The mainstay of treatment of intertrochanteric fracture is fixation with a screw slide plate device or intramedullary device. The intramedullary hip screw is a more biological method of fixation. Prospective randomized controlled trial of an intramedullary nail versus dynamic screw and plate for intertrochanteric fractures of the femur. Pdf fixation of intertrochanteric fractures of the femur. The duration of surgery was recorded intraoperatively. Feb 03, 2020 intramedullary nailing is surgery to repair a broken bone and keep it stable. Intramedullary nail versus dynamic hip screw semantic. Compared with dynamic hip screw, intramedullary nail fixation has better stability, and reduces the incidence of fracture varus and collapse, but there may be injury or aggravation of lateral wall injury when intramedullary nail is inserted.
A comparative study of dynamic hip screw and proximal. Comparing the intramedullary nailing method versus dynamic. To compare the results of dynamic hip screw and proximal femoral nail in the treatment of intertrochanteric fractures. Oct 29, 2019 the american academy of orthopedic surgeons aaos recommends dynamic hip screw and intramedullary nail as the main surgery options in stable intertrochanteric fracture. The funnel plot for the metaanalysis of mortality for intramedullary nail versus extramedullary fixation was. Is trochanteric fixation nail a better implant in the. Intertrochanteric fractures of femur by proximal femoral. Hip replacement as alternative to intramedullary nail in. Egol, md intramedullary fixation of midshaft clavicle fractures peter j. Cephalomedullary nailing of fractures of the proximal. Dynamic hip screw dhs has been the most preferable method for years 46, although intramedullary nail imn has been adopted to routine use of these fractures as well 1, 8. Oct 31, 2014 we sought to determine whether intramedullary fixation with proximal femoral nail antirotation produces comparable outcomes to dynamic hip screw in the treatment of unstable trochanteric fractures.
But with the improvement of cephalomedullary nailing system and technique, nailing has been gaining popularity among surgeons, especially for some types of unstable fractures like aoota arbeitsgemeinschaft fur osteosynthesefragen. In a cadaveric study by haynes and coworkers, 15 the short gamma nail gn was tested against the dynamic hip screw dhs in an osteotomized proximal femur simulating a subtrochanteric fracture with intertrochanteric extension. Intramedullary fixation is newer and has become popular for the treatment of pertrochanteric fractures, increasing from 3% of all cases in 1999 to 67% in 2006 in the united states. Sliding hip screw versus intramedullary nail for trochanteric hip fractures. Fracture pattern rate of contralateral hip fracture after dynamic hip screw vs intramedullary nail for treatment of pertrochanteric hip fractures. Fracture pattern rate of contralateral hip fracture after dynamic hip screw vs intramedullary nail for treatment of pertrochanteric hip fractures jonathan d. Comparing the intramedullary nail and extramedullary.
In this study, the use of proximal femoral nail and dynamic hip screw for treatment of intertrochanteric hip fractures were compared in terms of mortality and morbidity. The funnel plot for the metaanalysis of mortality for intramedullary nail. As with the compression hip screw, sliding of the lag screw and impaction of the fracture take place. The gamma nail was developed to circumvent the drawbacks of the dynamic hip screw by combining the advantages of intramedullary fixation with those of a sliding screw. The american academy of orthopedic surgeons aaos recommends dynamic hip screw and intramedullary nail as the main surgery options in stable intertrochanteric fracture. Comparison and analysis of reoperations in two different. Proximal femoral nail antirotation versus dynamic hip. Comparitive study between proximal femoral nailing and. Comparing the intramedullary nailing method versus dynamic hip. The intramedullary nail is placed directly into the marrow canal of the bone through an opening made at the top of the greater trochanter. The sliding hip screw is superior to the intramedullary nails in terms of the lower complication rate. Dynamic hip screw west chester, pa and the stryker gamma intramedullary locking nail kalamazoo, mi. Rate of contralateral hip fracture after dynamic hip screw.
Optimal fixation is based on the stability of fracture. Sliding hip screw versus im nail in reverse oblique trochanteric and. Hip nailing for hip fracture procedure is performed at a hospital. All measurements must be verified intraoperatively. Original article efficacy of proximal femoral nail anti. The purpose of this study is to investigate whether the lag screw configuration single vs integrated dual interlocking screw and the mode of lag screw locking static vs dynamic. The question is whether they have surpassed the dynamic hip screw in the treatment of these fractures.
The age of the patient ranged from 27 to 80 years with an average of 59. Intramedullary nail versus dynamic hip screw semantic scholar. High cost of implant cost of an intramedullary nail is 78 times the cost of a dynamic hip screw which may act as a restraint for use in all patients with intertrochanteric fractures. Comparision of dynamic hip screw and plate with proximal. Nail size, screw length and femoral neck angle may be determined. So there is still a place for dhs in intertrochanteric fractures especially stable ones. Biomechanical comparison of dynamic hip screw and gamma nail. Generally, intramedullary fixation proximal femoral nail pfn and gamma nail and extramedullary fixation dynamic hip screw dhs are the 2.
