Femoral stable interlocking intramedullary nail in the treatment of anterograde intertrochanteric fractures / 中华骨科杂志

ABSTRACT

Objective:To evaluate the efficacy of femoral stable interlocking intramedullary nail (FSIIN) in the treatment of anterograde intertrochanteric fractures.Methods:FSIIN was invented to treat femoral intertrochanteric fractures. From January 2005 to February 2019, 36 cases of anterograde intertrochanteric fractures were retrospectively analyzed. Among them, 29 cases were from the Fourth Central Hospital Affiliated to Nankai University and 7 cases were from the Second People's Hospital of Hulunbuir City. 15 cases (6 males and 9 females) were treated with FSIIN distal locking fixation(distal locking group). The average age was 68.53±10.82 years (range, 48-80 years old); According to AO/OTA classification, there were 7 cases of 31-A1 type and 8 cases of 31-A2 type. 21 cases (12 males and 9 females) were treated by FSIIN distal fixation non-locking (distal unlocking group). The average age was 67.86±11.70 years (range, 46-85 years). there were 9 cases of 31-A1 type and 12 cases of 31-A2 type. The operation time, intraoperative blood loss, fracture healing time, visual analogue scale (VAS) and Harris scores at the last follow-up were compared between the two fixation methods.Results:Both groups were followed up for 10-24 months, and the mean time in the lock group was 16.73±3.41 months. The mean time in the non-locking group was 16.10±3.36 months. In the locked group, the operation time was 43.47±2.39 min, the intraoperative blood loss was 149.33±44.96 ml, and the fracture healing time was 14.57±1.50 weeks. In the non-locking group, the operation time was 33.29±5.30 min, intraoperative blood loss was 97.62±38.46 ml, and fracture healing time was 10.16±1.20 weeks. The operation time of the non-locking group was shorter than the locking group ( t=6.930, P<0.001), intraoperative blood loss was decreased than the locking group ( t=3.708, P<0.001), fracture healing time was reduced than the locking group ( t=9.818, P<0.001). At the last follow-up, the VAS score of the locked group was 1.60±0.63 and the non-locked group was 1.81±1.08, which showed no significant difference( t=0.673, P=0.506). There was no significant difference in Harris score between the locked group 84.33±2.53 and the non-locked group 84.90±2.19( t=0.724, P=0.474). Eight weeks after the operation, the proximal inferior locking nail was withdrawn 1 cm in 1 case. The fracture healed without treatment. Conclusion:Both FSIIN distal locking and non-locking are effective methods for the treatment of femoral intertrochanteric fractures. Compared with the distal locking group, the non-locking group had more simpler operation, more minimally invasive, and enhanced recovery after surgery.