Management Of Unstable Intertrochanteric Fracture In Older Age Paitent With Fixation Versus Hemi Or Total Primary Replacement

Background and Objectives: For many decades, attempts have been made to overcome the difficulties which surgeons encounter in the treatment of proximal femoral fractures. Extra medullary and intramedullary implants have improved in recent years, although consensus is lacking concerning the definition and classification of unstable intertrochanteric fractures, with uncertainties regarding treatment. In this era of technologically sound and tested fixation methods we shall compare functional outcomes and complications of various methods available for unstable it fracture fixation. The purpose of this study is to analyze the role of primary hemi arthroplasty in cases of unstable osteoporotic intertrochanteric femur fractures and compare the outcomes with conventional fixation techniques to find out a better management plan for the patient Materials and Methods: This is a prospective study of fifty cases of unstable intertrochanteric fractures, either treated with primary replacement (hemi or total) or fixation. Between january 2016 to january 2018, fifty patients with an unstable comminuted intertrochanteric femoral fracture (AO/OTA type 31A2.2, A2.3, A3.2, A3.3) were enrolled in the study, which was approved by our institutional review board. Inclusion Criteria: 1. More than 60 years of age. 2. All patients with unstable IT femur fracture type a. 31- A2.2 and 31- A2.3 (AO/OTA classification) b. Posteromedial fragmentation c. Basicervical d. Reverse oblique e. Displaced greater trochanter (lateral wall fractures) f. Patient must be ambulatory before sustaining injury Exclusion Criteria: a. Chronically debilitated and bed ridden patients. b. Compound fracture c. Medically compromised patients- ASA grade iv &v d. Local infection ¾ Stable fracture Results: Maximum patients (88%) belonged to 60-80 years of age. Since most of the patient belong to elderly age group, medical comorbidities are very common. Average requirement of blood transfusion needed was significantly higher in hemi replacement group than in fixation group. (Z= 3.56, p<0.05). This indicated the surgical complexity of hemi replacement There was significant shortening of limb in fixation group as compared to hemi replacement. (Z=6.98,p value <0.05) Thus hemi replacement provided faster rehabilitation to the patient. This implies that those patients who had hemi replacement had a significantly better activity of daily living. Harris hip scores were significantly better in hemi replacement group. (Z=4.31, p value<0.05) suggesting better functional outcomes. There was no significant difference between immediate postoperative complications though skin incision, operating time, and blood loss were significantly higher in hemi replacement group.(Z=0.7, p>0.05) but the rate of delayed complications and revision surgeries were significantly higher in fixation group. (p<0.05) There was no significant difference in mortality rates of both groups despite more blood loss and duration of surgeries in hemi replacement group. Interpretation and Conclusion: In conclusion we state that hemi replacement arthroplasty, is a valid treatment option for mobile and mentally healthy patients, as compared to fixation for faster rehabilitation and better activity of daily living. Aims & Objectives: To study the results of primary replacement (hemi or total) in unstable intertrochanteric fractures and compare it with conventional methods of fixation. To assess functional outcome in patients having unstable intertrochanteric fractures in both groups as per Harris hip score. To study the effect of pre-existing illness on final outcome of the patients in both groups. To study the stability of fixation in osteoporotic bones. To note any complication developed. To compare final outcome of this study with that of the other studies

Outcome of Only Posterior Approach in Acetabular Fractures Involving Both Columns

Objective : Clinical outcome in patients with acetabular fractures involving both columns was done in civil hospital, Ahmedabad, aiming to evaluate the efficacy of posterior approach and its radiological and functional outcome.Quality of reduction directly correlates with functional outcomes and increases rate of anatomical reduction when performed <2 weeks. (p<0.05) Materials and methods : 20 cases were included with both column fractures. T-fractures and severely displaced both column with spur sign were excluded. Preoperative radiographs and CT scan were done to evaluate the fracture. Timing of surgery was noted. Surgery was performed under fluoroscopic guidance.Follow-up radiographs and functional status was assessed using Harris hip score. Result : Majority of the patients i.e., 12 out of 20 patients had Harris Hip score >90 after 6 months of the post-op. 4 patients had satisfactory score of 70- 90. 4 patients had poor outcome with score <60. Follow-up radiographs showed good reduction maintenance and union in 15 patients (75%). Conclusion : Its suggested that acetabular fractures involving both columns (excluding severely displaced both column and T fractures) can be managed by a single posterior approach with good clinical outcome along with lesser soft tissue complications and lesser hospital stay.

Effect of proximal femoral nailing in proximal third femur fracture.

Background: Proximal third femur fractures are common fractures seen in community. Till date large numbers of intramedullary and extramedullary implant were used in the treatment of these fractures. These fractures differ significantly from femoral shaft fractures and more proximal femoral fractures in mechanisms, treatment and complications. In 1996 AO group has introduced proximal femoral nail (PFN) for treatment of these fractures. The use of PFN in both these fractures resulted in rotational stability along with union in more anatomic position. Aims & Objective: To prove the advantages of PFN like (1) close reduction of fracture which decreases the blood loss and chance of infection; (2) controlled impaction of the fracture; (3) rotational stability; and (4) load bearing capacity of the implant. Material and Methods: We have done a retrospective study of proximal femur fractures operated with proximal femoral nailing at our institute with follow up of 5 – 36 months. Our study included 30 patients with 8 patients having intertrochanteric fracture and 22 patients having subtrochanteric fracture. Patient was asked to come for follow up on 1, 2, 3 and 6 months from the date of surgery. At each follow up patient was assessed clinically as per Harris Hip score12 and x ray AP/LAT view of hip with femur is taken. Results: It concludes that according to Boyd and Griffith classification type II is the most common variety. In our study excellent to good results noted in 74% patients. All of them performing their routine normal activity well. 5 patients had poor results. Complication rate in our study was much lower. There was only one infection which was known case of diabetes mellitus. Conclusion: The procedure takes less time and the patient can be mobilized fast postoperatively as well after fixation with PFN. PFN should always be considered for management of subtrochanteric fractures in young as well as elderly patients who have multiple pre-existing illnesses. PFN is a closed nailing procedure which achieves a Biological Fracture fixation with minimal blood loss, preserving the fracture hematoma and helping easy healing of the unstable subtrochanteric femoral fracture as well as intertrochanteric fracture.