Fixation of intertrochanteric femur fractures using Proximal Femoral Nail Antirotation (PFNA) in the lateral decubitus position without a traction table

Turgut, Ali; Kalenderer, Önder; Günaydın, Burak; Önvural, Burak; Karapınar, Levent; Ağuş, Haluk

doi:10.3944/aott.2014.14.0098

Cited by 17 publications

(12 citation statements)

References 13 publications

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“…[22,23] Among the studies evaluating the results of centralcentral or inferior-central application of the helical blade, a few inferior-posterior application cases were specified, and cut-out was not observed in these cases as we hypothesized so. [24][25][26] Lee et al [27] performed an evaluation of the biomechanical effect of different blade positions on a simulated pertrochanteric fracture by means of a computed tomography-based three-dimensional finite element model. They revealed that inferior and posterior blade positions had the larger area of compressive strain at the fracture surface than other three positions.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the quadrants of femoral neck-head in the cephalomedullary fixation of intertrochanteric fractures with a helical blade: Is inferior posterior quadrant also safe? A clinical study

Karapınar

2021

Jt Dis Relat Surg

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Objectives This study aims to investigate the positioning of the helical blade to prevent mechanical complications in surgically fixed intertrochanteric fractures (ITFs). Patients and methods In this retrospective study, 392 patients (158 males, 234 females; mean age: 75.5±13.4; range, 20 to 101) years) with ITFs treated in lateral decubitus position with proximal femoral nail anti-rotation in a single center between January 2009 and January 2017 were evaluated. The fractures were classified according to the Orthopedic Trauma Association classification preoperatively and grouped as stable or unstable. Postoperatively, tip-apex distance (TAD), Baumgaertner reduction criteria, and obtained quadrants were evaluated. Patients with an unstable fracture, proper TAD, and acceptable or good reduction were included in the final evaluation for statistical analysis to investigate the safest quadrant to prevent cut-out complication. Results Cut-out complications were observed in 19 (4.8%) patients. The scenario; unstable fracture, TAD <25 mm, acceptable or good reduction consisted of 111 patients in total and cut-out complication occurred in four of them (3.6%) (one in center-posterior, one in center-center, one in superior-anterior, and one in superior-center quadrants). There was no statistically significant difference between center-center, inferior-center, and inferior-posterior quadrants (p=0.49). Conclusion Inferior-posterior placement is as safe as central-central or inferior-central placement for blade fixation in the surgical treatment of ITF.

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Section: Discussionmentioning

confidence: 99%

Evaluation of the quadrants of femoral neck-head in the cephalomedullary fixation of intertrochanteric fractures with a helical blade: Is inferior posterior quadrant also safe? A clinical study

Karapınar

2021

Jt Dis Relat Surg

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“…Modifiable risk factors for cut-outs are mainly the reduction position, obtaining Cal-TAD or TAD values, and avoiding an inappropriate position of the implant in terms of femoral head quadrants. Turgut et al [26] concluded that these three important criteria should be fulfilled while treating intertrochanteric fractures with the help of a proximal femoral nailing. In light of their studies, the cases were divided into eight scenarios.…”

Section: Discussionmentioning

confidence: 99%

Clinical and Radiological Outcomes of Trochanteric AO/OTA 31A2 Fractures: Comparison between Helical Blade and Lag Screw – A Retrospective Cohort Study

