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Outcomes of Cephalomedullary Nailing in The Treatment of Extracapsular Proximal Femur Fractures and Factors Affecting it

July 10, 2020/in Volume 6 | Issue 2 | July-December 2020

Vol 6 | Issue 2 | July-Dec 2020 | page:2-6 | Vivek Sodhai, Meghraj Holambe, Chetan Pradhan, Atul Patil, Chetan Puram, Parag Sancheti, Ashok Shyam Author: Vivek Sodhai [1], Meghraj Holambe [2], Chetan Pradhan [1], Atul Patil [2], Chetan Puram [2], Parag Sancheti [2], Ashok Shyam [2,3]. [1] Department of Trauma, Sancheti Institute Of Orthopaedics […]

From The Editor’s Desk!!

July 10, 2020/in Volume 6 | Issue 2 | July-December 2020

Vol 6 | Issue 2 | July-Dec 2020 | page:1 | Ashok Shyam Author: Ashok Shyam [2,3]. [1] Indian Orthopaedic Research Group, Thane, Maharashtra, India. [2] Sancheti Institute for Orthopaedics & Rehabilitation, Pune, Maharashtra, India. Address of Correspondence Dr. Ashok Shyam Head of Academics, Sancheti Institute for Orthopaedics & Rehabilitation, Pune, Maharashtra, India. Email: editor.trauma.international@gmail.com […]

Outcomes of Cephalomedullary Nailing in The Treatment of Extracapsular Proximal Femur Fractures and Factors Affecting it

July 10, 2020/in Volume 6 | Issue 2 | July-December 2020

From The Editor’s Desk!!

July 10, 2020/in Volume 6 | Issue 2 | July-December 2020

Vol 6 | Issue 2 | July-Dec 2020 | page:2-6 | Vivek Sodhai, Meghraj Holambe, Chetan Pradhan, Atul Patil, Chetan Puram, Parag Sancheti, Ashok Shyam

Author: Vivek Sodhai [1], Meghraj Holambe [2], Chetan Pradhan [1], Atul Patil [2], Chetan Puram [2], Parag Sancheti [2], Ashok Shyam [2,3].

[1] Department of Trauma, Sancheti Institute Of Orthopaedics and Rehabilitation, Pune, India.
[2] Department of Orthopaedics, Sancheti Institute Of Orthopaedics and Rehabilitation, Pune, India.
[3] Department of Research, Indian Orthopaedic Research Group, Thane, India.

Address of Correspondence

Dr. Vivek Sodhai,
Lecturer, Department of Trauma, Sancheti Institute Of Orthopaedics and Rehabilitation, Pune, India.
E-mail: vivek.sodhai89@gmail.com

Abstract

Indroduction: Cephalomedullary nailing (CMN) has become popular in treatment of extracapsular proximal femur fractures due to its mechanical advantages. This study aims to analyse the functional outcomes of the same and factors affecting it.
Material and Methods: 140 prospective cases of extracapsular proximal femur fractures were treated with CMN between October 2016 and October 2017 with a minimum follow-up period of 12 months. Patients were clinically assessed with range of motion, weight bearing status, Harris hip score (HHS) and Short form (SF)-36 score. Radiologically, fracture reduction, change in neck shaft angle (NSA) and neck length ratio in comparison to unaffected hip.
Results: 140 patients, 52 had excellent while 88 had good HHS. Patient in age group 20-40 had an average HHS of 87.79, 40-60 age group had an average HHS of 87.41, while patients in age group > 60 years had an average HHS of 87.63. Patients achieved average full weight bearing at 9.94 ± 2.76 weeks (p-value 0.578). Change in the neck shaft angle (NSA) was statistically significant in the immediate post-operative and at 1-year radiographs (p-value <0.001). Comparison of neck length ratio between affected and unaffected hip showed no statistical difference. There was no significant difference in function, range of motion and HHS in males (88.51 ± 2.72) compared with females (87.61 ± 2.98) (p-value 0.082). There was no significant association between occurrence of limp with change in NSA and neck length ratio (all p values >0.05). 6 complications occurred (1 peri-implant fracture, 2 surgical site infections and 3 cases of helical blade migration).
Conclusion: CMN gives excellent functional outcomes in all AO types A1, A2, A3 irrespective of age and sex with early mobilisation, full weight bearing and better functional range of movement. Limp occurred independant of change in NSA and neck length ratio.
Keywords: Extracapsular proximal femur fractures; Cephalomedullary nailing; Unstable intertrochanteric fractures; Reverse oblique fractures..

