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Domenech P, Mariscal G, Marquina V, Baixauli F. Short versus long intramedullary nails for intertrochanteric hip fracture: Meta-analysis. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:T373-T382. [PMID: 38325571 DOI: 10.1016/j.recot.2024.01.023] [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: 02/14/2023] [Accepted: 03/26/2023] [Indexed: 02/09/2024] Open
Abstract
OBJECTIVE To compare short versus long intramedullary nails for intertrochanteric hip fractures in terms of efficacy and safety. METHODS We included cohort studies and randomized clinical trials. The methodological quality of the studies was assessed by the Newcastle-Ottawa Scale. The meta-analysis was performed using the Review Manager 5.4. Heterogeneity was checked with the I2 test. A fixed effects model was adopted if there was no heterogeneity. RESULTS Twelve studies were included. The reoperations rate was lower in the short nail group (OR: 0.58, 95%CI: 0.38-0.88) and there were no differences regarding the peri-implant fracture rate (OR: 1.77, 95%CI: 0.68-4.60). Surgery time and blood loss was significantly higher in the long nail group (MD: -12.44, 95%CI: -14.60 -10.28) (MD: -19.36, 95%CI: -27.24 -11.48). There were no differences in functional outcomes. CONCLUSIONS The long nail showed a higher reoperation rate, blood loss and surgery time compared to the short nail. LEVEL OF EVIDENCE III.
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Affiliation(s)
- P Domenech
- Department of Orthopedic Surgery and Traumatology, La Fe University and Polytechnic Hospital, Valencia, España; Department of Orthopedic Surgery and Traumatology, Valencia General University Hospital, Valencia, España
| | - G Mariscal
- Department of Orthopedic Surgery and Traumatology, La Fe University and Polytechnic Hospital, Valencia, España; Department of Orthopedic Surgery and Traumatology, Valencia General University Hospital, Valencia, España.
| | - V Marquina
- Department of Orthopedic Surgery and Traumatology, La Fe University and Polytechnic Hospital, Valencia, España; Department of Orthopedic Surgery and Traumatology, Valencia General University Hospital, Valencia, España
| | - F Baixauli
- Department of Orthopedic Surgery and Traumatology, La Fe University and Polytechnic Hospital, Valencia, España; Department of Orthopedic Surgery and Traumatology, Valencia General University Hospital, Valencia, España
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Domenech P, Mariscal G, Marquina V, Baixauli F. Short versus long intramedullary nails for intertrochanteric hip fracture: Meta-analysis. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:373-382. [PMID: 37488021 DOI: 10.1016/j.recot.2023.03.016] [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: 02/14/2023] [Accepted: 03/26/2023] [Indexed: 07/26/2023] Open
Abstract
OBJECTIVE To compare short versus long intramedullary nails for intertrochanteric hip fractures in terms of efficacy and safety. METHODS We included cohort studies and randomized clinical trials. The methodological quality of the studies was assessed by the Newcastle-Ottawa Scale. The meta-analysis was performed using the Review Manager 5.4. Heterogeneity was checked with the I2 test. A fixed effects model was adopted if there was no heterogeneity. RESULTS Twelve studies were included. The reoperations rate was lower in the short nail group (OR 0.58, 95% CI 0.38-0.88) and there were no differences regarding the peri-implant fracture rate (OR 1.77, 95% CI 0.68-4.60). Surgery time and blood loss was significantly higher in the long nail group (MD -12.44, 95% CI -14.60 to (-10.28)) (MD -19.36, 95% CI -27.24 to (-11.48)). There were no differences in functional outcomes. CONCLUSIONS The long nail showed a higher reoperation rate, blood loss and surgery time compared to the short nail.
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Affiliation(s)
- P Domenech
- Department of Orthopedic Surgery and Traumatology, La Fe University and Polytechnic Hospital, Valencia, Spain; Department of Orthopedic Surgery and Traumatology, Valencia General University Hospital, Valencia, Spain
| | - G Mariscal
- Department of Orthopedic Surgery and Traumatology, La Fe University and Polytechnic Hospital, Valencia, Spain; Department of Orthopedic Surgery and Traumatology, Valencia General University Hospital, Valencia, Spain.
| | - V Marquina
- Department of Orthopedic Surgery and Traumatology, La Fe University and Polytechnic Hospital, Valencia, Spain; Department of Orthopedic Surgery and Traumatology, Valencia General University Hospital, Valencia, Spain
| | - F Baixauli
- Department of Orthopedic Surgery and Traumatology, La Fe University and Polytechnic Hospital, Valencia, Spain; Department of Orthopedic Surgery and Traumatology, Valencia General University Hospital, Valencia, Spain
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Choi SH, Lee CJ, Cho YJ, Chun YS, Rhyu KH. Should the diameter of the proximal femoral nail be large enough to fill the canal in the treatment of intertrochanteric femoral fracture in patients over fifty? INTERNATIONAL ORTHOPAEDICS 2024; 48:857-864. [PMID: 38150006 DOI: 10.1007/s00264-023-06061-9] [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: 09/11/2023] [Accepted: 12/07/2023] [Indexed: 12/28/2023]
Abstract
PURPOSE Many studies have been conducted to evaluate the effects of nail shape, design, or length on the treatment of intertrochanteric fractures. However, the clinical implications of the nail diameter remain unclear. METHODS This study was conducted with 191 patients aged ≥ 50 years with unilateral intertrochanteric fractures treated with the same type of short cephalomedullary nail and followed for at least one year. We recorded the reduction type, tip-apex distance, cortical contact of the nail, and nail/canal diameter ratio (NCR) just distal to the locking screw. The effects of nail diameter on the clinical results were evaluated. RESULTS The average NCR was 68.7. The average union time was 4.78 months. Delayed union or nonunion was seen in 17 patients. Eight patients underwent additional surgery. The mean change in the modified Koval activity score was -0.84. The NCR did not significantly affect the clinical results. Comparisons of cases with NCRs above and below the average and the average - 1 standard deviation revealed no significant difference. The clinical outcome was not related to any variable associated with the nail diameter. CONCLUSION With this specific proximal femoral nail, a small diameter relative to that of the femoral canal had no adverse effect on the union of osteoporotic intertrochanteric fractures, even in patients with unstable fractures and those who had unsatisfactory reductions.
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Affiliation(s)
- Sun Hwan Choi
- Department of Orthopaedic Surgery, Kyung Hee University Hospital, Seoul, South Korea
| | - Chang Ju Lee
- Department of Orthopaedic Surgery, Kyung Hee University Hospital, Seoul, South Korea
| | - Yoon Je Cho
- Department of Orthopaedic Surgery, Kyung Hee University Hospital, Seoul, South Korea
| | - Young-Soo Chun
- Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
| | - Kee Hyung Rhyu
- Department of Orthopaedic Surgery, Kyung Hee University Hospital, Seoul, South Korea.
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Wu W, Zhao Z, Wang Y, Yao B, Shi P, Liu M, Peng B. Clinical observation and finite element analysis of femoral stable interlocking intramedullary nail in intertrochanteric fractures. INTERNATIONAL ORTHOPAEDICS 2023; 47:2319-2326. [PMID: 37358574 DOI: 10.1007/s00264-023-05865-z] [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: 01/22/2023] [Accepted: 05/07/2023] [Indexed: 06/27/2023]
Abstract
PURPOSE This study was designed to compare clinical outcomes of the femoral stable interlocking intramedullary nail (FSIIN) with proximal femoral nail anti-rotation (PFNA) for the treatment of intertrochanteric fractures (OTA 31A1 + A2). METHODS This study retrospectively analyzed a registered sample of 74 intertrochanteric fractures (OTA 31A1 + A2) surgically treated using FSIIN (n = 36) or PFNA (n = 38) from January 2015 to December 2021. The intra-operative variables (operation time, fluoroscopy time, intra-operative blood loss, length of incision) and fracture healing time were compared between the two groups in this study. Harris hip score (HHS) and visual analog scale (VAS) were used to evaluate the functional states. At the last follow-up, the incidence of related complications in patients was calculated. Eventually, the 3D finite element model was established to analyze the stress of FSIIN and PFNA. RESULTS The distribution of all basic characteristics was similar between the two groups (p > 0.05). The operation time, fluoroscopy time, intra-operative blood loss, and length of incision were significantly decreased in the FSIIN group (p < 0.001). The FSIIN group had a shorter fracture healing time than the PFNA group (p < 0.001). There is no significant difference between the two groups in the Harris and VAS (p > 0.05). The incidences of post-operative anaemia, electrolyte imbalance, varus malalignment, and thigh pain were significantly lower in FSIIN than in PFNA groups (all p < 0.05). The finite element results show that the stress shielding effect of FSIIN is smaller. CONCLUSIONS Our study revealed that FSIIN seemed to be superior to PFNA in the treatment of intertrochanteric fractures (OTA 31A1 + A2) due to less surgical damage and shorter fracture healing time.
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Affiliation(s)
- Weiyong Wu
- Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China
- Orthopedic Department, Tianjin Fourth Central Hospital, Tianjin, 300140, China
| | - Zhihui Zhao
- Orthopedic Department, Tianjin Fourth Central Hospital, Tianjin, 300140, China
| | - Yongqing Wang
- Orthopedic Department, Tianjin Fourth Central Hospital, Tianjin, 300140, China.
