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BACKGROUND: Intertrochanteric fracture of femur often occurs in the elderly, and there will be a large amount of hidden blood loss after surgery. Reducing hidden blood loss can decrease complications and hospital stay. OBJECTIVE: To evaluate the effect of prolonged use of tranexamic acid on hidden blood loss after proximal femoral nail antirotation implantation in senile intertrochanteric fractures. METHODS: From January 2022 to May 2023, 62 elderly admitted patients with intertrochanteric fracture of femur were selected from Zigong Fourth People’s Hospital. All of them were treated with proximal femoral nail antirotation implantation after closed reduction on the traction bed. According to the use time of tranexamic acid, they were divided into two groups. In the control group (n=38), 1 g tranexamic acid was given intravenically 15-30 minutes before incision, and 1 g was added 3 hours later. Based on the control group, the trial group (n=24) was given 1 g tranexamic acid intravenously once for 12 hours on the first day after surgery. Blood routine examinations were performed before surgery, on the day after surgery, and on the first, third and fifth days after surgery. Hemoglobin and hematocrit were counted. The theoretical total blood loss was calculated by Cross equation, and the incidence of complications in the two groups was recorded. RESULTS AND CONCLUSION: (1) Through statistical analysis, there was no significant difference in the amount of dominant blood loss between the two groups (P > 0.05). (2) The number of grams of hemoglobin decreased, total blood loss and hidden blood loss in the trial group during perioperative period were lower than those in the control group, and the differences were statistically significant (P < 0.05). (3) The hemoglobin values of the trial group on day 3 after surgery, and the hematocrit values on days 1 and 3 after surgery were higher than those of the control group, with statistical significance (P < 0.05). (4) The hemoglobin and platelet count showed a downward trend after surgery, and the hemoglobin value was the lowest value on day 3, and the platelet value was the lowest value on day 1 after surgery, and then began to rise in both groups. (5) There was no significant difference in postoperative complications between the two groups (P > 0.05). (6) The results show that prolonging use of tranatemic acid can effectively reduce the hidden blood loss in the treatment of femoral intertrochanteric fracture with proximal anti-rotation intramedullary nail, and does not increase the risk of complications. [ABSTRACT FROM AUTHOR]

Objective: To compare the clinical outcomes of InterTAN nail and proximal femoral nail antirotation (PFNA) internal fixation for the treatment of intertrochanteric fractures in the elderly. Methods: We retrospectively reviewed the clinical records of 151 elderly patients with intertrochanteric fractures treated in The Second People's Hospital of Hefei from October 2019 to December 2021. Among them, 73 patients had undergone InterTAN (InterTAN group) and 78 patients had undergone PFNA (PFNA group) internal fixation. Operation-related variables (operation time, incision length, intraoperative bleeding volume, hospital stays length, and fracture healing time), complications, and Harris scores were compared between the two groups. Results: The operation time and incision length were shorter and the intraoperative bleeding was less in the PFNA group than in the InterTAN group (all P-values <0.05), but the fracture healing time was longer in the PFNA group (P<0.05). We found similar hospital stays and surgical complications in the two groups (P>0.05). In addition, the Harris hip joint scores were significantly higher in the InterTAN group than in the PFNA group at one, six, and twelve months after the operation (P<0.05). Conclusions: InterTAN and PFNA internal fixation have their own advantages in treating patients with intertrochanteric fractures. InterTAN has better postoperative recovery results, while PFNA has less perioperative trauma. Clinically, InterTAN or PFNA should be selected based on the specific conditions of each patient to maximize the therapeutic benefit of each treatment method. [ABSTRACT FROM AUTHOR]

BACKGROUND: For elderly patients with traumatic hip fractures, the related factors of prognosis are very complex, and the integrity of the lateral wall is one of the influencing factors. It is of important clinical value to understand the effect of lateral wall injury on the prognosis of femoral intertrochanteric fracture. OBJECTIVE: To evaluate the relationship between the integrity of the lateral wall and hip functional recovery and other outcomes in patients with femoral intertrochanteric fractures. METHODS: Totally 82 patients with femoral intertrochanteric fractures were screened and all patients received proximal femoral nail antirotation fixation. According to the thickness of the lateral wall, the patients were divided into the lateral wall intact group (n=31) and lateral wall risk group (n=51). The perioperative indexes, weight-bearing time, fracture healing time, hip joint function and range of motion, postoperative pain and complications were compared between the two groups. RESULTS AND CONCLUSION: (1) The time of hospitalization and the number of fluoroscopies during operation in the lateral wall intact group were significantly lower than those in the lateral wall risk group (P < 0.05), but there was no significant difference in other perioperative indexes. (2) Both groups were able to get down to the ground early after surgery and finally complete weight-bearing, but in the lateral wall risk group, the time of fracture healing was longer; the time of complete weight-bearing was significantly delayed; the Harris score of the last follow-up was lower; the range of motion of hip extension and flexion and neck trunk angle on the affected side were smaller (P < 0.05). (3) There was no significant difference in the incidence of postoperative complications between the two groups, but the overall incidence of complications in the lateral wall intact group was significantly lower (P < 0.05). (4) In summary, after internal fixation of proximal femoral nail antirotation, patients with the intact lateral wall had a relatively better prognosis than those with risk lateral wall. [ABSTRACT FROM AUTHOR]

BACKGROUND: The proximal femoral nail antirotation is the preferred treatment for reverse osteoporotic intertrochanteric fractures. Bone cement enhancement can reduce the probability of proximal femoral nail antirotation cut-out and cut-through, but there are no relevant biomechanical studies demonstrating the effect of bone cement content and location on the stress and displacement of the fracture end. OBJECTIVE: To investigate the effects of different contents and locations of bone cement in cement-reinforced proximal femoral nail antirotation on stress, strain, and displacement of reverse osteoporotic femoral intertrochanteric fractures in the elderly by finite element analysis. METHODS: A healthy adult female right femur model was extracted by Mimics software and smoothed in Geometric software. Five types of internal fixation methods of proximal femoral nail antirotation (cementless, cephalic spherical 1 mL, cephalic spherical 2 mL, cephalic spherical 3.4 mL, and cylindrical 5 mL around spiral blade) and femoral intertrochanteric fracture (AO subtype 31-A3.1 type) model were established in Solidworks software. After assembly, the total stress distribution, peak stress and displacement of the five models of implants with the femur were compared in Ansys software. RESULTS AND CONCLUSION: (1) The peak stresses of proximal femoral nail antirotation with head-end spherical 1 mL, head-end spherical 2 mL, head-end spherical 3.4 mL, and cylindrical 5 mL enhanced proximal femoral nail antirotation around the spiral blade respectively were 571.07 MPa (located at the junction of the spiral blade and the main nail), 495.45 MPa (located at the junction of the spiral blade and the main nail), 467.20 MPa (located at the junction of the main nail and the distal screw connection), 642.70 MPa (located at the junction of the main nail and distal screw connection), and 458.58 MPa (located at the junction of the spiral blade and the main nail). (2) The maximum displacements of proximal femoral nail antirotation with head end sphere 1 mL, head end sphere 2 mL, head end sphere 3.4 mL, and with cylindrical 5 mL enhancement around the spiral blade were 9.260 5, 7.589 1, 7.316 8, 6.790 7, and 6.615 7 mm, respectively, all of which were located at the proximal end of the femoral head. (3) These findings revealed that for reverse femoral intertrochanteric fractures treated with proximal femoral nail antirotation, the bone cement enhancement had significant mechanical stability compared with no enhancement, and the enhancement of the spiral blade 5 mL around the perimeter was the best, which is more preferable for aged unstable intertrochanteric fractures. [ABSTRACT FROM AUTHOR]

Objective: To explore the efficacy and mechanism of taohong siwu decoction on promoting fracture healing after proximal femoral nail antirotation（PFNA） in elderly patients with fntertrochanteric fracture based on phosphatidylinositol 3-kinase（PI3K）/serine protein kinase（Akt） signaling pathway. Methods: 90 elderly patients with fntertrochanteric fracture treated with PFNA who were admitted to Suining Hospital of Traditional Chinese Medicine from July 2021 to December 2022 were selected, patients were divided into control group and study group according to the random number table method, 45 cases each. Control group received routine intervention after operation, and study group received taohong siwu decoction on the basis of control group. The traditional Chinese medicine syndrome scores, fracture healing time, Harris hip function scores, hemorheology, PI3K/Akt signaling pathway related indicators were compared between two groups. Results: The hip pain, pain, fatigue, limb weakness, dizziness, insomnia, forgetfulness, spontaneous sweating,fear of wind and cold, chest tightness, shortness of breath, skin nails, pale complexion score and total score in study group were lower than those in control group after treatment（P＜0.05). The fracture healing time in study group was shorter than that in control group, Harris hip function score was higher than that of control group（P＜0.05). The hematocrit, plasma specific viscosity, whole blood specific viscosity and erythrocyte electrophoresis time in study group were lower than those in control group（P＜0.05). PI3K m RNA and Akt m RNA in study group were higher than those in control group after treatment（P＜0.05). Conclusion: Elderly patients with fntertrochanteric fracture are treat with taohong siwu decoction after PFNA surgery, which can promote the clinical prognosis of patients, reduce traditional Chinese medicine syndrome scores, promote the recovery of hip joint function, shorten the healing time of fractures, improve hemorheology of the body, and regulate the expression of PI3K/Akt signaling pathway. [ABSTRACT FROM AUTHOR]

