scholarly journals Increased Fracture Collapse after Intertrochanteric Fractures Treated by the Dynamic Hip Screw Adversely Affects Walking Ability but Not Survival

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Christian Fang ◽  
Paata Gudushauri ◽  
Tak-Man Wong ◽  
Tak-Wing Lau ◽  
Terence Pun ◽  
...  
Keyword(s):  
Survival Data ◽  
Dynamic Contact ◽  
Dynamic Hip Screw ◽  
Walking Ability ◽  
Intertrochanteric Fractures ◽  
Term Survival ◽  
Kaplan Meier ◽  
Screw Position ◽  
Hip Screw

In osteoporotic hip fractures, fracture collapse is deliberately allowed by commonly used implants to improve dynamic contact and healing. The muscle lever arm is, however, compromised by shortening. We evaluated a cohort of 361 patients with AO/OTA 31.A1 or 31.A2 intertrochanteric fracture treated by the dynamic hip screw (DHS) who had a minimal follow-up of 3 months and an average follow-up of 14.6 months and long term survival data. The amount of fracture collapse and shortening due to sliding of the DHS was determined at the latest follow-up and graded as minimal (<1 cm), moderate (1-2 cm), or severe (>2 cm). With increased severity of collapse, more patients were unable to maintain their premorbid walking function (minimal collapse = 34.2%, moderate = 33.3%, severe = 62.8%, andp=0.028). Based on ordinal regression of risk factors, increased fracture collapse was significantly and independently related to increasing age (p=0.037), female sex (p=0.024), A2 fracture class (p=0.010), increased operative duration (p=0.011), poor reduction quality (p=0.000), and suboptimal tip-apex distance of >25 mm (p=0.050). Patients who had better outcome in terms of walking function were independently predicted by younger age (p=0.036), higher MMSE marks (p=0.000), higher MBI marks (p=0.010), better premorbid walking status (p=0.000), less fracture collapse (p=0.011), and optimal lag screw position in centre-centre or centre-inferior position (p=0.020). According to Kaplan-Meier analysis, fracture collapse had no association with mortality from 2.4 to 7.6 years after surgery. In conclusion, increased fracture collapse after fixation of geriatric intertrochanteric fractures adversely affected walking but not survival.

scholarly journals Lag screw cutout in intertrochanteric fractures fixed with DHS.

2020 ◽  
Vol 27 (09) ◽  
pp. 1862-1866
Author(s):  
Muhammad Nasir Ali ◽  
Muhammad Khalid Chishti ◽  
Kashif Siddiq ◽  
Muhammad Hamayun Hameed ◽  
Muhammad Tayyab Waheed ◽  
...  
Keyword(s):  
Cross Sectional Study ◽  
Intertrochanteric Fractures ◽  
Cross Sectional ◽  
Middle Position ◽  
Lag Screw ◽  
Screw Position ◽  
Hip Screw ◽  
The Mean ◽  
Study Setting

Objectives: To determine the failure of DHS (dynamic hip screw) in terms of lag screw cutout. Study Design: Hospital Based Cross Sectional study. Setting: BVH and Civil Hospital Bahawalpur. Period: From 2013 to 2018. Material & Methods: 273 patients of both genders with age more than 50 years having stable intertrochanteric fractures were included in this study. With the help of C arm, the best possible anatomical reduction and rigid internal fixation was done with 135 degree DHS. Lag screw position and TAD determined on first postoperative day on radiographs (Anteroposterior & Lateral). Failure of fixation was determined on the radiographs during follow up. Lag screw cut-out was the projection of the screw from the femoral head by more than 1mm. Results: The mean age of the patients was 68.6 years (50-88). There were 132 (51.1 %) males and 126 (48.8%) females. Overall lag screw cutout rate was 11.2%. 21(30.8%) had screw cutout while 47 (69.1%) healed successfully among 68 patients with TAD ≥ 25mm. On the other hand 8(4.2%) had screw cutout while 182 (95.7%) healed successfully among 190 patients with TAD < 25mm. Middle middle and inferior middle position had highest success rate (˃ 92%) while inferior posterior position had highest cutout rate (36.2%). Among different age categories high failure rate (17.8%) seen in patients more than 70 years. Conclusion: The incidence of lag screw cutout is 11.2 % and risk of cutout can be minimized by placing lag screw in middle middle or inferior middle position and keeping the TAD < 25mm. More attention during follow up should be paid to patients with age ˃ 70 years.

