Comparitive Analysis of Outcome of Proximal Femoral Nail Antirotation II (PFNA-II) and Dynamic Hip Screw (DHS) in the Management of Intertrochanteric Fractures of Femur

Background: To compare the clinical and radiological outcomes of patients with intertrochanteric fractures treated with PFNA-II versus DHS. Material & Methods:50 adult patients with inter-trochanteric fractures, >20 years old, were randomly distributed into the PFNA-II and DHS groups. DHS with side-plate and proximal femoral nail A-II of appropriate size was used. The patients were regularly followed up till 1 year post-operatively. The clinical, radiological and functional evaluations were done at regular intervals. The peri-operative, early and delayed complications were recorded, and the final outcome of either group was evaluated using the Harris Hip Score. Results:In the DHS group, the mean Harris Hip Score was slightly lower than that of the PFNA-II group at six month follow-up. However, at the 1 year follow-up, both the groups achieved similar Harris Hip Scores. Conclusion:PFNA-II provides a significantly shorter operative time with a smaller incision that leads to lesser blood loss and wound-related complications. However, the incidence of procedural errors was significantly higher in PFNA-II when compared with DHS as it is a technically more demanding procedure that leads to more implant failures and consequent re-operations.

Clinical effect of dynamic hip screw combined with CPM on intertrochanteric fractures in old patients / 中国康复理论与实践

@#ObjectiveTo investigate the clinical effect of dynamic hip screw (DHS) combined with continuous passive motion (CPM) on intertrochanteric fractures in old patients.MethodsThirty-six old patients with intertrochanteric fractures were treated with DHS internal fixation and began to exercise isometric contraction of quadriceps femoris and to move the big joints of affected limb with CPM machine on the 3rd day after operation.ResultsAll the patients were averagely followed-up for 14 months. According to the effective standard, 26 cases were excellent, 9 cases good and 1 case poor with a 97.2 percentage of fineness. All fractures healed well with no loosening and dislocation of internal fixation. Only one case with type of Evans Ⅲ remained less hip inversion.ConclusionDHS is a good method to treat intertrochanteric fractures of old patients under good preoperative disposal.

The association between the“Tip-Apex Distance”value and cut-out of the lag screw from the femoral head:a clinical retrospective study / 中华创伤骨科杂志

Objective To confirm the association between the“Tip-Apex Distance (TAD)”and cut-out of the lag screw from the femoral head.and to analyze other factors leading to the cut-out.Methods The complete radiographic and clinical data of 106 patients with femoral intertrochanteric fractures were available for this study. They were 65 men and 41 women,with an average age of 52.4 years (range,20 to 83 years).According to Evans classification.19 cases belonged to typeⅡ.25 to typeⅢ,32 to typeⅣ,29 to typeⅤ,and one to type R.The bone quality was classified by Singh rating system:44 cases were rated as typeⅥ.34 as typeⅤ,23 as typeⅣand five as typeⅢ.They were treated with open reduction and fixation with 135?dynamic hip screw (DHS).According to the finding of Baumgaertner that“TAD”beyond 25 mm would grcatly increase the risk of cut-out,the patients could be divided into two groups:59 cases with“TAD”less than 25 mm and 47 greater than 25 mm.Results The mean duration of follow-ups was 14.45 months (range,4.5 to 28.0 months).Of the 15 cases whose“TAD”was more than 30 mm,one had the cut-out.Of the seven cases whose“TAD”was more than 40 mm,two had the cut-out (P=0.000). The average age of the three patients was 78.7 years (range:75 to 83 years) and 27.1 years older than that of the 103 patients whose fracture healed (P=0.000).They belonged to the unstable intertrochanteric fracture of the femur (two to Evans type V and one to type R).The reduction was assessed as excellent in 43 cases,good in 47 cases,fair in nine cases (of whom one had the cut-out),poor in seven cases (of whom two had the cut-out). Conclusions The cut-out of the lag screw from the femoral head can be caused by age,fracture type and stability of reduction and“TAD”.The greater the“TAD”value,the greater possibility of cut-out.

