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
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
目的探讨防旋股骨近端髓内钉(proximal femoral nail antirotation,PFNA)治疗股骨逆转子间骨折的手术方法,并评估其疗效。方法2007年1月-2008年2月,采用闭合复位PFNA内固定治疗30例股骨逆转子间骨折。其中男14例,女16例;年龄40～88岁,平...目的探讨防旋股骨近端髓内钉(proximal femoral nail antirotation,PFNA)治疗股骨逆转子间骨折的手术方法,并评估其疗效。方法2007年1月-2008年2月,采用闭合复位PFNA内固定治疗30例股骨逆转子间骨折。其中男14例,女16例;年龄40～88岁,平均68.6岁。患者均为闭合骨折。骨折根椐AO分型:31-A3.1型6例,31-A3.2型7例,31-A3.3型17例。受伤至手术时间2～14d,平均5.3d。31-A3.1型及31-A3.2型骨折均以标准型PFNA固定,31-A3.3型骨折中9例以标准型PFNA固定,8例以加长型PFNA固定。患者均在术后1、2、3、6、12、18个月定期复查X线片并行功能检查,临床评价采用Sanders等评分标准。结果术中发生医源性股骨干骨折1例,因骨折稳定性较好未作特殊处理。1例术后5d发生切口浅表感染,经换药及应用抗生素后愈合;余切口均Ⅰ期愈合。30例均获随访,随访时间12～19个月,平均14.1个月。骨折均于术后12～30周愈合,平均16.2周。5例髋部疼痛,2例大腿外侧疼痛,经对症处理后疼痛缓解。1例合并同侧胫骨平台骨折的患者膝关节屈曲功能受限,1例合并同侧髋臼及骨盆骨折的患者髋关节功能受限,经功能锻炼后好转。无内固定断裂、螺旋刀片拔出或穿破股骨头关节面等并发症发生。根据Sanders等评分标准评定,获优22例,良6例,差2例,优良率93.3%。结论闭合复位PFNA内固定是一种治疗股骨逆转子间骨折的有效方法,具有骨折愈合率高、软组织损伤小、可早期功能锻炼、并发症少等优点。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。
文摘目的探讨防旋股骨近端髓内钉(proximal femoral nail antirotation,PFNA)治疗股骨逆转子间骨折的手术方法,并评估其疗效。方法2007年1月-2008年2月,采用闭合复位PFNA内固定治疗30例股骨逆转子间骨折。其中男14例,女16例;年龄40～88岁,平均68.6岁。患者均为闭合骨折。骨折根椐AO分型:31-A3.1型6例,31-A3.2型7例,31-A3.3型17例。受伤至手术时间2～14d,平均5.3d。31-A3.1型及31-A3.2型骨折均以标准型PFNA固定,31-A3.3型骨折中9例以标准型PFNA固定,8例以加长型PFNA固定。患者均在术后1、2、3、6、12、18个月定期复查X线片并行功能检查,临床评价采用Sanders等评分标准。结果术中发生医源性股骨干骨折1例,因骨折稳定性较好未作特殊处理。1例术后5d发生切口浅表感染,经换药及应用抗生素后愈合;余切口均Ⅰ期愈合。30例均获随访,随访时间12～19个月,平均14.1个月。骨折均于术后12～30周愈合,平均16.2周。5例髋部疼痛,2例大腿外侧疼痛,经对症处理后疼痛缓解。1例合并同侧胫骨平台骨折的患者膝关节屈曲功能受限,1例合并同侧髋臼及骨盆骨折的患者髋关节功能受限,经功能锻炼后好转。无内固定断裂、螺旋刀片拔出或穿破股骨头关节面等并发症发生。根据Sanders等评分标准评定,获优22例,良6例,差2例,优良率93.3%。结论闭合复位PFNA内固定是一种治疗股骨逆转子间骨折的有效方法,具有骨折愈合率高、软组织损伤小、可早期功能锻炼、并发症少等优点。
