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Decision Making in Management of Intertrochanteric Femur Fractures in Adults

April 10, 2026/in January-June 2026 | Volume 12 | Issue 1

Original Article | Vol 12 | Issue 1 | January-June 2026 | page: 49-55 | Sachin Kale, Wasudeo Gadegone, Sushant Srivastav, Nikhil Makhija, Ameey Abhishek, Arpan Mittal DOI: https://doi.org/10.13107/ti.2026.v12.i01.90 Submitted: 04/03/2023; Reviewed: 27/03/2023; Accepted: 07/05/2023; Published: 10/04/2026 Authors: Sachin Kale [1], Wasudeo Gadegone [2], Sushant Srivastav [1], Nikhil Makhija [1], Ameey Abhishek [1], Arpan Mittal […]

Comparison of a Breathable Mesh Cast Versus Conventional Fiberglass Cast in Distal Radius Fractures: A Prospective Randomized Controlled Trial of 450 Patients

April 10, 2026/in January-June 2026 | Volume 12 | Issue 1

Original Article | Vol 12 | Issue 1 | January-June 2026 | page: 44-48 | Shivam Mehra, Kamal Mehra, Sachin Y. Kale, Nitesh Kumar Saini, Ameey Abhishek, Nikhil Makhija, Riddhi Shah DOI: https://doi.org/10.13107/ti.2026.v12.i01.88 Submitted: 18/02/2026; Reviewed: 13/03/2026; Accepted: 25/03/2026; Published: 10/04/2026 Authors: Shivam Mehra [1], Kamal Mehra [1], Sachin Y. Kale [2], Nitesh Kumar Saini […]

Decision Making in Management of Intertrochanteric Femur Fractures in Adults

April 10, 2026/in January-June 2026 | Volume 12 | Issue 1

Comparison of a Breathable Mesh Cast Versus Conventional Fiberglass Cast in Distal Radius Fractures: A Prospective Randomized Controlled Trial of 450 Patients

April 10, 2026/in January-June 2026 | Volume 12 | Issue 1

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Decision Making in Management of Intertrochanteric Femur Fractures in Adults

April 10, 2026/in January-June 2026 | Volume 12 | Issue 1

DOI: https://doi.org/10.13107/ti.2026.v12.i01.90

Submitted: 04/03/2023; Reviewed: 27/03/2023; Accepted: 07/05/2023; Published: 10/04/2026

Authors: Sachin Kale [1], Wasudeo Gadegone [2], Sushant Srivastav [1], Nikhil Makhija [1], Ameey Abhishek [1], Arpan Mittal [1]

[1] Department of Orthopaedics, Dr. D.Y. Patil Medical College, Navi Mumbai, Maharashtra, India.

[2] Gadegone Hospital, Chandrapur, Maharashtra, India.

Address of Correspondence

Dr. Sachin Kale

Department of Orthopaedics, Dr. D.Y. Patil Medical College, Navi Mumbai, Maharashtra, India.

