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Liao CS, He FZ, Li XY, Han PF. Proximal femoral nail antirotation versus InterTan nail for the treatment of intertrochanteric fractures: A systematic review and meta-analysis. PLoS One 2024; 19:e0304654. [PMID: 38980889 PMCID: PMC11233004 DOI: 10.1371/journal.pone.0304654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 05/15/2024] [Indexed: 07/11/2024] Open
Abstract
PURPOSE This meta-analysis compared the efficacy and safety of Proximal Femoral Nail Antirotation (PFNA) and InterTan Nail in the treatment of intertrochanteric fractures. Given the high incidence of femoral intertrochanteric fractures in the elderly population and its impact on quality of life, choosing the most effective and safest surgical option is crucial. PFNA and InterTan are currently two commonly used techniques, but there is a lack of systematic evaluation comparing their safety and effectiveness. This study aims to fill this knowledge gap through Meta-analysis, providing clinicians with evidence-based treatment recommendations. MATERIALS AND METHODS A computer search was used to search for published literature on PFNA and InterTan in the treatment of intertrochanteric fractures in PubMed (Medline), Web of Science, Embase, Cochrane Library (CENTRAL), Cinahl, CBM, and CNKI.A total of 853 related literatures were retrieved, and 15 literatures were finally included. Newcastle-Ottawa-Scale and Cochrane systematic review methodologies were used to assess the quality of the literature. Meta-analysis was performed using Review Manager 5.4 software, following data extraction. RESULTS The comparison found that during the surgical treatment of intertrochanteric fractures, the operation time, fluoroscopy time, and blood loss in the PFNA group were significantly shorter than those in the InterTan group, and the difference was statistically significant. In terms of postoperative complication rates, the InterTan group had a significant advantage over the PFNA group. Shaft fracture, varus collapse, cut out, screw migration, and pain of hip and thigh were the most likely to occur in the PFNA group, and the differences were all statistically significant. In terms of postoperative efficacy, the results of the PFNA group and the InterTan group were comparable, and there was no significant differences. CONCLUSIONS When selecting surgical techniques for the treatment of femoral intertrochanteric fractures, it is necessary to conduct individualized assessments based on the patient's overall health status, surgical tolerance, and post-operative recovery needs. For patients who cannot tolerate long-term surgery or are in poor physical condition, PFNA may be more appropriate. While for patients who can tolerate long-term surgery or have more complex conditions, InterTan may be more suitable.
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Affiliation(s)
- Chang-sheng Liao
- Department of Orthopaedics, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, P.R. China
- Department of Graduate School, Graduate Student Department of Changzhi Medical College, Changzhi, P.R. China
| | - Fang-zheng He
- Department of Orthopaedics, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, P.R. China
- Department of Graduate School, Graduate Student Department of Changzhi Medical College, Changzhi, P.R. China
| | - Xi-yong Li
- Department of Orthopaedics, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, P.R. China
- Department of Graduate School, Graduate Student Department of Changzhi Medical College, Changzhi, P.R. China
| | - Peng-fei Han
- Department of Orthopaedics, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, P.R. China
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Long Y, Liu N, Huang X, Liang W, Liu J, Huang Z, Zhang Y, Wang W. Biomechanical evaluation of ortho-bridge system and proximal femoral nail antirotation in intertrochanteric fractures with lateral wall fracture based on finite element analysis. Front Bioeng Biotechnol 2024; 12:1368492. [PMID: 38974654 PMCID: PMC11224473 DOI: 10.3389/fbioe.2024.1368492] [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] [Received: 01/10/2024] [Accepted: 05/31/2024] [Indexed: 07/09/2024] Open
Abstract
Background The integrity of the lateral wall in femoral intertrochanteric fractures significantly impacts fracture stability and internal fixation. In this study, we compared the outcomes of treating intertrochanteric fractures with lateral wall involvement using the ortho-bridge system (OBS) combined with proximal femoral nail antirotation (PFNA) versus simple PFNA from a biomechanical perspective. Methods Finite-element models of femoral intertrochanteric fractures with lateral wall involvement were subjected to fixation with OBS combined with PFNA and simple PFNA. Von Mises stress measurements and corresponding displacement assessments for each component of the model, including the proximal femur and lateral wall, were used to evaluate the biomechanical effects of OBS fixation on bone and intramedullary nail stability. Results Using PFNA alone to fix intertrochanteric fractures with lateral wall involvement resulted in von Mises stress levels on the lateral wall exceeding safe stress tolerances for bone growth. OBS fixation significantly reduced stress on the lateral wall of the femur and minimized the stress on each part of the intramedullary nail, reducing the overall displacement. Conclusion In cases of intertrochanteric fractures with lateral wall involvement, PFNA fixation alone may compromise the biomechanical integrity of the lateral femoral wall, increasing the risk of postoperative complications. The addition of OBS to PFNA significantly reduces stress on the lateral femoral wall. Consequently, OBS should be considered for lateral wall fixation when managing intertrochanteric fractures combined with lateral wall fractures.
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Affiliation(s)
- Yuntao Long
- The First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology, Liuzhou, Guangxi Province, China
| | - Na Liu
- Tianjin Walkman Biomaterial Co., Ltd., Newton Laboratory, Tianjin, China
| | - Xiaomeng Huang
- The First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology, Liuzhou, Guangxi Province, China
| | - Weiming Liang
- The First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology, Liuzhou, Guangxi Province, China
| | - Jianke Liu
- Shandong First Medical University and Shandong Academy Medical Sciences, Jinan, Shandong, China
| | - Zhaozhao Huang
- Tianjin Walkman Biomaterial Co., Ltd., Newton Laboratory, Tianjin, China
| | - Yanhui Zhang
- Department of Orthopaedics, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, Shandong, China
| | - Wen Wang
- Department of Orthopaedics, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, Shandong, China
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Reed C, Huynh T, Schluns J, Phelps P, Hestekin J, Wolchok JC. Cell-Derived Extracellular Matrix Fiber Scaffolds Improve Recovery from Volumetric Muscle Loss. Tissue Eng Part A 2024; 30:181-191. [PMID: 37658842 DOI: 10.1089/ten.tea.2022.0227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023] Open
Abstract
There are currently no surgical procedures that effectively address the treatment of volumetric muscle loss (VML) injuries that has motivated the development of implantable scaffolding. In this study, the effectiveness of an allogenic scaffold fabricated using fibers built from the extracellular matrix (ECM) collected from muscle fibroblast cells during growth in culture was explored using a hindlimb VML injury (tibialis anterior muscle) in a rat model. Recovery outcomes (8 weeks) were explored in comparison with unrepaired controls as well previously examined allogenic scaffolds prepared from decellularized skeletal muscle (DSM) tissue (n = 9/sample group). At 8-week follow-up, we found that the repair of VML injuries using ECM fiber scaffolds in combination with an autogenic mince muscle (MM) paste significantly improved the recovery of peak contractile torque (79% ± 13% of uninjured contralateral muscle) when compared with unrepaired VML controls (57% ± 13%). Similar significant improvements were measured for muscle mass restoration (93% ± 10%) in response to ECM fiber+MM repair when compared with unrepaired VML controls (73% ± 13%). Of note, mass and contractile strength recovery outcomes for ECM fiber scaffolds were not significantly different from DSM+MM repair controls. These in vivo findings support the further exploration of cell-derived ECM fiber scaffolds as a promising strategy for the repair of VML injury with recovery outcomes that compare favorably with current tissue-sourced ECM scaffolds. Furthermore, although the therapeutic potential of ECM fibers as a treatment strategy for muscle injury was explored in this study, they could be adapted for high-throughput fabrication methods developed and routinely used by the textile industry to create a broad range of woven implants (e.g., hernia meshes) for even greater clinical impact.
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Affiliation(s)
- Cassandra Reed
- Department of Biomedical Engineering, College of Engineering, University of Arkansas, Fayetteville, Arkansas, USA
| | - Tai Huynh
- Department of Biomedical Engineering, College of Engineering, University of Arkansas, Fayetteville, Arkansas, USA
| | - Jacob Schluns
- Department of Biomedical Engineering, College of Engineering, University of Arkansas, Fayetteville, Arkansas, USA
| | - Payton Phelps
- Department of Biomedical Engineering, College of Engineering, University of Arkansas, Fayetteville, Arkansas, USA
| | - Jamie Hestekin
- Department of Chemical Engineering, College of Engineering, University of Arkansas, Fayetteville, Arkansas, USA
| | - Jeffrey C Wolchok
- Department of Biomedical Engineering, College of Engineering, University of Arkansas, Fayetteville, Arkansas, USA
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Rincón-Hoyos JA, Gómez-Ramírez JF, Cuesta-Montoya JS, Lara-Garavito AM, Muñoz-Medina SE, Castro-Dangond AJ. Treatment of intertrochanteric fractures using cephalomedullary nail: One or two cephalic screws? Injury 2023; 54 Suppl 6:110625. [PMID: 38143146 DOI: 10.1016/j.injury.2023.02.008] [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: 11/11/2022] [Accepted: 02/03/2023] [Indexed: 12/26/2023]
Abstract
OBJECTIVES To determine the incidence of cut-out, cut-in, cut-through, Z-effect, and reverse Z-effect in two cephalomedullary nail (CMN) systems: one with single cephalic screw fixation and the other with dual-screw fixation using a lag screw and an anti-rotation screw. METHODS A retrospective study from a cohort of patients was conducted between January 2017 and August 2019 in patients with intertrochanteric fractures treated with osteosynthesis using CMN. RESULTS One hundred ninety-six patients with intertrochanteric fractures who met the inclusion criteria were recruited. The median age was 81 years [interquartile range (IQR) 12]. Seventy-six percent had fractures classified as Orthopaedic Trauma Association/Arbeitsgemeinschaft für Osteosynthesefragen (OTA/AO) 31A2. Twenty-one mechanical complications occurred, 8.7% (17) was cut-out with a single cephalic screw CMN and 2% (4) was Z-effect with a dual-screw CMN non-integrated. The median tip-apex distance (TAD) was 19.4 mm (IQR 10.8) in patients who experienced cut-out and 19 mm (IQR 10) in those who experienced Z-effect. The median time to cut-out occurrence was 39,5 days (IQR 47,5), while the median time to Z-effect was 90 days (IQR 86). CONCLUSIONS The incidence of osteosynthesis failure using CMN is more frequent in patients treated with a single cephalic screw CMN. LEVEL OF EVIDENCE Therapeutic, Level III.
