Unstable Intertrochanteric Femur Fractures Research Articles

Augmentation of intramedullary nail in unstable intertrochanteric fractures with plate or cable.

This study aims to evaluate the clinical outcome of intramedullary nail supplemented by buttress plate or cable in the treatment of intertrochanteric fracture with broken lateral wall. From May 2015 to January 2022, patients with unstable intertrochanteric femoral fractures underwent intramedullary fixations strengthened with buttress plates or cables, which depended on the lateral femur wall fragment type. The clinical and radiographic results were compared between the two groups. The hip function was evaluated according to the Harris Hip Scoring (HHS) system. Forty-one patients who sustained intertrochanteric fracture + broken lateral wall were enrolled. Of these, thirty-four received a minimum of twelve months of follow-ups. No statistically significant differences in baseline and operative data were proved between these groups (p > 0.05). Three patients were observed fat liquefaction after surgery (plate group: 2 cases, cable group: 1 case). All patients could sustain partial/full weight-bearing and no case underwent subsequent operation. The HHS of the last follow-up presented 83.6 ± 4.9 points in the plate group and 83.8 ± 3.7 points in the cable group. Intertrochanteric femoral fracture with broken lateral wall is an unstable injury type, the operative treatments of which have been challenging and controversial over the years. Augmentation of intramedullary nailing system using plate/cable contributes to reconstructing the lateral femur wall.

Proximal Femur Bionic Nail (PFBN): A Panacea for Unstable Intertrochanteric Femur Fracture

With the aging population, intertrochanteric femur fracture in the elderly has become one of the most serious public health issues and a hot topic of research in trauma orthopedics. Due to the limitations of internal fixation techniques and the insufficient mechanical design of nails, the occurrence of complications delays patient recovery after surgical treatment. Design of a proximal femur bionic nail (PFBN) based on Zhang’s N triangle theory provides triangular supporting fixation, which dramatically decreases the occurrence of complications and has been widely used for clinical treatment of unstable intertrochanteric femur fracture worldwide. In this work, we developed an equivalent biomechanical model to analyze improvement in bone remodeling of unstable intertrochanteric femur fracture through PFBN use. The results show that compared with proximal femoral nail antirotation (PFNA) and InterTan, PFBN can dramatically decrease the maximum strain in the proximal femur. Based on Frost’s mechanostat theory, the local mechanical environment in the proximal femur can be regulated into the medium overload region by using a PFBN, which may render the proximal femur in a state of physiological overload, favoring post-operative recovery of intertrochanteric femur fracture in the elderly. This work shows that PFBN may constitute a panacea for unstable intertrochanteric femur fracture and provides insights into improving methods of internal fixation.

Biomechanical evaluation of three implants for treating unstable femoral intertrochanteric fractures: finite element analysis in axial, bending and torsion loads.

Purpose: How to effectively enhance the mechanical stability of intramedullary implants for unstable femoral intertrochanteric fractures (UFIFs) is challenging. The authors developed a new implant for managing such patients. Our aim was to enhance the whole mechanical stability of internal devices through increasing antirotation and medial support. We expected to reduce stress concentration in implants. Each implant was compared to proximal femoral nail antirotation (PFNA) via finite element method. Methods: Adult AO/OTA 31-A2.3 fracture models were constructed, and then the new intramedullary system (NIS), PFNA, InterTan nail models were assembled. We simulated three different kinds of load cases, including axial, bending, and torsion loads. For further comparison of PFNA and the NIS, finite element analysis (FEA) was repeated for five times under axial loads of 2100N. Two types of displacement and stress distribution were assessed. Results: Findings showed that the NIS had the best mechanical stability under axial, bending, and torsion load conditions compared to PFNA and InterTan. It could be seen that the NIS displayed the best properties with respect to maximal displacement while PFNA showed the worst properties for the same parameter in axial loads of 2100N. In terms of maximal stress, also the NIS exhibited the best properties while PFNA showed the worst properties in axial loads of 2100N. For bending and torsion load cases, it displayed a similar trend with that of axial loads. Moreover, under axial loads of 2100N, the difference between the PFNA group and the NIS group was statistically significant (p < 0.05). Conclusion: The new intramedullary system exhibited more uniform stress distribution and better biomechanical properties compared to the PFNA and InterTan. This might provide a new and efficacious device for managing unstable femoral intertrochanteric fractures.

