Biomechanical Comparison of Three Different Intramedullary Nails for Fixation of Unstable Basicervical Intertrochanteric Fractures of the Proximal Femur: Experimental Studies

Kwak, Dae-Kyung; Kim, Won-Hyeon; Lee, Sung-Jae; Rhyu, Sang-Hyun; Jang, Chul-Young; Yoo, Je-Hyun

doi:10.1155/2018/7618079

Cited by 46 publications

(45 citation statements)

References 39 publications

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“…However, they did not describe and compare the BMD, details of fracture patterns such the presence of a basicervical component and comminution of the anterior cortex, and quality of reduction, which can affect fixation failures such as cut-out. Further, they did not describe cut-through (the specific failure feature of PFNA), which is more likely to be caused by greater migration of the PFNA blade within the femoral head, as shown in a previous biomechanical study 33 . Finally, their cohort was relatively smaller than our cohort.…”

Section: Discussionmentioning

confidence: 93%

Gamma3 nail with U-Blade (RC) lag screw is effective with better surgical outcomes in trochanteric hip fractures

Han

Jung

Jang

et al. 2020

Sci Rep

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The objective of this retrospective study was to investigate the surgical outcomes of AO/OTA 31 A1-3 trochanteric fractures treated with the new-generation Gamma3 nail with U-Blade (RC) lag screw and to analyze the risk factors related to fixation failure. A total of 318 consecutive patients who underwent cephalomedullary nailing using Gamma3 nail with U-Blade lag screw for trochanteric hip fractures between September 2015 and June 2018 were enrolled. The average age was 80 years and most patients (69%) were women. The mean follow-up was 12.2 months with a minimum of 6 months. 309 (97.2%) showed bony union with a mean time to union of 13.5 ± 8.7 weeks. Cutout occurred in 2 patients (0.6%) and 7 patients showed excessive collapse (≥15 mm) of the proximal fragment. These 9 patients were assigned to the failure group. The presence of a basicervical fracture component and comminution of the anterior cortex on preoperative 3-D CT showed a significant association with fixation failure, including cutout , although comminution of the anterior cortex was the only independent risk factor for fixation failure on multivariate logistic regression analysis. Gamma3 nail with U-Blade lag screw showed favorable results for trochanteric hip fractures, with low cutout rate (0.6%). However, more caution is required in treating trochanteric fractures with a basicervical fracture component and anterior cortex comminution even with this nail.

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Section: Discussionmentioning

confidence: 93%

Gamma3 nail with U-Blade (RC) lag screw is effective with better surgical outcomes in trochanteric hip fractures

Han

Jung

Jang

et al. 2020

Sci Rep

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“…Compared with other fixation devices, PFNA‐II had the greatest failure load and structural stability. PFNA‐II was also more effective in minimizing the rotation instability of the proximal fragment in basicervical fractures.…”

Section: Discussionmentioning

confidence: 94%

Management of Low‐Energy Basicervical Proximal Femoral Fractures by Proximal Femoral Nail Anti‐Rotation

Wang

et al. 2019

Orthopaedic Surgery

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Objective: To evaluate clinical and radiological outcomes of proximal femoral nail anti-rotation (PFNA-II) devices and demonstrate the effectiveness of PFNA-II for the treatment of basicervical fractures in elderly patients. Methods:A retrospective review of all patients treated with PFNA-II for a proximal femoral fracture between January 2013 and February 2017 at three different institutions (Shanghai General Hospital, Shanghai Punan Hospital and Shanghai Seventh People's Hospital) was conducted. The X-ray films were strictly reviewed by three trauma surgeons and a professional radiology doctor. Patients over 60 years of age who met the following criteria were included: (i) sustained low-energy trauma; (ii) a two-part fracture; (iii) fracture line located at the base of the femoral neck and that was medial to the intertrochanteric line and exited above the lesser trochanter but was more lateral than a classic transcervical fracture. Follow-up time should be longer than 6 months. A total of 52 patients who met the inclusion criteria were selected. The average age at diagnosis was 75.1 years (range, 63-91 years); 13 patients were men and 39 were women. The same proximal femoral nail anti-rotation devices and the same surgical procedures were applied to all patients. Postoperative radiographic union time and modified Harris hip scores were used as major indicators for evaluating the effectiveness of surgery. Results:The average follow-up period was 22.5 months (18.5, 23.9, and 21.2 months, respectively) and radiographic unions were observed at an average of 19.6 weeks (range, 12-28 weeks). The patients were evaluated immediately after surgery, as well as 6 weeks, 3 months, 6 months, 1 year, and 2 years postoperatively. Of the 49 patients, 38 had good reduction qualities (75.5%), 9 acceptable (18.3%), and 3 poor (6.1%). Radiographic union was confirmed in all fractures at an average of 19.6 weeks (range, 12-28 weeks). The mean Harris hip score was 84.9 (range, 65-99): excellent in 9 patients (18.36%), good in 30 (61.22%), medium in 8 (16.32%), and poor in 2 (4.08%). Slight persistent pain occurred in 3 patients, but these patients could still walk with the help of a cane. Two patients had symptoms of excessive telescoping. Eight patients experienced postoperative medical complications, mainly pneumonia and urinary tract infection.Conclusion: Based on the clinical and radiological outcomes, the PFNA-II devices provide strong rotational stability and excellent clinical prognosis, and are an appropriate treatment option for basicervical proximal femoral fracture in elderly patients.

