COMPARISON OF PROXIMAL FEMORAL NAIL ANTIROTATION AND RECONSTRUCTION NAIL FOR IPSILATERAL FRACTURES OF HIP AND FEMORAL SHAFT_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Jinping ¹ , YANG Tianfu ² , NING Jianjun ¹ , FANG Yue ² , WANG Guanglin ² , LAN Yuping ³

1Department of Orthopedics, First Affiliated Hospital, South China University, Hengyang Hunan, 421001, P.R.China;;
2Department of Orthopedics, West China Hospital, Sichuan University;;
3Department of Orthopedics, Central Hospital of Panzhihua. Corresponding author: YANG Tianfu, E-mail: yangtianf@126.com;

Corresponding author：

Keywords：

Femoral shaft fracture; Hip fracture Internal fixation; Proximal femoral nail antirotation; Reconstruction nail; Minimally invasive technique

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Objective To compare the effectiveness of proximal femoral nail antirotation (PFNA) and reconstruction nail with minimally invasive technique for ipsilateral femoral shaft and extracapsular hip fractures in young and middle-aged patients. Methods Sixty-nine young and middle-aged patients with ipsilateral femoral shaft and extracapsular hip fractures were treated between January 2000 and August 2010, and their data were analyzed retrospectively. Of them, fractures were fixed by reconstruction nail in 44 cases (reconstruction nail group) and by PFNA in 25 cases (PFNA group). There was no significant difference in gender, age, weight, injury cause, fracture type, or disease duration between 2 groups (P gt; 0.05). The operation time, blood loss, fracture healing time, complications, and functional outcomes were compared between 2 groups to evaluate the effectiveness. Results The operation time and blood loss in the PFNA group were significantly less than those in the reconstruction nail group (P lt; 0.05). The follow-up time was 12-38 months (mean, 20 months ) in the PFNA group and was 12-48 months (mean, 22 months) in the reconstruction nail group. No complication occurred as follows in 2 groups: wound infection, deep venous thrombosis, pulmonary embolism, breakage of the implants, avascular necrosis of the femoral head, or serious rotation and shortening deformity of lower limbs. In the PFNA group and the reconstruction nail group, 1 patient underwent technical difficulty in nail implant and 7 patients underwent technical difficulty in proximal locking screw, respectively; 3 patients and 6 patients had intra-operative iatrogenic fracture of femoral shaft, respectively; and delayed union of femoral shaft was observed in 1 patient and 2 patients, respectively. The complication rate was 20% (5/25) in the PFNA group and 34% (15/44) in the reconstruction nail group, showing no significant difference (χ2=1.538, P=0.215). No significant difference was found in fracture healing time between 2 groups (P gt; 0.05). At last follow-up, there was no significant difference in Harris hip score and Evanich knee score between 2 groups (P gt; 0.05). Conclusion PFNA or reconstruction nail with minimally invasive technique is a good method to treat ipsilateral femoral shaft and extracapsular hip fractures, but the PFNA is superior to the reconstruction nail because of simple operation.

Citation： WANG Jinping,YANG Tianfu,NING Jianjun,FANG Yue,WANG Guanglin,LAN Yuping. COMPARISON OF PROXIMAL FEMORAL NAIL ANTIROTATION AND RECONSTRUCTION NAIL FOR IPSILATERAL FRACTURES OF HIP AND FEMORAL SHAFT. Chinese Journal of Reparative and Reconstructive Surgery, 2012, 26(8): 905-909. doi: Copy

1.	Bose WJ, Corces A, Anderson LD. A preliminary experience with the Russell-Taylor reconstruction nail for complex femoral fractures. J Trauma, 1992, 32(1): 71-76.
2.	林鸿宽, 周之平, 陈雁华, 等. 微创防旋髓内钉治疗股骨干骨折并同侧股骨近端骨折. 实用临床医学, 2011, 12(9): 31-32, 35.
3.	Vidyadhara S, Rao SK. Cephalomedullary nails in the management of ipsilateral neck and shaft fractures of the femur—one or two femoral neck screws? Injury, 2009, 40(3): 296-303.
4.	Hossam ElShafie M, Adel Morsey H, Emad Eid Y. Ipsilateral fracture of the femoral neck and shaft, treatment by reconstruction interlocking nail. Arch Orthop Trauma Surg, 2001, 121(1-2): 71-74.
5.	任凯, 杨欣建, 刘黎军, 等. 重建带锁髓内钉治疗同侧股骨干合并股骨颈骨折. 实用骨科杂志, 2011, 17(2): 114-116.
6.	Simmermacher RK, Ljungqvist J, Bail H, et al. The new proximal femoral nail antirotation (PFNA) in daily practice: results of a multicentre clinical study. Injury, 2008, 39(8): 932-939.
7.	陈瀛, 林朋, 杨连发, 等. 防旋股骨近端髓内钉治疗股骨粗隆间骨折的近期临床效果. 中国修复重建外科杂志, 2008, 22(7): 769-772.
8.	王文岳, 杨天府, 方跃, 等. 防旋股骨近端髓内钉治疗股骨逆转子间骨折. 中国修复重建外科杂志, 2009, 23(11): 1306-1310.
9.	吴俊, 商晓军, 刘锦波, 等. 加长型PFNA 治疗股骨粗隆周围骨折合并同侧股骨干骨折. 医学研究杂志, 2011, 40(10): 122-124.
10.	Whittle AP, Wood GWII. Fractures of lower extremity//Canale ST, ed. Campbell’s operative orthopaedics. 10th ed. St Louis: Mosby Inc, 2003: 2725-2872.
11.	汪金平, 杨天府, 孔清泉, 等. 交通伤中股骨颈骨折的漏诊分析. 中华创伤杂志, 2003, 19(10): 615-616.
12.	Alho A. Concurrent ipsilateral fractures of the hip and femoral shaft: a meta-analysis of 659 cases. Acta Orthop Scand, 1996, 67(1): 19-28.
13.	Bone LB, Anders MJ, Rohrbacher BJ. Treatment of femoral fractures in the multiply injured patient with thoracic injury. Clin Orthop Relat Res, 1998, (347): 57-61.
14.	Tsai CH, Hsu HC, Fong YC, et al. Treatment for ipsilateral fractures of femoral neck and shaft. Injury, 2009, 40(7): 778-782.
15.	Blair B, Koval KJ, Kummer F, et al. Basicervical fractures of the proximal femur: a biomechanical study of 3 internal fixation techniques. Clin Orthop Relat Res, 1994, (306): 256-263.
16.	Singh R, Rohilla R, Magu NK, et al. Ipsilateral femoral neck and shaft fractures: a retrospective analysis of two treatment methods. J Orthopaed Traumatol, 2008, 9(3): 141-147.
17.	孙林, 王满宜, 刘德全, 等. 股骨重建髓内针治疗股骨干骨折合并同侧髋部骨折36例. 中华创伤杂志, 2001, 17(4): 216-218.
18.	Hwang JH, Oh JK, Han SH, et al. Mismatch between PFNa and medullary canal causing difficulty in nailing of the pertrochanteric fractures. Arch Orthop Trauma Surg, 2008, 128(12): 1443-1446.