Assessment of Proximal Femoral Nail in Management of Unstable Intertrochanteric Femur Fractures

Assessment of Proximal Femoral Nail in Management of Unstable Intertrochanteric Femur Fractures

Bipolar Hemiarthoplasty versus Proximal Femoral Nail in Management of Unstable Intertrochanteric Femur Fracture

Background Intertrochanteric fractures (ITFs), commonly occurred in the elderly, are still a big challenge for orthopedic surgeons due to the multitude of co-morbidities and high 1-year mortality rate associated with them. Aim of the Work The aim of this study is to review systematically studies about the use of bipolar hemiarthoplasty versus proximal femoral nail in management of unstable intertrochanteric femur fracture. Patients and Methods We included randomized control trails (RCTs), controlled clinical trials, retrospective comparative cohort studies and prospective comparative cohort studies and we excluded case reports, case series studies, cross sectional studies and non English studies. Search results was conducted to systematic review management software and manually screened for eligibility to be included. Surgical treatment of unstable intertrochanteric femur fractures by bipolar hemiarthoplasty versus proximal femoral nail. Results Regarding the patients included in the review there is no significant difference in the age or sex between the two groups of comparison. This review provides us with enough evidence regarding the superiority of PFN, which being a significantly faster surgery and has relatively lower incidence of intraoperative blood loss this in turn provides general wellbeing to the patient and gives better function. Although there is no significant difference between two group of comparison regarding percentage of failure and percentage of reoperation, PFN shows the superiority of duration of hospital stay which could be beneficial for the mental health of the patients, which adds to their overall quality of life, also PFN show the superiority regarding percentage of infection, decreasing patient suffering and risk of reoperation, also PFN show the superiority regarding percentage of mortality increasing life expectancy of patients, percentage of DVT decreasing pulmonary complications and also PFN show the superiority regarding Harris hip score so show better outcomes. Conclusion PFN proves itself as a better modality than hemiarthroplasty in unstable intertrochanteric femur fractures in the elderly, with decreased post-operative mortality and better functional results. Hemiarthroplasty is best reserved for individuals with short life expectancies who require immediate weight bearing and mobilization.

Comparative analysis of the clinical, functional and radiological outcomes of proximal femoral nail alone verses proximal femoral nail along with lateral wall plating in management of unstable intertrochanteric femur fracture, AO/OTA, type 31A2 fractures with deficient lateral wall

Background: The objective of the study was to compare the effectiveness in terms of clinical, functional and radiological outcomes of management of unstable intertrochanteric femur fracture, AO/OTA type 31A2 intertrochanteric fractures with deficient lateral wall with proximal femoral nail (PFN) alone verses PFN along with lateral wall plating. Methods: In our study 52 patients with intertrochanteric femur fractures, AO/OTA type 31A2 which met the selection criteria were divided into two groups, group A (PFN) with lateral wall plating and group B (PFN) alone by randomization and were analysed prospectively with no significant difference in terms of gender, age, side of injury, cause of injury, and combined medical diseases. The intraoperative time and blood loss, time to full weight-bearing and radiological union, varus collapse, functional outcome and postoperative complications were recorded and compared. Results: Comparatively, no significant difference was observed between both groups for the time for full weight bearing. However significant difference was observed between both the groups for HHS at 9 months, neck shaft angle and time for radiological union (in weeks). Statistically significant difference was observed between both the groups for neck shaft angle and HHS at 9 months. The incidence of complications was 30.77% in group B. The incidence of complications was around 26.92% in group A; with no significant difference. At 9 months after operation, the Harris scores of pain, function, malunion, range of motion, and total score in group A were significantly better than those in group B. Conclusions: For unstable intertrochanteric femur fracture with incomplete lateral wall, the incidence of varus collapse after augmentation of PFN fixation with lateral wall plating was lower, the time for radiological union was earlier and functional outcome was better.

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.&#x0D; Study Design: Quasi-experimental study.&#x0D; Place and Duration of Study: Department of Orthopaedic Surgery, Combined Military Hospital, Malir Pakistan, from Dec 2020 to Aug 2021.&#x0D; 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. &#x0D; 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&lt; 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&lt;0.001).&#x0D; 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.

