Outcome of Pertrochanteric Femur Fractures with Proximal Femur Locking Compression Plate

Background: Fractures of the proximal femur, including fractures affecting the pertrochanteric region, have become a public health problem. Owing to aging of the population, we have to operate on even more elderly patients who sometimes present with significant co-morbidities. Although conventional implants have given good results in stable peritrochanteric fractures, proximal femur locking compression plate (PFLCP) which has been recently introduced is better suited for comminuted, unstable pertrochanteric fractures and osteoporotic bones. In PF-LCP, bone-implantconstruct so formed is mechanically stable and fixation failure due to screw loosening in osteoporotic bone can be reduced. Materials &Methods: This prospective study was conducted in our institute and was approved by local ethical committee. Twenty-five consecutive patients of either sex with age more than 60 years (range, 60-84) having pertrochanteric fractures were operated upon with PFLCP. A.O classification was followed in the study and Singh’s index for osteoporosis was calculated. Operating time, blood loss and any technical difficulty with the implant were recorded. Patients were followed clinically and radiologically for union at fracture site and implant-related complications for a period of 24 months. The Harris Hip Score was used to document hip functions at final follow-up. Observations: Amongst the 25 patients, the average operation time in our study was 66.60±10.57 minutes. The average radiological union was 3.40±0.63 months (13.6 weeks). Average time for full weight bearing was 13.12±1.90 weeks. There were two cases of wound infection, one case of coxa vara and one case of a proximal screw back-out. There was no case of plate lift or screw breakage. There was no case of non-union. Conclusion: The PFLCP can be a feasible alternative to the treatment of peritrochanteric fractures. Treatment with PFLCP can provide good-to-excellent healing in osteoporotic bones having comminuted and unstable peritrochanteric fractures, with a limited occurrence of complications.

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 usefulness of dual mobility cups in primary total hip arthroplasty patients at a risk of dislocation

This study aimed to evaluate the early results of primary total hip arthroplasty (THA) using dual mobility (DM) cups in patients at a risk of dislocation and compare them with that of fixed bearing (FB) THA. This retrospective study included patients who had undergone primary THA between January 2016 and December 2018 and were at a risk of dislocation. A propensity score-matched analysis was conducted for 63 THA procedures with vitamin-E infused highly cross-linked polyethylene (VEPE) DM bearing and 63 THA procedures performed with FB from the same manufacturer for a mean follow-up period of 3.1 and 3.5 years, respectively. The radiologic outcomes at the last follow-up and incidence of postoperative complications were evaluated and compared statistically between the two groups. The modified Harris hip score (mHHS) was used to assess patient-reported outcomes. Postoperative dislocation occurred in 4 cases (6.3%) in the FB group, but did not occur in the DM group (p = 0.042). There was no difference in the radiologic outcomes and postoperative complications between the two groups. The mHHS at the last follow-up showed satisfactory outcomes in both the groups (DM group, 90.5; FB group, 88.1), without a statistical difference between the groups. The early results of THA using VEPE DM bearing showed better outcomes than that of THA with FB for patients at a risk of dislocation. A longer follow-up period is recommended to assess the stability and overall outcomes.

Short-Term Clinical Efficacy of Femoral Neck System Versus Multiple Cannulated Compression Screws in the Treatment of Garden III and IV Femoral Neck Fractures

