A Multicenter Randomized Control Trial Comparing a Novel Intramedullary Device (InterTAN) Versus Conventional Treatment (Sliding Hip Screw) of Geriatric Hip Fractures

Sanders, David; Bryant, Dianne; Tieszer, Christina; Lawendy, Abdel-Rahman; MacLeod, Mark; Papp, Steven; Liew, Allan; Viskontas, Darius; Coles, Chad P.; Gurr, Kevin R.; Carey, Tim; Gofton, Wade; Bailey, Chris; Bartley, Debra; Trenholm, Andrew; Stone, Trevor; Leighton, Ross; Foxall, Julia; Zomar, Mauri; Trask, Kelly

doi:10.1097/bot.0000000000000713

Cited by 51 publications

(35 citation statements)

References 48 publications

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“…CM nailing has proved especially popular for the treatment of unstable intertrochanteric and subtrochanteric hip fractures [ 35 ]. Indeed, patients experience an improved outcome when an intramedullary nail is used to treat their unstable intertrochanteric fracture [ 36 ]. CM nailing, compared with SHS, is associated with a shorter operating time, reduced intra-operative blood loss, and improved walking ability in unstable hip fractures [ 37 , 38 ].…”

Section: Discussionmentioning

confidence: 99%

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

Aicale

Maffulli

2018

J Orthop Surg Res

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BackgroundTo 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.MethodsBetween 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).ResultsThere 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).ConclusionTo 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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Section: Discussionmentioning

confidence: 99%

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

Aicale

Maffulli

2018

J Orthop Surg Res

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“…Sub-group analysis showed that active and functional patients with unstable trochanteric fractures have better outcome regarding less shortening, better Functional Independence Measure (FIM) and Timed Up and Go test (TUG) after one year follow-up when the Trigen Intertan nail is used. 40 More prospective randomized comparative studies of recent dual lag screw systems with other fixation types are warranted to conclude what osteosynthesis is preferable in unstable trochanteric fractures.…”

Section: Discussionmentioning

confidence: 99%

Z-effect after intramedullary nailing systems for trochanteric femur fractures

Smeets

Kuijt

Eerten

2017

Chinese Journal of Traumatology

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PurposeThe aim of this study was to investigate the incidence of Z-effect after dual lag screw intramedullary nailing systems and risk factors contributing to this effect. We hypothesized that long nails provide more neck strength due to a longer lever than short nails and are therefore less likely to develop a misbalance of a higher head compressive strength than neck compressive strength.MethodsIn this retrospective cohort study 103 patients treated operatively with a dual lag screw intramedullary nailing device for (sub)trochanteric hip fracture were included. We analysed patient charts regarding patient and operation characteristics. Furthermore we conducted radiologic measurements within the 2-year follow-up period to investigate the quality of fracture fixation, implant failure and predictors for Z-effect. The re-operation risk was investigated with multivariate regression analysis.ResultsThe incidence of (reversed) Z-effect in this study was 9% (n = 80); 6 out of 7 Z-effects occurred in the short nail group, which was not significant. Patients who were treated with a long nail had a significant larger number of complications in comparison with the short nail group (median 2 vs 0.5, p = 0.001). The long nail group received more often erythrocytes blood transfusions (82% vs 31%, p < 0.01) and had a longer hospital stay (13 vs 21 days, p < 0.05). Migration of lag screws (p <0.05) and unstable fracture type (p < 0.05), were risk factors for re-operation. The re-operation rate within 2 year after surgery was 21%, of which one fourth was due to a Z-effect.ConclusionThe nail length was not associated with the development of a Z-effect. Migration of lag screws after intramedullary nailing is common and a risk factor for re-operation.

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“…Human joint moment prediction is crucial to rehabilitation evaluation [1][2][3], athlete training evaluation [4][5][6], prosthesis and orthosis design [7][8][9], intramedullary device design [10][11][12] and human-robot interaction [13][14][15][16][17][18][19][20][21]. The precise prediction of joint moment can be fulfilled by the use of instrumented implants [22] which measures the relevant parameters of joint load in real time.…”

Section: Introductionmentioning

confidence: 99%

Determining the Online Measurable Input Variables in Human Joint Moment Intelligent Prediction Based on the Hill Muscle Model

Xiong

Zeng

et al. 2020

Sensors

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Introduction: Human joint moment is a critical parameter to rehabilitation assessment and human-robot interaction, which can be predicted using an artificial neural network (ANN) model. However, challenge remains as lack of an effective approach to determining the input variables for the ANN model in joint moment prediction, which determines the number of input sensors and the complexity of prediction. Methods: To address this research gap, this study develops a mathematical model based on the Hill muscle model to determining the online input variables of the ANN for the prediction of joint moments. In this method, the muscle activation, muscle-tendon moment velocity and length in the Hill muscle model and muscle-tendon moment arm are translated to the online measurable variables, i.e., muscle electromyography (EMG), joint angles and angular velocities of the muscle span. To test the predictive ability of these input variables, an ANN model is designed and trained to predict joint moments. The ANN model with the online measurable input variables is tested on the experimental data collected from ten healthy subjects running with the speeds of 2, 3, 4 and 5 m/s on a treadmill. The variance accounted for (VAF) between the predicted and inverse dynamics moment is used to evaluate the prediction accuracy. Results: The results suggested that the method can predict joint moments with a higher accuracy (mean VAF = 89.67±5.56 %) than those obtained by using other joint angles and angular velocities as inputs (mean VAF = 86.27±6.6%) evaluated by jack-knife cross-validation. Conclusions: The proposed method provides us with a powerful tool to predict joint moment based on online measurable variables, which establishes the theoretical basis for optimizing the input sensors and detection complexity of the prediction system. It may facilitate the research on exoskeleton robot control and real-time gait analysis in motor rehabilitation.

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A Multicenter Randomized Control Trial Comparing a Novel Intramedullary Device (InterTAN) Versus Conventional Treatment (Sliding Hip Screw) of Geriatric Hip Fractures

Abstract: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Cited by 51 publications

References 48 publications

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

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

Z-effect after intramedullary nailing systems for trochanteric femur fractures

Determining the Online Measurable Input Variables in Human Joint Moment Intelligent Prediction Based on the Hill Muscle Model

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