Journal articles: 'Subtrochanteric hip fracture'

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Amanatullah, Derek F., Randall Farac, Thomas J. McDonald, H. David Moehring, and Paul E. Di Cesare. "Subtrochanteric Fracture following Removal of a Porous Tantalum Implant." Case Reports in Orthopedics 2013 (2013): 1–4. http://dx.doi.org/10.1155/2013/946745.

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Osteonecrosis of the hip accounts for about 10% of all total hip arthroplasty cases and presents a significant challenge for those patients with and without femoral head collapse. Subtrochanteric femur fractures have been reported with numerous types of proximal femoral implants. Care must be taken to avoid penetrating the lateral cortex of the proximal femur inferior to the distal border of the lesser trochanter. Core decompression requires a 3 mm to 20 mm defect in the lateral femoral cortex. Subtrochanteric femur fractures are a well-known complication of core decompression as well. We present a case of a subtrochanteric fracture following the removal of a porous tantalum implant.

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Gowda, Pradyumna R., and Manjunath J. "A prospective comparative study in the clinical outcome of trochanteric and subtrochanteric fracture femur with proximal femoral nail versus dynamic hip screw." International Journal of Research in Orthopaedics 3, no. 5 (August 24, 2017): 986. http://dx.doi.org/10.18203/issn.2455-4510.intjresorthop20173118.

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Background: Trochanteric fractures are the most common fractures encountered accounting for 50% of all hip fractures. Subtrochanteric femur fractures have high rate of complications associated with their management. 10%–34% of all hip fractures occur in the subtrochanteric region.The study was to compare the clinical outcome of trochanteric and subtrochanteric fracture femur with proximal femoral nail (PFN) versus dynamic hip screw (DHS).Methods: A prospective study of 50 patients with intertrochanteric and subtrochanteric fracture among which 30 were treated with Proximal Femoral Nail and 20 with Dynamic Hip Screw at SSIMS-SPARSH Davangere, Karnataka, India between June 2015 to November 2016. At final follow up results were assessed with Modified Harris Hip score.Results: Among the PFN Intertrochanteric fracture group, 9 patients showed excellent outcome, 6 patients showed good outcome and 2 patients showed fair outcome and 1 patient showed poor outcome. Among the PFN subtrochanteric fracture group, 7 patients showed excellent outcome, 3 patients showed good outcome and 1 patients showed fair outcome and 1 patient showed poor outcome. Among the DHS intertrochanteric fracture group, 3 patients showed excellent outcome, 3 patients showed good outcome and 2 patients showed fair outcome and 2 patient showed poor outcome. Among the DHS subtrochanteric fracture group, 1 patients showed excellent outcome, 2 patients showed good outcome and 3 patients showed fair outcome and 4 patient showed poor outcome. Conclusions: Fractures of the trochanteric region of the femur need a proper selection of implant based on fracture pattern. DHS has excellent results when used on stable fractures. For unstable fractures, PFN is the implant of choice. In case of subtrochanteric fractures PFN has better results in both stable and unstable fractures compared to DHS with less failure rates and restoring better hip biomechanics.

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Castagnini, Francesco, Giovanni Bracci, Enrico Tassinari, and Federico Biondi. "Cementless Total Hip Arthroplasty After an Iatrogenic Subtrochanteric Fracture due to Hardware Removal: A Case Report." Hospital Practices and Research 4, no. 3 (August 26, 2019): 105–6. http://dx.doi.org/10.15171/hpr.2019.21.

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Introduction: Total hip arthroplasty (THA) after proximal femoral fixation is a challenging procedure due to possible hardware-related complications. Case presentation: A 78-year-old female with hip osteoarthritis had a proximal femoral osteotomy fixed using a blade plate in the same femur 41 years ago. A two-step approach was planned. After a challenging hardware removal, an iatrogenic subtrochanteric fracture below the degenerated hip occurred after three months. THA with a tapered long stem was successfully performed with no need for additional osteosynthesis, and good results were seen two years later. Discussion: THAs in subtrochanteric fractures are technically demanding but feasible in selected cases. Hardware removal before THA implantation may carry important risks, and the surgical team should be prepared to perform arthroplasty in case of complications. Conclusion: THA in a subtrochanteric fracture below hip osteoarthritis is a feasible option in selected cases.

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Lee, Y. K., T. Y. Kim, Y. C. Ha, S. H. Song, J. W. Kim, H. C. Shon, J. S. Chang, and K. H. Koo. "Atypical subtrochanteric fractures in Korean hip fracture study." Osteoporosis International 28, no. 10 (June 14, 2017): 2853–58. http://dx.doi.org/10.1007/s00198-017-4112-2.

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Samy, Tarek M., Tarek M. Khalil, Maged Abouelsoud, Amr Abdelrahman, and Mohamed B. Elghonimy. "Fracture Cascade in Patients with End-Stage Renal Disease: Complications and Outcome." Case Reports in Orthopedic Research 1, no. 1-3 (December 5, 2018): 55–61. http://dx.doi.org/10.1159/000495148.

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We report a 68-year-old end-stage renal disease female patient on dialysis for 15 years. She sustained consecutive fractures starting with left-sided femoral neck fracture, followed 16 months later by a right-sided one. On her recovery from her right hip injury she sustained a stress type subtrochanteric fracture at the entry site of the fixation implants and an ipsilateral humeral shaft fracture. Cementless total hip replacement was done for the left femoral neck, and osteosynthesis was done for her undisplaced right femoral neck fracture. Revision fixation was done for her right subtrochanteric fracture with a long Gamma nail that was statically locked. The humeral fracture was fixed with an interlocking nail in a closed manner. This case highlights the fact that sequential hip fractures is an ominous event which is likely to be followed by a quick cascade of bone injuries with trivial trauma and a high rate of unexpected complications. Our treatment approach is explained here, stressing the unexpected complications and challenges met.

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Babcock, Sharon, and James F. Kellam. "Hip Fracture Nonunions: Diagnosis, Treatment, and Special Considerations in Elderly Patients." Advances in Orthopedics 2018 (November 25, 2018): 1–11. http://dx.doi.org/10.1155/2018/1912762.

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In the United States, more than 300,000 hip fractures occur annually in the elderly population with associated significant morbidity and mortality. Both intracapsular and extracapsular hip fractures have inherent treatment challenges and therefore are at risk of nonunion complications. A systematic assessment including radiographic, metabolic, and infectious evaluations should be completed for all patients suspected of nonunion. Failed internal fixation of intracapsular hip fractures is typically treated with arthroplasty, while extracapsular proximal femur nonunions may be amenable to revision internal fixation or arthroplasty. While not a classic hip fracture, bisphosphate associated subtrochanteric femur fractures affect a similar patient population and are historically difficult to treat. Atypical subtrochanteric femur fractures are at increased risk of nonunion given the altered biologic environment secondary to bisphosphonate use; therefore adjuvant therapies may be beneficial in setting of revision fixation. Having a thorough understanding of nonunion risks, recognition, evaluation, and treatment is necessary for appropriate patient care.

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Macdonald, J., A. Robinson, and I. Brown. "Fixation of a Periprosthetic Intertrochanteric Hip Fracture below a Birmingham Hip Resurfacing." Case Reports in Orthopedics 2014 (2014): 1–6. http://dx.doi.org/10.1155/2014/393984.

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This case report involves a 56-year-old female (Mrs X) with a traumatic intertrochanteric hip fracture with subtrochanteric extension below a previous Birmingham hip resurfacing. Periprosthetic fractures following hip resurfacing are usually subcapital and treated with a revision or conservative management. We present an unusual surgical problem with an interesting solution stabilising the fracture using a proximal femoral locking compression plate (LCP). Eight months following surgery the patient is able to walk pain free and there is good fixation and stability.

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Hossain, Md Mobarak, Fazlul Haque Qasem, Quazi Shahidul Alam, and MTI Noman. "Evaluation of the Outcome of Proximal Femoral Locking Compression Plate for the Treatment of Comminuted Trochanteric and Subtrochanteric Femoral Fractures in Lateral Decubitus Approach without Peroperative Image Intensifier." Journal of Dhaka Medical College 23, no. 2 (October 23, 2015): 179–85. http://dx.doi.org/10.3329/jdmc.v23i2.25387.

