Intertrochanteric fractures are common hip fractures seen in the elderly that occur between the greater and lesser trochanters. There is no consensus on the best treatment, but options include intramedullary nails, sliding hip screws with side plates, and hemiarthroplasty in some cases. While both operative and non-operative treatments can be used, surgery typically leads to better outcomes through earlier mobilization and weight bearing. Newer intramedullary nails may provide faster recovery of walking ability compared to sliding hip screws, though implant selection depends on the fracture pattern and stability.
Bone fractures are a very common orthopedic injury resulting from trauma and sudden loads or stresses applied to bones or a result from bones being weakened by certain diseases. More than 250,000 femur fracture patients are seen per year in the U.S. on average. Bone fractures are either a complete or partial break in a bone and in some cases a simple cast to immobilize the injury site is not enough to completely heal the fracture.
Immobilization from casts may not be enough to completely heal the fracture if a malunion (when both ends of the fractured bone misalign) occurs and/or if a non-union (when the fracture gap is too large and the fractured ends cannot re-attach to one another) occurs. In the case of a malunion or non-union, a possible solution to the problem is by surgically inserting an intramedullary rod into the center canal (diaphysial) region of the injured bone and fixating it into place with screws.
Intertrochanteric fractures and its management with DHS or PFN or Arthroplasty
SUMMARY
We should be able to minimize the morbidity associated with an intertrochanteric fracture by:
• Recognizing the fracture pattern.
• Choosing the appropriate fixation device.
• Performing accurate reduction.
• Ideal implant placement.
• Being conscious of implant COSTS.
Bone fractures are a very common orthopedic injury resulting from trauma and sudden loads or stresses applied to bones or a result from bones being weakened by certain diseases. More than 250,000 femur fracture patients are seen per year in the U.S. on average. Bone fractures are either a complete or partial break in a bone and in some cases a simple cast to immobilize the injury site is not enough to completely heal the fracture.
Immobilization from casts may not be enough to completely heal the fracture if a malunion (when both ends of the fractured bone misalign) occurs and/or if a non-union (when the fracture gap is too large and the fractured ends cannot re-attach to one another) occurs. In the case of a malunion or non-union, a possible solution to the problem is by surgically inserting an intramedullary rod into the center canal (diaphysial) region of the injured bone and fixating it into place with screws.
Intertrochanteric fractures and its management with DHS or PFN or Arthroplasty
SUMMARY
We should be able to minimize the morbidity associated with an intertrochanteric fracture by:
• Recognizing the fracture pattern.
• Choosing the appropriate fixation device.
• Performing accurate reduction.
• Ideal implant placement.
• Being conscious of implant COSTS.
Exploring the Effect of Web Based Communications on Organizations Service Qua...IOSR Journals
The paper aims to study the effect of web based communications on the service quality of organizations. Web based communications is used for a variety of reasons.The quality of a Web-based customer support system involves the information it supplies, the service it provides, andcharacteristics of the system itself; its effectiveness is reflected by the satisfaction of its users. This paper presents the results of astudy of quality and effectiveness in Web-based customer support systems. Data from a survey of 726 Internet users were used to test theoretically expected relationships. The results of this study indicate that information and system quality determine effectiveness while service quality has no impact. Practical implications for managers and designers are offered.The Internet is the latest in a long succession of communication technologies. The goal of this work is to draw lessons from the evolution of all these services. Little attention is paid to technology as such, since that has changed radically many times. Instead, the stress is on the steady growth in volume of communication, the evolution in the type of traffic sent, the qualitative change this growth produces in how people treat communication, and the evolution of pricing. The focus is on the user, and in particular on how quality and price differentiation have been used by service providers to influenceconsumer behavior, and how consumers have reacted.
