A Novel Method of Management of Unstable Trochanteric Fractures - A Retrospective Study in a Tertiary Care Hospital, Mysore

BACKGROUND Trochanteric fractures are commonly encountered in elderly patients, and the outcome may be bad, if not intervened early. Dynamic hip screw (DHS) fixation is the most common treatment in stable trochanteric fracture. In unstable trochanteric fractures, there is high incidence of failure in view of excessive collapse seen with dynamic hip screw. In order to limit the collapse, we have done a modification on dynamic hip screw implant. Here we have assessed fracture healing, collapse and implant failure, in unstable trochanteric fractures (Evan’s unstable fractures) treated by modified dynamic hip screw fixation. METHODS The present retrospective case record analysis was conducted among 31 patients with unstable trochanteric fracture classified according to Evan’s classification who were operated with modified DHS in a tertiary care hospital. The details about fracture healing, collapse of fracture fragments, implant failure were assessed in a structured checklist through the case record analysis. RESULTS Out of 31 patients in this study, 29 patients showed fracture healing (93.5 %) with or without minimal collapse and 2 patients had non-union (6.5 %) at the end of 5 months follow up. Ultimately, all fractures united at the end of 1-year follow-up. Out of 31 patients in this study, at first month follow-up, 26 patients showed no implant failure (83.9 %), 5 patient had implant migration not breaching cortex (16.1 %), at third month follow-up, out of 5 patients who had implant migration, two patients had implant migration not breaching cortex (6.4 %), 3 patients had implant migration breaching cortex (11.0 %), at fifth month follow-up, two patients had implant migration not breaching cortex (6.4 %), 3 patients who had implant migration breaching cortex underwent revision surgery (11.0 %). CONCLUSIONS Modified dynamic hip screw has shown improved results as compared to normal dynamic hip screw in treating unstable trochanteric fracture, which limits the collapse at fracture site. KEYWORDS Unstable Trochanteric Fractures, Collapse, Modified Dynamic Hip Screw

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Inferior Outcome after Unstable Trochanteric Fracture Patterns Compared to Stable Fractures in the Elderly

Journal of Clinical Medicine ◽

10.3390/jcm10020171 ◽

2021 ◽

Vol 10 (2) ◽

pp. 171

Author(s):

Johannes Gleich ◽

Carl Neuerburg ◽

Christoph Linhart ◽

Alexander Martin Keppler ◽

Daniel Pfeufer ◽

...

Keyword(s):

Trochanteric Fracture ◽

Fracture Pattern ◽

Proximal Femur Fracture ◽

Surgical Trauma ◽

Care Hospital ◽

Trochanteric Fractures ◽

Lesser Trochanter ◽

Fracture Patterns ◽

The Impact

Background: Various risk factors affecting outcome of elderly patients after proximal femur fracture have been identified. The present study aims to evaluate the impact of the fracture pattern in trochanteric fractures on postoperative mobility and complications. Methods: Ninety-two patients with a mean age of 84 years were included. According to the revised AO/OTA classification, fractures were divided into stable (AO 31A1) and unstable (AO 31A2/3) patterns. A follow-up examination was performed 12 months after cephalomedullary fixation to assess outcome parameters for mobility/activities of daily living (Parker Mobility Score (PMS)/Barthel Index (BI)) and complications (increase in requirement of care, hospital readmission, mortality rate). Results: At follow-up, patients with unstable trochanteric fracture patterns presented with lower PMS and BI compared to stable fractures (p < 0.05). Further, higher requirement of care and higher readmission rates compared to stable patterns were observed. Conclusion: Unstable trochanteric fractures presented inferior outcome compared to simple fracture patterns. This might be explained by the increasing surgical trauma in unstable fractures as well as by the mechanical impact of the lesser trochanter, which provides medial femoral support and is of functional relevance. Subsequent studies should assess if treatment strategies adapted to the specific fracture pattern (refixation of lesser trochanter) influence outcome in unstable trochanteric fractures.

