Radiological Assessment of Hip Fracture Union RUSH and Modified RUSH

Abstract Objective：Intertrochanteric fracture is a common senile disease, which is mainly treated by surgery. The evaluation of postoperative healing of such fractures has always been based on qualitative evaluation of clinical and radiological indicators. Currently, there are no quantitative evaluations of hip fracture union other than the Radiographic Union Score or Hip (RUSH) score. The aim of this study was to evaluate fracture healing of intertrochanteric fractures treated with intramedullary nailing and plates using RUSH and the modified RUSH score we developed. Methods：We collected a total of 96 patients with surgically treated intertrochanteric fractures, including 46 with lateral plate fixation and 50 with intramedullary nailing. Six orthopedic surgeons assessed the overall impression of fracture union on more than 200 postoperative X-rays without knowing any information, followed by the use of RUSH and modified RUSH to evaluate the x-rays separately to see if the two methods improved the consistency of intertrochanteric fracture union. Results：the consistency of overall fracture healing impression was moderate（ICC=0.487）, RUSH and modified RUSH improved the consistency to substantial（ICC=0.80）and basically perfect（ICC=0.81）, respectively. In addition, for the evaluation of union of all intertrochanteric fractures, the overall score of plate was always higher than that of intramedullary nail. When the lateral plate and intramedullary nail were separately scored, the RUSH score of plate was basically the same as modified RUSH, while the modified RUSH of intramedullary nail was higher than modified RUSH. Ultimately,the medial (r=0.54 and R =0.53) and anterior (r=0.55 and R =0.54) and the global score (R =0.68 and R =0.68) in the single cortex showed a high correlation with the overall fracture healing impression in both RUSH and modified RUSH scores. Ultimately,medial (r=0.54 and r =0.53) and anterior (r=0.55 and r=0.54) in individual cortices and overall scores (r=0.68 and r =0.68) showed a high correlation with overall fracture healing impressions in both RUSH and modified RUSH scores. Conclusions：we developed a new hip fracture score comparable to the RUSH score that significantly improves the consistency of radiographic assessment of intertrochanteric fracture union. Most importantly, modified RUSH filled the callus formation gap in RUSH scores between cortical bridging and no cortical bridging. Therefore, we recommend the use of RUSH or a modified RUSH score to improve orthopedic surgeons' assessment of intertrochanteric fracture union.

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Does short-term weekly teriparatide improve healing in unstable intertrochanteric fractures?

Journal of Orthopaedic Surgery ◽

10.1177/2309499018802485 ◽

2018 ◽

Vol 26 (3) ◽

pp. 230949901880248 ◽

Cited By ~ 1

Author(s):

Seung-Ju Kim ◽

Hyun-Soo Park ◽

Dong-Woo Lee ◽

Jae-Won Lee

Keyword(s):

Hip Fracture ◽

Internal Fixation ◽

Fracture Healing ◽

Intertrochanteric Fracture ◽

Long Term Results ◽

Complication Rates ◽

Intertrochanteric Fractures ◽

Short Term ◽

Group 2 ◽

Group 1

Slow recovery after hip fracture has been associated with negative consequences. Thus, there is medical need to improve healing and functional recovery after intertrochanteric fracture. The aim of this study was to measure whether short-term teriparatide would improve healing in intertrochanteric fractures after internal fixation as measured by (1) clinical scores, (2) radiographic fracture healing, and (3) complication rates. We retrospectively reviewed 96 patients (average age, 82 years) who underwent closed reduction and internal fixation with proximal femoral nail (PFN) for unstable intertrochanteric fractures between 2014 and 2016. Of the 96 patients, 56 patients were treated with a PFN alone (group 1). These patients were compared with 46 patients for whom the same device was used and a weekly subcutaneous injection of PTH 1-34 (teriparatide) was prescribed postoperatively (group 2). Questionnaire surveys or telephone interviews were conducted, and patients completed a self-report Harris hip score and visual analog scale scores. The radiological time to fracture healing was assessed as the primary end point. Postoperative complication rates were compared. Functional outcomes at 6 months after surgery were similar in both groups. There were no differences between groups in the proportion of patients achieving radiographic fracture healing. The frequency of patients reporting adverse events was 20% (10 of 50) in group 1 versus 17% (8 of 46) in group 2 ( p = 0.744). Short-term teriparatide did not improve radiographic signs of fracture healing of an intertrochanteric fracture and reduce the incidence of complications. The effect of teriparatide on fracture healing remains uncertain. Further multicenter prospective studies are needed to demonstrate objective long-term results of parathyroid hormone therapy in patient with hip fracture. Level of Evidence: Level IV, therapeutic study.

