Analysis of surgical factors of failure of PFNA after intertrochanteric fracture

doi:10.13418/j.issn.1001-165x.2020.06.020

Chinese Journal of Clinical Anatomy ›› 2020, Vol. 38 ›› Issue (6) : 728-734. DOI: 10.13418/j.issn.1001-165x.2020.06.020

NIU Guo-qing, WU Feng, PENG Zhi-hao, LU Guo-liang, HUO Zhi-qian

Author information +

History +

Abstract

Objective　To investigate the operative factors of failure in femoral intertrochanteric fractures treated with proximal femoral nail anti-rotation (PFNA).　Methods　The material of patients with intertrochanteric fracture who accepted fixation with PFNA were conducted from September 2015 to September 2018 in our hospital and were analyzed retrospectively. Patients who failed in PFNA fixation were 24. Preoperative lateral wall fracture, postoperative reduction mass of medial femoral trochanteric cortex, region of spiral blade located on X-ray film, and the tip-apex distance (TAD) were observed through the X-ray film of preoperative, postoperative and internal fixation failure.　Results　In the 24 cases who failed in PFNA fixation, 13 cases (accounting for 54%) had lateral wall fractures before operation, 5 cases had dangerous lateral wall fractures, and 6 cases had no lateral wall fractures. While there were 16 cases (accounting for 67%) of medial cortical reduction negative support, 6 cases of positive support and 2 cases of neutral support. At the same time, there were 16 cases (accounting for 67%) with TAD>25 mm, 6 cases with TAD between 10mm~25mm, 2 cases with TAD<10 mm. In the region of spiral blade located on the positive X-ray film, there were 19 cases (accounting for 79%) located on the upper side, 3 cases in the middle-lower side and 2 cases in the lower side. In addition, in the lateral X-ray film, there were 17 cases (accounting for 71%) located in the front side, 5 cases in the back side, and 2 cases in the middle side.　Conclusions　The risk of internal fixation increase when there were lateral wall fractures before operation, poor medial cortex reduction, oversize TAD and poor location of spiral blade on the X-ray film in the femoral intertrochanteric fracture fixed with PFNA.

Key words

Femoral intertrochanteric fracture / 　Proximal femoral nail anti-rotation (PFNA) / 　Failure of fixation

Cite this article

EndNote

Ris (Procite)

Bibtex

Download Citations

NIU Guo-qing, WU Feng, PENG Zhi-hao, LU Guo-liang, HUO Zhi-qian. Analysis of surgical factors of failure of PFNA after intertrochanteric fracture[J]. Chinese Journal of Clinical Anatomy. 2020, 38(6): 728-734 https://doi.org/10.13418/j.issn.1001-165x.2020.06.020

