A study on clinical outcomes of complex subtrochanteric femoral fractures with cephalomedullary nail

Background: The aim of the study was to evaluate the clinical outcomes of complex subtrochanteric fractures treated by using cephalomedulary nail.Methods: This is a prospective observational study of 30 cases of complex subtrochanteric femoral fractures admitted to our hospital from January 2018 to June 2019. Cases were taken according to the inclusion and exclusion criteria i.e. type IV, type V Seinsheimer’s classification, above 18 years and those who are willing to participate in the study has been included and pathological fractures, open fractures were excluded. All the patients are followed up on 2 post-operative day, after 4 weeks, 8 weeks, 12 weeks and 6months. X-ray hip with thigh anteroposterior (AP) and lateral view taken during each follow up. Out comes was assessed using modified Harris hip score.Results: In our study of 30 cases there are 22 males and 8 females and the mean age of 43.7 years. 73.3% patients are due to Road traffic accidents predominance of right side. In our study 66% had type 4 Seinsheimers and 34% cases had type 5 Seinsheimers fracture. The mean duration of hospital stay was 17 days. Mean time for full weight bearing is 12 weeks. Good to excellent results are seen in 80% of type 4 subtrochanteric fractures and 75% of cases of type 5 subtrochanteric fractures. 4 cases had surgical site infection, 3 cases had varus, 1 case had developed implant failure, and 1 case had reverse Z effect.Conclusions: From this study, we conclude that proximal femoral nail is an excellent implant in the treatment of complex subtrochanteric femoral fractures the terms of successful outcome include a good understanding of fracture biomechanics, good preoperative planning and accurate instrumentation.

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The effects of full weight-bearing mobilization on clinical outcomes and subsidence in cemented and uncemented hemiarthroplasty in osteoporotic patients: A retrospective single-center study

Journal of Back and Musculoskeletal Rehabilitation ◽

10.3233/bmr-210024 ◽

2021 ◽

pp. 1-8

Author(s):

Betül Başar ◽

Hakan Başar

Keyword(s):

Clinical Outcomes ◽

Weight Bearing ◽

Femoral Stem ◽

Harris Hip Score ◽

Full Weight Bearing ◽

Single Center ◽

Single Center Study ◽

Uncemented Hemiarthroplasty ◽

The Mean ◽

Center Study

BACKGROUND: Early full weight-bearing mobilization is controversial in osteoporotic patients who have undergone uncemented hemiarthroplasty (CH). OBJECTIVES: The aim of the study was to compare the results of early full weight-bearing mobilization in CH and uncemented hemiarthroplasty (UCH). The effect of subsidence on the results was also evaluated. METHODS: Fifty-nine patients who underwent CH and UCH were evaluated. The mean age was 79.8 years (10 females, 15 males) for CH and 75.5 years (10 females, 24 males) for UCH. All patients started immediate full weight-bearing mobilization and weight-bearing exercises. RESULTS: There was no difference between the groups according to the Harris Hip Score. Both groups were evaluated in subgroups according to whether there is varus in the femoral stem. There was no difference between subgroups according to the Harris Hip Score. The femoral subsidence was not determined in CH group. In the UCH group, the subsidence was 1.13 ± 1.03 mm in varus femoral stem subgroup and 0.81 ± 0.85 mm in without femoral stem varus subgroup. There was no difference in subsidence between femoral stem with varus and without varus. The subsidence did not affect the Harris Hip Score. CONCLUSION: Full weight-bearing mobilization could be safely preferred in UCH, as in CH. Femoral stem varus below 5 degrees does not affect the results and subsidence.

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Treatment of subtrochanteric fracture femur by open reduction and internal fixation by long proximal femoral nailing

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20195811 ◽

2019 ◽

Vol 6 (1) ◽

pp. 164

Author(s):

Prabhu P. Munavalli ◽

Gururaj N. G.