| | - Bin Yao
- Institute of Robotics and Automatic Information System Tianjin Key Laboratory of Intelligent Robotics, College Of Artificial Intelligence, Nankai University, Tianjin, 300350, China
| | - Pishun Shi
- Norinco Group Test and Measuring Academy, Huayin, 714200, Shanxi, China
| | - Meiyue Liu
- Orthopedic Department, Tianjin Fourth Central Hospital, Tianjin, 300140, China
| | - Bing Peng
- Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China
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S SM, Gupta NR, Soraganvi P. Long Versus Short Twin-Screw Integrated Cephalomedullary Nail (InterTAN) for the Surgical Management of Intertrochanteric Fractures of the Hip in Indians. Cureus 2023; 15:e45942. [PMID: 37885513 PMCID: PMC10599599 DOI: 10.7759/cureus.45942] [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: 09/25/2023] [Indexed: 10/28/2023] Open
Abstract
INTRODUCTION With an increasing life expectancy, there has been an increase in the incidence of intertrochanteric fractures. These fractures in the elderly are disabling and have a tremendous impact on the healthcare system. Despite substantial improvements in implant design and surgical techniques, high failure rates have been observed, varying with the severity of the fracture and the type of fixation. Intramedullary nails have become popular in recent times, especially in unstable fractures. The purpose of the present study is to compare the functional outcomes and complications of long versus short InterTAN cephalomedullary nails (Smith & Nephew, Memphis, Tennessee) used for intertrochanteric fracture fixation. MATERIALS AND METHODS All patients who had intertrochanteric fractures classifiable as AO OTA (Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association) 31-A and were treated with either a short InterTAN nail (SIN) or long InterTAN nail (LIN) between March 2017 and March 2020 were retrospectively assessed. AO subtype A1 fractures are considered to be stable whereas subtype A3 fractures are considered unstable. The stability of subtype A2 fractures is variable depending on the amount of posteromedial comminution. Both stable and unstable fractures were included. Patients aged above 18 years, who had a normal pre-injury gait and were operated on within seven days of trauma as per the records were included in the study. Postoperatively, functional outcome recorded using the modified Harris hip score (mHHS) was compared. The minimum follow-up period was 24 months. RESULTS A total of 89 patients fulfilling the inclusion criteria were included. The mean age was 67.5 ± 8.92 years. Of the patients, 72% were above 60 years of age and 68% of those were females. The mean follow-up period was 31 months (range: 24-54 months). Of the patients, 84.27% sustained fractures after a trivial trauma due to slip and fall at home. All fractures had united at nine to 12 months, except one had a screw cut-out, which required revision surgery. The mean mHHS at three months and nine to 12 months postoperatively was 42.46 ± 3.62 and 87.24 ± 6.44, respectively. The patients who were treated with LIN had a significantly better functional outcome at three-month follow-up (p-value < 0.05); however, post one year, this effect plateaued and no significant difference was seen when comparing SIN with LIN. The results also showed that there was no significant difference in complications among SIN and LIN. CONCLUSION Both LIN and SIN are equally effective for the surgical management of intertrochanteric fractures, and have similar functional outcomes. SIN, however, has shorter surgical procedure time and lesser estimated blood loss. LIN allowed in early recovery evidenced by better Harris hip scores at three months duration, thus improving the quality of life in the initial months post surgery. The choice of implant should be individualized according to fracture anatomy, patients' needs and expectations, and surgeons' expertise.
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Affiliation(s)
- Siva Mahesh S
- Department of Orthopaedics, St. Peter's Medical College, Hospital and Research Institute, Hosur, IND
| | - Nirav R Gupta
- Department of Orthopaedics, St. Peter's Medical College, Hospital and Research Institute, Hosur, IND
| | - Prasad Soraganvi
- Department of Orthopaedics, St. Peter's Medical College, Hospital and Research Institute, Hosur, IND
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Rajnish RK, Srivastava A, Kumar P, Yadav SK, Sharma S, Haq RU, Aggarwal AN. Comparison of Outcomes of Long Versus Short Cephalomedullary Nails for the Fixation of Intertrochanteric Femur Fractures: A Systematic Review and Meta-analysis of 14,547 Patients. Indian J Orthop 2023; 57:1165-1187. [PMID: 37525736 PMCID: PMC10386979 DOI: 10.1007/s43465-023-00915-5] [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: 05/25/2023] [Indexed: 08/02/2023]
Abstract
Purpose Intertrochanteric Femur Fractures (IFF) fixation could be done with short or long Cephalomedullary Nails (CMNs). Nevertheless, despite several studies in the literature, there has been a continued lack of consensus on which design of CMN is better than the other. Hence, the current review aimed to evaluate the evidence about short versus long CMNs for the fixation of IFF. Methodology PRISMA guidelines were followed, and the protocol for the study was registered to PROSPERO. Four databases, Medline/PubMed, Embase, Scopus, and Cochrane Library, were searched. A total of 31 studies with 6 randomized trials (RCTs) and 25 non-randomized studies were included. Demographic data, follow-up period, and primary and secondary outcomes were extracted and evaluated from each of the included studies; statistical analysis was done by Review Manager Software version 5.4.1. Results Fourteen thousand five hundred forty-seven patients were included in this review. Primary Outcomes Long CMNs showed statistically significant lower rates of ipsilateral shaft femur refracture (OR 1.60, 95% CI 1.14, 2.24, p = 0.007); however, the difference was not statistically significant between the two groups for mortality at 30 days and within 1 year. Secondary Outcomes Statistically significant shorter duration of surgery (MD-17.83 (95% CI - 22.03, - 13.63, p < 0.05), less intra-operative blood loss (MD - 62.65, 95% CI - 97.13 to - 28.17, p = < 0.05), and lower blood transfusion rates (OR 0.71, 95% CI 0.62, 0.83, p < 0.05) for short CMNs; no statistically significant difference for the length of hospital stay, implant-related complications, overall complications, re-operation rates, fluoroscopy time, and functional outcome between two groups of CMNs was seen. Conclusion With shorter operative time, lesser intra-operative blood loss, and lower postoperative transfusion rates for short CMNs, they have certain benefits over longer CMNs. However, more distal shaft femur fractures were seen in the shorter version of nail, which should be considered before offering these nails to a patient; careful and individualized postoperative weight-bearing protocol could minimize the same. Supplementary Information The online version contains supplementary material available at 10.1007/s43465-023-00915-5.
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Affiliation(s)
- Rajesh Kumar Rajnish
- Department of Orthopaedics, All India Institute of Medical Sciences, Jodhpur, India
| | - Amit Srivastava
- Department of Orthopaedics, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Prasoon Kumar
- Department of Orthopaedics, PGIMER, Chandigarh, India
| | - Sandeep Kumar Yadav
- Department of Orthopaedics, All India Institute of Medical Sciences, Jodhpur, India
| | | | - Rehan Ul Haq
- All India Institute of Medical Sciences, Bhopal, India
| | - Aditya Nath Aggarwal
- Department of Orthopaedics, University College of Medical Sciences and GTB Hospital, Delhi, India
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Biomechanical stability of short versus long proximal femoral nails in osteoporotic subtrochanteric A3 reverse-oblique femoral fractures: a cadaveric study. Arch Orthop Trauma Surg 2023; 143:389-397. [PMID: 35061084 PMCID: PMC9886623 DOI: 10.1007/s00402-022-04345-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/04/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE Due to the demographic change towards an older society, osteoporosis-related proximal femur fractures are steadily increasing. Intramedullary nail osteosyntheses are available in different lengths, where the field of application overlaps. The aim of this study was to investigate whether subtrochanteric fractures can also be treated stably using a short femoral intramedullary nail in cadaveric bones. METHODS A short PFNA and a long PFNA were implanted in both seven artificial bones and osteoporotic human specimens. A standardized AO 31-A3 (reverse-oblique) fracture was placed in the specimens with a lateral fracture spur 2 cm proximal to the distal locking screw (short PFNA) and embedded. The simulated iliotibial tract was preloaded to 50 N. The force was applied at 10 mm/min up to a force of 200-800 N (artificial bones) and 200-400 N (human specimens). The dislocation of the fracture gap, the axial bone stiffness of bone construct and the force curve of the tractus iliotibialis were measured. RESULTS There is no difference in the use of a short versus long PFNA in terms of stiffness of the overall construct and only a slight increase in dislocation in the fracture gap results with short PFNA compared to a long intramedullary nail. CONCLUSION In summary of the available literature, the present study supports the thesis that there is no clinical difference between long versus short nails in A3 femur fractures. Furthermore, the present study defines a safe biomechanical range of fracture extension above the locking screw of the short intramedullary nail. LEVEL OF EVIDENCE III.
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Vilar-Sastre I, Corró S, Tomàs-Hernández J, Teixidor-Serra J, Selga-Marsà J, Piedra-Calle CA, Molero-García V, García-Sánchez Y, Andrés-Peiró JV. Fractures after cephalomedullary nailing of the femur : Systematization of surgical fixation based on the analysis of a single-center retrospective cohort. INTERNATIONAL ORTHOPAEDICS 2022; 46:2357-2364. [PMID: 35779111 DOI: 10.1007/s00264-022-05490-2] [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: 04/05/2022] [Accepted: 06/16/2022] [Indexed: 11/29/2022]
Abstract
PURPOSES Femoral implant related fractures (IRF) are a growing pathology in an increasingly elderly and frail population. A series of IRF after cephalomedullary nail (CMN) fixation of a femoral fracture is analyzed and an algorithm described to guide the management of such fractures. METHODS All eligible patients operated on for IRF fixation after CMN were reviewed regarding their demographics, comorbidities, injury pattern, and treatment. Primary outcomes were mortality and local complications. Secondary outcomes were time to consolidation, time to weight-bearing initiation, length of hospitalization, and discharge destination. RESULTS The incidence of IRF requiring fixation was 1.3% after 3401 CMN implantation procedures. Elderly women with comorbidities and plate fixation predominated. One-year mortality was 18.6%, being higher for patients presenting with infection and those unable to walk at the end of follow-up. Local complications occurred in 25.6%. Median time to weight-bearing was 9.1 weeks, but longer for patients with plate fixation or complications. Patients presenting with an infection and those discharged to nursing facilities had more comorbidity. CONCLUSIONS Following an algorithm presented here, patients were treated either with nail exchange or lateral locking plate fixation, permitting straightforward evaluations and acceptable results in a very high-risk population.
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Affiliation(s)
- Inca Vilar-Sastre
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Sebastián Corró
- Department of Orthopaedic Surgery and Traumatology, Hospital de Manacor, Manacor, Spain
| | - Jordi Tomàs-Hernández
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department of Orthopaedic Surgery and Traumatology, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Jordi Teixidor-Serra
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department of Orthopaedic Surgery and Traumatology, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Jordi Selga-Marsà
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department of Orthopaedic Surgery and Traumatology, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Carlos-Alberto Piedra-Calle
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department of Orthopaedic Surgery and Traumatology, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Vicente Molero-García
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department of Orthopaedic Surgery and Traumatology, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Yaiza García-Sánchez
- Department of Orthopaedic Surgery and Traumatology, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - José-Vicente Andrés-Peiró
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
- Department of Orthopaedic Surgery and Traumatology, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.
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Therapeutic Effects of the Proximal Femoral Nail for the Treatment of Unstable Intertrochanteric Fractures. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:1001354. [PMID: 36091601 PMCID: PMC9463022 DOI: 10.1155/2022/1001354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 08/05/2022] [Indexed: 11/21/2022]
Abstract
Objective The aim of this study was to analyze the clinical effect of the proximal femoral nail on elderly patients with unstable intertrochanteric fracture and the effect of the proximal femoral nail on serum levels of matrix metalloproteinases (MMPs) and osteoprotegerin (OPG). Methods The elderly patients with unstable intertrochanteric fracture of the femur admitted to our hospital from January 2017 to January 2021 were studied. 100 patients were randomly divided into two groups: the control group (n = 50) and the observation group (n = 50). The patients in the control group were treated with a proximal femoral locking compression plate. The patients in the observation group were treated with the proximal femoral antirotation intramedullary nail. The clinical therapeutic effects of the two groups and the changes in serum MMPs and OPG levels before and after treatment were analyzed. Results Compared with the control group, the operation time, postoperative landing time, and fracture healing time of the observation group were significantly shortened, and intraoperative blood loss was significantly reduced (P < 0.05). Compared with the control group, the total effective rate of patients in the observation group was significantly higher (P < 0.05). After treatment, the levels of CRP, IL1β, IL2, MMP-2, MMP-6, TIMP-1, and RANKL decreased significantly in both groups (P < 0.05), while the levels of OPG increased significantly (P < 0.05). Compared with the control group, the changes in the above indexes were more obvious in the observation group (P < 0.05). Conclusion The proximal femoral antirotation intramedullary nail has a better therapeutic effect on elderly patients with unstable intertrochanteric fracture, and the level of MMPs and OPG may be related to the treatment process.
