Abstract
Purpose
There is no consensus about the best option of internal fixation for unstable intertrochanteric fractures. The aim of the present study was to compare proximal femoral nail (PFN) with contralateral reverse distal femoral locking compression plate (reverse-DFLCP) in the management of unstable intertrochanteric fractures with compromised lateral wall.
Method
In a randomized controlled study, from November 2011 to October 2012, 40 patients with unstable intertrochanteric fractures with compromised lateral wall (AO 31A 2.2 to 3.3) had osteosynthesis by PFN (n = 20) or reverse-DFLCP (n = 20). Intra-operative variables compared were duration of surgery, blood loss during surgery, fluoroscopy time and surgeons perception of the surgery. Patients were followed up clinically for a minimum of one year. Functional outcome was assessed by Parker Palmer mobility score (PPMS), Harris hip score (HHS), and Short Form-12. Failure was defined as any condition which would necessitate revision surgery with change of implant.
Results
Duration of surgery (p = 0.022), blood loss during surgery (p = 0.008) and fluoroscopy time (p = 0.0001) were significantly less in the PFN group than in the reverse-DFLCP group. No significant difference was found in type of reduction, difficulty in reduction and surgeon’s perception of surgery. The PFN group had better functional outcome than the reverse-DFLCP group. HHS for the PFN group was 81.53 ± 13.21 and for the reverse-DFLCP group it was 68.43 ± 14.36 (p = 0.018). SF-12 physical (p = 0.002) and mental component (p = 0.007) scores in the PFN group was significantly better than in the reverse-DFLCP group. There was one failure in the PFN group as compared to six in the reverse-DFLCP group (p = 0.036).
Conclusion
Due to favourable intra-operative variables, better functional outcome and lower failure rates, we conclude that PFN is a better implant than reverse-DFLCP for intertrochanteric fractures with compromised lateral wall.
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References
Koval KJ, Cantu RV (2006) Intertrochantreric fractures. In: Bucholz RW, Heckman JD, Court-Brown C (eds) Rockwood & Green’s Fractures in Adults, 6th edn. Lippincot Williams and Wilkins, Philadelphia, pp 1793–1825
Steinberg GG, Desai SS, Kornwitz NA, Sulvan TJ (1988) The intertrochanteric hip fracture. A retrospective analysis. Orthopedics 11:265–273
Watson JT, Moed BR, Cramer KE (1998) Comparison of the compression hip screw with the Medoff sliding plate for intertrochanteric fractures. Clin Orthop Relat Res 348:79–86
Rha JD, Kim YH, Yoon SI (1993) Factors affecting sliding of the lag screw in intertrochanteric fractures. Int Orthop 175:320–324
Kim WY, Han CH, Park JI (2001) Failure of intertrochanteric fracture fixation with a dynamic hip screw in relation to pre-operative fracture stability and osteoporosis. Int Orthop 25:360–362
Pajarinen J, Lindahl J, Michelsson O, Savolainen V, Hirvensalo E (2005) Pertrochanteric femoral fractures treated with a dynamic hip screw or a proximal femoral nail: A randomized study comparing post-operative rehabilitation. J Bone Joint Surg (Br) 87-B:76–81
Klinger HM, Baums MH, Eckert M, Neugebauer R (2005) A comparative study of unstable per- and intertrochanteric femoral fractures treated with dynamic hip screw (DHS) and trochanteric buttress plate vs. proximal femoral nail (PFN). Zentralbl Chir 130(4):301–306
Domingo LJ, Cecilia D, Herrera A, Resines C (2001) Trochanteric fractures treated with a proximal femoral nail. Int Orthop 25:298–301
Banan H, Al-Sabti A, Jimulia T, Hart AJ (2002) The treatment of unstable, extracapsular hip fractures with the AO/ASIF proximal femoral nail—our first 60 cases. Injury 33:401–405
