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, Erdo?an 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.	萬乾, 張擎柱, 張義, 等. 股骨近端防旋髓內釘與鎖定加壓鋼板治療老年腦梗死偏癱側股骨轉子間骨折的療效比較. 中國修復重建外科雜志, 2018, 32(11): 1411-1416.
3.	李明東, 胡稷杰, 黎早敏, 等. 不同手術方式治療老年股骨粗隆間骨折的療效比較. 中國修復重建外科雜志, 2017, 31(6): 653-658.
4.	侯宇, 姚琦, 張亙璦, 等. 第 3 代 Gamma 釘拉力螺釘釘尾距股骨外側皮質距離與術后拉力螺釘移位或切出關系研究. 中國修復重建外科雜志, 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.	田大為, 萬華, 熊敏, 等. PFNA 治療股骨粗隆間骨折內固定手術失敗的原因分析. 中國矯形外科雜志, 2018, 26(20): 1830-1834.
8.	王茂林, 易志堅, 盧明剛, 等. 防旋股骨近端髓內釘治療股骨粗隆間骨折術后失效原因分析. 中國骨與關節雜志, 2019, 8(7): 504-507.
9.	Turgut A, Kalenderer ?, Karap?nar 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.	張立智, 胡孫君, 杜守超, 等. 股骨頭內螺旋刀片與拉力螺釘的特點對比和生物力學的研究進展. 中國臨床解剖學雜志, 2015, 33(5): 608-611.
12.	陳鵬, 傅德皓. 股骨近端防旋髓內釘治療老年股骨轉子間骨折內固定失敗原因分析. 中國修復重建外科雜志, 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.	李海豐, 王華, 張英琪, 等. 頭髓釘治療高齡股骨轉子間骨折的尖頂距與螺旋刀片移位的關系. 中國修復重建外科雜志, 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, Erdo?an 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. 萬乾, 張擎柱, 張義, 等. 股骨近端防旋髓內釘與鎖定加壓鋼板治療老年腦梗死偏癱側股骨轉子間骨折的療效比較. 中國修復重建外科雜志, 2018, 32(11): 1411-1416.
3. 李明東, 胡稷杰, 黎早敏, 等. 不同手術方式治療老年股骨粗隆間骨折的療效比較. 中國修復重建外科雜志, 2017, 31(6): 653-658.
4. 侯宇, 姚琦, 張亙璦, 等. 第 3 代 Gamma 釘拉力螺釘釘尾距股骨外側皮質距離與術后拉力螺釘移位或切出關系研究. 中國修復重建外科雜志, 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. 田大為, 萬華, 熊敏, 等. PFNA 治療股骨粗隆間骨折內固定手術失敗的原因分析. 中國矯形外科雜志, 2018, 26(20): 1830-1834.
8. 王茂林, 易志堅, 盧明剛, 等. 防旋股骨近端髓內釘治療股骨粗隆間骨折術后失效原因分析. 中國骨與關節雜志, 2019, 8(7): 504-507.
9. Turgut A, Kalenderer ?, Karap?nar 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. 張立智, 胡孫君, 杜守超, 等. 股骨頭內螺旋刀片與拉力螺釘的特點對比和生物力學的研究進展. 中國臨床解剖學雜志, 2015, 33(5): 608-611.
12. 陳鵬, 傅德皓. 股骨近端防旋髓內釘治療老年股骨轉子間骨折內固定失敗原因分析. 中國修復重建外科雜志, 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. 李海豐, 王華, 張英琪, 等. 頭髓釘治療高齡股骨轉子間骨折的尖頂距與螺旋刀片移位的關系. 中國修復重建外科雜志, 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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