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Objective: To compare the outcome of DHS versus PFNA for treatment of intertrochanteric femoral fractures (IFFs) among elderly patients. Study Design: Randomized Clinical Trial. Setting: Sheikh Zayed Hospital, Lahore. Period: 2-03-2022 to 2-09-2022. Methods: In total 90 patients fulfilling inclusion criteria were registered after approval from the ethical review committee of the hospital. Every patient provided written informed consent. Patients were allotted to each group (Group A = PFNA, Group B = DHS) using lottery method. Patients were operated upon by a single surgical team. Data was obtained VIA questionnaires designed for pre- operative period, immediate post-operative period, 1 and 3 months follow up. Patients were interviewed and evaluated by blind researchers at each stage. Harris hip score was used to assess the functional outcomes. Results: In 90 patients (45 in each), 36.2% (n=17) were male in PFNA group and 63.8% (n=30) in DHS group and 65.1% (n=28) were female in PFNA and 34.9% (n=15) in DHS group, p=0.011. Mean age of PFNA group was calculated as 66.00± 3.41 years and mean age of DHS group was 66.80±3.71 years (p=0.714). Distribution of BMI was 28.14+6.20kg/m2 in PFNA group and 27.47+6.24kg/m2 in DHS group, p=0.612. Distribution of Harris hip score at 1 month was 31.11+4.08 in PFNA group and 30.11+4.18 in DHS group, p=0.254 and Harris hip score at 3 months was 88.68+1.23 in PFNA group and 81.68+0.95 in DHS group, p=0.000. Conclusion: We concluded that PFN is superior to DHS in treating Boyd and Griffin type II intertrochanteric fractures of femur. It's only a matter of time that PFN becomes the new gold standard for these fractures. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion Closed reduction and dynamic hip screw (DHS) osteosynthesis are preferred as joint‐preserving therapy in case of medial femoral neck fractures (MFNFs). A change in the femoral offset (CFO) can cause gait abnormality, impingement, or greater trochanteric pain syndrome. It is unknown whether the femoral offset (FO) can be postoperatively fully restored. The aim of the study was to investigate the extent of a possible CFO in hip joints after DHS osteosynthesis in the case of an MFNF.In this retrospective study, 104 patients (mean age: 71.02 years, men: n = 50, women: n = 54) with MFNF who underwent closed reduction and DHS osteosynthesis were analyzed by postoperative x‐rays to assess CFO between the operated (OS) and nonoperated joint side (NOS). The studies covered the time period 2010–2020. A statistical comparison was performed between the mean values of FO between OS and NOS, taking into account patient age, gender, and fracture severity.All operated hip joints showed a CFO. In 76.0% (79 of 104), the FO decreased (FOD), and in 24.0% (25 of 104), the FO increased (FOI). A critical CFO (>15% CFO) was detected in 52.9% (55 of 104). In hip joints with postoperative FOD, the mean FO between NOS (49.15 mm [±6.56]) and OS (39.32 mm [±7.87]) and in hip joints with postoperative FOI the mean FO between NOS (41.59 [±8.21]) and OS (47.27 [±6.68]) differed significantly (p < 0.001). Preoperative FO (rS: −0.41; p > 0.001) and caput–collum–diaphyseal angle (CCD; rS: 0.34; p > 0.001) correlated with postoperative CFO. FOD was found in hip joints with a preoperative FO >44 mm and CCD <134° vice versa FOI in hip joints with a preoperative FO <44 mm and CCD >134°.Closed reduction and DHS osteosynthesis in patients with MFNF result in a clustered significant CFO. The individual FO should be taken into account pre‐ and intraoperatively to avoid a postoperative extensive CFO. [ABSTRACT FROM AUTHOR]

Objective: To compare the functional and radiological outcomes of Dynamic Hip Screw (DHS) and Proximal Femoral Nail (PFN) treatments for patients with unstable intertrochanteric fractures. Study Design: Comparative study. Setting: Trauma Centre, Hayatabad Medical Complex Peshawar. Period: May 2020 to June 2022. Methods: The study comprised 150 patients aged over 40 years old and had Type 2 intertrochanteric fractures, as classified by Boyd and Griffin. Radiographs, functional assessments, and demographic information were collected and patients were followed for up to two years at regular intervals. Results: The mean age of patients was 70 years. The PFN group had significantly shorter surgery duration (57.47 minutes) compared to the DHS group (85.30 minutes), less blood loss (74 ml vs. 195 ml), and a shorter hospital stay (6.5 days vs. 11.8 days). Early weight bearing was achieved faster in the PFN group, with mean times to partial and full weight bearing of 3.12 and 8.45 weeks, respectively, compared to 5.52 and 12.32 weeks in the DHS group. Radiological union at three months was significantly better in the PFN group. Complications were fewer in the PFN group, with notable differences in screw cutout, migration, and backout rates. Pain levels were lower in the PFN group at three and six months post-operatively. Conclusion: PFN demonstrated superior outcomes in terms of reduced surgical time, blood loss, hospital stay, and faster weight-bearing capabilities compared to DHS. Radiological and functional outcomes also favoured PFN, making it a preferable option for treating unstable intertrochanteric fractures. [ABSTRACT FROM AUTHOR]

Key Clinical Message: The significance of taking femoral neck stress fractures into account as a possible consequence in sickle cell anemia patients is underscored by this case report. In this high‐risk group, early identification, timely diagnosis, and suitable care are crucial for averting major problems and improving results. When sickle cell anemia patients complain with hip or groin discomfort, healthcare practitioners should keep a high index of suspicion for femoral neck stress fractures to assure prompt management and prevent long‐term impairment. Sickle cell disease (SCD) is a prevalent genetic hemoglobinopathy with significant global implications, affecting a substantial portion of the population. Avascular necrosis of the femoral head is a common complication in SCD, leading to severe joint damage and immobility. This case report is of a 20‐year‐old male who presented with severe hip pain due to a femoral neck stress fracture, which progressed to a complete fracture. This patient had a past medical history of sickle cell anemia and a malunited subtrochanteric fracture that resulted in shortening, external rotation, and a limping gait. Surgical treatment via subtrochanteric osteotomy with fixation using a dynamic hip screw with or without iliac crest bone graft was planned, with a satisfactory reduction and closure of the fracture gap, postoperatively. In cases of sickle cell anemia patients, bone complications such as both osteonecrosis and stress fractures are common. As a healthcare provider, it is important to manage and address these not only through medical interventions, but also through counseling and patient education. Patients must be reminded about the importance of compliance with medical advice to avoid progression or recurrence of complications. [ABSTRACT FROM AUTHOR]

Abstract Background Basicervical femoral neck fracture is a rare proximal femur fracture with a high implant failure rate. Biomechanical comparisons between cephalomedullary nails (CMNs) and dynamic hip screws (DHSs) under torsion loading are lacking. This study compared the biomechanical performance of three fixations for basicervical femoral neck fractures under torsion load during early ambulation. Methods The biomechanical study models used three fixations: a DHS, a DHS with an anti-rotation screw, and a short CMN. Finite element analysis was used to simulate hip rotation with muscle forces related to leg swing applied to the femur. The equivalent von Mises stress (EQV) on fixation, fragment displacement, and strain energy density at the proximal cancellous bone were monitored for fixation stability. Results The EQV of the short CMN construct (304.63 MPa) was comparable to that of the titanium DHS construct (293.39 MPa) and greater than that of the titanium DHS with an anti-rotation screw construct (200.94 MPa). The proximal fragment displacement in the short CMN construct was approximately 0.13 mm, the greatest among the constructs. The risk of screw cutout for the lag screw in short CMNs was 3.1–5.8 times greater than that for DHSs and DHSs with anti-rotation screw constructs. Conclusions Titanium DHS combined with an anti-rotation screw provided lower fragment displacement, stress, and strain energy density in the femoral head than the other fixations under torsion load. Basicervical femoral neck fracture treated with CMNs may increase the risk of lag screw cutout. Graphical abstract

Objective: To find out the functional outcomes as per Harris hip score (HHS) among patients of pertrochanteric fractures undergoing dynamic hip screw (DHS) versus proximal femoral nail anti-rotation (PFNA) at a Tertiary care hospital. Study Design: Non-randomized Controlled Trial. Setting: Orthopedic Section, Department of Surgery, Agha Khan University Hospital, Karachi, Pakistan. Period: 1st August 2023 to 30th January 2023. Methods: A total of 40 patients of age 18 and older with confirmed pertrochanteric fractures were non-randomly allocated to ether fixation with DHS or PFNA. Intraopeative blood loss and duration of surgery were recorded. The functional outcome assessment was assessed using HHS. Results: In a total of 40 patients, 31 (77.5%) were female. The mean age was 67.63±15.13 years (ranging between 23 to 89 years). The most common mechanism of fall was tipped over loose carpet, noted in 17 (42.5%) patients. The mean intra-operative blood loss in DHS and PFNA groups were 73.75±20.06 ml, and 72.75±23.14 ml, respectively (p=0.885). The mean duration of surgery were 76.6±14.7 minutes, and 115.1±18.3 minutes in DHS and PFNA groups, respectively (p<0.001). Excellent, good, fair, poor, and failed outcomes were reported in 3 (7.5%), 17 (42.5%), 6 (15.0%), 10 (25.0%), and 4 (10.0%) patients respectively. When both groups were compared for outcomes, no statistically significant differences were observed (p=0.339). The mean HHS in DHS, and PFNA groups were 75.26±11.41, and 73.46±14.57, respectively (p=0.666). Conclusion: Functional outcomes as per HHS were relatively similar with DHS and PFNA approaches in patients with pertrochanteric fractures. [ABSTRACT FROM AUTHOR]

