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Query: UNIPROT:P50502 (Hip)
 7,003 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In trochanteric fractures of the femur, where operative techniques are preferable to conservative treatment, a change in the choice of implants has taken place over the past years. As several comparative studies show, the traditional system of nail/plate fixation has not been completely replaced by Ender nailing in many surgical departments. The system of nail/plate is, however, losing significance in face of the increasing usage of screwing-systems (such as, for instance, DHS of AO-Dynamic Hip Screw). The possibility of compression during the operation in screwing methods is the decisive factor.
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PMID:[From the nail/plate to the dynamic hip screw--example of a generation change in implants for para-articular femoral fractures]. 368 27

In the last four years we performed 182 osteosynthesizes with Dynamic Hip Screw, besides other methods on the fractures of the hip region. Here we are presenting the evaluation of our results, which, regarding the international scene, fall into the medium category. The operations were performed within three days after the injuries in 61 per cent of our patients. Our results are good in 80 per cent of our patients. The incidence of method-specific complications is 15 per cent in our statistics/such as wound haematomas, local infections, cut out of the device of the femoral head, metal failures, the fracture of the femur at the site of the introduction of the device). The rate of complications is 30 per cent in case of Ender nailing. More than a 1 cm shortening in the fracture after weight bearing was observed in the 47 per cent of our DHS cases. Patients who are complaining of pain during weight bearing belong to this group. In accordance with other authors, we consider the DHS osteosynthesis, due to its high stability, the best technique in case of unstable pertochanteric fractures of elderly patients. We recommend the angular plate fixation to the pertrochanteric fractures in young patients, in whose case it requires a more accurate reposition and who are able to walk without weight bearing. We can achieve good results with Ender nails in case of stable pertrochanteric fractures of elderly patients.
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PMID:[DHS (Dynamic Hip Screw)-osteosynthesis in the management of femoral fractures in the hip region and the place of this method in the treatment of such injuries]. 834 35

A reduction in perioperative mortality can be observed when the operative treatment of intertrochanteric femur fractures in the elderly is performed within a 6-h time limit, or after stabilisation of the patient within a 24-h frame. To insure optimal progress, a stable open reduction and internal fixation (ORIF) with a DHS or other implant, or a prosthetic replacement is needed to achieve early ambulation. The ability to walk and early ambulation are essential for a quick hospital discharge and reintegration into social life. The quality of life decreases due to the injury [Mayo Hip Score (2 M), and Traumatic Hip Rating Scale [4], 84.4% of pretrauma function, Functional Status Score [1], 68.2%]. About half of the injured (65% of the patients examined in our study) were able to return to their homes. This depends on the patient's age, independence before the accident and concomitant diseases.
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PMID:[Comparison of the quality of life before and after surgical management of pertrochanteric femoral fractures in elderly patients]. 910 46

Postoperative blood recovery in eighty elderly patients (11 male, 69 female) treated for femoral neck fracture was prospectively studied. Twenty-eight patients underwent hemiarthroplasty for intracapusular fracture and 52 underwent Dynamic Hip Screw fixation for extracapsular femoral neck fracture. The mean blood drainage in the postoperative period and the mean drop in haemoglobin level was higher in the DHS group as compared to the hemiarthroplasty group. Mean drainage in the first 6 postoperative hours was 150 ml (range: 10-450 ml) in the DHS group, versus 50 ml in the hemiarthroplasty group (range: 10-100 ml). Out of 52 cases of the dynamic hip screw fixation group, only 10 patients received autologous blood transfusion (19%), among which the drains collected more than 150 ml in only 4 (7%). The blood drainage in this group occurred in the first 6 hours only. Supplementary cross matched bank blood was transfused to patients in the DHS group (8%). Among 28 patients in the hemiarthroplasty group, only 6 patients received autologous blood reperfusion (21%), among which the drains collected more than 150 ml in only 4 (14%). Overall, only six patients out of 28 in the hemiarthroplasty and 10 out 52 in the DHS group had enough blood in their drains to warrant re-perfusion. We conclude that the routine use of Bellovac drains after femoral neck fracture surgery is not necessary and is not cost effective.
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PMID:The role of postoperative blood recovery for patients with femoral neck fracture. 1657 Aug 87

