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BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2017

Open Access 01-12-2017 | Research article

Influence of different great trochanteric entry points on the outcome of intertrochanteric fractures: a retrospective cohort study

Authors: Shuo Pan, Xiao-Hui Liu, Tao Feng, Hui-Jun Kang, Zhi-Guang Tian, Chun-Guang Lou

Published in: BMC Musculoskeletal Disorders | Issue 1/2017

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Abstract

Background

The Proximal Femoral Nail Antirotation (PFNA) system for treatment of intertrochanteric fractures is currently widely applied worldwide. However, even though the PFNA has produced good clinical outcomes, a poor introduction technique with an inappropriate entry point can cause surgical complications. Some researchers suggest improving clinical outcomes by modifying the entry point, but no research has focused on this issue. The purpose of the present study is to compare the clinical and radiological outcomes of two different trochanteric entry points for the treatment of intertrochanteric fractures using the PFNA system.

Methods

From May 2010 to October 2015, a total of 212 elderly patients with intertrochanteric fractures who were treated with the PFNA-II system were included into this retrospective cohort study. Group LA (98 patients) was treated using a lateral anterior trochanteric entry point, and group MP (114 patients) was treated using a medial posterior trochanteric entry point. All patients underwent follow-up assessments at 1, 3, 6, and 12 months after surgery. Radiographic evaluation was based on the impingement, tip-apex distance (TAD) and the position of the helical blade within the femoral head. Clinical evaluation was based on the surgical time, fluoroscopy time, blood loss, hospital stay, visual analogue scale (VAS), thigh pain, and Harris hip score.

Results

The impingement was significantly reduced (P = 0.011) in group MP. The helical blade positions were significantly lower (P = 0.001) in group MP. The TADs in group LA (22.40 ± 4.43) and group MP (23.39 ± 3.60) were not significantly different (P = 0.075). The fluoroscopy time of group LA (53.26 ± 14.44) was shorter than that of group MP (63.29 ± 11.12, P = 0.000). Five iatrogenic lateral proximal fractures and 3 helical blade cutouts occurred in group LA, but none occurred in group MP. At 1 and 3 months postoperation, the Harris hip scores were significantly higher in group MP (P = 0.001 and P = 0.000, respectively), and the VAS scores were lower (P < 0.05).

Conclusions

The medial posterior trochanteric entry point achieved excellent nail and helical blade position, reduced surgical complications, and enabled early hip function recovery but required longer fluoroscopy time than the lateral anterior trochanteric entry point.
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Metadata
Title
Influence of different great trochanteric entry points on the outcome of intertrochanteric fractures: a retrospective cohort study
Authors
Shuo Pan
Xiao-Hui Liu
Tao Feng
Hui-Jun Kang
Zhi-Guang Tian
Chun-Guang Lou
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2017
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-017-1472-x

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