BACKGROUND There are few studies in the literature comparing the clinical outcomes and radiographic results of proximal femoral nail(PFN)and proximal femoral nail antirotation(PFNA)for pertrochanteric femoral fracture...BACKGROUND There are few studies in the literature comparing the clinical outcomes and radiographic results of proximal femoral nail(PFN)and proximal femoral nail antirotation(PFNA)for pertrochanteric femoral fracture(PFF)in elderly patients.AIM To evaluate both clinical and radiographic outcomes after fixation with PFN and PFNA in an elderly patient population.METHODS One hundred fifty-eight patients older than 65 years with PFF who underwent fixation with either PFN or PFNA were included.Seventy-three patients underwent fixation with PFN,whereas 85 were fixed with PFNA.The mean follow-up was 2.4 years(range,1-7 years).Clinical outcome was measured in terms of operation time,postoperative function at each follow-up visit,and mortality within one year.Radiographic evaluation included reduction quality after surgery,Cleveland Index,tip-apex distance(TAD),union rate,time to union,and sliding distance of the screw or blade.Complications including nonunion,screw cutout,infection,osteonecrosis of the femoral head,and implant breakage were also investigated.RESULTS Postoperative function was more satisfactory in patients who underwent PFNA than in those who underwent PFN(P=0.033).Radiologically,the sliding difference was greater in PFN than in PFNA patients(6.1 and 3.2 mm,respectively,P=0.036).The rate of screw cutout was higher in the PFN group;eight for PFN(11.0%)and two for PFNA patients(2.4%,P=0.027).There were no differences between the two groups in terms of operation time,mortality rate at one year after the operation,adequacy of reduction,Cleveland Index,TAD,union rate,time to union,nonunion,infection,osteonecrosis,or implant breakage.CONCLUSION Elderly patients with PFF who underwent PFNA using a helical blade demonstrated better clinical and radiographic outcomes as measured by clinical score and sliding distance compared with patients who underwent PFN.展开更多
Objective Unstable intertrochanteric fractures （ITFs） are mostly treated by proximal femoral nail antirotation （PFNA）,Inter-Tan,Asian Hip,and other new internal fixation devices.But for complex unstable fractures,...Objective Unstable intertrochanteric fractures （ITFs） are mostly treated by proximal femoral nail antirotation （PFNA）,Inter-Tan,Asian Hip,and other new internal fixation devices.But for complex unstable fractures,such as crushed lateral wall of the greater trochanter,the loss of fixation point on lateral wall slightly reduces the fixing effect.This study aimed to compare the biomechanical strengths between reversed less invasive stabilization system （LISS） and PFNA for treatment of unstable ITFs.Methods Forty synthetic femurs were used to simulate unstable ITFs in vitro and were fixed using the reversed LISS or PFNA.These fractures were divided into two groups depending on whether the lateral wall of the greater trochanter is intact or not （AO classification：31-A2.3 and 31-A3.3,respectively）.The load-displacement of femur,stiffness,ultimate load,and cyclic fatigue resistance were detected using an incremental load test and a dynamic fatigue test through an MTS 858 test system.Results For both 31-A2.3 and 31-A3.3,the vertical sinking displacement （VSD） of the femoral head under 500 N load was insignificantly smaller after treatment with reversed LISS than with PFNA,and when the displacement was 5 mm,the femoral head bore insignificantly greater load.The fixation with reversed LISS resulted in greater axial stiffness of the femur but smaller ultimate load.During the same cycle in the dynamic fatigue test,the VSD was insignificantly smaller with the fixation of reversed LISS.Conclusion Reversed LISS and PFNA have similar biomechanical strength for unstable ITFs.This conclusion should be supported by additional large-size research on basic biomechanics and clinical application.This is the first comparative biomechanical study comparing reversed LISS and PFNA for unstable ITFs.展开更多
