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Objective: To study the effect of intramedullary fixation on the joint function of elderly patients with intertrochanteric fractures. Methods: Eighty elderly patients with femoral intertrochanteric fractures admitted to our hospital from September 2016 to September 2019 were selected as the study subjects. They were divided into two groups by the random number table method, with 40 cases in each group. Patients in the control group were treated with Gamma nails, and patients in the observation group were treated with proximal femoral anti-rotation intramedullary nails. The perioperative related indicators, fracture healing time, Harris score, clinical efficacy and complication rate were compared between the two groups. Results: The operation time, incision length, intraoperative blood loss, postoperative drainage volume, hospital stay and fracture healing time in the observation group were less or shorter than those in the control group (P<0.05). The Harris scores of both groups at 6 months and 12 months after operation were significantly higher than those preoperation, which were significantly higher in the observation group than those in the control group (P,<0.05). The excellent and good rate of treatment in the observation group was 92.50 %, which was significantly higher than that in the control group (75.00 %, P<0.05). There was no significant difference in the incidence of deep vein thrombosis, infection, bedsore, loosening of fixation, necrosis of femoral head and severe pain between the two groups (P>0.05). Conclusion: Proximal femoral anti-rotation intramedullary nailing is significantly better than Gamma nail treatment in the treatment of elderly femoral intertrochanteric fractures, which can effectively shorten the fracture healing time and improve the hip function. [ABSTRACT FROM AUTHOR]

Introduction: We aimed to quantify perioperative hidden blood loss (HBL) and investigate its influencing factors in elderly patients with intertrochanteric fractures (IFs) undergoing intramedullary fixation surgery.Materials and Methods: We prospectively collected the clinical data of 200 elderly patients with IFs treated with intramedullary fixation surgery in our hospital between December 1, 2014 and August 31, 2018. The intraoperative visible blood loss, blood transfusion rate, and pre- and postoperative hemoglobin (Hb) levels as well as the general characteristics of the enrolled patients were recorded. A multiple linear regression analysis model (stepwise) was used to identify independent factors affecting perioperative HBL.Results: The mean perioperative HBL was 614.72 ± 368.14 mL, which accounted for 84.05% of the mean total perioperative blood loss (731.37 ± 391.50 mL). The mean preoperative HBL was 368.33 ± 325.57 mL, which accounted for 50.36% of the mean total perioperative blood loss. Patients with fracture types AO/OTA 31-A2.2 to A3.3 had more severe preoperative HBL (median 580.10 mL), and most of them developed mild-to-moderate anemia before the operation, and 27.63% of them received preoperative blood transfusion. Compared with patients operated within 5 days after injury, patients operated over 5 days had lower Hb value at admission (101.56 ± 19.49 vs. 107.28 ± 16.53; P = 0.026) and higher preoperative transfusion rate (25.84% vs. 9.01%; P = 0.001). Multiple linear regression analysis revealed that fracture types AO/OTA 31-A2.2 to A3.3, male sex, right-sided injury, and operation time > 60 min were independently associated with increased perioperative HBL. Tranexamic acid treatment was negatively correlated with perioperative HBL.Conclusion: IFs in elderly patients undergoing intramedullary fixation surgery were associated with significant perioperative HBL and anemia. Persistent HBL occurred before the operation and on the first few postoperative days. Surgeons should pay more attention to preoperative HBL in patients with fracture types AO/OTA 31-A2.2 to A3.3 and regularly measure Hb levels preoperatively to avoid anemia. Shortening preoperative time may helps to reduce preoperative blood loss. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Surgery & Medicine (JOSAM) is the property of Journal of Surgery & Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

ABSTRACT Objective: To evaluate the mechanical behavior of the proximal end of the femur submitted to the X-shaped polymethylmethacrylate (PMMA) reinforcement technique. Methods: Fifteen synthetic femurs, with a Nacional® density of 10 PCF, were divided into two groups: the DX group, with 5 units that were submitted to PMMA reinforcement, and the DP group, with 10 units, which were evaluated intact. The volume of PMMA required, the maximum load, and the absorbed energy to fracture were analyzed by means of a static mechanical bending test simulating a fall on the greater trochanter. Results: A mean of 6 ml of PMMA was used to model the X-reinforcement; it was observed that the DX group presented significantly higher maximum load (median = 1553 N, p = 0.005) and absorbed energy to fracture (median = 9.7 J; p = 0.050) than the DP group (median = 905 N and 6.6 J). Conclusion: X-reinforcement of the proximal end of synthetic femurs showed a statistically significant increase in the maximum load and absorbed energy to fracture in the mechanical assay when compared to the control group. Level of Evidence III, Experimental study.

Abstract Background The purpose of this study was to assess the impact of uniform anti-rotational proximal femoral intramedullary nail (APFN) use on patient mobility status with the treatment of two different unstable intertrochanteric femur fracture groups of geriatric patients. Methods The study included patients aged > 65 years who underwent surgery with APFN. Group 1 comprised AO classification, AO/OTA 31-A22, and A23 patients, and group 2, A31 and A32 patients. The demographic data of the patients, postoperative complications, follow-up, mortality status, postoperative reduction, tip-apex distance (TAD), and the Parker-Palmer mobility (PPM) score were evaluated. Results There were no statistically significant differences between the groups in terms of gender, affected side, time from trauma to surgery, ASA score, anesthesia type, duration of hospitalization, duration of surgery, TAD values, reduction values, or mortality rate. The average age of patients in group 2 was significantly higher than that of patients in group 1 (p

Purpose: This study aimed to analyze the early clinical efficacy of Gamma 3 nail, percutaneous compression plate (PCCP) and femoral head replacement (FHR) treatments on senile unstable intertrochanteric fractures. Materials and Methods: Totally 116 patients were included to perform an retrospective study, which involved analysis of the operation time, intraoperative blood loss, and hemoglobin reduction on the first postoperative day compared with preoperative levels, fracture gap, neck shaft angle and tip apex distance on the first postoperative X-ray, hospital stay, time from surgery to mobilization, Harris hip scores and Barthel index six months after operation, and complications postoperative meanwhile were evaluated respectively among three groups. Results: The Harris hip score and Barthel index and time from surgery to mobilization after FHR treatment were superior to another two surgical methods, but had more blood loss and greater hemoglobin reduction. The mean PCCP hemoglobin reduction was notably shorter than that of the other two groups. Gamma 3 treatment had a lower operation time and blood loss than those treated with PCCP and FHR. Conclusions: Gamma 3 and PCCP treatments are a priority for senile unstable intertrochanteric fractures if patients are in good health and perform fair activities of daily living prior to the operation, but had a significantly longer mobilization time than that in FHR. Therefore, considering the senile patients who unable to tolerate long immobilization time, FHR treatment is a considerable choice for faster recovery of independent function and achieve a good clinical efficacy as well as improve quality of life.

