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2019, IP innovative publication pvt. ltd
Introduction: The proximal femoral nail (PFN) used as an intramedullary device for the treatment of fractures. Objectives: Study was taken to analyse the union of the subtrochanteric fracture, internally fixed with PFN. Materials and Methods: Study was conducted in the department of orthopaedics, GSL Medical College. Individuals with acute subtrochanteric femur fractures >18 years were included in the study. The patient was positioned supine on the fracture table under spinal or epidural or general anesthesia as the condition of the patient permitted. Pre-operatively one dose of antibiotic was also administered. The fracture was reduced by longitudinal traction on fracture table and the limb was placed in neutral or slight adduction to facilitate nail insertion through the greater trochanter ; P <0.05 was considered statistically significant. Results: At the end of five months, all except three patients could mobilise independently; statistically there was significant difference (P<0.05). Based on Harris Hip score obtained 3 patients outcome was excellent, 18 patients were good and 4 patients had fair outcome. Conclusion: Minimal exposure, better stability and early mobilization are the advantages with PFN. Fractures united in all cases and postoperative functional outcome was satisfactory. PFN could be a preferred implant of choice in treating subtrochanteric fractures especially in elderly.
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Study on functional outcome of subtrochanteric femur fractures treated with proximal femoral nailIntroduction: The difficult nature of treating subtrochanteric fracture stems in part from the fact that this injury pattern is anatomically distinct from other proximal femoral peritrochanteric fractures and also from the femoral shaft fractures. The present study was made attempt to evaluate the functional outcome of subtrochanteric femur fractures treated with proximal femoral nail. Materials and Methods: The present study conducted on subtrochanteric femur fracture cases admitted in GSL medical college and general hospital, Rajahmundry during December 2013 to July 2015. Ethical Committee Clearance was obtained before beginning of the study. All patients were maintained on traction before surgery. All surgeries were done under spinal or epidural anaesthesia, low molecular weight heparin prophylaxis is given subcutaneously for the high risk patients during the hospitalization. Result: Majority of the cases were due to high energy trauma of Road traffic Accidents involving relatively younger patients. The operating time for 72% cases was between 1 to 2 hours. Operating time decreased with increasing familiarity of the implant system. The average length of Hospital stay was 17.6 days. At the end of five months, all except three patients could mobilise independently without any aid. According to harris hip score, 3 (12%) patients had excellent outcome, 18 (72%) patients had good outcome and 4 (16%) patients had fair outcome. Conclusion: In conclusion, Proximal femoral nail is a good implant for subtrochanteric fracture of the femur. The advantages are minimal exposure (closed technique), better stability and early mobilisation. Fractures united in all cases and postoperative functional outcome was satisfactory.
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Fixation of rotationally unstable extracapsular fractures of proximal femurIntroduction: It was believed that the fractures of AO types A1.2 and A1.3 are rotationally stable; but, they were found to be unstable when fixed with the dynamic hip screw. Hence we hypothesize that they must be treated as rotationally unstable patterns. Materials and Methods: dynamic hip screw with derotation screw (DHS-DRS) was done in 83 proximal femur fractures of A1, A2, and B2.1 types and followed for 24 months. Immediate assessment of reduction and fixation are found to be accurate. Collapse of fractures assessed after 6 months of surgery. Fractures were classified into 2 groups: Inevitably unstable group (IUG) - A1.1, A2.1, A2.2, A2.3, and B2.1. Potentially unstable group (PUG) - A1.2 and A1.3 and results were statistically analyzed. Results: Reduction achieved in 77 patients was found to be adequate and same goes for the fixation in 71 patients. All fractures healing showed a mean time of 13.5 weeks, and the fracture collapse amounted to an average of 5.8 mm. 66 patients showed equalization of the lower limbs, and 80 patients showed healthy contralateral equalization of hip motion range. One case with AO type A1.2 needed a reoperation. Insignificant differences were found when outcome of IUG and PUG was made. Conclusion: The use of DHS/DRS composite showed restoration and maintenance of the anatomical structure. Differences between the outcomes of IUG and PUG groups were insignificant and creates a reasonable need of classifying AO A1.2 and A1.3 as rotationally unstable types.
