Which factor is most important for occurrence of cutout complications in patients treated with proximal femoral nail antirotation? Retrospective analysis of 298 patients

Turgut, Ali; Kalenderer, Önder; Karapınar, Levent; Kumbaracı, Mert; Akkan, Hasan Ali; Ağuş, Haluk

doi:10.1007/s00402-016-2410-3

Cited by 73 publications

(72 citation statements)

References 32 publications

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“…The overall complication rate in our study was 25%; it is similar to those of other authors [11,[23][24][25][26].…”

Section: Discussionsupporting

confidence: 92%

“…According to the literature, the cut-out of the lag screw is the most frequent complication of the nail for proximal femur fracture [11,23,[27][28][29][30][31] with an occurrence rate between 1 and 5% of surgeries [11,[23][24][25][26] causing the 84% of failures and revision surgery of these devices [32]. We found this complication in 3.7% of patients and only 4 of them occurred in group A.…”

Section: Discussionmentioning

confidence: 97%

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Intramedullary nailing for pertrochanteric fractures of proximal femur: a consecutive series of 323 patients treated with two devices

et al. 2019

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Introduction: Pertrochanteric fractures (PFs) frequently affect the lower limb of osteoporotic patients and represent an important cause of morbidity and mortality in the elderly. In this prospective randomized controlled trial, we have compared functional and radiological results and complications of patients affected by PFs treated with two intramedullary proximal femoral nails. Materials: We enrolled 323 subjects with PFs, classified according to AO/OTA system as 31.A1 (pertrochanteric simple) and 31.A2 (pertrochanteric multifragmentary). Patients were divided into two groups according to the osteosynthesis devices: group A, Elos-Intrauma® nail (155 cases) and group B, Gamma 3-Stryker® nail (168 cases). Pre-operatively, the baseline characteristics of each patient (gender, age, weight and BMI) were collected. Intraoperative blood loss, subjective pain by visual analogue scale (VAS), esthetic satisfaction, functional scores of the hip by Harris Hip Score (HHS), and Western Ontario and McMaster Universities Arthritis Index (WOMAC) were noted. The post-operative degree of fracture reduction was assessed. Each patient had a minimum follow-up of 12 months. Results: The study group was composed of 106 male and 217 female with an average age of 85.4 (range, 65-90, standard deviation (SD) 5.95) years. No statistical differences about sex and age distribution were noted between the two groups. Group A reported lower intraoperative blood loss, 45 ml vs 51 ml, respectively (p < 0.001). There was not any statistical difference about operative time. Group A had a better reduction of fracture (p = 0.0347). The greatest difference was detectable comparing subgroups 31.A2 (p = 0.032). There were no statistical differences about complication frequency and the overall rate was 25% (80 cases). Finally, there was no difference in terms of VAS, HHS, and WOMAC score between the two groups on each follow-up. Patients of group A showed a higher subjective satisfaction index at 1 post-operative year, 7.42 (SD 1.19) vs 6.45 (SD 1.35) of group B (p < 0.001). Conclusion: Elos® nail is a reliable device on a short-term follow-up and represents an alternative choice to the Gamma 3® nail, a well-known and appreciated system for over 25 years.

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“…The overall complication rate in our study was 25%; it is similar to those of other authors [11,[23][24][25][26].…”

Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 97%

Intramedullary nailing for pertrochanteric fractures of proximal femur: a consecutive series of 323 patients treated with two devices

et al. 2019

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“…From the results of our study, we observed that a TAD greater than 25 mm signi cantly increased the failure rate by using the extramedullary plate but not the intramedullary nail. Similar ndings were reported in previous reports [28][29][30]. Therefore, we postulate that the intramedullary nail provides more stability in treating unstable femoral intertrochanteric fractures than the extramedullary plate by restoring the femoral lateral wall, thus preventing the varus reduction/ xation and avoiding the medialization of the distal fragment [20,30,31].…”

Section: Discussionsupporting

confidence: 90%

Similarities between Inferior-Center and Center-Center Lag Screw Positions in Femoral Intertrochanteric Fracture Surgeries

Yeh

Liu

Chou

et al. 2020

Preprint

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Background: The center-center lag screw position has been widely accepted as the optimal lag screw/helical blade position in femoral intertrochanteric fracture surgery to achieve a tip-apex distance (TAD) less than 25 mm. Despite the inferior-center lag screw/helical blade position having some biomechanical advantages, and the emergence of calcar-referenced tip-apex distance (CalTAD), the clinical differences between the two commonly placed lag screw/helical blade positions remain unclear. This study aimed to (1) report radiological outcomes in managing geriatric femoral intertrochanteric fractures, (2) identify the influences of positions of lag screw/helical blade, and (3) identify the relationship between implants and the values of TAD and CalTAD.Methods: We retrospectively assessed the clinical and radiographic findings of geriatric patients (age ≥ 55 years) who underwent surgery for acute closed femoral intertrochanteric fractures during 1-year period and were followed up a minimum of 6 months. The radiographic parameters and incidences of fixation failure were compared between the different lag screw and helical blade positions (center-center vs. inferior-center). Subgroup analyses of different implant types (extramedullary and intramedullary) were also performed for comparisons for different lag screw positions, and TAD and CalTAD beyond the normal standard value of 25 mm.Results: A total of 206 patients were included during the study period, with a 7.8% fixation failure. There were no differences in incidences of fixation failure between the commonly inserted lag screw/helical blade positions (center-center vs. inferior-center), regardless of the implant types. Those with a TAD > 25 mm had significantly higher incidence of fixation failure than those with a TAD ≤ 25 mm in the extramedullary plate (17.0% vs. 1.2%, p = 0.001), but not in the intramedullary nails (16.1% vs. 4.4%, p = 0.08). There were no significant differences in incidences of fixation failure between CalTAD ≤ 25 mm and CalTAD > 25 mm in either extramedullary or intramedullary implants. Conclusion: Although TAD > 25 mm might increase the fixation failure rate in extramedullary plates, an inferior-center lag screw/helical blade position could achieve comparable radiographic results as a center-center position after osteosynthesis for geriatric femoral intertrochanteric fractures.

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“…Eine weitere Untersuchung zeigte das erhöhte Risiko für ein "cutting-out" bei reduzierter Knochendichte der Femurkopfspongiosa von < 0,6 cm 3 [14]. Besonders die unzureichende Reposition und Varusfehlstellung sind Hauptrisikofaktoren für das Implantatversagen [15]. Biomechanische Studien zeigen für die Zementaugmentationen von DHS und PFNA (AO 31-A2.3) eine signifikant höhere Stabilität im Vergleich zu den nicht augmentierten Kontrollen.…”

Section: Fraktureinteilung Und Indikationunclassified

Augmentation bei proximalen Femurfrakturen

Pfeufer¹,

Neuerburg²,

Mehaffey³

et al. 2017

OP-JOURNAL

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Which factor is most important for occurrence of cutout complications in patients treated with proximal femoral nail antirotation? Retrospective analysis of 298 patients

Cited by 73 publications

References 32 publications

Intramedullary nailing for pertrochanteric fractures of proximal femur: a consecutive series of 323 patients treated with two devices

Intramedullary nailing for pertrochanteric fractures of proximal femur: a consecutive series of 323 patients treated with two devices

Similarities between Inferior-Center and Center-Center Lag Screw Positions in Femoral Intertrochanteric Fracture Surgeries

Augmentation bei proximalen Femurfrakturen

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