Management of Subtrochanteric Fracture Femur- by ProximalFemoralNailing

Background: Numerous variations of intramedullary nailing have been evolved over the years for stable fixation and early mobilisation of subtrochanteric fracture, out of which one is proximal femoral nail. Aims and objectives –We conducted this study with an objective to evaluate the results of internal fixation of subtrochanteric fractures of the femur with proximal femoral nail – AO type Design.Methods:This was a prospective study carried out at our tertiary care institute on 30 patients who had suffered subtrochanteric fracture and were subsequently treated with a proximal femoral nail (PFN). Proximal femoral nail was inserted through the tip of greater trochanter. All patients were followed up for a period of one year; at an interval of 3 months and during each follow-up visit for the functional outcome by modified Harris Hip Score, was assessed in the form of walking, squatting, sitting and rising from chair.Results:Modified Harris hip score was used for the evaluation of results in our study which showed excellent result in 21 patients (70%), good results in 3 cases(10%), fair results in 3 patient (10%) and poor results in 3 cases(10%). The mean Harris hip score in our study was 90.6.Conclusion:PFN is an intramedullary load sharing implant. Reduction and management of subtrochanteric fractures is challenging in traumatology. Proximal femoral nailing spanning whole femur with proximal and distal locking appears to be a satisfactory implant in management of fractures of subtrochanteric femur.

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

<p class="abstract"><strong>Background:</strong> The aim of the study was to evaluate the clinical outcomes of complex subtrochanteric fractures treated by using cephalomedulary nail.</p><p class="abstract"><strong>Methods:</strong> 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.<strong></strong></p><p class="abstract"><strong>Results:</strong> 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.</p><p class="abstract"><strong>Conclusions:</strong> 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.</p>

TP9.1.3The Effect of Hip Fracture Anatomy and Surgical Modality on the Rate of Red Blood Cell Transfusion and Mortality: A Retrospective Analysis

Aims This study assesses the effect of hip fracture anatomy and operation performed on transfusion rates within our centre. We aim to identify patients most likely to require transfusion early, to improve outcomes. Methods A retrospective cohort study of 324 consecutive hip fracture patients presenting to a district general hospital over one year. Data was collected from patient records, local transfusion laboratory and the national hip fracture database. Results 324 hip fractures were categorised as 188 (58%) intracapsular, 121 (37%) intertrochanteric and 15 (5%) subtrochanteric fractures. The most common operation performed was hemiarthroplasty (128), followed by dynamic hip screw fixation (75). 75 (23%) patients received a blood transfusion. 15% of intracapsular, 35% of intertrochanteric and 33% of subtrochanteric fractures received transfusions. 47% of long intramedullary nails, 45% of short intramedullary nails, 29% of dynamic hip screws, 18% of hemiarthroplasties and 9% of total hip arthroplasties resulted in blood transfusions. One-year mortality was higher in the transfused cohort at 52% compared to 30.5% in non-transfused, with an odds ratio of 2.466 (95% CI 1.4555 to 4.178, p = 0.0008). Conclusions Almost a quarter of hip fracture patients received a blood transfusion, which was associated with an almost two and a half times increased risk of one-year mortality. Extracapsular (intertrochanteric and subtrochanteric) fractures most commonly led to transfusions. Long intramedullary nailings were most associated with transfusions and total hip arthroplasties the least. Patients more likely to require transfusion and subsequently have a higher one-year mortality risk can therefore be identified at presentation.

Finite Element Analysis of Proximal Femoral Nail Anti-Rotation Blade Combined with Cerclage Wire Fixation for Osteoporotic Subtrochanteric Fracture

