Fixation Of Femoral Intertrochanteric Fracture Research Articles

Robot Navigation System Assisted PFNA Fixation of Femoral Intertrochanteric Fractures in the Elderly: A Retrospective Clinical Study.

The incidence of hip fracture in the elderly is increasing. Robot navigation technology has the advantages of minimally invasive and accurate. To explore the difference between the clinical effects of proximal femoral anti-rotation intramedullary nail (PFNA) assisted by robot navigation in the treatment of femoral intertrochanteric fracture and traditional PFNA in the treatment of femoral intertrochanteric fracture in the elderly; analyze the advantages and feasibility of PFNA assisted by robot navigation in the treatment of femoral intertrochanteric fracture in the elderly. From February 2021 to October 2022, the elderly (>65 years old) with femoral intertrochanteric fracture underwent surgery in our center. Divided the patients included in the study into 2 groups based on the surgical method. The surgical method of robot group was PFNA fixation assisted by robot navigation, while the surgical method of traditional group was classic PFNA fixation, Baseline data (general condition, Evans classification, time from injury to operation, preoperative hemoglobin) and observation indicators (intraoperative bleeding, operation time, the length of incision for mail nail insertion, postoperative hemoglobin drop, blood transfusion rate and the Harris score of hip joint 1 year after operation) of the two groups were collected to compare whether there were differences between the two groups. There was no statistical difference in baseline data between the two groups (P>0.05). The intraoperative bleeding in the robot group was 68.17±10.66 mL, the intraoperative bleeding in the traditional group was 174±8.11mL (P<0.001). The operation time in the robot group was 68.81 ± 6.89 min, in the traditional group, the operation time was 76.94 ± 8.18 min (P<0.001). The length of incision for mail nail insertion in the robot group was 3.53 ± 0.63 cm, the length of the incision for mail nail insertion in the traditional group was 4.23 ± 0.71 cm (P<0.001). 5 patients (13.9%) in the robot group received blood transfusion treatment, and 13 patients (36.1%) in the traditional group received blood transfusion treatment (P=0.029). The hemoglobin in the robot group decreased by 14.81 ± 3.27 g/l after operation compared with that before operation, while that in the traditional group decreased by 16.69 ± 3.32 g/l (P=0.018). The Harris score of the hip joint of the affected limb in the robot group was excellent in 25 cases, good in 8 cases and poor in 3 cases one year after the operation; In the traditional group, Harris scores were excellent in 18 cases, good in 11 cases and poor in 7 cases (P=0.021). PFNA fixation of femoral intertrochanteric fracture with robot navigation assistance has the advantages of minimally invasive and accurate, shorter operation time, less bleeding and lower blood transfusion rate than traditional surgical methods, and has certain advantages in reducing postoperative complications of elderly patients.

Timing of artificial femoral head replacement in the treatment of femoral intertrochanteric fracture with intramedullary nail failure in elderly patients

To analyze the timing of artificial femoral head replacement in elderly patients with femoral intertrochanteric fracture after intramedullary nail failure. From July 2013 to September 2019, 17 elderly patients with femoral intertrochanteric fracture after intramedullary nail fixation failure were treated with artificial femoral head replacement. According to the interval from diagnosis of internal fixation failure to pedestrian femoral head replacement, the patients were divided into early operation and delayed operation groups. Among them, there were 8 cases of early operation, 5 males and 3 females;the age ranged from 80 to 89 years old with an average of (84.88±2.79) years old;the interval was 1 to 7 days with an average of(4.13±1.73) d. There were 9 cases of delayed operation, 4 males and 5 females;the age ranged from 80 to 89 year old with an average of(84.22±3.03) years old;The interval was 15 to 30 with days an average of (25.56±4.36) d. The operation time, intraoperative blood loss, the first postoperative weight-bearing time, postoperative hospital stay, the number of complications and deaths were compared between two groups. Harris score was used to evaluate hip function at 1 and 12 months after operation. The incision healed well after operation. There was 1 case of urinary tract infection in the early operation group;in the delayed operation group, there were 2 cases of intermuscular venous thrombosis, 1 case of pulmonary infection, 3 cases of urinary tract infection and 1 case of prosthesis dislocation. All 17 patients were followed up for 12 to 16 months with an average of (14.76±1.86) months. There was no significant difference in operation time, intraoperative blood loss and the number of deaths between two groups(P>0.05). There were significant differences in the first weight-bearing time, postoperative hospital stay and the number of complications between two groups(P<0.05). One month after operation, there was significant difference in Harris score between two groups(P<0.05). There was no significant difference in Harris score between two groups 12 months after operation(P>0.05). After the failure of intramedullary nail fixation of femoral intertrochanteric fracture in elderly patients, there is no significant difference in mortality and final hip function between early operation and delayed operation. However, early pedestrian femoral head replacement can make patients go down to the ground earlier, shorten the length of hospital stay, effectively reduce the complication rate and restore hip function as soon as possible.

