1
|
Huang C, Xu W, Ye X, Hong W, Xu Y, Liu Z, Li J. Changes in nail position and antirotation blade angles on the risk of femoral head varus in PFNA fixed patients: a clinical review and comprehensive biomechanical research. Eur J Med Res 2024; 29:336. [PMID: 38890700 PMCID: PMC11186283 DOI: 10.1186/s40001-024-01892-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 05/20/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Femoral head varus triggers poor clinical prognosis in intertrochanteric fracture patients with proximal femoral nail antirotation (PFNA) fixation. Studies present that changes in nail position and screw insertion angles will affect fixation stability, but the biomechanical significance of these factors on the risk of femoral head varus has yet to be identified in PFNA fixed patients. METHODS Clinical data in PFNA fixed intertrochanteric fracture patients have been reviewed, the relative position of intermedullary nail has been judged in the instant postoperative lateral radiography. Regression analyses have been performed to identify the effect of this factor on femoral head varus. Corresponding biomechanical mechanism has been identified by numerical mechanical simulations. RESULTS A clinical review revealed that ventral side nail insertion can trigger higher risk of femoral head varus, corresponding numerical mechanical simulations also recorded poor fixation stability in models with ventral side nail insertion, and changes in the trajectory of anti-rotation blade will not obviously affect this tendency. CONCLUSIONS Ventral side insertion of intramedullary nail can trigger higher risk of femoral head varus in PFNA fixed patients by deteriorating the instant postoperative biomechanical environment, and changes in blade trajectory cannot change this tendency biomechanically. Therefore, this nail position should be adjusted to optimize patients' prognosis.
Collapse
Affiliation(s)
- Chenyi Huang
- Department of Orthopedics, Luzhou Key Laboratory of Orthopedic Disorders, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, No. 182, Chunhui Road, Luzhou, 646000, Sichuan Province, People's Republic of China
| | - Wenqiang Xu
- Department of Orthopaedics, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, 210028, Jiangsu Province, People's Republic of China
| | - Xiong Ye
- Department of Orthopedics, Luzhou Key Laboratory of Orthopedic Disorders, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, No. 182, Chunhui Road, Luzhou, 646000, Sichuan Province, People's Republic of China
| | - Wanying Hong
- Department of Orthopaedics, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, 210028, Jiangsu Province, People's Republic of China
| | - Yue Xu
- Department of Orthopaedics, Changshu Hospital of Traditional Chinese Medicine, Changshu, 215500, Jiangsu Province, People's Republic of China
| | - Zongchao Liu
- Department of Orthopedics, Luzhou Key Laboratory of Orthopedic Disorders, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, No. 182, Chunhui Road, Luzhou, 646000, Sichuan Province, People's Republic of China.
| | - Jingchi Li
- Department of Orthopedics, Luzhou Key Laboratory of Orthopedic Disorders, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, No. 182, Chunhui Road, Luzhou, 646000, Sichuan Province, People's Republic of China.
| |
Collapse
|
2
|
Cha X, Zhou Q, Li J, Xu H, Xu W, Li J. Extending the intermedullary nail will not reduce the potential risk of femoral head varus in PFNA patients biomechanically: a clinical review and corresponding numerical simulation. BMC Musculoskelet Disord 2024; 25:405. [PMID: 38783225 PMCID: PMC11112938 DOI: 10.1186/s12891-024-07334-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 03/05/2024] [Indexed: 05/25/2024] Open
Abstract
Femoral head varus is an important complication in intertrochanteric fracture patients treated with proximal femoral nail anti-rotation (PFNA) fixation. Theoretically, extending the length of the intramedullary nail could optimize fixation stability by lengthening the force arm. However, whether extending the nail length can optimize patient prognosis is unclear. In this study, a review of imaging data from intertrochanteric fracture patients with PFNA fixation was performed, and the length of the intramedullary nail in the femoral trunk and the distance between the lesser trochanter and the distal locking screw were measured. The femoral neck varus status was judged at the 6-month follow-up. The correlation coefficients between nail length and femoral neck varus angle were computed, and linear regression analysis was used to determine whether a change in nail length was an independent risk factor for femoral neck varus. Moreover, the biomechanical effects of different nail lengths on PFNA fixation stability and local stress distribution have also been verified by numerical mechanical simulations. Clinical review revealed that changes in nail length were not significantly correlated with femoral head varus and were also not an independent risk factor for this complication. In addition, only slight biomechanical changes can be observed in the numerical simulation results. Therefore, commonly used intramedullary nails should be able to meet the needs of PFNA-fixed patients, and additional procedures for longer nail insertion may be unnecessary.
