Concomitant ipsilateral acetabular and femoral fractures – an appraisal of outcomes and complications in 34 patients

Umesh Kumar Meena; Mahesh Chand Bansal; Prateek Behera; Divyanshu Goyal; Rakesh Kumar

doi:10.52628/87.3.03

Concomitant ipsilateral acetabular and femoral fractures – an appraisal of outcomes and complications in 34 patients

Acta Orthopaedica Belgica ◽

10.52628/87.3.03 ◽

2021 ◽

Vol 87 (3) ◽

pp. 401-410

Author(s):

Umesh Kumar Meena ◽

Mahesh Chand Bansal ◽

Prateek Behera ◽

Divyanshu Goyal ◽

Rakesh Kumar

Keyword(s):

Road Traffic ◽

Tertiary Care ◽

Femoral Fractures ◽

Harris Hip Score ◽

Acetabular Fractures ◽

Common Mechanism ◽

Type B ◽

Young Males ◽

Hip Injuries

Concomitant ipsilateral femoral and acetabular fractures are complex injuries which result from high-velocity trauma. Surgical treatment is the accepted management of such injuries. The objectives of this study were to evaluate the outcomes and study the complications in patients treated for concomitant ipsilateral acetabular and femoral fractures (type ‘B’ floating hip injuries). This retrospective study was conducted at a tertiary care teaching hospital on patients operated for type B floating hip injuries, who had completed a minimum of one-year follow-up after the surgery and whose complete records were available. Those with floating hip injuries with pelvic fractures were excluded. All patients were operated on the femoral side first, followed by the acetabular side. 34 patients were included ; most of them were young males. A road traffic accident was the most common mode, with a dashboard injury being the most common mechanism of injury. No association between the type of acetabular and femoral fractures was found. The clinical (measured with Harris hip score) and radiological (Matta’s method) outcomes at the latest follow-up were excellent or good in >60% cases and had a significant association with the quality of reduction on the post-operative radiographs. Com- plications were seen in 12 out of the 34 patients. Type B floating hips injuries can be managed well with acceptable short-term results by following a femur first strategy. However, patients must be informed of the possible complications and the probabilities of poorer outcomes when compared to isolated acetabular or femoral fractures.

Traditional versus mirror three-dimensional printing technology for isolated acetabular fractures: a retrospective study with a median follow-up of 25 months

Journal of International Medical Research ◽

10.1177/03000605211028554 ◽

2021 ◽

Vol 49 (6) ◽

pp. 030006052110285

Author(s):

Kai Xiao ◽

Bo Xu ◽

Lin Ding ◽

Weiguang Yu ◽

Lei Bao ◽

...

Keyword(s):

3D Printing ◽

Three Dimensional ◽

Operation Time ◽

Harris Hip Score ◽

Acetabular Fractures ◽

Printing Technology ◽

Three Dimensional Printing ◽

3D Printing Technology ◽

Significant Difference

Objective To assess the outcomes of traditional three-dimensional (3D) printing technology (TPT) versus mirror 3D printing technology (MTT) in treating isolated acetabular fractures (IAFs). Methods Consecutive patients with an IAF treated by either TPT or MTT at our tertiary medical centre from 2012 to 2018 were retrospectively reviewed. Follow-up was performed 1, 3, 6, and 12 months postoperatively and annually thereafter. The primary outcome was the Harris hip score (HHS), and the secondary outcomes were major intraoperative variables and key orthopaedic complications. Results One hundred fourteen eligible patients (114 hips) with an IAF (TPT, n = 56; MTT, n = 58) were evaluated. The median follow-up was 25 months (range, 21–28 months). At the last follow-up, the mean HHS was 82.46 ±14.70 for TPT and 86.30 ± 13.26 for MTT with a statistically significant difference. Significant differences were also detected in the major intraoperative variables (operation time, intraoperative blood loss, number of fluoroscopic screenings, and anatomical reduction number) and the major orthopaedic complications (loosening, implant failure, and heterotopic ossification). Conclusion Compared with TPT, MTT tends to produce accurate IAF reduction and may result in better intraoperative variables and a lower rate of major orthopaedic complications.

