Outcome analysis of various modalities of fixation for extracapsular hip fractures in eldelrly

  • Dr Maravi D.S. Associate Professor, Department of Orthopaedics, Gandhi Medical College & Hamidia Hospital, Bhopal, India
  • Dr. Ganvir A Assistant Professor, Department of Orthopaedics, Gandhi Medical College & Hamidia Hospital, Bhopal, India
  • Dr. Shukla J. Professor, Department of Orthopaedics, Gandhi Medical College & Hamidia Hospital, Bhopal, India
  • Dr. Gaur S. Professor and Head, Department of Orthopaedics, Gandhi Medical College & Hamidia Hospital, Bhopal, India
Keywords: extracapsular hip fractures, Group II (PFN), pertrochanter area

Abstract

Introduction: Fracture distal to the capsular attachment, that is pertrochanter area of hip called as a extracapsular hip fracture. Fracture of the proximal femur are a big challenge in traumatology. Over the past 50 years a wide variety of implants and fixation strategies have been utilized for this type of fractures. Dynamic hip screw is gold standard, proximal femoral nail longer version and proximal femoral locking compression plate is new weapon in the orthopaedic surgeons armamentarium for fixation of this challenging fractures.

Aim of Study: This study is undertaken to assess the various modalities of surgical stabilization of extracapsular hip fractures in elderly and their clinical outcome in our institute.

Material and Methods : This is a prospective study from august 2013 to September 2014. The study included 98 patients (mean age 76 years) who underwent various modalities of surgical stabilization for extracapsular hip fractures in elderly. Out of 98 patients 32 underwent Dynamic Hip Screw fixation, 38 underwent Proximal Femoral Nailing, 12 underwent Proximal Femoral Locking Compression Plating and 16 patients underwent Dynamic Condylar Screw fixation. Final clinical outcome was made using the kyle's criteria.

Results: This study evaluated implant cost, familiarity of surgeon with procedure, surgical exposure, operation time, blood loss and blood transfusion, wound complication, reoperation and mortality in every group. Group II (PFN) found better results by comparing.

Conclusion : Optimal reduction of the fracture and positioning of the nail and screw, plate and screw remains the crucial importance and should be obtained in all times. We have concluded that group II (PFN) was good and effective to treat these extracapsular fractures in elderly with highest clinical outcome.

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References

Guyton JL(1998) Fracture of hip and pelvis. In: Terry canale s (edi)Campbell's operative orthopaedics Mosby, St. Louis, PP 2199-2209.

Lunsjo K. Gder L, Tidermark J, Hamberg P, Larsson B-E, Ragnarsson B, knebel RWC, Allvin I, Hjalmans K, Norberg S, Fornandes P, Hauggaard A, Stigsson L (1999) Extramedullary fixation of 107 subtrochanteric fracture. A randomized multicenter trial of the medoff sliding plate versus 3 other screw- plate system. Acta Ortop scand 70(5);459-446.

Whitelaw GP, Segal D, Sanzone C, Ober NS, Hadley N (1990) Unstable intertrochanteric/subtrochanteric fracture of the femur, Clin Orthop 252;238-245.

S. T. Canale and J. H. Beaty, Campbell's operative orthopedics, st. Lois, Mo, USA 11th edition 2007.

Rantanen J, Aro HT(1998) Intramedullary fixation of high subtrochanteric femoral fracture:a study comparing two implant design. the gamma nail and the intramedullary hip screw. J Orthop Trauma 12 (4);249-252.

Wheeler DL, Croy TJ, Woll TS, Scott MD, Senf DC, Duwelius PJ (1997) Comparison of reconstruction nails for high subtrochanteric femoral fracture fixation. Clin Orthop 338;231-239.

Clawson DK, Trochanteric fracture treated by the sliding screw plate fixation method. J Trauma. 1964;27:737-52

Schumpelick W, Jantzen PM. A new principle in the operative treatment of trochanteric fracture of the femur. J Bone Joint Surg Am. 1955;37:693-8.

Halder SC, The Gamma nail for peritrochanteric fracture, J Bone Joint Surg Br. 1992;74 :340-4

Leung KS, So WS, Shen Wy, Hui PW, Gamma nails abd dynamic hip screw for peritrochanteric fractures. A randomized prospective study in elderly patients. J Bone Joint Surg Br 1992;74:345-51.

Sowminarayanan S, Chandrasekaran A, Kumar RK, Finite element analysis of a subtrochanteric fractured femur with dynamic hip screw, dynamic condyler screw and proximal femur nail implant-a comparative study. 2008;222:117-27.

Harris LJ, Closed retrograde intramedullary nailing of peritrochanteric fracture of the femur with a new nail. J Bone Joint Surg Am. 1980;62:1185-93.

