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Intertrochanteric fractures have become a severe public health problem in elderly patients. Proximal femoral nail anti-rotation (PFNA) is a commonly used intramedullary fixation device for unstable intertrochanteric fractures. Pelvic perforation by cephalic screw is a rare complication. We reported an 84-year-old female who fell at home and sustained an intertrochanteric fracture. The patient underwent surgery with PFNA as the intramedullary fixation device. Routine postoperative examination revealed medial migration of the helical blade that eventually caused pelvic perforation. We performed a cemented total hip arthroplasty as the savage procedure. At the latest follow-up of 12 months after total hip arthroplasty, the patient had no pain or loosening of the prosthesis in the left hip. Pelvic perforation should be considered when choosing PFNA as the intramedullary fixation device, especially in patients with severe osteoporosis wherein the helical blade can be easily inserted during the operation. The lack of devices to avoid oversliding of the helical blade in PFNA is an unreported cause of this complication and should be considered in such cases.
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Aged , Aged, 80 and over , Female , Humans , Bone Nails/adverse effects , Femur , Fracture Fixation, Intramedullary/adverse effects , Hip Fractures/surgery , Retrospective Studies , Treatment OutcomeABSTRACT
Objective:To investigate the clinical effect of long-stem hemiarthroplasty in the treatment of unstable intertrochanteric fracture in elderly patients with severe osteoporosis.Methods:A retrospective analysis was performed on 48 elderly patients with unstable intertrochanteric fractures of the femur with severe osteoporosis in Liaocheng People′s Hospital from April 2017 to April 2019.Twenty three patients received long-stem hemiarthroplasty (LHA group). Twenty five patients were treated with proximal femoral nail anti-rotation (PFNA) (PFNA group). PFNA group was used as the control group.The operative time, intraoperative blood loss, perioperative blood transfusion volume, number of intraoperative fluoroscopy, weight-bearing time after operation, the incidence of postoperative complications, hospitalization time, and Harris hip score of 1, 3, 6, 12 months after surgery, to investigate the efficacy of the application of long-stem hemiarthroplasty.Results:In LHA group, 23 patients were followed up for (18.6±3.9) (range from 12.0 to 26.0) months, and 25 patients in the PFNA group were followed up for (17.8±3.3)(range from 12.0 to 24.0) months.There was no significant difference in follow-up time between the two groups ( Z=-0.552, P=0.581). The operation time of LHA Group (60 (55, 73) h) was longer than that of PFNA Group (55 (50, 60) h). The intraoperative blood loss in LHA Group ((179.35±63.47) mL) was more than that in PFNA Group ((122.80±49.03) mL). The number of fluoroscopy in LHA Group (2 (2, 2) times)was less than that in PFNA Group (16 (14.5, 19.5) times). The time of weight bearing in LHA Group (4 (3, 5) d) was earlier than that in PFNA Group (33 (30, 36) d), and the differences were statistically significant ( Z=2.459, t=3.470, Z=6.216, Z=5.959; all P<0.05). There were no significant differences in perioperative blood transfusion, hospital stay and postoperative complications between the two groups (all P>0.05). Harris hip function score was significantly higher in LHA Group ((76.70±5.96), (82.13±6.38), (85.96±7.16), (88.78±7.67) points) and PFNA Group ((63.80±3.46), (71.56±2.55), (81.60±3.38), (88.08±4.83) points) increased gradually with the increase of follow-up time ( Fintra-group=432.557, Pintra-group<0.001), and the score reached the highest 12 months after operation.Harris hip function score of LHA group was higher than that of PFNA group( Finter-group=25.437, Pinter-group<0.001). There was interaction effect between follow-up time point and operation mode( Finteraction=53.464, Pinteraction<0.001). Conclusion:For the elderly patients with unstable intertrochanteric fracture with severe osteoporosis, the application of lengthened stem hemiarthroplasty can get out of bed early, reduce the complications of bed rest, reduce the number of intraoperative fluoroscopy, and recover the function of hip joint earlier and better with satisfactory results.
