scholarly journals Short term results of modular bipolar hemiarthroplasty for the treatment of neglected trochanteric femur fracture in the elderly

2019 ◽  
Vol 6 (1) ◽  
pp. 53
Author(s):  
Towseef Ahmad Bhat ◽  
Zameer Ali ◽  
Manik Sehgal
Keyword(s):  
Femoral Fractures ◽  
The Elderly ◽  
Clinical Results ◽  
Good Choice ◽  
Harris Hip Score ◽  
Bipolar Hemiarthroplasty ◽  
Intertrochanteric Fractures ◽  
Postoperative Rehabilitation ◽  
Cemented Bipolar Hemiarthroplasty ◽  
Fractures Of The Femur

<p class="abstract"><strong>Background:</strong> In rural India because of native practitioner culture people tend to neglect orthopaedic injuries and often present late to the hospitals. Bipolar hemiarthroplasty for neglected intertrochanteric fractures of the femur in the elderly yields good clinical results in terms of early postoperative ambulation. This will have a direct effect on the general condition and postoperative rehabilitation.</p><p class="abstract"><strong>Methods:</strong> Sixteen patients with proximal extracapsular femoral fractures presented average 10.4 weeks late from the day of injury, were treated with modular bipolar hemiarthroplasty. There were 11 men and 5 women, with mean age of 72.8 years (range: 65–83 years). Primary cemented bipolar hemiarthroplasty was performed using the Hardinge lateral approach in a lateral decubitus position. Harris hip score was used for the clinical evaluation of the patients.<strong></strong></p><p class="abstract"><strong>Results:</strong> Clinically, the Harris hip score at the last follow-up ranged from 92 to 59, with a mean value of 81.7. Postoperative radiographs showed a good position in all patients. 1 patient developed complication during cementing and 1 case came with dislocation. No case of infection, acetabular erosion, periprostheic fracture or implant loosening was reported in this study.</p><p class="abstract"><strong>Conclusions:</strong> Primary cemented bipolar hemiarthroplasty is a good choice in elderly patients with neglected intertrochanteric fractures of the femur.</p>

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

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

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Intertrochanteric fracture is one of the most common fractures among the elderly osteoporotic population</span><span lang="FR">, 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 </span><span lang="EN-IN">cemented bipolar hemiarthroplasty with medial calcar augmentation for unstable intertrochanteric fractures in elderly.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">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</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">28%<strong> </strong>of<strong> </strong>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%. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">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.</span></p><p class="abstract"> </p><p> </p>

scholarly journals Breakage of a Third Generation Gamma Nail: A Case Report and Review of the Literature

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Takashi Iwakura ◽  
Takahiro Niikura ◽  
Sang Yang Lee ◽  
Yoshitada Sakai ◽  
Kotaro Nishida ◽  
...  
Keyword(s):  
Rare Complication ◽  
Trochanteric Fracture ◽  
High Strength ◽  
The Elderly ◽  
Gamma Nail ◽  
Bipolar Hemiarthroplasty ◽  
Third Generation ◽  
Trochanteric Fractures ◽  
Cemented Bipolar Hemiarthroplasty ◽  
Fractures Of The Femur

The use of intramedullary nails to treat trochanteric fractures of the femur has increased with the increasing size of the elderly population. The third generation Gamma nail is currently one of the most popular devices for the treatment of trochanteric fractures. Nail breakage is a rare complication, possibly resulting from fatigue fracture of the implant. We present the first reported case of breakage of a third generation Gamma nail that was not used to treat a pathological fracture. An 83-year-old woman with an unstable trochanteric fracture of the femur was treated using a third generation Gamma nail. She was referred to our hospital 14 months postoperatively with nail breakage at the opening for the lag screw. The breakage was secondary to nonunion, which was thought to be mainly due to insufficient reduction of the fracture. The broken nail was removed, and the patient underwent cemented bipolar hemiarthroplasty. At followup 18 months later, she was mobile with a walker and asymptomatic with no complications. This case shows that inadequate operation such as insufficient reduction of the trochanteric fracture may result in nonunion and implant breakage, even when using a high-strength, well-designed implant.

