scholarly journals A study of management of trochanteric fracture of femur treated with dynamic sliding hip screw-plate device vs. proximal femoral nail

2017 ◽  
Vol 3 (3) ◽  
pp. 524
Author(s):  
Upal Banerjee ◽  
Abhishek Chattopadhyay ◽  
Nirmal Kumar Dey ◽  
Prashant Kumar Sinha ◽  
Writtika Chattaraj ◽  
...  
Keyword(s):  
Proximal Femoral Nail ◽  
Complication Rates ◽  
Trochanteric Fractures ◽  
Treatment Groups ◽  
Femoral Nail ◽  
Duration Of Surgery ◽  
Hip Screw ◽  
Group 2 ◽  
Overall Mortality ◽  
Group 1

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">The incidence of intertrochanteric fractures has been increasing significantly due to the rising age of modern human populations. Generally, intramedullary fixation [proximal femoral nail (PFN) and gamma nail] and extra-medullary fixation [dynamic hip screw (DHS)] are the 2 primary options for treatment of such fractures. </span><span lang="EN-IN"> </span><span lang="EN-IN">Objectives: The goal of this study is to compare the clinical and radiographical results of DHS and PFN for the treatment of trochanteric hip fractures. </span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">Patients with trochanteric fractures were treated either with DHS or  PFN in the Department of Orthopaedics, M.G.M. Medical College and L.S.K Hospital, Kishanganj, Bihar from October 2010 to October 2012 were included for this study</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">Forty three patients (24 male and 19 female, ratio of M:F 1.26:1) surgically treated for trochanteric fractures were divided into two groups. Group 1: 25 hips treated with DHS and group 2: 18 hips treated with PFN. The outcome for each group was analyzed, and total operative time, time to union, complications (early and late), and mortality were recorded. The results were statistically compared. Out of 25 cases of DHS, majority cases (13) took between 1 hour 36 minutes to 2 hours. Whereas, out of 18 cases of PFN, majority (8) took 1 hour to 1 hour 30 minutes. The mean time to union for group 1 was 2.09 months and 1.69 months for group 2. Early and late complication rates between treatment groups revealed no statistically significant differences. Total duration of surgery was significantly lower for PFN than it was for DHS. A comparison of time to union and overall mortality demonstrated no statistically significant differences. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">We detected no differences between the two treatment groups in regard to early versus late complications, time to union, and overall mortality; however, with its shorter operative period, PFN is a good alternative to the DHS.</span></p>

scholarly journals Randomized comparative study to evaluate the role of proximal femoral nail and dynamic hip screw in unstable trochanteric fractures

2016 ◽  
Vol 2 (3) ◽  
pp. 75
Author(s):  
Shivanand C Mayi ◽  
Sachin Shah ◽  
Sadashiv R Jidgekar ◽  
Arunkumar Kulkarni
Keyword(s):  
Comparative Study ◽  
Functional Outcome ◽  
Trochanteric Fracture ◽  
Dynamic Hip Screw ◽  
Proximal Femoral Nail ◽  
Trochanteric Fractures ◽  
Stable Fixation ◽  
Femoral Nail ◽  
Duration Of Surgery ◽  
Hip Screw

<p class="abstract"><strong>Background:</strong> Treatment of unstable trochanteric fracture is much more challenging than stable fracture. These fractures require stable fixation to minimize the fracture and implant related complications. Need of this study is to assess the suitable implant for stable fixation of unstable trochanteric fracture with less intra and postoperative complications and good functional outcome.</p><p class="abstract"><strong>Methods:</strong> In this prospective randomized comparative study, 64 patients were distributed into two groups. Group A consisted of patients treated by proximal femoral nail (PFN) (n=32) and group B treated by dynamic hip screw (DHS) (n=32). All the patients were evaluated preoperatively and surgery was done according to the group they were allotted. Post-operative follow up was done at 6 weeks, 3, 6 and 12 months.<strong></strong></p><p class="abstract"><strong>Results:</strong> Average age of the patients in this study was 51.26±10.24 year. In this study patients were followed up for an average of 10.87±2.61 month. The duration of surgery was shorter in PFN group. Weight bearing was earlier in PFN group than DHS group. Mean functional ability score was better in PFN group with significant gain in function earlier as compared to DHS group.</p><strong>Conclusions:</strong> PFN is a better implant for internal fixation of unstable trochanteric fractures which allows early mobilization and has got better functional outcome score in early postoperative period than DHS

scholarly journals CLINICAL EVALUATION OF UNSTABLE INTER-TROCHANTERIC HIP FRACTURE BY INTRAMEDULLARY NAIL (PROXIMAL FEMORAL NAIL) - A PROSPECTIVE CLINICAL STUDY