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Randomized comparative study to evaluate the role of proximal femoral nail and dynamic hip screw in unstable trochanteric fractures

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20162618 ◽

2016 ◽

Vol 2 (3) ◽

pp. 75

Author(s):

Shivanand C Mayi ◽

Sachin Shah ◽

Sadashiv R Jidgekar ◽

Arunkumar Kulkarni

Keyword(s):

Comparative Study ◽

Functional Outcome ◽

Trochanteric Fracture ◽

Dynamic Hip Screw ◽

Proximal Femoral Nail ◽

Trochanteric Fractures ◽

Stable Fixation ◽

Femoral Nail ◽

Duration Of Surgery ◽

Hip Screw

Background: Treatment of unstable trochanteric fracture is much more challenging than stable fracture. These fractures require stable fixation to minimize the fracture and implant related complications. Need of this study is to assess the suitable implant for stable fixation of unstable trochanteric fracture with less intra and postoperative complications and good functional outcome.Methods: In this prospective randomized comparative study, 64 patients were distributed into two groups. Group A consisted of patients treated by proximal femoral nail (PFN) (n=32) and group B treated by dynamic hip screw (DHS) (n=32). All the patients were evaluated preoperatively and surgery was done according to the group they were allotted. Post-operative follow up was done at 6 weeks, 3, 6 and 12 months.Results: Average age of the patients in this study was 51.26±10.24 year. In this study patients were followed up for an average of 10.87±2.61 month. The duration of surgery was shorter in PFN group. Weight bearing was earlier in PFN group than DHS group. Mean functional ability score was better in PFN group with significant gain in function earlier as compared to DHS group.Conclusions: PFN is a better implant for internal fixation of unstable trochanteric fractures which allows early mobilization and has got better functional outcome score in early postoperative period than DHS

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A comparative study of 70 cases of inter-trochanteric fracture femur treated with dynamic hip screw and proximal femoral nailing

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20170788 ◽

2017 ◽

Vol 3 (2) ◽

pp. 293

Author(s):

Gaurav Singla

Keyword(s):

Hip Fractures ◽

Standard Procedure ◽

Trochanteric Fracture ◽

Dynamic Hip Screw ◽

Trochanteric Fractures ◽

Fracture Femur ◽

Femoral Nailing ◽

Significant Difference ◽

Hip Screw ◽

Proximal Femoral Nailing

Background: Inter-trochanteric fracture femur is a common and grievous injury, mostly suffered in elderly people. It accounts for approximately half of hip fractures in elderly and out of this, more than 50% of fractures are unstable. In old age, it occurs mostly due to trivial trauma. Various procedures of internal fixation had been proposed as a treatment. DHS considered to be the standard procedure for comparison of outcomes. The advantage of proximal femur nailing fixation is that it provides a more biomechanically stable construct by reducing the distance between hip joint and implant. The goal of this study is to compare the clinical and radio-graphical results of the DHS and PFN for the treatment of Intertrochanteric hip fractures (load bearing vs. load sharing).Methods: Seventy patients (more than 55 years old) presented to Adesh Hospital from March 2015 to November 2015 with trochanteric fracture femur. Patients were treated with osteosynthesis with dynamic hip screw (DHS) and proximal femoral nailing (PFN). The clinical results were compared between the dynamic hip screw and proximal femoral nailing groups of 35 patients each. All surgeries done on traction table and were followed up at regular intervals of 4 weeks, 6 weeks, 8 weeks, 10 weeks, 12 weeks, 6 months and at 1 year.Results: We observed no statistically significant difference between two groups in view of late & early complications and time to union. We observed significantly better outcomes in PFN group for unstable inter-trochanteric fractures and in unstable fractures reduction loss is significantly lower in PFN group.Conclusions: We concluded that PFN may be the better fixation device for most unstable inter-trochanteric fractures.

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A STUDY TO DETERMINE THE FUNCTIONAL OUTCOME IN THE MANAGEMENT OF STABLE PER TROCHANTERIC HIP FRACTURES WITH DYNAMIC HIP SCREW.

10.36106/ijar/4202586 ◽

2021 ◽

pp. 70-73

Author(s):

amit Supe ◽

Jayesh Anant Mhatre ◽

Nihar Modi ◽

Kartik Pande ◽

Eknath Pawar

Keyword(s):

