Application of 3D printing technology on the treatment of complex proximal humeral fractures (Neer3-part and 4-part) in old people. A new short uncemented, proximally fixed anatomic femoral implant with a prominent lateral flare: design rationals and study design of an international clinical trial Early functional results after Hemiarthroplasty for femoral neck fracture: a randomized comparison between a minimal invasive and a conventional approach Proximal femoral nails compared with reverse distal femoral locking plates in intertrochanteric fractures with a compromised lateral wall; a randomised controlled trial The value of a prognostic scoring system in the rehabilitation of elderly patients with proximal femoral fractures. Accelerated Weightbearing Rehabilitation After Matrix-Induced Autologous Chondrocyte Implantation in the Tibiofemoral Joint Proximal femoral fractures: issues and challenges. Intraoperative intravascular volume optimisation and length of hospital stay after repair of proximal femoral fracture: randomised controlled trial Improved performance in activities of daily living and mobility after a multidisciplinary postoperative rehabilitation in older people with femoral neck fracture: a randomized controlled trial with 1-year follow-up. A comparison of the long gamma nail with the sliding hip screw for the treatment of AO/OTA 31-A2 fractures of the proximal part of the femur: a prospective randomized trial. Maintenance of bone mineral density after implantation of a femoral neck hip prosthesis A Long-Term Prospective Evaluation of Marginal Bone Level Change Around Different Implant Systems. Retracted: Outcome of Short Proximal Femoral Nail Antirotation and Dynamic Hip Screw for Fixation of Unstable Trochanteric Fractures. A Randomised Prospective Comparative Trial Stepwise introduction of a bone-conserving osseointegrated hip arthroplasty using RSA and a randomized study: II. Clinical proof of concept—40 patients followed for 2 years Accelerated rehabilitation after proximal femoral fracture: a randomized controlled trial. A Comparative study of the Dynamic Hip Screw, the Cemented Bipolar Hemiarthroplasty and the Proximal Femoral Nail for the Treatment of Unstable Intertrochanteric Fractures. Protocol for a randomized controlled trial on risk adapted damage control orthopedic surgery of femur shaft fractures in multiple trauma patients
PURPOSE This study was conducted to investigate the feasibility and clinical potential of using the 3D printing technology ( 3DPT ) versus typical strategy ( thin-layer CT scan ) for the treatment of complicated proximal humeral fractures ( PHFs ) in old people . METHODS Sixty-six old patients age ranging from 61 to 76 years with persistent complicated PHFs were r and omly assigned to two groups as per the controlled r and omization table ( 34 cases in the test group and 32 cases in the control group ) . In the test group , 3DPT was applied to build the 3D facture model of a patient , according to the data acquired from the thin-layer CT scan and subsequently processed with Mimics software . This helped to confirm the diagnosis , design the individual operation plan , simulate the surgical procedures and perform the surgery as plan . In the control group , only thin-layer CT scan was applied for the design of the operation plan prior to the surgery . Here , parameters including surgery duration , blood loss volume during surgery , the number of fluoroscopy , time to union were statistically analyzed for two groups after the operation . The screw lengths design ed before the surgery and measured during the surgery were compared . RESULTS The 3D PHF model generated using 3DPT was able to provide the visual display and omni-directional observation of the direction and severity of the fracture dislocation , which facilitated preoperative diagnosis , operation planning and design , data measurement , pre selection of internal fixator and surgical outcome simulation . According to the follow-up ranging from 12∼28 months for the 66 patients , the results showed no significant difference in time to union between the two groups ( P>0.05 ) . Apart from that , less surgery duration , less blood loss during surgery , less number of fluoroscopy can be observed compared with the control group ( P<0.05 ) . CONCLUSIONS In this study , 3DPT showed great clinical feasibility of the treatment of complicated PHFs . The 3D-print PHF model had the ability to clearly display the fracture and thus was useful to determine the fracture classification and the magnitude of fracture injury . It benefited surgeons to gain a better underst and ing of complicated PHFs , design a most suitable operation plan prior to surgery and facilitate the doctor-patient communication . This therefore enabled the reduction of intraoperative injury and the optimization of surgical outcomes Background Anatomic short femoral prostheses with a prominent lateral flare have the potential to reduce stress-shielding in the femur through a more physiological stress distribution to the proximal femur . We present the design rationale of a new short uncemented , proximally fixed anatomic femoral implant and the study design of a prospect i ve multi-centre trial to collect long-term patient outcome and radiographic follow up data . Methods A prospect i ve surveillance study ( trial registry NCT00208555 ) in four European centres ( UK , Italy , Spain and Germany ) with a follow up period of 15 years will be executed . The recruitment target is 200 subjects , patients between the ages of 18 and 70 admitted for primary cementless unilateral THA will be included . The primary objective is to evaluate the five-year survivorship of the new cementless short stem .  