Unstable Trochanteric Fractures Research Articles

Primary cemented bipolar hemiarthroplasty by transtrochanteric approach in unstable intertrochanteric fractures

<p><strong>Background:</strong> The successful treatment of unstable intertrochanteric fractures of the femur in elderly patients is a challenge. Due to complications associated with internal fixation, primary hemiarthroplasty is increasingly becoming an alternative treatment to achieve early mobilisation. A transtrochanteric approach could potentially decrease the complications associated with primary hemiarthroplasty. Aim of the study is to document the postoperative outcome and complications associated with this treatment.</p><p><strong>Methods:</strong> In this retrospective study, all elderly patients with unstable trochanteric fractures, treated by primary hemiarthroplasty through a transtrochanteric approach, in a tertiary care centre, from September 2017 to December 2019, were enrolled. Their data from hospital records were analysed and results compared to literature.</p><p><strong>Results:</strong> 48 patients underwent the procedure. Average age was 85 years. One year mortality was 31.25%. Average duration of surgery is 85 min. 58.3% were ambulant at one year. One case of dislocation secondary to surgical site infection was present.</p><p><strong>Conclusions:</strong> Primary hemiarthroplasty as a primary treatment in this group of patients enables early mobilization and prevents complications associated with prolonged immobilization. Transtrochanteric approach reduces the duration of surgery. Achieving early ambulation is the key to successful treatment.</p>

Tip-neck distance ratio as a novel predictor for failure in cephalomedullary nailing of unstable trochanteric fractures (UTF).

Intertrochanteric femur fractures (ITFF) are frequently fixed with proximal femoral nailing (PFN), and a common cause of fixation failure is cut-out of the lag screws. In the literature, many factors have been defined to determine the failure risk, including the tip-apex distance (TAD), calcar-referenced tip-apex distance (CalTAD), the Cleveland zone and Parker's ratio. In this study, a novel technique is described which favors infero-posterior placement of the lag screw and predicts failure risk for PFN. The purpose of this study was to evaluate the tip-neck distance ratio as a factor for the prediction of cut-out after PFN of ITFF. A retrospective evaluation was made of the data of 125 patients applied with PFN for ITFF between October 2016 and September 2019. The occurrence of mechanical complications was analyzed in relation to age, gender, fracture side, American Society of Anaesthesiologists classification, fracture classification, reduction quality, bone quality, Cleveland zone, Parker's ratio, TAD, CalTAD and the TNDR. A total of 125 patients, including 16 with mechanical complications, were suitable for full analysis. In the univariate analysis, reduction quality (p = 0.003), the TAD (p = 0.048) and the TNDR (p = 0.030) were statistically associated with mechanical complications (p < 0.05). In the multivariate analysis, good quality of reduction reduced risk of mechanical failure (p = 0.011) and the TNDR (p < 0.001) indicated that these were two independent factors affecting mechanical complications. The results of this study provide clinical evidence that the TNDR is a predictor for cut-out risk. Placement of the lag screw posterior and inferior reduces the risk of mechanical complications. Level 3.

RESULTS OF TFN AND SHORT PFNA-II IN UNSTABLE TROCHANTERIC FRACTURES: A RETROSPECTIVE COMPARATIVE STUDY

Background: Advancements in modern medicine have given people the opportunity to live longer. The resultant increase in the elderly population has led to a higher incidence of peri-trochanteric fractures of the femur. The preferred implant for the comminuted unstable variety has been intramedullary nails with one or two head/neck compression screws, which are known to have high rate of complications like screw cut-out, back out, Z-effect, varus collapse and rotational instability, especially in the osteoporotic patients leading to the development of helical blade systems. Here we have compared the results of trochanteric xation nail (TFN) and short proximal femoral nail antirotation (PFNA)-II. Methods: It was a retrospective, comparative study in seventy-ve patients with comminuted unstable trochanteric fractures (AO classication31A2) treated using TFN in 34 and short PFNA-II in 41 patients with a minimum follow up period of six months. Results: Most of the data were comparable between the two groups except: signicantly higher operation time and implant-related complications in the TFN group. No signicant differences in the functional outcome between the two groups were noted as indicated by Harris Hip Score at six months. Conclusion: Short PFNA-II should be used in preference to TFN for comminuted unstable trochanteric fractures with no sub-trochanteric extension in the elderly osteoporotic patients in view of the shorter operative time, easier insertion and lower complications rate.

