A comparative study of functional outcome of short proximal femoral nail with long proximal femoral nail in proximal femoral fractures

Background: Trochanteric femoral fractures are often seen in patients aged they can be caused by high-energy or low-energy trauma or may be pathological. Particularly in the elderly, hip fractures are a major cause of increased mortality and morbidity. Because of the decreased physical capacity, concomitant systemic diseases, and increased vulnerability to environmental dangers, even low-energy trauma can cause unstable femoral trochanteric fractures in this age group. Compare the functional outcome of the short proximal femoral nail with a long proximal femoral nail in proximal femoral fractures.Methods: This retrospective study was conducted in the Department of Orthopaedics, Karpaga Vinayaga Institute of Medical Sciences and Research Centre, Chengalpattu Dist., Tamil Nadu, India. (KIMS & RC). Palmer/Parker score is obtained for the functional outcome of the short proximal femoral nail with a long proximal femoral nail in proximal femoral fractures.Results: It is concluded from our study that proximal femoral nailing is an attractive and suitable implant for Proximal Femoral Fractures and its use in unstable intertrochanteric fractures is very encouraging.  Conclusions: The database of our retrospective study regarding age & sex incidence, clinicopathological features and therapeutic outcome was comparable to other studies in various literatures

Proximal femoral nail- outcome and complications: a prospective study of 125 cases of proximal femoral fractures

Background: Fractures of the proximal femur are relatively common injuries in adults and common source of morbidity and mortality among the elderly. Fractures of the proximal femur include trochantric and subtrochantric fractures. The present study was designed to evaluate and analyze the role of proximal femoral nail (PFN) in the treatment of proximal femoral fractures.Methods: It was a prospective study on 125 cases of proximal femoral fractures. The fractures were classified according to AO classification. Salvati and Wilson Score were used for functional assessment.Results: In this study at 6 months follow up, union was achieved in 123 cases, open reduction was performed in 11% of cases (14 cases). Technical and mechanical complications were noted in 21% cases (27 cases). Reoperation rate was 4% (Five cases). According to Salvati and Wilson scoring system excellent results were seen in 36% of cases (45 cases), good results in 46% cases (58 cases), fair result in 13% cases (16 cases) and poor results in 5% cases (6 cases). Conclusions: It is concluded from our study that proximal femoral nailing is an attractive and suitable implant for Proximal Femoral Fractures and its use in unstable intertrochantric fractures is very encouraging

Comparative study between proximal femoral nailing and dynamic hip screw with proximal femoral locking compression plates in intertrochanteric fracture of femur

Background: Intertrochanteric fractures occur in people with poor bone quality, about half of the intertrochanteric fractures are comminuted and unstable. The purpose of the present study was to compare the outcome of surgical treatment of proximal femoral fracture by dynamic hip screw (DHS), proximal femoral nail (PFN) and proximal femoral locking compression plate (PFLCP).Methods: This prospective comparative observational study had included cases presented with intertrochanteric fractures of femur attended orthopedic OPD and emergency department were treated with dynamic hip screw (DHS), proximal femoral nailing (PFN) or proximal femoral locking compression plate. Post-operative x-rays were done to assess reduction and progress of union (non-union/mal-union), any post-operative complications e.g. operative wound infection, implant failure etc.Results: In our study, we found that PFNs prove to be more useful in difficult fractures with a subtrochanteric extension or reversed obliquity. The rotational stability was higher when proximal femoral nail is used in these fractures. The incidence of wound infection was found to be lower with intramedullary implants which resulted in early ambulation of the patients. Conclusions: In our study, we found that proximal femoral nails prove to be more useful in difficult fractures with a sub-trochanteric extension or reversed obliquity. The rotational stability was higher when PFN is used in these fractures. The incidence of wound infection was found to be lower with intramedullary implants which resulted in early ambulation of the patients. Non-union of trochanteric fracture although is a rare entity

Radiologic and functional outcome in patients with ipsilateral fractures of proximal femur and shaft treated by long proximal femoral nailing

Background: Combination of ipsilateral proximal femur and shaft of femur fractures are one of the rare fractures which were previously managed with two different implants for each fracture. Various studies have shown that long proximal femoral nailing is as effective as two different implants in fracture healing.Methods: 25 cases in the age group of 20-80 years with ipsilateral proximal femur and shaft of femur fractures were enrolled from July 2014 to July 2017 and treated with long proximal femoral nailing. The cases were followed up at 6 weekly intervals and were assessed for their functional outcome using Friedman and Wyman criteria.Results: Proximal femoral fractures united at an average time of 3.96 ±1.3 months, whereas the mean time shaft of femur fractures took to unite was 5.67±3 months. The mean time patients took to start full weight bearing was 6.15±2.76 months. Functional assessment at 12 months revealed outcome as good in18 (75%), fair in 5 (20.8%) and poor in 1 (4.1%).Conclusions: Long proximal femoral nailing is a good option in managing patients with ipsilateral proximal and shaft of femur fractures

Evaluation of association of vitamin D level with types of proximal femoral fractures in elderly patients

Background: Proximal femoral fractures are very common in elderly patients. These fractures are thought to be associated with osteoporosis. Vitamin D is a possible risk factor for osteoporosis. So, this study was done to evaluate the association of serum vitamin D level with types of femoral fractures in elderly patients.Methods: The study was done between September 2013 to August 2016, 75 patients with age >60 years (male and female both) with proximal femoral fractures were studied. Serum 25-hydroxy vitamin D, calcium, phosphate, alkaline phosphatase levels, liver function test, renal function test, hemoglobin and complete blood counts of all the patients were assessed.Results: On assessment of serum vitamin D in proximal femoral fracture in elderly patients, it shows an increase incidence of proximal femoral fractures in patients with low serum vitamin D level. Fracture of neck of femur was most common among all. Type of fracture has no significant statistical relationship with serum vitamin D levels.Conclusions: Osteoporosis and serum vitamin D level depends on age and sex of the patient. But type of proximal femoral osteoporotic fracture has no association with either grade of osteoporosis or serum vitamin D level

