Unstable Proximal Femoral Fractures Research Articles

A study of functional outcome in unstable intertrochanteric fractures treated by proximal femoral nailing in Bundelkhand region

Background: Intertrochanteric fractures are the most frequent fractures of the hip joint. This is attributed to the increase in the elderly population in our country, along with osteoporosis being prevalent in these populations. Aims and Objectives: The aim of the study is to prospectively analyze the functional outcome of unstable intertrochanteric fractures managed with “proximal femoral nail” (PFN). Materials and Methods: The prospective study was conducted on 48 cases of unstable intertrochanteric in Maharani Laxmi Bai Medical College, Jhansi, between June 2022 and December 2023. Results: In our study, the mean age of the patient is 36.16 and the most common age group is 41–60 years, 33.33%, and >60 years, 41.67%. In forty-eight cases, 37 (77.08%) were male patients, and 11 (22.92%) were female patients. The Harris hip score patients follow-up after 3 months 8 (16.67%) patients of excellent outcomes, 18 (37.50%) patients of good outcomes, 12 (25.00%) of fair outcomes, and 10 (20.83%) patients of poor outcomes. The Harris hip score patients follow-up after 6 months 24 (50%) patients of excellent outcomes, 20 (41.67%) patients of good outcomes, 2 (4.17%) of fair outcomes, and 2 (4.17%) patients of poor outcomes. Conclusion: In unstable proximal femur fractures, PFN is a significant advancement in the treatment of unstable trochanteric fractures which has the unique advantages of closed reduction, preservation of fracture hematoma, less tissue damage, early rehabilitation, and early return to work.

Comparison of Peri and Early Post-Operative Complications in Long Versus Short Proximal Femoral Nail for Unstable Proximal Femoral Fractures

Comparison of Peri and Early Post-Operative Complications in Long Versus Short Proximal Femoral Nail for Unstable Proximal Femoral Fractures

Extra Medullary Fixation in Unstable Proximal Femoral Fractures by PF-LCP.

Perception that extra-medullary fixation of these fractures are fraught with difficulties and deficiencies is becoming inappropriate. This device provides angular stable fixation retaining fracture biology with minimum interference to osseous and soft-tissue vascularity and it does not require reaming which destroys 80% of endosteal vasculature for 6-12weeks. PFLCP averts iatrogenic fracture in lateral trochanteric wall (LTW) which is frequent with DHS, protects LTW from secondary fracture in post-operative period. Aim is to assess outcome of unstable proximal femur fracture fixation by PFLCP. Study included 64 from 2016 to 2020, divided in two groups. (A) Unstable intertrochanteric fracture and (B) subtrochanteric fracture (Seinsheimer types II-V). All fractures fixed by MIPO with PFLCP. Loss of reduction, infection, cut-out, cut-through, backing of screws, bending or breaking of plate and screw, malunion, non-union and revision were evaluated. Fracture healing and functional recovery assessed by Reborne Score and Parker Mobility Score (PMS) respectively. Out of 64, 24 achieved pre-injury PMS, 32 declined by 1 point, 6 declined by 2 points and 1 by 3 points, one required revision. Using various parameters 37.5% patients had excellent results and 50% had good results, 9.38% had average and 3.12% had poor result. None reported non-union or breakage of plate. PFLCP provides angular stable fixation, torsional stability with high biomechanical strength to resist deforming stresses. MIPO avoids soft-tissue stripping reducing blood-loss, retains periosteal blood supply to inter-fragmentary bone fragments, enhancing fracture healing, reducing complications, such as delayed healing, nonunion, infection and implant failure.

Unlocking the Influence of Age and Fracture Side on Recovery in Unstable Proximal Femoral Fractures: Insights from a Tertiary Care Hospital in a Developing Country

