Cemented hemi-arthroplasty for unstable intertrochanteric fractures in the elderly: a retrospective study

Background: Unstable intertrochanteric fractures belonging to 31A2 and A3 varieties are difficult challenges for orthopaedic surgeons, particularly in the elderly patients. Osteosynthesis by dynamic hip screw or proximal femoral nail are often plagued by complications like screw cut-out, excessive collapse and fixation failures due to osteoporotic bones. Because of these complications, patients are often kept confined to the bed which may increase the risks of pressure sores, venous thrombosis and pulmonary infections. So, it is desirable to mobilize these elderly patients as quickly as possible following surgery. In recent decades, primary hemi-arthroplasty has emerged as a valuable treatment option for mobilizing these patients early.Methods: We present our retrospective study on 27 patients above 60 years of age, who were managed with cemented bipolar hemi-arthroplasty after sustaining unstable intertrochanteric fractures. All the patients were operated through modified Hardinge approach. The fractured fragments were secured by stainless steel wiring, particularly the greater trochanter, wherever necessary.Results: Twenty-three patients (85%) were able to stand up with walkers by third post-operative day and were able to walk by fifth post-operative day. There was one case of hip dislocation; it was reduced under anaesthesia. No other complications were encountered at an average follow-up of 3.1 years. The Harris hip score was ‘good’ or ‘excellent’ in more than 60% patients.Conclusions: Cemented hemi-arthroplasty appears to be a reliable treatment method for unstable intertrochanteric fractures in the elderly and it allows early weight-bearing and rehabilitation in most patients following surgery.

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

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20205573 ◽

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

Background: 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.Methods: 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.Results: 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.Conclusions: 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.

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Primary arthroplasty as an option for surgical treatment of unstable intertrochanteric fracture femur in elderly patients: a retrospective study

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20190425 ◽

2019 ◽

Vol 5 (2) ◽

pp. 237

Author(s):

Shashank Kanchan ◽

Vikash Raj ◽

Dinesh Agarwal ◽

Richa .

Keyword(s):

Retrospective Study ◽

Elderly Patients ◽

Functional Outcomes ◽

Intertrochanteric Fracture ◽

Harris Hip Score ◽

Bipolar Hemiarthroplasty ◽

Complication Rates ◽

Early Weight Bearing ◽

Femur Fractures ◽

Unstable Intertrochanteric Fracture

Background: An unstable intertrochanteric fracture in osteoporotic elderly patients presents a very challenging problem to the surgeons. This category of patients if kept in bed for long tends to have many complications like deep vein thrombosis, pneumonia, bed sores, etc. Surgeon’s worldwide face difficulty in getting a good anatomical reduction and do not allow early mobility to these patients because of risk of loss of reduction and implant cut out. The purpose of our study is to study the usefulness of arthroplasty in these patients in terms of better functional outcomes and no increase in complication rates.Methods: It was a retrospective study involving 25 patients (17 females, 8 males) with mean age of 76±2.3 years having intertrochanteric femur fractures (AO type A 2.2 and above) with osteoporosis operated upon with bipolar hemiarthroplasty at IQ City Medical College and NM Hospital between January 2015 and January 2017.Results: All the patients were followed up for a period of 1 year. We had a mean operative time of 75 min (range 55-125 min) with an average blood loss of 450 ml. 4 of our patients required postoperative blood transfusion. All patients walked on 2nd postoperative day. We had a mean Harris hip score of 82 and mean VAS of 1 at the end of 1 year.Conclusions: Hemiarthroplasty done in cases of unstable intertrochanteric femur fractures in elderly patients with osteoporotic bones allows early weight bearing thus improves the final functional outcomes. Further randomized trials are required before deriving any conclusions.

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An outcome analysis of intertrochanteric fracture of femur managed with proximal femoral nail antirotation II

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20192687 ◽

2019 ◽

Vol 5 (4) ◽

pp. 699

Author(s):

Hemeshwar Harshwardhan ◽

Shubhanshu Jain ◽

Manish Sharma

Keyword(s):

