Conversion to Hip Arthroplasty After Cut-out Complication of Proximal Femoral Nailing (PFN) in Pertrochanteric Fractures
Yıl: 2021 Cilt: 74 Sayı: 1 Sayfa Aralığı: 112 - 117 Metin Dili: İngilizce DOI: 10.4274/atfm.galenos.2020.09326 İndeks Tarihi: 20-01-2022
Conversion to Hip Arthroplasty After Cut-out Complication of Proximal Femoral Nailing (PFN) in Pertrochanteric Fractures
Öz: Objectives: A failed intertrochanteric fixation often leads to functional disability and pain. The most commonly observed complication is “cut-out”, which frequently requires hip arthroplasty in the subsequent period. In this study, we aimed to compare the results of total hip arthroplasty (THA) and hemiarthroplasty (HA) after cut-out complication of proximal femoral nailing (PFN). Materials and Methods: Forty patients who were treated with THA (20 patients) and HA (20 patients) due to cut-out complication following PFN were included in our retrospective study. Age, gender, classification of the pertrochanteric fracture (AO/OTA classification), time to arthroplasty surgery, operative time, total blood loss, and complications were reviewed. The clinical results were evaluated by the ambulatory status, Harris hip score (HHS) and visual analog scale (VAS) score at the second year follow-up. Results: The amount of blood loss and the operative time were significantly higher in the THA group (p=0.001). Post-operative second year VAS score and HHS were similar in both groups (p=0.989 and p=0.820, respectively). There was no significant difference between the two groups in terms of complications rate (p=0.294). Conclusion: Converting to hip arthroplasty is a successful choice in the treatment of cut-out complications following PFN. Both THA and HA groups had similar clinical results, with the HA group being more advantageous regarding cost, operative time, amount of blood loss, and rate of infection. However, the only valid option for those with acetabular defects during cut-out is THA.
Anahtar Kelime: Pertrokanterik Kırıklarda Proksimal Femoral Çivilemede (PFÇ) “Cut-out” Komplikasyonu Sonrası Kalça Artroplastisine Geçiş
Öz: Amaç: İntertrokanterik fiksasyon cerrahisinin başarısız sonuçlanması sıklıkla ağrı ve fonksiyon kaybına yol açmaktadır. En sık görülen komplikasyon “cut-out” olup, sıklıkla artroplasti ile tedavi edilir. Bu çalışmada, proksimal femur çivileme (PFÇ) cerrahisi sonrası “cut-out” komplikasyonu gelişen olgularda uygulanmış olan total kalça artroplastisi (TKA) ve parsiyel kalça artroplastisi (PKA) sonuçlarını araştırmayı hedefledik. Gereç ve Yöntem: Bu retrospektif çalışmaya, PFÇ sonrası “cut-out” gelişen 40 hasta (20 hasta-TKA, 20 hasta PKA) dahil edildi. Gruplar yaş, cinsiyet, var olan pertrokanterik kırık tipi (AO/OTA sınıflaması ile), artroplastiye geçiş zamanı, ameliyat süresi, toplam kan kaybı ve komplikasyonlar açısından karşılaştırıldı. Klinik sonuçlar hastaların ikinci yıldaki hareket edebilme kabiliyetleri, Harris kalça skoru (HKS) ve görsel analog ölçeği (VAS) skoru kullanılarak elde edildi. Bulgular: TKA grubunda ameliyat süresi ve toplam kan kaybı istatiksel olarak anlamlı bir şekilde daha fazlaydı (p=0,001). Grupların ikinci yıldaki HKS ve VAS skorları benzerdi (p=0,989 ve 0,820). Artroplasti sonrası gelişen komplikasyonlar açısından ise istatistiksel olarak anlamlı fark bulunmadı (p=0,294). Sonuç: PFÇ sonrasında oluşan “cut-out” komplikasyon tedavisinde artroplastiye geçiş başarılı sonuçlar veren bir tedavi seçimidir. Hem TKA hem de PKA grupları benzer klinik sonuçlara sahip olup, PKA maliyeti ameliyat süresi, kan kaybı ve postoperatif enfeksiyon yönünden daha avantajlı görülmektedir. Ancak, asetabulum defekti mevcut olan hastalarda tek geçerli tedavi yöntemi ise TKA’dır.
Anahtar Kelime: Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
- 1. Lohmann R, Frerichmann U, Stöckle U, et al. Proximale Femurfrakturen im Alter. Auswertung von Krankenkassendaten von über 23 Mio. Versicherten- -Teil 1 [Proximal femoral fractures in the elderly. Analysis of data from health insurance providers on more than 23 million insured persons--part 1]. Unfallchirurg. 2007;110:603-609.
