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Barick D, Sawarkar A, Waghe S, Suradkar P, Khobragade AS, Patil VE. Anterior Cortical Impingement With 240 mm Cephalo-Medullary Nail (PFN and PFNA-2) in Intertrochanteric Femur Fracture Fixation in the Indian Population: A Problem Statement. Cureus 2024; 16:e68207. [PMID: 39347299 PMCID: PMC11439410 DOI: 10.7759/cureus.68207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2024] [Indexed: 10/01/2024] Open
Abstract
Trochanteric fractures are common in the elderly population, and their incidence increases twice every decade after age 50. Intramural fixation has achieved good clinical efficacy in the treatment of unstable trochanteric fractures, but there have been complications reported in the literature in the Asian population. Most complications arise from a mismatch between the increase in the anterior femoral bow with advancing age and the proximal femoral nails (PFN) on the market, which still have straight designs on the sagittal plane. The non-anatomic shapes of the PFNs sometimes make the surgeries difficult or may lead to an inadvertent intraoperative fracture around the tip of the nail, particularly if they impinge on the anterior cortex of the femur. The entry point on the greater trochanter was divided into three equal parts, i.e., anterior 1/3rd, middle 1/3rd, and posterior 1/3rd on the lateral X-rays. Patients with posterior 1/3rd entry were excluded from the study as it is known that posterior positioning of nail entry can cause an increased incidence of anterior nail impingement. The AI was measured using the best available preoperative lateral roentgenogram of the femur using the incidence cortex (AI cortex) angle. This angle was measured using two tangential lines drawn parallel to the anterior cortex of the femur, proximal and distal to the most bowed point of the femur. We recommend that there is a need to introduce anterior curvature in the sagittal plane corresponding to the femoral bow in a 240 mm cephalomedullary nail to decrease complications. We also consider the use of either a short (i.e., 180 mm) or a long cephalomedullary nail in the Indian population, as the height of the population is shorter as compared to the western population, and the role of a 240 mm cephalomedullary nail is doubtful in the Indian population.
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Affiliation(s)
- Devashis Barick
- Orthopaedics and Traumatology, N. K. P. Salve Institute of Medical Sciences (NKPSIMS) and Research Centre (RC) Lata Mangeshkar Hospital, Nagpur, IND
| | - Ameya Sawarkar
- Orthopaedics and Traumatology, N. K. P. Salve Institute of Medical Sciences (NKPSIMS) and Research Centre (RC) Lata Mangeshkar Hospital, Nagpur, IND
| | - Suhas Waghe
- Orthopaedics and Trauma, N. K. P. Salve Institute of Medical Sciences (NKPSIMS) and Research Centre (RC) Lata Mangeshkar Hospital, Nagpur, IND
| | - Pranav Suradkar
- Orthopaedics and Traumatology, N. K. P. Salve Institute of Medical Sciences (NKPSIMS) and Research Centre (RC) Lata Mangeshkar Hospital, Nagpur, IND
| | - Akhilesh S Khobragade
- Orthopaedics and Traumatology, N. K. P. Salve Institute of Medical Sciences (NKPSIMS) and Research Centre (RC) Lata Mangeshkar Hospital, Nagpur, IND
| | - Virendra E Patil
- Orthopaedics, N. K. P. Salve Institute of Medical Sciences (NKPSIMS) and Research Centre (RC) Lata Mangeshkar Hospital, Nagpur, IND
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Thusoo V, Nagpal BS, Kudyar S, Chakrapani AS, Saini ES, Alok KV, Pathanaboina R, Palakkal N. Comparison of Twin Screw Derotation Type Versus Single Helical Blade Type Cephalomedullary Nail in the Management of Unstable Intertrochanteric Fractures. Cureus 2024; 16:e61638. [PMID: 38966482 PMCID: PMC11223722 DOI: 10.7759/cureus.61638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 06/04/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND The intertrochanteric fracture is a frequently occurring fracture, often attributed to osteoporosis in older populations. Recently, there has been a proposal to perform early surgical fixation on elderly patients to facilitate early rehabilitation. This approach has been shown to have a beneficial effect in lowering comorbidities. The study aims to compare the efficacy of the twin screw derotation type cephalomedullary nail with that of the single helical blade type cephalomedullary nail in the management of unstable intertrochanteric fractures. METHODOLOGY The research sample included patients from the orthopedic outpatient and emergency departments of Adesh Medical College and Hospital, Ambala Cantt, India, who were scheduled for surgery for unstable intertrochanteric femur fractures. The patients were categorized into two groups according to the kind of implant they were given: either a twin screw derotation cephalomedullary nail or a single helical blade cephalomedullary nail. The functional result was evaluated by comparing the modified Harris hip score (HHS). Patients with unstable intertrochanteric fractures, including reverse oblique fractures and fractures with posteromedial comminution, as well as patients who provided consent, were included in this study. RESULTS Thirteen individuals received treatment with proximal femoral nail antirotation (PFNA2), whereas 19 individuals received treatment with proximal femoral nail (PFN). The mean age in the PFNA2 group was 69.51, whereas the mean age in the PFN group was 70.804. There were three patients in the PFNA2 group and five patients in the PFN group who had a tip apex distance of more than 25 mm. According to the Cleveland index, nine patients in the PFNA2 group and eight patients in the PFN group had an implant location that was not optimum. Four patients in the PFNA2 group and seven patients in the PFN group had a neck shaft angle difference of more than 10° between their undamaged and operated sides. The mean HHS was 74.55 for the PFNA2 group and 69.88 for the PFN group. The PFNA2 group exhibited four problems, whereas the PFN group had five issues. CONCLUSION The study found that both implants offer similar functional outcomes, with adherence to specific radiological parameters optimizing results. While both face similar challenges with osteoporosis, there was no notable distinction between them. Notably, the PFNA2 group showed superior outcomes in perioperative morbidity.
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Affiliation(s)
- Varun Thusoo
- Department of Orthopaedics, Adesh Medical College and Hospital, Ambala Cantt, IND
| | | | - Sachin Kudyar
- Department of Orthopaedics, Government Medical Hospital, Jammu, IND
| | - Arjun S Chakrapani
- Department of Orthopaedics, Apollo Speciality Hospitals, Perungudi, Chennai, IND
| | - Eshaan Singh Saini
- Department of Orthopaedics, Adesh Medical College and Hospital, Ambala Cantt, IND
| | - K V Alok
- Department of Orthopaedics, Osmania Medical College, Hyderabad, IND
| | - Rahul Pathanaboina
- Department of Orthopaedics, Government Medical College, Jagtial, Hyderabad, IND
| | - Najeeb Palakkal
- Department of Orthopaedics, Osmania Medical College, Hyderabad, IND
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Kwon S, Lee M, Lee H, Hwang J. GS Hip Nail versus Affixus Hip Fracture Nail for the Intramedullary Nailing of Intertrochanteric Fractures. J Clin Med 2023; 12:6720. [PMID: 37959186 PMCID: PMC10650030 DOI: 10.3390/jcm12216720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 10/12/2023] [Accepted: 10/19/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Intertrochanteric fractures are a global health concern, especially in aging populations like the Republic of Korea. Surgical treatments like intramedullary nailing are preferred for their benefit. Various hip nails are used worldwide, each with unique features and challenges. This study aims to compare the GS hip nail with the Affixus hip fracture nail for the treatment of intertrochanteric fractures. MATERIAL AND METHODS This retrospective study, conducted at a single center, included 179 patients who underwent intramedullary nailing for intertrochanteric fractures using the GS hip nail or the Affixus hip fracture nail. Excluding specific cases, 43 patients in the GS group and 46 in the Affixus group met the minimum 6-month follow-up criteria. RESULT The GS group exhibited a significantly shorter mean operation time (43.26 min) compared to the Affixus group (51.11 min). Radiographically, both groups showed no significant differences in their reduction quality, tip, and apex distance (TAD), or Cleveland index in the immediate postoperative window. However, the GS group achieved a greater valgus reduction based on the contralateral femoral neck shaft angle (NSA). At 6 months post-operation, there were no significant differences in TAD or advancement and sliding distances. Complication rates were similar between the two groups, with no implant breakages. Clinical outcomes, as measured via mHHS and EQ-5D-5L, showed no significant differences. Despite a slightly higher implant cost, the GS group had a lower total hospital cost than the Affixus group, but this was not statistically significant. CONCLUSIONS This study highlights the efficiency of the GS hip nail in reducing the operation time compared to the Affixus hip fracture nail with comparable radiologic and clinical outcomes. Further research with long-term follow-up and larger patient studies are needed to fully assess its effectiveness in improving patient outcomes in hip fracture treatment.
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Affiliation(s)
- Seungcheol Kwon
- Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, College of Medicine, Hallym University, Seoul 07441, Republic of Korea; (S.K.); (M.L.)
| | - Minjae Lee
- Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, College of Medicine, Hallym University, Seoul 07441, Republic of Korea; (S.K.); (M.L.)
| | - Heeyeon Lee
- Department of Engineering of Regenerative, Dongguk University, Seoul 04620, Republic of Korea;
| | - Jihyo Hwang
- Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, College of Medicine, Hallym University, Seoul 07441, Republic of Korea; (S.K.); (M.L.)
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Zhao H, Deng X, Liu W, Chen W, Wang L, Zhang Y, Wang Z, Wang Y, Lian X, Hou Z, Zhang Q, Zhang Y. Proximal femoral bionic nail (PFBN)-an innovative surgical method for unstable femoral intertrochanteric fractures. INTERNATIONAL ORTHOPAEDICS 2023; 47:1089-1099. [PMID: 36719445 DOI: 10.1007/s00264-023-05696-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 01/07/2023] [Indexed: 02/01/2023]
Abstract
PURPOSE Intertrochanteric femoral fractures (IFF) are one of the most common traumatic conditions, but there are no established treatment methods for this condition due to implant failure and re-operation rates. The proximal femoral bionic nail (PFBN), which is a new design of the cephalomedullary nail, was developed by our team. The objective of this study was to assess the clinical and radiographic outcomes of PFBN in patients with unstable IFF. METHODS From October 2020 to August 2021, 12 patients diagnosed with unstable IFF (31-A2, 3) were treated with PFBN at the Third Hospital of Hebei Medical University. We evaluated the clinical therapeutic effects of this treatment by measuring peri-operative indicators and post-operative complications. Clinical outcomes, specific radiographic parameters, and post-operative complications were collected and analyzed within the first post-operative year. RESULTS The average age of the patients was 72.4 ± 16.1 years (five males and seven females). The mean operation time was 90.4 ± 16.0 min, whereas the operation time of 31-A2 fractures (83.1 ± 12.2 min) was shorter than that of 31-A3 fractures (105.0 ± 12.9 min) (p < 0.05). The blood loss was 175 ml (range: 50 to 500 ml), and the length of hospitalization was 10.0 ± 1.9 days. The prognosis evaluation was assessed at three, six and 12 months after the operation; for these time points, the Harris hip scores were 69.6 ± 4.1, 77.8 ± 3.8, and 82.6 ± 4.6, respectively, and the Parker-Palmer scores were 5.3 (5.0, 7.0), 6.3 (5.3, 7.0), and 7.8 (7.0, 8.0), respectively. CONCLUSION PFBN has shown advantages in the treatment of unstable IFF (particularly in geriatric patients) and possesses both stability and safety. This innovative method may provide a new option for treating unstable IFFs.
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Affiliation(s)
- Haiyue Zhao
- School of Medicine, Nankai University, Tianjin, 300071, China
| | - Xiangtian Deng
- Trauma Medical Center, Department of Orthopedics Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Weijian Liu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Wei Chen
- Department of Orthopedic Surgery of Hebei Province, Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Lei Wang
- School of Medicine, Nankai University, Tianjin, 300071, China
| | - Yiran Zhang
- School of Medicine, Nankai University, Tianjin, 300071, China
| | - Zhongzheng Wang
- Department of Orthopedic Surgery of Hebei Province, Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Yuchuan Wang
- Department of Orthopedic Surgery of Hebei Province, Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Xiaodong Lian
- Department of Orthopedic Surgery of Hebei Province, Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Zhiyong Hou
- Department of Orthopedic Surgery of Hebei Province, Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Qi Zhang
- Department of Orthopedic Surgery of Hebei Province, Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China.
| | - Yingze Zhang
- Department of Orthopedic Surgery of Hebei Province, Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China.
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Li Y, Zhang Y, Yu M, Huang T, Li K, Ye J, Huang H, Yu W. Favorable revision-free survivorship of cemented arthroplasty following failed proximal femoral nail antirotation: a case series with a median follow-up of 10 years. BMC Musculoskelet Disord 2022; 23:1024. [PMID: 36443844 PMCID: PMC9707067 DOI: 10.1186/s12891-022-05995-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 11/17/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Given the ever-increasing rate of failure related to proximal femoral nail antirotation (PFNA), it is expected that an increasing number of PFNA individuals will undergo conversion to total hip arthroplasty (THA). The long-term survivorship of conversion of the initial PFNA to cemented THA is still debated. The aim of this retrospective study was to assess the long-term revision-free survivorship of cemented THAs after initial failures of PFNA in geriatric individuals. METHODS Consecutive geriatric individuals who underwent secondary cemented THA after initial PFNA fixation from July 2005 to July 2018, were retrospectively identified from three medical centres. The primary outcome was revision-free survivorship estimated using the Kaplan-Meier method and Cox proportional hazards regression with revision for any reason as the endpoint; secondary outcomes were functional outcomes and key THA-related complications. Follow-ups occurred at 3 months, 6 months, 12 months and then every 12 months after conversion. RESULTS In total, 186 consecutive patients (186 hips) were available for study inclusion. The median follow-up was 120.7 months (60-180 months) in the cohort. Kaplan-Meier survivorship with revision for any reason as the end point showed that the 10-year revision-free survival rate was 0.852 (95% confidence interval [CI], 0.771-0.890). Good functional outcomes were seen, and the HHS decreased markedly over the 24th month to the final follow-up interval from 92.2 to 75.1 (each p < 0.05). The overall rate of key THA-related complications was 16.1% (30/186). CONCLUSION Cemented THA executed following initial PFNA failure may yield satisfactory revision-free survival and, at least for the initial 10 years after conversion, good functional outcomes and a 16.1% complication rate of key THA-related complications, which supports the trend towards increased use of cemented THA.
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Affiliation(s)
- Yi Li
- Department of Anesthesiology, Wuhan Fourth Hospital, No. 473, Hanzheng Street, Qiaokou District, Wuhan, 430030, China
| | - Yaodong Zhang
- Department of Anesthesiology, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, China
| | - Minji Yu
- Department of Traditional Chinese Medicine, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, China
| | - Tao Huang
- Department of Orthopedics, Wuhan Third Hospital, Tongren Hospital of Wuhan University, No. 241, Pengliuyang Road, Wuchang District, Wuhan, 430060, China
| | - Kunhong Li
- Department of Anesthesiology, Wuhan Fourth Hospital, No. 473, Hanzheng Street, Qiaokou District, Wuhan, China
| | - Junxing Ye
- Department of Orthopedics, The Affiliated Hospital of Jiangnan University, No. 1000, Hefeng Road, Wuxi, 214000, Jiangsu, China
| | - Heng Huang
- Department of Anesthesiology, Wuhan Fourth Hospital, No. 473, Hanzheng Street, Qiaokou District, Wuhan, 430030, China.
| | - Weiguang Yu
- Department of Orthopedics, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, China.