Blood Loss ◽

Intramedullary Nailing ◽

Operative Time ◽

Weight Bearing ◽

Harris Hip Score ◽

Intertrochanteric Fractures ◽

Time Duration ◽

Early Weight Bearing ◽

Pull Out ◽

The Mean

Background: Intertrochanteric fractures are common osteoporotic fractures in adults above 60 years with high mortality and morbidity. Common techniques for fixation of these fractures are sliding hip screw and plate or intramedullary nailing. Intramedullary nailing has advantage of short incision, less operative time, rapid rehabilition & thus decreased medical complications. PFNA II is newer intramedullary implant developed to obtain better fixation strength in osteoporotic bones. Biomechanical studies has demonstrated that PFNA II blade has a significance of higher cut out resistance than other commonly used screw systems.Methods: Prospective follow up study carried out at J.L.N. Medical College Ajmer from 1 March 2017 to 31st October 2018. 30 patients with unstable intertrochanteric fractures were included and operated on fracture table in supine position with PFNA2. We measured operative time, duration of hospital stay, modified Harris hip score and complications.Results: The mean age of the patients was 70.83 years of age. The mean time in surgery was 38.2 minutes. The mean amount of blood loss in surgery was 110.8 ml. In implant related complications, 2 patients had cut out and 1 patient had pull - out of the implant. Functional results according to modified Harris hip scores was found to be excellent in 8 (30%) patients, good in 12 (40%) patients, fair in 7 (20%) patients and poor in 3 (10%) patients.Conclusions: Elderly patients treated with PFNA2 has good outcome as less operative time, minimal blood loss, early weight bearing, less union time and very few cases of medial penetration and back out of spiral blade.

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Functional outcome of intertrochanteric fractures treated with bipolar hemiarthroplasty

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20164392 ◽

2016 ◽

Vol 3 (1) ◽

pp. 1

Author(s):

Rahul Kadam ◽

Ritesh Sawant ◽

Abhay Chhallani

Keyword(s):

Elderly Patients ◽

Functional Outcome ◽

Weight Bearing ◽

Treatment Modalities ◽

Bipolar Hemiarthroplasty ◽

Intertrochanteric Fractures ◽

Early Weight Bearing ◽

Non Union ◽

Cemented Bipolar Hemiarthroplasty ◽

Metal Failure

Background: Comminuted intertrochanteric fractures with severe displacement are common in elderly patients. These patients have poor bone quality and conventional osteosynthetic procedures frequently lead to non-union and metal failure. The primary goals of treatment are stable fixation and early rehabilitation. There are a many treatment for intertrochanteric fractures but our study is on unstable intertrochanteric fractures which are challenging for a surgeon. The aim of this study was to evaluate the results of cemented bipolar hemiarthroplasty as an alternative to other treatment modalities such as DHS or PFN. 21 elderly patients with comminuted and unstable intertrochanteric fractures underwent cemented bipolar hemiarthroplasty.Methods: This study includes 22 cases of intratrochantric fracture. Mean age of patients was 73.3 (range 60 - 91). All patients are treated with bipolar hemiarthoplasty. Patients are followed up for a mean period of 6 months (range 3-9 months).Results: These patients were evaluated using the Harris hip scoring system. 21 out of 22 had excellent to fair outcomes. Conclusions: In our study of 22 patients, 21 had excellent to fair outcomes with primary cemented bipolar hemiarthroplasty. Bipolar hemiarthoplasty offers good functional outcome and early weight bearing and mobilization.

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A study of prospective analysis of unipolar versus bipolar hemiarthroplasty of hip joint in patients with fracture neck of femur

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20211621 ◽

2021 ◽

Vol 7 (3) ◽

pp. 629

Author(s):

Raja X. ◽

Arjun Sarvesh ◽

Karthikeyen M. ◽

A. E. Manoharan

Keyword(s):

Femoral Neck ◽

Weight Bearing ◽

Femoral Neck Fractures ◽

Harris Hip Score ◽

Bipolar Hemiarthroplasty ◽

Neck Of Femur ◽

Early Weight Bearing ◽

Group I ◽

Significant Difference ◽

Group Ii

Background: Femoral neck fractures occur most commonly in elderly females and are a major cause of morbidity and mortality in this age group and require immediate and appropriate management. Aim of the study was to compare the functional outcome of unipolar Austin Moore's prosthesis (AMP) hemiarthroplasty (HA) and bipolar (BHA) HA with femoral neck fractures using Harris hip score system.Methods: The study was conducted on 60 patients aged above 50 years with fractured neck of femur admitted in Vinayaka missions Kirupananda Variyar medical college and hospital from August 2017 to August 2019. Patients with femoral neck fracture were allocated randomly to have 30 cases of AMP.Results: Out of the 60 cases, the patients in the bipolar (nonmodular) HA group II showed better functional outcomes compared to unipolar (AMP) HA group I after six months follow-ups. At 12 months of follow-up, there was no significant difference between group I (AMP) and group II (BHA).Conclusions: Our study demonstrates, hemiarthroplasty of the hip for femoral neck fractures is a good option in elderly patients. The mortality and morbidity are not high, the operative procedure is simple, complications are less disabling, early weight-bearing and functional results are satisfactory and second surgery are less frequently required.