scholarly journals Management of complex intertrochanteric fractures of the femur in elderly patients – dynamic hip screws or proximal femoral nails or arthroplasty

2017 ◽  
Vol 3 (4) ◽  
pp. 656
Author(s):  
Naushad Hussain ◽  
Hiren B. Patel ◽  
Nirmal D. Patil
Keyword(s):  
Elderly Patients ◽  
Comparative Evaluation ◽  
Fracture Site ◽  
Harris Hip Score ◽  
Bipolar Hemiarthroplasty ◽  
Intertrochanteric Fractures ◽  
Anatomical Reduction ◽  
Elderly Individuals ◽  
Fractures Of The Femur

<p class="abstract"><strong>Background:</strong> Ideal management of intertrochanteric fractures in elderly individuals has been debated for several years. Due to difficulty in obtaining anatomical reduction, management of the complex intertrochanteric fractures in elderly patients is challenging and controversial<span lang="EN-IN">.</span></p><p class="abstract"><strong>Methods:</strong> In the present study prospective comparative evaluation has been done between dynamic hip screws<strong> (</strong>DHS), proximal femoral nail (PFN) and bipolar hemiarthroplasty for overall clinical outcome of patients with unstable intertrochanteric fractures. The total numbers of patients were 90 with each group consisted of 30 patients.<strong></strong></p><p class="abstract"><strong>Results:</strong> Complication rate and requirement of revision surgery was more in DHS group but this was not found to be statistically significant. Harris Hip Score &amp; hence the functional outcome was found to be more in PFN group as compared to DHS which was statistically significant. Bipolar hemiarthroplasty provides early full wieght bearing leading to better HHS at 6 weeks evaluation but almost similar score to PFN in long term<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> PFN is better choice of fixation if good bone quality present while extremely osteoporotic patients or extreme comminution at fracture site favours bipolar hemiarthroplasty in elderly patients<span lang="EN-IN">.</span></p>

scholarly journals To Study the Functional Outcome of Primary Cemented Bipolar Hemiarthroplasty in the Management of Unstable Inter-Trochanteric Fracture of Femur among Elderly

2017 ◽  
Vol 4 (1) ◽  
pp. 78
Author(s):  
Parth Vinod Agrawal ◽  
Nitin Wagh ◽  
Sandeep Pangavane
Keyword(s):  
Care Center ◽  
Weight Bearing ◽  
Tertiary Care ◽  
Trochanteric Fracture ◽  
Harris Hip Score ◽  
Full Weight Bearing ◽  
Bipolar Hemiarthroplasty ◽  
Intertrochanteric Fractures ◽  
Cemented Bipolar Hemiarthroplasty ◽  
A Prospective Study

Aims and Objectives: To evaluate the results with regard to function, to restoring proper limb length after surgery and to study the associated complications in intertrochanteric fractures treated by cemented bipolar hemiarthroplasty in elderly. Methodology: This is a prospective study of 25 cases of Intertrochanteric fractures admitted to a tertiary care center between August 2013 and November 2015 treated with Cemented Bipolar Hemiarthroplasty for intertrochanteric fractures. Cases were taken according to inclusion and exclusion criteria. Results: In our study of 25 cases, there were 14 male and 11 female patients with mean age of 72.8 years. 80% of the cases admitted were due to trivial trauma, 20% due to RTA with left side being more common side affected. According to OTA classification Type 31A2.2 fractures accounted for 60% of cases &amp; Type 31A2.3 accounted for 40 %.. Mean duration of hospital stay was 13.2 days and mean time of full weight bearing was 4.7days in our patients. Excellent was seen in 24% cases Fair to Good results were seen in 72% of cases in our study according to Harris Hip Score. Conclusion: From our study we conclude that Cemented Bipolar Hemiarthroplasty for intertrochanteric fractures in elderly reduced the complications of prolonged immobilisation, prolonged rehabilitation, marked residual deformities and need for revision surgeries. The procedure offered, faster mobilization, rapid return to pre injury level, improved the quality of life.

