Clinical Outcome of Mid-Length Proximal Femoral Nail for Patients With Trochanteric Hip Fractures: Preliminary Investigation in a Japanese Cohort of Patients More Than 70 Years Old

Introduction: The TFN-ADVANCED Proximal Femoral Nailing System (TFNA) 235 mm (DePuySynthes) and Proximal Femoral Nail Antirotation (PFNA)-II 240 mm (DePuySynthes) were developed to obtain better stability for patients with trochanteric hip fractures without increasing surgical time and amount of blood loss. However, there are currently no studies concerning clinical and radiological outcomes of patients treated using these proximal femoral nails (PFNs) that have been performed in the Japanese population. The aim of this study was to retrospectively evaluate the clinical outcomes associated with 235 to 240 mm PFNs for Japanese patients >70 years old with trochanteric hip fractures who could walk independently before the injury. Materials and Methods: This study involved a retrospective analysis of data on trochanteric hip fracture patients who had undergone internal fixation from March 2016 to June 2018. The inclusion criteria were patients >70 years old with trochanteric hip fractures who could walk independently before the injury and were followed up for ≥3 months after surgery. Initially, 124 patients were identified, but 33 of these were excluded because other implants were used for internal fixation. Of the remaining 91 patients in whom PFNs were used at the time of internal fixation who were included for the perioperative evaluation, 66 patients followed up for ≥3 months were included in the clinical evaluations. Results: The average surgical time was 56.8 ± 19.6 minutes (range, 23-123 minutes). The average blood loss was 89 ± 41 mL (range, 0-245 mL). The union rate was 98%. Discussion: There were no cases of nail jamming, and all nails were successfully inserted below the end of the distal isthmus without additional reaming to dilate the canal. Conclusions: Proximal femoral nails were a useful implant in Japanese elderly patients with trochanteric hip fractures and gave comparable clinical outcomes despite the femoral length being short and occurrence of intensive bowing.

Download Full-text

Kết quả nắn kín và kết hợp xương bên trong sử dụng đinh nội tủy đầu trên xương đùi trong điều trị gãy liên mấu chuyển xương đùi

Journal of Clinical Medicine- Hue Central Hospital ◽

10.38103/jcmhch.2021.73.10 ◽

2021 ◽

Author(s):

Viet Hung Tran

Keyword(s):

