Effect of proximal femur nail anti-rotation on unstable intertrochanteric fractures: A prospective observational study

Objective:To assess the effect of proximal femur nail anti-rotation on the functional and radiological outcome of unstable intertrochanteric fractures.Methods:This prospective observational study was conducted in the orthopedic department of a tertiary care hospital.Altogether 86 patients with unstable intertrochanteric fractures treated with proximal femur nail anti-rotation between January 2010 and January 2015 were included.Patients were followed in the outpatient clinic at regular intervals after discharge to assess the radiological union of fractures and complications.The functional outcomes were evaluated after 2 years by Harris hip score.Results:All patients achieved a radiological union of fractures after a mean duration of 24.6 weeks.The follow up showed 23 complications(systemic and local).Eight patients developed urinary tract infections,and three patients developed chest infections,two patients had screw cut-out,one patient had knee stiffness,one patient developed superficial surgical site infection,and four patients developed varus collapse and shortening subsequently.The two year follow up showed that 69(80.2%)patients had an excellent and good functional outcome according to Harris hip score.Conclusions:With lower complication rates,proximal femur nail is a valid and reasonable option especially in treating unstable intertrochanteric fractures.

Surgical outcomes of acute acetabular transverse fracture using ilioinguinal and Stoppa approach

Objective: To compare surgical outcomes of acute acetabular transverse fracture using ilioinguinal and Stoppa approach. Methods: Twenty five patients who managed with ilioinguinal approach (group A) at a mean follow-up of (32.3±4.6) mo and 30 patients who managed with Stoppa approach (group B) at a mean follow-up of (29.7±3.8) mo were prospectively reviewed. The study was approved by the hospital ethical review committee (IRB approval no: 0189-2007). Patients were called for routine follow up and follow-up durations were set. End points of the study were: (1) blood loss was measured intraoperatively by measuring the blood loss in the suction drain and counting blood stained gauze and postoperatively by assessing hemoglobin after 6 h of surgery;(2) functional outcome was demonstrated using the Harris hip score;(3) reduction quality and radiological results were demonstrated by Matta scoring system. Results: Mean blood loss (intraoperatively +postoperatively) was (1 175.8±310.2) mL and (1 115.7±285.1) mL in patients operated with ilioinguinal and Stoppa approach, respectively. Mean operative time was (242.3±60.8) min and (198.9±50.3) min in patients operated with ilioinguinal and Stoppa approach, respectively. Functional outcome, radiological outcome and reduction quality showed no significant difference between two approaches. Complication rate was 36.0% in group A (9 patients) and 13.3% in group B (4 patients). Conclusions: Our study concludes that Stoppa approach allows less blood loss and operative time with fewer complications.

Predictability of Surgical Apgar Score for postoperative outcomes in hip fractures: A prospective observational study

Objective:To assess the utility and validation of the Surgical Apgar Score(SAS)in predicting postoperative complications of hip fractures.Methods:This prospective observational study included patients who received operations for hip fractures from 1st March 2017 to 30th June 2018 at the Department of Orthopedic Surgery,Liaquat National Hospital and Medical College.Patients were followed at the outpatient department,and complications and mortality were recorded through phone calls.The predictability of SAS for postoperative complications was assessed.Results:SAS≤4 was found as a significant predictor for postoperative pulmonary(P=0.008)and cardiac complications(P=0.042)as well as blood transfusion required to optimize postoperative hemoglobin(P=0.03)in the patients with hip fractures.Conclusions:SAS provides reliable feedback information about patients'postoperative risk during the surgery.Hip fracture patients with scores≤4 should be monitored for major complications both during the hospital admission and after the discharge.