Clinical and Radiological Outcomes of Trochanteric AO/OTA 31A2 Fractures: Comparison between Helical Blade and Lag Screw – A Retrospective Cohort Study

Abstract

Introduction The purpose of this study was to compare the clinical and radiological outcomes of AO/OTA type 31A2 fractures treated by the use of trochanteric nails either with a blade or a screw.

Patients and Methods This study was designed retrospectively. Between May 2007 and May 2014, a total of 144 patients with trochanteric fractures were admitted to the clinic, and only 65 of them met the inclusion criteria. Thirty-two of them (blade group) were treated with a helical blade and the rest of the 33 patients (screw group) were treated with a screw. The mean ages of the patients were 76.01 and 75.82, respectively (p = 0.905). The mean follow-up time was 27.6 months (blade group: 34.2 ± 19.1 months; screw group: 18.6 ± 7.9 months; p < 0.001). Between these two groups, we evaluated the differences in tip apex distances (TAD), calcar-referenced tip-apex distances (Cal-TAD), implant positions, cut-out rates, and implant failures. Functional outcomes were measured with the help of the Harris Hip Score.

Results No significant differences were seen between the blade and screw groups by means of cutting out, implant positions, and varus collapse. Cutting out was seen in a total of six patients (blade group n = 2; screw group = 4; p = 0.672) and varus collapse in nine patients (blade group n = 5, screw group n = 4; p = 0.733). Harris Hip Scores were similar between the two groups (blade group: 72.70 ± 18.43; screw group: 80.83 ± 18.75; p = 0.84).

Zusammenfassung

Einleitung Das Ziel dieser Studie ist die Untersuchung von klinischen und radiologischen Ergebnisse von pertrochantären AO/OTA 31A2 Frakturen, die mit proximalen Femurnagel (PFN), entweder mit Klinge oder Schraube als Schenkelhals-implantat, chirurgisch versorgt sind.

Patienten und Methoden Diese Arbeit ist eine retrospektiv durchgeführte Kohortenstudie. Im Zeitraum von Mai 2007 bis Mai 2014 haben sich 144 Patienten mit einer pertrochantären Fraktur an unser Krankenhaus gewandt. Fünfundsechzig von denen haben die Inklusionskriterien erfüllt. PFN mit Klinge wurde bei der Versorgung von den Frakturen von 32 Patienten (Klingengruppe) benutzt, und der Rest der Frakturen (Schraubengruppe, n = 33) wurde mit PFN mit Schraube versorgt. Das Durchschnittsalter betrug 76.01 Jahre in Klingengruppe und 75.82 Jahre in Schraubengruppe (p = 0.905). Die durchschnittliche Nachverfolgungsdauer betrug 27.6 Monaten (Klingengruppe: 34.2 ± 19.1 Monaten; Schraubengruppe: 18.6 ± 7.9 Monaten; p < 0.001). Die beiden Gruppen wurden im Rahmen von Tipp-Apex Abstand (TAD), Calcar referenzierter Tipp-Apex Abstand (Cal-TAD), Implantatenposition, Cut-Out Raten und Fehlschläge von Implantation. Funktionale Ergebnissen wurden mit Hilfe von Harris Hip Score (HHS) bewertet.

Ergebnisse Die beiden Gruppen unterschieden sich nicht im Rahmen von Cut-out, Implantatenposition und Varus-Kollaps. Insgesamt sechs Frakturen resultierten mit Cut-out (Klingengruppe n = 2, Schraubengruppe n = 4; p = 0.672), und neun Frakturen resultierten mit Varus-Kollaps (Klingengruppe n = 5, Schraubengruppe n = 4; p = 0,733). Harris Hip Scores waren ähnlich bei beiden Gruppen (Klingengruppe: 72.70 ± 18.43; Schraubengruppe: 80.83 ± 18.75; p = 0.84).