Domingo LJ, Cecilia D, Herrera A, Resines C, Trochanteric fractures treated with a proximal femoral nail. Int Orthop 2001;25:298-301.

Boldin C, Seibert F J, Frankhauser F. et. al. The proximal femoral nail(PFN):a minimal invasive treatment of unstable proximal femoral fractures:a prospective study of 55 patient with a follow up of 15 months. Acta Orthop Scand 2003;74:53-8.

M. E. Muller, S. Nazarian, P. koch, and J. Schatzker, The Comprehensive classification of fractures of Long Bones, Springer, New York, NY, USA, 1990.

B Tengre and J. Kjellander;Antibiotic prophylaxis in operation on trochanteric femoral fracture;Scand j prim health care sep 2002;20(3);188-92

Kyle R. F. , Gustillo R. B. Analysis of six hundred and twenty two intetrochanteric hip fractures J. B. J. S. Am. , 1979;61:216-21.

Peltier LF, Fracture: a history and iconography of their treatment. Sanfrancisco:Norman;1990. The internal fixation of fracture P 114-67.

Corzatt RD, Bosch AV, Internal fixation by the ender method JAMA. 1978;240:1366.

Chapman MW, Bowman WE, Csongradi JJ, Day LJ, Trafton PG, Bovill EG Jr. The use of Ender's pins in extracapsular fracture of the hip. J Bone Surg Am. 1981;63:14-28.

Sherk HH, Foster MD. Hip fractures: condylocephalic rod versus compression screw. Clin Orthop Relat Res. 1985;192:255-9.

I. Saarenpaa, T. Heikkinen, [ ], and P. Jalovarra "Functional comparison of the dynamic hip screw and the Gamma locking nail in unstable trochanteric hip fracture: a matched-pair study of 268 pateints";IntOrthop. Feb 2009;33(1):255-260.

Davis J, Harris MB, Duval M, D'Ambrosia R. Pertrochanteric fractures treated with the Gamma nail: technique and report of early results. Orthopedics. 1991;14:939-42.

Bridle SH, Patel AD, Bircher M, Calvert PT. Fixation of intertrochanteric fractures of the femur. A randomised prospective comparison of the gammanail and the dynamic hip screw. J Bone Joint Surg Br. 1991;73:330-4.

Lindsey RW, Teal P, Probe RA, Rhoads D, Davenport S, Schauder K. Early experience with the gamma interlocking nail for peritrochanteric fractures of the proximal femur. J Trauma. 1991;31:1649-58.

Boriani S, De Iure F, Bettelli G, Specchia L, Bungaro P, Montanari G, Capelli A, Canella P, Regnoli R, Triscari C. The results of a multicenter Italian study on the use of the Gamma nail for the treatment of pertrochanteric and subtrochanteric fractures: a review of 1181 cases. Chir Organi Mov. 1994;79:193203.

Dousa P, et. al. Osteosynthesis of trochanteric fracture using PFN. ActaChirOrthopTraumatolCech 2002;69(1):22-30.

Christian Boldin, Franz J Seibert, Florian Fankhauser, GeroifPeicha, Wolfgang and Rudolf Szyszkowitz. "The proximal femoral nail(PFN)- a minimal invasive treatment of unstable proximal femoral fractures A prospective study of 55 pateints with a follow -up of 15 months ActaOrthopScand 2003;74(1):53-5

Comparative study of intertrochanteric fracture with proximal femur locking compression plate, Wang y, Yang yy. Yuzh, Li cq, Wu ys, Zhengg xx, Zhongguo Gu Shang 2011 May;24(5):370-3

George J. Haidukewych, T. Andrew Israel, Daniel J. Berry "Reverse Obliquity Fractures of the Intertrochanteric Region of the Femur";The Journal of Bone & Joint Surgery May 2001, 83(5)643-650.

Christophe Sadowski, Anne Lubbeke, Marc Saudan, Richard Stern, Pierre Hoffmeyer "Treatment of Reverse oblique and transverse intertrochanteric fractutre with use of an Intramedullary Nail or a 95 degree screw-plate";The Journal of Bone and Joint Surgery May 2002, 84(3)372-381.

Hardy DC, Descamps PY, Krallis P, Fabeck L, Smets P , Bertens CL, Delince PE. Use of an intramedullary hip-screw compared with a compression hip-screw with a plate for intertrochanteric femoral fractures. A prospective, randomized study of one hundred patients. J Bone Joint Surg Am. 1998;80:618-30.

Radford PJ, Needoff M, Webb JK. A prospective randomised comparison of the dynamic hip screw and the gamma locking nail. J Bone Joint Surg Br. 1993; 75:789-93.