BACKGROUND: The stimulating effect of low level laser phototherapy on bone healing has been shown in a number of in vitro and animal studies. However, the effect of LLLT on the bone healing in human has not been previously wide demonstrated. The article reports an accidentally injury pattern and reported as fractures of the mid third of the left tibia. OBJECTIVE: The purpose of this case study was to demonstrate the biological effects of low-level laser therapy (LLLT) on tibial fractures treated surgically using radiographic, examinations. CASE REPORT: The case hospitalized for conventional surgery and followed by applying Low Level Laser Therapy LLLT to enhance and accelerate the bone fracture healing of the left tibia using the effect of laser bio-stimulation. Radiological x-ray imaging evaluation follow up for our case showed a significant bone healing rate as result of exposure of Diode Laser 650 nm with energy density of 5 J/cm2 three times/week for one month. Radiographic findings revealed no significant fracture callus thickness difference before using LLLT however, the fractures showed significant callus formation after using LLLT. CONCLUSION: The study suggests that LLLT accelerates the process of fracture repair or cause increases in callus volume
An Introduction, History, Diagnosis, Current Guidelines on Treatment of trochanteric fractures of femur. Presentation also contain an introduction of Dynamic Hip Screw and Surgical Techniques.
everytime i listen to a lecture, i wonder...shall i teach someone about ignoring, or how to ignore something...this concept was actually started with a though, how to ignore a teacher...Phylosophical presentation...
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
2. Introduction
• Extracapsular fractures of the proximal femur involving
the area between the greater and lesser trochanter.
• 50% of all fractures of the proximal femur
• One of the most common fracture in elderly
• High energy trauma in younger patients
• Carries risk with prolonged immobilization
3. • Mechanism of injury
• Clinical presentation
– Non ambulatory
– Limb is shortened, externally rotated and flexed at hip joint
– Bruises present at hip joint
• Radiographic evaluation
– AP view and cross table lateral view
– MRI
• Currently the imaging study of choice in delineating non displaced or
occult fractures that are not apparent on plain radiographs
– CT scan and bone scans are reserved
5. • Evans classification
– Based on prereduction and post reduction
stability
– Stable fracture patterns
• Posteromedical cortex remains intact or has minimal
communition
– Unstable fracture patterns
• Greater communition of the posteromedical cortex
6. Treatment
• Stable internal fixation, early mobilization and
full weight bearing ambulation.
• Good quality of fixation depends upon
– Bone quality
– Fracture pattern
– Fracture reduction
– Implant choice
– Implant placement
7. • Elderly hip fracture patients are at risk for
– increased rate of mortality
– inability to return to prior living circumstances
– the need for an increased level of care and
supervision
– decreased quality of life
– decreased level of mobility and ambulation
– secondary osteoporotic fractures, including a
second or contralateral side hip fracture.
8. • Available modalities for treatment
– Non operative
– Operative
• Compression screw with side plate
• Gottfried plate (percutaneous compression plate)
• Trochanteric stabilizing plate
• Intramedullary Nail
– Gamma Nail
– Intramedullary hip screw
• 95 degree Angle blade plate
– Dynamic compression screw
– Condylar blade plate
• Self dynamisable internal fixator
• External fixator
• Replacement arthroplasty
9. • Two types of implant are used in the treatment of
patients with intertrochanteric hip fracture:
– an SHS with a side plate, and
– an intramedullary (IM) nail with an SHS component.
• The IM component helps to buttress against fracture
collapse and medialization of the distal fracture
fragment, particularly in unstable (ie, reverse obliquity)
intertrochanteric fractures.
• the percutaneous insertion of the IM device may
reduce the amount of surgical trauma.
10. • In 1989, Hornby et al performed
– a randomized prospective study comparing nonsurgical
treatment (ie, traction) with a sliding hip screw (SHS) in 106
patients with intertrochanteric hip fracture.
– Complications were low in both groups, with no significant
difference in 6-month mortality, pain, leg swelling, or pressure
sores.
– Anatomic reduction was achieved more commonly with surgical
treatment, and these patients had shorter hospital stays.
– Patients treated with traction had greater loss of independence
at 6-month follow-up.
– recommended surgical treatment for medically stable patients.
11. Bridle SH, Patel AD, Bircher M, Cal- vert PT: Fixation of intertrochanteric fractures of the femur: A randomised prospective
comparison of the gamma nail and the dynamic hip screw. J Bone Joint Surg Br 1991;73:330-334.
• In 1991, Bridle et al reported on 100 patients with 41 stable
intertrochanteric fractures who were randomized to receive either a
Gamma nail (Stryker, Mahwah, NJ) or a dynamic hip screw (DHS).
– In this level I study, no differences were demonstrated in surgical time, blood
loss, wound complications, length of stay, or patient mobility at a minimum
follow-up of 6 months.
