Is Sliding Compression Necessary for Intramedullary Nailing Fixation of AO/OTA Type A3.3 Intertrochanteric Fracture?
Objectives The intramedullary nail is considered the gold standard for treating AO/OTA type A3.3 intertrochanteric fractures. However, it still faces a significant rate of failure, mainly due to the critical factor of comminuted lateral wall defects leading to inadequate proximal sliding compression...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2023-11-01
|
| Series: | Orthopaedic Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1111/os.13875 |
| _version_ | 1797640243972669440 |
|---|---|
| author | Cong Zhang Zhangxin Chen Mengyuan Wang Huiyu Chen Lingqi Zhu Wenqing Yang Zhenqi Ding Guofeng Huang |
| author_facet | Cong Zhang Zhangxin Chen Mengyuan Wang Huiyu Chen Lingqi Zhu Wenqing Yang Zhenqi Ding Guofeng Huang |
| author_sort | Cong Zhang |
| collection | DOAJ |
| description | Objectives The intramedullary nail is considered the gold standard for treating AO/OTA type A3.3 intertrochanteric fractures. However, it still faces a significant rate of failure, mainly due to the critical factor of comminuted lateral wall defects leading to inadequate proximal sliding compression. The primary objective of this study is to investigate the requirement of sliding compression in the treatment of unstable AO/OTA type A3.3 intertrochanteric fractures. To achieve this, we conduct a comparative analysis between two approaches: InterTAN alone and proximal femoral anti‐rotation blade nailing (PFNA) combined with lateral wall reconstruction for treating AO/OTA type A3.3 intertrochanteric fractures with lateral wall damage. Methods A retrospective analysis was conducted on the clinical data of patients who underwent intramedullary nailing fixation for AO/OTA type A3.3 intertrochanteric fractures at our hospital from January 2012 to January 2022. Patient characteristics as well as treatment details, including operative time, intraoperative blood loss, weight‐bearing time, fracture healing time, tip apex distance (TAD) loss, Harris hip scores (HHS), Parker–Palmer mobility score (PPMS), and postoperative complications, were collected and analyzed. Continuous variables were analyzed using independent sample t‐tests, while categorical variables were examined using the chi‐square test. For group comparisons, variance analysis was applied, and pairwise comparisons were conducted using the LSD‐t test. Results These patients were divided into PFNA combined with lateral wall reconstruction group (sliding compression group) and InterTAN fixation group (static fixation group) based on surgical methods. The operation time, intraoperative bleeding loss, HHS at 12 months and PPMS at 12 months in the sliding compression group were significantly higher than those in the static fixation group, and time to weight‐bearing and fracture healing time were significantly lower than those in the static fixation group (p < 0.05). There were no significant differences between two groups in terms of the TAD at 2 days, 2, and 12 months postoperatively, the incidence of complications (p > 0.05). At 6 months postoperatively, femoral neck length was shortened compared to 2 days postoperatively in both groups, and the sliding compression group had a significantly greater degree of femoral neck shortening than the static fixation group (p < 0.05). Conclusion The use of PFNA with lateral wall reconstruction for A3.3 intertrochanteric fractures demonstrated superior mobility, efficiency, and reduced internal fixation failure rates compared to InterTAN. These findings suggest that sliding compression may be required for intramedullary nailing treatment. |
| first_indexed | 2024-03-11T13:29:07Z |
| format | Article |
| id | doaj.art-09a3c1833c6c44628fcf355a283b6f9e |
| institution | Directory Open Access Journal |
| issn | 1757-7853 1757-7861 |
| language | English |
| last_indexed | 2024-03-11T13:29:07Z |
| publishDate | 2023-11-01 |
| publisher | Wiley |
| record_format | Article |
| series | Orthopaedic Surgery |
| spelling | doaj.art-09a3c1833c6c44628fcf355a283b6f9e2023-11-03T02:57:47ZengWileyOrthopaedic Surgery1757-78531757-78612023-11-0115112805281310.1111/os.13875Is Sliding Compression Necessary for Intramedullary Nailing Fixation of AO/OTA Type A3.3 Intertrochanteric Fracture?Cong Zhang0Zhangxin Chen1Mengyuan Wang2Huiyu Chen3Lingqi Zhu4Wenqing Yang5Zhenqi Ding6Guofeng Huang7Department of Orthopedics The 909th Hospital, School of Medicine, Xiamen University Zhangzhou ChinaDepartment of Orthopedics The 909th Hospital, School of Medicine, Xiamen University Zhangzhou ChinaSchool of Medicine Xiamen University Xiamen ChinaSchool of Medicine Xiamen University Xiamen ChinaDepartment of Orthopedics The 909th Hospital, School of Medicine, Xiamen University Zhangzhou ChinaDepartment of Orthopedics The 909th Hospital, School of Medicine, Xiamen University Zhangzhou ChinaDepartment of Orthopedics The 909th Hospital, School of Medicine, Xiamen University Zhangzhou ChinaDepartment of Orthopedics The 909th Hospital, School of Medicine, Xiamen University Zhangzhou