The PFNA® Augmented in Revision Surgery of Proximal Femur Fractures

Objectives: Modern implants for proximal femur fracture treatment have clearly improved clinical results. However, complications, including cut-out and loss of reduction, requiring revision surgery still occur. A major challenge in these cases is a loss of bone stock due to the existing implant, which is usually exacerbated by osteoporosis. A potential solution is the augmentation of implants, for example, of the femoral neck blade using bone cement. Materials and Methods: Ten patients (five loosening of femoral neck implant, two pseudarthrosis, two implant failures and one acute fracture) were included. The initial hardware was removed and a PFNA augmented was implanted. The perforated femoral neck blade was augmented using polymethyl methacrylate cement. Clinical and radiological follow-up was performed at a mean of 5.4 months (SD ±4.34). The main outcome parameters were fracture healing and implant-related complications. Results: Technical handling was uneventful in all cases. No cement leakage into the joint occurred in any of the cases. The mean amount of cement injected was 5.3 ml. The fracture healed during follow-up in all cases except two patients who died from causes unrelated to the procedure and prior to complete consolidation. Problem-free elective hardware removal of the PFNA augmented was performed in two cases. Discussion: The PFNA augmented is a potential implant for joint-preserving revision surgery in proximal femur fractures. The augmentation improves implant anchorage in the impaired bone stock. In this preliminary series, no negative biological side effects of the cement (i.e. osteonecrosis) were observed.

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Treatment of Proximal Femur Fractures on the Background of Osteoporosis

N.N. Priorov Journal of Traumatology and Orthopedics ◽

10.17816/vto200411127-31 ◽

2004 ◽

Vol 11 (1) ◽

pp. 27-31 ◽

Cited By ~ 1

Author(s):

A F Lazarev ◽

E I Solod ◽

A O Ragozin ◽

M G Kakabadze ◽

A F Lazarev ◽

...

Keyword(s):

Femoral Neck ◽

Proximal Femur ◽

Femoral Neck Fractures ◽

Mineral Density ◽

Stable Fixation ◽

Fracture Characteristics ◽

Proximal Femur Fractures ◽

Femur Fractures ◽

Choice Of Treatment ◽

Density Evaluation

Analysis of treatment of 526 patients with proximal femur fractures (362 patients with femoral neck fractures and 164 patients with trochanteric zone fractures) was performed. Patients' age ranged from 34 to 92 (mean 67). Algorithm of differentiated choice of operative tactics depending on fracture characteristics and injury term was presented. Low invasive osteosynthesis of femoral neck with bundle of stressed V-shaped pins was suggested. Theoretical and practical ground of that technique was given. Stress within fixative-bone system created after osteosynthesis by V-shaped pins, provided stable fixation even in marked osteoporosis. The importance of bone mineral density evaluation for the choice of treatment tactics as well as the necessity of medicamental correction of the disturbed bone remodeling after surgical treatment was noted.

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Mortality and morbidity of proximal femur fractures in elderly population – A three year follow-up study

Indian Journal of Orthopaedics Surgery ◽

10.18231/j.ijos.2020.013 ◽

2020 ◽

Vol 6 (2) ◽

pp. 69-72

Author(s):

Sandeep Krishna Avulapati ◽

◽

Avinash Bajjuri ◽

Sunil Boddu ◽

Anudeep Peddineni ◽

...

Keyword(s):

Proximal Femur ◽

Elderly Population ◽

Mortality And Morbidity ◽

Proximal Femur Fractures ◽

Follow Up Study ◽

Femur Fractures

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In-Hospital Mortality following Proximal Femur Fractures in Elderly Population

The Surgery Journal ◽

10.1055/s-0039-1692995 ◽

2019 ◽

Vol 05 (02) ◽

pp. e53-e56 ◽

Cited By ~ 3

Author(s):

Ganesan G. Ram ◽

Praveen Govardhan

Keyword(s):

