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Kund ASR, Boddana GK, Patnala C, Yalamanchili R. Parameters Governing the Fate of Fracture Fixation With Proximal Femoral Nailing (PFN) for Intertrochanteric Femur Fractures. Cureus 2023; 15:e40952. [PMID: 37503460 PMCID: PMC10368960 DOI: 10.7759/cureus.40952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2023] [Indexed: 07/29/2023] Open
Abstract
INTRODUCTION A high mortality rate is associated with hip fractures in the elderly. This is because their bones are osteoporotic with implants having less hold and there are more co-morbidities associated with the elderly. Osteosynthesis with the proximal femoral nail (PFN) features the advantages of high rotational stability of the head-neck fragment. However, the use of the nail is technically ambitious and is accompanied by some risks of error, which can lead to failure. This study aims to understand the technical difficulties related to PFN and methods to mitigate them and radiological indicators for successful outcomes of PFN. METHODS Our study aims to analyze the radiological parameters as indicators for the successful outcome of intertrochanteric fractures fixed using PFN and also the factors responsible for intraoperative conversion to dynamic hip screw (DHS). This is a prospective, observational study conducted from January 2020 to December 2020, on all the patients with intertrochanteric fractures who were planned to be treated by PFN and consented to be part of the study group at our institute. This study includes 99 cases of intertrochanteric fractures classified according to AO (Arbeitsgemeinschaft für Osteosynthesefragen)/Association of the Study of Internal Fixation (ASIF) and Evan's classification systems and followed postoperatively at regular intervals up to one year. Different methods of fracture reduction, intraoperative radiological parameters, and postoperative radiological parameters dictating the fate of PFN along with factors responsible for the intraoperative conversion to DHS were analyzed and discussed. RESULTS Out of 99 patients planned for PFN, four were converted to DHS intraoperatively and 15 patients expired within the follow-up period of one year, leaving only 80 patients in the study group. Of them, seven patients (11.4%) had implant-related complications. According to Chang's reduction quality criteria (CRQC), two cases have CRQC 1 (poor reduction), 11 cases have CRQC 2 (acceptable reduction), 39 cases have CRQC 3 (acceptable reduction), and 28 cases have CRQC 4 (excellent reduction). CONCLUSIONS Though PFN is technically challenging, with proper guidelines and technique, it gives excellent results. Most importantly, a nonvarus reduction, proper nail insertion and accurate placement of lag screws are the crucial factors for a successful outcome. Biomechanically stable reduction, by closed, percutaneous, or open means, is the key to treating unstable intertrochanteric fracture successfully.
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Affiliation(s)
| | - Gopi Krishna Boddana
- Department of Orthopaedics, Nizam's Institute of Medical Sciences, Hyderabad, IND
| | | | - Ranjith Yalamanchili
- Department of Orthopaedics, All India Institute of Medical Sciences, Bibinagar, Hyderabad, IND
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Kyriakopoulos G, Panagopoulos A, Pasiou E, Kourkoulis SK, Diamantakos I, Anastopoulos G, Tserpes K, Tatani I, Lakoumentas J, Megas P. Optimizing fixation methods for stable and unstable intertrochanteric hip fractures treated with sliding hip screw or cephalomedullary nailing: A comparative biomechanical and finite element analysis study. Injury 2022; 53:4072-4085. [PMID: 36272844 DOI: 10.1016/j.injury.2022.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/19/2022] [Accepted: 10/05/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Despite recent advances in implants and surgical techniques, catastrophic and clinical failures in the treatment of intertrochanteric fractures continue to occur, with dire consequences in an overall frail population subset. The aim of the current study is to evaluate the effect of the factors under the surgeons' control, namely fracture reduction and implant selection, on the biomechanical behavior of fracture fixation constructs. MATERIAL-METHODS An experimental protocol was conducted with the use of instrumented sawbones, in order to validate the finite element models. The implants used were the Gamma3®and DHS systems. Subsequently, a series of scenaria were considered, including various reduction and implant angle combinations. Data were retrieved concerning the peak cancellous bone stresses around the hip screw and the volume of cancellous bone in the femoral head stressed at critical levels, as well as implant stresses and stresses on the cortical bone of the distal fragment. RESULTS All stable fracture models displayed significantly decreased cancellous bone stresses and implant stresses compared to their unstable counterparts, regardless of implant used. The effect of increasing implant angle led to a decrease in implant stresses in all models studied, but had a beneficial effect on the stresses in the cancellous bone of the proximal fragment only in the subgroups of stable fractures with both implants and unstable fractures treated with a cephalomedullary nail (CMN). In unstable fractures anatomically reduced, the use of CMN led to significantly lower peak stresses in the cancellous bone and a smaller volume of bone stressed at critical levels. Increasing the reduction angle by 5 ° led to a significant decrease in both peak stresses and volume of bone stressed at critical levels, more prominent in the sliding hip screw (SHS) models. Decreasing the reduction angle into varus by 5 or 10 ° led to a significant increase in bone and implant stresses regardless of implant used. CONCLUSIONS In stable two-part (AO31.A2) fractures the use of the SHS appears to be biomechanically equivalent to CMN. In unstable, anatomically reduced fractures, the use of CMN leads to significantly reduced cancellous bone stresses and decreased rotation of the proximal fragment during loading. A reduction in varus should be avoided at all costs. In unstable fractures treated with SHS a reduction in slight valgus appears to be biomechanically beneficial. The highest implant angle that allows for proper screw position and trajectory in the femoral head should be used for stable fractures with both implants and unstable fractures treated with Gamma3®.
