scholarly journals Trigen Intertan Nail in Unstable Peritrochanteric femur fractures in the Elderly -functional and radiological outcomes in 50 cases

2020 ◽  
Vol 8 (5_suppl5) ◽  
pp. 2325967120S0007
Author(s):  
Sanjeev Patnaik ◽  
Akash Panda
Keyword(s):  
Femoral Fractures ◽  
The Elderly ◽  
Harris Hip Score ◽  
Radiographic Evaluation ◽  
Non Union ◽  
Femur Fractures ◽  
Modified Harris Hip Score ◽  
Head Neck ◽  
Intertan Nail

INTRODUCTION: Peritrochanteric femur fractures have increased significantly in recent decades and the trend continues, due to rising age of the population. Surgical treatment, in the form of rigid internal fixation and early mobilization is now the gold standard. One of the recent implant developments is the Trigen Intertan Nail (Smith & Nephew) for the treatment of peri-trochanteric femur fractures that uses 2 cephalocervical screws in an integrated mechanism allowing linear intra-operative compression and rotational 3-point stability of the head/neck fragment. AIMS & OBJECTIVE: To analyse the functional & radiological outcomes using TRIGEN INTERTAN nail for the treatment of peri-trochanteric femur fractures in the elderly population. DESIGN: Prospective study. METHODS: Between March 1, 2016, and March 31, 2019, 50 patients with an intertrochanteric femur fracture were treated with Trigen InterTan Nail (Smith-Nephew). All fractures were classified by OTA/AO Classification. All surviving patients were followed up for a minimum of 6 months post-operatively. Functional and radiographic evaluation were performed at 3 months & 6 months follow up using the modified Harris hip score. RESULTS: The age of the patients was 60-85 years. 2 patients died due to other co-morbidites, 3 did not come for follow up, leaving 45 patients available for final evaluation. The surgical time was 60-90 minutes. All fractures showed radiological union within 12-16 weeks . Radiographic analysis at healing revealed no loss of reduction, no uncontrolled collapse , no non-union, no femoral shaft fractures, and no implant failures. 2 cases had trochanteric split intra-operatively, requiring cerclage wiring, 1 case was poorly reduced and had varus malalignment. Modified Harris hip score was excellent in 20 patients, good in 10 cases, fair in 9 cases and poor in 1 case. CONCLUSIONS: The Trigen Intertan nail appears to be a reliable implant for the treatment of peri-trochanteric femoral fractures. Its design provides for stability against rotation and minimizes neck mal-unions (shortening) through linear intraoperative compression of the head/neck segment to the shaft. As a result of the minimal complication rate and improved clinical and radiological outcomes, this implant is now used as the standard implant for most unstable peri-trochanteric femur fractures at our institution.

scholarly journals A PROSPECTIVE STUDY OF FUNCTIONAL AND RADIOLOGICAL OUTCOME OF PERTROCHANTERIC FEMUR FRACTURES TREATED WITH PROXIMAL FEMORAL NAIL ANTI ROTATION II ( PFN A2)

2021 ◽  
pp. 138-140
Author(s):  
Kannelli Maneesh Chandra ◽  
A Sandeep Kumar ◽  
Mudra Dinesh
Keyword(s):  
Prospective Study ◽  
Trochanteric Fracture ◽  
The Elderly ◽  
Operative Management ◽  
Residual Effects ◽  
Harris Hip Score ◽  
Femur Fractures ◽  
Minimal Incision ◽  
Modified Harris Hip Score ◽  
A Prospective Study

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.

scholarly journals Evaluation of outcome following clamp assisted mini open reduction and internal fixation with intramedullary nailing of subtrochanteric femoral fractures

2019 ◽  
Vol 5 (6) ◽  
pp. 1126
Author(s):  
Chirag G. Prajapati ◽  
Rasik B. Dabhi ◽  
Nikunj D. Maru
Keyword(s):  
Intramedullary Nailing ◽  
Femoral Fractures ◽  
The Elderly ◽  
High Energy ◽  
High Rate ◽  
Excellent Outcome ◽  
Subtrochanteric Fractures ◽  
Femur Fractures ◽  
Subtrochanteric Femur Fractures