Femoral neck system (FNS) , as a novel minimally invasive internal fixation device, has been gradually applied in the treatment of femoral neck fracture.However, there are few related clinical studies on FNS at present, especially there is no clinical report on FNS in treating GardenIII and IV femoral neck fractures. The aim of the present study was to compare the short-term clinical efficacy of FNS and multiple cannulated compression screws (MCCS) in the treatment of Garden III and IV femoral neck fractures. The data of 78 patients with femoral neck fracture who were admitted to three teaching hospitals affiliated to Anhui Medical University and received internal fixation with FNS and MCCS from June 2019 to December 2020 were collected for a retrospective study. There were 39 patients in both the FNS and MCCS groups. The basic data, perioperative data were recorded and compared between the two groups of patients. The results of the study are encouraging. The operation time was shorter in FNS group than that in MCCS group (p<0.001). The post-operative partial and complete weight-bearing time was earlier in FNS group than that in MCCS group (p<0.001). The Harris hip score in FNS group was higher than that in MCCS group (p<0.001). The incidence rate of lateral thigh irritation in FNS group and MCCS group was 0 (0/39) and 33.3% (13/39), respectively (χ2=15.600, p<0.001). The length of femoral neck shortening was significantly shorter in FNS group than that in MCCS group (t=-5.093, p<0.001). In conclusion, The application of FNS for Garden III and IV femoral neck fractures can shorten the operation time, reduce the frequency of intraoperative fluoroscopy, and facilitate the recovery of hip joint function, so it provides a novel choice for the treatment of Garden III and IV femoral neck fractures in young people.

Outcomes of Arthroscopic Decompression of the Anterior Inferior Iliac Spine: A Systematic Review and Meta-analysis

Background: Anterior inferior iliac spine (AIIS) impingement has been increasingly recognized as a source of extra-articular impingement and hip pain. However, no aggregate data analysis of patient outcomes after AIIS decompression has been performed. Purpose: To evaluate outcomes after arthroscopic AIIS decompression. Study Design: Meta-analysis; Level of evidence, 4. Methods: A systematic review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. PubMed, EMBASE, and Cochrane Central Register of Controlled Trials were queried for all English-language studies reporting outcomes of arthroscopic AIIS decompression performed in isolation or in conjunction with hip impingement correction surgery. After screening, 10 articles were included. The indications for AIIS decompression were recorded, and weighted mean improvements in patient-reported outcome (PRO) scores, complication rates, and revision rates were calculated. Results: A total of 547 patients (311 women; 57%) were identified, with a total of 620 operative hips. The mean age was 28.42 ± 5.6 years, and the mean follow-up was 25.22 ± 11.1 months. A total of 529 hips (85%) underwent AIIS decompression, 530 hips (85%) underwent femoral osteochondroplasty, and 458 hips (74%) underwent labral repair. Of the patients, 13% underwent bilateral AIIS decompression. The mean modified Harris Hip Score improved from 61.3 ± 6.9 to 88.7 ± 4.7 postoperatively (change, 27.4 ± 5.7 points; P < .001), the Hip Outcome Score–Activities of Daily Living improved from 67.2 ± 10.6 to 91.1 ± 3.2 postoperatively (change, 24.0 ± 8.0 points; P = .001), and the Hip Outcome Score–Sports Specific Subscale improved from 36.8 ± 19.2 to 82.8 ± 3.8 postoperatively (change, 46.0 ± 18.2 points; P = .002). The pooled risk of postoperative complications was 1.1% (95% CI, 0.1%-2.1%), and the pooled risk of needing revision surgery was 1.0% (95% CI, 0.1%-2.0%). No complication was directly attributed to the AIIS decompression portion of the procedure. Conclusion: PROs improved significantly after hip arthroscopy with AIIS decompression, with a low risk of postoperative complications and subsequent revision surgeries. Failure to identify extra-articular sources of hip pain in outcomes of femoroacetabular impingement syndrome, including from the AIIS, could lead to poorer outcomes and future revision surgery.