Key words

helical blade - lag screw - cut-out - trochanteric fracture - proximal femoral nail

Schlüsselwörter

Klinge - Schraube - Cut-out - pertrochantäre Fraktur - proximaler Femurnagel

Publication History

Article published online:
24 November 2020

• References

• 1 Braithwaite RS, Col NF, Wong JB. Estimating hip fracture morbidity, mortality and costs. J Am Geriatr Soc 2003; 51: 364-370 doi:10.1046/j.1532-5415.2003.51110.x
• 2 Jain R, Basinski A, Kreder HJ. Nonoperative treatment of hip fractures. Int Orthop 2003; 27: 11-17 doi:10.1007/s00264-002-0404-y
• 3 Clayer MT, Bauze RJ. Morbidity and mortality following fractures of the femoral neck and trochanteric region: analysis of risk factors. J Trauma 1989; 29: 1673-1678 doi:10.1097/00005373-198912000-00016
• 4 Esen E, Dur H, Ataoglu MB. et al. Evaluation of proximal femoral nail-antirotation and cemented, bipolar hemiarthroplasty with calcar replacement in treatment of intertrochanteric femoral fractures in terms of mortality and morbidity ratios. Eklem Hastalik Cerrahisi 2017; 28: 35-40 doi:10.5606/ehc.2017.53247
• 5 Kaufer H. Mechanics of the treatment of hip injuries. Clin Orthop Relat Res 1980; (146) 53-61
• 6 Ruecker AH, Rupprecht M, Gruber M. et al. The treatment of intertrochanteric fractures: results using an intramedullary nail with integrated cephalocervical screws and linear compression. J Orthop Trauma 2009; 23: 22-30 doi:10.1097/BOT.0b013e31819211b2
• 7 Marsh JL, Slongo TF, Agel J. et al. Fracture and dislocation classification compendium – 2007: Orthopaedic Trauma Association classification, database and outcomes committee. J Orthop Trauma 2007; 21 (Suppl. 10) S1-S133 doi:10.1097/00005131-200711101-00001
• 8 Pervez H, Parker MJ, Vowler S. Prediction of fixation failure after sliding hip screw fixation. Injury 2004; 35: 994-998 doi:10.1016/j.injury.2003.10.028
• 9 Baumgaertner MR, Curtin SL, Lindskog DM. et al. The value of the tip-apex distance in predicting failure of fixation of peritrochanteric fractures of the hip. J Bone Joint Surg Am 1995; 77: 1058-1064 doi:10.2106/00004623-199507000-00012
• 10 Cleveland M, Bosworth DM, Thompson FR. et al. A ten-year analysis of intertrochanteric fractures of the femur. J Bone Joint Surg Am 1959; 41-A: 1399-1408
• 11 Goffin JM, Pankaj P, Simpson AH. The importance of lag screw position for the stabilization of trochanteric fractures with a sliding hip screw: a subject-specific finite element study. J Orthop Res 2013; 31: 596-600 doi:10.1002/jor.22266
• 12 Kuzyk PRT, Zdero R, Shah S. et al. Femoral head lag screw position for cephalomedullary nails: a biomechanical analysis. J Orthop Trauma 2012; 26: 414-421 doi:10.1097/BOT.0b013e318229acca
• 13 Al-Munajjed AA, Hammer J, Mayr E. et al. Biomechanical characterisation of osteosyntheses for proximal femur fractures: helical blade versus screw. Stud Health Technol Inform 2008; 133: 1-10
• 14 Okcu G, Ozkayin N, Okta C. et al. Which implant is better for treating reverse obliquity fractures of the proximal femur: a standard or long nail?. Clin Orthop Relat Res 2013; 471: 2768-2775 doi:10.1007/s11999-013-2948-0
• 15 Parker MJ, Palmer CR. A new mobility score for predicting mortality after hip fracture. J Bone Joint Surg Br 1993; 75: 797-798
• 16 Harris W. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am 1969; 51: 737-755
