Cement distribution and initial fixability of trochanteric fixation nail advanced (TFNA) helical blades

Mitsuzawa, Sadaki; Matsuda, Shinya

doi:10.1016/j.injury.2021.10.028

Cited by 6 publications

(9 citation statements)

References 30 publications

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“…These better results with CA on postoperative mobility are consistent with the findings of previous studies that show a high proportion of RPAL [28] and weight-bearing [29] in patients with CA. As reported in earlier studies [9,[28][29][30][31][32] (Table 5), we speculate that CA enhances a patient's initial mechanical stability, leading to an improved ADL score due to sufficient stability in the early postoperative period.…”

Section: Discussionsupporting

confidence: 80%

“…There are conflicting studies regarding the effectiveness of CA on pain reduction (Table 5). Two studies reported significant pain reduction at postoperative week 2 and at 12 months [32,33], but another study showed no such effect at 6 months postoperatively [31]. The inconsistent results may be partly due to the fact that these previous observational studies did not adjust for confounders in their statistical models.…”

Section: Discussionmentioning

confidence: 97%

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Effectiveness of Cement Augmentation on Early Postoperative Mobility in Patients Treated for Trochanteric Fractures with Cephalomedullary Nailing: A Prospective Cohort Study

Mochizuki¹,

Yamamoto

Fujii³

et al. 2022

JPM

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Fixation using cephalomedullary nails (CMNs) with additional cement augmentation (CA) was developed as a novel treatment option for the osteosynthesis of osteoporotic trochanteric fractures, though the effectiveness of CA on early postoperative mobility remains uncertain. This multicenter prospective cohort study aimed to estimate the effectiveness of CA on early postoperative mobility in patients with trochanteric fractures. We enrolled patients with femoral trochanteric fractures aged > 60 years who were able to walk independently before the injury. The primary outcome was the postoperative 3-day cumulated ambulation score (CAS); the secondary outcome was the visual analog scale (VAS) pain score at rest and during movement on postoperative days 1–3. The outcomes of the patients treated using CMNs with or without CA were compared. Sixty-three eligible patients were categorized into CA (n = 32) and control (n = 31) groups. In univariate analysis, the CA group had significantly higher CAS values, lower VAS scores at rest on day 1 postoperatively, and lower VAS scores during movement on day 3. In multivariable linear regression analyses, the CA group had significantly higher CAS values (beta, 2.1; 95% confidence interval, 0.5 to 3.6; p = 0.01). The CA group had a negative adjusted beta value in their VAS scores during movement. This study indicated that CA was associated with a high CAS value in patients with geriatric trochanteric fractures. However, CA was not associated with pain reduction at rest and during movement during the initial postoperative days.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 97%

Effectiveness of Cement Augmentation on Early Postoperative Mobility in Patients Treated for Trochanteric Fractures with Cephalomedullary Nailing: A Prospective Cohort Study

Mochizuki¹,

Yamamoto

Fujii³

et al. 2022

JPM

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“…Data were presented as the mean ± standard deviation (SD) and analyzed using JMP Pro 15.0 (SAS Institute, Cary, NC, USA). A priori analysis of sample size was calculated with a power of 0.80 / α error of 0.05, using G*power 3.1 (Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany), according to the previous study [ 10 ]. The Student’s t -test was used to compare the demographic data, radiographic parameters, and clinical outcomes of the Blade and Screw groups.…”

Section: Methodsmentioning

confidence: 99%

“…There have been no reports of cut-out or cut-through complications with cement augmentation [ 8 , 9 ]. Because the amount and distribution of injected cement in the femoral head is important for mechanical stability, we previously examined the distribution of cement around the TFNA helical blade in detail using computed tomography (CT) [ 10 ]. The TFNA system holds the perforated lag screw as well as the perforated helical blade.…”

Section: Introductionmentioning

confidence: 99%

Which head element is more effective for cement augmentation of TFNA? Helical blade versus lag screw

