Journal of Musculoskeletal Trauma

Original Articles

Retrospective Comparative Study of the Intraoperative Fracture Gap Compression in the Treatment of Intertrochanteric Fracture Using Proximal Femoral Nail Antirotation: Se Jin Kim, Hong Man Cho, Jiyeon Park, Ki Yong An, Young Woo Chung, Woojin Shin; J Korean Fract Soc 2020;33(4):179-188. Published online October 31, 2020; DOI: https://doi.org/10.12671/jkfs.2020.33.4.179

Purpose
Intertrochanteric fractures can be treated using proximal femoral nail antirotation (PFNA). This study examined the clinical and radiological results of the intraoperative fracture compression.
Materials and Methods
Ninety-four patients underwent intraoperative compression (Group I), and 88 patients underwent natural sliding only (Group II). The patients were followed-up for more than two years. All patients met the following seven conditions: (1) AO/OTA 31-A1, A2 type intertrochanter fracture, (2) availability of compression of more than one cortical bone in the anterior or medial region of the fracture site under the preoperative imaging test, (3) Singh index grade ≥3, (4) blade position: center-center, center-inferior, (5) tip-apex distance <25 mm, (6) reduction status of good or very good, and (7) positive or neutral medial cortical support position with slightly valgus reduction.
Results
A slight tendency toward significant differences in acute phase pain between the two groups was observed at six weeks postoperatively (p=0.073). Twenty-four months after surgery, lateral extension of the PFNA helical blade between the two groups showed significant differences (p=0.017). Fracture gaps measured immediately after surgery showed significant differences (p=0.001), and a clear tendency for a significant difference in the average fracture union time was found (p=0.065).
Conclusion
Intraoperative fracture compression, intraoperative fracture compression appears beneficial to achieve a successful union of trochanteric fractures provided that all conditions are met to apply the method safely.

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Benefits of a Demineralized Bone Matrix in Osteoporotic Intertrochanteric Femoral Fracture Patients
Se Jin Kim, Hong-Man Cho, Myung Cheol Jung
Journal of the Korean Fracture Society.2022; 35(4): 151. CrossRef

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The Determination of Optimal Entry Point for Proximal Femoral Nail Antirotation-II by Fluoroscopic Simulation: A Cadaveric Study: Jin Hoon Jeong, Gu Hee Jung; J Korean Fract Soc 2017;30(4):173-179. Published online October 31, 2017; DOI: https://doi.org/10.12671/jkfs.2017.30.4.173

Abstract PDF

PURPOSE
This study seeks to determine the anatomically optimal entry point of proximal femoral nail antirotation-II (PFNA-IIÂ®) according to geographic features of Korean cadaveric femoral trochanters for successful reduction of osteoporotic proximal femoral fractures.
MATERIALS AND METHODS
Forty-three adult cadaveric femurs without previous fractures or surgeries were included. Anteroposterior (AP) and lateral images of all femurs and PFNA-IIÂ® were taken with an image intensifier. Using the image synthesis process via the image editing program (Adobe Photoshop CS6), the optimal entry point was verified and compared with the tip of the greater trochanter (GT) and the cervicotro-chanteric junction on AP images, as well as the width of the trochanter and the neck on lateral images.
RESULTS
The optimal entry point of PFNA-IIÂ® was an average distance of 9.1 mm (range, 7â€“15 mm) medially from the tip of GT on AP images. The center of the nail was located at an average of 30% (range, 21%â€“44%) area from the posterior margin of the middle neck, which is an average area of 38% (range, 26%â€“48%) from the posterior cortex of the trochanter on lateral images. Furthermore, the ideal entry point was at the extended line of the cervico-trochanteric junction.
CONCLUSION
The optimal entry point, which was found to be medial to the tip of the GT and posterior to the center of the middle femoral neck and the trochanter, was at on the extended line of the cervicotrochanteric junction.

