Unstable Trochanteric Fractures Research Articles

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.].

Morphology Specific Lateral Wall Reconstruction Techniques Using Cerclage Wires in Unstable Trochanteric Fractures.

Trochanteric lateral wall fracture (LWF) indicates instability and is found to be an important predictor of reoperations following trochanteric fracture fixation. A single unified technique for lateral wall reconstruction may not adequately stabilize all the fracture patterns. We have presented morphology specific lateral wall reconstruction techniques using cerclage wire around proximal femoral nails. Various LWF patterns have been simplified into three types. Type-specific lateral wall reconstruction techniques using cerclage wire were adopted in 49 consecutive unstable trochanteric fractures presented to our institute between 2016 and 2018. We analyzed the fracture pattern, fixation method used, union time, and complications. The functional outcome was analyzed using the Harris hip score (HSS). The mean follow-up period was 13months (range 10-36months). The mean age of the population was 66years (range 36-91years). There were 15 patients with type 1 LWF pattern, 26 patients with type 2, and 8 were of type 3 pattern. The mean operating time was 66min. The mean union time was 14weeks (10-24weeks). HSS was excellent in 9 patients, good in 33 patients, fair in 4 patients, and poor in 5 patients. Complications include one patient with avascular necrosis (AVN) of the femoral head, varus collapse with non-union in one patient, screws back out in one patient, superficial infection in 4 patients, and distal screw breakage in one patient. Type 2 is the most common LWF type in our study. In unstable trochanteric fractures, morphology specific lateral wall reconstruction using cerclage wire loops around the proximal femoral nail is a simple technique with promising results with minimal complications.

Comparative evaluation of internal fixation using dynamic hip screw (DHS) and primary hemiarthroplasty in unstable trochanteric fractures

Background: Fractures of the trochanteric region are some of the most common fractures encountered by an orthopaedic surgeon. The Dynamic hip screw (DHS) may result in cut-out, risk of instability, and delayed weight bearing. Different types of arthroplasty such as the Leinbach and bipolar hip arthroplaties were then used. Hence; the present study was undertaken for comparatively evaluating efficacy of internal fixation using dynamic hip screw (DHS) and primary hemiarthroplasty in unstable trochanteric fractures. Materials & methods: A total of 60 patients with unstable trochanteric fractures were analyzed and broadly divided into two study groups with 30 patients in each group as follows: DHS group: Patients treated with Dynamic hip screw; andPHA group: Patients treated with primary hemiarthroplasty. All the patients underwent treatment according to their respective groups. Pre-operative and post-operative follow-up radiographs were analyzed. Harris hip score (HHS) was analyzed at follow-ups. Incidence of complications was analyzed and compared. Results: Mean HHS among the patients of DHS group and PHA group on final follow-up was found to be 76.13 and 90.69 respectively. While comparing the mean HHS among the patients of the two study groups, significant results were obtained. Three cases of non-union and two cases of delayed union were encountered in the DHS group while none of the patients of the PHA group exhibited non-union or delayed union. Incidence of complication was significantly higher in the DHS group.Conclusion: In patients undergoing treatment for unstable trochanteric fractures, better outcome with lesser complications are associated with primary hemiarthroplasty in comparison to dynamic hip screw.

The dual mobility hip arthroplasty for hip fracture in Parkinson’s disease

Backgroud: Patients with Parkinson’s disease are at increased risk for falls and associated hip fractures as a result of tremor, rigidity, and postural instability. The available literature is limited and conflicting regarding the optimal surgical treatment and risk for postoperative complications and mortality in this unique patient population. This study question the effectiveness of mobility total hip arthroplasty in Parkinson’s disease patients with proximal femoral fractures. Patients and methods: Twelve patients (13 hips) with proximal femoral fracture (fracture neck of femur in 6 cases, unstable trochanteric fracture in 5 cases and failed fixation of trochanteric fracture in 2 case). Cemented dual mobility acetabular components were used in 9 patients and a cementless dual mobility acetabular components was used in 4 patient. Follow up reports on:postoperative complication rates, in-hospital mortality, length of hospital stay, discharge status, mortality rate, recovery of prefracture ambulatory ability, and return to prefracture activities of daily living. The mean age 65 years and the mean follow-up 32 months.