Short term analysis of total hip replacement done with constrained acetabular component - functional and radiological outcome

<p class="abstract"><strong>Background:</strong> Dislocation remains at the forefront of complications after primary total hip arthroplasty (THA). In our study, we talk about the use of constrained liners and its outcomes in an unstable hip.</p><p class="abstract"><strong>Methods:</strong> The total number of patients included in the study was 15. The total number of hips in the study were 15. The age group of the patients varied between 51 years and 89 years with mean age group of 73 years. The most common indication in our study was dislocation contributing 60% (n=9) of the hips.<strong></strong></p><p class="abstract"><strong>Results:</strong> The post-operative mean Harris hip score (HHS) at immediate post-operative was 67.6. There was a gradual improvement in the HHS through 6 months (77.6), one year (83.3), two years (86.7) and 3 years (90.33). There were no cases with post-operative septic or aseptic loosening in the radiological analysis. The mean cup inclination was 34.3. Out of the 13 hips, in eight hips the femoral stem was in varus. Five hips had a centrally placed femoral stem. Stability management in THA have seen the component design take centre stage, primarily with the use of larger diameter femoral heads and the rise in popularity of constrained acetabular liners (CAL). Several authors have done studies which talk about the stability of this implant design and the reliability of this implant in unstable hips and in hips where instability was expected.</p><p class="abstract"><strong>Conclusions:</strong> In our study, proximal femur tumours, dislocated total hips, abductor insufficiencies and aseptic loosening all showed good results.</p>

Clinical Outcome and Biomechanical Analysis of Dynamic Hip Screw Combined with Derotation Screw in Treating Displaced Femoral Neck Fractures Based on Different Reduction Qualities in Young Patients (≤65 Years of Age)

Objective. To examine the clinical results and biomechanical mechanism of the dynamic hip screw (DHS) and derotation screw (DS) in the treatment of displaced femoral neck fractures (FNF) based on different reduction qualities in young patients (≤65 years of age). Methods. All patients with FNF who received closed reduction and internal fixation with DHS+DS from January 2014 to August 2019 were retrospectively analyzed. Data on demographics, surgery, clinical outcomes, and postoperative complications were collected. According to the reduction quality immediately after surgery, all patients were categorized into the positive buttress reduction group (PBRG) and the anatomical reduction group (ARG). The complications and clinical outcomes were compared between the two groups. Meanwhile, the biomechanical mechanism of different reduction qualities was further analyzed with finite element analysis (FEA). The distribution of von Mises stress, the peak stress of internal fixation, and the displacement of the proximal fragment were compared between the two groups. Results. A total of 68 patients were included in our study. Among them, 31 were divided into the PBRG while 37 were in the ARG. The surgical time and fluoroscopy time were significantly shorter in the PBRG than in the ARG ( p < 0.05 ). The degree of femoral neck shortening and the varus change of the femoral-neck shaft angle were lower in the PBRG compared to the ARG ( p < 0.05 ). The excellent-good rate of the Harris hip score was higher in the PBRG compared to the ARG (83.9% vs. 64.8%). The FEA results demonstrated that the stress of DHS+CS and the downward displacement of the proximal femoral neck fragment were greater in the ARG than in the PBRG. Conclusion. For displaced FNF with difficulty to achieve reduction, DHS+CS combined with positive buttress reduction was an effective treatment in young patients due to better mechanical support, shorter surgical time, less radiation exposure, and higher excellent-good rate of Harris hip score.

Management of Primary AVN with Total Hip Replacement

Introduction: Avascular necrosis (AVN) of femoral head is a dreadful and disabling condition. Total Hip Replacement (THR) is an effective solution. In this study we have analyzed the results of total hip replacement performed in ShSMCH, Dhaka for AVN of femoral head from July 2018 up to June 2020. Patients and Methods: In this prospective study, 19 total hip replacement were done. All patients were diagnosed as primary AVN of Ficat and Arlet Grade III and IV. Out of 19 patients, 15 patients operated with cementless pressfit implants and 4 patients with cemented implants. Results: Among the 19 patients 12 were male (63.15%) and 7 were female (36.85%). Mean age was 35.57 year. Operation done on right hip in 10 patients (52.63%) and on left hip 9 patients (47.37%). All the patients were evaluated pre-operatively and Harris Hip Score was poor ie, average 41.84. Three months post operatively Harris Hip Score improved significantly 47.36% patients value was 90-100 ie, excellent, 31.57% patients value was 80-90 ie, good and 21.05% patients value was 70-80 ie, fair. None documented as poor. In complication, 1 patient (5.26%) developed serous discharge which resolved with antibiotic treatment after culture and sensitivity. Conclusion: THR is the most effective method of removing pains and distress of end stage AVN of hip. J Shaheed Suhrawardy Med Coll 2020; 12(2): 87-89