BACKGROUND: Proximal femoral nail is the first choice for treating intertrochanteric fractures. The studies concerning proximal femoral nail for senile intertrochanteric fractures mainly focus on proximal femoral nail antirotation/proximal femoral nail antirotation II, Gamma 3 and intertrochanteric antegrade nail. OBJECTIVE: To investigate the clinical efficacy of proximal femoral nail antirotation II versus intertrochanteric antegrade nail in the treatment of intertrochanteric fracture in the elderly. METHODS: Forty-two cases of senile intertrochanteric fractures at Department of Orthopedics, First People's Hospital of Xuancheng City from January 2016 to December 2018 were included, involving 15 males and 27 females, aged 65-90 years. Among which, 22 patients received internal fixation using proximal femoral nail antirotation II and 20 patients using intertrochanteric antegrade nail. The operation time, intraoperative blood loss, fracture healing time, postoperative complications and the hip function scores at last follow-up were compared. The study was approved by the Ethics Committee of First People's Hospital of Xuancheng City, approval No. (2015)(17). RESULTS AND CONCLUSION: (1) The operation time in the proximal femoral nail antirotation group was shorter than that in the intertrochanteric antegrade nail group [(69.4±11.5), (90.0±9.7) minutes, P < 0.05], The intraoperative blood loss in the proximal femoral nail antirotation group was less than that in the intertrochanteric antegrade nail group [(70.6±10.0), (86.5±11.1) mL, P< 0.05], (2) There was no significant difference in the fracture healing time between two groups [(4.3±0.5), (4.1 ±0.4) months, P > 0.05], (3) In the proximal femoral nail antirotation group, three cases suffered from pain at the affected limb, and one case of coxa vara deformity. One case in the intertrochanteric antegrade nail group appeared with pain at the affected limb. The postoperative incidence of complications between two groups showed no significant difference (18.2%, 5.0%, P > 0.05). (4) No significant difference was found in the Harris scores at the last follow-up between two groups (90.3±2.8, 91,5±2.4, P > 0.05). (5) There were no fracture adverse reactions related to internal fixation materials in the two groups. (6) In summary, proximal femoral nail antirotation II and intertrochanteric antegrade nail internal fixation are effective methods for intertrochanteric fractures in the elderly. However, proximal femoral nail antirotation II has short operation time and few intraoperative blood losses. [ABSTRACT FROM AUTHOR]

Objectives: Fear of falling (FoF) is common and associated with poorer functional outcomes after hip fracture. We sought to differentiate patterns of FoF at 4 and 12 weeks after surgical repair for hip fracture and examine predictors of FoF. Methods/design: Secondary analysis of existing data from a 52‐week prospective study examining recovery after hip fracture. Participants (N = 263) were aged 60 and older with recent hip fracture recruited from eight hospitals. FoF was measured 4 and 12 weeks postfracture with the Short Falls Efficacy Scale‐International. Latent class mixed models were constructed to identify distinct patterns of FoF from 4 to 12 weeks postfracture and predictors of FoF. Predictors examined included age, gender, neuroticism, depression, negative affect, perceived social support, medical comorbidity, functional ability, cognition, and pain. Results: Three latent classes of FoF were identified: a group with minimal FoF at weeks 4 and 12 (72%), a group with high FoF that decreased (17%), and a group with high FoF that increased from week 4 to 12 (11%). In a multivariate model, higher neuroticism was associated with greater risk for high FoF (increasing or decreasing), whereas higher premorbid medical comorbidity was associated with increasing FoF, poorer premorbid functional ability was associated with decreasing FoF, and social support was not significantly associated. Conclusions: Older adults with higher neuroticism are more likely to have FoF in the first 12 weeks after a hip fracture. Screening for neuroticism in health care settings might identify individuals who would benefit from interventions to improve outcomes during recovery. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Tepecik Education & Research Hospital / İzmir Tepecik Eğitim ve Araştırma Hastanesi Dergisi is the property of Logos Medical Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: With an increase in the elderly population, the occurrence of hip fractures, femoral neck fractures, and intertrochanteric fractures (ITFs) is also increasing. It is important to establish effective perioperative methods that would help reduce the morbidity and mortality rates associated with ITFs. The purpose of this study was to determine the effects of ITFs according to the AO classification for perioperative hemoglobin drop.Methods: Seventy-six patients with ITFs classified as AO 31-A1 or A2 and fixated with intramedullary nails participated in this retrospective cohort study. Medical records of these patients were retrospectively reviewed from September 2016 to August 2018. The perioperative hemoglobin drop was chosen as the main outcome measure and calculated as the difference between pre- and postoperative hemoglobin levels. Multivariate linear regression analysis was performed and included the following variables: AO classification (A1.1-A2.1 [stable] vs. A2.2-A2.3 [unstable]), time interval between injury and surgery, age, body mass index, and the use of anticoagulants.Results: Among the 76 patients who met the inclusion criteria, a significantly higher hemoglobin drop was observed in the AO 31 A2.2-A2.3 (unstable) group than in the AO 31 A1.1-A2.1 (stable) group (p = 0.04). The multivariate analysis also showed a greater hemoglobin drop in the unstable group (p < 0.05).Conclusions: Patients with unstable ITFs exhibited a greater hemoglobin drop and a hidden blood loss was suspected around the fracture site. We believe that this should be taken into consideration when presurgical blood transfusion is being planned for patients with unstable ITFs, to reduce associated postoperative complications, especially in patients with severe anemia or high risk of mortality. [ABSTRACT FROM AUTHOR]

Following internal fixations for intertrochanteric fractures in elderly patients, lag screws or screw blades frequently cut the femoral head, leading to surgical failure. The bone mineral density (BMD) at various parts of the proximal femur is significantly correlated with the holding force of the lag screw, which in turn is closely associated with the stability of the fixation. However, the appropriate placement of the lag screw has been controversial. As a novel detection method for BMD, quantitative computed tomography (QCT) may provide relatively accurate measurements of three-dimensional structures and may provide an easy way to determine the appropriate lag screw placement. A total of 50 elderly patients with intertrochanteric fractures were selected for the present study. The BMD of the proximal femur on the healthy side, including the femoral intertrochanter, neck and head, was measured using QCT. For testing, the femoral head was divided into medial, central and lateral sections. The BMD of the femoral head was determined to be the highest, while the BMD of the femoral neck was the lowest. In the femoral head, the central section had the highest BMD, while the lateral section had the lowest BMD. The present study used QCT to detect differences in the BMD at various regions of the proximal femur and provided a novel theoretical reference for the placement of lag screws. To obtain maximum holding power, the lag screw must be placed in the central section of the femoral head. [ABSTRACT FROM AUTHOR]

Purpose: To compare outcomes (i.e., clinical and radiological findings, postoperative complication) in the fixation of intertrochanteric fractures with U-blade Gamma3 and Gamma3 nails. Materials and Methods: A review of 162 patients (both male and female) treated for intertrochanteric fractures between December 2012 and December 2018 was conducted. All patients were older than 65 years of age and treated with U-blade Gamma3 (n=90) or Gamma3 (n=72) nails. Evaluations included: (i) screw-head position, (ii) fracture-reduction status, (iii) time to union, (iv) cases of cut-out, (v) tip-apex distance, and (vi) lag screw sliding distance. Differences in pre- and postoperative ambulatory ability was also investigated. Results: There were no significant differences in baseline demographics between the two groups. While the lagscrew sliding distance was significantly shorter in U-blade Gamma3 nail group (4.7 mm vs. 3.6 mm; P=0.025), the mean time to union was similar between the groups (P=0.053). Three and six cases of cut-out were noted in the U-blade Gamma3 and Gamma3 nail groups, respectively (P=0.18), however no other postoperative complications were noted in either group. Lastly, there was no difference between the change from pre- to postoperative activity level between the groups (P=0.753). Conclusion: Of all the clinical and radiological outcomes assessed, the only significant improvement between those treated with U-Blade Gamma and Gamma3 nails was a shorter lag-screw sliding distance. These findings should benefit clinicians when deciding between the use of U-Blade Gamma or Gamma3 nails. [ABSTRACT FROM AUTHOR]

