LONG VERSUS SHORT PROXIMAL FEMORAL NAIL IN THE MANAGEMENT OF UNSTABLE INTERTROCHANTERIC FRACTURES IN ELDERLY POPULATION

Surgical Duration ◽

Cephalomedullary Nails

INTRODUCTION: Intertrochanteric fractures constitute a vast majority of geriatric orthopedic trauma having highest postoperative morbidity and mortality of surgically treated fractures. Use of cephalomedullary nails for treatment of highly unstable intertrochanteric fractures is now more common as plate xation is associated with higher risk of implant breakage and screw cutout. However, choice of length of these nails remains surgeon dependent. AIM: to compare the functional outcome and complications associated with the use of Long and Short PFN for the treatment of unstable intertrochanteric fractures (AO/OTAtype 31A1 and 31A2) in elderly population. METHOD: A prospective interventional study comprising of 58 patients distributed in two groups in which one group (n=25) was treated with long PFN while other group (n=33) was operated with short PFN. Parameters compared between these two groups included demographic data, intraoperative blood loss and surgical duration as well as analysis of radiological and clinical progression of union and postoperative complications in the form of hip pain, anterior thigh pain and failure rate. Functional assessment was done using Harris hip score. RESULT:This study included only AO/OTAtype 31A1 and 31A2 fracture types in elderly patients above 60 years of age. We found no statistically signicant difference with regard to age, sex as well as fracture type among two groups. Long PFN group had a shorter union time (11.4 weeks) and was associated with lesser postoperative complication and failure rate as compared to short PFN. Also, functional outcome evaluated using Harris hip score shown better scores in long PFN group. However, intraoperative blood loss and surgical duration was found to be signicantly lesser in short PFN group. CONCLUSION: use of cephalomedullary nails either short or long for xation of unstable intertrochanteric fractures particularly AO/OTA type 31A1 and 31A2 provides good results. However, longer nails should be preferred over short nails as these are associated with less postoperative complication such as hip pain or anterior thigh pain owing to excessive curvature of femur in Indian population with lesser union time and better functional outcome as compared to short PFN. Shorter nails may be used in cases of sick and polytrauma patients where shorter operative time with minimal blood loss is desirable

Comparison between the results of proximal femur nail anti-rotation and cemented bipolar hemiarthroplasty in treatment of intertrochanteric fractures in Sanglah Hospital in 2016

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20193931 ◽

2019 ◽

Vol 7 (9) ◽

pp. 3475

Author(s):

Wayan Suryanto Dusak ◽

Herryanto Agustriadi Simanjuntak ◽

I Gusti Ngurah Paramartha Wijaya Putra

Keyword(s):

Blood Loss ◽

Postoperative Complication ◽

Harris Hip Score ◽

Secondary Outcome ◽

Surgical Trauma ◽

Transfusion Rate ◽

Bipolar Hemiarthroplasty ◽

Surgical Time

Background: Hemiarthroplasty is now being considered as a primary treatment for comminuted unstable type of IT fracture in elderly on the grounds that it allows early mobilization and full weight bearing. Recently popular modality is fourth generation of intramedullary nails like the Proximal Femoral Nails. The goal of treatment is restoring mobility safely and efficiently, while minimizing the risk of medical complications and technical failure.Methods: A Forty patients, having Intertrochanteric fractures treated with PFNA or cemented BH at our institution between April 2016 and April 2017. The primary outcomes measures were postoperative complication and hip function. The secondary outcome measures were intraoperative blood loss, transfusion rate, surgical time, postoperative haemoglobin and hospital stay.Results: Seventeen patients in PFNA group and 23 patients in BH group were included for analysis. There were no significant differences between the two group regarding to the Harris Hip Score at 6 months follow up. Significant differences were found between PFNA and BH group in comparison of intraoperative blood loss (p < 0.001), length of stay (p = 0.006), surgical time (p < 0.001), postoperative transfusion (p < 0.001), and decrease of hemoglobin (p=0.001).Conclusions: These findings indicate that PFNA has obvious advantages over the BH in treatment of intertrochanteric fractures in case of surgical trauma and postoperative complication.

