Comparative study of intertrochanteric fracture fixation using proximal femoral nail with and without distal interlocking screws.

Autor:	Lil NA; Department of Orthopaedics, NHL Medical College, Ahmedabad 380006, Gujarat, India. nadeemlil@yahoo.com., Makwana VR; Department of Orthopaedics, NHL Medical College, Ahmedabad 380006, Gujarat, India., Patel TD; Department of Orthopaedics, NHL Medical College, Ahmedabad 380006, Gujarat, India., Patel AR; Department of Orthopaedics, NHL Medical College, Ahmedabad 380006, Gujarat, India.
Jazyk:	angličtina
Zdroj:	World journal of orthopedics [World J Orthop] 2022 Mar 18; Vol. 13 (3), pp. 267-277. Date of Electronic Publication: 2022 Mar 18 (Print Publication: 2022).
DOI:	10.5312/wjo.v13.i3.267
Abstrakt:	Background: Intertrochanteric (IT) fracture is one of the most common fractures seen in an orthopaedic practice. Proximal femoral nailing (PFN) is a common modality of fixing IT femur fracture. We retrospectively studied whether a PFN with two proximal lag screws can be done without distal interlocking screws in the 31-A1 and 31-A2 fracture patterns according to the Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) guidelines for IT femur fractures. Aim: To compare the outcomes of IT fractures (AO/OTA 31-A1 and 31-A2) treated by PFN with and without distal interlocking screws. Methods: We carried out a retrospective study of 140 patients in a tertiary care centre who had AO/OTA type 31-A1 and 31-A2 IT fractures. We divided the patients into two groups, in which one of the groups received distal interlocking screws (group 1) and the other group did not (group 2). The subjects were followed up for a mean period of 14 mo and assessed for radiological union time, fracture site collapse, mechanical stability of implant, and complications associated with the PFN with distal interlocking and without distal interlocking. Then, the results were compared. Results: PFN without distal interlocking screws has several advantages and gives better results over PFN with distal interlocking screws in the AO/OTA 31-A2 fracture pattern. However, similar results were observed in both groups with the fracture pattern AO/OTA 31-A1. In patients with fracture pattern AO/OTA 31-A2 treated by PFN without distal interlocking screws, there were minimal proximal lock-related complications and no risk of distal interlock-related complications. The operative time, IITV radiation time and time to radiological union were reduced. These patients also had better rotational alignment of the proximal femur, and the anatomy of the proximal femur was well maintained. It was also noted that in the cases where distal interlocking was performed, there was a gradual decrease in neck shaft angle, which led to varus collapse and failure of bone-implant construct in 21.40%. Conclusion: In fracture pattern AO/OTA 31-A2, PFN without distal interlocking had better results and less complications than PFN with distal interlocking. Competing Interests: Conflict-of-interest statement: The authors declare that they do not have any conflicts of interest. (©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.)
Databáze:	MEDLINE
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