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Comparison of the Sliding and Femoral Head Rotation among Three Different Femoral Head Fixation Devices for Trochanteric Fractures.

Chinzei N, Hiranaka T, Niikura T, Tsuji M, Kuroda R, Doita M, Kurosaka M - Clin Orthop Surg (2015)

Bottom Line: However, no significant differences between the sliding lengths of the different HFDs were observed among three groups.Furthermore, significant differences were also observed between GLN and PFNA with respect to the occurrence of femoral head rotation.The ability to stabilize femoral head appears to be greater with blade-type materials than with screw-type materials.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.

ABSTRACT

Background: Recently, various femoral head fixation devices (HFDs) for trochanteric fractures have become available. However, there are some cases in which femoral head rotation with excessive sliding of the HFD is observed and it is often followed by cutout. The purpose of this study is to compare the ability of the three types of HFDs to prevent femoral head rotation.

Methods: Between July 2005 and December 2009, 206 patients aged over 60 years with trochanteric fractures who had undergone surgical treatment using a short femoral nail in our institution were enrolled into the study. We used the gamma 3 nail (GMN) as the screw-type HFD in 66 cases, the gliding nail (GLN) as a non-cylindrical blade in 76 cases, and the proximal femoral nail antirotation (PFNA) as a cylindrical blade in 64 cases. The sliding length of HFDs and the occurrence of femoral head rotation were evaluated by assessing radiographs as the main outcome, and the results were compared among these devices.

Results: A comparison of the degree of sliding in the GMN group showed that femoral head rotation was observed significantly more frequently in cases with rotation. Further, it appeared that femoral head rotation occurred more frequently in comminuted fractures. However, no significant differences between the sliding lengths of the different HFDs were observed among three groups. Femoral head rotation was observed in 15 cases of GMN (22.7%), 0 case of GLN, and 5 case of PFNA (7.8%). Significant differences with regard to the occurrence of femoral head rotation were observed among the three groups. Furthermore, significant differences were also observed between GLN and PFNA with respect to the occurrence of femoral head rotation.

Conclusions: The ability to stabilize femoral head appears to be greater with blade-type materials than with screw-type materials. Furthermore, we believe that a non-cylindrical blade is preferable to a cylindrical blade for the surgical treatment of comminuted, unstable trochanteric fractures in order to prevent femoral head rotation and cut-out.

No MeSH data available.


Related in: MedlinePlus

Hypothesis of the mechanism of cut-out. We hypothesized that a lack of bony support would lead to femoral head rotation and cut-out.
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Figure 1: Hypothesis of the mechanism of cut-out. We hypothesized that a lack of bony support would lead to femoral head rotation and cut-out.

Mentions: However, cut-out is still a serious and unresolved complication. Previous reports have concluded that factors such as a screw positioning are the cause of this complication.8) However, in our observations, this can occur even when the screw is inserted at the optimal site. Fig. 1 shows our hypothesis that a "lack of bony support" is the most important factor involved in such complications, and we consider that the degree of sliding would be the indicator to evaluate the factor. However, orthopaedic surgeons cannot control lack of bony support because it is fixed at the point of injury and we have to accept the occurrence of excessive sliding to some extent. Therefore, we focused on the management of femoral head rotation to prevent cut-out in many cases. For this purpose, a blade has been developed to prevent femoral head fixation. There are two types of blade: a cylindrical spiral blade and a non-cylindrical H-shaped blade. The purpose of this study is to compare the capability of these three types of femoral head fixation devices with regard to the prevention of femoral head rotation. In this report, we use the term "femoral head fixation device" (HFD) as a general term to include both hip screws and various types of blades.


Comparison of the Sliding and Femoral Head Rotation among Three Different Femoral Head Fixation Devices for Trochanteric Fractures.

Chinzei N, Hiranaka T, Niikura T, Tsuji M, Kuroda R, Doita M, Kurosaka M - Clin Orthop Surg (2015)

Hypothesis of the mechanism of cut-out. We hypothesized that a lack of bony support would lead to femoral head rotation and cut-out.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4553275&req=5

Figure 1: Hypothesis of the mechanism of cut-out. We hypothesized that a lack of bony support would lead to femoral head rotation and cut-out.
Mentions: However, cut-out is still a serious and unresolved complication. Previous reports have concluded that factors such as a screw positioning are the cause of this complication.8) However, in our observations, this can occur even when the screw is inserted at the optimal site. Fig. 1 shows our hypothesis that a "lack of bony support" is the most important factor involved in such complications, and we consider that the degree of sliding would be the indicator to evaluate the factor. However, orthopaedic surgeons cannot control lack of bony support because it is fixed at the point of injury and we have to accept the occurrence of excessive sliding to some extent. Therefore, we focused on the management of femoral head rotation to prevent cut-out in many cases. For this purpose, a blade has been developed to prevent femoral head fixation. There are two types of blade: a cylindrical spiral blade and a non-cylindrical H-shaped blade. The purpose of this study is to compare the capability of these three types of femoral head fixation devices with regard to the prevention of femoral head rotation. In this report, we use the term "femoral head fixation device" (HFD) as a general term to include both hip screws and various types of blades.

Bottom Line: However, no significant differences between the sliding lengths of the different HFDs were observed among three groups.Furthermore, significant differences were also observed between GLN and PFNA with respect to the occurrence of femoral head rotation.The ability to stabilize femoral head appears to be greater with blade-type materials than with screw-type materials.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.

ABSTRACT

Background: Recently, various femoral head fixation devices (HFDs) for trochanteric fractures have become available. However, there are some cases in which femoral head rotation with excessive sliding of the HFD is observed and it is often followed by cutout. The purpose of this study is to compare the ability of the three types of HFDs to prevent femoral head rotation.

Methods: Between July 2005 and December 2009, 206 patients aged over 60 years with trochanteric fractures who had undergone surgical treatment using a short femoral nail in our institution were enrolled into the study. We used the gamma 3 nail (GMN) as the screw-type HFD in 66 cases, the gliding nail (GLN) as a non-cylindrical blade in 76 cases, and the proximal femoral nail antirotation (PFNA) as a cylindrical blade in 64 cases. The sliding length of HFDs and the occurrence of femoral head rotation were evaluated by assessing radiographs as the main outcome, and the results were compared among these devices.

Results: A comparison of the degree of sliding in the GMN group showed that femoral head rotation was observed significantly more frequently in cases with rotation. Further, it appeared that femoral head rotation occurred more frequently in comminuted fractures. However, no significant differences between the sliding lengths of the different HFDs were observed among three groups. Femoral head rotation was observed in 15 cases of GMN (22.7%), 0 case of GLN, and 5 case of PFNA (7.8%). Significant differences with regard to the occurrence of femoral head rotation were observed among the three groups. Furthermore, significant differences were also observed between GLN and PFNA with respect to the occurrence of femoral head rotation.

Conclusions: The ability to stabilize femoral head appears to be greater with blade-type materials than with screw-type materials. Furthermore, we believe that a non-cylindrical blade is preferable to a cylindrical blade for the surgical treatment of comminuted, unstable trochanteric fractures in order to prevent femoral head rotation and cut-out.

No MeSH data available.


Related in: MedlinePlus