Correlation between metabolic syndrome and adverse events after internal fixation of femoral intertrochanteric fracture in the elderly

To explore the effect of metabolic syndrome on 15 days postoperative adverse events of femoral intertrochanteric fractures with internal fixation. From January 2011 to June 2019, 986 elderly patients with intertrochanteric fracture were treated with internal fixation, including 312 males and 674 females, with an average age of(77.71± 7.58) years old. And there were 97 patients with metabolic syndrome and 889 patients without metabolic syndrome. Through the electronic medical record system, the patient's age, gender, fracture type, cause of trauma, body mass index, smoking history, preoperative comorbidities, preoperative bloodtransfusion, operation timing, ASA classification, anesthesia method, internal fixation type, operation duration, and 15 days postoperative adverse events, which include surgical site infection, acute heart failure, acute respiratory failure, pulmonary infection, acute renal failure, DVT, embolism in important organs, urinary tract infection, death, and blood transfusion after surgery were collected. The differences of preoperative and intraoperative baseline datas and 15 days postoperative adverse events between the two groups were compared and analyzed by t text or univariate χ2 test. Adjusted for the preoperative and intraoperative mixed factors with P<0.05, and 15 days postoperative adverse events with P<0.05 were then analyzed by multivariate unconditional Logistic regression analysis to further study the independent effects of metabolic syndrome on 15 days postoperative adverse events. There were statistical differences in age, body mass index, history of cardiac insufficiency, history of COPD, history of renal insufficiency, operation timing, ASA classification, operation duration, surgical site infection, acute heart failure, DVT, urinary tract infection and blood transfusion between two groups (P<0.05). Adjusted for the preoperative and intraoperative mixed factors, multivariate unconditional logistic regression analysis showed that metabolic syndrome could increase the infection rate of the surgical site [OR=3.785, 95%CI (1.086-13.188), P= 0.037], DVT incidence rate[OR=2.265, 95%CI(1.096-4.682), P=0.027], urinary tract infection rate[OR=2.703, 95%CI (1.049-6.963), P=0.0390], and blood transfusion rate [OR=1.811, 95%CI (1.142-2.870), P=0.012]. Elderly patients with intertrochanteric fracture with metabolic syndrome had higher postoperative surgical site infection rate, DVT incidence rate, urinary tract infection rate, and postoperative blood transfusion rate. Therefore, the orthopedic treatment team should give more attentionand optimize the treatment plan during the perioperative period with the cooperation of internal physician and anesthesiologist.

Application of oxycodone combined with intravenous inhalation anesthesia in PFNA internal fixation of femoral intertrochanteric fracture in the elderly.

article: Application of oxycodone combined with intravenous inhalation anesthesia in PFNA internal fixation of femoral intertrochanteric fracture in the elderly - Minerva Surgery 2022 February;77(1):90-2 - Minerva Medica - Journals

Efficacy and safety of intravenous combined with topical administration of tranexamic acid in reducing blood loss after intramedullary fixation of intertrochanteric femoral fractures