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Affiliation(s)
- Jairo Alonso Rincón-Hoyos
- Hip and orthopedic trauma surgeon, Clínica Universitaria Colombia, Carrera 21 No. 127D-39, Bogotá, 110121 Colombia
| | | | | | | | | | - Alfredo José Castro-Dangond
- Orthopedic trauma surgeon, Fundación Universitaria Sanitas, Clínica Universitaria Colombia, Bogotá, Colombia
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Zhang C, Chen Z, Wang M, Chen H, Zhu L, Yang W, Ding Z, Huang G. Is Sliding Compression Necessary for Intramedullary Nailing Fixation of AO/OTA Type A3.3 Intertrochanteric Fracture? Orthop Surg 2023; 15:2805-2813. [PMID: 37767609 PMCID: PMC10622258 DOI: 10.1111/os.13875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 08/02/2023] [Accepted: 08/07/2023] [Indexed: 09/29/2023] Open
Abstract
OBJECTIVES The intramedullary nail is considered the gold standard for treating AO/OTA type A3.3 intertrochanteric fractures. However, it still faces a significant rate of failure, mainly due to the critical factor of comminuted lateral wall defects leading to inadequate proximal sliding compression. The primary objective of this study is to investigate the requirement of sliding compression in the treatment of unstable AO/OTA type A3.3 intertrochanteric fractures. To achieve this, we conduct a comparative analysis between two approaches: InterTAN alone and proximal femoral anti-rotation blade nailing (PFNA) combined with lateral wall reconstruction for treating AO/OTA type A3.3 intertrochanteric fractures with lateral wall damage. METHODS A retrospective analysis was conducted on the clinical data of patients who underwent intramedullary nailing fixation for AO/OTA type A3.3 intertrochanteric fractures at our hospital from January 2012 to January 2022. Patient characteristics as well as treatment details, including operative time, intraoperative blood loss, weight-bearing time, fracture healing time, tip apex distance (TAD) loss, Harris hip scores (HHS), Parker-Palmer mobility score (PPMS), and postoperative complications, were collected and analyzed. Continuous variables were analyzed using independent sample t-tests, while categorical variables were examined using the chi-square test. For group comparisons, variance analysis was applied, and pairwise comparisons were conducted using the LSD-t test. RESULTS These patients were divided into PFNA combined with lateral wall reconstruction group (sliding compression group) and InterTAN fixation group (static fixation group) based on surgical methods. The operation time, intraoperative bleeding loss, HHS at 12 months and PPMS at 12 months in the sliding compression group were significantly higher than those in the static fixation group, and time to weight-bearing and fracture healing time were significantly lower than those in the static fixation group (p < 0.05). There were no significant differences between two groups in terms of the TAD at 2 days, 2, and 12 months postoperatively, the incidence of complications (p > 0.05). At 6 months postoperatively, femoral neck length was shortened compared to 2 days postoperatively in both groups, and the sliding compression group had a significantly greater degree of femoral neck shortening than the static fixation group (p < 0.05). CONCLUSION The use of PFNA with lateral wall reconstruction for A3.3 intertrochanteric fractures demonstrated superior mobility, efficiency, and reduced internal fixation failure rates compared to InterTAN. These findings suggest that sliding compression may be required for intramedullary nailing treatment.
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Affiliation(s)
- Cong Zhang
- Department of OrthopedicsThe 909th Hospital, School of Medicine, Xiamen UniversityZhangzhouChina
- School of MedicineXiamen UniversityXiamenChina
| | - Zhangxin Chen
- Department of OrthopedicsThe 909th Hospital, School of Medicine, Xiamen UniversityZhangzhouChina
- School of MedicineXiamen UniversityXiamenChina
| | | | - Huiyu Chen
- School of MedicineXiamen UniversityXiamenChina
| | - Lingqi Zhu
- Department of OrthopedicsThe 909th Hospital, School of Medicine, Xiamen UniversityZhangzhouChina
| | - Wenqing Yang
- Department of OrthopedicsThe 909th Hospital, School of Medicine, Xiamen UniversityZhangzhouChina
| | - Zhenqi Ding
- Department of OrthopedicsThe 909th Hospital, School of Medicine, Xiamen UniversityZhangzhouChina
- School of MedicineXiamen UniversityXiamenChina
| | - Guofeng Huang
- Department of OrthopedicsThe 909th Hospital, School of Medicine, Xiamen UniversityZhangzhouChina
- School of MedicineXiamen UniversityXiamenChina
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Yang F, Li X, Zhao L, Yang Q. Dual-screw versus single-screw cephalomedullary nails for intertrochanteric femoral fractures: a systematic review and meta-analysis. J Orthop Surg Res 2023; 18:607. [PMID: 37599361 PMCID: PMC10440877 DOI: 10.1186/s13018-023-04103-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 08/15/2023] [Indexed: 08/22/2023] Open
Abstract
BACKGROUND Internal fixation with cephalomedullary nails has been widely used in the treatment of intertrochanteric femoral fractures (IFF). Yet, the difference in efficacy and safety between the commonly used integrated dual-screw cephalomedullary nail (InterTAN) and single-screw cephalomedullary nail remains inconclusive. Thus we performed the present systematic review and meta-analysis. METHODS Randomized controlled trials (RCTs) or observational studies comparing InterTAN with proximal femoral nail anti-rotation (PFNA), the Asian PFNA (PFNA-II), or the Gamma3 nail in treating IFF were searched on PubMed, EMBASE, Web of Science and Cochrane Library from inception to April 30, 2023. The differences in perioperative parameters and clinical and radiological outcomes were evaluated by mean difference (MD) with 95% confidence interval (95%CI). The risks of various complications and mortality were assessed by risk ratio (RR) with 95%CI. RESULTS Twenty-three studies comprising 3566 patients were included. Compared with single-screw cephalomedullary nails (PFNA/PFNA-II, Gamma3), InterTAN conferred significantly reduced risk of implant failures (RR = 0.37, 95%CI 0.26 to 0.51, P < 0.001), hip and thigh pain (RR = 0.70, 95%CI 0.55 to 0.90, P = 0.006) and all-cause revision/reoperation (RR = 0.38, 95%CI 0.26 to 0.57, P < 0.001). Moreover, patients treated with InterTAN had significantly higher 1-year Harris Hip Score (MD = 0.82, 95%CI 0.20-1.44, P = 0.010) and shorter time to union/healing (MD = - 0.66 days, 95%CI - 1.16 to - 0.16, P = 0.009). Femoral neck shortening, time to full bearing, and incidences of non-union, infection, deep venous thrombosis, and mortality were comparable between both groups. CONCLUSIONS The integrated dual-screw InterTAN construct has superior performance in reducing risks of complications and improving clinical and functional outcomes in the treatment of IFF. More well-designed, high-quality RCTs are warranted to confirm these findings.
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Affiliation(s)
- Fan Yang
- Department of Traumatic Orthopedics, Yuncheng Central Hospital, Shanxi Medical University, No. 3690, Hedong East Street, Yanhu District, Yuncheng City, 044000, Shanxi Province, China.
| | - Xiafei Li
- Department of Traumatic Orthopedics, Yuncheng Central Hospital, Shanxi Medical University, No. 3690, Hedong East Street, Yanhu District, Yuncheng City, 044000, Shanxi Province, China
| | - Lei Zhao
- Department of Traumatic Orthopedics, Yuncheng Central Hospital, Shanxi Medical University, No. 3690, Hedong East Street, Yanhu District, Yuncheng City, 044000, Shanxi Province, China
| | - Qi Yang
- Department of Traumatic Orthopedics, Yuncheng Central Hospital, Shanxi Medical University, No. 3690, Hedong East Street, Yanhu District, Yuncheng City, 044000, Shanxi Province, China
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Intertrochanteric Femoral Fractures: A Comparison of Clinical and Radiographic Results with the Proximal Femoral Intramedullary Nail (PROFIN), the Anti-Rotation Proximal Femoral Nail (A-PFN), and the InterTAN Nail. Medicina (B Aires) 2023; 59:medicina59030559. [PMID: 36984560 PMCID: PMC10054110 DOI: 10.3390/medicina59030559] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 03/04/2023] [Accepted: 03/09/2023] [Indexed: 03/14/2023] Open
Abstract
Background and Objectives: The aim of this study was to evaluate retrospectively the radiological and functional outcomes of closed reduction and internal fixation for intertrochanteric femoral fractures (IFF) using three different proximal femoral nails (PFN). Materials and Methods: In total, 309 individuals (143 males and 166 females) who underwent surgery for IFF using a PFN between January 2018 and January 2021 were included in the study. Our surgical team conducted osteosynthesis using the A-PFN® (TST, Istanbul, Turkey) nail, the PROFIN® (TST, Istanbul, Turkey), and the Trigen InterTAN (Smith & Nephew, Memphis, TN, USA) nail. The PFNs were compared based on age, gender, body mass index (BMI), length of stay (LOS) in intensive care, whether to be admitted to intensive care, mortality in the first year, amount of transfusion, preoperative time to surgery, hospitalisation time, duration of surgery and fluoroscopy, fracture type and reduction quality, complication ratio, and clinical and radiological outcomes. The patients’ function was measured with the Harris Hip Score (HHS) and the Katz Index of Independence in Activities of Daily Living (ADL). Results: Pain in the hip and thigh is the most common complication, followed by the V-effect. The Z-effect was seen in 5.7% of PROFIN patients. A-PFN was shown to have longer surgical and fluoroscopy durations, lower HHS values, and much lower Katz ADL Index values compared to the other two PFNs. The V-effect occurrence was significantly higher in the A-PFN group (36.7%) than in the InterTAN group. The V-effect was seen in 33.1% of 31A2-type fractures but in none of the 31A3-type fractures. Conclusions: InterTAN nails are the best choice for IFFs because they have high clinical scores after surgery, there is no chance of Z-effect, and the rate of V-effect is low.