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@#Introduction: Both short and long PFNA are employed to treat intertrochanteric fractures. Controversy exists in the choice between the two nails as each implant has specific characteristics and theoretical advantages. This retrospective study seeks to examine the operative complication rates and clinical outcomes of short versus long (Proximal Femoral Nail Antirotation) PFNA in the treatment of intertrochanteric fractures. Materials and methods: Between July 2011 and February 2015, 155 patients underwent PFNA insertion. The decision on whether to use a short or long PFNA nail, locked or unlocked, was determined by the attending operating surgeon. Visual Analogue Pain Score (VAS) Harris Hip Scores (HHS), Short-form 36 Health Questionnaire (SF-36) and Parker Mobility Scores (PMS) were collected at six weeks, six months and one year post-operatively. Results: A total of 137 (88.4%) patients were successfully followed-up. Forty-two (30.7%) patients received a short PFNA. The patients were similar in baseline characteristics of age, gender, and comorbidities. Operative time was significantly longer in the short PFNA group (62 ±17 mins) versus the long PFNA group (56±17). While the patients in both groups achieved improvement in all outcome measures, there was no significant difference between the groups in terms of HHS (61.0 ±16.0 vs 63.0 ±16.8, p=0.443), PMS (2.3±1.5 vs 2.7±2.1, p=0.545) and VAS (1.7±2.9 vs 1.8 ±2.2 p=0.454). There were 3 (7.1%) and 7 (7.4%) complications in the short versus long PFNA group, respectively. Conclusion: Both short and long PFNA had similar clinical outcomes and complication rates in the treatment of intertrochanteric fractures in an Asian population.
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Objective: To compare the effectiveness of proximal femoral nail anti-rotation (PFNA) in the treatment of intertrochanteric fracture of femur in traction bed supine position and non-traction bed lateral position. Methods: A retrospective analysis of 102 elderly patients with intertrochanteric fracture of femur who met the selection criteria between January 2013 and April 2018 was made. According to the different operative positions, the patients were divided into two groups: group A (50 cases, PFNA internal fixation in traction bed supine position) and group B (52 cases, PFNA internal fixation in non-traction bed lateral position). There was no significant difference in age, gender, fracture side, cause of injury, AO classification, complications, and time from injury to operation between the two groups ( P>0.05). The preoperative preparation time, incision length, operation time, intraoperative blood loss, intraoperative X-ray fluoroscopy times, fracture healing time, and complications were recorded and compared between the two groups, and the effectiveness was evaluated by Harris hip score at 1 year after operation. Results: There was no significant difference in incision length between groups A and B ( t=1.116, P=0.268). In addition, the preoperative preparation time, operation time, intraoperative blood loss, and intraoperative X-ray fluoroscopy times in group A were significantly greater than those in group B ( P<0.05). Both groups were followed up 12-14 months, with an average of 13 months. There were 3 postoperative complications in group A and group B respectively. In group A, there were 2 cases of hip joint pain and 1 case of local fat liquefaction (healed after dressing change); in group B, there were 2 cases of hip joint pain and 1 case of deep vein thrombosis in lower extremity; there was no significant difference in the incidence of postoperative complications between the two groups ( P=0.642). The patients of the two groups had a good result of fracture reduction and the internal fixation quality, and there was no main nail loosening, screw fracture, spiral blade cutting, withdrawal, and the nail breakage occurred, and no nonunion of bone, coxa vara, and other complications occurred. X-ray showed that the fracture healed in both groups, and there was no significant difference in fracture healing time between the two groups ( t=1.515, P=0.133). There was no significant difference in Harris hip score between the two groups at 1 year after operation ( t=0.778, P=0.438). Conclusion: Compared with the traction bed supine position, PFNA internal fixation for intertrochanteric fracture of femur in the non-traction bed lateral position has the advantages of short preparation time, short operation time, less intraoperative blood loss, less X-ray fluoroscopy times, and satisfactory postoperative recovery effect.
