Journal articles on the topic 'Isolated Closed Femur Shaft Fracture'

<strong>Background:&nbsp;</strong>Closed isolated femur shaft fracture usually results from high energy trauma and traditionally assumed to have potential to cause hypotension that we rarely see in clinical practice. We wanted to find literature evidence of association between isolated closed femur shaft fracture and hypotension.&nbsp;<strong>Methods:&nbsp;</strong>Literature was searched on PubMed, Ovid databases and google scholar website. Hand-searching from references of the articles obtained. All the articles addressing this issue dating from 1955 to 2023 were included in this systematic review.&nbsp;<strong>Results:&nbsp;</strong>Overall, 13 articles were found that are directly or indirectly concerned about association of femur shaft fracture and hypotension. Out of which, 6 articles are directly related to isolated femur shaft fractures sustained in children or adults. 2 studies indirectly estimated high blood loss pattern with femur shaft fracture, but 5 studies that directly studied hypotension with isolated femur fractures in more than 500 patients, P values of these studies suggest isolated femur shaft fractures don&rsquo;t cause hypotension.&nbsp;<strong>Conclusion:&nbsp;</strong>The available evidence from the studies that actually studied incidence of clinical hypotension in isolated femur shaft fractures show closed isolated femur shaft fractures rarely cause clinical hypotension. &nbsp; &nbsp; &nbsp;

Background: Tibia is more often involved in open fractures because of its subcutaneous location. Severe open fractures of tibia are associated with high complication rate and poor long term outcomes. 70% of pediatric tibial fractures are isolated injuries and approximately 30% of pediatric shaft tibia fractures are associated with fibula fracture. AIM: The aim is to study clinical and radiological outcomes of patient with tibial and femoral fractures, who are treated with closed reduction and internal fixation with nailing versus treated conservatively by casting. Material and method: 40 cases with femur or tibia fractures treated with nailing and conservatively between 1st January 2022 to 30thNovember 2022 at rural medical college, loni a rural tertiary care hospital was analyzed retrospectively out of which 16 patients treated conservatively and 4 patients underwent operative management for tibia fractures while 16 patients were treated operatively and 4 patients treated conservatively for femur fractures. Results: Total 40 patients of shaft femur and shaft tibia fractures were treated conservatively with cast application and Closed reduction and internal fixation by elastic nailing. In comparision for simple transverse fracture, we can conclude that in most patients fracture can be treated conservatively to minimize soft tissue damage but only in unacceptable criteria for conservative management we can opt for minimally invasive procedure like TENS nailing. Conclusion: Immobilization time is shorter in surgical group but we have started mobilizing with cast application. It is the only advantage of surgical management which has been given in conservatively managed patients. Outcomes after 3 months.

<strong>Aim:&nbsp;</strong>To evaluate long term results of submuscular plating in closed paediatric femur fractures.&nbsp;<strong>Methods:</strong>&nbsp;This retrospective&nbsp; study was carried out in the department of Orthopaedics. Total 70 cases with closed femoral shaft fractures with age between 8 years to 16 years were included in the study.&nbsp;<strong>Results:</strong>&nbsp;Total 70 patients with 40 boys and 30 girls were included in the study. The average age of the patients was 13 years (range=8-16 years). 42 patients were with right femur fracture and 28 with left femur fracture. All the patients had unilateral femur fracture. 46 patients were having isolated femur fracture and 24 were cases of polytrauma. 61 out of 70 patients regularly followed up during the full duration of the study. The average follow up duration was 20-24 months. 26 fractures were comminuted, 19 were spiral, 15 were oblique and 10 were transverse.&nbsp;<strong>Conclusion:</strong> Submuscular plating is a surgical method with a learning curve and is a very effective method of fixation for paediatric femur fractures. It has definitive advantages over other surgical methods and is associated with minimal complications.

Introduction. Polytrauma remains a major social, economic and medicine affliction. A successful surgical treatment of polytrauma patients requires an approach predicated on prioritizing injuries. An isolated femur fractures rarely poses any threat but in association with multiple injuries, this fracture assumes greater significance. The proper management of femur fractures in polytrauma can greatly reduce the mortality and morbidity. Material and methods. We present our results in the treatment of 24 femur shaft fracture in 22 polytrauma patients treated by Mitkovic external fixator in 5 year period (2000-2004) on Orthopeadic and Traumatology Clinic - Clinical Center Nis. The average of patients age was 32.8 years (ranging from 17 to 62). There were 11 (46%) closed and 13 (54%) open fractures. Results. Eighteen fractures were treated by external fixation until union. The remaining six fractures were treated by conversion of the external fixation to internal fixation. Sixteen fractures (88.88%), in which the external fixation was the definitive method of treatment, healed completely. The average healing time was 6.29 (4-9) months. There were three pin-track infections (16.66%), one nonunion (5.55%) and only one deep infection (5.55%). Conclusion. The external fixation by the use of Mitkovic external fixator in the treatment of femur fractures is a safe procedure to achieve temporary rigid stabilisation in polytrauma patients before the subsequent internal fixation (damage control orthopaedics). The external fixation using Mitkovic external fixator can be definitive method of choice in treatment of open and comminutiwe femur fractures in polytrauma patients until union.

Objective: compare the frequency of post-operative surgical site infection of solid interlock intramedullary nail with cannulated open interlock intramedullary nail for management of isolated femoral fracture. Methodology: A total of 100 cases (50 in each group) with Isolated femoral shaft fracture, closed femoral shaft fractures or Gustilo and Anderson classification type I open femoral shaft fractures, Solid and cannulated open interlock fixation for femur shaft fractures between 20-60 years of age of either gender were enrolled in the study. Patients with bilateral femur fractures, Ipsilateral fracture of any other bone of involved side, unfit for surgery or anesthesia with comorbid condition, conversion to intramedullary nailing from external fixator of femur and presented after 30 days of fracture were excluded from the study. Results: In our study, out of 100 cases, (50 in each group), 18%(n=9) in Group-A and 16%(n=8) in Group-B were between 20-40 years of age while 82%(n=41) in Group-A and 84%(n=42) in Group-B were between 41-60 years of age, mean+sd was calculated as 46.78+7.53 years in Group-A and 47.76+6.49 years in Group-B, 62%(n=31) in Group-A and 60%(n=30) in Group-B were male while remaining 38%(n=19) in Group-A and 40%(n=20) in Group-B were females, surgical site infection was compared in both groups and it was recorded in 26%(n=13) in Group-A and 56%(n=28) in Group-B while remaining 74%(n=37) in Group-A and 44%(n=22) in Group-B had no findings of the morbidity, p value was calculated as 0.00 showing a significant difference between the two groups. Conclusion: We concluded that the frequency of post-operative surgical site infection of solid interlock intramedullary nail is significantly lower when compared with cannulated open interlock intramedullary nail for management of isolated femoral fracture. However, our results may create awareness regarding use of solid interlock intramedullary nail for the management of femoral shaft fracture. Keywords: Femoral fracture, solid interlock intramedullary, with cannulated open interlock intramedullary nail, surgical site infection

Background: Objective of the study was to find out the advantages of traction and single-leg spica cast in treatment of isolated femoral shaft fracture in children. Study design was Descriptive and place of the study was Darbhanga Medical College and hospital, Laheriasarai, Darbhanga, Bihar, India.Methods: 24 patients, age below 10 years, with a mean age of 5.37 years range with closed isolated femoral shaft fractures were included in the Study. Patients having compound fractures and those with associated injuries were excluded from the study. Spica cast was applied under sedation after preliminary skin traction, however immediate spica was given in children less than 2 year and those who had less than 2 cm shortening on telescopy. Follow up was done in OPD after 1,4,8,12,24 weeks with check x-rays taken at every visit.Results: 24 children were included in the study, with a mean age of 5.37 years range (2 months to 10 years). Average duration of skin traction was 14.8 days range (0-21) days. Average duration of hospital stay was 16 days range (2-22) days. Average time for fracture union was 7.4 weeks range (4-12) weeks. At final follow-up, 2 patient had Limb -Length Discrepancy (LLD) of 1.5 cm, 2 had LLD of 1 cm, 4 had LLD of 0.5cm, while 18 children had no LLD. None of the patients had short legged gait. None of the patients needed cast removal for any cast related complication.Conclusions: Traction followed by spica cast is a safe and effective method for closed fracture shaft of femur with very low risk of complication and can be done in children in less than 10 years of age.

Aim. This study aims to assess the results of open versus closed reduction in intramedullary nailing for femoral fractures and whether it delays union, predisposes to nonunion, or increases the rate of infection. Materials and Methods. A retrospective review of all adult patients with isolated femoral shaft fractures treated by intramedullary nailing was done. The primary outcome is union rate, and the secondary outcomes are operation time and the infection rate. Results. 110 isolated femoral shaft fractures, with 73 (66.4%) in the closed reduction group and 37 (33.6%) in the open reduction group, 90.4% males and 9.6% females, and the average age was 32.6 years. RTA is the most common cause of these injuries followed by the fall from height. The delayed union rate was 20% (22/110) with no difference between the two groups, p value 0.480, and the nonunion rate was 5.5% (6/110), and no statistical difference was observed between the two groups. The operation time was shorter in the closed groups, and no difference in the time to union was observed between two groups. No infection was found in the two groups. Conclusions. There is no statistical difference between the healing rates in closed and open reduction in femoral shaft fractures. In cases where closed reduction is difficult, it is better to open reduce the fracture if closed reduction cannot be achieved in 15 minutes, especially in polytrauma.

Femoral shaft fractures are among the commonest fracture of lower extremity in children and commonly require hospital admission. There are various modalities of treatments both operative and non-operative. The aim of treatment is to secure union, in good alignment with length restored and early rehabilitation. objective of this study was to compare the results of day 1 spica cast and skin traction followed by spica cast in the treatment of femoral shaft fractures in children (6 months to 10 years). A total of 64 patients with fracture shaft femur of either sex aged 6 months – 10 years with closed , isolated diaphyseal femur fracture were included in this study. Case with clinical evidence of infection, pathological fractures and multiple injuries including neurovascular injuries were excluded from the study. The patients were randomly assigned into two groups, Group -1 ( n-32) patients who underwent early spica application while Group -2 ( n-32) patients underwent skin traction in followed by spica cast. Mean age in group A was 5.06 years and 5.12 years in group B (range 6 month – 10 years). Ratio of males and female in Group A and Group B was 19:13 and 20:12 respectively. Average duration of hospital stay was 1.65 days and 11.65 days in group A and group B respectively. Average total time of spica cast application was 45.13 days 49.41 days in group A and group B patients respectively. There were no significant differences between early and delayed spica regarding the complications of treatment and functional outcome. But immediate spica decreased the hospitalization time and the cost of treatment significantly with increased availability of beds while having similar result as achieved by delayed spica application.

