Unstable trochanteric Fracture Fixation with P.F.N. augmented by T.B.W.

2021 ◽  
Vol 8 (1) ◽  
pp. 39-42
Author(s):  
Dr. Vijay Patil ◽  
Dr. Pandurang Daule ◽  
Dr. Deepak Naikwade
Keyword(s):  
Femoral Head ◽  
Trochanteric Fracture ◽  
Bony Union ◽  
Age Group ◽  
Lateral Migration ◽  
Trochanteric Fractures ◽  
Screw Breakage ◽  
Hip Function ◽  
The Stability

Biomechanically Proximal Femoral Nail (PFN) is a better choice of implant. Still it is associated with screw breakage, cut out through femoral head,”Z” effect, reverse “Z” effect and lateral migration of screws. The purpose of this study is to evaluate the results of augmented PFN in terms of post operative complication and failure rates in unstable trochanteric fracture. Methodology: We did study of 21 unstable trochanteric fractures from Jan 2016 to Nov .2020. 14 patients were males & 7 patients were females. Age group between 25 to 80 was included in this group. There were 15 A0 A2 (2.2, 2.3) and 6 were A0 A3 (3.1, 3.2, 3.3). All fractures were fixed with 25cm, 1350 PFN mainly 11 mm, 12mm in diameter augmented with one or two 16 gauge tension band wire, strengthening lateral trochanteric wall and holding either communiated   fragments or lesser trochanteric fracture. Results: The bone healing was observed in all cases with mean period of 16 weeks. Two patients developed complication of TBW breakage; one developed lateral migration of screws. Patients were followed till # union. At the end of follow up the Salvati and Wilson hip function was 30 (out of 40) in 80% patients. Conclusion: The stabilization of lateral trochanteric wall fracture and communicated fragments with additional one or two TBW increases the stability of construct enhancing bony union & better results.

scholarly journals 3D printing-based Ganz approach for treatment of femoral head fractures: a prospective analysis

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Jinwu Wang ◽  
Leyi Cai ◽  
Linzhen Xie ◽  
Hua Chen ◽  
Xiaoshan Guo ◽  
...  
Keyword(s):  
Femoral Head ◽  
3D Printing ◽  
Blood Loss ◽  
Surgical Approach ◽  
Type I ◽  
Type Ii ◽  
Femoral Head Fracture ◽  
Hip Function ◽  
The Mean

Abstract Background Femoral head fractures are uncommon injuries. Open reduction and internal fixation (ORIF) of femoral head fracture is the preferred treatment for most patients. There are several surgical approaches and treatments for this difficult fracture. However, the optimal surgical approach for the treatment of femoral head fracture remains controversial. Meanwhile, the operation is difficult and the complications are numerous. We prospectively reviewed patients with femoral head fractures managed surgically through the 3D printing-based Ganz approach to define a better approach with the least morbidity. Patients and methods Between 2012 and 2017, a total of 17 patients were included in this study. An exact 1:1 3D printing model of the injured hip side was fabricated for each patient and simulated surgery was finished preoperative. The surgical approach was performed as described by Ganz. Functional assessment was performed using the modified Merle d’Aubigne scores. The reduction of the fracture was evaluated according to Matta’s criteria. The incidence of complications, such as heterotopic ossification (HO) and avascular necrosis (AVN), and the need for additional surgery were also documented. Results Twelve of 17 patients (four females and eight males) were available for 2 years follow-up. The mean follow-up was 35 months (25–48 months). Average age for the 12 patients was 39.9 ± 12.2 years. According to the Pipkin classification, four patients were type I fracture, three patients were type II fracture, and five patients were type IV fracture. The mean operative time was 124.2 ± 22.1 min, and the estimated blood loss was 437.5 ± 113.1 ml. According to Merle d’ Aubigne scores, excellent results were achieved in six of the 12 patients; four good and two poor results occurred in the rest of the patients. On the radiograph evaluation, fracture reduction was defined as anatomical in eight patients, and imperfect in four. Most patients had good outcomes and satisfactory hip function at last follow-up. Almost all great trochanteric osteectomy healed uneventfully. One patient developed symptomatic AVN of the femoral head and underwent THA at 3 years. After THA, she regained a good hip function with the ability to return to work and almost no reduction in sports activities. Heterotopic ossification was found in four cases (type I-1, type II-2, and type III-1). Conclusions The 3D printing-based Ganz approach provides a safe and reliable approach and satisfactory results of treatment in femoral head fractures. Using 3D printed model for the fracture of the femoral head, the fracture can be viewed in every direction to provide an accurate description of fracture characteristics, which contributes to make a reasonable surgical plan for patients. In addition, the 3D printing-based Ganz approach can obtain excellent surgical exposure and protection of the femoral head blood supply, reduce the operation time and intraoperative blood loss, make the precise osteotomy, anatomically fix the intra-articular fragments, and effectively reduce postoperative complications. Trial registration We register our research at http://www.researchregistry.com. The Unique Identifying Number (UIN) from the Research Registry of the study is researchregistry4847.

