PROXIMAL FEMORAL NAILING VERSUS DYNAMIC HIP SCREW IN MANAGEMENT OF STABLE INTERTROCHANTERIC FEMUR FRACTURES: A COMPARISON OF CLINICAL AND RADIOLOGICAL OUTCOMES

Yıl 2021, Cilt: 84 Sayı: 4, 514 - 520, 01.10.2021

Tuna Pehlivanoğlu , Serkan Bayram , Mehmet Demirel , Mehmet Chodza Emre Kocazeybek , Ahmet Salduz , Turgut Akgül , Önder Yazıcıoğlu

Öz

Objective: The aim of this study was to compare the cost-effectivity, clinical and radiological outcomes of the proximal femoral nail (PFN) and Dynamic hip screw (DHS) in the management of stable intertrochanteric femur fractures (SIFFs). Material and Methods: Patients who underwent surgical treatment for a SIFF in our department were retrospectively identified and then divided into two groups according to the treatment modality: Group 1, 57 patients (36 female, 21 male; mean age = 74.5±9.9 years) treated with PFN and Group 2, 65 patients (34 female, 31 male; 72±10.2 years) treated with DHS. Primary outcome measures were: estimated blood loss (EBL), total operating time (TOT), duration of hospital stay (DHS), rate of postoperative complication, rate of mortality, and treatment cost. Radiographic assessment included anteroposterior/lateral tip-apex distance (TAD) and amount of limb length discrepancy (LLD). Results: No significant differences were observed in demographic characteristics between the two treatment groups (p>0.05). The mean follow-up was 44.2±31 months in group 1 and 53.7±38 months in group 2 (p=0.077). The mean TOT and EBL were significantly shorter in group PFN than in group DHS (p<0.001 and p=0.03). No significant difference was observed in the mean duration of hospital stay, rate of postoperative complication, rate of mortality, and treatment cost between the two treatment groups (p>0.05). The post-operative complication rate was 9.5% in group PFN and 8.3% in group DHS, with no significant difference (p=0.83). There were significant differences in neither TAD nor LLD between the two treatment groups (p=0.69 and p=0.87, respectively). Conclusion: The two treatment modalities seem to have similar effect to maintain stability for patients with stable IFFs. However, less EBL and shorter operation time can be expected from PFN compared to DHS in such patients.

Anahtar Kelimeler

Intertrochanteric fracture, dynamic hip screw, proximal femoral nailing, cost-effectivity

STABİL İNTERTROKANTERİK FEMUR KIRIKLARININ TEDAVİSİNDE PROKSİMAL FEMORAL ÇİVİ İLE DİNAMİK KALÇA VİDASI: KLİNİK VE RADYOLOJİK SONUÇLARIN KARŞILAŞTIRILMASI

Öz

Amaç: Bu çalışmanın amacı, stabil intertrokanterik femur kırıklarının (SIFF) tedavisinde proksimal femur çivisi (PFN) ve dinamik kalça vidasının (DHS) maliyet-etkililik, klinik ve radyolojik sonuçlarını karşılaştırmaktı. Gereç ve Yöntemler: SIFF nedeniyle cerrahi tedavi uygulanan hastalar geriye dönük olarak belirlendi ve tedavi şekline göre iki gruba ayrıldı: Grup 1, 57 hasta (36 kadın, 21 erkek; ortalama yaş = 74,5±9,9 yıl) PFN ile tedavi edilen ve Grup 2, DHS ile tedavi edilen 65 hasta (34 kadın, 31 erkek; 72±10,2 yıl). Birincil sonuç ölçütleri; tahmini kan kaybı (EBL), toplam ameliyat süresi (TOT), hastanede kalış süresi (DHS), ameliyat sonrası komplikasyon oranı, ölüm oranı ve tedavi maliyeti olarak yapıldı. Radyografik değerlendirme, ön-arka/yan uç-apeks mesafesini (TAD) ve uzuv uzunluk uyumsuzluğu miktarını (LLD) karşılaştırıldı. Bulgular: İki tedavi grubu arasında demografik özelliklerde anlamlı bir farklılık gözlenmedi (p>0,05). Ortalama takip süresi grup 1’de 44,2±31 ay ve grup 2’de 53,7±38 ay idi (p=0,077). Ortalama TOT ve EBL, grup PFN’de grup DHS’ye göre anlamlı olarak daha kısaydı (p<0,001 ve p=0,03). Ortalama hastanede kalış süresi, postoperatif komplikasyon oranı, mortalite oranı ve tedavi maliyeti açısından iki grup arasında anlamlı fark gözlenmedi (p>0.05). Ameliyat sonrası komplikasyon oranı grup PFN’de %9,5 ve grup DHS’de %8,3 idi ve anlamlı bir fark yoktu (p=0,83). İki tedavi grubu arasında ne TAD ne de LLD’de anlamlı farklılıklar yoktu (sırasıyla p=0,69 ve p=0,87). Sonuç: İki tedavi modalitesi, stabil IFF’leri olan hastalarda stabiliteyi sürdürmek için benzer etkiye sahip görünmektedir. Ancak bu tür hastalarda DHS’ye kıyasla PFN’den daha az EBL ve daha kısa operasyon süresi beklenebilir.