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Analytic study of functional outcome of retrograde intramedullary nailing for distal femoral fractures in adults

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20212430 ◽

2021 ◽

Vol 7 (4) ◽

pp. 824

Author(s):

Srujith Kommera ◽

Pradeep Reddy ◽

Saba Khaleel

Keyword(s):

Range Of Motion ◽

Functional Outcome ◽

Intramedullary Nailing ◽

Weight Bearing ◽

Femoral Fractures ◽

X Rays ◽

Fracture Union ◽

Distal Femoral Fractures ◽

Retrograde Intramedullary Nailing ◽

Articular Fractures

Background: The purpose of this Study was to evaluate the clinical and functional outcome of retrograde intramedullary nailing for distal femur fractures.Methods: This 2 years observational study was done between December 2018 to January 2021, 60 patients with distal femoral fractures were surgically treated at our hospital using retrograde intramedullary nail. The patient was placed supine on fracture table with affected limb flexed to 60 degrees. Through a Transpatellar approach, the nail was introduced in retrograde method after serial reaming. Postoperatively knee range of motion was started immediately and weight bearing was progressed after signs of fracture union were noted on x-rays. The outcome was evaluated for time taken for fracture union, complications and functional outcome with various types of fractures.Results: All the fractures in the present study healed at an average of 13 weeks. However 25 to 40% of these patients underwent bone grafting primarily with reports of delayed union and non-union. Shortening occurred in two patients (3.33%) did affect the final functional outcome. average range of motion is 120 deg. for all fractures, 119 deg. for extra-articular fractures and 118 deg. for intra-articular fractures. Infection rates are low (0% to 8%).Conclusions: The study shows distal femoral fractures were common due to high velocity injuries, retrograde nailing is an excellent technique for management of distal femoral fractures as it promotes high rate of fracture union with less complications.

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Effect of teriparatide in fracture healing of intertrochanteric fracture: a prospective study

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20184386 ◽

2018 ◽

Vol 4 (6) ◽

pp. 918

Author(s):

Sanjeev K. Singhal ◽

Naresh Aggarwal ◽

Ajay Sharma

Keyword(s):

Prospective Study ◽

Fracture Healing ◽

Large Scale ◽

Intertrochanteric Fracture ◽

Calcium Supplementation ◽

Geriatric Trauma ◽

Controlled Study ◽

Control Group ◽

Intertrochanteric Fractures ◽

Early Return

Background: Intertrochanteric fracture is a relatively common and serious medical issue in geriatric trauma result in serious health problems and decrease health related quality of life. Faster time-to-union is important for early return to daily activities and reduction of complications. Teriparatide has been shown to accelerate fracture-healing. The purpose of the present prospective, randomized, controlled study was to evaluate the effect of teriparatide on the course of intertrochanteric fracture-healing.Methods: Forty patients of intertrochanteric fractures who underwent surgical intervention between June 2016 and May 2017 were enrolled in this prospective study and followed for minimum of six months. Group A included patients who received only calcium supplementation; patients in Group B received teriparatide along with calcium supplementation postoperatively.Results: The mean time to fracture healing was between 8-12 weeks for the treatment group, compared with 12-16 weeks for the control group. There was also significant effectiveness with regards to Parker and Palmer mobility score at 6 months.Conclusions: Postoperative use of teriparatide for 6 months appears to be an effective adjunct therapy in the treatment of patients with intertrochanteric fractures. However, because of the limited power of the study a large-scale cohort study is still required for determining the efficacy of teriparatide.

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The Radiographic Union Score for Hip (RUSH): the use of a checklist to evaluate hip fracture healing improves agreement between radiologists and orthopedic surgeons

Skeletal Radiology ◽

10.1007/s00256-013-1605-8 ◽

2013 ◽

Vol 42 (8) ◽

pp. 1079-1088 ◽

Cited By ~ 41

Author(s):

Mary M. Chiavaras ◽

Simrit Bains ◽

Hema Choudur ◽

Naveen Parasu ◽

Jon Jacobson ◽

...

