Clinical profile of patients with complex proximal femur fractures

 

L Y Sathyanarayana¹, Mohammed Sajeed^2*

 

¹Assistant Professor, ²Sr. Resident, Department of Orthopedics, Shri Sathya Sai Medical Collage and Research Institute Ammapettai, Sembakkam Post 603108, Chengalpattu Taluk, Kancheepuram Distric, Tamil Nadu, INDIA.

Email: sathyanarayana2231@gmail.com

 

Abstract               Background: Femur fractures are devastating injuries that most commonly affect the elders and young population also. In young and healthy individuals, the injury results from high energy trauma, whereas in the elder age group, most of the fractures are osteoporotic, resulting from a trivial fall. Aim: To study the clinical profile of patients with complex proximal femur fractures. Material and Methods: In this study, 20 cases of adult patients with complex proximal femur fractures with communition and osteoporosis were studied. Clinical and demographic characteristic were studied such as mode of injury, side affected and associated injuries. Results: The majority of the patients were in the age group of 41-60 years and 61-80 years i.e., 8 patients each (40% each). Most of the patients were male i.e., 12 (60%) and 8 (40%) were female. The most common mode of injury was road traffic accidents in 10 patients (50%) followed by fall from height in 7 (35%) patients. Both right and left side were equally affected. Conclusion: The complex proximal femur fractures were more common in old age and in females which could be attributed by underlying osteoporosis prevalent more in females.

Key Words: Complex proximal femur fractures, old age, trivial fall, road traffic accidents.

 

 

 

INTRODUCTION

Femur fractures are devastating injuries that most commonly affect the elders and young population also. In young and healthy individuals, the injury results from high energy trauma, whereas in the elder age group, most of the fractures are osteoporotic, resulting from a trivial fall.¹ These fractures have a tremendous impact on both the health care system and society in general. Proximal femur fractures comprise, fractures of intertrochanteric and subtrochanteric region. Subtrochanteric fractures are complicated by delayed or non-union.² The factors responsible for these complications in subtrochanteric fractures are high stress concentration, predominance of cortical bone and difficulties in getting biomechanically sound reduction because of comminution and intense concentration of deforming forces. In inter-trochanteric fractures, which usually occur in the elderly, stabilization of the fracture and restoring the patient to his or her pre-injury functional activity at the earliest possible time is essential to prevent complications of recumbency.³ The present study of was aimed to study the clinical profile of patients with complex proximal femur fractures.

 

MATERIAL AND METHODS

This study was conducted in Raja Muthaiah Medical College and Hospital, Annamalai University over a period of two years. During the study period, 20 cases of adult patients with complex proximal femur fractures with communition and osteoporosis were selected according to inclusion criteria. The fractures were classified according to Boyd and Griffin’s classification⁴ and Seinsheimer’s classification.⁵

 

 

Inclusion Criteria

• Patients aged > 18yrs
• Patients with complex proximal femur fractures with communition and osteoporosis
• Patients willing and fit for surgery

Exclusion Criteria

• Any displacement of the femoral neck fracture
• Type 2 and 3 open fractures
• Inability to walk independently prior to injury
• Medically unfit for surgery
• Pathological fractures other than due to osteoporosis

At the arrival of the patient with suspected proximal femur fracture, patients were resuscitated depending on their general condition. Fracture was stabilized using Thomas splint, alternatively with skin traction. Routine laboratory investigations were done including echocardiogram. X-rays of pelvis with both hips-AP view, hip with femur full length of involved side-AP and lateral views and Chest –PA view. In all the patients Proximal femoral locking compression plate-implant were used for surgical management.

 

RESULTS

The majority of the patients were in the age group of 41-60 years and 61-80 years i.e., 8 patients each (40% each) followed by in the age group of 21-40 and 81-100 years were 10% each. Most of the patients were male i.e., 12 (60%) and 8 (40%) were female with mean age being 60 years.

 

Table 1: Distribution of patients as per age and sex

Patient characteristics	No. of cases	Percentage
Age group (years) 0-20 21-40 41-60 61-80 81-100 Sex Male Female	0 2 8 8 2   12 8	0 10 40 40 10   60 40

The most common mode of injury was road traffic accidents in 10 patients (50%) followed by fall from height in 7 (35%) patients. Both right and left side were equally affected. Distal radial fractures was the commonest associated injury. Communited subtrochantric fracture constituted 15 cases and subtrochanteric fracture with proximal femur extension in 5 cases.

 

 

 

 

 

Table 2: Clinical characteristics of patients

The majority of the patients were of Type IIIb 5 (25%); Type I was the least common type seen in only one patient.

