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Acta orthopaedica Belgica
Tyllianakis M, Panagopoulos A, Papadopoulos A, et al. Treatment of extracapsular hip fractures with the proximal femoral nail (PFN): long term results in 45 patientsJournal of Trauma Management & Outcomes
Complex proximal femoral fractures in the elderly managed by reconstruction nailing – complications & outcomes: a retrospective analysis2007 •
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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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Proximal femoral nailing in the management of subtrochanteric fractures of femur in adultsIntroduction: 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.
Aims: 1) Evaluation of Effectiveness and strength of Proximal Femoral nail in management of Trochantric and Sub-Trochantric Fractures. 2) Early mobilization and functional recovery of patient Objectives: 1) Stable Internal Fixation designed to fulfill biomechanical demands. 2) Toassist & enhance fracture healing. Method: It is a prospective study carried out from 2008 to 2014 in the Dept. Of Orthopaedics, RMC, Loni. Total 39 cases were treated. Boyd and Griffins classification is used. Majority of cases were from of 5 th-8 th decade of life. Stability of fractures is judged by presence of posterior-medial femoral cortex integrity. In all cases standard 25 mm PFN of 135 0 /130 0 were used. Results: After average follow-up of one year good to Excellent Hip range of motion was seen in 36 cases. All cases showed fracture union. No Z effect seen in any case. Except 2 cases which showed Reverse z effect and in 1 case nail breakage was seen without affecting functional abilities. Average fracture union time was 16 weeks. Conclusion: Proximal Femoral Nail is biomechanically sound fixation, minimally invasive which permits early mobilization, prevents excessive varus collapse at fracture site, produces less stress riser effect below tip of nail. But it also appears from this series that Indications of fixation are limited, excessive Lateral cortex comminution may limit its use. Still Proximal femoral nail is to be time tested to call it as best treatment modality for inter torchanteric & subtrochanteric fractures
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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.
International Orthopaedics
Evaluation of complications of three different types of proximal extra-articular femur fractures2007 •
Background: In elderly population it is most often due to trivial trauma. More than 20000 fractures occur every year and the incidence is expected to double by year 2020. 1. In 2003 Takigamiet al 2 introduced PFN-A which claimed to have better functional outcome in treating pertrochanteric and subtrochanteric fractures when compared to PFN.Most commonly used intramedullary devices for the management of the proximal femoral fractures are Gamma nail and Short PFN. There are different studies available in literature claiming superiority of Gamma nail 3,4 and Short PFN 5,6,7 individually. Among Short PFN and Gamma nail, Short PFN had shown either equal results 8 or better results 9 biomechanically in the management of unstable intertrochanteric fractures. However both implants have higher rate of complications like anterior thigh pain, femoral shaft fractures distal to or around the distal tip of nail 10,11,12,13 and all these lead to higher rate of revision surgery 14 in the form of exchange with other fixation device, screw removal or implant removal to achieve union and adequate mobility. Methodology: We have done a prospective study on stable intertrochanteric femur fractures operated with proximal femoral nailing at government general hospital / Siddhartha medical college for a period of 24 months.The study includes patients with stable intertrochanteric fractures admitted from January 2016 to July 2017,Based on inclusion and exclusion criteria. Results:In our series, total number of long PFN cases n = 15,mean age for men is 75.5 , mean age for women is 72 and mean age for long PFN group in our study is 73.7 years.Total number of short PFN cases n = 15, mean age for men is 77.8, mean age for women is 72.8 and mean age for short PFN group in our study is 75.3 years.In the present study, men were more commonly involved. Majority of the patients were male – 9(60%) cases and 6(40%) were females in long PFN group, 10 (66.66%) male and 5 (33.33%) female cases in short PFN groups.Right side was involved in 19 (63.33%) cases and left in 11(36.66%), right side was more commonly involved than left side. In both groups 14 cases (93.3%) affected were due to trivial fall, 1 case (6.66%) was due to RTA. Trivial fall was the most common mode of injury.Mean weeks for radiological union in long pfn group is 13.3 weeks.Mean weeks for radiological union in short pfn group is 14.4 weeks. In our study, according to Harris Hip Score 15 (modified), good results are seen in 66.66 % cases of intertrochanteric fractures operated using long PFN and 33.33% cases of intertrochanteric fractures operated using short PFN. Conclusion: In our results it was evident that the use of Long PFN has advantages over short PFN in terms of the less postoperative complications, less mean time of union & better lower extremity functional scores.Most of the complications of proximal femoral nailing are surgeon and instruments related which can be cut down by proper patient selection, good preoperative planning and preoperative good reduction before entry and correct length of the screws.
