Offset nail fixation for intertrochanteric fractures improves reduction and lag screw position

Abstract

Background Surgery for intertrochanteric fractures using intramedullary hip nails (IHNs) is among the most common surgical procedures in the orthopedic field. Although IHNs provide good overall outcomes, they sometimes cause complications, such as loss of reduction and cut-out. Here, we investigated the usefulness of IHNs with an anterior offset (Best Fit Nail® [BFN]) in maintaining fragment reduction and ensuring proper lag screw position compared with conventional non-offset nails (Proximal Femoral Nail Antirotation® [PFNA]), using postoperative computed tomography (CT). Methods Fifty consecutive patients with intertrochanteric fractures who underwent surgery with BFNs (BFN group) and 50 patients who underwent surgery with PFNAs (PFNA group) were retrospectively analyzed. Indices evaluated by postoperative CT were displacement distance of proximal fragment relative to distal fragment, reduction status (intramedullary, anatomical, and extramedullary types), lag screw direction, and angle between lag screw and femoral neck axis (deviation angle). Results Median [interquartile range] displacement distance was significantly smaller in the BFN group (0 [0, 0] mm) compared with the PFNA group (5.2 [3.6, 7.1] mm) (p<0.001). Reduction status was significantly better in the BFN group (anatomical type, 40 cases; intramedullary type, in 9 cases, and extramedullary type in 1 case) than in the PFNA group (anatomical type, 6 cases; intramedullary type, 43 cases; extramedullary type, 1 case) (p<0.001). Deviation of lag screw direction was observed in significantly fewer cases in the BFN group (20 cases; 40%) compared with the PFNA group (36 cases; 72%). Lag screw deviation angle was significantly smaller in the BFN group (−0.71°±4.0°) compared with the PFNA group (6.9°±7.1°). No adverse events related to surgery were observed in either group. Conclusions Intertrochanteric fracture surgery using offset BFNs exhibited significantly smaller displacement distance, better reduction status, and higher frequency of no deviation with central lag screw position, compared with surgery using non-offset PFNAs.

A Comparison of Tip-Apex Distance at Various Angles of Fixation Devices in Hip Fractures

“…The sliding barrel is designed to provide compression through a tension band mechanism and transmit the forces through the medial cortex of the proximal femur [ 14 ]. Controlled fracture impaction and union are more reliably achieved when the lag screw is positioned in the subchondral bone, and progressive load sharing with the bone is maintained; this is usually accomplished when the lag screw is perpendicular to the fracture line of the femoral neck [ 15 , 16 ]. Although this technique would cause a medialization of the femur and reduce the femoral neck length, it has been shown to have a lower incidence of screw cutout and joint penetration when compared with earlier fixed nail/plate designs [ 17 ].…”

Effect of rapid rehabilitation care on surgical site wound infection and pain in patients with intertrochanteric femoral fractures: A meta‐analysis

“…Surgery is the primary treatment for intertrochanteric femoral fractures in orthopaedic contions 30,31 . However, conventional surgical treatment often lacks in adequately reducing pain, impacting patient recovery negatively 32 .…”

“…Surgery is the primary treatment for intertrochanteric femoral fractures in orthopaedic contions. 30 , 31 However, conventional surgical treatment often lacks in adequately reducing pain, impacting patient recovery negatively. 32 Patients may experience psychological and physiological stresses before and after surgery, affecting their prognosis and recovery adversely.…”