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Comparison of the effects of lateral decubitus position and traction table on intramedullary nailing in trochanteric femur fractures

Year 2023, Volume: 48 Issue: 4, 1275 - 1281, 29.12.2023
https://doi.org/10.17826/cumj.1352439

Abstract

Purpose: The objective of this study is to evaluate the influence of patient positioning on intraoperative outcomes, specifically intraoperative time, fracture reduction, and implant location, in individuals with trochanteric femur fractures undergoing intramedullary nailing. The study compares two patient positions: the lateral decubitus position (LDP group) and the utilization of a traction table (TT group).
Materials and Methods: A total of 82 patients with trochanteric femur fractures, who underwent surgery were included. The patients were divided into LDP and TT groups. Various parameters, including age, gender, fracture details, setup time, operation time, anesthesia time, fluoroscopy time, tip-apex distance (TAD), collodiaphyseal angle (CDA), reduction quality, and implant position, were analyzed.
Result: Surgical time in the LD group was 33.90 ± 6.05 minutes, whereas in the TT group, it was 33.00 ± 6.64 minutes. Anesthesia time was 50.55 ± 7.46 minutes in the LD group and 55.26 ± 12.49 minutes in the TT group. Fluoroscopy time in the LD group was 45.20 ± 7.18 seconds, while in the TT group, it was 46.23 ± 4.50 seconds. Lateral decubitus position resulted in shorter setup and anesthesia times compared to the traction table.
Conclusion: Intramedullary nailing in the lateral decubitus position is a viable and practical choice for fracture reduction, with the potential to decrease morbidity and mortality rates especially in elderly patients.

References

  • results of proximal femoral nails used in the surgical treatment of hip fractures. Cukurova Med J. 2022;47:1350-8.
  • İlker E, Koyuncu D, Gönen E. İntertrokanterik femur kırığı sonrasında proksimal femur çivisi ile başarılı osteosentez elde edilen hastaların fonksiyonel sonuçları. Cukurova Med J. 2019;44:1323-8.
  • Bagır M, Mirioğlu A, Tekin M, Bicer Ö, Özkan C. Comparison of hematoma block and sedoanalgesia for analgesia before reduction of distal radius fractures. Cukurova Med J. 2021;46:1100-7.
  • Çiloğlu O, Dursun M, Kalkan T, Çiçek H, Seyfettinoğlu F, Oğur HU. Distal femur kırıklarında retrograd intramedüller çivi ve perkutan plak osteosentez yöntemlerinin karşılaştırılması. Cukurova Med J. 2017;42:490-8.
  • Yurteri A, Yildirim A, Çelik ZE, Vatansev H, Durmaz MS. The effect of quercetin on bone healing in an experimental rat model. Jt Dis Relat Surg. 2023;34:365-73.
  • Polat A, Misir A, Buyukkuscu MO, Basilgan S, Basar H. Factors associated with femoral neck shortening after closed or open reduction and screw fixation. Indian J Orthop. 2021;56:303-11.
  • Doğan N, Ertürk C, Gülabi D. Is proximal femoral nailing of unstable intertrochanteric fractures in the lateral decubitus position without a traction table as safe and effective as on a traction table? Injury. 2022;53:555-60.
  • Sonmez MM, Camur S, Erturer E, Ugurlar M, Kara A, Ozturk I. Strategies for proximal femoral nailing of unstable intertrochanteric fractures: lateral decubitus position or traction table. J Am Acad Orthop Surg. 2017;25:e37-e44.
  • de Souza EF, Hungria JOS, Rezende LRS, Bellan DG, Borracini JA. Comparative study between lateral decubitus and traction table for treatment of pertrochanteric fractures with cephalomedullary nails. Rev Bras Ortop. 2017;52:24-8.
  • Xue L, Zha L, Chen Q, Liang Y-j, Li K-r, Zhou Z et al. Randomized controlled trials of proximal femoral nail antirotation in lateral decubitus and supine position on treatment of intertrochanteric fractures. ScientificWorldJournal. 2013; 276015.
  • Mao W, Ni H, Li L, He Y, Chen X, Tang H et al. Comparison of Baumgaertner and Chang reduction quality criteria for the assessment of trochanteric fractures. Bone Joint Res. 2019;8:502-8.
  • Turgut A, Kalenderer Ö, Günaydin B, Önvural B, Karapinar L, Ağuş H. İntertrokanterik femur kırıklarının proksimal femoral çivi antirotasyon (PFNA) ile lateral dekübit pozisyonda tespiti. Acta Orthop Traumatol Turc. 2014;48:513-20.
  • Liu W, Zhou D, Liu F, Weaver MJ, Vrahas MS. Mechanical complications of intertrochanteric hip fractures treated with trochanteric femoral nails. J Trauma Acute Care Surg.2013;75:304-10.
  • Hwang J-H, Oh J-K, Oh C-W, Lee S-J, Myung-Rae C, Kim H et al. A biomechanical evaluation of proximal femoral nail antirotation with respect to helical blade position in femoral head: A cadaveric study. Indian J Orthop. 2012;46:627-32.
  • Kane P, Vopat B, Heard W, Thakur N, Paller D, Koruprolu S et al. Is tip apex distance as important as we think? A biomechanical study examining optimal lag screw placement. Clin Orthop Relat Res. 2014;472:2492-8.
  • Li S, Chang S-M, Jin Y-M, Zhang Y-Q, Niu W-X, Du S-C et al. A mathematical simulation of the tip-apex distance and the calcar-referenced tip-apex distance for intertrochanteric fractures reduced with lag screws. Injury. 2016;47:1302-8.