scholarly journals A comparative study of proximal femoral fracture fixation with proximal femoral nail and dynamic hip screw and plating

2017 ◽  
Vol 3 (4) ◽  
pp. 871
Author(s):  
Sridhar D. K. ◽  
Veeranna H. D. ◽  
Madhusudan H.
Keyword(s):  
Functional Outcome ◽  
Proximal Femoral Fracture ◽  
Dynamic Hip Screw ◽  
Common Mechanism ◽  
Walking Ability ◽  
Intertrochanteric Fractures ◽  
Equal Distribution ◽  
Intramedullary Device ◽  
Significant Difference ◽  
Hip Screw

<p class="abstract"><strong>Background:</strong> Trochanteric fractures are one of the commonest injuries sustained predominantly in patients over sixty years of age. They are three to four times more common in women. These usually occur through bone affected by osteoporosis; trivial fall being most common mechanism of injury Approximately 10-30% of patients die within one year of an intertrochanteric fracture.</p><p class="abstract"><strong>Methods:</strong> A prospective study comprising of patients identified for surgical treatment of fracture in the intertrochanteric region of femur admitted to Sri Siddhartha Medical College, Tumkur from 2016 to 2017 where 30 patients with 30 intertrochanteric fractures of femur were selected with equal distribution of 15 dynamic hip screw devices and 15 intramedullary devices.<strong></strong></p><p class="abstract"><strong>Results:</strong> The purpose of the present study is to verify theoretical advantages of intramedullary device over the dynamic hip screw devices and also whether it actually alters the eventual functional outcome of the patient. Excellent results were seen in 2 patients (13.3%) in the DHS group and in 6 patients (40%) in the PFN group. The overall functional outcome of patients treated with the PFN was significantly better than those treated with DHS (p=0.037). However when we compared the stable and unstable fractures separately, we found that there was no significant difference in the outcomes of the stable fractures in the two groups (p=0.198).</p><p><strong>Conclusions:</strong> We conclude that in stable intertrochanteric fractures, both the PFN and DHS have similar outcomes. However, in unstable intertrochanteric fractures the PFN has significantly better outcomes in terms of earlier restoration of walking ability as it is an intramedullary implant which can tolerate higher cylindrical loading when compared to DHS type of implants. In addition, as the PFN requires shorter operative time and smaller incision, it has distinct advantages over DHS even in stable intertrochanteric fractures. Hence, in our opinion, PFN may be the better fixation device for most intertrochanteric fractures.</p>

Fludarabine/Melphalan Conditioning for Allogeneic Stem Cell Transplantation (SCT) in Elderly Patients with AML/MDS.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 5410-5410
Author(s):  
Glen A. Kennedy ◽  
Jason Butler ◽  
Simon Durrant ◽  
Geoff R. Hill ◽  
Robyn Western ◽  
...  
Keyword(s):  
Stem Cell ◽  
Elderly Patients ◽  
Survival Data ◽  
Acute Gvhd ◽  
Chronic Gvhd ◽  
Conditioning Regimen ◽  
Term Survival ◽  
Phase 2 Trial ◽  
Kaplan Meier