scholarly journals Traumatic Obturator Hip Dislocation with Marginal Femoral Head Fracture in a 15-Year-Old Adolescent: A High-Energy Trauma—A Case Report and a Review of the Literature

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Yoann Durand ◽  
Clémence Bruyère ◽  
Marco Saglini ◽  
Aurélien Michel-Traverso
Keyword(s):  
Femoral Head ◽  
Hip Dislocation ◽  
High Energy ◽  
Hip Pain ◽  
X Rays ◽  
Hip Function ◽  
One Year ◽  
High Level ◽  
Joint Limitation

We report the case of a 15-year-old boy brought to the emergency department after a bike accident, complaining of an isolated left hip pain. The X-rays showed an obturator hip dislocation treated by closed reduction under general anaesthesia, followed by 6 weeks of discharge. The follow-up MRI performed 6 weeks after the trauma showed an avascular femoral head necrosis, for which we performed multiple retrograde femoral head drilling, completed by the injection of autologue stem cells from the iliaq crest. One year later, the patient has no hip pain, no joint limitation, and can practice BMX at a high level again. The purpose of this report is to make the physicians aware of this rare problem that may be damaging for hip function, especially in young people.

scholarly journals EVALUATION OF AVASCULAR NECROSIS DURING MIDTERM FOLLOW UP IN DDH CASES TREATED BY SINGLE STAGE SURGERY IN THE WALKING AGE GROUP

2021 ◽  
pp. 6005-6010
Keyword(s):  
Femoral Head ◽  
Surgical Procedures ◽  
Open Reduction ◽  
Soft Tissues ◽  
Developmental Dysplasia ◽  
Single Stage ◽  
Age Group ◽  
Developmental Dysplasia Of Hip ◽  
Walking Age

Developmental dysplasia of hip (DDH) represents a spectrum of disorders in which the femoral head has an abnormal relationship to the acetabulum. Management of DDH presenting in walking stage are primarily surgical because of changes in femoral head, acetabulum and soft tissues around joint. We looked at the incidence of AVN during midterm follow up period in DDH patients in the walking age group who had undergone single stage surgery. Also it evaluates association of different variables with occurrence of AVN. The AVN of head of femur is assessed according to Kalamchi and MacEwen’s classification and AVN gradings were compared with different surgical procedures. In our study, higher incidence of AVN was seen patients who were operated at a higher age, who had higher preoperative Tonnis grading and those who required osteotomies with open reduction. But statistically significant correlation could not be established independently with any of the above mentioned variables.

scholarly journals A Novel Method of Management of Unstable Trochanteric Fractures - A Retrospective Study in a Tertiary Care Hospital, Mysore