To investigate the efficacy and safety of intravenous combined with topical administration of tranexamic acid (TXA) in reducing blood loss after intramedullary fixation of intertrochanteric femoral fractures by a prospective controlled trial. Patients with intertrochanteric femoral fractures, who were admitted for intramedullary fixation between June 2015 and July 2019, were selected as the study subjects, 120 of whom met the selection criteria. The patients were randomly assigned to 3 groups: intravenous administration group (group A, 41 cases), topical administration group (group B, 40 cases), and combined administrations group (group C, 39 cases). In group A, 4 patients occurred deep vein thrombosis of lower extremity before operation, 1 patient died of myocardial infarction on the 5th day after operation, and 1 patient developed severe pulmonary infection after operation. In group B, 2 patients occurred deep vein thrombosis of lower extremity before operation and 1 patient had iatrogenic fracture during operation. In group C, 3 patients occurred deep vein thrombosis of lower extremity before operation and 1 patient developed pulmonary infection before operation and gave up surgical treatment. All the above patients were excluded from the study, and the remaining 107 cases were included in the analysis, including 35, 37, and 35 cases in groups A, B, and C, respectively. There was no significant difference in gender, age, height, body mass, injury cause, fracture side and type, the interval between injury and operation, and preoperative hemoglobin (Hb), hematocrit between groups ( P>0.05). Intraoperative TXA (15 mg/kg) was injected intravenously in group A at 30 minutes before operation, and 1 g of TXA was injected into the medullary cavity in group B after the proximal femur was grooted and before the intramedullary nail implantation, respectively. TXA was given in group C before and during operation according to the administration methods and dosage of groups A and B. Total blood loss, maximum Hb decrease, blood transfusion rate, operation time, fracture healing time, and the incidence of complications were recorded and compared between groups. The hip joint function were evaluated by Harris score. There was no significant difference in operation time between groups ( P>0.05). The total blood loss, the maximum Hb decrease, and the blood transfusion rate in group B were the highest, followed by group A and group C, and the differences between groups were significant ( P<0.05). No incision infection or pulmonary embolism occurred in the 3 groups after operation. The incidence of anemia in group C was significantly lower than that in groups A and B, the difference was significant ( P<0.05). There was no significant difference in the incidence of subcutaneous hematoma, aseptic exudation, and deep vein thrombosis of lower extremity between groups ( P>0.05). All patients in the 3 groups were followed up 8-35 months, with an average of 16.2 months. The fracture healing time of groups A, B, and C was (6.12±1.78), (5.89±1.63), and (5.94±1.69) months, respectively, and there was no significant difference between groups ( P>0.05). At last follow-up, the Harris scores of the hip joints in groups A, B, and C were 83.18±7.76, 84.23±8.01, and 85.43±8.34, and the difference was not significant ( P>0.05). Preoperative intravenous injection combined with intraoperative topical application of TXA can effectively reduce blood loss and blood transfusion after intramedullary fixation of femoral intertrochanteric fracture, without increasing the risk of deep vein thrombosis, and the efficacy is better than that of intravenous injection or topical administration.

Locking compression plate fixation of femoral intertrochanteric fractures in patients with preexisting proximal femoral deformity: a retrospective study

BackgroundTo investigate the clinical efficacy of locking compression plate fixation for the treatment of femoral intertrochanteric fractures in patients with preexisting proximal femoral deformity.MethodsA retrospective analysis was conducted on 37 patients with femoral intertrochanteric fractures combined with preexisting proximal femoral deformity between January 2013 and July 2019. The patients included 24 males and 13 females aged from 23 to 69 years old, with an average age of 47.5 years. The preexisting proximal femoral deformities resulted from poliomyelitis sequela, proximal femoral fibrous dysplasia, malunion and implant failure combined with coxa vara after intramedullary nailing fixation. There were 6 cases of 31-A2.1, 6 cases of 31-A2.2, 20 cases of 31-A3.1, and 5 cases of 31-A3.2, determined based on the AO classification of intertrochanteric fractures. All fractures were managed through open reduction and locking plate fixation. The hip disability and osteoarthritis outcome score (HOOS) was used to assess hip function before injury and at the last postoperative follow-up. The short form 36 (SF-36) Health Survey Questionnaire was used to assess quality of life.ResultsThirty-seven patients were followed up for 12 to 27 months (average, 20.7 months). All patients achieved bone healing within 5.1 months on average (range, 3 to 6 months). Postoperative complications included deep vein thrombosis in three patients, bedsores in one and delayed union in one patient. No other complications, such as surgical site infection, fat embolism, nonunion and re-fracture, were presented. There was no significant difference in the HOOS scores and the SF-36 Health Questionnaire outcomes at pre-injury and at the last postoperative follow-up (p > 0.05).ConclusionsIt is difficult to perform intramedullary fixation of femoral intertrochanteric fractures in patients with preexisting proximal femoral deformity, while locking compression plate fixation is a simple and effective method of treatment.

