Optimising the tip-apex-distance in trochanteric femoral fracture fixation using the ADAPT-navigated technique, a longitudinal matched cohort study

Herzog, Jan; Wendlandt, Robert; Hillbricht, S; Burgkart, Rainer; Schulz, Arndt P.

doi:10.1016/j.injury.2019.02.010

Cited by 19 publications

(16 citation statements)

References 28 publications

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“…TAD is a useful criterion for cut-out risks, the ideal value being 5 mm < TAD < 20 mm [ 16 , 17 ]. Herzog et al concluded that the use of ADAPT resulted in a significant reduction in TAD and a more optimal positioning of the lag screw [ 18 ]. Our results also showed a significant reduction in TAD with the use of ADAPT.…”

Section: Discussionmentioning

confidence: 99%

ADAPT system is a dramatic advance in computer-assisted surgery for femoral trochanteric fractures

Murakami¹,

Yamazaki²,

Ogasa³

2021

SICOT-J

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Introduction: In recent years, computer-assisted surgery has made it possible to undergo surgery with a high degree of precision. This study aimed to investigate the usefulness of computer-assisted surgery for femoral trochanteric fractures using the ADAPT (ADAptive Positioning Technology) system. Methods: A total of forty patients with femoral trochanteric fracture underwent intramedullary nailing for fracture fixation: in twenty patients, the ADAPT system (ADAPT group), and in the other twenty, it was not used (control group). The operative time, intraoperative fluoroscopy time, tip apex distance (TAD), and tip to head surface distance (TSD) were measured and compared between the two groups to assess the efficiency and accuracy of the surgery. Results: The operative time was significantly shorter (P < 0.05), intraoperative fluoroscopy time was significantly reduced (P < 0.01), and implant placement was significantly better in the ADAPT group (P < 0.01). Conclusion: Navigation systems have been developed to improve the efficiency of surgery. The ADAPT system was considered a very useful device for intramedullary nailing of femoral trochanteric fractures, as it reduced the intraoperative fluoroscopy time and improved the accuracy of implant placement, also reducing the operative time.

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Section: Discussionmentioning

confidence: 99%

ADAPT system is a dramatic advance in computer-assisted surgery for femoral trochanteric fractures

Murakami¹,

Yamazaki²,

Ogasa³

2021

SICOT-J

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“…Generally, the center of the lag screw/blade should be located in the second quarter of the head-neck interface line (safe zone) rather than the center of the neck 43 . Moreover, a TAD over 25 mm should be avoided as it has been shown to increase the risk of cutout 44 . During the fixation, the CMN independently provides centralized support to the proximal fragment and the interfragmentary compression, namely dynamization.…”

Section: Discussionmentioning

confidence: 99%

Loss of Reduction after Cephalomedullary Nail Fixation of Intertrochanteric Femoral Fracture: A Brief Report

Pang

Zhu

et al. 2020

Orthopaedic Surgery

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Objective: At present, cephalomedullary nail is the most frequently used implant in the management of intertrochanteric fractures around the world. The implant design and fixation techniques of the cephalomedullary nail have been continuously improved to ensure uncomplicated bone union during the past decade. However, a degree of reduction loss during bone healing is still not rare in clinical work. Many attributed this complication to misoperation during the surgery and hold that a series of techniques and tips could help to avoid the loss of reduction. However, until now there has been no research to explore whether the reduction loss after the operation can be fully prevented in the best cases. The purposes of the study are as follows: (i) to evaluate the efficiency of the current established CMN techniques; (ii) to quantify the loss of reduction under an appropriately implanted CMN to anatomically realigned intertrochanteric fractures; and (iii) to explore the possible underlying causes for the inevitable loss of reduction. Methods: In the retrospective study, 163 consecutive cases with the intertrochanteric fractures fixed with standard cephalomedullary nail technique were reviewed. The anatomical reduction and optimal positioning of the nail were confirmed by postoperative imaging. The fracture types ranged from 31-A1.1-2.3 according to the OTA/AO fracture classification. One hundred and fifteen cases with stable fracture types (31A1.1-2.1) were allocated to Group A, and 48 cases with unstable 31A2.2-2.3 fracture types were allocated to Group B. The radiological measurements included femoral neck shortening, loss of the neck-shaft angle, cutout, and cut-through of the blade. The outcomes between postoperative and 1 year after the operation were evaluated and compared. Results: The patients consisted of 66 males and 97 females with an average age of 69.4 (range: 46-78, SD: 14.6) years. At the 1-year follow-up, no fixation failure or nonunion was observed in each group. The mean femoral neck shortening and loss of the neck-shaft angle were 4.

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“…The value of each model parameter was listed in Table 1 and the parameters were described individually below. As previous publications comparing navigated IMN with traditional IMN had a short follow-up period (13,(25)(26)(27)(31)(32)(33), we used a 5-year time horizon for the present analysis. The model considered four states, which were categorized as follows: (1) successful IMN with the lag screw inside the safe zone, (2) successful IMN with the lag screw outside the safe zone, (3) salvage treatment of total hip arthroplasty (THA) after failed IMN and (4) death.…”

Section: Model Designmentioning

confidence: 99%

Navigated intramedullary nailing for patients with intertrochanteric hip fractures is cost-effective at high-volume hospitals in mainland China: A markov decision analysis

Tang

Yuan

et al. 2023

Front. Surg.

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ObjectivePrevious studies have reported that navigation systems can improve clinical outcomes of intramedullary nailing (IMN) for patients with intertrochanteric fractures. However, information is lacking regarding the relationship between the costs of navigated systems and clinical outcomes. The present research aimed to evaluate the cost-effectiveness of navigated IMN as compared with traditional freehand IMN for patients with intertrochanteric fractures.MethodsA Markov decision model with a 5-year time horizon was constructed to investigate the costs, clinical outcomes and incremental cost-effectiveness ratio (ICER) of navigated IMN for a 70-year-old patient with an intertrochanteric fracture in mainland China. The costs [Chinese Yuan (¥)], health utilities (quality-adjusted life-years, QALYs) and transition probabilities were obtained from published studies. The willingness-to-pay threshold for ICER was set at ¥1,40,000/QALY following the Chinese gross domestic product in 2020. Three institutional surgical volumes were used to determine the average navigation-related costs per patient: low volume (100 cases), medium volume (200 cases) and high volume (300 cases).ResultsInstitutes at which 300, 200 and 100 cases of navigated IMN were performed per year showed an ICER of ¥43,149/QALY, ¥76,132.5/QALY and ¥1,75,083/QALY, respectively. Navigated IMN would achieve cost-effectiveness at institutes with an annual volume of more than 125 cases.ConclusionsOur analysis demonstrated that the navigated IMN could be cost-effective for patients with inter-trochanteric fracture as compared to traditional freehand IMN. However, the cost-effectiveness was more likely to be achieved at institutes with a higher surgical volume.

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Optimising the tip-apex-distance in trochanteric femoral fracture fixation using the ADAPT-navigated technique, a longitudinal matched cohort study

Cited by 19 publications

References 28 publications

ADAPT system is a dramatic advance in computer-assisted surgery for femoral trochanteric fractures

ADAPT system is a dramatic advance in computer-assisted surgery for femoral trochanteric fractures

Loss of Reduction after Cephalomedullary Nail Fixation of Intertrochanteric Femoral Fracture: A Brief Report

Navigated intramedullary nailing for patients with intertrochanteric hip fractures is cost-effective at high-volume hospitals in mainland China: A markov decision analysis

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