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Objective To investigate the biomechanical stability of both DHS (dynamic hip screw) and PFN (proximal femoral nail) for treating unstable intertrochanteric fractures. Methods A standard 4-part osteotomy was performed in 8 pairs of fresh frozen human cadaver femurs, which were then randomly assigned to two groups: PFN group and DHS group for biomechanical testing. These specimens were applied to a cyclic load up to 200, 400, 600, 800, 1 000, 1 200, 1 400 N, respectively. Fracture displacement was measured during the loading to determine biomechanical stability of the implant. Each specimen was repeatedly loaded for 5 times to calculate the average displacement and draw the load-displacement curve. For failure testing, the initial load and loading rate was set at 1 400 N and 10 N/s, respectively. The applied compressive load was increased by 600 N each time for five cycles. The pressure was gradually increased to its peak force, and sustained for 10 second before it was gradually decreased to 0 N. The highest force value sustained before failure was defined as the maximum strength of the implant. Results The biomechanical testing on all specimens was completed successfully. There was no damage to the internal fixation. The average displacement and stiffness in DHS group were (3.92±2.21) mm and (215.28±58) N/mm, while those in PFN group were (4.22±1.80) mm and (197.06±34.20) N/mm, so no significant difference was found between the DHS and the PFN group (P> 0.05). New fracture occurred at the distal end of nail in PFN group. The DHS was fractured at the distal cortical screw, but no nail was cut out of the femoral head. The average load required for failure was (4 312±560) N in PFN group and (3 954±520) N in DHS group, and no significant difference was found between the two groups(P＞0.05). Conclusions The test shows that the PFN does not appear to offer any distinct biomechanical advantage over the DHS in the treatment of unstable intertrochanteric fractures. The implant chosen for treating intertrochanteric fractures must depend on patient’s fracture geometry, and anatomic reduction should be conducted in clinical treatment. If the anatomic reduction is difficult, trying to recover continuity of the posterior cortical bone would be necessary.
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This study reports the outcome in pertrochanteric and subtrochanteric femoral fractures in 25 patients treated by using PFN. Salvati and Wilson hip function scoring system and Kyle's criteria were used for follow up evaluation. At the end of 24 weeks follow up the Salvati and Wilson hip function was 32 (out of 40) in 88% of patients, the Kyle's criteria described the outcome as good or very good in 92% of patients and the level of function was similar to pre-injury level in 90% of patients. Distal locking difficulty was encountered in 3 cases. Difficulty in placement of neck screw was encountered in 4 cases. Secondary varus was noted in 3 cases and in 1 patient antirotational screw cut through was seen.However all fractures united well in all the patients.PFN was designed by AO/ASIF in 1996 for the treatment of peritrochanteric fractures.It combines the intrinsic advantages of the intramedullary nail and those of sliding screw is a valid and an important option in the treatment of pertrochanteric and subtrochanteric femoral fractures. It is a relatively easy procedure, a bio mechanically stable construct and a minimally invasive device; especially ideal in compromised elderly patients who are the majority population suffering from these type of fractures.With incorporation of single helical blade in place of two proximal screws in PFN, AO/ASIF has further enhanced the treatment modalities by devising PFNA (Proximal Femoral Nail Antirotation).
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PURPOSE: This study examined the clinical and radiologic results of a proximal femoral nail (PFN) used to treat an intertrochanteric fracture of the femur in elderly people more than 90 years of age. MATERIALS AND METHODS: Between January 2005 and December 2008, 20 patients over 90 years old with an intertrochanteric fracture were treated with a PFN. Among them, 16 patients (mean age, 93.9 years; 13 females and 3 males) were followed up for a minimum of 6 months. Clinically, the modified Koval index was evaluated. Radiological bony union and complications were evaluated from the plain X-ray film. RESULTS: The average modified Koval index decreased from 3.1 before surgery to 1.8 after surgery. Only 5 cases could return to their pre-injury status. Radiologic bony union was achieved after an average of 8.2 weeks and there were no complications, such as non-union and femoral head perforations. CONCLUSION: Thirty one percent of patients older than 90 years and treated for an intertrochanteric fracture with a PFN had recovered to their pre-injury ambulatory status. However, all cases showed bony union and no complications. Overall, PFN might be a good treatment option for intertrochanteric fractures in elderly people older than 90 years.
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Aged , Female , Humans , Femur , Head , Hip Fractures , Nails , X-Ray FilmABSTRACT
PURPOSE: To evaluate the clinical result of Proximal Femoral Nail (PFN) fixation for intertrochanteric fracture of the femur in elderly patients. MATERIALS AND METHODS: Between January 2004 and June 2006, 119 patients older than 65 years of age, with intertrochanteric fractures, were treated with PFN fixation. Ten patients who died within 4 weeks after operation were excluded from the analysis. Mean duration of follow-up was 13 months. There were 34 males and 75 females, and the mean age was 77.8 years. Operation time, amount of blood loss, transfusion requirement, time to ambulation, length of hospital stay, pre- and post-operative walking status, and post-operative complications were evaluated. Radiologic parameters such as amount of impaction, time to union, and neck-shaft angle were also evaluated. RESULTS: The mean operation time was 42 minutes, transfusion requirement averaged 340 ml, and amount of blood loss averaged 78 ml. The mean hospital stay was 20 days, and time to ambulation averaged 10.3 days. Eighty-five percent of patients returned to previous walking status. The average amount of fracture impaction was 3.8 mm, and mean time to radiologic bony union was 11.7 weeks. Neck-shaft angle was changed to 2.5 degrees varus displacement. Complications included intraoperative femur shaft fracture in 5 cases, protrusion of lag screw into the hip joint in 3 cases, backing out of lag screw in 2 cases, fixation failure in 2 cases, and proximal femur fracture in 1 case. Among these cases, 5 hips (2 cases of fixation failure and 3 cases of femoral head perforation by lag screw) were converted to total hip replacement. CONCLUSION: Because of reduction in operation time, low complication rate, and favorable outcome, PFN fixation is an acceptable alternative for fixation of intertrochanteric fractures in elderly patients.
