Comparison of proximal femoral nail anti-rotation operation in traction bed supine position and non-traction bed lateral position in treatment of intertrochanteric fracture of femur_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LI Mingdong ¹ , CHEN Jianfei ¹ , MA Yetao ¹ , LI Zaomin ¹ ,  QIN Junjun ²

1. Department of Orthopedic Trauma, Hainan General Hospital, Haikou Hainan, 570311, P.R.China;
2. Department of Orthopedics, the People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning Guangxi, 530021, P.R.China;

Corresponding?author：

QIN Junjun, Email: guinan666@163.com

Keywords：

Intertrochanteric fracture of femur; proximal femoral nail anti-rotation; position

DOI：

10.7507/1002-1892.201905076

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Objective To compare the effectiveness of proximal femoral nail anti-rotation (PFNA) in the treatment of intertrochanteric fracture of femur in traction bed supine position and non-traction bed lateral position.Methods A retrospective analysis of 102 elderly patients with intertrochanteric fracture of femur who met the selection criteria between January 2013 and April 2018 was made. According to the different operative positions, the patients were divided into two groups: group A (50 cases, PFNA internal fixation in traction bed supine position) and group B (52 cases, PFNA internal fixation in non-traction bed lateral position). There was no significant difference in age, gender, fracture side, cause of injury, AO classification, complications, and time from injury to operation between the two groups (P>0.05). The preoperative preparation time, incision length, operation time, intraoperative blood loss, intraoperative X-ray fluoroscopy times, fracture healing time, and complications were recorded and compared between the two groups, and the effectiveness was evaluated by Harris hip score at 1 year after operation.Results There was no significant difference in incision length between groups A and B (t=1.116, P=0.268). In addition, the preoperative preparation time, operation time, intraoperative blood loss, and intraoperative X-ray fluoroscopy times in group A were significantly greater than those in group B (P<0.05). Both groups were followed up 12-14 months, with an average of 13 months. There were 3 postoperative complications in group A and group B respectively. In group A, there were 2 cases of hip joint pain and 1 case of local fat liquefaction (healed after dressing change); in group B, there were 2 cases of hip joint pain and 1 case of deep vein thrombosis in lower extremity; there was no significant difference in the incidence of postoperative complications between the two groups (P=0.642). The patients of the two groups had a good result of fracture reduction and the internal fixation quality, and there was no main nail loosening, screw fracture, spiral blade cutting, withdrawal, and the nail breakage occurred, and no nonunion of bone, coxa vara, and other complications occurred. X-ray showed that the fracture healed in both groups, and there was no significant difference in fracture healing time between the two groups (t=1.515, P=0.133). There was no significant difference in Harris hip score between the two groups at 1 year after operation (t=0.778, P=0.438).Conclusion Compared with the traction bed supine position, PFNA internal fixation for intertrochanteric fracture of femur in the non-traction bed lateral position has the advantages of short preparation time, short operation time, less intraoperative blood loss, less X-ray fluoroscopy times, and satisfactory postoperative recovery effect.

Citation： LI Mingdong, CHEN Jianfei, MA Yetao, LI Zaomin, QIN Junjun. Comparison of proximal femoral nail anti-rotation operation in traction bed supine position and non-traction bed lateral position in treatment of intertrochanteric fracture of femur. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(1): 32-36. doi: 10.7507/1002-1892.201905076 Copy

