ABSTRACT
Abstracts: Background: Hip fractures are devastating injuries that most commonly affect the elderly and have a tremendous impact on both the health care system and society. It is now accepted universally that internal fixation is the best method of treatment of intracapsular fracture as it allows early stabilization and patient mobility.1 Methodology: This study consists of 20 cases of intertrochanteric fracture treated with dynamic hip screw and plate. Results: In our study most of the fractures were Boyd and Griffin type II fracture with 14 patients (70%) and type I were 6 patients (30%). In the study trochanteric fracture was common in old age group and were treated with Dynamic Hip screw, because of its sliding mechanism which gives compression at the fracture site. Discussion: The average time of consolidation of fracture in our study was 20 weeks. It was 9 months in conservative method with deformity as seen by Frew.2 So, dynamic hip screw is a better implant for the treatment of trochanteric fracture. This is because of sliding screw, which gives compression at the fracture site. Due to its sliding mechanism, the fracture union rate and movement at hip joint were good in most of our cases. Due to its sliding mechanism the fracture union rate and movement at the joint were good in most of the cases. Conclusion: DHS is a good modality of treatment for internal fixation of intertrochanteric fractures Boyd and Graffin’s type I & II. However good medial cortical opposition either by close reduction or open reduction with/without medial displacement of distal femoral fragment is mandatory for good result.
ABSTRACT
Intertrochanteric fracture of the femur is one of the commonfractures in the elderly. Dynamic Hip Screw (DHS) fixation is the gold standard for treatment of intertrochanteric femoral fracture. Conventional methods of achieving reduction prior to instrumentation require utilization of a traction table. A manual traction technique applied in the supine position using only a translucent table was devised to do away with the use of traction table. The rationale for this technique includes enhanced ease of set
ABSTRACT
Purpose: To evaluate the results of blade plate fixation and bone grafting for the treatment of failed intertrochanteric hip fractures. Materials and Methods: Eight patients were treated with 95° blade plate fixation and bone grafts were performed in 7 patients. The mean age of the patients was 73 years old and the mean follow-up period was 26 months (range, 6 to 65 months). Clinical and radiological results were evaluated based on pain, walking ability, union period, and maintenance of reduction. Results: 6 of 8 patients obtained a solid union after a median period of 20 weeks. The neck-shaft angle was changed from 118° to 133° postoperatively. One patient underwent revision of a bipolar hemiarthroplasty due to failed blade plate fixation and varus malunion occurred in one patient Conclusion: Blade plate fixation and bone grafting for failed internal fixation of intertrochanteric hip fractures can provide a solid union and a good clinical result.
Subject(s)
Humans , Bone Transplantation , Follow-Up Studies , Hemiarthroplasty , Hip Fractures , Hip , Transplants , WalkingABSTRACT
Objective To discuss the advantage and the poinf for affention to expandable(self-locking)intramedullary nail based upon its clinical application in intertrochanteric hip fracture.Methods Ninety-five cases of fresh intertrochanteric hip fracture admitted from Jan.2004 to Jan.2006 were reviewed retrospectively.All cases were divided into three groups:group A was treated with expandable proximal femoral nail(PFN),group B was treated with dynamic hip screw(DHS),group C was treated with Gamma nail.Perioperaive indices of patients were statistically analyzed,such as operative wound,blood loss,drainage,time to get out of bed,femoral neck angle and so on.The medium-term or long-term curative effect of each treatment was assessed.Results Of three groups,group A experienced relieved operative trauma,i.e.reduced operative time and less blood loss,compared with the other two groups.In the long run group A enjoyed more excellent cases and a higher recovery rate than that in other two groups,with a significant difference in former index between groups.Conclusions Expandable PFN is superior to DHS and Gamma nail in terms of controlling operative trauma.Despite its relatively safer than intramedullary nail system,it is still essential for surgeons using expandable PFN to carefully inspect radiograph preoperatively,for the purpose of knowing the medullary dimension and avoiding excessive medullary expansion.
ABSTRACT
[Objective]To discuss a reasonable treatment for unstable intertrochanteric hip fractures in senile patients by comparing the effects of PFN fixation and hemiarthroplasty.[Method]Totally 82 intertrochanteric hip fractures in senile patients with complete clinical data were retrospectively analyzed,who were treated with hemiarthroplasty or PFN fixation from April 2005 to April 2007.Forty-six were treated with hemiarthroplasty,36 were treated with PFN fixation.All of them had multiple medical co-morbidities.According to modified Evens-Jensen classification,all of them belonged to unstable fracture.Comparison was made between the two treated groups in terms of the length of incision,operative time,the blood lost,blood transfusion during or after surgery,time for bed rest postoperatively,postoperative complications and St.Michael hip score one year after surgery.[Result]The average duration of follow-up for PFN fixation and hemiarthroplasty were 16 and 18 months respectively.Compared with the group of hemiarthroplasty,the group of PFN fixation experienced longer operation time,longer time for bed rest postoperatively,less blood lost,less blood transfusion during or after surgery,shorter incision length,and the differences between two groups had statistical significance (P0.05).[Conclusion]Both of the two methods are reasonable treatment for unstable intertrochanteric hip fractures in senile patients.