Outcome of dynamic hip screw with trochanteric stabilizing plate in treatment of unstable intertrochanteric femoral fractures in elderly patients.

Objective: To know about the outcome of dynamic hip screw with trochanteric stabilizing plate in treatment of unstable inter-trochanteric femoral fractures in elderly patients. Study Design: Descriptive study. Setting: Maqsood Medical Complex, Pak Medical Centre and Habib Medical Complex. Period: August 2016 to July 2018. Material & Methods: Total of 70 patients with unstable inter-trochanteric fracture and age above 60 years were included in the study. The fracture was fixed with dynamic hip screw and trochanteric stabilizing plate. Patients were evaluated every month after surgery for healing of fracture. Final functional outcome was measured at 6 months after surgery with Harris Hip Score. Results: Out of 70 patients 44 (63%) were females and 26 (37%) were males. Mean age was 74.34(SD + 08.31) years with range of 60 to 87 years. Mean Harris Hip Score at 6 months was 85% with standard deviation of± 4.Ten (14%) patients had excellent, 40 (58%) patients had good, 16 (23%) patients fair and 4 (5%) patients poor functional outcome. Conclusion: Excellent and good functional outcome can be achieved in unstable inter-trochanteric fractures fixed with dynamic hip screw and trochanteric stabilizing plate in majority of patients.

Multiple Cannulated Screw Fixation of Femoral Neck Fractures with Comminution in Young and Middle Age Patients

Objective To investigate the distribution and influence of comminutions on femoral neck fracture (FNF) patients after cannulated screw fixation (CSF). Methods From January 2019 to June 2020, a total of 473 patients with FNF treated by CSF, aged 23–65 years, were included in present study. Based on location of the cortical comminution, the FNF patients were assigned as comminution group (anterior comminution, posterior comminution, superior comminution, inferior comminution, multiple comminutions) and without comminution group. The incidence of postoperative complications, quality of life and functional outcomes were recorded in different groups at 1 year-follow up. Results The comminution was more likely to appear in displaced FNF patients (86.8%) compared with non-displaced FNF patients (8.9%), while occurrence rate of comminution was also closely associated with Pauwels classification (3.2% vs 53.5% vs 83.9%, P<0.05). Besides, the incidence of osteonecrosis of femoral head (ONFH, 11.3% vs 2.9%, P<0.05), nonunion (7.5% vs 1.7%, P<0.05), femoral neck shortening (21.6% vs 13.4%, P<0.05) and internal fixation failure (11.8% vs 2.9%, P<0.05) in FNF patients with comminutions, especially with multiple comminutions, was significantly higher than those in FNF patients without comminution. Furthermore, there was a prominently difference in Harris hip score (HHS, 85.6±15.6 vs 91.3±10.8, P<0.05) and EuroQol five dimensions questionnaire (EQ-5D, 0.85±0.17 vs 0.91±0.18, P<0.05) score between FNF patients with comminution and FNF patients without comminution, whereas there was seem to be no significantly difference in Visual analogue scale (VAS, 1.46±2.49 vs 1.13±1.80, P>0.05) score between two groups at 1 year after surgery. Conclusion In our view, the comminution, easily happened in displaced FNF and Pauwel type III FNF, which was deemed to be a risk factor for postoperative complications in young and middle-aged patients underwent CSF, consequently causing an influence on recovery of hip function and life quality. However, further evaluation with better study design, larger sample and long-term follow-up was still imminently applied.