scholarly journals COMPARATIVE STUDY OF HEMIREPLACEMENT ARTHROPLASTY WITH BIPOLAR PROSTHETIC AND PROXIMAL FEMORAL NAIL (PFN) IN UNSTABLE INTERTROCHANTERIC FRACTURE OF FEMURE: INTERVENTIONAL PROSPECTIVE RANDOMIZED STUDY

2021 ◽  
Vol 5 (3) ◽  
Author(s):  
Mukesh Kumar Aswal ◽  
Vijay Aswal ◽  
Pramod Jain
Keyword(s):  
Randomized Study ◽  
Bed Rest ◽  
Proximal Femoral Nail ◽  
Harris Hip Score ◽  
P Value ◽  
Vein Thrombosis ◽  
Bipolar Group ◽  
Femoral Nail ◽  
Keywords Hip ◽  
Unstable Intertrochanteric Fracture

Background: Intertrochanteric femur fracture incidence has increased due to increased life expectancy and osteoporosis. Management of these fractures in elderly is challenging due to difficult anatomical reduction, poor bone quality and osteoporosis. Internal fixation in these cases usually involves prolonged bed rest to prevent implant failure which leads higher complication such as deep vein thrombosis, pneumonia pulmonary embolism, bed sores, increased morbidity. Methods: The present study was prospectively carried out in 60 consecutive patients of Fracture Intertrochanter Femur and treated with Hemiarthroplasty with Cemented Bipolar Prosthesis and Proximal Femoral Nail. Results: The average harris hip score in PFN group is 88.21±4.36 and in Bipolar group is 85.21±8.12. Final functional outcome were better in PFN group (P value 0.02) than by Bipolar group and significant. Conclusion: The outcomes of the stable fractures treated with either Bipolar or PFN were similar. Unstable comminuted fractures treated with Bipolar showed significantly better outcomes with all patients having good results. Keywords: Hip arthroplasty, PFN, Complication

scholarly journals COMPARATIVE STUDY OF HEMIREPLACEMENT ARTHROPLASTY WITH BIPOLAR PROSTHETIC AND PROXIMAL FEMORAL NAIL (PFN) IN UNSTABLE INTERTROCHANTERIC FRACTURE OF FEMURE: INTERVENTIONAL PROSPECTIVE RANDOMIZED STUDY

2021 ◽  
Vol 5 (12) ◽  
Author(s):  
Sawai Singh ◽  
Raghuveer Meena
Keyword(s):  
Randomized Study ◽  
Proximal Femoral Nail ◽  
Harris Hip Score ◽  
P Value ◽  
Bipolar Group ◽  
Femoral Nail ◽  
Keywords Hip ◽  
Unstable Intertrochanteric Fracture ◽  
Keywords Hip Arthroplasty ◽  
Intertrochanteric Femur Fracture

Background: Intertrochanteric femur fracture incidence has increased due to increased life expectancy and osteoporosis. Methods- The present study was prospectively carried out in 60 consecutive patients of Fracture Intertrochanter Femur and treated with Hemiarthroplasty with Cemented Bipolar Prosthesis and Proximal Femoral Nail. Results: The age of the patients in present study was in range of 60 - 80 years. There was a preponderance of female in present study in both groups. The mean duratioin of surgery in the Bipolar group (91.24±9.21Minutes) was much More That In PFN (53.12 ±6.02Minutes) Group. All patients of Bipolar group was discharged between 4 to 9 days and in PFN group 4 to 12 days after surgery. The average harris hip score in PFN group is 87.32±4.13 and in Bipolar group is 85.02±7.92. Final functional outcome were better in PFN group (P value 0.01) than by Bipolar group and significant. Conclusion: The outcomes of the stable fractures treated with either Bipolar or PFN were similar. Unstable comminuted fractures treated with Bipolar showed significantly better outcomes with all patients having good results. Keywords: Hip Arthroplasty, PFN, Complication

scholarly journals Functional and Radiological Outcome of Unstable Intertrochanteric Fracture in Old Age Treated with Proximal Femoral Nail Antirotation-2