Comminuted intertrochanteric fractures: Should the lesser trochanteric fragment be fixated? / 中华创伤骨科杂志

Objective Unstable intertrochanteric hip fractures are characterized by comminution of the posteromedial cortex and a fragment of variable size containing the lesser trochanter. This paper is to discuss whether it is necessary to perform reduction and fixation for this fragment. Methods 67 cases of intertrochanteric fractures were treated by dynamic hip screw (DHS) fixation between March 2001 and September 2002 and followed up for a minimum of 1 year. Their treatment results were retrospectively analyzed. Results No nonunion, coxa vara or failure of internal fixation occurred in all these patients. Conclusion If DHS provides stability, screw fixation of the lesser trochanteric fragment is unnecessary.

The treatment of proximal femoral fracture / 中华创伤骨科杂志

Proximal femur consists of femoral head, femoral neck and trochanter. The neck and trochanteric parts of femur are easy to get fractured under conbolution forces. As the conservative treatment tends to cause high rates of complication and mortality, more and more surgeons vote for early internal fixation in recent years. The best treatment for femoral neck fracture is now internal fixation with cannulate screws, especially for the patients with good bone density, fundus and intertrochanteric fractures as well as the type I, type Ⅱand part of type Ⅲfractures in Gardon's classification. Although intertrochanteric fractures are relatively stable, but internal fixation is necessary for good results and prevention of complications. DHS(dynamic hip screw)are advisable for A1, part of A2 and A3 intertrochanteric fractures in AO classification, especially for A1 cases. PFN (proximal femoral nail) is designed for intertrochanteric fractures, inversion and elevation intertrochanteric fractures. In order to get better prognosis in patients older than 70 years and with serious osteoporosis and A2 3, A3 3 fractures, we designed a special kind of prosthesis for them and therefore get satisfactory results.

Treatment of femoral intertrochanteric fractures by dynanic hip screw(DHS) internal fixation: report of 42 cases / 中华创伤骨科杂志

Objective To discuss the clinical effects of treatment of femoral intertrochanteric fracture by DHS internal fixation. Methods 42 cases with femoral intertrochanteric fracture were treated by DHS internal fixation. According to AO classification, there were 16 cases of type A1,14 A2,and 12 A3. Results 36 patients were followed up for 6 to 18 months, with an average of 10 months. Their results were satisfactory. Conclusion Treatment of femoral intertrochanteric fractures with DHS internal fixation is an effective method.

Treatment of intertrochanteric fractures with dynamic hip screw and cannulated screws / 中华创伤骨科杂志

Objective To discuss the application value of DHS and cannulated screws in treatment of the intertrochanteric fractures . Methods 23 cases of intertrochanteric fractures were treated with DHS and cannulated screws and 20 cases were followed up for an average period of 12 months. Results All the fractures healed . The recovery of function was excellent in 90%cases. Conclusions Using DHS and cannulated screws to treat the intertrochantenic fractures easily leads to anatomical reduction and rigid fixation, and gives large definitive rotational stability.

Treatment of Comminuted Trochanteric Fractures with Dynamic Hip Screw and DHS Trochanter Stabilizing Plate / 대한정형외과학회잡지

It has been emphasized that the treatment of choice for the trochanteric fracture of the femur is open reduction and rigid internal fixation. Regarding the stability of the fracture, most reports were focused on the comminution of the medial cortex, but few reports were paid attention to the additional fracture of the greater trochanter. This paper was aimed to evaluate the fragment of the greater trochanter on the maintenance of reduction. We treated 23 cases of unstable trochanteric fractures in which 16 cases were treated with Dynamic Hip Screw (DHS) alone, and 7 cases were treated with DHS and additional DHS Trochanter Stabilizing Plate (TSP). We compared the two groups and the results were as follows: 1. The average lag screw slipping distance was 17.1mm in DHS Group and 10.0mm in TSP Group. 2. The average distance of lateral displacement of greater trochanter over the trochantric fractures was 11.5mm in DHS Group and no change in TSP Group. The above results suggested that the comhined use of DHS Trochanter Stabilizing Plate with Dynamic Hip Screw provided good results in the treatment of uristable intertrochanteric fractures with completely detached greater trochanter and reverse oblique fracture.