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Cinque ME, Goodnough LH, Md BJS, Fithian AT, DeBaun M, Lucas JF, Md MJG, Bishop JA. Short versus long cephalomedullary nailing of intertrochanteric fractures: a meta-analysis of 3208 patients. Arch Orthop Trauma Surg 2022; 142:1367-1374. [PMID: 33484311 DOI: 10.1007/s00402-021-03752-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 01/01/2021] [Indexed: 02/09/2023]
Abstract
OBJECTIVES The purpose of the study was to compare treatment outcomes after short or long cephalomedullary nailing for intertrochanteric femur fractures. DATA SOURCES A systematic review of perioperative outcomes after short or long cephalomedullary nailing for intertrochanteric femur fractures was performed. The following databases were used: using the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed (1980-2019), and MEDLINE (1980-2019). The queries were performed in June 2019. STUDY SELECTION The following search term query was used: "Intramedullary Nail AND Intertrochanteric Fracture OR "Long OR Short Nail AND intertrochanteric Fracture." Studies were excluded if they were "single-arm" studies (i.e., reporting on either long or short CMN but not both), or did not report at least one of the outcomes being meta-analyzed. Furthermore, cadaveric studies, animal studies, basic science articles, editorial articles, surveys and studies were excluded. DATA EXTRACTION Two investigators independently reviewed abstracts from all identified articles. Full-text articles were obtained for review if necessary, to allow further assessment of inclusion and exclusion criteria. Additionally, all references from the included studies were reviewed and reconciled to verify that no relevant articles were missing from the systematic review. DATA SYNTHESIS Short nails were associated with statistically significantly less estimated blood loss and operative time compared to long nails. There were no significant differences in transfusion rates, implant failures or overall re-operation rates between implant lengths. Similarly, there was no significant difference in peri-implant fracture between implant lengths. CONCLUSIONS Overall, the available clinical evidence supports the use of short cephalomedullary nails for the majority of intertrochanteric femur fractures. STUDY DESIGN/LEVEL OF EVIDENCE Meta-analysis; Level III, therapeutic.
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Affiliation(s)
- Mark E Cinque
- Department of Orthopaedic Surgery, Stanford University Hospital, 300 Pasteur Drive, Palo Alto, CA, USA.
| | - L Henry Goodnough
- Department of Orthopaedic Surgery, Stanford University Hospital, 300 Pasteur Drive, Palo Alto, CA, USA
| | - Blake J Schultz Md
- Department of Orthopaedic Surgery, Stanford University Hospital, 300 Pasteur Drive, Palo Alto, CA, USA
| | - Andrew T Fithian
- Department of Orthopaedic Surgery, Stanford University Hospital, 300 Pasteur Drive, Palo Alto, CA, USA
| | - Malcolm DeBaun
- Department of Orthopaedic Surgery, Stanford University Hospital, 300 Pasteur Drive, Palo Alto, CA, USA
| | - Justin F Lucas
- Department of Orthopaedic Surgery, Santa Clara Valley Medical Center, San Jose, CA, USA
| | - Michael J Gardner Md
- Department of Orthopaedic Surgery, Stanford University Hospital, 300 Pasteur Drive, Palo Alto, CA, USA
| | - Julius A Bishop
- Department of Orthopaedic Surgery, Stanford University Hospital, 300 Pasteur Drive, Palo Alto, CA, USA
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Comparison of Short, Intermediate, and Long Cephalomedullary Nail Length Outcomes in Elderly Intertrochanteric Femur Fractures. J Am Acad Orthop Surg Glob Res Rev 2022; 6:01979360-202203000-00001. [PMID: 35245250 PMCID: PMC8893295 DOI: 10.5435/jaaosglobal-d-21-00322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 12/21/2021] [Indexed: 11/30/2022]
Abstract
Cephalomedullary nail (CMN) length for intertrochanteric femur fractures without subtrochanteric extension has been an ongoing debate. The authors hypothesize that increasing nail length would result in increasing surgical time, greater incidence of acute kidney injury (AKI), postoperative anemia, and blood loss requiring transfusion due to increased intramedullary reaming and pressurization of the canal with nail insertion.
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Viberg B, Eriksen L, Højsager KD, Højsager FD, Lauritsen J, Palm H, Overgaard S. Should Pertrochanteric and Subtrochanteric Fractures Be Treated with a Short or Long Intramedullary Nail?: A Multicenter Cohort Study. J Bone Joint Surg Am 2021; 103:2291-2298. [PMID: 34546997 DOI: 10.2106/jbjs.20.01904] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of the present multicenter cohort study was to compare the rates of reoperation in elderly patients with pertrochanteric and subtrochanteric fractures that had been treated with a short or long intramedullary nail. METHODS Eleven orthopaedic departments across Denmark delivered data that had been obtained from the Danish Multidisciplinary Hip Fracture Registry (DMHFR) and a review of health-care records. With use of surgical procedure codes for pertrochanteric and subtrochanteric fractures that had been treated with an intramedullary nail, the DMRHF was searched to identify patients who had been ≥65 years of age between 2008 and 2013. The health-care records for patients who had had major reoperations, defined as any reoperation with the exclusion of simple hardware removal, were retrieved from the DMHFR, were reviewed for the type of intramedullary nail and missed reoperations, including peri-implant fractures, within 2 years of follow-up. Crude logistic regression analysis with adjustment for age, sex, and comorbidity was performed, yielding odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS Of 2,245 pertrochanteric fractures, 1,867 were treated with a short intramedullary nail and 378 were treated with a long intramedullary nail. The rate of major reoperations was 4.0% in the short intramedullary nail group and 6.3% in the long intramedullary nail group. This yielded a crude OR of 1.61 (1.01 to 2.60) and an adjusted OR of 1.67 (1.04 to 2.70). Of 909 subtrochanteric fractures, 308 were treated with a short intramedullary nail and 601 were treated with a long intramedullary nail. The rate of major reoperations was 8.4% in the short intramedullary nail group and 4.0% in the long intramedullary nail group, yielding a crude OR of 0.45 (0.25 to 0.80) and an adjusted OR of 0.45 (0.25 to 0.81). CONCLUSIONS This is the first study confirming the theory that, for subtrochanteric fractures, a long intramedullary nail has a lower rate of major reoperations compared with a short intramedullary nail. In contrast, a short intramedullary nail has a lower rate of major reoperations compared with a long intramedullary nail for pertrochanteric fractures but with a lower absolute risk reduction compared with the results for subtrochanteric intramedullary nailing. There is a need for validation of these results in other large studies, especially for pertrochanteric fractures. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Bjarke Viberg
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark.,Department of Orthopaedic Surgery and Traumatology, Hospital Lillebaelt, University Hospital of Southern Denmark, Kolding, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Lasse Eriksen
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark.,Department of Orthopaedic Surgery and Traumatology, Hospital Lillebaelt, University Hospital of Southern Denmark, Kolding, Denmark
| | - Katia D Højsager
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
| | - Frederik D Højsager
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark.,Department of Orthopaedic Surgery and Traumatology, Hospital Lillebaelt, University Hospital of Southern Denmark, Kolding, Denmark
| | - Jens Lauritsen
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
| | - Henrik Palm
- Department of Orthopaedic Surgery and Traumatology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark.,Department of Orthopaedic Surgery and Traumatology, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
| | - Søren Overgaard
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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A comparison between Asians and Caucasians in the dimensions of the femoral isthmus based on a 3D-CT analysis of 1189 adult femurs. Eur J Trauma Emerg Surg 2021; 48:2379-2386. [PMID: 34319407 PMCID: PMC9192442 DOI: 10.1007/s00068-021-01740-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 06/19/2021] [Indexed: 10/27/2022]
Abstract
INTRODUCTION For successful intramedullary implant placement at the femur, such as nailing in unstable proximal femur fractures, the use of an implant that at least reaches or exceeds the femoral isthmus and yields sufficient thickness is recommended. A number of complications after intramedullary femoral nailing have been reported, particularly in Asians. To understand the anatomical features of the proximal femur and their ethnic differences, we aimed to accurately calculate the femoral isthmus dimensions and proximal distance of Asians and Caucasians. METHODS In total, 1189 Asian and Caucasian segmented 3D CT data sets of femurs were analyzed. The individual femoral isthmus diameter was precisely computed to investigate whether gender, femur length, age, ethnicity or body mass index have an influence on isthmus diameters. RESULTS The mean isthmus diameter of all femurs was 10.71 ± 2.2 mm. A significantly larger diameter was found in Asians when compared to Caucasians (p < 0.001). Age was a strong predictor of the isthmus diameter variability in females (p < 0.001, adjusted r2 = 0.299). With every year of life, the isthmus showed a widening of 0.08 mm in women. A Matched Pair Analysis of 150 female femurs showed a significant difference between isthmus diameter in Asian and Caucasian femurs (p = 0.05). In 50% of the cases the isthmus was found in a range of 2.4 cm between 16.9 and 19.3 cm distal to the tip of the greater trochanter. The female Asian femur differs from Caucasians as it is wider at the isthmus. CONCLUSIONS In absolute values, the proximal isthmus distance did not show much variation but is more proximal in Asians. The detailed data presented may be helpful in the development of future implant designs. The length and thickness of future standard implants may be considered based on the findings.