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Admission deep venous thrombosis of lower extremity after intertrochanteric fracture in the elderly: a retrospective cohort study

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-02092-9 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Jinzeng Zuo ◽

Yongcheng Hu

Keyword(s):

Risk Factors ◽

Elderly Patients ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Intertrochanteric Fracture ◽

Lower Extremities ◽

The Elderly ◽

Intertrochanteric Fractures ◽

Targeted Interventions ◽

Laboratory Test Results

Abstract Objective The purpose of this study was to investigate the incidence, location, and related factors of deep venous thrombosis (DVT) of the bilateral lower extremities after intertrochanteric fractures in the elderly. Methods Retrospective analysis was performed on the elderly patients with intertrochanteric fracture who were admitted from January 2017 to December 2019. At admission, patients receive routine ultrasound Doppler scanning of bilateral lower extremities to detect DVT; those with DVT were assigned to the case group and those without DVT to the control group. Patient data on demographics, comorbidities, injury-related data, and laboratory test results at admission were extracted. Logistic regression analyses were conducted to identify the independent risk factors associated with DVT. Results Five hundred seventy-eight patients were included, among whom 116 (20.1%) had DVT. Among those with DV, 70.7% (82/116) had DVT of the distal type, 24 (29.6%) had DVT of the proximal type, and 10 (10.4%) had mixed DVT. In 76.7% (89/116) of patients, DVT occurred in the fractured extremity, 9.5% (11/116) in the bilateral and 13.8% (16/116) in the non-fractured extremity. Multivariate analyses identified obesity, delay to admission, increased D-dimer level (> 1.44 mg/L) and reduced albumin (< 31.7 g/L) as independent factors. Conclusions Admission incidence of DVT was high in elderly patients with intertrochanteric fractures, especially the proximal DVT. Identification of associated risk factors is useful for individualized assessment risk of DVT and early targeted interventions.

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Comparison of Post-Operative Muscular Strength Between Gamma Nailing and Hemiarthroplasty System in Femoral Intertrochanteric Fractures

The Open Orthopaedics Journal ◽

10.2174/1874325001711010255 ◽

2017 ◽

Vol 11 (1) ◽

pp. 255-262 ◽

Cited By ~ 2

Author(s):

Mitsuaki Noda ◽

Yasuhiro Saegusa ◽

Masayasu Takahashi ◽

Chisa Noguchi ◽

Chihiro Yoshikawa ◽

...

Keyword(s):

Standard Deviation ◽

Muscle Strength ◽

Hip Joint ◽

Muscular Strength ◽

Weight Bearing ◽

Control Group ◽

Intertrochanteric Fractures ◽

Early Weight Bearing ◽

Abduction Strength ◽

Flexion Strength

Background: The current study focuses on the comparison of postoperative muscular strength around the hip joint of patients with femoral intertrochanteric fractures treated either by cephalo-medullary (CM) nailing or a new bipolar hip prosthesis (BHP), an especially attached device to secure displaced greater trochanteric fragment. Methods: Twenty patients treated with CM nailing were age- and sex- matched with a control group of 20 patients treated with BHP. Maximum isometric forces at the bilateral hip joint were measured during the follow up period. Means of 3 measurements were represented. Results: The mean and standard deviation values (kg) of muscle strength at the non-operative/ operative side in the CM nailing group were as follows: flexion strength 9.5±4.7/8.5±4.9 (P=0.06), extension strength 6.2±3.5/5.5±3.7 (P=0.08), abduction strength at 0 degrees 7.7±3.5/6.2±2.8 (p=0.002), abduction strength at 10 degrees 5.5±2.0/4.2±2.0 (p=0.001). In the BHP group, mean and standard deviation values of muscle strength at the non-operative/ operative side were as follows: flexion strength 6.5±2.8/6.0±3.4 (P=0.08), extension strength 4.4±0.9/4.4±0.6 (P=0.83), abduction strength at 0 degrees 5.1±1.9/5.0±1.6 (p=0.12), and that at 10 degrees 4.7±1.4/4.6±1.3 (p=0.10). Conclusion: Our results demonstrate that CM nailing may cause a 25-30% decrease in postoperative muscle strength around the hip joint, particularly during hip abduction. With the new BHP, greater trochanter reduction is achieved allowing early weight bearing and maintaining strength in abduction. Surgeons should consider postoperative muscular strength as one of the necessary factors for selection of the appropriate surgical procedure. Level of Evidence: Therapeutic Level III.

