EVALUATON OF CALCAR GRAFTING IN HIP HEMIARTHROPLASTY FOR COMMINUTED INTER-TROCHANTERIC FEMUR FRACTURES IN ELDERLY

Introduction: Treating intertrochanteric fractures in elderly with osteosynthesis is challenging, and is attributed to multiple factors like poor bone stock, difcult fracture pattern, and non orthopaedic complications arising due to periods of recumbency associated with internal xation. Hip replacement has come forward as a viable option for treating these cases, but it has its own share of difculties, such as limb length discrepancy, implant subsidence, long term implant stability and a greater cost. This study aimed at evaluating the utility if calcar strut grafting in dealing with these issues. Material And Methods: A total of 30 patients, with age more than 60 years, with comminuted intertrochanteric fractures, with postero-medial bone deciency, were treated with hemiarthroplasty, with augmentation with calcar strut grafting. The graft was prepared from the calcar region of the head and neck part of the femur and placed between the decient medial femoral cortex and medial edge of the implant. Result: In 24 out of the 30 patients, the graft got incorporated at its place without displacement. Shortening was seen in 4 patients, of which 2 reported a shortening of more than 2 centimetres. Conclusion: We can concludethat hemiarthroplasty has come forward as a viable and safe treatment modality for management of comminuted inter-trochanteric fractures in elderly patients.Calcar grafting as described here is useful in minimizing the subsidence of the implant and in maintaining the limb length, it facilitates early rehabilitation and quicker return normal activities

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A comparative study between proximal femur locking compression plate and dynamic hip screw fixation in management of intertrochantric femur fractures

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20164163 ◽

2016 ◽

Vol 2 (4) ◽

pp. 327

Author(s):

Mithlesh Kumar Meena ◽

Vinay Joshi

Keyword(s):

Locking Plate ◽

Locking Compression Plate ◽

Dynamic Hip Screw ◽

Intertrochanteric Fractures ◽

Trochanteric Fractures ◽

Superficial Infection ◽

Femur Fractures ◽

Compression Plate ◽

Hip Screw ◽

The Mean

Background: Proximal femur fractures are one of the commonest fracture encountered in orthopaedic trauma practice. Dynamic hip screw (DHS) is the gold standard procedure for treatment for stable intertrochanteric fractures, however problem arises with unstable fractures in maintenance of neck shaft angle and proper reduction. Here we are giving results of trochanteric fractures treated with proximal femoral locking compression plate (PFLCP) as compared with dynamic hip screw (DHS).Methods: This study was a prospective study. Two groups of trochanteric fractures of 25 patients operated with DHS and LCP were taken. Each patient was followed-up from July 2011 to October 2012 for minimum of 12 month or till the bony union. Every fracture was classified according to AO classification. Functional results will be assessed as per modified Harris hip evaluation score.Results: Among 25 patient treated with PFLCP, length discrepancy was .857 cm while that for DHS was 1.2 cm. The mean time of unaided walking with LCP Was 14.20 weeks while for DHS it was 16.20 weeks. The mean varus angulation for LCP 8 degree while for DHS 10.2 degree. In LCP in 1 case screw cut out from head and neck of femur while in DHS, same is seen in 2 cases and in addition loss of position of lag screw seen in 5 cases.one case was found with superficial infection in LCP while in case of DHS 3 cases with deep infection for that implant was removed and 6 cases were found with superficial infection.Conclusions: Proximal femoral locking plate (PFLCP) is simple, stable for fixation with fewer complications, and is an effective method for unstable intertrochanteric fractures. Comparing with DHS group, the locking plate has shorter operative time, fewer blood loss and drainage.