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Wang W, Ni B, Shen H, Lu H. Meta-analysis of InterTan, PFNA and PFNA-II internal fixation for the treatment of unstable intertrochanteric fractures in elderly individuals. Acta Orthop Belg 2023; 89:51-58. [PMID: 37294985 DOI: 10.52628/89.1.9923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Elderly individuals are often affected by osteoporosis and have poor stability after fracture reduction. Moreover, there is still controversy regarding the clinical effects of the treatment for unstable intertrochanteric fractures in the elderly. The Cochrane, Embase, PubMed, and other databases were searched, and a meta-analysis of the literature on the treatment of unstable intertrochanteric fractures of the elderly with InterTan, PFNA, and PFNA-II was conducted. Seven studies were screened, with a total of 1236 patients. Our meta-analysis results show that InterTan is not significantly different from PFNA in terms of operation and fluoroscopy times, but it takes longer than PFNA-II. In terms of postoperative screw cut, pain, femoral shaft fracture, and secondary operations, InterTan is superior to PFNA and PFNA-II. Conversely, in terms of intraoperative blood loss, hospital stay, and postoperative Harris score, there is no significant difference between InterTan and PFNA and PFNA-II. Compared to PFNA and PFNA-II, InterTan internal fixation has advantages in the treatment of unstable intertrochanteric fractures in elderly individuals in terms of screw cutting, femoral shaft fractures, and secondary operations. However, InterTan operation and fluoroscopy times take longer than PFNA and PFNA-II.
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Huang T, Zhang S, Liu X, Lv G, Huang H, Wang S, Zhao M, Xiong M, Yu W, Cheng Q, Huang T. Mid-Term Outcomes of Cemented or Uncemented Total Hip Arthroplasty for Failed Proximal Femoral Nail Antirotation Following Intertrochanteric Femur Fractures: A Retrospective Observational Study. Geriatr Orthop Surg Rehabil 2022; 13:21514593221132400. [PMID: 36238963 PMCID: PMC9551333 DOI: 10.1177/21514593221132400] [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] [Indexed: 11/16/2022] Open
Abstract
Introduction The aim of this retrospective study was to assess the clinical outcomes of cemented or uncemented total hip arthroplasty (CTHA or UTHA) following prior failed proximal femoral nail antirotation (PFNA) fixation in patients with intertrochanteric femur fractures (IFFs). Materials and methods Data from 244 patients with IFFs who experienced a conversion of PFNA to CTHA (n = 120) or to UTHA (n = 124) due to screw cut-out, mal/nonunion, or osteonecrosis during 2008-2018 were retrospectively analyzed. Follow-up occurred 1, 3, 6, and 12 months postoperatively and yearly thereafter. The primary outcome was the incidence of orthopedic complications; the secondary outcome was the Harris hip score (HHS). Results The median follow-up was 60 months (range, 50-67 months). The incidences of orthopedic complications were 10% in the PFNA to CTHA group and 19.3% in the PFNA to UTHA group (P = .040). Significant differences were also observed regarding the incidence of prosthesis revision (1.7% for PFNA to CTHA vs 7.2% for PFNA to UTHA, P = .036). From the three years after conversion surgery to the final follow-up, significant differences were detected in HHS between groups (each P < .05). At the final follow-up, a statistically significant difference was detected in the HHS (79.54±18.85 for PFNA to CTHA vs. 75.26±18.27 for PFNA to UTHA, P = .014). Conclusion The results of the study may demonstrate a significant statistical advantage with respect to the orthopedic complication rate and HHS in favor of CTHA compared to UTHA in patients with failed PFNA.
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Affiliation(s)
- Tao Huang
- Department of Orthopaedics, Wuhan
Third Hospital, Tongren
Hospital of Wuhan University, Wuhan,
China
| | - Shi Zhang
- Department of Anesthesiology,
Renmin
Hospital of Wuhan University, Wuhan,
China
| | - Xinhang Liu
- Department of Anesthesiology, East
Hospital, Renmin Hospital of Wuhan University, Wuhan, China
| | - Gang Lv
- Department of Anesthesiology,
Renmin
Hospital of Wuhan University, Wuhan,
China
| | - Heng Huang
- Department of Anesthesiology, Wuhan
Fourth Hospital, Puai Hospital, Tongji Medical College,
Huazhong
University of Science and Technology,
Wuhan, China
| | - Shuxin Wang
- Department of Orthopaedics, The
First Affiliated Hospital, Sun Yat-sen
University, Guangzhou, China
| | - Mingdong Zhao
- Department of Orthopaedics, Jinshan
Hospital, Fudan
University, Shanghai, China
| | - Min Xiong
- Department of Orthopaedics, Jinshan
Hospital, Fudan
University, Shanghai, China
| | - Weiguang Yu
- Department of Orthopaedics, The
First Affiliated Hospital, Sun Yat-sen
University, Guangzhou, China
| | - Qiuxia Cheng
- Department of Obstetrics,
Renmin
Hospital of Wuhan University, Wuhan,
China,Qiuxia Cheng, Department of Obstetrics,
Renmin Hospital of Wuhan University, No. 238, Jiefang Road, Wuchang District,
Wuhan, Hubei, 430060, China.
| | - Ting Huang
- Department of Anesthesiology, East
Hospital, Renmin Hospital of Wuhan University, Wuhan, China,Ting Huang, Department of
Anesthesiology, Renmin Hospital of Wuhan University, No. 238, Jiefang Road,
Wuchang District, Wuhan, Hubei, 430060, China.
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Treatment of Elderly Femoral Intertrochanteric Fracture by InterTan Intramedullary Nail and PFNA. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:5020960. [PMID: 35958926 PMCID: PMC9357690 DOI: 10.1155/2022/5020960] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 07/04/2022] [Indexed: 11/17/2022]
Abstract
To analyze the treatment of elderly femoral intertrochanteric fracture (EFIF) using InterTan intramedullary nail (InterTanIN) and proximal femoral nail antirotation (PFNA). A total of 75 patients suffering from EFIF receiving intramedullary fixation were retrospectively collected. According to intramedullary fixation methods, the patients were separated into InterTanIN group and PFNA group. Parameters including the surgery time, blood loss, number of X-ray fluoroscopy, hospital stays, bone-healing time, postoperative Harris hip score (HIS) (1 month, 3 months, 6 months, and 12 months), and complications were collected and analyzed. The results showed surgery time, blood loss, and number of X-ray fluoroscopy in InterTanIN group were higher than those in PFNA group (P < 0.05). The mean hospital stay in the InterTanIN group was comparable to that in the PFNA group (P > 0.05). There was no significant difference in bone-healing time between the InterTanIN group and PFNA group (P > 0.05). The postoperative HIS of InterTanIN group was statistically better than PFNA group at the 3rd month and the 6th month (P < 0.05). With the extension of recovery time, the gap between the two groups gradually narrowed. The postoperative implant displacement happened more often in the PFNA group than in the InterTanIN group. EFIF treated with InterTanIN or PFNA could achieve good long-term efficacy. Although InterTanIN has the disadvantages of increased operative time, blood loss, and radiation exposure compared to PFNA, the postoperative hip function recovery of InterTanIN seems to be more reliable and stable than PFNA.
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Onggo JR, Nambiar M, Onggo JD, Ambikaipalan A, Singh PJ, Babazadeh S. Integrated dual lag screws versus single lag screw cephalomedullary nail constructs: a meta-analysis and systematic review. Hip Int 2022; 32:550-557. [PMID: 33566701 DOI: 10.1177/1120700020985067] [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] [Indexed: 02/04/2023]
Abstract
BACKGROUND/AIM This study aims to determine the safety and efficacy of integrated dual lag screw (IDL) cephalomedullary nails (CMN) when compared with single lag screw (SL) constructs, in the internal fixation of intertrochanteric femoral fractures. METHODS The Smith & Nephew InterTan IDL was compared with SL CMN group consisting of the Stryker Gamma-3 (G3) and Synthes Proximal Femoral Nail Antirotation (PFNA) CMN. A multi-database search was performed according to PRISMA guidelines. Data from studies assessing the clinical and radiological outcomes, complications and perioperative parameters of InterTan versus G3 or PFNA CMN in patients with intertrochanteric femoral fractures were extracted and analysed. RESULTS 15 studies were included in this meta-analysis, consisting of 2643 patients. InterTan was associated with lower complication rates in terms of all-cause revisions (OR 0.34; 95% CI, 0.22-0.51; p < 0.001), cut-outs (OR 0.30; 95% CI, 0.17-0.51; p < 0.001), medial or lateral screw migration (OR 0.19; 95% CI, 0.06-0.65; p = 0.008) as well as persistent hip and thigh pain (OR 0.65; 95% CI, 0.47-0.90; p = 0.008). In terms of perioperative parameters, InterTan is associated with longer operative times (MD 5.57 minutes; 95% CI, 0.37-10.78 minutes, p = 0.04) and fluoroscopy times (MD 38.89 seconds, 95% CI, 15.88-61.91 seconds; p < 0.001). There was no statistically significant difference in terms of clinical Harris Hip Score and radiological outcomes, non-union, haematoma, femoral fractures, varus collapse, length of stay and mean intraoperative blood loss between the 2 groups. CONCLUSIONS Integrated dual lag screw cephalomedullary nails are associated with fewer revisions and complications. However, there is insufficient data to suggest that either nail construct is associated with better functional outcomes.
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Affiliation(s)
- James R Onggo
- Department of Orthopaedic Surgery, Maroondah Hospital, Victoria, Australia
| | - Mithun Nambiar
- Department of Orthopaedic Surgery, Maroondah Hospital, Victoria, Australia
| | - Jason D Onggo
- Department of Orthopaedic Surgery, Maroondah Hospital, Victoria, Australia
| | | | - Parminder J Singh
- Department of Orthopaedic Surgery, Maroondah Hospital, Victoria, Australia
| | - Sina Babazadeh
- Department of Orthopaedic Surgery, Maroondah Hospital, Victoria, Australia
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Stabilisation of AO OTA 31-A unstable proximal femoral fractures: Does the choice of intramedullary nail affect the incidence of post-operative complications? A systematic literature review and meta-analysis. Injury 2022; 53:827-840. [PMID: 35151468 DOI: 10.1016/j.injury.2022.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine if there was a difference in the risk of post-operative complications associated with the use of different intramedullary (IM) devices in the treatment of unstable AO OTA 31-A trochanteric fractures. DESIGN Systematic literature review and meta-analysis. METHODS A systematic literature review was carried out in January 2022 in the Embase, MEDLINE and Cochrane databases. Studies comparing INTERTAN™ to other intramedullary nails for the treatment of AO OTA 31-A trochanteric fractures were selected for inclusion. After data extraction, meta-analyses were carried out on postoperative outcomes, with specific focus placed on unstable fracture patterns. RESULTS Twenty-three studies were suitable for inclusion, of which seventeen reported on outcomes in unstable fractures. INTERTAN reduced the risk of revision/reoperation by 64% (RR 0.36, 95% CI 0.25 to 0.54, p <0.0001), implant failures by 62% (RR 0.38, 95% CI 0.25 to 0.57, p<0.0001) and hip and thigh pain by 50% (RR 0.50, 95% CI 0.35 to 0.71, p=0.0001) in unstable fractures. No differences were noted between IM nail designs for infection rates, healing time, non-union rates, femoral shortening, or Harris Hip Score. CONCLUSIONS The INTERTAN IM nail may reduce incidence of implant-related complications, hip and thigh pain, and the need for revision/reoperation without compromising clinical and functional outcomes.
