Unstable Intertrochanteric Femur Fractures Research Articles

Morphological variations in proximal femoral nails in Indian scenario and its clinical application

Background: There is an increasing trend of use of cephalomedullary nail for the management of both stable and unstable intertrochanteric and subtrochanteric femoral fractures. Various western and Indian proximal femoral nails with different morphologies are available in Indian market that sometimes creates confusion amongst orthopedic surgeons about which nail to be preferred in different clinical scenarios for accurate outcomes. Material and Methods: Ten different types of long femoral nails with 10 mm diameter (5 Western and 5 Indian) available in Indian market were taken and the morphology of these were studied and compared for 9 parameters. Results: A lot of variation was seen amongst the Indian nails and western nails in proximal diameter, shape of proximal part of nail, distance of lag screw from tip, distance at which actual size of nail becomes 10mm, M-L angle (medio lateral angle), shape of nail shaft, configuration of distal screws, morphology of neck screw and centrum-collum –diaphyseal (CCD) angle. Conclusion: Design of a nail may prove to be superior in some type of patients and fractures but may not be suitable for others. Pre-operative templating is must and surgeons need to consider all the factors in unison while deciding the type of nail to be used. Keywords: Intertrochantric fractures, Proximal femoral nail.

A clinical study of functional outcome of unstable intertrochanteric fractures treated with proximal femur nail anti rotation system II

Introduction: Unstable, Comminuted intertrochanteric fractures continue to pose a challenge to the orthopaedic surgeon because of severe osteoporosis and medical disorders that increase the risks associated with surgery and anaesthesia. To overcome problems like lateral wall impingement and prominence of the proximal end of the nail, the PFNA-II was introduced in 2008. The PFNA II design modifications include the flat lateral shape of the proximal portion and a decrease in the mediolateral bending angle from 60 to 50. The purpose of the study is to confirm that the PFNA II eliminates the problem of lateral wall impingement experienced with previous intramedullary nailing systems and provides stable fracture fixation with positive functional outcome.Materials and methods: This study was conducted on 52 patient of which 32 were available till follow up of 6 months. All patients we were diagnosed with unstable intertrochanteric fracture of femur and underwent closed reduction internal fixation with proximal femoral nail anti-rotation system II. Functional outcome was assessed with Modified Haris Hip Score and radiological outcome was assessed with TAD score and implant related complications. Results: Fracture union was appreciated on an average 4 months of postoperative period. 4 patient had superficial infection while 1 patient had deep infection. Only 1 patient had cut off of helical blade. According to modified Harris hip score, excellent to good outcome was noted in more than 80% of patient. Conclusion: From our study, we conclude that PFNA II can be a reliable and implant of choice for the management of unstable intertrochanteric fracture with high rates of union, restoring the anatomical alignment with less chances of implant failure and reduced chance of implant failure.

Intramedullary nails in combination with reconstruction plate in the treatment of unstable intertrochanteric femoral fractures with lateral wall damage.

The unstable intertrochanteric femur fracture remains a challenge for surgeons. However, few studies have compared the clinical effectiveness of intramedullary nail in combination with a reconstruction plate and intramedullary nail alone in the treatment of patients with unstable intertrochanteric femoral fractures with lateral wall damage. This study retrospectively analyzed 16 patients with 31 A3 intertrochanteric fractures treated with the intramedullary nail in combination with reconstruction plate (the study group) and 19 patients with 31 A3 intertrochanteric fractures treated with intramedullary nail alone (the control group) between January 2012 and January 2018. The operation time, intra-operative blood loss, time of fracture healing, and complication rates of post-operative fixation failure were assessed between the two groups. At the follow-up of post-operative six and 12 months, Harris hip score (HHS) and the Parker-Palmer mobility score (PPMS) were used to evaluate the functional states and mobility levels. The distribution of all basic characteristics was similar between the two groups (P ˃ 0.05). The study group had longer operation time and more intra-operative blood loss in comparison with the control group (P < 0.001), while the study group had shorter fracture healing time (P = 0.03) and lower fixation failure rate as compared with the control group. Regarding the functional outcome, the study group had higher HHSs and PPMS than the control group (P = 0.003). Although intramedullary nails in combination with reconstruction plates had longer operation time and more intra-operative blood loss, it might be superior to intramedullary nail alone in terms of fracture healing time, fixation failure complication rate, and post-operative functional recovery.

