For intramedullary nailing of femoral shaft fractures, talon fixation is helpful to cope with the troublesome distal locking, but conventional distal locking with screws offers a more stable construct: Talon femoral nail versus conventional femoral nail
Yıl: 2022 Cilt: 28 Sayı: 4 Sayfa Aralığı: 513 - 522 Metin Dili: İngilizce DOI: 10.14744/tjtes.2021.55867 İndeks Tarihi: 10-05-2023
For intramedullary nailing of femoral shaft fractures, talon fixation is helpful to cope with the troublesome distal locking, but conventional distal locking with screws offers a more stable construct: Talon femoral nail versus conventional femoral nail
Öz: BACKGROUND: A novel-design femoral nail (FN) with distal talon deployment (Talon-FN) has emerged in the market to cope with problematic distal locking. We aimed to compare the radiological and functional outcomes of the Talon-FN with a conventional FN (Con-FN) for the treatment of femoral shaft fracture (FSFs). METHODS: This retrospective study included 85 patients (57 men, 28 women; mean age: 46.8±23.9 years) with FSFs (AO types 32-A and B) who were treated with FNs (Talon-FN: 41, Con-FN: 44) during October 2014–2018. Knee injury and Osteoarthritis Outcome Score Physical Function Shortform, Hip injury and Osteoarthritis Outcome Score Physical Function Shortform, Short musculoskeletal function assessment bother and dysfunction indexes were used for functional assessment. RESULTS: The mean follow-up time was 25.8±6.7 months. The complication rates were 19.6% and 20.5% for Talon-FN and Con-FN, respectively (p=0.92). Malunion was the most common complication for each FN type (Talon-FN: 9.8%, Con-FN: 9.1%). All of the Talon-FN group’s malunions were axial (shortening and malrotation) and happened gradually. In contrast, the Con-FN group’s malunions were angular (varus and valgus) and caused by initial malreduction. The Talon-FN group’s two patients with shortening (4.9%) had AO 32-B type fractures, and the other two with malrotation (4.9%) had AO 32-A3 type fractures, all of four fractures were localized distal to the femoral isthmus. The post-operative functional outcomes were similar between the groups (all p>0.05). The mean operation/ fluoroscopy time and the mean blood loss were lower in the Talon-FN group, while the mean union time was shorter in the Con-FN group (all p<0.01). No nonunion was noted in either group. The reoperation rates were similar at approximately 5% (p=0.95). CONCLUSION: Our study results revealed that the Talon-FN shortens the operation/fluoroscopy time and decreases the intraoperative blood loss with similar functional outcomes. However, the Con-FN seems to offer a more stable construct against axial malunion with a shorter bone union time. The Talon-FN should not be used in FSFs distal to the femoral isthmus with certain types of fractures prone to shortening and malrotation.
Anahtar Kelime: Femur şaft kırıklarının intramedüller çivilenmesinde, talon fiksasyonu zahmetli distal kilitlemeyle başa çıkmada yararlıdır, ancak vidalarla konvansiyonel distal kilitleme daha stabil bir yapı sunar: Talon femoral çiviye karşı konvansiyonel femoral çivi