ABSTRACT
[Objective]To compare the fixation effects of cannulated compression screws and dynamic hip screws.[Method]From July 2000 to December 2006,152 old patients with intertrochanteric hip fracture were fixed with cannulated compression screws(n=68) and dynamic hip screws(n=84).They were followed up and their complete clinic data were obtained.A retrospective comparison was made between the two differet fixation devices in terms of operation time,blood loss,intraoperative and postoperative complications,functional recovery one year postoperatively and treatment expenses.[Result]The differences in operation time,blood loss between 2 groups had statistical significance(P0.05) for the Evans types Ⅰ,Ⅱ patients,but had statistical significance(P
ABSTRACT
[Objective]To discuss a reasonable treatment for unstable intertrochanteric hip fractures in senile patients by comparing the effects of hemiarthroplasty and DHS fixation.[Method]Totally 126 intertrochanteric hip fractures in senile patients with complete clinical data were retrospectively analyzed,who were treated with hemiarthroplasty or DHS fixation from June 2002 to October 2005.Of the 126 patients,53 were treated with hemiarthroplasty,73 were treated with DHS fixation.All of them had multiple medical co-morbidities and were combined with severe osteoporosis.According to modified Even-Jensen classification,all of them belonged to unstable fractures.Comparison was made between the two treated groups in terms of operative time,blood transfusion during or after surgery,time for bed rest postoperatively,postoperative complications and St.Michael hip score one year after surgery.[Result]The average duration of follow-up for hemiarthroplasty and DHS fixation was 16 and 18 months respectively.Compared with the group of DHS fixation,the group of hemiarthroplasty experienced shorter time for bed rest postoperatively,fewer postoperative complications and higher St.Michael score 1 year after surgery,and the differences between two groups had statistical significance(P0.05).[Conclusion]Cemented hemiarthroplasty has the advantages of allowing early full weight bearing after surgery,low complication rate and satisfactory functional recovery.It is a reasonable treatment for unstable intertrochanteric hip fractures in senile patients.
ABSTRACT
[Objective]To discuss the effective treatment of complicate intertrochanteric hip fracture.[Method]Thirty-five cases with complicate intertrochanteric hip fracture.The class of fracture,surgery method,operating time,complicatico,union rate of fracture were amounted statisti cally.[Result]All the 35 cases were surgical treated,l 4 cases with PFN(priemeral femur nail),21 cases with DHS(dynamic hip screw)with mean time of operation 1.8 h(1.5~3 h),mean amount of blood loss during operation 300 ml(150~500 ml),mean time in bed 2.4 monthes (1.2~3 monthes),mean following-up time 12 months(6~16months).Thirty-one cases got union,3 cases union time delayed,1 case nounion,union rate was 88.5%.Four cases suffered hip iversion( 11.4%),the screw in the neck removed in 6 cases(8.5%),5 cases feeled pain in hip( 14.2% ).[Conclusion]The complicate intertrochateric hip fracture is a kind of fracture which can not be treated easily.Using PFN and DHS can not control the stability effectively.Additional fixation of the greater trochantar fracture is necessary.Added out-fixation and avoid early bearing are useful.
ABSTRACT
Objective To explore a reasonable treatment for intertrochanteric hip fractures in the aged patients by comparing the fixation effects of cannulated compression screws and intramedullary fixation nails. Methods From January 1998 to December 2004, in our department 123 old patients with intertrochanteric hip fracture were fixed with cannulated compression screws or intramedullary nails. They were followed up and their complete clinic data kept. According to the Evans classification, of the 51 patients who received treatment with cannulated compression screws for their anterograde intertrochanteric hip fracture, 14 were type Ⅰ , 24 type Ⅱ , 10 type Ⅲ and three type Ⅳ , while of the 72 patients who received treatment with intramedullary nailing, 10 were type Ⅰ , 12 type Ⅱ , 28 type Ⅲ , 14 type Ⅵ , and eight retrograde intertrochanteric hip fractures. A retrospective comparison was made between the old patients treated with the two different fixation devices in terms of operative time, blood loss, transfusion, average hospitalization time, intraoperative and postoperative complications, functional recovery one year postoperatively and treatment expenses. Results The differences between the two groups in operative time, blood loss, transfusion, treatment expenses were of statistical significance (P0.05). Conclusions Cannulated compression screws should be chosen for old patients with anterograde intertrochanteric hip fractures of Evans types Ⅰ & Ⅱ or of Evans types Ⅲ & Ⅳ who are at a high risk, in a poor health or severely osteoporotic state. For patients with unstable Evans types Ⅲ & Ⅳ or with retrograde intertrochanteric hip fractures, intramedullary nails are suitable.