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Introduction: The Comminuted trochanteric and subtrochanteric femoral fractures are considered as one of the most difficult fractures to treat in the orthopaedic surgery and they associated with high incidence of nonunion, malunion. Various implants, both intramedullary and extramedullary, are available for their fixation.Objective: To assess the success rate of proximal femoral locking compression plate osteosynthesis in comminuted trochanteric and subtrochanteric femoral fracture in lateral decubitus approach without per operative image intensifier.Method: 20 consecutive patients with comminuted Trochanteric and subtrochanteric fractures were operated upon with PF-LCP. Detailed clinical conditions of all patients, duration of operation, technical difficulty with the implant, hospital stay period were recorded. Patients were visited at 6 weeks interval till union then 3 monthly. The Harris Hip Score was used to document hip function at final follow-up.Result: There were fifteen excellent (75%), two good (10%), two fair (10%) and one poor (5%) results according to Harris hip score. No instance of implant failure was recorded.Conclusion: Fixation of comminuted subtrochanteric fractures with PF-LCP in lateral decubitus approach without per operative image intensifier provides stable fixation with high union rate and fewer complications.J Dhaka Medical College, Vol. 23, No.2, October, 2014, Page 179-185

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Yuasa, Takahito, Koichi Maeda, Kazuo Kaneko, and Kazunori Yoshikata. "Total Hip Arthroplasty after Treatment of an Atypical Subtrochanteric Femoral Fracture in a Patient with Pycnodysostosis." Case Reports in Orthopedics 2015 (2015): 1–4. http://dx.doi.org/10.1155/2015/731910.

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The authors describe the case of a 51-year-old woman with an osteonecrosis of her right femoral head after treatment of an atypical subtrochanteric fracture caused by pycnodysostosis. She had this fracture after a low-trauma fall. She was of short stature with typical facial features, short stubby hands, and radiological features including open cranial sutures, obtuse mandible, and generalized skeletal sclerosis. The majority of cases of atypical subtrochanteric fractures are associated with long-term use of bisphosphonates; some occur in bisphosphonate-free patients. We report a rare case of total hip arthroplasty (THA) in a patient with pycnodysostosis who developed an osteonecrosis of the femoral head after treatment of an atypical subtrochanteric femoral fracture. We performed cementless THA in combination with a plate and cables. Cementless THA is a potential intervention in a patient with pycnodysostosis; although the bone quality may have been sclerotic, healing is not a problem in this condition.

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Kim, S. M., K. H. Rhyu, and S. J. Lim. "Salvage of failed osteosynthesis for an atypical subtrochanteric femoral fracture associated with long-term bisphosphonate treatment using a 95° angled blade plate." Bone & Joint Journal 100-B, no. 11 (November 2018): 1511–17. http://dx.doi.org/10.1302/0301-620x.100b11.bjj-2018-0306.r1.

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Aims The aim of this study was to evaluate the outcomes of a salvage procedure using a 95° angled blade plate for failed osteosynthesis of atypical subtrochanteric femoral fractures associated with the long-term use of bisphosphonates. These were compared with those for failed osteosynthesis of subtrochanteric fractures not associated with bisphosphonate treatment. Patients and Methods Between October 2008 and July 2016, 14 patients with failed osteosynthesis of an atypical subtrochanteric femoral fracture were treated with a blade plate (atypical group). Their mean age was 67.8 years (60 to 74); all were female. During the same period, 21 patients with failed osteosynthesis of a typical subtrochanteric fracture underwent restabilization using a blade plate (typical group). Outcome variables included the time of union, postoperative complications, Harris Hip Score, and Sanders functional rating scale. Results In the atypical group, union was achieved in 12 patients (85.7%) at a mean of 8.4 months (4 to 12). The mean follow-up was 31.2 months (12 to 92) The plate broke in one patient requiring further stabilization with a longer plate and strut-allograft. Another patient with failure of fixation and varus angulation at the fracture site declined further surgery. In the typical group, union was achieved in 18 patients (85.7%) at a mean of 7.9 months (4 to 12). There was no difference in the mean Harris Hip Score between the two groups (83.1 points vs 86.8 points; p = 0.522) at the time of final follow-up. Sanders functional rating scores were good or excellent in 78.6% of the atypical group and in 81.0% of the typical group. Conclusion The 95° angled blade plate was shown to be an effective fixation modality for nonunion of atypical subtrochanteric fractures with a high rate of union and functional improvement, comparable to those after fractures not associated with bisphosphonate treatment. Cite this article: Bone Joint J 2018;100-B:1511–17.

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Huang, S. Y., C. D. Grimsrud, J. Provus, M. Hararah, M. Chandra, B. Ettinger, and J. C. Lo. "The impact of subtrochanteric fracture criteria on hip fracture classification." Osteoporosis International 23, no. 2 (May 12, 2011): 743–50. http://dx.doi.org/10.1007/s00198-011-1622-1.

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Mahajan, Neetin P., Pranay Kondewar, Lalkar Gadod, Amey Sadar, and Shubham Atal. "A case of subtrochanteric femur fracture nonunion with failed implant in situ treated with exchange nailing using interlock nail and autologous bone grafting: a case report." International Journal of Research in Orthopaedics 7, no. 4 (June 23, 2021): 864. http://dx.doi.org/10.18203/issn.2455-4510.intjresorthop20212438.

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Subtrochanteric femur fracture accounts for 25% of all hip fracture and may land up in non-union due to the inadequate reduction and fixation tech, local muscle pull over fragments, biomechanical stress in subtrochanteric region and soft tissue interposition etc., non-union are managed with various choices of implants like exchange nailing , angle blade plate , dynamic condylar screw, augmentation of previous hardware with plate and by providing biological environments at fracture site using bone graft. Strict adherence to principles of providing stability to fracture and providing environment for bony growth gives good clinical outcome. A 52 years old male with subtrochanteric femur fracture was operated with long PFN, later presented to us after 18 months with failure of the hardware and atrophic non-union manifesting as pain during walking and limping. Patient was operated with removal of implant and exchange nailing using femur interlock nail and autologous bone grafting from iliac crest graft. 1 year follow up showed complete bony union and abundant of callus formation. Patient is currently doing all the daily activities and have no complaints at present. At 1 year follow up there is complete union at non-union site and good clinical outcome is achieved. Exchange nailing with interlock nail and autologous bone grafting for treatment of atrophic non-union of subtrochanteric femur fractures gives good clinical outcome.

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Yuasa, Takahito, Katsuhiko Maezawa, Yu Taniguchi, Kentaro Aritomi, and Kazuo Kaneko. "Atypical Subtrochanteric Femoral Fracture Below an Arthritic Hip." JBJS Case Connector 5, no. 1 (January 14, 2015): e1. http://dx.doi.org/10.2106/jbjs.cc.n.00030.

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Ceder, L. "(iii) The difficult extracapsular hip fracture (including subtrochanteric)." Current Orthopaedics 14, no. 2 (March 2000): 93–101. http://dx.doi.org/10.1054/cuor.2000.0094.

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Tani, Takayuki, Hiroaki Kijima, Natsuo Konishi, Hitoshi Kubota, Shin Yamada, Hiroshi Tazawa, Norio Suzuki, et al. "Incidence and Clinical Outcomes of Hip Fractures Involving Both the Subcapital Area and the Trochanteric or Subtrochanteric Area." Advances in Orthopedics 2019 (April 4, 2019): 1–4. http://dx.doi.org/10.1155/2019/1628683.

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Purpose. Proximal femoral fractures involving both the subcapital area and the trochanteric or subtrochanteric area have rarely been reported, but they are not uncommon. However, few studies have reported the incidence or clinical outcomes of such fractures. This study investigated such fractures.Methods. In area classification, the proximal femur is divided into 4 areas by 3 boundary planes: the first plane is the center of femoral neck; the second plane is the border between femoral neck and femoral trochanter; and the third plane links the inferior borders of greater and lesser trochanters. A fracture only in the first area is classified as a Type 1 fracture; one in the first and second areas is classified as a Type 1-2 fracture. Therefore, proximal femoral fractures involving both the subcapital area and the trochanteric area are classified as Type 1-2-3, and those involving both the subcapital area and the subtrochanteric area are classified as Type 1-2-3-4. In this study, a total of 1042 femoral proximal fractures were classified by area classification, and the treatment methods and the failure rates were investigated only for Types 1-2-3 and 1-2-3-4 cases. The failure rate was defined as the incidence of internal fixator cut-out or telescoping >10 mm.Results. Types 1-2-3 and 1-2-3-4 fractures accounted for 1.72%. Surgical treatment was performed for 89%. Of these, 56% underwent osteosynthesis, but the failure rate was 33%. The other patients (44%) underwent prosthetic replacement. Fracture lines of all these fractures were present along trochanteric fossa to intertrochanteric fossa in posterior aspect and just below the femoral head in anterior aspect.Conclusion. Fracture involving the subcapital area to the trochanteric or subtrochanteric area was found in approximately 2%. In patients for whom prosthetic replacement was selected, good results were obtained. However, 1/3 of patients who underwent osteosynthesis had poor results.

