Comparative study of femoral head replacement and internal fixation in the treatment of unstable intertrochanteric fractures in the elderly / 中国骨伤

OBJECTIVE@#To compare the clinical efficacy of femoral head replacement and internal fixation in the treatment of unstable intertrochanteric fractures in the elderly.@*METHODS@#Retrospective analysis of 70 cases of unstable intertrochanteric fractures treated from January 2016 to January 2019 and meeting the inclusion and exclusion criteria, 39 cases were fixed with closed reduction and new proximal femoral intramedullary nail(InterTAN), and 31 cases were treated with open trochanter reconstruction and artificial femoral head replacement. The operation time, intraoperative bleeding, hospital stay, weight bearing time, postoperative complication rate and hip function recovery (Harris score) were compared between two groups.@*RESULTS@#All cases were followed up for 12 to 24 months. There were no significant differences in intraoperative bleeding and hospital stay between the two groups (@*CONCLUSION@#InterTAN and femoral head replacement can treat unstable intertrochanteric fractures in the elderly, but femoral head replacement can move down early, improve the quality of life at the end of life, reduce postoperative complications and facilitate the treatment of coexisting diseases in internal medicine.

Analysis of the related factors of fever of unknown causes before operation of intertrochanteric fracture in the elderly / 中国骨伤

OBJECTIVE@#To explore the related factors of fever of unknown causes before operation of intertrochanteric fracture of femur in the elderly.@*METHODS@#From August 2015 to August 2018, 156 cases of intertrochanteric fracture of femur were treated by intramedullary nail fixation. According to the preoperative measurement, whether there was fever was divided into fever group and non fever group. There were 80 cases in fever group, 26 males and 54 females, aged 60 to 93 (75.063±13.082) years; 76 cases in non fever group, 39 males and 37 females, aged 60 to 96 (74.763±13.692) years. All patients' sex, age, basic diseases, WBC, NE%, Hb, CRP, D dimer and ALB were observed for single factor analysisand multi factor analysis.@*RESULTS@#Single factor analysis showed that gender, Hb, CRP had influence on preoperative fever, but other indexes had no influence; multi factor analysis showed that gender and CRP might have influence on fever. The probability of fever increased by 1.2%(=0.050) for every increase of CRP, and there was no significant difference between female and male in the probability of fever (=0.061).@*CONCLUSION@#CRP is an independent risk factor of preoperative fever in the elderly patients with intertrochanteric fracture of femur. The abnormality of CRP indicates that patients are more likely to have preoperative fever. Perioperative management should pay attention to the monitoring of CRP and early intervention.

Treatment of intertrochanteric fracture of femur with closed reduction of proximal femoral anti rotation intramedullary nail in supine position / 中国骨伤

OBJECTIVE@#To investigate the effect and feasibility of closed reduction and internal fixation with PFNA in the treatment of intertrochanteric fracture of femur in the supine position without traction bed.@*METHODS@#From June 2014 to March 2018, 45 patients with intertrochanteric fracture of femur who were treated and followed up were analyzed retrospectively. There were 21 males and 24 females, with an average age of 67.4 years (43 to 92 years);18 cases on the left side and 27 on the right side. According to Evans Jensen classification, there were 7 patients of type Ⅱ, 17 patients of type Ⅲ, 16 patients of type Ⅳ and 5 patients of type Ⅴ. The time from injury to operationwas 2 to 6 days. The operation time, blood loss and fracture healing, closing time, postoperative complications and Harris score of hip joint were recorded.@*RESULTS@#The operation time of 45 patients was 35 to 80 min, with an average of 52.6 min;the intraoperative bleeding volume was 40 to 110 ml, with an average of 68.7 ml;the hospitalization time was 6 to 11 days, with an average of 8.4 days;the follow up time was 12 to 18 months, with an average of 14.7 months;the internal fixation of 2 patients failed, and 43 patients achieved bony healing;the deep vein thrombosis of the lower extremity in the perioperative period was 1 case, and the inferior vena cava filter was inserted;the internal fixation of 2 patients was cut out, and the hip was renovated. The incidence of complications was 8.9%(4 / 45). At the final follow up, Harris score of hip joint was 56 to 95 (81.30±8.40), including excellent 15 cases, good 26 cases, fair 2 cases and poor 2 cases.@*CONCLUSION@#It is safe and feasible to treat intertrochanteric fracture of femur with closed reduction and anti rotation intramedullary nailing under the bed without traction in a supine position. It has the advantages of small trauma and low complications, and the clinical effect is satisfactory. It is worth popularizing and using in basic hospitals.