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Comparative analysis between dynamic hip screw with trochanteric stabilisation plate and dynamic hip screw alone in the management of unstable intertrochanteric femur fractures

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20204597 ◽

2020 ◽

Vol 6 (6) ◽

pp. 1280

Author(s):

Rajeev Anand ◽

Amit Dwivedi ◽

Anupinder Sharma

Keyword(s):

Comparative Analysis ◽

Functional Outcome ◽

Normal Function ◽

Dynamic Hip Screw ◽

Intertrochanteric Fractures ◽

Trochanteric Fractures ◽

Femur Fractures ◽

Good Score ◽

Hip Screw ◽

Fractures Of The Femur

Background: Intertrochanteric fractures of the femur are difficult to manage because of the complex patterns they present with. A dynamic hip screw (DHS) and a DHS supplemented with a trochanteric stabilisation plate (TSP) are among a variety of fixation methods used in the management of such injuries. We compared the efficacy of DHS with TSP to DHS alone in the treatment of unstable intertrochanteric femur fractures.Methods: 30 patients of intertrochanteric femur fractures (mean age 72 years) were included in the study, 14 were treated using DHS with TSP while 16 were treated using DHS alone, they were followed up till 16 weeks and the progress was recorded according to the parameters in the Salvati and Wilson score.Results: 14 patients were treated using DHS with TSP, 11 of them had excellent Salvati and Wilson scores, 3 patients recorded good scores, 11 patients were able to walk with no pain while 3 needed aids for walking due to pain, normal function was restored in 12 patients while very little restriction was seen in 2 patientsOf the16 patients treated using DHS alone, 10 had excellent scores, 6 recorded a good score, 10 patients walked with no pain while 6 needed aids for walking due to pain, normal function was re-stored in 11 patients, very little restriction was seen in 4 patients while 1 patient had restricted nor-mal activity.Conclusions: DHS with TSP appears to provide better fixation and functional outcome in unstable inter trochanteric fractures over DHS alone.

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Confounding variables affecting long term results of standard two screw cephalomedullary nail in intertrochanteric fractures of femur

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20205569 ◽

2020 ◽

Vol 7 (1) ◽

pp. 103

Author(s):

Rajeev Shukla ◽

Adhir Jain ◽

Pranav Mahajan ◽

Ravikant Jain

Keyword(s):

Functional Outcome ◽

Final Outcome ◽

Long Term Results ◽

Harris Hip Score ◽

Walking Ability ◽

Treatment Technique ◽

Trochanteric Fractures ◽

Excellent Outcome ◽

Femur Fractures

Background: Inter trochanteric fractures of femur are common fractures in the elderly. The aim of the study was to assess the long-term functional outcome of patients treated with trochanteric fixation nail (TFN) for inter trochanteric femur fractures and to determine variables which affect the final outcome of surgery at the end of five years.Methods: The study was done at tertiary centre in central India with 152 patients who sustained intertrochanteric femur fracture. The patients were followed up at 6 weeks, 6 months, 1 year, 2 years and 5 years after the surgery. The assessment of pain, functional activity, walking ability and range of motion were assessed by Harris hip score at 6 months, 1 year, 2 years and 5 years.Results: The good/excellent outcome at the end of 5 years was found in 84% of cases. Patients with age less than 65 years and male patients had better outcome at the end of five years. Some of the complications encountered with this type of implant were z effect, delayed union, screw back-out/breakage, varus collapse which affected the final outcome.Conclusions: TFN is effective treatment technique for inter trochanteric fractures of femur worldwide. There are some complications which can occur with this type of implant in early post-operative period but still long-term follow-up of patients suggested that the fracture pattern, preoperative mobility status, timing of surgery, post op mobilization also plays a key role in determining functional outcome of patients.

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Periprosthetic Femoral Insufficiency Fracture in a Patient on Long-term Bisphosphonate Therapy

The Duke Orthopaedic Journal ◽

10.5005/jp-journals-10017-1021 ◽

2012 ◽

Vol 2 (1) ◽

pp. 66-69 ◽

Cited By ~ 7

Author(s):

Samuel S Wellman ◽

David E Attarian ◽

Jordan F Schaeffer

Keyword(s):