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Loh J, Huang D, Lei J, Yeo W, Wong MK. Early Clinical Outcomes of Short versus Long Proximal Femoral Nail Anti-rotation (PFNA) in the Treatment of Intertrochanteric Fractures. Malays Orthop J 2021; 15:115-121. [PMID: 34429831 PMCID: PMC8381670 DOI: 10.5704/moj.2107.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 05/24/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Both short and long PFNA are employed to treat intertrochanteric fractures. Controversy exists in the choice between the two nails as each implant has specific characteristics and theoretical advantages. This retrospective study seeks to examine the operative complication rates and clinical outcomes of short versus long (Proximal Femoral Nail Antirotation) PFNA in the treatment of intertrochanteric fractures. MATERIAL AND METHODS Between July 2011 and February 2015, 155 patients underwent PFNA insertion. The decision on whether to use a short or long PFNA nail, locked or unlocked, was determined by the attending operating surgeon. Visual Analogue Pain Score (VAS) Harris Hip Scores (HHS), Short-form 36 Health Questionnaire (SF-36) and Parker Mobility Scores (PMS) were collected at six weeks, six months and one year post-operatively. RESULTS A total of 137 (88.4%) patients were successfully followed-up. Forty-two (30.7%) patients received a short PFNA. The patients were similar in baseline characteristics of age, gender, and comorbidities. Operative time was significantly longer in the short PFNA group (62 ±17 mins) versus the long PFNA group (56±17). While the patients in both groups achieved improvement in all outcome measures, there was no significant difference between the groups in terms of HHS (61.0 ±16.0 vs 63.0 ±16.8, p=0.443), PMS (2.3±1.5 vs 2.7±2.1, p=0.545) and VAS (1.7±2.9 vs 1.8 ±2.2 p=0.454). There were 3 (7.1%) and 7 (7.4%) complications in the short versus long PFNA group, respectively. CONCLUSION Both short and long PFNA had similar clinical outcomes and complication rates in the treatment of intertrochanteric fractures in an Asian population.
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Affiliation(s)
- Jlm Loh
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Dme Huang
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - J Lei
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - W Yeo
- Orthopaedic Diagnostic Centre, Singapore General Hospital, Singapore
| | - M K Wong
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
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Sadeghi C, Prentice HA, Okike KM, Paxton EW. Treatment of Intertrochanteric Femur Fractures with Long versus Short Cephalomedullary Nails. Perm J 2021; 24:19.229. [PMID: 32663128 DOI: 10.7812/tpp/19.229] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
CONTEXT Prior studies regarding indications for long vs short cephalomedullary nails in the treatment of intertrochanteric fractures had limited sample sizes and follow-up, suggesting a need for further investigation. OBJECTIVE To evaluate the association between cephalomedullary nail length and outcomes for the treatment of intertrochanteric femur fractures. DESIGN Cohort study using Kaiser Permanente's Hip Fracture Registry. A total of 5526 patients who underwent surgical treatment with cephalomedullary nails for an intertrochanteric femur fracture (2009-2014) were identified: 3108 (56.2%) with long nails and 2418 (43.8%) with short nails. Cox proportional hazards model regression was used to evaluate risks of all-cause revision and revision for periprosthetic fracture. Linear regression was used to evaluate operative time, estimated blood loss, and length of stay. Propensity score weights were used in all models to balance nail groups on patient and device characteristics. MAIN OUTCOME MEASURES All-cause revision surgery. RESULTS No association was found in risk of all-cause revision (hazard ratio = 0.75, 95% confidence interval [CI] = 0.48-1.15) or revision for periprosthetic fracture (hazard ratio = 0.59, 95% CI = 0.23-1.48) for long nails compared with short nails. Use of longer nails resulted in 18.80 more minutes of operative time (95% CI = 17.33-20.27 minutes), 41.10 mL more of estimated blood loss (95% CI = 31.71-50.48 mL), and a longer hospitalization (8.4 hours; β = 0.35, 95% CI = 0.12-0.58 hours). CONCLUSION These findings suggest that routine use of short cephalomedullary nails is safe and effective in the treatment of intertrochanteric fractures.
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Affiliation(s)
- Cameron Sadeghi
- Department of Orthopaedic Surgery, Southern California Permanente Medical Group, San Diego, CA, USA
| | - Heather A Prentice
- Surgical Outcomes and Analysis, Kaiser Permanente, San Diego, California, USA
| | - Kanu M Okike
- Department of Orthopaedic Surgery, Kaiser Moanalua Medical Center, Honolulu, HI, USA
| | - Elizabeth W Paxton
- Surgical Outcomes and Analysis, Kaiser Permanente, San Diego, California, USA
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Clinical outcomes between long and short proximal femoral nail antirotation (PFNA-II) devices in the management of extracapsular hip fractures: a retrospective cohort study. CURRENT ORTHOPAEDIC PRACTICE 2021. [DOI: 10.1097/bco.0000000000000987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Goodnough LH, Salazar BP, Furness J, Feng JE, DeBaun MR, Campbell ST, Lucas JF, Cross WW, Leucht P, Grant KD, Gardner MJ, Bishop JA. How are peri-implant fractures below short versus long cephalomedullary nails different? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 31:421-427. [PMID: 32909108 DOI: 10.1007/s00590-020-02785-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 09/01/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Cephalomedullary nails are a commonly used implant for the treatment of many pertrochanteric femur fractures and are available in short and long configurations. There is no consensus on ideal nail length. Relative advantages can be ascribed to short and long intramedullary nails, yet both implant styles share the potentially devastating complication of peri-implant fracture. Determining the clinical sequelae after fractures below nails of different lengths would provide valuable information for surgeons choosing between short or long nails. Thus, the purpose of the study was to compare injury patterns and treatment outcomes following peri-implant fractures below short or long cephalomedullary nails. METHODS This was a multicenter retrospective cohort study that identified 33 patients referred for treatment of peri-implant fractures below short and long cephalomedullary nails (n = 19 short, n = 14 long). We compared fracture pattern, treatment strategy, complications, and outcomes between these two groups. RESULTS Short nails were associated with more diaphyseal fractures (odds ratio [OR] 13.75, CI 2.2-57.9, p 0.002), which were treated more commonly with revision intramedullary nailing (OR, infinity; p 0.01), while long nails were associated with distal metaphyseal fractures (OR 13.75, CI 2.2-57.9, p 0.002), which were treated with plate and screw fixation (p 0.002). After peri-implant fracture, there were no differences in blood loss, operative time, weight bearing status, or complication rates based on the length of the initial nail. In patients treated with revision nailing, there was greater estimated blood loss (EBL, median 300 cc, interquartile range [IQR] 250-1200 vs median 200 cc, IQR 100-300, p 0.03), blood product utilization and complication rates (OR 11.1, CI 1.1-135.7, p 0.03), but a trend toward unrestricted post-operative weight-bearing compared to patients treated with plate and screw constructs. CONCLUSION Understanding fracture patterns and patient outcomes after fractures below nails of different lengths will help surgeons make more informed implant choices when treating intertrochanteric hip fractures. Revision to a long nail for the treatment of fractures at the tip of a short nail may be associated with increased patient morbidity.
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Affiliation(s)
- L Henry Goodnough
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 300 Pasteur Drive Room R144, Stanford, CA, 94305, USA.
| | - Brett P Salazar
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 300 Pasteur Drive Room R144, Stanford, CA, 94305, USA
| | - Jamie Furness
- Department of Orthopaedic Surgery, Beaumont Hospital, Royal Oak, MI, USA
| | - James E Feng
- Department of Orthopaedic Surgery, Beaumont Hospital, Royal Oak, MI, USA
| | - Malcolm R DeBaun
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 300 Pasteur Drive Room R144, Stanford, CA, 94305, USA
| | - Sean T Campbell
- Department of Orthopaedic Surgery, Harborview Medical Center, Seattle, WA, USA
| | - Justin F Lucas
- Department of Orthopaedic Surgery, Santa Clara Valley Medical Center, San Jose, CA, USA
| | - William W Cross
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Philipp Leucht
- Department of Orthopaedic Surgery, New York University Langone Health, New York, NY, USA
| | - Kevin D Grant
- Department of Orthopaedic Surgery, Beaumont Hospital, Royal Oak, MI, USA
| | - Michael J Gardner
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 300 Pasteur Drive Room R144, Stanford, CA, 94305, USA
| | - Julius A Bishop
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 300 Pasteur Drive Room R144, Stanford, CA, 94305, USA
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Buruian A, Silva Gomes F, Roseiro T, Vale C, Carvalho A, Seiça E, Mendes A, Pereira C. Distal interlocking for short trochanteric nails: static, dynamic or no locking? Review of the literature and decision algorithm. EFORT Open Rev 2020; 5:421-429. [PMID: 32818069 PMCID: PMC7407850 DOI: 10.1302/2058-5241.5.190045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Pertrochanteric hip fractures are among the most common and the use of short cephalomedullary nails as the treatment of choice is increasing. A systematic review regarding distal locking options for short cephalomedullary nails was undertaken using Medline/PubMed®, Embase® and Cochrane Library® in order to evaluate current indications, associated complications and to provide treatment recommendations. The results seem to support the use of distal static locking for unstable fractures, dynamic locking for length stable/rotational unstable fractures and no locking for stable fractures. Complications associated with distal locking include iatrogenic fractures, thigh pain, delayed union and nonunion, implant failure, screw loosening and breaking, drill bit breaking, soft tissue irritation, femoral artery branch injury, intramuscular haematoma and compartment syndrome. It is also associated with longer operative time and radiation exposure. In unlocked constructs, dorsomedial comminution and nail/medullary canal mismatch contribute to peri-implant fractures. Anterior cortical impingement is associated with cut-out and nonunion. Most studies comparing distally locked and unlocked nails report a short follow-up. Distal locking mode should be based on the fracture’s stability.
Cite this article: EFORT Open Rev 2020;5:421-429. DOI: 10.1302/2058-5241.5.190045
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Affiliation(s)
- Alexei Buruian
- Hospital Distrital da Figueira da Foz, Figueira Da Foz, Portugal
| | | | - Tiago Roseiro
- Hospital Distrital da Figueira da Foz, Figueira Da Foz, Portugal
| | - Claudia Vale
- Hospital Distrital da Figueira da Foz, Figueira Da Foz, Portugal
| | - André Carvalho
- Hospital Distrital da Figueira da Foz, Figueira Da Foz, Portugal
| | - Emanuel Seiça
- Hospital Distrital da Figueira da Foz, Figueira Da Foz, Portugal
| | - Antonio Mendes
- Hospital Distrital da Figueira da Foz, Figueira Da Foz, Portugal
| | - Carlos Pereira
- Hospital Distrital da Figueira da Foz, Figueira Da Foz, Portugal
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Li YH, Yu T, Shao W, Liu Y, Zhu D, Tan L. Distal locked versus unlocked intramedullary nailing for stable intertrochanteric fractures, a systematic review and meta-analysis. BMC Musculoskelet Disord 2020; 21:461. [PMID: 32660560 PMCID: PMC7359611 DOI: 10.1186/s12891-020-03444-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 06/22/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Intramedullary nails have become the main treatment for intertrochanteric fractures. However, a distal locking procedure during nailing gradually raised controversy. In this study, a systematic review and meta-analysis of clinical trials was performed to summarize existing evidence, aiming to determine the safety and efficacy of distal locking or unlocking in the nailing of stable intertrochanteric fractures. METHODS Appropriate articles were identified using the most common public databases, such as PubMed, Embase, the Cochrane Library, and Google Scholar from the inception of each database to April 2019, without restriction of language, publication date, and considering ongoing trials. Eligible studies were represented by randomized controlled trials or retrospective cohort studies, comparing distal locking and unlocking for the treatment of acute stable intertrochanteric fractures in adult patients. Information regarding methodological quality, patient demographics, and clinical outcomes were extracted independently by two reviewers. Subsequently, patients were divided into a locking and unlocking group. RESULTS This study included 9 articles, comprising a total of 1978 patients with a similar baseline. The results showed that the unlocking group had a shorter operation time, less intraoperative bleeding, lower transfusion rate, and less thigh pain after the treatment of femoral intertrochanteric fracture when compared with the distal locking group. No significant differences were observed in safety-related outcomes, including mortality, infection rate, cutting out, loss of reduction, backing out of lag screws, cephalic screw breakage, nail breakage, and peri-implant fractures between the two groups. In addition, efficacy-related outcomes including nonunion, delayed healing rates, and the Harris functional score were not significantly different between the two groups. CONCLUSIONS Our pooled analysis demonstrated that distal unlocking of stable intertrochanteric fractures can shorten the operation time, reduce intraoperative bleeding, and reduce the blood transfusion rate. The use of locked or unlocked intramedullary nailing does not affect long-term outcomes regarding complications and function.
