Efficacy of triangular mechanical reconstruction for treatment of failed fixation of intertrochanteric factures / 中华创伤杂志

ABSTRACT

Objective:To investigate the curative effect of triangular mechanical reconstruction in revision of failed fixation of intertrochanteric factures.Methods:A retrospective case series study was conducted for data of 11 patients with failed treatment of intertrochanteric fractures treated at First Medical Centre, Chinese PLA General Hospital from January 2017 to December 2019, including 7 males and 4 females, aged 41-75 years [(57.9±11.4)years]. The patients underwent revision surgery to achieve mechanical reconstruction of the proximal femoral triangular structure by two different implants. Among them, 6 patients were fixed using the dynamic condylar screw (DCS) combined with anteromedial plate and 5 patients were fixed using the cephalomedullary nail combined with anteromedial plate. The fracture healing rate and time, neck-shaft angle, neck anteversion angle and complications were detected. The lower extremity functional scale (LEFS), short form 12 health survey questionnaire (SF-12) and pain visual analogue scale (VAS) were measured at postoperative 6 and 12 months to evaluate functional recovery and quality of life.Results:All patients were followed up for 12-45 months [(19.1±10.8)months]. The fracture healing rate was 100%, with the healing time of 3-8 months [(4.7±1.8)months]. Compared with the unaffected limb, the neck-shaft angle and neck anteversion angle of the affected side were reduced ( P>0.05), and no secondary fracture reduction loss occurred before healing ( P>0.05). There were no postoperative complications such as femoral head avascular necrosis and implant failure. The LEFS score was (44.7±8.2)points at postoperative 12 months, significantly improved compared with that at postoperative 6 months [(61.6±10.4)points] ( P<0.05). The VAS was 1.5 (0, 2)points at postoperative 12 months, significantly decreased compared with that at postoperative 6 months [3.5(2, 4)points] ( P<0.05). The SF-12 score in physical state [(42.5±9.0)points] and mental state [(55.7±5.7)points] were also significantly improved compared with those at postoperative 6 months [(30.0±6.4)points, (43.6±6.2)points] ( P<0.05). Conclusions:Based on the characteristics of structural mechanics of the proximal femur, the DCS or cephalomedullary nail combined with anteromedial plate used to construct a triangular stable structure can achieve stable fracture reduction and maintenance reduction, relieve pain and improve function recovery as well as quality of life. This may provide an optimized revision strategy for failed fixation of intertrochanteric fractures.