Study the change of serum osteosclerotin and Dickkopf-3 expression in elderly patients with intertrochanteric fracture / 中国医师进修杂志

Objective:To investigate the changes of perioperative serum osteosclerosis protein (SOST) and Dickkopf-3 (Dkk-3) in elderly patients with femoral intertrochanteric fracture.Methods:Thirty elderly patients who underwent reduction and fixation of femoral intertrochanteric fracture in Baoding Second Hospital from May 2017 to December 2017 were prospectively selected as the observation group; 30 healthy subjects in the same period were selected as the healthy control group. Enzyme linked immunosorbent assay (ELISA) was used to detect the expression of serum SOST and Dkk-3 at 1 d before operation and at 1, 3, 5 d after operation and compared with the same period of healthy physical examination(normal control group). Spearman rank correlation analysis was used to analyze the correlation between SOST and Dkk-3 and disease activity score (ASDAS) and spinal imaging evaluation score (mSASSS).Results:There was a positive correlation between Dkk-3 level and ASDAS score in the observation group ( r = 0.331, P = 0.012); the level of SOST was negatively correlated with the scores of ASDAS ( r = - 0.162, P = 0.017). The levels of serum SOST and Dkk-3 in the observation group were lower than those in the healthy control group: 1.29(1.00, 2.40) μg/L vs. 1.96(1.63, 2.65) μg/L, (6.11 ± 1.15) μg/L vs. (9.81 ± 1.76) μg/L, P<0.05. The levels of serum SOST and Dkk-3 in the observation group increased first and then decreased on the 1st, 3rd and 5th day after operation. The level of serum Dkk-3 increased to the highest level on the 3rd day after operation, and then decreased gradually, but it was still slightly higher than that before operation. The level of serum SOST in the observation group increased to the highest level 1st day after operation, and decreased at 3rd and 5th day after operation. The perioperative serum levels of SOST and Dkk-3 in the observation group were positively correlated, the correlation coefficient was the largest at 1 day after operation ( r = 0.571) and the lowest before operation ( r = 0.119). Conclusions:The perioperative serum levels of SOST and Dkk-3 in elderly patients with femoral intertrochanteric fracture increased first and then decreased. The change of serum SOST level is more sensitive and can be used as a sensitive index to reflect the change of osteogenic ability.

Clinical study on the intervention of suspended moxibustion on deep vein thrombosis of lower extremity after intertrochanteric fracture of femur / 中国实用护理杂志

Objective:To study the clinical application of hanging moxibustion in intervention of deep venous thrombosis (DVT) of lower extremity after intertrochanteric fracture of femur, in order to provide theoretical basis for the clinical application of suspension moxibustion.Methods:By adopting a controlled clinical trial method, a total of 100 patients with femoral intertrochanteric fracture who came to Keqiao District Hospital of Traditional Chinese Medicine, Shaoxing City, Zhejiang Province for orthopaedic surgery from January 2021 to September 2022 were selected by convenient sampling method and randomly divided into the control group and the observation group, 50 cases in each group. The control group was given routine nursing intervention, and the observation group was given the traditional Chinese medicine nursing intervention of hanging moxibustion on the basis of the control group. The changes of coagulation function indexes, hemorheology indexes, hemodynamics, the swelling degree score of the affected limb, and the Visual Analogue Scale (VAS) of the affected limb pain in the two groups of patients with intertrochanteric fracture before and 14 days after the intervention, and the incidence of lower extremity deep venous thrombosis (DVT) in the two groups after 1 d, 3 d, 7 d, and 14 d of intervention were observed and recorded.Results:After 14 days of intervention, D-dimer, fibrinogen and prothrombin time in the observation group were (380.64 ± 41.78) μg/L, (4.51 ± 0.49) g/L and (10.46 ± 1.04) s, respectively, which were better than those in the control group (464.91 ± 46.81) μg/L, (4.82 ± 0.56) g/L and (12.85 ± 1.12) s with statistical difference ( t=9.50, 2.95, 11.06, all P<0.05). After 14 days of intervention, the whole blood low tangential viscosity, whole blood high tangential viscosity and plasma viscosity in the observation group were (8.34 ± 0.42), (3.72 ± 0.28) and (1.21 ± 0.18) mPa/s, respectively, which were significantly lower than (8.90 ± 0.46), (4.13 ± 0.26) and (1.53 ± 0.22) mPa/s in the control group ( t=6.36, 7.59, 7.96, all P<0.05). After 14 days of intervention, the postoperative blood flow, maximum blood flow velocity and average blood flow velocity in the observation group were (1.89 ± 0.26) L/min, (31.57 ± 3.29) cm/s, (34.41 ± 3.62) cm/s, which were significantly higher than (1.45 ± 0.21) L/min, (24.18 ± 2.85) cm/s, (27.96 ± 3.15) cm/s in the control group ( t=9.31, 12.01, 9.50, all P<0.05). After 14 days of intervention, the total incidence of lower limb DVT in the observation group was 2.00%(1/50) , lower than 24.00%(12/50) in the control group, the difference between the two groups was significant ( χ2=10.70, P<0.05). Conclusions:Suspended moxibustion can significantly improve the coagulation function, hemorheology, hemodynamics, swelling and pain of the affected limb in patients with postoperative intertrochanteric fracture of the femur, and reduce the occurrence of DVT in the lower extremity. It is recommended to be widely used in clinical practice.