2021 ◽  
Vol 8 (18) ◽  
pp. 1264-1269
Author(s):  
Praveen Duraisamy ◽  
Vivekanandan Andavar ◽  
Balachanderc Rajendran ◽  
Girish Chandra Rangaswamy
Keyword(s):  
Fracture Healing ◽  
Trochanteric Fracture ◽  
Dynamic Hip Screw ◽  
Implant Failure ◽  
Care Hospital ◽  
Trochanteric Fractures ◽  
Case Record ◽  
Implant Migration ◽  
Hip Screw

BACKGROUND Trochanteric fractures are commonly encountered in elderly patients, and the outcome may be bad, if not intervened early. Dynamic hip screw (DHS) fixation is the most common treatment in stable trochanteric fracture. In unstable trochanteric fractures, there is high incidence of failure in view of excessive collapse seen with dynamic hip screw. In order to limit the collapse, we have done a modification on dynamic hip screw implant. Here we have assessed fracture healing, collapse and implant failure, in unstable trochanteric fractures (Evan’s unstable fractures) treated by modified dynamic hip screw fixation. METHODS The present retrospective case record analysis was conducted among 31 patients with unstable trochanteric fracture classified according to Evan’s classification who were operated with modified DHS in a tertiary care hospital. The details about fracture healing, collapse of fracture fragments, implant failure were assessed in a structured checklist through the case record analysis. RESULTS Out of 31 patients in this study, 29 patients showed fracture healing (93.5 %) with or without minimal collapse and 2 patients had non-union (6.5 %) at the end of 5 months follow up. Ultimately, all fractures united at the end of 1-year follow-up. Out of 31 patients in this study, at first month follow-up, 26 patients showed no implant failure (83.9 %), 5 patient had implant migration not breaching cortex (16.1 %), at third month follow-up, out of 5 patients who had implant migration, two patients had implant migration not breaching cortex (6.4 %), 3 patients had implant migration breaching cortex (11.0 %), at fifth month follow-up, two patients had implant migration not breaching cortex (6.4 %), 3 patients who had implant migration breaching cortex underwent revision surgery (11.0 %). CONCLUSIONS Modified dynamic hip screw has shown improved results as compared to normal dynamic hip screw in treating unstable trochanteric fracture, which limits the collapse at fracture site. KEYWORDS Unstable Trochanteric Fractures, Collapse, Modified Dynamic Hip Screw

AN OBSERVATIONAL STUDY OF COMPARISON BETWEEN TREATMENT OUTCOME OF DHS AND DCS FIXATION IN HIP FRACTURE AND ITS ASSOCIATED MEDICAL COMPLICATIONS

2021 ◽  
pp. 63-64
Author(s):  
Nilabh Kumar ◽  
Laljee Chaudhary ◽  
Debarshi Jana
Keyword(s):  
Treatment Outcome ◽  
Hip Fracture ◽  
Urinary Infection ◽  
The Elderly ◽  
Age Group ◽  
Common Complication ◽  
Trochanteric Fractures ◽  
Time Of Admission ◽  
Tremendous Impact

Background: Trochanteric fractures are devastating injuries that commonly affect the elderly and have a tremendous impact on the health care system and society in general. Fracture are often associated with varies complications.The purpose of our study was to compare treatment outcome of DHS and DCS xation in hip fracture and its associated complications. Material and methods: A total of 60 patients were selected for the study. Clinical and radiographic examinations were performed at the time of admission and postoperatively. Follow up was done at an interval of 6th month, and 12th month. Various complications reported were recorded. Result: Most common complication reported was urinary infection in our study. There was no signicant treatment outcome of two different groups. Conclusion: Over 90% of hip fracture occurs in older age group i.e. 65 years. With the increasing age increases the in complications has been noticed

scholarly journals Inferior Outcome after Unstable Trochanteric Fracture Patterns Compared to Stable Fractures in the Elderly