Background: Basicervical femoral neck fracture is a rare proximal femur fracture with a high implant failure rate. Biomechanical comparisons between cephalomedullary nails (CMNs) and dynamic hip screws (DHSs) under torsion loading are lacking. This study compared the biomechanical performance of three fixations for basicervical femoral neck fractures under torsion load during early ambulation. Methods: The biomechanical study models used three fixations: a DHS, a DHS with an anti-rotation screw, and a short CMN. Finite element analysis was used to simulate hip rotation with muscle forces related to leg swing applied to the femur. The equivalent von Mises stress (EQV) on fixation, fragment displacement, and strain energy density at the proximal cancellous bone were monitored for fixation stability. Results: The EQV of the short CMN construct (304.63 MPa) was comparable to that of the titanium DHS construct (293.39 MPa) and greater than that of the titanium DHS with an anti-rotation screw construct (200.94 MPa). The proximal fragment displacement in the short CMN construct was approximately 0.13 mm, the greatest among the constructs. The risk of screw cutout for the lag screw in short CMNs was 3.1–5.8 times greater than that for DHSs and DHSs with anti-rotation screw constructs. Conclusions: Titanium DHS combined with an anti-rotation screw provided lower fragment displacement, stress, and strain energy density in the femoral head than the other fixations under torsion load. Basicervical femoral neck fracture treated with CMNs may increase the risk of lag screw cutout. [ABSTRACT FROM AUTHOR]

Key Clinical Message The significance of taking femoral neck stress fractures into account as a possible consequence in sickle cell anemia patients is underscored by this case report. In this high‐risk group, early identification, timely diagnosis, and suitable care are crucial for averting major problems and improving results. When sickle cell anemia patients complain with hip or groin discomfort, healthcare practitioners should keep a high index of suspicion for femoral neck stress fractures to assure prompt management and prevent long‐term impairment. Abstract Sickle cell disease (SCD) is a prevalent genetic hemoglobinopathy with significant global implications, affecting a substantial portion of the population. Avascular necrosis of the femoral head is a common complication in SCD, leading to severe joint damage and immobility. This case report is of a 20‐year‐old male who presented with severe hip pain due to a femoral neck stress fracture, which progressed to a complete fracture. This patient had a past medical history of sickle cell anemia and a malunited subtrochanteric fracture that resulted in shortening, external rotation, and a limping gait. Surgical treatment via subtrochanteric osteotomy with fixation using a dynamic hip screw with or without iliac crest bone graft was planned, with a satisfactory reduction and closure of the fracture gap, postoperatively. In cases of sickle cell anemia patients, bone complications such as both osteonecrosis and stress fractures are common. As a healthcare provider, it is important to manage and address these not only through medical interventions, but also through counseling and patient education. Patients must be reminded about the importance of compliance with medical advice to avoid progression or recurrence of complications.

BACKGROUND & OBJECTIVE: Femur fractures result in a high rate of mortality and morbidity. Objective was to compare effectiveness of percutaneous dynamic hip screw fixation technique (PC-DHS) and conventional open dynamic hip screw (DHS) in terms of mean operative time, wound size, pain scores, intraoperative blood loss, screening time, hospital stay at 2 weeks, mean full weight bearing mobilization at 6 weeks, mean hip Harris scores at 6 weeks and 3 months and mean radiological healing at 3 months in older patients having an intertrochanteric fracture of femur neck at tertiary care hospital. METHODOLOGY: The study design was a prospective observation study at the Department of Orthopedics, POF hospital. The study duration was 2 years (2018-2020). The sample size was 130 with 1:1 randomization in each group. Patients were selected through nonprobability sampling (lottery method) and divided into two groups; Group A underwent PC-DHS and Group B underwent conventional DHS procedure. Data was analyzed using SPSS version 24. RESULTS: A total of 130 patients were studied. Patients who underwent PC-DHS showed significantly low operative time (p<0.00), wound size (p<0.00), intraoperative blood loss (p<0.00), pain scores (p<0.00), hospital stay length (p<0.00) at 2 weeks as compared to conventional DHS. PC-DHS patients showed high Hip scores (p<0.00) at 3 months and at 6 months (p<0.00). The frequency of chronic hip pain, non-union, implant failure, avascular necrosis, chronic osteomyelitis, and deep venous thrombosis was high in conventional open DHS. CONCLUSION: We found PC-DHS as a more effective and safe technique for intertrochanteric fracture fixation resulting in significant improvement in surgical outcomes at 2 weeks, 6 weeks, 3 months, and 6 months. [ABSTRACT FROM AUTHOR]

Intertrochanteric fractures are a common type of proximal femoral fracture, and account for high morbidity and mortality. Early recognition and management of such fractures is important, with surgery preferably undertaken within 48 hours. The choice of surgical strategy remains variable between centres and individual surgeons; in part because evidence to support a specific strategy has been weak. Herein, we provide the latest evidence on the management of these fractures. [ABSTRACT FROM AUTHOR]

The aim of this study is to present the results of single-stage total hip arthroplasty (THA) after Dynamic Hip Screw (DHS) failure, or secondary posttraumatic osteoarthrosis. From 2003 to 2020, 15 THAs were performed in group of 15 patients for the treatment of DHS failure, or for late complications following femoral neck and pertrochanteric fractures. The mean follow-up period after arthroplasty was 46.9 months (range 7–139). The patients were evaluated retrospectively—both clinically and radiographically, focussing on the demography, infection rate and other complications (revision surgery), during the year 2023. 9 males and 6 females were included in the study, with a mean age of 56.5 years (range 29–93) at the time of primary osteosynthesis. Each of them had proximal femoral fracture treated primarily with a DHS and then late one-stage revision surgery, with hardware removal and THA implantation. The median time between DHS osteosynthesis and THA was 41.2 months (range 4–114). Four patients (26.6%) had complications after THA, with the need for revision in two cases (13.3%). Dislocation rate was 6.6% (one case), with the need for repeated-revision of THA. The infection rate was 6.6% (one patient) with the need for revision of THA. Peroperative periprosthetic femoral fracture was observed in 13.3% (two patients) without any other problems. Six patients (40%) died during the follow-up period. Single-stage total hip arthroplasty with concomitant hardware removal bears a high- mortality rate, with a higher incidence of postoperative complications compared to elective THA. [ABSTRACT FROM AUTHOR]

Background:About half of all hip fractures brought on by low energy mechanisms are pertrochanteric fracture (PTFs). There are several risk factors, such as osteoporosis, female gender, growing age, and abnormal gait. Thus, this study aimed to analyze the functional outcome of the patients with PTFs who underwent dynamic hip screw (DHS) implant. Materials and Methods:This prospective observational study involved 30 adult patients with PTFs who underwent surgery with DHS implant in the Department of Orthopedics of a tertiary care institute. The patients were followed-up at 6-weeks, 1-month, 3-months, and 6-months. Postoperatively, and at each follow-up, clinical and radiological examination was performed. Moreover, at the end of the study, functional outcome was assessed with Harris Hip Score (HHS). Results:The study population had female predominance (50%) with half of the patients belonging to the age group of 60-70 years. Trivial trauma (93.33%) was the most common injury with Boyd and Griffin type 2 (43.33%) being the most common fracture type. The duration of fracture union was 10.46 ± 2.43 weeks and complete union was observed in 28 (93.33%) patients. Assessment with HHS revealed excellent and good functional outcome in 18 (60%) and 6 (20%) patients, respectively. Conclusion:In patients with PTFs, DHSprovides stable construct and facilitates early mobilization and weight bearing to the patients. [ABSTRACT FROM AUTHOR]

Introduction: Intertrochanteric fractures are the most common, especially in elderly people with osteoporotic bones. They typically occur as a result of low-energy trauma, such as a simple fall. There is a bimodal age distribution for hip fractures. Only 3% of patients under the age of 50 years, while 97% of patients over 50 years of age. The goal of this study is to compare PFN and DHS outcomes and complications when treating patients with unstable intertrochanteric fractures. Methods and Methodology: This study consists of 30 cases of intertrochanteric fractures of femur that met the inclusion exclusion criteria, which randomly divided into group A and group B. Results: Anatomical results were assessed by the presence or absence of shortening, the range of movements and deformities.73.33% of these cases had good results in PFN series as compared to 66.66% in DHS series. Functional results were assessed in the 30 cases based on modified harris hip scoring system. These constituted of 15 cases in PFN series and 15 cases in DHS series. In PFN Series, results were excellent results in 11 cases, good in 4 cases. In DHS Series, results were excellent in 7 cases, good in 6 cases and poor in 2 cases. Conclusion: In the light of these results, one can conclude that the proximal femoral nail, despite a few unfavorable results and complications, it is a satisfactory method of treatment in intertrochanteric fractures, with Comminution and instability. Results with intramedullary devices have been very good with union ratesupto 100% compared with other extra medullary devices which show union upto 80% only. The nail in the medullary canal provides a physical block to a significant shortening of the head and neck segments in the fractures. [ABSTRACT FROM AUTHOR]