Femoral shaft fractures are among the commonest fracture of lower extremity in children and commonly require hospital admission. There are various modalities of treatments both operative and non-operative. The aim of treatment is to secure union, in good alignment with length restored and early rehabilitation. objective of this study was to compare the results of day 1 spica cast and skin traction followed by spica cast in the treatment of femoral shaft fractures in children (6 months to 10 years). A total of 64 patients with fracture shaft femur of either sex aged 6 months – 10 years with closed , isolated diaphyseal femur fracture were included in this study. Case with clinical evidence of infection, pathological fractures and multiple injuries including neurovascular injuries were excluded from the study. The patients were randomly assigned into two groups, Group -1 ( n-32) patients who underwent early spica application while Group -2 ( n-32) patients underwent skin traction in followed by spica cast. Mean age in group A was 5.06 years and 5.12 years in group B (range 6 month – 10 years). Ratio of males and female in Group A and Group B was 19:13 and 20:12 respectively. Average duration of hospital stay was 1.65 days and 11.65 days in group A and group B respectively. Average total time of spica cast application was 45.13 days 49.41 days in group A and group B patients respectively. There were no significant differences between early and delayed spica regarding the complications of treatment and functional outcome. But immediate spica decreased the hospitalization time and the cost of treatment significantly with increased availability of beds while having similar result as achieved by delayed spica application.

Introduction: Isolated cerebral fat embolism syndrome (FES) is a rare complication that occurs within the first 3 days of the initial insult. We report a case of multiple long bone fractures with isolated cerebral FES, despite undergoing early total care with definitive fixation. Case Presentation: A 22-year-old female presented with type IIIA open femur shaft fracture on the right side (AO 32B2), closed femur shaft fracture (AO 32B2), comminuted patella fracture on the left side (AO 34C3), and undisplaced mandible fracture. She had a normal sensorium with a Glasgow Coma Scale (GCS) of E4V5M6. A whole body computed tomography (CT) scan was done to rule out other injuries. All initial scans were normal. After about 6 h in the ICU, she was noticed to have disconjugate gaze and was answering in monosyllables. A repeat CT scan of the brain was normal. The early total care and definitive fixation with titanium intramedullary nails for femur fractures and tension band wiring for patella was done under general anesthesia. On 1st post-operative day (POD), her GCS dropped to E1VTM1. On the 3rd POD, she developed decerebrate rigidity and generalized tonic clonic seizures. Fundoscopic examination showed multiple fat globules along the vessel in the entire field of both eyes. Since there were no other signs of FES in the lungs or on the skin, an MRI brain was done which revealed a hyperintensive starfield pattern on diffusion-weighted images, suggestive of cerebral fat embolism (CFE). At 4 weeks, her upper limb and lower limb muscle power improved. By 2 months, she was mobilized with support. Her Mini-Mental State Examination showed no cognitive impairment. At the latest follow-up at 1 year, her fractures are completely healed and she has no neurological or functional impairment. Conclusion: We must always suspect isolated cerebral FES as a diagnosis in polytrauma patients even when the classical findings are not present. MRI compatible implants have to be used as far as possible as MRI may be required to confirm the diagnosis of CFE. The early total care with definitive fixation and supportive treatment helped us in this patient’s complete recovery without cognitive impairment.

Background: The debate regarding optimal management of femoral shaft fractures in the pediatric population is still far from resolved. While some consensus exists in the treatment of this injury in children younger than the age of six, opinion still widely divided in children six to 11 years.Objective: The aim of study was to compare the outcome of primary hip spica versus initial traction and hip spica of fracture of shaft of femur at or below the junction of the upper and middle third in children in terms of deformity and fracture healing.Method: A RCT study was carried out in the departments of Orthopedics, B.P.Koirala Institute of Health Sciences, Dharan, Nepal from March 2004 to January 2006. Forty five patients were included in the study in which 22 patients included in early spica casting (group I) and 23 patients in traction with spica casting (group II). The functional outcomes were assessed with Pearson’ Chi-square test, Independent samples test and union was assessed radiologically.Result: There was no statistically significant difference in time of union; all of them united in 8-10 weeks follow up. No significant overall difference in terms of deformity was noted in the two groups(p value-0.306).There was significant difference in terms of hospital stay in both the groups(p value&lt;0.05).Conclusion: The study showed that there is significant advantage in primary hip spica cast for the treatment of isolated , closed femur fractures in children ages less than 10 years and weight less than 80 pounds(45kg) which allowed us to treat these fractures without any worry of wound dehiscence, pin site infections, avascular necrosis of the femoral head.Health Renaissance 2015;13(2): 80-91

Abstract This is a prospective study to evaluate the efficacy of the Perkins traction in the treatment of adult femoral shaft fractures from October 1, 2007, to the present at the Black Lion Hospital in Addis Ababa University Hospital in Ethiopia. All femur fractures admitted to the hospital were reviewed and evaluated for treatment. Black Lion Hospital (Tikur Anbessa) is the university hospital in Addis Ababa and the highest tertiary teaching hospital in a country of 85 million inhabitants. A 67-bed orthopedic department offers the main ground for teaching to the undergraduate medical students. The hospital is also the pivotal center for the formation of the orthopedic residents. Patients from different parts of the country are referred to this institution for orthopedic care. A total of 68 adult (older than 16 years) patients with 69 femoral shaft fractures were considered for treatment during the study period. Consent was obtained and prospective treatment initiated. A standard Perkins traction was applied by an orthopedic team composed of consultants, orthopedic residents, physical therapists, and nurses. A protocol was developed for patients undergoing such traction. The physiotherapists will supervise all individual or group therapy sessions. Progressive knee range of motion to facilitate quadriceps and hamstring muscle strengthening exercises were implemented four times a day and recorded. Demographic information, fracture patterns, duration of traction, thigh circumference leg length discrepancy, and pin sites were routinely monitored and charted. Data were computerized and analyzed weekly, and appropriate adjustments were made accordingly. Clinical evidence of a competent callus and confirmation by radiographic studies will influence the cessation of traction to allow gait training with toe-touch crutch ambulation. Progress will be monitored during the following outpatient visits in the fracture clinic. A total of 68 consecutive patients with 69 femoral shaft fractures were treated with the Perkins traction. There were 60 men (88.2%) and only 8 women (11.8%), for a ratio of 8 men to 1 woman. The age of the cohort patient varied between 18 and 28 years. The mechanisms of injury for most of the fractures were motor vehicle accidents, resulting in an isolated femoral shaft fracture in 49.2% of the patients. Half of the fractures were by means of closed injury (n = 44; 64.7%). One patient with a bilateral femoral shaft fracture was also added to the study. The right side was more often involved, with 41 fractures (60%), than the left, with 28 fractures (40%). Most of the fractures involved the proximal third of the femur (n = 34; 50%), but the most common fracture pattern was transverse (n = 29; 42.6%), followed by a comminuted pattern (n = 18; 26.5%). Three segmental fractures were also encountered. The mean hospital stay was 45 days (33 patients; 48.5%), with the length of time in traction varying from 30 to 40 days. Only 2 patients remained in traction for a period of 60 days. At the end of the traction period, 8 patients (11.8%) showed a decrease in the quadriceps mass, and 7 patients (10.3%) showed stiffness of the knee with a range of motion limited to 0° to 90°. Most patients were discharged after about 8 months of treatment. One patient suffered a nonunion, and one was malunited. Superficial pin care infections were noted in 8 patients (11.8%) and treated appropriately. The conservative treatment of 69 femoral shaft fractures using the Perkins traction at Black Lion University Hospital in Addis Ababa, Ethiopia, has been proven to be a safe and effective method. It should be encouraged in countries like ours where it is a luxury to have a C-Arm in the operating room and where the hardware often is not available to perform a stable stabilization of the long bone fractures.

Background: One of the body's main joints for bearing weight is the knee. Its issues are likewise difficult to resolve. Damage to this joint can cause abnormalities in the alignment, stability, and motion of the knee, which impairs function. Objective: To compare the functional and radiological outcome in AO type C1 distal femur fractures fixed with locking plate versus dynamic condylar screw. Methods: The study comprised 94 patients aged 18 to 60 years who had an isolated distal femur fracture and an Arbeitsgemeinschaft für Osteosynthesefragen (AO) type C1 closed fracture. Patients with diabetes mellitus, chronic renal disease, chronic liver disease, ischemic heart disease, pathological fractures, head injuries with a Glasgow coma scale of less than 14, and malignancy were excluded from the sample. The patients were assigned by lottery to groups A and B. In groups A and B, they were treated with dynamic condylar screws (DCS) and locking plate fixation, respectively.. Results: Among 94 patients, 30 (63.8%) were men and 17 (36.2%) were women in Group A; similarly, 33 (70.2%) were men and 14 (29.8%) were women in Group B. Patients in group A had an average age of 38.8±6.19 years, whereas those in group B had an average age of 39.5±7.36 years. 02 patients (4.2%) in Group-A and 05 patients (10.6%) in Group-B experienced infection. The union rate was 45 (95.7%) in group A (locking plate fixation technique) and 40 (85.10%) in group B (dynamic condylar screw technique). 35 (74.46%) in group A, 08 (17.1%) in good, 03 (6.38%) in average, and 01 (2.1%) in poor; in group B, 25 (53.2%) in excellent, 09 (19.2%) in decent, and 10 (21.3%) had average and 03(6.3%) had poor functional outcome. Conclusion: In terms of clinical and radiological evaluation, the type C1 distal shaft femur fixation with locking plate performs better than the dynamic condylar screw, which has a lower infection rate and better union and functional success

Introduction: In school going children surgical treatment is favoured with the introduction of elastic intramedullary nails. The aim of this study was to determine the management outcome of fracture shaft of femur in children between 7-14 years of age by intra medullary rush nail. Patients and Methods: This study was conducted at department of orthopedic surgery, Dow University of health science and civil hospital Karachi. Duration of study was 12 months from 01-09-2011 to 31-8-2012. Children with closed fracture shaft of femur age 7-14 years of either sex meeting the inclusion criteria were included. Children were diagnosed clinically and confirmed on X ray, open reduction and internal fixation with appropriate size rush nail was done by senior orthopedic surgeon. Thereafter patients were followed every month and the final outcome was measured at the end of third month post operatively. Results: male were 58% while female were 42%, the average age of the patients were 11.78±1.40 years. Management outcome of fracture shaft of femur in children by intra medullary rush nail showed that 100% children fracture were healed. Conclusions: We found a very high success rate in the management of closed fracture shaft femur with intramedullary rush nail. This surgical procedure is simple, technically less demanding, and suitable in peripheral rural hospital in developing countries.