Tertiary Care ◽

The Elderly ◽

Dynamic Hip Screw ◽

Biomechanical Property ◽

Care Hospital ◽

Trochanteric Fractures ◽

Early Ambulation ◽

Intertrochanteric Hip Fracture ◽

Hip Screw ◽

Fractures Of The Femur

BACKGROUND: The use of a dynamic hip screw (DHS) for stable as well as unstable intertrochanteric hip fracture xation has been successfully applied in fracture healing for more than 25years. DHS xation on unstable trochanteric fractures still has a more failure rate compared to stable fractures, mostly due to osteoporosis in patients. Thus, this study is aimed to investigate the biomechanical property of the DHS system to provide the stable xation in intertrochanteric A1 and A2 fractures1. MATERIAL AND METHODS: This is a retrospective study of 54 patients with trochanteric fractures of the femur that were treated with DHS (Dynamic hip screw) during the period of two years from April 2019 to March 2021 in a tertiary care hospital. All surgeries were performed under spinal and epidural anaesthesia. Surgery done was an internal xation with DHS plate. Results: Among 54 cases, 55.5% were A1, and 44.4% were A2 pertrochanter fractures. The clinical and functional outcomes of the procedure were excellent in 25 patients (46.29%), good in 19 patients (35.18%), fair in 8 patients (14.81%), and 2 (3.7%) of the patients had poor results. CONCLUSIONS: Intertrochanteric fractures are essentially fractures of the elderly, which demand prompt treatment and early ambulation. The dynamic hip screw is the operative treatment of choice for stable trochanteric fractures

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Evaluation of osteoporotic trochanteric fractures treated with cement-augmented dynamic hip screw

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20163121 ◽

2016 ◽

Vol 2 (3) ◽

pp. 147

Author(s):

Rahul Kumar Chandan ◽

Dharampal Verma ◽

R. C. Meena ◽

Jakir Husain

Keyword(s):

Weight Bearing ◽

Trochanteric Fracture ◽

Fracture Site ◽

Dynamic Hip Screw ◽

Intertrochanteric Fractures ◽

Partial Weight Bearing ◽

Hip Screw ◽

Lost To Follow Up ◽

Partial Weight

Background: Dynamic hip screw (DHS) has been the standard treatment for stable trochanteric fracture patterns. However, primary stabilization with dynamic/sliding hip screw is not always successful, especially in osteoporotic fractures. Internal fixation in such a situation may achieve a satisfactory initial fracture site reduction, but late fracture collapse into varus during weight bearing, can lead to a high failure rate. Since 1975, polymethylmethacrylate (PMMA) cement-augmented DHS have been used as a solution in unstable ITFs by adding an anchoring ability to the lag screw.Methods: A series of 33 osteoporotic intertrochanteric fractures were operated with cement augmented dynamic hip screw. One patient lost to follow up. All patients were then allowed partial weight bearing walker aided ambulation under the guidance of physiotherapist on the second or third postoperative day. The patients were followed radio logically and clinically at regular intervals (1st month, than at 3rd month and then at 6th month interval after surgery). Results were graded as excellent (score >31), good (score 24-31), fair (score 16-23), and poor (score <16). Clinical result was given according to Salvati and Wilson scoring.Results: Total 33 patients were taken for the study they were followed for minimum 6 months and at 6 months the clinical outcome was rated as per the Salvati and Wilson scoring system. One patient lost to follow-up. Final clinical results as evaluated by Salvati and Wilson scoring were; excellent in 24 cases (75%), good in 7 cases (21.88%), fair in 1 case (3.12%) and poor in 0 cases (0%). There were no non-union, AVN, implant failure and screw cut-out in our study.Conclusions: The surgical management of intertrochanteric fractures with PMMA augmented DHS provide a stable fixation with moderate pain free early mobilisation and better outcome in osteoporotic patients without the complications of superior screw cut-out, sliding collapse, and with the appropriate placement of bone cement along with proper amount (4-5 ml) of cement we can also reduce the cement related complications such as delayed healing, nonunion, heat necrosis and avascular necrosis.

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Dynamic Hip Screw (DHS) versus Proximal Femoral Nail Anti-rotation (PFNA) Fixation for Unstable (Evans-Jensen II and III) Inter-trochanteric Fractures of Femur in Elderly

Journal of College of Medical Sciences-Nepal ◽

10.3126/jcmsn.v15i3.25554 ◽

2019 ◽

Vol 15 (3) ◽

pp. 222-225

Author(s):

Manoj Kandel ◽

Robin Shrestha ◽

Krishna Prasad Poudel ◽

Shrawan Thapa ◽

Sushil Thapa ◽

...