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Affiliation(s)
- Yan-Hui Li
- Department of Cardiology and Echocardiography, the First Hospital of Jilin University, Changchun, 130021 China
| | - Tiecheng Yu
- Department of Orthopedic Trauma, the First Hospital of Jilin University, No. 71 Xinmin Street, Changchun, 130021 Jilin China
| | - Wenjing Shao
- Department of Obstetrics and Gynecology, the First Hospital of Jilin University, Changchun, 130021 China
| | - Yanwei Liu
- Department of Orthopedic Trauma, the First Hospital of Jilin University, No. 71 Xinmin Street, Changchun, 130021 Jilin China
| | - Dong Zhu
- Department of Orthopedic Trauma, the First Hospital of Jilin University, No. 71 Xinmin Street, Changchun, 130021 Jilin China
| | - Lei Tan
- Department of Orthopedic Trauma, the First Hospital of Jilin University, No. 71 Xinmin Street, Changchun, 130021 Jilin China
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Impact of Resident Training Level on Radiation Exposure During Fixation of Proximal Femur Fractures. J Orthop Trauma 2020; 34:e170-e175. [PMID: 31688438 DOI: 10.1097/bot.0000000000001686] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To identify whether residents are at greater risk of radiation exposure from intraoperative fluoroscopy while earlier in their training and during more complex procedures. METHODS We analyzed 852 extracapsular proximal femur fracture fixation cases. We compared fluoroscopy times by various levels of resident training, fracture type, and implant used. Attending-only cases were used as a control group. RESULTS Fluoroscopy times during subtrochanteric fracture fixation (176.1 ± 11.27 seconds) were longer than intertrochanteric (111.4 ± 2.44 seconds) and basicervical fractures (91.49 ± 5.77 seconds). Long nail (150.2 ± 3.75 seconds) times were longer than short (92.3 ± 3.15 seconds) and intermediate (76.45 ± 3.01 seconds) nails. Significantly, more fluoroscopy was used in junior (115.9 ± 4.24 seconds), senior (123.0 ± 6.08 seconds), junior combo (130.6 ± 7.74 seconds), and senior combo cases (131.8 ± 6.11 seconds) compared with the control (94.91 ± 3.91). CONCLUSION Orthopaedic surgery residents and attendings must remain aware of radiation exposure secondary to intraoperative fluoroscopy. Appropriate personal protective equipment should be worn, and more experienced surgeons should take a more active role in the complex cases to decrease exposure risk. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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姚 晓, 伍 玲, 李 建, 黄 文, 段 鑫, 顾 祖, 王 跃. [Effectiveness analysis of closed or limited open reduction and intramedullary nail fixation in treatment of Seinsheimer type Ⅴ subtrochanteric fracture]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:457-462. [PMID: 32291981 PMCID: PMC8171499 DOI: 10.7507/1002-1892.201908100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 01/27/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate the effectiveness of closed or limited open reduction and intramedullary nail fixation in the treatment of Seinsheimer type Ⅴ subtrochanteric fracture. METHODS Between May 2014 and July 2018, 36 patients with Scinsheimer type Ⅴ subtrochanteric fractures were treated with closed or limited open reduction and intramedullary nail fixation. There were 25 males and 11 females with an age of 23-86 years (mean, 55.8 years). The cause of injury included falling in 19 cases, traffic accident in 9 cases, falling from height in 7 cases, and heavy object injury in 1 case; all were fresh closed injuries. The interval between injury and operation was 1-14 days (mean, 6.8 days). There were 18 cases of closed reduction and 18 cases of limited open reduction during the operation. Seventeen cases were fixed with femoral reconstruction intramedullary nail, 5 with InterTan long nail, 14 with lengthened proximal femoral nail anti-rotation, and 7 cases were assisted with auxiliary steel wire binding. After operation, through X-ray film and clinical follow-up, the fracture reduction and maintenance status, internal fixation position, and fracture healing were judged; the range of motion, walking ability, and complications of hip joint were observed, and the function of hip joint was evaluated according to Merle d'Aubigne Postel hip joint scoring standard. RESULTS All the incisions of medullary operation healed by first intention, and no vascular, nerve injury, or infection occurred. All patients were followed up 12-24 months, with an average of 14.2 months. Among the 36 patients, 1 patient received revision surgery due to varus displacement of femoral head and screw penetration at 2 months after closed reduction, with poor recovery of hip function. X-ray film re-examination showed that the fractures of the other 35 patients healed after 9-15 months, with an average of 11.5 months. During follow-up, there was no complication such as internal fixation failure, fracture redisplacement, bone nonunion or malunion, and deep vein thrombosis of lower extremity occurred. The function of hip joint recovered well, and the patients could walk and squat normally without affecting daily life or work. At last follow-up, according to Merle d'Aubigne Postel hip joint scoring standard, 28 cases were rated as excellent, 4 cases as good, 3 cases as fair, and 1 case as poor, the excellent and good rate was 88.9%. CONCLUSION C-arm X-ray fluoroscopic closed or limited open reduction and intramedullary nail fixation for the treatment of Seinheimer Ⅴ type subtrochanteric fracture, if necessary, with the aid of auxiliary steel wire binding, it has the advantages of less blood supply destruction at the fracture end, satisfactory reduction, firm fixation, and early rehabilitation training, with definite effectiveness.
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Affiliation(s)
- 晓克 姚
- 成都市第一人民医院骨科(成都 610041)Department of Orthopedics, Chengdu First People’s Hospital, Chengdu Sichuan, 610041, P.R.China
| | - 玲娜 伍
- 成都市第一人民医院骨科(成都 610041)Department of Orthopedics, Chengdu First People’s Hospital, Chengdu Sichuan, 610041, P.R.China
| | - 建华 李
- 成都市第一人民医院骨科(成都 610041)Department of Orthopedics, Chengdu First People’s Hospital, Chengdu Sichuan, 610041, P.R.China
| | - 文刚 黄
- 成都市第一人民医院骨科(成都 610041)Department of Orthopedics, Chengdu First People’s Hospital, Chengdu Sichuan, 610041, P.R.China
| | - 鑫 段
- 成都市第一人民医院骨科(成都 610041)Department of Orthopedics, Chengdu First People’s Hospital, Chengdu Sichuan, 610041, P.R.China
| | - 祖超 顾
- 成都市第一人民医院骨科(成都 610041)Department of Orthopedics, Chengdu First People’s Hospital, Chengdu Sichuan, 610041, P.R.China
| | - 跃 王
- 成都市第一人民医院骨科(成都 610041)Department of Orthopedics, Chengdu First People’s Hospital, Chengdu Sichuan, 610041, P.R.China
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Yan WS, Cao WL, Sun M, Ma DY, Zhang P. Distal locked or unlocked nailing for stable intertrochanteric fractures? A meta-analysis. ANZ J Surg 2019; 90:27-33. [PMID: 31083793 DOI: 10.1111/ans.15232] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 03/11/2019] [Accepted: 03/17/2019] [Indexed: 01/11/2023]
Abstract
BACKGROUND To date, there are just several studies comparing distal locked nails with distal unlocked nails in treating intertrochanteric fractures. We report the first meta-analysis about this issue. METHODS Systematic search was conducted for studies in PubMed, Embase and Cochrane Library. Meta-analyses were performed regarding intra operative outcomes, complications and functional outcomes. RESULTS Pooled results showed insignificant difference between distal locking group and distal unlocking group in hip pain (relative risk (RR) 1.14, 95% confidence interval (CI) 0.59-2.19), distal tip fracture (RR 1.08, 95% CI 0.37-3.11), lag screw cut-out (RR 1.60, 95% CI 0.54-4.78), delayed or nonunion (RR 1.32, 95% CI 0.25-7.06), deep vein thrombosis (RR 1.06, 95% CI 0.23-4.84), wound infection (RR 0.58, 95% CI 0.28-1.22), Harris hip score (standard mean deviation (SMD) 0.03, 95% CI -0.15 to 0.21) and walking ability. However, significant difference was detected in operation time (SMD 0.77, 95% CI 0.36-1.17), fluoroscopy exposure time (SMD 1.02, 95% CI 0.52-1.52), blood loss (SMD 0.80, 95% CI 0.62-0.99) and total incision length (SMD 1.16, 95% CI 0.86-1.47). Result of trial sequential analysis indicated conclusive evidence. CONCLUSION Current evidence indicates that the distal locked intramedullary nails should not be recommended as routine choice for stable intertrochanteric fractures.