Comparison of Cementless Calcar-Replacement Hemiarthroplasty With Proximal Femoral Nail for the Treatment of Unstable Intertrochanteric Fractures at Older Age Group.

Background: The aim of this study was to compare the outcomes of unstable intertrochanteric femur fractures treated with cementless calcar-replacement bipolar hemiarthroplasty (CRH) and proximal femoral nail (PFN) in elderly patients.Methods: All consecutive unstable intertrochanteric fractures treated with cementless CRH or PFN at our institution between January 2015 and January 2019 were reviewed retrospectively. The primary outcome measures were postoperative complications, reoperation rate, and hip function. The secondary outcome measures were intraoperative blood loss, transfusion rate, surgical time, hospital stay, and two- year mortality.Results: Ninety-four patients in the hemiarthroplasty group and 77 patients in the PFN group were included for analysis. There were no significant differences between the two groups regarding the complications, ASA score, and reoperation rate. Significant differences were found between hemiarthroplasty and PFN group in comparison of the average length of hospital stay (P < 0.05), time from hospitalization to operation (P < 0.05), intraoperative blood loss (P < 0.001), transfusion rate (P < 0.001), operation time (P < 0.001), Harris Hip Score (HHS; P < 0.001), and two-year mortality (P < 0.05).Conclusion: Both hemiarthroplasty and PFN produce satisfactory results in surgically treated unstable intertrochanteric femur fractures in the elderly. Both groups are associated with their own complications, but in the PFN group, better functional results, less surgery-related trauma, and lower mortality rates are the main advantages.

Evaluation of Dynamic Hip Screw with Trochanteric Stabilization Plate in management of Unstable Inter-Trochanteric Fractures

The goal of this study is to gauge the radiological results and therefore the functional outcomes consistent with Parker mobility score of the patients after using of Dynamic hip screw with trochanteric stabilizing plate in fixation of unstable trochanteric fractures and assess the complication. Twenty patients (ages ranged from 51 to 70 with an average age of 64.20 ± 6.338 years, 12 of them (60%) were females and 8 (40%) were males) with unstable trochanteric fracture were treated with Dynamic Hip Screw with Trochanteric Stabilization Plate between first of September 2019 to end of March 2020 at Beni-Suef University Hospital. Most of the operations were done in the first week 16 (80%) and only 4 (20%) patients had intraoperative complication and the same percent had post-operative complications. Parkers score was higher in non-diabetic patients p value (p value 0.041).The ASIA score was higher in patients with good bone quality and without intraoperative complication and this difference was statistically significant significantly (p-value, 0.011). DHS with TSP fixation of unstable intertrochanteric fractures of femur is an effective technique and has excellent functional and radiological outcomes with minimal complications and early rehabilitations rates.

The Outcome of Coxofemoral Bypass Using Cemented Bipolar Hemiarthroplasty in the Treatment of Unstable Intertrochanteric Fracture of Femur in a Rural Setup

The Outcome of Coxofemoral Bypass Using Cemented Bipolar Hemiarthroplasty in the Treatment of Unstable Intertrochanteric Fracture of Femur in a Rural Setup

Functional outcome of hemiarthoplasty as a treatment option for trochanteric fractures