Purpose: Several surgical implants have been used for the treatment of neck of femur fracture (NOF) in younger patients such as dynamic hip screw (DHS) and cannulated compression screw. However, the superiority of one or another osteosynthesis device remains a matter of debate. The aim of this work is to evaluate and compare three fixation modalities: Cannulated Hip Screws (CHS), DHS and DHS associated to anti-rotating screw for surgical treatment of femoral neck fracture in young adults. Methods: It is a retrospective comparative study of three series of NOF fractures treated surgically over a period of ten years; including young adult patients (age > 18 years and < 65 years) treated conservatively using closed or open reduction and internal fixation. All types of NOF fractures according to Garden classification were included. Pathological, basi-cervical fractures and fractures on previously operated hips were excluded. The minimum follow-up recommended was two years. Clinical evaluation was based on the Postel Merle d'Aubigné score (PMA), the visual analogue scale (VAS), the Parker score, and the Hip Disability and Osteoarthritis Outcome Score (HOOS score). Reduction quality was assessed on X-rays. Results: Our series included 72 patients that were divided in three groups: Group A: Fixation using cannulated hip screws (33 patients). Group B: Fixation using DHS only (21 patients). Group C: Fixation using DHS associated to anti-rotation screw (18 patients). The patients of group A had better PMA and VAS scores, but there was no statistically significant difference. However, a significant difference (p=0.001) was found for the HOOS score. The fractures treated with DHS associated with anti-rotating screws, had the highest loss of reduction in the vertical axis (Yp) with the highest femoral head collapse (Zp) values. Group A had the lowest loss of reduction in the horizontal axis (Xp). There was no significant difference between the three methods of osteosynthesis in terms of loss of correction though. Conclusion: We found comparable results in terms of healing and complication rates and loss of reduction for the three groups with no significant difference. However, the HOOS score was significantly better in the cannulated hip screw group. [ABSTRACT FROM AUTHOR]

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Background and Objective: Femur fractures result in a high rate of mortality and morbidity. Objective was to compare effectiveness of percutaneous dynamic hip screw fixation technique (PC-DHS) and conventional open dynamic hip screw (DHS) in terms of mean operative time, wound size, pain scores, intraoperative blood loss, screening time, hospital stay at 2 weeks, mean full weight bearing mobilization at 6 weeks, mean hip Harris scores at 6 weeks and 3 months and mean radiological healing at 3 months in older patients having an intertrochanteric fracture of femur neck at tertiary care hospital. Methodology: The study design was a prospective observation study at the Department of Orthopedics, POF hospital. The study duration was 2 years (2018-2020). The sample size was 130 with 1:1 randomization in each group. Patients were selected through nonprobability sampling (lottery method) and divided into two groups; Group A underwent PC-DHS and Group B underwent conventional DHS procedure. Data was analyzed using SPSS version 24. Results: A total of 130 patients were studied. Patients who underwent PC-DHS showed significantly low operative time (p

Abstract Background Our aim was to determine the best operative procedure in human participants with a displaced or non-displaced femoral neck fracture comparing cannulated screw (CS) fixation, dynamic hip screw (DHS) fixation, hemiarthroplasty (HA), and total hip arthroplasty (THA) in terms of surgical and functional outcomes, reoperation and postoperative complications. Methods We searched PubMed, The Cochrane Library, Clinical trials, CINAHL, and Embase for randomized controlled trials (RCTs) or quasi-RCTs up to 31 July 2022. A frequentist network meta-analysis was performed to assess the comparative effects of the four operative procedures, using fixed-effects and random-effects models. Mean differences (MDs) with 95% confidence intervals (CIs) were estimated for continuous variables and odds ratios (ORs) with 95% CIs were estimated for binary variables. Results A total of 33 RCTs with 5703 patients were included in our network meta-analysis. CS fixation was best in terms of operation time (CS: MD = − 57.70, 95% CI − 72.78; − 42.62; DHS: MD = − 53.56, 95% CI − 76.17; − 30.95; HA: MD = − 20.90, 95% CI − 30.65; − 11.15; THA: MD = 1.00 reference) and intraoperative blood loss (CS: MD = − 3.67, 95% CI − 4.44; − 2.90; DHS: MD = − 3.20, 95% CI − 4.97; − 1.43; HA: MD = − 1.20, 95% CI − 1.73; − 0.67; THA: MD = 1.00 reference). In life quality and functional outcome, measured at different time points with EQ-5D and the Harris Hip Score (HHS), THA ranked first and HA second (e.g. EQ-5D 2 years postoperatively: CS: MD = − 0.20, 95% CI − 0.29; − 0.11; HA: MD = − 0.09, 95% CI − 0.17; − 0.02; THA: MD = 1.00 reference; HHS 2 years postoperatively: CS: MD = − 5.50, 95% CI − 9.98; − 1.03; DHS: MD = − 8.93, 95% CI − 15.08; − 2.78; HA: MD = − 3.65, 95% CI − 6.74; − 0.57; THA: MD = 1.00 reference). CS fixation had the highest reoperation risk, followed by DHS fixation, HA, and THA (CS: OR = 9.98, 95% CI 4.60; 21.63; DHS: OR = 5.07, 95% CI 2.15; 11.96; HA: OR = 1.60, 95% CI 0.89; 2.89; THA: OR = 1.00 reference). Conclusion In our cohort of patients with displaced and non-displaced femoral neck fractures, HHS, EQ-5D, and reoperation risk showed an advantage of THA and HA compared with CS and DHS fixation. Based on these findings, we recommend that hip arthroplasty should be preferred and internal fixation of femoral neck fractures should only be considered in individual cases. Level of evidence I: a systematic review of randomized controlled trials. Trial registration: PROSPERO on 10 August 2022 (CRD42022350293).

Abstract Background Hip fractures are still unsolved problems nowadays. We evaluated the functional outcomes and complications in the treatment of hip fractures (AO/OTA31A1-A3) to find potential difference and risk between intramedullary nail (IMN) and dynamic hip screw (DHS). Method We searched PubMed, Embase, Cochrane library up to 19 June 2023 and retrieved any studies comparing IMN and DHS in treatment of Hip fractures. The main outcomes and complications were extracted from the included studies. The fixed-effect model was selected to pool the data for homogeneous studies (I2 50%). The analysis of sensitivity and subgroup was performed to explore the homogeneous studies among studies. The p-value of less than 0.05 was considered statistically significant. Results 30 RCT studies were included in this meta-analysis. There were significant difference of in the items of blood loss, screening time, femoral neck shortening, non-union, and femoral fractures (p

Background: Our aim was to determine the best operative procedure in human participants with a displaced or non-displaced femoral neck fracture comparing cannulated screw (CS) fixation, dynamic hip screw (DHS) fixation, hemiarthroplasty (HA), and total hip arthroplasty (THA) in terms of surgical and functional outcomes, reoperation and postoperative complications. Methods: We searched PubMed, The Cochrane Library, Clinical trials, CINAHL, and Embase for randomized controlled trials (RCTs) or quasi-RCTs up to 31 July 2022. A frequentist network meta-analysis was performed to assess the comparative effects of the four operative procedures, using fixed-effects and random-effects models. Mean differences (MDs) with 95% confidence intervals (CIs) were estimated for continuous variables and odds ratios (ORs) with 95% CIs were estimated for binary variables. Results: A total of 33 RCTs with 5703 patients were included in our network meta-analysis. CS fixation was best in terms of operation time (CS: MD = − 57.70, 95% CI − 72.78; − 42.62; DHS: MD = − 53.56, 95% CI − 76.17; − 30.95; HA: MD = − 20.90, 95% CI − 30.65; − 11.15; THA: MD = 1.00 reference) and intraoperative blood loss (CS: MD = − 3.67, 95% CI − 4.44; − 2.90; DHS: MD = − 3.20, 95% CI − 4.97; − 1.43; HA: MD = − 1.20, 95% CI − 1.73; − 0.67; THA: MD = 1.00 reference). In life quality and functional outcome, measured at different time points with EQ-5D and the Harris Hip Score (HHS), THA ranked first and HA second (e.g. EQ-5D 2 years postoperatively: CS: MD = − 0.20, 95% CI − 0.29; − 0.11; HA: MD = − 0.09, 95% CI − 0.17; − 0.02; THA: MD = 1.00 reference; HHS 2 years postoperatively: CS: MD = − 5.50, 95% CI − 9.98; − 1.03; DHS: MD = − 8.93, 95% CI − 15.08; − 2.78; HA: MD = − 3.65, 95% CI − 6.74; − 0.57; THA: MD = 1.00 reference). CS fixation had the highest reoperation risk, followed by DHS fixation, HA, and THA (CS: OR = 9.98, 95% CI 4.60; 21.63; DHS: OR = 5.07, 95% CI 2.15; 11.96; HA: OR = 1.60, 95% CI 0.89; 2.89; THA: OR = 1.00 reference). Conclusion: In our cohort of patients with displaced and non-displaced femoral neck fractures, HHS, EQ-5D, and reoperation risk showed an advantage of THA and HA compared with CS and DHS fixation. Based on these findings, we recommend that hip arthroplasty should be preferred and internal fixation of femoral neck fractures should only be considered in individual cases. Level of evidence I: a systematic review of randomized controlled trials. Trial registration: PROSPERO on 10 August 2022 (CRD42022350293). [ABSTRACT FROM AUTHOR]

