Cementation of proximal femoral nails of the very elderly subject in per-trochanteric fractures

The management of pertrochanteric fractures (PTF) in the very elderly relies on early verticalisation to limit complications of the decubitus and this requires stable osteosynthesis allowing immediate full support without risk of mechanical failure. The aim of the study was to analyse the value of cementing the cervicocephalic blade during osteosynthesis with a proximal femoral nail. A prospective bicentric comparative study was con- ducted. Patients over 90 years of age with PTF were included. Centre A used a PFNA (Proximal Femoral Nail Antirotation) nail without blade cementing and Centre B used the same nail with blade cementing. The primary endpoint was the occurrence of disassembly of the osteosynthesis requiring revision surgery. Secondary endpoints were functional out- come (resumption of walking), postoperative pain and duration of surgery. Sixty-four patients were included in Centre A and 23 patients were included in Centre B. Mean age, gender, functional abilities before fracture, fracture type and tip-apex distance were comparable between the groups. Postoperative pain and duration of surgery did not show significant differences between the groups. Four patients operated on with an uncemented PFNA (6.25%) and one patient operated on with a cemented PFNA nail (4.35%) showed early dismantling. The rate of patients returning to walking was significantly higher in the cemented group (p=0.00005). No significant differences in the rate of dismantling were observed between the two groups. However, the group operated on with a cemented PFNA showed better functional recovery with a significantly higher rate of walking recovery.

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Dynamic Hip Screw versus Proximal Femoral Nail in the Management of Intertrochanteric Fractures - A Retrospective Analysis from Rajasthan

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/424 ◽

2021 ◽

Vol 8 (26) ◽

pp. 2271-2277

Author(s):

Gajanand Shriram Dhaked ◽

Abhishek Komalsingh Jaroli ◽

Khushboo Parmanand Malav ◽

Harish Narayan Singh Rajpurohit

Keyword(s):

Functional Outcome ◽

Functional Outcomes ◽

Statistical Significance ◽

Dynamic Hip Screw ◽

Proximal Femoral Nail ◽

Final Decision ◽

Intertrochanteric Fractures ◽

Femoral Nail ◽

Duration Of Surgery ◽

Hip Screw

BACKGROUND Current management of Intertrochanteric (IT) fractures has evolved with the introduction of dynamic hip screw (DHS) and proximal femoral nail (PFN). The purpose of this study was to compare the functional outcomes between the DHS and PFN for IT fracture fixation. METHODS This study is a retrospective comparative analysis of 455 patients with IT fractures; DHS (292) and PFN (163), who were treated from June 2012 to June 2015. The patients were reviewed postoperatively for a minimum of 12 months to evaluate functional outcome using Salvati-Wilson score. Categorical data was present as absolute number or percentages, and parametric variables were presented as Mean ± SD, while non parametric data were presented as median. Statistical significance was defined as P < 0.05. RESULTS Intramedullary nails offer no advantage over extramedullary devices to treat IT fractures caused by low-energy trauma (AO 31 - A1). However, clinically significant outcomes were established for PFN group in terms of duration of surgery, x- ray exposure and SW Score for AO / OTA 31 - A2 and 31 - A3. Reoperations encountered for local pain due to implant prominence were significantly higher in the PFN group (4.90 % versus 1.02 %). Kaplan Meier survival probability of 69.3 % and 79.5 % predicted for DHS and PFN respectively, 3 years postoperatively. CONCLUSIONS Our conclusion reinforces indication for PFN in unstable IT fractures (31 - A2 and 31 - A3), owing to its better functional outcome and biomechanical properties. Functional outcomes for stable IT fracture (AO 31 - A1) were comparable between DHS and PFN, therefore final decision for implant choice depends on implant cost, surgeon’s preference for specific technique. However, understanding the morphology of proximal femur, peritrochanteric region is crucial to analyse the anatomical variations in Indian population which will provide the basis for intramedullary nail design modifications. KEYWORDS Intertrochanteric Fractures, DHS Fixation, PFN Fixation

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Rewriting the tip apex distance for the proximal femoral nail anti-rotation