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

10.36106/gjra/5201498 ◽

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 ◽

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.

Functional Outcome Of primary Total Hip Arthroplasty using Harris Hip Score in Arthritic Hip

Europasian Journal of Medical Sciences ◽

10.46405/ejms.v2i2.78 ◽

2020 ◽

Vol 2 (2) ◽

pp. 4-10

Author(s):

Suman Babu Marahatta ◽

Dirgha Raj RC ◽

Kapil Mani KC ◽

Arun Sigdel

Keyword(s):

Total Hip Arthroplasty ◽

Blood Loss ◽

Functional Outcome ◽

Hip Arthroplasty ◽

Operative Time ◽

Harris Hip Score ◽

Total Hip ◽

Primary Total Hip Arthroplasty

Introduction: Total hip arthroplasty (THA) is a well-established procedure for advanced arthritis of the hip joint. It significantly improves the quality of life by relieving pain and improving functional disability. The objective of this study was to evaluate the clinical and functional outcome of primary total hip arthroplasty using the Harris Hip Score. Method: Prospective study was conducted in Civil Service Hospital. Out of 145 THA performed from Jan 2014 to Dec 2018, the first 100 cases that fulfilled the inclusion criteria were analyzed. Patient demographic and site, operative indication, and pre-operative Harris Hip Score was documented. Operative time, total intraoperative blood loss, and complications were noted. Patients were followed in 3 weeks, 6 weeks, 3 months, 6 months, and yearly. In each visit, clinical evaluation using Harris Hip Score and radiological evaluation was done and documented. The duration of follow up ranged from 12 months to 4.5 years. Results: Age varied from 21 to 75 years, 59% were male and 41% female, right side involvement was seen in 55% and left side in 45%. The major indication for surgery was avascular necrosis 46% and primary osteoarthritis in 24%. The average operative time was 65 minutes and the average intraoperative blood loss was 655 ml. Pre-operative Harris Hip Score ranged from 25 to 59 with a mean of 45.5. The mean Harris hip score in last follow up increased to 90.5 with a minimum of 76 and a maximum of 97. Our study found that 85% had excellent, 9% had good and 6% had fair results. Complications include 2% dislocation, 1% infection, 1% greater trochanter avulsion and 1% screw irritation. Conclusion: Primary THA is a safe and effective procedure. It improves pain and function hence improving the activity of daily living and has fewer complications.

Benefit of lag screw placement by a single- or two-screw nailing system in elderly patients with AO/OTA 31-A2 trochanteric fractures

Journal of International Medical Research ◽

10.1177/03000605211003766 ◽

2021 ◽

Vol 49 (3) ◽

pp. 030006052110037

Author(s):

Fulong Zhao ◽

Lijuan Guo ◽

Xuefei Wang ◽

Yakui Zhang

Keyword(s):

Blood Loss ◽

Elderly Patients ◽

Fracture Healing ◽

Healing Time ◽

Harris Hip Score ◽

Trochanteric Fractures ◽

Surgical Time ◽

Gamma3 Nail ◽

Intertan Nail

Objective To retrospectively analyze the clinical outcomes of two intramedullary fixation devices, the INTERTAN nail and Gamma3 nail, for treatment of AO/OTA 31-A2 trochanteric fractures in elderly patients. Methods In total, 165 elderly patients underwent treatment for AO/OTA 31-A2 trochanteric fractures in our hospital from June 2017 to June 2018 (INTERTAN group, n = 79; Gamma3 group, n = 86). All patients underwent radiological and clinical investigations and were followed up for an average of 12 months. Age, sex, fracture type, surgical time, intraoperative blood loss, fracture healing time, and complications were compared between the two groups. Results The surgical time was significantly shorter and the intraoperative blood loss volume was significantly lower in the Gamma3 than INTERTAN group (58.2 ± 2.5 vs. 81.7 ± 14.2 minutes and 170 ± 29 vs. 220 ± 16 mL, respectively). However, there were no significant differences in the reduction quality, hospital stay, fracture healing time, Harris hip score, postoperative complications, or 1-year postoperative mortality. Conclusion Both INTERTAN and Gamma3 nails may be effective for surgical treatment of AO/OTA 31-A2 trochanteric fractures in elderly patients. However, the Gamma3 nail was superior to the INTERTAN nail in terms of surgical time and intraoperative blood loss.