The secondary objectives of this investigation are to evaluate the long term survivorship and the clinical performance of the implant , the impact on the subjects health related Quality of Life and the affect of the prosthesis on bone mineral density . Peri- and postoperative complications will be registered . Clinical and radiographic evaluation of prosthesis positioning will be done post-operatively and at 3 , 6 , 12 , 24 , 60 , 120 and 180 months follow up . Discussion Shortening of the distal stem can maximise bone and soft tissue conservation . New stem types have been design ed to improve the limitations of traditional implants in primary THA . A new , uncemented femoral short stem is introduced in this paper . A long-term follow up study has been design ed to verify stable fixation and to research into the clinical outcome . The results of this trial will be presented as soon as they become available Background A minimal invasive approach for elective hip surgery has been implemented in our institution in the past . It is widely hypothesized that implanting artificial hips in a minimal invasive fashion decreases surgical trauma and is helpful in the rehabilitation process in elective hip surgery . Thereby geriatric patients requiring emergency hip surgery also could theoretically benefit from a procedure that involves less tissue trauma . Methods Sixty patients who sustained a fractured neck of femur were r and omly assigned into two groups . In the minimal invasive arm , the so called “ direct anterior approach ” ( DAA ) was chosen , in the conventional arm the Watson-Jones-Approach was used for implantation of a bipolar hemi-arthroplasty . Primary outcome parameter was the mobility as measured by the four-item-Barthel index . Secondary outcome parameters included pain , haemoglobin-levels , complications , duration of surgery , administration of blood transfusion and external length of incision . Radiographs were evaluated . Results A statistically significant difference ( p = 0,009 ) regarding the mobility as measured with the four-item Barthel index was found at the 5th postoperative day , favouring the DAA . Evaluation of the intensity of pain with a visual analogue scale ( VAS ) showed a statistically significant difference ( p = 0,035 ) at day 16 . No difference was evident in the comparison of radiographic results . Conclusions Comparing two different approaches to the hip joint for the implantation of a bipolar hemi-arthroplasty after fractured neck of femur , it can be stated that mobilization status is improved for the DAA compared to the WJA when measured by the four-item Barthel index , there is less pain as measured using the VAS . There is no radiographic evidence that a minimal invasive technique leads to inferior implant position . Level of Evidence : Level II therapeutic study Purpose There is no consensus about the best option of internal fixation for unstable intertrochanteric fractures . The aim of the present study was to compare proximal femoral nail ( PFN ) with contralateral reverse distal femoral locking compression plate ( reverse-DFLCP ) in the management of unstable intertrochanteric fractures with compromised lateral wall . Method In a r and omized controlled study , from November 2011 to October 2012 , 40 patients with unstable intertrochanteric fractures with compromised lateral wall ( AO 31A 2.2 to 3.3 ) had osteo synthesis by PFN ( n = 20 ) or reverse-DFLCP ( n = 20 ) . Intra-operative variables compared were duration of surgery , blood loss during surgery , fluoroscopy time and surgeons perception of the surgery . Patients were followed up clinical ly for a minimum of one year . Functional outcome was assessed by Parker Palmer mobility score ( PPMS ) , Harris hip score ( HHS ) , and Short Form-12 . Failure was defined as any condition which would necessitate revision surgery with change of implant . Results Duration of surgery ( p = 0.022 ) , blood loss during surgery ( p = 0.008 ) and fluoroscopy time ( p = 0.0001 ) were significantly less in the PFN group than in the reverse-DFLCP group . No significant difference was found in type of reduction , difficulty in reduction and surgeon ’s perception of surgery . The PFN group had better functional outcome than the reverse-DFLCP group . HHS for the PFN group was 81.53 ± 13.21 and for the reverse-DFLCP group it was 68.43 ± 14.36 ( p = 0.018 ) . SF-12 physical ( p = 0.002 ) and mental component ( p = 0.007 ) scores in the PFN group was significantly better than in the