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van der Sijp MPL, de Groot M, Meylaerts SA, du Pré KJ, Verhage SM, Schipper IB, Niggebrugge AHP. High risks of failure observed for A1 trochanteric femoral fractures treated with a DHS compared to the PFNA in a prospective observational cohort study. Arch Orthop Trauma Surg 2022; 142:1459-1467. [PMID: 33635400 PMCID: PMC9217838 DOI: 10.1007/s00402-021-03824-0] [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: 12/13/2020] [Accepted: 02/07/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Both the DHS and the PFNA are common and well-studied treatment options for stable trochanteric fractures. The aim of the current study was to compare the implant failure rates of these two implants in 31A1 type trochanteric femoral fractures. MATERIALS AND METHODS A single-centre observational cohort study was conducted in the Hip Fracture Unit of a multicentre level 1 trauma teaching hospital between December 2016 and October 2018. Patients with an AO/OTA type 31A1 fracture were included. Pathological fractures, bilateral fractures, high-energy traumas and patients younger than 18 years of age were excluded. Surgery was performed using either a DHS or PFNA. Both were used routinely for stable trochanteric fractures, and allocation was decided by the surgeon performing the operation. The primary outcome of this study was the implant failure rate in the first postoperative year. Secondary outcomes included the reoperation rate, functional recovery, pain and morphine use. RESULTS Data were available from 126 patients treated with a DHS (n = 32, 25.4%) or PFNA (n = 95, 74.6%). Minor differences were observed in the patient characteristics including the prevalence of cognitive impairment (18.8% vs 40.2%; P = 0.028), prefracture independence in activities of daily living (87.1% vs 67.4%; P = 0.034) and prefracture mobility (independently without aides: 61.3% vs 40.4%; P = 0.033). Fractures treated with a DHS showed 25% implant failures, compared to 1.1% for fractures treated with a PFNA (P = 0.004). No differences were observed in any of the secondary outcomes. CONCLUSIONS Significantly more implant failures were observed for the DHS compared the PFNA within 1 year after surgery. Despite the fact that this did not result in differences in revision surgery, we conclude that the PFNA, considering the minimal number of implant-related fractures is a viable implant for A1 type trochanteric fractures.
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Affiliation(s)
- Max P. L. van der Sijp
- Department of Surgery, Haaglanden Medical Centre, P.O. Box 432, 2501 CK The Hague, The Netherlands
| | - Marianne de Groot
- Department of Surgery, Haaglanden Medical Centre, P.O. Box 432, 2501 CK The Hague, The Netherlands
| | - Sven A. Meylaerts
- Department of Surgery, Haaglanden Medical Centre, P.O. Box 432, 2501 CK The Hague, The Netherlands
| | - Karel J. du Pré
- Department of Orthopaedics, Haaglanden Medical Centre, P.O. Box 432, 2501 CK The Hague, The Netherlands
| | - Sander M. Verhage
- Department of Surgery, Haaglanden Medical Centre, P.O. Box 432, 2501 CK The Hague, The Netherlands
| | - Inger B. Schipper
- Department of Trauma Surgery, Leiden University Medical Centre, P.O. Box 9600, 2300 RC Leiden, The Netherlands
| | - Arthur H. P. Niggebrugge
- Department of Surgery, Haaglanden Medical Centre, P.O. Box 432, 2501 CK The Hague, The Netherlands
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Nakajima T, Aoki Y, Watanabe A, Inoue M, Yamaguchi S, Nakamura J, Matsuura Y, Hagiwara S, Himeno D, Ohtori S. Mechanical testing of cephalomedullary nail lag screws after the addition of hydroxyapatite substitutes. OTA Int 2021; 4:e160. [PMID: 34913029 PMCID: PMC8670595 DOI: 10.1097/oi9.0000000000000160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 11/06/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To compare the effects of 3 implant designs, with and without hydroxyapatite reinforcement, on push/pull-out strength and rotational torque. METHODS Three implant designs (Gamma 3, INTERTAN, and PFNA-II) were selected for comparison. A hydroxyapatite cylinder (NEOBRACE) was used to reinforce the interface between the femoral head and the lag screw. Maximum push-out strength, maximum pull-out strength, and peak rotational torque were measured in cellular blocks mimicking osteoporotic cancellous bone, with and without NEOBRACE. RESULTS In the push-out test, INTERTAN produced a significantly higher push-out strength in osteoporotic bone density cellular blocks than the other lag screws and blades (P < .05). With the addition of NEOBRACE, push-out strength was significantly higher for INTERTAN and PFNA-II (P < .05) than for the non-NEOBRACE group. In the pull-out test, INTERTAN produced a significantly higher pull-out strength in the osteoporotic bone density cellular blocks than did the other lag screws and blades (P < .05). With the addition of NEOBRACE, the pull-out strengths of INTERTAN and Gamma 3 versus those of the non-NEOBRACE group significantly increased (P < .05). In the rotational torque test, INTERTAN produced significantly greater rotational torque in the osteoporotic cellular blocks than the other lag screws and blades (P < .05). The addition of NEOBRACE resulted in a significant increase in rotational torque only for INTERTAN (P < .05). CONCLUSION The use of NEOBRACE supported an increase in push/pull-out strength and rotational torque, especially in systems with a relatively increased bone or implant interface area.Level of Evidence: Level V.
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Affiliation(s)
| | - Yasuchika Aoki
- Department of Orthopedic Surgery, Eastern Chiba Medical Center
| | - Atsuya Watanabe
- Department of Orthopedic Surgery, Eastern Chiba Medical Center
| | - Masahiro Inoue
- Department of Orthopedic Surgery, Eastern Chiba Medical Center
| | - Satoshi Yamaguchi
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Togane, Japan
| | - Junichi Nakamura
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Togane, Japan
| | - Yusuke Matsuura
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Togane, Japan
| | - Shigeo Hagiwara
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Togane, Japan
| | - Daisuke Himeno
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Togane, Japan
| | - Seiji Ohtori
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Togane, Japan
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Association of the lateral wall integrity with clinical outcomes in older patients with intertrochanteric hip fractures treated with the proximal femoral nail anti-rotation-Asia. INTERNATIONAL ORTHOPAEDICS 2021; 45:3233-3242. [PMID: 34546389 DOI: 10.1007/s00264-021-05211-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 09/06/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The purpose of this study is to assess the role of the lateral wall in post-operative clinical outcomes in patients with intertrochanteric fractures treated with the proximal femoral nail anti-rotation-Asia (PFNA-II). METHODS A cohort of 466 patients (OTA type 31A1 or A2) was divided into two groups: one was intact lateral wall group, and the other was fractured lateral wall group. Radiographic outcomes were measured by using the loss of neck-shaft angle (NSA), femoral neck shortening (FNS), and offset shortening (OS). Functional outcomes were assessed by using the Harris score and SF-36 Physical Component Summary (SF-36 PCS). Post-operative complications were recorded. RESULTS The fractured lateral wall group had a greater loss of NSA (mean [SD], fractured group (8.7°) [2.7°] vs intact group (4.8°) [2.8°]; mean difference, 3.3° [95% CI 2.9 to 3.8]; P < 0.001) compared with the intact lateral wall group. Similar results were found for FNS and OS. The fractured lateral wall group had a worse Harris scores at the three month follow-up (mean [SD] score, fractured group (66.6) [5.2] points vs intact group (71.3) [5.8] points; mean difference, - 3.3 points [95% CI - 3.9 to - 2.7]; P < 0.001) compared with the intact lateral wall group. Similar results were observed for Harris scores at the three and 12-month follow-ups and SF-36 PCS at the three, six and 12-month follow-ups. The fractured lateral wall group had a higher risk of post-operative complications compared with the intact lateral wall group. CONCLUSION Among older patients with intertrochanteric fractures, the fractured lateral wall was associated with worse clinical outcomes compared with the intact lateral wall. Clinicians should pay attention to the lateral wall integrity in patients with intertrochanteric fractures treated with the PFNA-II.
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Comparison of clinical and radiological outcomes in intertrochanteric fractures treated with InterTAN nail against conventional cephalomedullary nails: a systematic review. Future Sci OA 2021; 7:FSO668. [PMID: 33437510 PMCID: PMC7787143 DOI: 10.2144/fsoa-2020-0182] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Intertrochanteric fractures, accountable for 50% of hip fractures, can be fixed with cephalomedullary devices such as Proximal Femoral Nail Antirotation (PFNA™), Gamma3 nailing system and TRIGEN™ InterTAN™ nail (IT). IT uniquely uses two cephalocervical screws that allow for linear compression and provide additional resistance to femoral head rotation. A literature review assessing clinical outcomes of these devices was conducted, with 14 studies enrolling 3104 patients meeting the inclusion criteria. PFNA and Gamma3 had better intraoperative outcomes compared with IT; however, IT had superior implant-related outcomes of cut-out and screw migration. No difference was found between IT and PFNA or Gamma3 in Harris Hip Scores, time to union, malunion and nonunion. Further long-term studies are needed to evaluate clinical outcomes and cost–effectiveness of cephalomedullary devices.
