Is PFN with talon locking system as successful as PFNA in geriatric hip fracture?

Year 2019, Volume: 3 Issue: 3, 261 - 266, 26.10.2019

Gökhun Arıcan , Özay Subaşı Ahmet Özmeriç Serkan İltar , Kadir Bahadır Alemdaroğlu , Veysel Ercan Dinçel

https://doi.org/10.30565/medalanya.567751

Cited By: 3

Abstract

Aim: We compared the functional and radiological results and radiation exposure of patients treated with PFN-A and the Talon-locked PFN.

Methods: The study included 92 patients (43 women, 49 men; mean age 75.01 years) who underwent PFN with the diagnosis of proximal femur fracture between 2014-2018. In our retrospective study, patients were divided into two groups: the Talon locked PFN group 1 (n= 46) and the PFN-A group 2 (n = 46). Demographic data, radiographic findings, WOMAC scores and C-arm scopy shots were evaluated.

Results : The mean follow-up period was 11.05 months. Mortality was %4.3 in Group I and %6.5 in Group II. The collodiaphyseal angle was 129.5 ± 3.4 in Group I and 126.8 ± 3.6 in Group II (p = 0.01); Singh index was found to be 4.1 in Group I and 3.62 in Group II (p = 0.06); union was 4.62 ± 1.06 in Group I and 5.1 ± 1.51 in Group II (p = 0.68). The duration of fluoroscopy was 53.08 (45-89) in Group I and 97.4 (76- 150) in Group II (p <0.05). The duration of fracture union was 4.62 ± 1.06 in Group I, 5.1 ± 1.51 (p = 0.68) in Group II, 69.9 ± 4.26 in Group I and 70.2 ± 5.75 in Group II (p = 0.78).

Conclusion: As a result, PFN with Talon lock is an easy and reliable alternative to PFN systems because of less radiation exposure and shorter surgical time. 

Keywords

PFN, PFN-A, talon, intertrochanteric fracture

Talon Proksimal Femoral Çivileme(Pfn) Proksimal Femoral Çivi-Antirotasyon (Pfna) Kadar Başarılı Mı?

Abstract

Amaç: PFN-A kullanılarak tedavi edilen hastaların fonksiyonel ve radyolojik sonuçlarını ve radyasyon maruziyetini Talon kilitli PFN ile karşılaştırdık.

Yöntem: Çalışmaya 2014-2018 tarihleri arasında proksimal femur kırığı tanısı ile PFN yapılan 60 yaşından büyük 92 hasta (43 kadın,49 erkek; ort. yaş 75.01 yıl) dahil edildi. Retrospektif çalışmamızda hastalar Talon kilitli PFN grubu (grup 1, n=46) ve PFN-A grubu (grup 2, n=46) olmak üzere iki gruba ayrıldı. Hastaların demografik verileri, kırık tipleri, takip süreleri, kırık kaynama zamanları, radyografik bulguları, WOMAC skorları ile C-kollu skopi çekim sayıları değerlendirmeye alındı.

Bulgular: Hastaların ortalama takip süreleri 11.05 aydı. Mortalite Grup I de %4.3, Grup II de %6.5 olarak bulundu. Kollodiafizer açı Grup I de 129.5±3.4, Grup II de 126.8±3.6 (p=0.01); Singh indeksi Grup I de 4.1, Grup II de 3.62 (p=0.06); kayna-ma Grup I de 4.62±1.06, Grup II de 5.1±1.51(p=0.68) olarak gözlendi. Skopi çekim süresi Grup I de 53.08 (45-89), Grup II de 97.4 (76-150) (p<0.05) olarak gözlendi. Kırık kaynama süreleri Grup I de 4.62±1.06, Grup II de 5.1±1.51 (p=0.68), WOM-AC skorları Grup I de 69.9±4.26, Grup II de 70.2±5.75 (p=0.78) olarak tespit edildi. Grup I de 2 hastada (%4.3) komplikasyon gözlenirken, Grup II de 5 hastada (%10.8) komplikasyon gözlendi.

Sonuç: Talon kilitli PFN, radyasyon maruziyetinin az olması, cerrahi sürenin daha kısa olması sebebiyle PFN sistemlerinin kolay ve güvenilir bir alternatifidir. 