Keyword(s):

Hip Fracture ◽

Fracture Healing ◽

Orthopedic Surgeons ◽

Radiographic Union

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Surgical Selection of Unstable Intertrochanteric Fractures: PFNA Combined with or without Cerclage Cable

BioMed Research International ◽

10.1155/2021/8875370 ◽

2021 ◽

Vol 2021 ◽

pp. 1-12

Author(s):

Chaoqing Huang ◽

Xing Wu

Keyword(s):

Internal Fixation ◽

Fracture Healing ◽

Weight Bearing ◽

Good Choice ◽

Fixation Method ◽

Intertrochanteric Fractures ◽

Orthopedic Surgeons ◽

One Year ◽

The Stability ◽

Selection Of

Due to the instability of unstable intertrochanteric fractures, the selection of a suitable internal fixation has always been a challenge for orthopedic surgeons. This study is aimed at comparing the clinical efficacy of PFNA combined with cerclage cable and without cerclage cable and finally recommend a stable internal fixation method to provide the basis for clinical therapy. From January 2014 to January 2018, we retrospectively analyzed all cases of unstable intertrochanteric fractures who received treatment in the Orthopedics Department of our hospital and finally screened 120 cases, 51 of whom were treated with cerclage cable, 69 without cerclage cable. The follow-up period was one year. HHS, BI, and RUSH scores were given within the specified time. We divided the patients into the PFNA+cable (PFNA combined with cerclage cable) group and the PFNA group. The time of fracture healing and weight-bearing in the PFNA+cable group was shorter than that in the PFNA group. With regard to HHS, BI, and RUSH, the PFNA+cable group was higher than the PFNA group at 1 month, 3 months, 6 months, and 12 months after operation. For HHS rating, the PFNA+cable group has a higher excellent rate than the PFNA group, which was 96.1% and 84.1%, respectively. All the results mentioned above were statistically significant. Compared with the group without cerclage cable, the application of cerclage cable can reduce the incidence of complications. From the comparison between the two groups, it can be seen that the surgical method of PFNA combined with cerclage cable can not only help to improve the stability of fracture reduction, shorten the time of fracture healing and postoperative weight-bearing, and significantly improve patients’ self-care ability but also reduce the incidence of postoperative complications. Therefore, we think PFNA combined with cerclage cable is a good choice.

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Proximal femoral nail antirotation II in fixation of intertrochanteric fractures: retrospective and prospective observational study

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20201733 ◽

2020 ◽

Vol 6 (3) ◽

pp. 593

Author(s):

Arvind Kumar S. M. ◽

Arun Kumar B.

Keyword(s):

Blood Loss ◽

Intertrochanteric Fracture ◽

Interquartile Range ◽

Proximal Femoral Nail ◽

Intertrochanteric Fractures ◽

X Rays ◽

Femoral Nail ◽

Unstable Intertrochanteric Fracture ◽

The Mean ◽

Proximal Femoral Nail Antirotation

Background: Intertrochanteric fractures occur mostly in elderly patients, and the outcome may be extremely poor if there is prolonged bed-rest. The best treatment for trochanteric fracture remains controversial. Proximal femoral nail antirotation (PFNA) II has excellent fit as the design is adapted to the anatomical situation of small statured patients also. It has a medial lateral angle of 5 degrees. It has several distal locking options viz static/dynamic. Objective of this study was to observe the operating time, blood loss and fracture union in intertrochanteric fractures treated with PFNA II from the data collected from patient’s case sheets and post-operative X-rays.Methods: 25 patients who were operated with PFNA II for unstable intertrochanteric fracture were selected using random selection and following parameters were noted from the records.Results: The mean age of the participants is 70.72±8.55 years with range from 52 years to 89 years. The mean duration was 1.98 hours ±0.66. The median duration was 2 with interquartile range from 1.5 to 2.5 hours. Mean blood loss was estimated to be 390 ml±62.78. The median blood loss was 370 ml with interquartile range from 360 to 420 ml.Conclusions: The PFNA II is an ideal implant for unstable intertrochanteric fracture since stable intramedullary fixation can be achieved with almost 100% union in the studied population.