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Sharma, Rohit, Sahil Singla, Rajan Sharma, Ranbir S. Bawa, Arshpreet Singh, Navpreet S. Sidhu, Satinderpal K. Satti, and Arshpreet S. Dhillon. "Subtrochanteric Femur Fracture in Neonates: A Rare Complication after Breech Presentation." Journal of Orthopedics and Joint Surgery 2, no. 2 (2020): 79–81. http://dx.doi.org/10.5005/jp-journals-10079-1028.

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ABSTRACT Fetus born in breech presentation are commonly delivered via cesarean section which is necessary to prevent trauma, and this extraction by operative maneuver can rarely lead to trauma and may result in femur fracture. But delivery of breech via vaginal route leads to various complications such as fractures. Femur fracture although being relatively a rare complication one of the most common fractures of the lower extremity presenting in newly born babies. In our case, 39-week mature fetus with weight 3,300 g breech presentation delivered by cesarean section presented with subtrochanteric femur fracture left side. A complete healing of the fracture, without any sequelae, was noted when the patient was simply immobilized with hip in flexion, abduction, and external rotation. The possibility of accidental injuries and traumatic complications are significantly reduced in cesarean section, especially in breech delivery when compared with vaginal delivery, but it does not completely eliminate the possible birth injuries and thus fractures of the newborn. So, clinicians must check for fractures even after cesarean section in breech presentation. How to cite this article: Singla S, Sharma R, Sharma R, et al. Subtrochanteric Femur Fracture in Neonates: A Rare Complication after Breech Presentation. J Orth Joint Surg 2020;2(2):79–81.

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Pop, Dan Vasile, Cristina Vlad Daliborca, Daniela Radu, Dinu Vermesan, Bogdan Deleanu, Ahmed Abu Awwad, and Adrian Todor. "Lymphocyte and Neutrophil to Lymphocyte Ratio do not Predict Mortality in Hip Fracture Patients." Revista de Chimie 70, no. 8 (September 15, 2019): 2854–56. http://dx.doi.org/10.37358/rc.19.8.7442.

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Our study aimed to assess whether admission hemoglobin, lymphocyte count and neutrophil to lymphocyte ratio (N/R) can predict 1-year survival in patients with hip fractures. In the study, data from 54 patients with femoral neck fractures, 119 with trochanteric fractures respectively 24 with subtrochanteric fractures was analyzed. All the included patients were older than 55 years and were followed up to 2 years or until the decease occurred. The following parameters were recorded in patients with femoral neck, trochanteric respectively subtrochanteric fractures: average age: 76; 79.7 respectively 73.3 years; male to female ratio: 1:2.86; 1:3.1 respectively 1:2; average hemoglobin at admission: 13.13, 11.56 respectively 11.81; average lymphocyte count: 1.69; 1.7 respectively 1.75. At the logistic regression model built having the death as outcome and the lymphocytes respectively the N/L as predictors, we did notfound any significant associations in neither of the groups (p values of 0.837, 0.171 and 0.162 for lymphocyte and 0.920, 0.764 and 0.168 for N/L respectively). When age, gender and hemoglobin at admittance were accounted for, only for fractures of the trochanteric region age was predictive of survival with p[0.001. Our study showed no prediction for survival of hip fracture patients by using perioperatively collected total lymphocyte count and neutrophil to lymphocyte ratio.

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Paloski, Michael, Benjamin C. Taylor, and Mark Willits. "Subtrochanteric Femur Fracture after Slipped Capital Femoral Epiphysis Pinning: A Novel Treatment." Advances in Orthopedics 2011 (2011): 1–4. http://dx.doi.org/10.4061/2011/809136.

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Slipped capital femoral epiphysis is a common injury suffered by adolescents worldwide. Treatment of most slips can be accomplished by percutaneous screw fixation, as this is an accepted and proven method associated with minimal morbidity. Complications, although limited, can be problematic for both the patient and treating physician. These include avascular necrosis, chondrolysis, infection, and fracture. We report a case of an individual who sustained a subtrochanteric femure fracture three weeks afterin situpinning of his left hip treated with a reconstruction intramedullary nail. This option allowed both the subtrochanteric fracture and SCFE to be treated concomitantly with minimized morbidity.

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Ozaki, Yu, Tomonori Baba, Hironori Ochi, Yasuhiro Homma, Taiji Watari, Mikio Matsumoto, and Kazuo Kaneko. "Total Hip Arthroplasty for Implant Rupture after Surgery for Atypical Subtrochanteric Femoral Fracture." Case Reports in Orthopedics 2016 (2016): 1–4. http://dx.doi.org/10.1155/2016/7146419.

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Treatment methods for delayed union and nonunion of atypical femoral fracture are still controversial. Moreover, no treatment method has been established for implant rupture caused by delayed union and nonunion. We encountered a 74-year-old female in whom nonunion-induced implant rupture occurred after treatment of atypical subtrochanteric femoral fracture with internal fixation using a long femoral nail. It was unlikely that sufficient fixation could be obtained by repeating osteosynthesis alone. Moreover, the patient was elderly and early weight-bearing activity was essential for early recovery of ADL. Based on these reasons, we selected one-stage surgery with total hip arthroplasty and osteosynthesis with inverted condylar locking plate as salvage procedures. Bone union was achieved at 6 months after surgery. This case illustrated that osteosynthesis-combined one-staged total hip arthroplasty could be considered as one of the options for nonunion-induced implant rupture of atypical femoral subtrochanteric fracture.

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Yoon, Taek Rim, Sung Man Rowe, Keun Bae Lee, and Jae Il Oh. "Surgical Treatment of Subtrochanteric Fracture with Compression Hip Screw." Journal of the Korean Society of Fractures 14, no. 1 (2001): 1. http://dx.doi.org/10.12671/jksf.2001.14.1.1.

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Kjærvik, Cato, Eva Stensland, Hanne Sigrun Byhring, Jan-Erik Gjertsen, Eva Dybvik, and Odd Søreide. "Hip fracture treatment in Norway." Bone & Joint Open 1, no. 10 (October 1, 2020): 644–53. http://dx.doi.org/10.1302/2633-1462.110.bjo-2020-0124.r1.

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Aims The aim of this study was to describe variation in hip fracture treatment in Norway expressed as adherence to international and national evidence-based treatment guidelines, to study factors influencing deviation from guidelines, and to analyze consequences of non-adherence. Methods International and national guidelines were identified and treatment recommendations extracted. All 43 hospitals routinely treating hip fractures in Norway were characterized. From the Norwegian Hip Fracture Register (NHFR), hip fracture patients aged > 65 years and operated in the period January 2014 to December 2018 for fractures with conclusive treatment guidelines were included (n = 29,613: femoral neck fractures (n = 21,325), stable trochanteric fractures (n = 5,546), inter- and subtrochanteric fractures (n = 2,742)). Adherence to treatment recommendations and a composite indicator of best practice were analyzed. Patient survival and reoperations were evaluated for each recommendation. Results Median age of the patients was 84 (IQR 77 to 89) years and 69% (20,427/29,613) were women. Overall, 79% (23,390/29,613) were treated within 48 hours, and 80% (23,635/29,613) by a surgeon with more than three years’ experience. Adherence to guidelines varied substantially but was markedly better in 2018 than in 2014. Having a dedicated hip fracture unit (OR 1.06, 95%CI 1.01 to 1.11) and a hospital hip fracture programme (OR 1.16, 95% CI 1.06 to 1.27) increased the probability of treatment according to best practice. Surgery after 48 hours increased one-year mortality significantly (OR 1.13, 95% CI 1.05 to 1.22; p = 0.001). Alternative treatment to arthroplasty for displaced femoral neck fractures (FNFs) increased mortality after 30 days (OR 1.29, 95% CI 1.03 to 1.62)) and one year (OR 1.45, 95% CI 1.22 to 1.72), and also increased the number of reoperations (OR 4.61, 95% CI 3.73 to 5.71). An uncemented stem increased the risk of reoperation significantly (OR 1.23, 95% CI 1.02 to 1.48; p = 0.030). Conclusion Our study demonstrates a substantial variation between hospitals in adherence to evidence-based guidelines for treatment of hip fractures in Norway. Non-adherence can be ascribed to in-hospital factors. Poor adherence has significant negative consequences for patients in the form of increased mortality rates at 30 and 365 days post-treatment and in reoperation rates. Cite this article: Bone Joint Open 2020;1-10:644–653.

