Outcomes of trochanteric femoral fractures treated with proximal femoral nail: an analysis of 100 consecutive cases

Proximal Femoral Nail Mechanical Failure: A Case Report and Biomechanical Study

Intramedullary nailing is an established method for treating pertrochanteric fractures. However, the widespread use of this technique comes along with a variety of complications. We present a case of a 50-year-old female who presented to the emergency department suffering a left pertrochanteric fracture. She was treated with proximal femoral nailing and discharged home. Nine months later, she presented again to the emergency department with pain and an inability to bear weight. Imaging revealed the mechanical failure of the hip screw and loss of fracture fixation. Revision surgery included extraction of the broken hardware and a left hip hemiarthroplasty. The removed implant was sent for further evaluation. Fractographic analysis showed acute breakage due to bending and torsion forces acting on the screw with no relevant signs of metal fatigue. This biomechanical method is of great value for the surgeon and the implant manufacturer in order to understand the failure pattern and optimize future implants and fixation techniques. Improved implant biomechanical properties together with meticulous surgical technique constitute the cornerstones for optimal results.

Primary cemented hemiarthroplasty for unstable intertrochanteric fractures in elderly severe osteoporotic patients

OBJECTIVE

To evaluate the outcome of unstable intertrochanteric fractures with primary cemented hemiarthroplasty (HA) in elderly severe osteoporotic patients.

MATERIAL AND METHODS

In January 2009 to July 2017, 277 patients were selected according to inclusion criteria and results were analyzed prospectively. According to AO/OTA Classification, only type 31-A2.2(148 cases) and 31-A2.3(129cases) were included. 53 cases were males and 224 cases were females. The mean age was 75.4 years. The mean follow-up period was 50 months. The Harris Hip Score (HHS) and perioperative index (including the time duration of the surgery, intraoperative blood loss, postoperatively weight bearing time, implant complications) were analyzed clinically.

RESULTS

Follow-up evaluations were performed at 6 weeks, 3, 6, 9 and 12 months, and every year thereafter (mean 50 months). The average duration of surgery was 43.2 min (range 21-65 min), with a mean blood loss of 225.8 ml (range 70-425 ml). All patients were out of the bed and mobile with help of walker with average of 3.3 days (range 1-5 days). The average duration of hospital stay was 12.3 days. Average HHS improved from 83.7 (range 63-90) at 6 months follow up to 90.3 (range 74-92) at final follow up.

CONCLUSION

For the severe osteoporotic elderly with unstable fractures, bipolar hemiarthroplasty is an effective method to treat the unstable intertrochanteric fractures in the severe osteoporotic elderly. It can decrease complications, reduce mortality, improve the patient's life quality, and reduce family burden. In Summation, when deciding on treatment methods for intertrochanteric fractures several factors must be considered, which are (included but not limited to) the type of fracture, the patient's age, health status, severity of osteoporosis. As long as there was no absolute contraindication for surgery, it is appropriate to have surgery and to restore function as early as possible.

The relationship between preoperative American Society of Anesthesiologists Physical Status Classification scores and functional recovery following hip-fracture surgery

Background

Little is known about the relationship of the American Society of Anesthesiologists Physical Status Classification scores (ASA scores) on patient outcomes following hip fracture surgery in Asian countries. Therefore, this study explored the association of patients’ preoperative ASA scores on trajectories of recovery in physical functioning and health outcomes during the first year following postoperative discharge for older adults with hip-fracture surgery in Taiwan.

Methods

The data for this study was generated from three prior studies. Participants (N = 226) were older hip-fracture patients from an observational study (n = 86) and two clinical trials (n = 61 and n = 79). Participants were recruited from the trauma wards of one medical center in northern Taiwan and data was collected prior to discharge and at 1, 3, 6, and 12 months after hospital discharge. Participants were grouped as ASA class 1–2 (50.5%; ASA Class 1, n = 7; ASA Class 2, n = 107) and ASA class 3 (49.5%, n = 112). Measures for mortality, service utilization, activities of daily living (ADL), measured by the Chinese Barthel Index, and health related quality of life, measured by Medical Outcomes Study Short Form-36, were assessed for the two groups. Generalized estimating equations (GEE) were used to analyze the changes over time for the two groups.

Results

During the first year following hip-fracture surgery, ASA class 1–2 participants had significantly fewer rehospitalizations (6%, p = .02) and better scores for mental health (mean = 70.29, standard deviation = 19.03) at 6- and 12-months following discharge than those classified as ASA 3. In addition, recovery of walking ability (70%, p = .001) and general health (adjusted mean = 58.31, p = .003) was also significantly better than ASA 3 participants.

Conclusions

There was a significant association of hip-fracture patients classified as ASA 1–2 with better recovery and service utilization during the first year following surgery. Interventions for hip fractured patients with high ASA scores should be developed to improve recovery and quality of life.

Mechanical failures after fixation with proximal femoral nail and risk factors

Background

This study aims at assessing the clinical results, radiographic findings, and associated complications after osteosynthesis of trochanteric hip fractures with proximal femoral nail (PFN).

Methods

A total of 152 patients with hip fractures who underwent osteosynthesis with PFN were included. The hip fracture types in the patients included in the study were classified according to the American Orthopedic/Orthopedic Trauma Association (AO/OTA). AO/OTA A1, A2, and A3 type fractures were found in 24 (15.8%), 107 (70.4%), and 21 (13.8%) patients, respectively. The Baumgaertner scale was used to assess the degree of postoperative reduction. The Salvati–Wilson hip function (SWS) scoring system was used to evaluate functional results. After a follow-up period, clinical and radiographic results were evaluated and complications were assessed. The relationship between the complications and SWS score, age, sex, fracture type, reduction quality, and time from the fracture to surgery was evaluated.

Results

Eighty-five (55.9%) female patients and 67 (44.1%) male patients were enrolled in the study. Seventy-nine (51.9%) patients had left hip fractures, and 73 (48.1%) had right hip fractures. The mean age was 76 (range 21–93) years, and the mean follow-up duration was 23.6 (range 7–49) months. Postoperatively, one patient (0.6%) had a poor reduction, 16 patients (10.5%) had an acceptable reduction, and 135 patients (88.9%) had a good reduction according to the above criteria. The SWS scores were excellent, good, moderate, and poor in 91 (59.8%), 45 (29.6%), 15 (9.8%), and one (0.6%) patients, respectively. Late postoperative complications were seen in 27 patients (17.7%). A total of 14 patients (9.2%) underwent a revision procedure for mechanical complications.

Conclusion

The study results suggest that the quality of fracture reduction is an important factor that affects the revision rate and SWS score in patients with mechanical complications after osteosynthesis with PFN for trochanteric fractures.