Blade type nails cause more varus collapse than screw type nails in the treatment of elderly trochanteric fractures

Year 2020, Volume: 12 Issue: 1, 45 - 51, 01.03.2020

Mustafa Caner Okkaoğlu Yüksel Uğur Yaradılmış , İsmail Demirkale , Hakan Şeşen Mahmut Özdemir Murat Altay

https://doi.org/10.21601/ortadogutipdergisi.587286

Abstract

Aim: Blade and screw type nail designs are widely used in the treatment of trochanteric fractures. Although, blade designs were put as last generation nails on the market, it remains unclear which design has better clinical and radiographic outcomes. The purposes of our study were to compare two cephalo medullary nail designs as helical blade and lag screw type for trochanteric fractures (AO/OTA 31-A type fractures), to analyse and compare clinical and functional outcomes, complication rates.
Material and Methods: This study comprised 101 patients with trochanteric fractures treated with either proximal femoral nail antirotation (PFNA) as blade type nail, or Peritrochanteric nail (PTN) as screw type nail for a minimum of 6 months. We assessed comorbidities, fracture type pre-operatively, operation time, blood loss, reduction quality, tip apex distance intra and post operatively, medical and mechanical complications, partial, full weight bearing time, Harris hip scores and Short form 36 scores and mortality during follow up period.
Results: There was no significant difference in the operation time, blood loss, total mechanical or medical complications, partial, full weight bearing time, mortality rate, and Harris Hip scores of PTN or PFNA groups. Lateral migration and varus collapse rates of patients treated with PFNA were significantly higher than patients treated with PTN. However particular SF 36 scores of PFNA group were significantly higher than PTN group.
Conclusion: Blade type nail designs caused more varus collapse than screw type nails in the treatment of elderly trochanteric fractures, however these radiographic complications didn’t influence on clinical outcomes of patients.

Keywords

elderly, trochanteric fractures, blade type nail, screw type nail, varus collapse

Yaşlı hastalarda trokanterik kırıkların tedavisinde bıçak tipi çiviler vida tipi çivilere göre daha fazla varus kollapsa neden olur

Abstract

Amaç: Bıçak ve vida tipi çivi tasarımları trokanterik kırıkların tedavisinde yaygın olarak kullanılmaktadır. Her ne kadar bıçak tasarımları piyasada son nesil çiviler olarak kullanılıyor olsa da, hangi tasarımın daha iyi klinik ve radyografik sonuçlara sahip olduğu belirsizliğini koruyor. Bu çalışmada yaşlı trokanterik kırıklarında(AO / OTA 31-A tipi kırıklar) bıçak ve vida tipi sefalomedüller çivi tasarımlarının, klinik ve fonksiyonel sonuçlarını ve komplikasyon oranlarını karşılaştırmayı amaçladık.
Gereç ve Yöntemler: Bu çalışmaya, en az 6 ay takibi olan, vida tipi çivi olarak Peritrochanteric Nail (PTN) veya bıçak tipi çivi olarak Proximal Femoral Nail Antirotation (PFNA) ile tedavi edilen trokanterik kırığı olan 101 hasta dahil edildi. Çalışmamızda komorbiditeleri, ameliyat öncesi kırık tiplerini, operasyon süresini, kan kaybını, redüksiyon kalitesini, uç apex mesafesini intra ve post operatif olarak, medikal ve mekanik komplikasyonları, mortaliteleri, kısmi, tam yük verebilme sürelerini, Harris kalça skorlarını ve Kısa Form 36 skorlarını analiz ettik ve karşılaştırdık
Bulgular: Operasyon süresi, kan kaybı, total mekanik veya medikal komplikasyonlar, kısmi, tam yük verme süresi, mortalite oranı ve Harris Kalça skorları açısından PTN veya PFNA grupları arasında anlamlı fark yoktu. PFNA ile tedavi edilen hastaların lateral migrasyon ve varus çökme oranları PTN ile tedavi edilen hastalara göre anlamlı derecede yüksekti. Bununla birlikte, PFNA grubunun özellikle SF 36 skorları PTN grubundan anlamlı derecede yüksekti.
Sonuç: Bıçak tipi çivi tasarımları yaşlı trokanterik kırıkların tedavisinde vida tipi çivilere göre daha fazla varus çökmesine neden olmuştur, ancak bu radyografik komplikasyonlar hastaların klinik sonuçları üzerinde etkili olmamıştır.

Keywords

yaşlı, trokanterik kırıklar, bıçak tipi çiviler, vida tipi çiviler, varus kollaps

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