Trokanterik femur kırıklarında lateral dekübit pozisyonu ve traksiyon masasının intramedüller çivilemeye etkisinin karşılaştırılması

Year 2023, Volume: 48 Issue: 4, 1275 - 1281, 29.12.2023
https://doi.org/10.17826/cumj.1352439

Abstract

Amaç: Bu çalışmanın amacı intramedüller çivileme uygulanan trokanterik femur kırıklarında, intraoperatif hasta pozisyonunun intraoperatif süre, kırık redüksiyonu ve implant yerleşimi gibi intraoperatif sonuçlar üzerindeki etkisini değerlendirmektir. Çalışma iki farklı cerrahi hasta pozisyonunu karşılaştırmaktadır: Lateral dekübit pozisyonu (LDP grubu) ve traksiyon masası kullanımı (TT grubu).
Gereç ve Yöntem: Ameliyat edilen trokanterik femur kırığı olan toplam 82 hasta çalışmaya dahil edildi. Hastalar LDP ve TT olarak iki gruba ayrıldı. Yaş, cinsiyet, kırık özellikleri, ameliyat hazırlık süresi, operasyon süresi, anestezi süresi, floroskopi süresi, tip-apeks mesafesi (TAD), kollodiafizer açı (CDA), redüksiyon kalitesi ve implant yerleşimi gibi çeşitli parametreler analiz edildi.
Bulgular: Cerrahi süresi, LDP grubunda 33,90 ± 6,05 dakikayken TT grubunda 33,00 ± 6,64 dakikaydı. Anestezi süresi, LDP grubunda 50,55 ± 7,46 dakikayken TT grubunda 55,26 ± 12,49 dakikaydı. Floroskopi süresi, LDP grubunda 45,20 ± 7,18 saniyeyken TT grubunda 46,23 ± 4,50 saniyeydi. Lateral dekübit pozisyonun traksiyon masasına göre daha kısa ameliyat hazırlık ve anestezi süresi sağladığı belirlendi.
Sonuç: Bulgular, lateral dekübit pozisyonunda intramedüller çivilemenin kırık redüksiyonu için uygun ve pratik bir seçenek olduğunu, buna bağlı olarak özellikle yaşlı hastalarda morbidite ve mortalite oranlarını azaltma potansiyeli olduğunu göstermektedir.