<p class="abstract"><strong>Background:</strong> Subtrochanteric fractures of the proximal femur have been defined as the fractures extending from lesser trochanter distally for 5 cm. These fractures usually occur in two age distributions. In the elderly osteopenic population resulting from trivial trauma as fall from standing height or in the younger ones as a result of high energy trauma. Incidence has been on the rise and they comprise about 7 to 10% hip fractures and could lead quickly to large amount of blood loss and other complications.</p><p class="abstract"><strong>Methods:</strong> This is a multicentric prospective prognostic study level 1 consisting of 25 patients admitted in government civil hospital, Ahmedabad during April 2013 to May 2015 having high subtrochanteric femur fractures treated by clamp assisted reduction and intramedullary nailing. Out of these, 20 patients (80%) came for final follow up with average follow up of 11.5 months and evaluated for union, complication and functional outcome.<strong></strong></p><p class="abstract"><strong>Results:</strong> In our study final outcome is assessed based on hip outcome score (modified) based on which 85% had excellent outcome, 10% had good outcome and 5% had fair outcome with none of the patient having poor outcome.</p><p><strong>Conclusions:</strong> We found that clamp-assisted reduction and intramedullary nail fixation provides excellent reduction quality, high rate of fracture union, with no apparent increase in complications in subtrochanteric fractures of the femur. </p>

scholarly journals Mechanism of Unstable Inter-trochanteric Fractures in the Elderly

2020 ◽  
pp. 120-134
Author(s):  
S. Santhosh
Keyword(s):  
Femoral Fractures ◽  
Early Mobilization ◽  
The Elderly ◽  
Trochanteric Fractures ◽  
Non Union ◽  
Prospective Comparative Study ◽  
Hip Screw ◽  
Hemi Arthroplasty ◽  
Tremendous Impact

The aim of this prospective comparative study is to analyse the short term follow-up results of unstable inter-trochanteric fractures in the elderly treated with Bipolar hemi-arthroplasty and Dynamic hip screw fixation done in our institution from March 2017 to October 2018. Proximal femoral fractures in the elderly individuals have a tremendous impact on both the health care system and society. Upon treatment of inter-trochanteric factures with conservative management, it usually unites with a mal-union, non-union and with shortening, but the problem of non –union in trochanteric fractures has less incidence. Because of complications associated with prolonged recumbency and its associated morbidities. Primary hemiarthroplasty in these patients provides for adequate fixation and early mobilization. It alleviates pain and improves function. It also prevents post-operative complications such as pneumonia, lung atelectasis and pressure sores. From our clinical observation we would suggest that unstable intertrochanteric fractures in elderly result most frequently from accidental fall (52.5%), being the most common described mechanism of injury.

scholarly journals INTERTAN nail versus proximal femoral nail antirotation-Asia for intertrochanteric femur fractures in elderly patients with primary osteoporosis

2017 ◽  
Vol 45 (4) ◽  
pp. 1297-1309 ◽  
Author(s):  
Hui Zhang ◽  
Xianshang Zeng ◽  
Nan Zhang ◽  
Dan Zeng ◽  
Ping Xu ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Proximal Femoral Nail ◽  
Harris Hip Score ◽  
Primary Osteoporosis ◽  
Femur Fractures ◽  
Femoral Nail ◽  
Increased Risk ◽  
Proximal Femoral Nail Antirotation ◽  
Intertan Nail

Objectives To compare the long-term functional and radiographic outcomes of the proximal femoral nail antirotation-Asia (PFNA-II) and INTERTAN nail (IT) in the management of intertrochanteric femoral fractures (IFFs) (AO/OTA Type 31A1.1-A2.3) in elderly patients with primary osteoporosis. Methods A retrospective comparative study was performed in our institution. From January 2009 to March 2012, 243 patients with osteoporosis (243 hips) with IFFs (AO/OTA Type 3.1A1.1-A2.3) underwent repair with either a PFNA-II or IT. Follow-up assessments were performed 1, 3, 6, 9, and 12 months postoperatively and every year thereafter. All implant position changes were noted. Patient-related functional outcomes were evaluated based on the Harris hip score. Results In total, 174 patients with osteoporosis (IT, n = 86; PFNA-II, n = 88) were evaluated during a mean follow-up period of 40 months (range, 38–60 months). An increased risk of femoral shaft fracture after implant removal was observed at month 9 of follow-up in 0.0% and 4.4% of the IT and PFNA-II groups, respectively. This difference remained over time with rates of 1.1% and 6.8%, respectively, at the last follow-up. Conclusion The IT nail appears to be a reliable implant in the management of IFFs (AO/OTA Type 3.1A1.1-A2.3) in elderly patients with primary osteoporosis.