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Affiliation(s)
- G Kyriakopoulos
- Department of Orthopaedics, "Georgios Gennimatas" General Hospital, Athens, Greece.
| | - A Panagopoulos
- Department of Adult Reconstruction, Orthopaedic Clinic, Patras University Hospital, Patras, Greece
| | - E Pasiou
- Laboratory of Biomechanics and Biomedical Physics, Department of Mechanics, School of Applied Mathematical and Physical Sciences, NTUA, Greece
| | - S K Kourkoulis
- Laboratory of Biomechanics and Biomedical Physics, Department of Mechanics, School of Applied Mathematical and Physical Sciences, NTUA, Greece
| | - I Diamantakos
- Department of Mechanical Engineering, School of Engineering, University of the Peloponnese, Patras, Greece
| | - G Anastopoulos
- Department of Orthopaedics, "Georgios Gennimatas" General Hospital, Athens, Greece
| | - K Tserpes
- Laboratory of Technology and Strength of Materials, Department of Mechanical Engineering and Aeronautics, University of Patras, Patras, Greece
| | - I Tatani
- Department of Adult Reconstruction, Orthopaedic Clinic, Patras University Hospital, Patras, Greece
| | - J Lakoumentas
- Department of Medical Physics, School of Medicine, University of Patras, Greece
| | - P Megas
- Department of Adult Reconstruction, Orthopaedic Clinic, Patras University Hospital, Patras, Greece
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Baek SH, Baek S, Won H, Yoon JW, Jung CH, Kim SY. Does proximal femoral nail antirotation achieve better outcome than previous-generation proximal femoral nail? World J Orthop 2020; 11:483-491. [PMID: 33269214 PMCID: PMC7672801 DOI: 10.5312/wjo.v11.i11.483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/29/2020] [Accepted: 09/01/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There are few studies in the literature comparing the clinical outcomes and radiographic results of proximal femoral nail (PFN) and proximal femoral nail antirotation (PFNA) for pertrochanteric femoral fracture (PFF) in elderly patients.
AIM To evaluate both clinical and radiographic outcomes after fixation with PFN and PFNA in an elderly patient population.
METHODS One hundred fifty-eight patients older than 65 years with PFF who underwent fixation with either PFN or PFNA were included. Seventy-three patients underwent fixation with PFN, whereas 85 were fixed with PFNA. The mean follow-up was 2.4 years (range, 1-7 years). Clinical outcome was measured in terms of operation time, postoperative function at each follow-up visit, and mortality within one year. Radiographic evaluation included reduction quality after surgery, Cleveland Index, tip-apex distance (TAD), union rate, time to union, and sliding distance of the screw or blade. Complications including nonunion, screw cutout, infection, osteonecrosis of the femoral head, and implant breakage were also investigated.
RESULTS Postoperative function was more satisfactory in patients who underwent PFNA than in those who underwent PFN (P = 0.033). Radiologically, the sliding difference was greater in PFN than in PFNA patients (6.1 and 3.2 mm, respectively, P = 0.036). The rate of screw cutout was higher in the PFN group; eight for PFN (11.0%) and two for PFNA patients (2.4%, P = 0.027). There were no differences between the two groups in terms of operation time, mortality rate at one year after the operation, adequacy of reduction, Cleveland Index, TAD, union rate, time to union, nonunion, infection, osteonecrosis, or implant breakage.
