scholarly journals Risk factors for implant failure of proximal femoral nail anti-rotation (PFNA –II) in the treatment of intertrochanteric fractures (AO/OTA 31 A1 and A2)

2020 ◽  
Author(s):  
Shaobo Nie ◽  
Hui Ji ◽  
ming li ◽  
di yang ◽  
Yeqing Qi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intertrochanteric Fracture ◽  
Implant Failure ◽  
Proximal Femoral Nail ◽  
Coxa Vara ◽  
Therapeutic Effects ◽  
Intertrochanteric Fractures ◽  
Failure Group ◽  
Femoral Nail ◽  
Significant Difference

Abstract Background Intertrochanteric fracture is associated with severe morbidity and mortality. The results of postoperative implant failure are catastrophic. The aim of this study was to determine risk factors for implant failure in intertrochanteric fractures treated with proximal femoral nail anti-rotation (PFNA–II) through the assessment of early therapeutic effects. Methods A single-center retrospective study was conducted on a continuous series of 123 intertrochanteric fracture patients treated with PFNA-II between Dec 2018 and Oct 2019. Perioperative medical and imaging data were collected. The patients were divided into two groups according to whether implant failure of not. The differences in reduction quality, nail length and tip apex distance (TAD) were analyzed to determine the risk factors of implant failure. Results A total of 80 patients were enrolled, with an average age of 80.2 years old. There were 6 patients with implant failure. There was no significant difference in demographic index between the two groups. The reduction quality of failure group was good, accept and poor with each 2 patients, and that of the non-failure group was 35, 35 and 4 patients respectively. The difference of reduction quality between the two groups was statistically significant. The risk of postoperative implant failure in patients with poor reduction quality was 8.75 times that of patients with good and acceptable reduction from the Logistic regression analysis(OR = 8.75,95%CI 1.215–62.99). The differences in nail length, ASA and bone quality were not statistically significant. Conclusion Reduction quality is a risk factor of implant failure in intertrochanteric fractures treated with PFNA-II. Even if the medial femoral cortex is anatomically reduced, there will be a triangular void area between the nail and the medial femur, which are prone to coxa vara and implant failure. Therefore, good reduction is the key to treat intertrochanteric fracture.

scholarly journals Risk factors for mechanical failure of proximal femoral nail anti-rotation (PFNA–II) in the treatment of intertrochanteric fractures (AO/OTA 31-A1, A2)

2020 ◽  
Author(s):  
Shaobo Nie ◽  
Hui Ji ◽  
ming li ◽  
di yang ◽  
Yeqing Qi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intertrochanteric Fracture ◽  
Implant Failure ◽  
Proximal Femoral Nail ◽  
Coxa Vara ◽  
Therapeutic Effects ◽  
Intertrochanteric Fractures ◽  
Failure Group ◽  
Femoral Nail ◽  
Significant Difference

Abstract Background: Intertrochanteric fracture is associated with severe morbidity and mortality. The results of postoperative implant failure are catastrophic. The aim of this study was to determine risk factors for implant failure in intertrochanteric fractures treated with proximal femoral nail anti-rotation (PFNA–II) through the assessment of early therapeutic effects.Methods: A single-center retrospective study was conducted on a continuous series of 123 intertrochanteric fracture patients treated with PFNA-II between Dec 2018 and Oct 2019. Perioperative medical and imaging data were collected. The patients were divided into two groups according to whether implant failure of not. The differences in reduction quality, nail length and tip apex distance (TAD) were analyzed to determine the risk factors of implant failure.Results: A total of 80 patients were enrolled, with an average age of 80.2 years old. There were 6 patients with implant failure. There was no significant difference in demographic index between the two groups. The reduction quality of failure group was good, accept and poor with each 2 patients, and that of the non-failure group was 35, 35 and 4 patients respectively. The difference of reduction quality between the two groups was statistically significant. The risk of postoperative implant failure in patients with poor reduction quality was 8.75 times that of patients with good and acceptable reduction from the Logistic regression analysis（OR=8.75，95%CI 1.215-62.99）. The differences in nail length, ASA and bone quality were not statistically significant. Conclusion: Reduction quality is a risk factor of implant failure in intertrochanteric fractures treated with PFNA-II. Even if the medial femoral cortex is anatomically reduced, there will be a triangular void area between the nail and the medial femur, which are prone to coxa vara and implant failure. Therefore, good reduction is the key to treat intertrochanteric fracture.

