The influence of proximal femur canal size on reduction of intertrochanteric fracture with cephalomedullary nail

Ma, Hsuan-Hsiao; Chiang, Chao-Ching; Lin, Chun‐Cheng; Wang, Chien-Shun

doi:10.1016/j.otsr.2021.103006

Cited by 6 publications

(4 citation statements)

References 25 publications

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“…The holding force is improved, and the distal screw can be dynamically locked, producing dynamic compression on the fracture end and promoting healing. 16 In terms of hospital stay and complications, we found similar values in both groups, a difference from the study of Ma HH et al, 17 in which patients receiving PFNA treatment had shorter hospital stays, and more complications than those undergoing InterTAN procedures. PFNA may produce less trauma than InterTAN, shortening hospital stays; but InterTAN shows good biomechanics and a stable internal fixation, which could enable patients to get out of bed soon reducing the complications caused by long-term bed rest.…”

Section: Discussionsupporting

confidence: 54%

Comparison of InterTAN and PFNA internal fixation for elderly patients with intertrochanteric fracture: A retrospective cohort study

Li,

Fang,

Gao

et al. 2024

Pak J Med Sci

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Objective: To compare the clinical outcomes of InterTAN nail and proximal femoral nail antirotation (PFNA) internal fixation for the treatment of intertrochanteric fractures in the elderly. Methods: We retrospectively reviewed the clinical records of 151 elderly patients with intertrochanteric fractures treated in The Second People’s Hospital of Hefei from October 2019 to December 2021. Among them, 73 patients had undergone InterTAN (InterTAN group) and 78 patients had undergone PFNA (PFNA group) internal fixation. Operation-related variables (operation time, incision length, intraoperative bleeding volume, hospital stays length, and fracture healing time), complications, and Harris scores were compared between the two groups. Results: The operation time and incision length were shorter and the intraoperative bleeding was less in the PFNA group than in the InterTAN group (all P-values <0.05), but the fracture healing time was longer in the PFNA group (P<0.05). We found similar hospital stays and surgical complications in the two groups (P>0.05). In addition, the Harris hip joint scores were significantly higher in the InterTAN group than in the PFNA group at one, six, and twelve months after the operation (P<0.05). Conclusions: InterTAN and PFNA internal fixation have their own advantages in treating patients with intertrochanteric fractures. InterTAN has better postoperative recovery results, while PFNA has less perioperative trauma. Clinically, InterTAN or PFNA should be selected based on the specific conditions of each patient to maximize the therapeutic benefit of each treatment method. doi: https://doi.org/10.12669/pjms.40.4.8794 How to cite this: Li L, Fang X, Gao J, Han W, Kong X. Comparison of InterTAN and PFNA internal fixation for elderly patients with intertrochanteric fracture: a retrospective cohort study. Pak J Med Sci. 2024;40(4):589-594. doi: https://doi.org/10.12669/pjms.40.4.8794 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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Section: Discussionsupporting

confidence: 54%

Comparison of InterTAN and PFNA internal fixation for elderly patients with intertrochanteric fracture: A retrospective cohort study

Li,

Fang,

Gao

et al. 2024

Pak J Med Sci

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“…A biomechanical study by Marcin Ceynowa et al[ 15 ] showed that small diameter nails in the wide medullary canal might dislocate early with insufficient distal locking, and it was concluded that long nails might be more stable. On the other hand, in a study conducted by Ma et al[ 16 ] involving 108 ITFF patients, the authors investigated the effect of narrow proximal femoral canal diameter on reduction quality. They concluded that a narrow femoral canal diameter was a significant factor in reduction deterioration during surgery, and reduction was frequently impaired during nail placement in cases with a narrow femoral canal.…”

Section: Discussionmentioning

confidence: 99%

What is the importance of distal nail diameter in the treatment of intertrochanteric femur fractures?