A Comparative Study of Unstable Intertrochanteric Fracture by Proximal Femoral Nail versus Proximal Femoral Nail Anti-Rotation among Adult Patients

Objective: To compare unstable intertrochanteric fracture by proximal femoral nail versus proximal femoral nail anti-rotation among adult patients. Methods: This was a comparative study. Patients were randomized into 2 groups: Proximal Femoral Nail Anti-rotation (n=30) and Proximal femoral nail group (n=30). Singh’s index was used to grade the radiographs for the degree of osteoporosis. Functional evaluation was done at 3 months, 6 months, 9 months and 12 months by using Harris Hip Score. Results: Majority of patients in both PFN (60%) and PFNA (70%) were between 61-70 years. More than half of patients of PFN (56.7%) and 43.3% of PFNA were males. The operative time was 84.00±9.39 minutes among patients of PFN and 61.03±5.75 minutes among patients of PFNA with significant difference between the groups. Singh’s grade III was most common among patients of both PFN (36.7%) and PFNA (36.7%). There was no significant (p&gt;0.05) difference in Harris Hip score between the groups at all the time periods. Excellent outcome was in 63.3% patients of PFNA and in 46.7% patients of PFNA. Good outcome was in 33.3% patients of PFN and in 10% of PFNA. Conclusion: The study suggests that both PFN and PFNA perform well, showing equally good functional outcomes following fixation of unstable trochanteric fractures. PFNA offers no significant benefits over PFN in terms of post-operative complications. Keywords: Unstable intertrochanteric fracture, Proximal femoral nail, Proximal femoral nail anti-rotation.

English

BACKGROUND Trochanteric fractures are commonly encountered in elderly patients, and the outcome may be bad, if not intervened early. Dynamic hip screw (DHS) fixation is the most common treatment in stable trochanteric fracture. In unstable trochanteric fractures, there is high incidence of failure in view of excessive collapse seen with dynamic hip screw. In order to limit the collapse, we have done a modification on dynamic hip screw implant. Here we have assessed fracture healing, collapse and implant failure, in unstable trochanteric fractures (Evan’s unstable fractures) treated by modified dynamic hip screw fixation. METHODS The present retrospective case record analysis was conducted among 31 patients with unstable trochanteric fracture classified according to Evan’s classification who were operated with modified DHS in a tertiary care hospital. The details about fracture healing, collapse of fracture fragments, implant failure were assessed in a structured checklist through the case record analysis. RESULTS Out of 31 patients in this study, 29 patients showed fracture healing (93.5 %) with or without minimal collapse and 2 patients had non-union (6.5 %) at the end of 5 months follow up. Ultimately, all fractures united at the end of 1-year follow-up. Out of 31 patients in this study, at first month follow-up, 26 patients showed no implant failure (83.9 %), 5 patient had implant migration not breaching cortex (16.1 %), at third month follow-up, out of 5 patients who had implant migration, two patients had implant migration not breaching cortex (6.4 %), 3 patients had implant migration breaching cortex (11.0 %), at fifth month follow-up, two patients had implant migration not breaching cortex (6.4 %), 3 patients who had implant migration breaching cortex underwent revision surgery (11.0 %). CONCLUSIONS Modified dynamic hip screw has shown improved results as compared to normal dynamic hip screw in treating unstable trochanteric fracture, which limits the collapse at fracture site. KEYWORDS Unstable Trochanteric Fractures, Collapse, Modified Dynamic Hip Screw

Primary hemiarthroplasty after unstable trochanteric fracture in elderly patients: mortality, readmission and reoperation

