Gamma nail in the management of intertrochanteric fractures of femur in adults

Background: Intertrochanteric fracture is an extracapsular fracture of the proximal femur. Gamma nail is a cephalomedullary nail that is emerging as the treatment of choice for intertrochanteric fractures. For intertrochanteric fractures, the use of cephalomedullary devices has increased dramatically to 67% among surgeons over the years. Aims of this study was to observe the results of operative treatment of intertrochanteric fractures with Gamma 3 trochanteric nail.Methods: This prospective study was conducted in the Post Graduate Department of Orthopaedics of Government Medical College, Srinagar. This study included 30 cases of intertrochanteric fractures who attended hospital for bone and joint surgery.Results: Excellent results were obtained in 80% patients and good results were obtained in rest 20% with an average Harris hip score of 93.8. Average time to union was 11.6 weeks. There were no non-unions, screw cut outs or peri-implant fractures. The most common complication was varus malunion occurring in 20% patients. However, significant malunion (greater than 10 degrees) was present in only one patient among them.Conclusions: This study finds Gamma 3 nail to be a versatile, easy to use and dependable implant in intertrochanteric fractures. Gamma 3 nail is an ideal implant for stable as well as unstable intertrochanteric fractures and is a distinct advance over the previous methods of treatment, though it has an initial learning curve.

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COMPARATIVE ASSESSMENT OF PRIMARY AND SECONDARY OUTCOME WITH PFNA AND HEMIARTHROPLASTY FOR SENILE INTERTROCHANTERIC FRACTURES MANAGEMENT: A PROSPECTIVE RANDOMIZED CLINICAL STUDY.

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v4i3.1091 ◽

2020 ◽

Vol 4 (3) ◽

Author(s):

Kanhaiya Lal Gupta

Keyword(s):

Intertrochanteric Fracture ◽

Functional Results ◽

Statistical Test ◽

Comparative Assessment ◽

Harris Hip Score ◽

Secondary Outcome ◽

Intertrochanteric Fractures ◽

Sample Analysis ◽

Randomized Clinical Study ◽

Multiple Variables

Aim: assessment of primary and secondary outcome among patients treated with PFNA and hemiarthroplasty. Materials and Methods: 20 patients each were included in PFNA group and hemiarthroplasty Patient followed. Patients were evaluated with multiple variables, complications and Harris hip score. The statistical test applied for the independent sample analysis was student t-test using SPSS version 20. Results: PFNA groups had significantly less blood loss, less surgery time, less hospital stay as compared to hemiarthroplasty group. There were no significant differences between the two groups regarding to the Harris Hip Score. Conclusion: From the present investigation it seems that intertrochanteric fractures treated with PFNA may achieve better functional results than treated with hemiarthroplasty. It can definitely be a better option than replacement in elderly intertrochanteric fracture. Keywords: Harris hip score, Hemiarthroplasty, PFNA, Intertrochanteric fracture

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Treatment of stable and unstable intertrochanteric fractures using proximal femoral nail and their functional assessment using modified Harris hip score

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20185340 ◽

2018 ◽

Vol 5 (1) ◽

pp. 162

Author(s):

Lakshya P. Rathore ◽

Lokesh Gupta ◽

Sanjay Thakur ◽

Sandeep Vaidya ◽

Devender Sharma ◽

...

Keyword(s):

Intertrochanteric Fracture ◽

Proximal Femoral Nail ◽

Harris Hip Score ◽

Functional Evaluation ◽

Intertrochanteric Fractures ◽

Good Reduction ◽

Non Union ◽

Femoral Nail ◽

Modified Harris Hip Score ◽

A Prospective Study

Background: Intertrochanteric fracture is common injury and is found in both elderly and the young. Proximal femoral nail (PFN) has been in widespread use for the same in the recent past. There are advocates both for and against this implant. The aim was to study the results of PFN in the treatment of intertrochanteric fractures and their functional evaluation using the modified Harris hip score.Methods: A prospective study done on 104 patients operated for intertrochanteric fractures with PFN. Patients were followed up at 6 weekly intervals and evaluated at each visit using the modified Harris hip score (HHS).Results: The study consisted of 104 patients aged from 36 to 96 years with average age of 67.8 years. Most patients belonged to 60-80 years category. Malunion was observed in three patients (2.8%) and non union was not seen in any patient. Excellent to good results were seen in 73% patients 18% patients had a fair outcome, 7.7% had poor and 2% patients had very poor outcome.Conclusions: PFN is a good implant for intertrochanteric fracture treatment that demands a sound technique and a good reduction prior to insertion. The assessment of results using HHS has been too similar to those obtained using Kyle’s criteria in the previous studies, proving its role in the same.

