INTRAMEDULLARY PROXIMAL FEMORAL NAILING FOR UNSTABLE PERITROCHANTRIC FRACTURE: A PROSPECTIVE STUDY

2021 ◽  
pp. 79-82
Author(s):  
Arun Kumar C ◽  
Rakesh Kumar B ◽  
Vaibhav Chaurasia ◽  
Venkatachalam K ◽  
Sathish Babu ◽  
...  
Keyword(s):  
Prospective Study ◽  
Wound Infection ◽  
Trochanteric Fracture ◽  
Operation Time ◽  
Fracture Site ◽  
Harris Hip Score ◽  
Bipolar Hemiarthroplasty ◽  
Trochanteric Fractures ◽  
A Prospective Study

Trochanteric fracture id one of the commonest fractures in Orthopaedics and also among the most devastating injuries of the elderly. The incidence of this fracture increases with advancing age. Around 50% of the Peri-trochanteric variant of these fractures, are of the unstable type. PFNA2 deploys a helical blade which provides compressibility and an additional rotation control at the fracture site.The aim of this study is to assess the effectiveness of Intra-medullary xation of unstable peri-trochanteric fractures with inter-locking proximal femoral nail PFNA2, in a prospective study. This study was done in Department of Orthopaedics, Chettinad Hospital and Research institute, Kelambakkam, Chengalpattu district, Tamilnadu and was spread over 4 years from Jan 2017 to December 2020 with minimum follow-up period of 12 months. 66 patients participated in this study. Harris Hip Score was used to assess the functional outcome. The Harris Hip Score, mean at 6 months was 75.35, which improved to 82.02 by 12 months of follow-up. With regard to our complications 4 patients had a superior cut out of helical screw, which required re-operation by bipolar hemiarthroplasty of the cemented variant. 9 patients had a varus deformity of 10-12 degrees. Abductor lurch was noted in 11 patients. Supercial-wound infection occurred in 8 patients and deep wound infection, requiring surgical irrigation occurred in 3 patients. In conclusion, PFNA2 has better stability, better rotatory stress shielding, superior compaction at fracture site, less blood loss, shorter operation time, less radiation exposure and better clinico-radiological outcomes. PFNA2 is a good implant choice to tackle the complex problems encountered in displaced unstable trochanteric fractures

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

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.

scholarly journals Non-Operative Management of Femoroacetabular Impingement: A Prospective Study

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0006 ◽  
Author(s):  
Andrew T. Pennock ◽  
James D. Bomar ◽  
Kristina Parvanta ◽  
Vidyadhar Vinayak Upasani
Keyword(s):  
Prospective Study ◽  
Operative Treatment ◽  
Femoroacetabular Impingement ◽  
Steroid Injection ◽  
Operative Management ◽  
Harris Hip Score ◽  
Labral Tears ◽  
A Prospective Study ◽  
Non Operative Management

