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Open Access 01-12-2016 | Research article

Proximal femoral nails anti-rotation versus dynamic hip screws for treatment of stable intertrochanteric femur fractures: an outcome analyses with a minimum 4 years of follow-up

Authors: Weiguang Yu, Xinchao Zhang, Xingfei Zhu, Zuochong Yu, Yinfeng Xu, Guoqing Zha, Jun Hu, Jianhua Yi, Yunjiang Liu

Published in: BMC Musculoskeletal Disorders | Issue 1/2016

Abstract

Background

Dynamic hip screws (DHSs) and proximal femoral nails anti-rotation (PFNAs) are well-documented implants for stable intertrochanteric femur fractures(IFFs); however, there is no consensus regarding which type of implant is the better option for stable IFFs. This study aimed to compare DHSs with PFNAs in the management of stable intertrochanteric fractures.

Methods

A retrospective study was performed in our institution. Between June, 2005 and November, 2015, 267 patients (267 hips) with stable IFFs (AO/OTA Type 3.1A1) were treated with a DHS or a PFNA. Inclusion and exclusion criteria were designed to focus on isolated stable IFFs in ambulatory patients. Follow-up was undertaken at 1, 3, 12, 15, 18, 21, 24, 36, 48 postoperative months, and at final follow-up. Radiograph outcomes were obtained at all visits. The primary outcome measure was re-operation rate. The secondary outcome was patient function, evaluated using Harris hip score (HHS). Tertiary outcomes included: intra- and post-operative orthopaedic complications.

Results

Two hundred twenty two patients (110 in the PFNA group and 112 in the DHS group) were evaluated with a mean follow-up period of 53 months (range, 48–60 months). There was an increased risk of reoperation after DHS in one-year follow-up: 0 % and 5.4 % for PFNA and DHS, respectively (P = 0.029). The difference persisted with time: 6.4 % and 13.4 % at last follow-up (P < 0.05). There are statistical differences in postoperative HHS at 12, 15, 18, 21, 24, 36, 48 months postoperatively and at final follow-up. No statistical differences in medical complications was observed between the two groups. The orthopaedic complications were more in the DHS group (n = 42) compared with the PFNA group (n = 18) (P <0.05).

Conclusion

Compared with PFNA device, DHS device might not be the preferred implant for stable intertrochanteric femur fractures.

Zhang K, Zhang S, Yang J, Dong W, Wang S, Cheng Y, et al. Proximal femoral nail vs. dynamic hip screw in treatment of intertrochanteric fractures: a meta-analysis. Med Sci Monitor. 2014;20:1628–33.CrossRef

Ma KL, Wang X, Luan FJ, Xu HT, Fang Y, Min J, et al. Proximal femoral nails antirotation, Gamma nails, and dynamic hip screws for fixation of intertrochanteric fractures of femur: a meta-analysis. Orthop Traumatol Surg Res. 2014;100(8):859–66. doi:10.1016/j.otsr.2014.07.023.CrossRefPubMed

Shen L, Zhang Y, Shen Y, Cui Z. Antirotation proximal femoral nail versus dynamic hip screw for intertrochanteric fractures: A meta-analysis of randomized controlled studies. Orthop Traumatol Surg Res. 2013;99(4):377–83. doi:10.1016/j.otsr.2012.12.019.CrossRefPubMed

Avakian Z, Shiraev T, Lam L, Hope N. Dynamic hip screws versus proximal femoral nails for intertrochanteric fractures. ANZ J Surg. 2012;82(1–2):56–9. doi:10.1111/j.1445-2197.2011.05929.x.CrossRefPubMed

Hong JY, Suh SW, Park JH, Shin YS, Yoon JR, Yang JH. Comparison of soft-tissue serum markers in stable intertrochanteric fracture: dynamic hip screw versus proximal femoral nail-a preliminary study. Injury. 2011;42(2):204–8. doi:10.1016/j.injury.2010.09.008.CrossRefPubMed

Niu E, Yang A, Harris AHS, Bishop J. Which fixation device is preferred for surgical treatment of intertrochanteric hip fractures in the united states? a survey of orthopaedic surgeons. Clin Orthop Relat R. 2015;473(11):3647–55. doi:10.1007/s11999-015-4469-5.CrossRef

Bhandari M, Schemitsch E, Joensson A, Zlowodzki M, Haidukewych GJ. Gamma nails revisited: gamma nails versus compression hip screws in the management of intertrochanteric fractures of the hip: a meta-analysis. J Orthop Trauma. 2009;23(6):460–4.CrossRefPubMed

Jones HW, Johnston P, Parker M. Are short femoral nails superior to the sliding hip screw? a meta-analysis of 24 studies involving 3,279 fractures. Int Orthop. 2006;30(2):69–78. doi:10.1007/s00264-005-0028-0.CrossRefPubMedPubMedCentral

Mereddy P, Kamath S, Ramakrishnan M, Malik H, Donnachie N. The AO/ASIF proximal femoral nail antirotation (PFNA): a new design for the treatment of unstable proximal femoral fractures. Injury. 2009;40(4):428–32. doi:10.1016/j.injury.2008.10.014.CrossRefPubMed

10.

Little NJ, Verma V, Fernando C. A prospective trial comparing the Holland nail with the dynamic hip screw in the treatment of intertrochanteric fractures of the hip. J Bone Joint Surg Br. 2008;90B(8):1073–8. doi:10.1302/0301-620x.90b8.20825.CrossRef

11.

Ul Haq R, Manhas V, Pankaj A, Srivastava A, Dhammi IK, Jain AK. Proximal femoral nails compared with reverse distal femoral locking plates in intertrochanteric fractures with a compromised lateral wall; a randomised controlled trial. Int Orthop. 2014;38(7):1443–9. doi:10.1007/s00264-014-2306-1.CrossRef

12.