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Dubey S, Iyer RD, Azam MQ, Sarkar B, Nongdamba H. Thigh Pain and Peri-Implant Fractures with the Use of Short Cephalo-medullary Nails: A Retrospective Study of 122 Patients. Malays Orthop J 2022; 16:17-23. [PMID: 36589363 PMCID: PMC9791908 DOI: 10.5704/moj.2211.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 02/21/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction To assess the incidence and causes of persistent thigh pain and peri-implant fractures after union in patients of intertrochanteric fractures treated with short cephalo-medullary nails. Materials and methods A retrospective observational study conducted at a Level 1 Trauma centre. A total of 122 patients of intertrochanteric fractures who were operated using short cephalo-medullary nails (170mm and 200mm lengths) between January 2018 to June 2019 were included in the study. Main outcomes measured were the incidence of thigh pain and peri-implant fractures. Results Out of the 122 patients with a mean follow-up of 14.1 month, 12 patients had persistent thigh pain. Six patients had the helical blade protruding from the lateral cortex, two of them had distal tip of nail abutting on the anterior cortex and four cases had prominent proximal segment of nail which may explain the cause of their pain. Five of these patients had a combination of these findings. Two patients had pain for which no other obvious cause was found. There were no cases of peri-implant fractures in our study. Conclusion Thigh pain associated with the use of short cephalon-medullary nails is often unrelated to nail length and can be prevented by using proper surgical technique. There seems to be no association between the use of short nails and peri-implant fractures.
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Affiliation(s)
- S Dubey
- Department of Orthopaedics, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, India
| | - RD Iyer
- Department of Orthopaedics, All India Institute of Medical Sciences, Raipur, India,Corresponding Author: Iyer R Dinesh, Department of Orthopaedics, All India Institute of Medical Sciences, Gate No, 1, Great Eastern Rd, opposite Gurudwara, AIIMS Campus, Tatibandh, Raipur, Chhattisgarh 492099, India
| | - MQ Azam
- Department of Trauma Surgery, All India Institute of Medical Sciences, Rishikesh, India
| | - B Sarkar
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - H Nongdamba
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
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Jin JW, Kim HS, Jang MJ. Refracture After Removal of the PFNA in a Healed Intertrochanteric Femoral Fracture: Case Report. Geriatr Orthop Surg Rehabil 2022; 13:21514593221074179. [PMID: 35299833 PMCID: PMC8922191 DOI: 10.1177/21514593221074179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 12/28/2021] [Indexed: 11/17/2022] Open
Abstract
Hardware removal in a healed intertrochanteric fracture in elderly, which is not a routine procedure, should be needed in the case of irritable hardware. The reports of refracture after hardware removal can be seen as sparse in current literature, which are focused to secondary femoral neck fracture after removal of the lag screw or blade. We experienced a case of the intertrochanteric refracture and varus collapse after the PFNA removal in a healed fracture, treated with valgus trochanteric osteotomy and angled blade plate fixation. The PFNA is an innovative device for the treatment of the trochanteric fracture; however, the complications after removal never end. Therefore, the removal from healed fracture in elderly who have osteoporosis should not be recommended unless intractable pain had persisted.
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Affiliation(s)
- Jin-Woo Jin
- Department of Orthopedic Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Geyongsangnam-do, Republic of Korea
| | - Hyeon-Soo Kim
- Department of Orthopedic Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Geyongsangnam-do, Republic of Korea
| | - Min-Jae Jang
- Department of Orthopedic Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Geyongsangnam-do, Republic of Korea
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Mismatch of short straight proximal femur nails with anterior bow of femur in Indian population- A radiological and functional analysis. J Orthop 2022; 29:65-70. [PMID: 35145329 PMCID: PMC8814591 DOI: 10.1016/j.jor.2022.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/24/2022] [Accepted: 01/26/2022] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Intra-medullary devices are the most common mode of fixation of inter-trochanteric fractures. Short proximal femur nails (PFN) used for fixing these fractures, unlike the long nails, are non-anatomic and are usually straight with no curvature in antero-posterior plane. As a result, there is always a chance of the nail tip impinging against the anterior cortex of femur. MATERIALS AND METHODS A total of 80 patients with trochanteric fractures (AO 31A2 and 31A3), operated with short PFN, were followed up retrospectively and prospectively from 2019 to 2021, for a period of 6 months. All fractures were fixed with PFNs, with nails ranging from 170 to 250 mm. Radiological analysis was done on hip lateral X-rays (taken at 6 months) using Angle at Distant Axis (ADA) and Nail Tip Position (NTP). Functional outcome analysis was done using Harris Hip Score. Patients were graded into 2 groups according to ADA (ADA>4° and ADA<4°). Incidence of anterior thigh pain was noted in patients on follow up and was statistically evaluated with nail size, nail diameter, ADA and NTP. RESULTS Mean ADA was 4.19° ± 1.45; mean NTP grade was 1.98 ± 1.11. Mean nail size was 201.87 mm with a mean nail diameter of 9.76 mm. Twenty patients complained of anterior thigh pain on follow-up. Twenty-five patients had NTP grade 3 or above of which 16 complained of anterior thigh pain (p < 0.001). Fifty-five patients had nail diameter of 10 mm or above of which 14 had anterior thigh pain (p < 0.01). Fifty-three patients had a nail length of 200 mm or above of which 16 patients complained of thigh pain on follow up (p < 0.01). CONCLUSION There is a mismatch of short PFNs with anterior bow of femur. Use of shorter nails with narrow diameters will avoid this mismatch to an extent.
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Jin Z, Xu S, Yang Y, Wei Y, Tian Y, Wang Z, Bai L. Cemented hemiarthroplasty versus proximal femoral nail antirotation in the management of intertrochanteric femoral fractures in the elderly: a case control study. BMC Musculoskelet Disord 2021; 22:846. [PMID: 34610813 PMCID: PMC8493738 DOI: 10.1186/s12891-021-04586-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 08/06/2021] [Indexed: 02/06/2023] Open
Abstract
Background The treatment for intertrochanteric femoral fractures (IFF) among the elderly has been a controversial topic. Hemiarthroplasty (HA) and proximal femoral nail antirotation (PFNA) have their own advantages in the management of IFF. Hence, this study aims to compare and analyze differences in the effectiveness of both procedures on IFF among the elderly. Methods Overall, 99 patients (81.09 ± 8.29 years; 68 women) underwent HA or PFNA from January 2016 to May 2020. IFF were classified according to the Arbeitsgemeins für Osteosynthesefragen (AO) classification. The difference in underlying diseases, the American Society of Anesthesiologists (ASA) grade, Singh index, Harris scores, surgical time, intraoperative bleeding, postoperative blood test results, postoperative number of days to partially bearing weight, and survival outcomes were analyzed. Postoperative follow-ups were performed every 3 months. Results There was no significant difference in the AO classification, underlying diseases, ASA grade, Singh index, surgical time, and survival outcomes of the HA (45 patients) group and PFNA group (54 patients). The HA group was associated with earlier partial weight-bearing (HA: 4 [2 ~ 4.5] days, PFNA: 10 [8~14] days). It also had a higher total Harris score than the PFNA group at the 6-month follow-up visit (HA: 86.8 [81.90 ~ 90.23], PFNA: 83.48 [75.13 ~ 88.23]). Harris scores decreased more in patients aged ≥90 years in the PFNA group than in the HA group. The postoperative stress recovery rate in the HA group was faster based on postoperative blood test results. Conclusions PFNA and HA have good therapeutic effects in the treatment of IFF. The advantages of HA were reflected in short-term weight bearing, faster recovery from stress, and better joint function in the long term. This advantage is more obvious in the patient population aged over 90 years. Therefore, we suggest that surgeons should consider the benefit of HA in the treatment of IFF among the elderly. Trial registration Chinese Clinical Trial Registry, ChiCTR2000035814. Registered 17 August 2020, https://www.chictr.org.cn/showproj.aspx?proj=57083
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Affiliation(s)
- Zhuangzhuang Jin
- China Medical University, Shenyang, Liaoning, China.,Department of Emergence Medicine, Shengjing Hospital Affiliated China Medical University, Shenyang, Liaoning, China
| | - Shuoyan Xu
- China Medical University, Shenyang, Liaoning, China.,Department of Nuclear medicine, The First Hospital Affiliated China Medical University, Shenyang, Liaoning, China
| | - Yue Yang
- China Medical University, Shenyang, Liaoning, China.,Department of Orthopedics, Shengjing Hospital Affiliated China Medical University, Heping District, 110004, Liaoning, China
| | - Yingliang Wei
- China Medical University, Shenyang, Liaoning, China.,Department of Orthopedics, Shengjing Hospital Affiliated China Medical University, Heping District, 110004, Liaoning, China
| | - Yicheng Tian
- China Medical University, Shenyang, Liaoning, China.,Department of Orthopedics, Shengjing Hospital Affiliated China Medical University, Heping District, 110004, Liaoning, China
| | - Ziyuan Wang
- China Medical University, Shenyang, Liaoning, China.,Department of Orthopedics, Shengjing Hospital Affiliated China Medical University, Heping District, 110004, Liaoning, China
| | - Lunhao Bai
- China Medical University, Shenyang, Liaoning, China. .,Department of Orthopedics, Shengjing Hospital Affiliated China Medical University, Heping District, 110004, Liaoning, China.
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Çölbe SA, Çiftdemir M, Ustabaşıoğlu FE, Özgür C. Iatrogenic gluteus medius muscle insertion injury while trochanteric entry nailing due to trochanteric fractures: a comparative study in forty patients with gray-scale ultrasound and shear-wave elastography. INTERNATIONAL ORTHOPAEDICS 2021; 45:3253-3261. [PMID: 34448922 DOI: 10.1007/s00264-021-05177-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 07/30/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Trochanteric entry nailing potentially causes damage to the gluteus medius (GM) tendon. The aim of this study is to determine the amount of iatrogenic damage to the tendon during reaming by measuring the thickness and stiffness of the GM muscle in patients with trochanteric fractures who are treated with trochanteric entry nails using gray-scale ultrasound (GSUS) and shear-wave elastography (SWE). METHODS Thickness and stiffness values of bilateral GM muscles in 40 patients with trochanteric fractures treated with PFN-A were measured using GSUS and SWE at post-operative sixth week or later. Harris Hip Scores and bilateral active hip abduction measurements of the patients were recorded. The data was analyzed using statistical methods to assess the extent and amount of iatrogenic injury that occurred during trochanteric entry. RESULTS Mean age of the patients was 70. Thirty-three fractures occurred with low-energy trauma. In the SWE evaluation, there was no statistically significant difference between ipsi- and contralateral GM muscle thickness measurements or ipsi- and contralateral GM muscle stiffness measurements. Also, the difference between the clinical evaluation results of the ipsi- and contralateral hip functions was not statistically significant. DISCUSSION In this study, we used the Harris Hip Score and hip abduction range of motion in addition to SWE and GSUS in order to assess the patients' functional status. There are studies in the literature that report significant injury to the GM tendon with cephalomedullary nailing. The majority of these studies are cadaver studies with only clinically irrelevant or uncertain evidence. In this study, we aimed to evaluate the potential negative effects of the iatrogenic damage to the bone-tendon junction during nailing, by measuring the stiffness (consistency) and atrophy of the GM muscle alongside the functional evaluation. CONCLUSION We have found no statistically significant difference between operated and intact side GM muscles in terms of stiffness, atrophy, and functional evaluation in patients with TFs treated using PFN-A. The results of our study should not be interpreted as trochanteric entry nailing does not cause any damage on the GM tendon.
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Affiliation(s)
- Süleyman Alp Çölbe
- Department of Orthopedics and Traumatology, Faculty of Medicine, Trakya University, Balkan Yerleşkesi, 22030, Edirne, Turkey
| | - Mert Çiftdemir
- Department of Orthopedics and Traumatology, Faculty of Medicine, Trakya University, Balkan Yerleşkesi, 22030, Edirne, Turkey.
| | - Fethi Emre Ustabaşıoğlu
- Department of Radiology, Faculty of Medicine, Trakya University, Balkan Yerleşkesi, 22030, Edirne, Turkey
| | - Cihan Özgür
- Department of Radiology, Faculty of Medicine, Trakya University, Balkan Yerleşkesi, 22030, Edirne, Turkey
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11
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Sarai H, Schmutz B, Schuetz M. Effects of ethnicity on proximal femoral intramedullary nail protrusion-a 3D computer graphical analysis. Arch Orthop Trauma Surg 2021; 141:845-853. [PMID: 32728977 DOI: 10.1007/s00402-020-03539-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/15/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Antegrade nailing of proximal femur or femoral shaft fractures is a proven treatment with good to excellent results. Nonetheless, clinical evidence from Asia indicates that proximal femur nails can be too proud at the greater trochanter (GT) causing irritation for some Asian patients. This study aimed to identify any significant differences in proximal nail misfit for a set of Asian and Caucasian femora. MATERIALS AND METHODS Two nails (Gamma3, TFNA) were virtually inserted into 63 femoral 3D models (28 Japanese, 4 Thai, 31 Caucasian). In AP, the entry point was 4° lateral for Gamma3 and 5° for TFNA; laterally the same location was used for both. Insertion depth was controlled by aligning the lag screw centre head. The distance of the nail end from the GT was measured at five (medial, lateral, anterior, posterior and centre) reference points (RPs). The correlation between GT height, CCD angle and proximal nail distance to GT was analysed. RESULTS There was no significant difference between either nail (p = 1.0). The TFNA was overall less prominent than the Gamma3, and significantly less prominent at all RPs except lateral. The Asian femora were 3.76 (p = 0.016) times more likely to have the nail protruding proximally. The Asian subjects were shorter (p < 0.05) than the Caucasians. Their GT height was slightly shorter and CCD angles larger compared to Caucasian (Asian: 41.1 mm, 128.1°, Caucasian: 42.2 mm, 126.4°), but the differences were not significant (p = 0.36). Stature, GT height and CCD angle significantly correlated with nail distance to GT. CONCLUSIONS This study illustrated a significantly increased incidence of proximal nail protrusion in Asian compared to Caucasian femora, corroborating clinical findings. The combination of shorter stature and GT height and a larger CCD angle in Asians likely contributes to this difference.