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Clinical Research through Computational Anatomy and Virtual Fixation
Ju Yeong Kim, Dong-Geun Kang, Gu-Hee Jung
Journal of the Korean Orthopaedic Association.2023; 58(4): 299. CrossRef
Does the Entry Point of Proximal Femoral Nail Antirotation Affect the Malalignment of Intertrochanteric Fracture? A Cadaveric Study
Chittawee Jiamton, Nonpawit Nimmankiatkul, Pongsakorn Rungchamrassopa, Wichan Kanchanatawan, Pariyut Chiarapatanakom, Wirat Kongcharoensombat
Journal of Southeast Asian Orthopaedics.2022;[Epub] CrossRef

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The PFNA Nail for Pertrochanteric Fracture of the Femur without Fracture Table: Jeoung Ho Kim, Sang Hong Lee, Kwang Chul Lee, Sung Won Cho; J Korean Fract Soc 2011;24(3):217-222. Published online July 31, 2011; DOI: https://doi.org/10.12671/jkfs.2011.24.3.217

Abstract PDF

PURPOSE
The purpose of this study is to analyze the results of intertrochanteric fractures treatment with proximal femoral nail antirotation (PFNA) without using fracture tables and thereby prevent complications.
MATERIALS AND METHODS
Forty cases of intertrochanteric fracture of 39 patients that were treated with PFNA without using fracture tables between January 2008 to December 2009 were analyzed. There were 13 males and 27 females. The mean age was 76 years old. Using AO classification, 6 cases were A1, 25 cases were A2 and 9 cases were A3. The operation was done without using fracture tables at supine position. Operation time, intraoperative bleeding were checked. For the result, Cleveland index, tip apex distance, fracture site sliding rate, change of femur neck and shaft angle were evaluated. Bone union time and complications were also estimated from the follow up radiograph. Statistics were analyzed using Independent T-test.
RESULTS
The mean operation time was 40 minutes (25 to 70 minutes) and mean intraoperative bleeding was 113 cc (40 to 250 cc). The Cleveland index was shown 94% of 5, 6, 8 and 9 zone, the tip apex distance was 12.96 mm (6 to 22 mm), the fracture sliding distance was 1.9 mm (0 to 6 mm), the change of femur neck and shaft angle was 2.5 degree (0~10 degree) and the average bone union time was 15 weeks (8 to 24 weeks). The complication include 2 cases of delayed union and 2 cases of varus deformities.
CONCLUSION
We have shortened the operation time by closed reduction methods without using the fracture tables, and the complication were minimized with using simple tools like a reduction forcep or bone hook at PFNA blade insertion.

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Clinical and Radiologic Outcome of Intertrochanteric Fracture Treatment Using TFNA (Trochanteric Fixation Nail-Advanced)
Hyeon Joon Lee, Hyun Bai Choi, Ba Rom Kim, Seung Hwan Jo, Sang Hong Lee
Journal of the Korean Fracture Society.2021; 34(3): 105. CrossRef
The Treatment of Subtrochanteric Fractures with Proximal Femoral Nail Antirotation
Chi Hyoung Pak, Sang Hong Lee, Sang Ho Ha, Gwang Chul Lee, Kyoung Chul Song
Journal of the Korean Fracture Society.2013; 26(4): 284. CrossRef

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Comparison of the Compression Hip Screw (CHS) and the Proximal Femoral Nail Antirotation (PFNA) for Intertrochanteric Femoral Fracture: Jong Min Lim, Jeung Il Kim, Jong Seok Oh, Kuen Tak Suh, Jae Min Ahn, Dong Joon Kang; J Korean Fract Soc 2010;23(4):360-366. Published online October 31, 2010; DOI: https://doi.org/10.12671/jkfs.2010.23.4.360

Abstract PDF

PURPOSE
To evaluate the radiologic, clinical results between who had intertrochanteric fracture, treated with Compression Hip Screw (CHS) and Proximal Femoral Nail Antirotation (PFNA).
MATERIALS AND METHODS
We retrospectively reviewed each 36 and 48 patients of intertrochanteric fracture which were treated with CHS or PFNA by one surgeon from January 2005 to June 2009. We evaluated mean operation time, amount of bleeding, radiologic results, and the clinical outcomes with the mobility score of Parker and Palmer, social function scoring system.
RESULTS
The mean operation time, amount of bleeding were less in the PFNA group, there were 116.7 min, 486.1 ml for the CHS group versus 87.7 min, 289.6 ml for the PFNA group. The radiologic results were not significantly different. Decrease of mobility score of Parker and Palmer, social function score were similar. Proximal migration of leg screw and perforation of femoral head was 2 case and deep infection was 1 cases in CHS group.
CONCLUSION
There were no significant differences that are clinical and radiological results in treatment of intertrochanteric fracture using the CHS and PFNA. But PFNA is less invasive device than CHS, therefore it may be useful device in elderly patients.

