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The Effect of Proximal Femoral Nail and Position in the Femur on Clinical and Radiological Outcomes of Intertrochanteric Fractures

Yıl 2024, Cilt: 14 Sayı: 1, 99 - 107, 31.03.2024

Mehmet Fevzi Çakmak Levent Horoz

https://doi.org/10.31832/smj.1350817

Öz

Purpose: Intramedullary nail treatment for intertrochanteric fractures has gained widespread popularity in recent years. Predisposing factors for mechanical failure of the proximal femoral nail include lag screw position, tip apex distance, reduction quality, and the femoral neck/shaft angle (FNSA). Our study aimed to evaluate the effect of the position of the nail end on the mechanical failure rates and radiological parameters.
Method: The data of 118 patients who underwent proximal femoral nail repair due to intertrochanteric fractures were analyzed between June 2019 and September 2022. The patients were divided into three groups according to the proximal femoral nail end positioning of the femoral canal, and tip apex distance, FNSA, reduction quality, lag screw position, union time, and complications were evaluated on postoperative and follow-up radiographs.
Results: When all patients included in the study were evaluated, cut-out was observed in 9. The cut-out rates were significantly higher in the medial group (n=7, p=0.003). Regarding FNSA, there were statistically significant differences among all three groups (<0.001M-S, M-L, S-L). In the medial group, the superiorly located lag screw, and in the lateral group, the inferiorly located lag screw was higher than in the other groups(p<0.001)
Conclusion: It has been observed that placement of the distal tip of the nail in the canal affects both these parameters and clinical results, and the clinical and radiological results were worse in cases where the distal nail was medial to the canal.

Anahtar Kelimeler

Intertrochanteric femur fracture Proximal femoral nail Tip apex distance Reduction

