Comparison of radiological and functional outcome of unstable intertrochanteric femur fractures treated using PFN and PFNA-2 in patients with osteoporosis

Mallya, Sharan; Kamath, Surendra U.; Madegowda, Arkesh; Krishnamurthy, Sarala; Jain, Manesh; Holla, Ramesh

doi:10.1007/s00590-019-02401-x

Cited by 29 publications

(28 citation statements)

References 25 publications

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“…By synergistically altering the PSA and theanteversion angle, TAD can be easily adjusted to be less than 25 mm (20.52 ± 2.80 mm) which is recommended by several scholars during the fixation of IEFs in order to prevent complications [ 24 , 25 ]. The accessibility and perfection of TAD adjustment in our study smoothed the surgery (shorter operative time: 65.82 ± 11.16 min vs 79.50 ± 21.12 min [ 21 , 26 , 27 ] and fluoroscopy time: 2.03 ± 0.79 min vs 2.9 ± 0.16 min) [ 7 ]), improved the treatment effects (higher HHS: range, 57–89 vs 36–97 [ 28 ]) and decreased the complications (rate: 12.00%, 6/50 vs 57.44%, 108/188 [ 21 ]; cut-out: 0% vs 4% [ 29 ] or 2.7% [ 30 ]) compared with previous studies where TAD was higher than 25 mm, even modified 30 mm [ 31 ] in some cases [ 28 – 30 ].…”

Section: Discussionmentioning

confidence: 99%

How to get better TAD? Relationship between anteversion angle of nail and position of femoral neck guide pin during nailing of intertrochanteric fractures

Wang

Liu

et al. 2020

BMC Musculoskelet Disord

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Background: To demonstrate the correlation between guide pin-shaft angle (PSA) at the anteroposterior film and anteversion angle of guide pin at the lateral film and investigate whether excellent tip-apex distance (TAD) can be obtained by changing the entry point via axial rotation of the main intramedullary nail. Methods: Fifty patients with intertrochanteric femoral fractures (IFFs) undergoing internal fixation with intramedullary nails under 2D fluoroscopy were retrospectively enrolled. Both of the PSA at the anteroposterior film and anteversion angle at the lateral film before and after adjustment of the guide pin were collected. Pearson correlation analysis was performed to investigate their correlation. Intraoperative and postoperative outcomes were recorded. Furthermore, the software of Mimics 10.0 and Pro/E were used to establish the 3D models of the proximal femur and main intramedullary nail/guide pin, respectively. Surgery was simulated on the Pro/E software platform and solid geometry analysis was conducted to calculate the correlation between the PSA and the anteversion angle. Results: Pearson correlation analysis indicated there was a positive correlation between PSA and anteversion angle, with the correlation coefficient of 0.902 (p < 0.01). By altering the PSA and anteversion angle, TAD was adjusted to be less than 25 mm in all patients. The mean operative time, fluoroscopy time and length of hospital stay were 65.82 ± 11.16 min, 2.03 ± 0.79 min and 6.66 ± 2.49 d. Thirty-one patients received blood transfusions (3.55 ± 1.95 U). Fracture reduction was considered to be good or acceptable in all patients. Complications occurred only in 6 patients (12.00%). At a 3-month follow-up, the mean Timed Up and Go was 31.54 ± 20.95 s and Harris Hip Score was 72.88 ± 8.79. The 3D surgery model also showed when the main intramedullary nail was externally rotated or internally rotated of 20°at the standard location, the PSA of guide pin at the anteroposterior position and anteversion angle of the guide pin at the lateral position were simultaneously increased or decreased. Conclusion: Our findings suggest altering the PSA and anteversion angle may be beneficial for obtaining excellent TAD and achieving superior outcomes.

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Section: Discussionmentioning

confidence: 99%

How to get better TAD? Relationship between anteversion angle of nail and position of femoral neck guide pin during nailing of intertrochanteric fractures

Wang

Liu

et al. 2020

BMC Musculoskelet Disord

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“…In the elderly population, which is associated with high blood pressure, heart disease, diabetes and other chronic diseases, lying in bed for a long time can often aggravate the condition and lead to morbidities, such as: lung and blood clots in the brain, heart, kidney, and lung; urinary tract infections; and pressure sores. Therefore, the present and consistent view is, for elderly patients who can tolerate such procedures, to operate as soon as possible and to perform early activities in bed in order to reduce complications, reduce the risk of death, and improve the quality of life of patients with fractures. The British NICE hip fracture clinical guidelines suggest that elderly patients should undergo surgery within 48 h as often as possible in order to reduce mortality.…”

Section: Discussionmentioning

confidence: 99%

Procedure for Femoral Intertrochanteric Fractures using the “Three‐Finger Method” Assisted by Proximal Femoral Nail Antirotation

