractures, especially older fractures, is often a challenge. The aim of this study was to investigate the clinical and radiological outcomes of periprosthetic fracture treatment with the anatomic Peri-Plate claw plate. Material and methodsThirteen new fractures (≤6 weeks after occurrence) and 8 older Vancouver AG fractures (35.4 ± 26.1 weeks after occurrence) were followed radiologically and clinically with a follow-up of 44.6 ± 18.8 (24–81) months. ResultsAt 6 months, osseous consolidation had occurred in 12 cases and fibrous union in 9 cases. At 12 months one additional osseous consolidation was shown. The Harris hip score (HHS) increased from 37.2 ± 10.3 preoperatively to 87.6 ± 10.3 12 months after surgery. Thirteen patients reported no, 7 mild and one patient significant local trochanteric pain. ConclusionsThe Peri-Plate claw plate can achieve reproducibly good outcomes in terms of fracture stabilization and bony consolidation, as well as with regard to clinical outcomes in the treatment of new and older periprosthetic trochanteric fractures.

Relative instability ratios of bone wall defects in trochanteric hip fractures: A finite element analysis.

Background: For decades, medial and lateral wall fragments of trochanteric hip fractures were considered two pivotal factors that could influence the stability of postoperative femur-implant complex. However, most studies seemed to misunderstand the concept of the posteromedial fragment and equated it with the medial wall, which overlooked vital roles of the anteromedial wall. Roles of the posterior coronal bone fragment were also highlighted in some research. However, influences of the bone walls above the trochanteric fracture instability are yet to be investigated and quantified by means of finite element analysis. Methods: Eight trochanteric fracture fixation models with different wall defects were constructed. Outcome indicators were the von Mises stress of the implant models, the maximum/minimum principal strain, the risky tensile/compressive volume and the volume ratios of the bone models, the femoral head vertex displacement, and the fracture surface gap. Based on these indicator values, the relative instability ratios were computed. Results: Outcome indicators, absolute values, and nephograms of all models showed the same upward and concentrating trends with exerted hip contact loads shifting from static walking to dynamic climbing. Similarly, these indicators also exhibited the same trends when the eight models were solved in sequence. Moreover, the relative instability ratio of the medial wall (100%), particularly the anteromedial part (78.7%), was higher than the figure for the lateral wall (36.6%). Conclusion: The anteromedial wall played relatively pivotal stabilizing roles in trochanteric hip fractures compared with the posteromedial wall and the lateral wall, which indicated that orthopedic surgeons should attach more importance to the anteromedial cortex support in an operating theatre.

Accompanying Therapy in the Surgical Treatment of Pathological Fractures of the Long Bones and Chronic Fractures of the Trochanteric Region

The article presents a study of palliative surgical treatment of patients with pathological fractures of the long bones and chronic trochanteric fractures. Those patients are not indicated for special oncological treatment. Therefore, the article does not provide staging of malignant neoplasms. The surgical treatment was aimed at improving the quality of life of palliative patients, and accompanying therapy in the form of the Altaicae extract adaptogen and the neutral anolyte led in our study to an increase in the effectiveness of surgical treatment of such a severe contingent of patients.INTRODUCTION According to domestic and foreign literature, the number of oncological diseases in young and old people is growing. There is a trend to neglecting the disease and late visits to doctors. Almost all types of cancer of various localization and other malignant tumors metastasize to the bones. An increase in the number of pathological (metastatic) fractures of the trochanteric region and the long bones was also noted. Surgical treatment of patients with such a severe type of fractures leads to an aggravation of the already existing immunodeficiency and, as a rule, creates the prerequisites for the occurrence of infectious complications in the postoperative period. The choice of a conservative method of treatment often does not justify itself as well, it leads to diagnostic and therapeutic errors, and in the future — to chronic pathological fractures.AIM To improve the effectiveness of surgical treatment and the quality of life of palliative patients with pathological (metastatic) fractures of the long bones and chronic trochanteric fractures using original authors’ accompanying therapy.MATERIAL AND METHODS 177 patients were examined and divided into two groups the main and the control groups. 72 patients were included in the main group, and 105 patients in the control group. There were 110 men and 67 women. The patient age ranged from 35 to 90 years. The main group received surgical treatment with the use of new accompanying therapy along with the basic one, and the control group received only surgical treatment and basic therapy.RESULTS In the main group patients with chronic pathological fractures of the trochanteric region, who underwent endoprosthetic replacement, osteosynthesis, a new method of surgical treatment of metastatic fractures of the long bones and the authors’ accompanying therapy, the effectiveness of surgical treatment increased significantly compared to the comparison group. As a result, most of the unwanted symptoms disappeared, time spent in hospital decreased, the psychoemotional status and immunity improved, the functional state of the body was optimized, and the quality of life improved.CONCLUSION The use of new accompanying therapy, the authors’ method of surgical treatment of patients with pathological (metastatic) fractures of the long bones, chronic fractures of the trochanteric region allows us to successfully and effectively operate on such severe patients and perform a fast track surgery program in the early postoperative period.