2020 ◽  
pp. 1-3
Author(s):  
Appurv jaiswal ◽  
Rajeev joshi ◽  
Mahendra Panwar
Keyword(s):  
Proximal Femoral Nail ◽  
Prospective Clinical Study ◽  
Trochanteric Fractures ◽  
Level Of Evidence ◽  
Superficial Infection ◽  
Femoral Nail ◽  
Duration Of Surgery ◽  
Hip Screw ◽  
One Year

Introduction Dynamic hip screw and cephalomedullary nails are currently considered as a standard treatment for inter-trochanteric fractures. Although both clinical and biomechanical studies suggest that intramedullary implants have a mechanical advantage over extramedullary implants. We report the results of 118 unstable inter-trochanteric hip fractures internally fixed with proximal femoral nail Materials and methods Between Dec 2013 and Dec 2015, 138 patients with unstable inter-trochanteric fractures were internally fixed with proximal femoral nail.Number of patients requiring open reduction, duration of surgery and hospitalization, post-operative complications, implant-specific complications were recorded in a predefined proforma; serial post-operative radiographs taken. Functional outcomes were assessed according to the Harris Hip scoring (HHS) system. Results: Mean HHS at one year follow up was 93.356 (range-60-100). There were four superficial infection, one lag screw migration in to joint (fixation revised) and one implant failure (converted to hemiarthroplasty). Union was achieved in 117 cases. Fourteen patients expired due to unrelated reasons and six patients could not complete the follow up. Conclusion: We have used proximal femoral nail for fixation of unstable inter-trochanteric fractures with less operative time, good clinico-radiological outcome and low complication rate. Level of evidence: IV

Dynamic Hip Screw versus Proximal Femoral Nail in the Management of Intertrochanteric Fractures - A Retrospective Analysis from Rajasthan

2021 ◽  
Vol 8 (26) ◽  
pp. 2271-2277
Author(s):  
Gajanand Shriram Dhaked ◽  
Abhishek Komalsingh Jaroli ◽  
Khushboo Parmanand Malav ◽  
Harish Narayan Singh Rajpurohit
Keyword(s):  
Functional Outcome ◽  
Functional Outcomes ◽  
Statistical Significance ◽  
Dynamic Hip Screw ◽  
Proximal Femoral Nail ◽  
Final Decision ◽  
Intertrochanteric Fractures ◽  
Femoral Nail ◽  
Duration Of Surgery ◽  
Hip Screw

BACKGROUND Current management of Intertrochanteric (IT) fractures has evolved with the introduction of dynamic hip screw (DHS) and proximal femoral nail (PFN). The purpose of this study was to compare the functional outcomes between the DHS and PFN for IT fracture fixation. METHODS This study is a retrospective comparative analysis of 455 patients with IT fractures; DHS (292) and PFN (163), who were treated from June 2012 to June 2015. The patients were reviewed postoperatively for a minimum of 12 months to evaluate functional outcome using Salvati-Wilson score. Categorical data was present as absolute number or percentages, and parametric variables were presented as Mean ± SD, while non parametric data were presented as median. Statistical significance was defined as P < 0.05. RESULTS Intramedullary nails offer no advantage over extramedullary devices to treat IT fractures caused by low-energy trauma (AO 31 - A1). However, clinically significant outcomes were established for PFN group in terms of duration of surgery, x- ray exposure and SW Score for AO / OTA 31 - A2 and 31 - A3. Reoperations encountered for local pain due to implant prominence were significantly higher in the PFN group (4.90 % versus 1.02 %). Kaplan Meier survival probability of 69.3 % and 79.5 % predicted for DHS and PFN respectively, 3 years postoperatively. CONCLUSIONS Our conclusion reinforces indication for PFN in unstable IT fractures (31 - A2 and 31 - A3), owing to its better functional outcome and biomechanical properties. Functional outcomes for stable IT fracture (AO 31 - A1) were comparable between DHS and PFN, therefore final decision for implant choice depends on implant cost, surgeon’s preference for specific technique. However, understanding the morphology of proximal femur, peritrochanteric region is crucial to analyse the anatomical variations in Indian population which will provide the basis for intramedullary nail design modifications. KEYWORDS Intertrochanteric Fractures, DHS Fixation, PFN Fixation