1.	Chang SM, Song DL, Ma Z, et al. Mismatch of the short straight cephalomedullary nail (PFNA-Ⅱ) with the anterior bow of the femur in an Asian population. J Orthop Trauma, 2014, 28(1): 17-22.
2.	Takemoto RC, Lekic N, Schwarzkopf R, et al. The effect of two different trochanteric nail lag-screw designs on fixation stability of four-part intertrochanteric fractures: a clinical and biomechanical study. J Orthop Sci, 2014, 19(1): 112-119.
3.	羅勤瑜, 胡奕山, 郭予立, 等. 側臥位行股骨近端防旋髓內釘治療老年股骨粗隆間骨折的臨床療效分析. 中國矯形外科雜志, 2011, 19(18): 1572-1574.
4.	丁濤, 張保焜, 田少奇, 等. 老年髖部骨折手術方法的選擇原則及應用現狀. 中國修復重建外科雜志, 2018, 32(11): 1435-1440.
5.	Cho SH, Lee SH, Cho HL, et al. Additional fixations for sliding hip screws in treating unstable pertrochanteric femoral fractures (AO Type 31-A2): short-term clinical results. Clin Orthop Surg, 2011, 3(2): 107-113.
6.	Makki D, Matar HE, Jacob N, et al. Comparison of the reconstruction trochanteric antigrade nail (TAN) with the proximal femoral nail antirotation (PFNA) in the management of reverse oblique intertrochanteric hip fractures. Injury, 2015, 46(12): 2389-2393.
7.	Pan S, Liu XH, Feng T, et al. Influence of different great trochanteric entry points on the outcome of intertrochanteric fractures: a retrospective cohort study. BMC Musculoskelet Disord, 2017, 18(1): 107.
8.	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.
9.	Kumar N, Kataria H, Yadav C, et al. Evaluation of proximal femoral locking plate in unstable extracapsular proximal femoral fractures: Surgical technique & mid term follow up results. J Clin Orthop Trauma, 2014, 5(3): 137-145.
10.	Della Valle CJ, Mesko NW, Quigley L, et al. Primary total hip arthroplasty with a porous-coated acetabular component. A concise follow-up, at a minimum of twenty years, of previous reports. J Bone Joint Surg (Am), 2009, 91(5): 1130-1135.
11.	胥少汀, 葛寶豐, 徐印坎. 實用骨科學. 4 版. 北京: 人民軍醫出版社, 2012: 947-948.
12.	Thomas PR, Richard EB, Christopher GM. AO principles of fracture management. 2nd ed. 上海: 科學技術出版社, 2010: 560.
13.	張懷華, 孫永青. 股骨粗隆間骨折術后患者死亡率分析. 實用骨科雜志, 2012, 18(1): 21-23.
14.	Hong JB, Dan Y, Ouyang L, et al. Biomechanical study on different lengths of PFNA fixation for unstable intertrochanteric femoral fractures. J Musculoskelet Neuronal Interact, 2017, 17(4): 299-302.
15.	黃紹東, 韋瑋, 盧顯威, 等. PFNA 近端鎖定板和人工股骨頭置換術對高齡骨質疏松性股骨粗隆間骨折患者圍術期指標髖功能恢復及下肢靜脈血栓的影響. 河北醫學, 2019, 25(2): 241-245.
16.	李建濤, 張里程, 唐佩福. 股骨粗隆間骨折治療理念與內固定器械的發展概述. 中國修復重建外科雜志, 2019, 33(1): 1-7.
17.	王昌剛. 側臥位 PFNA 內固定術治療老年股骨粗隆間骨折的臨床療效觀察. 臨床醫藥文獻電子雜志, 2019, 6(55): 21-22.
18.	李景光, 章平治, 徐名洪, 等. 側臥位斯氏針撬撥、PFNA內固定治療不易復位的股骨粗隆間骨折. 創傷外科雜志, 2019, 21(6): 431-434.
19.	Zhang K, Zhang S, Yang J, et al. Proximal femoral nail vs. dynamic hip screw in treatment of intertrochanteric fractures: a meta-analysis. Med Sci Monit, 2014, 20: 1628-1633.
20.	Zhang L, Shen J, Yu S, et al. Percutaneous compression plate versus dynamic hip screw for treatment of intertrochanteric Hip fractures: a meta-analyse of five randomized controlled trials. Sci World J, 2014, 2014: 512512.
21.	Sonmez MM, Camur S, Erturer E, et al. Strategies for proximal femoral nailing of unstable intertrochanteric fractures: lateral decubitus position or traction table. J Am Acad Orthop Surg, 2017, 25(3): e37-e44.
22.	Gong J, Liu P, Cai M. Imaging evaluation of the safe region for distal locking screw of proximal femoral nail anti-rotation in patients with proximal femoral fracture. Med Sci Monit, 2017, 23: 719-724.
23.	Arirachakaran A, Amphansap T, Thanindratarn P, et al. Comparative outcome of PFNA, Gamma nails, PCCP, Medoff plate, LISS and dynamic hip screws for fixation in elderly trochanteric fractures: a systematic review and network meta-analysis of randomized controlled trials. Eur J Orthop Surg Traumatol, 2017, 27(7): 937-952.
24.	Chechik O, Amar E, Khashan M, et al. Favorable radiographic outcomes using the expandable proximal femoral nail in the treatment of hip fractures-a randomized controlled trial. J Orthop, 2014, 11(2): 103-109.