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Liu W, Liu J, Ji G. Comparison of clinical outcomes with proximal femoral nail anti-rotation versus InterTAN nail for intertrochanteric femoral fractures: a meta-analysis. J Orthop Surg Res 2020; 15:500. [PMID: 33121518 PMCID: PMC7596936 DOI: 10.1186/s13018-020-02031-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/20/2020] [Indexed: 12/05/2022] Open
Abstract
Background A meta-analysis to access the pros and cons of proximal femoral nail anti-rotation (PFNA) versus InterTAN nail for intertrochanteric femoral fractures including available evidence extracted from literature. 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, and other complications in both RCTs and observational studies. In terms of other outcomes, for the RCTs, results showed that there were shorter tip–apex distance and 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 were 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. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-020-02031-8.
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Affiliation(s)
- Wei Liu
- Department of Orthopaedics, Xiang'an Hospital, School of Medicine, Xiamen University, Xiamen, 361102, China
| | - Jie Liu
- Graduate School, Tianjin Medical University, Tianjin, 300070, China
| | - Guangrong Ji
- Department of Orthopaedics, Xiang'an Hospital, School of Medicine, Xiamen University, Xiamen, 361102, China.
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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. Adv Orthop 2020; 2020:2834816. [PMID: 32280544 PMCID: PMC7142344 DOI: 10.1155/2020/2834816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 03/03/2020] [Indexed: 11/18/2022] Open
Abstract
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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Kokoroghiannis C, Vasilakos D, Zisis K, Dimitriou G, Pappa E, Evangelopoulos D. Is rotation the mode of failure in pertrochanteric fractures fixed with nails? Theoretical approach and illustrative cases. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 30:199-205. [PMID: 31538272 DOI: 10.1007/s00590-019-02557-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 09/16/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE The present article reviews data from biomechanical and clinical studies which indicate that rotational instability can cause failure of fixation due to the particular characteristics of the fracture, the mechanical properties of the chosen implant or flaws in surgical technique. METHODS Although radiographs give a similar impression in failure of fractures fixed with cephalomedullary nails, different mechanisms involving rotation of the femoral head may play a key role. RESULTS The incidence of failure in pertrochanteric fracture fixation is decreasing as implants continue to evolve. It is possible that currently reported low failure rates do not apply equally to all subtypes of this diverse group of fractures. Since the introduction of sliding hip screws, "cut-out" due to varus collapse of the proximal fracture fragment has been the only reported mode of failure. CONCLUSION Excessive rotation leading to eventual "cut-out" has not been adequately studied, and thus, available evidence is not sufficient to definitely prove this theoretical approach. As nailing is gradually overtaking extramedullary fixation as the treatment of choice, especially for comminuted pertrochanteric fractures which can be rotationally unstable, further research is warranted to improve our understanding of the pathogenetic mechanisms of failure.
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Affiliation(s)
- C Kokoroghiannis
- 5th Department of Orthopaedics, "KAT" General Hospital of Athens, Nikis 2 Str, Athens, Greece
| | - D Vasilakos
- 5th Department of Orthopaedics, "KAT" General Hospital of Athens, Nikis 2 Str, Athens, Greece
| | - K Zisis
- 5th Department of Orthopaedics, "KAT" General Hospital of Athens, Nikis 2 Str, Athens, Greece
| | - G Dimitriou
- 5th Department of Orthopaedics, "KAT" General Hospital of Athens, Nikis 2 Str, Athens, Greece
| | - E Pappa
- 5th Department of Orthopaedics, "KAT" General Hospital of Athens, Nikis 2 Str, Athens, Greece.
| | - D Evangelopoulos
- 5th Department of Orthopaedics, "KAT" General Hospital of Athens, Nikis 2 Str, Athens, Greece
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Duramaz A, İlter MH. The impact of proximal femoral nail type on clinical and radiological outcomes in the treatment of intertrochanteric femur fractures: a comparative study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 29:1441-1449. [DOI: 10.1007/s00590-019-02454-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 05/25/2019] [Indexed: 10/26/2022]
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Helical Blade or the Integrated Lag Screws: A Matched Pair Analysis of 100 Patients With Unstable Trochanteric Fractures. J Orthop Trauma 2018; 32:274-277. [PMID: 29432318 DOI: 10.1097/bot.0000000000001145] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To compare the radiological and clinical results with PFNA-II and InterTan in the treatment of unstable trochanteric fractures in the elderly. DESIGN Retrospective, multicenter, matched pair. SETTING Three tertiary level trauma centers. PATIENTS Hundred elderly patients who underwent intramedullary stabilization with either the PFNA-II or the InterTan for osteoporotic unstable trochanteric fractures. INTERVENTIONS Fifty matched pairs consisting of OTA/AO-A2 and A3 fractures were created from a cohort of 290 patients who underwent internal fixation for unstable trochanteric fractures with the PFNA-II or InterTan nails. OUTCOME MEASUREMENTS Radiological assessment was performed to compare union rates, varus collapse, medial or lateral screw/blade migration, and cut-out. Functional outcome at 1 year was assessed and compared using Harris hip score, Timed Up and Go test, and the mobility score. RESULTS Union rates, fracture reduction, neck shaft angle, and tip-apex distance were similar in both groups. The PFNA-II group had a significantly higher degree of lateral sliding of the helical blade (P < 0.001). The InterTan group had a better Harris hip score, mobility score, Timed Up and Go test scores, and abductor strength (P < 0.05) at 1 year. The incidence of varus collapse and medial blade migration were higher in the PFNA-II group (P > 0.05). The need for repeat surgery to address surgery-related complications were significantly high in the PFNA-II group (P = 0.045). CONCLUSIONS The InterTan may provide superior functional outcome and reduced complications than does the Proximal Femur Nail - Antirotation in elderly patients with unstable trochanteric fractures. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Aicale R, Maffulli N. Greater rate of cephalic screw mobilisation following proximal femoral nailing in hip fractures with a tip-apex distance (TAD) and a calcar referenced TAD greater than 25 mm. J Orthop Surg Res 2018; 13:106. [PMID: 29720223 PMCID: PMC5930512 DOI: 10.1186/s13018-018-0814-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 04/17/2018] [Indexed: 01/13/2023] Open
Abstract
Background To ascertain whether the tip–apex distance (TAD), calcar referenced TAD (CalTAD), and the sum of both (TADcalTAD) are predictive measurements of mobilisation of the cephalic screw in patients with trochanteric hip fractures. Methods Between 2014 and 2015, 68 patients (mean age 86 years, 45 females, 23 males) with a trochanteric hip fracture underwent intramedullary nailing. The TAD and CalTAD were measured, and for each parameter, we calculated sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Results There is evidence of a statistically significant association between a TAD and CalTAD greater than 25 mm and a TADcalTAD greater than 50 mm and mobilisation of the cephalic screw. All measurements have similar sensitivity, but the TAD presents the highest specificity (p < 0.01). Conclusion To avoid the risk of mobilisation of the cephalic screw and possible subsequent failure of the construct, surgeons should strive for a TAD and CalTAD less than 25 mm and a TADcalTAD less than 50 mm when using intramedullary fixation.
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Affiliation(s)
- Rocco Aicale
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy. .,Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, England.
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Radaideh AM, Qudah HA, Audat ZA, Jahmani RA, Yousef IR, Saleh AAA. Functional and Radiological Results of Proximal Femoral Nail Antirotation (PFNA) Osteosynthesis in the Treatment of Unstable Pertrochanteric Fractures. J Clin Med 2018; 7:E78. [PMID: 29649099 PMCID: PMC5920452 DOI: 10.3390/jcm7040078] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 04/06/2018] [Accepted: 04/09/2018] [Indexed: 11/29/2022] Open
Abstract
Pertrochanteric femur fractures are considered amongst the most commonly encountered fractures in the geriatric age group. We evaluated radiographic and functional outcomes of patients with unstable pertrochanteric fractures treated with the proximal femur nail antirotation (PFNA). Between March 2013 and December 2015, fifty patients (28 male and 22 females with a mean age of 72.8 years (range, 20-94)) with unstable pertrochanteric fractures (AO 31.A2 and 31.A3) were fixed with the PFNA at our institution, and they were retrospectively evaluated. Forty one patients were treated with short PFNA and nine with long PFNA. Operative time ranged between 30 and 150 (average 73.60) min, blood loss ranged between 50 and 250 (average 80) milliliter and hospital stay ranged between 3 and 18 (6.86) days. The mean follow-up period was 18 months (range, 11-31). At final follow-up, solid union of all fractures had been achieved without any implant-related complications, the mean Harris Hip Score (HHS) was 79.34 ± 9.10 points and the mean neck-shaft angle was 127.2° ± 5.07°. No significant differences were encountered between the functional and radiographic outcomes of the PFNA with regards to the AO fracture classification and the implant version. PFNA is a recommended option for the treatment of unstable pertrochanteric fractures owing to its easy insertion, reduced blood loss, stable fixation and satisfactory functional and radiological outcomes.
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Affiliation(s)
- Ahmad M Radaideh
- Department of Orthopedics, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid 22110, Jordan.
| | - Hashem A Qudah
- Department of Orthopedics, Jordan Hospital, Amman 11152, Jordan.
| | - Ziad A Audat
- Department of Orthopedics, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid 22110, Jordan.
| | - Rami A Jahmani
- Department of Orthopedics, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid 22110, Jordan.
| | - Ibraheem R Yousef
- Department of Orthopedics, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid 22110, Jordan.
| | - Abed Allah A Saleh
- Department of Orthopedics, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid 22110, Jordan.
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Zhang C, Xu B, Liang G, Zeng X, Yang C, Zhang F, Wan Z, Yu W, Chen D, Ge Z, Zhang X. Rivaroxaban versus nadroparin for preventing deep venous thrombosis after total hip arthroplasty following femoral neck fractures: A retrospective comparative study. J Int Med Res 2018; 46:1936-1946. [PMID: 29560772 PMCID: PMC5991221 DOI: 10.1177/0300060518762281] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Objective This study was performed to evaluate the efficacy of rivaroxaban versus nadroparin for preventing deep venous thrombosis (DVT) in elderly patients with osteoporosis undergoing initial total hip arthroplasty (THA) for femoral neck fractures. Methods Prospectively maintained databases were reviewed to retrospectively compare elderly patients with osteoporosis who underwent initial THA for femoral neck fractures from 2007 to 2015. The patients received peroral rivaroxaban at 10 mg/day for 2 weeks or subcutaneous injections of nadroparin at 0.3 mL/day for 2 weeks until the primary analysis cut-off date. The time to first on-study DVT was the primary endpoint. Results In total, 399 patients were included (rivaroxaban group: n=200; mean age, 70.20 ± 9.16 years and nadroparin group: n = 199; mean age, 69.90 ± 8.87 years), with a mean 3-year follow-up. The time to first on-study DVT was significantly longer in the rivaroxaban than nadroparin group (12 and 5 days, respectively). The incidence of DVT within the 2-week follow-up was significantly higher in the nadroparin than rivaroxaban group (6.8% and 19.7%, respectively), but this difference was no longer present at the final follow-up. Conclusion Rivaroxaban was associated with a significant reduction in the occurrence of first on-study DVT compared with nadroparin.
