Optimal surgical methods to treat intertrochanteric fracture: a Bayesian network meta-analysis based on 36 randomized controlled trials

Cheng, Yan-Xiao; Sheng, Xia

doi:10.1186/s13018-020-01943-9

Cited by 36 publications

(22 citation statements)

References 52 publications

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“…The intraoperative fixation methods include intramedullary fixation and extramedullary fixation. The former is represented by proximal femoral nail anti-rotation (PFNA), and the latter is represented by percutaneous compression plate (PCCP) [ 4 ]. The two are the hot spots in the treatment of femoral intertrochanteric fractures.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of Curative Effect between PFNA and PCCP in the Treatment of Femoral Intertrochanteric Fractures

Fan

Xiao

et al. 2022

Emergency Medicine International

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Objective. To compare and analyze the clinical efficacy of proximal femoral nail anti-rotation (PFNA) and percutaneous compression plate (PCCP) for minimally invasive treatment of femoral intertrochanteric fractures. Methods. A retrospective analysis of 98 patients with femoral intertrochanteric fractures admitted to our hospital from January 2019 to December 2020 was used as the research object, and they were divided into PFNA group and PCCP group according to different treatment methods, with 51 cases and 47 cases. The intraoperative and postoperative indicators were compared between the two groups of patients. Results. There was no significant difference in the operative time, postoperative fracture healing time, and Harris score of hip joint function between the two groups (t = −1.43, 1.86, 1.63; P > 0.05 ). Compared with the PFNA group, the intraoperative blood loss and postoperative drainage volume in the PCCP group were lower than those in the PFNA group (t = 11.38, 9.66; P < 0.05 ). Compared with the PFNA group, the time of weight-bearing in the PCCP group was longer than that in the PFNA group (t = −2.23, P < 0.05 ). The total incidence of postoperative complications was 7.84% in the PFNA group and 10.64% in the PCCP group, and there was no significant difference between the two groups ( P > 0.05 ). Conclusion. The PFNA and PCCP are both effective measures for the clinical treatment of intertrochanteric fractures, and internal fixation should be reasonably selected according to the specific conditions of the patients.

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Section: Introductionmentioning

confidence: 99%

“…e former is represented by proximal femoral nail anti-rotation (PFNA), and the latter is represented by percutaneous compression plate (PCCP) [4].…”

Section: Introductionmentioning

confidence: 99%

Comparison of Curative Effect between PFNA and PCCP in the Treatment of Femoral Intertrochanteric Fractures

Fan

Xiao

et al. 2022

Emergency Medicine International

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“…Here, we did not model the stress distribution arising in response to PFNA, which may be considered a weakness of the study. However, PFNA, akin to other modifications performed, has not displaced the time-proven DHS and GNF given the comparable functional outcomes of all these methods of pertrochanteric fractures stabilization [ 7 , 8 , 27 , 44 ]. There are other limitations of this study.…”

Section: Discussionmentioning

confidence: 99%

“…Currently, the gamma nail system (GNS) and the dynamic hip screw (DHS) are the most widespread stabilization methods used [ 7 , 8 ]. The criteria of choosing one or the other are not fully clear.…”

Section: Introductionmentioning

confidence: 99%

In Silico Finite Element Modeling of Stress Distribution in Osteosynthesis after Pertrochanteric Fractures

Lorkowski

Pokorski

2022

JCM

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A stabilization method of pertrochanteric femur fractures is a contentious issue. Here, we assess the feasibility of rapid in silico 2D finite element modeling (FEM) to predict the distribution of stresses arising during the two most often used stabilization methods: gamma nail fixation (GNF) and dynamic hip screw (DHS). The modeling was based on standard pre-surgery radiographs of hip joints of 15 patients with pertrochanteric fractures of type A1, A2, and A3 according to the AO/OTA classification. The FEM showed that the stresses were similar for both GNF and DHS, with the medians ranging between 53–60 MPa and consistently lower for A1 than A3 fractures. Stresses also appeared in the fixation materials being about two-fold higher for GNF. Given similar bone stresses caused by both GNF and DHS but shorter surgery time, less extensive dissection, and faster patient mobilization, we submit that the GNF stabilization appears to be the most optimal system for pertrochanteric fractures. In silico FEM appears a viable perioperative method that helps predict the distribution of compressive stresses after osteosynthesis of pertrochanteric fractures. The promptness of modeling fits well into the rigid time framework of hip fracture surgery and may help optimize the fixation procedure for the best outcome. The study extends the use of FEM in complex orthopedic management. However, further datasets are required to firmly position the FEM in the treatment of pertrochanteric fractures.

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“…Cheng and Sheng compared eight treatment options for intertrochanteric fractures [dynamic hip screw, compression hip, percutaneous compression plate, Medoff sliding plate, less invasive stabilisation system, gamma nail, proximal femoral nail, and proximal femoral nail anti-rotating (PFNA)] and identified PFNA as the preferable surgical method with fewer blood loss and high functional outcomes, according to the Harris hip score [ 51 ]. When using intramedullary nails, the use of a helical blade in comparison to a lag screw is associated with a higher rate of collapse of the neck-shaft angle and the concomitant dislocation of the screw (cut-out) in the femoral head [ 50 ].…”

Section: Operative Managementmentioning

confidence: 99%

Management of proximal femur fractures in the elderly: current concepts and treatment options

et al. 2021

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As one of the leading causes of elderly patients’ hospitalisation, proximal femur fractures (PFFs) will present an increasing socioeconomic problem in the near future. This is a result of the demographic change that is expressed by the increasing proportion of elderly people in society. Peri-operative management must be handled attentively to avoid complications and decrease mortality rates. To deal with the exceptional needs of the elderly, the development of orthogeriatric centres to support orthogeriatric co-management is mandatory. Adequate pain medication, balanced fluid management, delirium prevention and the operative treatment choice based on comorbidities, individual demands and biological rather than chronological age, all deserve particular attention to improve patients’ outcomes. The operative management of intertrochanteric and subtrochanteric fractures favours intramedullary nailing. For femoral neck fractures, the Garden classification is used to differentiate between non-displaced and displaced fractures. Osteosynthesis is suitable for biologically young patients with non-dislocated fractures, whereas total hip arthroplasty and hemiarthroplasty are the main options for biologically old patients and displaced fractures. In bedridden patients, osteosynthesis might be an option to establish transferability from bed to chair and the restroom. Postoperatively, the patients benefit from early mobilisation and early geriatric care. During the COVID-19 pandemic, prolonged time until surgery and thus an increased rate of complications took a toll on frail patients with PFFs. This review aims to offer surgical guidelines for the treatment of PFFs in the elderly with a focus on pitfalls and challenges particularly relevant to frail patients.

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Optimal surgical methods to treat intertrochanteric fracture: a Bayesian network meta-analysis based on 36 randomized controlled trials

Cited by 36 publications

References 52 publications

Comparison of Curative Effect between PFNA and PCCP in the Treatment of Femoral Intertrochanteric Fractures

Comparison of Curative Effect between PFNA and PCCP in the Treatment of Femoral Intertrochanteric Fractures

In Silico Finite Element Modeling of Stress Distribution in Osteosynthesis after Pertrochanteric Fractures

Management of proximal femur fractures in the elderly: current concepts and treatment options

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