Outcome of buttress plate-nail construct used for reconstruction of broken lateral wall in intertrochanteric fractures / 中华创伤杂志(英文版)

PURPOSE@#Intramedullary implants are well accepted fixation of all types of intertrochanteric (IT) fractures, both stable and unstable types. Intramedullary nails have an ability to effectively support the posteromedial part, but fail to buttress the broken lateral wall requiring lateral augmentation. The aim of this study was to evaluate the outcome of proximal femoral nail augmented with trochanteric buttress plate for broken lateral wall with IT fractures, which was fixed to the femur through hip screw and anti-rotation screw nail.@*METHODS@#Of 30 patients, 20 had Jensen-Evan type III and 10 had type V fractures. Patients with IT fracture of broken lateral wall and aged more than 18 years, in whom satisfactory reduction was achieved by closed methods, were included in the study. Patients with pathologic or open fractures, polytrauma, prior hip surgery, non-ambulatory prior to surgery, and those who refused to participate were excluded. The operative time, blood loss, radiation exposure, quality of reduction, functional outcome, and union time were evaluated. All data were coded and recorded in Microsoft Excel spread sheet program. SPSS 20.0 was used for data analysis and normality of the continuous data was checked using Kolmogorv Smirnov test.@*RESULTS@#The mean age of patients in the study was 60.3 years. The mean duration of surgery (min), mean intra-operative blood loss (mL) and mean number of exposures were 91.86 ± 12.8 (range 70 - 122), 144.8 ± 3.6 (range 116 - 208), and 56.6 (range 38 - 112), respectively. The mean union time was 11.6 weeks and the mean Harris hip score was 94.1.@*CONCLUSION@#Lateral trochanteric wall in IT fractures is significantly important, and needs to be reconstructed adequately. Nail-plate construct of trochanteric buttress plate fixed with hip screw and anti-rotation screw of proximal femoral nail can be successfully used to augment, fix or buttress the lateral trochanteric wall giving excellent to good results of early union and reduction.

Primary repair for concurrent bilateral intertrochanteric fracture and femoral head necrosis with prolonged shank biologic total hip replacement: A case report and surgical techniques / 中华创伤杂志(英文版)

For the treatment of an intertrochanteric fracture combined with femoral head necrosis in middle-age patients, it has been controversial whether to perform fracture reduction and fixation first then total hip replacement, or direct total hip replacement. We present a rare case of 53-year-old male patient suffered from bilateral intertrochanteric fracture caused by a road traffic injury. The patient had a history of femoral head necrosis for eight years, and the Harris score was 30. We performed total hip replacement with prolonged biologic shank prostheses for primary repair. One year after the surgery, nearly full range of motion was achieved without instability (active flexion angle of 110°, extension angle of 20°, adduction angle of 40°, abduction angle of 40°, internal rotation angle of 25°, and external rotation angle of 40°). The Harris score was 85. For the middle-aged patient with unstable intertrochanteric fractures and osteonecrosis of the femoral head, we can choose primary repair for concurrent bilateral intertrochanteric fracture and femoral head necrosis with prolonged shank biologic total hip replacement.

Effectiveness validation of a novel comprehensive classification for intertrochanteric fractures / 中国修复重建外科杂志