Role of Proximal Femoral Nail Antirotation in Management of Unstable Intertrochanteric Fracture of Femur

Background: The aim of this study is to evaluate the management of intertrochanteric fracture of the femur using Proximal Femoral Nail Antirotation (PFNA).&#x0D; Materials and methods: Sixty patients of unstable pertrochanteric fractures were treated by closed reduction and internal fixation by proximal femoral nail antirotation from July 2015 to June 2017. Four patients were lost to follow-ups. The remaining 56 patients were followed for a mean period of 2 years. The results were evaluated by assessing the patients regarding their clinical and functional outcome at follow up as per kyle’s criteria&#x0D; Results: Peroperative failure to proximal head neck blade fixation (n-1) jamming of nail (n=2) and post operative lateral migration of head neck blade (n=1) and fracture related infection (n=1) were complications observed. End results were excellent in 46.34%, good in 36.58%, fair is 14.64% and poor in 2.43%.&#x0D; Conclusion: Proximal Femoral Nail Antirotation (PFNA) is the biomechanically and biologically suitable implant for the management of intertrochanteric fracture of the femur.&#x0D; JCMCTA 2020 ; 31 (1) : 64-70

Bipolar Hemiarthroplasty in Unstable Intertrochanteric Fractures with an Effective Wiring Technique.

Bipolar hemiarthroplasty has recently been acknowledged as an effective option for treatment of unstable intertrochanteric fracture. Trochanteric fragment nonunion can cause postoperative weakness of the abductor muscle and dislocation; therefore, reduction and fixation of the fragment is essential. The purpose of this study was to perform an evaluation and analysis of the outcomes of bipolar hemiarthroplasty using a useful wiring technique for management of unstable intertrochanteric fractures. A total of 217 patients who underwent bipolar hemiarthroplasty using a cementless stem and a wiring technique for management of unstable intertrochanteric femoral fractures (AO/OTA classification 31-A2) at our hospital from January 2017 to December 2020 were included in this study. Evaluation of clinical outcomes was performed using the Harris hip score (HHS) and the ambulatory capacity reported by patients was classified according to Koval stage at six months postoperatively. Evaluation of radiologic outcomes for subsidence, breakage of wiring, and loosening was also performed using plain radiographs at six months postoperatively. Among 217 patients, five patients died during the follow-up period as a result of problems unrelated to the operation. The mean HHS was 75±12 and the mean Koval category before the injury was 2.5±1.8. A broken wire was detected around the greater trochanter and lesser trochanter in 25 patients (11.5%). The mean distance of stem subsidence was 2.2±1.7 mm. Our wiring fixation technique can be regarded as an effective additional surgical option for fixation of trochanteric fracture fragments during performance of bipolar hemiarthroplasty.

Assessment of the functional results of hemiarthroplasty in geriatric individuals with unstable intertrochanteric femur fractures

Background: The objective of our study is to measure early weight bearing, mobilization, rapid rehabilitation, complications in unstable intertrochanteric femur after hemiarthroplasty fractures in elderly patients. Methods: Prospective and retrospective, non-randomized study was conducted to assess functional results of hemiarthroplasty in elderly individuals with unstable intertrochanteric femur fractures following surgery in patients who underwent surgery from 2019 to 2021 in department of orthopaedics of Seth Nandlal Dhoot Hospital, Aurangabad. Out of total 44 participants, there were 16 males and 28 females with mean age of 79.54 years of study participants. The patients were evaluated radiologically with routine X-rays i.e. pelvis with both hip joint anteroposterior (AP) view and affected side hip lateral view and clinically early weight bearing, mobilization, rapid rehabilitation and complication with Harris hip score. Results: In our study we observed good result of 86.53±5.73 mean Harris hip score at the end of 1 year was following surgery in 44 study participants who underwent hemiarthroplasty in unstable intertrochanteric femur fractures in elderly patients. Conclusions: Primary hemiarthroplasty offers an essentially pain-free movable joint and is a preferable mode of treatment for older osteoporotic patients who suffers from unstable intertrochanteric femur fractures. Hemiarthroplasty allows for early mobilization and offers rapid stability and mobility, preventing the issues associated with recumbency. Hemiarthroplasty has a lower rate of complications and revision surgery than fixation. According to the Harris hip score, primary bipolar hemiarthroplasty results in a good functional outcome, but long-term monitoring is necessary.

