Ipsilateral Neck/Inter-Trochanteric and Mid-shaft Femoral Fractures Treated with Dual Construct Implants

Abstract

Background: Various management protocols for ipsilateral neck/intertrochanteric and shaft fracture femur have been formulated, there have been many disagreements related to their ideal fixation plan. The aim of this study was to discuss the various type of fixation system available for such kind of complex injuries and the advantages of using dual construct fixation system.
 Patient and Methods: In the present study we prospectively evaluated ipsilateral neck/intertrochanteric and shaft fracture femur in 7 cases managed from January 2018 to December 2020. All the patients were managed with dual constructs fixation system using dynamic hip screw (DHS) and locking plate. The outcome was evaluated using Friedman and Wyman scoring system.
 Results: The average surgical time was 120.4 min (range 98–143 minutes) with a blood loss ranging from 290-565 mL (average 460 mL). In 6 patients follow-up was undertaken between 10 and 22-months after surgery, with a mean follow-up time of 16.2 months. 1 patient lost follow-up at 3-month. The neck/IT fractures achieved union in 6 patients at the final follow-up. 3-6 months was the duration for bone union, with an average of 4.1 months. The mid-shaft femur fractures achieved solid union in 6 cases at the most recent follow-up. 3 to 11 months was the duration of union, with a mean of 5.1 months. 1 patient went into non-union 11 months after the surgery. According to Friedman and Wyman scoring, 4 patients the functional outcome was good, in 2 patients the functional outcome was fair, and in 1 patient the functional outcome at the final follow-up was poor. The problems noted were surgical site infection in 1, Angulations (varus/valgus) of femoral neck in 1, non-union of neck femur fracture in 1, and avascular necrosis of femoral head in 1.
 Conclusion: The management of ipsilateral neck/intertrochanteric and shaft fracture femur with dual construct implants dynamic hip screw for neck/IT fracture and locking plate for shaft femoral fractures yielded good union rates and good functional outcomes.

Surgical management of bifocal femoral fractures: a systematic review and pooled analysis of treatment with a single implant versus double implants

“… D.I. Time to union PF (months) Time to union SF (months) Mean follow-up (range) Chaudhary et al (2021) [ 61 ] 2018–2020 7 (7) 5 (71%) 35 (27–45) 7 (100%) FN + TF N.A. 0 7 4.1 (3–6) 5.1 (3–11) 16.2 (10–22) Rana et al (2021) [ 62 ] 2018–2020 13 (13) 8 (62%) 38 (23–54) 13 (100%) FN N.A.…”

“…Only seven studies reported sufficient data concerning operation time and perioperative blood loss [ 19 , 28 , 49 , 54 , 59 , 61 , 62 ]. Table 2 shows the pooled analysis for operation time and perioperative blood loss for both treatment groups.…”

“…(95% CI 124–177 min.) for patients treated with a double implant [ 19 , 28 , 49 , 54 , 59 , 61 , 62 ]. The overlapping confidence intervals suggest that operation time is unrelated to the number of implants.…”

“…In the group treated with a single implant, pooled perioperative blood loss was 334 mL (95% CI 152–516 mL) compared to 373 mL (95% CI 233–512 mL) in patients treated with a double implant [ 19 , 54 , 59 , 61 , 62 ].…”

Automated Grading Of Early Stages Of The Human Embryo Development

“…The embryo goes through perforation at this time, the blastocoel is large enough to push the trophectoderm up against the zona pellucida, and the latter begins to thin. This is when the to cleavage is defined as the first observed frame in which the newly formed blastomeres are completely separated by epithelial cell membranes (11)(12)(13)(14)(15)(16)(17)(18)(19)(20).…”