Long versus short proximal femoral nail antirotation in treatment of intertrochanteric fractures

doi:10.3969/j.issn.2095-4344.2014.04.018

Abstract

Abstract:

BACKGROUND: There are few clinical controlled trials about the clinical effects in patients with pertrochanteric femur fractures after treatment with short or long proximal femoral nail antirotation.

OBJECTIVE: To compare the clinical outcomes in patients with AO/ASIF-A1/2 pertrochanteric femur fractures after treatment with short or long proximal femoral nail antirotation.

METHODS: A total of 98 patients with AO/ASIF-A1/2 pertrochanteric femur fractures were treated by proximal femoral nail antirotation. They were divided into two groups according to the type of proximal femoral nail antirotation: short nail group (n=50) and long nail group (n=48). The operative time, blood loss, and hospital stay were recorded in both groups. In follow-up, fracture healing time, imaging and clinical complications were evaluated. In the final follow-up, Harris hip score was used to evaluate functional recovery.

RESULTS AND CONCLUSION: Compared with the short nail group, operative time was shorter and blood loss was less in the long nail group (P < 0.05). No significant difference in hospital stay was detected between the short nail and long nail groups (P > 0.05). Average follow-up periods were respectively (15.8±6.4) months and (16.2±5.7) months in the long nail and short nail groups. “Cutting-out” or infection occurred in five patients in the long nail group and three in the short nail group. Besides above-mentioned patients, the remaining patients in the two groups achieved fracture healing. No significant difference in average fracture healing time was detected between groups (P=0.588). In the final follow-up, no significant difference in Harris hip score was detectable in the two groups (P=0.204). The incidence rates of total postoperative complications in the long and short nail groups were 31.2% and 16.0%, respectively (P=0.075). Results suggested that no differences in the union and complication rates between the two groups were identified, suggesting that long nails offer no advantage compared with short nails for stabilizing AO/ASIF-A1/A2 pertrochanteric femur fractures.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

全文链接：

Key words: femur, hip fractures, fracture fixation, intramedullary, treatment outcome

CLC Number:

R318

Chen Xing-hua, Liu Tao, Huang Zhen-gu. Long versus short proximal femoral nail antirotation in treatment of intertrochanteric fractures[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(4): 595-600.

Figures/Tables 4

References

[1] Matre K, Havelin LI, Gjertsen JE,et al. Intramedullary nails result in more reoperations than sliding hip screws in two-part intertrochanteric fractures.Clin Orthop Relat Res. 2013;471(4): 1379-1386.

[2] Lee YK, Chung CY, Park MS,et al.Intramedullary nail versus extramedullary plate fixation for unstable intertrochanteric fractures: decision analysis.Arch Orthop Trauma Surg. 2013; 133(7):961-968.

[3] Lee SR, Kim ST, Yoon MG,et al.The stability score of the intramedullary nailed intertrochanteric fractures: stability of nailed fracture and postoperative patient mobilization.Clin Orthop Surg. 2013;5(1):10-8.

[4] Gallagher D, Adams B, El-Gendi H,et al.Is distal locking necessary? A biomechanical investigation of intramedullary nailing constructs for intertrochanteric fractures.J Orthop Trauma. 2013;27(7):373-378.

[5] Zhu Y, Meili S, Zhang C,et al.Is the lag screw sliding effective in the intramedullary nailing in A1 and A2 AO-OTA intertrochanteric fractures? A prospective study of Sliding and None-sliding lag screw in Gamma-III nail.Scand J Trauma Resusc Emerg Med. 2012;20:60.

[6] Radcliff TA, Regan E, Cowper Ripley DC,et al. Increased use of intramedullary nails for intertrochanteric proximal femoral fractures in veterans affairs hospitals: a comparative effectiveness study. J Bone Joint Surg Am. 2012;94(9): 833-840.

[7] Kokoroghiannis C, Aktselis I, Deligeorgis A, et al.Evolving concepts of stability and intramedullary fixation of intertrochanteric fractures--a review.Injury. 2012;43(6): 686-693.

[8] Ertürer RE, Sönmez MM, Sar? S,et al. Intramedullary osteosynthesis of instable intertrochanteric femur fractures with Profin® nail in elderly patients.Acta Orthop Traumatol Turc. 2012;46(2):107-112.

[9] de Grave PW, Tampere T, Byn P,et al. Intramedullary fixation of intertrochanteric hip fractures: a comparison of two implant designs. A prospective randomised clinical trial.Acta Orthop Belg. 2012;78(2):192-198.

[10] Haidukewych GJ.Intertrochanteric fractures: ten tips to improve results.Instr Course Lect. 2010;59:503-9.

[11] Haidukewych GJ.Intertrochanteric fractures: ten tips to improve results.J Bone Joint Surg Am. 2009;91(3):712-719.

[12] 杨沛彦,李耀锋,尤元璋.股骨近端抗旋髓内钉与股骨近端解剖型锁定板治疗不稳定型转子间骨折的疗效比较[J].中华创伤杂志, 2013, 29(4): 330-333.

