TY - JOUR
T1 - Intramedullary nailing of subtrochanteric fractures in elderly patients
T2 - Comparative study of helical blade cephalomedullary nail versus reconstruction nail
AU - Yoon, Yong Cheol
AU - Park, Ki Chul
AU - Oh, Chang Wug
AU - Kim, Joon Woo
AU - Kim, Ji Wan
AU - Park, Kyeong Hyeon
AU - Kim, Tae Seong
AU - Song, Hyung Keun
AU - Abdel Baki, Sharkawy Wagih
N1 - Publisher Copyright:
© 2022
PY - 2022/4
Y1 - 2022/4
N2 - Introduction: Intramedullary nailing (IMN), which is a common method for treating subtrochanteric fractures, is conducted as cephalomedullary (CMN) or reconstruction (RCN) nailing. Numerous studies have reported the effectiveness of CMN, which requires a shorter surgery time and provides stronger fixation strength with blade-type devices. However, the radiographic and clinical outcomes of the use of CMN and RCN in elderly patients aged ≥65 years have not been compared yet. This study aimed to investigate whether CMN offers superior outcomes over RCN in the treatment of subtrochanteric fractures in elderly patients. Materials and methods: This retrospective study included 60 elderly patients (17 men and 43 women; mean age: 74.9 years) diagnosed with subtrochanteric fractures and treated with IMN with helical blade CMN (CMN group: 30 patients) or RCN (RCN group: 30 patients) between January 2013 and December 2018 with at least 1 year of follow-up period. Radiologic outcomes were evaluated based on the postoperative state of alignment and the achievement and timing of bony union at the final follow-up. Clinical outcomes were evaluated using the Merle d'Aubigné–Postel score. Radiologic and clinical outcomes in the two groups were compared and analyzed, and the occurrence of complications was examined. Results: The difference in malalignment between the two groups was not significant; however, the RCN group achieved more effective reduction. At the final follow-up, bony union was achieved within 18.9 weeks, on average, in 28 patients in the CMN group and within 21.6 weeks, on average, in 27 patients in the RCN group. Twenty patients in the CMN group and 26 in the RCN group showed good or better results according to the Merle d'Aubigné–Postel score. No significant differences were found for any of the parameters. Conclusions: In the treatment of difficult subtrochanteric fractures in elderly patients, RCN can provide excellent reduction and strong fixation similar to CMN and can result in outstanding clinical and radiologic outcomes.
AB - Introduction: Intramedullary nailing (IMN), which is a common method for treating subtrochanteric fractures, is conducted as cephalomedullary (CMN) or reconstruction (RCN) nailing. Numerous studies have reported the effectiveness of CMN, which requires a shorter surgery time and provides stronger fixation strength with blade-type devices. However, the radiographic and clinical outcomes of the use of CMN and RCN in elderly patients aged ≥65 years have not been compared yet. This study aimed to investigate whether CMN offers superior outcomes over RCN in the treatment of subtrochanteric fractures in elderly patients. Materials and methods: This retrospective study included 60 elderly patients (17 men and 43 women; mean age: 74.9 years) diagnosed with subtrochanteric fractures and treated with IMN with helical blade CMN (CMN group: 30 patients) or RCN (RCN group: 30 patients) between January 2013 and December 2018 with at least 1 year of follow-up period. Radiologic outcomes were evaluated based on the postoperative state of alignment and the achievement and timing of bony union at the final follow-up. Clinical outcomes were evaluated using the Merle d'Aubigné–Postel score. Radiologic and clinical outcomes in the two groups were compared and analyzed, and the occurrence of complications was examined. Results: The difference in malalignment between the two groups was not significant; however, the RCN group achieved more effective reduction. At the final follow-up, bony union was achieved within 18.9 weeks, on average, in 28 patients in the CMN group and within 21.6 weeks, on average, in 27 patients in the RCN group. Twenty patients in the CMN group and 26 in the RCN group showed good or better results according to the Merle d'Aubigné–Postel score. No significant differences were found for any of the parameters. Conclusions: In the treatment of difficult subtrochanteric fractures in elderly patients, RCN can provide excellent reduction and strong fixation similar to CMN and can result in outstanding clinical and radiologic outcomes.
KW - Cephalomedullary nailing
KW - Elderly patients
KW - Reconstruction nailing
KW - Subtrochanteric fracture
UR - http://www.scopus.com/inward/record.url?scp=85123898007&partnerID=8YFLogxK
U2 - 10.1016/j.injury.2022.01.038
DO - 10.1016/j.injury.2022.01.038
M3 - Article
C2 - 35120730
AN - SCOPUS:85123898007
SN - 0020-1383
VL - 53
SP - 1477
EP - 1483
JO - Injury
JF - Injury
IS - 4
ER -