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Hançerli CÖ, Büyükdoğan H. Predicting mechanical complications in proximal femoral nailing for elderly patients: a radiological scoring system based on a single-centre retrospective cohort with 586 cases. Eur J Trauma Emerg Surg 2025; 51:172. [PMID: 40220190 PMCID: PMC11993480 DOI: 10.1007/s00068-025-02850-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2025] [Accepted: 03/23/2025] [Indexed: 04/14/2025]
Abstract
BACKGROUND Proximal femoral nailing (PFN) is a preferred treatment for intertrochanteric femoral fractures in elderly patients due to its minimally invasive nature and early mobilisation benefits. However, mechanical complications such as implant failure, cutout, and reduction collapse remain significant challenges. This study introduces the targeted surgical score (TSS), a novel scoring system designed to predict and mitigate mechanical complications by evaluating modifiable surgical factors. METHODS A retrospective analysis of 586 patients aged 65 and older treated with PFN between 2015 and 2022 was conducted. Data on demographic characteristics, fracture classifications, and surgical parameters were collected. Radiographic assessments included tip-apex distance (TAD) and lag screw positioning for implant placement quality, medial and anterior cortical support (MCS and ACS), and fracture alignment in both AP and lateral planes for reduction quality. Each parameter was scored, resulting in a cumulative TSS ranging from 0 to 8. Logistic regression and ROC curve analysis were performed to evaluate the predictive capacity of TSS. RESULTS The average TSS was 4.06 ± 2.22 in the complication group and 6.14 ± 1.56 in the non-complication group (p < 0.001). A one-point increase in TSS was associated with a 44.9% reduction in complication risk (OR 0.551; p < 0.001). Independent risk factors included lag screw placement (non-central superior quadrants), inadequate cortical support in AP and lateral planes (MCS and ACS), and TAD (≥ 25 mm). The TSS demonstrated relatively good discriminative ability with an AUC of 0.768. CONCLUSION TSS may aid in predicting and mitigating mechanical complications while potentially guiding surgical applications in PFN, but further prospective multicentre validation is required. While certain parameters of TSS could be considered intraoperatively, its full implementation may be more practical for postoperative risk assessment.
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Affiliation(s)
- Cafer Özgür Hançerli
- Bahçeşehir University, Medical Park Göztepe Hospital, Department of Orthopaedics and Traumatology, Istanbul, Turkey
| | - Halil Büyükdoğan
- Health Sciences University, Istanbul Kanuni Sultan Süleyman Training and Research Hospital, Department of Orthopaedics and Traumatology, Istanbul, Turkey.
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Zhou F, Fan J, Lv Y. The proximal femoral universal nail system (PFUN): a novel intramedullary nail for treating complex proximal femoral fractures and its biomechanical comparison with the proximal femoral nail anti-rotation (PFNA). J Orthop Surg Res 2025; 20:317. [PMID: 40140851 PMCID: PMC11948893 DOI: 10.1186/s13018-025-05724-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2025] [Accepted: 03/15/2025] [Indexed: 03/28/2025] Open
Abstract
AIMS The loss of medial and lateral wall support were the main risk factors of implant failure for proximal femoral fractures. A novel intramedullary nail, called proximal femoral universal nail system (PFUN), was proposed by our team to reconstruct the medial wall and lateral wall integrity and the biomechanical performance was evaluated in this study. METHODS The synthetic femora were assigned to three groups randomly according to three different proximal femoral fracture types. For each group, the PFUN or PFNA were implanted separately and divided into PFUN subgroup and PFNA subgroup. Biomechanical tests were separately conducted in the axial compression test, torsional test, and fatigue test in sequence. The finite element analysis (FEA) was conducted by ANSYS 14.5 and we analyzed the von Mises stress distribution and the model displacement of two implant models in three different fracture types. RESULTS For proximal femoral fractures with intact medial wall and lateral wall, our biomechanical results showed that the PFUN had a similar biomechanical property with the PFNA. Furthermore, the biomechanical results showed that the PFUN had a larger axial stiffness, higher torsional strength, and a similar failure load when compared with the PFNA for proximal femoral fracture with medial wall fracture. For proximal femoral fractures with broken medial wall and lateral wall, a larger axial stiffness, higher average torque and higher failure load were found in the PFUN when compared with the PFNA. The FEA results showed that the PFUN model had a higher stress concentration compared with the PFNA model, and the total displacement of the PFNA model increased by 11.63% when compared with the PFUN model in the proximal femoral fracture with broken medial wall and lateral wall. CONCLUSION Our results showed that PFUN had better biomechanical performance than PFNA, especially for complex proximal femoral fractures with medial wall fracture and lateral wall fracture, indicating that the PFUN had great potential as a new fixation strategy in future clinical applications.
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Affiliation(s)
- Fang Zhou
- Department of Orthopedics, Peking University Third Hospital, No. 49, North Garden Rd., Haidian District, Beijing, 100191, China.
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, 10091, China.
| | - Jixing Fan
- Department of Orthopedics, Peking University Third Hospital, No. 49, North Garden Rd., Haidian District, Beijing, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, 10091, China
| | - Yang Lv
- Department of Orthopedics, Peking University Third Hospital, No. 49, North Garden Rd., Haidian District, Beijing, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, 10091, China
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Garabano G, Juri A, Perez Alamino L, Rodriguez JA, Pesciallo CA. Predicting cut-out in intertrochanteric fractures fixed with cephalomedullary nails: the role of tip-to-apex distance referenced to calcar (calTAD)--A retrospective analysis of 158 cases. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 35:24. [PMID: 39585420 DOI: 10.1007/s00590-024-04130-2] [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: 08/25/2024] [Accepted: 10/26/2024] [Indexed: 11/26/2024]
Abstract
INTRODUCTION The optimal positioning of the cephalic screw in intertrochanteric fractures (ITFs) is crucial for minimizing the risk of cut-out. This study assesses the predictive value of the tip-to-apex distance (TAD) and tip-to-apex distance referenced to calcar (calTAD) for cut-outs in patients undergoing fixation with cephalomedullary nails. METHOD We analyzed 158 consecutive patients aged over 65 years (mean 83.6 ± 15.9) with intertrochanteric hip fractures who underwent cephalomedullary nailing between January 2016 and July 2022. Receiver operating characteristic (ROC) curves were used to determine the optimal cut-off points for TAD and calTAD. Uni- and multivariate logistic regression analyses were conducted to identify independent predictors of cut-out, considering demographic data, comorbidities, fracture type (AO/OTA), reduction quality (according to Baumgartner classification), TAD, and calTAD. RESULTS Cut-out occurred in 12 patients (7.5%). ROC analysis identified 18.99 mm as the optimal cut-off for TAD (sensitivity 83.3%, specificity 63.7%; area under the curve-AUC- 0.703, p = 0.009) and 24.95 mm for calTAD (sensitivity 100%, specificity 82.9%, AUC = 0.906, p = < 0.0001). Univariate analysis revealed no significant differences in demographics, fracture type, or reduction quality between patients with and without cut-outs. Multivariate analysis identified calTAD > 24.95 mm as the only independent predictor of cut-out, with an Odds ratio of 24.62 (95% Confidence Interval 27.61-68.92, p = 0.001). CONCLUSION Our findings suggest that calTAD is a helpful measure for predicting cut-outs in intertrochanteric fracture fixation using cephalomedullary nails in the context of good fracture reduction. Surgeons should aim to keep calTAD values below 24.95 mm to reduce the risk of cut-out, as values above this threshold significantly increase the risk.
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Affiliation(s)
- Germán Garabano
- Orthopaedic and Trauma Surgery Department, British Hospital of Buenos Aires, Perdriel 74, C1280 AEB, Buenos Aires, Argentina.
- Scientific Advisory Committee, British Hospital of Buenos Aires, Buenos Aires, Argentina.
| | - Andres Juri
- Orthopaedic and Trauma Surgery Department, British Hospital of Buenos Aires, Perdriel 74, C1280 AEB, Buenos Aires, Argentina
| | - Leonel Perez Alamino
- Orthopaedic and Trauma Surgery Department, British Hospital of Buenos Aires, Perdriel 74, C1280 AEB, Buenos Aires, Argentina
| | - Joaquin Anibal Rodriguez
- Orthopaedic and Trauma Surgery Department, British Hospital of Buenos Aires, Perdriel 74, C1280 AEB, Buenos Aires, Argentina
| | - Cesar Angel Pesciallo
- Orthopaedic and Trauma Surgery Department, British Hospital of Buenos Aires, Perdriel 74, C1280 AEB, Buenos Aires, Argentina
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Wu LF, Zhang TS, Li J, Huang H, Zhou CH, Li X. Construction and validation of a nomogram prediction model for internal fixation failure after proximal femoral anti-rotation intramedullary nailing in the treatment of intertrochanteric fractures of the femur. Medicine (Baltimore) 2024; 103:e40575. [PMID: 39809193 PMCID: PMC11596523 DOI: 10.1097/md.0000000000040575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 10/30/2024] [Indexed: 01/16/2025] Open
Abstract
The aim was to study the independent risk factors of internal fixation failure in proximal femoral anti-rotation intramedullary nailing for intertrochanteric femur fracture, and to build a nomogram prediction model accordingly. Clinical data of patients with intertrochanteric femoral rotor fractures admitted to the First People's Hospital of Longquanyi District from January 2018 to January 2023 were retrospectively collected. The occurrence of spiral blade cut out, internal fixation breakage, peri-internal fixation fracture, hip internal rotation deformity, and fracture nonunion within 1 year after surgery were included in the internal fixation failure group, and the rest were included in the internal fixation success group. Univariate and multivariate logistic regression analyses were used to determine the independent risk factors for postoperative internal fixation failure, and the corresponding nomogram was established. Subject operating characteristic curves and calibration curves were plotted to assess model performance, and to further improve the reliability of the validation results, internal validation was performed using Bootstrap combined with 10-fold cross-validation rows to assess the clinical utility of the model using decision curve analysis. Ultimately, 374 patients with intertrochanteric fractures were included in the study, and 57 patients were included in the internal fixation failure group, with an internal fixation failure rate of 15.24%. After univariate and multivariate logistic regression analyses, a total of 5 factors were identified as independent risk factors for internal fixation failure after intertrochanteric femur fracture surgery: unstable fracture, comorbid underlying disease, severe osteoporosis, a cusp distance of >30 mm, and poor quality of fracture reduction. Postoperative internal fixation failure of intertrochanteric fractures of femur is affected by multiple factors, and clinically orthopedic surgeons should formulate reasonable and effective solutions for high-risk patients in order to protect the surgical effect and improve the success rate of surgery.
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Affiliation(s)
- Lin-Feng Wu
- Department of Orthopedics, The First People’s Hospital of Longquanyi District, Chengdu, Sichuan, China
| | - Tian-Shuang Zhang
- Department of Orthopedics, The First People’s Hospital of Longquanyi District, Chengdu, Sichuan, China
| | - Juan Li
- Rehabilitation Department, The First People’s Hospital of Longquanyi District, Chengdu, Sichuan, China
| | - Hui Huang
- Pain Medicine, The First People’s Hospital of Longquanyi District, Chengdu, Sichuan, China
| | - Cai-Hong Zhou
- Department of Orthopedics, The First People’s Hospital of Longquanyi District, Chengdu, Sichuan, China
| | - Xu Li
- Department of Orthopedics, The First People’s Hospital of Longquanyi District, Chengdu, Sichuan, China
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Yang FC. Conversion hip arthroplasty for failed nailing of intertrochanteric fracture: Reflections on some important aspects. World J Orthop 2024; 15:997-1000. [PMID: 39473519 PMCID: PMC11514554 DOI: 10.5312/wjo.v15.i10.997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Revised: 09/03/2024] [Accepted: 09/12/2024] [Indexed: 10/11/2024] Open
Abstract
In this editorial, I present my comments on the article by Solarino et al. Conversion hip arthroplasty, which is an optional salvage procedure performed following unsuccessful fixation of intertrochanteric femur fractures in elderly patients, entails more complex processes and higher rates of operative complications than primary arthroplasty. Hence, it is important to consider the appropriateness of the primary treatment choice, as well as the adequacy of nailing fixation for intertrochanteric fractures. This article briefly analyzes the possible factors contributing to the nailing failure of intertrochanteric fractures and attempts to find corresponding countermeasures to prevent fixation failures. It also analyzes the choice of treatment between nailing fixation and primary arthroplasty for intertrochanteric fractures.
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Affiliation(s)
- Fu-Chun Yang
- Department of Orthopedic Trauma and Hand Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
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Horoz L, Kilic AI, Kircil C, Cakmak MF. Flexible reamer use to overcome entry point errors in proximal femoral nail application in severe obese intertrochanteric fracture patients. BMC Musculoskelet Disord 2024; 25:810. [PMID: 39402546 PMCID: PMC11472549 DOI: 10.1186/s12891-024-07933-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 10/08/2024] [Indexed: 10/19/2024] Open
Abstract
INTRODUCTION Proximal femoral nailing (PFN) offers biomechanical benefits for intertrochanteric fractures but can lead to higher complication rates from poor reduction and technique errors, particularly in obese patients. Incorrect entry points may cause reduction loss, iatrogenic fractures, and misplaced lag screws. The study aims to investigate the effect of using an oriented flexible reamer instead of a rigid reamer on clinical and radiological results to obtain a medial entry point and better positioning of the nail in the intramedullary area in obese intertrochanteric fracture patients. MATERIALS AND METHODS A retrospective analysis was conducted on patients aged 65 years and older who underwent PFN treatment between March 2020 and June 2022 at a single institution, with at least 1-year postoperative follow-up. Patients were divided into two groups: those applied with a flexible reamer and a rigid reamer. Parameters analyzed from postoperative radiographs included tip-apex distance (TAD), calcar-referenced tip-apex distance (CalTAD), reduction quality, femoral neck-shaft angle, and lag screw placement. Complication rates and types were recorded for each group. RESULT The analysis included 91 patients, with 45 treated using a flexible reamer and 46 treated using a rigid reamer. There was no statistical difference between the two groups regarding age, gender, BMI, and AO class distributions of the patients (p > 0.05). The Femur neck shaft angle was significantly higher in the flexible reamer group (p < 0.001). As a result of the reduction types analysis, medial type reduction was significantly higher in the group where the flexible reamer was applied (p < 0.001). The CalTAD was shorter in the Flexible reamer group (p = 0.005). Complications and the need for reoperation were statistically significantly higher in the rigid reamer group (p < 0.048). CONCLUSION The oriented flexible reamer reduces application-related errors in patients undergoing proximal femoral nail (PFN) treatment due to intertrochanteric fracture. The oriented flexible reamer technique allows a more medial entry point. Oriented flexible reamer creates enough space on both fracture sides at the level of intertrochanteric fracture to avoid nail pass-related complications. LEVEL OF EVIDENCE Level III, Case-control study.
