Unstable Intertrochanteric Femur Fractures Research Articles

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

Background: Intertrochanteric femur fractures are one amongst the most common hip fracture presenting to our centre. Clinical efficacy and safety of PFNA and DHS in the treatment of unstable intertrochanteric fractures in elderly patients and found that compared with the control group (DHS), the observation group (PFNA) experienced shorter operation time and fracture healing time and less intraoperative blood loss, and suffered a shorter incision. The purpose of this study was to compare the functional outcomes and related complications between DHS and PFNA in treatment of unstable intertrochanteric femur fracture. Methodology: Total of 60 patients having unstable intertrochanteric femur fracture were included in this study and was equally divided into two groups. Group-P included patients with unstable intertrochanteric femur fracture managed by PFN-A II while Group-D patients managed by DHS. The result was analysed using descriptive statistics and making comparisons among various groups. Categorial data were summarized as in proportions and percentage (%) while discrete as mean ± SD. Results: At final follow-up; it was found that 72.4% of the cases of PFNA have achieved excellent union as compared to 44.4% for DHS group, 24.1% cases of PFNA have good union as compared to 51.9% in DHS group and the difference of mean DHS was significantly higher for PFNA group (p=0.001). Conclusion: PFNA-II have benefits like minimally invasive procedure, less soft tissue dissection, less amount of blood loss and provides better result in terms of union. Therefore PFNA-II is recommended as a better choice as compared to DHS in management of unstable intertrochanteric fractures in terms of functional outcome.

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).

FUNCTIONAL OUTCOMES OF BIPOLAR HEMIARTHROPLASTY IN UNSTABLE INTERTROCHANTERIC FRACTURES IN ELDERLY PATIENTS

Background: Intertrochanteric fractures account for about 45% to 50% of all hip joint fractures in elderly patients. Conservative treatment carries the disadvantages of non-union and malunion, which in turn will increase the morbidity and mortality. Currently hemiarthroplasty and internal xation are the two considerable surgical options for xation for hip fractures. The purpose of this study was primarily to study functional recovery in patients with unstable intertrochanteric fractures treated with bipolar hemiarthroplasty while studying other relevant intraoperative and postoperative parameters of patients in these groups. 16 patients underwent bipolar Methods: hemiarthroplasty for unstable intertrochanteric femur fracture. Patients were evaluated in post-operative period for mobilization and full weight bearing. Harris hip score was used for functional evaluation on follow up visit for a period of 12months In our study the mean age (years) was Results: 73.31 ± 7.79. Seven (43.8%) of the participants had AO Type: A2.2 fracture, four patients (25.0%) had AO Type: A2.3, two (12.5%) of the participants had AO Type: A3.1. and three of them (18.8%) had AO Type: A3.3 fracture. The mean (SD) of Surgical Time (Minutes) was 111.50. The mean (SD) of Blood Loss (ml) was 491.25. The mean (SD) of Full Weight Bearing Day was 3.81. During the nal follow-up Excellent to fair results were obtained in 13 (81.25 %) cases and in 3 (18.75%) cases, results were poor. Bipolar hemiarthroplasty is suitable for intertroc Conclusions: hanteric fractures in elderly patients who have mechanically weak and porotic bones. Bipolar hemiarthroplasty has fair functional outcomes in unstable intertrochanteric femur fractures.

The lesser trochanter “Sling fixation technique” in proximal intramedullary nailing of unstable intertrochanteric fractures: A polymer-based cerclage wiring

