Sliding compression technique with proximal femoral nail antirotation for intertrochanteric fractures in the elderly patients / 中华创伤骨科杂志

ABSTRACT

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.