Critical analysis of factors determining mechanical failures in proximal femoral nailing

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20190504 ◽

2019 ◽

Vol 5 (2) ◽

pp. 275 ◽

Cited By ~ 1

Author(s):

Karthik Ramachandran ◽

K. K. Arvind Manoj ◽

A. Vishnu Sankar

Keyword(s):

Failure Rate ◽

Mechanical Failure ◽

Proximal Femoral Nail ◽

Harris Hip Score ◽

Excellent Outcome ◽

Lag Screw ◽

Femoral Nailing ◽

Femoral Nail ◽

Proximal Femoral Nailing

Background: 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.Methods: 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.Results: Among the patients 33% 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 (TADAR -TADLS) 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.Conclusions: From our study we like to conclude that the 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.

Patient-reported results of simultaneous direct anterior approach and posterolateral approach total hip arthroplasties performed in the same patients

Journal of Orthopaedics and Traumatology ◽

10.1186/s10195-021-00611-w ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Zhi Yang ◽

Shuo Feng ◽

Kai-Jin Guo ◽

Guo-Chun Zha

Keyword(s):

Blood Loss ◽

Anterior Approach ◽

Operative Time ◽

Direct Anterior Approach ◽

Hip Pain ◽

Posterolateral Approach ◽

Harris Hip Score ◽

Total Hip ◽

Patient Reported

Abstract Background Several studies have compared clinical results of the direct anterior approach (DAA) and the posterolateral approach (PLA) in total hip arthroplasty (THA); however, the effect of the surgical approach on outcome of THA remains controversial. Most of these studies used two distinct groups of patients, and THAs were performed by different surgeons, using different designs of prosthesis. These confounding factors may limit the strength of the conclusions. The purpose of this prospective, simultaneous bilateral randomized study was to investigate whether patients would perceive the difference between the direct anterior approach (DAA) and the posterolateral approach (PLA) after THA. Materials and methods Among 20 patients scheduled to undergo same-day bilateral THA between October 2017 and August 2019, one hip was randomly assigned to DAA and the other to PLA. Patient-reported outcome measures [Hip disability and Osteoarthritis Outcome Score (HOOS), patients’ hip pain on mobilization] and physician-assessed measures [Harris Hip Score (HHS), operative time, intraoperative blood loss, cup abduction, cup anteversion, stem orientation, and incidence of complications (intraoperative fracture, nerve damage, incisional problem, or postoperative dislocation)] were compared. Results All patients were followed up for 12 months. Hip pain was significantly less with DAA-THA compared with PLA-THA at postoperative 1, 3, and 7 days (p < 0.05). There was no clinical difference between DAA-THA and PLA-THA in terms of the VAS, HOOS, or HSS at 6 weeks and 3, 6, and 12 months postoperatively (p > 0.05). DAA-THA had a longer operative time and shorter length of incision compared with PLA-THA. There was no statistical difference between DAA-THA and PLA-THA in terms of intraoperative blood loss, cup abduction, cup anteversion, stem orientation, and perioperative complications (p > 0.05). Conclusions This study demonstrates that DAA-THA and PLA-THA could provide comparable HHS and HOOS at all follow-ups. Compared with PLA-THA, DAA-THA is associated with less hip pain within postoperative 7 days and shorter incision length, but longer operative time. Level of evidence Level I, therapeutic study. Trial registration Chinese Clinical Trail Registry, ChiCTR1800019816. Registered 30 November 2018—retrospectively registered, http://www.chictr.org.cn/showproj.aspx?proj=30863

Assessment of the outcome of fracture intertrochanteric femur treated by trochanteric fixation nail in the elderly population