The Reconstruction Accuracy of the Hip Center of Rotation After Cementless Total Hip Arthroplasty for Failed Treatment of Acetabular Fractures. Does It Matter?

10.21203/rs.3.rs-1057572/v1 ◽

2021 ◽

Author(s):

Liang Zhang ◽

Mingxue Chen ◽

Zhuyi Ma ◽

Tao Bian ◽

Shaoliang Li ◽

...

Keyword(s):

Harris Hip Score ◽

Acetabular Fractures ◽

X Rays ◽

Reconstruction Accuracy ◽

Center Of Rotation ◽

Total Hip ◽

Radiographic Outcomes ◽

Negative Effect ◽

Hip Arthroplasties

Abstract Background To assess the impaction of reconstruction accuracy of hip center of rotation (COR) on midterm clinical and radiographic results of cementless reconstruction of total hip arthroplasties (THAs) for patients after failed treatment of acetabular fractures. Methods One hundred and four patients (107 hips) who underwent THAs after failed treatment of acetabular fractures were retrospectively evaluated and cementless cups and stems were implanted in all hips. Clinical outcomes were assessed using the Harris hip score (HHS) and Western Ontario and McMaster Universities Arthritis Index (WOMAC) scoring system. Radiographic results were analyzed by serial perioperative x-rays. Results At the latest follow-up examination, the median HHS increased from 52 (42-65) before surgery to 93 (90-97) (p < 0.001) and the median WOMAC decreased from 52 (36-65) before surgery to 5.8 (1.5-8) (p < 0.001). Compared with normal contralateral hip, 79 cups migrated superiorly (0.2-33.6mm) and 22 cups migrated inferiorly (0.2-16.1mm). The distance of superior migration of reconstructed COR was correlated with positive Trendelenburg sign at the latest follow-up examination (r=0.504; p < 0.001). The percentage of postoperative Trendelenburg sign was significantly higher in superior migration subgroup than that in subgroup with anatomical restoration of COR (P=0.015). Conclusions Cementless THAs in patients after failed treatment for acetabular fractures achieved predictable clinical and radiographic outcomes. A superiorly migrated hip COR appeared to exert a negative effect on abductor muscle function.

FUNCTIONAL OUTCOME OF PIRIFORMIS MUSCLE SPARING POSTEROLATERAL APPROACH IN BIPOLAR HEMIARTHROPLASTY: A RETROSPECTIVE STUDY.

10.36106/ijsr/6003850 ◽

2021 ◽

pp. 30-32

Author(s):

Nadeem A. Lil ◽

Vipul R. Makwana ◽

Arjav R. Patel ◽

Aakrut S. Modi ◽

Tirth D. Patel ◽

...

Keyword(s):

Functional Outcome ◽

Single Case ◽

Tertiary Care ◽

Hip Dislocation ◽

Posterolateral Approach ◽

Harris Hip Score ◽

Bipolar Hemiarthroplasty ◽

Care Hospital ◽

Piriformis Muscle

INTRODUCTION: Hemiarthroplasty for hip fracture is a common surgical procedure and is the treatment of choice for displaced intracapsular neck of femur fracture. Numerous approaches are used to access the hip joint. The standard posterior approach is used by many surgeons to preserve the abductor complex but is associated with higher dislocation rate. In this study we assess functional outcomes of piriformis sparing posterolateral approach for hemiarthroplasty of hip. MATERIAL AND METHODOLOGY: We retrospectively reviewed 96 patients who underwent bipolar hemiarthroplasty of hip performed by chief surgeon between May 2018 to September 2020. All the database was retrieved from institutional database of tertiary care hospital. Functional outcome was measured by modied HARRIS HIP SCORE. RESULTS: Till minimum 1 year follow up we noticed that there was no single case of hip dislocation. Joint proprioception was preserved. In the nal follow up average Harris hip score was 92.2. No infection, nerve injury, implant migration occurred in our study. DISCUSSION: The main aim of the arthroplasty procedure is to decrease pain, to achieve mobility and restore anatomy. The piriformis sparing approach not only preserves abductor complex but also piriformis muscle. The muscle works like cradle, at the posterosuperior part of the joint, an area with a high risk of dislocation. The only disadvantage was noted in this approach was increased exposure difculty in obese patients CONCLUSION: From this study we conclude that Piriformis sparing posterolateral approach is safe, demands some technical aspects and should be used by surgeons using posterolateral approach.