IntroductionLesser trochanter (LT) fixation to restore the continuity of the posteromedial fragment using a cerclage wire has been reported to provide a more stable reduction in the treatment of unstable femoral neck fractures with LT involvement. However, LT fixation is not commonly performed due to the complications associated with the traditional monofilament cerclage metal wires. In this study, we investigate the clinical and radiological outcomes of a new technique for LT fixation in conjunction with Intramedullary (IM) fixation with nail and screws when compared to isolated IM fixation. The Sling Fixation Technique involves a new wiring technique and the use of a polymer-based cerclage cable characterized by iso-elastic properties that is hypothesized to provide better clinical and radiographic outcomes. Patients and methodsThis prospective observational study included 30 patients who underwent proximal IM nailing from July 2019 to April 2020. Thirty consecutive patients (30) were assigned to 2 different treatment groups. Fifteen (15) patients were treated with the IM Nailing and Sling Fixation Technique and 15 with IM nailing only. Patients were comparable for demographic features, fracture pattern, age, gender and associated medical comorbidities. Clinical outcomes were analyzed in terms of time needed to achieve complete weight bearing, Harris hip score (HHS), Barthel Index (BI) and Radiographic Union Scale for Hip (RUSH). The follow-up period was one year. ResultsTime for fracture healing and to achieve weight-bearing in the “Sling” group were shown to be significantly shorter than in the IM group. The Sling group showed furthermore better HHS, BI and RUSH scores when compared to the IM group at 1, 3, 6, and 12 months from the surgery. No complications such as wiring breakage, cut-outs, breakage or pullout of the fixation screws were observed; one case of heterotrophic ossification was reported. ConclusionIn cases of unstable intertrochanteric fractures of the proximal femur with lesser trochanter involvement, the Sling fixation technique using an isoelastic polymer-based wire showed superior results in terms of stability and consequently better clinical and radiographic outcomes than IM nailing only.

Clinical, functional and radiological outcome of unstable intertrochanteric femur fracture treated with proximal femur nail

Objective: To determine the clinical, functional and radiological outcome of unstable intertrochanteric femur fractures treated with proximal femur nailMethods: The study is a prospective study on 20 patients to analyse clinical, functional and radiological outcome of unstable intertrochanteric femur fractures treated with proximal femur nail conducted in the Department of Orthopedics at Stanley medical college, Chennai from June 2018 to August 2020. Functional outcome was assessed using Harris hip score.Results: 20 patients of unstable intertrochanteric fracture were treated surgically with proximal femur nail and the results were functionally and radiologically analysed. Patients were followed up from 11months to 22 months and mean follow up in months was 15.9 ± 2.73. Mean Harris hip space at 3months was 73.85 ± 3.4, Mean Harris hip score at 6months was 85.15 ± 2.66. Radiological Fracture union was noted between 12-16 weeks and mean time for union was 12.90 ± 1.4 weeksConclusion: Intramedullary nailing with the PFN has distinct advantages over DHS like shorter operating time and lesser blood loss for unstable trochanteric fractures. Early mobilization and weight bearing is allowed in patients treated with PFN thereby decreasing the incidence of bedsores, uraemia and hypostatic pneumonia. The incidence of pre-operative and postoperative planning and correct technique, adequate reaming of femoral canal, insertion by hand and meticulous placement of distal locking screws. PFN is a significant advancement in the treatment of unstable trochanteric fractures which has the unique advantage of closed reduction, preservation of fracture haematoma, less tissue damage during surgery, early rehabilitation and early return to work.

Hemiarthroplasty through Direct Anterior Approach for Unstable Femoral Intertrochanteric Fractures in the Elderly: Analysis of Early Cases.

PurposeThe purpose of this study was to determine whether the direct anterior approach (DAA) can be applied to hemiarthroplasty for treatment of unstable femoral intertrochanteric fractures in elderly patients.Materials and MethodsWe conducted a retrospective review of 34 cases (34 patients) who underwent bipolar hemiarthroplasty using a DAA from February 2019 to April 2020. The mean age of the patients was 82.68 years (range, 67-95 years). A cementless distal fixation hip system was used in all cases. Operation time, total amount of blood loss, intraoperative and postoperative fractures, infections, and reoperations were measured. The patients performed weight-bearing walking as tolerated immediately after surgery. Measurement of migration of the greater trochanter (GT) and progressive subsidence of the femoral stem was performed using follow-up radiographs.ResultsThe mean operative time was 83.50 minutes (range, 60-120 minutes). The mean amount of bleeding was 263.53 mL (range, 112-464 mL). Walking started a mean of 3-03 days (range, 3-4 days) after surgery. There was no case of progressive migration of the GT more than 5 mm even though it was not fixed. There were no cases of infection, dislocation, or reoperation.ConclusionBipolar hemiarthroplasty using the DAA for treatment of unstable femoral intertrochanteric fractures could be considered a useful option that provides many advantages in elderly patients.

