Xinchao Zhang

A retrospective analysis of the InterTan nail and proximal femoral nail anti-rotation-Asia in the treatment of unstable intertrochanteric femur fractures in the elderly

BackgroundThe purpose of this study was to compare the clinical outcomes of elderly patients undergoing surgery for treatment of unstable trochanteric fractures receiving either proximal femoral nails anti-rotation-Asia (PFNA-IIs) or InterTan nails (ITs).MethodsBetween January 1, 2012, and June 31, 2015, 168 elderly patients with unstable intertrochanteric femur fractures enrolled in this study. The only intervention was ITs or PFNA-IIs of the unstable trochanteric femur fractures. Follow-up was at 1, 3, 6, and 12xa0months postoperatively and yearly thereafter. Intraoperative variables and postoperative complications were compared between the two groups.ResultsEight patients died, six were too infirmed for follow-up, and seven were lost during follow-up, leaving 147 patients meeting the criteria were evaluated at a mean follow-up of 20xa0months (range 16–26xa0months). Significant differences were observed between the two groups regarding local complications (IT, nu2009=u200910 vs. PFNA-II, nu2009=u200920), varus collapse of the head/neck or femoral shaft fractures at the tip of the nail (IT, nu2009=u20091 vs. PFNA-II, nu2009=u20098), femoral neck shortening (IT, 4.4u2009±u20091.1xa0mm vs. PFNA-II, 7.4u2009±u20092.4xa0mm), fracture healing time (IT, 14.7u2009±u20092.1xa0weeks vs. PFNA-II, 15.7u2009±u20092.4xa0weeks), femoral shaft fractures (IT, nu2009=u20090 vs. PFNA-II, nu2009=u20094), rotational loss of reduction (IT, nu2009=u20090 vs. PFNA-II, nu2009=u20099), lateral cortex fractures of the proximal femur or lateral greater trochanter fractures (IT, nu2009=u20098 vs. PFNA-II, nu2009=u20091), operative time (IT, 71.9u2009±u20096.8xa0min vs. PFNA-II, 52.3u2009±u20094.0xa0min), intraoperative blood loss (IT, 190.6u2009±u20096.0xa0mL vs. PFNA-II, 180.9u2009±u200910.8xa0mL), fluoroscopy time (IT, 5.0u2009±u20090.48xa0min vs. PFNA-II, 2.8u2009±u20090.33xa0min), hospital stay (IT, 9.65u2009±u20090.95xa0days vs. PFNA-II, 8.58u2009±u20090.93xa0days), cut-out (IT, nu2009=u20090 vs. PFNA-II, nu2009=u20096), and tip-apex distance (IT, 26.7u2009±u20090.91xa0mm vs. PFNA-II, 23.2u2009±u20091.22xa0mm). No significant differences existed for the other observation indexes (pu2009>u20090.05).ConclusionsThe IT nail may have more advantage for patients with unstable intertrochanteric fractures of the femur. However, for those complicated with lateral greater trochanter fractures, lateral cortex fractures of the proximal femurs, or unfit for surgery, the PFNA-II nail could be a good option. In addition, a large-sample, multicenter observational study is required for evaluation of its long-term efficacy, and optimal management strategies for specific unstable fracture patterns, different sorts of bone quality, and different levels of patient demand.

INTERTAN nail versus proximal femoral nail antirotation-Asia for intertrochanteric femur fractures in elderly patients with primary osteoporosis:

Objectives To compare the long-term functional and radiographic outcomes of the proximal femoral nail antirotation-Asia (PFNA-II) and INTERTAN nail (IT) in the management of intertrochanteric femoral fractures (IFFs) (AO/OTA Type 31A1.1-A2.3) in elderly patients with primary osteoporosis. Methods A retrospective comparative study was performed in our institution. From January 2009 to March 2012, 243 patients with osteoporosis (243 hips) with IFFs (AO/OTA Type 3.1A1.1-A2.3) underwent repair with either a PFNA-II or IT. Follow-up assessments were performed 1, 3, 6, 9, and 12 months postoperatively and every year thereafter. All implant position changes were noted. Patient-related functional outcomes were evaluated based on the Harris hip score. Results In total, 174 patients with osteoporosis (IT, nu2009=u200986; PFNA-II, nu2009=u200988) were evaluated during a mean follow-up period of 40 months (range, 38–60 months). An increased risk of femoral shaft fracture after implant removal was observed at month 9 of follow-up in 0.0% and 4.4% of the IT and PFNA-II groups, respectively. This difference remained over time with rates of 1.1% and 6.8%, respectively, at the last follow-up. Conclusion The IT nail appears to be a reliable implant in the management of IFFs (AO/OTA Type 3.1A1.1-A2.3) in elderly patients with primary osteoporosis.

