Online ISSN: 2515-8260

Keywords : harris hip score


Prospective Study of Functional Outcome of Comminuted Unstable Inter-Trochanteric Fracture with Cemented Bipolar Prosthesis in Elderly Patients

Laxman Choudhary, Sachin Pachori, Chetan Mehra, Mohit Kumar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 358-369

Introduction: An intertrochanteric femur fracture is one of the most important health problems amongst the elder population.
Aim: To evaluate the functional outcome and complications of cemented bipolar arthroplasty in unstable intertrochanteric femur fracture in Indian elderly patients.
Methods: This study was conducted in the Department of Orthopedics, SMS medical college, and associated groups of hospitals, Jaipur between July 2017 to Dec 2019. 30 cases of unstable [four-part] Trochanter fracture have been included in this study.
Results: The average age of the study patient was 75 years with the involvement of the left side in 55%. There was no case with the poor radiological result. There were two cases reported with limb lengthening less than 2 cm, and two patients with limb shortening one with < 2cm and one with > 2cm but these patients had good harris hip scores. At the final 1-year follow-up harris hip scoring system, 36-36% of patients had an excellent result, 46.66% had a good result, 10% of patients have fair results and 6.66% have a poor result. The patients who showed poor scores suffered from multiple medical problems and poor preoperative general physical health.
Conclusion: According to our result, we believe that cemented bipolar hemiarthroplasty is of choice in the freely mobile elderly patient above seventy years of age with an intertrochanteric femoral fracture.

A PROSPECTIVE STUDY TO ANALYSE THE SURGICAL OUTCOME OF POSTERIOR ACETABULAR FRACTURES.

Dr. N.Vishnu Vardhan, Dr. Biju Ravindran, Dr. Yadav Vinod Ramlal

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 231-238

Acetabular fractures incidence accounts for 3 patients / 100,000 / year during the last 2 decades. Among acetabular fractures posterior wall accounts for most common acetabular fracture type (25%). The aims and objectives of the study was to evaluate the functional and radiological outcome of posterior acetabular fractures treated with different surgical techniques and the possible post operative complications.
METHODS
A total of 27 patients who had a history of either motor vehicle accident or accidental fall and were radiologically diagnosed with posterior acetabular fracture as per Judet and Letournel classification and underwent surgery for the same. Radiographs were taken after each follow up and patients were evaluated for functional outcome by Modified Harris Hip Score and surgical complications. Statistical analyses were performed using the Statistical Package for the Social Sciences software A p<0.05 was considered statistically significant.
RESULTS
In the present study, the age group range was between 20 and 71 years, and the mean age in the study was 41.9 years. Road traffic accident was the most common cause of fracture (80%) followed by accidental fall (20%) in our study. Right acetabular fracture was the most common (60%) followed by left (40%). Radiological union was achieved in thirteen cases (45%) by 4 months and in 12 cases (55%) by the end of 12 months whereas 2 patients developed non-union. Functional outcomes of all the cases were assessed in terms of Harris hip score grading. 60% of the cases had good, 15% excellent, 20% fair and 5% poor outcome in our study.
CONCLUSIONS
Operative treatment of displaced acetabular fractures gives satisfactory functional results. Functional outcome is better with patient operated within one week of injury than a delay of more than one week

The functional outcome of intracapsular fracture of femoral neck with modular bipolar prosthesis

Dr. Rakshith Kumar K, Dr. KM Pawan Kumar, Dr. Sunil Santhosh

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 278-285

Fracture neck of femur is a leading cause of hospital admissions in elderly age group. The number of such admissions is on a rise because of increased longevity, osteoporosis and sedentary habits. Conservative methods of treatment is not acceptable because it results in nonunion with unstable hip and limitation of hip movement as well as complications of prolonged immobilization like bed sores, deep vein thrombosis and respiratory infections. The present study was a prospective study of 20 cases of fracture neck of femur admitted to hospital. Cases were selected according to inclusion and exclusion criteria i.e., patients with intra-capsular fracture neck of femur above the age of 50yrs. Medically unfit and patients not willing for surgery were excluded from the study. At the final one year follow up assessment with Harris Hip Score 6 patients (30%) achieved 'Excellent' result, 9 patients (45%) achieved 'Good' result, 2 patients (10%) achieved 'fair' result and 3 patients (15%) achieved 'poor' result. Overall, 75% of the patients achieved an excellent or good result. On enquiry regarding the overall satisfaction with the procedure and return to pre-fracture levels of activity, 8 patients (35%) were 'very satisfied', 12 (50%) were 'fairly satisfied' and 2 (15%) were 'not satisfied'.

