Effect of screw blade position on proximal femoral nail anti-rotation internal fixation for unstable intertrochanteric fractures in the elderly_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZENG Jinyuan ,  YE Junjian , XIE Yun , CHEN Chunyong , LIN Zhangxiong

Department of Orthopaedic Trauma, the First Affiliated Hospital of Fujian Medical University, Trauma Center of Fujian, Fuzhou Fujian, 350005, P.R.China;

Corresponding author：

YE Junjian, Email: yejunjian@sohu.com

Keywords：

Intertrochanteric fracture; unstable fracture; proximal femoral nail anti-rotation; screw blade; tip-apex distance; the elderly

DOI：

10.7507/1002-1892.201909069

Video：

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Objective To investigate the effect of the screw blade position on the effectiveness of proximal femoral nail anti-rotation (PFNA) internal fixation for unstable intertrochanteric fractures in the elderly.Methods A clinical data of 131 elderly patients with unstable intertrochanteric fractures who were treated with PFNA internal fixation between January 2010 and January 2017 was retrospectively analyzed. According to the anteroposterior X-ray films, the screw blades were placed in the middle of the femoral neck in 72 patients (group A) and at one-third of the femoral neck in 59 patients (group B). There was no significant difference between the two groups (P>0.05) in the gender, age, bone density, classification of fractures, other medical diseases, and the time between injury and operation. Multiple treatment indexes were analyzed, including complications, hip Harris score, the healing status of fracture, tip-apex distance (TAD), and the height of the tail nail.Results All patients were followed up 11-14 months, with an average of 12.1 months. All incisions healed by first intention with no complications. All fractures healed and no significant difference in bone healing time between the two groups (Z=−0.190, P=0.849). At 6 months after operation, TAD was (2.23±0.07) cm in group A and (2.85±0.12) cm in group B, showing significant difference (t=−47.643, P=0.000); and the height of the tail nail was (1.72±0.14) cm in group A and (0.53±0.26) cm in group B, showing significant difference (t=31.031, P=0.000). According to the Harris score, the hip functions were rated as excellent in 48 cases, good in 15 cases, and poor in 9 cases in group A, while as excellent in 38 cases, good in 16 cases, and poor in 5 cases in group B, with no significant difference between the two groups (Z=−0.075, P=0.941).Conclusion For the unstable intertrochanteric fracture in the elderly, the PFNA internal fixation with appropriated TAD and the screw blades placed in the middle or at one-third of the femoral neck can obtain good effectiveness.

Citation： ZENG Jinyuan, YE Junjian, XIE Yun, CHEN Chunyong, LIN Zhangxiong. Effect of screw blade position on proximal femoral nail anti-rotation internal fixation for unstable intertrochanteric fractures in the elderly. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(5): 569-573. doi: 10.7507/1002-1892.201909069 Copy

1.	Desteli EE, Imren Y, Erdoğan M, et al. Quality of life following treatment of trochanteric fractures with proximal femoral nail versus cementless bipolar hemiarthroplasty in elderly. Clin Invest Med, 2015, 38(2): E63-E72.
2.	万乾, 张擎柱, 张义, 等. 股骨近端防旋髓内钉与锁定加压钢板治疗老年脑梗死偏瘫侧股骨转子间骨折的疗效比较. 中国修复重建外科杂志, 2018, 32(11): 1411-1416.
3.	李明东, 胡稷杰, 黎早敏, 等. 不同手术方式治疗老年股骨粗隆间骨折的疗效比较. 中国修复重建外科杂志, 2017, 31(6): 653-658.
4.	侯宇, 姚琦, 张亘瑷, 等. 第 3 代 Gamma 钉拉力螺钉钉尾距股骨外侧皮质距离与术后拉力螺钉移位或切出关系研究. 中国修复重建外科杂志, 2018, 32(1): 40-44.
5.	Lenz M, Schwinn J, Hofmann-Fliri L, et al. Influence of reduced tip-apex distance on helical blade fixation-a biomechanical study. J Orthop Res, 2019, 37(3): 649-654.
6.	Ibrahim I, Appleton PT, Wixted JJ, et al. Implant cut-out following cephalomedullary nailing of intertrochanteric femur fractures: Are helical blades to blame? Injury, 2019, 50(4): 926-930.
7.	田大为, 万华, 熊敏, 等. PFNA 治疗股骨粗隆间骨折内固定手术失败的原因分析. 中国矫形外科杂志, 2018, 26(20): 1830-1834.
8.	王茂林, 易志坚, 卢明刚, 等. 防旋股骨近端髓内钉治疗股骨粗隆间骨折术后失效原因分析. 中国骨与关节杂志, 2019, 8(7): 504-507.
9.	Turgut A, Kalenderer Ö, Karapınar L, et al. Which factor is most important for occurrence of cutout complications in patients treated with proximal femoral nail antirotation? Retrospective analysis of 298 patients. Arch Orthop Trauma Surg, 2016, 136(5): 623-630.
10.	Caruso G, Bonomo M, Valpiani G, et al. A six-year retrospective analysis of cut-out risk predictors in cephalomedullary nailing for pertrochanteric fractures: can the tip-apex distance (TAD) still be considered the best parameter. Bone Joint Res, 2017, 6(8): 481-488.
11.	张立智, 胡孙君, 杜守超, 等. 股骨头内螺旋刀片与拉力螺钉的特点对比和生物力学的研究进展. 中国临床解剖学杂志, 2015, 33(5): 608-611.
12.	陈鹏, 傅德皓. 股骨近端防旋髓内钉治疗老年股骨转子间骨折内固定失败原因分析. 中国修复重建外科杂志, 2019, 33(10): 1270-1274.
13.	Flores SA, Woolridge A, Caroom C, et al. The utility of the tip-apex distance in predicting axial migration and cutout with the trochanteric fixation nail system helical blade. J Orthop Trauma, 2016, 30(6): e207-211.
14.	李海丰, 王华, 张英琪, 等. 头髓钉治疗高龄股骨转子间骨折的尖顶距与螺旋刀片移位的关系. 中国修复重建外科杂志, 2019, 33(10): 1234-1238.
15.	Born CT, Karich B, Bauer C, et al. Hip screw migration testing: first results for hip screws and helical blades utilizing a new oscillating test method. J Orthop Res, 2011, 29(5): 760-766.
16.	Kuzyk P, Zdero R, Shah S, et al. Femoral head lag screw position for cephalomedullary nails: a biomechanical analysis. J Orthop Trauma, 2012, 26(7): 414-421.
17.	Murena L, Moretti A, Meo F, et al. Predictors of cut-out after cephalomedullary nail fixation of pertrochanteric fractures: a retro-spective study of 813 patients. Arch Orthop Trauma Surg, 2018, 138(3): 351-359.
18.	Jiamton C, Boernert K, Babst R, et al. The nail-shaft-axis of the of proximal femoral nail antirotation (PFNA) is an important prognos-tic factor in the operative treatment of intertrochanteric fractures. Arch Orthop Trauma Surg, 2018, 138(3): 339-349.