The aim of this study was an evaluation which operative method of treatment: stabilisation with the Dynamic Hip Screw or with Ender's nails is less invasive procedure in elderly patients with trochanteric fractures. 100 consecutive patients with trochanteric fracture were enrolled into the study, of which 53 patients (49 women, 4 men; mean age 89 years) were stabilised intramedullarily with the use of Ender's nails and 47 patients (26 women, 21 men; mean age 76 years) were treated operatively with the use of Dynamic Hip Screw. The factors compared the mean length of hospital stay, the mean duration of the surgery, post-operative blood loss, early local and general complication rate and mortality in both groups. We took into account their general health and coexisting illnesses according to the American Society of Anesthesiologists (ASA) classification, type of fracture according to AO and Evan's classifications and the surgeon's experience. The mean duration of the surgery was 27 minutes longer in the case of DHS stabilisation. The complication rate was higher and the mean length of postoperative hospital stay was longer after Ender nailing. The mean blood loss: the drop in Red Blood Cells (RBC), Haematocrit (Ht) and the Mean Haemoglobin Concentration (Hb) was also higher in patients treated with the use of Ender nails. The mean rate of blood units that had to be transfused postoperatively was also higher in "Ender" group. The difference was statistically significant, especially in the group of patients treated as emergency procedure at the day of admission (p < 0.05). The operative treatment of trochanteric fractures in elderly patients with the use of DHS device showed to be a less invasive procedure in comparison to Ender nailing. In conclusion, the indications for this method of trochanteric fractures' treatment should be expanded, especially in the case of unstable fractures.
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PMID:[Comparison of the Ender's nailing and Dynamic Hip Screw (DHS) fixation in the treatment of trochanteric fractures in elderly patients]. 1745 26

The author describes a rare case of repetitive reoperation of Dynamic Hip Screw failure due to the pull-out of the plate. An 86-year-old female patient suffered an injury - a pertrochanteric fracture of the left femur which was treated by DHS. After 14 weeks a new fall occurred and caused the DHS to fail - the plate pulled out and all cortical screws were broken. The first reoperation using a six-hole plate was performed. After a year and the patients new fall, a femoral fracture occurred in the area of the distal cortical screw underneath the plate. The DHS was removed, plate osteosynthesis of the femur was performed and the trochanteric fracture healed. No further complications were found, the patient died almost two years after the second reoperation. The biomechanical analysis of this case revealed a stress concentration close to the implant yield limit in the area of the distal cortical screw. Femoral neck screw placement was suitable with regard to the stress distribution. Key words: dynamic hip screw - proximal femoral fractures - osteosynthetic material breakage.
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PMID:[Repetitive reoperation of the DHS failure: clinical and biomechanical analysis - a case report]. 2400 79

Hip fractures are ranked among the frequent injuries. These fractures have been often coupled with high energy trauma in children and in patients with normal bone structure, low energy trauma and osteoporotic fracture (fragility fracture) is typical in elder patients. Hip fractures are divided into five groups: femoral head fracture, femoral neck fracture, pertrochanteric, intertrochateric and subtrochanteric fracture. Surgical treatment is indicated in all patients unless contraindications are present. Long bed rest has been accompanied by a high risk of development of thromboembolic disease, pneumonia and bed sore. Healing in the wrong position and nonunions are often the result of conservative treatment. Screw osteosynthesis is performed in isolated femoral head factures. Three cannulated screws or a DHS plate (dynamic hip screw) are used in fractures of the femoral neck with normal femoral head perfusion, total hip replacement is recommended in elder patients and in case of loss of blood supply of the femoral head. Pertrochanteric and intertrochanteric fractures can be stabilized by the femoral nails (PFN, PFN A, PFH - proximal femoral nail), nails are suitable for minimally invasive insertion and provide higher stability in the shaft, or plates (DHS) designed for stable pertronchanteric and intertrochanteric fractures. Subtrochanteric fractures can be fixed also intramedullary (nails - PFN long, PFN A long) and extramedullary (plates - DCS dynamic condylar screw, proximal femoral LCP - locking compression plate). Open reduction with internal plate fixation is advantageous for pathological fractures, as biopsy sampling can be performed. Hip fracture rehabilitation is integral part of the treatment, including walking on crutches or with a walker with partial weight bearing for at least six weeks.
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PMID:[Hip fractures]. 2413 59

