Comparative Analysis of Functional Outcomes: Extramedullary Versus Intramedullary Fixation in Unstable Inter-Trochanteric Femoral Fractures
Extramedullary Versus Intramedullary Fixation
DOI:
https://doi.org/10.54393/pjhs.v5i06.1736Abstract
Unstable trochanteric femoral fractures are challenging to manage. Two options exist for the operative treatment and management of unstable trochanteric fractures; i.e. extramedullary or intramedullary stabilization. However, there is a dearth of good evidence of the clinical efficacy of either of the two methods especially in terms of functional outcomes. Objective: To compare the functional outcome following fixation of unstable trochanteric femoral fractures via extramedullary versus intramedullary methods. Methods: This prospective cohort was conducted upon 46 adult patients and admitted at Liaquat University Hospital Hyderabad/Jamshoro, after taking written informed consent from parents. Functional outcomes utilizing the Timed Up and Go Test and Harris Hip Score, at 3 months and 6 months post-surgery and radiographic parameters were gathered to evaluate heterotopic ossification and femoral neck shortening at follow-up visits using a pre-structured questionnaire. The data was analyzed with SPSS V.21 and Microsoft Excel 2016. Results: The sample predominantly consisted of males, with a mean age of 31 ± 5 years. Intramedullary fixation showed superior early mobility outcomes and maintained better hip function scores compared to extramedullary fixation for unstable inter-trochanteric femoral fractures. Intramedullary fixation also demonstrated lower rates of heterotopic ossification and less femoral neck shortening, indicating potential benefits in reducing complications and preserving anatomical integrity. Conclusions: In conclusion, the study findings suggest intramedullary fixation as a favorable option for optimizing functional recovery and radiographic outcomes in such fractures
References
Alessio-Mazzola M, Traverso G, Coccarello F, Sanguineti F, Formica M. Dynamic hip screw versus intramedullary nailing for the treatment of A1 intertrochanteric fractures: A retrospective, comparative study and cost analysis. Joint Diseases and Related Surgery. 2022 Aug; 33(2): 314. doi: 10.52312/jdrs.2022.646. DOI: https://doi.org/10.52312/jdrs.2022.646
Morsy AM, Abu-Elgeat ZI, Eltawila MM. Intramedullary Nailing versus Dynamic Screw and Plate for Treatment of Trochanteric Fractures of the Femur. QJM: An International Journal of Medicine. 2023 Jun; 116(1): hcad069-618. doi: 10.1093/qjmed/hcad069.618. DOI: https://doi.org/10.1093/qjmed/hcad069.618
Sivakumar A, Edwards S, Millar S, Thewlis D, Rickman M. Reoperation rates after proximal femur fracture fixation with single and dual screw femoral nails: a systematic review and meta-analysis. EFORT Open Reviews. 2022 Jul; 7(7): 506-15. doi: 10.1530/EOR-21-0067. DOI: https://doi.org/10.1530/EOR-21-0067
Vallon F and Gamulin A. Fixation of AO-OTA 31-A1 and A2 trochanteric femur fractures using a sliding hip screw system: can we trust a two-hole side plate construct? A review of the literature. EFFORT Open Reviews. 2020 Feb; 5(2): 118-25. doi: 10.1302/2058-5241.5.190020. DOI: https://doi.org/10.1302/2058-5241.5.190020
Baumgaertner MR, Curtin SL, Lindskog DM. Intramedullary versus extramedullary fixation for the treatment of intertrochanteric hip fractures. Clinical Orthopaedics and Related Research. 1998 Mar; 348: 87-94. doi: 10.1097/00003086-199803000-00015. DOI: https://doi.org/10.1097/00003086-199803000-00015
Chang SM, Wang ZH, Tian KW, Sun GX, Wang X, Rui YF. A sophisticated fracture classification system of the proximal femur trochanteric region (AO/OTA-31A) based on 3D-CT images. Frontiers in Surgery. 2022 Aug; 9: 919225. doi: 10.3389/fsurg.2022.919225. DOI: https://doi.org/10.3389/fsurg.2022.919225
Besselaar PP, Marti RK. Valgisation osteosynthesis for the unstable pertrochanteric fracture in the elderly patient. In: Marti RK, Dunki Jacobs PB, editors. Proximal Femoral Fractures Operative Techniques and Complications. London: Medical Press Limited; 1993. 299-310.