• 17 Strauss E, Frank J, Lee J. et al. Helical blade versus sliding hip screw for treatment of unstable intertrochanteric hip fractures: a biomechanical evaluation. Injury 2006; 37: 984-989 doi:10.1016/j.injury.2006.06.008
• 18 Sommers MB, Roth C, Hall H. et al. A laboratory model to evaluate cutout resistance of implants for pertrochanteric fracture fixation. J Orthop Trauma 2004; 18: 361-368 doi:10.1097/00005131-200407000-00006
• 19 Luo Q, Yuen G, Lau TW. et al. A biomechanical study comparing helical blade with screw design for sliding hip fixations of unstable intertrochanteric fractures. ScientificWorldJournal 2013; 2013: 351936 doi:10.1155/2013/351936
• 20 Park JH, Lee YS, Park JW. et al. A comparative study of screw and helical proximal femoral nails for the treatment of intertrochanteric fractures. Orthopedics 2010; 33: 81-85 doi:10.3928/01477447-20100104-11
• 21 DʼArrigo C, Carcangiu A, Perugia D. et al. Intertrochanteric fractures: comparison between two different locking nails. Int Orthop 2012; 36: 2545-2551 doi:10.1007/s00264-012-1684-5
• 22 Stern R, Lübbeke A, Suva D. et al. Prospective randomised study comparing screw versus helical blade in the treatment of low-energy trochanteric fractures. Int Orthop 2011; 35: 1855-1861 doi:10.1007/s00264-011-1232-8
• 23 Kashigar A, Vincent A, Gunton MJ. et al. Predictors of failure for cephalomedullary nailing of proximal femoral fractures. Bone Joint J 2014; 96-B: 1029-1034 doi:10.1302/0301-620X.96B8.33644
• 24 Lee PY, Lin KJ, Wei HW. et al. Biomechanical effect of different femoral neck blade position on the fixation of intertrochanteric fracture: a finite element analysis. Biomed Tech (Berl) 2016; 61: 331-336 doi:10.1515/bmt-2015-0091
• 25 Hwang JH, Garg AK, Oh JK. et al. A biomechanical evaluation of proximal femoral nail antirotation with respect to helical blade position in femoral head: A cadaveric study. Indian J Orthop 2012; 46: 627-632 doi:10.4103/0019-5413.104186
• 26 Turgut A, Kalenderer Ö, Günaydın B. et al. Proximal Femoral Nail Antirotation (PFNA) in the lateral decubitus position without a traction table. Acta Orthop Traumatol Turc 2014; 48: 513-520 doi:10.3944/AOTT.2014.14.0098
• 27 Bojan AJ, Beimel C, Taglang G. et al. Critical factors in cut-out complication after Gamma Nail treatment of proximal femoral fractures. BMC Musculoskelet Disord 2013; 14: 1 doi:10.1186/1471-2474-14-1
• 28 Hsueh KK, Fang CK, Chen CM. et al. Risk factors in cutout of sliding hip screw in intertrochanteric fractures: an evaluation of 937 patients. Int Orthop 2010; 34: 1273-1276 doi:10.1007/s00264-009-0866-2
• 29 Andress HJ, Forkel H, Grubwinkler M. et al. Versorgung der per- bis subtrochantären Femurfraktur durch Gammanagel und modulare Hüftprothese. Differentialindikation und Ergebnisse. Unfallchirurg 2000; 103: 444-451 doi:10.1007/s001130050564
• 30 Choi HJ, Kim E, Shin YJ. et al. The timing of surgery and mortality in elderly hip fractures: A retrospective, multicenteric cohort study. Indian J Orthop 2014; 48: 599-604 doi:10.4103/0019-5413.144232
• 31 Espinosa KA, Gélvez AG, Torres LP. et al. Pre-operative factors associated with increased mortality in elderly patients with a hip fracture: A cohort study in a developing country. Injury 2018; 49: 1162-1168 doi:10.1016/j.injury.2018.04.007
• 32 Gillespie WJ, Walenkamp GH. Antibiotic prophylaxis for surgery for proximal femoral and other closed long bone fractures. Cochrane Database Syst Rev 2010; (03) CD000244 DOI: 10.1002/14651858.CD000244.pub2.