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Clinical Trial
. 2004 Dec;28(6):347-53.
doi: 10.1007/s00264-004-0590-x. Epub 2004 Sep 10.

Femoral shaft medialisation and neck-shaft angle in unstable pertrochanteric femoral fractures

J Pajarinen  1 , J Lindahl, V Savolainen, O Michelsson, E Hirvensalo
Affiliations
Clinical Trial

Femoral shaft medialisation and neck-shaft angle in unstable pertrochanteric femoral fractures

J Pajarinen et al. Int Orthop. 2004 Dec.

Abstract
in English, French

We analysed the time-dependent mean changes in the femoral neck length, neck-shaft angle and hip offset in a randomised study comprising 48 patients who were treated with the dynamic hip screw (DHS) or the proximal femoral nail (PFN) for an unstable intertrochanteric femoral fracture. As a consequence of fracture compression, the mean post-operative neck length was significantly shorter in patients treated with the DHS. During the first 6 weeks after the operation, a mean decrease of 4.6 degrees was observed in the neck-shaft angle, but there was not a significant difference between the treatment groups. The radiographic measures remained virtually unaffected during the interval from 6 weeks to 4 months in both groups. When the operated hip was compared to the opposite hip, patients who had received the DHS showed significantly greater medialisation of the femoral shaft at 4 months than those treated with the PFN. We thus recommend that unstable intertrochanteric fractures should be initially reduced in a slight valgus position in order to achieve an outcome after healing that is as normal as possible. As a result of differences in operative technique and implant stability, the PFN may be superior to the DHS in retaining the anatomical relations in the hip region in unstable intertrochanteric fractures.

Nous avons analysé les modifications, en fonction du temps, des valeurs moyennes de la longueur du col fémoral, de l’angle cervico-diaphysaire et du bras de levier de la hanche dans une étude randomisée qui comprenait 48 malades traités avec une Vis Dynamique (DHS) ou un Clou Fémoral Proximal (PFN) aprés une fracture intertrochantérienne instable. Par suite de la compression de la fracture, la longueur du col était nettement plus courte chez les malades traités avec une DHS. Pendant les premières six semaines après l’opération, une baisse moyenne de 4.6° de l’angle cervico-diaphysaire a été observée mais il n’y avait pas de différence notable entre les groupes de traitement. Les mesures radiographiques sont restées pratiquement non affectées pendant l’intervalle de six semaines à quatre mois dans les deux groupes. Comparé à la hanche opposée, les malades qui avaient reçu une DHS ont montré à 4 mois une nettement plus grande médialisation de la diaphyse que ceux traités avec le PFN. Nous recommandons que ces fractures intertrochantériennes instables soient réduites en léger valgus pour avoir une situation aussi normale que possible après consolidation. Par suite de différences dans la technique opératoire et dans la stabilité de l’implant, le PFN semble supérieur au DHS pour rétablir l’anatomie de la région de la hanche dans les fractures intertrochantériennes instables.

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Figures

Fig. 1
Fig. 1
AO/ASIF categorisation of pertrochanteric femoral fractures. Only unstable type A2 fractures were included.
Fig. 2
Fig. 2
Two lines were drawn to help evaluation of hip measures, one crossing the centre of rotation of the femoral head and the centre of the femoral neck and the other parallel to the femoral shaft (a). Subsequently, femoral-neck length (A), femoral-neck-shaft angle (B) and hip offset (C) were measured (b).
Fig. 3
Fig. 3
Partition of the femoral head into nine zones and the number of the tip of the compression screws of the dynamic hip screw (DHS) and the neck screws of the proximal femora nail (PFN) in each zone.
Fig. 4
Fig. 4
Failure of fixation in an unstable pertrochanteric femoral fracture a treated with the proximal femoral nail (PFN). b Primary reduction was not satisfactory, and c the screws of the PFN backed out within 3 months. The patient was re-operated 3 months from primary fixation.
See this image and copyright information in PMC

References

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