Keyword(s):

Internal Fixation ◽

Open Reduction ◽

Road Traffic ◽

Weight Bearing ◽

Subtrochanteric Fracture ◽

High Rate ◽

Full Weight Bearing ◽

Subtrochanteric Fractures ◽

Fractures In Children ◽

Pathologic Fractures

Background: Subtrochanteric fractures are devasting injuries that most commonly affect the elderly population and also in young.Methods: This is a prospective study of 20 cases of subtrochanteric fracture admitted to KIMS, Huballi between November 2008 to August 2010 treated with left proximal femoral nail (LPFN) by open method. Cases were taken according to inclusion and exclusion criteria, i.e., fresh subtrochanteric fracture in adults. Pathologic fractures, multiple fractures, fractures in children, old neglected fractures were excluded from the study. Objectives of this study were to study subtrochanteric fractures and to determine effectiveness of LPFN in tretment of subtrochanteric fractures by open reduction and internal fixation (ORIF).Results: In our study of 20 cases, there were 16 male and 4 female patients with age ranging from 17 years to 75 years with most patients in between 21-40 years. 65% of the cases admitted were road traffic accidents, 25% due to fall from height and 10% due to trivial fall with right side being more common side affected. Russell and Taylor type IA fracture accounted for 40% of cases. Mean duration of hospital stay was 24 days and mean time of full weight bearing was 14 weeks in our patients. Good to excellent results were seen in 85% of cases in our study.Conclusions: Subtrochanteric fractures of femur can be successfully treated by ORIF by LPFN resulting in proper anatomical reduction and hence alignment and high rate of bone union.

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Outcome of proximal femoral nail antirotation in peritrochanteric fractures: A prospective study

Asian Journal of Medical Sciences ◽

10.3126/ajms.v12i8.36401 ◽

2021 ◽

Vol 12 (8) ◽

pp. 125-129

Author(s):

Pratyenta Raj Onta ◽

Dilip C Agarwal ◽

Upendra Jung Thapa ◽

Pabin Thapa ◽

Krishna Wahegoankar ◽

...

Keyword(s):

Blood Loss ◽

Weight Bearing ◽

Invasive Procedure ◽

Proximal Femoral Nail ◽

Harris Hip Score ◽

Full Weight Bearing ◽

Femoral Nail ◽

The Mean ◽

Proximal Femoral Nail Antirotation ◽

A Prospective Study

Background: The incidence of peritrochanteric fractures are increasing worldwide. Early mobilization in these fractures prevents from other medical complications. There are many methods of treatment but the ideal method should be less invasive procedure, intramedullary device and stable fixation of fracture. Proximal femoral nail antirotation (PFNA) is biomechanically considered one of the most effective methods of treatment with promising results. Aims and Objectives: The aim of our study was to evaluate the clinical and radiological outcomes in patient who were treated with PFNA in peritrochanteric fracture. Materials and Methods: This study was a prospective study which included 37 patients, conducted in Manipal Teaching Hospital from 1st October 2019 to 30th September 2020. All the patients were clinically evaluated and detail history was obtained. After the anaesthesia clearance the patients were operated. Operating time, intraoperative blood loss and complications were noted. Postoperatively the duration of hospital stay, time of partial and full weight bearing, time for radiological union and complications were noted. At the final follow up Harris Hip Score was used for functional outcome. Results: The mean age of the patient in this study was 64 years (45-88 years). The average time to complete the surgery was 62.49 minutes (45-75 minutes) and the average blood loss was 129.32 ml (65-210 ml). Partial weight bearing was started at the mean time of 8.57 weeks (6-12 weeks) whereas full weight bearing was done at the mean of 14.43 weeks (10-20 weeks). Fracture union was seen at the average of 11.41 weeks (8-18 weeks). The mean Harris Hip score at final follow up was 84.73 (65.8-95.0) with the functional status of 35.1% excellent result, 45.9% good, 13.5% fair and 5.4% poor. Conclusion: Proximal femoral nail antirotation in peritrochanteric fracture is a good method of fixation. The procedure is easy with reduced operative time and radiation exposure. Since this is minimally invasive procedure the blood loss is very less compared to DHS or plate fixation. The patient could be mobilized early from the bed that reduced the complication of immobilization. So we strongly recommend using PFNA for fixation of peritrochanteric fracture of hip.

