RESULTS OF TFN AND SHORT PFNA-II IN UNSTABLE TROCHANTERIC FRACTURES: A RETROSPECTIVE COMPARATIVE STUDY

2021 ◽  
pp. 58-60
Author(s):  
Saha Partha ◽  
Shashank Kanchan
Keyword(s):  
Comparative Study ◽  
Operation Time ◽  
The Elderly ◽  
Modern Medicine ◽  
High Rate ◽  
Harris Hip Score ◽  
Rotational Instability ◽  
Trochanteric Fractures ◽  
Helical Blade ◽  
Retrospective Comparative Study

Background: Advancements in modern medicine have given people the opportunity to live longer. The resultant increase in the elderly population has led to a higher incidence of peri-trochanteric fractures of the femur. The preferred implant for the comminuted unstable variety has been intramedullary nails with one or two head/neck compression screws, which are known to have high rate of complications like screw cut-out, back out, Z-effect, varus collapse and rotational instability, especially in the osteoporotic patients leading to the development of helical blade systems. Here we have compared the results of trochanteric xation nail (TFN) and short proximal femoral nail antirotation (PFNA)-II. Methods: It was a retrospective, comparative study in seventy-ve patients with comminuted unstable trochanteric fractures (AO classication31A2) treated using TFN in 34 and short PFNA-II in 41 patients with a minimum follow up period of six months. Results: Most of the data were comparable between the two groups except: signicantly higher operation time and implant-related complications in the TFN group. No signicant differences in the functional outcome between the two groups were noted as indicated by Harris Hip Score at six months. Conclusion: Short PFNA-II should be used in preference to TFN for comminuted unstable trochanteric fractures with no sub-trochanteric extension in the elderly osteoporotic patients in view of the shorter operative time, easier insertion and lower complications rate.

scholarly journals A Comparative Study of Endoscopic versus Microscopic Cartilage Type I Tympanoplasty

2019 ◽  
Vol 24 (01) ◽  
pp. e80-e85 ◽  
Author(s):  
Dipesh Shakya ◽  
Arun KC ◽  
Ajit Nepal
Keyword(s):  
Comparative Study ◽  
Success Rate ◽  
Demographic Data ◽  
Operation Time ◽  
Type I ◽  
Success Rates ◽  
Type I Tympanoplasty ◽  
Graft Success ◽  
Retrospective Comparative Study ◽  
Endoscopic Tympanoplasty

Abstract Introduction The use of endoscope is rapidly increasing in otological and neuro-otological surgery in the last 2 decades. Middle ear surgeries, including tympanoplasty, have increasingly utilized endoscopes as an adjunct to or as a replacement for the operative microscope. Superior visualization and transcanal access to diseases normally managed with a transmastoid approach are touted as advantages with the endoscope. Objectives The present study aimed to compare the outcomes of endoscopic and microscopic cartilage tympanoplasty (Type I) Methods This was a retrospective comparative study of 70 patients (25 males and 45 females) who underwent type I tympanoplasty between March 2015 and April 2016. The subjects were classified into 2 groups: endoscopic tympanoplasty (ET, n = 35), and microscopic tympanoplasty (MT, n = 35). Tragal cartilage was used as a graft and technique used was cartilage shield tympanoplasty in both groups. Demographic data, perforation size of the tympanic membrane at the preoperative state, operation time, hearing outcome, and graft success rate were evaluated. Results The epidemiological profiles, the preoperative hearing status, and the perforation size were similar in both groups. The mean operation time of the MT group (52.63 ± 8.68 minutes) was longer than that of the ET group (48.20 ± 10.37 minutes), but the difference was not statistically significant. The graft success rates 12 weeks postoperatively were 91.42% both in the ET and MT groups, that is, 32/35; and these values were not statistically significantly different. There was a statistically significant improvement in hearing within the groups, both pre- and postoperatively, but there was no difference between the groups. Conclusion Endoscopic tympanoplasty is a minimally invasive surgery with similar graft success rate, comparable hearing outcomes and shorter operative time period as compared to microscopic use.

