Ipsilateral Neck/Inter-Trochanteric and Mid-shaft Femoral Fractures Treated with Dual Construct Implants

Background: Various management protocols for ipsilateral neck/intertrochanteric and shaft fracture femur have been formulated, there have been many disagreements related to their ideal fixation plan. The aim of this study was to discuss the various type of fixation system available for such kind of complex injuries and the advantages of using dual construct fixation system. Patient and Methods: In the present study we prospectively evaluated ipsilateral neck/intertrochanteric and shaft fracture femur in 7 cases managed from January 2018 to December 2020. All the patients were managed with dual constructs fixation system using dynamic hip screw (DHS) and locking plate. The outcome was evaluated using Friedman and Wyman scoring system. Results: The average surgical time was 120.4 min (range 98–143 minutes) with a blood loss ranging from 290-565 mL (average 460 mL). In 6 patients follow-up was undertaken between 10 and 22-months after surgery, with a mean follow-up time of 16.2 months. 1 patient lost follow-up at 3-month. The neck/IT fractures achieved union in 6 patients at the final follow-up. 3-6 months was the duration for bone union, with an average of 4.1 months. The mid-shaft femur fractures achieved solid union in 6 cases at the most recent follow-up. 3 to 11 months was the duration of union, with a mean of 5.1 months. 1 patient went into non-union 11 months after the surgery. According to Friedman and Wyman scoring, 4 patients the functional outcome was good, in 2 patients the functional outcome was fair, and in 1 patient the functional outcome at the final follow-up was poor. The problems noted were surgical site infection in 1, Angulations (varus/valgus) of femoral neck in 1, non-union of neck femur fracture in 1, and avascular necrosis of femoral head in 1. Conclusion: The management of ipsilateral neck/intertrochanteric and shaft fracture femur with dual construct implants dynamic hip screw for neck/IT fracture and locking plate for shaft femoral fractures yielded good union rates and good functional outcomes.

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Proximal Femoral Locking Plate versus Dynamic Hip Screw for Unstable Intertrochanteric Femoral Fractures

Journal of Orthopaedic Surgery ◽

10.1177/230949901302100311 ◽

2013 ◽

Vol 21 (3) ◽

pp. 317-322 ◽

Cited By ~ 15

Author(s):

Anoop C Dhamangaonkar ◽

Deepak Joshi ◽

Arvind B Goregaonkar ◽

Akhil A Tawari

Keyword(s):

Locking Plate ◽

Femoral Fractures ◽

Dynamic Hip Screw ◽

Plate Versus ◽

Hip Screw

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Mechanism of Unstable Inter-trochanteric Fractures in the Elderly

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2020/v32i1430612 ◽

2020 ◽

pp. 120-134

Author(s):

S. Santhosh

Keyword(s):

Femoral Fractures ◽

Early Mobilization ◽

The Elderly ◽

Trochanteric Fractures ◽

Non Union ◽

Prospective Comparative Study ◽

Hip Screw ◽

Hemi Arthroplasty ◽

Tremendous Impact

The aim of this prospective comparative study is to analyse the short term follow-up results of unstable inter-trochanteric fractures in the elderly treated with Bipolar hemi-arthroplasty and Dynamic hip screw fixation done in our institution from March 2017 to October 2018. Proximal femoral fractures in the elderly individuals have a tremendous impact on both the health care system and society. Upon treatment of inter-trochanteric factures with conservative management, it usually unites with a mal-union, non-union and with shortening, but the problem of non –union in trochanteric fractures has less incidence. Because of complications associated with prolonged recumbency and its associated morbidities. Primary hemiarthroplasty in these patients provides for adequate fixation and early mobilization. It alleviates pain and improves function. It also prevents post-operative complications such as pneumonia, lung atelectasis and pressure sores. From our clinical observation we would suggest that unstable intertrochanteric fractures in elderly result most frequently from accidental fall (52.5%), being the most common described mechanism of injury.

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Outcome of Distal Femoral Fracture Treated with Locking Plate

10.53350/pjmhs211562142 ◽

2021 ◽

Vol 15 (6) ◽

pp. 2142-2144

Author(s):

Muhammad Shoaib Zardad ◽

Abdus S. Awan ◽

Muhammad Younas ◽

Shahkeel A. Shah ◽

S. Sohail Akhtar ◽

...

