scholarly journals Outcome of external fixator in the treatment of intertrochanteric fracture in elderly patients with co-morbidities

2019 ◽  
Vol 7 (1) ◽  
pp. 3-7
Author(s):  
Deepak Kumar Dutta ◽  
R, Sinha
Keyword(s):  
Elderly Patients ◽  
Functional Outcome ◽  
External Fixator ◽  
Intertrochanteric Fracture ◽  
Harris Hip Score ◽  
External Fixators ◽  
Intertrochanteric Fractures ◽  
Early Ambulation ◽  
Medical Comorbidities ◽  
Mean Time

Background and Objectives: Incidence of intertrochanteric fracture is rising because of increasing number of elderly. They tend to have many comorbidities of different systems; therefore, major surgeries are not possible at times. In these patients, external fixator can be an option as it promotes early ambulation, thereby preventing recumbency-associated complications. Material and Methods: Elderly patients of interetrochanteric fracture and with medical comorbidities were managed with external fixator. Functional outcome was measured by Harris Hip Score (HHS) on first post-operative day and in follow ups on 4, 12, and 24 weeks. Results: Thrity patients (19 males, 11 females), of mean age 77.63 years (SD=9.06) were studied. HHS scores steadily increased from 37.6±5.28 on the first post-operative dayto 49.43±6.9 on 4 weeks, 59.83±7.17 on 12 weeks, and 72.47±4.17 on 24 weeks. The changes were all very highly significant (all p=0.000). Mean time taken to union was 14.67±2.28 weeks. None of the patients had recumbency-related complications. Conclusion: External fixators for intertrochanteric fractures in medically comorbid elderly patientsis effective in promoting ambulation and preventing recumbency-related complications.

scholarly journals Radiological and functional outcome of unstable intertrochanteric fractures treated with proximal femoral locking plate

2021 ◽  
Vol 7 (5) ◽  
pp. 968
Author(s):  
Chanchal Kumar Singh ◽  
Juhi Deshpande
Keyword(s):  
Functional Outcome ◽  
Intertrochanteric Fracture ◽  
Locking Plate ◽  
Lateral Wall ◽  
Harris Hip Score ◽  
Intertrochanteric Fractures ◽  
Systemic Complications ◽  
Neck Shaft Angle ◽  
Loss Of Reduction ◽  
Unstable Intertrochanteric Fracture

<p class="abstract"><strong>Background:</strong> Intertrochanteric fracture is a common orthopaedic injury sustained in elderly population because of osteoporosis and trivial fall. Life threatening systemic complications occur mainly due to immobility.</p><p class="abstract"><strong>Methods:</strong> We included 62 patients (40 males and 22 females) of unstable intertrochanteric fracture (AO 31 A2 and A3) attending Department of Orthopaedics. They were all subjected to surgical treatment with proximal femoral locking plate. Patients were followed up at 3rd, 6th and 12th month for outcomes variables i.e.; functional (Harris hip score, Palmer and Parker mobility score) and radiological outcomes (neck shaft angle, loss of reduction, union and implant related complications). Statistical analysis was done using Friedman’s test after calculating the data in terms of mean and median using SPSS 20 software.<strong></strong></p><p class="abstract"><strong>Results:</strong> Mean age of our patients was 64 years, 40 were males and 22 females. 50 patients sustained fracture due to trivial fall and 12 due to RTA. 35 out of 62 patients had medical co-morbidites. 26 patients needed open reduction of fracture and 36 were close reduced. 22 of patients had severe comminution (AO A 3 III type). Average blood loss was 254 ml. Mean degree of loss of reduction was 5 degrees in 6th month and 4 degrees in 12th month. Union was achieved in 48 out of 50 patients at 12th month.  Most of the patients achieved fair to good functional outcome scores at 12th month of follow up. We noticed difficulties in fracture reduction as well as complications related to implant.</p><p class="abstract"><strong>Conclusions:</strong> PFLP is an effective implant in comminuted intertrochanteric fractures with broken lateral wall. Complications can be minimised by following principles of locking plate meticulously.</p>

A STUDY OF COXO-FEMORAL BYPASS IN INTERTROCHANTERIC FRACTURE FEMUR OF ELDERLY PATIENTS

2021 ◽  
pp. 38-39
Author(s):  
Suneet Tandon ◽  
Manoj Kumar ◽  
Kashif Iqbal ◽  
Mohit Asthana ◽  
Abhishek Pathak ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Functional Assessment ◽  
Intertrochanteric Fracture ◽  
Early Rehabilitation ◽  
Long Term Results ◽  
Harris Hip Score ◽  
Intertrochanteric Fractures ◽  
Fracture Femur