Sciacca S, Lidder SS, Grechenig C, Grechenig S, Staresinic M, Bakota B, et al. Variations of treatment in selected proximal femur fractures among surgeons with different surgical experience-a survey at an international AO course. Injury. 2015;46:S57–60. doi:10.1016/j.injury.2015.10.066.CrossRefPubMed

13.

Zhong B, Zhang Y, Zhang C, Luo CF. A comparison of proximal femoral locking compression plates with dynamic hip screws in extracapsular femoral fractures. Orthop Traumatol Surg Res. 2014;100(6):663–8. doi:10.1016/j.otsr.2014.06.012.CrossRefPubMed

14.

Han FS, Guo FX, Zeng XT, Zhang B, Ping J. Comments on "Anti-rotation proximal femoral nail versus dynamic hip screw for intertrochanteric fractures: A meta-analysis of randomized controlled studies" of L. Shen, Y. Zhang, Y. Shen, Z. Cui published in Orthop Traumatol Surg Res 2013;99:377–83. Orthop Traumatol Surg Res. 2014;100(2):259–60. doi:10.1016/j.otsr.2014.01.002.CrossRefPubMed

15.

Zeng C, Wang YR, Wei I, Gao SG, Zhang FJ, Sun ZQ, et al. Treatment of trochanteric fractures with proximal femoral nail antirotation or dynamic hip screw systems: a meta-analysis. J Int Med Res. 2012;40(3):839–51.CrossRefPubMed

16.

Setiobudi T, Ng YH, Lim CT, Liang S, Lee K, De Das S. Clinical outcome following treatment of stable and unstable intertrochanteric fractures with dynamic hip screw. Ann Acad Med Singap. 2011;40(11):482–7.PubMed

17.

Li M, Wu L, Liu Y, Wang C. Clinical evaluation of the Asian proximal femur intramedullary nail antirotation system (PFNA-II) for treatment of intertrochanteric fractures. J Orthop Surg Res. 2014;9. doi:10.1186/s13018-014-0112-5

18.

Schmidt-Rohlfing B, Heussen N, Knobe M, Pfeifer R, Kaneshige JR, Pape HC. Reoperation rate after internal fixation of intertrochanteric femur fractures with the percutaneous compression plate: what are the risk factors? J Orthop Trauma. 2013;27(6):312–7. doi:10.1097/BOT.0b013e3182703730.CrossRefPubMed

19.

Li MH, Peng H, Liu Y. Clinical evaluation of asian proximal femoral nail antirotation in treatment of intertrochanteric fractures in the elderly. J Am Geriatr Soc. 2013;61:S330–1.

20.

Moroni A, Faldini C, Pegreffi F, Hoang-Kim A, Vannini F, Giannini S. Dynamic hip screw compared with external fixation for treatment of osteoporotic pertrochanteric fractures - A prospective, randomized study. J Bone Joint Surg Am. 2005;87A(4):753–9. doi:10.2106/jbjs.d.01789.

21.

Vekris MD, Lykissas MG, Manoudis G, Mavrodontidis AN, Papageorgiou CD, Korompilias AV et al. Proximal screws placement in intertrochanteric fractures treated with external fixation: comparison of two different techniques. J Orthop Surg Res. 2011;6. doi:10.1186/1749-799x-6-48

22.

Gotfried Y. Integrity of the lateral femoral wall in intertrochanteric hip fractures: An important predictor of a reoperation. J Bone Joint Surg Am. 2007;89A(11):2552–3.CrossRef

23.

Dhamangaonkar AC, Joshi D, Goregaonkar AB, Tawari AA. Proximal femoral locking plate versus dynamic hip screw for unstable intertrochanteric femoral fractures. J Orthop Surg. 2013;21(3):317–22.CrossRef

24.

Paul O, Barker JU, Lane JM, Helfet DL, Lorich DG. Functional and radiographic outcomes of intertrochanteric hip fractures treated with calcar reduction, compression, and trochanteric entry nailing. J Orthop Trauma. 2012;26(3):148–54. doi:10.1097/BOT.0b013e31821e3f8c.CrossRefPubMed

25.

Bohl DD, Basques BA, Golinvaux NS, Miller CP, Baumgaertner MR, Grauer JN. extramedullary compared with intramedullary implants for intertrochanteric hip fractures thirty-day outcomes of 4432 procedures from the ACS NSQIP database. J Bone Joint Surg Am. 2014;96A(22):1871–7. doi:10.2106/jbjs.n.00041.CrossRef

26.

Aktselis I, Kokoroghiannis C, Fragkomichalos E, Koundis G, Deligeorgis A, Daskalakis E, et al. Prospective randomised controlled trial of an intramedullary nail versus a sliding hip screw for intertrochanteric fractures of the femur. Int Orthop. 2014;38(1):155–61. doi:10.1007/s00264-013-2196-7.CrossRefPubMed

Title: Proximal femoral nails anti-rotation versus dynamic hip screws for treatment of stable intertrochanteric femur fractures: an outcome analyses with a minimum 4 years of follow-up
Authors: Weiguang Yu
Xinchao Zhang
Xingfei Zhu
Zuochong Yu
Yinfeng Xu
Guoqing Zha
Jun Hu
Jianhua Yi
Yunjiang Liu
Publication date: 01-12-2016
Publisher: BioMed Central
Published in: BMC Musculoskeletal Disorders / Issue 1/2016
Electronic ISSN: 1471-2474
DOI: https://doi.org/10.1186/s12891-016-1079-7

At a glance: The STEP trials

Springer Medicine

Proximal femoral nails anti-rotation versus dynamic hip screws for treatment of stable intertrochanteric femur fractures: an outcome analyses with a minimum 4 years of follow-up

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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