Intertrochanteric fracture PFN vs DHS

Background: DHS fixation has remained a well-established gold standard in intertrochanteric fractures of femur for a long time. 1 However, it has shortcomings and pitfalls. In inter-trochanteric fractures of femur, DHS fixation has shown higher failure rates. PFN is a new fixation device proposed for fixation of unstable intertrochanteric fractures. 1 Being intramedullary, it is a biomechanically advantageous device which should allow better fixation of unstable intertrochanteric translating into lesser failure rates of fixation and also permitting early mobilization and faster rehabilitation especially in elderly patients. We present a study comparing outcomes of managing unstable intertrochanteric fractures with PFN and DHS. Materials and Methods: We evaluated 30 (PFN: 15; DHS: 15) cases of intertrochanteric fractures of femur out of which 26 were unstable and 4 stable type, from January 2017 to December 2018, with minimum 12 months follow up period. Mean age was 60 years for both PFN and DHS group. We studied the surgical complications in both groups and also compared functional and radiographic results of both groups. Results: There was significantly more clinical shortening in DHS group than in PFN group (average 1- 1.9 cm versus 0.5-0.9 cm). There were 3 cases of superficial and 2 cases of deep infection in the DHS group while there was one case of infection in PFN group. There was no case of implant failure in the DHS group compared to one case in PFN group (due to screw breakage). Harris hip score at follow up was fair to excellent in PFN as compared to DHS. This difference was statistically significant. Discussion: DHS despite remaining a gold standard for fixation of intertrochanteric fractures of femur for a long time, it may not be suitable for certain fracture patterns and in older age groups with more medical co-morbidities and osteoporosis. PFN is a biomechanically sound device for fixation of comminuted intertrochanteric fractures of femur2 which has lesser surgical morbidity and should be especially beneficial in elderly, osteoporotic and medically compromised patients. Its load sharing capability provides a more stable fixation allowing early mobilization and rehabilitation.Conclusion: PFN is unequivocally a better choice of implant for fixation of unstable intertrochanteric fractures of femur, especially in osteoporotic and medically compromised patients as compared to DHS fixation device.

AO Reconstruction Plate as Buttressing for Greater Trochanter in Hemiarthroplasty Procedure

INTRODUCTIONThe trend of intertrochanter fractures has gradually increased leading to a high frequency of difficulties and damage as the result of the increased age and risk factors. Accordingly, the aim of stable fixation in these fractures is designed with appropriate surgical procedures and patient care. The contribution of a stable fixation is due to several considerations including fracture shape and assurance, bone quality, comminution pattern, implant choice, and surgical technique. This study aimed to assess the functional outcomes of the patients with an intertrochanteric fracture who underwent hemiarthroplasty with AO recon as buttressing.MATERIALS AND METHODSThis was a case series study conducted in Gadjah Mada University Academic Hospital in Yogyakarta from July 2017 to August 2018. Patients with Evans unstable intertrochanteric femoral fractures who underwent simultaneous bipolar hemiarthroplasty and fixation with AO reconstruction plate and SS wire as buttressing were evaluated. Pre and postoperative radiographs, postoperative Visual Analog Scale (VAS) score, walking ability using Harris Hip Score (HHS), and Lower Extremity Functional Score (LEFS) were the outcome parameters.RESULTSA total of 6 patients, 4 of whom were male with an average age of 81 years old were included in this study. All the mechanisms of injury were low-energy trauma. The mean VAS score was decreased, from 7 pre-operatively to 1.5 post-operatively at final follow-up (p-value 0.05). The patients had a mean HHS of 82.5 and a LEFS mean of 56.7.CONCLUSIONButtress plate fixation using an AO reconstruction plate for trochanteric fracture following bipolar hemiarthroplasty resulted in a good functional outcome.

