Nail Length in the Management of Intertrochanteric Fracture of the Femur

Horwitz, Daniel S.; Tawari, Akhil; Suk, Michael

doi:10.5435/jaaos-d-15-00325

Cited by 44 publications

(39 citation statements)

References 20 publications

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“…The relevance of nail length in determining PNFs is still a matter of debate [ 30 – 32 ]. Recently, Shannon et al in their randomized controlled trial reported a similar rate of PNFs around both short and long nails (2.4% vs. 2.7%) [ 30 ].…”

Section: Resultsmentioning

confidence: 99%

“…Moreover, Daner et al in their biomechanical study did not observe any difference in stiffness between long and short nails under rotational forces, thus making the fracture risk similar [ 17 ]. These inconclusive evidences on the role of nail length in determining PNFs and the observation that a clear definition of long nail did not exist (long nails are considered those longer than 240 mm, 300 mm, and 340 mm depending on the nail and the authors [ 32 – 35 ]) did not lead the research group to reach a consensus on the putative role played by nail length in their PNF management.…”

Section: Resultsmentioning

confidence: 99%

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Fractures around Trochanteric Nails: The “Vergilius Classification System”

Toro

Moretti

Ambrosio³

et al. 2021

Advances in Orthopedics

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Introduction. The fractures that occurred around trochanteric nails (perinail fractures, PNFs) are becoming a huge challenge for the orthopaedic surgeon. Although presenting some specific critical issues (i.e., patients’ outcomes and treatment strategies), these fractures are commonly described within peri-implant ones and their treatment was based on periprosthetic fracture recommendations. The knowledge gap about PNFs leads us to convene a research group with the aim to propose a specific classification system to guide the orthopaedic surgeon in the management of these fractures. Materials and Methods. A steering committee, identified by two Italian associations of orthopaedic surgeons, conducted a comprehensive literature review on PNFs to identify the unmet needs about this topic. Subsequently, a panel of experts was involved in a consensus meeting proposing a specific classification system and formulated treatment statements for PNFs. Results and Discussion. The research group considered four PNF main characteristics for the classification proposal: (1) fracture localization, (2) fracture morphology, (3) fracture fragmentation, and (3) healing status of the previous fracture. An alphanumeric code was included to identify each characteristic, allowing to describe up to 54 categories of PNFs, using a 3- to 4-digit code. The proposal of the consensus-based classification reporting the most relevant aspects for PNF treatment might be a useful tool to guide the orthopaedic surgeon in the appropriate management of these fractures.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Fractures around Trochanteric Nails: The “Vergilius Classification System”

Toro

Moretti

Ambrosio³

et al. 2021

Advances in Orthopedics

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“…We must admit limitations of our study including the possibility of surgeon bias towards the use of either a straight or cephallomedullary nail in certain fracture patterns, which remains hidden in our retrospective study design. Despite the fact that long nails seem to offer no clinical advantage compared to standard nails for the treatment of 31 A3 type fractures except a reduced rate of secondary femur fracture [22, 44, 45], we included only long nails. This is in accordance with the recently published algorithm for the treatment of per-/intertrochanteric fractures of the hip [19].…”

Section: Discussionmentioning

confidence: 99%

Outcome of intramedullary nailing treatment for intertrochanteric femoral fractures

