Comparison of radiological outcome of unstable Intertrochanteric femur fractures in elderly patients treated with Indian and Foreign Cephalomedullary nails

Background: The COVID-19 pandemic is challenging healthcare systems worldwide. This study examines geriatric patients with proximal femur fractures during the COVID-19 pandemic, shifts in secondary disease profile, the impact of the pandemic on hospitalization and further treatment. Methods: In a retrospective monocentric study, geriatric proximal femur fractures treated in the first six months of 2020 were analyzed and compared with the same period of 2019. Pre-traumatic status (living in a care home, under supervision of a legal guardian), type of trauma, accident mechanism, geriatric risk factors, associated comorbidities, time between hospitalization and surgery, inpatient time and post-operative further treatment of 2 groups of patients, aged 65-80 years (Group 1) and 80+ years (Group 2) were investigated. Results: The total number of patients decreased (70 in 2019 vs. 58 in 2020), mostly in Group 1 (25 vs. 16) while the numbers in Group 2 remained almost constant (45 vs. 42). The percentage of patients with pre-existing neurological conditions rose in 2020. This corresponded to an increase in patients under legal supervision (29.3%) and receiving pre-traumatic care in a nursing home (14.7%). Fractures were mostly caused by minor trauma in a home environment. In 2020, total number of inpatient days for Group 2 was lower compared to Group 1 (p = 0.008). Further care differed between the years: fewer Group 1 patients were discharged to geriatric therapy (69.6% vs. 25.0%), whereas in Group 2 the number of patients discharged to a nursing home increased. Conclusions: Falling by elderly patients is correlated to geriatric comorbidities, consequently there was no change in the case numbers in this age group. Strategic measures to avoid COVID-19 infection in hospital setting could include reducing the length of hospital stays by transferring elderly patients to a nursing home as soon as possible and discharging independent, mobile patients to return home.

Download Full-text

P16 An audit of elderly patients with a femoral fracture: is the quality of care received by patients affected by where in the femur the fracture occurs?

BJS Open ◽

10.1093/bjsopen/zrab032.015 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

Author(s):

O A Javed ◽

M J Khan ◽

Y Abbas ◽

S Pillai ◽

K Hristova ◽

...

Keyword(s):

Risk Assessment ◽

Elderly Patients ◽

Bone Health ◽

Nutritional Assessment ◽

Femur Fracture ◽

Femoral Fractures ◽

Neck Of Femur ◽

Femur Fractures ◽

Neck Of Femur Fracture ◽

Health Review

Abstract Introduction Elderly patients with femoral fractures are often frail and require a multidisciplinary approach to optimise medical care, rehabilitation and prevention of further injury. Previously, neck of femur fracture patients were the focus of such an approach, but NICE and BOAST guidelines emphasise extending this care to other elderly trauma patients. Methods A retrospective analysis of 43 patients over 60 years old at Gloucestershire Hospitals NHS Foundation Trust in 2019 with a femoral fracture other than a neck of femur fracture. BOAST guideline standards were surgery within 36 hours, orthogeriatric assessment within 72 hours, a documented ceiling of treatment, falls risk assessment, bone health review, nutritional assessment and physiotherapy review. Results Our study showed worse outcomes in all standards for patients with femoral shaft, distal femur and periprosthetic femur fractures compared to neck of femur fractures: surgery within 36 hours (63.9% vs. 66%); orthogeriatric assessment within 72 hours (32.6% vs. 91.9%); falls risk assessment (76.7% vs. 99.6%); bone health review (41.9% vs. 99.7%); nutritional assessment (55.8% vs. 99.6%); physiotherapy review (97.7% vs. 98.9%). The group also had worse outcomes for average length of stay (19 days vs. 14 days) and 30 day mortality (9.3% vs. 8.6%). Discussion Our study showed a discrepancy in care received by elderly patients with femoral fractures other than neck of femur. We will introduce a proforma for all femoral fractures, present our findings to orthogeriatric, bone health and physiotherapy teams to involve them in the care of such patients and re-audit following these recommendations.

Download Full-text

Role of cephalomedullary nail in proximal femur fractures

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20173154 ◽

2017 ◽

Vol 3 (5) ◽

pp. 929

Author(s):

Nishant Kumar ◽

Dhruv Sharma ◽

Kuljit Kumar

Keyword(s):