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Knauf, Tom, Daphne Eschbach, Benjamin Buecking, Matthias Knobe, Juliane Barthel, Katherine Rascher, Steffen Ruchholtz, Rene Aigner, and Carsten Schoeneberg. "Open Reduction in Subtrochanteric Femur Fractures Is Not Accompanied by a Higher Rate of Complications." Medicina 57, no. 7 (June 27, 2021): 659. http://dx.doi.org/10.3390/medicina57070659.

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Backgroundand Objectives: Hip fractures are among the most typical geriatric fractures. Subtrochanteric fractures are considered difficult to treat, and, to date, there is no consensus on the optimal surgical treatment. Materialisand Methods: We analyzed data from the Registry for Geriatric Trauma, which includes patients ≥ 70 years old with hip fractures or periprosthetic fractures requiring surgery (21,734 patients in 2017–2019). For this study, we analyzed only the subgroup of patients with a subtrochanteric fracture. We analyzed the difference between closed and open surgical methods on a range of outcomes, including mortality, mobility, length of acute hospital stay, and the need for surgical revisions. Results: A total of 506 patients with subtrochanteric fractures were analyzed in this study. The median age was 85 years (interquartile range of 81–89). About 21.1% (n = 107) were operated on with a closed technique, 73.3% (n = 371) with open reduction without using a cerclage, and 5.53% (n = 28) with open reduction with the additional use of one or more cerclage wires. A total of 3.56% (n = 18) of the patients had complications requiring operative revision, most commonly soft tissue interventions (open vs. closed reduction—3.26% vs. 4.67%) (p = 0.687). Patients treated with open reduction were significantly more mobile 7 days after surgery (p = 0.008), while no significant effects on mortality (p = 0.312), length of hospital stay (p = 0.968), or surgical complications (p = 0.687) were found. Conclusion: Proper reduction is the gold standard practice for successful union in subtrochanteric fractures. This study shows that open reduction is not associated with a higher complication rate but does lead to increased mobility 7 days after operation. Therefore, in case of doubt, a good reduction should be aimed for, even using open techniques.

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Jennison, T., and M. Brinsden. "Fracture admission trends in England over a ten-year period." Annals of The Royal College of Surgeons of England 101, no. 3 (March 2019): 208–14. http://dx.doi.org/10.1308/rcsann.2019.0002.

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Introduction Fractures are a common reason for admission to hospital around the world. Varying incidences have been reported but these are mainly based on small studies from individual centres. The aim of our study was to analyse fracture admissions in England over a ten-year period. Methods Data were collated from the Hospital Episodes Statistics database. Since 2004, data have been collected for all admitted patients in England using the International Classification of Diseases codes for the primary diagnosis. Data were analysed for the ten-year period between 2004–2005 and 2013–2014. Results There were 2,489,052 fracture admissions in England over the 10-year study period. The risk of admission for fracture was 47.84 per 10,000 population. The rate of fracture admission has remained stable. Hip fractures were the most common fracture requiring hospitalisation (n=641,263), followed by distal radius fractures (n=406,313), ankle fractures (n=332,617) and hand fractures (n=244,013). Hip fractures accounted for 58% of hospital bed days, ankle fractures for 10%, and femoral shaft fractures and subtrochanteric femoral fractures for 5% each. The number of bed days per year for hip fractures has reduced from 1,549,939 bed days in 2004–2005 to 1,319,642 in 2013–2014. Conclusions This study provides an updated picture of the incidence of fractures that required hospital admission over a ten-year period in England. It may be used as a platform from which the effect of modern patient treatment pathways can be monitored.

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Abdul Aziz, Ansari Muqtadeer, Rahul Gopikishan Jaju, and Ajit J. Deshmukh. "Management of sub-trochanteric femoral fractures in adults using proximal femoral nail in lateral position: a prospective study." International Journal of Research in Orthopaedics 4, no. 3 (April 25, 2018): 452. http://dx.doi.org/10.18203/issn.2455-4510.intjresorthop20181796.

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Background: Subtrochanteric fractures are devastating injuries that not only affect the elderly but also the young. Despite marked improvement in implant design, surgical technique and patient care; subtrochanteric fractures continue to consume a substantial proportion of our health care resources.Methods: This prospective study consists of 20 adult patients of subtrochanteric fractures of femur, who were treated with internal fixation using PFN. All patients were followed up at an interval of 4 to 6 weeks till fracture union and then once in 3 months till 1 year.Results: Anatomical results are noted as good or poor depending upon shortening, varus deformity, hip movements and knee movements and functional result as excellent, good, fair and poor depending upon the hip pain, ambulatory status, ability to squat, and sit cross leg. In the study 2 patients had shortening of l cm. None of the patients had any varus deformity. Overall excellent to good results were achieved in 85% cases.Conclusions: The potential advantages of the proximal femoral nail over extramedullary devices with regards to minimal invasiveness due to closed technique and minimal soft tissue dissection, better biomechanical design to prevent implant failure and ability to bear more stress, shows that this technique holds considerable promise in complex fractures. Early rehabilitation, less blood loss, less surgical trauma, cosmetic incision, make it the implant of choice in complex, comminuted unstable subtrochanteric fractures in adults.

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Govindasamy, Rajesh, Ramkumar Gnanasundaram, Saravanan Kasirajan, Jimmy J. Meleppuram, and Kumar Archit. "Proximal femur locking compression plate in complex proximal femoral fractures: a retrospective analysis." International Journal of Research in Orthopaedics 2, no. 3 (September 3, 2016): 104. http://dx.doi.org/10.18203/issn.2455-4510.intjresorthop20162805.

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Background: Proximal femoral fractures are one of the most common fractures in old age patients. Fixation of these fractures is technically high demanding owing to the high risk of complications. The aim of our study is to analyze the outcomes of proximal femoral locking compression plate (PF-LCP) in these fractures.Methods: We retrospectively analyzed 18 proximal femoral fractures treated with PF-LCP from May 2012 to May 2015. There were 12 females (67%) and six males (33%) with an average age of 59.6 years (range, 32 to 84 years). The peritrochanteric fractures constituted by intertrochanteric and subtrochanteric fractures were classified by Boyd and Griffin classification along with Seinshemier’s classification, respectively. Among that, 14 cases (77%) were of intertrochanteric and four cases (23%) were of subtrochanteric fracture pattern. The functional outcome was evaluated by harris hip score and the parker palmer mobility score one year after surgery.Results: Among 18 patients, 16 patients obtained fracture union without further intervention; two patients required additional bone grafting. There were no cases of hip screw cutting the femoral head. There was no post-operative mortality in our study. The average harris hip score was 85.5 (83-94). The assessment by parker and palmar mobility score was 7.6 (range 4-9).Conclusions: The PF-LCP is a good stable alternative in the treatment of complex proximal femoral fractures. It provides good to excellent bone healing with limited complications.

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Whittingham-Jones, Paul, Godfrey Charnley, Jason Francis, and Satyanarayana Annapureddy. "Internal Fixation After Subtrochanteric Femoral Fracture After Hip Resurfacing Arthroplasty." Journal of Arthroplasty 25, no. 2 (February 2010): 334.e1–334.e4. http://dx.doi.org/10.1016/j.arth.2008.10.015.

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Harper, Katharine D., Paul Navo, Frederick Ramsey, Sainabou Jallow, and Saqib Rehman. "“Hidden” Preoperative Blood Loss With Extracapsular Versus Intracapsular Hip Fractures: What Is the Difference?" Geriatric Orthopaedic Surgery & Rehabilitation 8, no. 4 (November 22, 2017): 202–7. http://dx.doi.org/10.1177/2151458517729615.