– Loss of reduction (lag screw, nail cutout) was similar between the two groups
of the patients treated with the Gamma nail, four experienced femoral shaft
fracture requiring revision surgery.
– For both groups, union occurred at an average of 6 months.
• Radford et al and Saudan et al found nearly identical results in their level I
studies of 200 and 206 patients, respectively, who were ran- domized to
receive either an IM nail or SHS fixation.
12. Adams CI, Robinson CM, Court- Brown CM, McQueen MM: Prospec- tive randomized controlled trial of an intramedullary nail
versus dynamic screw and plate for intertrochanteric fractures of the femur. J Orthop Trauma 2001;15:394-400.
• In 2001, Adams et al
– a prospective, randomized controlled trial assessing
IM nailing versus a DHS and side plate in 400 patients.
– Revision rates, femoral shaft fractures, and lag screw
cutout were slightly higher in patients treated with IM
nailing but did not differ significantly from the cohort
treated with a DHS.
– There was no difference in early or 1-year functional
outcomes.
13. • A 2003 retrospective level III study
– reviewed a population database to compare mortality rates in patients
with severe comorbidities who were treated either nonsurgically or
surgically for intertrochanteric hip fracture.
– The 30-day mortality rate was lower in patients treated surgically.
– However, when the authors compared surgical fixation with
nonsurgical treatment with early mobilization (ie, out of bed to chair),
they found no significant difference in mortality rate.
• recommend early mobilization out of bed to chair in patients with
nonsurgically managed hip fracture when it is feasible.
14. • Pajarinen et al
– Recovery of ambulation was a focus of the study who compared a
DHS with a proximal femoral nail (PFN) (Synthes, Oberdorf,
Switzerland) in 108 patients.
– Although the immediate postoperative outcomes did not differ
between the two groups, patients treated with IM devices had a
significantly faster return to preoperative ambulation levels (P = 0.04).
– Fracture healing was similar between the two groups at 4 months,
with two patients in each group requiring revision.
• Concluded that the PFN provided faster restoration of walking
ability than did the DHS in patients with unstable fracture patterns.
15. • Sadowski et al
– reported the results of 39 unstable reverse obliquity
intertrochanteric fractures managed with either an IM device or
a fixed-angle screw-plate device (Dynamic Condylar Screw;
Synthes).
– Clinical and radiographic follow-up demonstrated a shorter
mean surgical time for patients treated with IM nailing and a
significantly higher rate of implant failure and nonunion in the
group treated with the Dynamic Condylar Screw (P = 0.008 and
P = 0.007, respectively).
– Excluding patients with nonunion or failure, there was no
significant difference in postoperative walking ability or level of
independence.
16. • In 2005, Papasimos et al
– performed a randomized, prospective study of 120
patients with unstable intertrochanteric fractures
comparing an SHS, Gamma nail, and PFN.
– Mean blood loss, length of hospital stay, screw cutout, and
fracture reduction were not statistically different between
the three groups.
– Patients treated with PFN had a significantly longer
surgical time (P < 0.05), which the investigators suggested
was due to lack of surgeon experience with that device.
17. • Intramedullary Nails for extracapuslar hip fractures
– Gamma nail vs PFN
– ACE trochanteric nail and gamma nail
– Proximal femoral nail antirotation (PFNA) nail vs gamma nail
– Gliding nail vs. gamma nail
– Russell taylor recon nail vs gamma nail
– PFNA nail vs Targon PF nail
– Dynamically vs staticall y locked intramedullary hip screw
– Sliding vs non sliding gamma nail
– Long vs standard PFNA nails
• Concluded that limited evidence to determine whether there are
important differences in outcome between different designs of
intramedullary nails used in treating extracapsular hip fractures
Cochrane Database
18. • Cochrane database
– concluded that side plates are superior to
intramedullary nails in the treatment of
intertrochanteric femoral fractures.
– is meta-analysis, however, included older versions of
cephalomedullary nails, which had problems with
fracture at the distal tip of the nail.
– Although this complication does still occur, it is much
less frequent with newer nail designs.
19. InterTAN nail vs IM nail or SHS
• A newer intramedullary device (InterTAN) uses two integrated
proximal interlocking screws that allow linear intraoperative
compression.