A retrospective analysis of the InterTan nail and proximal femoral nail anti-rotation in the treatment of intertrochanteric fractures in elderly patients with osteoporosis: a minimum follow-up of 3 years

BackgroundThe study aims to compare the long-term functional and radiographic outcomes of two devices for the treatment of primary intertrochanteric fractures (IFs, OTA 3.1A2.1–A2.3) in elderly patients with osteoporosis.MethodsBetween December 2010 and August 2014, 332 elderly osteoporosis patients with IFs (OTA 3.1A2.1–A2.3) fixed by an InterTAN nail (IT) or a proximal femoral nail anti-rotation (PFNA) device were retrospectively evaluated. Follow-up occurred 1, 3, 6, and 12xa0months postoperatively and every year thereafter. Mortality was recorded. Patient-related functional and radiographic outcomes were compared. The primary endpoint was the long-term radiographic outcomes. The secondary endpoint was the long-term functional outcomes.ResultsA total of 283 patients (283 hips) with osteoporosis (IT, nxa0=xa0144; PFNA, nxa0=xa0139) were evaluated with a mean follow-up period of 38.8xa0months (range, 36–43xa0months). No between-group significant differences were noted in the patient demographics, operation variables, and postoperative Harris Hip Score. More radiographic complications were noted in terms of screw cut-out, femoral shaft fracture distal or around the tip of the main nail, and varus collapse of the femoral head in the PFNA group compared with that in the IT group (Pxa0<xa00.05).ConclusionFor osteoporotic IFs (OTA 3.1A2.1–A2.3) in elderly patients, the use of IT aids in decreasing radiographic complications, but the between-group functional outcomes showed no significant difference.

The visible and hidden blood loss of Asia proximal femoral nail anti-rotation and dynamic hip screw in the treatment of intertrochanteric fractures of elderly high- risk patients: a retrospective comparative study with a minimum 3 years of follow-up

BackgroundThe purpose of this study was to evaluate whether PFNA-II (Asia proximal femoral nail anti-rotation) and DHS (dynamic hip screw) carry substantial post-operative hidden blood loss and to compare PFNA-II with DHS in terms of post-operative hidden blood loss in elderly high-risk patients with intertrochanteric femur fractures(IFFs).MethodsThe clinical data from Jan 2005 to Apr 2015 of 186 patients with PFNA-II and 177 patients with DHS were analyzed retrospectively. Indexes including pre- and post-operative blood routine, intra- and post-operative blood loss and blood transfusion situation were analyzed. The situation of perioperative blood loss (visible and hidden) was assessed.ResultsThe intra-operative blood loss in the PFNA-II group was 34.7u2009±u20092.5xa0ml, the post-operative visible blood loss was 54.7u2009±u20092.5xa0ml, and the hidden blood loss was 277.2u2009±u20097.6xa0ml. In the DHS group, the intra-operative blood loss was 102.0u2009±u20097.0xa0ml, the post-operative visible blood loss was 78.8u2009±u20094.7xa0ml, and the hidden blood loss was 139.3u2009±u20099.6xa0ml. The intra-operative blood loss and the post-operative visible blood loss in the PFNA-II group were significantly less than in the DHS group (pu2009<u20090.01). However, the post-operative hidden blood loss and the total blood loss in the PFNA-II group were larger than in the DHS group (pu2009<u20090.01).ConclusionThis study demonstrated that with PFNA-II and DHS, much post-operative hidden blood loss exists in the treatment of intertrochanteric fractures in elderly high-risk patients and DHS is more favourable than PFNA-II in terms of post-operative hidden blood loss.

Proximal femoral nail antirotation versus dynamic hip screw fixation for treatment of osteoporotic type 31-A1 intertrochanteric femoral fractures in elderly patients:

Objective To evaluate long-term radiographic and functional outcomes between dynamic hip screw (DHS) and proximal femoral nail antirotation (PFNA) fixation for treatment of osteoporotic type 31-A1 intertrochanteric femoral fractures (IFFs) among elderly patients Methods A retrospective comparative study was carried out. Follow-up was performed at 1, 3, 6, 9, and 12 months postoperatively and yearly thereafter. The primary outcome was the radiographic outcome, and the secondary outcome was the functional outcome. Results A significant difference in radiographic complications was observed between the DHS group (nu2009=u200945, 40.2%) and PFNA group (nu2009=u200915, 13.6%). The risk of femoral shaft fracture after implant removal at the 1-year follow-up was increased by 0.9% (nu2009=u20091) and 6.3% (nu2009=u20097) in the PFNA and DHS groups, respectively. This difference persisted with rates of 3.6% (nu2009=u20094) and 12.5% (nu2009=u200914) at the final follow-up. Additionally, significant differences were present in the Harris hip score at each visit. Conclusion Our results indicate that PFNA yields better outcomes than DHS fixation among elderly patients with osteoporotic type 31-A1 IFFs.