THE CHANGING FACE OF FEMORAL FRAGILITY FRACTURES: INCIDENCE; FRACTURE PATTERNS; AND MANAGEMENT

The purpose of this study was to determine whether there have been changes in the complexity of femoral fragility fractures presenting to our Dunedin Orthopaedic Department, New Zealand, over a period of ten years.Patients over the age of 60 presenting with femoral fragility fractures to Dunedin Hospital in 2009 −10 (335 fractures) were compared with respect to demographic data, incidence rates, fracture classification and treatment details to the period 2018-19 (311 fractures). Pathological and high velocity fractures were excluded.The gender proportion and average age (83.1 vs 83.0 years) was unchanged. The overall incidence of femoral fractures in people over 60 years in our region fell by 27% (p<0.001). Intracapsular fractures (31 B1 and B2) fell by 29% (p=0.03) and stable trochanteric fractures by 56% (p<0.001). The incidence of unstable trochanteric fractures (31A2 and 31A3) increased by 84.5% from 3.5 to 6.4/10,000 over 60 years (p = 0.04). The proportion of trochanteric fractures treated with an intramedullary (IM) nail increased from 8% to 37% (p <0.001). Fewer intracapsular fractures were treated by internal fixation (p<0.001) and the rate of acute total hip joint replacements increased from 13 to 21% (p=0.07). The incidence of femoral shaft fractures did not change significantly with periprosthetic fractures comprising 70% in both cohorts.While there has been little difference in the numbers there has been a decrease in the incidence of femoral fragility fractures likely due to the increasing use of bisphosphonates. However, the incidence of unstable trochanteric fractures is increasing. This has led to the increased use of IM nails which are increasingly used for stable fractures as well.The increasing complexity of femoral fragility fractures is likely to have an impact on implant use, theatre time and cost.

Predictors of Failure Following Fixation of Trochanteric Fractures

BACKGROUND: Trochanteric fractures are frequent and mainly affect the elderly causing autonomy loss. Their incidence is increasing, and they are associated with substantial morbidity and high cost. AIM: The aim of our study was to identify epidemiological, radiological, and technical predictors of failure of trochanteric fracture fixation in the elderly. METHODS: We conducted a retrospective study including 188 patients aged over 65 years, who underwent surgery for trochanteric fractures, in the period between 2015 and 2020 at the orthopedics department of the Military Hospital of Tunis. The minimum follow-up was 12 months. RESULTS: Thirty-four patients had a mechanical failure (18.1% of cases), including 12 cases of cephalic screw migration (CSM) (6.4%), 12 cases of disassembly (6.4%), eight cases of malunion (4.3%), and four cases of non-union (2.1%). Bone fragility with a Singh index ≤III was associated with CSM, disassembly of fixation material, and malunion (respectively, p < 0.001; p = 0.01 and p = 0.044). Reduction quality was associated with disassembly (p < 0.001) and CSM (p = 0.004). Eccentric screw positioning on anteroposterior (p < 0.001) and lateral views (p = 0.018), high tip-apex distance (TAD) (p < 0.001), and calcar-referenced TAD (p < 0.001) were predictive of CSM. Logistic regression analysis showed that poor reduction quality was an independent factor associated with the occurrence of mechanical complications. Functional outcomes were assessed using Parker and Postel Merle d’Aubigné scores. CONCLUSION: To minimize the risk of mechanical complications, the surgeon must pay close attention to the fracture reduction and to the correct positioning of the cervical screw.