Application of warm liquid in proximal femoral nail antirotation(PFNA) internal fixation / 中国骨伤

OBJECTIVE@#To investigate the effect and application of warm fluid in patients with proximal femoral nail antirotation(PFNA) internal fixation.@*METHODS@#From November 2012 to December 2016, 80 patients with femoral intertrochanteric fracture were treated with PFNA internal fixation, including 35 males and 45 females, aged from 62 to 90 years old. The patients were divided into two groups. In the control group 40 patients were infused and rinsed at the normal temperature liquid(22 to 24 °C) during the operation; in the experimental group 40 patients were infused and rinsed at warm liquid(36.5 to 37.5 °C). The amount of bleeding, the temperature, the occurrence of shiver and the C-reaction protein in the two groups were analyzed.@*RESULTS@#The incidence of hypothermia and shiver in the experimental group was significantly lower than that in the control group(<0.05). The amount of intraoperative bleeding and C-reaction protein were significantly decreased(<0.05).@*CONCLUSIONS@#The application of warm liquid infusion and flushing in PFNA internal fixation can effectively reduce the incidence of hypothermia and shiver, reduce the amount of bleeding in the operation and the infection rate of the surgical site, improve the comfort of the patients, and ensure the safety of the patients.

Influence of femoral neck area on larger anteversion angle of lag screw guide pin initial placement in proximal femoral intramedullary nail fixation / 中国骨伤

OBJECTIVE@#To invstigate the influence of femoral neck area on larger anteversion angle of lag screw guide pin initial placement in proximal femoral intertrochanteric fracture treated with intramedullary nail.@*METHODS@#From June 2014 to June 2016, 60 patients with femoral intertrochanteric fractures were treated with intramedullary nail, including 27 males and 33 females with an average age of 75 years old ranging from 49 to 88 years old. The lateral images of femoral neck were divided into areas during operation. The anteversion angle of lag screw guide pin of proximal femoral nail was observed at the time of initial insertion. The incidence of normal and larger was counted and the angle index of influencing factors was recorded.@*RESULTS@#Among 60 patients, the screw guide pins of 23 cases were in the central region of the femoral neck and the anteversion angle was normal;screw guide pins of 37 cases were in the front area of the femoral neck, leading to larger anteversion angle. The single factor analysis showed that the independent variables influence factors of larger anteversion were internal collection of the affected limb, internal rotation of the affected limb, hip elevation and screw guide pin level(<0.05). The multi-factor regression analysis showed that the anteversion angle larger was significantly related to the internal rotation of the affected limb and screw guide pin level, and the screw guide pin level was the most relevant(=0.030).@*CONCLUSIONS@#The internal rotation of the affected limb and screw guide pin level may affect the anteversion angle of femoral neck when lag screw guide pin initial insertion, cause it to be too large and the screw guide pin level is the main influencing factor.

Finite element analysis of InterTan for the treatment of femoral intertrochanteric fractures / 中国骨伤

OBJECTIVE@#To study the biomechanical characteristics of InterTan for the treatment of femoral intertrochanteric fracture of Evans-Jensen IV.@*METHODS@#Scanning the femur and internal plant of volunteers with spiral CT to obtain DICOM format data. Three-dimensional models of left femur and InterTan were reconstructed by Mimics software. On this basis, a three-dimensional finite element model of internal fixation for Evans-Jensen IV intertrochanteric fracture of femur was established. The stress and microstrain distribution of Von Mses in different models were studied. The biomechanical stability after internal fixation of the Evans Jensen IV femoral intertrochanteric fracture was analyzed.@*RESULTS@#The stress pattern of the femur of InterTan model was the same as that of the normal femur, which was mainly located on the medial side of the proximal femur and the lower third of the femur. However, the stress of femur in InterTan model was lower than that in the same part of normal femur. The peak stress of the femur in the model was 13.92 MPa, located at the end of the inner plant in contact with the femur. The stress peak of the plant in the model was 146.5 MPa at the lower contact point between the tension nail and the main nail.@*CONCLUSIONS@#InterTan fixation has obvious biomechanical advantages and is not easy to cause stress fractures in the middle femur in patients with osteopenic Evans-Jensen IV intertrochanteric fractures. In particular, for patients with greater activity in the intertrochanteric fracture of the Evans-Jensen IV femur, InterTan fixation has better stability and provides a theoretical basis for the choice of internal fixation.

