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




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BMC Musculoskeletal Disorders

, 18:107

Orthopedics and biomechanics

Abstract

BackgroundThe 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.

MethodsFrom 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.

ResultsThe 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.

ConclusionsThe 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.

KeywordsIntertrochanteric hip fracture PFNA Trochanteric entry point AbbreviationsASAAmerican Society of Anesthesiologists

IMIntramedullary

PFNAProximal femoral nail antirotation

SPMSQShort Portable Mental Status Questionnaire

TADTip-apex distance

VASVisual analogue scale

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

Fuente: https://link.springer.com/







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