ABSTRACT
Objective To explore the surgical methods and evaluate the postoperative outcomes after cerclage cables and long cephalomedullary nails fixation with minimally invasive technique for the treatment of subtrochanteric femoral fractures.Methods From January 2013 to February 2016,21 patients with subtrochanteric femoral fractures surgically treated were retrospectively analyzed.There were 14 males and 7 females with an average age of 43.5 years old (ranged from 24 to 71 years old).11 patients suffered by traffic accidents,8 patients fell down from heights and 2 patients injured by collapses of heavy objectives.Subtrochanteric fractures were classified by Seinsheimer classification with 2 cases of type] B,5 cases of type Ⅱ C,7 cases of Ⅲ A,2 cases of Ⅲ B,1 case of Ⅳ and 4 cases of Ⅴ.CT scans of bilateral femurs were performed to measure the length,canal diameter and anterior ache before the operation.All the fractures were treated by cerclage cables and long cephalomedullary nails with minimal invasive technique.7 cases were fixed by one cable and 14 cases by two or more cables.Results All the patients were followed up with an average of 22.5 months (ranged from 12 to 36 months).The healing time of 20 patients was 3-6 months,with an average time of 4.1 months,except 1 was union by re-operation and the healing time was 13 months after initial operation.According to Harris function evaluation,the average score was 85.4 (ranged from 68 to 97).The clinical outcomes were rated with excellent in 13 cases,good in 6 cases,fair in 1 case and poor in 1 case.The excellent and good rate was 90.5％.Complications included 1 case of screw cut-out and 1 case of nonunion.Conclusion For the treatment of subtrochanteric fractures with spiral,oblique pattern or a big butterfly fragment,satisfactory outcome could be achieved by fixation of cerclage cables and long cephalomedullary nails.The key to healing is to protect the blood supply of the fracture fragments with minimally invasive technique.
ABSTRACT
Objective To investigate the clinical effects of high restrictive anti-dislocation prosthesis total hip arthroplasty(THA)in treating elderly femoral neck fracture patients with hemiplegia.Methods From June 2015 to January 2017,Fortythree elderly femoral neck fracture patients with hemiplegia were treated with CombiCup THA system.There were 15 males and 28 females with an average age of 71.5±5.6 years (60-84 years).The left side was involved in 20 cases,while the right side in 23 cases.There were 15 cases with Garden Ⅲ type and 28 cases with type Ⅳ.Lower limb muscle strength grade were 20 cases in grade 3,19 cases in grade 4,and 5 cases in grade 5.Sixteen cases walked independently before injury,while 27 of them walked with the aid of crutches.The duration between injuries to operation ranged from 2 days to 5 days.The size of the prosthesis and offset distance were recorded by template technique pre-operation.The appropriate type of prosthesis was selected to restore the offset and to reconstruct the abductor muscle arm,according to the actual measurement in the operation and the preoperative plan.Based on the bone mineral density and medullary cavity morphology,biological or cemented femoral stem prosthesis was selected.The quality of the implant and the length of both lower limbs were evaluated by pelvic X-ray immediately after operation.The patients were followed-up at 2 weeks,1 months,2 months,3 months,6 months,1 and 2 years.Functional exercise guidance and complications were recorded at the follow-up duration.At the last follow-up,the hip function and limb function were evaluated according to the Harris score and Fugl-Meyer motor function assessment respectively.Results Based on pelvic X-ray evaluation after operation,all prosthesis position were favorable with the average angle of acetabular abduction 45.1±2.3 degrees and the length difference of both limbs less than 5 mm (average 2.2±0.8 mm).The follow-up duration ranged from 6 to 24 months with an average of 11.2±3.5 months.There was no complication such as prosthesis dislocation and infection.Deep venous thrombosis in calf occurred in 3 patients at 2 days after operation,who underwent recanalization after thrombolysis.At the last follow-up,the average score of Harris hip function and Fugl-Meyer were 90.2±3.8 (77 to 96) and 97.1±2.5 (83 to 100),respectively.No dislocation,infection,loosening,subsidence and osteolysis phenomenon was found during the follow-up.Conclusion The elderly patients with Garden type Ⅲ or Ⅳ femoral neck fractures accompanied with hemiplegia can be treated with anti-dislocation prosthesis THA.It does have the advantages of low dislocation rate and imoroved hemiolegic limb function.