Effectiveness of proximal femur bionic nail for intertrochanteric fracture in the elderly_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YANG Dongsong ¹ , WANG Qiong ¹ , LUAN Zhonghao ² , LING Jiansheng ¹ , CHEN Peng ¹ , CHEN Xudong ¹ , YUAN Dongtao ¹ , ZHEN Xiangzhou ¹ ,  WANG Junqiang ³

1. Department of Orthopedics, the Second Affiliated Hospital of Luohe Medical College, Luohe Henan, 462300, P. R. China;
2. Department of Information, the Second Affiliated Hospital of Luohe Medical College, Luohe Henan, 462300, P. R. China;
3. Department of Orthopaedic Trauma, Beijing Jishuitan Hospital, Beijing, 100035, P. R. China;

Corresponding author：

WANG Junqiang, Email: drw-jq1997@163.com

Keywords：

Intertrochanteric fracture; proximal femoral nail antirotation; proximal femur bionic nail; internal fixation; the elderly

DOI：

10.7507/1002-1892.202305083

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Objective To evaluate effectiveness of proximal femur bionic nail (PFBN) in treatment of intertrochanteric fractures in the elderly compared to the proximal femoral nail antirotation (PFNA). Methods A retrospective analysis was made on 48 geriatric patients with intertrochanteric fractures, who met the selection criteria and were admitted between January 2020 and December 2022. Among them, 24 cases were treated with PFBN fixation after fracture reduction (PFBN group), and 24 cases were treated with PFNA fixation (PFNA group). There was no significant difference in baseline data such as age, gender, cause of injury, side and type of fracture, time from injury to operation, and preoperative mobility score, American Society of Anesthesiologists (ASA) score, Alzheimer’s disease degree scoring, self-care ability score, osteoporosis degree (T value), and combined medical diseases between the two groups (P>0.05). The operation time, intraoperative blood loss, number of blood transfusions, transfusion volume, length of hospital stay, occurrence of complications, weight-bearing time after operation, and postoperative visual analogue scale (VAS) score, walking ability score, mobility score, self-care ability score were recorded and compared between the two groups. And the radiographic assessment of fracture reduction quality and postoperative stability, and fracture healing time were recorded. Results The operations in both groups were successfully completed. All patients were followed up 6-15 months with an average time of 9.8 months in PFBN group and 9.6 months in PFNA group. The operation time was significantly longer in PFBN group than in PFNA group (P<0.05), but there was no significant difference in intraoperative blood loss, number of blood transfusions, transfusion volume, length of hospital stay, change in activity ability score, and change in self-care ability score between the two groups (P>0.05). The weight-bearing time after operation was significantly shorter in PFBN group than in PFNA group (P<0.05), and the postoperative VAS score and walking ability score were significantly better in PFBN group than in PFNA group (P<0.05). Radiographic assessment showed no significant difference in fracture reduction scores and postoperative stability scores between the two groups (P>0.05). All fractures healed and there was no significant difference in fracture healing time between the two groups (P>0.05). The incidence of complications was significantly lower in PFBN group (16.7%, 4/24) than in PFNA group (45.8%, 11/24) (P<0.05). Conclusion Compared with PFNA, PFBN in the treatment of elderly intertrochanteric fractures can effectively relieve postoperative pain, shorten bed time, reduce the risk of complications, and facilitate the recovery of patients’ hip joint function and walking ability.

Citation： YANG Dongsong, WANG Qiong, LUAN Zhonghao, LING Jiansheng, CHEN Peng, CHEN Xudong, YUAN Dongtao, ZHEN Xiangzhou, WANG Junqiang. Effectiveness of proximal femur bionic nail for intertrochanteric fracture in the elderly. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(10): 1198-1204. doi: 10.7507/1002-1892.202305083 Copy