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Retrograde intramedullary nailing for fractures of distal femur: a prospective study

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20164003 ◽

2016 ◽

Vol 2 (4) ◽

pp. 276 ◽

Cited By ~ 1

Author(s):

Dileep K. S. ◽

Mahesha K

Keyword(s):

Range Of Motion ◽

Functional Outcome ◽

Intramedullary Nailing ◽

Distal Femur ◽

Rating Scale ◽

X Rays ◽

Fracture Union ◽

Retrograde Intramedullary Nailing ◽

Interlocking Nailing ◽

Secondary Procedures

Background: The objective of the present study was to evaluate the clinical and functional outcome of retrograde intramedullary interlocking nailing for fractures of distal femur.Methods: This two-year prospective observational study includes all patients with fractures of distal femur who underwent retrograde intramedullary interlocking nailing. The patient was placed supine on fracture table with the affected limb flexed to 60o. Through a transpatellar approach, the nail was introduced in a retrograde method after serial reaming. Postoperatively knee range of motion was started immediately and weight-bearing was progressed after signs of fracture union were noted on x-rays. The outcome was evaluated for time taken for fracture union, complications and secondary procedures, knee range of motion and function at 1 year follow up using modified knee-rating scale of the hospital for special surgery.Results: There were 21 patients who underwent retrograde intramedullary nailing for fractures of distal femur during the study period. According to AO/ASIF system, fractures were classified as A1 (n=15), A2 (n=3), and A3 (n=3). In 17 patients, fracture united without complications or secondary procedures. Fractures united at a mean time of 19.4 weeks. There were no varus or valgus malalignments but one patient had significant limb shortening. At the end of 1 year, excellent to good functional outcome was noted in 81% of patients. Conclusions: Retrograde intramedullary nail fixation is a reliable method for treatment of fractures of distal femur. It promotes high rates of fracture union with minimal complications. This method does not interfere significantly with the knee function postoperatively.

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Does Bisphosphonate Delay Bone Healing After Proximal Femoral Nail Anti-Rotation

10.21203/rs.3.rs-29935/v1 ◽

2020 ◽

Author(s):

Ong-art Phruetthiphat ◽

Sasawat Tonvichien ◽

Suphot Phruetthiphat ◽

J. Lawrence Marsh

Keyword(s):

Surgical Treatment ◽

Hip Fracture ◽

Mortality Rate ◽

Elderly Patients ◽

Fracture Healing ◽

Functional Outcome ◽

Bone Healing ◽

Intertrochanteric Fracture ◽

Harris Hip Score ◽

Radiographic Union

Abstract BackgroundBisphosphonates are widely used for osteoporotic patients to decrease the rate of osteoporotic fractures and they have been shown to reduce the mortality rate in clinical trials. A yearly intravenous zoledronic acid in a clinical study (The HORIZON-RFT) significantly reduced any new clinical fracture and also secondary prevention of hip fracture while bisphosphonates are known to delay remodeling of bone raising the risk that they may delay fracture healing. However, current studies lack data demonstrating whether bisphosphonate (BPs) delays bone healing after hip fracture treatment in clinical practice. Purpose of study was to determine whether treating elderly patients with Bisphosphonate (BP’s) after proximal femoral nail fixation (PFNA) for intertrochanteric fractures delays fracture healing compared to similar patients not treated with BP’s. A secondary goal was to compare the functional outcome, complications and mortality between the two treatment groups.MethodsOne hundred ninety-six elderly patients underwent PFNA fixation for intertrochanteric fracture between 2015 and 2017 with age > 60 years and minimum 1-year follow-up inclusive of functional scores and complications.Intervention: Surgical treatment of intertrochanteric fracture plus calcium and vitamin D supplementation.Main Outcome Measurements: Time to clinical union and radiographic union (weeks), the functional outcome (Harris Hip Score) and complications including mechanical failure and mortality rate. Setting: Level 1 Trauma CenterResults There were comparable functional class and comorbidity between those with BP’s and not treated BP’s. In addition, there was no different in mortality rate (4.0%% vs 6.6%, p=0.537), time to clinical union (6.0 weeks vs 6.0 weeks, p=0.822), radiographic union (11.8 weeks vs 12.0 weeks, p=0.849), and functional outcome (Harris Hip Score) (74.4 vs 69.9, p=0.177) between two groups.ConclusionsBP’s can be used after surgical treatment of an osteoporotic hip fracture without concern that fracture healing will be delayed.Level of Evidence: Prognostic level III.