Anahtar Kelimeler

İntertrokanterik kırık, dinamik kalça vidası, proksimal femoral çivileme, maliyet etkinliği

Kaynakça

• 1. Veronese N, Maggi S. Epidemiology and social costs of hip fracture. Injury 2018;49(8):1458-60. [CrossRef]
• 2. Mundi S, Pindiprolu B, Simunovic N, Bhandari M. Similar mortality rates in hip fracture patients over the past 31 years: A systematic review of RCTs. Acta Orthop 2014;85(1):54-9. [CrossRef]
• 3. Marsh JL, Slongo TF, Agel J, Broderick JS, Creevey W, DeCoster TA, et al. Fracture and dislocation classification compendium - 2007: Orthopaedic Trauma Association classification, database and outcomes committee. J Orthop Trauma 2007;21(10 Suppl):S1-133. [CrossRef]
• 4. Barton TM, Gleeson R, Topliss C, Greenwood R, Harries WJ, Chesser TJ. A comparison of the long gamma nail with the sliding hip screw for the treatment of AO/OTA 31-A2 fractures of the proximal part of the femur: a prospective randomized trial. J Bone Joint Surg Am 2010;92(4):792-8. [CrossRef]
• 5. Irisson E, Hémon Y, Pauly V, Parratte S, Argenson JN, Kerbaul F. Tranexamic acid reduces blood loss and financial cost in primary total hip and knee replacement surgery. Orthop Traumatol Surg Res 2012;98(5):477-83. [CrossRef]
• 6. Baumgaertner MR CS, 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. [CrossRef]
• 7. Matre K, Vinje T, Havelin LI, Gjertsen JE, Furnes O, Espehaug B, et al. TRIGEN INTERTAN intramedullary nail versus sliding hip screw: a prospective, randomized multicenter study on pain, function, and complications in 684 patients with an intertrochanteric or subtrochanteric fracture and one year of follow-up. J Bone Joint Surg Am 2013;95(3):200-8. [CrossRef]
• 8. Parker MJ, Handoll HH. Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures in adults. Cochrane Database Syst Rev 2008;(3):CD000093. [CrossRef]
• 9. Aune AK, Ekeland A, Odegaard B, Grøgaard B, Alho A. Gamma nail vs compression screw for trochanteric femoral fractures. 15 reoperations in a prospective, randomized study of 378 patients. Acta orthopaedica Scandinavica 1994;65(2):127-30. [CrossRef]
• 10. Hardy DC, Descamps PY, Krallis P, Fabeck L, Smets P, Bertens CL, et al. Use of an intramedullary hip-screw compared with a compression hip-screw with a plate for intertrochanteric femoral fractures. A prospective, randomized study of one hundred patients. J Bone Joint Surg Am 1998;80(5):618-30. [CrossRef]
• 11. Herrera A, Domingo LJ, Calvo A, Martínez A, Cuenca J. A comparative study of trochanteric fractures treated with the Gamma nail or the proximal femoral nail. Int Orthop 2002;26(6):365-9. [CrossRef]
• 12. Abreu ELd, Sena CB, Rodrigues Filho SAS. Effectiveness of treatment of transtrochanteric fractures with Dynamic Hip Screws using minimally invasive access. Rev Bras Ortop 2016;51(2):138-42. [CrossRef]
• 13. Mahmood A, Kalra M, Patralekh M. Comparison between conventional and minimally invasive dynamic hip screws for fixation of intertrochanteric fractures of the femur. ISRN Orthop 2013;2013:484289 [CrossRef]
• 14. Saudan M, Lübbeke A, Sadowski C, Riand N, Stern R, Hoffmeyer P. Pertrochanteric fractures: is there an advantage to an intramedullary nail?: a randomized, prospective study of 206 patients comparing the dynamic hip screw and proximal femoral nail. J Orthop Trauma 2002;16(6):386-93. [CrossRef]
• 15. Aros B, Tosteson AN, Gottlieb DJ, Koval KJ. Is a sliding hip screw or im nail the preferred implant for intertrochanteric fracture fixation? Clin Orthop Relat Res 2008;466(11):2827- 32. [CrossRef]
• 16. Aktselis I, Kokoroghiannis C, Fragkomichalos E, Koundis G, Deligeorgis A, et al. Prospective randomised controlled trial of an intramedullary nail versus a sliding hip screw for intertrochanteric fractures of the femur. Int Orthop 2014;38(1):155-61. [CrossRef]
• 17. Kumar R, Singh R, Singh B. Comparative prospective study of proximal femoral nail and dynamic hip screw in treatment of intertrochanteric fracture femur. J Clin Orthop Trauma. 2012;3(1):28-36. [CrossRef]
• 18. Taeger G, Schmid C, Zettl R, Schweiberer L, Nast-Kolb D. Stable and unstable pertrochanteric femoral fractures. Differentiated indications for the dynamic hip screw. Unfallchirurg 2000;103(9):741-8. [CrossRef]
• 19. Lavini F, Renzi-Brivio L, Aulisa R, Cherubino F, Di Seglio PL, Galante N, et al. The treatment of stable and unstable proximal femoral fractures with a new trochanteric nail: results of a multicentre study with the Veronail. Strategies Trauma Limb Reconstr 2008;3(1):15-22. [CrossRef]
• 20. Z Zhang S, Zhang K, Jia Y, Yu B, Feng W. InterTan nail versus Proximal Femoral Nail Antirotation-Asia in the treatment of unstable trochanteric fractures. Orthopedics 2013;36(3):182- e292. [CrossRef]
• 21. Memon K, Siddiqui AM, Khan ZA, Zahoor A. Dynamic hip screw fixation vs. proximal femur nail for unstable pertrochanteric fractures: a comparative analysis of outcomes and complications. J Ayub Med Coll Abbottabad. 2021;33(1):34-38.
• 22. Ricci MJ, McAndrew CM, Miller AN, Kamath G, Ricci WM. Are two-part intertrochanteric femur fractures stable and does stability depend on fixation method? J Orthop Trauma 2019;33(9):428-431. [CrossRef]