Distally-fixed non-modular monoblock fluted long-stem hemiarthroplasty versus proximal femoral nailing for elderly patients with an osteoporotic intertrochanteric fracture: a retrospective comparative study

2020 ◽  
pp. 112070002096352
Author(s):  
Osman Çiloğlu ◽  
Evren Karaali ◽  
Aslıhan Kuşvuran Özkan ◽  
Timur Ekiz
Keyword(s):  
Mortality Rate ◽  
Elderly Patients ◽  
Intertrochanteric Fracture ◽  
Harris Hip Score ◽  
Femoral Nailing ◽  
Singh Index ◽  
Significant Difference ◽  
Unstable Intertrochanteric Fracture ◽  
Long Stem ◽  
Proximal Femoral Nailing

Background: The treatment of Intertrochanteric fractures in the elderly osteoporotic patient is still controversial. The aim of this study was to compare the outcomes of proximal femoral nailing (PFN) and a distally-fixed non-modular monoblock fluted long-stem hemiarthroplasty (HA) in elderly patients with an osteoporotic intertrochanteric fracture. Methods: This retrospective study included patients who had undergone surgery for an unstable intertrochanteric fracture. The patients were separated into PFN and HA groups. The demographic features of the 2 groups were compared. All patients were evaluated using the Singh index, ASA score, AO/OTA classification, Harris Hip Score (HHS), and Parker and Palmer mobility score. Results: The most common complications were nonunion (12.0%) and cut-out of the screw (10.7%) in the PFN group, and dislocation of the prosthesis (6.7%) and wound infection (5.7%) in the HA group. Overall, the 2-year mortality rate was 29.3%. Mortality, particularly within the first 3 months, was 2.4 times higher in the PFN Group than in the HA group (40% vs. 19.75%). Although the HHS was significantly higher in the first year for the HA group, no significant difference was seen between the 2 groups at 24 months. Conclusions: Although PFN and HA have similar good outcomes at 2 years, HA allows earlier mobilisation and has fewer complications and a lower mortality rate.

scholarly journals Primary arthroplasty as an option for surgical treatment of unstable intertrochanteric fracture femur in elderly patients: a retrospective study

2019 ◽  
Vol 5 (2) ◽  
pp. 237
Author(s):  
Shashank Kanchan ◽  
Vikash Raj ◽  
Dinesh Agarwal ◽  
Richa .
Keyword(s):  
Retrospective Study ◽  
Elderly Patients ◽  
Functional Outcomes ◽  
Intertrochanteric Fracture ◽  
Harris Hip Score ◽  
Bipolar Hemiarthroplasty ◽  
Complication Rates ◽  
Early Weight Bearing ◽  
Femur Fractures ◽  
Unstable Intertrochanteric Fracture

<p class="abstract"><strong>Background:</strong> An unstable intertrochanteric fracture in osteoporotic elderly patients presents a very challenging problem to the surgeons. This category of patients if kept in bed for long tends to have many complications like deep vein thrombosis, pneumonia, bed sores, etc. Surgeon’s worldwide face difficulty in getting a good anatomical reduction and do not allow early mobility to these patients because of risk of loss of reduction and implant cut out. The purpose of our study is to study the usefulness of arthroplasty in these patients in terms of better functional outcomes and no increase in complication rates.</p><p class="abstract"><strong>Methods:</strong> It was a retrospective study involving 25 patients (17 females, 8 males) with mean age of 76±2.3 years having intertrochanteric femur fractures (AO type A 2.2 and above) with osteoporosis operated upon with bipolar hemiarthroplasty at IQ City Medical College and NM Hospital between January 2015 and January 2017.<strong></strong></p><p class="abstract"><strong>Results:</strong> All the patients were followed up for a period of 1 year. We had a mean operative time of 75 min (range 55-125 min) with an average blood loss of 450 ml. 4 of our patients required postoperative blood transfusion. All patients walked on 2<sup>nd</sup> postoperative day. We had a mean Harris hip score of 82 and mean VAS of 1 at the end of 1 year.</p><p class="abstract"><strong>Conclusions:</strong> Hemiarthroplasty done in cases of unstable intertrochanteric femur fractures in elderly patients with osteoporotic bones allows early weight bearing thus improves the final functional outcomes. Further randomized trials are required before deriving any conclusions.</p>

scholarly journals Comparative study between proximal femoral nailing versus dynamic hip screw in unstable inter-trochanteric fractures of the femur in adults