Neck of femur fractures are the most prevalent type of injury in elderly trauma patients. Both intra and extra capsular type of fractures are equally distributed in the given population. Traditionally, Extra capsular fractures are fixed with Dynamic Hip screw or Intra medullary nailing based on the type of fracture. NICE (National Institute of Clinical Excellence) recommends fixing 31-A1 and 31-A2 fractures with DHS (Dynamic Hip Screw) whereas AO recommends fixing 31-A1 with DHS and 31-A2.1 subtype with DHS and 31-A2.2 and 31-A2.3with IMN (Intra medullary nail). In regional trauma centre 178 patients, 125 females and 53 males with extra capsular neck of femur fractures fixed were selected in a retrospective study. The data was spanning over a period of 1 year. Fractures were classified as per AO classification by two registrars. The implant selection was analysed in terms of the short term out come to find out the cost effectiveness of one over the other. The quality of reduction was assessed as per standard criteria and consideration of lateral femoral wall thickness was taken into account to assess the stability of fracture. The study found more risk of peri prosthetic fractures associated with Intra medullary nailing as compared to Dynamic Hip screw and more risk of Varus collapse was found to be associated with DHS as compared to IM Nail. Moreover, despite of Nail being costly as compared to DHS, the study did not reveal its superiority in terms of inpatient hospital stay. In appropriately selected patient DHS provides results in terms of hospital stay, revision rate and wound complications comparable to IM Nail in the short term justifying its use in the above-mentioned fracture patterns as per the standard National Institute of clinical Excellence guidelines.
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PMID:Implants For Extracapsular Neck Of Femur Fracture Dynamic Hip Screw Versus Intramedullary Nailing. 2933 Oct 10

Proximal femur fractures represent a major healthcare problem in the aging society. High rates of post-operative infections are linked to risk factors that seem to affect local microcirculation. Patterns and time courses of alterations in microcirculation have, however, not been previously investigated. The aim of this prospective cohort study was to evaluate perioperative changes in microcirculation after trochanteric femur fractures using non-invasive laser-Doppler spectrophotometry to analyze how oxygen saturation (SO2), hemoglobin content (Hb) and blood flow changed before and after surgery, and how these parameters were altered by implant type, gender, smoking, diabetes and age. Measurements were separately recorded for nine locations around the greater trochanter in 2, 8, and 15 mm depths, before surgery and 8, 24, 48 h, 4, 7, and 12 days after surgery in 48 patients. Three implants were compared: Dynamic Hip Screw, Gamma3 Nail, and Percutaneous Compression Plate. Surgery resulted in significant differences between the healthy and injured leg in SO2, Hb and flow. Each parameter showed comparable values for both legs prior to surgery. Significantly higher values in SO2 and flow were registered in women compared to men before and after surgery. Smoking caused significant increases in SO2, Hb, and flow only in the superficial layer of the skin after surgery. Diabetes decreased blood flow at 2 and 8 mm depth and increased SO2 at 8 and 15 mm depth after surgery. Age revealed a significant negative correlation with flow. The ability to increase the flow rate after surgery decreased with age. Comparison of implants indicated the minimally invasive implant PCCP altered microcirculation less than the DHS or the Gamma3 nail. Overall, the proximal femur fracture alone did not alter local skin microcirculation significantly in a way comparable to the effect caused by surgery. In conclusion, microcirculation after proximal femur fractures is highly affected by surgery, gender, smoking, diabetes, age and implant in ways specified in this study.
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PMID:Microcirculation After Trochanteric Femur Fractures: A Prospective Cohort Study Using Non-invasive Laser-Doppler Spectrophotometry. 3096 85