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Evaluation of Outcome of Treatment of Intertrochanteric Fracture with Dynamic Hip Screw (DHS)

Ibrahim Cardiac Medical Journal ◽

10.3329/icmj.v9i1-2.53986 ◽

2020 ◽

Vol 9 (1-2) ◽

pp. 36-41

Author(s):

Jonaed Hakim ◽

Afrina Jahan ◽

Mahbubur Rahman Khan ◽

Md Humayun Reza ◽

Rasel Al Zilani ◽

...

Keyword(s):

Intertrochanteric Fracture ◽

Treatment Strategies ◽

Dynamic Hip Screw ◽

Harris Hip Score ◽

Intertrochanteric Fractures ◽

College Hospital ◽

Female Ratio ◽

Femur Fractures ◽

Fixation Techniques ◽

Hip Screw

Background & Objective: Intertrochanteric femur fractures are becoming increasingly common as our population ages. Effective treatment strategies that result in high rates of union of these fractures and low rates of complication are important. This study was designed to evaluate the clinical outcome of intertrochanteric fracture treated with dynamic hip screw, among many other fixation techniques available to fix intertrochanteric fractures. Methods: This prospective interventional study was done in the Department of Orthopaedics & Traumatology Department of Dhaka Medical College Hospital, Dhaka between June 2013 to November 2014. A total of 30 patients having intertrochanteric femur fracture were treated with Dynamic Hip Screw (DHS) after doing all necessary investigations for anesthetic fitness. Regular follow up was done up to six months after each operation and was observed for fracture healing, stability, complications and functional outcome by the prescribed scoring system (Harris Hip Score). Result: Nearly one third (30.0%) of the patients belonged to 7th decade and male to female ratio was 1:1.3. According to Harris Hip Score, 13(44.82%) patients were rated as excellent, 9 (31.03%) good, 5(17.24%) fair and 2(6.89%) poor. Conclusion: Dynamic hip screw (DHS) is a reliable method of fixing the stable intertrochanteric femur fractures. The reliability and long-term effect of dynamic hip screw used to treat intertrochanteric fractures of unstable variety are unsatisfactory and not up to the mark. Ibrahim Card Med J 2019; 9 (1&2): 36-41

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Radiological and functional outcome of unstable intertrochanteric fractures treated with proximal femoral locking plate

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20213377 ◽

2021 ◽

Vol 7 (5) ◽

pp. 968

Author(s):

Chanchal Kumar Singh ◽

Juhi Deshpande

Keyword(s):

Functional Outcome ◽

Intertrochanteric Fracture ◽

Locking Plate ◽

Lateral Wall ◽

Harris Hip Score ◽

Intertrochanteric Fractures ◽

Systemic Complications ◽

Neck Shaft Angle ◽

Loss Of Reduction ◽

Unstable Intertrochanteric Fracture

Background: Intertrochanteric fracture is a common orthopaedic injury sustained in elderly population because of osteoporosis and trivial fall. Life threatening systemic complications occur mainly due to immobility.Methods: We included 62 patients (40 males and 22 females) of unstable intertrochanteric fracture (AO 31 A2 and A3) attending Department of Orthopaedics. They were all subjected to surgical treatment with proximal femoral locking plate. Patients were followed up at 3rd, 6th and 12th month for outcomes variables i.e.; functional (Harris hip score, Palmer and Parker mobility score) and radiological outcomes (neck shaft angle, loss of reduction, union and implant related complications). Statistical analysis was done using Friedman’s test after calculating the data in terms of mean and median using SPSS 20 software.Results: Mean age of our patients was 64 years, 40 were males and 22 females. 50 patients sustained fracture due to trivial fall and 12 due to RTA. 35 out of 62 patients had medical co-morbidites. 26 patients needed open reduction of fracture and 36 were close reduced. 22 of patients had severe comminution (AO A 3 III type). Average blood loss was 254 ml. Mean degree of loss of reduction was 5 degrees in 6th month and 4 degrees in 12th month. Union was achieved in 48 out of 50 patients at 12th month. Most of the patients achieved fair to good functional outcome scores at 12th month of follow up. We noticed difficulties in fracture reduction as well as complications related to implant.Conclusions: PFLP is an effective implant in comminuted intertrochanteric fractures with broken lateral wall. Complications can be minimised by following principles of locking plate meticulously.

