Intertrochanteric hip stress fracture in a male ultramarathon runner

Stress fractures are injuries frequently seen in high-performance athletes, especially runners. In the femur, the most commonly affected locations are the femoral neck, condylar area and proximal shaft. Intertrochanteric fractures are much more common in the elderly population, especially among those with osteoporosis, but they can also be a result of high-energy repetitive mechanisms. We present a case of an intertrochanteric stress fracture in a young male runner. The diagnosis was suspected after persistent pain following his first marathon, and it was confirmed with an MRI. Operative fixation of the fracture was performed 22 days after the pain started, which allowed the patient to return to his activities, including 50 km marathon 4 months following the surgery.

Development of Clinical Prediction Rules for One-Year Postoperative Functional Outcome in Patients with Intertrochanteric Fractures: The Intertrochanteric Fracture Ambulatory Prediction (IT-AP) Tool

Individualized prediction of postoperative ambulatory status for patients with intertrochanteric fractures is clinically relevant, during both preoperative and intraoperative periods. This study intended to develop clinical prediction rules (CPR) to predict one-year postoperative functional outcomes in patients with intertrochanteric fractures. CPR development was based on a secondary analysis of a retrospective cohort of patients with intertrochanteric fractures aged ≥50 years who underwent a surgical fixation. Good ambulatory status was defined as a New Mobility Score ≥5. Two CPR for preoperative and intraoperative predictions were derived using clinical profiles and surgical-related parameters using logistic regression with the multivariable fractional polynomial procedure. In this study, 221 patients with intertrochanteric fractures were included. Of these, 160 (72.4%) had good functional status at one year. The preoperative model showed an acceptable AuROC of 0.77 (95%CI 0.70 to 0.85). After surgical-related parameters were incorporated into the preoperative model, the model discriminative ability was significantly improved to an AuROC of 0.83 (95%CI 0.77 to 0.88) (p = 0.021). The newly-derived CPR enable physicians to provide patients with intertrochanteric fractures with their individualized predictions of functional outcome one year after surgery, which could be used for risk communication, surgical optimization and tailoring postoperative care that fits patients’ expectations.

Influence of Timing of Postoperative Weight-Bearing on Implant Failure Rate Among Older Patients With Intertrochanteric Hip Fractures: A Propensity Score Matching Cohort Study

Introduction: The purpose of this study was to determine whether immediate weight-bearing as tolerated increased the risk of implant failure and decreased functional outcomes compared with restricted weight-bearing.Methods: From January 2010 to December 2018, 1,125 consecutive patients (≥65 years) with intertrochanteric fractures were identified. Of them, 130 patients were excluded, resulting in 995 patients in final cohort (563 receiving immediate weight-bearing and 432 receiving restricted weight-bearing). Propensity score (PS) matching yielded 403 patient pairs. Primary outcome was implant failure at 12 months. Secondary outcomes were implant failure at 3 months, functional outcomes at 12 months, and time to full weight-bearing.Results: Among 806 patients who were matched by PS, the mean age was 77.8 years (SD, 7.6), and 603 patients (74.8%) were women. After matching, there was no significant difference between immediate (10.0% [39/389]) and restricted (9.1%, [35/385]) weight-bearing for implant failure at 12 months (absolute risk difference, 0.93% [95% CI, −3.26 to 5.13%]; RR, 1.11 [95% CI, 0.69 to 1.80]; p = 0.66). Additionally, no significant difference was seen for implant failure at 3 months and functional outcomes at 12 months. Patients with immediate weight-bearing had shorter time to full weight-bearing (mean [SD], 87.6 days [7.5] vs. 121.3 days [11.0]; mean difference, −33.7 [95% CI, −35.0 to −32.3]; p < 0.001).Conclusions: Among older patients with intertrochanteric fractures, receipt of immediate weight-bearing as tolerated did not increase risks of implant failure or worsen functional outcomes compared with receipt of restricted weight-bearing. However, patients receiving immediate weight-bearing had a shorter time to full weight-bearing.

A comparative study of Dynamic Hip Screw and Proximal Femoral Nail in the management of Intertrochanteric Fractures of the Femur

Introduction: Intertrochanteric fractures account for approximately half of the hip fractures in the elderly because of the osteoporotic nature of the bone. There are various modalities to treat these fractures. The objective of this study was to compare and evaluate the clinical and radiological outcome of intertrochanteric femur fracture treated with Dynamic hip screw (DHS) and proximal femoral nail (PFN). Methods: This study was conducted at Nepalgunj medical college, Department of orthopedics Nepalgunj over a time span of two years. A total of 52 patients were included and randomized into Dynamic hip screw (n=26) and Proximal femoral nail (n=26) group. Patient’s demographic details, perioperative findings, radiological findings and follow up findings were recorded. The results were evaluated and compared. Results: The mean age in our study was 57.63 years. Trivial fall was the most common mode of injury. There was significantly higher intraoperative blood loss in the DHS group. Radiological union and functional outcomes were similar overall, but in case of unstable fracture functional outcome was clinically better in PFN group. Conclusion: From our study we concluded that PFN has better outcome in case of unstable intertrochanteric fractures, however in stable fracture also it has distinct advantage over DHS.

Impact of Rehabilitation in a Complex Case of Intertrochanteric Fracture in Geriatric – A Case Report

Peri-trochanteric femoral fractures are among the most prevalent fractures in the aged population. Injury and trauma are the leading causes of intertrochanteric fractures. The intertrochanteric aspect of the femur is made up of dense trabecular bone and lies between the greater and lesser trochanters. The female to male ratio for sustaining these fractures is seen between 2:1 and 8:1.Patients with femoral neck fractures are usually in geriatric age group. The dynamic screw approach is used to treat intertrochanteric fractures surgically. An 88year old male patient with left intertrochanteric fracture, diagnosed on x-ray after a fall in toilet was operated and was referred immediately for physical therapy, which included strengthening exercises, balance retrainig, and breathing exercises. According to the case study, a physiotherapy treatment technique resulted in considerable and gradual improvement of functional goals.

Role of Pre-operative Intravenous Methylprednisolone for Post-operative Pain Control after IFF Surgery

Background: Intertrochanteric region are common in older ages. 33% females and 15% males in their 90s suffer from hip fracture, most commonly intertrochanteric fractures (50%). The pain associated with the surgery of the intertrochanteric fractures is quite troublesome and reduces patient mobilization thus increasing morbidity. Aim: To compare preoperative intravenous methylprednisolone vs control in terms of mean VAS score in patients presenting with intertrochanteric femur fractures. Study design: Randomized control trial Place and duration of study: Orthopaedic Department & General Surgery Department POF Hospital Wah Cantt and Izzat Ali Shah Hospital Wah Cantt from 1st Jan 2020 till 31st Dec 2020 Methodology: Sixty patients were enrolled and divided in two groups. Thirty patients in methylprednisolone group and 30 patients in control Group were enrolled. Age 40-75 years old people of both genders with intertrochanteric femur fractures were included. Post-operative pain was recorded at resting position and 45° hip flexion position 24 hours post-surgery through VAS. Results: In group A, 18 patients were males and 12 were female. In group B 19 patients were male and 11 were female. Mean age in group A was 56.37±4.56 years and in group B, 55.89±4.13 years. Mean VAS pain score in the control group was 5.03±1.542 while the mean VAS pain score in the treatment group was 3.70±15.79 (P=0.002). Conclusion: Methylprednisolone preoperatively reduces postoperative pain at 24 hours after surgery in patients undergoing intertrochanteric fracture fixation. Keywords: Methylprednisolone, Preoperative, Visual Analogue Scale, Pain, Postoperative’