IOSR Journals
A Prospective Study of Functional Outcome of Intertrochanteric Fracture of Femur Treated With Proximal Femoral Nail Fixation2019 •
Introduction: Intertrochanteric femur fracture is one of the most common fractures of the hip especially in the elderly with osteoporotic bones, usually due to trivial trauma. Age of patient, osteoporosis, general health, associated co-morbidities are some of the key factors to be considered for the successful treatment of these fractures. Materials and Methods: In our institution, we have selected 24 cases of unstable intertrochanteric fractures for this prospective study. All cases enrolled were managed with the proximal femoral nail. These cases were studied from the mechanism of injury, classification, and treatment with the proximal femoral nail and their surgical and functional outcome with or without residual comp. Results: Patients were followed up for an average period of 8.58 months. The mean Harris hip score was 88.75 at 6th month. The score was excellent in 12 patients, good in 10 patients, fair in 1 patient and poor in 1 patient. In our study of 24 patients with unstable intertrochanteric fracture, the average age incidence was 54.64 years. In the present study male: female was 5:3. Conclusion: In unstable proximal femur fractures, PFN is a significant advancement in the treatment of unstable trochanteric fractures which has the unique advantages of closed reduction, preservation of fracture hematoma, less tissue damage, early rehabilitation and early return to work.
Innovative publication
Evaluation of results of " short proximal femoral nailing " in unstable trochanteric fracturesThe incidence of the hip fracture has been rising with an aging population in many parts of the world. Growing number of population and the road traffic accidents have resulted in an enormous increase in these types of fractures. In younger patients the fractures usually result from high energy trauma like RTA and fall from height and accounts for only 10%. Older patients suffering from a minor fall can sustain fracture in this area because of weakened bone due to osteoporosis or pathological fracture and these accounts for 90%. Surgical management of trochanteric fractures aims at restoring the pre-fracture functional status of patients as far as ambulatory skills are concerned. A variety of implants of internal fixation have been employed to achieve this goal with variable success. The diversity of fixation devices available for treatment of trochanteric fractures illustrates the difficulties encountered for fixation, and the discussion about ideal implant for such cases continues. For the last 20-30 years a better understanding of the biomechanics of the fracture and the development of better implants have lead to radical changes in treatment modalities. With the thorough understanding of fracture geometry and biomechanics optimal treatment can be selected for individual cases. Unstable fracture patterns with postero-medial instability and a fracture with reverse obliquity poses specific challenges in their treatment as well as treatment outcome. Intramedullary devices, theoretically due to its position providing more efficient load transfer and shorter lever arm; can decrease tensile stress and thereby decreasing the risk of implant failure. We conducted a Prospective study, with a sample size of 60, with an aim to evaluate the functional outcome of treatment of unstable Inter-trochanteric Femoral fractures by Short Proximal Femoral Nail (PFN) in terms of maintaining of anatomy radiologically, to assess healing or union of fracture clinico-radiologically, Counteracting the per-operative and post-operative complications, to assessment of functional outcome by Harris Hip Score & Comparison of results with standard literature.
