CHOICE AND EFFECTIVENESS EVALUATION OF PROXIMAL FEMORAL NAIL ANTIROTATION AND InterTAN IN TREATMENT OF ELDERLY INTERTROCHANTERIC FRACTURES_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANGJinhui , ZHANGKexue , ZHANGLihai , ZHANGLicheng , CHENChao ,  TANGPeifu , ZHANGBoxun

Department of Orthopedics, General Hospital of Chinese PLA, Beijing, 100853, P. R. Chin;

Corresponding author：

TANGPeifu, Email: pftang301@163.com

Keywords：

Femoral intertrochanteric fracture; Internal fixation; Proximal femoral nail antirotation; InterTAN; Elderly patient

DOI：

10.7507/1002-1892.20150117

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Objective To compare the effectiveness and complications of proximal femoral nail antirotation (PFNA) and InterTAN nail in treatment of elderly intertrochanteric fractures. Methods A total of 178 patients with intertrochanteric fractures between January 2011 and June 2013 were enrolled. PFNA was used in 100 cases (PFNA group) and InterTAN in 78 cases (InterTAN group). No significant difference was found in gender, age, side of fracture, cause of injury, fracture classification, and time between injury and operation between 2 groups (P>0.05). The operation time, intraoperative blood loss, intraoperative fluoroscopy time, postoperative complications, hospitalization time, fracture healing time, and Harris score were compared between 2 groups to evaluate the effectiveness. Results The operation time, intraoperative blood loss, intraoperative fluoroscopy time in PFNA group were significantly less than those in InterTAN group (P<0.05). The hospitalization time had no significant difference between the 2 groups (t=1.270, P=0.206). Primary healing was obtained in the others except 2 cases having red and swollen in each group respectively. Ninety-two cases of PFNA group and 63 cases of InterTAN group were followed up 11 months on average (range, 8-16 months). In the patients who were lost, there were 4 deaths in PFNA group and 3 deaths in InterTAN group. The complication rate was 4.2% in PFNA group (2 cases of deep venous thrombosis and 2 cases of hip varus) and was 4.5% in InterTAN group (1 case of deep venous thrombosis and 2 cases of hip varus), showing no significant difference between 2 groups (χ²=0.077, P=0.782). X-ray showed that the fracture line disappeared; no complications of malunion, bone nonunion, infection, and loosening of internal fixation occurred. The patients could walk normally. The healing time and Harris hip scores at last follow-up showed no significant difference between 2 groups (t=1.324, P=0.188; t=1.594, P=0.113). Conclusion PFNA is suitable for elderly patients with osteoporosis in treatment of femoral intertrochanteric fracture; InterTAN can be a better choice for younger patients or patients with unstable fracture.

Citation： ZHANGJinhui, ZHANGKexue, ZHANGLihai, ZHANGLicheng, CHENChao, TANGPeifu, ZHANGBoxun. CHOICE AND EFFECTIVENESS EVALUATION OF PROXIMAL FEMORAL NAIL ANTIROTATION AND InterTAN IN TREATMENT OF ELDERLY INTERTROCHANTERIC FRACTURES. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(5): 538-541. doi: 10.7507/1002-1892.20150117 Copy

1.	张逸凌, 沈景, 毛智, 等. 股骨粗隆间骨折内固定手术隐性失血的相关因素分析. 中国修复重建外科杂志, 2014, 28(3):318-322.
2.	Jain R, Basinski A, Kreder HJ. Nonoperative treatment of hip fractures. Int Orthop, 2003, 27(1):11-17.
3.	Bergeron E, Moore L, Fournier K, et al. Patients with isolated hip fracture must be considered for surgery irrespectively of their age, comorbidity status and provenance:a statement applicable even to nonagerians. Arch Orthop Trauma Surg, 2009, 129(11):1549-1555.
4.	Xu YZ, Geng DC, Mao HQ, et al. A comparsion of the proximal femoral nail antirotation device and dynamic hips crew in the treatment of unstable pertrochanteric fracture. J Int Med Res, 2010, 38(4):1266-1275.
5.	Crawford CH, Malkani AL, Cordray S, et al. The trochanteric nail versus the sliding hip screw for intertrochanteric hip fractures:a review of 93 cases. J Trauma, 2006, 60(2):325-328.
6.	刘爱国, 谷文光, 邓亮, 等. 不同手术方法治疗老年股骨转子间骨折疗效分析. 中国矫形外科杂志, 2012, 20(12):1072-1075.
7.	沈光银. 防旋股骨近端髓内钉与动力髋螺钉治疗老年股骨粗隆间骨折疗效比较. 中国修复重建外科杂志, 2012, 26(6):671-674.
8.	李必奎, 陈周兵, 徐富生. 股骨近端锁定钢板治疗股骨转子间骨折. 中国修复重建外科杂志, 2011, 25(10):1273-1275.
9.	Kraemer WJ, Hearn TC, Powell JN, et al. Fixation of segmental subtrochanteric fractures. A biomechanical study. Clin Orthop Relat Res, 1996, (332):71-79.
10.	Mahomed N, Harrington I, Kellam J, et al. Biomechanical analysis of the Gamma nail and sliding hip screw. Clin Orthop Relat Res, 1994, (304):280-288.
11.	周荣, 高峰. 股骨近端髓内钉内固定治疗股骨粗隆间骨折. 实用骨科杂志, 2008, 14(6):366-368.
12.	李耀武, 蒋大权, 李茂才, 等. 延期切开DHS内固定治疗严重粉碎性股骨粗隆间骨折. 中国骨与关节损伤杂志, 2011, 26(6):527-528.
13.	Strauss E, Frank J, Lee J, et al. Helical blade versus liding hip screw for treatment of unstable intertrochanteric hip fracture:a biomechanical evaluation. Injury, 2006, 37(10):984-989.
14.	Brunner A, Jöckel JA, Babst R. The PFNA proximal femur nail in treatment of unstable proximal femur fractures-3 cases of postoperative perforation of the helical blade into the hip joint. J Orthop Trauma, 2008, 22(10):731-736.
15.	Ruecker AH, Rupprecht M, Gruber M, et al. The treatment of intertrochanteric fractures:results using an intramedullary nail with integrated cephalocervical screws and linear compression. J Orthop Trauma, 2009, 23(1):22-30.
16.	Megas P, Kaisidis A, Zouboulis P, et al. Comparative study of the treatment of pertrochanteric fractures-trochanteric gamma nail vs. proximal femoral nail. Z Orthop Ihre Grenzgeb, 2005, 143(2):252-257.
17.	秦晖, 安智全. InterTan治疗股骨粗隆间骨折的疗效评估. 中国修复重建外科杂志, 2010, 24(12):1424-1427.
18.	Yang E. New concepts in pertrochanteric hip fracture treatment. Orthopedics, 2006, 29(11):981-983.
19.	Webb LX. Proximal femoral fractures. J South Orthop Assoc, 2002, 11(4):203-212.
20.	Lin WC, Chen CH, Wong CY. Salvage procedures for failed compression hip screw fixation of intertrochanteric femoral fractures:analysis of 50 cases. Kaohsiung J Med Sci, 2002, 18(9):459-465.

