Research Article
BibTex RIS Cite

İntertrokanterik femur kırıklarının proksimal femoral çivi antirotasyon (PFNA) ile lateral dekübit pozisyonda tespiti

Year 2014, , 513 - 520, 12.11.2014
https://doi.org/10.3944/AOTT.2014.14.0098

Abstract

Amaç: Bu çalışmanın amacı, intertrokanterik femur kırıklarının Proksimal Femoral Çivi Antirotasyon (PFNA) kullanılarak, traksiyon masasız, lateral dekübit pozisyonda uygun bir şekilde redükte edilip tespit edilip edilemediğinin değerlendirilmesi idi.

Çalışma planı: Çalışmaya 81’i erkek, 126’sı kadın olmak üzere 207 hasta (ortalama yaş: 75, dağılım: 22-95) dahil edildi. Evans sınıflamasına göre; 7 Tip 1, 40 Tip 2, 33 Tip 3, 38 Tip 4, 61 Tip 5 ve 28 ters oblik kırık mevcuttu. Ameliyat sonrası röntgenlerde; implant ucu-apeks mesafesi, helikal bıçağın Cleveland ve Bosworth kadranı, Ikuta redüksiyon alt grubu, kollodiyafizer açı ve redüksiyon aralıkları ölçüldü.

Bulgular: Ortalama takip süresi 20.4 (dağılım: 6-38) ay olan hastalarda Ikuta sınıflamasına göre 176 kırık (%85) normal alt tip, 15 kırık (%7.2) posterior alt tip ve 16 kırık (%7.7) anterior alt tip olarak redükte edilmişti. Herman kriterlerine göre hastaların %99’unda iyi veya kabul edilebilir redüksiyon sağlandığı görüldü. Ortalama implant ucu-apeks mesafesi 29.2 mm, ortalama ameliyat süresi 57.2 dakika olarak ölçüldü. Uygun kadran (merkez-merkez, alt-merkez) yerleşimi hastaların %53.5’inde sağlanmışken, üst-arka kadran yerleşimi hastaların sadece %2.4’ünde görüldü. Dokuz hastada (%4.3) sıyrılma komplikasyonu gerçekleşti.

Çıkarımlar: İntertrokanterik kırıkların lateral dekübit pozisyonda çivilenmesi uygun kadran yerleşiminin sağlanması ve implant ucu-apeks mesafesinde ideal değerlerin elde edilmesinde başarılı olmasa da, muhtemelen PFNA tarafından sağlanan mükemmel stabilite sayesinde sonuçlar cesaret vericidir.

References

  • Aguado-Maestro I, Escudero-Marcos R, García-García JM, Alonso-García N, Pérez-Bermejo D D, AguadoHernández HJ, et al. Results and complications of pertrochanteric hip fractures using an intramedullary nail with a helical blade (proximal femoral nail antirotation) in 200 patients. [Article in Spanish] Rev Esp Cir Ortop Traumatol 2013;57:201-7. [Abstract]
  • Frei HC, Hotz T, Cadosch D, Rudin M, Käch K. Central head perforation, or “cut through,” caused by the helical blade of the proximal femoral nail antirotation. J Orthop Trauma 2012;26:102-7.
  • Vaquero J, Munoz J, Prat S, Ramirez C, Aguado HJ, Moreno E, et al. Proximal Femoral Nail Antirotation versus Gamma3 nail for intramedullary nailing of unstable trochanteric fractures. A randomised comparative study. Injury 2012;43 Suppl 2:47-54.
  • Brandt E, Verdonschot N. Biomechanical analysis of the sliding hip screw, cannulated screws and Targon1 FN in intracapsular hip fractures in cadaver femora. Injury 2011;42:183-7.
  • Oh JH, Hwang JH, Sahu D. Nailing of intertrochanteric fractures: review on pitfalls and technical tips. JOTR 2010;14:3-7.
  • Takigawa N, Moriuchi H, Abe M, Yasui K, Eshiro H, Kinoshita M. Complications and fixation techniques of trochanteric fractures with the TARGON(®) PF. Injury 2014;45 Suppl 1:44-8.
  • Herman A, Landau Y, Gutman G, Ougortsin V, Chechick A, Shazar N. Radiological evaluation of intertrochanteric fracture fixation by the proximal femoral nail. Injury 2012;43:856-63.
  • Callanan I, Choudhry V, Smith H. Perineal sloughing as a result of pressure necrosis from the traction post during prolonged bilateral femoral nailing. Injury 1994;25:472.
  • Brumback RJ, Ellison TS, Molligan H, Molligan DJ, Mahaffey S, Schmidhauser C. Pudendal nerve palsy complicating intramedullary nailing of the femur. J Bone Joint Surg Am 1992;74:1450-5.
  • Evans EM. The treatment of trochanteric fractures of the femur. J Bone Joint Surg Br 1949;31B:190-203.
  • Baumgaertner MR, Curtin SL, Lindskog DM, Keggi JM. The value of the tip-apex distance in predicting failure of fixation of peritrochanteric fractures of the hip. J Bone Joint Surg Am 1995;77:1058-64. Journal 2013;2013:276015.
  • Soucanye de Landevoisin E, Bertani A, Candoni P, Charpail C, Demortiere E. Proximal femoral nail antirotation (PFN-ATM) fixation of extra-capsular proximal femoral fractures in the elderly: retrospective study in 102