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Affiliation(s)
- Levent Horoz
- Orthopedics and Traumatology, Kirşehir Ahi Evran University, Kirsehir, Turkey
| | - Ali Ihsan Kilic
- Orthopedics and Traumatology, Izmir Bakircay University, Orthopedics and Traumatology, Cigli Training and Research Hospital, Izmir, 35620, Turkey.
| | - Cihan Kircil
- Orthopedics and Traumatology, Kirşehir Ahi Evran University, Kirsehir, Turkey
| | - Mehmet Fevzi Cakmak
- Orthopedics and Traumatology, Kirşehir Ahi Evran University, Kirsehir, Turkey
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Gonzalez CA, Van Rysselberghe NL, Whittaker MJ, Ngo D, Michaud JB, Gardner MJ. Integrated Dual Lag Screws Have Higher Reoperation Rates for Fixation Failure Than Single Lag Component Cephalomedullary Nails: A Retrospective Study of 2,130 Patients with Intertrochanteric Femoral Fractures. J Bone Joint Surg Am 2024; 106:1673-1679. [PMID: 39042721 DOI: 10.2106/jbjs.23.01152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
BACKGROUND Previous studies comparing reoperation risk between integrated dual lag screw (IDL) and single lag component (SL) cephalomedullary nails (CMNs) in the treatment of intertrochanteric femoral fractures have demonstrated mixed results. The purpose of this study was to assess the rates of reoperation for fixation failure and all-cause reoperation in a large, multi-institutional cohort of patients with an intertrochanteric fracture treated with an IDL or SL CMN. We hypothesized that there would be no difference between the groups with respect to either of the reoperation rates. METHODS Adults (≥18 years old) who sustained an intertrochanteric fracture (AO/OTA 31A1 to 31A3) treated with an IDL or SL CMN between January 2014 and May 2021 at 1 of 13 Level-I trauma centers were included. Patients with <3 months of follow-up or pathologic fractures were excluded. Rates of reoperation were compared with use of the chi-square test and multivariable regression, controlling for age, gender, injury mechanism, fracture pattern, and postoperative neck-shaft angle. RESULTS A total of 2,130 patients met the inclusion criteria. The median age was 78 years, and 62.5% of patients were female. The cohort consisted of 287 patients (13.5%) with an IDL CMN and 1,843 patients (86.5%) with an SL CMN. A total of 99 patients (4.6%) had a reoperation of any type, of whom 29 (1.4% of all patients) had a reoperation for fixation failure. Compared with patients with an SL CMN, those with an IDL CMN had higher rates (4.2% versus 0.9%; p < 0.001) and odds (odds ratio [OR], 4.95 [95% confidence interval (CI), 2.29 to 10.69]; p < 0.001) of reoperation for fixation failure as well as higher rates (7.3% versus 4.2%; p = 0.021) and odds (OR, 1.83 [95% CI, 1.10 to 3.06]; p = 0.021) of all-cause reoperation. CONCLUSIONS Intertrochanteric femoral fractures treated with an IDL CMN were associated with low but significantly higher rates and significantly higher odds of reoperation for fixation failure and all-cause reoperation compared with those treated with an SL CMN. We suggest caution to surgeons in the use of IDL CMNs for high-risk patients and recommend using SL CMNs for most patients with intertrochanteric femoral 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)
| | | | - Mathew J Whittaker
- Stanford Health Care, Stanford University Medical Center, Stanford, California
| | - Daniel Ngo
- University of Texas Health Science Center at Houston, Houston, Texas
| | - John B Michaud
- Stanford Health Care, Stanford University Medical Center, Stanford, California
| | - Michael J Gardner
- Stanford Health Care, Stanford University Medical Center, Stanford, California
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Tang Z, Zhu Z, Lv Y, Lu Y, Huang S, Zhou C, Zhang Y, Wang B. Biomechanical difference analysis of new and classic intramedullary nail devices in the treatment of basal femoral neck fractures: finite element analysis. BMC Musculoskelet Disord 2024; 25:697. [PMID: 39223520 PMCID: PMC11370041 DOI: 10.1186/s12891-024-07830-2] [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: 07/09/2024] [Accepted: 08/29/2024] [Indexed: 09/04/2024] Open
Abstract
OBJECTIVE There is currently a lack of in-depth comparative evaluation regarding the biomechanical properties of novel intramedullary nail devices in the treatment of basal femoral neck fractures (BFNF). This study aims to utilize finite element analysis to compare the performance differences of two novel devices with traditional PFNA and InterTan nails in the fixation of BFNF. METHODS Based on a validated finite element model, this study constructed an accurate BFNF model and implanted four different intramedullary nail devices: PFNA, InterTan nail, PFBN (proximal femoral biomimetic nail), and NIS (novel intramedullary system). Under a vertical load of 2100N, the displacement and Von Mises stress (VMS) distribution of each group of models were evaluated through simulation testing. RESULTS Under a load of 2100N, the PFBN device exhibited the best performance in terms of displacement and peak stress, while PFNA performed poorly. The peak displacement of the NIS device was lower than that of PFNA and InterTan nails, while the peak stress of the InterTan nail was lower than that of PFNA and NIS. CONCLUSION The PFBN device demonstrates stronger load-bearing and shear-resistant properties in the treatment of BFNF, and the NIS device also shows significant improvement in stability. Therefore, both the PFBN and NIS devices are reliable internal fixation techniques for the treatment of CFIFs, with potential clinical application prospects.
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Affiliation(s)
- Zhongjian Tang
- Department of Orthopaedics, The Second Affiliated Hospital of XuZhou Medical University, Xuzhou, 221000, China
- Graduate School of Xuzhou Medical University, Xuzhou, 221000, China
| | - Zhexi Zhu
- Department of Orthopaedics, The Second Affiliated Hospital of XuZhou Medical University, Xuzhou, 221000, China
- Graduate School of Xuzhou Medical University, Xuzhou, 221000, China
| | - Yongxiang Lv
- Department of Orthopaedics, The Second Affiliated Hospital of XuZhou Medical University, Xuzhou, 221000, China
| | - Yafei Lu
- Department of Orthopaedics, The Second Affiliated Hospital of XuZhou Medical University, Xuzhou, 221000, China
- Graduate School of Xuzhou Medical University, Xuzhou, 221000, China
| | - Shaolong Huang
- Department of Orthopaedics, The Second Affiliated Hospital of XuZhou Medical University, Xuzhou, 221000, China
- Graduate School of Xuzhou Medical University, Xuzhou, 221000, China
| | - Chengqiang Zhou
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400000, China
| | - Yazhong Zhang
- Department of Orthopaedics, The Second Affiliated Hospital of XuZhou Medical University, Xuzhou, 221000, China
| | - Bin Wang
- Department of Orthopaedics, The Second Affiliated Hospital of XuZhou Medical University, Xuzhou, 221000, China.
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Horoz L, Cakmak MF, Cici H. Efficacy of poller screw in addition to lag screw in the treatment of intertrochanteric fractures with proximal femoral nail: a biomechanical evaluation. Eur J Trauma Emerg Surg 2024; 50:1591-1598. [PMID: 38480566 DOI: 10.1007/s00068-024-02477-z] [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: 11/06/2023] [Accepted: 02/19/2024] [Indexed: 10/08/2024]
Abstract
PURPOSE The most common type of failure in treating intertrochanteric fractures with proximal femoral nails is cut-out due to varus collapse. We aim to evaluate the effect of the poller screw applied to the proximal fragment and the lag screw on varus collapse and stability in intertrochanteric fractures. METHODS An unstable intertrochanteric fracture model without medial support was simulated in 20 synthetic femur models. In the poller screw group, in addition to the lag screw, pole screws were applied to the proximal fragment superior and inferior to the lag screw. In the progressive cyclic loading test, starting from 100 N, the loading was increased by 50 N in each cycle, and the test was continued until the maximum load at which failure occurred as a result of conditioning cycles and progressive cyclic loading tests, stiffness, type of failure, force at failure, lag screw displacement, and varus collapse were recorded. RESULT The average stiffness was found to be 124.705 N/mm in the poller screw group and 102.77 N/mm in the control group (P < 0.001). The maximum load to failure was 1897.10 N in the poller screw group and 1475.20 N in the control group (P < 0.001). The average displacement of the lag screw within the femoral head was 0.85 mm in the poller screw group and 3.60 mm in the control group (P < 0.001). CONCLUSION As a result, it has been shown that poller screws applied around the lag screw increase fixation stiffness and reduce varus collapse.
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Affiliation(s)
- Levent Horoz
- Kirsehir Ahi Evran University, Kırşehir, Turkey.
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Sun SH, Chen CY, Lin KC. A New Postoperative Stability Score to Predict Loss of Reduction in Intertrochanteric Fractures in Elderly Patients. Life (Basel) 2024; 14:858. [PMID: 39063612 PMCID: PMC11277649 DOI: 10.3390/life14070858] [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: 05/19/2024] [Revised: 06/28/2024] [Accepted: 07/03/2024] [Indexed: 07/28/2024] Open
Abstract
The study aimed to validate a newly developed postoperative stability score for evaluating clinical follow-up in elderly patients with low-energy hip fractures. From 1 January 2020 to 31 December 2021, we enrolled patients aged over 65 who underwent cephalomedullary nail fixation using proximal femoral nail antirotation II (PFNAII) and had at least 6 months of follow-up; excluding multiple fractures, pathological fractures, and periprosthetic fractures. We collected general patient data. Parameters such as TAD, Parker's ratio (AP and lateral), and the new postoperative stability score were recorded. A loss of reduction was defined using the decline in the Chang reduction quality criteria (CRQC) score within one month. Among the 108 enrolled patients, 23 (21.3%) experienced a loss of reduction, with a mean age of 82.1 years and a mean follow-up time of 7.4 months. Univariate analysis showed no significant association between loss of reduction and general data. However, the new postoperative stability score correlated significantly with loss of reduction (mean scores: 6.68 vs. 4.83, p = 0.045). Multivariate analysis confirmed this association (odds ratio: 0.076, 95% confidence interval: 0.022-0.263, p < 0.05). The newly developed postoperative stability score, incorporating surgical technique assessment, improves prediction accuracy for loss of reduction in elderly intertrochanteric fracture (ITF) patients.
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Affiliation(s)
- Shih-Heng Sun
- Department of Rehabilitation, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan 330, Taiwan;
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
| | - Chun-Yu Chen
- Department of Orthopedics, Kaohsiung Veterans General Hospital, Kaohsiung 81341, Taiwan;
| | - Kai-Cheng Lin
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
- Department of Orthopedics, Kaohsiung Veterans General Hospital, Kaohsiung 81341, Taiwan;
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Tangkanjanavelukul P, Thaitalay P, Srisuwan S, Petchwisai P, Thasanaraphan P, Saramas Y, Nimarkorn K, Warojananulak W, Kanchanomai C, Rattanachan ST. Feasibility biomechanical study of injectable Biphasic Calcium Phosphate bone cement augmentation of the proximal femoral nail antirotation (PFNA) for the treatment of two intertrochanteric fractures using cadaveric femur. Biomed Phys Eng Express 2024; 10:045043. [PMID: 38772347 DOI: 10.1088/2057-1976/ad4e3c] [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: 02/20/2024] [Accepted: 05/21/2024] [Indexed: 05/23/2024]
Abstract
This study evaluated the feasibility of the femoral bone after fixation using biphasic calcium phosphate cement-augmentation of the proximal femoral nail antirotation (PFNA) compared with PFNA without cement. This study presented to compare the stiffness, fatigue testing, and compressive strength between stable (AO31-A2.1) and unstable (AO31-A3.3) intertrochanteric fractures treated by cement augmented PFNA of the cadaveric femoral. Biphasic calcium phosphate cement was injected to align and compatible with PFNA and the reconstructive procedure was monitored the cement placement using x-ray imaging during operation. The testing demonstrated that the cement could be injected through a small needle (13 G, 16 cm length, 1.8 mm inner diameter) within a suitable operating time. The feasibility study of the biomechanical testing was divided into three tests: stiffness test, fatigue cyclic load, and compression test. The results showed that the cement-augmented specimens exhibited higher stiffness than the control specimens without cement. The cement-augmented specimens also showed lower strain energy during the fatigue test, resulting in higher compressive strength (4730.7 N) compared to the control specimens (3857.4 N). There is a correlation between BMD and fracture load and the increase in compression load of the cement-augmented femoral compared to the controls as well as an increase in strain energy of fatigue cyclic testing was found. Biphasic calcium phosphate cement-augmented of the PFNA biomechanically enhanced the cut-out resistance in intertrochanteric fracture. This procedure is especially efficient for unstable intertrochanteric fracture suggesting the potential benefits of using biphasic calcium phosphate cement in medical applications.