Study of surgical management of trochanteric fracture of the femur with dynamic hip screw

Background: The use of a dynamic hip screw (DHS) for stable trochanteric hip fracture fixation has been successfully applied in fracture healing for more than 20 years. DHS fixation on unstable trochanteric fractures still has a more failure rate, particularly in osteoporosis patients. Thus, this study is aimed to investigate the biomechanical property of the DHS system to provide the lesser trochanter fragment stable fixation. Material and methods: This cross-sectional, observational, and follow-up study was conducted in the Department of Orthopedics, GSL Medical College and General Hospital, Rajamahendravaram with a total of 40 cases of trochanteric fractures. All surgeries were performed under spinal anesthesia. Surgery done was an internal fixation with DHS and 135-degree angled blade plate. Results: Among 40 cases, 32.5% were Type I, and 67.5% were Type II Trochanteric fractures. 40% cases had grade 3 osteoporosis and 30% had grade4-osteoporosis rest of the patients were having grade 2 (20%), grade 5 (7.5%), grade 6 (2.5%) and grade1 (0%), according to Singh’s index. The clinical and functional outcomes of the procedure were excellent in 10 hips (25%), Good in 20 hips (50%), Fair in 6 hips (15%), and 4 (10%) of the patients had poor results. Conclusions: Trochanteric fractures are essentially fractured of the elderly, with osteoporotic bones. The dynamic hip screw is the operative treatment of choice for stable trochanteric fractures.

Outcome of Gamma Nail Fixation in Unstable Trochanteric Fracture of Femur

Outcome of Gamma Nail Fixation in Unstable Trochanteric Fracture of Femur

Rehabilitation protocols in unstable trochanteric fractures treated with cephalomedullary nails in elderly: current practices and outcome.

Optimal rehabilitation treatment after surgery for fixation of unstable trochanteric fractures is challenging in elderly patients. The objective of this study is to analyse the existing literature on available rehabilitation protocols with regards to permitting or restricting early weight bearing following fixation of unstable trochanteric fractures treated by the use of cephalomedullary nails in patients at least 65years of age. A systematic review was performed based on the checklist of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Studies published between 1948 and 2018 on elderly patients with unstable trochanteric fractures treated with cephalomedullary nails that offered information on the postoperative rehabilitation protocol have been selected. Subsequently, the results and complications have been analysed according to the protocols. Fifteen of the 7056 initial articles have been selected for analysis. Authors who did not restrict weight bearing to their patients reported a shorter hospitalization time and a lower orthopaedic complication rate but a greater systemic complication rate, worse functional scores, and a higher reoperation and mortality rates. Those results should be taken with caution because of the heterogeneity of provided clinical information and the fact that none of the included studies considered the different rehabilitation protocols as study variables to analyse its influence on the results. With evidence available to date, there is no clear agreement on the postoperative rehabilitation protocol following fixation of an unstable trochanteric fracture by cephalomedullary nail in the elderly.

Outcomes of U-Blade Lag Screw for Cephalomedullary Fixation of Unstable Trochanteric Femur Fractures: A Case Control Study.

Background:Unstable trochanteric femur fractures in elderly patients with osteoporosis are still challenging. Gamma3 nail with the U-blade lag screw (U-blade gamma nail) has been developed to improve mechanical stability of proximal femoral fragment. This study aimed to compare the clinical and radiologic outcomes of U-blade gamma nail to proximal femoral nail antirotation (PFNA), and standard Gamma3 nail (gamma nail) for unstable trochanteric femur fractures.Methods:A retrospective matched-pair case study was performed with U-blade gamma nail, PFNA, and gamma nail. During 2012-2018, 970 patients with unstable trochanteric femur fractures were reviewed. Matching criteria were set as follows: 1) sex; 2) age (± 3 years); 3) body mass index (± 2 kg/m2); 4) bone mineral density (± 1 T-score in femur neck). Finally, a total of 159 patients were enrolled. We assessed the tip-apex distance (TAD), neck shaft angle, and hip screw sliding distance using plain radiographs. Also, we evaluated the clinical outcomes with Koval’s grade and fixation failure during 2 years.Results:The mean postoperative TAD was not significantly different among the 3 groups (p = 0.519). However, the change in the TAD at 1 year (p = 0.027) and 2 years (p = 0.008) after surgery was significantly smaller in U-blade gamma nail group compared with PFNA and gamma nail group. The hip screw sliding distance at 1 year (p = 0.004) and 2 years (p = 0.001) after surgery was significantly smaller in U-blade gamma nail group compared with PFNA and gamma nail group. However, there was no significant difference of Koval’s grade and fixation failure among the 3 groups (p = 0.535).Conclusion:U-blade gamma nail showed favorable radiologic results in terms of the change in the hip screw position. However, U-blade gamma nail was not superior to PFNA and gamma nail in clinical outcomes.

