Fracture of the subtrochanteric area of the femur is one of the most difficult about the hip to manage. Many of these fractures are comminuted and result from high-energy trauma. Nonoperative treatment of these fractures may result in a significant rate of malunion, nonunion and other complications. Therefore, subtrochanteric fractures is preferred to be treated with operative methods. The Russell-Taylor classification is useful in planning the type of internal fixation. For fractures located below the level of the lesser trochanter, standard locked intramedullary nails can be used effectively. For fractures that extend into the lesser trochanter but do not involve the piriformis fossa, the options of a cephalomedullary nail versus a 95 degree fixed angle device have yielded the best results. For fractures that have proximal trochanteric extension into the area of the piriformis fossa, sliding nail screw devices may have some usefulness. The DHS implant is not employed for the treatment of subtrochanteric femoral fractures.
Hip Fractures ; surgery ; Humans

The study was conducted on 55 patients (39 males and 16 females) with 56 trochanteric hip fractures related to surgical treatment trauma. These patients were treated by internal bone fixation using angle splint in Orthopedic Department of Viet- Duc Hospital from 1/2000 - 12/2001. Good and very good outcomes were reached in 82% of patients, 14% of patients had moderate and 4% had poor outcomes. Mass angle splints were used for intertrochanteric fractures: Unstable intertrochanteric fractures, trochanteric fracture with femoral neck fracture line, intertrochanteric fractures with multiple fractures in 1/3 above and 1/3 below of ipsilateral femoral bone. Intertrochanteric fractures occurred in any patient with quick movement prior event. Inter- and inferior trochanteric fractures occurred with two points. DHS is applied with most efficiency. Internal bone fixation using angle splint for intertrochanteric fractures was the most effective method. There were no complication in terms of vascular obstruction related to fat and heart failure. Setting a broken bone wass carried out in surgical position and fixed by angle splints. Separated pieces in backside and inside can be rearranged under the surgery and fixed by soft screws. Rehabilitation and follow-up exammination was needed after surgery.
Hip Fractures ; Surgery ; Therapeutics ; Splints

Humans ; Hip Fractures/surgery* ; Recovery of Function

Humans ; Aged ; Hip Fractures/surgery* ; Treatment Outcome

Fracture Fixation, Internal ; Hip Dislocation ; surgery ; Hip Fractures ; surgery ; Hip Joint ; surgery ; Humans ; Male ; Young Adult

OBJECTIVE: To summarize the research progress on the evaluation methods of head-neck nail positions in femoral intertrochanteric fractures. METHODS: The literature about the evaluation methods of head-neck nail positions for femoral intertrochanteric fractures in recent years was extensively reviewed, and research progress in the aspects of evaluation methods, clinical applications, and limitations were summarized. RESULTS: The position of head-neck nails in femoral intertrochanteric fractures is closely related to postoperative complications of head-neck nail cutting. Currently, the tip-apex distance (TAD) and femoral head zoning are widely used to evaluate the position of head-neck nails. The main opinion in the literature is that the use of TAD and femoral head zoning can effectively reduce the incidence of head-neck nails cutting. Parker's ratio, as one of the evaluation methods, has been controversial in subsequent studies and has not been widely used in clinical practice. The TAD as referenced to the calcar (CalTAD), which was modified based on TAD, has been gradually accepted by the clinic, but whether it is better than the TAD has not yet been conclusively determined. In recent years, new evaluation methods have been proposed to supplement the previous evaluation methods, such as the tip-neck distance ratio (TNDR) and the standardized TAD (STAD) to avoid the limitations of the TAD and the CalTAD by the volume of the femoral head, and the axis-blade angle (ABA) to supplement the direction of the head-neck nails channel, but at present the clinical application is relatively underutilized, and the validity of the method needs to be further verified. CONCLUSION Currently, there are many methods for evaluating the position of head-neck nails in femoral intertrochanteric fractures, TAD<25 mm combined with head-neck nails placed in the middle-middle quadrant or lower-middle quadrant of the femoral head division is currently a highly recognized assessment in the literature, but the optimal assessment is still controversial, and further research needs to be studied.
Humans ; Nails ; Head ; Neck ; Femoral Fractures ; Hip Fractures/surgery*

Femoral head fractures without dislocation or subluxation are extremely rare injuries. We report a neglected case of isolated comminuted fracture of femoral head without hip dislocation or subluxation of one year duration in a 36-year-old patient who sustained a high energy trauma due to road traffic accident. He presented with painful right hip and inability to bear full weight on right lower limb with Harris hip score of 39. He received cementless total hip replacement. At latest follow-up of 2.3 years, functional outcome was excellent with Harris hip score of 95. Such isolated injuries have been described only once in the literature and have not been classified till now. The purpose of this report is to highlight the extreme rarity, possible mechanism involved and a novel classification system to classify such injuries.
Adult ; Arthroplasty, Replacement, Hip ; Femur Head ; injuries ; Fractures, Comminuted ; surgery ; Hip Fractures ; surgery ; Humans ; Male

Aged, 80 and over ; Arthroplasty, Replacement, Hip ; Female ; Fractures, Comminuted ; surgery ; Hip Fractures ; surgery ; Hip Prosthesis ; Humans ; Male

Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Hip ; methods ; Female ; Hip Fractures ; surgery ; Hip Prosthesis ; Humans ; Male

Hip trauma has been a leading cause of death in senile patients for more than a centenary. Although the mortality decreased due to the advanced technique in medication, surgery and nursing, the increasing mortality should not be neglected in elders after orthopedic operation nowadays. Many factors are considered to influence the causes of death after trauma, such as age, gender, personal customs, comorbidities, types of fracture, timing of surgery, procedure, anesthesia, complications, medical treatment, activity of daily living, or even marriage status. This article reviews these causes from the aspects of patient's own factors, iatrogenic factors, medical treatment and other factors and provides some clues for further clinical application according to the recent foreign and domestic researches. According to the present research, it is essential for surgeons to perform a comprehensive estimation for patients suffering from hip trauma.
Cause of Death ; Hip Fractures ; surgery ; Humans ; Orthopedic Procedures ; Regression Analysis