Contribution of the Dual Mobility Acetabulum in the Treatment of Trochanteric Fracture in the Elderly

Background: Hip fractures in the elderly are frequent. Intertrochanteric hip fractures account for approximately half of all hip fractures in the elderly; of these, from 50% to 60% are classified as unstable. In our study we tried to compare outcome of unstable trochantric fracture in terms length of PFN (180 vs 240 mm).Methods: 80 patients of unstable trochanteric fracture were randomly allotted to 2 groups who were treated with closed reduction and internal fixation with proximal femoral nail of size 180 mm(group A) and 240mm (group B). Patients in both the group were compared right from the fracture configuration till the one year post-operative period.Results: In the study of 80 patients there were 18 males (45%) and 22 females (55%) in group 1, and 23 male (57%) and 17 female (42.5%) in group 2. Group 1 patient had a better range of movements than group 2. Femoral canal impingement was present in 6 (15%) of patients of group 1 and 28(70%) patients of group 2 showed femoral canal impingement.Conclusions: There are very few studies which compare the length of PFN to the outcome. The standard PFN group presented with complications like femoral nail impingement and hence more thighs pain and less range of movements even after one year of follow up. We conclude that for Indian group of population who have a relatively short femora gives a better result with a shorter length implant.

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Breakage of a Third Generation Gamma Nail: A Case Report and Review of the Literature

Case Reports in Orthopedics ◽

10.1155/2013/172352 ◽

2013 ◽

Vol 2013 ◽

pp. 1-5 ◽

Cited By ~ 11

Author(s):

Takashi Iwakura ◽

Takahiro Niikura ◽

Sang Yang Lee ◽

Yoshitada Sakai ◽

Kotaro Nishida ◽

...

Keyword(s):

Rare Complication ◽

Trochanteric Fracture ◽

High Strength ◽

The Elderly ◽

Gamma Nail ◽

Bipolar Hemiarthroplasty ◽

Third Generation ◽

Trochanteric Fractures ◽

Cemented Bipolar Hemiarthroplasty ◽

Fractures Of The Femur

The use of intramedullary nails to treat trochanteric fractures of the femur has increased with the increasing size of the elderly population. The third generation Gamma nail is currently one of the most popular devices for the treatment of trochanteric fractures. Nail breakage is a rare complication, possibly resulting from fatigue fracture of the implant. We present the first reported case of breakage of a third generation Gamma nail that was not used to treat a pathological fracture. An 83-year-old woman with an unstable trochanteric fracture of the femur was treated using a third generation Gamma nail. She was referred to our hospital 14 months postoperatively with nail breakage at the opening for the lag screw. The breakage was secondary to nonunion, which was thought to be mainly due to insufficient reduction of the fracture. The broken nail was removed, and the patient underwent cemented bipolar hemiarthroplasty. At followup 18 months later, she was mobile with a walker and asymptomatic with no complications. This case shows that inadequate operation such as insufficient reduction of the trochanteric fracture may result in nonunion and implant breakage, even when using a high-strength, well-designed implant.

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A PROSPECTIVE STUDY OF FUNCTIONAL AND RADIOLOGICAL OUTCOME OF PERTROCHANTERIC FEMUR FRACTURES TREATED WITH PROXIMAL FEMORAL NAIL ANTI ROTATION II ( PFN A2)

10.36106/paripex/3710887 ◽

2021 ◽

pp. 138-140

Author(s):

Kannelli Maneesh Chandra ◽

A Sandeep Kumar ◽

Mudra Dinesh

Keyword(s):

