Clin Orthop Surg.  2019 Mar;11(1):36-42. 10.4055/cios.2019.11.1.36.

The Effect of Valgus Reduction on the Position of the Blade of the Proximal Femoral Nail Antirotation in Intertrochanteric Hip Fractures

Affiliations
  • 1Department of Orthopedic Surgery, Samsung Medical Center, Seoul, Korea.
  • 2Department of Orthopedic Surgery, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea. ybs58@paik.ac.kr
  • 3Department of Orthopedic Surgery, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea.

Abstract

BACKGROUND
The purpose of this study was to evaluate the quantitative association between the degree of reduction and the position of the blade of the proximal femoral nail antirotation (PFNA) in intertrochanteric hip fractures.
METHODS
From March 2009 to April 2015, 530 patients treated with PFNA for intertrochanteric hip fractures were retrospectively reviewed. Patients were divided into a valgus reduced group (group 1) and a non-valgus reduced group (group 2), and the "valgus reduced" was defined as valgus reduction over 5°. We compared the calcar referenced tip-apex distance (calTAD) and the area between the blade of PFNA and the medial cortex of the femoral neck between the two groups.
RESULTS
The calTAD was measured as 22.5 ± 4.1 mm in group 1 and 24.8 ± 3.8 mm in group 2 (p < 0.05). The area between the blade and the medial femoral neck was measured as 135.5 ± 49.8 mm2 in group 1 and 145.1 ± 54.8 mm2 in group 2 (p = 0.074). The area corrected for the length difference in the femoral neck was 0.55 ± 0.16 in group 1 and 0.79 ± 0.19 in group 2 (p < 0.05).
CONCLUSIONS
Valgus reduction resulted in less calTAD and inferior position of the blade at the femoral neck in the treatment of intertrochanteric hip fractures with PFNA.

Keyword

Femur; Intertrochanteric fractures; Intramedullary nailing; Fracture closed reduction

MeSH Terms

Femur
Femur Neck
Fracture Fixation, Intramedullary
Hip Fractures*
Hip*
Humans
Retrospective Studies

Figure

  • Fig. 1 The flowchart shows patient selection and exclusion criteria. PFNA: proximal femoral nail antirotation.

  • Fig. 2 The postoperative anteroposterior (A) and lateral (B) plain radiographs showed that the position of the blade tip was located within 10–15 mm of the subchondral bone.

  • Fig. 3 Postoperative anteroposterior and lateral plain radiographs showing how to calculate the calcar referenced tip-apex distance (calTAD). (A) Tip-apex distance (TAD) in reference to the calcar calculated on the anteroposterior radiograph (calTAD ap). Dotted line: the line passing through the midline of the femoral head and femoral neck was moved parallel to the medial femoral neck on the anteroposterior radiograph. (B) TAD calculated on the lateral radiograph (TAD lat). calTAD = calTAD ap + TAD lat. Dotted line: a line passing through the midline of the femoral head and femoral neck on the lateral radiograph. X cal ap: the distance between the blade tip and the point where the dotted line and femoral head cortex meet on the anteroposterior radiograph, D ap: the calculated diameter of the lag-screw on the anteroposterior radiograph, D true: the known diameter of the lag-screw (10.5 mm), D lat: the calculated diameter of the lag-screw on the lateral radiograph, X lat: the distance between the blade tip and the point where the dotted line and femoral head cortex meet on the lateral radiograph.

  • Fig. 4 Postoperative anteroposterior plain radiographs showing how to calculate the area between the blade and the medial femoral neck. (A) First, two inflection points where the femoral neck and the femoral head meet are connected by a line (1). Then, the line is moved in parallel to pass the inflection point where the femoral neck and the greater trochanter meet (2). The area of trapezoidal shape between the blade and the medial femoral neck is obtained. To correct for differences in the femoral neck length, the area is divided by the square of the height (h) of the trapezoid. (B) Actual calculation process of the trapezoidal area on the picture archiving and communication system (PACS; Marosis M-view 5.4, Marotech, Seoul, Korea). SD: standard deviation.

  • Fig. 5 Comparison of the valgus reduced group (A) and the non-valgus reduced group (B). In the valgus reduced group, the calcar referenced tip-apex distance and the area between the blade and the medial femoral neck are smaller than those in the non-valgus group. In other words, in the valgus-reduced group, the blade position was located inferiorly in the femoral neck.


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