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Comparative study between InterTAN and Trochanteric femoral nailing (TFN) in Inter-trochanteric fractures: A prospective study of functional and radiological outcomesto Compare between Inter-Tan and trochanteric femoral nailing in Inter-trochanteric fractures and study functional and radiological outcomes. Methods: All the patients attending OPD and emergency with inter trochanteric fracture without any sub trochanteric extension were admitted in our hospital and operated over a period of 2 year and 3 months. A total of 40 patients were included in our study of age group 40 to 70 years and divided in two groups (n 1 =20) and (n 2 =20). AO classification for fractures was used and 31-A1 and 31-A2 whereas 31-A3 variant was excluded from study. Patients were operated with two nailing systems i.e., n1= Inter-tan nailing system and n2=trochanteric nailing system. Follow-up assessments were performed at 2, 4, 6 weeks and every 6 months thereafter. Radiological assessment was done at each follow up and all associated implant position changes were also noted simultaneously. Functional outcomes were evaluated using Harris hip score. Results: InterTAN had better outcomes in terms of varus collapse of the neck (InterTAN, n = 1 vs. TFN, n = 3), anterior thigh pain (InterTAN, n = 1 vs. TFN, n = 4), femoral neck shortening (InterTAN, 4.2 mm vs. TFN, 5.4 mm), fracture healing time (InterTAN, 13 weeks vs. TFN, 15 weeks), femoral shaft fractures (InterTAN, n = 0 vs. TFN, n = 1), screw back out (InterTAN, n = 0 vs. TFN, n = 3), lateral cortex fractures of the proximal femur (InterTAN, n = 3 vs. TFN, n = 2), operative time (InterTAN-65 min vs. TFN-50 min), fluoroscopy time (InterTAN, 4.0 min vs. TFN, 3 min), hospital stay (InterTAN, 7 days vs. TFN, 7 days), cutout (InterTAN, n = 0 vs. TFN, n = 3). Harris Hip score (InterTAN-82, TFN 78). Conclusion: The results of our study shows that the incidence of varus collapse of the head/neck, hip and anterior thigh pain, implant cutouts , and femoral neck shortening and femoral shaft fractures at distal tip of implant, rotational loss of reduction were comparatively less in InterTAN subjects comparing with TFN subjects. The time for surgical procedure and fluoroscopy time was more as compared to TFN which can be reduced if procedure is done more frequently. Better radiological and functional outcomes with less degree of complications makes InterTAN a better option for fixation of Intertrochanteric fractures.
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A comparative study between cemented hemiarthroplasty and proximal femoral nail in proximal femur fractures in elderly patientsIntroduction: Incidence of fractures around the hip is increasing worldwide owing to increased life span of the people and secondary to osteoporotic fragile bones. Stable intertrochanteric fractures can be easily treated by internal fixation methods. Unstable comminuted and osteoporotic idsntertrochanteric fractures are very difficult to treat. They can be treated by internal fixation with proximal femoral nail. But chances of implant failure and non union are high with highly osteoporotic and comminuted fractures. In such cases primary hemiarthroplasty is an useful alternative option. We have compared the outcomes of unstable intertrochanteric fractures treated with hemiarthroplasty and proximal femoral nail. Materials and Methods: Our study was conducted in BGS Global Institute of Medical Sciences, Bangalore from January 2014 to December 2016 on patients who had sustained intertrochanteric fractures. It was a prospective study done for a period of two years. Patients with intertrochanteric fractures who had come to our hospital were included in our study. Patients aged more than 60 years with closed intertrochanteric fractures were included in the study. Patients were divided as group I- operated with hemiarthroplasty and group IIoperated with proximal femoral nail. Functional outcome of both groups was assessed using Harris Hip scale and various parameters were compared. Results: Majority of the patients were in the age group 70-79 years, 16 being females and 14 males. Commonest mode of injury was trivial fall (83.33%). Average duration of hospital stay for hemi-arthroplasty patients was 14.33 days and for PFN patients was 11.86 days.15 patients had associated conditions like diabetes or hypertension. Average intra-operative blood loss was 516.66 ml for hemi-arthroplsty and 187.33 ml for PFN. Average operating time for hemi-arthroplasy was 80 minutes whereas for PFN was 83.33 minutes. Mean harris hip score at the end of one year for hemi-arthroplasty was 76.46 and for PFN was 77.8. Conclusion: The outcomes of both the modalities are almost equal. PFN has an advantage of shorter operative time, less blood loss, lower hospital stay with no difference in functional outcome or general complications as compared to hemiarthroplasty. Major advantage of PFN is patients treated with PFN can squat and sit cross legged after fracture union. Hemiarthroplasty does provide a stable, pain-free, and mobile joint with a very low complication rate as seen in our study; however a larger prospective randomized study with longer follow up comparing the use of PFN against primary hemi-arthroplasty for proximal femur fractures needs to be done.
