Operative management of periprosthetic femur fractures in the elderly using biological fracture reduction and fixation techniques

BACKGROUND: Femoral Inter-Trochanteric fracture is one of the most frequently occurring fractures in the elderly, usually following trivial trauma. In the younger age group of people, it occurs almost always due to high velocity trauma. OBJECTIVES: This study aimed to study the functional and radiological outcomes of operative management of intertrochanteric fracture treated by PFN-A2. MATERIAL & METHODS: A prospective study of 20 cases of intertrochanteric femur fracture treated by PFN-A2, minimum 6 months of follow up. All cases are evaluated according to Modified Harris Hip Score on residual effects on clinical ground at final examination. Pain & functional capacity are the two basic considerations for this scoring system. Points are given for pain, function, range of motion & absence of deformity. RESULT: Functional result according to Modified Harris Hip score was found to be excellent in 11(55%) patients, good in 5(25%) patients, fair in 3(15%) patients & poor in 1(5%) patients. poor outcome occurs due to development of complications. CONCLUSION : PFN A2 has the advantage of minimal incision, shorter operative time, rapid rehabilitation, lower medical complications among other options.

Download Full-text

A biomechanical study on proximal plate fixation techniques in periprosthetic femur fractures

Injury ◽

10.1016/j.injury.2013.10.027 ◽

2014 ◽

Vol 45 ◽

pp. S71-S75 ◽

Cited By ~ 33

Author(s):

Mark Lenz ◽

Stephan M. Perren ◽

Boyko Gueorguiev ◽

Robert G. Richards ◽

Gunther O. Hofmann ◽

...

Keyword(s):

Plate Fixation ◽

Biomechanical Study ◽

Femur Fractures ◽

Fixation Techniques ◽

Periprosthetic Femur Fractures

Download Full-text

Fracture Reduction and Fixation Techniques

10.1007/978-3-030-24608-2 ◽

2020 ◽

Keyword(s):

Fracture Reduction ◽

Fracture Reduction And Fixation ◽

Fixation Techniques

Download Full-text

Fracture Reduction and Fixation Techniques

10.1007/978-3-319-68628-8 ◽

2018 ◽

Keyword(s):

Fracture Reduction ◽

Fracture Reduction And Fixation ◽

Fixation Techniques

Download Full-text

Management of proximal femur fractures in the elderly: current concepts and treatment options

European Journal of Medical Research ◽

10.1186/s40001-021-00556-0 ◽

2021 ◽

Vol 26 (1) ◽

Author(s):

H. Fischer ◽

T. Maleitzke ◽

C. Eder ◽

S. Ahmad ◽

U. Stöckle ◽

...

Keyword(s):

Proximal Femur ◽

Treatment Options ◽

Fluid Management ◽

Young Patients ◽

The Elderly ◽

Operative Management ◽

Old Patients ◽

Proximal Femur Fractures ◽

Femur Fractures ◽

Frail Patients

AbstractAs one of the leading causes of elderly patients’ hospitalisation, proximal femur fractures (PFFs) will present an increasing socioeconomic problem in the near future. This is a result of the demographic change that is expressed by the increasing proportion of elderly people in society. Peri-operative management must be handled attentively to avoid complications and decrease mortality rates. To deal with the exceptional needs of the elderly, the development of orthogeriatric centres to support orthogeriatric co-management is mandatory. Adequate pain medication, balanced fluid management, delirium prevention and the operative treatment choice based on comorbidities, individual demands and biological rather than chronological age, all deserve particular attention to improve patients’ outcomes. The operative management of intertrochanteric and subtrochanteric fractures favours intramedullary nailing. For femoral neck fractures, the Garden classification is used to differentiate between non-displaced and displaced fractures. Osteosynthesis is suitable for biologically young patients with non-dislocated fractures, whereas total hip arthroplasty and hemiarthroplasty are the main options for biologically old patients and displaced fractures. In bedridden patients, osteosynthesis might be an option to establish transferability from bed to chair and the restroom. Postoperatively, the patients benefit from early mobilisation and early geriatric care. During the COVID-19 pandemic, prolonged time until surgery and thus an increased rate of complications took a toll on frail patients with PFFs. This review aims to offer surgical guidelines for the treatment of PFFs in the elderly with a focus on pitfalls and challenges particularly relevant to frail patients.