Abstract Aims: To assess the tolerability and efficacy of a reduced-intensity, non-TBI based allogeneic SCT conditioning regimen utilising fludarabine and melphalan (FluMel) in elderly patients with AML /MDS. Methods: Fludarabine (25mg/m2 D-7 to D-3) and melphalan (120mg/m2 D-2) allogeneic SCT was performed as part of a prospective phase 2 trial to assess the tolerability of the preparative regimen across a range of haematological malignancies. For this analysis, all patients aged &gt;50yrs with AML /MDS who underwent FluMel transplantation were retrospectively reviewed. Standard GVHD prophylaxis was cyclosporine + methotrexate (D1–11). Both HLA-matched siblings and volunteer unrelated donors (VUD) were permitted as stem cell donors. Graft source was G-CSF stimulated PBPC; all grafts were T-cell replete. Survival data was calculated utilising the Kaplan-Meier product-limit method. Results: In total 20 patients &gt;50yrs (16M and 4F) had received FluMel allogeneic SCT for AML (n=15) or MDS (n=5). Median age at SCT was 60yrs (range 50 to 67yrs). AML transplants were performed in CR1 (n=5), early 1st relapse (n=3), CR2 (n=3), MDS phase post CR1 (n=2), early 3rd relapse (n=1), and primary refractory disease (n=1); 7/15 AML patients had intermediate risk and 7/15 poor risk cytogenetics (1 no data available). All 5 MDS patients were previously untreated; all had INT-1 risk disease on IPSS. Donors were HLA-matched siblings in 14 cases and VUD in 6. A total of 6 patients have died, including 2 prior to engraftment (1 of hepatic failure and 1 from idiopathic pneumonia syndrome) and 4 after day 75 (relapsed AML 2 cases; acute GVHD 1 case; multi-organ failure 1 case). All 18 patients who survived the initial cytopenic period achieved durable engraftment; 10 (50%) subsequently developed acute GVHD, including grades II-IV in 9 cases (45%) and grades III-IV in 3 (15%). Of the 12 patients with follow-up &gt;3mths post-SCT, 9 (75%) developed chronic GVHD, which was extensive-stage in 8 (67%). At a median follow-up of 2.4 yrs (range 0.1–5.2 yrs), overall and event-free survival at 2 years for the whole cohort are both 66%. Conclusions: Our experience suggests that allogeneic SCT with FluMel conditioning in elderly patients AML /MDS is associated with acceptable treatment-related toxicity and significant long-term survival. Further studies on this transplant approach in older patients are warranted.

scholarly journals The prognostic value of tip-to-apex distance (TAD index) in intertrochanteric fractures fixed by dynamic hip screw

2012 ◽  
Vol 4 (4) ◽  
pp. 32 ◽  
Author(s):  
Ali Sadighi ◽  
Jafar Ganjpour Sales ◽  
Sahar Alavi
Keyword(s):  
Dynamic Hip Screw ◽  
Intertrochanteric Fractures ◽  
X Ray ◽  
Wide Acceptance ◽  
Grade 5 ◽  
Screw Position ◽  
Hip Screw ◽  
Grade 3 ◽  
The Many ◽  
Type Of Fracture

Intertrochanteric fractures (ITFs) are the most common type of fractures requiring surgical intervention. They also have the highest surgical mortality among orthopedic operations. Among the many different techniques used for fixation of this type of fracture, use of the Dynamic Hip Screw (DHS) has gained wide acceptance. This current study was designed to assess positive predictive value of tip-to-apex distance (TAD) index in the prognosis of patients treated with DHS. The study was designed according to a descriptive-analytic protocol, made up of 100 cases of ITFs caused by falling, treated in the Shohada Orthopedic Center, Tabriz, Iran. All patients underwent lateral and antero-posterior hip X-ray to measure TAD index. The cohort was followed for three months after DHS placement. Of a total of 100 cases (53 male, 47 female) with a mean age of 76.7 years (range 29-100 years), 43% had grade 4, 29% grade 3, 21% grade 5, 5% grade 2 and 2% grade 6 osteoporosis. The screw position was postero-inferior in 57%, central in 40% and superior in 3% of patients. Minimum and maximum TAD index were 20 and 28 mm, respectively. Mean TAD was 23.5 mm. There were no post-operative complications in 84% of cases. Screw failure was the most common complication in the remaining 16% of patients. The study shows a statistically significant correlation between TAD index and cut-off rate in patients with intertrochanteric fractures of femoral bone treated by DHS. This validates the use of TAD index in determining the prognosis of patients treated by DHS.

scholarly journals INTER-TROCHANTERIC FRACTURES;

2019 ◽  
Vol 26 (03) ◽  
Author(s):  
Farhad Alam ◽  
Mudassar Jabeen
Keyword(s):  
Internal Fixation ◽  
Case Series ◽  
Deep Infection ◽  
Dynamic Hip Screw ◽  
Intertrochanteric Fractures ◽  
Superficial Infection ◽  
Group A ◽  
Hip Screw ◽  
Group B