Table 3: Type of fractures

 

DISCUSSION

Hip fractures in young adults are often the result of high-energy trauma, such as a motor vehicle accident or a fall from a height. In these instances, assessment must be made of possible associated head, neck, chest, and abdominal injuries. In contrast, 90% of hip fractures in the elderly result from a simple fall.⁶ In our study the mean age at fracture was 60 years. The tendency to fall increases with age and is exacerbated by several factors, including poor vision, decreased muscle power, labile blood pressure, decreased reflexes, vascular disease, and coexisting musculoskeletal pathology. The age-related decline in muscle mass around the hip may help account for the increased incidence of hip fractures with aging. Although the muscles surrounding the hip can provide protection, contraction of these muscles during a fall may actually lead to increased rates of hip fracture. The mean age at fracture in our study was 60 years, which is lower compared to that quoted by authors in literature Parker et al⁷ (71 years), Boldin et al⁸ (73 years) and Pavelka et al (67 years).⁹ In our study, there were 12 male patients and 8 female patients. this could be the fact that in old age groups females are more prone for the osteoporosis as compared to males these findings are similar to Bostrom et al;¹⁰ Kesemenli C et al¹¹ in 2001 studied 27 patients with average age of 78 years. Amongst them 14 (51%) patients were females and 13 (49%) patients were males. Higher female preponderance was reported by Boldin et al²⁶ and Pavelka et al.⁵⁰ In our study, the common mode of injury being high velocity (RTA) and fall from height accounting for 75% of the cases. Boldin et al⁸ and Pavelka et al⁹states low energy trauma due to fall being the commonest mode fractures in elderly. Fractures of the proximal femur occur by one of the three mechanisms. In the elderly, these fractures are usually due to low energy trauma, typically a minor fall. Spiral fractures generally result perhaps with butterfly comminution. The second mechanism is that of the trivial trauma, with fracture through a defect in the proximal femur due to neoplasia. Most commonly metastatic carcinoma. Such pathological subtrochanteric fractures require assessment and management of the neoplastic process as well as of the fracture. The third mechanism is high-energy trauma, motor vehicle accident or fall from significant height. Comminution, soft tissue damage including possible open wound and presence of associated injuries are typical concerns.¹² From our study findings it can be concluded that the complex proximal femur fractures were more common in old age and in females which could be attributed by underlying osteoporosis prevalent more in females.

 

REFERENCES

• Kaufer H. Mechanics of the Treatment of Hip Injuries. Clin Orthop. 1980; 146:53-61.
• Balasubramanian N, Babu G, Prakasam S. Treatment of Non Unions of Subtrochanteric Fractures Using an Anatomical Proximal Femur Locked Compression Plate – A Prospective Study of 13 Patients. Journal of Orthopaedic Case Reports. 2016;6(1):65-68.
• Lorich DG, Geller DS. Nielson JH. Osteoporotic pertrochanteric hip fractures. Management and current controversies. J Bone Joint Surg. 2004; 86A:398-410.
• Boyd HB, Griffin. Classification and treatment of trochanteric fractures. Arch surgery. 1949; 58:853-66.
• Seinsheimer. Subtrochanteric fractures of the femur. J Bone Joint Surg Am. 1978 Apr;60(3):300-6.
• Carpintero P, Caeiro JR, Carpintero R, Morales A, Silva S, Mesa M. Complications of hip fractures: A review. World Journal of Orthopedics. 2014;5(4):402-411. 
• Parker MJ, Dutta BK, Sivaji C, Pryor GA. Subtrochanteric fractures of the femur. Injury. 1997;28(2):91–95.
• Boldin C, Seibert FJ, Fankhauser F, et al. The proximal femoral nail (PFN)-a minimal invasive treatment of unstable proximal femoral fractures. Acta Orthop Scand. 2003; 74(1): 53-58.
• Pavelka T, Kortus J, Linhart M. Osteosyntehsis of proximal femoral fractures using short proximal femoral nails. Acta Chir Orhtop Traumatol Cech. 2003; 70(1):31-8.
• Bostrom MPG, Simie PM, Lyden JP, Cornell CM, Thorngren KG, Tolo ET. Epidemiology of hip fractures. Bone. 1996; 18:57S-63S.
• Kesemenli C, Subasi M, Arsian H. Treatment of Intertrochanteric fracture in elderly patients with leinbach type endoprosthesis. Ulus Trauma Derg. 2001; 7(4):254- 257.
• Kulkarni GS. Treatment of Trochanteric fractures of the hip by Modified Richard’s Compressing and Collapsing screw. Indian Journal of Orthopaedics. 1984; 18(1):30-34.