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Purpose: Excessive blood loss with hip fracture management has been shown to result in increased rates of complications. Our goal is to compare blood loss and transfusion rates between patients with intracapsular and extracapsular (both intertrochanteric (IT) and subtrochanteric (ST)) hip fractures. Methods: 472 patients were evaluated over a five-year period. Those who presented to the hospital with a proximal femur fracture (femoral neck, IT or ST) were considered for the study. Exclusion criteria included polytrauma, gunshot injuries, periprosthetic fractures, and non-operative management. Primary endpoint was hemoglobin (Hgb) drop from admission to day of surgery (DOS); secondary endpoint was need for pre-op transfusion and discharge location. Results: 304 patients were analyzed who sustained a proximal femur fracture. Median IC Hgb drop was 0.6g/dL; median EC Hgb drop was 1.1g/dL from admission to DOS ( p = 0.0272). Rate of pre-operative transfusions was higher in EC (36/194 = 18.6%) than IC fractures (5/105 = 4.5%) ( p = 0.0006), and overall transfusion rates remained higher throughout hospital stay (55.7% EC vs. 32.7% IC; p = 0.0001). Breakdown of bleeding rate and tranfusion rates between IT and ST fractures were not significant ( p = 0.07; p = 0.4483). Extracapsular hip fractures were more likely to be discharged to a skilled nursing facility (SNF) (84.4% EC vs. 73.8% IC; p = 0.027). Conclusion: Intracapsular hip fractures have significantly less pre-operative blood loss and fewer pre-operative transfusions than their extracapsular counterparts. These findings can be used to establish appropriate pre-operative resuscitative efforts, ensuring that hip fracture protocols account for the increased likelihood of blood loss in extracapsular fractures.

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Prajapati, Chirag G., Rasik B. Dabhi, and Nikunj D. Maru. "Evaluation of outcome following clamp assisted mini open reduction and internal fixation with intramedullary nailing of subtrochanteric femoral fractures." International Journal of Research in Orthopaedics 5, no. 6 (October 22, 2019): 1126. http://dx.doi.org/10.18203/issn.2455-4510.intjresorthop20194818.

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Background: Subtrochanteric fractures of the proximal femur have been defined as the fractures extending from lesser trochanter distally for 5 cm. These fractures usually occur in two age distributions. In the elderly osteopenic population resulting from trivial trauma as fall from standing height or in the younger ones as a result of high energy trauma. Incidence has been on the rise and they comprise about 7 to 10% hip fractures and could lead quickly to large amount of blood loss and other complications.Methods: This is a multicentric prospective prognostic study level 1 consisting of 25 patients admitted in government civil hospital, Ahmedabad during April 2013 to May 2015 having high subtrochanteric femur fractures treated by clamp assisted reduction and intramedullary nailing. Out of these, 20 patients (80%) came for final follow up with average follow up of 11.5 months and evaluated for union, complication and functional outcome.Results: In our study final outcome is assessed based on hip outcome score (modified) based on which 85% had excellent outcome, 10% had good outcome and 5% had fair outcome with none of the patient having poor outcome.Conclusions: We found that clamp-assisted reduction and intramedullary nail fixation provides excellent reduction quality, high rate of fracture union, with no apparent increase in complications in subtrochanteric fractures of the femur.

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Yeak, Raymond, Yee Yee Yap, and Nizlan M. Nasir. "58 Epidemiology of Falls and HIP Fractures among the Elderly Community Dwellers in Malaysia." Age and Ageing 48, Supplement_4 (December 2019): iv13—iv17. http://dx.doi.org/10.1093/ageing/afz164.58.

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Abstract Introduction Elderly community dweller has a high risk of falls. It has a high incidence of morbidity and mortality if it involves hip fractures. Our aim is to report the incidence of falls presenting with hip fractures to a Malaysian tertiary centre. Method We have collected data from a Malaysian tertiary centre. The incidence of falls involving elderly patients aged 65 and above from January 2018 till December 2018 was examined. The falls were divided based on the time of fall, place and the type of fracture. Time of fall was divided into day (0800 to 1559), evening (1600 to 2359), night (0000 to 0759). The place was either outdoor or indoor. Results There were 114 falls that involved hip fractures recorded over the past 12 months. There were 85 female cases versus 29 male cases. The average age was 77.3 years. There was a higher incidence in the Chinese (n=59) followed by the Malay (n=40) and Indian (n=15). There were no cases of nursing homes falls that involved hip fractures. Most of the falls with hip fractures occurred indoor with only 11 cases that occurred outdoor. The falls tend to occur in the day (n=65) followed by evening (n=31) and night (n=18). October recorded the highest number of falls with 14 cases followed by April (n=13), and December (n=12). The type of fracture in descending order were intertrochanteric fracture (n=61), neck of femur fracture (n=47), subtrochanteric fracture (n=4) and acetabular fracture (n=2). Conclusion Asians generally care for their aging parents in the family home. Although falls were reported to be higher in nursing homes, this differs in the Asian population. Therefore, fall prevention measures should be implemented at home as falls is a significant cause of morbidity and mortality in the elderly especially if it involves hip fractures.

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Wellman, Samuel S., David E. Attarian, and Jordan F. Schaeffer. "Periprosthetic Femoral Insufficiency Fracture in a Patient on Long-term Bisphosphonate Therapy." Duke Orthopaedic Journal 2, no. 1 (2012): 66–69. http://dx.doi.org/10.5005/jp-journals-10017-1021.

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ABSTRACT Recent literature shows an association between long-term bisphosphonate therapy and low-energy fractures of the subtrochanteric femur. It is thought that the pharmacology of bisphosphonates and stress characteristics of the sub-trochanteric femur predispose patients on long-term therapy to fracture. There are few reports in the literature of bisphos-phonate-associated periprosthetic fractures with the characteristic fracture pattern. We report a case in a patient with a 10- year history of sustained bisphosphonate use. The patient is a 79-year-old female that developed new thigh pain 9 years following a cemented total hip arthroplasty. Radiographs revealed lateral cortical thickening and a transverse periprosthetic stress fracture of the lateral femoral cortex at the level of the distal stem. This fracture appears consistent with a bisphosphonate-associated insufficiency fracture, demonstrating that this pattern is not isolated to nonarthroplasty patients. Schaeffer JF, Attarian DE, Wellman SS. Periprosthetic Femoral Insufficiency Fracture in a Patient on Long-term Bisphosphonate Therapy. The Duke Orthop J 2012;2(1):66-69.

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Malik, Shwetabh, Parimal Malviya, Alfven Vieira, and Deepak Jain. "A prospective study of management of subtrochanteric femur fracture using proximal femoral nail." International Journal of Research in Orthopaedics 6, no. 2 (February 25, 2020): 292. http://dx.doi.org/10.18203/issn.2455-4510.intjresorthop20200739.

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Background: Proximal femur fractures present considerable challenge in management. They are due to high velocity trauma, with or without soft tissue injury and usually with a metaphyseal and diaphyseal involvement. The surgeon has to face many challenges like identifying the entry, reduction the fracture, and difficulty due to a narrow medullary canal and comminution. The present study was conducted to assess the utility and effectiveness of Proximal Femoral Nail for subtrochanteric fractures of femur.Methods: In this study a total of 30 patients with Sub trochanteric femur fracture admitted to MGM medical college and hospital from June 2015 to July 2017 were selected for treatment with proximal femur nail.Results: 30 patients were included in this study with subtrochanteric fractures of femur treated with Proximal femoral nail. Maximum 21(70%) of patients were below 61 yrs of age. Mean age was 47.9 years. There was 21 male and 9 females in the study. There were 6 patients with local complications. Final result of our study, we had 26.7% excellent, 46.6% good, 20% fair and 6.7 % poor results according to Harris hip score.Conclusions: In our study, looking at the results we found that Proximal femoral Nail proves to be a good implant in management of subtrochanteric fractures of femur. However, it is a small study to conclude anything definitely.

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Lian, Kevin, Jacques Trollip, Supna Sandhu, Mandana Moosavi, Amninder Gill, David Kendler, Larry Dian, and Brian Lentle. "Audit of Atypical Femoral Fractures and a Description of Some of Their Features." Canadian Association of Radiologists Journal 67, no. 1 (February 2016): 69–75. http://dx.doi.org/10.1016/j.carj.2015.09.014.