Functional Outcome of Unstable Intertrochanteric fracture Treated with Proximal Femoral Nail Anti-Rotation

Background: Intertrochanteric fractures are one of the most disabling injuries, most commonly observed among the elderly, and shows a challenging problem for orthopedic surgeons. Nowadays, intertrochanteric fractures are being treated with different extramedullary and intramedullary devices. Among them, intramedullary fixations show the best outcome, and are widely used for different treatment of unstable intertrochanteric fractures (type 31A2, 31A3). A new device designed by AO/ASIF, the Proximal Femoral Nail Anti-Rotation (PFNA) represents a unique intramedullary nail system for improved management, with decrease in the number of complications. Material Methods: This prospective hospital based clinical trial was conducted at the Department of Orthopaedic Surgery, Chittagong Medical College Hospital, Chattogram, Bangladesh. The study duration was 2 years, from January 2018 to December 2019. During this period, a total of 48 patients who were admitted in the study place with unstable intertrochanteric fracture of femur were included in the study. Patients were followed up for 24 weeks, and overall outcome was measured using Kyle’s Criteria. Results: 48 patients were treated for unstable intertrochanteric fractures. The majority were between 50-80 years old (62.5%), with a mean age of 58.38. Gender distribution was even, with 50% male and 50% female. 75% of fractures were caused by a fall from height and 25% by a road traffic accident. 68.75% of fractures were type 31A3 and 31.25% were type 31A2. 68.75% of patients did not have comorbidities. The mean time interval for fixation was 12.6 days, and the majority of operations lasted between 45-90 minutes. 87.5% had a closed reduction and 12.5% had an open reduction. 64.58% of patients had radiation time between 2.5-3.3 minutes. At 2 weeks follow-up, 21.28% had poor functional outcome, 78.72% had fair functional outcome, and none had good or excellent outcomes. At 6 months follow-up, 2.17% had poor outcomes, 8.70% had fair outcomes, 34.78% had good outcomes, and 54.35% had excellent outcomes. 16.67% of patients experienced complications such as infection, varus, delayed union, and lateral migration. Conclusion: Most patients achieved good to excellent functional outcomes after treatment, with minimal 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.

Comparison of clinical outcomes with proximal femoral nail anti-rotation versus dynamic hip screw for unstable intertrochanteric femoral fractures: A meta-analysis.

The aim of this meta-analysis was to evaluate the advantages and disadvantages of proximal femoral nail anti-rotation (PFNA) versus dynamic hip screw (DHS) for the treatment of unstable intertrochanteric fractures, including the available evidence drawn from the literature. A systematic search was conducted to identify available and relevant randomized controlled trials and retrospective comparative observational studies regarding PFNA compared against DHS in treating unstable femoral intertrochanteric fractures in Embase, PubMed, Cochrane Library, Web of Science, and Scopus Online up to February 12, 2022. Data from the included studies were extracted independently by 2 reviewers and analyzed using RevMan 5.3, and the quality of the studies was assessed. Five randomized controlled trials and 12 observational studies were recruited and met the inclusion criteria, which consisted of 1332 patients with PFNA and 1271 patients with DHS. The results of the meta-analysis showed that, compared with the DHS, PFNA exhibited a beneficial role in postoperative Harris Hip Scores, operation time, intraoperative blood loss, length of hospital stay, fracture healing time and full weight-bearing time, limb shortening, cutout, reoperation, union problems, the varus collapse of the femoral head/neck, and infection; however, DHS was superior to PFNA in hidden blood loss (relative risk [RR] = 139.81, 95% confidence interval [CI] [136.18, 143.43], P < .00001), postoperation drainage (RR = -17.85, 95% CI [-30.10, -5.60], P = .004), total blood loss (RR = 50.34, 95% CI [42.99, 57.69], P < .00001), and femoral shaft fracture (RR = 4.72, 95% CI [1.15, 19.32], P = .03) treated by DHS were significantly decreased, compared with those by PFNA; however, no significant differences were observed in tip-apex distance, fixation failures, screw migration, or other complicants between the 2 surgical methods. Analysis of a large number of relevant clinical indicators available shows that PFNA has better clinical manifestation than DHS in treating unstable femoral intertrochanteric fractures.

