Antirotation proximal femoral nail versus dynamic hip screw for intertrochanteric fractures: A meta-analysis of randomized controlled studies

Shen, Liangfang; Zhang, Y.; Shen, Yuhui; Cui, Zhuang

doi:10.1016/j.otsr.2012.12.019

Cited by 87 publications

(72 citation statements)

References 24 publications

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“…However, Shen et al 13 opined that this superiority was attributable to variation in the skills of the surgeons and different patterns of per-trochanteric fractures.…”

Section: Discussionmentioning

confidence: 99%

A Comparative Study of Functional Outcome Between Dynamic Hip Screw and Proximal Femoral Nail in Surgical Management of Per - Trochanteric Fractures

Shivanna¹,

Rudrappa²

2015

jemds

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BACKGROUND:The choice of implant between the extramedullary Dynamic Hip Screw (DHS) and intramedullary Proximal Femoral Nail (PFN) in the surgical management of pertrochanteric fractures is still an enigma. Various meta-analysis conducted so far have yield conflicting results. METHODS: Prospective randomized controlled study including 30 patients with 30 pertrochanteric fractures out of which 15 were treated with DHS and 15 with PFN. RESULTS: The overall functional outcome of patients treated with the PFN was significantly better than those treated with DHS (p<0.037), especially in patients with unstable fractures. Other advantages of PFN included smaller incisions, shorter operative times, relatively less blood loss and less postoperative pain and early ambulation. CONCLUSION: We conclude that in stable intertrochanteric fractures, both the PFN and DHS have similar outcomes. However, in unstable intertrochanteric fractures the PFN has significantly better outcomes in terms of earlier restoration of walking ability and less limb length shortening.

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“…However, Shen et al 13 opined that this superiority was attributable to variation in the skills of the surgeons and different patterns of per-trochanteric fractures.…”

Section: Discussionmentioning

confidence: 99%

A Comparative Study of Functional Outcome Between Dynamic Hip Screw and Proximal Femoral Nail in Surgical Management of Per - Trochanteric Fractures

Shivanna¹,

Rudrappa²

2015

jemds

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“…The lack of structural bone on posterior and medial area of the proximal femoral metaphysis in 31.A2 type fractures and in the lateral cortex on type 31.A3 may theoretically cause instability with varus or rotational deformity and consequent pending cut-outs. Many studies report a lower incidence of complications for PFNa (46,49,50). According to these studies, we recorded a single mechanical failure of such nail requiring surgery.…”

Section: Discussionmentioning

confidence: 94%

“…The unstable fractures are usually challenging, and several reports confirmed the superiority of nails over plates in fixation and stability (21,22,24,30). Referring to the PFNa system is reported less blood loss and shorter duration of hospitalization (31,46) and also a lower biomechanical-inflammatory profile that can be related to a lower invasiveness of the procedure (47). Other Authors reported good results also with the SHS (5,6,15,25) with the same risk of postoperative complications of PFNa (48).…”

Section: Discussionmentioning

confidence: 95%

A comparison of two fixation methods for femoral trochanteric fractures: a new generation intramedullary system vs sliding hip screw

Carulli¹

2017

ccmbm

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SummaryIntroduction. Trochanteric fractures are frequent and generally associated with bone fragility. There is still debate on the best fixation device to treat stable or rather stable trochanteric fractures: we report our clinical and radiological results of fixation with Proximal Femoral Nail "antirotation" (PFNa) in a population of patients compared to a control group treated by Sliding Hip Screw (SHS). Materials and methods. A prospective study was conducted in 71 consecutive patients treated by PFNa (group A), and 69 by a SHS (group B), with a mean age of 81.6 and 83.4 years respectively. Short Form 12 was administered to check postoperative results, and the following parameters were evaluated: range of motion, evaluation of pain, gait ability, X-rays, and Tip Apex Distance Index. Results. A minimum follow-up was conducted in 128 patients: 66 subjects belonging to the PFNa group and 62 to the DHS group. All patients in the group A were able to reach partial or full weight-bearing on the operated leg before leaving the hospital. Forty-four patients (63.8%) of the group B were able to walk with partial weight-bearing before discharge. We recorded 17 complications with a final overall percentage of 17.2% on the overall study population with one single case of failure in both the two groups. Discussion. A statistical significance (p<0.01) of superiority for PFNa was demonstrated regarding surgical time, amplioscope time, intraoperative blood loss, hospital stay, recovery of weight-bearing before discharge. Less significant results (p<0.05) were found for walking ability at the three-months follow-up and patients' satisfaction 6 months after surgery. Conclusions. PFNa may be considered an useful choice for the treatment of stable or rather stable trochanteric