2021 ◽  
Author(s):  
Manoj Kumar ◽  
Zubair A. Lone ◽  
M. Farooq Bhatt ◽  
Abdul Basit
Keyword(s):  
Hip Fractures ◽  
Dynamic Hip Screw ◽  
Harris Hip Score ◽  
Trochanteric Fractures ◽  
Femoral Nailing ◽  
Significant Difference ◽  
Duration Of Surgery ◽  
Hip Screw ◽  
Proximal Femoral Nailing ◽  
Unstable Fractures

Background: Hip fractures are more common in elderly among them intertrochanteric fractures are most common, more than 50% fractures are unstable. The proximal femoral nailing (PFN) and dynamic hip screw (DHS) are frequently used modalities from last two decades in both stable and unstable fractures. The DHS has been shown to produce good results but complications are frequent, particularly in unstable inter-trochanteric fracture. The advantage of PFN fixation is that it provides a more biomechanically stable construct with good collapse control. The goal of this study was to compare the clinical and radiographical results of the DHS and PFN for the treatment of inter-trochanteric hip fractures as one is load bearing another is load shearing.Methods: In our study we included 70 inter-trochanteric fractures, out of which 40 were treated with DHS fixation and 30 were treated with PFN, and were followed up at regular intervals of 2 weeks, 8 weeks, 12 weeks, 6 months and annually thereafter.Results: The functional results were assessed with Harris hip score and observed 35% excellent results in DHS group and 63.3% excellent results in PFN group. We observed no statistically significant difference between two groups in view of late and early complications and time to union. We observed significantly better outcomes in PFN group for unstable inter-trochanteric fractures and in unstable fractures reduction loss was significantly lower in PFN group. We observed total duration of surgery was significantly lower in PFN group.Conclusions: We concluded that PFN may be the better fixation device for most unstable inter-trochanteric fractures. 

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

2021 ◽  
Vol 6 (1) ◽  
pp. 27-33
Author(s):  
Santosh Kumar Singh ◽  
Raj Kumar Bhartiya
Keyword(s):  
Comparative Study ◽  
Intertrochanteric Fracture ◽  
Adult Patients ◽  
Proximal Femoral Nail ◽  
Harris Hip Score ◽  
Functional Evaluation ◽  
Excellent Outcome ◽  
Femoral Nail ◽  
Significant Difference ◽  
Unstable Intertrochanteric Fracture

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>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.

scholarly journals Does Bisphosphonate Delay Bone Healing After Proximal Femoral Nail Anti-Rotation

2020 ◽  
Author(s):  
Ong-art Phruetthiphat ◽  
Sasawat Tonvichien ◽  
Suphot Phruetthiphat ◽  
J. Lawrence Marsh
Keyword(s):  
Surgical Treatment ◽  
Hip Fracture ◽  
Mortality Rate ◽  
Elderly Patients ◽  
Fracture Healing ◽  
Functional Outcome ◽  
Bone Healing ◽  
Intertrochanteric Fracture ◽  
Harris Hip Score ◽  
Radiographic Union

Abstract BackgroundBisphosphonates are widely used for osteoporotic patients to decrease the rate of osteoporotic fractures and they have been shown to reduce the mortality rate in clinical trials. A yearly intravenous zoledronic acid in a clinical study (The HORIZON-RFT) significantly reduced any new clinical fracture and also secondary prevention of hip fracture while bisphosphonates are known to delay remodeling of bone raising the risk that they may delay fracture healing. However, current studies lack data demonstrating whether bisphosphonate (BPs) delays bone healing after hip fracture treatment in clinical practice. Purpose of study was to determine whether treating elderly patients with Bisphosphonate (BP’s) after proximal femoral nail fixation (PFNA) for intertrochanteric fractures delays fracture healing compared to similar patients not treated with BP’s. A secondary goal was to compare the functional outcome, complications and mortality between the two treatment groups.MethodsOne hundred ninety-six elderly patients underwent PFNA fixation for intertrochanteric fracture between 2015 and 2017 with age > 60 years and minimum 1-year follow-up inclusive of functional scores and complications.Intervention: Surgical treatment of intertrochanteric fracture plus calcium and vitamin D supplementation.Main Outcome Measurements: Time to clinical union and radiographic union (weeks), the functional outcome (Harris Hip Score) and complications including mechanical failure and mortality rate. Setting: Level 1 Trauma CenterResults There were comparable functional class and comorbidity between those with BP’s and not treated BP’s. In addition, there was no different in mortality rate (4.0%% vs 6.6%, p=0.537), time to clinical union (6.0 weeks vs 6.0 weeks, p=0.822), radiographic union (11.8 weeks vs 12.0 weeks, p=0.849), and functional outcome (Harris Hip Score) (74.4 vs 69.9, p=0.177) between two groups.ConclusionsBP’s can be used after surgical treatment of an osteoporotic hip fracture without concern that fracture healing will be delayed.Level of Evidence: Prognostic level III.

