Controlled study on Gamma nail and proximal femoral locking plate for unstable intertrochanteric femoral fractures with broken lateral wall

Han, Lei; Liu, Jingjing; Hu, Yun-Gen; Quan, Renfu; Fang, Weili; Jin, Bo; Lin, Weilong

doi:10.1038/s41598-018-28898-6

Cited by 17 publications

(17 citation statements)

References 24 publications

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“…Although the difference was not significant, higher blood loss in the PFN group could be attributed to the more frequently required open reduction with wider incision and opening fracture hematoma which led to more blood loss. Intraoperative blood loss for our PFN group was comparable to that of Han et al,[ 21 ] but considerably less in the Zhang et al’s[ 22 ] study. According to Madsen et al,[ 19 ] the DHS group lost more blood than the TSP group.…”

Section: Discussionsupporting

confidence: 80%

“…Likewise, in another study, 20 patients with unstable trochanteric fractures and lateral wall fractures were treated with PFN. [ 21 ] The patients started partial weight-bearing one week after surgery. Zhang et al[ 22 ] reported that using intramedullary fixation to treat unstable intertrochanteric femoral fractures was encouraging.…”

Section: Discussionmentioning

confidence: 99%

“…The findings from Klinger et al[ 20 ] were similar to ours, 11 weeks for PFN and 12.5 weeks for DHS and TSP; however, it did not reach statistical significance. The time to union in the studies by Han et al[ 21 ] and Zhang et al[ 22 ] was 18.8 and 16 weeks, respectively.…”

Section: Discussionmentioning

confidence: 99%

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Functional and radiological outcomes of dynamic hip screw with trochanteric stabilizing plate versus short proximal femoral nail in management of unstable trochanteric fractures: A randomized-controlled trial

Kassem¹,

Younan²,

Abaskhron³

et al. 2022

Jt Dis Relat Surg

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Objectives This study aims to compare dynamic hip screw (DHS) with trochanteric stabilizing plate (TSP) versus short proximal femoral nail (PFN) in unstable trochanteric fractures in terms of the functional and radiological outcomes. Patients and methods Between June 2019 and March 2020, a total of 68 patients (32 males, 36 females; mean age: 69.7±8.2 years; range, 60 to 88 years) with unstable trochanteric fractures were included in this randomized-controlled trial. Eligible patients were randomized to undergo DHS with TSP (n=34) or short PFN (n=34) and followed for 12 months. The outcome measures including Harris Hip Score (HHS), operating room time, the amount of blood loss and need for intraoperative transfusion, return to activity, time to union, postoperative complications, failure rate, and mortality rate were analyzed. Results The mean operative time in the DHS+TSP group was 105±10 min, while in the PFN group it was 94±8 min (p=0.001). The mean time until union in the DHS+TSP group was 10.1±1.9 weeks, while in the PFN group, it was 8.8±1.8 weeks (p=0.008). The mean time to return to the pre-fracture activity level in the DHS+TSP group was 12.6±2.6 weeks, while in the PFN group, it was 10.8±2.1 weeks (p=0.005). The mean HHS for the DHS+TPS group was 77.9±8.4, while for the PFN group, it was 80.4±8.7 (p=0.26). There was no significant difference in the walking capability between the two groups. One-year mortality rate was 29.4% in the PFN group and 17.6% in the DHS+TSP group (p=0.284), indicating no significant difference. Mechanical failure was recorded in three cases (8.8%) in the DHS+TSP group compared to two cases (5.8%) in the PFN group with no statistically significant difference. These five cases needed later revisions with total hip replacement. Conclusion The use of PFN in unstable trochanteric fractures was associated with a shorter time until union and a faster return to the pre-fracture level of activity than the DHS+TSP group. Postoperative hip function, walking independence, as well as complication and one-year mortality rates were comparable.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

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Functional and radiological outcomes of dynamic hip screw with trochanteric stabilizing plate versus short proximal femoral nail in management of unstable trochanteric fractures: A randomized-controlled trial

Kassem¹,

Younan²,

Abaskhron³

et al. 2022

Jt Dis Relat Surg

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“…In AO 31-A3.3 type intertrochanteric fractures, the fracture line involves the lateral wall of femur and the medial lesser trochanter, and the instability of the fracture end leads to a significantly higher postoperative failure rate than that of other types of fractures [22][23]. The bone mass of patients with osteoporosis is reduced, and the internal bone microstructure is damaged, resulting in loose trabecular bone and increased bone brittleness.…”

Section: Discussionmentioning

confidence: 99%

Finite element analysis of proximal femoral nail anti-rotation in the treatment of osteoporotic AO3.3 intertrochanteric fracture