Download Full-text

The role of the internal medicine specialist in the management of infective complications in general surgical wards

Italian Journal of Medicine ◽

10.4081/itjm.2008.2.12 ◽

2013 ◽

pp. 12-19

Author(s):

Patrizia Zoboli ◽

Giuseppe Chesi ◽

Fabrizio Boni ◽

Federica Maselli ◽

Lisa Zambianchi

Keyword(s):

Internal Medicine ◽

Elderly Patients ◽

Risk Evaluation ◽

Medical Condition ◽

The Elderly ◽

Operative Management ◽

Surgical Team ◽

Medical Consultant ◽

Post Surgery

BACKGROUND Internal medicine specialists are often asked to evaluate a patient before surgery. Perioperative risk evaluation for elderly patients is important, because complications increase with age. The increasing age of the general population increases the probabilities of surgery in the older patients. The manifestation of a surgical problem, is more likely to be severe and complicated in the elderly patients. In fact, emergency surgery treatment occurs more frequently in the elderly (e.g., it is much more common to see intestinal obstruction complicating colorectal cancer in the elderly compared with a younger population). Old age is an independent factor for long hospital stay after surgery. The role of the preoperative medical consultant is to identify and evaluate a patient’s current medical status and provide a clinical risk profile, in order to decide whether further tests are indicated prior to surgery, and to optimise the patient’s medical condition in the attempt of reducing the risk of complications. The medical consultant must know which medical condition could eventually influence the surgery, achieve a good contact and communication between the medical and surgical team, in order to obtain the best management planning. AIM OF THE STUDY This paper focuses on the rational use of antibiotic prophylaxis and on the treatment of the complications of post-surgery infections (e.g., pulmonary complication, peritonitis, intra-abdominal infection). Specific aspects of pre-operative risk evaluation and peri and post-operative management are discussed. CONCLUSIONS The internal medicin specialist in collaboration with the surgical team is necessary in the peri and post-surgery management.

Download Full-text

COMplex Fracture Orthopedic Rehabilitation (COMFORT) - Real-time visual biofeedback on weight bearing versus standard training methods in the treatment of proximal femur fractures in the elderly: study protocol for a multicenter randomized controlled trial

Trials ◽

10.1186/s13063-018-2612-9 ◽

2018 ◽

Vol 19 (1) ◽

Cited By ~ 4

Author(s):

Marco Raaben ◽

Syaiful Redzwan ◽

Robin Augustine ◽

Taco Johan Blokhuis

Keyword(s):

Controlled Trial ◽

Weight Bearing ◽

The Elderly ◽

Training Methods ◽

Randomized Controlled ◽

Femur Fractures ◽

Visual Biofeedback ◽

Orthopedic Rehabilitation ◽

Multicenter Randomized Controlled Trial ◽

Standard Training

Download Full-text

Orthopaedic surgery

10.1093/med/9780198799481.003.0016 ◽

2021 ◽

pp. 597-698

Keyword(s):

Fracture Healing ◽

Bone Healing ◽

Orthopaedic Surgery ◽

Fracture Reduction ◽

Fracture Reduction And Fixation ◽

Reduction Techniques ◽

Careful Handling ◽

Tunnel Syndrome ◽

Primary Bone ◽

Secondary Bone Healing

This chapter examines orthopaedic surgery. It begins by detailing the examination of a joint and of the limbs and trunk. The chapter then discusses fracture healing and the reduction and fixation of fractures. Fracture healing occurs as either primary or secondary bone union. Primary bone healing does not produce callus, while secondary bone healing does. Modern fracture reduction and treatment centres around four key principles: fracture reduction and fixation to restore anatomical relationships; stability by fixation or splintage as the personality of the fracture and the injury dictates; preservation of the blood supply to the soft tissue and bone by careful handling and gentle reduction techniques; and early and safe mobilization of the part and patient. Finally, the chapter looks at the skeletal radiograph and considers injuries of the phalanges and metacarpals; wrist injuries; dislocations and fractures of the elbow, shoulders, ribs, pelvis, and neck; spinal injuries; bone tumours; osteoarthrosis (osteoarthritis); Paget’s disease (osteitis deformans); and carpal tunnel syndrome.

Download Full-text