Evaluation of functional outcome and comparison of three different surgical modalities for management of intertrochanteric fractures in elderly population.

INTRODUCTION: The purpose of this study was to compare the role of the various surgical modalities ie, Hemiarthroplasty (HA), Dynamic Hip Screw (DHS), Cephalo-medullary nail (CMN) in the management of intertrochanteric fractures in elder patients with comparison of the results and assessment of the complications encountered with each method. METHODS: Total 105 adult patients having intertrochanteric fractures managed during July 2013 to December 2018 at tertiary trauma care centre and followed for minimum 12 months were included in the study. Patients were divided into three groups. Primary hemiarthroplasty was done in 35 patients (group A) while DHS and PFN was done in 35 patients each in group B and group C respectively. Functional evaluation was done using Modified Harris Hip score (HHS) at different intervals while ambulatory function was measured using the Parker Mobility Score. RESULTS: The mean age of patients was 72.14±2.9 years. Mean operative time and blood loss in group A was significantly higher than the other two groups. Hemiarthroplasty group could ambulate earlier than DHS/PFN group. Mean HHS at final follow up was 85.40±7 in group A while in group B and group C these values were 76.36±16.45 and 86.85±10.52 respectively. HHS was significantly higher (P, 0.01) in hemiarthroplasty group in comparison to DHS group. Post-operative complications were comparable in all the groups. CONCLUSION: We support the use of hemiarthroplasty for unstable intertrochanteric fracture in elderly patients with lesser failure rates, early mobilization and better functional outcomes. Early mobilization and less hospital stay should be the goal of every surgical procedure in the elder population.

Radiological and functional outcome in unstable, osteoporotic trochanteric fractures stabilized with dynamic helical hip system.

A dynamic hip screw (DHS) remains the implant of choice for stabilization of trochanteric fractures because of its favourable results and low rate of non-union or hardware failure, but complication rates of the DHS are higher in unstable and osteoporotic trochanteric fractures. The proponents of the dynamic helical hip system (DHHS) report that it has the potential to decrease the cut-out rates in such fractures as helical blade allows compaction in osteoporotic femoral head which in itself improves anchorage. The purpose of the present study was to evaluate the radiological and functional outcome of DHHS in unstable and osteoporotic trochanteric fractures. This was a prospective observational study. The mean age of the 51 patients (24 men and 27 women) was 72.8 years. Fractures were type AO31A2.2 in 28 patients and AO31A2.3 in 23 patients. According to DEXA scans, 41 patients had osteoporosis and 10 patients had osteopenia. Osteoporosis was grade 3 in 36 patients and grade 2 in 15 patients according to Singh's index. The mean follow-up was 1.84 years. The average sliding of the lag screw was 3.6 mm (range 2-10 mm). The mean operative time was 54.74 (range 48-65) min. The average tip-apex distance was 20.24 mm (range 12-28 mm). All but one fractures united. The average time to union was 13.14 (range 11-24) weeks. There were four mechanical complications namely late helical blade migration (n = 1), late medialization of shaft (n = 2) and varus collapse with cut through (n = 1). No patient was noted to have a plate pull-out. The average Harris hip score was 92.87 (range 76-97). The use of a DHHS for stabilization of unstable(AO31A2), osteoporotic trochanteric fractures in the elderly patients was associated with reliable rates of union and functional outcome and a decreased incidence of screw cut-out and side plate pull-out.

Comparative evaluation of isosorbide mononitrate and alendronate in management of postmenopausal osteoporosis.

BACKGROUND: Osteoporosis, a skeletal disorder that adversely affects bone strength , is common among postmenopausal women primarily due to reduced ovarian estrogens. PURPOSE: The present study was taken up to evaluate the role of isosorbide mononitrate (IMN) in the management of postmenopausal osteoporosis and to compare its efficacy with that of alendronate. METHODS: This prospective systematic randomized study was conducted on 90 postmenopausal women with lumbar spine BMD >2.5 SD below the young adult reference range. The participants received either Tab Alendronate 70 mg orally, once weekly (Group I) or Tab IMN 40 mg orally once daily (Group II) for 9 months, in addition to 500 mg of oral calcium daily. The BMD of the lumbar spine was measured using DEXA scan at enrolment and after 9 months. The data was analyzed by Student's t test and Chi-square test. RESULTS: The mean baseline BMD was 0.67 + 0.097 and 0.68 + 0.067 g/cm(2) in Group I and II, respectively. An increase of 11.94% in the mean BMD was noted after 9 months of treatment with alendronate as against 8.82% with IMN. Headache, flushing and palpitations in Group II and nausea, epigastric pain and heart burn in Group I were the most common adverse effects. CONCLUSION: IMN has a beneficial effect on bone turnover in cases of postmenopausal osteoporosis and that the effect is comparable to that of alendronate. IMN is a promising and safe alternative to alendronate for the management of postmenopausal osteoporosis.