scholarly journals Cement augmentation of the proximal femoral nail antirotation for the treatment of two intertrochanteric fractures - a comparative finite element study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Liqin Zheng ◽  
Xinmin Chen ◽  
Yongze Zheng ◽  
Xingpeng He ◽  
Jingxiong Wu ◽  
...  
Keyword(s):  
Finite Element ◽  
Femoral Head ◽  
Maximum Stress ◽  
Intertrochanteric Fracture ◽  
Cement Augmentation ◽  
Proximal Femoral Nail ◽  
Intertrochanteric Fractures ◽  
Unstable Intertrochanteric Fracture ◽  
Helical Blade ◽  
Proximal Femoral Nail Antirotation

Abstract Background There are concerns regarding initial stability and cutout effect in proximal femoral nail antirotation (PFNA) treating intertrochanteric fractures. No study have used finite element analysis (FEA) to investigate the biomechanics. This study aimed to compare the cutout effect, stress and displacement between stable (AO31-A1.3) and unstable (AO31-A2.2) intertrochanteric fractures treated by cement augmented PFNA. Methods Four femoral finite element models (FEMs) were constructed and tested under the maximum loading during walking. Non-augmented and augmented PFNA in two different intertrochanteric fractures were respectively simulated, assuming Tip Apex Distance (TAD) < 25 mm within each FEM. The cutout effect, stress and displacement between femur and PFNA were compared in each condition. Results Cutout effect was observed in both non-augmented femoral head and was more apparently in unstable intertrochanteric fracture model. After reinforced by bone cement, no cutout effect occurred in two models. Stress concentration were observed on medial part of intertrochanteric region and the proximal part of helical blade before augmented while were observed on femoral shaft and the conjunction between blade and nail after augmented in both FEMs. Displacement mainly appeared on femoral head and the helical blade tip before augmented while distributed moderately on intertrochanteric region and the upper part of nail after augmented in both FEMs. The maximum stress and displacement value of femur decreased both in stable and unstable model after augmented but was more significantly in the unstable one. The maximum stress and displacement value of PFNA increased both in stable and unstable model after augmented but was more significantly in the unstable one. Conclusion Our FEA study indicated that the cement augmentation of the PFNA biomechanically enhances the cutout resistance in intertrochanteric fracture, this procedure is especially efficient for the unstable intertrochanteric fracture.

scholarly journals Finite element analysis of two cephalomedullary nails in treatment of elderly reverse obliquity intertrochanteric fractures: zimmer natural nail and proximal femoral nail antirotation-ΙΙ

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Jian Chen ◽  
Jian-xiong Ma ◽  
Ying Wang ◽  
Hao-hao Bai ◽  
Lei Sun ◽  
...  
Keyword(s):  
Finite Element Analysis ◽  
Finite Element ◽  
Internal Fixation ◽  
Intertrochanteric Fracture ◽  
Proximal Femoral Nail ◽  
Intertrochanteric Fractures ◽  
Element Analysis ◽  
Femoral Nail ◽  
Unstable Intertrochanteric Fracture ◽  
Proximal Femoral Nail Antirotation

Abstract Background More elderly patients are suffering from intertrochanteric fractures. However, the choice of internal fixation is still controversial, especially in the treatment of unstable intertrochanteric fracture; thus, previous implants continue to be improved, and new ones are being developed. The purpose of our study was to compare the biomechanical advantages between the zimmer natural nail (ZNN) and proximal femoral nail antirotation-II (PFNA-II) in the treatment of elderly reverse obliquity intertrochanteric fractures. Methods A three-dimensional finite element was applied for reverse obliquity intertrochanteric fracture models (AO31-A3.1) fixed with the ZNN or PFNA-II. The distribution, peak value and position of the von Mises stress and the displacement were the criteria for comparison between the two groups. Results The stresses of the internal fixation and femur in the ZNN model were smaller than those in the PFNA-II model, and the peak values of the two groups were 364.8 MPa and 171.8 MPa (ZNN) and 832.3 MPa and 1795.0 MPa (PFNA-II). The maximum amount of displacement of the two groups was similar, and their locations were the same, i.e., in the femoral head vertex (3.768 mm in the ZNN model and 3.713 mm in the PFNA-II model). Conclusions The displacement in the two models was similar, but the stresses in the implant and bone were reduced with the ZNN. Therefore, the ZNN implant may provide biomechanical advantages over PFNA-II in reverse obliquity intertrochanteric fractures, as shown through the finite element analysis. These findings from our study may provide a reference for the perioperative selection of internal fixations.

