DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20173154

Role of cephalomedullary nail in proximal femur fractures

Nishant Kumar, Dhruv Sharma, Kuljit Kumar

Abstract


Background: Hip fractures are recognized to be a major public health problem. Key determinants of hip fractures include age, osteoporosis, and falls. In these determinants socioeconomic status, have not been well explored. Under eccentric loading, high bending loads occur, leading to failure of the osteosynthetis anchorage at the center of the femoral head.The introduction of the reconstruction nail has broadened the indications for the intramedullary fixation of difficult femoral fractures. The operative technique is however complicated. Some technical difficulties encountered during its use are presented together with guidance to allow these problems to be avoided.

Methods: This Study had included 47 cases which were operated by single surgeon and use of different implant (cephalomedullary nail) was randomized irrespective of fracture types and pattern. This study was done over a period of 12 months (October 2013 to October 2014) with 1 month, 3 months, 6 months, 12 months follow up. At every visit patient were assessed as per Oxford hip score. Type of implant used was PFNA, Intertan, Sirus Nail.

Results: The mean age of the patients was 65.68 (±13.55) years. Severe pain was observed among majority of the patients at one month (70.2%) which became mild (40.4%) and moderate (34%) at 3 months. Very mild pain was found in 36.2% patients at 6 months and in 61.7% at 12 months. The limping was all the time among all the patients at one month. However, the limping was found often in 46.8% at 3 months and sometimes in 57.4% at 6 months and 53.2% at 12 months. The hip score was found to be severe among all the patients at one month. However, moderate to severe hip was in 46.8% patients at 3 months, mild to moderate was in 57.4% at 6 months and satisfactory joint function was in 68.1% at 12 months. The comparison of Hip score according to long or short nail at one 3, 6 and 12 months showed no difference.

Conclusions: Cephalomedullary nails with adequate technique so that the lag screws by purchase in the centre-centre or posterior-inferior quadrant combines the benefit of sliding hip screw as well as intramedullary implants. So we recommend the use of cephalomedullary nails in proximal femur fractures especially the unstable fractures.


Keywords


Proximal femur fracture, Cephalomedullary nail

Full Text:

PDF

References


Cooper C, Campion G, Melton LJ 3rd. Hip fractures in the elderly: a world-wide projection. Osteoporos Int. 1992;2(6):285-9.

Kannus P, Parkkari J, Sievanen H, Heininen A, Vuori I, Jarvinen M. Epidemiology of hip fractures. Bone. 1996;18(1):57-63.

Dhanwal DK, Dennison EM, Harvey NC, Cooper C. Epidemiology of hip fracture: Worldwide geographic variation. Indian J Orthop. 2011;45(1):15–22.

Hagino H, Katagiri H, Okano T, Yamamoto K, Teshima R. Increasing incidence of hip fracture in Tottori Prefecture, Japan: Trend from 1986 to 2001. Osteoporos Int. 2005;16:1963–8.

Lau EM, Cooper C, Fung H, Lam D, Tsang KK. Hip fracture in Hong Kong over the last decade--a comparison with the UK. J Public Health Med. 1999;21:249–50.

Russell TA. Intertrochanteric fractures. In: Bucholz RW, Court- Browm CM, Heckman JD, Tornetta III P, editors. Rockwood and Green’s. Volume 2. 7th ed. China: Lippincott Williams & Wilkins: 2010: 1597.

Marks R. Hip fracture epidemiological trends, outcomes, and risk factors, 1970–2009. Int J Gen Med. 2010;3:1–17

Bonnaire F, Zenker H, Lill C, Weber AT, Linke B. Treatment strategies for proximal femur fractures in osteoporotic patients. Osteoporous Int. 2005;16 Suppl 2:93-102.

Coleman NP, Greenough CG, Warren PJ, Clark DW, Burnett R. Technical aspects of the use of the Russell-Taylor reconstruction nail. Injury. 1991;22(2):89-92.

Clawson DK. Trochanteric fractures treated by the sliding screw plate fixation method. J Trauma. 1964;4:737–52.

Kyle RF, Gustilo RB, Premer RF. Analysis of six hundred and twenty-two inter trochantenc hip fractures. J. Bone joint (Am). 1979;61:216-21.

Kivi MM, Mirbolook A, Jahromi SK, Rad MR. Fixation of Intertrochanteric Fractures: Dynamic Hip Screw versus Locking Compression Plate.Trauma Mon. 2013;18(2):67–70.