reverse-DFLCP group . There was one failure in the PFN group as compared to six in the reverse-DFLCP group ( p = 0.036 ) . Conclusion Due to favourable intra-operative variables , better functional outcome and lower failure rates , we conclude that PFN is a better implant than reverse-DFLCP for intertrochanteric fractures with compromised lateral wall AIM To evaluate a prognostic scoring system for elderly patients with hip fractures , which can , on admission , predict on the basis of pre-injury prognostic factors the possible length of stay in hospital , progress of rehabilitation , level of self-caring and rehousing needs at discharge . METHODS A prognostic scoring system , developed on the basis of pre-injury level of independence in activities of daily living ( ADL ) ( Katz ) , medical comorbidities and Pfeiffer 's mental scoring system was used ( Svensson O et al. J Bone Joint Surg 1996 ; B78 : 115 - 8 ) . The study was conducted on a cohort of 63 patients prospect ively recruited from consecutive admissions . RESULTS Ninety percent of the patients ( without comorbidities and mental score > 7 ; group 3/3 ) who were independently mobile pre-injury remained independently mobile at discharge ( CI 95 % 0.79 - 0.97 ) . Pre-injury score was found to be significantly related to the level of ADL at 2 weeks after operation and at discharge from hospital ( CI 95 % 0.69 - 0.9 ) . There was a pattern in duration of hospital stay in different groups ( score 3/3 = 22 days , 2/3 = 31 days and 1/3 = 33 days ) . A pattern of community placement and housing after discharge was noticed in relation to the pre-injury score . CONCLUSION 3/3 score groups are most likely to achieve independence with mobility and ADL on the acute orthopaedic ward and to be discharged directly to their pre-injury homes . They also were the least likely group to need rehabilitation in a dedicated orthogeriatric rehabilitation unit . 2/3 score groups are most likely to benefit from rehabilitation in a dedicated orthogeriatric rehabilitation unit . 1/3 and 0/3 score groups are least likely to benefit from rehabilitation in a dedicated orthogeriatric unit , in terms of achieving independence with mobility and ADL . They were also the most likely group to need long-term high dependency residential care . Early liaison with social and community services is essential for effective and timely planning of discharge Background : Matrix-induced autologous chondrocyte implantation ( MACI ) has become an established technique for the repair of full-thickness chondral defects in the knee , although best patient outcomes appear limited by a lack of evidence -based knowledge on how to progressively increase postoperative weightbearing ( WB ) and rehabilitation exercises . Hypothesis : To determine the safety and efficacy of an accelerated WB regimen after MACI in the tibiofemoral joint . Study Design : R and omized controlled trial ; Level of evidence , 1 . Methods : Clinical and radiological assessment s were performed in 28 knees at 12 months after MACI to the medial or lateral femoral condyle . Both rehabilitation interventions sought to protect the implant for an initial period and then incrementally increase load bearing . Under the “ accelerated ” ( AR ) protocol , patients reached full WB at 6 weeks after surgery compared with 8 weeks for what was considered to be the current “ best practice ” ( CR ) WB regimen based on previous research . Assessment s included the Knee Injury and Osteoarthritis Outcome Score ( KOOS ) , 36-Item Short Form Health Survey ( SF-36 ) , visual analog scale , 6-minute walk test , and active knee range of motion ( ROM ) .  High-resolution magnetic resonance imaging ( MRI ) was used to describe the quality and quantity of repair tissue via the assessment of pertinent parameters of graft repair as well as an MRI composite score . Results : Patients in both groups demonstrated significant improvement ( P < .05 ) in all clinical measures over the preoperative and postoperative timeline from before surgery to 12 months after surgery . The AR group reported significantly better ( P < .05 ) SF-36 physical component scores at 8 weeks and significantly greater ( P < .05 ) KOOS quality of life scores at 6 and 12 months postoperatively . Although no differences ( P > .05 ) were observed between the 2 groups for active knee ROM , the AR group did achieve full active knee extension as early as 4 weeks compared with the CR group at 12 weeks . There was no difference ( P > .05 ) in graft quality as assessed by MRI ( MOCART composite score : AR , 3.34 ; CR , 3.04 ) , with no patients suffering any adverse effects from the implant up to 12 months , regardless of the rehabilitation protocol employed . Conclusion : The AR approach that reduced the length of time spent ambulating on crutches result ed in improved general physical function and quality of life and an earlier attainment of full active knee extension when compared with the CR approach . There were no graft complications ascertained through MRI . This regimen appears safe and may potentially speed up the recovery of normal gait function . A larger patient cohort and follow-up are required to observe long-term graft outcomes Proximal femur fractures ( PFF ) , place a heavy dem and on orthopaedic departments worldwide . In Engl and it is estimated that by year 2020 , 100,000 patients annually with PFF will require surgical fixation . There are unique challenges as those with PFF are older , by definition have increased co-morbidities and predisposition factors and conditions such as osteoporosis . It is of note that globally around 13 % of the population are over 65 years of age and not surprisingly 1.6 million hip fractures are secondary to osteoporosis . Interestingly , besides osteoporosis , while many other factors have been suggested to increase the risk of PFF , in Europe a high BMI decreases the incidence of hip fractures . Despite a number of initiatives , advances and guidelines that have been implemented disappointingly mortality for PFF has not changed significantly in 40 years . For this reason , PFF remain a focused topic for both commissioners and providers of health care and for the clinicians a subject of ongoing research activity . Optimising patient ’s pre and post-surgery , has been reinforced by NICE guidelines and target driven hospital remuneration in an attempt to reduce mortality , which is estimated to be 10 % at 30 days and 31 % at 3 months . Thus , early identification and the ability to predict those patients who are likely to have adverse postoperative outcomes is critical . It enables a focus of re sources and the use of adjunctive therapies . Hu et al ’s meta- analysis showed that such factors have been identified as predictive of high mortality as advanced age , male gender , nursing home or facility residence , poor preoperative walking capacity , poor activities of daily living , higher ASA grading , poor mental state , multiple co morbidities , dementia or cognitive impairment , diabetes , cancer and cardiac disease . At five years post-surgical fixation , Abbreviated Mental Test Score , mobility and living circumstances have a predicted value in mortality . Some of these factors can be identified from simply good admission clerking . Not surprisingly therefore , st and ard proforma ’s have been introduced in a number of countries to facilitate good clerking and co-ordination of a multidisciplinary approach . Nonetheless , there is lack of a large prospect i ve study establishing whether this translates into improved patient outcomes . With pressure on re sources , two hospitals in Engl and have adopted efficiency ideology from the car manufacturer Toyota , known as the ‘ ‘ Lean ’ ’ principle . It aims to improve outcomes of care at key stages of hip fracture management . Essentially the patients are aggressively moved through the patient journey from presentation to discharge , through a multidisciplinary approach aim ed at optimisation physiologically and socially to return Abstract Objectives : To assess whether intraoperative intravascular volume optimisation improves outcome and shortens hospital stay after repair of proximal femoral fracture . Design : Prospect i ve , r and omised controlled trial comparing conventional intraoperative fluid management with repeated colloid fluid challenges monitored by oesophageal Doppler ultrasonography to maintain maximal stroke volume throughout the operative period . Setting : Teaching hospital , London . Subjects : 40 patients undergoing repair of proximal femoral fracture under general anaesthesia . Interventions : Patients were r and omly assigned to receive either conventional intraoperative fluid management ( control patients ) or additional repeated colloid fluid challenges with oesophageal Doppler ultrasonography used to maintain maximal stroke volume throughout the operative period ( protocol patients ) . Main outcome measures : Time declared medically fit for hospital discharge , duration of hospital stay ( in acute bed ; in acute plus long stay bed ) , mortality , perioperative haemodynamic changes . Results : Intraoperative intravascular fluid loading produced significantly greater changes in stroke volume ( median 15 ml ( 95 % confidence interval 10 to 21 ml ) ) and cardiac output ( 1.2 l/min ( 0.1 to 2.3 l/min ) ) than in the conventionally managed group ( −5 ml ( −10 to 1 ml ) and −0.4 l/min ( −1.0 to 0.2 l/min ) ) ( P<0.001 and P<0.05 , respectively ) . One protocol patient and two control patients died in hospital . In the survivors , postoperative recovery was significantly faster in the protocol patients , with shorter times to being declared medically fit for discharge ( median 10 ( 9 to 15 ) days v 15 ( 11 to 40 ) days , P<0.05 ) and a 39 % reduction in hospital stay ( 12 ( 8 to 13 ) days v 20 ( 10 to 61 ) days , P<0.05 ) . Conclusions : Proximal femoral fracture repair constitutes surgery in a high risk population . Intraoperative intravascular volume loading to optimal stroke volume result ed in a more rapid postoperative recovery and a significantly reduced hospital stay . Key messages Patients undergoing hip fracture repair constitute a high risk group with considerable mortality and morbidity