Currently available finite element (FE) models of intertrochanteric fractures cannot accurately represent the real material properties of femurs. This paper aimed to create and validate an FE model of intertrochanteric fractures with inhomogeneous material properties assigned from CT images by a node-based approach. The geometry of a femur was automatically generated from its CT images. The density and Young's modulus were assigned to the FE model via an in-house program. The fractured femur was fixed with a dynamic hip screw (DHS) system. The resonant frequencies of the intact femur were calculated by finite element analyses (FEA) and then compared with the existing experimental results. The strains at the femoral neck and the lesser trochanter and the reaction forces under compression were also investigated by the finite element analysis. These simulation results were validated by in vitro experimental tests. In addition, the FE model with homogeneous material properties was used for comparison. Relative error analyses showed that the FE predictions matched the experimental results very well (as the errors of all the four indexes were lower than 10%), which meant that the node-based inhomogeneous material model was accurate and that the FE model could be used to investigate the intertrochanteric fractures. [ABSTRACT FROM AUTHOR]

Introduction: The purpose of this study is to evaluate the clinical and radiographic result in patients who got salvage treatment for the failed fixation of intertrochanteric fracture and to evaluate the factors that may affect healing of these treatment.Patients and Methods: Between 1997 and 2016, 39 patients who could be followed up for more than 1 year after treatment were enrolled. For determining of factor that may affect healing of treatment, the primary outcome was based on union. There were success group which achieved a restored union and failure group which had an additional revisional surgery because of another complication for analysis. And neck-shaft angle (NSA) was measured with a goniometer.Results: Fracture healing as a primary outcome (after revision surgery) was achieved 31 out of 39 patients (80%). There were no statistically significant differences between two groups in terms of age, sex, BMI and laterality. In the clinical outcomes, four categories of outcomes were compared between the success and failure groups and significant improvements were observed. In measurements at final follow-up, it the angle was 133.4° in the success group and 123.4° in the failure group.Conclusion: The clinical and radiographic results of the salvage treatment for the failed fixation of intertrochanteric fracture were satisfactory in our study. Restoration of femoral neck-shaft angle of failed intertrochanteric fracture is key factors for obtaining successful results. [ABSTRACT FROM AUTHOR]

BACKGROUND Femoral intertrochanteric fracture is an important cause of disability in the elderly. Low muscle mass, especially those of the lower limbs, has been associated with osteoporosis and higher fall incidents. This study was aimed to assess the association between the anthropometric indices and intertrochanteric fractures. METHODS This case-control study was performed from September 2013 to July 2015. The criteria of case group were elderly patients with intertrochanteric fractures admitted in Dr. Sardjito Hospital within 72 hours after a low energy injury without multiple fractures or pathological fracture. For control group, the subjects were matched according to age and gender without any fracture. Thigh and calf circumferences were done on healthy limbs. Body mass index (BMI) was calculated. History of steroid use was obtained. Adjusted odds ratio (aOR) was calculated using logistic regression after analyzed with student's t-test or chi-square test. RESULTS There were 82 subjects on each group. Smaller thigh and calf circumferences and also lower BMI were risk factors of intertrochanteric fractures. Thigh circumference <39 cm (aOR 5.12; 95% CI 2.30-11.43; p < 0.001) and calf circumference <29 cm (aOR 9.42; 95% CI 4.14-21.40; p < 0.001) were independently associated with intertrochanteric fracture after adjustment of BMI and steroid use. CONCLUSIONS Calf and thigh circumferences were independently associated with femoral intertrochanteric fractures in Indonesian elderly. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the efficacy and safety of hip replacement and intramedullary nails for treating unstable intertrochanteric fractures in elderly patients. Methods: Randomized clinical trials (RCTs) to compare hip replacement with intramedullary nail in the management of elderly patients with unstable intertrochanteric femur fracture were retrieved from Cochrane Library (up to January 2018), CNKI (China National Knowledge Infrastructure), Wanfang Data, PubMed, and Embase. The methodological quality of the included trials was assessed using the Cochrane risk of bias assessment tool, and relevant data was extracted. Statistical analysis was performed by Revman 5.3. Where possible, we performed the limited pooling of data. Results: Fourteen trials including a total of 1067 participants aged 65 and above were included for qualitative synthesis and meta‐analysis. The methodological quality of the included study was poor. The meta‐analysis indicated that the hip replacement group benefited more than the intramedullary nail group in terms of the bearing load time (WMD ‐14.61, 95% CI −21.51 to −7.7, P < 0.0001), mechanical complications (OR 0.34, 95% CI 0.21 to 0.57, P < 0.0001), and post‐operative complications (OR 0.46, 95% CI 0.22 to 0.93, P = 0.03). While the intramedullary nail was superior to arthroplasty regarding the intraoperative blood loss (WMD 58.36, 95% CI 30.77 to 85.94, P < 0.0001). However, there were no statistical significances in the length of surgery (WMD 5.27, 95% CI 4.23 to 14.77, P = 0.28), units of blood transfusion (WMD 0.34, 95% CI ‐0.16 to 0.85, P = 0.18), length of hospital stay (WMD ‐1.00, 95% CI ‐2.93 to 0.93, P = 0.31), Harris hip score (WMD 0.31, 95% CI ‐0.39 to 1.01, P = 0.38), and mortality (OR 1.24, 95% CI 0.12 to 13.10, P = 0.86). Conclusions: This systematic review and meta‐analysis provided evidence for the efficacy and safety of hip replacement and intramedullary nail in treating unstable intertrochanteric fractures. However, the results should be interpreted cautiously because of methodological limitations and publication bias. [ABSTRACT FROM AUTHOR]

Cephalomedullary nails are presently the gold standard in management of unstable trochanteric fractures. The tip-apex distance (TAD) is one of the most important factors that determines success or failure of fixation, but was described originally in context of an extramedullary hip screw. Cephalomedullary nails use a different biomechanical approach to fixation; and it is hypothesized that the TAD rule may not apply similarly with these. The aim of this study is to assess whether a high TAD correlates with poor outcomes with cephalomedullary nails, and to elucidate other factors that may predict such outcome. We retrospectively reviewed the clinical and radiographic records of patients with intertrochanteric fractures, treated at our institution over a 2-year period. Those with unstable fractures (31.A2 and 31.A3), and who were treated with cephalomedullary nails were included in the study. The TAD and the position of the device in the femoral head (Cleveland index) were assessed. Other factors that could influence outcome like age, gender, AO fracture type, restoration of neck-shaft angle and degree of osteoporosis were analysed. Radiographic records of up-to at-least 3 months post-operatively were assessed for complications. After applying the exclusion criteria, 75 patients were included in the analysis. The overall rate of complications was 12%. They occurred in two major patterns - varus collapse and cut-out occurred in 5 patients (6.67%), and device migration in 4 patients (5.33%). The average TAD of patients with cut-out was 28.78 mm, compared to 19.44 mm in those without cut-out (p = 0.002). Our data predicted a cut-off TAD >23.56 mm as most significant for cut-out with cephalomedullary nails. On univariate logistic regression, high TAD (p = 0.009), sub-optimal device positioning (p = 0.02) and poor restoration of neck-shaft angle (p = 0.04) were found to be significant for varus collapse and cut-out, but not for complications relating to device migration. On multivariate analysis, none of the above factors reached statistical significance in isolation. As with extramedullary devices, TAD, along with sub-optimal device positioning and poor restoration of neck-shaft angle is a useful predictor of cut-out even with cephalomedullary nails, negating the initial hypothesis. The above factors in combination have a more significant effect than any one factor in isolation to cause varus collapse and implant cut-out. However these do not affect Z effect, reverse Z effect or other types of device migration seen especially with dual-screw nails. [ABSTRACT FROM AUTHOR]