OBJECTIVE@#To validate the effectiveness of a novel comprehensive classification for intertrochanteric fracture (ITF).@*METHODS@#The study included 616 patients with ITF, including 279 males (45.29%) and 337 females (54.71%); the age ranged from 23 to 100 years, with an average of 72.5 years. Two orthopaedic residents (observers Ⅰ and Ⅱ) and two senior orthopaedic surgeons (observers Ⅲ and Ⅳ) were selected to classify the CT imaging data of 616 patients in a random order by using the AO/Orthopaedic Trauma Association (AO/OTA) classification of 1996/2007 edition, the AO/OTA classification of 2018 edition, and the novel comprehensive classification method at an interval of 1 month. Kappa consistency test was used to evaluate the intra-observer and inter-observer consistency of the three ITF classification systems.@*RESULTS@#The inter-observer consistency of the three classification systems evaluated by 4 observers twice showed that the 3 classification systems had strong inter-observer consistency. Among them, the κ value of the novel comprehensive classification was higher than that of the AO/OTA classification of 1996/2007 edition and 2018 edition, and the experience of observers had a certain impact on the classification results, and the inter-observer consistency of orthopaedic residents was slightly better than that of senior orthopaedic surgeons. The intra-observer consistency of two evaluations of three classification systems by 4 observers showed that the consistency of the novel comprehensive classification was better for the other 3 observers, except that the consistency of observer Ⅳ in the AO/OTA classification of 2018 version was slightly higher than that of the novel comprehensive classification. The results showed that the novel comprehensive classification has higher repeatability, and the intra-observer consistency of senior orthopaedic surgeons was better than that of orthopaedic residents.@*CONCLUSION@#The novel comprehensive classification system has good intra- and inter-observer consistency, and has high validity in the classification of CT images of ITF patients; the experience of observers has a certain impact on the results of the three classification systems, and those with more experiences have higher intra-observer consistency.

Circumpsoas block - an anterior myofascial plane block for lumbar plexus elements: case report

Abstract In an attempt to improvise the analgesia in patients with femoral fractures, we aimed at depositing local anesthetic deep to anterior psoas fascia (APf) under ultrasound (US) guidance to block lumbar plexus elements which emerge lateral, anterior, and medial to the psoas major muscle. We termed this as circumpsoas block (CPB). Clinical and computed tomography contrast studies revealed that a continuous CPB infusion with a catheter provided a reliable block of the lumbar plexus elements. No adverse were events noted. We conclude that US guided CPB is a reliable technique for managing postoperative pain after surgery of femur fractures.

The Role of Computed Tomography and Radiographs in the Management of Intertrochanteric Fractures

@#Introduction: The Intertrochanteric fracture is a common hip trauma encountered in elderly patients. There is a lack of general agreement regarding its surgical management and choice of implant. Purpose of this study to conclude the final decision matrix regarding surgical management of intertrochanteric fractures based on parameters assessed on plain radiographs and CT scan. Materials and methods: We have retrospectively evaluated 55 patients with intertrochanteric fractures presented to our institute after informed consent with radiographs and CT scans between July 2017 to July 2018. Assessment of various parameters regarding fracture geometry and classification as well as measurement was done. Results: Mean lateral wall thickness in present study was 20.76mm. Incidence of coronal fragments was 90.9% and absence of coronal fragment in 5 patients. We noted the cases with anterior comminution had also a posterior comminution rendered the fracture unstable in almost 20 % cases. Conclusion: Better understanding of fracture geometry by combined used of radiograph and CT scan enhanced preoperative planning, choice of suitable implant, helps in reduction manoeuvre and improving quality of osteosynthesis.

Fixation of Intertrochanteric Fractures with Dynamic Hip Screws: Randomized Controlled Trial Comparing Hardinge and Minimally Invasive Approaches / Fraturas intertrocantéricas fixadas com parafuso dinâmico de quadril: Ensaio clínico randomizado comparando a via lateral de Hardinge e o acesso minimamente invasivo

Abstract Objective To compare the techniques for the osteosynthesis of intertrochanteric fractures with dynamic hip screws (DHSs) through the Hardinge and minimally-invasive access routes of the hip, evaluating the operative time, the degree of pain in the immediate postoperative period, the hematimetric loss, and the functional aspects of active mobility. Methods A randomized, double-blinded clinical trial in which 66 patients with intertrochanteric fractures were submitted to osteosynthesis by DHS. The patients were divided into a test group, submitted to the minimally-invasive access, and a control group, in whom the surgery was performed through the Hardinge route. Results Patients submitted to the minimally-invasive treatment presented a lower degree of postoperative pain compared to the group treated by the Hardinge lateral route (p< 0.001), as well as lower hematimetric loss (p< 0.001), shorter operative time (p< 0.001), and improvement in immediate postoperative active mobility tests (p <0.05). Conclusion The study demonstrated the clinical superiority of the minimally-invasive access route parameters analyzed in relation to the Hardinge access for the fixation of intertrochanteric fractures when DHS is the choice osteosynthesis method. Level of evidence I.

