scholarly journals Closed reduction and proximal femoral nailing in the management of intertrochanteric fractures: a prospective study

2018 ◽  
Vol 4 (3) ◽  
pp. 488
Author(s):  
Santosha .
Keyword(s):  
Functional Outcome ◽  
Closed Reduction ◽  
Harris Hip Score ◽  
Type I ◽  
Intertrochanteric Fractures ◽  
Femoral Nailing ◽  
Type Iv ◽  
Modified Harris Hip Score ◽  
A Prospective Study ◽  
Proximal Femoral Nailing

<p class="abstract"><strong>Background:</strong> Open reduction and dynamic hip screw with plate was considered as the standard method of treatment for intertrochantric fracture of femur previously. With the introduction of proximal femoral nails, closed reduction and proximal femoral nailing are used extensively for the treatment of intertrochantric fractures in the last two decades. The purpose of this study was to evaluate the functional outcome in early treatment of intertrochanteric fractures of Femur by closed reduction and proximal femoral nailing.</p><p class="abstract"><strong>Methods:</strong> Study was conducted in the department of orthopaedics in Regional Institute of Medical Sciences (RIMS), Imphal, Manipur, from August 2014 to August 2016. Forty cases of intertrochantric fractures are treated with proximal femoral nails. Patients were followed up for a period of 24 weeks. The modified Harris hip score (MMHS) was used to evaluate the functional outcome of surgery.<strong></strong></p><p class="abstract"><strong>Results:</strong> Forty consecutive patients were included in this study. Fractures were classified according to Boyd and Griffin classification system. According to the classification 16 cases were type I, 14 cases were type II, 5 were type III and 5 were of type IV. After 12 months of follow-up, all 40 patients were available for evaluation. Radiological union was achieved in a mean time of 14.5 weeks. MHHS was excellent in 13 patients good in 16 patients, fair in 8 patients and poor in 3 patients.</p><p class="abstract"><strong>Conclusions:</strong> Proximal femoral nailing systems are minimally invasive techniques with shorter operative time and good union rate.</p>

scholarly journals A comparative study on the functional outcome of intertrochanteric fractures treated by proximal femoral nailing or dynamic hip screw fixation

2020 ◽  
Vol 7 (1) ◽  
pp. 51
Author(s):  
Gineshmon Chandy ◽  
Saju S.
Keyword(s):  
Functional Outcome ◽  
Dynamic Hip Screw ◽  
Harris Hip Score ◽  
Intertrochanteric Fractures ◽  
Femoral Nailing ◽  
Hip Screw ◽  
Group 2 ◽  
Proximal Femoral Nailing ◽  
Radiological Union ◽  
Unstable Fractures

<p class="abstract"><strong>Background:</strong> Intertrochanteric fractures are one of the commonly occurring injuries in elderly patients and are high among females and those with osteoporosis. They were treated with either dynamic hip screw (DHS) fixation or proximal femoral nailing (PFNA2) here at our institution. The study was conducted in order to find which method of surgical fixation has better functional outcome.  </p><p class="abstract"><strong>Methods:</strong> Total 96 patients of intertrochanteric fractures admitted during the study period of November 2017 to April 2019 were included for the study. These patients were randomly divided into two groups; DHS was used as implant in group1 and PFNA2 in group 2. Postoperatively patients were followed up after 1 month, 3months and 6 months of the surgery and were assessed using Harris hip score.<strong></strong></p><p class="abstract"><strong>Results:</strong> Harris hip score was higher with PFNA2 group compared to DHS group in all follow-ups. In unstable fractures DHS group had poor outcome compared to PFNA2. Radiological union occurred in 27.1 % cases by 3 months and 72.9% cases by 6 months with DHS whereas 70.8% and 97.9% respectively with PFNA2.  </p><p class="abstract"><strong>Conclusions:</strong> PFNA2 gives a better functional outcome when compared to DHS. Even though DHS gives good functional outcome in stable fractures it is not so in the case of unstable fractures. The radiological union also is faster with proximal femoral nailing. Hence in our opinion PFNA2 can be the better fixation device compared to DHS especially in unstable fractures.  </p>

scholarly journals Can proximal femoral nailing of unstable trochanteric fractures help to regain pre-injury functional status in Indian rural patients? A prospective study of functional outcome of unstable intertrochanteric fractures with proximal femoral nailing