Intertrochanteric fracture is one of the most common and severe fractures occurring in the elderly population. We conducted a randomized prospective study to compare the functional and radiological outcome of Proximal Femoral Nail anti-rotation-Asia(PFNA-II) and Dynamic Hip screw (DHS) used in fixation of stable (AO type 31 A1-A2.1) intertrochanteric fractures in elderly. 60 elderly patients with stable intertrochanteric fractures treated with DHS and PFNA-II between August 2014 to Dec 2016 were enrolled in the study. Intraoperative variables-surgical time, blood loss, fluoroscopy time and post-operative variables-union rate, change in neck shaft angle(NSA), functional outcome in terms of Modified Harris Hip Score(HHS) & SF-12, complication rate and mortality at one year were studied and compared between both the groups. The mean age of patients in our study was 70.96 years. We found patients treated with DHS required significantly longer surgical time and had more blood loss compared to PFNA-II group. However, there was no significant difference in both the groups in terms of intra-operative fluoroscopy time, change in neck shaft angle, union rate, complication rate and Modified Harris Hip Score & SF-12 at three months; six months and one year follow-up. Both DHS and PFNA-II can be used effectively in the treatment of elderly patients with stable intertrochanteric fracture with comparable outcome. However, in high-risk elderly patients requiring shorter surgical time and less blood loss, PFNA-II can be used. [ABSTRACT FROM AUTHOR]

Intertrochanteric femur fractures are common in older patients and often have a significant impact on disability. The treatment aims to achieve a rapid return to the prior functional level with a low rate of complications and mortality. Surgical management by internal fixation is the mainstay of treatment for most of these fractures. Even when treated with intramedullary nails, the overall complication rates are high, especially for unstable or highly comminuted fractures or in the presence of poor bone quality. Hip arthroplasty is an alternative in older patients with intertrochanteric femur fractures at high risk of fixation failure or with concomitant intraarticular pathologies. Especially patients whose condition precludes prolonged bedrest and who are at risk of significant deterioration if their locomotor function cannot be restored rapidly are likely to benefit from hip arthroplasty. The choice of the surgical technique mainly depends on the surgeon’s preferences and the fracture characteristics. Bipolar hemiarthroplasty is the most common type of prosthesis used with primary or revision femoral stems. Compared with intramedullary nails, hip arthroplasty has a better early functional outcome and lower rates of surgical complications as well as reoperations. However, the functional outcome and the mortality rate in the longer term tend to favor intramedullary nails, even though the results are inconsistent, and a statistically significant difference cannot always be obtained. Currently, there are no guidelines that define the role of hip arthroplasty in the treatment of intertrochanteric femur fractures in older patients. The literature only offers an overview of the possibilities of the usage of hip arthroplasty, but methodological limitations are common, and evidence levels are low. Further studies are needed to identify the intertrochanteric fractures that are at high risk of internal fixation failure, the characteristics that determine which patients may benefit most from hip arthroplasty, and the optimal surgical technique.

Background: Studies demonstrate an increase incidence of intertrochanteric fractures within the United States. Matched studies evaluating intertrochanteric fractures managed with either sliding hip screw (SHS) or intramedullary nail (IMN) within the Medicare population are limited. The purpose of this study was to investigate: 1) annual utilization trends; 2) patient demographics; and 3) complications including mortality., Methods: A retrospective query using a nationwide database was performed. Patients undergoing SHS or IMN for intertrochanteric fractures were identified. The query yielded a total of 37,929 patients utilizing SHS (n = 11,665) or IMN (n = 26,264). Patients were matched 1:1 based on comorbidities. Primary outcomes included: utilization trends, patient demographics, 90-day complications, and 90-day readmission rates. Linear regression analyses were used to compare utilization trends. Pearson's c2 analyses were used to compare patient-demographics, medical complications, and 90-day readmission rates. A p-value less than 0.05 was considered statistically significant., Results: Linear regression analysis demonstrated a statistically significant decrease in utilization of SHS for IT fractures (p<0.0001); whereas utilization for IMN stayed consistent (p=0.36). IMN had significantly higher prevalence of comorbidities compared to SHS, notably, hyperlipidemia (70.6 vs. 62.6%; p<0.0001). Based on 1:1 match, IMN patients had significantly higher rates of 90-day medical complications, such as respiratory failure (11.0 vs. 8.1%; p<0.0001) and VTE (4.2 vs. 3.2%; p<0.001; however, there was not a statistical difference in postoperative infection (1.4 vs. 1.5%, p=0.06). There was no statistical difference in 90-day mortality between IMN and SHS cohorts (0.19 vs .13%, p = 0.249)., Conclusion: This analysis demonstrates a difference in utilization of SHS and IMN for patients with IT fractures. Patients with IMN had significantly higher prevalence of comorbid conditions and incidence of 90-day postoperative complications compared to SHS patients. The study can be utilized by orthopaedic surgeons to potentially anticipate healthcare utilization depending on implant selection. Level of Evidence: III ., Competing Interests: Disclosures: The authors report no potential conflicts of interest related to this study., (Copyright © The Iowa Orthopaedic Journal 2023.)

Purpose: To determine how the reduction of medial and anteromedial cortices using CT findings in 31-A2 intertrochanteric fractures treated with the intramedullary nail could affect the clinical outcomes and complication rates of the fractures.Methods: We retrospectively analyzed the data of 43 patients with 31-A2 intertrochanteric fractures who underwent closed reduction and intramedullary internal fixation (CRIF) between January 2010 and December 2013. Patients were classified into two groups based on the post-operative CT scans taken from the sagittal and coronal planes, respectively. Five radiographic parameters and three clinical parameters were used to evaluate the post-operative functional states and mobilization levels in this study. Post-operative complications were also recorded.Results: The mean loss of the femoral neck-shaft angle (FNSA) was significantly smaller in Group C1 than that in Group C2. There were significant differences in the sliding distance of the cephalic nail and the loss of femoral head height between the two groups. In terms of the reduction conditions shown on the sagittal planes, the FNSA, sliding distance of the cephalic nail, and the loss of FHH were significantly different, although differences in TCD were not significant. Patients in groups C1 (3.6%) and S1 (0.0%) had lower complication rates compared to patients in groups C2 (26.7%) and S2 (27.8%).Conclusion: Patients with good reduction quality of the medial and anteromedial sustainable cortices had better clinical outcomes and lower complication rates. The sustainable stability and anti-rotational function of these validated reductions might play a critical role in maintaining the fragment positions and reducing the incidence of complications in patients. [ABSTRACT FROM AUTHOR]