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Management of Recurrent Posterior Hip Dislocation in a Down Syndrome Patient with Dysplastic Hip Using Ganz Periacetabular Osteotomy: Follow Up After 4 Years

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00036 ◽

2020 ◽

Vol 8 (5_suppl5) ◽

pp. 2325967120S0003

Author(s):

Ismail H. Dilogo ◽

Jessica Fiolin

Keyword(s):

Down Syndrome ◽

Periacetabular Osteotomy ◽

Weight Bearing ◽

Hip Dislocation ◽

Harris Hip Score ◽

Syndrome Patient ◽

Down Syndrome Patient ◽

Dysplastic Hip ◽

Posterior Hip Dislocation

Recurrent hip dislocation in a Down Syndrome patient with dysplastic hip is a very challenging case to treat even for an expert orthopaedic hip surgeon. Least compliant patient and family, lowly educated with low socioeconomic status and the dysplastic hip forces limited option as a treatment. This is the first case world wide reporting 4 year follow up of dysplastic hip with Down Syndrome treated successfully with PAO technique. Methods: An eighteen years old female with history of Down Syndrome had multiple posterior hip dislocation episodes since 3 years prior. Several attempts of close reduction and hip spica applications were performed upon dislocation despite no successful retaining of reduction. Acetabular index of right hip were 550 and epiphyseal plate hasclosed. PatientwasperformedopenreductionusingSouthern-Mooreposteriorapproachand osteotomy of ischium, continued with capsulorrhaphy followed with Smith-Peterson anterior approach and osteotomy of superior ramus pubis and iliac bone. Then, derotation maneuver was performed under image intensifier to obtain adequate coveragefollowedwithbonegraftandfixationusing2cannulatedscrewandhipspica castapplication. Results: Within four years after surgery, the hip has never been dislocated again, patient could sit without pain and walk with full weight bearing although Harris Hip Score could not be performed due to Down Syndrome. Leg length discrepancy was negligible,fracture has fully united and acetabularin dex was300. Conclusions: Ganz periacetabular osteotomy, although a technically demanding surgery, is a preferable treatment in recurrent hip dislocation for Down Syndrome patient with good to excellent clinical and radiological ou tcome

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Functional and early weight-bearing protocol for achilles tendon ruptures: a retrospective study

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-020-01376-3 ◽

2020 ◽

Author(s):

Stijn Gillissen ◽

Ilan Halperin ◽

Vinay Balesar ◽

Erwin Gorter ◽

Alexander Greeven

Keyword(s):

Retrospective Study ◽

Achilles Tendon ◽

Weight Bearing ◽

Early Weight Bearing ◽

Tendon Ruptures

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Total Ankle Replacement for Treatment of End-Stage Osteoarthritis in Elderly Patients

Journal of Aging Research ◽

10.1155/2012/345237 ◽

2012 ◽

Vol 2012 ◽

pp. 1-8 ◽

Cited By ~ 8

Author(s):

Beat Hintermann ◽

Markus Knupp ◽

Lukas Zwicky ◽

Alexej Barg

Keyword(s):

Elderly Patients ◽

Weight Bearing ◽

Ankle Arthrodesis ◽

Total Ankle Replacement ◽

Long Term Results ◽

Postoperative Rehabilitation ◽

Early Weight Bearing ◽

Ankle Replacement ◽

First Choice ◽

End Stage

End-stage osteoarthritis of the ankle is a disabling problem, particularly in elderly patients who experience an overall loss of mobility and functional impairment and who then need compensatory adaption. Ankle arthrodesis, which has been demonstrated to provide postoperative pain relief and hindfoot stability, leaves the patient with a stiff foot and gait changes. For elderly patient, these changes may be more critical than generally believed. Additionally, the long duration of healing and rehabilitation process needed for ankle arthrodesis may be problematic in the elderly. In contrast to ankle arthrodesis, total ankle replacement has significant advantages including a less strenuous postoperative rehabilitation and preservation of ankle motion which supports physiological gait. Recently, total ankle replacement has evolved as a safe surgical treatment in patients with end-stage ankle osteoarthritis with reliable mid- to long-term results. Total ankle replacement needs less immobilization than arthrodesis and does allow for early weight-bearing and should be considered as a treatment option of first choice in many elderly patients with end-stage osteoarthritis of the ankle, especially in elderly patients with lower expectations and physical demands.

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