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Affiliation(s)
- Chi Zhang
- 1 Department of Joint Surgery, The Third Affiliated Hospital of Guangzhou Medical University, Liwan District, Guangzhou, Guangdong, China
| | - Bo Xu
- 2 Department of Thoracic Surgery, The First Affiliated Hospital of Sun Yat-sen University, Yuexiu District, Guangzhou, Guangdong, People's Republic of China
| | - Guanzhao Liang
- 3 Emergency Department, The First Affiliated Hospital of Sun Yat-sen University, Yuexiu District, Guangzhou, Guangdong, People's Republic of China
| | - Xianshang Zeng
- 4 Department of Orthopaedics, The First Affiliated Hospital of Sun Yat-sen University, Yuexiu District, Guangzhou, Guangdong, People's Republic of China
| | - Chen Yang
- 5 Department of Physical Examination, The First Affiliated Hospital of Sun Yat-sen University, Yuexiu District, Guangzhou, Guangdong, People's Republic of China
| | - Fan Zhang
- 6 Department of Radiology, The First Affiliated Hospital of Sun Yat-sen University, Yuexiu District, Guangzhou, Guangdong, People's Republic of China
| | - Zi Wan
- 7 Department of Urology, The First Affiliated Hospital of Sun Yat-sen University, Yuexiu District, Guangzhou, Guangdong, People's Republic of China
| | - Weiguang Yu
- 4 Department of Orthopaedics, The First Affiliated Hospital of Sun Yat-sen University, Yuexiu District, Guangzhou, Guangdong, People's Republic of China
| | - Deng Chen
- 8 Department of Joint Surgery, The First People's Hospital of Jingmen, Hubei, Dongbao District, Jingmen, Hubei, People's Republic of China
| | - Zhe Ge
- 9 Department of Orthopaedics, Jinshan Hospital, Fudan University, Jinshan District, Shanghai, People's Republic of China
| | - Xinchao Zhang
- 9 Department of Orthopaedics, Jinshan Hospital, Fudan University, Jinshan District, Shanghai, People's Republic of China
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25
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Zhang C, Xu B, Liang G, Zeng X, Zeng D, Chen D, Ge Z, Yu W, Zhang X. Optimizing stability in AO/OTA 31-A2 intertrochanteric fracture fixation in older patients with osteoporosis. J Int Med Res 2018. [PMID: 29517952 PMCID: PMC5991238 DOI: 10.1177/0300060518761504] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Objectives To compare the functional and radiographic outcomes of InterTAN nail (IT) and proximal femoral nail anti-rotation (PFNA) for managing primary AO/OTA 31-A2 intertrochanteric hip fractures (IHFs) in older osteoporotic patients. Methods Patients aged 60 years or older who received surgical treatment for IHFs (AO/OTA 3.1A2.1-A2.3) with IT or PFNA were retrospectively evaluated. The primary outcome was the postoperative treatment failure rate. The secondary outcome was the Harris Hip Score (HHS). Results A total of 326 osteoporotic cases (326 hips: IT, n = 162; PFNA, n = 164) were assessed with a mean follow-up of 43.5 months (range, 38–48 months). For the entire cohort, the incidence of postoperative treatment failure (periprosthetic fracture and reoperation) was 29/326 (8.9%); the IT-treated cohort (7/162, 4.3%) had a significantly lower rate compared with the PFNA-treated cohort (22/165, 13.3%). The incidence of postoperative periprosthetic fractures was significantly lower in the IT-treated cohort than in the PFNA-treated cohort (2.5% vs 7.9%). The postoperative HHS at the final follow-up was not significantly different between the groups. Conclusion IT might show a better outcome in managing osteoporotic AO/OTA 31-A2 IHFs in terms of periprosthetic fracture and reoperation compared with PFNA.
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Affiliation(s)
- Chi Zhang
- 1 Department of Joint Surgery, The Third Affiliated Hospital of Guangzhou Medical University, Liwan District, Guangzhou, Guangdong, China
| | - Bo Xu
- 2 Department of Thoracic Surgery, The First Affiliated Hospital of Sun Yat-sen University, Huangpu District, Guangzhou, Guangdong, China
| | - Guanzhao Liang
- 3 Emergency Department, The First Affiliated Hospital of Sun Yat-sen University, Huangpu District, Guangzhou, Guangdong, China
| | - Xianshang Zeng
- 4 Department of Orthopaedics, The First Affiliated Hospital of Sun Yat-sen University, Huangpu District, Guangzhou, Guangdong, China
| | - Dan Zeng
- 5 Ultrasonography Department, The First Affiliated Hospital of Sun Yat-sen University, Huangpu District, Guangzhou, Guangdong, China
| | - Deng Chen
- 6 Department of Joint Surgery, The First People's Hospital of Jingmen, Hubei, Dongbao District, Jingmen, Hubei, China
| | - Zhe Ge
- 7 Department of Orthopaedics, Jinshan Hospital, Fudan University, Jinshan District, Shanghai City, China
| | - Weiguang Yu
- 4 Department of Orthopaedics, The First Affiliated Hospital of Sun Yat-sen University, Huangpu District, Guangzhou, Guangdong, China
| | - Xinchao Zhang
- 7 Department of Orthopaedics, Jinshan Hospital, Fudan University, Jinshan District, Shanghai City, China
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26
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Ma JX, Kuang MJ, Fan ZR, Xing F, Zhao YL, Zhang LK, Chen HT, Han C, Ma XL. Comparison of clinical outcomes with InterTan vs Gamma nail or PFNA in the treatment of intertrochanteric fractures: A meta-analysis. Sci Rep 2017; 7:15962. [PMID: 29162931 PMCID: PMC5698321 DOI: 10.1038/s41598-017-16315-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 11/09/2017] [Indexed: 12/13/2022] Open
Abstract
Intertrochanteric fractures are common injuries in the elderly. Conventional intramedullary nails including Gamma 3 locking nail and proximal femoral nail antirotation (PFNA) were designed for unstable intertrochanteric fractures. The InterTan (IT) nail system, introduced in 2005, has been reported superior biomechanical and clinical outcomes compared with 1-screw nailing system. However, some recent studies have reported that IT did not improve functional recovery in patients with intertrochanteric fractures. Randomized controlled trials (RCTs) or prospective cohort studies were included in our meta-analysis. We used the PRISMA guidelines and Cochrane Handbook to evaluate the quality of included studies to ensure that the pooled data of our meta-analysis were reliable and veritable. Our pooled data analysis demonstrated that IT was as effective as the control group in terms of Harris Hip Score (HHS), blood loss, total complications, union time, length of hospital stay, revision rate, and fluoroscopy time. IT shows less implant cut-out rate and femoral fractures when compared with control groups.
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Affiliation(s)
- Jian-Xiong Ma
- Biomechanics Labs of Orthopaedics Institute, Tianjin Hospital, Tianjin, 300050, People's Republic of China
| | - Ming-Jie Kuang
- Biomechanics Labs of Orthopaedics Institute, Tianjin Hospital, Tianjin, 300050, People's Republic of China.,Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, 300052, People's Republic of China
| | - Zheng-Rui Fan
- Biomechanics Labs of Orthopaedics Institute, Tianjin Hospital, Tianjin, 300050, People's Republic of China.,Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, 300052, People's Republic of China
| | - Fei Xing
- Biomechanics Labs of Orthopaedics Institute, Tianjin Hospital, Tianjin, 300050, People's Republic of China.,Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, 300052, People's Republic of China
| | - Yun-Long Zhao
- Biomechanics Labs of Orthopaedics Institute, Tianjin Hospital, Tianjin, 300050, People's Republic of China.,Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, 300052, People's Republic of China
| | - Lu-Kai Zhang
- Biomechanics Labs of Orthopaedics Institute, Tianjin Hospital, Tianjin, 300050, People's Republic of China
| | - Heng-Ting Chen
- Biomechanics Labs of Orthopaedics Institute, Tianjin Hospital, Tianjin, 300050, People's Republic of China.,Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, 300052, People's Republic of China
| | - Chao Han
- Biomechanics Labs of Orthopaedics Institute, Tianjin Hospital, Tianjin, 300050, People's Republic of China.
| | - Xin-Long Ma
- Biomechanics Labs of Orthopaedics Institute, Tianjin Hospital, Tianjin, 300050, People's Republic of China. .,Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, 300052, People's Republic of China.
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27
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Xie H, Wang Z, Zhang J, Xu L, Chen B. Clinical outcome of dynamic hip locking plates and proximal femoral nails anti-rotation-Asia for treating intertrochanteric femur fracture with lateral wall fractures in the elder patients. Oncotarget 2017; 8:82700-82704. [PMID: 29137295 PMCID: PMC5669921 DOI: 10.18632/oncotarget.19754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 06/19/2017] [Indexed: 11/25/2022] Open
Abstract
Purpose To compare the clinical results of DHLP (Dynamic hip locking plates) and PFNA-IIs (proximal femoral nails anti-rotation-Asia) for treating intertrochanteric femur fracture (IFF) with lateral wall fractures in the elder patients and provide a rationale for the clinical practice. Methods A retrospective analysis of 43 patients of IFF with lateral wall fractures was performed from December 2009 to April 2015. Intraoperative variables and postoperative complications and function were compared between the two groups. Results 17 cases were treated by DHLPs, and 26 treated by PFNA-IIs. Patients were followed up from 6 to 16 months with an average of 11 months. Both the groups were comparable for demographic data before surgery. The PFNA-II group had less operation time, time of full weight bearing and healing time of fracture, but larger blood loss in comparison with the DHLP group (p<0.05). Additionally, internal fixation failure was significantly more in the DHLP group than in the PFNA-II group. The mean HHS and the rate of good-to-excellent in the PFNA-II group was significantly higher than that in the DHLP group both in third month after surgery (p<0.05). Conclusions PFNA-IIs treatment should be recommended for the elderly patients of IFF with lateral wall fractures, because of its shorter operation time, faster full weight bearing, faster function recovery, and lower failure rate. However, more attention should be payed to its larger blood loss.
