Clinical comparison of the second and third generation of intramedullary devices for trochanteric fractures of the hip—Blade vs screw

Lenich, Andreas; Vester, Helen; Nerlich, Michael; Mayr, Edgar; Stöckle, Ulrich; Füchtmeier, Bernd

doi:10.1016/j.injury.2010.07.499

Cited by 103 publications

(94 citation statements)

References 19 publications

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“…The PFNA was widely described to be a reliable implant to fix pertrochanteric fractures [18,20,26,35] and the augmented version was previously reported to lead to good short-term functional results [16]. Furthermore, the augmentation of the blade gives the fixation construct much more stability due to a larger bone-implant interface [8-11, 37, 40].…”

Section: Discussionmentioning

confidence: 99%

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Long-term results of the augmented PFNA: a prospective multicenter trial

Kammerlander

Doshi

Gebhard

et al. 2013

Arch Orthop Trauma Surg

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MethodsIn 5 european clinics, 62 patients (79 % female, mean age 85.3 years) suffering from an osteoporotic pertrochanteric fracture (AO 31) were treated with the augmented PFNA ® . The primary objectives were assessment of activities of daily living, pain and mobility. Furthermore, the X-rays were analyzed for the cortical thickness index, changes of the trabecular structure around the cement and the hip joint space. Results The mean follow-up time was 15.3 months. We observed callus healing in all cases. The surgical complication rate was 3.2 % with no complication related to the cement augmentation. A mean volume of 3.8 ml of cement was injected and no complication was reported due to this procedure. 59.9 % reached their prefracture mobility level until follow-up. The mean hip joint space did not change significantly until follow-up and there were no signs of osteonecrosis in the follow-up X-rays. Furthermore, no blade migration was assessed. Conclusion This study makes us believe that the standardized augmentation of the PFNA with a perforated blade is a safe method to treat pertrochanteric femoral fractures. It leads to good functional results and is not associated with cartilage or bone necrosis.

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Section: Discussionmentioning

confidence: 99%

“…Failures requiring reoperation such as a cutting out off the femoral head are still reported to be as high as up to 16 % [2,25,29,36] with screw devices and up to 5.7 % [18] with the PFNA. In this context, it is worth to notice that this affects a high number of people due to the increasing incidence of pertrochanteric fractures.…”

Section: Discussionmentioning

confidence: 99%

Long-term results of the augmented PFNA: a prospective multicenter trial

Kammerlander

Doshi

Gebhard

et al. 2013

Arch Orthop Trauma Surg

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“…[7][8][9]37 Nevertheless, there are complications such as cutting out of the femoral head or blade loosening reported in the literature. [7][8][9] All these complications are catastrophic failures for these patients due to the necessity of reoperation.…”

Section: Discussionmentioning

confidence: 99%

Standardised cement augmentation of the PFNA using a perforated blade: A new technique and preliminary clinical results. A prospective multicentre trial

Kammerlander

Gebhard

Meier

et al. 2011

Injury

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“…The larger surface area of the blade allows a more stable fixation in terms of axial loading especially in severe osteoporotic a wider distribution of forces within the place of highest bone density decreasing the risk of fracture [6]. 4.…”

Section: Patients' Characteristics Frequencies (%)mentioning

confidence: 99%

“…Many studies have compared different radiological parameters for assessing the rate of mechanical failure [4][5][6][7]. Tip Apex Distance (TAD) is considered one of the strongest predictors of cut-out using intramedullary nails [8].…”

Section: Introductionmentioning

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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Clinical comparison of the second and third generation of intramedullary devices for trochanteric fractures of the hip—Blade vs screw

Cited by 103 publications

References 19 publications

Long-term results of the augmented PFNA: a prospective multicenter trial

Long-term results of the augmented PFNA: a prospective multicenter trial

Standardised cement augmentation of the PFNA using a perforated blade: A new technique and preliminary clinical results. A prospective multicentre trial

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

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