Using Three‐Dimensional Computational Modeling to Compare the Geometrical Fitness of Two Kinds of Proximal Femoral Intramedullary Nail for Chinese Femur

Zhang, Sheng; Zhang, Kairui; Wang, Yimin; Wei, Feng; Wang, Bowei; Yu, Bo

doi:10.1155/2013/978485

Cited by 11 publications

(8 citation statements)

References 20 publications

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“…Therefore, due to the differences in methodology, implant types, and specimens used, the results of our study cannot be directly compared with prior data. Nevertheless, these previous studies consistently reported mismatches of the nail fit in Asian specimens: with a Gamma nail in both Thai and Chinese subjects; with a retrograde nail in Asian subjects; and with PFNA-II and InterTan in Chinese subjects [ 16 – 19 ].…”

Section: Discussionmentioning

confidence: 97%

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Quantification of cephalomedullary nail fit in the femur using 3D computer modelling: a comparison between 1.0 and 1.5m bow designs

Schmutz

Amarathunga

Kmiec³

et al. 2016

J Orthop Surg Res

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BackgroundThe radius of curvature (ROC) misfit of cephalomedullary nails during anterograde nailing can lead to complications such as distal anterior cortical encroachment. This study quantified the anatomical fit of a new nail with 1.0-m ROC (TFN-ADVANCED™ Proximal Femoral Nailing System [TFNA]) compared with a nail with 1.5-m ROC (Gamma3 Long Nail R1.5 [Gamma3]).MethodsWe generated 63 three-dimensional models (48 female, 45 right femur) representing the cortical surfaces of the femora (31 Caucasian, 28 Japanese, and 4 Thai). The mean age of the specimens was 77 years (±8.1), and the mean height was 158.5 cm (±9.6). Utilizing a customized software tool, nail fit was determined from the total surface area of nail protrusion from the inner cortex surface and maximum distance of nail protrusion in the axial plane; the position of the distal nail tip within the canal was also determined.ResultsOverall, TFNA had both a significantly smaller mean total surface area of nail protrusion (915.8 vs. 1181.6 mm2; P < 0.05) and a mean maximum distance of nail protrusion in the axial plane (1.9 vs. 2.1 mm; P = 0.007) when compared with Gamma3. The mean total surface area of nail protrusion was significantly smaller with TFNA versus Gamma3 in both the Caucasian (P = 0.0009) and Asian (Japanese and Thai) samples (P = 0.000002); the mean maximum distance of TFNA protrusion was significantly smaller in Asians (P = 0.04), but not in Caucasians (P = 0.08). Most tip positions for both nail types were anterior, but TFNA had a higher number of center positions than Gamma3 (13 vs. 7) and a shift from the far anterior cortex to the center of the medullary canal (overall and in Caucasians). In Asians, the most prominent position was far anterior for both nails.ConclusionsThe 1.0-m ROC TFNA nail resulted in better fit than the 1.5-m ROC Gamma3 nail. Clinical trials and case studies should be conducted in the future to verify if these findings would also result in clinical improvements.

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Section: Discussionmentioning

confidence: 97%

“…Previous studies using 3D modelling to assess quantitative nail fit within the femurs do exist [ 16 – 19 ]. However, these studies were conducted with short nails and with Asian specimens only.…”

Section: Discussionmentioning

confidence: 99%

Quantification of cephalomedullary nail fit in the femur using 3D computer modelling: a comparison between 1.0 and 1.5m bow designs

Schmutz

Amarathunga

Kmiec³

et al. 2016

J Orthop Surg Res

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“…It has been well documented that PFN antirotation (PFNA) (Synthes, Switzerland) may cause femoral fractures or valgus impingement of the lateral cortex, especially in the Asian population (9,(22)(23)(24). Because of these data in the literature, its proximal diameter, lateral bending angle and lateral surface have been revised and improved, and reproduced as PFNA-II which has been shown to be more appropriate for the Asian population.…”

Section: Discussionmentioning

confidence: 99%

Düz Proksimal Femur Çivileri Femurun Anterior Eğimi ile Uyumsuzdur

Yıldız¹,

Güzel²,

Erden³

et al. 2019

bs.