Keywords

PFN, PFN-A, talon, intertrokanterik kırık

References

• 1. Cooper C, Cole Z, Holroyd C, Earl S, Nicholas C, Elaine M et al. Secular trends in the incidence of hip and other osteoporotic fractures. Osteoporosis international. 2011;22(5):1277. doi:https://doi.org/10.1007/s00198-011-1601-6
• 2. Tanner DA, Kloseck M, Crilly RG, Chesworth B, Gilliland J. Hip fracture types in men and women change differently with age. BMC geriatrics. 2010;10(1):12.doi: https://doi.org/10.1186/1471-2318-10-12
• 3. Bridle SH, Patel A, Bircher M, Calvert PT. Fixation of intertrochanteric fractures of the femur. A randomised prospective comparison of the gamma nail and the dynamic hip screw. The Journal of bone and joint surgery British volume. 1991;73(2):330-334.doi: https://doi.org/10.1302/0301-620X.73B2.2005167 4. Browner D, Jupiter J, Levine A, Trafton P. Intertrochanteric femur fracture. Skelatal Trauma. 1996;2:1883-1926. doi: https://doi.org/10.17341/gazimmfd.416539
• 5. Larsson S, Friberg S, Hansson L-I, Trochanteric fractures. Influence of reduction and implant position on impaction and complications. Clinical orthopaedics and related research, 1990(259): p. 130-139. PMID: 2208847
• 6. Min W-K, Kim S-Y, Kim T-K, Lee K-B, Cho M-R, Ha Y-C et al. Proximal femoral nail for the treatment of reverse obliquity intertrochanteric fractures compared with gamma nail. Journal of Trauma and Acute Care Surgery. 2007;63(5):1054-1060. doi: 10.1097/01.ta.0000240455.06842.a0
• 7. Brunner A, Jöckel JA, Babst R. The PFNA proximal femur nail in treatment of unstable proximal femur fractures-3 cases of postoperative perforation of the helical blade into the hip joint. Journal of orthopaedic trauma, 2008. 22(10): p. 731-736. doi: 10.1097/BOT.0b013e3181893b1b
• 8. Schipper I, Marti R, Van der Werken C. Unstable trochanteric femoral fractures: extramedullary or intramedullary fixation: review of literature. Injury. 2004;35(2):142-151. doi: https://doi.org/10.1016/S0020-1383(03)00287-0
• 9. Sharma A, Mahajan A, John B. A comparison of the clinico-radiological outcomes with proximal femoral nail (PFN) and proximal femoral nail antirotation (PFNA) in fixation of unstable intertrochanteric fractures. Journal of clinical and diagnostic research: JCDR. 2017;11(7):RC05. PMID: 28892987
• 10. Konya MN, Korkusuz F, Maralcan G, Demir T, Aslan A. The use of a proximal femoral nail as a hip prosthesis: A biomechanical analysis of a newly designed implant. Proc Inst Mech Eng H. 2018 Feb;232(2):200-206. doi: 10.1177/0954411917751561. Epub 2018 Jan 3. PMID: 29298621.
• 11. Park SY, Yang KH, Yoo JH, Yoon HK, Park HW. The treatment of reverse obliquity intertrochanteric fractures with the intramedullary hip nail. Journal of Trauma and Acute Care Surgery. 2008;65(4):852-857. doi: 10.1097/TA.0b013e31802b9559
• 12. Bramlet DG, Wheeler D. Biomechanical evaluation of a new type of hip compression screw with retractable talons. Journal of orthopaedic trauma. 2003;17(9):618-624. PMID: 14574189
• 13. Zehir S, Şahin E, Zehir R. Comparison of clinical outcomes with three different intramedullary nailing devices in the treatment of unstable trochanteric fractures. Ulus Travma Acil Cerrahi Derg. 2015;21(6):469-476. doi: 10.5505/tjtes.2015.28227
• 14. Efstathopoulos NE, Nikolaou VS, Lazarettos JT. Intramedullary fixation of intertrochanteric hip fractures: a comparison of two implant designs. International orthopaedics. 2007;31(1):71-76. doi:10.1007/s00264-006-0128-5
• 15. Uzun M, Ertürer E, Oztürk I, Akman S, Seckin F, Ozcelik IB. Long-term radiographic complications following treatment of unstable intertrochanteric femoral fractures with the proximal femoral nail and effects on functional results. Acta Orthop Traumatol Turc. 2009;43(6):457-463. doi:10.3944/AOTT.2009.457
• 16. Sadowski C, Lübbeke A, Saudan M, Riand N, Stern R, Hoffmeyer P. Treatment of reverse oblique and transverse intertrochanteric fractures with use of an intramedullary nail or a 95 screw-plate: a prospective, randomized study. JBJS. 2002;84(3):372-381. PMID: 11886906
• 17. Boldin C, Seibert FJ, Fankhauser F, Peicha G, Grechenig W, Szyszkowitz R. The proximal femoral nail (PFN)-a minimal invasive treatment of unstable proximal femoral fractures: a prospective study of 55 patients with a follow-up of 15 months. Acta Orthopaedica Scandinavica. 2003;74(1):53-58. doi: 10.1080/00016470310013662
• 18. Konya MN, Verim Ö. Numerical Optimization of the Position in Femoral Head of Proximal Locking Screws of Proximal Femoral Nail System; Biomechanical Study. Balkan Med J. 2017 Sep 29;34(5):425-431. Epub 2017 Apr 6. doi: 10.4274/balkanmedj.2016.0732.
• 19. Sommers MB, Roth C, Hall H, Benjamin CC, Larry W, James C et al. A laboratory model to evaluate cutout resistance of implants for pertrochanteric fracture fixation. Journal of orthopaedic trauma. 2004;18(6):361-368. PMID: 15213501
• 20. Stone Jr ME, Barbaro C, Bhamidipati C, Cucuzzo J, Simon R. Elderly hip fracture patients admitted to the trauma service: does it impact patient outcome? Journal of Trauma and Acute Care Surgery. 2007;63(6):1348-1352. doi: 10.1097/TA.0b013e31815b838c
• 21. Hayda RA, Hsu RY, DePasse JM, Gil JA. Radiation Exposure and Health Risks for Orthopaedic Surgeons. JAAOS - Journal of the American Academy of Orthopaedic Surgeons. 2018;26(8):268-277. doi: 10.5435/JAAOS-D-16-00342