Midterm results of consecutive periprosthetic femoral fractures Vancouver type A and B

Clinics and Practice ◽

10.4081/cp.2016.871 ◽

2016 ◽

Vol 6 (3) ◽

Cited By ~ 4

Author(s):

Klemens Trieb ◽

Rainer Fiala ◽

Christian Briglauer

Keyword(s):

Femoral Fractures ◽

Type A ◽

Periprosthetic Femoral Fracture ◽

Type B ◽

Single Center ◽

Midterm Results ◽

Periprosthetic Femoral Fractures ◽

Multimorbid Patients ◽

Lost To Follow Up

Surgical treatment of periprosthetic femoral fractures has a high complication and mortality rate of more than 10%. The aim of this study is to report the outcome of a consecutive single center patient group. Thirty-four consecutive patients (mean age 81.2+/-8.5 years, 14 male, 20 female) with a periprosthetic femoral fracture Vancouver type A (n=5) or type B (n=29) were followed-up after 43.2 months, none of the patients were lost to follow- up. Nineteen of the patients were treated through change of the stem and cerclage fixation, five by plates and ten by cerclage cables. One successfully treated infection was observed. No further complications have been reported peri- or postoperatively, therefore resulting in 2.9% overall complication rate. These results demonstrate that precisely selected revision surgery protocol following periprosthetic femoral fractures within elderly multimorbid patients may lead to beneficial outcomes at a low risk of complications.

Treatment and outcomes of Vancouver type B periprosthetic femoral fractures

The Bone & Joint Journal ◽

10.1302/0301-620x.102b3.bjj-2019-0935.r1 ◽

2020 ◽

Vol 102-B (3) ◽

pp. 293-300

Author(s):

Hanlong Zheng ◽

Hangyu Gu ◽

Hongyi Shao ◽

Yong Huang ◽

Dejin Yang ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Postoperative Complications ◽

Conservative Treatment ◽

Internal Fixation ◽

Clinical Outcomes ◽

Femoral Fractures ◽

Harris Hip Score ◽

Type B ◽

Periprosthetic Femoral Fractures

Aims Vancouver type B periprosthetic femoral fractures (PFF) are challenging complications after total hip arthroplasty (THA), and some treatment controversies remain. The objectives of this study were: to evaluate the short-to-mid-term clinical outcomes after treatment of Vancouver type B PFF and to compare postoperative outcome in subgroups according to classifications and treatments; to report the clinical outcomes after conservative treatment; and to identify risk factors for postoperative complications in Vancouver type B PFF. Methods A total of 97 consecutive PPFs (49 males and 48 females) were included with a mean age of 66 years (standard deviation (SD) 14.9). Of these, 86 patients were treated with surgery and 11 were treated conservatively. All living patients had a minimum two-year follow-up. Patient demographics details, fracture healing, functional scores, and complications were assessed. Clinical outcomes between internal fixation and revisions in patients with or without a stable femoral component were compared. Conservatively treated PPFs were evaluated in terms of mortality and healing status. A logistic regression analysis was performed to identify risk factors for complications. Results In surgically treated patients, all fractures united and nine complications were identified. The mean postoperative Visual Analogue Scale (VAS) for pain was 1.5 (SD 1.3), mean Parker Mobility Score (PMS) was 6.5 (SD 2.4), and mean Harris Hip Score (HHS) was 79.4 (SD 16.2). Among type B2 and type B3 fractures, patients treated with internal fixation had significantly lower PMS (p = 0.032) and required a longer time to heal (p = 0.012). In conservatively treated patients, one-year mortality rate was 36.4% (4/11), and two patients ultimately progressed to surgery. Young age (p = 0.039) was found to be the only risk factor for complications. Conclusion The overall clinical outcome among Vancouver type B PFF was satisfactory. However, treatment with internal fixation in type B2 and B3 fractures had a significantly longer time to heal and lower mobility than revision cases. Conservative treatment was associated with high rates of early mortality and, in survivors, nonunion. This probably reflects our selection bias in undertaking surgical intervention. In our whole cohort, younger patient age was a risk factor for postoperative complications in Vancouver type B PFF. Cite this article: Bone Joint J 2020;102-B(3):293–300