Harrington P, Nihal A, Singhania AK, Howell FR. Intramedullary hip screw versus sliding hip screw for unstable intertrochanteric femoral fractures in the elderly. Injury. 2002;33:23-8.

O'Brien PJ, Meek RN, Blachut PA, Broekhuyse HM, Sabharwal S. Fixation of intertrochanteric hip fractures: gamma nail versus dynamic hip screw. A randomized, prospective study. Can J Surg. 1995;38:516-20.

Ahrengart L, T¨ornkvist H, Fornander P, Thorngren KG, Pasanen L, Wahlstr¨om P, Honkonen S, Lindgren U. A randomized study of the compression hip screw and Gamma nail in 426 fractures. Clin Orthop Relat Res. 2002;401:209-22.

Pajarinen J, Lindahl J, Michelsson O, Savolainen V , Hirvensalo E. Pertrochanteric femoral fractures treated with a dynamic hip screw or a proximal femoral nail. A randomised study comparing postoperative rehabilitation. J Bone Jint Surg Br. 2005;87:76-81.

Dujardin FH, Benez C, Polle G, Alain J, Biga N, Thomine JM. Prospective randomized comparison between a dynamic hip screw and a mini-invasive static nail in fractures of the trochanteric area: preliminary results. J Orthop Trauma. 2001 ;15:4016.

Park SR, Kang JS, Kim HS, Lee WH, Kim YH. Treatment of intertrochanteric fracture with the Gamma AP locking nail or by a compression hip screw- a randomised prospective trial. Int Orthop. 1998;22:157-60.

Aune AK, Ekeland A, Odegaard B, Grøgaard B, Alho A. Gamma nail vs compression screw for trochanteric femoral fractures. 15 reoperations in a prospective, randomized study of 378 patients. Acta Orthop Scand. 1994;65:127-30.

Butt MS, Krikler SJ, Nafie S, Ali MS. Comparison of dynamic hip screw and gamma nail: a prospective, randomized, controlled trial. Injury. 1995;26: 615-8.

Madsen JE, Naess L, Aune AK, Alho A, Ekeland A, Strømsøe K. Dynamic hip screw with trochanteric stabilizing plate in the treatment of unstable proximal femoral fractures: a comparative study with the Gamma nail and compression hip screw. J Orthop Trauma. 1998;12:241-8.

Crawford CH, Malkani AL, Cordray S, Roberts CS, Sligar W. The trochanteric nail versus the sliding hip screw for intertrochanteric hip fractures: a review of 93 cases. J Trauma. 2006;60:325-9.

Baumgaertner MR, Curtin SL, Lindskog DM. Intramedullary versus extramedullary fixation for the treatment of intertrochanteric hip fractures. Clin Orthop Relat Res. 1998;348:87-94.

Herrera A, Domigo LJ, Calvo A, Martinez A. Acomparative study of trochanteric fractures treated with the Gamma nail of the proximal femoral nail. Int Orthop 2002; 26: 365-9.

H. W. Jones, P. Johnston, and M. Parker, " Are short femoral nails superior to the sliding hip screw? A meta-analysis of 24 studies involving 3279 fractures". International Orthopedics Vol 30, no 2, PP 69-78, 2006.

M. J. Parker and H. H. Handoll " Gamma and other cephalocondylic intramedullary nails versus extramedullary hip fractures in adults". Cochrane Database of systematic Reviews. Vol 16 no. 3 Article ID CD000093, 2010.

X. Pan, D. Xiao, B. Lin and G. Huang, " Dynamic hip screrws (DHS) and proximal femoral nails (PFN) in treatment of intertrochanteric fractures of femur in elderly patients, " Chinese Journal of Orthopedic Trauma, Vol 6, no. 7, pp 785-789, 2004.

M. Parker, T. Bowers, and G. Pryor, " Sliding hip screws versus the targon PF nail in the treatment of trochanteric fractures of the hip: a randomized trial of 600 fractures, " Journal of Bone and Joint Surgery B, vol 94, no. 3, pp. 391-397, 2012.

M. Saudan, A. Lubbeke, C. Sadowski, N. Riand, R. Stern, and P. Hoffmeyer, " Pertrochanteric fractures : is there an advantage to an intramedullary nail? A randomized, prospective study of 206 patients comparing the dynamic hip screw and proximal femoral nail, " Journal of Orthopedic Trauma, vol 16, no. 6, pp. 389-393, 2002.
Published
2015-06-30
How to Cite
1.
Dr Maravi D.S., Dr. Ganvir A, Dr. Shukla J., Dr. Gaur S. Outcome analysis of various modalities of fixation for extracapsular hip fractures in eldelrly. ojmpc [Internet]. 2015Jun.30 [cited 2024Mar.29];21(1):24-6. Available from: https://ojmpc.com/index.php/ojmpc/article/view/2
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