scholarly journals A Study on the outcome of surgical management of Unstable Intertrochanteric Fractures in the geriatric population by various modalities

2020 ◽  
Vol 8 (1) ◽  
pp. 43-47
Author(s):  
Ram Reddy V ◽  
Mohd Inayatulla Khan
Keyword(s):  
Surgical Management ◽  
Surgical Intervention ◽  
Operative Management ◽  
Bipolar Hemiarthroplasty ◽  
Intertrochanteric Fractures ◽  
Geriatric Population ◽  
Cross Sectional ◽  
Unique Challenge ◽  
Mortality And Morbidity ◽  
Cemented Bipolar Hemiarthroplasty

Background: Unstable hip fractures in elderly patients a unique challenge for orthopedic surgeons. Most of the cases are to be managed by surgical intervention. The problems of old age include the presence of osteoporosis, pre-existing arthritis, the overall health of the patient. We in the present study tried to evaluate the functional outcome of surgical management of unstable intertrochanteric fractures by various methods and study the effectiveness and complications of the operative management of unstable fractures. Methods: This cross-sectional study was carried out in the Department of Orthopedics, Prathima Institute of Medical Sciences, Nagunur, Karimnagar. All patients with unstable intertrochanteric fractures with age > 65 years who are treated by the surgical intervention were included in the study. All the patients were operated in Spinal anesthesia and The standard surgical procedures were followed for different modalities like DHS, PFN, Enders Nail’s and cemented bipolar hemiarthroplasty was done. Results: Out of n=50 patients n=28(56%) were female and n=22(44%) were males. The average duration of hospital stay was 14 days, with a range of 10-25 days. The mean blood loss in cemented bipolar hemiarthroplasty was 300 ml, PFN 100 ml, DHS was 250ml, and Ender’s Nail was 50ml. In our study of Bipolar hemiarthroplasty out of n=9 patients n=3 (33.34%) had excellent, n=5(55.56%) good outcome, n=1(11.12%) had fair outcomes respectively. Out of n=9 patients of PFN n=4 (44.44 %) of excellent, good n=4(44.44%), fair n=1 (11.12%) patient and no poor results. Out of n=25 patients of DHS n=20 (80%) patients are excellent to good results, n=3(12%) patient had fair and n=2 (8%) patients had poor results. Out of 7 patients of Ender’s nails n=2(28.573) had excellent and n=3(42.85%) had good and n=1(14.28%) fair, n=1(14.28) had poor results. Conclusion: Intertrochanteric Fractures in the geriatric population are a unique challenge it requires early operative management which will reduce both mortality and morbidity. Early mobilization following operative treatment will reduce the risks associated with prolonged bed rest in geriatric patients. Since failure rate is still high in unstable intertrochanteric fractures selection of proper implants is important for the ultimate success of the treatment.

scholarly journals Treatment of Displaced Femoral Neck Fractures: Unipolar Hemiarthroplasty Versus Bipolar Hemiarthroplasty

KYAMC Journal ◽  
2017 ◽  
Vol 8 (1) ◽  
pp. 10-14
Author(s):  
Md Ashraful Islam ◽  
Md Abdur Rashid ◽  
Md Rafiqul Islam ◽  
Md Masudar Rahman ◽  
Md Asmaul Hossain Khan ◽  
...  
Keyword(s):  
Femoral Neck ◽  
Early Mobilization ◽  
The Elderly ◽  
Femoral Neck Fractures ◽  
Harris Hip Score ◽  
Bipolar Hemiarthroplasty ◽  
Medical College ◽  
Bipolar Group ◽  
Displaced Femoral Neck Fractures ◽  
Displaced Fracture