1.	胡孙君, 杜守超, 熊文峰, 等. 股骨近端防旋髓内钉内固定治疗高位股骨转子间骨折. 中国修复重建外科杂志, 2021, 35(3): 307-311.
2.	中国脆性骨折联盟, 中国老年医学学会骨与关节分会创伤骨科学术工作委员会, 白求恩·骨科加速康复联盟, 等. 老年股骨转子间骨折诊疗指南. 中华创伤骨科杂志, 2020, 22(2): 93-99.
3.	Li J, Yin P, Zhang L, et al. Medial anatomical buttress plate in treating displaced femoral neck fracture a finite element analysis. Injury, 2019, 50(11): 1895-1900.
4.	张世民. 老年髋部转子间骨折. 北京: 科学出版社, 2023: 518-519.
5.	朱燕宾, 陈伟, 叶丹丹, 等. 股骨近端N三角理论及股骨近端仿生髓内钉(PFNB)的设计理念. 中华老年骨科与康复电子杂志, 2021, 7(5): 257-259.
6.	张殿英. “杠杆-支点重建”理论重新认识股骨转子间骨折内固定的过去和未来. 中华创伤骨科杂志, 2020, 22(10): 841-845.
7.	李祖涛, 殷剑, 肖伟, 等. 股骨近端仿生髓内钉与股骨近端防旋髓内钉固定治疗老年股骨转子间骨折的近期疗效比较. 中华创伤骨科杂志, 2022, 24(6): 528-532.
8.	凌峰, 张伟, 常锐, 等. 股骨近端仿生髓内钉与股骨近端防旋髓内钉固定治疗股骨转子间骨折的近期疗效比较. 中华创伤骨科杂志, 2023, 25(6): 544-548.
9.	Parker MJ, Palmer CR. A new mobility score for predicting mortality after hip fracture. J Bone Joint Surg (Br), 1993, 75(5): 797-798.
10.	Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist, 1969, 9(3): 179-186.
11.	Sainsbury A, Seebass G, Bansal A, et al. Reliability of the Barthel Index when used with older people. Age Ageing, 2005, 34(3): 228-232.
12.	张世民, 张英琪, 李清, 等. 内侧皮质正性支撑复位对老年股骨粗隆间骨折内固定效果的影响. 中国矫形外科杂志, 2014, 22(14): 1256-1261.
13.	林栋, 陈长青, 王升, 等. 股骨近端仿生髓内钉与股骨近端防旋髓内钉固定治疗老年股骨转子间骨折的早期疗效比较. 中华创伤杂志, 2022, 38(11): 1027-1035.
14.	Wang Y, Chen W, Zhang L, et al. Finite element analysis of proximal femur bionic nail (PFBN) compared with proximal femoral nail antirotation and intertan in treatment of intertrochanteric fractures. Orthop Surg, 2022, 14(9): 2245-2255.
15.	朱燕宾, 丁凯, 李泳龙, 等. 三角支撑固定系统固定股骨转子间骨折的生物力学有限元分析. 中华骨科杂志, 2021, 41(18): 1361-1366.
16.	张世民, 胡孙君, 杜守超,等. 股骨转子间骨折一种新的综合分类法. 中国修复重建外科杂志, 2022, 36(9): 1056-1063.

1. 胡孙君, 杜守超, 熊文峰, 等. 股骨近端防旋髓内钉内固定治疗高位股骨转子间骨折. 中国修复重建外科杂志, 2021, 35(3): 307-311.
2. 中国脆性骨折联盟, 中国老年医学学会骨与关节分会创伤骨科学术工作委员会, 白求恩·骨科加速康复联盟, 等. 老年股骨转子间骨折诊疗指南. 中华创伤骨科杂志, 2020, 22(2): 93-99.
3. Li J, Yin P, Zhang L, et al. Medial anatomical buttress plate in treating displaced femoral neck fracture a finite element analysis. Injury, 2019, 50(11): 1895-1900.
4. 张世民. 老年髋部转子间骨折. 北京: 科学出版社, 2023: 518-519.
5. 朱燕宾, 陈伟, 叶丹丹, 等. 股骨近端N三角理论及股骨近端仿生髓内钉(PFNB)的设计理念. 中华老年骨科与康复电子杂志, 2021, 7(5): 257-259.
6. 张殿英. “杠杆-支点重建”理论重新认识股骨转子间骨折内固定的过去和未来. 中华创伤骨科杂志, 2020, 22(10): 841-845.
7. 李祖涛, 殷剑, 肖伟, 等. 股骨近端仿生髓内钉与股骨近端防旋髓内钉固定治疗老年股骨转子间骨折的近期疗效比较. 中华创伤骨科杂志, 2022, 24(6): 528-532.
8. 凌峰, 张伟, 常锐, 等. 股骨近端仿生髓内钉与股骨近端防旋髓内钉固定治疗股骨转子间骨折的近期疗效比较. 中华创伤骨科杂志, 2023, 25(6): 544-548.
9. Parker MJ, Palmer CR. A new mobility score for predicting mortality after hip fracture. J Bone Joint Surg (Br), 1993, 75(5): 797-798.
10. Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist, 1969, 9(3): 179-186.
11. Sainsbury A, Seebass G, Bansal A, et al. Reliability of the Barthel Index when used with older people. Age Ageing, 2005, 34(3): 228-232.
12. 张世民, 张英琪, 李清, 等. 内侧皮质正性支撑复位对老年股骨粗隆间骨折内固定效果的影响. 中国矫形外科杂志, 2014, 22(14): 1256-1261.
13. 林栋, 陈长青, 王升, 等. 股骨近端仿生髓内钉与股骨近端防旋髓内钉固定治疗老年股骨转子间骨折的早期疗效比较. 中华创伤杂志, 2022, 38(11): 1027-1035.
14. Wang Y, Chen W, Zhang L, et al. Finite element analysis of proximal femur bionic nail (PFBN) compared with proximal femoral nail antirotation and intertan in treatment of intertrochanteric fractures. Orthop Surg, 2022, 14(9): 2245-2255.
15. 朱燕宾, 丁凯, 李泳龙, 等. 三角支撑固定系统固定股骨转子间骨折的生物力学有限元分析. 中华骨科杂志, 2021, 41(18): 1361-1366.
16. 张世民, 胡孙君, 杜守超,等. 股骨转子间骨折一种新的综合分类法. 中国修复重建外科杂志, 2022, 36(9): 1056-1063.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of proximal femur bionic nail for intertrochanteric fracture in the elderly

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