1. 张逸凌, 沈景, 毛智, 等. 股骨粗隆间骨折内固定手术隐性失血的相关因素分析. 中国修复重建外科杂志, 2014, 28(3):318-322.
2. Jain R, Basinski A, Kreder HJ. Nonoperative treatment of hip fractures. Int Orthop, 2003, 27(1):11-17.
3. Bergeron E, Moore L, Fournier K, et al. Patients with isolated hip fracture must be considered for surgery irrespectively of their age, comorbidity status and provenance:a statement applicable even to nonagerians. Arch Orthop Trauma Surg, 2009, 129(11):1549-1555.
4. Xu YZ, Geng DC, Mao HQ, et al. A comparsion of the proximal femoral nail antirotation device and dynamic hips crew in the treatment of unstable pertrochanteric fracture. J Int Med Res, 2010, 38(4):1266-1275.
5. Crawford CH, Malkani AL, Cordray S, et al. The trochanteric nail versus the sliding hip screw for intertrochanteric hip fractures:a review of 93 cases. J Trauma, 2006, 60(2):325-328.
6. 刘爱国, 谷文光, 邓亮, 等. 不同手术方法治疗老年股骨转子间骨折疗效分析. 中国矫形外科杂志, 2012, 20(12):1072-1075.
7. 沈光银. 防旋股骨近端髓内钉与动力髋螺钉治疗老年股骨粗隆间骨折疗效比较. 中国修复重建外科杂志, 2012, 26(6):671-674.
8. 李必奎, 陈周兵, 徐富生. 股骨近端锁定钢板治疗股骨转子间骨折. 中国修复重建外科杂志, 2011, 25(10):1273-1275.
9. Kraemer WJ, Hearn TC, Powell JN, et al. Fixation of segmental subtrochanteric fractures. A biomechanical study. Clin Orthop Relat Res, 1996, (332):71-79.
10. Mahomed N, Harrington I, Kellam J, et al. Biomechanical analysis of the Gamma nail and sliding hip screw. Clin Orthop Relat Res, 1994, (304):280-288.
11. 周荣, 高峰. 股骨近端髓内钉内固定治疗股骨粗隆间骨折. 实用骨科杂志, 2008, 14(6):366-368.
12. 李耀武, 蒋大权, 李茂才, 等. 延期切开DHS内固定治疗严重粉碎性股骨粗隆间骨折. 中国骨与关节损伤杂志, 2011, 26(6):527-528.
13. Strauss E, Frank J, Lee J, et al. Helical blade versus liding hip screw for treatment of unstable intertrochanteric hip fracture:a biomechanical evaluation. Injury, 2006, 37(10):984-989.
14. Brunner A, Jöckel JA, Babst R. The PFNA proximal femur nail in treatment of unstable proximal femur fractures-3 cases of postoperative perforation of the helical blade into the hip joint. J Orthop Trauma, 2008, 22(10):731-736.
15. Ruecker AH, Rupprecht M, Gruber M, et al. The treatment of intertrochanteric fractures:results using an intramedullary nail with integrated cephalocervical screws and linear compression. J Orthop Trauma, 2009, 23(1):22-30.
16. Megas P, Kaisidis A, Zouboulis P, et al. Comparative study of the treatment of pertrochanteric fractures-trochanteric gamma nail vs. proximal femoral nail. Z Orthop Ihre Grenzgeb, 2005, 143(2):252-257.
17. 秦晖, 安智全. InterTan治疗股骨粗隆间骨折的疗效评估. 中国修复重建外科杂志, 2010, 24(12):1424-1427.
18. Yang E. New concepts in pertrochanteric hip fracture treatment. Orthopedics, 2006, 29(11):981-983.
19. Webb LX. Proximal femoral fractures. J South Orthop Assoc, 2002, 11(4):203-212.
20. Lin WC, Chen CH, Wong CY. Salvage procedures for failed compression hip screw fixation of intertrochanteric femoral fractures:analysis of 50 cases. Kaohsiung J Med Sci, 2002, 18(9):459-465.

Chinese Journal of Reparative and Reconstructive Surgery

CHOICE AND EFFECTIVENESS EVALUATION OF PROXIMAL FEMORAL NAIL ANTIROTATION AND InterTAN IN TREATMENT OF ELDERLY INTERTROCHANTERIC FRACTURES

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