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@#Non-union is a challenging complication following a femoral neck fracture. Inability to achieve anatomical reduction and compression over the fracture leads to non-union. We reported a 10-case series of femoral neck non-union treated with sliding compression screw and anti-rotational screw with or without gluteus medius local trochanteric flap. When compression could not be achieved and a gap was present over the non-union site, a gluteus medius trochanteric flap was used to enhance the union. Surgeries were performed as a single-stage procedure through the Watson Jones approach. The initial implants were removed, followed by fracture reduction, during which the varus deformity was corrected, and the neck length was preserved as much as possible. Patients were advised for strict non-weight bearing until the presence of trabecular bone crossing the fracture on the radiographs. Union was achieved at three months in all cases. Patients undergoing surgery without trochanteric flap had normal abduction strength, and the neck length was maintained. All cases had no significant loss of function. Patients with trochanteric myo-osseous flap had neck shortening with weak abductors with MRC grade 4. Two out of 10 cases developed avascular necrosis of the femoral head before intervention. One case progressed to collapse of the femoral head requiring implant removal. This and the femoral neck shortening, caused this patient to have weak abductors and a positive Trendelenburg gait. We observed that delayed surgery leads to neck shortening and fracture gap requiring trochanteric myo-osseous flap to achieve union.
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Objective: To investigate the effectiveness of percutaneous compression plate (PCCP) fixation for femoral neck fracture. Methods: A clinical data of 100 patients with femoral neck fractures who were treated with internal fixation were analyzed retrospectively. The fractures were fixed with the cannulated screws (CS) in 55 patients (CS group) and with the PCCP in 45 patients (PCCP group). There was no significant difference in gender, age, the cause of injury, the fracture type, complications, and disease duration between the two groups ( P>0.05). The quality of fracture reduction, bone resorption, screw slipping, femoral neck shortening, complications (nonunion, failure of fixation, and osteonecrosis of femoral head), and functional recovery of hip (Harris score) were compared between the two groups. Results: All incisions healed by first intention. All patients were followed up 24-56 months, with an average of 30.7 months. The quality of fracture reduction was excellent in 26 cases, good in 18 cases, fair in 9 cases, and poor in 2 cases in CS group and excellent in 21 cases, good in 17 cases, fair in 4 cases, and poor in 3 cases in PCCP group, showing no significant difference between the two groups ( Z=-0.283， P=0.773). The incidence of nonunion in PCCP group was significantly lower than that in CS group ( P=0.046), and the fracture healing time in PCCP group was shorter than that in CS group ( t=2.155, P=0.034). There was no significant difference in the incidences of bone resorption, screw slipping, femoral neck shortening, failure of fixation, and osteonecrosis of femoral head between the two groups ( P>0.05). The overall complication rates were 27.27% (15/55) in CS group and 8.89% (4/45) in PCCP group, showing significant difference ( χ2=5.435, P=0.020). The Harris score in PCCP group at 6 months after operation was significantly higher than that in CS group ( t=-2.073, P=0.041). However, there was no significant difference in the Harris score at 12, 18, and 24 months after operation between the two groups ( P>0.05). Conclusion: Stable sliding compression of PCCP is benefit for the femoral neck fracture healing, especially shortening union.
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Objective To observe the clinical efficacy of sliding compression technique with proximal femoral nail antirotation (PFNA) for the treatment of intertrochanteric fractures in the elderly patients.Methods A retrospective study was conducted in the 97 elderly patients with intertrochanteric fracture who had received PFNA internal fixation at Department of Orthopaedics,The Second Fuzhou Hospital Affiliated to Xiamen University from January 2010 to December 2017.They were divided into 2 groups depending on whether the sliding compression technique was used or not in the PFNA fixation.In the sliding compression group of 51 patients,there were 31 males and 20 females with an age of 79.9 ± 6.2 years,and 2 cases of type Ⅰ,8 cases of type Ⅱ,21 cases of type Ⅲ,16 cases of type Ⅳ,3 cases of type Ⅴ and one case of type Ⅵ according to the modified Evans classification.In the conventional PENA group of 46 cases,there were 27 males and 19 females with an age of 77.5 ± 8.0 years,and 3 cases of type Ⅰ,6 cases of type Ⅱ,15 cases of type Ⅲ,18 cases of type Ⅳ and 4 cases of type Ⅴ according to the modified Evans classification.The 2 groups were compared in terms of the separation of fracture ends at immediate postoperation and 4 weeks postoperation,anesthesia time,operative time,intraoperative bleeding,fracture reduction,fracture healing time,Harris scores of hip function at one year postoperation and postoperative complications.Results There were no significant differences between the 2 group of patients in their preoperative general data,indicating they were compatible (P ＞ 0.05).The sliding compression group had significantly shorter separation of fracture ends at immediate postoperation and at 4 weeks postoperation (2.18 ± 0.59 mm and 0.92 ± 0.27 mm) and significantly shorter fracture healing time (5.2 ± 0.9 weeks) than the conventional PENA group (3.91 ± 0.76 mm and 2.15 ± 0.52 mm;6.5 ±0.9 weeks) (P ＜ 0.05).There were no significant differences between the 2 groups in anesthesia time,operative time,intraoperative bleeding,fracture reduction or Harris scores of hip function at one year postoperation (P ＞ 0.05).The sliding compression group had significantly lower incidences in pulmonary infection [9.8％ (5/51)],blade loosening or cutout [0 (0/51)] and incision complications [0 (0/51)] than the conventional PENA group [26.1％ (12/46),17.4％ (8/46) and 19.6％ (9/46),respectively] (P ＜ 0.05).Conclusions In the treatment of intertrochanteric fractures in the elderly people,sliding compression technique with PFNA may lead to fewer postoperative complications and faster fracture healing.
