scholarly journals Internal Fixation of Intertrochanteric Hip Fractures: A Clinical Comparison of Two Implant Designs

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Ran Tao ◽  
Yue Lu ◽  
Hua Xu ◽  
Zhen-Yu Zhou ◽  
You-Hua Wang ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Weight Bearing ◽  
Harris Hip Score ◽  
Femur Fractures ◽  
Fixation Devices ◽  
Duration Of Surgery ◽  
Envelope Method ◽  
Bony Healing ◽  
Proximal Femur Nail

Objective. To compare two internal fixation devices clinically in stabilisation of intertrochanteric femur fractures.Methods. Eighty-seven patients were randomised upon their admission to the hospital using a sealed envelope method. Forty-five were treated with proximal femur nail antirotation (PFNA) and 42 with reverse less invasive stabilisation system (LISS). The perioperative data were recorded and compared in relation to fracture type.Results. In each type of fractures, no significant differences were found with respect to the blood loss, the quality of reduction, the time to bony healing, and the Harris hip score between the 2 groups. The mean duration of surgery was significantly longer in reverse LISS group than in PFNA group.Conclusion. Both the PFNA and the reversed LISS are effective in the treatment of different types of intertrochanteric femur fractures. PFNA is superior to reverse LISS in terms of surgical time, weight-bearing, and perhaps fluoroscopy time.

scholarly journals Hip function and health-related quality of life in intramedullary and extramedullary internal fixation of trochanteric fractures

2020 ◽  
Vol 148 (7-8) ◽  
pp. 451-454
Author(s):  
Milan Mitkovic ◽  
Sasa Milenkovic ◽  
Ivan Micic ◽  
Igor Kostic ◽  
Predrag Stojiljkovic ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Internal Fixation ◽  
Harris Hip Score ◽  
Health Related Quality ◽  
Trochanteric Fractures ◽  
Component Score ◽  
Related Quality ◽  
Health Related ◽  
Hip Function

Introduction/Objective. There are extramedullary and intramedullary methods of trochanteric fractures? internal fixation with implants having a lag screw. The objective of this study was to examine the difference in impact of these fixation types on final hip function and health-related quality of life. Method. There were 75 patients treated for a trochanteric fracture, using self-dynamisable internal fixator (SIF group), as an extramedullary method, or gamma nail (GN group), as an intramedullary method. These patients were called for the evaluation of Harris Hip Score (HHS) and SF-12 questionnaire at least two years after surgery. The SF-12 questionnaire has dual expression ? physical component score (PCS) and mental component score (MCS). Results. There were no significant differences between the SIF group and the GN group regarding HHS, PCS, and MCS. Positive correlation was confirmed between HHS, PCS, and MCS, with the strongest relation between HHS and PCS. Negative correlation was confirmed between age and HHS. Conclusion. There was no difference in final hip function and health-related quality of life between SIF and GN methods in trochanteric fractures treatment (p > 0.05). These parameters of outcome were confirmed to have positive interrelation (p < 0.05). Both submuscular presence of extramedullary implant with dimensions of SIF and the need for bone reaming in cephalomedullary fixation were considered not to have significant impact in HHS and SF-12 scores after trochanteric fractures treatment by internal fixation.

Evidence Based Management of Intracapsular Neck of Femur Fractures

2017 ◽  
Vol 27 (5) ◽  
pp. 415-424 ◽  
Author(s):  
Wayne Hoskins ◽  
Darren Webb ◽  
Roger Bingham ◽  
Marinis Pirpiris ◽  
Xavier L. Griffin
Keyword(s):  
Quality Of Life ◽  
Cognitive Impairment ◽  
Internal Fixation ◽  
Standard Of Care ◽  
Minimal Risk ◽  
Neck Of Femur ◽  
Femur Fractures ◽  
Increased Risk ◽  
Reoperation Rates

Neck of femur fractures are occurring at an increased incidence. Functionally independent patients without cognitive impairment can expect reasonable life expectancy. This indicates the need for a durable surgical option that optimises the chance to return to pre-injury functional status, with minimal risk of complications and reoperation. Most fractures are displaced. Surgical options include internal fixation, hemiarthroplasty or total hip arthroplasty (THA). Evidence is conclusive that arthroplasty options outperform internal fixation in terms of function, quality of life and reoperation rates. In anyone other than young patients where head preserving surgery is required, arthroplasty is the standard of care. Hemiarthroplasty is the heavily favoured arthroplasty option for surgeons. However, in patients other than the extreme elderly, medically infirm, neurologically impaired, or with little or no ambulatory capacity, the evidence to support hemiarthroplasty is lacking. In functionally independent patients without cognitive impairment, THA should be considered the gold standard, producing better functional and quality of life outcomes, lower reoperation rates and better cost effectiveness, with no difference in complications or mortality. An increased risk of dislocation does exist. This may be reduced with modern surgical technique and implant options. Low amounts of research have been afforded to undisplaced fractures. For this fracture type, surgery is the standard of care. Despite a higher risk of reoperation, internal fixation is the preferred option for all age groups. Further study is required to identify the difference between internal fixation and THA, in particular, for unstable fracture patterns in elderly patients.

