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

Abstract Background A meta-analysis to access the pros and cons of proximal femoral nail anti-rotation (PFNA) versus InterTAN nail for intertrochanteric femoral fractures including available evidence extracted from literature. 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, and other complications in both RCTs and observational studies. In terms of other outcomes, for the RCTs, results showed that there were shorter tip–apex distance and 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 were 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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Comparison of clinical outcomes with proximal femoral nail anti-rotation versus InterTAN nail for intertrochanteric femoral fractures: A meta-analysis

10.21203/rs.3.rs-21889/v1 ◽

2020 ◽

Author(s):

Wei Liu ◽

Guangrong Ji ◽

Jie Liu

Keyword(s):

Observational Studies ◽

Femoral Shaft Fracture ◽

Femoral Shaft ◽

Shaft Fracture ◽

Proximal Femoral Nail ◽

Harris Hip Score ◽

Intertrochanteric Fractures ◽

Femoral Nail ◽

Tip Apex Distance ◽

Intertan Nail

Abstract 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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Observational study on titanium elastic nailing in femoral shaft fractures in children

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20185146 ◽

2018 ◽

Vol 5 (1) ◽

pp. 32

Author(s):

Jyotirtmayee Bahinipati ◽

R. G. Asutosh Mohapatra

Keyword(s):

Femoral Shaft Fracture ◽

Femoral Fractures ◽

Femoral Shaft ◽

Limb Length Discrepancy ◽

Shaft Fracture ◽

Titanium Elastic Nailing ◽

Fractures In Children ◽

Group 5 ◽

One Year ◽

Prolonged Immobilization

Background: Nowadays femoral fractures in children are more commonly managed with operative fixation rather than conservative treatment because of more rapid recovery and avoidance of prolonged immobilization. Our aim of study was to assess the outcome of titanium elastic nailing in femoral shaft fracture in children.Methods: Twenty five children in age group 5-15 years with femoral shaft fracture were stabilized with two titanium nails. Children were followed up for one year. The operative outcome was evaluated using criteria of Flynn. Complications associated with procedure were recorded and analyzed.Results: The final outcome was excellent in 67% (19 of 25) of patients, satisfactory in 16% (4 of 25) of patients and poor in 8% (2 of 25) of patients. Poor outcome was due to limb length discrepancy, pain in the knee and angular misalignment.Conclusions: We concluded that titanium elastic nailing is an ideal method of femoral shaft fixation in children.

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Comparing Augmentative Plating and Exchange Nailing for the Treatment of Nonunion of Femoral Shaft Fracture after Intramedullary Nailing: A Meta‐analysis

Orthopaedic Surgery ◽

10.1111/os.12580 ◽

2020 ◽

Vol 12 (1) ◽

pp. 50-57

Author(s):

Yao‐feng Jin ◽

Hai‐chao Xu ◽

Zhong‐hai Shen ◽

Xue‐kang Pan ◽

Hui Xie

Keyword(s):

Intramedullary Nailing ◽

Femoral Shaft Fracture ◽

Meta Analysis ◽

Femoral Shaft ◽

Shaft Fracture ◽

Exchange Nailing

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CONSOLIDATION OF FEMORAL FRACTURES AT APPLICATION OF DIFFERENT TREATMENT METHODS TAKING INTO CONSIDERATION DURATION OF THE PERIOD FROM TRAUMA TO OSTEOSYNTHESIS

Novosti Khirurgii ◽

10.18484/2305-0047.2021.1.5 ◽

2021 ◽

Vol 29 (1) ◽

pp. 5-12

Author(s):

A.A. Emanov ◽

◽

M.V. Stogov ◽

E.A. Kireeva ◽

N.V. Tushina ◽

...

Keyword(s):

Femoral Shaft Fracture ◽

Femoral Fractures ◽

Femoral Shaft ◽

Shaft Fracture ◽

Group 4 ◽

External Fixation Device ◽

Group 3 ◽

Group 2 ◽

First Time ◽

Group 1

Objective. To study the characteristics and healing duration of the diaphyseal femoral fractures, depending on the technologies used for osteosynthesis and the time between trauma and osteosynthesis. Methods. The study was performed on bred dogs (n=24). In the operating theatre all animals were modeled the transverse fracture of the femoral diaphysis in the middle third using a chisel. The animals were divided into 4 groups (6 per group). Animals of group 1 (one hour after the fracture) underwent transosseousosteosynthesis with a pin-rod external fixation device (PREF). In group 2, PREF was performed on the fourth day after the injury. In group 3 (one hour after the injury) blockable intramedullary osteosynthesis (BIOS) was performed. In group 4, the similar BIOS was performed on the fourth day after the fracture. To assess the results of treatment, the clinical, radiological and laboratory research methods were used. The duration of post-operative observation of the animals was 100 days. Results. It has been found out that the dynamics of osteoreparative processes in the studied groups was similar and did not depend on the time between trauma and osteosynthesis. The median time for the femoral shaft fracture healing in animals of group 1 was 46 days (Q1-Q3: 38-57), in group 2 - 73 days (Q1-Q3: 71-78) (differences between groups are significant at p=0.004); in group 3 - 49 days (Q1-Q3: 44-60), in group 4 - 72 days (Q1-Q3: 70-93) (differences between groups are significant at p=0.008). It is shown that the reason for the increase in fixation terms in dogs with the delayed osteosynthesis is the long-term persistence of the acute phase reaction caused by trauma (using the growth of C-reactive protein as an example). Conclusion. The healing terms of a femoral shaft fracture with the use of PREF technology and BIOS technology are comparable, both in the conditions of urgent and delayed osteosynthesis. What this paper adds It has been determined the similarity of the osteoreparation dynamics in the healing of diaphyseal femoral fractures: under conditions of osteosynthesis with a pin-rod external fixation device (PREF) and blocked intramedullary osteosynthesis (BIOS). For the first time it has been shown that healing terms of a diaphyseal femoral fractures when osteosynthesis performed in 4 days after injury is 1.5 fold longer in comparison with the performance of osteosynthesis within 1 hour after the injury. For the first time it has been shown that in the case of delayed osteosynthesis, the effectiveness of PREF and BIOS is comparable in terms of the duration of the consolidation of the diaphyseal femoral fractures.

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