[13] Aprato A, Jayasekera N, Villar RN. Does the modified Harris hip score reflect patient satisfaction after hip arthroscopy. Am J Sports Med. 2012;40(11):2557-2560.

[14] Shayesteh-Azar M, Karimi-Nasab MH, Sajjadi-Saravi M,et al.Comparison of surgical complications of intertrochanteric hip fractures between non-osteoporotic and osteoporotic patients.J Pak Med Assoc. 2013;63(6):752-755.

[15] Shen L, Zhang Y, Shen Y,et al. Antirotation proximal femoral nail versus dynamic hip screw for intertrochanteric fractures: a meta-analysis of randomized controlled studies.Orthop Traumatol Surg Res. 2013;99(4):377-383.

[16] Streubel PN, Moustoukas MJ, Obremskey WT. Mechanical failure after locking plate fixation of unstable intertrochanteric femur fractures.J Orthop Trauma. 2013; 27(1):22-28.

[17] Sun B, Li K, Zhu Y,et al. Posterior wall reconstruction using intertrochanteric crest strut graft in comminuted posterior acetabular wall fractures.Hip Int. 2013;23(2):199-203.

[18] Talmo CT, Sambaziotis C, Bono JV. Conversion Hemiarthroplasty and Valgus Osteotomy After Failed ORIF of Hip Intertrochanteric Fractures.Orthopedics. 2013;36(9): 693-696.

[19] Tao R, Lu Y, Xu H,et al. Internal fixation of intertrochanteric hip fractures: a clinical comparison of two implant designs.ScientificWorldJournal. 2013;2013:834825.

[20] Xue L, Zha L, Chen Q,et al. Randomized controlled trials of proximal femoral nail antirotation in lateral decubitus and supine position on treatment of intertrochanteric fractures. ScientificWorldJournal. 2013;2013:276015.

[21] Yang YH, Wang YR, Jiang SD,et al. Proximal femoral nail antirotation and third-generation Gamma nail: which is a better device for the treatment of intertrochanteric fractures.Singapore Med J. 2013;54(8):446-450.

[22] Huang FT, Lin KC, Yang SW,et al. Comparative study of the proximal femoral nail antirotation versus the reconstruction nail in the treatment of comminuted proximal femoral fracture.Orthopedics. 2012;35(1):e41-47.

[23] Gong H, Wang L, Zheng D,et al. The potential application of functionally graded material for proximal femoral nail antirotation device.Med Hypotheses. 2012;79(3):415-417.

[24] Frei HC, Hotz T, Cadosch D,et al. Central head perforation, or "cut through," caused by the helical blade of the proximal femoral nail antirotation.J Orthop Trauma. 2012;26(8): e102-107.

[25] Fliri L, Lenz M, Boger A,et al. Ex vivo evaluation of the polymerization temperatures during cement augmentation of proximal femoral nail antirotation blades.J Trauma Acute Care Surg. 2012;72(4):1098-1101.

[26] Takigami I, Ohnishi K, Ito Y,et al. Acetabular perforation after medial migration of the helical blade through the femoral head after treatment of an unstable trochanteric fracture with proximal femoral nail antirotation (PFNA): a case report.J Orthop Trauma. 2011;25(9):e86-89.

[27] Lv C, Fang Y, Liu L,et al.The new proximal femoral nail antirotation-Asia: early results.Orthopedics. 2011;34(5):351.

[28] Han N, Sun GX, Li ZC,et al.Comparison of proximal femoral nail antirotation blade and reverse less invasive stabilization system-distal femur systems in the treatment of proximal femoral fractures.Orthop Surg. 2011;3(1):7-13.

[29] Garg B, Marimuthu K, Kumar V,et al. Outcome of short proximal femoral nail antirotation and dynamic hip screw for fixation of unstable trochanteric fractures. A randomised prospective comparative trial.Hip Int. 2011;21(5):531-536.

[30] Cheung JP, Chan CF.Cutout of proximal femoral nail antirotation resulting from blocking of the gliding mechanism during fracture collapse.J Orthop Trauma. 2011;25(6):e51-55.

[31] Xu YZ, Geng DC, Mao HQ,et al. A comparison of the proximal femoral nail antirotation device and dynamic hip screw in the treatment of unstable pertrochanteric fracture.J Int Med Res. 2010;38(4):1266-1275.

[32] Xu Y, Geng D, Yang H,et al.Treatment of unstable proximal femoral fractures: comparison of the proximal femoral nail antirotation and gamma nail 3.Orthopedics. 2010;33(7):473.

[33] Wang WY, Yang TF, Fang Y,et al.Treatment of subtrochanteric femoral fracture with long proximal femoral nail antirotation. Chin J Traumatol. 2010;13(1):37-41.

