Clin Orthop Surg.  2015 Sep;7(3):291-297. 10.4055/cios.2015.7.3.291.

Comparison of the Sliding and Femoral Head Rotation among Three Different Femoral Head Fixation Devices for Trochanteric Fractures

• Chinzei N
• Hiranaka T
• Niikura T
• Tsuji M
• Kuroda R
• Doita M
• Kurosaka M

• KMID: 2234081
• DOI: http://doi.org/10.4055/cios.2015.7.3.291

Abstract

BACKGROUND
Recently, various femoral head fixation devices (HFDs) for trochanteric fractures have become available. However, there are some cases in which femoral head rotation with excessive sliding of the HFD is observed and it is often followed by cutout. The purpose of this study is to compare the ability of the three types of HFDs to prevent femoral head rotation.
METHODS
Between July 2005 and December 2009, 206 patients aged over 60 years with trochanteric fractures who had undergone surgical treatment using a short femoral nail in our institution were enrolled into the study. We used the gamma 3 nail (GMN) as the screw-type HFD in 66 cases, the gliding nail (GLN) as a non-cylindrical blade in 76 cases, and the proximal femoral nail antirotation (PFNA) as a cylindrical blade in 64 cases. The sliding length of HFDs and the occurrence of femoral head rotation were evaluated by assessing radiographs as the main outcome, and the results were compared among these devices.
RESULTS
A comparison of the degree of sliding in the GMN group showed that femoral head rotation was observed significantly more frequently in cases with rotation. Further, it appeared that femoral head rotation occurred more frequently in comminuted fractures. However, no significant differences between the sliding lengths of the different HFDs were observed among three groups. Femoral head rotation was observed in 15 cases of GMN (22.7%), 0 case of GLN, and 5 case of PFNA (7.8%). Significant differences with regard to the occurrence of femoral head rotation were observed among the three groups. Furthermore, significant differences were also observed between GLN and PFNA with respect to the occurrence of femoral head rotation.
CONCLUSIONS
The ability to stabilize femoral head appears to be greater with blade-type materials than with screw-type materials. Furthermore, we believe that a non-cylindrical blade is preferable to a cylindrical blade for the surgical treatment of comminuted, unstable trochanteric fractures in order to prevent femoral head rotation and cut-out.

Keyword

Hip fractures; Femur head; Postoperative complication; Orthopedic fixation devices

MeSH Terms

Aged
Aged, 80 and over
Female
Femur Head/*surgery
Hip Fractures/*surgery
Humans
Internal Fixators/*statistics & numerical data
Male
Postoperative Complications/epidemiology
Range of Motion, Articular/physiology
Retrospective Studies

Figure

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  Fig. 1 Hypothesis of the mechanism of cut-out. We hypothesized that a lack of bony support would lead to femoral head rotation and cut-out.

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  Fig. 2 Fixation devices. We used a gamma 3 nail as the screw-type head fixation device (A), gliding nail as the non-cylindrical blade (B), and proximal femoral nail antirotation as the cylindrical blade (C) in our study.

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  Fig. 3 Measurement of the sliding length of head fixation device (HFD). The sliding length was calculated by subtracting the central length (AC/AB × real HFD length) measured at two weeks after surgery from the length measured immediately after surgery. AB: HFD axis, C: intersection of AB and nail axis.

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  Fig. 4 Recognition of femoral head rotation. Femoral head rotation was detected by an apparent change in H': H or N':N.

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