CONCLUSION Elderly patients with PFF who underwent PFNA using a helical blade demonstrated better clinical and radiographic outcomes as measured by clinical score and sliding distance compared with patients who underwent PFN.
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Affiliation(s)
- Seung-Hoon Baek
- Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu 41944, South Korea
- Department of Orthopedic Surgery, School of Medicine, Kyungpook National University, Daegu 41944, South Korea
| | - Seunggil Baek
- Department of Orthopedic Surgery, Goodssen Hospital, Daegu 42010, South Korea
| | - Heejae Won
- Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu 41944, South Korea
| | - Jee-Wook Yoon
- Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu 41944, South Korea
| | - Chul-Hee Jung
- Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu 41944, South Korea
| | - Shin-Yoon Kim
- Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu 41944, South Korea
- Department of Orthopedic Surgery, School of Medicine, Kyungpook National University, Daegu 41944, South Korea
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Jha V, Ahmed T. Modified Short Proximal Femoral Nail for Intertrochanteric Fractures of Femur in Indian Patients - our Experience. Malays Orthop J 2020; 14:72-82. [PMID: 32983380 PMCID: PMC7513656 DOI: 10.5704/moj.2007.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction Proximal femoral nail (PFN) is a commonly used implant for intertrochanteric fractures which is designed according to western femoral measurements. However, anthropometry of proximal femur in Indian and in general, Asian, are smaller. So a modified short PFN with smaller dimensions was developed. This study analyses the radiological and functional outcome of treatment of intertrochanteric fractures with modified short PFN. Materials and Methods A retrospective study analysed 120 adult patients operated between 2014-2017 using modified short PFN for intertrochanteric fractures, having a minimum follow-up of 12 months. Clinical and radiological parameters including tip-apex distance (TAD), position of tip of lag screw in femoral head, lateral slide of lag screw as well as length of anti-rotation screw were measured. Final functional outcome was assessed using Barthel's index and Kyle's criteria. Results Good reduction was achieved in 90.83% cases and 79.16% had ideal placement of lag screw in femoral head. Intra-operative difficulties were encountered in 13.33% (n=16). Mean TAD AP (anteroposterior) was 11.8mm, TAD LAT (lateral) was 11.0mm and mean TAD TOT was 22.8mm. Overall mean lateral slide was 3.20mm and it was more in unstable fracture. We had five mechanical failures, one patient with screw breakage without loss of reduction and two peri-implant fractures after union. 81.66% returned to pre-injury levels of activity with 88.33% good to excellent outcome as per Kyle's criteria. Conclusion Although, not devoid of complications, modified short PFN results in good functional recovery of patients with intertrochanteric fractures of femur.
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Affiliation(s)
- V Jha
- Department of Orthopaedics, Maharishi Markandeshwar Medical College and Hospital, Solan, India
| | - T Ahmed
- Department of Orthopaedics, Apollo Gleneagles Hospital, Kolkata, India
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Jia Z, Wang S, Xiao T, Jiang W, Zhou T, Liu Q, Li G, Hu X. The design of an "H" joystick for closed reduction and its application in segmental and comminuted femoral shaft fractures: an innovative technique. J Orthop Surg Res 2020; 15:357. [PMID: 32847603 PMCID: PMC7449011 DOI: 10.1186/s13018-020-01898-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 08/17/2020] [Indexed: 11/28/2022] Open
Abstract
Background Closed reduction and locked intramedullary nailing has become a common surgical method in the treatment of femoral shaft fractures. Overlap and rotation displacements can usually be corrected through the use of an orthopedic traction table. However, lateral displacement and angulation persist. Methods In this paper, we describe a joystick that can be used in the closed reduction of a fracture. It can correct lateral displacement and angulation, and has the advantage of multi-direction reduction. The device described in this paper includes two parallel horizontal joysticks, one vertical main joystick and four assistant rods. Moreover, there are many specific spacing holes in the two parallel horizontal joysticks and a groove structure in the vertical main joystick. When the main “H” joystick is pressed, it can adjust lateral displacements and angulation because of the lever principle. The distance between parallel horizontal joysticks and assistant rods can be adjusted to the fracture position and body mass index of different patients. Results The study participants consisted of 11 males and 5 females with a mean age of 31.0 years. All participants had good closed reduction and achieved bony union without any complications such as infection, nerve injury, non-union, malunion, and limb length discrepancy. By using an “H” joystick, closed femoral shaft fracture reduction and locked intramedullary nailing becomes simpler and faster. Conclusion Based on the use of this instrument, we can easily and conveniently obtain the correct reduction situation, which leads to better surgical results. This device can be applied in the reduction of clinical femoral fractures and gradually extended to the reduction of other fractures.
