Do PFNA devices and Intertan nails both have the same effects in the treatment of trochanteric fractures? A prospective clinical study

Seyhan, Mustafa; Türkmen, İsmail; Unay, Koray; Ozkut, Afsar T.

doi:10.1007/s00776-015-0750-4

Cited by 43 publications

(83 citation statements)

References 24 publications

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“…The mean duration of surgery for InterTan intramedullary nail in the late group of patients was 64.97 (95% CI 59.59 to 70.36) min, similar to the operative time reported in earlier research that ranged from 48 to 73.91 min [4, 5, 15, 18–20], excluding one study that reported an average time that was less than 30 minutes [21]. These studies also reported that the mean operative time for GN, PFNA, or PFNA-II treatments [4, 5, 15, 18–20] was 44.41–72.98 minutes.…”

Section: Discussionsupporting

confidence: 83%

“…Compared to other implants, the advantages of InterTan nail include the ability to maintain compression, eliminate Z-effect intertrochanteric rotational stability and medial migration, control rotation during reduction, and prevent periprosthetic fractures. Additionally, it has a lower rate of implant failure and reoperation, lower risk of secondary femoral fractures [4, 13–15], faster time to fracture union [14–16], and a high rate of return to prefracture status [2, 14, 15]. …”

Section: Discussionmentioning

confidence: 99%

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Learning Curve and Clinical Outcomes of Performing Surgery with the InterTan Intramedullary Nail in Treating Femoral Intertrochanteric Fractures

Zhang

Wang

et al. 2017

BioMed Research International

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Purpose. The purpose of this study is to evaluate the learning curve of performing surgery with the InterTan intramedullary nail in treating femoral intertrochanteric fractures, to provide valuable information and experience for surgeons who decide to learn a new procedure. Methods. We retrospectively analyzed data from 53 patients who underwent surgery using an InterTan intramedullary nail at our hospital between July 2012 and September 2015. The negative exponential curve-fit regression analysis was used to evaluate the learning curve. According to 90% learning milestone, patients were divided into two group, and the outcomes were compared. Results. The mean operative time was 69.28 (95% CI 64.57 to 74.00) minutes; with the accumulation of surgical experience, the operation time was gradually decreased. 90% of the potential improvement was expected after 18 cases. In terms of operative time, intraoperative blood loss, hospital stay, and Harris hip score significant differences were found between two groups (p = 0.009, p = 0.000, p = 0.030, and p = 0.002, resp.). Partial weight bearing time, fracture union time, tip apex distance, and the number of blood transfusions and complications were similar between two groups (p > 0.5). Conclusion. This study demonstrated that the learning curve of performing surgery with the InterTan intramedullary nail is acceptable and 90% of the expert's proficiency level is achieved at around 18 cases.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Learning Curve and Clinical Outcomes of Performing Surgery with the InterTan Intramedullary Nail in Treating Femoral Intertrochanteric Fractures

Zhang

Wang

et al. 2017

BioMed Research International

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“…The use of both observational and randomised controlled trials (RCTs) ensures that no useful evidence is discarded; thus, all available evidence is incorporated into the analysis. The single helical blade comparison had been evaluated in six studies, two RCTs [19, 20] and four [21–24] observational studies while the single lag screw analysis was evaluated in three studies, two RCTs [14, 15] and one observational study [16]. …”

Section: Discussionmentioning

confidence: 99%

Comparing the costs and outcomes of an integrated twin compression screw (ITCS) nail with standard of care using a single lag screw or a single helical blade cephalomedullary nail in patients with intertrochanteric hip fractures

et al. 2018

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BackgroundSurgical treatment is the optimal strategy for managing intertrochanteric fractures as it allows for early rehabilitation and functional recovery. The purpose of the study was to assess the cost-effectiveness of commonly used cephalomedullary nails for the treatment of unstable intertrochanteric hip fractures.MethodsA decision analytic model was developed from a US payer’s perspective using clinical data from a pairwise meta-analysis of randomised controlled trials (RCTs) and comparative observational studies comparing the integrated twin compression screw (ITCS) nail versus two single-screw or blade cephalomedullary nails [single lag screw (SLS) nail and single helical blade (SHB) nail]. The model considered a cohort of 1000 patients with a mean age of 76, as reported in the clinical studies over a 1-year time period. Cost data was obtained from the Center for Medicare and Medicaid Services website and published literature and adjusted for inflation. One-way and probabilistic sensitivity analyses were conducted to assess the effect of uncertainty in model parameters on model conclusions.ResultsThe model estimated 0.546 quality-adjusted life years (QALYs) and 0.78 complications avoided by using the ITCS nail and 0.455 QALYs and 0.67 complications avoided for the standard of care, using SLS or SHB nails. The cost per patient was $34,336 for patients treated with an ITCS nail and $37,036 for patients treated with the standard of care respectively, resulting in a cost saving of $2700 in favour of the ITCS nail. More savings were observed when the ITCS nail was compared to the SHB ($3280 per patient) and SLS ($1652 per patient). The findings were robust to a range of both one-way and the probabilistic sensitivity analyses.ConclusionIn conclusion, the ITCS nail can be considered a cost saving intervention in patients undergoing intertrochanteric fracture fixation with an intramedullary device. Clinicians and policy makers should be encouraged to adopt healthcare technologies such as ITCS that will help them to provide quality healthcare despite falling budgets.

