PFNA Group Research Articles

A biomechanical investigation of a novel intramedullary nail used to salvage failed internal fixations in intertrochanteric fractures

PurposeThe ideal approach for revision surgery following femoral head salvage treatments for an intertrochanteric fracture is still up for debate. A novel variety of proximal femoral bionic intramedullary nail (PFBN) has been created in clinical practice. We aimed to compare the biomechanical results of the novel implant to conventional intramedullary and extramedullary fixation in the treatment of intertrochanteric fracture following primary internal fixation failure.MethodsUsing finite element analysis, we created a three-dimensional model of the intertrochanteric fracture's helical blade cut-out for this investigation. The PFBN 1 group, the PFBN 2 group, the PFNA group, and the DHS group were our four test groups. For each fracture group, the von Mises stress and displacements of the femur and internal fixation components were measured under 2100 N axial loads.ResultsThe values for the femoral displacement in the PFBN1 group, PFBN2 group, PFNA group, and DHS group were 6.802 mm, 6.716 mm, 8.080 mm, and 8.679 mm, respectively. The internal implant displacement values were 6.201 mm, 6.138 mm, 7.396 mm, and 8.075 mm in the PFBN1 group, PFBN2 group, PFNA group, and DHS group, respectively. The maximum von Mises Stress in the femoral was 187.2 MPa, 85.18 MPa, 106.6 MPa, and 386.2 MPa in the PFBN1 groups, PFBN2 groups, PFNA groups, and DHS groups, respectively. In the PFBN1 groups, PFBN2 groups, PFNA groups, and DHS groups, the maximum von Mises Stress in internal fixation was 586.7 MPa, 559.8 MPa, 370.7 MPa, and 928.4.8 MPa, respectively.ConclusionOur biomechanical research demonstrates that intramedullary fixation is more stable than extramedullary fixation when salvaging failed internal fixations in intertrochanteric fracture. Compared with PFNA and DHS, PFBN showed better biomechanical stability in the treatment of patients with revised intertrochanteric fractures. In light of this, we advocate PFBN fixation as the method of choice for intertrochanteric fracture revision. This result still has to be confirmed in more clinical research.

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

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). 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). 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. 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.

EVALUATION OF NECK SHAFT ANGLE AS A PREDICTOR OF CUT-OUT FAILURE IN PERTROCHANTERIC FRACTURES- AN OBSERVATIONAL STUDY

Introduction: Femoral trochanteric fractures are extremely common fractures of old age. Due to the fracture, there is a change in the neck shaft angle (NSA) which if not restored can lead to further disability [1]. In this study, we aim to evaluate the neck shaft angle as a predictor of cut out failure in patients with pertrochanteric fractures after surgical xation by various xation methods. Materials and methods: A total of 100 patients with pertrochanteric fractures were enrolled in the study, who underwent surgical xation with either of three 3 methods- DHS/PFN/PFN-A. Patients were followed up at 6 weeks, 3months and 6 months. Neck shaft angle (NSA) of the normal side was calculated on pre-operative x-rays and of affected side on post operative radiographs. Results: The mean NSA of normal side (N) and operated side (O) across various xation methods in our study was as follows- DHS- Normal side(N)-127.890, Operated side(O)- 130.80; PFN- N-126.60, O-128.50; PFN-A- N-126.330, O-127.40. In all three groups, the fracture was xed in valgus position. 6 cases of cut-out failure observed in the study, 4 among the DHS group and 2 among the PFN group. The mean NSA on operated side, mean difference between normal and operated side, change at 6 weeks, 3 months and 6 months was signicantly more among DHS group compared to PFN and PFN-A groups.