Injury ◽

10.1016/j.injury.2017.06.020 ◽

2017 ◽

Vol 48 (8) ◽

pp. 1843-1847 ◽

Cited By ~ 5

Author(s):

Michael Yam ◽

Anuj Chawla ◽

Ernest Kwek

Keyword(s):

Proximal Femoral Nail ◽

Femoral Nail ◽

Tip Apex Distance

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The Results of Unstable Intertrochanteric Femur Fracture Treated with Proximal Femoral Nail Antirotation-2 with respect to Different Greater Trochanteric Entry Points

Advances in Orthopedics ◽

10.1155/2020/2834816 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Sharan Mallya ◽

Surendra U. Kamath ◽

Rajendra Annappa ◽

Nithin Elliot Nazareth ◽

Krithika Kamath ◽

...

Keyword(s):

Entry Point ◽

Proximal Femoral Nail ◽

Harris Hip Score ◽

Care Hospital ◽

Femoral Nail ◽

Tip Apex Distance ◽

Proximal Femoral Nail Antirotation ◽

Modified Harris Hip Score

Background. Proximal femoral nail antirotation-2 (PFNA-2) has been widely used to treat intertrochanteric fractures with varied outcomes in the previous studies. The entry point of the nail plays an important role in achieving acceptable reduction, stable fixation, and avoiding implant related complications. This study was proposed to determine the optimal greater trochanteric entry point for PFNA-2 in unstable intertrochanteric femur fractures. Methods. We conducted an observational study on 40 patients with unstable intertrochanteric fracture treated with PFNA-2 implant in a tertiary care hospital. The patients were grouped into two based on the entry point: group L for lateral and group M for medial entry. Randomization was carried out by assigning the patients to the group by alternate allocation. The quality of reduction, tip apex distance, Cleveland index, and all the complications were noted. The final follow-up was conducted at six months. The functional outcome was evaluated using modified Harris hip score. The data analysis was performed using Student’s t-test, chi square test, and Mann–Whitney test. A P value below 0.05 was considered significant. Results. Forty patients with 20 patients treated with medial entry point were included in group M and 20 patients in group L with lateral entry point. The group L had an average tip apex distance of 20.53 and group M had 20.02 (P=0.8). The complication of screw back out was seen in 3 out of 4 patients with poor reduction in group L. As per the Cleveland index, 6 patients in each group had suboptimal position and 4 out of 6 patients in group L with suboptimal position had screw back out. The lateral cortex impingement was seen in 14 patients of group L and 6 patients in group M with significant comparison (P=0.01). Three patients in group L had varus collapse with screw back out. Also, none in group M (0.05). The average modified Harris hip score in group L at six months follow-up was 71.94 and 76.8 in group M (P=0.84). Conclusion. Overall, to achieve good quality of fixation and reducing damage to gluteus medius entry point for PFNA-2 should be 5 mm medial to the greater trochanter tip.

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SIGNIFICANCE OF TIP APEX DISTANCE (TAD) IN PROXIMAL FEMORAL NAIL ANTIROTATION (PFNA) II SYSTEM USED IN TRAUMA CASES OF PROXIMAL FEMORAL FRACTURES

International Journal of Orthopaedics Traumatology & Surgical Sciences ◽

10.47618/ijotss/v5i2.11 ◽

2019 ◽

Vol 5 (2) ◽

pp. 296-299

Author(s):

Ramavtar Saini

Keyword(s):

Femoral Fractures ◽

Proximal Femoral Nail ◽

Proximal Femoral Fractures ◽

Femoral Nail ◽

Tip Apex Distance ◽

Proximal Femoral Nail Antirotation

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Randomized comparative study to evaluate the role of proximal femoral nail and dynamic hip screw in unstable trochanteric fractures

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20162618 ◽

2016 ◽

Vol 2 (3) ◽

pp. 75

Author(s):

Shivanand C Mayi ◽

Sachin Shah ◽

Sadashiv R Jidgekar ◽

Arunkumar Kulkarni

Keyword(s):