Subject(s)
Aged , Female , Humans , Male , Displacement, Psychological , Femur , Follow-Up Studies , Head , Hip , Hip Fractures , Hip Joint , Length of Stay , Nails , WalkingABSTRACT
Objective To compare proximal femoral nail(PFN)introduction by percutaneous K-wire through a small incision with conventional PFN introduction protocol in the treatment of intertrochanteric fractures. Methods From January 2004 to March 2005,51 patients with intertrochanteric fractures were randomly dis- tributed into a minimally invasive treatment group(group MI)and a conventional treatment group(group C).All the fractures were closely reduced.In group MI a K-wire was percutaneously inserted through the tip of the greater troehanter into the center of medullary canal of the pruximal femur before the PFN was inserted under the guidance of K-wire through a small incision made along the K-wire while in group C the PFN was introduced according to the conventional procedure.The operation time,intra-operative blood loss,length of incision,X-ray exposure,duration of in-patient stay and time of bone union in both groups were recorded and compared.Results The mean oper- ation time,mean intraoperative blood loss and mean length of incisions in group MI were 77.20 min,104.20 mL and 5.12 cm respectively and significantly lower than those in group C(P＜0.01).The X-ray exposure and the reduction time in group MI lasted longer than in group C(P＜0.01).The mean time of bone union and in-patient stay in both groups were nearly equal(P＞0.05).At the latest tollow-up,all the fractures united in both groups without nonuuion or delayed union.Conclusion Compared with the conventional protocol,introduction of PFN by a pereutaneuus K-wire inserted into the central medullary canal of the proximal femur is much more minimally in- vasive and effective.
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Proximal femur consists of femoral head, femoral neck and trochanter. The neck and trochanteric parts of femur are easy to get fractured under conbolution forces. As the conservative treatment tends to cause high rates of complication and mortality, more and more surgeons vote for early internal fixation in recent years. The best treatment for femoral neck fracture is now internal fixation with cannulate screws, especially for the patients with good bone density, fundus and intertrochanteric fractures as well as the type I, type Ⅱand part of type Ⅲfractures in Gardon's classification. Although intertrochanteric fractures are relatively stable, but internal fixation is necessary for good results and prevention of complications. DHS(dynamic hip screw)are advisable for A1, part of A2 and A3 intertrochanteric fractures in AO classification, especially for A1 cases. PFN (proximal femoral nail) is designed for intertrochanteric fractures, inversion and elevation intertrochanteric fractures. In order to get better prognosis in patients older than 70 years and with serious osteoporosis and A2 3, A3 3 fractures, we designed a special kind of prosthesis for them and therefore get satisfactory results.
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Objective To compare the clinical results of the intramedullary nails (Gamma nail and the proximal femoral nail) in treatment of intertrochanteric fractures of femur. Methods A review study was conducted on 116 intertrochanteric fractures of femur treated with the Gamma nail and 89 treated with PFN in our hospital between 2000 and 2003. Results In the Gamma nail group, the mean time for operation was 68.3(48 to 106)minutes,the mean blood loss during operation was 261(180 to 400)mL,the mean time for walking after operation was 5.0 (2.3 to 8.9)weeks and the mean time for bone union was 8.6(7.1 to 12.6)weeks. In the PFN group, the mean time for operation was 48.0(36 to 85)minutes, the mean blood loss during operation was 192(120 to 360)mL,the mean time for walking after operation was 5.3(2.5 to 8.1)weeks and the mean time for bone union was 8.8(6.9 to 12.1)weeks. There were significant differences in the mean time for operation and the mean blood loss between the 2 groups(P
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Intertrochanteric fractures occur mostly in the elderly population. Direction of fracture line, lesser trochanteric fracture, comminution and displacement are the chief concerns in radiological diagnosis of intertrochanteric fractures. Interchanteric fractures can be classified by Evansgrading, Jensens modification of Evansgrading, AO classification, and so on, which are to judge the stability of the fracture. Currently, the basic priciple of management is operation and fixation. The common implants of internal fixation consist of two basic kinds: gliding compression screws with lateral plate, such as dynamic hip screws (DHS), and intramedullary nail fixation, such as Gamma nails and proximal femoral nails. Exteranl fixators are only applied in cases of severe multiple trauma and elderly patients, and artificial joint replacements in those of serere comminuted fractures combined with high osteoporosis.
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Objective To evaluate the clinical effects in t he treatment of femoral peritrochan teric frac-tures by PFN(proximal femoral nail).Methods A retrospective analysis was done in the treatment of femoral peritrochanteric fractures(72cases).38cases were male and 44cases female.Their age ranged 64～96years old with the average age being 78years old.70cases were intertrochanteric f ractures(EvensⅠtype 16,Ⅱtype 31,ⅢA type 14,ⅢB type 6,Ⅳtype 3),and 2cases subtrochanteric fractu res.Results65patients were followed up for over 6months.All fractures healed and all patients could take care of themselves and were satisfied with t he clinical curative effect except one patient who had the lag screw pulled o ut and coxa vara because of serious os-teoporosis.Conclusion PFNis a better way to cure femoral peritrochanteric fractures because of few complications and simple surgical procedure.Bein g a micro-trauma technique,it is worthy of wide application in clinic.[