In this study we tried to nd and analyse the outcome of coxofemoral bypasss in intertrochanteric fractures which were operated at our centre and completed the follow up till 12 months. These patients were analysed on various intra-operative and post-operative parameters. Functional assessment was done using Harris Hip Score. Harris Hip Score showed that 04(20%) patients had excellent results, 08(40%) patient had good results, 04(20%) patients had fair and 02(10%) had poor results, poor results seen in patient with multiple co-morbidity.Our study indicate that coxofemoral bypass in elderly patients have shown to achieve early rehabilitation of the patient and good long-term results intertrochanteric fractures.

scholarly journals Functional analysis of cemented bipolar hemiarthroplasty with medial calcar augmentation for unstable intertrochanteric fractures in elderly

2017 ◽  
Vol 4 (1) ◽  
pp. 141
Author(s):  
Sivabalan T. ◽  
Thirunarayanan V. ◽  
Senthil Kumar S. ◽  
Ramprasath D. R. ◽  
Basheer Ahmed S.
Keyword(s):  
Functional Outcome ◽  
Intertrochanteric Fracture ◽  
The Elderly ◽  
Fracture Pattern ◽  
Harris Hip Score ◽  
Bipolar Hemiarthroplasty ◽  
Intertrochanteric Fractures ◽  
Excellent Outcome ◽  
Unstable Intertrochanteric Fracture ◽  
Cemented Bipolar Hemiarthroplasty

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Intertrochanteric fracture is one of the most common fractures among the elderly osteoporotic population</span><span lang="FR">, constituting about 50% of hip fractures. These fractures are managed either by fixation using dynamic hip screw (DHS), proximal femur nail (PFN) or by replacement, based on the stability of fracture pattern, age of the patient, quality of bone and associated co-morbid conditions. Prosthetic replacement which is routinely done for femoral neck fractures requires modification when done for trochanteric fractures to improve stability. This study aims to analyse the short term functional outcome of </span><span lang="EN-IN">cemented bipolar hemiarthroplasty with medial calcar augmentation for unstable intertrochanteric fractures in elderly.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">Our study includes 60 patients of age more than 70 years admitted in our institution during June 2012 to September 2016 with unstable intertrochanteric fractures. All patients operated through posterior approach to hip and cemented hemiarthroplasty with medial calcar augmentation with bone graft was done. Patients were followed up for an average of period of 2 years. Functional outcome was evaluated with Harris Hip score</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">28%<strong> </strong>of<strong> </strong>cases had excellent outcome. 43% of cases had good and 23% of cases had fair outcome. 2% of cases ended with poor outcome. The in-hospital mortality rate was 3.3%. The survival rate of the patients in this study at the end of one year is 85%. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">Cemented bipolar hemiarthroplasty with medial calcar augumentation can be considered as a good primary option for elderly unstable intertrochanteric fracture patients with osteoporotic bones and associated co-morbidities.</span></p><p class="abstract"> </p><p> </p>

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

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.

scholarly journals Role of dynamic hip screw with locking side plate in intertrochanteric fractures in elderly patients

2020 ◽  
Vol 7 (1) ◽  
pp. 73
Author(s):  
Harjot Singh Gurudatta ◽  
R. K. Arora ◽  
Gagan Khanna ◽  
Karandeep Singh Johal ◽  
Deepinder Singh ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Functional Outcome ◽  
Trauma Surgery ◽  
Harris Hip Score ◽  
Intertrochanteric Fractures ◽  
Trochanteric Fractures ◽  
Side Plate ◽  
Pull Out ◽  
Hip Screw

