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Lv J, Li X, Qiu W, Ji J, Cao L, Li L, Zhang Y, Su Z. Effect of knee osteoarthritis on the postoperative outcome of proximal femoral nail anti-rotation in the treatment of intertrochanteric fractures in the elderly: a retrospective analysis. BMC Musculoskelet Disord 2023; 24:868. [PMID: 37940993 PMCID: PMC10631145 DOI: 10.1186/s12891-023-07012-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 11/02/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND The proximal femoral nail anti-rotation (PFNA) is a commonly used internal fixation system for intertrochanteric fractures (IFs) in older adults. Knee osteoarthritis (KOA) is a degenerative lower extremity disease that occurs most frequently in the elderly. Some patients have already had KOA before the IFs. However, whether KOA impacts the postoperative outcome of IFs has not been reported. OBJECTIVE This study aimed to investigate the effect of KOA on the fracture side on the outcome after PFNA for IFs in the elderly. METHODS Between January 2016 and November 2021, 297 elderly patients treated with PFNA for IFs were enrolled in this study. They were divided into two groups according to the American Rheumatism Association KOA clinical and radiographic criteria: the control group and the KOA group. Intraoperative bleeding, operative time, length of hospital stay, postoperative time out of bed, fracture healing time, postoperative complications, postoperative Harris hip function score, and Barthel ability to daily living Score were compared between the two groups. Follow-up was routinely scheduled at 1, 3, 6, and 12 months postoperatively. RESULTS Based on the exclusion criteria, 254 patients who met the requirements were left to be included in this study, including the control group (n = 133) and the KOA group (n = 121). Patients were followed up for a mean of 17.5 months (12-24 months). There was no significant difference between the two groups in preoperative demographic data, intraoperative blood loss, operation time, and length of stay in the hospital. The control group was statistically significant compared to the KOA group in terms of postoperative time out of bed (17.8 ± 4.0 days vs. 19.1 ± 5.8 days), fracture healing time (13.7 ± 2.2 weeks vs. 14.6 ± 3.7 weeks), and postoperative complications (12.8 vs. 23.1%). The Harris hip function score and Barthel ability to daily living score were higher in the control group than in the KOA group at 1, 3, 6, and 12 months postoperatively (the control group: 63.8 ± 10.9, 71.8 ± 10.3, 81.5 ± 8.7, and 91.6 ± 6.3 vs. The KOA group 61.0 ± 10.4, 68.6 ± 9.1, 79.0 ± 9.2, and 88.5 ± 5.9). CONCLUSIONS In elderly patients with IFs combined with KOA of the fracture side treated with PFNA internal fixation, KOA increases the incidence of postoperative complications of the fracture, prolongs postoperative time out of bed and fracture healing, and reduces postoperative hip function and ability to daily living. Therefore, treating KOA on the fractured side needs to be considered when treating IFs in the elderly.
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Affiliation(s)
- Jiaxing Lv
- Kaifeng Central Hospital, Orthopedic Ward 2, Kaifeng/ Henan, 475000, P. R. China
| | - Xiaolong Li
- Kaifeng Central Hospital, Orthopedic Ward 2, Kaifeng/ Henan, 475000, P. R. China
| | - Wenkui Qiu
- Kaifeng Central Hospital, Orthopedic Ward 2, Kaifeng/ Henan, 475000, P. R. China
| | - Jianjun Ji
- Kaifeng Central Hospital, Orthopedic Ward 2, Kaifeng/ Henan, 475000, P. R. China
| | - Lichao Cao
- Kaifeng Central Hospital, Orthopedic Ward 2, Kaifeng/ Henan, 475000, P. R. China
| | - Lei Li
- Kaifeng Central Hospital, Orthopedic Ward 2, Kaifeng/ Henan, 475000, P. R. China
| | - Yihong Zhang
- Kaifeng Central Hospital, Orthopedic Ward 2, Kaifeng/ Henan, 475000, P. R. China.
| | - Zhenyan Su
- Kaifeng Central Hospital, Orthopedic Ward 2, Kaifeng/ Henan, 475000, P. R. China.
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Wang KM, Wei SP, Yin XY, Meng QJ, Kong YM. Effects of alendronate sodium combined with InterTan on osteoporotic femoral intertrochanteric fractures and fracture recurrence. World J Clin Cases 2022; 10:7324-7332. [PMID: 36158017 PMCID: PMC9353902 DOI: 10.12998/wjcc.v10.i21.7324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/27/2022] [Accepted: 06/27/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Osteoporosis is a global disease affecting 6.6% of the total population. Osteoporosis complications include fractures, increased bone fragility, and reduced bone strength. The most commonly affected parts are the vertebral body, hip, and wrist.
AIM To examine the effect of alendronate sodium combined with InterTan for osteoporotic femoral intertrochanteric fractures on bone and fracture recurrence
METHODS In total, 126 cases of osteoporotic femoral intertrochanteric fractures were selected and divided into two groups according to the 1:1 principle by the simple random method. They were admitted to the Department of Orthopedics, First Affiliated Hospital of Xingtai Medical College, from January 2018 to September 2020. The control group was treated with InterTan fixation combined with placebo, and the observation group with alendronate sodium based on InterTan fixation. Operation-related indicators, complications, and recurrent fractures were compared between the groups. Changes in bone metabolism markers, t value for hip bone mineral density, and Harris Hip Score were observed.
