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Nie S, Li J, Liu X, Liu J, Wu X, Tang P, Zhao Y, Li M, Zhang L. The clinical efficacy of Medial Sustain Nail(MSN) and Proximal femoral nail anti-rotation(PFNA) for fixation of medial comminuted trochanteric fractures: a prospective randomized controlled trial. INTERNATIONAL ORTHOPAEDICS 2024:10.1007/s00264-024-06220-6. [PMID: 38772935 DOI: 10.1007/s00264-024-06220-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 04/30/2024] [Indexed: 05/23/2024]
Abstract
PURPOS To evaluate the clinical efficacy of the Medial Sustain Nail (MSN) for medial comminuted trochanteric fractures fixation in comparison to Proximal Femoral Nail Antirotation (PFNA) through a clinical study. METHODS A non-inferiority randomized controlled trial was conducted at a single centre between July 2019 and July 2020. Fifty patients diagnosed comminuted trochanteric fractures were randomly assigned to either the MSN group (n = 25) or the PFNA group (n = 25). A total of forty-three patients were included in the final study analysis. The primary outcome measure was Short Form 36 health surgery physical component summary (SF-36 PCS) score. Secondary outcomes included the Oxford Hip Scores (OHS), weight bearing, complication relate to implant and so on. This study was not blined to surgeons, but to patients and data analysts. RESULTS The MSN demonstrated significantly better functional outcomes as measured by SF-36 PCS and OHS at six months postoperative compared to PFNA (p < 0.05). Union of fractures in the MSN group reached 90.9% at three months after surgery, whereas the PFNA group achieved a union rate of 57.1% (p < 0.05). Furthermore, weight-bearing time of MSN group was earlier than PFNA group (p < 0.05). Additionally, complications related to implant usage were more prevalent in the PFNA group (33.3%) compared to the MSN group (4.5%) (p < 0.05). CONCLUSION MSN exhibited superior quality of life outcomes compared to PFNA at six months postoperative. This indicates that MSN effectively reconstructs medial femoral support in patients with comminuted trochanteric fractures, which facilitates early weight-bearing and accelerates the recovery process. TRIAL REGISTRATION Trial registration number: NCT01437176, Date of the trial registration:2011-9-1, Date of commencement of the study:2011-9, Date of enrolment/recruitment of the study subjects:2019-7.
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Affiliation(s)
- Shaobo Nie
- Department of Orthopaedics, The First Medical Centre of Chinese PLA General Hospital, Beijing, 100853, China
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, 100853, China
| | - Jiantao Li
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, 100853, China
- Senior Department of Orthopaedics, The Fourth Medical Center of Chinese, PLA General Hospital, Beijing, 100853, China
| | - Xiao Liu
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, 100853, China
- Senior Department of Orthopaedics, The Fourth Medical Center of Chinese, PLA General Hospital, Beijing, 100853, China
| | - Jianheng Liu
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, 100853, China
- Senior Department of Orthopaedics, The Fourth Medical Center of Chinese, PLA General Hospital, Beijing, 100853, China
| | - Xiaoyong Wu
- Department of Orthopaedics, The First Medical Centre of Chinese PLA General Hospital, Beijing, 100853, China
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, 100853, China
| | - Peifu Tang
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, 100853, China
- Senior Department of Orthopaedics, The Fourth Medical Center of Chinese, PLA General Hospital, Beijing, 100853, China
| | - Yanpeng Zhao
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, 100853, China.
- Senior Department of Orthopaedics, The Fourth Medical Center of Chinese, PLA General Hospital, Beijing, 100853, China.
| | - Ming Li
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, 100853, China.
- Senior Department of Orthopaedics, The Fourth Medical Center of Chinese, PLA General Hospital, Beijing, 100853, China.
| | - Licheng Zhang
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, 100853, China.
- Senior Department of Orthopaedics, The Fourth Medical Center of Chinese, PLA General Hospital, Beijing, 100853, China.