Original Research Paper FUNCTIONAL OUTCOME OF BIPOLAR HEMIARTHROPLASTY IN DISPLACED INTRACAPSULAR FEMORAL NECK FRACTURE IN ELDERLY IN RURAL TERTIARY HOSPITAL <strong>Authors:</strong> <strong>¹</strong><strong>Dr. Saikrishna Rengerla</strong><strong>, </strong><strong>²</strong><strong>Dr. Akhil Lohkare, ³Dr. CM Badole</strong> <em>^1,2</em><em>Senior Resident, Dept of Orthopaedics, MGIMS Sevagram</em> <em>³</em><em>Director-Professor &amp; HOD, Dept of Orthopaedics, MGIMS Sevagram</em> Corresponding Author: Dr. Saikrishna Rengerla, Dept of Orthopaedics, MGIMS Sevagram <strong>Article Received:</strong>&nbsp; 10-08-2022&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <strong>Revised:</strong>&nbsp; 31-08-2022&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <strong>Accepted:</strong> 21-09-2022 <strong>ABSTRACT: </strong> Femoral neck fractures, one of the most common injuries in the elderly have always presented great challenges to orthopaedic surgeons. The present study was conducted in 42 elderly patients with closed displaced intracapsular fracture of femoral neck following all inclusion and exclusion criteria who were present to the Orthopaedics department from October 2019-May 2021 to evaluate functional outcome of bipolar hemiarthroplasty in displaced intracapsular femoral neck fracture in elderly who were followed for duration of 6 months at an interval of 6 weeks, 3 months and 6 months. Most of the patients were belonging to 65-69 years of age group accounting to 33.33%. Females outnumbered males accounting to 59.52% with female to male ratio of 1.47:1. Transcervical fractures outnumbered and accounted for 90.48%. There were more left sided fractures accounting for 71.43%. Most of the patients were operated within 7 days of fracture accounting for 45.24% with average hospital stay of 14.71&plusmn;4.79 days. Most common mode of injury was trivial trauma i.e.92.86%. 41mm Bipolar prosthesis size accounted for maximum of 28.6%. Harris Hip Score was used to evaluate the functional outcome of Bipolar Hemiarthroplasty was noted at regular follow ups. &nbsp;Mean Harris Hip score at 6 weeks was 74.21&plusmn;10.07, at 3 months was 77.66&plusmn;10.59, at 6 months was 80.40&plusmn;10.60 with upward trend in the mean score over follow up period. There was 2.38% cases of posterior dislocation noted at 1 month in Uncemented Bipolar Hemiathroplasty postoperatively, 4.76% cases of infection and 7.14% cases of lengthening, 7.14% cases of Bedsores. The final functional outcome at 6 months of follow up revealed excellent results in 13 patients(30.95%), Good in 11 patients(26.19), Fair in 12 patients(28.57%) and Poor results in 6 patients(14.29%). Our study concludes that Bipolar Hemiarthroplasty offers excellent, painless mobility and ease in rehabilitation and return to function. <strong><em>Key words: Bipolar hemiarthroplasty, Elderly patients, Harris hip score, Intracapsular femoral neck fracture, Complications, Functional Outcome.</em></strong> &nbsp; &nbsp; <strong>INTRODUCTION:</strong> Femoral neck fractures, one of the most common injuries in the elderly have always presented great challenges to orthopaedic surgeons. The prevalence of these fractures has increased with improvement in life expectancy, increased incidence of osteoporosis, poor vision, neuro-muscular incoordination and changes in lifestyle leading to sedentary habits⁽¹⁾. In the elderly with osteoporotic bones, a trivial fall is the cause of hip fractures in about 90% of cases⁽²⁾. The prevalence of the fracture also doubles for each decade of life after fifth decade⁽³⁾. Treatment of displaced femoral neck fractures in elderly has been controversial. Open reduction and internal fixation of these fractures in the elderly have poor outcome including high rate of nonunion and avascular necrosis⁽¹⁾. Various prosthesis have been designed which can be broadly divided into two types- unipolar and bipolar. Of unipolar prosthesis, the most commonly used are the THOMPSONS and AUSTIN MOORES prosthesis. Main problems with these prosthesis were stem loosening and migration⁽⁴⁾. In modern days the bipolar prosthesis with cement is the best option wherein they can be more active⁽⁵⁾. PMMA cement offers advantages as its use as a grouting agent to replace thinning trabecular bone thus greatly simplifying rehabilitation. The Bipolar prosthesis was introduced to prevent and retard acetabular wear. These prosthesis have a 22 to 32mm head that articulates with ultra-high-density polyethylene inner liner which is covered with a polished metal outer head that articulates with acetabular cartilage. It causes less articular wear⁽⁴⁾. Advantages of uncemented femoral components is including faster implantation and potential lower risk of fat and marrow embolism compared to cemented implants. Disadvantages of uncemented implants in elderly are potential for retarded osteointegration, osteopenia and concern for fracture and in patients with wide femoral canal has mismatch of proximal/distal diameters^(6,7,8). There was no significant difference in using cemented and uncemented bipolar prosthesis⁽⁹⁾. The aim of the study is to evaluate the functional outcome of Bipolar hemiarthroplasty in closed displaced intracapsular femoral neck fracture in elderly. <strong>METHODOLOGY: </strong> This was a follow up study and conducted in 42 elderly patients with closed displaced intracapsular fracture of femoral neck reported to the Orthopaedics Department of MGIMS and Kasturba hospital following all inclusion and exclusion criteria from October 2019-May 2021. Inclusion criteria was patients of age 60 years and above, nonunited/old fracture neck of femur. Exclusion criteria was pathological fractures of neck of femur, medically unfit for surgery, Bilateral fracture neck femur, Previously operated fracture neck femur of same and opposite side, Non ambulators, those who would not complete 6 months of final follow up. Informed consent was taken at the initiation of study, in English and in regional language, after explaining the procedure in detail. Preoperative Protocol consisted of thorough history taking and clinical examination and evaluation was done and then Anteroposterior radiographs of pelvis with both hip. All study Patients were put on skin traction, given oral or parenteral analgesics to relieve pain. Adequate medical management of associated comorbid conditions like diabetes mellitus, systemic hypertension, COPD and heart diseases was initialized to optimize patient&rsquo;s fitness for anaesthesia. All measures were taken so that the patient could be taken up for surgery at the earliest. Operative Approach was Moore&rsquo;s posterior approach for all patients in Lateral decubitus position on the operating table with the affected side facing up. A curved incision taken from a point 10cm distal to posterior superior iliac spine and extended distally and laterally parallel to the fibres of gluteus maximus to the posterior margin of greater trochanter. Deep fascia was exposed over gluteus maximus, was then split in the direction of its fibres by blunt dissection. By retracting the proximal fibres of the muscle proximally, the greater trochanter was exposed after trochanteric bursa excised. Distal fibres were retracted distally and divided at their insertion over linea aspera. The sciatic nerve was not usually exposed . It was protected with the finger in the lateral part of the incision and gently retracted out of the way. The gemelli and obturator internus and piriformis tendon were divided at their insertions after tagging them for easier identification and reattachment. The posterior part of the capsule thus exposed was incised from distal to proximal along the line of neck of femur and at right angle to it, thus making a L shaped opening in the capsule. The fractured head and neck of the femur were levered out of the acetabulum and size measured using femoral head gauge. The size was confirmed using trial prosthesis by its suction fit in the acetabulum. The acetabulum was prepared by excising remnants of ligamentum teres and soft tissue. The femoral shaft was rasped using a broach(rasp) and prepared for the insertion of the prosthesis. Femoral neck if long was nibbled keeping 2 to 2.5cm of calcar above the lesser trochanter. The appropriate sized prosthesis was then inserted into the femoral shaft(reamed canal) in taking care to place in 10⁰ to 15⁰ of anteversion and impacted into the femur. The reduction of prosthesis done using gentle traction of the thigh. If Prosthesis became loose intraoperatively, cemented procedure were performed. In these cases, the stem was cemented in place using standard cementing technique- lavage, cleaning, drying and plugging of the canal. Absolute haemostasis obtained. After suturing the capsule, the external rotators sutured. The wound closed in layers over a suction drain, were removed at the first changing of dressing after 48hours. Post operatively, patients were kept in the ward with limbs in wide abduction with the help of abduction pillow. Adduction, internal rotation and flexion were avoided. Static exercise in bed for quadriceps and breathing exercises along with active limb movement to decrease limb edema. Ambulation started within a week with walker and progressive weight bearing. Postoperatively DVT prophylaxis was added to high risk patients according to the advice given by Physician/Anaesthetist. Patients were advised not to sit cross legged or squat. All patients were followed up monthly for first 3 months and then at 6 months. Minimum follow up of 6 months and HARRIS HIP SCORE⁽¹⁰⁾was noted and radiographs of the affected hip were taken. Final evaluation of the study was done after completion of study according to criteria. <strong>RESULTS:</strong> 42 study participants fulfilling inclusion and exclusion criteria were selected and evaluated for associated comorbidities and operated by Bipolar Hemiarthroplasty and&nbsp; followed for duration of 6 months at an interval of 6 weeks, 3 months and 6 months during the study period. <strong>Age distribution:</strong> majority of the patients were belonging to 65-69 years of age group accounting to 33.33%, followed by 60-64 years of age group accounting 26.19%, followed by 70-74 years of age group accounting 21.43%, followed by 75-79 years of age group and 80-84 years of age group accounting 7.14% each and followed by &gt;84 years of age group accounting 4.76%. Mean age in general was 68.66 &plusmn; 7.03 with range of 60-85 years. <strong>Gender:</strong> In the present study, females outnumbered males accounting to 25(59.52%) and males proportion was 17(40.48%). Female to male ratio in our study was 1.47:1 <strong>Fracture side distribution:</strong> There were more left sided fractures accounting for 30 cases (71.43%) Garden classification: Patients with Type 4 of Garden classification accounted for maximum of 83.33%, followed by Type 3 for 9.52% and Type 2 for 7.14%. <strong>Anatomical Classification:</strong> Patients with Transcervical fractures outnumbered and accounted for 90.48%, followed by Subcapital fracture for 7.14% and followed by Basicervical for 2.38% <strong>Distribution of patients according to duration between fracture and surgery:</strong> Duration(days) No of patients Percentage &lt;7 days 19 45.24 7-30 days 18 42.86 &gt;30 days 5 11.90 Total 42 100 Mean&plusmn;SD 13.11 &plusmn; 16.20(2-95 days) <strong>Table 1</strong> <strong>Duration between admission and surgery: </strong>In our study, majority of the patients operated within 3-7 days of admission i.e. 26(61.90%) followed by more than 7days i.e. 9(21.43%) and within 3 days in only 7 patients i.e.16.67% <strong>Mode of injury: </strong>In our study most of the patients had trivial trauma which accounted for 39 cases (92.86%) followed by road traffic accident of 3 cases(7.14%) <strong>Distribution of patients according to comorbidities</strong> Comorbidities No of patients Percentage Asthma 4 9.52 Diabetes Mellitus 8 19.05 Chronic Kidney Disease 3 7.14 Hypertension 16 38.10 &nbsp;Rheumatoid Arthritis 1 2.38 Thyroid Disease 1 2.38 Ischemic heart disease 1 2.38 Lung consolidation 1 2.38 <strong>Table 2</strong> <strong>Average hospital stay:</strong> was 14.71&plusmn;4.79 days with maximum of 28 days and minimum of 4 days. <strong>Prosthesis Size:</strong> 41mm Bipolar prosthesis accounted for maximum of 28.6% in 12 cases and least used was 53mm Bipolar prosthesis in 1 case (2.4%) &nbsp; Frequency Percent P R O S T H E S I S 37 mm 2 4.8 39 mm 3 7.1 41 mm 12 28.6 43 mm 7 16.7 45 mm 5 11.9 47 mm 4 9.5 49 mm 6 14.3 51 mm 2 4.8 53 mm 1 2.4 Total 42 100.0 <strong>Table 3</strong> &nbsp; &nbsp; &nbsp; <strong>Position of stem:</strong> Position of stem No of patients Percentage Valgus 5 11.90 Varus 6 14.29 Neutral 31 73.81 Total 42 100 <strong>Table 4</strong> <strong>Intraoperative time and blood loss: </strong>average blood loss was 326.66 &plusmn; 109.18ml with range of 150-750ml and average intraoperative time was 63.45 &plusmn; 11.64 min with range of 45-90 min. <strong>Harris Hip Score: </strong>used to evaluate the functional outcome of Bipolar Hemiarthroplasty which was noted at regular follow ups at 6 weeks, 3 months and 6 months. The Mean Harris Hip score at 6 weeks was 74.21&plusmn;10.07 with range of 47-87. The Mean Harris Hip score at 3 months was 77.66&plusmn;10.59 with range of 50-90. The Mean Harris Hip score at 6 months was 80.40&plusmn;10.60 with range of 52-90. There was an upward trend in the mean score over follow up period. &nbsp; N Minimum Maximum Mean Std. Deviation 6 weeks 42 47.00 87.00 74.21 10.07 3 months 42 50.00 90.00 77.66 10.59 6 months 42 52.00 92.00 80.40 10.60 <strong>Table 5</strong> Graph 1: Distribution of patients according to Harris Hip Score &nbsp; &nbsp; <strong>Distribution of patients according to complications:</strong> Complications No of patients Percentage Dislocation 1 2.38 Infection 2 4.76 Lengthening 3 7.14 Other(Bed Sore) 3 7.14 <strong>Table 6</strong> &nbsp; <strong>Functional outcome: </strong>In our study, the final functional outcome at 6 months of follow up using Harris Hip Score. We observed excellent results in 13 patients(30.95%), Good in 11 patients(26.19), Fair in 12 patients(28.57%) and Poor results in 6 cases(14.29%). &nbsp; &nbsp; <strong>Distribution of patients according to functional outcome at final follow up(6 months)</strong> Functional Outcome No of patients Percentage Poor 6 14.29 Fair 12 28.57 Good 11 26.19 Excellent 13 30.95 Total 42 100 <strong>Table: 7</strong> <strong>DISCUSSION:</strong> Elderly patients with fracture neck of femur who were mobile before injury should be able to restore to their preoperative functional and ambulatory status. In active older patients especially needing early mobilization, conservative method of treatment is not acceptable because it results in non union with unstable hip and limitation of hip movement as well as complications of prolonged immobilization like bedsores, deep vein thrombosis and respiratory infections. Result for femoral neck fracture treatment illustrated by Leighton et al⁽¹¹⁾recommended prosthetic replacement for patients more than 60 years old having femur neck fracture. Bateman and Giliberty in 1974 introduced Bipolar hemiarthroplasty, which is a self articulating prosthesis. Advantage of Bipolar prosthesis is that erosion and protrusion of acetabulum would be less because, there is dual articulation between inner head and shell and acetabulum⁽¹²⁾. The Aim of present study was to evaluate the functional outcome of Bipolar Hemiarthroplasty in displaced intracapsular femoral neck fracture in elderly. 