Hip Fracture ◽

Hospital Mortality ◽

Proximal Femur ◽

Categorical Variables ◽

Proximal Femur Fracture ◽

P Value ◽

Exclusion Criteria ◽

Proximal Femur Fractures ◽

Femur Fractures ◽

Significant Difference

Context In India, hip fracture crude incidence above the age of 50 years was 129 per 100,000. Aims The aim of this study is to analyze the in-hospital mortality following proximal femur fractures in elderly Indian population. Methods and Material The study was done in Sri Ramachandra Medical Center, Chennai, India. Patient's records were retrospectively evaluated for a period of 3 years from January 1, 2015 to January 1, 2018. The inclusion criteria were patients both male and female aged more than 65 years admitted with the diagnosis of neck of femur or intertrochanteric or subtrochanteric fractures. The exclusion criteria were patients having any associated fracture or previous hip fracture history or diagnosed primary or secondary malignancies. To evaluate any surgical delay two groups were formed. After eliminating cases based on exclusion criteria, we had 270 patients for evaluation. Statistical Analysis Used The collected data were analyzed with IBM.SPSS statistics software 23.0 Version. To describe about the data descriptive statistics frequency analysis, percentage analysis were used for categorical variables and the mean and standard deviation (SD) were used for continuous variables. To find the significant difference between the bivariate samples, Student's t-test and analysis of variance (ANOVA) were used. The p-value of 0.05 is considered as significant level. Results We had a total of 24 mortalities with 15 males and 9 females. The in-hospital mortality of patients who underwent replacement surgeries for proximal femur fractures was 14 in our study. Sixteen of the in-hospital mortality patients had low Parker's mobility score. Twenty patients had mortality when surgery was delayed more than 48 hours. Conclusions In-hospital mortality in elderly patients having proximal femur fracture increases significantly if the patient was having low-preoperative mobility status, if surgery was delayed more than 48 hours, and if patient undergoes replacement surgeries.

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Factors in Pulmonary Embolus Diagnosis via CT Pulmonary Angiogram in Patients Undergoing Repair of Proximal Femur Fractures

The Open Orthopaedics Journal ◽

10.2174/1874325001812010236 ◽

2018 ◽

Vol 12 (1) ◽

pp. 236-251

Author(s):

Peter Moriarty ◽

Heather Moriarty ◽

Michael Maher ◽

James Harty

Keyword(s):

Pulmonary Artery ◽

Proximal Femur ◽

Femur Fracture ◽

Main Pulmonary Artery ◽

Fracture Repair ◽

Proximal Femur Fracture ◽

Pulmonary Emboli ◽

Proximal Femur Fractures ◽

Femur Fractures ◽

D Dimer

Background:As imaging technology improves small Pulmonary Emboli (PE) of debatable clinical relevance are increasingly detected leading to higher numbers of patients receiving anticoagulation. Although PE are an important cause of morbidity and mortality in patients undergoing repair of proximal femur fractures, this cohort of patients are at increased falls risk and are therefore largely unsuitable for long term anticoagulant therapy.Objective:1. To review sequential Computed Tomography Pulmonary Angiograms (CTPA) performed in patients who underwent repair of proximal femur fractures at our institution. 2. To establish the perioperative CT imaging performed.Design:A retrospective cross sectional study of all patients undergoing proximal femur fracture repair at a single tertiary referral.Methods:The theatre database was interrogated to reveal all patients undergoing proximal femur fracture repair over a 28 month period from 01/01/12 to 07/04/14 inclusive. This was cross-referenced with the Picture Archiving Communication System (PACS) to establish all imaging undertaken in the perioperative period. CTPA studies performed within the time period of 1 week prior to and 6 months post proximal femur fixation were included. CTPA studies and reports were assessed for quality and findings. D-Dimer results, if performed within 72 hours of the CTPA study, were recorded.Results:1388 patients underwent neck of femur fracture repair in the 28-month study period. Of this cohort 71 CTPA studies were performed in 71 patients (5.2%) with a mean age of 77.8 years (range 38 - 100). 53 (74.6%) of studies were negative for embolus and 17 (23.9%) studies revealed clot in a pulmonary artery (1 saddle embolus, 2 main pulmonary artery emboli, 7 lobar vessel emboli, 2 segmental artery emboli, 5 subsegmental emboli). Overall PE detection rate was 1.2% of our total study population. In all 71 studies, Houndsfield Unit (HU) in the main pulmonary artery (PA) was >200; which is considered to be of satisfactory quality to assess for segmental pulmonary emboli. 32% of patients had D Dimer levels performed, however no relationship with presence of PE on CTPA was demonstrated.Conclusion:The rate of positive CTPA studies in patients undergoing proximal femur fracture repair is 23.9% in our patient population, comparing favorably to published data. This is likely to reflect good compliance with prevention measures at ward level. D-Dimer results are unreliable for PE prediction.