2021 ◽  
Author(s):  
OP Jamshad ◽  
Jacob Mathew ◽  
Raju Karuppal
Keyword(s):  
Proximal Femoral Nail ◽  
Harris Hip Score ◽  
Intertrochanteric Fractures ◽  
Biological Reduction ◽  
Neck Shaft Angle ◽  
Femoral Nail ◽  
Unstable Intertrochanteric Fracture ◽  
Shaft Angle ◽  
The Mean ◽  
Proximal Femoral Nail Antirotation

Introduction: Intertrochanteric fractures are prevalent in the elderly, which leave patients with functional restrictions. Proximal Femoral Nail Antirotation-2 (PFNA) was developed to achieve better fixation strength, particularly in the presence of osteoporotic unstable intertrochanteric fractures. Aim: To evaluate the role and result of PFNA-2 in the treatment of unstable intertrochanteric fractures in geriatric patients. Materials and Methods: A prospective analytical study was conducted in 35 patients with unstable intertrochanteric fractures. They were followed-up clinically and radiologically for one year. The quality of fixation was assessed, by neck-shaft angle and Tip Apex Distance (TAD). A functional assessment was done with the Harris Hip Score (HHS). Results: The mean follow-up period was 13 months (range, 12-14). The mean age of patients was 65.6 years and the majority were female patients (62.85%). Functional results according to modified HHS were found to be excellent in 6 (17.1%) patients, good in 14 (40%) patients, fair in 12 (34.3%) patients and poor in 3 (8.6%) patients. The average HHS in this study was 81.6. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 16.0. Conclusion: PFNA-2 helps in achieving biological reduction and good stability which enables early mobilisation and prevention of excessive collapse. A good functional outcome could be achieved when the radiological parameters are restored, i.e., TAD <25 mm and neck-shaft angle difference <5° (compared to the opposite side).

scholarly journals Functional outcome of unstable intertrochanteric fractures managed with proximal femoral nail: a prospective analysis

2018 ◽  
Vol 4 (6) ◽  
pp. 945
Author(s):  
C. Joney Mandice ◽  
Raship Khan ◽  
Heber Anandan
Keyword(s):  
Functional Outcome ◽  
Hip Fractures ◽  
Proximal Femoral Nail ◽  
Harris Hip Score ◽  
Intertrochanteric Fractures ◽  
Femur Fractures ◽  
Efficient Management ◽  
Femoral Nail ◽  
Early Return ◽  
Unstable Intertrochanteric Fracture

<p class="abstract"><strong>Background:</strong> Hip fractures are a growing concern for the orthopedic surgeons all over the world because the incidence of hip fractures is increasing dramatically and these fractures impose a significant challenge in their efficient management. The aim of the study was to prospectively analyze the functional outcome of unstable intertrochanteric fractures managed with ‘proximal femoral nail’.</p><p class="abstract"><strong>Methods:</strong> In our institution, we have selected 24 cases of unstable intertrochanteric fractures for this prospective study. All cases enrolled were managed with the proximal femoral nail. These cases were studied from the mechanism of injury, classification, and treatment with the proximal femoral nail and their surgical and functional outcome with or without residual comp.<strong></strong></p><p class="abstract"><strong>Results:</strong> Patients were followed up for an average period of 8.58 months. The mean Harris hip score was 88.75 at 6th month. The score was excellent in 12 patients, good in 10 patients, fair in 1 patient and poor in 1 patient. In our study of 24 patients with unstable intertrochanteric fracture, the average age incidence was 54.64 years. In the present study male: female was 5:3.</p><p class="abstract"><strong>Conclusions:</strong> In unstable proximal femur fractures, PFN is a significant advancement in the treatment of unstable trochanteric fractures which has the unique advantages of closed reduction, preservation of fracture hematoma, less tissue damage, early rehabilitation and early return to work.</p>