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The concept of a cementless isoelastic monoblock cup made of highly cross-linked polyethylene infused with vitamin E: Clinical outcome and radiological analyses of migration and wear using EBRA at mid-term follow-up

10.21203/rs.3.rs-20410/v1 ◽

2020 ◽

Author(s):

Yama Afghanyar ◽

Sebastian Joser ◽

Jonas Tecle ◽

Philipp Drees ◽

Jens Dargel ◽

...

Keyword(s):

Vitamin E ◽

Weight Bearing ◽

Harris Hip Score ◽

Full Weight Bearing ◽

Acetabular Bone ◽

Total Wear ◽

The Mean ◽

Term Data ◽

Primary Total Hip Arthroplasty

Abstract Background The newest generation of cementless titanium coated, isoelastic monoblock cup with vitamin E-blended highly cross-linked polyethylene (HXLPE) has been introduced to the market in 2009. Aim of the present study was to obtain mid-term data including the analyses of migration and wear. Methods The present prospective study investigated 101 primary total hip arthroplasty (THA) cases in 96 patients at a single institution. Patients were allowed full weight-bearing on the first day postoperatively. Harris hip score (HHS) as well as pain and satisfication on visual analogue scale (VAS) were assessed during a mean follow-up of 79.0 months. Migration and wear were assessed using Einzel-Bild-Roentgen-Analyse (EBRA) software. Additionally, radiological alterations in the acetabular bone and complications were documented. Results At mid-term follow-up (mean 79.0 months (range: 51.8 – 101.7)), HHS was 91.1 (range 38.0 – 100.0), satisfaction on VAS was 9.6 (range 6.0 – 10.0), rest pain on VAS was 0.2 (range 0.0 – 4.0), and load pain on VAS was 0.6 (range 0.0 – 9.0). Mean migration was 0.86 mm (range: 0.0 – 2.56) after 24 months and 1.34 mm (range: 0.09 – 3.14) after 5 years. Mean annual migration rate was 0.22 (range: -0.24 – 1.34) at 5 years. Mean total wear was 0.4 mm (range: 0.03 – 1.0) at 5 years. The mean annual wear rate was 0.06 mm per year (range: 0.0 – 0.17). Radiographic analysis showed osteolysis in none of the cases and no revision surgeries had to be performed. Conclusion The concept of vitamin-E blended HXLPE in cementless isoelastic monoblock cups prevents osteolysis, aseptic loosening and the need of revision surgery at mid-term. Values for cup migration and wear stay well below the benchmarks which are considered predictive for potential future failure.

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DIAPHYSEAL FEMORAL FRACTURES

The Professional Medical Journal ◽

10.29309/tpmj/2015.22.04.1332 ◽

2015 ◽

Vol 22 (04) ◽

pp. 476-482

Author(s):

Muhammad Azeem Akhund ◽

Karam Ali Shah ◽

Allah Nawaz Abbasi ◽

Zulfiqar Ali Mastoi

Keyword(s):