EPIDEMIOLOGICAL STUDY OF TRAUMA IN A TERTIARY CARE CENTRE IN NORTHWEST INDIA

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v5i12.2340 ◽

2021 ◽

Vol 5 (12) ◽

Author(s):

Mohit Badgurjar ◽

Vaibhav Lakhanpal ◽

Pankaj Saxena ◽

Suman Parihar ◽

Poojan Thakor ◽

...

Keyword(s):

Road Traffic ◽

Tertiary Care ◽

Total Mortality ◽

Public Health Problem ◽

Common Mechanism ◽

Mechanism Of Injury ◽

Care Centre ◽

Tertiary Care Centre ◽

Keywords Trauma ◽

Number Of Patients

Objective: Traumatic injuries are a matter of concern worldwide. However, the rapidly changing socio economical dynamics in a developing country like India deeply influence the epidemiology behind trauma. The aim of this study was to document and analyze the epidemiological parameters and characteristics behind trauma victims admitted to our tertiary care centre. Methods: The observational study was carried out over a period of one year (January 2019 to December 2019) enrolling a total of 300 trauma patients. The age, sex, locality, delay in hospitalization, mechanism of injury, sites of injury and outcomes were documented. Results: Injuries occurred predominantly in the 20-40 age group with males being the chief victims. There was a considerable amount of delay in hospitalization ranging from one hour to more than 24 hours while only 7 patients arrived to the emergency within one hour of trauma. Vehicular trauma (54%) was the most common mechanism of injury. Injuries to the extremities (38.6%) and head (28.6%) were the most common sites. A considerable number of patients (45.3%) required care in the intensive care unit. A total of 172 patients required surgical interventions of various kinds and there was a total mortality rate of 6%. Amongst the polytrauma cases, 54 patients (81.8%) required ICU admission, 42 patients (63.6%) required surgical intervention and 6 patients (9.1%) died after admission. Conclusion: The results of this study highlight some of the problems with our existing infrastructure bringing to light the need for stricter enforcement of traffic safety laws and improvement of infrastructure particularly the roadways in rural areas as well as the referral systems. Vehicular trauma should be seen as a public health problem and appropriate interventions should be implemented. Keywords: Trauma, Road Traffic Accidents, Epidemiology, Head injuries

A study on clinical outcomes of complex subtrochanteric femoral fractures with cephalomedullary nail

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20214188 ◽

2021 ◽

Vol 7 (6) ◽

pp. 1194

Author(s):

S. F. Kammar ◽

Karthik B. ◽

V. K. Bhasme ◽

Suryakanth Kalluraya

Keyword(s):