Aim: The Purpose of this study was to evaluate biomechanical factors working around hip which leads to implant failure. Material & Methods: This was an observational study. All 20 cases below 75 years of age with proximal femoral fracture [fracture Inter-trochanteric & Sub-trochanteric included] fixed with PFN irrespective of the centre where surgery was performed attending routine out-door of Department of Orthopaedics, Shridevi Institute of Medical Sciences & Research Hospital, Tumkur, India with implant failure were registered for the study. Results: In our study we registered total of 20 cases with mean age of registered cases was 64.86 + 8.50 years. 15 patients (75%) were male and 5 (25%) were females. Except 3, all cases of implant failure in our study were categorized as unstable type according to EVAN’s & A.O. classifications preoperatively. Out of 20 cases registered, pattern of implant failure in our study were 6 cases (30%) had implant failure pattern of Z- effect, 5 cases (25%) had implant failure pattern of reverse Z-effect; 2 (10%) had breakage of nails; 1 cases (5%) had both screw breakage with varus collapse; 3 (15%) had single upper proximal screw breakage; & 3 cases (15%) were associated with spiral fracture femur just distal to the tip of PFN. Conclusion: Proper implant selection is critical and should be done on an individualized patient and fracture pattern basis. Poor surgical technique, implant-related issues, delayed fracture union, and poor patient compliance and health status alone or in combination can lead to breakage of the implants requiring challenging treatment options. Prevention of such catastrophic complications is crucial for the patient’s health and quality of life. Biomechanical study of the broken implant may provide useful information regarding failure causes and guide future treatment. Surgeons and mechanics should work hand in hand for implants evolution in order to optimize patient treatment. [ABSTRACT FROM AUTHOR]

Objective: To determine the efficacy of preoperative Tranexamic Acid (TXA) in reducing perioperative allogenic blood transfusion frequency in patients with intertrochanteric fractures treated with Dynamic Hip Screw (DHS). Methods: We conducted this placebo controlled double-blinded randomized trial in Orthopaedics & Traumatolgy Division Lady Reading Hospital, Peshawar from 1st January 2020 to 25th December 2022. All patients with intertrochanteric hip fractures fulfilling the inclusion criteria were treated with Dynamic Hip Screw (DHS) and were randomly divided into two equal groups. One group was administered single dose IV Tranexamic Acid (TXA) in a dose of 15mg/kg body weight in 100ml of saline while the other group (Placebo) was given 100 ml normal saline preoperatively. Postoperative Hemoglobin was measured on first, second and third day. The frequency of allogenic blood transfusions in the perioperative period was determined in both groups based upon the transfusion trigger (Hemoglobin 9g/dl). Categorical variables were compared with Chi-square test and mean with Independent sample t-test. P value of <0.05 was considered significant. Results: The total number of patients in our trial were 200 which were equally but randomly allocated into TXA group and Placebo group each containing 100 patients. The mean age of the patients in TXA group was 48.16±1.75 years and the age of patients in the Placebo group was 48.35±1.60. The baseline demographic and clinical variables of both groups were identical (p< 0.05). The average preoperative hemoglobin was 11.5±4.2 g/dl in TXA group and 11.3±2.4g/ dl in the Placebo group (p>0.05). The frequency of allogenic blood transfusion was significantly lower (p<0.05) in TXA group (13%, n=13) than in the Placebo group (41%, n=41). Conclusion: Tranexamic acid (TXA) significantly reduces the frequency of peri operative allogenic blood transfusion in patients undergoing Dynamic Hip Screw (DHS) for intertrochanteric fractures. [ABSTRACT FROM AUTHOR]

Background: The femoral neck system (FNS) was introduced as a minimally invasive fixation device for managing femoral neck fractures. Objective: To compare radiographic, clinical, and patient-reported outcome measures (PROMs) of femoral neck fracture patients following FNS compared to dynamic hip screw (DHS) implantation combined with an anti-rotational screw. Methods: Patients who underwent closed reduction and internal fixation of a femoral neck fracture between 2020 and 2022 were retrospectively included. We measured leg length, femoral offset, and centrum–collum–diaphyseal (CCD) angle in plain radiographs. Scar length, Harris Hip Score, short-form health survey 36-item score (SF-36), and Numeric Rating Scale (NRS) were assessed during follow-up visits. Results: We included 43 patients (22 females) with a median age of 66 (IQR 57, 75). In both groups, leg length differences between the injured and the contralateral side increased, and femoral offset and CCD angle differences were maintained over time. FNS patients had shorter scars and reported fewer emotional problems and more energy. There were no differences between groups regarding the remaining SF-36 sub-scores, Harris Hip Score, and NRS. Conclusions: The FNS allows for a comparable leg length, femoral offset, and CCD angle reconstruction while achieving similarly high functional and global health scores to the DHS. [ABSTRACT FROM AUTHOR]

In this study, a meta‐analysis was conducted to comprehensively analyse the effectiveness of using proximal femoral nail anti‐rotation (PFNA) and dynamic hip screws (DHS) to treat intertrochanteric fractures on postoperative surgical site infections (SSI). PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure (CNKI), and Wanfang databases were searched from their inception until December 2022 to identify studies that compared PFNA and DHS in the treatment of intertrochanteric fractures. Two investigators independently screened the retrieved studies to assess their quality and verify their eligibility for inclusion. Meta‐analyses were performed with RevMan 5.4 software. Thirty studies, including 3158 patients, met the inclusion criteria. These studies included 1574 patients treated with PFNA, and 1584 were treated with DHS. The findings of the meta‐analysis revealed a significant reduction in the incidence of SSI in patients treated with PFNA compared with those treated with DHS (2.64% vs 6.76%, odds ratio [OR]: 0.40, 95% confidence intervals [CIs]: 0.28–0.57, P <.001), superficial SSI (2.58% vs 5.01%, OR: 0.53, 95% CIs: 0.33–0.85, P =.008) and deep SSI (1.26% vs 3.43%, OR: 0.41, 95% CIs: 0.19–0.92, P =.03). PFNA was more effective than DHS in reducing the incidence of SSI. Even so, significant variations in sample sizes among the included studies meant that the methodology for some studies had qualitative deficiencies. Therefore, additional studies with large sample sizes are needed to validate these results. [ABSTRACT FROM AUTHOR]

Considered from the point of view of incidence, the second type of neoplasm present in men, prostate cancer frequently leads to the appearance of various secondary bone determinations located especially at the level of the proximal femur. In addition to the pathologic bone fractures that can occur with low-intensity trauma, joint pain can be high-intensity and in many situations the analgesic treatment can be exceeded. In order to increase the quality of life and the mobility of the joints of these patients, surgical treatment can be performed by preventive fixation of the proximal femur affected by bone metastases with different types of implants such as Dynamic Hip Screw (DHS) and Gamma Nail. Surgical management of a patient with bone metastases should take into account the patient's condition at the time of presentation, but also the best option to reduce pain and increase joint mobility, limiting the risk of pathologic fractures. [ABSTRACT FROM AUTHOR]

Background: Hip fractures are still unsolved problems nowadays. We evaluated the functional outcomes and complications in the treatment of hip fractures (AO/OTA31A1-A3) to find potential difference and risk between intramedullary nail (IMN) and dynamic hip screw (DHS). Method: We searched PubMed, Embase, Cochrane library up to 19 June 2023 and retrieved any studies comparing IMN and DHS in treatment of Hip fractures. The main outcomes and complications were extracted from the included studies. The fixed-effect model was selected to pool the data for homogeneous studies (I2 < 50%). Otherwise, the random effects model was selected (heterogeneity, I2 > 50%). The analysis of sensitivity and subgroup was performed to explore the homogeneous studies among studies. The p-value of less than 0.05 was considered statistically significant. Results: 30 RCT studies were included in this meta-analysis. There were significant difference of in the items of blood loss, screening time, femoral neck shortening, non-union, and femoral fractures (p < 0.05). Significant difference was found in the parameter of open reduction of fracture after sensitive analysis (p < 0.05). No significant difference was found in the parameter of Mobility Score at the last follow-up after sensitive analysis (p ≥ 0.05). There was no significant difference in the parameters of open reduction of fracture, required blood transfusion, mean surgical time, hospital stays, time to healing, mean Harris Hip Score, infection, cut out, poor reduction, breakage of implant, failure of fixation, reoperation, and systemic complications of chest infection, decubital ulcer, urinary tract infection and persistent pain in the hip (p ≥ 0.05). Conclusions: Our meta-analysis revealed that hip fractures treated with IMN have merits with lower rate of blood loss, femoral neck shortening and non-union; shortcoming of increased risk of femoral fractures. It is suggested that special attention should be paid to the risk of femoral fracture when intramedullary nail was inserted in the intraoperative. [ABSTRACT FROM AUTHOR]

