EFFECT OF POSTEROINFERIOR LAG SCREW POSITION FOR CEPHALOMEDULLARY NAIL ON IMPLANT FAILURE AND FUNCTIONAL OUTCOME COMPARED TO THE CENTER-CENTER POSITION IN INTERTROCHANTERIC FRACTURE

Authors

  • Kardo Mohammed Salih Hassan Department of Orthopedics, Shar Teaching Hospital, Directorate of Health, Sulaimani, Kurdistan Region, Iraq.
  • Areewan Mohammed Salih Saeed Department of Surgery, College of Medicine, University of Sulaimani, Kurdistan Region, Iraq.

DOI:

https://doi.org/10.17656/jsmc.10391

Keywords:

Proximal femoral nail, Tip apex distance, Intertrochanteric fracture, Singh index, Cleveland index

Abstract

Background 

Intertrochanteric fracture (ITF) is one of the most common injuries in older people and is more prevalent in females. Thus, we aimed to compare two proximal femoral nail screw positions (centre-centre and posteroinferior) in stable ITF types.

Objectives 

To determine better techniques for screw placement, especially in the emergency department.

Patients and Methods

Prospectively and retrospectively, 76 (33 males and 43 females) patients aged > 55 years were registered; 44 of them were treated with proximal femoral nails with screw positions centre-centre inside the femoral neck (group A), and 32 patients treated with proximal femoral nail with screw positions posteroinferior inside the femoral neck (group B). They were followed up after 3, 6, and 12 months postoperatively to compare screw position effect on implant failure and functional outcome using MHHS. The reduction quality was assessed using neck-shaft angle (NSA), while the quality of Fixation was assessed using tip-apex distance (TAD) and calcar tip-apex distance (CalTAD). Singh index (SI) was used for osteoporosis assessment.

Results

The mean age of patients was 72.93±8.4 (group A) and 70.13±6.86 (group B). There was no significant correlation in incidences of implant failure among TAD (<25 mm) and CalTAD (>25 mm) in group A. For group B in Cleveland index (CI) areas 8 and 9, TAD and CalTAD were ≥ 25 mm, and there were no correlations with end-result and implant failure. In group A, 2 cases of implant-related complications were recorded; in group B, one patient was recorded. The functional score was higher in group B. Fixation quality between the two groups remained comparable. 

Conclusion

The functional outcome of group B was better with optimal surgical conditions. Both groups had comparable radiological and Fixation failure outcomes.

References

Zheng N., Tang N., & Qin L.. Atypical femoral fractures and current management. Journal of Orthopaedic Translation. (2016), 7, 7-22. DOI: https://doi.org/10.1016/j.jot.2016.06.029

Haidukewych G.J. Intertrochanteric fractures: ten tips to improve results. Instructional Course Lectures. (2010).59, 503-9.

Bovbjerg P., Froberg L., & Schmal H.. Short versus long intramedullary nails for treating intertrochanteric femur fractures (AO 31-A1 and AO 31-A2): a systematic review. European Journal of Orthopaedic Surgery & Traumatology. (2019) 29(8), 1823-31. DOI: https://doi.org/10.1007/s00590-019-02495-3

Horwitz D.S., Tawari A., & Suk M. Nail length in the management of intertrochanteric fracture of the femur. JAAOS-Journal of the American Academy of Orthopaedic Surgeons. (2016).24(6), e50-e8. DOI: https://doi.org/10.5435/JAAOS-D-15-00325

Sonawane D.V.. Classifications of intertrochanteric fractures and their clinical importance. Trauma International. (2015)1(1), 7-11. DOI: https://doi.org/10.13107/ti.2015.v01i01.003

Voleti P.B., Liu S.Y., Baldwin K.D., Mehta S., & Donegan D.J.. Intertrochanteric femur fracture stability: a surrogate for general health in elderly patients? Geriatric Orthopaedic Surgery & Rehabilitation. (2015) 6(3), 192-6. DOI: https://doi.org/10.1177/2151458515585321

Sasabuchi Y., Matsui H., Lefor A.K., Fushimi K., & Yasunaga H.. Timing of surgery for hip fractures in the elderly: a retrospective cohort study. Injury. (2018)49(10), 1848-54. DOI: https://doi.org/10.1016/j.injury.2018.07.026

Narsaria N., Arun G., & Srivastava V. Treatment of unstable trochanteric femur fractures: proximal femur nail versus proximal femur locking compression plate. American Journal of Orthopedics. (2017)46(2), E116-E23.

Sreejith K., Jyothiprasanth M., & Sunku N. A Comparative Study to Assess the Preoperative Thickness of Lateral Trochanteric Wall as a Predictor of Postoperative Lateral Wall Fracture in Intertrochanteric Fracture Treated by Dynamic Hip Screw. Journal of Bone Reports & Recommendations. (2017).3(3), 12.

