Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Dec 20;25(1):1051.
doi: 10.1186/s12891-024-08197-0.

An overview of patients with intertrochanteric femoral fractures treated with proximal femoral nail fixation using important criteria

Ümit Aygün  1 , Eyüp Şenocak  2 , Mehmet Fatih Aksay  3 , Ali Can Çiçek  3 , Orkun Halaç  4 , Serdar Toy  5
Affiliations

An overview of patients with intertrochanteric femoral fractures treated with proximal femoral nail fixation using important criteria

Ümit Aygün et al. BMC Musculoskelet Disord. .

Abstract

Background: This study aimed to assess important criteria, including osteoporosis, fracture type, implant position within the bone, fracture reduction, and radiographic union, in patients with intertrochanteric femoral fractures treated with proximal femoral nail (PFN) fixation and to show their effect on clinical outcomes.

Methods: PFN fixation was applied in 73 patients (41 females, 32 males; mean age: 64.5 ± 6.2). The T score, fracture type according to the AO Foundation and Orthopedic Trauma Association (AO/OTA), implant-related complications (IRCs), Harris hip score (HHS), Jensen social function (JSF) score, and Parker-Palmer mobility score (PPMS), postoperative reduction classification, screw position according to the Cleveland zone, Radiographic Union Scale for the Hip (RUSH) score, and tip-apex distance (TAD) were recorded.

Results: Most screws were in central-central (n = 42) and inferior-central (n = 11) positions. IRCs were seen mostly in cases of screws placed in peripheral zones (n = 10) and were not observed in almost any patient with a TAD ≤ 25 mm (n = 52) (p < 0.001). Most of the patients with acceptable or good fracture reduction did not have IRCs (n = 11 and 50, respectively) (p < 0.001). Half of type 3A1 (n = 13) and most type 3A2 (n = 20) fractures showed radiographic union at 3 months, and most type 3A3 (n = 9) fractures showed radiographic union at 5 months (p < 0.05). At 12 months, type 3A2 fractures had the highest HHS (79.2 ± 5.3) and PPMS (3.9 ± 1.5), while type 3A3 fractures had the lowest HHS (70.3 ± 4.6) and PPMS (0.6 ± 2.8) (p < 0.05). At 12 and 24 months, type 3A3 fractures had higher JSF scores (2.8 ± 0.4 and 3.5 ± 0.5, respectively); at 3 months, type 3A1 fractures had higher JSF scores (3.1 ± 0.3) (p < 0.05). The radiographic bone union time was prolonged in patients with a T score ≤ -2.5 standard deviation (SD) (p < 0.05). The HHS and PPMS increased while the RUSH score, considered as the radiographic union, was going towards the 4th month and decreased after the 4th month (p < 0.05).

Conclusions: Considering the criteria (osteoporosis, fracture type, implant position within the bone, fracture reduction, and radiographic union) examined in this study, satisfactory results can be obtained with PFN fixation in the treatment of patients with intertrochanteric femoral fractures.

Keywords: Cleveland zone; Functional scores; Intertrochanteric femoral fracture; Postoperative reduction classification; Radiographic union scale for the hip; Tip-apex distance.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics approval and consent to participate: The research follows the basic principles of the Declaration of Helsinki, the study protocol was approved by the Ethics committee of Istinye University (No. 3/2022.K-20), and all individuals signed informed consent when participating in this study. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Screw position according to the Cleveland zone system. The first number represents the number of patients with IRCs, and the second number represents the number of patients without IRCs
Fig. 2
Fig. 2
Examples of radiographic evaluation of PFN fixation. (A) Cleveland zone. (B) AP X-ray; TAD. (C) Lateral X-ray; TAD
Fig. 3
Fig. 3
Relationship of the TAD (A), postoperative reduction classification (B), and AO-OTA classification (C) with IRCs
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Gjertsen JE, Baste V, Fevang JM, Furnes O, Engesæter LB. Quality of life following hip fractures: results from the Norwegian hip fracture register. BMC Musculoskelet Disord. 2016;17:265. - PMC - PubMed
    1. Papadimitriou N, Tsilidis KK, Orfanos P, Benetou V, Ntzani EE, Soerjomataram I, et al. The burden of the hip fracture using disability-adjusted life-years: a pooled analysis of prospective cohorts in the CHANCES consortium. Lancet Public Health. 2017;2:E239–46. - PubMed
    1. LeBlanc ES, Hillier TA, Petula KL, Rizzo JH, Cawthon PM, Fink HA, et al. Hip fracture and increased short-term but not long-term mortality in healthy older women. Arch Intern Med. 2011;171:1831–7. - PMC - PubMed
    1. Gaumetou E, Zilber S, Hernigou P. Non-simultaneous bilateral hip fracture: epidemiologic study of 241 hip fractures. Orthop Traumatol Surg Res. 2011;97:22–7. - PubMed
    1. Takigami I, Matsumoto K, Ohara A, Yamanaka K, Naganawa T, Ohashi M, et al. Treatment of trochanteric fractures with the PFNA (proximal femoral nail antirotation) nail system-report of early results. Bull NYU Hosp Jt Dis. 2008;66:276–9. - PubMed

LinkOut - more resources