Background. Sub-trochanteric fractures are challenging to treat due to various anatomical and biomechanical factors. High tensile forces contribute to the challenge of fracture reduction. Intramedullary nailing has become the treatment of choice. If anatomical reduction is not achieved, any mal-alignment will predispose to implant failure. Open reduction with cerclage wires can add to construct stability and improve the quality of reduction. There is no consensus or classification to guide surgeons on when to perform open reduction, which is often performed intra-operatively when closed reduction fails often with no planning. This can lead to intraoperative delays as theatre staff would not have prepared the correct equipment necessary for open reduction. Objectives. The purpose of this study was to assess outcomes of closed and open reduction of traumatic sub-trochanteric fractures treated with intramedullary nailing and to propose a new classification system to dictate management. Methods. After a review of current classification systems, a 3-tier classification was proposed (Type 1, 2 and 3). Type 1 indicated a transverse fracture, Type 2 was a spiral fracture with an intact posterior and medial wall and a Type 3 fracture were fractures with no posterior and/or medial walls. Over a two-year period (2013–2015), patients with sub trochanteric fractures were classified into Type 1, 2 or 3 injuries based on radiographic appearances by two senior clinicians. Patients with Type 3 injuries were divided into two groups based on whether they were treated with open or closed reduction. A clinical and radiographic review was performed. The primary outcome measure was the incidence of implant failure, whereas secondary outcome measures were related to fracture reduction. Statistical analysis was performed using GraphPad Prism Version 6 (GraphPad Software Inc. California, USA). Fisher's exact test was used for independent categorical data and Mann–U Whitney for continuous nonparametric data. Statistical significance was set at p<0.05. Results. 75 patients had intramedullary nailing for subtrochanteric fractures over the study period with a mean age of 82.6 years. There were 48 patients who had a Type 3 fracture pattern with a deficient medial and/or posterior wall. Reduction was achieved open with cerclage wires in 42% of patients (n=20 and closed in 58% (n=28). Overall there were a total of 18 (37.5%) major complications. In patients treated with closed reduction, 9 patients suffered mechanical complications (6 distal locking screw failures, 3 lag screw cut outs). There was a significantly increased risk of implant failure in patients treated with closed reduction compared to open reduction (p=0.006). No cases with cerclage wire had implant failure. Open reduction with cerclage wires improved the quality of reduction (p=0.0001) compared with closed reduction. There was no significant increase in operating time in patients treated with cerclage wires (p=0.4334). Conclusions. Open reduction with cerclage wires should be considered in patients with Type 3 sub-trochanteric fractures as it has shown to significantly reduce the risk of implant failure and improve the quality of reduction with no significant increase in operating time

Aims

Revision total hip arthroplasty in patients with Vancouver type B3 fractures with Paprosky type IIIA, IIIB, and IV femoral defects are difficult to treat. One option for Paprovsky type IIIB and IV defects involves modular cementless, tapered, revision femoral components in conjunction with distal interlocking screws. The aim of this study was to analyze the rate of reoperations and complications and union of the fracture, subsidence of the stem, mortality, and the clinical outcomes in these patients.

Aims

The risk of mechanical failure of modular revision hip stems is frequently mentioned in the literature, but little is currently known about the actual clinical failure rates of this type of prosthesis. The current retrospective long-term analysis examines the distal and modular failure patterns of the Prevision hip stem from 18 years of clinical use. A design improvement of the modular taper was introduced in 2008, and the data could also be used to compare the original and the current design of the modular connection.

Objectives

The paradoxical migration of the femoral neck element (FNE) superomedially against gravity, with respect to the intramedullary component of the cephalomedullary device, is a poorly understood phenomenon increasingly seen in the management of pertrochanteric hip fractures with the intramedullary nail. The aim of this study was to investigate the role of bidirectional loading on the medial migration phenomenon, based on unique wear patterns seen on scanning electron microscopy of retrieved implants suggestive of FNE toggling.