A comparison study of proximal femoral nail and dynamic hip screw devices in unstable trochanteric fractures

2018 ◽  
Vol 35 (3) ◽  
pp. 413
Author(s):  
MohamedA Mostafa ◽  
HassanH Ahmed ◽  
HaniA.M Bassiooni ◽  
ElsayedM Mohamady
Keyword(s):  
Dynamic Hip Screw ◽  
Proximal Femoral Nail ◽  
Comparison Study ◽  
Trochanteric Fractures ◽  
Femoral Nail ◽  
Hip Screw

scholarly journals Treatment of Trochanteric Fractures with Proximal Femoral Nail Antirotation or Dynamic Hip Screw Systems: A Meta-Analysis

2012 ◽  
Vol 40 (3) ◽  
pp. 839-851 ◽  
Author(s):  
C Zeng ◽  
Y-R Wang ◽  
J Wei ◽  
S-G Gao ◽  
F-J Zhang ◽  
...  
Keyword(s):  
Blood Loss ◽  
Meta Analysis ◽  
Dynamic Hip Screw ◽  
Proximal Femoral Nail ◽  
Intraoperative Blood Loss ◽  
Trochanteric Fractures ◽  
Fixation Failure ◽  
Duration Of Surgery ◽  
Hip Screw ◽  
Proximal Femoral Nail Antirotation

OBJECTIVE: A meta-analysis to compare the intraoperative and postoperative outcome data for the proximal femoral nail antirotation (PFNA) and dynamic hip screw (DHS) implant systems for the treatment of patients with trochanteric fractures. METHODS: A detailed search of several electronic databases was undertaken to identify randomized controlled trials published before 5 December 2011 that compared PFNA with DHS in patients with trochanteric fractures. RESULTS: A quantitative meta-analysis of 11 studies including 798 patients was performed. PFNA was associated with significant reductions in duration of surgery (weighted mean difference [WMD] −21.38 min; 95% confidence interval [CI] −33.50, −9.26 min), intraoperative blood loss (WMD −176.36 ml; 95% CI −232.20, −120.52 ml), rate of fixation failure (relative risk [RR] 0.27, 95% CI 0.11, 0.62) and rate of postoperative complications (RR 0.46; 95% CI 0.31, 0.70) compared with DHS. CONCLUSION: The use of PFNA for treatment of trochanteric fractures was found to be superior to DHS in terms of the duration of surgery, intraoperative blood loss, and rates of fixation failure and overall complications.

scholarly journals Perioperative and Early Postoperative Outcome of Proximal Femoral Nailing for Stable and Unstable Trochanteric Fractures

2016 ◽  
Vol 33 (1) ◽  
pp. 43-47
Author(s):  
Nina Đorđević ◽  
Miloš Stanojlović ◽  
Saša Milenković ◽  
Predrag Stojiljković ◽  
Mirjana Kocić ◽  
...  
Keyword(s):  
Fracture Fixation ◽  
Trochanteric Fracture ◽  
Postoperative Outcome ◽  
Trochanteric Fractures ◽  
Number Of Patients ◽  
Duration Of Surgery ◽  
Group 2 ◽  
Fracture Stability ◽  
Early Postoperative Outcome ◽  
Group 1

SummaryThe aim of the study was to analyze perioperative parameters as well as early postoperative period of patients with trochanteric fractures nailing in relation to the fracture stability.The prospective study included 46 patients with trochanteric fractures fixed with the third generation cephalomedullary nail. Two groups were formed - stable fractures (Group 1) and unstable fractures (Group 2). There were 20 patients in Group 1, and 26 in Group 2. All the patients underwent Bioimpianti “basic-nail” fracture fixation. Perioperative and early postoperative parameters were monitored and the groups were compared.The average duration of surgery in both groups was not significantly different. The number of patients needing transfusion as well as the average transfusion volume was similar in both groups. Average Intensive care unit (ICU) stay and hospitalization were longer in Group 1, though not significantly. In both groups, 80% of patients started early rehabilitation according to the protocol.Trochanteric fracture fixation with Bioimpianti “Basic-nail” is a minimally invasive, safe method, giving the similar perioperative and early postoperative outcome regardless of the fracture stability. It enables fast postoperative recovery and reduction of early postoperative complications.