scholarly journals Short-Term Clinical Efficacy of Femoral Neck System Versus Multiple Cannulated Compression Screws in the Treatment of Garden III and IV Femoral Neck Fractures

2022 ◽  
Author(s):  
Xuefeng Zhou ◽  
Sichao Gu ◽  
Li Li ◽  
Lei Xu ◽  
Xujin Wang ◽  
...  
Keyword(s):  
Femoral Neck ◽  
Internal Fixation ◽  
Clinical Efficacy ◽  
Weight Bearing ◽  
Operation Time ◽  
Femoral Neck Fractures ◽  
Teaching Hospitals ◽  
Harris Hip Score ◽  
Clinical Report ◽  
Short Term

Abstract Femoral neck system (FNS) , as a novel minimally invasive internal fixation device, has been gradually applied in the treatment of femoral neck fracture.However, there are few related clinical studies on FNS at present, especially there is no clinical report on FNS in treating GardenIII and IV femoral neck fractures. The aim of the present study was to compare the short-term clinical efficacy of FNS and multiple cannulated compression screws (MCCS) in the treatment of Garden III and IV femoral neck fractures. The data of 78 patients with femoral neck fracture who were admitted to three teaching hospitals affiliated to Anhui Medical University and received internal fixation with FNS and MCCS from June 2019 to December 2020 were collected for a retrospective study. There were 39 patients in both the FNS and MCCS groups. The basic data, perioperative data were recorded and compared between the two groups of patients. The results of the study are encouraging. The operation time was shorter in FNS group than that in MCCS group (p<0.001). The post-operative partial and complete weight-bearing time was earlier in FNS group than that in MCCS group (p<0.001). The Harris hip score in FNS group was higher than that in MCCS group (p<0.001). The incidence rate of lateral thigh irritation in FNS group and MCCS group was 0 (0/39) and 33.3% (13/39), respectively (χ2=15.600, p<0.001). The length of femoral neck shortening was significantly shorter in FNS group than that in MCCS group (t=-5.093, p<0.001). In conclusion, The application of FNS for Garden III and IV femoral neck fractures can shorten the operation time, reduce the frequency of intraoperative fluoroscopy, and facilitate the recovery of hip joint function, so it provides a novel choice for the treatment of Garden III and IV femoral neck fractures in young people.

scholarly journals Dual mobility total hip arthroplasty for salvaging failed internal fixation for neck of femur fractures

2020 ◽  
Vol 27 (1) ◽  
pp. 68-71
Author(s):  
Jatinder Singh Luthra ◽  
Suwailim Al Ghannami ◽  
Salim Al Habsi ◽  
Soubhik Ghosh
Keyword(s):  
Total Hip Arthroplasty ◽  
Internal Fixation ◽  
Hip Fractures ◽  
Hip Arthroplasty ◽  
Harris Hip Score ◽  
Neck Of Femur ◽  
Dual Mobility ◽  
Wound Debridement ◽  
Total Hip ◽  
Femur Fractures

Internal fixation is commonly used to treat fractures in the hip. However, failure of proximal femoral fracture fixation is common and treated with total hip replacement (THR). The aim of this study is to present our midterm results of dual mobility (DM) THR for failed internal fixation of proximal femur fractures. Between 2010 and 2015, a total of 28 cases of failed internal fixation for hip fractures were treated through DM total hip arthroplasty. Two patients died during the early postoperative period due to medical complications. The average follow-up was 3.4 years. We had one patient with superficial surgical site infection which was managed by local wound debridement and dressings. The average Harris hip score was 85. DM THR is the procedure of choice for revising failed internal fixation for hip fractures in our patients with good clinical outcome.

386 Proximal Femoral Nail (PFN) Versus Dynamic Hip Screw (DHS) In Unstable Intertrochanteric Fractures of Femur -A Comparative Clinical Study

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
V Dubey ◽  
B Spiegelberg ◽  
S Shahane ◽  
A Samant
Keyword(s):  
Blood Loss ◽  
Randomized Study ◽  
Dynamic Hip Screw ◽  
Harris Hip Score ◽  
Intertrochanteric Fractures ◽  
Leg Length ◽  
Femur Fractures ◽  
Intertrochanteric Femoral Fracture ◽  
Duration Of Surgery ◽  
Hip Screw

