Online ISSN: 2515-8260

Keywords : Intertrochanteric fracture


De-rotation boot cast and traction in intertrochanteric fracture hip: An implant guy’s envy and a government surgeon’s pride

Bheemsingh Samorekar, Ravikumar Naganur, Vijaykumar Angadi, Yogesh Kadam

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 267-273

Introduction: In this genre of AO principles, most of the fractures are fixed surgically unless it's a
hairline fracture or a very high risk patient with co-morbidities.
Material & methods: Our study involves 23 patients visiting a remote government medical college
with hip intertrochanteric fracture (IT) which were managed non-operatively due to co-morbidities
and/or patients not willing for operative management. All those patients were applied de-rotation boot
cast and applied 10% traction of their body weight over it. Clinical and functional outcome was
measured by Harris hip score at admission, 6, 12 and 18 months follow-up. Radiological evaluation
done by radiographs of hip-AP and lateral views.
Results: Statistical analysis was done using SPSS software for descriptive data. Paired ‘t’ test was
applied to see improvement in functional & clinical outcome (Harris hip score), first between 6 month
follow up and 12 month follow up & 18 month follow up and results were tabulated. The ‘p’ value was
< 0.01 for Harris hip scores analysis by ‘t’ pair test between 6, 12 and 18 months follow-ups and was
significant.
Conclusion: Operative treatment of intertrochanteric fractures though gives early mobilization and less
hospital stay, after one year of injury both non-operative and operative management are of less
significance with respect to mortality, functional outcome and medical complications.

A PROSPECTIVE STUDY- COMPARSION OF DISTAL UNLOCKED VERSUS LOCKED PROXIMAL FEMORAL NAILS IN STABLE INTERTROCHANTERIC FRACTURES

DR.SHIVA SHANKARAN GB, DR.MAHESH KUMAR NB*, DR. ROSHAN KUMAR BN, DR.SURESH I .

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 331-342

INTRODUCTION:
Intertrochanteric fractures are commonly seen in patients over 70yrs of age. In younger population, intertrochanteric fracture occurs due to high velocity trauma, whereas in elderly population, it is most often due to trivial trauma.Cephalomedullary device is used for management of intertrochanteric fracture
OBJECTIVES :
 To compare the surgical results in patients with inter-trochanteric femur fractures Treated by PFN with and without distal locking .
METHODOLOGY:  In a prospective study 40 patients were enrolled with mean age 59.05 years with proximal femur fracture which included 25females and 15 males who underwent Long proximal femoral nail with distally locked and distally unlocked. AO system of classification was used. 31 A1 was the commonest type. Operative time, overall fluoroscopy shots, intra-operative blood loss, the duration of hospitalization, and the surgical complications were noted. Patients were followed up at 6weeks, 3months, 6 months. Functional outcome assessed according to the Harris hip scoring system.
RESULTS:
            Mean age of 59.05 years in PFN without distal locking and 54.75 years in PFN with distal locking.  Mean duration of surgery in PFN without and with distal locking was 40.45 & 54.75 mints respectively.  Mean amount of blood loss  in PFN without  and with distal locking 154.7 ml and 206.3 ml respectively .Mean length of incision in PFN without  and with distal locking was 10.95  & 12.65 cm respectively.  Mean fluoroscopic time in PFN without and with distal locking was 61.3 & 71.3 shots respectively. Mean duration of hospital stay in Group A & B is 15.3 & 15.2 days respectively . Out of 40 cases no case was lost in follow up.  we had good to excellent results in 90%, fair in 10%, we had no case with poor results.
CONCLUSION:
             From this study, we consider that long proximal femoral nailing without distal locking shows subtle advantages for duration of surgery, amount of blood loss, incision length ,fluoroscopy exposure time ,post-op stiffness in stable  intertrochanteric fracture.

A Novel Technique For Reducing Sagitally Unstable Intertrochanteric Hip Fractures

Kumar Rahul, Saksham Mittal, Pankaj Anand, Amite Pankaj Aggarwal

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 1, Pages 818-825

Introduction: Intertrochanteric fractures are common fractures which needs to be reduced
and fixed appropriately for optimum outcome. Poor reduction increases the chances of its
failure by multiple times. Sagitally split fractures are notorious due to the associated flexion
and sagging of distal fragment. Indirect reduction techniques have been used but with less
reliability. Methods: This study tries to evaluate and put forward a technique to fix these
fractures adequately translating into good clinical outcome. the fracture reduction was tried
under traction. A stab incision was put anteriorily to manage the flexion of the proximal
fragment.Conclusion: it is a simple and effective technique. Digital palpation by the
operating surgeon aids in reduction and gets the idea of spatial orientation of the neck and
thus it is easy to direct the guide wire along the direction of the neck which otherwise may
take multiple trials and increased radiation exposure.

A comparative study of 30 cases of intertrochanteric fracture femur in elderly patients treated with Proximal Femoral Nailing Anti Rotation-2(PFNA-2) and Proximal Femoral Nailing (PFN)

Dr.ManjitSingh, Dr.DilmohanSingh Karday,Dr. DharminderSingh

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 3, Pages 3189-3196

Increased life expectancy has led to a considerably increased incidence of proximal femoral
fractures. The standard of peritrochanteric fracture treatment is stable fixation, which allows
early full weight-bearing mobilization of the patient. A prospective, observational and
randomized study was carried out with a total of thirty patients with intertrochanteric femur
fractures admitted in Govt. Medical College and Rajindra Hospital Patiala after fulfilling the
inclusion criteria and were treated with osteosynthesis with proximal femoral nailing antirotation-
2 (PFNA-2) and proximal femoral nailing (PFN) after dividing them into two groups
randomly i.e. Group A and Group B with 15 cases in each. Harris Hip Score was used as criteria
for evaluation of results and functional outcome was graded accordingly. The authors conclude
that PFNA2 gives better results than PFN in intertrochanteric fractures in terms of the amount of
blood loss during surgery, duration of surgery, postoperative complications. However, there is no
difference between the two modalities in terms of duration of hospitalization, fracture union, and
early rehabilitation (mortality and morbidity).