MEASURING METHOD OF TIP-APEX DISTANCE IN TREATMENT OF FEMORAL INTERTROCHANTERIC FRACTURE WITH PROXIMAL FEMORAL NAIL ANTIROTATION_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 WANGHongchuan , WANGYongcai , YANBing , ZHONGLang , JIANGJunwei

Department of Orthopedics, Leshan People's Hospital, Leshan Sichuan, 614000, P. R. China;

Corresponding?author：

WANGHongchuan, Email: 2603757827@qq.com

Keywords：

Proximal femoral nail antirotation; Femoral intertrochanteric fracture; Tip apex distance

DOI：

10.7507/1002-1892.20140012

Video：

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Objective To investigate the method to measure the tip-apex distance (TAD) in treatment of femoral intertrochanteric fracture with proximal femoral nail antirotation (PFNA). Methods Between March 2008 and March 2011, 35 patients with femoral intertrochanteric fracture underwent closed reduction and internal fixation with PFNA, which were all closed fractures. There were 14 males and 21 females with an average age of 72.3 years (range, 48-88 years). According to Evans classification, 1 case belonged to type III, 27 cases to type IV, and 7 cases to type V. The time between injury and operation was 2-7 days (mean, 4.3 days). The TAD was measured according to relationship between tip of helical blade and the center point of femoral head radius during operation, and according to X-ray films after operation. Results Primary healing of incision was obtained in all cases, and no infection or deep venous thrombosis occurred. At 2 days after operation, the X-ray films showed TAD was 18-24 mm (mean, 22.6 mm). Thirty-two cases were followed up 10-22 months (mean, 16 months). All fractures healed, with a mean healing time of 7.6 months (range, 6-10 months). The patients could walk without stick at 11-16 weeks (mean, 13 weeks). Pulmonary infection occurred in 1 case at 5 days after operation; no breakage of femoral nail or cut-out helical blade from femoral head was observed. At 10 months after operation, the Parker hip scores were 9 in 23 cases, 8 in 4 cases, 7 in 3 cases, and 5 in 2 cases, with a mean score of 8.44. Conclusion It is easy to control the TAD in treatment of femoral intertrochanteric fracture with PFNA with an simple method and important to prevent breakage and cut-out helical blade from the femoral head.

Citation： WANGHongchuan, WANGYongcai, YANBing, ZHONGLang, JIANGJunwei. MEASURING METHOD OF TIP-APEX DISTANCE IN TREATMENT OF FEMORAL INTERTROCHANTERIC FRACTURE WITH PROXIMAL FEMORAL NAIL ANTIROTATION. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(1): 53-55. doi: 10.7507/1002-1892.20140012 Copy

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2.	Efstathopoulos NE,Nikolaou VS,Lazareyyos JT.Intramedullary fixation of intertrochanteric hip fractures:a comparison of two implant designs.Int Orthop,2007,31(1):71-76.
3.	Lorich DG,Geller DS,Nielson JH.Osteoporotic pertrochanteric hip fractures:management and current controversies.J Bone Joint Surg (Am),2004,86:398-410.
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5.	Simmermacher RK,Ljungqvist J,Bail H,et al.The new proximal femoral nail antirotation (PFNA) in daily practice:results of amulticentre clinical study.Injury,2008,39(8):932-939.
6.	Parker MJ,Palmer CR.A new mobility score for predicting mortality after hip fracture.J Bone Joint Surg (Br),1993,75(5):797-798.
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12.	Geller JA,Saifi C,Morrison TA,et al.Tip-apex distance of intramedullary devices as a predictor of cut-out failure in the treatment of peritrochanteric elderly hip fractures.Int Orthop,2010,34(5):719-722.
13.	Hsueh KK,Fang CK,Chen CM,et al.Risk of in cutout of sliding hip screw in intertrochanteric fractures:an evaluation of 937 patients.Int Orthop,2010,34(8):1273-1276.
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15.	李旭,徐賢,吳韋,等.亞洲型髖關節髓內釘系統治療股骨轉子間骨折.實用骨科雜志,2010,16(3):176-178.
16.	孟勇,信效堂,姜鵬,等.動力髖螺釘置入內固定治療骨質疏松性轉子間骨折110例.中國組織工程研究與臨床康復,2010,14(39):7291-7294.
17.	葉茂,劉軍,宋文超,等.動力髖螺釘結合尖頂距值治療骨質疏松性股骨轉子間骨折.實用骨科雜志,2010,26(19):3591-3593.
18.	夏青,魏振,江海良,等.股骨近端外側加壓型鎖定板治療轉子間不穩定性四部分骨折.中國骨科臨床與基礎研究雜志,2010,2(4):287-291.
19.	王全兵,馮宗權,謝祥仁,等.防旋髓內釘治療老年不穩定股骨轉子間骨折的體會.實用骨科雜志,2011,17(5):453-454.
20.	李雙,王棟,張世民.尖頂距與股骨頭內拉力螺釘切出的研究進展.中國矯形外科雜志,2007,15(19):1484-1485,1491.
21.	Khurana A,Guha AR,Mohanty K,et al.Pecutaneous fusion of the sacroiliac joint with hollow modular anchorage screws:clinical and radiological outcome.J Bone Joint Surg (Br),2009,91(5):627-631.
22.	李鋒生,葉冬平,梁偉國,等.X線透視導航下運用Gamma釘治療股骨轉子間骨折18例.廣東醫學,2012,33(4):474-476.