Objectives: Management of unstable intertrochanteric fractures in elderly patients is challenging due to osteoporosis. Comminuted unstable intertrochanteric fractures require early postoperative immobilization. Most of the recent reports have recommended Hemiarthroplasty for treatment of unstable intertrochanteric fractures to avoid various immobilization-associated complications like bed sore, pneumonia, urinary infection. The purpose of this study was to evaluate the functional and clinical outcomes of bipolar hemiarthroplasty for intertrochanteric fractures. Methods: Fifteen patients aged over 60 years underwent hemiarthroplasty to treat unstable intertrochanteric fractures and were followed up over 12 months. All surgeries were performed by the same surgical team using the Hardinge (lateral) approach. Wires, cables, and plates were used as required. Use of cemented protheses was considered when the lesser trochanter had been displaced. All patients were allowed full weight-bearing as tolerated as soon as possible. Clinical evaluation was based on Harris Hip Scores. Results: In our study, there were 6 male and 9 female patients with mean age of 70.26 years. 86.67% of the cases admitted were due to trivial trauma, 13.33% due to RTA with right side being more common side affected. In all patient partial weight bearing was started within 5 days. Good to excellent results were seen in 92.85% cases & Fair results were seen in 7.15% of cases in our study according to Harris Hip Score.Conclusions: Primary bipolar hemiarthroplasty for treating unstable intertrochanteric fractures provide a stable, pain free and mobile joint. It also eliminates the need for prolonged immobilization and permits early ambulation. As reported by others, hip hemiarthroplasty is an effective treatment choice for unstable intertrochanteric femoral fracture in older patients.

Functional outcome of proximal femoral nailing (PFN) versus dimon hughston osteotomy with dynamic hip screw (DHS) fixation in unstable intertrochanteric femur fractures

Intertrochanteric fracture is one of the most common fractures of the hip especially in the elderly with osteoporotic bones, usually due to low energy trauma like simple falls. The goal of the treatment of these fractures is stable fixation, which allows early mobilization of the patient. This study was conducted to compare the functional and radiological outcome of proximal femoral nailing and Dimon Hughston Osteotomy with Dynamic Hip Screw (DHS) fixation in treatment of unstable intertrochanteric femur fractures amongst 60 patients, with 30 patients in each group. In our study we found that patients treated with DHS group showed better results in comparing PFN in terms of early weight bearing, functional outcome, early radiological union but had its own complications. Both are effective in the treatment of unstable intertrochanteric fractures, it is the fracture geometry and bone quality which will influence the choice of fixation.

Twin interlocking cephalomedullary nail vs PFN for unstable intertrochanteric fractures: Short term outcome, an Indian perspective

Objective: The main objective of the study was to compare proximal femoral nail and Twin interlocking cephalomedullary nail in terms of short-term functional and radiological outcome. Methods: 30 patients with unstable intertrochanteric femur fractures operated by a single surgeon were included in the study. 15 in the PFN group and 15 in the Twin interlocking cephalomedullary nail group. Modified Harris Hip score was used to assess the functional outcome. Results: The time to union and the functional outcome was comparable in both the groups and desired linear compression of up to 10mm at the fracture site could be achieved in the twin interlocking cephalomedullary nail group.Conclusion: Twin interlocking Cephalomedullary nail is a very good alternative to PFN in treatment of Unstable Intertrochanteric fractures of the Femur.

Biomechanical Comparison of INTERTAN Nail and Gamma3 Nail for Intertrochanteric Fractures

ObjectiveTo compare the biomechanical stabilities of Gamma3 nail and INTERTAN nail (ITN) for stable (AO/OTA 31A1.1) and unstable (AO/OTA 31A2.2) femoral intertrochanteric fracture.MethodsTwenty‐four synthetic femora were randomly divided into four groups. After internal fixation (Gamma3 nail or ITN) had been implanted, stable and unstable intertrochanteric fracture models were produced. A cyclic testing protocol with increasing loads was performed for both stable and unstable intertrochanteric fracture models, and then torsional test and axial compression failure test were conducted. Stiffness, failure load, torque, and fragment displacement were recorded.ResultsFor stable fracture model: fragment displacement in ITN group were smaller than Gamma3 nail group (Gamma3 nail: 1.66 ± 0.13 mm; ITN: 1.55 ± 0.1 mm); stiffness (Gamma3 nail: 1142.6 ± 161.1 N/mm, ITN: 1159.3 ± 203.5 N/mm, P = 0.872) and failure load (Gamma3 nail: 5715.42 ± 616.34 N, ITN: 5690.27 ± 625.59 N, P = 0. 951) of the two nails were similar after cyclic test; torque of the ITN group was larger than the Gamma3 nail group. For unstable fracture model: fragment displacement in ITN group was significantly smaller than in the Gamma3 nail group when the axial load was larger than 800 N (Gamma3 nail: 3.59 ± 0.19 mm; ITN: 2.93 ± 0.28 mm); ITN group showed a significantly higher failure load than Gamma3 nail group (Gamma3 nail: 2942.77 ± 573.4 N, ITN: 3672.3 ± 790.5 N, P = 0. 011); torque was significantly higher for the ITN group compared to the Gamma3 nail group for three different angles.ConclusionsBoth ITN and Gamma3 nail can maintain sufficient biomechanical stability for stable intertrochanteric fractures, but ITN was a better choice for unstable intertrochanteric fractures.