To investigate the predictive value of serum neuron specific enolase (NSE), lipoprotein-associated phospholipase A2 (LP-PLA2) combined with C-reactive protein to albumin ratio (CAR) on postoperative delirium in elderly patients with intertrochanteric fracture of femur after proximal femoral nail antirotation (PFNA) internal fixation. 209 elderly patients with intertrochanteric fracture of femur who were admitted to The Third Affiliated Hospital of Beijing University of Traditional Chinese Medicine from April 2020 to February 2023 were selected. All patients were treated with PFNA internal fixation, serum NSE, LP-PLA2 and CAR were detected before operation, patients were divided into delirium group and non-delirium group according to whether delirium occurred after operation. The factors affecting postoperative delirium were analyzed by multivariate Logistic regression analysis. The value of NSE, LP-PLA2 and CAR in predicting postoperative delirium were analyzed by receiver operating characteristic (ROC) curve. Postoperative delirium occurred in 43 cases, with an incidence of 20.57%. Serum NSE, LP-PLA2 and CAR in delirium group were higher than those in non-delirium group (P<0.05). Multivariate Logistic regression analysis showed that older age, longer operation time, high NSE, high LP-PLA2 and high CAR were risk factors for postoperative delirium in elderly patients with intertrochanteric fracture of femur (P<0.05). The area under the curve(AUC) of NSE, LP-PLA2 and CAR in predicting postoperative delirium in elderly patients with intertrochanteric fracture of femur was 0.784, 0.808 and 0.820 respectively, the AUC of combined prediction was 0.907, which was higher than that of single prediction. The levels of serum NSE, LP-PLA2 and CAR are increase in postoperative delirium in elderly patients with intertrochanteric fracture of femur after PFNA internal fixation, high levels of NSE, LP-PLA2 and CAR are the main risk factors for postoperative delirium. The combination of NSE, LP-PLA2 and CAR has a high predictive value for the risk of postoperative delirium. [ABSTRACT FROM AUTHOR]

Background: Tranexamic acid (TXA) has been used in the management of bleeding. We are conducting a retrospective cohort study to analyse the effect of intravenous TXA infusion on the surgical outcomes of geriatric hip fracture cases which undergoes proximal femoral nail antirotation. Methods: In this study, 364 patients who had undergone proximal femoral nail antirotation between January 2018 and December 2019 in United Christian Hospital have been recruited. Two-hundred thirteen patients were recruited in controlled group and 151 patients were recruited in TXA group. One gram of TXA acid was injected intravenously on induction of anaesthesia and before surgical incision. Outcomes including length of stay, operation time, intraoperative blood loss, haemoglobin and haematocrit drop and post-operative blood transfusion have been measured. Results: There was a reduction in operative time, intraoperative blood loss, post-operative haemoglobin and haematocrit drop and post-operative blood transfusion in TXA group, with a reduction in the intraoperative blood loss (Controlled group: 97.8 ± 67.7 ml, TXA group: 76.0 ± 71.4, Difference −22.3%, p -value: 0.0036) and post-operative haematocrit drop (Controlled group: 0.04 ± 0.03, TXA group: 0.03 ± 0.03, Difference −25%, p -value: 0.05) being statistically significant. The length of stay is not statistically significant between the two groups. TXA is an antifibrinolytic agent which acts by binding to plasminogen which inhibits plasma formation. It has a potential reduction in blood loss in major operations. Conclusion: Intravenous TXA infusion helps to reduce blood loss in a patient undergoing proximal femoral nail antirotation. It is safe to use in the geriatric group of patients. We would recommend the usage of TXA infusion to improve the surgical outcome. [ABSTRACT FROM AUTHOR]

Abstract 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 0.05), 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.

To observe the effect of iliac fascia space block combined with esketamine intravenous general anesthesia in proximal femoral nail antirotation (PFNA) of the elderly. Eighty elderly patients who underwent PFNA were randomly divided into experimental group and control group. In the experimental group, iliac fascial block combined with esketamine and propofol intravenous general anesthesia was used to keep spontaneous breathing. The control group used iliac fascia block combined with remifentanil and propofol intravenous general anesthesia to maintain spontaneous breathing. Record important indexes such as heart rate (HR), mean arterial pressure (MAP), pulse oxygen saturation (SpO2), visual analogue score (VAS) scores, etc. at different moment during the operation. Trial data showed that there were significant differences in HR, MAP, and SpO2 between the two groups at the beginning of operation, and there was no significant difference in VAS scores between the two groups at each moment after surgery, and there were significant differences in the number of vasopressor applications, length of hospital stay, and QoR-15 scores between the two groups, and there were significant differences in the incidence of total adverse reactions and the incidence of hypotension. The trial indicated that patients in the experimental group have more stable hemodynamics and lower stress response, which is conducive to rapid recovery after surgery.

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. [ABSTRACT FROM AUTHOR]

Background: Intertrochanteric fracture is a common condition seen in elderly population which is managed with operative procedure in the department of orthopedics. The proximal femoral nail antirotation (PFNA) system was developed by the AO/ASIF in 2004 for this fracture that provides optimal anchoring and stability when the implant is inserted into the osteoporotic bone. The main characteristic of the implant is the use of a single blade with a large surface area and insertion of the blade compacts the cancellous bone. Aims and Objectives: The aim of the study was to study the functional outcome of intertrochanteric fracture managed with PFNA2. Materials and Methods: The prospective and observational study was conducted in patients diagnosed with intertrochanteric fracture admitted in orthopedic ward, Western Regional Hospital, Pokhara. Pre- and post-operative fracture alignment, Harris hip score (HHS), post-operative complications were taken into account. Results: Out of 55 cases taken into study, 36 (65.45%) were male and 19 (34.55%) were female. Maximum number of patients allocated in our study falls in 71–80 years group (29%) with least number in age group of 90 years or more (1.9%). Right-sided intertrochanteric fracture were 27 (49%) and left side involved were 28 (51%). Twenty-eight (51%) falls in Type II and 27 (49%) falls in Type III Boyd and Griffin intertrochanteric fractures. There was a marked improvement in fracture alignment after the operation with various parameters taken into consideration. Pre-operative HHS was 5.52±5.38 (Poor) and immediately after the procedure, it was 30.41±3.04 (Poor), 89.86±3.59 (Good) at 6 months, and 95.56±1.257 (Excellent) at 12 months. One case had blade cut out at immediate post-operative period, eight cases had surgical site infection, and five cases had GT fracture. Conclusion: This study showed that PFNA2 is an effective operative procedure in management of intertrochanteric fractures by achieving better fixation through bone impaction especially in osteoporotic bone.

Background: Intertrochanteric fracture is a common condition seen in elderly population which is managed with operative procedure in the department of orthopedics. The proximal femoral nail antirotation (PFNA) system was developed by the AO/ASIF in 2004 for this fracture that provides optimal anchoring and stability when the implant is inserted into the osteoporotic bone. The main characteristic of the implant is the use of a single blade with a large surface area and insertion of the blade compacts the cancellous bone. Aims and Objectives: The aim of the study was to study the functional outcome of intertrochanteric fracture managed with PFNA2. Materials and Methods: The prospective and observational study was conducted in patients diagnosed with intertrochanteric fracture admitted in orthopedic ward, Western Regional Hospital, Pokhara. Pre- and post-operative fracture alignment, Harris hip score (HHS), post-operative complications were taken into account. Results: Out of 55 cases taken into study, 36 (65.45%) were male and 19 (34.55%) were female. Maximum number of patients allocated in our study falls in 71-80 years group (29%) with least number in age group of 90 years or more (1.9%). Right-sided intertrochanteric fracture were 27 (49%) and left side involved were 28 (51%). Twenty-eight (51%) falls in Type II and 27 (49%) falls in Type III Boyd and Griffin intertrochanteric fractures. There was a marked improvement in fracture alignment after the operation with various parameters taken into consideration. Pre-operative HHS was 5.52±5.38 (Poor) and immediately after the procedure, it was 30.41±3.04 (Poor), 89.86±3.59 (Good) at 6 months, and 95.56±1.257 (Excellent) at 12 months. One case had blade cut out at immediate post-operative period, eight cases had surgical site infection, and five cases had GT fracture. Conclusion: This study showed that PFNA2 is an effective operative procedure in management of intertrochanteric fractures by achieving better fixation through bone impaction especially in osteoporotic bone. [ABSTRACT FROM AUTHOR]

Background: Pertrochanteric femoral fracture is the most common fractures of the hip especially in the elderly patients with osteoporotic bone, usually due to low-energy trauma like simple falls. Dynamic hip screw (DHS) is still considered the gold standard for treating such factures. Not many studies compare DHS with Proximal Femoral Nail Antirotation (PFNA). We try to compare the efficacy of PFNA with DHS in management of unstable pertrochanteric factors. Aims and Objectives: We aimed to evaluate and compare the clinical and functional outcomes of DHS and PFNA treatment of unstable pertrochanteric femoral fractures in elderly patients. Materials and Methods: This study was a prospective study which included total of 39 patients, 25 patients treated with PFNA and 14 patients with DHS. The study was conducted in Manipal Teaching Hospital from March 1, 2019, to August 1, 2021. All the patients were clinically evaluated and detail history was obtained. After the anesthesia clearance, the patients were operated. Length of skin incision, operating time, intraoperative blood loss, and complications were noted. Postoperatively, the duration of hospital stay, time of partial and full weight-bearing, time for radiological union, and complications were noted. Functional outcome was assessed using Harris hip score at 3 months and 6 months follow-up. Results: The mean age of the patient in this study was 74.68 years for PFNA and 75.57 years for DHS. The average time to complete the surgery was 71 min for PFNA and 92.86 min for DHS. The average blood loss was 162 ml for PFNA and 403 ml for DHS which was found to be statically significant. Partial weight-bearing on axillary crutches was started at the mean time of 3.7 weeks for PFNA and 8.1 weeks for DHS, whereas full weight-bearing was done at the mean of 8.2 weeks for PFNA and 12.1 weeks for DHS. Radiological union was seen at the average of 18.72 weeks for PFNA and 20.14 weeks for DHS which was not statically significant. The mean Harris Hip score at 3 months and 6 months follow-up was 63.84 and 88 for PFNA and 48.50 and 81.43 for DHS, respectively, which showed significantly better result with PFNA. Conclusion: Compared to DHS treatment, PFNA treatment in unstable pertrochanteric femoral fracture is associated with reduced blood loss, shorter operative time, and hospital stay with few intraoperative and post-operative complication. Post-operative rehabilitation with the early mobilization and return to pre-injury status was better with PFNA.