Öz: AMAÇ: Distal kilitlemenin zorluğuyla başa çıkmak için distal talon açılımına sahip yeni tasarımlı bir femoral çivi (Talon-FÇ) piyasaya çıkmıştır. Bu çalışmada, femoral şaft kırıklarının (FŞK) tedavisinde Talon-FÇ’nin radyolojik ve fonksiyonel sonuçlarının konvansiyonel bir femoral çivi (Kon-FÇ) ile karşılaştırılması amaçlandı. GEREÇ VE YÖNTEM: Bu geriye dönük çalışmaya, Ekim 2014–2018 arası, FŞK (AO tip 32-A ve B) nedeniyle ameliyat edilen 85 hasta (57 erkek, 28 kadın; ortalama yaş: 46.8±23.9 yıl, Talon-FÇ: 41 hasta, Kon-FÇ: 44 hasta) alındı. Fonksiyonel değerlendirme için, Diz Yaralanması ve Osteoartrit Sonuç Skoru Fiziksel Fonksiyon Kısa Formu, Kalça Yaralanması ve Osteoartrit Sonuç Skoru Fiziksel Fonksiyon Kısa Formu, Kısa Kas-İskelet Fonksiyon Değerlendirmesi Rahatsızlık ve Disfonksiyon İndeksleri kullanıldı. BULGULAR: Ortalama takip süresi 25.8±6.7 aydı. Talon-FÇ ve Kon-FÇ için komplikasyon oranları sırasıyla %19.6 ve %20.5 idi (p=0.92). Malunion, iki çivi tipi için de en yaygın komplikasyondu (Talon-FÇ: %9.8, Kon-FÇ: %9.1). Talon-FÇ grubunun tüm malunionları aksiyeldi (kısalık ve malrotasyon) ve zaman içinde kademeli olarak gerçekleşti. Buna karşılık, Kon-FÇ grubunun tüm malunionları angülerdi (varus ve valgus) ve malredüksiyon kaynaklı idi. Talon-FÇ grubunun kısalığı olan iki hastasında (%4.9) AO 32-B tipi kırık, malrotasyonu olan diğer ikisinde (%4.9) AO 32-A3 tipi kırık vardı ve bu dört kırığın tamamı da femoral istmusun distalinde lokalize idi. Ameliyat sonrası fonksiyonel sonuçlar gruplar arasında benzerdi (tümü p>0.05). Ortalama operasyon/floroskopi süresi ve ortalama kan kaybı Talon-FÇ grubunda daha düşükken, ortalama kaynama süresi Con-FN grubunda daha kısaydı (tümü p<0.01). Her iki grupta da nonunion görülmedi. Reoperasyon oranları iki grupta da yaklaşık %5 olmak üzere benzerdi (p=0.95). TARTIŞMA: Çalışma sonuçlarımız, Kon-FÇ ile benzer fonksiyonel sonuçlara sahip olan Talon-FÇ’nin ameliyat/floroskopi süresini kısalttığını ve intraoperatif kan kaybını azalttığını ortaya koymuştur. Bununla birlikte, Kon-FÇ, daha kısa bir kemik kaynama süresi ile aksiyel maluniona karşı daha stabil bir yapı sunmaktadır. Talon-FÇ, femoral istmusun distalindeki kısalık ve malrotasyona açık bazı FŞK tiplerinde kullanılmamalıdır.
Anahtar Kelime: Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
- 1. Weiss RJ, Montgomery SM, Al Dabbagh Z, Jansson KÅ. National data of 6409 Swedish inpatients with femoral shaft fractures: Stable incidence between 1998 and 2004. Injury 2009;40:304–8.
- 2. Enninghorst N, McDougall D, Evans JA, Sisak K, Balogh ZJ. Population- based epidemiology of femur shaft fractures. J Trauma Acute Care Surg 2013;74:1516–20.
- 3. Singer BR, McLauchlan GJ, Robinson CM, Christie J. Epidemiology of fractures in 15 000 adults: The influence of age and gender. J Bone Joint Surg 1998;80:243–8.
- 4. Saita Y, Kaneko K, Ishijima M. Atypical femoral fractures and bisphosphonate use: Current evidence and clinical implications. Ther Adv Chronic Dis 2015;6:185–93.
- 5. DeCoster T, Bozorgnia S, Kakish S. Antegrade nailing of femur shaft fractures: A review. UNM Orthop Res J 2017;6:19.
- 6. Nowotarski P, Turen C, Brumback R, Scarboro J. Conversion of external fixation to intramedullary nailing for fractures of the shaft of the femur in multiply injured patients. J Bone Joint Surg Am 2000;82:781–8.
- 7. Krettek C, Miclau T, Grun O, Schandelmaier P, Tscherne H. Intraoperative control of axes, rotation and length in femoral and tibial fractures. Technical note. Injury 1998;29 Suppl 3:C29–39.
- 8. Gul ED, Yilmaz O, Bodur H. Reliability and validity of the Turkish version of the knee injury and osteoarthritis outcome score-physical function short-form (KOOS-PS). J Back Musculoskelet Rehabil 2013;26:461–6.
- 9. Yilmaz O, Gul ED, Bodur H. Cross-cultural adaptation and validation of the Turkish version of the hip disability and osteoarthritis outcome scorephysical function Short-form (HOOS-PS). Rheumatol Int 2014;34:43–9.
- 10. Swiontkowski MF, Engelberg R, Martin DP, Agel J. Short musculoskeletal function assessment questionnaire: Validity, reliability, and responsiveness. J Bone Joint Surg Am 1999;81:1245–60.
