Treatment of reverse oblique trochanteric femoral fractures poses a lot of challenges. There have been proponents of intramedullary devices as well as extramedullary devices. We present the results of proximal femoral...Treatment of reverse oblique trochanteric femoral fractures poses a lot of challenges. There have been proponents of intramedullary devices as well as extramedullary devices. We present the results of proximal femoral nailing surgery performed for reverse obliquity intertrochanteric fractures using two proximal lag screws and a nail of 250 mm. There is prospective study of fifty three patients with AO/OTA 31 A-A3 fractures being treated by proximal femoral nailing in our institute after seeking approval from the Hospital ethics board. The quality of the reduction, the operative time, complications and the functional status of the patients were the parameters on which the results were evaluated. The mean Harris hip score was 76.66 (range 70 - 93) and the mean Barthel activity score was 16.21 (range 12 - 20). The average surgical time was 50 minutes and the mean consolidation time was 11.5 weeks. Intramedullary nailing with proximal femoral nails seems to be a good option in the treatment of reverse obliquity intertrochanteric fractures as against the various existing options available for the management.展开更多
Background:Reverse intertrochanteric fractures are usually initially treated with closed reduction.However,sometimes these fractures are not amenable to closed reduction and require open reduction.To date,few studies ...Background:Reverse intertrochanteric fractures are usually initially treated with closed reduction.However,sometimes these fractures are not amenable to closed reduction and require open reduction.To date,few studies have been conducted on predictors of and reduction techniques for irreducible reverse intertrochanteric fractures.Therefore,this study aimed to summarize the displacement patterns of irreducible reverse intertrochanteric fractures and corresponding reduction techniques,and explore predictors of irreducibility.Methods:We reviewed 1174 cases of trochanteric fractures treated in our hospital from January 2006 to October 2018,113 of which were reverse intertrochanteric fractures.An irreducible fracture was determined according to intra-operative fluoroscopy imaging after closed manipulation.Fractures were assessed for displacement patterns,radiographic features of irreducibility,and reduction techniques.Logistic regression analysis was performed on potential predictors for irreducibility,including gender,age,body mass index,AO Foundation/Orthopaedic Trauma Association(AO/OTA)classification,and radiographic features.Results:Seventy-six irreducible fractures were identified,accounting for 67%of reverse intertrochanteric fractures.Six patterns of fracture displacement after closed manipulation were identified;the most common pattern was medial displacement and posterior sagging of the femoral shaft relative to the head-neck fragment.Multivariate logistic regression analysis identified three predictors of irreducibility:a medially displaced femoral shaft relative to the head-neck fragment on the anteroposterior(AP)view(odds ratio[OR],8.00;95%confidence interval[CI],3.04–21.04;P<0.001),a displaced lesser trochanter(OR,3.61;95%CI,1.35–9.61;P=0.010),and a displaced lateral femoral wall(OR,2.92;95%CI,1.02–8.34;P=0.046).Conclusions:A high proportion of reverse intertrochanteric fractures are not amenable to closed reduction.Six patterns of fracture displacement after closed manipulation were identified.Different reduction techniques are required for different displacement patterns.Predictors of irreducibility include a medially displaced femoral shaft relative to the head-neck fragment on the AP view,a displaced lesser trochanter,and a displaced lateral femoral wall.These patients warrant special consideration in terms of recognition and management.展开更多