Introduction: Intertrochanteric fractures are predominantly treated by dynamic hip screw (DHS) fixation. However, recent evidence has found acceptable clinical results following hemiarthroplasty for these fractures. Thus, a systematic review was conducted to compare hemiarthroplasty with DHS fixation for intertrochanteric fractures. Methods: A computerised search was performed, using the databases Medline, EMBASE, CINAHL and the Cochrane Central Register of Controlled Trials, with supplementation from Google Scholar and appropriate reference lists. Studies with comparative data comparing clinical outcomes of hemiarthroplasty versus DHS fixation were included. Data were extracted and quality assessment of the papers performed by 2 reviewers. Results: 320 articles were independently reviewed by the investigators. A total of 10 studies met the inclusion criteria, comprising 2 randomised controlled trials and 8 cohort designs. 7 of the studies assessed unstable fracture patterns. There was no difference in operating time (SMD −1.169 min; 95% CI, −0.657 to 0.689) or blood transfusion volume (SMD−0.110 units; 95% CI, −0.520 to 0.891) between modalities. There was also no difference in length of stay (SMD −0.778 days; 95% CI, −0.606 to 0.336), mortality (RR 0.942; 95% CI, 0.749–1.183) or major complications. Hemiarthroplasty conferred significantly better Harris Hip Scores at 12 months (SMD 12.3; 95% CI, 0.0135–2.789) and allowed earlier weight-bearing than DHS fixation. Discussion: Qualitative and quantitative compilation of the included studies demonstrates hemiarthroplasty to result in better functional scores and a quicker time to weight-bearing than DHS fixation for intertrochanteric fractures. Results are comparable for other major parameters, including operative time, length of stay and mortality. Thus, hemiarthroplasty is a suitable alternative to DHS fixation for unstable intertrochanteric fractures in elderly patients. [ABSTRACT FROM AUTHOR]

Abstract Background Ipsilateral femoral neck and hip fractures are uncommon high energy injuries. In the literature no single method of treatment has emerged as superior to the others. A recent publication has documented the successful application of the rendezvous technique using dual-implants for treating these injuries. However in some cases, this technique may fail and revision surgery is required. Case presentation A 67-year old man sustained ipsilateral fractures of his femur and femoral neck in a road traffic accident. His injuries were treated by a dual construct consisting of a retrograde femoral nail and dynamic hip screw. Three months after surgery the hip screw cut out of the femoral head necessitating revision to a total hip arthroplasty. Surgery was carried out using a single stage two part procedure on a standard operating table without having to reposition or redrape the patient. There were no postoperative complications and at 1 year from surgery the patient is satisfied with the result and has returned to work. Conclusion Conversion hip arthroplasty in the presence of dual implants is a technically challenging and unpredictable procedure, with an increased risk of complications. Our surgical approach provides a framework for orthopedic surgeons to safely perform this complex procedure.

Background: Although femoral neck fractures are common in elderly individuals, it is an uncommon occurrence in young patients. It is crucial to achieve anatomical reduction as well as stable fixation so as to avoid complications in young individuals who are expected to have considerable functional demand in post-surgical period. Dynamic hip screws are commonly used for internal fixation of these fractures. Although satisfactory functional outcomes have been reported in the patients treated by DHS, complications such as malunion and osteonecrosis remain an area of concern. Aims and Objectives: The aims of the study were to study the functional outcome of young patients with femoral neck fractures treated by DHS with CC screws and to study the complications in young patients with femoral neck fractures treated by DHS with CC screws. Materials and Methods: This was a prospective cohort study in which 80 young adults (below the age of 45 years) having femoral neck fractures and treated by DHS with 2CC screws were included in this study on the basis of a predefined inclusion and exclusion criteria. Gender and distribution, nature of injury, type of fracture, functional outcome, and complications were studied in studied cases. Open reduction and internal fixation was done using dynamic hip screw. The functional outcome was assessed using modified Harris hip score. All patients were assessed for complications such as non-union, malunion, and osteonecrosis. Statistical analysis was done using SSPS 21.0 software and P

• Femoral neck system, multiple cancellous screws, and dynamic hip screws are effective for femoral neck fractures. • Femoral neck system is a simpler operation, with earlier weight-bearing time, than multiple cancellous screws. • The main advantage of femoral neck system over dynamic hip screws is a minimally invasive operation. To compare the short-term outcomes of the femoral neck system (FNS) with multiple cancellous screws (MCS) and dynamic hip screws (DHS) in the treatment of femoral neck fractures. A retrospective analysis was performed on 157 patients with fresh femoral neck fractures treated with FNS (from September 2019 to October 2020), MCS, and DHS (from January 2018 to October 2020). According to internal fixation methods, all patients were divided into the FNS group (54 cases), MCS group (51 cases), and DHS group (52 cases). Demographic data were also collected, recorded, and compared, including the follow-up time, days of hospitalization, operation time, blood loss, intraoperative fluoroscopy times (IFT), weight-bearing time (WBT), length of femoral neck shortening (LFNS), Harris hip score, and complications (such as internal fixation failure, bone nonunion, and avascular necrosis of the femoral head) between the three groups. Overall, 157 patients with a mean age of 61.8 (range, 18–89) years were analyzed. In the FNS group, IFT (median 10.5) was significantly lower than that in the MCS group (median 21) and DHS group (median 20.5) (P <0.05), and WBT was significantly earlier than that of the MCS group (P <0.05). In the FNS group, the median hospitalization time, operation time, and blood loss were 2 (2, 4) days, 45 (40–59) min, and 30 (20, 50) ml, respectively. They were all significantly less than 3.5 (3, 6) days, 72 (55–88.75) min, and 50 (30, 50) ml in the DHS group, respectively (P < 0.05). There was no statistical difference in LFNS, quality of reduction, internal fixation failure rate, and Harris hip score at the latest follow-up (P >0.05). No surgical complications such as incision infection, deep infection, pulmonary embolism, or femoral head necrosis were found in any of the three groups. FNS, MCS, and DHS are all effective for femoral neck fractures. However, a lower IFT of FNS shortens the operation time. Compared to MCS, FNS has the advantages of being a simple operation, with early WBT; compared to DHS, a minimally invasive operation is the main advantage of FNS. [ABSTRACT FROM AUTHOR]

Objective: To compare Dynamic Hip Screw with Proximal Femoral Nail in unstable Inter Trochanteric femur fractures. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Orthopaedic Surgery, Combined Military Hospital, Malir Pakistan, from Dec 2020 to Aug 2021. Methodology: This study comprised patients aged 40 to 80 years with unstable inter Trochanteric proximal femoral fractures (AO Classification 31A2, 31A3). These patients were randomised into two Groups. Group-A patients underwent Dynamic hip screw fixation, and Group-B patients were subjected to Proximal Femoral Nailing. Follow-up was done at 2,6,12 weeks postoperatively. Two variables, namely operative time and blood loss, were evaluated. Result: Thirty patients were recruited in this study, with 18 patients in each Group. The average blood loss for Group-A Dynamic Hip Screw was measured to be 193.3±29.10 ml, and for Group-B Proximal Femoral Nail was 79.44±17.98 ml (p< 0.001). Group-A (DHS) scored an average operative time of 51.56±7.76 min, and Group-B Proximal Femoral Nail was 36.89±3.66 min (p

Background: Pertrochanteric femoral fracture is the most common fractures of the hip especially in the elderly patients with osteoporotic bone, usually due to low-energy trauma like simple falls. Dynamic hip screw (DHS) is still considered the gold standard for treating such factures. Not many studies compare DHS with Proximal Femoral Nail Antirotation (PFNA). We try to compare the efficacy of PFNA with DHS in management of unstable pertrochanteric factors. Aims and Objectives: We aimed to evaluate and compare the clinical and functional outcomes of DHS and PFNA treatment of unstable pertrochanteric femoral fractures in elderly patients. Materials and Methods: This study was a prospective study which included total of 39 patients, 25 patients treated with PFNA and 14 patients with DHS. The study was conducted in Manipal Teaching Hospital from March 1, 2019, to August 1, 2021. All the patients were clinically evaluated and detail history was obtained. After the anesthesia clearance, the patients were operated. Length of skin incision, operating time, intraoperative blood loss, and complications were noted. Postoperatively, the duration of hospital stay, time of partial and full weight-bearing, time for radiological union, and complications were noted. Functional outcome was assessed using Harris hip score at 3 months and 6 months follow-up. Results: The mean age of the patient in this study was 74.68 years for PFNA and 75.57 years for DHS. The average time to complete the surgery was 71 min for PFNA and 92.86 min for DHS. The average blood loss was 162 ml for PFNA and 403 ml for DHS which was found to be statically significant. Partial weight-bearing on axillary crutches was started at the mean time of 3.7 weeks for PFNA and 8.1 weeks for DHS, whereas full weight-bearing was done at the mean of 8.2 weeks for PFNA and 12.1 weeks for DHS. Radiological union was seen at the average of 18.72 weeks for PFNA and 20.14 weeks for DHS which was not statically significant. The mean Harris Hip score at 3 months and 6 months follow-up was 63.84 and 88 for PFNA and 48.50 and 81.43 for DHS, respectively, which showed significantly better result with PFNA. Conclusion: Compared to DHS treatment, PFNA treatment in unstable pertrochanteric femoral fracture is associated with reduced blood loss, shorter operative time, and hospital stay with few intraoperative and post-operative complication. Post-operative rehabilitation with the early mobilization and return to pre-injury status was better with PFNA.