Prospective Study ◽

Trochanteric Fracture ◽

The Elderly ◽

Operative Management ◽

Residual Effects ◽

Harris Hip Score ◽

Femur Fractures ◽

Minimal Incision ◽

Modified Harris Hip Score ◽

A Prospective Study

BACKGROUND: Femoral Inter-Trochanteric fracture is one of the most frequently occurring fractures in the elderly, usually following trivial trauma. In the younger age group of people, it occurs almost always due to high velocity trauma. OBJECTIVES: This study aimed to study the functional and radiological outcomes of operative management of intertrochanteric fracture treated by PFN-A2. MATERIAL & METHODS: A prospective study of 20 cases of intertrochanteric femur fracture treated by PFN-A2, minimum 6 months of follow up. All cases are evaluated according to Modified Harris Hip Score on residual effects on clinical ground at final examination. Pain & functional capacity are the two basic considerations for this scoring system. Points are given for pain, function, range of motion & absence of deformity. RESULT: Functional result according to Modified Harris Hip score was found to be excellent in 11(55%) patients, good in 5(25%) patients, fair in 3(15%) patients & poor in 1(5%) patients. poor outcome occurs due to development of complications. CONCLUSION : PFN A2 has the advantage of minimal incision, shorter operative time, rapid rehabilitation, lower medical complications among other options.

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Interest of Surgical Treatment of Per-Trochanteric Fractures by Gamma Nail: About 100 Cases

Galician Medical Journal ◽

10.21802/gmj.2018.4.4 ◽

2018 ◽

Vol 25 (4) ◽

Author(s):

Omar Mourafiq ◽

Youssef Benyias ◽

Hicham Benomar ◽

Valery Kamenan ◽

Jalal Boukhriss ◽

...

Keyword(s):

Trochanteric Fracture ◽

Functional Results ◽

The Elderly ◽

Gamma Nail ◽

Infectious Complications ◽

Trochanteric Fractures ◽

Male Predominance ◽

Trochanteric Region ◽

The Military ◽

Consolidation Time

Gamma nail closed osteosynthesis has surpassed several methods previously used in the treatment of fractures in the trochanteric region. The objective of the research was to carry out an epidemiological study and to assess the evolutionary profile of patients with per-trochanteric fracture treated with gamma nail. Materials and methods. In this retrospective study, we report the experience of the Traumatology-Orthopedics Service II of the Military Teaching Hospital Mohamed V-Rabat, in the treatment of per-trochanteric fractures by gamma nail in 100 cases, collected between January 2011 and March 2016. Results. The average age of our patients was 68 years, with a male predominance of 67%. The most reported etiology (92% of cases) was simple drop. Stable fractures were the most common (81%), with a predominance of simple per-trochanteric fractures. The average response time was 24 hours, the average duration of the surgical procedure was 45 minutes. The rate of infectious complications was 1%; the rate of mechanical complications was 1%. The functional results were excellent and good in 95% of cases. The average consolidation time was 8 weeks. Conclusions. Trochanteric fracture is a delayed emergency which is seen primarily in the elderly. The gamma nail represents one of the latest improvements in implants for the treatment of these fractures. We report a series of 100 cases of trochanteric fractures treated surgically by gamma nail. The functional results were very encouraging compared to those reported in the literature.

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Structural Study of Proximal femur in the Elderly Femoral Neck & Trochanteric Fracture

Journal of the Korean Fracture Society ◽

10.12671/jksf.1998.11.1.175 ◽

1998 ◽

Vol 11 (1) ◽

pp. 175

Author(s):

Byung Chul Park ◽

Chang Wug Oh ◽

Seung Hoon Oh

Keyword(s):

Femoral Neck ◽

Structural Study ◽

Proximal Femur ◽

Trochanteric Fracture ◽

The Elderly

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Prospective study of the reproducibility of X-rays and CT scans for assessing trochanteric fracture comminution in the elderly: a series of 110 cases

European Journal of Orthopaedic Surgery & Traumatology ◽

10.1007/s00590-015-1666-6 ◽

2015 ◽

Vol 25 (7) ◽

pp. 1165-1170 ◽

Cited By ~ 12

Author(s):

Ronald Isida ◽

Varenka Bariatinsky ◽

Gregory Kern ◽

Gregoire Dereudre ◽

Xavier Demondion ◽

...