Functional outcome of proximal femoral nailing for unstable intertrochanteric fracture in elderly

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; This study is intended to analyse the functional outcome of proximal femoral nailing (PFN) for unstable intertrochanteric fractures in elderly.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The data was collected from the 35 patients with unstable intertrochanteric femur fracture who were subjected to PFN from 2015 to 2018. All patients were followed up at 3 months and 6 months after the operation to check the functional outcome based on harris hip score (HHS) and complication if any.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Result:&lt;/strong&gt; In 35 patients, 1 patient was lost to follow-up and 34 patients were followed-up at 3 months and 6 months. All patient’s union was achieved at 3 and 6 months follow up. The cause of fractures was trivial fall in all 35 patients. No incidence of non-union and delayed union was reported. Functional outcome was rated as per HHS, we got excellent results in 20 cases, good in 10, fair in 03 and poor in one patient at end of 6 months.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; PFN provides stable fixation and early post-operative mobilization with fracture union especially complex proximal femoral fractures which includes unstable, communited, reverse oblique fractures and fractures in osteoporotic bones. PFN has shown excellent results in our study.&lt;/p&gt;

Comparative analysis between dynamic hip screw with trochanteric stabilisation plate and dynamic hip screw alone in the management of unstable intertrochanteric femur fractures

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Intertrochanteric fractures of the femur are difficult to manage because of the complex patterns they present with. A dynamic hip screw (DHS) and a DHS supplemented with a trochanteric stabilisation plate (TSP) are among a variety of fixation methods used in the management of such injuries. We compared the efficacy of DHS with TSP to DHS alone in the treatment of unstable intertrochanteric femur fractures.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 30 patients of intertrochanteric femur fractures (mean age 72 years) were included in the study, 14 were treated using DHS with TSP while 16 were treated using DHS alone, they were followed up till 16 weeks and the progress was recorded according to the parameters in the Salvati and Wilson score.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; 14 patients were treated using DHS with TSP, 11 of them had excellent Salvati and Wilson scores, 3 patients recorded good scores, 11 patients were able to walk with no pain while 3 needed aids for walking due to pain, normal function was restored in 12 patients while very little restriction was seen in 2 patients&lt;/p&gt;&lt;p class="abstract"&gt;Of the16 patients treated using DHS alone, 10 had excellent scores, 6 recorded a good score, 10 patients walked with no pain while 6 needed aids for walking due to pain, normal function was re-stored in 11 patients, very little restriction was seen in 4 patients while 1 patient had restricted nor-mal activity.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; DHS with TSP appears to provide better fixation and functional outcome in unstable inter trochanteric fractures over DHS alone.&lt;/p&gt;

Comparison of long-stemmed cementless hemiarthroplasty with proximal femur nail in unstable intertrochanteric femur fractures over 85 years of age

Aim: The most appropriate treatment option for intertrochanteric femoral fractures is still controversial. While there are articles showing that proximal femoral nails are superior to partial prostheses, other studies claim that partial prostheses result in better patient outcomes. We aimed to compare long-stemmed cementless hemiarthroplasty (LFS-BPH) and proximal femur nail (PFN), which are the treatment options applied in unstable intertrochanteric hip fractures in patients over 85 years of age. Methods: The records of 64 patients with unstable intertrochanteric femur fractures who were operated between May 2016 and December 2018 in the Orthopedics and Traumatology Clinic of Maltepe University Medical Faculty Hospital were evaluated. A retrospective cohort study was conducted and 42 patients who met the inclusion criteria were included in the study. The patients were divided into 2 groups as the proximal nail group and the prosthesis group, and evaluated in terms of total hospitalization time, operation time, amount of blood transfusion, time until the patient walked independently, postoperative complications, and Harris hip scores. Results: There were statistically significant differences in favor of the PP group in terms of total length of stay, fully independent mobilization time, deep vein thrombosis and decubitus development in the postoperative period. There was no difference between LFS-BPH and PFN in terms of total hospitalization time, blood transfusion amount, and Harris hip scores in unstable intertrochanteric hip fractures occurring above 85 years of age. Conclusion: LFS-BPH was superior to PFN in terms of operation time, early independent mobilization, reduction of deep vein thrombosis and decubitus development rate in the postoperative period.