Comparative Study ◽

Functional Outcome ◽

Trochanteric Fracture ◽

Dynamic Hip Screw ◽

Proximal Femoral Nail ◽

Trochanteric Fractures ◽

Stable Fixation ◽

Femoral Nail ◽

Duration Of Surgery ◽

Hip Screw

Background: Treatment of unstable trochanteric fracture is much more challenging than stable fracture. These fractures require stable fixation to minimize the fracture and implant related complications. Need of this study is to assess the suitable implant for stable fixation of unstable trochanteric fracture with less intra and postoperative complications and good functional outcome.Methods: In this prospective randomized comparative study, 64 patients were distributed into two groups. Group A consisted of patients treated by proximal femoral nail (PFN) (n=32) and group B treated by dynamic hip screw (DHS) (n=32). All the patients were evaluated preoperatively and surgery was done according to the group they were allotted. Post-operative follow up was done at 6 weeks, 3, 6 and 12 months.Results: Average age of the patients in this study was 51.26±10.24 year. In this study patients were followed up for an average of 10.87±2.61 month. The duration of surgery was shorter in PFN group. Weight bearing was earlier in PFN group than DHS group. Mean functional ability score was better in PFN group with significant gain in function earlier as compared to DHS group.Conclusions: PFN is a better implant for internal fixation of unstable trochanteric fractures which allows early mobilization and has got better functional outcome score in early postoperative period than DHS

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Comparative study between proximal femoral nail and proximal femoral nail antirotation in management of unstable trochanteric fractures

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20164168 ◽

2016 ◽

Vol 2 (4) ◽

pp. 354 ◽

Cited By ~ 2

Author(s):

Manoj R. Kashid ◽

Tushar Gogia ◽

Anjan Prabhakara ◽

Mohammad A. Jafri ◽

Dilip S. Shaktawat ◽

...

Keyword(s):

Blood Loss ◽

Functional Recovery ◽

Proximal Femoral Nail ◽

Functional Evaluation ◽

Trochanteric Fractures ◽

Non Union ◽

Femoral Nail ◽

Walking Aids ◽

Duration Of Surgery ◽

Proximal Femoral Nail Antirotation

Background: In the management of peri-trochanteric fractures, intramedullary (IM) devices have proven advantage over extramedullary devices. IM devices allow for stable anatomical fixation of more comminuted fractures without shortening the abductor lever arm or changing the proximal femoral anatomy. Between IM devices like proximal femoral nail (PFN) and proximal femoral nail antirotation (PFNA), the helical blade of latter is believed to provide stability, compression and rotational control of the fracture with higher cut out strength. The following study was undertaken in an attempt to compare these two types of Intra-medullary devices.Methods: Between January 2012 and June 2013, 50 patients with unstable intertrochanteric fractures fulfilling inclusion and exclusion criteria, were randomized into 2 groups to undergo CRIF with either standard PFN (n=25) or PFNA (n=25). They were compared in terms of demography, per-operative variables and postoperative parameters including functional evaluation till 1year postoperatively.Results: Background demographic variables, fracture type and pre-injury ambulatory status were comparable between the groups. Operative duration of surgery, amount of blood loss and number of fluoroscopic images were significantly lower in PFNA group as compared to PFN group. Post op complications like infection, non-union, cut out/z-effect, loss of reduction, re-operation and mortality rates didn’t differ significantly between the groups. Post op functional recovery as evaluated by pain, use of walking aids and Harris hip scores were similar in both groups. Conclusions: PFNA significantly reduces the operative time, amount of blood loss and fluoroscopic imaging as compared to PFN. However PFNA offers no significant benefits over PFN in terms of post-operative functional recovery or complications.

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P04 Is the tip apex distance a predictor of failure in intertrochanteric hip fractures treated with proximal femoral nail?

Injury ◽

10.1016/s0020-1383(16)30555-1 ◽

2016 ◽

Vol 47 ◽

pp. S26

Author(s):

K. Kayaokay ◽

N. Ozkayin ◽

M.C. Sozbilen ◽

B. Ozcanyuz ◽

J. Mirzazade ◽

...