scholarly journals Comparative study of management of intertrochanteric fracture by dynamic hip screw and proximal femoral nailing

2021 ◽  
Vol 7 (3) ◽  
pp. 487
Author(s):  
Vivek Kumar Parsurampuriya ◽  
M. Shahbaz Siddiqui ◽  
Ritesh Kumar ◽  
Rejo Varghese Jacob
Keyword(s):  
Dynamic Hip Screw ◽  
Harris Hip Score ◽  
P Value ◽  
Unstable Fracture ◽  
Femoral Nailing ◽  
Intramedullary Device ◽  
Number Of Patients ◽  
Significant Difference ◽  
Hip Screw ◽  
Proximal Femoral Nailing

<p><strong>Background:</strong> The purpose of the present study is to verify the theoretical advantages of the intramedullary device over the dynamic hip screw devices and also whether it actually alters the eventual functional outcome of the patient.          </p><p><strong>Methods:</strong> The study is comparative prospective study in which 40 patients were taken and treated either with dynamic hip screw or proximal femoral nailing. The clinical data will be collected and compared with pre-injury activity and present functional level with modified Harris hip score.</p><p><strong>Results:</strong> We found that there is no significant difference between Harris hip score in stable fracture (p value=0.222) fixed either with DHS or PFN. But there is statistically significant difference of score in unstable fracture (p value 0.040) treated by DHS and PFN. Functionally, utilizing the Harris hip scoring system, at the final follow-up, our study affirms PFN to be superior to DHS in unstable intertrochanteric fractures while in stable fractures, functional results are same.                                                                                         </p><p><strong>Conclusions:</strong> PFN is also found better in unstable fractures, because a greater number of patients having excellent Harris hip score. In stable fracture, functional result is same in both groups.</p>

scholarly journals Functional outcome of proximal femoral nailing for unstable intertrochanteric fracture in elderly

2020 ◽  
Vol 6 (6) ◽  
pp. 1186
Author(s):  
Ankit Jose ◽  
Edward Nazareth ◽  
Vivian Roshan D. A. ◽  
Mohan Kumar C. R.
Keyword(s):  
Functional Outcome ◽  
Femoral Fractures ◽  
Delayed Union ◽  
Harris Hip Score ◽  
Non Union ◽  
Femoral Nailing ◽  
Unstable Intertrochanteric Fracture ◽  
Intertrochanteric Femur Fracture ◽  
Proximal Femoral Nailing

<p class="abstract"><strong>Background:</strong> This study is intended to analyse the functional outcome of proximal femoral nailing (PFN) for unstable intertrochanteric fractures in elderly.</p><p class="abstract"><strong>Methods:</strong> The data was collected from the 35 patients with unstable intertrochanteric femur fracture who were subjected to PFN from 2015 to 2018. All patients were followed up at 3 months and 6 months after the operation to check the functional outcome based on harris hip score (HHS) and complication if any.</p><p class="abstract"><strong>Result:</strong> In 35 patients, 1 patient was lost to follow-up and 34 patients were followed-up at 3 months and 6 months. All patient’s union was achieved at 3 and 6 months follow up. The cause of fractures was trivial fall in all 35 patients. No incidence of non-union and delayed union was reported. Functional outcome was rated as per HHS, we got excellent results in 20 cases, good in 10, fair in 03 and poor in one patient at end of 6 months.</p><p class="abstract"><strong>Conclusions:</strong> PFN provides stable fixation and early post-operative mobilization with fracture union especially complex proximal femoral fractures which includes unstable, communited, reverse oblique fractures and fractures in osteoporotic bones. PFN has shown excellent results in our study.</p>

