Authors: Matthias Knobe Wolf Drescher Nicole Heussen Richard Martin Sellei HansChristoph Pape
Publish Date: 2012/02/07
Volume: 470, Issue: 8, Pages: 2302-2312
Abstract
Technical advancements have produced many challenges to intramedullary implants for unstable pertrochanteric fractures Helical blade fixation of the femoral head has the theoretical advantages of higher rotational stability and cutout resistance and should have a lower rate of reoperation than a locked plating techniqueWe prospectively enrolled 108 patients with unstable pertrochanteric fractures in a surgeonallocated study between November 2005 and November 2008 54 with percutaneous compression plates PCCP and 54 with proximal femoral nail antirotation PFNA We evaluated patients regarding reoperation mortality and function Seventyfour patients had a minimum followup of 24 months mean 26 months range 24–30 monthsWe found no differences in the number of reoperations attributable to mechanical problems in the two groups PCCP = six and PFNA = five Despite a greater incidence of postoperative lateral wall fractures with helical blade nailing only postoperative varisation of the neckshaft angle and tipapex distance 33 mm versus 28 mm predicted reoperation Mortality and function were similar in the two groupsOur data suggest unstable pertrochanteric fractures may be fixed either with locked extramedullary smalldiameter screw systems to avoid lateral wall fractures or with the new intramedullary systems to avoid potential mechanical complications of a broken lateral wall Tipapex distance and preservation of the preoperative femoral neckshaft angle are the key technical factors for prevention of reoperationClinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment drug or device Readers are encouraged to always seek additional information including FDAapproval status of any drug or device prior to clinical useEach author certifies that his or her institution approved the human protocol for this investigation that all investigations were conducted in conformity with ethical principles of research and that informed consent for participation in the study was obtained
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