Citations

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Chronic kidney disease patients with intertrochanteric fracture have a high mortality rate
Tae Woo Kim, Sang-Min Lee, Nam Hoon Moon, Won Chul Shin
Injury.2021; 52(8): 2350. CrossRef
Comparison between the Results of Internal Fixation Using Proximal Femur Nail Anti-rotation and Bipolar Hemiarthroplasty in Treatment of Unstable Intertrochanteric Fractures of Elderly Patients
Sung-Hwan Kim, Soo-Won Lee, Gyu-Min Kong, Mid-Um JeaGal
Hip & Pelvis.2012; 24(1): 45. CrossRef
Treatment of Intertrochanteric Fractures Using Targon Proximal Femoral Nails
Il Ho Park, Jong Kyoung Won, Kye Young Han
Hip & Pelvis.2012; 24(2): 117. CrossRef
A Comparison of Intramedullary and Extramedullary Fixations for the Treatment of Reverse Oblique or Transverse Intertrochanteric Femoral Fractures
Yerl-Bo Sung, Jung-Yun Choi, Eui-Yub Jung
Hip & Pelvis.2012; 24(2): 109. CrossRef

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Treatment of the Unstable Intertrochanteric Fracture with Proximal Femoral Nail Antirotation: Comparison with Compression Hip Screw with Trochanteric Stabilizing Plate: Tae Ho Kim, Jong Oh Kim, Seung Yup Lee, Geon Ung Yun; J Korean Fract Soc 2010;23(4):353-359. Published online October 31, 2010; DOI: https://doi.org/10.12671/jkfs.2010.23.4.353

Abstract PDF

PURPOSE
To evaluate the effectiveness of Proximal Femoral Nail Anti-rotation (PFNA) for the treatment of unstable intertrochanteric fracture comparing with Compression Hip Screw (CHS) with Trochanteric Stabilizing Plate (TSP).
MATERIALS AND METHODS
With clinical study, 43 patients who were treated surgically for unstable intertrochanteric fractures were retrospectively evaluated. One group was treated with CHS and TSP (Group 1, 22 cases) and the other was treated with PFNA (Group 2, 21 cases). By postoperative radiograph and last follow up radiograph we measured Tip-apex distance, Cleveland index, Lag screw slippage, Neck-shaft angle change and Union time. And By retrospective medical record review, the clinical results were evaluated with the operation time, intraoperative estimated blood loss, amount of drainage, amount of transfusion, walking ability change and complication.
RESULTS
There was a lower operation time, intraoperative estimated blood loss, amount of drainage, amount of transfusion, lag screw slippage and neck shaft angle change in the Group 2 than in the Group 1 (p<0.05).
CONCLUSION
PFNA showed better results than CHS with TSP in operation time, estimated blood loss, amount of drainage and transfusion, lag screw slippage and neck-shaft angle change.

