الفهرس 
Anatomy of the femurOnly 14 pages are availabe for public view
 |  | from | 167 |  |  |
| | | from | 167 | | |
Abstract
Femoral intertrochanteric fractures account for approximately half the hip fractures in elderly patients. Because of the frequently associated osteoporosis, they are often associated with notable morbidity and mortality. Decrease in bone mineral density is the natural consequence of aging and severe osteoporosis is more likely to be associated with fracture in the trochanteric region than fracture in the femoral neck, since the trochanteric region is shown to have a thinner cortical bone. Most intertrochanteric femoral fractures occur in elderly individuals as a result of mild to moderate trauma due to osteoporotic bones while in younger patients these fractures usually result from high-energy trauma. The goal of treatment of any intertrochanteric fracture is to restore mobility safely and efficiently while minimizing the risk of medical complications and restore the patient to pre-operative status. The characteristic morphology of the proximal extremity of the femur and the muscle balance of the hip are factors that make weight bearing possible among patients. Recent studies have been conducted with the intention of showing the relationship between fracture of the proximal extremity of the femur and the anatomical configuration of the hip. Anatomical reduction with stable rigid fixation and immediate mobilization is considered the gold standard treatment in such fractures. Although many fixation devices can be used, but still the dynamic hip screw (DHS) with a four-hole side plate is a commonly used device to offer these properties in many centers, but theoretically it has a biomechanical disadvantage because of a wider distance between the weight bearing axis and the implants. The evolution of intramedullary nails for proximal femoral fractures really began in the 1940s in Germany during world war II with the I-beam nail designed by Pohl and used by Kutscher, which evolved into the Y-nail after the war. The Gamma nail was described by its designers as a derivative of the Y-nail followed by the proximal femoral nail—antirotation (PFNA) in 1999. Nevertheless, cephalomedullary nailing systems combine the biomechanical advantages of a sliding hip screw with those of intramedullary nailing. The sliding hip screw provides a controlled impaction of the fracture, leading to increased fracture stability, less collapse and decreased bone healing time. The intramedullary nail is located closer to the central weight bearing axis of the femur, reducing the bending stresses up to 30 % due to smaller moment of inertia of the lag screw. The aim of this study was to evaluate the results of the treatment of different types of intertrochanteric fractures in adults using Dynamic Hip Screw (DHS) and Gamma nail and evaluate radiologically the effect of these implants on normal proximal femoral morphology. In our study, there are statistically non-significant differences between the studied groups regarding gender, age and occupation. Also, there is statistically non-significant difference between the studied groups regarding mechanism of injury or side of lesion. Fifty-five percent within each group had fractures due to simple falls. Twenty percent within nail group and 15% within DHS group had trauma due to road traffic accident (RTA). There is statistically non-significant difference between the studied groups regarding side of lesion (fifty-five percent of patients within nail group versus half of patients within DHS group had right-side lesion). Regarding follow up time, there is statistically non-significant difference between the studied groups regarding time for follow up which ranged from 5 to 12 months with mean of 8.5 months in gamma nail group and 8.8 months in DHS group. Regarding HHS score, there is statistically non-significant difference between the studied groups regarding HHS. Larger percentage within each group (65% and 70% within gamma nail and DHS groups respectively had good score). Excellent score occurred in 15% and 20% within nail group and DHS group respectively. Regarding postoperative complications, there is statistically nonsignificant difference between the studied groups. Larger percentage within each group were not complicated (80% within nail group, versus 75% within DHS group). Ten percent within nail group and 15% within DHS group had superficial infection.