42 patients of fracture neck femur were treated using Bipolar Hemiarthroplasty, both cemented and uncemented. A concept that has been generally held by Orthopaedic surgeons is that Cemented femoral fixation is required in elderly patients because of poor bone stock⁽¹³⁾. However, cemented technique has also been associated with greater risk of fat embolization and hypotension⁽¹³⁾. Many Orthopaedic surgeons feel that stable femoral fixation can be achieved in elderly patients with cementless femoral stem⁽¹⁴⁾. The complications following the Bipolar Hemiarthroplasty is reported in varying incidences. Early surgical complications after Bipolar Hemiarthroplasty may be the origin of cascades leading to general complications and increased mortality. That is why their prevention is very important⁽¹⁵⁾. In present study, there was 1(2.38%) case of posterior dislocation noted in <em>(CASE 1)</em> 76 years old female with multiple co morbidities like right lower lung consolidation, Diabetes Mellitus, Hypertension, Chronic Kidney Disease, Asthma admitted on the same day of trauma with transcervical neck femur fracture of left side due to trivial trauma operated with Uncemented Bipolar Hemiathroplasty and postoperatively at 1 month there was posterior dislocation occurred due to sudden adduction of hip, which was managed by revision Cemented Bipolar Hemiarthroplasty immediately and later after 12 weeks she developed deep infection in wound which was managed by debridement which eventually healed with final Harris Hip Score of 72 at 6 months of follow up. In our study all cases were operated by posterior approaches. Dislocation of the Hip Hemiarthroplasty have been a concern for Orthopaedic surgeons since the advent of the procedure. Furthermore, early dislocation is associated with increased mortality rate⁽¹⁶⁾. Dislocation of the Bipolar prosthesis is a rare phenomenon. It has been reported in literature ranging from 1.1% at one year follow up to 5% at 20 years⁽¹⁷⁾. Saberi S et al⁽¹⁸⁾, in his study related to the complications following Bipolar Hemiarthroplasty amongst the 150 patients at 1 year follow up reported 6.5% dislocation rate. Rajak MK et al⁽¹⁹⁾, reported 3% prosthesis dislocation following Bipolar Hemiarthroplasty. Unwin et al⁽²⁰⁾, reported 6.5% of dislocation rate among all their patients with those having posterior approach being three times more likely to dislocate. &nbsp; <strong><em>CASE 1</em></strong> &nbsp; <strong>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Pre-operative X-RAY&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Post-operative X-RAY</strong> &nbsp; <strong>Dislocation At 1 Month</strong> &nbsp; <strong>Open Reduction of Dislocation with Revision Cemented Prosthesis and Drain Placement</strong> <strong>X-RAY At 3 Months&nbsp; of Revision Procedure</strong> &nbsp; <strong>X-RAY At 6 Months</strong> &nbsp; In our study there were 2(4.76%) cases of infection out of which 1 was superficial wound infection and 1 deep wound infection. 73 year old male patient with no comorbidities observed superficial infection after 4 months of Uncemented Bipolar Hemiarthroplasty who was managed by antibiotic and dressing. Another patient, 76 year old female with multiple comorbidities including Diabetes had developed deep wound infection after cemented Bipolar Hemiarthroplasty as a revision procedure following posterior dislocation after 6 weeks which was managed by debridement and appropriate antibiotic after culture and sensitivity and diabetic control. Naidu KA et al⁽²¹⁾, observed superficial wound infection in 2 patients in the 1^st week of operation, of which 1 patient was diabetic. Treated with proper antibiotic and dressing which resulted in prolongation of their hospital stay. The organism isolated in the above cases were Staphylococcus Aureus. Maruthi CV and Shivanna⁽⁵⁾, observed 1 patient(2%) had a superficial wound infection in the 1^st week of operation which led to the prolongation of the hospital stay treated with proper antibiotics and dressing. The organism isolated was Staphylococcus Aureus. In present study, we observed lengthening of the operated limb in 3 patients upto 1 cm(7.14%). Ponraj RK et al⁽⁹⁾, observed in two cases had limb lengthening(1 cm). Naidu KA et al⁽²¹⁾, reported limb length discrepancy seen in 2 patients(9.09%) of which lengthening was noted in both patients. Rajak MK et al⁽¹⁹⁾, observed limb lengthening in 1(3%) patient about 1.5cm which was managed by compensatory footwear in the opposite limb. While Marya SKS et al⁽²²⁾, observed limb lengthening in 7% of the cases. Limb lengthening of less than 3.5cm was not significant and did not affect outcome. Patel KC et al⁽²³⁾, in 84% of the patient there was no limb length discrepancy. No case showed limb shortening while 16% showed limb lengthening. All the cases in our series were assessed according to Harris Hip Score and graded accordingly as Excellent , Good, Fair and Poor. In present study, we evaluated mean Harris Hip score at the end of 6 months follow up which was 80.4 points. Our findings are consistent with the study of Rajak MR et al⁽¹⁹⁾,Bezwada HP et al⁽²⁴⁾, Ponraj RK et al⁽⁹⁾, Maruthi CV and Shivanna⁽⁵⁾<strong>. </strong> &nbsp; <strong>&nbsp;Studies with Harris Hip Score</strong> STUDIES MEAN HARRIS HIP SCORE Bezwada HP et al⁽²⁴⁾ At 3.5 years 82 points with range of 54-92 Shukla R et al⁽²⁾ At 6 months 74.68 points At 1 year 78.24 points At 2 years 81.40 Saberi S et al⁽¹⁸⁾ At 6 months 74.5 points At 1 year 80.7 points Maruthi CV and Shivanna⁽⁵⁾ At 6 months range of 35 to 94.6 Reddy YH et al⁽²⁵⁾ At 1 year 90.36points Rajak MK et al⁽¹⁹⁾ At 6 months 82.1 points At 1 year 83.1 points Ebrahimpour A et al⁽²⁶⁾ At 1 year 83.5 points Ponraj RK et al⁽⁹⁾ At 6 months 84.2 points Our study At 6 weeks 74.21 points At 3 months 77.66 points At 6 months 80.4 points <strong>Table 8</strong> <strong>Studies with Functional Outcome</strong> Study Duration Excellent Good Fair Poor Naidu KA et al⁽²¹⁾ 22 cases for 6 months 31.82% 54.55% 9.09% 4.54% Kalantri A et al⁽²⁷⁾ 30 cases for 6 months 53.33% 33.3% 16.67% 6.67% Ponraj RK et al⁽⁹⁾ 30 cases for minimum 6 months 23.33% 56.66% 13.33% 6.66% Jindal RC et al⁽²⁸⁾ 30 cases for 6 months 40% 40% 6.7% 13.3% Patel KC et al⁽²³⁾ 50 cases for 12 months 64% 28% 8% 0% Bezwada HP et al⁽²⁰⁾ 248 cases for 3.5 years 10% 55% 30% 5% Rajak MK et al⁽¹⁹⁾ 30 cases for 12 months 33.33% 43.33% 16.66% 6.66% Malhotra R et al⁽²⁹⁾ 32 cases 75% 15.6% 6.3% 3.1% Our study 42 cases for 6 months 30.95% 26.19% 28.57% 14.29% <strong>Table 9</strong> &nbsp; <strong>CONCLUSION:</strong> Our study concludes that Bipolar Hemiarthroplasty is a good method to manage intracapsular fracture neck femur in elderly patients . It offers excellent, painless mobility and ease in rehabilitation and return to function. The surgery is relatively easy to perform, takes less operating time and less blood loss with low complication rate. <strong>REFERENCES:</strong> Adapureddi HT, Kamareddy SB, Kumar A, Paturi SK, Anne S, Reddy JP. Prospective study of management of fracture neck of femur by Hemiarthroplasty with cemented Bipolar. Journal of Evolution of Medical and Dental Sciences. 2015; 4(98): 16309-16314. Shukla R, Singh M, Jain RK, Mahajan P, Kumar R. Functional Outcome of Bipolar Prosthesis versus Total Hip Replacement in the Treatment of Femoral Neck Fracture in Elderly Patients. Malaysian Orthopaedic Journal<em>.</em> 2017; 11(1): 1 -5. Leighton RK: Fractures of the Neck Femur. In: Bucholz RW, Heckman JD,Court-Brown CM. (eds.) Rockwood and Green&rsquo;s fracture in adults. 6^th edition. Philadelphia, Lippincott Williams &amp; Wilkins 2006; 1753-1791. Sharoff L, Nazeer M, Unnikrishnan R. Functional outcome of cemented bipolar hemiarthroplasty in fracture neck of femur in elderly: A prospective observational study. International Journal of Medical Research &amp; Health Sciences. 2016; 5(2): 70-76. Maruthi CV, Shivanna. Management of fracture neck of femur in elderly by hemiarthroplasty: A study. Indian Journal of Orthopaedics Surgery<em>. </em>2016; 2(2): 170-180. Parvizi J, Ereth MH, Lewallen DG. Thirty-Day Mortality Following Hip Arthroplasty for Acute Fracture. The Journal of Bone &amp; Joint Surgery. 2004; 86: 1983-1988. Parker MJ, Guruswamy KS, Azegami S.(2010). Arthroplasty(with and without bone cement)for proximal femoral fractures in adults. The Cochrane database of systematic reviews. 2010(6),CD001706-CD. Ahn J, Man LX, Park S, Sodl J F, Esterhai JL. Systematic Review of Cemented and Uncemented Hemiarthroplasty Outcomes for Femoral Neck Fractures. Clinical Orthopaedic Related Research. 2008; 466: 2513-2518. Ponraj RK, Arumugam S, Ramabadran P. Functional Outcome of Bipolar Hemiarthroplasty in Fracture Neck of Femur. Scholars Journal of Applied Medical Sciences. 2014; 2(5D): 1785-1790. Harris WH. Traumatic Arthritis of the Hip after Dislocation and Acetabular Fractures: Treatment by Mold Arthroplasty. The Journal of Bone &amp; Joint Surgery<em>. </em>1969; 51-A(4): 737-755. Leighton RK, Schmidt AH, Collier P, Trask K. Advances in the treatment of intracapsular hip fractures in the elderly. Injury 2007; 38: 24-34. Bateman JE. Single assembly Total hip prosthesis: Preliminary report. Orthop Dig. 1974; 2: 15-19. Dorr LD, Glousman R, Sew Hoy AL, et al. Treatment of femoral neck fractures with total hip replacement versus cemented and non cemented hemiarthroplasty. Journal of Arthroplasty<em>.</em> 1986; 1: 21. Keisu KS, Orozco F, Sharkey PF, et al. Primary cementless total hip arthroplasty in octagenarians: two to eleven year follow up<em>. </em>The Journal of Bone and Joint Surgery. 2001; 83: 359. Biber R, Brem M, Singler K, Moellers M, Sieber C, Bail HJ. Dorsal versus transgluteal approach for hip hemiarthroplasty: an analysis of early complications in seven hundred and four consecutive cases. International Orthopaedics<em>.</em> 2012; 36(11): 2219-23. Peterson MB, Jorgenson HL, Hansen K, Duus BR. Factors affecting postoperative mortality of patients with displaced femoral neck fracture<em>. </em>Injury<em>. 2006</em>; 37(8): 705-11. Sierra, Rafael J et al. Dislocation of Bipolar Hemiarthroplasty: Rate, Contributing Factors, and Outcome. Clinical Orthopaedics &amp; Related Research. 2006; 442: 230-238. Saberi S, Arabzadeh A, Khomeisi B, Berehnegard E, Mortazavi SMJ. Early Complications Following Bipolar Hemiarthroplasty for Femoral Neck Fracture in Elderly Patients. Academic Journal of Surgery. 2014; 1(3-4): 45-48. Rajak MK, Jha R, Kumar P, Thakur R. Bipolar hemiarthroplasty for intracapsular femorla neck fracturres in elderly patients. Journal of Orthopaedic Surgery. 2013; 21(3): 313-316. Unwin AJ, Thomas M. Dislocation after hemiarthroplasty of the hip: a comparison of the dislocation rate after posterior and lateral approaches to the hip. Ann of the Royal College of Surgeons of England. 1994; 76(5): 327-9. Naidu KA, Sunil T, Koduru SK. A clinical study of Management of intracapsular fracture neck of the femur in elderly with Bipolar Hemiarthroplasty. International Journal of Orthopaedic Sciences. 2020; 6(2): 319-325. Marya SKS, Thukral R, Hasan R, Tripathi M. Cementless bipolar hemiarthroplasty in femoral neck fractures in elderly. Indian Journal of Orthopaedics. 2011; 45(3): 236-242. Patel KC, Moradiya N, Gawatre P, Desai TV. Early outcome of hemireplacement arthroplasty using cemented bipolar prosthesis in fracture neck femur in elderly: A Study of 50 cases. International Journal of Orthopaedic Sciences. 2017; 3(1): 303-307. Bezwada HP, Shah AR, Harding SH, Baker J, Johanson NA, Mont MA. Cementless Bipolar Hemiarthroplasty for Displaced Femoral Neck Fractures in the Elderly<em>. </em>The Journal of Arthroplasty<em>. </em>2004; 19(7): 73-77. Reddy YH, Vishnu K. A study of management of intracapsular fracture neck femur using bipolar prosthesis. Indian Archives of Integrated Medicine. 2018; 5(1): 28-35. Ebrahimpour A, Zandi R, Ayazi M, Safdari F. The Outcomes of Treating Femoral Neck Fractures Using Bipolar Hemiarthroplasty. Trauma Monthly. 2017; 22(1): e61806. Kalantri A, Barod S, Kothari D, Kothari A, Nagla A, Bhambani P. Hemiarthroplasty for intra-capsular fracture neck of femur in elderly patients: a prospective observational study. International Journal of Research in Orthopaedics. 2017; 3(5): 991-997. Jindal RC, Gill SS, Singh M, Gautam RK. Functional Outcome of Bipolar Arthroplasty for Fracture Neck Femur in Elderly People. Indian Journal of Research. 2016; 5(11): 7-10. Malhotra R, Arya R, Bhan S. Bipolar hemiarthyroplasty in femoral neck fractures. Archives of Orthopaedic Trauma Surgery. 1995; 114(2): 79-82. &nbsp; &nbsp;