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

A COMPARATIVE STUDY OF PROXIMAL FEMORAL NAILING VERSUS DYNAMIC HIP SCREW IN SURGICAL MANAGEMENT OF INTERTROCHANTERIC FRACTURES CONDUCTED AT ONE OF THE TERTIARY CARE HOSPITALS IN LUCKNOW

Introduction: Proximal femoral Fractures are a subset of fractures that occur in the hip region and occupy large proportion of hospitalization amongst trauma cases.An overwhelming majority of these patients (>90%) are aged above 50 years. These are classified on the basis of anatomic location for example, femur neck fracture; inter trochanteric fracture and subtrochanteric fracture.Therefore,the aim of the present study was to achieve fracture union by using two different kinds of internal fixation modality devices in similar type of fractures. Material and Methods: This is a randomized prospective study of 40 cases of intertrochanteric fractures,admitted to Career Institute of Medical Science, Lucknow.All fractures were classified by the Seinsheimer classification system.The patients were treated with proximal femoral nailing (PFN) and/or dynamic hip screw (DHS) and were categorised randomly into two groups, each of 20 patients, 20 were treated by dynamic hip screw and 20 were treated with proximal femoral nail (PFN). Results: The intraoperative parameters were in favour of PFN with significantly less duration of surgery,length of incision and blood loss but more fluoroscopy time.Postoperatively also,PFN group patients excelled with significantly less post-operative pain, less incidence of deep infection, less mean limb length discrepancy and more patients regaining their pre injury walking capability with also fewer complications. Conclusion: PFN emerged to be superior to DHS in unstable intertrochanteric fractures.Intramedullary implants have been quite effective in sub-trochanteric fractures and should be preferred better than extra-medullary plate fixation systems.

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.

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.

Effects of Compression Intervention on the Thigh Using Elastic Bandage on Lateral Femoral Pain After Trochanteric Fractures: A Multicenter Randomized Controlled Trial.

A trochanteric fracture is one type of hip fracture. Management of postoperative pain after trochanteric fracture that is caused by decreased gliding between tissues in the lateral thigh is not established. The aim of this study was to examine the effect of compression of the thigh using an elastic bandage on trochanteric fracture after surgery. Multicenter randomized controlled trial was conducted in collaboration with the Comprehensive Rehabilitation Unit (sub-acute rehabilitation Unit) in two hospitals. Eligible volunteers (n = 34) with trochanteric fractures after surgery were randomly assigned to two groups. In the treatment group, participants practiced standing and walking under compression of the thigh with an elastic bandage. The control group was blinded to the intervention and practiced standing and walking under non-compression of the thigh with an elastic bandage. Both groups underwent a standard physical therapy program 2 times a day, daily. Two-way repeated measures of ANOVA showed significant main effect between the groups for gliding between tissue (p < .001), lateral femoral pain (p < .001), subcutaneous tissue thickness (p = .044). Compression of the thigh with an elastic bandage significantly improved subcutaneous tissue thickness, gliding between tissues, lateral thigh pain. Gait velocity improved with these functional improvements.

RELATION OF FEMUR FRACTURES LOCATION WITH CLINICAL OUTCOMES IN ELDERLY PATIENTS.