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Objective: To investigate the effect of the screw blade position on the effectiveness of proximal femoral nail anti-rotation (PFNA) internal fixation for unstable intertrochanteric fractures in the elderly. Methods: A clinical data of 131 elderly patients with unstable intertrochanteric fractures who were treated with PFNA internal fixation between January 2010 and January 2017 was retrospectively analyzed. According to the anteroposterior X-ray films, the screw blades were placed in the middle of the femoral neck in 72 patients (group A) and at one-third of the femoral neck in 59 patients (group B). There was no significant difference between the two groups ( P>0.05) in the gender, age, bone density, classification of fractures, other medical diseases, and the time between injury and operation. Multiple treatment indexes were analyzed, including complications, hip Harris score, the healing status of fracture, tip-apex distance (TAD), and the height of the tail nail. Results: All patients were followed up 11-14 months, with an average of 12.1 months. All incisions healed by first intention with no complications. All fractures healed and no significant difference in bone healing time between the two groups ( Z=-0.190, P=0.849). At 6 months after operation, TAD was (2.23±0.07) cm in group A and (2.85±0.12) cm in group B, showing significant difference ( t=-47.643, P=0.000); and the height of the tail nail was (1.72±0.14) cm in group A and (0.53±0.26) cm in group B, showing significant difference ( t=31.031, P=0.000). According to the Harris score, the hip functions were rated as excellent in 48 cases, good in 15 cases, and poor in 9 cases in group A, while as excellent in 38 cases, good in 16 cases, and poor in 5 cases in group B, with no significant difference between the two groups ( Z=-0.075, P=0.941). Conclusion: For the unstable intertrochanteric fracture in the elderly, the PFNA internal fixation with appropriated TAD and the screw blades placed in the middle or at one-third of the femoral neck can obtain good effectiveness.
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Objective: To compare the effectiveness of proximal femoral nail anti-rotation (PFNA) combined with minimally invasive percutaneous plate osteosynthesis (MIPPO) and Intertan intramedullary nail fixation by closed reduction in the treatment of AO/Orthopaedic Trauma Association (AO/OTA) type 31-A3.3 intertrochanteric fracture with incomplete lateral wall. Methods: The clinical data of 54 patients with AO/OTA type 31-A3.3 intertrochanteric fracture who met the selection criteria and were admitted between January 2012 and January 2018 were retrospectively analyzed. According to different surgical methods, the patients were divided into group A (24 cases with lateral wall reconstruction by MIPPO combined with PFNA internal fixation) and group B (30 cases with Intertan intramedullary nail fixation by closed reduction only). There was no significant difference between the two groups ( P>0.05) in terms of gender, age, side of injury, cause of injury, and combined medical diseases. The operation time, intraoperative blood loss, time to weight-bearing, fracture healing time, and postoperative complications were recorded and compared between the two groups. The tip apex distance (TAD) was measured at 2 days, 2 months, and 1 year after operation. At 12 months after operation, the hip joint function was evaluated according to Harris scoring standard, and the rate of conformity (Harris score were more than 70) was calculated. Results: The wounds of the two groups healed by first intention, without infection, skin deformity, and other incision complications. The operation time and intraoperative blood loss of group A were significantly more than those of group B, and the time to weight-bearing and fracture healing were significantly shorter than those of group B ( P0.05). There was 1 case of infection, 1 case of screw withdrawal, 2 cases of screw removal, and 1 case of bone nonunion in group B, the incidence of complications was 16.7%; there was only 1 case of screw withdrawal combined with screw blade withdrawal in group A, the incidence of complications was 4.2%; there was no significant difference between the two groups ( χ2=2.109, P=0.146). At 12 months after operation, the Harris scores of pain, function, malunion, range of motion, and total score in group A were significantly better than those in group B ( P<0.05). The rate of conformity of group A was 95.83% (23/24) and 76.67% (23/30) in group B, and the difference between the two groups was significant ( χ2=3.881, P=0.049). Conclusion: For the AO/OTA type 31-A3.3 intertrochanteric fracture with incomplete lateral wall, compared with the closed reduction Intertan intramedullary nail fixation, the incidence of internal fixation failure after MIPPO reconstruction with lateral wall combined with PFNA fixation was lower, the time to weight-bearing was earlier, and the postoperative function was better.
