Effectiveness of proximal femoral nail anti-rotation for high plane intertrochanteric femur fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

HU Sunjun , DU Shouchao , XIONG Wenfeng , CHEN Shiyi , SONG Hui ,  CHANG Shimin

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

Corresponding author：

CHANG Shimin, Email: shiminchang11@aliyun.com

Keywords：

High plane intertrochanteric femur fracture; proximal femoral nail anti-rotation; internal fixation

DOI：

10.7507/1002-1892.202007114

Video：

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Objective To evaluate the effectiveness of proximal femoral nail anti-rotation (PFNA) in treatment of high plane intertrochanteric femur fractures.Methods A retrospective analysis was performed on 33 patients who underwent closed reduction and PFNA fixation for high plane intertrochanteric femur fracture between January 2016 and June 2019. There were 12 males and 21 females with an average age of 75.1 years (mean, 47-89 years). The fractures were caused by falling from height in 21 cases, by traffic accident in 7 cases, and by other injuries in 5 cases. Fractures were classified as type A in 14 cases and type B in 19 cases according to self-defined fracture classification criteria; and as type 31-A1.2 in 14 cases and as type 31-A2.2 in 19 cases according to AO/Orthopedic Trauma Association (AO/OTA) classification criteria. The time from injury to operation was 2-5 days (mean, 2.7 days). The operation time, intraoperative blood loss, hospital stay, fracture reduction quality, fracture healing time, internal fixation failure, and Parker-Palmer score were recorded.Results The operation time was 40-75 minutes (mean, 55 minutes). The intraoperative blood loss was 50-150 mL (mean, 64 mL). The hospital stay was 5-15 days (mean, 8.7 days). All incisions healed by first intention. Twenty-eight patients were followed up 12-18 months with an average of 13.6 months. The fracture reduction quality was rated as excellent in 9 cases (32.1%), good in 17 cases (60.7%), and poor in 2 cases (7.1%) by Chang’s criteria. Parker-Palmer score was 6-9 (mean, 7.9) at last follow-up.Conclusion High plane intertrochanteric femur fracture is a special type of intertrochanteric fracture, which can be diagnosed by imaging examination. PFNA fixation can achieve satisfactory results and prevent the occurrence of internal fixation failure effectively.

Citation： HU Sunjun, DU Shouchao, XIONG Wenfeng, CHEN Shiyi, SONG Hui, CHANG Shimin. Effectiveness of proximal femoral nail anti-rotation for high plane intertrochanteric femur fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(3): 307-311. doi: 10.7507/1002-1892.202007114 Copy

1.	纪方, 佟大可. 重视股骨转子间骨折内固定的手术细节. 中华创伤骨科杂志, 2020, 22(4): 277-281.
2.	张铁超, 张志山, 周方, 等. 颈基底型股骨粗隆部骨折的诊断及治疗. 北京大学学报 (医学版), 2017, 49(2): 246-251.
3.	张世民. 老年髋部转子间骨折. 上海: 科学出版社, 2019: 276-280.
4.	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.
5.	张世民, 余斌. AO/OTA-2018 版股骨转子间骨折分类的解读与讨论. 中华创伤骨科杂志, 2018, 20(7): 583-587.
6.	尹博, 周君琳, 何远铭, 等. 股骨转子间骨折三维新分型的可靠性分析. 中华创伤骨科杂志, 2020, 22(1): 55-59.
7.	Hu SJ, Yu GR, Zhang SM. Surgical treatment of basicervical intertrochanteric fractures of the proximal femur with cephalomeduallary hip nails. Orthop Surg, 2013, 5(2): 124-129.
8.	Zhang Y, Hu J, Li X, et al. Reverse wedge effect following intramedullary nailing of a basicervical trochanteric fracture variant combined with a mechanically compromised greater trochanter. BMC Musculoskelet Disord, 2020, 21(1): 195-204.
9.	Su BW, Heyworth BE, Protopsaltis TS, et al. Basicervical versus intertrochanteric fractures: an analysis of radiographic and functional outcomes. Orthopedics, 2006, 29(10): 919-925.
10.	Johnson J, Deren M, Chambers A, et al. Biomechanical analysis of fixation devices for basicervical femoral neck fractures. J Am Acad Orthop Surg, 2019, 27(1): e41-e48.
11.	Kwak DK, Kim WH, Lee SJ, et al. Biomechanical comparison of three different intramedullary nails for fixation of unstable basicervical intertrochanteric fractures of the proximal femur: experimental studies. Biomed Res Int, 2018, 2018: 7618079.
12.	Tasyıkan L, Ugutmen E, Sanel S, et al. Short-term results of surgical treatment with cephalomedullary nails for basicervical proximal femoral fractures. Acta Orthop Belg, 2015, 81(3): 427-434.
13.	Kweon SH, Lee SH, Kook SH, et al. Outcomes of cephalomedullary nailing in basicervical fracture. Hip Pelvis, 2017, 29(4): 270-276.
14.	Lee YK, Yoon BH, Hwang JS, et al. Risk factors of fixation failure in basicervical femoral neck fracture: which device is optimal for fixation? Injury, 2018, 49(3): 691-696.
15.	Sharma A, Sethi A, Sharma S. Comparative analysis of treatment of basicervical femur fractures in young adults with CCS, DHS, and PFN. Rev Bras Ortop, 2018, 53(6): 783-787.
16.	Okano I, Sawada T, Kushima N, et al. Treatment with helical blade cephalomedullary nail for two-part basicervical proximal femoral fracture in elderly patients: A retrospective observational study. Geriatr Orthop Surg Rehabil, 2017, 8(4): 244-251.
17.	Wang Q, Gu XH, Li X, et al. Management of low-energy basicervical proximal femoral fractures by proximal femoral nail anti-rotation. Orthop Surg, 2019, 11(6): 1173-1179.
18.	李双, 张世民, 张立智, 等. 不同组合前内侧皮质支撑复位对股骨转子间骨折髓内钉术后稳定性影响的生物力学研究. 中华创伤骨科杂志, 2019, 21(1): 57-64.
19.	Xiong WF, Du SC, Chang SM. Choosing an optimal implant fixation for basicervical femoral neck fractures. Injury, 2018, 49(6): 1238-1239.