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Affiliation(s)
- Harminder Sarai
- Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, QLD, 4059, Australia
| | - Beat Schmutz
- Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, QLD, 4059, Australia. .,Jamieson Trauma Institute, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, QLD, 4029, Australia.
| | - Michael Schuetz
- Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, QLD, 4059, Australia.,Jamieson Trauma Institute, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, QLD, 4029, Australia.,Department of Orthopaedics and Trauma Service, Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia
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12
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Das P, Karmakar A. Evaluation of outcome of halifax nail and proximal femoral nail antirotation-asia in management of proximal femoral fractures – A prospective comparative study. JOURNAL OF ORTHOPAEDIC DISEASES AND TRAUMATOLOGY 2021. [DOI: 10.4103/jodp.jodp_14_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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13
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Swaroop S, Gupta P, Bawari R, Marya SK, Patnaik S. Factors Affecting the Outcome of Unstable Intertrochanteric Fractures Managed With Proximal Femoral Nail Anti-Rotation 2: A Prospective Outcome Study in Elderly Indian Population. Cureus 2020; 12:e11973. [PMID: 33425545 PMCID: PMC7790322 DOI: 10.7759/cureus.11973] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background The proximal femoral nail anti-rotation Asia (PFNA 2) is an implant designed for unstable osteoporotic intertrochanteric fractures in Asians as the PFNA was designed for Caucasians and had various complications when applied to the Asian population due to the femoral geometrical mismatch. This study observes the functional outcomes and complications associated with PFNA 2 in unstable intertrochanteric fractures in the elderly Indian population. Methods Sixty-one above 60 years old patients with an unstable intertrochanteric fracture who were operated with PFNA 2 were included in this prospective observational study. They were followed up for one year. The functional and radiographic evaluations were done at 6, 12, 20 weeks, and the functional outcome was evaluated at the end of one year. Association of age, American Society of Anaesthesiologists (ASA) grade, AO Foundation classification, osteoporosis to the functional outcome of modified Harris hip score (MHHS) was evaluated. Results Type A2 fractures demonstrated a statistically higher-good reduction than Type A3 (Student t-test, P < 0.05). The difference in mean surgical duration in Type A3 (45.47 minutes) and Type A2 (40.30 minutes) was statistically significant (Student t-test, P < 0.05). Mean blood loss was 110.66 ml (SD = 48.40 ml). MHHS at 6, 12, 20 weeks, and one year were 40.37, 63.93, 79.03, and 82.34, respectively. At the end of the year, 46 (82.1%) patients achieved good scores, eight (14.3%) achieved fair scores, and two (3.5%) achieved poor scores. There was one case of nonunion and medial migration of the helical blade. The mortality rate was 6.55% at the end of one year. Conclusion A good reduction was associated with a better functional outcome. PFNA 2 is an efficient implant in managing unstable intertrochanteric fractures in elderly Indian patients with good outcomes, low morbidity rates, and mortality. Implant mismatch was not a problem in the Indian population. However, large multi-centric studies with a larger sample size are required. Moreover, achieving a good reduction cannot be over-emphasized in unstable intertrochanteric fractures, especially in the elderly, to achieve a good functional outcome.
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Affiliation(s)
- Shakti Swaroop
- Orthopedics, Institute of Medical Sciences, SUM Hospital, Siksha 'O' Anusandhan (Deemed to be) University, Bhubaneswar, IND
| | - Prateek Gupta
- Orthopedics, Max Super Specialty Hospital, Saket, Delhi, IND
| | - Rajesh Bawari
- Orthopedics, Max Super Specialty Hospital, Saket, Delhi, IND
| | - Sanjiv K Marya
- Orthopedics, Max Super Specialty Hospital, Saket, Delhi, IND
| | - Swati Patnaik
- Public Health Dentistry, Institute of Dental Sciences, Siksha 'O' Anusandhan (Deemed to be) University, Bhubaneswar, IND
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Das PB, Singh A, Lenka BS, Pani S. Osteosynthesis of intertrochanteric fractures by PFN and DHS – A prospective randomized comparative study. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2020. [DOI: 10.1177/2210491720971832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction: As the geriatric population increases, the incidence of intertrochanteric fractures (ITF) has also increased significantly. There are various modalities to treat these fractures. In this study our aim is to analyse outcomes of Proximal Femoral Nail (PFN) in comparison to those of Dynamic Hip Screw (DHS) for the treatment of ITF. Materials and Methods: This study was carried out during 2017–20. 150 patients of unstable ITF (AO type 31-A2, 31-A3) in elderly were randomly divided into two groups of 75 each and were treated either by DHS or PFN and were followed up regularly. Results: The results were compared between the groups and statistical analyses were performed. The results were assessed with Harris Hip Score(HHS) & Parker Palmer mobility score (PPMS) which were better in PFN group. Conclusion: PFN is a better fixation device for unstable ITF (31 A2 and 31 A3) in elderly patients.
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Affiliation(s)
- Pulin Bihari Das
- Department of Orthopaedics, Institute of Medical Science and SUM Hospital, Bhubaneswar, India
| | - Anurag Singh
- Department of Orthopaedics, Institute of Medical Science and SUM Hospital, Bhubaneswar, India
| | - Bhabani Shankar Lenka
- Department of Orthopaedics, Institute of Medical Science and SUM Hospital, Bhubaneswar, India
| | - Sunit Pani
- Department of Orthopaedics, Institute of Medical Science and SUM Hospital, Bhubaneswar, India
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Barla M, Egrise F, Zaharia B, Bauer C, Parot J, Mainard D. Prospective assessment of trochanteric fracture managed by intramedullary nailing with controlled and limited blade back-out. Orthop Traumatol Surg Res 2020; 106:613-619. [PMID: 32249158 DOI: 10.1016/j.otsr.2019.11.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 08/26/2019] [Accepted: 11/25/2019] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The main objective of the present prospective study was to assess mechanical complications associated with an original intramedullary nail with limited and controlled blade back-out in the treatment of trochanteric fracture. MATERIAL AND METHOD All patients treated for trochanteric fracture in a single orthopedic/traumatologic surgery department over a 2-year period were included. Minimum follow-up was 6 months. Fracture stability was assessed on the AO criteria. The TFP® intramedullary nail has a monobloc helicoid blade. Its main feature is the controlled and limited blade back-out, optimizing fracture site compression in weight-bearing, without the drawback of excessive back-out. The main endpoint was onset of mechanical complications: cut-out, intra-articular protrusion, non-union, and pain. Baumgaertner's Tip-Apex Distance (TAD), blade centering within the femoral head and fracture reduction were also assessed. RESULTS One hundred thirty-eight patients (mean age, 83 years) were operated on, and 118 followed up. There were 9 mechanical complications (7.6%): 4 cut-outs (3.4%), 3 intra-articular protrusions (2.5%), 1 non-union (0.8%) and 1 case of pain (0.8%). TAD length was not associated with complications rate. Poor reduction was significantly associated with more complications (p=0.02), as was blade malpositioning. Mean back-out was 3.3mm, affecting 22 nails (19%). There were no complications in case of back-out, versus a 9.4% rate in absence of back-out, although this difference was not significant (p=0.21). There were no postoperative infections. CONCLUSION The TFP® nail is useful for fixation of trochanteric fracture, whether stable or unstable, due to its low rate of mechanical complications compared to the literature.
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Affiliation(s)
- Manuela Barla
- CHRU, Hôpital Central, 29, avenue du Maréchal de Lattre-de-Tassigny, 54000 Nancy, France.
| | - François Egrise
- CHRU, Hôpital Central, 29, avenue du Maréchal de Lattre-de-Tassigny, 54000 Nancy, France
| | - Bogdan Zaharia
- CHRU, Hôpital Central, 29, avenue du Maréchal de Lattre-de-Tassigny, 54000 Nancy, France
| | - Camille Bauer
- CHRU, Hôpital Central, 29, avenue du Maréchal de Lattre-de-Tassigny, 54000 Nancy, France
| | - Jauffrey Parot
- CHRU, Hôpital Central, 29, avenue du Maréchal de Lattre-de-Tassigny, 54000 Nancy, France
| | - Didier Mainard
- CHRU, Hôpital Central, 29, avenue du Maréchal de Lattre-de-Tassigny, 54000 Nancy, France
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Schmutz B, Schuetz F, Alkadhi H, Rühli F, Eppenberger P. Secular evolution of femoral morphology from a clinical perspective. Clin Anat 2020; 33:887-898. [PMID: 32115778 DOI: 10.1002/ca.23585] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 02/08/2020] [Accepted: 02/19/2020] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Intramedullary nailing is the surgical method of choice for the treatment of proximal femur or femoral shaft fractures. Implant manufacturers aim to design implants fitting for the broadest possible population segment. As complete morphological data sets of long bones are not widely available, anatomical collections of historical dry bone specimens may represent abundant additional sources of morphological three-dimensional (3D) data for implant design, provided they are consistent with present populations. This study aims to investigate secular trends and age-related changes of femoral morphology of the Caucasian population over the past 800 years. MATERIALS AND METHODS Computer graphical measurements of 3D-datasets of right and left femora derived from computed tomography (CT) scans, representative of the present Caucasian population, were compared to computer graphical measurements of 3D-datasets of right and left femora derived from CT scans of specimens from a historical medieval European bone collection. RESULTS Clinically relevant parameters of historical medieval European femora were found mostly consistent with correlative data of the present Caucasian population. Additionally, for some of the evaluated parameters, particularly anteversion, morphological differences significantly correlated to individual age and sex could be identified, whereas other parameters such as caput-collum-diaphyseal angle or radius of anterior femoral bowing were not correlated to individual age or sex. CONCLUSION The findings suggest that more recent historical specimen collections may be a convenient and easily accessible source of new 3D morphological data, as well as to complement existing data, to be used by researchers and manufacturers for the development of intramedullary femoral nails.
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Affiliation(s)
- Beat Schmutz
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Frederik Schuetz
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Hatem Alkadhi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Frank Rühli
- Institute of Evolutionary Medicine, University of Zurich, Zurich, Switzerland
| | - Patrick Eppenberger
- Institute of Evolutionary Medicine, University of Zurich, Zurich, Switzerland
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Kim SS, Kim HJ, Lee CS. Clinical outcomes of PFNA-II in the Asian intertrochanteric fracture patients: Comparison of clinical results according to proximal nail protrusion. Injury 2020; 51:361-366. [PMID: 31812322 DOI: 10.1016/j.injury.2019.11.040] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 10/14/2019] [Accepted: 11/28/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE This study intended to explore the clinical outcomes of PFNA-II, one of the commonly used fixation devices for intertrochanteric fractures and the association of clinical results with the extent of proximal nail protrusion. MATERIALS AND METHODS Of 315 cases that underwent internal fixation using PFNA-II between September 2010 and June 2018 among intertrochanteric fracture patients aged over 65 years, a total of 86 patients with an ability to communicate clearly and a minimum follow-up of 6 months were retrospectively reviewed. We classified the subjects according to PFNA-II protrusion over the greater trochanter area on anteroposterior radiographs. Differences between the two groups were examined by comparing demographic characteristics including gender, age, height, weight and BMI, instrumental characteristics including PFNA nail size, nail diameter, blade length and blade position, radiologic characteristics including reduction quality, Dorr type and bone union, and clinical characteristics including GT pain,VAS score and Harris Hip Score (HHS). RESULTS A total of 86 cases were divided into 30 (34.9%) in the protrusion group (group A) and 56 (65.1%) in the non-protrusion group (group B). No significant difference was found in demographic characteristics such as gender, age, height, weight and BMI between the two groups. Two groups had no statistically significant difference in PFNA nail length, nail diameter and blade length, but showed a statistically significant difference in blade position. At the latest follow-up, the mean HHS shows no statistically significant difference between the two groups. On the contrary, the number of patients complaining of GT pain and VAS score were statistically significantly higher in group A. Removal of metal implants was performed in two patients in the protrusion group due to a complaint of persistent GT pain. CONCLUSION Nail protrusion over the greater trochanter area occurs frequently after the surgical treatment of intertrochanteric fracture using PFNA-II. When the nail protruded into the greater trochanter, the number of patients who clinically complained of pain was statistically significantly high. We recommend a modification to the PFNA-II that would further shorten the proximal nail end suitable for the Asian population to achieve better clinical results in the fixation of intertrochanteric fractures.
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Affiliation(s)
- Sung Soo Kim
- Department of Orthopedic Surgery, College of Medicine, Dong-A University, Dongdaesin-Dong 3-ga, Busan 602-715, Republic of Korea
| | - Hyeon Jun Kim
- Department of Orthopedic Surgery, College of Medicine, Dong-A University, Dongdaesin-Dong 3-ga, Busan 602-715, Republic of Korea.
| | - Chan Soo Lee
- Department of Orthopedic Surgery, College of Medicine, Dong-A University, Dongdaesin-Dong 3-ga, Busan 602-715, Republic of Korea
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Wang D, Zhang K, Qiang M, Jia X, Chen Y. Computer-assisted preoperative planning improves the learning curve of PFNA-II in the treatment of intertrochanteric femoral fractures. BMC Musculoskelet Disord 2020; 21:34. [PMID: 31948409 PMCID: PMC6966829 DOI: 10.1186/s12891-020-3048-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 01/07/2020] [Indexed: 11/12/2022] Open
Abstract
Background Intertrochanteric femoral fractures are prevalent among the elderly, and usually demands surgical treatments. Proximal femoral nail antirotation Asian version (PFNA-II) is widely used for intertrochanteric fracture treatment. The computer-assisted preoperative planning (CAPP) system has the potential to reduce the difficulty of PFNA-II in the treatment of intertrochanteric fractures. The aim of the study was to investigate and compare the learning curves of PFNA-II treatment with CAPP and conventional preoperational planning methods for intertrochanteric femoral fractures. Methods A total of 125 patients with intertrochanteric fracture who were treated with PFNA-II between March 2012 and June 2015 were retrospectively analyzed. Patients who underwent surgery with CAPP procedure by a junior surgeon were regarded as group A (n = 53); patients who underwent the conventional surgery by another junior surgeon were regarded as group B (n = 72). Each group was divided into three subgroups (case 1–20, case 21–40, case 41–53 or case 41–72). Results The average operation time of group A was 45.00(42.00, 50.00) minutes, and in group B was 55.00 (50.00, 60.00) minutes (P < 0.01). Average radiation frequency and blood loss were 13.02 ± 2.32, 160.00 (140.00, 170.00) ml and 20.92 ± 3.27, 250.00 (195.00, 279.50) ml, respectively, with significant differences (P < 0.01). The learning curve of the surgical procedure in group A was steeper than that in group B. There were no significant differences in patient reported outcomes, hospital stay and complication rate between the two groups. Significant differences were observed between group A and B in Harris score at last follow-up in the AO/OTA type 31-A2 intertrochanteric fracture (P < 0.05). Conclusion Compared with conventional preoperative planning methods, CAPP system significantly reduced operation time, radiation frequency and blood loss, thus reshaped the learning curve of PFNA-II treatment with lower learning difficulty. Trial registration researchregistry4770. Registered 25 March 2019.
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Affiliation(s)
- Dongdong Wang
- Department of Orthopaedic Trauma, East Hospital, Tongji University School of Medicine, Shanghai, 200120, China
| | - Kun Zhang
- Department of Orthopaedic Trauma, East Hospital, Tongji University School of Medicine, Shanghai, 200120, China
| | - Minfei Qiang
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Xiaoyang Jia
- Department of Orthopaedic Trauma, East Hospital, Tongji University School of Medicine, Shanghai, 200120, China
| | - Yanxi Chen
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
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Zhou S, Liu J, Zhen P, Shen W, Chang Y, Zhang H, Zhu Q, Li X. Proximal femoral nail anti-rotation versus cementless bipolar hemiarthroplasty for unstable femoral intertrochanteric fracture in the elderly: a retrospective study. BMC Musculoskelet Disord 2019; 20:500. [PMID: 31664982 PMCID: PMC6820901 DOI: 10.1186/s12891-019-2793-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 08/27/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The treatment for unstable intertrochanteric fractures in the elderly has always been a controversial issue. The aim in this study was to compare the curative effects of proximal femoral nail anti-rotation (PFNA) and cementless bipolar hemiarthroplasty (CPH) on femoral intertrochanteric fracture in the elderly. METHODS From March 2008 to December 2012, 108 elderly patients with femoral intertrochanteric fractures were treated by PFNA or CPH. There were 63 males and 45 females, aged 75.3-99.1 years [(83.7 ± 5.6) years]. The patients' bone mineral density was routinely measured, and the fractures were classified according to Evans-Jensen. The patients were divided into CPH group and PFNA group. The differences in operation time, intraoperative bleeding, immobilization duration, hospitalization time, Harris scores and postoperative complications including deep venous thrombosis, lung and urinary infection were analyzed. RESULTS All patients were followed for 12.5-36.2 months [(28.0 ± 6.3) months)]. The operation time was (53.7 ± 15.2) min and (77.5 ± 16.8) min in PFNA group and CPH group, respectively (P < 0.05); intraoperative bleeding was (132.5 ± 33.2) mL and (286.3 ± 43.2) mL, respectively (P < 0.05); immobilization duration was (28.2 ± 3.7) days and (3.1 ± 1.2) days, respectively (P < 0.05); hospitalization time was (7.6 ± 1.8) days and (6.9 ± 2.2) days, respectively (P > 0.05); and the Harris scores after 1 year were (87.7 ± 7.9) points and (88.3 ± 9.2) points, respectively (P > 0.05). There was no significant difference in postoperative complications between the two groups (P > 0.05). CONCLUSION Both PFNA and CPH are safe and effective treatments for femoral intertrochanteric fracture in elderly patients. Nonetheless, CPH allows faster mobilization and recovery. TRIAL REGISTRATION Registration Number: ChiCTR1900022846 . Reg Date:2019-04-26 00:27:33 Retrospective registration.