Road Traffic ◽

Callus Formation ◽

Weight Bearing ◽

Femoral Fractures ◽

P Value ◽

Female Ratio ◽

Femur Fractures ◽

Group A ◽

The Mean ◽

Group B

The femur fractures usually happen with oomph forces like motor vehicleaccidents. Objectives: To assess the mode of injury and complications of the management, indiaphyseal femoral fractures, in comparison of close versus open intramedullary interlockingnail (IMN). Study Design: Experimental and comparative study. Period: April 2013 to March2014. Setting: Department of Orthopaedic Surgery, Peoples University of Medical & Healthsciences, Nawabshah. Methods: The cases were divided into two groups A and B. Group Awas treated by open nailing (n = 20) and group B by close nailing (n = 20), all the cases wereoperated within 48 hours of admission. All the data were recorded on well structured proforma.Serial radiographies were performed at 3, 6, 12 weeks, and 6 months; additional radiographieswere performed as needed postoperatively. Knee, ankle, and hip motions were begun andprotected weight bearing was started on the second day postoperatively and increasedgradually to full WB depending on x-ray findings of callus formation. The patients were followedfor two years. Results of open and closed I.M.N were assessed and the complications if anywere observed over a mean follow-up period of two years. Results: The mean age in groupA was 29.40 years and the mean age in group B was 30.45 years. Out of 40 cases, 32(80.0%)were males with male to female ratio 1:4. Mean ± SD hospital stay was 19.80 ± 14.60 days ingroup A, and 17.90 ± 5.95 days in group B (p value 0.55). Average time between injury andadmission was 1.53 days (n = 40), in the group A it was 1.05 days, and in the group B it was2.0 days (p value 0.03). The average of time between injury and operation in the group A was8.75 days, and in the group B, it was 8.20 days, (p value 0.71). The average of time betweenadmission and discharge in the group A was 11.0 days, and in the group B was 9.15 days,(p value 0.55). Mean ± SD union time was 11.70 ± 6.45 weeks, in group A and 11.90 ± 5.77weeks, in group B. (p value 0.91). All the patients had full ranged of hip motion and 2 (10.0%)patients of group A had mild limitation of knee motion with a flexion ranges between 80 and110 degrees. Final functional results based on Thoresen BO criteria16. Excellent results wereobserved in 19 (47.5%) cases, out of them 5(25.0%) were in group A and 14(70.0%) were ingroup B. Good results were found in 13(32.5%) patients, out of these 7(35.0%) were in group Aand 6(30.0%) were in group. Fair and poor results were detected in 4(10.0%) cases of group A.Conclusions: Road traffic accidents by motorcycle was found the commonest (47.5%) causeof femur fracture, a few complications were observed in open interlocking nailing as comparedto closed interlocking nails.

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Radiologic and functional outcome in patients with ipsilateral fractures of proximal femur and shaft treated by long proximal femoral nailing

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20205574 ◽

2020 ◽

Vol 7 (1) ◽

pp. 129

Author(s):

Saju S. ◽

Thomas M. A.

Keyword(s):

Functional Outcome ◽

Proximal Femur ◽

Weight Bearing ◽

Femoral Fractures ◽

Full Weight Bearing ◽

Femoral Nailing ◽

Femur Fractures ◽

The Mean ◽

Mean Time ◽

Proximal Femoral Nailing

Background: Combination of ipsilateral proximal femur and shaft of femur fractures are one of the rare fractures which were previously managed with two different implants for each fracture. Various studies have shown that long proximal femoral nailing is as effective as two different implants in fracture healing.Methods: 25 cases in the age group of 20-80 years with ipsilateral proximal femur and shaft of femur fractures were enrolled from July 2014 to July 2017 and treated with long proximal femoral nailing. The cases were followed up at 6 weekly intervals and were assessed for their functional outcome using Friedman and Wyman criteria.Results: Proximal femoral fractures united at an average time of 3.96 ±1.3 months, whereas the mean time shaft of femur fractures took to unite was 5.67±3 months. The mean time patients took to start full weight bearing was 6.15±2.76 months. Functional assessment at 12 months revealed outcome as good in18 (75%), fair in 5 (20.8%) and poor in 1 (4.1%).Conclusions: Long proximal femoral nailing is a good option in managing patients with ipsilateral proximal and shaft of femur fractures.

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The concept of a cementless isoelastic monoblock cup made of highly cross-linked polyethylene infused with vitamin E: Radiological analyses of migration and wear using EBRA and clinical outcomes at mid-term follow-up

10.21203/rs.3.rs-20410/v3 ◽

2021 ◽

Author(s):

Yama Afghanyar ◽

Sebastian Joser ◽

Jonas Tecle ◽

Philipp Drees ◽

Jens Dargel ◽

...

Keyword(s):