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Management of Seinsheimer type IIB and type IIIA subtrochanteric fracture with proximal femoral nail (PFN) versus proximal femoral locking compression plate (PF-LCP): Prospective comparative studyIntroduction: Seinsheimer subtrochanteric fracture of femur are important to treat and associated with high rate of complications. Among all fractures of hip upto 34% present in subtrochanteric area. Objectives: Comparison of clinical outcome in Seinsheimer type IIB and type IIIA subtrochanteric fractures treated with proximal femoral nail (PFN) versus proximal femoral locking compression plate (PF-LCP). Materials and Methods: Patients presented with Seinsheimer subtrochanteric fracture at our hospital i.e, R L Jalappa Hospital, Tamaka, Kolar, Karnataka, India between May 2018 to June 2019 among which fourty patients were included as per the inclusion criteria. In which twenty patients were treated with Proximal Femoral Nail and twenty patients with Proximal Femoral Locking Compression Plate. By using Modified Harris Hip Score results were assessed at final follow up. Results: Group PFN shows at final follow up 45% excellent outcome, 45% good outcome and 10% fair outcome whereas group PF-LCP shows 60% good outcome, 20% fair outcome and 20% poor. Conclusion: For Seinsheimer subtrochanteric fractures proximal femoral nail shows better results compared to plating group with respect to functional outcome and clinical outcome.
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Effect of encerclage wiring with intermedullary nailing in subtrochanteric fractures of femurIntroduction: Subtrochanteric typically defined as area from lesser trochanter to 5cm distal. Treating a subtrochanteric fractures is associated with difficulties due to anatomical and biomechanical factors comprising mainly due to poor reduction, varus deformity, non union, poor bone quality, comorbidities. Encerclage wire helps in reduction but its use remains controversial due to disturbance of blood supply to the underlying bone and soft tissue damage. This study was undertaken to study the use of encerclage wire for fracture reduction and associated complications. Materials and Methods: Retrospective analysis of patients of age group 20 years and above having subtrochanteric femur fracture, admitted and treated with Long PFN between June 2016 and Sept 2018 were considered in this study. After exclusion 34 patients with an average follow up of 16.8 months were included in this study. Indications for encerclage were fracture patterns like long oblique, spiral, spiral wedge or comminuted fracture with butterfly fragment. Cerclage wire was employed in 15 patients and wire passed through cerclage wire passer. Assessment was done in terms of operation time, quality of reduction, neck shaft angle, union time, complications and final functional outcome by Harris Hip Score. Result: Average operation time and blood loss was significantly higher in cerclage group as compared to without encerclage (p =0.042), anatomical reduction was achieved by in 93% in encerclage group as compared to 79% in non encerclage group. Postoperative Neck shaft angle was 132.80 versus 132.10. Mean Union rate was 14.3 weeks versus 15.6 weeks. 3 patient in non encerclage developed non-union of which 2 patients had nail breakage superficial wound infection was seen in 1 patient in encerclage group and was resolved with regular dressing. Mean range of hip flexion was 123.6o and extension was 14.8o. Conclusion: Encerclage wire gives a better outcome for fracture reduction, decreases varus deformity, and overall there are no major complications. It is although associated with increased operation time and blood loss.
Background: Intertrochanteric fracture is one of the most common fractures of the hip especially in the elderly with porotic bones, usually due to low-energy trauma like simple falls. The present study was undertaken to assess outcome of 50 patients of intertrochanteric fractures treated with short proximal femoral nail. Methods: 50 cases of intertrochanteric fractures in adults treated by short proximal femoral nail were studied. Results assessed by Modified Harris Hip Score at the end of 12 months. Maximum age was 84 years and minimum age was 26 years. 32 were male and 18 were female. 11 of type I, 19 of type II, 12 of type III, 8 of type IV Boyd and Griffin classification were reviewed. Result: Most common type of intertrochanteric fracture was Boyd and Griffin type II. Average time for union was 15.56 weeks. Malunion with varus angulation was seen in 4 cases. Z effect was seen in two cases. Reverse Z effect was seen in two cases. There was one case having broken implant 4 month post operatively. Shortening of more than 1 cm was seen in five cases. 70% excellent and good results were obtained among all cases and 62% excellent and good results were obtained in unstable type 3 and type 4 fractures. Conclusion: The rigid fixation, more efficient load transfer, shorter lever arm of SPFN improves stability of fracture. These features makes SPFN very suitable implant for unstable intertrochanteric fractures. Less operative time, less blood loss, decreased complications makes short PFN superior implant for stable and unstable intertrochanteric fractures.
