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.

A COMPARATIVE PROSPECTIVE STUDY OF DYNAMIC HIP SCREW AND PROXIMAL FEMORAL NAIL IN TREATMENT OF SUBTROCHANTERIC FRACTURE FEMUR

Subtrochanteric fractures are relatively rare, accounting for 10 - 34% of all hip fractures1,2,3. They may be very difficult to fix, and the risk of failure has been high with loss of the lesser trochanter and the medial buttresses 3,4, Various intramedullary and extramedullary devices have been developed in an attempt to address potential complications of device failure, mal- or non-union and deformities. In our prospective case series 29 subtrochanteric fractures were involved. The aim of this study is to assess fracture union and functional outcome in subtrochanteric fracture femur treated with proximal femoral nailing and dynamic hip screw, and also to evaluate advantages, disadvantages and major postoperative complications associated with the proximal femoral nailing and dynamic hip screw. Conclusion: The average functional scores for the PFN group at 6 months was 31.5 (excellent) which was significantly greater than the DHS group 27.1(good) (p = 0.03). There was no significant difference in time to union in both groups (average 5.7 months for DHS group and 5.2 months for PFN group) (p = 0.26). The intraoperative complication rate for the PFN group was 36% which was significantly higher than the DHS group (0%) (p =0.001). The PFN had a significantly better functional outcome than DHS plating at 6 months. Long term studies may be needed to observe whether the difference persists on further follow ups. The PFN had a significant advantage over the DHS with side plate in subtrochanteric fractures with regards to less blood loss, less requirement for transfusions, better functional scores, less shortening and fewer incidences of postoperative complications. From the study, we consider PFN as better alternative to DHS in the treatment of subtrochanteric fracture femur but is technically difficult procedure and requires more expertise compared to DHS.

Comparison outcome in management of femoral neck fracture using multiple cancellous screws with and without fibular graft

Multiple cancellous cannulated screw is preferred method in fresh cases of fracture neck of femur in young patients. Fibular strut graft is sometimes used along with multiple cancellous cannulated screws to enhance union and early restoration of function. We conducted a retrospective study to patients aged between 20-50 years old with femoral neck fracture treated with multiple cancellous screws either with or without fibular graft between the period of January 2016 to January 2018. We obtained total of six patients (five males and one female) with femoral neck fracture treated with multiple cancellous screws either with or without fibular graft. All fractures were garden type II-IV fresh femoral neck fractures. The functional outcome based on Harris hip score was excellent for all patients. The mean time of full weight bearing was 16±8 weeks in both multiple cancellous screws without fibular group and multiple cancellous screws with fibular group. The mean time of union was also 16±8 weeks in both groups. There is no complication such as non-union, avascular necrosis of femoral head and/or broken fibular graft in both the groups occurrences. Fixation with cancellous screws and fibular strut grafts for femoral neck fractures is cost effective and technically less demanding and associated with good outcomes. There is no added advantage of non-vascularized fibular grafting with multiple hip screw fixation in fresh femoral neck fractures in young adults over multiple hip screw fixation alone.

Internal fixation strategies for different lateral wall types of intertrochanteric fractures of the femur / 中国组织工程研究

BACKGROUND: The importance of the lateral wall of the femoral trochanter in the intertrochanteric fracture has been paid more and more attention. The research on the classification of the external wall in guiding clinical operation has become a hot issue. OBJECTIVE: To review the treatment strategies of different lateral wall types of intertrochanteric fractures, and the selection of the built-in materials, provide reference and help for future clinical research. METHODS: The first author searched the Chinese database ofWanfang and China National Knowledge Infrastructure with the keywords of “intertrochanteric fracture of femur; lateral wall of femoral trochanter; fracture classification; fracture fixation, internal; implant; intramedullary fixation; extramedullary fixation; complications; elderly; prognosis”. Meanwhile, PubMed English database was retrieved with the keywords “intertrochanteric fracture of femur; lateral wall of femoral trochanter; fracture classification; fracture fixation, internal; implant; intramedullary fixation; extramedullary fixation; complications; elderly; prognosis”. The retrieval time was from May 2009 to May 2019. A total of 166 literatures were retrieved. According to the inclusion and exclusion criteria, 47 literatures were selected as the research object and summarized. RESULTS AND CONCLUSION: (1) During the surgical treatment of intertrochanteric fracture of the femur, intramedullary fixation system and extramedullary fixation system have their own advantages and disadvantages. After full analysis of lateral femoral trochanter wall classification and reasonable preoperative evaluation, it is a combination of theory and practice. Signing, correctly assessing the severity of fractures and judging the prognosis, and fully preoperative evaluation can greatly help the patient’s treatment effect and prognosis. (2) It is a basic quality of doctors and a responsible attitude towards patients to formulate different treatment plans according to their economic conditions and physical qualities. “Individualization” has become the future development trend. (3) There are still many disputes in the treatment of intertrochanteric fractures. More clinical research and data support are needed in the future to solve and improve it.