Kaynakça

  • 1. Friedman SM, Mendelson DA. Epidemiology of fragility fractures. Clin Geriatr Med. 2014;30(2):175-181.
  • 2. Kanis JA, Odén A, McCloskey EV, et al. A systematic review of hip fracture incidence and probability of fracture worldwide. Osteoporos Int. 2012;23(9):2239-2256.
  • 3. Adams J, Peng W, Cramer H, et al. The prevalence, patterns, and predictors of chiropractic use among US adults. Spine. 2017;42(23):1810-1816.
  • 4. Mathur HH, Rathva BM. Clinico-radiological and functional outcome of intertrochanteric femur fractures treated by proximal femoral nail antirotation Asia 2 (PFNA2) in Indian patients. nt. J. Orthop. 2020;6(2):864-866.
  • 5. Singh NK, Sharma V, Trikha V, et al. Is PFNA-II a better implant for stable intertrochanteric fractures in elderly population ? A prospective randomized study [published correction appears in J Clin Orthop Trauma. 2020 Nov- Dec;11(6):1169-1171] [published correction appears in J Clin Orthop Trauma. 2021 Aug 05;21:101557]. J Clin Orthop Trauma. 2019;10(Suppl 1):S71-S76.
  • 6. Sun D, Wang C, Chen Y, et al. A meta-analysis comparing intramedullary with extramedullary fixations for unstable femoral intertrochanteric fractures. Medicine. 2019;98(37).
  • 7. Sancheti K, Sancheti P, Shyam A, Patil S, Dhariwal Q, Joshi R. Primary hemiarthroplasty for unstable osteoporotic intertrochanteric fractures in the elderly: A retrospective case series. Indian J Orthop. 2010;44(4):428-434.
  • 8. Zhang W, Antony Xavier RP, Decruz J, Chen YD, Park DH. Risk factors for mechanical failure of intertrochanteric fractures after fixation with proximal femoral nail antirotation (PFNA II): a study in a Southeast Asian population. Arch Orthop Trauma Surg. 2021;141(4):569-575.
  • 9. Schipper IB, Steyerberg EW, Castelein RM, et al. Treatment of unstable trochanteric fractures. Randomised comparison of the gamma nail and the proximal femoral nail. J Bone Joint Surg Br. 2004;86(1):86-94.
  • 10. Ehlinger M, Favreau H, Eichler D, Adam P, Bonnomet F. Early mechanical complications following fixation of proximal femur fractures: From prevention to treatment. Orthop Traumatol Surg Res. 2020;106(1S):S79-S87.
  • 11. Norris R, Bhattacharjee D, Parker MJ. Occurrence of secondary fracture around intramedullary nails used for trochanteric hip fractures: a systematic review of 13,568 patients. Injury. 2012;43(6):706-711.
  • 12. Li H, Wang H, Zhang Y, Zhou J, Yuan F. The migration of helical blade and the tip apex distance value in cephalomedullary nail for geriatric intertrochanteric fractures. Zhongguo xiu fu Chong Jian wai ke za zhi= Zhongguo Xiufu Chongjian Waike Zazhi= Chinese Journal of Reparative and Reconstructive Surgery. 2019;33(10):1234-1238.
  • 13. Li J, Zhang L, Zhang H, et al. Effect of reduction quality on post-operative outcomes in 31-A2 intertrochanteric fractures following intramedullary fixation: a retrospective study based on computerised tomography findings. Int Orthop. 2019;43(8):1951-1959.
  • 14. Nie S, Li M, Li J, et al. Risk factors for anterior cortical impingement of short Cephalomedullary nail in Chinese elderly patients with Intertrochanteric fracture. Ther Clin Risk Manag. 2020;16:523.
  • 15. Tao YL, Ma Z, Chang SM. Does PFNA II avoid lateral cortex impingement for unstable peritrochanteric fractures?. Clin Orthop Relat Res. 2013;471(4):1393-1394.
  • 16. Chang S-M, Song D-L, Ma Z, et al. Mismatch of the short straight cephalomedullary nail (PFNA-II) with the anterior bow of the femur in an Asian population. J Orthop Trauma. 2014;28(1):17-22.
  • 17. Chan G, Hughes K, Barakat A, et al. Inter-and intra-observer reliability of the new AO/OTA classification of proximal femur fractures. Injury. 2021;52(6):1434-1437.
  • 18. Yoon Y-C, Oh C-W, Sim J-A, Oh J-K. Intraoperative assessment of reduction quality during nail fixation of intertrochanteric fractures. Injury. 2020;51(2):400-406.
  • 19. Cleveland M, Bosworth DM, Thompson FR, Wilson HJ, Ishizuka T. A ten-year analysis of intertrochanteric fractures of the femur. JBJS. 1959;41(8):1399-1408.
  • 20. Zhang W-Q, Sun J, Liu C-Y, Zhao H-Y, Sun Y-F. Comparing the intramedullary nail and extramedullary fixation in treatment of unstable intertrochanteric fractures. Sci Rep. 2018;8(1):1-8.
  • 21. Pan S, Liu XH, Feng T, Kang HJ, Tian ZG, Lou CG. Influence of different great trochanteric entry points on the outcome of intertrochanteric fractures: a retrospective cohort study. BMC Musculoskelet Disord. 2017;18(1):107.
  • 22. Tsai S-W, Lin C-FJ, Tzeng Y-H, et al. Risk factors for cutout failure of Gamma3 nails in treating unstable intertrochanteric fractures: an analysis of 176 patients. J Chin Med Assoc. 2017;80(9):587-594.
  • 23. Jiamton C, Nimmankiatkul N, Rungchamrassopa P, Kanchanatawan W, Chiarapatanakom P, Kongcharoensombat W. Does the Entry Point of Proximal Femoral Nail Antirotation Affect the Malalignment of Intertrochanteric Fracture? A Cadaveric Study. JseaOrtho. 2023;5(1): 30-37.
  • 24. Shetty M, Kumar S, Sagar SK. Pre fixation compression screw as a cutting-edge technique for varus correction during proximal femoral nailing for intertrochanteric fractures: a study on 46 cases. JCOrth. 2020;5(2):6-12.
  • 25. Hoffmann MF, Khoriaty JD, Sietsema DL, Jones CB. Outcome of intramedullary nailing treatment for intertrochanteric femoral fractures. J Orthop Surg Res. 2019;14:1-7.
  • 26. Mao W, Ni H, Li L, et al. Comparison of Baumgaertner and Chang reduction quality criteria for the assessment of trochanteric fractures. Bone Joint Res. 2019;8(10):502- 508.
  • 27. Andruszkow H, Frink M, Frömke C, et al. Tip apex distance, hip screw placement, and neck shaft angle as potential risk factors for cut-out failure of hip screws after surgical treatment of intertrochanteric fractures. Int Orthop. 2012;36(11):2347-2354.
  • 28. S Shin WC, Seo JD, Lee SM, Moon NH, Lee JS, Suh KT. Radiographic Outcomes of Osteosynthesis Using Proximal Femoral Nail Antirotation (PFNA) System in Intertrochanteric Femoral Fracture: Has PFNA II Solved All the Problems?. Hip Pelvis. 2017;29(2):104-112.
  • 29. Yeh Y-C, Liu C-H, Chou Y-C, Hsu Y-H, Yu Y-H. Similarities between Inferior-Center and Center-Center Lag Screw Positions in Femoral Intertrochanteric Fracture Surgeries. 2020.
  • 30. Liang C, Peng R, Jiang N, Xie G, Wang L, Yu B. Intertrochanteric fracture: Association between the coronal position of the lag screw and stress distribution. Asian J Surg. 2018;41(3):241-249.
  • 31. Goffin JM, Pankaj P, Simpson AH. The importance of lag screw position for the stabilization of trochanteric fractures with a sliding hip screw: a subject-specific finite element study. J Orthop Res. 2013;31(4):596-600.
  • 32. Kashigar A, Vincent A, Gunton MJ, Backstein D, Safir O, Kuzyk PR. Predictors of failure for cephalomedullary nailing of proximal femoral fractures. Bone Joint J. 2014;96-B(8):1029-1034.
  • 33. 33. Yoon RS, Adams DM, Seigerman DA, Lim PK, Don egan DJ, Liporace FA. Impact of Surrounding Canal Size on Time to Union After Intramedullary Nailing of Femur Fractures: Are 10-mm Nails All We Need?. J Orthop Trauma. 2020;34(4):180-185.