Management of unstable pertrochanteric fractures, evaluation of forgotten treatment options

Introduction: Unstable trochanteric fractures are challenging with a high rate of implant failure and re-operation. Cephalomedullary nails proved to be a rational management choice for these injuries, yet other management options have not been well assessed. The aim of this study was to compare the use of DHS with trochanteric stabilizing plate (TSP) and proximal femoral locked plate (PFLP) in unstable pertrochanteric fractures. Methods: This randomized controlled trial (RCT) included 40 patients (22 males, 18 females) with unstable pertrochanteric fractures (AO/OTA 31A2.2/A2.3). The patients were randomized into group 1 managed by DHS with TSP while group 2 was managed by PFLP. All patients were followed up for 1 year. Patients were assessed radiographically and clinically using Harris hip score (HHS) at 3, 6 and 12 months. Operative time, estimated blood loss and time to union were also compared. Results: The difference of intra-operative variables, including operative time and intra-operative blood loss, between both groups was statistically insignificant. Time to bony union was faster in the first group with a statistically significant P value (p = 0.04). Functional outcome per HHS was significantly better in group 1 (p < 0.01) and implant failure in group 1 occurred statistically lesser (p < 0.01). Discussion: DHS with TSP appears to be a good option of management for unstable pertrochanteric fractures. In contrast, the use of PFLP in unstable pertrochanteric fractures in the elderly does not appear to be a good alternative.

Hip arthroplasty in unstable trochanteric fractures in elderly

Hip arthroplasty in unstable trochanteric fractures in elderly

Role of arthroplasty in unstable trochanteric fractures in elderly patients

Objective: Unstable intertrochanteric fractures in elderly patients pose a challenge for treatment in view of coexistent medical problems and osteoporosis. Osteosynthesis in these group of patients often leads to implant failure and also does not allow early weight bearing. The objective of the present study is evaluate Arthroplasty as primary treatment of choice in these unstable intertrochanteric fractures in elderly. Methods: Between January 2013 to Feb 2016, 25 elderly patients with unstable intertrochanteric fractures who had undergone arthroplasties (Hemi/THR) were followed up. Their fractures were classified according to the AO/OTA classification and their osteoporosis was evaluated by Singh’s index and graded accordingly. After optimization of medical problems and pre-anesthetic workup, Arthroplasty was performed in all patients and the outcomes analyzed using the Harris hip score system.Conclusion: In select elderly patients with unstable intertrochanteric fractures arthroplasty has a role instead of Osteosynthesis which allows early pain free mobilization of patients, thereby avoiding revision surgeries, prolonged morbidity and uncertainty associated with Osteosynthesis.

Outcomes of Unstable Trochanteric Fractures Treated with Short Proximal Femoral Nail

AbstractBackground: Hip fractures are considered one of the major health problems in aging populations. These fractures are associated with increased disability and mortality and decreased quality of life. Nowadays, most hip fractures are treated by extramedullary or intramedullary implants, which allow a stable fixation in the majority of cases.Aim of Study: Is to evaluate clinical, radiological and functional outcomes of short proximal femoral nail in treatment of unstable trochanteric femoral fractures.Patients and Methods: 21 patients with unstable trochanter-ic fractures underwent fixation with proximal femoral nail, assessment was done using Harris hip score.Results: 15 patients achieved satisfactory results (seven excellent-eight good), four cases had fair outcome and two cases had poor outcome, one case had deep wound infection that led to backing out of screws and fixation failure.Conclusion: The proximal femoral nail provides a stable construct for fixation of unstable trochanteric fractures that allows early post-operative weight bearing with minimal incidence of implant related failures.