Proximal femoral nails anti-rotation versus dynamic hip screws for treatment of stable intertrochanteric femur fractures: an outcome analyses with a minimum 4 years of follow-up

BackgroundDynamic hip screws (DHSs) and proximal femoral nails anti-rotation (PFNAs) are well-documented implants for stable intertrochanteric femur fractures(IFFs); however, there is no consensus regarding which type of implant is the better option for stable IFFs. This study aimed to compare DHSs with PFNAs in the management of stable intertrochanteric fractures.MethodsA retrospective study was performed in our institution. Between June, 2005 and November, 2015, 267 patients (267 hips) with stable IFFs (AO/OTA Type 3.1A1) were treated with a DHS or a PFNA. Inclusion and exclusion criteria were designed to focus on isolated stable IFFs in ambulatory patients. Follow-up was undertaken at 1, 3, 12, 15, 18, 21, 24, 36, 48 postoperative months, and at final follow-up. Radiograph outcomes were obtained at all visits. The primary outcome measure was re-operation rate. The secondary outcome was patient function, evaluated using Harris hip score (HHS). Tertiary outcomes included: intra- and post-operative orthopaedic complications.ResultsTwo hundred twenty two patients (110 in the PFNA group and 112 in the DHS group) were evaluated with a mean follow-up period of 53xa0months (range, 48–60 months). There was an increased risk of reoperation after DHS in one-year follow-up: 0xa0% and 5.4xa0% for PFNA and DHS, respectively (Pu2009=u20090.029). The difference persisted with time: 6.4xa0% and 13.4xa0% at last follow-up (Pu2009<u20090.05). There are statistical differences in postoperative HHS at 12, 15, 18, 21, 24, 36, 48xa0months postoperatively and at final follow-up. No statistical differences in medical complications was observed between the two groups. The orthopaedic complications were more in the DHS group (nu2009=u200942) compared with the PFNA group (nu2009=u200918) (P <0.05).ConclusionCompared with PFNA device, DHS device might not be the preferred implant for stable intertrochanteric femur fractures.

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

BackgroundConversion to total hip arthroplasty (CTHA) is a relatively common procedure after a failed dynamic hip screw (DHS) or proximal femoral nail anti-rotation (PFNA) fixation of intertrochanteric fractures, but there have been far fewer reports specifically describing the long-term results of CTHA after failed treatments of stable intertrochanteric fractures with DHS or PFNA. The aim of the present study was to compare the clinical and radiological outcomes of CTHA after failed PFNA or DHS fixations of stable intertrochanteric fractures after a minimum follow-up of 3xa0years.MethodsBetween January 2005 and April 2014, we retrospectively reviewed 142 active elderly patients treated at our institution (a single institution study). A total of 72 patients (72 hips; 41 women, 31 men; mean age 76.9xa0years old; range 60–92xa0years old) who underwent conversion of a failed PFNA to a THA were compared with 70 patients (70 hips; 36 women, 34 men; mean age 75.0xa0years old; range 60–90xa0years old) who underwent CTHA after a failed DHS fixation. The mean follow-up periods were 48 (range 43–52) and 48 (range 44–52) months for the DHS and PFNA groups, respectively. Clinical and radiologic evaluations were performed on all patients. The primary outcome was the Harris Hip Score (HHS). The secondary outcomes were the complication rates.ResultsThe Harris Hip Score (HHS) improved from 50.61u2009±u20093.23 preoperatively to 85.28u2009±u20094.45 at the last follow-up in the PFNA group and from 51.46u2009±u20093.90 to 84.50u2009±u20094.34 in the DHS group, with no significant differences noted between the groups at each follow-up (Pu2009>u20090.05). However, the complication rate in the converted DHS patients was significantly higher (42.9%) than that in the converted PFNA patients (20.8%; Pu2009=u20090.003). Thirty-seven PFFs (2.4%) occurred during a mean follow-up of 44.4xa0months. The incidence of periprosthetic fractures was found to be significantly higher (Pu2009=u20090.021) for the DHS group (15.7%) than for the PFNA group (4.2%).ConclusionsCTHA after failed DHS fixations of stable intertrochanteric fractures might be associated with a significantly higher complication rate than CTHA after failed PFNA fixations. Therefore, PFNA patients with stable intertrochanteric fractures may be more suitable for CTHA.