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Objective: Increased anterior bow of the femur due to advanced age and osteoporosis impinges with the distal part of the non-anatomic, standard proximal femoral nails (PFN), which is one of the most preferred implant for the fixation of trochanteric fractures (TF) in the elderly. The relation between increased femoral bowing and standard PFN application was investigated.Methods: Radiographs of 111 patients (59 men, 52 women; mean age 74.5 years), who were treated with PFN due to TF between 2011 and 2015, were evaluated retrospectively. Relation between the nail and the anterior cortex was determined by measuring the angle between distal anatomical axes of the nail and the femur (ADA). The patients were divided into two groups according to their ADA (group 1 ADA ≤4° and group 2 ADA >4°). Functional results and pain was evaluated using Harris Hip Score (HHS) and visual analog scale (VAS). Complications were also recorded. Results:The mean amount of ADA was 4.5°±1.5°. Forty-seven patients were classified in group 1 and 64 patients were in group 2. The mean HHSs were 80.6 and 79.3 (p=0.464), and the mean VAS scores were 2.13 and 5.35 (p<0.001) in group 1 and 2, respectively. Five patients were revised due to cut-out of the lag screws (total hip arthroplasty in two patients and revision of the nails in three patients). Union was achieved in all patients without infection. Conclusion:Because straight femoral nails impinges anterior cortex of the femur with increased bowing, new design PFN with anterior curve is needed especially for shorter or osteoporotic people, or Caucasian population.

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“…The huge clinical benefits of these two types of intramedullary fixation have prompted surgeons and researchers to compare the clinical outcomes of PFNA and InterTAN nail; however, the date on this aspect are so far insufficient or even controversy. For example, through CT analysis of a large number of Chinese cadaver femurs and comparison using 3D calculation models, Zhang et al have found that PFNA-II may be more suitable for Chinese femurs than InterTAN, with higher anatomical similarity, however, the distal part of InterTAN may be superior to PFNA-II [19]. A previous meta-analysis by Ma et al showed the clinical outcomes including cutout and femoral fracture fractures in favor of the InterTAN nails group when compared to the PFNA group [20].…”

Section: Introductionmentioning

confidence: 99%

Comparison of clinical outcomes with proximal femoral nail anti-rotation versus InterTAN nail for intertrochanteric femoral fractures: A meta-analysis

Liu

2020

Preprint

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Objective: To access the efficacy and safety of proximal femoral nail anti-rotation (PFNA) and InterTAN nail for intertrochanteric femoral fractures.Methods: According to the Cochrane systemic analysis method, randomized control trials (RCTs) and retrospective comparative observational studies which were related to the comparison of PFNA and InterTAN nail in the treatment of the elderly with intertrochanteric fractures were retrieved. Data were independently extracted from the included studies by two reviewers and analyzed using RevMan 5.3 , and the quality of the studies was assessed.Results: Two RCTs and seven observational studies were recruited, which consisted of 681 patients with PFNA and 651 patients with InterTAN nail. The meta-analyses showed no significant differences between the two approaches on Harris Hip Score, operation time, blood loss, time to union, mean hospital stay, union problems, intraoperative complications, hematoma, infection, other complication in both RCTs and observational studies. In terms of other outcomes, for the RCTs, results showed that there were shorter tip–apex distance, reduced pain at thigh or hip in InterTAN nail than in PFNA; however, InterTAN nail was not superior to PFNA in cutout, reoperation, and femoral shaft fracture; for observational studies, the risk of the screw migration (RR=5.13, 95%CI: [1.33,19.75], P=0.02), cutout (RR=3.26, 95%CI: [1.64,6.47], P=0.0008), the varus collapse of the femoral head (RR=7.19, 95%CI: [2.18,23.76], P=0.001), femoral shaft fracture (RR=5.73, 95%CI: [2.24,14.65], P=0.0003) treated by InterTAN nail were significantly decreased, compared with those by PFNA; however, no significant differences was observed in the aspects of tip–apex distance and pain at thigh or hip between these two groups.Conclusion: Analysis of a large number of relevant clinical indicators available shows that InterTAN nail has better clinical manifestation than PFNA in treating unstable femoral intertrochanteric fractures.

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Using Three‐Dimensional Computational Modeling to Compare the Geometrical Fitness of Two Kinds of Proximal Femoral Intramedullary Nail for Chinese Femur

Cited by 11 publications

References 20 publications

Quantification of cephalomedullary nail fit in the femur using 3D computer modelling: a comparison between 1.0 and 1.5m bow designs

Quantification of cephalomedullary nail fit in the femur using 3D computer modelling: a comparison between 1.0 and 1.5m bow designs

Düz Proksimal Femur Çivileri Femurun Anterior Eğimi ile Uyumsuzdur

Comparison of clinical outcomes with proximal femoral nail anti-rotation versus InterTAN nail for intertrochanteric femoral fractures: A meta-analysis

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