IMAGING STUDY ON DESIGN AND GEOMETRIC MATCH OF A NEW TYPE OF SHORT FEMORAL INTERTROCHANTERIC NAIL WITH ANTERIOR CURVATURE_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 ZHANGShimin , ZHANGYingqi , HUSunjun , MAZhuo , YAOMengwei , YAOXizhou

Department of Orthopedics, Yangpu Hospital, Tongji University School of Medicine, Shanghai, 200090, P. R. China;

Corresponding author：

ZHANGShimin, Email: shiminchang11@aliyun.com

Keywords：

Femoral intertrochanteric fracture; Short femoral intertrochanteric nail; Femur anterior bow; Geometric match; Nail tip impingement; Nail-tail prominence

DOI：

10.7507/1002-1892.20160246

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To design a new type of short femoral intertrochanteric nail (FITN) with anterior curvature (19.5 cm in length and 120 cm in radius) and observe the geometric match with medullary cavity of the femur. Methods Between November 2015 and June 2016, 25 geriatric patients with femoral intertrochanteric fractures were treated with the newly designed FITN. There were 7 males and 18 females with an average age of 82.3 years (range, 65-94 years). According to AO/OTA fracture classification, 3 cases were rated as A1.2, 2 cases as A1.3, 5 cases as A2.1, 8 cases as A2.2, and 7 cases as A2.3. The interval between injury and operation was 3.2 days (range, 2-7 days). Postoperatively, the nail entry point position (anterior, central, and posterior) on sagittal plane, the nail tip position (6-grade scale) and the nail tail level (3-grade scale) were measured using fluoroscopy and X-ray films to evaluate the geometric match of the nail with medullary cavity of the femur. Results One patient with Parkinson disease died of asphyxia and pulmonary infection. The other 24 patients were followed up 1-8 months (mean, 4 months). Fracture union time was 6-10 weeks (mean, 8 weeks). The mean Parker-Palmer mobility score was 5.5 (range, 4-8). No patient had hip-thigh pain. The nail entry point was positioned anterior in 2 cases (8%), central in 18 cases (72%), and posterior in 5 cases (20%). The distal nail tip located at the central canal axis (grade 0) in 15 cases (60%), at anterior without contact with the anterior inner cortex (grade 1) in 8 cases (32%), at posterior (grade -1) in 1 case (4%), and at anterior with slight nail-tip impingement with the anterior cortex (grade 2) in 1 case (4%). The proximal nail tail level did not protrude out beyond the greater trochanter (grade 0) in 13 cases (52%), protruded out less than 5 mm (grade 1) in 9 cases (36%), and more than 5 mm (grade 2) in 3 cases (12%). Conclusion The newly designed FITN has a good geometric match with the femur medullary canal in Chinese population, which may reduce the nail related complications.

Citation： ZHANG Shimin, ZHANG Yingqi, HU Sunjun, MA Zhuo, YAO Mengwei, YAO Xizhou. IMAGING STUDY ON DESIGN AND GEOMETRIC MATCH OF A NEW TYPE OF SHORT FEMORAL INTERTROCHANTERIC NAIL WITH ANTERIOR CURVATURE. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(10): 1200-1204. doi: 10.7507/1002-1892.20160246 Copy

1.	Niu E, Yang A, Harris AH, et al. Which fixation device is preferred for surgical treatment of intertrochanteric hip fractures in the United States? A survey of orthopaedic surgeons. Clin Orthop Relat Res, 2015, 473(11):3647-3655.
2.	张世民, 祝晓忠, 黄轶刚, 等. 外侧壁危险型股骨粗隆间骨折DHS与PFNA治疗的回顾性对比研究. 中国矫形外科杂志, 2010, 18(22):1868-1872.
3.	宋德磊, 张世民. 亚洲型股骨近端防旋髓内钉与国人股骨前弓匹配性的影像学研究. 中华创伤骨科杂志, 2012, 14(2):103-107.
4.	Chang SM, Song DL, Ma Z, et al. Mismatch of short straight cephalomedullary nail (PFNA-Ⅱ) with the anterior bow of the femur in Asian population. J Orthop Trauma, 2014, 28(1):17-22.
5.	Peña OR, Gómez Gélvez A, Espinosa KA, et al. Cephalomedullary nails:factors associated with impingement of the anterior cortex of the femur in a hispanic population. Arch Orthop Trauma Surg, 2015, 135(11):1533-1540.
6.	张世民. 一种带有前弓弧度的短型股骨头髓钉:中国, ZL201120196067.9. 2012-1-11.
7.	张世民, 赵向东, 王宏宝. 老年髋部骨折患者术后早期死亡的风险预测评分系统. 中国矫形外科杂志, 2015, 23(20):1869-1875.
8.	张世民, 张英琪, 李清, 等. 内侧皮质正性支撑复位对老年股骨粗隆间骨折内固定效果的影响. 中国矫形外科杂志, 2014, 22(14):1256-1261.
9.	Chang SM, Zhang YQ, Ma Z, et al. Fracture reduction with positive medial cortical support:a key element in stability reconstruction for the unstable pertrochanteric hip fractures. Arch Orthop Trauma Surg, 2015, 135(6):811-818.
10.	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.
11.	Zhou JQ, Chang SM. Failure of PFNA:helical blade perforation and tip-apex distance. Injury, 2012, 43(7):1227-1228.
12.	胡孙君, 张世民, 张英琪, 等. 股骨转子间骨折术中侧位一次性准确置入导针的手术技巧. 中华创伤骨科杂志, 2015, 17(11):993-996.
13.	Maratt J, Schilling PL, Holcombe S, et al. Variation in the femoral bow:a novel high-throughput analysis of 3922 femurs on cross-sectional imaging. J Orthop Trauma, 2014, 28(1):6-9.
14.	Su XY, Zhao Z, Zhao JX, et al. Three-dimensional analysis of the curvature of the femoral canal in 426 Chinese femurs. Biomed Res Int, 2015, 2015:318391.
15.	Kanawati AJ, Jang B, McGee R, et al. The influence of entry point and radius of curvature on femoral intramedullary nail position in the distal femur. J Orthop, 2014, 11(2):68-71.
16.	Mallow M, Nazarian LN. Greater trochanteric pain syndrome diagnosis and treatment. Phys Med Rehabil Clin N Am, 2014, 25(2):279-289.
17.	Li S, Chang SM, Jin YM, et al. A mathematical simulation of the tip-apex distance and the calcar referenced tip-apex distance for intertrochanteric fractures reduced with lag screws. Injury, 2016, 47(6):1302-1308.
18.	熊良平, 张世民. 亚洲型股骨近端防旋髓内钉术后影像学测量. 同济大学学报(医学版), 2013, 34(4):72-75.