2017 ◽  
Vol 3 (4) ◽  
pp. 728
Author(s):  
Shankar Linga S. ◽  
Janardhana Aithala P. ◽  
Amarnath Savur
Keyword(s):  
Functional Outcome ◽  
Harris Hip Score ◽  
Walking Ability ◽  
Trochanteric Fractures ◽  
Femoral Nailing ◽  
Femur Fractures ◽  
Time Period ◽  
Hip Screw ◽  
A Prospective Study ◽  
Proximal Femoral Nailing

<p class="abstract"><strong>Background:</strong> In view of the high incidence of implant failure and varus collapse seen in unstable inter trochanteric femur fractures treated with dynamic hip screw (DHS), proximal femoral nailing (PFN) has gained popularity.<sup>1,2</sup> However there is limited literature regarding functional outcome following PFN especially in Indian patients. In this study, our aim was to assess functional outcome following PFN of unstable inter trochanteric femur fractures which includes the ability to sit cross leg and squat.</p><p class="abstract"><strong>Methods:</strong> This prospective observational study was done at the associated hospitals of KMC Mangalore, spanning a time period of around 2 years, from October 2014 to July 2016. All patients who presented with isolated closed unstable inter-trochanteric fractures were included in the study. Patients were treated with proximal femoral nailing and followed up for a minimum period of 6 months. Outcome measures included Harris hip score, walking status and ability to sit cross leg and squat.<strong></strong></p><p class="abstract"><strong>Results:</strong> 40 consecutive patients (Mean age 61 years, range 25-95) were included in the study, all fractures united within 6 months. As per Harris hip score, 25 patients (62.5%) had excellent or good results, 8 patients (20%) had fair and 7 patients (17.5%) had poor results. 74% (20 out of 27) regained their gainful working status. 80% (24 out of 30) were able to squat easily  or with some  difficulty and 74% (20 out of 27) patients were able to sit crossed leg with or without difficulty. 82% (23 out of 28) regained their unassisted walking status.</p><p><strong>Conclusions:</strong> For unstable inter trochanteric femur fracture PFN gives good results in terms of union, walking ability and majority of the patients regained their pre injury activity status including squatting and cross leg sitting. </p>

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>

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

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

<p class="abstract"><strong>Background:</strong> 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.</p><p class="abstract"><strong>Methods:</strong> 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).<strong></strong></p><p class="abstract"><strong>Results:</strong> 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.</p><p class="abstract"><strong>Conclusions:</strong> 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.</p><p> </p>

scholarly journals A prospective comparative study of Proximal Femoral Nailing Anti-rotation (PFNA) and Sliding Hip Screw (SHS) for Per-trochanteric Femur Fracture

2020 ◽  
Vol 24 (2) ◽  
pp. 156-160
Author(s):  
Amer Khan ◽  
Muhammad Ali ◽  
Ayesha Tahir ◽  
Muhammad Saleem ◽  
Usman Sarwar ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Functional Outcome ◽  
Femur Fracture ◽  
Weight Bearing ◽  
Harris Hip Score ◽  
Complication Rates ◽  
Sliding Hip Screw ◽  
Femoral Nailing ◽  
Hip Screw ◽  
Proximal Femoral Nailing

Objectives: To determine the functional outcome, operative risks, rate of union, and complication in Per-trochanteric  Fracture fixed with PFNA and SHS. Material and Methods: The present study has been conducted at Shalamar Medical and Dental College Lahore from January 2018 to December 2018.40 patients with per-trochanteric femur fracture treated with proximal femoral nailing anti-rotation (PFNA)  and Sliding hip screw (SHS) were enrolled in our study.20 patients were treated by PFNA and 20 patients by SHS. Timing of surgery, mobilization status, hospital stay, infection, weight-bearing status, radiological union, complications both technical and implant-related, amount of blood loss(ml), C ARM Exposures, and Harris hip score at the end of 6 months were recorded. Results: Union was better in the PFNA group (95%) as compared to the SHS group (85%). Complication rate, hospital stay, surgery timing, and requirement of revision surgery were more in the SHS group. The functional outcome was better in the PFNA group as compared to the SHS group. Conclusion: From our study, we concluded that PFNA is a better alternative than SHS in terms of higher union rates, low complication rates, and better functional outcomes.  

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