Functional and radiological outcomes of intertrochanteric fractures treated with proximal femoral nail

Authors

  • Mayur Chopra Department of Orthopaedics, Medanta the Medicity, Gurugram, Haryana, India
  • Sanjay Kumar Srivastava Department of Orthopaedics, Medanta the Medicity, Gurugram, Haryana, India
  • Sumit Kumar Department of Orthopaedics, Medanta the Medicity, Gurugram, Haryana, India
  • Deepak Kumar Mishra Department of Orthopaedics, Medanta the Medicity, Gurugram, Haryana, India

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20203721

Keywords:

Proximal femoral nail, Intertrochanteric fractures, Hip fracture, Harris hip score, Lower extremity functional scale

Abstract

Background: Hip fracture is one of the most invalidating diseases affecting geriatric populations and in fall related fractures, they lead to most severe morbidity and mortality. Their surgical treatment allows stable fracture fixation which allows the early weight bearing. Many devices have been developed, yet mechanical failures still occur. The aim of this study was to assess the functional and radiological outcomes of intertrochanteric fractures treated with proximal femoral nail.

Methods: 46 patients with intertrochanteric fractures fixed with proximal femoral nail were assessed. Functional outcome was measured by Harris hip score (HHS) and lower extremity functional scale (LEFS) and radiological outcome was measured by tip apex distance (TAD), any changes in neck shaft angle, neck length and the offset as compared to uninjured hip.

Results: The tip apex distance on the postoperative X-ray was found to be 22.02±2.499 mm, change in the neck length as compared to the uninjured hip was found to be 1.507±1.1808 and change in the offset and neck shaft angle was 1.470±1.0126 and -1.602±1.5992 respectively. The LEFS was found to be 70.63±6.584 whereas the HHS was found to be 90.35±7.593

Conclusions: With the increase in TAD the functional and radiological outcome worsens. It was also seen that the cutoff of 25 mm stands true in predicting the outcome of the patients with PFN in intertrochanteric fractures. Hence, the TAD should be routinely measured and if found more than 25 mm then proper precautions like delayed weight bearing may be advised.

Author Biography

Mayur Chopra, Department of Orthopaedics, Medanta the Medicity, Gurugram, Haryana, India

Resident 

Department of orthopaedics

Medanta the medicity

gurgaon

india

References

Hall SE, Williams JA, Senior JA, Goldswain PR, Criddle RA: Hip fracture outcomes: quality of life and functional status in older adults living in the community. ANZJ Med. 2000;30:327-32.

Jacobsen SJ, Goldberg J, Miles TP. Hip fracture incidence among the old and very old: a population-based study of 745,435 cases. Am J Public Health.1990;80:871-3.

Malhotra N, Mithal A: Osteoporosis in Indians. Indian J Med Res. 2008;127:263-268.

Jha RM, Mithal A, Malhotra N, Brown EM. Pilot case-control investigation of risk factors for hip fractures in the urban Indian population. BMC Musculoskeletal Disorders. 2010;11:49.

Trikha V, Rastogi S. Epidemiology and Rehabilitation of Hip Fractures in the Geriatric Population. IJPMR. 2005;16(1):16-9.

Jewett EL. One-piece angle nail for trochanteric fractures. Journal of Bone and Joint Surgery. 1941;23:803-10.

McLoughlin SW, Wheeler DL, Rider J, Bolhofner B. Biomechanical evaluation of the dynamic hip screw with two- and four-hole side plates. Journal of Orthopaedics and Traumatology. 2000;14(5):318-23.

Cleveland M, Bosworth DM, Thompson FR, Wilson HJ Jr., Ishizuka T. A ten-year analysis of intertrochanteric fracture of the femur. Journal of Bone and Joint Surgery. 1959;41-A:1399-1408.

Kyle RF, Gustilo RB, Premer RF. Analysis of six hundred and twenty-two intertrochanteric hip fractures. Journal of Bone and Joint Surgery.1979;61A:216-21.

Baumgartner MR. Intertrochanteric hip fracture. In: Browner BD, Jupiter JB, Levine AM, Trafton PG, eds. Skeletal Trauma. Philadelphia, PA Saunders: 2003;1776-816.

Parker MJ. Cutting-out of the dynamic hip screw related to its position. Journal of Bone and Joint Surgery. 1992;74(4):625.

Geller JA, Saifi C, Morrison TA, Macaulay W. Tip-apex distance of intramedullary devices as a predictor of cut-out failure in the treatment of peri trochanteric elderly hip fractures. International Orthopaedics. 2010;34:719–722.

Blumefeld TJ. Explaining the use of the Harris Hip Questionnaire. Available at: http://www.bananarepublican.info/Files/Harris_Hip_Score.pdf. Accessed on 10 April 2020.

Harris Hip Score. Available at: http:// www.advancedortho.info/upload/HarrisHipScore.pdf. Accessed on 10 April 2020.

Binkley JM, Stratford PW, Lott SA, Riddle DL. The Lower Extremity Functional Scale (LEFS): scale development, measurement properties, and clinical application. North American Orthop-aedic Rehabilitation Research Network. Phys Ther. 1999;79(4):371-83.

Shields RK, Enloe EJ, Evans RE, Smith KB, Steckel SD. Reliability, validity, and responsiveness of functional tests in patients with total joint replacement. Physical Therapy.1995;75(3):169-76.