Keyword(s):

Hip Fractures ◽

Proximal Femoral Nail ◽

Femoral Nail ◽

Tip Apex Distance

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Dynamic Hip Screw in Comparison with Proximal Femoral Nail Technique in Intertrochanteric Femur Fracture Patients

10.53350/pjmhs2115112966 ◽

2021 ◽

Vol 15 (11) ◽

pp. 2966-2968

Author(s):

Mudir Khan ◽

Muhammad Siraj ◽

Abbas Ali

Keyword(s):

Blood Loss ◽

Femur Fracture ◽

Dynamic Hip Screw ◽

Proximal Femoral Nail ◽

Harris Hip Score ◽

Femoral Nail ◽

Duration Of Surgery ◽

Hip Screw ◽

Intertrochanteric Femur Fracture ◽

Better Than

Background: Hip bone fractures are the main cause of concern on a worldwide level. The main two operative techniques involve dynamic hip screw and proximal femoral nail technique. Aim: To compare the dynamic hip screw with proximal femoral nail technique in intertrochanteric femur fracture patients. Study design: Retrospective study Place and duration of study: Department of Orthopaedics, Khyber Teaching Hospital, Peshawar from 1-7-2019 to 30-12- 2021. Methodology: Seventy patients were enrolled and they were divided in two groups; Group 1 patients were operated with dynamic hip screw (DHS) while group 2 patients were operated by proximal femoral nail (PFN) technique. The detailed pre and post-operative clinical information including blood loss, incision size, Harris hip score and rate of complication was documented. Results: The mean age of patients was 58.62±6.71 year with more male patients than females. The Harris hip score of proximal femoral nail technique was better than distal hip screw. The incision length of distal hip screw cases was 7.61±0.89 in comparison to 4.72±0.73 in proximal femoral nail technique cases with a longer duration of surgery and inter-operative blood loss in case of distal hip screw cases. Conclusion: Proximal femoral nail technique is comparatively better than the distal hip screw procedure. Keywords: Proximal femoral nail technique, distal hip screw, Hip fracture

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Treatment of Unstable Intertrochanteric Fractureswith Proximal Femoral Nail Antirotation II: Our Experience in Indian Patients§

The Open Orthopaedics Journal ◽

10.2174/1874325001509010456 ◽

2015 ◽

Vol 9 (1) ◽

pp. 456-459 ◽

Cited By ~ 5

Author(s):

G.N. Kiran Kumar ◽

Gaurav Sharma ◽

Kavin Khatri ◽

Kamran Farooque ◽

Devendra Lakhotia ◽

...

Keyword(s):

Operative Time ◽

Proximal Femoral Nail ◽

Harris Hip Score ◽

Intertrochanteric Fractures ◽

Femoral Nail ◽

Tip Apex Distance ◽

The Mean ◽

Postoperative Fracture ◽

Fracture Stability

Introduction:Unstable intertrochanteric fractures are difficult to manage and the choice of implant is critical for fracture fixation. The purpose of this study was to evaluate the functional and radiological outcome of proximal femoral nail antirotationII (PFNA II) in the treatment of unstable intertrochanteric fractures.Materials and Methods:We reviewed 45 patients of unstable intertrochanteric fractures, who were treated with the PFNA II between 2011 and 2013. Of which, 3 patients were died within 6 months of follow up. Hence, 42 patients were available for the study including 26 men and 16 women. The mean age was 61 years (range, 35 -90). Clinical evaluation was done using Harris hip score. The position of the blade in the femoral head was evaluated using Cleveland zones and tip apex distance. The fracture reduction was assessed using the Garden Alignment Index and postoperative fracture gap (mm) measurement.Results:The mean follow up period was 15.3 months (range, 9-27). Excellent to good results were accounted for 78% of cases according to Harris hip score. No cases of cut out or breakage of the implant noted. Implant removal was done in 2 patients due to persistent anterior thigh pain.Conclusion:We recommend PFNA II for fixation of unstable intertrochanteric fractures with less operative time and low complication rate. However, proper operative technique is important for achieving fracture stability and to avoid major complications.

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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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