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.

The natural history of greater trochanteric pain syndrome: an 11-year follow-up study

Background Greater trochanteric pain syndrome (GTPS) is a musculoskeletal condition which can cause disability and reduce quality of life. However, limited evidence is available on the long-term outcomes of people with GTPS. Our aims were to determine the long-term prevalence of GTPS; to calculate the proportion of people with GTPS who had developed hip osteoarthritis (OA); and to determine the level of function and quality of life, 11-years after initial GTPS diagnosis. Methods A prospective 11-year natural history study. Two groups [GTPS group (n = 24), asymptomatic control (ASC) group (n = 20)] were evaluated at baseline, 12-months and 11-years. At 11-years all participants completed the modified Harris Hip Score (mHHS), Oswestry Disability Index (ODI) and Assessment of Quality-of-Life questionnaire. At 11-year follow-up 20/24 GTPS and 19/20 ASC participants were clinically assessed for GTPS and hip OA, completed the 10 metre-walk-test, timed up and go, and hip abduction and external rotation strength testing. Results At 11-year follow-up 45.0% of GTPS participants had GTPS compared to 5.3% of ASC participants (p = 0.008), OR [95% CI]: 10.19 [1.95, 104.3], and 35.0% of GTPS participants were clinically diagnosed with hip OA compared to none of the ASC participants (p = 0.002), OR [95% CI]: 21.6, [2.3, 2898.0]. GTPS participants reported more pain and disability than ASC participants via the ODI, mean difference [95% CI]: 6.1 [0.7, 11.6] but not the modified Harris Hip Score, mean difference [95% CI]: -3.3 [-10.3, 3.7]. Both groups had similar levels of quality of life and measures of function. Conclusions GTPS is a chronic condition: people with GTPS at baseline had twice the odds of being clinically diagnosed with GTPS or hip OA than the control group at 11-years. Further, there appears to be a temporal relationship between GTPS and the development of hip OA. This finding highlights the need to identify effective treatments that address the underlying impairments associated with GTPS. Pain and function results varied depending on the assessment tools used. Between group differences in quality of life seen at baseline are not found at the 11-year follow-up. The small sample size means the results must be considered with caution. Level of Evidence Level II Natural history Study.

A PROSPECTIVE STUDY OF FUNCTIONAL AND RADIOLOGICAL OUTCOME OF PERTROCHANTERIC FEMUR FRACTURES TREATED WITH PROXIMAL FEMORAL NAIL ANTI ROTATION II ( PFN A2)

BACKGROUND: Femoral Inter-Trochanteric fracture is one of the most frequently occurring fractures in the elderly, usually following trivial trauma. In the younger age group of people, it occurs almost always due to high velocity trauma. OBJECTIVES: This study aimed to study the functional and radiological outcomes of operative management of intertrochanteric fracture treated by PFN-A2. MATERIAL & METHODS: A prospective study of 20 cases of intertrochanteric femur fracture treated by PFN-A2, minimum 6 months of follow up. All cases are evaluated according to Modified Harris Hip Score on residual effects on clinical ground at final examination. Pain & functional capacity are the two basic considerations for this scoring system. Points are given for pain, function, range of motion & absence of deformity. RESULT: Functional result according to Modified Harris Hip score was found to be excellent in 11(55%) patients, good in 5(25%) patients, fair in 3(15%) patients & poor in 1(5%) patients. poor outcome occurs due to development of complications. CONCLUSION : PFN A2 has the advantage of minimal incision, shorter operative time, rapid rehabilitation, lower medical complications among other options.

Does Juvenile Idiopathic Arthritis Affect the Course of Legg–Calvé–Perthes Disease? A Case-Control Study with a Mean Follow-Up of 8 Years

Background: This study aimed to determine the clinical and radiological course in children who had Legg–Calvé–Perthes disease (LCPD) associated with juvenile idiopathic arthritis (JIA). Methods: In a retrospective chart review between 2007 and 2019, eight consecutive JIA patients diagnosed with concomitant LCPD were identified and compared with a case-control group of 10 children with LCPD only. Results: LCPD was diagnosed at a mean age of 8.1 years (3.0–14.7) in children with JIA as compared to 6.1 years (2.9–10.0) in controls. According to the modified Harris Hip Score (mHHS), four children with JIA and all controls had an excellent result. Regarding the fragmentation severity and the duration of each stage, we found no differences using the lateral pillar and modified Elizabethtown classification. Five hips were classified as Stulberg I/II, two hips as Stulberg III, and one hip as Stulberg V with no evidence of hip dysplasia or severe overcoverage in either group. Conclusions: The radiological outcome of LCPD did not differ between both groups, while the clinical outcome was slightly better in controls. Physicians should be aware that children with LCPD may have JIA too. In suspicious cases, further investigations are recommended, and patients should be referred to pediatric rheumatologists.