- 11. Jaarsma RL, van Kampen A. Rotational malalignment after fractures of the femur. J Bone Joint Surg Br 2004;86:1100–4.
- 12. Çamurcu Y, Sofu H, Issin A, Koçkara N, Genç E, Çetinkaya M. Is talon tibial intramedullary nailing clinically superior compared to conventional locked nailing? Eklem Hast Cerrahisi 2017;28:152–7.
- 13. Yapici F, Ucpunar H, Camurcu Y, Emirhan N, Tanoglu O, Tardus I. Clinical and radiological outcomes of patients treated with the talon distalfix proximal femoral nail for intertrochanteric femur fractures. Injury 2020;51:1045–50.
- 14. Aycan MF. Comparison of biomechanical properties of implant systems used in treatment of proximal femur fractures. J Fac Eng Archit Gazi Univ 2019;34:811–8.
- 15. Zehir S, Şahin E, Zehir R. Comparison of clinical outcomes with three different intramedullary nailing devices in the treatment of unstable trochanteric fractures. Ulus Travma Acil Cerrahi Derg 2015;21:469–76.
- 16. Arican G, Subaşı Ö, Özmeriç A, İltar S, Alemdaroğlu KB, Dinçel VE. Talon Proksimal femoral çivileme (Pfn) proksimal femoral çivi-antirotasyon (Pfna) kadar başarili mi? Acta Med Alan 2019;3:261–6.
- 17. Yapici F, Ucpunar H, Gur V, Onaç O, Alpay Y, Karaköse R, et al. Functional and radiological comparison of three cephalomedullary nails with different designs used in the treatment of unstable intertrochanteric femur fractures of elderly. Ulus Travma Acil Cerrahi Derg 2022. Apr. doi: 10.14744/tjtes.2021.55867. [Ahead of Print].
- 18. Whatling GM, Nokes LD. Literature review of current techniques for the insertion of distal screws into intramedullary locking nails. Injury 2006;37:109–19.
- 19. Knothe U, Knothe Tate ML, Klaue K, Perren SM. Development and testing of a new self-locking intramedullary nail system: Testing of handling aspects and mechanical properties. Injury 2000;31:617–26.
- 20. Lepore L, Lepore S, Maffulli N. Intramedullary nailing of the femur with an inflatable self-locking nail: Comparison with locked nailing. J Orthop Sci 2003;8:796–801.
- 21. Dalton JE, Salkeld SL, Satterwhite YE, Cook SD. A biomechanical comparison of intramedullary nailing systems for the humerus. J Orthop Trauma 1993;7:367–74.
- 22. Ricci WM, Bellabarba C, Lewis R, Evanoff B, Herscovici D, Dipasquale T, et al. Angular malalignment after intramedullary nailing of femoral shaft fractures. J Orthop Trauma 2001;15:90–5.
- 23. Karpos PA, McFerran MA, Johnson KD. Intramedullary nailing of acute femoral shaft fractures using manual traction without a fracture table. J Orthop Trauma 1995;9:57–62.
- 24. Majkowski RS, Baker AS. Interlocking nails for femoral fractures: An initial experience. Injury 1991;22:93–6.
- 25. Song SH. Radiologic outcomes of intramedullary nailing in infraisthmal femur-shaft fracture with or without poller screws. Biomed Res Int 2019;2019:9412379.
- 26. Pihlajamäki HK, Salminen ST, Böstman OM. The treatment of nonunions following intramedullary nailing of femoral shaft fractures. J Orthop Trauma 2002;16:394–402.
- 27. Wolinsky PR, McCarty E, Shyr Y, Johnson K. Reamed intramedullary nailing of the femur: 551 cases. J Trauma 1999;46:392–9.
- 28. Kim JT, Jeong HJ, Lee SJ, Kim HJ, Yoo JJ. Adjuvant teriparatide therapy for surgical treatment of femoral fractures; does it work? Hip Pelvis 2016;28:148–56.
- 29. Ko SB, Lee SW, Park CM, Lee SH. Clinical analysis of femur shaft insufficiency fractures. Clin Orthop Surg 2012;4:227–33.
- 30. Somford MP, van den Bekerom MPJ, Kloen P. Operative treatment for femoral shaft nonunions, a systematic review of the literature. Strateg Trauma Limb Reconstr 2013;8:77–88.
