Helical Blade or the Integrated Lag Screws: A Matched Pair Analysis of 100 Patients With Unstable Trochanteric Fractures

Gavaskar, Ashok S.; Tummala, Naveen C.; Srinivasan, Parthasarathy; Gopalan, Hitesh; Karthik, B; S, Santosh

doi:10.1097/bot.0000000000001145

Cited by 28 publications

(31 citation statements)

References 25 publications

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“…TAD value of CMN is considered a key indicator to predict postoperative cut-out complications. Patients with a TAD < 25 mm were less likely to encounter screw cut-outs complication [24]. In our study and average TAD was 20.3 mm and associated with fewer failures than previous studies.…”

Section: Discussioncontrasting

confidence: 42%

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Comparison of Clinical Outcomes Between Cephalomedullary Nails and Dynamic Hip Screws for Basicervical Proximal Femoral Fractures

Jian

et al. 2020

Preprint

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Background Basicervical proximal femoral fractures have greater biomechanical instability and higher incidence of implant-related complications than other types of proximal femoral fractures. The present retrospective study was performed to find a proper fixation treating basicervical proximal femoral fractures by a comparation of clinical outcomes between cephalomedullary nails and dynamic hip screws, and introduce our experience in surgical tricks and perioperative management. Methods Between January 2015 and December 2018, 821 patients aged 60 years or older suffering from a proximal femoral fracture and receive internal fixation surgery were reviewed. 25 patients of basicervical femoral fractures were included in the study according to inclusion and exclusion criteria. 7 patients were treated with a DHS, 18 with the CMN. Relevant operational data and clinical evaluation were collected. Results Reduction qualities of 6 patients were good (85.7%), 1 were acceptable (14.3%) in DHS Group and 14 of the 18 patients were good (77.8%), 4 were acceptable (22.2%) in CMN Group. The mean TAD in DHS Group of was 17.4 mm while 20.3 mm in CMN Group. Bone union had been achieved 19.9 weeks in DHS Group and 17.8 weeks in CMN Group. The mean Harris score at the final follow up was 83.9, 84.4 respectively in DHS and CMN Group with no significant difference. Conclusions DHS was not inferior for the treatment of basicervical proximal femoral fractures compared to CMNs with blade type or two integrated screw type. When applied properly, both CMNs with blade type or two integrated screw type and DHS can achieve satisfied prognosis. Our unique experiences included anatomic reduction during surgery, anti-osteoporosis treatment and prolonged weight-bearing time.

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Section: Discussioncontrasting

confidence: 42%

“…Inserting the PFNA blade can also compact the cancellous bone and provide additional stability [12]. As for unstable proximal femeral frature, PFNA and InterTAN nail are effective CMN options [23,24]. TAD value of CMN is considered a key indicator to predict postoperative cut-out complications.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Clinical Outcomes Between Cephalomedullary Nails and Dynamic Hip Screws for Basicervical Proximal Femoral Fractures

Jian

et al. 2020

Preprint

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“…The search yielded 308 potentially relevant reports, and 117 remained after the duplicate articles were deleted, of which 57 were excluded by preliminary screening; further careful screening of the full text excluded 51 articles leaving 9 for detailed evaluation. Nine studies ( n = 1332 patients) are published between January 2013 and December 2019 that fulfilled the inclusion and exclusion criteria, including 2 RCTs and 7 observational studies [ 14 , 20 – 27 ]. A total of 1332 patients were relatively evenly distributed in PFNA ( n = 681 patients) and InterTAN nail groups ( n = 651 patients), and the proportion of the two surgical procedures in A1, A2, and A3 fractures is 88/80, 479/460, and 113/112, respectively.…”

Section: Resultsmentioning

confidence: 99%

“…All the results were robust except for the outcome of pain at the hip or thigh. When a certain study [ 20 ] resulting in heterogeneity was removed, no heterogeneity was found in the remaining studies (RCTs: chi 2 = 0.83, df = 1, P = 0.36, I 2 = 0%; observational studies: chi 2 = 0.11, df = 2, P = 0.95, I 2 = 0%; total: chi 2 = 0.95, df = 4, P = 0.92, I 2 = 0%; Fig S 1 ), which could be explained by the different surgical skills of the surgeons between included studies. In addition, considering the length of follow-up time may have an impact on the complications of patients, by excluding 1 study with shorter follow-up time [ 22 ], it can be found that the heterogeneity has not changed significantly, which proves that the statistical results are reliable.…”

Section: Resultsmentioning

confidence: 99%

Comparison of clinical outcomes with proximal femoral nail anti-rotation versus InterTAN nail for intertrochanteric femoral fractures: a meta-analysis