A randomized, prospective study of 206 patients comparing thedynamic hip screw and proximal femoral nail. May, 2020 a comparison of the long gamma nail with the sliding hip screw for the treatment of aoota 31a2 fractures of the proximal part of the femur. Original article is proximal femoral nail antirotation. Hence we conducted a study in our rural set up to compare the result of treatment of these fractures by ei ther of those two methods that is proximal femoral nail ing and dynamic hip screw. Comparative study of proximal femoral nailing and dynamic. At latest followup, there was no difference in the percentage of functional recovery between the two fixation groups baungaertner, 1998. Dynamic hip screw is used for fractures considered as stable within the respective. Introduced in 1991 with its design, the imhs system provided a more minimally invasive technique than the traditional compression hip screw.
Different treatment protocols are used by two similar swedish regional emergency care hospitals. There are challenges in the operation of lateral wall fractures associated with unstable fractures of. Intertrochanteric osteotomy using a dynamic hip screw for. Previous studies showed that the gamma nail did not perform as well as dhs because it. S dynamic hip screw with side plate assembly is most commonly used device for fixation of intertrochanteric fractures. A prospective randomized and comparative study was. Intramedullary nail instruments synthes intramedullary nail instruments 360. Surgery for hip fracture dynamic hip screw this leaflet aims to answer your questions about having surgery for a hip fracture. Proximal femoral nail pfn and gamma nail are 2 commonly used devices in the intramedullary fixation. The postoperative radiographs demonstrate that the lag screw is superior in the femoral head with a tipapex distance of 40 millimeters. Hip replacement versus intramedullary nail in elderly. Cephalomedullary nail versus sliding hip screw for. Pdf comparison of proximal femoral nail and dynamic hip.
These types are not well controlled by the sliding compression hip screw and side plate and are associated with a high rate of fixation failure when treated with dynamic hip screw. Orthopedic trauma affixus hip fracture nail system. The affixus hip fracture nail system provides an efficient, practical solution for treating a wide range of proximal femoral fractures. The most common extramedullary implants are the sliding hip screw, also called a compression hip screw or dynamic hip screw. Surgery for hip fracture intramedullary nail insertion this leaflet aims to answer your questions about having surgery for a hip fracture. Intramedullary nail advantages and disadvantages introduction. Dynamic hip screw dhs fixation and proximal femoral nail antirotation pfna fixation are both frequently used to treat intertrochanteric femoral fractures iffs. Proximal femoral nail antirotation against dynamic hip screw. Our study consists of 30 patient with intertrochanteric fractures out of which 15 was treated with dhs and 15 with pfn. If you have any further questions, please speak to a doctor or nurse caring for you. Cephalomedullary nailing of fractures of the proximal femur. So it is a matter of debate that which one is the best treatment, dynamic hip screw or proximal femoral nailing. Rate of contralateral hip fracture after dynamic hip screw vs. Hardy et al performed a prospective, randomized study comparing use of a sliding hip screw to use of an intramedullary hip screw imhs for stabilization of 100.
Original article trauma international 2015 julysep. Dynamic hip screw fixation is currently considered as a standard treatment for pretrochanteric fractures. Intramedullary nails in comparison with sliding hip screws. Proximal femoral nail antirotation pfna is an intramedullary device designed with a helical blade rather than a screw, and is expected to provide better angular and rotational stability, and reduce the. Original article biomechanical comparison of dynamic hip. Dynamic hip screw fixation of intertrochanteric fractures. In this study, the use of proximal femoral nail and dynamic hip screw for treatment of intertrochanteric hip fractures were compared in terms of. Allocation of the fractures to each treatment group was done on basis of patients choice. Imhs cp intramedullary hip screw is the first and only intramedullary hip screw device that provides a barrel through which a lag screw can slide. Dynamic hip screws dhs and proximal femoral nails pfn in treatment of intertrochanteric fractures of femur in elderly patients. To compare the intraoperative use, immediate postoperative rehabilitation and outcome between intertrochanteric fractures treated with gamma intramedullary. Note as template magnification levels are set at 117%, all measurements are estimates of true size. A comparative study of intramedullary nail strengthened. Rate of contralateral hip fracture after dynamic hip screw vs intramedullary nail for treatment of pertrochanteric hip fractures.
