Surgical Results of the Cephalomedullary Nail for the Femoral Intertrochanteric Fracture: Comparison between Non-experienced Surgeons and Experienced Surgeon

Abstract

PurposeCephalomedullary nail (CM nail) in the treatment of femoral intertrochanteric fractures is in the lime light in recent years. The purpose of this study is to compare surgical outcomes between experienced surgeon and non-experienced surgeons in respect of CM nail for femoral intertrochanteric fractures.Materials and MethodsThe 129 patients underwent CM nail for femoral intertrochanteric fracture more than six months of follow-up from April 2011 to March 2014 in Seoul Medical Center (Seoul, Korea) were participated in this study. For this study, group A consisted of experienced surgeons who performed more than 500 times of CM nail, and group B consisted of non-experienced surgeons who performed less than 50 times of CM nail. Clinical and radiologic outcomes, complications and the need for reoperation between both groups were compared in the study.ResultsAccording to clinical result, both the mean operation time and transfusion volume were significantly longer and greater in group B (P<0.05). In the radiologic outcomes, adequacy of reduction, tip-apex distance and numbers of case placed in the Cleveland zones 5, 6 and 8; there was no statistical difference between both groups. Moreover, rate of complication and reoperation had same results as radiologic outcomes.ConclusionThere was no significant difference with statistical data in complications from CM nail for femoral intertrochanteric fractures between experienced surgeon and non-experienced surgeon. Although the operation time and transfusion volume were significantly longer and greater in the case of operation by non-experienced surgeon, satisfactory performance was seen in the complications and the need for reoperation.

Outcome and complications of intertrochanteric femur fractures treated by proximal femoral nail

“…Longer antirotation screws increases the cutout risk because in this situation, the thinner screw assumes a load-bearing function. [5] Rethnam et al [13] Korkmaz et al [6] Menezes et al [15] Seo et al [10] Simmermacher et al [16] Our…”

“…Our results on implant related complications are in accordance with the existing literature on PFN related complications (Table 4). Previous studies have reported complication rates ranging from 4.5 -9.3%, re-operation rates of 3 -12%, and screw cutout rates of 1.2 -5.4% [5,10,11,15] . We had no cases of peri-implant fracture.…”

“…This is higher than similar studies in literature. Seo JS et al in 2016 compared the surgical results of cephalomedullary nails in intertrochanteric fractures and reported a mean operative time of 77.9 minutes [10] . Altintas et al in 2014 reported a mean operative time of 61.3 minutes [11] .…”

Screw versus helical proximal femoral nail in the treatment of unstable trochanteric fractures in the elderly

“…30,31 Cephalo-medullary implants have shorter lever arm for the fixation device allowing lower potential for the fracture collapse and limb shortening when used for unstable trochanteric fractures. 21 Even the cephalo-medullary implants have been evolving over the last two decades. Screw proximal femoral nail was developed by AO/ASIF in 1996 to reduce difficulties faced in earlier intramedullary devices with design features like fluting of nail tip, additional anti-rotation screw and more proximal shifting of distal locking screw to enable gradual change in stiffness of nail construct.…”

“…19 The quality of the fracture reduction was quantified by the measurement of the postoperative fracture gap and the Garden Alignment Index. 20 The implant position in the femoral head was documented via the Cleveland zones 21,22 and the Tip Apex Distance (TAD). 18,23 The TAD was calculated by measuring the distance between the tip of the proximal implant (lag screw) to the apex of the femoral head on the AP and lateral X-ray after Baumgaertner's formula.…”