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Affiliation(s)
- Ponthep Tangkanjanavelukul
- Institute of Medicine, Suranaree University of Technology, 111 University Avenue, Muang, Nakhon Ratchasima 30000, Thailand
| | - Paritat Thaitalay
- Institute of Engineering, Suranaree University of Technology, 111 University Avenue, Muang, Nakhon Ratchasima 30000, Thailand
| | - Sawitri Srisuwan
- Institute of Engineering, Suranaree University of Technology, 111 University Avenue, Muang, Nakhon Ratchasima 30000, Thailand
| | - Pongpayap Petchwisai
- Fort Suranari Hospital, 211 Pibool La-Iad Rd, Nong Phai Lom, Mueang, Nakhon Ratchasima 30000, Thailand
| | - Pornsak Thasanaraphan
- Thailand Institute of Scientific and Technological Research, 35 Mu 3, Khlong Ha, Khlong Luang, Pathum Thani, 12120, Thailand
| | - Yotakarn Saramas
- Thailand Institute of Scientific and Technological Research, 35 Mu 3, Khlong Ha, Khlong Luang, Pathum Thani, 12120, Thailand
| | - Kittiphong Nimarkorn
- Thailand Institute of Scientific and Technological Research, 35 Mu 3, Khlong Ha, Khlong Luang, Pathum Thani, 12120, Thailand
| | - Woranat Warojananulak
- Thailand Institute of Scientific and Technological Research, 35 Mu 3, Khlong Ha, Khlong Luang, Pathum Thani, 12120, Thailand
| | - Chaosuan Kanchanomai
- Faculty of Engineering, Thammasat University, 99 Moo18 Phaholyothin Rd. Ampher Khlongluang, Pathumthani 12120, Thailand
| | - Sirirat Tubsungnoen Rattanachan
- Institute of Engineering, Suranaree University of Technology, 111 University Avenue, Muang, Nakhon Ratchasima 30000, Thailand
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Zhu Z, Yang Y, Li L, Zhu SJ, Zhang L. A probabilistic approach for assessing the mechanical performance of intertrochanteric fracture stabilized with proximal femoral nail antirotation. PLoS One 2024; 19:e0299996. [PMID: 38603691 PMCID: PMC11008846 DOI: 10.1371/journal.pone.0299996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 02/19/2024] [Indexed: 04/13/2024] Open
Abstract
Maintaining post-operative mechanical stability is crucial for successfully healing intertrochanteric fractures treated with the Proximal Femoral Nail Antirotation (PFNA) system. This stability is primarily dependent on the bone mineral density (BMD) and strain on the fracture. Current PFNA failure analyses often overlook the uncertainties related to BMD and body weight (BW). Therefore, this study aimed to develop a probabilistic model using finite element modeling and engineering reliability analysis to assess the post-operative performance of PFNA under various physiological loading conditions. The model predictions were validated through a series of experimental test. The results revealed a negative nonlinear relationship between the BMD and compressive strain. Conversely, the BW was positively and linearly correlated with the compressive strain. Importantly, the compressive strain was more sensitive to BW than to BMD when the BMD exceeded 0.6 g/cm3. Potential trabecular bone compression failure is also indicated if BMD is equal to or below 0.15 g/cm3 and BW increases to approximately 2.5 times the normal or higher. This study emphasizes that variations in the BMD significantly affect the probability of failure of a PFNA system. Thus, careful planning of post-operative physical therapy is essential. For patients aged > 50 years restrictions on high-intensity activities are advised, while limiting strenuous movements is recommended for those aged > 65 years.
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Affiliation(s)
- Zhiqi Zhu
- Department of Orthopedics, Longgang District People’s Hospital of Shenzhen, Guangdong, P. R. China
| | - Yi Yang
- Department of Infrastructure Engineering, The University of Melbourne, Victoria, Australia
| | - Lunjian Li
- Department of Infrastructure Engineering, The University of Melbourne, Victoria, Australia
| | - Shuang Jie Zhu
- Department of Mechanical and Product Design Engineering, Swinburne University of Technology, Victoria, Australia
| | - Lihai Zhang
- Department of Infrastructure Engineering, The University of Melbourne, Victoria, Australia
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13
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Rashid RH, Zahid M, Mariam F, Ali M, Moiz H, Mohib Y. Effectiveness of Proximal Femur Nail in the Management of Unstable Per-Trochanteric Fractures: A Retrospective Cohort Study. Cureus 2024; 16:e58078. [PMID: 38738121 PMCID: PMC11088713 DOI: 10.7759/cureus.58078] [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: 04/07/2024] [Indexed: 05/14/2024] Open
Abstract
Background Intertrochanteric (IT) fractures in the elderly demand surgical intervention for optimal recovery. While dynamic hip screw (DHS) is standard for stable fractures, its use in unstable cases is debated. Proximal femur nail (PFN) addresses unstable per-trochanteric fractures, boasting biomechanical advantages. Many studies favor PFN over DHS, despite concerns like screw migration. In resource-constrained developing nations, the choice of implant is pivotal. This research assesses proximal femur nailing outcomes for unstable fractures, providing insights for regional orthopedic protocols and contributing to tailored treatment guidelines in contexts with limited resources. Objective To assess the clinical and radiological outcomes in patients undergoing proximal femur nailing for unstable per-trochanteric fractures. Material and Methods This retrospective single-arm cohort study was conducted from January 2020 to July 2022. All the consecutive patients who underwent PFN for unstable per-trochanteric fractures were included in this study. Harris Hip Score (HHS) and ambulation status were recorded to evaluate functional outcomes. In contrast, the radiological outcome was assessed by calculating Radiographic Union Score for Hip (RUSH) scores at six weeks, three months, and six months post-operatively. Results A total of 48 patients were included in this study with equal gender distribution and a mean age of 66 years. The functional outcome was recorded with 2.1% (1), 33.3% (16), and 50% (24) of patients achieving full weight bearing (FWB) without pain at six weeks, three months, and six months respectively while 14.6% (7) of the patients never achieved FWB. The radiological outcome was assessed by calculating RUSH score with 6.3% (3), 43.8% (21), and 50% (24) of the patients achieving complete union at the end of six weeks, three months, and six months respectively. One patient (2.1%) experienced malunion. Conclusion PFN remains an optimal treatment modality for the fixation of unstable per-trochanteric fractures yielding promising functional and radiological outcomes.
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Affiliation(s)
- Rizwan H Rashid
- Orthopedic Surgery, Aga Khan University Hospital, Karachi, PAK
| | - Marij Zahid
- Orthopedics and Traumatology, Aga Khan University Hospital, Karachi, PAK
| | - Fizzah Mariam
- Orthopedic Surgery, Aga Khan University Hospital, Karachi, PAK
| | - Moiz Ali
- Orthopedic Surgery, Aga Khan University Hospital, Karachi, PAK
| | - Hassan Moiz
- Orthopedic Surgery, Aga Khan University Hospital, Karachi, PAK
| | - Yasir Mohib
- Orthopedic Surgery, Aga Khan University Hospital, Karachi, PAK
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14
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Cheng X, Yang Y, Zhu J, Li G, Chen W, Wang J, Zhang Q, Zhang Y. Finite element analysis of basicervical femoral neck fracture treated with proximal femoral bionic nail. J Orthop Surg Res 2023; 18:926. [PMID: 38053203 DOI: 10.1186/s13018-023-04415-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 11/27/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Dynamic hip screws (DHS) and proximal femoral nail anti-rotation (PFNA) were recommended for basicervical femoral neck fracture (BFNF), however, with high rate of postoperative femoral neck shortening. The proximal femoral bionic nail (PFBN) was designed to decrease the postoperative complications associated with DHS and PFNA. The aim of this study is to compare the biomechanical characters of DHS, PFNA, and PFBN for fixation of BFNF. METHODS Using finite element analysis, we created a three-dimensional model of the BFNF for this investigation. The PFBN group, the PFNA group and the DHS + DS group were our three test groups. For each fracture group, the von Mises stress and displacements of the femur and internal fixation components were measured under 2100 N axial loads. RESULTS The PFBN group demonstrated the lowest stress on the implants, significantly lower than the PFNA and DHS + DS groups. In terms of stress on the implants, the PFBN group exhibited the best performance, with the lowest stress concentration at 112.0 MPa, followed by the PFNA group at 124.8 MPa and the DHS + DS group at 149.8 MPa. The PFBA group demonstrated the smallest displacement at the fracture interface, measuring 0.21 mm, coupled with a fracture interface pressure of 17.41 MPa, signifying excellent stability. CONCLUSIONS Compared with DHS and PFNA, PFBN has advantages in stress distribution and biological stability. We believe the concept of triangle fixation will be helpful to reduce femoral neck shortening associated with DHS and PFNA and thus improve the prognosis of BFNF.
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Affiliation(s)
- Xiaodong Cheng
- Department of Orthopaedics, Trauma Emergency Center, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, Hebei, 050051, People's Republic of China
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China
| | - Yanjiang Yang
- Department of Orthopaedics, Trauma Emergency Center, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, Hebei, 050051, People's Republic of China
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China
| | - Jian Zhu
- Shanxi Bethune Hospital, Shanxi Academy of Medical Science, No. 99, Longcheng Street, Taiyuan, 030032, Shanxi Province, People's Republic of China
| | - Guimiao Li
- Department of Orthopaedics, Trauma Emergency Center, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, Hebei, 050051, People's Republic of China
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China
| | - Wei Chen
- Department of Orthopaedics, Trauma Emergency Center, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, Hebei, 050051, People's Republic of China
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China
| | - Juan Wang
- Department of Orthopaedics, Trauma Emergency Center, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, Hebei, 050051, People's Republic of China
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China
| | - Qi Zhang
- Department of Orthopaedics, Trauma Emergency Center, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, Hebei, 050051, People's Republic of China.
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China.
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China.
| | - Yingze Zhang
- Department of Orthopaedics, Trauma Emergency Center, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, Hebei, 050051, People's Republic of China.
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China.
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China.
- NHC Key Laboratory of Intelligent Orthopaedic Equipment, Shijiazhuang, Hebei, 050051, People's Republic of China.
- Hebei Orthopaedic Clinical Research Center, Shijiazhuang, Hebei, 050051, People's Republic of China.
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15
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Mao Q, Zhang Y, Hua J, He B. Mid-Term Follow-Up Results After Hemiarthroplasty Using Long Femoral Stem Prosthesis (Peerless-160) for Intertrochanteric Fractures in Octogenarians. Geriatr Orthop Surg Rehabil 2023; 14:21514593231184314. [PMID: 37360575 PMCID: PMC10286170 DOI: 10.1177/21514593231184314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 06/04/2023] [Accepted: 06/08/2023] [Indexed: 06/28/2023] Open
Abstract
Purpose To analyze the clinical effect and imaging data of cementless bipolar hemiarthroplasty employing a long femoral stem (peerless-160) and 2 reconstructed femoral titanium wires to repair intertrochanteric fractures among the octogenarians. Methods Between June 2014 and August 2016, 58 octogenarians with femoral intertrochanteric fractures underwent the long femoral stem (peerless-160) cementless bipolar hemiarthroplasty by the same surgeon. We assessed clinical and radiological outcomes such as operative time, bleeding volume, blood transfusion volume, length of hospital stay, full weight-bearing walking time, walking ability calculated by Koval classification and Harris Hip Score (HHS), including fracture healing and greater trochanter fragments subsidence. Result The surgery was successfully performed in all patients. The average operation time was 72.8 ± 13.2 min, the average blood loss during surgery was 225.0 ± 91.4 mL, 200 mL of blood was transfused, the mean duration of hospitalization was 11.9 ± 4.0 days, the mean time of full weight bearing was 12.5 ± 3.8 days. Patients were followed up for 24-68 months, averagely 49.4 ± 10.3 months. During follow-up, 4 (6.9%) patients died, and 1 (1.7%) was completely lost to ask about the recent situation. The average Harris Hip Score at the last follow-up was 87.8 ± 6.1, most of the patients recovered walking ability, under radiological examination, the prosthesis showed no signs of loosening. All trochanteric fractures gradually healed, the clinical and radiographic signs of healing occurred at average of 4.0 ± 1.1 months postoperatively. Conclusion For osteoporotic unstable intertrochanteric fractures in octogenarians, this study confirmed that the Cementless Bipolar Hemiarthroplasty Using a Long Femoral stem (peerless-160) with double cross binding technique is a satisfactory and safe choice for the octogenarians.