Keyword(s):

Femoral Fracture ◽

Traffic Accidents ◽

Locking Plate ◽

Road Traffic ◽

Femoral Fractures ◽

Delayed Union ◽

Distal Femoral Fracture ◽

Non Union ◽

One Year

Objective: The aim of this study is to determine the outcome of distal femoral fracture treated with locking plate. Study Design:Prospective study Place and Duration: Conducted at Orthopaedic Unit Ayub Medical Teaching Institute, Abbottabad for one year duration from 1stJanuary 2020 to 31st December 2020. Methods: Total 90 patients of both genders were presented in this study.Patients were aged between 18-80 years of age. Patients’ detailed demographics including age, sex and body mass index were recorded after taking informed written consent. All the patients had distal femoral fracture treated with locking plate. Radiological assessment was done. Mean union time and complications associated to procedure were examined.Functional outcomes were analyzed according to the Flyn’s criteria. Follow-up was taken at 6 months postoperatively. Complete data was analyzed by SPSS 24.0 version. Results:There were 58 (64.4%) patients were males and 32 (35.6%) were females. Mean age of the patients were 42.61±12.88 years with mean BMI 27.65±9.56 kg/m2. According AO/OTA classification 55 (61.1%) had A1, A2 fracture was among 18 (20%) cases and the rest were 17 (18.9%) had A3. 62 (68.9%) fractures were caused due road traffic accidents, falling from height were among 17 (18.9%) cases and 11 (12.2%) cases were due to sports. Right side fracture was the most common side of fracture among 54 (60%). Mean union time among patients was 5.16±1.27 months.According to Flyn’s criteria, 38 (42.2%) cases had excellent results, 32 (35.6%) patients had good, fair results were among 16 (17.8%) cases and poor results were among 4 (4.4%) cases. Complications were delayed union, stiffness, varus deformityand non union observed among all cases. Conclusion: We concluded in this study that the locking plate for the treatment of distal femoral fractures was effective in terms of good results with fewer complications. Keywords:Distal femoral fracture, Locking plate, RTA, Complications

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Proximal Femoral Locking Plate versus Dynamic Hip Screw for Unstable Intertrochanteric Femoral Fractures

Journal of Orthopaedic Surgery ◽

10.1177/230949901402200132 ◽

2014 ◽

Vol 22 (1) ◽

pp. 130-131 ◽

Cited By ~ 1

Author(s):

Sachin Upadhyay ◽

HKT Raza

Keyword(s):

Locking Plate ◽

Femoral Fractures ◽

Dynamic Hip Screw ◽

Plate Versus ◽

Hip Screw

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Comparative evaluation of management of intertrochanteric fracture femur with proximal femoral nailing versus dynamic hip screw

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20203730 ◽

2020 ◽

Vol 6 (5) ◽

pp. 1050

Author(s):

Navneet Adhikari ◽

Chandra Shekhar ◽

Ganesh Singh ◽

Hardev Singh

Keyword(s):

Intertrochanteric Fracture ◽

Joint Stiffness ◽

Dynamic Hip Screw ◽

Harris Hip Score ◽

Functional Grade ◽

Fracture Femur ◽

Trochanteric Region ◽

Hip Screw ◽

A Prospective Study

Background: Fractures involving trochanteric region of femur are one of the common fractures affecting elderly population. Presently surgical treatment is the treatment of choice with early mobilisation as primary goal. The two most common implants that are used are Dynamic hip screw (DHS) and Proximal femoral nail (PFN).Methods: This was a prospective study with 50 patients divided randomly into two groups of 25 each. One group operated by PFN and other with DHS. Patients were evaluated periodically and final comparison between two group was done at six months for analysing results on the basis of Harris hip score.Results: At final follow up in patients in PFN group 9 (36%), 7 (28%), 5 (20%), 4 (16%) patients had functional grade in excellent, good, fair and poor category respectively. In DHS group patients, 7 (28%), 10 (40%), 6 (24%), 2 (8%) patients had functional grade in excellent, good, fair and poor functional grade. Harris hip score was insignificantly (p>0.05) lower in patients of PFN (82.68±12.28) than DHS (84.60±10.39).Conclusion: At final follow up we found that pain, limp, use of support while walking and hospital stay was less in PFN group. However, range of motion and hip functions were better in patients treated with DHS. Complications like Varus malunion and infection were common in DHS group while hip joint stiffness was seen more commonly in PFN group. So, both PFN and DHS in are comparable in respect to most of functional criteria for treatment of intertrochanteric fracture femur.

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Outcome of dynamic hip screw with trochanteric stabilizing plate in treatment of unstable intertrochanteric femoral fractures in elderly patients.

