Mehmet Veysel BAŞKAN, ALİ ÇAĞDAŞ YÖRÜKOĞLU, AHMET NADİR AYDEMİR, NİHAL BÜKER, NUSRET ÖK, AHMET FAHİR DEMİRKAN

Comparison of dynamic hip screw and proximal femoral nail in intertrochanteric femur fractures and cost analysis

Purpose: The study was planned to compare the results of dynamic hip screw (DHS) and proximal femoral nail antirotation (PFNA) applications to femur intertrochanteric fractures and to implement a cost analysis. Materials and methods: A retrospective evaluaton was made of 75 patients who were treated for intertrochanteric femur fracture between May 2009 and December 2012. Evaluation was made of differences between the groups in reduction quality, mean duration of hospitalization, complication rates, functional outcomes and treatment costs. Results: Thirty patients were treated with DHS and forty five patients with PFNA. The average follow-up period was 21.5 (12-49) months. Functional outcomes were similar, with no significant difference between the groups. Length of hospital stay was shorter in the PFNA group, the treatment and care costs were lower compared to the DHS group. Conclusion: Although PFNA is a much more expensive implant than DHS, there is no significant difference between total hospital costs. Nevertheless, as DHS has similar functional results, it is still a preferrable treatment method for intertrochanteric femur fractures.

İntertrokanterik femur kırıklarında dinamik kalça çivisi ile proksimal femoral çivisi karşılaştırılması ve maliyet analizi

Amaç: Çalışmamız femur intertrokanterik kırıklarında dinamik kalça vidası (DHS) – proksimal femoral çivi antirotasyon (PFNA) uygulamalarının sonuçlarının karşılaştırılması ve bu konuda maliyet analizinin yapılması için planlanmıştır. Gereç ve yöntem: Mayıs-2009 Aralık-2012 tarihleri arasında intertrokanterik femur kırığı nedeniyle ameliyat olmuş 75 hasta retrospektif olarak değerlendirildi. Gruplar arasında redüksiyon kalitesi, ortalama yatış süresi, komplikasyon oranları, fonksiyonel sonuçlar ve tedavi masrafları açısından fark olup olmadığı değerlendirildi. Bulgular: Otuz hastaya DHS, Kırk beş hastaya PFNA uygulandı. Çalışmamızda takip süresi ortalama 21.55 (6-49) aydır. Fonksiyonel sonuçlar gruplar arasında anlamlı fark olmayacak şekilde birbirine yakındı. PFNA uygulanan hastaların DHS uygulanan hastalara göre hastanede yatış sürelerinin kısa; tedavi ve bakım masraflarının daha düşük olduğu görülmektedir. Sonuç:PFNA; DHS’ye oranla pahalı bir implant olsa da hastane toplam maliyeti değerlendirildiğinde aralarında anlamlı bir farklılık görülmemektedir. Bunun yanında benzer fonksiyonel sonuçları ile DHS intertrokanterik femur kırıklarında tercih edilebilir bir tedavi yöntemidir.

PDF

___

Cummings SR, Rubin SM, Black D. The future of hip fractures in United States: Numbers, costs and potential effects of postmenopausal estrogen. Clin Orthop Relat Res 1990;252:163-166.

Koval JK, Sala DA, Kummer FJ, Zuckerman JD. Postoperative weight-bearing after a fracture of the femoral neck or an intertrochanteric fracture. J Bone Joint Surg Am 1998;80:352-356.

Jonnes C, Sm S, Najimudeen S. Type II intertrochanteric fractures: proximal femoral nailing (PFN) versus dynamic hip screw (DHS). Arch Bone Jt Surg 2016;4:23-28.

Parker MJ. Cutting-out of the dynamic hip screw related to its position. J Bone Joint Surg Br 1992;74:625.

Baumgaertner MR, Curtin SL, Lindskog DM, Keggi JM. The value of the tip-apex distance in predicting failure of fixation of peritrochanteric fractures of the hip. J Bone Joint Surg Am 1995;77:1058-1064.

DeLee JC. Fractures and dislocations of the hip. Rockwood’s and Green’s fractures in adults. 3rd. J.B.Lippincott Company: Phil 1996:1481-1555.

Lorich DG, Geller DS, Nielson JH. Osteoporotic pertrochanteric hip fractures management and current controversies. Instr Course Lect 2004;53:441-54.

Browner DB, Jupiter JB, Levine AM, Trafton PG. Skeletal trauma. V:2, WB Saunders Company 1996:1833-1926.

Cooper C, Campion G, Melton LJ. Hip fractures in the elderly: a world-wide projection. Osteoporosis Int 1992;2:285-289.

Davidson TI, Bodey WN. Factors influencing survival following fractures of the upper end of the femur. Injury 1986;17:12-14.

Kristek D, Lovric I, Kristek J. Biljan M, Kristek G, Sakić K. The proximal femoral nail antirotation (PFNA) in the treatment of proximal femoral fractures. Coll Antropol 2010;34:937-940.

Gadegone WM, Salphale YS. Short proximal femoral nail fixation for trochanteric fractures. J Orthop Surg 2010;18:39-44.

Xu YZ, Geng DC. Mao HQ, Zhu XS, Yang HL. A Comparison of the proximal femoral nail antirotation device and dynamic hip screw in the treatment of unstable pertrochanteric fracture. J Int Med Res 2010;38:1266-1275.

Mereddy P, Kamath S, Ramakrishnan M. Malik H, Donnachie N. The AO/ASIF proximal femoral nail antirotation (PFNA): a new design for the treatment of unstable proximal femoral fractures. Injury 2009;40:428-432.

Stem R, Lübbeke A, Suva D, Miozzari H, Hoffmeyer P. Prospective randomized study comparing screw versus helical blade in the treatment of low-energy trochanteric fractures. Int Orthop 2011;35:1855-1861.

Bruijn K.D, Hartog D, Tuinebreijer W, Roukema G. Reliability of predictors for screw cutout in intertrochanteric hip fractures. J Bone Joint Surg Am 2012;94:1266-1272.

Radcliff T.A, Regan E, Ripley D.C.C, Hutt E. Increased use of intramedullary nails for intertrochanteric proximal femoral fractures in veterans affairs hospitals: a comparative effectiveness study. J Bone Joint Surg Am 2012;94:833-840.

Mansukhani SA, Tuteja SV, Kasodekar VB, Mukhi SR. A comparative study of the dynamic hip screw, the cemented bipolar hemiarthroplasty and the proximal femoral nail for the treatment of unstable intertrochanteric fractures. J Clin Diagn Res. 2017;11:14-19.

Müller F, Galler M, Zellner M, Bäuml C, Marzouk A, Füchtmeier B. Peri-implant femoral fractures: the risk is more than three times higher within PFN compared with DHS. Injury. 2016;47:2189-2194.

Guerra MT, Pasqualin S, Souza MP, Lenz R. Functional recovery of elderly patients with surgically-treated intertrochanteric fractures: preliminary results of a randomised trial comparing the dynamic hip screw and proximal femoral nail techniques. Injury. 2014;45:26- 31.

Kumar R, Singh RN, Singh BN. Comparative prospective study of proximal femoral nail and dynamic hip screw in treatment of intertrochanteric fracture femur. J Clin Orthop Trauma. 2012;3:28-36.

Jonnes C, Sm S, Najimudeen S. Type II Intertrochanteric Fractures: Proximal femoral nailing (PFN) versus dynamic hip screw (DHS). Arch Bone Jt Surg. 2016;4:23-28.