and an often protracted postoperative hospital stay These patients often have depleted intravascular volume in the perioperative period and rarely receive either invasive haemodynamic monitoring or high dependency care Haemodynamic optimisation guided by pulmonary artery catheter in the perioperative period has been shown to improve outcome in high risk patients undergoing major surgery , but this is not considered routinely practicable for hip fracture repair Intravascular volume optimisation directed by minimally invasive oesophageal Doppler monitoring in the intraoperative period significantly reduces hospital OBJECTIVE To investigate the short- and long-term effects of a multidisciplinary postoperative rehabilitation programme in patients with femoral neck fracture . DESIGN AND SUBJECTS A r and omized controlled trial in patients ( n = 199 ) with femoral neck fracture , aged > or= 70 years . METHODS The primary outcomes were : living conditions , walking ability and activities of daily living performance on discharge , 4 and 12 months postoperatively . The intervention consisted of staff education , individualized care planning and rehabilitation , active prevention , detection and treatment of postoperative complications . The staff worked in teams to apply comprehensive geriatric assessment , management and rehabilitation . A geriatric team assessed those in the intervention group 4 months postoperatively , in order to detect and treat any complications . The control group followed conventional postoperative routines . RESULTS Despite shorter hospitalization , significantly more people from the intervention group had regained independence in personal activities of daily living performance at the 4- and 12-month follow-ups ; odds ratios ( 95 % confidence interval ( CI ) ) 2.51 ( 1.00 - 6.30 ) and 3.49 ( 1.31 - 9.23 ) , respectively . More patients in the intervention group had also regained the ability to walk independently indoors without walking aids by the end of the study period , odds ratio ( 95 % confidence interval ) 3.01 ( 1.18 - 7.61 ) . CONCLUSION A multidisciplinary postoperative intervention programme enhances activities of daily living performance and mobility after hip fracture , from both a short-term and long-term perspective BACKGROUND Controversy exists with regard to whether to treat AO/OTA 31-A2 fractures of the proximal part of the femur with an intramedullary device or an extramedullary device . A prospect i ve , r and omized , controlled trial was performed to compare the outcome of treatment of these unstable fractures of the proximal part of the femur with either a sliding hip screw or a long gamma nail . METHODS Two hundred and ten patients presenting with an AO/OTA 31-A2 fracture of the proximal part of the femur were r and omized , at the time of admission , to fixation with use of either a long gamma nail or a sliding hip screw .  The primary outcome measure was reoperation within the first postoperative year . Secondary measures included mortality , length of hospital stay , transfusion rate , change in mobility and residence , and quality of life as measured with the EuroQol 5D outcome score . RESULTS There was no significant difference between the reoperation rates for the two groups . In total , five patients ( three from the long-gamma-nail group and two from the sliding-hip-screw group ) underwent revision surgery because of cut-out . Tip-apex distance was found to correlate with the implant cut-out rate . There was no significant difference between the two groups in terms of the EuroQol 5D outcome scores , the mortality rates after correction for the mini-mental score , or any of the secondary outcome measures . CONCLUSIONS When compared with the long gamma nail , the sliding hip screw should remain the gold st and ard for the treatment of AO/OTA 31-A2 fractures of the proximal part of the femur because it is associated with similar outcomes with less expense Background Stress shielding of the proximal femur has been observed in a number of conventional cementless implants used in total hip arthroplasty .  Short femoral-neck implants are cl aim ing less interference with the biomechanics of the proximal femur . The goal of this study was to investigate the changes of bone-mineral density in the proximal femur and the clinical outcome after implantation of a short femoral-neck prosthesis . Methods We prospect ively assessed the clinical outcome and the changes of bone mineral density of the proximal femur up to one year after implantation of a short femoral neck prosthesis in 20 patients with a mean age of 47 years ( range 17 to 65 ) . Clinical outcome was assessed using the Harris Hip Score . The WOMAC was used as a patient-relevant outcome -measure . The bone mineral density was determined using dual energy x-ray absorptiometry , performed 10 days , three months and 12 months after surgery . Results The Harris Hip Score improved from an average preoperative score of 46 to a postoperative score at 12 months of 89 points , the global WOMAC index from 5,3 preoperatively to 0,8 at 12 months postoperatively . In