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Affiliation(s)
- Qiang Mao
- Department of Orthopedics, The First Affiliated Hospital of Zhejiang Chinese Medicine University, Hangzhou, China
| | - Yi Zhang
- The Zhejiang Chinese Medicine University, Hangzhou, China
| | - Jiang Hua
- Department of Orthopedics, The First Affiliated Hospital of Zhejiang Chinese Medicine University, Hangzhou, China
| | - Bangjian He
- Department of Orthopedics, The First Affiliated Hospital of Zhejiang Chinese Medicine University, Hangzhou, China
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16
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Suh YS, Nho JH, Song MG, Lee DW, Jang BW. Midterm Outcomes of Intramedullary Fixation of Intertrochanteric Femoral Fractures Using Compression Hip Nails: Radiologic and Clinical Results. Clin Orthop Surg 2023; 15:373-379. [PMID: 37274494 PMCID: PMC10232309 DOI: 10.4055/cios22149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 08/20/2022] [Accepted: 08/22/2022] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Various implants are used to treat intertrochanteric fractures. However, the optimal implant to stabilize intertrochanteric femoral fractures is still a matter of debate. The purpose of the present study was to evaluate the midterm outcomes of patients treated using compression hip nails (CHNs). METHODS Between March 2013 and April 2018, 164 patients with intertrochanteric femoral fractures who were treated with internal fixation using CHNs were enrolled in this study. The mean age of the patients was 79.6 years. We retrospectively collected and estimated information such as reduction state, implant position, operation time, blood loss, hospital stay, time to achieve union, clinical scores (Harris hip score [HHS] and EuroQol five-dimensional [EQ-5D]), intraoperative complications (such as lag jamming and drill bit breakage), failure of fixation, avascular necrosis, and surgical site infection. RESULTS The mean follow-up period was 39.69 months. Eight percent of the patients required an open reduction. The mean operation time was 131 minutes, the mean blood loss was 221.19 mL, the mean hospital stay was 20.66 days, and the average time to union was 18 weeks. Intraoperative complications included 8 cases of breakage of the drill bit while making distal holes. The failure rate was 3.7% and revision surgery was performed in 6 cases (for cut-out in 5 and pull-out of the lag screw in 1). Asymptomatic venous thromboembolism occurred in 2 cases and hematoma requiring intervention occurred in 1 case. There were no other complications such as avascular necrosis, infection, and lateral irritation. At the 2-year follow-up, the averages of HHS and EQ-5D were 71.54 and 0.68, respectively. CONCLUSIONS Among the implants used to treat intertrochanteric femoral fractures, CHNs had a surgical failure of 3.7% and showed good radiologic and clinical results.
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Affiliation(s)
- You-Sung Suh
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, Seoul, Korea
| | - Jae-Hwi Nho
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, Seoul, Korea
| | - Min Gon Song
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, Seoul, Korea
| | - Dong Woo Lee
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, Seoul, Korea
| | - Byung-Woong Jang
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Gumi, Gumi, Korea
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17
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Zhao H, Deng X, Liu W, Chen W, Wang L, Zhang Y, Wang Z, Wang Y, Lian X, Hou Z, Zhang Q, Zhang Y. Proximal femoral bionic nail (PFBN)-an innovative surgical method for unstable femoral intertrochanteric fractures. INTERNATIONAL ORTHOPAEDICS 2023; 47:1089-1099. [PMID: 36719445 DOI: 10.1007/s00264-023-05696-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 01/07/2023] [Indexed: 02/01/2023]
Abstract
PURPOSE Intertrochanteric femoral fractures (IFF) are one of the most common traumatic conditions, but there are no established treatment methods for this condition due to implant failure and re-operation rates. The proximal femoral bionic nail (PFBN), which is a new design of the cephalomedullary nail, was developed by our team. The objective of this study was to assess the clinical and radiographic outcomes of PFBN in patients with unstable IFF. METHODS From October 2020 to August 2021, 12 patients diagnosed with unstable IFF (31-A2, 3) were treated with PFBN at the Third Hospital of Hebei Medical University. We evaluated the clinical therapeutic effects of this treatment by measuring peri-operative indicators and post-operative complications. Clinical outcomes, specific radiographic parameters, and post-operative complications were collected and analyzed within the first post-operative year. RESULTS The average age of the patients was 72.4 ± 16.1 years (five males and seven females). The mean operation time was 90.4 ± 16.0 min, whereas the operation time of 31-A2 fractures (83.1 ± 12.2 min) was shorter than that of 31-A3 fractures (105.0 ± 12.9 min) (p < 0.05). The blood loss was 175 ml (range: 50 to 500 ml), and the length of hospitalization was 10.0 ± 1.9 days. The prognosis evaluation was assessed at three, six and 12 months after the operation; for these time points, the Harris hip scores were 69.6 ± 4.1, 77.8 ± 3.8, and 82.6 ± 4.6, respectively, and the Parker-Palmer scores were 5.3 (5.0, 7.0), 6.3 (5.3, 7.0), and 7.8 (7.0, 8.0), respectively. CONCLUSION PFBN has shown advantages in the treatment of unstable IFF (particularly in geriatric patients) and possesses both stability and safety. This innovative method may provide a new option for treating unstable IFFs.
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Affiliation(s)
- Haiyue Zhao
- School of Medicine, Nankai University, Tianjin, 300071, China
| | - Xiangtian Deng
- Trauma Medical Center, Department of Orthopedics Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Weijian Liu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Wei Chen
- Department of Orthopedic Surgery of Hebei Province, Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Lei Wang
- School of Medicine, Nankai University, Tianjin, 300071, China
| | - Yiran Zhang
- School of Medicine, Nankai University, Tianjin, 300071, China
| | - Zhongzheng Wang
- Department of Orthopedic Surgery of Hebei Province, Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Yuchuan Wang
- Department of Orthopedic Surgery of Hebei Province, Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Xiaodong Lian
- Department of Orthopedic Surgery of Hebei Province, Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Zhiyong Hou
- Department of Orthopedic Surgery of Hebei Province, Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Qi Zhang
- Department of Orthopedic Surgery of Hebei Province, Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China.
| | - Yingze Zhang
- Department of Orthopedic Surgery of Hebei Province, Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China.
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Wang W, Ni B, Shen H, Lu H. Meta-analysis of InterTan, PFNA and PFNA-II internal fixation for the treatment of unstable intertrochanteric fractures in elderly individuals. Acta Orthop Belg 2023; 89:51-58. [PMID: 37294985 DOI: 10.52628/89.1.9923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Elderly individuals are often affected by osteoporosis and have poor stability after fracture reduction. Moreover, there is still controversy regarding the clinical effects of the treatment for unstable intertrochanteric fractures in the elderly. The Cochrane, Embase, PubMed, and other databases were searched, and a meta-analysis of the literature on the treatment of unstable intertrochanteric fractures of the elderly with InterTan, PFNA, and PFNA-II was conducted. Seven studies were screened, with a total of 1236 patients. Our meta-analysis results show that InterTan is not significantly different from PFNA in terms of operation and fluoroscopy times, but it takes longer than PFNA-II. In terms of postoperative screw cut, pain, femoral shaft fracture, and secondary operations, InterTan is superior to PFNA and PFNA-II. Conversely, in terms of intraoperative blood loss, hospital stay, and postoperative Harris score, there is no significant difference between InterTan and PFNA and PFNA-II. Compared to PFNA and PFNA-II, InterTan internal fixation has advantages in the treatment of unstable intertrochanteric fractures in elderly individuals in terms of screw cutting, femoral shaft fractures, and secondary operations. However, InterTan operation and fluoroscopy times take longer than PFNA and PFNA-II.
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Fan J, Lv Y, Xu X, Zhou F, Zhang Z, Tian Y, Ji H, Guo Y, Yang Z, Hou G. Evaluation of femoral head bone quality by Hounsfield units: A predictor of implant failure for intertrochanteric fractures after intramedullary nail fixation. Front Surg 2023; 9:816742. [PMID: 36684160 PMCID: PMC9852507 DOI: 10.3389/fsurg.2022.816742] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 10/21/2022] [Indexed: 01/09/2023] Open
Abstract
Purpose The aim of present study is to evaluate the femoral head bone quality by Hounsfield units and its relationship to the occurrence of implant failure for intertrochanteric fractures after intramedullary nail fixation. Methods This retrospective study assessed 160 intertrochanteric fractures treated with intramedullary fixation. Patients with and without implant failure were divided into failure and control groups, respectively. The demographic information, femoral head Hounsfield unit (HU) value, the reduction quality, status of posteromedial support and position of the screw/blade were collected and compared. The logistic regression analyses were performed to evaluate risk factors of implant failure in intertrochanteric fractures after intramedullary nail fixation. Results Of the patients, 15 (9.38%) suffered from implant failure after intramedullary fixation. The mean HU value of femoral head was much lower in the failure group than the control group (133.25 ± 34.10 vs. 166.12 ± 42.68, p = 0.004). And the univariate analyses showed that A3 fracture and poor reduction quality were associated with implant failure (p < 0.05). After adjustment for confounding variables, the multivariable logistic regression analyzes showed that femoral head HU value (odds ratio [OR], 0.972; 95% CI, 0.952-0.993; p = 0.008) and poor reduction quality (OR, 7.614; 95% CI, 1.390-41.717; p = 0.019) were independent influencing factors for implant failure. Conclusion The femoral head HU value was significantly correlated with the incidence of implant failure and can be used as an independent factor to predict implant failure for intertrochanteric fractures after intramedullary fixation.
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Affiliation(s)
- Jixing Fan
- Department of Orthopedics, Peking University Third Hospital, Beijing, China,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Yang Lv
- Department of Orthopedics, Peking University Third Hospital, Beijing, China,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Xiangyu Xu
- Department of Orthopedics, Peking University Third Hospital, Beijing, China,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Fang Zhou
- Department of Orthopedics, Peking University Third Hospital, Beijing, China,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China,Correspondence: Fang Zhou
| | - Zhishan Zhang
- Department of Orthopedics, Peking University Third Hospital, Beijing, China,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Yun Tian
- Department of Orthopedics, Peking University Third Hospital, Beijing, China,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Hongquan Ji
- Department of Orthopedics, Peking University Third Hospital, Beijing, China,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Yan Guo
- Department of Orthopedics, Peking University Third Hospital, Beijing, China,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Zhongwei Yang
- Department of Orthopedics, Peking University Third Hospital, Beijing, China,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Guojin Hou
- Department of Orthopedics, Peking University Third Hospital, Beijing, China,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
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20
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Wang F, Zou JL, Shang J. Does matching degree matter for proximal femoral intramedullary nail on reoperation rate in intertrochanteric fractures? J Orthop Surg Res 2022; 17:573. [PMID: 36581940 PMCID: PMC9801600 DOI: 10.1186/s13018-022-03476-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 12/23/2022] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Previous articles reported on the tip-apex distance, lag screw placement, fracture pattern, reduction quality, osteoporosis and other factors associated with second surgery. The current study focused on investigating the association of the matching degree between proximal femoral intramedullary nail and femoral medullary cavity on reoperation rate. PATIENTS AND METHODS A retrospective cohort study was conducted. It included patients with intertrochanteric fracture who were treated with proximal femoral anti-rotatory intramedullary nail (PFNA) between January 2016 and April 2021. The gap between the intramedullary nail and the femoral medullary cavity was equal to the difference in diameter between the two. According to the gap size, all patients were divided into three groups, as follows: high-matching group: gap ≤ 2 mm; middle-matching group: 2 < gap < 4 mm; and low-matching group: gap ≥ 4 mm. The mean gap was measured through standard images. The primary observational index was whether the reoperation was needed, and secondary observational indexes included operative time, length of hospital stay. Patient characteristics were recorded, as follows: age, sex, follow-up time, fracture pattern, reduction grade and length of intramedullary nail. RESULTS A total of 203 eligible patients were recorded, including 78 males (38.4%) and 125 females (61.6%). They had a mean age of 77.8 ± 9.9 years old and an average follow-up time of 58.1 ± 24.0 weeks. Twenty-seven patients (13.3%) needed a second operation. Coxa varus combined with screw cutting was the most common reason for reoperation (11 cases). Unstable fracture pattern with poor reduction grade tended to contribute to reoperation, whose odds ratio (OR) was 6.61 (95% confidence interval [CI], 1.98-22.09; P = 0.002). The three groups had 11 cases (13.7%), 12 cases (13.8%) and 4 cases (11.1%) of reoperation, respectively, and logistic regression showed no significant association was noted between matching degree of intramedullary nail and reoperation rate. CONCLUSIONS The matching degree between proximal femoral intramedullary nail and femoral medullary cavity did not seem to be an important factor for reoperation, which offered more options of intramedullary nail size intraoperatively and reduced implants stock from inventory.
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Affiliation(s)
- Fei Wang
- grid.412596.d0000 0004 1797 9737The First Affiliated Hospital of Harbin Medical University, No. 23 Post Office Street, Nangang District, Harbin, Heilongjiang China
| | - Ji-Long Zou
- grid.412596.d0000 0004 1797 9737The First Affiliated Hospital of Harbin Medical University, No. 23 Post Office Street, Nangang District, Harbin, Heilongjiang China
| | - Jian Shang
- grid.263488.30000 0001 0472 9649Shenzhen University General Hospital, Shenzhen University, 1098 Xueyuan Avenue, Xili University Town, Nanshan District, Shenzhen, Guangdong China
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21
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Effect of screw tunnels on proximal femur strength after screw removal: A finite element analysis. Orthop Traumatol Surg Res 2022; 108:103408. [PMID: 36116705 DOI: 10.1016/j.otsr.2022.103408] [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: 03/04/2022] [Revised: 06/14/2022] [Accepted: 07/12/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND The presence of screw tunnels in the femoral neck is a problem for patients with proximal femoral fractures after removal of internal fixation. The question of how much does the existence of the screw tunnels affect the strength of the femur and whether the patient needs to be protected with an adjunctive device has been controversial. The objective of this finite element analysis was to determine (1) whether the screw tunnels affects normal weight bearing after removal of internal fixation of a proximal femur fracture, (2) which screw tunnels parameters affect the weight bearing capacity of the entire femur. HYPOTHESIS The presence of the screw tunnels reduces the load-bearing capacity of the femur, and the arrangement, diameter and wall thickness of the screw tunnels affect the load-bearing capacity of the femur. MATERIALS AND METHODS Twenty patients who underwent surgical treatment for proximal femur fracture at our hospital were included in the study. Computed tomography (CT) values of the screw tunnel wall in the femur after removal of internal fixations were analysed. Mimics v16.0 and Hypermesh v13.0 software programs were used to generate 3-dimensional (3D) tetrahedral finite element models of the proximal femur with different screw tunnel numbers, diameters, thicknesses, and arrangements. An acetabulum exerting a vertical pressure load of 600N on the femoral head was simulated and the force on various parts of the femur in each model was calculated. RESULTS There was no difference in the Hounsfield Units of the tunnel walls and cortical bone of the proximal femur (893.48±61.28 vs. 926.34±58.43; p=0.091). In each of the 3D models, the cancellous bone was the first structure to reach maximal stress. The compressive strength of the femur decreased with increasing thickness of the screw tunnel wall and decreased with increasing tunnel diameter. The femoral neck model with the inverted triangle screw tunnel arrangement had the highest compressive strength. DISCUSSION The femoral neck with screw tunnels can withstand day-to-day stress without special intervention. For femoral neck fractures fixed with cannulated screws, inverted triangle screws are recommended; For a single screw tunnel in the femoral neck, the larger the diameter of the femoral neck internal screw channel, the weaker the load-bearing capacity of the femur. LEVEL OF EVIDENCE III; well-designed computational non-experimental study.
