Subtrochanteric fractures treated by cerclage cables and long cephalomedullary nails with minimally invasive technique / 中华骨科杂志

ABSTRACT

Objective To explore the surgical methods and evaluate the postoperative outcomes after cerclage cables and long cephalomedullary nails fixation with minimally invasive technique for the treatment of subtrochanteric femoral fractures.Methods From January 2013 to February 2016,21 patients with subtrochanteric femoral fractures surgically treated were retrospectively analyzed.There were 14 males and 7 females with an average age of 43.5 years old (ranged from 24 to 71 years old).11 patients suffered by traffic accidents,8 patients fell down from heights and 2 patients injured by collapses of heavy objectives.Subtrochanteric fractures were classified by Seinsheimer classification with 2 cases of type] B,5 cases of type Ⅱ C,7 cases of Ⅲ A,2 cases of Ⅲ B,1 case of Ⅳ and 4 cases of Ⅴ.CT scans of bilateral femurs were performed to measure the length,canal diameter and anterior ache before the operation.All the fractures were treated by cerclage cables and long cephalomedullary nails with minimal invasive technique.7 cases were fixed by one cable and 14 cases by two or more cables.Results All the patients were followed up with an average of 22.5 months (ranged from 12 to 36 months).The healing time of 20 patients was 3-6 months,with an average time of 4.1 months,except 1 was union by re-operation and the healing time was 13 months after initial operation.According to Harris function evaluation,the average score was 85.4 (ranged from 68 to 97).The clinical outcomes were rated with excellent in 13 cases,good in 6 cases,fair in 1 case and poor in 1 case.The excellent and good rate was 90.5％.Complications included 1 case of screw cut-out and 1 case of nonunion.Conclusion For the treatment of subtrochanteric fractures with spiral,oblique pattern or a big butterfly fragment,satisfactory outcome could be achieved by fixation of cerclage cables and long cephalomedullary nails.The key to healing is to protect the blood supply of the fracture fragments with minimally invasive technique.