Sliding hip screw versus intramedullary nail for trochanteric. The dynamic hip screw dhs, commonly used in extramedullary fixation, has become a standard implant in treatment of these fractures 3,4. The aim of this metaanalysis was to compare the outcomes of proximal femoral nail pfn and dynamic hip screw dhs in treatment of intertrochanteric fractures. The dynamic hip screw, which is routinely used for intertrochanteric hip fractures, also provides a technically simple means of fixation for intertrochanteric valgus osteotomies in the treatment of femoral neck nonunions. Dynamic hip screw dhs has been considered as the gold standard in the treatment of osteoporotic intertrochanteric fractures. Dynamic hip screw an overview sciencedirect topics. Millet, md intramedullary nailing in the lateral position without a traction table for an atypical subtrochanteric femoral fracture andr. By featuring a centering sleeve to enhance lag screw. A comparative study of reconstruction nailing versus. Dynamic hip screw dhs as extramedullary and proximal femoral nail pfn as intramedullary systems are established and standard in treatment of trochanteric femoral fractures 5, 6. The system combines the principles of a compression hip screw with the biomechanical advantage of an intramedullary nail. What is the efficacy of intramedullary nail fixation in the.
Currently, dynamic hip screw dhs and proximal femoral nail antirotation pfna internal fixation are popular in the treatment of. Of the 60 patients in the study, 30 were treated with recon nailing and 30 with dynamic hip screw fixation. Intramedullary nails in comparison with sliding hip screws for. Comparing the intramedullary nail and extramedullary fixation. Intramedullary nails in the treatment of intertrochanteric fractures have become popular over the last two decades.
For this reason, the proximal femoral nail antirotation device pfna was designed by the arbeitsgemeinschaft fur osteo. Pdf is a sliding hip screw or im nail the preferred implant for. Materialmethods relevant randomized or quasirandomized controlled studies comparing the effects of pfn and dhs were searched for following the requirements of the cochrane library. It is a fixation device which permits the proximal fragment to collapse or settle on the fixation device seeking its. A comparison of the proximal femoral nail antirotation device. It is a fixation device which permits the proximal fragment to collapse or settle on the fixation device seeking its own position of stability. Dynamic hip screw dhs, proximal femur compression plate pfcp, percutaneous compression plate pccp and locking compression plate lcp and the commonly used intramedullary fixations are ender nail, ace trochanteric nail, gamma nailing system, proximal femoral nail pfn, proximal femoral nail antirotation. Pdf a study of management of trochanteric fracture of. Aug 24, 2017 in treatment of unstable trochanteric fractures dynamic hip screw and medoff sliding plate devices are designed to allow secondary fracture impaction, whereas intramedullary nails aim to maintain fracture alignment. Theoretical biomechanical advantages of intramedullary nails over screw and plate fixation are attributed to a reduced distance between the hip joint and the implant. Eight patients underwent intertrochanteric valgus osteotomy for femoral neck nonunion using a dynamic hip screw for fixation.
Aaos recommends dynamic hip screw and intramedullary nail as the main surgery options in stable intertrochanteric fracture. The authors found that in the harder bone model, the gn had a failure load of 5761 n versus the dhs with a failure. A permanent nail or rod is placed into the center of the bone. Since 1950s surgical treatment of extracapsular hip fractures is done using a variety of different implants. Extramedullary device primarily include the dynamic hip screw which include the richard screw in fixed angle and side plate, which is considered gold standard in. A lag screw is then placed through the nail and up into the neck and head of the hip. Dynamic hip screw blade fixation for intertrochanteric hip. The fractures were fixed with either recon nailing or dynamic hip screw fixation. A comparative study of fixation of pertrochanteric.
Intramedullary nailing of acute femoral shaft fractures using manual traction without a. In this study, we intended to investigate the biomechanical behavior of two different implants. After appropriate placement of the nail, the muscles, fascia, and skin are closed. Comparative study of intertan and dynamic hip screw in. The trigen intertan nail preoperative template set 71674200 may be used to assist with preoperative implant selection. The aim of this study is to compare the effects and complications of intertan nail versus dynamic hip screw dhs in treatment of femoral intertrochanteric fractures. Pdf this study was performed to determine whether patients who sustain an intertrochanteric fracture have better outcomes when stabilized using a. Earlygeneration intramedullary nails and dynamic interlocking have been associated with a significantly higher risk for iatrogenic femoral fractures after intramedullary nailing for hip fractures. We assessed publication bias using beggs test and eggers test. Earlygeneration intramedullary nails and dynamic interlocking have been associated with a significantly higher risk for iatrogenic femoral fractures after intramedullary nailing for hip. The most common bones fixed by this procedure are the thigh, shin, hip, and upper arm. Theoretically intramedullary sliding nail possesses certain.
It explains the benefits, risks and alternatives, as well as what you can expect when you come into hospital and after you have gone home. Jul 25, 2015 high cost of implant cost of an intramedullary nail is 78 times the cost of a dynamic hip screw which may act as a restraint for use in all patients with intertrochanteric fractures. Internal fixation is appropriate for most intertrochanteric fractures. A comparative study of dynamic hip screw and proximal femoral. Feb 11, 2019 a nail is inserted through the greater trochanter, with a compression hip screw inserted through the upper portion of the nail, into the femoral head. Dynamic hip screw, traction table, intertrochanteric hip fracture introduction i 9 352. Open reduction internal fixation with dynamic hip screw kenneth a.
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