Cephalomedullary Nail versus Sliding Hip Screw for Unstable Intertrochanteric Fractures in Elderly Patients

Chua, Ivan Tjun Huat; Rajamoney, Ganesan Naidu; Kwek, Ernest Beng Kee

doi:10.1177/230949901302100309

Cited by 38 publications

(29 citation statements)

References 21 publications

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“…Chua et al recently showed that elderly patients who sustained unstable intertrochanteric fractures treated with cephalomedullary nails had better short-term ambulatory function when compared to those treated with sliding hip screws. They had significantly higher Parker Mobility Scores and ability to ambulate independently or with a walking aid 1-year post-operatively [16]. Ziran et al also had similar findings when their IMHS group had better bed transfers, ambulatory ability, and gait distance at discharge [17].…”

Section: Discussionsupporting

confidence: 53%

Wedge effect following intramedullary hip screw fixation of intertrochanteric proximal femur fracture

O’Malley

Kang

Azer

et al. 2015

Arch Orthop Trauma Surg

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Section: Discussionsupporting

confidence: 53%

Wedge effect following intramedullary hip screw fixation of intertrochanteric proximal femur fracture

O’Malley

Kang

Azer

et al. 2015

Arch Orthop Trauma Surg

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“…Statistical Package for the Social Sciences (SPSS) software version 18.0 was used to analyze the data. Continuous data with normal distribution were presented as means and standard deviations, and compared with t test.…”

Section: Discussionmentioning

confidence: 99%

Predicting Factors for Return to Prefracture Ambulatory Level in High Surgical Risk Elderly Patients Sustained Intertrochanteric Fracture and Treated With Proximal Femoral Nail Antirotation (PFNA) With and Without Cement Augmentation

Kulachote

Sa-ngasoongsong

Sirisreetreerux

et al. 2020

Geriatr Orthop Surg Rehabil

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Introduction: Postoperative outcomes in the elderly patients with intertrochanteric fracture were generally poor with a low rate of return to prefracture ambulatory level (RPAL). Recent studies showed that proximal femoral nail antirotation (PFNA) with cement augmentation might be useful for postoperative functional recovery. This study aimed to compare the outcomes in elderly patients with high surgical risk, American Society of Anesthesiologist (ASA) grade 3 or 4, who sustained intertrochanteric fractures and were treated with PFNA with and without cement augmentation, and to correlate perioperative surgical factors with the RPAL. Methods: A retrospective consecutive series was conducted based on 135 patients with prefracture ambulation classified as independent in community with or without a single cane (68 in augmented group and 67 in control group). Perioperative data and data on the complications within 1-year postsurgery were collected and compared. Predictive factors for RPAL were analyzed via logistic regression analysis. Results: The overall 1-year postoperative mortality rate was 10% (n = 14) with no significant difference between groups ( P = .273). The proportion of elderly patients with RPAL in the augmented group was significantly higher than for those in the control group (48% vs 29%, P = .043). Via univariate analysis, ASA grade 4 ( P = .077), history of stroke ( P = .035), and use of cement augmentation ( P = .041) were correlated with RPAL. However, multivariate regression analysis showed that ASA grade 4 (odds ratio [OR] = 0.40, 95% confidence interval [CI]: 0.18-0.90, P = .026) and use of cement augmentation (OR = 2.72, 95% CI: 1.22-6.05, P = .014) were the significant predictors for RPAL. Discussion and Conclusions: The results of the present study showed that PFNA with cement augmentation is safe and effectiveness in the intertrochanteric fracture treatment of elderly. Postoperative functional recovery, like RPAL, in elderly patients who sustained intertrochanteric fractures is relatively low, especially in those with ASA grade 4. However, cement augmentation with PFNA might be helpful for increasing the RPAL in high-surgical-risk geriatric patients.

