Elsevier

Injury

Volume 42, Issue 2, February 2011, Pages 204-208
Injury

Comparison of soft-tissue serum markers in stable intertrochanteric fracture: Dynamic hip screw versus proximal femoral nail—A preliminary study

https://doi.org/10.1016/j.injury.2010.09.008Get rights and content

Abstract

Design

Prospective randomised comparative study.

Objectives

To analyse and compare serum soft-tissue marker differences after dynamic hip screw (DHS) and proximal femoral nail (PFN) fixation of stable intertrochanteric fractures in the elderly.

Materials and methods

Twenty elderly patients (>60 years old) with a stable intertrochanteric fracture were enrolled in this study. Patients were divided into two groups of 10 each according to the device used (DHS or PFN). All 20 patients had a stable intertrochanteric fracture, and all were operated on by the same surgeon using minimal invasive approach. A biochemical comparison of soft-tissue serum markers was performed. The serum markers examined were haemoglobin (Hb), haematocrit (Hct), creatine kinase (CK), myoglobin (MYO), troponin I and C-reactive protein (CRP), and their levels were determined before surgery, and 1, 8, 16, 24, 36, 48 and 72 h after surgery. Differences between the DHS and PFN groups were compared.

Results

No inter-group differences were observed with respect to preoperative demographics, operation time, incision length or blood loss. In terms of serum markers, both methods showed similar patterns of change for CK, MYO and CRP pre- to post-operatively. In addition, pre- and post-operative Hb and Hct levels were similar. Furthermore, no inter-group differences were observed between the absolute values of serum markers at any point.

Conclusion

The absolute values and temporal changes of serum markers were similar in the two study groups. These findings suggest that DHS and PFN fixation of stable intertrochanteric fractures produce similar levels of soft-tissue damage.

Introduction

Intertrochanteric fractures are commonly encountered in osteoporotic elderly patients, and recent developments in orthopaedic surgery indicate that intertrochanteric fractures can be treated successfully using advanced implants. Dynamic hip screws (DHSs) and proximal femoral nails (PFNs) are commonly used to treat intertrochanteric fractures and both produce good results.4, 5, 28, 32 Nevertheless, surgeons are commonly concerned about the decision to adopt the DHS or PFN option. If good fracture healing and reduction can be obtained using both devices under similar surgical indications, then, the determining factors could well be surgeon's convenience or habit.

Minimally invasive surgery has been reported recently to produce good results for the treatment of intertrochanteric fractures.9, 22, 30 A minimal incision approach has been used for PFN devices for some time, but the introduction of a less-invasive DHS device and a minimal invasive approach for DHS has redressed the balance.22 Soft tissue is also an important factor because intertrochanteric fractures often occur in the elderly, in whom tissue healing is as important as the fracture. Accordingly, soft-tissue preservation is an important determinant of device selection. However, no comparative study has been conducted on soft-tissue damage after intertrochanteric fractures have been treated with these two devices. We considered that a comparison of the soft-tissue invasivenesses of these two devices would provide useful information to surgeons considering which device to use. Accordingly, the aim of this study was to determine the soft-tissue invasiveness of the two devices after surgery for stable intertrochanteric fractures in the elderly.

Section snippets

Study design and patients

Twenty patients operated on between May 2009 and October 2009 by a single surgeon (JHY) were enrolled in this consecutive, prospective, randomised study. The inclusion criteria were an intertrochanteric fracture in a patient over 60 years old with no concurrent fracture or injury, an AO classification A1 or A2 fracture, surgery within 2 weeks of trauma and no prior disease that could have possibly affected serum markers. The exclusion criteria were a pathologic fracture, multi-trauma or open

Results

No differences were observed between the DHS and PFN groups with respect to preoperative demographic data, and the two groups were similar in terms of intra-operative results, including surgery time, incision length and blood loss (p > 0.05) (Table 1). No malunion or nonunion was encountered in either group, and no implant-related complications were evident at final follow-up (minimum 6 months after surgery).

In terms of serum marker levels, the two groups showed similar temporal patterns.

Discussion

Intertrochanteric fractures of the femur are common in elderly patients, and rigid fixation with early mobilisation should be considered the standard treatment. Many implants and surgical techniques have been proposed, and of these, two main alternatives are available.6, 7, 11, 13, 20, 29 The first type of implant consists of a sliding neck screw or bolt connected to a plate in the lateral femoral cortex, and the second is a sliding neck screw that stabilises the head–neck fragment using an

Conclusion

Our analysis of serum markers revealed that absolute levels and temporal changes were similar in the DHS and PFN groups. Furthermore, our findings indicate that when used to treat stable intertrochanteric fractures in the elderly, DHS and PFN performed by the same surgeon using a common approach produce similar levels of soft-tissue damage. Accordingly, our findings suggest that DHS and PFN be viewed as good alternatives for the treatment of stable intertrochanteric fractures.

Conflict of interest statement

No benefits of funds were received in support of the study. Further, the authors declare that they have no vested interest that could be construed to have inappropriately influenced this study.

Acknowledgements

The authors thank Ms. Mun-Hee Lee and Ms. Mi-Nyeo Yoon for their assistance during the data collection.

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