Special operative techniques for intertrochanteric fractures without lesser trochanter fracture / 中华骨科杂志

ABSTRACT

Objective To explore the operative techniques for AO/OTA type 31-A3.1 and 31-A3.2 intertrochanteric fractures fixed with intrameduallary nail.Methods Seventy-four cases of unstable intertrochanteric fracture (AO/OTA type 31-A3.1 and 31-A3.2) from January 2007 to December 2010 were analyzed retrospectively.There were 33 males and 41 females,aged from 36-87 years (mean,71 years).The right hip was involved in 34 patients and the left in 40 patients.The mechanism of injury was traffic injuries in 27 cases,fall damage in 43 cases,injury by falling in 3 case and crush injury in 6 cases.Percutaneous joystick technique,Homann retractor technique,clamp technique and mini-incision was applied to aid reduction during the surgery.All cases were fixed with proximal intrameduallary nail.Clinical and radiographic outcomes were recorded.The postoperative hip function was evaluated using Harris score.Results With the aid of C-arm,closed reduction was performed in 73 cases.Only one patient experienced open reduction because of failure of closed reduction.Sixty-five cases were followed up for 8 to 23 months (mean,14.5 months).Bone union was observed in all cases with the average time of 7.4 months (range,8-23).The operation time,blood loss,the frequency of X-ray exposure was 75±4 minutes,135±5 ml and 24±3 times,respectively.At final follow-up,29 cases were classified as excellent,31 as good,and 5 as fair.The mean Harris hip score was 91.4 points (range,87-95).The overall rate of excellent or good result was 92.3％.Conclusion It is difficult to perform close reduction for unstable intertrochanteric hip fracture (AO/OTA type 31-A3.1and 31-A3.2),especially in relatively young patients.Special operative skills are necessary in some cases.