Background: Femoral neck fractures are common in the elderly population. To avoid the poor outcome of internal fixation and for early mobilization, hemiarthroplasty is performed. However, there is inadequate evidence to support the choice between unipolar or bipolar hemiarthroplasty.Objectives: The aim of this study was to compare the outcome of unipolar with the bipolar prosthesis in geriatric patients.Methods: Forty-one patients above 60 years of age and an acute displaced fracture of the femoral neck were randomly allocated to treatment by either unipolar or bipolar hemiarthroplasty, in the Department of Orthopaedics at Khwaja Yunus Ali Medical College and Hospital, Enayetpur, Sirajgonj, Bangladesh in between December 2014 and February 2017. Functional outcome was assessed and compared using Harris hip score and radiological parameters with a follow-up of one year.Results: The two groups of patients with mean age of 67.3 in bipolar group and 75.6 in unipolar group did not differ in their pre-injury characteristics and perioperative parameters. The mean Harris hip score in bipolar and unipolar groups was 86.18±12.18 and 79.79±15.55, respectively (p=0.183); range of motion was 210.63±28.39 and 181.58±37(p=0.015) with bipolar and unipolar groups, respectively. Functional activities were better in the bipolar group. Complications like painful hip, posterior dislocation, periprosthetic fracture and acetabular erosion were encountered in unipolar prostheses.Conclusion: The use of bipolar endoprosthesis in the management of displaced femoral neck fractures in the elderly was associated with better mean Harris hip score and incidence of complications was limited. Hence, bipolar would be a better option in elderly patients with fracture neck of femur.KYAMC Journal Vol. 8, No.-1, Jul 2017, Page 10-14

scholarly journals Assessment of the outcome of fracture intertrochanteric femur treated by trochanteric fixation nail in the elderly population

2020 ◽  
Vol 7 (1) ◽  
pp. 125
Author(s):  
Vipin Tyagi ◽  
Rahul Kakran ◽  
Amit Dwivedi ◽  
Fenil Shah
Keyword(s):  
Elderly Population ◽  
The Elderly ◽  
Early Rehabilitation ◽  
Harris Hip Score ◽  
High Morbidity ◽  
Intertrochanteric Fractures ◽  
Early Weight Bearing ◽  
Duration Of Surgery ◽  
The Mean ◽  
Trochanteric Fixation Nail

<p class="abstract"><strong>Background:</strong> Intertrochanteric fractures femur in elderly population are more commonly forbidden high morbidity. The surgical stabilization together with early rehabilitation is the main challenge. The elderly population have poor bone mass quality and also the chances of complications like nonunion or implant failure are more with conventional procedures. Stable fixation and early rehabilitation is the main aim in intertrochanteric fractures. The aim is to assess the functional outcome of intertrochanteric fractures femur managed by trochanteric fixation nail (TFN) in the elderly population.</p><p class="abstract"><strong>Methods:</strong> The study includes 40 patients, 30 male and 10 female, with fracture intertrochanteric femur treated with TFN from September 2018 to May 2019 at Yashoda Superspeciality Hospital, Nehrunagar, Ghaziabad. The patients were evaluated at 4, 8, 12 weeks postoperatively and assessed by the Modified Harris hip score. Classification used is AO classification.<strong></strong></p><p class="abstract"><strong>Results:</strong> The mean age of patients was 64 years. The mean duration of surgery was 48±10 min. The Harris hip score was 96.90±4.60, which is better than scores from other implants used for intertrochanteric fractures femur.</p><p class="abstract"><strong>Conclusions:</strong> In this study, we conclude that TFN is a good choice in managing the intertrochanteric fractures, having higher bone union rate and less union time. The period of immobilization is decreased, early weight bearing and less complications.</p>

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