Objective: To investigate the association between the tip apex distance (TAD) and migration of helical blade in the femoral head of geriatric intertrochanteric fractures.
Methods: A retrospective study of intertrochanteric fractures treated with the proximal femoral nail antirotation (PFNA) between June 2015 and June 2018 was performed. There were 32 males and 55 females with an average age of 84.7 years (range, 80-101 years). All of them were unilateral fresh closed intertrochanteric fractures caused by low energy injury. According to AO/Orthopaedic Trauma Association (AO/OTA) classification, 33 cases belonged to type 31-A1, 35 cases to type 31-A2, and 19 cases to type 31-A3. The time interval from injury to operation was 1-16 days (mean, 3.7 days). The TAD was measured according to immediate postoperative X-ray films. The cases were divided into two groups: group A with TAD less than 20 mm and group B with TAD greater than 20 mm. The difference of fracture healing and migration of helical blade between the two groups were observed.
Results: According to the TAD value immediately after operation, 49 patients in group A had TAD of 8.9-19.7 mm, with an average of 18.6 mm; 38 patients in group B had TAD of 20.1-41.4 mm, with an average of 27.7 mm. The 87 patients were followed up for an average of 11.7 months, ranging from 4 to 28 months. Three cases (all in group B) underwent screw blade cutting and displacement, which resulted in internal fixation failure, including 1 case with femoral head cut upward and 2 cases with femoral head penetrated inward. The remaining 84 cases had bone healing without internal fixation related complications such as fracture of internal fixator and fracture of femoral shaft. There was significant difference in the incidence of internal fixation failure between group A and group B ( =0.049).
Conclusion: Reducing the TAD value of helical blade appropriately (15-20 mm) in PFNA internal fixation for intertrochanteric fracture patients over 80 years old can increase initial stability without increasing the risk of helical blade migration.
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http://dx.doi.org/10.7507/1002-1892.201904125 | DOI Listing |
ACS Appl Opt Mater
December 2024
School of Materials Science and Engineering, Georgia Institute of Technology, Atlanta, Georgia 30332-0245, United States.
Injury
October 2024
Traumatology and Orthopaedics Surgery Department, Hospital Clínico Universitario Valladolid, Av. Ramón y Cajal, 47007, Valladolid, Spain; School of Medicine, Valladolid University, Av. Ramón y Cajal, 47007, Valladolid, Spain.
Introduction: The management of extracapsular proximal femoral fractures (EPFF) with intramedullary nails in the elderly is hindered by osteoporosis, leading to complications that significantly impact functionality due to restrictions for full weight-bearing. We hypothesized that cement augmentation of the cephalic blade could enhance the bone-implant interface and reduce mechanical failure, thereby improving patient functionality in the management of EPFF.
Materials And Methods: A retrospective cohort study was conducted on patients ≥ 70 years old with type 31-A EPFF (AO/OTA classification) treated with intramedullary nailing between 2017 and 2021, with and without cephalic blade augmentation with bone cement.
J Orthop Case Rep
November 2024
Department of Orthopaedic Surgery, Dr. D. Y. Patil Medical College, Hospital and Research centre, Dr D. Y. Patil University, Pimpri, Pune, Maharashtra, India.
Introduction: Intertrochanteric fractures are one of the most common fractures around the pelvis and hip joint. Intrerotrochanteric fracture commonly occurs in elderly adult as a result of a simple domestic fall or slippage due to osteoporosis and young adult due to high-energy trauma. In 1990, 26% of all intertrochanteric fractures were reported in Asia, this figure is estimated to 32% in 2025 and 38% in 2050.
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 PDFAngew Chem Int Ed Engl
October 2024
State Key Laboratory for Physical Chemistry of Solid Surfaces, iChEM (Collaborative Innovation Center of Chemistry for Energy Materials), Department of Chemistry, Xiamen University, Xiamen, 361005, China.
Herein, corannulene-based quintuple [6]helicenes (Q[6]H-1 and Q[6]H-2) and [7]helicene (Q[7]H) were synthesized via penta-fold Heck and Mallory reaction. Notably, Q[7]H represents the highest reported helicene based on corannulene. X-ray crystallography reveals that Q[6]H-2 adopts a propeller-shaped conformation with a well-preserved corannulene core, while Q[6]H-1 and Q[7]H exhibit quasi-propeller-shaped conformations.
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