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20205573 ◽

2020 ◽

Vol 7 (1) ◽

pp. 125

Author(s):

Vipin Tyagi ◽

Rahul Kakran ◽

Amit Dwivedi ◽

Fenil Shah

Keyword(s):

Elderly Population ◽

The Elderly ◽

Early Rehabilitation ◽

Harris Hip Score ◽

High Morbidity ◽

Early Weight Bearing ◽

Duration Of Surgery ◽

The Mean ◽

Trochanteric Fixation Nail

Background: Intertrochanteric fractures femur in elderly population are more commonly forbidden high morbidity. The surgical stabilization together with early rehabilitation is the main challenge. The elderly population have poor bone mass quality and also the chances of complications like nonunion or implant failure are more with conventional procedures. Stable fixation and early rehabilitation is the main aim in intertrochanteric fractures. The aim is to assess the functional outcome of intertrochanteric fractures femur managed by trochanteric fixation nail (TFN) in the elderly population.Methods: The study includes 40 patients, 30 male and 10 female, with fracture intertrochanteric femur treated with TFN from September 2018 to May 2019 at Yashoda Superspeciality Hospital, Nehrunagar, Ghaziabad. The patients were evaluated at 4, 8, 12 weeks postoperatively and assessed by the Modified Harris hip score. Classification used is AO classification.Results: The mean age of patients was 64 years. The mean duration of surgery was 48±10 min. The Harris hip score was 96.90±4.60, which is better than scores from other implants used for intertrochanteric fractures femur.Conclusions: In this study, we conclude that TFN is a good choice in managing the intertrochanteric fractures, having higher bone union rate and less union time. The period of immobilization is decreased, early weight bearing and less complications.

A comparative study on the functional outcome of intertrochanteric fractures treated by proximal femoral nailing or dynamic hip screw fixation

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20205559 ◽

2020 ◽

Vol 7 (1) ◽

pp. 51

Author(s):

Gineshmon Chandy ◽

Saju S.

Keyword(s):

Functional Outcome ◽

Dynamic Hip Screw ◽

Harris Hip Score ◽

Femoral Nailing ◽

Hip Screw ◽

Group 2 ◽

Proximal Femoral Nailing ◽

Radiological Union ◽

Unstable Fractures

Background: Intertrochanteric fractures are one of the commonly occurring injuries in elderly patients and are high among females and those with osteoporosis. They were treated with either dynamic hip screw (DHS) fixation or proximal femoral nailing (PFNA2) here at our institution. The study was conducted in order to find which method of surgical fixation has better functional outcome. Methods: Total 96 patients of intertrochanteric fractures admitted during the study period of November 2017 to April 2019 were included for the study. These patients were randomly divided into two groups; DHS was used as implant in group1 and PFNA2 in group 2. Postoperatively patients were followed up after 1 month, 3months and 6 months of the surgery and were assessed using Harris hip score.Results: Harris hip score was higher with PFNA2 group compared to DHS group in all follow-ups. In unstable fractures DHS group had poor outcome compared to PFNA2. Radiological union occurred in 27.1 % cases by 3 months and 72.9% cases by 6 months with DHS whereas 70.8% and 97.9% respectively with PFNA2. Conclusions: PFNA2 gives a better functional outcome when compared to DHS. Even though DHS gives good functional outcome in stable fractures it is not so in the case of unstable fractures. The radiological union also is faster with proximal femoral nailing. Hence in our opinion PFNA2 can be the better fixation device compared to DHS especially in unstable fractures.