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Affiliation(s)
- Zhaofeng Jia
- Department of Osteoarthropathy, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University and the First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, 518035, Guangdong Province, China
| | - Shijin Wang
- Department of Orthopaedics, Taian City Central Hospital, Taian City, 271000, Shan dong Province, China
| | - Tinghui Xiao
- Department of Osteoarthropathy, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University and the First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, 518035, Guangdong Province, China
| | - Wei Jiang
- Department of Osteoarthropathy, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University and the First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, 518035, Guangdong Province, China
| | - Tianjian Zhou
- Department of Osteoarthropathy, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University and the First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, 518035, Guangdong Province, China
| | - Qisong Liu
- Department of Osteoarthropathy, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University and the First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, 518035, Guangdong Province, China.,Institute for Regenerative Medicine, Texas A&M Health Science Center College of Medicine, Temple, TX, 76502, USA
| | - Guangheng Li
- Department of Osteoarthropathy, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University and the First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, 518035, Guangdong Province, China
| | - Xinjia Hu
- Department of Osteoarthropathy, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University and the First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, 518035, Guangdong Province, China.
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Siddiqui YS, Khan AQ, Asif N, A Sherwani MK. Modes of failure of proximal femoral nail (PFN) in unstable trochanteric fractures. ACTA ACUST UNITED AC 2019. [DOI: 10.15406/mojor.2019.11.00460] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Mavrogenis AF, Igoumenou VG, Megaloikonomos PD, Panagopoulos GN, Galanopoulos IP, Vottis CT, Karamanis E, Koulouvaris P, Papagelopoulos PJ. Dual head screw hip nailing for trochanteric fractures. SICOT J 2017; 3:61. [PMID: 29043967 PMCID: PMC5646173 DOI: 10.1051/sicotj/2017049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 09/04/2017] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION There are limited information and inconclusive results for dual head screw intramedullary hip nails for trochanteric fractures. Therefore, we performed a prospective study to evaluate the healing of fractures, and survival, function, and complications of patients operated with this implant. METHODS We prospectively studied 79 patients (61 women and 18 men; mean age: 84.7 years; range: 65-96 years) with a low-energy trochanteric fracture, treated with a dual head screw intramedullary hip nail from 2013 to 2016. The mean follow-up was 2.1 years (range: 1-3 years); seven patients were lost to follow up. This left 72 patients for further analysis. We evaluated the healing of fractures, and survival, function, and complications of patients. RESULTS Fracture healing was evident in 70 patients (97.2%) at 2-3 months postoperatively. One patient experienced cut-out and z-effect phenomenon of the head screws. Another patient experienced a periprosthetic femoral diaphysis fracture at the distal tip of the nail. A third patient experienced an acute postoperative superficial skin infection that was treated successfully with wound dressing changes and a course of antibiotics. Sixteen patients (22.2%) deceased within 12 months postoperatively. In the remaining patients, the Harris Hip Score (HHS) at 12 months postoperatively was excellent in 16 (28.6%), good in 23 (41.1%), fair in 10 (17.8%), and poor in 7 patients (12.5%). The function declined after the patients' fracture. Fair and poor results were related to age > 85 years, poor pre-fracture level of function, and AO/OTA-31-A3 fracture types. CONCLUSION The dual head screw intramedullary hip nail is associated with high healing and low complication rates for intertrochanteric fractures. The function of the patients is good or excellent in most cases; however, it declines, especially for those patients with age > 85 years, poor pre-fracture level of function, and AO/OTA-31-A3 fracture types.