Abstract Background The treatments for trochanteric fractures try to regain early mobility and limit morbidity and risk of reoperations. The most currently used dynamic hip screw (DHS) and the proximal femoral nail (PFN) are both with pros and cons. We aimed to assess the comparative effectiveness of these interventions for trochanteric fractures by evaluating the surgical performance and postoperative outcomes. Methods PubMed, Web of Science and Cochrane Central Register were searched for RCTs comparing DHS and PFN for trochanteric fractures. All selected studies and the risk of bias were assessed. Clinical data including operative time, intraoperative blood loss, intraoperative fluoroscopy time, successful closed reduction and complications like nonunion, implant failure and reoperation were recorded. Random-effects models were used in Review Manager software, and GRADE was applied for the interpretation of the evidence. Results From 286 identified trials, twelve RCTs including 1889 patients were eligible for inclusion; six RCTs directly comparing DHS with PFN, while other six compared DHS with proximal femoral nail antirotation (PFNA). Compared to DHS, PFN had shorter operative time and led to less intraoperative blood loss. However, DHS need less intraoperative fluoroscopy time than PFN. No difference was seen for the achievement of closed reduction. For risk of postoperative complications, no difference was seen between PFN and DHS for non-union, risk of implant failure and revision surgery. Conclusions PFN(A) resulted in a shorter operative time and less intraoperative blood loss compared to DHS. However, no difference was seen for postoperative complications. Trial registration PROSPERO: CRD42021239974.

BACKGROUND: The biomechanical strength of dynamic hip screw plus anti-rotation screw internal fixation for femoral neck fracture is higher than that of cannulated screw, but it fails to reflect the principle of minimally invasive surgery. Femoral neck system with minimally invasive surgery for the treatment of femoral neck fractures has few surgical complications, strong postoperative stability and good outcomes, and can reduce the incidence of complications such as internal fixation failure and fracture displacement.OBJECTIVE: To compare the short-term effects of dynamic hip screw plus anti-rotation screw internal fixation and femoral neck system internal fixation in the treatment of Garden II-IV femoral neck fracture. METHODS: Totally 93 patients with Garden II-IV femoral neck fractures in the Guizhou Orthopedic Hospital from January 2019 to February 2021 were enrolled in this study. They were at the age of 24-79 years. All patients were randomly divided into control group (n=43) and trial group (n=50). The control group was implanted with dynamic hip screws and anti-rotation screws for fracture fixation and reduction, while the trial group was implanted with femoral neck system for fracture fixation and reduction. The incision size, blood loss, operation time, fluoroscopy times, and fracture reduction were recorded in both groups. Fracture healing time, Harris score, visual analogue scale score, the incidence of complications, and the rate of reoperation in the two groups were observed after operation. RESULTS AND CONCLUSION: (1) Incision length, blood loss, operation time, and fluoroscopy times were less in the trial group than those in the control group (P < 0.05). The fracture reduction was good in both groups, and there was no significant difference between the two groups (P > 0.05). (2) Both groups completed the 6-month postoperative follow-up. There was no significant difference in the incidence of internal fixation failure, fracture nonunion and femoral head necrosis between the two groups (P > 0.05). There was no significant difference in the total incidence of postoperative complications and reoperation rate between the two groups (P > 0.05). (3) There was no significant difference in the fracture healing time between the two groups (P > 0.05). Harris score and visual analogue scale score 6 months after treatment in the two groups were significantly improved compared with those before treatment (P < 0.05). There was no significant difference in Harris score and visual analogue scale score between the two groups 6 months postoperatively (P > 0.05). (4) These findings suggest that the mechanical properties of dynamic hip screw plus screw and femoral neck system are good, but the advantages of femoral neck system internal fixation are simple operation, less fluoroscopy, short operation time, less trauma and less bleeding. [ABSTRACT FROM AUTHOR]

Background: Ipsilateral femoral neck and hip fractures are uncommon high energy injuries. In the literature no single method of treatment has emerged as superior to the others. A recent publication has documented the successful application of the rendezvous technique using dual-implants for treating these injuries. However in some cases, this technique may fail and revision surgery is required. Case presentation: A 67-year old man sustained ipsilateral fractures of his femur and femoral neck in a road traffic accident. His injuries were treated by a dual construct consisting of a retrograde femoral nail and dynamic hip screw. Three months after surgery the hip screw cut out of the femoral head necessitating revision to a total hip arthroplasty. Surgery was carried out using a single stage two part procedure on a standard operating table without having to reposition or redrape the patient. There were no postoperative complications and at 1 year from surgery the patient is satisfied with the result and has returned to work. Conclusion: Conversion hip arthroplasty in the presence of dual implants is a technically challenging and unpredictable procedure, with an increased risk of complications. Our surgical approach provides a framework for orthopedic surgeons to safely perform this complex procedure. [ABSTRACT FROM AUTHOR]

Introduction: Geriatric patients who suffer femoral neck fractures have high morbidity and mortality. Prophylactic fixation of the femoral neck is a potential avenue to reduce the incidence of femoral neck fractures. We studied 3 different implants traditionally used to stabilize the femoral neck: 6.5 mm cannulated screws (CANN), the femoral neck system (FNS) (Depuy Synthes), and the dynamic hip screw (DHS) (Depuy Synthes). Materials and Methods: Five osteoporotic Sawbone femurs were used for each model and a control group. Two scenarios were investigated: single leg stance to measure construct stiffness and lateral impact to measure construct stiffness, energy to fracture, and qualitative examination of fracture patterns. Stiffness for each femur and energy to fracture for the lateral impact scenario were calculated and compared between groups using one-way ANOVA. Results: DHS showed significantly higher stiffness than the other 2 implants and the control in single leg stance. In the lateral impact scenario, the DHS and CANN were significantly stiffer FNS and the control. Femurs implanted with CANN tended to fracture at the greater trochanter while FNS fractured in a transverse subtrochanteric pattern, and DHS fractured obliquely in the subtrochanteric region. Discussion: FNS and DHS experienced fracture patterns less amenable to surgical correction. CANN and DHS proved better able to resist external forces in the lateral fall scenario. CANN also proved better able to resist external forces in the single leg stance scenario and experienced a more amenable fracture pattern in the lateral fall scenario. Conclusions: FNS was less able to resist external forces compared with the other implants. This work informs the potential implications between the choice of implants that, although historically have not been used prophylactically, may be considered in the future for prophylactic stabilization of the femoral neck. Cadaveric study and clinical trials are recommended for further study. [ABSTRACT FROM AUTHOR]

Background: Despite recent advances in implants and surgical techniques, catastrophic and clinical failures in the treatment of intertrochanteric fractures continue to occur, with dire consequences in an overall frail population subset. The aim of the current study is to evaluate the effect of the factors under the surgeons' control, namely fracture reduction and implant selection, on the biomechanical behavior of fracture fixation constructs.Material-methods: An experimental protocol was conducted with the use of instrumented sawbones, in order to validate the finite element models. The implants used were the Gamma3®and DHS systems. Subsequently, a series of scenaria were considered, including various reduction and implant angle combinations. Data were retrieved concerning the peak cancellous bone stresses around the hip screw and the volume of cancellous bone in the femoral head stressed at critical levels, as well as implant stresses and stresses on the cortical bone of the distal fragment.Results: All stable fracture models displayed significantly decreased cancellous bone stresses and implant stresses compared to their unstable counterparts, regardless of implant used. The effect of increasing implant angle led to a decrease in implant stresses in all models studied, but had a beneficial effect on the stresses in the cancellous bone of the proximal fragment only in the subgroups of stable fractures with both implants and unstable fractures treated with a cephalomedullary nail (CMN). In unstable fractures anatomically reduced, the use of CMN led to significantly lower peak stresses in the cancellous bone and a smaller volume of bone stressed at critical levels. Increasing the reduction angle by 5 ° led to a significant decrease in both peak stresses and volume of bone stressed at critical levels, more prominent in the sliding hip screw (SHS) models. Decreasing the reduction angle into varus by 5 or 10 ° led to a significant increase in bone and implant stresses regardless of implant used.Conclusions: In stable two-part (AO31.A2) fractures the use of the SHS appears to be biomechanically equivalent to CMN. In unstable, anatomically reduced fractures, the use of CMN leads to significantly reduced cancellous bone stresses and decreased rotation of the proximal fragment during loading. A reduction in varus should be avoided at all costs. In unstable fractures treated with SHS a reduction in slight valgus appears to be biomechanically beneficial. The highest implant angle that allows for proper screw position and trajectory in the femoral head should be used for stable fractures with both implants and unstable fractures treated with Gamma3®. [ABSTRACT FROM AUTHOR]