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Purpose Atypical femoral fractures (AFF) are recently described events related to osteoporosis and, potentially, a rare result of antiresorptive treatment. Methods We set out to audit the diagnosis of AFF in an acute hospital. Charts and radiographs were reviewed retrospectively from patients diagnosed with subtrochanteric femoral fractures according to hospital discharge coding at Vancouver General Hospital (VGH), Canada, from January 2005 to March 2013. Results A total of 3084 patients were discharged from the hospital with a diagnosis of hip fracture between 2005 and 2013. Of these, 204 were coded as having had subtrochanteric fractures; 178 of the patients thus coded had radiographic evidence of other fracture types—usually intertrochanteric fractures. Eleven patients did not have available radiographs. Of the remaining 193 patients whose radiographs were reviewed, 24 (12.4%) fulfilled the published criteria for AFF. Our observations were 1) laterality: 13 of 24 AFF (54.2%) were right-sided; 2) there was only one incomplete AFF in this series: a completed fracture was an inclusion criterion, but 1 patient with an AFF had both that fracture and an incomplete fracture and further foci of periosteal or endosteal foci of new bone (PENB) involving the contralateral femur; 3) radiologists had only diagnosed AFF in only 1 of the 24 patients with characteristic radiographic signs of AFF; 4) all but 1 patient had a focus of periosteal and/or endosteal new bone (PENB) through which the fracture line invariably passed, and in the 1 exception the radiography was too poor to be sure of this but there was a symmetrical contralateral focus of PENB; 5) in 19 of 24 patients there was an adequate image of part of the contralateral femur and of these 12 (63%) had a contralateral focus of PENB situated ±2.5 cm from the index lesion site when measured from the upper aspect of the greater trochanter, and in another patient a prior fracture of the contralateral femur had been treated surgically and it was at a symmetrical contralateral location from the index fracture.; 6) in 3 of the 19 patients multiple foci of PENB were detected on the lateral aspect of the contralateral femur even though the examination was of limited extent; and 7) AFFs were associated with bisphosphonate medication in 75% of the patients studied. Conclusions Hospital discharge coding misclassified a great majority of femoral fractures as subtrochanteric. As an essential criteria for diagnosing AFF is their subtrochanteric location, this misclassification impaired our ability to retrospectively search for AFF patients. Radiologists tended not to report AFF when typical radiographic characteristics were present. Bilateral and multifocal disease is of interest in pointing to the diagnosis and in suggesting that the mechanism of injury in respect of these unusual fractures is more complex than simple low-energy trauma.

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Small, Ilan, Rami Efrati, Gabriel Agar, Tomer Keidan, Yaron Bar Ziv, and Noam Shohat. "The Missing Piece: A Subtrochanteric Hip Fracture Presenting with Abdominal Pain." JBJS Case Connector 10, no. 3 (2020): e19.00192-e19.00192. http://dx.doi.org/10.2106/jbjs.cc.19.00192.

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Yang, Jae-Hyuk, Jung-Ro Yoon, Kyu-Bok Kang, Ho-Hyun Yun, Young-Soo Shin, and Yun-Ku Cho. "Deep Femoral Vessel Injury Following Subtrochanteric Hip Fracture - A Case Report -." Journal of the Korean Fracture Society 25, no. 1 (2012): 64. http://dx.doi.org/10.12671/jkfs.2012.25.1.64.

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Sferopoulos, N. K. "Subtrochanteric osteoid osteoma: A misdiagnosed case complicated by a hip fracture." Chinese Journal of Traumatology 19, no. 5 (October 2016): 283–85. http://dx.doi.org/10.1016/j.cjtee.2016.03.006.

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Hickey, Ben, Huw M. Jones, and Stephen Jones. "Is distal screw entry point associated with subtrochanteric fracture after intracapsular hip fracture fixation?" ANZ Journal of Surgery 84, no. 4 (February 12, 2014): 245–48. http://dx.doi.org/10.1111/ans.12498.

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Gomberg, Stephen J., Rosanna L. Wustrack, Nicola Napoli, Claude D. Arnaud, and Dennis M. Black. "Teriparatide, Vitamin D, and Calcium Healed Bilateral Subtrochanteric Stress Fractures in a Postmenopausal Woman with a 13-Year History of Continuous Alendronate Therapy." Journal of Clinical Endocrinology & Metabolism 96, no. 6 (June 1, 2011): 1627–32. http://dx.doi.org/10.1210/jc.2010-2520.

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Background: Oral bisphosphonates comprise the most widely prescribed class of antiosteoporotic drugs. Recent reports, however, propose a link between prolonged bisphosphonate use and atypical, low-energy, subtrochanteric fractures. Objectives: The aim was to describe the clinical course of a patient treated long-term with alendronate who developed subtrochanteric stress fractures and to propose a hypothesis to explain teriparatide's potential contribution in healing the patient's stress fractures. Results: Magnetic resonance imaging (MRI) showed classical bilateral stress fractures of the mid-femora. Baseline serum 25-hydroxyvitamin D3 was low; bone-specific alkaline phosphatase was slightly increased; serum carboxyterminal cross-linking telopeptide of bone collagen and urine aminoterminal cross-linking telopeptide of bone collagen were low to normal, as was serum osteocalcin. Dual-energy x-ray absorptiometry showed osteopenic vertebral bone mineral density and osteoporotic hip values. Treatment with large doses of oral vitamin D increased serum 25-hydroxyvitamin D3 to normal within 2 months, after which it remained in the normal range with maintenance doses. Thigh pain, present as an initial symptom, intensified, and the MRI appearance of the fractures worsened. Teriparatide treatment commenced, and 6 months later, a repeat MRI showed decreased edema at the fracture sites with faint cortical bridging. Thigh pain and lower limb weakness disappeared over the next year, and complete fracture healing was established (MRI). Conclusions: Based upon the chronology of fracture healing in our patient and published evidence that teriparatide heals stress fractures in a rat model, we think that teriparatide was probably primary in this patient's positive response to therapy, with calcium, vitamin D therapy, and alendronate discontinuation playing secondary roles.

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Cohen, Ilan, Alexander Blankstein, and Aharon Chechick. "An iatrogenic subtrochanteric fracture ?a rare complication of pinning for subcapital fractures of the hip." Unfallchirurgie 25, no. 3-4 (August 1999): 150–53. http://dx.doi.org/10.1007/bf00578723.

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Singh, Ajay Pal, Arun Pal Singh, and Vivek Mittal. "Traumatic inferior hip dislocation with ipsilateral open subtrochanteric fracture: A rare case." Injury Extra 39, no. 12 (December 2008): 384–85. http://dx.doi.org/10.1016/j.injury.2008.08.002.

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Rollo, Giuseppe, Giuseppe Rinonapoli, Paolo Pichierri, Michele Bisaccia, Auro Caraffa, and Luigi Meccariello. "Breakage in Two Points of a Short and Undersized “Affixus” Cephalomedullary Nail in a Very Active Elderly Female: A Case Report and Review of the Literature." Case Reports in Orthopedics 2018 (September 13, 2018): 1–8. http://dx.doi.org/10.1155/2018/9580190.

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Introduction. Trochanteric fractures of the femur are common in elderly individuals with osteoporosis. The use of cephalomedullary nails is increasing, and they are now the most commonly used fixation devices, especially for the treatment of unstable trochanteric fractures. The nail breakage is not the most common complication of intramedullary nailing. Many scientific papers report nail breakage in a specific location: through the lag screw hole, the nail shaft, or the distal locking hole. Materials and Methods. We present a case of an 84-year-old patient treated with modular revision hip arthroplasty due to the breakage in two points of a cephalomedullary nail implanted 3 years earlier for a subtrochanteric fracture. Results. After modular revision hip arthroplasty, the functional results and quality of life have been excellent. Conclusions. As far as we could determine, this appears to be the first case of a breakage of a cephalomedullary nail in two points after nonunion in a very active elderly female.

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Konda, Sanjit R., Hesham Saleh, Ariana Lott, and Kenneth A. Egol. "Predicting Discharge Location among Low-Energy Hip Fracture Patients Using the Score for Trauma Triage in the Geriatric and Middle-Aged (STTGMA)." Advances in Orthopedics 2018 (November 18, 2018): 1–6. http://dx.doi.org/10.1155/2018/9793435.