Liu

2020

J Orthop Surg Res

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Background A meta-analysis to access the pros and cons of proximal femoral nail anti-rotation (PFNA) versus InterTAN nail for intertrochanteric femoral fractures including available evidence extracted from literature. Methods According to the Cochrane systemic analysis method, randomized control trials (RCTs) and retrospective comparative observational studies which were related to the comparison of PFNA and InterTAN nail in the treatment of the elderly with intertrochanteric fractures were retrieved. Data were independently extracted from the included studies by two reviewers and analyzed using RevMan 5.3, and the quality of the studies was assessed. Results Two RCTs and seven observational studies were recruited, which consisted of 681 patients with PFNA and 651 patients with InterTAN nail. The meta-analyses showed no significant differences between the two approaches on Harris Hip Score, operation time, blood loss, time to union, mean hospital stay, union problems, intraoperative complications, hematoma, infection, and other complications in both RCTs and observational studies. In terms of other outcomes, for the RCTs, results showed that there were shorter tip–apex distance and reduced pain at thigh or hip in InterTAN nail than in PFNA; however, InterTAN nail was not superior to PFNA in cutout, reoperation, and femoral shaft fracture; for observational studies, the risk of the screw migration (RR = 5.13, 95%CI [1.33,19.75], P = 0.02), cutout (RR = 3.26, 95%CI [1.64,6.47], P = 0.0008), the varus collapse of the femoral head (RR = 7.19, 95%CI [2.18,23.76], P = 0.001), femoral shaft fracture (RR = 5.73, 95%CI [2.24,14.65], P = 0.0003) treated by InterTAN nail were significantly decreased, compared with those by PFNA; however, no significant differences were observed in the aspects of tip–apex distance and pain at thigh or hip between these two groups. Conclusion Analysis of a large number of relevant clinical indicators available shows that InterTAN nail has better clinical manifestation than PFNA in treating unstable femoral intertrochanteric fractures.

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“…By synergistically altering the PSA and theanteversion angle, TAD can be easily adjusted to be less than 25 mm (20.52 ± 2.80 mm) which is recommended by several scholars during the fixation of IEFs in order to prevent complications [ 24 , 25 ]. The accessibility and perfection of TAD adjustment in our study smoothed the surgery (shorter operative time: 65.82 ± 11.16 min vs 79.50 ± 21.12 min [ 21 , 26 , 27 ] and fluoroscopy time: 2.03 ± 0.79 min vs 2.9 ± 0.16 min) [ 7 ]), improved the treatment effects (higher HHS: range, 57–89 vs 36–97 [ 28 ]) and decreased the complications (rate: 12.00%, 6/50 vs 57.44%, 108/188 [ 21 ]; cut-out: 0% vs 4% [ 29 ] or 2.7% [ 30 ]) compared with previous studies where TAD was higher than 25 mm, even modified 30 mm [ 31 ] in some cases [ 28 – 30 ].…”

Section: Discussionmentioning

confidence: 99%

How to get better TAD? Relationship between anteversion angle of nail and position of femoral neck guide pin during nailing of intertrochanteric fractures

Wang

Liu

et al. 2020

BMC Musculoskelet Disord

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Background: To demonstrate the correlation between guide pin-shaft angle (PSA) at the anteroposterior film and anteversion angle of guide pin at the lateral film and investigate whether excellent tip-apex distance (TAD) can be obtained by changing the entry point via axial rotation of the main intramedullary nail. Methods: Fifty patients with intertrochanteric femoral fractures (IFFs) undergoing internal fixation with intramedullary nails under 2D fluoroscopy were retrospectively enrolled. Both of the PSA at the anteroposterior film and anteversion angle at the lateral film before and after adjustment of the guide pin were collected. Pearson correlation analysis was performed to investigate their correlation. Intraoperative and postoperative outcomes were recorded. Furthermore, the software of Mimics 10.0 and Pro/E were used to establish the 3D models of the proximal femur and main intramedullary nail/guide pin, respectively. Surgery was simulated on the Pro/E software platform and solid geometry analysis was conducted to calculate the correlation between the PSA and the anteversion angle. Results: Pearson correlation analysis indicated there was a positive correlation between PSA and anteversion angle, with the correlation coefficient of 0.902 (p < 0.01). By altering the PSA and anteversion angle, TAD was adjusted to be less than 25 mm in all patients. The mean operative time, fluoroscopy time and length of hospital stay were 65.82 ± 11.16 min, 2.03 ± 0.79 min and 6.66 ± 2.49 d. Thirty-one patients received blood transfusions (3.55 ± 1.95 U). Fracture reduction was considered to be good or acceptable in all patients. Complications occurred only in 6 patients (12.00%). At a 3-month follow-up, the mean Timed Up and Go was 31.54 ± 20.95 s and Harris Hip Score was 72.88 ± 8.79. The 3D surgery model also showed when the main intramedullary nail was externally rotated or internally rotated of 20°at the standard location, the PSA of guide pin at the anteroposterior position and anteversion angle of the guide pin at the lateral position were simultaneously increased or decreased. Conclusion: Our findings suggest altering the PSA and anteversion angle may be beneficial for obtaining excellent TAD and achieving superior outcomes.

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Helical Blade or the Integrated Lag Screws: A Matched Pair Analysis of 100 Patients With Unstable Trochanteric Fractures

Abstract: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Cited by 28 publications

References 25 publications

Comparison of Clinical Outcomes Between Cephalomedullary Nails and Dynamic Hip Screws for Basicervical Proximal Femoral Fractures

Comparison of Clinical Outcomes Between Cephalomedullary Nails and Dynamic Hip Screws for Basicervical Proximal Femoral Fractures

Comparison of clinical outcomes with proximal femoral nail anti-rotation versus InterTAN nail for intertrochanteric femoral fractures: a meta-analysis

How to get better TAD? Relationship between anteversion angle of nail and position of femoral neck guide pin during nailing of intertrochanteric fractures

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