Intracapusular Neck Of Femur Fracture Treated With Dynamic Hip Screw And Antirotation Screw: A Retrospective Analysis

Background: Internal fixation is the primary treatment choice in younger age group suffering from fracture neck femur. But rate of failure of internal fixation in neck of femur fractures is high despite all measures. Fixation can be done by using three cannulated hip screws or by dynamic hip screw with or without a derotation screw. The outcomes of fracture neck of femur in young patients treated with Dyanamic Hip Screw (DHS) with a de-rotation were analyzed. Materials and methods: The study was conducted on 54 patients were selected based on pre-determined eligibility criteria. The dynamic hip screw was inserted with a standard technique by means of a straight lateral incision on the lateral aspect of the thigh and hip. Result:shows effect of dynamic hip screw with derotation screw is good. Conclusion : Osteosynthesis of intra-capsular femoral neck fracture with dynamic hip screw with derotation screw is good.

Intramedullary Hip Screw (IMHS) for the Treatment of Intertrochanteric Hip Fracture: A Retrospective Study

Background: Intramedullary hip screw (IMHS) is a cephalomedullary nail used for surgical treatment of hip fracture for the past two decades but only a few studies have been reported. Aim of the study: To evaluate the effectiveness of IMHS for intertrochanteric fracture in Thammasat university hospital. Materials and methods: Ninety-two intertrochanteric fracture patients were retrospectively reviewed. Results: Mean operative time was 87 minutes (45-154 min) with an average blood loss of 150 ml (50- 300 ml). Intraoperative femoral shaft fracture was found in two cases which required the immediate exchange to long IMHS intraoperatively. One displaced large greater tuberosity fragment during nail insertion was treated by tension band wiring and five lateral cortex fractures were managed conservatively. Failed IMHS were found in 3 cases with two cases screw cut out the femoral head and one fracture extending from intertrochanter to the superior neck. All of these three cases were changed to hip prosthesis. Most of the patients stayed in the hospital for 3 weeks (61.4%), younger patients tend to have shorter hospital stay (<1 week) and preexisting medical complications may prolong hospitalization (>1 month). From this study, IMSH can safely treat a hip fracture patient and Sunyarn Niempoog, Sukanis Chumchuen, Chayanin Angthong, Krit Boontanapibul. Intramedullary Hip Screw (IMHS) for the Treatment of Intertrochanteric Hip Fracture: A Retrospective Study. IAIM, 2019; 6(8): 51-61. Page 52 its complications can be avoided by correct entry point, over-reaming and manually pushing the nail with use of a hammer and a centering sleeve.Conclusion: IMSH is a choice of treatment for hip fracture in Thais with a satisfactory outcome, and complications can be avoided by locating the correct entry point, over-reaming and manually push the nail while using a hammer and a centering sleeve

The Effect of Positive Medial Cortical Support in Reduction of Pertrochanteric Fractures with Posteromedial Wall Defect Using a Dynamic Hip Screw