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“…Two patients who treated with PFNA underwent cutout due to poor reduction, and 1 patient had avascular necrosis after cutout. The authors found that PFNA was superior in terms of the functional status of the patient and return to pre-fracture mobilization as opposed to our study [29]. Varela-Egocheaga and colleagues conducted a prospective, randomized study of 80 patients with stable intertrochanteric femur fractures aged over 60 years old who were treated with a proximal compression plate or proximal femoral nail.…”

Section: Discussionmentioning

confidence: 65%

Comparison of proximal femoral nail and dynamic hip screw for treating intertrochanteric fractures

Öçalan¹,

Özkayın²,

Aktuğlu³

2018

Journal of Surgery and Medicine

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How to cite / Atıf için: Öçalan E, Özkayın N, Aktuğlu K. Comparison of proximal femoral nail and dynamic hip screw for treating intertrochanteric fractures.This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0 (CC BY-NC-ND 4.0) where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal. AbstractAim: In this study, the use of proximal femoral nail and dynamic hip screw for treatment of intertrochanteric hip fractures were compared in terms of mortality and morbidity. Methods: 131 patients who had an operation due to intertrochanteric hip fractures were evaluated demographic characteristics and surgical data (72 female, 59 male, mean age 77.85, range 65-98 years). 98 patients (74.8%) PFN method, 33 patients (25.2%) DHS method was applied. The age and gender of patients, etiology, type of anesthesia, preoperative waiting period, preoperative ASA (American Society Anesthesiologists) score calculated by anesthesia physicians, Singh index, track time, the type of fracture, complication rate, the degree of reduction, tip-apex distance, shortening the existence and mortality were investigated. The Harris Hip Score was used for functional assessment.Results: The average post-operative follow-up period was 25.23 (1-66) months. The group that were applied DHS were found significantly different for reduction success (p<0.05). Harris Hip Scoring of patients in the DHS group were found significantly better (p<0.05). The success of the reduction in the DHS group was significantly related with the Harris HipScore (p<0.05). Conclusion: We have concluded that the preoperative waiting time has no impact on mortality, increasing age increases the systemic disease, therefore increases ASA score. So that increasing ASA score increases the mortality. Unstable intertrochanteric fractures of the femur PFNA, due to the higher success rate of reduction should be preferred. But between two methods there were no significant differences about healing time and mortality. In conclusion, surgical techniques to be used should be selected according to the fracture type and age of the patient. Öz Amaç: Bu çalışmada Intertrokanterik kalça kırığı tedavisinde kullanılan Proksimal femur çivisi ve dinamik kalça vidası cerrahi yöntemleri mortalite ve morbidite açısından karşılaştırıldı. Yöntemler: Intertrokanterik kırık nedeniyle opere olan 131 hastanın (72 kadın, 59 erkek, ort yaş 77.85; dağılım 65-98 yıl) demografik özellikleri ve ameliyat verileri değerlendirildi. Doksan sekiz hastaya (%74,8) PFNA, otuz üç hastaya ise (%25,2) DHS uygulanmıştır. Hastaların yaş, cinsiyet, kırık olan kalça tarafı, kırık etyolojisi, anestezi tipi, preoperatif bekleme süresi, anestezi hekimince hesaplanan preop ASA (American Society Anesthesiologists) skoru, Singh indeksi, takip süresi, kırık tipi, komplikasyon oranı, redüksiyon derecesi, tip-apeks mesafesi, kısalık v...

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Cephalomedullary Nail versus Sliding Hip Screw for Unstable Intertrochanteric Fractures in Elderly Patients

Cited by 38 publications

References 21 publications

Wedge effect following intramedullary hip screw fixation of intertrochanteric proximal femur fracture

Wedge effect following intramedullary hip screw fixation of intertrochanteric proximal femur fracture

Predicting Factors for Return to Prefracture Ambulatory Level in High Surgical Risk Elderly Patients Sustained Intertrochanteric Fracture and Treated With Proximal Femoral Nail Antirotation (PFNA) With and Without Cement Augmentation

Comparison of proximal femoral nail and dynamic hip screw for treating intertrochanteric fractures

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