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Affiliation(s)
- Andreas F Mavrogenis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, 41 Ventouri Str., 15562 Athens, Greece
| | - Vasilios G Igoumenou
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, 41 Ventouri Str., 15562 Athens, Greece
| | - Panayiotis D Megaloikonomos
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, 41 Ventouri Str., 15562 Athens, Greece
| | - George N Panagopoulos
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, 41 Ventouri Str., 15562 Athens, Greece
| | - Ioannis P Galanopoulos
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, 41 Ventouri Str., 15562 Athens, Greece
| | - Christos Th Vottis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, 41 Ventouri Str., 15562 Athens, Greece
| | - Eirinaios Karamanis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, 41 Ventouri Str., 15562 Athens, Greece
| | - Panayiotis Koulouvaris
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, 41 Ventouri Str., 15562 Athens, Greece
| | - Panayiotis J Papagelopoulos
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, 41 Ventouri Str., 15562 Athens, Greece
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Jain MJ, Mavani KJ, Patel D. Role of Provisional Fixation of Fracture Fragments By Steinmann-Pin and Technical Tips in Proximal Femoral Nailing for Intertrochanteric Fracture. J Clin Diagn Res 2017; 11:RC01-RC05. [PMID: 28764254 DOI: 10.7860/jcdr/2017/25755.10117] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 04/07/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Proximal Femoral Nailing (PFN) in Intertrochanteric Fractures (IF) is becoming the choice of implant due to better biomechanics and prevention of varus collapse associated with Dynamic Hip Screw (DHS). Technical difficulties and implant related complications are yet to be addressed. AIM To understand the technical difficulties involved in PFN and role of provisional fixation of fracture by Steinmann-pin. MATERIALS AND METHODS In this study, 55 patients presented to a tertiary trauma center in India with trochanteric fractures from April 2010 to March 2012 were included and treated with PFN. All patients were followed-up for two years and final outcome assessment included shortening, neck shaft angle and Harris Hip Score was done. RESULTS In all except one, neck shaft angle greater than 130° was achieved and also maintained in the final follow up (Mean 131.1°). All fractures were united with mean shortening of 3.6 mm and average Harris Hip Score of 91 after two years. There were five complications which included one shortening, two varus collapses, one backed out screws and one reverse Z effect. CONCLUSION Though PFN is technically challenging, with proper technique, gives excellent results with negligible varus collapse even in unstable fractures. Three most important technical aspects are achieving good non-varus reduction, inserting nail correctly and accurate placement of lag screws. The technique of provisional fixation of fracture fragments by Steinmann-pin significantly helps in achieving these and reduces the risk of implant failure.
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Affiliation(s)
- Mohit J Jain
- Assistant Professor and Consultant Trauma Surgeon, Department of Orthopaedics, Pravara Institute of Medical Sciences, Loni, Maharashtra, India
| | - Kinjal J Mavani
- Senior Resident and Lecturer, Department of Orthodontics, Maratha Mandal Institute, Belgaum, Karnataka, India
| | - Dhaval Patel
- Clinical Fellow in Trauma, Kentucky, Louisville, U.S.A
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Sambandam SN, Chandrasekharan J, Mounasamy V, Mauffrey C. Intertrochanteric fractures: a review of fixation methods. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2016; 26:339-53. [PMID: 27028746 DOI: 10.1007/s00590-016-1757-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 02/25/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Senthil Nathan Sambandam
- Department of Orthopaedics, K.G. Hospital and Postgraduate Medical Institute, Arts College Road, Coimbatore, Tamil Nadu, 641018, India
| | - Jayadev Chandrasekharan
- Department of Orthopaedics, K.G. Hospital and Postgraduate Medical Institute, Arts College Road, Coimbatore, Tamil Nadu, 641018, India
| | - Varatharaj Mounasamy
- VCU Medical Center, Ambulatory Care Center, 417 North 11th Street, Richmond, VA, USA.