Keyword(s):

Prospective Study ◽

Trochanteric Fracture ◽

The Elderly ◽

Ct Scans ◽

X Rays

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A Evaluation of Initial Treatment of Trochanteric Fractures using Gamma Nails

International Archives of Medicine ◽

10.3823/2619 ◽

2020 ◽

Vol 13 ◽

Author(s):

Quang-Tri LE ◽

Minh-Hoang Nguyen

Keyword(s):

Range Of Motion ◽

Initial Treatment ◽

Treatment Effectiveness ◽

Trochanteric Fracture ◽

The Elderly ◽

Bone Union ◽

Military Hospital ◽

Trochanteric Fractures ◽

Functional Rehabilitation ◽

Neck Shaft Angle

Background: Trochanteric fractures are extra-joint fractures, account for 55% of femoral proximal fractures. They often happen in the elderly with increased frequency due to age. Treatment experiences at 7A Military Hospital showed increased trochanteric fracture cases. To properly assess treatment effectiveness and select proper treatment methods, the study of “Evaluation of initial treatment of trochanteric fractures using gamma nails at 7A Military Hospital and made the conclusions of indications and applied techniques” was carried out. The study objectives are evaluating the initial treatment of trochanteric fractures using gamma nails at 7A Military Hospital and made the conclusions of indications and applied techniques. Methods and findings: nineteen patients diagnosed with traumatic trochanteric fractures and surgically treated with Gamma nails were monitored and evaluated for bone fusion, bone union, range of motion, limb shortening, and functional rehabilitation according to Merle D'Aubigné scale. Fourteen patients (82.35%) achieved proper bone union with the femoral neck-shaft angle of 1250 - 1300, three patients (17.65%) got slightly deviated bone union. Amongst patients aged under 60, 14/17 cases (82.35%) achieved “good” and “very good” functional rehabilitation, scored over 15 points according to Merle D΄aubigne Index; 3/17 cases (17.65%) got “average” recovery. Hip range of motion in 14 cases (82.35%) achieved “very good” (normal movement) or “good” (over 10% movement limitation) outcome, 3 cases had “average” movement (17.65%). Limb shortening of below 1cm took place in 10 patients (58.82%), 1 – 2 cm in 4 patients (23,53%) and over 3 cm in 3 patients (17.65%). Conclusions: The surgical treatment of trochanteric fractures using gamma nails yielded positive outcomes. Keywords: Gamma nails, trochanteric fractures, elderly, extra-joint.

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Hat-Trick: On a Case of Hip Replacement Complicated by Dislocation and Infection and Periprosthetic Fracture

Surgical Case Reports ◽

10.31487/j.scr.2020.04.07 ◽

2020 ◽

pp. 1-4

Author(s):

Giuseppe Solarino ◽

Antonio Virgilio ◽

Biagio Moretti ◽

Francesco Maruccia ◽

Giuseppe Solarino ◽

...

Keyword(s):

Hip Replacement ◽

Periprosthetic Fracture ◽

Elderly Population ◽

The Elderly ◽

Single Shot ◽

Dual Mobility ◽

Case Presentation ◽

Long Stem ◽

Poor Outcomes

Case Presentation: A 79-year-old man with several general medical comorbidities referred to our orthopaedic Unit with dislocation, infection and periprosthetic fracture of a long-stem hip hemiarthroplasty. Results: A one-stage revision was performed using a dual mobility cup and a standard modular-neck stem, both fixed with antibiotic-loaded cement. Conclusion: Hip replacement is a common treatment for femoral neck fractures in the elderly population with a significant improvement in the quality of life of patients. Local complications can lead to poor outcomes. The simultaneous presence of dislocation, infection and periprosthetic fracture is a challenge of treatment for the surgeon and the frailty of the patients get this scenario even worse. Every attempt must be driven toward a safe and time-preserving “single-shot” procedure.

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