This study was designed to investigate the possible relationship between the anatomical location of the PFF (head-neck fractures) and the demographic features, comorbidities, and risk factors of elderly patients. 233 patients aged 65 years and over, who were admitted to the emergency department with a diagnosis of proximal femur fracture were included in this study. Most patients (59.6%) had a trochanteric fracture. The incidence of trochanteric fractures had a statistically significant positive correlation with age. Falls at ground level were found to be highly associated with trochanteric fractures (92,8%). At least one complication was observed in 57 (41,0%) cases and 31 (22,3%) died in one year, of the patients with trochanteric fractures. Comorbidity was not related to fracture location statistically. Fall ground level (p = 0.013), complication rate (73.7%; p <0.001), and Charlesen comorbidity index (p = 0.019) were statistically significantly associated with death. The logistic regression analysis of variables determined that only the quantity of comorbidities may be related to femoral neck fractures (p = 0.047). Female patients with trochanteric fractures were found to be older than male patients. Fall ground level, mortality, and complications were more frequently seen in patients with trochanteric fractures. Level of Evidence II, Retrospective study.

Proposal of a modified tip apex distance for prediction of lag screw cut-out in trochanteric hip fractures.

Lag screw cut-out is a serious complication of dynamic hip screw fixation of trochanteric hip fractures. The lag screw position has been acknowledged as one of the important factors affecting the lag screw cut-out. We propose a modification of the Tip Apex Distance (TAD) and hypothesise that it could improve the reliability of predicting lag screws cut-out in these injuries. A retrospective study was conducted for hip fracture entries in the period from Jan 2018 to July 2022. A hundred and nine patients were suitable for the final analysis. The modified TAD was measured in millimetres based on the sum of the traditional TAD in the lateral view and the net value of two distances in the AP view, the first distance is from the tip of the lag screw to the opposite point on the femoral head along the axis of the lag screw while the second distance is from that point to the femoral head apex. The first distance is a positive value, whereas the second distance is positive if the lag screw is superior and negative if inferior. A receiver operating characteristic curve was used to evaluate the reliability of the different parameters assessing the lag screw position within the femoral head. Reduction quality, fracture pattern as per the AO/OTA classification, TAD, Calcar Referenced TAD, Axis Blade Angle, Parker's ration in the AP view, Cleveland Zone 1, and modified TAD were statistically associated with lag screw cut-out. Among the tested parameters, the modified TAD had 90.1% sensitivity and 90.9% specificity for lag screw cut-out at a cut-off value of 25mm with a P-value<0.001. The modified TAD had the highest reliability in the prediction of lag screw cut-out. A value ≤25mm could potentially protect against lag screw cut-out in trochanteric hip fractures.

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.

The Effects of Three Different Low-molecular-weight Heparins on Blood Loss After Intramedullary Nailing of Trochanteric Fractures.

The three most commonly used low-molecular-weight heparins (LMWH) in Bosnia and Herzegovina for thromboprophylaxis in patients with hip fracture are reviparin, dalteparin and enoxaparin. The purpose of this study was to compare the effects of reviparin, dalteparin and enoxaparin on intraoperative blood loss in patients with trochanteric fracture treated with intramedullary nailing. This retrospective multicenter study included 100 patients with trochanteric fracture who were divided into three groups according to the low-molecular-weight heparin administered. In all cases, a short third generation Gamma-nail was used for osteosynthesis. Complete blood count and number of red blood cell transfusions (RBC) were evaluated. Results: The mean value of postoperative hemoglobin level was lower in the enoxaparin group compared to the reviparin group, with significant difference (p=0.001; 95% CI: 4.1-18.87). Patients in the dalteparin group received more RBC transfusions compared to the reviparin and enoxaparin group (p=0.048). The use of enoxaparin and dalteparin in hip fracture patients can result in lower postoperative haemoglobin levels and more RBC transfusions compared to reviparin.

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.