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Affiliation(s)
- Shenghu Zhou
- Department of Joint Surgery, Institute of Orthopedics, Xijing Hospital of Fourth Military Medical University, Xi'an, 710032, China.,Department of Joint Surgery, Institute of Orthopedics, General Hospital of Lanzhou Military Command, Lanzhou, 730050, China
| | - Jun Liu
- Department of Joint Surgery, Institute of Orthopedics, General Hospital of Lanzhou Military Command, Lanzhou, 730050, China
| | - Ping Zhen
- Department of Joint Surgery, Institute of Orthopedics, General Hospital of Lanzhou Military Command, Lanzhou, 730050, China
| | - Weiwei Shen
- Department of Joint Surgery, Institute of Orthopedics, General Hospital of Lanzhou Military Command, Lanzhou, 730050, China
| | - Yanfeng Chang
- Department of Joint Surgery, Institute of Orthopedics, General Hospital of Lanzhou Military Command, Lanzhou, 730050, China
| | - Haoqiang Zhang
- Department of Joint Surgery, Institute of Orthopedics, General Hospital of Lanzhou Military Command, Lanzhou, 730050, China
| | - Qingsheng Zhu
- Department of Joint Surgery, Institute of Orthopedics, Xijing Hospital of Fourth Military Medical University, Xi'an, 710032, China.
| | - Xusheng Li
- Department of Joint Surgery, Institute of Orthopedics, General Hospital of Lanzhou Military Command, Lanzhou, 730050, China.
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Li Y, Hu C, Mao L, Zhu Y, Cai X. [Treatment of AO/OTA type 31-A3 intertrochanteric fracture with proximal femoral nail antirotation combined with mini plate reconstruction of lateral femoral wall]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:1223-1227. [PMID: 31544429 PMCID: PMC8337622 DOI: 10.7507/1002-1892.201904151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 07/29/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To explore the effectiveness of proximal femoral nail antirotation (PFNA) combined with mini plate for reconstruction of lateral femoral wall in the treatment of type AO/Orthopaedic Trauma Association (AO/OTA) type 31-A3 intertrochanteric fracture. METHODS The clinical data of 70 elderly patients with AO/OTA type 31-A3 intertrochanteric fracture treated between January 2013 and January 2018 were retrospectively analyzed. They were divided into group A (PFNA alone, 35 cases) and group B (PFNA combined with mini plate reconstruction of lateral femoral wall, 35 cases). There was no significant difference in the general data of gender, age, side, cause of injury, time from injury to operation between the two groups ( P>0.05). The operation time, intraoperative blood loss, fracture healing time, postoperative complications, and the tip apex distance (TAD) at 2 months after operation were recorded and compared between the two groups. Harris hip score was used to evaluate the function at 12 months after operation. RESULTS Both groups were followed up 9-21 months, with an average of 16.6 months. The operation time and intraoperative blood loss in group A were significantly less than those in group B ( P<0.05); there was no significant difference in TAD between the two groups at 2 months after operation ( t=0.096, P=0.462). There were 5 complications (14.3%) occurred in group A, including 2 cases of blade perforating from the hip joint, 2 cases of screw back out, and 1 case of bone nonunion; only 1 case (2.9%) in group B had screw back out after operation; there was no significant difference in the incidence of complications between the two groups ( χ 2=2.917, P=0.088). All the fracture healed in group B, and 1 patient in group A suffered bone nonunion and eventually main nail fracture. The healing time of fracture in group A [(15.6±2.7) weeks] was significantly longer than that in group B [(12.5±2.5) weeks], showing significant difference ( t=2.064, P=0.023). At 12 months after operation, according to Harris score, the results were excellent in 5 cases, good in 9 cases, fair in 13 cases, and poor in 8 cases in group A, the qualified rate (Harris score>70) was 77.14%; and the results were excellent in 7 cases, good in 11 cases, fair in 16 cases, and poor in 1 case in group B, the qualified rate was 97.14%; there was significant difference in the qualified rate between the two groups ( χ 2=6.248, P=0.012). CONCLUSION Compared with PFNA alone, the treatment of AO/OTA type 31-A3 intertrochanteric fracture with PFNA combined with mini plate reconstruction of lateral femoral wall can significantly reduce postoperative complications, promote fracture healing, and improve functional recovery of patients after operation.
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Affiliation(s)
- Yao Li
- Department of Orthopedics, Shanghai Tenth People's Hospital, Shanghai, 200072, P.R.China
| | - Chuanzhen Hu
- Department of Orthopedics, Shanghai Tenth People's Hospital, Shanghai, 200072, P.R.China
| | - Lingzhou Mao
- Department of Orthopedics, Shanghai Tenth People's Hospital, Shanghai, 200072, P.R.China
| | - Yuchang Zhu
- Department of Orthopedics, Shanghai Tenth People's Hospital, Shanghai, 200072, P.R.China
| | - Xinyu Cai
- Department of Orthopedics, Shanghai Tenth People's Hospital, Shanghai, 200072,
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Raghuraman R, Kam JW, Chua DTC. Predictors of failure following fixation of intertrochanteric fractures with proximal femoral nail antirotation. Singapore Med J 2019; 60:463-467. [PMID: 31570952 DOI: 10.11622/smedj.2019114] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION This retrospective matched case-control study aimed to identify predictors of cut-out following intramedullary nailing of intertrochanteric fractures with the 200-mm Synthes proximal femoral nail antirotation (PFNA). METHODS 609 patients underwent intramedullary nailing for intertrochanteric fractures at our institution between January 2011 and December 2014. 370 patients satisfied the inclusion criteria. There were 20 cases of implant cut-out. Cases and controls were matched using a propensity score-matching method with an m:n ratio, matching the criteria of gender, age and side of operation. Radiographs were assessed to determine fracture classification, fracture reduction quality, tip-apex distance, calcar referenced tip-apex distance (CalTAD), anteroposterior (AP) Parker's ratio index, lateral Parker's ratio index and cervical angle difference. Conditional logistic regression analysis was performed to determine any association between potential predictors and cut-outs. RESULTS The cut-out incidence was 5.4%. Of the 20 cut-outs, 16 were superior and four were cut-throughs. Univariate analysis only showed a significant association between unsatisfactory fracture reduction quality and cut-outs (odds ratio [OR] 10.1, 95% confidence interval [CI] 1.31-77.6, p = 0.027). This association remained significant with multivariate logistic regression analysis (OR 16.4, 95% CI 1.9-140.4, p = 0.011). Cut-throughs had significantly lower CalTAD (16.2 vs. 27.5, p = 0.016) and AP Parker's ratio index values (38.7 vs. 50.7, p = 0.007) than superior cut-outs. CONCLUSION Unsatisfactory fracture reduction quality was a significant predictor of cut-out in intertrochanteric fractures treated with the 200-mm PFNA. Cut-outs had two distinct modes, with cut-throughs having a deeper and more inferior helical blade position in the femoral head compared to superior cut-outs.
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Affiliation(s)
| | - Jia Wen Kam
- Clinical Trials and Research Unit, Changi General Hospital, Singapore
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22
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Singh NK, Sharma V, Trikha V, Gamanagatti S, Roy A, Balawat AS, Aravindh P, Diwakar AR. Is PFNA-II a better implant for stable intertrochanteric fractures in elderly population ? A prospective randomized study. J Clin Orthop Trauma 2019; 10:S71-S76. [PMID: 31700206 PMCID: PMC6823828 DOI: 10.1016/j.jcot.2019.02.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 02/06/2019] [Accepted: 02/06/2019] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Intertrochanteric fracture is one of the most common and severe fractures occurring in the elderly population. We conducted a randomized prospective study to compare the functional and radiological outcome of Proximal Femoral Nail anti-rotation-Asia(PFNA-II) and Dynamic Hip screw (DHS) used in fixation of stable (AO type 31 A1-A2.1) intertrochanteric fractures in elderly. METHODS 60 elderly patients with stable intertrochanteric fractures treated with DHS and PFNA-II between August 2014 to Dec 2016 were enrolled in the study. Intraoperative variables-surgical time, blood loss, fluoroscopy time and post-operative variables-union rate, change in neck shaft angle(NSA), functional outcome in terms of Modified Harris Hip Score(HHS) & SF-12, complication rate and mortality at one year were studied and compared between both the groups. RESULTS The mean age of patients in our study was 70.96 years. We found patients treated with DHS required significantly longer surgical time and had more blood loss compared to PFNA-II group. However, there was no significant difference in both the groups in terms of intra-operative fluoroscopy time, change in neck shaft angle, union rate, complication rate and Modified Harris Hip Score & SF-12 at three months; six months and one year follow-up. CONCLUSIONS Both DHS and PFNA-II can be used effectively in the treatment of elderly patients with stable intertrochanteric fracture with comparable outcome. However, in high-risk elderly patients requiring shorter surgical time and less blood loss, PFNA-II can be used.
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Affiliation(s)
- Navin Kumar Singh
- Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, India
| | - Vijay Sharma
- Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, India
| | - Vivek Trikha
- Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, India
| | - Shiva Gamanagatti
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Amit Roy
- Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, India
| | - Avtar Singh Balawat
- Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, India
| | - Palaniswamy Aravindh
- Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, India
| | - Amrut Raje Diwakar
- Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, India
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23
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Bonnaire F, Lein T, Fülling T, Bula P. Reduced complication rates for unstable trochanteric fractures managed with third-generation nails: Gamma 3 nail versus PFNA. Eur J Trauma Emerg Surg 2019; 46:955-962. [PMID: 31520157 DOI: 10.1007/s00068-019-01200-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 07/28/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Third-generation nails for the management of unstable trochanteric fractures were evaluated with regard to outcomes. PATIENTS AND METHODS A prospective observational study comparing the Gamma 3 nail and the Proximal Femoral Nail Antirotation (PFNA) in 106 unstable trochanteric fractures confirms the recently reported low intra- and postoperative complication rates from retrospective cohort studies. RESULTS Studies of same generations of both intramedullary nail systems did not reveal significant differences in intra- or postoperative complications. Intraoperative dislocation during nail insertion occurred 7 times for the Gamma nail and 9 times for the PFNA. The standard PFNA had to be exchanged intraoperatively for a shorter one on two occasions. Superficial wound healing disorders and hematoma requiring revision were observed in four patients in the Gamma 3 nail group and in three patients in the PFNA group. No deep infections were documented. Mechanical complications required revision in four patients (7.5%) after Gamma nailing and in two patients (3.8%) after PFNA. Postoperative rotation of the head-neck fragment was observed for the Gamma nail in three patients, not in the PFNA group. This was not statistically significant (p = 0.08). There were neither incidences of cut out without renewed trauma nor intraoperative fracture or postoperative femoral fracture. Nonunion affected 1 of 18 patients in late follow-up (p = 0.3) in the Gamma 3 nail group. DISCUSSION The Gamma 3 nail and the PFNA yielded comparable clinical results and significantly improved outcomes for unstable trochanteric fractures compared to older nail generations.
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Affiliation(s)
- Felix Bonnaire
- Städtisches Klinikum Dresden Standort Friedrichstadt, Friedrichstrasse 41, 01067, Dresden, Germany.
| | - Thomas Lein
- Städtisches Klinikum Dresden Standort Friedrichstadt, Friedrichstrasse 41, 01067, Dresden, Germany.,Diakonissenkrankenhaus Dresden, Holzhofgasse 29, 01099, Dresden, Germany
| | - Tim Fülling
- Städtisches Klinikum Dresden Standort Friedrichstadt, Friedrichstrasse 41, 01067, Dresden, Germany
| | - Philipp Bula
- Städtisches Klinikum Dresden Standort Friedrichstadt, Friedrichstrasse 41, 01067, Dresden, Germany.,Klinikum Gütersloh, Reckenberger Str. 19, 33332, Dresden, Germany
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Nayak M, Yadav R, Ganesh V, Digge V. An unusual case of femoral head perforation following fixation with proximal femoral nail antirotation (PFNA-II) for an unstable intertrochanteric fracture: Case report and literature review. Trauma Case Rep 2019; 20:100178. [PMID: 30805427 PMCID: PMC6374611 DOI: 10.1016/j.tcr.2019.100178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2019] [Indexed: 11/24/2022] Open
Abstract
The proximal femoral nail antirotation (PFNA-II) is designed for fixation of unstable proximal femoral fractures in Asian patients due to its superior biomechanical properties. The helical blade achieves purchase through bone compaction and requires less removal of bone than a screw. Medial migration of the helical blade with perforation into the hip joint without loss of reduction is a rare problem noted with PFNA. Past literature reporting the migration of the helical blade medially, perforating the femoral head has been addressed as a characteristic complication of the PFNA. A review of literature suggests various reasons for the same such as fresh trauma, fracture settlement and failure of lateralization of the blade. We report a case of postoperative medial migration of the helical blade perforating the femoral head due to loosening of the locking bolt of the helical blade without any signs of rotational or varus displacement of the fracture.
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Affiliation(s)
- Mayur Nayak
- Jay Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Rahul Yadav
- Jay Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - V Ganesh
- Jay Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Vijay Digge
- Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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25
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Femoral antecurvation-A 3D CT Analysis of 1232 adult femurs. PLoS One 2018; 13:e0204961. [PMID: 30300421 PMCID: PMC6177158 DOI: 10.1371/journal.pone.0204961] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 09/16/2018] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION For optimal treatment of femoral fractures, it is essential to understand the anatomical antecurvation of the human femur. Recent clinical studies have highlighted the problem of distal anterior encroachment or even perforation of the nail tip. The aim of this study was to accurately describe the femoral antecurvation in a large cohort. Another objective was to identify the most important influences on femoral antecurvation, such as age, femur length, gender and ethnicity. METHODS A three dimensional modelling and analytical technology was applied for the analysis of 1,232 femurs. Individual femoral antecurvation was precisely computed to determine whether gender, femur length, age, ethnicity or body mass index influence the radius of curvature (ROC). RESULTS The calculated mean ROC for all femurs was 943 mm. The lowest ROC of 826 mm was found in female Asian femurs. A regression analysis demonstrated that age and femur length could predict the variability of the curvature, with femoral length as most powerful predictor. A matched pair subgroup analysis between Asians and Caucasians could not show any significant differences of ROC values. CONCLUSIONS The mean radius of the femoral antecurvation may be smaller than previously reported revealing a significant mismatch between the actual individual anatomy and existing implants. In opposite to existing literature, this study suggests, that antecurvation differences between various ethnicities may exclusively be attributed to differences in femoral length and age. The findings of this study may be found helpful in the development of novel designs for intra- and extramedullary implants.