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Pandey KK, Maravi LS, Turkar R. Letter to the editor: Proximal femoral locking compression plate for proximal femoral fractures. J Orthop Surg (Hong Kong) 2015; 23:133-4. [PMID: 25920664 DOI: 10.1177/230949901502300134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Krishna Kumar Pandey
- NSCB Medical College Jabalpur, Rani Durgawati University, Jabalpur, Madhyapradesh, India
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López-Vega M, Gil-Monzó E, Rodrigo-Pérez J, López-Valenciano J, Salanova-Paris R, Peralta-Nieto J, Morales-Suárez M. Randomized prospective study on the influence distal block and Gamma 3 nail on the treatment of intertrochanteric fractures of femur. Rev Esp Cir Ortop Traumatol (Engl Ed) 2015. [DOI: 10.1016/j.recote.2014.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Kanthimathi B, Narayanan V. Early Complications in Proximal Femoral Nailing Done for Treatment of Subtrochanteric Fractures. Malays Orthop J 2014; 6:25-9. [PMID: 25279038 DOI: 10.5704/moj.1203.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
ABSTRACT AIM To analyse the early complications following the use of PFN in subtrochanteric fractures. BACKGROUND Osteosynthesis with PFN in subtrochanteric fracture features the advantages of high rotational stability of the head-neck fragment, an unreamed implantation technique and the possibility of static or dynamic distal locking. However, the use of the nail requires technical expertise and is accompanied by some risks of error which can lead to osteosynthesis failure. METHODS Between May 2009 and May 2011, 50 consecutive patients with PFN fixations for subtrochanteric fractures were observed for intraoperative and postoperative complications. RESULTS We identified intraoperative technical difficulties in four patients and six patients showed postoperative complications. CONCLUSION When subtrochanteric fractures are to be stabilised with a PFN, the precise and expert technical performance of implantation is the basic surgical requirement. Good reduction with minimal dissection and the use of an appropriate implant is necessary to avoid treatment failure. KEY WORDS Subtrochanteric fractures, trochanteric fractures, proximal femoral nail, PFN.
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Affiliation(s)
- B Kanthimathi
- Division Of Orthopaedics, Rajah Muthiah Medical College Annamalai University, Tamilnadu, India
| | - Vl Narayanan
- Division Of Orthopaedics, Rajah Muthiah Medical College Annamalai University, Tamilnadu, India
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[Randomized prospective study on the influence distal block and Gamma 3 nail on the treatment of intertrochanteric fractures of femur]. Rev Esp Cir Ortop Traumatol (Engl Ed) 2014; 59:26-35. [PMID: 25088240 DOI: 10.1016/j.recot.2014.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Revised: 06/16/2014] [Accepted: 06/18/2014] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE The purpose of this study is to assess the need to lock the Gamma 3 nail (Stryker, Mahwah New Jersey USA) distally for intertrochanteric fractures of femur 31-A1 and 31-A2 of the AO. MATERIAL AND METHODS Details were recorded on a sample of 177 patients with intertrochanteric femoral fractures treated in our hospital by a standard Gamma nail between June 2011 and January 2013. A prospective study was conducted by randomizing patients by year of birth, even numbers with, or odd number without, distal locking, forming two groups of 90 and 87 fractures, respectively. RESULTS The patients treated with a distal locking nail had an increased incidence of medical complications, a lower incidence of biomechanical complications, and an increase in the fracture collapse compared with the control group, with statistical significance (p < 0.05). It is also observed in the group with distal locking increased transfusion requirement and a higher death rate, with statistically significant differences (p < 0.05), but this significance disappears when adjusting for other patient-related characteristics. CONCLUSIONS Based on the results found in this work, the use of distal locking screw in the Gamma 3 nails should be restricted to unstable trochanteric fractures after reduction where additional stability to the intramedullary nail is required, and may decrease the risk of complications from use.
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Carneiro MB, Alves DPL, Mercadante MT. Physical therapy in the postoperative of proximal femur fracture in elderly. Literature review. ACTA ORTOPEDICA BRASILEIRA 2013; 21:175-8. [PMID: 24453665 PMCID: PMC3861999 DOI: 10.1590/s1413-78522013000300010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Accepted: 03/27/2012] [Indexed: 11/21/2022]
Abstract
The proximal femoral fracture in the elderly is a serious public health problem. Surgical treatment of this fracture is used to reduce morbidity, together with postoperative physical therapy. The objective was to conduct a systematic review of physical therapy protocols in postoperative for fractures of the proximal femur in elderly. We selected randomized controlled trials in elderly in the past 10 years, in Portuguese and English. There were 14 articles in the literature. Physical therapy has an important role in functional recovery of the elderly. Level of Evidence I, Systematic Review RCTs (Study results were homogenous).