Fixation of intertrochanteric femur fractures using Proximal Femoral Nail Antirotation (PFNA) in the lateral decubitus position without a traction table

Year 2014, , 513 - 520, 12.11.2014
https://doi.org/10.3944/AOTT.2014.14.0098

Abstract

Objective: The aim of this study was to evaluate whether intertrochanteric femur fractures can be reduced and nailed properly in the lateral decubitus position using Proximal Femoral Nail Antirotation (PFNA) as a fixation device without the use of a traction table.

Methods: The study included 207 patients (81 male and 126 female; mean age: 75 years, range: 22 to 95 years). According to the Evans classification, there were 7 Type 1, 40 Type 2, 33 Type 3, 38 Type 4, 61 Type 5 and 28 reverse oblique fractures. Radiographs were used to measure the  tip-apex distance (TAD), the quadrant of the helical blade according to Cleveland and Bosworth, Ikuta’s reduction subgroup, collodiaphyseal angle and reduction gaps postoperatively.

Results: Mean follow-up time was 20.4 (range: 6 to 38) months. According to Ikuta’s classification, 176 (85%) reduced fractures were of subtype N, 15 (7.2%) subtype P and 16 (7.7%) subtype A. Good or acceptable reduction according to the Herman criteria was obtained in 99% of fractures. Mean TAD was 29.2 millimeters. Mean operation time was 57.2 minutes. Optimal blade position (center-center or inferior-center) was achieved in 53.5% of patients and was in the superior-posterior quadrants in only 2.4% of patients. Cut-out complication occurred in 9 patients (4.3%).

Conclusion: While the nailing of intertrochanteric fractures in a lateral decubitus position does not provide ideal quadrant placement and TAD, results are encouraging probably due to the excellent stability that is provided by PFNA.

References

  • Aguado-Maestro I, Escudero-Marcos R, García-García JM, Alonso-García N, Pérez-Bermejo D D, AguadoHernández HJ, et al. Results and complications of pertrochanteric hip fractures using an intramedullary nail with a helical blade (proximal femoral nail antirotation) in 200 patients. [Article in Spanish] Rev Esp Cir Ortop Traumatol 2013;57:201-7. [Abstract]
  • Frei HC, Hotz T, Cadosch D, Rudin M, Käch K. Central head perforation, or “cut through,” caused by the helical blade of the proximal femoral nail antirotation. J Orthop Trauma 2012;26:102-7.
  • Vaquero J, Munoz J, Prat S, Ramirez C, Aguado HJ, Moreno E, et al. Proximal Femoral Nail Antirotation versus Gamma3 nail for intramedullary nailing of unstable trochanteric fractures. A randomised comparative study. Injury 2012;43 Suppl 2:47-54.
  • Brandt E, Verdonschot N. Biomechanical analysis of the sliding hip screw, cannulated screws and Targon1 FN in intracapsular hip fractures in cadaver femora. Injury 2011;42:183-7.
  • Oh JH, Hwang JH, Sahu D. Nailing of intertrochanteric fractures: review on pitfalls and technical tips. JOTR 2010;14:3-7.
  • Takigawa N, Moriuchi H, Abe M, Yasui K, Eshiro H, Kinoshita M. Complications and fixation techniques of trochanteric fractures with the TARGON(®) PF. Injury 2014;45 Suppl 1:44-8.
  • Herman A, Landau Y, Gutman G, Ougortsin V, Chechick A, Shazar N. Radiological evaluation of intertrochanteric fracture fixation by the proximal femoral nail. Injury 2012;43:856-63.
  • Callanan I, Choudhry V, Smith H. Perineal sloughing as a result of pressure necrosis from the traction post during prolonged bilateral femoral nailing. Injury 1994;25:472.
  • Brumback RJ, Ellison TS, Molligan H, Molligan DJ, Mahaffey S, Schmidhauser C. Pudendal nerve palsy complicating intramedullary nailing of the femur. J Bone Joint Surg Am 1992;74:1450-5.
  • Evans EM. The treatment of trochanteric fractures of the femur. J Bone Joint Surg Br 1949;31B:190-203.
  • Baumgaertner MR, Curtin SL, Lindskog DM, Keggi JM. The value of the tip-apex distance in predicting failure of fixation of peritrochanteric fractures of the hip. J Bone Joint Surg Am 1995;77:1058-64. Journal 2013;2013:276015.
  • Soucanye de Landevoisin E, Bertani A, Candoni P, Charpail C, Demortiere E. Proximal femoral nail antirotation (PFN-ATM) fixation of extra-capsular proximal femoral fractures in the elderly: retrospective study in 102
There are 12 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Original Article
Authors