Recent Literature ◽

Insufficiency Fracture ◽

Bisphosphonate Therapy ◽

Fracture Pattern ◽

Term Therapy ◽

Femoral Cortex ◽

History Of ◽

Long Term Therapy ◽

Cemented Total Hip Arthroplasty

ABSTRACT Recent literature shows an association between long-term bisphosphonate therapy and low-energy fractures of the subtrochanteric femur. It is thought that the pharmacology of bisphosphonates and stress characteristics of the sub-trochanteric femur predispose patients on long-term therapy to fracture. There are few reports in the literature of bisphos-phonate-associated periprosthetic fractures with the characteristic fracture pattern. We report a case in a patient with a 10- year history of sustained bisphosphonate use. The patient is a 79-year-old female that developed new thigh pain 9 years following a cemented total hip arthroplasty. Radiographs revealed lateral cortical thickening and a transverse periprosthetic stress fracture of the lateral femoral cortex at the level of the distal stem. This fracture appears consistent with a bisphosphonate-associated insufficiency fracture, demonstrating that this pattern is not isolated to nonarthroplasty patients. Schaeffer JF, Attarian DE, Wellman SS. Periprosthetic Femoral Insufficiency Fracture in a Patient on Long-term Bisphosphonate Therapy. The Duke Orthop J 2012;2(1):66-69.

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The role of preoperative computed tomography in surgical planning of intertrochanteric femur fractures fixation

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20210615 ◽

2021 ◽

Vol 7 (2) ◽

pp. 211

Author(s):

El Sayed A. Abdullah ◽

Mina E. Salama

Keyword(s):

Surgical Planning ◽

Preoperative Evaluation ◽

Fracture Pattern ◽

Harris Hip Score ◽

Intertrochanteric Fractures ◽

3D Ct ◽

X Ray ◽

Femur Fractures ◽

Number Of Patients ◽

Ct Classification

Background: A precise preoperative evaluation of stability of intertrochanteric fractures is crucial for surgical planning. Three dimensional CT scanning is a useful tool for understanding the exact type of fracture pattern. Methods: A prospective study included 40 patients with intertrochanteric femoral fractures. They were classified into stable and unstable intertrochanteric fractures according to the X-ray based AO/OTA classification and according to Nakano 3D-CT classification and both classifications were correlated. The patients were operated on using dynamic hip screw (DHS) and were assessed radiologically and clinically by Harris hip score (HHS) after 6 months. Results: There was significant statistical difference (p=0.031) and relation (p<0.001) between X-ray based AO/OTA classification and 3D-CT classification. Six cases from the 24 cases with stable pattern in AO/OTA system have unstable patterns in the 3D-CT (25%) and their percent from the 22 unstable patterns in 3D-CT is 27.27% and their percent from the total number of patients in the study is 15%. Conclusions: The superolateral support in the form of the greater trochanter which affects the lateral wall thickness is as important as the posteromedial lesser fragment in assessing the stability of the fracture pattern.

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Intramedullary Bone Lengthening Following Preceding Hip Surgery—A Case Series

Journal of Clinical Medicine ◽

10.3390/jcm9124104 ◽

2020 ◽

Vol 9 (12) ◽

pp. 4104

Author(s):

Lukas Zak ◽

Thomas Manfred Tiefenboeck ◽

Gerald Eliot Wozasek

Keyword(s):

