Comparison of the Sliding and Femoral Head Rotation among Three Different Femoral Head Fixation Devices for Trochanteric Fractures

Chinzei, Nobuaki; Hiranaka, Takafumi; Niikura, Takahiro; Tsuji, Mineo; Kuroda, Ryosuke; Doita, Minoru; Kurosaka, Masahiro

doi:10.4055/cios.2015.7.3.291

Cited by 28 publications

(35 citation statements)

References 29 publications

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“…The treatment of these fractures is subject to controversy, particularly concerning the use of intramedullary versus extramedullary devices. However, there is one point on which the different studies seem to agree: extramedullary sliding devices (e.g., SHS) are not adequate for fractures of this kind [2][3][4][5]. As a result of their distinct biomechanics, these devices distract rather than compress the fracture fragments thus leading to a high percentage of failures.…”

Section: Discussionmentioning

confidence: 91%

“…The instability of these fractures is exerted by the iliopsoas muscle that inserts in the fractured lesser trochanter and therefore medializes the comminuted postero-medial cortex of the fracture; this reduces the area of contact between the two ends of the fracture, delaying bone callus formation and increasing the risk of implant failure [1]. This fracture´s controversy seems to center on the type of treatment used: extramedullary devices versus intramedullary nail [2][3][4][5]. The different biomechanical forces involved because the extramedullary devices to produce distraction of the fracture, which leads to a high percentage of implant failures.…”

Section: Introductionmentioning

confidence: 99%

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AO/OTA 31-A2 Fractures: Long or Short Gamma Nail?

Luque¹

2017

BJSTR

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Introduction: The Gamma 3 nail is widely used for AO31A1-3 fractures. The aim of this study was to compare outcomes in patients with 31A2 fractures treated with two lengths of Gamma3 nail. Material:A prospective study of 104 non-pathological 31A2 fractures treated January 2012-January 2014. 14 patients were eliminated due to inadequate follow up. Mean follow-up was 18 months (range 12-36). Average age was 81 years (range 50-99), 78% of the patients were female. We studied two groups: Long Gamma3 Nail (LGN) and Short Gamma3 Nail (SGN). Preoperative variables included: age, medical pathologies, gait, anesthetic risk, associated fractures, hemoglobin and hematocrit values. Postoperatively, we evaluated: functional and radiographic results, quality of life, hemoglobin concentration, hematocrit, transfusion, gait and pain. Intraoperative and postoperative complications were recorded: malunion, nonunion, infection rates, cut-outs and periprosthetic fractures. Results:We obtained a correct reduction in 73% of cases. We found two intraoperative complications (greater trochanteric fractures) in two LGN cases. 38% of the patients with LGN presented nail tip impaction upon the distal anterior femoral cortex, associated with anterior knee pain. Blood loss was statistically different between groups but neither clinical outcomes nor quality of life presented any differences. Conclusion:Our results with these two sizes of the Gamma3 Nail in 31A2 fractures showed no overall differences in clinical outcomes and complication rates. Despite this, the LGN presented a statistically significant higher decrease of the postoperative hematocrit and more transfused blood concentrates. We therefore recommend the use of locked SGN to treat the 31A2 fractures.

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Section: Discussionmentioning

confidence: 91%

Section: Introductionmentioning

confidence: 99%

AO/OTA 31-A2 Fractures: Long or Short Gamma Nail?

Luque¹

2017

BJSTR

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“…Nobuaki chinzei et al In their study of comparison of sliding and femoral head rotation among three different femoral head fixation devices for trochanteric fractures concluded that the ability to stabilise femoral head appears to be greater with blade type materials than with screw type materials. Furthermore non cylindrical blade is preferable to a cylindrical blade [36] . In the study by Takigami et al the length of the surgical procedure averaged 20.3 minutes (range 9-83 minutes).…”

Section: Resultsmentioning

confidence: 99%

Choice of implant in stable intertrochanteric fracture femur: PFNA vs DHS

Rathva¹,

Patel²,

Patel³

et al. 2018

Int. J. Orthop. Sci.