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BACKGROUND: The proximal femur anti-rotation intramedullary nail is an ideal internal fixation method for the treatment of intertrochanteric fractures, but there is still a 6% to 21% failure rate of internal fixation. Tip-apex distance is considered as an important cause of postoperative proximal femur anti-rotation intramedullary nail failure. Tip-apex distance is the sum of the distance from the tip of lag screw to the vertex of femoral head measured on anteroposterior and lateral X-ray films. Most scholars now believe that the tip-apex distance of head pulp nail ≤ 25 mm has a good prognosis, but there is still a lot of controversy. OBJECTIVE: To investigate the biomechanical differences of the treatment of intertrochanteric femoral fractures by proximal femoral anti-rotation intramedullary nail with different tip-apex distances and provide a new idea and experimental basis for the clinical treatment of intertrochanteric fractures. METHODS: CT data of one volunteer were imported into Mimics 19.0 and Geomagic studio 2017 software to extract and optimize the three-dimensional model of the right femur. SolidWorks 2017 software was used to draw the internal fixation model and assemble it with the AO2.1 type fracture femur model in different tip-apex distance according to the standard operation technology. Totally four models with tip-apex distance of 15, 20, 25, and 30 mm were obtained and imported into HyperMesh 14.0 software to mesh. The four models were imported into Abaqus 2016 software in inp format to set up with material property parameters, boundary conditions and applied loads. Finally, operation results were viewed in the visualization module. RESULTS AND CONCLUSION: (1) When tip-apex distance was too large (30 mm) or too small (15 mm), the stress at the proximal femur was reduced, but the displacement of the femur head and neck fragment and the lesser trochanter fragment was larger and the inversion was more serious. When tip-apex distance was in the middle (20, 25 mm), the displacement and varus of femoral head and neck fragment were small, and the lesser trochanteric fragment was basically unshifted. (2) In the treatment of intertrochanteric femur fractures, tip-apex distance should be adjusted to 20-25 mm to reduce displacement and obtain a better biomechanical effect.
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BACKGROUND: Proximal femoral anti-rotation intramedullary nail for treating intertrochanteric fracture is widely used in clinical practice, but there are still some cases of failure of internal fixation after operation, and osteoporosis of proximal femur is considered as an important reason. Singh index is an important index to evaluate the severity of osteoporosis in the proximal femur. Based on the Singh index, it is of great significance to explore the effect of different degrees of osteoporosis on the treatment of intertrochanteric fracture with anti-rotation intramedullary nail in the proximal femur, so as to reduce the failure rate of internal fixation and increase the success rate of operation. OBJECTIVE: To explore the effect of different osteoporosis on the treatment of intertrochanteric fracture with proximal femoral anti-rotation intramedullary nail, so as to provide new ideas and experimental basis for clinical treatment of intertrochanteric fracture. METHODS: CT data of one patient with intertrochanteric fracture of the left femur were imported into Mimics 19.0 and Geomagic studio 2017 software to extract and optimize the three-dimensional model of the right femur. SolidWorks 2017 software was used to draw the internal fixation model and assemble it with the femur model according to the standard operation technology, and import it into HyperMesh 14.0 software in STEP format to cut the bone according to AO-2.1 type of intertrochanteric fracture. Trabecular bone based on Singh index 1-6 was established to obtain six models of A-F. Material property parameters, boundary conditions and applied loads were set. Finally, the data were stored as K files and imported into LS-DYNA software for solution. RESULTS AND CONCLUSION: (1) When the femoral head was stressed, the spiral blade in the bone block of the femoral head and neck of Singh 6-Singh 1 was cut, the common bone trabecula disappeared, the stress bone trabecula wrapped with the spiral blade did not disappear, but loaded with certain stress, so that the spiral blade still had a large contact area and holding force, maintained the reduction of the fracture, and reduced the varus and rotation of the bone block of the femoral head and neck. (2) From Singh 6-Singh 1, with the disappearance of stress bone trabecula, the more serious osteoporosis is, the more likely failure will be in the treatment of intertrochanteric fracture with proximal femoral anti-rotation intramedullary nail. (3) The spongy bone trabeculae, especially the stress bone trabeculae, play an important role in maintaining the elastic stability of the proximal femur by resisting and buffering the bending strain.