Biomechanical Study of Three Fixation Systems for Complex Unstable Femoral Intertrochanteric Fractures / 医用生物力学

Objective To compare the effectiveness and mechanical differences in the dynamic hip screw (DHS), proximal femoral nail antirotation (PFNA), and proximal femoral internal fixator (PFI) for fixing complex unstable proximal intertrochanteric fractures by biomechanical testing. Methods Eighteen Synbones of the proximal femur were made to simulate complex unstable femoral intertrochanteric fracture models (Evans-Jensen TypeⅢ), which were fixed by DHS, PFNA, and PFI, respectively. The models were tested using a biomechanical testing machine, in order to compare their differences and advantages for fixing fractures. Results Under the compressive loads of 300, 600, and 1 200 N, the fracture displacement of the DHS was the maximum, with a significant difference compared with PFNA and PFI (P0.05). Under torsional loads of 300, 600, and 1 200 N, the torsional displacements of DHS and PFNA at the fracture ends were the maximum, with no significant difference (P>0.05). There were significant differences between PFI and PFNA as well as PFI and DHS (P<0.05). Conclusions For complex unstable proximal intertrochanteric fractures, the stability of the compression resistance of the PFI system is similar to that of the PFNA system. However, the torsional resistance of PFI is stronger than that of PFNA. The DHS system shows the least resistance with respect to compression and torsion.

Clinical observation of proximal femoral anti-rotation nail for the treatment of femoral intertrochanteric fracture / 中国骨伤

<p><b>OBJECTIVE</b>To explore the curative effect and the recessive loss of blooding of PFNA for the treatment of intertrochanteric fractures of femur.</p><p><b>METHODS</b>From January 2012 to January 2015, a total of 49 patients with intertrochanteric fractures of femur were treated with proximal femoral anti-rotation nail including 41 males and 8 females with an average age of 79 years old ranging from 65 to 91 years old. According to the modified Evans type, 1 case was type I, 12 cases were type II, 36 cases were type III. All cases were fresh fractures. Patients had hip pain, movement limited, joint swelling, bruising, extorsion deformity, X-ray and CT examination showed completely fractures. All patients were treated by closed reduction and PFNA internal fixation. Three comminuted fractures using closed reduction were not satisfied, then were treated by limited PFNA fixation after open reduction.</p><p><b>RESULTS</b>The patients' incision got the grade A healing, no complications such as infection and internal fixation failure happened. All patients were followed up from 6 to 36 months (means 22 months). The pain VAS score decreased from preoperative 7.70±1.97 to 1.00±0.26 at 6 months after operation(<0.01). Harris hip score improved from preoperative 8.70±4.19 to 91.70±5.31 at 6 months after operation(<0.01). The outcome at 6 months after operation was excellent in 34 cases, good in 7, poor in 1. The fracture healing time was from 8 to 16 weeks with an average of 12 weeks after operation. One patient with osteoporosis, crushing broken, poor compliance, associated with schizophrenia at the same time, appeared with the displacement of the femoral greater trochanter, with conservative treatment for healing.</p><p><b>CONCLUSIONS</b>Intertrochanteric fractures of femur are common in the elderly trauma, in pain relief, recovery of hip function, to provide quality of life for the patients, PFNA achieved satisfactory effect, but its existence is worth to pay close attention to the recessive loss of blood.</p>

Meta-analysis of the efficacy and safety of PFNA and InterTAN for the treatment of intertrochanteric fractures / 中国骨伤