Abstract Introduction The goal of treatment of an intertrochanteric femoral fracture is restoration of patient's mobility as early as possible. The dynamic hip screw (DHS) has been used for several decades to treat these fractures. Proximal femoral nails (PFN) are reported to have an advantage in such fractures. This study aims at comparing the results of unstable intertrochanteric fractures femur treated with PFN and DHS. Method This was a prospective, randomized study which includes sixty patients. All patients were available for follow up with 30 patients in each group. The data about intraoperative blood loss, time to union, leg length shortening was collected. The functional outcome at the end of one year was evaluated using Harris Hip Score. Results Blood loss, duration of surgery, time to union and leg length shortening was significantly less in the patients treated with PFN (p &lt; 0.05). The mean harris hip score for patients managed with PFN was significantly more than in DHS group, 12 months after surgery (p = 0.05). Conclusions PFN requires a smaller incision, lesser operative time, less blood loss and has improved functional results. In our opinion PFN may be a better fixation device for most of the unstable intertrochanteric femur fractures.

scholarly journals Bipolar Hemiarthroplasty as Coxofemoral Bypass Technique in Treating Unstable Pertrochanteric Comminuted Fracture of Elderly Patients

2021 ◽  
Vol 10 (43) ◽  
pp. 3683-3688
Author(s):  
Neetin Pralhad Mahajan ◽  
Pramod K. Bagimani ◽  
Kartik Prashant Pande ◽  
Ravi Rameshbhai Dadhaniya
Keyword(s):  
Average Duration ◽  
Harris Hip Score ◽  
Common Mechanism ◽  
Bipolar Hemiarthroplasty ◽  
Pertrochanteric Fractures ◽  
Femur Fractures ◽  
Early Return ◽  
Study Results ◽  
Duration Of Surgery ◽  
Pertrochanteric Femur Fractures

BACKGROUND Pertrochanteric fractures in the elderly are highly unstable and osteoporotic. Comminution of fragments and distraction fragments make union difficult owing to forces acting on the proximal hip joint. The internal fixation in these cases leads to prolonged bed rest and immobilization to prevent implant failure. The purpose of this study was to analyse the role of bipolar hemiarthroplasty in cases of unstable pertrochanteric femur fractures as bypassing forces transmission through the proximal femur. METHODS 30 patients with pertrochanteric fractures were randomized and operated on as bipolar hemiarthroplasty using the indigenous bipolar prosthesis between July 2017 and July 2021. The inclusion criteria were patients more than 65 years of age, Type 4 intertrochanteric fracture (As per Evans classification) AO/ OTA type 31A2.3, 31A3.2, 31A3.3. Patients with polytrauma, compound injuries, pathological fractures and medically unfit patients were excluded from the study. RESULTS The mean age was 67 ± 5 years. The most common mechanism of injury was domestic fall comprising 80 %. The average duration of surgery from the time of injury was 3.5 ± 1.5 days. The average surgical duration was 85.5 mins. The average duration of stay in the hospital was 8.5 ± 1.5 days. Final results were calculated using the Harris Hip score with 33.3 % cases as excellent, 56.6 % cases as good and 10 % cases had fair results respectively. Follow-up was done at 6 weeks, 3, 6, 12 and 24 months. CONCLUSIONS Bipolar hemiarthroplasty in pertrochanteric femur fractures has the advantage of stable adequate fixation with early return to activities of daily living, thus preventing serious life-threatening complications. KEY WORDS Intertrochanteric Fractures, Hemiarthroplasty, Femur, Harris Hip Score

scholarly journals Finite Element Analysis of Proximal Femoral Nail Anti-Rotation Blade Combined with Cerclage Wire Fixation for Osteoporotic Subtrochanteric Fracture

2021 ◽  
Vol 4 (3) ◽  
Keyword(s):  
Internal Fixation ◽  
Weight Bearing ◽  
Bed Rest ◽  
Biological Properties ◽  
Subtrochanteric Fracture ◽  
Intramedullary Nails ◽  
Element Analysis ◽  
Cerclage Wire ◽  
Subtrochanteric Fractures ◽  
Femur Fractures

Osteoporosis is a type of systemic bone disease wherein the patient is highly vulnerable to bone fracture because of the decrease in bone density and quality, destruction of the bone microstructure, and an increase in the bone fragility. Most of the osteoporotic subtrochanteric fractures are unstable in nature, requiring the conservative treatment of a long-duration bed rest and traction; this condition is prone to complications resultant from extended bed rest, often leading to death. Presently, the preferred treatment is internal fixation, such as sliding hip screws, blade plates, locking compression plates, and femoral intramedullary nails [1-8]. Owing to its valuable biological properties, intramedullary nail can be used for the optimal fixation of subtrochanteric fractures [9-11]. Unless any contraindication exist, immediate tolerable weight-bearing activities may be allowed to patients with subtrochanteric femur fractures who have been treated with statically locked intramedullary nails [12]. Considering that the proximal femoral fracture occurs under the traction of the surrounding muscles, it is extremely challenging to perform precision reduction and fixation in the surgery. Inappropriate reduction and selection of internal fixation can easily lead to failure of internal fixation, resulting in complications such as lower limb shortening deformity, hip varus deformity, and nonunion of fracture. Presently, good outcomes have been reported with the use of PFNA combined with cerclage wire for the treatment of subtrochanteric fracture of the femur [13-15]. There are few studies to help decide whether PFNA should be combined with cerclage wire or used alone according the Seinsheimer classification of subtrochanteric fractures.

scholarly journals Which TAD and CALTAD Cut-Offs Best Predict Cut-Out Risk for Intramedullary Fixation of Proximal Femur Fractures?

