Table 16. Questionnaire.
CR: Commercial Registration; No: Number; BMI: Body Mass Index; H/O: History Of; AO/OTA: Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association; NSA: Neck Shaft Angle; CalTAD: Calcar Tip Apex Distance; AP: Anteroposterior; Lat: Lateral; GTOL : Greater Trochanter Orthogonal Line
| Name : | |
| Age : | |
| Sex : | |
| Height : | |
| BMI: | |
| CR No : | |
| Address : | |
| Phone no : | |
| Date of Injury: | |
| Date of presentation: | |
| Date of Surgery: | |
| Total duration of stay: | |
| Mode of injury: | |
| Side of injury: | |
| Associated injuries: | |
| Comorbidities if any: | |
| History of previous medications (if any): | |
| Level of physical activity: | |
| Ambulation status : | |
| Previous H/O similar injury or osteoporotic fracture in opposite hip : | |
| Investigations : | |
| Bedsore : | |
| Singh’s Index : | |
| Metabolic bone disease/Bone pathology (if any) : | |
| Diagnosis : | |
| Intertrochanteric fracture classification : | |
| Boyd and Griffin class: | |
| Evans class: | |
| AO/OTA Class: | |
| Surgical details | |
| Interval between injury and surgery : | |
| Interval between presentation and surgery : | |
| Parameters taken into consideration | |
| 1)Reduction Manoeuvre Acceptable or not | Closed / Percutaneous / Open |
| 2) Entry point : | |
| 3) Anterior cortical reduction : | |
| 4) Variance: | |
| 5) NSA-Immediate post op : | |
| 6) NSA of follow up after weight bearing : | |
| 7) NSA loss after weight bearing : | |
| 8) Loss of Neck length after weight bearing on follow up: | |
| 9) The hip screw placement: In Antero posterior view : | |
| 10) The hip screw placement : In Lateral view : | |
| 11) Parker’s ratio: Anteroposterior : Lateral : | |
| 12) CalTAD : (AP calTAD) + (lat) = | |
| 13) Length of the nail : | |
| 14) Diameter of the nail : | |
| 15) Length of lag screw : | |
| 16) Horizontal offset (immediate post op): | |
| 17) Horizontal offset (post weight bearing): | |
| 18) Vertical offset (immediate post op) : | |
| 19) Vertical offset (post weight bearing) : | |
| 20 Length of de-rotation screw: | |
| 21) Distal locking : | |
| 22) Chang’s quality of fracture reduction : | |
| 23) GTOL : | |
| 24) Anterior Cortical Line : | |
| 25) Amount of blood loss : | |
| 26) Operating time: | |
| 27) Post op Blood transfusion : NIL | |
| 28)Adverse events: | |
| Intraoperative: | |
| Immediate: | |
| Late: | |
| 29) Harris hip score at 6 months : | |
| 30) Gait evaluation at 6 months : | |
| 31) Abductor strength : |