BackgroundMost unstable trochanteric fractures are treated with internal fixation and often with high complication rates. Hemiarthroplasty might be an alternative method in difficult condition, especially in unstable comminuted fracture in fragile bone. However, few have investigated the long-term outcomes after hemiarthroplasty for unstable trochanteric fracture. We conducted a population-based retrospective cohort study of trochanteric fracture after primary hemiarthroplasty using competing risk analysis on their long-term outcomes, including mortality, readmission and reoperation.MethodsWe studied a total of 2798 patients over 60 years old, with a mean age of 79 years, of which 68% are females and 67.23% have at least one comorbidity. They underwent a hemiarthroplasty for unstable trochanteric fracture during the period between January 1, 2000 and December 31, 2010 and were follow-up until the end of 2012, or death. Survival analysis and Cox model were used to characterize mortality. Competing risk analysis and Fine and Gray model were used to estimate the cumulative incidences of the first readmission and the first reoperation.ResultsThe follow-up mortality rate for 1-year was 17.94%; 2-year, 29.76%; 5-year, 56.8%; and 10-year, 83.38%. The cumulative incidence of the first readmission was 16.4% for 1-year and 22.44% for 3-year. The cumulative incidence of the first reoperation was 13.87% for 1-year, 18.11% for 2-year, 25.79% for 5-year, and 38.24% for 10-year. Male gender, older age, higher Charlson Comorbidity Index (CCI) and lower insured amount were all risk factors for the overall mortality. Older age and higher CCI were risk factors for the first readmission. Older age was a protective factor for reoperation, which is likely due to the competing death.ConclusionsThe mortality and revision rates after hemiarthroplasty for unstable trochanteric fracture are acceptable as a salvage procedure for this fragile sub-population.

Medial Calcar Comminution and Intramedullary Nail Failure in Unstable Geriatric Trochanteric Hip Fractures.

Background and Objectives: An increasing global burden of geriatric hip fractures is anticipated. The appropriate treatment for fractures is of ongoing interest and becoming more relevant with an aging population and finite health resources. Trochanteric fractures constitute approximately half of all hip fractures with the medial calcar critical to fracture stability. In the management of unstable trochanteric fractures, it is assumed that intramedullary nails and longer implants will lead to less failure. However, the lack of power, inclusion of older generation femoral nails, and a variable definition of stability complicate interpretation of the literature. Materials and Methods: Between January 2012 and December 2017, a retrospective analysis of operatively treated geriatric trochanteric hip fracture patients were examined at a Level 1 Trauma Centre. The treatment was with a long and short version of one type of trochanteric nail. Unstable trochanteric fractures with medial calcar comminution were examined (AO31A2.3, 2.3 & 3.3). The length of the medial calcar loss, nail length, demographics, fracture morphology, and relevant technical factors were examined in univariate and multivariate analysis using competing risk regression analysis. The primary outcome was failure of fixation with post-operative death the competing event and powered to previously reported failure rates. Results: Unstable patterns with medial calcar comminution loss constituted 617 (56%) of operatively treated trochanteric fractures. Failure occurred in 16 (2.6%) at a median post-operative time of 111 days (40–413). In univariate and multivariate analysis, only younger age was a significant predictor of failure (years; SHR: 0.91, CI 95%: 0.86–0.96, p < 0.001). Nail length, medial calcar loss, varus reduction, and other technical factors did not influence nail failure. Conclusions: In a cohort of unstable geriatric trochanteric hip fractures with medial calcar insufficiency, only younger patient age was predictive of nail failure. Neither the length of the medial calcar fragment or nail was predictive of failure.

PROSPECTIVE RANDOMISED COMPARATIVE STUDY OF PFN AND PFNA2 PROXIMAL FEMORAL NAILS FOR THE TREATMENT OF INTERTROCHANTERIC FRACTURES

Introduction: Trochanteric fractures are among the most common injuries which are usually resulting from minimal to moderate physical trauma to areas of bone signicantly weakened by osteoporosis. The greatest problems for the orthopedic surgeon to treating the unstable trochanteric fracture and the complications (implant failure, varus collapse, non union) occur from xation that result of instability. The implants have evolved from extramedullary implants like dynamic hip screw to the intramedullary types of PFNA2 nail. 50 patients were Material and Methods : included in our study from December 2018 to December 2020. 25 patients were treated with PFNA2 (Group I) and 25 patients with PFN (Group II) Nails. Mean blood loss during surgery was 153.8±10.92 &amp; 201.6±38.48 in group I &amp; group II respectiv Results : ely and the mean duration of surgery in group I and group II was 65.24+6.57 min and 85.44 + 11.08 min respectively. We concluded Conclusion : that use of helical blade PFN is certainly better in 31A2.2 and 31A3.3 type of fracture than screw PFN.