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“…PFNA provides less blood loss and shorter fluoroscopy time compared to gamma nail and DHS [3,[18][19][20][21]. Also, it had shorter fluoroscopy time as compared to third generation gamma nail and fewer complications as compared to DHS and a faster recovery as compared to both [21][22][23]. In addition, minimal failure rate noted for PFNA as compared to others and it even showed less cut out rate (1.9%) compared to PFN (4.8%) attributing it to the superiority of blade compared to leg screw in the stabilization of bone stock [24].…”

Section: Patients' Characteristics Frequencies (%)mentioning

confidence: 99%

Predictors of Mechanical Failure Rate in Reduction of Intertrochanteric Fracture of the Femur Using Proximal Femoral Nail with Helical Blade

2018

J Orthopedics Rheumatol

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Background: The optimal implant for reducing intertrochanteric fracture is unknown. Several bone-related, implant-related and radiological variables seem to play a role in predicting the rate of intraoperative and postoperative mechanical failure. The objective of this study was to evaluate the rate and predictors of mechanical failure and its relationship with quality of reduction through assessing certain radiological parameters. Materials and methods:A retrospective study reviewed patients with stable (AO/OTA Type 3.1A1) and unstable (AO/OTA Type 3.1A2 and A3) intertrochanteric femur fracture who were treated with proximal femoral nail with helical blades (PFNA) between 2011 and 2017. Exclusion criteria were patients with pathologic fractures. Followup was undertaken at 1 day, 4-6 weeks, and 3 months postoperatively by reviewing radiographs and medical charts. The primary outcome was the rate of mechanical failure. Radiologic parameters of Tip apex distance (TAD), neck shaft angle and displacements were evaluated as indicators of reduction quality. All these were compared to each other and baseline patient characteristics to identify any association. Results:We found 69 patients who underwent PFNA procedure. There was no case of intraoperative or postoperative mechanical failure or non-orthopedic complication. The postoperative radiological outcomes revealed variable quality of reduction with: mean TAD of 26.07±3.69° (bimodal), mean neck shaft angle of 133±5.6° (range: 116-140°), 35% of patients having lesser trochanter displacement, 28% having displaced femoral shaft. There was no statistical significant relation between any of the radiological outcomes and patient characteristics except between neck shaft angle and osteoporosis (p=0.03). Conclusion:The radiological outcomes are independent of the patient's characteristics except for Neck Shaft Angle and Osteoporosis. Absence of mechanical failure despite the variability in reduction quality (optimal/suboptimal) might be explained by the decent implant design. Further studies are needed to confirm that PFNA implant design is the major preventer of mechanical failure. Level of evidence: IV

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Antirotation proximal femoral nail versus dynamic hip screw for intertrochanteric fractures: A meta-analysis of randomized controlled studies

Abstract: Level II, meta-analysis of low powered randomized study.

Cited by 87 publications

References 24 publications

A Comparative Study of Functional Outcome Between Dynamic Hip Screw and Proximal Femoral Nail in Surgical Management of Per - Trochanteric Fractures

A Comparative Study of Functional Outcome Between Dynamic Hip Screw and Proximal Femoral Nail in Surgical Management of Per - Trochanteric Fractures

A comparison of two fixation methods for femoral trochanteric fractures: a new generation intramedullary system vs sliding hip screw

Predictors of Mechanical Failure Rate in Reduction of Intertrochanteric Fracture of the Femur Using Proximal Femoral Nail with Helical Blade

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