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Objective: To explore the difference of the proximal femoral shortening (PFS) between the third generation of Gamma nail (TGN) and the proximal femoral nail anti-rotation (PFNA) in treating intertrochanteric fracture of femur.
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Objective: To evaluate the feasibility and effectiveness of proximal femoral nail anti-rotation (PFNA) combined with curettage and bone graft through Watson-Jones approach in the treatment of proximal femur benign tumors and tumor like lesions. Methods: The clinical data of 38 patients with benign tumors and tumor like lesions in the proximal femur who were treated through the Watson-Jones approach with PFNA combined with curettage and bone graft between January 2008 and January 2015 were retrospective analysed. There were 24 males and 14 females with an average age of 28 years (range, 15-57 years). Pathological types included 20 cases of fibrous dysplasia, 7 cases of bone cyst, 5 cases of aneurysmal bone cyst, 3 cases of giant cell tumor of bone, 2 cases of enchondroma, and 1 case of non-ossifying fibroma. Before operation, hip pain occurred in 19 patients, pathological fracture occurred in 12 patients, limb shortening and coxa varus deformity was found in 4 patients, and 3 patients received surgery for the local recurrence. The operation time, intraoperative blood loss, and full-weight bearing time after operation were recorded. Patients were followed up to observe union of bone graft and the position of internal fixator on X-ray films and CT images. Visual analogue scale (VAS) score was used to evaluate the level of pain. The Musculoskeletal Tumor Society (MSTS93) score was used to evaluate lower limb function. Harris hip score was used to evaluate hip joint function. Results: The operation time was 130-280 minutes (mean, 182 minutes) and the intraoperative blood loss was 300-1 500 mL (mean, 764 mL). After operation, 3 cases of fat liquefaction of incision healed successfully by carefully dressing, and the rest incisions healed by first intention. All patients started partially weight-bearing exercise at 2-4 weeks after operation. The total weight-bearing time was 3-6 months (mean, 4.2 months). All the patients were followed up 24-108 months (median, 60 months). Imaging examination showed that the bone graft fused and the fusion time was 8-18 months (mean, 11.4 months). During the follow-up period, there was no complication such as pathological fracture, femoral head ischemic necrosis, hip joint dislocation, internal fixation loosening and fracture, and no tumor recurrence or distant metastasis occurred. At last follow-up, the VAS score, MSTS93 score, and Harris score were significantly improved when compared with preoperative ones ( P<0.05). Conclusion: The treatment of proximal femoral benign lesions by PFNA combined with curettage and bone graft through the Watson-Jones approach is safe and effective, with advantages of better mechanical stability, less residual tumor, and less postoperative complications.
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Objective: To investigate the difference in the effectiveness between proximal femoral nail anti-rotation (PFNA) and proximal femoral locking compression plate (PFLCP) for intertrochanteric fracture in elderly patients combined with hemiplegia due to cerebral infarction. Methods: The clinical data of 67 cases of intertrochanteric femoral fractures combined with hemiplegia due to cerebral infarction between October 2013 and January 2017 were retrospectively analyzed. Among them, 32 cases were treated with PFNA internal fixation (PFNA group), and 35 cases were treated with PFLCP internal fixation (PFLCP group). There was no significant difference in gender, age, injury side, modified Evans classification of fracture, preoperative medical disease, and interval from injury to operation between 2 groups ( P>0.05). The operation time, intraoperative blood loss, postoperative bed time, incidence of perioperative complications, time of fracture healing, and hip Harris score at 6 months and 1 year after operation were recorded and compared. Results: Both groups were followed up 12-24 months with an average of 14 months. Compared with the PFLCP group, the PFNA group had shorter operation time, less intraoperative blood loss, and shorter bed time, and the differences were significant ( P0.05); However, the joint deformity and activity score of the PFNA group was significantly better than that of the PFLCP group ( t=4.112, P=0.000). Conclusion: For intertrochanteric fracture in elderly patients with cerebral infarction hemiplegia, the PFNA has shorter operative time, less intraoperative blood loss, shorter bed time after operation, and better short-term hip function when compared with the PFLCP.