Ergişi

Özdemir²,

Korkmazer³

et al. 2022

Jt Dis Relat Surg

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Hip fractures have become an important public health problem all over the world due to increased life expectancy. The main causes of hip fractures in the elderly are higher incidence of falls and osteoporosis. Hip fractures have many negative impacts on individuals due to their morbidity and mortality, as well as negative socioeconomic effects on society. [1,2] Intertrochanteric femur fractures (ITFFs) constitute about 50% of hip fractures. [3] Cephalomedullary nailing (CMN) has become the primary treatment method for ITFF in many trauma centers in the past decade due to its biomechanical advantages such as allowing mobilization by weight-bearing in the early postoperative period, and being more reliable and less invasive than other surgical options. [4] Objectives: The aim of this study was to investigate the effect of distal nail diameter in the treatment of geriatric intertrochanteric femur fractures (ITFFs).Patients and methods: Between January 2017 and January 2021, a total of 91 patients (34 males, 57 females; mean age: 80.6±7.8 years; range, 65 to 96 years) who had osteosynthesis due to an ITFF with a short cephalomedullary nail (CMN) were retrospectively analyzed. The patients were divided into two groups: Group 1 (n=18) included patients with a distal nail diameter of ≤10 mm and Group 2 (n=73) included patients with a distal nail diameter of >10 mm. Patients' age, sex, fracture type according to AO classification, intramedullary femoral canal diameter, canal fit ratio, operation duration, reduction quality, the distal diameter of the CMN, and complications were evaluated.Results: There was no statistically significant difference between Group 1 and Group 2 in terms of the mean age, sex, fracture type, mean intramedullary canal diameter, reduction quality, and implant failure (p>0.05). The mean operation duration was significantly shorter in Group 2 (112.9±39.9 min) compared to Group 1 (128.8±36.4 min) (p=0.048). A total of three intraoperative peri-implant fractures occurred which included one 9 mm nail, one 12 mm nail, and one 14 mm nail. Conclusion:Our study results suggest that there is no advantage of using a >10-mm CMN in the treatment of geriatric ITFFs in terms of reducing the implant failure rate. However, the utility of a >10-mm CMN can reduce the operation duration.

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“…As the first choice for treatment of intertrochanteric fractures, compared with plates and screws, intramedullary devices have better biomechanical advantages, and minimal soft tissue injury. [6][7][8] It has been well established that no matter what kind of devices are used, intraoperative traction reduction is an important part of successful surgery. 9,10 In order to obtain better reduction quality, the currently preferred treatment method of intramedullary nailing for the treatment of intertrochanteric fractures is to take the supine position on the orthopedic surgery traction table.…”

Section: Introductionmentioning

confidence: 99%

“…High-quality reduction is critical for attaining the ideal position of the implant and achieving a good clinical outcome. 8,38 For patients in the non-traction table group, the surgeon can adjust the reduction at each stage of the procedure, the quality of the reduction can be more precisely controlled. For the patients in the traction table group, the adjustment of the reduction was completed during the setup time at the beginning of the operation, and it was difficult to finely adjust the reduction during the operation, as the fine adjustment is made with a nonsterile device.…”

mentioning

confidence: 99%

Whether Assisted Intramedullary Nail Implantation Without Traction Table is as Safe and Effective as Using Traction Table of Older Intertrochanteric Fracture Patients?

Li¹,

Chungui²,

Zhang³

2023

CIA

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Despite promising clinical outcome proposals, there has been relatively little published regarding the use of traction tableassisted intramedullary nail implantation for intertrochanteric fractures. The purpose of this study is to further summarize and evaluate published clinical studies comparing the clinical outcomes of using traction table and without traction table in the management of intertrochanteric fracture. Methods: A comprehensive literature search using PubMed, Cochrane Library, and Embase was systematically performed to evaluate all studies included in the literature up to May 2022. The search terms included "intertrochanteric fractures", "hip fractures", and "traction table" with Boolean operators "AND" and "OR". The following information was extracted and summarized: demographic information, setup time, surgical time, amount of bleeding, fluoroscopy exposure time, reduction quality, and Harris Hip Score (HHS). Results: A total of eight clinical controlled studies involving 620 patients were eligible for the review. The mean age at the time of injury was 75.3 years (traction table group 75.7 years, non-traction table group 74.9 years). The most common assisted intramedullary nail implantation method of non-traction table group included lateral decubitus position (4 studies), traction repositor, (3 studies) and manual traction (1 studies). Included studies results all support that there was no difference between the two groups in terms of reduction quality and Harris Hip Score, and the non-traction table group had an advantage in terms of setup time. However, there were still disputes in terms of surgical time, amount of bleeding and fluoroscopy exposure time. Conclusion:For patients with intertrochanteric fractures, assisting intramedullary nail implantation without traction table is as safe and effective as using traction table and doing so without a traction table may be more advantageous in terms of setup time.

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The influence of proximal femur canal size on reduction of intertrochanteric fracture with cephalomedullary nail

Cited by 6 publications

References 25 publications

Comparison of InterTAN and PFNA internal fixation for elderly patients with intertrochanteric fracture: A retrospective cohort study

Comparison of InterTAN and PFNA internal fixation for elderly patients with intertrochanteric fracture: A retrospective cohort study

What is the importance of distal nail diameter in the treatment of intertrochanteric femur fractures?

Whether Assisted Intramedullary Nail Implantation Without Traction Table is as Safe and Effective as Using Traction Table of Older Intertrochanteric Fracture Patients?

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