Optimizing stability in AO/OTA 31-A2 intertrochanteric fracture fixation in older patients with osteoporosis

Objectives To compare the functional and radiographic outcomes of InterTAN nail (IT) and proximal femoral nail anti-rotation (PFNA) for managing primary AO/OTA 31-A2 intertrochanteric hip fractures (IHFs) in older osteoporotic patients. Methods Patients aged 60 years or older who received surgical treatment for IHFs (AO/OTA 3.1A2.1-A2.3) with IT or PFNA were retrospectively evaluated. The primary outcome was the postoperative treatment failure rate. The secondary outcome was the Harris Hip Score (HHS). Results A total of 326 osteoporotic cases (326 hips: IT, nu2009=u2009162; PFNA, nu2009=u2009164) were assessed with a mean follow-up of 43.5 months (range, 38–48 months). For the entire cohort, the incidence of postoperative treatment failure (periprosthetic fracture and reoperation) was 29/326 (8.9%); the IT-treated cohort (7/162, 4.3%) had a significantly lower rate compared with the PFNA-treated cohort (22/165, 13.3%). The incidence of postoperative periprosthetic fractures was significantly lower in the IT-treated cohort than in the PFNA-treated cohort (2.5% vs 7.9%). The postoperative HHS at the final follow-up was not significantly different between the groups. Conclusion IT might show a better outcome in managing osteoporotic AO/OTA 31-A2 IHFs in terms of periprosthetic fracture and reoperation compared with PFNA.

Ring versus non-ring plate for the treatment of displaced scapular body fractures: a retrospective study with a mean follow-up of 5 years

Objective To compare surgical complications and functional outcomes of the ring plate versus the non-ring plate approach to the surgical repair of scapular body fractures (SBFs; AO/OTA classification: 14-A2.2). Methods This retrospective study reviewed data from adults with SBFs who underwent a modified Judet approach combined with non-ring or ring plates between November 2006 and June 2013. The primary outcomes were the Constant and Murley score and the Disabilities of the Arm, Shoulder and Hand (DASH) score. The secondary outcomes were radiographic findings. Results A total of 318 patients had a non-ring or ring plate internal fixation, of which 147 patients (ring-treated, nu2009=u200972; non-ring-treated, nu2009=u200975) were evaluated with a mean follow-up period of 60 months. At the 3-month follow-up, the complication rate was 2.8% and 13.3% for the ring-treated and non-ring-treated groups, respectively. The difference persisted over time, with significantly different rates of 8.3% and 20.0% at the final follow-up for the ring and non-ring groups, respectively. The ring-treated group had significantly higher postoperative Constant and Murley scores and lower DASH scores compared with the non-ring-treated group. Conclusion Application of a modified Judet approach combined with ring plate internal fixation for the treatment of SBFs may be the preferred treatment option.

Rivaroxaban versus nadroparin for preventing deep venous thrombosis after total hip arthroplasty following femoral neck fractures: A retrospective comparative study:

Objective This study was performed to evaluate the efficacy of rivaroxaban versus nadroparin for preventing deep venous thrombosis (DVT) in elderly patients with osteoporosis undergoing initial total hip arthroplasty (THA) for femoral neck fractures. Methods Prospectively maintained databases were reviewed to retrospectively compare elderly patients with osteoporosis who underwent initial THA for femoral neck fractures from 2007 to 2015. The patients received peroral rivaroxaban at 10u2009mg/day for 2 weeks or subcutaneous injections of nadroparin at 0.3 mL/day for 2 weeks until the primary analysis cut-off date. The time to first on-study DVT was the primary endpoint. Results In total, 399 patients were included (rivaroxaban group: n=200; mean age, 70.20u2009±u20099.16 years and nadroparin group: nu2009=u2009199; mean age, 69.90u2009±u20098.87 years), with a mean 3-year follow-up. The time to first on-study DVT was significantly longer in the rivaroxaban than nadroparin group (12 and 5 days, respectively). The incidence of DVT within the 2-week follow-up was significantly higher in the nadroparin than rivaroxaban group (6.8% and 19.7%, respectively), but this difference was no longer present at the final follow-up. Conclusion Rivaroxaban was associated with a significant reduction in the occurrence of first on-study DVT compared with nadroparin.