Pertrochanteric Fractures: Is There an Advantage to an Intramedullary Nail?

Saudan, Marc; Lübbeke, Anne; Sadowski, Christophe Raphael; Riand, N.; Stern, Richard; Hoffmeyer, Pierre

doi:10.1097/00005131-200207000-00004

Cited by 274 publications

(78 citation statements)

References 31 publications

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“…18 In line with our results, 87 (51.8%) of the patients lived at home, but the authors did not report the number of patients who were able to walk independently. Although the mean pre-and post-operative scores of function and mobility did not differ significantly between the treatment groups, there was an increase by a factor of 1.5 in the score for social function during follow-up in the PFN group compared with the DHS group.…”

Section: Discussionsupporting

confidence: 76%

Pertrochanteric femoral fractures treated with a dynamic hip screw or a proximal femoral nail

Pajarinen

Lindahl

Michelsson

et al. 2005

The Journal of Bone and Joint Surgery. British volume

253

169

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We treated 108 patients with a pertrochanteric femoral fracture using either the dynamic hip screw or the proximal femoral nail in this prospective, randomised series. We compared walking ability before fracture, intra-operative variables and return to their residence. Patients treated with the proximal femoral nail (n = 42) had regained their pre-operative walking ability significantly (p = 0.04) more often by the four-month review than those treated with the dynamic hip screw (n = 41). Peri-operative or immediate post-operative measures of outcome did not differ between the groups, with the exception of operation time. The dynamic hip screw allowed a significantly greater compression of the fracture during the four-month follow-up, but consolidation of the fracture was comparable between the two groups. Two major losses of reduction were observed in each group, resulting in a total of four revision operations.Our results suggest that the use of the proximal femoral nail may allow a faster postoperative restoration of walking ability, when compared with the dynamic hip screw.The incidence of pertrochanteric femoral fractures has increased significantly during recent decades, and this tendency will probably continue in the near future due to the rising age of the population.

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Section: Discussionsupporting

confidence: 76%

Pertrochanteric femoral fractures treated with a dynamic hip screw or a proximal femoral nail

Pajarinen

Lindahl

Michelsson

et al. 2005

The Journal of Bone and Joint Surgery. British volume

253

169

View full text Add to dashboard Cite

show abstract

“…In our study, the mean age of the patient was 69.17 years and the highest incidence (33.33%) of injury was seen among the age group of 70 to 80 due to poor vision, osteoporotic bone quality, menopausal ladies, slippery mud and negligence by the family members as noted by history. Various studies also showed mean age more than 60 years [11][12][13][14] . Around 58% patients were male and 42% were female.…”

Section: Discussionmentioning

confidence: 97%

Minimal Invasive Dynamic Hip Screw Fixation for Intertrochanteric Fractures of Femur

Kandel

Pathak

Singh

et al. 2016

International Journal of Orthopaedics

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nonunion, implant cut out, joint infection, delayed union and varus deformity was not observed in any of these patients. Moreover, Harris Hip Score showed good functional outcome. CONCLUSION: Fixation of DHS with minimal invasive technique for stable hip fracture has good functional outcome in cost effective way with fewer incidences of complications resulting in great advantage over the conventional method of fixation. INTRODUCTIONHip fractures are leading cause of death and disability among the elderly. Proximal femoral fracture accounts 30% of all hospital admissions with mortality of 15-20% worldwide. Among these, trochanteric fractures are around four times more with female predominance. Treatment goals for these populations include early rehabilitation, restoration of the anatomic alignment of the proximal part of femur and maintenance of fracture reduction [1][2][3][4] . Though resistance augmented Baixauli plates, Medroff plates, trochanteric stabilizing plates, percutaneous compression plates and intra medullary devices are focused on unstable inter-trochantric fracture, it is now almost universally accepted that internal fixation is the best method in which fixation with Dynamic Hip Screw (DHS) is considered as the standard one [5][6][7][8][9] . In the last decade, minimal invasive DHS (MIDHS) technique offered a better outcome compared to conventional approach, while maintaining equal fixation stability. The experimental basis of minimal invasive surgery is based on the fact that nutrient artery gives 2/3 rd of the blood supply to the bone, and 1/3 rd comes from the periosteum inflow [3] . So, this study which was conducted to ascertain the short term

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“…11 In 2002, Saudan M and Sadowski C performed a randomized prospective study of 206 patients comparing dynamic hip screw and proximal femoral nail and stated the advantages of an intramedullary nail. 12 In 2002, Al Yassari G, Jones JW, Al Lami M published the advantages of the AO proximal femoral nail for the treatment of unstable trochanteric fractures. 13 In 2004, Schipper IB, Steyerberg EW and Kerver AJH did a randomized comparison of the gamma nail and proximal femoral nail of 424 cases.…”

Section: Review Of Literaturementioning

confidence: 99%

A Prospective Study of Treatment of Intertrochanteric Fracture Femur With Trochanteric Entry Nail in Adults

Reddy¹,

M²

2016

jemds

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In the current series, we have done a randomized study of 50 cases of intertrochanteric fracture femur treated by minimally invasive intramedullary fracture fixation technique using trochanteric entry femoral nail. All the cases have been operated by senior Orthopaedic surgeons or have been operated under their guidance and supervision. All the cases have been followed up for a minimum period of 4-12 months. Average follow-up is 4 months. The results have been evaluated on the basis of Harris Hip Score. The results of this study have been compared to the I. B. Schipper series Gamma Nail and Proximal Femoral Nail in 424 cases of peritrochanteric fractures are done. The stable variety of intertrochanteric fractures (AO Type 31A.1) have good-to-excellent results in all the patients in the present series. The unstable variety (AO Type 31A.2 and A.3) in the current series have good to excellent results in 79% cases and fair results in 17.64% cases. However, various studies with extramedullary implants have shown only 59% good results. In the reverse oblique type of fracture as well as with subtrochanteric extension, Trochanteric entry femoral nail has given consistently good results, whereas studies with extramedullary implants have shown only 36% good results. So there is distinct advantage of intramedullary fixation in unstable varieties. The present study shows that trochanteric entry femoral nail has definite clear advantage over extramedullary implants in unstable fractures. At the same time, the implant that has good results in unstable fractures can always be used for stable fractures also.

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Pertrochanteric Fractures: Is There an Advantage to an Intramedullary Nail?

Abstract: There is no advantage to an intramedullary nail versus a sliding compression hip screw for low-energy pertrochanteric fractures AO/OTA 31-A1 and A2, specifically with its increased cost and lack of evidence to show decreased complications or improved patient outcome.

Cited by 274 publications

References 31 publications

Pertrochanteric femoral fractures treated with a dynamic hip screw or a proximal femoral nail

Pertrochanteric femoral fractures treated with a dynamic hip screw or a proximal femoral nail

Minimal Invasive Dynamic Hip Screw Fixation for Intertrochanteric Fractures of Femur

A Prospective Study of Treatment of Intertrochanteric Fracture Femur With Trochanteric Entry Nail in Adults

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