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Affiliation(s)
- Wen-Shan Yan
- Department of Orthopaedics, Binhai Hospital of Tianjin Medical University General Hospital, Tianjin, China
| | - Wei-Li Cao
- Department of Gastroenterology, Binhai Hospital of Tianjin Medical University General Hospital, Tianjin, China
| | - Ming Sun
- Department of Orthopaedics, Binhai Hospital of Tianjin Medical University General Hospital, Tianjin, China
| | - Deng-Yue Ma
- Department of Orthopaedics, Binhai Hospital of Tianjin Medical University General Hospital, Tianjin, China
| | - Peng Zhang
- Department of Orthopaedics, Characteristic Medical Center of Chinese People's Armed Police Forces, Tianjin, China
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Hulet DA, Whale CS, Beebe MJ, Rothberg DL, Gililland JM, Zhang C, Presson AP, Stuart AR, Kubiak EN. Short Versus Long Cephalomedullary Nails for Fixation of Stable Versus Unstable Intertrochanteric Femur Fractures at a Level 1 Trauma Center. Orthopedics 2019; 42:e202-e209. [PMID: 30668883 DOI: 10.3928/01477447-20190118-03] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 08/17/2018] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to compare failure and complication rates associated with short cephalomedullary nail vs long cephalomedullary nail fixation for stable vs unstable intertrochanteric femur fractures. This study included 201 adult patients with nonpathologic intertrochanteric femur fractures without subtrochanteric extension (OTA 31-A1.1-3, 31-A2.1-3, 31-A3.1-3) who were treated with a short cephalomedullary nail (n=70) or a long cephalomedullary nail (n=131) and had at least 6 months of follow-up. Treatment groups were similar in terms of age, sex, and comorbidities. In the stable fracture group (N=81), there was no difference in total complications (adjusted P=.73), failure (adjusted P=.78), or mortality (adjusted P=.62) between short cephalomedullary nails and long cephalomedullary nails. Unstable fracture patterns were more likely to be treated with a long cephalomedullary nail than a short cephalomedullary nail (P=.01). In the unstable fracture group (N=120), there was no difference in total complications (adjusted P=.32) or failure (adjusted P=.31) between short cephalomedullary nails and long cephalomedullary nails. A cumulative mortality curve showed a trend toward increasing mortality in unstable fractures treated with short cephalomedullary nails. Traumatologists did not display a statistically significant preference between short cephalomedullary nails and long cephalomedullary nails when compared with nontraumatologists. [Orthopedics. 2019; 42(2):e202-e209.].
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Thamyongkit S, MacKenzie JS, Sirisreetreerux N, Shafiq B, Hasenboehler EA. Outcomes after unstable pertrochanteric femur fracture: intermediate versus long cephalomedullary nails. Eur J Trauma Emerg Surg 2018; 46:963-968. [PMID: 30143808 DOI: 10.1007/s00068-018-1002-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 08/20/2018] [Indexed: 01/10/2023]
Abstract
PURPOSE Optimal cephalomedullary nail (CMN) length for unstable pertrochanteric femur fractures is controversial. Long CMNs (L-CMNs) are currently recommended; however, intermediate-length CMNs (I-CMNs) may provide stable fixation without the additional surgical steps required by L-CMNs. We analyzed outcomes after unstable pertrochanteric femur fractures treated with L-CMNs or I-CMNs to determine whether functional outcomes, perioperative measures, complications, and mortality and reoperation rates differ by CMN length. METHODS We retrospectively reviewed medical records at our institution for 100 patients who received surgical treatment for pertrochanteric femur fractures from June 2014 to June 2016. Data from 43 unstable pertrochanteric femur fractures treated with L-CMNs (n = 25) or I-CMNs (n = 18) were analyzed. We evaluated operative time, fluoroscopy time, intraoperative blood loss, blood transfusions, and perioperative complications; peri-implant fracture, malunion, reoperation, and death; and neck-shaft angle, tip-apex distance, and 6-month postoperative functional scores. We analyzed categorical data with Fisher exact tests and continuous data with Student t tests. P < 0.05 was considered significant. RESULTS The I-CMN group had shorter operative time (68 versus 92 min; P = 0.048), shorter fluoroscopy time (72 versus 110 s; P = 0.019), and less intraoperative blood loss (80 versus 168 mL; P < 0.001) than the L-CMN group. The groups were similar in rates of blood transfusion, perioperative complications, peri-implant fracture, malunion, reoperation, and death. Six-month postoperative functional scores were similar between groups (P > 0.05). CONCLUSIONS We found operative advantages of I-CMNs over L-CMNs with no difference in treatment outcomes. LEVEL OF EVIDENCE Level IV, Retrospective case series study.
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Affiliation(s)
- Sorawut Thamyongkit
- Department of Orthopaedic Surgery, The Johns Hopkins University/Johns Hopkins Bayview Medical Center, 4940 Eastern Ave., #A667, Baltimore, MD, 21224-2780, USA.,Chakri Naruebodindra Medical Institute, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchatewi, Bangkok, 10400, Thailand
| | - James S MacKenzie
- Department of Orthopaedic Surgery, The Johns Hopkins University/Johns Hopkins Bayview Medical Center, 4940 Eastern Ave., #A667, Baltimore, MD, 21224-2780, USA
| | - Norachart Sirisreetreerux
- Department of Orthopaedic Surgery, The Johns Hopkins University/Johns Hopkins Bayview Medical Center, 4940 Eastern Ave., #A667, Baltimore, MD, 21224-2780, USA
| | - Babar Shafiq
- Department of Orthopaedic Surgery, The Johns Hopkins University/Johns Hopkins Bayview Medical Center, 4940 Eastern Ave., #A667, Baltimore, MD, 21224-2780, USA
| | - Erik A Hasenboehler
- Department of Orthopaedic Surgery, The Johns Hopkins University/Johns Hopkins Bayview Medical Center, 4940 Eastern Ave., #A667, Baltimore, MD, 21224-2780, USA.
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Yu X, Wang H, Duan X, Liu M, Xiang Z. Intramedullary versus extramedullary internal fixation for unstable intertrochanteric fracture, a meta-analysis. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2018; 52:299-307. [PMID: 29602699 PMCID: PMC6150441 DOI: 10.1016/j.aott.2018.02.009] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 02/26/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The aim of this meta-analysis was to explore the difference between and compare intramedullary fixation (IF) and extramedullary fixation (EF) for unstable intertrochanteric fractures. METHODS We searched Pubmed database and Cochrane library following by including and excluding articles based from inception to December, 2016. All randomized controlled trials (RCTs) comparing IF and EF for unstable intertrochanteric fractures were assessed and selected by two researchers independently. Data were analyzed using Review Manager 5.1 version. RESULTS 17 RCTs were enrolled in our meta-analysis comparing IF and EF and showed evidence that IF had lower rate of implant failure RR = 0.2695%CI 0.13-0.51, P < 0.0001 and re-operation (RR = 0.60, 95%CI 0.37-0.98, P = 0.04), while there was no statistical differences of cut-out, postoperative infections and other complications. Moreover, PPM scores verified that IF had better postoperative hip mobility recovery (MD = 0.87, 95%CI 0.08-1.66, P = 0.03). CONCLUSION IF has lower incidence of failure of implant and reoperation and shows better postoperative functional recovery when treating adult unstable intertrochanteric fracture while the most postoperative complications were not statistically different from EF. LEVEL OF EVIDENCE Level I, therapeutic study.
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Affiliation(s)
- Xi Yu
- Rehabilitation Medicine Center, West China School of Medicine, Sichuan University, Chengdu, Sichuan, PR China
| | - Hong Wang
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Xin Duan
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Ming Liu
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Zhou Xiang
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China.
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Mavrogenis AF, Igoumenou VG, Megaloikonomos PD, Panagopoulos GN, Galanopoulos IP, Vottis CT, Karamanis E, Koulouvaris P, Papagelopoulos PJ. Dual head screw hip nailing for trochanteric fractures. SICOT J 2017; 3:61. [PMID: 29043967 PMCID: PMC5646173 DOI: 10.1051/sicotj/2017049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 09/04/2017] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION There are limited information and inconclusive results for dual head screw intramedullary hip nails for trochanteric fractures. Therefore, we performed a prospective study to evaluate the healing of fractures, and survival, function, and complications of patients operated with this implant. METHODS We prospectively studied 79 patients (61 women and 18 men; mean age: 84.7 years; range: 65-96 years) with a low-energy trochanteric fracture, treated with a dual head screw intramedullary hip nail from 2013 to 2016. The mean follow-up was 2.1 years (range: 1-3 years); seven patients were lost to follow up. This left 72 patients for further analysis. We evaluated the healing of fractures, and survival, function, and complications of patients. RESULTS Fracture healing was evident in 70 patients (97.2%) at 2-3 months postoperatively. One patient experienced cut-out and z-effect phenomenon of the head screws. Another patient experienced a periprosthetic femoral diaphysis fracture at the distal tip of the nail. A third patient experienced an acute postoperative superficial skin infection that was treated successfully with wound dressing changes and a course of antibiotics. Sixteen patients (22.2%) deceased within 12 months postoperatively. In the remaining patients, the Harris Hip Score (HHS) at 12 months postoperatively was excellent in 16 (28.6%), good in 23 (41.1%), fair in 10 (17.8%), and poor in 7 patients (12.5%). The function declined after the patients' fracture. Fair and poor results were related to age > 85 years, poor pre-fracture level of function, and AO/OTA-31-A3 fracture types. CONCLUSION The dual head screw intramedullary hip nail is associated with high healing and low complication rates for intertrochanteric fractures. The function of the patients is good or excellent in most cases; however, it declines, especially for those patients with age > 85 years, poor pre-fracture level of function, and AO/OTA-31-A3 fracture types.
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Affiliation(s)
- Andreas F Mavrogenis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, 41 Ventouri Str., 15562 Athens, Greece
| | - Vasilios G Igoumenou
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, 41 Ventouri Str., 15562 Athens, Greece
| | - Panayiotis D Megaloikonomos
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, 41 Ventouri Str., 15562 Athens, Greece
| | - George N Panagopoulos
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, 41 Ventouri Str., 15562 Athens, Greece
| | - Ioannis P Galanopoulos
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, 41 Ventouri Str., 15562 Athens, Greece
| | - Christos Th Vottis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, 41 Ventouri Str., 15562 Athens, Greece
| | - Eirinaios Karamanis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, 41 Ventouri Str., 15562 Athens, Greece
| | - Panayiotis Koulouvaris
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, 41 Ventouri Str., 15562 Athens, Greece
| | - Panayiotis J Papagelopoulos
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, 41 Ventouri Str., 15562 Athens, Greece
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Zhang H, Zhu X, Pei G, Zeng X, Zhang N, Xu P, Chen D, Yu W, Zhang X. A retrospective analysis of the InterTan nail and proximal femoral nail anti-rotation in the treatment of intertrochanteric fractures in elderly patients with osteoporosis: a minimum follow-up of 3 years. J Orthop Surg Res 2017; 12:147. [PMID: 29017580 PMCID: PMC5634834 DOI: 10.1186/s13018-017-0648-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Accepted: 09/25/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The study aims to compare the long-term functional and radiographic outcomes of two devices for the treatment of primary intertrochanteric fractures (IFs, OTA 3.1A2.1-A2.3) in elderly patients with osteoporosis. METHODS Between December 2010 and August 2014, 332 elderly osteoporosis patients with IFs (OTA 3.1A2.1-A2.3) fixed by an InterTAN nail (IT) or a proximal femoral nail anti-rotation (PFNA) device were retrospectively evaluated. Follow-up occurred 1, 3, 6, and 12 months postoperatively and every year thereafter. Mortality was recorded. Patient-related functional and radiographic outcomes were compared. The primary endpoint was the long-term radiographic outcomes. The secondary endpoint was the long-term functional outcomes. RESULTS A total of 283 patients (283 hips) with osteoporosis (IT, n = 144; PFNA, n = 139) were evaluated with a mean follow-up period of 38.8 months (range, 36-43 months). No between-group significant differences were noted in the patient demographics, operation variables, and postoperative Harris Hip Score. More radiographic complications were noted in terms of screw cut-out, femoral shaft fracture distal or around the tip of the main nail, and varus collapse of the femoral head in the PFNA group compared with that in the IT group (P < 0.05). CONCLUSION For osteoporotic IFs (OTA 3.1A2.1-A2.3) in elderly patients, the use of IT aids in decreasing radiographic complications, but the between-group functional outcomes showed no significant difference.