Efficacy of proximal femoral nail augmentation in unstable intertrochanteric fracture

&lt;p class="abstract"&gt;&lt;strong&gt;&lt;span lang="EN-US"&gt;Background: &lt;/span&gt;&lt;/strong&gt;&lt;span lang="EN-US"&gt;To assess the short term functional and radiological outcome of unstable intertrochanteric fracture fixation using proximal femoral nail with augmentation using Cannulated Cancellous (CC) screw or Stainless Steel (SS) wiring.&lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;&lt;span lang="EN-US"&gt;Methods: &lt;/span&gt;&lt;/strong&gt;&lt;span lang="EN-US"&gt;A prospective study was conducted with 20 cases of unstable intertrochanteric femoral fractures from May 2017 to March 2019. Six females and fourteen male patients in the age group between 40 and 80 years were included in this study. There were 8 cases of AO31A2 and 12 cases of AO31 A3. Fracture were fixed by proximal femoral nail with augmentation by an additional CC screw or encirclage with SS wires to strengthen the lateral trochanteric wall.&lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;&lt;span lang="EN-US"&gt;Results: &lt;/span&gt;&lt;/strong&gt;&lt;span lang="EN-US"&gt;Fracture union was achieved in all cases with a mean period of 15.4 weeks. Patients were followed up for a period of 6 months. At the end of follow up the Modified Harris Hip Score was found to be more than 90 % in 16 cases.&lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;&lt;span lang="EN-US"&gt;Conclusion:&lt;/span&gt;&lt;/strong&gt;&lt;span lang="EN-US"&gt; Augmentation of proximal femoral nail in unstable intertrochanteric fracture with additional screw or cerclage wire increases the efficacy and stability of construct, aiding union and expedition of time to union.&lt;/span&gt;&lt;/p&gt;

Study of comminuted unstable intertrochanteric fractures of femur managed with proximal femoral locking plate

Aim & Objective: The main aim of the present study to investigate the comminuted unstable intertrochanteric fractures of femur managed with proximal femoral locking plate.Methodology: The present study was conducted at NRI Medical College & General Hospital, Chinnakakani, Guntur, Andhra Pradesh. During the period of April 2018 to March 2020. All the patients were selected into the study based on inclusion and exclusion criteria. The type of surgery was internal fixation of comminuted unstable intertrochanteric fractures with proximal femoral locking plate. All patients were followed up at 6weeks, 12 weeks, 6, 9, and 12 months.Results: Out of 30 patients, 20 were males and10 were females. Both anatomical and functional outcomes were assessed in these patients. Out comes were assessed with Harris hip score. The results were good to excellent in 80.01% of the cases. The majority of injured patients were males (66.66%). The average follow up period was 10 months. 60% of patients do not have any pain during follow-up. 28 of 30 fractures united within a period of 14 months. The average time of union was 14.5 weeks. Four patients had delayed union for whom delayed weight bearing was advised. 95% of fractures united within 16 weeks. The functional outcome was more that 90%.Conclusion: Proximal femoral Locking Compression Plate provides the surgeon with flexibility to achieve angular stability or axial compression with the plate to bone apposition.