Abstract Background Although proximal femoral nail anti-rotation (PFNA) and bipolar hemiarthroplasty (BHA) are selected by most of the orthopaedic surgeons for elderly intertrochanteric fractures (ITFs) patients, there is still no consensus on the superiority of PFNA and BPH for the elderly with unstable comminuted ITFs. The study aims to compare the curative effects of PFNA and cementless BHA on unstable comminuted ITFs in the elderly. Methods From January 2012 to December 2016, we retrospectively reviewed 62 ITFs patients up to the inclusion and exclusion criteria in the study. Depending on the type of surgery, the patients were divided into two groups: Group BHA (n= 30) and Group PFNA (n = 32). The ITFs were classified according to Evans-Jensen. Hospitalization time, operation time, bleeding loss, weight bearing duration, Harris hip scores, 10-m walking speed, gait and postoperative complications were compared between the two groups. Results There was no significant difference between the groups in hospital stay (P > 0.05). The BHA group trended to have a shorter operation time and a larger volume of blood loss (P 0.05). There was no significant difference in postoperative complications between the two groups (P > 0.05). Conclusion The BHA allows an earlier return to weight-bearing activity, but ultimately has the same effective treatments as the PFNA for the elderly with unstable comminuted ITFs.

To observe the effect of iliac fascia space block combined with esketamine intravenous general anesthesia in proximal femoral nail antirotation (PFNA) of the elderly. Eighty elderly patients who underwent PFNA were randomly divided into experimental group and control group. In the experimental group, iliac fascial block combined with esketamine and propofol intravenous general anesthesia was used to keep spontaneous breathing. The control group used iliac fascia block combined with remifentanil and propofol intravenous general anesthesia to maintain spontaneous breathing. Record important indexes such as heart rate (HR), mean arterial pressure (MAP), pulse oxygen saturation (SpO2), visual analogue score (VAS) scores, etc. at different moment during the operation. Trial data showed that there were significant differences in HR, MAP, and SpO2 between the two groups at the beginning of operation, and there was no significant difference in VAS scores between the two groups at each moment after surgery, and there were significant differences in the number of vasopressor applications, length of hospital stay, and QoR-15 scores between the two groups, and there were significant differences in the incidence of total adverse reactions and the incidence of hypotension. The trial indicated that patients in the experimental group have more stable hemodynamics and lower stress response, which is conducive to rapid recovery after surgery. [ABSTRACT FROM AUTHOR]

Abstract Background There are concerns regarding initial stability and cutout effect in proximal femoral nail antirotation (PFNA) treating intertrochanteric fractures. No study have used finite element analysis (FEA) to investigate the biomechanics. This study aimed to compare the cutout effect, stress and displacement between stable (AO31-A1.3) and unstable (AO31-A2.2) intertrochanteric fractures treated by cement augmented PFNA. Methods Four femoral finite element models (FEMs) were constructed and tested under the maximum loading during walking. Non-augmented and augmented PFNA in two different intertrochanteric fractures were respectively simulated, assuming Tip Apex Distance (TAD)

Long-term bisphosphonate therapy is associated with atypical or insufficiency fractures, particularly in the proximal femur. We observed a case of an atypical femoral shaft fracture in a patient with a long-term history of alendronate therapy. A 36-year-old woman was admitted with a complaint of pain in her right mid-thigh following low-energy trauma. She had been taking alendronate for more than 15 years. X-rays indicated a fracture of the right femoral shaft. The patient was treated with proximal femoral nail antirotation (PFNA) fixation. This case highlights concerns regarding long-term bisphosphonate therapy and its potential complications.

Pseudoaneurysm of the internal iliac artery is a very rare complication of intertrochanteric fracture. Here, the case of an 88-year-old female patient, who presented with intense pain following surgery for intertrochanteric fracture of the femur, is reported. Radiography revealed intertrochanteric fracture of the left femur fixed by proximal femoral nail antirotation (PFNA). The PFNA was found to have disassembled, and the screw had penetrated through the acetabulum. As computed tomography (CT) revealed a haematoma behind the acetabulum, CT angiography was immediately performed. A pseudoaneurysm of the internal iliac artery caused by PFNA was revealed. Percutaneous endovascular treatment of the pseudoaneurysm was undertaken on an urgent basis. Three days later, the PFNA was removed, and the fracture was reduced and fixed with locking proximal femoral plate. The patient's pain was significantly reduced following this corrective surgery. This case illustrates that substandard PFNA surgery for intertrochanteric fracture may result in pseudoaneurysm of the internal iliac artery.

Background: Pertrochanteric femoral fracture is the most common fractures of the hip especially in the elderly patients with osteoporotic bone, usually due to low-energy trauma like simple falls. Dynamic hip screw (DHS) is still considered the gold standard for treating such factures. Not many studies compare DHS with Proximal Femoral Nail Antirotation (PFNA). We try to compare the efficacy of PFNA with DHS in management of unstable pertrochanteric factors. Aims and Objectives: We aimed to evaluate and compare the clinical and functional outcomes of DHS and PFNA treatment of unstable pertrochanteric femoral fractures in elderly patients. Materials and Methods: This study was a prospective study which included total of 39 patients, 25 patients treated with PFNA and 14 patients with DHS. The study was conducted in Manipal Teaching Hospital from March 1, 2019, to August 1, 2021. All the patients were clinically evaluated and detail history was obtained. After the anesthesia clearance, the patients were operated. Length of skin incision, operating time, intraoperative blood loss, and complications were noted. Postoperatively, the duration of hospital stay, time of partial and full weight-bearing, time for radiological union, and complications were noted. Functional outcome was assessed using Harris hip score at 3 months and 6 months follow-up. Results: The mean age of the patient in this study was 74.68 years for PFNA and 75.57 years for DHS. The average time to complete the surgery was 71 min for PFNA and 92.86 min for DHS. The average blood loss was 162 ml for PFNA and 403 ml for DHS which was found to be statically significant. Partial weight-bearing on axillary crutches was started at the mean time of 3.7 weeks for PFNA and 8.1 weeks for DHS, whereas full weight-bearing was done at the mean of 8.2 weeks for PFNA and 12.1 weeks for DHS. Radiological union was seen at the average of 18.72 weeks for PFNA and 20.14 weeks for DHS which was not statically significant. The mean Harris Hip score at 3 months and 6 months follow-up was 63.84 and 88 for PFNA and 48.50 and 81.43 for DHS, respectively, which showed significantly better result with PFNA. Conclusion: Compared to DHS treatment, PFNA treatment in unstable pertrochanteric femoral fracture is associated with reduced blood loss, shorter operative time, and hospital stay with few intraoperative and post-operative complication. Post-operative rehabilitation with the early mobilization and return to pre-injury status was better with PFNA. [ABSTRACT FROM AUTHOR]

Background: The incidence of peritrochanteric fractures are increasing worldwide. Early mobilization in these fractures prevents from other medical complications. There are many methods of treatment but the ideal method should be less invasive procedure, intramedullary device and stable fixation of fracture. Proximal femoral nail antirotation (PFNA) is biomechanically considered one of the most effective methods of treatment with promising results. Aims and Objectives: The aim of our study was to evaluate the clinical and radiological outcomes in patient who were treated with PFNA in peritrochanteric fracture. Materials and Methods: This study was a prospective study which included 37 patients, conducted in Manipal Teaching Hospital from 1st October 2019 to 30th September 2020. All the patients were clinically evaluated and detail history was obtained. After the anaesthesia clearance the patients were operated. Operating time, intraoperative blood loss and complications were noted. Postoperatively the duration of hospital stay, time of partial and full weight bearing, time for radiological union and complications were noted. At the final follow up Harris Hip Score was used for functional outcome. Results: The mean age of the patient in this study was 64 years (45-88 years). The average time to complete the surgery was 62.49 minutes (45-75 minutes) and the average blood loss was 129.32 ml (65-210 ml). Partial weight bearing was started at the mean time of 8.57 weeks (6-12 weeks) whereas full weight bearing was done at the mean of 14.43 weeks (10-20 weeks). Fracture union was seen at the average of 11.41 weeks (8-18 weeks). The mean Harris Hip score at final follow up was 84.73 (65.8-95.0) with the functional status of 35.1% excellent result, 45.9% good, 13.5% fair and 5.4% poor. Conclusion: Proximal femoral nail antirotation in peritrochanteric fracture is a good method of fixation. The procedure is easy with reduced operative time and radiation exposure. Since this is minimally invasive procedure the blood loss is very less compared to DHS or plate fixation. The patient could be mobilized early from the bed that reduced the complication of immobilization. So we strongly recommend using PFNA for fixation of peritrochanteric fracture of hip.