Objective: The aim of our research is to identify the clinical and demographic characteristics that affect the functional results in patients with proximal femur fractures who are treated with dynamic condylar screws. Method: A descriptive cross-sectional survey conducted from September 2019 to March 2022, enrolled 115 patients aged 20-60 years with unstable proximal femoral fractures managed with dynamic condylar screws. The data was collected 12 weeks following the surgery to assess the factors influencing the Harris Hip Score. The data on clinical, demographic, and surgical detail was collected and analyzed employing the SPSS version 22, using the Shapiro-Wilk test. Results: The study revealed significant functional improvement associated with the age group 41-60 years, additionally, patients with left-sided fracture showed statistically significant functional outcomes in comparison to patients with right-sided fractures. No significant association of HHS score was found in relation to clinical, surgical, socioeconomic or occupational factors on postoperative outcomes. The findings highlight a complex interplay of demographic factors following the fracture management for unstable PFF. Conclusion: The uni-variant results yield higher age and left-sided fracture associated with higher functional outcomes following an unstable proximal femur fracture managed with dynamic condylar screws. The statistical results showed no significant association of clinical factors influencing the functional status. The unique demographic finding needs further larger multi-variant research to establish the clinical and demographic factors influencing the functional outcomes following the dynamic condylar screw in patients with proximal femur fracture.

The "foothill" entry for cephalomedullary nailing in unstable proximal femoral fractures: a technical note with a review of the literature.

Cephalomedullary nailing for unstable proximal femoral fractures is widely utilized, especially for geriatric osteoporotic fractures. There are two starting points for entry, namely trochanteric tip entry and pyriformis fossa entry, both have advantages and disadvantages, the tip of the greater trochanter seems that it is not the ideal starting point for trochanteric entry nails, the study presents the foothill entry point as a reproducible, technically feasible entry point to overcome the shortcoming of both standard starting points, and it could be easy executed with clear intraoperative fluoroscopic landmarks and lead to appropriate nail position without intraoperative complications.

Improved Durability of a Modular Axial Fixator for Stable and Unstable Proximal Femoral Fractures: A Patient-Specific Finite Element Analysis

Abstract Femoral neck fractures, comprising 8–10% of all bodily fractures in the elderly, often necessitate alternatives to extensive surgical interventions. Despite limited research, external fixators are considered promising. This study evaluates the design and durability of a novel modular axial fixator (MAF) for stable and unstable proximal femoral fractures, using numerical method-based engineering analysis. Employing patient-specific CT scan data, three-dimensional (3D) solid modeling, and finite element analysis (FEA), the MAF-bone fixation is examined in eight simulation scenarios under static loading conditions. FEA results show a peak femur head displacement of 7.429 mm in FEA 001, with Schanz screw no. 2 reaching the maximum equivalent stress at 431.060 MPa in FEA-006. Notably, the 7.429-mm displacement improves stability compared to previous studies, yet interfragmentary movement surpasses the 100–200 μm reference range for primary fracture healing, posing challenges to direct healing despite enhanced stability. This study validates the durability of the innovative MAF for femoral neck fractures through engineering simulations. It contributes to understanding MAF durability issues, with implications for improving medical implant design in the industry. Simulation results offer opportunities for optimizing structure and production, enhancing the MAF's design, and ultimately benefiting medical implant manufacturing.

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

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

Dynamic condylar screw functional outcome in the treatment of unstable proximal femoral fractures in adult patients

Objective: The purpose of this study was to assess the functional outcome of dynamic condylar screw (DCS) fixation in the treatment of unstable proximal femoral fractures in adults. Study Place and Duration: This descriptive study was done from March 2021 to November 2022 at MTI Lady Reading Hospital Peshawar. Methods: A descriptive study, employing dynamic condylar screws to treat proximal femur fractures in all adult patients who met the inclusion criteria, was utilized in this in-depth examination (DCS). The Harris Hip Score was used to determine post-surgery mobility. Results: The average age of patients was 63 having standard deviation of 14. Fracture union took 14.3 +/- 3.8 weeks on the average. At 24 months, the typical HHS was 85.2 +/-12.3, and 78.1% of patients reported adequate or outstanding functional performance. Nonunion, malunion, or hardware failure occurred in 13.3% of patients. Complications were unaffected by age, gender, or fracture type. Conclusion: Dynamic condylar screw therapy has demonstrated promising functional and radiological benefits with few adverse effects in people with unstable proximal femoral fractures. DCS fixation, an efficient treatment for such fractures, is one of the best treatment for such fractures.

