Prospective randomized study comparing two cephalomedullary nails for elderly intertrochanteric fractures: Zimmer natural nail versus proximal femoral nail antirotation II

Shin, Yang Sik; Chae, Jin-Eon; Kang, Taewook; Han, Seung-Beom

doi:10.1016/j.injury.2017.04.011

Cited by 34 publications

(26 citation statements)

References 20 publications

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“…However, the cut-out of the cephalic implant after surgery has remained a main complication for both IF and EF devices. 49 , 50 Our meta-analysis found no statistical significant difference of cut-out between IF and EF groups, which was consistence with previous studies. 14 , 15 Besides cut-out, bone non-union, infection and other complications were taken into this research as well.…”

Section: Discussionsupporting

confidence: 91%

Intramedullary versus extramedullary internal fixation for unstable intertrochanteric fracture, a meta-analysis

Wang

Duan

et al. 2018

Acta Orthopaedica et Traumatologica Turcica

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ObjectiveThe aim of this meta-analysis was to explore the difference between and compare intramedullary fixation (IF) and extramedullary fixation (EF) for unstable intertrochanteric fractures.MethodsWe searched Pubmed database and Cochrane library following by including and excluding articles based from inception to December, 2016. All randomized controlled trials (RCTs) comparing IF and EF for unstable intertrochanteric fractures were assessed and selected by two researchers independently. Data were analyzed using Review Manager 5.1 version.Results17 RCTs were enrolled in our meta-analysis comparing IF and EF and showed evidence that IF had lower rate of implant failure RR = 0.2695%CI 0.13–0.51, P < 0.0001 and re-operation (RR = 0.60, 95%CI 0.37–0.98, P = 0.04), while there was no statistical differences of cut-out, postoperative infections and other complications. Moreover, PPM scores verified that IF had better postoperative hip mobility recovery (MD = 0.87, 95%CI 0.08–1.66, P = 0.03).ConclusionIF has lower incidence of failure of implant and reoperation and shows better postoperative functional recovery when treating adult unstable intertrochanteric fracture while the most postoperative complications were not statistically different from EF.Level of evidenceLevel I, therapeutic study.

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Section: Discussionsupporting

confidence: 91%

Intramedullary versus extramedullary internal fixation for unstable intertrochanteric fracture, a meta-analysis

Wang

Duan

et al. 2018

Acta Orthopaedica et Traumatologica Turcica

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“…In addition, postoperative complications showed no significant differences between the two groups. The complication rates were similar with those reported in previous studies [20,38].…”

Section: Discussionsupporting

confidence: 91%

Computer-assisted preoperative planning improves the learning curve of PFNA-II in the treatment of intertrochanteric femoral fractures

Wang

Kun

Qiang

et al. 2020

BMC Musculoskelet Disord

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Background: Intertrochanteric femoral fractures are prevalent among the elderly, and usually demands surgical treatments. Proximal femoral nail antirotation Asian version (PFNA-II) is widely used for intertrochanteric fracture treatment. The computer-assisted preoperative planning (CAPP) system has the potential to reduce the difficulty of PFNA-II in the treatment of intertrochanteric fractures. The aim of the study was to investigate and compare the learning curves of PFNA-II treatment with CAPP and conventional preoperational planning methods for intertrochanteric femoral fractures.Methods: A total of 125 patients with intertrochanteric fracture who were treated with PFNA-II between March 2012 and June 2015 were retrospectively analyzed. Patients who underwent surgery with CAPP procedure by a junior surgeon were regarded as group A (n = 53); patients who underwent the conventional surgery by another junior surgeon were regarded as group B (n = 72). Each group was divided into three subgroups (case 1-20, case 21-40, case 41-53 or case 41-72). Results:The average operation time of group A was 45.00(42.00, 50.00) minutes, and in group B was 55.00 (50.00, 60.00) minutes (P < 0.01). Average radiation frequency and blood loss were 13.02 ± 2.32, 160.00 (140.00, 170.00) ml and 20. 92 ± 3.27, 250.00 (195.00, 279.50) ml, respectively, with significant differences (P < 0.01). The learning curve of the surgical procedure in group A was steeper than that in group B. There were no significant differences in patient reported outcomes, hospital stay and complication rate between the two groups. Significant differences were observed between group A and B in Harris score at last follow-up in the AO/OTA type 31-A2 intertrochanteric fracture (P < 0.05).Conclusion: Compared with conventional preoperative planning methods, CAPP system significantly reduced operation time, radiation frequency and blood loss, thus reshaped the learning curve of PFNA-II treatment with lower learning difficulty.

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“…Although it varies based on study populations and definition of failure, the overall major implant failure rate of trochanteric fracture is generally around 5% even with any implant, 2% to 10% with SHS, 2% to 12% with lag screw CMN, and 1% to 8% with blade CMN. 3 , 18 - 26 Meanwhile, the implant-related complication rate of basicervical fracture in previous studies showed considerable variations. 3 , 5 - 7 , 11 - 13 , 27 , 28 One possible reason is the multiformity of the definition and inclusion criteria of basicervical fracture 5 ( Table 2 ).…”

Section: Discussionmentioning

confidence: 99%

Treatment With Helical Blade Cephalomedullary Nail for Two-Part Basicervical Proximal Femoral Fracture in Elderly Patients: A Retrospective Observational Study

Okano

Sawada

Kushima

et al. 2017

Geriatr Orthop Surg Rehabil

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Background:Basicervical proximal femoral fracture is a known subtype of extracapsular fracture and is mechanically unstable, especially for the rotational direction, which may lead to implant failure. A cephalomedullary nail (CMN) is widely used for the fixation of unstable extracapsular fracture; however, its application for basicervical fracture remains controversial. Helical blade CMN is proven to have more rotational stability than traditional lag screw implants and potentially advantageous in the treatment of basicervical fracture. The aim of this study is to assess the effectiveness of helical blade CMN for basicervical fracture in elderly patients.Methods:We conducted a retrospective review of 500 consecutive extracapsular fracture patients treated surgically between January 2005 and February 2015. Patients who had trochanteric extension or multifragment fracture were excluded. Sixteen cases of 2-part basicervical proximal femoral fracture were identified. All patients were treated with the same single helical blade CMN system (DePuy Synthes PFNA-II). Implant-related complications were recorded.Results:Two patients dropped out during follow-up and 14 patients were included in the analysis. The average follow-up period was 21.9 months. No major complication was observed. The patients were subcategorized into 2 groups: nondisplaced (displacement <2 mm at any point of the fracture line) or displaced. Excessive telescoping was observed in 2 patients, both of whom were in the displaced fracture group. The overall implant-related complication rate was 14.2% (2/16).Conclusion:Internal fixation with the helical blade CMN system can be considered as a treatment option for 2-part basicervical proximal femoral fracture in elderly patients.

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Prospective randomized study comparing two cephalomedullary nails for elderly intertrochanteric fractures: Zimmer natural nail versus proximal femoral nail antirotation II

Cited by 34 publications

References 20 publications

Intramedullary versus extramedullary internal fixation for unstable intertrochanteric fracture, a meta-analysis

Intramedullary versus extramedullary internal fixation for unstable intertrochanteric fracture, a meta-analysis

Computer-assisted preoperative planning improves the learning curve of PFNA-II in the treatment of intertrochanteric femoral fractures

Treatment With Helical Blade Cephalomedullary Nail for Two-Part Basicervical Proximal Femoral Fracture in Elderly Patients: A Retrospective Observational Study

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