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“…Of course, elderly patients cannot be excluded because of their low activity level, which results in a low amount of weight‐bearing on the femoral head and a low pressure on the femoral head; this results in a low incidence of femoral head necrosis, which requires follow‐up analysis of large samples in the future. In addition, after the spiral blade is inserted into the femoral head and neck, the blade cannot rotate and the bone anchor closes tightly with the greatest degree of bone filling pressure and anchorage force, which is not easy to loosen, with the greatest degree of bone filling pressure and anchor force; thus, this procedure is more suitable for patients with fractures due to osteoporosis or instability and is advantageous for patients who participate in early weight‐bearing. This procedure can improve that curative effect.…”

Section: Discussionmentioning

confidence: 99%

Procedure for Femoral Intertrochanteric Fractures using the “Three‐Finger Method” Assisted by Proximal Femoral Nail Antirotation

Cheng

Lin

Zhu

et al. 2020

Orthopaedic Surgery

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Objective: To assess long-term follow-up evaluations for the treatment of femoral intertrochanteric fractures with the "three-finger method" assisted by proximal femoral nail antirotation (PFNA). , 123 patients were selected and followed for the treatment of femoral intertrochanteric fractures with PFNA assisted by the "three-finger method" (application of the index finger, middle finger, and ring finger in the process of surgery to assist PFNA). There were 56 male patients and 67 female patients aged 52-93 years with an average age of 75.6 years, and 88 cases were due to a fall and 35 due to a traffic accident injury. The femoral necks were fixed with PFNA assisted by the "three-finger method" applying the following procedure: traction reduction, determining the incision, inserting the needle, and placing screw. The Harris hip score, postoperative complications, hip pain and function status were statistically analyzed to evaluate the surgical efficacy and to discuss the surgical technique of the "three-finger method" assisted by PFNA.Results: According to the Harris scoring criteria, patients were followed for 1, 2, 4, 6, and 8 years, and the good outcomes of patients were recorded. The excellent and good rate of 87% was the highest in the second year of follow-up. Then, the rate decreased following the eighth year of follow-up. The excellent and good rate of 82.7% was the lowest. The patients with incisions healed well, there were no instances of fat liquefaction or infection. There were three cases of effusion, the rate was 2.4%. The secretions were cultured, and no bacterial growth was found. After treatment of the wound, it healed, and the spiral blade used for the femoral head did not wear out. There was one case of femoral head necrosis. There was no significant correlation between hip pain and sex and age (P > 0.05), and the function of the hip joint was significantly correlated with the age of the patients (P < 0.05). Conclusion:The "three-finger method" in the process of surgery to assist PFNA for the treatment of patients with intertrochanteric fractures of the femur simplified the operation steps, reduced the operation difficulty, shortened the operation time, improved the operation efficiency, and reduced the incidence of postoperative complications.

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Biomechanical Comparison of Three Different Intramedullary Nails for Fixation of Unstable Basicervical Intertrochanteric Fractures of the Proximal Femur: Experimental Studies

Cited by 46 publications

References 39 publications

Gamma3 nail with U-Blade (RC) lag screw is effective with better surgical outcomes in trochanteric hip fractures

Gamma3 nail with U-Blade (RC) lag screw is effective with better surgical outcomes in trochanteric hip fractures

Management of Low‐Energy Basicervical Proximal Femoral Fractures by Proximal Femoral Nail Anti‐Rotation

Procedure for Femoral Intertrochanteric Fractures using the “Three‐Finger Method” Assisted by Proximal Femoral Nail Antirotation

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