AO/OTA 31A2 and 31A3 Intertrochanteric Fractures Managed by Proximal Femoral Nail Antirotation (PFNA)

2021 ◽  
Vol 15 (10) ◽  
pp. 2616-2618
Author(s):  
Zamir Hussain Tunio ◽  
Rizwan Ali Jhatiyal ◽  
Muhammad Azeem Akhund ◽  
M. Kashif Abbasi ◽  
S. Muhammad Ali ◽  
...  
Keyword(s):  
Intertrochanteric Fracture ◽  
Proximal Femoral Nail ◽  
Harris Hip Score ◽  
Psychiatric Disease ◽  
Unstable Fracture ◽  
Intertrochanteric Fractures ◽  
Femoral Nail ◽  
Intramedullary Device ◽  
Unstable Intertrochanteric Fracture ◽  
Proximal Femoral Nail Antirotation

Aim: To study the clinical and radiological outcome of unstable intertrochanteric fracture AO/OTA 31A2, 31A3 fixed by proximal femoral nail antirotation Study design: Descriptive cross sectional study. Place and duration of study: Department of Orthopedic Surgery and Traumatology, Pir Abdul Qadir Shah Jilani Institute of Medical Sciences, Gambat, Sindh from 1st January 2016 to 31st December 2019. Methodology: Forty four cases having intertrochanteric fracture AO/OTA 31A2, 31A3 with age ranging from 18 year to 55 year of either gender were selected; patients having close fracture, who were willing were included in the study, while patients older than 55 year and younger than 18 year, AO/OTA 31A1 fracture, open fracture, bilateral injuries, smoker, alcoholic, drug addicted, poly-trauma, pathological fracture and history of poor compliance, psychiatric disease were excluded. Results: There were 26(59.09%) males and 18(40.91%) females with mean age was 41.3±7.7 years. Regarding classification; AO/OTA 31A2 were 33 (75%), and 31A3 were 11 (25%). Mean time for union was 18.5±3.55 weeks. The average time of follow-up was 48.5±6.6 weeks. Harris Hip Score was excellent (90-100) in 31(70.45%), good (80-89) in 7(15.91%), fair (70-80) in 3 (6.81%) and poor (<70) in 3 (6.81%). Conclusion: Intramedullary device proximal femoral nail antirotation can be labelled as implant of choice for unstable intertrochanteric fractures AO/OTA 31A2, 31A3, with fruitful clinical and radiological outcomes, and with fewer complications. Hip Harris score was excellent-good in 86% of the patients. Key words: Proximal femoral nail antirotation (PFNA), AO/OTA 31A2, 31A3, Intertrochanteric, unstable fracture

scholarly journals A Comparative Study of Unstable Intertrochanteric Fracture by Proximal Femoral Nail versus Proximal Femoral Nail Anti-Rotation among Adult Patients

2021 ◽  
Vol 6 (1) ◽  
pp. 27-33
Author(s):  
Santosh Kumar Singh ◽  
Raj Kumar Bhartiya
Keyword(s):  
Comparative Study ◽  
Intertrochanteric Fracture ◽  
Adult Patients ◽  
Proximal Femoral Nail ◽  
Harris Hip Score ◽  
Functional Evaluation ◽  
Excellent Outcome ◽  
Femoral Nail ◽  
Significant Difference ◽  
Unstable Intertrochanteric Fracture