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...
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.
IOSR Journals
A Prospective Study of Functional Outcome of Intertrochanteric Fracture of Femur Treated With Proximal Femoral Nail Fixation2019 •
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Functional and radiological outcome of unstable intertrochanteric fractures treated by proximal femoral nail and dynamic hip screwInternational Journal of Research in Orthopaedics
Functional outcomes of reverse distal femoral locking plate in the extra capsular fractures of proximal femur2019 •
2006 •
Injury
Radiographic outcomes of intertrochanteric hip fractures treated with the trochanteric fixation nail2007 •
2003 •
Strategies in trauma and limb reconstruction (Online)
Dual lag screw cephalomedullary nail versus the classic sliding hip screw for the stabilization of intertrochanteric fractures. A prospective randomized study2012 •
IP Innovative Publication Pvt Ltd
Comparative study on evaluation of results of DHS/PFN in management of intertrochanteric fractures femurhttps://www.ijrrjournal.com/IJRR_Vol.3_Issue.7_July2016/Abstract_IJRR0010.html
To Study Outcome of Various Surgical Methods in Intertrochanteric Fractures of the FemurInternational Orthopaedics
Is distal locking with IMHN necessary in every pertrochanteric fracture?2010 •
Indian Journal of Orthopaedics
Primary hemiarthroplasty for unstable osteoporotic intertrochanteric fractures in the elderly: A retrospective case series2010 •
2013 •
Indian Journal of Orthopaedics
Primary hemiarthroplasty for unstable osteoporotic intertrochanteric fractures in the elderly2011 •
European Journal of Orthopaedic Surgery & Traumatology
Comparison of proximal femoral nail antirotation (PFNA) with AO dynamic condylar screws (DCS) for the treatment for unstable peritrochanteric femoral fractures2013 •
journal of evidence based medicine and healthcare
CALCAR PRESERVING OSTEOTOMY IN CEMENTED BIPOLAR HEMIARTHROPLASTY FOR UNSTABLE TROCHANTERIC FRACTURESThe Journal of Arthroplasty
Management of Failed Trochanteric Fracture Fixation With Cementless Modular Hip Arthroplasty Using a Distally Fixing Stem2011 •
MEDICA INNOVATICA Dec 2015
Gender differences in prevalence of internet addiction among Indian college studentsArchives of Orthopaedic and Trauma Surgery
Long gamma nail in the treatment of subtrochanteric fractures2004 •
Clinical Orthopaedics and Related Research®
Type of Hip Fracture Determines Load Share in Intramedullary Osteosynthesis2009 •
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Effect of encerclage wiring with intermedullary nailing in subtrochanteric fractures of femur2012 •
International Orthopaedics
Hip arthroplasty for failed treatment of proximal femoral fractures2010 •
Injury-international Journal of The Care of The Injured
Subtrochanteric fracture: fixation using the AO tibial nail1992 •
International Journal of Advanced Research (2014), Volume 2, Issue 4 ,581-591
The use of sliding hip screw versus Targon proximal femoral nail in the treatment of unstable pertrochanteric fractures AO:31-A2. A prospective randomized trial2014 •
BMC Musculoskeletal Disorders
3066 consecutive Gamma Nails. 12 years experience at a single centre2010 •
International journal of orthopaedic sciences
A comparative study of surgical management of intertrochanteric fractures using dynamic hip screw (DHS) and proximal femoral nail (PFN2020 •