Comparison of the reconstruction trochanteric antigrade nail (TAN) with the proximal femoral nail antirotation (PFNA) in the management of reverse oblique intertrochanteric hip fractures

Makki, Daoud; Matar, Hosam E; Jacob, Nebu C; Lipscombe, S.; Gudena, Ravindra

doi:10.1016/j.injury.2015.09.038

Cited by 43 publications

(56 citation statements)

References 8 publications

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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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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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“…Failure often results from the blade inserting into the hip joint, the blade dropping out, coxa vara, and proximal femoral splitting fracture. The failure rate was reported to be 3% to 40% [11,12], and typically caused by improper operation, unstable fracture, and osteoporosis. The PFLCP was an alternative method for proximal femoral fracture, and is one of the most widely used extramedullary implants.…”

Section: Discussionmentioning

confidence: 99%

“…There were various biomechanical studies [16][17][18] comparing intramedullary versus extramedullary devices to treat intertrochanteric fractures; from these studies, we found that intramedullary devices were superior to extramedullary devices in terms of biomechanical properties. A series of clinical studies reported the intramedullary device's superiority in less surgery damage, stable fixation, and fewer complications when compared to extramedullary implants [9,[19][20][21]. One biomechanical study [22] compared PFLCP and PFNA for reverse oblique intertrochanteric fractures; however, to the best of our knowledge, no comparative study of PFNA, PFLCP, medial buttress plate, and bilateral plate exists.…”

Section: Discussionmentioning

confidence: 99%

Investigation of a novel implant design for the treatment of reverse oblique femoral intertrochanteric fractures

Zhang¹,

Wang²,

Luo³

et al. 2019

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Objective: To evaluate the biomechanical properties of intramedullary fixation, lateral plate, medial buttress plate and bilateral plate for fixing reverse oblique intertrochanteric fractures. Methods: Twenty-four synthetic femoral bone models (Synbone) were divided into four groups [proximal femoral nail anti-rotation (PFNA), proximal femoral medial buttress plate (PFMBP), proximal femoral locking compression plate (PFLCP) and proximal femoral medial buttress plate + proximal femoral locking compression plate (PFMBL+PFLCP)], and an unstable, reverse oblique femoral intertrochanteric fracture was made. After fixation, each model underwent axial load testing, torsion testing, and axial load-to-failure testing. The stiffness of axial and torsion, the torque of different torsion angles and the failure load of every model were recorded. Results: The bilateral plate showed the best performance in axial load, torsion, and load-to-failure testing. The stiffness of axial and torsion in the PFMBP was superior to the PFNA [162.05±22.05 N/mm vs. 119.13±29.14 N/mm in axial, (1.36±0.32) N × mm/deg vs. (1.10±0.13) N × mm/deg in torsion, P<0.05], whereas there was no significant difference between PFMBP, PFLCP and PFLCP+PFMBP in torsion stiffness [(1.36±0.32) N × mm/deg, (1.45±0.44) N × mm/deg, (1.45±0.18) N × mm/deg, P>0.05]. Conclusion: Our newly designed medial buttress plate achieved greater stiffness in axial load and torsion than PFNA and PFLCP to fix reverse oblique intertrochanteric fractures in biomechanical research, whereas the bilateral plate showed better stiffness than PFMBP.

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“…[3][4][5][6] Currently PFNA (proximal femoral nail anti-rotation, PFNA) is a mature surgical treatment for senile ITF, which is characterized by maintaining strong fixation, biomechanical stability and minimally invasion. 7,8 ERAS (Enhanced Recovery after Surgery) is one of the two important development directions leading the development of modern surgery in the 21st century, which is first proposed by Kehlet in 1997. 9 ERAS aims to integrate the perioperative diagnosis and treatment concept by optimizing a series of effective approaches and methods with evidence-based medical evidence, so as to reduce trauma invasion and alleviate the stress reaction caused by surgery.…”

Section: Introductionmentioning

confidence: 99%

The efficacy of Enhanced recovery after surgery (ERAS) for elderly patients with intertrochanteric fractures received surgery: study protocol for a randomized, blinded, controlled trial

Yin¹,

Yao²,

Fan³

et al. 2020

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Background: Intertrochanteric fracture (ITF) is increasing with the rapid increase in the aging population, often causes a high mortality rate in old patients and increases the economic burden of the family and society. ERAS (Enhanced Recovery after Surgery) is a powerful guarantee for patients to accelerate their recovery after surgery. TCM (traditional Chinese medicine) promote repair of injured tissues and eliminate traumatic aseptic inflammation. Therefore, this prospective randomized controlled clinical trial aims to evaluate the clinical effect of the evidence-based ERAS pathway of integrating TCM with and western medicine on perioperative outcomes in ITF patients undergoing intramedullary fixation, and provide reliable evidence-based data for applying the program to clinical practice. Methods/design: We will conduct a prospective randomized, blinded, controlled trial to compare the effectiveness of ERAS care pathway with traditional care pathway, and to investigate whether the ERAS care pathway can improve the perioperative outcome in ITF patients undergoing intramedullary fixation. A total of 60 patients with ITF will be enrolled and treated with the two care pathway, respectively. Length of stay, economic indicators, Harris score, VAS score, time get out of bed, 30-day readmission rates, postoperative transfusion rates, discharge to home and mortality will be evaluated. Any signs of acute adverse reactions will be recorded at each visit during treatment. Discussion: Although an evidence-based process using the best available literature and Delphi expert-opinion method has been used to establish an ERAS pathway of integrating TCM with western medicine. But, there is a lack of consensus about its effectiveness. This trial will provide convincing evidence about the effect of ERAS pathway Trial registration: Registered on 12 Oct 2019; Trial number is ChiCTR190t0026487 Keywords: intertrochanteric fracture; enhanced recovery after surgery; perioperative period; integrating TCM with and western medicine; randomized controlled trial

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Comparison of the reconstruction trochanteric antigrade nail (TAN) with the proximal femoral nail antirotation (PFNA) in the management of reverse oblique intertrochanteric hip fractures

Cited by 43 publications

References 8 publications

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

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

Investigation of a novel implant design for the treatment of reverse oblique femoral intertrochanteric fractures

The efficacy of Enhanced recovery after surgery (ERAS) for elderly patients with intertrochanteric fractures received surgery: study protocol for a randomized, blinded, controlled trial

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