Resumo Objetivo Comparar as técnicas de osteossíntese de fraturas intertrocantéricas com o parafuso dinâmico de quadril (dynamic hip screw, DHS, em inglês) pelas vias de acesso de Hardinge e minimamente invasiva do quadril, avaliando o tempo cirúrgico, o grau de dor no pós-operatório imediato, a perda hematimétrica, e os aspectos funcionais de mobilidade ativa. Métodos Estudo clínico randomizado e duplo-cego, em que 66 pacientes com fratura intertrocantérica foram submetidos a osteossíntese com DHS. Os pacientes foram divididos em um grupo teste, submetidos ao acesso minimamente invasivo, e um controle, em que a cirurgia foi realizada pela via de Hardinge. Resultados Os pacientes submetidos ao tratamento pela via minimamente invasiva apresentaram um grau de dor pós-operatória inferior em comparação ao grupo tratado pela via lateral de Hardinge (p< 0,001), assim como menor perda hematimétrica (p< 0,001), menor tempo operatório (p< 0,001), e melhora nos testes de mobilidade ativa pós-operatória imediata (p< 0,05). Conclusão O estudo demonstrou a superioridade clínica nos parâmetros analisados da via de acesso minimamente invasiva em relação ao acesso de Hardinge para a fixação de fraturas intertrocantéricas, quando o DHS for a opção de osteossíntese escolhida. Nível de evidência I.

Prognosis of hip fracture in elderly patients with dementia / 中华全科医师杂志

Objective:To investigate the prognosis of hip fracture in elderly patients with dementia.Methods:From January 2012 to December 2017, 91 dementia patients aged (82.7±6.6)y (21 males and 70 females) with hip fracture were enrolled in the study; 91 non-dementia patients matched by age, gender and fracture type were selected as controls. There were 54 cases of intertrochanteric fracture and 37 cases of femoral neck fracture. The length of hospital stay, mortality within 30 days and 1 year, walking ability and risk of reoperation were compared between the two groups. The effect of dementia on the mortality after surgery was analyzed by adjusting confounding factors through multivariate logistic regression analysis.Results:There was no significant difference in the length of hospital stay between dementia group and non-dementia group [(13.95±7.33) vs.(12.63±8.68)d, t=1.12, P=0.266]. The incidence rate of perioperative complications in dementia group was higher than that in non-dementia group [63.7%(58/91) vs. 23.1%(21/91), χ 2 = 44.59, P<0.001]. The incidence of delirium in dementia group was higher than that in non-dementia group [35.3%(42/91) vs.13.2%(12/91), χ 2 = 5.71, P=0.017]. The incidence of pulmonary infection in dementia group was higher than that in non-dementia group [11.0%(10/91) vs. 2.2%(2/91), χ 2= 11.989, P<0.001]. There was no significant difference in 30-day fatality rate [7.7%(7/91) vs. 1.1%(1/91), χ 2= 3.27, P=0.071] between two groups; while the 1-year fatality rate in dementia group was higher than that in non-dementia group [27.5%(25/91) vs. 14.3%(13/91), χ 2= 4.79, P=0.029]. After adjusting for the differences of confounding factors between the two groups, dementia was an independent risk factor for 1-year mortality after hip fracture surgery ( OR = 1.852, 95 %CI:1.048-3.043, P= 0.022). For walking ability of 1 year after operation, 22 (33.3%) patients in dementia group walked independently, 38 (57.6%) patients partially walked independently, 6 (9.1%) patients were in bed; while in non-dementia group, 45 (57.7%) patients walked independently, 27 (34.6%) patients partially walked independently, 6 (7.7%) patients were in bed; there was significant difference between the two groups (χ 2= 8.82, P=0.012). There was no significant difference in reoperation rate between two groups [6.6%(6/91) vs. 5.5%(5/91), χ2=0.10, P=0.756]. Conclusion:Compared to non-dementia patients, dementia patients with hip fracture have poorer prognosis, higher incidence of perioperative complications, pulmonary infection and delirium, higher risk of mortality 1 year after operation, and poorer ability of independent walking.

Effect of continuous nursing intervention on nursing quality and postoperative function in elderly patients after femoral intertrochanteric fracture / 中国康复理论与实践

@#Objective To explore the effect of continuous nursing intervention on limb function and nursing quality after proximal femoral nail antirotation (PFNA) internal fixation for femoral intertrochanteric fracture in the elderly. Methods From February, 2017 to November, 2018, 100 elderly patients with femoral intertrochanteric fracture who underwent PFNA internal fixation in our hospital were randomly divided into control group (n = 50) and observation group (n = 50), who accepted routine nursing and continuous nursing respectively for three months. They were assessed with Harris score and visual analogue scale for pain (VAS) before and after the intervention. The postoperative nursing effect was compared. Results The Harris score increased in both groups after the intervention (t > 45.98, P < 0.001), and increased more in the observation group than in the control group (t = 15.03, P < 0.001). The VAS score decreased in both groups after the intervention (t > 16.33, P < 0.001), and decreased more in the observation group than in the control group (t = 9.749, P < 0.001). The effect of nursing was better in the observation group than in the control group (Z = -2.272, P = 0.023). Conclusion Continuous nursing intervention can significantly improve the limb function and nursing satisfaction of elderly patients with femoral intertrochanteric fracture after PFNA.