E-mail: sachinkale@gmail.com

Abstract

Intertrochanteric femur fractures are among the most common proximal femoral injuries, particularly in the elderly with osteoporosis. They are associated with significant morbidity, mortality, and loss of independence. Although these fractures generally have good vascularity and low nonunion rates, their inherent mechanical instability demands precise assessment of stability and individualized implant selection. This chapter provides a clinically oriented review of anatomy, biomechanics, classification, radiological evaluation, and evidence-based management strategies. Fracture stability—guided primarily by the integrity of the posteromedial cortex, lateral wall, and overall pattern—remains the cornerstone of decision-making. Stable fractures (AO/OTA 31-A1) are reliably managed with a sliding hip screw (DHS), while unstable patterns (most 31-A2 and all 31-A3) are best treated with cephalomedullary nails (e.g., PFNA or equivalent) due to their superior biomechanical stability and load-sharing properties. The integrity of the lateral wall plays a critical role in determining implant choice, as its compromise significantly increases the risk of fixation failure with extramedullary devices. Achieving proper reduction, particularly avoiding varus malalignment, is essential to prevent complications. Early surgical intervention and mobilization are key factors in reducing systemic complications such as deep vein thrombosis and pulmonary complications. In India, intertrochanteric fractures predominate among proximal femoral injuries, often with delayed presentation. Osteoporosis (Singh’s index), domestic falls, and comorbidities (hypertension, diabetes) are common. Early surgery (ideally within 48 hours when medically optimized), multidisciplinary care, and rehabilitation remain challenges but are essential for improving functional recovery and reducing mortality. Early surgical fixation and mobilization, within a multidisciplinary framework, are critical to optimizing outcomes. Individualized treatment planning, meticulous surgical technique, and early mobilization remain the cornerstones of achieving favorable functional outcomes, particularly in the elderly population.

Keywords: Intertrochanteric fracture, proximal femoral nail, dynamic hip screw, fracture stability, lateral wall, cephalomedullary nailing

References

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Baumgaertner MR, Curtin SL, Lindskog DM, Keggi JM. The value of the tip-apex distance in predicting failure of fixation. J Bone Joint Surg Am. 1995;77(7):1058–1064.
Parker MJ, Handoll HH. Intramedullary nails for extracapsular hip fractures. Cochrane Database Syst Rev. 2006;(3):CD004961.
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How to Cite this article: Kale S, Gadegone W, Srivastav S, Makhija N, AbhishekA, Mittal M. Decision Making in Management of Intertrochanteric Femur Fractures in Adults. | January-June 2026; 12(1): 49-55 | https://doi.org/10.13107/ti.2026.v12.i01.90

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Comparison of a Breathable Mesh Cast Versus Conventional Fiberglass Cast in Distal Radius Fractures: A Prospective Randomized Controlled Trial of 450 Patients

April 10, 2026/in January-June 2026 | Volume 12 | Issue 1

DOI: https://doi.org/10.13107/ti.2026.v12.i01.88

Submitted: 18/02/2026; Reviewed: 13/03/2026; Accepted: 25/03/2026; Published: 10/04/2026

Authors: Shivam Mehra [1], Kamal Mehra [1], Sachin Y. Kale [2], Nitesh Kumar Saini [3], Ameey Abhishek [2], Nikhil Makhija [2], Riddhi Shah [2]

[1] Department of Orthopaedics, Mehra Hospital and Research Institute, Lucknow, Uttar Pradesh, India

[2] Department of Orthopaedics, Dr. D.Y. Patil School of Medicine, Navi Mumbai, Maharashtra, India.

[3] Department of Orthopaedics, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

Address of Correspondence Dr. Shivam Mehra Consultant Orthopaedic Surgeon, Mehra Hospital and Research Institute, Lucknow, Uttar Pradesh, India Email: drshivammehra@gmail.com

Abstract

Introduction: Clavicle Background: Distal radius fractures are among the most common fractures managed conservatively. Conventional fiberglass casts, although effective in immobilization, are frequently associated with patient discomfort, itching, sweating, and skin-related complications due to poor ventilation and moisture retention [1,2]. Breathable mesh casts have been developed to improve ventilation, hygiene, and overall patient experience.

Methods: A total of 450 adult patients with closed distal radius fractures were enrolled in this prospective randomized controlled trial and equally allocated into two groups: breathable mesh cast (n = 225) and conventional fiberglass cast (n = 225). The primary outcome was patient comfort assessed using the Visual Analog Scale (VAS) for itching. Secondary outcomes included skin complications, patient compliance, and radiological fracture union. Statistical analysis was performed using independent t-tests and chi-square tests, with p < 0.05 considered significant.

