Klinische Evaluation des PFNA® und Zusammenhang zwischen Tip-Apex-Distanz und mechanischem Versagen

Kraus, M.; Krischak, Gert; Wiedmann, K. H.; Riepl, C.; Gebhard, Florian; Jöckel, Jens Arne; Scola, Alexander

doi:10.1007/s00113-011-1975-0

Cited by 40 publications

(14 citation statements)

References 22 publications

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“…Furthermore, we did not test the impact of the improved accuracy in terms of an optimized TSD on the strength of fixation as our intent was to study the effect of the ADAPT system on the accuracy of implant placement. However, several studies analysed the correlation of the TAD and the likelihood of a cut-out [10,12,14,15,20-22]. Further biomechanical or clinical studies should be undertaken to investigate whether these findings can be extrapolated to the TSD measurement and whether the TSD proves useful as an intraoperative assessment tool.…”

Section: Discussionmentioning

confidence: 99%

“…They demonstrated that increasing TAD above 25 mm was strongly correlated with an increased risk of lag screw cut-out through the femoral head. Several other studies supported this conclusion, showing that the TAD is a highly significant predictor of mechanical failure due to cut-out [10,12,14,15,21,22]. In a later study, Pervez et al recommended a TAD of less than 20 mm [21].…”

Section: Introductionmentioning

confidence: 93%

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Improved lag screw positioning in the treatment of proximal femur fractures using a novel computer assisted surgery method: a cadaveric study

Regling

Blau

Probe

et al. 2014

BMC Musculoskelet Disord

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BackgroundThe importance of the tip-apex distance (TAD) to predict the cut-out risk of fixed angle hip implants has been widely discussed in the scientific literature. Intra-operative determination of TAD is difficult and can be hampered by image quality, body habitus, and image projection. The purpose of this paper is to evaluate, through a cadaveric study, a novel computer assisted surgery system (ADAPT), which is intended for intraoperative optimisation of lag screw positioning during antegrade femoral nailing. A 3D measure for optimal lag screw position, the tip-to-head-surface distance (TSD), is introduced.Methods45 intra-medullary hip screw procedures were performed by experienced and less experienced surgeons in a cadaveric test series: in 23 surgeries the ADAPT system was used, and in 22 it was not used. The position of the lag screw within the femoral head and neck was evaluated using post-operative CT scans. TAD, TSD, fluoroscopy as well as procedure time and variability were assessed.ResultsThe use of the ADAPT system increased accuracy in TSD values (i.e. smaller variability around the target value) for both groups of surgeons (interquartile range (IQR) of experienced surgeons: 4.10 mm (Conventional) vs. 1.35 mm (ADAPT) (p = 0.004)/IQR of less experienced surgeons: 3.60 mm (Conventional) vs. 0.85 mm (ADAPT) (p = 0.002)). The accuracy gain in TAD values did not prove to be significant in the grouped analysis (p = 0.269 for experienced surgeons; p = 0.066 for less experienced surgeons); however, the overall analysis showed a significant increase in accuracy (IQR: 4.50 mm (Conventional) vs. 2.00 mm (ADAPT) (p = 0.042)). The fluoroscopy time was significantly decreased by the use of the ADAPT system with a median value of 29.00 seconds (Conventional) vs. 17.00 seconds (ADAPT) for the less experienced surgeons (p = 0.046). There was no statistically significant impact on the procedure time (p = 0.739).ConclusionsThe ADAPT system improved the position of the lag screw within the femoral head, regardless of the surgeon’s level of clinical experience, and at the same time decreased overall fluoroscopy usage. These positive effects are achieved without increasing procedure time.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 93%

Improved lag screw positioning in the treatment of proximal femur fractures using a novel computer assisted surgery method: a cadaveric study

Regling

Blau

Probe

et al. 2014

BMC Musculoskelet Disord

View full text Add to dashboard Cite

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“…Given the gravity of the event, it is important to determine risk factors which contribute to and are associated with implant failure. Kraus et al 11 reported that tip-apex-distance (TAD) greater than 30 mm was the main risk factor. Turgut et al 12 believed that if the coxa vara cannot be corrected, the lag screw will be in a unfavorable position.…”

