Ulus Travma Acil Cerrahi Derg. 2022; 28(5): 668-677 | DOI: 10.14744/tjtes.2020.80733

Functional and radiological comparison of three cephalomedullary nails with different designs used in the treatment of unstable intertrochanteric femur fractures of elderly

Furkan Yapýcý¹, Hanifi Üçpunar¹, Volkan Gür¹, Osman Onaç², Yakup Alpay³, Reþit Karaköse¹, Yalkýn Çamurcu^4
1Department of Orthopedics and Traumatology, Erzincan Binali Yýldýrým University Facult of Medicine, Erzincan-Turkey
²Department of Orthopedics and Traumatology, Bitlis State Hospital, Bitlis-Turkey
³Department of Orthopedics and Traumatology, Sultanbeyli State Hospital, Ýstanbul-Turkey
⁴Department of Orthopedics and Traumatology, Atlas University Faculty of Medicine, Ýstanbul-Turkey

BACKGROUND: The aim of this study to compare three cephalomedullary nails (CMNs) with different designs in terms of complica-tion, reoperation, implant failure, mortality rates, and functional outcomes in the treatment of unstable intertrochanteric fractures (UIFs).
METHODS: This retrospective study included patients with UIFs (AO/OTA type 31-A2 and 31-A3) who were treated with one of these CMNs (74 patients with Talon-PFN, 70 patients with PFN-III, and 69 patients with Intertan) between October 2014 and October 2018.
RESULTS: A total of 213 patients (122 females and 91 males) with a mean age of 81.0±9.3 years have participated in this study. The mean follow-up time was 26.1±6.3 months. Malfixation was the most common complication and the most common reason of reop-eration for each type of CMN. Complication and reoperation rates, post-operative functional status, mean union times, and overall mortality rates were similar between groups. Mean operation/fluoroscopy time and mean blood loss were low in the Talon-PFN group, whereas the highest means of these parameters were in the PFN-III group. There were six (8.2%) implant failures in the Talon-PFN group and one (1.5%) in PFN-III group. No implant failure was seen in the Intertan group. The highest rate (58.6%) of anatomic reduc-tion was detected in PFN-III group.
CONCLUSION: Our study results showed that each implant type had its own advantages and disadvantages in the treatment of UIFs with similar functional and reoperation outcomes. Intertan was advantageous with its absence of implant failures. Talon-PFN decreased the operation/fluoroscopy time and intraoperative blood loss but had the highest implant failure rate. There was a need for more anatomic reduction to centralize two separate parallel lag screws in the femoral neck in PFN-III group, and that costs operation/fluo-roscopy time and blood loss. Malfixation, which was the most common cause of complications and reoperations, should be avoided.

Keywords: Hip fracture, Intertrochanteric fracture, Intramedullary nailing, Fracture healing, Treatment outcome, Postoperative complications, Elderly, Cephalomedullary Nail.

---

Yaþlýlarda instabil intertrokanterik femur kýrýklarýnýn tedavisinde kullanýlan dizaynlarý farklý üç sefalomedüller çivinin fonksiyonel ve radyolojik açýdan karþýlaþtýrýlmasý

Furkan Yapýcý¹, Hanifi Üçpunar¹, Volkan Gür¹, Osman Onaç², Yakup Alpay³, Reþit Karaköse¹, Yalkýn Çamurcu^4
1Erzincan Üniversitesi Týp Fakültesi, Ortopedi ve Travmatoloji Anabilim Dalý, Erzincan
²Bitlis Devlet Hastanesi, Ortopedi ve Travmatoloji Kliniði, Bitlis
³Sultanbeyli Devlet Hastanesi, Ortopedi ve Travmatoloji Kliniði, Ýstanbul
⁴Atlas Üniversitesi Týp Fakültesi, Ortopedi ve Travmatoloji Anabilim Dalý, Ýstanbul

AMAÇ: Ýnstabil intertrokanterik kýrýklarýn (ÝÝTK) tedavisinde kullanýlan farklý tasarýmlara sahip üç sefalomedüller çivinin (SMÇ) komplikasyon, reope-rasyon, implant yetersizliði, mortalite oranlarý ve fonksiyonel sonuçlarý açýsýndan karþýlaþtýrýlmasýdýr.
GEREÇ VE YÖNTEM: Bu geriye dönük çalýþma, Ekim 2014 ile Ekim 2018 yýllarý arasýnda bu SMÇ’lerden biriyle (Talon-PFN: 74 hasta, PFN-III: 70 hasta ve Intertan: 69 hasta) tedavi edilmiþ ÝÝTK’lý hastalarý (AO/OTA tip 31-A2 ve 31-A3) içermektedir.
BULGULAR: Çalýþmaya yaþ ortalamasý 81.0±9.3 yýl olan toplam 213 hasta (122 kadýn ve 91 erkek) katýlmýþtýr. Ortalama takip süresi 26.1±6.3 aydýr. Malfiksasyonun, herbir SMÇ tipi için en sýk komplikasyon ve reoperasyon nedeni olduðu görülmüþtür. Komplikasyon ve reoperasyon oranlarý, ame-liyat sonrasý fonksiyonel durum, ortalama kaynama süreleri ve genel mortalite oranlarý gruplar arasýnda benzer bulunmuþtur. Ortalama operasyon/floroskopi süresi ve ortalama kan kaybý Talon-PFN grubunda düþük iken, bu parametrelerin en yüksek ortalamalarý PFN-III grubundaydý. Talon-PFN grubunda altý (%8.2) ve PFN-III grubunda bir (%1.5) implant yetersizliði mevcuttu. Intertan grubunda hiç implant yetersizliði görülmemiþtir. En yüksek anatomik redüksiyon oraný (%58.6) PFN-III grubunda tespit edilmiþtir.
TARTIÞMA: Çalýþma sonuçlarýmýz, ÝÝTK’larýn tedavisinde benzer fonksiyonel ve reoperasyon sonuçlarýna sahip olmakla beraber her bir implant tipi-nin farklý avantaj ve dezavantajlara sahip olduðunu göstermiþtir. Intertan, implant yetersizliði olmamasýyla avantajlýdýr. Talon-PFN ameliyat/floroskopi süresini ve intraoperatif kan kaybýný azaltmakla beraber en yüksek implant yetersizliði oranýna sahiptir. PFN-III’ün iki ayrý paralel boyun vidasýný femur boynunda merkezi yerleþtirebilmek için daha fazla anatomik redüksiyona ihtiyaç duyduðu ve bunun operasyon/floroskopi süresinin uzamasýna ve kan kaybýnýn artmasýna sebep olduðu görülmüþtür. En sýk komplikasyon ve reoperasyon sebebi olan malfiksasyondan kaçýnýlmalýdýr.

Anahtar Kelimeler: Kalça kýrýðý, Ýntertrokanterik kýrýk, Ýntramedüller çivileme, Kýrýk iyileþmesi, Tedavi sonuçlarý, Postoperatif komplikasyonlar, Yaþlýlar, Sefalomedüller çivi.

---

CITE