<p><b>OBJECTIVE</b>To system evaluate the clinical effect and safety of PFNA and InterTAN internal fixation methods for femoral intertrochanteric fracture.</p><p><b>METHODS</b>According to the Cochrane systemic analysis method, randomized controlled trials and quasi-randomized controlled trials which were about the comparison of PFNA and InterTAN for intertrochanteric fracture were collected from Cochrane Library(2017, issue 4), PubMed (January, 2003-May, 2017), Wanfang Med Online (January, 2003-May, 2017) and China Academic Journals Full-text Database(January, 2003-May, 2017) by computer searching. Cross-checking was done after assessing the quality of the included trials and extracting the data by two reviewers independently. Data analysis were performed with RevMan 5.3.</p><p><b>RESULTS</b>Two randomized controlled trials and five quasi-randomized controlled trials involving 611 cases met the inclusion criteria. The meta-analyses showed no significant differences between the two methods on Harris scores[MD=-1.00, 95%CI(-2.29, 0.28),=0.13], union time[MD=0.04, 95%CI (-0.70, 0.77),=0.92], full weight-bearing time[MD=1.06, 95%CI(-0.29, 2.42),=0.13], hospital stay[MD=-0.04, 95%CI (-0.52, 0.45),=0.89] and length of incision[MD=-1.00, 95%CI (-2.64, 0.65),=0.23]. There were significant differences between the two methods on operative time[MD=-25.75, 95%CI (-37.47, -14.03),<0.000 1], intraoperative blood loss[MD=-55.67, 95%CI(-108.07, -3.27),=0.04] and the internal fixation complication rate[MD=4.17, 95%CI (1.33, 13.08),=0.01].</p><p><b>CONCLUSIONS</b>Both PFNA and InterTAN could provide good effect for intertrochanteric fracture. The operation time of PFNA is shorter than that of InterTAN, and there is less blood loss during operation. PFNA may be the first choice for the treatment of patients who have many complications and can't endure long-time operation. The complications of PFNA are more than those of InterTAN. In patients with long life expectancy and high requirements, InterTAN may be preferentially selected to reduce complications. According to the patient's situation, after a comprehensive consideration, appropriate treatment can be selected.</p>

Biomechanical study of the lateral wall of the femur in the treatment of femoral intertrochanteric fracture with intramedullary or extramedullary fixation / 中国骨伤

<p><b>OBJECTIVE</b>To observe the biomechanical effects of the lateral wall of the femur in treating femoral intertrochanteric fractures with intramedullary or extramedullary fixation to guide the choice of clinical fixed methods.</p><p><b>METHODS</b>Twelve adults femur specimens of intertrochanteric fractures were belong to the type A1 of the AO fracture classification and randomly divided into the lateral wall complete PFNA group, the lateral wall complete PF-LCP group, the lateral wall breakage PFNA group, lateral wall breakage PF-LCP group, every group had 3 specimens. The four groups of specimens were subjected to compressive loading experiment with Universal Material Testing Machine. The maximum loading force was observed. The distance between fracture ends, the distance of fracture dislocation and the sliding distance of the fracture fragments along the intertrochanteric were measured with Calipers.</p><p><b>RESULTS</b>The maximum loading force of lateral wall complete PFNA group were larger than that of lateral wall complete PF-LCP group, and the maximum loading force of lateral wall breakage PFNA group were larger than that of lateral wall breakage PF-LCP group, there were significant differences (<0.05). The distance between fracture ends of the four groups before compression were not significant differences(>0.05). The distance between fracture ends, the distance of fracture dislocation and the sliding distance of the fracture fragments were not significant differences between lateral wall complete PFNA group and lateral wall complete PF-LCP group after compression (>0.05). But the distance between fracture ends, the distance of fracture dislocation and the sliding distance of the fracture fragments of lateral wall breakage PFNA group were less than that of lateral wall breakage PF-LCP group(<0.05).</p><p><b>CONCLUSIONS</b>Intramedullary fixation of intertrochanteric fractures have stronger loading force. Both intramedullary and extramedullary fixation of intertrochanteric fractures have strong stability when the lateral wall of the femur is complete, but intramedullary fixation of intertrochanteric fractures is stronger stability than extramedullary fixation when the lateral wall of the femur is broken. So the intramedullary fixation is the first choice for the treatment of intertrochanteric fracture.</p>

