Comparison of the reconstruction trochanteric antigrade nail (TAN) with the proximal femoral nail antirotation (PFNA) in the management of reverse oblique intertrochanteric hip fractures.
Reverse oblique intertrochanteric fractures have unique mechanical characteristics and are often treated with intramedullary implants. We compared the outcomes of the reconstruction trochanteric antegrade nail (TAN) with the proximal femoral nail antirotation (PFNA). Between July 2008 and February 2014, we reviewed all patients with reverse oblique intertrochanteric fractures treated at our hospital. Patients with pathological fractures and those who were treated with other than TAN and PFNA nailing systems were excluded. Preoperative assessment included the Abbreviated mental test score (AMT), the ASA grade, pre-injury mobility and place of residence. Postoperative outcome measures included the type of implant used, time to fracture union, failures of fixation and revision surgeries. Fifty-eight patients were included and divided into two groups based on the treatment: 22 patients treated with TAN and 36 patients treated with PFNA systems. The two groups were well matched with regards to demographics and fracture type. The overall union rate was similar in both groups but the time to union was shorter in the TAN group. There were 8 implant failures in the PFNA (22.2%) group compare to none in the TAN group. Implant failure was associated with the severity of fracture (AO 31.A3.3) but was not related to fracture malreduction or screw position (Tip-apex-distance). Our study suggests that the use of reconstruction system with two screws such as TAN may be more suitable implant for reverse oblique intertrochanteric hip fractures.
Speciality Registrar Trauma & Orthopaedics, Department of Trauma & Orthopaedics, St Helens &Knowsley Teaching Hospitals NHS Trust, Whiston Hospital, Warrington Road, Prescot, L35 5DR. Electronic address: daoudmakki@hotmail.com.
Daoud
D
Makki
Speciality Registrar Trauma & Orthopaedics, Department of Trauma & Orthopaedics, St Helens &Knowsley Teaching Hospitals NHS Trust, Whiston Hospital, Warrington Road, Prescot, L35 5DR. Electronic address: hematar@doctors.org.uk.
Hosam E
HE
Matar
Clinical Fellow, Department of Trauma & Orthopaedics, St Helens &Knowsley Teaching Hospitals NHS Trust, Whiston Hospital, Warrington Road, Prescot, L35 5DR. Electronic address: nebujacob@yahoo.com.
Nebu
N
Jacob
Consultant Trauma & Orthopaedic Surgeon, St Helens &Knowsley, Teaching Hospitals NHS Trust, Whiston Hospital, Warrington Road, Prescot, L35 5DR. Electronic address: stephen.lipscombe@sthk.nhs.uk.
Stephen
S
Lipscombe
Consultant Trauma & Orthopaedic Surgeon, St Helens &Knowsley, Teaching Hospitals NHS Trust, Whiston Hospital, Warrington Road, Prescot, L35 5DR. Electronic address: Ravindra.Gudena@sthk.nhs.uk.
Ravindra
R
Gudena
D000368:Aged; D000369:Aged, 80 and over; D001858:Bone Nails; D005260:Female; D005500:Follow-Up Studies; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D017102:Fracture Healing; D006620:Hip Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006621:Hip Joint / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D061646:Operative Time; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000601:surgery*; D012086:Reoperation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012399:Rotation
Elderly patients; Intertrochanteric hip fractures; Proximal Femoral Nail Antirotation (PFNA); Reverse oblique; Trochanteric Antigrade Nail (TAN)