Intertrochanteric fractures of the femur account for 50% of hip fractures in the elderly. Conservative treatment is prone to complications such as deep vein thrombosis, pulmonary embolism, pressure sores, and pulmonary infections. The mortality rate within one year exceeds 20%. Therefore, in cases where the patient's physical condition allows, early surgical internal fixation is the preferred treatment for intertrochanteric fractures.
Intramedullary nail internal fixation is currently the gold standard for the treatment of intertrochanteric fractures. In studies on the factors influencing PFNA internal fixation, factors such as PFNA nail length, varus angle, and design have been reported in numerous previous studies. However, it is still unclear whether the thickness of the main nail affects functional outcomes. To address this, foreign scholars have used intramedullary nails with equal length but different thickness to fix intertrochanteric fractures in elderly individuals (age > 50), aiming to compare whether there are differences in functional outcomes.
The study included 191 cases of unilateral intertrochanteric fractures, all treated with PFNA-II internal fixation. When the lesser trochanter was fractured and detached, a 200mm short nail was used; when the lesser trochanter was intact or not detached, a 170mm ultra-short nail was used. The diameter of the main nail ranged from 9-12mm. The main comparisons in the study focused on the following indicators:
1. Lesser trochanter width, to assess whether the positioning was standard;
2. Relationship between the medial cortex of the head-neck fragment and the distal fragment, to evaluate the quality of reduction;
3. Tip-Apex Distance (TAD);
4.Nail-to-canal ratio (NCR). NCR is the ratio of the main nail diameter to the medullary canal diameter on the distal locking screw plane.
Among the 191 patients included, the distribution of cases based on the length and diameter of the main nail is shown in the following figure:
The average NCR was 68.7%. Using this average as a threshold, cases with NCR greater than the average were considered to have a thicker main nail diameter, while cases with NCR less than the average were considered to have a thinner main nail diameter. This led to the classification of patients into the Thick Main Nail group (90 cases) and the Thin Main Nail group (101 cases).
The results indicate that there were no statistically significant differences between the Thick Main Nail group and the Thin Main Nail group in terms of Tip-Apex Distance, Koval score, delayed healing rate, reoperation rate, and orthopedic complications.
Similar to this study, an article was published in the "Journal of Orthopaedic Trauma" in 2021: [Title of the Article].
The study included 168 elderly patients (age > 60) with intertrochanteric fractures, all treated with cephalomedullary nails. Based on the diameter of the main nail, patients were divided into a 10mm group and a group with a diameter greater than 10mm. The results also indicated that there were no statistically significant differences in reoperation rates (either overall or non-infectious) between the two groups. The authors of the study suggest that, in elderly patients with intertrochanteric fractures, using a 10mm diameter main nail is sufficient, and there is no need for excessive reaming, as it can still achieve favorable functional outcomes.
Post time: Feb-23-2024