Clinical outcomes of total hip arthroplasty using Wagner SL revision stem in femoral intertrochanteric fractures for patients with old fracture or painful arthritis before injury / 中国骨伤

<p><b>OBJECTIVE</b>To retrospectively study the clinical results of total hip arthroplasty(THA) using Wagner SL revision stem for patients with femoral intertrochanteric fracture.</p><p><b>METHODS</b>From 2006 January to 2009 December, 29 consecutive patients with femoral intertrochanteric fractures were performed THA using Wagner SL revision stem and intertrochanteric reconstruction, including 18 males and 11 females with an average age of 49 years old ranging from 43 to 58. Among them, 8 cases were oboslete femoral intertrochanteric fractures and 21 cases were the intertrochanteric fractures with painful arthritis before injuries. After the operation, the follow-up results were evaluated with clinical and radiographic criteria. The clinical follow-up results were evaluated by Harris score, limb length discrepancy, ROM of hips and the strength of the hip abductor. The X-ray imaging follow-up results were evaluated by periprosthetic osteolysis, prosthesis loosening and radiolucent.</p><p><b>RESULTS</b>All the operations were successfully completed without serious complications associated with THA. Twenty-nine cases were followed up for a mean duration of 8.2 years (ranged, 6 to 10). There was no acceptable thigh pain. The first time walk after operation, 8 patients with oboslete intertrochanteric fracture complained the surgical sides were longer, with the passage of time, the complaint significantly reduced. At 3 months after operation, X-ray films of 21 cases showed intertrochanteric fractures healed well who had painful arthritis before injuries. An average of 6 months after operation (ranged, 3 to 8), X-ray films of 8 cases of oboslete intertrochanteric fracture showed that the bone graft and trochanter with obvious callus connection. There were no obvious prosthesis subsidence on X-ray film at the final follow-up. The recovery of hip movement range was satisfactory, no hip abduction strength was weak. More than 6 years after the operation, according to the Harris scoring evaluation of hip joint, the result was excellent in 18 cases, good in 9 cases, general in 2 cases.</p><p><b>CONCLUSIONS</b>The clinical results of total hip arthroplasty using Wagner SL revision stem for patient with femoral intertrochanteric fracture is a reliable method, intertrochanteric reconstruction not only makes for prosthesis and joint stability, but also increases bone reserve.</p>

Proximal femoral nail antirotation combined with normalized anti-osteoporosis drugs in treatment of elderly patients with osteoporotic femoral intertrochanteric fractures / 第二军医大学学报

Objective To evaluate the clinical efficacy of proximal femoral nail antirotation (PFNA) internal fixtion combined with normalized anti-osteoporosis drugs in treating elderly patients with osteoporotic femoral intertrochanteric fractures. Methods Seventy-eight elderly osteoporosis patients (≥60 years old, 25 males and 53 females) with femoral intertrochanteric fractures were enrolled, who received PFNA operation from Jun. 2012 to Jun. 2014 and had complete follow-up data. Patients were divided into anti-osteoporosis treatment group and control group according to whether anti-osteoporosis treatment was given. Patients in anti-osteoporosis treatment group (n=40) were treated with PFNA and received salmon calcitonin and zoledronic acid for sequential therapy based on the supplementation of calcium and active vitamin D, while the control group (n=38) was treated with PFNA only. Bone healing was observed with X-ray and bone mineral density (BMD) was measured regularly by dual energy X-ray absorptiometry after surgery. Harris score was used toevaluate the function of hip joint, and the complications, adverse reaction and subsequent fragility fractures were recorded after surgery. Results All patients were successfully operated, without any complication such as infection and internal fixation failure. X-ray results confirmed that clinical bone healing was achieved in all cases. There were no significant differences in fracture healing time or Harris’ hip functional score between the two groups. BMD of contralateral hip joint of patients in the anti-osteoporosis treatment group was significantly higher than that in the control group on the 6 months, 12 months and 18 months after surgery (P<0. 05), while the subsequent fragility fracture rate was significantly lower (P<0. 05). Conclusion Method for treating elderly patients with osteoporotic femoral intertrochanteric fractures by PFNA conforms to concept of minimally invasive, with simple operation and satisfactory effect PFNA combined with normalized anti-osteoporosis drugs can increase BMD and reduce subsequent fragile fractures.