A COMPARISON OF PFNA VERSUS INTERTAN CEPHALOMEDULLARY NAILS FOR UNSTABLE PROXIMAL FEMUR FRACTURES

Failure of cephalomedullary fixation for proximal femur fractures is an uncommon event associated with significant morbidity to the patient and cost to the healthcare system. This institution changed nailing system from the PFNA (DePuy Synthes) to InterTan (Smith and Nephew) in February 2020. To assess for non-inferiority, a retrospective review was performed on 247 patients treated for unstable proximal femur fractures (AO 31 A2; A3).Patients were identified through manual review of fluoroscopic images. Stable fracture patterns were excluded (AO 31 A1). Pre/post operative imaging, demographic data, operative time and ASA scores assessed. Internal/external imaging and national joint registry data were reviewed for follow up.No significant difference was found in overall failure rate of PFNA vs InterTan (4.84% vs 3.23%; p = 0.748). Overall, short nails were more likely to fail by cut-out than long nails (7.5% vs 1.2%; p = 0.015). Nails which failed by varus cut-out had a higher tip/apex distance (TAD) (26.2mm vs 17.0mm; p &lt; 0.001). Of concern, varus cut-out occurred in two InterTan nails with TAD of &lt;25mm. The PFNA enjoyed a shorter operative time for both the short (59.1 vs 71.8 mins; p = 0.022) and long nails (98.8 vs 114.3 mins; p = 0.016) with no difference in 120-day survival rate.Overall failure rates of the PFNA and InterTan nailing systems were comparable. However, the failure rate of short nails in this study is concerning. Using long nails with a lag screw design for unstable intertrochanteric femoral fractures may reduce failure rates. Cumulative frequency analysis suggests stringent tip-apex distances of less than 21mm may reduce failure rates in lag-screw design cephulomedullary nails. This dataset suggests that unstable intertrochanteric fractures may be more reliably managed with a long cephalomedullary device.

Proximal femoral bionic nail (PFBN)-an innovative surgical method for unstable femoral intertrochanteric fractures.

Intertrochanteric femoral fractures (IFF) are one of the most common traumatic conditions, but there are no established treatment methods for this condition due to implant failure and re-operation rates. The proximal femoral bionic nail (PFBN), which is a new design of the cephalomedullary nail, was developed by our team. The objective of this study was to assess the clinical and radiographic outcomes of PFBN in patients with unstable IFF. From October 2020 to August 2021, 12 patients diagnosed with unstable IFF (31-A2, 3) were treated with PFBN at the Third Hospital of Hebei Medical University. We evaluated the clinical therapeutic effects of this treatment by measuring peri-operative indicators and post-operative complications. Clinical outcomes, specific radiographic parameters, and post-operative complications were collected and analyzed within the first post-operative year. The average age of the patients was 72.4 ± 16.1years (five males and seven females). The mean operation time was 90.4 ± 16.0min, whereas the operation time of 31-A2 fractures (83.1 ± 12.2min) was shorter than that of 31-A3 fractures (105.0 ± 12.9min) (p < 0.05). The blood loss was 175ml (range: 50 to 500ml), and the length of hospitalization was 10.0 ± 1.9days. The prognosis evaluation was assessed at three, six and 12months after the operation; for these time points, the Harris hip scores were 69.6 ± 4.1, 77.8 ± 3.8, and 82.6 ± 4.6, respectively, and the Parker-Palmer scores were 5.3 (5.0, 7.0), 6.3 (5.3, 7.0), and 7.8 (7.0, 8.0), respectively. PFBN has shown advantages in the treatment of unstable IFF (particularly in geriatric patients) and possesses both stability and safety. This innovative method may provide a new option for treating unstable IFFs.

Dynamic Hip Screw Augmented by Trochanteric Stabilizing Plate versus Proximal Femoral Nail in Fixing Unstable intertrochanteric Femoral Fracture

Dynamic Hip Screw Augmented by Trochanteric Stabilizing Plate versus Proximal Femoral Nail in Fixing Unstable intertrochanteric Femoral Fracture

Long PFNA-II versus dynamic hip screw for treatment of unstable intertrochanteric femur fracture: A prospective comparative study

Long PFNA-II versus dynamic hip screw for treatment of unstable intertrochanteric femur fracture: A prospective comparative study

Prospective study of management of unstable intertrochantric femur fractures in elderly: hemiarthroplasty vs. osteosynthesis by proximal femoral nail

