A comparison of two fixation methods for femoral trochanteric fractures: a new generation intramedullary system vs sliding hip screw

Abstract

SummaryIntroduction. Trochanteric fractures are frequent and generally associated with bone fragility. There is still debate on the best fixation device to treat stable or rather stable trochanteric fractures: we report our clinical and radiological results of fixation with Proximal Femoral Nail "antirotation" (PFNa) in a population of patients compared to a control group treated by Sliding Hip Screw (SHS). Materials and methods. A prospective study was conducted in 71 consecutive patients treated by PFNa (group A), and 69 by a SHS (group B), with a mean age of 81.6 and 83.4 years respectively. Short Form 12 was administered to check postoperative results, and the following parameters were evaluated: range of motion, evaluation of pain, gait ability, X-rays, and Tip Apex Distance Index. Results. A minimum follow-up was conducted in 128 patients: 66 subjects belonging to the PFNa group and 62 to the DHS group. All patients in the group A were able to reach partial or full weight-bearing on the operated leg before leaving the hospital. Forty-four patients (63.8%) of the group B were able to walk with partial weight-bearing before discharge. We recorded 17 complications with a final overall percentage of 17.2% on the overall study population with one single case of failure in both the two groups. Discussion. A statistical significance (p<0.01) of superiority for PFNa was demonstrated regarding surgical time, amplioscope time, intraoperative blood loss, hospital stay, recovery of weight-bearing before discharge. Less significant results (p<0.05) were found for walking ability at the three-months follow-up and patients' satisfaction 6 months after surgery. Conclusions. PFNa may be considered an useful choice for the treatment of stable or rather stable trochanteric

High risks of failure observed for A1 trochanteric femoral fractures treated with a DHS compared to the PFNA in a prospective observational cohort study

“…Cognitive impairment was defined as a previously diagnosed form of dementia or a Six Item Cognitive Impairment Test (6CIT) score of ≥ 11 upon admission. The prefracture independence in activities of daily living was rated using the Katz Index of Independence in Activities of Daily Living (Katz ADL), categorized into two groups: independent (0-1) and dependent (3)(4)(5)(6) [11]. The prefracture mobility was subdivided in three groups: independent mobility, mobile with a walking aid (walking stick, crutch or stroller) or no independent mobility [26].…”

“…Many studies comparing intramedullary nails and extramedullary implants in trochanteric fractures find only minor differences in implant failure rates. These range between 0 and 6% for the DHS and between 0 and 3% for the PFNA [1,4,5,20,30]. A systematic review by Parker et al (2008) comparing intramedullary nails and extramedullary implants for extracapsular hip fractures demonstrated higher rates of surgical complications for intramedullary nails, but included only one study involving the PFNA [17,18].…”

Migration of the Lag Screw after Intramedullary Treatment of AO/OTA 31.A2.1-3 Pertrochanteric Fractures Does Not Result in Higher Incidence of Cut-Outs, Regardless of Which Implant Was Used: A Comparison of Gamma Nail with and without U-Blade (RC) Lag Screw and Proximal Femur Nail Antirotation (PFNA)

“…An optimal operative treatment is immanent regarding the typical geriatric patient, benefiting from early mobilization and weight bearing in order to avoid immobility-related complications [1,2]. Additionally, the enormous socioeconomic impact has to be considered [1,2,3,4]. The best fixation method remains debated, with an overall tendency to use cephalomedullary implants [2,4,5] especially in unstable fracture patterns where the implant’s mechanical properties are superior to extramedullary systems [6,7,8,9].…”

“…Additionally, the enormous socioeconomic impact has to be considered [1,2,3,4]. The best fixation method remains debated, with an overall tendency to use cephalomedullary implants [2,4,5] especially in unstable fracture patterns where the implant’s mechanical properties are superior to extramedullary systems [6,7,8,9]. The Gamma Nail ® (Stryker Trauma, Murnau, Germany) and Proximal Femur Nail Antirotation (PFNA) ® (DePuy Synthes, Umkirch, Germany) are the most commonly used intramedullary nails for the treatment of pertrochanteric fractures.…”

Comparison of osteoporotic intertrochanteric fracture fixation using a proximal femoral nail with a helical blade and lag screw type proximal femoral nail

“…For fracture fixation, historically, two instruments are used, the sliding hip screw and proximal intramedullary nail (proximal femoral nail) [5,6]. While both instruments have been shown to have excellent outcomes, a trend toward using the proximal femoral nail has been observed in the modern era owing to its ease of application, shorter surgical time, and superior biomechanics [7][8][9][10][11]. As the prevalence of intertrochanteric fracture is high, numerous innovations have been made to improve the outcome by modifying the instrument design.…”