Gibson approach and surgical hip dislocation according to Ganz in the treatment of femoral head fractures

Background The purpose of the study is to evaluate clinical and radiological outcomes in those patients with femoral head fracture, treated with open reduction and internal fixation through Gibson approach and Ganz flip trochanter osteotomy. The treatment of Pipkin fractures is very challenging, especially for small trauma centers, because of the unusual fracture patterns and high-level surgical skills required. Case presentation Between 2017 and 2020, nine cases of Pipkin fractures came to the Emergency Department at the Trauma Center of our Hospital in Rome. Inclusion criteria were the diagnosis of femoral head fracture, the open reduction and internal fixation as surgical choice and at least 24 months follow-up. Patients older than 65 years and those treated through total hip replacement or combined hip procedure (CHP) were excluded. Thus, five patients were included in our case series. The clinical outcome was evaluated according to Western Ontario and McMaster Universities Arthritis Index, Vail Hip score, modified Harris Hip score and Merle D’Aubignè Postel score. Radiographic assessment was scored according to Epstein-Thompson classification and heterotopic ossification was assessed through Brooker classification. The mean follow-up was 24 months (range 12-24). Average modified Harris Hip score was 92.1 points (range 75.9–100), and the average Vail score was 81.8 (range 55-95). WOMAC score was assessed in three different subscales, pain (A), stiffness (B) and physical condition (C), with the following results: 1.4 A (range 0-7), 1.2 B (range 0-6) and 6.4 C (range 0-22). Merle d’Aubignè Postel score resulted excellent for four patients and good for one patient. According to Epstein-Thompson score of the radiological outcome, four patients showed a good result and one a fair result. No mechanical or infective complications occurred in the five patients. Conclusions Gibson’s approach and surgical hip dislocation through Ganz trochanteric flip osteotomy allow a good exposure of the femoral head and acetabulum, giving us the possibility to perform an anatomical reduction of the fracture. In our case series, satisfactory clinical and radiological short-term results were obtained without significant complications.

Safety and efficacy of a single intra-articular injection of hyaluronic acid in osteoarthritis of the hip: a case series of 87 patients

Background Osteoarthritis (OA) is the most prevalent form of joint disease and commonly affects the hip. Hip OA is associated with a high socioeconomic burden. Intra-articular hyaluronic acid (HA) injection may be of benefit but quality evidence for HA use in hip OA is lacking. The purpose of this study was to assess the safety and efficacy of ultrasound guided injection of a high molecular weight, non-animal derived, stabilised HA (NASHA) in patients with mild to moderate hip OA. Methods This single site study is an analysis of prospectively collected outcome data for 87 consecutive patients over a 2-year period who received a single HA (Durolane) injection for symptomatic hip OA. Inclusion criteria were male or female patients over 18-years of age with mild to moderate hip OA on x-ray. Patients with severe hip OA were excluded. The primary outcome measure was a modified Harris Hip Score (mHHS) questionnaire at baseline and 6-weeks with a minimal clinically important difference (MCID) of 10 points. All adverse events were recorded and assessed. Results Data from 87 patients, 49 women and 38 men with mean age of 54 (SD = 10.8) were analysed. At baseline, mean mHHS was 58.47 (SD 14.31). At the 6 week follow up, mean mHHS improved to 71.30 (SD 16.46), a difference of 12.83 (p < 0.01). This was greater than the MCID of 10. No significant adverse events were encountered. Five patients reported short-lived injection site pain. Conclusion A single injection of HA (NASHA) in the setting of hip joint OA was both safe and efficacious in this 87 patient cohort. Improvement in pain and function as measured with mHHS was statistically significant and reached the MCID of 10. Trial registration The study was retrospectively registered on the 1st of February 2021 in the Australian New Zealand Clinical Trials Registry with registry number ACTRN12621000098831. All research was performed in accordance with the Declaration of Helsinki.

730 Is The Total Hip Arthroplasty For Hip Fracture Comparable With Matched Elective Cohort ? A Prospective Study

Aim Total hip replacement (THR) has been effective in managing osteoarthritis but its effectiveness in managing neck of femur fracture (#NOF) is debatable due to higher risk of morbidity and mortality. We aimed to review the selection criteria for trauma THR and to compare the functional outcomes and complication profiles of trauma THR cohort with elective THR cohorts. Method we prospectively reviewed patients undergoing THR for #NOF with follow-up. The functional outcomes, any further complications-related admissions and death within a year were noted for subsequent analysis. All the patients and data collected were subsequently matched with the elective cohort. Results Forty-one matched cases were included in our study. The Modified Harris Hip Score (mHHS) was significantly lower pre-operatively in elective cohort (41.4±14.3 VS 60.3±22.2, P &lt; 0.001) and achieved significantly higher score than trauma cohort 1-year post operatively (88.2±10.9 VS 82.6±12.7, P = 0.029). As for the mHHS Function, the trauma cohort achieved similar value with the pre-operative score post-operatively, and no significant difference was witnessed between the trauma and elective cohort post-operatively (35.1±7.4 VS 37.6±7.7, P = 0.142). mHHS Pain score was significantly higher in trauma cohort pre-operatively (19.8±15.3 VS 12.7±6.3, P = 0.034), but the score was significantly higher than trauma cohort 1-year postoperatively (42.7±4.4 VS 40.7±7.7, P = 0.027). Both cohorts had similar complication rate. Conclusions Our study further justified the clinical indication of THR for #NOF. With careful selection, trauma THR can achieve similar HHS function and better pain score. Further randomized controlled trials are warranted to justify our findings.