İntertrokanterik Kırıkların Tedavisinde Proksimal Femur Çivi Ucunun Femur Kanalındaki Pozisyonunun Klinik Ve Radyolojik Sonuçlarına Etkisi

Yıl 2024, Cilt: 14 Sayı: 1, 99 - 107, 31.03.2024

Mehmet Fevzi Çakmak Levent Horoz

https://doi.org/10.31832/smj.1350817

Öz

Amaç : İntertrokanterik femurkırıklarında intramedüller çivi tedavisi son yıllarda yaygın olarak kullanılmaktadır. İntertrokanterik kırıkların intramedüller tespitinden sonra mekanik komplikasyon oranları %2-13 arasındadır. Proksimal femoral çivi uygulamasının mekanik başarısızlığına ilişkin risk faktörleri arasında lag vidası konumu, uç-apeks mesafesi, redüksiyon kalitesi ve femur boynu/şaft açısı yer alır. Çalışmamız femoral çivi ucunun femoral kanaldaki konumunun mekanik başarısızlık oranlarına ve radyolojik parametrelere etkisini değerlendirmeyi amaçlamaktadır.
Gereç ve Yöntem : Haziran 2019 ile Eylül 2022 tarihleri arasında intertrokanterik kırık nedeniyle proksimal femur çivisi uygulanan 118 hastanın verileri analiz edildi. Hastalar femur kanalındaki proksimal femoral çivi ucunun pozisyonuna göre üç gruba ayrıldı. Ameliyat sonrası ve takip radyografilerinde uç apeks mesafesi, femur boynu/şaft açısı, redüksiyon kalitesi, lag vida konumu, kaynama süresi ve komplikasyonlar değerlendirildi.
Bulgular : Çalışmaya dahil edilen tüm hastalar değerlendirildiğinde 9 hastada femur boynundan sıyrıldığı görüldü. Medial grupta sıyrılma oranları anlamlı olarak daha yüksekti (n=7, p=0,003). FNSA açısından her üç grupta da birbirinden istatistiksel olarak anlamlı farklar mevcuttu (<0,001M-S. M-L, S-L). Medial grupta süperiorda yer alan lag vidası, lateral grupta ise inferiorda yer alan lag vidası diğer gruplara göre daha yüksekti (p<0,001). Medial grupta kötü redüksiyon kalitesi oranı diğer gruplara göre daha yüksekti (p=0,004).
Çivinin distal ucunun kanala yerleştirilmesinin hem parametreleri hem de klinik sonuçları etkilediği görülmüştür. Çivi distalinin santral ve lateral olduğu durumlarda istenilen radyolojik parametrelerin ve klinik sonuçların daha iyi olduğu görülmüştür. Ayrıca çivinin distalinin kanal içerisinde medialde olduğu durumlarda klinik ve radyolojik sonuçların daha kötü olduğu gözlendi.

