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| LETTER TO EDITOR |
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| Year : 2023 | Volume
: 43
| Issue : 4 | Page : 196 |
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Surgical and nonsurgical treatments for proximal femur fractures: A narrative review
Wei-Chin Chen1, Zhi-Hong Zheng2
1 Department of Orthopedic Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
2 Department of Orthopedic Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei; Department of Orthopedic Surgery, Hualien Armed Forces General Hospital, Hualien, Taiwan
| Date of Submission | 17-Jan-2023 |
| Date of Decision | 23-Feb-2023 |
| Date of Acceptance | 14-Mar-2023 |
| Date of Web Publication | 26-Apr-2023 |
Correspondence Address:
Dr. Zhi-Hong Zheng
Department of Orthopedic Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Chenggong Rd., Neihu Dist., Taipei 114, Taiwan. Department of Orthopedic Surgery, Hualien Armed Forces General Hospital, No. 163, Jiali Rd., Xincheng Township, Hualien 971
Taiwan
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jmedsci.jmedsci_22_23
How to cite this article:
Chen WC, Zheng ZH. Surgical and nonsurgical treatments for proximal femur fractures: A narrative review. J Med Sci 2023;43:196 |
Dear Editor,
We read the article “Surgical and nonsurgical treatments for proximal femur fractures: A narrative review” by Frydoni and Esmaeilnejad-Ganji,[1] with a lot of interest. We commend the authors' efforts. We wrote this letter to present some updated references with higher levels of evidence.
| For Femoral Neck Fractures | |  |
To our knowledge, a study which published in the Lancet has provided a prospective randomized evidence. According to the study, there were no differences in revision surgery rates within 24 months between dynamic hip screws (DHS) and multiple cancellous screws (MCS); MCS had higher revision surgery rates for implant removal, and DHS had higher rates of conversion to total hip arthroplasty and osteonecrosis.[2]
Femoral neck system (FNS), MCS, and DHS are effective for femoral neck fractures. Xu et al.[3] revealed FNS shortened the operation time by decreasing the intraoperative fluoroscopy times. FNS has the advantages of being a simple operation, with early weight bearing which compared with MCS. Compared to DHS, the main advantage of FNS is minimal invasive surgery.
| For Intertrochanteric Fractures | | |
For standard obliquity fracture patterns with posteromedial comminution, a randomized, controlled trial comparing DHS and cephalomedullary nails revealed no differences in functional outcomes. Less femoral neck shortening with cephalomedullary nails group, at 12 months after operation.[4]
Failure rates remain low with either treatment (DHS and cephalomedullary nails), and later conversion to hip joint arthroplasty does not appear to favor one implant over the other. The study results had no difference between these implants including surgical time, hospital length of stay, Trendelenburg gait, complication rates, or 5-year survivorship of the joint arthroplasty.[5]
Data availability statement
Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Frydoni MB, Esmaeilnejad-Ganji SM. Surgical and nonsurgical treatments for proximal femur fractures: A narrative review. J Med Sci 2021;41:53-7.  [Full text] |
| 2. | Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) Investigators. Fracture fixation in the operative management of hip fractures (FAITH): An international, multicentre, randomised controlled trial. Lancet 2017;389:1519-27. |
| 3. | Xu X, Fan J, Zhou F, Lv Y, Tian Y, Ji H, et al. Comparison of femoral neck system to multiple cancellous screws and dynamic hip screws in the treatment of femoral neck fractures. Injury 2022;S0020-1383(22)00231-5. doi:10.1016/j.injury.2022.03.041. [Published online ahead of print, 2022 Mar 25]. |
| 4. | Reindl R, Harvey EJ, Berry GK, Rahme E, Canadian Orthopaedic Trauma Society (COTS). Intramedullary versus extramedullary fixation for unstable intertrochanteric fractures: A prospective randomized controlled trial. J Bone Joint Surg Am 2015;97:1905-12. |
| 5. | Yuan BJ, Abdel MP, Cross WW, Berry DJ. Hip arthroplasty after surgical treatment of intertrochanteric hip fractures. J Arthroplasty 2017;32:3438-44. |
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