Geriatric Physiotherapeutic Approach for Intertrochanteric Fracture- A Case Report

Hip fractures are a growing concern around the world as the geriatric population increases rapidly. The purpose of this study was to assess the impact of proximal femoral nailing on elderly. Despite the fact that intertrochanteric fracture fixation is generally successful, treatment is difficult when fixation fails. The purpose of this study was to assess the efficacy of an evidence-based protocol designed for the treatment of failed intertrochanteric fractures. When treating an unstable intertrochanteric fracture, there is a lesser risk of implant failure and reoperation, as well as a better postoperative functional recovery is seen. But in some rare cases some implant failures are major and requires a long-term treatment. Intertrochanteric femur fractures, particularly those with unstable patterns, are increasingly being treated with intramedullary implants. Despite the widespread use of nails in the treatment of these fractures, perspectives on the proper length of an intramedullary nail differ. Long nails were created to alleviate the risk of diaphyseal fracture that came with prior short nail designs. The main aim is to govern the unstable nail fixation of the intertrochanteric femoral fractures.

COMPARATIVE STUDY OF HEMIREPLACEMENT ARTHROPLASTY WITH BIPOLAR PROSTHETIC AND PROXIMAL FEMORAL NAIL (PFN) IN UNSTABLE INTERTROCHANTERIC FRACTURE OF FEMURE: INTERVENTIONAL PROSPECTIVE RANDOMIZED STUDY

Background: Intertrochanteric femur fracture incidence has increased due to increased life expectancy and osteoporosis. Methods- The present study was prospectively carried out in 60 consecutive patients of Fracture Intertrochanter Femur and treated with Hemiarthroplasty with Cemented Bipolar Prosthesis and Proximal Femoral Nail. Results: The age of the patients in present study was in range of 60 - 80 years. There was a preponderance of female in present study in both groups. The mean duratioin of surgery in the Bipolar group (91.24±9.21Minutes) was much More That In PFN (53.12 ±6.02Minutes) Group. All patients of Bipolar group was discharged between 4 to 9 days and in PFN group 4 to 12 days after surgery. The average harris hip score in PFN group is 87.32±4.13 and in Bipolar group is 85.02±7.92. Final functional outcome were better in PFN group (P value 0.01) than by Bipolar group and significant. Conclusion: The outcomes of the stable fractures treated with either Bipolar or PFN were similar. Unstable comminuted fractures treated with Bipolar showed significantly better outcomes with all patients having good results. Keywords: Hip Arthroplasty, PFN, Complication

A COMPARATIVE STUDY ON FUNCTIONAL OUTCOME OF UNSTABLE INTERTROCHANTERIC FRACTURE IN ELDERLY TREATED WITH BIPOLAR HEMIARTHROPLASTY AND DYNAMIC HIP SCRE

Trochanteric hip fractures in elderly patients have beneted from advances in internal xation. Early failure of internal xation occurs however in a number of cases. The failure after internal xation had been due to initial fracture pattern, communication, sub-optimal fracture xation and poor bone quality. The aim of this prospective comparative study is to analyze the short term follow up results of unstable Intertrochanteric fractures in elderly treated with bipolar hemiarthroplasty and dynamic hip screw (DHS) xation.

Cement augmentation of the proximal femoral nail antirotation for the treatment of two intertrochanteric fractures - a comparative finite element study

Background There are concerns regarding initial stability and cutout effect in proximal femoral nail antirotation (PFNA) treating intertrochanteric fractures. No study have used finite element analysis (FEA) to investigate the biomechanics. This study aimed to compare the cutout effect, stress and displacement between stable (AO31-A1.3) and unstable (AO31-A2.2) intertrochanteric fractures treated by cement augmented PFNA. Methods Four femoral finite element models (FEMs) were constructed and tested under the maximum loading during walking. Non-augmented and augmented PFNA in two different intertrochanteric fractures were respectively simulated, assuming Tip Apex Distance (TAD) < 25 mm within each FEM. The cutout effect, stress and displacement between femur and PFNA were compared in each condition. Results Cutout effect was observed in both non-augmented femoral head and was more apparently in unstable intertrochanteric fracture model. After reinforced by bone cement, no cutout effect occurred in two models. Stress concentration were observed on medial part of intertrochanteric region and the proximal part of helical blade before augmented while were observed on femoral shaft and the conjunction between blade and nail after augmented in both FEMs. Displacement mainly appeared on femoral head and the helical blade tip before augmented while distributed moderately on intertrochanteric region and the upper part of nail after augmented in both FEMs. The maximum stress and displacement value of femur decreased both in stable and unstable model after augmented but was more significantly in the unstable one. The maximum stress and displacement value of PFNA increased both in stable and unstable model after augmented but was more significantly in the unstable one. Conclusion Our FEA study indicated that the cement augmentation of the PFNA biomechanically enhances the cutout resistance in intertrochanteric fracture, this procedure is especially efficient for the unstable intertrochanteric fracture.