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Outcome of external fixator in the treatment of intertrochanteric fracture in elderly patients with co-morbidities

Janaki Medical College Journal of Medical Science ◽

10.3126/jmcjms.v7i1.29918 ◽

2019 ◽

Vol 7 (1) ◽

pp. 3-7

Author(s):

Deepak Kumar Dutta ◽

R, Sinha

Keyword(s):

Elderly Patients ◽

Functional Outcome ◽

External Fixator ◽

Intertrochanteric Fracture ◽

Harris Hip Score ◽

External Fixators ◽

Intertrochanteric Fractures ◽

Early Ambulation ◽

Medical Comorbidities ◽

Mean Time

Background and Objectives: Incidence of intertrochanteric fracture is rising because of increasing number of elderly. They tend to have many comorbidities of different systems; therefore, major surgeries are not possible at times. In these patients, external fixator can be an option as it promotes early ambulation, thereby preventing recumbency-associated complications. Material and Methods: Elderly patients of interetrochanteric fracture and with medical comorbidities were managed with external fixator. Functional outcome was measured by Harris Hip Score (HHS) on first post-operative day and in follow ups on 4, 12, and 24 weeks. Results: Thrity patients (19 males, 11 females), of mean age 77.63 years (SD=9.06) were studied. HHS scores steadily increased from 37.6±5.28 on the first post-operative dayto 49.43±6.9 on 4 weeks, 59.83±7.17 on 12 weeks, and 72.47±4.17 on 24 weeks. The changes were all very highly significant (all p=0.000). Mean time taken to union was 14.67±2.28 weeks. None of the patients had recumbency-related complications. Conclusion: External fixators for intertrochanteric fractures in medically comorbid elderly patientsis effective in promoting ambulation and preventing recumbency-related complications.

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AO/OTA 31A2 and 31A3 Intertrochanteric Fractures Managed by Proximal Femoral Nail Antirotation (PFNA)

10.53350/pjmhs2115102616 ◽

2021 ◽

Vol 15 (10) ◽

pp. 2616-2618

Author(s):

Zamir Hussain Tunio ◽

Rizwan Ali Jhatiyal ◽

Muhammad Azeem Akhund ◽

M. Kashif Abbasi ◽

S. Muhammad Ali ◽

...

Keyword(s):

Intertrochanteric Fracture ◽

Proximal Femoral Nail ◽

Harris Hip Score ◽

Psychiatric Disease ◽

Unstable Fracture ◽

Intertrochanteric Fractures ◽

Femoral Nail ◽

Intramedullary Device ◽

Unstable Intertrochanteric Fracture ◽

Proximal Femoral Nail Antirotation

Aim: To study the clinical and radiological outcome of unstable intertrochanteric fracture AO/OTA 31A2, 31A3 fixed by proximal femoral nail antirotation Study design: Descriptive cross sectional study. Place and duration of study: Department of Orthopedic Surgery and Traumatology, Pir Abdul Qadir Shah Jilani Institute of Medical Sciences, Gambat, Sindh from 1st January 2016 to 31st December 2019. Methodology: Forty four cases having intertrochanteric fracture AO/OTA 31A2, 31A3 with age ranging from 18 year to 55 year of either gender were selected; patients having close fracture, who were willing were included in the study, while patients older than 55 year and younger than 18 year, AO/OTA 31A1 fracture, open fracture, bilateral injuries, smoker, alcoholic, drug addicted, poly-trauma, pathological fracture and history of poor compliance, psychiatric disease were excluded. Results: There were 26(59.09%) males and 18(40.91%) females with mean age was 41.3±7.7 years. Regarding classification; AO/OTA 31A2 were 33 (75%), and 31A3 were 11 (25%). Mean time for union was 18.5±3.55 weeks. The average time of follow-up was 48.5±6.6 weeks. Harris Hip Score was excellent (90-100) in 31(70.45%), good (80-89) in 7(15.91%), fair (70-80) in 3 (6.81%) and poor (<70) in 3 (6.81%). Conclusion: Intramedullary device proximal femoral nail antirotation can be labelled as implant of choice for unstable intertrochanteric fractures AO/OTA 31A2, 31A3, with fruitful clinical and radiological outcomes, and with fewer complications. Hip Harris score was excellent-good in 86% of the patients. Key words: Proximal femoral nail antirotation (PFNA), AO/OTA 31A2, 31A3, Intertrochanteric, unstable fracture