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Patterns of discharge location may be evident based on the “sickness” profile of the patient. This study sought to evaluate the ability of the STTGMA tool, a validated mortality risk index for middle-aged and geriatric trauma patients, to predict discharge location in a cohort of low-energy elderly hip fracture patients, with successful discharge planning measured by readmission rates. Low-energy hip fracture patients aged 55 years and older were prospectively followed throughout their hospitalization. On initial evaluation in the Emergency Department, each patient’s age, comorbidities, injury severity, and functional status were utilized to calculate a STTGMA score. Discharge location was recorded with the primary outcome measure of an unsuccessful discharge being readmission within 30 days. Patients were risk stratified into minimal-, low-, moderate-, and high-risk STTGMA cohorts. A p-value of <0.05 was considered significant for all statistical tests. 408 low-energy hip fractures were enrolled in the study with a mean age of 81.3±10.6 years. There were 214 (52.5%) intertrochanteric fractures, 167 (40.9%) femoral neck fractures, and 27 (6.6%) subtrochanteric femur fractures. There was no difference in readmission rates within STTGMA risk cohorts with respect to discharge location; however, among individual discharge locations there was significant variation in readmission rates when patients were risk stratified. Overall, STTGMA risk cohorts appeared to adequately risk-stratify readmission with 3.5% of minimal-risk patients experiencing readmission compared to 24.5% of moderate-risk patients. Specific cohorts deemed high-risk for readmission were adequately identified. The STTGMA tool allows for prediction of unfavorable discharge location in hip fracture patients. Based on observations made via the STTGMA tool, improvements in discharge planning can be undertaken to increase home discharge and to more closely track “high-risk” discharges to help prevent readmissions.

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Ung, Sia, Zulkiflee Bin Osman, Nur Syahida Binti Mohd Termizi, and Mohd Firdaus Hafni Bin Ahmad. "Congenital Insensitivity to Pain and Anhidrosis: A painful experience by a painless child." Hong Kong Journal of Orthopaedic Research 4, no. 1 (April 25, 2021): 4–7. http://dx.doi.org/10.37515/ortho.8231.4102.

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A three-year-old boy with congenital insensitivity to pain and anhidrosis (CIPA) was first presented with transphyseal separation of distal left humerus. Surgical treatment with closed reduction and k-wiring of transphyseal separation of distal humerus resulted in devastating surgical site infection and osteomyelitis. Multiple surgical debridement and application of external fixator to eliminate infection were futile. At the age of four years, he refused to bear weight as a result of left hip dislocation. Closed reduction and spica cast was unsuccessful, resulting in recurrent left hip dislocation. He has since not been able to walk. At the age of five years, the right hip was dislocated followed by ipsilateral subtrochanteric femur fracture. Appropriate treatments such as hip spica and titanium elastic nail were not possible due to extensive bruising and skin ulceration over the right thigh. This child ended up with a functionless left upper limb, bilateral hip dislocation and malunited right femur fracture. Conservative treatment and watchful neglect might be the ideal treatment for patients with CIPA.

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Vande Voorde, Kira, Jan Dauwe, and Jan Van Oost. "Late Presentation of an Iatrogenic Pseudoaneurysm of the Profunda Femoris Artery following Intramedullary Nailing." Case Reports in Orthopedics 2018 (September 23, 2018): 1–5. http://dx.doi.org/10.1155/2018/8270256.

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Introduction. Hip fractures are one of the most common osteoporotic fractures, and the incidence is expected to increase in the future. Vascular injury of the femoral vessels, although uncommon, is an intermittently reported complication in the treatment of proximal femoral fractures. This may be iatrogenic or less frequently as a result of the fracture itself. The profunda femoris artery is most commonly involved, probably because of its close relationship to the femur in the subtrochanteric region. Case Presentation. We report a well-documented case of pseudoaneurysm of the profunda femoris artery after intramedullary nailing of an intertrochanteric femoral fracture. Arterial damage was due to overpenetration when drilling the distal locking hole. Because of the late presentation, pressure on the medial femoral diaphysis caused severe cortical scalloping. This resulted in an obvious radiographic image rarely reported before. Conclusion. This case report illustrates the uncommon complication of pseudoaneurysm after intramedullary hip nailing. Because of the risk of potentially limb- and life-threatening complications, we advise careful drilling and placement of the distal locking screw. Excessive screw length should be avoided. The injured limb should be returned to the neutral position and lower-limb traction should be reduced before drilling the distal locking hole.

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Luo, Y., Z. Ferdous, and W. D. Leslie. "A preliminary dual-energy X-ray absorptiometry-based finite element model for assessing osteoporotic hip fracture risk." Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine 225, no. 12 (October 17, 2011): 1188–95. http://dx.doi.org/10.1177/0954411911424975.

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To more accurately assess osteoporotic hip fracture risk in a specific patient, a dual-energy X-ray absorptiometry (DXA)-based finite element model was constructed from the patient’s femur DXA image. The outermost contour of the femur bone segmented from the DXA image was used to generate a finite element mesh. Bone mechanical properties, such as Young’s modulus, are correlated with areal bone mineral density (BMD) captured in the DXA image. A quasi-static loading condition representing a sideway fall was applied to the finite element model. Three fracture risk indices were introduced and expressed as ratios of internal forces caused by impact forces occurring in sideway fall to bone ultimate cross-section strength at the three critical locations, i.e. the femoral neck, the intertrochanteric region, and the subtrochanteric region. The proposed finite element modelling procedure was validated against six representative clinical cases extracted from the Manitoba BMD database, where initial and follow-up DXA images have been taken to monitor longitudinal variation of areal BMD in individual patients. It was found from the clinical validation that variations in the proposed fracture risk indices have the same trends as those indicated by the conventional areal BMD and T-score. In addition, by the three proposed fracture risk indices it is possible to further identify the specific fracture location. It was also found that for the same subject, the variations in the three fracture risk indices have quite different magnitudes, with intertrochanteric region the largest and subtrochanteric region the smallest, which is probably owing to the different content of trabecular and cortical bones in the three regions. With further development, it is promising that the proposed DXA-based finite element model will be a useful tool for accurate assessment of osteoporosis development and for treatment monitoring.

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Bryant, Jonathan, Leroy Butler, Brandon Green, and Daniel Krenk. "Complications in a Young Adult Attributable to a Retained Pediatric Dynamic Hip Screw." Case Reports in Orthopedics 2019 (July 17, 2019): 1–6. http://dx.doi.org/10.1155/2019/6814375.

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Introduction. Orthopedic implants are used for many different conditions in the pediatric population. The literature on hardware removal is controversial and vague.Case Report. We highlight a young adult male who underwent a dynamic hip screw (DHS) due to a motor vehicle accident at 11 years old. He healed the fracture and did well for years. He was lost to follow-up and the hardware was never removed. The patient presented to our facility with a periprosthetic subtrochanteric proximal femur fracture just distal to the retained hardware. The DHS was removed and the fracture fixed with an intramedullary nail. The patient healed the fracture and did well.Discussion. A literature review was performed to highlight the benefits and complications of hardware removal vs. retention. We hope to equip the orthopedic surgeon with the reasons for or against hardware removal to optimize treatment to each patient. In this instance, we recommend hardware removal due to the serious consequences of retained hardware in the adolescent/young adult population.

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Choi, Siu-Wai, Frankie K. L. Leung, Tak-Wing Lau, and Gordon T. C. Wong. "Impact of postoperative haemoglobin on length of stay post fractured hip repair in patients with standardised perioperative management." HIP International 29, no. 2 (May 7, 2018): 172–76. http://dx.doi.org/10.1177/1120700018773428.

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Introduction: Perioperative blood transfusion is not without risk and effort should be made to limit patients’ exposure to allogeneic blood. However, there is conflicting data regarding the impact of anaemia on postoperative recovery in patients with repaired hip fractures. It is hypothesised that for a given baseline functional status and fracture type, lower postoperative haemoglobin will increase rehabilitation time and prolong total length of hospital stay. Methods: This is a retrospective study on data collected prospectively on patients entered into the Clinical Pathway aged >65 years admitted to Queen Mary Hospital (QMH) with a fractured neck of femur during 2011–2013. Potential predictor variables were analysed with linear regression with respect to total length of stay and those that reached a significance level of 0.05 were included in further analysis. Results: 1092 patients were admitted to QMH with a suspected fractured neck of femur; data from 747 patients were analysed. The fracture sites were neck of femur (50%), intertrochanteric (48%) and subtrochanteric fracture (2%). Approximately 30% of patients received blood transfusions. Of these only the development of postoperative medical complications statistically prolonged hospital stay. No relationship was seen with haemoglobin levels cut-off above and below 10 g/dl with the result remaining non-significant down to a cut-off of above and below 8 g/dl. Discussion: This study revealed that post-surgical haemoglobin level of between 8 g/dl and 10 g/dL did not have an impact on the total length of hospital stay. The development of postoperative medical complications was the only factor that prolonged the total length of stay.