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>

scholarly journals REAMED INTRAMEDULLARY EXCHANGE NAILING FOR ASEPTIC NON- UNION OF ISTHMUS & ENHANCED DISTAL FIXATION EXCHANGE NAILING FOR NON- UNION OF DISTAL THIRD SHAFT FEMUR FRACTURES.

2020 ◽  
Vol 4 (6) ◽  
Author(s):  
Govind S. Kulkarni ◽  
Supreet N. Bajwa ◽  
Siddharth S Vakil ◽  
Deepak Garg ◽  
Umesh S Shelke ◽  
...  
Keyword(s):  
Harris Hip Score ◽  
Radiological Outcome ◽  
Superficial Infection ◽  
Non Union ◽  
Femur Fractures ◽  
Screw Augmentation ◽  
Exchange Nailing ◽  
Poller Screw ◽  
Lost To Follow Up

Background: The aim of this study was to evaluate the role of exchange nailing in isthmus and exchange nailing with poller screw fixation & multiplanar interlocking screws for Distal Third shaft femur aseptic non union. The evaluation was addressed by measuring the clinical, functional and radiological outcome of our treatment methods in both non union groups. Design: Retrospective study. Methods: Between 2006 to 2014, 55 patients with Non Union of shaft femur were operated using a standardised protocol at our institute and followed up for functional and radiological outcome. 5 patients were lost to follow up and thus were excluded from this study. Out of 50 patients, 29 were cases of Isthmus Non union and remaining 21 were cases of Distal Third Non union. Our approach in Isthmus group was closed Exchange nailing with 2mm larger nail with medullary reaming. Some needed isthmus when radiological signs of healing were delayed. In Distal Third group, poller screws were used in conjugation with reamed exchange nailing with a 2mm larger diameter nail and interlocking screws in different planes. Out of the 50 patients, 48 were men and 2 women. Their mean post surgical procedure period at presentation of non union was 11.60 months. Results: Out of a total 55, 5 were lost to follow up- all from isthmus group. In isthmus group, healing was observed in 25 out of 29 patients with union achieved in a mean of 7.60 months. Delayed union was seen in 3 patients and addressed with dynamisation of distal screws leading to union in all cases in a mean of 13 months without further intervention.1 patient had superficial infection which resolved with debridement at 4 months. 1 patient required additional bone grafting for persistent non union and healed at 18 months. Non union was encountered in 3 patients who refused further treatment and accepted functional limitations. Harris Hip Score for this group was 87.40. In Distal Third group, all 21 patients achieved union in a mean time of 10.30 months. No patients required further revisions however 4 patients had superficial infection which was treated with antibiotics and debridement. No further complications were encountered in this group of patients and bony union was uneventful otherwise. Harris Hip Score of this group was 92.40. Conclusion: Using exchange nailing for isthmus and poller screw augmentation for Distal Third Shaft Femur Non union yields excellent clinical, functional and radiological outcome. Exchange nailing with or without poller screw augmentation is a less invasive method to treat aseptic non union of shaft femur fractures without additional complications. Keywords: Nonunion, exchange nailing, poller screw, femoral non union, aseptic non union.

scholarly journals Modular tapered conical revision stem in hip revision surgery: mid- term results

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Loris Perticarini ◽  
Stefano Marco Paolo Rossi ◽  
Alberto Fioruzzi ◽  
Eugenio Jannelli ◽  
Mario Mosconi ◽  
...  
Keyword(s):  
Preoperative Assessment ◽  
Bone Defects ◽  
Implant Design ◽  
Harris Hip Score ◽  
Radiographic Evaluation ◽  
Stem Design ◽  
Additional Surgery ◽  
Prime Concern ◽  
Distal Fixation

