MEASURING METHOD OF TIP-APEX DISTANCE IN TREATMENT OF FEMORAL INTERTROCHANTERIC FRACTURE WITH PROXIMAL FEMORAL NAIL ANTIROTATION_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 WANGHongchuan , WANGYongcai , YANBing , ZHONGLang , JIANGJunwei

Department of Orthopedics, Leshan People's Hospital, Leshan Sichuan, 614000, P. R. China;

Corresponding author：

WANGHongchuan, Email: 2603757827@qq.com

Keywords：

Proximal femoral nail antirotation; Femoral intertrochanteric fracture; Tip apex distance

DOI：

10.7507/1002-1892.20140012

Video：

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Objective To investigate the method to measure the tip-apex distance (TAD) in treatment of femoral intertrochanteric fracture with proximal femoral nail antirotation (PFNA). Methods Between March 2008 and March 2011, 35 patients with femoral intertrochanteric fracture underwent closed reduction and internal fixation with PFNA, which were all closed fractures. There were 14 males and 21 females with an average age of 72.3 years (range, 48-88 years). According to Evans classification, 1 case belonged to type III, 27 cases to type IV, and 7 cases to type V. The time between injury and operation was 2-7 days (mean, 4.3 days). The TAD was measured according to relationship between tip of helical blade and the center point of femoral head radius during operation, and according to X-ray films after operation. Results Primary healing of incision was obtained in all cases, and no infection or deep venous thrombosis occurred. At 2 days after operation, the X-ray films showed TAD was 18-24 mm (mean, 22.6 mm). Thirty-two cases were followed up 10-22 months (mean, 16 months). All fractures healed, with a mean healing time of 7.6 months (range, 6-10 months). The patients could walk without stick at 11-16 weeks (mean, 13 weeks). Pulmonary infection occurred in 1 case at 5 days after operation; no breakage of femoral nail or cut-out helical blade from femoral head was observed. At 10 months after operation, the Parker hip scores were 9 in 23 cases, 8 in 4 cases, 7 in 3 cases, and 5 in 2 cases, with a mean score of 8.44. Conclusion It is easy to control the TAD in treatment of femoral intertrochanteric fracture with PFNA with an simple method and important to prevent breakage and cut-out helical blade from the femoral head.

Citation： WANGHongchuan, WANGYongcai, YANBing, ZHONGLang, JIANGJunwei. MEASURING METHOD OF TIP-APEX DISTANCE IN TREATMENT OF FEMORAL INTERTROCHANTERIC FRACTURE WITH PROXIMAL FEMORAL NAIL ANTIROTATION. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(1): 53-55. doi: 10.7507/1002-1892.20140012 Copy

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15.	李旭,徐贤,吴韦,等.亚洲型髋关节髓内钉系统治疗股骨转子间骨折.实用骨科杂志,2010,16(3):176-178.
16.	孟勇,信效堂,姜鹏,等.动力髋螺钉置入内固定治疗骨质疏松性转子间骨折110例.中国组织工程研究与临床康复,2010,14(39):7291-7294.
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18.	夏青,魏振,江海良,等.股骨近端外侧加压型锁定板治疗转子间不稳定性四部分骨折.中国骨科临床与基础研究杂志,2010,2(4):287-291.
19.	王全兵,冯宗权,谢祥仁,等.防旋髓内钉治疗老年不稳定股骨转子间骨折的体会.实用骨科杂志,2011,17(5):453-454.
20.	李双,王栋,张世民.尖顶距与股骨头内拉力螺钉切出的研究进展.中国矫形外科杂志,2007,15(19):1484-1485,1491.
21.	Khurana A,Guha AR,Mohanty K,et al.Pecutaneous fusion of the sacroiliac joint with hollow modular anchorage screws:clinical and radiological outcome.J Bone Joint Surg (Br),2009,91(5):627-631.
22.	李锋生,叶冬平,梁伟国,等.X线透视导航下运用Gamma钉治疗股骨转子间骨折18例.广东医学,2012,33(4):474-476.

