Key result
Surgery in the supine position without a traction table significantly reduced mean operative time compared to using a traction table (88.23 vs 95.18 minutes, p=0.001), with similar radiologic and clinical outcomes.
Why the study?
To compare clinical and radiologic results and reveal intraoperative advantages and disadvantages of two different patient positions used during PFNA for intertrochanteric femur fractures.
Does supine position without a traction table reduce operative time compared to a traction table in patients undergoing surgical treatment of unstable intertrochanteric fractures with PFNA?
Cohort (n=123)
No
Does supine position without a traction table reduce operative time compared to a traction table in patients undergoing surgical treatment of unstable intertrochanteric fractures with PFNA?
Absolute Event Rate: 88.23% vs 95.18%
p-value: p=0.001
Performing PFNA for intertrochanteric fractures in the supine position without a traction table significantly reduces operative time without compromising reduction quality or clinical outcomes compared to using a traction table.
Similar outcomes with shorter operative time support manual traction as alternative; leaves open optimal positioning without prospective trials.
Aim: Intertrochanteric femur fractures (IFF) are a major cause of morbidity and mortality in the elderly population. Proximal femoral nail-anti-rotation (PFNA) is one of the most preferred surgical treatment methods. This study aimed to compare the clinical and radiologic results of two different patient positions used during PFNA and to reveal the intraoperative advantages and disadvantages. Material and Method: Cases operated due to IFF between January 2020 and December 2022 were retrospectively analyzed. The study was conducted with 123 patients meeting the inclusion criteria. The minimum follow-up period was determined as one year. Two groups were formed: those operated on the traction table (opereted-TT) and those operated in supine lithotomy without traction table (operated-SP). The groups were compared regarding operative time, reduction quality, type-apex distance (calTAD), and radiologic and clinical results. Results: There were 76 patients in the operated-TT group and 47 in the operated-SP group. The mean age of the operated-TT group was 81.00±8.52 years, and the mean age of the operated-SP group was 79.30±8.12 years. (p=0.213) Gender, follow-up time, time from trauma to surgery, and fracture classification were similar for the groups. The mean operative time was 95.18±8.54 minutes in the operated-TT group and 88.23±7.12 minutes in the operated-SP group, and the operation was completed in a shorter time in the operated-SP group. (p=0.001) There were no differences between the groups in terms of reduction quality, calTAD, Harris Hip Score, VAS score, infection rates, and cut-out rates. Conclusion: Based on this study, the radiologic and clinical results of the cases operated with manual traction in the supine position and those operated using a traction table in treating IFF with PFNA are similar. In addition, it was concluded that shorter operation time was an advantage of the operated-SP group.
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AVCİ et al. (2023) conducted a cohort in Unstable intertrochanteric femur fractures (n=123). Supine lithotomy position without traction table vs. Traction table was evaluated on Operative time (minutes) (p=0.001). Surgery in the supine position without a traction table significantly reduced mean operative time compared to using a traction table (88.23 vs 95.18 minutes, p=0.001), with similar radiologic and clinical outcomes.
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