Citations

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Results of Asian Type Gamma 3 Nail in Treatment of Trochanteric Fractures
Bing Zhe Huang, Yong Wook Park, Jin Su Park, Kyu Cheol Noh, Soung Yon Kim, Kook Jin Chung, Hong Kyun Kim, Hyong Nyun Kim, Yong Hyun Yoon, Ji Hyo Hwang
Journal of the Korean Fracture Society.2014; 27(3): 213. CrossRef
Comparative Study of Intertrochanteric Fracture Treated with the Proximal Femoral Nail Anti-Rotation and the Third Generation of Gamma Nail
Jae-Cheon Sim, Tae-Ho Kim, Ki-Do Hong, Sung-Sik Ha, Jong-Seong Lee
Journal of the Korean Fracture Society.2013; 26(1): 37. CrossRef
Comparative Study of Proximal Femoral Nail Antirotation and Zimmer Natural Nail for the Treatment of Stable Intertrochanteric Fractures
Jee-Hoon Kim, Oog-Jin Shon
Journal of the Korean Fracture Society.2013; 26(4): 305. CrossRef
A Comparison between Compression Hip Screw and Intramedullary Nail for the Treatment of AO/OTA A2.2 Intertrochanteric Femoral Fracture
Phil Hyun Chung, Suk Kang, Jong Pil Kim, Young Sung Kim, Ho Min Lee, Jong Hyun Kim
Journal of the Korean Fracture Society.2013; 26(1): 44. CrossRef
The Treatment of Intertrochanteric Femoral Fracture with Proximal Femoral Nail Antirotation
Jong Won Kim, Hyun Soo Park, Young Soo Jang, Jae Hyuk Choi, Sung Ju Bae, Chan Il Bae
Journal of the Korean Fracture Society.2012; 25(4): 257. CrossRef
Operative Treatment with Gamma 3 Nail in Femur Intertrochanteric Fracture
Ki-Do Hong, Jae-Chun Sim, Sung-Sik Ha, Tae-Ho Kim, Yoon-Ho Choi, Jong-Hyun Kim
Journal of the Korean Fracture Society.2011; 24(1): 7. CrossRef

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Proximal Femoral Nail Antirotation versus Compression Hip Screw with Trochanter Stabilizing Plate for Unstable Intertrochanteric Hip Fractures: Jae Young Rho, Sang Bum Kim, Youn Moo Heo, Seong Jin Cho, Dong Sik Chae, Woo Suk Lee; J Korean Fract Soc 2010;23(2):161-166. Published online April 30, 2010; DOI: https://doi.org/10.12671/jkfs.2010.23.2.161

Abstract PDF

PURPOSE
To analyze and compare the clinical and radiologic results of treatments in unstable intertrochanteric fractures of the femur with proximal femoral nail antirotation (PFNA) and compression hip screw with trochanter stabilizing plate (CHS with TSP).
MATERIALS AND METHODS
We retrospectively reviewed the results of 66 cases of unstable intertrochanteric fractures of the femur treated with PFNA (Group I) and CHS with TSP (Group II) which could be followed up for minimum a year. We evaluated several comparative factors such as operation time, blood loss, time to bone union, changes in neck-shaft angle, sliding of screw (or blade), complications, postoperative pain, social-function score of Jensen, and mobility score of Parker and Palmer.
RESULTS
Group I showed shorter operation time and less blood loss with significance than group II (p<0.05), but there were no differences between the groups in the mean time to bone union, changes in neck-shaft angle, sliding of screw (or blade), complications, postoperative pain, and social-function score of Jensen (p>0.05). Two cases of cutting out of the blade through the femoral head were found in group I. One case of cutting out of the screw, one case of the breakage of the plate, and loosening of the plate were found in group II as complications.
CONCLUSION
We think that there were no significant differences between PFNA and CHS with TSP in view point of radiologic and clinical outcomes in unstable intertrochanteric fractures of the femur, but PFNA is less invasive device than CHS with TSP, therefore it may be useful device in elderly patients.

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Results of Use of Compression Hip Screw with Trochanter Stabilizing Plate for Reverse Oblique Intertrochanteric Fracture
Byung-Woo Min, Kyung-Jae Lee, Gyo-Wook Kim, Ki-Cheor Bae, Si-Wook Lee, Du-Han Kim
Journal of the Korean Fracture Society.2014; 27(2): 120. CrossRef
Effectiveness of the Valgus Reduction Technique in Treatment of Intertrochanteric Fractures Using Proximal Femoral Nail Antirotation
Ji-Kang Park, Hyun-Chul Shon, Yong-Min Kim, Eui-Sung Choi, Dong-Soo Kim, Kyoung-Jin Park, Byung-Ki Cho, Jung-Kwon Cha, Sang-Woo Kang
Journal of the Korean Orthopaedic Association.2013; 48(6): 441. CrossRef
A Comparison of Intramedullary and Extramedullary Fixations for the Treatment of Reverse Oblique or Transverse Intertrochanteric Femoral Fractures
Yerl-Bo Sung, Jung-Yun Choi, Eui-Yub Jung
Hip & Pelvis.2012; 24(2): 109. CrossRef

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3 Crossref

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