ABSTRACT
Objective: To compare the effectiveness of proximal femoral nail anti-rotation (PFNA) combined with minimally invasive percutaneous plate osteosynthesis (MIPPO) and Intertan intramedullary nail fixation by closed reduction in the treatment of AO/Orthopaedic Trauma Association (AO/OTA) type 31-A3.3 intertrochanteric fracture with incomplete lateral wall. Methods: The clinical data of 54 patients with AO/OTA type 31-A3.3 intertrochanteric fracture who met the selection criteria and were admitted between January 2012 and January 2018 were retrospectively analyzed. According to different surgical methods, the patients were divided into group A (24 cases with lateral wall reconstruction by MIPPO combined with PFNA internal fixation) and group B (30 cases with Intertan intramedullary nail fixation by closed reduction only). There was no significant difference between the two groups ( P>0.05) in terms of gender, age, side of injury, cause of injury, and combined medical diseases. The operation time, intraoperative blood loss, time to weight-bearing, fracture healing time, and postoperative complications were recorded and compared between the two groups. The tip apex distance (TAD) was measured at 2 days, 2 months, and 1 year after operation. At 12 months after operation, the hip joint function was evaluated according to Harris scoring standard, and the rate of conformity (Harris score were more than 70) was calculated. Results: The wounds of the two groups healed by first intention, without infection, skin deformity, and other incision complications. The operation time and intraoperative blood loss of group A were significantly more than those of group B, and the time to weight-bearing and fracture healing were significantly shorter than those of group B ( P0.05). There was 1 case of infection, 1 case of screw withdrawal, 2 cases of screw removal, and 1 case of bone nonunion in group B, the incidence of complications was 16.7%; there was only 1 case of screw withdrawal combined with screw blade withdrawal in group A, the incidence of complications was 4.2%; there was no significant difference between the two groups ( χ2=2.109, P=0.146). At 12 months after operation, the Harris scores of pain, function, malunion, range of motion, and total score in group A were significantly better than those in group B ( P<0.05). The rate of conformity of group A was 95.83% (23/24) and 76.67% (23/30) in group B, and the difference between the two groups was significant ( χ2=3.881, P=0.049). Conclusion: For the AO/OTA type 31-A3.3 intertrochanteric fracture with incomplete lateral wall, compared with the closed reduction Intertan intramedullary nail fixation, the incidence of internal fixation failure after MIPPO reconstruction with lateral wall combined with PFNA fixation was lower, the time to weight-bearing was earlier, and the postoperative function was better.
ABSTRACT
Objective To evaluate the clinical effect of InterTAN (IT) and dynamic hip screw (DHS) in treatment of femoral intertrochanteric fractures.Methods From July 2008 to November 2011,the patients with femoral intertrochanteric fractures were treated by IT (IT group,21 patients) and DHS (DHS group,35 patients).The intraoperative data (operative time,intraoperative blood loss,incision length and hospitalization period),postoperative complications (wound infection,lower limb deep venous thrombosis,bedsore,urinary tract infection and pneumonia) and fracture healing (fracture healing time,femoral neck crispation,coxa vara and Harris scores) were compared.Results IT group was superior to DHS group in operative time,intraoperative blood loss,incision length and hospitalization period [(62.16 ± 15.26) min vs.(85.78 ± 19.50) min,(237.73 ± 108.51) ml vs.(490.87 ± 127.90) ml,(10.20 ±2.02) cm vs.(19.83 ± 2.98) cm and (10.23 ±5.52) d vs.(15.58 ±5.32) d,P ＜0.01].However,there was no significant difference in postoperative complications (P ＞ 0.05).There was significant difference between IT group and DHS group in femoral neck crispation,coxa vara [9.52％ (2/21)vs.28.57％ (10/35),14.29％ (3/21)vs.31.43％ (11/35),P ＜ 0.01].There was no significant difference in fracture healing time and Harris scores (P ＞ 0.05).Conclusions Compared with DHS,IT has extensive application,shorter surgical time and reliable fixation effect.Therefore,IT is suitable to femoral intertrochanteric fractures.