BACKGROUND: We evaluated the radiological and clinical results of reduction using a dynamic hip screw according to the grade of medial cortical support in patients with AO Foundation and Orthopaedic Trauma Association (AO/OTA) classification type 31-A2 pertrochanteric fractures. METHODS: We enrolled 100 patients with AO/OTA type 31-A2 fractures with displaced lesser trochanter fragments (length of the cortical area longer than 20 mm on the pelvis anteroposterior view). Patients with positive medial cortical support were assigned to group 1 (n = 28); neutral medial cortical support, group 2 (n = 42); and negative medial cortical support, group 3 (n = 30). Radiological evaluation was done by measuring the change in the femoral neck-shaft angle and sliding distance of the lag screw. Clinical outcomes of each group were compared by means of the walking ability score proposed by Ceder. RESULTS: Group 1 showed significantly less changes in the femoral neck-shaft angle and shorter sliding distance than groups 2 and 3. Group 2 showed significantly less changes in the femoral neck-shaft angle and shorter sliding distance than group 3. Group 1 showed significantly higher walking ability scores than group 3 (p = 0.00). The use of trochanter stabilizing plates or fixation using wires for posteromedial wall defect resulted in no significant changes in terms of the femoral neck-shaft angle or sliding distance. CONCLUSIONS: In the treatment of pertrochanteric fractures accompanied by posteromedial wall defect using a dynamic hip screw, reduction with negative cortical support should be avoided.

Outcomes of Internal Fixation with Compression Hip Screws in Lateral Decubitus Position for Treatment of Femoral Intertrochanteric Fractures / 대한고관절학회지

PURPOSE: Internal fixation using compression hip screws (CHS) and traction tables placing patients in the supine position is a gold standard option for treating intertrochanteric fractures; however, at our institution, we approach this treatment with patients in a lateral decubitus position. Here, the results of 100 consecutive elderly (i.e., ≥45 years of age) patients who underwent internal fixation with CHS in lateral decubitus position are analyzed. MATERIALS AND METHODS: Between March 2009 and May 2011, 100 consecutive elderly patients who underwent internal fixation with CHS for femoral intertrochanteric fracture were retrospectively reviewed. Clinical outcomes (i.e., Koval score, Harris hip score [HHS]) and radiographic outcomes (i.e., bone union time, amount of sliding of lag screw, tip-apex distance [TAD]) were evaluated. RESULTS: Clinical assessments revealed that the average postoperative Koval score decreased from 1.4 to 2.6 (range, 0–5; P < 0.05); HHS was 85 (range, 72–90); and mean bone union time was 5.0 (range, 2.0–8.2) months. Radiographic assessments revealed that anteroposterior average TAD was 6.95 (range, 1.27–14.63) mm; lateral average TAD was 7.26 (range, 1.20–18.43) mm; total average TAD was 14.21 (range, 2.47–28.66) mm; average lag screw sliding was 4.63 (range, 0–44.81) mm; and average angulation was varus 0.72°(range, −7.6°−12.7°). There were no cases of screw tip migration or nonunion, however, there were four cases of excessive screw sliding and six cases of varus angulation at more than 5° CONCLUSION: CHS fixation in lateral decubitus position provides favorable clinical and radiological outcomes. This technique is advisable for regular CHS fixation of intertrochanteric fractures.

Treatment of benign bone lesions of proximal femur using dynamic hip screw and intralesional curettage via Watson-Jones approach / 中国修复重建外科杂志

Objective: To explore the effectiveness of dynamic hip screw (DHS) and intralesional curettage via Watson-Jones approach in treatment of benign bone lesions of the proximal femur.

A Comparison of Clinical Results between Compression Hip Screw and Proximal Femoral Nail as the Treatment of AO/OTA 31-A2.2 Intertrochanteric Femoral Fractures / 대한정형외과학회잡지

PURPOSE: This study compared the clinical results between compression hip screw (CHS) and proximal femoral nail (PFN) after the treatment of AO/OTA A2.2 intertrochanteric (ITC) fractures. MATERIALS AND METHODS: We retrospectively reviewed 125 cases of AO/OTA A2.2 ITC fracture, treated with either CHS (group I, 34 cases) or PFN (group II, 91 cases) between March 1994 and December 2014. We evaluated the mean operation time, estimated blood loss and transfusion, hospitalization stay, sliding length of lag screw, tip-apex distance, change of neck shaft angle, mean union time, weight bearing time, mechanical failure, and ambulatory ability by the Parker and Palmer mobility scores. RESULTS: Operative time, estimated blood loss, transfusion, hospitalization stay, tip-apex distance, change of neck-shaft angle, and Parker and Palmer mobility scores were not significantly different between the two groups (p>0.05). However, the mean sliding length of lag screw was 8.15 mm and 3.94 mm for group I and II, respectively, the mean union time was 16.85 weeks and 15.57 weeks, respectively, and the mean full weight bearing time was 4.54 weeks and 2.31 weeks, respectively. The mean sliding length of lag screw, union time, and full weight bearing time all had statistical significance (p<0.05). There were a total of 3 cases of postoperative complications in group I and 4 cases in group II. CONCLUSION: We conclude that PFN is more reliable than CHS as a treatment method for AO/OTA A2.2 intertrochanteric fracture.