1. Chang SM, Song DL, Ma Z, et al. Mismatch of the short straight cephalomedullary nail (PFNA-Ⅱ) with the anterior bow of the femur in an Asian population. J Orthop Trauma, 2014, 28(1): 17-22.
2. Takemoto RC, Lekic N, Schwarzkopf R, et al. The effect of two different trochanteric nail lag-screw designs on fixation stability of four-part intertrochanteric fractures: a clinical and biomechanical study. J Orthop Sci, 2014, 19(1): 112-119.
3. 羅勤瑜, 胡奕山, 郭予立, 等. 側臥位行股骨近端防旋髓內釘治療老年股骨粗隆間骨折的臨床療效分析. 中國矯形外科雜志, 2011, 19(18): 1572-1574.
4. 丁濤, 張保焜, 田少奇, 等. 老年髖部骨折手術方法的選擇原則及應用現狀. 中國修復重建外科雜志, 2018, 32(11): 1435-1440.
5. Cho SH, Lee SH, Cho HL, et al. Additional fixations for sliding hip screws in treating unstable pertrochanteric femoral fractures (AO Type 31-A2): short-term clinical results. Clin Orthop Surg, 2011, 3(2): 107-113.
6. Makki D, Matar HE, Jacob N, et al. Comparison of the reconstruction trochanteric antigrade nail (TAN) with the proximal femoral nail antirotation (PFNA) in the management of reverse oblique intertrochanteric hip fractures. Injury, 2015, 46(12): 2389-2393.
7. Pan S, Liu XH, Feng T, et al. Influence of different great trochanteric entry points on the outcome of intertrochanteric fractures: a retrospective cohort study. BMC Musculoskelet Disord, 2017, 18(1): 107.
8. 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.
9. Kumar N, Kataria H, Yadav C, et al. Evaluation of proximal femoral locking plate in unstable extracapsular proximal femoral fractures: Surgical technique & mid term follow up results. J Clin Orthop Trauma, 2014, 5(3): 137-145.
10. Della Valle CJ, Mesko NW, Quigley L, et al. Primary total hip arthroplasty with a porous-coated acetabular component. A concise follow-up, at a minimum of twenty years, of previous reports. J Bone Joint Surg (Am), 2009, 91(5): 1130-1135.
11. 胥少汀, 葛寶豐, 徐印坎. 實用骨科學. 4 版. 北京: 人民軍醫出版社, 2012: 947-948.
12. Thomas PR, Richard EB, Christopher GM. AO principles of fracture management. 2nd ed. 上海: 科學技術出版社, 2010: 560.
13. 張懷華, 孫永青. 股骨粗隆間骨折術后患者死亡率分析. 實用骨科雜志, 2012, 18(1): 21-23.
14. Hong JB, Dan Y, Ouyang L, et al. Biomechanical study on different lengths of PFNA fixation for unstable intertrochanteric femoral fractures. J Musculoskelet Neuronal Interact, 2017, 17(4): 299-302.
15. 黃紹東, 韋瑋, 盧顯威, 等. PFNA 近端鎖定板和人工股骨頭置換術對高齡骨質疏松性股骨粗隆間骨折患者圍術期指標髖功能恢復及下肢靜脈血栓的影響. 河北醫學, 2019, 25(2): 241-245.
16. 李建濤, 張里程, 唐佩福. 股骨粗隆間骨折治療理念與內固定器械的發展概述. 中國修復重建外科雜志, 2019, 33(1): 1-7.
17. 王昌剛. 側臥位 PFNA 內固定術治療老年股骨粗隆間骨折的臨床療效觀察. 臨床醫藥文獻電子雜志, 2019, 6(55): 21-22.
18. 李景光, 章平治, 徐名洪, 等. 側臥位斯氏針撬撥、PFNA內固定治療不易復位的股骨粗隆間骨折. 創傷外科雜志, 2019, 21(6): 431-434.
19. Zhang K, Zhang S, Yang J, et al. Proximal femoral nail vs. dynamic hip screw in treatment of intertrochanteric fractures: a meta-analysis. Med Sci Monit, 2014, 20: 1628-1633.
20. Zhang L, Shen J, Yu S, et al. Percutaneous compression plate versus dynamic hip screw for treatment of intertrochanteric Hip fractures: a meta-analyse of five randomized controlled trials. Sci World J, 2014, 2014: 512512.
21. Sonmez MM, Camur S, Erturer E, et al. Strategies for proximal femoral nailing of unstable intertrochanteric fractures: lateral decubitus position or traction table. J Am Acad Orthop Surg, 2017, 25(3): e37-e44.
22. Gong J, Liu P, Cai M. Imaging evaluation of the safe region for distal locking screw of proximal femoral nail anti-rotation in patients with proximal femoral fracture. Med Sci Monit, 2017, 23: 719-724.
23. Arirachakaran A, Amphansap T, Thanindratarn P, et al. Comparative outcome of PFNA, Gamma nails, PCCP, Medoff plate, LISS and dynamic hip screws for fixation in elderly trochanteric fractures: a systematic review and network meta-analysis of randomized controlled trials. Eur J Orthop Surg Traumatol, 2017, 27(7): 937-952.
24. Chechik O, Amar E, Khashan M, et al. Favorable radiographic outcomes using the expandable proximal femoral nail in the treatment of hip fractures-a randomized controlled trial. J Orthop, 2014, 11(2): 103-109.

Chinese Journal of Reparative and Reconstructive Surgery

Comparison of proximal femoral nail anti-rotation operation in traction bed supine position and non-traction bed lateral position in treatment of intertrochanteric fracture of femur

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