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22
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Qi L, Zhang W, Chang Z, Zuo Z, Li J, Li J, Chen H, Tang P. Is the reconstruction of medial support important for revision following failed treatment of femoral trochanteric fractures? a retrospective comparative study. BMC Musculoskelet Disord 2022; 23:1028. [PMID: 36447239 PMCID: PMC9707300 DOI: 10.1186/s12891-022-06004-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 11/18/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Hip-preserving revision in patients with failed treatment of femoral trochanteric fracture is still a major challenge. Whether the medial support reconstruction could benefit the patients and improve the success rate of hip-preserving revision is still controversial. Hence, the purpose of this study was to evaluate the clinical significance and prognosis of medial support reconstruction during the hip-preserving revision of failed femoral trochanteric fracture treatment. METHODS Patients with failed femoral trochanteric fractures treatments addressed by hip-preserving revision at our hospital from January 2014 to December 2020 were analyzed retrospectively. 31 patients were included and divided into a medial support group (n = 16) and a non-medial support group (n = 15). The fracture healing rate was the primary measurement. In addition, the differences in Oxford Hip Score (OHS), quality of life, surgical trauma, and complications were also evaluated. RESULTS The fracture healing rate (100%, 16/16 vs. 66.67%, 10/15), the OHS (42.06 ± 4.12 vs. 30.93 ± 11.56, M ± SD), and the mental component score of the 12-item Short-Form Survey (SF-12) (54.48 ± 5.38 vs. 47.90 ± 3.47, M ± SD), were significantly better and the incidence of complications [0(0/16) vs. 40%(6/15)] was significantly lower in the medial support group than the non-medial support group (p < 0.05). No significant differences in the physical component score of the SF-12, surgical trauma and reduction in collodiaphyseal angle of affected femur were observed between groups. CONCLUSIONS The reconstruction of medial support seems important for revision following failed treatment of femoral trochanteric fractures. Due to the medial augmentation and improvement of the mechanical stability for proximal femur, the patients might benefit from fracture healing prognosis and functional.
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Affiliation(s)
- Lin Qi
- grid.488137.10000 0001 2267 2324Chinese PLA Medical School, No.28 Fuxing Road, Haidian, Beijing, 100853 China ,grid.414252.40000 0004 1761 8894Department of Orthopaedics, the First Medical Center, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian, Beijing, 100853 China
| | - Wei Zhang
- grid.411614.70000 0001 2223 5394School of Sports Engineering, Beijing Sport University, No. 48 Information Road, Haidian District, Beijing, 100084 China
| | - Zuhao Chang
- grid.488137.10000 0001 2267 2324Chinese PLA Medical School, No.28 Fuxing Road, Haidian, Beijing, 100853 China ,grid.414252.40000 0004 1761 8894Department of Orthopaedics, the First Medical Center, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian, Beijing, 100853 China
| | - Zhaoxia Zuo
- National Clinical Center for Orthopedics, Sports Medicine & Rehabilitation, No.28 Fuxing Road, Haidian, Beijing, 100853 China
| | - Jiaqi Li
- grid.488137.10000 0001 2267 2324Chinese PLA Medical School, No.28 Fuxing Road, Haidian, Beijing, 100853 China ,grid.414252.40000 0004 1761 8894Department of Orthopaedics, the First Medical Center, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian, Beijing, 100853 China
| | - Jiantao Li
- grid.414252.40000 0004 1761 8894Department of Orthopaedics, the First Medical Center, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian, Beijing, 100853 China
| | - Hua Chen
- grid.414252.40000 0004 1761 8894Department of Orthopaedics, the First Medical Center, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian, Beijing, 100853 China
| | - Peifu Tang
- grid.414252.40000 0004 1761 8894Department of Orthopaedics, the First Medical Center, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian, Beijing, 100853 China
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23
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Li Y, Zhang Y, Yu M, Huang T, Li K, Ye J, Huang H, Yu W. Favorable revision-free survivorship of cemented arthroplasty following failed proximal femoral nail antirotation: a case series with a median follow-up of 10 years. BMC Musculoskelet Disord 2022; 23:1024. [PMID: 36443844 PMCID: PMC9707067 DOI: 10.1186/s12891-022-05995-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 11/17/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Given the ever-increasing rate of failure related to proximal femoral nail antirotation (PFNA), it is expected that an increasing number of PFNA individuals will undergo conversion to total hip arthroplasty (THA). The long-term survivorship of conversion of the initial PFNA to cemented THA is still debated. The aim of this retrospective study was to assess the long-term revision-free survivorship of cemented THAs after initial failures of PFNA in geriatric individuals. METHODS Consecutive geriatric individuals who underwent secondary cemented THA after initial PFNA fixation from July 2005 to July 2018, were retrospectively identified from three medical centres. The primary outcome was revision-free survivorship estimated using the Kaplan-Meier method and Cox proportional hazards regression with revision for any reason as the endpoint; secondary outcomes were functional outcomes and key THA-related complications. Follow-ups occurred at 3 months, 6 months, 12 months and then every 12 months after conversion. RESULTS In total, 186 consecutive patients (186 hips) were available for study inclusion. The median follow-up was 120.7 months (60-180 months) in the cohort. Kaplan-Meier survivorship with revision for any reason as the end point showed that the 10-year revision-free survival rate was 0.852 (95% confidence interval [CI], 0.771-0.890). Good functional outcomes were seen, and the HHS decreased markedly over the 24th month to the final follow-up interval from 92.2 to 75.1 (each p < 0.05). The overall rate of key THA-related complications was 16.1% (30/186). CONCLUSION Cemented THA executed following initial PFNA failure may yield satisfactory revision-free survival and, at least for the initial 10 years after conversion, good functional outcomes and a 16.1% complication rate of key THA-related complications, which supports the trend towards increased use of cemented THA.
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Affiliation(s)
- Yi Li
- Department of Anesthesiology, Wuhan Fourth Hospital, No. 473, Hanzheng Street, Qiaokou District, Wuhan, 430030, China
| | - Yaodong Zhang
- Department of Anesthesiology, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, China
| | - Minji Yu
- Department of Traditional Chinese Medicine, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, China
| | - Tao Huang
- Department of Orthopedics, Wuhan Third Hospital, Tongren Hospital of Wuhan University, No. 241, Pengliuyang Road, Wuchang District, Wuhan, 430060, China
| | - Kunhong Li
- Department of Anesthesiology, Wuhan Fourth Hospital, No. 473, Hanzheng Street, Qiaokou District, Wuhan, China
| | - Junxing Ye
- Department of Orthopedics, The Affiliated Hospital of Jiangnan University, No. 1000, Hefeng Road, Wuxi, 214000, Jiangsu, China
| | - Heng Huang
- Department of Anesthesiology, Wuhan Fourth Hospital, No. 473, Hanzheng Street, Qiaokou District, Wuhan, 430030, China.
| | - Weiguang Yu
- Department of Orthopedics, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, China.
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Joeris A, Kabiri M, Galvain T, Vanderkarr M, Holy CE, Plaza JQ, Tien S, Schneller J, Kammerlander C. Cost-Effectiveness of Cement Augmentation Versus No Augmentation for the Fixation of Unstable Trochanteric Fractures. J Bone Joint Surg Am 2022; 104:2026-2034. [PMID: 36053020 DOI: 10.2106/jbjs.21.01516] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND A previous randomized controlled trial (RCT) demonstrated a trend toward a reduced risk of implant-related revision surgery following fixation with use of a Proximal Femoral Nail Antirotation (PFNA) with TRAUMACEM V+ Injectable Bone Cement augmentation versus no augmentation in patients with unstable trochanteric fractures. To determine whether this reduced risk may result in long-term cost savings, the present study assessed the cost-effectiveness of TRAUMACEM V+ cement augmentation versus no augmentation for the fixation of unstable trochanteric fractures from the German health-care payer's perspective. METHODS The cost-effectiveness model comprised 2 stages: a decision tree simulating clinical events, costs, and utilities during the first year after the index procedure and a Markov model extrapolating clinical events, costs, and utilities over the patient's lifetime. Sources of model parameters included the previous RCT, current literature, and administrative claims data. Outcome measures were incremental costs (in 2020 Euros), incremental quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). Model uncertainty was assessed with deterministic and probabilistic sensitivity analyses. RESULTS The base-case analysis showed that fixation with cement augmentation was the dominant strategy as it was associated with cost savings (€50.3/patient) and QALY gains (0.01 QALY/patient). Major influential parameters for the ICER were the utility of revision, rates of revision surgery within the first year after fixation surgery, and the costs of augmentation and revision surgery. Probabilistic sensitivity analyses demonstrated that estimates of cost savings were more robust than those of increased QALYs (66.4% versus 52.7% of the simulations). For a range of willingness-to-pay thresholds from €0 to €50,000, the probability of fixation with cement augmentation being cost-effective versus no augmentation remained above 50%. CONCLUSIONS Fixation with use of cement augmentation dominated fixation with no augmentation for unstable trochanteric fractures, resulting in cost savings and QALY gains. Given the input parameter uncertainties, future analyses are warranted when long-term costs and effectiveness data for cement augmentation are available. LEVEL OF EVIDENCE Economic and Decision Analysis Level II . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Alexander Joeris
- AO Innovation Translation Center, Clinical Science, AO Foundation, Davos, Switzerland
| | - Mina Kabiri
- Global Provider and Payer Value Demonstration, Global Health Economics, Johnson & Johnson Medical Devices, New Brunswick, New Jersey
| | - Thibaut Galvain
- Global Provider and Payer Value Demonstration, Global Health Economics, Johnson & Johnson Medical Devices, New Brunswick, New Jersey
| | | | - Chantal E Holy
- Medical Device Epidemiology, Johnson & Johnson, New Brunswick, New Jersey
| | | | - Stephanie Tien
- Global Provider and Payer Value Demonstration, Global Health Economics, Johnson & Johnson Medical Devices, New Brunswick, New Jersey
| | - Julia Schneller
- Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
| | - Christian Kammerlander
- Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany.,AUVA Trauma Hospital Styria, Graz, Austria.,AUVA Trauma Hospital Styria, Kalwang, Austria
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Predictors of and predictive nomogram for cut-out of proximal femur nail anti-rotation device in intertrochanteric fractures. Arch Orthop Trauma Surg 2022:10.1007/s00402-022-04676-y. [PMID: 36348087 DOI: 10.1007/s00402-022-04676-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 10/25/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE This study determined independent predictors and developed a predictive nomogram for failed correction of intertrochanteric fractures due to cut-out of the proximal femur nail anti-rotation (PFNA) device. METHODS Demographic and radiological data of 592 adult patients with intertrochanteric fractures (AO 31A) treated by PFNA were collected retrospectively. Independent predictors of cut-out were obtained through univariate and multivariate analyses, and a predictive nomogram was established. The discrimination, calibration, and clinical utility of the nomogram were based on receiver operating characteristic curve (AUC), concordance index (C-index), calibration curve, and decision curve analysis, respectively. RESULTS Overall, 18 (3.04%) cases of cut-out occurred. Independent predictors according to the multivariate analysis were body mass index (BMI), poor-to-acceptable quality of reduction, PFNA blade position, and tip-apex distance (TAD). AUC of the nomogram was 0.849, and C-index was 0.849 (95% CI [0.844-0.854]). Bootstrapping yielded a corrected C-index of 0.849. The calibration and decision curves indicated good agreement and clinical benefit of the nomogram. CONCLUSION A reliable predictive nomogram was developed for cut-out of the PFNA in intertrochanteric fractures, based on BMI, quality of reduction, blade position, and TAD.
