Gunshot-induced fractures of the proximal femur typically present with severe comminution and bone loss. These fractures may also be associated with local damage to soft tissue, neurovascular structures and injuries to abdominal organs. The aim was to evaluate the outcomes of civilian gunshot injuries to the proximal femur at a major trauma center in South Africa. A retrospective review of all patients who sustained gunshot-induced proximal femur fractures between January 2014 and December 2017 was performed. Patients with gunshot injuries involving the hip joint, neck of femur or pertrochanteric fractures were included. Patient demographics, clinical- treatment and outcome data were collected. Results are reported as appropriate given the distribution of continuous data or as frequencies and counts. Our study included 78 patients who sustained 79 gunshot-induced proximal femur fractures. The mean age of patients was 31 ± 112, and the majority of patients were male (93.6%). Pertrochantenteric fractures were the most common injuries encountered (73.4%). Treatment included cephalomedullary nail (60.8%), arthrotomy and internal fixation (16.4%) and interfragmentary fixation with cannulated screws (6%). One case of complete neck of femur fracture had fixation failure, which required conversion to total hip arthroplasty. The overall union rate was 69.6%, and 6.3% of patients developed a fracture-related infection in cases who completed follow-up. The study shows an acceptable union rate when managing these fractures and a low risk of infection. As challenging as they are, individual approaches for each fracture and managing each fracture according to their merits yield acceptable outcomes

Aim:. To audit pertrochanteric fractures treated with a cephalomedullary device in a public health institution. Method:. A retrospective 3 year analysis from January 2007 to December 2010 using theatre records and patient files. Analysis was done in terms of age, time to surgery, duration of surgery, elective or emergency, type of device used, perioperative complications and other factors. Results:. A total of 96 cases were confirmed. The average age was 67.4 years (13 to 99 years). The average time to theatre was 6.9 days. The average duration of surgery was 2 hours 59 minutes. A Trigen reconstruction nail was used in 59.4 % of the cases followed by a PFNA (26%) and others (13.6%). In 30% of cases surgery time was >3 hours and most were done electively (85.4%) during normal working hours. Revision surgery due to poor surgical technique was reported in 8 of 96 (8.3%) cases. Conclusion:. Our audit confirms that pertrochanteric fractures are common in elderly and young patients involved in high velocity trauma especially motor vehicle accidents. Pertrochanteric fractures lead to prolonged morbidity in hospital stay and theatre time. Cephalomedullary devices have reduced these complications and resulted in early rehabilitation and hospital discharge with only 8% of revisions in 3 years

Controversy exists whether to treat unstable pertrochanteric hip fractures with either intra-medullary or extra-medullary devices. A prospective randomised control trial was performed to compare the outcome of unstable pertrochanteric hip fractures stabilised with either a sliding hip screw or long Gamma Nail. The hypothesis was that there is no difference in outcome between the two modes of treatment. Over a four year period, 210 patients presenting with an unstable pertrochanteric hip fracture (AO/OTA 31 A2) were recruited into the study. Eligible patients were randomised on admission to either long Gamma Nail or sliding hip screw. Follow-up was arranged for three, six, and twelve months. Primary outcome measures were implant failure or ‘cut-out’. Secondary measures included mortality, length of hospital stay, transfusion rate, change in mobility and residence, and EuroQol outcome score. Five patients required revision surgery for implant cut-out (2.5%), of which three were long Gamma Nails and two were sliding hip screws (no significant difference). There were no incidences of implant failure or deep infection. Tip apex distance was found to correlate with implant cut-out. There was no statistically significant difference in either the EuroQol outcome scores or mortality rates between the two groups when corrected for mini mental score. There was no difference in transfusion rates, length of hospital stay, and change in mobility or residence. There was a clear cost difference between the implants. The sliding hip screw remains the gold standard in the treatment of unstable pertrochanteric fractures of the proximal femur

Introduction. Internal fixation of pertrochanteric fractures is evolving as newer implants are being developed. Proximal Femoral Nail Antirotation (PFNA) is a recently introduced implant from AO/ASIF designed to compact the cancellous bone and may be particularly useful in unstable and osteoporotic hip fractures. This study is a single and independent centre experience of this implant used in management of acute hip fractures. Methods. 68 patients involving 68 PFNA nailing procedures done over a period of 2 years (2007–09) were included in the study. Average follow-up period of patients was 1 year. AO classification for trochanteric fractures was used to classify all the fractures. Radiological parameters including tip-apex distance and neck shaft angle measurement were assessed. Results. Average age of patients included in the study was 80 years. 18 patients died during the follow up period due to non-procedure related causes. Average tip-apex distance was 12.7 mm and radiological fracture union time was 5 months. Revision of short to a long PFNA was needed for periprosthetic fracture of shaft of femur in two patients. Two patients needed a complex total hip replacement eventually and further two patients had removal of the implant due to PFNA blade penetration through the femoral head. Discussion. PFNA is a technically demanding procedure and has a learning curve. Our experience shows that it is a useful implant in unstable pertrochanteric fracture fixation. A close radiological and clinical follow up is recommended due to the risk of late fracture and implant related complications

Proximal Femoral Nail Antirotation (PFNA) I one of the implants commonly used to stabilise subtrochanteric fractures or communited inter/pertrochanteric fractures. The aim of this project was to assess the outcome of PFNA in a busy District General Hospital. Between November 2009 to November 2012, 76 patients underwent PFNA. These patients were identified from the local hip fracture database, which is prospectively collected. The mean age of the patients was 80.11 years (range of 26.83 to 98.53). 27 were male and 49 female. Right hip was involved in 36 cases and left hip in 40. 9 patients required revision surgery due to failure of the primary surgery. 2 patients died due to other causes. 5 out of the 9 patients who underwent revision surgery had their primary surgery performed by a trainee under consultant supervision and a consultant surgeon performed the other 4 cases. In our series failure rate was 11.8%. We conclude that although PFNA is an excellent device to fix subtrochanteric or communited intertrochanteric fractures of the proximal femur one needs to be cautious and follow the correct operative technique to avoid failures

Patients with above knee amputation face many challenges to mobility including difficulty with socket fit and fatigue due to high energy consumption. The aim of the Endo - Exo-Femur Prosthesis is to avoid problems at the interface between the sleeve of the socket-prosthesis and the soft tissue coat of the femur stump which often impedes an inconspicuous and harmonic gait. In 1999 we began using a transcutaneous, press-fit distal femoral intramedullary device whose most distal external aspect serves as a hard point for AKA prosthesis attachment. The bone guided prosthesis enables an advanced gait via osseoperception and leads to a decreased oxygen consumption of the patient. 43 patients were implanted between 1999 and 2009. Four of the 43 required removal:one for intramedullary infection, one due to stem fracture (replaced), and the two for soft tissue infection. The remaining 39 original prostheses remained. Two pertrochanteric fractures occurred, treated with ORIF. Two bilateral procedures were performed. Initially, twenty patients had chronic soft tissue irritation requiring debridement. This completely resolved by changing the connecting components to a highly polished cobalt chrome. All patients reported increased comfort when compared to socket use. The following additional advantages were observed: improved mobility and endurance, improved proprioception, decreased time required for prosthetic donning, lack of concern regarding changing body weight, and the absence of skin irritation. All patients reported an improvement in sense of position and tactile sensation, leading to an improved gait pattern. Subjectively, the EEFP represents a significant improvement in terms of comfort. Since the introduction of high-gloss polished surfaces, soft tissue irritation is largely eliminated. Intramedullary infection has been negligible, as osseointegration seals the medullary cavity. In summary, the EEFP appears to be an attractive option in transfemoral amputees