Proximal Femoral Nail Antirotation (PFNA) has been commonly used to treat intertrochanteric fractures, despite the risk of implant failure. The integrity of the femur could influence the risk of implant failure. This study evaluated the influence of lateral femoral wall thickness on the potential of implant failure. A finite element model of the hip was reconstructed from the Computed Tomography of a female patient. Five intertrochanteric fracture models at different lateral femoral wall thickness (T1 = 27.6 mm, T2 = 25.4 mm, T3 = 23.4 mm, T4 = 21.4 mm, and T5 = 19.3 mm) were then created and fixed with PFNA. We simulated a critical loading condition by a high loading case during walking. Elastoplastic material models with yield stress and failure strain were applied to the bone and implant in which breakage can be simulated using the element deletion function. In addition, the stress and displacement of the implant and femur were analysed. Implant breakage occurred at the sides of the proximal nail canal in cases of T4 and T5 which was further supported by the higher maximum von Mises stress and nail displacement. The increased stress and displacement of the implant may implicate a reduction of stability and risk of implant failure. We suggested that precaution shall be taken when the wall thickness was less than 21.4 mm. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the effects of proximal femoral nail antirotation (PFNA) and total hip arthroplasty for the treatment of femoral intertrochanteric fractures. Methods: Clinical data from 110 femoral intertrochanteric fracture patients treated at our hospital between January 2019 and July 2020 were analyzed retrospectively. Patients were divided into two groups based on the type of surgical intervention used. One group included patients (n= 59) who had undergone PFNA internal fixation and another group (n=51) included patients who had undergone total hip arthroplasty. Perioperative situation, joint function progression, and complication incidence were assessed. Results: Total hip arthroplasty group was associated with longer operation durations, longer incisions, and more intraoperative blood loss than PFNA group (P<0.05). Joint function and pain scores in the total hip arthroplasty group were superior than PFNA group (P<0.05). The Harris score of total hip arthroplasty group was significantly higher than that of PFNA group at three, six and 12 months after operation (P<0.05). The rate of complications in patients after total hip arthroplasty was lower than that of PFNA group (P<0.05) within 12 months of the surgery. Conclusion: PFNA and total hip arthroplasty can both achieve good results for treatment of femoral intertrochanteric fractures. PFNA offers less trauma and shorter operations, while total hip arthroplasty offers advantages in terms of more rapid limb function improvements and shorter rehabilitation processes. The two kinds of surgery have advantages, and the clinical needs to have a careful look at various factors and choose the appropriate operation method. [ABSTRACT FROM AUTHOR]

BACKGROUND: The proximal femoral nail antirotation has significant advantages in the treatment of intertrochanteric fractures, but there is still a 3.35%-31.08% failure rate of internal fixation. Internal fixation failures are not only of various types, but also of complex causes. Therefore, to summarize and analyze the causes of the failure of various proximal femoral nail antirotation internal fixations, and to clarify the boundary between the selection of long nails and short nails as well as the secondary surgical strategies after the failure of postoperative internal fixation is the key to better targeted prevention of the corresponding internal fixation failure and subsequent treatment in clinical practice. OBJECTIVE: To investigate the causes of various types of internal fixation failure secondary surgical strategies after the application of proximal femoral nail antirotation for the treatment of intertrochanteric fractures. METHODS: To search the relevant documents from January 2010 to May 2021 on PubMed, CNKI and Wanfang databases, with English search terms as “intertrochanteric fractures, risk factors, failure of internal fixation, PFNA, nonunion of fracture, cut out, cut in, helical blade position, osteoporosis, long and short intramedullary, revision surgery”. Chinese search terms were “intertrochanteric fracture, PFNA, failure of internal fixation, helical blade cut-out, periprosthetic fracture, non-union of fracture, osteoporosis, long and short intramedullary, revision surgery”. In addition, the reasons for the failure of various types of internal fixation and secondary surgical strategies after proximal femoral nail antirotation treatment of intertrochanteric fracture of femur were summarized. RESULTS AND CONCLUSION: The six common types of internal fixation failure after proximal femoral nail antirotation surgery are helical blade cut out, hip varus, fracture nonunion, head nail withdrawal, internal fixation fracture, and fracture around the implant. (1) Improper placement of the blade, poor reduction of the neck shaft angle and anteversion angle, unstable fracture type, severe osteoporosis and high age are the main reasons for blade cut out. (2) Hip varus can be caused by postoperative lack of support of the medial femur due to a bone defect in the posterior medial part of the proximal femur, or secondary to other types of fixation failure, which can be avoided by delaying the loading time. (3) Fracture nonunion is affected by systemic and local factors, and the use of distal locking nails should be carefully considered. (4) Osteoporosis is the most common cause of blade withdrawal. In patients with severe osteoporosis, it is necessary to use a long-tailed cap to fix the spiral helical during the operation and delayed the postoperative loading time. (5) Failure of internal fixation may result from poor reduction, bone nonunion, and unstable fractures with distal locking nails and a mismatch between implant and bone. (6) Fractures around the implant are often associated with the mismatch between the bone marrow cavity and the intramedullary nail, the deviation of the main nail entry point, resulting in increased cortical impingement rate and local stress concentration. Clinically, the appropriate length of the main nail should be selected to avoid the occurrence of the “middle trousers effect”. (7) Except for some special cases, it is recommended that clinicians choose short nails for fixation. In addition, the choice of long and short intramedullary nails for A3 type intertrochanteric fractures is a direction that orthopedic surgeons need to continue to explore in the future. (8) For the reoperation strategy after the failure of proximal femoral nail antirotation internal fixation, it is a good choice to determine the second revision strategy from three aspects: the degree of femoral head destruction, the fracture site and the bone defect. [ABSTRACT FROM AUTHOR]

Background: Surgical procedures in patients suffering from coronavirus disease 2019 (COVID‑19) are possible under strict hygiene and protective measures and are currently carried out regularly. This study examined how much additional work this involves. Material and methods: A structured evaluation of 71 surgical procedures performed at the Augsburg University Hospital between 1 November 2020 until 31 December 2020 was carried out. The operations on COVID‑19 patients were compared to procedures on non-COVID‑19 patients with respect to temporal, structural and staff resources, exemplified by four interventions: transbrachial embolectomy, total hip arthroplasty (H-TEP), proximal femoral nail antirotation (PFN-A) and new implantations of cardiac pacemakers. Results: The incision to suture times between the interventions in patients with COVID‑19 and non-COVID‑19 patients did not show any significant differences in any of the four interventions evaluated. The postoperative monitoring in the operating room, which is identified as time-consuming in many interventions, was often circumvented by postoperative transfer to the intensive care unit or by the use of local anesthetic procedures. For major operations, such as H‑TEP, the preparation time was shown to be significantly longer (p = 0.037). Furthermore, there was a significantly higher requirement for anesthesia nursing personnel of 1.5 vs. 1.0 (p = 0.02). Conclusion: A quantification of the additional effort of operative treatment is difficult due to the already complex care of COVID‑19 patients; however, it can be assumed that there is an increased need for additional human and structural resources due to the supply of material from outside the operating room, which is not documented in the standard recording. [ABSTRACT FROM AUTHOR]

Background: There are concerns regarding initial stability and cutout effect in proximal femoral nail antirotation (PFNA) treating intertrochanteric fractures. No study have used finite element analysis (FEA) to investigate the biomechanics. This study aimed to compare the cutout effect, stress and displacement between stable (AO31-A1.3) and unstable (AO31-A2.2) intertrochanteric fractures treated by cement augmented PFNA.Methods: Four femoral finite element models (FEMs) were constructed and tested under the maximum loading during walking. Non-augmented and augmented PFNA in two different intertrochanteric fractures were respectively simulated, assuming Tip Apex Distance (TAD) < 25 mm within each FEM. The cutout effect, stress and displacement between femur and PFNA were compared in each condition.Results: Cutout effect was observed in both non-augmented femoral head and was more apparently in unstable intertrochanteric fracture model. After reinforced by bone cement, no cutout effect occurred in two models. Stress concentration were observed on medial part of intertrochanteric region and the proximal part of helical blade before augmented while were observed on femoral shaft and the conjunction between blade and nail after augmented in both FEMs. Displacement mainly appeared on femoral head and the helical blade tip before augmented while distributed moderately on intertrochanteric region and the upper part of nail after augmented in both FEMs. The maximum stress and displacement value of femur decreased both in stable and unstable model after augmented but was more significantly in the unstable one. The maximum stress and displacement value of PFNA increased both in stable and unstable model after augmented but was more significantly in the unstable one.Conclusion: Our FEA study indicated that the cement augmentation of the PFNA biomechanically enhances the cutout resistance in intertrochanteric fracture, this procedure is especially efficient for the unstable intertrochanteric fracture. [ABSTRACT FROM AUTHOR]

Introduction: Intertrochanteric femur fracture in elderly presents a challenge as the source of morbidity if not well-treated. This study investigates the functional outcome and revision rate of two of the most common treatments of choice for this condition, proximal femoral nail antirotation (PFNA) and dynamic hip screw (DHS), while furthermore investigate the secondary functional outcome of the two procedures if proceeded to conversion to total hip arthroplasty (CTHA). Methods: A systematic search was conducted based on PRISMA guideline to identify relevant studies through PubMed, Google Scholar, and Cochrane database. A total of 9 studies (2.251 patients) were included, divided into three meta-analysis, processed using Review Manager 5.3. Results: For primary Harris Hip Score (HHS), 3 articles were included, with a total sample of 371 patients (184 PFNA vs. 187 DHS). For primary HHS, the mean HHS at 12-month follow-up for PFNA (n = 184) was 77.77, as for DHS (n = 187) was 78.33, indicating no significant difference (P = 0.73). For the revision rate, 4 articles were included, with a total of 1550 samples (784 PFNA vs. 766 DHS). The mean revision rates for PFNA (n = 784) was 2.68%, as for DHS (n = 766) was 2.48%, indicating no significant difference (P = 0.61). For secondary HHS after CTHA, two articles were included, with a total amount of 332 patients (142 PFNA vs. 190 DHS). In terms of secondary HHS after CTHA, the mean HHS 12-month postoperatively for PFNA (n = 142) was 83.97, as for DHS (n = 190) was 83.65, indicating no significant difference (P = 0.59). Conclusion: The current systematic review and meta-analysis suggest that PFNA and DHS both have comparable primary functional outcome, revision rate, and post-CTHA secondary functional outcome.

