Intertrochanteric fractures constitute one of the most typical fractures of the hip. The incidence of fractures in the trochanteric area has risen with an increase in numbers of the older person with osteoporosis. Mortality, morbidity ratios are increasing in patients with inter-trochanteric fractures. Advanced age and associated co-morbidities are two primary added source for high mortality in trochanteric fracture patients. We conducted this study to assess the mortality rate and the functional outcome in inter-trochanteric fractures after proximal femoral nailing. This is a prospective study, in which 60 Intertrochanteric fractures of femur patients who came to our hospital EMS. Inclusion and Exclusion criteria were included in this study and were done from a period from January 2014 to July 2017. They were evaluated on each follow-up clinically using Harris Hip score and radio-logically using RUST score. The overall mortality rate at the end of the 3-year follow-up in our study is 13.3%. The factor which significantly influenced the mortality rate was Coronary artery disease. Four patients had implant-related complications. One patient developed non-union, which was later revised with Bipolar Hemi-arthroplasty. One patient developed screw back out, and two patients developed screw breakage. Results of our study concluded that elderly patients of age group 75-89 years of age were at higher risk for intertrochanteric fractures. Associated comorbid condition plays a significant role in the mortality of this fractures. In our study, coronary artery disease had a significant influence on the mortality rate for intertrochanteric fractures with a 4.63 fold rise in the mortality rate for these patients.

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Hip fractures are a common entity in the elderly. Hemiarthroplasty is a common treatment option for displaced neck of femur fractures and have been found to be successful in restoring mobility, reducing pain and improving quality of life following hip fractures in elderly. Many studies have reported that advanced age, male gender, long term stay in the intensive care unit, poor postoperative mobilization ability, a poor or dependent ADL score preoperatively, multiple comorbidities which result in a high ASA score have been associated with higher mortality. A retrospective study was done at the Department of Orthopaedics at Mahatma Gandhi Medical College and Research Institute, Pondicherry which included all patients who underwent hemiarthroplasty (both cemented and uncemented) from 2017-2020. The details of patients satisfying the inclusion criteria were obtained from the medical records department and were analysed by a single investigator. In case the subjects had not reviewed following surgeries, details were obtained by telephonic communication. In our study of 40 patients, mortality was observed in 4 patients which included 3 females and 1 male. It was also observed that mortality was high between the ages of 61-80 years, patients with multiple comorbidities and patients with high ASA scores. The hazard ratio was calculated for 3 parameters namely age, time to surgery and surgical duration and is 1.014, 0.842 and 0.984 respectively but this was not found to be statistically significant. This may due to the small sample size and retrospective nature of our study.

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Introduction: Hip fracture surgeries are associated with substantial blood loss, exposing patients to postoperative anemia. The severity of anemia is related to reduced functional recovery, which is related to long-term mortality. Patients undergoing hemiarthroplasty surgeries require 1 to 2 pints of blood transfusion post operatively. There are many transfusion related health hazards. Tranexamic acid is a less expensive pharmacological agent that interferes with fibrinolysis and reduces blood loss in hemiarthroplasty surgeries. The aim of this study is to evaluate the efficacy of intra-venous administration of tranexamic acid in patients who underwent hemiarthroplasty with regards to blood loss at peri and post-operative period. Materials and Methods: Patients with fracture neck of femur, above 60 years who primarily presented to Emergency medical service medicine in our institution fulfilling the inclusion criteria were included in our study. After obtaining the informed consent, patients were grouped into two categories; group 1 and group 2. Group 1 intervention: Placebo-50 ml of normal saline intravenously was administered 10 minutes before starting the surgery. Group 2 intervention: Study-Tranexamic acid -1500mg diluted in 50ml normal saline intravenously was administered 10 minutes before the surgery. Intra-operative blood loss was assessed by collecting the number of fully soaked mopping pads, gauze pieces and the quantity of irrigation fluid after substracting the amount of saline wash. Post operatively the efficacy was assessed by evaluating the hemoglobin and packed cell volume values. The blood collected in the drain on day 1 and 2 were also analysed and compared between the control group and the study group. Result: In our study we included 40 patients who had undergone hemiarthroplasty for neck of femur fracture. Intra operatively we did PRBC transfusion for 11 patients in the control group and 3 patients in the study group. Postoperatively 2 patients received PRBC transfusion in the control group and none of the patients received PRBC transfusion in the study group. The post surgery blood loss was also very minimal in the control group as compared to the study group. Conclusion:In our study, there was a significant amount of blood loss reduction in tranexamic acid administered group when compared to the placebo group. Tranexamic acid was cost effective and safer when compared to blood components. Tranexamic acid was useful and effective in reducing intraoperative blood loss and reduces the need for blood transfusion post-operatively. Tranexamic acid should be considered for routine use in hemiarthroplasty surgery to decrease blood loss.