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26
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Yang YF, Huang JW, Gao XS, Xu ZH. Eccentric distance zone analysis system: New regional evaluation of cephalic fixator tip location for predicting cut-out in geriatric intertrochanteric fractures with internal fixation. Front Surg 2022; 9:956877. [PMID: 36329979 PMCID: PMC9622757 DOI: 10.3389/fsurg.2022.956877] [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: 05/31/2022] [Accepted: 09/22/2022] [Indexed: 11/07/2022] Open
Abstract
Objective The aim of this study was to investigate an eccentric distance (ED) zone analysis system for regional evaluation of the cephalic fixator tip based on the ED of the cephalic fixator tip referenced to the radius of its own femoral head to predict cut-out in intertrochanteric fractures (ITF) with internal fixation. Methods First, we assumed all the femoral heads were regular spheres with the radius (RFD) of “3” for a complete match of the Cleveland zone system and calculated the ED of the cephalic fixator tip by measuring the distances from the cephalic fixator tip to the geometric central axis in the femoral neck and head on both anteroposterior (AP) view and lateral view radiographs. Second, we defined the maximum transverse section of the femoral head into three zones named ED Zone A with ED less than “1,” Zone B with ED ranging in “1–2,” and Zone C with ED ranging in “2–3” in turns by concentric circles (circles A, B, and C) with the radius of 1/3, 2/3, and 3/3 times of RFD, respectively. Third, we evaluated the ED zones according to the ED and location of the cephalic fixator tip in the eligible 123 ITF patients with single-screw cephalomedullary nail (SCMN) fixation and then analyzed the correlation between the cut-out rate and the ED zones. Results The cut-out rates in ED Zones A, B, and C were 4.17%, 38.46%, and 100%, respectively. Multivariate logistic regression indicated that ED Zone A had at least a 14 times lower rate of cut-out compared with ED Zone B. The cephalic fixator tip located in ED Zone A has a lower cut-out rate than that in Cleveland Zone 5. The cut-out rate in ED Zone A is significantly lower than that in the region inside Cleveland Zone 5 but outside ED Zone A. Conclusion ED zone analysis system is a reliable regional evaluation of the cephalic fixator tip position for predicting cut-out in geriatric ITF patients with SCMN fixations and potentially an artificial intelligence measurement during surgery. For decreasing the cut-out rate, the cephalic fixator tip should be located in ED Zone A.
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Affiliation(s)
- Yun-fa Yang
- Department of Orthopaedic Surgery, Guangzhou First People's Hospital, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou, China,Correspondence: Yun-fa Yang
| | - Jian-wen Huang
- Department of Orthopaedic Surgery, Guangzhou First People's Hospital, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Xiao-sheng Gao
- Department of Orthopaedic Surgery, Guangzhou First People's Hospital, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Zhong-he Xu
- Department of Orthopaedic Surgery, Guangzhou First People's Hospital, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou, China
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CT analysis of femoral malrotation after intramedullary nailing of trochanteric fractures. Arch Orthop Trauma Surg 2022; 142:1865-1871. [PMID: 33881592 DOI: 10.1007/s00402-021-03902-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/06/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Functional results after internal fixation of trochanteric femoral fractures may be negatively affected by healing in a non-physiological position. The aim of this study was to evaluate the occurrence and severity of femoral malrotation after nailing of trochanteric fractures. MATERIALS AND METHODS The authors conducted a prospective study focused on a CT analysis of malrotation after intramedullary nailing of trochanteric fractures (AO 31A1-3) in 101 patients. We recorded the type of fracture, method of anesthesia, scheduled surgery vs. acute surgery, and the surgeon's experience as possible risk factors for limb malrotation after trochanteric fracture surgeries. RESULTS The average extent of malrotation was 9° of internal rotation ranging from 29° of external to 48°of internal rotation. In 35% of patients, we observed a rotation greater than 15°, and in 15 patients (15%), the rotation was greater than 25°. The risk of significant internal malrotation was significantly higher than external malrotation (37 vs. 4 patients). None of the factors observed proved to be statistically significant. The effect of general anesthesia and the type of intertrochanteric fracture came closest to having a significant effect on rotational error. CONCLUSION Improper reduction of a trochanteric fracture is a common problem that can lead to femur malrotation. In our study, a rotational error greater than 15° occurred in 35% of the patients, but none of the monitored factors represented a statistically significant risk for this complication.
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Phruetthiphat OA, Paiboonrungroj S, Satravaha Y, Lawanprasert A. The effect of CKD on intertrochanteric fracture treated with proximal femoral nail anti-rotation: A 7-year study. J Orthop 2022; 32:151-155. [PMID: 35733927 DOI: 10.1016/j.jor.2022.06.003] [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: 02/28/2022] [Revised: 05/24/2022] [Accepted: 06/02/2022] [Indexed: 11/27/2022] Open
Abstract
Background Intertrochanteric fracture is one of the most burdensome osteoporotic fractures in the elderly. Chronic kidney disease is associated with sarcopenia, especially in its advanced stages and, thus may impact functional status. Combining an intertrochanteric fracture with advanced CKD may diminish results after surgical fixation. This study aims to distinguish whether CKD affects the result of intertrochanteric fracture fixation in terms of mechanical and functional outcomes. Methods A retrospective study reviews all intertrochanteric fractures treated with PFNA fixation from 2012 to 2018. 445 patients were classified into 5 stages of CKD and divided by eGFR = 90 ml/min/1.73 m2 into CKD and non-CKD group and by eGFR = 30 ml/min/1.73 m2 into advanced CKD and non-advanced CKD group. The primary outcome was one year Harris Hip Score (HHS). Secondary outcomes were medical complications, surgical complications, and a 1-year mortality rate. Results Harris Hip Scores (HHS) were not different between non-CKD and CKD groups (eGFR <90 mL/min/1.73 m2). However, there was a difference between non-advanced CKD and advanced CKD groups (eGFR <30 mL/min/1.73 m2) (p < 0.001). Medical complications were not different, except for sepsis in CKD stage 5 compared with stage 1 (p = 0.023). Even though AO/OTA types were more severe in the advanced CKD group, surgical complications and 1-year mortality were not different. Conclusion Advanced stage CKD treated with PFNA fixation is associated with lower functional outcomes at one year. Sepsis is more prone to occur after surgery in CKD stage 5. Level of evidence Level III; Retrospective cohort study.
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Affiliation(s)
| | | | - Yodhathai Satravaha
- Department of Orthodontics, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
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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: 2.3] [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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Song QC, Dang SJ, Zhao Y, Wei L, Duan DP, Wei WB. Comparison of clinical outcomes with proximal femoral nail anti-rotation versus bipolar hemiarthroplasty for the treatment of elderly unstable comminuted intertrochanteric fractures. BMC Musculoskelet Disord 2022; 23:628. [PMID: 35778710 PMCID: PMC9248155 DOI: 10.1186/s12891-022-05583-4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 06/24/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Although proximal femoral nail anti-rotation (PFNA) and bipolar hemiarthroplasty (BHA) are selected by most of the orthopaedic surgeons for elderly intertrochanteric fractures (ITFs) patients, there is still no consensus on the superiority of PFNA and BPH for the elderly with unstable comminuted ITFs. The study aims to compare the curative effects of PFNA and cementless BHA on unstable comminuted ITFs in the elderly. METHODS From January 2012 to December 2016, we retrospectively reviewed 62 ITFs patients up to the inclusion and exclusion criteria in the study. Depending on the type of surgery, the patients were divided into two groups: Group BHA (n= 30) and Group PFNA (n = 32). The ITFs were classified according to Evans-Jensen. Hospitalization time, operation time, bleeding loss, weight bearing duration, Harris hip scores, 10-m walking speed, gait and postoperative complications were compared between the two groups. RESULTS There was no significant difference between the groups in hospital stay (P > 0.05). The BHA group trended to have a shorter operation time and a larger volume of blood loss (P < 0.01).The weight bearing duration was shorter in the BHA group than the PFNA group (P < 0.05).The Harris hip score was higher, the 10-m walking speed was faster and the gait was better in group BHA than group PFNA at three months postoperatively (P < 0.05), but there was no significant difference between the two groups at 6 and 12 months postoperatively (P > 0.05). There was no significant difference in postoperative complications between the two groups (P > 0.05). CONCLUSION The BHA allows an earlier return to weight-bearing activity, but ultimately has the same effective treatments as the PFNA for the elderly with unstable comminuted ITFs.
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Affiliation(s)
- Qi-Chun Song
- grid.452672.00000 0004 1757 5804First Department of Orthopaedics, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, 710004 Shaanxi China
| | - Sha-Jie Dang
- Department of Anesthesia, Shaanxi Provincial Cancer Hospital, Xi’an, 710061 Shaanxi China ,grid.43169.390000 0001 0599 1243The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi’an Jiaotong University, Xi’an, 710049 Shaanxi China
| | - Yan Zhao
- grid.452672.00000 0004 1757 5804First Department of Orthopaedics, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, 710004 Shaanxi China
| | - Ling Wei
- Department of Pain, Yangling Demonstration Zone Hospital, Yangling, 712100 Shaanxi China
| | - Da-Peng Duan
- grid.440288.20000 0004 1758 0451Department of Orthopedics, Shaanxi Provincial People’s Hospital, Xi’an, 710068 Shaanxi China
| | - Wen-Bo Wei
- grid.440288.20000 0004 1758 0451Department of Orthopedics, Shaanxi Provincial People’s Hospital, Xi’an, 710068 Shaanxi China
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The correlation between cutout and eccentric distance (ED) of the cephalic fixator tip in geriatric intertrochanteric fractures with internal fixation. J Orthop Surg Res 2022; 17:263. [PMID: 35562761 PMCID: PMC9107135 DOI: 10.1186/s13018-022-03153-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 05/01/2022] [Indexed: 11/22/2022] Open
Abstract
Background The location of cephalic fixator tip with different eccentric distance (ED) should have different risks of cutout. This study aims to evaluate the cephalic fixator tip position by measuring ED of the cephalic fixator tip in geriatric ITF patients with single-screw cephalomedullary nail (SCMN) fixation and analyze the correlation between the cutout and the ED. Methods Firstly, we assumed all the femoral head was a regular sphere and standardized the radius of the femoral head (RFD) as “3” no matter how big the RFD was for complete match of the Cleveland zone system and convenient identification of artificial intelligence. Secondly, we measured the ED of the cephalic fixator tip by calculating the distances from the cephalic fixator tip to the geometric central axis of the femoral neck and head on both AP view and lateral view radiographs. Thirdly, we evaluated all the ED of the cephalic fixator tip in the eligible 123 geriatric ITF patients and analyzed the correlation between the cutout and the ED. Results The ED in cutout group (1.25 ± 0.43) is much bigger than that in non-cutout group (0.64 ± 0.34) with significant difference (OR = 50.01, 95% CI 8.42–297.19, p < 0.001). The probability of cutout increased with ED increasing, especially when “ED ≥ 1.” The best cutoff value of ED for predicting cutout was “1.022” (“1.022” was just a little bit more than 1/3 times of RFD because “RFD = 3,” sensitivity = 73.3%, specificity = 86.1%, and AUC = 0.867, p < 0.001). Conclusion ED is suitable for evaluation of the cephalic fixator tip position for predicting cutout in geriatric ITF patients with SCMN fixation, and ED can potentially be used as artificial intelligence application during surgery. The smaller the ED, the lower the cutout rate. For avoiding cutout, the ED of the cephalic fixator tip should be less than one-third times of the radius of the femoral head.
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Fan J, Xu X, Zhou F, Zhang Z, Tian Y, Ji H, Guo Y, Lv Y, Yang Z, Hou G. Risk factors for implant failure of intertrochanteric fractures with lateral femoral wall fracture after intramedullary nail fixation. Injury 2021; 52:3397-3403. [PMID: 34321191 DOI: 10.1016/j.injury.2021.07.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 07/10/2021] [Accepted: 07/13/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Few studies have specifically evaluated the comminution extent of lateral femoral wall (LFW) fracture and risk factors of implant failure in intertrochanteric fractures with LFW fracture. The aim of present study was to evaluate the influence of comminution extent of LFW fracture on implant failure and identify risk factors of implant failure in cases with LFW fracture after intramedullary fixation. METHODS This retrospective study included 130 intertrochanteric fracture with LFW fracture treated with intramedullary fixation at a teaching hospital over a 13-year period from January 2006 to December 2018. Demographic information, cortical thickness index, the reduction quality, status of medial support, position of the screw/blade and status of lateral femoral wall were collected and compared. The logistic regression analyzes was performed to evaluate risk factors of implant failure in intertrochanteric fractures with LFW fracture after intramedullary nail fixation. RESULTS 10 patients (7.69%) suffered from mechanical failure after intramedullary fixation. Univariate analyzes showed that comminuted LFW fracture (OR, 7.625; 95%CI, 1.437~40.446; p = 0.017), poor reduction quality (OR, 49.375; 95%CI, 7.217~337.804; p < 0.001) and loss of medial support (OR, 17.818; 95%CI, 3.537~89.768; p < 0.001) were associated with implant failure. After adjustment for confounding variables, the multivariable logistic regression analyzes showed that poor reduction quality (OR, 11.318; 95%CI, 1.126~113.755; p = 0.039) and loss of medial support (OR, 7.734; 95%CI, 1.062~56.327; p = 0.043) were independent risk factors for implant failure. Whereas, comminuted LFW fracture was not associated with implant failure (p = 0.429). CONCLUSIONS The comminution extent of the LFW fracture might influence the stability of intertrochanteric fractures; and intramedullary fixation might be an effective treatment method. Furthermore, poor reduction quality and loss of medial support could increaze the risk of implant failure in intertrochanteric fractures with LFW fractures after intramedullary fixation. Therefore, we should pay great emphasis on fracture reduction quality in future.
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Affiliation(s)
- Jixing Fan
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China; Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing 100191, China
| | - Xiangyu Xu
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China; Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing 100191, China
| | - Fang Zhou
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China; Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing 100191, China.
| | - Zhishan Zhang
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China; Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing 100191, China
| | - Yun Tian
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China; Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing 100191, China
| | - Hongquan Ji
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China; Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing 100191, China
| | - Yan Guo
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China; Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing 100191, China
| | - Yang Lv
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China; Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing 100191, China
| | - Zhongwei Yang
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China; Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing 100191, China
| | - Guojin Hou
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China; Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing 100191, China
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Impact of Wedge Effect on Outcomes of Intertrochanteric Fractures Treated with Intramedullary Proximal Femoral Nail. J Clin Med 2021; 10:jcm10215112. [PMID: 34768632 PMCID: PMC8585090 DOI: 10.3390/jcm10215112] [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: 08/19/2021] [Revised: 10/19/2021] [Accepted: 10/26/2021] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study is to investigate the risk factors for wedge effect and its relevance between blade cut-out in patients with intertrochanteric fractures (ITF) treated with proximal femoral nail antirotation II (PFNA-II). A total of 113 patients with ITF treated with PFNA-II between 2012 and 2016 were retrospectively analyzed. Radiographic variables including preoperative fracture pattern, fracture classification, lateral wall fracture, and postoperative neck–shaft angle (NSA), femoral offset (FO), blade cut-out, and Parker’s ratio were measured for analysis. An average of 4.16° of varus malalignment in NSA and 5.5 mm of femoral shaft lateralization in FO was found post-operatively. The presence of lateral wall fracture was significantly related to post-operative varus change of NSA (p < 0.05). After at least one year of follow up, the blade cut-out rate was 2.65% (3/113), and Parker’s ratio was significantly higher in patients with blade cut-out (p = 0.0118). This study concluded that patients with ITF-present preoperative lateral wall fracture and postoperative higher Parker’s ratio in AP radiography showed higher incidence of wedge effect that might increase risk of blade cut out.