Unstable trochanteric Fracture Fixation with P.F.N. augmented by T.B.W.

Biomechanically Proximal Femoral Nail (PFN) is a better choice of implant. Still it is associated with screw breakage, cut out through femoral head,”Z” effect, reverse “Z” effect and lateral migration of screws. The purpose of this study is to evaluate the results of augmented PFN in terms of post operative complication and failure rates in unstable trochanteric fracture. Methodology: We did study of 21 unstable trochanteric fractures from Jan 2016 to Nov .2020. 14 patients were males &amp; 7 patients were females. Age group between 25 to 80 was included in this group. There were 15 A0 A2 (2.2, 2.3) and 6 were A0 A3 (3.1, 3.2, 3.3). All fractures were fixed with 25cm, 1350 PFN mainly 11 mm, 12mm in diameter augmented with one or two 16 gauge tension band wire, strengthening lateral trochanteric wall and holding either communiated fragments or lesser trochanteric fracture. Results: The bone healing was observed in all cases with mean period of 16 weeks. Two patients developed complication of TBW breakage; one developed lateral migration of screws. Patients were followed till # union. At the end of follow up the Salvati and Wilson hip function was 30 (out of 40) in 80% patients. Conclusion: The stabilization of lateral trochanteric wall fracture and communicated fragments with additional one or two TBW increases the stability of construct enhancing bony union &amp; better results.

INTRAMEDULLARY PROXIMAL FEMORAL NAILING FOR UNSTABLE PERITROCHANTRIC FRACTURE: A PROSPECTIVE STUDY

Trochanteric fracture id one of the commonest fractures in Orthopaedics and also among the most devastating injuries of the elderly. The incidence of this fracture increases with advancing age. Around 50% of the Peri-trochanteric variant of these fractures, are of the unstable type. PFNA2 deploys a helical blade which provides compressibility and an additional rotation control at the fracture site.The aim of this study is to assess the effectiveness of Intra-medullary xation of unstable peri-trochanteric fractures with inter-locking proximal femoral nail PFNA2, in a prospective study. This study was done in Department of Orthopaedics, Chettinad Hospital and Research institute, Kelambakkam, Chengalpattu district, Tamilnadu and was spread over 4 years from Jan 2017 to December 2020 with minimum follow-up period of 12 months. 66 patients participated in this study. Harris Hip Score was used to assess the functional outcome. The Harris Hip Score, mean at 6 months was 75.35, which improved to 82.02 by 12 months of follow-up. With regard to our complications 4 patients had a superior cut out of helical screw, which required re-operation by bipolar hemiarthroplasty of the cemented variant. 9 patients had a varus deformity of 10-12 degrees. Abductor lurch was noted in 11 patients. Supercial-wound infection occurred in 8 patients and deep wound infection, requiring surgical irrigation occurred in 3 patients. In conclusion, PFNA2 has better stability, better rotatory stress shielding, superior compaction at fracture site, less blood loss, shorter operation time, less radiation exposure and better clinico-radiological outcomes. PFNA2 is a good implant choice to tackle the complex problems encountered in displaced unstable trochanteric fractures

Incidence of rotational malalignment and its effect on functional outcome after nail osteosynthesis of unstable trochanteric fractures: a prospective cohort study