Blood Loss ◽

Internal Fixation ◽

Closed Reduction ◽

Weight Bearing ◽

Proximal Femoral Nail ◽

Minimally Invasive Surgical ◽

Femoral Nail ◽

Incision Size ◽

The Mean ◽

Intertrochanteric Femur Fracture

Mục tiêu: Trước đây điều trị gãy liên mấu chuyển (LMC) xương đùi chủ yếu là nắn mở và kết hợp xương (KHX) bên trong bằng DHS, nẹp khóa … đòi hỏi sự bộc lộc rộng rãi và mở ổ gãy, sẽ dẫn đến tình trạng mất máu, đau, hạn chế vận động sau mổ và sẽ dẫn đến các biến chứng. Đối với những trường hợp gãy mất vững, tổn thương thành ngoài nhiều thì việc điều trị bằng DHS, nẹp khóa thường dẫn đến di lệch thứ phát và thất bại trong quá trình điều trị. Với sự ra đời của đinh nội tủy Gamma, PFNA, Reconstruction và thế hệ đinh mới nhất hiện nay InterTAN, với kỹ thuật mổ xâm nhập tối thiểu, không mở ổ gãy rút ngắn thời gian phẫu thuật và lượng máu mất, kết hợp xương vững về mặt cơ học, giúp bệnh nhân vận động sớm sau mổ giúp ngăn ngừa các biến chứng do nằm lâu. Báo cáo này nhằm đánh giá kết quả điều trị gãy liên mấu chuyển với kỹ thuật nắn kín trên bàn chỉnh hình và KHX bên trong bằng đinh nội tủy đầu trên xương đùi. Phương pháp: Chúng tôi thực hiện mổ nắn kín trên bàn chỉnh hình có sử dụng C arm, kỹ thuật mổ áp dụng theo AO trên 58 trường hợp gãy liên mấu chuyển xương đùi. Ghi nhận độ dài đường mổ, thời gian phẫu thuật, ước tính lượng máu mất, đánh giá thang điểm đau VAS, thời gian nằm viện, các biến chứng, kết quả điều trị, chức năng khớp háng theo thang điểm Harris ở thời điểm 3 tháng, 6 tháng và 12 tháng. Kết quả: Phương tiện đinh PFNA 41 trường hợp, đinh Gamma 5 trường hợp, đinh Reconstruction 12 trường hợp. Tuổi trung bình 78,86 ± 11,67 (38 - 97), nữ chiếm 72,4%. Thời gian mổ trung bình 70,34 ± 20,5 phút (45 - 135), kích thước vết mổ 6,70 ± 1,09 cm (5 - 10), ước tính lượng máu mất trung bình 257,1 ± 163,04 mL. Điểm đau VAS trước mổ và sau mổ trung bình lần lượt là 7,26 và 2,79. Thời gian nằm viện trung bình 13,37 ± 4,38 (5 - 24). Biến chứng trong phẫu thuật ghi nhân 1 trường hợp gãy rạn thân xương đùi và một trường hợp nắn kín thất bại. X quang liền xương ghi nhận ở tất cả trường hợp bệnh nhân tái khám, 4 trường hợp có can lệch. Điểm Harris ở thời điểm 3,6,12 tháng lần lượt là 76,42 ± 13,01, 85,96 ± 6,36, 90,25 ± 2,63. Kết luận: KHX bằng đinh nội tủy đầu trên xương đùi cho thấy kỹ thuật mổ xâm nhập tối thiểu giúp giảm mất máu, kích thước vết mổ nhỏ, bệnh nhân tỳ lực sớm và phục hồi sớm sau mổ. ABSTRACT THE RESULTS OF CLOSED REDUCTION AND INTERNAL FIXATION SINGPROXIMAL FEMORAL NAIL IN TREATMENT OF INTERTROCHANTERIC FEMUR FRACTURE Objective: In the past, treatment of intertrochanteric fractures was mainly to open reduction and internal fixation with DHS, locking plate … require extensive exposure, open fractures, will lead to blood loss, pain, and limited mobility postoperatively and lead to complications.In cases of unstable fractures with large external wall injuries treatment with DHS, locking plate often lead to secondary displacement and failure of treatment. With the introduction of intramedullary nails Gamma, PFNA, Reconstruction, and the latest generation of nails InterTAN, with minimally invasive surgical technique, without opening the fracture, shorter surgery time and blood loss, mechanically more stable, helping patients to move and weight bearing early after surgery and prevent complications due to prolonged lying down. This report aims to evaluate the results of treatmentintertrochanteric fractures with closed reduction technique on the orthopedic table and internal fixation with the proximal femoral nail. Material and method: We perform closed reduction on the orthopedic table using C Arm. And using surgical techniques applied according to AO on 58 cases of intertrochanteric fracture. Record the length of incision, surgery time, estimated blood loss, VAS pain score, hospital stay, complications, treatment results, hip function according to Harris scale. at 3 months, 6 months and 12 months. Results: The mean age was 78.86 ± 11.67 (38 - 97), female accounted for 72.4%. Means of nailing PFNA 41 cases, Gamma nails 5 cases, Reconstruction nails 12 cases. Average operative time 70.34 ± 20.5 minutes (45 - 135), incision size 6.70 ± 1.09 cm (5 - 10), estimated average blood loss 257.1 ± 163, 04 mL. The mean preoperative and postoperative VAS pain scores were 7.26 and 2.79, respectively. Average length of hospital stay was 13.37 ± 4.38 (5 - 24). Intraoperative complications recorded 1 case of femoral shaft fracture and 1 case of failure of closed manipulation. X-ray of bone healing was recorded in all patients at follow - up examination, 4 cases with fracture deformity. Harris score at 3,6,12 months is 76.42 ± 13.01, 85.96 ± 6.36, 90.25 ± 2.63, respectively. Conclusions: Treatment with a proximal femoral nail (PFN) showed that minimally invasive surgical technique, reduced blood loss, small incision size, allows early full weight bearing and postoperative recovery. Keywords: Proximal femoral nail, intertrochanteric femur fracture.

Download Full-text

Functional outcome of long proximal femoral nail versus short proximal femoral nail in peritrochanteric fractures

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20211415 ◽

2021 ◽

Author(s):

Sanjeev Gupta ◽

Pallav Gupta ◽

Gagandeep Singh Raina ◽

Manoj Kumar ◽

Gagandeep Singh

Keyword(s):

Blood Loss ◽

Functional Outcome ◽

Proximal Femoral Nail ◽

Surgical Time ◽

Femoral Nail ◽

Significant Difference ◽

Intramedullary Implant ◽

Group 2 ◽

Surgical Duration ◽

Group 1

Background: Proximal femoral nail (PFN) is an intramedullary implant which has been commonly used in the fixation of intertrochanteric fractures. However, controversy comes about the effect of nail length on fracture union and other complications. A comparative evaluation of surgical treatment and functional outcome of patients with peritrochanteric fractures treated with short versus long PFN.Methods: Total of 100 patients have been included in study out of which 57 belonged to group 1 and were operated with short PFN and rest 43 were group 2 operated with long PFN. Patients were followed up for 6 months and were compared on various parameters.Results: There is no significant difference noted in the two group. However, the surgical duration and blood loss for short PFN was significantly less as compared to long PFN.Conclusions: Short PFN is better implant for peritrochantric fractures both stable and unstable with quicker surgical time and lesser blood loss.

Download Full-text