Alexander Brunner1, Markus Büttler2, Uwe Lehmann3, Hans Curd Frei4, Renato Kratter5, Marco Di Lazzaro6, Alexander Scola7, An Sermon8, Rene Attal9. 1. Medical University Innsbruck, Department of Trauma Surgery, Anichstrasse 35, 6020 Innsbruck, Austria. 2. DePuy Synthes, Luzernstrasse 21, 4528 Zuchwil, Switzerland. 3. Clinic Forchheim, Trauma Surgery Department, Krankenhausstraße 10, 91301 Forchheim, Germany. 4. Davos Hospital, Department of Trauma and Orthopaedic Surgery, Promenade 4, 7270 Davos Platz, Switzerland. 5. Lachen Hospital, Department of Trauma Surgery, Oberdorfstrasse 41, 8853 Lachen, Switzerland. 6. Männedorf Hospital, Asylstrasse 10, 8708 Männedorf, Switzerland. 7. Ulm University, Department of Orthopaedic Trauma, Albert-Einstein-Allee 23, 89081 Ulm, Germany. 8. University Hospitals Gasthuisberg, Department of Traumatology, Herestraat 49, 3000 Leuven, Belgium. 9. Medical University Innsbruck, Department of Trauma Surgery, Anichstrasse 35, 6020 Innsbruck, Austria. Electronic address: rene.attal@tirol-kliniken.at.
Abstract
PURPOSE: To evaluate the outcome after different types of revision operations for blade 'cut-out' and 'cut-through' after fixation of trochanteric fractures with proximal femoral nail antirotation (PFNA) or a trochanter fixation nail (TFN). METHODS: Twenty hospitals participated in this multicentre study. A total of 4109 patients were retrospectively screened for cut-out or cut-through complications after nailing of trochanteric fractures using PFNA or TFN. Fifty-seven patients (28 with 'cut-through' and 29 with 'cut-out') were included in the study. In the 'cut-through' group, 16 patients underwent a blade exchange, six patients had a blade exchange with bone cement augmentation, and six received total hip arthroplasty (THA). In the 'cut-out' group, three patients had a blade exchange, one had a blade exchange with augmentation, three underwent re-nailing of the fracture with a new PFNA, one had a girdlestone procedure and 21 had THA procedures. RESULTS: In the 'cut-through' group, eight patients who had a blade exchanges (50%) and two patients with blade exchange and augmentation (33%) required further revision operations. THA was the definite treatment in all 6 cases. In the 'cut-out' group, two patients (66%) who had blade exchanges and two (66%) who underwent re-nailing required additional revision operations during the subsequent course. One patient (4%) who had total hip arthroplasty needed revision surgery for acetabular replacement. Overall, a total of 81 revision procedures were performed. CONCLUSION: Based on the data from this study, we recommend THA as the only valid salvage procedure for 'cut-out' and 'cut-through' of helical blades after fixation of trochanteric fractures with the PFNA and TFN.
PURPOSE: To evaluate the outcome after different types of revision operations for blade 'cut-out' and 'cut-through' after fixation of trochanteric fractures with proximal femoral nail antirotation (PFNA) or a trochanter fixation nail (TFN). METHODS: Twenty hospitals participated in this multicentre study. A total of 4109 patients were retrospectively screened for cut-out or cut-through complications after nailing of trochanteric fractures using PFNA or TFN. Fifty-seven patients (28 with 'cut-through' and 29 with 'cut-out') were included in the study. In the 'cut-through' group, 16 patients underwent a blade exchange, six patients had a blade exchange with bone cement augmentation, and six received total hip arthroplasty (THA). In the 'cut-out' group, three patients had a blade exchange, one had a blade exchange with augmentation, three underwent re-nailing of the fracture with a new PFNA, one had a girdlestone procedure and 21 had THA procedures. RESULTS: In the 'cut-through' group, eight patients who had a blade exchanges (50%) and two patients with blade exchange and augmentation (33%) required further revision operations. THA was the definite treatment in all 6 cases. In the 'cut-out' group, two patients (66%) who had blade exchanges and two (66%) who underwent re-nailing required additional revision operations during the subsequent course. One patient (4%) who had total hip arthroplasty needed revision surgery for acetabular replacement. Overall, a total of 81 revision procedures were performed. CONCLUSION: Based on the data from this study, we recommend THA as the only valid salvage procedure for 'cut-out' and 'cut-through' of helical blades after fixation of trochanteric fractures with the PFNA and TFN.
Authors: Chi Zhang; Bo Xu; Guanzhao Liang; Xianshang Zeng; Dan Zeng; Deng Chen; Zhe Ge; Weiguang Yu; Xinchao Zhang Journal: J Int Med Res Date: 2018-03-08 Impact factor: 1.671