Comparison of the effects of physiotherapy and ergotherapy applications on independent movement in hip fracture patients with hemiarthroplasty and PFN-A

Objective:In this study, our aim is to compare the effects of post-hip fracture hemiarthroplasty or PFN-A applications on the post-operative hip joint to provide enough range of motion to assist in daily activities, helping to regain lost muscle strength and to compare the effects on independent movement. Patients and Methods: 15 patients who underwent hemiarthroplasty (Group 1) and 15 patients who underwent PFN-A (Group 2) were included in this study. These patients were aged between 50-80 who had operated at least 3 months ago, had no other lower extremity operation or trauma in the last 6 months, did not have any other physical and mental problems that prevented physiotherapy and occupational therapy due to the hip fracture. Physical therapy and occupational therapy methods were applied to both groups after surgery. These two group were evaluated with the early postoperative period, after physical therapy and after occupational therapy, the Lower Extremity Functional Scale, Functional Independence Scale, Barthel Daily Living Activities Index, Harris Hip Assessment Scale and Timed Get Up and Go tests. Results: After physical therapy applied according to the early postoperative period; a significant difference was obtained for all patients in the evaluations made with lower extremity function scale, Functional independence scale, Timed up and go test, and Harris hip assessment scale. In addition to this treatment, a significant difference was achieved for all patients after the ergotherapy methods. No statistically significant differences were found for Barthel's daily life activities test. Conclusion: The negative thoughts created by the limitations in the functions of the elderly people is reduced with the ergotherapy application plan and providing support both physically and psychologically. The emotional changes that vary on according to the level of dependency of the patients, the use of auxiliary devices is taught in elderly individuals, especially considering their desire to be independent, their functions were restored with the multiple working method and the quality of life is increased.

Comparison of proximal femoral nailing (PFN) and proximal femoral locking plate (PFLP) for intertrochanteric femur fracture in elderly.

Objective: To compare the functional outcome of PFN and PFLP for the treatment of unstable four part intertrochanteric femur fracture. Study Design: Randomized Controlled Trial study. Setting: Orthopedics Department, Dow International Medical College, Karachi. Period: February 2019 to January 2020. Material &amp; Methods: 281 patients were included and assigned to each group PFNA and PFLP alternatively. Both groups were compared for functional evaluation by Harris hip score. Result: Duration of surgery, perioperative hemoglobin loss, and duration of fracture healing were significantly lower in PFNA group as compared to PFLP, P&lt;0.05. But Harris Hip score was significantly higher in PFNA group as compare to PFLP P&gt;0.05. Conclusion: PFN has better functional outcome. This makes it a better method of fixation as compared to PFLP in elderly intertrochanteric femur fracture.

Assessment of factors resulting to functional outcome of intertrochanteric fracture of femur managed by proximal femoral nail: Antirotation 2 (PFNA 2)

Background: Intertrochanteric femur fracture management in elderly needs more attention to reduce malunion and increase early mobilisation to reduce mortality and morbidity. Ideal choice of treatment is internal fixation by intramedullary or extramedullary devices. Intramedullary devices provide more stable proximal femoral anatomical fixation. Between PFN and PFNA; helical blade in PFAN provides more stability, better compression and rotational control with lower cut-out rate. Aim: a) To assess the factors for functional outcome of PFNA2. b) Evaluation of effectiveness and stability of PFNA 2. Material and Methods: 30 patients with unstable Intertrochanteric femur fracture between Nov 2020 to July 2021 fulfilling inclusion and exclusion criteria were included in this study and underwent closed reduction and intermal fixation by PFNA(n=30). Assessment was done in terms of demography, preoperative and intraoperative variables, postoperative parameters mainly functional outcome till 1 year postoperative. Results: Preoperative variables, AO fracture type were assessed preoperatively. Duration of surgery, blood loss and fluoroscopy imaging were significantly lower in PFNA as compared to PFN. Postoperative complications like cut-out rate, shortening, varus malalignment, return to pre-fracture state were also lower in PFNA group than PFN. Postoperative functional assessment done by Harris Hip Score shows better outcome in PFNA than other fixation devices. Conclusion: PFNA reduces duration of surgery, blood loss, fluoroscopy imaging as compared to other implants. PFNA also offers better postoperative functional outcome.

Surgical Selection of Unstable Intertrochanteric Fractures: PFNA Combined with or without Cerclage Cable.