2021 ◽  
Vol 10 (2) ◽  
pp. 171
Author(s):  
Johannes Gleich ◽  
Carl Neuerburg ◽  
Christoph Linhart ◽  
Alexander Martin Keppler ◽  
Daniel Pfeufer ◽  
...  
Keyword(s):  
Trochanteric Fracture ◽  
Fracture Pattern ◽  
Proximal Femur Fracture ◽  
Surgical Trauma ◽  
Care Hospital ◽  
Trochanteric Fractures ◽  
Lesser Trochanter ◽  
Fracture Patterns ◽  
The Impact

Background: Various risk factors affecting outcome of elderly patients after proximal femur fracture have been identified. The present study aims to evaluate the impact of the fracture pattern in trochanteric fractures on postoperative mobility and complications. Methods: Ninety-two patients with a mean age of 84 years were included. According to the revised AO/OTA classification, fractures were divided into stable (AO 31A1) and unstable (AO 31A2/3) patterns. A follow-up examination was performed 12 months after cephalomedullary fixation to assess outcome parameters for mobility/activities of daily living (Parker Mobility Score (PMS)/Barthel Index (BI)) and complications (increase in requirement of care, hospital readmission, mortality rate). Results: At follow-up, patients with unstable trochanteric fracture patterns presented with lower PMS and BI compared to stable fractures (p < 0.05). Further, higher requirement of care and higher readmission rates compared to stable patterns were observed. Conclusion: Unstable trochanteric fractures presented inferior outcome compared to simple fracture patterns. This might be explained by the increasing surgical trauma in unstable fractures as well as by the mechanical impact of the lesser trochanter, which provides medial femoral support and is of functional relevance. Subsequent studies should assess if treatment strategies adapted to the specific fracture pattern (refixation of lesser trochanter) influence outcome in unstable trochanteric fractures.

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 Functional Outcome And Mortality Assessment Following Proximal Femoral Nailing In Inter Trochanteric Fracture

2020 ◽  
Vol 11 (4) ◽  
pp. 5431-5440
Author(s):  
Prabhakaran A ◽  
Selvakumar Pandiyan ◽  
Pradeepkumar T ◽  
Thayumana Sundaram G ◽  
Dharav Parikh ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Mortality Rate ◽  
Functional Outcome ◽  
Trochanteric Fracture ◽  
Intertrochanteric Fractures ◽  
Trochanteric Fractures ◽  
Artery Disease ◽  
Proximal Femoral Nailing

Intertrochanteric fractures constitute one of the most typical fractures of the hip. The incidence of fractures in the trochanteric area has risen with an increase in numbers of the older person with osteoporosis. Mortality, morbidity ratios are increasing in patients with inter-trochanteric fractures. Advanced age and associated co-morbidities are two primary added source for high mortality in trochanteric fracture patients. We conducted this study to assess the mortality rate and the functional outcome in inter-trochanteric fractures after proximal femoral nailing. This is a prospective study, in which 60 Intertrochanteric fractures of femur patients who came to our hospital EMS. Inclusion and Exclusion criteria were included in this study and were done from a period from January 2014 to July 2017. They were evaluated on each follow-up clinically using Harris Hip score and radio-logically using RUST score. The overall mortality rate at the end of the 3-year follow-up in our study is 13.3%. The factor which significantly influenced the mortality rate was Coronary artery disease. Four patients had implant-related complications. One patient developed non-union, which was later revised with Bipolar Hemi-arthroplasty. One patient developed screw back out, and two patients developed screw breakage. Results of our study concluded that elderly patients of age group 75-89 years of age were at higher risk for intertrochanteric fractures. Associated comorbid condition plays a significant role in the mortality of this fractures. In our study, coronary artery disease had a significant influence on the mortality rate for intertrochanteric fractures with a 4.63 fold rise in the mortality rate for these patients.