Functional outcomes of reverse distal femoral locking plate in the extra capsular fractures of proximal femur

Background: The optimal management of unstable proximal femoral fractures is controversial. In this prospective study, the functional outcomes of reverse distal femoral locking plate for the treatment of comminuted unstable proximal femoral fractures were assessed. Objectives were to study the functional outcomes of reverse locking plate in extra-capsular fractures of the proximal femur, with respect to quality of reduction, time to bony union, mobility achieved, complications of the procedure, secondary procedures performed (if any) and delayed complications like implant breakage, delayed union, non-union.Methods: 17 patients with unstable proximal femoral fractures were assessed and managed with reverse distal femur plates, and evaluated with X-ray, physical examination, Palmer and Parker mobility score.Results: Union was achieved in all the patients, with average time to union 6.43±1.18 months (range 3-12 months). There was one loosening of implant and wound breakdown, which was managed conservatively. One case of loosening of proximal screws was there, but the fracture united in 9 months with some varus angulation. Superficial infection occurred in one patient, which healed after debridement and IV antibiotics.Conclusions: Taking into consideration the simple surgical technique, good healing rate and minimum complications, it is strongly recommended to use reverse locked distal femoral plates for the management of proximal femoral fractures and further in lean patients, sum-muscular MIPPO should be attempted

What do we know about atypical femoral fractures? Insights and enigmas

Although the existence of atypical femoral fractures is well established and bisphosphonate therapy is thought to be a major risk factor, the underlying mechanisms are poorly understood. Epidemiological data show that atypical femoral fractures account for only a small proportion of diaphyseal subtrochanteric femoral fractures, being about 100 times less common than proximal femoral fractures. Consequently, the existence of atypical femoral fractures does not call into question the extremely favorable risk/benefit ratio of bisphosphonate therapy in patients with osteoporosis. Clearly, the number of fractures prevented by bisphosphonate therapy far exceeds the number of atypical femoral fractures potentially related to bisphosphonates

Proximal femur locking compression plate in complex proximal femoral fractures: a retrospective analysis

Background: Proximal femoral fractures are one of the most common fractures in old age patients. Fixation of these fractures is technically high demanding owing to the high risk of complications. The aim of our study is to analyze the outcomes of proximal femoral locking compression plate (PF-LCP) in these fractures.Methods: We retrospectively analyzed 18 proximal femoral fractures treated with PF-LCP from May 2012 to May 2015. There were 12 females (67%) and six males (33%) with an average age of 59.6 years (range, 32 to 84 years). The peritrochanteric fractures constituted by intertrochanteric and subtrochanteric fractures were classified by Boyd and Griffin classification along with Seinshemier’s classification, respectively. Among that, 14 cases (77%) were of intertrochanteric and four cases (23%) were of subtrochanteric fracture pattern. The functional outcome was evaluated by harris hip score and the parker palmer mobility score one year after surgery.Results: Among 18 patients, 16 patients obtained fracture union without further intervention; two patients required additional bone grafting. There were no cases of hip screw cutting the femoral head. There was no post-operative mortality in our study. The average harris hip score was 85.5 (83-94). The assessment by parker and palmar mobility score was 7.6 (range 4-9).Conclusions: The PF-LCP is a good stable alternative in the treatment of complex proximal femoral fractures. It provides good to excellent bone healing with limited complications

Outcome Analysis in Ipsilateral Proximal Femur and Femoral Shaft Fractures treated by Intramedullary Nail and Plate Combinations: A Comparative study

INTRODUCTION: Ipsilateral proximal femur and femoral shaft fractures are uncommon injuries encountered following high energy trauma. Despite availability of various treatment modalities, controversy exists regarding the optimal management of these fractures. This study compares the intramedullary nailing technique (reconstruction type or long proximal femur nail type) and various plate combinations type (dynamic hip screw with long side plate or combination of dynamic hip screw and compression plate) on the clinical, radiological and functional outcome in patients with these fractures. AIM OF THE STUDY: To study & compare the Clinical, Radiological and Functional outcome of Ipsilateral proximal femur and femoral shaft fractures treated by two methods nailing/plating in our Institute of Orthopaedics and Traumatology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai during the period of March 2016 to September 2016. OBJECTIVES: 1. To assess and study ipsilateral proximal femur and femoral shaft fractures with special reference to fracture anatomy and stability. 2. To assess the results obtained in the treatment of these fracture with intramedullary nail or extra medullary screw plate devices and to compare the results with previously done studies. 3. To evaluate the status of this technique and method with special emphasis on: a. Time for union, b. Assessment of complications, c. Functional outcome, d. Recovery duration after surgery. METHODS: 20 patients with Ipsilateral proximal femur and femoral shaft fractures were operated by one of the two methods- Intramedullary nailing (Group I, 10 patients) and plate combinations (Group II, 10 patients) according to surgeon’s preference. The functional results of the patients were assessed with the system used by Friedman and Wyman. Radiological and functional assessment was done. RESULTS: The mean age was 49 years in group I and 38 years in group II. The average follow up was 14 months. The average union time in group I and group II for proximal femur fracture was 3.78 and 3.80 weeks and for femoral shaft fracture was 8.00 and 11.22 months respectively. 8 patients in group I and 7 patients in group II showed good functional results. Two patients needed re-surgery in group I and 3 patients in group II. CONCLUSION: Ipsilateral proximal femur and femoral shaft fractures can be treated satisfactorily either with intramedullary nailing or plate combinations with similar outcome