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. Original article trauma international 2015 julysep. At latest followup, there was no difference in the percentage of functional recovery between the two fixation groups baungaertner, 1998. Note as template magnification levels are set at 117%, all measurements are estimates of true size.
Theoretically intramedullary sliding nail possesses certain. 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. The sliding hip screw is superior to the intramedullary nails in terms of the lower complication rate. Optimal fixation is based on the stability of fracture. 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. 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. As with the compression hip screw, sliding of the lag screw and impaction of the fracture take place. 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. We assessed publication bias using beggs test and eggers test. The dynamic hip screw dhs, commonly used in extramedullary fixation, has become a standard implant in treatment of these fractures 3,4. Intramedullary nails in the treatment of intertrochanteric fractures have become popular over the last two decades.
Intramedullary nailing of acute femoral shaft fractures using manual traction without a. 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. So there is still a place for dhs in intertrochanteric fractures especially stable ones. So it is a matter of debate that which one is the best treatment, dynamic hip screw or proximal femoral nailing. Allocation of the fractures to each treatment group was done on basis of patients choice. Rate of contralateral hip fracture after dynamic hip screw vs.
Earlygeneration intramedullary nails and dynamic interlocking have been associated with a significantly higher risk for iatrogenic femoral fractures after intramedullary nailing for hip. Prospective randomized controlled trial of an intramedullary nail versus dynamic screw and plate for intertrochanteric fractures of the femur. A prospective randomized and comparative study was. 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. The most common bones fixed by this procedure are the thigh, shin, hip, and upper arm. Dynamic hip screw fixation is currently considered as a standard treatment for pretrochanteric fractures. Hip nailing for hip fracture procedure is performed at a hospital. Sliding hip screw versus intramedullary nail for trochanteric hip fractures. Since 1950s surgical treatment of extracapsular hip fractures is done using a variety of different implants. Materialmethods relevant randomized or quasirandomized controlled studies comparing the effects of pfn and dhs were searched for following the requirements of the cochrane library. Comparative study of intertan and dynamic hip screw in. Intramedullary nails in comparison with sliding hip screws for.
Pdf fixation of intertrochanteric fractures of the femur. What is the efficacy of intramedullary nail fixation in the. Fracture pattern rate of contralateral hip fracture after dynamic hip screw vs intramedullary nail for treatment of pertrochanteric hip fractures jonathan d. Cephalomedullary nail versus sliding hip screw for. Comparing the intramedullary nail and extramedullary. 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. 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. Pdf this study was performed to determine whether patients who sustain an intertrochanteric fracture have better outcomes when stabilized using a. The american academy of orthopedic surgeons aaos recommends dynamic hip screw and intramedullary nail as the main surgery options in stable intertrochanteric fracture. Pdf is a sliding hip screw or im nail the preferred implant for. Dynamic hip screw dhs has been considered as the gold standard in the treatment of osteoporotic intertrochanteric fractures.
Open reduction internal fixation with dynamic hip screw kenneth a. A comparative study of dynamic hip screw and proximal femoral. Intramedullary nail advantages and disadvantages introduction. 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 comparative study of reconstruction nailing versus. The system combines the principles of a compression hip screw with the biomechanical advantage of an intramedullary nail. Dynamic hip screw fixation of intertrochanteric fractures. For this reason, the proximal femoral nail antirotation device pfna was designed by the arbeitsgemeinschaft fur osteo. Internal fixation is appropriate for most intertrochanteric fractures. Comparing the intramedullary nailing method versus dynamic hip. Original article biomechanical comparison of dynamic hip.
Aaos recommends dynamic hip screw and intramedullary nail as the main surgery options in stable intertrochanteric fracture. A randomized, prospective study of 206 patients comparing thedynamic hip screw and proximal femoral nail. Original article is proximal femoral nail antirotation. The postoperative radiographs demonstrate that the lag screw is superior in the femoral head with a tipapex distance of 40 millimeters. Intertrochanteric fractures of femur by proximal femoral. 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.
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 dhs as extramedullary and proximal femoral nail pfn as intramedullary systems are established and standard in treatment of trochanteric femoral fractures 5, 6. Feb 03, 2020 intramedullary nailing is surgery to repair a broken bone and keep it stable. In this study, the use of proximal femoral nail and dynamic hip screw for treatment of intertrochanteric hip fractures were compared in terms of. 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. A comparative study of intramedullary nail strengthened. The funnel plot for the metaanalysis of mortality for intramedullary nail. Sliding hip screw versus intramedullary nail for trochanteric.
Currently, dynamic hip screw dhs and proximal femoral nail antirotation pfna internal fixation are popular in the treatment of. Dynamic hip screws dhs and proximal femoral nails pfn in treatment of intertrochanteric fractures of femur in elderly patients. Intertrochanteric osteotomy using a dynamic hip screw for. 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. Eight patients underwent intertrochanteric valgus osteotomy for femoral neck nonunion using a dynamic hip screw for fixation. Hip replacement versus intramedullary nail in elderly. Dynamic hip screw blade fixation for intertrochanteric hip. Pdf a study of management of trochanteric fracture of. Egol, md intramedullary fixation of midshaft clavicle fractures peter j.