Research of Building 3D Model in External Fixator for Proximal Femoral Fracture Based on Locking Plate Shape / 中国医疗器械杂志

The software of 3D-Modeling(UG NX 10.0) was used to design a new external fixator model for proximal femoral fracture, and fresh femoral cadaver specimens were used to simulate experimental operation. The results showed that the external fixator designed with the proximal femoral locking plate shape can improve the accuracy of Kirschner wire penetration into the femoral neck, reduce fluoroscopic and soft tissue incision injuries, and make a good stability and is easy to operate, which has a certain value for patients with proximal femoral fracture, such as intolerant surgery and poor physical condition.

Interlocking intramedullary nail for proximal femur versus proximal femoral anti-rotation intramedullary nail or proximal femoral anti-rotation intramedullary nail of asian for intertrochanteric fractures in older adults: A meta-analysis / 中国组织工程研究

OBJECTIVE: The most commonly used intramedullary fixation systems for the treatment of elderly intertrochanteric fractures include the proximal femoral anti-rotation intramedullary nail (PFNA), the proximal femoral anti-rotation intramedullary nail of Asian (PFNA-II) and interlocking intramedullary nail for proximal femur (Inter-TAN), but the clinical effect of the three in the treatment of A2 and A3 type intertrochanteric fractures is still controversial. Meta-analysis was used to compare the clinical efficacy of Inter-TAN, PFNA, and PFNA-II in the treatment of unstable intertrochanteric fractures in the elderly. METHODS: A computer was used to search databases such as Cochrane, Embase, PubMed, Sinomed, CNKI, Wanfang, and VIP to collect and compare the literatures of Inter-TAN, PFNA, and PFNA-II in the treatment of elderly unstable intertrochanteric fractures. The search period was from the establishment of the database to December 2019. Two reviewers independently read the screening literature, extracted data and evaluated the quality. Meta-analysis was performed using RevMan5.3 software. RESULTS: (1) A total of eight studies were included, with 1 349 patients, including two randomized controlled studies and six cohort studies. The evidence level was ≥ III. (2) Meta-analysis showed that the operation time and intraoperative fluoroscopy time were longer, and intraoperative blood loss was more in the Inter-TAN group than those of the PFNA-II group [MD=-16.60, 95%CI (-23.22,-9.99), P 0.05). There was no significant difference in tip-apex distance, length of hospital stay, and Harris score of Inter-TAN group compared with PFNA group and PFNA-II group (P > 0.05). The incidence of postoperative screw cut-out in the Inter-TAN group was less than in the PFNA group and the PFNA-II group [OR=6.47, 95%CI(2.79, 15.00), P 0.05). CONCLUSION: For patients with osteoporosis and poor stability, Inter-TAN can provide better stability and reduce postoperative complications. For patients with poor general conditions and greater surgical risk, PFNA-II internal fixation can be selected.

Comparison of the standard and long-stem bone cement prosthesis replacement in the treatment of intertrochanteric fractures in elderly patients / 中国组织工程研究

BACKGROUND: The choice of standard femoral prosthesis or lengthened femoral prosthesis for the treatment of femoral intertrochanteric fracture in the elderly with hemihip replacement has always troubled clinicians. OBJECTIVE: To compare the short-term clinical efficacy of standard and long-stem prosthesis replacement in the treatment of elderly comminuted intertrochanteric Jensen V fractures. METHODS: Data of 216 elderly patients with comminuted intertrochanteric femoral Jensen V fractures undergoing bone cement artificial half hip arthroplasty in Loudi Central Hospital from January 2008 to January 2019 were retrospectively analyzed. According to the type of prosthesis, the patients were divided into standard stem prosthesis placement group (n=92) and long-stem prosthesis replacement group (n=124). According to the fracture situation, the wire Kirschner wire was used to reduce the trochanteric fracture. At 1 year after surgery, Hariss score of the hip joint was evaluated. X-ray examination was used to observe imaging manifestations around the prosthesis. RESULTS AND CONCLUSION: (1) Two patients in the standard stem prosthesis placement group died; three patients in the long-stem prosthesis replacement group died. The remaining patients were followed up for 12-24 months. (2) At 1 year after surgery, Hariss scores were (88.6±2.9) in the standard stem prosthesis placement group with an excellent and good rate of 83.3%, and (86.9±2.7) in the long-stem prosthesis replacement group with an excellent and good rate of 82.6%; no significant difference was found between the two groups (P > 0.05). (3) In the standard stem prosthesis placement group, one case affected femoral greater trochanteric fracture nonunion; two cases had femoral small trochanteric fracture nonunion; two cases experienced Brooker’s grade 1 heterotopic ossification. In the long-stem prosthesis replacement group, one case affected femoral greater trochanteric fracture nonunion; three cases had femoral small trochanteric fracture nonunion; two cases experienced Brooker’s grade 1 heterotopic ossification. There was no significant difference in the incidence of complications between the two groups (P > 0.05). (4) It is indicated that the short-term clinical efficacy of standard and long-stem cement-type prosthesis replacement in the treatment of Jensen V type trochanteric fracture in elderly patients is satisfactory, with no statistical difference, but the long-term effect remains to be studied.