The Professional Medical Journal ◽

10.29309/tpmj/2022.29.01.3433 ◽

2021 ◽

Vol 29 (01) ◽

pp. 31-35

Author(s):

Muhammad Asif ◽

Yaqoob ur Rehman ◽

Sardar Sohail Afsar

Keyword(s):

Elderly Patients ◽

Functional Outcome ◽

Femoral Fractures ◽

Trochanteric Fracture ◽

Dynamic Hip Screw ◽

Harris Hip Score ◽

Trochanteric Fractures ◽

Poor Functional Outcome ◽

Hip Screw ◽

Study Setting

Objective: To know about the outcome of dynamic hip screw with trochanteric stabilizing plate in treatment of unstable inter-trochanteric femoral fractures in elderly patients. Study Design: Descriptive study. Setting: Maqsood Medical Complex, Pak Medical Centre and Habib Medical Complex. Period: August 2016 to July 2018. Material & Methods: Total of 70 patients with unstable inter-trochanteric fracture and age above 60 years were included in the study. The fracture was fixed with dynamic hip screw and trochanteric stabilizing plate. Patients were evaluated every month after surgery for healing of fracture. Final functional outcome was measured at 6 months after surgery with Harris Hip Score. Results: Out of 70 patients 44 (63%) were females and 26 (37%) were males. Mean age was 74.34(SD + 08.31) years with range of 60 to 87 years. Mean Harris Hip Score at 6 months was 85% with standard deviation of± 4.Ten (14%) patients had excellent, 40 (58%) patients had good, 16 (23%) patients fair and 4 (5%) patients poor functional outcome. Conclusion: Excellent and good functional outcome can be achieved in unstable inter-trochanteric fractures fixed with dynamic hip screw and trochanteric stabilizing plate in majority of patients.

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Proximal femoral nail antirotation versus dynamic hip screw fixation for treatment of osteoporotic type 31-A1 intertrochanteric femoral fractures in elderly patients

Journal of International Medical Research ◽

10.1177/0300060517703277 ◽

2017 ◽

Vol 45 (3) ◽

pp. 1109-1123 ◽

Cited By ~ 9

Author(s):

Xianshang Zeng ◽

Nan Zhang ◽

Dan Zeng ◽

Lili Zhang ◽

Ping Xu ◽

...

Keyword(s):

Elderly Patients ◽

Femoral Fractures ◽

Dynamic Hip Screw ◽

Proximal Femoral Nail ◽

Harris Hip Score ◽

Secondary Outcome ◽

Femoral Nail ◽

Hip Screw ◽

Proximal Femoral Nail Antirotation

Objective To evaluate long-term radiographic and functional outcomes between dynamic hip screw (DHS) and proximal femoral nail antirotation (PFNA) fixation for treatment of osteoporotic type 31-A1 intertrochanteric femoral fractures (IFFs) among elderly patients Methods A retrospective comparative study was carried out. Follow-up was performed at 1, 3, 6, 9, and 12 months postoperatively and yearly thereafter. The primary outcome was the radiographic outcome, and the secondary outcome was the functional outcome. Results A significant difference in radiographic complications was observed between the DHS group (n = 45, 40.2%) and PFNA group (n = 15, 13.6%). The risk of femoral shaft fracture after implant removal at the 1-year follow-up was increased by 0.9% (n = 1) and 6.3% (n = 7) in the PFNA and DHS groups, respectively. This difference persisted with rates of 3.6% (n = 4) and 12.5% (n = 14) at the final follow-up. Additionally, significant differences were present in the Harris hip score at each visit. Conclusion Our results indicate that PFNA yields better outcomes than DHS fixation among elderly patients with osteoporotic type 31-A1 IFFs.

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Functional outcome of proximal femoral nailing for unstable intertrochanteric fracture in elderly

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20204582 ◽

2020 ◽

Vol 6 (6) ◽

pp. 1186

Author(s):

Ankit Jose ◽

Edward Nazareth ◽

Vivian Roshan D. A. ◽

Mohan Kumar C. R.

Keyword(s):

Functional Outcome ◽

Femoral Fractures ◽

Delayed Union ◽

Harris Hip Score ◽

Non Union ◽

Femoral Nailing ◽

Unstable Intertrochanteric Fracture ◽

Intertrochanteric Femur Fracture ◽

Proximal Femoral Nailing

Background: This study is intended to analyse the functional outcome of proximal femoral nailing (PFN) for unstable intertrochanteric fractures in elderly.Methods: The data was collected from the 35 patients with unstable intertrochanteric femur fracture who were subjected to PFN from 2015 to 2018. All patients were followed up at 3 months and 6 months after the operation to check the functional outcome based on harris hip score (HHS) and complication if any.Result: In 35 patients, 1 patient was lost to follow-up and 34 patients were followed-up at 3 months and 6 months. All patient’s union was achieved at 3 and 6 months follow up. The cause of fractures was trivial fall in all 35 patients. No incidence of non-union and delayed union was reported. Functional outcome was rated as per HHS, we got excellent results in 20 cases, good in 10, fair in 03 and poor in one patient at end of 6 months.Conclusions: PFN provides stable fixation and early post-operative mobilization with fracture union especially complex proximal femoral fractures which includes unstable, communited, reverse oblique fractures and fractures in osteoporotic bones. PFN has shown excellent results in our study.