Vishwanathan K., Akbari K., & Patel A.J.. Is the modified Harris hip score a valid and responsive instrument for outcome assessment in the Indian population with pertrochanteric fractures? Journal of Orthopaedics. (2018)15(1), 40-6. DOI: https://doi.org/10.1016/j.jor.2017.12.001

Liu Z., Gao H., Bai X., Zhao L., Li Y., & Wang B.. Evaluation of Singh Index and Osteoporosis Self-Assessment Tool for Asians as risk assessment tools of hip fracture in patients with type 2 diabetes mellitus. Journal of Orthopaedic Surgery and Research. (2017)12(1), 1-7. DOI: https://doi.org/10.1186/s13018-017-0539-6

Mast N.H., Impellizzeri F., Keller S., & Leunig M.. Reliability and agreement of measures used in radiographic evaluation of the adult hip. Clinical Orthopaedics and Related Research®. (2011)469(1), 188-99. DOI: https://doi.org/10.1007/s11999-010-1447-9

Bhandari A., & Deane A. Evaluation of the neck shaft angle achieved after surgical Fixation of intertrochanteric fracture of the femur. International Journal of Orthopaedics Sciences. (2018).4(2), 742-4. DOI: https://doi.org/10.22271/ortho.2018.v4.i2k.107

Zielinski S.M., Keijsers N.L., Praet S.F., Heetveld M.J., Bhandari M., Wilssens J.P., et al.. Femoral neck shortening after internal Fixation of a femoral neck fracture. Orthopedics. (2013)36(7), e849-e58. DOI: https://doi.org/10.3928/01477447-20130624-13

Pan S., Liu X.-H., Feng T., Kang H.-J., Tian Z.-G., & Lou C.-G.. Influence of different great trochanteric entry points on the outcome of intertrochanteric fractures: a retrospective cohort study. BMC Musculoskeletal Disorders. (2017)18(1), 1-9. DOI: https://doi.org/10.1186/s12891-017-1472-x

Lu Y., & Uppal H.S. Hip fractures: relevant anatomy, classification, and biomechanics of fracture and Fixation. Geriatric Orthopaedic Surgery & Rehabilitation. (2019)10, 2151459319859139. DOI: https://doi.org/10.1177/2151459319859139

Simmermacher R., Ljungqvist J., Bail H., Hockertz T., Vochteloo A., Ochs U., et al. The new proximal femoral nail anti-rotation (PFNA®) in daily practice: results of a multicentre clinical study. Injury. (2008).39(8), 932-9. DOI: https://doi.org/10.1016/j.injury.2008.02.005

Kuderna H., Böhler N., & Collon D. Treatment of intertrochanteric and subtrochanteric fractures of the hip by the Ender method. The Journal of Bone and Joint Surgery American Volume. (1976).58(5), 604-11. DOI: https://doi.org/10.2106/00004623-197658050-00004

Alpantaki K., Papadaki C., Raptis K., Dretakis K., Samonis G., & Koutserimpas C. Gender and Age Differences in Hip Fracture Types among Elderly: a Retrospective Cohort Study. Maedica. (2020).15(2), 185-90.

Bhattacharya S., Chakraborty P., & Mukherjee A. Correlation between neck shaft angle of the femur with age and anthropometry: a radiographic study. Indian Journal of basic and applied Medical Research. (2014).3(3), 100-7.

Chandak R., Malewar N., Jangle A., Agarwal R., Sharma M., & Kekatpure A.. Description of new "epsilon sign" and its significance in a reduction in a highly unstable variant of intertrochanteric fracture. European Journal of Orthopaedic Surgery & Traumatology. (2019) 29(7), 1435-9. DOI: https://doi.org/10.1007/s00590-019-02478-4

Yeh Y.-C., Liu C.-H., Chou Y.-C., Hsu Y.-H., & Yu Y.-H. Similarities between Inferior-Center and Center-Center Lag Screw Positions in Femoral Intertrochanteric Fracture Surgeries. Preprint. (2020) DOI: 10.21203/rs.3.rs-46130/v1 DOI: https://doi.org/10.21203/rs.3.rs-46130/v1

Liang C., Peng R., Jiang N., Xie G., Wang L., & Yu B.. Intertrochanteric fracture: Association between the coronal position of the lag screw and stress distribution. Asian Journal of Surgery. (2018) 41(3), 241-9. DOI: https://doi.org/10.1016/j.asjsur.2017.02.003

Puthezhath K, Jayaprakash C. Is calcar-referenced tip-apex distance a better-predicting factor for cutting out in biaxial cephalomedullary nails than tip-apex distance? J Orthop Surg (Hong Kong). 2017 Sep-Dec;25(3):2309499017727920. doi: 10.1177/2309499017727920. PMID: 28847243. DOI: https://doi.org/10.1177/2309499017727920

Caruso G, Corradi N, Caldaria A, Bottin D, Lo Re D, Lorusso V, Morotti C, Valpiani G, Massari L. New tip-apex distance and calcar-referenced tip-apex distance cut-offs may be the best predictors for cut-out risk after intramedullary Fixation of proximal femur fractures. Sci Rep. 2022 Jan 10;12(1):357. doi: 10.1038/s41598-021-04252-1. PMID: 35013492; PMCID: PMC8748913. DOI: https://doi.org/10.1038/s41598-021-04252-1

Published

2023-03-21

How to Cite

1.
Hassan K, Saeed A. EFFECT OF POSTEROINFERIOR LAG SCREW POSITION FOR CEPHALOMEDULLARY NAIL ON IMPLANT FAILURE AND FUNCTIONAL OUTCOME COMPARED TO THE CENTER-CENTER POSITION IN INTERTROCHANTERIC FRACTURE. JSMC [Internet]. 2023 Mar. 21 [cited 2024 Feb. 29];13(1):1-11. Available from: https://jsmc.univsul.edu.iq/index.php/jsmc/article/view/jsmc-10391

Similar Articles

1-10 of 62

You may also start an advanced similarity search for this article.