Development of a Nomogram to Predict Postoperative Transfusion in the Elderly After Intramedullary Nail Fixation of Femoral Intertrochanteric Fractures.

PurposeThe aim of our study was to explore the risk factors related to blood transfusion after intramedullary nail fixation of elderly femoral intertrochanteric fracture (FTF) and establish a nomogram prediction model.Patients and MethodsWe conducted a retrospective study including elderly FTF patients treated by intramedullary nail between January 2017 and December 2019. Perioperative information was obtained retrospectively, uni- and multivariate regression analyses were performed to determine risk factors for blood transfusion. A nomogram model was established to predict the risk of blood transfusion, and consistency coefficient (C-index) and correction curve were used to evaluate the prediction performance and consistency of the model.ResultsOf 148 patients, 119 were finally enrolled in the study and and 46 patients (38.7%) received a blood transfusion after the operation. Logistic regression analysis the female, lower preoperative Hb, ASA score >2, general anesthesia, and higher intraoperative blood loss were independently associated with the blood transfusion. The accuracy of the contour map for predicting transfusion risk was 0.910.ConclusionThese risk factors are shown on the nomogram and verified. Through the assessment of the risk of blood transfusion and the intervention of modifiable risk factors, we may be able to reduce the blood transfusion rate to a certain extent, so as to further guarantee the safety of the elderly patients during the perioperative period.

Biomechanical comparison of Gamma3 and InterTan nails for stable and unstable intertrochanteric fractures

Objective To compare the biomechanical properties of Gamma3 and InterTan nails in the fixation of femoral intertrochanteric fractures. Methods Twelve synthetic femora of 4th generation were randomized into 4 equal groups (n=3) for assessment of the 2 constructs of fracture fixation (Gamma3 versus InterTan nails). Groups A and B were made into models of stable femoral intertrochanteric fracture (AO/OTA type 31-A1.1) and groups C and D into unstable ones(AO/OTA type 31-A2.3). The biomechanical properties of Gamma3 and InterTan nails in the 4 models were tested and compared. Results For stable fracture models, the fracture gap movement increased with the increasing axial load and the torque increased with the increasing torsion angle. There were significant differences between groups A and B in fracture gap movement and torque (P 0.05). For unstable fracture models, there were no significant differences between groups C and D in fracture gap movement when the axial loads were 500 N, 600 N or 700 N (P >0.05), but there was a significant difference between the 2 groups when the axial load was larger than 800 N (P< 0.05). With the increasing torsion angle, the torque increased in groups C and D. There was a significant difference between the 2 groups in the torque at the same torsion angle (P< 0.05). There were a significant difference between groups C and D in failure load (2,781.5±600.6 N versus 3,150.5±633.8 N) (P=0.007). Conclusions For stable femoral intertrochanteric fractures, InterTan and Gamma3 nails may exhibit similar biomechanical properties. For unstable femoral intertrochanteric fractures, InterTan nails may provide obviously better biomechanical stability than Gamma3 nails. Key words: Hip fractures; Fracture fixation, intramedullary; Bone nails; Biomechanics

Comparison of proximal femoral nail antirotation and proximal femoral nail antirotation-II in treatment of femur intertrochanteric fracture

Objective To compare the clinical effects of proximal femoral nail antirotation (PFNA) and proximal femoral nail antirotation-Ⅱ (PFNA-Ⅱ) in the internal fixation of femoral intertrochanteric fracture. Methods A retrospective study was conducted of the 54 patients with femoral intertrochanteric fracture who had been treated at our department from May 2009 through July 2014. During May 2009 and November 2011, 27 of them were treated with PFNA; during December 2011 and July 2014, the other 27 of them were treated with PFNA -Ⅱ. The 2 groups were compared in terms of operation time, intraoperative blood loss volume, hidden blood loss volume, intraoperative and postoperative complications, fracture healing time and Harris hip score at the last follow-up. Results In the PFNA group, 27 patients were followed up for an average time of 22.6±4.8 months. In the PFNA-Ⅱ group, 27 patients were followed up for an average time of 19.5±4.6 months. The PFNA group had significantly more intraoperative blood loss volume (130.1±74.3 mL), and significantly higher rates of intraoperative lateral wall fracture of the proximal femur (18.5%, 5/27), postoperative lateral thigh soft tissue irritation (22.2%, 6/27) and postoperative thigh pain (22.2%, 6/27) than the PFNA-Ⅱ group [46.3±23.1 mL, 0, 3.7% (1/27), 3.7% (1/27), respectively] (P 0.05). Conclusion Compared with PFNA, PFNA-Ⅱ may lead to a smaller volume of intraoperative blood loss and a lower incidence of complications related to internal fixation. Key words: Hip fractures; Fracture fixation, intramedullary; Bone nails