Abstract Background The aim of this paper is to evaluate the clinical and radiological outcomes of a fluted tapered modular distal-fixation stem at medium to long-term follow-up. The hypothesis of this investigation was to verify if the use of this implant design may have provided potential advantages in femoral revisions and post-traumatic instances where the restoration of the anatomy was the prime concern. Methods We retrospectively reviewed 62 cases of femoral revision surgeries, performed in Paprosky type IIIA and IIIB bone defects between January 2001 and December 2011 with a mean follow-up of 8.5 ± 1.5 years (range 5.1–15.9 years) where a modular fluted stem was used. The clinical assessment was performed with the Harris Hip Score (HHS), and the radiographic evaluation was carried in order to assess the stability of the femoral component. Intra-operative and postoperative complications were recorded, and the rates of complications and revisions for any cause were determined. Results Mean HHS improved 35.4 points from the preoperative assessment. Radiographic evaluation showed a stable stem anchorage in 90.3% of the cases at the last follow-up. Five (8%) implants required additional surgery. Neither breakage of the stem nor loosening of the taper junction were recorded. Kaplan-Meier survivorship was 89.4% (CI: 88.8–90%) for any complication and 92.3% (CI: 91.8–92.7%) according to revision for any causes at 81 months follow-up. Conclusions Our findings suggest that this stem design is a reliable option in cases of complex femoral bone defects, as well as in cases with high functional deficiencies, with promising survivorship.

Integrated dual lag screws versus single lag screw cephalomedullary nail constructs: a meta-analysis and systematic review

2021 ◽  
pp. 112070002098506
Author(s):  
James R Onggo ◽  
Mithun Nambiar ◽  
Jason D Onggo ◽  
Anuruban Ambikaipalan ◽  
Parminder J Singh ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Meta Analysis ◽  
Femoral Fractures ◽  
Harris Hip Score ◽  
Complication Rates ◽  
Non Union ◽  
Lag Screw ◽  
Significant Difference ◽  
Lower Complication ◽  
Cephalomedullary Nails

Background/Aim: This study aims to determine the safety and efficacy of integrated dual lag screw (IDL) cephalomedullary nails (CMN) when compared with single lag screw (SL) constructs, in the internal fixation of intertrochanteric femoral fractures. Methods: The Smith & Nephew InterTan IDL was compared with SL CMN group consisting of the Stryker Gamma-3 (G3) and Synthes Proximal Femoral Nail Antirotation (PFNA) CMN. A multi-database search was performed according to PRISMA guidelines. Data from studies assessing the clinical and radiological outcomes, complications and perioperative parameters of InterTan versus G3 or PFNA CMN in patients with intertrochanteric femoral fractures were extracted and analysed. Results: 15 studies were included in this meta-analysis, consisting of 2643 patients. InterTan was associated with lower complication rates in terms of all-cause revisions (OR 0.34; 95% CI, 0.22–0.51; p < 0.001), cut-outs (OR 0.30; 95% CI, 0.17–0.51; p < 0.001), medial or lateral screw migration (OR 0.19; 95% CI, 0.06–0.65; p = 0.008) as well as persistent hip and thigh pain (OR 0.65; 95% CI, 0.47–0.90; p = 0.008). In terms of perioperative parameters, InterTan is associated with longer operative times (MD 5.57 minutes; 95% CI, 0.37–10.78 minutes, p = 0.04) and fluoroscopy times (MD 38.89 seconds, 95% CI, 15.88–61.91 seconds; p < 0.001). There was no statistically significant difference in terms of clinical Harris Hip Score and radiological outcomes, non-union, haematoma, femoral fractures, varus collapse, length of stay and mean intraoperative blood loss between the 2 groups. Conclusions: Integrated dual lag screw cephalomedullary nails are associated with fewer revisions and complications. However, there is insufficient data to suggest that either nail construct is associated with better functional outcomes.

scholarly journals Primary total hip arthroplasty using an uncemented Wagner SL stem in elderly patients with Dorr type C femoral bone

