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

Year 2019, , 261 - 266, 26.10.2019
https://doi.org/10.30565/medalanya.567751

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. 

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

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

Year 2019, , 261 - 266, 26.10.2019
https://doi.org/10.30565/medalanya.567751

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. 

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
There are 20 citations in total.

Details

Primary Language Turkish
Subjects Surgery
Journal Section Research Article
Authors

Gökhun Arıcan 0000-0002-1726-7145

Özay Subaşı This is me 0000-0002-8647-5853

Ahmet Özmeriç This is me 0000-0003-4104-0458

Serkan İltar 0000-0001-8143-9063

Kadir Bahadır Alemdaroğlu 0000-0002-5922-9921

Veysel Ercan Dinçel This is me 0000-0001-5605-7514

Publication Date October 26, 2019
Submission Date May 20, 2019
Acceptance Date August 15, 2019
Published in Issue Year 2019

Cite

Vancouver Arıcan G, Subaşı Ö, Özmeriç A, İltar S, Alemdaroğlu KB, Dinçel VE. Talon Proksimal Femoral Çivileme(Pfn) Proksimal Femoral Çivi-Antirotasyon (Pfna) Kadar Başarılı Mı?. Acta Med. Alanya. 2019;3(3):261-6.

9705 

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