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赵 益, 朱 凤, 常 庆, 刘 继, 张 瑞, 宋 富, 褚 风, 宰 庆, 郭 伟, 杨 现, 石 强, 张 锋, 王 海, 姜 振. [Research on the classification criteria of femoral intertrochanteric fractures based on irreducibility or not]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:1086-1092. [PMID: 34523271 PMCID: PMC8444130 DOI: 10.7507/1002-1892.202103233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 07/23/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To formulate the classification criteria of femoral intertrochanteric fractures based on irreducibility or not in order to predict the difficulty of fracture recovery. METHODS A clinical data of 244 patients with closed femoral intertrochanteric fractures admitted between January 2017 and March 2020 was retrospectively analyzed. There were 116 males and 128 females with an average age of 77.9 years (range, 45-100 years). The cause of injury included falling in 190 cases, traffic accident in 36 cases, smashing in 13 cases, and falling from height in 5 cases. The time from injury to operation was 1-14 days (mean, 3.6 days). According toAO/Orthopaedic Trauma Association (AO/OTA) classification, the fractures were classified as type 31-A1 in 38 cases, type 31-A2 in 160 cases, and type 31-A3 in 46 cases. According to whether the recovery difficulty occurred after intraoperative closed traction reset, the patients were divided into reducible-group and irreducible-group; combined with the literature and preoperative imaging data of two groups, the classification criteria of femoral intertrochanteric fractures was formulated based on the irreducibility or not. The 244 fractures were classified by the doctors who did not attend the operation according to the classification criteria, predicted the difficulty of fracture reduction, and compared with the actual intraoperative reduction situation. RESULTS The 244 patients were divided into reducible-group ( n=164, 67.21%) and irreducible-group ( n=80, 32.79%) according to the intraoperative difficulty of reduction. Comparing the imaging data and characteristics of the two groups, and formulating the classification criteria of femoral intertrochanteric fractures based on irreducibility or not, the fractures were mainly divided into two categories of irreducibility and reducibility. The fractures of irreducibility category was divided into typesⅠ-Ⅴ, among which type Ⅲ was divided into subtypes 1-4; the fractures of reducibility category was divided into typesⅠand Ⅱ. Compared with the actual intraoperative evaluation results, the total accuracy rate of the doctors who did not attend the operation was 81.15% (198/244) based on the classification criteria of femoral intertrochanteric fractures. The accuracy rate of irreducibility category was 65.74% (71/108), and the reducibility category was 93.38% (127/136). All patients were followed up 13-25 months, with an average of 17.6 months. All fractures healed except 2 cases died of infection. CONCLUSION The classification criteria of femoral intertrochanteric fractures based on irreducibility or not can accurately predict the reducible cases preoperatively, and most of the irreducible cases can be correctly predicted in a wider way. But the classification criteria still need to be further improved and supplemented.
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Affiliation(s)
- 益峰 赵
- 济宁医学院附属医院创伤骨科（山东济宁 272029）Department of Traumatic Orthopedics, Affiliated Hospital of Jining Medical University, Jining Shandong, 272029, P.R.China
| | - 凤华 朱
- 济宁医学院附属医院创伤骨科（山东济宁 272029）Department of Traumatic Orthopedics, Affiliated Hospital of Jining Medical University, Jining Shandong, 272029, P.R.China
| | - 庆华 常
- 济宁医学院附属医院创伤骨科（山东济宁 272029）Department of Traumatic Orthopedics, Affiliated Hospital of Jining Medical University, Jining Shandong, 272029, P.R.China
| | - 继恒 刘
- 济宁医学院附属医院创伤骨科（山东济宁 272029）Department of Traumatic Orthopedics, Affiliated Hospital of Jining Medical University, Jining Shandong, 272029, P.R.China
| | - 瑞 张
- 济宁医学院附属医院创伤骨科（山东济宁 272029）Department of Traumatic Orthopedics, Affiliated Hospital of Jining Medical University, Jining Shandong, 272029, P.R.China
| | - 富强 宋
- 济宁医学院附属医院创伤骨科（山东济宁 272029）Department of Traumatic Orthopedics, Affiliated Hospital of Jining Medical University, Jining Shandong, 272029, P.R.China
| | - 风龙 褚
- 济宁医学院附属医院创伤骨科（山东济宁 272029）Department of Traumatic Orthopedics, Affiliated Hospital of Jining Medical University, Jining Shandong, 272029, P.R.China
| | - 庆书 宰
- 济宁医学院附属医院创伤骨科（山东济宁 272029）Department of Traumatic Orthopedics, Affiliated Hospital of Jining Medical University, Jining Shandong, 272029, P.R.China
| | - 伟 郭
- 济宁医学院附属医院创伤骨科（山东济宁 272029）Department of Traumatic Orthopedics, Affiliated Hospital of Jining Medical University, Jining Shandong, 272029, P.R.China
| | - 现伟 杨
- 济宁医学院附属医院创伤骨科（山东济宁 272029）Department of Traumatic Orthopedics, Affiliated Hospital of Jining Medical University, Jining Shandong, 272029, P.R.China
| | - 强 石
- 济宁医学院附属医院创伤骨科（山东济宁 272029）Department of Traumatic Orthopedics, Affiliated Hospital of Jining Medical University, Jining Shandong, 272029, P.R.China
| | - 锋 张
- 济宁医学院附属医院创伤骨科（山东济宁 272029）Department of Traumatic Orthopedics, Affiliated Hospital of Jining Medical University, Jining Shandong, 272029, P.R.China
| | - 海滨 王
- 济宁医学院附属医院创伤骨科（山东济宁 272029）Department of Traumatic Orthopedics, Affiliated Hospital of Jining Medical University, Jining Shandong, 272029, P.R.China
| | - 振 姜
- 济宁医学院附属医院创伤骨科（山东济宁 272029）Department of Traumatic Orthopedics, Affiliated Hospital of Jining Medical University, Jining Shandong, 272029, P.R.China
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Cho HM, Park KM, Jung TG, Park JY, Lee Y. Conventional versus helical blade screw insertion following the removal of the femoral head screw: a biomechanical evaluation using trochanteric gamma 3 locking nail versus PFN antirotation. BMC Musculoskelet Disord 2021; 22:767. [PMID: 34496801 PMCID: PMC8428115 DOI: 10.1186/s12891-021-04658-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 08/27/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE When a hip screw needs to be changed, choosing between the conventional (C-type) and helical blade (H-type) types is difficult. In this biomechanical study, we compared these two screw types relative to the type of the initial screw used. METHODS C- or H-type screws were inserted (leading screw) in three types of polyurethane bone models (Sawbone, Pacific Research Laboratories, Inc., Washington, USA: 130 × 180 × 40 mm) of different bone mineral densities (pounds per cubic feet [PCF] 5, 80 kg/m3; PCF 10, 160 kg/m3; and PCF 15, 240 kg/m3), and then successively or alternately inserted (following screw) after the leading screw removal. An original model (original C and H) of a leading screw without removal was created as a control. The strengths of resistance to pullout (PO) and rotational stress were measured. For each experimental condition, there were 30 experimental models. RESULTS The original C screw was superior in PO strength, and the original H-type screw was superior in rotational strength. When the C- or H-type screw was the leading screw, using the C-type screw again as the following screw (C1-C2, H1-C2) showed the greatest resistance to PO, and using the H-type screw as the following screw (C1-H2, H1-H2) showed superior resistance to rotational strength. However, the rotational strength of the C2 screw decreased by more than 50% compared with that of the original C screw. Moreover, the PO and rotational strengths of the H2 screw decreased to less than 30% overall compared with those of the original H screw. CONCLUSION The H-type screw should be used for second-time screw insertion procedures in cases where it is difficult to choose between PO and rotational strengths.
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Affiliation(s)
- Hong Man Cho
- Department of Orthopedic Surgery, Gwangju Veterans Hospital, 99 Cheomdanwolbong-ro, Gwangsan-gu, Gwangju, 62284, South Korea.
| | - Kwang Min Park
- Osong Medical Innovation Foundation, Medical Device Development Center, Cheongju, South Korea
| | - Tae Gon Jung
- Osong Medical Innovation Foundation, Medical Device Development Center, Cheongju, South Korea
| | - Ji Yeon Park
- Department of Orthopedic Surgery, Gwangju Veterans Hospital, 99 Cheomdanwolbong-ro, Gwangsan-gu, Gwangju, 62284, South Korea
| | - Young Lee
- Veterans Medical Research Institute, Veterans Health Service Medical Center, Seoul, South Korea
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Zhong G, Teng L, Li HB, Huang FG, Xiang Z, Cen SQ. Surgical Treatment of Internal Fixation Failure of Femoral Peritrochanteric Fracture. Orthop Surg 2021; 13:1739-1747. [PMID: 34142451 PMCID: PMC8523769 DOI: 10.1111/os.13110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 05/20/2021] [Accepted: 05/23/2021] [Indexed: 02/05/2023] Open
Abstract
Objective To investigate the factors, surgical treatment methods and clinical effect of internal fixation failure of intertrochanteric and subtrochanteric fractures. Methods From June 2015 to May 2019, arthroplasty and internal fixation revision were used to treat 18 cases of internal fixation failure of intertrochanteric and subtrochanteric fractures. There were 10 males and eight females, with an average age of 67.3 years (38–92 years). The 16 cases of initial intertrochanteric fractures were classified according to AO/OTA:13 cases of A2 and 3 cases of A3, the other 2 cases were subtrochanteric fractures (Seinsheimer type IV). The internal fixation failure was treated with total hip arthroplasty (6 cases), bipolar hemiarthroplasty (4 cases), revision with proximal femoral lockingplate (4 cases) and extend intramedullary nail (4 cases). Results All patients were followed up for an average of 24.7 months (range, 12 to 36 months). The average operative time was 111.4 min (range, 72 to 146 min) and the average intraoperative blood loss was 403.6 mL (range, 200 to 650 mL). The average time of fracture union was 6.9 months (range, 5 to 9 months) for cases of internal fixation revision. The operative time of the arthroplasty group was shorter than the revision group (P < 0.001), and the intraoperative blood loss of the arthroplasty group was less than the revision group (P = 0.001). The affected limb shortening of postoperative (0.21 ± 0.19 cm) was better than preoperative (2.01 ± 0.60 cm) (P < 0.001), while the limb shortening of the arthroplasty group (0.11 ± 0.21 cm) was less than the revision group (0.33 ± 0.09 cm) (P = 0.015). At the last follow‐up, all injured limbs regained walking function, and the Harris hip score was 81.3 ± 9.4 points. The Harris score of postoperative was better than preoperative (33.4 ± 5.9 points) (P < 0.001), while there were no significant differences between the arthroplasty group and the revision group at 3 months (76.5 ± 8.5 vs 71.1 ± 10.6, P = 0.249), 6 months (80.9 ± 7.9 vs 78.9 ± 12.9,P = 0.687) postoperative and the last follow‐up (80.5 ± 8.3 vs 82.3 ± 11.7, P = 0.716) respectively. Conclusion For internal fixation failure of peritrochanteric fractures, young patients could accept internal fixation revision to restore normal anatomical structure, correct varus deformity and autograft; while elderly patients and patients with damaged femoral head could be treated with arthroplasty to restore walking function.
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Affiliation(s)
- Gang Zhong
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China
| | - Lin Teng
- Department of Orthopaedics, The First People's Hospital in Shuangliu Distract/West China Airport Hospital, Sichuan University, Chengdu, China
| | - Hai-Bo Li
- Department of Orthopaedics, The First People's Hospital in Shuangliu Distract/West China Airport Hospital, Sichuan University, Chengdu, China
| | - Fu-Guo Huang
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China
| | - Zhou Xiang
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China
| | - Shi-Qiang Cen
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China
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Yamamoto N, Imaizumi T, Noda T, Inoue T, Kawasaki K, Ozaki T. Postoperative computed tomography assessment of anteromedial cortex reduction is a predictor for reoperation after intramedullary nail fixation for pertrochanteric fractures. Eur J Trauma Emerg Surg 2021; 48:1437-1444. [PMID: 34057554 DOI: 10.1007/s00068-021-01718-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 05/26/2021] [Indexed: 12/20/2022]
Abstract
PURPOSE Postoperative radiographs are routinely used to assess fracture reduction following intramedullary nail fixation for pertrochanteric fractures, even though computed tomography (CT) is a superior modality. We aimed to determine the association between reduction quality assessed by CT and rates of reoperation and to evaluate the association of reoperation and reduction quality according to the assessment modality (plain radiographs vs. CT). METHODS A retrospective analysis of 299 consecutive patients treated with intramedullary nail fixation for pertrochanteric fractures was conducted. Fracture reduction measured by postoperative radiographs and CT was categorized as anatomical type, extramedullary type, or intramedullary type. Postoperative data for analysis included reduction status, tip-apex distance (TAD), screw position in the femoral head, sliding distance, and conditions associated with reoperation. RESULTS Of the 299 patients included with a mean age of 83.1 ± 8.2 years, there were six patients who required reoperation (2.0%). According to the CT assessments, there were 42 intramedullary reductions (14.0%). Patients with a non-intramedullary reduction based on postoperative CT images were significantly more likely to have proper placement of the screw, a reduced TAD, a reduced sliding distance, and a lower reoperation rate than those with an intramedullary reduction (P < 0.05). The reduction quality assessed by postoperative CT was significantly associated with reoperation (95% CI, 1.45-29.31). CONCLUSIONS Intramedullary reduction assessed by CT was associated with reoperation. The reduction quality based on CT findings was more predictive for reoperation than that from plain radiographs.