Cementless Extensive Porous-Coated Mono-block Long Stem Hemiarthroplasty versus Proximal femoral Nail for Unstable Osteoporotic Intertrochanteric Fracture in the Elderly Patients: a retrospective study

Introduction: The treatment for unstable intertrochanteric fractures in the elderly patient has always been controversial. The aim of this study was to compare the outcome of porous coated cementless mono-block long stem hemiarthroplasty (CPH) and proximal femoral nail (PFN) on unstable intertrochanteric femoral fracture in the elderly patients. Methods: From March 2017 and March 2020, 132 elderly patients with unstable femoral intertrochanteric fractures were treated by CPH or PFN. 73 patients were treated using proximal femoral nail (PFN) and 59 were treated using hemiarthroplasty (CPH). Bleeding amount, weight training time, hospitalization time, Harris scores, one-year mortality, pre-existing disease and postoperative complications were analyzed. Results: The average follow-up time was 23.2 months in the CPH group and 22.9 months in the PFN group. No significant differences was found between the two groups in terms of demographic data. There was no significant differences between the two groups regarding the ASA score, pre-existing disease, postoperative complications, and revision surgery. The mean operation time and the average amount of blood loss were significantly higher in the CPH group (p&lt;0.05). Conclusion: Both PFN and CPH are two satisfactory methods for treating the elderly with unstable IT fractures but in the CPH group, early postoperative mobilization and decreased dependency are the primary advantages.

COMPARATIVE STUDY OF MANAGEMENT AND CLINICAL OUTCOME OF INTRAMEDULLARY VERSUS EXTRAMEDULLARY FIXATION FOR UNSTABLE INTERTROCHANTERIC FRACTURES

Introduction: Surgery is the common therapy for intertrochanteric fractures as this fracture takes a long time to heal on its own. Open reduction and internal xation (ORIF) is one of the surgical treatments for this fracture (4). Based on the location and type of the fracture different kinds of xation devices are used. However, the best repairing method for intertrochanteric fractures is still controversial. To Evaluate Aim And Objective: functional outcome and Compare the result of treatment with intramedullary (PFN) versus extramedullary (DHS and PFLCP) xation for unstable intertrochantric fracture. In this prospective study from March 2018 to October 2019, 40 conse Methodology: cutive patients with unstable intertrochanteric femoral fractures having an unstable pattern, of either sex were randomized by computer generated tables to undergo xation with either Intramedullary and extramedullary xation.A detailed history and clinical examination was done in a systemic manner and noted on a specially designed proforma. Plain radiographs were obtained on admission and all fractures categorized according to AO/ASIF. In Result: intramedullary group the mean blood loss was 142.5 ml whereas in DHS group it was 330 ml and PFLCP group it was 415 ml. In intramedullary group 5% subjects had wound infection, In DHS group 10% subjects each had malunion, wound infection and screw cutout, whereas in PFLCP group 2(20%) subjects each had wound infection and screw cutout. in unstable intertrochante Conclusion: ric fractures, the intramedullary xation has signicantly better outcome in terms of early restoration of walking ability, shorter operative time, a smaller incision and less blood loss during surgery as compare to extramedullary xation of unstable intertrochanteric fractures.

Proximal femoral nail antirotation versus cemented calcar-replacement hemiarthroplasty for unstable intertrochanteric fracture in elderly: an overall survival study.

The aim of this study is to compare the perioperative complications and overall survival of patients who underwent proximal femoral nail antirotation (PFNA) and patients who underwent cemented calcar-replacement hemiarthroplasty (CCRH) for unstable intertrochanteric fracture in patients aged 75 years and older. A total of 94 patients who underwent PFNA or CCRH between 2010 and 2012 because of femur fracture (A2.2 and A2.3 according to the Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) classification) were analyzed retrospectively. Hospitalization times, blood transfusion needs, reoperation rates, and overall survival were compared. Forty-eight patients in the PFNA group and 46 patients in the CCRH group were included for analysis. There was no statistically significant difference between the two groups in terms of hospitalization times, blood transfusion needs, reoperation rates, and survival rates. Both PFNA and CCRH techniques can be used for surgical treatment of unstable intertrochanteric femur fractures.