1. Bose WJ, Corces A, Anderson LD. A preliminary experience with the Russell-Taylor reconstruction nail for complex femoral fractures. J Trauma, 1992, 32(1): 71-76.
2. 林鸿宽, 周之平, 陈雁华, 等. 微创防旋髓内钉治疗股骨干骨折并同侧股骨近端骨折. 实用临床医学, 2011, 12(9): 31-32, 35.
3. Vidyadhara S, Rao SK. Cephalomedullary nails in the management of ipsilateral neck and shaft fractures of the femur—one or two femoral neck screws? Injury, 2009, 40(3): 296-303.
4. Hossam ElShafie M, Adel Morsey H, Emad Eid Y. Ipsilateral fracture of the femoral neck and shaft, treatment by reconstruction interlocking nail. Arch Orthop Trauma Surg, 2001, 121(1-2): 71-74.
5. 任凯, 杨欣建, 刘黎军, 等. 重建带锁髓内钉治疗同侧股骨干合并股骨颈骨折. 实用骨科杂志, 2011, 17(2): 114-116.
6. Simmermacher RK, Ljungqvist J, Bail H, et al. The new proximal femoral nail antirotation (PFNA) in daily practice: results of a multicentre clinical study. Injury, 2008, 39(8): 932-939.
7. 陈瀛, 林朋, 杨连发, 等. 防旋股骨近端髓内钉治疗股骨粗隆间骨折的近期临床效果. 中国修复重建外科杂志, 2008, 22(7): 769-772.
8. 王文岳, 杨天府, 方跃, 等. 防旋股骨近端髓内钉治疗股骨逆转子间骨折. 中国修复重建外科杂志, 2009, 23(11): 1306-1310.
9. 吴俊, 商晓军, 刘锦波, 等. 加长型PFNA 治疗股骨粗隆周围骨折合并同侧股骨干骨折. 医学研究杂志, 2011, 40(10): 122-124.
10. Whittle AP, Wood GWII. Fractures of lower extremity//Canale ST, ed. Campbell’s operative orthopaedics. 10th ed. St Louis: Mosby Inc, 2003: 2725-2872.
11. 汪金平, 杨天府, 孔清泉, 等. 交通伤中股骨颈骨折的漏诊分析. 中华创伤杂志, 2003, 19(10): 615-616.
12. Alho A. Concurrent ipsilateral fractures of the hip and femoral shaft: a meta-analysis of 659 cases. Acta Orthop Scand, 1996, 67(1): 19-28.
13. Bone LB, Anders MJ, Rohrbacher BJ. Treatment of femoral fractures in the multiply injured patient with thoracic injury. Clin Orthop Relat Res, 1998, (347): 57-61.
14. Tsai CH, Hsu HC, Fong YC, et al. Treatment for ipsilateral fractures of femoral neck and shaft. Injury, 2009, 40(7): 778-782.
15. Blair B, Koval KJ, Kummer F, et al. Basicervical fractures of the proximal femur: a biomechanical study of 3 internal fixation techniques. Clin Orthop Relat Res, 1994, (306): 256-263.
16. Singh R, Rohilla R, Magu NK, et al. Ipsilateral femoral neck and shaft fractures: a retrospective analysis of two treatment methods. J Orthopaed Traumatol, 2008, 9(3): 141-147.
17. 孙林, 王满宜, 刘德全, 等. 股骨重建髓内针治疗股骨干骨折合并同侧髋部骨折36例. 中华创伤杂志, 2001, 17(4): 216-218.
18. Hwang JH, Oh JK, Han SH, et al. Mismatch between PFNa and medullary canal causing difficulty in nailing of the pertrochanteric fractures. Arch Orthop Trauma Surg, 2008, 128(12): 1443-1446.

Chinese Journal of Reparative and Reconstructive Surgery

COMPARISON OF PROXIMAL FEMORAL NAIL ANTIROTATION AND RECONSTRUCTION NAIL FOR IPSILATERAL FRACTURES OF HIP AND FEMORAL SHAFT

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