Background: Although femoral neck fractures are common in elderly individuals, it is an uncommon occurrence in young patients. It is crucial to achieve anatomical reduction as well as stable fixation so as to avoid complications in young individuals who are expected to have considerable functional demand in post-surgical period. Dynamic hip screws are commonly used for internal fixation of these fractures. Although satisfactory functional outcomes have been reported in the patients treated by DHS, complications such as malunion and osteonecrosis remain an area of concern. Aims and Objectives: The aims of the study were to study the functional outcome of young patients with femoral neck fractures treated by DHS with CC screws and to study the complications in young patients with femoral neck fractures treated by DHS with CC screws. Materials and Methods: This was a prospective cohort study in which 80 young adults (below the age of 45 years) having femoral neck fractures and treated by DHS with 2CC screws were included in this study on the basis of a predefined inclusion and exclusion criteria. Gender and distribution, nature of injury, type of fracture, functional outcome, and complications were studied in studied cases. Open reduction and internal fixation was done using dynamic hip screw. The functional outcome was assessed using modified Harris hip score. All patients were assessed for complications such as non-union, malunion, and osteonecrosis. Statistical analysis was done using SSPS 21.0 software and P<0.05 was taken as statistically significant. Results: Out of 80 studied cases having femoral neck fractures, there were 54 (67.50%) males and 26 (32.50%) females with an M: F ratio of 1:0.48. The mean age of male and female patients was found to be 38.37±4.62 and 38.80±4.97 years, respectively. The most frequent cause of fracture was fall from height (48 cases) followed by road traffic accident (31 cases). Forty-six patients had complete fracture with partial displacement (Type III) and remaining 34 patients had complete fracture with total displacement (Type IV). Associated injuries were seen in 9 (11.25%) patients. Nine (11.25%) cases of avascular necrosis of femoral head were seen in our study. Surgery more than 48 h after injury and complete fracture with total displacement were associated with increased risk of avascular necrosis of femoral head (P<0.05). Conclusion: Femoral neck fractures in young patients treated by dynamic hip screws with CC screws have found to have excellent functional results in majority of cases. The complications such as osteonecrosis of femoral head can be minimized by decreased time duration between fracture and surgical intervention. [ABSTRACT FROM AUTHOR]

Background: The femoral neck system (FNS) was introduced as a minimally invasive fixation device for managing femoral neck fractures. Objective: To compare radiographic, clinical, and patient-reported outcome measures (PROMs) of femoral neck fracture patients following FNS compared to dynamic hip screw (DHS) implantation combined with an anti-rotational screw. Methods: Patients who underwent closed reduction and internal fixation of a femoral neck fracture between 2020 and 2022 were retrospectively included. We measured leg length, femoral offset, and centrum–collum–diaphyseal (CCD) angle in plain radiographs. Scar length, Harris Hip Score, short-form health survey 36-item score (SF-36), and Numeric Rating Scale (NRS) were assessed during follow-up visits. Results: We included 43 patients (22 females) with a median age of 66 (IQR 57, 75). In both groups, leg length differences between the injured and the contralateral side increased, and femoral offset and CCD angle differences were maintained over time. FNS patients had shorter scars and reported fewer emotional problems and more energy. There were no differences between groups regarding the remaining SF-36 sub-scores, Harris Hip Score, and NRS. Conclusions: The FNS allows for a comparable leg length, femoral offset, and CCD angle reconstruction while achieving similarly high functional and global health scores to the DHS.

Background: Intertrochanteric fracture is one of the most common fractures of the hip, especially in the elderly with osteoporotic bones, usually due to low-energy trauma like simple falls. This study was done to compare the functional and radiological outcome of PFN with dynamic hip screw (DHS) in treatment of type 31-A2, intertrochanteric fractures. Materials and Methods: From June 2019 to June 2021, prospective randomized and comparative study was conducted on the 162 patients of type 31-A2 intertrochanteric fractures of hip who were operated using PFN or DHS. Intraoperative complications were noted. Functional outcome was assessed using Harris hip score (HHS) and radiological findings were compared at 6, 12, and 24 months postoperatively. Results: In our study, out of 162 patients, 77 patients are managed with DHS, while 85 patients are managed with PFN. The average age group of the patients was 61–70 years. In our series, we found that patients with DHS had longer duration of surgery (111 min) and required longer time for mobilization, while patients who underwent PFN had shorter duration of surgery (97 min) and allowed early mobilization. In addition, complications such as DVT, lag screw cutout, shortening, and superficial infection are more in DHS group as compared to PFN group. The patients treated with PFN started early ambulation as they had better HHS in the early postoperative period as well as late postoperative period. Conclusion: PFN is better than DHS in type 31-A2 intertrochanteric fractures in terms of decreased blood loss, reduced duration of surgery, early weight-bearing and mobilization, reduced hospital stay, decreased risk of infection, and decreased complications.

Introduction: Dynamic hip screw fixation (DHS) with a 4-hole side plate and 4 bi-cortical screws is considered by many to be the standard implant for extracapsular hip fractures. The 4-hole side plate, however, has several disadvantages including longer incision, increase in operating time, bleeding and increased wound morbidity. Biomechanical studies have shown that most of the force in a 4-hole DHS fixation is borne by the proximal three screws. This study (specifically) compares the outcome of fixation using 3-hole and 4-hole DHS in extracapsular hip fracture fixations (with the hypothesis being that 3-hole plate is adequate even in unstable intertrochanteric fractures. Patients and Methods: A total of 72 consecutive patients who had DHS fixation with either a 3 hole or 4 hole DHS side plate and who were either directly operated or supervised by a single consultant were recruited. Fractures were classified using the AO fracture classification system as stable (AO/OTA 31A1–31A2.1) and unstable (31A2.2–31A3.3 subtypes) for ease of comparison. Failure was defined as metalwork breakage, nonunion, screw cut-out or pull out or any other complications of bone healing requiring a revision. Results: A total of 23 patients (68.1%) were female, whereas 49 patients (31.9%) were male. Fractures in 33 patients were classified as stable with the (AO/OTA 31A1–31A2.1) and unstable in 39 patients with (31A2.2–31A3.3 subtypes). Thirty-three (45.8%) patients had fixation with 3-hole side plate, whereas 39 (55.2%) patients had fixation with 4-hole side plate. In the 3 hole group, 17 patients had stable fractures, whereas 16 patients had unstable fracture configuration while in the 4-hole DHS side plate group, 16 patients had stable fracture configuration, whereas 23 patients had unstable fracture. The mean change in hemoglobin was lower for the 3-hole DHS group (3 hole-6.64 g/l versus 4Hole 12.41 g/l) (t = 1.732, P = 0.090, P ≤ 0.05). One patient in each group also had metalwork failure with screw cut-out through the head and the other being (screw breakage) complete failure of the screw necessitating conversion to total hip arthroplasty. Conclusion: Three-hole DHS plate offers comparable outcome with its 4-hole counterpart even with unstable intertrochanteric fractures, with slightly less blood loss and smaller scars.

Background: Intertrochanteric fractures of femur are one of the most common fractures encountered in the elderly population. Dynamic hip screw (DHS) with a side plate is the standard modality of treatment especially in the case of stable fractures because it creates a controlled collapse at fracture site, leading to union. A comparative study between minimally invasive surgical technique with the conventional surgical technique for the fixation of intertrochanteric fractures with the DHS device was done. Methods: Thirty patients with stable intertrochanteric fractures (31A1.1, 31A1.2, and 31A1.3) were treated with the conventional open technique and another thirty with a new minimally invasive technique. Patients in both groups were followed up for at least 9 months. Results: There was less preoperative and postoperative blood loss, less soft-tissue destruction, less pain postoperatively, shorter hospital stays, and early mobilization and faster union with the minimally invasive technique. Conclusion: The study concludes that minimally invasive technique is superior to conventional (open) DHS in stable fractures.