Correlation between metabolic syndrome and adverse events after internal fixation of femoral intertrochanteric fracture in the elderly / 中国骨伤

OBJECTIVE@#To explore the effect of metabolic syndrome on 15 days postoperative adverse events of femoral intertrochanteric fractures with internal fixation.@*METHODS@#From January 2011 to June 2019, 986 elderly patients with intertrochanteric fracture were treated with internal fixation, including 312 males and 674 females, with an average age of(77.71± 7.58) years old. And there were 97 patients with metabolic syndrome and 889 patients without metabolic syndrome. Through the electronic medical record system, the patient's age, gender, fracture type, cause of trauma, body mass index, smoking history, preoperative comorbidities, preoperative bloodtransfusion, operation timing, ASA classification, anesthesia method, internal fixation type, operation duration, and 15 days postoperative adverse events, which include surgical site infection, acute heart failure, acute respiratory failure, pulmonary infection, acute renal failure, DVT, embolism in important organs, urinary tract infection, death, and blood transfusion after surgery were collected. The differences of preoperative and intraoperative baseline datas and 15 days postoperative adverse events between the two groups were compared and analyzed by t text or univariate @*RESULTS@#There were statistical differences in age, body mass index, history of cardiac insufficiency, history of COPD, history of renal insufficiency, operation timing, ASA classification, operation duration, surgical site infection, acute heart failure, DVT, urinary tract infection and blood transfusion between two groups (@*CONCLUSION@#Elderly patients with intertrochanteric fracture with metabolic syndrome had higher postoperative surgical site infection rate, DVT incidence rate, urinary tract infection rate, and postoperative blood transfusion rate. Therefore, the orthopedic treatment team should give more attentionand optimize the treatment plan during the perioperative period with the cooperation of internal physician and anesthesiologist.

Comparison of mortality rate between bipolar hemiarthroplasty and proximal femoral nail anti-rotation for intertrochanteric fractures in Sanglah hospital, Bali

Introduction: Intertrochanteric fractures occur in about 50% of all hip fracture events, with a mortality rate within 1 year after fracture reaching 15 to 20%. The most common treatment nowadays is either the bipolar hemiarthroplasty procedure or proximal femoral nail anti-rotation (PFNA), although there is still no consensus regarding which is better from the two, especially on patient mortality.Method: This study was an observational study using a retrospective cohort design. A total of 102 study subjects who met the inclusion requirements were grouped into 2 groups, one with bipolar hemiarthroplasty fixation treatment and another with PFNA fixation treatment. Mortality rate was recorded by survey 2 years after surgery.Result: Chi-square test showed that 2-year mortality rate after intertrochanteric fracture treated with bipolar hemiarthroplasty (21.4%) was significantly higher than the PFNA group (10.3%) (p=0.028). Bipolar hemiarthroplasty group also had longer length of stay (LoS) (50%) than the PFNA group (32.4%), albeit statistically insignificant (p=0.13). There was no significant difference between the 2-year mortality rate and LoS (p=0.976).Conclusion: Patients with intertrochanteric fractures who underwent bipolar hemiarthroplasty have significantly higher 2-year mortality rate than similar patients underwent fixation with PFNA, while they did not experience higher LoS than the PFNA group. Future prospective, multi-center study with larger sample size will be likely to validate similar fixation choice needed to decrease the mortality rate in intertrochanteric fractures.

