In this clinical study forty cases of intracapsular fracture neck of femur in elderly patients above the age of 60 years treated by bipolar hemiarthroplasty and were followed up and functional results were analysed with the objectives, to study the age and sex incidence of fracture neck of femur, quality of life after hemiarthroplasty, morbidity and mortality associated with the procedure, recovery of physical, social and vocational independence, number of days of stay in hospital and associated complications. Methods: Forty cases of fracture neck of femur in elderly patients above the age of 60 years treated by hemiarthroplasty using bipolar prosthesis between November 2017 to May 2019 were selected according to inclusion and exclusion criteria. Cases were followed up for 6 months and the short term functional results were analysed by using modified Harris hip score. Results: Most of the patients were in the age group of 60 to 70 years with mean average age of 69.2 years. Females were predominant. In 62.5 percent cases mode of injury was trivial trauma. Associated comorbidities hypertension, diabetes mellitus and anaemia were common. The complications observed were superficial infection of the wound, bedsore, periprosthetic fracture and posterior prosthetic dislocation. There were 30% excellent results and 45% good results. Conclusion:The success of hemiarthroplastydepends on preoperative planning and attention to surgical details to achieve the optimum biomechanical stability. Bipolar hemiarthroplasty for fractures neck femur provides betterrange of movement, freedom from pain and more rapid return to unassisted activity with an acceptable complication rate. The end functional results depend on the age of the patient, associated co-morbidity and optimum post-operative rehabilitation. Early functional results are satisfactory.
Background: Distal femur fractures are complex injuries producing long term disability and present considerable challenges in management. These fractures poses challenges to the treating surgeon because of thin cortex of the femoral condyles, wide medullary canal, relative osteopenia, short condylar fragment and comminution involving articular surface. Distal femur fracture disrupts normal knee joint functioning, hence needed anatomical reduction and stable internal fixation to prevent crippling disabilities and hardware failure. Objective: To evaluate the functional and radiological outcome of comminuted metaphyseal fracture of distal femur treated by Lateral locking compression plate and medial TENS nail using NEER'S score. Methods: In this study, 20 cases of comminuted metaphyseal fracture of distal femur were operated between November 2018 to April 2020 with distal femur lateral locking compression plate and medial augmentation with tens nail. Patients were selected based on inclusion and exclusion criteria and were followed up for 12 months. The results were analysed with NEER'S score. Results: Out of 20 patients with comminuted metaphseal distal femur fractures AO-Muller type A3subtypes 15 and C2 subtypes 5 patients were studied. Mean age of the patients was 45.5 years with age ranging from 20 years to 80 years. Right sided fractures were predominant. In 65% cases mode of injury was road traffic accident and rest were self-fall. 2 cases were operated under MIPPO technique and rest all were operated on with standard open lateral approach. Average surgical procedure timing was 119.5 minutes in our study. Average duration of radiological union was 18.6 weeks and average duration of weight bearing was 20.5 weeks. Complications such as superficial wound infection, knee pain and stiffness were observed in 9 patients. The NEER'S score was excellent in 45%, good-fair in 50% and 5% poor outcome. Conclusion: Comminuted distal femur fracture needs dual column fixation to achieve bone healing and restore function of the affected limb in shortest time without compromising stability. The advantage medial augmentation with TENS is active range of motion can be started earlier, stable internal fixation that does not allow varus collapse, mal-union and further implant failure.
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