Proximal Femoral Nail Versus Dynamic Hip Screw in Unstable Proximal Femoral Fracture

Background: Unstable proximal femoral fracture occurs at the top of femur bone, typically in elderly people or those involved in high-impact accidents. The fracture can occur in different ways, including intertrochanteric, subtrochanteric, or femoral neck fractures. The two most common techniques implied for its repair are Proximal Femoral Nail (PFN) and Dynamic Hip Screw (DHS). Objectives: The research was conducted to evaluate these both techniques and compare their clinical outcome in terms of Harris Hip Score, clinical assessment and clinical complications. Methods: Cross-sectional study was completed in 2020-2022 and comprised 104 patients equally divided into Group A (DHS) and Group B (PFN). Both techniques were comparatively analyzed and the outcomes were evaluated using Harris Hip Score and clinical assessment. Results: Group A and B had mean surgery duration of 76.78+13.40 and 57.09+11.67 minutes, mean intra-operative blood loss of 239+32.98 and 149+17.29 ml, mean weight bearing time was 3.13+0.56 and 2.98+0.39 months, average incision length was 8.78+2.81 and 5.12+1.94 cm, radiological union of the fractured bones took 3.27+0.78 and 3.11+0.82 months, respectively. Harris Hip Scores were recorded on monthly basis and revealed that 1st monthly scores of Group A and B were 71 and 74, 2nd month had 77 and 81, 3rd month had 80 and 84, 4th month had 83 and 88, 5th month had 84 and 89 and 6th month revealed 86 and 90 scores, respectively. Practical implication: The surgeons would prefer PFN technique while surgery of unstable femoral fracture to avoid complications and achieve better results. Conclusion: PFN technique was associated with less blood loss, lower complications and a higher Harris Hip Score. It has marginally superior results to DHS. Thus PFN is a minimally invasive technique that necessitates less tissue dissection, resulting in negligible blood loss. In treating unstable femoral fractures, an analysis of clinical indicators revealed that PFN has superior clinical manifestation than DHS. Keywords: Femoral fractures; Harris Hip Scores; Intramedullary device; Osteoporosis.

EVALUATION OF CLINICAL AND RADIOLOGICAL OUTCOME OF INTERTROCHANTERIC FRACTURES OF FEMUR TREATED WITH PROXIMAL FEMORAL NAIL : A PROSPECTIVE STUDY

Background: With purpose to evaluate the outcome of proximal femur nail procedure ,we carried out a prospective observational study in which 40 patients, underwent Proximal Femoral nailing for intertrochanteric fracture femur at Govt. R.D.B.P Jaipuria Hospital, Jaipur, Rajasthan. Materials and Methods: Patients were included as per the inclusion and exclusion criteria in the study. All patients were followed up at 4 weeks, 6 weeks, 8 weeks, 12 weeks, 16weeks and 24 weeks and later depending on the fracture healing status. X ray of the operated hip with femur –anteroposterior and lateral views were taken during follow up. Kyle's criteria and Harris hip score was measured at 6 months follow up. Results:The Kyle's criteria was Excellent in 22 patients (55%), Good in 13 patients (32.5%), Fair in 4 patients (10%) and poor in 1 patient (2.5%) Conclusion: proximal femoral nail (PFN) is a good minimally invasive implant for stable and unstable proximal femoral fractures. It's particularly benecial in elderly and osteoporotic population. Adequate fracture reduction is critical in management of the intertrochanteric fractures. Achieving good anatomical reduction and maintaining the tip apex distance less than 25mm will avoid the implant related complications

Outcome of treatment of Unstable Intertrochanteric Fracture by Proximal Femoral Nail (PFN)