et al. 2019

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IntroductionThe OTA/AO type 31 A3 intertrochanteric fracture has a transverse or reverse oblique fracture at the lesser trochanteric level, which accentuates the varus compressive stress in the region of the fracture and the implant. Intramedullary fixation using different types of nails is commonly preferred. The purpose of this study is to evaluate intertrochanteric femoral fractures with intramedullary nail treatment in regard to surgical procedure, complications, and clinical outcomes.MethodsFrom one level 1 trauma center, 216 consecutive adult intertrochanteric femoral fractures (OTA/AO type 31 A3) were retrospectively identified with intramedullary nail fixation from 2004 through 2013. Of these, 193 patients (58.5% female) met the inclusion criteria. The average age was 70 years (range 19–96 years).ResultsCephalomedullary nails were utilized in 176 and reconstruction nails in 17 patients. After the index procedure, 86% healed uneventfully. Nonunion development was observed in 6% and 5% had an unscheduled reoperation due to implant or fixation failure. Active smoking was reported in 16.6%. Current smokers had an increased nonunion risk compared to those who do not currently smoke (15.6% vs. 4.3%; p = 0.016). The femoral neck angle averaged 128.0° ± 5°. Fixation failure occurred in 11.1% of patients with a neck-shaft-angle < 125° compared to 2.6% (4/155) of patients with a neck-shaft angle ≥125° (p = 0.021). Patients treated with a reconstruction nail required a second surgical intervention in 23.5%, which was no different compared to 25.0% in the cephalomedullary group (p = 0.893). In the cephalomedullary group, 4.5% developed a nonunion compared to 23.5% in the reconstruction group (p = 0.002). Painful hardware led to hardware removal in 8.8%. All of them were treated with a cephalomedullary device (p = 0.180). During the last office visit, two-thirds of the patients reported no or only mild pain but most patients had reduced hip range of motion.ConclusionIntramedullary nailing is a reliable surgical technique when performed with adequate reduction. Varus reduction with a neck-shaft angle < 125° resulted in an increase in fixation failures. Patient and implant factors affected nonunion formation. Smoking increased nonunion formation. Utilization of a cephalomedullary device reduced the nonunion rate, but had higher rates of painful prominent hardware compared to reconstruction nailing.

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“…(1) Patients aged > 60 years; (2) Patients diagnosed with an intertrochanteric fracture after preoperative imaging examination; 9 (3) Patients without local trauma or local bone-related diseases in the past; (4) Be voluntarily recruited to the research and sign the consent form; (5) No obvious mental disorder, able to cooperate in completing the research work.…”

Section: Methodsmentioning

confidence: 99%

Evaluation of the clinical efficacy of 3D Printing technology assisted surgery combined with early postoperative comprehensive rehabilitation in the treatment of Senile Intertrochanteric Fractures

Zhao¹,

Liu²,

Mao³

et al. 2021

Pak J Med Sci

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Objectives: To observe the clinical value of 3D printing technology assisted surgery combined with early postoperative comprehensive rehabilitation in elderly patients with intertrochanteric fractures. Methods: Sixty elderly patients with intertrochanteric fractures of the femur who were treated in our hospital from January 2018 to January 2020 were selected and randomly divided into two groups. In the experimental group, 3D printing technology assisted surgery combined with early postoperative comprehensive rehabilitation was used for treatment. While in the control group, traditional open reduction and dynamic hip screw internal fixation combined with postoperative conventional treatment was utilized. The duration of surgery, intraoperative blood loss, postoperative hospital stay, weight bearing time, fracture healing time and other surgical indicators were recorded respectively, and hip joint function recovery was evaluated prior to and 2 weeks after surgery. All patients were followed up for six months to observe the occurrence of complications within half a year, including deep vein thrombosis, incision infection, avascular necrosis of femoral head, hip joint stiffness, delayed fracture healing, etc. Subsequently, the differences in postoperative complications between the two groups were compared and analyzed. Results: The operation time, blood loss, postoperative hospital stay, weight bearing time and fracture healing time of the experimental group were better than those of the control group, and the difference was statistically significant (p<0.05). After treatment, the hip joint function of the experimental group was significantly improved compared with the control group, with a statistically significant difference(p=0.03). The incidence of operative complications in the experimental group was 10% (3/30) within six months postoperatively, significantly lower than the 33% (10/30) in the control group, with statistical significance (p=0.03). Conclusion: 3D printing with early rehab proved to be effective treatment in our study. Such a combined treatment has the advantages of precise operative reduction, fast postoperative recovery, and certain safety and effectiveness. doi: https://doi.org/10.12669/pjms.37.3.3988 How to cite this:Zhao Y, Liu YH, Mao SG, Zhang XX. Evaluation of the clinical efficacy of 3D Printing technology assisted surgery combined with early postoperative comprehensive rehabilitation in the treatment of Senile Intertrochanteric Fractures. Pak J Med Sci. 2021;37(3):---------. doi: https://doi.org/10.12669/pjms.37.3.3988 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Nail Length in the Management of Intertrochanteric Fracture of the Femur

Cited by 44 publications

References 20 publications

Fractures around Trochanteric Nails: The “Vergilius Classification System”

Fractures around Trochanteric Nails: The “Vergilius Classification System”

Outcome of intramedullary nailing treatment for intertrochanteric femoral fractures

Evaluation of the clinical efficacy of 3D Printing technology assisted surgery combined with early postoperative comprehensive rehabilitation in the treatment of Senile Intertrochanteric Fractures

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