Objective: To compare unstable intertrochanteric fracture by proximal femoral nail versus proximal femoral nail anti-rotation among adult patients. Methods: This was a comparative study. Patients were randomized into 2 groups: Proximal Femoral Nail Anti-rotation (n=30) and Proximal femoral nail group (n=30). Singh’s index was used to grade the radiographs for the degree of osteoporosis. Functional evaluation was done at 3 months, 6 months, 9 months and 12 months by using Harris Hip Score. Results: Majority of patients in both PFN (60%) and PFNA (70%) were between 61-70 years. More than half of patients of PFN (56.7%) and 43.3% of PFNA were males. The operative time was 84.00±9.39 minutes among patients of PFN and 61.03±5.75 minutes among patients of PFNA with significant difference between the groups. Singh’s grade III was most common among patients of both PFN (36.7%) and PFNA (36.7%). There was no significant (p>0.05) difference in Harris Hip score between the groups at all the time periods. Excellent outcome was in 63.3% patients of PFNA and in 46.7% patients of PFNA. Good outcome was in 33.3% patients of PFN and in 10% of PFNA. Conclusion: The study suggests that both PFN and PFNA perform well, showing equally good functional outcomes following fixation of unstable trochanteric fractures. PFNA offers no significant benefits over PFN in terms of post-operative complications. Keywords: Unstable intertrochanteric fracture, Proximal femoral nail, Proximal femoral nail anti-rotation.

scholarly journals Efficacy of proximal femoral nail augmentation in unstable intertrochanteric fracture

2020 ◽  
Vol 6 (5) ◽  
pp. 1043
Author(s):  
Purushotham V. J. ◽  
M. Ayyub Khan ◽  
Navneeth Kumar
Keyword(s):  
Intertrochanteric Fracture ◽  
Femoral Fractures ◽  
Proximal Femoral Nail ◽  
Harris Hip Score ◽  
Cerclage Wire ◽  
Femoral Nail ◽  
Unstable Intertrochanteric Fracture ◽  
Male Patients ◽  
Modified Harris Hip Score ◽  
A Prospective Study

<p class="abstract"><strong><span lang="EN-US">Background: </span></strong><span lang="EN-US">To assess the short term functional and radiological outcome of unstable intertrochanteric fracture fixation using proximal femoral nail with augmentation using Cannulated Cancellous (CC) screw or Stainless Steel (SS) wiring.</span></p><p class="abstract"><strong><span lang="EN-US">Methods: </span></strong><span lang="EN-US">A prospective study was conducted with 20 cases of unstable intertrochanteric femoral fractures from May 2017 to March 2019. Six females and fourteen male patients in the age group between 40 and 80 years were included in this study. There were 8 cases of AO31A2 and 12 cases of AO31 A3. Fracture were fixed by proximal femoral nail with augmentation by an additional CC screw or encirclage with SS wires to strengthen the lateral trochanteric wall.</span></p><p class="abstract"><strong><span lang="EN-US">Results: </span></strong><span lang="EN-US">Fracture union was achieved in all cases with a mean period of 15.4 weeks. Patients were followed up for a period of 6 months. At the end of follow up the Modified Harris Hip Score was found to be more than 90 % in 16 cases.</span></p><p class="abstract"><strong><span lang="EN-US">Conclusion:</span></strong><span lang="EN-US"> Augmentation of proximal femoral nail in unstable intertrochanteric fracture with additional screw or cerclage wire increases the efficacy and stability of construct, aiding union and expedition of time to union.</span></p>

scholarly journals Critical analysis of factors determining mechanical failures in proximal femoral nailing

2019 ◽  
Vol 5 (2) ◽  
pp. 275 ◽  
Author(s):  
Karthik Ramachandran ◽  
K. K. Arvind Manoj ◽  
A. Vishnu Sankar
Keyword(s):  
Failure Rate ◽  
Mechanical Failure ◽  
Proximal Femoral Nail ◽  
Harris Hip Score ◽  
Intertrochanteric Fractures ◽  
Excellent Outcome ◽  
Lag Screw ◽  
Femoral Nailing ◽  
Femoral Nail ◽  
Proximal Femoral Nailing