Clinical efficacy of PFNA and InterTan nail in treatment of unstable femoral intertrochanteric fractures in elderly patients: A prospective comparative study / 第二军医大学学报

Objective To compare the clinical efficacy of proximal femoral nail antirotation (PFNA) and InterTan nail in the treatment of unstable femoral intertrochanteric fractures in elderly patients. Methods Totally 102 elderly patients (≥65 years old) with A2. 2., A2. 3 and A3 type unstable femoral intertrochanteric fractures were enrolled in this prospective study. The patients were divided into PFNA group (n = 48., with a mean age of [75. 6±6. 7] years) and InterTan group (n = 54, with a mean age of [75. 3±6. 6] years) according to the surgical method. During follow-up, the Harris hip score was recorded at the last outpatient review, and the survival information of patients was obtained by telephone interview and census register database. Results There was no significant difference in baseline characteristics of patients between the two groups. The operation time, intraoperative fluoroscopy time and bleeding volume of patients in the InterTan group were significantly higher than those in the PFNA group (P0. 05). Screw cut-out occurred in 4 patients in the PFNA group, and the hospital death occurred in 3 (2.9%) patients in the two groups. There was no significant difference in the healing time and Harris hip score between the two groups during follow-up (P>0. 05). The median survival time of patients in the PFNA group and the InterTan group was 33. 9 and 27. 4 months, respectively, with no significant difference between the two groups (P>0. 05). Conclusion PFNA and InterTan nail have similar therapeutic effect on elderly patients with unstable femoral intertrochanteric fractures. PFNA is better in improving operation time, intraoperative fluoroscopy time and intraoperative bleeding volume, but has the risk of screw cutting-out.

Intramedullary nail fixation in treatment of unstable femoral intertrochanteric fractures in elderly patients / 第二军医大学学报

Objective To explore the surgical technique and efficacy of intramedullary nails fixation in treatment of unstable femoral intertroehanteric fracture in elderly patients. Methods We retrospectively analyzed the data of 64 elderly patients with unstable intertrochanteric fractures who were treated with intramedullary nall fixation in our department from Jul. 2014 to Dec. 2015. There were 21 males and 43 females, with a mean age of (81. 9±5. 2) years old, ranging from75 to 96 years. Thirty-one cases were type 31-A2. 2, 23 were type 31-A2. 3, and 10 were type 31-A3. 3 according to AO classification. All patients were treated with intramedullary nail fixation and were divided into Group 1 (limited open reduction and temporary fixation by accessory appliances, n=19) and Group 2 (direct close reduction and fixation, n=45). The operation time, intraoperative blood loss, follow-up and fracture healing time, and Harris score of the hip at the last follow-up of patients were compared between the two groups. Results Compared with the Group 2, the intraoperative blood loss in the Group 1 was significantly higher ([365. 8 ± 81. 2] mL vs [238. 9 ± 56. 7] mL, P0. 05). There were no complications such as deep infection, avascular necrosis of the femoral head, hip varus deformity, femoral shatt fractures, implant failure or fracture in the two groups. Conclusion Unstable femoral intertrochanteric fractures is common in elderly patients. The limited open reduction combined with temporary fixation by accessory appliances is required for good reduction when the closed reduction is hard to reset Although the technique will greatly increase intraoperative blood loss and operation time, it does not affect the overall clinical effectiveness.

