Ulus Travma Acil Cerrahi Derg. 2023; 29(3): 379-388 | DOI: 10.14744/tjtes.2022.78678

The effectiveness of fixation of hydroxyapatite-coated helical blade in preventing of the cut-out observed in treatment with proximal femoral nail of fractures of the femur intertrochanteric in elderly

Haci Bayram Tosun¹, Abuzer Uludað², Sancar Serbest³, Necati Çiçek², Sukru Demir^4
1Department of Orthopaedics and Traumatology, SBÜ Elazýð Fethi Sekin Þehir SUAM, Elazýð-Türkiye
²Department of Orthopaedics and Traumatology, Adýyaman University Faculty of Medicine, Adýyaman-Türkiye
³Department of Orthopaedics and Traumatology, Kýrýkkale University Faculty of Medicine, Kýrýkkale-Türkiye
⁴Department of Orthopaedics and Traumatology, Fýrat University Faculty of Medicine, Elazýð-Türkiye

BACKGROUND: This study aimed to retrospectively evaluate the effectiveness of hydroxyapatite-coated (HA-coated) implants and other caput–collum implants in preventing cut-out observed in treatment with proximal femoral nail (PFN) of intertrochanteric femur fractures in elderly patients.
METHODS: A total of 98 consecutive patients (56 males and 42 females; mean age: 79.42 (61–115) years) treated with three differ-ent PFNs for intertrochanteric femoral fractures were retrospectively examined. The mean of the follow-up period was 7.87 (4–48) months. It was used a threaded lag screw in 40 patients, an HA-coated helical blade in 28 patients and a non-coated helical blade in 30 patients for PFN. The reduction quality, fracture type, and radiological outcomes among all groups were evaluated.
RESULTS: Unstable type was seen in 50 (52.1%) patients according to AO Foundation/Orthopedic Trauma Association fracture classi-fication. An acceptable-good reduction quality was seen in 87 (88.8%) of all patients. The average of tip-apex distance (TAD) value was 27.61 mm, calcar-referenced TAD (CalTAD) value was 28.72 mm, caput-collum diaphyseal angle was 128,° Parker’s anteroposterior ratio was 46.36%, and Parker’s lateral ratio was 46.82%. The best suitable implant position was observed in 49 (50%) patients. Cut-out was observed in 7 (7.14%) patients, and secondary varus displacement of more than 10° was observed in 12 (12.24%) patients. Correlation analysis and multivariate logistic regression analysis showed a significant difference between HA-coated and other implants in cut-out. Furthermore, implant type was the strongest predictive factor for cut-out complications in the multivariate logistic regression analysis.
CONCLUSION: HA-coated implants may reduce the long-term cut-out risk due to increased osteointegration and bone ingrowth in elderly patients with intertrochanteric femoral fractures with poor bone quality. However, this alone is not enough; a suitable screw position, optimal TAD values, and excellent reduction quality are other important factors.

Keywords: Caput-collum implant, cut-out; hydroxyapatite-coated; intertrochanteric femur fractures; proximal femoral nail.

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Yaþlýlarda intertrokanterik femur kýrýklarýnýn proksimal femur çivisi ile tedavisinde gözlenen cut-out’un önlenmesinde hidroksiapatit kaplý helikal blade tespitinin etkinliði

Haci Bayram Tosun¹, Abuzer Uludað², Sancar Serbest³, Necati Çiçek², Sukru Demir^4
1SBÜ Elazýð Fethi Sekin Þehir SUAM, Ortopedi ve Travmatoloji Kliniði, Elazýð
²Adýyaman Üniversitesi Týp Fakültesi, Ortopedi ve Travmatoloji Anabilim Dalý, Adýyaman
³Kýrýkkale Üniversitesi Týp Fakültesi, Ortopedi ve Travmatoloji Anabilim Dalý, Kýrýkkale
⁴Fýrat Üniversitesi Týp Fakültesi, Ortopedi ve Travmatoloji Anabilim Dalý, Elazýð

AMAÇ: Bu çalýþmada, yaþlý hastalarda intertrokanterik femur kýrýklarýnýn proksimal femur çivi (PFN) ile tedavisinde gözlenen cut-out’un önlenme-sinde hidroksiapatit kaplý implantlar ve diðer baþ-boyun implantlarýnýn etkinliði geriye dönük olarak deðerlendirildi.
GEREÇ VE YÖNTEM: Ýntertrokanterik femur kýrýðý nedeniyle üç farklý PFN ile tedavi edilen toplam 98 ardýþýk hasta (56 erkek ve 42 kadýn; ortalama yaþ: 79.42 (61–115) yýl) geriye dönük olarak incelendi. Ortalama takip süresi 7.87 (4–48) aydý. PFN’de kullanýlan baþ-boyun implant için 40 hastada yivli lag vidasý, 28 hastada HA-kaplý helikal blade ve 30 hastada ise kaplamasýz helikal blade kullanýldý. Tüm gruplar arasýnda redüksiyon kalitesi, kýrýk tipi ve radyolojik sonuçlar deðerlendirildi.
BULGULAR: AO/OTA sýnýflamasýna göre 50 (%52.1) hastada instabil kýrýk tipi gözlendi. Hastalarýn 87’sinde (%88.8) iyi bir redüksiyon ve/veya kabul edilebilir redüksiyon kalitesi görüldü. Ortalama tip-apeks mesafesi (TAD) 27.61 mm, kalkar referanslý tip-apeks mesafesi (CalTAD) 28.72 mm, baþ-boyun cisim açýsý (CCD) 128°, Parker ön-arka oraný %46.36, Parker lateral oraný %46.82 idi. En optimal implant pozisyonu 49 (%50) hastada göz-lendi. Yedi (%7.14) hastada cut-out, 12 (%12.24) hastada ise10°’den fazla sekonder varus deplasmaný gözlendi. Korelasyon analizi ve çok deðiþkenli lojistik regresyon analizinde cut-out açýsýndan HA-kaplý ve diðer implantlar arasýnda anlamlý bir farklýlýk gözlendi. Ayrýca, implant tipinin çok deðiþkenli lojistik regresyon analizinde cut-out komplikasyonu açýsýndan en güçlü prediktif faktör olduðu gözlendi.
TARTIÞMA: HA-kaplý implantlar, kötü kemik kalitesine sahip intertrokanterik femur kýrýðý olan yaþlý hastalarda artmýþ osteointegrasyon ve kemik içe büyümesi nedeniyle uzun vadede cut-out riskini azaltabilir. Ancak, bu tek baþýna yeterli olmayýp, uygun bir vida konumu, optimum TAD deðerleri ve mükemmel redüksiyon kalitesi cut-out’un önlenmesinde diðer önemli faktörlerdir.

Anahtar Kelimeler: Baþ-boyun implantý, cut-out; hidroksiapatit kaplama; intertrokanterik femur kýrýklarý; proksimal femoral çivi.

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