This study evaluated the feasibility of the femoral bone after fixation using biphasic calcium phosphate cement-augmentation of the proximal femoral nail antirotation (PFNA) compared with PFNA without cement. This study presented to compare the stiffness, fatigue testing, and compressive strength between stable (AO31-A2.1) and unstable (AO31-A3.3) intertrochanteric fractures treated by cement augmented PFNA of the cadaveric femoral. Biphasic calcium phosphate cement was injected to align and compatible with PFNA and the reconstructive procedure was monitored the cement placement using x-ray imaging during operation. The testing demonstrated that the cement could be injected through a small needle (13 G, 16 cm length, 1.8 mm inner diameter) within a suitable operating time. The feasibility study of the biomechanical testing was divided into three tests: stiffness test, fatigue cyclic load, and compression test. The results showed that the cement-augmented specimens exhibited higher stiffness than the control specimens without cement. The cement-augmented specimens also showed lower strain energy during the fatigue test, resulting in higher compressive strength (4730.7 N) compared to the control specimens (3857.4 N). There is a correlation between BMD and fracture load and the increase in compression load of the cement-augmented femoral compared to the controls as well as an increase in strain energy of fatigue cyclic testing was found. Biphasic calcium phosphate cement-augmented of the PFNA biomechanically enhanced the cut-out resistance in intertrochanteric fracture. This procedure is especially efficient for unstable intertrochanteric fracture suggesting the potential benefits of using biphasic calcium phosphate cement in medical applications., (© 2024 IOP Publishing Ltd.)

Background: The incidence of peritrochanteric fractures are increasing worldwide. Early mobilization in these fractures prevents from other medical complications. There are many methods of treatment but the ideal method should be less invasive procedure, intramedullary device and stable fixation of fracture. Proximal femoral nail antirotation (PFNA) is biomechanically considered one of the most effective methods of treatment with promising results. Aims and Objectives: The aim of our study was to evaluate the clinical and radiological outcomes in patient who were treated with PFNA in peritrochanteric fracture. Materials and Methods: This study was a prospective study which included 37 patients, conducted in Manipal Teaching Hospital from 1st October 2019 to 30th September 2020. All the patients were clinically evaluated and detail history was obtained. After the anaesthesia clearance the patients were operated. Operating time, intraoperative blood loss and complications were noted. Postoperatively the duration of hospital stay, time of partial and full weight bearing, time for radiological union and complications were noted. At the final follow up Harris Hip Score was used for functional outcome. Results: The mean age of the patient in this study was 64 years (45-88 years). The average time to complete the surgery was 62.49 minutes (45-75 minutes) and the average blood loss was 129.32 ml (65-210 ml). Partial weight bearing was started at the mean time of 8.57 weeks (6-12 weeks) whereas full weight bearing was done at the mean of 14.43 weeks (10-20 weeks). Fracture union was seen at the average of 11.41 weeks (8-18 weeks). The mean Harris Hip score at final follow up was 84.73 (65.8-95.0) with the functional status of 35.1% excellent result, 45.9% good, 13.5% fair and 5.4% poor. Conclusion: Proximal femoral nail antirotation in peritrochanteric fracture is a good method of fixation. The procedure is easy with reduced operative time and radiation exposure. Since this is minimally invasive procedure the blood loss is very less compared to DHS or plate fixation. The patient could be mobilized early from the bed that reduced the complication of immobilization. So we strongly recommend using PFNA for fixation of peritrochanteric fracture of hip. [ABSTRACT FROM AUTHOR]

BACKGROUND: There is still no uniform standard for the optimal use of tranexamic acid in proximal femoral nail antirotation for femoral intertrochanteric fracture.OBJECTIVE: To investigate the effect and safety of repeated intravenous tranexamic acid in the perioperative period of proximal femoral nail antirotation in patients with femoral intertrochanteric fracture. METHODS: Totally 100 patients with intertrochanteric fracture treated by proximal femoral nail antirotation in the Affiliated Hospital of Xuzhou Medical University from September 2017 to June 2020 were randomly divided into three groups. In the single-dose group, 33 patients were given tranexamic acid 1.0 g intravenously half an hour before operation. In the repeated-dose group, 35 patients were given the same medicine as the single-dose group before operation, and repeated intravenous drip of tranexamic acid 1.0 g at 3 and 6 hours after operation. In the control group, 32 patients were given an equal volume of physiological saline half an hour before operation. The baseline data, operation time, intraoperative blood loss, postoperative drainage volume, perioperative hemoglobin, hematocrit, C-reactive protein and interleukin-6 were collected from the three groups. Color Doppler ultrasound examination of lower extremity deep vein was conducted; and the total blood loss, hidden blood loss and thrombosis rate were calculated before and 7 days after operation. RESULTS AND CONCLUSION: (1) Total blood loss was significantly lower in the repeated-dose group (499.20±189.80) mL than that in the single-dose group (722.33±241.76) mL and control group (859.41±165.03) mL (P < 0.05). The hidden blood loss was significantly lower in the repeated-dose group (359.03± 208.57) mL than that in the single-dose group (544.73±290.69) mL and control group (719.22±204.08) mL (P < 0.05). (2) Compared with C-reactive protein and interleukin-6 in three groups after operation, the inflammatory indexes in repeated-dose group were the lowest and those in the control group were the highest (P < 0.05). (3) There was no pulmonary embolism in the three groups, and the lower extremity thrombosis was asymptomatic intermuscular venous thrombosis. There were two cases (2/32) in the control group, four cases (4/33) in single-dose group, and three cases (3/35) in repeated-dose group. The difference was not statistically significant (P < 0.05). (4) It is indicated that repeated use of tranexamic acid in the perioperative period of proximal femoral nail antirotation can further reduce the hidden blood loss, and reduce the inflammatory reaction without increasing the risk of thrombosis. [ABSTRACT FROM AUTHOR]

BACKGROUND: Elderly with femoral intertrochanteric fractures experienced more adverse events after surgical treatment, such as such as coxa vara, screw penetration, and hip pain. In recent years, study on the posterior medial wall of intertrochanteric femur has been deepened. The reconstruction and fixation of the posteromedial wall have gradually been used in clinical work. OBJECTIVE: To investigate the application characteristics and efficacy of posteromedial wall reconstruction in surgical treatment of A2 type intertrochanteric fractures of the elderly. METHODS: The medical records of 75 patients with type A2 intertrochanteric fractures who were treated with proximal femoral nail antirotation in Third Affiliated Hospital of Anhui Medical University from March 2016 to March 2020 were retrospectively analyzed. Patients undergoing posteromedial wall and fixation served as trial group (n=32) and those without reconstruction as control group (n=43). After long-term follow-up, the Harris function score, fracture healing time, full weight bearing time, and adverse events of the two groups were compared. RESULTS AND DISCUSSION: (1) Operation time and intraoperative blood loss had no significant difference in both groups (P > 0.05). (2) Compared with the control group, the fracture healing time was early; Harris hip function scores were high at postoperative 1, 3, and 6 months; complications were less in the trial group; and the above differences were statistically significant (P < 0.05). (3) Follow-up data were obtained from both groups for more than 12 months. One case of sciatic nerve injury occurred in the trial group. In the trial group, there was one case of sciatic nerve injury, which was numb on the back of the foot on the same side after injury, and returned to normal after oral medication. In the control group, there were six cases of coxa vara, three cases of screw penetration, and one case of heterotopic ossification. (4) The results showed that after the reconstruction and fixation of the posteromedial wall, the patients could get down to the ground early and experience effective recovery of the hip function, with less postoperative adverse events and satisfactory clinical effect. [ABSTRACT FROM AUTHOR]