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Affiliation(s)
- Norio Yamamoto
- Department of Orthopedic Surgery, Kagawa Prefectural Central Hospital, 1-2-1, Asahi-machi, Takamatsu, Kagawa, 760-8557, Japan.
| | - Takahiro Imaizumi
- Department of Orthopedic Surgery, Kagawa Prefectural Central Hospital, 1-2-1, Asahi-machi, Takamatsu, Kagawa, 760-8557, Japan
| | - Tomoyuki Noda
- Department of Orthopedic Surgery, Kagawa Prefectural Central Hospital, 1-2-1, Asahi-machi, Takamatsu, Kagawa, 760-8557, Japan
| | - Tomoo Inoue
- Department of Orthopedic Surgery, Kagawa Prefectural Central Hospital, 1-2-1, Asahi-machi, Takamatsu, Kagawa, 760-8557, Japan
| | - Keisuke Kawasaki
- Department of Orthopedic Surgery, Kagawa Prefectural Central Hospital, 1-2-1, Asahi-machi, Takamatsu, Kagawa, 760-8557, Japan
| | - Toshifumi Ozaki
- Department of Orthopedic Surgery, Kagawa Prefectural Central Hospital, 1-2-1, Asahi-machi, Takamatsu, Kagawa, 760-8557, Japan
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Mei J, Pang L, Jiang Z. Strategies for managing the destruction of calcar femorale. BMC Musculoskelet Disord 2021; 22:460. [PMID: 34011332 PMCID: PMC8136139 DOI: 10.1186/s12891-021-04324-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 05/05/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The calcar femorale was identified long ago. However, our current understanding of the calcar is insufficient, and its related concepts are sometimes confused. The calcar femoral is an important anatomical structure of the proximal femur, and its function can be overlooked. In trauma, tumors, or other diseases, the calcar femorale can be destroyed or changed pathologically. As a result, the mechanical structure of the proximal femur becomes destroyed, causing pathological fractures. How to address the destruction of the calcar femorale or the damage to the calcar femorale is discussed in this article. MAIN TEXT Destruction of the calcar femorale is accompanied by many conditions, including trauma, tumors, and other diseases. The types of hip fractures caused by trauma include femoral neck fractures and intertrochanteric fractures. Dynamic hip screws, proximal femoral nail anti-rotation, and multiple parallel cannulate pins can be used in different conditions. When metastatic and primary bone tumors involve the calcar femorale, endoprostheses are widely used. Other diseases, such as fibrous dysplasia and aneurysmal bone cyst are treated differently. CONCLUSIONS The calcar femorale can redistribute stresses and the destruction of the calcar femorale can lead to an increase in posterior medial stress. Many factors need to be considered when deciding whether to reconstruct the calcar femorale. Effective treatment strategies for managing the destruction of calcar femorale will need first establishing the precise mechanism of the destruction of the calcar and then designing therapies towards these mechanisms. Further investigation to the calcar needs to be carried out.
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Affiliation(s)
- Jin Mei
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610072 Sichuan Province China
| | - Lili Pang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610072 Sichuan Province China
| | - Zhongchao Jiang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610072 Sichuan Province China
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赵 益, 姜 振, 李 涛, 徐 重, 韩 亮, 褚 风, 吴 彬, 高 明, 王 海. [Treatment of irreducible intertrochanteric femoral fracture with minimally invasive clamp reduction technique via anterior approach]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:544-549. [PMID: 33998205 PMCID: PMC8175198 DOI: 10.7507/1002-1892.202012030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/18/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To explore the effectiveness of minimally invasive clamp reduction technique via anterior approach in treatment of irreducible intertrochanteric femoral fractures. METHODS Between January 2015 and January 2019, 59 patients with irreducible intertrochanteric femoral fractures were treated with minimally invasive clamp reduction technique via anterior approach. There were 29 males and 30 females with an average age of 77.9 years (range, 45-100 years). The causes of injury included falling in 46 cases, traffic accident in 6 cases, smashing in 2 cases, and falling from height in 5 cases. The time from injury to operation was 1-14 days (mean, 3.8 days). The fractures were classified as AO type 31-A1 in 12 cases, type 31-A2 in 25 cases, type 31-A3 in 22 cases. RESULTS All fractures were reduced well and the fracture reduction took 10 to 30 minutes, with an average of 19 minutes. All patients were followed up 13-25 months, with an average of 17.6 months. Among them, 2 cases of pronation displacement of proximal fracture segment died for infection or falling pneumonia after internal fixation failed. Six patients with reversed intertrochanteric femoral fractures experienced re-pronation and abduction displacement of the lateral wall after internal fixation, but the fractures all healed. The rest of the patients had no fracture reduction loss, and the fractures healed with an average healing time of 5.9 months (range, 3-9 months). Except for 2 patients who died, the Harris score of hip joint function of the remaining 57 patients was excellent in 49 cases and good in 8 cases at last follow-up. CONCLUSION The minimally invasive clamp reduction technique via anterior approach for irreducible intertrochanteric femoral fractures is simple and effective. For irreducible intertrochanteric femoral fractures related to lateral wall displacement, after clamp reduction and intramedullary nail fixation, the lateral wall should be reinforced in order to avoid reduction loss and internal fixation failure.
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Affiliation(s)
- 益峰 赵
- 济宁医学院附属医院创伤骨科（山东济宁 272029）Department of Traumatic Orthopedics, Affiliated Hospital of Jining Medical University, Jining Shandong, 272029, P.R.China
| | - 振 姜
- 济宁医学院附属医院创伤骨科（山东济宁 272029）Department of Traumatic Orthopedics, Affiliated Hospital of Jining Medical University, Jining Shandong, 272029, P.R.China
| | - 涛 李
- 济宁医学院附属医院创伤骨科（山东济宁 272029）Department of Traumatic Orthopedics, Affiliated Hospital of Jining Medical University, Jining Shandong, 272029, P.R.China
| | - 重阳 徐
- 济宁医学院附属医院创伤骨科（山东济宁 272029）Department of Traumatic Orthopedics, Affiliated Hospital of Jining Medical University, Jining Shandong, 272029, P.R.China
| | - 亮 韩
- 济宁医学院附属医院创伤骨科（山东济宁 272029）Department of Traumatic Orthopedics, Affiliated Hospital of Jining Medical University, Jining Shandong, 272029, P.R.China
| | - 风龙 褚
- 济宁医学院附属医院创伤骨科（山东济宁 272029）Department of Traumatic Orthopedics, Affiliated Hospital of Jining Medical University, Jining Shandong, 272029, P.R.China
| | - 彬 吴
- 济宁医学院附属医院创伤骨科（山东济宁 272029）Department of Traumatic Orthopedics, Affiliated Hospital of Jining Medical University, Jining Shandong, 272029, P.R.China
| | - 明 高
- 济宁医学院附属医院创伤骨科（山东济宁 272029）Department of Traumatic Orthopedics, Affiliated Hospital of Jining Medical University, Jining Shandong, 272029, P.R.China
| | - 海滨 王
- 济宁医学院附属医院创伤骨科（山东济宁 272029）Department of Traumatic Orthopedics, Affiliated Hospital of Jining Medical University, Jining Shandong, 272029, P.R.China
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Du SC, Wang XH, Chang SM. The Pre-Loaded Set-Screw in InterTAN Nail: Should It Be Tightened or Not Tightened in Pertrochanteric Hip Fractures. Geriatr Orthop Surg Rehabil 2021; 12:2151459321990640. [PMID: 33628611 PMCID: PMC7882741 DOI: 10.1177/2151459321990640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 01/02/2021] [Accepted: 01/04/2021] [Indexed: 12/02/2022] Open
Abstract
Background: InterTAN is a specific type of cephalomedullary nail with a twin interlocking de-rotation and compression screw, which has inherent ability of anti-rotation. Whether to tighten or not to tighten the preloaded setscrew to allow or not allow secondary sliding in InterTan nail is controversial in clinical practice. Methods: We retrospectively collected 4 nonunion cases of unstable pertrochanteric femur fractures (AO/OTA-31A2), all were treated with InterTan nail and the preloaded setscrew was tightened in order to prevent further secondary sliding and femoral neck shortening. Results: After 6 months to 2 years follow-up, the fractures showed nonunion in radiography and the patients complained slight to middle degrees of pain, and had to use walking stick assistant in activities of daily life. Tightening the pre-loaded setscrew to prevent postoperative secondary sliding as static constructs might keep the femoral neck length, but lose the opportunity of telescoping for fracture impaction, and take the risk of healing complications, such as fracture nonunion, femoral head cutout or nail breakage. Conclusions: As the harm outweighs benefit, we advocate the preloaded setscrew in InterTan nail should not be tightened in standard-obliquity pertrochanteric hip fractures (AO/OTA-31A1 and A2).
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Affiliation(s)
- Shou-Chao Du
- Department of Orthopedic Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Xiu-Hui Wang
- Department of Orthopaedic Surgery, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, People's Republic of China
| | - Shi-Min Chang
- Department of Orthopedic Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
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Swaroop S, Gupta P, Bawari R, Marya SK, Patnaik S. Factors Affecting the Outcome of Unstable Intertrochanteric Fractures Managed With Proximal Femoral Nail Anti-Rotation 2: A Prospective Outcome Study in Elderly Indian Population. Cureus 2020; 12:e11973. [PMID: 33425545 PMCID: PMC7790322 DOI: 10.7759/cureus.11973] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background The proximal femoral nail anti-rotation Asia (PFNA 2) is an implant designed for unstable osteoporotic intertrochanteric fractures in Asians as the PFNA was designed for Caucasians and had various complications when applied to the Asian population due to the femoral geometrical mismatch. This study observes the functional outcomes and complications associated with PFNA 2 in unstable intertrochanteric fractures in the elderly Indian population. Methods Sixty-one above 60 years old patients with an unstable intertrochanteric fracture who were operated with PFNA 2 were included in this prospective observational study. They were followed up for one year. The functional and radiographic evaluations were done at 6, 12, 20 weeks, and the functional outcome was evaluated at the end of one year. Association of age, American Society of Anaesthesiologists (ASA) grade, AO Foundation classification, osteoporosis to the functional outcome of modified Harris hip score (MHHS) was evaluated. Results Type A2 fractures demonstrated a statistically higher-good reduction than Type A3 (Student t-test, P < 0.05). The difference in mean surgical duration in Type A3 (45.47 minutes) and Type A2 (40.30 minutes) was statistically significant (Student t-test, P < 0.05). Mean blood loss was 110.66 ml (SD = 48.40 ml). MHHS at 6, 12, 20 weeks, and one year were 40.37, 63.93, 79.03, and 82.34, respectively. At the end of the year, 46 (82.1%) patients achieved good scores, eight (14.3%) achieved fair scores, and two (3.5%) achieved poor scores. There was one case of nonunion and medial migration of the helical blade. The mortality rate was 6.55% at the end of one year. Conclusion A good reduction was associated with a better functional outcome. PFNA 2 is an efficient implant in managing unstable intertrochanteric fractures in elderly Indian patients with good outcomes, low morbidity rates, and mortality. Implant mismatch was not a problem in the Indian population. However, large multi-centric studies with a larger sample size are required. Moreover, achieving a good reduction cannot be over-emphasized in unstable intertrochanteric fractures, especially in the elderly, to achieve a good functional outcome.
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Affiliation(s)
- Shakti Swaroop
- Orthopedics, Institute of Medical Sciences, SUM Hospital, Siksha 'O' Anusandhan (Deemed to be) University, Bhubaneswar, IND
| | - Prateek Gupta
- Orthopedics, Max Super Specialty Hospital, Saket, Delhi, IND
| | - Rajesh Bawari
- Orthopedics, Max Super Specialty Hospital, Saket, Delhi, IND
| | - Sanjiv K Marya
- Orthopedics, Max Super Specialty Hospital, Saket, Delhi, IND
| | - Swati Patnaik
- Public Health Dentistry, Institute of Dental Sciences, Siksha 'O' Anusandhan (Deemed to be) University, Bhubaneswar, IND
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Customised proximal femoral nail in treatment of intertrochanteric fracture with ipsilateral femoral shaft malunion: A case report. Trauma Case Rep 2020; 29:100348. [PMID: 32793796 PMCID: PMC7414000 DOI: 10.1016/j.tcr.2020.100348] [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] [Accepted: 07/27/2020] [Indexed: 11/22/2022] Open
Abstract
Peritrochanteric fractures are the most common fragility fractures for which patient are admitted in hospital and often require surgical interventions. With increasing life expectancy and early age of presentation, revision surgeries are increasing due to re-trauma, implant failure, infections etc. Here we present the case of a 65 years female, with inter trochanteric fracture femur right side with ipsilateral malunited proximal femur fracture, which was managed with customised proximal femoral nail. This case exemplifies the need for novel techniques and implants in our armamentarium to deal with such unusual fractures in elderly population.
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