&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;A prospective study was done to compare the outcomes of management of unstable intertrochantric femur fractures in elderly by hemiarthroplasty and osteosynthesis by proximal femoral nail.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This was an interventional prospective study.&lt;strong&gt; &lt;/strong&gt;The study was carried out over 3 years from 2019 to 2022 at PCMC’s PGI YCMH, Pimpri, Pune, Maharashtra, India&lt;strong&gt;. &lt;/strong&gt;The study was carried out over 3 years from 2019 to 2022;50 Patients were randomly divided into two groups; Group A (unstable intertrochanteric femur fracture patients treated by bipolar hemi-arthroplasty) and Group B (unstable intertrochanteric femur fracture patients treated by proximal femoral nailing) with 25 patients in each group. Outcomes were evaluated based on functional outcomes, mean surgical time, mean blood loss during surgery, post-operative length of stay, post-operative complications. Harris hip Score was used to assess clinical functional outcomes.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The PFN group showed a better Harris Hip score at 1, 3, and 6 months follow ups.&lt;strong&gt; &lt;/strong&gt;Mean surgical time was more in bipolar hemiarthroplasty group. Mean blood loss during surgery was more in bipolar hemiarthroplasty group. Post-operative length of stay was more in bipolar hemiarthroplasty group. Post-operative complications like infections, limb length discrepencies were more in bipolar hemiarthroplasty group, whereas 2 implant failures occurred in PFN group compared to a single one in bipolar hemiarthroplasty group.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Both PFN and bipolar-hemiarthroplasty appear to produce satisfactory outcomes in surgically treated unstable IT fractures, bipolar-hemiarthroplasty has the advantages of early mobilization and early weight bearing, no risk of non-union but PFN group is superior when it comes to functional outcomes, mean surgical time, Mean blood loss during surgery, post-operative length of stay, post-operative complications.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;

Prospective Comparative Study Between Proximal Femoral Nail vs. Screw Augmented Proximal Femoral Nail in Unstable Intertrochanteric Fractures of Femur.

Introduction The proximal femoral nail (PFN) is a widely accepted fixation method for the management of unstable intertrochanteric fractures. Reconstructing the lateral trochanteric wall and ensuring the stability of the trochanteric fragments are considered to be essential for enhancing the prognosis of unstable intertrochanteric fractures. The aim of this study is to evaluate and compare the results of the management of unstable intertrochanteric fracture of the femur using PFN and the screw-augmented PFN (aPFN). Methods This prospectivecomparative study was undertaken from January 2020 to July 2021 and included 60 patients presenting with unstable intertrochanteric fractures (AO/OTA type 31-A2.2 and 31-A2.3) at a tertiary care teaching institute in northern India. The enrolled patients were randomly divided into two groups(group 1 and group 2)andwere managed with screw-augmented PFN and PFN, respectively. Functional outcome was evaluated using the Salvati and Wilson score at the 12-month follow-up. SPSS version 24.0 (IBM Corp., Armonk, NY, USA) was used for statistical analysis. A p-value less than 0.05 was regarded as significant. Results The average time to union of the fractures in group 1 was 12.66 ± 1.68 weeks, while it was 13.47 ± 1.47 weeks in group 2 (p = 0.055). At the 12-month follow-up, the average functional outcome, as evaluated by Salvati and Wilson score,was 34 ± 2.40 in group 1, whereas it was 31.58 ± 4.4 in group 2; and the difference was observed to bestatistically significant (p = 0.011). Group 1 had 28 patients (93.33%) with excellent to good results, while group 2 had 25 patients (83.33%) with excellent to good results. One patient in group 1 and five patients in group 2 had poor outcomes at the 12-month follow-up. Conclusion Screw-augmented PFN has better functional outcomes as compared to PFN alone for the management of unstable intertrochanteric fractures. Hence, in our opinion, screw augmentation of PFN may be the better fixation technique for most unstable intertrochanteric femur fractures.

Comparison of the dynamic HIP screw to PFN (proximal femoral nail) for unstable peri trochanteric femur fracture

Introduction: One of the most common fractures in the elderly is inter-trochanteric fractures where surgical management allows better functional and rehabilitation outcomes making it a treatment of choice. Aim: To compare radiological, functional, and clinical outcomes following treatment of unstable intertrochanteric femur fractures using dynamic hip screw (DHS) or proximal femur nail (PFN). Methods: The study assessed 120 subjects with unstable intertrochanteric femur fractures where 60 were treated with DHS and the other 60 with PFN. For assessment of the outcomes, Harris hip scores were used. Results: Most surgeries were done in 56-70 minutes in 30% (n=18) subjects and 37% (n=22) subjects in DHS and PFN group respectively which was statistically non-significant with p=0.86. Most common complication was lateral cortex shattering in 16.6% (n=10) study subjects followed by ill-fitting jig in 13.3% (n=8) study subjects and distal locking difficulty in 10% (n=6) study subjects respectively. Mean Harris hip score was higher in PFN group (83.5±2.38) compared to DHS group (82.1±2.32).