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PERTROCHANTERIC FRACTURE FEMUR;

The Professional Medical Journal ◽

10.29309/tpmj/2013.20.03.916 ◽

2013 ◽

Vol 20 (03) ◽

pp. 462-471

Author(s):

NOOR AKBAR SIAL, ◽

NASIR MAHMOOD,

Keyword(s):

Image Intensifier ◽

Standard Technique ◽

Dynamic Hip Screw ◽

Pertrochanteric Fracture ◽

Walking Ability ◽

X Rays ◽

Fracture Femur ◽

Hip Screw ◽

A Prospective Study

Background: Pertrochanteric fracture is common in elderly population. The dynamic hip screw is widely accepted in thetreatment of P/T fractures of the proximal femur. Objective: The purpose of this study was to assess radiological and clinical union inelderly patients after operative treatment of a pertrochanteric femoral fracture with DHS. Design: A prospective study. Setting:Orthopaedic surgery department of Independent Medical College Faisalabad. Study Period: Between July 2009 and June 2012. Method:The study group included 22 males and 51 females aged 50-95 years following pertrochanteric fracture femur either stable or unstable.Relevant history and x-rays were taken. We followed the inclusion and exclusion criteria. All patients were operated on routine operationlist under image intensifier after necessary investigations and fitness for anaesthesia. All the cases were treated by closed/openreduction and a dynamic hip screw (DHS) was inserted by a standard technique. An outpatient follow-up with x-ray check-ups wascarried out at one-month, 3months, 6 months and after 1year intervals to assess union and walking ability as outcome measures.Results: 73 cases were included in study 22 males and 51 females.66 fractures (90%) healed at an average of 12 weeks postoperatively(range 8-28 weeks). There were 4 patients (5.47%) requiring further surgical intervention. No obvious shortening of more than 1.6 cmwas noted compared to the contra lateral normal limb. Our results suggest that fixation with DHS may allow a faster post-operativerestoration of walking ability. Mortality upto1 year 11(15.06%).Further 6(8.22%) patients were lost to follow up. Conclusion: It isconcluded that the Dynamic Hip Screw is safe, suitable and reliable fixation.

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Comparative study of fixation of intertrochanteric fracture of the femur by proximal femur nail versus dynamic hip screw

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20202047 ◽

2020 ◽

Vol 6 (4) ◽

pp. 717

Author(s):

H. B. Shivakumar ◽

Ramalingaiah Yatish ◽

Channappa T. Seetharam ◽

Manju Jayaram ◽

Amith Kamath K.

Keyword(s):

Functional Outcome ◽

Proximal Femur ◽

Dynamic Hip Screw ◽

Harris Hip Score ◽

Functional Evaluation ◽

Intertrochanteric Fractures ◽

Age Group ◽

Hip Screw ◽

Proximal Femur Nail

Background: Intertrochanteric fractures are common in old age group, but uncommon in younger age group. The goal of treatment of intertrochanteric fractures is restoration to pre-injury status at the earliest. The purpose of this study is to compare the functional outcome of the two fixation devices proximal femur nail (PFN) and dynamic hip screw available for intertrochanteric fractures in terms of the eventual functional outcome of the patient.Methods: Prospective study of 30 cases of Intertrochanteric fractures admitted and operated in KIMS hospital from November 2017 to May 2019. Follow-up of these patients was done at 6 weeks, 12 weeks and 24 weeks with functional evaluation was done using Harris hip score at the 24th week.Results: The results at the end of 24 weeks follow-up were calculated by the Harris hip score were better with the PFN. 66.7% of the patients operated with PFN gave excellent results as compared to 60% of patients operated with dynamic hip screw (DHS).Conclusions: We conclude that the use of PFN for the fixation of trochanteric fractures against the proven DHS offered better results along with a few advantages. PFN required smaller incision, shorter duration of surgery, less blood loss and faster recovery and better functional outcome at the end of 24 weeks. But still PFN is technically more demanding than the DHS and was found to have longer fluoroscopy exposure.

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