An outcome analysis of intertrochanteric fracture of femur managed with proximal femoral nail antirotation II

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20192687 ◽

2019 ◽

Vol 5 (4) ◽

pp. 699

Author(s):

Hemeshwar Harshwardhan ◽

Shubhanshu Jain ◽

Manish Sharma

Keyword(s):

Blood Loss ◽

Intramedullary Nailing ◽

Operative Time ◽

Weight Bearing ◽

Harris Hip Score ◽

Time Duration ◽

Early Weight Bearing ◽

Pull Out ◽

The Mean

Background: Intertrochanteric fractures are common osteoporotic fractures in adults above 60 years with high mortality and morbidity. Common techniques for fixation of these fractures are sliding hip screw and plate or intramedullary nailing. Intramedullary nailing has advantage of short incision, less operative time, rapid rehabilition & thus decreased medical complications. PFNA II is newer intramedullary implant developed to obtain better fixation strength in osteoporotic bones. Biomechanical studies has demonstrated that PFNA II blade has a significance of higher cut out resistance than other commonly used screw systems.Methods: Prospective follow up study carried out at J.L.N. Medical College Ajmer from 1 March 2017 to 31st October 2018. 30 patients with unstable intertrochanteric fractures were included and operated on fracture table in supine position with PFNA2. We measured operative time, duration of hospital stay, modified Harris hip score and complications.Results: The mean age of the patients was 70.83 years of age. The mean time in surgery was 38.2 minutes. The mean amount of blood loss in surgery was 110.8 ml. In implant related complications, 2 patients had cut out and 1 patient had pull - out of the implant. Functional results according to modified Harris hip scores was found to be excellent in 8 (30%) patients, good in 12 (40%) patients, fair in 7 (20%) patients and poor in 3 (10%) patients.Conclusions: Elderly patients treated with PFNA2 has good outcome as less operative time, minimal blood loss, early weight bearing, less union time and very few cases of medial penetration and back out of spiral blade.

Intramedullary nailing for pertrochanteric fractures of proximal femur: a consecutive series of 323 patients treated with two devices

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-019-1506-1 ◽

2019 ◽

Vol 14 (1) ◽

Cited By ~ 1

Author(s):

Pompeo Catania ◽

Daniele Passaretti ◽

Giorgio Montemurro ◽

Simone Ripanti ◽

Stefano Carbone ◽

...

Keyword(s):

Blood Loss ◽

Age Distribution ◽

Harris Hip Score ◽

Consecutive Series ◽

Pertrochanteric Fractures ◽

Functional Scores ◽

Group A ◽

Group B

Abstract Introduction Pertrochanteric fractures (PFs) frequently affect the lower limb of osteoporotic patients and represent an important cause of morbidity and mortality in the elderly. In this prospective randomized controlled trial, we have compared functional and radiological results and complications of patients affected by PFs treated with two intramedullary proximal femoral nails. Materials We enrolled 323 subjects with PFs, classified according to AO/OTA system as 31.A1 (pertrochanteric simple) and 31.A2 (pertrochanteric multifragmentary). Patients were divided into two groups according to the osteosynthesis devices: group A, Elos-Intrauma® nail (155 cases) and group B, Gamma 3-Stryker® nail (168 cases). Pre-operatively, the baseline characteristics of each patient (gender, age, weight and BMI) were collected. Intraoperative blood loss, subjective pain by visual analogue scale (VAS), esthetic satisfaction, functional scores of the hip by Harris Hip Score (HHS), and Western Ontario and McMaster Universities Arthritis Index (WOMAC) were noted. The post-operative degree of fracture reduction was assessed. Each patient had a minimum follow-up of 12 months. Results The study group was composed of 106 male and 217 female with an average age of 85.4 (range, 65–90, standard deviation (SD) 5.95) years. No statistical differences about sex and age distribution were noted between the two groups. Group A reported lower intraoperative blood loss, 45 ml vs 51 ml, respectively (p < 0.001). There was not any statistical difference about operative time. Group A had a better reduction of fracture (p = 0.0347). The greatest difference was detectable comparing subgroups 31.A2 (p = 0.032). There were no statistical differences about complication frequency and the overall rate was 25% (80 cases). Finally, there was no difference in terms of VAS, HHS, and WOMAC score between the two groups on each follow-up. Patients of group A showed a higher subjective satisfaction index at 1 post-operative year, 7.42 (SD 1.19) vs 6.45 (SD 1.35) of group B (p < 0.001). Conclusion Elos® nail is a reliable device on a short-term follow-up and represents an alternative choice to the Gamma 3® nail, a well-known and appreciated system for over 25 years.