Hip Fractures ◽

Proximal Femur ◽

Femoral Fractures ◽

Public Health Problem ◽

Major Public Health Problem ◽

Cephalomedullary Nail ◽

Proximal Femur Fractures ◽

Femur Fractures ◽

Bending Loads ◽

Cephalomedullary Nails

Background: Hip fractures are recognized to be a major public health problem. Key determinants of hip fractures include age, osteoporosis, and falls. In these determinants socioeconomic status, have not been well explored. Under eccentric loading, high bending loads occur, leading to failure of the osteosynthetis anchorage at the center of the femoral head.The introduction of the reconstruction nail has broadened the indications for the intramedullary fixation of difficult femoral fractures. The operative technique is however complicated. Some technical difficulties encountered during its use are presented together with guidance to allow these problems to be avoided.Methods: This Study had included 47 cases which were operated by single surgeon and use of different implant (cephalomedullary nail) was randomized irrespective of fracture types and pattern. This study was done over a period of 12 months (October 2013 to October 2014) with 1 month, 3 months, 6 months, 12 months follow up. At every visit patient were assessed as per Oxford hip score. Type of implant used was PFNA, Intertan, Sirus Nail.Results: The mean age of the patients was 65.68 (±13.55) years. Severe pain was observed among majority of the patients at one month (70.2%) which became mild (40.4%) and moderate (34%) at 3 months. Very mild pain was found in 36.2% patients at 6 months and in 61.7% at 12 months. The limping was all the time among all the patients at one month. However, the limping was found often in 46.8% at 3 months and sometimes in 57.4% at 6 months and 53.2% at 12 months. The hip score was found to be severe among all the patients at one month. However, moderate to severe hip was in 46.8% patients at 3 months, mild to moderate was in 57.4% at 6 months and satisfactory joint function was in 68.1% at 12 months. The comparison of Hip score according to long or short nail at one 3, 6 and 12 months showed no difference. Conclusions: Cephalomedullary nails with adequate technique so that the lag screws by purchase in the centre-centre or posterior-inferior quadrant combines the benefit of sliding hip screw as well as intramedullary implants. So we recommend the use of cephalomedullary nails in proximal femur fractures especially the unstable fractures.

Download Full-text

Surgical outcomes of simple distal femur fractures in elderly patients treated with the minimally invasive plate osteosynthesis technique: can percutaneous cerclage wiring reduce the fracture healing time?

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-020-03385-8 ◽

2020 ◽

Vol 140 (10) ◽

pp. 1403-1412 ◽

Cited By ~ 3

Author(s):

Jae-Ho Lee ◽

Ki-Chul Park ◽

Seung-Jae Lim ◽

Kyeu-Back Kwon ◽

Ji Wan Kim

Keyword(s):

Minimally Invasive ◽

Elderly Patients ◽

Surgical Outcomes ◽

Distal Femur ◽

Plate Osteosynthesis ◽

Healing Time ◽

Minimally Invasive Plate Osteosynthesis ◽

Femur Fractures ◽

Cerclage Wiring ◽

Osteosynthesis Technique

Download Full-text

The use of interfragmentary positional screw in minimally invasive plate osteosynthesis for simple distal femur fractures in elderly patients: Is the evidence enough?

Injury ◽

10.1016/j.injury.2017.07.034 ◽

2017 ◽

Vol 48 (10) ◽

pp. 2365

Author(s):

Prasoon Kumar ◽

Siddhartha Sharma ◽

Rajesh Kumar Rajnish ◽

Saurabh Agarwal

Keyword(s):

Minimally Invasive ◽

Elderly Patients ◽

Distal Femur ◽

Plate Osteosynthesis ◽

Minimally Invasive Plate Osteosynthesis ◽

Femur Fractures

Download Full-text

Clinical Outcomes of Intermediate-Length Cephalomedullary Nails for Intertrochanteric Femur Fracture Repair in Older Adults

Kansas Journal of Medicine ◽

10.17161/kjm.v13i1.13726 ◽

2020 ◽

Vol 13 (1) ◽

pp. 106-111

Author(s):

Paul Enns ◽

Sue Nyberg ◽

Gina Berg ◽

Morgan Galliart ◽

Brent Sarauer ◽

...

Keyword(s):

Older Adults ◽

Hip Fractures ◽

Fracture Repair ◽

Fracture Rate ◽

Inpatient Stay ◽

Hardware Failure ◽

Femur Fractures ◽

Estimated Blood Loss ◽

Cephalomedullary Nails

Introduction. Hip fracture is a major cause of morbidity and mortality in older adults. Intertrochanteric hip fractures often are treated surgically using cephalomedullary nails (CMN), in either a short or long length. Their outcomes are documented in the literature; however, outcomes of the intermediate-length CMN have not been well described. Methods. A retrospective review was conducted of older adults with intertrochanteric hip fractures that were treated with cephalomedullary nail fixation using an intermediate-length (235 mm Synthes Trochanteric Fixation® nail or 240 mm Stryker Gamma 3®) nail. Outcome data were collected during the inpatient stay and 16 months post-operatively. Results. Seventy-seven patients met inclusion criteria and were reviewed during inpatient stay; however, only 42 had documented post-operative outcomes. Of those, two patients died post-discharge and were not included in the 16-month follow-up. Comparison of results to published literature suggested that intermediate-length nails are comparable to short-length nails with regard to time in the operating room and estimated blood loss. The rate of blood transfusion was lower and length of hospital stay was shorter than in comparable studies of both short- and long-length nails. There were no post-operative periprosthetic fractures in the 16-month follow-up. This rate was lower than published rates for short and long nails. The hardware failure rate (3/42, 7.1%) of intermediate-length nails was higher than comparison studies of both short- and long-length nails. Conclusions. Patient outcomes for intermediate-length nails were similar to outcomes of shorter length nails. Utilization of the intermediate-length nail appears to be an effective treatment option for repair of intertrochanteric femur fractures. However, direct comparison is difficult since periprosthetic fracture rate may increase over time and nail length and hardware failure are not defined consistently in the literature. Further study is needed with a larger sample size followed over a longer period of time to confirm our findings.

Download Full-text