References

1. Parker MJ, Handoll HH. (2008) Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures in adults. Cochrane Database Syst Rev Jul 16;(3):CD000093.
2. Gullberg B, Johnell O, Kanis JA. (1997) World-wide projections for hip fracture. Osteoporos Int. 7(5):407-13.
3. Kaufer H, Mathews LS, Sonstegard D, Arbor A. (1974) Stable Fixation of Intertrochanteric Fractures A BIOMECHANICAL EVALUATION. J Bone Joint Surg. 56(5):899-907.
4. Weise K, Schwab E. (2001) Stabilization in treatment of per- and subtrochanteric fractures of the femur. Chirug. 72(11):1277-82.
5. Merredy P, Kamath S, Ramakrishnan M, et al. (2009) The AO/ASIF proximal femoral nail antirotation (PFNA): a new design for the treatment of unstable proximal femoral fractures. Injury. Apr;40(4):428–32.
6. Sircar P, Godkar D, Mahgerefteh S, Chambers K, Niranjan S, Cucco R. (2007) Morbidity and mortality among patients with hip fractures surgically repaired within and after 48 hours. Am J Ther. Nov-Dec;14(6):508–13.
7. Garg B, Marimuthu K, Kumar V, Malhotra R, Kotwal PP. (2011) Outcome of short proximal femoral nail antirotation and dynamic hip screw for fixation of unstable trochanteric fractures. A randomised prospective comparative trial. Hip Int. Sep-Oct;21(5):531–6.
8. Shen L, Zhang Y, Shen Y, Cui Z. (2013) Antirotation proximal femoral nail versus dynamic hip screw for intertrochanteric fractures: a meta-analysis of randomized controlled studies. Orthop Traumatol Surg Res. Jun;99(4):377–383.
9. Zou J, Xu Y, Yang H. (2009) A comparison of proximal femoral nail antirotation and dynamic hip screw devices in trochanteric fractures. J Int Med Res. Jul-Aug;37(4):1057–1064.
10. Hwang JH, Garg AK, Oh JK, Oh CW, Lee SJ, Myung-Rae C et al. (2012) A biomechanical evaluation of proximal femoral nail antirotation with respect to helical blade position in femoral head: a cadaveric study. Indian J Orthop. Nov;46(6):627–32.
11. Vaquero J, Munoz J, Prat S, Ramirez C, Aguado HJ, Moreno E et al. (2012) Proximal Femoral Nail Antirotation versus Gamma3 nail for intramedullary nailing of unstable trochanteric fractures. A randomised comparative study. Injury. Dec;43 Suppl 2:S47–S54.
12. D’Arrigo C, Carcangiu A, Perugia D, Scapellato S, Alonzo R, Frontini S et al. (2012) Intertrochanteric fractures: comparison between two different locking nails. Int Orthop. Dec;36(12):2545–2551.
13. Simmermacher RK, Ljungqvist J, Bail H, Hockertz T, Vochteloo AJ, Ochs U et al. (2008) The new proximal femoral nail antirotation (PFNA) in daily practice: results of a multicentre clinical study. Injury Aug;39(8):932–9.
14. Gadegone WM, Salphale YS. (2007) Proximal femoral nail – an analysis of 100 cases of proximal femoral fractures with an average follow up of 1 year. Int Orthop. Jun;31(3):403-8.
15. Boldin C, Seibert FJ, Frankhauser F, Peicha G, Grechenig W, Szyszkowitz R. (2003) The proximal femoral nail (PFN) — a minimal invasive treatment of unstable proximal femoral fractures: a prospective study of 55 patients with a follow-up of 15 months. Acta Orthop Scand. Feb;74(1):53-8.
16. Krigbaum H, Takemoto S, Kim HT, Kuo AC. (2016) Costs and Complications of Short Versus Long Cephalomedullary Nailing of OTA 31-A2 Proximal Femur Fractures in U.S. Veterans. J Orthop Trauma. Mar;30(3):125-9.
17. Jacob J, Desai A, Trompeter A. (2017) Decision Making in the Management of Extracapsular Fractures of the Proximal Femur – is the Dynamic Hip Screw the Prevailing Gold Standard? Open Orthop J. Oct 31;11:1213-1217.
18. https://www2.aofoundation.org/wps/portal/surgerypopup?bone=Femur&segment=Proximal&showPage=indication&print=no&soloState=fbox&teaserTitle=&contentUrl=srg/popup/additional_material/31/31_Classification.jsp
19. Rosenblum SF, Zuckerman JD, Kummer FJ, Tam BS. (1992) A biomechanical evaluation of the gamma nail. J Bone Joint Surg Br. May;74(3):352-7.
20. Leung KS, So WS, Shen WY, Hui PW. (1992) Gamma nails and dynamic hip screws for peritrochanteric fractures: A randomised prospective study in elderly patients. J Bone Joint Surg Br. May;74(3):345-51.
21. Radford PJ, Needoff M, Webb JK. (1993) A prospective randomised comparison of the dynamic hip screw and the gamma locking nail. J Bone Joint Surg Br. Sep;75(5):789-93.