BACKGROUND: Studying and controlling hidden blood loss, and ultimately reducing the adverse effects of hidden blood loss on the treatment of intertrochanteric fractures in the elderly, can obviously improve and guide the treatment process, and contribute to rapid recovery, improve prognosis, and reduce mortality. OBJECTIVE: To review the history, status, calculation process and affecting factors of hidden blood loss, so as to provide theoretical guidance for surgical treatment of senile intertrochanteric fractures. METHODS: Databases of PubMed, Ovid and CNKI were searched for the articles related to surgical treatment of intertrochanteric fractures in middle-aged and older adults between 1960 and 2018. The keywords were “aged people, intertrochanteric fracture, hidden bleeding” in English and Chinese, respectively. Forty-three articles were included for review in accordance with the inclusion and exclusion criteria. RESULTS AND CONCLUSION: (1) There are various surgical treatments of intertrochanteric fractures, and all have disadvantages and disadvantages, so individualized method is recommended. (2) Pathogenesis of hidden bleeding remains controversial, and still needs in-depth study. (3) Sex, body mass index and surgical approach are considered to the factors that increase the hidden bleeding, and other factors required to be investigated further. [ABSTRACT FROM AUTHOR]

Aim: The aim of our study is to investigate the results of constrained total hip arthroplasty as a primary treatment of intertrochanteric fractures (ITF) in elderly patients with high comorbidities. Materials and methods: Total hip replacement (THR) with a retentive cup was performed on 73 patients with ITF over the age of 54 years who had high comorbidities and a Charlson score above five. Short- and long-term complications were determined by follow-up. Bivariate analysis was conducted in order to determine the possible determinants of mortality and factors associated with comorbidity as measured by the Charlson comorbidities index. Results: Patient demographics that consisted of females (58.9%) (p < 0.04) with the mean age of both males and females demonstrated no statistical significance. The mean hospitalization time and weight bearing time were 11 and 2.67 days, respectively. Only 4.1% needed re-intervention due to re-fracture and none due to prosthesis failure. There was a statistical significance between the comorbidity index and the mortality rate. However, no statistical significance was identified between the comorbidity index and the functional status after constrained THR. Conclusion: High comorbidity index is not associated with high morbidity and mortality when employing constrained arthroplasty as a primary treatment for ITF in elderly patients. [ABSTRACT FROM AUTHOR]

Background: There has been heightened interest in the effect of osteoanabolic agents on acceleration of fracture healing.Objectives: The purpose of this study was to identify whether short-term daily teriparatide prescribed for osteoporosis treatment would improve postoperative outcomes including clinical scores, radiographic healing, and complication rates.Methods: Between 2014 and 2017, we retrospectively assessed 112 patients who underwent closed reduction and internal fixation with proximal femoral nail (PFN) for unstable intertrochanteric fractures. In 60 of 112 patients, patients were treated with a PFN alone (group I). These patients were compared with 52 patients for whom the same device was used and a daily subcutaneous injection of teriparatide (1-34 PTH, Forsteo®) was prescribed postoperatively (group II). Teriparatide was administered by nurses during a hospital stay and then self-injection was monitored by follow-up visits to the outpatient clinic after discharge. Questionnaire surveys were conducted and patients completed a self-report Harris hip score (HHS) and visual analog scale (VAS) scores.Results: Teriparatide therapy significantly increased HHS (p = 0.02) and decreased VAS pain scores (p = 0.008). The mean time to fracture healing post-operatively was 14.8 weeks (SD 7.1) and 12.1 weeks (SD 6.4) in group I and II, respectively (p = 0.002). The frequency of patients reporting postoperative complications was also markedly reduced in the teriparatide-treated groups (p = 0.028).Conclusions: Short-term daily teriparatide used for osteoporosis treatment improved radiographic fracture healing of a hip fracture and reduced complication rates. However, because of the limited power of the study, additional randomized placebo-controlled trials are needed to determine the potential benefit of PTH as an adjunct to enhance fracture healing and its efficacy in broader populations with varying comorbidities and fracture types. [ABSTRACT FROM AUTHOR]

Background: Retrograde intramedullary nailing of femur is now an established method of fixation of mid-shaftand distal femoral fractures. Other indications include ipsilateral femoral neck and shaftfractures, floating knee injuries, obesity and pregnancy. Objective: To determine the outcome of retrograde femoral nailing with SIGN FIN Nail in patients with minimally comminuted mid and distal diaphyseal femoral fractures in terms of radiological union, SMFA score and complications. Material and Methods: A descriptive case study incorporating 71 patients was conducted from April 2016 to June 2017 at Orthopedic Unit of Ghurki Trust Teaching Hospital, Lahore. Patients were admitted through emergency department. After following ATLS protocol, diagnosis was confirmed with orthogonal radiographs. After proper informed consent, Retrograde intramedullary nailing of the femoral fractures was done using SIGN FIN nail. Outcome was assessed in terms of radiological bony union, SMFA score and post-operative complications. Follow-up was done at 2 weeks, 4 weeks, 3 months and 6 months Results: Mean age was 35.1±11.8 with 53(74.6%) males and 18(25.4%) females. 42(59.1%) fractures were mid-shaftand 29(40.9%) were distal diaphyseal. Mean follow-up time was 4.7 months (2-7 months). Radiological union was achieved in 92% of the patients at a mean follow-up of 4.5 months. Mean improvement in SMFA score was 56. 2(2.8%) patients lost to follow-up. 3(4.2%) patients developed superficial SSI which settled with antibiotics. 2(2.8%) patients later required exchange nailing and bone grafting for non-union. Conclusion: Retrograde intramedullary nailing with SIGN FIN nail is easy to perform, time saving and results in excellent union rates. Good post-operative and long term musculo-skeletal function can be expected. [ABSTRACT FROM AUTHOR]

Background: Dynamic hip screw (DHS) osteosynthesis represents one of the most frequently performed fixation methods in orthopedic practice. The purpose of this study was to determine the potential risk of vascular damage by DHS side-plate screws (PS) and plunging instruments for individual femoral vessels and screw positions.Methods: In ten hemipelvic/leg specimens mounted with a large femur distractor, a DHS system with a four-hole side-plate was inserted. PS were inserted in 3 consecutive courses with different inclinations in the frontal plane of 0° (group 1), - 30° posterior (group 2) and + 30° anterior (group 3) in relation to the side-plate's surface, resulting in 120 PS positions. After screw tightening, the soft tissues on the medial side of the femur were dissected and investigated for vascular compromise; in each course, the effect of overshot instruments within a range of 50 mm beyond the side-plate's surface was also tested.Results: Totally, 37/120 screw positions (31%) revealed potential vascular compromise which comprised of 15/120 (13%) direct hits by screw tips and 22/120 (18%) potential impacts by plunging instruments. The deep femoral artery system (DFA) was significantly (p = 0.007) most often affected but no significant differences for individual vascular structures were seen. Direct vascular impacts occurred significantly more often (p = 0.0047) in screws with 0° inclination compared to + 30° inclination (p = 0.017). Significant differences among individual screw positions were only found in group - 30° with direct vessel contacts (p = 0.038).Conclusions: The DFA system is significantly more at risk while significant preference of a certain vessel is missing. Our data indicate that more than 30% of 120 screw positions in DHS osteosynthesis revealed a potential danger of vascular compromise, when surgical principles are denied in hip fracture fixation.Clinical Relevance: Though vascular complications are infrequently encountered in DHS osteosynthesis they have to be considered as a potential complication when surgical principles are not followed in this anatomic area. [ABSTRACT FROM AUTHOR]