References

  • results of proximal femoral nails used in the surgical treatment of hip fractures. Cukurova Med J. 2022;47:1350-8.
  • İlker E, Koyuncu D, Gönen E. İntertrokanterik femur kırığı sonrasında proksimal femur çivisi ile başarılı osteosentez elde edilen hastaların fonksiyonel sonuçları. Cukurova Med J. 2019;44:1323-8.
  • Bagır M, Mirioğlu A, Tekin M, Bicer Ö, Özkan C. Comparison of hematoma block and sedoanalgesia for analgesia before reduction of distal radius fractures. Cukurova Med J. 2021;46:1100-7.
  • Çiloğlu O, Dursun M, Kalkan T, Çiçek H, Seyfettinoğlu F, Oğur HU. Distal femur kırıklarında retrograd intramedüller çivi ve perkutan plak osteosentez yöntemlerinin karşılaştırılması. Cukurova Med J. 2017;42:490-8.
  • Yurteri A, Yildirim A, Çelik ZE, Vatansev H, Durmaz MS. The effect of quercetin on bone healing in an experimental rat model. Jt Dis Relat Surg. 2023;34:365-73.
  • Polat A, Misir A, Buyukkuscu MO, Basilgan S, Basar H. Factors associated with femoral neck shortening after closed or open reduction and screw fixation. Indian J Orthop. 2021;56:303-11.
  • Doğan N, Ertürk C, Gülabi D. Is proximal femoral nailing of unstable intertrochanteric fractures in the lateral decubitus position without a traction table as safe and effective as on a traction table? Injury. 2022;53:555-60.
  • Sonmez MM, Camur S, Erturer E, Ugurlar M, Kara A, Ozturk I. Strategies for proximal femoral nailing of unstable intertrochanteric fractures: lateral decubitus position or traction table. J Am Acad Orthop Surg. 2017;25:e37-e44.
  • de Souza EF, Hungria JOS, Rezende LRS, Bellan DG, Borracini JA. Comparative study between lateral decubitus and traction table for treatment of pertrochanteric fractures with cephalomedullary nails. Rev Bras Ortop. 2017;52:24-8.
  • Xue L, Zha L, Chen Q, Liang Y-j, Li K-r, Zhou Z et al. Randomized controlled trials of proximal femoral nail antirotation in lateral decubitus and supine position on treatment of intertrochanteric fractures. ScientificWorldJournal. 2013; 276015.
  • Mao W, Ni H, Li L, He Y, Chen X, Tang H et al. Comparison of Baumgaertner and Chang reduction quality criteria for the assessment of trochanteric fractures. Bone Joint Res. 2019;8:502-8.
  • Turgut A, Kalenderer Ö, Günaydin B, Önvural B, Karapinar L, Ağuş H. İntertrokanterik femur kırıklarının proksimal femoral çivi antirotasyon (PFNA) ile lateral dekübit pozisyonda tespiti. Acta Orthop Traumatol Turc. 2014;48:513-20.
  • Liu W, Zhou D, Liu F, Weaver MJ, Vrahas MS. Mechanical complications of intertrochanteric hip fractures treated with trochanteric femoral nails. J Trauma Acute Care Surg.2013;75:304-10.
  • Hwang J-H, Oh J-K, Oh C-W, Lee S-J, Myung-Rae C, Kim H et al. A biomechanical evaluation of proximal femoral nail antirotation with respect to helical blade position in femoral head: A cadaveric study. Indian J Orthop. 2012;46:627-32.
  • Kane P, Vopat B, Heard W, Thakur N, Paller D, Koruprolu S et al. Is tip apex distance as important as we think? A biomechanical study examining optimal lag screw placement. Clin Orthop Relat Res. 2014;472:2492-8.
  • Li S, Chang S-M, Jin Y-M, Zhang Y-Q, Niu W-X, Du S-C et al. A mathematical simulation of the tip-apex distance and the calcar-referenced tip-apex distance for intertrochanteric fractures reduced with lag screws. Injury. 2016;47:1302-8.
There are 16 citations in total.

Details

Primary Language English
Subjects Orthopaedics
Journal Section Research
Authors

Ahmet Yurteri 0000-0001-5242-0275

Numan Mercan 0000-0002-0581-7023

Mehmet Kılıç 0000-0001-7013-7879

Ahmet Yıldırım 0000-0002-3953-091X

Publication Date December 29, 2023
Acceptance Date November 24, 2023
Published in Issue Year 2023 Volume: 48 Issue: 4

Cite

MLA Yurteri, Ahmet et al. “Comparison of the Effects of Lateral Decubitus Position and Traction Table on Intramedullary Nailing in Trochanteric Femur Fractures”. Cukurova Medical Journal, vol. 48, no. 4, 2023, pp. 1275-81, doi:10.17826/cumj.1352439.