Due to the instability of unstable intertrochanteric fractures, the selection of a suitable internal fixation has always been a challenge for orthopedic surgeons. This study is aimed at comparing the clinical efficacy of PFNA combined with cerclage cable and without cerclage cable and finally recommend a stable internal fixation method to provide the basis for clinical therapy. From January 2014 to January 2018, we retrospectively analyzed all cases of unstable intertrochanteric fractures who received treatment in the Orthopedics Department of our hospital and finally screened 120 cases, 51 of whom were treated with cerclage cable, 69 without cerclage cable. The follow-up period was one year. HHS, BI, and RUSH scores were given within the specified time. We divided the patients into the PFNA+cable (PFNA combined with cerclage cable) group and the PFNA group. The time of fracture healing and weight-bearing in the PFNA+cable group was shorter than that in the PFNA group. With regard to HHS, BI, and RUSH, the PFNA+cable group was higher than the PFNA group at 1 month, 3 months, 6 months, and 12 months after operation. For HHS rating, the PFNA+cable group has a higher excellent rate than the PFNA group, which was 96.1% and 84.1%, respectively. All the results mentioned above were statistically significant. Compared with the group without cerclage cable, the application of cerclage cable can reduce the incidence of complications. From the comparison between the two groups, it can be seen that the surgical method of PFNA combined with cerclage cable can not only help to improve the stability of fracture reduction, shorten the time of fracture healing and postoperative weight-bearing, and significantly improve patients' self-care ability but also reduce the incidence of postoperative complications. Therefore, we think PFNA combined with cerclage cable is a good choice.

Intramedullary nailing confers an increased risk of medial migration compared to dynamic hip screw fixation in unstable intertrochanteric hip fractures

IntroductionMedial migration of the femoral neck element (FNE) superomedially against gravity with respect to the intramedullary component of the cephalomedullary nail is a complication increasingly recognized to cause femoral head cut-out in intramedullary nailing of pertrochanteric hip fractures. Although cut-outs are common to both intra- and extramedullary fixation, especially in unstable pertrochanteric hip fractures, FNE medial migration in sliding hip screws continues to remain sparse despite increased awareness of the phenomenon. This study aims to investigate whether intramedullary nailing is biomechanically predisposed to FNE medial migration compared to extramedullary fixation with sliding hip screws to account for the discrepancy in reported FNE medial migration rates. Materials and methodsTwelve fourth-generation synthetic femurs (Sawbones) with unstable intertrochanteric fractures were divided into 2 groups (n=6 per group). Fracture fixation was performed using the Proximal Femoral Nail Antirotation (PFNA, Synthes) (n=6) in the first group, and the Dynamic Hip Screw (DHS, Synthes) (n=6) in the second group. Both groups were subjected to bidirectional cyclic loading (600N compression loading, 120N tensile loading) at 2 Hz for 5000 cycles. The medial migration distance (MMD) was recorded at the end of the testing cycles. ResultsThe mean MMD in the PFNA group was 4.56mm (SD 0.69mm) with consistent reproduction of medial migration across all constructs tested. This was significantly more compared to the MMD of 1.17mm (SD 0.69mm) in the DHS group (p<0.001). ConclusionIntramedullary nailing of unstable intertrochanteric hip fractures is inherently predisposed to FNE medial migration making it more susceptible to consequent cut-out compared to fixation with the DHS.

Comparative study of PFN antirotation vs bipolar hemiarthroplasty in unstable senile intertrochanteric fractures