Anahtar Kelimeler

: İntertrokanterik femur kırığı Proksimal femur çivisi Uç apeks mesafesi Redüksiyon

Kaynakça

  • 1. Friedman SM, Mendelson DA. Epidemiology of fragility fractures. Clin Geriatr Med. 2014;30(2):175-181.
  • 2. Kanis JA, Odén A, McCloskey EV, et al. A systematic review of hip fracture incidence and probability of fracture worldwide. Osteoporos Int. 2012;23(9):2239-2256.
  • 3. Adams J, Peng W, Cramer H, et al. The prevalence, patterns, and predictors of chiropractic use among US adults. Spine. 2017;42(23):1810-1816.
  • 4. Mathur HH, Rathva BM. Clinico-radiological and functional outcome of intertrochanteric femur fractures treated by proximal femoral nail antirotation Asia 2 (PFNA2) in Indian patients. nt. J. Orthop. 2020;6(2):864-866.
  • 5. Singh NK, Sharma V, Trikha V, et al. Is PFNA-II a better implant for stable intertrochanteric fractures in elderly population ? A prospective randomized study [published correction appears in J Clin Orthop Trauma. 2020 Nov- Dec;11(6):1169-1171] [published correction appears in J Clin Orthop Trauma. 2021 Aug 05;21:101557]. J Clin Orthop Trauma. 2019;10(Suppl 1):S71-S76.
  • 6. Sun D, Wang C, Chen Y, et al. A meta-analysis comparing intramedullary with extramedullary fixations for unstable femoral intertrochanteric fractures. Medicine. 2019;98(37).
  • 7. Sancheti K, Sancheti P, Shyam A, Patil S, Dhariwal Q, Joshi R. Primary hemiarthroplasty for unstable osteoporotic intertrochanteric fractures in the elderly: A retrospective case series. Indian J Orthop. 2010;44(4):428-434.
  • 8. Zhang W, Antony Xavier RP, Decruz J, Chen YD, Park DH. Risk factors for mechanical failure of intertrochanteric fractures after fixation with proximal femoral nail antirotation (PFNA II): a study in a Southeast Asian population. Arch Orthop Trauma Surg. 2021;141(4):569-575.
  • 9. Schipper IB, Steyerberg EW, Castelein RM, et al. Treatment of unstable trochanteric fractures. Randomised comparison of the gamma nail and the proximal femoral nail. J Bone Joint Surg Br. 2004;86(1):86-94.
  • 10. Ehlinger M, Favreau H, Eichler D, Adam P, Bonnomet F. Early mechanical complications following fixation of proximal femur fractures: From prevention to treatment. Orthop Traumatol Surg Res. 2020;106(1S):S79-S87.
  • 11. Norris R, Bhattacharjee D, Parker MJ. Occurrence of secondary fracture around intramedullary nails used for trochanteric hip fractures: a systematic review of 13,568 patients. Injury. 2012;43(6):706-711.
  • 12. Li H, Wang H, Zhang Y, Zhou J, Yuan F. The migration of helical blade and the tip apex distance value in cephalomedullary nail for geriatric intertrochanteric fractures. Zhongguo xiu fu Chong Jian wai ke za zhi= Zhongguo Xiufu Chongjian Waike Zazhi= Chinese Journal of Reparative and Reconstructive Surgery. 2019;33(10):1234-1238.
  • 13. Li J, Zhang L, Zhang H, et al. Effect of reduction quality on post-operative outcomes in 31-A2 intertrochanteric fractures following intramedullary fixation: a retrospective study based on computerised tomography findings. Int Orthop. 2019;43(8):1951-1959.
  • 14. Nie S, Li M, Li J, et al. Risk factors for anterior cortical impingement of short Cephalomedullary nail in Chinese elderly patients with Intertrochanteric fracture. Ther Clin Risk Manag. 2020;16:523.
  • 15. Tao YL, Ma Z, Chang SM. Does PFNA II avoid lateral cortex impingement for unstable peritrochanteric fractures?. Clin Orthop Relat Res. 2013;471(4):1393-1394.
  • 16. Chang S-M, Song D-L, Ma Z, et al. Mismatch of the short straight cephalomedullary nail (PFNA-II) with the anterior bow of the femur in an Asian population. J Orthop Trauma. 2014;28(1):17-22.
  • 17. Chan G, Hughes K, Barakat A, et al. Inter-and intra-observer reliability of the new AO/OTA classification of proximal femur fractures. Injury. 2021;52(6):1434-1437.
  • 18. Yoon Y-C, Oh C-W, Sim J-A, Oh J-K. Intraoperative assessment of reduction quality during nail fixation of intertrochanteric fractures. Injury. 2020;51(2):400-406.