et al. 2020

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Introduction The purpose of this study was to compare the clinical and radiological outcomes of AO/OTA type 31A2 fractures treated by the use of trochanteric nails either with a blade or a screw. Patients and Methods This study was designed retrospectively. Between May 2007 and May 2014, a total of 144 patients with trochanteric fractures were admitted to the clinic, and only 65 of them met the inclusion criteria. Thirty-two of them (blade group) were treated with a helical blade and the rest of the 33 patients (screw group) were treated with a screw. The mean ages of the patients were 76.01 and 75.82, respectively (p = 0.905). The mean follow-up time was 27.6 months (blade group: 34.2 ± 19.1 months; screw group: 18.6 ± 7.9 months; p < 0.001). Between these two groups, we evaluated the differences in tip apex distances (TAD), calcar-referenced tip-apex distances (Cal-TAD), implant positions, cut-out rates, and implant failures. Functional outcomes were measured with the help of the Harris Hip Score. Results No significant differences were seen between the blade and screw groups by means of cutting out, implant positions, and varus collapse. Cutting out was seen in a total of six patients (blade group n = 2; screw group = 4; p = 0.672) and varus collapse in nine patients (blade group n = 5, screw group n = 4; p = 0.733). Harris Hip Scores were similar between the two groups (blade group: 72.70 ± 18.43; screw group: 80.83 ± 18.75; p = 0.84).

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“…The feasibility of these operations without using the traction table has been reported in previous studies. Researchers who used the manual traction method with the lateral decubitus position due to the absence of a traction table in their centers reported that, this method did not completely obviate the tip-apex distance and ideal quadrant placement of the screw [10]. Şahin et al compared the patients who were operated with traction table with those manual traction applied in the supine position in unstable intertrochanteric femur fractures and no significant difference was observed between the groups when the surgical or postoperative parameters were evaluated [5].…”

Section: Discussionmentioning

confidence: 99%

İntertrokanterik kırıklarda çift eksenli femoral çivilemede traksiyon masası ve traksiyonsuz supin pozisyonunun karşılaştırılması

Yörükoğlu¹,

Aydemir²,

Yücens³

et al. 2019

Pamukkale Medical Journal

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The aim of this study was to compare the traction table and supine position without traction table in double axis femoral nailing of intertrochanteric fractures in terms of reduction quality and complication rates. Material and Method: Sixty-three patients with a mean age of 68.54±16.42 (29-97) were retrospectively analyzed. 42 patients were operated without the traction table, 21 patients were operated with the traction table. Collodiaphyseal angles and Baumgartner reduction criteria were used for radiologic evaluation. The union time of the fractures, complications, and nonunion cases were assessed. Results: The restoration of collodiaphyseal angle was better in the group using the traction table, the reduction quality could not be restored well in the group without the traction table (p<0.05). The mean union time was calculated as 3.2±2.2 months in patients operated with the traction table while in patients who were operated without a traction table was calculated as 4.26±2.23 months (p>0.05). Cutout and nonunion complications were more common in the group operated without traction table. Increasing difference of the collodiaphyseal angle was found to be correlated with the complication rates and union time. Conclusion: Better reduction was achieved in the patient group that operation performed using the traction table and the complication rates were low in this group. Operation with the traction table should be the first choice for intertrochanteric fractures. The supine position without traction table may be a preferable treatment method for intertrochanteric fractures when the traction table is not available.

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Fixation of intertrochanteric femur fractures using Proximal Femoral Nail Antirotation (PFNA) in the lateral decubitus position without a traction table

Abstract: While the nailing of intertrochanteric fractures in a lateral decubitus position does not provide ideal quadrant placement and TAD, results are encouraging probably due to the excellent stability that is provided by PFNA.

Cited by 17 publications

References 13 publications

Evaluation of the quadrants of femoral neck-head in the cephalomedullary fixation of intertrochanteric fractures with a helical blade: Is inferior posterior quadrant also safe? A clinical study

Evaluation of the quadrants of femoral neck-head in the cephalomedullary fixation of intertrochanteric fractures with a helical blade: Is inferior posterior quadrant also safe? A clinical study

Clinical and Radiological Outcomes of Trochanteric AO/OTA 31A2 Fractures: Comparison between Helical Blade and Lag Screw – A Retrospective Cohort Study

İntertrokanterik kırıklarda çift eksenli femoral çivilemede traksiyon masası ve traksiyonsuz supin pozisyonunun karşılaştırılması

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