Role of PFN in ipsilateral fracture neck and shaft femur: a single solution to double fracture

Background: Ipsilateral, concomitant femoral neck and shaft fracture is a rare fracture pattern that presents a diagnostic and treatment challenge. A variety of management modalities have been tried to treat this complex fracture pattern ranging from conservative approach to recently introduced proximal femoral nails (PFN).Methods: We analysed the retrospective data of 25 consecutive patients who had sustained a high energy trauma who had concomitant ipsilateral fractures of the femoral shaft associated with proximal femur fractures treated with PFN between January 2010 and January 2017.Results: Average follow up period was 1.2 years. All ipsilateral neck and shaft fractures were united with proximal femur nail (PFN). Neck fracture union averaged 4.3 months (range, 3–6 months). Shaft fracture union averaged 5.4 months (range, 4–7 months). Eighteen patients (70%) had a good functional result, five patients (21%) had fair result and in two patients the result (9%) was poor.Conclusions: We observed although technically demanding, the reconstruction nail is an acceptable, cost effective and minimal invasive alternative for the management of concomitant ipsilateral fractures of the femoral neck and shaft, with a good functional outcome and fewer complications

Role of PFN in ipsilateral fracture neck and shaft femur: a single solution to double fracture

Background: Ipsilateral, concomitant femoral neck and shaft fracture is a rare fracture pattern that presents a diagnostic and treatment challenge. A variety of management modalities have been tried to treat this complex fracture pattern ranging from conservative approach to recently introduced proximal femoral nails (PFN).Methods: We analysed the retrospective data of 25 consecutive patients who had sustained a high energy trauma who had concomitant ipsilateral fractures of the femoral shaft associated with proximal femur fractures treated with PFN between January 2010 and January 2017.Results: Average follow up period was 1.2 years. All ipsilateral neck and shaft fractures were united with proximal femur nail (PFN). Neck fracture union averaged 4.3 months (range, 3–6 months). Shaft fracture union averaged 5.4 months (range, 4–7 months). Eighteen patients (70%) had a good functional result, five patients (21%) had fair result and in two patients the result (9%) was poor.Conclusions: We observed although technically demanding, the reconstruction nail is an acceptable, cost effective and minimal invasive alternative for the management of concomitant ipsilateral fractures of the femoral neck and shaft, with a good functional outcome and fewer complications

Antifibrinolytic in reducing postoperative blood loss in total hip replacement and its effect on coagulation profile: A prospective randomized study

BACKGROUND: Studies have shown that tranexamic acid reduces blood loss and transfusion need in patients undergoing total hip arthroplasty. However, till date, no study has been large enough to determine definitively whether the drug is safe and effective in total hip arthroplasty. We examined whether intravenous tranexamic acid, when compared with placebo, is safe and effective in total hip arthroplasty. MATERIALS AND METHODS: A prospective, randomized, double blinded study was conducted in a group of 142 patients undergoing total hip arthroplasty divided equally into tranexamic acid group and control group. Our protocol included administration of one dose of 15 mg/kg of TXA (given as infusion over 15 min ) in 100 ml NS just 15 min before incision and the subsequent 8 hourly in TXA group. In control group we have given 100 ml normal saline infusion just before operation and 100 ml NS infusion 8 hourly for 2 days postoperatively. Postoperative blood parameters were recorded. RESULTS: The total postoperative drain output and transfusion requirement was found to be lower in patients who received TXA (352-412 ml) as compared to control group (804-878 ml). We have observed 3 and 4 cases of DVT in TXA and control group respectively. Coagulation profile is least affected in both the groups. CONCLUSION: We conclude that tranexamic acid significantly reduces postoperative blood loss and transfusion requirements during total hip arthroplasty