Osteoporosis is a type of systemic bone disease wherein the patient is highly vulnerable to bone fracture because of the decrease in bone density and quality, destruction of the bone microstructure, and an increase in the bone fragility. Most of the osteoporotic subtrochanteric fractures are unstable in nature, requiring the conservative treatment of a long-duration bed rest and traction; this condition is prone to complications resultant from extended bed rest, often leading to death. Presently, the preferred treatment is internal fixation, such as sliding hip screws, blade plates, locking compression plates, and femoral intramedullary nails [1-8]. Owing to its valuable biological properties, intramedullary nail can be used for the optimal fixation of subtrochanteric fractures [9-11]. Unless any contraindication exist, immediate tolerable weight-bearing activities may be allowed to patients with subtrochanteric femur fractures who have been treated with statically locked intramedullary nails [12]. Considering that the proximal femoral fracture occurs under the traction of the surrounding muscles, it is extremely challenging to perform precision reduction and fixation in the surgery. Inappropriate reduction and selection of internal fixation can easily lead to failure of internal fixation, resulting in complications such as lower limb shortening deformity, hip varus deformity, and nonunion of fracture. Presently, good outcomes have been reported with the use of PFNA combined with cerclage wire for the treatment of subtrochanteric fracture of the femur [13-15]. There are few studies to help decide whether PFNA should be combined with cerclage wire or used alone according the Seinsheimer classification of subtrochanteric fractures.

1533 The Effect of Hip Fracture Anatomy and The Modality of Surgery on Red Blood Cell Transfusion and Mortality: A Retrospective Analysis

Introduction Hip fractures are common, with most requiring surgical management. Blood loss occurs from the fracture and intraoperatively. Often, blood transfusions are required. Hip fractures can be classified by their anatomy: intracapsular, intertrochanteric or subtrochanteric fractures. This study assesses the effect of fracture pattern and operation performed on transfusion rates within our centre. We aim to identify the patients most likely to require transfusion early, to improve outcomes. Method A retrospective cohort study of 324 consecutive hip fracture patients presenting to a district general hospital over one year. Data was collected from electronic patient records, the local transfusion laboratory, and the national hip fracture database. Results 324 hip fractures were divided into 188 (58%) intracapsular, 121 (37%) intertrochanteric and 15 (5%) subtrochanteric fractures. The most common operation performed was hemiarthroplasty (128), followed by dynamic hip screw fixation (75). 75 (23%) of all patients received a blood transfusion. 28 (15%) of intracapsular, 42 (35%) of intertrochanteric and 5 (33%) of subtrochanteric fractures received transfusions. 47% of long intramedullary nails, 45% of short intramedullary nails, 29% of dynamic hip screws, 18% of hemiarthroplasties and 9% of total hip arthroplasties resulted in blood transfusions. One-year mortality in the transfused cohort was 52% and 30.5% in non-transfused. Conclusions Almost a quarter of hip fracture patients received a blood transfusion, which was associated with an increased risk of mortality. Intertrochanteric fractures most commonly led to a transfusion. The operation most associated with transfusions were long intramedullary nailings, and total hip arthroplasties were the least.

1260 Comparison of the Intramedullary Nail and Dynamic Hip Screw in the Management of Subtrochanteric Femoral Fractures

Aim Subtrochanteric femoral fractures are said to occur in the 5cm of bone immediately distal to the lesser trochanter. This study aims to compare peri-operative outcome measures in patients with subtrochanteric fractures treated with either an IMN, or an alternative construct, the dynamic hip screw (DHS). Method A retrospective review of all subtrochanteric fractures presenting to our institution between October 2014 and May 2019 was performed. All patients were classified into two treatment groups, IMN or DHS. These groups were compared on outcome measures including radiation dose area product (DAP), length of hospital stay, estimated blood loss, mortality, and re-operation/complication rate. Results A total of 86 patients presented to our institution with a subtrochanteric femoral fracture during the study time period. Of these, 74 (86%) received an IMN and the remaining 12 (14%) received a DHS. The only comparative outcome measures showing a statistically significant difference between the two groups were radiation DAP and blood loss., both of which were significantly lower in the DHS group. All other comparative outcome measures failed to reach statistical significance. Conclusions Although current United Kingdom national guidelines advise all subtrochanteric femoral fractures should be treated with an IMN, the outcome measures used in this study suggest that the DHS, which also has a reduced implant cost compared to an IMN, may be the better option in some cases. There may not be one optimal implant for all subtrochanteric fractures. Recent biomechanical research suggests that the DHS is able to provide adequate fixation in more stable fracture subtypes, whereas an IMN may be required for unstable subtrochanteric fractures.