Introduction: Treatment of intertrochanteric fracture in elderly is not only to mobilise early but also to avoid complications and morbidity. With available treatments it is difficult to address all the issue with same surgical option. A recent advance for treatment of senile unstable intertrochanteric fracture is PFN antirotation which may help in early mobilisation with less complications. The purpose of this study is to compare the outcome of PFNA and hemiarthoplasty and to study advantages, disadvantages, complications of both the groups. Materials and Methods: 20 patients each were included in PFNA group and hemiarthroplasty group from January 2016 to January 2017 who satisfied the inclusion and exclusion criteria. Patient followed up upto 1 year. Patients were evaluated with multiple variables, complications and harris hip score. Results: PFNA groups had significantly less blood loss, less surgery time, less hospital stay as compared to hemiarthroplasty group. Both groups had similar medical and orthopaedic complications. PFNA patients can be mobilised early as with hemiarthroplasty group. Hemiarthoplasty groups have better harris hip score in initial 3 months but similar score at the end of 1 year. Conclusion: PFNA provide less morbidity to patients with early mobilisations and good functional outcome. It can definitely be a better option than replacement in elderly intertrochanteric fracture. Keywords: PFNA, Bipolar, Intertrochanteric fracture, Hemiarthroplasty, Harris hip score, Replacement.

A RETROSPECTIVE STUDY COMPARING PROXIMAL FEMORAL NAIL ANTI-ROTATION WITH CEMENTLESS BIPOLAR HEMIARTHROPLASTY FOR UNSTABLE FEMORAL INTERTROCHANTERIC FRACTURE

Background: Intertrochanteric femoral fractures are one of the most common types of bone fractures that are usually caused by severe direct or indirect force. It has also been estimated that nearly 50% of all the fractures are intertrochanteric fractures and the remaining are unstable fractures. Also, it has been found that the mortality related to hip fractures is as high as 15-20%. With an increase in the life expectancy of people, there has been a substantial increase in the number of patients with postmenopausal or senile osteoporosis.&#x0D; Aim: To compare Proximal femoral nail anti-rotation with cementless bipolar hemiarthroplasty for unstable femoral intertrochanteric fracture&#x0D; Methods: It was a retrospective study carried out at the Government Medical College, Baramati for a period of 1 year. One hundred patients were included for the scope of the study. Out of which 50 patients belonged to the PFNA group, and 50 patients belonged to the CPH group.&#x0D; Results: The number of patients in the PFNA group was 50 and that in the CPH group was 50. Both groups show male preponderance. The mean age among both the groups was almost the same, and there was no statistically significant difference among the two groups regarding the mean age. The mean operation time for PFNA was 54.15±16.1 mins, and that of the CPH group was 76.69±15.89 mins. The mean bleeding time for PFNA was 133.12±33.16 ml, and that of the CPH group was 289.25±44.01 ml. There was no statistically significant difference among the ASAA grade scores of the two groups. There was no statistically significant difference among the Evans-Jensen classification of the two groups. The mean length of hospital stay for PFNA group was 7.89±2.0 days, and the mean hospital stay for CPH group was 6.54±1.9 days.&#x0D; Conclusion: The current study depicted that CPH and PFNA are both safe and effective methods of treating elderly patients suffering from intertrochanteric fractures. However, it was found in the current study that CPH was found to have more mean operative time and increased blood loss. Still, the recovery and hospitalization time was almost similar in both the groups. Both the groups had almost similar ASA and Evans Jensen scores that made both the techniques equally safe

COMPARATIVE ASSESSMENT OF PRIMARY AND SECONDARY OUTCOME WITH PFNA AND HEMIARTHROPLASTY FOR SENILE INTERTROCHANTERIC FRACTURES MANAGEMENT: A PROSPECTIVE RANDOMIZED CLINICAL STUDY.

Aim: assessment of primary and secondary outcome among patients treated with PFNA and hemiarthroplasty.&#x0D; Materials and Methods: 20 patients each were included in PFNA group and hemiarthroplasty Patient followed. Patients were evaluated with multiple variables, complications and Harris hip score. The statistical test applied for the independent sample analysis was student t-test using SPSS version 20.&#x0D; Results: PFNA groups had significantly less blood loss, less surgery time, less hospital stay as compared to hemiarthroplasty group. There were no significant differences between the two groups regarding to the Harris Hip Score.&#x0D; Conclusion: From the present investigation it seems that intertrochanteric fractures treated with PFNA may achieve better functional results than treated with hemiarthroplasty. It can definitely be a better option than replacement in elderly intertrochanteric fracture.&#x0D; Keywords: Harris hip score, Hemiarthroplasty, PFNA, Intertrochanteric fracture