Introduction: Hip fractures are a leading cause of death and disability among elderly. Approximately half of these injuries are intertrochanteric fractures and the incidence is continuously increasing. These fractures are the most common injuries around the hip region and are more common in elderly people. Different types of implants were tried at different times for internal fixation of these fractures, of which dynamic hip screw has remained the most popular one. But with the advent of some newer implants, the efficacy of dynamic hip screw is being questioned. Objectives: To determine the results of dynamic hip screw as a method of internal fixation in closed stable as well as unstable intertrochanteric fractures of femur in adults. Design: Descriptive case series. Setting: The study was conducted in orthopedic department Allied Hospital Faisalabad. Period: 11months (from 26th, march, 2015 to 25th Feb, 2016). Subjects and Methods: Sixty cases of intertrochanteric fractures were included and operated for internal fixation with dynamic hip screw under fluoroscopic guidance. Pre, per and post-operative findings during hospital stay and follow-up period were recorded. Results: We had a total 60 cases, 20 patients in group A stable intertrochanteric fractures and 40 patients in group B unstable intertrochanteric fractures. We have reported the follow up study up to 20 weeks. There were 10 (50%) male and 10 (50%) female in group A. In group B 27 (67.5%) males and 13 (32.5%) females. The youngest pt was 25 years in group A and 16 years in group B. The mean age in group A was 59.10 and st/deviation 16.942. In group B mean age was 54.85 and st/ deviation 14.123. Infection rate in group A was 5%. In group B superficial infection was 5% and deep infection was 2.5%. Nonunion in both groups was 5%. The failure rate was 5% in group A and 20% in group B. Conclusion: The use of Dynamic hip screw with aside plate is associated with good results and acceptable complication rate. Dynamic hip screw is implant of choice in both stable and unstable intertrochanteric fractures.

scholarly journals Evaluation of osteoporotic trochanteric fractures treated with cement-augmented dynamic hip screw

2016 ◽  
Vol 2 (3) ◽  
pp. 147
Author(s):  
Rahul Kumar Chandan ◽  
Dharampal Verma ◽  
R. C. Meena ◽  
Jakir Husain
Keyword(s):  
Weight Bearing ◽  
Trochanteric Fracture ◽  
Fracture Site ◽  
Dynamic Hip Screw ◽  
Intertrochanteric Fractures ◽  
Partial Weight Bearing ◽  
Hip Screw ◽  
Lost To Follow Up ◽  
Partial Weight

<p class="abstract"><strong>Background:</strong> Dynamic hip screw (DHS) has been the standard treatment for stable trochanteric fracture patterns. However, primary stabilization with dynamic/sliding hip screw is not always successful, especially in osteoporotic fractures. Internal fixation in such a situation may achieve a satisfactory initial fracture site reduction, but late fracture collapse into varus during weight bearing, can lead to a high failure rate. Since 1975, polymethylmethacrylate (PMMA) cement-augmented DHS have been used as a solution in unstable ITFs by adding an anchoring ability to the lag screw.</p><p class="abstract"><strong>Methods:</strong> A series of 33 osteoporotic intertrochanteric fractures were operated with cement augmented dynamic hip screw. One patient lost to follow up. All patients were then allowed partial weight bearing walker aided ambulation under the guidance of physiotherapist on the second or third postoperative day. The patients were followed radio logically and clinically at regular intervals (1st month, than at 3rd month and then at 6th month interval after surgery). Results were graded as excellent (score &gt;31), good (score 24-31), fair (score 16-23), and poor (score &lt;16). Clinical result was given according to Salvati and Wilson scoring.<strong></strong></p><p class="abstract"><strong>Results:</strong> Total 33 patients were taken for the study they were followed for minimum 6 months and at 6 months the clinical outcome was rated as per the Salvati and Wilson scoring system. One patient lost to follow-up. Final clinical results as evaluated by Salvati and Wilson scoring were; excellent in 24 cases (75%), good in 7 cases (21.88%), fair in 1 case (3.12%) and poor in 0 cases (0%). There were no non-union, AVN, implant failure and screw cut-out in our study.</p><p><strong>Conclusions:</strong> The surgical management of intertrochanteric fractures with PMMA augmented DHS provide a stable fixation with moderate pain free early mobilisation and better outcome in osteoporotic patients without the complications of superior screw cut-out, sliding collapse, and with the appropriate placement of bone cement along with proper amount (4-5 ml) of cement we can also reduce the cement related complications such as delayed healing, nonunion, heat necrosis and avascular necrosis.</p>

PERTROCHANTERIC FRACTURE FEMUR;

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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