The open orthopaedics journal
Double axis cephalocondylic fixation of stable and unstable intertrochanteric fractures: early results in 60 cases with the veronail system2014 •
This prospective case-series, without control group, study presents our early experience in the treatment of both stable and unstable peri-trochanteric fractures with a new cephalocondylic implant; the Veronail system. Enrolment in our study was from January 2008 through September 2009, with follow-up until October 2011 (at least 1 year). During this period 65 consecutively patients with a fracture in the trochanteric region of the femur (31.A1, A2 and A3 according to AO classification) were surgically managed and prospectively followed up for at least one year. Average age was 78 years old (range 42 to 93) with 40 female and 25 male patients. All patients were surgically treated using the Veronail system. Demographic and nursery data such as pre-existing illness, previous ambulatory status, type of anaesthesia, duration of surgery, volume of blood loss, transfusions, length of hospital stay, time to union and overall complications were systematically recorded and analysed. Mean fol...
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Functional and radiological outcome of unstable intertrochanteric fractures treated by proximal femoral nail and dynamic hip screwInternational Orthopaedics
Is distal locking with IMHN necessary in every pertrochanteric fracture?2010 •
BMC Musculoskeletal Disorders
3066 consecutive Gamma Nails. 12 years experience at a single centre2010 •
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The Treatment of Intertrochanteric Fractures: Results Using an Intramedullary Nail With Integrated Cephalocervical Screws and Linear Compression2009 •
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Indian Journal of Orthopaedics
Ipsilateral femoral neck and trochanter fracture2011 •
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Evaluation of complications of three different types of proximal extra-articular femur fractures2007 •
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Complex proximal femoral fractures in the elderly managed by reconstruction nailing – complications & outcomes: a retrospective analysis2007 •
International Orthopaedics
Tip-apex distance of intramedullary devices as a predictor of cut-out failure in the treatment of peritrochanteric elderly hip fractures2010 •
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International Orthopaedics
The history of internal fixation of proximal femur fractures Ernst Pohl—the genius behind2014 •
The Journal of the American Academy of Orthopaedic Surgeons
Surgical management of hip fractures: an evidence-based review of the literature. I: femoral neck fractures2008 •
Ortopedia Traumatologia Rehabilitacja
The treatment of intertrochanteric fractures of the femur with Endovis nail2011 •
The open orthopaedics journal
Treatment of trochanteric fractures with the gamma3 nail - methodology and early results of a prospective consecutive monitored clinical case series2014 •
MEDICA INNOVATICA Dec 2015
Gender differences in prevalence of internet addiction among Indian college studentsJournal of Orthopaedic Trauma
The PFNA Proximal Femur Nail in Treatment of Unstable Proximal Femur Fractures-3 Cases of Postoperative Perforation of the Helical Blade Into the Hip Joint2008 •
Clinical Biomechanics
Auxiliary locking plate improves fracture stability and healing in intertrochanteric fractures fixated by intramedullary nail2012 •
Injury
Radiographic outcomes of intertrochanteric hip fractures treated with the trochanteric fixation nail2007 •
Clinical Orthopaedics and Related Research®
Letter to the Editor: Intramedullary Nails Result in More Reoperations Than Sliding Hip Screws in Two-part Intertrochanteric Fractures2013 •
The Journal of Bone and Joint Surgery (American)
TRIGEN INTERTAN Intramedullary Nail Versus Sliding Hip Screw2013 •
European Journal of Orthopaedic Surgery & Traumatology
Proximal femoral nailing without a fracture table2009 •