purpose. To compare the short-term ambulatory function of elderly patients after fixation of unstable intertrochanteric fractures with either the AO-ASIF proximal femoral nail anti-rotation (PFNA) device or the dynamic hip screw (DHS). Methods. 63 patients aged ≥60 years underwent fixation for unstable intertrochanteric fractures (AO types A2 and A3) using the PFNA (n=25) or DHS (n=38). The decision for the type of implant used was based on the lead surgeon's preference, according to perceived fracture stability and clinical experience. In patients having PFNA fixation, weight bearing ambulation and rehabilitation was commenced on day 2. The extent of weight bearing was decided by the lead surgeon based on the stability of the fracture. In patients having DHS fixation, non-weight bearing and ambulation with a walking aid was commenced on day 2. Ambulatory function before injury and after surgery was measured using the Parker Mobility Score (PMS). The 2 groups were compared in terms of the PMS, ambulatory independence, and environmental mobility.

In atypical femoral fractures associated with bisphosphonate use, more distal diaphyseal fractures occurred with a higher degree of anterior and lateral femoral bow.

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Background Whether an anterior shoulder fracture dislocation should be reduced under sedation in the emergency department is still a dilemma. This retrospective study aimed to determine when it is safe to perform a closed reduction based on the fracture pattern. Methods Surgically treated anterior shoulder fracture dislocations over eight years were classified into three groups. Group 1 involved an isolated greater tuberosity fracture. Group 2 and 3 involved surgical and or anatomical neck fractures. In group 2, the head and the shaft fragments were displaced together anteriorly and inferiorly; whereas in group 3, the head was displaced and locked under the glenoid, but the shaft migrated superiorly. The outcome and complications of closed reduction were reviewed. Results Twenty-nine patients with 30 surgically treated anterior shoulder fracture dislocations were reviewed. These included twelve patients (thirteen shoulders) in group 1, six patients in group 2, and eleven patients in group 3. Closed reduction was attempted in twelve shoulders in group 1, five shoulders in group 2, and six shoulders in group 3. Eleven group 1, four group 2, and none group 3 dislocations were successfully reduced. The patient who failed reduction in group 1 sustained an iatrogenic anatomical neck fracture. One patient failed reduction in group 2. His surgical neck fracture was displaced further after manipulation. No other complications occurred after closed manipulation. Discussion and Conclusion Closed reduction under sedation is usually successful and safe for group 1 injuries with an iatrogenic complication rate of only 8.3% (1/12) in our series. It should also be considered for group 2 injuries as 80% (4/5) were successfully reduced. However, further displacement from the reduction maneuver may warrant an urgent open reduction. Closed reduction is futile for group 3 injuries. We recommend an acute management algorithm based on our results.