scholarly journals Risk factors for implant failure in reverse oblique and transverse intertrochanteric fractures treated with proximal femoral nail antirotation (PFNA)

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Youliang Hao ◽  
Zhishan Zhang ◽  
Fang Zhou ◽  
Hongquan Ji ◽  
Yun Tian ◽  
...  
Keyword(s):  
Risk Factors ◽  
Implant Failure ◽  
Proximal Femoral Nail ◽  
Intertrochanteric Fractures ◽  
Geriatric Population ◽  
Femoral Nail ◽  
Type Reduction ◽  
Helical Blade ◽  
Causes Of Mortality ◽  
Proximal Femoral Nail Antirotation

Abstract Background The incidence of intertrochanteric hip fracture is expected to increase as the global population ages. It is one of the most important causes of mortality and morbidities in the geriatric population. The incidence of reverse oblique and transverse intertrochanteric (AO/OTA 31-A3) fractures is relatively low; however, the incidence of implant failure in AO/OTA 31-A3 fractures is relatively high compared with that in AO/OTA 31-A1 and A2 fractures. To date, the risk factors for implant failure in AO/OTA 31-A3 fractures treated with proximal femoral nail antirotation (PFNA) have remained ambiguous. The purpose of this study was to identify the predictive factors of implant failure in AO/OTA 31-A3 fractures treated with PFNA. Methods The data of all patients who underwent surgery for trochanteric fractures at our institution between January 2006 and February 2018 were retrospectively reviewed. All AO/OTA 31-A3 fractures treated with PFNA were included. Logistic regression analysis of potential predictors of implant failure was performed. Potential predictors included age, sex, body mass index, fracture type, reduction method, status of posteromedial support and lateral femoral wall, reduction quality, tip-apex distance and position of the helical blade in the femoral head. Results One hundred four (9.3%) patients with AO/OTA 31-A3 fractures were identified. Forty-five patients with AO/OTA 31-A3 fractures treated with PFNA were suitable for our study. Overall, implant failure occurred in six (13.3%) of forty-five patients. Multivariate analysis identified poor reduction quality (OR, 28.70; 95% CI, 1.91–431.88; p = 0.015) and loss of posteromedial support (OR, 18.98; 95% CI, 1.40–257.08; p = 0.027) as factors associated with implant failure. Conclusions Poor reduction quality and loss of posteromedial support are predictors of implant failure in reverse oblique and transverse intertrochanteric fractures treated with PFNA.

scholarly journals A study to assess proximal femoral nailing versus dynamic hip screw device in surgical management of intertrochanteric fractures: a comparative study

2018 ◽  
Vol 5 (1) ◽  
pp. 23
Author(s):  
E. S. Radhe Shyam ◽  
K. Ashwin
Keyword(s):  
Functional Outcome ◽  
Intertrochanteric Fracture ◽  
Trochanteric Fracture ◽  
Dynamic Hip Screw ◽  
Proximal Femoral Nail ◽  
Technical Failure ◽  
Intertrochanteric Fractures ◽  
Femoral Nail ◽  
Fracture Management ◽  
Hip Screw

<p class="abstract"><strong>Background:</strong> The incidence of inter trochanteric fracture is expected to have doubled by 2040. Inter trochanteric fractures account for about 45% to 50% of all hip fractures in the elderly populationand out of these, near about 50% to 60% are classified as unstable intertrochanteric fractures. The goal of treatment is restoring mobility safely and efficiently, while minimizing the risk of medical complications and technical failure. This study as performed<strong> </strong>to assess functional outcome with dynamic hip screw and proximal femoral nail in intertrochanteric fracture management.</p><p class="abstract"><strong>Methods:</strong> It was prospective observational study done for a period of 1year from January 2016-January 2017 among patients who attended OPD or emergency department with intertrochanteric fracture. Two different implants were used dynamic hip screw (DHS) and proximal femoral nail (PFN).<strong></strong></p><p class="abstract"><strong>Results:</strong> Excellent results in functional outcome was more in case of PFN (66.6%) compared to DHS (50%). The type of trauma in DHS group was road traffic accident in 38.8%, domestic fall in 50% and others such as assault was in 11.1% while in PFN group intertrochanteric fracture was seen in 61.1% due to domestic fall.</p><p class="abstract"><strong>Conclusions:</strong> The functional outcome was more better with proximal femoral nail (PFN) compared to dynamic hip screw (DHS). Therefore, proximal femoral nail (PFN) should be preferred for management of intertrochanteric fractures.</p>

scholarly journals Comparison of mortality rate between bipolar hemiarthroplasty and proximal femoral nail anti-rotation for intertrochanteric fractures in Sanglah hospital, Bali