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Complications following proximal femoral locking compression plating in unstable proximal femur fractures: medium-term follow-up

European Journal of Orthopaedic Surgery & Traumatology ◽

10.1007/s00590-017-1981-1 ◽

2017 ◽

Vol 27 (8) ◽

pp. 1117-1124 ◽

Cited By ~ 1

Author(s):

Sandro Hodel ◽

Frank J. P. Beeres ◽

Reto Babst ◽

Björn-Christian Link

Keyword(s):

Proximal Femur ◽

Medium Term ◽

Proximal Femur Fractures ◽

Femur Fractures ◽

Compression Plating

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Proximal femur fractures - effect of preoperative mental status of patients on postoperative mobility of patients

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20185057 ◽

2018 ◽

Vol 5 (1) ◽

pp. 27

Author(s):

Sandeep Krishna Avulapati ◽

Senthil Kumar Mahalingam ◽

T. Munirathnam ◽

Jagadeesh Gudaru ◽

Deepak Kaki

Keyword(s):

Mental Status ◽

Proximal Femur ◽

Femur Fracture ◽

Proximal Femur Fracture ◽

Mobility Patterns ◽

Mental Test Score ◽

Proximal Femur Fractures ◽

Femur Fractures ◽

Postoperative Mobility ◽

Abbreviated Mental Test

Background: In the elderly population, proximal femur fractures are most common which can result in increase of morbidity and mortality. Pre and postoperative mobility patterns, also depends upon the Mental Status of the patient. Incidence of Mental health disorders of patient can increases with age and co morbidities. The aim of the study was to evaluate the effect and relationship of preoperative mental status, on postoperative mobility in proximal femur fracture patients. On null hypothesis; there exists no co-relation between pre-operative mental status on pre and postoperative mobility those had surgery for proximal femur fractures.Methods: This is a retrospective study, carried out during the period of 14th March, 2016 to 14th March, 2017 at BIRRD (T) Hospital. All the patients who underwent proximal femur fracture surgeries were included in the study. Patients were evaluated for Abbreviated Mental Score Test pre-operatively. Mobility patterns were before injury and after surgery evaluated in patients with proximal femur fractures. Postoperatively patients were followed up to one year.Results: 50 patients were included into the study, where 12 patients could not present to follow-up due to various reasons, thus we have complete data of 38 patients. There is significant reduction in mobility status of individuals i.e. from 6.18 (preoperative pre fracture mobility) to 5.36 (postoperative mobility). Average abbreviated mental test score is 7.55. There exists a correlation between the variables.Conclusions: Null hypothesis remains rejected. There is statistically significant relationship between the variables (pre and postoperative mobility, and abbreviated mental test score), which appears to be positive correlation.

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Outcomes of the proximal femur fractures repaired with half-pin devices as compared with various types of osteosynthesis

Genij Ortopedii ◽

10.18019/1028-4427-2021-27-2-175-181 ◽

2021 ◽

Vol 27 (2) ◽

pp. 175-181

Author(s):

F.B. Salokhiddinov ◽

Keyword(s):

Femoral Neck ◽

Proximal Femur ◽

Fixation Device ◽

Group Iii ◽

Proximal Femur Fractures ◽

Bone Fixation ◽

Femur Fractures ◽

Group I ◽

Pin Fixation ◽

Poor Outcomes

Objective To review outcomes of the proximal femur fractures repaired with half-pin apparatus in comparison with various types of osteosynthesis. Material and methods The study enrolled 86 patients with proximal femur fractures treated at the general hospital of the Tashkent Medical Academy. Of these, 52 were females and 34 were males. The mean age of the participants was 54.1 ± 1.1 years (range, 22 to 92 years). The effectiveness of the treatment was evaluated depending on the treatment method used. The patients were divided into 3 groups: group I included 39 patients who underwent closed percutaneous osteosynthesis with Ilizarov wires; group II consisted of 29 patients who underwent osteosynthesis with bone plates; group III included 18 patients who underwent surgical treatment using the external half-pin fixator we developed. Results Outcomes were evaluated in 58 patients at one to two years. In group I, good results were rated as good obtained in 45.8% (n = 11), as fair in 33.3% (n = 8) and poor in 20.9 % (n = 5) of patients due to nonunited fracture, avascular necrosis of the femoral head and hip joint ankylosis. Group II showed 68.4 % (n = 12) good, 4 (21 % (n = 4) fair and 10.5 % (n = 2) poor results. The latter occurred due to patient noncompliance and unauthorized early removal of the plaster cast. Group III demonstrated 73.4 % (n = 11) good, 13.3% (n = 2) fair and 13.3 % (n = 2) poor outcomes. Patients with poor outcomes developed lesion of the femoral neck following a subcapital femoral neck fracture at 2 months of frame removal that healed with a 2.0 cm limb length discrepancy. Conclusion The external half-pin fixator offered could facilitate stable bone fixation after reduction and gradual dynamic compression for successful bone healing. The bone fixation period with external half-pin fixation device was dependent on the fracture type and averaged to 4 ± 1 months in type A fracture and 5 ± 1 months in type B fractures. Fixation of the proximal femur fractures with half-pin fixation device allows stabilization of the general state of patients, easier postoperative care, prevention of secondary complications and early exercises for the adjacent joints. The technique offered can be a method of choice among the current technologies.