Cheng

Lin

Zhu

et al. 2020

Orthopaedic Surgery

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Objective: To assess long-term follow-up evaluations for the treatment of femoral intertrochanteric fractures with the "three-finger method" assisted by proximal femoral nail antirotation (PFNA). , 123 patients were selected and followed for the treatment of femoral intertrochanteric fractures with PFNA assisted by the "three-finger method" (application of the index finger, middle finger, and ring finger in the process of surgery to assist PFNA). There were 56 male patients and 67 female patients aged 52-93 years with an average age of 75.6 years, and 88 cases were due to a fall and 35 due to a traffic accident injury. The femoral necks were fixed with PFNA assisted by the "three-finger method" applying the following procedure: traction reduction, determining the incision, inserting the needle, and placing screw. The Harris hip score, postoperative complications, hip pain and function status were statistically analyzed to evaluate the surgical efficacy and to discuss the surgical technique of the "three-finger method" assisted by PFNA.Results: According to the Harris scoring criteria, patients were followed for 1, 2, 4, 6, and 8 years, and the good outcomes of patients were recorded. The excellent and good rate of 87% was the highest in the second year of follow-up. Then, the rate decreased following the eighth year of follow-up. The excellent and good rate of 82.7% was the lowest. The patients with incisions healed well, there were no instances of fat liquefaction or infection. There were three cases of effusion, the rate was 2.4%. The secretions were cultured, and no bacterial growth was found. After treatment of the wound, it healed, and the spiral blade used for the femoral head did not wear out. There was one case of femoral head necrosis. There was no significant correlation between hip pain and sex and age (P > 0.05), and the function of the hip joint was significantly correlated with the age of the patients (P < 0.05). Conclusion:The "three-finger method" in the process of surgery to assist PFNA for the treatment of patients with intertrochanteric fractures of the femur simplified the operation steps, reduced the operation difficulty, shortened the operation time, improved the operation efficiency, and reduced the incidence of postoperative complications.

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“…Intertrochanteric fractures often occur in the combination of osteoporosis in the elderly, as older patients often merge many medical conditions such as cardiovascular system (12)(13)(14).Some scholars believe that PFNA is suitable for most senile osteoporotic intertrochanteric fractures (15). PFNA fixation of intertrochanteric fractures has significant advantages in mechanical principle and anti-rotation function (16), which is currently the most widely used fixation method.…”

Section: Discussionmentioning

confidence: 99%

Hemiarthroplasty for the Management of unstable femoral intertrochanteric fractures in elderly patients over 75 years old: a retrospective matched comparative study

Wang³

et al. 2020

Preprint

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Background To compare and analyze the therapeutic effect of Proximal Femoral Nail Antirotation and hemiarthroplasty on intertrochanteric fracture. Methods 45 patients with intertrochanteric fractures (17 males and 28 females) admitted to our hospital from January 2016 to January 2018 were collected. The mean age was 84.82 ± 0.73 years. All injuries were caused by falls during daily activities. Patients were divided into two groups according to the surgical method: the first group was the hemiarthroplasty group, referred to as the hemiarthroplasty group, with a total of 22 patients, and the average length of hospital stay was 13.09 ± 5.03 days. According to the improved Evans-Jensen classification [5], there were 1 cases of III, 9 cases of IV, and 12 cases of V12.The second group was the Proximal Femoral Nail Antirotation group, and the average length of hospital stay was 13.09 ± 6.97 days. According to the Evans-Jensen classification, 1 patient was III, 16 patients were IV, and 6 patients were V. Results Intraoperative blood loss was higher in the The Proximal Femoral Nail Antirotation group than in the hemiarthroplasty group(P=0.034).In the postoperative recovery of the two groups, the time from operation to partial weight-bearing of the hemiarthroplasty group was shorter than that of the PFNA group༈p༝0.000༉, and the postoperative HHS of the hemiarthroplasty group was also better than the latter (p ༝0.0005). In terms of total cost during hospitalization, the Hemiarthroplasty group was less than the PFN group(p ༝ 0.017). One year after surgery, the mortality rate increased to 34% in the PNFA group and 9% in the hemiarthroplasty group( P = 0.038), which was statistically significant. Conclusion Hemiarthroplasty for intertrochanteric fractures in the elderly can reduce intraoperative blood loss, achieve early recovery, improve survival rates, and reduce the economic burden on patients

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Comparison of radiological and functional outcome of unstable intertrochanteric femur fractures treated using PFN and PFNA-2 in patients with osteoporosis

Cited by 29 publications

References 25 publications

How to get better TAD? Relationship between anteversion angle of nail and position of femoral neck guide pin during nailing of intertrochanteric fractures

How to get better TAD? Relationship between anteversion angle of nail and position of femoral neck guide pin during nailing of intertrochanteric fractures

Procedure for Femoral Intertrochanteric Fractures using the “Three‐Finger Method” Assisted by Proximal Femoral Nail Antirotation

Hemiarthroplasty for the Management of unstable femoral intertrochanteric fractures in elderly patients over 75 years old: a retrospective matched comparative study

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