Guo

Chen

Lian

et al. 2022

Preprint

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Background: We aimed to use the finite element method to simulate the biomechanical effects of bone cement on the treatment of unstable intertrochanteric fractures with different degrees of osteoporosis using proximal femoral nail anti-rotation (PFNA) to provide personalized treatment plans for patients with type 31-A3.3 intertrochanteric fractures based on the AO Foundation/Orthopaedic Trauma Association classification. Methods: A finite element model of a normal right femur was created from CT images using related finite element analysis software, and its effectiveness was verified. In the experimental group, 12 types of fracture models with different degrees of osteoporosis were fixed using PFNA, while in the control group, 12 types of osteoporotic fracture models were fixed using bone cement augmented PFNA. A 700 N force was applied to the femoral head in a direction that simulated the direction of load-bearing while standing. The differences in the maximum displacement of the femur, PFNA, femoral stress, and varus angle between the two groups were observed and compared in ANSYS software. Results: Compared with the common PFNA model, the femoral head displacement, PFNA displacement, and varus angle of the femoral head were significantly smaller in the bone cement augmented PFNA model. However, the maximum stress in the femur was significantly increased. Compared with the experimental group, the change rate of femoral head displacement, PFNA displacement, and varus angle decreased from 2.94% to 5.89%, 3.23% to 4.79%, and 0.41% to 8.51% with increase in the degree of femur osteoporosis. The maximum stress change rate of the femur increased from 12.2% to 5.74%. Conclusion: Common PFNA for treatment of A3.3 intertrochanteric fracture is likely to fail in severe osteoporosis, and the varus angle and displacement can be significantly reduced with cement reinforcement. Therefore, PFNA internal fixation with bone cement should be considered for treatment of severe osteoporosis. When used in mild osteoporosis, bone cement increases the stress at the joint between the screw blade and the main nail; therefore, the use of PFNA alone should be considered for treatment in such cases to increase the service life of internal fixation devices.

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“…Surgery treatments for trochanteric fractures have become the recommended treatment, while functional and conservative treatments are only applicable in rare cases with non-displace fractures or strictly contra-indication to surgery. Treatments with internal fixation devices, including intramedullary and extramedullary fixation devices, are widely used with advantages and disadvantages [2] Gamma nail treatment is a classic intramedullary fixation device that combines a sliding hip screw with a primary nail fit into the intra medulla cavity. Treatments with Gamma nails has been widely used internationally with several advantages reported, such as increasing stability at the fracture site, advancing healing, shortening operation time, and allowing early rehabilitation [3].…”

Section: Introductionmentioning

confidence: 99%

A Evaluation of Initial Treatment of Trochanteric Fractures using Gamma Nails

Lê¹,

Nguyen²

2020

int arch med

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Background: Trochanteric fractures are extra-joint fractures, account for 55% of femoral proximal fractures. They often happen in the elderly with increased frequency due to age. Treatment experiences at 7A Military Hospital showed increased trochanteric fracture cases. To properly assess treatment effectiveness and select proper treatment methods, the study of “Evaluation of initial treatment of trochanteric fractures using gamma nails at 7A Military Hospital and made the conclusions of indications and applied techniques” was carried out. The study objectives are evaluating the initial treatment of trochanteric fractures using gamma nails at 7A Military Hospital and made the conclusions of indications and applied techniques. Methods and findings: nineteen patients diagnosed with traumatic trochanteric fractures and surgically treated with Gamma nails were monitored and evaluated for bone fusion, bone union, range of motion, limb shortening, and functional rehabilitation according to Merle D'Aubigné scale. Fourteen patients (82.35%) achieved proper bone union with the femoral neck-shaft angle of 1250 - 1300, three patients (17.65%) got slightly deviated bone union. Amongst patients aged under 60, 14/17 cases (82.35%) achieved “good” and “very good” functional rehabilitation, scored over 15 points according to Merle D΄aubigne Index; 3/17 cases (17.65%) got “average” recovery. Hip range of motion in 14 cases (82.35%) achieved “very good” (normal movement) or “good” (over 10% movement limitation) outcome, 3 cases had “average” movement (17.65%). Limb shortening of below 1cm took place in 10 patients (58.82%), 1 – 2 cm in 4 patients (23,53%) and over 3 cm in 3 patients (17.65%). Conclusions: The surgical treatment of trochanteric fractures using gamma nails yielded positive outcomes. Keywords: Gamma nails, trochanteric fractures, elderly, extra-joint.

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Controlled study on Gamma nail and proximal femoral locking plate for unstable intertrochanteric femoral fractures with broken lateral wall

Cited by 17 publications

References 24 publications

Functional and radiological outcomes of dynamic hip screw with trochanteric stabilizing plate versus short proximal femoral nail in management of unstable trochanteric fractures: A randomized-controlled trial

Functional and radiological outcomes of dynamic hip screw with trochanteric stabilizing plate versus short proximal femoral nail in management of unstable trochanteric fractures: A randomized-controlled trial

Finite element analysis of proximal femoral nail anti-rotation in the treatment of osteoporotic AO3.3 intertrochanteric fracture

A Evaluation of Initial Treatment of Trochanteric Fractures using Gamma Nails

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