Confounding variables affecting long term results of standard two screw cephalomedullary nail in intertrochanteric fractures of femur
Keywords:Inter-trochanteric hip fractures, Trochanteric fixation nail, Functional outcome
Background: Inter trochanteric fractures of femur are common fractures in the elderly. The aim of the study was to assess the long-term functional outcome of patients treated with trochanteric fixation nail (TFN) for inter trochanteric femur fractures and to determine variables which affect the final outcome of surgery at the end of five years.
Methods: The study was done at tertiary centre in central India with 152 patients who sustained intertrochanteric femur fracture. The patients were followed up at 6 weeks, 6 months, 1 year, 2 years and 5 years after the surgery. The assessment of pain, functional activity, walking ability and range of motion were assessed by Harris hip score at 6 months, 1 year, 2 years and 5 years.
Results: The good/excellent outcome at the end of 5 years was found in 84% of cases. Patients with age less than 65 years and male patients had better outcome at the end of five years. Some of the complications encountered with this type of implant were z effect, delayed union, screw back-out/breakage, varus collapse which affected the final outcome.
Conclusions: TFN is effective treatment technique for inter trochanteric fractures of femur worldwide. There are some complications which can occur with this type of implant in early post-operative period but still long-term follow-up of patients suggested that the fracture pattern, preoperative mobility status, timing of surgery, post op mobilization also plays a key role in determining functional outcome of patients.
Knobe M, Gradl G, Ladenburger A, Tarkin IS, Pape HC. Unstable Intertrochanteric Femur Fractures: Is There a Consensus on Definition and Treatment in Germany? Clin Orthop Relat Res. 2013;471(9):2831-40.
Boyd HB, Griffin. Classification and treatment of trochanteric fractures. Arch surg. 1949;58(6): 853-66.
Bhandari M, Schemitsch E, Jonsson 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;23:460-4.
Halder SC. The gamma nail for peritrochanteric fractures. J Bone Joint Surg. 1992;74-B:340-4.
Fogagnolo F, Kfuri Jr M, Paccola CA. Intramedullary fixation of pertrochanteric hip fractures with the short AO-ASIF proximal femoral nail. Arch Orthop Trauma Surg. 2004;124:31-7.
Muller ME, Nazarian S. Classification of fractures of the femur and its use in the A.O. index (author’s transl). Rev Chir Orthop Reparatrice Appar Mot. 1981;67:297-309.
Harris WH. 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;51:737-55.
Gotfried Y. The lateral trochanteric wall: a key element in the reconstruction of unstable pertrochanteric hip fractures. Clin Orthop. 2004;425:82-6.
Haidukewych GJ, Israel TA, Berry DJ. Reverse obliquity fractures of the intertrochanteric region of the femur. J Bone Joint Surg Am. 2001;83:643-50.
Palm H, Jacobsen S, Sonne-Holm S, Gebuhr P. Integrity of the lateral femoral wall in intertrochanteric hip fractures: an important predictor of a re-operation. J Bone Joint Surg Am. 2007;89:470-5.
Brown TD, Ferguson AB Jr. Mechanical property distributions in the cancellous bone of the human proximal femur. Acta Orthop Scand. 1980;51:429-37.
Koyuncu S, Altay T, Kayalı C, Ozan F, Yamak K. Mechanical failures after fixation with proximal femoral nail and risk factors. Clin Interv Aging. 2015;10:1959-65.
Simmermacher RKJ, Bosch AM, Van der Werken C. The AO/ ASIF- Proximal femoral nail: a new device for the treatment of unstable proximal femoral fractures. Injury. 1999;30(5):327-32.
Smeets SJM, Kuijt G, Van Eerten PV. Z-effect after intramedullary nailing systems for trochanteric femur fractures. Chin J Traumatol. 2017;20(6):333-8.
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.
Chun YS, Oh H, Cho YJ, Rhyu KH. Technique and Early Results of Percutaneous Reduction of Sagittally Unstable Intertrochateric Fractures. Clin Orthop Surg. 2011;3(3):217-24.
Reindl R, Harvey EJ, Berry GK, Rahme E. Canadian Orthopaedic Trauma Society (COTS). Intramedullary Versus Extramedullary Fixation for Unstable Intertrochanteric Fractures: A Prospective Randomized Controlled Trial. J Bone Joint Surg Am. 2015;97(23):1905-12.
Niu E, Yang A, Harris AH, 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 Res. 2015;473(11):3647-55.
Kulkarni SG, Babhulkar SS, Kulkarni SM, Kulkarni GS, Kulkarni MS, Patil R. Augmentation of intramedullary nailing in unstable intertrochanteric fractures using cerclage wire and lag screws: a comparative study. Injury. 2017;48(2):S18-S22.