Objective Unstable intertrochanteric fractures （ITFs） are mostly treated by proximal femoral nail antirotation （PFNA）,Inter-Tan,Asian Hip,and other new internal fixation devices.But for complex unstable fractures,...Objective Unstable intertrochanteric fractures （ITFs） are mostly treated by proximal femoral nail antirotation （PFNA）,Inter-Tan,Asian Hip,and other new internal fixation devices.But for complex unstable fractures,such as crushed lateral wall of the greater trochanter,the loss of fixation point on lateral wall slightly reduces the fixing effect.This study aimed to compare the biomechanical strengths between reversed less invasive stabilization system （LISS） and PFNA for treatment of unstable ITFs.Methods Forty synthetic femurs were used to simulate unstable ITFs in vitro and were fixed using the reversed LISS or PFNA.These fractures were divided into two groups depending on whether the lateral wall of the greater trochanter is intact or not （AO classification：31-A2.3 and 31-A3.3,respectively）.The load-displacement of femur,stiffness,ultimate load,and cyclic fatigue resistance were detected using an incremental load test and a dynamic fatigue test through an MTS 858 test system.Results For both 31-A2.3 and 31-A3.3,the vertical sinking displacement （VSD） of the femoral head under 500 N load was insignificantly smaller after treatment with reversed LISS than with PFNA,and when the displacement was 5 mm,the femoral head bore insignificantly greater load.The fixation with reversed LISS resulted in greater axial stiffness of the femur but smaller ultimate load.During the same cycle in the dynamic fatigue test,the VSD was insignificantly smaller with the fixation of reversed LISS.Conclusion Reversed LISS and PFNA have similar biomechanical strength for unstable ITFs.This conclusion should be supported by additional large-size research on basic biomechanics and clinical application.This is the first comparative biomechanical study comparing reversed LISS and PFNA for unstable ITFs.展开更多
目的:综合分析动力髋螺钉(dynamic hip screw,DHS)在不同类型转子间骨折中的疗效,着重探讨其在反转子间骨折中的应用价值。方法:根据AO分类,将转子间骨折分潍A1、A2、A33型,每型又分为3个亚型。对DHS治疗的102例股骨转子间骨折的总体疗...目的:综合分析动力髋螺钉(dynamic hip screw,DHS)在不同类型转子间骨折中的疗效,着重探讨其在反转子间骨折中的应用价值。方法:根据AO分类,将转子间骨折分潍A1、A2、A33型,每型又分为3个亚型。对DHS治疗的102例股骨转子间骨折的总体疗效和各不同类型转子间骨折的疗效进行对比分析。结果:DHS治疗102例转子间骨折总体优良率81%。A1型优良率95%,A2型优良率84%。反转子间骨折优良率48%。反转子间骨折优良率和总体优良率及A1型或A2型优良率间差异均有统计学意义(P<0.01)。反转子间骨折手术失败率与总体手术失败率及A2型手术失败率间差异有统计学意义(P<0.05)。结论:DHS对大多数标准转子间骨折疗效良好,对反转子间骨折疗效欠佳。展开更多
目的比较股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)和InterTAN髓内钉治疗股骨粗隆间反斜形骨折的疗效差异。方法回顾性分析2015年1月至2016年6月保定第七医院采用PFNA和InterTAN两种髓内钉治疗股骨反转子间斜行骨折...目的比较股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)和InterTAN髓内钉治疗股骨粗隆间反斜形骨折的疗效差异。方法回顾性分析2015年1月至2016年6月保定第七医院采用PFNA和InterTAN两种髓内钉治疗股骨反转子间斜行骨折共64例病人的临床资料,其中PFNA组39例,InterTAN组25例。比较两组一般资料、术前美国麻醉医师协会(ASA)分级、受伤前活动水平以及手术切口长度、手术时间、术中失血量、住院时间、Harris评分、完全负重时间。结果两组术前ASA分级、受伤前活动状态及手术切口长度、住院时间、Harris评分,均差异无统计学意义(P>0.05);PFNA组在手术时间(59.3±7.6)min、术中失血量(167.6±96.2)mL方面,优于InterTAN组(76.1±9.4)min、(249.1±87.3)mL(P<0.05);在完全负重时间方面,InterTAN组(8.7±3.4)周优于PFNA组(11.3±2.7)周(P<0.05)。结论 PFNA和InterTAN两种髓内钉均有出血较少、固定牢固、并发症少等优点,但又各有优势。PFNA髓内钉技术较为成熟、操作方便、组织损伤小,临床应用广泛;而InterTAN髓内钉稳定性较高,为近年新发展的术式,临床应用前景更为广阔。展开更多
文摘Treatment of reverse oblique trochanteric femoral fractures poses a lot of challenges. There have been proponents of intramedullary devices as well as extramedullary devices. We present the results of proximal femoral nailing surgery performed for reverse obliquity intertrochanteric fractures using two proximal lag screws and a nail of 250 mm. There is prospective study of fifty three patients with AO/OTA 31 A-A3 fractures being treated by proximal femoral nailing in our institute after seeking approval from the Hospital ethics board. The quality of the reduction, the operative time, complications and the functional status of the patients were the parameters on which the results were evaluated. The mean Harris hip score was 76.66 (range 70 - 93) and the mean Barthel activity score was 16.21 (range 12 - 20). The average surgical time was 50 minutes and the mean consolidation time was 11.5 weeks. Intramedullary nailing with proximal femoral nails seems to be a good option in the treatment of reverse obliquity intertrochanteric fractures as against the various existing options available for the management.
