Background: Previous studies have clearly demonstrated superior biomechanical behavior of augmented proximal femoral nail antirotation (PFNA) blades compared with nonaugmented ones with respect to implant cutout. Nevertheless, there is concern about thermal bone necrosis due to exothermic curing of polymethylmethacrylate (PMMA)-based bone cements. The objective of this study was to quantify the temperatures arising around perforated titanium PFNA blades when augmenting with PMMA.
Methods: Cylindrical samples from six pairs of fresh frozen human cadaveric femoral heads implanted with a PFNA blade were placed in a 37°C water bath and augmented with 3 mL and 6 mL PMMA. During augmentation, temperatures were measured using six K-type thermocouples that were placed at controlled distances around the implant. With the help of high-resolution quantitative computed tomography images, the locations of all thermocouples with respect to the cement-bone interface were reconstructed.
Results: No temperatures higher than 45°C were measured in the interface region and the surrounding cement-free cancellous bone. In the same regions, the longest exposure time above 41°C was 8.5 minutes and was measured in a 6-mL sample. Average maximum temperature was significantly lower for the 3-mL group compared with the 6-mL group (p = 0.017).
Conclusion: The results of this study suggest that augmentation of titanium PFNA blades is not associated with a risk of thermal bone necrosis when using up to 6 mL of PMMA. However, larger amounts of cement lead to higher temperatures. PMMA application should therefore be kept low to minimally alter the biological system.
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http://dx.doi.org/10.1097/TA.0b013e318248bfa7 | DOI Listing |
Am J Transl Res
October 2024
Department of Trauma Orthopaedics, Shengli Oilfield Central Hospital Dongying 257034, Shandong, China.
Objective: Intertrochanteric femur fractures are prevalent among the elderly, leading to substantial morbidity. Proximal femoral nail anti-rotation (PFNA) is commonly used for internal fixation, but excessive lateral migration of the PFNA blade poses a significant complication. Understanding the risk factors for this complication is crucial for optimizing patient care.
View Article and Find Full Text PDFJ Orthop Case Rep
November 2024
Department of Orthopaedics, Jaipur Golden Hospital, Institutional Area Sector 3 Rohini, Delhi, India.
Introduction: Proximal femoral nail antirotation - II (PFNA- II) is a common treatment for intertrochanteric fractures in the elderly. Removing PFNA is difficult in rare circumstances due to blade head stripping or breaking. In this article, we endeavored to explain an easy methodology that can be utilized to remove stripped, damaged anti-rotation blades for which few had been formulated but other procedures have failed.
View Article and Find Full Text PDFZhongguo Gu Shang
August 2024
Department of Orthopaedics, Guangxi Zhuang Autonomous Region Jiangbin Hospital, Nannning 530021, Guangxi, China.
Objective: To investigate the effect of locking plate internal fixation for the treatment of proximal lateral femoral wall fracture.
Methods: From January 2021 to June 2022, 31 patients with intertrochanteric fractures and lateral wall fractures were treated. Among them, 15 patients were treated with proximal femoral nail antirotation (PFNA) fixation including 3 males and 12 females with an average age of (75.
Front Bioeng Biotechnol
July 2024
Department of Orthopaedics, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, Changshu, Jiangsu, China.
Intertrochanteric femur fracture is a common type of osteoporotic fracture in elderly patients, and postoperative femoral head varus following proximal femoral nail anti-rotation (PFNA) fixation is a crucial factor contributing to the deterioration of clinical outcomes. The cross-angle between the implant and bone might influence fixation stability. Although there is a wide range of adjustment in the direction of anti-rotation blades within the femoral neck, the impact of this direct variation on the risk of femoral head varus and its biomechanical mechanisms remain unexplored.
View Article and Find Full Text PDFOrthop Surg
October 2024
Department of Traumatic, Surgery, The First Affiliated Hospital of Baotou Medical College, Baotou, China.
Intertrochanteric femur fracture is the most common hip fracture in elderly people, and the academic community has reached a consensus that early surgery is imperative. Proximal femoral nail anti-rotation (PFNA) and InterTan are the preferred internal fixation devices for intertrochanteric femur fractures in elderly individuals due to their advantages, such as a short lever arm, minimal stress shielding, and resistance to rotation. However, PFNA is associated with complications such as nail back-out and helical blade cut-out due to stress concentration.
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