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Ping Zhen ◽  
Jun Liu ◽  
Xusheng Li ◽  
Hao Lu ◽  
Shenghu Zhou
Keyword(s):  
Lateral View ◽  
Harris Hip Score ◽  
Radiographic Evaluation ◽  
Femoral Bone ◽  
Stem Design ◽  
Total Hip ◽  
Tapered Stem ◽  
Type C ◽  
Hip Arthroplasties

Abstract Background The purpose of this study was to review retrospectively the primary total hip arthroplasties operated upon with the cementless Wagner Self-Locking stem in patients with type C femoral bone. Methods Twenty-eight total hip arthroplasties were performed in 25 patients aged ≥ 60 years using a cementless Wagner Self-Locking femoral component between 2006 and 2011. According to Dorr’s criteria, all 28 femora were classified as type C bone. All patients were treated with THA using a cementless Wagner cone prosthesis. Clinical and radiologic evaluations were performed on all patients. Results Mean follow-up period was 125 ± 10.5 months (range 96 to 156 months). Average Harris hip score pre-operatively was 46 ± 9 (range 39 to 62) and at the last follow-up was 90 ± 9 (range 83 to 98). The stem to canal fill is calculated as percentages on the operative side at three distinct levels: just below the lesser trochanter, at midstem, and 1 cm above the tip of the component on anteroposterior radiograph. The mean proximal stem-to-canal fill percentages were 97% ± 2.1%, 95% ± 3.5%, and 88% ± 2.6%, respectively (anteroposterior view) and 92% ± 2.2%, 86% ± 1.9%, and 83% ± 2.5%, respectively (lateral view). Radiographic evaluation demonstrated good osteointegration of the implants in the follow-up. Conclusions Based on the long-straight cylindrical tapered stem design, the cementless Wagner SL stem can achieve reliable stability by close apposition of the stem and wide stovepipe femoral canal from metaphysis to diaphysis in type C bone.

scholarly journals Ten-year comparison of two different techniques for femoral bone cavity preparation—broaching versus compaction in patients with cementless total hip arthroplasty

2021 ◽  
Vol 2 (12) ◽  
pp. 1035-1042
Author(s):  
Maciej Okowinski ◽  
Mette Holm Hjorth ◽  
Sebastian Breddam Mosegaard ◽  
Jonathan Hugo Jürgens-Lahnstein ◽  
Stig Storgaard Jakobsen ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Clinical Outcomes ◽  
Hip Arthroplasty ◽  
Harris Hip Score ◽  
Femoral Bone ◽  
Total Hip ◽  
Stem Subsidence ◽  
Femur Fractures

Aims Femoral bone preparation using compaction technique has been shown to preserve bone and improve implant fixation in animal models. No long-term clinical outcomes are available. There are no significant long-term differences between compaction and broaching techniques for primary total hip arthroplasty (THA) in terms of migration, clinical, and radiological outcomes. Methods A total of 28 patients received one-stage bilateral primary THA with cementless femoral stems (56 hips). They were randomized to compaction on one femur and broaching on the contralateral femur. Overall, 13 patients were lost to the ten-year follow-up leaving 30 hips to be evaluated in terms of stem migration (using radiostereometry), radiological changes, Harris Hip Score, Oxford Hip Score, and complications. Results Over a mean follow-up period of 10.6 years, the mean stem subsidence was similar between groups, with a mean of -1.20 mm (95% confidence interval (CI) -2.28 to -0.12) in the broaching group and a mean of -0.73 mm (95% CI -1.65 to 0.20) in the compaction group (p = 0.07). The long-term migration patterns of all stems were similar. The clinical and radiological outcomes were similar between groups. There were two intraoperative fractures in the compaction group that were fixed with cable wire and healed without complications. No stems were revised. Conclusion Similar stem subsidence and radiological and clinical outcomes were identified after the use of compaction and broaching techniques of the femur at long-term follow-up. Only the compaction group had intraoperative periprosthetic femur fractures, but there were no long-term consequences of these. Cite this article: Bone Jt Open 2021;2(12):1035–1042.

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