Causes for failed internal fixation of femoral intertrochanteric fracture in senile patients

Objective To investigate the causes and countermeasures of failed internal fixation of femoral intertrochanteric fracture in the senile patients. Methods From September 2008 to June 2014, 96 patients with femoral intertrochanteric fracture were operated on using varied internal fixations. These patients were 42 males and 54 females in age range of 65-98 years (mean, 72.5 years). There were 19 Evans type Ⅰ, 32 type Ⅱ, 25 type Ⅲ, 16 type Ⅳ and 4 type Ⅴ fractures. Internal fixation methods, failure causes as well as types, and failure incidence were analyzed. Results All the patients were followed up for 3 to 36 months (mean, 11.8 months). Totally 9 patients resulted in failed internal fixation, with the failure rate of 9% (2 stable and 7 unstable fractures). Failed internal fixations were proximal femoral nail antirotation (PFNA, n=2), anatomic plate fixation (n=3), locking plate osteosynthesis (n=8) and dynamic hip screw (n=1). Failure types were hip varus and shortening deformity because of incorrect operation and internal fixation breakage or loosening as the screws were not tightened during operation. Conclusion Osteoporosis, incorrect internal fixation methods, faulty operative procedures and postoperative rehabilitation are the most important factors responsible for the internal fixation failure for femoral intertrochanteric fracture in senile patients. Key words: Femoral fractures; Fracture fixation, internal; Internal fixation failure

Does integrity of the lesser trochanter influence the surgical outcome of intertrochanteric fracture in elderly patients?

BackgroundMost surgeons do not fix the lesser trochanter when managing femoral intertrochanteric fractures with intramedullary nails. We have not found any published clinical studies on the relationship between the integrity of the lesser trochanter and surgical outcomes of intertrochanteric fractures treated with intramedullary nails. The purpose of this study was to evaluate the impact of the integrity of the lesser trochanter on the surgical outcome of intertrochanteric fractures.MethodsA retrospective review of 85 patients aged more than 60 years with femoral intertrochanteric fractures from January 2010 to July 2012 was performed. The patients were allocated to two groups: those with (n = 37) and without (n = 48) preoperative integrity of the lesser trochanter. Relevant patient variables and medical comorbidities were collected. Medical comorbidities were evaluated according to the American Society of Anesthesiologists classification and medical records were also reviewed for age, sex, time from injury to operation, intraoperative blood loss, volume of transfusion, operative time, length of stay, time to fracture union, Harris Hip Score 1 year postoperatively, and incidence of postoperative complications. Postoperative complications included deep infection (beneath the fascia lata), congestive heart failure, pulmonary embolus, cerebrovascular accident, pneumonia, cardiac arrhythmia, urinary tract infection, wound hematoma, pressure sores, delirium, and deep venous thrombosis. Variables were statistically compared between the two groups, with statistical significance at P<0.05.ResultsPatients with and without preoperative integrity of the lesser trochanter were comparable for all assessed clinical variables except fracture type (P < 0.05). There were no statistically significant differences between these groups in time from injury to operation, volume of transfusion, length of stay, time to fracture union, Harris Hip Score at 1 year postoperatively, and incidence of postoperative complication (P > 0.05). The group with preoperative integrity of the lesser trochanter had significantly less blood loss (107.03 ± 49.21 mL) than those without it (133.96 ± 58.08 mL) (P < 0.05) and the operative time was significantly shorter in the former (0.77 ± 0.07 hours) than the latter (0.84 ± 0.11 hours) group (P < 0.05).ConclusionsThe integrity of the lesser trochanter has no significant influence on the surgical outcome of intramedullary nail internal fixation of femoral intertrochanteric fractures.