Keyword(s):

Average Length ◽

Trochanteric Fracture ◽

Operation Time ◽

Healing Time ◽

Dynamic Hip Screw ◽

Proximal Femoral Nail ◽

Trochanteric Fractures ◽

Femoral Nail ◽

Fixation Group ◽

Hip Screw

Background: Dynamic hip screw (DHS) and proximal femoral nail anti-rotation (PFNA) are the two most commonly used fixation devices for inter-trochanteric fracture of femur. However, many clinical studies have shown lack of differences in the clinical outcome consistently with between these two fixation techniques. The main objective of this study is to compare the results of dynamic hip screw (DHS) and proximal femoral nail anti-rotation (PFNA) fixation in elderly patients with unstable inter-trochanteric fractures of femur. Methods: We retrospectively reviewed patients who underwent operative management for inter- trochanteric fractures of femur in our hospital between February 2013 and September 2017. Elderly patients (Age >60yrs) with unstable inter-trochanteric fracture of femur treated either with DHS fixation or with PFNA fixation were included and divided into two groups: DHS fixation group and PFNA fixation group. The comparative statistical analysis was done between two group using following parameters: average length of the incision, operation time, blood loss, fracture healing time, and degree of postoperative functional recovery. Results: The mean follow-up period, in DHS fixation group was 16 month (range 12 to 24 months) and in PFNA fixation group was 14 months (range 12 to 18 months). The differences between two groups regarding average length of the incision, operation time, and blood loss were statistically significant (p<0.05) and better in PFNA group whereas the differences between two groups regarding fracture healing time and the degree of postoperative functional recovery were not statistically significant (p >0.05). Conclusions: PFNA fixation may be better than DHS fixation for the treatment of unstable inter-trochanteric fractures of the femur in the elderly. However, the application and usage of DHS fixation could not be neglected and the choice of treatment depends upon the systemic condition and socioeconomic status of the patient, patient’s preferences, surgeon’s experience and availability of treatment facility.

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Outcome of dynamic hip screw with trochanteric stabilizing plate in treatment of unstable intertrochanteric femoral fractures in elderly patients.

The Professional Medical Journal ◽

10.29309/tpmj/2022.29.01.3433 ◽

2021 ◽

Vol 29 (01) ◽

pp. 31-35

Author(s):

Muhammad Asif ◽

Yaqoob ur Rehman ◽

Sardar Sohail Afsar

Keyword(s):

Elderly Patients ◽

Functional Outcome ◽

Femoral Fractures ◽

Trochanteric Fracture ◽

Dynamic Hip Screw ◽

Harris Hip Score ◽

Trochanteric Fractures ◽

Poor Functional Outcome ◽

Hip Screw ◽

Study Setting

Objective: To know about the outcome of dynamic hip screw with trochanteric stabilizing plate in treatment of unstable inter-trochanteric femoral fractures in elderly patients. Study Design: Descriptive study. Setting: Maqsood Medical Complex, Pak Medical Centre and Habib Medical Complex. Period: August 2016 to July 2018. Material & Methods: Total of 70 patients with unstable inter-trochanteric fracture and age above 60 years were included in the study. The fracture was fixed with dynamic hip screw and trochanteric stabilizing plate. Patients were evaluated every month after surgery for healing of fracture. Final functional outcome was measured at 6 months after surgery with Harris Hip Score. Results: Out of 70 patients 44 (63%) were females and 26 (37%) were males. Mean age was 74.34(SD + 08.31) years with range of 60 to 87 years. Mean Harris Hip Score at 6 months was 85% with standard deviation of± 4.Ten (14%) patients had excellent, 40 (58%) patients had good, 16 (23%) patients fair and 4 (5%) patients poor functional outcome. Conclusion: Excellent and good functional outcome can be achieved in unstable inter-trochanteric fractures fixed with dynamic hip screw and trochanteric stabilizing plate in majority of patients.

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A Comparison of Proximal Femoral Nail Antirotation and Dynamic Hip Screw Devices in Trochanteric Fractures

Journal of International Medical Research ◽

10.1177/147323000903700410 ◽

2009 ◽

Vol 37 (4) ◽

pp. 1057-1064 ◽

Cited By ~ 48

Author(s):

J Zou ◽

Y Xu ◽

H Yang

Keyword(s):

Functional Outcome ◽

Trochanteric Fracture ◽

Dynamic Hip Screw ◽

Proximal Femoral Nail ◽

Trochanteric Fractures ◽

Femoral Nail ◽

Operation Rate ◽

Significant Difference ◽

Hip Screw ◽

Proximal Femoral Nail Antirotation

This prospective, randomized study compared the functional outcome and complications associated with a proximal femoral nail antirotation (PFNA) device with those of a traditional extramedullary device, the dynamic hip screw (DHS), in patients with trochanteric fracture. A total of 121 patients were randomized to the PFNA group ( n = 58) or the DHS group ( n = 63). Perioperative information and complications were recorded, and assessments of functional outcome were made. The DHS group required a longer operative time and was associated with greater blood loss than the PFNA group. The re-operation rate was lower in the PFNA group compared with the DHS group, especially in patients with unstable fractures, although there was no statistically significant difference in the overall complication rate between the two groups. There were no significant differences in functional outcome between the PFNA and the DHS groups. In conclusion, the PFNA device is useful in the treatment of trochanteric fractures.

