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

Yıl 2020, , 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

Öz

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.

Anahtar Kelimeler

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

Öz

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.

Anahtar Kelimeler

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

Kaynakça

• Ghafoori S, Keshtkar A, Khashayar P. The risk of osteoporotic fractures and its associating risk factors according to the FRAX model in the Iranian patients: a follow-up cohort. J Diabetes Metab Disord 2014:22;13(1):93.
• Allfram PA. An epidemiological study of cervical and trochanteric fractures of the femur in an urban population. Analysis of 1,664 cases with spe-cial reference to etiologic factors. ActaOrthop Scand Suppl 1964;65:Suppl65:1-109.
• Gallagher JC, Melton LJ, RiggsBL, Bergstrath E. Epidemiology of the fractures of the proximal femur in Rochester, Minnesota. Clin OrthopRelat Res 1980:(150):163-71.
• DeLee JC. Fractures and Dislocations of the Hip, Rockwood and Green’s Fractures in Adults Vol.2; Lippincott-Raven 1996:1659-827.
• Green S, Moore T. Bipolar prosthetic replacement for the management of unstable inter trochanteric hip fractures in the elderly. Clin Orthop 1987;224:168-77.
• Bannister GC, Gibson AG, Ackroyd CE, Newman JH. The fixation and prognosis of trochanteric fractures. A randomized prospective controlled trial. Clin Orthop Relat Res 1990;254:242-6.
• Simpson AH, Varty K, Dodd CA. Sliding hip screws: modes of failure. Injury 1989;20:227-31.
• Haentjens P, Lamraski G. Endoprosthetic replacement of unstable, comminuted intertrochanteric fracture of the femur in the elderly, osteoporotic patient: a review. Disabil Rehabil 2005;27:1167-80.
• Rockwood, C. Intertrochanteric fractures. Rockwood and Green’s fractures in adults (6th ed., Vol. 2, p. 1807,1808). Philadelphia: Lippincott Williams & Wilkins. 2006.
• Kim SY, Kim YG, Hwang JK. Cementless calcar-replacement hemiarthroplasty compared with intramedullary fixation of unstable intertrochanteric fractures. A prospective, randomized study. J Bone Joint Surg Am 2005;87:2186-92.
• Strauss E, Frank J, Lee J, Kummer FJ, Tejwani N. Helical blade versus sliding hip screw for treatment of unstable intertrochanteric hip fractures: a biomechanical evaluation. Injury 2006;37(10):984-9.
• Al-Munajjed AA, Hammer J, Mayr E, Nerlich M, Lenich A. Biomechanical characterisation of osteosyntheses for proximal femur fractures: helical blade versus screw. Stud Health Technol Inform 2008;(133):1-10.
• Sommers MB, Roth C, Hall H, Kam BC, Ehmke LW, Krieg JC, Madey SM, Bottlang M. A laboratory model to evaluate cutout resistance of implants for pertrochanteric fracture fixation. J Orthop Trauma 2004;18(6):361-8.
• Windolf M, Braunstein V, Dutoit C, Schwieger K. Is a helical shaped implant a superior alternative to the Dynamic Hip Screw for unstable femoral neck fractures? A biomechanical investigation Clinical Biomechanics 2009; 24(1):59-64.
• D’Arrigo C, Carcangiu A, Perugia D, Scapellato S, Alonzo R, Frontini S, Ferretti A. Intertrochanteric fractures: comparison between two different locking nails International Orthopaedics (SICOT) 2012:36:2545–51.
• Lenich A, Vester H, Nerlich M, Mayr E, Stöckle U, Füchtmeier B. Clinical comparison of the second and third generation of intramedullary devices for trochanteric fractures of the hip Blade vs Screw. Injury 2010;41(12):1292-6.
• Stern R, Lübbeke A, Suva D, Miozzari H, Hoffmeyer P. Prospective randomised study comparing screw versus helical blade in the treatment of low-energy trochanteric fractures International Orthopaedics (SICOT) 2011:35:1855–61.
• Yang Y-H, Wang Y-R, Jiang S-D, Jiang L-S. Proximal femoral nail antirotation and third-generation Gamma nail: which is a better device for the treatment of intertrochanteric fractures? Singapore Med J 2013; 54(8): 446-4.
• Vaqueroa J, Munoza J, Pratb S, Ramirezc C, Aguadod HJ, Morenoe E, Perezf MD. Proximal Femoral Nail Antirotation versus Gamma3 nail for intramedullary nailing of unstable trochanteric fractures. A randomised comparative study Injury, Int. J. Care Injured 2012;43(S2):47–54.
• Xu Y, Geng D, Yang H, Zhu G, Wang X. Comparative study of trochanteric fracture treated with the proximal femoral nail anti-rotation and the third generation of gamma nail Injury, Int. J. Care Injured 2010:41;1234–8.
• Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis 1987;40:373–83.
• Fogagnolo F, Kfuri M Jr, Paccola CA. Intramedullary fixation of pertrochanteric hip fractures with the short AO-ASIF proximal femoral nail. Arch Orthop Trauma Surg 2004;124(1):31-7.
• Baumgaertner MR, Solberg BD. Awareness of tip-apex distance reduces failure of fixation of trochanteric fractures of the hip. J Bone Joint Surg Br 1997;79:969–71
• Cleveland M, Bosworth DM, Thompson FR, Wilson HJ, Jr, Ishizuka T. A ten-year analysis of intertrochanteric fractures of the femur. J Bone Joint Surg Am. 1959;41-A(8):1399–408.
• Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am 1969;51(4):737-55.
• Ware JEJ, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 1992;30:473-83.