scholarly journals Prospective study of prognosis of intertrochanteric fractures with lateral wall involvement as compared to intertrochanteric fractures with intact lateral wall

2019 ◽  
Vol 6 (1) ◽  
pp. 129
Author(s):  
Amit Bansal
Keyword(s):  
Functional Outcome ◽  
Lateral Wall ◽  
Mechanical Complication ◽  
Intertrochanteric Fractures ◽  
Neck Shaft Angle ◽  
Shaft Angle ◽  
Tip Apex Distance ◽  
Specific Fixation ◽  
Primary Lateral ◽  
Worse Prognosis

<p class="abstract"><strong>Background:</strong> Intertrochanteric fractures with fracture lateral wall (FLW) are biomechanically unstable fractures.</p><p class="abstract"><strong>Methods:</strong> 40 patients who met inclusion criteria underwent surgery. Post-operatively patients were followed up for a minimum period of 24 weeks. Radiological and functional assessment was done post-operatively. Endpoints of fracture were studied thoroughly.<strong></strong></p><p class="abstract"><strong>Results:</strong> Secondary lateral wall fractures were common than primary lateral wall fractures. Functional outcome was found to be poor in FLW than intact lateral wall (ILW) group (p=0.01). HHS of ILW fracture was 70, while in FLW it was 46. Displacement was found to be a better radiological parameter to assess reduction quality (p=0.02) than neck shaft angle. Implant position with Cleveland method was found to be a better predictor of fixation quality than tip apex distance. There were 6 (15%) mechanical failures. Screw cut out (3 cases) found to be most common mechanical complication (7.5%). There were four failures (33%) in FLW. Secondary lateral wall fractures were found to have poor prognosis than primary lateral wall fractures. A2.3 was found to have more chance of conversion to A3 due to thinned out lateral wall. Many of them happened when DHS was the implant of choice (60%).</p><p class="abstract"><strong>Conclusions:</strong> Functional outcome of FLW is poor than ILW. Secondary lateral wall fractures have worse prognosis than primary lateral wall fractures. Fragment specific fixation is difficult in secondary lateral wall fractures as compare to primary lateral wall fracture, due to higher comminution.</p>

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

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

<p class="abstract"><strong>Background:</strong> 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.</p><p class="abstract"><strong>Methods:</strong> 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.<strong></strong></p><p class="abstract"><strong>Results:</strong> 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.</p><p class="abstract"><strong>Conclusions:</strong> PFLP is an effective implant in comminuted intertrochanteric fractures with broken lateral wall. Complications can be minimised by following principles of locking plate meticulously.</p>

scholarly journals Functional and radiological outcomes of intertrochanteric fractures treated with proximal femoral nail

2020 ◽  
Vol 6 (5) ◽  
pp. 1001
Author(s):  
Mayur Chopra ◽  
Sanjay Kumar Srivastava ◽  
Sumit Kumar ◽  
Deepak Kumar Mishra
Keyword(s):  
Weight Bearing ◽  
Proximal Femoral Nail ◽  
Harris Hip Score ◽  
Intertrochanteric Fractures ◽  
Radiological Outcome ◽  
Neck Length ◽  
Neck Shaft Angle ◽  
Femoral Nail ◽  
Shaft Angle ◽  
Tip Apex Distance

<p><strong>Background:</strong> Hip fracture is one of the most invalidating diseases affecting geriatric populations and in fall related fractures, they lead to most severe morbidity and mortality. Their surgical treatment allows stable fracture fixation which allows the early weight bearing. Many devices have been developed, yet mechanical failures still occur. The aim of this study was to assess the functional and radiological outcomes of intertrochanteric fractures treated with proximal femoral nail.</p><p><strong>Methods:</strong> 46 patients with intertrochanteric fractures fixed with proximal femoral nail were assessed. Functional outcome was measured by Harris hip score (HHS) and lower extremity functional scale (LEFS) and radiological outcome was measured by tip apex distance (TAD), any changes in neck shaft angle, neck length and the offset as compared to uninjured hip.</p><p><strong>Results:</strong> The tip apex distance on the postoperative X-ray was found to be 22.02±2.499 mm, change in the neck length as compared to the uninjured hip was found to be 1.507±1.1808 and change in the offset and neck shaft angle was 1.470±1.0126 and -1.602±1.5992 respectively. The LEFS was found to be 70.63±6.584 whereas the HHS was found to be 90.35±7.593</p><p><strong>Conclusions:</strong> With the increase in TAD the functional and radiological outcome worsens. It was also seen that the cutoff of 25 mm stands true in predicting the outcome of the patients with PFN in intertrochanteric fractures. Hence, the TAD should be routinely measured and if found more than 25 mm then proper precautions like delayed weight bearing may be advised.</p>