contrast to conventional implants , the DEXA-scans overall revealed a slight increase of bone mineral density in the proximal femur in the 12 months following the implantation . Conclusion The short femoral neck stem lead to a distinct bone reaction . This was significantly different when compared to the changes in bone mineral density reported after implantation of conventional implants PURPOSE The purpose of this prospect i ve study was to assess the change of marginal bone level around three different types of external-hex implants  after 5 years using radiography . MATERIAL S AND METHODS Included in this study were 54 patients r and omly put into three different groups ;  rough-surface implants ( Brånemark ) , machined coronal aspect implants ( Restore ) , and microthreaded coronal aspect implants ( Hexplant ) .  Clinical and radiographic assessment s were performed contemporaneously with implant loading ( baseline ) and at 1 , 3 , and 5 years post-functional loading . A mixed-model analysis was employed to examine mean marginal bone change significance in the three treatment groups . RESULTS In a total of 31 out of 54 patients , 81 of 135 implants remained to the end of the study . At 5 years , the microthreaded coronal aspect implants had 0.61 ± 0.32 mm mean crestal bone loss ; the rough-surface implants without microthread , 0.99 ± 0.38 mm ; and the machined coronal aspect implants , 1.06 ± 0.39 mm . The rough-surface implants and the machined coronal aspect implants did not exhibit statistically significantly different marginal bone loss , whereas the microthreaded coronal aspect implants exhibited significantly less marginal bone loss ( P = .0015 ) . CONCLUSION In this research , rough-surface implants with microthreads showed positive long-term effects in preserving peri-implant bone level against functional loads when compared with implants lacking these aspects at the coronal part . Most of the bone loss was shown within 1 year of loading , and all types of implants stabilized after 1 year A prospect i ve , r and omised , controlled trial was performed to compare the outcome of treatment of unstable trochanteric fractures with either a short proximal femoral nail antirotation ( PFNA ) or dynamic hip screw ( DHS ) .  Eighty one patients with unstable fracture of the proximal part of the femur were r and omised , at the time of admission , for fixation with either a short PFNA ( n=42 ) or DHS ( n= 39 ) . The primary outcome measure was reoperation within the first postoperative year and mortality at the end of one year . Operative time , fluoroscopy time , blood loss , and any intra-operative complication were recorded for each patient . Clinical and radiological follow-up was undertaken for a minimum of 36 months . Any changes in the position of the implant or fixation failure were recorded . Hip range of motion , pain in the hip or thigh and return to work were used to compare the outcomes . There was no significant difference between 1 year mortality rates for the two groups . The mean operative time was significantly less in PFNA group ( 25 min ) than in the DHS group ( 38 min ) . Patients treated with a PFNA experienced a shorter fluoroscopy time and less blood loss . Six patients in DHS group had implant failure while none experienced this in PFNA group . The PFNA group had a better functional outcome than the DHS group Background We have developed a bone-conserving commercially pure titanium hip replacement system using osseointegration principles : a metaphyseal loading proximal femoral component affixing into the retained neck and metaphysis only , leaving the femoral canal untouched . The acetabular cup closely fits a dual-geometry cavity , avoiding stress protection at the dome . Patients and methods After extensive laboratory and clinical pilot trial investigations , the surface-engineered implants were su bmi tted to a prospect i ve r and omized controlled clinical trial involving 40 patients ( 40 hips ) , in which they were compared to the cemented Spectron femoral component and cementless Trilogy cup as control implant . The following clinical measures were used to monitor progress at regular intervals for the first 2 postoperative years : radiostereometric analysis ( RSA ) , Harris Hip Score , pain score , WOMAC , and SF-36 . Results After 2 years of follow-up , no statistically significant differences were seen between the groups concerning rotation or translation along the cardinal axes . The patients receiving the Gothenburg osseointegrated titanium ( GOT ) system had significantly higher Harris Hip Score at 6 months , suggesting more rapid recovery . WOMAC , SF-36 and pain analysis were similar for the first 2 postoperative years . Interpretation Our RSA data suggest that osseointegration was achieved for all patients receiving the GOT hip system . This bone-conserving prosthesis may provide a good alternative , especially for young and active patients This r and omized controlled trial compared accelerated rehabilitation after surgical treatment of proximal femoral fracture with conventional care and was conducted in a general