Comparison of the Clinical Effectiveness of PFNA, PFLCP, and DHS in Treatment of Unstable Intertrochanteric Femoral Fracture

Huang, Shouguo; Chen, Bin; Zhang, Yong; Nie, Fengfeng; Ju, Liang; Li, Ming; Zhang, Yinghua

doi:10.1097/mjt.0000000000000346

Cited by 34 publications

(43 citation statements)

References 21 publications

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“…A graph and summary of selection bias, performance bias, detection bias, attrition bias, reporting bias, and other biases identified in each RCT are shown in Figures 2 and 3. The randomization technique was not mentioned in 3 trials, [22,26,32] and the information of allocation concealment was not provided for 7 studies. [22–26,29,32] The term “blinding of outcome assessment” was assessed as “high risk” for 15 studies owing to no difference in the postoperative radiological data between the 2 groups.…”

Section: Resultsmentioning

confidence: 99%

A meta-analysis comparing intramedullary with extramedullary fixations for unstable femoral intertrochanteric fractures

et al. 2019

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Section: Resultsmentioning

confidence: 99%

A meta-analysis comparing intramedullary with extramedullary fixations for unstable femoral intertrochanteric fractures

et al. 2019

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“…During internal fixation of DHS, hip screws anchor less sclerotin and have a poor antirotation effect, resulting in prolonged operation time and increased intra-operative bleeding volume. Poor osteoarticular blood supply affects late recovery, which is likely to delay the healing process ( 8 , 9 ). Therefore, DHS fixation is not applicable in patients with severe osteoporosis or comminuted fracture in the lateral cortical bone of the femoral trochanter ( 10 ).…”

Section: Discussionmentioning

confidence: 99%

Comparison of efficacy, complications and TGF‑β2 expression between DHS and PFNA in elderly patients with osteoporotic femoral intertrochanteric fracture

et al. 2018

Exp Ther Med

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The aim of the present study was to compare the efficacy and complications of two fixation techniques, namely dynamic hip screw (DHS) and proximal femoral nail antirotation (PFNA), in the treatment of osteoporotic femoral intertrochanteric fracture in elderly patients, and to detect changes in transforming growth factor β2 (TGF-β2) expression in the two groups. A total of 100 elderly patients with femoral intertrochanteric fracture were randomly divided into two groups that were treated with either DHS or PFNA. Peri-operative complications were observed in the patients and ELISA was used to detect TGF-β2 expression levels at 1, 7, 15 and 30 days after surgical treatment. The clinical efficacy and the incidence rate of complications at 3 months after the operation were compared. In comparison with the DHS group, the PFNA group had a shorter operation time, a lower bleeding volume and a shorter post-operative weight-bearing time. The contents of TGF-β2 in the two groups at 7 days after the operation were higher than those at 1 day, reached a peak at 15 days and had gradually decreased again at 30 days after the operation. The contents of TGF-β2 at 1, 7 and 15 days in the PFNA group were higher than those at the identical time-points in the DHS group (P<0.01). Regarding the clinical efficacy in the two groups at 3 months of post-surgery, the rate of excellent/good efficacy in the PFNA fixation group (90.0%) was higher than that in the DHS fixation group (74.0%). Of note, PFNA fixation had a higher clinical efficacy, a shorter operation time, less intra-operative trauma, a relatively faster fracture healing process and fewer complications in comparison with DHS fixation, and is therefore more suitable for treating osteoporotic femoral intertrochanteric fracture in the elderly. PFNA fixation is superior to DHS fixation, which may be associated with the higher level of TGF-β2 expression in comparison with that in the DHS group.

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“…This rate was reported to be 1.5% and 2.6% and 3.6% in studies by Zhang and Chan and Setibudy, respectively [16].…”

Section: Screw Cutout and Device Failurementioning

confidence: 95%

“…Zhang et al showed 1.5%; Qiang et al 2.6%; Setiobudi et al 3.6% device failure in their patients [16].…”

Section: Screw Cutout and Device Failurementioning

confidence: 99%

An Assessment of the Relationship between Nonunion and Device Failure Following the Treatment of Intertrochanteric Fracture, by Dynamic Hip Screw (DHS) Using Arbeitsgemeinschaft fur Osteosynthesfrogen/Orthopedic Trauma Association (AO/OTA) and Dorr Classification

Torkaman¹,

Yazdi²,

Hamdollahzadeh³

et al. 2017

OJO

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Background: Intertrochanteric fractures are of intense interest globally. They are the most frequently operated fracture type, have the highest postoperative fatality rate of surgically treated fractures, and have become a serious health resource issue due to the high cost of care required after injury. A number of problems exist when determining the best option for treatment for intertrochanteric fractures. The classification systems do not work well enough for preoperative planning and the reduction criteria have not been well defined. Methods: All patients who presented to Firoozgar Hospital, Tehran with intertrochanteric fracture, between March 20th 2013 and December 21st 2015, underwent DHS implementation, after 6-month follow-up period. Demographic data, preoperative radiographic fracture, bone quality typing (AO/OTA and Dorr classification), American Society of Anesthesiologists (ASA) score and evaluation of their correlation with the complication of fixation including nonunion and device failure were recorded and analyzed. A. Torkaman et al. 3330 to 94 years; the most frequent age period was 76 -85 years, injured by low-energy trauma mechanism and 23.8% patients were injured in a highenergy trauma. 56 patients completed the 6-month follow-up evaluation which ranged from 1 to 80 weeks. According to AO/OTA classification, the most common type among the patient population was A2, 27 patients (51.5%); while the most common group from Dorr classification turned to be group B (39.6%). Classification by ASA score revealed Class II to be most frequent among the patient population (56.4%). Nonunion was seen in eight of patients (14.3%). Three patients (5.4%) had device failure, two cases showed side plate breakage, and another one had screw cut out. There was no significant relationship between AO/OTA classification with the both complications i.e. the development of device failure (P = 0.85) and nonunion (P = 0.99). Non-significant correlation was found between Dorr classification with device failure (P = 0.06) and nonunion (P = 0.11). Conclusion: Regarding recent studies, more effective factor on the outcome is patient's medical condition before surgery compared to the radiographic findings including AO/OTA and Dorr classification.

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Comparison of the Clinical Effectiveness of PFNA, PFLCP, and DHS in Treatment of Unstable Intertrochanteric Femoral Fracture

Cited by 34 publications

References 21 publications

A meta-analysis comparing intramedullary with extramedullary fixations for unstable femoral intertrochanteric fractures

A meta-analysis comparing intramedullary with extramedullary fixations for unstable femoral intertrochanteric fractures

Comparison of efficacy, complications and TGF‑β2 expression between DHS and PFNA in elderly patients with osteoporotic femoral intertrochanteric fracture

An Assessment of the Relationship between Nonunion and Device Failure Following the Treatment of Intertrochanteric Fracture, by Dynamic Hip Screw (DHS) Using Arbeitsgemeinschaft fur Osteosynthesfrogen/Orthopedic Trauma Association (AO/OTA) and Dorr Classification

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