Background: Trochanteric fractures are common to general, trauma, and geriatric orthopaedic practice. We undertook this study to measure the degree of malrotation after fixation of unstable trochanteric fractures and its effect on functional outcomes in an elderly patient population. Methods: With strict inclusion and exclusion criteria, a total of 58 patients were included in this analysis. Based on postoperative CT, the patients were divided into the nonmalalignment group (NMG, n=38 with rotational malalignment less than 15 degrees) and the malalignment group (MG, n=20 with rotational malalignment greater than 15 degrees). The patients returned for follow-up at 3 mo, 12 mo, and 24 mo, at which time Harris hip scores (HHS), Oxford Hip scores (OHS), Oxford knee scores (OKS) and visual analogue scores (VAS) were recorded and analyzed. Results: There were no significant differences in mean age, fracture sub types by AO Foundation/Orthopaedic Trauma Association classification (AO/OTA), number of comorbidities, time from injury to surgery, or duration of surgery in these two groups. Only the gender distribution was different, with significantly more female patients in the malalignment group. The mean malrotation in the MG and the NMG was 24.9 degrees and 7.73 degrees, respectively, which were significantly different. We found that the HHS, OHS, OKS, and VAS were significantly better in the NMG. More patients in the MG had significant gait abnormality, significant deterioration of knee function, significantly reduced ability to squat and sit cross-legged, and greater requirement of assistive devices for ambulation when compared with the NMG. Conclusions: Rotational malalignment after trochanteric fracture fixation is unavoidable despite best efforts, and these patients have a significantly poorer functional outcome when compared with patients in whom there is no malalignment. Level of Evidence: Level IV.

COMPARATIVE STUDY BETWEEN INTRAMEDULLARY FIXATION AND ARTHROPLASTY FOR THE MANAGEMENT OF UNSTABLE TROCHANTERIC FRACTURE IN ELDERLY

Background: Intertrochanteric fractures involve those occurring in the region extending from the extra capsular basilar neck region to the region along the lesser trochanter proximal to the development of the medullary canal, these fractures account for forty percent of proximal femoral fractures in elderly.Aim of the Work: is to compare intramedullary fixation and hip arthroplasty in treatment of unstable trochanteric fracture in elderly in terms of surgical techniques, clinical and radiological outcome, complications, functional outcome and patient satisfaction.Patients and Methods: The thesis is a prospective comparative randomized study between PFN and Hemiarthroplasty for the treatment of unstable trochanteric fractures in elderly. Patients were followed up at 1, 3, 6, 12 month postoperative, clinical and radiological data collected and documented starting from perioperative data (operative time, blood loss, transfusion).Results: We compared intramedullary fixation and hip arthroplasty in treatment of unstable, comminuted trochanteric fracture in elderly in terms of surgical techniques, clinical and radiological outcome, complications, functional outcome. We did our best to execute it in an objective unbiased scientific manner by allocating patients randomly into two groups using closed opaque envelops. This was confirmed by the mean personal data (Age, sex), side of the fracture, pre-existing comorbidities, and fracture type according to AO classification, both groups were comparable, with no significant difference. Comparison of operative data showed significant difference in operative time, mean operative time was [78.4 min for group 1 Vs 112.6 min for group 2], favoring group 1 as less operative time.Conclusion: Hemiarthroplasty could be valid option in management of unstable trochanteric fractures in elderly, giving the advantage of early full weight bearing, yet it is more technically demanding, require higher surgical experience.

Intramedullary nailing versus sliding hip screw for A1 and A2 trochanteric hip fractures.

This study evaluated variation in the surgical treatment of stable (A1) and unstable (A2) trochanteric hip fractures among an international group of orthopaedic surgeons, and determined the influence of patient, fracture, and surgeon characteristics on choice of implant (intramedullary nailing (IMN) versus sliding hip screw (SHS)). A total of 128 orthopaedic surgeons in the Science of Variation Group evaluated radiographs of 30 patients with Type A1 and A2 trochanteric hip fractures and indicated their preferred treatment: IMN or SHS. The management of Type A3 (reverse obliquity) trochanteric fractures was not evaluated. Agreement between surgeons was calculated using multirater kappa. Multivariate logistic regression models were used to assess whether patient, fracture, and surgeon characteristics were independently associated with choice of implant. The overall agreement between surgeons on implant choice was fair (kappa = 0.27 (95% confidence interval (CI) 0.25 to 0.28)). Factors associated with preference for IMN included USA compared to Europe or the UK (Europe odds ratio (OR) 0.56 (95% CI 0.47 to 0.67); UK OR 0.16 (95% CI 0.12 to 0.22); p < 0.001); exposure to IMN only during training compared to surgeons that were exposed to both (only IMN during training OR 2.6 (95% CI 2.0 to 3.4); p < 0.001); and A2 compared to A1 fractures (Type A2 OR 10 (95% CI 8.4 to 12); p < 0.001). In an international cohort of orthopaedic surgeons, there was a large variation in implant preference for patients with A1 and A2 trochanteric fractures. This is due to surgeon bias (country of practice and aspects of training). The observation that surgeons favoured the more expensive implant (IMN) in the absence of convincing evidence of its superiority suggests that surgeon de-biasing strategies may be a useful focus for optimizing patient outcomes and promoting value-based healthcare. Cite this article: Bone Joint J2021;103-B(4):775-781.

