ABSTRACT
Objective:To compare the clinical efficacy between a bidirectional-traction reduction device and a traction table in the treatment of femoral neck fracture with femoral neck system (FNS).Methods:A retrospective study was conducted in the 46 patients with femoral neck fracture who had been treated at Department of Orthopedics, The First Central Hospital of Baoding from January 2020 to January 2021. There were 19 males and 27 females, aged from 30 to 64 years (average, 47.1 years). According to the Garden classification, 29 cases were type Ⅲ and 17 type Ⅳ. By the reduction method, the patients were assigned into an observation group ( n=24) in which the reduction was assisted by a bidirectional-traction reduction device and a control group ( n=22) in which the reduction was assisted by a traction table. FNS fixation was conducted in both groups. The 2 groups were compared in terms of operation time, reduction time, fluoroscopy frequency, intraoperative blood loss, femoral neck shortening at immediate postoperation and 12 months postoperation, Harris scores of the affected hip at 3, 6, and 12 months postoperation, and incidence of lower extremity venous thrombosis. Results:There were no significant differences in age, gender or fracture type between the 2 groups, showing they were comparable ( P>0.05). The observation group needed significantly less operation time [57.5 (54.0, 64.5) min], reduction time [(16.3±3.0) min] and fluoroscopy frequency [(20.5±4.6) times] than the control group did [85.0 (71.3, 92.0) min, (21.0±6.0) min and (29.7±4.7) times, respectively] (all P<0.05). There was no significant difference in intraoperative blood loss between 2 groups ( P>0.05). All patients were followed up for 12 to 22 months (average, 15.5 months). There was no significant difference in femoral neck shortening between the 2 groups at immediate postoperation or 12 months postoperation ( P>0.05). The Harris score of the affected hip in the observation group was significantly better than that in the control group at 3 months after surgery ( P<0.05), but such a significant difference was not observed at 6 or 12 months postoperation ( P>0.05). The incidence of thrombotic complications in the observation group (12.5%, 3/24) was significantly lower than that in the control group (40.9%, 9/22) ( P<0.05). Conclusions:In the FNS treatment of femoral neck fracture, compared with a traction table, reduction assisted by a bidirectional-traction reduction device is more advantageous because it is simpler and less time-consuming, incurs less fluoroscopy and leads to better early functional recovery of the affected hip and lower incidence of thrombotic complications.
ABSTRACT
Objective: To investigate the effectiveness and advantages of skeletal tractor in closed reduction and proximal femoral nail antirotation (PFNA) internal fixation of intertrochanteric fracture compared with traction table. Methods: The clinical data of 86 patients with intertrochanteric fractures, who were treated with closed reduction and PFNA internal fixation between October 2016 and March 2018 and met the selection criteria, was retrospectively analysed. Among them, 44 cases were treated with skeletal tractor (trial group) and 42 cases were treated with traction table (control group). There was no significant difference between the two groups in gender, age, cause of injury, fracture side, AO classification, and degree of osteoporosis ( P>0.05). The preoperative position time, operation time, intraoperative fluoroscopy times, intraoperative blood loss, fracture healing time, intraoperative and postoperative complications, and postoperative Harris score were compared between the two groups. Results: The operation was successfully completed in both groups. Compared with the control group, the patients in the trial group had shorter preoperative position time and operation time, fewer intraoperative fluoroscopy times, and less intraoperative blood loss ( P<0.05). The patients were followed up 12-21 months in trial group (mean, 14.2 months) and 12-22 months in control group (mean, 14.3 months). Venous thrombosis of lower extremity occurred in 8 patients (3 cases of trial group and 5 cases of control group) after operation. Internal fixation failure occurred in 5 patients (2 cases of trial group and 3 cases of control group) during 1 year after operation. All fractures healed except for those with internal fixation failure, the fracture healing time was (11.6±2.9) weeks in trial group and (12.4±3.6) weeks in control group; and there was no significant difference between the two groups ( t=1.250, P=0.214). At 1 year after operation, Harris score of the trial group was 86.2±5.9 and that of the control group was 84.1±6.1. There was no significant difference between the two groups ( t=1.768, P=0.080). Conclusion: Compared with traction table, skeletal tractor in closed reduction and PFNA internal fixation of intertrochanteric fracture can significantly shorten the preoperative position time and operation time, reduce the intraoperative fluoroscopy times, improve the operation efficiency, and have similar effectiveness.
ABSTRACT
Objective To study the treatment of femoral intertrochanteric fractures by reduction without a traction table in a special position and fixation with proximal femoral nail antirotation (PFNA).Methods From May 2016 to May 2017,34 patients with femoral intertrochanteric fracture were treated with PFNA.They were 20 men and 14 women,from 36 to 89 years of age (average,69.9 years).The left side was affected in 15 cases and the right side in 19.By AO classification,there were 10 cases of type AO 31-A1,13 ones of type 31-A2,and 11 ones of type 3 l-A3.Two cases were complicated with other fractures,and 5 with internal system disease,3 of whom had more than 2 concomitant diseases.Preoperative deep venous thrombosis was found in 2 cases.Surgery was performed for them between 2 and 8 days after injury (average,3.7 days).Reduction was performed in a special position without a traction table.The duration of anesthesia,operation time,intraoperative hemorrhage,postoperative complications and hip function by Harris scores were recorded.Results For the 34 patients,the anesthesia time ranged from 57 to 85 min (average,67.5 min),the operation time ranged from 28 to 65 min (average,40.9 min),and the intraoperative hemorrhage from 80 to 150 mL (average,110.6 mL).They received effective follow-up for 6 to 12 months (average,8.4 months).All the fractures healed after 6 to 12 months(average,7.2 months).No failure of internal fixation was observed during follow-ups.By the Harris scores at the final follow-up,the function of the affected hip was rated as excellent in 9 cases,as good in 21 and as fair in 4,giving an excellent to good rate of 88.2％.Conclusion In the treatment of femoral intertrochanteric fractures,reduction without a traction table in a special position and PFNA fixation may reduce anesthesia time,leading to satisfactory clinical outcomes.
ABSTRACT
Intertrochanteric fracture of the femur is one of the commonfractures in the elderly. Dynamic Hip Screw (DHS) fixation is the gold standard for treatment of intertrochanteric femoral fracture. Conventional methods of achieving reduction prior to instrumentation require utilization of a traction table. A manual traction technique applied in the supine position using only a translucent table was devised to do away with the use of traction table. The rationale for this technique includes enhanced ease of set