1. 王亦璁.骨与关节损伤.4版.北京:人民卫生出版社,2007:1184-1194.
2. Efstathopoulos NE,Nikolaou VS,Lazareyyos JT.Intramedullary fixation of intertrochanteric hip fractures:a comparison of two implant designs.Int Orthop,2007,31(1):71-76.
3. Lorich DG,Geller DS,Nielson JH.Osteoporotic pertrochanteric hip fractures:management and current controversies.J Bone Joint Surg (Am),2004,86:398-410.
4. Baumgaertner MR,Curtin SL,Lindskog DM,et al.The value of the tip-apex distance in predicting failure of fixation of peritrochanteric fractures of the hip.J Bone Joint Surg (Am),1995,77(7):1058-1064.
5. Simmermacher RK,Ljungqvist J,Bail H,et al.The new proximal femoral nail antirotation (PFNA) in daily practice:results of amulticentre clinical study.Injury,2008,39(8):932-939.
6. Parker MJ,Palmer CR.A new mobility score for predicting mortality after hip fracture.J Bone Joint Surg (Br),1993,75(5):797-798.
7. Efstatjopoulos NE,Nikolaou VS,Lazarettos JT.Intramedullary fixation of intertrochanteric hip fractures a comparison of two implant designs.Int Orthop,2007,31(1):71-76.
8. Verettas DA,Ifantides P,Chatzipaas CN,et al.Systematic effects of surgical treatment of hip fractures:gliding screw-plating vs intramedullary nailing.Injury,2010,41(3):279-284.
9. 张经纬,蒋垚,张先龙,等.股骨转子间骨折不同手术方法比较.中华骨科杂志,2005,25(1):7-11.
10. Dousa P,Bartonicek J,Jehlicka D,et al.Osteosynthesis of trochanteric fractures using proximal femoral nails.Aeta Chir Orthop Traymatol Cech,2002,69(1):22-30.
11. 安维军,马小明,陈军,等.股骨转子部骨折的手术治疗.中华创伤骨科杂志,2004,6(5):499-501.
12. Geller JA,Saifi C,Morrison TA,et al.Tip-apex distance of intramedullary devices as a predictor of cut-out failure in the treatment of peritrochanteric elderly hip fractures.Int Orthop,2010,34(5):719-722.
13. Hsueh KK,Fang CK,Chen CM,et al.Risk of in cutout of sliding hip screw in intertrochanteric fractures:an evaluation of 937 patients.Int Orthop,2010,34(8):1273-1276.
14. Kyle RF,Gustilo RB,Premer RF.Analysis of six hundren and twenty-two intertrochanteric hip fractures.A retrospective and prospective study.J Bone Joint Surg (Am),1979,61(2):216-221.
15. 李旭,徐贤,吴韦,等.亚洲型髋关节髓内钉系统治疗股骨转子间骨折.实用骨科杂志,2010,16(3):176-178.
16. 孟勇,信效堂,姜鹏,等.动力髋螺钉置入内固定治疗骨质疏松性转子间骨折110例.中国组织工程研究与临床康复,2010,14(39):7291-7294.
17. 叶茂,刘军,宋文超,等.动力髋螺钉结合尖顶距值治疗骨质疏松性股骨转子间骨折.实用骨科杂志,2010,26(19):3591-3593.
18. 夏青,魏振,江海良,等.股骨近端外侧加压型锁定板治疗转子间不稳定性四部分骨折.中国骨科临床与基础研究杂志,2010,2(4):287-291.
19. 王全兵,冯宗权,谢祥仁,等.防旋髓内钉治疗老年不稳定股骨转子间骨折的体会.实用骨科杂志,2011,17(5):453-454.
20. 李双,王栋,张世民.尖顶距与股骨头内拉力螺钉切出的研究进展.中国矫形外科杂志,2007,15(19):1484-1485,1491.
21. Khurana A,Guha AR,Mohanty K,et al.Pecutaneous fusion of the sacroiliac joint with hollow modular anchorage screws:clinical and radiological outcome.J Bone Joint Surg (Br),2009,91(5):627-631.
22. 李锋生,叶冬平,梁伟国,等.X线透视导航下运用Gamma钉治疗股骨转子间骨折18例.广东医学,2012,33(4):474-476.

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Chinese Journal of Reparative and Reconstructive Surgery

MEASURING METHOD OF TIP-APEX DISTANCE IN TREATMENT OF FEMORAL INTERTROCHANTERIC FRACTURE WITH PROXIMAL FEMORAL NAIL ANTIROTATION

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