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BACKGROUND:Stable intertrochanteric fractures can be treated by closed reduction and internal fixation,but there is no absolute advantage for unstable intertrochanteric fractures with osteoporosis. OBJECTIVE:To investigate the efficacy of arthroplasty in the treatment of unstable intertrochanteric fractures in the elderly with osteoporosis by comparing the indexes related to closed reduction internal fixation and arthroplasty. METHODS:Clinical data of 102 elderly patients with unstable intertrochanteric fractures of the femur treated in Affiliated Hospital of Qingdao University from January 2017 to January 2020 were retrospectively analyzed.Patients were divided into two groups according to the surgical method.In the Gamma3 group,62 cases received Gamma3 internal fixation system.In the joint replacement group,40 cases received an artificial femoral head replacement or total hip replacement.Surgical information,hospitalization,hip function,and postoperative complications were compared between the two groups. RESULTS AND CONCLUSION:(1)There were statistical differences between the Gamma3 group and the joint replacement group in weight-bearing time(P＜0.001),hospital stay(P＜0.05),intraoperative bleeding(P＜0.001),and length of surgery(P＜0.001).The mean weight-bearing time and hospital stay were shorter in the joint replacement group than in the Gamma3 group.Intraoperative bleeding and duration of surgery were better in the Gamma3 group than in the joint replacement group.(2)There was no significant difference in Harris hip score,subitem centesimal hip score,and postoperative complications 12 months after surgery in both groups(P=0.526,0.788,0.228).(3)It is indicated that arthroplasty has achieved better outcomes in the treatment of elderly unstable intertrochanteric fractures combined with osteoporosis,enabling early weight bearing and functional exercise.Careful selection of the appropriate patient and prosthesis type for arthroplasty will result in greater patient benefit.
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Objective: To explore the difference of the proximal femoral shortening (PFS) between the third generation of Gamma nail (TGN) and the proximal femoral nail anti-rotation (PFNA) in treating intertrochanteric fracture of femur.
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Objective: To confirm the association between tail femur distance (TFD) and lag screw migration or cutting-out in the treatment of intertrochanteric fracture with the third generation of Gamma nail (TGN).
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In unstable femoral trochanteric fracture, we usually used transversing K-wires through the lesser trochanter to achieve an anatomical reduction, and using sliding hip screws. However, in patients with comminuted lesser trochanter or osteoporosis, an intrusion of the wire into the lesser trochanter and/or iatrogenic intertrochanteric fractures were often resulted. Those who were not familiar with a technique of puncturing two holes through the lesser trochanter might have had to face some difficulties. In order to overcome aforementioned drawbacks, the authors had quite satisfactory results by employing the method of passing each of two wires above and below the iliopsoas muscle, and they were twisted posteriorly and then anteriorly; and finally they were pulled together posteriorly. Through this technique, both firm fixation of the lesser trochanter and more stable bony union were obtained.
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Humans , Femur , Hip , Hip Fractures , OsteoporosisABSTRACT
Objective To evaluate the clinical effectiveness of minimally invasive external fixation in the treatment of intertrochanteric fractures of the femur in high-risk patients. Methods By using a monolateral external fixator with oblique pin-insertion, we treated 77 consecutive elderly patients (mean age, 71.3) with intertrochanteric fractures of the femur associated with at least one kind of severe systemic diseases from June 1996 to June 2004. Fractures included 70 cases of anterograde intertrochanteric fracture (According to the Evans classification, there were 5 cases of type Ⅰ fracture, 11 cases of type Ⅱ, 34 type ⅢA, 9 type ⅢB, and 11 type Ⅳ.) and 7 cases of retrograde intertrochanteric fracture. A total of 8 patients were combined with multiple injuries. Results A follow-up was made for 5~60 months (mean, 24.3 months). Complete bone union was achieved in all the patients within a period of 8~20 weeks (mean, 12 weeks). Postoperatively, no non-union or coxa vara occurred. According to the Harris hip scores, 49 patients were classified as “excellent” results, 21 as “good”, and 7 as “poor” (all of which were fatal cases), the “excellent-and-good” rate being 91%. Conclusions Minimally invasive external fixation is an alternative to open internal fixation in the management of intertrochanteric fractures in high-risk elderly patients, especially suitable to those with multiple injuries.