Hip Dysplasia ◽

Young Patients ◽

Limb Lengthening ◽

Limb Length Discrepancy ◽

Limb Length ◽

Hip Surgery ◽

Bone Lengthening ◽

Safe Procedure ◽

Length Discrepancy ◽

Healing Index

Limb length discrepancy (LLD) is a common problem after joint-preserving hip surgeries, hip dysplasia, and hip deformities. Limping, pain, sciatica, paresthesia, and hip instability are common clinical findings and may necessitate limb-lengthening procedures. The study included five patients (two female and three male, mean age of 28 years (20–49; SD: 12)) with symptomatic limb length discrepancy greater than 2.5 cm (mean: 3.6 cm) after total hip arthroplasty (THA), hip dysplasia, or post-traumatic hip surgery. They underwent either ipsi- or contralateral intramedullary limb-lengthening surgeries using the PRECICE™ telescopic nail. All patients achieved complete bone healing and correction of the pelvic obliquity after intramedullary lengthening. None of the patients had a loss of proximal or distal joint motion. The mean distraction-consolidation time (DCT) was 3.8 months, the distraction index (DI) 0.7 mm/day, the lengthening index (LI) 1.8 months/cm, the consolidation index (CI) 49.2 days/cm, the healing index (HI) 1.1 months/cm, and the modified healing index (HI*) 34 days/cm. Intramedullary limb lengthening after LLD in cases of hip dysplasia, hip deformity, and various kinds of hip surgery is a useful and safe procedure in young patients to achieve equal limb length. No functional impairment of the preceded hip surgery was seen.

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Debridement, Antibiotics, and Implant Retention Is a Viable Treatment Option for Early Periprosthetic Joint Infection Presenting More Than 4 Weeks After Index Arthroplasty

Clinical Infectious Diseases ◽

10.1093/cid/ciz867 ◽

2019 ◽

Vol 71 (3) ◽

pp. 630-636 ◽

Cited By ~ 3

Author(s):

Claudia A M Löwik ◽

Javad Parvizi ◽

Paul C Jutte ◽

Wierd P Zijlstra ◽

Bas A S Knobben ◽

...

Keyword(s):

Treatment Failure ◽

Periprosthetic Joint Infection ◽

Joint Infection ◽

Viable Option ◽

Time Intervals ◽

Implant Retention ◽

Time Point ◽

Viable Treatment

Abstract Background The success of debridement, antibiotics, and implant retention (DAIR) in early periprosthetic joint infection (PJI) largely depends on the presence of a mature biofilm. At what time point DAIR should be disrecommended is unknown. This multicenter study evaluated the outcome of DAIR in relation to the time after index arthroplasty. Methods We retrospectively evaluated PJIs occurring within 90 days after surgery and treated with DAIR. Patients with bacteremia, arthroscopic debridements, and a follow-up <1 year were excluded. Treatment failure was defined as (1) any further surgical procedure related to infection; (2) PJI-related death; or (3) use of long-term suppressive antibiotics. Results We included 769 patients. Treatment failure occurred in 294 patients (38%) and was similar between time intervals from index arthroplasty to DAIR: the failure rate for Week 1–2 was 42% (95/226), the rate for Week 3–4 was 38% (143/378), the rate for Week 5–6 was 29% (29/100), and the rate for Week 7–12 was 42% (27/65). An exchange of modular components was performed to a lesser extent in the early post-surgical course compared with the late course (41% vs 63%, respectively; P < .001). The causative microorganisms, comorbidities, and durations of symptoms were comparable between time intervals. Conclusions DAIR is a viable option in patients with early PJI presenting more than 4 weeks after index surgery, as long as DAIR is performed within at least 1 week after the onset of symptoms and modular components can be exchanged.

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Does robotic-assisted surgery improve outcomes of total hip arthroplasty compared to manual technique? A systematic review and meta-analysis

Postgraduate Medical Journal ◽

10.1136/postgradmedj-2021-141135 ◽

2021 ◽

pp. postgradmedj-2021-141135

Author(s):

Vishal Kumar ◽

Sandeep Patel ◽

Vishnu Baburaj ◽

Rajesh Kumar Rajnish ◽

Sameer Aggarwal

Keyword(s):