Objectives: Little attention has been given to the non-operative management of femoroacetabular impingement (FAI) in the literature despite a rapidly expanding body of research on the topic. The purpose of the current project was to perform a prospective study utilizing a non-operative protocol on a consecutive series of patients presenting to our clinic with FAI. Methods: Between 2013 and 2016, patients referred to our clinic for hip pain that had a positive impingement sign were prospectively recruited in a non-operative FAI study. The protocol consisted of an initial trial of rest, physical therapy, and activity modification with a focus on avoidance of high hip flexion (Activity Mod group). Patients who remained symptomatic were then treated with an image-guided intra-articular steroid injection (Injection group). Patients with residual symptoms were then offered arthroscopic treatment (Surgery group). Outcome scores were collected at 12 and 24 months. Statistical analysis was performed to identify risk factors for failure of non-operative treatment. Results: 129 symptomatic hips in 100 patients were enrolled. After our exclusion criteria were applied, 110 hips in 84 patients remained with a mean follow-up of 25.5 months. Eighty-one hips (73.6%) were managed with PT, rest, and activity modification alone. Thirteen hips (11.8%) required a steroid injection, but did not progress to surgery. Sixteen hips (14.5%) required arthroscopic management. All three groups saw similar improvements in modified Harris hip score (mHHS)(p=0.706) and non-arthritic hips score (NAHS)(p=0.712). Initial, and most recent, mHHS and NAHS can be found in Table 1. Labral tears were distributed similarly among the three groups (n=41, p=0.09) and saw similar improvements in outcomes (p>0.5) as hips without labral tears. The surgical patients attempted non-operative treatment for a mean of 8.8 months prior to surgical intervention. Delays in surgery were not associated with worse outcomes. Cam lesion size, acetabular coverage, and the presence of a labral tear were not associated with non-operative treatment failure (p=0.579). Conclusion: A large majority of adolescent patients presenting with FAI can be managed nonoperatively with significant improvements in outcomes scores and continuation of sport at a mean follow up of two years. This is the first prospective study evaluating the outcomes of a standardized non-operative protocol for the management of FAI. Our results show that a commitment to non-operative care can work for a large percentage of patients. We will be following these patients further into the future to examine the durability of these results. [Table: see text]

scholarly journals To Study the Functional Outcome of Primary Cemented Bipolar Hemiarthroplasty in the Management of Unstable Inter-Trochanteric Fracture of Femur among Elderly

2017 ◽  
Vol 4 (1) ◽  
pp. 78
Author(s):  
Parth Vinod Agrawal ◽  
Nitin Wagh ◽  
Sandeep Pangavane
Keyword(s):  
Care Center ◽  
Weight Bearing ◽  
Tertiary Care ◽  
Trochanteric Fracture ◽  
Harris Hip Score ◽  
Full Weight Bearing ◽  
Bipolar Hemiarthroplasty ◽  
Intertrochanteric Fractures ◽  
Cemented Bipolar Hemiarthroplasty ◽  
A Prospective Study

Aims and Objectives: To evaluate the results with regard to function, to restoring proper limb length after surgery and to study the associated complications in intertrochanteric fractures treated by cemented bipolar hemiarthroplasty in elderly. Methodology: This is a prospective study of 25 cases of Intertrochanteric fractures admitted to a tertiary care center between August 2013 and November 2015 treated with Cemented Bipolar Hemiarthroplasty for intertrochanteric fractures. Cases were taken according to inclusion and exclusion criteria. Results: In our study of 25 cases, there were 14 male and 11 female patients with mean age of 72.8 years. 80% of the cases admitted were due to trivial trauma, 20% due to RTA with left side being more common side affected. According to OTA classification Type 31A2.2 fractures accounted for 60% of cases & Type 31A2.3 accounted for 40 %.. Mean duration of hospital stay was 13.2 days and mean time of full weight bearing was 4.7days in our patients. Excellent was seen in 24% cases Fair to Good results were seen in 72% of cases in our study according to Harris Hip Score. Conclusion: From our study we conclude that Cemented Bipolar Hemiarthroplasty for intertrochanteric fractures in elderly reduced the complications of prolonged immobilisation, prolonged rehabilitation, marked residual deformities and need for revision surgeries. The procedure offered, faster mobilization, rapid return to pre injury level, improved the quality of life.

scholarly journals Role of Biplane Double Supported Screw Fixation For Fracture Neck Femur In Elderly Population: A Prospective Study

2018 ◽  
Vol 12 (1) ◽  
pp. 514-524
Author(s):  
Anoop Kalia ◽  
Jagdeep Singh ◽  
Nasir Ali
Keyword(s):  
Total Hip Arthroplasty ◽  
Prospective Study ◽  
Hip Arthroplasty ◽  
Screw Fixation ◽  
Harris Hip Score ◽  
Total Hip ◽  
Fracture Neck Femur ◽  
The Mean ◽  
A Prospective Study