FUNCTIONAL OUTCOME IN PATIENTS TREATED WITH PROXIMAL FEMORAL NAIL IN TYPE TWO UNSTABLE TROCHANTERIC FRACTURES: A PROSPECTIVE STUDY

Background: For many years, the sliding hip screw and plate had been the gold standard in treating pertrochanteric fractures. there is always a grey zone of decision of implant to be applied in unstable type A2.2 and A2.3 fractures. This study was designed for the functional outcome of the PFN device in patients with unstable type 2 trochanteric fractures (AO/ASIF classification: 31-A2.2 & 31-A2.3) Material and method: In this prospectively designed study, 30 consecutive patients having Fracture according to AO/ASIF classification 31-A2.2 and 31- A2.3 are included for the study. The functional outcome and clinical results of the patients was evaluated and graded using HARRIS HIP SCORE system. Patients were followed up fortnightly in the first month, then monthly until 6 months or till clinical or radiological union is achieved. Results: The average blood loss in PFN was 88.3ml. Hospital stay after surgery in PFN was average days 4.13. Harris hip score in PFN 22 (73.33%) were good, 06 (20%) were fair and 02 (6.66%). Average time of union in PFN was 13.4 weeks. Conclusion: Functional and radiological status of PFN was much better in unstable type of intertrochanteric fractures. It provides a advantage of lesser blood loss, shorter operating time, faster union, better functional outcome and low infection and complication rate. Keywords: Unstable trochanteric fractures, PFN

Implanted related complications and mortality after gamma nail fsor unstable trochanteric fractures: (a report of 450 consecutive cases)

Implanted related complications and mortality after gamma nail fsor unstable trochanteric fractures: (a report of 450 consecutive cases)

Tip-apex distance and other predictors of outcome in cephalomedullary nailing of unstable trochanteric fractures

BackgroundCephalomedullary nails are presently the gold standard in management of unstable trochanteric fractures. The tip-apex distance (TAD) is one of the most important factors that determines success or failure of fixation, but was described originally in context of an extramedullary hip screw. Cephalomedullary nails use a different biomechanical approach to fixation; and it is hypothesized that the TAD rule may not apply similarly with these. The aim of this study is to assess whether a high TAD correlates with poor outcomes with cephalomedullary nails, and to elucidate other factors that may predict such outcome. MethodsWe retrospectively reviewed the clinical and radiographic records of patients with intertrochanteric fractures, treated at our institution over a 2-year period. Those with unstable fractures (31.A2 and 31.A3), and who were treated with cephalomedullary nails were included in the study. The TAD and the position of the device in the femoral head (Cleveland index) were assessed. Other factors that could influence outcome like age, gender, AO fracture type, restoration of neck-shaft angle and degree of osteoporosis were analysed. Radiographic records of up-to at-least 3 months post-operatively were assessed for complications. ResultsAfter applying the exclusion criteria, 75 patients were included in the analysis. The overall rate of complications was 12%. They occurred in two major patterns - varus collapse and cut-out occurred in 5 patients (6.67%), and device migration in 4 patients (5.33%). The average TAD of patients with cut-out was 28.78 mm, compared to 19.44 mm in those without cut-out (p = 0.002). Our data predicted a cut-off TAD >23.56 mm as most significant for cut-out with cephalomedullary nails. On univariate logistic regression, high TAD (p = 0.009), sub-optimal device positioning (p = 0.02) and poor restoration of neck-shaft angle (p = 0.04) were found to be significant for varus collapse and cut-out, but not for complications relating to device migration. On multivariate analysis, none of the above factors reached statistical significance in isolation. ConclusionAs with extramedullary devices, TAD, along with sub-optimal device positioning and poor restoration of neck-shaft angle is a useful predictor of cut-out even with cephalomedullary nails, negating the initial hypothesis. The above factors in combination have a more significant effect than any one factor in isolation to cause varus collapse and implant cut-out. However these do not affect Z effect, reverse Z effect or other types of device migration seen especially with dual-screw nails.

Analysis of outcome of proximal femoral nailing in unstable trochanteric fractures: A prospective study

Inter-trochanteric fractures are the common fractures of hip which occurs in young adults as a result of high velocity injury and in osteoporotic elderly due to low velocity injury. Inter-trochanteric fractures are treated by various surgical modalities. Proximal femoral nailing is now been used widely for the treatment of unstable inter-trochanteric fractures. The clinical and radiological outcomes are good with low rates of complications. We prospectively studied 36 unstable inter-trochanteric fractures treated with proximal femoral nailing. The overall functional result was assessed by the Harris Hip Score which was Excellent in 13.34%, Good in 41.67%, Fair in 19.44% and Poor only in 5.55%.