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

2021 ◽  
Vol 87 (2) ◽  
pp. 293-298
Author(s):  
Sorya Plang ◽  
Romain Dayan ◽  
Frédéric Khiami ◽  
Clément Preneau ◽  
Olivier Barbier ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Proximal Femoral Nail ◽  
Functional Abilities ◽  
Very Elderly ◽  
Femoral Nail ◽  
Duration Of Surgery ◽  
Stable Osteosynthesis ◽  
Secondary Endpoints ◽  
Tip Apex Distance ◽  
Walking Recovery

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.

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

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

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

Injury ◽  
2017 ◽  
Vol 48 (8) ◽  
pp. 1843-1847 ◽  
Author(s):  
Michael Yam ◽  
Anuj Chawla ◽  
Ernest Kwek
Keyword(s):  
Proximal Femoral Nail ◽  
Femoral Nail ◽  
Tip Apex Distance

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

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.

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

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

<p class="abstract"><strong>Background:</strong> 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.</p><p class="abstract"><strong>Methods:</strong> 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.<strong></strong></p><p class="abstract"><strong>Results:</strong> 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.</p><strong>Conclusions:</strong> 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

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

2016 ◽  
Vol 2 (4) ◽  
pp. 354 ◽  
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

<p class="abstract"><strong>Background:</strong> <span lang="EN-GB">In the management of peri-trochanteric fractures, </span>intramedullary (IM) devices have proven advantage over <span lang="EN-GB">extramedullary devices. IM devices</span> 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<span lang="EN-IN">.</span></p><p class="abstract"><strong>Methods:</strong> 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.<strong></strong></p><p class="abstract"><strong>Results:</strong> 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<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> 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<span lang="EN-IN">.</span></p>

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

Injury ◽  
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

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

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

scholarly journals Functional and radiological outcomes of intertrochanteric fractures treated with proximal femoral nail

2020 ◽  
Vol 6 (5) ◽  
pp. 1001
Author(s):  
Mayur Chopra ◽  
Sanjay Kumar Srivastava ◽  
Sumit Kumar ◽  
Deepak Kumar Mishra
Keyword(s):  
Weight Bearing ◽  
Proximal Femoral Nail ◽  
Harris Hip Score ◽  
Intertrochanteric Fractures ◽  
Radiological Outcome ◽  
Neck Length ◽  
Neck Shaft Angle ◽  
Femoral Nail ◽  
Shaft Angle ◽  
Tip Apex Distance

<p><strong>Background:</strong> Hip fracture is one of the most invalidating diseases affecting geriatric populations and in fall related fractures, they lead to most severe morbidity and mortality. Their surgical treatment allows stable fracture fixation which allows the early weight bearing. Many devices have been developed, yet mechanical failures still occur. The aim of this study was to assess the functional and radiological outcomes of intertrochanteric fractures treated with proximal femoral nail.</p><p><strong>Methods:</strong> 46 patients with intertrochanteric fractures fixed with proximal femoral nail were assessed. Functional outcome was measured by Harris hip score (HHS) and lower extremity functional scale (LEFS) and radiological outcome was measured by tip apex distance (TAD), any changes in neck shaft angle, neck length and the offset as compared to uninjured hip.</p><p><strong>Results:</strong> The tip apex distance on the postoperative X-ray was found to be 22.02±2.499 mm, change in the neck length as compared to the uninjured hip was found to be 1.507±1.1808 and change in the offset and neck shaft angle was 1.470±1.0126 and -1.602±1.5992 respectively. The LEFS was found to be 70.63±6.584 whereas the HHS was found to be 90.35±7.593</p><p><strong>Conclusions:</strong> With the increase in TAD the functional and radiological outcome worsens. It was also seen that the cutoff of 25 mm stands true in predicting the outcome of the patients with PFN in intertrochanteric fractures. Hence, the TAD should be routinely measured and if found more than 25 mm then proper precautions like delayed weight bearing may be advised.</p>

scholarly journals CLINICAL EVALUATION OF UNSTABLE INTER-TROCHANTERIC HIP FRACTURE BY INTRAMEDULLARY NAIL (PROXIMAL FEMORAL NAIL) - A PROSPECTIVE CLINICAL STUDY

2020 ◽  
pp. 1-3
Author(s):  
Appurv jaiswal ◽  
Rajeev joshi ◽  
Mahendra Panwar
Keyword(s):  
Proximal Femoral Nail ◽  
Prospective Clinical Study ◽  
Trochanteric Fractures ◽  
Level Of Evidence ◽  
Superficial Infection ◽  
Femoral Nail ◽  
Duration Of Surgery ◽  
Hip Screw ◽  
One Year

Introduction Dynamic hip screw and cephalomedullary nails are currently considered as a standard treatment for inter-trochanteric fractures. Although both clinical and biomechanical studies suggest that intramedullary implants have a mechanical advantage over extramedullary implants. We report the results of 118 unstable inter-trochanteric hip fractures internally fixed with proximal femoral nail Materials and methods Between Dec 2013 and Dec 2015, 138 patients with unstable inter-trochanteric fractures were internally fixed with proximal femoral nail.Number of patients requiring open reduction, duration of surgery and hospitalization, post-operative complications, implant-specific complications were recorded in a predefined proforma; serial post-operative radiographs taken. Functional outcomes were assessed according to the Harris Hip scoring (HHS) system. Results: Mean HHS at one year follow up was 93.356 (range-60-100). There were four superficial infection, one lag screw migration in to joint (fixation revised) and one implant failure (converted to hemiarthroplasty). Union was achieved in 117 cases. Fourteen patients expired due to unrelated reasons and six patients could not complete the follow up. Conclusion: We have used proximal femoral nail for fixation of unstable inter-trochanteric fractures with less operative time, good clinico-radiological outcome and low complication rate. Level of evidence: IV

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