Introduction: The incidence of ipsilateral fracture of the shaft of the femur and dislocation of the hip are extremely rare injuries. However, the incidence of complex fractures is increasing day by day due to an increasing variety of traumatic mechanisms. This type of injury constitutes various diagnostic and treatment difficulties for the surgeon. Such injuries should be managed on an urgent basis for better functional outcomes. Case Report: We hereby describe two such cases: First case hip was reduced using external fixator pins, stabilization of the shaft femur fracture was done with an external fixator and the second case hip was reduced with bone holding clamps and the shaft femur fracture was fixed with interlocking nail. Conclusion: Fixator-assisted closed reductions are the first line of treatment in the management of posterior dislocation hip complicated with ipsilateral femoral shaft fractures. If closed reduction fails, fracture site can be opened and direct forces can be applied to the proximal femur to aid hip reduction with minimum complications. Keywords: Ipsilateral, posterior hip dislocation, shaft femur fracture, close reduction.

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Rigid interlocking nailing for femoral shaft fracture is ideal for use in adolescents in terms of stability of the fracture and convenience for the patient. Closed reduction and intramedullary interlocking nailing is the surgical treatment of choice for the closed shaft fractures of femur. Present study conducted to study the principles of intramedullary interlocking nailing and to assess the outcome of the patient.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The present study comprises of 28 cases of fracture shaft of the femur admitted in orthopaedics wards of JJM Medical College, Davangere. Total 28 cases considered for closed intramedullary nailing.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; In 55% cases closed intramedullary nailing given excellent healing of fracture, in 25% cases healing was good, in 10% cases it was average and 5% cases poor healing was observed.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; It is concluded that closed intramedullary interlocking nailing method given good result in treatment of shaft fractures of femur.&lt;/p&gt;

Background: Femoral shaft fractures are common adult injuries, necessitating effective treatment strategies to optimize patient outcomes. Closed locked intramedullary nailing is widely recommended for femoral shaft fractures due to its high union rates. Objective: This study aims to determine the outcome of managing closed femoral shaft fractures in adult patients using Closed Femur Nailing. Methods: This prospective study was conducted at the Department of Orthopedics, Rangpur Medical College Hospital, and a multicentral private hospital in Rangpur Zone from January 2016 to December 2019. Adult patients aged 16 years and above, presenting with closed femoral shaft fractures within two weeks of injury, were included, while pathological fractures were excluded from the study. Standard techniques were employed for the Closed Femur Nailing procedure, and each patient was followed up for at least 1 year. Results: A total of 112 adult patients were enrolled, with a mean age of 36.9 ± 11.7 years and a male-to-female ratio of 2.9:1. Road traffic crashes were the predominant cause of closed femoral shaft fractures (95.3%), with motorcycle-related incidents being the most prevalent (56.1%). The study demonstrated an impressive union rate of 95.3%, with an average time to radiological union of 14.0 ± 1.2 weeks and a mean time to painless full weight-bearing of 14.2 ± 1.2 weeks. Complications encountered included broken nails (4.7%), infection, loosening of the distal screw, and limb length discrepancy (2.3% each). Thoresen's criteria revealed excellent results in 93% of patients, with poor outcomes in only 4.7%. Conclusion: Closed Femur Nailing emerges as an effective and reliable method for managing closed femoral shaft fractures in adult patients, yielding excellent clinical outcomes with a high union rate and relatively low complication rates.

Introduction: Fracture of the shaft of the femur is among the most commonfractures encountered in orthopedics practice.1 Objectives: The aim of the study was alsocompare the outcome of solid versus canmulated inter locking nails as a method of internalfixation in closed fractures of the shaft of femur in adults. Design: Quasi Experiment design.Setting: Orthopedic Department Allied Hospital P.M.C Faisalabad. Results: We had total of60 cases, 30 in groups of solid I/M nailing and 30 in group B of Cannulated in I/M nailing wehave reported the follow up study up to 9 months. (1) There were 27 (90%) males and 3 (10%)females in group A. (2) If in group B 26 (86.666%) were males 4 (13.333%). (3) The mean agewas 37.4 + 1.61 years. Union: Group A, In 26 (86.666%) patients the fracture uniting within 3months. 3 (10%) patients went into phase of delayed union which ultimately united. 1 (3333%)patient into non-union for which bone grafts has to be done after nine months. Group B: In 26(86.666%) patients the fracture united within 3 months. Patient in group B went into nonuniondue to deep infection, second due to nail breakage an in third no apparent causes was found.Total no of cases of non-union in group B were 3. Infection: In group A one patient in groupB 2 patient had superficial infection which were treated with appropriate antibiotics. In groupB one patient had deep infection and went into non-union due to infection. Implant Failure:In group B one case with nail breakage.. 2 Cases with distal Inter Locking screws breakage&amp; 1 case with proximal interlocking screw breakage were noted. Conclusion: (1) There isno statistical difference in union and infection in both groups (P-Value &gt; 0.05). (2) There issignificant difference in implant failure in both groups no patients in group A went with implantfailure but four patients in group B developed implant failure (P-value &lt; 0..05) so Solid interlocking nail is stronger than cannulated interlocking nail.