Primary Long Distal Fitting Bipolar Hemiarthroplasty for Unstable Intertrochanteric Fracture in Elderly Patients

Background: Intertrochanteric fracture in elderly patients is a frequent problem and is becoming more prominent as the proportion of this injury increases. The ideal treatment for an unstable intertrochanteric femoral fracture in senile osteoporotic patients remains controversial. Methods: Seventy-five patients (over 70 years of age) with unstable intertrochanteric fractures were randomized into three groups and treated with three different procedures including long-stem bipolar hemiarthroplasty, proximal femoral nail (PFN), and dynamic hip screw (DHS). Estimated blood loss, duration of the operation, time of full weight-bearing, and Harris Hip Score (HHS) were determined for each patient. Results: Surgical time was longer in hemiarthroplasty group, but the HHS and time from surgery to mobilization in these patients were significantly superior to the two other groups. PFN group had the lowest bleeding volume during surgery. Revision surgery was lower in hemiarthroplasty compared to the internal fixation, although it was not statistically significant. Conclusions: In elderly patients with an unstable intertrochanteric femoral fracture who cannot tolerate long immobilization time, primary long distal fitting bipolar hemiarthroplasty is a valid treatment option for faster mobilization, good clinical efficacy, and satisfactory functional outcome.

Comparison of reamed long and short intramedullary nail constructs in unstable intertrochanteric femur fractures: A biomechanical study.

Objectives:There is no definitive evidence to guide clinicians in their decision-making for implant choice regarding long or short intramedullary nails for unstable fracture patterns. Historically short nails were associated with higher rates of perisprothetic fractures which seem to have improved with newer designs. Long intramedullary nails have higher blood loss and time under anesthesia. The purpose of this study was to assess stability of long and short intramedullary nail constructs in unstable intertrochanteric fracture patterns to better elucidate if unstable intertrochanteric fractures are amenable to treatment with short intramedullary nails.Methods:This study utilized composite model femurs which were assigned to either a comminuted or reverse obliquity fracture pattern, then subsequently assigned to implantation with either a long or short intramedullary nail. All the samples were reamed to the level of the distal femur and instrumented with the appropriate nail. Axial and torsional stiffness as well as axial load to failure values were determined using a servohydraulic loading system.Results:Short nail constructs exhibited significantly greater axial stiffness in A1 fractures and torsional stiffness in A3 fractures when compared with long nails. There was no significant difference between axial load to failure between long nails and short nails.Discussion:We found no significant difference in axial load to failure values between long and short intramedullary nail fixation in 2 unstable intertrochanteric fracture patterns in a composite femur model. Short nails exhibited greater stiffness in axial loads in the A1 pattern and torsional stiffness in the A3 pattern. This suggests short or long intramedullary nails could be appropriately employed for fixation of unstable intertrochanteric hip fracture patterns.

A RETROSPECTIVE STUDY COMPARING PROXIMAL FEMORAL NAIL ANTI-ROTATION WITH CEMENTLESS BIPOLAR HEMIARTHROPLASTY FOR UNSTABLE FEMORAL INTERTROCHANTERIC FRACTURE

Background: Intertrochanteric femoral fractures are one of the most common types of bone fractures that are usually caused by severe direct or indirect force. It has also been estimated that nearly 50% of all the fractures are intertrochanteric fractures and the remaining are unstable fractures. Also, it has been found that the mortality related to hip fractures is as high as 15-20%. With an increase in the life expectancy of people, there has been a substantial increase in the number of patients with postmenopausal or senile osteoporosis.&#x0D; Aim: To compare Proximal femoral nail anti-rotation with cementless bipolar hemiarthroplasty for unstable femoral intertrochanteric fracture&#x0D; Methods: It was a retrospective study carried out at the Government Medical College, Baramati for a period of 1 year. One hundred patients were included for the scope of the study. Out of which 50 patients belonged to the PFNA group, and 50 patients belonged to the CPH group.&#x0D; Results: The number of patients in the PFNA group was 50 and that in the CPH group was 50. Both groups show male preponderance. The mean age among both the groups was almost the same, and there was no statistically significant difference among the two groups regarding the mean age. The mean operation time for PFNA was 54.15±16.1 mins, and that of the CPH group was 76.69±15.89 mins. The mean bleeding time for PFNA was 133.12±33.16 ml, and that of the CPH group was 289.25±44.01 ml. There was no statistically significant difference among the ASAA grade scores of the two groups. There was no statistically significant difference among the Evans-Jensen classification of the two groups. The mean length of hospital stay for PFNA group was 7.89±2.0 days, and the mean hospital stay for CPH group was 6.54±1.9 days.&#x0D; Conclusion: The current study depicted that CPH and PFNA are both safe and effective methods of treating elderly patients suffering from intertrochanteric fractures. However, it was found in the current study that CPH was found to have more mean operative time and increased blood loss. Still, the recovery and hospitalization time was almost similar in both the groups. Both the groups had almost similar ASA and Evans Jensen scores that made both the techniques equally safe