- 2. Frei HC, Hotz T, Cadosch D, et al. Central head perforation, or “cut through,” caused by the helical blade of the proximal femoral nail antirotation. J Orthop Trauma. 2012;26:102-107.
- 3. Lenich A, Mayr E, Rüter A, et al. First results with the trochanter fixation nail (TFN): a report on 120 cases. Arch Orthop Trauma Surg. 2006;126:706-712.
- 4. Simmermacher RK, Bosch AM, Van der Werken C. The AO/ASIF-proximal femoral nail (PFN): a new device for the treatment of unstable proximal femoral fractures. Injury. 1999;30:327-332.
- 5. Wu CC, Shih CH, Chen WJ, et al. Treatment of cutout of a lag screw of a dynamic hip screw in an intertrochanteric fracture. Arch Orthop Trauma Surg. 1998;117:193-196.
- 6. Bojan AJ, Beimel C, Taglang G, et al. Critical factors in cut-out complication after Gamma Nail treatment of proximal femoral fractures. BMC Musculoskelet Disord. 2013;14:1.
- 7. Haidukewych GJ, Berry DJ. Hip arthroplasty for salvage of failed treatment of intertrochanteric hip fractures. J Bone Joint Surg Am. 2003;85:899-904.
- 8. Baker HR. Ununited İntertrochanteric Fractures of the Femur. Clin Orthop. 1960;18:209-220.
- 9. Nordin S, Zulkifli O, Faisham WI. Mechanical failure of Dynamic Hip Screw (DHS) fixation in intertrochanteric fracture of the femur. Med J Malaysia. 2001;56:12-17.
- 10. Utrilla AL, Reig JS, Muñoz FM, et al. Trochanteric gamma nail and compression hip screw for trochanteric fractures: a randomized, prospective, comparative study in 210 elderly patients with a new design of the gamma nail. J Orthop Trauma. 2005;19:229-233.
- 11. Brunner A, Büttler M, Lehmann U, et al. What is the optimal salvage procedure for cut-out after surgical fixation of trochanteric fractures with the PFNA or TFN?: A multicentre study. Injury. 2016;47:432-438.
- 12. Chen YT, Chen WM, Lee KS, et al. Diaphyseal locking hip arthroplasty for treatment of failed fixation of intertrochanteric hip fractures. J Arthroplasty. 2008;23:241-246.
- 13. Mariani EM, Rand JA. Nonunion of intertrochanteric fractures of the femur following open reduction and internal fixation. Results of second attempts to gain union. Clin Orthop Relat Res. 1987;218:81-89.
- 14. Fernandez DL, Capo JT, Gonzalez-Hernandez E, et al. Nonunion of greater trochanter following total hip arthroplasty: Treated by an articulated hook plate and bone grafting. Indian J Orthop. 2017;51:273-279.
- 15. Bonnevialle P, Saragaglia D, Ehlinger M, et al. Trochanteric locking nail versus arthroplasty in unstable intertrochanteric fracture in patients aged over 75 years. Orthop Traumatol Surg Res. 2011;97:95-100.
- 16. Enocson A, Mattisson L, Ottosson C, et al. Hip arthroplasty after failed fixation of trochanteric and subtrochanteric fractures. Acta Orthop. 2012;83:493-498.
- 17. Mehlhoff T, Landon GC, Tullos HS. Total hip arthroplasty following failed internal fixation of hip fractures. Clin Orthop Relat Res. 1991;269:32-37.