BACKGROUND: Tropisetron hydrochloride has been shown to effectively reduce postoperative nausea and vomiting in patients undergoing proximal femoral nail antirotation fixation, and it is safe and effective. At present, the use of tropisetron in this operation is mainly added to patient controlled intravenous analgesia or intravenous drip after the operation. However, the comparison of two administration methods of tropisetron is rarely reported. OBJECTIVE: To investigate the effectiveness and safety of different administration methods of tropisetron hydrochloride for reduction of postoperative nausea and vomiting in proximal femoral nail antirotation. METHODS: Ninety patients with intertrochanteric fracture of femur who underwent proximal femoral nail antirotation admitted in Shantou Hospital of Traditional Chinese Medicine from July 2018 to March 2020 were randomly divided into two groups (n=45). Patients in the group A (intravenous drip administration group) were given tropisetron hydrochloride 5 mg + normal saline 100 mL by intravenous drip immediately after the operation, and the patient controlled intravenous analgesia pump (tropisetron hydrochloride was not added into the pump) was used. Patients in the group B (patient controlled intravenous analgesia pump group) were given 100 mL normal saline by intravenous drip immediately after the operation, and the patient controlled intravenous analgesia pump (5 mg tropisetron hydrochloride was added into the pump) was used. The pain score, sedative score, postoperative nausea and vomiting score and postoperative nausea and vomiting incidence at 1, 6, 12, 24, and 48 hours after the operation of two groups were counted and compared. RESULTS AND CONCLUSION: (1) The pain score and sedative score of the two groups were not statistically significant (P > 0.05) at various time points. (2) The postoperative nausea and vomiting score and postoperative nausea and vomiting incidence of group A were significantly less than those in the group B at 1 and 6 hours after the operation (P < 0.05). The differences in postoperative nausea and vomiting score and postoperative nausea and vomiting incidence of the two groups were not statistically significant at 12, 24, and 48 hours after the operation (P > 0.05). (3) There was no significant difference in incidence of adverse reactions between the two groups (P > 0.05). (4) Compared with added tropisetron hydrochloride to patient controlled intravenous analgesia pump, postoperative intravenous drip administration of tropisetron hydrochloride can quickly reduce the occurrence of nausea and vomiting after proximal femoral nail antirotation fixation. [ABSTRACT FROM AUTHOR]

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

Objective: To explore the effectiveness of irreducible intertrochanteric femoral fracture in the elderly by treating with folding top technique and right-angle pliers prying and pulling under G-arm X-ray fluoroscopy., Methods: The clinical data of 74 elderly patients with irreducible intertrochanteric femoral fracture admitted between February 2016 and December 2022 and met the selection criteria were retrospectively analyzed. Among them, 38 cases were treated with folding top technique combined with right-angle pliers prying and pulling under G-arm X-ray fluoroscopy and intramedullary nailing fixation (study group), and 36 cases were treated with limited open reduction combined with other reduction methods and intramedullary nailing fixation (control group). There was no significant difference in baseline data between the two groups, such as age, gender, cause of injury, affected side and classification of fractures, complicated medical diseases, and time from injury to operation ( P >0.05). The operation time, intraoperative blood loss, hospital stay, fracture reduction time, fracture healing time, and complications of the two groups were recorded and compared. The quality of fracture reduction was evaluated by Baumgaertner et al. and Chang et al. fracture reduction standards., Results: Patients in both groups were followed up 10-14 months, with an average of 12 months. The operation time and intraoperative blood loss in the study group were significantly less than those in the control group ( P <0.05), there was no significant difference in hospital stay between the two groups ( P >0.05). At 2 days after operation, according to the fracture reduction standards of Baumgaertner et al. and CHANG Shimin et al. , the quality of fracture reduction in the study group was better than that in the control group, and the fracture reduction time in the study group was shorter than that in the control group, with significant differences ( P <0.05). After operation, the fractures of the two groups all healed, and there was no significant difference in healing time between the two groups ( P >0.05). During the follow-up, there was no complication such as incision infection, internal fixation failure, deep venous thrombosis of lower limbs, intramedullary nail breakage, spiral blade cutting, or hip varus in the two groups, except for 2 cases of coxa vara in the control group., Conclusion: For the irreducible intertrochanteric femoral fracture, using folding top technique combined with right-angle pliers prying and pulling under G-arm X-ray fluoroscopy can obviously shorten the operation time, reduce the intraoperative blood loss, and improve the quality of fracture reduction.

Background: A comparative analysis of the role of various proximal femoral nail antirotation (PFNA) lengths in the union of trochanteric fracture in elderly patients treated with long and short PFNA. Objective: To investigate the significance of PFNA length in trochanteric fracture union in elderly patient. Materials and methods: A retrospective review study was conducted in elderly patients with trochanteric fractures treated between March 2010 and December 2017 in a tertiary care hospital. Hospital records of 517 patients who were treated for trochanteric fracture with various sizes of PFNA, were analyzed as per inclusion criteria and finally 503 patients records were included in the study, of which 261 were treated with short PFNA and 242 with long PFNA. The patients were allocated to two groups: those treated with long nail (n   =   2 4 2) and short nail (n   =   2 6 1). Demographic data were comparatively analyzed regarding the time of fracture union and complications. Results: In this study, no remarkable differences were noted between two groups with regards to types of fracture, time from injury to surgery and duration of hospital stay. The duration of surgery in a short PFNA was significantly less (60.5 min) compared to that of a long PFNA (82.2 min). However, the time taken for fracture to unite was not statistically significant. Conclusions: The variation in the length of the nail whether short or long does not affect union in trochanteric fracture in the elderly however surgical duration for short nail was much less than the long nail. [ABSTRACT FROM AUTHOR]

BACKGROUND: Osteoporosis and fracture type are two important reasons for the failure of internal fixation of proximal femoral nail antirotation. Type AO31-A3.3 intertrochanteric fracture, because of its involvement in the lateral wall, greatly increased the instability of the fracture. In addition, the elderly are mostly osteoporosis patients, so failure and postoperative complications of internal fixation of proximal femoral nail antirotation in the elderly with type AO31-A3.3 intertrochanteric fracture are higher. OBJECTIVE: To explore the difference of biomechanics between bone cement augmented and common proximal femoral nail antirotation in the treatment of type AO31-A3.3 intertrochanteric fracture. METHODS: CT data of one 75-year-old volunteer with intertrochanteric fracture were selected to import into Mimics 19.0 and Geomagic studio 2017 software to extract and optimize the three-dimensional model of the right femur. SolidWorks 2017 software was used to draw the internal fixation model and assemble it with the femur model according to the standard operation technology. The model was imported into Hypermesh 14.0 software to cut the bone to obtain the type AO31-A3.3 model with common proximal femoral nail antirotation. The cancellous bone around the proximal end of the screw blade was redefined as bone cement, which is the model of bone cement augmented proximal femoral nail antirotation. The material property parameters, boundary conditions and applied loads were set up and stored as K files respectively and imported into LS-DYNA software for solution. RESULTS AND CONCLUSION: (1) Compared with the common proximal femoral nail antirotation, the treatment of the elderly type AO31-A3.3 intertrochanteric fracture with the bone cement augmented proximal femoral nail antirotation has the advantages of lighter cutting degree of the screw blade, smaller varus, rotation angle and displacement of the femoral head and neck bone block, and better biomechanical effect. (2) The complete lateral wall can effectively support the femoral head and neck bone block and resist the skull and neck bone block as the lateral action point of three-point support. The pronation and rotation tendency can effectively prevent the head and neck screws from withdrawing. (3) The strong anchoring force of bone cement can stabilize the screw blade, enhance the internal action point of three-point support, and conduct and disperse the pressure. [ABSTRACT FROM AUTHOR]

BACKGROUND: Tranexamic acid has been shown to effectively reduce dominant and hidden blood loss in patients undergoing proximal femoral nail antirotation fixation, and it is safe and effective. At present, the use of tranexamic acid in this operation is mainly divided into intravenous infusion and local intramedullary perfusion; intravenous infusion can be divided into single use or multiple uses, and most of the local use is single use. For the combined local use with intravenous infusion is rarely reported. However, the combined use of tranexamic acid in hip and knee arthroplasties has been proven to be safe and effective. OBJECTIVE: To explore the effectiveness and safety of intravenous combined with local application oftranexamic acid on the perioperative blood loss in proximal femoral nail antirotation. METHODS: Ninety patients with intertrochanteric fracture who underwent proximal femoral nail antirotation in Shantou Hospital of Traditional Chinese Medicine from January 2016 to December 2018 were enrolled, and randomly divided into combined, intravenous and local groups (n=30/group ). All patients signed the informed consents and the study was approved by the hospital ethical committee. In the combined group, tranexamic acid (20 mg/kg dissolved in 20 mL normal saline) was injected intravenously at 30 minutes before surgery, followed by femoral intracavitary injection of tranexamic acid (1 g, dissolved in 20 mL normal saline) after proximal femoral nail antirotation. Intravenous group only underwent intravenous injection oftranexamic acid. Local group only received femoral intracavitary injection oftranexamic acid. The total blood loss, dominant blood loss, hidden blood loss, International Normalized Ratio, prothrombin time, activated partial thromboplastin time, blood transfusion rate and the incidence of deep venous thrombosis were counted and compared in the three groups. RESULTS AND CONCLUSION: (1) The total blood loss in the combined group was significantly less than that in the intravenous and local groups (P 0.05). (2) The hidden blood loss in the combined group was significantly less than that in the intravenous and local groups (P 0.05). (3) There was no significant difference in the dominant blood loss among groups (P > 0.05). (4) The International Normalized Ratio, prothrombin time, and activated partial thromboplastin time before and after surgery showed no significant difference among groups (P > 0.05). (5) The blood transfusion rate showed no significant difference among groups (P > 0.05). (6) None presented with deep venous thrombosis. (7) These results suggest that compared with single intravenous and intracavitary injection of tranexamic acid, their combination can obviously reduce total and hidden blood loss of proximal femoral nail anti rotation without increasing the risk of deep venous thrombosis. In addition, single intravenous and intramedullary injection of tranexamic acid has no significant difference in total or hidden blood loss. [ABSTRACT FROM AUTHOR]

