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The purpose of this study is to investigate the risk factors for wedge effect and its relevance between blade cut-out in patients with intertrochanteric fractures (ITF) treated with proximal femoral nail antirotation II (PFNA-II). A total of 113 patients with ITF treated with PFNA-II between 2012 and 2016 were retrospectively analyzed. Radiographic variables including preoperative fracture pattern, fracture classification, lateral wall fracture, and postoperative neck-shaft angle (NSA), femoral offset (FO), blade cut-out, and Parker's ratio were measured for analysis. An average of 4.16° of varus malalignment in NSA and 5.5 mm of femoral shaft lateralization in FO was found post-operatively. The presence of lateral wall fracture was significantly related to post-operative varus change of NSA ( < 0.05). After at least one year of follow up, the blade cut-out rate was 2.65% (3/113), and Parker's ratio was significantly higher in patients with blade cut-out ( = 0.0118). This study concluded that patients with ITF-present preoperative lateral wall fracture and postoperative higher Parker's ratio in AP radiography showed higher incidence of wedge effect that might increase risk of blade cut out.
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http://dx.doi.org/10.3390/jcm10215112 | DOI Listing |
Zhongguo Gu Shang
July 2025
Department of Orthopaedics and Traumatology, the Traditional Chinese Medicine Hospital of Haian County, Haian 226600, Jiangsu, China.
Objective: To investigate the clinical efficacy and key techniques of proximal femoral nail antirotation (PFNA) in the treatment of Basicervical fracture.
Methods: A retrospective analysis was performed on 23 patients with Basicervical fractures who underwent closed reduction and PFNA internal fixation under C-arm X-ray fluoroscopy between March 2019 and March 2023. The cohort included 9 males and 14 females.
Adv Orthop
April 2025
Department of Orthopaedics, Faculty of Medicine, Kasetsart University, Bangkok, Thailand.
The optimal length of cephalomedullary nails for treating unstable pertrochanteric fractures, particularly in populations with distinct femoral anatomy, remains debated. This study compares the clinical outcomes of using the shortest effective cephalomedullary nails (170 mm) to various short length (200 mm and 240 mm), focusing on Asian patients. In this randomized controlled trial, 50 patients aged 50 years or older with unstable intertrochanteric fractures (AO types 31A2-3) were randomly assigned to two groups.
View Article and Find Full Text PDFGeriatr Orthop Surg Rehabil
March 2025
Department of Orthopaedics and Traumatology, Eskişehir Osmangazi University, Eskişehir, Turkey.
Hip fractures are common in older adults and are associated with significant morbidity and mortality. Surgical fixation with intramedullary devices, such as proximal femoral nails (PFN), is a common treatment method. However, complications such as implant cut-out remain a challenge despite advancements in implant designs.
View Article and Find Full Text PDFObjectives: TAD > 25 mm is a risk factor for cut-out in intramedullary nailing. Less attention has been given to the risk factors for central cut-through and the possible outcomes of TAD <10 mm. Furthermore, the risk of cut-through depending on minimum depth on either anterior-posterior (AP) or lateral views has not been explored.
View Article and Find Full Text PDFMedicine (Baltimore)
November 2024
Department of Orthopedics, The First People's Hospital of Longquanyi District, Chengdu, Sichuan, China.
The aim was to study the independent risk factors of internal fixation failure in proximal femoral anti-rotation intramedullary nailing for intertrochanteric femur fracture, and to build a nomogram prediction model accordingly. Clinical data of patients with intertrochanteric femoral rotor fractures admitted to the First People's Hospital of Longquanyi District from January 2018 to January 2023 were retrospectively collected. The occurrence of spiral blade cut out, internal fixation breakage, peri-internal fixation fracture, hip internal rotation deformity, and fracture nonunion within 1 year after surgery were included in the internal fixation failure group, and the rest were included in the internal fixation success group.
View Article and Find Full Text PDF