Background: Proximal Femoral Nail (PFN) is a surgical technique used to treat unstable intertrochanteric fractures, which are fractures that occur in the upper portion of the thigh bone (femur). The procedure involves using a nail-like device that is inserted into the femur and secured in place with screws to stabilize the fracture and promote healing. It is a commonly used treatment option for this type of fracture and can lead to good outcomes in most cases. The aim of the study was to observe the outcome of Unstable Intertrochanteric fracture by Proximal Femoral Nail (PFN). Material Methods: This prospective observational study was conducted at the Department of Orthopedics, National Institute of Traumatology and Orthopedic Rehabilitation (NITOR), Dhaka, Bangladesh. The study duration was 2 years, from July 2017 to June 2019. A total of 34 cases were included in the study sing purposive sampling (non-randomized) according to availability of the patients and considering inclusion and exclusion criteria. Results: The participants’ age range was 16-90, with a mean of 56.91 ± 17.76. Most (35.29%) were 61-75 years old. 61.76% were female and 38.24% were male. 50% were housewives, 14.71% ex-service holders, 14.71% service holders, 11.76% businessmen, 5.88% students, and 2.94% farmers. The leading cause of injury was falls on slippery ground (55.88%), followed by motor vehicle injuries (44.12%). 70.59% of injuries occurred on the right side and 29.41% on the left. 76% had Kyle Type III fractures, 24% had type IV. 85.29% had open reduction, 14.71% had closed reduction. The mean duration of injury to operation was 15.59 days and the mean hospital stay was 19.15 days. 70.59% had no complications and 55.88% reported no pain at last follow-up. 58.82% had a good Harris hip score and 58.82% had excellent outcomes by final follow-up. Conclusion: The majority of patients in this study were in the 61-75 age range and female, with the most common cause of injury being falls on slippery ground. The most common fracture type was Kyle type IV, with a major portion of cases requiring open reduction. The rate of complications was relatively low, and the functional outcomes were acceptable and comparable to other studies. The duration of injury to operation and hospital stay were slightly longer than other studies, likely due to the busy nature of the study location. Overall, the Proximal Femoral Nail is a safe and effective treatment option for unstable proximal femoral 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 < 0.001). Of concern, varus cut-out occurred in two InterTan nails with TAD of <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.

General health and functional improvement among patients with unstable extracapsular proximal femoral fractures managed with proximal femoral nail by using SF-36 score

<p><strong>Background</strong>: Proximal femoral nail is emerging as the treatment of choice for unstable extra capsular proximal femoral fractures. This study comprises of functional evaluation of the treated patients by using SF 36 score.</p><p><strong>Methods</strong>: This was a prospective hospital-based study done on 54 patients with unstable proximal femoral fractures classified according to the AO/ASIF classification system and were treated by using PFN in the department of Orthopaedics DRPGMC, Tanda. Functional outcome was assessed by using SF-36 score on, 14th postoperative day, at three months and six months.</p><p><strong>Results</strong>: Our study has mean scores of short form-36 subscales as physical function 70.6, role limitation due to physical health 68.1, role limitation due to emotional health 90, energy/fatigue 66, emotional wellbeing 78, social functioning 67.7, pain 75 and general health 73.3.</p><p><strong>Conclusions</strong>: The results of this study confirm that intramedullary nailing with the use of a PFN in unstable proximal femoral fractures is a safe method. A significant change was seen in quality of life postoperatively as evidenced by various scores used in present study. Weaknesses of this study include a short follow-up period and the inclusion of a small study group.</p>

Functional and Radiological Outcomes of Unstable Proximal Femur Fractures Fixed With Anatomical Proximal Locking Compression Plate.

IntroductionPeritrochanteric fractures are the most frequent fractures of the proximal femur that accounts for nearly half of all proximal femur fractures. They are a major cause of disability in the elderly. The aim is to study the functional and radiological outcome of unstable proximal femur fractures fixed with proximal femur locking compression plate (PF-LCP) and its complications. Unstable proximal femur fracture patients operated with proximal femur locking compression plate were followed up functionally by Harris Hip Score and radiologically by neck-shaft angle measure.Materials and methodsA retrospective analysis of 30 patients with unstable peritrochanteric fractures treated with PF-LCP in the first-level trauma center was conducted between 2015 and 2019. Stable peritrochanteric, pediatric and open fractures, and polytrauma were excluded. As a mid-term follow-up, functional and radiological outcomes were assessed at six weeks, three months, six months, and 12 months. Data was analyzed using a chi-square test, and results were compared with available western literature. ResultsThirty patients with unstable peritrochanteric fractures operated between 2015 and 2019, complying with our inclusion criteria, were analyzed. All patients were operated by the same surgeon and were available for a mid-term follow-up (12 months). Mean radiological union time was 12.5+/-2 weeks, with 24 patients achieving union between 10-15 weeks, three patients had union little more than 15 weeks. Two patients had non-union and required re-surgery. Functional results were assessed in the 30 patients available for follow-up using Harris Hip Score. Excellent results were seen in 17, good in seven, fair in three, and poor in three patients.ConclusionsThe choice of implant used to manage unstable peritrochanteric fractures has always been a debatable subject in our orthopedic fraternity. In our study, we used the anatomic, fixed-angle plates in peritrochanteric fractures and obtained significant functional and radiological outcomes over a midterm follow-up. We recommend PF-LCP as a good, stable alternative in the treatment of peritrochanteric femoral fractures. We consider that fracture pattern and extent in the proximal femur have a definite influence in determining the implant of choice. It provides good-to-excellent bone healing with reduced complications and better biomechanical stability.