EVALUATE INTRAOPERATIVE VARIABLES AND POSTOPERATIVE OUTCOMES OF INTERTROCHANTERIC FRACTURES WITH VULNERABLE/ BROKEN LATERAL WALL MANAGED WITH SHORT AND LONG CEPHALOMEDULLARY NAIL

2021 ◽  
pp. 36-37
Author(s):  
Rahul Kumar ◽  
Wasim Ahmed ◽  
Indrajeet Kumar
Keyword(s):  
Blood Loss ◽  
Functional Outcome ◽  
Postoperative Outcomes ◽  
Treatment Modalities ◽  
Harris Hip Score ◽  
Intertrochanteric Fractures ◽  
Neck Shaft Angle ◽  
Duration Of Surgery ◽  
One Year ◽  
Lateral Walls

Purpose: To evaluate intraoperative variables and postoperative outcomes of intertrochanteric fractures with vulnerable/broken lateral walls managed with short and long cephalomedullary nails. Materials & Methodology: Twenty prospective cases of patients treated with LCMN and twenty retrospective cases treated with SCMN were included in the study. Intraoperative variables compared were duration of surgery, blood loss during surgery, and surgeon's perception of surgery. Functional outcome was evaluated by Parker Palmer mobility score (PPMS), Harris hip score (HHS), and Short Form-12 at one year. Radiological assessment were done at six months/one year to look for progress of fracture union, change in neck-shaft angle, and any signs of implant failure. Results: Duration of surgery (p<0.001), blood loss during surgery (p=0.002), and surgeon's perception of surgery (p=0.002) were signicantly more in the LCMN group. The LCMN group had a better functional outcome. HHS for the LCMN group was 89.15±9.53, and for the SCMN group it was 81.53±13.21 (p=0.021). PPMS for LCMN group was 8.85± 0.67 and for the SCMN group was 7.53±1.807 (p=0.005). There were four implant failures in the LCMN group compared to none in the SCMN group (p=0.036). Conclusion: Both SCMN and LCMN are effective treatment modalities for unstable intertrochanteric fractures with vulnerable/broken lateral walls. In the absence of more extensive study and long-term follow-up, the superiority of one implant over the other cannot be recommended.

scholarly journals Functional and Radiological Outcome of Unstable Intertrochanteric Fracture in Old Age Treated with Proximal Femoral Nail Antirotation-2

2021 ◽  
Author(s):  
OP Jamshad ◽  
Jacob Mathew ◽  
Raju Karuppal
Keyword(s):  
Proximal Femoral Nail ◽  
Harris Hip Score ◽  
Intertrochanteric Fractures ◽  
Biological Reduction ◽  
Neck Shaft Angle ◽  
Femoral Nail ◽  
Unstable Intertrochanteric Fracture ◽  
Shaft Angle ◽  
The Mean ◽  
Proximal Femoral Nail Antirotation

Introduction: Intertrochanteric fractures are prevalent in the elderly, which leave patients with functional restrictions. Proximal Femoral Nail Antirotation-2 (PFNA) was developed to achieve better fixation strength, particularly in the presence of osteoporotic unstable intertrochanteric fractures. Aim: To evaluate the role and result of PFNA-2 in the treatment of unstable intertrochanteric fractures in geriatric patients. Materials and Methods: A prospective analytical study was conducted in 35 patients with unstable intertrochanteric fractures. They were followed-up clinically and radiologically for one year. The quality of fixation was assessed, by neck-shaft angle and Tip Apex Distance (TAD). A functional assessment was done with the Harris Hip Score (HHS). Results: The mean follow-up period was 13 months (range, 12-14). The mean age of patients was 65.6 years and the majority were female patients (62.85%). Functional results according to modified HHS were found to be excellent in 6 (17.1%) patients, good in 14 (40%) patients, fair in 12 (34.3%) patients and poor in 3 (8.6%) patients. The average HHS in this study was 81.6. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 16.0. Conclusion: PFNA-2 helps in achieving biological reduction and good stability which enables early mobilisation and prevention of excessive collapse. A good functional outcome could be achieved when the radiological parameters are restored, i.e., TAD <25 mm and neck-shaft angle difference <5° (compared to the opposite side).