The Effect of Prospective Nursing to Lower Deep Vein Thrombosis after the Internal Fixation of Femoral Intertrochanteric Fracture

Objective: The effect of prospective nursing to lower deep vein thrombosis afer the internal fixation of femoral intertrochanteric fracture was studied. Method: 80 patients, who treated with the internal fixation of femoral intertrochanteric fracture in the orthopedics department of our hospital between January 2012 and June 2013 were selected, the patients were randomly allocated to control group and test group, 40 cases per group, the control group were treated by conventional nursing measures, while the test group used the prospective nursing measures. Compared the living quality and the lower deep vein thrombosis of two groups. Results: For the living quality, the scores of all items in prospective nursing group were better than conventional nursing group. The number of lower deep vein thrombosis in the prospective nursing group was 2 cases and the conventional nursing group was 8 cases, with statistical difference. Conclusion: The prospective nursing could reduce the incidence of lower deep vein thrombosis after the internal fixation of femoral intertrochanteric fracture, improved the living quality of such patients after surgery, worth clinical promotion.

The Effect of Prospective Nursing to Lower Deep Vein Thrombosis after the Internal Fixation of Femoral Intertrochanteric Fracture

&lt;strong&gt;Objective:&lt;/strong&gt; The effect of prospective nursing to lower deep vein thrombosis afer the internal fixation of femoral intertrochanteric fracture was studied. &lt;strong&gt;Method: &lt;/strong&gt;80 patients, who treated with the internal fixation of femoral intertrochanteric fracture in the orthopedics department of our hospital between January 2012 and June 2013 were selected, the patients were randomly allocated to control group and test group, 40 cases per group, the control group were treated by conventional nursing measures, while the test group used the prospective nursing measures. Compared the living quality and the lower deep vein thrombosis of two groups.&lt;strong&gt; Results: &lt;/strong&gt;For the living quality, the scores of all items in prospective nursing group were better than conventional nursing group. The number of lower deep vein thrombosis in the prospective nursing group was 2 cases and the conventional nursing group was 8 cases, with statistical difference. &lt;strong&gt;Conclusion:&lt;/strong&gt; The prospective nursing could reduce the incidence of lower deep vein thrombosis after the internal fixation of femoral intertrochanteric fracture, improved the living quality of such patients after surgery, worth clinical promotion.

Biomechanical consideration of total hip arthroplasty following failed fixation of femoral intertrochanteric fractures – A finite element analysis

ObjectiveThe current study aimed to perform a biomechanical analysis of the effect and distribution of stress and strain values in the femur and its residual screw holes from the implantation of different lengths of total hip prostheses following failed dynamic hip screw (DHS) fixation of AO type A1.1 and A1.3 intertrochanteric fractures. MethodsMedical image processing, computer-assisted engineering design, and finite element analysis were combined for the analysis and the reliability of the model confirmed by convergence testing and comparison with a physical model. Using finite element analysis, patterns of stress from implantation of total hip prostheses with different stem length were obtained. ResultsStress distribution was concentrated over the third and fourth residual screw holes, especially in the models with shorter stem length. Fracture type (AO type A1.1 or A1.3) did not alter its distribution. In proximal cancellous bone, a stress-shielding effect was seen at the region of the residual fracture fragment, especially in the A1.1 fracture. In the fracture fixed with 2 cable wires, the maximum von Mises stress was in the proximal cable wire. ConclusionThe results suggest that an increase in the original stem length equal to the diameter of the femoral isthmus, or a distance between the most distal residual screw hole and the end of the femoral prosthesis, provide improved stress distribution.

Causes and countermeasures for postoperative complications following DHS internal fixation of femoral intertrochanteric fractures

股骨转子间骨折是老年常见骨折,在中老年患者中其发生率可高达38%[1].对于股骨转子间骨折的治疗,目前多主张早期手术内固定,动力髋螺钉(dynamic hip screw,DHS)内固定是临床最常采用的方式之一,但由于适应证的选择及术中操作不当、术后过早负重等原因常导致术后并发症的发生.2004年1月～2006年7月我院应用DHS内固定治疗股骨转子间骨折患者172例,其中29例出现并发症,发生率为16.9%.本文对其在适应证选择、手术操作及术后功能锻炼等方面失误进行总结,旨在为临床提供经验并提出相应对策。