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Affiliation(s)
- Hui Zhang
- Emergency Department, The First Affiliated Hospital of Sun Yat-sen University, Huangpu East Road No. 183, Huangpu District, Guangzhou, Guangdong, 510700, China.
| | - Xiaoxiao Zhu
- Endocrine Department, The First Affiliated Hospital of Sun Yat-sen University, Huangpu East Road No. 183, Huangpu District, Guangzhou, Guangdong, 510700, China
| | - Genwang Pei
- Department of ENT, The First Affiliated Hospital of Sun Yat-sen University, Huangpu East Road No. 183, Huangpu District, Guangzhou, Guangdong, 510700, China
| | - Xianshang Zeng
- Department of Orthopedics, The First Affiliated Hospital of Sun Yat-sen University, Huangpu East Road No. 183, Huangpu District, Guangzhou, Guangdong, 510700, China
| | - Nan Zhang
- Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-sen University, Huangpu East Road No. 183, Huangpu District, Guangzhou, Guangdong, 510700, China
| | - Ping Xu
- Radiology Department, The First Affiliated Hospital of Sun Yat-sen University, Huangpu East Road No. 183, Huangpu District, Guangzhou, Guangdong, 510700, China
| | - Deng Chen
- Department of Joint Surgery, The First People's Hospital of Jingmen, Xiangshan Avenue No. 168, Dongbao District, Jingmen, Hubei, 448000, China
| | - Weiguang Yu
- Department of Orthopedics, The First Affiliated Hospital of Sun Yat-sen University, Huangpu East Road No. 183, Huangpu District, Guangzhou, Guangdong, 510700, China
| | - Xinchao Zhang
- Department of Orthopaedics, Jinshan Hospital, Fudan University, Longhang Road No. 1508, Jinshan District, Shanghai City, 201508, China.
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Zhang Y, Zhang S, Wang S, Zhang H, Zhang W, Liu P, Ma J, Pervaiz N, Wang J. Long and short intramedullary nails for fixation of intertrochanteric femur fractures (OTA 31-A1, A2 and A3): A systematic review and meta-analysis. Orthop Traumatol Surg Res 2017; 103:685-690. [PMID: 28546048 DOI: 10.1016/j.otsr.2017.04.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 01/07/2017] [Accepted: 04/26/2017] [Indexed: 02/02/2023]
Abstract
UNLABELLED Previous studies have reported conflicting findings concerning the efficacy and safety of the treatment of intertrochanteric fractures (OTA 31-A1,A2 and A3) using short intramedullary nails (SIN) and long intramedullary nails (LIN). The present meta-analysis and literature review investigated the outcomes of SIN and LIN, thereby providing guidance for the treatment of intertrochanteric femur fractures. When used to treat intertrochanteric femur fractures, LIN did not decrease the secondary femoral shaft refracture or reoperation rates. Eight electronic databases were searched for studies related to the use of SIN compared to LIN in treating intertrochanteric fractures. The modified Jadad Scale and the Newcastle-Ottawa Scale (NOS) were used to assess the methodological quality and the risk of bias of these studies. The two groups were compared based on nine indicators, including the surgical times, intraoperative blood loss, transfusion, length of hospital stay, secondary femoral shaft refracture, reoperation, 1-year mortality, Harris hip scores (1 year) and complications. A total of 2431 patients were included in the analysis, with 1498 LIN cases and 940 SIN cases (bilateral nails were used in 7 cases), and the average patient age was 74.83 years. The pooled results indicated that patients in the LIN group had longer surgical times (MD [mean difference]: 12.56; 95% CI: 8.28-16.84; P<0.00001), more intraoperative blood loss (MD: 37.44; 95% CI: 8.06-66.82, P=0.01) and a higher transfusion rate (OR [odds ratio]: 1.53; 95% CI: 1.12-2.10, P=0.008) than patients in the SIN group. However, there was no significant difference in the length of hospital stay (MD: 0.24; 95% CI: -0.58-1.06, P=0.56), occurrence of secondary femoral shaft refractures (OR: 0.72; 95% CI: 0.34-1.53, P=0.39), reoperation rate (OR: 0.95; 95% CI: 0.60-1.50, P=0.82), 1-year mortality (OR: 1.1; 95% CI: 0.67-1.8, P=0.71), Harris hip score (MD: 1.87; 95% CI: -2.8-6.54, P=0.43) or complication rate (OR: 1.29; 95% CI: 0.84-1.99, P=0.25). LIN may not be a better method or provide more effective treatment for intertrochanteric femur fractures; the LIN patients demonstrated the same prognosis as the SIN patients, particularly in terms of secondary femoral shaft refracture and reoperation rate, but they experienced greater trauma. Due to the limitations of the included studies, however, more highly powered randomized controlled trials are needed to clarify the findings. Systematic review and meta-analysis. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Y Zhang
- Key Laboratory of Orthopedics of Gansu Province, The Second Hospital of Lanzhou University, Lanzhou University, No. 82, Cui Ying Men Street, 730030 Lanzhou, Gansu, PR China
| | - S Zhang
- Key Laboratory of Orthopedics of Gansu Province, The Second Hospital of Lanzhou University, Lanzhou University, No. 82, Cui Ying Men Street, 730030 Lanzhou, Gansu, PR China
| | - S Wang
- Key Laboratory of Orthopedics of Gansu Province, The Second Hospital of Lanzhou University, Lanzhou University, No. 82, Cui Ying Men Street, 730030 Lanzhou, Gansu, PR China
| | - H Zhang
- Key Laboratory of Orthopedics of Gansu Province, The Second Hospital of Lanzhou University, Lanzhou University, No. 82, Cui Ying Men Street, 730030 Lanzhou, Gansu, PR China
| | - W Zhang
- Key Laboratory of Orthopedics of Gansu Province, The Second Hospital of Lanzhou University, Lanzhou University, No. 82, Cui Ying Men Street, 730030 Lanzhou, Gansu, PR China
| | - P Liu
- Key Laboratory of Orthopedics of Gansu Province, The Second Hospital of Lanzhou University, Lanzhou University, No. 82, Cui Ying Men Street, 730030 Lanzhou, Gansu, PR China
| | - J Ma
- Key Laboratory of Orthopedics of Gansu Province, The Second Hospital of Lanzhou University, Lanzhou University, No. 82, Cui Ying Men Street, 730030 Lanzhou, Gansu, PR China
| | - N Pervaiz
- Research Institute of Pathogenic Biology School of Basic Medicine, Lanzhou University, 730000 Lanzhou, Gansu, PR China
| | - J Wang
- Key Laboratory of Orthopedics of Gansu Province, The Second Hospital of Lanzhou University, Lanzhou University, No. 82, Cui Ying Men Street, 730030 Lanzhou, Gansu, PR China.
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Zeng X, Zhang N, Zeng D, Zhang L, Xu P, Cao L, Yu W, Zhan K, Zhang X. Proximal femoral nail antirotation versus dynamic hip screw fixation for treatment of osteoporotic type 31-A1 intertrochanteric femoral fractures in elderly patients. J Int Med Res 2017; 45:1109-1123. [PMID: 28417681 PMCID: PMC5536426 DOI: 10.1177/0300060517703277] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To evaluate long-term radiographic and functional outcomes between dynamic hip screw (DHS) and proximal femoral nail antirotation (PFNA) fixation for treatment of osteoporotic type 31-A1 intertrochanteric femoral fractures (IFFs) among elderly patients Methods A retrospective comparative study was carried out. Follow-up was performed at 1, 3, 6, 9, and 12 months postoperatively and yearly thereafter. The primary outcome was the radiographic outcome, and the secondary outcome was the functional outcome. Results A significant difference in radiographic complications was observed between the DHS group (n = 45, 40.2%) and PFNA group (n = 15, 13.6%). The risk of femoral shaft fracture after implant removal at the 1-year follow-up was increased by 0.9% (n = 1) and 6.3% (n = 7) in the PFNA and DHS groups, respectively. This difference persisted with rates of 3.6% (n = 4) and 12.5% (n = 14) at the final follow-up. Additionally, significant differences were present in the Harris hip score at each visit. Conclusion Our results indicate that PFNA yields better outcomes than DHS fixation among elderly patients with osteoporotic type 31-A1 IFFs.
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Affiliation(s)
- Xianshang Zeng
- 1 Department of Orthopedics, The First Affiliated Hospital of Sun Yat-sen University, Huangpu District, Guangzhou, Guangdong, China
| | - Nan Zhang
- 2 Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-sen University, Huangpu District, Guangzhou, Guangdong, China
| | - Dan Zeng
- 3 Ultrasonography Department, The First Affiliated Hospital of Sun Yat-sen University, Huangpu District, Guangzhou, Guangdong, China
| | - Lili Zhang
- 2 Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-sen University, Huangpu District, Guangzhou, Guangdong, China
| | - Ping Xu
- 4 Radiology Department, The First Affiliated Hospital of Sun Yat-sen University, Huangpu District, Guangzhou, Guangdong, China
| | - Lei Cao
- 5 Department of Anesthesiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Jiang'an District, Wuhan, Hubei, China
| | - Weiguang Yu
- 1 Department of Orthopedics, The First Affiliated Hospital of Sun Yat-sen University, Huangpu District, Guangzhou, Guangdong, China
| | - Ke Zhan
- 1 Department of Orthopedics, The First Affiliated Hospital of Sun Yat-sen University, Huangpu District, Guangzhou, Guangdong, China
| | - Xinchao Zhang
- 6 Department of Orthopaedics, Jinshan Hospital, Fudan University, Jinshan District, Shanghai City, China
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Frisch NB, Nahm NJ, Khalil JG, Les CM, Guthrie ST, Charters MA. Short Versus Long Cephalomedullary Nails for Pertrochanteric Hip Fracture. Orthopedics 2017; 40:83-88. [PMID: 27874910 DOI: 10.3928/01477447-20161116-01] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 09/29/2016] [Indexed: 02/03/2023]
Abstract
This study compared patients who underwent treatment with short or long cephalomedullary nails with integrated cephalocervical screws and linear compression. Patients with AO/OTA 31-A2 or A3 pertrochanteric fractures treated with either short (n=72) or long (n=97) InterTAN (Smith & Nephew, Memphis, Tennessee) cephalomedullary nails were reviewed. Information on perioperative measures (estimated blood loss, surgical time, and fluoroscopy time) and postoperative orthopedic complications (infection, implant failure, screw cutout, and periprosthetic femur fracture) was included. Estimated blood loss (short nail, 161 mL; long nail, 208 mL; P=.002) and surgical time (short nail, 64 minutes; long nail, 83 minutes; P=.001) were lower in the short nail group. There were no differences in fluoroscopy time (short nail, 90 seconds; long nail, 142 seconds; P=.071) or rates of infection (short nail, 1.4%; long nail, 3.1%; P=.637) or overall orthopedic complications (short nail, 11.1%; long nail, 9.3%; P=.798) between the 2 groups. The long nail group had a trend toward more screw cutouts (long nail, 5.2%; short nail, 0.0%; P=.134) but fewer periprosthetic femur fractures (short nail, 8.3%; long nail, 0.0%; P=.013). This study found a similar overall rate of orthopedic complications between short and long nails with integrated cephalocervical screws and linear compression. These results confirm the suspected advantages of short nails, including faster surgery and less blood loss; however, the rate of periprosthetic femur fracture remains high, despite changes to implant design. [Orthopedics. 2017; 40(2):83-88.].