Clinical and Radiological Outcomes of Trochanteric AO/OTA 31A2 Fractures: Comparison between Helical Blade and Lag Screw – A Retrospective Cohort Study

2020 ◽  
Author(s):  
Sertan Hancıoğlu ◽  
Kadir Gem ◽  
Hakan Koray Tosyali ◽  
Güvenir Okçu
Keyword(s):  
Functional Outcomes ◽  
Harris Hip Score ◽  
Inclusion Criteria ◽  
Trochanteric Fractures ◽  
Group 4 ◽  
Cutting Out ◽  
Helical Blade ◽  
The Mean ◽  
Screw Group

Abstract Introduction The purpose of this study was to compare the clinical and radiological outcomes of AO/OTA type 31A2 fractures treated by the use of trochanteric nails either with a blade or a screw. Patients and Methods This study was designed retrospectively. Between May 2007 and May 2014, a total of 144 patients with trochanteric fractures were admitted to the clinic, and only 65 of them met the inclusion criteria. Thirty-two of them (blade group) were treated with a helical blade and the rest of the 33 patients (screw group) were treated with a screw. The mean ages of the patients were 76.01 and 75.82, respectively (p = 0.905). The mean follow-up time was 27.6 months (blade group: 34.2 ± 19.1 months; screw group: 18.6 ± 7.9 months; p < 0.001). Between these two groups, we evaluated the differences in tip apex distances (TAD), calcar-referenced tip-apex distances (Cal-TAD), implant positions, cut-out rates, and implant failures. Functional outcomes were measured with the help of the Harris Hip Score. Results No significant differences were seen between the blade and screw groups by means of cutting out, implant positions, and varus collapse. Cutting out was seen in a total of six patients (blade group n = 2; screw group = 4; p = 0.672) and varus collapse in nine patients (blade group n = 5, screw group n = 4; p = 0.733). Harris Hip Scores were similar between the two groups (blade group: 72.70 ± 18.43; screw group: 80.83 ± 18.75; p = 0.84).

scholarly journals Arthroplasty Is Not Superior Than Internal Fixation for Intertrochanteric Fractures in the Elderly: a Meta-analysis

2021 ◽  
Author(s):  
Kexiao Yu ◽  
Weizhong Lu ◽  
Qiuke Xiao ◽  
Ruijie Wan ◽  
Lujue Dong ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Blood Loss ◽  
Internal Fixation ◽  
Meta Analysis ◽  
Operation Time ◽  
The Elderly ◽  
Harris Hip Score ◽  
Intertrochanteric Fractures ◽  
Increased Risk ◽  
Significant Difference

Abstract Background: Surgical treatment is the first choice for intertrochanteric fractures in the elderly as it allows early rehabilitation and functional recovery. Recently, more and more surgeons prefer arthroplasty instead of internal fixation in the treatment of senile intertrochanteric fractures. However, there is conflicting evidence as to which is the best surgical treatment for them. In this article, we performed a systematic review and meta-analysis to compare the clinical effectiveness of internal fixation (IF) and arthroplasty (AR) for intertrochanteric fractures in the elderly. Methods: The online databases of PubMed, Cochrane Database, and Web of Science were searched to include studies conducted from 01/01/2000 to 11/30/2018 in English using keywords to identify articles relevant to this study. All studies had to have evaluated the treatment of patients with intertrochanteric fractures in the elderly(≥60 years of age). The quality of the trials was assessed and meta-analyses were conducted using the Cochrane Collaboration’s RevMan 5.3 version. Results: A total of 14 studies involving a total of 1588 patients were suitable for inclusion in this meta-analysis. There was no significant difference between the IF and AR groups for postoperative complications-related general condition (OR=1.24; 95% CI= 0.90, 1.70; P=0.19), hospital stay (SMD=0.16; 95% CI= -0.5, 0.82; P =0.64), and Harris hip score (SMD= -0.12; 95% CI= -0.79, 0.54; P =0.71). AR group had a significantly lower rate of complications-related operation (OR= 2.21; 95% CI= 1.41, 3.45; P=0.0005) and reoperation (OR=2.74; 95% CI= 1.57, 4.76; P=0.0004). However, compared with AR group, IF group could reduce the blood loss (OR=-4.08; 95% CI=-4.58, -3.59; P<0.00001), transfusion requirement (SMD= -0.67; 95% CI= -1.08, -0.26; P=0.001), operation time (SMD= -0.80; 95% CI= -1.47, -0.12; P < 0.00001), and have a lower rate of mortality within 1-year (OR= 0.67; 95% CI= 0.52, 0.86; P=0.002).Conclusion: AR is associated with less rates of complications-related operation and reoperation but has an increased risk of blood loss, transfusion, operation time and mortality within 1-year. Our findings demonstrated that AR does not have significant advantages over IF for intertrochanteric fractures in the elderly.

