Comparison of Supine Position and Traction Table in the Surgical Treatment of Unstable Intertrochanteric Fractures with PFNA

Abstract

Aim: Intertrochanteric femur fractures (IFF) are a major cause of morbidity and mortality in the elderly population. Proximal femoral nail-anti-rotation (PFNA) is one of the most preferred surgical treatment methods. This study aimed to compare the clinical and radiologic results of two different patient positions used during PFNA and to reveal the intraoperative advantages and disadvantages.
 Material and Method: Cases operated due to IFF between January 2020 and December 2022 were retrospectively analyzed. The study was conducted with 123 patients meeting the inclusion criteria. The minimum follow-up period was determined as one year. Two groups were formed: those operated on the traction table (opereted-TT) and those operated in supine lithotomy without traction table (operated-SP). The groups were compared regarding operative time, reduction quality, type-apex distance (calTAD), and radiologic and clinical results.
 Results: There were 76 patients in the operated-TT group and 47 in the operated-SP group. The mean age of the operated-TT group was 81.00±8.52 years, and the mean age of the operated-SP group was 79.30±8.12 years. (p=0.213) Gender, follow-up time, time from trauma to surgery, and fracture classification were similar for the groups. The mean operative time was 95.18±8.54 minutes in the operated-TT group and 88.23±7.12 minutes in the operated-SP group, and the operation was completed in a shorter time in the operated-SP group. (p=0.001) There were no differences between the groups in terms of reduction quality, calTAD, Harris Hip Score, VAS score, infection rates, and cut-out rates.
 Conclusion: Based on this study, the radiologic and clinical results of the cases operated with manual traction in the supine position and those operated using a traction table in treating IFF with PFNA are similar. In addition, it was concluded that shorter operation time was an advantage of the operated-SP group.

The Effect of the Preoperative Position on the Success of Intertrochanteric Fracture Surgery

“…However, not only was reduction quality similar to that of the other groups, but also, when the cut-out rates were examined, it was seen that there was no significant difference from the other groups. In a study comparing the supine hemilithotomy position with the traction table, it was observed that there was no significant clinical or radiological difference between these two positions, except for duration of surgery [26] . When we look at the literature, well-leg compartment syndrome can be seen in patients in the supine hemilithotomy position, and it is thought that this complication may be due to a surgery duration of over four hours, body mass index, coagulopathy, and perioperative hypotension [27,28].…”