Purpose:To investigate the clinical value of proximal femoral nail antirotation and anatomical locking plate of proximal femur in the treatment of intertrochanteric fracture of femur.Methods:The study group is treated...Purpose:To investigate the clinical value of proximal femoral nail antirotation and anatomical locking plate of proximal femur in the treatment of intertrochanteric fracture of femur.Methods:The study group is treated with PFNA internal fixation.The control group is treated by internal fixation with anatomical locking plate of proximal femur.Results:The time of operation,the amount of intraoperative bleeding and the time of fracture healing in the study group are significantly less than those in the control group.The incidence rate of complication in the study group(3.23%)is significantly lower than that in the control group(17.2%).Data comparison shows P<0.05.Conclusion:The curative effect and prognosis for patients with intertrochanteric fracture of femur treated by PFNA internal fixation are more ideal.展开更多
Purpose To investigate the clinical value of proximal femoral nail antirotation and anatomical locking plate of proximal femur in the treatment of intertrochanteric fracture of femur.Methods The study group is treated...Purpose To investigate the clinical value of proximal femoral nail antirotation and anatomical locking plate of proximal femur in the treatment of intertrochanteric fracture of femur.Methods The study group is treated with PFNA internal fixation.The control group is treated by internal fixation with anatomical locking plate of proximal femur.Results The time of operation,the amount of intraoperative bleeding and the time of fracture healing in the study group are significantly less than those in the control group.The incidence rate of complication in the study group(3.23%)is significantly lower than that in the control group(17.2%).Data comparison shows P<0.05.Conclusion The curative effect and prognosis for patients with intertrochanteric fracture of femur treated by PFNA internal fixation are more ideal.展开更多
Purpose:Hidden blood loss(HBL)during the perioperative period significantly impacts postoperative recovery and complications,yet it is frequently disregarded.This study aimed to investigate the effects of tip-apex dis...Purpose:Hidden blood loss(HBL)during the perioperative period significantly impacts postoperative recovery and complications,yet it is frequently disregarded.This study aimed to investigate the effects of tip-apex distance(TAD)and calcar-referenced tip-apex distance(calTAD)on HBL in the treatment of intertrochanteric fractures utilizing proximal femoral nail antirotation(PFNA).The study also seeks to evaluate the possible decrease in HBL subsequent to PFNA treatment by optimizing nail positioning.Method:A historical cohort study was conducted from January 2020 to December 2022.Patients diagnosed with unilateral acute closed femoral intertrochanteric fracture and who underwent PFNA internal fixation surgery met the inclusion criteria,and were grouped according to the value of calTAD and TAD.The participants were divided into low TAD group(TAD<20 mm)and high TAD group(TAD≥20 mm);low calTAD group(calTAD<7.625 mm)and high calTAD group(calTAD≥7.625 mm),respectively.The primary outcome measures were intraoperative blood loss(including HBL,overt blood loss,and total blood loss).Continuous data were analyzed using an independent samplet-test or Mann-WhitneyU test,and categorical data were analyzed using the Pearson Chi-square test.Univariate analysis was used to evaluate the association between various indicators and perioperative HBL.A stepwise multiple linear regression analysis model was used to determine the independent factors affecting perioperative HBL.Ap value less than 0.05 was considered statistically significant.Results:A total of 131 patients were initially included,of which 80 were assigned to the calTAD group(with 61 in the high calTAD group and 19 in the low calTAD group),and 80 were assigned to the TAD group(with 34 in the high TAD group and 46 in the low TAD group).The average HBL for the low TAD group was 772.85 mL,whereas for the high TAD group it was 919.68 mL(p>0.05).The average HBL for the low calTAD group was 611.42 mL,whereas for the high calTAD group it was 904.97 mL(p<0.05).Subsequent analysis revealed that the patient''s height,preoperative hemoglobin levels,changes in hemoglobin and hematocrit levels from pre-to post-surgery,and calTAD are independent risk factors influencing HBL.Conclusion:In summary,our investigation revealed a significant correlation between the positioning of nails in PFNA and HBL during the perioperative period.By optimizing the placement of the cephalic nail,specifically by ensuring a calTAD of less than 7.625 mm,a significant decrease in HBL can be attained.Additionally,we identified that height,preoperative hemoglobin,differences in preoperative and postoperative hemoglobin and hematocrit,and the positioning of the cephalic nail were independent risk factors for HBL.展开更多