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15
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The proximal femur nail antirotation: an identifiable improvement in the treatment of unstable pertrochanteric fractures? ACTA ACUST UNITED AC 2011; 71:169-74. [PMID: 21818023 DOI: 10.1097/ta.0b013e3182213c6e] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND The optimal surgical treatment of patients with an unstable extracapsular proximal femoral fracture is yet to be found. From the biomechanical point of view, the use of an intramedullary device in combination with a dynamic femoral head/neck stabilization implant seems an optimal technique. One of these intramedullary devices, the Proximal Femoral Nail (PFN), has several drawbacks in practice. The Proximal Femur Nail Antirotation (PFNA) has been designed to address these. We hypothesized that the placement of one femoral head/neck fixation device in the PFNA would improve positioning of the implant in the femoral head compared with the PFN and reduce the number of reoperations in both short and long term. METHODS We followed 157 consecutive patients with unstable trochanteric fractures (Arbeitsgemeinschaft für Osteosynthesefragen classification 31.A.2 and A.3) treated with a PFN or a PFNA for 1 year. The radiologic position of the implant was evaluated, and the postoperative local and systemic complications were registered. RESULTS The position of the femoral head/neck stabilization implant was "good" in 39 (44.8%) patients in the PFN group and 23 (32.9%) patients in the PFNA group; the position was "acceptable" in 30 (34.5%) versus 33 (47.1%) patients, and in 18 (20.7%) versus 14 (20%) patients, the position was "poor" (p = 0.277). Because of implant-related complications, three patients in the PFN group and four patients in the PFNA group needed an early reoperation (p = 0.136). A late reoperation because of implant-related complications was performed in 13 patients in the PFN group and in three in the PFNA group (p = 0.016). CONCLUSIONS This study shows that osteosynthesis with the PFNA does not improve the position of the implant in the femoral head compared with the PFN. However, the risk of a secondary complication and the necessity of a late reoperation are significantly higher in patients treated with a PFN compared with patients treated with a PFNA.
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Long proximal femoral nails versus short proximal femoral nails for the management of proximal femoral fractures: a retrospective study of 124 patients. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2010. [DOI: 10.1007/s00590-010-0683-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Makridis KG, Georgaklis V, Georgoussis M, Mandalos V, Kontogeorgakos V, Badras L. Comparing two intramedullary devices for treating trochanteric fractures: a prospective study. J Orthop Surg Res 2010; 5:9. [PMID: 20167058 PMCID: PMC2831869 DOI: 10.1186/1749-799x-5-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2009] [Accepted: 02/18/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intertrochanteric fractures are surgically treated by using different methods and implants. The optional type of surgical stabilization is still under debate. However, between devices with the same philosophy, different design characteristics may substantially influence fracture healing. This is a prospective study comparing the complication and final functional outcome of two intramedullary devices, the intramedullary hip screw (IMHS) and the ENDOVIS nail. MATERIALS AND METHODS Two hundred fifteen patients were randomized on admission in two treatment groups. Epidemiology features and functional status was similar between two treatment groups. Fracture stability was assessed according to the Evan's classification. One hundred ten patients were treated with IMHS and 105 with ENDOVIS nail. RESULTS There were no significant statistical differences between the two groups regarding blood loss, transfusion requirements and mortality rate. In contrast, the number of total complications was significantly higher in the ENDOVIS nail group. Moreover, the overall functional and walking competence was superior in the patients treated with the IMHS nail. CONCLUSIONS These results indicate that the choice of the proper implant plays probably an important role in the final outcome of surgical treatment of intertrochanteric fractures. IMHS nail allows for accurate surgical technique, for both static and dynamic compression and high rotational stability. IMHS nail proved more reliable in our study regarding nail insertion and overall uncomplicated outcome.
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Affiliation(s)
- Konstantinos G Makridis
- Orthopaedic Surgeon, Resident, Department of Orthopaedic Surgery, General Hospital of Volos, Polimeri 134, 38222 Greece.
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Medial migration of lag screw with intrapelvic dislocation in gamma nailing--a unique problem? A report of 2 cases. J Orthop Trauma 2010; 24:e6-e11. [PMID: 20101128 DOI: 10.1097/bot.0b013e3181a4eeb2] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Within the last decade, intramedullary nailing systems have gained popularity in the treatment of unstable fractures of the trochanteric region with good clinical results. However, these implants are not free of complications. Commonly reported treatment failures include implant cutout through the femoral neck, stress-derived femur fractures at the distal end of the nail, and secondary rotational displacement and varus deformity of the femoral neck and head. Only few reports exist on primary medial migration of the lag screw after treatment with intramedullary implants. We report on a rarely described complication in 2 patients who underwent osteosynthesis with a Gamma 3 nail (Stryker, Mahwah, NJ). Both patients presented with implant failures due to primary medial migration of the lag screw. Complete separation of the implant occurred, and the lag screw penetrated through the acetabulum into the pelvis. The patient's histories and course of treatment are reported. The literature on this topic is discussed.
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