scholarly journals Dynamic Hip Screw with Trochanter-Stabilizing Plate Compared with Proximal Femoral Nail Antirotation as a Treatment for Unstable AO/OTA 31-A2 and 31-A3 Intertrochanteric Fractures

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Chun-Wei Fu ◽  
Ji-Ying Chen ◽  
Yueh-Ching Liu ◽  
Kuang-Wen Liao ◽  
Yung-Chang Lu
Keyword(s):  
Intertrochanteric Fracture ◽  
Operation Time ◽  
Dynamic Hip Screw ◽  
Proximal Femoral Nail ◽  
Intertrochanteric Fractures ◽  
Residual Pain ◽  
Unstable Intertrochanteric Fracture ◽  
Hip Screw ◽  
Proximal Femoral Nail Antirotation ◽  
Im Nailing

Background. The dynamic hip screw (DHS) with the addition of an angular stable trochanter-stabilizing plate (TSP) has been considered the ideal treatment for the unstable intertrochanteric fracture type. However, there have been few comparisons between DHS+TSP augmentation with intramedullary (IM) nailing. The aim of this retrospectively registered study was to compare the clinical outcomes of patients with the unstable type of intertrochanteric fractures treated with DHS+TSP or IM nailing (proximal femoral nail antirotation (PFNA)). Methods. From June 2013 to April 2018, 358 patients with proximal femur fracture AO/OTA type 31A2 and 31A3 treated with PFNA or DHS+TSP and followed for ≥10 months postoperatively were included. The surgical-dependent outcome evaluation included the operation time, intraoperative blood loss, postoperative decrease in hemoglobin, and blood transfusion amount. Functional status was also measured. Radiographic findings and postoperative complications were recorded and analyzed. Result. The operation time was significantly shorter in the DHS+TSP group than that in the PFNA group for both A2 and A3 fractures (A2 type: 84.0 vs.96.4 min; p<0.05; A3 type: 102.4 vs.116.1 min; p<0.05). Postoperative decrease in hemoglobin was more significant in the PFNA group than that in the DHS+TSP group for both fracture types (A2 type: −1.88 vs. −1.29 (mg/dL); p<0.05; A3 type: −1.63 vs. −1.04 (mg/dL); p<0.05). However, the patients treated with DHS+TSP had significantly more residual pain than those treated with PFNA during the final follow-up (Visual Analog Scale score, A2 type: 28.4 vs.23.2; p<0.05; A3 type: 27.5 vs.23.6; p<0.05) and complained of greater implant irritation. Conclusion. We found that DHS+TSP was associated with less operation time and less postoperative decrease in hemoglobin but more residual pain and implant irritation than those of PFNA. As a treatment for unstable intertrochanteric fracture, DHS+TSP provided ideal surgical outcomes which were not inferior to the PFNA.

AO/OTA 31A2 and 31A3 Intertrochanteric Fractures Managed by Proximal Femoral Nail Antirotation (PFNA)

2021 ◽  
Vol 15 (10) ◽  
pp. 2616-2618
Author(s):  
Zamir Hussain Tunio ◽  
Rizwan Ali Jhatiyal ◽  
Muhammad Azeem Akhund ◽  
M. Kashif Abbasi ◽  
S. Muhammad Ali ◽  
...  
Keyword(s):  
Intertrochanteric Fracture ◽  
Proximal Femoral Nail ◽  
Harris Hip Score ◽  
Psychiatric Disease ◽  
Unstable Fracture ◽  
Intertrochanteric Fractures ◽  
Femoral Nail ◽  
Intramedullary Device ◽  
Unstable Intertrochanteric Fracture ◽  
Proximal Femoral Nail Antirotation