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Jung CH, Cha Y, Chung JY, Park CH, Kim TY, Yoo JI, Kim JT, Jeon Y. Trajectory of bolt and length of plate in femoral neck system determine the stability of femur neck fracture and risk of subsequent subtrochanteric fracture : a finite element analysis. BMC Musculoskelet Disord 2023; 24:465. [PMID: 37280558 DOI: 10.1186/s12891-023-06579-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 05/30/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND This study aimed to analyze the differences in the stability of fractures, stress distribution around the distal-most screw according to the length of the plate and the trajectory of the bolt in Pauwels type III femoral neck fracture using the femoral neck system (FNS). METHODS Finite element models of Pauwels type III femoral neck fractures were established with surgical variations in the trajectory of the bolt (central, inferior, valgus, and varus) and length of the lateral plate (1- and 2-hole plate). The models were subsequently subjected to normal walking and stair-climbing loads. RESULTS The screw-holding cortical bone in subtrochanter in the model with a 2-hole plate and the bolt in the inferior trajectory and the models with 1-hole or 2-hole plate and the bolt in valgus trajectory had shown greater maximum principal strain than the models with central or varus trajectories. The gap and sliding distance on the fracture surface were larger with inferior or varus trajectories of the bolt and smaller with the valgus trajectory of the bolt under both loads, compared to those of the central trajectory. CONCLUSION For the fixation of Pauwels type III femoral neck fracture, the trajectory of the FNS bolt and the length of the plate affect the mechanical stability of the fracture and the strain of cortical bone around the distal-most screw. The surgical target should stay on the central trajectory of the bolt and the 2-hole plate's mechanical benefits did not exceed the risk.
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Affiliation(s)
- Chang-Ho Jung
- Department of Mechanical Engineering, Ajou University, Suwon, Korea
| | - Yonghan Cha
- Department of Orthopaedic Surgery, Eulji university hospital, Daejeon, Korea
| | - Jun Young Chung
- Department of Orthopaedic Surgery, Ajou University School of Medicine, Ajou Medical Center, 164, World cup-ro, Yeongtong-gu, Suwon, 16499, Korea
| | - Chan Ho Park
- Department of Orthopaedic Surgery, New Daesung Hospital, Bucheon, Korea
| | - Tae Young Kim
- Department of Orthopaedic Surgery, Ajou University School of Medicine, Ajou Medical Center, 164, World cup-ro, Yeongtong-gu, Suwon, 16499, Korea
| | - Jun-Il Yoo
- Department of Orthopedic Surgery, Inha University Hospital, Incheon, Korea
| | - Jung-Taek Kim
- Department of Orthopaedic Surgery, Ajou University School of Medicine, Ajou Medical Center, 164, World cup-ro, Yeongtong-gu, Suwon, 16499, Korea.
| | - Yongho Jeon
- Department of Mechanical Engineering, Ajou University, Suwon, Korea
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Cho Y, Shin JU, Kim S. Comparative Study for Osteosynthesis of Femoral Neck Fractures: Cannulated Screws versus Femoral Neck System. Hip Pelvis 2023; 35:47-53. [PMID: 36937213 PMCID: PMC10020727 DOI: 10.5371/hp.2023.35.1.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 10/28/2022] [Accepted: 10/29/2022] [Indexed: 03/18/2023] Open
Abstract
Purpose The purpose of this study is to compare the radiological results of fixation using the femoral neck system (FNS) and cannulated screw (CS) for treatment of femoral neck fractures. Materials and Methods A retrospective study of patients with femoral neck fractures who underwent internal fixation and had follow-up of more than six months from 2010 to 2020 was conducted. A total of 87 patients were enrolled in the study. The FNS group included 20 patients and the CS group included 67 patients. Classification of fractures was performed according to Garden and Pauwels classification. Operation time, intraoperative blood loss, sliding distance of the implant, lateral soft tissue irritation caused by implants, and complications were evaluated. Results The mean operation time was 40.30 minutes in the FNS group and 46.84 minutes in the CS group. The mean intraoperative bleeding volume was 51.25 mL in the FNS group and 72.16 mL in the CS group. Bone union was achieved in 18 patients in the FNS group (90.0%) and in 61 patients in the CS group (91.0%). The mean sliding distance of the implant was 4.06 mm in the FNS group and 3.92 mm in the CS group. No patients in the FNS group and 12 patients in the CS group complained of soft tissue irritation. Conclusion A shorter operative time, less intraoperative bleeding, and less irritation of soft tissue were observed in the FNS group. FNS could be an alternative to CS for fixation of femoral neck fractures.