Prospective study of Intertrochanteric femur fractures managed with proximal femoral nailing

Background: Elderly patients with a minor fall can sustain a fracture in this area because of debilitated bone due to osteoporosis or pathological fracture and this account for 90%. Benefits of intramedullary devices like PFN include preserved blood supply to the bone fragments, less operative blood loss and less disruption of the environment. The study was conducted to determine the union rate, functional outcome and the complication in intertrochanteric fractures treated by PFN. Materials and Methods: A prospective observational study on 30 patients with intertrochanteric fractures were done at a tertiary care centre between April 2018 to March 2019. All patients were managed by proximal femoral nail. The patients were evaluated radiologically and functionally. The radiographic evaluation was done for a minimum of three cortices union on anteroposterior and lateral views. The functional evaluation was done on the basis of Harris Hip Score (HHS).Results: The results of the treatment of stable intertrochanteric fractures using Proximal Femoral Nail were assessed by Harris Hip Score system. Most of the patients were having fair to excellent outcome.Conclusion: we consider that the PFN is a highly accepted minimally invasive implant for unstable proximal femoral fractures but future modification of the implant to avoid Z-effect phenomenon, careful surgical technique and selection of the patients should further reduce its complication rate. Early post-operative ambulation and physiotherapy improves the results of PFN.

A comparison between Asians and Caucasians in the dimensions of the femoral isthmus based on a 3D-CT analysis of 1189 adult femurs

IntroductionFor successful intramedullary implant placement at the femur, such as nailing in unstable proximal femur fractures, the use of an implant that at least reaches or exceeds the femoral isthmus and yields sufficient thickness is recommended. A number of complications after intramedullary femoral nailing have been reported, particularly in Asians. To understand the anatomical features of the proximal femur and their ethnic differences, we aimed to accurately calculate the femoral isthmus dimensions and proximal distance of Asians and Caucasians.MethodsIn total, 1189 Asian and Caucasian segmented 3D CT data sets of femurs were analyzed. The individual femoral isthmus diameter was precisely computed to investigate whether gender, femur length, age, ethnicity or body mass index have an influence on isthmus diameters.ResultsThe mean isthmus diameter of all femurs was 10.71 ± 2.2 mm. A significantly larger diameter was found in Asians when compared to Caucasians (p < 0.001). Age was a strong predictor of the isthmus diameter variability in females (p < 0.001, adjusted r2 = 0.299). With every year of life, the isthmus showed a widening of 0.08 mm in women. A Matched Pair Analysis of 150 female femurs showed a significant difference between isthmus diameter in Asian and Caucasian femurs (p = 0.05). In 50% of the cases the isthmus was found in a range of 2.4 cm between 16.9 and 19.3 cm distal to the tip of the greater trochanter. The female Asian femur differs from Caucasians as it is wider at the isthmus.ConclusionsIn absolute values, the proximal isthmus distance did not show much variation but is more proximal in Asians. The detailed data presented may be helpful in the development of future implant designs. The length and thickness of future standard implants may be considered based on the findings.

Comparison of efficacy of extramedullary fixation devices and proximal femoral nail in the management of subtrochanteric fracture femur

Introduction: Hip is one of the important joint for locomotion in human beings. So fractures in and around hip joint are of great concern to treating surgeon and patient. We have made an attempt to evaluate these complex fractures and compared the efficacy of proximal femoral nail and extamedullary devices in treatment of subtrochanteric fracture femur. Materials and Methods: After informed consent was given, all 56 consecutive patients with subtrochanteric fracture of femur were randomized into two treatment groups. One group of patients were treated with dynamic hip screw or Dynamic condylar screw (Group I) and other group received proximal femoral nail (Group II). All procedures were performed by staff surgeons with patient supine on a fracture table. Result: The mean operative time in Group I (93.57 min) was significantly higher than in Group II (80 min) with a P value of Conclusion: We conclude that subtrochanteric fractures are difficult to understand and manage. We consider that the PFN is a good minimally invasive implant for unstable proximal femoral fractures when closed reduction is possible. In general, PFN afforded early return to physical activity, faster rehabilitation & walking ability, lesser blood loss and comparable success rate. Keywords: Extramedullary fixation, Proximal femoral nail, Subtrochanteric fracture femur, Dynamic condylar screw.

