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Objective@#To evaluate the fixation with proximal femoral nail antirotation-Ⅱ (PFNAⅡ) for femoral intertrochanteric fractures involving the lateral wall.@*Methods@#A retrospective study was conducted of the 491 patients with femoral intertrochanteric fracture who had been treated from January 2013 to December 2017 at Department of Hip Surgery, Orthopedic Hospital, Affiliated Hospital to Panzhihua University. Of them, the lateral wall was involved in 104 (group A), 43 males and 61 females with an age of 72.3±2.1 years; their later wall fractures were classified as type Ⅰ (simple lateral wall fracture) in 45 cases, as type Ⅱ (fragmental lateral wall fracture) in 23 cases and as type Ⅲ (combined fracture of lateral wall and subtrochanter) in 36 cases. In the other 387 cases (group B), the lateral wall was not involved. They were 186 males and 201 females with an age of 74.7±1.5 years. The 2 groups were compared in terms of incision length, operating time, intraoperative blood loss, fracture healing time, postoperative weight-bearing time, Harris scores at the last follow-up and complications.@*Results@#There were no significant differences between the 2 groups of patients in their preoperative general data, indicating they were compatible(P>0.05). All the 491 patients obtained an average follow-up of 25.5 months (from 12 to 50 months). The fracture healing time in group A (27.2±12.1 weeks) was significantly longer than in group B (13.1±2.2 weeks) and the rate of delayed union in the former (16.4%, 17/104) was significantly higher than that in the latter (2.3%, 9/387) (both P<0.05). There were no significant differences between the 2 groups in incision length (7.1±1.2 cm versus 6.5±2.2 cm), operating time (60.8±1.2 min versus 56.5±1.5 min), intraoperative blood loss (96.2±2.1 mL versus 92.1±2.4 mL), postoperative weight-baring time (2.5±2.1 d versus 2.1±2.9 d), the Harris scores at the last follow-up (83.3±2.3 versus 85.1±3.4) or incidence of other complications [5.8% (6/104) versus 4.7%(18/387)] (all P>0.05).@*Conclusion@#Femoral intertrochanteric fractures involving the lateral wall can be effectively treated by PFNA Ⅱ fixation, but they usually take longer time to get united than those without lateral wall fracture.
ABSTRACT
Objective To evaluate the fixation with proximal femoral nail antirotation-Ⅱ (PFNA Ⅱ) for femoral intertrochanteric fractures involving the lateral wall.Methods A retrospective study was conducted of the 491 patients with femoral intertrochanteric fracture who had been treated from January 2013 to December 2017 at Department of Hip Surgery,Orthopedic Hospital,Affiliated Hospital to Panzhihua University.Of them,the lateral wall was involved in 104 (group A),43 males and 61 females with an age of 72.3 ± 2.1 years;their later wall fractures were classified as type Ⅰ (simple lateral wall fracture) in 45 cases,as type Ⅱ (fragmental lateral wall fracture) in 23 cases and as type Ⅲ (combined fracture of lateral wall and subtrochanter) in 36 cases.In the other 387 cases (group B),the lateral wall was not involved.They were 186 males and 201 females with an age of 74.7 ± 1.5 years.The 2 groups were compared in terms of incision length,operating time,intraoperative blood loss,fracture healing time,postoperative weight-bearing time,Harris scores at the last follow-up and complications.Results There were no significant differences between the 2 groups of patients in their preoperative general data,indicating they were compatible(P ＞ 0.05).All the 491 patients obtained an average follow-up of 25.5 months (from 12 to 50 months).The fracture healing time in group A (27.2 ± 12.1 weeks) was significantly longer than in group B (13.1 ±2.2 weeks)and the rate of delayed union in the former (16.4％,17/104) was significantly higher than that in the latter (2.3％,9/387) (both P ＜ 0.05).There were no significant differences between the 2 groups in incision length (7.1 ± 1.2 cm versus 6.5 ±2.2 cm),operating time (60.8 ± 1.2 min versus 56.5 ± 1.5 min),intraoperative blood loss (96.2 ± 2.1 mL versus 92.1 ± 2.4 mL),postoperative weight-baring time (2.5 ± 2.1 d versus 2.1 ± 2.9 d),the Harris scores at the last follow-up (83.3 ± 2.3 versus 85.1 ± 3.4) or incidence of other complications [5.8％ (6/104) versus 4.7％ (18/387)] (all P ＞ 0.05).Conclusion Femoral intertrochanteric fractures involving the lateral wall can be effectively treated by PFNA Ⅱ fixation,but they usually take longer time to get united than those without lateral wall fracture.
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Objective To investigate the clinical outcomes of proximal femoral nail antirotation (PFNA) Ⅱ in the treatment of femoral intertrochanteric fractures.Methods From January 2011 to June 2016,240 patients with intertrochanteric fracture were treated at our department.They were 132 males and 108 females,aged from 30 to 106 years (average,71.4 years).Of them,168 cases were older than 70 years.According to AO classification,21 patients were of type 31-A1.1,15 of type 31-A1.2,27 of type 31-A1.3,39 of type 3 1-A2.1,51 of type 3 1-A2.2,32 of type 3 1-A2.3,12 of type 3 1-A3.1,23 of type 3 1-A3.2 and 20 of type 31-A3.3.The time from injury to surgery in this series ranged from 38 to 140 hours,averaging 52 hours.All the patients were treated by fixation with PFNA Ⅱ.Results The average operating time was 45 min,average operation incision 5 cm,and average blood loss during operation 85 mL.Primary wound healing was achieved in 239 patients,and one patient developed postoperative incision infection which was cured after implants were taken out and debridement was carried out 8 weeks after operation.This group obtained an average follow-up of 31.5 months (from 6 to 51 months).Primary fracture healing was achieved in 235 patients after 6 to 23 weeks (average,12.6 weeks);fracture healing was delayed in 5 patients after 36 to 96 weeks (average,56 weeks).There was no in-hospital mortality,and the survival rate 6 months after operation was 98.8％ (237/240).One year after operation,132 patients obtained an average Harris hip score of 85.2 (from 72 to 94).No implant-related complications or implant failure happened.Conclusions Internal fixation with PFNA Ⅱ is an effective treatment for different types of femoral intertrochanteric fractures,because it is simple and less invasive,and leads to limited complications,especially for senile patients.
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Objective To investigate the efficacy of external fixators in the treatment of unstable pelvic fractures( Tile B and Tile C ). Methods The different results of 78 patients who had been treated with or without external fixator were compared. Results In 38 cases who were treated without external fixator, the cure rate for hemorrhagic shock was 76%, the mortality 10.6%, and the average ISS score 11.6. In 40 cases who were treated with external fixator, the cure rate for hemorrhagic shock was 90%, the mortality 2.5%, and the average ISS score 9.8. Conclusion The treatment of unstable pelvic fracture with external fixator is simple and reliable, and can reduce the mortality significantly.
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The latest literature concerning operative treatment for distal radius fracture was reviewed to find out the newest developments in this field.This paper summarizes bilateral internal fixation with combined palmar and dorsal incisions,dorsal open reduction and plate internal fixation,internal fixation with LCP(locking compression plate),dorsal Pi-plate internal fixation combined with external fixators,and arthroscopic treatment of distal radius fractures,for they are reported to have reached excellent or good results.The reports show that each subtype of distal radius fractures merits a unique approach,because distinct fracture patterns result from different mechanisms of injury.