Study of proximal femoral locking plate internal fixation after dynamic hip fixation intertrochanteric fracture / 局解手术学杂志

Objective To study the mechanics situation of proximal femoral locking plate internal fixation after dynamic hip fixation in-tertrochanteric fracture. Methods Totally 10 couple of elderly proximal femur specimens were collected and intertrochanteric fracture model were prepared. Fixation material was removed after dynamic hip screw fixation. The left sides were collected as control group and given anti-rotation intramedullary nail internal fixation, while the right side were collected as observation group and given proximal femoral locking plate internal fixation. Then vertical displacement, axial stiffness and rotational stiffness under different loads were compared. Results Under dif-ferent loads, femoral bone vertical displacement and femur tuberosity vertical displacement in the observation group were both significantly shorter than those in the control group (P<0. 05), and femoral bone and femur tuberosity axial stiffness and rotational stiffness in the observation group were significantly higher than those of the control group (P<0. 05). Conclusion Proximal femoral locking plate internal fixation can improve stress load and enhance axial stiffness and rotational stiffness, and it's an ideal material for refracture fixation model after dynamic hip fixation intertrochanteric fracture.

Clinical efficacy of DHS and PFNA for treatment of senile patients with intertrochanteric fracture and Parkin-son’ s disease / 局解手术学杂志

Objective To explore the clinical efficacy of dynamic hip screw( DHS) and proximal femoral nail anti-rotation( PFNA) in treatment of patients with Parkinson’ s disease and intertrochanteric fracture. Methods A total of 62 elderly patients of Parkinson’ s disease with femoral intertrochanteric fracture in our hospital from February 2010 to February 2014 were divided into two groups according to different internal fixations,with 31 cases in DHS group and PFNA group respectively. The operation time,X-ray fluoroscopy times,intraoperatve blood soss,the healing time of fracture,postoperative complications and Harris score between two groups were recorded and compared statistically. Results The operation time,intraoperatve blood soss and the clinical healing time of PFNA group were significantly lower than those of DHS group,the differences were statistically significant (P0. 05). Conclusion The PFNA has the advantages of shorter operation time,less bleed-ing,faster healing time in treatment for elderly patients with Parkinson’ s disease and intertrochanteric fracture,worth clinical promotion.

Surgical Treatment for Stable 2-Part Intertrochanteric Femur Fracture Using Dynamic Hip Screw with 2-Hole Side Plate in Elderly Patients

PURPOSE: The purpose of this study is to evaluate the postoperative outcomes of elderly patients with stable 2-part intertrochanteric femur fractures surgically treated using dynamic hip screw with 2-hole side plate. MATERIALS AND METHODS: From February 2008 to January 2014, 50 patients older than the age of 65 years, who had been followed-up for more than 6 months after the operation at The Catholic University of Korea, Bucheon St. Mary's Hospital were enrolled. A clinical evaluation of the skin incision length, operating time, and ambulatory status, using Clawson's Ambulation Capacity Classification, was performed, and a radiologic evaluation of Fogagnolo reduction quality, tip-apex distance (TAD), Cleveland index, sliding extent of lag screws, time duration till bony union, and complications was also done. RESULTS: The mean skin incision length was 9.8 cm (range, 8-13 cm), the mean operating time was 41.4 minutes (range, 30-60 minutes), and 32 patients recovered their ambulatory function. Forty-eight patients gained bony union, and the time lapsed till union was average 10.6 weeks (range, 8-16 weeks). The evaluation of postoperative radiologic images showed the following reduction statuses by the Fogagnolo classification: 46 cases of "Good", 3 cases of "Acceptable," and 1 case of "Poor." Moreover, the mean TAD was 18.9 mm (range, 9.0-24.9 mm). While 45 cases fit into the zone 5 of the Cleveland index, other 3 were within zone 8 and the other 2 were within zone 6. The mean sliding length of the lag screws were 4.9 mm (range, 0.1-19.4 mm). There were a case of nonunion and a case of periprosthetic infection with nonunion as complications. CONCLUSION: Using dynamic hip screws with 2-hole side plate for stable 2-part intertrochanteric femur fractures in elderly patients showed satisfactory results with respect to the recovery of ambulatory functions and bony union.

