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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

Recognition of femoral head rotation. Femoral head rotation was detected by an apparent change in H': H or N':N.
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Figure 4: Recognition of femoral head rotation. Femoral head rotation was detected by an apparent change in H': H or N':N.

Mentions: We measured the degree of sliding of HFD (Fig. 3). If we define the HFD axis as AB, and the intersection of AB and the nail axis as C, then the central length was calculated as AC / AB × actual HFD length; the degree of sliding was calculated by subtracting the central length at two weeks postoperatively from the length just after the surgery.1415) We also assessed femoral head rotation radiologically at two weeks or more postoperatively. Femoral head rotation was confirmed by an apparent change in H': H or N': N (Fig. 4). Postoperative follow-ups were planned at two weeks post-surgery, one month after discharge from hospital, followed by monthly until six months post-surgery, and thereafter according to the estimated occurrence of bone union.


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)

Recognition of femoral head rotation. Femoral head rotation was detected by an apparent change in H': H or N':N.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: Recognition of femoral head rotation. Femoral head rotation was detected by an apparent change in H': H or N':N.
Mentions: We measured the degree of sliding of HFD (Fig. 3). If we define the HFD axis as AB, and the intersection of AB and the nail axis as C, then the central length was calculated as AC / AB × actual HFD length; the degree of sliding was calculated by subtracting the central length at two weeks postoperatively from the length just after the surgery.1415) We also assessed femoral head rotation radiologically at two weeks or more postoperatively. Femoral head rotation was confirmed by an apparent change in H': H or N': N (Fig. 4). Postoperative follow-ups were planned at two weeks post-surgery, one month after discharge from hospital, followed by monthly until six months post-surgery, and thereafter according to the estimated occurrence of bone union.

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