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HIP FRACTURES IN 5 YEARS AT HUE UNIVERSITY HOSPITAL

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2013.6.8 ◽

2014 ◽

pp. 47-50

Author(s):

Duy Binh Ho ◽

Nghi Thanh Nhan Le ◽

Maasalu Katre ◽

Koks Sulev ◽

Märtson Aare

Keyword(s):

Hip Fracture ◽

Femoral Neck ◽

Hip Fractures ◽

Age Groups ◽

Femoral Fractures ◽

Femoral Neck Fractures ◽

University Hospital ◽

High Risk Population ◽

Intertrochanteric Fractures ◽

Significant Difference

Aim: This study aimed to review the clinical findings and surgical intervention of the hip fracture at the Hue University Hospital in Vietnam. Methods:The data of proximal femoral fractures was collected retrospectively. All patients, in a period of 5 years, from Jan 2008 to December 2012, suffered either from intertrochanteric or femoral neck fractures. The numbers of patients were gathered separately for each year, by age groups (under 40, 40-49, 50-59, 60-69, 70-79, older) and by sex. We analyzed what kind of treatment options were used for the hip fracture. Results:Of 224 patients (93 men and 131 women) studied, 71% patients are over 70 years old, 103 women and 56 men (p<0.05). For patients under 40 years, there were 1 woman and 11 men (p<0.05). There were 88 intertrochanteric and 136 femoral neck fractures. There was no significant difference in the two fractures between men and women. The numbers of hip fracture increased by each year, 29/224 cases in 2010, 63/224 cases in 2011, 76/224 cases in 2012. Treatment of 88 intertrochanteric fractures: 49 cases (55.7%) of dynamic hip screw (DHS), 14 cases of hemiarthroplasty (15.9%), 2 cases of total hip replacement (2.3%). Treatment of 136 femoral neck fractures: 48 cases of total replacement (35.3%), 43 cases of hemiarthroplasty (31.6%), 15 cases of screwing (11%). In cases of 40 patients (17.9%) hip fracture was managed conservatively, 23 were femoral neck fractures and 17 were intertrochanteric fractures. Conclusions: Hip fracture is growing challenge in Hue medical university hospital. The conservative approach is still high in people who could not be operable due to severe medical conditions as well as for patients with economic difficulties. Over 70% of the hip fractures in people 70+ are caused by osteoporosis. The number of hip fracture is increasing in the following years, most likely due to the increase in the prevalence of osteoporosis. Early detection and prevention of osteoporosis should be addressed, particularly in high risk population. More aggressive surgical approach should be implemented in order to improve the quality of life in patients with hip fractures. Key words:Hip fracture.

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Do Orthopedic Surgeons or Neurosurgeons Detect More Hip Disorders in Patients with Hip-Spine Syndrome? A Nationwide Database Study

Brain Sciences ◽

10.3390/brainsci11040485 ◽

2021 ◽

Vol 11 (4) ◽

pp. 485

Author(s):

Tsung-Cheng Yin ◽

Adam M. Wegner ◽

Meng-Ling Lu ◽

Yao-Hsu Yang ◽

Yao-Chin Wang ◽

...

Keyword(s):

Lumbar Spine ◽

Spine Surgery ◽

Hip Surgery ◽

Lumbar Spine Surgery ◽

Research Database ◽

X Rays ◽

Replacement Surgery ◽

Orthopedic Surgeons ◽

Spine Pathology ◽

Sh Group

Background: Disorders of the hip and lumbar spine can create similar patterns of pain and dysfunction. It is unknown whether all surgeons, regardless of orthopedic or neurosurgery training, investigate and diagnose concurrent hip and spine pathology at the same rate. Methods: Data were retrieved from Taiwan’s National Health Insurance Research Database (NHIRD). Enrolled patients were stratified into hip and spine surgery at the same admission (Both), hip surgery before spine surgery (HS), or spine surgery before hip surgery (SH). The SH group was further subdivided based on whether spine surgery was performed by an orthopedic surgeon (OS) or neurosurgeon (NS), and differences in preoperative radiographic examinations and diagnoses were collected and analyzed. Results: In total, 1824 patients received lumbar spine surgery within 1 year before or after hip replacement surgery. Of these, 103 patients had spine and hip surgery in the same admission (Both), 1290 patients had spine surgery before hip surgery (SH), and 431 patients had hip surgery before spine surgery (HS). In the SH group, patients were categorized into spine surgery by orthopedic surgeons (OS) (n = 679) or neurosurgeons (NS) (n = 522). In the SH group, orthopedic surgeons investigated hip pathology with X-rays more often (52.6% vs. 38.1%, p < 0.001) and diagnosed more cases of hip disease (43.6% vs. 28.9%, p < 0.001) than neurosurgeons. Conclusions: Of patients in Taiwan’s NHIRD who had concurrent surgical degenerative hip and lumbar spine disorders who had spine surgery before hip surgery, orthopedic surgeons obtained hip images and made hip-related diagnoses more frequently than did neurosurgeons.

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