Aim: To study the clinical and radiological outcome of unstable intertrochanteric fracture AO/OTA 31A2, 31A3 fixed by proximal femoral nail antirotation Study design: Descriptive cross sectional study. Place and duration of study: Department of Orthopedic Surgery and Traumatology, Pir Abdul Qadir Shah Jilani Institute of Medical Sciences, Gambat, Sindh from 1st January 2016 to 31st December 2019. Methodology: Forty four cases having intertrochanteric fracture AO/OTA 31A2, 31A3 with age ranging from 18 year to 55 year of either gender were selected; patients having close fracture, who were willing were included in the study, while patients older than 55 year and younger than 18 year, AO/OTA 31A1 fracture, open fracture, bilateral injuries, smoker, alcoholic, drug addicted, poly-trauma, pathological fracture and history of poor compliance, psychiatric disease were excluded. Results: There were 26(59.09%) males and 18(40.91%) females with mean age was 41.3±7.7 years. Regarding classification; AO/OTA 31A2 were 33 (75%), and 31A3 were 11 (25%). Mean time for union was 18.5±3.55 weeks. The average time of follow-up was 48.5±6.6 weeks. Harris Hip Score was excellent (90-100) in 31(70.45%), good (80-89) in 7(15.91%), fair (70-80) in 3 (6.81%) and poor (<70) in 3 (6.81%). Conclusion: Intramedullary device proximal femoral nail antirotation can be labelled as implant of choice for unstable intertrochanteric fractures AO/OTA 31A2, 31A3, with fruitful clinical and radiological outcomes, and with fewer complications. Hip Harris score was excellent-good in 86% of the patients. Key words: Proximal femoral nail antirotation (PFNA), AO/OTA 31A2, 31A3, Intertrochanteric, unstable fracture

scholarly journals Proximal femoral nail antirotation II in fixation of intertrochanteric fractures: retrospective and prospective observational study

2020 ◽  
Vol 6 (3) ◽  
pp. 593
Author(s):  
Arvind Kumar S. M. ◽  
Arun Kumar B.
Keyword(s):  
Blood Loss ◽  
Intertrochanteric Fracture ◽  
Interquartile Range ◽  
Proximal Femoral Nail ◽  
Intertrochanteric Fractures ◽  
X Rays ◽  
Femoral Nail ◽  
Unstable Intertrochanteric Fracture ◽  
The Mean ◽  
Proximal Femoral Nail Antirotation

<p class="abstract"><strong>Background:</strong> Intertrochanteric fractures occur mostly in elderly patients, and the outcome may be extremely poor if there is prolonged bed-rest. The best treatment for trochanteric fracture remains controversial. Proximal femoral nail antirotation (PFNA) II has excellent fit as the design is adapted to the anatomical situation of small statured patients also. It has a medial lateral angle of 5 degrees. It has several distal locking options viz static/dynamic. Objective of this study was to observe the operating time, blood loss and fracture union in intertrochanteric fractures treated with PFNA II from the data collected from patient’s case sheets and post-operative X-rays.</p><p class="abstract"><strong>Methods:</strong> 25 patients who were operated with PFNA II for unstable intertrochanteric fracture were selected using random selection and following parameters were noted from the records.<strong></strong></p><p class="abstract"><strong>Results:</strong> The mean age of the participants is 70.72±8.55 years with range from 52 years to 89 years. The mean duration was 1.98 hours ±0.66. The median duration was 2 with interquartile range from 1.5 to 2.5 hours. Mean blood loss was estimated to be 390 ml±62.78. The median blood loss was 370 ml with interquartile range from 360 to 420 ml.</p><p class="abstract"><strong>Conclusions:</strong> The PFNA II is an ideal implant for unstable intertrochanteric fracture since stable intramedullary fixation can be achieved with almost 100% union in the studied population.</p>

scholarly journals Functional and Radiological Outcome of Unstable Intertrochanteric Fracture in Old Age Treated with Proximal Femoral Nail Antirotation-2

2021 ◽  
Author(s):  
OP Jamshad ◽  
Jacob Mathew ◽  
Raju Karuppal
Keyword(s):  
Proximal Femoral Nail ◽  
Harris Hip Score ◽  
Intertrochanteric Fractures ◽  
Biological Reduction ◽  
Neck Shaft Angle ◽  
Femoral Nail ◽  
Unstable Intertrochanteric Fracture ◽  
Shaft Angle ◽  
The Mean ◽  
Proximal Femoral Nail Antirotation