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26
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Radaideh AM, Qudah HA, Audat ZA, Jahmani RA, Yousef IR, Saleh AAA. Functional and Radiological Results of Proximal Femoral Nail Antirotation (PFNA) Osteosynthesis in the Treatment of Unstable Pertrochanteric Fractures. J Clin Med 2018; 7:E78. [PMID: 29649099 PMCID: PMC5920452 DOI: 10.3390/jcm7040078] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 04/06/2018] [Accepted: 04/09/2018] [Indexed: 11/29/2022] Open
Abstract
Pertrochanteric femur fractures are considered amongst the most commonly encountered fractures in the geriatric age group. We evaluated radiographic and functional outcomes of patients with unstable pertrochanteric fractures treated with the proximal femur nail antirotation (PFNA). Between March 2013 and December 2015, fifty patients (28 male and 22 females with a mean age of 72.8 years (range, 20-94)) with unstable pertrochanteric fractures (AO 31.A2 and 31.A3) were fixed with the PFNA at our institution, and they were retrospectively evaluated. Forty one patients were treated with short PFNA and nine with long PFNA. Operative time ranged between 30 and 150 (average 73.60) min, blood loss ranged between 50 and 250 (average 80) milliliter and hospital stay ranged between 3 and 18 (6.86) days. The mean follow-up period was 18 months (range, 11-31). At final follow-up, solid union of all fractures had been achieved without any implant-related complications, the mean Harris Hip Score (HHS) was 79.34 ± 9.10 points and the mean neck-shaft angle was 127.2° ± 5.07°. No significant differences were encountered between the functional and radiographic outcomes of the PFNA with regards to the AO fracture classification and the implant version. PFNA is a recommended option for the treatment of unstable pertrochanteric fractures owing to its easy insertion, reduced blood loss, stable fixation and satisfactory functional and radiological outcomes.
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Affiliation(s)
- Ahmad M Radaideh
- Department of Orthopedics, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid 22110, Jordan.
| | - Hashem A Qudah
- Department of Orthopedics, Jordan Hospital, Amman 11152, Jordan.
| | - Ziad A Audat
- Department of Orthopedics, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid 22110, Jordan.
| | - Rami A Jahmani
- Department of Orthopedics, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid 22110, Jordan.
| | - Ibraheem R Yousef
- Department of Orthopedics, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid 22110, Jordan.
| | - Abed Allah A Saleh
- Department of Orthopedics, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid 22110, Jordan.
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27
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Chen F, Zhao Z, Gao C, Liu J, Su X, Zhao J, Tang P, Liao H. Clustering of Morphological Features for Identifying Femur Cavity Subtypes With Difficulties of Intramedullary Nail Implantation. IEEE J Biomed Health Inform 2017; 22:1209-1217. [PMID: 29028216 DOI: 10.1109/jbhi.2017.2761980] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Intramedullary (IM) nail implantation is currently the standard treatment for femoral intertrochanteric fractures. However, individual differences in femur cavity bring a challenge in designing well-matched IM nails and cause difficulties in IM nail implantation. Therefore, there is an intense need to analyze femur cavities to predict difficulties in IM nail implantation to assist the design of IM nails. This study proposed a method to automatically identify subtypes of femur cavities that exhibit differences in potential difficulties in nail implantation by clustering the morphological features of femur models. The unsupervised subtype extraction method offers a scientific approach to stratify patients for designing and choosing well-matched IM nails. First, the quantitative morphological features of 422 femur cavities were extracted from computed tomography patient models. Second, 422 femur cavities were clustered into three distinct subtypes using a density peak-based k-means clustering method to provide a possible solution for the scientific design of IM nails. The effectiveness of the identified subtypes was validated by comparing subtype differences associated with IM nail implantation and the natural attributes of the patient. Quantitative evaluation of the mismatch degree and real clinical cases confirmed that the clustering results were clinically effective, with clear differences in the subtypes. Therefore, particular IM nails designed from the identified subtypes will potentially facilitate IM nail implantation and reduce complications. Compared with state-of-the-art methods, we used the largest scale dataset and unsupervised clustering to achieve subtype identification of femur cavities with clinical significance.
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28
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Zheng SN, Yao QQ, Mao FY, Zheng PF, Tian SC, Li JY, Yu YF, Liu S, Zhou J, Hu J, Xu Y, Tang K, Lou Y, Wang LM. Application of 3D printing rapid prototyping-assisted percutaneous fixation in the treatment of intertrochanteric fracture. Exp Ther Med 2017; 14:3644-3650. [PMID: 29042960 PMCID: PMC5639369 DOI: 10.3892/etm.2017.4991] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 04/21/2017] [Indexed: 12/14/2022] Open
Abstract
The aim of the present study was to investigate the application of 3D printing (3DP) rapid prototyping (RP) technique-assisted percutaneous fixation in the treatment of femoral intertrochanteric fracture (ITF) using proximal femoral nail anti-rotation (PFNA). A total of 39 patients with unstable ITF were included in the current study. Patients were divided into two groups: 19 patients were examined using computed tomography scanning and underwent PFNA with SDP-RP whereas the other 20 patients underwent conventional PFNA treatment. Anatomical data were converted from the Digital Imaging and Communications in Medicine format to the stereolithography format using M3D software. The 3DP-RP model was established using the fused deposition modeling technique and the length and diameter of the main screw blade was measured during the simulation. The postoperative femoral neck-shaft angle (NSA), surgery duration, intraoperative and postoperative blood loss, and the duration of hospital stay were recorded and compared with the corresponding values in conventional surgery. No significant differences were observed in mean PFNA size between the implants used and the preoperative planning estimates. It was demonstrated that the 3DP-RP assisted procedure resulted in more effective reduction of the NSA. Furthermore, patients undergoing 3DP-RP experienced a significant reduction in duration of surgery (P<0.01), as well as reductions in intraoperative (P=0.02) and postoperative (P=0.03) blood loss, compared with conventional surgery. At 6 months post-surgery, no cases of hip varus/vague deformities or implant failure were observed in patients that underwent either the 3DP-RP-assisted or conventional procedure. The results of the present study suggest that the 3DP-RP technique is able to create an accurate model of the ITF, which facilitates surgical planning and fracture reduction, thus improving the efficiency of PFNA surgery for ITFs.
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Affiliation(s)
- Sheng-Nai Zheng
- Department of Orthopedic Surgery, Nanjing Medical University, Nanjing Hospital, Nanjing, Jiangsu 210006, P.R. China.,Clinical Medical Center of Orthopedic Surgery, Nanjing Medical University, Nanjing Hospital, Nanjing, Jiangsu 210006, P.R. China
| | - Qing-Qiang Yao
- Department of Orthopedic Surgery, Nanjing Medical University, Nanjing Hospital, Nanjing, Jiangsu 210006, P.R. China.,Clinical Medical Center of Orthopedic Surgery, Nanjing Medical University, Nanjing Hospital, Nanjing, Jiangsu 210006, P.R. China.,Digital Medicine Institute, Nanjing Medical University, Nanjing Hospital, Nanjing, Jiangsu 210006, P.R. China
| | - Feng-Yong Mao
- Department of Orthopedic Surgery, Nanjing Medical University, Nanjing Hospital, Nanjing, Jiangsu 210006, P.R. China.,Clinical Medical Center of Orthopedic Surgery, Nanjing Medical University, Nanjing Hospital, Nanjing, Jiangsu 210006, P.R. China
| | - Peng-Fei Zheng
- Digital Medicine Institute, Nanjing Medical University, Nanjing Hospital, Nanjing, Jiangsu 210006, P.R. China
| | - Shu-Chang Tian
- Department of Orthopedic Surgery, Nanjing Medical University, Nanjing Hospital, Nanjing, Jiangsu 210006, P.R. China
| | - Jia-Yi Li
- Department of Orthopedic Surgery, Nanjing Medical University, Nanjing Hospital, Nanjing, Jiangsu 210006, P.R. China.,Clinical Medical Center of Orthopedic Surgery, Nanjing Medical University, Nanjing Hospital, Nanjing, Jiangsu 210006, P.R. China
| | - Yi-Fan Yu
- Department of Orthopedic Surgery, Nanjing Medical University, Nanjing Hospital, Nanjing, Jiangsu 210006, P.R. China.,Clinical Medical Center of Orthopedic Surgery, Nanjing Medical University, Nanjing Hospital, Nanjing, Jiangsu 210006, P.R. China
| | - Shuai Liu
- Department of Orthopedic Surgery, Nanjing Medical University, Nanjing Hospital, Nanjing, Jiangsu 210006, P.R. China
| | - Jin Zhou
- Department of Orthopedic Surgery, Nanjing Medical University, Nanjing Hospital, Nanjing, Jiangsu 210006, P.R. China
| | - Jun Hu
- Department of Orthopedic Surgery, Nanjing Medical University, Nanjing Hospital, Nanjing, Jiangsu 210006, P.R. China.,Clinical Medical Center of Orthopedic Surgery, Nanjing Medical University, Nanjing Hospital, Nanjing, Jiangsu 210006, P.R. China
| | - Yan Xu
- Clinical Medical Center of Orthopedic Surgery, Nanjing Medical University, Nanjing Hospital, Nanjing, Jiangsu 210006, P.R. China.,Digital Medicine Institute, Nanjing Medical University, Nanjing Hospital, Nanjing, Jiangsu 210006, P.R. China
| | - Kai Tang
- Digital Medicine Institute, Nanjing Medical University, Nanjing Hospital, Nanjing, Jiangsu 210006, P.R. China
| | - Yue Lou
- Digital Medicine Institute, Nanjing Medical University, Nanjing Hospital, Nanjing, Jiangsu 210006, P.R. China
| | - Li-Ming Wang
- Department of Orthopedic Surgery, Nanjing Medical University, Nanjing Hospital, Nanjing, Jiangsu 210006, P.R. China.,Clinical Medical Center of Orthopedic Surgery, Nanjing Medical University, Nanjing Hospital, Nanjing, Jiangsu 210006, P.R. China.,Digital Medicine Institute, Nanjing Medical University, Nanjing Hospital, Nanjing, Jiangsu 210006, P.R. China
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Lee PY, Lin KJ, Wei HW, Hu JJ, Chen WC, Tsai CL, Lin KP. Biomechanical effect of different femoral neck blade position on the fixation of intertrochanteric fracture: a finite element analysis. ACTA ACUST UNITED AC 2017; 61:331-6. [PMID: 26351785 DOI: 10.1515/bmt-2015-0091] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 08/05/2015] [Indexed: 11/15/2022]
Abstract
Medial migration or cutout of the neck helical blade has commonly occurred in the treatment of trochanteric fracture of the femur. The position of the helical blade within the femoral head is one of the influencing factors that cause the blade to perforate the intact joint surface; however, the ideal placement of the helical blade is not currently known. A finite element model of a femur/nail construct was utilized to analyze five possible blade positions in the femoral head. Normal strain at the fracture surface, the minimum principal strain in the cancellous bone, and the von Mises stress in the implant itself were calculated and compared between different blade positions. The results showed that a large area of normal compressive strain at the fracture surface was observed in the inferior and posterior blade positions. The volume of cancellous bone strained to yielding in the femoral head and neck was lower for the inferior and posterior positions, whereas it was the highest for the superior position. The inferior and posterior positions had lower von Mises stress in the implant itself. The inferior and posterior positions may be the ideal position for the intramedullary nail with a helical neck blade.
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Li M, Hu J, Li Z, Chen J, Gao X, Liu J. [Efficacy comparison of different methods to treat femoral intertrochanteric fracture in aged patients]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2017; 31:653-658. [PMID: 29798644 DOI: 10.7507/1002-1892.201703047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To compare the efficacy of proximal femoral nail anti-rotation (PFNA), locking compression plate (LCP), and artificial femoral head replacement for femoral intertrochanteric fracture in aged patients so as to provide reference for clinical treatment. Methods A retrospective analysis was made on the clinical data of 150 aged patients with femoral intertrochanteric fracture treated between September 2009 and March 2016. PFNA was used in 51 cases (group A), LCP in 53 cases (group B), and artificial femoral head replacement in 46 cases (group C). There was no significant difference in sex, age, side, cause of injury, injury to operation time, type of fracture, and combined medical diseases between groups ( P>0.05). The incision length, operation time, intraoperative blood loss, time for full weight bearing, hip Harris score, and complications were recorded and compared between groups. Results The patients were followed up 12-23 months (mean, 18.6 months) in group A, 12-25 months (mean, 19.0 months) in group B, and 12-24 months (mean, 18.9 months) in group C. The incision length, operation time, and intraoperative blood loss of group A were significantly less than those of groups B and C ( P<0.05); the operation time of group C was significantly shorter than that of group B ( P<0.05), but there was no significant difference in incision length and intraoperative blood loss ( P>0.05). The time for full weight bearing was significantly shorter in group C than groups A and B, and in group A than group B ( P<0.05). Postoperative complications occurred in 11 patients of group A (21.6%), 14 patients of group B (26.4%), and 2 patients of group C (4.3%), showing significant difference between group C and group A or group B ( P<0.05), but no significant difference was found between groups A and B ( P>0.05). Hip Harris score at 12 months after operation had no significant difference between groups ( P>0.05). Conclusion PFNA, LCP, and artificial femoral head replacement are all effective methods to treat femoral intertrochanteric fracture in aged patients. PFNA has the advantages of small incision, short operation time, less bleeding and simple procedure, and artificial femoral head replacement has the advantages of early time for full weight bearing, less bed rest time, and less complications. For these patients, PFNA and artificial femoral head replacement are appropriate.
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Affiliation(s)
- Mingdong Li
- Department of Orthopedic Trauma, Hainan General Hospital, Haikou Hainan, 570311, P.R.China
| | - Jijie Hu
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Nanfang Medical University, Guangzhou Guangdong, 510515, P.R.China
| | - Zaomin Li
- Department of Orthopedic Trauma, Hainan General Hospital, Haikou Hainan, 570311, P.R.China
| | - Jianfei Chen
- Department of Orthopedic Trauma, Hainan General Hospital, Haikou Hainan, 570311, P.R.China
| | - Xing Gao
- International Nursing College, Hainan Medical University, Haikou Hainan, 571199,
| | - Jian Liu
- Department of Orthopedic Spine, Hainan General Hospital, Haikou Hainan, 570311, P.R.China
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Pan S, Liu XH, Feng T, Kang HJ, Tian ZG, Lou CG. Influence of different great trochanteric entry points on the outcome of intertrochanteric fractures: a retrospective cohort study. BMC Musculoskelet Disord 2017; 18:107. [PMID: 28288607 PMCID: PMC5348905 DOI: 10.1186/s12891-017-1472-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 03/06/2017] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND The Proximal Femoral Nail Antirotation (PFNA) system for treatment of intertrochanteric fractures is currently widely applied worldwide. However, even though the PFNA has produced good clinical outcomes, a poor introduction technique with an inappropriate entry point can cause surgical complications. Some researchers suggest improving clinical outcomes by modifying the entry point, but no research has focused on this issue. The purpose of the present study is to compare the clinical and radiological outcomes of two different trochanteric entry points for the treatment of intertrochanteric fractures using the PFNA system. METHODS From May 2010 to October 2015, a total of 212 elderly patients with intertrochanteric fractures who were treated with the PFNA-II system were included into this retrospective cohort study. Group LA (98 patients) was treated using a lateral anterior trochanteric entry point, and group MP (114 patients) was treated using a medial posterior trochanteric entry point. All patients underwent follow-up assessments at 1, 3, 6, and 12 months after surgery. Radiographic evaluation was based on the impingement, tip-apex distance (TAD) and the position of the helical blade within the femoral head. Clinical evaluation was based on the surgical time, fluoroscopy time, blood loss, hospital stay, visual analogue scale (VAS), thigh pain, and Harris hip score. RESULTS The impingement was significantly reduced (P = 0.011) in group MP. The helical blade positions were significantly lower (P = 0.001) in group MP. The TADs in group LA (22.40 ± 4.43) and group MP (23.39 ± 3.60) were not significantly different (P = 0.075). The fluoroscopy time of group LA (53.26 ± 14.44) was shorter than that of group MP (63.29 ± 11.12, P = 0.000). Five iatrogenic lateral proximal fractures and 3 helical blade cutouts occurred in group LA, but none occurred in group MP. At 1 and 3 months postoperation, the Harris hip scores were significantly higher in group MP (P = 0.001 and P = 0.000, respectively), and the VAS scores were lower (P < 0.05). CONCLUSIONS The medial posterior trochanteric entry point achieved excellent nail and helical blade position, reduced surgical complications, and enabled early hip function recovery but required longer fluoroscopy time than the lateral anterior trochanteric entry point.