A Prospective Comparative Study of Unstable Inter Trochanteric Fracture by Proximal Femoral Nail and Proximal Femoral Nail Antirotation in Elderly Patients in Terms of Functional and Radiological Outcomes

Intramedullary devices allow for stable anatomical fixation of more comminuted fractures without shortening the abductor lever arm or changing the proximal femoral anatomy. Between intramedullary devices like proximal femoral nail and proximal femoral nail antirotation, the helical blade of latter is believed to provide stability, compression and rotational control of the fracture with higher cut out strength. The aim of the study was to manage and compare the functional and radiological outcomes between Proximal Femoral Nail or Proximal Femoral Nail Anti-rotation II in elderly patients of unstable intertrochanteric fractures.METHODSThis is a prospective comparative study conducted in the Department of Orthopaedics at MLN Medical College and Swaroop Rani Hospital, Prayagraj, from November 2017 till June 2019.RESULTSPreoperative and post-operative clinical evaluation, radiological evaluation, assessment of operative time, number of fluoroscopy shoots, time for fracture union, and post-operative complications in all cases were noted. Results were evaluated using Harris hip score. There was significant (p= 0.0001) association of final outcome between the groups.CONCLUSIONSPFN A offers significant results over PFN in relation to post-operative complications. PFN A significantly reduces the operative time, amount of blood loss and fluoroscopic imaging as compared to PFN. However PFN A offers no significant benefits over PFN in terms of post-operative functional recovery or complications.

A Prospective Study of the Functional Outcome of Intertrochanteric Femoral Fracture Managed with Short Proximal Femoral Nail

Introduction: Fractures through the intertrochanteric lineof the upper end of the femur, and peritrochanteric fractures,unite readily no matter what treatment is used because thebroad fractured surfaces are richly supplied with blood andthere is seldom wide displacement. But at the same time,unless suitable precautions are taken, the fracture may unitein a position of coxavara with shortening of the limb andlimitation of hip movements. Hence we conducted a studyin our set up to know the functional result of short proximalfemoral nail (PFN) in treatment of these fractures.Material and Methods: We included all intertrochantericfracture of femur in skeletally mature patient who are fit forsurgery in our study. Fifty patients treated with short PFNwere included in the study.Results: Majority of the patient in our study were between61-80 years with a mean age of 74.46 ± 12.04 years. About 52percent of the patients were female and 48 percent male. Fallat home was the most common mode of injury. Right hip wasinvolved in 48% of the patient and left hip was 52%. The shortPFN required shorter incisions, less blood loss and operativetimes. Average time for operation was 42.30±10.01. Postoperative complications included revision surgery 2 (4.0%)patients, superficial infection in 2 (4.0%), Z effect in 1 (2.0%)patient, inadequate reduction in 1 (2.0%) patient, difficultyin distal locking in 1 (2.0%) patient and varus in 1 (2.0%)patient. The average harris hip score came out to be 87.37at 24 weeks and 90% of the patients belonged to the ‘good’group and 6% of the patients belonged to the ‘excellent’group intertrochanteric fractures, treated with short PFN, hadsignificantly better outcomes with all patients having goodresults in 24 weeks which is very short time. Conclusion:Intra operative technical difficulties associated with short PFNcan be reduced by thorough knowledge and understanding ofboth the anatomy and implant. By using some technical tipsdifficult closed reduction can be done and internal fixationwith PFN can be attempted.

Effects of Different Surgical Methods for Treating Femoral Intertrochanteric Fracture in the Elderly and Biomechanical Study / 医用生物力学

Objective To analyze the efficacy and biomechanical properties of locking proximal femoral plate (LPFP) and proximal femoral nail anti-rotation (PFNA) for treating intertrochanteric fracture in elderly patients. Methods One hundred and six elderly patients with intertrochanteric fracture of femur were randomly divided into LPFP group (53 cases) and PFNA group (53 cases). After treatment intervention, the operation time, intraoperative bleeding volume, weight-bearing time, fracture healing time and Harris hip function score of 9 months after operation in two groups were recorded. The complications after operation in two groups were analyzed. Ten elderly fresh femoral specimens were selected to prepare the model of intertrochanteric femoral fracture in the elderly. They were randomly divided into PFNA group and LPFP group with 5 models in each group. After treatment and intervention, axial compression test, destructive load test and torsional stiffness test were conducted by mechanical testing machine, and biomechanical properties were recorded. Results The average operation time, weight-bearing time and fracture healing time in PFNA group were shorter than those in LPFP group (P<0.05), and the average intraoperative bleeding volume in PFNA group was less than that in LPFP group (P<0.05), and the average Harris score was higher than that in LPFP group (P<0.05). The total incidence of postoperative complications in PFNA group and LPFP group was 7.56% and 18.87%, respectively, indicating a significant difference between the two groups (P<0.05). After intervention treatment, the average axial compression, damage load and torsional stiffness in PFNA group were higher than those in LPFP group (P<0.05). ConclusionsPFNA caused minimal trauma for treating intertrochanteric femoral fractures in the elderly. With its good biomechanical properties, PFNA could effectively promote fracture healing and hip function recovery, and significantly reduce the incidence of hip varus, screw loosening and cutting complications.