Objective To investigate biomechanics of proximal femoral nail anti-rotation (PFNA) with different entry points in the treatment of lateral wall fracture of femoral intertrochanteric fracture by finite element method. Methods Based on CT data of the hip of volunteers, three-dimensional model of right femur was extracted and optimized by Mimics and Geomagic software. Then, three A models (crushed lateral femoral wall and completed medial femoral wall) and three B models (crushed lateral femoral wall and medial femoral wall) were obtained by assembling different entry points with PFNA model in SolidWorks software and simulating different fracture lines of lateral wall. All the six models were imported into Abaqus software to set material properties and boundary conditions for transportation. The Von Mises cloud pictures of the model were calculated and viewed. Results In model A, the upper entry of the lateral wall formed stress concentration, the middle showed largest displacement and the bottom showed uniform stress distribution and smaller displacement. In model B, the upper entry of the lateral wall showed larger displacement, the middle showed largest stress concentration and the bottom showed smaller stress dispersion and displacement. Conclusion PFNA, which is selected the bottom entry of lateral femoral wall, has the best biomechanical effect in the treatment of lateral wall fracture of femoral intertrochanteric fracture. [ABSTRACT FROM AUTHOR]

BACKGROUND: For the treatment of intertrochanteric fracture in elderly patients, if there is no operative contraindication, surgical treatment is recommended. Operative methods include internal fixation and joint replacement. Surgical techniques are mature, but the choice of surgical methods is controversial. OBJECTIVE: To compare the efficacy of artificial femoral head arthroplasty and proximal femoral nail antirotation in elderly patients with injured lateral wall femoral intertrochanteric fracture so as to provide the basis of clinical method selection and to provide the original data for the systematic analysis of large sample. METHODS: According to the case criterion, 48 cases of AO classification of type A2.2, A2.3 intertrochanteric fractures were selected in Department of Orthopedics, the 71 Group Army Hospital of Chinese PLA from January 2012 to December 2017. They were divided into femoral head arthroplasty group (n=29) and proximal femoral nail antirotation group (n=19). All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. The patients were followed up for 1-3 years. Operation time, bleeding volume, hospitalization expenses, the incidence of complications, and Harris hip score at 1 month and 1 year after the surgery were compared between the two groups. RESULTS AND CONCLUSION: (1) After statistical analysis, operation time was significantly shorter in the femoral head arthroplasty group than in the proximal femoral nail antirotation group (P < 0.05). There was no statistically significant in bleeding volume between the two groups (P > 0.05). The cost of hospitalization was significantly more in the femoral head arthroplasty group than in the proximal femoral nail antirotation group (P < 0.05}. (2) Harris hip score was significantly better in the femoral head arthroplasty group than in the proximal femoral nail antirotation group at 1 month after operation (P < 0.05}. There was no significant difference in Harris hip score between the two groups at 1 year after operation (P > 0.05). (3) There was no significant difference in the incidence of complications between the two groups (P > 0.05}. (4) For the patients over 70 years old with intertrochanteric fracture of injured lateral wall, artificial femoral head replacement has the advantages of early getting out of bed, high quality of life and quick recovery of joint function. It is suggested to choose artificial femoral head replacement first. [ABSTRACT FROM AUTHOR]

Abstract Background The major objective of the present study is to investigate the differences in the load and strain changes in the intertrochanteric region of human cadaveric femora between the loss of medial or lateral wall and after treatment with proximal femoral nail antirotation (PFNA). Methods After measuring the geometry of the proximal femur region and modeling the medial or lateral wall defect femoral models, six pairs of freshly frozen human femora were randomly assigned in the medial or lateral wall group. According to a single-leg stance model, an axial loading was applied, and the strain distribution was measured before and after PFNA implantation. The strains of each specimen were recorded at load levels of 350, 700, and 1800 N and the failure load. Paired t test was performed to assess the differences between two groups. Results The failure mode of almost all defect model femora was consistent with that of the simulated type of intertrochanteric fractures. After the PFNA implantation, the failure mode of almost all stabilized femora was caused by new lateral wall fractures. The failure load of the lateral wall group for defect model femora was significantly higher than that of the medial wall group (p

The choice of implant is one of the most easily controllable factors affecting the outcome of intertrochanteric fractures. While most of the caput-collum-diaphysis (CCD) angles of the femur are within the range of 125° and 130°, there is a shortage of data on whether 125° or 130° implants are preferable. Thus, the present finite element analysis (FEA) aimed to compare the biomechanical effects on the fracture surface when using implants with different CCD angles where the anatomical CCD angle of the femur was between 125° and 130°. After establishing a finite element model of an unstable intertrochanteric fracture from the femur with a native CCD angle of 127.3°, proximal femoral nail antirotation (PFNA) models with CCD angles of 125° and 130° were virtually implanted to have the same position of screw tip, respectively. In the one-leg stance during walking, when the implant with 130º CCD angle was used, the magnitude of compressive stress (1.61 and 2.12 MPa in the 130° and 125° model, respectively) was lower and the area of the fracture surface under tensile stress (55% and 5% in 130° and 125° model, respectively), the interfragmentary movements (40.9% more movement in 130° model), and the magnitude of bone deformation (23.5% more deformation in 130° model) were more than those of the 125° model. The intertrochanteric fracture fixed with PFNA with a 125º CCD angle revealed less interfragmentary movement on the fracture surface when the native CCD was an in-between angle in the FEA. [ABSTRACT FROM AUTHOR]

BACKGROUND: Methods of hip fracture repair include arthroplasty and proximal femoral nail antirotation placement. Whether Portsmouth-Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity is feasible for risk assessment before bone surgeries needs to be investigated. OBJECTIVE: To compare the preoperative prediction and actual mortality in senile hip fracture treated with different implants based on Portsmouth-Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity, so as to explore the clinical application value of the scoring system. METHODS: One hundred and sixty-six cases of hip fractures with the age of above 70 years admitted in the Zhengzhou Orthopaedics Hospital from January 2016 to January 2017 were collected, and assigned into hemiarthroplasty group (bipolar artificial femoral head replacement, n=85, femoral neck fracture), and proximal femoral nail antirotation group (n=81, intertrochanteric fracture). All patients signed the informed consents, and the study was approved by the ethics committee of the hospital. The total mortality rate of 166 patients was calculated, and then the actual mortality rate in the two groups was calculated. The predictive mortality rate of all patients and two groups was calculated by Portsmouth-Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity system. The actual and predictive data were compared and analyzed. RESULTS AND CONCLUSION: ① The actual mortality rate of 166 patients (including 12 cases of death) was 7.2%, and the predictive mortality rate was 5.4%. ② The actual mortality rate in the hemiarthroplasty group (totally 85 cases, 4 cases of death) was 4.7%, and the predictive mortality rate was 3.5%. ③ The actual mortality rate in the proximal femoral nail antirotation group (totally 81 cases, 8 cases of death) was 9.9%, and the predictive mortality rate was 6.2%. ④ There was no significant difference in the actual mortality rate and predictive mortality rate (P>0.05). ⑤ In summary, Portsmouth-Physiological and Operative Severity Score system for the Enumeration of Mortality and Morbidity system can objectively and effectively predict the risk of the older adults with hip fractures undergoing hemiarthroplasty and internal fixation of proximal femoral nail antirotation. [ABSTRACT FROM AUTHOR]

BACKGROUND: Inter-trochanteric fractures are one of the common reasons for the patients reporting to the orthopaedics department. Proximal femoral nail (PFN) is one of the common treatments employed for surgical treatment of inter-trochanteric fractures. Another line of treatment for such inter-trochanteric cases is proximal femoral nail-antirotation (PFN-A). Hence; the present study was undertaken for comparatively evaluating the results of surgical management of Inter-trochanteric femoral fractures treated by PFN and PFN-A. MATERIALS & METHODS: A study was conducted on 30 adult patientswith Intertrochanteric femoral fractures were assessed. 15 Patients each were randomly selected for PFN and PFN-A fixation. Pre-operative evaluation was done in all the patients. All the patients underwent surgical intervention according to their respective study groups. Postoperative follow-up was done in all the patients. All patients were advised regular follow up, initially at 3 weekly intervals, till 12th postoperative week and then at 6 weekly interval till the completion of 24 weeks postoperatively. All the results were compiled in Microsoft excel sheet and were analyzed by SPSS software. RESULTS: The mean hospital stay of all patients off the PFN group and PFNA group was 14.27 days and 10.80 days respectively. The mean time of union for PFN group was 12.07 weeks whereas in the PFN A group mean time of union was 12.60 weeks. Only 1 patient (7%) had postoperative complications, as superficial wound infection in the PFN A group while no patient suffered from any post op complication in PFN group. CONCLUSION: The functional outcomes achieved after treatment of unstable intertrochanteric fractures with both PFN and PFNA are satisfactory and comparable. [ABSTRACT FROM AUTHOR]