- 31. Bain GI, Zacest AC, Paterson DC, Middleton J, Pohl AP. Abduction strength following intramedullary nailing of the femur. J Orthop Trauma 1997;11:93–7.
- 32. Hennrikus WL, Kasser JR, Rand F, Millis MB, Richards KM. The function of the quadriceps muscle after a fracture of the femur in patients who are less than seventeen years old. J Bone Joint Surg Ser A 1993;75:508–13.
- 33. Danckwardt-Lillieström G, Sjögren S. Postoperative restoration of muscle strength after intramedullary nailing of fractures of the femoral shaft. Acta Orthop 1976;47:101–7.
- 34. Archdeacon M, Ford KR, Wyrick J, Paterno MV, Hampton S, Ludwig MB, et al. A prospective functional outcome and motion analysis evaluation of the hip abductors after femur fracture and antegrade nailing. J Orthop Trauma 2008;22:3–9.
- 35. Sanders DW, MacLeod M, Charyk-Stewart T, Lydestad J, Domonkos A, Tieszer C. Functional outcome and persistent disability after isolated fracture of the femur. Can J Surg 2008;51:366–70.
- 36. Helmy N, Jando VT, Lu T, Chan H, O’Brien PJ. Muscle function and functional outcome following standard antegrade reamed intramedullary nailing of isolated femoral shaft fractures. J Orthop Trauma 2008;22:10–5.
- 37. El Moumni M, Voogd EH, Ten Duis HJ, Wendt KW. Long-term functional outcome following intramedullary nailing of femoral shaft fractures. Injury 2012;43:1154–8.
- 38. Ricci WM, Devinney S, Haidukewych G, Herscovici D, Sanders R. Trochanteric nail insertion for the treatment of femoral shaft fractures. J Orthop Trauma 2005;19:511–7.
- 39. Daglar B, Gungor E, Delialioglu OM, Karakus D, Ersoz M, Tasbas BA, et al. Comparison of knee function after antegrade and retrograde intramedullary nailing for diaphyseal femoral fractures: Results of isokinetic evaluation. J Orthop Trauma 2009;23:640–4.
| APA | Yapici F, GÜR V, Onac O, alpay y, Tarduş İ, ÜÇPUNAR H, Camurcu Y (2022). For intramedullary nailing of femoral shaft fractures, talon fixation is helpful to cope with the troublesome distal locking, but conventional distal locking with screws offers a more stable construct: Talon femoral nail versus conventional femoral nail. , 513 - 522. 10.14744/tjtes.2021.55867 |
| Chicago | Yapici Furkan,GÜR VOLKAN,Onac Osman,alpay yakup,Tarduş İsmail,ÜÇPUNAR HANİFİ,Camurcu Yalkin For intramedullary nailing of femoral shaft fractures, talon fixation is helpful to cope with the troublesome distal locking, but conventional distal locking with screws offers a more stable construct: Talon femoral nail versus conventional femoral nail. (2022): 513 - 522. 10.14744/tjtes.2021.55867 |
| MLA | Yapici Furkan,GÜR VOLKAN,Onac Osman,alpay yakup,Tarduş İsmail,ÜÇPUNAR HANİFİ,Camurcu Yalkin For intramedullary nailing of femoral shaft fractures, talon fixation is helpful to cope with the troublesome distal locking, but conventional distal locking with screws offers a more stable construct: Talon femoral nail versus conventional femoral nail. , 2022, ss.513 - 522. 10.14744/tjtes.2021.55867 |
| AMA | Yapici F,GÜR V,Onac O,alpay y,Tarduş İ,ÜÇPUNAR H,Camurcu Y For intramedullary nailing of femoral shaft fractures, talon fixation is helpful to cope with the troublesome distal locking, but conventional distal locking with screws offers a more stable construct: Talon femoral nail versus conventional femoral nail. . 2022; 513 - 522. 10.14744/tjtes.2021.55867 |
| Vancouver | Yapici F,GÜR V,Onac O,alpay y,Tarduş İ,ÜÇPUNAR H,Camurcu Y For intramedullary nailing of femoral shaft fractures, talon fixation is helpful to cope with the troublesome distal locking, but conventional distal locking with screws offers a more stable construct: Talon femoral nail versus conventional femoral nail. . 2022; 513 - 522. 10.14744/tjtes.2021.55867 |