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Objective To compare the clinical effect between proximal femoral anatomic locking plate (ALP) and proximal femoral nail anti-rotation (PFNA) in the treatment of elderly patients with intertrochanteric fracture.Methods A total of 89 elderly patients with intertrochanteric fracture were selected from January 2014 to May 2017 in the Third Affiliated Hospital of Xinxiang Medical University.The patients were divided into ALP group (n =43) and PFNA group (n =46) according to the internal fixation,the patients in ALP group were treated with ALP,and the patients in PFNA group were treated with PFNA.The effect was compared between the two groups.Results The incision length,operation time and hospitalization time in the PFNA group were significantly shorter than those in the ALP group(P ＜ 0.05),and the intraoperative blood loss and postoperative drainage volume in PFNA group were significantly less than those in ALP group (P ＜ 0.05).The fineness rate in PFNA group and ALP group was 86.96％ (40/46) and 67.44％ (29/43) respectively,and the fineness rate in PFNA group was significantly higher than that in ALP group (x2 =4.858,P ＜0.05).The incidence of complications in PFNA group and ALP group was 6.52％ (3/46) and 20.93％ (9/43) respectively,and the incidence of complications in PFNA group was significantly lower than that in ALP group (x2 =3.955,P ＜ 0.05).Conclusion The effect of PFNA and ALP in the treatment of elderly patients with intertrochanteric fractures was affirmatory.Compared with ALP,PFNA internal fixation has the advantages of less surgical trauma,short operation time,less intraoperative bleeding,quick postoperative recovery and fewer complications.
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Objective To analyze the risk factors of failure of internal fixation of unstable femoral intertrochanteric fractures treated with proximal femoral nail anti-rotation (PFNA) in elderly patients,and to provide reference for clinical treatment.Methods Collected the clinical data of 251 aged and unstable femoral intertrochanteric fracture patients who have recieved PFNA treatment from January 2012 to December 2016.Preoperative clinical general data and intraoperative clinical factors were used as analysis variable to analyze the high risk factors and risk factors of internal fixation failure in PFNA treatment by χ2 test ,Wilcoxon rank sum test and Logistic regression.Results Through the analysis of 78 aged patients with internal fixation failure after PFNA treatment,the χ2 test and Wilcoxon rank sum test showed that,type of fractures,osteoporosis Singh index grade, tip-apex distance,application of hormone,basic diseases were risk factors for internal fixation failure after PFNA treatment (P<0.05).Among thses factors,type of fractures,osteoporosis Singh index grade, tip-apex distance were independent high risk factors for internal fixation failure after PFNA treatment(P<0.05).Conclusion Severe type of fractures (type Ⅲ and Ⅳ),osteoporosis of grade 4 to 6,and tip-apex distance greater than 25 mm are high risk factors of failure of internal fixation of unstable femoral intertrochanteric fractures treated with PFNA,and it is better to give more attention and effective intervention or other treatment.
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Objective To evaluate the effect of preoperative intravenous drip of tranexamic acid(TXA) on perioperative bleeding in proximal femoral nail anti-rotation(PFNA) operation of elderly intertrochanteric fracture.Methods A total of 115 elderly patient with intertrochanteric fracture undergoing PFNA internal fixation were selected and divided into the treatment group(58 cases) and control group (57 cases).The treatment group was intravenously dripped with 20mg/kg TXA before operation,while the control group had no special treatment.Hemoglobin (Hb) and hematocrit(Hct) were recorded before operation and on postoperative 1,3 d.The total amounts of perioperative blood loss were calculated by using the Gross equation and Nadler equation.The blood transfusion rate and thromboembolic complications occurrence situation in the two groups were performed the statistics.Results The total amounts of perioperative blood loss were (872.21±312.53) mL in the treatment group and (1 162.41±368.64) mL in the control group,the difference was statistically significant(P0.05).Conclusion Preoperatively intravenous drip of 20mg/kg TXA in PFNA internal fixation of elderly intertrochanteric fracture can effectively decrease perioperative blood loss without increasing the risk of thrombus formation.