Comparative study of PFN A2 vs bipolar hemiarthroplasty in unstable senile intertrochanteric fractures

Introduction: Successful outcome in the treatment of intertrochanteric fracture in elderly lies in early mobilization of the patient so as to avoid the morbidity, complications and poor recovery. With the associated medical comorbidities and osteoporosis, presents a great challenge in selecting the surgical procedures in these patients. Even though the primary choice of surgery revolves around Osteosynthesis in these type of fractures, there is a conspiracy in the choice of implants for the fractures. Many surgeons have resorted to primary hemiarthroplasty in these fractures to avoid uncertainties and implant failures and able to allow full weight bearing walking after surgery. Off late PFNA2 nail have been preferably used to stabilize these fractures with relatively lesser complications and early mobilization of these patients. The purpose of this study is to compare the outcome of PFNA2 and hemiarthroplasty and to study advantages, disadvantages, complications of both the groups. Materials and Methods: 20 patients each were included in PFNA2 group and hemiarthroplasty group from May 2017 to August 2018 who satisfied the inclusion and exclusion criteria. Patient followed up upto 1 year. Patients were evaluated with multiple variables, complications and Harris hip score. Results: PFNA groups had significantly less blood loss, less surgery time, less hospital stay as compared to hemiarthroplasty group. Both groups had similar medical and Orthopaedic complications. PFNA patients can be mobilised early as with hemiarthroplasty group. Hemiarthroplasty groups have better Harris hip score in initial 3 months but similar score at the end of 1 year. Conclusion: PFNA2 provide less morbidity to patients with early mobilisation and good functional outcome. It can definitely be a better option than replacement in elderly intertrochanteric fracture.

Is PFN with talon locking system as successful as PFNA in geriatric hip fracture?

Amaç: PFN-A kullanılarak tedavi edilen hastaların fonksiyonel ve radyolojik sonuçlarını ve radyasyon maruziyetini Talon kilitli PFN ile karşılaştırdık.Yöntem: Çalışmaya 2014-2018 tarihleri arasında proksimal femur kırığı tanısı ile PFN yapılan 60 yaşından büyük 92 hasta (43 kadın,49 erkek; ort. yaş 75.01 yıl) dahil edildi. Retrospektif çalışmamızda hastalar Talon kilitli PFN grubu (grup 1, n=46) ve PFN-A grubu (grup 2, n=46) olmak üzere iki gruba ayrıldı. Hastaların demografik verileri, kırık tipleri, takip süreleri, kırık kaynama zamanları, radyografik bulguları, WOMAC skorları ile C-kollu skopi çekim sayıları değerlendirmeye alındı.Bulgular: Hastaların ortalama takip süreleri 11.05 aydı. Mortalite Grup I de %4.3, Grup II de %6.5 olarak bulundu. Kollodiafizer açı Grup I de 129.5±3.4, Grup II de 126.8±3.6 (p=0.01); Singh indeksi Grup I de 4.1, Grup II de 3.62 (p=0.06); kayna-ma Grup I de 4.62±1.06, Grup II de 5.1±1.51(p=0.68) olarak gözlendi. Skopi çekim süresi Grup I de 53.08 (45-89), Grup II de 97.4 (76-150) (p&amp;lt;0.05) olarak gözlendi. Kırık kaynama süreleri Grup I de 4.62±1.06, Grup II de 5.1±1.51 (p=0.68), WOM-AC skorları Grup I de 69.9±4.26, Grup II de 70.2±5.75 (p=0.78) olarak tespit edildi. Grup I de 2 hastada (%4.3) komplikasyon gözlenirken, Grup II de 5 hastada (%10.8) komplikasyon gözlendi.Sonuç: Talon kilitli PFN, radyasyon maruziyetinin az olması, cerrahi sürenin daha kısa olması sebebiyle PFN sistemlerinin kolay ve güvenilir bir alternatifidir.