[34] Wang WY, Liu L, Wang GL,et al.Ipsilateral basicervical femoral neck and shaft fractures treated with long proximal femoral nail antirotation or various plate combinations: comparative study.J Orthop Sci. 2010;15(3):323-330.

[35] Tang X, Liu L, Yang TF,et al. Preliminary effect of proximal femoral nail antirotation on emergency treatment of senile patients with intertrochanteric fracture.Chin J Traumatol. 2010;13(4):212-216.

[36] Sahin S, Ertürer E, Oztürk I,et al. Radiographic and functional results of osteosynthesis using the proximal femoral nail antirotation (PFNA) in the treatment of unstable intertrochanteric femoral fractures.Acta Orthop Traumatol Turc. 2010;44(2):127-134.

[37] Liu Y, Tao R, Liu F,et al. Mid-term outcomes after intramedullary fixation of peritrochanteric femoral fractures using the new proximal femoral nail antirotation (PFNA).Injury. 2010;41(8):810-817.

[38] Kristek D, Lovri? I, Kristek J,et al.The proximal femoral nail antirotation (PFNA) in the treatment of proximal femoral fractures.Coll Antropol. 2010;34(3):937-940.

[39] Zou J, Xu Y, Yang H.A comparison of proximal femoral nail antirotation and dynamic hip screw devices in trochanteric fractures.J Int Med Res. 2009;37(4):1057-1064.

[40] Schmidt-Rohlfing B, Heussen N, Knobe M,et al. Reoperation rate after internal fixation of intertrochanteric femur fractures with the percutaneous compression plate: what are the risk factors. J Orthop Trauma. 2013;27(6):312-317.

[41] Rubio-Avila J, Madden K, Simunovic N,et al.Tip to apex distance in femoral intertrochanteric fractures: a systematic review.J Orthop Sci. 2013;18(4):592-598.

[42] Pui CM, Bostrom MP, Westrich GH,et al. Increased Complication Rate Following Conversion Total Hip Arthroplasty After Cephalomedullary Fixation For Intertrochanteric Hip Fractures: A Multi-center Study.J Arthroplasty. 2013;28(8 Suppl):45-47.

[43] Barton TM, Gleeson R, Topliss C,et al. A comparison of the long gamma nail with the sliding hip screw for the treatment of AO/OTA 31-A2 fractures of the proximal part of the femur: a prospective randomized trial. J Bone Joint Surg Am. 2010; 92(4):792-798.

[44] Zhang S, Zhang K, Jia Y,et al. InterTan nail versus Proximal Femoral Nail Antirotation-Asia in the treatment of unstable trochanteric fractures.Orthopedics. 2013;36(3):e288-294.

[45] Sahin EK, Imerci A, K?n?k H,et al. Comparison of proximal femoral nail antirotation (PFNA) with AO dynamic condylar screws (DCS) for the treatment for unstable peritrochanteric femoral fractures. Eur J Orthop Surg Traumatol. 2013. [Epub ahead of print]

[46] Kumbaraci M, Karapinar L, Incesu M,et al. Treatment of bilateral simultaneous subtrochanteric femur fractures with proximal femoral nail antirotation (PFNA) in a patient with osteopetrosis: case report and review of the literature.J Orthop Sci. 2013;18(3):486-489.

[47] Huang Y, Zhang C, Luo Y. A comparative biomechanical study of proximal femoral nail (InterTAN) and proximal femoral nail antirotation for intertrochanteric fractures. Int Orthop. 2013. [Epub ahead of print]

[48] Fensky F, Nüchtern JV, Kolb JP,et al. Cement augmentation of the proximal femoral nail antirotation for the treatment of osteoporotic pertrochanteric fractures--a biomechanical cadaver study.Injury. 2013;44(6):802-807.

[49] Zeng C, Wang YR, Wei J,et al.Treatment of trochanteric fractures with proximal femoral nail antirotation or dynamic hip screw systems: a meta-analysis.J Int Med Res. 2012;40(3): 839-851.

[50] Wang WY, Yang TF, Liu L,et al. A comparative study of ipsilateral intertrochanteric and femoral shaft fractures treated with long proximal femoral nail antirotation or plate combinations.Orthop Surg. 2012;4(1):41-46.

[51] Vaquero J, Munoz J, Prat S,et al. Proximal Femoral Nail Antirotation versus Gamma3 nail for intramedullary nailing of unstable trochanteric fractures. A randomised comparative study. Injury. 2012;43 Suppl 2:S47-54.

[52] Bjørgul K, Reikerås O. Outcome after treatment of complications of Gamma nailing: a prospective study of 554 trochanteric fractures.Acta Orthop. 2007;78(2):231-235.

[53] Stern R. Are there advances in the treatment of extracapsular hip fractures in the elderly. Injury. 2007;38 Suppl 3:S77-87.

[54] Sears BR, Ostrum RF, Litsky AS. A mechanical study of gap motion in cadaveric femurs using short and long supracondylar nails.J Orthop Trauma. 2004;18(6):354-360.