Morphology character and reduction methods of sagittally unstable intertrochanteric fractures / 北京大学学报(医学版)

Objective:To investigate the morphology character of sagittally unstable intertrochanteric fractures and reduction methods.Methods: A retrospective study was used to analyze the clinical data of sagittally unstable intertrochanteric fractures cases,which were treated with proximal femoral nail anti-rotation (PFNA) fixation from March 2009 to June 2016.In the study,36 cases were followed up completely,in which 17 cases accepted open reduction,and the other 19 cases accepted minimally invasive reduction.The operation time,amount of bleeding,the fluoroscopy times,postoperative radiographic measurements,such as tip-apex distance (TAD) and sliding distance of the spiral screw,and hip Harris scores were analyzed.The morphology character of the fractures was documented and investigated.Results: The average follow-up time was 15 months.The amount of bleeding of the open reduction group was (170.5±19.7) mL,and the amount of bleeding of the minimally invasive group was (54.7±12.5) mL.The amount of bleeding of the minimally invasive group was significantly less than that of the open reduction group (P<0.001).Between the two groups,there were no significant differences in other evaluation parameter,including operation time (P=0.054),the fluoroscopy times (P=0.053),fracture healing time (P=0.305),postoperative radiographic measurements,such as TAD (P=0.317) and sliding distance of the spiral screw (P=0.206),and hip Harris scores (P=0.459).In regard to morphology character of the fractures,the proximal anterior unstable fractures with separation displacement were more common than the proximal posterior unstable fractures with impaction.The characteristic feature of the proximal anterior unstable fractures was the proximal anterior and medial long oblique fracture,and a V shape cortical defect in the distal fracture fragment on the externally rotation X-ray.Conclusion: Sagittally unstable intertrochanteric fractures can be divided into the proximal anterior unstable fractures with separation displacement,and the proximal posterior unstable fractures with impaction.The two types have their own morphology character individually.The reduction should be performed by minimally invasive techniques.

Clinical observation of low molecular weight heparin in different age points before and after femoral intertrochanteric fracture / 中国生化药物杂志

Objective To analyze the clinical application of molecular heparin in the treatment of skeletal intertrochanteric fractures at different time points before and after operation.Methods The extraction time of 160 elderly patients with intertrochanteric fractures was divided into group A, group B, group C and group D according to the order of admission in our hospital from March 2015 to September 2016.Patients in group A were treated with molecular heparin at 48 h before surgery.Patients with group B were treated with molecular heparin 24 h before operation.Patients in group C were treated with molecular heparin at 12 h before surgery.Patients in group D were treated with molecular heparin at 12 h postoperatively.Results The incidence of DVT in the four groups was 2.5%, 15%, 15% and 37.5% respectively.The incidence of DVT in group A and group B, group C and group D was statistically significant.The statistical significance was significant(P< 0.05).The incidence of DVT in group B and group C was compared with that in group B.There was no statistically significant difference.1 month after surgery 4 groups of patients with lower extremity vascular color Doppler ultrasound review, there are 6 cases of new DVT patients, 3 months after surgery on the lower extremity vascular color Doppler ultrasound review of 2 cases of new patients, in addition to the four groups of patients with bleeding There was no statistically significant difference between the data.Conclusion The use of molecular heparin in the elderly patients with intertrochanteric fractures for 48 hours can effectively prevent the occurrence of DVT, and will not improve the incidence of hemorrhagic events and have high safety and reliability.

Features analysis of hidden blood loss in the elderly femoral intertrochanteric fractures treated with extramedullary and intramedullary fixations or hip arthroplasty / 实用医学杂志

Objective To analyze the features of hidden blood loss in the elderly femoral intertrochanteric fractures treated with extramedullary dynamic hip screw (DHS), intramedullary nails (Gamma 3, PFN) and hip arthroplasty (LBFH). Methods The clinicle records of 193 elderly patients (ages ≥75 year old) with femoral intertrochanteric fractures treat by DHS,Gamma3, PFNA and LBFH in our hospital were retrospectively analyzed. The estimated blood loss were calculated by Gross equation, according to the height,weight and changes of blood routine test reoperative and postoperative,the differences of hidden blood loss among DHS group,Gamma 3 group, PFN group and LBFH group were compared. Results Total blood loss in intramedullary nail groups were significantly higher than DHS group [(766 ± 83) mL],P 0.05), The hidden blood loss were significantly higher in the intramedullary nail groups than those in the LBFH group [(453 ± 98) mL,accounting 54%] and DHS group [(429 ± 59) mL,accounting 56%] (P 0.05). Conclusion Noteworthy, the hidden blood loss is major part of perioperative total blood loss in the elderly femoral intertrochanteric fractures , intramedullary fixations may result in greater hidden blood loss than extramedullary fixations and hip arthroplasty ,which may cause postoperative anemia.