The Role of Beta-Tricalcium Phosphate Graft in the Dynamic Hip Screw Fixation of Unstable Intertrochanter Fracture

PURPOSE: The purpose of this study was to introduce our method of stabilizing unstable intertrochanteric fractures by using the dynamic hip screw (DHS) with a beta-tricalcium phosphate (β-TCP) graft and to compare the outcomes of this procedure with those of the conventional DHS without β-TCP. MATERIALS AND METHODS: Patients who underwent surgery by using DHS between March 2002 and January 2016 were retrospectively reviewed for analysis of the outcomes. The inclusion criteria were: 1) age of 60 years and older; 2) low-energy fracture resulting from a fall from no greater than the standing height; 3) multifragmentary pertrochanteric fracture (AO classification 31-A2.2, 2.3); and 4) follow-up of over 3 months. We compared 29 patients (29 hips) who underwent surgery, using DHS without β-TCP, with 29 age-sex matched patients (29 hips) who underwent surgery using DHS with grafted β-TCP granules to empty the trochanter area after reaming. We investigated the fracture union rate, union time, and length of lag screw sliding. RESULTS: Bone union was achieved in all cases. The mean union time was 7.0 weeks in the β-TCP group and 8 .8 weeks in the non-β-TCP group. The length of lag screw sliding was 3.6 mm in the β-TCP group and 5 .5 mm in the non-β-TCP group. There were no implant failure cases in both groups. CONCLUSION: The β-TCP graft for reinforcement DHS acquired satisfactory clinical outcomes for treating unstable intertrochanteric fractures.

Intertrochanteric fracture fixation with Dynamic Hip Screw: Is tip-apex distance measurement useful for predicting fixation failure?

Introduction: Application of dynamic hip screw (DHS) implant for the treatment of unstable intertrochanteric fractures continues to raise concern related to risk of lag screw cut-out with or without subsequent damage to the acetabulum. Measurement of tip-apex distances (TAD) has been recommended to guide the optimal placement of lag screw and to predict subsequent risk of screw cut-out. In this study, the value of TAD was evaluated to verify its usefulness. Methods: This is a retrospective study of 33 consecutive patients with intertrochanteric fracture treated with DHS. Demographic data of the patients were traced from their case notes. Post-operative radiographs were reviewed by focusing on measurement of TAD on anteroposterior and lateral radiographs. Radiographs at one year follow-up were reviewed to depict any fixation-related failure or complication. Results: Fifty two percent of patients did not achieved the recommended TAD of ≤ 25mm. The mean post-operative TAD was 25.9mm and elderly patients were likely to achieve TAD of ≤ 25mm. The overall complication rate of 6% was attributed to screw cut-out in two cases. The unstable left-sided fracture was identified to be a potential risk for screw cut-out or migration. Conclusion: TAD is a valuable measurement to guide optimal placement of lag screw during DHS fixation of intertrochanteric fracture.

Comparison of the curative effect of proximal femoral nail anti -rotation and dynamic hip screw in the treatment of intertrochanteric fracture / 中国基层医药

Objective To compare the clinical curative effect of proximal femoral nail anti rotation ( PFNA) and dynamic hip screw fixation in the treatment of the femoral intertrochanteric fracture,and provide reference for the development of clinical surgery scheme.Methods 74 patients with femoral intertrochanteric fracture in our hospital were selected and randomly divided into observation group and control group,37 cases in each group.The control group was treated with dynamic hip screw fixation,and the observation group was treated with PFNA therapy.Opera-tive time,bleeding volume and wound healing were compared between the two groups.The time of bone healing and complications were compared between the two groups after operation 1,3,6 months, functional recovery of hip was evaluated after operation by Harris score in the two groups.Results Intraoperative bleeding in the observation group was (115.68 ±72.38)mL,the operation time was (43.26 ±11.47)min,which were significantly less than the con-trol group(t=9.62,7.11,all P0.05).1 month after surgery,the Harris score of the observation group was (71.39 ±4.38)points, which was significantly higher than the control group (t=3.17,P0.05 ) .Conclusion PFNA had less surgical trauma,early functional exercise for patients after surgery by comparison with dynamic screw fixation.It could promote fracture and hip joint function rehabilitation.