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Affiliation(s)
- Hui Xie
- Department of Orthopaedics, Jiaxing No. 2 Hospital, Jiaxing University, Jiaxing 314001, China
| | - Zhan Wang
- Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, Department of Orthopaedics, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310000, China
| | - Junji Zhang
- Department of Infection Management, Suzhou Municipal Hospital, Suzhou 215002, China
| | - Langhai Xu
- Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, Department of Orthopaedics, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310000, China
| | - Bao Chen
- Department of Orthopaedics, Jiaxing No. 2 Hospital, Jiaxing University, Jiaxing 314001, China
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28
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Zhang H, Zhu X, Pei G, Zeng X, Zhang N, Xu P, Chen D, Yu W, Zhang X. A retrospective analysis of the InterTan nail and proximal femoral nail anti-rotation in the treatment of intertrochanteric fractures in elderly patients with osteoporosis: a minimum follow-up of 3 years. J Orthop Surg Res 2017; 12:147. [PMID: 29017580 PMCID: PMC5634834 DOI: 10.1186/s13018-017-0648-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Accepted: 09/25/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The study aims to compare the long-term functional and radiographic outcomes of two devices for the treatment of primary intertrochanteric fractures (IFs, OTA 3.1A2.1-A2.3) in elderly patients with osteoporosis. METHODS Between December 2010 and August 2014, 332 elderly osteoporosis patients with IFs (OTA 3.1A2.1-A2.3) fixed by an InterTAN nail (IT) or a proximal femoral nail anti-rotation (PFNA) device were retrospectively evaluated. Follow-up occurred 1, 3, 6, and 12 months postoperatively and every year thereafter. Mortality was recorded. Patient-related functional and radiographic outcomes were compared. The primary endpoint was the long-term radiographic outcomes. The secondary endpoint was the long-term functional outcomes. RESULTS A total of 283 patients (283 hips) with osteoporosis (IT, n = 144; PFNA, n = 139) were evaluated with a mean follow-up period of 38.8 months (range, 36-43 months). No between-group significant differences were noted in the patient demographics, operation variables, and postoperative Harris Hip Score. More radiographic complications were noted in terms of screw cut-out, femoral shaft fracture distal or around the tip of the main nail, and varus collapse of the femoral head in the PFNA group compared with that in the IT group (P < 0.05). CONCLUSION For osteoporotic IFs (OTA 3.1A2.1-A2.3) in elderly patients, the use of IT aids in decreasing radiographic complications, but the between-group functional outcomes showed no significant difference.
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Affiliation(s)
- Hui Zhang
- Emergency Department, The First Affiliated Hospital of Sun Yat-sen University, Huangpu East Road No. 183, Huangpu District, Guangzhou, Guangdong, 510700, China.
| | - Xiaoxiao Zhu
- Endocrine Department, The First Affiliated Hospital of Sun Yat-sen University, Huangpu East Road No. 183, Huangpu District, Guangzhou, Guangdong, 510700, China
| | - Genwang Pei
- Department of ENT, The First Affiliated Hospital of Sun Yat-sen University, Huangpu East Road No. 183, Huangpu District, Guangzhou, Guangdong, 510700, China
| | - Xianshang Zeng
- Department of Orthopedics, The First Affiliated Hospital of Sun Yat-sen University, Huangpu East Road No. 183, Huangpu District, Guangzhou, Guangdong, 510700, China
| | - Nan Zhang
- Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-sen University, Huangpu East Road No. 183, Huangpu District, Guangzhou, Guangdong, 510700, China
| | - Ping Xu
- Radiology Department, The First Affiliated Hospital of Sun Yat-sen University, Huangpu East Road No. 183, Huangpu District, Guangzhou, Guangdong, 510700, China
| | - Deng Chen
- Department of Joint Surgery, The First People's Hospital of Jingmen, Xiangshan Avenue No. 168, Dongbao District, Jingmen, Hubei, 448000, China
| | - Weiguang Yu
- Department of Orthopedics, The First Affiliated Hospital of Sun Yat-sen University, Huangpu East Road No. 183, Huangpu District, Guangzhou, Guangdong, 510700, China
| | - Xinchao Zhang
- Department of Orthopaedics, Jinshan Hospital, Fudan University, Longhang Road No. 1508, Jinshan District, Shanghai City, 201508, China.
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29
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Zheng SN, Yao QQ, Mao FY, Zheng PF, Tian SC, Li JY, Yu YF, Liu S, Zhou J, Hu J, Xu Y, Tang K, Lou Y, Wang LM. Application of 3D printing rapid prototyping-assisted percutaneous fixation in the treatment of intertrochanteric fracture. Exp Ther Med 2017; 14:3644-3650. [PMID: 29042960 PMCID: PMC5639369 DOI: 10.3892/etm.2017.4991] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 04/21/2017] [Indexed: 12/14/2022] Open
Abstract
The aim of the present study was to investigate the application of 3D printing (3DP) rapid prototyping (RP) technique-assisted percutaneous fixation in the treatment of femoral intertrochanteric fracture (ITF) using proximal femoral nail anti-rotation (PFNA). A total of 39 patients with unstable ITF were included in the current study. Patients were divided into two groups: 19 patients were examined using computed tomography scanning and underwent PFNA with SDP-RP whereas the other 20 patients underwent conventional PFNA treatment. Anatomical data were converted from the Digital Imaging and Communications in Medicine format to the stereolithography format using M3D software. The 3DP-RP model was established using the fused deposition modeling technique and the length and diameter of the main screw blade was measured during the simulation. The postoperative femoral neck-shaft angle (NSA), surgery duration, intraoperative and postoperative blood loss, and the duration of hospital stay were recorded and compared with the corresponding values in conventional surgery. No significant differences were observed in mean PFNA size between the implants used and the preoperative planning estimates. It was demonstrated that the 3DP-RP assisted procedure resulted in more effective reduction of the NSA. Furthermore, patients undergoing 3DP-RP experienced a significant reduction in duration of surgery (P<0.01), as well as reductions in intraoperative (P=0.02) and postoperative (P=0.03) blood loss, compared with conventional surgery. At 6 months post-surgery, no cases of hip varus/vague deformities or implant failure were observed in patients that underwent either the 3DP-RP-assisted or conventional procedure. The results of the present study suggest that the 3DP-RP technique is able to create an accurate model of the ITF, which facilitates surgical planning and fracture reduction, thus improving the efficiency of PFNA surgery for ITFs.
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Affiliation(s)
- Sheng-Nai Zheng
- Department of Orthopedic Surgery, Nanjing Medical University, Nanjing Hospital, Nanjing, Jiangsu 210006, P.R. China.,Clinical Medical Center of Orthopedic Surgery, Nanjing Medical University, Nanjing Hospital, Nanjing, Jiangsu 210006, P.R. China
| | - Qing-Qiang Yao
- Department of Orthopedic Surgery, Nanjing Medical University, Nanjing Hospital, Nanjing, Jiangsu 210006, P.R. China.,Clinical Medical Center of Orthopedic Surgery, Nanjing Medical University, Nanjing Hospital, Nanjing, Jiangsu 210006, P.R. China.,Digital Medicine Institute, Nanjing Medical University, Nanjing Hospital, Nanjing, Jiangsu 210006, P.R. China
| | - Feng-Yong Mao
- Department of Orthopedic Surgery, Nanjing Medical University, Nanjing Hospital, Nanjing, Jiangsu 210006, P.R. China.,Clinical Medical Center of Orthopedic Surgery, Nanjing Medical University, Nanjing Hospital, Nanjing, Jiangsu 210006, P.R. China
| | - Peng-Fei Zheng
- Digital Medicine Institute, Nanjing Medical University, Nanjing Hospital, Nanjing, Jiangsu 210006, P.R. China
| | - Shu-Chang Tian
- Department of Orthopedic Surgery, Nanjing Medical University, Nanjing Hospital, Nanjing, Jiangsu 210006, P.R. China
| | - Jia-Yi Li
- Department of Orthopedic Surgery, Nanjing Medical University, Nanjing Hospital, Nanjing, Jiangsu 210006, P.R. China.,Clinical Medical Center of Orthopedic Surgery, Nanjing Medical University, Nanjing Hospital, Nanjing, Jiangsu 210006, P.R. China
| | - Yi-Fan Yu
- Department of Orthopedic Surgery, Nanjing Medical University, Nanjing Hospital, Nanjing, Jiangsu 210006, P.R. China.,Clinical Medical Center of Orthopedic Surgery, Nanjing Medical University, Nanjing Hospital, Nanjing, Jiangsu 210006, P.R. China
| | - Shuai Liu
- Department of Orthopedic Surgery, Nanjing Medical University, Nanjing Hospital, Nanjing, Jiangsu 210006, P.R. China
| | - Jin Zhou
- Department of Orthopedic Surgery, Nanjing Medical University, Nanjing Hospital, Nanjing, Jiangsu 210006, P.R. China
| | - Jun Hu
- Department of Orthopedic Surgery, Nanjing Medical University, Nanjing Hospital, Nanjing, Jiangsu 210006, P.R. China.,Clinical Medical Center of Orthopedic Surgery, Nanjing Medical University, Nanjing Hospital, Nanjing, Jiangsu 210006, P.R. China
| | - Yan Xu
- Clinical Medical Center of Orthopedic Surgery, Nanjing Medical University, Nanjing Hospital, Nanjing, Jiangsu 210006, P.R. China.,Digital Medicine Institute, Nanjing Medical University, Nanjing Hospital, Nanjing, Jiangsu 210006, P.R. China
| | - Kai Tang
- Digital Medicine Institute, Nanjing Medical University, Nanjing Hospital, Nanjing, Jiangsu 210006, P.R. China
| | - Yue Lou
- Digital Medicine Institute, Nanjing Medical University, Nanjing Hospital, Nanjing, Jiangsu 210006, P.R. China
| | - Li-Ming Wang
- Department of Orthopedic Surgery, Nanjing Medical University, Nanjing Hospital, Nanjing, Jiangsu 210006, P.R. China.,Clinical Medical Center of Orthopedic Surgery, Nanjing Medical University, Nanjing Hospital, Nanjing, Jiangsu 210006, P.R. China.,Digital Medicine Institute, Nanjing Medical University, Nanjing Hospital, Nanjing, Jiangsu 210006, P.R. China
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30
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Zhang H, Zeng X, Zhang N, Zeng D, Xu P, Zhang L, Chen D, Yu W, Zhang X. INTERTAN nail versus proximal femoral nail antirotation-Asia for intertrochanteric femur fractures in elderly patients with primary osteoporosis. J Int Med Res 2017; 45:1297-1309. [PMID: 28587540 PMCID: PMC5625524 DOI: 10.1177/0300060517710584] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Objectives To compare the long-term functional and radiographic outcomes of the proximal femoral nail antirotation-Asia (PFNA-II) and INTERTAN nail (IT) in the management of intertrochanteric femoral fractures (IFFs) (AO/OTA Type 31A1.1-A2.3) in elderly patients with primary osteoporosis. Methods A retrospective comparative study was performed in our institution. From January 2009 to March 2012, 243 patients with osteoporosis (243 hips) with IFFs (AO/OTA Type 3.1A1.1-A2.3) underwent repair with either a PFNA-II or IT. Follow-up assessments were performed 1, 3, 6, 9, and 12 months postoperatively and every year thereafter. All implant position changes were noted. Patient-related functional outcomes were evaluated based on the Harris hip score. Results In total, 174 patients with osteoporosis (IT, n = 86; PFNA-II, n = 88) were evaluated during a mean follow-up period of 40 months (range, 38-60 months). An increased risk of femoral shaft fracture after implant removal was observed at month 9 of follow-up in 0.0% and 4.4% of the IT and PFNA-II groups, respectively. This difference remained over time with rates of 1.1% and 6.8%, respectively, at the last follow-up. Conclusion The IT nail appears to be a reliable implant in the management of IFFs (AO/OTA Type 3.1A1.1-A2.3) in elderly patients with primary osteoporosis.