Intertrochanteric femoral Fractures forms approximately one percent of all fractures. To assess the functional outcomes, operative time, period of union,blood loss, and complications of femoral neck fracture treated with gamma nail versus DHS we managed 124 patients with closed intertrochanteric fractures, AO type A1 and A2, during the period between October 2012 and October 2017 followed up for 12 - 24 months at al Sader Teaching hospital in Najef /Iraq. There were 62 cases treated by gamma nails method and 62 patients treated by dynamic hip screws (DHS). Functionally outcome was measured using Harris Hip Score, fluoroscopic exposure,operative time,blood loss, period of union, reoperation rate, weight-bearing time, with other parameters. Regarding gamma nail method, the outcome was excellent in 42 %, good in 45 %, and fair in 9.7% and poor in 3.3 % of cases, but with (DHS) method the outcome was excellent in 35.5%, good in 35.5%, fair in 19.3 % and poor in 9.7%.We concluded that the gamma nail fixation method is superior to the (DHS) fixation method. [ABSTRACT FROM AUTHOR]

Objective: We aimed to investigate the factors affecting postoperative mortality associated with intertrochanteric femoral fractures in patients age 65 and older who were treated with osteosynthesis with a proximal femoral nail (PFN). Materials and Methods: Patients were categorized and examined according to age, gender, pre-operative American Society of Anesthesiologist (ASA) scores, time of surgery and type of anesthesia. Patients with more than two systemic additional diseases and an ASA of score 5 were not included in the study. Post-operative mortality results and the factors associated with mortality were investigated. Results: Thirty-one patients (36.1%) were male and 55 (63.9%) were female. The mean age was 78.31 years and forty-eight of the patients were under 80 years old (55.8%) and 38 were over 80 years old (44.2%). According to the Jensen fracture classification, 35 (40.6%) of the patients were evaluated as type 3, 15 (17.4%) patients were type 4 and 36 (42%) patients were type 5. The ASA score was used for preoperative risk assessment. Thirty (34.8%) patients had an ASA score of 1-2, while 56 (65.2%) had an ASA asore of 3-4. Patients were categorized as "3 days before" or "3 days after" according to the time of surgery, and the mean time to surgery was 3.7 days. The type of anesthesia was classified as general and regional with 65 patients (75.5%) operating under regional anesthesia and 21 patients (24.4%) under general anesthesia. After a mean follow-up of 18 months, the mortality rate was 20.9% (18/86). Mortality was significantly higher in patients over 80 years old (36.8% vs 8.3%, p=0.004). Conclusion: Patients 80 years and older are at serious risk for mortality when they have unstable trochanteric fractures treated with PFN. These patients are at especially high risk for mortality within the first year and should be monitored closely. [ABSTRACT FROM AUTHOR]

Introduction: Intertrochanteric fractures are common in the elderly especially with the increase in the incidence of osteoporosis. Various studies have shown good results when treated with intramedullary devices such as the proximal femoral nail (PFN) while other studies have shown high rates of complications. Aim: To study the outcome of intertrochanteric fractures treated with proximal femoral nailing by using Kyle's criteria. Materials and Methods: The study involved fifty cases of intertrochanteric fractures of femur that were treated with PFN. Fractures were classified using Orthopaedic Trauma Association classification. Patients were followed up at 4 weeks, 3 months, and 6 months and results were evaluated using Kyle's criteria. Results: The study included fifty patients, 32 males and 18 females of age 38-94 years with an average of 57 years. Excellent and good results were found in 44 patients (88%). Intra- and post-operative complications were found in 12 patients (24%). Conclusion: Good fracture reduction is critical in the management intertrochanteric fractures with PFN. Proximal femoral nailing is an excellent treatment option for unstable intertrochanteric fractures.

Background: There is no consensus about intertrochanteric fractures with lateral wall treated with intramedullary nail-proximal femoral nail antirotation (PFNA). The aim of the present study was to compare function outcomes between lateral wall and no lateral wall fractures after surgery by PFNA., Methods: This retrospective study evaluated patients with or without lateral wall fractures who underwent PFNA between January 2015 and June 2018. The operative time, intraoperative blood loss, time to fracture healing, complications and functional outcomes qualified by Harris hip score and Parker - Palmer mobility score (PPMS) were compared between the two groups., Results: Two groups were comparable with regard to patient age, sexual distribution, mechanism of injury, fracture type, body mass index (BMI), Time to surgery, American Society of Anesthesiologists (ASA) score and quality of reduction. The incomplete group had a longer operation time (54.1 ± 8.74 min vs. 51.0 ± 9.86 min) and more intraoperative blood loss (228.4 ± 48.8 ml vs. 151.3 ± 43.5 ml) in comparison with the control group (P < 0.01). Regarding functional outcome, the HHSs of the two groups were 76.2 ± 11.6 vs 75.6 ± 12.5 at the 3 months (P = 0.603), 81.9 ± 9.4 vs 82.6 ± 8.7 at the six months (P = 0.224), 83.8 ± 6.6 vs 84.5 ± 6.0 at the twelve months 85.2 ± 5.5 vs 86.0 ± 5.8 at the twenty-four months (P > 0.05), respectively. Similar results were obtained about PPMS. We found no difference in Weight bearing time, Time of fracture healing, and Complications between incomplete group and intact group., Conclusions: There is no substantial difference in functional results or complication rates for intertrochanteric fractures with lateral wall fractures, except from increased blood loss and operation time. We believe that an intramedullary nail will be sufficient to repair an intertrochanteric fracture with or without a lateral wall fracture., (© 2023. The Author(s).)

Background: Closed reduction and internal fixation with intramedullary nails has been widely accepted for treating intertrochanteric fractures., Aim: To focus on how to avoid displacement of the lesser trochanter in unstable intertrochanteric fractures., Methods: We developed a lesser trochanteric reduction fixator for treating intertrochanteric fractures through fixing the lesser trochanter by combining the loop plate through the fixator after reduction by the reducer. Five patients with intertrochanteric fractures treated with the newly developed lesser trochanteric reduction fixator and loop plate combined with intramedullary nails, and 20 patients with intertrochanteric fractures treated with simple intramedullary nails were selected from December 2020 to March 2021., Results: The postoperative Harris hip score was significantly higher in patients treated with the lesser trochanteric reduction fixator than in patients treated without the lesser trochanteric reduction fixator, which indicated that this lesser trochanteric reduction fixator had a positive impact on rehabilitation of the hip joint after surgery and could significantly improve the quality of life of patients., Conclusion: We fully realize the significance of trochanteric reduction and fixation, namely, reconstruction of structures under pressure, in the treatment of intertrochanteric fractures. As long as the general condition of patients is favorable and they are willing to undergo surgery, fixation of the main fracture end should be performed and the lesser trochanter should be reduced and fixed at the same time., Competing Interests: Conflict-of-interest statement: The authors declare no competing interests for this article., (©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.)