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 Arthroplasty versus internal fixation for intertrochanteric fractures in the elderly: A meta-analysis

2020 ◽  
Author(s):  
Kexiao Yu ◽  
Weizhong Lu ◽  
Qiuke Xiao ◽  
Ruijie Wan ◽  
Lujue Dong ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Blood Loss ◽  
Internal Fixation ◽  
Meta Analysis ◽  
Operation Time ◽  
The Elderly ◽  
Harris Hip Score ◽  
Intertrochanteric Fractures ◽  
Increased Risk ◽  
Significant Difference

Abstract Background Surgical treatment is the first choice for intertrochanteric fractures in the elderly as it allows early rehabilitation and functional recovery. Recently, more and more surgeons prefer arthroplasty instead of internal fixation in the treatment of senile intertrochanteric fractures. However, there is conflicting evidence as to which is the best surgical treatment for them. In this article, we performed a systematic review and meta-analysis to compare the clinical effectiveness of internal fixation (IF) and arthroplasty (AR) for intertrochanteric fractures in the elderly. Methods The online databases of PubMed, Cochrane Database, and Web of Science were searched to include studies conducted from 01/01/2000 to 11/30/2018 in English using keywords to identify articles relevant to this study. All studies had to have evaluated the treatment of patients with intertrochanteric fractures in the elderly(≥ 60 years of age). The quality of the trials was assessed and meta-analyses were conducted using the Cochrane Collaboration’s RevMan 5.3 version. Results A total of 14 studies involving a total of 1588 patients were suitable for inclusion in this meta-analysis. There was no significant difference between the IF and AR groups for postoperative complications-related general condition (OR = 1.24; 95% CI = 0.90, 1.70; P = 0.19), hospital stay (SMD = 0.16; 95% CI= -0.5, 0.82; P = 0.64), and Harris hip score (SMD= -0.12; 95% CI= -0.79, 0.54; P = 0.71). AR group had a significantly lower rate of complications-related operation (OR = 2.21; 95% CI = 1.41, 3.45; P = 0.0005) and reoperation (OR = 2.74; 95% CI = 1.57, 4.76; P = 0.0004). However, compared with AR group, IF group could reduce the blood loss (OR=-4.08; 95% CI=-4.58, -3.59; P < 0.00001), transfusion requirement (SMD= -0.67; 95% CI= -1.08, -0.26; P = 0.001), operation time (SMD= -0.80; 95% CI= -1.47, -0.12; P < 0.00001), and have a lower rate of mortality within 1-year (OR = 0.67; 95% CI = 0.52, 0.86; P = 0.002). Conclusion AR is associated with less rates of complications-related operation and reoperation but has an increased risk of blood loss, transfusion, operation time and mortality within 1-year. Our findings demonstrated that AR does not have significant advantages over IF for intertrochanteric fractures in the elderly.

Laparoscopic Cholecystectomy under Epidural Anesthesia: A Retrospective Comparison of 100 Patients

2012 ◽  
Vol 78 (1) ◽  
pp. 107-110 ◽  
Author(s):  
Hong-Wei Zhang ◽  
Ya-Jin Chen ◽  
Ming-Hui Cao ◽  
Feng-Tao Ji
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Comparative Study ◽  
Epidural Anesthesia ◽  
Hospital Cost ◽  
Recovery Room ◽  
Operation Time ◽  
Time Duration ◽  
Duration Of Stay ◽  
The Mean ◽  
Retrospective Comparative Study

There are limited data about laparoscopic cholecystectomy (LC) under epidural anesthesia. This retrospective comparative study aimed to evaluate on the feasibility and advantages of LC under epidural anesthesia. In this retrospective comparative study, 100 patients (46 men and 54 women) with symptomatic cholelithiasis undergoing laparoscopic cholecystectomy using epidural anesthesia (EA) were compared with 100 patients undergoing laparoscopic cholecystectomy using general anesthesia (GA). Both groups were evaluated with regard to intraoperative mean arterial pressure, heart rate, operation time, duration of stay in the recovery room, and hospital cost. Laparoscopic operation was performed for 200 patients. Mean age of patients was 46.4 ± 6.9 years and 45.3 ± 6.8 years in EA and GA, respectively. Forty-six and 50 per cent of subjects were male in EA and GA, respectively. The mean operation time was 24 minutes and 25.58 minutes for EA and GA, respectively ( P = 0.652). The duration of stay in the recovery room was significantly shorter in EA than that in GA (19.56 ± 2.55 minutes vs 56.27 ± 6.85 minutes, respectively; P = 0.0001). In the EA group, 23 patients (23%) had severe shoulder pain during surgery. After receiving pethidine intravenously, all these patients could subsequently undergo surgery smoothly. There were no complications or mortality in either group. Most of the patients regarded EA as a comfortable procedure. The mean hospital cost for the EA group was only three-fourths that of the GA group. LC under EA is feasible and safe in selected patients.

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