Primary Long Distal Fitting Bipolar Hemiarthroplasty for Unstable Intertrochanteric Fracture in Elderly Patients

2020 ◽  
Author(s):  
Reza Zandi ◽  
Amin Karimi ◽  
Mehrdad Sadighi ◽  
Mohammadreza Minator-Sajjadi ◽  
Mohammad Ali Okhovatpour ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Femoral Fracture ◽  
Intertrochanteric Fracture ◽  
Weight Bearing ◽  
Operation Time ◽  
Harris Hip Score ◽  
Bipolar Hemiarthroplasty ◽  
Intertrochanteric Femoral Fracture ◽  
Estimated Blood Loss ◽  
Unstable Intertrochanteric Fracture

Background: Intertrochanteric fracture in elderly patients is a frequent problem and is becoming more prominent as the proportion of this injury increases. The ideal treatment for an unstable intertrochanteric femoral fracture in senile osteoporotic patients remains controversial. Methods: Seventy-five patients (over 70 years of age) with unstable intertrochanteric fractures were randomized into three groups and treated with three different procedures including long-stem bipolar hemiarthroplasty, proximal femoral nail (PFN), and dynamic hip screw (DHS). Estimated blood loss, duration of the operation, time of full weight-bearing, and Harris Hip Score (HHS) were determined for each patient. Results: Surgical time was longer in hemiarthroplasty group, but the HHS and time from surgery to mobilization in these patients were significantly superior to the two other groups. PFN group had the lowest bleeding volume during surgery. Revision surgery was lower in hemiarthroplasty compared to the internal fixation, although it was not statistically significant. Conclusions: In elderly patients with an unstable intertrochanteric femoral fracture who cannot tolerate long immobilization time, primary long distal fitting bipolar hemiarthroplasty is a valid treatment option for faster mobilization, good clinical efficacy, and satisfactory functional outcome.

scholarly journals Critical analysis of factors determining mechanical failures in proximal femoral nailing

2019 ◽  
Vol 5 (2) ◽  
pp. 275 ◽  
Author(s):  
Karthik Ramachandran ◽  
K. K. Arvind Manoj ◽  
A. Vishnu Sankar
Keyword(s):  
Failure Rate ◽  
Mechanical Failure ◽  
Proximal Femoral Nail ◽  
Harris Hip Score ◽  
Intertrochanteric Fractures ◽  
Excellent Outcome ◽  
Lag Screw ◽  
Femoral Nailing ◽  
Femoral Nail ◽  
Proximal Femoral Nailing

<p class="abstract"><strong>Background:</strong> Intertrochanteric fractures are one of the commonest fractures encountered in elderly population. Though there are various implants, proximal femoral nail has been the standard choice for management of unstable fractures. Inspite of its biomechanical advantages, various complications like screw cut out, Z effect, reverse Z effect does occur in proximal femoral nailing. The aim of the study is to analyse various factors determining the mechanical failures in patients operated with proximal femoral nail.</p><p class="abstract"><strong>Methods:</strong> This is a prospective study conducted in our institution from June 2014 to May 2018. The study included 72 patients with unstable intertrochanteric fractures treated with proximal femoral nail. All patients were followed for average period of 2 years. Functional outcome was assessed using Harris Hip score.<strong></strong></p><p class="abstract"><strong>Results:</strong> Among the patients<strong> </strong>33%<strong> </strong>had excellent outcome. 42% had good and 14% had fair outcome. 11% of cases ended with poor outcome. Mechanical failure rate was less in patients with positive medial cortical support (PMCS) and in patients with tip apex distance difference between antirotation screw and lag screw (TAD<sub>AR </sub>-TAD<sub>LS</sub>) more than 15 mm. Whereas the difference in the position of lag screw centre had no significant influence in the mechanical failure rate in our study.</p><p class="abstract"><strong>Conclusions:</strong> From our study we like to conclude that the<strong> </strong>fracture reduction with positive medial cortical support and the TAD difference play a major role in determining the incidence of mechanical failure in proximal femoral nailing.</p>

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