GMCANA Auditorium,Guntur Medical College.Guntur - 522 001. A.P. India

6th - 8th March

Inter-Trochanteric Fractures of Hip in Elderly Treated with Recon Hemi-Arthroplasty Facilitates Outcome and Early Ambulation

Dr V S N RajuChief Orthopaedic & Trauma Surgeon

Specialized in Micro Surgery & Replantations

ARC ORTHOPAEDIC HOSPITAL, Hyderabad, INDIA.

HYDERABAD, INDIA

Introduction:

Elderly with fractures about hip are vulnerable to succumb to co-morbid conditions that risk life, though operated by routine procedures and nursed in bed. (Pre, Per and Post operative risks)

Modified hemi arthroplasty reduces such risks, improves outcome and also allows early ambulation. (Duration of surgery, Technique, Secondary Trauma/Insult)

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Inter-Trochanteric Fractures of Hip in Elderly Treated with Recon Hemi-Arthroplasty Facilitates Outcome and Early Ambulation

Objectives:

To operate upon fractures of hip in elderly, associated with high risk conditions with modified hemi-arthroplasty and to mobilize early.

Thus, most pre and post operative co-morbidities from are overcome, improving quality of life and its expectancy.

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Inter-Trochanteric Fractures of Hip in Elderly Treated with Recon Hemi-Arthroplasty Facilitates Outcome and Early Ambulation

Methodology:

73 patients, 28 male and 45 female, aged 76 to 99 years in the last 16 years. Comminuted inter-trochanteric fractures associated with age related co-morbidities.

Basal osteotomy at neck of fractured femur helps enucleate and deliver the head of femur retaining the inter-trochanteric area with fracture.

Hemi arthroplasty is then completed thus impacting the fractured inter-trochanteric area.

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Inter-Trochanteric Fractures of Hip in Elderly Treated with Recon Hemi-Arthroplasty Facilitates Outcome and Early Ambulation

When comminuted, the lesser trochanter is made to remain intact & impacted as original calcar of femoral neck to maintain neck of femur and length of limb.

A harness screw across the fenestration in the stem of implant avoids collapse/sink of implant in osteoporotic femora.

Bone cement not mandatory if sinking is countered. Obliquity of fracture of neck of Femur does not matter.

Methodology: ....Continued

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Inter-Trochanteric Fractures of Hip in Elderly Treated with Recon Hemi-Arthroplasty Facilitates Outcome and Early Ambulation

Reconstructive Hemi Arthroplasty

Case I

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Inter-Trochanteric Fractures of Hip in Elderly Treated with Recon Hemi-Arthroplasty Facilitates Outcome and Early Ambulation

The lower Fenestration in the Stem Lodges a Harness Screw toPrevent Sink/Shortening

Reconstructive Hemi

Arthroplasty

Case II

Case III

HYDERABAD

Inter-Trochanteric Fractures of Hip in Elderly Treated with Recon Hemi-Arthroplasty Facilitates Outcome and Early Ambulation

9 months P.O.

HYDERABAD

Inter-Trochanteric Fractures of Hip in Elderly Treated with Recon Hemi-Arthroplasty Facilitates Outcome and Early Ambulation

The lower Fenestration in the Stem Lodges a Harness Screw toPrevent Sink/Shortening

Case IV

HYDERABAD

Inter-Trochanteric Fractures of Hip in Elderly Treated with Recon Hemi-Arthroplasty Facilitates Outcome and Early Ambulation

The lower Fenestration in the Stem Lodges a Harness Screw toPrevent Sink/Shortening

Case V

HYDERABAD

Inter-Trochanteric Fractures of Hip in Elderly Treated with Recon Hemi-Arthroplasty Facilitates Outcome and Early Ambulation

The lower Fenestration in the Stem Lodges a Harness Screw toPrevent Sink/Shortening

Case VI

Results:

Passive and active knee and ankle movements are initiated on second and third post operative days, respectively.

Partial weight bear ambulation is encouraged on the third day and full weight bearing as early as by 15 days.

HYDERABAD

Inter-Trochanteric Fractures of Hip in Elderly Treated with Recon Hemi-Arthroplasty Facilitates Outcome and Early Ambulation

Advantage :

Average time needing strict bed rest is 3 to 8 days in Recon HAwhile it extends to 4 to 8 weeks in routine fixations of an IT Fracture.

Conclusion:

Marked and overall fall in complications from age related co-morbid conditions observed.

Thus, this modified hemi-arthroplasty coined as reconstructive hemi-arthroplasty edges over other modalities of treatment for inter-trochanteric fractures of hip that need longer bed rest in the elderly with co-morbid health constraints.

Costs substantially less compared to THR and technically simpler with comparable success rates.

HYDERABAD

Inter-Trochanteric Fractures of Hip in Elderly Treated with Recon Hemi-Arthroplasty Facilitates Outcome and Early Ambulation

Key Words:

Hemi arthroplasty, fracture of hip in elderly, co-morbid conditions, inter trochanteric fracture, high risk fracture.

Key Message:Hemi arthroplasty in fragile elderly with inter-trochanteric fracture enables reduced duration of bed rest, early ambulation & better survival rates from age related co-morbid conditions.

HYDERABAD

Inter-Trochanteric Fractures of Hip in Elderly Treated with Recon Hemi-Arthroplasty Facilitates Outcome and Early Ambulation

References:-

Scholarly articles for treatment of intertrochanteric fractures in the elderly with hemiarthroplasty

… for elderly patientswith intertrochantricfractures Chan - Cited by 345Treatment for unstable intertrochanteric fractures in … - Kayali - Cited by 71… hemiprosthesis for unstable intertrochanteric fractures - Rodop - Cited by 203

1.Primary hemiarthroplasty for unstable osteoporotic ...www.ncbi.nlm.nih.gov › ... › Indian J Orthop › v.44(4); Oct-Dec 2010

by KH Sancheti - 2010 - Cited by 30 - Related articlesThe management of unstable osteoporotic intertrochantric fractures in elderly is ..Hemiarthroplasty for unstable osteoporotic intertrochanteric fractures in elderly ...

 Journal of Orthopaedic Case Reportswww.jocr.co.in/wp/wp-content/.../11/jocr-july-sep-2012-article-8.pdfby SG Venkata - 2012 - Related articlesIntertrochanteric Fractures Treated With Cemented. Bipolar Hemiarthroplasty: A Technical Note. 1. 1. 1* ... occur in elderly frail patients with osteoporotic bones

Unstable Intertrochanteric Fractures In High Risk Elderly ...medind.nic.in/gaa/t13/i2/gaat13i2p68.pdf by N Maru - Related articlesKEY WORDS : Hemiarthroplasty, unstable intertrochanteric fractures, high risk ... The management of unstable osteoporotic intertrochantric fractures in elderly is .

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Inter-Trochanteric Fractures of Hip in Elderly Treated with Recon Hemi-Arthroplasty Facilitates Outcome and Early Ambulation

“Simplifying Geriatric Care – Real Problems, Practical Solutions”

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Centre of Excellence for Tissue Repair & Reconstruction by Micro Surgical Skills & Techniques

Dr V S N RajuChief Orthopaedic & Trauma SurgeonSpecialized in Micro Surgery & ReplantationsARC ORTHOPAEDIC CLINIC, Hyderabad, INDIA.

intacthands@gmail.com

Thank You !

Inter-Trochanteric Fractures of Hip in Elderly Treated with Recon Hemi-Arthroplasty Facilitates Outcome and Early Ambulation