| IEEE | Yapici F,GÜR V,Onac O,alpay y,Tarduş İ,ÜÇPUNAR H,Camurcu Y "For intramedullary nailing of femoral shaft fractures, talon fixation is helpful to cope with the troublesome distal locking, but conventional distal locking with screws offers a more stable construct: Talon femoral nail versus conventional femoral nail." , ss.513 - 522, 2022. 10.14744/tjtes.2021.55867 |
| ISNAD | Yapici, Furkan vd. "For intramedullary nailing of femoral shaft fractures, talon fixation is helpful to cope with the troublesome distal locking, but conventional distal locking with screws offers a more stable construct: Talon femoral nail versus conventional femoral nail". (2022), 513-522. https://doi.org/10.14744/tjtes.2021.55867 |
| APA | Yapici F, GÜR V, Onac O, alpay y, Tarduş İ, ÜÇPUNAR H, Camurcu Y (2022). For intramedullary nailing of femoral shaft fractures, talon fixation is helpful to cope with the troublesome distal locking, but conventional distal locking with screws offers a more stable construct: Talon femoral nail versus conventional femoral nail. Ulusal Travma ve Acil Cerrahi Dergisi, 28(4), 513 - 522. 10.14744/tjtes.2021.55867 |
| Chicago | Yapici Furkan,GÜR VOLKAN,Onac Osman,alpay yakup,Tarduş İsmail,ÜÇPUNAR HANİFİ,Camurcu Yalkin For intramedullary nailing of femoral shaft fractures, talon fixation is helpful to cope with the troublesome distal locking, but conventional distal locking with screws offers a more stable construct: Talon femoral nail versus conventional femoral nail. Ulusal Travma ve Acil Cerrahi Dergisi 28, no.4 (2022): 513 - 522. 10.14744/tjtes.2021.55867 |
| MLA | Yapici Furkan,GÜR VOLKAN,Onac Osman,alpay yakup,Tarduş İsmail,ÜÇPUNAR HANİFİ,Camurcu Yalkin For intramedullary nailing of femoral shaft fractures, talon fixation is helpful to cope with the troublesome distal locking, but conventional distal locking with screws offers a more stable construct: Talon femoral nail versus conventional femoral nail. Ulusal Travma ve Acil Cerrahi Dergisi, vol.28, no.4, 2022, ss.513 - 522. 10.14744/tjtes.2021.55867 |
| AMA | Yapici F,GÜR V,Onac O,alpay y,Tarduş İ,ÜÇPUNAR H,Camurcu Y For intramedullary nailing of femoral shaft fractures, talon fixation is helpful to cope with the troublesome distal locking, but conventional distal locking with screws offers a more stable construct: Talon femoral nail versus conventional femoral nail. Ulusal Travma ve Acil Cerrahi Dergisi. 2022; 28(4): 513 - 522. 10.14744/tjtes.2021.55867 |
| Vancouver | Yapici F,GÜR V,Onac O,alpay y,Tarduş İ,ÜÇPUNAR H,Camurcu Y For intramedullary nailing of femoral shaft fractures, talon fixation is helpful to cope with the troublesome distal locking, but conventional distal locking with screws offers a more stable construct: Talon femoral nail versus conventional femoral nail. Ulusal Travma ve Acil Cerrahi Dergisi. 2022; 28(4): 513 - 522. 10.14744/tjtes.2021.55867 |
| IEEE | Yapici F,GÜR V,Onac O,alpay y,Tarduş İ,ÜÇPUNAR H,Camurcu Y "For intramedullary nailing of femoral shaft fractures, talon fixation is helpful to cope with the troublesome distal locking, but conventional distal locking with screws offers a more stable construct: Talon femoral nail versus conventional femoral nail." Ulusal Travma ve Acil Cerrahi Dergisi, 28, ss.513 - 522, 2022. 10.14744/tjtes.2021.55867 |
| ISNAD | Yapici, Furkan vd. "For intramedullary nailing of femoral shaft fractures, talon fixation is helpful to cope with the troublesome distal locking, but conventional distal locking with screws offers a more stable construct: Talon femoral nail versus conventional femoral nail". Ulusal Travma ve Acil Cerrahi Dergisi 28/4 (2022), 513-522. https://doi.org/10.14744/tjtes.2021.55867 |