Hoeksma HL, Van den Ende CHM, Ronday HK, Heering A, Breedveld FC, Dekker J. Comparison of the responsiveness of the Harris Hip Score with generic measures for hip function in osteoarthritis of the hip. Ann Rheum Dis. 2003;62:935-38.

Yeung TS, Wessel J, Stratford P, Macdermid J. Reliability, validity, and responsiveness of the lower extremity functional scale for inpatients of an orthopaedic rehabilitation ward. J Orthop Sports Phys Ther. 2009;39(6):468-77.

Karagas MR, Lu-Yao GL, Barrett JA, Beach ML, Baron JA: Heterogeneity of hip fracture: age, race, sex, and geographic patterns of femoral neck and trochanteric fractures among the US elderly. American Journal of Epidemiology. 1996;143(7):677-82.

Chang KP, Center JR, Nguyen TV, Eisman JA. Incidence of hip and other osteoporotic fractures in elderly men and women: Dubbo Osteoporosis Epidemiology Study. J Bone Miner Res. 2004 Apr;19(4):532-6.

Tanner DA, Kloseck M, Crilly RG, Chesworth B, Gilliland J. Hip fracture types in men and women change differently with age. BMC Geriatr. 2010;10:12.

Paul TV, Thomas N, Seshadri MS, Oommen R, Jose A, Mahendri NV. Prevalence of osteoporosis in ambulatory postmenopausal women from a semiurban region in Southern India: relationship to calcium nutrition and vitamin D status. Endocr Pract. 2008;14(6):665-71.

Agarwal N, Mithal A, Dhingra V, Kaur P, Godbole MM, Shukla M. Effect of two different doses of oral cholecalciferol supplementation on serum 25-hydroxy-vitamin D levels in healthy Indian postmenopausal women: A randomized controlled trial. Indian J Endocrinol Metab., 2013 Sep-Oct; 17(5):883–889.

Güven M, Yavuz U, Kadıo˘glu B, Akman B, Kılınc¸o˘glu V, Ünayc K, Altıntas F. Importance of screw position in intertrochanteric femoral fractures treated by dynamic hip screw. Orthopaedics & Traumatology: Surgery & Research. 2010;96:21-7

Andruszkow H, Frink M, Frömke C, Matityahu A, Zeckey C, Mommsen P, Suntardjo S, Krettek C, Hildebrand F. Tip apex distance, hip screw placement, and neck shaft angle as potential risk factors for cut-out failure of hip screws after surgical treatment of intertrochanteric fractures. International Orthopaedics. 2012;36:2347-54.

Lindsey RW, Ahmed S, Overturf S, Tan A, Gugala Z. Accuracy of lag screw placement for the dynamic hip screw and the cephalomedullary nail. Orthopedics. 2009;32(7):5.

Siwach RC, Rohilla R, Singh R, Singla R, Sangwan SS, Gogna P. Radiological and functional outcome in unstable, osteoporotic trochanteric fractures stabilized with dynamic helical hip system. StratTraum Limb Recon.2013;8:117-22

Lobo-Escolar A, Joven E, Iglesias D, Herrera A. Injury, Int. J. Care Injured. 2010;41:1312-6.

Zirngibl B, Biber R, Bail HJ. How to prevent cut-out and cut-through in biaxial proximal femoral nails: is there anything beyond lag screw positioning and tip-apex distance?. Int Orthop. 2013;37(7):1363-68.

Uzun M, Erturer E, Özturk I, Akman S, Seckin F, Özcelik IB. Long-term radiographic complications following treatment of unstable intertrochanteric femoral fractures with the proximal femoral nail and effects on functional results. Acta Orthop Traumatol Turc. 2009;43(6):457-63

Davies J, Mokawem M, Guy S.Tip Apex Distance: a useful method to assess extra-capsular neck of femur fixation? J Trauma Treatment. 2012;1(3)1-3.

Pajarinen J, Lindahl J, Savolainen V, Michelsson O, Hirvensalo E. Femoral shaft medialisation and neck-shaft angle in unstable pertrochanteric femoral fractures. International Orthopaedics (SICOT). 2004;28:347-53.

Akan K, Cift H, Ozkan K, Eceviz E, Tasyikan L, Eren A. Effect of osteoporosis on clinical outcomes in intertrochanteric hip fractures treated with a proximal femoral nail. The Journal of International Medical Research. 2011;39:857-65.

Tandon S, Vijayvargiya M, Pathak A. Outcome Analysis of Proximal Femoral Nail in Stable intertrochanteric Femur Fractures. Journal of Evolution of Medical and Dental Sciences. 2015;4(15):2533-40.

Kraus M, Krischak G, Wiedmann K, Riepl C, Gebhard F, Jöckel JA et al. Clinical evaluation of PFNAA (R) and relationship between the tip-apex distance and mechanical failure. Der Unfallchirurg.2011;114(6):470-8.

Bruijn KD, Hartog DD, Tuinebreijer W, Roukema G. Reliability of Predictors for Screw Cutout in Intertrochanteric Hip Fractures. J Bone Joint Surg Am. 2012;94:1266-72.

Nikoloski AN, Osbrough AL, Yates PJ. Should the tip-apex distance (TAD) rule be modified for the proximal femoral nail antirotation (PFNA)? A retrospective study. Journal of Orthopaedic Surgery and Research. 2013;8:35.

Downloads

Published

2020-08-26

Issue

Section

Original Research Articles