Section: Introductionmentioning

confidence: 99%

Risk factors for mechanical failure of proximal femoral nail anti-rotation (PFNA–II) in the treatment of intertrochanteric fractures (AO/OTA 31-A1, A2)

Nie¹,

Jiang²,

Li³

et al. 2020

Preprint

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Background: Intertrochanteric fracture is associated with severe morbidity and mortality. The results of postoperative implant failure are catastrophic. The aim of this study was to determine risk factors for implant failure in intertrochanteric fractures treated with proximal femoral nail anti-rotation (PFNA–II) through the assessment of early therapeutic effects.Methods: A single-center retrospective study was conducted on a continuous series of 123 intertrochanteric fracture patients treated with PFNA-II between Dec 2018 and Oct 2019. Perioperative medical and imaging data were collected. The patients were divided into two groups according to whether implant failure of not. The differences in reduction quality, nail length and tip apex distance (TAD) were analyzed to determine the risk factors of implant failure.Results: A total of 80 patients were enrolled, with an average age of 80.2 years old. There were 6 patients with implant failure. There was no significant difference in demographic index between the two groups. The reduction quality of failure group was good, accept and poor with each 2 patients, and that of the non-failure group was 35, 35 and 4 patients respectively. The difference of reduction quality between the two groups was statistically significant. The risk of postoperative implant failure in patients with poor reduction quality was 8.75 times that of patients with good and acceptable reduction from the Logistic regression analysis（OR=8.75，95%CI 1.215-62.99）. The differences in nail length, ASA and bone quality were not statistically significant. Conclusion: Reduction quality is a risk factor of implant failure in intertrochanteric fractures treated with PFNA-II. Even if the medial femoral cortex is anatomically reduced, there will be a triangular void area between the nail and the medial femur, which are prone to coxa vara and implant failure. Therefore, good reduction is the key to treat intertrochanteric fracture.

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“…The treatment of proximal femur fractures has improved due to new implant designs in recent years [1, 2]. However, postoperative complication rates resulting from the procedure of up to 10.7% are still reported [3].…”

Section: Introductionmentioning

confidence: 99%

The PFNA® Augmented in Revision Surgery of Proximal Femur Fractures

Scola¹,

Gebhard²,

Dehner³

et al. 2014

TOORTHJ

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Objectives: Modern implants for proximal femur fracture treatment have clearly improved clinical results. However, complications, including cut-out and loss of reduction, requiring revision surgery still occur. A major challenge in these cases is a loss of bone stock due to the existing implant, which is usually exacerbated by osteoporosis. A potential solution is the augmentation of implants, for example, of the femoral neck blade using bone cement.Materials and Methods: Ten patients (five loosening of femoral neck implant, two pseudarthrosis, two implant failures and one acute fracture) were included. The initial hardware was removed and a PFNA augmented was implanted. The perforated femoral neck blade was augmented using polymethyl methacrylate cement. Clinical and radiological follow-up was performed at a mean of 5.4 months (SD ±4.34). The main outcome parameters were fracture healing and implant-related complications.Results: Technical handling was uneventful in all cases. No cement leakage into the joint occurred in any of the cases. The mean amount of cement injected was 5.3 ml. The fracture healed during follow-up in all cases except two patients who died from causes unrelated to the procedure and prior to complete consolidation. Problem-free elective hardware removal of the PFNA augmented was performed in two cases.Discussion: The PFNA augmented is a potential implant for joint-preserving revision surgery in proximal femur fractures. The augmentation improves implant anchorage in the impaired bone stock. In this preliminary series, no negative biological side effects of the cement (i.e. osteonecrosis) were observed.

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Klinische Evaluation des PFNA® und Zusammenhang zwischen Tip-Apex-Distanz und mechanischem Versagen

Cited by 40 publications

References 22 publications

Improved lag screw positioning in the treatment of proximal femur fractures using a novel computer assisted surgery method: a cadaveric study

Improved lag screw positioning in the treatment of proximal femur fractures using a novel computer assisted surgery method: a cadaveric study

Risk factors for mechanical failure of proximal femoral nail anti-rotation (PFNA–II) in the treatment of intertrochanteric fractures (AO/OTA 31-A1, A2)

The PFNA® Augmented in Revision Surgery of Proximal Femur Fractures

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