scholarly journals Cemented hemi arthroplasty for unstable intertrochanteric fractures in elderly

2019 ◽  
Vol 5 (2) ◽  
pp. 244
Author(s):  
Y. V. S. Prabhakar ◽  
Venkata Sivaram G. V. ◽  
R. K. L. Jaiswal
Keyword(s):  
Harris Hip Score ◽  
Intertrochanteric Fractures ◽  
Trochanteric Fractures ◽  
Medical Sciences ◽  
Senior Faculty ◽  
Hip Screw ◽  
Senior Faculty Member ◽  
Hemi Arthroplasty

<p class="abstract"><strong>Background:</strong> The incidence of the intertrochanteric fractures is increasing in recent times. It is found that more and more of these fractures are seen in elderly. The treatment of these fractures was historically non surgical. The use of dynamic hip screw and angled blade plate in the surgical management of these fractures is a recent practice. The objective of the study was to analyse the role of cemented hemi-arthroplasty in the treatment of unstable inter trochanteric fractures in elderly.</p><p class="abstract"><strong>Methods:</strong> This study was conducted between June 2014 to June 2016. Results were analysed prospectively. From a total 94 inter trochanteric fractures admitted during this period 20 patients were chosen who fulfilled our inclusion criteria. All the patients were treated in Malla Reddy Institute of Medical Sciences. Primary cemented hemiarthroplasty was done in the entire patient by a senior faculty member. The results were assessed according to Harris hip score.<strong></strong></p><p class="abstract"><strong>Results:</strong> There were 13 females and 7 males in our study. The average age was 69.2 years. There was Evan’s type 1-c 11, 1-d 7 and 1-e 2 in numbers all the patients were followed up for a period of 18 months.</p><p class="abstract"><strong>Conclusions:</strong> In our short study, it is concluded that the primary cemented hemi arthroplasty is a good option in unstable inter trochanteric fractures in elderly.</p>

scholarly journals Role of dynamic hip screw with locking side plate in intertrochanteric fractures in elderly patients

2020 ◽  
Vol 7 (1) ◽  
pp. 73
Author(s):  
Harjot Singh Gurudatta ◽  
R. K. Arora ◽  
Gagan Khanna ◽  
Karandeep Singh Johal ◽  
Deepinder Singh ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Functional Outcome ◽  
Trauma Surgery ◽  
Harris Hip Score ◽  
Intertrochanteric Fractures ◽  
Trochanteric Fractures ◽  
Side Plate ◽  
Pull Out ◽  
Hip Screw

<p><strong>Background: </strong>Dynamic hip screw (DHS) is a vital mainstay implant in managing intertrochanteric fractures. While most of the modifications of implant have been done in screw design, this study evaluates the role of employing locking side plate with DHS to increase the screw hold and avoid plate pull out in trochanteric fractures of elderly patients.</p><p><strong>Methods: </strong>A prospective study was conducted from August 2012 to August 2014 on 30 patients having trochanteric fractures. The fixation, fracture consequences, functional outcome and complications were assessed clinically and radiologically in immediate post-operative period and on follow-ups at six weeks, three months, six months and one year. Young patients (&lt;55 years), fractures with subtrochanteric extension and pathological fractures were excluded from study. Fractures in elderly patients from AO 31A1.1 to AO 31A3.1 were included in study. Evaluation of the clinical outcome was done by modified Harris hip score at the last follow-up.<strong></strong></p><p><strong>Results: </strong>Average age of the patients in study was 64 years; males had better outcome scores, which was statistically significant. The mean trauma-surgery interval was four days. Trauma surgery interval and functional outcome by Harris hip score was statistically significant and was inversely proportional. Union was achieved in all patients with delayed union noted in four cases; the average time to union was 12.2 weeks with no major complications and good functional outcome by Harris hip score.</p><p><strong>Conclusions: </strong>This study suggests that locking side plate with DHS would make a stronger bone implant construct and a valuable modification to prevent sliding, screw cut-out and side plate pull-out with low infection rates.</p>

scholarly journals Randomized control trial comparing the functional outcomes of dynamic hip screw and locking plate dynamic hip screw in intertrochanteric fractures of femur

2020 ◽  
Vol 6 (3) ◽  
pp. 525
Author(s):  
Kiran Ramachandran ◽  
Dileep Sasidharan ◽  
Oommen Mathew
Keyword(s):  
Functional Outcomes ◽  
Locking Plate ◽  
Dynamic Hip Screw ◽  
Research Centre ◽  
Harris Hip Score ◽  
Intertrochanteric Fractures ◽  
Neck Shaft Angle ◽  
Operative Care ◽  
Significant Difference ◽  
Hip Screw