Analysis of Implant Related Complications following Proximal Femoral Nail Anirotation (PFNA) fixation in Unstable Intertrochanteric fractures - early follow up

INTRODUCTION; Intertrochanteric fractures present in a wide variety of patterns that range from simple to complex and may be minimally displaced or widely displaced. Unstable intertrochanteric fracture can fail due to mechanical problems, including loss of fixation, re-fracture, or implant failure. PURPOSE; The aim of this study was to analyse the failures in patients with unstable intertrochanteric femur fractures treated with short Proximal Femoral Nail Antirotation (Synthes) METHODS; A retrospective analysis of 97 patients with unstable intertrochanteric factures (AO : 31A2, n = 65 / 67.01 % ; 31-A3: n = 32 /32.9 %) treated with a PFNA in a self-contained district general hospital was conducted. RESULTS; The study included 25 (26%) males and 72 (74%) females with mean age of 82 years. The study period was over 12 months with mean follow up of 11 months (range 6 to 18 months). Intraoperative and postoperative radiographs showed good reduction in 80 patients, acceptable in 12 and poor in 3. Twenty patients had implant related complications, consequently ten patients (10.5 %) had to undergo revision surgery. The reasons of revision surgery were; Implant failures = 8 (8.4%), Helical Blade backing out =1( 1.05 %) and Greater trochanter splintering =1 (1.05%). CONCLUSION ; Implant related complications requiring revision occurred in 10 patients (10.5 %) in early follow up. Of those requiring revision 6 patients had highly unstable 31 A2.3 type fracture. Our study reinforces high failures in unstable intertrochantric fractures. Though Ideal implant remains elusive but Optimum intraoperative reduction and use of augments should be considered to improve outcomes.

Medium-term efficacy of bio-lengthened stem arthroplasty in the treatment of unstable intertrochanteric femoral fractures in elderly patients

To explore the clinical effect of bio lengthened stem arthroplasty replacement in the treatment of unstable intertrochanteric fractures in the elderly. From January 2015 to January 2018, 64 elderly patients with unstable intertrochanteric fractures were analyzed retrospectively. According to the surgical treatment, patients were divided into arthroplasty replacement group (bio-lengthened stem arthroplasty replacement) and internal fixation group (PFNA). In the arthroplasty group, there were 34 cases, including 19 males and 15 females, with an average age of (81.32±3.81) years old. The Evans classification of fracture was type Ⅲ in 15 cases, type Ⅳ in 16 cases and type Ⅴ in 3 cases. In the internal fixation group, there were 30 cases, including 14 males and 16 females, with an average age of (79.90±3.61) years old. The Evans classification of fracture was type Ⅲ in 10 cases, type Ⅳ in 15 cases and type V in 5 cases. X ray and CT showed unstable intertrochanteric fracture of femur. The operation time, intraoperative blood loss and complications were observed. Harris hip function score and SF-36 life quality score were used to evaluate the clinical effect. All the incisions healed in stage Ⅰ. All patients were followed up for 13 to 39 months with an average of 23.4 months. The operation time and bleeding volume of the patients in the arthroplasty replacement group were more than those in the internal fixation group (P<0.05). At the final follow-up, Harris function score of hip joint in the arthroplasty group was better than that in the internal fixation group (P< 0.05);SF-36 life quality score in the arthroplasty group was better than that in the internal fixation group (P<0.05). The treatmentof unstable intertrochanteric fractures with bio-lengthened stem arthroplasty replacement and internal fixation can achieve good clinical results, but with bio-lengthened stem arthroplasty replacement, the postoperative complications are less, the function of hip joint is better, and the life quality and satisfaction of patients are higher.