scholarly journals Biomechanical Evaluation of Extramedullary Versus Intramedullary Reduction in Unstable Femoral Trochanteric Fractures

2021 ◽  
Vol 12 ◽  
pp. 215145932199861
Author(s):  
Tadashi Kawamura ◽  
Hiroaki Minehara ◽  
Ryo Tazawa ◽  
Terumasa Matsuura ◽  
Rina Sakai ◽  
...  
Keyword(s):  
Femoral Neck ◽  
Sagittal Plane ◽  
Frontal Plane ◽  
Screw Hole ◽  
Neck Shaft Angle ◽  
Distal Screw ◽  
Compression Stiffness ◽  
Shaft Angle ◽  
Tip Apex Distance ◽  
The Stability

Introduction: The failure rate of operations involving the cephalomedullary nail technique for unstable femoral trochanteric fractures is 3-12%. Changing the reduction strategy may improve the stability. This study aimed to confirm whether reducing the proximal fragment with the medial calcar contact, as opposed to utilizing an intramedullary reduction, would improve the stability of such fractures. Materials and Methods: The unstable femoral trochanteric fracture model was created with fixation by cephalomedullary nails in 22 imitation bones. The 2 reduction patterns were as follows: one was with the proximal head-neck fragment external to the distal bone in the frontal plane and anterior in the sagittal plane as “Extramedullary,” while the other was the opposite reduction position, that is, bone in the frontal plane and sagittal plane as “Intramedullary.” We evaluated the tip-apex distance, compression stiffness, change in femoral neck-shaft angle, amount of blade telescoping, and diameter of the distal screw hole after the compression test. Statistical analysis was conducted using the Mann-Whitney U test. Results: No significant differences were seen in compression stiffness ( p = 0.804) and femoral neck-shaft angle change ( p = 0.644). Although the “Extramedullary” tip-apex distance was larger than the “Intramedullary” distance ( p = 0.001), it indicated clinically acceptable lengths. The amount of blade telescoping and the distal screw hole diameter were significantly larger in “Intramedullary” than in “Extramedullary” ( p < 0.001, p = 0.019, respectively). Our results showed that “Intramedullary” had significantly larger blade telescoping and distal screw hole diameters than “Extramedullary,” and contrary to our hypothesis, no significant differences were seen in compression stiffness and femoral neck-shaft angle change. Conclusions: As opposed to the “Intramedullary” reduction pattern, the biomechanical properties of the “Extramedullary” reduction pattern improved stability during testing and decreased sliding.

scholarly journals Impact of Wedge Effect on Outcomes of Intertrochanteric Fractures Treated with Intramedullary Proximal Femoral Nail

2021 ◽  
Vol 10 (21) ◽  
pp. 5112
Author(s):  
Shen-Ho Yen ◽  
Cheng-Chang Lu ◽  
Cheng-Jung Ho ◽  
Hsuan-Ti Huang ◽  
Hung-Pin Tu ◽  
...  
Keyword(s):  
Femoral Shaft ◽  
Lateral Wall ◽  
Fracture Pattern ◽  
Proximal Femoral Nail ◽  
Intertrochanteric Fractures ◽  
Neck Shaft Angle ◽  
Femoral Nail ◽  
Increase Risk ◽  
One Year ◽  
Wedge Effect

The purpose of this study is to investigate the risk factors for wedge effect and its relevance between blade cut-out in patients with intertrochanteric fractures (ITF) treated with proximal femoral nail antirotation II (PFNA-II). A total of 113 patients with ITF treated with PFNA-II between 2012 and 2016 were retrospectively analyzed. Radiographic variables including preoperative fracture pattern, fracture classification, lateral wall fracture, and postoperative neck–shaft angle (NSA), femoral offset (FO), blade cut-out, and Parker’s ratio were measured for analysis. An average of 4.16° of varus malalignment in NSA and 5.5 mm of femoral shaft lateralization in FO was found post-operatively. The presence of lateral wall fracture was significantly related to post-operative varus change of NSA (p < 0.05). After at least one year of follow up, the blade cut-out rate was 2.65% (3/113), and Parker’s ratio was significantly higher in patients with blade cut-out (p = 0.0118). This study concluded that patients with ITF-present preoperative lateral wall fracture and postoperative higher Parker’s ratio in AP radiography showed higher incidence of wedge effect that might increase risk of blade cut out.