RESULTS Operation time, intraoperative blood loss, postoperative ambulation time, and complications were compared between the groups, and no significant difference was found. The fracture healing time was significantly shorter in the observation group than in the control group. β-Collagen-specific sequence (β-CTX) and total aminoterminal propeptide of type I procollagen (T-PINP) in the control group at 3 mo after operation were compared with those before operation, and the difference was not significant. Six months after the operation, the β-CTX level decreased and T-PINP level increased. β-CTX level at 3 and 6 mo in the observation group after operation was lower, and T-PINP level was higher, than that before operation. Compared with the control group, T-PINP level of the observation group was significantly higher and β-CTX level was significantly lower at 3 and 6 mo after operation. The t value of hip bone mineral density was compared in the control group before and 1 mo after operation, and significant difference was not found. Compared with the control group, the t value of hip bone mineral density in the observation group was significantly higher at 1, 3, 6, and 12 mo after operation. Compared with the control group, the Harris score of the observation group was significantly higher at 1, 3, 6, and 12 mo after operation. The recurrence rate of fractures in the observation group within 12 mo was 0.00%, which was significantly lower than 6.35% in the control group.
CONCLUSION Alendronate sodium combined with InterTan in the treatment of osteoporotic femoral intertrochanteric fractures can increase bone mineral density, improve hip joint function, promote fracture healing, and reduce fracture recurrence.
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Affiliation(s)
- Ke-Meng Wang
- Department of Orthopedics, First Affiliated Hospital of Xingtai Medical College, Xingtai 054001, Hebei Province, China
| | - Shi-Ping Wei
- Department of Basic Medicine, Xingtai Medical College, Xingtai 054001, Hebei Province, China
| | - Xiao-Yan Yin
- Department of Basic Medicine, Xingtai Medical College, Xingtai 054001, Hebei Province, China
| | - Qing-Ju Meng
- Department of Orthopedics, First Affiliated Hospital of Xingtai Medical College, Xingtai 054001, Hebei Province, China
| | - Yu-Ming Kong
- Department of Orthopedics, The First Hospital of Xingtai, Xingtai 054001, Hebei Province, China
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Lu GL, Li SJ, Li WX. Biomechanical study of extramedullary and intramedullary fixation in the treatment of unstable intertrochanteric reversed-tilt fractures of the femur. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:191. [PMID: 35280356 PMCID: PMC8908151 DOI: 10.21037/atm-22-93] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 02/18/2022] [Indexed: 01/22/2023]
Abstract
Background To investigate the efficacy of the 135° hip screw, 95° intramedullary hip screw (IMHS) and 95° hip screw in the treatment of intertrochanteric reverse dip fracture of the femur. Methods We retrospectively analyzed 125 matched pairs of human femurs (median age 64 years) which were osteotomized at a 33° angle in the left femur and extended downward from the minor trochanter to simulate a reverse oblique intertrochanteric fracture. The right femur served as a control. The left femur (n=4) was implanted with a 135° hip screw, 95° hip screw, or IMHS. A strain detector was placed distal to the fracture site to monitor fragment strain. The lateral displacement of the proximal femur was measured by a linear variable differential transformer. An Instron tester measured stiffness, strain, and lateral displacement at 25° adduction, and 90° adduction with vertical loads on the femoral head. A 2 cm gap was then formed at the fracture site to simulate comminution and the mechanical test was repeated. Results Before the formation of the gap, there was no significant difference in stiffness among different bone structures (P>0.05), but after the formation of the gap, the stiffness of all the adduction structures decreased (P=0.03), and the difference in adduction was statistically significant (135° hip screw: 46.6%±3%; 95° hip screw: 22.9%±2%; IMHS: 53.7%±7.8%; P<0.05). Similar results were found for the abduction and buckling positions. There was no significant difference in the lateral displacement of the gap before (P=0.92) and after (P=0.26), but a significant difference in the failure load was found (135° hip screw: 1,222±560 N; 95° hip screw: 2,566±283 N; IMHS: 4,644±518 N; P=0.02). Conclusions There was no statistically significant difference in stiffness among different structures (P>0.05). However, in the presence of gaps, IMHS bone implant structures are much stiffer than 135° and 95° structures and have a greater destructive load.