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Objective To investigate the application of 3 D visualization (3 DV) assisted proximal femoral nail anti-rotation (PFNA) surgery in the treatment of elderly intertrochanteric fracture (ITF).Methods Totally 11 cases of elderly unstable ITF were treated with 3DV assisted PFNA fixation surgery.All these patients were examined with multi-row spiral CT volume scan,and the anatomical data of Dicom was reconstructed through M3 D software.Computer aided design (CAD) was performed based on 3 D reconstruction data,including anatomical data measurement,fracture reduction simulation,and proximal femoral head nail (PFNA) implant parameter design.And the CAD data were showed by S-3DV system during operation to guide the operation.Time of operation,intra-operative blood lose,post-operative drainage volume,hospital stay time and Harris hip score were recorded and compared to the non-3DV assisted PFNA procedure.Results In 3 DV-PFNA surgery,there was no significant difference between the preoperative planned average PFNA size and the implanted average PFNA size (P ＞ 0.05).Compared to the non-3DV-PFNA surgery,3 DV-PFNA surgery has less intra-operative blood lose and post-operative drainage volume,shorter time of preoperative traction reduction and operation (P ＜ 0.05).Harris hip function score of 3 DV-PFNA surgery was better than the conventional surgery 1 week after operation,and there was no significant difference in VAS score I month after operation.The 11 cases treated with 3DV-PFNA technology were healed well,and the rate of complications was lower than the conventional surgery.Conclusion 3DV technique can show accuracy CAD model of ITF,which may play an important role to improve efficiency and accuracy of PFNA surgery.
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Objective To evaluate the effects and security of PFNA and DHS in the treatment of unstable intertrochanteric fractures through meta analysis .Methods The randomized controlled trials(RCT) for comparing PFNA and DHS in the treatment of unstable intertrochanteric fracture were retrieved from MEDLINE ,EMbase ,Pubmed ,Cochrane library ,CBM ,CNKI ,VIP data‐bases by computer .The related orthopedic relevant documents and conference papers were collected by manual retrieval .The Rev‐Man5 .1 statistical software was used for conducting the meta analysis .Results Nineteen RCT were included ,involving 1 690 pa‐tients ,in which 871 cases were treated by using PFNA and 819 cases were treated by using DHS .Compared with DHS ,PFNA had the advantages of little trauma ,less blood loss ,short operation time ,short fracture healing time and postoperative bed time ,good hip function and low incidence of postoperative coxa vara and screw cutting ,but there were no statistical differences in the aspects of length of hospital stay ,fatality rate ,and incidences of fracture nonunion ,breakage of internal fixation ,femoral head necrosis ,short‐ening of the femoral neck ,femoral shaft fractures ,deep vein thrombosis ,urinary tract infection and other complications between the two groups(P>0 .05) .Conclusion The retrieved literatures show that PFNA internal fixation is superior to DHS internal fixation in treatment of unstable intertrochanteric fractures .