Al-yassari G, Langstaff RJ, Jones JWM, Al-Lami M (2002) The AO/ASIF proximal femoral nail (PFN) for the treatment of unstable trochanteric femoral fracture. Injury 33:395–399
Leung KS, Procter P, Robioneck B, Behrens K (1996) Geometric mismatch of the Gamma nail to the Chinese femur. Clin Orthop Relat Res 323:42–48
Hwang JH, Oh JK, Han SH, Shon WY, Oh CW (2008) Mismatch between PFNa and medullary canal causing difficulty in nailing of the pertrochanteric fractures. Arch Orthop Trauma Surg 128:1443–1446
Streubel PN, Moustoukas MJ, Obremskey WT (2013) Mechanical failure after locking plate fixation of unstable intertrochanteric femur fractures. J Orthop Trauma 27:22–28
Glassner PJ, Tejwani NC (2011) Failure of proximal femoral locking compression plate: a case series. J Orthop Trauma 25:76–83
Yao C, Zhang CQ, Jin DX, Chen YF (2011) Early results of reverse less invasive stabilization system plating in treating elderly intertrochanteric fractures: a prospective study compared to proximal femoral nail. Chin Med J (Engl) 124:2150–2157
Zhou F, Zhang ZS, Yang H, Tian Y, Ji HQ, Guo Y, Lv Y (2012) Less invasive stabilization system (LISS) versus proximal femoral nail anti-rotation (PFNA) in treating proximal femoral fractures: a prospective randomized study. J Orthop Trauma 26:155–162
Tao R, Lu Y, Xu H, Zhou ZY, Wang YH, Liu F (2013). Internal fixation of intertrochanteric hip fractures: a clinical comparison of two implant designs. Scientific World J: 834825
Muller ME, Allgower M, Schneider R (1990) The comprehensive classification of fractures of long bones, 3rd edn. Springer-Verlag, New York, p 118
Canale ST, Beaty JH (2013) Campbell’s Operative Orthopaedics. Elsevier, Philadelphia
Gotfried Y (2004) The lateral trochanteric wall: a key element in the reconstruction of unstable pertrochanteric hip fractures. Clin Orthop Relat Res 425:82–86
Palm H, Jacobsen S, Sonne-Holm S, Gebuhr P (2007) Integrity of the lateral femoral wall in intertrochanteric hip fractures: An important predictor of a reoperation. J Bone Joint Surg Am 89:470–475
Im G, Shin YW, Song YJ (2005) Potentially unstable intertrochanteric fractures. J Orthop Trauma 19:5–9
Haidukewych GJ (2009) Intertrochanteric fractures: ten tips to improve results. J Bone Joint Surg Am 91:712–719
Parker MJ, Pryor GA (1996) Gamma nail versus DHS nailing for extracapsular femoral fractures: meta-analysis of ten randomized trials. Int Orthop 20:163–168
Osnes EK, Lofthus CM, Falch JA, Meyer HE, Stensvold I, Kristiansen IS et al (2001) More postoperative femoral fractures with the Gamma nail than the sliding screw plate in the treatment of trochanteric fractures. Acta Orthop Scand 72:252–256
Han N, Sun GX, Li ZC, Li GF, Lu QY, Han QH, Wei X (2011) Comparison of proximal femoral nail antirotation blade and reverse less invasive stabilization system-distal femur systems in the treatment of proximal femoral fractures. Orthop Surg 3:7–13
Reska M, Veverkova L, Divis P, Konecny J (2006) Proximal femoral nail: a new stage in the therapy of extracapsular femoral fracture. Scr Med (Brno) 79(2):115–122
Woo-Kie M, Shin-Yoon K, Tae-Kong K, Kyu-Bong L, Myung-Rae C, Yong-Chan H et al (2007) Proximal femoral nail for the treatment of reverse obliquity intertrochanteric fractures compared with gamma nail. J Trauma 63:1054–1060
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Haq, R.U., Manhas, V., Pankaj, A. et al. Proximal femoral nails compared with reverse distal femoral locking plates in intertrochanteric fractures with a compromised lateral wall; a randomised controlled trial. International Orthopaedics (SICOT) 38, 1443–1449 (2014). https://doi.org/10.1007/s00264-014-2306-1
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DOI: https://doi.org/10.1007/s00264-014-2306-1