The trigen intertan nail preoperative template set 71674200 may be used to assist with preoperative implant selection. If you have any further questions, please speak to a doctor or nurse caring for you. Rate of contralateral hip fracture after dynamic hip screw. The intramedullary nail is placed directly into the marrow canal of the bone through an opening made at the top of the greater trochanter.
Rate of contralateral hip fracture after dynamic hip screw vs intramedullary nail for treatment of pertrochanteric hip fractures. Dynamic hip screw, traction table, intertrochanteric hip fracture introduction i 9 352. Is trochanteric fixation nail a better implant in the. Biomechanical comparison of dynamic hip screw and gamma nail. Comparision of dynamic hip screw and plate with proximal. Of the 60 patients in the study, 30 were treated with recon nailing and 30 with dynamic hip screw fixation. Dynamic hip screw an overview sciencedirect topics. 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. 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. A permanent nail or rod is placed into the center of the bone. Original article efficacy of proximal femoral nail anti. Hip replacement as alternative to intramedullary nail in. Dynamic hip screw is used for fractures considered as stable within the respective.
Theoretical biomechanical advantages of intramedullary nails over screw and plate fixation are attributed to a reduced distance between the hip joint and the implant. Dynamic hip screw west chester, pa and the stryker gamma intramedullary locking nail kalamazoo, mi. Sliding hip screw versus im nail in reverse oblique trochanteric and. Surgery for hip fracture intramedullary nail insertion this leaflet aims to answer your questions about having surgery for a hip fracture. All measurements must be verified intraoperatively. 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. Different treatment protocols are used by two similar swedish regional emergency care hospitals.
To compare the results of dynamic hip screw and proximal femoral nail in the treatment of intertrochanteric fractures. Intramedullary nail instruments synthes intramedullary nail instruments 360. Intramedullary nail versus dynamic hip screw semantic scholar. S dynamic hip screw with side plate assembly is most commonly used device for fixation of intertrochanteric fractures.
The age of the patient ranged from 27 to 80 years with an average of 59. Proximal femoral nail antirotation versus dynamic hip. 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 fractures were fixed with either recon nailing or dynamic hip screw fixation. Comparing the intramedullary nailing method versus dynamic. 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. 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. Cephalomedullary nailing of fractures of the proximal.
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. Comparative study of proximal femoral nailing and dynamic. Cephalomedullary nailing of fractures of the proximal femur. Comparing the intramedullary nail and extramedullary fixation. The intramedullary hip screw is a more biological method of fixation. The duration of surgery was recorded intraoperatively.
Millet, md intramedullary nailing in the lateral position without a traction table for an atypical subtrochanteric femoral fracture andr. Nail size, screw length and femoral neck angle may be determined. Intramedullary nails in comparison with sliding hip screws. 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. Surgery for hip fracture dynamic hip screw this leaflet aims to answer your questions about having surgery for a hip fracture.
A comparison of the proximal femoral nail antirotation device. A comparative study of fixation of pertrochanteric. There are challenges in the operation of lateral wall fractures associated with unstable fractures of. The most common extramedullary implants are the sliding hip screw, also called a compression hip screw or dynamic hip screw.
The question is whether they have surpassed the dynamic hip screw in the treatment of these fractures. 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. To compare the intraoperative use, immediate postoperative rehabilitation and outcome between intertrochanteric fractures treated with gamma intramedullary. 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. Introduced in 1991 with its design, the imhs system provided a more minimally invasive technique than the traditional compression hip screw. The funnel plot for the metaanalysis of mortality for intramedullary nail versus extramedullary fixation was. It is a fixation device which permits the proximal fragment to collapse or settle on the fixation device seeking its own position of stability. Earlygeneration intramedullary nails and dynamic interlocking have been associated with a significantly higher risk for iatrogenic femoral fractures after intramedullary nailing for hip fractures. 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.
It is a fixation device which permits the proximal fragment to collapse or settle on the fixation device seeking its. Previous studies showed that the gamma nail did not perform as well as dhs because it. Comparison and analysis of reoperations in two different. A comparative study of dynamic hip screw and proximal. Our study consists of 30 patient with intertrochanteric fractures out of which 15 was treated with dhs and 15 with pfn.
By featuring a centering sleeve to enhance lag screw. The mainstay of treatment of intertrochanteric fracture is fixation with a screw slide plate device or intramedullary device. Pdf comparison of proximal femoral nail and dynamic hip. 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. Comparitive study between proximal femoral nailing and. Fracture pattern rate of contralateral hip fracture after dynamic hip screw vs intramedullary nail for treatment of pertrochanteric hip fractures. A lag screw is then placed through the nail and up into the neck and head of the hip. Intramedullary nail versus dynamic hip screw semantic. Generally, intramedullary fixation proximal femoral nail pfn and gamma nail and extramedullary fixation dynamic hip screw dhs are the 2. Proximal femoral nail pfn and gamma nail are 2 commonly used devices in the intramedullary fixation. 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 authors found that in the harder bone model, the gn had a failure load of 5761 n versus the dhs with a failure. 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.
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