Screening time for extra-capsular proximal femoral fracture fixation; the difference between extra-medullary and intra-medullary implant usage

Keyhole Sliding Hip Screw Fixation for Stable Intertrochanteric Hip Fractures: A Novel Technique

Intertrochanteric hip fractures are common orthopaedic injuries and the incidence is growing with increasing life expectancy. Several randomized controlled studies have shown the advantages of intramedullary devices over hip screw fixation in unstable intertrochanteric fractures. However, the proven advantage of the intramedullary device in stable intertrochanteric fractures, OTA (Orthopaedic Trauma Association) classification 31-A1 and some 31-A2 fractures are in less blood loss compared with standard hip screw fixation. In the current technical note, we describe a novel minimally invasive technique of hip screw fixation that use a keyhole size incision to fix stable intertrochanteric fractures using sliding hip screw. The less invasive nature and potentially reduced blood loss makes this technique an attractive option for stabilizing stable intertrochanteric hip fractures.

Comparison of fluoroscopy time in short and long cephalomedullary nailing for 31A2 intertrochanteric hip fractures

There is no study that has compared the radiation exposure during short (Short PFN) and long proximal femoral nailing (Long PFN) for 31A2 intertrochanteric hip fractures. The objective of the present study was to compare the radiation exposure time in short and long proximal femoral nail during the treatment of 31A2 intertrochanteric hip fractures. This prospective cohort study was carried out in a University teaching hospital. Sixty one consecutive patients with 31A2 intertrochanteric femur fracture treated with pro- ximal femoral nail were included in the study. The distal locking in the short PFN was performed using the locking zig and distal locking in the long PFN was performed using the free hand perfect circle technique. The same mobile image intensifier (Multimobil 5E, Siemens, Erlangen, Germany) was used in the entire study. The outcome measure was the fluoroscopy exposure time (seconds) which was measured directly from the image intensifier. Thirty patients underwent fixation with short PFN and 31 patients underwent fixation using long PFN. The mean fluoroscopy exposure time in short PFN cohort was 189.5 seconds ± 26 (range : 150-250 seconds) and the mean fluoroscopy exposure time in long PFN cohort was 283.4 seconds ± 43.8 (range : 200-400 seconds). The mean fluoroscopy exposure time was 93.9 seconds shorter in the short PFN cohort and this difference was statistically significant (p < 0.0001 ; 95% CI : 75.4 to 112.3). The radiation exposure to the operating team is significantly less during treatment with short PFN in 31A2 intertrochanteric fractures.