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Affiliation(s)
- Shuo Pan
- Department of Orthopaedic Surgery, Shijiazhuang No. 1 Hospital, NO.36 Fanxi Road, Shijiazhuang, 050011, Hebei, China.
| | - Xiao-Hui Liu
- Department of Orthopaedic Surgery, Shijiazhuang No. 1 Hospital, NO.36 Fanxi Road, Shijiazhuang, 050011, Hebei, China
| | - Tao Feng
- Department of Orthopaedic Surgery, Shijiazhuang No. 1 Hospital, NO.36 Fanxi Road, Shijiazhuang, 050011, Hebei, China
| | - Hui-Jun Kang
- Department of Orthopaedic Surgery, Shijiazhuang No. 1 Hospital, NO.36 Fanxi Road, Shijiazhuang, 050011, Hebei, China
| | - Zhi-Guang Tian
- Department of Orthopaedic Surgery, Shijiazhuang No. 1 Hospital, NO.36 Fanxi Road, Shijiazhuang, 050011, Hebei, China
| | - Chun-Guang Lou
- Judicial Authentication Center of The People's Procuratorate of Hebei Province, Shijiazhuang, 050011, Hebei, China
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3D Computer graphical anatomy study of the femur: a basis for a new nail design. Arch Orthop Trauma Surg 2017; 137:321-331. [PMID: 28168640 DOI: 10.1007/s00402-016-2621-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Current intramedullary nails with a radius of curvature (ROC) of 1500-2000 mm sometimes cause distal anterior cortical encroachment. Furthermore, clinical data indicate that the proximal nail end is too long for some Asian patients. The objective of our study was to develop a comprehensive 3D measurement protocol that measures both the anatomy of the canal and the proximal region. The protocol was used to obtain measurements from Caucasian and Asian (Japanese and Thai) specimens. MATERIALS AND METHODS A total of 90 3D bone models representative of hip fracture patients were reconstructed from CT data. RapidForm 2006 was used to generate the reference geometries required for determining radius and angulation of shaft antecurvature as well as measurements of the proximal anatomy. Multiple linear regression analyses were used to determine the relative contribution of height, age, ethnicity, gender, and body side on the total variance. RESULTS The mean ROC in the natural 3D antecurvature plane was 885 mm overall, 974 mm in Caucasians and 787 mm in Asians. Height, age, ethnicity, gender, and body side significantly predicted ROC (R = 0.53, p = 0.000). The mean values of anteversion measurements for Asians (Japanese: 22.1°; Thai: 22.7°) were significantly larger than those of the Caucasians (14.5°; p = 0.001). There was virtually no difference (p = 0.186) between the measurements pertaining to the length of the proximal nail end between Caucasian and Asian samples. There was no significant difference between the mean neck-to-shaft angles (Caucasian: 126°; Japanese: 128.2°; Thai: 125.7°; p = 0.198 for Asians vs Caucasians). CONCLUSIONS The developed comprehensive anatomical 3D measurement protocol could serve as standardised approach for anthropometric studies in the future. Our data suggest that the ROC of current nail designs should be reduced from between 1500 and 2000 to 1000 mm to achieve an improved fit for the investigated population.
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Bajpai J, Maheshwari R, Bajpai A, Saini S. Treatment options for unstable trochanteric fractures: Screw or helical proxima femoral nail. Chin J Traumatol 2016; 18:342-6. [PMID: 26917025 DOI: 10.1016/j.cjtee.2015.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
PURPOSE To compare treatment outcome of screw proximal femoral nail (PFN) system with that of a helical PFN. METHODS The study included 77 patients with closed unstable intertrochanteric fracture classified as AO 31A2&31A3, between June 2008 to August 2011. Inclusion criteria were: all mature skeletons above 50 years of age; closed unstable trochanteric fracture classified as AO 31A2&A3. Exclusion criteria were: immature skeleton, pathological fracture of any cause other than osteoporosis, inability to walk inde- pendently prior to injury. Patients were randomized to 2 treatment groups based on admission sequence. Forty patients were treated with screw PFN and thirty seven were treated with helical PFN. RESULTS Both groups were similar in respect of time of surgery, blood loss and functional assessment and duration of hospitalization. In screw PFN group 2 patients had superficial wound infection, 1 patient had persistent hip pain and 1 patient had shortening>1 cm but<2 cm, while in helical PFN group 1 patient had superficial wound infection. CONCLUSION Both screw and helical PFN are very effective implants in osteoporotic and unstable trochanteric fractures even in Indian patients where the bones are narrow and neck diameter is small. It is an implant of choice for osteoporotic and unstable trochanteric fractures.
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Affiliation(s)
- Jeetendra Bajpai
- Department of Orthopaedics, Himalayan Institute of Medical Sciences, HIHT University, Jollygrant, Dehradun 248140, India
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Díaz VJ, Cañizares ACP, Martín IA, Peinado MA, Doussoux PC. Predictive variables of open reduction in intertrochanteric fracture nailing: a report of 210 cases. Injury 2016; 47 Suppl 3:S51-S55. [PMID: 27692107 DOI: 10.1016/s0020-1383(16)30606-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Factors that impede closed reduction in intertrochanteric fractures remain unknown. This study was designed with the aim of establishing radiological variables that can predict an open reduction when nailing those type of fractures. MATERIALS AND METHODS Observational prospective study carried out between March 2013 and March 2015. Patients of both gender who suffered an intertrochanteric fracture, and who were surgically treated by intramedullary nailing (PFN-A), were included. Patients were evaluated by means of a questionnaire designed in 12 de Octubre Trauma department. Radiological parameters assessed preoperatively, after fracture reduction in the traction table, and after fixation were: calcar, lateral wall and posterior buttress integrity or disruption; lesser trochanter location, varus or valgus deformities, and flexion or extension of the proximal fragment. RESULTS Association between open reduction and the following types of fractures was statistically significant (p<0.001): subtypes A2.3, A3.2 and A3.3 of AO classification and subtypes IV and V of Evans classification. There were four radiological parameters associated with the need for open reduction: disruption of lateral wall (p<0.0000), posterior wall fracture (p<0.001), calcar (p<0.004) and malalignment in the axial view (p<0.001). CONCLUSIONS Open reduction seems to be necessary for complex fracture patterns such as A2.3, A3.2 and A3.3 types of AO/OTA classification, as well as types IV and V of Evans classification. There are four major radiological parameters that can predict the need of approaching the fracture site: posterior buttress, calcar disruption, lateral wall disruption and proximal fragment flexion. The development of high quality evidence regarding this topic is necessary due to the vast impact that open reduction can have on elderly patients.
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Affiliation(s)
- Verónica Jiménez Díaz
- Department of Orthopaedic and Trauma Surgery, Hospital Universitario 12 de Octubre, Madrid, Spain.
| | | | - Ismael Auñón Martín
- Department of Orthopaedic and Trauma Surgery, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Miguel Aroca Peinado
- Department of Orthopaedic and Trauma Surgery, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Pedro Caba Doussoux
- Department of Orthopaedic and Trauma Surgery, Hospital Universitario 12 de Octubre, Madrid, Spain
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Yang JH, Jung TG, Honnurappa AR, Cha JM, Ham CH, Kim TY, Suh SW. The Analysis of Biomechanical Properties of Proximal Femur after Implant Removal. Appl Bionics Biomech 2016; 2016:4987831. [PMID: 27597807 PMCID: PMC4997010 DOI: 10.1155/2016/4987831] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 05/20/2016] [Accepted: 06/13/2016] [Indexed: 11/17/2022] Open
Abstract
Introduction. To compare the biomechanical stability of the femur following the removal of proximal femoral nail antirotation (PFNA-II) and dynamic hip screw (DHS). Material and Methods. 56 paired cadaveric femurs were used as experimental and control groups. In the experimental group, PFNA-II and DHS were randomly inserted into femurs on both sides and then removed. Thereafter, compression load was applied until fracture occurred; biomechanical stability of the femurs and associated fracture patterns were studied. Results. The ultimate load and stiffness of the control group were 6227.8 ± 1694.1 N and 990.5 ± 99.8 N/mm, respectively. These were significantly higher than experimental group (p = 0.014, <0.001) following the removal of PFNA-II (4085.6 ± 1628.03 N and 656.3 ± 155.3 N/mm) and DHS (4001.9 ± 1588.3 N and 656.3 ± 155.3 N/mm). No statistical differences in these values were found between the 2 device groups (p = 0.84, 0.71), regardless of age groups. However, fracture patterns were different between two devices, intertrochanteric and subtrochanteric fractures. Conclusions. Mechanical stability of the proximal femurs does not differ after the removal of 2 different of fixation devices regardless of the age. However, it was significantly lower compared to an intact femur. Different fracture patterns have been shown following the removal of different fixation devices as there are variations in the site of stress risers for individual implants.
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Affiliation(s)
- Jae Hyuk Yang
- Scoliosis Research Institute, Department of Orthopedics, Korea University Medical College, Guro Hospital, Guro 2-dong, Guro-gu, Seoul 152-703, Republic of Korea
| | - Tae Gon Jung
- Osong Medical Innovation Foundation, Medical Device Development Center, Cheongju 363-951, Republic of Korea
| | - Arjun Rupanagudi Honnurappa
- Scoliosis Research Institute, Department of Orthopedics, Korea University Medical College, Guro Hospital, Guro 2-dong, Guro-gu, Seoul 152-703, Republic of Korea
| | - Jae Min Cha
- The Division of Biological Sciences at The University of Chicago, Undergraduate Class of 2014, 5801 South Ellis Avenue Chicago, IL 60637, USA
| | - Chang Hwa Ham
- Scoliosis Research Institute, Department of Orthopedics, Korea University Medical College, Guro Hospital, Guro 2-dong, Guro-gu, Seoul 152-703, Republic of Korea
| | - Tae Yoon Kim
- Jung-Hwa Girls High School, San 105 Beomeo-4-dong Sunsung-gu, Daegu 706-819, Republic of Korea
| | - Seung Woo Suh
- Scoliosis Research Institute, Department of Orthopedics, Korea University Medical College, Guro Hospital, Guro 2-dong, Guro-gu, Seoul 152-703, Republic of Korea
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Kim JW, Cuellar DO, Hao J, Herbert B, Mauffrey C. Prevention of inaccurate targeting of proximal screws during reconstruction femoral nailing. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2016; 26:391-6. [PMID: 27048548 DOI: 10.1007/s00590-016-1769-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 03/18/2016] [Indexed: 11/27/2022]
Abstract
PURPOSE The purpose of this study was to identify the underlying cause by simulating the forces involved in a controlled laboratory setting, and then to illustrate some intraoperative tips on how to detect this malalignment and suggest solutions prevent this intraoperative complication. METHODS The Expert Asian Femoral Nail (A2FN) and Proximal Femoral Nail Antirotation (PFNA) reconstruction nail systems were evaluated to compare the characteristics of each nailing system and their reactions to soft tissue tension at the time of proximal reconstruction screw placement. Soft tissue tension was simulated by placing a fulcrum under the distal drill sleeve and exerting a load on the targeting device via the addition of weights. The occurrence and degree of guide malalignment were determined while gradually increasing the weight. RESULTS When soft tissue tension was simulated on the drill/guide sleeve of the A2FN, the drill sleeve deviated from the proximal screw hole proportionally to the weight applied and the K-wire guide passed outside of the nail at a weight of 7 kg. However, the drill sleeve of the PFNA was aligned exactly to the center of nail axis and the K-wire passed cleanly through the proximal locking hole regardless of weight applied. CONCLUSIONS Inaccurate guidance of the screw-targeting device can be caused by soft tissue tension. Thus, the authors recommend that careful attention be placed on minimizing soft tissue tension during proximal screw placement while using the targeting device of the A2FN system.
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Affiliation(s)
- Ji Wan Kim
- Department of Orthopaedic Surgery, Haeundae Paik Hospital, Inje University, College of Medicine, 1435, Jwa-dong, Haeundae-gu, Busan, 612-862, Republic of Korea
| | - Derly O Cuellar
- Department of Orthopaedic Surgery, Saint Louis University School of Medicine, 3635 Vista at Grand Blvd., St. Louis, MO, 63104, USA
| | - Jiandong Hao
- Department of Orthopaedics, Denver Health Medical Center, University of Colorado, School of Medicine, 777 Bannock Street, Denver, CO, 80204, USA
| | - Benoit Herbert
- Department of Orthopaedics, Denver Health Medical Center, University of Colorado, School of Medicine, 777 Bannock Street, Denver, CO, 80204, USA
| | - Cyril Mauffrey
- Department of Orthopaedics, Denver Health Medical Center, University of Colorado, School of Medicine, 777 Bannock Street, Denver, CO, 80204, USA.
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Yeganeh A, Taghavi R, Moghtadaei M. Comparing the Intramedullary Nailing Method Versus Dynamic Hip Screw in Treatment of Unstable Intertrochanteric Fractures. Med Arch 2016; 70:53-6. [PMID: 26980933 PMCID: PMC4779359 DOI: 10.5455/medarh.2016.70.53-56] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Accepted: 01/06/2016] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Dynamic Hip Screw fixation is currently considered as a standard treatment for pre-trochanteric fractures; however, due to the long-term hospitalization and some other complications, some researchers have proposed intramedullary nailing as the alternative surgical treatment. The aim of this study was to compare and examine the consequences of the using intramedullary nailing method versus Dynamic Hip Screw. METHODS In this study 114 patients with unstable Intertrochanteric fracture refer to Rasoul Akram hospital during 2011 to 2013 has been selected. After reduction, fixation surgery with PFN nail (60 patients) and Dynamic Hip Screw (54 patients) has been performed. All patients were screen during surgery and six months after surgery and some parameters like, bleeding, union, as well as complications such as collapse, varus and medialization of the distal fragment were record and patients. RESULTS About some parameters like cutting length, surgery duration, bleeding there were significant differences between two groups. In six months follow up period 2 patinas from nail and 8 patients from DHS group had non-union. Also from the point of radiologic and clinical parameters, like anterior thigh pain, cut out, medialization of the distal fragment, collapse of the neck, walking recovery and daily activities were significant between two groups. CONCLUSION Due to the reduced hospital stay in intramedullary nailing method and the necessity of doing repeated surgery and applying intramedullary nailing when the patients are not treated with external fixation, the researchers recommend intramedullary nailing as the first option in treating such patients.