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TO EVALUATE THE EFFICACY OF KICK STAND SCREW IN FIXATION OF SUBTROCHANTERIC FEMORAL FRACTURES USING CONTRALATERAL REVERSED DISTAL FEMORAL LOCKING PLATEPROSPECTIVE SINGLE CENTRIC STUDY

10.36106/ijar/9401597 ◽

2020 ◽

pp. 1-4

Author(s):

Prashant Pandey ◽

K K Pandey ◽

Ajay Dhanopeeya ◽

Surya Prakash Garg

Keyword(s):

Proximal Femur ◽

Locking Plate ◽

Harris Hip Score ◽

Plate Bending ◽

Neck Shaft Angle ◽

Subtrochanteric Fractures ◽

Proximal Femur Fractures ◽

Femur Fractures ◽

Shaft Angle

PURPOSE- All type of plates when used for proximal femur fractures always has chances of mechanical failure due to lack of strength of the construct, but addition of ‘kick stand screw’ has some effects on stability of the construct. Aim of our study is to evaluate the efficacy of kick stand screw in fixation of subtrochanteric fractures using contralateral reversed distal femoral locking plate. METHOD- 30 patients of subtrochanteric fractures fixed using contralateral reversed distal femoral locking plate. N(1st)=15 fixed without kick stand screw and other N(2nd)=15 fixed using kick stand screw. Calcar screw( Kick Stand Screw) is placed to support calcar region (inferior to the center in AP view and central in Lateral view). In other group screws are placed as oriented in screw holes. Outcome was assessed using Harris Hip Score and VAS score and change in the neck shaft angle is also followed. RESULT- Union rate was 80% in 1st group as compare to 94% in second group. Mean Harris hip score at the one year follow up was 71.2 in 1st group as compare to 89.2 in 2nd group. Mean Visual analogue scale was 3.2 in first group as compare to 1.6 in second group at final follow up. Mean neck shaft angle at final follow-up was 120 degree in first group as compared to135 degree in second group. Complication- 1st Group of patients had three failures 2 in the form of screw break down and one in the form of plate bending, all three lend up in to varus deformity but the 2nd group had only one failure in the form of plate bending. CONCLUSION-In our study cases in which kick stand screw was used they showed better mechanical strength and gave better clinical results. So in proximal femur fractures including subtrochanteric fracture fixation ‘kick stand screw’ must be used.

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Surgical management of pertrochanteric fractures with proximal lateral femur locking compression plate

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20163496 ◽

2016 ◽

Vol 2 (4) ◽

pp. 234

Author(s):

Biju R. ◽

Kumar Babu B.L.S. ◽

Sarat Chandra M.

Keyword(s):

Proximal Femur ◽

Weight Bearing ◽

High Stress ◽

Locking Compression Plate ◽

Full Weight Bearing ◽

Proximal Femur Fractures ◽

Femur Fractures ◽

Compression Plate ◽

Type 3

Background: Pertrochanteric femoral fractures are of intense interest globally. Pertrochanteric fracture is a one of the most serious cause of mortality and morbidity in elderly people. The number of such admissions is on a raise because of increasing life span, sedentary habits and increased road traffic accidents. Pertrochanteric region is a high stress area. Hence delayed union, implant failures, varus collapse and non-union are common complications. Choice of implant was also a tough decision for surgeons in this area. Hence this study was intended to evaluate the functional outcome of proximal femur fractures treated with proximal femur locking compression plate (PFLCP) in terms of union of fracture, patient compliance and complications.Methods: This prospective study was conducted at the department of orthopaedics, Narayana Medical College and Hospital, Nellore from December 2014 to June 2016. The complete data was collected from all the patients by taking history of illness and by doing detailed clinical examination and relevant investigations. Finally after the diagnosis, the patients were selected for the study depending on the inclusion and exclusion criteria. Postoperatively all the cases were followed for the minimum period of 6 months to maximum period of 1 year.Results: In this study 22 patients were involved. There were 14 males and 8 females, with a mean age of 46 years. 19 cases were admitted due to slip and fall and with slight predominance of right side. Mean duration of hospital stay was 20 days and mean time of full weight bearing is 10 weeks. Out of 22 cases 2 cases lost follow up before first follow up time of 6 weeks. Out of 20, remaining cases 8 were type 3 and 12 were type 4. Functional results were graded by Harris hip scoring system. Good to excellent results were seen in 87% cases of type 3 fractures and 83% cases in type 4 fractures.Conclusions: Treatment with a PFLCP can provide good-to-excellent healing for proximal femur fractures, with a limited occurrence of complications especially for severe comminuted fracture and osteoporosis.

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