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A STUDY OF COXO-FEMORAL BYPASS IN INTERTROCHANTERIC FRACTURE FEMUR OF ELDERLY PATIENTS

10.36106/1201230 ◽

2021 ◽

pp. 38-39

Author(s):

Suneet Tandon ◽

Manoj Kumar ◽

Kashif Iqbal ◽

Mohit Asthana ◽

Abhishek Pathak ◽

...

Keyword(s):

Elderly Patients ◽

Functional Assessment ◽

Intertrochanteric Fracture ◽

Early Rehabilitation ◽

Long Term Results ◽

Harris Hip Score ◽

Intertrochanteric Fractures ◽

Fracture Femur

In this study we tried to nd and analyse the outcome of coxofemoral bypasss in intertrochanteric fractures which were operated at our centre and completed the follow up till 12 months. These patients were analysed on various intra-operative and post-operative parameters. Functional assessment was done using Harris Hip Score. Harris Hip Score showed that 04(20%) patients had excellent results, 08(40%) patient had good results, 04(20%) patients had fair and 02(10%) had poor results, poor results seen in patient with multiple co-morbidity.Our study indicate that coxofemoral bypass in elderly patients have shown to achieve early rehabilitation of the patient and good long-term results intertrochanteric fractures.

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Intertrochanteric Fracture of the Ankylosed Hip Joint Treated by a Gamma Nail: A Case Report

Case Reports in Orthopedics ◽

10.1155/2012/278156 ◽

2012 ◽

Vol 2012 ◽

pp. 1-3 ◽

Cited By ~ 2

Author(s):

Daichi Ishimaru ◽

Satoshi Nozawa ◽

Masato Maeda ◽

Katsuji Shimizu

Keyword(s):

Hip Joint ◽

Rare Case ◽

Intertrochanteric Fracture ◽

Gamma Nail ◽

Fracture Site ◽

Fracture Repair ◽

Intertrochanteric Fractures ◽

Hip Joints ◽

The Status ◽

Type Of Fracture

We herein report a rare case of an intertrochanteric fracture complicated with an ankylosed hip joint in a 76-year-old man. Generally, operative treatment is performed for elderly people with intertrochanteric fractures to prevent general complications, maintain mobility, and release pain. However, intertrochanteric fractures of ankylosed hip joints are rare, and the optimal surgery for this condition is unknown. In addition, surgical fracture repair is challenging because unusual instability of the fracture site is suspected owing to the long lever arm of the lower extremity. Nevertheless, we successfully treated this rare fracture using a gamma nail, which may be a useful implant with which to treat this type of fracture if the status of the arthrodesed hip joint allows.

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Functional analysis of cemented bipolar hemiarthroplasty with medial calcar augmentation for unstable intertrochanteric fractures in elderly

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20175662 ◽

2017 ◽

Vol 4 (1) ◽

pp. 141

Author(s):

Sivabalan T. ◽

Thirunarayanan V. ◽

Senthil Kumar S. ◽

Ramprasath D. R. ◽

Basheer Ahmed S.