Introduction: The treatment of fracture neck femur varies according to the age of patient, the displacement of fracture fragments and the duration of the fracture. Various treatment options available for elderly are screw fixation, hemiarthroplasty and total hip arthroplasty. Materials and Methods: This is a prospective study done at authors institutes between January 2014- December 2016. 30 patients aged more than 50 years who sustained fracture neck femur were included in the study. 3 patients were lost to follow up and 2 patients died due to medical comorbidities. Out of the 25 remaining patients, 17 were males and 8 were females and they were operated by the biplane double supported screw fixation method (BDSF TECHNIQUE) and were followed up for a period of two years. The final Harris Hip Score at the last follow up was calculated. Results: Out of the 25 patients, the union was achieved in all the patients. The mean duration of union was 10 weeks. 1 patient had progressive femoral head resorption due to chondrolysis resulting in antalgic gait and unbearable pain and underwent total hip arthroplasty. The mean harris hip score was 81.2 Conclusion: In elderly patients with osteoporosis and in those patients who can not afford arthroplasty or in those patients where arthroplasty is contraindicated, BDSF method is an alternate method for fixing fracture neck femur.

scholarly journals A Prospective Study of Posterior (Transpedicular) Approach versus Anterior (Transthoracic/Thoracoabdominal) Approach for Posttraumatic Compression Fracture of Thoracolumbar Vertebra in a Tertiary Care Center: Comparison of Clinical and Radiological Outcomes

2020 ◽  
Author(s):  
Rahul Varshney ◽  
Parthasarathi Datta ◽  
Pulak Deb ◽  
Santanu Ghosh
Keyword(s):  
Prospective Study ◽  
Posterior Approach ◽  
Spinal Injuries ◽  
Anterolateral Approach ◽  
Kyphotic Angle ◽  
Posterior Group ◽  
Thoracoabdominal Approach ◽  
A Prospective Study ◽  
Anterior Group

Abstract Objective The aim of this article was to analyze the clinical and radiological outcomes of transpedicular decompression (posterior approach) and anterolateral approach in patients with traumatic thoracolumbar spinal injuries. Methods  It was a prospective study of patients with fractures of dorsolumbar spine from December 2011 to December 2013. A total of 60 patients with traumatic spinal injuries were admitted during the study period (December 2011–2013), of which 51 cases were finally selected and taken for operations while 3 were eventually lost in follow-up. Twenty patients were operated by anterolateral approach, titanium mesh cage, and fixation with bicortical screws. Twenty-eight patients were treated with posterior approach and transpedicular screw fixation. Clinical and radiographic evaluations were performed on all 48 patients before and after surgery. Results There were 48 patients of thoracolumbar burst fractures with 40 male and 8 female patients. Range of follow-up was from 1 month to 20 months, with a mean of 7.4. Preoperatively in anterior group, 65% of the patients were bed ridden, 20% patients were able to walk with support, and 15% of the patients were able to walk without support. In posterior group, 78.57% patients were bed ridden, 10.71% were able to walk with support, and 10.71% patients were able to walk without support. Kyphotic angle changes were seen in 16 patients out of 18 in anterior group and 20 patients in posterior group out of 25. Out of 18 patients in anterior group, 14 showed reduction in kyphotic angle of 10 to 100 (improvement), with mean improvement of 4.070. In posterior group, 7 patients showed improvement of 10 to 80 (reduction in kyphotic angle) whereas 13 patients showed deterioration of 1 to 120. The mean improvement was 2.140 in 7 patients and mean deterioration was 4.920. No statistical difference was found (p > 0.05) regarding improvement in urinary incontinence during the follow-up period. Conclusion There are significant differences in anterior and posterior approaches in terms of clinical improvement. Compared with posterior approach, the anterolateral approach can reduce fusion segment and well maintain the kyphosis correction. The selection of treatment should be based on clinical and radiological findings, including neurological deficit.

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