The inverted Vancouver C fracture. Case series of unstable proximal femur fractures above a knee revision stem treated by short cephalomedullary nail and lateral submuscular overlapping plate.

Unstable proximal femur fractures above a knee revision stem are an emerging complication that is especially difficult to treat. Since this pattern does not adapt to any previously reported classification, we named it "inverted Vancouver C fracture". In this single-centre case series, we pose a nail-plate combination for the treatment of such clinical picture. The incidence was low among proximal and implant-related femoral fractures. All the fractures healed without records of major local complications. Thus, we consider this technique safe and reproducible.

Comparison between the Results of Management of Recent Unstable Proximal Femoral Fractures by Proximal Femoral Nailing and Locked Plating

Careful adjustment of the intertrochanteric cracks and early activation of the patients are the ideal treatment to forestall the confusions of delayed immobilization, aside from in patients with clinical issues in whom medical procedure is contraindicated. The Dynamic hip screw (DHS) has been the norm and the best archived embed in rewarding intertrochanteric breaks and in a few randomized preliminaries it has been related with lower difficulties and reoperation rates. Also, it is a more affordable embed, however hypothetically it has a biomechanical drawback in view of a more extensive separation between the weight bearing pivot and the embed A sum of 20 instances of shaky proximal femoral breaks were incorporated, and they were partitioned into two equivalent gatherings; the principal bunch experienced PFN, while the other one experienced LP. Follow up visits was at 1st,3rd,6th weeks and third and sixth months in outpatient facility and results were recorded. Altered Harris Hip Score had a middle of 88 and 85 in the femoral nail and bolted plate bunches separately (p = 0.114). Postponed association was experienced uniquely in one case in the bolted plate gathering, while it was not experienced in the other gathering (p = 0.345). Radiological assessment uncovered a middle score of 3 in both examination gatherings. all the inserts in their own privilege are magnificent modalities in the administration of unsteady proximal cracks of the femur. Precarious proximal femoral cracks with rotational mal-arrangement issues were dealt with best by PFN. Precarious proximal femoral cracks particularly with expanded comminution do give a choice to be fixed by LP.

Ninety-Five Degree Angled Blade Plate Fixation of High-Energy Unstable Proximal Femur Fractures Results in High Rates of Union and Minimal Complications.

To describe the surgical technique and clinical outcomes of high-energy proximal femur fractures treated with a 95-degree angled blade plate. Retrospective case series. Single academic Level I trauma center. Forty-five consecutive patients from March 2012 to April 2017 who sustained a high-energy, unstable proximal femur fracture including (OTA/AO 31-A1, 31-A2, 31-A3, 31-B3, 32-A1a, and 32-C3i). Open reduction internal fixation with a 95-degree angled blade plate used in conjunction with an articulated tensioning device. Nonunion, malunion, secondary operations, and postoperative infection. Twenty six patients were available for follow-up. The mean age was 43.8 (range 22-86) years, and 81% (21/26) were men. The most common fracture pattern was OTA/AO 31-A3.3. Two fractures were open. The articulated tensioner was used in 100% of cases. Average clinical follow-up was 19.2 (range 7-40) months. Twenty-four of 26 patients (92%) achieved osseous union after the index procedure. One patient underwent nonunion repair, and 2 patients had the blade plate removed as it was symptomatic laterally. No other secondary procedures were performed, and no instances of implant failure were seen. No patients had evidence of a superficial or deep infection. We found that high-energy proximal femur fractures treated with a 95-degree condylar blade plate and articulated tensioning device had a high rate of union with minimal postoperative complications. Although intramedullary nailing of these fractures remains a preferred treatment modality, the angled blade plate with articulated tensioning device is an excellent option to restore anatomical alignment and obtain bony union in certain highly comminuted fracture patterns. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.