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Introduction:The best treatment for trochanteric fracture remains controversial Many methods have been recommended. Stable fixation that allows early mobilization is the treatment of choice. In this study, we aimed to compare the results of osteosynthesis using the PFNA and DHS system, in the treatment of stable intertrochanteric fractures including operative and postoperative complications, general complications and final outcome measurements. Method: We randomised 60 patients with low-energy extracapsular pertrochanteric stable femoral fractures (AO category 31-A1.1-31A.2.1)7 to be treated with the dynamic hip screw or the proximal femoral nail A2. All fractures were categorised according to the AO/ASIF classification. Follow-up reviews were undertaken at four weeks, three and six months post-operatively using Harris hip score. Results: From the first to the 6 th month, there was a significant improvement in Harris hip score (p<0.05), when each time point was compared with the previous one in both groups. On 3 -month followup, PFNA2 group had significantly better daily functioning than DHS group, as defined by Harris hip score. At 6 months, the PFNA2 group approached but did not normalise to its pre-operative Harris hip screw values (p =0.043). In contrast, DHS group values at 6 months lagged significantly to pre-operative values (p<0.001) PFNA group has fewer complications compared to DHS group. Conclusion: PFNA can benefit peritrochaneric fractures with less blood loss, earlier mobilization, better functional outcome and fewer complication compared to DHS.

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“…In the cases treated with a screw and side plate device, sliding distance was measured on anteroposterior radiographs [ 10 , 20 , 21 ]. The distance was defined as the distance the inserted lag screw slid within the fixed angle sliding hip screw device.…”

Section: Methodsmentioning

confidence: 99%

Three-Dimensional Computed Tomographic Analysis for Comminution of Pertrochanteric Femoral Fracture: Comminuted Anterior Cortex as a Predictor of Cutting Out

Tsukada¹,

Wakui²,

Yamada³

et al. 2016

TOORTHJ

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Background:Fixed angle sliding hip screw devices allow controlled impaction between the head neck fragment and the femoral shaft fragment in the surgical treatment of pertrochanteric fractures. This study was performed to evaluate the frequency and pattern of comminution at the fracture site, which may prevent the intended impaction.Materials and Methods:Three-dimensional computed tomography was used to investigate 101 pertrochanteric fractures treated with fixed angle sliding hip screw devices, with emphasis on the comminuted cortex. A comminuted fracture was defined as a fracture that had a third fracture fragment at the main fracture line.Results:There were 40 fractures without comminution and 61 with comminution. All 61 comminuted fractures had a comminuted posterior cortex, and 3 of 61 fractures also had comminution at the anterior cortex. The prevalence of cutting out of the implant from the femoral head was significantly higher in cases involving comminution at both the posterior and anterior cortices than in cases involving comminution only at the posterior cortex (66.7 % and 3.4 %, p < 0.0001).Conclusion:The posterior cortex was comminuted in 60.4% of pertrochanteric fractures and the anterior cortex in 3.0%. Intended impaction at the fracture site could not be obtained at any cortex in cases with comminution at both the anterior and posterior cortices; comminution at the anterior cortex may be a predictor of cutting out.

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Comparison of the Sliding and Femoral Head Rotation among Three Different Femoral Head Fixation Devices for Trochanteric Fractures

Cited by 28 publications

References 29 publications

AO/OTA 31-A2 Fractures: Long or Short Gamma Nail?

AO/OTA 31-A2 Fractures: Long or Short Gamma Nail?

Choice of implant in stable intertrochanteric fracture femur: PFNA vs DHS

Three-Dimensional Computed Tomographic Analysis for Comminution of Pertrochanteric Femoral Fracture: Comminuted Anterior Cortex as a Predictor of Cutting Out

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