Intramedullary nailing for pertrochanteric fractures of proximal femur: a consecutive series of 323 patients treated with two devices

Abstract

Introduction: Pertrochanteric fractures (PFs) frequently affect the lower limb of osteoporotic patients and represent an important cause of morbidity and mortality in the elderly. In this prospective randomized controlled trial, we have compared functional and radiological results and complications of patients affected by PFs treated with two intramedullary proximal femoral nails. Materials: We enrolled 323 subjects with PFs, classified according to AO/OTA system as 31.A1 (pertrochanteric simple) and 31.A2 (pertrochanteric multifragmentary). Patients were divided into two groups according to the osteosynthesis devices: group A, Elos-Intrauma® nail (155 cases) and group B, Gamma 3-Stryker® nail (168 cases). Pre-operatively, the baseline characteristics of each patient (gender, age, weight and BMI) were collected. Intraoperative blood loss, subjective pain by visual analogue scale (VAS), esthetic satisfaction, functional scores of the hip by Harris Hip Score (HHS), and Western Ontario and McMaster Universities Arthritis Index (WOMAC) were noted. The post-operative degree of fracture reduction was assessed. Each patient had a minimum follow-up of 12 months. Results: The study group was composed of 106 male and 217 female with an average age of 85.4 (range, 65-90, standard deviation (SD) 5.95) years. No statistical differences about sex and age distribution were noted between the two groups. Group A reported lower intraoperative blood loss, 45 ml vs 51 ml, respectively (p < 0.001). There was not any statistical difference about operative time. Group A had a better reduction of fracture (p = 0.0347). The greatest difference was detectable comparing subgroups 31.A2 (p = 0.032). There were no statistical differences about complication frequency and the overall rate was 25% (80 cases). Finally, there was no difference in terms of VAS, HHS, and WOMAC score between the two groups on each follow-up. Patients of group A showed a higher subjective satisfaction index at 1 post-operative year, 7.42 (SD 1.19) vs 6.45 (SD 1.35) of group B (p < 0.001). Conclusion: Elos® nail is a reliable device on a short-term follow-up and represents an alternative choice to the Gamma 3® nail, a well-known and appreciated system for over 25 years.

Reoperation rates after proximal femur fracture fixation with single and dual screw femoral nails: a systematic review and meta-analysis

“…Totally 5330 articles were identified from the initial search, of which 42 studies were included in the meta-analysis ( Fig. 1 ) ( 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 ).

Figure 1 Flowchart summarizing study identification and selection of included studies.

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Biomechanical evaluation of a new intramedullary nail compared with proximal femoral nail antirotation and InterTAN for the management of femoral intertrochanteric fractures

“…Cortical and cancellous bones were identified via Hounsfield Unit (HU) and the boundary was set as 700 (Abdul Wahab et al, 2020). AO/OTA 31-A1.3 is a type of FIFs with a high incidence (Catania et al, 2019;Shi et al, 2021). An AO/OTA 31-A1.3 FIF model was constructed through an osteotomy line from the greater trochanter to the lesser trochanter according to previous literature (Meinberg et al, 2018;Wang et al, 2022).…”

Comparison of Unstable Per-Trochanteric Fractures Fixed with Proximal Femoral Nail Versus Dynamic Hip Screw Using Harris Hip Score

“…The following procedure was performed to evaluate patients: Per-trochanteric fractures; a fracture through the per-trochanteric region of the femur; a form of extra capsular hip fracture diagnosed by using two dimensional X-rays as diagnostic tool. 9 Unstable fractures were included in Boyd & Griffin classification 1 to 4 types. 10 Comprehensive history and thorough examination were performed of all patients on scheduled follow up.…”