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Affiliation(s)
- Youngho Cho
- Department of Orthopaedic Surgery, Daegu Fatima Hospital, Daegu, Korea
| | - Jae-uk Shin
- Department of Orthopaedic Surgery, Daegu Fatima Hospital, Daegu, Korea
| | - Sangwoo Kim
- Department of Orthopaedic Surgery, Daegu Fatima Hospital, Daegu, Korea
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Xia G, Liu W, Bai H, Xue Y, Dai Y, Lei P, Zhang J. Surgical Tool Handle Vibration-Based Drilling State Recognition During Hip Fracture Fixation. Orthop Surg 2022; 14:2964-2978. [PMID: 36177881 PMCID: PMC9627077 DOI: 10.1111/os.13507] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 08/10/2022] [Accepted: 08/24/2022] [Indexed: 11/29/2022] Open
Abstract
Objectives Traditional manual drilling during hip fracture fixation can easily lead to unstable fixation and vascular damage. This study aimed to investigate a safe and easy‐to‐use robot‐assisted method to automatically drill bone and distinguish critical bone drilling states with high accuracy in real‐time for the bone hole‐making process during hip fracture fixation. Methods A bone‐drilling robotic system was designed to automatically create holes in the femoral neck. Four fresh pig femurs were drilled at the posterosuperior femoral neck using three modes: “all‐in” (AI), “in‐out‐in” (IOI), and “percutaneous fixation” (PF). A high‐frequency accelerometer captured the generated vibrations of the drill handle, which were then transferred to a personal computer using a data acquisition card. Five bone drilling states are defined, including: “drill idling,” “initial drilling,” “in the cancellous bone,” “out the femoral neck,” and “in the cortical bone.” The harmonic distribution of the vibration signal was extracted by fast Fourier transform (FFT) and used as a critical feature to identify different drilling states. To prove the difference in the harmonic distribution at different drilling states, an independent sample t‐test was used to compare the percentage of the first harmonic amplitude in the first 10 harmonics at each drilling state. A neural network classifier was trained with the frequency spectrum as the input and the drilled state as the output to distinguish the critical bone drilling states with high accuracy in real‐time. The classifier was trained and tested on four specimens to ensure that the surgical robot could accurately identify the five drilling states. Results In each specimen, the harmonic distributions of the drilling vibration at different drilling modes were significantly different (p < 0.05). The average recognition accuracies of the drilling state for the four specimens were all higher than 84%. The three defined modes were distinguished with extremely high accuracies. The recognition accuracies of “in the cancellous bone” for specimens 1 to 4 were 83.2%, 84.8%, 92.9%, and 84.7%. The recognition accuracies of “in out the femoral neck” from specimens 1 to 4 are 98.2%, 88.4%, 95.8%, and 88.8%. The recognition accuracies of “in the cortical bone” for specimens 1 to 4 were 94.6%, 80.8%, 95.5%, and 85.8%. Conclusions The proposed robot‐assisted method can automatically distinguish five critical bone‐drilling states with high accuracy in real‐time to avoid weak fixation and damage to the lateral epiphyseal artery.
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Affiliation(s)
- Guangming Xia
- Institute of Robotics and Automatic Information System, Tianjin, China
| | - Wei Liu
- Department of Orthopedic Surgery, Tianjin Medical University General Hospital, Tianjin, China.,Department of Orthopaedic Surgery, Tianjin Baodi Hospital, Tianjin, China
| | - He Bai
- Department of Orthopedic Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Yuan Xue
- Department of Orthopedic Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Yu Dai
- Institute of Robotics and Automatic Information System, Tianjin, China
| | - Ping Lei
- Department of Geriatrics, Tianjin Medical University General Hospital, Tianjin, China
| | - Jianxun Zhang
- Institute of Robotics and Automatic Information System, Tianjin, China
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