文摘Background:Reverse intertrochanteric fractures are usually initially treated with closed reduction.However,sometimes these fractures are not amenable to closed reduction and require open reduction.To date,few studies have been conducted on predictors of and reduction techniques for irreducible reverse intertrochanteric fractures.Therefore,this study aimed to summarize the displacement patterns of irreducible reverse intertrochanteric fractures and corresponding reduction techniques,and explore predictors of irreducibility.Methods:We reviewed 1174 cases of trochanteric fractures treated in our hospital from January 2006 to October 2018,113 of which were reverse intertrochanteric fractures.An irreducible fracture was determined according to intra-operative fluoroscopy imaging after closed manipulation.Fractures were assessed for displacement patterns,radiographic features of irreducibility,and reduction techniques.Logistic regression analysis was performed on potential predictors for irreducibility,including gender,age,body mass index,AO Foundation/Orthopaedic Trauma Association(AO/OTA)classification,and radiographic features.Results:Seventy-six irreducible fractures were identified,accounting for 67%of reverse intertrochanteric fractures.Six patterns of fracture displacement after closed manipulation were identified;the most common pattern was medial displacement and posterior sagging of the femoral shaft relative to the head-neck fragment.Multivariate logistic regression analysis identified three predictors of irreducibility:a medially displaced femoral shaft relative to the head-neck fragment on the anteroposterior(AP)view(odds ratio[OR],8.00;95%confidence interval[CI],3.04–21.04;P<0.001),a displaced lesser trochanter(OR,3.61;95%CI,1.35–9.61;P=0.010),and a displaced lateral femoral wall(OR,2.92;95%CI,1.02–8.34;P=0.046).Conclusions:A high proportion of reverse intertrochanteric fractures are not amenable to closed reduction.Six patterns of fracture displacement after closed manipulation were identified.Different reduction techniques are required for different displacement patterns.Predictors of irreducibility include a medially displaced femoral shaft relative to the head-neck fragment on the AP view,a displaced lesser trochanter,and a displaced lateral femoral wall.These patients warrant special consideration in terms of recognition and management.
文摘Objective Unstable intertrochanteric fractures （ITFs） are mostly treated by proximal femoral nail antirotation （PFNA）,Inter-Tan,Asian Hip,and other new internal fixation devices.But for complex unstable fractures,such as crushed lateral wall of the greater trochanter,the loss of fixation point on lateral wall slightly reduces the fixing effect.This study aimed to compare the biomechanical strengths between reversed less invasive stabilization system （LISS） and PFNA for treatment of unstable ITFs.Methods Forty synthetic femurs were used to simulate unstable ITFs in vitro and were fixed using the reversed LISS or PFNA.These fractures were divided into two groups depending on whether the lateral wall of the greater trochanter is intact or not （AO classification：31-A2.3 and 31-A3.3,respectively）.The load-displacement of femur,stiffness,ultimate load,and cyclic fatigue resistance were detected using an incremental load test and a dynamic fatigue test through an MTS 858 test system.Results For both 31-A2.3 and 31-A3.3,the vertical sinking displacement （VSD） of the femoral head under 500 N load was insignificantly smaller after treatment with reversed LISS than with PFNA,and when the displacement was 5 mm,the femoral head bore insignificantly greater load.The fixation with reversed LISS resulted in greater axial stiffness of the femur but smaller ultimate load.During the same cycle in the dynamic fatigue test,the VSD was insignificantly smaller with the fixation of reversed LISS.Conclusion Reversed LISS and PFNA have similar biomechanical strength for unstable ITFs.This conclusion should be supported by additional large-size research on basic biomechanics and clinical application.This is the first comparative biomechanical study comparing reversed LISS and PFNA for unstable ITFs.
文摘目的:综合分析动力髋螺钉(dynamic hip screw,DHS)在不同类型转子间骨折中的疗效,着重探讨其在反转子间骨折中的应用价值。方法:根据AO分类,将转子间骨折分潍A1、A2、A33型,每型又分为3个亚型。对DHS治疗的102例股骨转子间骨折的总体疗效和各不同类型转子间骨折的疗效进行对比分析。结果:DHS治疗102例转子间骨折总体优良率81%。A1型优良率95%,A2型优良率84%。反转子间骨折优良率48%。反转子间骨折优良率和总体优良率及A1型或A2型优良率间差异均有统计学意义(P<0.01)。反转子间骨折手术失败率与总体手术失败率及A2型手术失败率间差异有统计学意义(P<0.05)。结论:DHS对大多数标准转子间骨折疗效良好,对反转子间骨折疗效欠佳。
文摘目的比较股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)和InterTAN髓内钉治疗股骨粗隆间反斜形骨折的疗效差异。方法回顾性分析2015年1月至2016年6月保定第七医院采用PFNA和InterTAN两种髓内钉治疗股骨反转子间斜行骨折共64例病人的临床资料,其中PFNA组39例,InterTAN组25例。比较两组一般资料、术前美国麻醉医师协会(ASA)分级、受伤前活动水平以及手术切口长度、手术时间、术中失血量、住院时间、Harris评分、完全负重时间。结果两组术前ASA分级、受伤前活动状态及手术切口长度、住院时间、Harris评分,均差异无统计学意义(P>0.05);PFNA组在手术时间(59.3±7.6)min、术中失血量(167.6±96.2)mL方面,优于InterTAN组(76.1±9.4)min、(249.1±87.3)mL(P<0.05);在完全负重时间方面,InterTAN组(8.7±3.4)周优于PFNA组(11.3±2.7)周(P<0.05)。结论 PFNA和InterTAN两种髓内钉均有出血较少、固定牢固、并发症少等优点,但又各有优势。PFNA髓内钉技术较为成熟、操作方便、组织损伤小,临床应用广泛;而InterTAN髓内钉稳定性较高,为近年新发展的术式,临床应用前景更为广阔。