Ali Turgut This is me

Onder Kalenderer This is me

Burak Gunaydin This is me

Burak Onvural This is me

Levent Karapinar This is me

Haluk Agus This is me

Publication Date November 12, 2014
Published in Issue Year 2014

Cite

APA Turgut, A., Kalenderer, O., Gunaydin, B., Onvural, B., et al. (2014). Fixation of intertrochanteric femur fractures using Proximal Femoral Nail Antirotation (PFNA) in the lateral decubitus position without a traction table. Acta Orthopaedica Et Traumatologica Turcica, 48(5), 513-520. https://doi.org/10.3944/AOTT.2014.14.0098
AMA Turgut A, Kalenderer O, Gunaydin B, Onvural B, Karapinar L, Agus H. Fixation of intertrochanteric femur fractures using Proximal Femoral Nail Antirotation (PFNA) in the lateral decubitus position without a traction table. Acta Orthopaedica et Traumatologica Turcica. November 2014;48(5):513-520. doi:10.3944/AOTT.2014.14.0098
Chicago Turgut, Ali, Onder Kalenderer, Burak Gunaydin, Burak Onvural, Levent Karapinar, and Haluk Agus. “Fixation of Intertrochanteric Femur Fractures Using Proximal Femoral Nail Antirotation (PFNA) in the Lateral Decubitus Position Without a Traction Table”. Acta Orthopaedica Et Traumatologica Turcica 48, no. 5 (November 2014): 513-20. https://doi.org/10.3944/AOTT.2014.14.0098.
EndNote Turgut A, Kalenderer O, Gunaydin B, Onvural B, Karapinar L, Agus H (November 1, 2014) Fixation of intertrochanteric femur fractures using Proximal Femoral Nail Antirotation (PFNA) in the lateral decubitus position without a traction table. Acta Orthopaedica et Traumatologica Turcica 48 5 513–520.
IEEE A. Turgut, O. Kalenderer, B. Gunaydin, B. Onvural, L. Karapinar, and H. Agus, “Fixation of intertrochanteric femur fractures using Proximal Femoral Nail Antirotation (PFNA) in the lateral decubitus position without a traction table”, Acta Orthopaedica et Traumatologica Turcica, vol. 48, no. 5, pp. 513–520, 2014, doi: 10.3944/AOTT.2014.14.0098.
ISNAD Turgut, Ali et al. “Fixation of Intertrochanteric Femur Fractures Using Proximal Femoral Nail Antirotation (PFNA) in the Lateral Decubitus Position Without a Traction Table”. Acta Orthopaedica et Traumatologica Turcica 48/5 (November 2014), 513-520. https://doi.org/10.3944/AOTT.2014.14.0098.
JAMA Turgut A, Kalenderer O, Gunaydin B, Onvural B, Karapinar L, Agus H. Fixation of intertrochanteric femur fractures using Proximal Femoral Nail Antirotation (PFNA) in the lateral decubitus position without a traction table. Acta Orthopaedica et Traumatologica Turcica. 2014;48:513–520.
MLA Turgut, Ali et al. “Fixation of Intertrochanteric Femur Fractures Using Proximal Femoral Nail Antirotation (PFNA) in the Lateral Decubitus Position Without a Traction Table”. Acta Orthopaedica Et Traumatologica Turcica, vol. 48, no. 5, 2014, pp. 513-20, doi:10.3944/AOTT.2014.14.0098.
Vancouver Turgut A, Kalenderer O, Gunaydin B, Onvural B, Karapinar L, Agus H. Fixation of intertrochanteric femur fractures using Proximal Femoral Nail Antirotation (PFNA) in the lateral decubitus position without a traction table. Acta Orthopaedica et Traumatologica Turcica. 2014;48(5):513-20.