Comprehensive evaluation of intramedullary fixation and extramedullary fixation in the treatment of unstable femoral intertrochanteric fractures / 中国组织工程研究

BACKGROUND:Nowadays, the internal fixation materials for the clinical treatment of unstable femoral intertrochanteric fractures are broadly divided into two categories:intramedul ary fixation system and extramedul ary fixation system. However, the effects of the treatments usual y lack of macro evaluation. OBJECTIVE:To compare the effect of intramedul ary fixation system and extramedul ary internal fixation system in the treatment of unstable femoral intertrochanteric fractures. METHODS:217 patients with unstable femoral intertrochanteric fracture (Evans typing: Ⅲ type to Ⅴ type and R type) were treated by using intramedul ary fixation system and extramedul ary internal fixation system:18 cases were treated with dynamic condylar screw, 67 cases were treated with dynamic hip screw, 43 cases were treated with reconstruction nail, 72 cases were treated with proximal femoral anti-rotation blade nail, and 17 cases were treated with new generation of antegrade interlocking intramedul ary nail. The operative time, length of incision, blood loss, time in bed, fracture healing time, complications and Harris hip score were analyzed and compared. RESULTS AND CONCLUSION:In the aspects of operative time, blood loss, time in bed, complications and Harris hip score, the intramedul ary fixation system was superior to extramedul ary internal fixation system. But there were significant differences in the aspects of length of incision and fracture healing time between two methods. The results showed that the treatment of unstable femoral intertrochanteric fractures by using intramedul ary fixation system was better than the extramedul ary internal fixation system, as the intramedul ary fixation system could effectively shorten the operative time and reduce blood loss. This stable and reliable fixation enables patients to take early postoperative functional exercise, and could significantly shorten the time in bed and reduce the incidence of complications and it is conducive to postoperative hip function recovery. Therefore, intramedul ary fixation system is an ideal method for the treatment of unstable femoral intertrochanteric fractures.

Observation on the effect of prosthetic replacement for the management of intertrochanteric fractures in olderly patients / 中国基层医药

Objective To explore the method and effect of prosthetic replacement for the management of intertrochanteric fracture in the elderly.Methods 24 elderly patients with intertrochanteric fracture were treated with prosthetic replacement.According to the Evans classification,there were 4 cases of Evans Ⅱ,16 Evans Ⅲ and 4 Evans Ⅳ.Results The mean time to ambulation following the surgery was (6.0 ± 2.2) days.No prosthetic loosening or infection were observed in the follow-up of 6 to 27 months(average 12 months).According to the Harris hip score,the excellent and good rate was 83.3％.Conclusion Prosthetic replacement is safe and effective for intertrochanteric fractures in elderly patients,which allows early ambulation and have a relatively low rate of complications.

A comparative study of dynamic hip screw and proximal femoral nail antirotation in treatment of femoral intertrochanteric fractures / 中国矫形外科杂志

[Objective]To compare the therapeutic effect on femoral intertrochanteric fractures with dynamic hip screw(DHS) and proximal femoral nail antirotation(PFNA).[Method]A retrospective study of 483 patients with femoral intertrochanteric fractures in Changhai Hospital from December 2001 to January 2008 were carried out.Totally 109 patients were treated with PFNA,while 374 patients were treated with DHS.The data of operative time,blood loss,walking time,union time and hip function scores were recorded.[Result]All the patients were followed up for 6～38 months(15.3 months in average).There were significant differences in operative time,blood loss and walking time between two groups.There were no significant difference in union time.There were no significant difference in the excellent rate between the two groups in stable femoral intertrochanteric fractures.The excellent rate of PFNA group was significantly higher than DHS group in unstable femoral intertrochanteric fractures.[Conclusion]Each of them have its own advantages and indications.Both are effective ways to treat stable femoral intertrochanteric fractures.PFNA has more advantages to treat unstable femoral intertrochanteric fractures.