BACKGROUND: Surgical treatment is an accepted method for intertrochanteric fractures. For the older adults accompanied by severe osteoporosis and other diseases, how to treat intertrochanteric fractures still remains controversial. OBJECTIVE: To evaluate the effectiveness and safety of proximal femoral nail antirotation versus hemiarthroplasty in the treatment of unstable intertrochanteric fractures in older adults through meta-analysis. METHODS: According to the Cochrane system evaluation, a computer-based retrieval of Medline, PubMed, SPINGER, John Wiley, Science Direct, EBSCO, CNKI, WanFang, and VIP databases between 2008 and 2018 was performed. The keywords were “proximal femoral nail antirotation or PFNA, hemiarthroplasty, unstable intertrochanteric fractures” in English and Chinese, respectively. The literate was screened based on inclusion and exclusion criteria, and then quality evaluation was conducted. Meta-analysis was undergone on the Rev-Man 5.1 software. RUSULTS AND CONCLUSION: (1) Thirteen clinical trials were included, involving 1 223 patients, and including 6 randomized controlled trials. (2) Meta-analysis results showed that the operation time in the proximal femoral nail antirotation group was shorter [MD=-6.54, 95%Cl (-12.81, -0.21), P < 0.01], intraoperative blood loss was lower [MD=-130.83, 95%CI (-190.99, -70.68), P < 0.01], and the incidence of implant complications was higher [RR=2.32, 95%Cl (1.12, 4.84), P < 0.01] compared with the hemiarthroplasty group. (3) In the hemiarthroplasty group, the ambulation time was earlier [MD=18.06, 95%CI (10.3, 25.79), P < 0.000 1], and the Harris scores were increased [MD=-8.19, 95%Cl (-9.45, -6.93), P < 0.01] compared with the proximal femoral nail antirotation group. (4) There was no significant difference in the postoperative complications, hospitalization time or excellent and good rate in Harris scores between two groups (P > 0.05). (5) In summary, the operation time in the proximal femoral nail antirotation group is shorter and the amount of bleeding was less than those in the hemiarthroplasty group, but the incidence of implant complications is higher than that in the hemiarthroplasty group. The hemiarthroplasty group has an advantage in postoperative Harris score and postoperative loading time. [ABSTRACT FROM AUTHOR]

Objective: To compare the therapeutic effect of proximal femoral nail antirotation(PFNA) and artificial femoral head replacement(FHR) in the treatment of unstable femoral intertrochanteric fractures(UFIF) in the elderly. Methods: 156 elderly patients with UFIF who were underwent surgical treatment in our hospital from September 2015 to June 2017 were selected to carry out research.The patients were divided into the observation group(n=78) and the control group(n=78) according to the different surgical procedures.The observation group was treated with FHR, and the control group was treated with PFNA. The patients were followed up for 6 months,the effects, complications, the operative time, incision length, intraoperative bleeding volume and out of bed time were observed in the two groups, the visual analogue scale(VAS) scores of two groups before operation, 1 months after operation, 3 months after operation and 6 months after operation were evaluated. Results: The excellent and good rate of the observation group was 92.31%, compared with88.46% of the control group, the difference was not statistically significant(P>0.05). The out of bed time in the observation group was significantly less than the control group, however, the operative time, incision length and intraoperative bleeding volume were significantly higher than the control group(P <0.05). The incidence of postoperative blood transfusion in the observation group was significantly higher than that of the control group(P <0.05), there was no significant difference in the incidence of internal plant loosening, nonunion of fracture and deep vein thrombosis of lower extremities in the two groups(P>0.05). The VAS scores of patients in two groups at 1 months, 3 months and 6 months after operation were all lower than those before operation, and the VAS score was gradually decreased with time going on, the difference was statistically significant(P<0.05). Conclusion: The effect and safety of PFNA and FHR were better for the elderly UFIF patients. The appropriate surgical procedure can be selected according to the actual degree of fracture of the patient. [ABSTRACT FROM AUTHOR]

Purpose: The optimal internal fixation device for unstable intertrochanteric fracture remains a matter of controversy. By performing network meta-analysis, we developed a ranking of the following four surgical methods: proximal femoral nail antirotation, InterTan nail, gamma nail (GN) and sliding hip screws. We compare the complication rates in patients with unstable intertrochanteric fractures.Materials and Methods: After an exhaustive search of MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials for relevant studies, randomized controlled trials meeting selection criteria were entered into our network meta-analysis. Statistical analyses were conducted using Stata software, version 13.0 (Stata Corporation, College Station, Texas, USA).Results: We included 12 randomized controlled trials. Compared to Sliding hip screw, there were no substantial differences in rates of complications in unstable intertrochanteric fractures patient undergoing various treatments (all p > 0.05). Nevertheless, the surface under the cumulative ranking curve (SUCRA) for GN (80.6%) was significantly higher than those of the other three methods.Conclusion: GN had the highest probability of reducing the total incidence of complications among the four interventions for treating unstable intertrochanteric fractures. [ABSTRACT FROM AUTHOR]

Introduction: A comparative evaluation of the surgical treatment and outcome of patients with pertrochanteric fractures treated with short versus long proximal femoral nail antirotation. Materials and methods: A retrospective review was conducted of patients with pertrochanteric fractures treated between January 2011 and June 2012. In all 80 patients were enrolled in the study, of which 40 were treated with short PFNA and the remaining with long PFNA. Comparative analyses of demographic data, peri-operative outcome and complications were carried out. Results: There was no significant difference noted in the two groups with regards to Arbeitsgemeinschaft fur Osteosynthesefragen (AO) fracture classification, time from injury to surgery, blood transfusion post surgery and hospital stay. The surgical duration for a short PFNA procedure was significantly less (58 minutes) when compared to that of a long PFNA (87 minutes). Similarly intra-operative blood loss was significantly higher in the long PFNA group as compared to the short PFNA. Conclusions: A relatively quicker surgical time of just under an hour , lesser blood loss and better learning curve with trainee surgeons make short PFNA a better implant choice in the treatment of pertrochanteric fractures.

Objective: To evaluate effectiveness of proximal femur bionic nail (PFBN) in treatment of intertrochanteric fractures in the elderly compared to the proximal femoral nail antirotation (PFNA)., Methods: A retrospective analysis was made on 48 geriatric patients with intertrochanteric fractures, who met the selection criteria and were admitted between January 2020 and December 2022. Among them, 24 cases were treated with PFBN fixation after fracture reduction (PFBN group), and 24 cases were treated with PFNA fixation (PFNA group). There was no significant difference in baseline data such as age, gender, cause of injury, side and type of fracture, time from injury to operation, and preoperative mobility score, American Society of Anesthesiologists (ASA) score, Alzheimer's disease degree scoring, self-care ability score, osteoporosis degree (T value), and combined medical diseases between the two groups ( P >0.05). The operation time, intraoperative blood loss, number of blood transfusions, transfusion volume, length of hospital stay, occurrence of complications, weight-bearing time after operation, and postoperative visual analogue scale (VAS) score, walking ability score, mobility score, self-care ability score were recorded and compared between the two groups. And the radiographic assessment of fracture reduction quality and postoperative stability, and fracture healing time were recorded., Results: The operations in both groups were successfully completed. All patients were followed up 6-15 months with an average time of 9.8 months in PFBN group and 9.6 months in PFNA group. The operation time was significantly longer in PFBN group than in PFNA group ( P <0.05), but there was no significant difference in intraoperative blood loss, number of blood transfusions, transfusion volume, length of hospital stay, change in activity ability score, and change in self-care ability score between the two groups ( P >0.05). The weight-bearing time after operation was significantly shorter in PFBN group than in PFNA group ( P <0.05), and the postoperative VAS score and walking ability score were significantly better in PFBN group than in PFNA group ( P <0.05). Radiographic assessment showed no significant difference in fracture reduction scores and postoperative stability scores between the two groups ( P >0.05). All fractures healed and there was no significant difference in fracture healing time between the two groups ( P >0.05). The incidence of complications was significantly lower in PFBN group (16.7%, 4/24) than in PFNA group (45.8%, 11/24) ( P <0.05)., Conclusion: Compared with PFNA, PFBN in the treatment of elderly intertrochanteric fractures can effectively relieve postoperative pain, shorten bed time, reduce the risk of complications, and facilitate the recovery of patients' hip joint function and walking ability.

Introduction: New implant designs like the Proximal Femoral Nail Antirotation (PFNA) were developed to reduce failure rates in unstable pertrochanteric fractures in the elderly. Standardized implant augmentation with up to 6 mL of polymethylmethacrylate (PMMA) cement has been introduced to enhance implant anchorage by increasing the implant-bone interface in osteoporotic bone conditions. Biomechanically, loads to failure were significantly higher with augmentation. The primary objective of this study was to compare the mobility of patients with closed unstable trochanteric fractures treated by PFNA either with or without cement augmentation.Patients and Methods: A prospective multicentre, randomized, patient-blinded trial was conducted with ambulatory patients aged 75 or older who sustained a closed, unstable trochanteric fracture. Surgical fixation had to be performed within 72 h after admission. Outcomes were evaluated at baseline, during surgery, 3 to 14 days after surgery, 3 months, 6 months, and 12 months after surgery. To evaluate the primary objective, patients' walking speed was assessed by the Timed Up and Go (TUG) test. Secondary objectives included the analysis of implant migration assessed on radiographs, quality of life measured by the Barthel Index, mobility measured by the Parker Mobility Score, and complications.Results: Of 253 randomized patients, 223 patients were eligible: 105 patients were allocated to the PFNA Augmentation group and 118 to PFNA group. At 3 to 14 days after surgery, there was no statistical significant difference in mean walking speed between the treatment groups. For the secondary objectives, also no statistical significant differences were found. However, no patient in the PFNA Augmentation group had a reoperation due to mechanical failure or symptomatic implant migration compared to 6 patients in the PFNA group.Conclusions: Augmentation of the PFNA blade did not improve patients' walking ability compared to the use of a non-augmented PFNA but might have the potential to prevent reoperations by strengthening the osteosynthesis construct. [ABSTRACT FROM AUTHOR]