22. Puram C, Pradhan C, Patil A, Sodhai V, Sancheti P, Shyam A. (2017) Outcomes of dynamic hip screw augmented with trochanteric wiring for treatment of unstable type A2 intertrochanteric femur fractures. Injury. Aug;48 Suppl 2:S72-S77.
23. Kuzyk PR, Bhandari M, McKee MD, Russell TA, Schemitsch EH. (2009) Intramedullary versus extramedullary fixation for subtrochanteric femur Fractures. J Orthop Trauma Jul;23(6):465-70.
24. Xianshang Zeng, Ke Zhan, Lili Zhang, Dan Zeng, Weiguang Yu, Xinchao Zhang et al. (2017) Conversion to total hip arthroplasty after failed proximal femoral nail antirotations or dynamic hip screw fixations for stable intertrochanteric femur fractures: a retrospective study with a minimum follow-up of 3 years. BMC Musculoskelet Disord. 18:38.
25. Kothiyal P, Vij K, Gupta P, Rawat P, Sharma N. (2017) Functional evaluation of proximal femoral fractures managed with cephalomedullary nailing by oxford hip score – A prospective study. International Journal of Orthopaedics Sciences 3(3):980-985.
26. Christian Carulli, Federico Piacentini, Tommaso Paoli, Roberto Civinini, Massimo Innocenti. (2017) A comparison of two fixation methods for femoral trochanteric fractures: a new generation intramedullary system vs sliding hip screw. Clin Cases Miner Bone Metab. Jan-Apr;14(1):40-47.
27. Galanopoulos IP, Mavrogenis AF, Mageloikonomos PD, Vottis CT, Mitsiokapa E, Koulouvaris P et al. (2018) Similar function and complications for patients with short versus long hip nailing for unstable pertrochanteric fractures. SICOT J. 4:23.
28. Kleweno C, Morgan J, Redshaw J, Harris M, Rodriguez E, Zurakowski D et al. (2014) Short versus long cephalomedullary nails for the treatment of intertrochanteric hip fractures in patients older than 65 years. J Orthop Trauma. Jul;28(7):391-7.
29. Robinson CM, Houshian S, Khan LA. (2005) Trochanteric-entry long cephalomedullary nailing of subtrochanteric fractures caused by low-energy trauma. J Bone Joint Surg Am. Oct;87(10):2217-26.
30. Murena L, Moretti A, Meo F, Saggioro E, Barbati G, Ratti C et al. (2018) Predictors of cut-out after cephalomedullary nail fixation of pertrochanteric fractures: a retrospective study of 813 patients. Arch Orthop Trauma Surg. Mar;138(3):351–9.
31. Nherera L, Trueman P, Horner A, Watson T, Johnstone AJ. (2018) Comparison of a twin interlocking derotation and compression screw cephalomedullary nail (InterTAN) with a single screw derotation cephalomedullary nail (proximal femoral nail antirotation): a systematic review and meta-analysis for intertrochanteric fractures. J Orthop Surg Res. Dec;13:46.
32. Keong-Hwan Kim, Kye Young Han, Keun Woo Kim, Jun Hee Lee, Myung Ki Chung. (2018) Local Postoperative Complications after Surgery for Intertrochanteric Fractures Using Cephalomedullary Nails. Hip Pelvis. Sep;30(3):168-174.
33. WL Loo, SYJ Loh, HC Lee. (2011) Review of Proximal Nail Antirotation (PFNA) and PFNA-2 –Our Local Experience. Malaysian Orthopaedic Journal Vol 5 No 2.
34. Ma KL, Wang X, Luan FJ, Xu HT, Fang Y, Min J et al. (2014) Proximal femoral nails antirotation, Gamma nails, and dynamic hip screws for fixation of intertrochanteric fractures of femur: A meta-analysis. Orthop Traumatol Surg Res 100(8):859–66.

How to Cite this article: Sodhai V, Holambe M, Pradhan C, Patil A, Puram C, Sancheti P, Shyam A | Outcomes of cephalomedullary nailing in the treatment of extracapsular proximal femur fractures and factors affecting it. | Trauma International | July-December 2020; 6(2): 02-06.

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Outcomes of Cephalomedullary Nailing in The Treatment of Extracapsular Proximal Femur Fractures and Factors Affecting it

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Outcomes of Cephalomedullary Nailing in The Treatment of Extracapsular Proximal Femur Fractures and Factors Affecting it

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Outcomes of Cephalomedullary Nailing in The Treatment of Extracapsular Proximal Femur Fractures and Factors Affecting it

Author: Vivek Sodhai [1], Meghraj Holambe [2], Chetan Pradhan [1], Atul Patil [2], Chetan Puram [2], Parag Sancheti [2], Ashok Shyam [2,3].

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Author: Ashok Shyam [2,3].

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