Sagittal traction in fixation with proximal femoral nail anti-rotation for senile intertrochanteric fractures / 中华创伤骨科杂志

ABSTRACT

Objective:To observe the effect of sagittal traction on the internal fixation with proximal femoral nail anti-rotation (PFNA) for femoral intertrochanteric fractures in the elderly patients.Methods:A retrospective study was conducted to analyze the clinical data of 61 elderly patients with intertrochanteric fracture who had been treated from January 2016 to January 2018 at Department of Orthopaedics, The Ninth Hospital of Ningbo. Of them, horizontal traction of the affected limb was performed in 31 (16 males and 15 females with an age of 73.6 years ± 9.4 years) while 10°-20° sagittal traction of the affected limb in 30 (15 males and 15 females with an age of 75.0 years ± 7.2 years). The 2 groups were compared in terms of operation time, intraoperative blood loss, times of intraoperative fluoroscopy, fracture healing time, hip function at 6 months after operation by Harris scoring and complications.Results:There was no statistically significant difference between the 2 groups in the general clinical data, showing comparability ( P>0.05). The operation time (47.1 min ± 4.7 min), intraoperative blood loss (72.3 mL ± 9.1 mL), and times of intraoperative fluoroscopy (11.5 ± 1.4) in the sagittal traction group were significantly less than those in the horizontal traction group (56.7 min ± 4.6 min, 103.9 mL ± 19.2 mL, and 14.6±1.6) ( P< 0.05). This cohort was followed up for 6 to 18 months (12.6 months on average). There were no significant differences between the 2 groups in quality of postoperative fracture reduction, fracture healing time or hip Harris scores at postoperative 6 months ( P>0.05). Internal fixation loosening and hip pain occurred in one patient in the sagittal traction group. Follow-ups observed no complications like wound infection, bedsores, deep vein thrombosis or hip varus deformity in either group. Conclusion:As 10°-20° sagittal traction can lift the affected limb upward to avid blockage by the iliac wing, hip soft tissue and lateral abdominal wall, it lends convenience to surgeons, reducing intraoperative bleeding volume, times of fluoroscopy and operation time.