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“…There are many studies related to the treatment of intertrochanteric fracture with PFNA, most of which focus on instrument characteristics [2, 4, 5, 17–21]. With further research and development, more investigators have found that the surgical technique (particularly the entry point) plays an important role in the clinical outcome [8, 10–12, 22, 23].…”

Section: Discussionmentioning

confidence: 99%

“…This difference is due to many factors, such as age, fracture type, implant design, fracture reduction, and implant position. Recently, an increasing number of studies have shown that a poor introduction technique leads to a poor outcome [5–7]. The entry point is the most important issue of the introduction technique.…”

Section: Introductionmentioning

confidence: 99%

Influence of different great trochanteric entry points on the outcome of intertrochanteric fractures: a retrospective cohort study

Pan

Liu

Feng

et al. 2017

BMC Musculoskelet Disord

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BackgroundThe Proximal Femoral Nail Antirotation (PFNA) system for treatment of intertrochanteric fractures is currently widely applied worldwide. However, even though the PFNA has produced good clinical outcomes, a poor introduction technique with an inappropriate entry point can cause surgical complications. Some researchers suggest improving clinical outcomes by modifying the entry point, but no research has focused on this issue. The purpose of the present study is to compare the clinical and radiological outcomes of two different trochanteric entry points for the treatment of intertrochanteric fractures using the PFNA system.MethodsFrom May 2010 to October 2015, a total of 212 elderly patients with intertrochanteric fractures who were treated with the PFNA-II system were included into this retrospective cohort study. Group LA (98 patients) was treated using a lateral anterior trochanteric entry point, and group MP (114 patients) was treated using a medial posterior trochanteric entry point. All patients underwent follow-up assessments at 1, 3, 6, and 12 months after surgery. Radiographic evaluation was based on the impingement, tip-apex distance (TAD) and the position of the helical blade within the femoral head. Clinical evaluation was based on the surgical time, fluoroscopy time, blood loss, hospital stay, visual analogue scale (VAS), thigh pain, and Harris hip score.ResultsThe impingement was significantly reduced (P = 0.011) in group MP. The helical blade positions were significantly lower (P = 0.001) in group MP. The TADs in group LA (22.40 ± 4.43) and group MP (23.39 ± 3.60) were not significantly different (P = 0.075). The fluoroscopy time of group LA (53.26 ± 14.44) was shorter than that of group MP (63.29 ± 11.12, P = 0.000). Five iatrogenic lateral proximal fractures and 3 helical blade cutouts occurred in group LA, but none occurred in group MP. At 1 and 3 months postoperation, the Harris hip scores were significantly higher in group MP (P = 0.001 and P = 0.000, respectively), and the VAS scores were lower (P < 0.05).ConclusionsThe medial posterior trochanteric entry point achieved excellent nail and helical blade position, reduced surgical complications, and enabled early hip function recovery but required longer fluoroscopy time than the lateral anterior trochanteric entry point.

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Do PFNA devices and Intertan nails both have the same effects in the treatment of trochanteric fractures? A prospective clinical study

Cited by 43 publications

References 24 publications

Learning Curve and Clinical Outcomes of Performing Surgery with the InterTan Intramedullary Nail in Treating Femoral Intertrochanteric Fractures

Learning Curve and Clinical Outcomes of Performing Surgery with the InterTan Intramedullary Nail in Treating Femoral Intertrochanteric Fractures

Comparing the costs and outcomes of an integrated twin compression screw (ITCS) nail with standard of care using a single lag screw or a single helical blade cephalomedullary nail in patients with intertrochanteric hip fractures

Influence of different great trochanteric entry points on the outcome of intertrochanteric fractures: a retrospective cohort study

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