PFNA combined reconstruction and locking titanium plate for the treatment of comminuted femoral intertrochanteric fractures involving lateral wall

To investigate the operative effect of PFNA combined with reconstructive locking plate on the treatment of comminuted femoral intertrochanteric fracture which involving the lateral wall. A total of 35 patients with comminuted femoral intertrochanteric fractures involving the lateral wall were surgically treated from November 2014 to January 2016. According to whether there was reconstruction of the lateral wall or not and the internal fixation method, the patients were divided into PFNA group (no reconstruction of the lateral wall), PFNA recontruction group (reconstructive locking plate was used to reconstruct the lateral wall, PFNA internal fixation). The clinical curative effect was evaluated by the analysis of operation time, intraoperative blood loss, postoperative activity time, the time of fracture healing, complications, and hip joint Harris score at 12 months after operation. All 35 patients completed the operation successfully. All the incisions were healed by first intention and no incision infection or fat liquefaction occurred. All 35 patients were followed up from 12 to 16 months with an average of 14.4 months. All patients had bone healing. There was no statistical significant in surgery time and intraoperative blood loss between two groups(P>0.05). There were 5 postoperative complications in the PFNA group and 1 in the PFNA combined with reconstructive locking plate group. There was a statistical difference between two groups(P<0.05). The postoperative activity time, bone healing time, complications, and Harris score of PFNA reconstruction group were all superior to PFNA group, there were statistically significant differences between two groups. Although the operation time and blood loss of PFNA combined with reconstructive locking plate in treatment of comminuted femoral intertrochanteric fracture which involving the lateral wall are more than those in the PFNA group, and the surgical trauma is larger than PFNA, the fracture healing time, postoperative activity time, and hip joint function were all superior to those of the PFNA group, which can effectively shorten the postoperative bed rest time, and reduce bed complications as well as improve hip joint function.

Treatment with total hip arthroplasty for the failure of stable(3.1A1) femoral intertrochanteric fractures surgery using proximal femoral nail antirotation or dynamic hip screw

Objective To investigate the clinical effect of total hip arthroplasty in the treatment of failure of femoral intertrochanteric fractures(3.1A1.1-3) with proximal femoral nail antirotaion or dynamic hip screw. Methods A retrospective study was performed on 192 patients(192 hips) underwent total hip arthroplasty(THA) to cure failed femoral intertrochanteric fractures surgery using proximal femoral nail antirotation or dynamic hip screw from January 2007 to April 2016.The preoperative and postoperative data,from the reasons for internal fixation failure,imaging changes,improved Harris score and postoperative complications were analyzed. Results The scores of Harris in each group were significantly higher than those before operation(P<0.05). There was no significant difference between the two groups.There were more postoperative complications in the DHS group compared with PFNA group,and the difference was statistically significant(P<0.05). Conclusion The total hip arthroplasty in the treatment of femoral intertrochanteric fractures with proximal femoral nail or dynamic hip screw failure has good clinical results.The postoperative complications are more likely to occur in patients with DHS for the first time,there is no significant difference between the two prostheses of bone cement and non-bone cement. Key words: Femoral intertrochanteric fracture; Total hip arthroplasty; Dynamic hip screw; Proximal femoral nail antirotaion

Effectiveness of controlled telescoping system for lateral hip pain caused by sliding of blade following intramedullary nailing of trochanteric fracture

