Yeni Nesil Proksimal Femur Çivileri, İntertrokanterik Femur Kırıklarının Tedavisinde Gerçekten Daha mı Üstündür?
European Regional Congress 2024, İstanbul, Türkiye, 10 - 12 Ekim 2024, ss.6, (Tam Metin Bildiri)
- Yayın Türü: Bildiri / Tam Metin Bildiri
- Basıldığı Şehir: İstanbul
- Basıldığı Ülke: Türkiye
- Sayfa Sayıları: ss.6
- Açık Arşiv Koleksiyonu: AVESİS Açık Erişim Koleksiyonu
- İstanbul Üniversitesi-Cerrahpaşa Adresli: Evet
Özet
ARE THE NEW GENERATION PROXIMAL FEMORAL NAILS TRULY SUPERIOR IN THE TREATMENT OF INTERTROCHANTERIC FEMUR FRACTURES?
Goker Utku Deger1 , Ersin Taskın2 , Salih Candost Yetismis3 , Mahmut Kursat Özsahin4 , Huseyin Botanlıoglu4 , Ali Seker4 1 Beykoz State Hospital, Department of Orthopedics and Traumatology, Istanbul, Türkiye 2 Düzici State Hospital, Department of Orthopedics and Traumatology, Osmaniye, Türkiye 3 Familjelakarna Saltsjöbaden, Department of Family Medicine, Stockholm, Sweden 4 Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Orthopedics and Traumatology, Istanbul, Türkiye
Aim In the treatment of intertrochanteric femur fractures, proximal femoral nails are frequently utilized.These nails are updated when deemed insufficient, with claims of addressing their shortcomings. Our objective is to compare the radiological and clinical outcomes of older generation nails with two traction screws to those of newer generation nails with a compression screw that locks into a traction screw. Methods Patients who underwent fixation with either the TRIGENä-TAN (an older generation system with two separate cephalomedullary traction screws) or the TRIGENä-INTERTANä (a newer generation system with one traction screw and a locking compression screw) antegrade intramedullary nail due to intertrochanteric femur fracture following acute trauma were analyzed. Patients with a minimum follow-up of six months, with complete AP/lateral hip radiographs at the last follow-up and recorded preoperative and postoperative Barthel scores were included in the study. A retrospective comparison was made between 45 patients from a cohort of 100 treated with the older generation nail between 2006 and 2010, and 44 patients from a cohort of 197 treated with the newer generation nail between 2014 and 2019, who met the inclusion criteria. The study assessed patient age, gender, side of the fracture, preoperative and postoperative hospitalization duration, radiological fracture type, reduction quality, postoperative and follow-up collodiaphyseal angle (CDA) measurements, comparison of these measurements with the CDA of the unaffected side, tip-apex distance (TAD) measurement, and complication development. Clinical status was compared using preoperative and postoperative Barthel Index scores. Results The average age of the patients was 72.4 years. 61.8% of the fractures were classified as unstable. Complications developed in 3 patients (7%) in the INTERTAN group and in 5 patients (11%) in the other group, with no statistical significance (p=0.37). Intergroup analysis revealed that the reduction in CDA postoperatively and at follow-up was significantly greater in the INTERTAN group (p<0.05). A greater reduction in CDA was observed in females, though this was not statistically significant (p=0.15). Barthel scores decreased postoperatively in both groups, with a significantly greater decline in the INTERTAN group (p<0.05). No correlation was found between the TAD and complications. Conclusion Although no significant differences were observed between the old and new generation nails, patients in the old generation nail group exhibited better functional outcomes. Complications in the old generation nail group were related to screw issues, whereas varus deformity and nonunion were observed in the new generation nail group. This suggests that each system has different mechanical advantages, consistent with the literature. The significant decrease in CDA during follow-up in female patients may be related to their bone quality. References 1. Kaynak G, Ünlü MC, Güven MF, Erdal OA, Tok O, Botanlıoğlu H, Aydıngöz Ö. Intramedullary nail with integrated cephalocervical screws in the intertrochanteric fractures treatment: Position of screws in fracture stability. Ulus Travma Acil Cerrahi Derg. 2018 May;24(3):268-273. 2. Berger-Groch J, Rupprecht M, Schoepper S, Schroeder M, Rueger JM, Hoffmann M. Five-Year Outcome Analysis of Intertrochanteric Femur Fractures: A Prospective Randomized Trial Comparing a 2-Screw and a Single-Screw Cephalomedullary Nail. J Orthop Trauma. 2016 Sep;30(9):483-8 3. Hoffmann MF, Khoriaty JD, Sietsema DL, Jones CB. Outcome of intramedullary nailing treatment for intertrochanteric femoral fractures. J Orthop Surg Res. 2019 Nov 12;14(1):360. 4. John B, Sharma A, Mahajan A, Pandey R. Tip-apex distance and other predictors of outcome in cephalomedullary nailing of unstable trochanteric fractures. J Clin Orthop Trauma. 2019 Oct;10(Suppl 1):S88-S94. 5. Nherera L, Trueman P, Horner A, Watson T, Johnstone AJ. Comparison of a twin interlocking derotation and compression screw cephalomedullary nail (InterTAN) with a single screw derotation cephalomedullary nail (proximal femoral nail antirotation): a systematic review and meta-analysis for intertrochanteric fractures. J Orthop Surg Res. 2018 Mar 2;13(1):46.