Meta-analysis on PFNA and DHS in treatment of unstable intertrochanteric fracture / 重庆医学

Objective To evaluate the effects and security of PFNA and DHS in the treatment of unstable intertrochanteric fractures through meta analysis .Methods The randomized controlled trials(RCT) for comparing PFNA and DHS in the treatment of unstable intertrochanteric fracture were retrieved from MEDLINE ,EMbase ,Pubmed ,Cochrane library ,CBM ,CNKI ,VIP data‐bases by computer .The related orthopedic relevant documents and conference papers were collected by manual retrieval .The Rev‐Man5 .1 statistical software was used for conducting the meta analysis .Results Nineteen RCT were included ,involving 1 690 pa‐tients ,in which 871 cases were treated by using PFNA and 819 cases were treated by using DHS .Compared with DHS ,PFNA had the advantages of little trauma ,less blood loss ,short operation time ,short fracture healing time and postoperative bed time ,good hip function and low incidence of postoperative coxa vara and screw cutting ,but there were no statistical differences in the aspects of length of hospital stay ,fatality rate ,and incidences of fracture nonunion ,breakage of internal fixation ,femoral head necrosis ,short‐ening of the femoral neck ,femoral shaft fractures ,deep vein thrombosis ,urinary tract infection and other complications between the two groups(P>0 .05) .Conclusion The retrieved literatures show that PFNA internal fixation is superior to DHS internal fixation in treatment of unstable intertrochanteric fractures .

Comparison of conservative and internal fixation with dynamic hip screw methods in management of intertrochanteric fractures of the femur

Background: Intertrochanteric fractures are the most commonly treated fractures by Orthopedic surgeon. Many techniques are described in literature but internal fixation with Dynamic Hip screw is most efficient method. Aim: The present study was conducted to compare the results of conservative methods and internal fixation with dynamic hip screw in management of intertrochanteric fractures of the femur. Materials and methods: This study included 40 patients of intertrochanteric fractures of the femur, out of which 30 patients were treated by conservative methods considered as Group I and 10 patients were treated by internal fixation with Dynamic Hip Screw (DHS) considered as Group II. All the results were evaluated by using Kyle’s criteria. Results: In Group I, 4 (13.3%) cases had excellent results, 6 (20%) case had good results, 20 (66.6%) cases had poor results. In Group II, 8 (80%) cases had excellent results, 6 (20%) cases had good results. In Group I, 73.3% of cases had unstable fractures and in Group II, 80% of cases had unstable fractures Conclusion: The quality of results was better with internal fixation with dynamic hip screw (DHS) as compared to conservative methods

Our experience of management of sub trochanteric fractures of femur by proximal femoral nail.

Background: Sub trochanteric fractures of the femur remain some of the most challenging fractures. Most of the fractures result from trivial fall in the elderly; while in the younger age group, it's mainly due to road traffic accidents. Operative management is the preferred treatment. This study is intended to assess the outcome of the intramedullary fixation of sub trochanteric fractures with Proximal Femoral Nail (PFN). Methods: This study is a prospective, uncontrolled study of 40 cases of sub trochanteric fracture of femur admitted to a tertiary level hospital between August 2011 and November 2013; and treated with proximal femoral nails. Adults with recent sub trochanteric fracture of femur were included in this study; while patients less than eighteen years of age, pathologic fractures, periprosthetic fractures, and old neglected fractures were excluded from the study. Results: In our study of 40 cases, there were 28 male and 12 female patients with mean age of 51.43 years (range 22-87 years). Based on Seinsheimer’s classification, type IIIA fractures accounted for majority (32.5%) of the cases. majority of patients, i.e. 35% (n=14) showed union at 20 weeks after surgery. Cases were followed up and assessed according to the Harris hip scoring system (Modified). The outcome was good to excellent in 82.9% cases. Conclusions: From our study we conclude that PFN is a reliable minimally invasive implant for sub trochanteric fractures, with good to excellent functional outcome in the majority of cases.

A Retrospective Study In The Management Of Inter Trochanteric Fracture By DHS Fixation In Boyd And Graffin Type I & II Fractures.

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.