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LETTER TO EDITOR  
Year : 2014  |  Volume : 48  |  Issue : 3  |  Page : 343
A biomechanical evaluation of proximal femoral nail antirotation with respect to helical blade position in femoral head: A cadaveric study


1 Department of Orthopaedics and Traumatology, Izmir Katip «elebi University Ataturk Research and Training Hospital, Turkey
2 Department of Orthopaedics and Traumatology, Izmir Katip «elebi University, School of Medicine, Turkey

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Date of Web Publication14-May-2014
 

How to cite this article:
Akcay S, Satoglu IS. A biomechanical evaluation of proximal femoral nail antirotation with respect to helical blade position in femoral head: A cadaveric study. Indian J Orthop 2014;48:343

How to cite this URL:
Akcay S, Satoglu IS. A biomechanical evaluation of proximal femoral nail antirotation with respect to helical blade position in femoral head: A cadaveric study. Indian J Orthop [serial online] 2014 [cited 2019 Oct 19];48:343. Available from: http://www.ijoonline.com/text.asp?2014/48/3/343/132537
Sir,

We read with interest the study entitled "A biomechanical evaluation of proximal femoral nail antirotation with respect to helical blade position in femoral head: A cadaveric study" [1] and believe that the results of the study provide substantial contribution to the literature. However, the proximal femoral nail antirotation (PFNA) II implant used in this cadaveric study has a version designed for the Asian population which has two different angular options (125° and 130°) for the helical blade which is different from the regular PFNA II which has three (125°, 130°, 135°) options.The authors did not specify which version and angle was used in their study. [2] The mean collodiaphyseal angle was reported as 133° in the study. In this instance, if PFNA II was fixed at 125°, the tip - apex distance (TAD) for center - center or center - inferior should be measured higher than normal. We believe that angle helical blade of PFNA fixed should be determined depending on the radiological measurement of the collodiaphyseal angle of the samples for standardization of the results.

As stated in the study, the TAD index is not the only prognostic factor for implant failure, but also quality of the fracture reduction, varus angle, and quality of the bone are important parameters. [3],[4],[5] Osteoporosis is known to increase the risk for hip fractures, so we believe that osteoporotic study models for hip fractures will give more accurate results.

Z and reverse Z effects are reported in the literature especially for osteoporotic femur intertrochanteric fractures with classical double lag screw proximal femoral nails. [5] How does the mineral density difference between femoral head and Ward's triangle affect the fixation stability against axial and rotational forces for helical blade systems are the questions yet to be answered. We believe that this cadaveric study would yield more accurate results if performed in bone models with different osteoporosis levels of the femoral head and neck and if ideal position of the helical blade in the femoral head is also evaluated.

 
   References Top

1.Hwang J, Oh J, Oh C, Lee S, 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.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.PFNA. Proximal Femoral Nail Antirotation. Technique Guide. Synthes. p. 55-6.  Back to cited text no. 2
    
3.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;77:1058-64.  Back to cited text no. 3
    
4.Barrios C, Broström LA, Stark A, Walheim G. Healing complications after internal fixation of trochanteric hip fractures: The prognostic value of osteoporosis. J Orthop Trauma 1993;7:438-42.  Back to cited text no. 4
    
5.Akan K, Cift H, Ozkan K, Eceviz E, Tasyikan L, Eren A. Effect of osteoporosis on clinical outcomes in intertrochanteric hip fractures treated with a proximal femoral nail. J Int Med Res 2011;39:857-65.  Back to cited text no. 5
    

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Correspondence Address:
Serkan Akcay
Department of Orthopaedics and Traumatology, Izmir Katip «elebi University Ataturk Research and Training Hospital, Basinsitesi, Karabaglar/Izmir, 35360
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5413.132537

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