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Is Helical Blade Nailing Superior to Locked Minimally Invasive Plating in Unstable Pertrochanteric Fractures?

  • Clinical Research
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Clinical Orthopaedics and Related Research®

Abstract

Background

Technical advancements have produced many challenges to intramedullary implants for unstable pertrochanteric fractures. Helical blade fixation of the femoral head has the theoretical advantages of higher rotational stability and cutout resistance and should have a lower rate of reoperation than a locked plating technique.

Questions/purposes

We asked whether (1) helical blade nailing reduces the rate of reoperation within 24 months compared with locked plating and (2) any of various preoperative, intraoperative, or postoperative factors predicted failure in these two groups.

Methods

We prospectively enrolled 108 patients with unstable pertrochanteric fractures in a surgeon-allocated study between November 2005 and November 2008: 54 with percutaneous compression plates (PCCP) and 54 with proximal femoral nail antirotation (PFNA). We evaluated patients regarding reoperation, mortality, and function. Seventy-four patients had a minimum followup of 24 months (mean, 26 months; range, 24–30 months).

Results

We found no differences in the number of reoperations attributable to mechanical problems in the two groups: PCCP = six and PFNA = five. Despite a greater incidence of postoperative lateral wall fractures with helical blade nailing, only postoperative varisation of the neck-shaft angle and tip-apex distance (33 mm versus 28 mm) predicted reoperation. Mortality and function were similar in the two groups.

Conclusions

Our data suggest unstable pertrochanteric fractures may be fixed either with locked extramedullary small-diameter screw systems to avoid lateral wall fractures or with the new intramedullary systems to avoid potential mechanical complications of a broken lateral wall. Tip-apex distance and preservation of the preoperative femoral neck-shaft angle are the key technical factors for prevention of reoperation.

Level of Evidence

Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Matthias Nossek MD, Bernhard Schmidt-Rohlfing MD, Michael Lörken MD, Hans-Josef Erli MD, Alexander Schug MD, and Fridtjof Trommer MD for participation in the surgeries using the implants.

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Authors and Affiliations

  1. Department of Orthopedic and Trauma Surgery, Medical Faculty, RWTH Aachen University, 30 Pauwelsstreet, 52074, Aachen, Germany

    Matthias Knobe MD, Wolf Drescher MD, PhD, Richard Martin Sellei MD & Hans-Christoph Pape MD

  2. Department of Medical Statistics, Medical Faculty, RWTH Aachen University, Aachen, Germany

    Nicole Heussen MD

Authors
  1. Matthias Knobe MD
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  2. Wolf Drescher MD, PhD
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  3. Nicole Heussen MD
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  4. Richard Martin Sellei MD
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  5. Hans-Christoph Pape MD
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Corresponding author

Correspondence to Matthias Knobe MD.

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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA-approval status, of any drug or device prior to clinical use.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Knobe, M., Drescher, W., Heussen, N. et al. Is Helical Blade Nailing Superior to Locked Minimally Invasive Plating in Unstable Pertrochanteric Fractures?. Clin Orthop Relat Res 470, 2302–2312 (2012). https://doi.org/10.1007/s11999-012-2268-9

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  • DOI: https://doi.org/10.1007/s11999-012-2268-9

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