Purpose: This study was designed to compare clinical outcomes of the femoral stable interlocking intramedullary nail (FSIIN) with proximal femoral nail anti-rotation (PFNA) for the treatment of intertrochanteric fractures (OTA 31A1 + A2)., Methods: This study retrospectively analyzed a registered sample of 74 intertrochanteric fractures (OTA 31A1 + A2) surgically treated using FSIIN (n = 36) or PFNA (n = 38) from January 2015 to December 2021. The intra-operative variables (operation time, fluoroscopy time, intra-operative blood loss, length of incision) and fracture healing time were compared between the two groups in this study. Harris hip score (HHS) and visual analog scale (VAS) were used to evaluate the functional states. At the last follow-up, the incidence of related complications in patients was calculated. Eventually, the 3D finite element model was established to analyze the stress of FSIIN and PFNA., Results: The distribution of all basic characteristics was similar between the two groups (p > 0.05). The operation time, fluoroscopy time, intra-operative blood loss, and length of incision were significantly decreased in the FSIIN group (p < 0.001). The FSIIN group had a shorter fracture healing time than the PFNA group (p < 0.001). There is no significant difference between the two groups in the Harris and VAS (p > 0.05). The incidences of post-operative anaemia, electrolyte imbalance, varus malalignment, and thigh pain were significantly lower in FSIIN than in PFNA groups (all p < 0.05). The finite element results show that the stress shielding effect of FSIIN is smaller., Conclusions: Our study revealed that FSIIN seemed to be superior to PFNA in the treatment of intertrochanteric fractures (OTA 31A1 + A2) due to less surgical damage and shorter fracture healing time., (© 2023. The Author(s) under exclusive licence to SICOT aisbl.)

Purpose: Cephalomedullary (CM) nailing is widely performed in treatment of elderly patients with femoral intertrochanteric fractures. However, in cases of fixation failure, re-operation is usually necessary, thus determining factors that may contribute to fixation failure is important. In this study, we examined factors affecting the occurrence of fixation failure, such as age or fracture stability, after CM nailing in elderly patients., Materials and Methods: This study was conducted retrospectively using registered data. From April 2011 to December 2018, CM nailing was performed in 378 cases diagnosed with femoral intertrochanteric fractures, and 201 cases were finally registered. Cases involving patients who were bed-ridden before injury, who died from causes unrelated to surgery, and those with a follow-up period less than six months were excluded., Results: Fixation failure occurred in eight cases. Comparison of the surgical success and fixation failure group showed that the mean age was significantly higher in the fixation failure group compared with the control group (81.3±6.4 vs. 86.4±6.8; P =0.034). A significantly high proportion of unstable fractures was also observed (139/54 vs. 3/5; P =0.040), with a significantly high ratio of intramedullary reduction (176/17 vs. 5/3; P =0.034). A significantly higher ratio of unstable fractures compared with that of stable fractures was observed in the intramedullary reduction group (132/49 vs. 10/10; P =0.033)., Conclusion: Fixation failure of CM nailing is likely to occur in patients who are elderly or have unstable fracture patterns. Thus, care should be taken in order to avoid intramedullary reduction., Competing Interests: CONFLICT OF INTEREST: Sang-Min Kim has been an editorial board member since January 2022, but had no role in the decision to publish this article. No other potential conflict of interest relevant to this article was reported., (Copyright © 2023 by Korean Hip Society.)

Purpose: This study aims to determine which intertrochanteric (IT) hip fracture and patient characteristics predict the necessity for adjunct reduction aides prior to prep and drape aiming for a more efficient surgery., Materials and Methods: Institutional fracture registries from two academic medical centers from 2017-2022 were analyzed. Data on patient demographics, comorbidities, fracture patterns identified on radiographs including displacement of the lesser trochanter (LT), thin lateral wall (LW), reverse obliquity (RO), subtrochanteric extension (STE), and number of fracture parts were collected, and the need for additional aides following traction on fracture table were collected. Fractures were classified using the AO/OTA classification. Regression analyses identified significant risk factors for needing extra reduction aides., Results: Of the 166 patients included, the average age was 80.84±12.7 years and BMI was 24.37±5.3 kg/m 2 . Univariate regression revealed increased irreducibility risk associated with RO (odds ratio [OR] 27.917, P ≤0.001), LW (OR 24.882, P <0.001), and STE (OR 5.255, P =0.005). Multivariate analysis significantly correlated RO (OR 120.74, P <0.001) and thin LW (OR 131.14, P <0.001) with increased risk. However, STE ( P =0.36) and LT displacement ( P =0.77) weren't significant. Fracture types 2.2, 3.2, and 3.3 displayed elevated risk ( P <0.001), while no other factors increased risk., Conclusion: Elderly patients with IT fractures with RO and/or thin LW are at higher risk of irreducibility, necessitating adjunct reduction aides. Other parameters showed no significant association, suggesting most fracture patterns can be achieved with traction manipulation alone., Competing Interests: CONFLICT OF INTEREST: Author F.A.L. reports no direct disclosures related to the submitted work, however, reports the following disclosures that could be perceived as a real or apparent conflict of interest in the context of the subject of this manuscript. AAOS: Board or committee member, AO: Unpaid consultant, Biomet: IP royalties; Paid consultant; Paid presenter or speaker; Research support, DePuy, A Johnson & Johnson Company: IP royalties; Research support, Orthopedic Trauma Association: Board or committee member, Stryker: IP royalties, Synthes: Paid consultant; Paid presenter or speaker. Author R.S.Y. reports no direct disclosures related to the submitted work, however, reports the following disclosures that could be perceived as a real or apparent conflict of interest in the context of the subject of this manuscript. American Association of Hip and Knee Surgeons: Board or committee member, Arthrex, Inc.: IP royalties; Paid consultant, Bicomposites: Research support, Biomet: Research support, BuiltLean: Unpaid consultant, DePuy, A Johnson & Johnson Company: Paid consultant, Foundation for Physician Advancement: Board or committee member, Foundation of Orthopedic Trauma: Board or committee member, Horizon Therapeutics: Paid presenter or speaker, LifeNet Health: Paid consultant; Research support, Organogenesis: Research support, Ortho Grid: Paid consultant, Orthopedic Trauma Association: Board or committee member, ORTHOXEL: Paid consultant, SI-Bone: Paid consultant, Springer: Publishing royalties, financial or material support, Stryker: IP royalties; Paid consultant, Synthes: Paid consultant; Research support, Use-Lab: Paid consultant, WNT Scientific: Stock or stock options. No other potential conflict of interest relevant to this article has been declared., (Copyright © 2023 by Korean Hip Society.)

