The Tip-apex Distance (TAD) as a Ppredictor of Cut out Failure Following Proximal Femoral Nail Fixation in Peritrochanteric Fracture
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Abstract
Background: The hip fractures are common problem in the world, especially in the elderly patient. The unstable pattern of fracture peritrochanteric are common and challenging for the Orthopedic surgeon. The most popular instrument and surgery are proximal femoral nail antirotation (PFNA). The most common mode of failure of any device to treat these fractures are cut-out. The optimal blade tip placement is not known for the PFNA.
Objective: The aim of this study is to determine the optimal tip apex distance in PFNA , comparison rate of cut out in 3 groups, TAD<20 mm, TAD 20-30 mm and TAD>30 mm
Methods: The retrospective cohort study from the electronic x-ray database of Buriram hospital. In all patients with peritrochanteric fracture who received surgical PFNA treatment from January 1, 2019 to June 30, 2021 the x-ray images were assessed after surgery on the day of surgery or after 1 day of surgery and during 1 to 3 months. TAD and cut out rates were measured.
Results: Two hundred forty PFNAs were implanted during the study period, with 162 cases included in this study. 54% were female. The AO31A2.2 group was the most patients of this study (27 patients). In TAD 20-30 mm group was the most patients (98 patients). There were 7 cases surgical implant-related failures (cut-out) in all groups, 6 cases in TAD<20 mm There was no cut-out in cases where the TAD was from 20-30 mm
Conclusions: The PFNA is a suitable fixation device for the treatment of unstable peritrochanteric fracture. From this study, we should avoid TAD<20 mm because highest rate of cut-out (medial perforation). The suitable TAD should be TAD 20-30 mm
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References
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