2020 ◽  
Vol 8 (10) ◽  
pp. 3503
Author(s):  
I. Wayan Suryanto Dusak ◽  
I. Gusti Ngurah Wien Aryana ◽  
Cokorda Gde Oka Dharmayuda ◽  
I. Wayan Subawa ◽  
Hans Kristian Nugraha ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Proximal Femoral Nail ◽  
Bipolar Hemiarthroplasty ◽  
Intertrochanteric Fractures ◽  
Chi Square ◽  
Femoral Nail ◽  
Significant Difference ◽  
Fixation Treatment ◽  
Chi Square Test ◽  
Multi Center Study

Introduction: Intertrochanteric fractures occur in about 50% of all hip fracture events, with a mortality rate within 1 year after fracture reaching 15 to 20%. The most common treatment nowadays is either the bipolar hemiarthroplasty procedure or proximal femoral nail anti-rotation (PFNA), although there is still no consensus regarding which is better from the two, especially on patient mortality.Method: This study was an observational study using a retrospective cohort design. A total of 102 study subjects who met the inclusion requirements were grouped into 2 groups, one with bipolar hemiarthroplasty fixation treatment and another with PFNA fixation treatment. Mortality rate was recorded by survey 2 years after surgery.Result: Chi-square test showed that 2-year mortality rate after intertrochanteric fracture treated with bipolar hemiarthroplasty (21.4%) was significantly higher than the PFNA group (10.3%) (p=0.028). Bipolar hemiarthroplasty group also had longer length of stay (LoS) (50%) than the PFNA group (32.4%), albeit statistically insignificant (p=0.13). There was no significant difference between the 2-year mortality rate and LoS (p=0.976).Conclusion: Patients with intertrochanteric fractures who underwent bipolar hemiarthroplasty have significantly higher 2-year mortality rate than similar patients underwent fixation with PFNA, while they did not experience higher LoS than the PFNA group. Future prospective, multi-center study with larger sample size will be likely to validate similar fixation choice needed to decrease the mortality rate in intertrochanteric fractures.

scholarly journals Comparison of Mortality Rate Between Bipolar Hemiarthroplasty and Proximal Femoral Nail Anti-rotation for Intertrochanteric Fractures in Sanglah Hospital, Bali

2020 ◽  
Vol 1 (1) ◽  
pp. 36-42
Author(s):  
I Wayan Suryanto Dusak ◽  
I Gusti Ngurah Wien Aryana ◽  
Cokorda Gde Oka Dharmayuda ◽  
I Wayan Subawa ◽  
Hans Kristian Nugraha ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Length Of Stay ◽  
Proximal Femoral Nail ◽  
Bipolar Hemiarthroplasty ◽  
Intertrochanteric Fractures ◽  
Chi Square ◽  
Femoral Nail ◽  
Significant Difference ◽  
Fixation Treatment ◽  
Multi Center Study

Introduction: Intertrochanteric fractures occur in about 50% of all hip fracture events, with a mortality rate within 1 year after fracture reaching 15 to 20%. The most common treatment nowadays is either the bipolar hemiarthroplasty procedure or proximal femoral nail anti-rotation (PFNA), although there is still no consensus regarding which is better from the two, especially on patient mortality.Method: This study was an observational study using a retrospective cohort design. A total of 102 study subjects who met the inclusion requirements were grouped into 2 groups, one with bipolar hemiarthroplasty fixation treatment and another with PFNA fixation treatment. Mortality rate was recorded by survey 2 years after surgery.Results: Chi-square test showed that 2-year mortality rate after intertrochanteric fracture treated with bipolar hemiarthroplasty (21.4%) was significantly higher than the PFNA group (10.3%) (p = 0.028). Bipolar hemiarthroplasty group also had longer length of stay (50%) than the PFNA group (32.4%), albeit statistically insignificant (p = 0.13). There was no significant difference between the 2-year mortality rate and length of stay (p = 0.976).Conclusion: Patients with intertrochanteric fractures who underwent bipolar hemiarthroplasty have significantly higher 2- year mortality rate than similar patients underwent fixation with PFNA, while they did not experience higher length of stay than the PFNA group. Future prospective, multi center study with larger sample size will be likely to validate similar fixation choice needed to decrease the mortality rate in intertrochanteric fractures.

