Cephalomedullary Nails in the Treatment of High-energy Proximal Femur Fractures in Young Patients: A Prospective, Randomized Comparison of Trochanteric Versus Piriformis Fossa Entry Portal

Background: Hip fractures are recognized to be a major public health problem. Key determinants of hip fractures include age, osteoporosis, and falls. In these determinants socioeconomic status, have not been well explored. Under eccentric loading, high bending loads occur, leading to failure of the osteosynthetis anchorage at the center of the femoral head.The introduction of the reconstruction nail has broadened the indications for the intramedullary fixation of difficult femoral fractures. The operative technique is however complicated. Some technical difficulties encountered during its use are presented together with guidance to allow these problems to be avoided.Methods: This Study had included 47 cases which were operated by single surgeon and use of different implant (cephalomedullary nail) was randomized irrespective of fracture types and pattern. This study was done over a period of 12 months (October 2013 to October 2014) with 1 month, 3 months, 6 months, 12 months follow up. At every visit patient were assessed as per Oxford hip score. Type of implant used was PFNA, Intertan, Sirus Nail.Results: The mean age of the patients was 65.68 (±13.55) years. Severe pain was observed among majority of the patients at one month (70.2%) which became mild (40.4%) and moderate (34%) at 3 months. Very mild pain was found in 36.2% patients at 6 months and in 61.7% at 12 months. The limping was all the time among all the patients at one month. However, the limping was found often in 46.8% at 3 months and sometimes in 57.4% at 6 months and 53.2% at 12 months. The hip score was found to be severe among all the patients at one month. However, moderate to severe hip was in 46.8% patients at 3 months, mild to moderate was in 57.4% at 6 months and satisfactory joint function was in 68.1% at 12 months. The comparison of Hip score according to long or short nail at one 3, 6 and 12 months showed no difference. Conclusions: Cephalomedullary nails with adequate technique so that the lag screws by purchase in the centre-centre or posterior-inferior quadrant combines the benefit of sliding hip screw as well as intramedullary implants. So we recommend the use of cephalomedullary nails in proximal femur fractures especially the unstable fractures.

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Avoiding malalignment in proximal femur fractures treated with newer generation cephalomedullary nails: Some technical tips

Journal of Clinical Orthopaedics and Trauma ◽

10.1016/j.jcot.2018.11.008 ◽

2019 ◽

Vol 10 ◽

pp. S242-S246

Author(s):

Arvind Kumar ◽

Samarth Mittal ◽

Aditya Jain ◽

Vivek Trikha

Keyword(s):

Proximal Femur ◽

Proximal Femur Fractures ◽

Femur Fractures ◽

Cephalomedullary Nails

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

Journal of Orthopaedic Trauma ◽

10.1097/bot.0000000000001505 ◽

2019 ◽

Vol 33 (7) ◽

pp. 335-340 ◽

Cited By ~ 2

Author(s):

Marschall B. Berkes ◽

Patrick C. Schottel ◽

Matthew Weldon ◽

Denise H. Hansen ◽

Timothy S. Achor

Keyword(s):

Proximal Femur ◽

Plate Fixation ◽

High Energy ◽

Blade Plate ◽

Proximal Femur Fractures ◽

Femur Fractures

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High-Energy Proximal Femur Fractures in Geriatric Patients

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/2151458511427702 ◽

2011 ◽

Vol 2 (5-6) ◽

pp. 195-202 ◽

Cited By ~ 7

Author(s):

Jens Hahnhaussen ◽

David J Hak ◽

Sebastian Weckbach ◽

Wolfgang Ertel ◽

Philip F Stahel

Keyword(s):

Proximal Femur ◽

Geriatric Patients ◽

High Energy ◽

Proximal Femur Fractures ◽

Femur Fractures

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06 - 95° Angled Blade Plate Fixation of High-Energy Unstable Proximal Femur Fractures Results in High Rates of Union and Minimal Complications

10.26226/morressier.5cffabaef6074e97f94aae29 ◽

2019 ◽

Author(s):

Marschall Berkes ◽

Timothy Achor ◽

Patrick C Schottel

Keyword(s):

Proximal Femur ◽

Plate Fixation ◽

High Energy ◽

Blade Plate ◽

Proximal Femur Fractures ◽

Femur Fractures

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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.

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Geriatric Proximal Femur Fractures During the Covid-19 Pandemic - Fewer Cases, But More Comorbidities

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/21514593211009657 ◽

2021 ◽

Vol 12 ◽

pp. 215145932110096

Author(s):

Christina Polan ◽

Heinz-Lothar Meyer ◽

Manuel Burggraf ◽

Monika Herten ◽

Paula Beck ◽

...

Keyword(s):

Nursing Home ◽

Elderly Patients ◽

Proximal Femur ◽

Minor Trauma ◽

Proximal Femur Fractures ◽

Femur Fractures ◽

Number Of Patients ◽

Group 2 ◽

The Impact ◽

Group 1

Background: The COVID-19 pandemic is challenging healthcare systems worldwide. This study examines geriatric patients with proximal femur fractures during the COVID-19 pandemic, shifts in secondary disease profile, the impact of the pandemic on hospitalization and further treatment. Methods: In a retrospective monocentric study, geriatric proximal femur fractures treated in the first six months of 2020 were analyzed and compared with the same period of 2019. Pre-traumatic status (living in a care home, under supervision of a legal guardian), type of trauma, accident mechanism, geriatric risk factors, associated comorbidities, time between hospitalization and surgery, inpatient time and post-operative further treatment of 2 groups of patients, aged 65-80 years (Group 1) and 80+ years (Group 2) were investigated. Results: The total number of patients decreased (70 in 2019 vs. 58 in 2020), mostly in Group 1 (25 vs. 16) while the numbers in Group 2 remained almost constant (45 vs. 42). The percentage of patients with pre-existing neurological conditions rose in 2020. This corresponded to an increase in patients under legal supervision (29.3%) and receiving pre-traumatic care in a nursing home (14.7%). Fractures were mostly caused by minor trauma in a home environment. In 2020, total number of inpatient days for Group 2 was lower compared to Group 1 (p = 0.008). Further care differed between the years: fewer Group 1 patients were discharged to geriatric therapy (69.6% vs. 25.0%), whereas in Group 2 the number of patients discharged to a nursing home increased. Conclusions: Falling by elderly patients is correlated to geriatric comorbidities, consequently there was no change in the case numbers in this age group. Strategic measures to avoid COVID-19 infection in hospital setting could include reducing the length of hospital stays by transferring elderly patients to a nursing home as soon as possible and discharging independent, mobile patients to return home.

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