Clinical Outcomes ◽

Road Traffic ◽

Weight Bearing ◽

Femoral Fractures ◽

Lateral View ◽

Successful Outcome ◽

Harris Hip Score ◽

Full Weight Bearing ◽

Subtrochanteric Fractures ◽

The Mean

Background: The aim of the study was to evaluate the clinical outcomes of complex subtrochanteric fractures treated by using cephalomedulary nail.Methods: This is a prospective observational study of 30 cases of complex subtrochanteric femoral fractures admitted to our hospital from January 2018 to June 2019. Cases were taken according to the inclusion and exclusion criteria i.e. type IV, type V Seinsheimer’s classification, above 18 years and those who are willing to participate in the study has been included and pathological fractures, open fractures were excluded. All the patients are followed up on 2 post-operative day, after 4 weeks, 8 weeks, 12 weeks and 6months. X-ray hip with thigh anteroposterior (AP) and lateral view taken during each follow up. Out comes was assessed using modified Harris hip score.Results: In our study of 30 cases there are 22 males and 8 females and the mean age of 43.7 years. 73.3% patients are due to Road traffic accidents predominance of right side. In our study 66% had type 4 Seinsheimers and 34% cases had type 5 Seinsheimers fracture. The mean duration of hospital stay was 17 days. Mean time for full weight bearing is 12 weeks. Good to excellent results are seen in 80% of type 4 subtrochanteric fractures and 75% of cases of type 5 subtrochanteric fractures. 4 cases had surgical site infection, 3 cases had varus, 1 case had developed implant failure, and 1 case had reverse Z effect.Conclusions: From this study, we conclude that proximal femoral nail is an excellent implant in the treatment of complex subtrochanteric femoral fractures the terms of successful outcome include a good understanding of fracture biomechanics, good preoperative planning and accurate instrumentation.

The Olerud Extensile Anterior Approach for Complex Distal Femoral Fractures: A Systematic Review

The Journal of Knee Surgery ◽

10.1055/s-0039-3400954 ◽

2019 ◽

Author(s):

Anton Khlopas ◽

Linsen T. Samuel ◽

Assem A. Sultan ◽

Benjamin Yao ◽

Damien G. Billow ◽

...

Keyword(s):

Systematic Review ◽

Postoperative Complications ◽

Anterior Approach ◽

Road Traffic ◽

Femoral Fractures ◽

Treatment Technique ◽

Distal Femoral Fractures ◽

Pubmed Database ◽

The Mean

AbstractThe management of AO/OTA (AO Foundation/Orthopaedic Trauma Association) 33-C3 complex distal femoral fractures presents challenges for orthopaedic surgeons. The extensile anterior approach may be an appropriate alternative treatment technique. The purpose of this systematic review is to (1) evaluate the Olerud approach (extensile anterior approach) for the treatment of 33-C3 complex distal femoral fractures and (2) evaluate postoperative patient outcomes. A systematic literature search was performed to retrieve studies that evaluated the treatment of 33-C3 complex distal femoral fractures. The PubMed database query resulted in 429 studies. Two reviewers independently reviewed the studies, of which six were identified. Patient demographics, AO/OTA fracture, surgical intervention, follow-up duration, clinical outcomes, and postoperative complications were collected and analyzed. The systematic review included six studies reporting on 85 patients (43 males and 42 females); the mean patient age was 45 years (range: 16–101 years). The most common cause of injury was road/traffic accident (51 patients). The mean follow-up time was 26 months (range: 3–72 months). In five studies, the mean time for union was 5.8 months (range: 2–9 months). The three most commonly reported complications were infection (seven [8.2%] patients), failure/malunion (three [3.5%] patients), and delayed tibial tuberosity osteotomy healing (three [3.5%] patients). Seventy (82.4%) patients did not suffer any postoperative complications. Out of 72 patients, 7 (9.7%) had resultant varus/valgus deformity. Overall, 57.1% had excellent/good functional outcomes. Based on the systematic literature review, the extensile anterior approach may be a viable alternative surgical option for 33-C3 complex distal femoral fractures. Given the current literature, more comprehensive and extensive studies need to be performed to ensure the best possible outcome.