Vitamin E ◽

Weight Bearing ◽

Harris Hip Score ◽

Full Weight Bearing ◽

Acetabular Bone ◽

Total Wear ◽

Radiological Data ◽

The Mean ◽

Primary Total Hip Arthroplasty

Abstract Background: The newest generation of cementless titanium-coated, isoelastic monoblock cup with vitamin E-blended highly cross-linked polyethylene (HXLPE) was introduced to the market in 2009. The aim of the present study was to obtain mid-term follow-up data including migration and wear analyses.Methods: This prospective study investigated 101 primary total hip arthroplasty (THA) cases in 96 patients treated at a single institution. Patients were allowed full weight-bearing on the first day postoperatively. Harris hip score (HHS) and pain and satisfication on a visual analogue scale (VAS) were assessed at a mean follow-up of 79.0 months. Migration and wear were assessed using Einzel-Bild-Roentgen-Analyse (EBRA) software. Radiological acetabular bone alterations and complications were documented.Results: At mid-term follow-up (mean 79.0 months, range: 51.8–101.7), 81 cases with complete clinical and radiological data were analyzed. Utilisable EBRA measurements were obtained for 42 hips. The mean HHS was 91.1 (range 38.0–100.0), VAS satisfaction was 9.6 (range 6.0–10.0), VAS rest pain was 0.2 (range 0.0–4.0), and VAS load pain was 0.6 (range 0.0–9.0). Mean migration was 0.86 mm (range: 0.0–2.56) at 24 months and 1.34 mm (range: 0.09–3.14) at 5 years, and the mean annual migration rate was 0.22 (range: -0.24–1.34). The mean total wear was 0.4 mm (range: 0.03–1.0), corresponding to a mean annual wear rate of 0.06 mm per year (range: 0.0–0.17). Radiographic analysis did not reveal any cases of osteolysis, and no revision surgeries had to be performed.Conclusions: After using vitamin-E blended HXLPE in cementless isoelastic monoblock cups, there were no obvious signs of osteolysis or aseptic loosening occurred. No patients required revision surgery after mid-term follow-up. Cup migration and wear values were well below the benchmarks considered predictive for potential future failure.

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The concept of a cementless isoelastic monoblock cup made of highly cross-linked polyethylene infused with vitamin E: radiological analyses of migration and wear using EBRA and clinical outcomes at mid-term follow-up

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-03981-8 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Yama Afghanyar ◽

Sebastian Joser ◽

Jonas Tecle ◽

Philipp Drees ◽

Jens Dargel ◽

...

Keyword(s):

Vitamin E ◽

Weight Bearing ◽

Trial Registration ◽

Harris Hip Score ◽

Full Weight Bearing ◽

Link Type ◽

Radiological Data ◽

Registration Number ◽

The Mean

Abstract Background The newest generation of cementless titanium-coated, isoelastic monoblock cup with vitamin E-blended highly cross-linked polyethylene (HXLPE) was introduced to the market in 2009. The aim of the present study was to obtain mid-term follow-up data including migration and wear analyses. Methods This prospective study investigated 101 primary total hip arthroplasty (THA) cases in 96 patients treated at a single institution. Patients were allowed full weight-bearing on the first day postoperatively. Harris hip score (HHS) and pain and satisfication on a visual analogue scale (VAS) were assessed at a mean follow-up of 79.0 months. Migration and wear were assessed using Einzel-Bild-Roentgen-Analyse (EBRA) software. Radiological acetabular bone alterations and complications were documented. Results At mid-term follow-up (mean 79.0 months, range: 51.8–101.7), 81 cases with complete clinical and radiological data were analyzed. Utilisable EBRA measurements were obtained for 42 hips. The mean HHS was 91.1 (range 38.0–100.0), VAS satisfaction was 9.6 (range 6.0–10.0), VAS rest pain was 0.2 (range 0.0–4.0), and VAS load pain was 0.6 (range 0.0–9.0). Mean migration was 0.86 mm (range: 0.0–2.56) at 24 months and 1.34 mm (range: 0.09–3.14) at 5 years, and the mean annual migration rate was 0.22 (range: − 0.24–1.34). The mean total wear was 0.4 mm (range: 0.03–1.0), corresponding to a mean annual wear rate of 0.06 mm per year (range: 0.0–0.17). Radiographic analysis did not reveal any cases of osteolysis, and no revision surgeries had to be performed. Conclusions After using vitamin-E blended HXLPE in cementless isoelastic monoblock cups, there were no obvious signs of osteolysis or aseptic loosening occurred. No patients required revision surgery after mid-term follow-up. Cup migration and wear values were well below the benchmarks considered predictive for potential future failure. Trial registration The trial registration number on ClinicalTrials.gov: NCT04322916 (retrospectively registered at 26.03.2020).