Introduction: The specific aim of this retrospective study was to determine whether bone quality has any effect on the complication rates or overall survivorship between helical blades and lag screws in cephalomedullary nails used for intertrochanteric hip fractures., Methods: The authors reviewed clinical charts and radiographic studies of patients between January 2012 and August 2019. We reviewed radiographic images (pre-, intra-, and post-operative) to evaluate fracture fixation type, fracture reduction grade, and post-operative complications. We collected dual energy x-ray absorptiometry scan results (T-score) and serum alkaline phosphatase (ALP) isoenzyme activity values to evaluate patient bone quality., Results: We included 303 cases (helical: 197, screw: 106) in the study. Complications were found in 31 (16%) helical blade cases and 23 (22%) lag screw cases. No statistically significant difference was detected when comparing complication rates with patient bone quality between the two groups. These two groups had similar one-year implant survivorship with respect to T-score, the low ALP level group, and normal ALP level group. The helical blade had higher implant survivorship compared to lag screw in five-year survival rate with respect to osteoporotic group, high ALP level group, and normal ALP level group (osteoporotic: 77% vs 69%, high ALP: 73% vs 67%, normal ALP: 70% vs 64%)., Conclusions: Similar complication rates were observed between helical blade and lag screw constructs in cephalomedullary femoral nails when accounting for patient bone quality. However, the helical blade design had a higher five-year survival rate., (© 2023 The University of Kansas Medical Center.)

Background: Hip fractures are an increasingly common consequence of falls in older people that are associated with a high risk of death and reduced function. The vast majority of intertrochanteric fractures require surgical treatment to withstand early mobilization and weight bearing, which prevents complications due to prolonged bed rest and aids in fracture healing., Methods: This study is compromised by two parts, the experimental study and the clinical part. In the first part, a standard 130° nail will be used with the appropriate lag screw(s) and dynamic distal locking in synthetic osteoporotic femurs and the transmission of forces in the proximal femur, measured by a cortical surface-strain distribution, will be evaluated using digital image correlation. Finite element parametric models of the bone, the nails and their interface will be also developed. Finite element computations of surface strains in implanted femurs, after being validated against biomechanical testing measurements, will be used to assist the comparison of the nails by deriving important data on the developed stress and strain fields, which cannot be measured through biomechanical testing. In the other part, will set up a prospective, randomized, comparative clinical study among the Gamma3 and IT cephalomedullary nailing, in order to investigate if there are any statistical important differences in the main radiological measurements and functional status in closed unstable intertrochanteric fractures (A21-3) in patients aged over 70 years old at the 24-week follow-up evaluation using patient reported disease-specific outcomes., Discussion: This study will be the first to compare clinical, radiological and biomechanical measurements of the two different cephalomedullary nails. Our main hypothesis is that the IT nail would provide better radiological outcome and probably better clinical results than the Gama3 nail. Clinical trial registration International Standard Randomized Controlled Trial Number (ISRCTN): https://doi.org/10.1186/ISRCTN15588442 , registered on 19/4/2022., (© 2023. The Author(s).)

Background: Hip fractures are common in elderly patients, and almost all the patients undergo surgery. This study aimed to develop a novel modified lymphocyte C-reactive protein (CRP) score (mLCS) to simply and conveniently predict 3-year mortality in elderly patients undergoing intertrochanteric fracture surgery., Methods: A retrospective study was conducted on elderly patients who underwent intertrochanteric fracture surgery between January 2014 and December 2017. The mLCS was developed according to the value of CRP and lymphocyte counts. Univariate and multivariate Cox regression analyses were used to identify independent risk factors for 3-year mortality after surgery. The performances of the lymphocyte CRP score (LCS) and mLCS to predict 3-year mortality were then compared using C-statistics, decision curve analysis (DCA), net reclassification index (NRI) and integrated discrimination improvement (IDI)., Results: A total of 291 patients were enrolled, of whom 52 (17.9%) died within 3 years after surgery. In the multivariate Cox regression analysis, mLCS (hazard ratio (HR), 5.415; 95% confidence interval (CI), 1.743-16.822; P = 0.003) was significantly associated with postoperative 3-year mortality. The C-statistics of LCS and mLCS for predicting 3-year mortality were 0.644 and 0.686, respectively. The NRI (mLCS vs. LCS, 0.018) and IDI (mLCS vs. LCS, 0.017) indicated that the mLCS performed better than the LCS. DCA also showed that mLCS had a higher clinical net benefit., Conclusions: mLCS is a promising predictor that can simply and conveniently predict 3-year mortality in elderly patients undergoing intertrochanteric fracture surgery., (© 2023. The Author(s).)

Summary: The use of calcium phosphate bone cement has been described to allow for retention of reduction. Therefore, we evaluated whether augmentation with resorbable calcium phosphate could improve fracture stability in osteoporotic hip fractures. The results showed that augmentation with calcium phosphate cement significantly improved the stability of intertrochanteric fractures.Introduction: The aim with this study was to measure whether augmentation with resorbable calcium phosphate cement could improve fracture stability in osteoporotic hip fractures.Methods: We retrospectively reviewed 82 patients who underwent closed reduction and internal fixation with proximal femoral nail (PFN) for unstable intertrochanteric fractures between 2014 and 2017. In 42 of 82 patients, patients were treated with a PFN alone (group I). These patients were compared with 40 patients for whom the same device combined with calcium phosphate cement for augmentation was used (group II). Questionnaire surveys or telephone interviews were conducted and patients completed a self-report Harris hip score (HHS) and visual analog scale (VAS) scores. Radiographic outcomes including mean sliding distance of screw, femoral shortening, and varus collapse were compared. Postoperative complications were compared.Results: Clinical outcomes at 6 months after surgery were equivalent in both groups. Screw sliding, femoral shortening, and varus collapse were all significantly reduced in the cemented group at the last follow-up (p < 0.001, p = 0.005, p < 0.001, respectively). A total of 9 (21%) complications occurred in group I. In contrast, 2 (5%) complications were seen in group II (p = 0.029).Conclusions: Augmentation with calcium phosphate cement significantly improved the stability of intertrochanteric fractures fixed with a PFN and reduced overall failure rates. We believe augmentation with resorbable calcium phosphate cement for osteoporotic hip fractures is a reasonable option in selected patients. [ABSTRACT FROM AUTHOR]

Purpose: Cephalomedullary nails (CMN) are commonly used for the surgical treatment of intertrochanteric fractures. This study aimed to evaluate overall postoperative local complications by reviewing patients who received surgical treatment using three different types of implants. Materials and Methods: The study sample included 353 patients (107 males, 246 females) who underwent surgery using CMN for intertrochanteric fractures. Three different types of implants were used: i) the Gamma3® (Stryker) in 80 cases, ii) the Targon® PF (Aesculap) in 225 cases, and iii) the Compression Hip Nail® (Trademedics) in 48 cases. The mean age was 82.6 (range, 60-109) years and the average follow-up period was 15 (range, 6-80) months. Postoperative local complications and risk factors of cut-out were assessed. Results: The most common complication was cut-out (n=26). Other complications included non-union (n=3), periprosthetic fracture (n=2), avascular necrosis (n=1), heterotopic ossification (n=1), and sleeve pull out (n=1). Multivariate analysis revealed that the cut-out group had a higher rate of poor reduction compared to the noncomplicated group (P<0.001). Although the mean tip-apex distance (TAD) was 18.4 mm in the non-complicated group, lower than that of the cut-out group (P=0.001), multivariate analysis revealed that TAD was not a significant risk factor for cut-out (P=0.065). Conclusion: Cut-out is the most common local complication associated with surgical treatment of intertrochanteric fractures using CMN. Proper reduction appears to be important in lowering the risk of cut-out. Maintaining low TAD is another critical factor in achieving sufficient fixation of lag screw to the subchondral bone of the femoral head. [ABSTRACT FROM AUTHOR]

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