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Objective@#To observe the clinical efficacy of sliding compression technique with proximal femoral nail antirotation (PFNA) for the treatment of intertrochanteric fractures in the elderly patients.@*Methods@#A retrospective study was conducted in the 97 elderly patients with intertrochanteric fracture who had received PFNA internal fixation at Department of Orthopaedics, The Second Fuzhou Hospital Affiliated to Xiamen University from January 2010 to December 2017. They were divided into 2 groups depending on whether the sliding compression technique was used or not in the PFNA fixation. In the sliding compression group of 51 patients, there were 31 males and 20 females with an age of 79.9±6.2 years, and 2 cases of type Ⅰ, 8 cases of type Ⅱ, 21 cases of type Ⅲ, 16 cases of type Ⅳ, 3 cases of type Ⅴ and one case of type Ⅵ according to the modified Evans classification. In the conventional PENA group of 46 cases, there were 27 males and 19 females with an age of 77.5±8.0 years, and 3 cases of type Ⅰ, 6 cases of type Ⅱ, 15 cases of type Ⅲ, 18 cases of type Ⅳ and 4 cases of type Ⅴ according to the modified Evans classification. The 2 groups were compared in terms of the separation of fracture ends at immediate postoperation and 4 weeks postoperation, anesthesia time, operative time, intraoperative bleeding, fracture reduction, fracture healing time, Harris scores of hip function at one year postoperation and postoperative complications.@*Results@#There were no significant differences between the 2 group of patients in their preoperative general data, indicating they were compatible (P>0.05). The sliding compression group had significantly shorter separation of fracture ends at immediate postoperation and at 4 weeks postoperation (2.18±0.59 mm and 0.92±0.27 mm) and significantly shorter fracture healing time (5.2±0.9 weeks) than the conventional PENA group (3.91±0.76 mm and 2.15±0.52 mm; 6.5±0.9 weeks) (P<0.05). There were no significant differences between the 2 groups in anesthesia time, operative time, intraoperative bleeding, fracture reduction or Harris scores of hip function at one year postoperation (P>0.05). The sliding compression group had significantly lower incidences in pulmonary infection [9.8% (5/51)], blade loosening or cutout [0 (0/51)] and incision complications [0 (0/51)] than the conventional PENA group [26.1% (12/46), 17.4% (8/46) and 19.6% (9/46), respectively] (P<0.05).@*Conclusions@#In the treatment of intertrochanteric fractures in the elderly people, sliding compression technique with PFNA may lead to fewer postoperative complications and faster fracture healing.
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Due to the instability of intertrochanteric fractures in elderly patients, various methods of reduction and fixation were introduced to obtain stable reduction and solid union, But there have been many controversies regarding advantages between anatomical reduction group and non-anatomical reduction group. The authors analyzed the 68 unstable intertrochanteric fractures out of total 94 cases of intertrochanteric fractures treated from Jan. 1988 to Jan. 1994 with mean follow-up 17 months and evaluated the radiologic and clinical results between those two groups. The results were obtained as follows: 1. The most common cause was low energy injury and according to the Tronzo classification, the type III was most common in 54 cases (79.4%). 2. The average union time was 14.0wks (84%), the union rate was low in the medialized reduction group(A-P) and anterior displaced reduction group(A-P), anterior displaced and anatomical reduction groups(Lateral). 3. The compression length more than 10mm of lag screw was deep in medialized reduction group(A-P), another displaced and anatomical reduction groups(Lateral). 4. The average length of lag screw sliding was 9.2mm and depth sliding of 6.8mm (74%) was occurred within immediate postoperative 1 month.
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Aged , Humans , Classification , Femur , Follow-Up Studies , Hip Fractures , HipABSTRACT
Commonly used internal devices to fix the stable and unstable intertrochanteric fractures are fixed nail plate (Jewett nail, Holt nail), sliding nail plate (compression hip screw) and intramedullary device (Ender, Harris nail). The choice of internal device is influenced by the general coditions of patients, the pattern of fracture and the personal preference of surgeon. There are many reports that sliding nail plate appears to give better result than fixed nail plate because the latter device leads to high failure rate. Twenty nine unstable intertrochanteric fractures treated with Jewett nail plate (group I) and sliding compression hip screw (group II) between 1981 and 1988 were reviewed after minimal twelve months follow up. Group I comprised of fourteen cases, Group II, of fifteen. There were seventeen males and twelve females. The ages ranged from thirty-two to seventy-eight years, the average age being 57.8 years. Eighteen cases were caused by slip down; eight, traffic accident; and three, fall down. The average operation time was 124 minutes in group I and 148 minutes in group II. The average amout of blood loss was 1024cc in group I and 1040cc in group II. The average time to union was 13 weeks in group I and 12.9 weeks in group II. In Jewett nail plate fixed group, there were three complication; one coxa vara, and superior migration of nail, and one subcapital fracture and one superficial wound infection. In sliding compression hip screw group, one was complicated with coxa vara. Above results suggest that the use of Jewett nail plate in unstable intertrochanteric fracture could be got good results with method using compression hip screw.