Introduction: Intertrochanteric fractures are prevalent in the elderly, which leave patients with functional restrictions. Proximal Femoral Nail Antirotation-2 (PFNA) was developed to achieve better fixation strength, particularly in the presence of osteoporotic unstable intertrochanteric fractures. Aim: To evaluate the role and result of PFNA-2 in the treatment of unstable intertrochanteric fractures in geriatric patients. Materials and Methods: A prospective analytical study was conducted in 35 patients with unstable intertrochanteric fractures. They were followed-up clinically and radiologically for one year. The quality of fixation was assessed, by neck-shaft angle and Tip Apex Distance (TAD). A functional assessment was done with the Harris Hip Score (HHS). Results: The mean follow-up period was 13 months (range, 12-14). The mean age of patients was 65.6 years and the majority were female patients (62.85%). Functional results according to modified HHS were found to be excellent in 6 (17.1%) patients, good in 14 (40%) patients, fair in 12 (34.3%) patients and poor in 3 (8.6%) patients. The average HHS in this study was 81.6. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 16.0. Conclusion: PFNA-2 helps in achieving biological reduction and good stability which enables early mobilisation and prevention of excessive collapse. A good functional outcome could be achieved when the radiological parameters are restored, i.e., TAD <25 mm and neck-shaft angle difference <5° (compared to the opposite side).

scholarly journals Predicting Factors for Return to Prefracture Ambulatory Level in High Surgical Risk Elderly Patients Sustained Intertrochanteric Fracture and Treated With Proximal Femoral Nail Antirotation (PFNA) With and Without Cement Augmentation

2020 ◽  
Vol 11 ◽  
pp. 215145932091212 ◽  
Author(s):  
Noratep Kulachote ◽  
Paphon Sa-ngasoongsong ◽  
Norachart Sirisreetreerux ◽  
Kulapat Chulsomlee ◽  
Sorawut Thamyongkit ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Elderly Patients ◽  
Functional Recovery ◽  
Intertrochanteric Fracture ◽  
Cement Augmentation ◽  
Control Group ◽  
Intertrochanteric Fractures ◽  
Surgical Risk ◽  
High Surgical Risk ◽  
Proximal Femoral Nail Antirotation

Introduction: Postoperative outcomes in the elderly patients with intertrochanteric fracture were generally poor with a low rate of return to prefracture ambulatory level (RPAL). Recent studies showed that proximal femoral nail antirotation (PFNA) with cement augmentation might be useful for postoperative functional recovery. This study aimed to compare the outcomes in elderly patients with high surgical risk, American Society of Anesthesiologist (ASA) grade 3 or 4, who sustained intertrochanteric fractures and were treated with PFNA with and without cement augmentation, and to correlate perioperative surgical factors with the RPAL. Methods: A retrospective consecutive series was conducted based on 135 patients with prefracture ambulation classified as independent in community with or without a single cane (68 in augmented group and 67 in control group). Perioperative data and data on the complications within 1-year postsurgery were collected and compared. Predictive factors for RPAL were analyzed via logistic regression analysis. Results: The overall 1-year postoperative mortality rate was 10% (n = 14) with no significant difference between groups ( P = .273). The proportion of elderly patients with RPAL in the augmented group was significantly higher than for those in the control group (48% vs 29%, P = .043). Via univariate analysis, ASA grade 4 ( P = .077), history of stroke ( P = .035), and use of cement augmentation ( P = .041) were correlated with RPAL. However, multivariate regression analysis showed that ASA grade 4 (odds ratio [OR] = 0.40, 95% confidence interval [CI]: 0.18-0.90, P = .026) and use of cement augmentation (OR = 2.72, 95% CI: 1.22-6.05, P = .014) were the significant predictors for RPAL. Discussion and Conclusions: The results of the present study showed that PFNA with cement augmentation is safe and effectiveness in the intertrochanteric fracture treatment of elderly. Postoperative functional recovery, like RPAL, in elderly patients who sustained intertrochanteric fractures is relatively low, especially in those with ASA grade 4. However, cement augmentation with PFNA might be helpful for increasing the RPAL in high-surgical-risk geriatric patients.

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