Mid- to long-term clinical outcomes of arthroscopic surgery for external snapping hip syndrome

ABSTRACT This study evaluated the outcomes of arthroscopic surgery for the treatment of external snapping hip at 2- to 10-year follow-ups. Eighteen patients with refractory external snapping hip treated by arthroscopic surgery were enrolled in this prospective study. All patients underwent unsuccessful conservative treatment for more than 3 months before surgery. We made diamond-shaped defects on the iliotibial band and resected peripheral fibrosis tissues for iliotibial band release with an arthroscopic approach. The visual analog scale (VAS), modified Harris hip score and return to previous level of activity were evaluated as functional outcomes. In addition, residual discomfort or the presentation of complications was also investigated. The average follow up period was 7 years. The modified Harris hip score increased from 70.08 preoperatively to 93.14 postoperatively, and the VAS score decreased from 3.67 preoperatively to 1.17 2 weeks after the operation and declined to 0.33 at the last follow-up. Neither recurrence of snaps nor complications were recorded. Two patients complained of a tight sensation with tenderness after exertion. Our clinical outcomes were compatible with those of previous studies, and no long-term complications were noted, even with a relatively longer follow-up period than what was reported in previous studies. Arthroscopic surgery is a safe and effective treatment that can provide promising long-term clinical outcomes for patients with refractory external snapping hip.

Midterm Outcomes Following Hip Labral Augmentation

Objectives: Arthroscopic hip labral preservation techniques have evolved over the last decade. Arthroscopic hip labral augmentation with iliotibial band (ITB) autograft placed into a labral defect with viable circumferential fibers is a novel treatment option to restore the hip suction seal and improve functionality. The purpose of this study is to determine midterm (3-5 year follow up) outcomes of arthroscopic hip labral augmentation procedure. Methods: Patients who underwent arthroscopic hip labral augmentation from August 2011 to March 2017 were prospectively evaluated. Pre- and post-operative patient reported outcome scores were compared and included SF12 PCS, SF12 MCS, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Modified Harris Hip Score (mHHS), Hip Outcome Score (HOS) (Activities of Daily Living (ADL) and Sport). Post-operative Tegner Activity Scale and patient satisfaction (1 – 10) were also evaluated. Results: One hundred and six patients underwent arthroscopic hip labral augmentation with minimum 3-year follow-up. Mean follow-up was 5-year follow-up (range, 3 to 9.2 years). All patient reported outcomes improved after labral augmentation (SF12 PCS 39±8 vs. 50±10, p>0.01; mHHS 59±15 vs. 79±21, p<0.01; WOMAC 31±16 vs. 16±17, p<0.01; HOS ADL 64±17 vs. 84±21, p<0.01; HOS Sport 41±22 vs. 71±29, p<0.01). Median post-operative Tegner score was 4. Median post-operative patient satisfaction was 9 out of 10 (range, 1-10). In terms of survivorship, 12 patients (11%) required revision surgery and 6 (5.7%) converted to total hip arthroplasty (THA). Conclusions: Arthroscopic hip labral augmentation is a successful treatment option for patients that have viable circumferential fibers present at the time of arthroscopy. This technique continues to show improved patient reported outcomes and is another hip labral preservation technique that may help reestablish the intra-articular fluid suction seal.

Evaluation of functional outcome of displaced fracture neck of femur in elderly treated with cemented bipolar prosthesis by modified Harris hip score

<p><strong>Background: </strong>The current research was conducted to determine the functional outcome of the displaced fracture neck of femur in elderly patients treated with cemented bipolar hip prosthesis.</p><p><strong>Methods:</strong> The present research was a prospective study of 44 cases of displaced fracture neck of femur admitted to our institute between October 2017 and October 2019. Cases were chosen on the basis of inclusion and exclusion criteria. Cases were surgically treated with cemented bipolar hip hemiarthroplasty and functional findings were recorded with modified Harris hip score.</p><p><strong>Results:</strong> In our series of 44 cases there were 30 females and 14 males, with a maximum age of 92 years, minimum age of 65 years, and the average age was 72.72 years. At one-year follow-up, the average modified Harris hip score was 86.75% (maximum score of 95 and a minimum score of 66), overall, 20 patients (45.46%) achieved excellent, 16 patients (36.36%) achieved good, 5 patients (11.36%) achieved fair and 3 patients (6.82%) achieved poor results. 81.82% of the patients returned to the pre-fracture level of activity and independent ambulation. Patients had few complications like limb length discrepancy, 36.3% of patients had limb lengthening between 1 to 1.5 cm.</p><p><strong>Conclusions: </strong>In<strong> </strong>elderly patients with displaced neck femur fractures, cemented bipolar hip prosthesis provides good functional outcome<strong>.</strong> However further study for a longer period in a larger sample with a direct comparison between the cemented versus uncemented groups is required.</p>