Keyword(s):

Functional Outcome ◽

Intertrochanteric Fracture ◽

The Elderly ◽

Fracture Pattern ◽

Harris Hip Score ◽

Bipolar Hemiarthroplasty ◽

Intertrochanteric Fractures ◽

Excellent Outcome ◽

Unstable Intertrochanteric Fracture ◽

Cemented Bipolar Hemiarthroplasty

Background: Intertrochanteric fracture is one of the most common fractures among the elderly osteoporotic population, constituting about 50% of hip fractures. These fractures are managed either by fixation using dynamic hip screw (DHS), proximal femur nail (PFN) or by replacement, based on the stability of fracture pattern, age of the patient, quality of bone and associated co-morbid conditions. Prosthetic replacement which is routinely done for femoral neck fractures requires modification when done for trochanteric fractures to improve stability. This study aims to analyse the short term functional outcome of cemented bipolar hemiarthroplasty with medial calcar augmentation for unstable intertrochanteric fractures in elderly.Methods: Our study includes 60 patients of age more than 70 years admitted in our institution during June 2012 to September 2016 with unstable intertrochanteric fractures. All patients operated through posterior approach to hip and cemented hemiarthroplasty with medial calcar augmentation with bone graft was done. Patients were followed up for an average of period of 2 years. Functional outcome was evaluated with Harris Hip score.Results: 28% of cases had excellent outcome. 43% of cases had good and 23% of cases had fair outcome. 2% of cases ended with poor outcome. The in-hospital mortality rate was 3.3%. The survival rate of the patients in this study at the end of one year is 85%. Conclusions: Cemented bipolar hemiarthroplasty with medial calcar augumentation can be considered as a good primary option for elderly unstable intertrochanteric fracture patients with osteoporotic bones and associated co-morbidities.

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Optimal surgical methods to treat intertrochanteric fracture: a Bayesian network meta-analysis based on 36 randomized controlled trials

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-01943-9 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Yan-xiao Cheng ◽

Xia Sheng

Keyword(s):

Blood Loss ◽

Intertrochanteric Fracture ◽

Meta Analysis ◽

Gamma Nail ◽

Harris Hip Score ◽

Surgical Interventions ◽

Surgical Methods ◽

Medoff Sliding Plate ◽

Hip Screw ◽

Sliding Plate

Abstract Background There are several surgical methods to treat intertrochanteric fracture: dynamic hip screw (DHS), compression hip screw (CHS), percutaneous compression plate (PCCP), Medoff sliding plate, less invasive stabilization system (LISS), Gamma nail, proximal femoral nail (PFN), and proximal femoral nail anti-rotating (PFNA). We therefore conducted a network meta-analysis to compare eight surgical interventions, including DHS, CHS, PCCP, Medoff sliding plate, LISS, Gamma nail, PFN, and PFNA, to provide the optimal surgical intervention for intertrochanteric fracture. Methods An electronic search of 4 databases (PubMed, Embase, Cochrane library, and Web of Science) from inception to July 2020. Two or more of the eight surgical interventions, including the DHS, CHS, PCCP, Medoff sliding plate, LISS, Gamma nail, PFN, and PFNA, for intertrochanteric fracture were included. The methodological quality of the included studies was assessed using the Cochrane Collaboration risk of bias (ROB) tool. Network meta-analysis was conducted by using R-3.5.1 software with the help of package “gemtc”. The odd ratios (ORs) with 95% credibility interval (CrI) were used to assess complications and standard mean difference (SMD) with 95% CrI to calculate the continuous outcomes (operative time, intraoperative blood loss, and Harris hip score). Surfaces under the cumulative ranking curves (SUCRA) were used to rank the intervention. Results A total of 36 RCTs were included in this study. The results of this network meta-analysis showed that, compared with the CHS and DHS group, PFNA exhibited a beneficial role in reducing the blood loss (SMD, 152.50; 95% CrI, 72.93 to 232.45; and SMD, 184.40; 95% CrI, 132.99 to 235.90, respectively). PFNA achieved the lowest value for the surface under the cumulative ranking curve (SUCRA) for the blood loss (SURCA = 0.072) and highest of Harris hip score (SURCA = 0.912). PCCP may have the lowest probability of the operative time (SURCA = 0.095). There were no significant differences among the eight surgical procedures in complications. Conclusion PFNA technique is the optimal treatment method for intertrochanteric fracture. Larger, longitudinal RCTs addressing current limitations, including sources of bias, inconsistency, and imprecision, are needed to provide more robust and consistent evidence.

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