&lt;p class="abstract"&gt;Femur shaft fractures are the most common fractures requiring hospitalization in children. Management of these fractures mainly depend on the age of the child. Associated injuries, fracture pattern, weight of the child and overlying soft tissue condition also influence the management. Still, the definitive treatment remains controversial in children between 5-16 years. We present our experience in management of 5 year old boy with mid shaft femur fracture and its complications. In his paper we want to highlight the importance of sticking to the basic principles and the recommendations in the management of the paediatric femur shaft fractures.&lt;/p&gt;

Background: Fractures of the shaft of the femur are among the most common fractures encountered in orthopedic practice. Various treatment options are available but closed interlocking intramedullary nail for fracture shaft of the femur is the gold standard treatment.&#x0D; Objectives: This randomized clinical trial was conducted to evaluate the results of closed intramedullary interlocking nailing for proximal and mid shaft femoral fractures in adult in our country.&#x0D; Materials and Method: This study was conducted at the National Institute of Traumatology and Orthopedic Rehabilitation (NITOR), Sher-E-Bangla Nagar, Dhaka and private Hospital of Dhaka and Rajshahi over a period of four and half years (August 2013-August 2017). Adult patients with closed fracture of proximal and mid shaft of the femur were the study population. A total of 50 patients (50 femoral shaft fractures) aged 18-65 years irrespective of sex were included in the study. The mean age of the patients was 36.52 ± 15.24. Majority of the patients were male. Twenty seven (54%) patients were operated on left side and twenty three (46%) patients were operated on right side. Average time interval between injury and date of surgery was 8.26 days and average time of operation was 95 minutes.&#x0D; Results: 42 patients (84%) has found union within 20 weeks, 6 patients (12%) has found delayed union and was dynamized and united, 01(2%) patient has lost follow up and 01(2%) patient has died at home at 16th post-operative day. Full range of knee movements was found in all cases.&#x0D; Conclusion: Closed locking intramedullary nailing for fracture proximal and mid shaft of the femur is a good option due to less infection, early healing and less scar formation, good range of knee and hip movement.&#x0D; TAJ 2019; 32(2): 27-35

&lt;p class="abstract"&gt;&lt;strong&gt;Background: &lt;/strong&gt;Fracture shaft of femur is a common and major musculoskeletal injury and in most of the cases the patients are immediately brought to hospitals for specialist orthopaedic management. The purpose of this study was to evaluate the effectiveness of early protected weight bearing in fractures of shaft of femur.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This was observational study conducted on 35 patient’s hospital with transverse fracture mid-shaft of femur, between March 2007 and July 2011. Patients with high velocity trauma, with transverse fracture of mid shaft of femur amenable to closed reduction and interlocking intramedullary nailing and otherwise healthy individuals were included in this study. The preoperative parameters were recorded included age, gender, side of the fracture and medical history. All patients were operated on second day of admission.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 35 consecutive cases were included, 34 patients were males and 1 was female. In 74% cases closed intramedullary nailing given excellent healing of fracture, in 14% cases healing was good, in 6% cases it was average and 6% cases poor healing was observed.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Our study demonstrate that this method provides anatomical reduction and maintenance of femur length and early ambulation which promotes fracture healing by a stable internal fixation allowing micro motion at fracture site enhancing callous formation.&lt;/p&gt;

Abstract Case 1 and 2 Two young male patients, sustained injury to the superficial femoral artery (SFA) following a closed femur shaft fracture. The arterial injuries were confirmed by computed tomography angiography and both underwent fracture fixation and on SFA exploration; a thrombosed arterial segment was noted at the fracture site, addressed with arteriotomy and thrombectomy to restore the vascularity. At 1-year follow-up, both patients had good union at the fracture site and a well-perfused limb. Conclusion Thorough clinical examination and appropriate diagnostic studies can diagnose these rare vascular injuries in closed fractures and with early vascular repair potentially limb-threatening complications can be prevented.

Background: The most frequent fracture in children is a pediatric femoral shaft fracture. The use of intramedullary nails, dynamic compression plates, and external fixators in the surgical treatment of pediatric femur fractures has expanded; each has advantages and disadvantages of its own. One of the greatest surgical techniques is flexible intramedullary nailing using titanium elastic nails. Objective: To see the outcome of pediatric long bone fracture utilizing intramedullary elastic nail. Materials and Methods: A prospective interventional study was conducted in the department of orthopaedic surgery, Jahurul Islam Medical College &amp; Hospital, Bhagolpur, Bajitpur, Kishoregonj from January 2023 to December 2023 among 130 patients. Purposive sampling technique was used. Patients with age between 5-10 years, both sexes, fracture shaft of femur at least 3cm distal to lesser trochanter and 3cm proximal to distal physis post traumatic closed or open GA Type I, II shaft of femur fractures was included. Results: Majority 90(69.2%) were closed surgery, RTA was the most common mode of injury, accounting for 62 (47.7%). The average time of union was 7.19 (±4.30) weeks. Majority 70(53.8%) of the patients’ results were excellent, 40(30.8%) were satisfactory and 20(15.4%) were poor outcome. Conclusion: The titanium elastic nail is the most suitable and safest option for treating a femur fracture in children between the ages of one and sixteen.

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; A femoral fracture is a bone fracture that involves the femur. They are typically sustained in high-impact trauma, such as car crashes, due to the large amount of force needed to break the bone. The objective of the study was to evaluate the functional outcome of fractures of the shaft of the femur treated with closed intra-medullary interlocking nailing.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The present study was carried out between June 2015 to May 2016 in Orthopedic Department, Vydehi institute of medical sciences and research centre, Bengaluru. Antegrade nailing using the standard intramedullary interlocking nail was performed on 50 cases who presented with shaft fractures of the femur.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; In the present study maximum number of patients belongs to 18 to 27 years age group (24 cases) followed by 28 to 37 years age group (12 cases), maximum number of patients sustained femur fracture due to RTA (42 cases) followed by fall (08 cases), maximum number of patients sustained closed/simple femur fracture (40 cases), followed by open / compound tibia fracture (10 cases), 32 patients had excellent functional results and 10 patients had good functional outcome, while only 5 patients had fair functional outcome.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; A femur fracture is always considered a medical emergency requiring immediate evaluation and treatment in a hospital. The treatment is largely dependent on the location of the fracture and the pattern and extent of the break.&lt;/p&gt;

Objective: The purpose of this research is to evaluate the efficacy of closed versus open interlocking nails in treating femur shaft fractures. Study Design: Retrospective cohort study Place and Duration: This Retrospective cohort study was conducted at MTI Lady Reading Hospital Peshawar and Khyber Teaching Hospital Peshawar in the duration from 1st March, 2022 to 31 August, 2022. Methods: This research involved 108 cases with age 20-72-year had femoral shaft fracture were included. After informed written consent, age, sex, body mass index, and fracture reason were computed. Patients were equally divided in two groups. Group I utilized open interlocking nails, whereas group II used closed. Post-operative radiological and surgical results were evaluated for union, non-union, and delayed union. Calculated infection prevalence for both groups. Flynn's criterion assessed functional results. SPSS 24.0 analyzed all data. Results: In group I operation time was higher as compared to group II with p value &lt;0.004. Closed group union time was 17.3±6.51 weeks compared to open group 27.8±6.20 weeks. Group II had 51 (94.4%) unions, whereas group I had 45 (83.3%). Group I had 12 (22.2%) delayed unions while group II had 5 (9.3%). Closed interlocking nail performed better than open approach with p value &lt;0.03. The closed interlocking group had fewer complications as compared to open approach (p &lt;0.02). Conclusion: This study found that closed interlocking nails for the femur shaft were superior to open interlocking nails in terms of radiographic and functional success. In addition, patients who were given a closed interlocking nail experienced less complications after surgery. Keywords: Surgery, Femur Shaft, Complications, Closed/Open interlocking nail, Functional Outcomes

Introduction: Fractures of femoral shaft are among the most common fractures that orthopedic surgeons encounter. Femoral shaft fractures can be managed conservatively or surgically. The surgical treatment has gone into revolutionary changes over the period of time and with advent of new antibiotics and better surgical procedures, even open fractures can be fixed internally. The method studied for this research is Surgical Management of Fracture Shaft of Femur with Intramedullary Interlocking Nail. Aim : to study the effectiveness of interlocking intramedullary nailing of diaphyseal fracture of femur in adults. We also studied complications of interlocking intramedullary nailing. Methods : This prospective short term study was done from October 2018 to December 2019 in 20 patients with 20 diaphysis fracture of femur who were admitted in SDM Hospital, Jaipur and who were treated with A.O. femoral interlocking nail. The patients were followed for about 1 year. Results : Majority of fractures were oblique-8(40%), comminuted fractures in 5(25%), spiral fractures in 4 (20%) and transverse in case of 3(15%) of fractures. Excellent result were obtained in 10 cases (50%), good result were obtained in 7 cases (35%) and fair result in 3 cases (15%).

Introduction: The management of fractures of the femoral diaphysis has changed considerably in the last 30 years. Since the advent and popularization of intramedullary nailing the treatment of fracture shaft of femur has become a good, safe and reproducible procedure for the successful management of fracture shaft of femur.Objective: The objective of the study was to assess the various postoperative outcomes of the interlocking nail of fracture shaft of femur.Methodology: This study was prospective cohort study conducted at B.P. Koirala Institute of Health Sciences, Dharan from March 2002 to Feb 2004. Seventy five consecutive patients, having fractures shaft of femur were treated by anterograde closed interlocking nail. Data analysis was done by using EpiInfo 2000 software.Results: The most common cause of fractures shaft of femur was road traffic accident (69.3%). The average union time was 14.9 ± 1.3 weeks. There was wound infection in four cases superficial infection in open grade II but no deep infection. There was two cases of pudendal nerve palsy which recovered within 4 months. There were 5 cases of broken interlocking distal screw and 4 cases had more than 1.5 cm shortening of femurConclusions: The antegrade reamed femoral nailing provides excellent results in management of fractures shaft of femur.Birat Journal of Health SciencesVol.2/No.3/Issue 4/Sep- Dec 2017, Page: 244-247

Introduction: Distal femur fractures are high-velocity injuries which accounts for 7–10% of all femoral fractures of which 5–10% are open fractures. Despite advances in techniques and implants, treatment remains a challenge, in many situations due to increased risk of infection, non-union and loss of range of motion. Surgical management of such complex injury includes radical debridement with stabilization followed by management of gap non-union with appropriate techniques and restores the range of motion. Case Report: We present a case of 20-year-old man who had suffered multiple orthopedic trauma following accident. The patient had open comminuted fracture of the right distal femur, closed fracture of the same side tibia shaft, and right side closed both bone forearm shaft fracture. The patient was initially treated with debridement and knee-spanning limb reconstruction system (LRS). The patient developed infection and subsequently osteomyelitis of the distal femur shaft and gap non-union of 8 cm. The patient was operated for two-stage-induced membrane technique (IMT) and bone grafting using LRS followed by non-vascularized fibula strut grafting and plating. Quadriceps contracture was later on treated with quadricepsplasty to get good functional and radiological outcome. Conclusion: A case of open distal femur comminuted fracture with a very small distal fragment complicated with osteomyelitis and gap non-union. We have shown that the use of IMT followed by non-vascularized fibula strut grafting and plating along with quadricepsplasty can give a very good outcome. Keywords: Gap non-union, induced membrane technique, limb reconstruction system.