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Affiliation(s)
- Guo-Liang Lu
- Department of Orthopedic Trauma, Foshan Hospital of TCM (The Eighth Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine), Foshan, China
| | - Song-Jun Li
- Department of Orthopedics, the Fifth Affiliated Hospital of Zunyi Medical University, Zhuhai, China
| | - Wen-Xue Li
- Department of Orthopedics, Dongying Hospital of Traditional Chinese Medicine, Dongying, China
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Lin X, Yang K, Tan H, Gan F, Jiang J. Comparison of the Curative Effects of Hip Arthroplasty with Bio-Type Femoral Stem and Cemented Femoral Stem in Elderly Patients with Unstable Osteoporotic Intertrochanteric Femur Fractures. J Med Biol Eng 2021. [DOI: 10.1007/s40846-021-00627-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Chen J, Yue C, He P, Huang Z, Li L, Zhang X, Fan Y, Liu Y. Comparison of clinical outcomes with hip replacement versus PFNA in the treatment of intertrochanteric fractures in the elderly: A systematic review and meta-analysis (PRISMA). Medicine (Baltimore) 2021; 100:e24166. [PMID: 33655910 PMCID: PMC7939162 DOI: 10.1097/md.0000000000024166] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 12/10/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The purpose of this meta-analysis was to evaluate the clinical efficacy and safety of HR and PFNA in the treatment of intertrochanteric fractures in the elderly. METHODS We carried out this review according to the principle of preferred reporting items for systematic reviews and meta-analyses (PRISMA) guideline. The clinical randomized controlled trials (RCTs), prospective cohort studies, retrospective cohort studies (RCSs), and case-control studies involving HR and PFNA in the treatment of intertrochanteric fractures in the elderly from 2000 to 2020 were compared by searching Web of Science, Pubmed, the Cochrane Library, and Embase. The quality of the included cohort study (CS) lines was evaluated using the Newcastle-Ottawa Scale (NOS). The quality of the included RCT lines was evaluated using Jadad. Forest plots were drawn by RevMan5.4 software based on the results and the data were analyzed. RESULTS After screening, a total of 9 articles were included, of which one was a clinical RCT and eight were RCSs with 1374 patients. The operative time of the PFNA group was shorter [WMD = 15.20; 95% CI (13.17, 17.23), P < .05] and the intraoperative blood loss was less [WMD = 178.81; 95% CI (97.24, 260.38), P < .05] than the HR group, while the first weight-bearing time of the HR group was shorter [WMD = -7.70; 95% CI (-10.54, -4.86), P < .05] than the PFNA group. There was no significant difference in the length of hospital stay, HHS, postoperative orthopedic complications, and postoperative medical complications between the 2 groups. CONCLUSION With the development of HR technology and minimally invasive technology, the trauma caused by surgery is decreasing. Under the premise of improving perioperative management, such as optimizing the preoperative preparation and postoperative management, shortening the operative time, reducing intraoperative blood loss, and actively managing co-existing diseases, HR has more advantages than PFNA in the treatment of senile intertrochanteric fractures.
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Affiliation(s)
- Junming Chen
- Key Laboratory of Orthopedics & Traumatology of Traditional Chinese Medicine and Rehabilitation (Fujian University of TCM), Ministry of Education, Fujian University of Traditional Chinese Medicine, Fuzhou
| | - Chen Yue
- Department of Orthopedic Surgery, Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Luoyang, China
| | - Peilin He
- Key Laboratory of Orthopedics & Traumatology of Traditional Chinese Medicine and Rehabilitation (Fujian University of TCM), Ministry of Education, Fujian University of Traditional Chinese Medicine, Fuzhou
| | - Zeling Huang
- Key Laboratory of Orthopedics & Traumatology of Traditional Chinese Medicine and Rehabilitation (Fujian University of TCM), Ministry of Education, Fujian University of Traditional Chinese Medicine, Fuzhou
| | - Li Li
- Key Laboratory of Orthopedics & Traumatology of Traditional Chinese Medicine and Rehabilitation (Fujian University of TCM), Ministry of Education, Fujian University of Traditional Chinese Medicine, Fuzhou
| | - Xue Zhang
- Department of Orthopedic Surgery, Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Luoyang, China
| | - Yanan Fan
- Department of Orthopedic Surgery, Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Luoyang, China
| | - Youwen Liu
- Department of Orthopedic Surgery, Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Luoyang, China
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Abstract
Subtrochanteric (ST) femur fractures are proximal femur fractures, which are often difficult to manage effectively because of their deforming anatomical forces. Operative management of ST fractures is the mainstay of treatment, with the two primary surgical implant options being intramedullary (IM) nails and extramedullary plates. Of these, IM nails have a biologic and biomechanical superiority, and have become the gold standard for ST femur fractures. The orthopaedic surgeon should become familiar and facile with several reduction techniques to create anatomical alignment in all unique ST fracture patterns. This article presents a comprehensive and current review of the epidemiology, anatomy, biomechanics, clinical presentation, diagnosis, and management of subtrochanteric femur fractures.
Cite this article: EFORT Open Rev 2021;6:145-151. DOI: 10.1302/2058-5241.6.200048
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Affiliation(s)
- Ian Garrison
- Department of Orthopaedic Surgery, University of South Alabama, College of Medicine, Alabama, USA
| | - Grayson Domingue
- Department of Orthopaedic Surgery, University of South Alabama, College of Medicine, Alabama, USA
| | - M Wesley Honeycutt
- Department of Orthopaedic Surgery, University of South Alabama, College of Medicine, Alabama, USA
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