Static vs dinamic short nail in pertrochanteric fractures: experience of two center in Northern Italy (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.
Injury, 2016
We investigated whether a proximal femoral nail can be implanted without a distal locking screw in AO/ OTA 31-A1 and 31-A2 pertrochanteric stable femur fractures. A multicentre, randomised study was conducted in six level-two trauma centres in our area (Puglia, Italy). A total of 333 patients received their allocated intervention (162 in the locking group [LG] and 171 in the unlocking group [UG]) and 266 patients were included in the final analysis at 1 year. Our data showed no statistically significant difference between the two groups at 1-year follow-up for ability to walk, SF-36 questionnaire results, residual pain (visual analogue scale [VAS] score) and level of overall satisfaction. There were also no statistically significant differences between groups for mortality and length of hospital stay. Conversely, the UG was associated with shorter operation and fluoroscopy times, shorter surgical incision length, and less blood loss and residual thigh pain. Pertrochanteric stable fractures (31-A1, 31-A2) can be treated successfully with intramedullary nails without distal locking, reducing patient and clinical personnel radiation exposure and sanitary costs (surgery time and screws costs).
The Treatment of Intertrochanteric Fractures of the Femur with Proximal Femoral Nail
2012
Background. The incidence of fractures in the trochanteric area has risen with the increasing numbers of elderly persons with osteoporosis. The imperative goals of treatment are early mobilization by means of stable fixation using as minimally invasive a procedure as possible. Nowadays, there is an increasing interest in intra medullary nailing, especially for unstable intertrochanteric fractures. The aim of the present paper is to assess the efficacy of closed intramedullary osteosynthesis with the proximal femoral nail (Endovis®) in the treatment of peritrochanteric fractures to solve the problems associated with the use of intramedullary fixation devices. Material and methods. The authors describe their experience with 87 stable and unstable proximal extracapsular femoral fractures treated with the Endovis femoral nail from July 2007 to March 2009. The results were evaluated clinically, functionally and radiographically during the 1st, 3th, 6th and 12th months post-op. Pre-injury...
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.
International Journal of Research in Orthopaedics
Background: Over the past decades the incidence of intertrochanteric fractures has increased and there is a universal agreement about the intramedullary nail being the preferred implant of fixation for these fractures.Methods: In this study we have attempted to assess and compare the results and immediate as well as long term outcome of fractures managed by proximal femoral nail anti rotation and the intertan nail. We included 102 patients in our study, half in the group managed by proximal femoral nail anti rotation group and half in the group managed by intertan nail. Over a period of almost one and half years we evaluated the patients in immediate and late post op period for the union of the fracture, functional outcomes and the short- and long-term complications.Results: The results were evaluated in the terms of intraoperative variables like fluoroscopy time, mean blood loss and reduction achieved and postoperatively in terms of superficial wound infections and Harris hip score...
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...
BMC Musculoskeletal Disorders, 2012
Background: Intramedullary nailing of pertrochanteric femoral fractures has grown in popularity over the past 2 decades likely because this procedure is associated with a low risk for postoperative morbidity and a fast recovery of function. The evaluation of outcomes associated with pertrochanteric nailing has mainly been based on objective measures. The purpose of the present study is to correlate patients' health-related quality of life results after intramedullary nailing of pertrochanteric fractures with objective outcome measures. Methods: We conducted a single-center study including 62 patients (mean age 80 ± 10 years) with pertrochanteric fractures treated with a Gamma 3 Nail. Health related quality of life was measured using the Short Form-36. These results were compared to both US and Austrian age and sex-adjusted population norms. The objective outcome measures studied at one year postoperatively included Harris Hip Score, range of motion, leg length, body mass index, neck-shaft angle and grade of osteoarthritis. Results: According to the Harris Hip Score 43 patients (67%) had excellent or good results. There was no significant difference in the average neck-shaft angle comparing affected hip to non-affected hip at 12 months postoperatively. The average osteoarthritis score, for both the injured and uninjured hip, did not differ significantly. We found significant differences between the bodily pain, social functioning and mental health subscales and two summary scores of the Short-Form 36 in comparison to Austrian population norms. Complication rate was 8%. Conclusions: The results of this study confirm that intramedullary nailing with the use of a Gamma Nail is a safe treatment option for stable and unstable pertrochanteric fractures. Despite good functional and radiographic results we noticed a substantial fall off in patients' quality of life up to 12 months after operation.
Mini-invasive nail versus DHS to fix pertrochanteric fractures: a case-control study
Orthopaedics & traumatology, surgery & research : OTSR, 2009
Fixation devices to treat trochanteric fractures belong to two general categories: dynamic hip screw (DHS) type and intramedullary type implants. In spite of possible pitfalls, both are considered valid options. Comparing a sliding screw-plate system (DHS) along a mini-invasive nailing device (BCM nail) with primary insertion of the cephalic screw, sheds light on the debated management of trochanteric fractures. Due to its design, the BCM nailing system allows a stable internal fixation and promotes enhanced postoperative functional recovery. To test this hypothesis in a comparative prospective case-control study using the DHS screw-plate as a reference. Two groups of 30 patients, older than 60 years old, with trochanteric fractures were included in this study. The screw-plates were placed according to the standard method. Regarding the nailing system, the cephalic screw was positioned first, then the nail was inserted through the screw via a mini-invasive approach and locked distal...