hospital in an outer urban area . Participating were 261 sequentially admitted patients over the age of 50 years who met predetermined inclusion criteria and all were followed up until death or 4 months after fracture . Patients who were treated with the accelerated rehabilitation programme had a 20 % reduction in length of hospital stay . Improved physical independence ( as measured by Barthel Index ) was observed after fracture in accelerated rehabilitation programme patients with limited pre-existing disability . Non-nursing-home patients receiving accelerated rehabilitation were also less likely to be discharged to nursing-home care or die in hospital . Accelerated rehabilitation led to a substantial reduction in length of hospital stay with a modest short-term improvement in level of physical independence and accommodation status after discharge INTRODUCTION Fractures of the Intertrochanteric ( IT ) region are some of the most common fractures encountered by an orthopedic surgeon in his lifetime . With increase in life expectancy , the incidence of these fractures is also increasing . By 2040 , the incidence of these fractures is expected to double . Unstable IT fractures are a major cause of concern in the elderly due to the associated increase in morbidity and mortality . AIM The purpose of this study was to compare the intraoperative and postoperative parameters using the Dynamic Hip Screw ( DHS ) , the Cemented Bipolar Hemiarthroplasty ( BH ) and the Proximal Femoral Nail ( PFN ) for the management of unstable IT fractures . MATERIAL S AND METHODS Fifty patients , having unstable IT fractures with age more than 60 years were r and omly selected and were followed up averagely for 19 months ( 12- 30 months ) . The type of implant for a particular patient and a particular type of fracture was r and omly selected and the same surgical team treated all patients . Total number of 19 patients were operated using the DHS ( Group-1 ) , 13 using the BH ( Group-2 ) and 18 using the PFN ( Group-3 ) . All patients in the three groups were compared in terms of preoperative , intraoperative and postoperative parameters and functionally assessed using the Harris hip score and the mobility score of Parker and Palmer . RESULTS Patients operated using the PFN had significantly lower mean blood loss as compared to the other two groups . The mean days to unaided Full Weight Bearing ( FWB ) was significantly higher in patients treated by the DHS as compared to the other two groups . All three groups were comparable in terms of functional assessment . CONCLUSION Treatment of unstable IT fracture of femur is a matter open to debate . IT fractures of elderly must be treated with considering the age of the patient , mental status , bone quality , and the type of fracture . Level of Evidence according to OCEBM Levels of Evidence Working Group - Level 2 Background Fractures of the long bones and femur fractures in particular are common in multiple trauma patients , but the optimal management of femur fractures in these patients is not yet resolved . Although there is a trend towards the concept of " Damage Control Orthopedics " ( DCO ) in the management of multiple trauma patients with long bone fractures as reflected by a significant increase in primary external fixation of femur fractures , current literature is insufficient . Thus , in the era of " evidence -based medicine " , there is the need for a more specific , clarifying trial . Methods / Design The trial is design ed as a r and omized controlled open-label multicenter study . Multiple trauma patients with femur shaft fractures and a calculated probability of death between 20 and 60 % will be r and omized to either temporary fracture fixation with fixateur externe and defined secondary definitive treatment ( DCO ) or primary reamed nailing ( early total care ) . The primary objective is to reduce the extent of organ failure as measured by the maximum sepsis-related organ failure assessment ( SOFA ) score . Discussion The Damage Control Study is the first to evaluate the risk adapted damage control orthopedic surgery concept of femur shaft fractures in multiple trauma patients in a r and omized controlled design . The trial investigates the differences in clinical outcome of two currently accepted different ways of treating multiple trauma patients with femoral shaft fractures . This study will help to answer the question whether the " early total care " or the „ damage control ” concept is associated with better outcome .Trial registration Current Controlled Trials IS RCT
The clinical evidence behind the current implants used for proximal femoral fractures is weak considering the number of implants used worldwide .
Sporadic evaluation is not sufficient to identify long term problems .
INTRODUCTION Evaluation of the long-term performance of  implants used in trauma surgery relies on post-marked clinical studies since no registry based implant assessment exists .
The purpose of this study was to evaluate the evidence of performance of implants  currently used for treating proximal femoral fractures ( PFF ) in Denmark .