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Affiliation(s)
- Ali Yeganeh
- Department of orthopedics, Rasool-e-akram Hospital, Iran university of Medical Science, Tehran, Iran
| | - Roozbeh Taghavi
- Department of orthopedics, Rasool-e-akram Hospital, Iran university of Medical Science, Tehran, Iran
| | - Mehdi Moghtadaei
- Department of orthopedics, Rasool-e-akram Hospital, Iran university of Medical Science, Tehran, Iran
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Brunner A, Büttler M, Lehmann U, Frei HC, Kratter R, Di Lazzaro M, Scola A, Sermon A, Attal R. What is the optimal salvage procedure for cut-out after surgical fixation of trochanteric fractures with the PFNA or TFN?: A multicentre study. Injury 2016; 47:432-8. [PMID: 26748415 DOI: 10.1016/j.injury.2015.11.027] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 11/13/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the outcome after different types of revision operations for blade 'cut-out' and 'cut-through' after fixation of trochanteric fractures with proximal femoral nail antirotation (PFNA) or a trochanter fixation nail (TFN). METHODS Twenty hospitals participated in this multicentre study. A total of 4109 patients were retrospectively screened for cut-out or cut-through complications after nailing of trochanteric fractures using PFNA or TFN. Fifty-seven patients (28 with 'cut-through' and 29 with 'cut-out') were included in the study. In the 'cut-through' group, 16 patients underwent a blade exchange, six patients had a blade exchange with bone cement augmentation, and six received total hip arthroplasty (THA). In the 'cut-out' group, three patients had a blade exchange, one had a blade exchange with augmentation, three underwent re-nailing of the fracture with a new PFNA, one had a girdlestone procedure and 21 had THA procedures. RESULTS In the 'cut-through' group, eight patients who had a blade exchanges (50%) and two patients with blade exchange and augmentation (33%) required further revision operations. THA was the definite treatment in all 6 cases. In the 'cut-out' group, two patients (66%) who had blade exchanges and two (66%) who underwent re-nailing required additional revision operations during the subsequent course. One patient (4%) who had total hip arthroplasty needed revision surgery for acetabular replacement. Overall, a total of 81 revision procedures were performed. CONCLUSION Based on the data from this study, we recommend THA as the only valid salvage procedure for 'cut-out' and 'cut-through' of helical blades after fixation of trochanteric fractures with the PFNA and TFN.
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Affiliation(s)
- Alexander Brunner
- Medical University Innsbruck, Department of Trauma Surgery, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Markus Büttler
- DePuy Synthes, Luzernstrasse 21, 4528 Zuchwil, Switzerland
| | - Uwe Lehmann
- Clinic Forchheim, Trauma Surgery Department, Krankenhausstraße 10, 91301 Forchheim, Germany
| | - Hans Curd Frei
- Davos Hospital, Department of Trauma and Orthopaedic Surgery, Promenade 4, 7270 Davos Platz, Switzerland
| | - Renato Kratter
- Lachen Hospital, Department of Trauma Surgery, Oberdorfstrasse 41, 8853 Lachen, Switzerland
| | | | - Alexander Scola
- Ulm University, Department of Orthopaedic Trauma, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - An Sermon
- University Hospitals Gasthuisberg, Department of Traumatology, Herestraat 49, 3000 Leuven, Belgium
| | - Rene Attal
- Medical University Innsbruck, Department of Trauma Surgery, Anichstrasse 35, 6020 Innsbruck, Austria.
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Hu SJ, Chang SM, Ma Z, Du SC, Xiong LP, Wang X. PFNA-II protrusion over the greater trochanter in the Asian population used in proximal femoral fractures. Indian J Orthop 2016; 50:641-646. [PMID: 27904220 PMCID: PMC5122260 DOI: 10.4103/0019-5413.193475] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The treatment of proximal femoral fractures in geriatric osteoporotic patients continues to be a challenge in orthopaedic trauma. Various kinds of cephalomedullary nails, such as gamma nail, InterTan and PFNA were used clinically. The latest generation PFNA II, specially designed for Asian population, is commonly used for geriatric per-/intertrochanteric fractures. The aim of this study was to determine whether the current PFNA-II proximal segment length is suitable for the greater trochanter height, as assessed by postoperative radiograph measurements. MATERIALS AND METHODS 51 consecutive patients with per-/intertrochanteric fractures treated with the PFNA-II between July 2012 and December 2012 were enrolled in this study. There were 19 males and 32 females, with an average age of 78.6 years (range 66-92 years). According to AO/OTA classification system, there were 4 cases of 31A1 fractures, 35 cases of 31A2 fractures, and 12 cases of 31A3 fractures. The nail protrusion height over the lateral greater trochanter and the Parker ratio of the helical blade tip in the femoral head were measured and compared using pelvic digital anteroposterior radiographs taken within 2 weeks postoperatively. Patients were followed up for a minimum period of 1 year to check whether they had lateral trochanter pain. RESULTS Postoperative digital anteroposterior (AP) films were used for assessment and any prominence was recorded as positive. Overall, nail protrusion over the greater trochanter occurred in 87.8% of cases. In 60.8% of the cases, protrusion height was >5 mm. The average protrusion height was 6.25 ± 4.27 mm (male average 4.84 ± 4.38 mm, and female average 7.09 ± 4.70 mm). The average Parker ratio of all cases was 51.0 ± 6.9% (male average 49.8 ± 7.5% and female average 51.7 ± 6.5%). Protrusion height was positively correlated (r = 0.394, P = 0.004) with the helical blade position in the femoral head (Parker ratio). Clinically, a total of 42 patients were followed up at an average of 15.0 ± 2.6 months (range 12-24 months) they were able to walk independently or with a stick. There were 13 patients with lateral trochanter pain on the injured side. Protrusion height of these patients was 11.13 ± 3.75 mm, whereas the protrusion height of the remaining 29 patients was 3.87 ± 3.39 mm. CONCLUSIONS There was a morphologic mismatch between the proximal segment length of the PFNA-II and the greater trochanter in the Asian population, which may be the cause of postoperative lateral trochanter pain. A modification to shorten the proximal part of the nail is proposed to avoid protrusion over the greater trochanter.
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Affiliation(s)
- Sun-Jun Hu
- Department of Orthopaedic Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai 200090, P.R. China
| | - Shi-Min Chang
- Department of Orthopaedic Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai 200090, P.R. China,Address for correspondence: Prof. Shi-Min Chang, Department of Orthopaedic Surgery, Yangpu Hospital, Tongji University School of Medicine, 450 Tengyue Road, Shanghai 200090, P.R. China. E-mail:
| | - Zhuo Ma
- Department of Orthopaedic Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai 200090, P.R. China
| | - Shou-Chao Du
- Department of Orthopaedic Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai 200090, P.R. China
| | - Liang-Ping Xiong
- Department of Orthopaedic Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai 200090, P.R. China
| | - Xin Wang
- Department of Orthopaedic Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai 200090, P.R. China
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Kanakaris NK, Noviello C, Saeed Z, Mitrogiannis L, Tosounidis TH, Tartaglia N. Preliminary results of the treatment of proximal femoral fractures with the AFFIXUS nail. Injury 2015; 46 Suppl 5:S12-7. [PMID: 26384659 DOI: 10.1016/j.injury.2015.08.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Contemporary fixation of the proximal femur is performed utilising a number of implants adopting different concepts and techniques. Cephalomedullary nails in particular represent one of two main options, the other being dynamic hip screw (DHS). The aim of this cohort study is to present the early experience of two large units from different countries of the use of the AFFIXUS nail for stabilisation of proximal femoral fractures. Over a period of almost three years, data from 476 proximal femoral fractures were collected and analysed using a specific research protocol, assessing data relevant to basic demographic details, in-hospital stay, surgical technique and post discharge outcomes with a minimum follow up of 6 months. Both the short and long versions of the nail were used in both centres, however, with some statistically significant differences as far as the type of fractures stabilised with the nail, which also translated to differences in the combination or not of 2 lag screws, and the static or dynamic mode of the proximal fixation construct. Other areas of difference amongst the 2 units, were the length of hospital stay and return of patients to their pre-injury residence, most likely reflecting the different social circumstances between the 2 countries. Overall mortality at a median follow up period of 17 months (range 6 to 35) was limited to 6.3%, nonunion and cut out rates 2.7%, whilst revision surgery occurred in just 2.5%. Over the first 6 months of follow up 63.6% returned to their pre-injury ambulatory status and 90.5% to their pre-injury residence. Further studies and higher level of scientific evidence is needed to verify the findings of this retrospective cohort study as to the effectiveness and safety of this new cephalomedullary nail.
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Affiliation(s)
- Nikolaos K Kanakaris
- Academic Department of Trauma and Orthopaedics, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.
| | - Chiara Noviello
- Department of Trauma and Orthopaedics, Ospedale Regionale F. Miulli Bari, Italy.
| | - Zumbair Saeed
- Academic Department of Trauma and Orthopaedics, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.
| | - Leonidas Mitrogiannis
- Academic Department of Trauma and Orthopaedics, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.
| | - Theodoros H Tosounidis
- Academic Department of Trauma and Orthopaedics, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.
| | - Nicola Tartaglia
- Department of Trauma and Orthopaedics, Ospedale Regionale F. Miulli Bari, Italy.
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Rowland P, Phelan N, Gardiner S, Linton KN, Galvin R. The Effectiveness of Corticosteroid Injection for De Quervain's Stenosing Tenosynovitis (DQST): A Systematic Review and Meta-Analysis. Open Orthop J 2015; 9:456-9. [PMID: 27468839 PMCID: PMC4645863 DOI: 10.2174/1874325001509010456] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 05/12/2015] [Accepted: 08/05/2015] [Indexed: 12/28/2022] Open
Abstract
De Quervain's stenosing tenosynovitis (DQST) treatments include corticosteroid injection around the tendon sheath; however there is some ambiguity concerning the efficacy of this treatment. The aim of this systematic review and meta-analysis is to examine the totality of evidence relating to the use of corticosteroid injection in DQST when compared to placebo or other active treatments. A systematic literature search was conducted in July 2014. Only randomized control trials (RCTs) were included. Outcome measures included impairment, activity limitation and participation restriction. Five RCTs were identified with 165 patients, 88 in the treatment group and 77 in the control group.Patients who received corticosteroid injection (n=142) had a higher rate of resolution of symptoms [RR 2.59, 95% CI: 1.25 to 5.37, p=0.05, I2=62%]. This group reported greater pain relief as assessed by Visual Analogue Scale (VAS) at first assessment [mean difference -2.51, 95% CI: -3.11 to -1.90, p=0.0003, I2=65%] and demonstrated a statistically significant improvement in function (n=78) as measured by the DASH score and Dutch AIMS-HFF score [SMD -0.83, 95% CI: -1.54 to -0.12, p=0.02, I2=48]. This review confirms that corticosteroid injection results in a statistically significant increase in resolution of symptoms, pain relief and increased function in the treatment of DQST.
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Affiliation(s)
- Patrick Rowland
- Department of Trauma and Orthopaedic Surgery, Royal College of Surgeons in Ireland, 123 St. Stephens Green, Dublin 2, Ireland
| | - Nigel Phelan
- Department of Trauma and Orthopaedic Surgery, Royal College of Surgeons in Ireland, 123 St. Stephens Green, Dublin 2, Ireland
| | - Sean Gardiner
- Department of Trauma and Orthopaedic Surgery, Royal College of Surgeons in Ireland, 123 St. Stephens Green, Dublin 2, Ireland
| | - Kenneth N Linton
- Department of Trauma and Orthopaedic Surgery, Royal College of Surgeons in Ireland, 123 St. Stephens Green, Dublin 2, Ireland; Department of Trauma and Orthopaedic Surgery, Our Lady of Lourdes Hospital, Drogheda, Co. Louth, Ireland
| | - Rose Galvin
- HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, 123 St. Stephen’s Green, Dublin 2, Ireland
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Li J, Cheng L, Jing J. The Asia proximal femoral nail antirotation versus the standard proximal femoral antirotation nail for unstable intertrochanteric fractures in elderly Chinese patients. Orthop Traumatol Surg Res 2015; 101:143-6. [PMID: 25701162 DOI: 10.1016/j.otsr.2014.12.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 12/16/2014] [Accepted: 12/17/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND The best options of internal fixation for unstable intertrochanteric fractures in elderly Chinese patients remain controversial. The Asia proximal femoral nail antirotation (PFNA-II) was specifically designed for Asian patients, which could be more effective than the regular proximal femoral nail antirotation (PFNA). Compared to PFNA, whether PFNA-II is associated with shorter operative time and lower rates of complications is unknown. HYPOTHESIS The rate of complications using PFNA-II is lower than PFNA for the treatment of unstable intertrochanteric fractures in elderly Chinese patients, and the operation using PFNA-II is quicker. MATERIALS AND METHODS Between June 2008 and December 2011, 188 patients with unstable intertrochanteric fractures treated with the PFNA-II (n=118) or PFNA (n=70) were retrospectively evaluated. Follow-up evaluations were performed at 1, 3, 6, 9 and 12 months, and every year thereafter. According to residual valgus-varus deformation, the quality of the fracture reduction was graded as poor (>10° deformation), acceptable (5° to 10° deformation), or good (<5° deformation). The operative time, intraoperative blood loss, overall time of fluoroscopy, blood transfusion volume, postoperative drainage, length of hospital stay and postoperative complications were recorded. RESULTS The mean operative time in the PFNA-II group was significantly shorter than that in the PFNA group (66.25±13.15 vs 79.50±21.12 minutes; P<0.05), intraoperative blood loss was smaller (131.86±69.16 vs 162.14±66.18 mL; P<0.05), and fewer local complications were observed (25% vs 46%; P<0.05). There was no significant difference in the postoperative blood transfusions, overall time of fluoroscopy, postoperative drainage, length of hospital stay, fracture reduction, the position of the implant and tip apex distance between the two groups. At follow-up, no significant difference was found between the two groups in Harris hip score (HHS) (86.19±6.53 vs 85.27±5.47; P>0.05), visual analogue scale (VAS) (0.87±0.85 vs 0.97±0.87; P>0.05). DISCUSSION Due to its special design for the Asian population, PFNA-II offers a better match with the Chinese people's proximal femur anatomic structure. This study showed that the rate of complications using PFNA-II is lower than PFNA for the treatment of unstable intertrochanteric fractures in elderly Chinese patients, and the operation time is shorter. LEVEL OF EVIDENCE Level III, case control study.
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Affiliation(s)
- J Li
- Department of Orthopaedics, The Second Hospital of Anhui Medical University, 678, Furong Avenue, Hefei, Anhui 230601, PR China
| | - L Cheng
- Department of Orthopaedics, The Second Hospital of Anhui Medical University, 678, Furong Avenue, Hefei, Anhui 230601, PR China
| | - J Jing
- Department of Orthopaedics, The Second Hospital of Anhui Medical University, 678, Furong Avenue, Hefei, Anhui 230601, PR China.