Eladawy AM and El-Hewalaand TA. Outcome of Gamma Nail Fixation in Unstable Trochanteric Fracture of Femur. Zagazig University Medical Journal. 2022 Nov; 28(6.2): 198-204. doi: 10.21608/zumj.2020.14010.1276. DOI: https://doi.org/10.21608/zumj.2020.14010.1276
Shiraz S, Shujauddin M, Hasan K, Elramadi A, Ahmed G. Comparison of dynamic hip screw and proximal femoral nailing techniques in stable intertrochanteric fractures. Cureus. 2023 Jan; 15(1). doi: 10.7759/cureus.33366. DOI: https://doi.org/10.7759/cureus.33366
Reindl R, Harvey EJ, Berry GK, Rahme E. Intramedullary versus extramedullary fixation for unstable intertrochanteric fractures: a prospective randomized controlled trial. Journal of Bone & Joint Surgery. 2015 Dec; 97(23): 1905-12. doi: 10.2106/JBJS.N.01007. DOI: https://doi.org/10.2106/JBJS.N.01007
Chirodian N, Arch B, Parker MJ. Sliding hip screw fixation of trochanteric hip fractures: outcome of 1024 procedures. Injury. 2005 Jun; 36(6): 793-800. doi: 10.1016/j.injury.2005.01.017. DOI: https://doi.org/10.1016/j.injury.2005.01.017
Buciuto R, Uhlin B, Hammerby S, Hammer R. RAB-plate vs Richards CHS plate for unstable trochanteric hip fractures: A randomized study of 233 patients with 1-year follow-up. Acta Orthopaedica Scandinavica. 1998 Jan; 69(1): 25-8. doi: 10.3109/17453679809002350. DOI: https://doi.org/10.3109/17453679809002350
Butt MS, Krikler SJ, Nafie S, Ali MS. Comparison of dynamic hip screw and gamma nail: a prospective, randomized, controlled trial. Injury. 1995 Nov; 26(9): 615-8. doi: 10.1016/0020-1383(95)00126-T. DOI: https://doi.org/10.1016/0020-1383(95)00126-T
He S, Yan B, Zhu J, Huang X, Zhao J. High failure rate of proximal femoral locking plates in fixation of trochanteric fractures. Journal of Orthopaedic Surgery and Research. 2018 Dec; 13: 1-9. doi: 10.1186/s13018-018-0951-6. DOI: https://doi.org/10.1186/s13018-018-0951-6
Chevalley F and Gamba D. Gamma nailing of pertrochanteric and subtrochanteric fractures: clinical results of a series of 63 consecutive cases. Journal of Orthopaedic Trauma. 1997 Aug; 11(6): 412-5. doi: 10.1097/00005131-199708000-00006. DOI: https://doi.org/10.1097/00005131-199708000-00006
Zeelenberg ML, Plaisier AC, Nugteren LH, Loggers SA, Joosse P, Verhofstad MH et al. Extramedullary versus intramedullary fixation of unstable trochanteric femoral fractures (AO type 31-A2): a systematic review and meta-analysis. Archives of Orthopaedic and Trauma Surgery. 2024 Mar; 144(3): 1189-209. doi: 10.1007/s00402-023-05138-9. DOI: https://doi.org/10.1007/s00402-023-05138-9
Werner M, Macke C, Gogol M, Krettek C, Liodakis E. Differences in hip fracture care in Europe: a systematic review of recent annual reports of hip fracture registries. European Journal of Trauma and Emergency Surgery. 2022 Jun; 48(3): 1625-1638. doi: 10.1007/s00068-021-01797-8. DOI: https://doi.org/10.1007/s00068-021-01797-8
Xie H, Xie L, Wang J, Chen C, Zhang C, Zheng W. Intramedullary versus extramedullary fixation for the treatment of subtrochanteric fracture: A systematic review and meta-analysis. International Journal of Surgery. 2019 Mar; 63: 43-57. doi: 10.1016/j.ijsu.2019.01.021. DOI: https://doi.org/10.1016/j.ijsu.2019.01.021
Subramanian A, Adejuyigbe B, Niknam K, Gomez-Alvarado F, Morshed S, Shearer D. Retrospective cohort study analyzing outcomes of the SIGN Fin Nail in adult femoral fractures using the retrograde approach. Journal of Orthopaedics. 2024 Aug; 54: 103-7. doi: 10.1016/j.jor.2024.03.020. DOI: https://doi.org/10.1016/j.jor.2024.03.020
Arnone PA, McCanse AE, Farmen DS, Alano MV, Weber NJ, Thomas SP et al. Plain Radiography: A Unique Component of Spinal Assessment and Predictive Health. InHealthcare. 2024 Mar; 12(6): 633. doi: 10.3390/healthcare12060633. DOI: https://doi.org/10.3390/healthcare12060633
Ibrahim MF, Saeed FS, El-Morshidy EM, Hassan KM, Hassan MG, El-Sharkawi M et al. Posterolateral Fusion versus Posterior Lumbar Interbody Fusion for Adult Low-Grade Isthmic Spondylolisthesis: Analysis of Sagittal Radiographic Parameters-A Randomized Controlled Trial. Global Spine Journal. 2024 May. doi: 10.1177/21925682241254317. DOI: https://doi.org/10.1177/21925682241254317
Wang J, Jia H, Ma X, Ma J, Lu B, Bai H et al. Biomechanical study of intramedullary versus extramedullary implants for four types of subtrochanteric femoral fracture. Orthopaedic Surgery. 2022 Aug; 14(8): 1884-91. doi: 10.1111/os.13364. DOI: https://doi.org/10.1111/os.13364
Gu A, Doe K, Bracey L, Agarwal A, Raffa T, Farley B et al. Increased 1-year revision rates among left-sided intertrochanteric femur fractures. Journal of Orthopaedic Trauma. 2022 Mar; 10-97. doi: 10.1097/BOT.0000000000002829. DOI: https://doi.org/10.1097/BOT.0000000000002829
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