Analysis of elderly patients with inter-trochanteric fracture and failure of postoperative internal fixation

Abstract

Objective

This study aims to compare the efficacy and safety of Proximal Femoral Nail Anti-Rotation (PFNA) versus Dynamic Hip Screw (DHS) in the treatment of intertrochanteric fractures (IF) in elderly patients. We specifically evaluate perioperative indicators, postoperative hip function, and the rate of internal fixation failure.

Methods

300 elderly IF patients treated in our hospital from July 2018 to May 2022 were divided into the PFNA group (n = 150), control group (n = 150), PFNA group treated with PFNA, and control group treated with mobility hip screw (DHS). Perioperative bleeding, operation time, postoperative time and hospital time were observed in the two groups: fracture reduction, hip function at 1 and 6 months after surgery, and failure of internal fixation. Observe the postoperative internal fixation failure in the PFNA group.

Results

The intraoperative blood loss, operation time, first postoperative time and hospital time in the PFNA group were less than in the control group (P < 0.05). One month after surgery, the Harris score of the PFNA group was less than that of the control group (P < 0.05); the Harris score was not different at 6 months (P > 0.05). The excellent rate of fracture reduction in the PFNA group was greater than that in the control group (P < 0.05). The failure rate of internal fixation in the PFNA group was less than that in the control group (P < 0.05). By univariate analysis, Sing Index classification, Evans classification, 25 min and underlying disease were risk factors for postoperative internal fixation failure in PFNA patients (P < 0.05). After multivariate Logistic regression analysis, Sing Index grade, Evans classification, and tip distance 25min were independent risk factors for postoperative internal fixation failure in PFNA patients (P < 0.05).

Conclusion

The treatment of elderly IF patients with PFNA has the advantages of small trauma, good fracture reduction, firm internal fixation, low failure rate of internal fixation, and quick postoperative recovery. Sing index classification, Evans classification, and 25min tip distance mainly caused internal fixation failure in patients with PFNA.

Keywords

Proximal femoral rotation intramedullary nail femoral inter-trochanteric fracture advanced age postoperative internal fixation cause of failure

Get full access to this article

View all access options for this article.

References

Chang

Hou

, et al. Intertrochanteric femur fracture treatment in Asia: what we know and what the world can learn. Orthop Clin 2020 Apr 1; 51: 189–205.

Wang

Duan

, et al. Intramedullary versus extramedullary internal fixation for unstable inter-trochanteric fracture, a meta-analysis. Acta Orthop Traumatol Turc. 2018 Jul 1; 52: 299–307.

Min

Lee

, et al.

Salvage treatment of failed internal fixation of inter-trochanteric fractures: what factors determine the failure of treatment?

Injury 2020 Feb 1; 51: 367–371.

Kim

Yoon

Lee

, et al. Incomplete inter-trochanteric fracture: a pattern analysis using multiplanar reformation computed tomography. Clin Orthop Surg. 2022 Sep; 14: 328.

Thakur

Khanal

Amatya

. Functional outcome of proximal femoral nailing in inter-trochanteric fracture. J Nepal Health Res Counc 2022; 19: 805–808.

VanWagner

Porter

Spaulding

, et al. Inter-trochanteric fracture fixation in solid organ transplant patients: outcomes and survivorship. Arch Orthop Trauma Surg. 2022 Oct; 142: 2739–2745.

Fan

Zhou

. The lateral femoral wall thickness on the risk of postoperative lateral wall fracture in inter-trochanteric fracture after DHS fixation: a finite element analysis. Injury 2022 Feb 1; 53: 346–352.

Memon

Siddiqui

Khan

. Dynamic hip screw fixation vs. proximal femur nail for unstable per-trochanteric fractures: a comparative analysis of outcomes and complications. J Ayub Med Coll Abbottabad-Pak 2021 Jan 1; 33.

, et al. Comparison of efficacy, complications and TGF–β2 expression between DHS and PFNA in elderly patients with osteoporotic femoral inter-trochanteric fracture. Exp Ther Med. 2018 Jul 1; 16: 394–399.

10.

Guobin

Cui

Maoquan

, et al. A comparison between proximal femoral nail anti-rotation (PFNA) and inter Tan nail for the surgical treatment of unstable inter-trochanteric fracture: a case series. Asian J Surg. 2021 Jun 10; 44: 1095–1096.

11.

Durgut

Şahin

Ciftci

, et al. Proximal femoral nail antirotation versus cemented calcar-replacement hemiarthroplasty for unstable inter-trochanteric fracture in elderly: an overall survival study. Turk J Med Sci. 2022; 52: 463–466.

12.

. Comparison of proximal femoral nail anti-rotation and total hip arthroplasty in the treatment of the femoral inter-trochanteric fracture. Pak J Med Sci. 2022 Mar; 38: 1016.

13.

Liu

Deng

, et al. The postoperative prognosis of older intertrochanteric fracture patients as evaluated by the Chang reduction quality criteria. BMC Geriatr. 2022 Dec 1; 22: 928.

14.

Steffann

Duval

Huten

. Should trochanteric fractures in older adults be treated by arthroplasty or internal fixation? Orthop Traumatol: Surg Res 2023 Nov 29; 110: 103778.

15.

Yang

Chen

, et al. Analysis of risk factors for 90-day mortality after surgery in elderly patients with intertrochanteric fractures and a history of cardiovascular disease. Ann Palliat Med. 2022 Jan; 11: 15562–15162.

16.

Xiang

, et al. Selection of internal fixation method for femoral inter-trochanteric fractures using a finite element method. World J Clin Cases. 2021 Aug 8; 9: 6343–6356.

17.

Zarie

Mohamoud

Farhoud

, et al. Evaluation of the inter and intra-observer reliability of the AO classification of inter-trochanteric fractures and the device choice (DHS, PFNA, and DCS) of fixations. Ethiop J Health Sci. 2020 Sep 1; 30: 755–760.

18.

Yam

Kang

Chawla

, et al. Cephalomedullary blade cut-ins: a poorly understood phenomenon. Arch Orthop Trauma Surg. 2020 Dec; 140: 1939–1945.

19.

Yuzhuo

Yuxin

Tengyang

, et al. Risk factor analysis for failure of PFNA in inter-trochanteric fractures in the elderly. Chin J Orthop Surg 2020; 28: 292–296.

20.

Yawei

Xuemei

Mingqiang

, et al. Meta-analysis of factors for failing internal fixation between femoral trochanteric fractures. Chin J Orthop Surg 2022; 30: 712–716.

21.

Chen

. Failure analysis of proximal femoral nail antirotation in treatment of geriatric inter-trochanteric fractures. Zhongguo xiu fu Chong Jian wai ke za zhi = Zhongguo Xiufu Chongjian Waike Zazhi = Chin J Reparative Reconstructive Surg 2019 Oct 1; 33: 1270–1274.