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Xue D, Yu J, Zheng Q, Feng G, Li W, Pan Z, Wang J, Li H. The treatment strategies of intertrochanteric fractures nonunion: An experience of 23 nonunion patients. Injury 2017; 48:708-714. [PMID: 28139213 DOI: 10.1016/j.injury.2017.01.042] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 01/18/2017] [Accepted: 01/23/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Intertrochanteric femoral fractures are common, but the nonunion of intertrochanteric fractures is not. The purpose of this study was to divide intertrochanteric fracture nonunion into different types and give corresponding treatment strategies. METHODS We retrospectively evaluated 23 patients with intertrochanteric fracture nonunion. The patients were divided into five groups and each group was treated with a different strategy. All patients had staged clinical and radiographic follow-ups and the mean follow-up was 16.0±4.6months. RESULTS Except for the patients treated with total hip arthroplasty, all patients achieved fracture union. The mean union time was 4.7±1.2months. The Harris hip function score differed significantly from preoperative (28.9±6.8) to postoperative (83.8±6.3; p<0.05). For the three patients who were classified as type III, the femoral neck shaft angle was corrected to a significant degree, from 97.3±6.4 to 127.3±2.5 (p<0.05). For the four patients who were classified as type V, the mean time from debridement to re-internal fixation was 3.7±1.5months. CONCLUSIONS There are several factors associated with the failure of intertrochanteric fracture treatments. We need to analyze the causes of fracture treatment failure carefully. Based on our five classifications and corresponding treatment strategies, the radiographic and functional treatment outcomes were satisfactory. Future larger comparative studies are needed to confirm our results.
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Affiliation(s)
- Deting Xue
- Department of Orthopaedics, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, Zhejiang, China.
| | - Jiawei Yu
- Department of Orthopaedics, Zhuji People's Hospital of Zhejiang Province, Shaoxing, 311800, Zhejiang, China.
| | - Qiang Zheng
- Department of Orthopaedics, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, Zhejiang, China.
| | - Gang Feng
- Department of Orthopaedics, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, Zhejiang, China.
| | - Weixu Li
- Department of Orthopaedics, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, Zhejiang, China.
| | - Zhijun Pan
- Department of Orthopaedics, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, Zhejiang, China.
| | - Jian Wang
- Department of Orthopaedics, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, Zhejiang, China.
| | - Hang Li
- Department of Orthopaedics, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, Zhejiang, China.
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Socci AR, Casemyr NE, Leslie MP, Baumgaertner MR. Implant options for the treatment of intertrochanteric fractures of the hip. Bone Joint J 2017; 99-B:128-133. [DOI: 10.1302/0301-620x.99b1.bjj-2016-0134.r1] [Citation(s) in RCA: 116] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 08/17/2016] [Indexed: 11/05/2022]
Abstract
Aims The aim of this paper is to review the evidence relating to the anatomy of the proximal femur, the geometry of the fracture and the characteristics of implants and methods of fixation of intertrochanteric fractures of the hip. Materials and Methods Relevant papers were identified from appropriate clinical databases and a narrative review was undertaken. Results Stable, unstable, and subtrochanteric intertrochanteric fractures vary widely in their anatomical and biomechanical characteristics, as do the implants used for their fixation. The optimal choice of implant addresses the stability of the fracture and affects the outcome. Conclusion The treatment of intertrochanteric fractures of the hip has evolved along with changes in the design of the implants used to fix them, but there remains conflicting evidence to guide the choice of implant. We advocate fixation of 31A1 fractures with a sliding hip screw and all others with an intramedullary device. Cite this article: Bone Joint J 2017;99-B:128–33.
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Affiliation(s)
- A. R. Socci
- Yale University School of Medicine, Department
of Orthopaedics and Rehabilitation, 800 Howard Ave, New
Haven, CT 06520, USA
| | - N. E. Casemyr
- Yale University School of Medicine, Department
of Orthopaedics and Rehabilitation, 800 Howard Ave, New
Haven, CT 06520, USA
| | - M. P. Leslie
- Yale University School of Medicine, Department
of Orthopaedics and Rehabilitation, 800 Howard Ave, New
Haven, CT 06520, USA
| | - M. R. Baumgaertner
- Yale University School of Medicine, Department
of Orthopaedics and Rehabilitation, 800 Howard Ave, New
Haven, CT 06520, USA
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Is distal locking with short intramedullary nails necessary in stable pertrochanteric fractures? A prospective, multicentre, randomised study. Injury 2016; 47 Suppl 4:S98-S106. [PMID: 27523625 DOI: 10.1016/j.injury.2016.07.038] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We investigated whether a proximal femoral nail can be implanted without a distal locking screw in AO/OTA 31-A1 and 31-A2 pertrochanteric stable femur fractures. A multicentre, randomised study was conducted in six level-two trauma centres in our area (Puglia, Italy). A total of 333 patients received their allocated intervention (162 in the locking group [LG] and 171 in the unlocking group [UG]) and 266 patients were included in the final analysis at 1year. Our data showed no statistically significant difference between the two groups at 1-year follow-up for ability to walk, SF-36 questionnaire results, residual pain (visual analogue scale [VAS] score) and level of overall satisfaction. There were also no statistically significant differences between groups for mortality and length of hospital stay. Conversely, the UG was associated with shorter operation and fluoroscopy times, shorter surgical incision length, and less blood loss and residual thigh pain. Pertrochanteric stable fractures (31-A1, 31-A2) can be treated successfully with intramedullary nails without distal locking, reducing patient and clinical personnel radiation exposure and sanitary costs (surgery time and screws costs).
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Costs and Complications of Short Versus Long Cephalomedullary Nailing of OTA 31-A2 Proximal Femur Fractures in U.S. Veterans. J Orthop Trauma 2016; 30:125-9. [PMID: 26894639 DOI: 10.1097/bot.0000000000000521] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES In fractures without subtrochanteric extension, the indications for the use of short versus long cephalomedullary nails (CMNs) for intertrochanteric femur fractures are unclear. We hypothesized that long nails would be associated with higher costs and similar complication rates. DESIGN Retrospective comparative study. SETTING United States Department of Veterans Affairs Medical Centers. PARTICIPANTS Patients receiving CMNs for OTA 31-A2 pertrochanteric fractures from 2001 to 2010. INTERVENTIONS Short versus long cephalomedullary nailing. MAIN OUTCOME MEASUREMENTS Costs, perioperative complications, readmissions, surgical failures, and mortality. RESULTS We identified 262 patients with OTA 31-A2 pertrochanteric fractures (125 treated with short CMNs and 137 treated with long CMNs). The 2 cohorts had similar demographic and medical characteristics. There were no significant differences in perioperative complications, readmissions within 30 days, surgical failures within one year, or death within 30 days or one year. The average cost of hospitalization was significantly higher for the cohort treated with long nails (greater than $7000 in actual costs, and greater than $3000 when statistically adjusted for differences in postoperative lengths of stay). Multivariable analyses showed no significant differences in the rates of development of at least one complication, readmission, or death. CONCLUSIONS In a cohort of patients with similar characteristics and fracture patterns, the use of long CMNs was associated with similar rates of complications, readmission, and reoperations, but significantly higher costs than with the use of short nails. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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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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Tosounidis TH, Castillo R, Kanakaris NK, Giannoudis PV. Common complications in hip fracture surgery: Tips/tricks and solutions to avoid them. Injury 2015; 46 Suppl 5:S3-11. [PMID: 26298022 DOI: 10.1016/j.injury.2015.08.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Surgical management of hip fractures in elderly people is challenging and complications relating to surgery could be devastating. They often lead to reoperation and revision surgery and can be associated with significantly increased morbidity and mortality. The most common surgical complications after internal fixation of hip fractures include cut-out, nonunion, Z-effect/medial migration, periimplant failure and avascular necrosis. High quality surgical fixation is of outmost importance to avoid surgical complications. This article presents the aetiology, risk factors and incidence of perioperative and post-fracture fixation complications. Technical tips and tricks for a successful fixation as well as the contemporary evidence surrounding the augmentation of osteoporotic bone fixation in internal fixation of hip fractures are discussed.
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Affiliation(s)
- Theodoros H Tosounidis
- Academic Department of Trauma & Orthopaedic Surgery, University of Leeds, Clarendon Wing, Floor A, Great George Street, Leeds General Infirmary, LS1 3EX Leeds, UK; NIHR Leeds Biomedical Research Unit, Chapel Allerton Hospital, Leeds, West Yorkshire, Leeds LS7 4SA, UK
| | - Raul Castillo
- Academic Department of Trauma & Orthopaedic Surgery, University of Leeds, Clarendon Wing, Floor A, Great George Street, Leeds General Infirmary, LS1 3EX Leeds, UK
| | - Nikolaos K Kanakaris
- Academic Department of Trauma & Orthopaedic Surgery, University of Leeds, Clarendon Wing, Floor A, Great George Street, Leeds General Infirmary, LS1 3EX Leeds, UK
| | - Peter V Giannoudis
- Academic Department of Trauma & Orthopaedic Surgery, University of Leeds, Clarendon Wing, Floor A, Great George Street, Leeds General Infirmary, LS1 3EX Leeds, UK; NIHR Leeds Biomedical Research Unit, Chapel Allerton Hospital, Leeds, West Yorkshire, Leeds LS7 4SA, UK.
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