Intramedullary femoral nails: one or two lag screws? A preliminary study

Wang, Changjiang; Brown, Chris; Yettram, A.L.; Procter, Philip

doi:10.1016/s1350-4533(00)00081-3

Cited by 60 publications

(36 citation statements)

References 24 publications

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“…[20] In our study, the cut-out rate as a result of varus collapse was 4.5% in Group I, consistent with studies by Ruecker et al [21] Zhang et al have reported a cut-out rate of 1-3% in a PFNA group, whereas no patient has developed cut-out in the Intertan group. [19] In the biomechanical study of Huang et al, femoral strength, stability, and bearing capacity have been higher in the InterTAN group than in the PFNA group.…”

Section: Discussionsupporting

confidence: 92%

Comparison of Two Types of Proximal Femoral Nails in the Treatment of Intertrochanteric Femur Fractures

Uzer

Elmadağ

Yıldız

et al. 2015

Ulus Travma Acil Cerrahi Derg

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BACKGROUND: Hip nailing is frequently used to treat unstable intertrochanteric femoral fractures (ITF) in elderly patients. In this retrospective study, we compared the functional and radiological results, and the complications, of patients treated using proximal femoral nails (PFN) with an integrated, interlocking, compression lag screw, or two separate lag screws, which allow linear compression at the fracture site.

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Section: Discussionsupporting

confidence: 92%

Comparison of Two Types of Proximal Femoral Nails in the Treatment of Intertrochanteric Femur Fractures

Uzer

Elmadağ

Yıldız

et al. 2015

Ulus Travma Acil Cerrahi Derg

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“…The pitfalls and complications were similar and were mainly surgeon or fracture related, rather than implant related. In an experimental study comparing the eYcacy of one versus two femoral neck screws with an intramedullary nail, it was found that a two-lag-screw conWguration should be avoided in patients with a high risk of osteoporotic cut-out [22]. However, lag-screw cut-out remains a signiWcant problem, especially with less stable fracture patterns.…”

mentioning

confidence: 99%

Proximal femoral nail anti-rotation (PFNA) to treat peritrochanteric fractures in elderly patients

Karapınar

Kumbaracı

Kaya

et al. 2011

Eur J Orthop Surg Traumatol

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The treatment of peritrochanteric fractures in elderly patients with osteoporosis due to the diYculty of obtaining and maintaining stable Wxation. Although many implants have been developed to solve this problem, the choice of implant has been controversial. We present 71 consecutive peritrochanteric fractures treated with proximal femoral nail anti-rotation (PFNA). The average age of the patients was 80.75 § 6.42 (71-96) years. The fractures were closely reduced and Wxed with PFNA. All of the fractures healed in an average of 14 weeks. The mean operation time was 44.68 § 8.44 (30-73) minutes, and the mean blood loss was 126.77 § 49.04 (50-300) ml. One patient was reoperated because of a poor blade position. In three patients, a lateral cortex fracture was observed, and, in one patient, a greater trochanter fracture was observed. At the time of the Wnal follow-up, 78.7% of the patients returned to their pre-injury activity levels. PFNA might be one treatment choice to solve the mechanical problems associated with these fractures because of its improved Wxation strength, simpler technique, shorter operation time and reduced blood loss.

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“…Cut-out, Z-effect, reverse Zeffect, lateral migration of the screws are the mostly reported complications resulting from inappropriate placement of screws, low-bone mineral density and alteration of the weight on the lag screws during weight bearing cycles. 9,11,12 Different screw combinations and designs have been developed to overcome these problems and improve the success of treatment.…”

Section: Resultsmentioning

confidence: 99%

“…In a finite element analyses of two lag screws compared with one screw Wang et al had showed that the smaller diameter two screws develop increased stresses in the bone of the femoral head, which potentially could lead to premature screw cut-out. 11 Another issue making treatment of intertrochanteric femur fractures challenging is excessive forces exerted to the femoral head. Cephalomedullary nails have been designed to provide controlled impaction by transforming these forces into a compressor force on fracture site.…”

Section: Resultsmentioning

confidence: 99%

A biomechanical comparison of two cephalomedullary nails; one using a single lag screw with antirotator blade and a nail using two lag screws for unstable intertrochanteric fractures

et al. 2016

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Background: Implant choice for fixation of intertrochanteric fractures remains controversial despite being one of the most commonly performed operations. Although use of sliding hip screws is still considered a gold standard in treatment of these fractures, there is a wide tendency in using cephalomedullary nails because of their biomechanical superiority over sliding hip screws. This trial was initiated in order to compare the biomechanical properties of two different cephalomedullary nails, aPFN and the PROFIN under axial loading, based on the questions that can a single lag screw with an antirotator blade render better rotational stability? Is there a difference between one lag screw or two lag screws with respect to superior migration or cut-out of the screws? And do different nail designs cause different types of failure and what are the pros and cons of classical and new designs from the view point of biomechanical aspects?Methods: Ten pairs of third generation synthetic bone models simulating unstable intertrochanteric fracture were used for biomechanical testing.Results: No posterior displacement of screws was recorded in both groups suggesting rotational unstability. There was not a significant difference between forces values loaded at the time of failure.Conclusions: Although there was no statistically significant difference between compressive strengths at the time of failure, aPFN may provide equal rigid fixation with less possible cut-out which may have an important consequences in real clinical applications.

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Intramedullary femoral nails: one or two lag screws? A preliminary study

Cited by 60 publications

References 24 publications

Comparison of Two Types of Proximal Femoral Nails in the Treatment of Intertrochanteric Femur Fractures

Comparison of Two Types of Proximal Femoral Nails in the Treatment of Intertrochanteric Femur Fractures

Proximal femoral nail anti-rotation (PFNA) to treat peritrochanteric fractures in elderly patients

A biomechanical comparison of two cephalomedullary nails; one using a single lag screw with antirotator blade and a nail using two lag screws for unstable intertrochanteric fractures

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