Functional outcome of subtrochanteric femur fracture treated surgically with long proximal femoral nail

Dr. E Saikrishna, Dr. Punith Kumar PC, Dr. Girisha KG

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 3036-3042

Background and objectives: Subtrochanteric area is described as the region from the lesser trochanter to 5cm distal of proximal femur. It is one of the most challenging fractures for the orthopaedic surgeons. The cause of frequent comminution is that these fractures occur at the junction of trabecular bone and cortical bone where the mechanical stress is highest. Conservative management of subtrochanteric femur fractures poses difficulties in obtaining and maintaining a reduction, making operative management the preferred treatment. This study is aimed to prospectively evaluate the clinical and functional outcomes of subtrochanteric fractures treated with Long PFN.
Material & Methods: 30 patients above the age of 18 years with subtrochanteric fractures were included in the study. All patients were followed up post-operatively at 6 weeks, 12 weeks and every 6 weeks thereafter till fracture union was noted then at 6 months, 9 months and 1 year. Functional evaluation of the patient was done on each follow up.
Results: A total of 30 patients (22 males and 8 females) were evaluated which with age ranging from 18 years to 80 years with most patients in between 60-80 years; 53.33% of the cases were road traffic accidents, 30% due to fall from height and 16.66% due to trivial fall with right side being more common side affected. In our study most of the cases belong to Seinsheimer type IIIA (30%) Mean duration of hospital stay was 11 days. Out of 30 cases, excellent results were seen in 60% of cases in our study.
Conclusion: Long PFN is an effective, efficient and biomechanically stable device for the treatment of subtrochanteric fractures with a high rate of bony union and good functional outcome.

Early functional outcome between Moore and Modified Hardinge approach in hemi-replacement hip arthroplasty – A Prospective Interventional Study.

Dr.Manjunath.Patil, Dr.Sangamesh.V.Hawaldar, Dr.Anirudh. Madhav

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 634-645

Introduction: Hemiarthroplasty is a common treatment for patient with a fragility displaced femoral neck fracture. The surgical approach used for hemiarthroplasty is expected to affect the treatment outcomes, in terms of dislocations, performance in daily activities, quality of life after the procedure and the learning curve for surgeons. However, little is known about how the approaches influences the functional outcome following hemi arthroplasty. We hypothesized that both approaches would give comparable results.
 
Aim : To assess the overall functional outcome in patients undergoing hemi replacement hip arthroplasty using Moore’s approach and modified Hardinge approach.
Material and methods: In a prospective interventional study between January 2020 to June 2021 which included 43 hips with a displaced Fracture Neck of Femur at RajaRajeswari medical college and hospital, Bangalore. Sample size was calculated using formula n=Z2*(SD)2/L2. Subjects were assigned to treatment groups using simple random sampling technique. Intra-operative and immediate post-operative parameters was entered in MS EXCEL spread sheet and analysis was done using Statistical Package for Social Sciences (SPSS) version 22.0. The student’s t-test was used for normally distributed data and the Mann-Whitney U test for ordinal data. The chi-squared test or Fisher’s exact test were used for nominal data. Patients were followed up for a duration of 6months post-operatively. Functional outcome was assessed by Harris Hip Score (HHS).
Results: The mean age was 70.46 years and 31 (72.09%) patients had left sided hip involvement. Mean operating time was significantly more in the Modified Hardinge’s group (112 minutes) compared to the Moore’s group (91.30minutes). Length of incision and amount of blood loss was significantly high in Moore’s approach (p <0.001). Two patients (8.6%) had posterior dislocation of hip postoperative and one patient (4.3 %) had superficial surgical site infection in Moore’s group. Mean Harris Hip score at 6weeks (65.42 ± 5.70, 70.68 ± 4.81, p value <0.03) and 3 months (71.21 ± 5.57, 76.35 ± 5.25, p value <0.004) follow-up was significantly higher in Modified Hardinge’s Group and 6 months (84.31 ± 6.19, 85.9 ± 2.55, p value >0.05) did not show any significant difference between the two groups.
 
Conclusion: Adopting the Modified Hardinge’s approach instead of the posterior approach in hip hemi arthroplasty for femoral neck fracture patients could lower the rate of complications

A Clinical Study To Evaluate The Functional Outcome Of Fracture Of Femoral Neck With Bipolar Prosthesis

Dr Virender Singh Kadyan, Dr Karan Alawadhi

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 829-832

Background: The advantages of bipolar hemiarthroplasty compared to total hip arthroplasty were that the surgical procedure was simple, the volume of blood was small, and the incidence of dislocation was low.The present study was conducted to evaluate the functional outcome of fracture of femoral neck with bipolar prosthesis.
Material & Methods: Patients who had fracture of neck of femur were selected for the study. Patient were analysed clinically and radiologically. Required investigations were done. A total of 40 cases were selected or the study. Allpatientswere followed upforaperiodof 1year atregularintervals.Diagnosisconfirmed by radiograph. HarrisHip Score was recorded.
Results: The maximum patients belong to age group 50-60 years (62.5%). Females were predominant in the study (67.5%). Patients with left side being affected in 65% of the patients. The most common prosthesis used in the study was uncemented bipolar prosthesis (87.5%) and in 12.5% patients cemented prosthesis was used. In our study, the final Harris Hip Score as evaluated at one year follow-up. Overall, 7 patients (17.5%) achieved Excellent result, 24 patients (60%) achieved Good result, 7 patients (17.5%) achieved fair result and 2 patients (5%) achieved poor result.
Conclusion: The present study concluded that hemiarthroplasty with bipolar prosthesis shows better results.

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.