Trigen Intertan Nail in Unstable Peritrochanteric femur fractures in the Elderly -functional and radiological outcomes in 50 cases

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00079 ◽

2020 ◽

Vol 8 (5_suppl5) ◽

pp. 2325967120S0007

Author(s):

Sanjeev Patnaik ◽

Akash Panda

Keyword(s):

Femoral Fractures ◽

The Elderly ◽

Harris Hip Score ◽

Radiographic Evaluation ◽

Non Union ◽

Femur Fractures ◽

Modified Harris Hip Score ◽

Head Neck ◽

Intertan Nail

INTRODUCTION: Peritrochanteric femur fractures have increased significantly in recent decades and the trend continues, due to rising age of the population. Surgical treatment, in the form of rigid internal fixation and early mobilization is now the gold standard. One of the recent implant developments is the Trigen Intertan Nail (Smith & Nephew) for the treatment of peri-trochanteric femur fractures that uses 2 cephalocervical screws in an integrated mechanism allowing linear intra-operative compression and rotational 3-point stability of the head/neck fragment. AIMS & OBJECTIVE: To analyse the functional & radiological outcomes using TRIGEN INTERTAN nail for the treatment of peri-trochanteric femur fractures in the elderly population. DESIGN: Prospective study. METHODS: Between March 1, 2016, and March 31, 2019, 50 patients with an intertrochanteric femur fracture were treated with Trigen InterTan Nail (Smith-Nephew). All fractures were classified by OTA/AO Classification. All surviving patients were followed up for a minimum of 6 months post-operatively. Functional and radiographic evaluation were performed at 3 months & 6 months follow up using the modified Harris hip score. RESULTS: The age of the patients was 60-85 years. 2 patients died due to other co-morbidites, 3 did not come for follow up, leaving 45 patients available for final evaluation. The surgical time was 60-90 minutes. All fractures showed radiological union within 12-16 weeks . Radiographic analysis at healing revealed no loss of reduction, no uncontrolled collapse , no non-union, no femoral shaft fractures, and no implant failures. 2 cases had trochanteric split intra-operatively, requiring cerclage wiring, 1 case was poorly reduced and had varus malalignment. Modified Harris hip score was excellent in 20 patients, good in 10 cases, fair in 9 cases and poor in 1 case. CONCLUSIONS: The Trigen Intertan nail appears to be a reliable implant for the treatment of peri-trochanteric femoral fractures. Its design provides for stability against rotation and minimizes neck mal-unions (shortening) through linear intraoperative compression of the head/neck segment to the shaft. As a result of the minimal complication rate and improved clinical and radiological outcomes, this implant is now used as the standard implant for most unstable peri-trochanteric femur fractures at our institution.

Hemiarthroplasty for intra-capsular fracture neck of femur in elderly patients: a prospective observational study

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20173119 ◽

2017 ◽

Vol 3 (5) ◽

pp. 991

Author(s):

Abhishek Kalantri ◽

Sunil Barod ◽

Dilip Kothari ◽

Archana Kothari ◽

Ashok Nagla ◽

...

Keyword(s):

Elderly Patients ◽

Road Traffic ◽

Excellent Result ◽

Operative Procedure ◽

Functional Results ◽

Harris Hip Score ◽

Neck Of Femur ◽

Mortality And Morbidity ◽

Fracture Neck Of Femur

Background: Hip fractures in older patients are associated with impaired mobility, excess morbidity and mortality, and loss of independence. This study was aimed at evaluating the outcome of hemiarthroplasty, by assessing the quality of life and degree of function in the operated limb.Methods: Out of 30 patients treated in this manner, all cases were available for follow-up period of 6 months. Patients of age 60 years and above, diagnosed with fracture neck of femur, were included in the study.Results: Majority of patients belongs to age group 60-69 years was 56.7% Females were more common 56.7% than males in the present study. About 13.3% patients sustained the injury due to a fall from a height and 23.3% due to a road traffic accident. About 20 patients (60%) had a stay of less than 20 days in hospital. In our study Harris hip score, at end of six month ranged from 35 to 94.6. At final 6 months follow-up by Harris hip scoring system, 53.33% had excellent result, 33.3% had good results, 16.67% had fair results and 6.67% had poor results. Conclusions: We conclude that hemiarthroplasty for fracture neck of femur is a good option in elderly patients. The mortality and morbidity are not high, operative procedure is simple, complications are less disabling. Early functional results are satisfactory.