<p><strong>Background: </strong>Dynamic hip screw (DHS) is a vital mainstay implant in managing intertrochanteric fractures. While most of the modifications of implant have been done in screw design, this study evaluates the role of employing locking side plate with DHS to increase the screw hold and avoid plate pull out in trochanteric fractures of elderly patients.</p><p><strong>Methods: </strong>A prospective study was conducted from August 2012 to August 2014 on 30 patients having trochanteric fractures. The fixation, fracture consequences, functional outcome and complications were assessed clinically and radiologically in immediate post-operative period and on follow-ups at six weeks, three months, six months and one year. Young patients (&lt;55 years), fractures with subtrochanteric extension and pathological fractures were excluded from study. Fractures in elderly patients from AO 31A1.1 to AO 31A3.1 were included in study. Evaluation of the clinical outcome was done by modified Harris hip score at the last follow-up.<strong></strong></p><p><strong>Results: </strong>Average age of the patients in study was 64 years; males had better outcome scores, which was statistically significant. The mean trauma-surgery interval was four days. Trauma surgery interval and functional outcome by Harris hip score was statistically significant and was inversely proportional. Union was achieved in all patients with delayed union noted in four cases; the average time to union was 12.2 weeks with no major complications and good functional outcome by Harris hip score.</p><p><strong>Conclusions: </strong>This study suggests that locking side plate with DHS would make a stronger bone implant construct and a valuable modification to prevent sliding, screw cut-out and side plate pull-out with low infection rates.</p>

scholarly journals Clinical outcome of primary cemented hemiarthroplasty in unstable trochanteric fractues in elderly patients

2018 ◽  
Vol 4 (4) ◽  
pp. 543
Author(s):  
Jayanta Mukherjee ◽  
Ritwik Ganguli
Keyword(s):  
Elderly Patients ◽  
Functional Outcome ◽  
Trochanteric Fracture ◽  
Early Mobilization ◽  
Harris Hip Score ◽  
Bipolar Hemiarthroplasty ◽  
Early Ambulation ◽  
Fracture Stabilization ◽  
Hip Screw ◽  
Cemented Bipolar Hemiarthroplasty

<p class="abstract"><strong>Background:</strong> Management of unstable trochanteric fracture in elderly patients is challenging due to poor bone quality. Fracture stabilization and early mobilization is very important in preventing the complications. Fixation of the fracture with proximal femoral nail and dynamic hip screw has its complication and it takes time to mobilization of the patient after consolidation of fracture. Cemented bipolar hemiarthroplasty in osteoporotic unstable comminuted trochanteric fracture helps in early mobility and reduces complications.</p><p class="abstract"><strong>Methods:</strong> We prospectively analyzed 20 cases of cemented hemiarthroplasty in unstable intertrochanteric fractures. The functional outcomes were assessed based by Harris hip score.<strong></strong></p><p class="abstract"><strong>Results:</strong> The functional outcome measured with Harris hip score is excellent to good in most of the patients.</p><p class="abstract"><strong>Conclusions:</strong> Primary cemented hemiarthroplasty in unstable trochanteric fracture in elderly results in early ambulation with good functional outcome.</p>

EVALUATE INTRAOPERATIVE VARIABLES AND POSTOPERATIVE OUTCOMES OF INTERTROCHANTERIC FRACTURES WITH VULNERABLE/ BROKEN LATERAL WALL MANAGED WITH SHORT AND LONG CEPHALOMEDULLARY NAIL

2021 ◽  
pp. 36-37
Author(s):  
Rahul Kumar ◽  
Wasim Ahmed ◽  
Indrajeet Kumar
Keyword(s):  
Blood Loss ◽  
Functional Outcome ◽  
Postoperative Outcomes ◽  
Treatment Modalities ◽  
Harris Hip Score ◽  
Intertrochanteric Fractures ◽  
Neck Shaft Angle ◽  
Duration Of Surgery ◽  
One Year ◽  
Lateral Walls

Purpose: To evaluate intraoperative variables and postoperative outcomes of intertrochanteric fractures with vulnerable/broken lateral walls managed with short and long cephalomedullary nails. Materials & Methodology: Twenty prospective cases of patients treated with LCMN and twenty retrospective cases treated with SCMN were included in the study. Intraoperative variables compared were duration of surgery, blood loss during surgery, and surgeon's perception of surgery. Functional outcome was evaluated by Parker Palmer mobility score (PPMS), Harris hip score (HHS), and Short Form-12 at one year. Radiological assessment were done at six months/one year to look for progress of fracture union, change in neck-shaft angle, and any signs of implant failure. Results: Duration of surgery (p<0.001), blood loss during surgery (p=0.002), and surgeon's perception of surgery (p=0.002) were signicantly more in the LCMN group. The LCMN group had a better functional outcome. HHS for the LCMN group was 89.15±9.53, and for the SCMN group it was 81.53±13.21 (p=0.021). PPMS for LCMN group was 8.85± 0.67 and for the SCMN group was 7.53±1.807 (p=0.005). There were four implant failures in the LCMN group compared to none in the SCMN group (p=0.036). Conclusion: Both SCMN and LCMN are effective treatment modalities for unstable intertrochanteric fractures with vulnerable/broken lateral walls. In the absence of more extensive study and long-term follow-up, the superiority of one implant over the other cannot be recommended.