IntroductionThe purpose of this study was to demonstrate the effectiveness of controlled telescoping system for lateral hip pain caused by sliding of the blade following intramedullary nailing of trochanteric fractures. Materials and methodsA retrospective cohort study was performed to compare the controlled telescoping system (Compression Hip Nail; CHN) with the conventional sliding system (Proximal Femoral Nail Antirotation; PFNA) for trochanteric fractures. 74 cases in the PFNA group and 77 cases in the CHN group were included from two university hospitals in this study. All patients had a minimum of 12-month follow up period. Lateral hip pain was evaluated and operation time and blood loss during the surgery were measured. The fracture classification was evaluated. The quality of postoperative reduction and other complications after surgery were also evaluated and tip-apex distance (TAD), telescoping and lateral protrusion of the blade and lag screw were measured. ResultsThe mean age was 78.5 years in the PFNA group and 74.7 years in the CHN group (p=0.25). The mean telescoping was 19.2mm in the PFNA group and 10.7mm in the CHN group (p<0.001). The mean length of lateral protrusion was 10.5mm in the PFNA group and 2.5mm in the CHN group (p<0.001). Twenty-eight patients in the PFNA group complained of lateral hip pain, whereas 12 patients in the CHN group did (p=0.002). These four variables showed statistically significant differences between the PFNA and CHN groups (p<0.05). The length of lateral protrusion was the only variable significantly related to lateral hip pain through multivariate logistic regression analysis (p=0.045). ConclusionsThe degree of lateral protrusion was mainly related to lateral hip pain. Therefore, controlled telescoping would help to decrease lateral hip pain by decreasing the lateral protrusion beyond the lateral femoral cortex.

A comparison of two fixation methods for femoral trochanteric fractures: a new generation intramedullary system vs sliding hip screw.

Trochanteric fractures are frequent and generally associated with bone fragility. There is still debate on the best fixation device to treat stable or rather stable trochanteric fractures: we report our clinical and radiological results of fixation with Proximal Femoral Nail "antirotation" (PFNa) in a population of patients compared to a control group treated by Sliding Hip Screw (SHS). A prospective study was conducted in 71 consecutive patients treated by PFNa (group A), and 69 by a SHS (group B), with a mean age of 81.6 and 83.4 years respectively. Short Form 12 was administered to check postoperative results, and the following parameters were evaluated: range of motion, evaluation of pain, gait ability, X-rays, and Tip Apex Distance Index. A minimum follow-up was conducted in 128 patients: 66 subjects belonging to the PFNa group and 62 to the DHS group. All patients in the group A were able to reach partial or full weight-bearing on the operated leg before leaving the hospital. Forty-four patients (63.8%) of the group B were able to walk with partial weight-bearing before discharge. We recorded 17 complications with a final overall percentage of 17.2% on the overall study population with one single case of failure in both the two groups. A statistical significance (p<0.01) of superiority for PFNa was demonstrated regarding surgical time, amplioscope time, intraoperative blood loss, hospital stay, recovery of weight-bearing before discharge. Less significant results (p<0.05) were found for walking ability at the three-months follow-up and patients' satisfaction 6 months after surgery. PFNa may be considered an useful choice for the treatment of stable or rather stable trochanteric fractures as well as DHS. The light superiority of PFNa may be principally related to its mechanical advantages.

Biomechanical study of the lateral wall of the femur in the treatment of femoral intertrochanteric fracture with intramedullary or extramedullary fixation

To observe the biomechanical effects of the lateral wall of the femur in treating femoral intertrochanteric fractures with intramedullary or extramedullary fixation to guide the choice of clinical fixed methods. Twelve adults femur specimens of intertrochanteric fractures were belong to the type A1 of the AO fracture classification and randomly divided into the lateral wall complete PFNA group, the lateral wall complete PF-LCP group, the lateral wall breakage PFNA group, lateral wall breakage PF-LCP group, every group had 3 specimens. The four groups of specimens were subjected to compressive loading experiment with Universal Material Testing Machine. The maximum loading force was observed. The distance between fracture ends, the distance of fracture dislocation and the sliding distance of the fracture fragments along the intertrochanteric were measured with Calipers. The maximum loading force of lateral wall complete PFNA group were larger than that of lateral wall complete PF-LCP group, and the maximum loading force of lateral wall breakage PFNA group were larger than that of lateral wall breakage PF-LCP group, there were significant differences (P<0.05). The distance between fracture ends of the four groups before compression were not significant differences(P>0.05). The distance between fracture ends, the distance of fracture dislocation and the sliding distance of the fracture fragments were not significant differences between lateral wall complete PFNA group and lateral wall complete PF-LCP group after compression (P>0.05). But the distance between fracture ends, the distance of fracture dislocation and the sliding distance of the fracture fragments of lateral wall breakage PFNA group were less than that of lateral wall breakage PF-LCP group(P<0.05). Intramedullary fixation of intertrochanteric fractures have stronger loading force. Both intramedullary and extramedullary fixation of intertrochanteric fractures have strong stability when the lateral wall of the femur is complete, but intramedullary fixation of intertrochanteric fractures is stronger stability than extramedullary fixation when the lateral wall of the femur is broken. So the intramedullary fixation is the first choice for the treatment of intertrochanteric fracture.