<strong>Introduction:</strong>&nbsp;Fractures of the femur shaft a`re common in all age groups and are frequently caused by high-energy events. For stable adults, intramedullary nailing is the recommended course of action, emphasizing prompt healing and functional recovery. 1.6% of juvenile bone injuries in children are femur fractures, and flexible intramedullary nailing has become a valuable surgical technique that provides stability, early mobilization, and less sequelae.&nbsp;<strong>Aim and Objectives:&nbsp;</strong>This study examines the functional and radiological results of the Titanium Elastic Nail System in kids who have fractured their femur shafts.&nbsp;<strong>Method:&nbsp;</strong>A one-year prospective institutional study was conducted with 28 patients aged 5-16 with femur shaft fractures using Titanium Elastic Nails (TENS) at a hospital. Initial assessment included airway, breathing, and circulation evaluation. Radiographs, limb immobilization with a Thomas splint, and comprehensive surveys were conducted. Inclusion criteria: ages 5-16, femur shaft fractures on X-rays, completion of investigations. Exclusion criteria: &lt;5 or &gt;16 years, prior fractures, pathological fractures, non-ambulatory/neuromuscular children, bilateral/compound femoral fractures.&nbsp;<strong>Result:</strong>&nbsp;The demographics, etiology, and fracture characteristics of pediatric femoral shaft fractures are examined in this study. Most reductions are closed because they are faster than open reductions. The majority of fractures heal in 8&ndash;9 weeks with little malunion. The surgical results show that Flynn&rsquo;s method has a high success rate. Clinical decisions for the therapy of juvenile femur shaft fractures are informed by an understanding of these criteria, which emphasize effective interventions and postoperative care for the best possible results.&nbsp;<strong>Conclusion:</strong>&nbsp;Based on the research, Titanium Elastic Nails are very successful at promoting quick union, stability, and fewer problems in pediatric femur shaft fractures. &nbsp; &nbsp; &nbsp;

Radiation in orthopaedic surgeries was considered to be commonly hazardous, but also can be used as tool to improvise the surgical skills, limitations of exposure, risk analysis and making of alternate arrangements whenever required. We aim to analyse the number of times of imaging taken intra-operatively with C-arm for all acute closed lower limb fractures, which are all electively planned for intramedullary nailing fixation. It was a single centre, prospective randomized control double blind study, acute closed single plane fracture of lower limb like tibia shaft fracture, femur shaft fracture and intertrochanteric fracture electively posted for intramedullary nailing fixation were included. Total of 168 fractures, 38 intertrochanteric fractures (22.61%), 52 femur shaft fractures (30.95%), 78 tibia shaft fractures (46.42%) were electively planned for nailing fixation with intra-operative image guidance. Mean age was 42 which was statistically significant. Males were more than females, (89 male 52.97% and 79 female 47.02%) observed to be statistically not significant. Right lower limb 90 (53.57%) was observed to be more injured than the left lower limb 78(46.42%) which was statistically not significant (p&lt;0.56). Mean imaging for intramedullary fixation in intertrochanteric fractures was 75 (17.30%) , femur 120 (37.76%) and tibia 95 (44.93%) was observed to be statistically significant. Radiation in orthopaedic surgeries can be otherwise and also be utilized by operating primary trauma surgeon with focus on average number of imaging for the elective nailing procedure as a self-monitoring tool for skill improvement with reproducible potential, radiation minimisation, call for help and technical improvisation for the future years, besides its occupational ill effects.

Comminuted fracture shaft of the femur is a common entity faced by orthopaedic surgeon. Road traffic accidents are the majorcause of these comminuted fractures. But with increase in violence, gun shots are also causing these fractures frequently. Objectives: To seeand compare the result of intramedullary interlocking nailing and biological plating in terms of infection rate, union rate and to assess the othercomplications. Design: Prospective study Setting: Department of Orthopedic Surgery Allied Hospital Faisalabad. Period: From Sept 2001 toSept 2003. Patients &amp; M e t h o d s : Forty comminuted fractures of femur were managed .twenty by bridge plating and twenty by interlockingnailing. Results: Results were compared with reference to healing time, infection rate, operating time and hospital stay and was comparableto other studies. Conclusions: Closed interlocked intra-medullary nailing is an excellent method for treating comminuted femoral shaft fracture.But requires expensive equipment and more expertise. Bridge plating require no special instrumentations and can be done at periphery withless facilities available.

Aeromonas hydrophilia can cause soft tissue infection in both immunocompromised and healthy persons. A healthy 15-year-old adolescent fell into a ditch after a scooter accident and sustained a right distal tibial shaft closed fracture, a right femoral shaft closed fracture, and a dirty laceration over the medial aspect of the distal thigh above the right knee. After empiric antibiotics and radical debridement of the contaminated wound, a femoral interlocking nail and tibial external fixator were applied. However, acute osteomyelitis later presented in his femur and tibia, and Aeromonas hydrophilia grew in cultures from the knee wound and the fracture sites. During the follow-up, his tibia became an infected nonunion, and was successfully treated with the induced membrane technique. In an otherwise healthy patient with a closed fracture, Aeromonas hydrophilia can cause acute osteomyelitis and necrotizing fasciitis by spreading from a nearby contaminated wound. Exposure to water is a risk factor for Aeromonas hydrophilia infection.

Background: Fracture is a discontinuity of bone which is often followed by damage to the surrounding soft tissue, such as blood vessels, muscles, and nerves. World health organization (WHO) stated that there are 5.6 million people died due to fractures and 1.3 million people suffering fractures due to traffic accidents in 2011-2012. One of the most common fractures on lower extremities due to severe trauma is femur fracture. Femur fracture is usually caused by trauma due to pressure that exceeds the capacity of the femur. Femur fracture today is still common and remains one of the major challenges for orthopaedists. Although management in orthopaedic had been growing rapidly, the one-year mortality rate post-trauma is still high, about 10-20%. This study aims to determine the characteristic of femur fracture patients at Sanjiwani hospital Gianyar in 2019.Methods: This study is a retrospective descriptive study that aims to identify the characteristic of femur fracture patients at Sanjiwani hospital Gianyar in 2019. The samples of this study were collected using total sampling technique. The data was obtained from medical record of patients diagnosed with femur fracture at Sanjiwani hospital Gianyar during January-December 2019. Variables in this study including age, sex, cause of femur fractures, type of fractures, and location of the fractures. All obtained data will be analysed using SPSS statistics 22 software.Results The result of this study showed that most of samples are male with 26 peoples (61.9%) and age group is 21-30 years old is the most common age group with 11 peoples (26.2%). Close fracture is the most common fracture type with 38 peoples (90.5%) and located in the middle shaft of femur with 20 peoples (47.6%).Conclusions: In conclusion, the most common characteristic of femur fracture patients at Sanjiwani hospital Gianyar in 2019 is male, age 21-30 years old, closed fracture and located in the middle shaft of the femur.

Introduction: Femoral shaft fractures are common in children, with intramedullary nailing being the "gold standard" due to its short hospital stay, fast fracture union, and early functional use. Submuscular plating is an alternative, but the choice for adolescents remains unclear. Herein, we systematically review the union rates after submuscular plate or Intramedullary elastic nail treatment to treat closed fracture middle shaft femur and the other clinical outcomes of these methods. Methods: We conducted clinical data searches in PubMed, ScienceDirect, and ResearchGate. The studies included were RCT or cohort studies that assessed the outcomes of intramedullary nailing and submuscular plating in treating adolescent femur fractures with limitation studies published during the years 2008-2023 and using English as its language. Results: Nine studies of 390 cases were included in this review, consisting of 155 cases treated with submuscular plating and 235 with intramedullary nailing. The average time of bone union in 155 patients was 2.71 months, while 235 cases had a faster union time, with an average of 2.37 months. The other complications reviewed were malunion, nonunion, delayed union, length-leg discrepancy, coronal angular deformity, sagittal angular deformity, decreased ROM, implant prominence, implant failure, and reoperation rates. Conclusion: This study found that intramedullary nailing and submuscular plating are safe, feasible, and successful treatments for adolescent femur shaft fractures. Submuscular plating was more effective than ESIN but had a higher risk of complications. Future clinical trials should compare outcomes with a more specific population. Keywords: adolescent, intramedullary nailing, midshaft femur fracture, submuscular plating

This is a case report of a 4-year-old girl who sustained a femoral shaft fracture 2 weeks after radiofrequency ablation of an osteoid osteoma. The fracture occurred after a relatively low-energy impact, jumping off the second to last step of a staircase. The pathologic fracture was successfully treated with closed reduction and spica casting, with full return to activities. Cases have been reported in the literature of femoral shaft fractures in older patients after radiofrequency ablation, but all are farther out than 2 weeks and none in patients as young as 4 years.

Pediatric femoral fractures is a topical issue of modern pediatric traumatology. They are among the most common fractures of long bones and are the most common orthopaedic injury requiring hospitalization. Treatment of femur fractures in children vary on the basis of the mechanism of injury, the patient’s age, weight, the fracture pattern, family circumstances, and cost. Non-operative management plays a role in some cases but operative fixation as it allows early mobilisation and shorter hospital stays. Purpose – to analyze our experience in surgical treatment pediatric femoral shaft fractures with different methods, early and late complication. Materials and methods. For the period from 2008 to 2019, 148 children with acute femur shaft fractures were treated in our department, pathological fractures were exclude. They were divided according to surgical approach into 4 groups: elastic intramedullary nail (ESIN) – 109 patients (113 femurs), intramedullary locking nail (IMN) – 27 patients (27 femurs), external fixator – 8 patients (8 femurs), and plating – 4 (4 femurs). Comparisons were made between 2 groups: intramedullary nailing with closed reduction (124 femurs) and open reduction (16 femurs), of which 102 male and 38 female; aged of patients was 6–17 years. Hospitalization time of – up to 24 hours – 92 (63 boys, 29 girls), 1–7 days – 56 (39 boys, 17 girls). The indication for the use of flexible intramedullary rods was the age of children under 14 years of age with a weight of no more than 50 kg; in children of the older age group, an intramedullary blocked rod with an insertion point through the apex of the greater trochanter was used. Results. Flexible intramedullary nailing was used in 109 (74%) by standard retrograde technique 102 patients (106 femurs) and antegrade technique 7 patients (7 femurs), closed reduction was done in 121 patients (124 femur), open reduction in 15 patients (16 femurs). A blocking intramedullary rod was used in 27 children of the older age group, which amounted to 18%. Aseptic necrosis of the femoral head or changes in the proximal femur was not observed in any patient. There were only 4 (3%) children in the plating group, one case had refracture, 2 cases had infection. In all patients, except one with polytrauma, complete consolidation of the fracture was observed. The duration of the operation, the time of stay in the hospital, the amount of blood loss and postoperative pain were significantly lower in the group with closed reduction technique than in the group where the open reduction of the fragments was used. The dependence of the results of treatment and the beginning of the axial load on the affected limb on the duration of surgery was not found. Most common early complication was soft tissue irritation at the nail entry site (32 patients – 18 boys, 14 girls). Varus deformity of the femur was observed in 9 children (5 boys, 4 girls), in one patient this deformity was combined with limb shortening, valgus deformity was found in 3 patients (2 boys, 1 girl), rotational deformity in 2 patients (2 girls). According to Flynn’s criteria, only 2 patients had a poor result. Conclusions. Titanium elastic nailing is a relatively simple, minimally invasive method of surgical treatment of fractures of the shaft femur in children and adolescents with high rates of good and excellent results. For children of the older age group use of an intramedullary blocked nail is a safe procedure without the development of any changes in the proximal femur. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: femur shaft fracture, elastic intramedullary nail, swivel rod, surgical treatment.