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Mittal, Ashima, and Murray B. Gordon. "Paget ‘s Disease: Not So Typical for Atypical Femur Fracture." Journal of the Endocrine Society 5, Supplement_1 (May 1, 2021): A209—A210. http://dx.doi.org/10.1210/jendso/bvab048.426.

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Abstract Introduction: Atypical femur fractures (AFF) are reported in patients taking prolonged bisphosphonate therapy, but Paget’s disease (PD) has been rarely reported as a cause of AFF. Case: 71-year-old female with past medical history of right hip osteoarthritis, seizure disorder, hypertension, and Hashimoto’s thyroiditis presented with persistent right hip pain. There was no history of trauma or fall. She had otosclerosis with bilateral hearing loss and bilateral stapedectomies. Her medications were primidone, levothyroxine, lisinopril-hydrochlorothiazide, and vitamin D. She did not smoke tobacco or drink alcohol. She had elevated serum alkaline phosphatase of 300 U/L (35–104). The X-ray of the skull was negative for any cortical thickening. CT of right femur revealed cortical thickening and coarsening of trabeculae of the proximal right femur consistent with PD and incomplete atypical subtrochanteric proximal fracture. Urine NTx 303 BCE/mM Cr (<89). Bone scan showed uptake in the R proximal femur, L distal tibia, and L3-L4 vertebral bodies suspicious of PD. DXA showed osteopenia. She was given zoledronic acid 5 mg IV. Discussion: PD leads to an increased incidence of fractures particularly of the lower extremities with most fractures transverse in nature. Non-union is not uncommon1. Stress fractures in PD are caused by disorganized bone remodeling due to excessive breakdown and formation of bone. Our patient met the major criteria for AFF as per the ASBMR 2010 task force report but there was no exposure to bisphosphonates2. The ASBMR task force recommended that bisphosphonates should be discontinued in patients with bisphosphonate-associated AFF due to their severely suppressed bone turnover status. On the other hand, the AFF in patients with PD may heal in response to bisphosphonate treatment. References: 1. Singer FR. Bone Quality in Paget’s Disease of Bone. Curr Osteoporos Rep. 2016;14(2):39–42. DOI:10.1007/s11914-016-0303-62. Shane E, Burr D, Ebeling PR, Abrahamsen B, Adler RA et.al. Atypical subtrochanteric and diaphyseal femoral fractures: report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res. 2010; 25:2267–2294.

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Nordling, P., M. Strandberg, N. N. G. Strandberg, T. O. Kiviniemi, K. T. Mäkelä, and K. E. J. Airaksinen. "Preoperative myocardial troponin T elevation is associated with the fracture type in patients with proximal femoral fracture." Scandinavian Journal of Surgery 108, no. 4 (December 6, 2018): 305–12. http://dx.doi.org/10.1177/1457496918816928.

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Background and Aims: Cardiovascular complications are common in hip fracture patients but the role of fracture type and operative method in these is unclear. This prospective cohort study aimed to evaluate the impact of fracture- and operative characteristics on perioperative cardiovascular complications and prognosis in unselected hip fracture patients. Material and Methods: During a 7-month trial registration period, a population of 197 consecutive hip fracture patients (median age 84 years) diagnosed with femoral neck or pertrochanteric fracture was formed. The exclusion criteria were patient refusal, subtrochanteric fracture, or death preoperatively. Pre- and postoperative troponin T (TnT) elevation, perioperative N-terminal fragment of pro-B-type natriuretic peptide (NT-proBNP) level, perioperative cardiovascular adverse events, and all-cause 30-day and 2- and 5-year mortalities were studied. Results: Femoral neck fracture was independently associated with preoperative myocardial injury witnessed by TnT elevation (HR 2.95, 95% confidence interval 1.21–7.19, p = 0.018). The fracture type, surgery delay, or operative method were not significantly associated with NT-proBNP levels, cardiovascular adverse event diagnoses, or prognosis. Cardiovascular adverse events were clinically diagnosed in 28 (14%) participants, and these had a higher mortality compared to participants without such diagnosis (at 30 days, 32% vs 5%; 2 years, 71% vs 31%; and 5 years, 86% vs 59%; p < 0.001). Conclusion: While the femoral neck fracture independently predicts preoperative cardiovascular morbidity, the operative method does not affect perioperative cardiovascular complications or the prognosis, and it may be selected by the treating clinician based on other criteria.

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Masters, James, David Metcalfe, Nick R. Parsons, Juul Achten, Xavier L. Griffin, and Matt L. Costa. "Interpreting and reporting fracture classification and operation type in hip fracture." Bone & Joint Journal 101-B, no. 10 (October 2019): 1292–99. http://dx.doi.org/10.1302/0301-620x.101b10.bjj-2019-0213.r1.

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Aims This study explores data quality in operation type and fracture classification recorded as part of a large research study and a national audit with an independent review. Patients and Methods At 17 centres, an expert surgeon reviewed a randomly selected subset of cases from their centre with regard to fracture classification using the AO system and type of operation performed. Agreement for these variables was then compared with the data collected during conduct of the World Hip Trauma Evaluation (WHiTE) cohort study. Both types of surgery and fracture classification were collapsed to identify the level of detail of reporting that achieved meaningful agreement. In the National Hip Fracture Database (NHFD), the types of operation and fracture classification were explored to identify the proportion of “highly improbable” combinations. Results The records were reviewed for 903 cases. Agreement for the subtypes of extracapsular fracture was poor; most centres achieved no better than “fair” agreement. When the classification was collapsed to a single option for “extracapsular” fracture, only four centres failed to have at least “moderate” agreement. There was only “moderate” agreement for the subtypes of intracapsular fracture, which improved to “substantial” when collapsed to “intracapsular”. Subtrochanteric fracture types were well reported with “substantial” agreement. There was near “perfect” agreement for internal fixation procedures. “Perfect” or “substantial” agreement was achieved when the type of arthroplasty surgery was reported at the level of “hemiarthroplasty” and “total hip replacement”. When reviewing data submitted to the NHFD, a minimum of 5.2% of cases contained “highly improbable” procedures for the stated fracture classification. Conclusion The complexity of collecting fracture classification data at a national scale compromises the accuracy with which detailed classification systems can be reported. Data around type of surgery performed show similar tendencies. Data capture, reporting, and interpretation in future studies must take this into account. Cite this article: Bone Joint J 2019;101-B:1292–1299

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Roth, Justin, Brian Goldman, Lewis Zirkle, John Schlechter, John Ibrahim, and David Shearer. "Early clinical cxperience with the SIGN hip construct: a retrospective case series." SICOT-J 4 (2018): 55. http://dx.doi.org/10.1051/sicotj/2018050.

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Background: As the population ages, the developing world industrializes, and more urban centers emerge, the burden of orthopedic trauma will steadily increase. SIGN Fracture Care International has developed a unique intramedullary device for fixation of hip fractures in low-resource settings lacking fluoroscopy. The purpose of this study is to report the safety profile and complication rate for a consecutive series of hip fracture patients managed using this implant. Methods: We conducted a retrospective analysis of the first 170 patients treated with the SIGN Hip Construct (SHC) from 2009 to 2014 using the SIGN Online Surgical Database (SOSD). Patients with follow-up greater than 12 weeks and adequate radiographs were included. Data recorded include patient demographics, time-to-surgery, union rate, AO/OTA classification, complications, neck-shaft angle, and clinical outcomes including painless weight bearing and knee flexion greater than 90°. Results: Of 170 patients, 71 met inclusion criteria with mean follow-up of 39 weeks. Mean age was 49.5 and by WHO, regions were Africa (27), Eastern Mediterranean (21), Western Pacific (17), Americas (3), and Southeast Asia (3). Fractures included intertrochanteric (55), subtrochanteric (7), femoral neck (4), and combined (5). Reduction quality was good in 35 (49%), acceptable in 19 (27%), and poor in 17 (24%). Major complications consisted of varus collapse (6), non- or delayed union (3), intra-articular screw (5), and infection (3). Average postoperative neck-shaft angle was 126° and 119.3° at final follow-up. Conclusions: This is the first comprehensive report of a novel implant for hip fractures specifically designed for low-resource settings. The early clinical data and outcomes suggest that the SHC can be safely inserted in the absence of fluoroscopy, and facilitates early mobilization while maintaining acceptable reduction until union.

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Journal articles on the topic 'Subtrochanteric hip fracture'

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