scholarly journals Functional outcome of long proximal femoral nail versus short proximal femoral nail in peritrochanteric fractures

2021 ◽  
Author(s):  
Sanjeev Gupta ◽  
Pallav Gupta ◽  
Gagandeep Singh Raina ◽  
Manoj Kumar ◽  
Gagandeep Singh
Keyword(s):  
Blood Loss ◽  
Functional Outcome ◽  
Proximal Femoral Nail ◽  
Surgical Time ◽  
Femoral Nail ◽  
Significant Difference ◽  
Intramedullary Implant ◽  
Group 2 ◽  
Surgical Duration ◽  
Group 1

Background: Proximal femoral nail (PFN) is an intramedullary implant which has been commonly used in the fixation of intertrochanteric fractures. However, controversy comes about the effect of nail length on fracture union and other complications. A comparative evaluation of surgical treatment and functional outcome of patients with peritrochanteric fractures treated with short versus long PFN.Methods:  Total of 100 patients have been included in study out of which 57 belonged to group 1 and were operated with short PFN and rest 43 were group 2 operated with long PFN. Patients were followed up for 6 months and were compared on various parameters.Results: There is no significant difference noted in the two group. However, the surgical duration and blood loss for short PFN was significantly less as compared to long PFN.Conclusions: Short PFN is better implant for peritrochantric fractures both stable and unstable with quicker surgical time and lesser blood loss.

scholarly journals Comparative study between proximal femoral nail and proximal femoral nail antirotation in management of unstable trochanteric fractures

2016 ◽  
Vol 2 (4) ◽  
pp. 354 ◽  
Author(s):  
Manoj R. Kashid ◽  
Tushar Gogia ◽  
Anjan Prabhakara ◽  
Mohammad A. Jafri ◽  
Dilip S. Shaktawat ◽  
...  
Keyword(s):  
Blood Loss ◽  
Functional Recovery ◽  
Proximal Femoral Nail ◽  
Functional Evaluation ◽  
Trochanteric Fractures ◽  
Non Union ◽  
Femoral Nail ◽  
Walking Aids ◽  
Duration Of Surgery ◽  
Proximal Femoral Nail Antirotation

<p class="abstract"><strong>Background:</strong> <span lang="EN-GB">In the management of peri-trochanteric fractures, </span>intramedullary (IM) devices have proven advantage over <span lang="EN-GB">extramedullary devices. IM devices</span> allow for stable anatomical fixation of more comminuted fractures without shortening the abductor lever arm or changing the proximal femoral anatomy. Between IM devices like proximal femoral nail (PFN) and proximal femoral nail antirotation (PFNA), the helical blade of latter is believed to provide stability, compression and rotational control of the fracture with higher cut out strength. The following study was undertaken in an attempt to compare these two types of Intra-medullary devices<span lang="EN-IN">.</span></p><p class="abstract"><strong>Methods:</strong> Between January 2012 and June 2013, 50 patients with unstable intertrochanteric fractures fulfilling inclusion and exclusion criteria, were randomized into 2 groups to undergo CRIF with either standard PFN (n=25) or PFNA (n=25). They were compared in terms of demography, per-operative variables and postoperative parameters including functional evaluation till 1year postoperatively.<strong></strong></p><p class="abstract"><strong>Results:</strong> Background demographic variables, fracture type and pre-injury ambulatory status were comparable between the groups. Operative duration of surgery, amount of blood loss and number of fluoroscopic images were significantly lower in PFNA group as compared to PFN group. Post op complications like infection, non-union, cut out/z-effect, loss of reduction, re-operation and mortality rates didn’t differ significantly between the groups. Post op functional recovery as evaluated by pain, use of walking aids and Harris hip scores were similar in both groups<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> PFNA significantly reduces the operative time, amount of blood loss and fluoroscopic imaging as compared to PFN. However PFNA offers no significant benefits over PFN in terms of post-operative functional recovery or complications<span lang="EN-IN">.</span></p>

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