The benefit of using a long intramedullary device for the treatment of geriatric intertrochanteric hip fractures is unknown. The InterTAN device (Smith and Nephew, Memphis TN) is offered in either Short (180–200 mm) or Long (260–460 mm) constructs and was designed to provide stable compression across primary intertrochanteric fracture fragments. The objective of our study was to determine whether Short InterTANs are equivalent to Long InterTANs in terms of functional and adverse outcomes for the treatment of geriatric intertrochanteric hip fractures.

108 patients with OTA classification 31A–1 and 31A–2 intertrochanteric hip fractures were included in our study and prospectively followed at one of four Canadian Level-1 Trauma Centres. Our primary outcomes included two validated primary outcome measures: the Functional Independence Measure (FIM), to measure function, and the Timed Up and Go (TUG), to measure motor performance. Secondary outcome measures included blood loss, length of procedure, length of stay and adverse events. A pre-injury FIM was measured by retrospective recall and all postoperative outcomes were assessed on postoperative day 3, at discharge, at 6 weeks, 3 months, 6 months and 12 months postoperatively. Unpaired t-tests and Chi-square tests were used for the comparison of continuous and categorical variables respectively between the Short and Long InterTAN groups. A statistically significant difference was defined as p<0.05.

Our study included 71 Short InterTAN and 37 Long InterTAN patients with 31A–1 and 31A–2 intertrochanteric hip fractures. Age, sex, BMI, side, living status and comorbidities were similar between the two groups. The mean operative time was significantly lower in the Short InterTAN group (61 mins) as compared to the Long InterTAN group (71 mins)(p0.05). There were 5 periprosthetic femur fractures in the short InterTAN group versus 1 in the long InterTAN group. Non-mechanical adverse outcomes such as myocardial infarction, pulmonary embolism, urinary tract infections, pneumonia and death all had similar incidence rates between the two InterTAN groups.

Both the Short and Long InterTAN patient cohorts displayed similar improvements in performance and overall function over the course of a year following intertrochanteric hip fracture fixation. The recorded operative times for Short InterTAN fixation were significantly shorter than those recorded for the Long InterTAN patients. Alternatively, a significantly higher proportion of Short InterTAN patients sustained periprosthetic femur fractures within a year of implantation as compared to the Long InterTAN group.

Purpose: To compare the reoperation rates of three commonly used forms of fixation for distal femur fractures.

Method: 89 patients treated between 2002 and 2006 were retrospectively reviewed (mean follow up 28 months).. 40 fractures were treated with an intramedullary nail (IMN), 34 with the LISS internal fixator and 16 with a DCS construct. Patients were reviewed clinically and radiographically. The primary treatment outcome was the rate of secondary surgical intervention; secondary outcomes included radiographic alignment and clinical outcome measures (LEM and SF-36).

Results: Reoperation: Reoperation rate for the DCS group was 12.5%, compared to 17.5 % in the IMN group and 44 % in the LISS group. Failure rates were the same when only AO type C fractures were considered. Most concerning in the LISS group was the rate of failure in distal short oblique type A fractures, in which catastrophic failure was observed in 4 of 9 patients. Alignment was similar comparing all three groups; the average radiographic distal femoral articular angle (DFAA) of was 10 degrees valgus in the DCS group, compared to 8 degrees in the IMN group and the LISS patients.

Conclusion: Reoperation rate was highest in this study when the LISS fixator was used for distal short oblique fractures of the femur. These fractures may benefit from fixation which achieves direct interfragmentary compression, such as an intramedullary device or compression plating.

This study is designed to evaluate intra-operative stress testing on detection of syndesmosis injuries. We evaluated forty patients with ankle fractures requiring surgery. Their ankles were subjected to stress examinations after each stage of fixation. These were compared to the contralateral side. Biomechanical criteria were used to predict need for syndesmosis fixation. In 42% of the fractures, intra-operative fluoroscopy found an unpredicted syndesmosis injury. In 8% the syndesmosis was intact despite prediction. Medial malleolar fixation was not adequate for syndesmosis fixation as shown by stress testing. These findings may have implications for future diagnosis and treatment of syndesmosis injuries.