1. Niu E, Yang A, Harris AH, et al. Which fixation device is preferred for surgical treatment of intertrochanteric hip fractures in the United States? A survey of orthopaedic surgeons. Clin Orthop Relat Res, 2015, 473(11):3647-3655.
2. 张世民, 祝晓忠, 黄轶刚, 等. 外侧壁危险型股骨粗隆间骨折DHS与PFNA治疗的回顾性对比研究. 中国矫形外科杂志, 2010, 18(22):1868-1872.
3. 宋德磊, 张世民. 亚洲型股骨近端防旋髓内钉与国人股骨前弓匹配性的影像学研究. 中华创伤骨科杂志, 2012, 14(2):103-107.
4. Chang SM, Song DL, Ma Z, et al. Mismatch of short straight cephalomedullary nail (PFNA-Ⅱ) with the anterior bow of the femur in Asian population. J Orthop Trauma, 2014, 28(1):17-22.
5. Peña OR, Gómez Gélvez A, Espinosa KA, et al. Cephalomedullary nails:factors associated with impingement of the anterior cortex of the femur in a hispanic population. Arch Orthop Trauma Surg, 2015, 135(11):1533-1540.
6. 张世民. 一种带有前弓弧度的短型股骨头髓钉:中国, ZL201120196067.9. 2012-1-11.
7. 张世民, 赵向东, 王宏宝. 老年髋部骨折患者术后早期死亡的风险预测评分系统. 中国矫形外科杂志, 2015, 23(20):1869-1875.
8. 张世民, 张英琪, 李清, 等. 内侧皮质正性支撑复位对老年股骨粗隆间骨折内固定效果的影响. 中国矫形外科杂志, 2014, 22(14):1256-1261.
9. Chang SM, Zhang YQ, Ma Z, et al. Fracture reduction with positive medial cortical support:a key element in stability reconstruction for the unstable pertrochanteric hip fractures. Arch Orthop Trauma Surg, 2015, 135(6):811-818.
10. 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.
11. Zhou JQ, Chang SM. Failure of PFNA:helical blade perforation and tip-apex distance. Injury, 2012, 43(7):1227-1228.
12. 胡孙君, 张世民, 张英琪, 等. 股骨转子间骨折术中侧位一次性准确置入导针的手术技巧. 中华创伤骨科杂志, 2015, 17(11):993-996.
13. Maratt J, Schilling PL, Holcombe S, et al. Variation in the femoral bow:a novel high-throughput analysis of 3922 femurs on cross-sectional imaging. J Orthop Trauma, 2014, 28(1):6-9.
14. Su XY, Zhao Z, Zhao JX, et al. Three-dimensional analysis of the curvature of the femoral canal in 426 Chinese femurs. Biomed Res Int, 2015, 2015:318391.
15. Kanawati AJ, Jang B, McGee R, et al. The influence of entry point and radius of curvature on femoral intramedullary nail position in the distal femur. J Orthop, 2014, 11(2):68-71.
16. Mallow M, Nazarian LN. Greater trochanteric pain syndrome diagnosis and treatment. Phys Med Rehabil Clin N Am, 2014, 25(2):279-289.
17. Li S, Chang SM, Jin YM, et al. A mathematical simulation of the tip-apex distance and the calcar referenced tip-apex distance for intertrochanteric fractures reduced with lag screws. Injury, 2016, 47(6):1302-1308.
18. 熊良平, 张世民. 亚洲型股骨近端防旋髓内钉术后影像学测量. 同济大学学报(医学版), 2013, 34(4):72-75.

Chinese Journal of Reparative and Reconstructive Surgery

IMAGING STUDY ON DESIGN AND GEOMETRIC MATCH OF A NEW TYPE OF SHORT FEMORAL INTERTROCHANTERIC NAIL WITH ANTERIOR CURVATURE

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