Mitsuzawa,

Nakamata,

Mitamura

et al. 2023

BMC Musculoskelet Disord

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Background Early fixation and rehabilitation is the gold standard treatment for intertrochanteric femur fractures. Cement augmentation through perforated head elements has been developed to avoid postoperative complications such as cut-out or cut-through. The purpose of this study was to compare two head elements in terms of cement distribution using computed tomography (CT) and to examine their initial fixation and clinical outcomes. Methods Elderly patients who had intertrochanteric fractures were treated with a trochanteric fixation nail advanced (TFNA) helical blade (Blade group) or a TFNA lag screw (Screw group). In both groups, 4.2 mL of cement was injected under an image intensifier (1.8 mL of cement was directed cranially and 0.8 mL each caudally, anteriorly, and posteriorly). Patient demographics and clinical outcome were investigated post-operatively. Cement distribution from the center of the head element was evaluated with CT. Maximum penetration depth (MPD) were measured in the coronal and sagittal planes. On each axial plane, the cross-sectional areas in the cranial, caudal, anterior and posterior directions were calculated. The sum of cross-sectional areas (successive 36 slices) was defined as the volume of the head element. Results The Blade group included 14 patients, and the Screw group included 15 patients. In the Blade group, MPD in the anterior and caudal direction was significantly greater than that in the posterior direction (p < 0.01). In the Screw group, volume in the cranial and posterior direction was significantly greater than that in the Blade group (p = 0.03). Subsequently, the total volume in the Screw group was significantly larger than that in the Blade group (p < 0.01). No significant correlation was detected between bone mineral density, T score, young adult mean, and total cement volume. Change in radiographic parameters and clinical outcome such as Parker score and visual analog scale were similar in both groups. No patients suffered from cut-out / cut through or non-union. Conclusions The position of cement distribution through the lag screw is different from that through the helical blade, and the total volume of the head element is significantly larger in the lag screw. Both groups had similarly effective results in terms of mechanical stability after surgery, postoperative pain and early phase of rehabilitation. Trial registration Current Controlled Trials ISRCTN45341843, 24/12/2022, Retrospectively registered.

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“…Actually, cut-out is highly associated with the placement of the cephalic fixator tip (7)(8)(9)(10)(11)(12)(13)(14)(15). Furthermore, the cephalic fixator should locate in the geometric center of the transversal surface of the femoral head.…”

Section: Introductionmentioning

confidence: 99%

Eccentric distance zone analysis system: New regional evaluation of cephalic fixator tip location for predicting cut-out in geriatric intertrochanteric fractures with internal fixation

Yang

Huang²,

Gao³

et al. 2022

Front. Surg.

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ObjectiveThe aim of this study was to investigate an eccentric distance (ED) zone analysis system for regional evaluation of the cephalic fixator tip based on the ED of the cephalic fixator tip referenced to the radius of its own femoral head to predict cut-out in intertrochanteric fractures (ITF) with internal fixation.MethodsFirst, we assumed all the femoral heads were regular spheres with the radius (RFD) of “3” for a complete match of the Cleveland zone system and calculated the ED of the cephalic fixator tip by measuring the distances from the cephalic fixator tip to the geometric central axis in the femoral neck and head on both anteroposterior (AP) view and lateral view radiographs. Second, we defined the maximum transverse section of the femoral head into three zones named ED Zone A with ED less than “1,” Zone B with ED ranging in “1–2,” and Zone C with ED ranging in “2–3” in turns by concentric circles (circles A, B, and C) with the radius of 1/3, 2/3, and 3/3 times of RFD, respectively. Third, we evaluated the ED zones according to the ED and location of the cephalic fixator tip in the eligible 123 ITF patients with single-screw cephalomedullary nail (SCMN) fixation and then analyzed the correlation between the cut-out rate and the ED zones.ResultsThe cut-out rates in ED Zones A, B, and C were 4.17%, 38.46%, and 100%, respectively. Multivariate logistic regression indicated that ED Zone A had at least a 14 times lower rate of cut-out compared with ED Zone B. The cephalic fixator tip located in ED Zone A has a lower cut-out rate than that in Cleveland Zone 5. The cut-out rate in ED Zone A is significantly lower than that in the region inside Cleveland Zone 5 but outside ED Zone A.ConclusionED zone analysis system is a reliable regional evaluation of the cephalic fixator tip position for predicting cut-out in geriatric ITF patients with SCMN fixations and potentially an artificial intelligence measurement during surgery. For decreasing the cut-out rate, the cephalic fixator tip should be located in ED Zone A.

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Cement distribution and initial fixability of trochanteric fixation nail advanced (TFNA) helical blades

Cited by 6 publications

References 30 publications

Effectiveness of Cement Augmentation on Early Postoperative Mobility in Patients Treated for Trochanteric Fractures with Cephalomedullary Nailing: A Prospective Cohort Study

Effectiveness of Cement Augmentation on Early Postoperative Mobility in Patients Treated for Trochanteric Fractures with Cephalomedullary Nailing: A Prospective Cohort Study

Which head element is more effective for cement augmentation of TFNA? Helical blade versus lag screw

Eccentric distance zone analysis system: New regional evaluation of cephalic fixator tip location for predicting cut-out in geriatric intertrochanteric fractures with internal fixation

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