scholarly journals A study to assess proximal femoral nailing versus dynamic hip screw device in surgical management of intertrochanteric fractures: a comparative study

2018 ◽  
Vol 5 (1) ◽  
pp. 23
Author(s):  
E. S. Radhe Shyam ◽  
K. Ashwin
Keyword(s):  
Functional Outcome ◽  
Intertrochanteric Fracture ◽  
Trochanteric Fracture ◽  
Dynamic Hip Screw ◽  
Proximal Femoral Nail ◽  
Technical Failure ◽  
Intertrochanteric Fractures ◽  
Femoral Nail ◽  
Fracture Management ◽  
Hip Screw

<p class="abstract"><strong>Background:</strong> The incidence of inter trochanteric fracture is expected to have doubled by 2040. Inter trochanteric fractures account for about 45% to 50% of all hip fractures in the elderly populationand out of these, near about 50% to 60% are classified as unstable intertrochanteric fractures. The goal of treatment is restoring mobility safely and efficiently, while minimizing the risk of medical complications and technical failure. This study as performed<strong> </strong>to assess functional outcome with dynamic hip screw and proximal femoral nail in intertrochanteric fracture management.</p><p class="abstract"><strong>Methods:</strong> It was prospective observational study done for a period of 1year from January 2016-January 2017 among patients who attended OPD or emergency department with intertrochanteric fracture. Two different implants were used dynamic hip screw (DHS) and proximal femoral nail (PFN).<strong></strong></p><p class="abstract"><strong>Results:</strong> Excellent results in functional outcome was more in case of PFN (66.6%) compared to DHS (50%). The type of trauma in DHS group was road traffic accident in 38.8%, domestic fall in 50% and others such as assault was in 11.1% while in PFN group intertrochanteric fracture was seen in 61.1% due to domestic fall.</p><p class="abstract"><strong>Conclusions:</strong> The functional outcome was more better with proximal femoral nail (PFN) compared to dynamic hip screw (DHS). Therefore, proximal femoral nail (PFN) should be preferred for management of intertrochanteric fractures.</p>

scholarly journals Admission deep venous thrombosis of lower extremity after intertrochanteric fracture in the elderly: a retrospective cohort study

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Jinzeng Zuo ◽  
Yongcheng Hu
Keyword(s):  
Risk Factors ◽  
Elderly Patients ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Intertrochanteric Fracture ◽  
Lower Extremities ◽  
The Elderly ◽  
Intertrochanteric Fractures ◽  
Targeted Interventions ◽  
Laboratory Test Results

Abstract Objective The purpose of this study was to investigate the incidence, location, and related factors of deep venous thrombosis (DVT) of the bilateral lower extremities after intertrochanteric fractures in the elderly. Methods Retrospective analysis was performed on the elderly patients with intertrochanteric fracture who were admitted from January 2017 to December 2019. At admission, patients receive routine ultrasound Doppler scanning of bilateral lower extremities to detect DVT; those with DVT were assigned to the case group and those without DVT to the control group. Patient data on demographics, comorbidities, injury-related data, and laboratory test results at admission were extracted. Logistic regression analyses were conducted to identify the independent risk factors associated with DVT. Results Five hundred seventy-eight patients were included, among whom 116 (20.1%) had DVT. Among those with DV, 70.7% (82/116) had DVT of the distal type, 24 (29.6%) had DVT of the proximal type, and 10 (10.4%) had mixed DVT. In 76.7% (89/116) of patients, DVT occurred in the fractured extremity, 9.5% (11/116) in the bilateral and 13.8% (16/116) in the non-fractured extremity. Multivariate analyses identified obesity, delay to admission, increased D-dimer level (> 1.44 mg/L) and reduced albumin (< 31.7 g/L) as independent factors. Conclusions Admission incidence of DVT was high in elderly patients with intertrochanteric fractures, especially the proximal DVT. Identification of associated risk factors is useful for individualized assessment risk of DVT and early targeted interventions.

Sign in / Sign up

Export Citation Format

Share Document