Fixation with proximal femoral nail antirotation-Ⅱ for femoral intertrochanteric fractures involving lateral wall / 中华创伤骨科杂志

ABSTRACT

Objective To evaluate the fixation with proximal femoral nail antirotation-Ⅱ (PFNA Ⅱ) for femoral intertrochanteric fractures involving the lateral wall.Methods A retrospective study was conducted of the 491 patients with femoral intertrochanteric fracture who had been treated from January 2013 to December 2017 at Department of Hip Surgery,Orthopedic Hospital,Affiliated Hospital to Panzhihua University.Of them,the lateral wall was involved in 104 (group A),43 males and 61 females with an age of 72.3 ± 2.1 years;their later wall fractures were classified as type Ⅰ (simple lateral wall fracture) in 45 cases,as type Ⅱ (fragmental lateral wall fracture) in 23 cases and as type Ⅲ (combined fracture of lateral wall and subtrochanter) in 36 cases.In the other 387 cases (group B),the lateral wall was not involved.They were 186 males and 201 females with an age of 74.7 ± 1.5 years.The 2 groups were compared in terms of incision length,operating time,intraoperative blood loss,fracture healing time,postoperative weight-bearing time,Harris scores at the last follow-up and complications.Results There were no significant differences between the 2 groups of patients in their preoperative general data,indicating they were compatible(P ＞ 0.05).All the 491 patients obtained an average follow-up of 25.5 months (from 12 to 50 months).The fracture healing time in group A (27.2 ± 12.1 weeks) was significantly longer than in group B (13.1 ±2.2 weeks)and the rate of delayed union in the former (16.4％,17/104) was significantly higher than that in the latter (2.3％,9/387) (both P ＜ 0.05).There were no significant differences between the 2 groups in incision length (7.1 ± 1.2 cm versus 6.5 ±2.2 cm),operating time (60.8 ± 1.2 min versus 56.5 ± 1.5 min),intraoperative blood loss (96.2 ± 2.1 mL versus 92.1 ± 2.4 mL),postoperative weight-baring time (2.5 ± 2.1 d versus 2.1 ± 2.9 d),the Harris scores at the last follow-up (83.3 ± 2.3 versus 85.1 ± 3.4) or incidence of other complications [5.8％ (6/104) versus 4.7％ (18/387)] (all P ＞ 0.05).Conclusion Femoral intertrochanteric fractures involving the lateral wall can be effectively treated by PFNA Ⅱ fixation,but they usually take longer time to get united than those without lateral wall fracture.