Subtrochanteric fractures pose a therapeutic challenge to the surgeons. With the advent of proximal femoral nails, most of the cases are treated with nailing. Newer nails like proximal femoral nail antirotation （PFNA...Subtrochanteric fractures pose a therapeutic challenge to the surgeons. With the advent of proximal femoral nails, most of the cases are treated with nailing. Newer nails like proximal femoral nail antirotation （PFNA） require the blade to be directly hammered into the bone compared to older nails where the screws are drilled and tapped before insertion. We report one such case in a middle aged female that had intraoperative lateral cortex blowout during PFNA blade insertion in a sclerotic bone. This occurrence to the best of our knowledge is unreported in literature. It is therefore imperative to consider the quality of bone before a decision is made on the implant chosen.展开更多
文摘BACKGROUND There are few studies in the literature comparing the clinical outcomes and radiographic results of proximal femoral nail(PFN)and proximal femoral nail antirotation(PFNA)for pertrochanteric femoral fracture(PFF)in elderly patients.AIM To evaluate both clinical and radiographic outcomes after fixation with PFN and PFNA in an elderly patient population.METHODS One hundred fifty-eight patients older than 65 years with PFF who underwent fixation with either PFN or PFNA were included.Seventy-three patients underwent fixation with PFN,whereas 85 were fixed with PFNA.The mean follow-up was 2.4 years(range,1-7 years).Clinical outcome was measured in terms of operation time,postoperative function at each follow-up visit,and mortality within one year.Radiographic evaluation included reduction quality after surgery,Cleveland Index,tip-apex distance(TAD),union rate,time to union,and sliding distance of the screw or blade.Complications including nonunion,screw cutout,infection,osteonecrosis of the femoral head,and implant breakage were also investigated.RESULTS Postoperative function was more satisfactory in patients who underwent PFNA than in those who underwent PFN(P=0.033).Radiologically,the sliding difference was greater in PFN than in PFNA patients(6.1 and 3.2 mm,respectively,P=0.036).The rate of screw cutout was higher in the PFN group;eight for PFN(11.0%)and two for PFNA patients(2.4%,P=0.027).There were no differences between the two groups in terms of operation time,mortality rate at one year after the operation,adequacy of reduction,Cleveland Index,TAD,union rate,time to union,nonunion,infection,osteonecrosis,or implant breakage.CONCLUSION Elderly patients with PFF who underwent PFNA using a helical blade demonstrated better clinical and radiographic outcomes as measured by clinical score and sliding distance compared with patients who underwent PFN.
文摘Objective Unstable intertrochanteric fractures （ITFs） are mostly treated by proximal femoral nail antirotation （PFNA）,Inter-Tan,Asian Hip,and other new internal fixation devices.But for complex unstable fractures,such as crushed lateral wall of the greater trochanter,the loss of fixation point on lateral wall slightly reduces the fixing effect.This study aimed to compare the biomechanical strengths between reversed less invasive stabilization system （LISS） and PFNA for treatment of unstable ITFs.Methods Forty synthetic femurs were used to simulate unstable ITFs in vitro and were fixed using the reversed LISS or PFNA.These fractures were divided into two groups depending on whether the lateral wall of the greater trochanter is intact or not （AO classification：31-A2.3 and 31-A3.3,respectively）.The load-displacement of femur,stiffness,ultimate load,and cyclic fatigue resistance were detected using an incremental load test and a dynamic fatigue test through an MTS 858 test system.Results For both 31-A2.3 and 31-A3.3,the vertical sinking displacement （VSD） of the femoral head under 500 N load was insignificantly smaller after treatment with reversed LISS than with PFNA,and when the displacement was 5 mm,the femoral head bore insignificantly greater load.The fixation with reversed LISS resulted in greater axial stiffness of the femur but smaller ultimate load.During the same cycle in the dynamic fatigue test,the VSD was insignificantly smaller with the fixation of reversed LISS.Conclusion Reversed LISS and PFNA have similar biomechanical strength for unstable ITFs.This conclusion should be supported by additional large-size research on basic biomechanics and clinical application.This is the first comparative biomechanical study comparing reversed LISS and PFNA for unstable ITFs.