This study is designed to evaluate the utility of intra-operative fluoroscopic stress testing in diagnosing tibio-fibular syndesmotic injuries.

Forty skeletally mature patients with unilateral external rotation ankle fractures requiring open reduction and internal fixation were prospectively recruited. Intra-operatively the injured ankle was examined fluoroscopically using external rotation, valgus and anterior drawer stress tests, as well as static antero-posterior, mortise, and lateral ankle views. Stress testing was performed using a standardized force of 37.5 N. Stress testing was done after each stage of fixation (lateral, medial, and syndesmotic). The uninjured contralateral limb was examined as a control, and a 1 mm side to side difference was defined as a positive stress examination.

Intra-operative fluoroscopy detected unpredicted syndesmotic injuries in 42 % of ankle injuries. In all cases, fixation of the medial malleolus did not restore syndesmotic stability. In 8 % of ankle injuries, a syndesmotic injury was predicted but stress testing revealed the syndesmosis intact.

Intra-operative fluoroscopy is a more sensitive modality for detection of otherwise unpredicted syndesmotic injuries compared to criteria based upon static radiographs. Medial malleolar fixation did not add stability to syndesmotic injuries in this study.

Injuries involving the distal tibio-fibular syndesmosis are difficult to detect. Previously, the decision to stabilize the syndesmosis in ankle fractures was based upon biomechanical criteria and static radiography. This and other recent studies challenge this, suggesting fluoroscopic stress testing is a better diagnostic method for these poorly tolerated injuries.

Funding: Synthes Canada, Smith Nephew Richards Inc.

Recovery after femur fractures is slow, despite rapid bone union. Causes of disability require investigation. Forty patients with isolated, diaphyseal femur fractures treated with antegrade locked intramedullary nailing were prospectively studied. Functional outcome was measured using the Western Ontario – McMaster University Osteoarthritis Index (WOMAC) and Short Musculoskeletal Functional Assessment (SMFA). Pain scores from the groin, buttock, thigh, and knee six months following the injury were correlated with functional outcome. Severity of pain was highest at the knee. Both knee and thigh pain had strong correlations with functional outcome measures following diaphyseal femur fractures. Further investigation into post-traumatic pain is warranted.

This study was performed to compare pain at the knee, thigh, buttock and groin with functional outcome scores 6 months following femur fractures.

Pain at the knee and thigh correlated with functional outcome measures.

Many patients with femoral fractures have prolonged disability. Knee pain is common, severe, and correlates with functional outcome.

Forty skeletally-mature patients with diaphyseal femoral fractures treated with locked antegrade intramedullary nails were prospectively enrolled. Exclusion criteria included polytrauma, ipsilateral injuries, metaphyseal extension, and pathologic fractures. Functional outcomes were assessed using the Western Ontario-McMaster University Osteoarthritis Index (WOMAC) and the Short Musculoskeletal Function Assessment (SMFA). Patients were instructed to record pain in the groin, buttock, thigh or knee of the fractured extremity on a 10-point visual analog scale.

Patients reported more pain at the knee (3.7 ± 3.1), compared to the thigh (2.5 ± 2.7), buttock (1.7 ± 2.7), and groin (1.0 ± 1.7) (p=0.003). Pain and functional outcomes were plotted on scatter graphs and correlations performed using the Spearman rank test. Strongest correlations were noted between knee pain and WOMAC pain (ρ=0.748, p< 0.001), function (ρ=0.701, p< 0.001), and SMFA (ρ=0.733, p< 0.001); and between thigh pain and WOMAC pain (ρ=0.705, p< 0.001), stiffness (ρ=0.707, p< 0.001), function (ρ=0.731, p< 0.001), and SMFA (ρ=0.723, p< 0.001). Weaker correlations were noted between groin and buttock pain and functional outcomes.

Knee pain is common and severe after femur fractures. Knee and thigh pain correlate with functional outcomes. Further investigation should be directed to this common problem.

Funding: Funding from Synthes Canada, Smith and Nephew Richards Canada, and the Lawson Health Research Institute was received in support of this study.