<p class="abstract"><strong>Background:</strong> The objective of the study was to compare the functional outcomes of intertrochanteric fractures of the femur treated with dynamic hip screw (DHS) and locking plate DHS in elderly.</p><p class="abstract"><strong>Methods:</strong> 48 participants (23 in DHS and 25 in locking plate DHS) aged ≥ 50 years with intertrochanteric fracture of femur were enrolled in the present randomized open label parallel group trial conducted at Pushpagiri Institute of Medical Sciences and Research Centre during a period of 1 year. Open, pathological, other fractures in the same limb and participants with neurological involvement were excluded. Standard of care (pre and post-operative care) was given to all participants. Sociodemographic, radiological findings, fracture type and Singh’s index were recorded at baseline, 6 weeks, 3 and 6 months. Study commenced after approval from Institutional Ethics Committee and written informed consent was obtained from all study participants. Participants were randomized in 1:1 ratio using coin flip method. Quantitative variables were expressed means and medians and qualitative variables were expressed as proportions. Tests of significance were independent sample t test, Mann Whitney U test, Friedman test and Chi square test.<strong></strong></p><p class="abstract"><strong>Results:</strong> Between DHS and locking plate DHS, no significant difference in baseline parameters, neck shaft angle, tip apex distance, shortening, Harris hip score, range of motion score and length of hospital stay were observed.</p><p class="abstract"><strong>Conclusions:</strong> The functional outcomes and complications between DHS and locking plate DHS were not significantly different.</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 A comparative study between proximal femur locking compression plate and dynamic hip screw fixation in management of intertrochantric femur fractures

2016 ◽  
Vol 2 (4) ◽  
pp. 327
Author(s):  
Mithlesh Kumar Meena ◽  
Vinay Joshi
Keyword(s):  
Locking Plate ◽  
Locking Compression Plate ◽  
Dynamic Hip Screw ◽  
Intertrochanteric Fractures ◽  
Trochanteric Fractures ◽  
Superficial Infection ◽  
Femur Fractures ◽  
Compression Plate ◽  
Hip Screw ◽  
The Mean

<p class="abstract"><strong>Background:</strong> Proximal femur fractures are one of the commonest fracture encountered in orthopaedic trauma practice. Dynamic hip screw (DHS) is the gold standard procedure for treatment for stable intertrochanteric  fractures, however problem arises with unstable fractures in maintenance of neck shaft angle and proper reduction. Here we are giving results of trochanteric fractures treated with proximal femoral locking compression plate (PFLCP) as compared with dynamic hip screw (DHS).</p><p class="abstract"><strong>Methods:</strong> This study was a prospective study. Two groups of trochanteric fractures of 25 patients operated with DHS and LCP were taken. Each patient was followed-up from July 2011 to October 2012 for minimum of 12 month or till the bony union.<strong> </strong>Every fracture was classified according to AO classification. Functional results will be assessed as per modified Harris hip evaluation score.<strong></strong></p><p class="abstract"><strong>Results:</strong> Among 25 patient treated with PFLCP, length discrepancy was .857 cm while that for DHS was 1.2 cm. The mean time of unaided walking with LCP Was 14.20 weeks while for DHS it was 16.20 weeks. The mean varus angulation for LCP 8 degree while for DHS 10.2 degree. In LCP in 1 case screw cut out from head and neck of femur while in DHS, same is seen in 2 cases and in addition loss of position of lag screw seen in 5 cases.one case was found with superficial infection in LCP while in case of DHS 3 cases with deep infection for that implant was removed and 6 cases were found with superficial infection.</p><p><strong>Conclusions:</strong> Proximal femoral locking plate (PFLCP) is simple, stable for fixation with fewer complications, and is an effective method for unstable intertrochanteric fractures.  Comparing with DHS group, the locking plate has shorter operative time, fewer blood loss and drainage.</p>

scholarly journals Osteosynthesis of intertrochanteric fractures by PFN and DHS – A prospective randomized comparative study

2020 ◽  
pp. 221049172097183
Author(s):  
Pulin Bihari Das ◽  
Anurag Singh ◽  
Bhabani Shankar Lenka ◽  
Sunit Pani
Keyword(s):  
Elderly Patients ◽  
Comparative Study ◽  
Statistical Analyses ◽  
Harris Hip Score ◽  
Intertrochanteric Fractures ◽  
Fixation Device ◽  
Geriatric Population ◽  
Hip Screw ◽  
Parker Palmer ◽  
Mobility Score

