ABSTRACT
BACKGROUND:Intertrochanteric fracture is one of the common fracture, and accompanied by osteoporosis and high energy injury. The fracture line often descended, and induced A3 intertrochanteric fracture. This type of fracture is difficult to treat. Common intramedulary fixation includes proximal femoral nail anti-rotation and InterTan, which have high stability, are minimaly invasive, and have been extensively used. OBJECTIVE: To compare the biomechanical stability of A3 intertrochanteric fracture fixed with proximal femoral nail anti-rotation and InterTan by finite element analysis. METHODS:Three three-dimensional finite element models of the AO3.1, AO3.2 and AO3.3 intertrochanteric fracture fixed with proximal femoral nail anti-rotation and InterTan were established. Fixation was completed according to the requirement of Department of Orthopedics. Stress distribution of femur and fixator of different models was observed. Stress peak at different areas was compared in femur and fixation models. Biomechanical stability was analyzed. RESULTS AND CONCLUSION: The maximum pressure concentration area in AO3.1 intertrochanteric fracture with proximal femoral nail anti-rotation was located in the lateral proximal femur, and with Intertan was located in the medial proximal femur. The AO3.2 had little differences between two types of nails. The AO3.3 intertrochanteric fracture with proximal femoral nail anti-rotation was located in the medial proximal femur and the medial distal implant. There was no significant pressure concentration with InterTan. The von Mises pressure of six models was concentrated in the medial distal implant, and higher maximum von Mises pressure was found in the proximal femoral nail anti-rotation. There was significant difference of von Mises distribution between the lateral and medial implant with proximal femoral nail anti-rotation. Except the AO3.3 intertrochanteric fracture with proximal femoral nail anti-rotation, the maximum pressures of remaining models were located in the main nail and interlocking nail infal. These results concluded that the fracture fixed with InterTan exhibited fine fixation stability in the AO3.1 and AO3.3 intertrochanteric fracture. There was no significant difference of fixation stability between proximal femoral nail anti-rotation and InterTan in AO3.2. The von Mises distribution of InterTan for intertrochanteric fracture is more reasonable.
ABSTRACT
BACKGROUND:There was a variety of surgery treatment method in senile patients with unstable intertrochanteric fractures, such as hip replacement and internal fixation, but there was a great deal of controversy about advantages and disadvantages of different methods. OBJECTIVE:To evaluate clinical effect and safety of total hip replacement, hemiarthroplasty and proximal femoral nail in senile patients with unstable intertrochanteric fractures. METHODS:103 senile patients with unstable intertrochanteric fractures were selected, including 43 males and 60 females at the age of 62 to 80 years old. There were 28 cases of total hip replacement, 34 cases of hemiarthroplasty and 41 cases of proximal femoral nail. Perioperative complications and recovery of hip function after repair were compared among three groups. RESULTS AND CONCLUSION:(1) The incidence of postoperative complications of internal medicine was higher in the proximal femoral nail group than in the total hip replacement and hemiarthroplasty groups (P < 0.05). No significant difference in the incidence of complications was found between the hemiarthroplasty and total hip replacement groups. (2) The incidence of prosthesis complications was lower in the total hip replacement group than in the hemiarthroplasty and proximal femoral nail groups (P < 0.05). No significant difference in the incidence of prosthesis complications was detectable between the total hip replacement and hemiarthroplasty groups. (3) The recovery of hip function was better in the total hip replacement and hemiarthroplasty groups than in the proximal femoral nail group during 12-month folow-up (P < 0.05), and no significant difference in the recovery of hip function was found between the total hip replacement and hemiarthroplasty groups. These results showed that total hip replacement and hemiarthroplasty had good curative effect on unstable intertrochanteric fractures in senile patients, and could effectively restore the hip function and reduce complications.
ABSTRACT
BACKGROUND:Proximal femoral nail anti-rotation has good biomechanical basis, and has obvious advantages for intertrochanteric fracture in aged patients, but there are some problems in the clinic, because of improper handling of material matching and operation details, which can impact therapeutic effects and functional recovery. OBJECTIVE:To analyze the efficacy and issues of proximal femoral nail anti-rotation in the treatment of intertrochanteric fracture in patients at more than 60 years old. METHODS:From July 2011 to July 2012, proximal femoral nail anti-rotation was used to treat 56 cases of intertrochanteric fractures. Clinical data bank was established to analyze intraopeative problems and postoperative complications. At 1, 3, 6, 9 and 12 months postoperatively, outpatient and telephone folow-up were carried out to evaluate therapeutic effects and functional recovery of hip joint. RESULTS AND CONCLUSION:Four patients died within 1 year. Seven patients lost within a year for other reasons. The remaining 45 patients were folowed with the time from 12 to 24 months, with an average time of 18.2 months. Harris score was (85.00±6.75) points. There were excelent in 26 cases, good in 15 cases, average in 3 cases and poor in 1 case, with an excelent and good rate of 91%. 18 cases were not satisfied with the position of fracture fragments. In 9 cases, proximal femur was not match with the proximal femoral nail anti-rotation. Seven cases were not satisfied because of the location and length of the spiral blade. Seven cases affected lateral cortex fracture. One case experienced postoperative pulmonary embolism. One case suffered from cardiovascular and cerebrovascular diseases. Nine cases suffered from local sweling. 13 cases experienced hip pain. Five cases affected the healing of fracture extended. Results showed that proximal femoral nail anti-rotation for intertrochanteric fracture in aged patients obtained good outcomes, but we should improve the separation of fracture fragments and reduce intraoperative and postoperative complications.