1. 王亦璁.骨與關節損傷.4版.北京:人民衛生出版社,2007:1184-1194.
2. Efstathopoulos NE,Nikolaou VS,Lazareyyos JT.Intramedullary fixation of intertrochanteric hip fractures:a comparison of two implant designs.Int Orthop,2007,31(1):71-76.
3. Lorich DG,Geller DS,Nielson JH.Osteoporotic pertrochanteric hip fractures:management and current controversies.J Bone Joint Surg (Am),2004,86:398-410.
4. Baumgaertner MR,Curtin SL,Lindskog DM,et al.The value of the tip-apex distance in predicting failure of fixation of peritrochanteric fractures of the hip.J Bone Joint Surg (Am),1995,77(7):1058-1064.
5. Simmermacher RK,Ljungqvist J,Bail H,et al.The new proximal femoral nail antirotation (PFNA) in daily practice:results of amulticentre clinical study.Injury,2008,39(8):932-939.
6. Parker MJ,Palmer CR.A new mobility score for predicting mortality after hip fracture.J Bone Joint Surg (Br),1993,75(5):797-798.
7. Efstatjopoulos NE,Nikolaou VS,Lazarettos JT.Intramedullary fixation of intertrochanteric hip fractures a comparison of two implant designs.Int Orthop,2007,31(1):71-76.
8. Verettas DA,Ifantides P,Chatzipaas CN,et al.Systematic effects of surgical treatment of hip fractures:gliding screw-plating vs intramedullary nailing.Injury,2010,41(3):279-284.
9. 張經緯,蔣垚,張先龍,等.股骨轉子間骨折不同手術方法比較.中華骨科雜志,2005,25(1):7-11.
10. Dousa P,Bartonicek J,Jehlicka D,et al.Osteosynthesis of trochanteric fractures using proximal femoral nails.Aeta Chir Orthop Traymatol Cech,2002,69(1):22-30.
11. 安維軍,馬小明,陳軍,等.股骨轉子部骨折的手術治療.中華創傷骨科雜志,2004,6(5):499-501.
12. Geller JA,Saifi C,Morrison TA,et al.Tip-apex distance of intramedullary devices as a predictor of cut-out failure in the treatment of peritrochanteric elderly hip fractures.Int Orthop,2010,34(5):719-722.
13. Hsueh KK,Fang CK,Chen CM,et al.Risk of in cutout of sliding hip screw in intertrochanteric fractures:an evaluation of 937 patients.Int Orthop,2010,34(8):1273-1276.
14. Kyle RF,Gustilo RB,Premer RF.Analysis of six hundren and twenty-two intertrochanteric hip fractures.A retrospective and prospective study.J Bone Joint Surg (Am),1979,61(2):216-221.
15. 李旭,徐賢,吳韋,等.亞洲型髖關節髓內釘系統治療股骨轉子間骨折.實用骨科雜志,2010,16(3):176-178.
16. 孟勇,信效堂,姜鵬,等.動力髖螺釘置入內固定治療骨質疏松性轉子間骨折110例.中國組織工程研究與臨床康復,2010,14(39):7291-7294.
17. 葉茂,劉軍,宋文超,等.動力髖螺釘結合尖頂距值治療骨質疏松性股骨轉子間骨折.實用骨科雜志,2010,26(19):3591-3593.
18. 夏青,魏振,江海良,等.股骨近端外側加壓型鎖定板治療轉子間不穩定性四部分骨折.中國骨科臨床與基礎研究雜志,2010,2(4):287-291.
19. 王全兵,馮宗權,謝祥仁,等.防旋髓內釘治療老年不穩定股骨轉子間骨折的體會.實用骨科雜志,2011,17(5):453-454.
20. 李雙,王棟,張世民.尖頂距與股骨頭內拉力螺釘切出的研究進展.中國矯形外科雜志,2007,15(19):1484-1485,1491.
21. Khurana A,Guha AR,Mohanty K,et al.Pecutaneous fusion of the sacroiliac joint with hollow modular anchorage screws:clinical and radiological outcome.J Bone Joint Surg (Br),2009,91(5):627-631.
22. 李鋒生,葉冬平,梁偉國,等.X線透視導航下運用Gamma釘治療股骨轉子間骨折18例.廣東醫學,2012,33(4):474-476.

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Chinese Journal of Reparative and Reconstructive Surgery

MEASURING METHOD OF TIP-APEX DISTANCE IN TREATMENT OF FEMORAL INTERTROCHANTERIC FRACTURE WITH PROXIMAL FEMORAL NAIL ANTIROTATION

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