Role of the distal fourth fixation factor in treatment of unstable femoral intertrochanteric fractures with intramedullary nails / 第二军医大学学报

Objective: To investigate the role of the distal fourth fixation factor in the treatment of unstable femoral intertrochanteric fractures with intramedullary nails. Methods: A total of 108 patients with unstable femoral intertrochanteric fractures (AO type: A2.2-A.3.3) treated from Jun. 2014 to Jun. 2018 in our hospital were selected and divided into three groups. The injury was fixed with short intramedullary nails and had matched medullary cavity in group A (n=42). The injury was fixed with short intramedullary nails and had mismatched medullary cavity in group B (n=40). The injury was fixed with long intramedullary nails in group C (n=26). Operation time, intraoperative blood loss, fracture healing time, postoperative complications and clinical efficacy were compared among the three groups. The efficacy was evaluated by the Harris hip score. Results: There was no significant difference in the age, gender composition, or causes of injury between groups (P>0.05), but there was statistic difference in the AO type between groups (P0.05). The amount of intraoperative bleeding in group A was (149.19 ± 45.97) mL, which was significantly less than that in group C ([230.77 ± 57.40] mL, P0.05). The fracture healing time in group B was (14.10 ± 2.22) months, which was significantly longer than that in group A ([11.43 ± 2.95] months) and group C ([12.35 ± 4.47] months, P<0.05). At the last follow-up, the Harris score in group B was 77.33 ± 8.18, which was significantly lower than that in group A and C (85.52 ± 10.76, 89.12 ± 9.14, P<0.05). Two patients in group A developed coxa vara. Eight patients had lost restoration in group B. No complications occurred in group C. There was significant difference in the incidence of complication among the three groups (Fisher exact test, P=0.013). Conclusion: The technique using the distal fourth fixation factor can reduce the complications of unstable femoral intertrochanteric fractures such as postoperative loss of restoration and internal fixation failure, shorten the fracture healing time, and achieve early weight-bearing exercise.

Evaluation of internal fixation with proximal femoral nail antirotation in elderly knee osteoarthritis patients with femoral intertrochanteric fractures / 中国组织工程研究

BACKGROUND: Proximal femoral nail antirotation is a commonly used internal fixation system for the treatment of femoral intertrochanteric fracture in the elderly. Simultaneously, the elderly are often associated with knee osteoarthritis, which may affect the postoperative effect of femoral intertrochanteric fracture. OBJECTIVE: To investigate the effect of knee osteoarthritis at the fracture side on the efficacy of postopenxtine proximal femoral nail antirotation in elderly femoral intertrochanteric fractures. METHODS: Totally 92 patients aged over 65 years old with femoral intertrochanteric fractures treated with proximal femoral nail antirotation internal fixation were divided into five groups according to the preoperative knee X-ray Kellgren-Lawrence grade: grade 0 as group A (13 cases), grade I as group B (18 cases), grade II as group C (23 cases), grade III as group D (22 cases), and grade IV as group E (16 cases). The hospitalization time, postoperative complications, postoperative landing time, fracture healing time, hip Harris score and Barthel index score of daily living ability at 1, 3 and 6 months after operation were recorded in the five groups. This study was approved by the Ethics Committee of Affiliated Hospital of Chengde Medical University. RESULTS AND CONCLUSION: (1) There was no significant difference in the length of hospital stay among the five groups (P > 0.05). (2) The postoperative landing time and fracture healing time of group D and group C were longer than those in group A, group B, and group C (P < 0.05). (3) The number of postoperative complications of group C was more than those in group A and group B (P < 0.05). The number of postoperative complications of group D and group E was more than that in group A, group B and group C (P < 0.05). (4) The scores of Harris and Barthel index of group C and D were lower than those in group A and B at 1, 3 and 6 months after operation (P < 0.05). The scores of Harris and Barthel index of group E was lower than those in group A, group B, group C and group D at 1, 3 and 6 months after operation (P < 0.05). (5) The results showed that the higher the grade of knee osteoarthritis, the greater the influence on the postoperative efficacy of proximal femoral nail antirotation in the treatment of elderly patients with femoral intertrochanteric fracture. It is manifested by increased postoperative complications, prolonged postoperative landing time and fracture healing time, and the decrease of hip function and ability of daily living.