Ozkan K, Turkmen I, Sahin A, Yildiz Y, Erturk S, Soylemez MS. A biomechanical comparison of proximal femoral nails and locking proximal anatomic femoral plates in femoral fracture fixation: A study on synthetic bones. Indian J Orthop. 2015;49(3):347-51.

Laskin RS, Gruber MA, Zimmerman AJ. Intertrochanteric fractures of the hip in the elderly: a retrospective analysis of 236 cases. Clin Orthop. 1979;(141):188-95.

Nue Meller B, Lucht U, Grymer F, Bartholdy NJ. Early rehabilitation following osteosynthesis with the sliding hip screw for trochanteric fractures. Scand J Rehabil Med. 1985;17(1):39-43.

Pillar T, Gaspar E, Poplingher AR, Dickstein R. Operated versus non-operated hip fractures in a geriatric rehabilitation hospital. Int Disabil Stud. 1988;10(3):104-6.

Babhulkar SS. Management of trochanteric Fractures. Indian J Orthop. 2006;40(4):210-8.

Mittal R, Banerjee S. Proximal femoral fractures: Principles of management and review of literature. J Clin Orthop Trauma. 2012;3(1):15–23.

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.

Matre K, Havelin LI, Gjertsen JE, Espehaug B, Eevang JM. Intramedullary Nails Result in More Reoperations Than Sliding Hip Screws in Two-part Intertrochanteric Fractures. Clin Orthop Relat Res. 2013;471(4):1379–86.

Aros B, Tosteson ANA, ScD, Gottlieb DJ, Koval KJ. Is a Sliding Hip Screw or IM Nail the Preferred Implant for Intertrochanteric Fracture Fixation? Clin Orthop Relat Res. 2008;466(11):2827–32.

Parker MJ, Handoll HH. Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures in adults. Cochrane Database Syst Rev. 2008;(3):CD000093.

Radford PJ, Needoff M, Webb JK. A prospective randomised comparison of the dynamic hip screw and the gamma locking nail. J Bone Jt Surgery, Br Vol. 1993;75:789–93.

O’Brien PJ, Meek RN, Blachut PA, Broekhuyse HM, Sabharwal S. Fixation of intertrochanteric hip fractures:Gamma nail versus dynamic hip screw. A randomized, prospective study. Can J Surg. 1995;38:516–20.

Bhandari M, Schemitsch E, Jönsson 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.

Kouvidis G, Sakellariou VI, Mavrogenis AF, Stavrakakis J, Kampas D, Galanakis J, et al. Dual lag screw cephalomedullary nail versus the classic sliding hip screw for the stabilization of intertrochanteric fractures. A prospective randomized study. Strategies Trauma Limb Reconstr. 2012;7(3):155–62.

Hoffman CW, Lynskey TG. Intertrochanteric fractures of the femurs: randomised prospective comparison of the gamma nail and the Ambi hip screw. Aust N Z J Surg. 1996;66(3):151-5.

Curtis MJ. Proximal femoral fractures:a biomechanical study to compare intramedullary and extramedullary fixation. Injury. 1994;25(2):99–104.

Georgiannos D, Lampridis V, Bisbinas I. Complications following Treatment of Trochanteric Fractures with the Gamma3 Nail: Is the Latest Version of Gamma Nail Superior to Its Predecessor? Surg Res Pract. 2014;2014:143598.

Y Arai, S Tokugawa, S Fujita, K Chatani, T Kubo. Proximal femoral nail for treatment of trochanteric femoral fractures. J Orthop Surg. 2007;15(3):273-7.

Cheung JP, Chan CF. Cutout of proximal femoral nail antirotation resulting from blocking of the gliding mechanism during fracture collapse. J Orthop Trauma. 2011;25(6):51-5.

Menezes DF, Gamulin A, Noesberger B. Is the proximal femoral nail a suitable implant for treatment of all trochanteric fractures? Clin Orthop Relat Res. 2005;439:221-7.

Robinson CM, Houshian S, Khan LA. Trochanteric-entry long cephalomedullary nailing of subtrochanteric fractures caused by low-energy trauma. J Bone Joint Surg. 2005;87(10):2217-26.

Hong CC, Nashi N, Makandura MC, Tan JH, Peter L, Murphy D. The long and short of cephalomedullary nails in the treatment of osteoporotic pertrochanteric fracture. Singapore Med J. 2016;58(2):85–91.