1. Desteli EE, Imren Y, Erdoğan M, et al. Quality of life following treatment of trochanteric fractures with proximal femoral nail versus cementless bipolar hemiarthroplasty in elderly. Clin Invest Med, 2015, 38(2): E63-E72.
2. 万乾, 张擎柱, 张义, 等. 股骨近端防旋髓内钉与锁定加压钢板治疗老年脑梗死偏瘫侧股骨转子间骨折的疗效比较. 中国修复重建外科杂志, 2018, 32(11): 1411-1416.
3. 李明东, 胡稷杰, 黎早敏, 等. 不同手术方式治疗老年股骨粗隆间骨折的疗效比较. 中国修复重建外科杂志, 2017, 31(6): 653-658.
4. 侯宇, 姚琦, 张亘瑷, 等. 第 3 代 Gamma 钉拉力螺钉钉尾距股骨外侧皮质距离与术后拉力螺钉移位或切出关系研究. 中国修复重建外科杂志, 2018, 32(1): 40-44.
5. Lenz M, Schwinn J, Hofmann-Fliri L, et al. Influence of reduced tip-apex distance on helical blade fixation-a biomechanical study. J Orthop Res, 2019, 37(3): 649-654.
6. Ibrahim I, Appleton PT, Wixted JJ, et al. Implant cut-out following cephalomedullary nailing of intertrochanteric femur fractures: Are helical blades to blame? Injury, 2019, 50(4): 926-930.
7. 田大为, 万华, 熊敏, 等. PFNA 治疗股骨粗隆间骨折内固定手术失败的原因分析. 中国矫形外科杂志, 2018, 26(20): 1830-1834.
8. 王茂林, 易志坚, 卢明刚, 等. 防旋股骨近端髓内钉治疗股骨粗隆间骨折术后失效原因分析. 中国骨与关节杂志, 2019, 8(7): 504-507.
9. Turgut A, Kalenderer Ö, Karapınar L, et al. Which factor is most important for occurrence of cutout complications in patients treated with proximal femoral nail antirotation? Retrospective analysis of 298 patients. Arch Orthop Trauma Surg, 2016, 136(5): 623-630.
10. Caruso G, Bonomo M, Valpiani G, et al. A six-year retrospective analysis of cut-out risk predictors in cephalomedullary nailing for pertrochanteric fractures: can the tip-apex distance (TAD) still be considered the best parameter. Bone Joint Res, 2017, 6(8): 481-488.
11. 张立智, 胡孙君, 杜守超, 等. 股骨头内螺旋刀片与拉力螺钉的特点对比和生物力学的研究进展. 中国临床解剖学杂志, 2015, 33(5): 608-611.
12. 陈鹏, 傅德皓. 股骨近端防旋髓内钉治疗老年股骨转子间骨折内固定失败原因分析. 中国修复重建外科杂志, 2019, 33(10): 1270-1274.
13. Flores SA, Woolridge A, Caroom C, et al. The utility of the tip-apex distance in predicting axial migration and cutout with the trochanteric fixation nail system helical blade. J Orthop Trauma, 2016, 30(6): e207-211.
14. 李海丰, 王华, 张英琪, 等. 头髓钉治疗高龄股骨转子间骨折的尖顶距与螺旋刀片移位的关系. 中国修复重建外科杂志, 2019, 33(10): 1234-1238.
15. Born CT, Karich B, Bauer C, et al. Hip screw migration testing: first results for hip screws and helical blades utilizing a new oscillating test method. J Orthop Res, 2011, 29(5): 760-766.
16. Kuzyk P, Zdero R, Shah S, et al. Femoral head lag screw position for cephalomedullary nails: a biomechanical analysis. J Orthop Trauma, 2012, 26(7): 414-421.
17. Murena L, Moretti A, Meo F, et al. Predictors of cut-out after cephalomedullary nail fixation of pertrochanteric fractures: a retro-spective study of 813 patients. Arch Orthop Trauma Surg, 2018, 138(3): 351-359.
18. Jiamton C, Boernert K, Babst R, et al. The nail-shaft-axis of the of proximal femoral nail antirotation (PFNA) is an important prognos-tic factor in the operative treatment of intertrochanteric fractures. Arch Orthop Trauma Surg, 2018, 138(3): 339-349.

Chinese Journal of Reparative and Reconstructive Surgery

Effect of screw blade position on proximal femoral nail anti-rotation internal fixation for unstable intertrochanteric fractures in the elderly

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