Results: Mean VAS itching scores were significantly lower in the breathable cast group at all time points (p < 0.001). Skin complications occurred in 8.4% of patients in the mesh cast group compared with 25.3% in the fiberglass group (p = 0.001). Compliance was significantly higher in the mesh cast group (95.1% vs 84.0%, p = 0.006). Fracture union rates were comparable between the groups (97.3% vs 95.6%, p = 0.48).

Conclusion: Breathable mesh casts significantly improve patient comfort and reduce skin complications without compromising fracture healing, making them a superior alternative to conventional fiberglass casts.

Keywords: Breathable mesh, Cast, Distal radius fractures, VAS

References

1. Leung J, Smith A, Patel R, et al. Monitoring skin temperature through orthopedic casts with infrared thermography: a feasibility study. Med Eng Phys. 2026.

2. Mitchell BC, Baldwin K. Properties and pitfalls of various casting materials. JPOSNA. 2025.

3. Hutchinson MJ, Hutchinson MR. Factors contributing to temperature beneath plaster or fiberglass cast material. J Orthop Surg Res. 2008;3:10.

4. Davids JR, Meyer LC, Blackhurst DW. Skin surface pressure beneath an above-the-knee cast: plaster versus fiberglass. J Bone Joint Surg Am. 1997;79(4):565–569.

5. Haley CA, et al. Waterproof versus cotton cast liners: a randomized prospective comparison. Am J Orthop. 2006;35(5):234–238.

6. Thibodaux B, et al. Sub-bandage pressure changes with fiberglass splints. BMC Vet Res. 2024;20.

7. Zhang X, Li Y, Chen Z, et al. Biobased polyester versus synthetic fiberglass casts in upper limb fractures. BMC Musculoskelet Disord. 2023;24.

8. Kaplan SS. Burns following application of plaster splints. J Bone Joint Surg Am. 1981;63(2):226–230.

9. Pope MH, et al. Setting temperatures of synthetic casts. J Bone Joint Surg Am. 1985;67(3):472–476.

10. Gannaway JK, Hunter JR. Thermal effects of casting materials. Clin Orthop Relat Res. 1983;(173):242–248.

How to Cite this article: Mehra S, Mehra K, Kale SY, Saini NK, Abhishek A, Makhija N, Shah R | Comparison of a Breathable Mesh Cast Versus Conventional Fiberglass Cast in Distal Radius Fractures: A Prospective Randomized Controlled Trial of 450 Patients | January-June 2026; 12(1): 44-48 | https://doi.org/10.13107/ti.2026.v12.i01.88

Half Sized Blog Element (Single Author Style)

Half Sized Blog Element (Multi Author Style)

Decision Making in Management of Intertrochanteric Femur Fractures in Adults

Comparison of a Breathable Mesh Cast Versus Conventional Fiberglass Cast in Distal Radius Fractures: A Prospective Randomized Controlled Trial of 450 Patients

Decision Making in Management of Intertrochanteric Femur Fractures in Adults

Comparison of a Breathable Mesh Cast Versus Conventional Fiberglass Cast in Distal Radius Fractures: A Prospective Randomized Controlled Trial of 450 Patients

Full Sized Blog Element (Big Preview Pic)

Decision Making in Management of Intertrochanteric Femur Fractures in Adults

Authors: Sachin Kale [1], Wasudeo Gadegone [2], Sushant Srivastav [1], Nikhil Makhija [1], Ameey Abhishek [1], Arpan Mittal [1]

Abstract

References

(Abstract Text HTML) (Download PDF)

Comparison of a Breathable Mesh Cast Versus Conventional Fiberglass Cast in Distal Radius Fractures: A Prospective Randomized Controlled Trial of 450 Patients

Authors: Shivam Mehra [1], Kamal Mehra [1], Sachin Y. Kale [2], Nitesh Kumar Saini [3], Ameey Abhishek [2], Nikhil Makhija [2], Riddhi Shah [2]

Abstract

References

(Abstract Text HTML) (Download PDF)

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