Intramedullary nail in the treatment of pertrochanteric fractures in elderly patients (original) (raw)
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Journal of Orthopaedic Surgery and Research
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 a...
Pertrochanteric Fractures: Is There an Advantage to an Intramedullary Nail?
Journal of Orthopaedic Trauma, 2002
Objectives: To compare the results between a sliding compression hip screw and an intramedullary nail in the treatment of pertrochanteric fractures. Design: Prospective computer-generated randomization of 206 patients into two study groups: those treated by sliding compression hip screw (Group 1; n ס 106) and those treated by intramedullary nailing (Group 2; n ס 100). Setting: University Level I trauma center. Patients: All patients over the age of fifty-five years presenting with fractures of the trochanteric region caused by a lowenergy injury, classified as AO/OTA Type 31-A1 and A2. Intervention: Treatment with a sliding compression hip screw (Dynamic Hip Screw; Synthes-Stratec, Oberdorf, Switzerland) or an intramedullary nail (Proximal Femoral Nail; Synthes-Stratec, Oberdorf, Switzerland). Main Outcome Measurements: Intraoperative: operative and fluoroscopy times, the difficulty of the operation, intraoperative complications, and blood loss. Radiologic: fracture healing and failure of fixation. Clinical: pain, social functioning score, and mobility score. Results: The minimum follow-up was one year. We did not find any statistically significant difference, intraoperatively, radiologically, or clinically, between the two groups of patients. Conclusions: There is no advantage to an intramedullary nail versus a sliding compression hip screw for low-energy pertrochanteric fractures AO/OTA 31-A1 and A2, specifically with its increased cost and lack of evidence to show decreased complications or improved patient outcome.
2021
Background and aim: Lateral fractures of proximal femur are the most frequent to treat for the traumatologist surgeon. Intramedullary nailing is the gold standard treatment of this type of fracture. The aim of the study is to analyze the results obtained with the Elos Intrauma nail by the experience of two Departments of Orthopedics and Traumatology (“Guglielmo da Saliceto” Hospital in Piacenza and the Maggiore hospital in Bologna). Methods: We performed a retrospective cohort study of 400 patients with lateral femoral neck fracture surgically treated with Elos Intrauma standard nail. The examined period is from 1st Jannuary 2018 to 31st Dicember 2020. In all patients we implanted Elos® - Intrauma nail, a titanium cervical diaphyseal nail, according to the standard technique. Results: We evaluate at a minumum of three months of follow up 286/400 patients. Average follow up was 3.94 months, minimum 3 months and maximum 24 months. We obtain the 96.85 % of fracture healing, recording 3...
Treatment of Pertrochanteric Fractures (OTA 31-A1 and A2)
Journal of Orthopaedic Trauma, 2013
Objectives: To retrospectively compare the clinical outcomes in patients with pertrochanteric femur fractures without subtrochanteric extension (OTA 31-A1 and A2) after treatment with short or long cephalomedullary nails.
Study of surgical management of pertrochanteric fracture in our institute with proximal femoral nail
2020
Background: Pertrochanteric fracture are devastating injuries that most commonly affect the elderly and also young. Numerous variations of intramedullary nails have been devised to achieve a stable fixation and early mobilization of pertrochanteric fractures; among these, the proximal femoral nail (PFN), devised by the AO/ASIF group in 1996, has proven to be a promising implant in per-, inter-, or subtrochanteric femoral fractures. Hence; the present study was conducted for assessing the surgical management of pertrochanteric fracture in our institute with proximal femoral nail. Methods: This was a prospective study of 20 cases of trochanteric and sub trochanteric fractures admitted to Akash institute of medical sciences and research centre between January 2017 to December 2018. Cases were taken according to inclusion and exclusion criteria. i.e. patients with pertrochanteric fractures above the age of 18 years and post traumatic pertrochanteric fractures. Results: In our 20 cases t...
International Journal of Research in Orthopaedics, 2019
Background: The objective of the study was to compare the fracture union of long vs. short proximal femoral intramedullary nail antirotation (PFNA) in the treatment of intertrochanteric fractures in elderly patients who was more than 60 years old.Methods: A retrospective analysis of 170 cases of intertrochanteric fractures of the femur (AO type A1 and A2) in the elderly was conducted. There were 64 males (37.6%) and 106 females (62.3%) with the age of 60–90 (mean age 75) years. The general demographic data of patients, operation time, intraoperative blood loss, length of hospital stay, blood transfusion rate, anterior thigh pain, postoperative complications like periprosthetic fractures, infections were recorded.Results: The short nail group also had a significantly shorter operation time (41.5±15.3 minutes vs. 62.5±25.3 minutes, p=0.002) and lower rate of postoperative transfusion (31.3% vs. 58.7%, p=0.041). However the length of hospital stay showed no significant differences. Aft...
Role of gamma nail in management of pertrochanteric fractures of femur
Indian Journal of Orthopaedics, 2008
Background: Pertrochanteric fractures which involve trochanteric fractures with varying fracture geometry pose a signifi cant challenge to the treating orthopedic surgeon. The aim of this study is to evaluate the management of pertrochanteric fractures of the femur using gamma nail [Asia pacifi c (AP)]. Materials and Methods: Sixty patients of pertrochanteric fractures were treated by closed reduction internal fi xation by gamma nail from 1 January 1993 to 31 December 2000. Four patients were lost to follow-up. The remaining 56 patients were followed for a mean period of 3.2 years (range 2-4 years).The results were evaluated by assessing the patients regarding their clinical and functional outcome at follow-up as per Kyle's criteria. Results: Peroperative jamming of nail (n = 1), failed distal locking (n = 1), superior cut out of lag screw (n = 1) and postoperative varus malreduction (n = 1) were the complications observed. End results were excellent in 46.34%, good in 36.58%, fair in 14.64%, poor in 2.43%. Conclusion: Gamma nail in expert hands is a suitable implant for management of pertrochanteric fractures of the femur.
Zimmer Natural Nail and ELOS nails in pertrochanteric fractures
Journal of Orthopaedic Surgery and Research, 2021
Background Pertrochanteric fractures of the femur in the elderly are very common. As the average age of the population increases, the incidence of such fractures also raises, resulting in high healthcare costs. The type of surgical devices employed for their surgical management influences these costs. Methods A comparative clinical study was conducted on patients operated by one single surgeon between December 2018 and November 2020 in a high-volume regional referral centre. All patients who received a Zimmer Natural Nail (ZNN) or ELOS devices were included. Results In 119 (66.48%) of the 179 fractures, a ZNN nail was used. Post-operatively, the TAD (tip-to-apex distance) was measured at an average value of 17.05 (4.42–41.85) mm and the CalTAD (calcar-referenced TAD) at an average of 20.76 (10.82–43.63) mm. The mean hospitalization time was 10.19 (4–22) days. In the other 60 trochanteric fractures, an ELOS nail was used. Post-operative imaging indicated a TAD of 19.65 (5.08–31.4) mm...