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Objective To examine the difference in the effectiveness between proximal femoral nail anti-rotation (PFNA) and femoral head replacement (FHR) of intertrochanteric fracture in elderly patients.Methods This study collected 69 patients that underwent PFNA or FHR after intertrochanteric fractures between June 2012 and September 2014.PFNA group was composed of 41 subjects (17 males and 24 females) aged 80-101 years (mean,86.7 years),and time from injury to operation was (3.12 ± 0.95)days.FHR group was composed of 28 subjects (13 males and 15 females) aged 80-99 years (mean,87.2 years),and time from injury to operation was (3.2 ± 1.0) days.Comparison of operation time,intraoperative blood loss,postoperative blood transfusion,off-bed time,complication incidence,hemoglobin concentration and hip function was made between groups.Results Duration of follow-up was 1-3 years (mean,1.8 years).Operation time and intraoperative blood loss in PFNA group were (46.8 ± 4.4) minutes and (77.0 ± 24.2) ml respectively,differed from (57.4 ± 5.9) minutes and (150.7 ± 46.5) ml in FHR group (P ＜ 0.05).Three days after operation,a similar decrease in hemoglobin concentration was seen in PFNA group [(21.3 ±6.1)g/L] and FHR group [(23.2 ±5.8)g/L] (P ＞ 0.05).Off-bed time in FHR group was (3.2 ± 1.2) days,shorter than (7.1-± 2.5) days in PFNA group (P ＜ 0.05).Incidence of postoperative complications in FHR group was 14％,lower than 37％ in PFNA group (P ＜ 0.05).Hip function of the two groups presented no significant difference six months after operation,but the proportion of excellent results in FHR group was higher than that in PFNA group (82％ vs.73％) (P ＞ 0.05).Conclusion FHR provides better results over PFNA regarding off-bed time,complication incidence and hip function,and hence is preferred for the treatment of elderly patients with intertrochanteric fractures,especially in those with severe osteoporosis.
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Objective To observe the effect of proximal femoral nail anti-rotation(PFNA)combined with salmon calcitonin for the treatment of unstable intertrochanteric fractures in the elderly.Methods A total of 90 elderly patients with unstable intertrochanteric frac-tures were randomly divided into group A,group B and group C(30 cases in each group).Patients in group A received open reduction with DHS,patients in group B got closed reduction with PFNA,and patients in group C received operation as group B but combined with salmon calcitonin after the operation.The intraoperative and postoperative stuation of three groups were compared.Results The intraoperative and postoperative stuation of group B was better than those of group A,the time of weight-bearing exercise and fracture healing in group C was shorter than those of group B(t =4.42;t =5.0,P <0.05).The group B had a less complication than group A(χ2 =7.03,P <0.05).Con-clusion The PFNA has a good restoration effect with shorter operative time,less bleeding and lower complication rate.And combined with the salmon calcitonin,which can shorten the time of recovery.
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Objective To explore the clinical efficacy of dynamic hip screw( DHS) and proximal femoral nail anti-rotation( PFNA) in treatment of patients with Parkinson’ s disease and intertrochanteric fracture. Methods A total of 62 elderly patients of Parkinson’ s disease with femoral intertrochanteric fracture in our hospital from February 2010 to February 2014 were divided into two groups according to different internal fixations,with 31 cases in DHS group and PFNA group respectively. The operation time,X-ray fluoroscopy times,intraoperatve blood soss,the healing time of fracture,postoperative complications and Harris score between two groups were recorded and compared statistically. Results The operation time,intraoperatve blood soss and the clinical healing time of PFNA group were significantly lower than those of DHS group,the differences were statistically significant (P0. 05). Conclusion The PFNA has the advantages of shorter operation time,less bleed-ing,faster healing time in treatment for elderly patients with Parkinson’ s disease and intertrochanteric fracture,worth clinical promotion.
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Objective To investigate the clinical effect of proximal femoral nail anti rotation intramedullary nail (PFNA)in the treatment of intertrochanteric osteoporotic fractures in elderly patients.Methods 42 cases of femoral intertrochanteric fracture were treated with proximal femoral nail anti rotation intramedullary nail (PFNA)in cases (AO type,A1 type 13 cases,A2 type 24 cases,type A3 5 cases).Results The group of 42 patients after 12 -36 months of follow -up,the average follow -up time of 18 months,all the patients were healed,1 case of deep venous thrombosis,1 case of mild coxa vara.According to the Harris evaluation standard:excellent 32 cases,good in 9 cases,fair in 1 case,the excellent rate was 97.6%.Conclusion The proximal femoral nail anti rotation (PFNA) anti tensile,anti sliding and anti rotation function is good,and has the advantages of simple operation,small trauma,for osteoporotic intertrochanteric fracture patients can be applied.