ChinaObjectives The intramedullary nail is considered the gold standard for treating AO/OTA type A3.3 intertrochanteric fractures. However, it still faces a significant rate of failure, mainly due to the critical factor of comminuted lateral wall defects leading to inadequate proximal sliding compression. The primary objective of this study is to investigate the requirement of sliding compression in the treatment of unstable AO/OTA type A3.3 intertrochanteric fractures. To achieve this, we conduct a comparative analysis between two approaches: InterTAN alone and proximal femoral anti‐rotation blade nailing (PFNA) combined with lateral wall reconstruction for treating AO/OTA type A3.3 intertrochanteric fractures with lateral wall damage. Methods A retrospective analysis was conducted on the clinical data of patients who underwent intramedullary nailing fixation for AO/OTA type A3.3 intertrochanteric fractures at our hospital from January 2012 to January 2022. Patient characteristics as well as treatment details, including operative time, intraoperative blood loss, weight‐bearing time, fracture healing time, tip apex distance (TAD) loss, Harris hip scores (HHS), Parker–Palmer mobility score (PPMS), and postoperative complications, were collected and analyzed. Continuous variables were analyzed using independent sample t‐tests, while categorical variables were examined using the chi‐square test. For group comparisons, variance analysis was applied, and pairwise comparisons were conducted using the LSD‐t test. Results These patients were divided into PFNA combined with lateral wall reconstruction group (sliding compression group) and InterTAN fixation group (static fixation group) based on surgical methods. The operation time, intraoperative bleeding loss, HHS at 12 months and PPMS at 12 months in the sliding compression group were significantly higher than those in the static fixation group, and time to weight‐bearing and fracture healing time were significantly lower than those in the static fixation group (p < 0.05). There were no significant differences between two groups in terms of the TAD at 2 days, 2, and 12 months postoperatively, the incidence of complications (p > 0.05). At 6 months postoperatively, femoral neck length was shortened compared to 2 days postoperatively in both groups, and the sliding compression group had a significantly greater degree of femoral neck shortening than the static fixation group (p < 0.05). Conclusion The use of PFNA with lateral wall reconstruction for A3.3 intertrochanteric fractures demonstrated superior mobility, efficiency, and reduced internal fixation failure rates compared to InterTAN. These findings suggest that sliding compression may be required for intramedullary nailing treatment.https://doi.org/10.1111/os.13875InterTANLateral wall reconstructionPFNAType A3.3 intertrochanteric fracture |
| spellingShingle | Cong Zhang Zhangxin Chen Mengyuan Wang Huiyu Chen Lingqi Zhu Wenqing Yang Zhenqi Ding Guofeng Huang Is Sliding Compression Necessary for Intramedullary Nailing Fixation of AO/OTA Type A3.3 Intertrochanteric Fracture? Orthopaedic Surgery InterTAN Lateral wall reconstruction PFNA Type A3.3 intertrochanteric fracture |
| title | Is Sliding Compression Necessary for Intramedullary Nailing Fixation of AO/OTA Type A3.3 Intertrochanteric Fracture? |
| title_full | Is Sliding Compression Necessary for Intramedullary Nailing Fixation of AO/OTA Type A3.3 Intertrochanteric Fracture? |
| title_fullStr | Is Sliding Compression Necessary for Intramedullary Nailing Fixation of AO/OTA Type A3.3 Intertrochanteric Fracture? |
| title_full_unstemmed | Is Sliding Compression Necessary for Intramedullary Nailing Fixation of AO/OTA Type A3.3 Intertrochanteric Fracture? |
| title_short | Is Sliding Compression Necessary for Intramedullary Nailing Fixation of AO/OTA Type A3.3 Intertrochanteric Fracture? |
| title_sort | is sliding compression necessary for intramedullary nailing fixation of ao ota type a3 3 intertrochanteric fracture |
| topic | InterTAN Lateral wall reconstruction PFNA Type A3.3 intertrochanteric fracture |
| url | https://doi.org/10.1111/os.13875 |
| work_keys_str_mv | AT congzhang isslidingcompressionnecessaryforintramedullarynailingfixationofaootatypea33intertrochantericfracture AT zhangxinchen isslidingcompressionnecessaryforintramedullarynailingfixationofaootatypea33intertrochantericfracture AT mengyuanwang isslidingcompressionnecessaryforintramedullarynailingfixationofaootatypea33intertrochantericfracture AT huiyuchen isslidingcompressionnecessaryforintramedullarynailingfixationofaootatypea33intertrochantericfracture AT lingqizhu isslidingcompressionnecessaryforintramedullarynailingfixationofaootatypea33intertrochantericfracture AT wenqingyang isslidingcompressionnecessaryforintramedullarynailingfixationofaootatypea33intertrochantericfracture AT zhenqiding isslidingcompressionnecessaryforintramedullarynailingfixationofaootatypea33intertrochantericfracture AT guofenghuang isslidingcompressionnecessaryforintramedullarynailingfixationofaootatypea33intertrochantericfracture |