2021 ◽  
Author(s):  
Gaetano Caruso ◽  
Nicola Corradi ◽  
Antonio Caldaria ◽  
Daniele Bottin ◽  
Dario Lo Re ◽  
...  
Keyword(s):  
Weight Bearing ◽  
Cross Sectional Study ◽  
Screw Head ◽  
Cross Sectional ◽  
Femur Fractures ◽  
Tip Apex Distance ◽  
Minimal Reduction ◽  
Shed Light

Abstract Purpose: Cut-out is one of the most common mechanical failures in the internal fixation of trochanteric hip fractures. The tip-apex distance (TAD), and the calcar-referenced tip apex distance (CalTAD) are the radiographic parameters that most predict the risk of cut-out. The optimal CalTAD value has not yet been defined, but the optimal TAD value is reported as 25 mm or less. However, this cut-off is highly specific but poorly sensitive. The aim of this study was to determine highly specific and sensitive TAD and CalTAD values and shed light on the role of other clinical variables.Methods: A total of 604 patients were included in this retrospective cross-sectional study. For each patient the following data were recorded: number of cut-out, AO/OTA classification, quality of the reduction, type of nail, cervicodiaphyseal angle, type of distal locking, post-operative weight-bearing, TAD and CalTAD values, and the position of the screw head in the femoral head according to the Cleveland system.Results: The incidence of cut-out across the sample was 3.1%. The median TAD in the cut-out group was 38.72, while in the no cut-out group it was 22.16. The median CalTAD in the cut-out group was 39.34, while in the no cut-out group it was 22.19. The cut-off values for TAD and CalTAD with highest value of sensitivity and specificity for the risk of cut-out were 34.8 and 35.2, respectively. Conclusions: The incidence of cut-out can be reduced by performing careful minimal reduction and ensuring stable fixation by avoiding TAD>34.8mm and CalTAD>35.2 mm.

scholarly journals Surgical Selection of Unstable Intertrochanteric Fractures: Proximal Femoral Nail Antirotation Combined With or Without Cerclage Cable

2020 ◽  
Author(s):  
Qing-Chao Huang ◽  
Xing Wu
Keyword(s):  
Internal Fixation ◽  
Fracture Healing ◽  
Weight Bearing ◽  
Proximal Femoral Nail ◽  
Fixation Method ◽  
Harris Hip Score ◽  
Intertrochanteric Fractures ◽  
Femoral Nail ◽  
Proximal Femoral Nail Antirotation ◽  
Selection Of

Abstract Background: Due to the instability of unstable intertrochanteric fractures, the selection of a suitable internal fixation remains challenging for orthopedic surgeons. This study aims to compare the clinical efficacy of proximal femoral nail antirotation (PFNA) combined with a cerclage cable and without a cerclage cable so as to recommend a stable internal fixation method.Methods: From January 2014 to January 2018, we retrospectively analyzed all unstable intertrochanteric fracture cases who received treatment in the Orthopedics Department of our hospital. One hundred and twenty cases were screened, of which 51 were treated with a cerclage cable, and 69 without a cerclage cable. The follow-up period was one year. Patients were divided into either the PFNA and cerclage cable group (PFNA+cable) or the PFNA only (PFNA) group. Results: The Harris hip score (HHS), Barthel Index (BI), and Radiographic Union Scale for Hip (RUSH) were evaluated.The fracture healing and weight-bearing time of the PFNA+cable group were shorter than the PFNA group. Regarding the HHS, BI, and RUSH, the PFNA+cable group was higher than the PFNA group at 1, 3, 6, and 12 months after the operation. For the HHS rating, the PFNA+cable group had a higher-excellent rate than the PFNA group, with 96.1% and 84.1%, respectively. All the results mentioned above were statistically significant. The application of a cerclage cable was found to reduce the incidence of complications.It was found that PFNA combined with a cerclage cable improved the stability of fracture reductions, shortened the fracture healing time and postoperative weight-bearing time, significantly improved patients’ ability to self-care, and reduced the incidence of postoperative complications. Conclusions: Therefore, we think PFNA combined with a cerclage cable is a good choice for patients with unstable intertrochanteric fractures.

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