AO/OTA 31A2 and 31A3 Intertrochanteric Fractures Managed by Proximal Femoral Nail Antirotation (PFNA)

Aim: To study the clinical and radiological outcome of unstable intertrochanteric fracture AO/OTA 31A2, 31A3 fixed by proximal femoral nail antirotation Study design: Descriptive cross sectional study. Place and duration of study: Department of Orthopedic Surgery and Traumatology, Pir Abdul Qadir Shah Jilani Institute of Medical Sciences, Gambat, Sindh from 1st January 2016 to 31st December 2019. Methodology: Forty four cases having intertrochanteric fracture AO/OTA 31A2, 31A3 with age ranging from 18 year to 55 year of either gender were selected; patients having close fracture, who were willing were included in the study, while patients older than 55 year and younger than 18 year, AO/OTA 31A1 fracture, open fracture, bilateral injuries, smoker, alcoholic, drug addicted, poly-trauma, pathological fracture and history of poor compliance, psychiatric disease were excluded. Results: There were 26(59.09%) males and 18(40.91%) females with mean age was 41.3±7.7 years. Regarding classification; AO/OTA 31A2 were 33 (75%), and 31A3 were 11 (25%). Mean time for union was 18.5±3.55 weeks. The average time of follow-up was 48.5±6.6 weeks. Harris Hip Score was excellent (90-100) in 31(70.45%), good (80-89) in 7(15.91%), fair (70-80) in 3 (6.81%) and poor (<70) in 3 (6.81%). Conclusion: Intramedullary device proximal femoral nail antirotation can be labelled as implant of choice for unstable intertrochanteric fractures AO/OTA 31A2, 31A3, with fruitful clinical and radiological outcomes, and with fewer complications. Hip Harris score was excellent-good in 86% of the patients. Key words: Proximal femoral nail antirotation (PFNA), AO/OTA 31A2, 31A3, Intertrochanteric, unstable fracture

Radiological and functional outcome of unstable intertrochanteric fractures treated with proximal femoral locking plate

<p class="abstract"><strong>Background:</strong> Intertrochanteric fracture is a common orthopaedic injury sustained in elderly population because of osteoporosis and trivial fall. Life threatening systemic complications occur mainly due to immobility.</p><p class="abstract"><strong>Methods:</strong> We included 62 patients (40 males and 22 females) of unstable intertrochanteric fracture (AO 31 A2 and A3) attending Department of Orthopaedics. They were all subjected to surgical treatment with proximal femoral locking plate. Patients were followed up at 3rd, 6th and 12th month for outcomes variables i.e.; functional (Harris hip score, Palmer and Parker mobility score) and radiological outcomes (neck shaft angle, loss of reduction, union and implant related complications). Statistical analysis was done using Friedman’s test after calculating the data in terms of mean and median using SPSS 20 software.<strong></strong></p><p class="abstract"><strong>Results:</strong> Mean age of our patients was 64 years, 40 were males and 22 females. 50 patients sustained fracture due to trivial fall and 12 due to RTA. 35 out of 62 patients had medical co-morbidites. 26 patients needed open reduction of fracture and 36 were close reduced. 22 of patients had severe comminution (AO A 3 III type). Average blood loss was 254 ml. Mean degree of loss of reduction was 5 degrees in 6th month and 4 degrees in 12th month. Union was achieved in 48 out of 50 patients at 12th month. Most of the patients achieved fair to good functional outcome scores at 12th month of follow up. We noticed difficulties in fracture reduction as well as complications related to implant.</p><p class="abstract"><strong>Conclusions:</strong> PFLP is an effective implant in comminuted intertrochanteric fractures with broken lateral wall. Complications can be minimised by following principles of locking plate meticulously.</p>