文摘Purpose:To investigate the clinical value of proximal femoral nail antirotation and anatomical locking plate of proximal femur in the treatment of intertrochanteric fracture of femur.Methods:The study group is treated with PFNA internal fixation.The control group is treated by internal fixation with anatomical locking plate of proximal femur.Results:The time of operation,the amount of intraoperative bleeding and the time of fracture healing in the study group are significantly less than those in the control group.The incidence rate of complication in the study group(3.23%)is significantly lower than that in the control group(17.2%).Data comparison shows P<0.05.Conclusion:The curative effect and prognosis for patients with intertrochanteric fracture of femur treated by PFNA internal fixation are more ideal.
文摘Purpose To investigate the clinical value of proximal femoral nail antirotation and anatomical locking plate of proximal femur in the treatment of intertrochanteric fracture of femur.Methods The study group is treated with PFNA internal fixation.The control group is treated by internal fixation with anatomical locking plate of proximal femur.Results The time of operation,the amount of intraoperative bleeding and the time of fracture healing in the study group are significantly less than those in the control group.The incidence rate of complication in the study group(3.23%)is significantly lower than that in the control group(17.2%).Data comparison shows P<0.05.Conclusion The curative effect and prognosis for patients with intertrochanteric fracture of femur treated by PFNA internal fixation are more ideal.
文摘Purpose:Hidden blood loss(HBL)during the perioperative period significantly impacts postoperative recovery and complications,yet it is frequently disregarded.This study aimed to investigate the effects of tip-apex distance(TAD)and calcar-referenced tip-apex distance(calTAD)on HBL in the treatment of intertrochanteric fractures utilizing proximal femoral nail antirotation(PFNA).The study also seeks to evaluate the possible decrease in HBL subsequent to PFNA treatment by optimizing nail positioning.Method:A historical cohort study was conducted from January 2020 to December 2022.Patients diagnosed with unilateral acute closed femoral intertrochanteric fracture and who underwent PFNA internal fixation surgery met the inclusion criteria,and were grouped according to the value of calTAD and TAD.The participants were divided into low TAD group(TAD<20 mm)and high TAD group(TAD≥20 mm);low calTAD group(calTAD<7.625 mm)and high calTAD group(calTAD≥7.625 mm),respectively.The primary outcome measures were intraoperative blood loss(including HBL,overt blood loss,and total blood loss).Continuous data were analyzed using an independent samplet-test or Mann-WhitneyU test,and categorical data were analyzed using the Pearson Chi-square test.Univariate analysis was used to evaluate the association between various indicators and perioperative HBL.A stepwise multiple linear regression analysis model was used to determine the independent factors affecting perioperative HBL.Ap value less than 0.05 was considered statistically significant.Results:A total of 131 patients were initially included,of which 80 were assigned to the calTAD group(with 61 in the high calTAD group and 19 in the low calTAD group),and 80 were assigned to the TAD group(with 34 in the high TAD group and 46 in the low TAD group).The average HBL for the low TAD group was 772.85 mL,whereas for the high TAD group it was 919.68 mL(p>0.05).The average HBL for the low calTAD group was 611.42 mL,whereas for the high calTAD group it was 904.97 mL(p<0.05).Subsequent analysis revealed that the patient''s height,preoperative hemoglobin levels,changes in hemoglobin and hematocrit levels from pre-to post-surgery,and calTAD are independent risk factors influencing HBL.Conclusion:In summary,our investigation revealed a significant correlation between the positioning of nails in PFNA and HBL during the perioperative period.By optimizing the placement of the cephalic nail,specifically by ensuring a calTAD of less than 7.625 mm,a significant decrease in HBL can be attained.Additionally,we identified that height,preoperative hemoglobin,differences in preoperative and postoperative hemoglobin and hematocrit,and the positioning of the cephalic nail were independent risk factors for HBL.
文摘Subtrochanteric fractures pose a therapeutic challenge to the surgeons. With the advent of proximal femoral nails, most of the cases are treated with nailing. Newer nails like proximal femoral nail antirotation （PFNA） require the blade to be directly hammered into the bone compared to older nails where the screws are drilled and tapped before insertion. We report one such case in a middle aged female that had intraoperative lateral cortex blowout during PFNA blade insertion in a sclerotic bone. This occurrence to the best of our knowledge is unreported in literature. It is therefore imperative to consider the quality of bone before a decision is made on the implant chosen.