Comparison of clinical effect betweem reconstructing femoral calcar and proximal femoral antirotation nail for the treatment of unstable femoral intertrochanteric fracture in elderly patients

To compare the clinical effects of two methods of internal fixation in treating unstable femoral intertrochanteric fractures in elderly patients. From August 2009 to August 2014, 68 elderly patients with unstable femoral intertrochanteric fracture treated with locking proximal femur plate and auxiliary short reconstructed plate (reconstructing calcar group) and proximal femoral nail antirotation (PFNA group) with clinical course from 1 to 3 days were retrospectively analyzed. In reconstructing calcar group, there were 30 patients including 8 males and 22 females, aged from 63 to 85 years old with an average of (73.41±5.12) years old, the fractures were classified to type AO 31-A2.2 in 12 cases, A2.3 in 11 cases, A3.3 in 7 cases according to AO/ASIF classification. In PFNA group, there were 38 patients including 10 males and 28 females, aged from 65 to 90 years old with an average of (74.26±4.53) years old, the fractures were classified to type AO 31-A2.2 in 15 cases, A2.3 in 13 cases, A3.3 in 10 cases. All fracture were caused by injury, leading pain and swelling. Femoral intertrochanteric fracture was confirmed by X ray films. The data of each group were collected for statistical analysis on the following aspects: the incision length, operation time, blood loss volume, postoperative partial weight bearing standing time, clinical healing time of fracture, postoperative complications, and hip functional score of Harris. All incisions were healed at stage I. In the aspect of postoperative complications, there were 1 case of screw blade cutting and 1 case of deep venous thrombosis in PFNA group; there was 1 case of deep venous thrombosis in the reconstructing calcar group (χ²=0.000, P=1.000). Patients were followed up from 20 to 24 months with an average of 22.5 months. There were no significant in postoperative partial weight bearing standing time, postoperative complications, hip functional score of Harris between two group. There were significant in the incision length, operation time, blood loss volume, clinical healing time of fracture. In the incision length, operation time, blood loss volume, clinical healing time of fracture, the PFNA group was significantly differently less than that of the reconstructing calcar group (P<0.001). In the clinical healing time of fracture, the PFNA group was significantly differently less than that of the reconstructing calcar group (P<0.05). For the treatment of unstable femoral intertrochanteric fractures in elderly patients, reconstructing calcar and PFNA are both effective, and proximal femoral intramedullary nails may be the best choice, which can be simpler operation, smaller incision and less healing time.

Comparison of Short vs Long Anti-rotation in Treating Trochanteric Fractures.

Introduction: A comparative evaluation of the surgical treatment and outcome of patients with pertrochanteric fractures treated with short versus long proximal femoral nail antirotation.Materials and methods: A retrospective review was conducted of patients with pertrochanteric fractures treated between January 2011 and June 2012. In all 80 patients were enrolled in the study, of which 40 were treated with short PFNA and the remaining with long PFNA. Comparative analyses of demographic data, peri-operative outcome and complications were carried out.Results: There was no significant difference noted in the two groups with regards to Arbeitsgemeinschaft fur Osteosynthesefragen (AO) fracture classification, time from injury to surgery, blood transfusion post surgery and hospital stay. The surgical duration for a short PFNA procedure was significantly less (58 minutes) when compared to that of a long PFNA (87 minutes). Similarly intra-operative blood loss was significantly higher in the long PFNA group as compared to the short PFNA.Conclusions: A relatively quicker surgical time of just under an hour , lesser blood loss and better learning curve with trainee surgeons make short PFNA a better implant choice in the treatment of pertrochanteric fractures.