Background: Femoral shaft fracture is the most common major paediatric orthopaedic. For generations traction and casting was the standard treatment for all femoral shaft fractures in children. Over the past two decades the advantages of fixation and rapid mobilisation have been increasingly recognised. Methods: A prospective study was conducted in five private hospitals in the district of Bankura, West Bengal over a period of two years (April 2010 to March 2012) on 70 patients with closed shaft femur fractures between 6- 14 years age of either sex. The aim was to find out the short term complications of titanium elastic nailing in diaphyseal fracture of femur in children and compare the findings of this study with pre- existing studies in this field. Results: In our study the most common complication was pain at nail entry site (60%). 5.71% had local inflammatory reaction due to nails. Superficial infection occurred in 2.85%. At the end of 1 year, 2.85% had limb length discripancies. Proximal migration occurred in 2.85%. 2.85% encountered acute reactive synovitis, 5.71% developed angulation of fracture site and 2.85% developed per operative breakage of nail. Conclusion: The treatment of paediatric shaft femur fracture has been drastically changed over the last two decades to internal fixation by elastically stable intra- medullary nail (ESIN). In our study, we encountered only a few complications most of them being minor. Most of the complications were surgical technique related and were seen at the initial phase of the learning curve.

Introduction. Wakeboarding is an extreme sport that has shown increasing popularity in recent years, with an estimated 2.9 million participants in 2017. Due to this trend, injuries related to this sport are likely to become more common. Isolated femoral shaft are rare; however, they occur much more frequently in youth as a result of high velocity events, such as dashboard-related injuries. Few studies have addressed injuries related to wakeboarding, and of those that have, most have reported on muscle injuries, ligament ruptures, and sprains. Due to the dearth in literature, we want to present two cases of isolated noncontact femoral shaft fractures that resulted from wakeboarding. Case Presentation. Two 28-year-old, otherwise healthy, wakeboarders—patient A, male, and patient B, female—presented to our Department of Orthopaedics and Sports Medicine with isolated femoral shaft fractures. Both were admitted due to wakeboard-related noncontact injuries, where patient A fell while performing a sit-down start during cable wakeboarding and patient B after attempting a wake-jump. Both patients were being pulled by motorboats at roughly 40 km/h. After clinical examination and radiography, left spiral (AO classification: 32-A1.2) (patient A) and right-sided bending, wedge (AO classification 32-B2.2) (patient B) isolated femoral shaft fractures were diagnosed. No concomitant injuries were reported. For treatment, long reamed locked nails were applied, while the patients were under spinal anaesthesia. Physiotherapy was prescribed postoperatively. Patient A returned to wakeboarding 155 days after the surgery, and patient B returned after approximately half a year. Conclusion. This case series shows that even in noncontact sports such as wakeboarding, high-energy forces applied to the femur can cause isolated femoral shaft fractures. Despite multiple reports in various sports of stress fractures of the femur, there are few publications of direct trauma.

Introduction: Pediatric femoral shaft fracture is commonest fracture in children. Surgical management of pediatric femur fracture has widened using intramedullary nail, dynamic compression plate and external fixator which have their own merits and demerits. Flexible Intramedullary nailing in the form of titanium elastic nail is one of the best surgical modalities. This technique is considered to be ideal and effective method with least complications and has become increasingly popular in children. The aim of the study was to assess outcome of titanium elastic nail for treatment of femur fracture in children of age group 5-11 years. MATERIALS AND METHODS: Prospective interventional study was conducted in NMCTH, Birgunj among 35 children of age group 5-11 years who presented with shaft of femur fracture at least 3 cm distal to lesser trochanter and 3cm proximal to distal physis, closed or open fracture with Gustilo Anderson type I and II. Ethical approval was obtained from institutional review committee and proper informed consent was taken. The patients were treated with titanium elastic nail and followed up at 2 weeks, 4 weeks and 6 weeks and then every month till the radiological union was achieved. Data obtained were analyzed in SPSS version 26.0. Flynn criteria was used for final functional outcome. RESULT: Out of the total 35 cases, the mean age of the patient was 7.71 ± 1.75 years. Majority of the patients 16(45.7%) were of age group 7-9 years. Most of them 24(68.6%) were male whereas 11(21.4%) were female. The study findings showed that more than half 18(51.4%) patients sustained injury due to road traffic accident. Almost equal number of patients had fracture of left side 18(51.4%) and right side 17(48.6%). Majority of the patients 33(94.3%) had closed fracture and transverse fracture 13(37.1%). The mean time taken for surgery was 69.43 minutes ± 14.33 and mean duration of hospital stay was 6.46 days ± 1.01. Majority of them (85.7%) did partial weight bearing crutch walking on 2nd week and (88.6%) did full weight bearing on 6th week. The mean time for radiological union was 10.40 weeks ± 0.81. Fylnn criteria was used to assess outcome of the treatment, according to which, majority 33(94.30%) reported excellent result and only 2(5.7%) cases reported successful result. Regarding complications, there were no major complications reported, 1(2.9%) case of nail protrusion due to long nail and in 1(2.9%) case superficial infection at nail insertion site which was treated with antibiotic. CONCLUSION: Titanium elastic nail used for treatment of femur fracture in children of 5-11 years is an acceptable and safest option with minimal complications. Key words: Paediatrics Shaft of femur fracture, Titanium elastic nail system (TENS), Flexible intramedullary nail, Flynn criteria.

Objective: Aim of current study is to compare the outcomes between closed vs open interlocking nail among patients had femur shaft fracture. Study Design:Retrospective cohort study Place and Duration:Orthopedics department of Mardan Medical Complex and Muhammad Medical College and Hospital, Mirpurkhas during the period from 16th June 2020 to 15th July 2021. Methods:One hundred and twenty eight patients with ages 25-70 years were included in this study. All the patients had femoral shaft fracture. Patients’ age, sex, body mass index and cause of fracture was calculated after taking informed written consent. Included patients were equally divided in two groups. Group O received open interlocking nail and closed interlocking nail technique was used in group P group. Post-operatively radiological and surgical outcomes among both groups were assessed and compared in terms of union, non-union and delayed union. Prevalence of infection among both groups was also calculated. Flynn’s criteria were used to assessfunctional outcomes. We used SPSS 23.0 edition to analyze all of the data. Results:Majority of the cases were males 80 (62.5%) and 48 (37.5%) were females. There was no any significantly difference among both groups related to age and body mass index. High impact of collision was the most common cause found in 75 (58.6%) followed by RTA 35 (27.3%) and fall found in 18 (14.1%) cases. Mean duration of surgery in group O was 92.34±5.23 minutes and in group P was 62.12±3.33 minutes. Mean union time in closed group was lower 19.14±5.45 weeks as compared to open group 28.7±6.19 weeks. Frequency of union in group P was higher among 64 (96.9%) as compared to group O 52 (81.3%) cases. Delayed union in group O found among 14 (21.9%) cases and in group P was among 7 (10.9%) cases. According to Flynn’s criteria, closed interlocking nail showed significantly excellent and good results with pp value &lt;0.05 as compared to open technique. Rate of complications were also lower in closed group with p value &lt;0.05. Conclusion: In this research we concluded that closed interlocking nail for femur shaft was effective and useful as compared to open interlocking nail in terms of good radiological and functional outcomes. Except this, post-operative complications were also noticed lower in patients who received closed interlocking nail. Keywords:Closed/Open interlocking nail, Surgery, Femur Shaft, Outcomes, Complications

Objective: To compare the effects of closed and open techniques with its associated complications used for the management of distal femoral fracture in younger to older populations. Methodology: This was a case series study conducted in the Department of Orthopaedic Surgery, Pakistan Institute of Medical Sciences (PIMS), Islamabad from Sept 2018- March 2019. A total of 66 adult patients were stratified according to treatment technique; closed technique group and open technique group with 33 patients in each group between age 18 - 65 years with fractured close distal 1/3rd shaft of femur distal femur fractures based on AO/OTA classification were included in the study. The Chi-square test was applied to contrast outcomes of closed and open technique and HSS score categories in both procedures. Results: The study findings showed that the mean age of the patient was slightly greater in the open technique group (41.5 + 23.5 years) compared to the closed technique (29.8 + 11.8 years). Most of the patients had type A femur fracture. The postoperative mean HSS knee score was 70.1 + 15.1 in the open technique group compared to 74.5 + 12.5 in the closed technique group with an insignificant difference between the two means (p&lt;0.949). An insignificant difference was observed in postoperative infection, non-union, and implant failure between both groups. Conclusion: This study concluded that superior outcomes such as bony union without infection were achieved in patients with femur fractures treated with closed technique as compared to open technique, although the findings were statistically insignificant. Moreover, the functional outcome of the knee joint was also distinctly improved in the closed technique. Keywords: Distal femur fracture, retrograde intramedullary femoral nail, locking compression plate, complications

Objectives: In non-operative methods, hip spica casting is a gold standard for children under six years of age because of excellent bone union and remodeling qualities. The study was conducted to determine the frequency of limb shortening in femur shaft fractures in children treated by hip spica casting. Study Design: Descriptive cross sectional study. Setting: Orthopedics Department of Combined Military Hospital, Rawalakot, Pakistan. Period: One year from July, 2016 to June, 2017. Material and Methods: After approval of the study from institution’s ethical committee, all patients fulfilling the inclusion criteria were admitted through emergency or outpatient department for hip spica casting. It was descriptive cross sectional study and sampling was done by non-probability convenience sampling in 107 femur fracture patients treated by hip spica casting. Diagnosis of the fracture was based upon history of trauma with break in the continuity of shaft as seen by X-ray. Informed consent was obtained from parents/guardian to be included in the study. Results: The mean age was 5(± 2.04) years. Sixty eight percent patients were male and 32% were female. Sixty three percent patients had proximal femoral shaft fracture, 32% had middle femoral shaft fracture and 4% patients had distal femoral shaft fracture. The shortening of limb length was found in14% of patients. Conclusion: In closed femoral shaft fractures, hip spica casting is a safe treatment in children. It has a low risk of complications. We recommend its use except for open fractures, multiple fractures, or fractures in older children.

A 49-year-old man was involved in a high-energy motor vehicle accident. Haemodynamic instability with multiple long bone fractures of lower limbs was the hallmarks of the injury. Closed fragmented fracture of left femur shaft and open displaced supracondylar fracture of the contralateral femur. Closed comminuted high-grade fracture of the Tibia plateau (Schatzker VI) was diagnosed bilaterally. ‘Orthopaedic damage control’ was initiated with bilateral ‘cross knee’ external fixation, followed by conversion to open reduction internal fixation of all fracture sits at 8 days later. The patient underwent nine subsequent hospitalisations, of which eight involved operative treatment. The interval from admission to last documented surgery was 7 years. The endpoint was total knee arthroplasty (TKA) with mega prosthesis of the left knee and a primary-type TKA in the right knee. Both arthroplasties were non-assisted, conventional procedures. Postoperative Western Onterio and McMaster Universities Arthritis Index (WOMAC) score was 85 at 9-year follow-up from the injury incurred.