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Affiliation(s)
- Hui Zhang
- 1 Emergency Department, The First Affiliated Hospital of Sun Yat-sen University, Huangpu District, Guangzhou, Guangdong, China
| | - Xianshang Zeng
- 2 Department of Orthopedics, The First Affiliated Hospital of Sun Yat-sen University, Huangpu District, Guangzhou, Guangdong, China
| | - Nan Zhang
- 3 Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-sen University, Huangpu District, Guangzhou, Guangdong, China
| | - Dan Zeng
- 4 Ultrasonography Department, The First Affiliated Hospital of Sun Yat-sen University, Huangpu District, Guangzhou, Guangdong, China
| | - Ping Xu
- 5 Radiology Department, The First Affiliated Hospital of Sun Yat-sen University, Huangpu District, Guangzhou, Guangdong, China
| | - Lili Zhang
- 3 Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-sen University, Huangpu District, Guangzhou, Guangdong, China
| | - Deng Chen
- 6 Department of Joint Surgery, The First People's Hospital of Jingmen, Hubei, Xiangshan Avenue No. 168, Dongbao District, Jingmen, Hubei, China
| | - Weiguang Yu
- 2 Department of Orthopedics, The First Affiliated Hospital of Sun Yat-sen University, Huangpu District, Guangzhou, Guangdong, China
| | - Xinchao Zhang
- 7 Department of Orthopaedics, Jinshan Hospital, Fudan University, Longhang Road No. 1508, Jinshan District, Shanghai City, China
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31
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Learning Curve and Clinical Outcomes of Performing Surgery with the InterTan Intramedullary Nail in Treating Femoral Intertrochanteric Fractures. BIOMED RESEARCH INTERNATIONAL 2017; 2017:6781070. [PMID: 28503572 PMCID: PMC5414508 DOI: 10.1155/2017/6781070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 03/14/2017] [Accepted: 04/03/2017] [Indexed: 11/26/2022]
Abstract
Purpose. The purpose of this study is to evaluate the learning curve of performing surgery with the InterTan intramedullary nail in treating femoral intertrochanteric fractures, to provide valuable information and experience for surgeons who decide to learn a new procedure. Methods. We retrospectively analyzed data from 53 patients who underwent surgery using an InterTan intramedullary nail at our hospital between July 2012 and September 2015. The negative exponential curve-fit regression analysis was used to evaluate the learning curve. According to 90% learning milestone, patients were divided into two group, and the outcomes were compared. Results. The mean operative time was 69.28 (95% CI 64.57 to 74.00) minutes; with the accumulation of surgical experience, the operation time was gradually decreased. 90% of the potential improvement was expected after 18 cases. In terms of operative time, intraoperative blood loss, hospital stay, and Harris hip score significant differences were found between two groups (p = 0.009, p = 0.000, p = 0.030, and p = 0.002, resp.). Partial weight bearing time, fracture union time, tip apex distance, and the number of blood transfusions and complications were similar between two groups (p > 0.5). Conclusion. This study demonstrated that the learning curve of performing surgery with the InterTan intramedullary nail is acceptable and 90% of the expert's proficiency level is achieved at around 18 cases.
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32
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Zeng X, Zhang N, Zeng D, Zhang L, Xu P, Cao L, Yu W, Zhan K, Zhang X. Proximal femoral nail antirotation versus dynamic hip screw fixation for treatment of osteoporotic type 31-A1 intertrochanteric femoral fractures in elderly patients. J Int Med Res 2017; 45:1109-1123. [PMID: 28417681 PMCID: PMC5536426 DOI: 10.1177/0300060517703277] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To evaluate long-term radiographic and functional outcomes between dynamic hip screw (DHS) and proximal femoral nail antirotation (PFNA) fixation for treatment of osteoporotic type 31-A1 intertrochanteric femoral fractures (IFFs) among elderly patients Methods A retrospective comparative study was carried out. Follow-up was performed at 1, 3, 6, 9, and 12 months postoperatively and yearly thereafter. The primary outcome was the radiographic outcome, and the secondary outcome was the functional outcome. Results A significant difference in radiographic complications was observed between the DHS group (n = 45, 40.2%) and PFNA group (n = 15, 13.6%). The risk of femoral shaft fracture after implant removal at the 1-year follow-up was increased by 0.9% (n = 1) and 6.3% (n = 7) in the PFNA and DHS groups, respectively. This difference persisted with rates of 3.6% (n = 4) and 12.5% (n = 14) at the final follow-up. Additionally, significant differences were present in the Harris hip score at each visit. Conclusion Our results indicate that PFNA yields better outcomes than DHS fixation among elderly patients with osteoporotic type 31-A1 IFFs.
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Affiliation(s)
- Xianshang Zeng
- 1 Department of Orthopedics, The First Affiliated Hospital of Sun Yat-sen University, Huangpu District, Guangzhou, Guangdong, China
| | - Nan Zhang
- 2 Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-sen University, Huangpu District, Guangzhou, Guangdong, China
| | - Dan Zeng
- 3 Ultrasonography Department, The First Affiliated Hospital of Sun Yat-sen University, Huangpu District, Guangzhou, Guangdong, China
| | - Lili Zhang
- 2 Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-sen University, Huangpu District, Guangzhou, Guangdong, China
| | - Ping Xu
- 4 Radiology Department, The First Affiliated Hospital of Sun Yat-sen University, Huangpu District, Guangzhou, Guangdong, China
| | - Lei Cao
- 5 Department of Anesthesiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Jiang'an District, Wuhan, Hubei, China
| | - Weiguang Yu
- 1 Department of Orthopedics, The First Affiliated Hospital of Sun Yat-sen University, Huangpu District, Guangzhou, Guangdong, China
| | - Ke Zhan
- 1 Department of Orthopedics, The First Affiliated Hospital of Sun Yat-sen University, Huangpu District, Guangzhou, Guangdong, China
| | - Xinchao Zhang
- 6 Department of Orthopaedics, Jinshan Hospital, Fudan University, Jinshan District, Shanghai City, China
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Kara A, Celik H, Seker A, Uzun M, Sonmez MM, Erdil M. Procedural outcomes of double vs. single fluoroscopy for fixing intertrochanteric femur fractures. Arch Orthop Trauma Surg 2016; 136:929-34. [PMID: 27155881 DOI: 10.1007/s00402-016-2473-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This study compares reducing radiation and operation time between single and double C-arm fluoroscopy in the treatment of intertrochanteric femur fractures with intramedullary nails. PATIENTS AND METHODS Forty four patients participated in the study. Patients were divided into two groups as single (23 patients) and double fluoroscope (21 patients). The time of preparation, the duration of the surgery, the total amount of blood loss, and the total duration of radiation exposure were compared, retrospectively. The collo-diaphyseal angle was compared with that of the contralateral hip on postoperative radiographs. Furthermore, the tip-apex distance and the position of the screws in the femoral head were recorded. RESULTS The mean preparation periods, collo-diaphyseal angles and blood loss did not differ between groups. In the double-fluoroscopy group, the duration of surgery was 15.9 min shorter (p < 0.001), and the radiation time was 25.7 s shorter (p < 0.001). CONCLUSION The double fluoroscopy technique can significantly reduce surgical and radiation exposure times during surgery.
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Affiliation(s)
- Adnan Kara
- Department of Orthopaedics and Traumatology, Istanbul Medipol University, Istanbul, Turkey
| | - Haluk Celik
- Zonguldak Ataturk State Hospital, Orthopaedics and Traumatology, Zonguldak, Turkey
| | - Ali Seker
- Department of Orthopaedics and Traumatology, Istanbul Medipol University, Istanbul, Turkey. .,Medipol Mega Hastane, TEM Avrupa Otoyolu Göztepe Cikisi No:1 Bagcilar, Istanbul, Turkey.
| | - Metin Uzun
- Maslak Acibadem Hospital, Istanbul, Turkey
| | - Mehmet Mesut Sonmez
- Sisli Etfal Training and Research Hospital Orthopaedics and Traumatology Clinic, Istanbul, Turkey
| | - Mehmet Erdil
- Department of Orthopaedics and Traumatology, Istanbul Medipol University, Istanbul, Turkey
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