Patients with severe slipped capital femoral epiphysis treated by the modified Dunn procedure have low rates of avascular necrosis, good outcomes, and little osteoarthritis at long-term follow-up

2019 ◽  
Vol 101-B (4) ◽  
pp. 403-414 ◽  
Author(s):  
T. D. Lerch ◽  
S. Vuilleumier ◽  
F. Schmaranzer ◽  
K. Ziebarth ◽  
S. D. Steppacher ◽  
...  
Keyword(s):  
Femoral Head ◽  
Avascular Necrosis ◽  
Slipped Capital Femoral Epiphysis ◽  
Harris Hip Score ◽  
Slip Angle ◽  
Functional Scores ◽  
Screw Breakage ◽  
Long Term Follow Up

AimsThe modified Dunn procedure has the potential to restore the anatomy in hips with severe slipped capital femoral epiphyses (SCFE). However, there is a risk of developing avascular necrosis of the femoral head (AVN). In this paper, we report on clinical outcome, radiological outcome, AVN rate and complications, and the cumulative survivorship at long-term follow-up in patients undergoing the modified Dunn procedure for severe SCFE.Patients and MethodsWe performed a retrospective analysis involving 46 hips in 46 patients treated with a modified Dunn procedure for severe SCFE (slip angle > 60°) between 1999 and 2016. At nine-year-follow-up, 40 hips were available for clinical and radiological examination. Mean preoperative age was 13 years, and 14 hips (30%) presented with unstable slips. Mean preoperative slip angle was 64°. Kaplan–Meier survivorship was calculated.ResultsAt the latest follow-up, the mean Merle d’Aubigné and Postel score was 17 points (14 to 18), mean modified Harris Hip Score was 94 points (66 to 100), and mean Hip Disability and Osteoarthritis Outcome Score was 91 points (67 to 100). Postoperative slip angle was 7° (1° to 16°). One hip (2%) had progression of osteoarthritis (OA). Two hips (5%) developed AVN of the femoral head and required further surgery. Three other hips (7%) underwent implant revision due to screw breakage or change of wires. Cumulative survivorship was 86% at ten-year follow-up.ConclusionThe modified Dunn procedure for severe SCFE resulted in a low rate of AVN, low risk of progression to OA, and high functional scores at long-term follow-up. The slip deformities were mainly corrected but secondary impingement deformities can develop in some hips and may require further surgical treatment. Cite this article: Bone Joint J 2019;101-B:403–414.

scholarly journals Post - Traumatic Hip with Obtu rator Dislocation: Case Report a nd Review of t he Literature

2018 ◽  
Vol 2 (3) ◽  
pp. 1-3
Author(s):  
Mehdi Omar Krimech
Keyword(s):  
Femoral Head ◽  
External Rotation ◽  
Road Accident ◽  
Aseptic Necrosis ◽  
The Public ◽  
Public Road ◽  
Post Traumatic ◽  
The Stability

Introduction: Traumatic dislocation of the coxofemoral joint is defined as the permanent posterior or anterior displacement of the femoral head out of the acetabular cavity. It is generally the consequence of a violent trauma, most often an accident on the public road. o ur case it is a post - traumatic hip obtu rator dislocation, managed in our department. Clinical case and results: 16 years old patient, with no particular history, victim of a road accident, causing a closed trauma to his left hip, right ankle and left wrist. It presents with a vicious attitude: left lower limb in flexion, abductio n, external rotation. An X - ray reques ted objective obturator dislocation with a small bone fragment of the head. A bone reconstruction CT was completed in favour of obturator dislocation with head fracture type 1 according to Pipkin's classification. Patient sent directly to the block, he ben efits from a reduction under sedation according to Boehler's maneuver, control by scopy, then immoblisation by zimmer splint after testing the stability of dislocation. Patient is hospitalized in our ward for monitoring then follow - up in consultation. Resu lts were satisfactory, removal of the zimmer splint at the 6th week. Total support was possible at week 12, with complete mobility, patient reviewed afterworld without clinico - radiological signs of aseptic necrosis of the femoral - head. Conclusion: The frac ture - luxation of the femoral head is a serious lesion. It is necessary to think about it in front of each dislocation not to ignore the associated fracture which still darkens the prognosis.

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