ABSTRACT
BACKGROUND:The limitation of the traditional intramedulary nailing relies on the personal experience of the doctor. Moreover, the enlargement of the bone marrow causes the destruction of the biological environment of the marrow cavity and affects the healing of bone. OBJECTIVE:To observe therapeutic effect of digital technology assisted intramedulary nail fixation for femoral shaft fracture. METHODS:A total of 80 patients with femoral shaft fracture, who were treated in the Department of Orthopedics, Affiliated Hospital of Putian University from January 2010 to January 2014, were enroled. Digital technology was used to assist treatment. Three-dimensional digital model of femoral shaft fracture was established before treatment. Virtual reduction was conducted in the three-dimensional digital fractures. The diameter of medulary cavity was measured. Appropriate specification of intramedulary nailing was selected according to the measurement data. Closed reduction and intramedulary nailing were performed according to operation scheme of digital technology. RESULTS AND CONCLUSION:The 80 patients were folowed up for 12 to 24 months. Fractures were completely healed. At 12 months after treatment, they were evaluated by clinical curative effect standard in department of orthopedics. There were excelent in 62 cases, good in 15 cases, and good in 3 cases, with the excelent and good rate of 96%. No complications occurred such as infection, fixator breakage or loosening. These results verify that digital technology assisted intramedulary nail fixation for femoral shaft fracture obtained positive therapeutic effects, could obviously shorten operation time, reduce surgical trauma, and diminish intraoperative X-ray emission to patients and health care workers.
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BACKGROUND:The classification and treatment of subtrochanteric fracture experienced a long process of development. Surgical treatment was currently used popularly, including extramedulary and intramedulary fixation. It should be selected according to the type of fracture and clinical practice, and it is inconclusive in the clinic. OBJECTIVE:To summarize the study and present application of intramedulary and extramedulary fixation in the subtrochanteric fracture in recent years. METHODS:The first author researched two books, and retrieved PubMed, Wanfang Database, and Chinese Journal Ful-text Database for articles about clinical trials on fixation for subtrochanteric fractures, and the safety and efficacy of fixation for subtrochanteric fractures published until March 2014. A total of 42 clinical studies on type, intramedulary and extramedulary fixations were selected. RESULTS AND CONCLUSION:With the progress of fixation methods of subtrochanteric fracture, there was a great progress in improving the rate of fracture healing and reducing hip malunion, and limited mobility. Whether extramedulary fixation, intramedulary fixation or arthroplasty, clinical reports have achieved satisfactory results at present. The intramedulary fixation was stil dominated among various therapeutic methods. However, the type of fracture, age and osteoporosis fractures were different in patients. There was no uniform standard of the specific choice of surgical approach, which stil should be further studied. Authors believed that when fracture line was below the lesser trochanter, interlocking intramedulary nail could be used. High subtrochanteric fracture could utilize proximal femoral nail anti-rotation. However, if the medulary cavity was narrow, the fracture was involved in the greater trochanter or piriformis fossa area, locking proximal femoral plate or less invasive stabilization system could be employed. No matter intramedulary or extramedulary fixation, minimal invasion and biological fixation were the present trend of development. The new minimaly invasive techniques and internal fixation are stil the goal. Although intramedulary fixation has advantages, but cannot completely replace the current extramedulary fixation. It is important to have a perfect surgery plan, standardized surgical approach and long-term postoperative folow-up, in order to achieve better clinical outcomes.
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Objective:To summarize the 10 year clinical experience of treating tibiafibular fractures with rectangle shaped intramedullary nails(RIN). Methods:From January 1987 to December 1996, 4 682 cases (3 278 male and 1 404 female) of tibiafibular fractures from 9 hospitals were treated with RIN . Three kinds of reduction methods including open reduction, semi open reduction and closed reduction were used during operation. Results:Results showed 2 173 cases (62.89%) got excellent result, 947 got good (27.40%), 214 got moderate (6.19%), 121 got poor (3.50%). The total healing rate was 90.29%. Conclusion:RIN has excellent biological characteristics which can provide a flexible interfixation when treating tibiafibular fractures, and the operation is simple, it also can be used for severe open fractures. RIN is one of the good techniques in treating tibiafibular fractures.