Prospective randomised comparative study.
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.
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.
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.
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- Prospective randomized controlled trial of an intramedullary nail versus dynamic screw and plate for intertrochanteric fractures of the femur.J Orthop Trauma. 2001; 15: 394-400
- Minimally invasive dynamic hip screw: prospective randomized trial of two techniques of insertion of a standard dynamic fixation device.J Orthop Trauma. 2004; 18: 207-212
- Implant-related complications in the treatment of unstable intertrochanteric fractures: meta-analysis of dynamic screw-plate versus dynamic screw-intramedullary nail devices.Int Orthop. 2003; 27: 197-203
- The treatment of unstable, extracapsular hip fractures with the AO/ASIF proximal femoral nail (PFN)—our first 60 cases.Injury. 2002; 33: 401-405
- The proximal femoral nail (PFN)—a minimal invasive treatment of unstable proximal femoral fractures: a prospective study of 55 patients with a follow-up of 15 months.Acta Orthop Scand. 2003; 74: 53-58
- Results of intertrochanteric femur fractures treated with a 135-degree sliding screw with a two-hole side plate.J Orthop Trauma. 1999; 13: 5-8
- Percutaneous compression plating (PCCP) versus the dynamic hip screw for pertrochanteric hip fractures: preliminary results.Injury. 2002; 33: 413-418
- The relationship between skeletal muscle serum markers and primary THA: a pilot study.Clin Orthop Relat Res. 2009; 467: 1747-1752
- Mini-invasive nail versus DHS to fix pertrochanteric fractures: a case–control study.Rev Chir Orthop Traumatol. 2009; 95: 592-598
- Evaluation of “new” cardiac markers for ruling out myocardial infarction after coronary artery bypass grafting.Chest. 2002; 122: 1316-1321
- Percutaneous compression plating of intertrochanteric hip fractures.J Orthop Trauma. 2000; 14: 490-495
- Creatine kinase MB in skeletal muscle and serum of spine-fusion patients.Clin Orthop Relat Res. 1985; 195: 282-288
- Percutaneous intramedullary fixation of trochanteric fractures of the femur clinical trial of a new hip nail.Injury. 2000; 31: 483-487
- Unstable trochanteric fractures. A comparative analysis of four methods of internal fixation.Acta Orthop Scand. 1980; 51: 949-962
- Are short femoral nails superior to the sliding hip screw? A meta-analysis of 24 studies involving 3,279 fractures.Int Orthop. 2006; 30: 69-78
- Preventive measures of back muscle injury after posterior lumbar spine surgery in rats.Spine (Phila Pa 1976). 1998; 23 (discussion 8): 2282-2287
- Comparison of the effect of 3 different approaches to the lumbar spinal canal on postoperative paraspinal muscle damage.Surg Neurol. 2008; 69 (discussion 13): 109-113
- The quantitative analysis of tissue injury markers after mini-open lumbar fusion.Spine (Phila Pa 1976). 2006; 31: 712-716
- Serum myoglobin and creatine kinase following surgery.Br J Anaesth. 2000; 84: 763-766
- Dynamic hip screw in the treatment of intertrochanteric fractures: a comparison of two fixation methods.Int Orthop. 2007; 31: 683-688
- Increase in creatine kinase MB isoenzyme levels after spinal surgery.J Spinal Disord. 1994; 7: 70-76
- Conventional muscle-reflection approach versus mini-incision muscle-splitting approach in dynamic hip screw fixation.J Orthop Surg (Hong Kong). 2008; 16: 156-161
- The prognostic significance of serial myoglobin, troponin I, and creatine kinase-MB measurements in patients evaluated in the emergency department for acute coronary syndrome.Ann Emerg Med. 2003; 42: 343-350
- Increases in serum concentrations of cardiac proteins and the prediction of early postoperative cardiovascular complications in noncardiac surgery patients.Anaesthesia. 2000; 55: 641-647
- C-reactive protein as a parameter of surgical trauma: CRP response after different types of surgery in 349 hip fractures.Acta Orthop. 2006; 77: 788-790
- Fixation of intertrochanteric hip fractures: gamma nail versus dynamic hip screw. A randomized, prospective study.Can J Surg. 1995; 38: 516-520
- A biomechanical evaluation of the gamma nail.J Bone Joint Surg Br. 1992; 74: 352-357
- Treatment of reverse oblique and transverse intertrochanteric fractures with use of an intramedullary nail or a 95 degrees screw-plate: a prospective, randomized study.J Bone Joint Surg Am. 2002; 84-A: 372-381
- The treatment of transtrochanteric fractures of the femur with a minimally invasive technique using an extramedullary implant MINUS System.Int Orthop. 2008; 32: 159-165
- Minimally invasive technique versus conventional technique of dynamic hip screws for intertrochanteric femoral fractures.Arch Orthop Trauma Surg. 2009; 130: 613-620
- Factors predictive of acute renal failure in rhabdomyolysis.Arch Intern Med. 1988; 148: 1553-1557
- Dynamic hip screw in the management of reverse obliquity intertrochanteric neck of femur fractures.Injury. 2005; 36: 105-109
Accepted: September 6, 2010
Received in revised form: August 27, 2010
Received: April 26, 2010
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