| APA | Merter A, Başarır K, Kocaoğlu H, KARACA M, ÖZBEK E, Kalem M (2021). Conversion to Hip Arthroplasty After Cut-out Complication of Proximal Femoral Nailing (PFN) in Pertrochanteric Fractures. , 112 - 117. 10.4274/atfm.galenos.2020.09326 |
| Chicago | Merter Abdullah,Başarır Kerem,Kocaoğlu Hakan,KARACA Mustafa Onur,ÖZBEK Emre Anıl,Kalem Mahmut Conversion to Hip Arthroplasty After Cut-out Complication of Proximal Femoral Nailing (PFN) in Pertrochanteric Fractures. (2021): 112 - 117. 10.4274/atfm.galenos.2020.09326 |
| MLA | Merter Abdullah,Başarır Kerem,Kocaoğlu Hakan,KARACA Mustafa Onur,ÖZBEK Emre Anıl,Kalem Mahmut Conversion to Hip Arthroplasty After Cut-out Complication of Proximal Femoral Nailing (PFN) in Pertrochanteric Fractures. , 2021, ss.112 - 117. 10.4274/atfm.galenos.2020.09326 |
| AMA | Merter A,Başarır K,Kocaoğlu H,KARACA M,ÖZBEK E,Kalem M Conversion to Hip Arthroplasty After Cut-out Complication of Proximal Femoral Nailing (PFN) in Pertrochanteric Fractures. . 2021; 112 - 117. 10.4274/atfm.galenos.2020.09326 |
| Vancouver | Merter A,Başarır K,Kocaoğlu H,KARACA M,ÖZBEK E,Kalem M Conversion to Hip Arthroplasty After Cut-out Complication of Proximal Femoral Nailing (PFN) in Pertrochanteric Fractures. . 2021; 112 - 117. 10.4274/atfm.galenos.2020.09326 |
| IEEE | Merter A,Başarır K,Kocaoğlu H,KARACA M,ÖZBEK E,Kalem M "Conversion to Hip Arthroplasty After Cut-out Complication of Proximal Femoral Nailing (PFN) in Pertrochanteric Fractures." , ss.112 - 117, 2021. 10.4274/atfm.galenos.2020.09326 |
| ISNAD | Merter, Abdullah vd. "Conversion to Hip Arthroplasty After Cut-out Complication of Proximal Femoral Nailing (PFN) in Pertrochanteric Fractures". (2021), 112-117. https://doi.org/10.4274/atfm.galenos.2020.09326 |
| APA | Merter A, Başarır K, Kocaoğlu H, KARACA M, ÖZBEK E, Kalem M (2021). Conversion to Hip Arthroplasty After Cut-out Complication of Proximal Femoral Nailing (PFN) in Pertrochanteric Fractures. Ankara Üniversitesi Tıp Fakültesi Mecmuası, 74(1), 112 - 117. 10.4274/atfm.galenos.2020.09326 |
| Chicago | Merter Abdullah,Başarır Kerem,Kocaoğlu Hakan,KARACA Mustafa Onur,ÖZBEK Emre Anıl,Kalem Mahmut Conversion to Hip Arthroplasty After Cut-out Complication of Proximal Femoral Nailing (PFN) in Pertrochanteric Fractures. Ankara Üniversitesi Tıp Fakültesi Mecmuası 74, no.1 (2021): 112 - 117. 10.4274/atfm.galenos.2020.09326 |
| MLA | Merter Abdullah,Başarır Kerem,Kocaoğlu Hakan,KARACA Mustafa Onur,ÖZBEK Emre Anıl,Kalem Mahmut Conversion to Hip Arthroplasty After Cut-out Complication of Proximal Femoral Nailing (PFN) in Pertrochanteric Fractures. Ankara Üniversitesi Tıp Fakültesi Mecmuası, vol.74, no.1, 2021, ss.112 - 117. 10.4274/atfm.galenos.2020.09326 |
| AMA | Merter A,Başarır K,Kocaoğlu H,KARACA M,ÖZBEK E,Kalem M Conversion to Hip Arthroplasty After Cut-out Complication of Proximal Femoral Nailing (PFN) in Pertrochanteric Fractures. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2021; 74(1): 112 - 117. 10.4274/atfm.galenos.2020.09326 |
| Vancouver | Merter A,Başarır K,Kocaoğlu H,KARACA M,ÖZBEK E,Kalem M Conversion to Hip Arthroplasty After Cut-out Complication of Proximal Femoral Nailing (PFN) in Pertrochanteric Fractures. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2021; 74(1): 112 - 117. 10.4274/atfm.galenos.2020.09326 |
| IEEE | Merter A,Başarır K,Kocaoğlu H,KARACA M,ÖZBEK E,Kalem M "Conversion to Hip Arthroplasty After Cut-out Complication of Proximal Femoral Nailing (PFN) in Pertrochanteric Fractures." Ankara Üniversitesi Tıp Fakültesi Mecmuası, 74, ss.112 - 117, 2021. 10.4274/atfm.galenos.2020.09326 |
| ISNAD | Merter, Abdullah vd. "Conversion to Hip Arthroplasty After Cut-out Complication of Proximal Femoral Nailing (PFN) in Pertrochanteric Fractures". Ankara Üniversitesi Tıp Fakültesi Mecmuası 74/1 (2021), 112-117. https://doi.org/10.4274/atfm.galenos.2020.09326 |