<p class="abstract"><strong>Background:</strong> Intertrochanteric fractures are one of the commonest fractures encountered in elderly population. Though there are various implants, proximal femoral nail has been the standard choice for management of unstable fractures. Inspite of its biomechanical advantages, various complications like screw cut out, Z effect, reverse Z effect does occur in proximal femoral nailing. The aim of the study is to analyse various factors determining the mechanical failures in patients operated with proximal femoral nail.</p><p class="abstract"><strong>Methods:</strong> This is a prospective study conducted in our institution from June 2014 to May 2018. The study included 72 patients with unstable intertrochanteric fractures treated with proximal femoral nail. All patients were followed for average period of 2 years. Functional outcome was assessed using Harris Hip score.<strong></strong></p><p class="abstract"><strong>Results:</strong> Among the patients<strong> </strong>33%<strong> </strong>had excellent outcome. 42% had good and 14% had fair outcome. 11% of cases ended with poor outcome. Mechanical failure rate was less in patients with positive medial cortical support (PMCS) and in patients with tip apex distance difference between antirotation screw and lag screw (TAD<sub>AR </sub>-TAD<sub>LS</sub>) more than 15 mm. Whereas the difference in the position of lag screw centre had no significant influence in the mechanical failure rate in our study.</p><p class="abstract"><strong>Conclusions:</strong> From our study we like to conclude that the<strong> </strong>fracture reduction with positive medial cortical support and the TAD difference play a major role in determining the incidence of mechanical failure in proximal femoral nailing.</p>

scholarly journals Biomechanical comparison of medial sustainable nail and proximal femoral nail antirotation in the treatment of an unstable intertrochanteric fracture

2020 ◽  
Vol 9 (12) ◽  
pp. 840-847
Author(s):  
Shaobo Nie ◽  
Ming Li ◽  
Hui Ji ◽  
Zhirui Li ◽  
Wenwen Li ◽  
...  
Keyword(s):  
Cyclic Loading ◽  
Torsional Stiffness ◽  
Proximal Femoral Nail ◽  
Axial Stiffness ◽  
Intertrochanteric Fractures ◽  
Loading Test ◽  
Cyclic Loading Test ◽  
Femoral Nail ◽  
Unstable Intertrochanteric Fracture ◽  
The Mean

Aims Restoration of proximal medial femoral support is the keystone in the treatment of intertrochanteric fractures. None of the available implants are effective in constructing the medial femoral support. Medial sustainable nail (MSN-II) is a novel cephalomedullary nail designed for this. In this study, biomechanical difference between MSN-II and proximal femoral nail anti-rotation (PFNA-II) was compared to determine whether or not MSN-II can effectively reconstruct the medial femoral support. Methods A total of 36 synthetic femur models with simulated intertrochanteric fractures without medial support (AO/OTA 31-A2.3) were assigned to two groups with 18 specimens each for stabilization with MSN-II or PFNA-II. Each group was further divided into three subgroups of six specimens according to different experimental conditions respectively as follows: axial loading test; static torsional test; and cyclic loading test. Results The mean axial stiffness, vertical displacement, and maximum failure load of MSN-II were 258.47 N/mm (SD 42.27), 2.99 mm (SD 0.56), and 4,886 N (SD 525.31), respectively, while those of PFNA-II were 170.28 N/mm (SD 64.63), 4.86 mm (SD 1.66), and 3,870.87 N (SD 552.21), respectively. The mean torsional stiffness and failure torque of MSN-II were 1.72 N m/° (SD 0.61) and 16.54 N m (SD 7.06), respectively, while those of PFNA-II were 0.61 N m/° (SD 0.39) and 6.6 N m (SD 6.65), respectively. The displacement of MSN-II in each cycle point was less than that of PFNA-II in cyclic loading test. Significantly higher stiffness and less displacement were detected in the MSN-II group (p < 0.05). Conclusion The biomechanical performance of MSN-II was better than that of PFNA-II, suggesting that MSN-II may provide more effective mechanical support in the treatment of unstable intertrochanteric fractures. Cite this article: Bone Joint Res 2020;9(12):840–847.

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