  • 19. Cleveland M, Bosworth DM, Thompson FR, Wilson HJ, Ishizuka T. A ten-year analysis of intertrochanteric fractures of the femur. JBJS. 1959;41(8):1399-1408.
  • 20. Zhang W-Q, Sun J, Liu C-Y, Zhao H-Y, Sun Y-F. Comparing the intramedullary nail and extramedullary fixation in treatment of unstable intertrochanteric fractures. Sci Rep. 2018;8(1):1-8.
  • 21. Pan S, Liu XH, Feng T, Kang HJ, Tian ZG, Lou CG. Influence of different great trochanteric entry points on the outcome of intertrochanteric fractures: a retrospective cohort study. BMC Musculoskelet Disord. 2017;18(1):107.
  • 22. Tsai S-W, Lin C-FJ, Tzeng Y-H, et al. Risk factors for cutout failure of Gamma3 nails in treating unstable intertrochanteric fractures: an analysis of 176 patients. J Chin Med Assoc. 2017;80(9):587-594.
  • 23. Jiamton C, Nimmankiatkul N, Rungchamrassopa P, Kanchanatawan W, Chiarapatanakom P, Kongcharoensombat W. Does the Entry Point of Proximal Femoral Nail Antirotation Affect the Malalignment of Intertrochanteric Fracture? A Cadaveric Study. JseaOrtho. 2023;5(1): 30-37.
  • 24. Shetty M, Kumar S, Sagar SK. Pre fixation compression screw as a cutting-edge technique for varus correction during proximal femoral nailing for intertrochanteric fractures: a study on 46 cases. JCOrth. 2020;5(2):6-12.
  • 25. Hoffmann MF, Khoriaty JD, Sietsema DL, Jones CB. Outcome of intramedullary nailing treatment for intertrochanteric femoral fractures. J Orthop Surg Res. 2019;14:1-7.
  • 26. Mao W, Ni H, Li L, et al. Comparison of Baumgaertner and Chang reduction quality criteria for the assessment of trochanteric fractures. Bone Joint Res. 2019;8(10):502- 508.
  • 27. Andruszkow H, Frink M, Frömke C, et al. Tip apex distance, hip screw placement, and neck shaft angle as potential risk factors for cut-out failure of hip screws after surgical treatment of intertrochanteric fractures. Int Orthop. 2012;36(11):2347-2354.
  • 28. S Shin WC, Seo JD, Lee SM, Moon NH, Lee JS, Suh KT. Radiographic Outcomes of Osteosynthesis Using Proximal Femoral Nail Antirotation (PFNA) System in Intertrochanteric Femoral Fracture: Has PFNA II Solved All the Problems?. Hip Pelvis. 2017;29(2):104-112.
  • 29. Yeh Y-C, Liu C-H, Chou Y-C, Hsu Y-H, Yu Y-H. Similarities between Inferior-Center and Center-Center Lag Screw Positions in Femoral Intertrochanteric Fracture Surgeries. 2020.
  • 30. Liang C, Peng R, Jiang N, Xie G, Wang L, Yu B. Intertrochanteric fracture: Association between the coronal position of the lag screw and stress distribution. Asian J Surg. 2018;41(3):241-249.
  • 31. Goffin JM, Pankaj P, Simpson AH. The importance of lag screw position for the stabilization of trochanteric fractures with a sliding hip screw: a subject-specific finite element study. J Orthop Res. 2013;31(4):596-600.
  • 32. Kashigar A, Vincent A, Gunton MJ, Backstein D, Safir O, Kuzyk PR. Predictors of failure for cephalomedullary nailing of proximal femoral fractures. Bone Joint J. 2014;96-B(8):1029-1034.
  • 33. 33. Yoon RS, Adams DM, Seigerman DA, Lim PK, Don egan DJ, Liporace FA. Impact of Surrounding Canal Size on Time to Union After Intramedullary Nailing of Femur Fractures: Are 10-mm Nails All We Need?. J Orthop Trauma. 2020;34(4):180-185.
Toplam 33 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Kurumları Yönetimi
Bölüm Makaleler
Yazarlar

Mehmet Fevzi Çakmak 0000-0001-9338-8232

Levent Horoz 0000-0002-7052-207X

Erken Görünüm Tarihi 20 Mart 2024
Yayımlanma Tarihi 31 Mart 2024
Gönderilme Tarihi 27 Ağustos 2023
Yayımlandığı Sayı Yıl 2024 Cilt: 14 Sayı: 1

Kaynak Göster

AMA Çakmak MF, Horoz L. The Effect of Proximal Femoral Nail and Position in the Femur on Clinical and Radiological Outcomes of Intertrochanteric Fractures. Sakarya Tıp Dergisi. Mart 2024;14(1):99-107. doi:10.31832/smj.1350817
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