Implants for trochanteric fractures in Norway: the role of the trochanteric stabilizing plate\u2014a study on 20,902 fractures from the Norwegian hip fracture register 2011\u20132017

BackgroundThe trochanteric stabilizing plate (TSP) is used as an adjunct to the sliding hip screw (SHS) in unstable trochanteric and subtrochanteric fractures. We wanted to describe the choice of implant for trochanteric fractures with a focus on the TSP in Norway.MethodsA total of 20,902 fractures from the Norwegian Hip Fracture Register treated surgically in 43 hospitals from 2011 to 2017 were included. Logistic regression analyses were performed to detect factors potentially influencing implant choice.ResultsThe mean age was 83 years, and 15,137 (72%) were women. An SHS was used in 13,273 (63%) fractures, of them 4407 (33%) with a TSP. Fracture classification was the most important determinant of TSP. In cases where an SHS was used, the odds ratio (OR) for using a TSP was 14 for AO/OTA 31A2 fractures and 71 for AO/OTA 31A3 and subtrochanteric fractures, compared to AO/OTA 31A1 fractures. The probability of receiving a TSP was higher in urban, academic, and high-volume hospitals (OR 1.2 to 1.3) and lower in Central and Northern Norway (OR 0.3 to 0.7). The use of an intramedullary nail (IMN) (n = 7629 (36%)) was also to a degree decided by fracture classification (OR 1.8 to 5.3). However, hospital factors, with OR 0.1 to 0.4 for IMN in academic, urban, and high-volume hospitals and OR 1.5 to 2.6 outside South-Eastern Norway (all p < 0.001), were also important.ConclusionsFracture classification was the main determinant for TSP use. Any additional benefit from a TSP on postoperative fracture stability or clinical outcome needs to be clarified.

Inferior Outcome after Unstable Trochanteric Fracture Patterns Compared to Stable Fractures in the Elderly

Background: Various risk factors affecting outcome of elderly patients after proximal femur fracture have been identified. The present study aims to evaluate the impact of the fracture pattern in trochanteric fractures on postoperative mobility and complications. Methods: Ninety-two patients with a mean age of 84 years were included. According to the revised AO/OTA classification, fractures were divided into stable (AO 31A1) and unstable (AO 31A2/3) patterns. A follow-up examination was performed 12 months after cephalomedullary fixation to assess outcome parameters for mobility/activities of daily living (Parker Mobility Score (PMS)/Barthel Index (BI)) and complications (increase in requirement of care, hospital readmission, mortality rate). Results: At follow-up, patients with unstable trochanteric fracture patterns presented with lower PMS and BI compared to stable fractures (p < 0.05). Further, higher requirement of care and higher readmission rates compared to stable patterns were observed. Conclusion: Unstable trochanteric fractures presented inferior outcome compared to simple fracture patterns. This might be explained by the increasing surgical trauma in unstable fractures as well as by the mechanical impact of the lesser trochanter, which provides medial femoral support and is of functional relevance. Subsequent studies should assess if treatment strategies adapted to the specific fracture pattern (refixation of lesser trochanter) influence outcome in unstable trochanteric fractures.

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.