Introduction: As the geriatric population increases, the incidence of intertrochanteric fractures (ITF) has also increased significantly. There are various modalities to treat these fractures. In this study our aim is to analyse outcomes of Proximal Femoral Nail (PFN) in comparison to those of Dynamic Hip Screw (DHS) for the treatment of ITF. Materials and Methods: This study was carried out during 2017–20. 150 patients of unstable ITF (AO type 31-A2, 31-A3) in elderly were randomly divided into two groups of 75 each and were treated either by DHS or PFN and were followed up regularly. Results: The results were compared between the groups and statistical analyses were performed. The results were assessed with Harris Hip Score(HHS) & Parker Palmer mobility score (PPMS) which were better in PFN group. Conclusion: PFN is a better fixation device for unstable ITF (31 A2 and 31 A3) in elderly patients.

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 A comparative study between dynamic hip screw and intramedullary nail fixation in trochanteric fractures

2021 ◽  
Vol 7 (4) ◽  
pp. 794
Author(s):  
Krishan Kumar ◽  
Anurag Chhabra ◽  
Ashok Kumar ◽  
Sourabh Jain ◽  
Ankush Berwal
Keyword(s):  
Blood Loss ◽  
Traffic Accidents ◽  
Road Traffic ◽  
Common Type ◽  
Dynamic Hip Screw ◽  
Harris Hip Score ◽  
Trochanteric Fractures ◽  
Surgical Time ◽  
Significant Difference ◽  
Hip Screw

<p class="abstract"><strong>Background:</strong> The trochanteric fractures are one of the commonest fractures in elderly population. Incidence of these fractures is increasing due to better life expectancy, growing number of population, industrialization and the road traffic accidents. Variety of implants are available but still there is no consensus for single implant.</p><p class="abstract"><strong>Methods:</strong> A prospective randomized control study was conducted on total 60 patients of intertrochanteric fractures which were randomized into 2 groups of 30 each, treated with dynamic hip screw (DHS) and proximal femoral nail (PFN). All the patients were followed up for a maximum of 6 months. Outcomes were reviewed and compared such as mode of injury, complications, functional and radiological outcomes.<strong></strong></p><p class="abstract"><strong>Results:</strong> There was no significant difference between two groups of patients as regards to mean age and sex. The mode of injury by slip and fall was main cause. The most common type of fracture as per AO-orthopaedic trauma association (OTA) classification was 31-A2 (65%) and 31-A3 (5%) being the least common type. Mean surgical time of DHS group and PFN group was 125.17 minutes and 89.93 minutes respectively. Mean blood loss in DHS group and PFN group was 251.67 ml and 158.67 ml respectively. Mean radiological union time of fracture in DHS group and PFN group was 12.3 and 9.5weeks respectively. Mean Harris hip score at six month in DHS group and PFN group was 80.77 and 85.47 respectively.</p><p class="abstract"><strong>Conclusions:</strong> We conclude that though both the implants can achieve comparable union rates but PFN are better than DHS as of better Harris hip score, shorter surgical time and less intra operative blood loss.</p>

386 Proximal Femoral Nail (PFN) Versus Dynamic Hip Screw (DHS) In Unstable Intertrochanteric Fractures of Femur -A Comparative Clinical Study

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
V Dubey ◽  
B Spiegelberg ◽  
S Shahane ◽  
A Samant
Keyword(s):  
Blood Loss ◽  
Randomized Study ◽  
Dynamic Hip Screw ◽  
Harris Hip Score ◽  
Intertrochanteric Fractures ◽  
Leg Length ◽  
Femur Fractures ◽  
Intertrochanteric Femoral Fracture ◽  
Duration Of Surgery ◽  
Hip Screw

Abstract Introduction The goal of treatment of an intertrochanteric femoral fracture is restoration of patient's mobility as early as possible. The dynamic hip screw (DHS) has been used for several decades to treat these fractures. Proximal femoral nails (PFN) are reported to have an advantage in such fractures. This study aims at comparing the results of unstable intertrochanteric fractures femur treated with PFN and DHS. Method This was a prospective, randomized study which includes sixty patients. All patients were available for follow up with 30 patients in each group. The data about intraoperative blood loss, time to union, leg length shortening was collected. The functional outcome at the end of one year was evaluated using Harris Hip Score. Results Blood loss, duration of surgery, time to union and leg length shortening was significantly less in the patients treated with PFN (p &lt; 0.05). The mean harris hip score for patients managed with PFN was significantly more than in DHS group, 12 months after surgery (p = 0.05). Conclusions PFN requires a smaller incision, lesser operative time, less blood loss and has improved functional results. In our opinion PFN may be a better fixation device for most of the unstable intertrochanteric femur fractures.

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