Systematic Review ◽

Total Hip Arthroplasty ◽

Clinical Outcomes ◽

Hip Arthroplasty ◽

Meta Analysis ◽

Operating Time ◽

Limb Length ◽

Robot Assisted ◽

Total Hip

BackgroundRobot-assisted total hip arthroplasty (THA) is an emerging technology that claims to position implants with very high accuracy. However, there is currently limited data in literature on whether this improved accuracy leads to better long-term clinical outcomes. This systematic review compares the outcomes of THA done with the help of robotic assistance (RA) to those done with conventional manual techniques (MTs).MethodsFour electronic databases were searched for eligible articles that directly compared robot-assisted THA to manual THA and had data on the radiological or clinical outcomes of both. Data on various outcome parameters were collected. Meta-analysis was conducted using a random-effects model with 95% CIs.ResultsA total of 17 articles were found eligible for inclusion, and 3600 cases were analysed. Mean operating time in the RA group was significantly longer than in the MT group. RA resulted in significantly more acetabular cups being placed inside Lewinnek’s and Callanan’s safe zones (p<0.001) and had significantly reduced limb length discrepancy compared with MT. There were no statistically significant differences in the two groups in terms of incidence of perioperative complications, need for revision surgery and long-term functional outcome.ConclusionRA leads to highly accurate implant placement and leads to significantly reduced limb length discrepancies. However, the authors do not recommend robot-assisted techniques for routine THAs due to lack of adequate long-term follow-up data, prolonged surgical times and no significant differences in the rate of complications and implant survivorship compared with conventional MTs.

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Dynamic limb length discrepancy at heel strike is a better indicator of walking performance than static limb length discrepancy among patients with hemiplegic cerebral palsy

Developmental Medicine & Child Neurology ◽

10.1111/dmcn.65_14017 ◽

2018 ◽

Vol 60 ◽

pp. 43-43

Keyword(s):

Cerebral Palsy ◽

Limb Length Discrepancy ◽

Limb Length ◽

Heel Strike ◽

Length Discrepancy ◽

Hemiplegic Cerebral Palsy ◽

Walking Performance

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Selected life quality variables of women treated surgically due to intertrochanteric femur fractures in the aspect of nursing and rehabilitation standards

Rehabilitacja Medyczna ◽

10.5604/01.3001.0010.8158 ◽

2018 ◽

Vol 21 (3) ◽

pp. 4-13

Author(s):

Małgorzata Kamińska ◽

Joanna Golec ◽

Dorota Czechowska

Keyword(s):

Quality Of Life ◽

Femur Fracture ◽

Femoral Fractures ◽

Femur Fractures ◽

Short And Long Term ◽

Intertrochanteric Femur Fracture ◽

Long Term Observation ◽

Nursing Standards

Introduction: The aim of presented study was to evaluate selected quality of life indicators for women treated surgically due to intertrochanteric femur fractures in terms of implementation of physiotherapeutic and nursing standards. Clinical Hospital in Krakow (5WSK) within the period from January 2015 to December 2016. At that time, 145 women with intertrochanteric femur fracture were admitted to the hospital. The age of the patients ranged between 58 and 92 years, with an average of 83.6 years. The following questionnaires and score scales were used to assess the quality of life: Short Pfeiffer Mental Status Questionnaire (SPMSQ), Instrumental Activities of Daily Living (IADL) scale, SF-36 Quality of Life Questionnaire, Barthel scale, HOOS scale, Geriatric Depression Scale (GDS) by Yesavage, the author’s questionnaire on rehabilitation care problems related to urinary tract infections, bed sores, pneumonia, gastrointestinal disorders, gastrointestinal infections and thromboembolic complications as well as survival rate. Results and conclusions: 1. The quality of life of women operated because of intertrochanteric femoral fractures using an intramedullary Gamma nail had deteriorated in both short and long-term observation. 2. Maintenance and individualization of nursing standards and rehabilitation in women treated surgically due to intertrochanteric femoral fractures had a positive effect on the overall process of their treatment. 3.The level of physical activity declared by women operated due to intertrochanteric femur fracture prior to the occurrence of these fractures, has a signifi cant effect on their functional results in short and long-term observation. The higher the level of physical activity of these patients before the fracture, the more favourable was the functional outcome. 4. The level of mood and self-acceptance of the disease in women treated surgically for this fracture had signifi cant impact on the process of their nursing as well as rehabilitation, and on functional status in short and long-term follow-up. The higher the level of mood and self-acceptance of the disease in these women, the better the process of their nursing, rehabilitation and the functional outcome.

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