• The nail’s geometry and integrated proximal interlocking at least
theoretically improve rotational stability in the proximal segment.
20. Concluded that both screw proximal femoral nails and helical proximal femoral nail are
suitable for intertrochanteric fractures but that helical proximal femoral nails offer
some advantage over functionality and complication rates
21. • Self dynamisable internal fixator
– recommend selfdynamisable
internal fixator as a safe
extramedullary implant for
fixation.
– It provides stable biological
fixation of proximal femoral
fractures, further adding
impaction of the fragments along
each axis (the axis of the femoral
neck and the axis of the femoral
shaft) whenever it is necessary to
achieve the union
22. ORIF Vs Arthroplasty
• Prosthetic hip replacement generally has not been
considered a primary treatment option for
intertrochanteric fractures.
• In the patient with preexisting symptomatic
degenerative arthritis, primary prosthetic replacement
may be the best option.
• considered for intertrochanteric fractures with extreme
comminution in severely osteoporotic bone in which
internal fixation methods are unlikely to be successful.
23. • In 2005, Kim et al
– performed a prospective randomized (level I) study of
unstable intertrochanteric fractures in elderly patients in
which long-stem cementless calcar-replacement hemi-
arthroplasty was compared with a PFN.
– No significant differences were found between the two
groups in terms of functional outcomes, hospital stay, time
to weight bearing, and risk of complications.
– However, surgical time (P < 0.001), blood loss (P < 0.001),
need for blood transfusions (P < 0.001), and mortality rates
(P < 0.006) were all significantly lower in the PFN group.
24. Kim SY, Kim YG, Hwang JK: Cement- less calcar-replacement hemiarthro- plasty compared with intramedullary fixation of unstable
intertrochanteric fractures: A prospective, randomized study. J Bone Joint Surg Am 2005;87: 2186-2192.
Haentjens P, Casteleyn PP, De Boeck H, Handelberg F, Opdecam P: Treatment of unstable intertrochanteric and subtrochanteric fractures in
el- derly patients: Primary bipolar arthro- plasty compared with internal fixa- tion. J Bone Joint Surg Am 1989;71: 1214-1225.
• Hemiarthroplasty Vs IM nail
– the hemiarthroplasty group was reported to have higher
transfusion rates.
– There is no overwhelming evidence from randomized
clinical trials to indicate that arthroplasty is more effective
than IM and extramedullary fixation of intertrochanteric
hip fractures.
• No significant differences in complications have been
reported between hemiarthroplasty or THA versus IM
fixation.
25. Kevin Kaplan, MD, et al Surgical Management of Hip Fractures: An Evidence-based Review of the Literature. II:
Intertrochanteric Fractures Volume 16, Number 11, November 2008
• There is no consensus regarding the ideal implant for
treating intertrochanteric fractures.
• based on the available evidence-based data, recommends
either a DHS or an IM device for stable intertrochanteric
fractures.
• For unstable fractures, we recommend an IM device.
• IM devices aid in early mobilization, return of ambulatory
function, decreased blood loss, and less surgical time.
• higher cost associated with the use of IM devices.
26. The current evidence is conflicting and does not
always support the treatment modalities that
are widely used in practice.
Techniques and implants continue to be
modified, making the older literature less
relevant to current practice.
27. With ongoing improvements in endoprostheses
and total hip replacements, increased surgeon
experience, and the need to separate stable
from unstable fractures, it is difficult to
recommend one optimum treatment of
intertrochanteric fractures from a purely
evidence-based perspective.
28. AAOS – Ten tips to better outcome
• Use the tip to apex distance
• No lateral wall, no hip screw
• Know the unstable intertrochanteric fracture patterns and Nail them
• Beware of the anterior bow of the femoral shaft
• When using a trochanteric entry nail, start slightly medial to the exact tip
of the greater trochanter
• Donot ream an unreduced fracture
• Becautious about the nail insertion trajectory and no not use a hammer to
seat the nail
• Avoid varus angulation of the proximal fragment – use the relation ship
between the tip of the trochanter and the center of the femoral head
• When nailing, lock the nail distally if the fracture is axially or rotationally
unstable
• Avoid fracture distraction when nailing