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Shen J, Luo F, Sun D, Huang Q, Xu J, Dong S, Xie Z. Mid-term results after treatment of intertrochanteric femoral fractures with percutaneous compression plate (PCCP). Injury 2015; 46:347-57. [PMID: 24880886 DOI: 10.1016/j.injury.2014.04.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 03/10/2014] [Accepted: 04/20/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND With the ageing of the population, intertrochanteric femoral fracture is associated with increased morbidity. There is continuing controversy over the best treatment for the injury, and the choice of internal fixation method has been a focus of dispute. The purpose of this study was to evaluate the results of these fractures being treated with the percutaneous compression plate (PCCP) technique. METHODS From March 2009 to May 2012, 154 patients with intertrochanteric femoral fractures were treated using the PCCP method. Forty-one patients were excluded from the study. According to the AO classification, the remaining 113 fractures were classified as 35 cases of 31A1 fractures, 59 cases of 31A2 fractures, and 19 cases of 31A3 fractures. The clinical data and imaging results were retrospectively analysed. RESULTS The mean operation time was 42.0 (range, 25-82) min, the mean intraoperative blood loss was 40.5 (range, 10-100) ml, and the mean hospital stay was 8.6 (range, 3-18) days. One patient died of renal failure in the perioperative period. Twelve patients died during the 12 months after surgery. The remaining 100 patients were followed-up for 12-36 months and healed their fractures except one, whose neck screw cut out from the femoral neck after 1 postoperative month and resulting in a revision to a hemiarthroplasty. The mean time to bone healing was 12.6 (range, 6-23) weeks. Sixteen patients had pain. There were 13 major device-related complications, including 5 cases of coxa vara, 4 cases of fracture collapse, 2 cases of head penetration, and 2 cases of fracture collapse combined with head penetration. At the time of the last follow-up, 81 patients had regained a pre-injury level of function. The median Harris hip score was 89 points. The median Parker-Palmer score was 7 points. Patients with poor quality of reduction and bad positioning of neck screw were more likely to suffer complications (p<0.05). CONCLUSION The results suggest that the PCCP is an effective and safe method in the treatment of all types of intertrochanteric femoral fractures, but good fracture reduction and ideal positioning of the neck screw are prerequisites for the success of the device.
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Affiliation(s)
- Jie Shen
- National & Regional United Engineering Laboratory of Tissue Engineering, Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Fei Luo
- National & Regional United Engineering Laboratory of Tissue Engineering, Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Dong Sun
- National & Regional United Engineering Laboratory of Tissue Engineering, Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Qiang Huang
- National & Regional United Engineering Laboratory of Tissue Engineering, Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Jianzhong Xu
- National & Regional United Engineering Laboratory of Tissue Engineering, Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Shiwu Dong
- Department of Biomedical Materials Science, College of Biomedical Engineering, Third Military Medical University, Chongqing 400038, China
| | - Zhao Xie
- National & Regional United Engineering Laboratory of Tissue Engineering, Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing 400038, China.
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Kim JW, Kim TY, Ha YC, Lee YK, Koo KH. Outcome of intertrochanteric fractures treated by intramedullary nail with two integrated lag screws: A study in Asian population. Indian J Orthop 2015; 49:436-41. [PMID: 26229165 PMCID: PMC4510798 DOI: 10.4103/0019-5413.159647] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The incidence of intertrochanteric fracture has increased during recent years as life expectancy has also increased. Currently, orthopedic surgeons use various fixation methods for intertrochanteric fractures like, intramedullary (IM) nailing or dynamic hip screws and plates. The intramedullary (IM) nail with two integrated lag screws has been used recently in intertrochanteric fractures to overcome Z-affect phenomenon. However, no study is available in an Asian population. This prospective study was undertaken to document the clinical and radiologic outcomes of the IM nail with two integrated lag screws and its limitations in Asian patients. MATERIALS AND METHODS Osteosynthesis was performed using InterTAN nail in 100 patients with an intertrochanteric fractures followed up for at least 1 year after surgery. We evaluated the recovery rates to prefracture status, time to bony union and the incidence of complications. RESULTS Seventy four patients were available for at least 1 year followup examinations. Forty-five patients (60.8%) recovered prefracture status. Mean time to bony union was 18.3 ± 8.6 weeks. Intraoperative technical problems related to an unavoidable superior positioning of the lag screw occurred in five cases. Postoperative complications requiring reoperation occurred in three patients; two cases of varus collapse with cut out and one case of periprosthetic fracture. CONCLUSIONS The IM nail with two integrated lag screws showed favorable outcomes in Asian patients with an intertrochanteric fracture even though several complications that were not previously reported with this nail were found. The proper selection of patients and careful insertion of two lag screws should be mandatory in Asian patients.
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Affiliation(s)
- Jong-Won Kim
- Department of Orthopaedic Surgery, Gangnam Himchan Hospital, Seoul, South Korea
| | - Tae-Young Kim
- Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Anyang, South Korea,Address for correspondence: Dr. Tae-Young Kim, 896 Pyeongchon-Dong, Dongan-Gu, Anyang 431-070, South Korea. E-mail:
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Chung-Ang University, Seoul, South Korea
| | - Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Kyung-Hoi Koo
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
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Abstract
PURPOSE The purpose was to study the performance of expandable proximal femoral nails (EPFNs) for the treatment of unstable intertrochanteric fractures in elderly patients. PATIENTS AND METHODS Eighty-four patients were treated with a newly designed EPFN and followed up for one year. RESULTS The mean operating time was 50.1 ± 3.2 min and the mean blood loss was 112.3 ± 5.3 ml. Patients were treated with EPFNs of 220 mm (n = 24), 240 mm (n = 59), and 340 mm (n = 1) length. At six months postoperatively, the Harris Hip Score was 74.5 ± 5.3. At the end of follow up, 75% of patients completely recovered their preoperative function and resumed their normal activities. Seven patients died within one year postoperatively. During the operation, one patient experienced proximal femoral diaphyseal slight crack fracture. This crack fracture was treated by using a long EPFN (340 mm). Two patient developed screw cut-outs, which were solved by reoperation. And one developed deep infection resolved favorably by the appropriate antibiotic treatment. Implant failure, deep venous thrombosis, fat embolism, secondary fracture, and nonunion were not encountered. CONCLUSIONS In conclusion, the results of the EPFNs were satisfactory in most elderly patients with unstable intertrochanteric fracture. However, during the inflation period, the pressure on the nail must be monitored carefully in order to prevent a crack fracture.
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Affiliation(s)
- Feng Gao
- Department of Orthopedic Surgery, Shanghai Jiao Tong University affiliated Sixth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai Jiaotong University , Shanghai , China
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Outcomes of Geriatric Hip Fractures Treated with AFFIXUS Hip Fracture Nail. Adv Orthop 2014; 2014:509592. [PMID: 25580303 PMCID: PMC4281450 DOI: 10.1155/2014/509592] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 12/01/2014] [Indexed: 11/18/2022] Open
Abstract
Geriatric hip fractures are one of the commonest fractures worldwide. The purpose of this study was to report the outcomes of a series of unstable geriatric hip fractures treated with AFFIXUS hip fracture nail. A retrospective study of 100 unstable geriatric hip fractures treated with AFFIXUS hip fracture nail is presented. The mean follow-up duration was 8 months (range 3-32). Of the patients 83% were female. The average age was 85 years. The fracture was treated by closed reduction and intramedullary fixation. The mean acute hospital stay was 17.6 days. Systemic complications occurred in 29 patients (29%) and local complications in 3 patients (3%) including lag screw cutout in one patient (1%), lag screw backout in one patient (1%), and deep infection in one patient (1%). Mechanical failures and periprosthetic fractures were not observed in our series. Fractures united in all patients. Preinjury activity level was recovered in 78% of the patients. The results of AFFIXUS hip fracture nail were satisfactory in most elderly patients. The unique design of the lag screw and its thread spacing had effectively reduced cut-out rate.
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Li M, Wu L, Liu Y, Wang C. Clinical evaluation of the Asian proximal femur intramedullary nail antirotation system (PFNA-II) for treatment of intertrochanteric fractures. J Orthop Surg Res 2014; 9:112. [PMID: 25391985 PMCID: PMC4233078 DOI: 10.1186/s13018-014-0112-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Accepted: 10/30/2014] [Indexed: 12/15/2022] Open
Abstract
Background The preferred treatment of intertrochanteric fractures in aged patients is controversial. The purpose of the present study was to evaluate the outcomes of the Asian proximal femur intramedullary nail antirotation system (PFNA-II) for stabilization of such fractures. Methods The PFNA-II was used to treat intertrochanteric fractures in 163 elderly patients from March 2010 to March 2013. The patients comprised 69 men and 94 women with a mean age of 74.7 ± 13.0 years. All fractures were classified by the Orthopaedic Trauma Association classification system; 53, 83, and 27 fractures were classified as 31A1, 31A2, and 31A3, respectively. We statistically evaluated the intraoperative blood loss, operation time, incision length, X-ray exposure time, and postoperative outcomes. Patients were followed up for a mean of 15.2 months (range, 10–24 months). Functional outcomes were assessed according to the Harris hip scoring system. Results Statistical analysis revealed an average operation time of 45.7 min (range, 35–110 min), average intraoperative blood loss of 115.2 mL (range, 65–430 mL), X-ray exposure time of 2.7 ± 1.4 s (range, 2–6 s), and total incision length of 6.5 ± 2.2 cm (range, 5.5–13.0 cm). Patients were followed up for a mean of 14.5 months (range, 10–24 months). The neck shaft angle was 134° ±15° (range, 115°–150°), and the fracture healing time was 14.0 ± 2.5 weeks (range, 11–19 weeks). The Harris hip score was 85.6 ± 17.5 points (range, 65–100 points) and included 41 excellent cases (25.15%), 92 good cases (56.44%), 26 moderate cases (15.95%), and 4 poor cases (2.45%) for a positive outcome rate of 81.60%. There were no varus hip deformities, screw cutouts, or femoral shaft fractures. Fourteen patients had thigh pain (9.82%), and five had inner thigh pain (3.07%); seven had more severe pain that was improved by physical therapy. Conclusion PFNA-II has the advantages of a simple operation, few complications, and clinical efficacy for the treatment of intertrochanteric fractures. However, evaluation of its long-term efficacy and risk of other complications requires a large-sample, multicenter observational study.
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Affiliation(s)
- MingHui Li
- Department of Orthopaedics, Fifth Hospital of Wuhan City (Second Affiliated Hospital of Jianghan University), Wuhan, 430050, Hubei Province, China.
| | - Lei Wu
- Department of Orthopaedics, Fifth Hospital of Wuhan City (Second Affiliated Hospital of Jianghan University), Wuhan, 430050, Hubei Province, China.
| | - Yang Liu
- Department of Orthopaedics, Fifth Hospital of Wuhan City (Second Affiliated Hospital of Jianghan University), Wuhan, 430050, Hubei Province, China.
| | - CaiMing Wang
- Department of Orthopaedics, Fifth Hospital of Wuhan City (Second Affiliated Hospital of Jianghan University), Wuhan, 430050, Hubei Province, China.
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Sawaguchi T, Sakagoshi D, Shima Y, Ito T, Goldhahn S. Do design adaptations of a trochanteric nail make sense for Asian patients? Results of a multicenter study of the PFNA-II in Japan. Injury 2014; 45:1624-31. [PMID: 24985469 DOI: 10.1016/j.injury.2014.06.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 06/02/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE Asian patients with osteoporosis suffer from an increased incidence of hip fracture and a potentially increased risk of fixation failure due to anatomical differences compared to Caucasians. To cope with these differences, an Asian size- and geometry-adapted Proximal Femoral Nail Antirotation (PFNA-II) was developed. The objective of this prospective multicenter study was to assess the risk of fracture fixation complications (FFCs), the occurrence of mismatch and the quality of life status of patients treated with the PFNA-II. PATIENTS AND METHODS 176 Japanese patients with an isolated, unstable, closed trochanteric fracture were treated with the PFNA-II. Patients were prospectively screened for anticipated complications and classified accordingly; complications were centrally reviewed by a complication review board to avoid bias by the treating surgeon, and categorized using a standardized reporting system. Outcome measurements included the occurrence and evaluation of FFCs, the radiological assessment of mismatch and quality of life measured with the EQ-5D score. RESULTS 3 Intraoperative and 15 postoperative complications were found in 16/176 patients. The risk of sustaining any intraoperative or postoperative FFC was 1.7% (3/176; 95% CI: 0.35-4.9) and 8% (14/176; 95% CI: 4.4-13), respectively. The most likely cause for FFCs was the "bone/fracture" factor (9/14 patients). Radiologically detectable contact of the implant with the inner cortex ("mismatch") was reported for 17/173 patients (10%). CONCLUSIONS The reported complication risks and mismatches are reasonable for this patient cohort. The geometry- and size-adapted PFNA-II is relatively safe but requires standardized assessment in a larger target cohort.
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Affiliation(s)
- Takeshi Sawaguchi
- Department of Orthopaedic Surgery & Joint Reconstructive Surgery at Toyama Municipal Hospital, 2-1, Imaizumi-hokubu, Toyama City 939-8511, Japan.
| | - Daigo Sakagoshi
- Department of Orthopaedic Surgery & Joint Reconstructive Surgery at Toyama Municipal Hospital, 2-1, Imaizumi-hokubu, Toyama City 939-8511, Japan.
| | - Yosuke Shima
- Department of Orthopaedic Surgery at Hokuriku Hospital, 2-13-43, Izumigaoka, Kanazawa City 921-8035, Japan.
| | - Takaaki Ito
- Orthopaedic Department at Saiseikai Toyama Hospital, 33-1 Kusunoki, Toyama City 931-8533, Japan.
| | - Sabine Goldhahn
- AO Foundation, AO Clinical Investigation and Documentation, Stettbachstrasse 6, 8600 Duebendorf, Switzerland.
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Treatment of unstable intertrochanteric fractures with percutaneous non-contact bridging plates. Int J Surg 2014; 12:538-43. [DOI: 10.1016/j.ijsu.2014.02.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 02/24/2014] [Accepted: 02/27/2014] [Indexed: 11/23/2022]
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50
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Huang X, Leung F, Liu M, Chen L, Xu Z, Xiang Z. Is helical blade superior to screw design in terms of cut-out rate for elderly trochanteric fractures? A meta-analysis of randomized controlled trials. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2014; 24:1461-8. [PMID: 24557412 DOI: 10.1007/s00590-014-1429-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 02/08/2014] [Indexed: 02/05/2023]
Abstract
PURPOSE This meta-analysis was conducted to investigate whether helical blade implant system had advantages in terms of cut-out rate when compared to screw implant system for trochanteric fractures of elderly population. METHODS The databases of MEDLINE, Cochrane Library and OVID were searched from inception to September 2013, and all randomized controlled trials comparing outcomes between helical blade system and screw system in treating trochanteric fractures were selected. Three researchers assessed the methodological quality and extracted data of the enrolled studies independently. Data were analysed using Review Manager 5.1 version. RESULTS Six studies including 759 patients were involved. Results revealed that compared with screw group, blade group had similar outcomes of "centre-centre" position (95% CI 0.89-1.06, P = 0.48) and tip-apex distance (95% CI-0.08 to 1.31, P = 0.08). Cut-out and other complications were also comparable between the two groups (95% CI 0.34-1.54, P = 0.41; 95% CI 0.73-1.32, P = 0.90). Operation time and fluoroscopy time of blade group were significantly less than that of screw group (95% CI -5.13 to -3.70, P < 0.00001; 95% CI -32.50 to -27.07, P < 0.00001). Outcome of post-operative function was similar between two groups (95% CI 0.94-1.15, P = 0.45). CONCLUSIONS Blade group required less operation time and fluoroscopy time than that of screw group treating trochanteric fractures in the elderly, but the differences observed could be biased due to grouping and other limitations. Outcomes of cut-out complication, other complications, position of implant and post-operative function were similar between two groups.
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Affiliation(s)
- Xiao Huang
- Department of Orthopaedics, West China Hospital, Sichuan University, 37# Guoxue Rd, Chengdu, 610041, Sichuan, China
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