References

[1] Daugaard CL, Jørgensen HL, Riis T, et al. Is mortality after hip fracture associated with surgical delay or admission during weekends and public holidays? A retrospective study of 38,020 patients[J]. Acta Orthop, 2012, 83(6): 609-613.
[2] 张世民, 李海丰, 俞光荣. 老年髋部骨折的临床治疗流程[J]. 中国矫形外科杂志, 2005, 13(18): 1365-1368.
[3] Cho JW, Kent WT, Yoon YC, et al. Fracture morphology of AO/OTA 31-A trochanteric fractures: a 3D CT study with an emphasis on coronal fragments[J]. Injury, 2017, 48(2): 277-284.
[4] Kroupa J. [Classification and treatment of open fractures of the long bones of extremities][J]. Rozhl Chir, 1981, 60(8): 513-21.
[5] Sun LL, Li Q, Chang SM. The thickness of proximal lateral femoral wall[J]. Injury, 2016, 47(3): 784-785.
[6] Gotfried Y, Kovalenko S, Fuchs D. Nonanatomical reduction of displaced subcapital femoral fractures (Gotfried reduction)[J]. J Orthop Trauma, 2013, 27(11): e254-e259.
[7] Cleveland M, Bosworth DM, Thompson FR, et al. A ten-year analysis of intertrochanteric fractures of the femur[J]. J Bone Joint Surg Am, 1959, 41(8): 1399-1408.
[8] Gao Z, Lv Y, Zhou F, et al. Risk factors for implant failure after fixation of proximal femoral fractures with fracture of the lateral femoral wall[J]. Injury, 2018, 49(2): 315-322.
[9] Pradeep AR, Kirankumar A, Dheenadhayalan J, et al. Intraoperative lateral wall fractures during Dynamic Hip Screw fixation for intertrochanteric fractures-incidence, causative factors and clinical outcome[J]. Injury, 2018, 49(2): 334-338.
[10]Gotfried, Y. The lateral trochanteric wall: a key element in the reconstruction of unstable pertrochanteric hip fractures[J]. Clin Orthop Relat Resh, 2004, 425: 82-86.
[11]Chehade MJ, Carbone T, Awward D, et al. Influence of fracture stability on early Patient mortality and reoperation after pertrochanteric and intertrochanteric hip fractures[J]. J Orthop Trauma, 2015, 29(12): 538-543.
[12] Gotfried Y. Integrity of the lateral femoral wall in intertrochanteric hip fractures: an important predictor of a reoperation[J]. J Bone Joint Surg Am, 2007, 89(11): 2552-2553.
[13]Díaz VJ, Cañizares ACP, Martín IA, et al. Predictive variables of open reduction in intertrochanteric fracture nailing: a report of 210 cases[J]. Injury, 2016, 47(Suppl 3): S51-S55.
[14]Kulkarni SG, Babhulkar SS, Kulkarni SM, et al. Augmentation of intramedullary nailing in unstable intertrochanteric fractures using cerclage wire and lag screws: a comparative study[J]. Injury, 2017,48 (Suppl 2): S18-S22.
[15] 俞光荣, 梅炯, 王家骐, 等. 防旋股骨近端髓内钉治疗不稳定性转子间骨折33例[J]. 中华创伤杂志, 2007, 23(2): 83-86.
[16] 李双, 张世民, 张立智, 等. 不同组合前内侧皮质支撑复位对股骨转子间骨折髓内钉术后稳定性影响的生物力学研究[J]. 中华创伤骨科杂志, 2019, 21(1): 57-64.
[17]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]. J Orthop Trauma, 2009, 23(1): 22-30.
[18]Chang SM, Zhang YQ, Ma Z, et al. Fracture reduction with positive medial cortical support: a key element in stability reconstruction for the unstable pertrochanteric hip fractures[J]. Arch Orthop Trauma Surg, 2015, 135(6): 811-818.
[19]张世民, 张英琪, 李清, 等. 内侧皮质正性支撑复位对老年股骨粗隆间骨折内固定效果的影响[J]. 中国矫形外科杂志, 2014, 22(14): 1256-1261.
[20]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]. J Bone Joint Surg Am, 1995, 77(7): 1058-1064.
[21]Baumgaertner MR, Solberg BD. Awareness of tip-apex distance reduces failure of fixation of trochanteric fractures of the hip[J]. J Bone Joint Surg, 1997, 79(6): 969-971.
[22]Li S, Chang SM, Jin YM, et al. A mathematical simulation of the tip-apex distance and the calcar-referenced tip-apex distance for intertrochanteric fractures reduced with lag screws[J]. Injury, 2016, 47(6): 1302-1308.
[23]李建涛, 张里程, 唐佩福. 股骨粗隆间骨折治疗理念与内固定器械的发展概述[J]. 中国修复重建外科杂志, 2019, 33(1): 8-14.
[24]Zhou JQ, Chang SM. Failure of PFNA: helical blade perforation and tip-apex distance[J]. Injury, 2012, 43(7): 1227-1228.
[25] Parker MJ. Cutting-out of the dynamic hip screw related to its position[J]. J Bone Joint Surgery Jr, 1992, 74(4): 625.
[26]Kuzyk PRT, Zdero R, Shah S, et al. Femoral head lag screw position for cephalomedullary nails: a biomechanical analysis[J]. J Orthop Trauma, 2012, 26(7): 414-421.
[27]Turgut A, Kalenderer Ö, Karapınar L, et al. Which factor is most important for occurrence of cutout complications in patients treated with proximal femoral nail antirotation? Retrospective analysis of 298 patients[J]. Arch Orthop Trauma Surg, 2016, 136(5): 623-630.
[28]Kane P, Vopat B, Heard W, et al. Is tip apex distance as important as we think? A biomechanical study examining optimal lag screw placement[J]. Clin Orthop Relat Res, 2014, 472(8): 2492-2498.