Purpose: Although a concomitant ipsilateral femoral neck and intertrochanteric fracture has been considered to be a rare type of injury, its incidence has been increasing, especially among elderly hip fracture patients. However, there is limited evidence on the optimal treatment option. This study surveys surgical outcomes of different implants in order to assist in selecting the best possible implant for a combined femoral neck and intertrochanteric fracture. Methods: The postoperative complications after the treatment of a concomitant ipsilateral femoral neck and intertrochanteric fracture via cephalomedullary nail (CMN), dynamic hip screw (DHS), and hip arthroplasty groups were analyzed by retrospectively reviewing the electronic medical records of 115 consecutive patients. Results: The patient demographics and perioperative details showed no significant discrepancies amongst different surgical groups, except for the operative time; a CMN had the shortest mean operative time (standard deviation) of 85.6 min (31.1), followed by 94.7 min (22.3) during a DHS, and 107.3 min (37.2) during an HR (p = 0.021). Of the 84 osteosynthesis patients, 77 (91.7%) achieved a fracture union. Only one (3.2%) of the 31 HR cases had a dislocation. The sub-analysis of the different osteosynthesis methods showed a higher incidence of excessive sliding and the nonunion of the fracture fragment in the DHS group than that in the CMN group (p = 0.004 and p = 0.022, respectively). The different surgical methods did not significantly vary in other outcome variables, such as the re-operation rate, mortality, and hip function. Conclusions: For the surgical treatment of combined femoral neck and trochanteric fractures, osteosynthesis did not differ significantly from an HR in terms of the overall postoperative complications, reoperation and mortality rate, and hip function, however, the risk of nonunion and more mechanical complications should be considered when choosing a DHS. Our suggestion for the treatment of a femoral neck and ipsilateral trochanteric fracture is that a surgeon should choose wisely between an HR and a CMN depending on the patient's age, the displacement of the femoral neck, and one's expertise. [ABSTRACT FROM AUTHOR]

Pertrochanteric fractures (PFs) are life threatening due to the prolonged immobilization of the elderly patient that affects, indirectly, the function of most organs. PFs may have an impact on the symmetry of the human body and contribute to poor global alignment. The aim of the study is to evaluate the functional, pedobarographic and radiological outcomes in a group of subjects with PFs treated with either a dynamic hip screw (DHS) or an intramedullary gamma nail fixation. A study group of 40 patients, admitted to hospital for pertrochanteric fractures between 2015 and 2019, at a mean age of 74.87 (range 65–99), were enrolled. A control group included 20 subjects free from significant disorders of the musculoskeletal system and any other disorders that might induce a compensatory abnormal gait pattern. Functional results were assessed by the Harris Hip Score, and the plantar pressure distribution and arch index were measured with a pedobarographic examination. Radiographic parameters were assessed based on the preoperative and postoperative standing AP pelvic radiographs and axial projection of the hip. The obtained results were evaluated at 9-month follow-up. The obtained results showed no significant difference between both study groups within the scope of the variables under study. To sum up, surgical treatment, either with DHS or intramedullary gamma nail fixation, and rehabilitation treatment support the symmetry of the musculoskeletal system. However, the full return of symmetry was not achieved at 9-month follow-up compared to the control group. [ABSTRACT FROM AUTHOR]

Introduction In the UK, hip fractures are a common reason for presentations to the emergency departments, which places significant pressure on NHS hospitals, appropriate choice of an implant to treat the hip fracture is one among many other factors that affect patients' outcomes. This audit aims to identify and compare the outcome difference between the dynamic hip screws (DHS) and short cephalomedullary nails in the treatment of extracapsular hip fractures. Methods In a retrospective study of 52 patients admitted as a result of hip fractures in one NHS trust, data collection was done from the patients' records using the trust's online system, we studied different variables to compare the outcome difference between DHS and short intramedullary (IM) nails, two senior authors interpreted the patients' X-rays and verified the coding and classification of the neck of femur fractures. Results This retrospective study examined 52 extracapsular hip fracture cases, including 37 females and 15 males. Forty-six (88%) of the included patients were ASA 3 and 4 (American Society of Anesthesiologists), and the average days to discharge from therapies were 8.4 (SD-+ 4) days compared to 11 (SD-+ 5.2) days for short IM nails and DHS, respectively (P= 0.03), the 30-day mortality rate for short nails was 7% (n= 4/52) patients and 6% (n= 3/52) for DHS (P =0.69). The mean operating times for the different implants were 58.11 (SD-+ 15.1) minutes for DHS and 58.03 (SD-+ 23.2) minutes for the short nail (P =0.98). Compliance with the national guidelines for providing an appropriate operation to treat hip fractures initially went from 63% (n=33/52) initially to 73% (n=38/52). This means that more patients who are appropriate for nailing are being treated with IM nails. Conclusion Short IM nails are associated with faster hospital discharge; this fact may be reflecting the lower postoperative pain as a result of avoiding soft tissue dissection associated with extramedullary devices. keeping in mind that IM devices have mechanical advantages over sliding hip screws; hence, they are more commonly used for more complex fracture patterns, leading to nearly similar outcomes when compared to extramedullary devices, this can be a source of bias in retrospective studies, larger randomized trials may lead to different outcomes., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Trust's Audit Office issued approval RN1303879. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Al-Dahan et al.)

Comparison of treatment of subtrocentric femoral fractures of type A with condylar dynamic screw and hip dynamic screw in hospitalized patients in Shahid Beheshti Hospital, Yasuj, Iran, 2007- 2016 Background: Treatment of sub trochanteric fractures is very challenging for bone and joint surgeons. The techniques used to treat these fractures are fracture reduction and the use of condylar dynamic screws and hip dynamic screws. The aim of this study was to compare the treatment of sub trochanteric fractures of type A femur with condylar dynamic screw and hip dynamic screw in hospitalized patients in Shahid Beheshti Hospital, Yasuj, Iran, 2007- 2016 and Access is a better treatment that has fewer side effects and better rehabilitation. Material and Methods: This study is a study based on exist data that was performed by reviewing the files of 50 patients with sub trochanteric fracture type A hospitalized in Shahid Beheshti Hospital, Yasuj, Iran, 2007- 2016. These patients were randomly divided into two equal groups of 25 in terms of treatment with condylar dynamic screw (DCS) and hip dynamic screw (DHS). In these two groups, the variables of treatment failure, pain, and range of motion of the hip in three-month and six-month periods were compared. In order to compare the quantitative data between the two groups of failure therapy and the type of treatment intervention, K_S and MANN_WHITNEY U tests were used and qualitative data were compared from Chi-square test. Results: Of these 50 patients, 11 (22%) failed treatment, of which four (16%) were treated with DHS and seven (28%) with DCS. There was no statistically significant relationship between age (P = 0.1), sex (P = 0.3) and type of intervention (P = 0.9) with treatment failure. Treatment failure (approximately 90%) occurred in the first four months and all within six months. Conclusion: Both treatments (using DCS and DHS) were optimally effective in the treatment of sub trochanteric fractures of type A and no statistically significant differences were observed between them.

Background: Hip fractures in elderly patients is common and occurs with trivial fall. Continuous epidural anesthesia (CEA) and Continuous spinal anesthesia (CSA) are available modalities for lower extremities surgeries. This study was done to compare the effectiveness of CEA and CSA. Methods: A prospective open-label randomized control trial was carried out in the Department of Anaesthesiology and Critical care at GMC, Kadapa, from January 2019 to July 2020. One hundred patients were enrolled and divided into Group A and B, with 50 participants in each group. Group A received continuous spinal anesthesia, and Group B was given continuous epidural anesthesia. VAS score, Onset of sensory block, the Onset of motor block and no. of rescue analgesia, etc., were considered as the primary outcome variable. coGuide statistical software was used for analysis. Results: There was a statistically significant difference between the study groups (Group A vs. Group B) in the Onset of sensory block (7.6 ± 1.6 min, 17.5 ± 1.62 min), the start of motor block (10.1 ± 1.11 min,20.28 ± 1.36 min), duration of sensory block (108.7 ± 16.84 min, 147.4 ± 20.39 min), duration of motor block (175.8 ± 12.47 min, 219.4 ± 18.56 min) and analgesia duration (199.2 ± 11.92 min, 327.6 ± 18.8 min) respectively. The Difference in the number of rescue analgesia in 24 hrs between the study group was significant with a P-value of

Objective: To compare the fixation stability of the lag screw with a undercut thread design for the dynamic hip screw (DHS) system versus the lag screw with the conventional buttress thread.Methods: The lag screws with the undercut thread (a flat crest feature, a tip-facing undercut feature) and buttress thread were both manufactured. Fixation stability was investigated using cyclic compressive biomechanical testing on custom osteoporotic femoral head sawbone. The forces required for the same vertical displacement in the two types of lag screw were collected to evaluate the resistance to migration. Varus angle was measured on X-ray images to assess the ability in preventing varus collapse. Finite element analysis (FEA) was performed to analyze the stress and strain distribution at the bone-screw interface of the two types of lag screws.Results: The biomechanical test demonstrated that the force required to achieve the same vertical displacement of the lag screw with the undercut thread was significantly larger than the lag screw with conventional buttress thread (p < 0.05). The average varus angles generated by the undercut and buttress threads were 3.38 ± 0.51° and 5.76 ± 0.38°, respectively (p < 0.05). The FEA revealed that the region of high-stress concentration in the bone surrounding the undercut thread was smaller than that surrounding the buttress thread.Conclusion: The proposed DHS system lag screw with the undercut thread had higher migration resistance and superior fixation stability than the lag screw with the conventional buttress thread.