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Short-term results of a novel management of supracondylar fracture with coexisting osteoarthritis with bifold fixation and total knee arthroplasty

Arthroplasty ◽

10.1186/s42836-021-00098-0 ◽

2021 ◽

Vol 3 (1) ◽

Author(s):

Nicholas A. Antao ◽

Sanjay Londhe ◽

Rajan Toor ◽

Rajesh Shirishkar ◽

Siddharth Aiyer

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Locking Plate ◽

Weight Bearing ◽

Femoral Fractures ◽

Womac Score ◽

Full Weight Bearing ◽

Osteoarthritis Of The Knee ◽

Total Knee ◽

The Mean

Abstract Purpose Presence of supracondylar and periarticular femoral fracture with associated arthritis of knee poses a challenging situation to the orthopaedic surgeon. The results of fixation of fracture in osteoporosis are not very satisfactory and have complications. With fixation alone, they still cannot bear weight on affected leg due to severe disability of osteoarthritis. To make patient walk, conventionally three surgeries in the form of fracture fixation, removal of implant and total knee arthroplasty (TKA) needs to be done in staged manner. We propose a novel management in form of bifold fixation and simultaneous TKA. Methods Eight cases (6 females, 2 males) of supracondylar femoral fractures with severe osteoarthritis of the knee and osteoporosis were primarily fixed with bifold fixation using SIGN nail (www.signfracturecare.org) and locking plate together with simultaneous total knee arthroplasty. There were five cases (2 males and 3 females) of grade 4 (Kellgren-Lawrence grading) osteoarthritis (OA) and three cases (all females) of severe rheumatoid arthritis (RA). Results The mean age was 68 years and average time for full weight bearing was 6 days. Radiographic evidence of fracture union was achieved in 16.25 weeks. The mean Knee Society Score (KSS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score at 26 months was 83.13 and 22.13 respectively. Conclusions Single stage combined bifold osteosynthesis with interlocking nail and locking plate together with total knee arthroplasty helps in one time management of these difficult injuries. It is a cost-effective and economically sound option and gives excellent results with good patient satisfaction.

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Comparison of Clinical Outcomes Between Cephalomedullary Nails and Dynamic Hip Screws for Basicervical Proximal Femoral Fractures

10.21203/rs.3.rs-37367/v1 ◽

2020 ◽

Author(s):

Zhen Jian ◽

Tao Lv ◽

Rongguang Ao ◽

Xinhua Jiang ◽

Jianhua Zhou ◽

...

Keyword(s):

Clinical Outcomes ◽

Weight Bearing ◽

Femoral Fractures ◽

Osteoporosis Treatment ◽

Proximal Femoral Fracture ◽

Proximal Femoral Fractures ◽

Anatomic Reduction ◽

Significant Difference ◽

The Mean ◽

Cephalomedullary Nails

Abstract Background Basicervical proximal femoral fractures have greater biomechanical instability and higher incidence of implant-related complications than other types of proximal femoral fractures. The present retrospective study was performed to find a proper fixation treating basicervical proximal femoral fractures by a comparation of clinical outcomes between cephalomedullary nails and dynamic hip screws, and introduce our experience in surgical tricks and perioperative management. Methods Between January 2015 and December 2018, 821 patients aged 60 years or older suffering from a proximal femoral fracture and receive internal fixation surgery were reviewed. 25 patients of basicervical femoral fractures were included in the study according to inclusion and exclusion criteria. 7 patients were treated with a DHS, 18 with the CMN. Relevant operational data and clinical evaluation were collected. Results Reduction qualities of 6 patients were good (85.7%), 1 were acceptable (14.3%) in DHS Group and 14 of the 18 patients were good (77.8%), 4 were acceptable (22.2%) in CMN Group. The mean TAD in DHS Group of was 17.4 mm while 20.3 mm in CMN Group. Bone union had been achieved 19.9 weeks in DHS Group and 17.8 weeks in CMN Group. The mean Harris score at the final follow up was 83.9, 84.4 respectively in DHS and CMN Group with no significant difference. Conclusions DHS was not inferior for the treatment of basicervical proximal femoral fractures compared to CMNs with blade type or two integrated screw type. When applied properly, both CMNs with blade type or two integrated screw type and DHS can achieve satisfied prognosis. Our unique experiences included anatomic reduction during surgery, anti-osteoporosis treatment and prolonged weight-bearing time.

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