scholarly journals INTERTROCHANTERIC FRACTURES;

2017 ◽  
Vol 24 (11) ◽  
pp. 1740-1744
Author(s):  
Faaiz Ali Shah ◽  
Waqar Alam ◽  
Mian Amjad Ali
Keyword(s):  
Case Series ◽  
Dynamic Hip Screw ◽  
Mechanical Complication ◽  
Intertrochanteric Fractures ◽  
Contributing Factors ◽  
Exclusion Criteria ◽  
Lag Screw ◽  
Hip Screw ◽  
Tip Apex Distance ◽  
Superior Portion

Objectives: To determine the frequency of lag screw cut out in intertrochantericfractures fixed with dynamic hip screw and to identify the possible contributing factors for screwcut out. Study Design: Descriptive case series. Place and Duration of the Study: Orthopaedic& Traumatology Unit”A” Lady. Reading Hospital Peshawar from January 2014 to January 2017.Material and Methods: Patients of either gender or age with intertrochanteric fractures fulfillingthe inclusion and exclusion criteria were fixed with dynamic hip screw (DHS). Post operativelyfracture reduction, position of screw in head of femur and tip apex distance were calculatedon anterio posterior and lateral radiographs. All the patients were reviewed fortnightly for twomonth and then monthly for six months for lag screw cut out on radiographs. Results: Total 110patients mean age 72(range 22 to 98 years) years were fixed with dynamic hip screw. Lag screwcut out was noted in 12(10.9%) patients with 4(33.3%) male and 8(66.6%) female patients.The mean age was 62 years. Right side was involved in two (16.6%) patients while left in ten(83.3%) patients. Radiographically fracture reduction was poor in most (50%, n=6)) patients.The mean tip apex distance (TAD) was 32mm (range 24 to 40 mm). Majority (75%, n=9) ofcut out screw were in superior portion of the head of femur. Four (33.3%) patients had screwcut out at 8th week postoperatively while eight (66.6%) patients had screw cut out at 12th week.Conclusion: Lag screw cut out wasthe most common mechanical complication after fixation ofintertrochanteric fractures and all of the cut out patients were elderly with inadequately reducedfracture, superiorly placed lag screw and longer tip apex distance.

scholarly journals Reconstruction of the Hip in Multiple Hereditary Exostoses

Children ◽  
2021 ◽  
Vol 8 (6) ◽  
pp. 490
Author(s):  
Dong Hoon Lee ◽  
Dror Paley
Keyword(s):  
Hip Joint ◽  
Joint Involvement ◽  
Neck Shaft Angle ◽  
Multiple Hereditary Exostoses ◽  
Femur Neck ◽  
Radiographic Outcomes ◽  
Surgical Dislocation ◽  
Center Edge ◽  
Shaft Angle ◽  
Coxa Valga

The hip joint involvement in multiple hereditary exostoses (MHE) occurs in 30–90%, causing pain and limitation of motion by femoroacetabular impingement, coxa valga, acetabular dysplasia, hip joint subluxation, and osteoarthritis. The purpose of this study was to investigate the clinical and radiographic outcomes of ten hips in seven patients treated by surgical dislocation and corrective osteotomies between 2004 and 2009. Surgical dislocation and excision of the osteochondromas and varus intertrochanteric osteotomies were performed in all cases when the neck–shaft angle was > 150°. Common sites of osteochondromas were medial, posterior, and anterior neck of the femur. Neck–shaft angle of the femur was improved from a mean of 157° to 139°, postoperatively. On an average, the center-edge angle improved from 20° to 30° postoperatively. We believe that Ganz’s safe surgical dislocation technique is the preferred treatment of MHE. This safeguards the circulation of the femoral head and the osteochondromas can be resected under direct vision. It can be combined with additional corrective osteotomies because the hip affected by MHE is frequently associated with dysplastic changes which can result in premature osteoarthritis.

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