1. 纪方, 佟大可. 重视股骨转子间骨折内固定的手术细节. 中华创伤骨科杂志, 2020, 22(4): 277-281.
2. 张铁超, 张志山, 周方, 等. 颈基底型股骨粗隆部骨折的诊断及治疗. 北京大学学报 (医学版), 2017, 49(2): 246-251.
3. 张世民. 老年髋部转子间骨折. 上海: 科学出版社, 2019: 276-280.
4. 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.
5. 张世民, 余斌. AO/OTA-2018 版股骨转子间骨折分类的解读与讨论. 中华创伤骨科杂志, 2018, 20(7): 583-587.
6. 尹博, 周君琳, 何远铭, 等. 股骨转子间骨折三维新分型的可靠性分析. 中华创伤骨科杂志, 2020, 22(1): 55-59.
7. Hu SJ, Yu GR, Zhang SM. Surgical treatment of basicervical intertrochanteric fractures of the proximal femur with cephalomeduallary hip nails. Orthop Surg, 2013, 5(2): 124-129.
8. Zhang Y, Hu J, Li X, et al. Reverse wedge effect following intramedullary nailing of a basicervical trochanteric fracture variant combined with a mechanically compromised greater trochanter. BMC Musculoskelet Disord, 2020, 21(1): 195-204.
9. Su BW, Heyworth BE, Protopsaltis TS, et al. Basicervical versus intertrochanteric fractures: an analysis of radiographic and functional outcomes. Orthopedics, 2006, 29(10): 919-925.
10. Johnson J, Deren M, Chambers A, et al. Biomechanical analysis of fixation devices for basicervical femoral neck fractures. J Am Acad Orthop Surg, 2019, 27(1): e41-e48.
11. Kwak DK, Kim WH, Lee SJ, et al. Biomechanical comparison of three different intramedullary nails for fixation of unstable basicervical intertrochanteric fractures of the proximal femur: experimental studies. Biomed Res Int, 2018, 2018: 7618079.
12. Tasyıkan L, Ugutmen E, Sanel S, et al. Short-term results of surgical treatment with cephalomedullary nails for basicervical proximal femoral fractures. Acta Orthop Belg, 2015, 81(3): 427-434.
13. Kweon SH, Lee SH, Kook SH, et al. Outcomes of cephalomedullary nailing in basicervical fracture. Hip Pelvis, 2017, 29(4): 270-276.
14. Lee YK, Yoon BH, Hwang JS, et al. Risk factors of fixation failure in basicervical femoral neck fracture: which device is optimal for fixation? Injury, 2018, 49(3): 691-696.
15. Sharma A, Sethi A, Sharma S. Comparative analysis of treatment of basicervical femur fractures in young adults with CCS, DHS, and PFN. Rev Bras Ortop, 2018, 53(6): 783-787.
16. Okano I, Sawada T, Kushima N, et al. Treatment with helical blade cephalomedullary nail for two-part basicervical proximal femoral fracture in elderly patients: A retrospective observational study. Geriatr Orthop Surg Rehabil, 2017, 8(4): 244-251.
17. Wang Q, Gu XH, Li X, et al. Management of low-energy basicervical proximal femoral fractures by proximal femoral nail anti-rotation. Orthop Surg, 2019, 11(6): 1173-1179.
18. 李双, 张世民, 张立智, 等. 不同组合前内侧皮质支撑复位对股骨转子间骨折髓内钉术后稳定性影响的生物力学研究. 中华创伤骨科杂志, 2019, 21(1): 57-64.
19. Xiong WF, Du SC, Chang SM. Choosing an optimal implant fixation for basicervical femoral neck fractures. Injury, 2018, 49(6): 1238-1239.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of proximal femoral nail anti-rotation for high plane intertrochanteric femur fractures

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