A New Joystick Technique for the Reduction of Unstable Trochanteric Hip Fractures: Especially With Rotational Deformity

We are performing surgical treatment of trochanteric hip fractures using an intramedullary nail. There are irreducible fractures in which the correct reduction cannot be performed with the usual traction and internal rotation. In particular, the rotational deformity is difficult to reduce. One of the causes of this is the instability and uncontrollability of the proximal bone fragment. To address this problem, we devised a new joystick technique. From the same skin incision as used for inserting the intramedullary nail, a 3.0 mm Kirschner wire (K-wire) is inserted into the femoral neck perpendicularly. A K-wire is inserted at the front part of the femoral neck so as not to interfere with the lag screw. The fracture is reduced by operating the proximal bone fragment by using the K-wire as a joystick. The proximal bone fragment is operated in the varus-valgus direction by moving the K-wire proximally-distally and in internal-external rotation directions by moving the K-wire anteriorly-posteriorly. No complications, such as cut-out of the femoral neck due to the K-wire or neurovascular injury, were observed. The joystick technique was used in the following situations: (1) stabilization of the proximal bone fragment, (2) rotational reduction of the proximal bone fragment, and (3) prevention of rotational deformity caused by lag screw insertion. This joystick technique is simple and less invasive so we do not consider it a problem to apply it routinely, in all cases.

Result of hemiarthroplasty and internal fixation in trochanteric fractures in elderly

Background: There is no specific protocol as to whether internal fixation or hemiarthroplasty is more appropriate for the treatment of intertrochanteric femur fractures in elderly patients. Hemiarthroplasty offers early mobilization, internal fixation preserves the hip joint and avoids long-term complications associated with the prosthesis. A large number of patients with trochanteric fractures are admitted in our hospital including those cases referred from peripheral hospitals. Considering the superior infrastructural set up in our hospital in terms of pre-operative planning and rehabilitations, comparative study was conducted between cemented hemiarthroplasty and internal fixations in unstable trochanteric fractures in elderly to dictate a treatment protocol.Objective: To compare the post operative clinical and functional outcome between hemiarthroplasty and internal fixation.Method: 75 patients, all of who were more than 60 years of age, with trochanteric fractures and comminution were treated between 2015 to 2017 (45 women, 30 men; 50 hemiarthoplasty, 25 internal fixation). 22 of 25 patients in the internal fixation group (G1) and 41 of 50 patients in the hemiarthoplasty group (G2) were alive at the final follow-up. The mean follow up was at 10+/-3 months. In both the groups the post operative ambulation capacity were assessed according to Clawson classification and complications related to implant were evaluated with radiographic examination.Results: At the end of the follow up clinical comparision in both the groups were done through the ambulatory capacity which were found more to be in class 4 with G2 according to Clawson classification.Conclusion: Primary cemented hemiarthroplasty as a treatment for unstable trochanteric fractures is a viable option for the elderly population. It results in early mobilization which avoids the hazards of prolonged inactivity and prevents implant failure due to osteoporosis.

Effect of types of proximal femoral fractures on physical function such as lower limb function and Activities of Daily Living

This study aimed to assess physical function such as lower limb function and Activities of Daily Living after surgery for proximal femoral fractures ( unstable medial femoral neck fracture and trochanteric fracture). This study enrolled 68 patients with proximal femoral fractures. Isometric knee extension strength (IKES), the Japanese Orthopedic Association (JOA) hip score, and the number of days required to develop straight leg raising, transfer, and T-caneassisted gait abilities to become independent were assessed. Patients were classified based on the types of proximal femoral fractures, namely unstable medial femoral neck fracture (bipolar hip arthroplasty [BHA] group), stable trochanteric fracture (S group), and unstable trochanteric fracture (US group). IKES and the JOA hip score were significantly better in the BHA group than in the S and US groups. IKES and the JOA hip score were significantly worse in the US group than in the BHA and S groups. Both transfer and T-cane-assisted gait abilities of patients in the BHA and S groups were indifferent. However, all physical functions were significantly worse in the US group. Our study results suggested that physical therapists plan the different rehabilitation program for the patients with proximal femoral fractures who were classified into three types, namely unstable medial femoral neck fracture, stable trochanteric fracture, and unstable trochanteric fracture, instead of two types.

Retracted: The Effect of Synthetic Osteoconductive Bone Graft Material for Augmentation of Internally Fixed Unstable Trochanteric Fractures.

[This retracts the article DOI: 10.1155/2019/5879089.].