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 Comparison of Clinical Outcomes With Proximal Femoral Nail Anti-rotation Versus Bipolar Hemiarthroplasty for the Treatment of Elderly Intertrochanteric Fractures

2021 ◽  
Author(s):  
Wen-Bo Wei ◽  
Sha-Jie Dang ◽  
Ling Wei ◽  
MengXi Xin
Keyword(s):  
Postoperative Complications ◽  
Operation Time ◽  
The Elderly ◽  
Proximal Femoral Nail ◽  
Bipolar Hemiarthroplasty ◽  
Intertrochanteric Fractures ◽  
Hospitalization Time ◽  
Femoral Nail ◽  
Time Operation ◽  
Significant Difference

Abstract Background: Although proximal femoral nail anti-rotation (PFNA) and bipolar hemiarthroplasty (BHA) are selected by most of the orthopaedic surgeons for elderly intertrochanteric fractures (ITFs) patients, there is still no consensus on the superiority of PFNA and BPH for ITFs in the elderly. The study aims to compare the curative effects of proximal femoral nail anti-rotation (PFNA) and cementless bipolar hemiarthroplasty (BHA) on ITFs in the elderly. Methods: From January 2012 to December 2016, a total of 62 patients participated in the study: BHA (Group B, n=30), PFNA (Group P, n=32). The fractures were classified according to Evans-Jensen. Hospitalization time, operation time, bleeding loss, Harris scores and postoperative complications were compared between the two groups. Results: The operation time was (125.76 ± 33.49) min and (94.38 ± 20.94) min in PFNA group and BHA group (P < 0.05); bleeding loss was (153.33 ± 59.96) mL and (335.31 ± 90.87) mL(P < 0.05); hospitalization time was (17.13 ± 2.92) days and (16.63 ± 3.64) days (P > 0.05); and the Harris scores were (73.20 ± 6.56) points and (68.91 ± 8.15) points (P < 0.05). There was no significant difference in postoperative complications between the two groups (P > 0.05). Conclusion: Both PFNA and BHA are safe and effective treatments for femoral intertrochanteric fractures in elderly patients. Nonetheless, BHA can be considered for those with the poor bone condition and short life expectancy.

scholarly journals Treatment of stable and unstable intertrochanteric fractures using proximal femoral nail and their functional assessment using modified Harris hip score

2018 ◽  
Vol 5 (1) ◽  
pp. 162
Author(s):  
Lakshya P. Rathore ◽  
Lokesh Gupta ◽  
Sanjay Thakur ◽  
Sandeep Vaidya ◽  
Devender Sharma ◽  
...  
Keyword(s):  
Intertrochanteric Fracture ◽  
Proximal Femoral Nail ◽  
Harris Hip Score ◽  
Functional Evaluation ◽  
Intertrochanteric Fractures ◽  
Good Reduction ◽  
Non Union ◽  
Femoral Nail ◽  
Modified Harris Hip Score ◽  
A Prospective Study

<p class="abstract"><strong>Background:</strong> Intertrochanteric fracture is common injury and is found in both elderly and the young. Proximal femoral nail (PFN) has been in widespread use for the same in the recent past. There are advocates both for and against this implant. The aim was to study the results of PFN in the treatment of intertrochanteric fractures and their functional evaluation using the modified Harris hip score.</p><p class="abstract"><strong>Methods:</strong> A prospective study done on 104 patients operated for intertrochanteric fractures with PFN. Patients were followed up at 6 weekly intervals and evaluated at each visit using the modified Harris hip score (HHS).<strong></strong></p><p class="abstract"><strong>Results:</strong> The study consisted of 104 patients aged from 36 to 96 years with average age of 67.8 years. Most patients belonged to 60-80 years category. Malunion was observed in three patients (2.8%) and non union was not seen in any patient. Excellent to good results were seen in 73% patients 18% patients had a fair outcome, 7.7% had poor and 2% patients had very poor outcome.</p><p class="abstract"><strong>Conclusions:</strong> PFN is a good implant for intertrochanteric fracture treatment that demands a sound technique and a good reduction prior to insertion. The assessment of results using HHS has been too similar to those obtained using Kyle’s criteria in the previous studies, proving its role in the same.</p><p> </p>

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