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Dynamic hip screw technique in the management of trochanteric fracture

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20195795 ◽

2019 ◽

Vol 6 (1) ◽

pp. 58

Author(s):

N. V. Narasimha Rao ◽

C. Siva Rama Krishna ◽

K. Aditya ◽

T. Jaya Chandra

Keyword(s):

Weight Bearing ◽

Trochanteric Fracture ◽

Dynamic Hip Screw ◽

Type I ◽

Trochanteric Fractures ◽

Medical College ◽

Long Time ◽

Hip Screw ◽

Male Patients ◽

Third Generation Cephalosporins

Background: Study was conducted to find the results of dynamic hip screw in the management of trochanteric fracture by analyzing the factors which influence post-operative mobility.Methods: Study was conducted in the department of orthopedics, GSL Medical College. Individuals >18 years, both genders who were diagnosed having trochanteric type I and II Boyd and Griffin stable fractures were included in the study. All surgeries were performed under spinal anesthesia, internal fixation with dynamic hip screw and 135o angled blade plate. Injectable third generation cephalosporins were used 24 hours preoperatively, intra- operatively and 5 days post-operatively, and oral antibiotics till suture removal. Patients allowed to sit on bed on 2nd and 3rd day and static quadriceps exercises were started from 2nd day onwards, hip and knee flexion exercises from 6 or 7th day and weight bearing walking form 10th day.Results: The average age was of the participants was 61.53 years, ranged between 41 to 80 years; 65% were female participants and 35% were male patients. In the study, 20 (50%) patients had right side fracture and left sided affection of trochanteric fracture to the remaining 50%. Most of the patients (67.5%) in this study were classified as type II Boyd and Griffin criteria, and 32.5% were type I. The clinical and functional outcome was calculated using the Kyle's criteria; 25% (10) showed excellent response, followed by good (50%), fair (15%) and poor (10%) results.Conclusions: Dynamic hip screw is the operative treatment of choice for stable trochanteric fractures. However, studies on large sample for long time are recommended.

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Use of Tranexamic Acid in Dynamic Hip Screw Plate Fixation for Trochanteric Fractures

Journal of Orthopaedic Surgery ◽

10.1177/1602400322 ◽

2016 ◽

Vol 24 (3) ◽

pp. 379-382 ◽

Cited By ~ 16

Author(s):

Ranjit Kumar Baruah ◽

Pranab Jyoti Borah ◽

Russel Haque

Keyword(s):

Adverse Event ◽

Blood Transfusion ◽

Blood Loss ◽

Plate Fixation ◽

Trochanteric Fracture ◽

Dynamic Hip Screw ◽

Trochanteric Fractures ◽

Control Groups ◽

Hip Screw ◽

And Control

Purpose To evaluate perioperative blood loss and blood transfusion requirement in patients who underwent dynamic hip screw plate fixation for a stable trochanteric fracture with or without preoperative intravenous tranexamic acid (TXA). Methods 49 men and 11 women (mean age, 56.5 years) who underwent open reduction and internal fixation with a dynamic hip screw plate for a stable trochanteric fracture by a single surgeon were equally randomised to receive either a single dose of intravenous TXA (15 mg/kg) 15 minutes prior to surgery or an equal volume of normal saline by slow infusion. Intra- and post-operative blood loss and the need for blood transfusion were assessed, as was any thromboembolic adverse event. Results The TXA and control groups were comparable in terms of age, gender, body mass index, blood pressure, pulse rate, time from injury to surgery, operating time, and preoperative haematological data. Blood loss was lower in the TXA than control group intraoperatively (320.3 vs. 403.33 ml, p<0.001), during 0 to 24 hours (61.67 vs. 186.67 ml, p<0.001), and during 24 to 48 hours (27 vs. 86.67 ml, p<0.001), as well as the total volume (408.97 vs. 676.67 ml, p<0.001). Respectively for the TXA and control groups, 27 and 30 required 28 and 41 units of blood intra-operatively (p<0.001), and 6 and 15 required 6 and 15 units of blood postoperatively (p=0.014). No patient had any thromboembolic adverse event. Conclusion TXA is safe and effective in reducing blood loss in dynamic hip screw plate fixation for stable trochanteric fractures.

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