Collapse
Affiliation(s)
- Xiaofeng Cha
- Department of Orthopaedics, Luzhou Hospital of Traditional Chinese Medicine, Luzhou, Sichuan Province, 646000, P.R. China
| | - Qin Zhou
- Department of Orthopaedics, Luzhou Hospital of Traditional Chinese Medicine, Luzhou, Sichuan Province, 646000, P.R. China
| | - Jujie Li
- Department of Orthopaedics, Luzhou Hospital of Traditional Chinese Medicine, Luzhou, Sichuan Province, 646000, P.R. China
| | - Hong Xu
- Department of Orthopaedics, Luzhou Hospital of Traditional Chinese Medicine, Luzhou, Sichuan Province, 646000, P.R. China
| | - Wenqiang Xu
- Department of Orthopaedics, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, 210028, P.R. China.
| | - Jingchi Li
- Department of Orthopedics, Luzhou Key Laboratory of Orthopedic Disorders, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, Sichuan Province, P.R. China.
| |
Collapse
|
3
|
Kürüm H, Tosun HB, Aydemir F, Ayas O, Orhan K, Key S. Intertrochanteric Femoral Fractures: A Comparative Analysis of Clinical and Radiographic Outcomes Between Talon Intramedullary Nail and Intertan Nail. Cureus 2023; 15:e50877. [PMID: 38259364 PMCID: PMC10801105 DOI: 10.7759/cureus.50877] [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: 12/20/2023] [Indexed: 01/24/2024] Open
Abstract
Introduction Hip fractures in the elderly constitute a significant health concern, and their incidence is on the rise. It has been reported that intertrochanteric femoral fractures comprise a large portion of hip fractures, and they are especially prevalent among women. Over 75% of these types of fractures in the elderly occur as a result of simple falls. Surgical intervention must be performed for these fractures to expedite the healing process in patients. The application of a proximal femoral nail (PFN) is conducted using a minimally invasive technique after the fracture has been reduced using closed techniques. This technique maintains the fracture hematoma while minimizing the occurrence of consequences such as surgical trauma, hemorrhaging, infection, and issues with the wound site. This study aimed to assess the radiologic and functional outcomes among the groups following surgical procedures utilizing two distinct PFNs. Methods Between November 2021 and June 2023, a total of 96 individuals (38 males and 58 females) who underwent surgery for ITF using PFN were included in the study. Our surgical team utilized the Talon™ DistalFix™ PFN system (Orthopedic Designs North America Inc., FL, USA) and the Trigen InterTAN® nail (Smith & Nephew). Results The surgery time (number of scopes) for the Talon PFN was recorded as 25 (25-30), while it was 30 (30-35) in the InterTAN group (p<0.001). No nail protrusion was observed in the InterTAN group, whereas nail protrusion was observed in 12 patients (31.6%) in the Talon PFN group (p<0.001). Nail jamming was observed in two (5.3%) patients in the Talon PFN group, while none was observed in the InterTAN group (p<0.07). Conclusion In ITF fractures, the InterTAN nail is a more reliable implant. The shorter surgery time, reduced radiation exposure, and more minimally invasive nature of the Talon PFN might be preferred for geriatric patient populations with comorbidities where prolonged anesthesia could elevate mortality risks or for fractures of two or three pieces (Evans-Jansen Type 1 and Type 2). However, for more unstable fractures (Evans-Jensen Type 3) and in the active elderly patient group, we recommend the use of the InterTAN nail.
Collapse
Affiliation(s)
- Hüseyin Kürüm
- Orthopaedics and Traumatology Department, Ergani State Hospital, Ministry of Health, Diyarbakir, TUR
| | | | - Faruk Aydemir
- Emergency Department, Elazığ Fethi Sekin Training and Research Hospital, Elazığ, TUR
| | - Orhan Ayas
- Orthopaedics and Traumatology Department, Elazığ Fethi Sekin Training and Research Hospital, Elazığ, TUR
| | - Kübra Orhan
- Physical Therapy and Rehabilitation Department, İnönü University Turgut Özal Medical Center, Malatya, TUR
| | - Sefa Key
- Orthopedics and Traumatology Department, Firat University Hospital, Firat University, Elazığ, TUR
| |
Collapse
|