BACKGROUND Closed reduction and internal fixation with intramedullary nails has been widely accepted for treating intertrochanteric fractures.AIM To focus on how to avoid displacement of the lesser trochanter in unsta...BACKGROUND Closed reduction and internal fixation with intramedullary nails has been widely accepted for treating intertrochanteric fractures.AIM To focus on how to avoid displacement of the lesser trochanter in unstable intertrochanteric fractures.METHODS We developed a lesser trochanteric reduction fixator for treating intertrochanteric fractures through fixing the lesser trochanter by combining the loop plate through the fixator after reduction by the reducer.Five patients with intertrochanteric fractures treated with the newly developed lesser trochanteric reduction fixator and loop plate combined with intramedullary nails,and 20 patients with intertrochanteric fractures treated with simple intramedullary nails were selected from December 2020 to March 2021.RESULTS The postoperative Harris hip score was significantly higher in patients treated with the lesser trochanteric reduction fixator than in patients treated without the lesser trochanteric reduction fixator,which indicated that this lesser trochanteric reduction fixator had a positive impact on rehabilitation of the hip joint after surgery and could significantly improve the quality of life of patients.CONCLUSION We fully realize the significance of trochanteric reduction and fixation,namely,reconstruction of structures under pressure,in the treatment of intertrochanteric fractures.As long as the general condition of patients is favorable and they are willing to undergo surgery,fixation of the main fracture end should be performed and the lesser trochanter should be reduced and fixed at the same time.展开更多
Background The trochanteric fixation nail （TFN） can be used to treat stable and unstable fractures of intertrochanteric hip fractures.We study the common lateral migration that occurs with telescoping of intertrocha...Background The trochanteric fixation nail （TFN） can be used to treat stable and unstable fractures of intertrochanteric hip fractures.We study the common lateral migration that occurs with telescoping of intertrochanteric hip fractures treated with TFN and identify the predictors and relationships to clinical outcomes.Methods Patient demographic information,fracture type （Arbeitsgemeinschaft f＆#252;r Osteosynthesefragen （AO）/Orthopaedic Trauma Association （OTA） classification）,radiographic data,and clinical data were collected.Lateral migration with telescoping was measured.Statistical analyses were performed to determine which variables predicted lateral migration with telescoping.Patient outcome scores were recorded using the Modified Harris Hip Score （MHHS）,Hip Outcome Score-Activity of Daily Living （HOS-ADL）,and Visual Analog Scale for pain.Results Two hundred and twenty-three patients （67 males,156 females） fitted the radiographic and follow-up （average 24.6 months） criteria.The average age was 77.2 years.The average lateral migration with telescoping was 4.8 mm.Twenty-one patients （9.4%） had excessive lateral migration with telescoping （≥10 mm）.The quality of calcar reduction （P=0.01） and unstable fracture patterns （P=0.006） were significant predictive factors of lateral migration with telescoping.The mean outcome scores （MHHS and HOS-ADL） were 80.1 points and 78.7 points,respectively.All subjects had no significant relationship to lateral migration with telescoping （P 〉0.05）.Of all the patients who developed lateral migration with telescoping,only one required removal of the blade for hip pain and all patients went on to uneventful union at an average time of 4.5 months.Conclusions Lateral migration with telescoping is a common mechanical complication of intertrochanteric hip fracture treated with the TFN procedure.It was predicted by the quality of calcar reduction and fracture type.However,this did not affect stable fixation and fracture healing,so rarely leads to clinical problems.展开更多
目的评估有限切开、微创复位工具辅助复位并股骨近端防旋髓内钉(proximal femoral nail anti-rotation,PFNA)内固定治疗难以闭合复位的老年股骨转子间骨折的临床效果以及手术技巧。方法回顾性分析2014年7月—2015年12月期间采用该方法...目的评估有限切开、微创复位工具辅助复位并股骨近端防旋髓内钉(proximal femoral nail anti-rotation,PFNA)内固定治疗难以闭合复位的老年股骨转子间骨折的临床效果以及手术技巧。方法回顾性分析2014年7月—2015年12月期间采用该方法手术的23例老年股骨转子间骨折患者。分析患者的年龄、性别、骨折分型、手术时间、术中出血、复位质量、骨折愈合时间以及并发症等,特别是骨折复位丢失和不愈合。结果根据股骨转子间骨折的AO/ASIF分型标准,A1.3型3例,A2.2型8例,A2.3型12例。平均手术时间(47.2±5.5)min(42~61 min),平均术中出血(56.4±7.6)m L(45~70 m L),所有患者在随访期内达到骨折愈合,平均愈合时间(14.5±1.7)周(12~17周)。术后X光显示21例颈干角在正常范围,2例出现轻度髋内翻。所有患者复位后骨折端移位<3 mm,顶尖距均小于25 mm。1例患者术后出现下肢长度偏差超过1 cm,2例患者出现下肢远端旋转较对侧偏差超过15°。结论有限切开、微创复位工具辅助复位PFNA内固定的方法治疗闭合复位困难的老年股骨转子间骨折,骨折复位质量高,创伤小,安全可行。展开更多
文摘BACKGROUND Closed reduction and internal fixation with intramedullary nails has been widely accepted for treating intertrochanteric fractures.AIM To focus on how to avoid displacement of the lesser trochanter in unstable intertrochanteric fractures.METHODS We developed a lesser trochanteric reduction fixator for treating intertrochanteric fractures through fixing the lesser trochanter by combining the loop plate through the fixator after reduction by the reducer.Five patients with intertrochanteric fractures treated with the newly developed lesser trochanteric reduction fixator and loop plate combined with intramedullary nails,and 20 patients with intertrochanteric fractures treated with simple intramedullary nails were selected from December 2020 to March 2021.RESULTS The postoperative Harris hip score was significantly higher in patients treated with the lesser trochanteric reduction fixator than in patients treated without the lesser trochanteric reduction fixator,which indicated that this lesser trochanteric reduction fixator had a positive impact on rehabilitation of the hip joint after surgery and could significantly improve the quality of life of patients.CONCLUSION We fully realize the significance of trochanteric reduction and fixation,namely,reconstruction of structures under pressure,in the treatment of intertrochanteric fractures.As long as the general condition of patients is favorable and they are willing to undergo surgery,fixation of the main fracture end should be performed and the lesser trochanter should be reduced and fixed at the same time.
文摘Background The trochanteric fixation nail （TFN） can be used to treat stable and unstable fractures of intertrochanteric hip fractures.We study the common lateral migration that occurs with telescoping of intertrochanteric hip fractures treated with TFN and identify the predictors and relationships to clinical outcomes.Methods Patient demographic information,fracture type （Arbeitsgemeinschaft f＆#252;r Osteosynthesefragen （AO）/Orthopaedic Trauma Association （OTA） classification）,radiographic data,and clinical data were collected.Lateral migration with telescoping was measured.Statistical analyses were performed to determine which variables predicted lateral migration with telescoping.Patient outcome scores were recorded using the Modified Harris Hip Score （MHHS）,Hip Outcome Score-Activity of Daily Living （HOS-ADL）,and Visual Analog Scale for pain.Results Two hundred and twenty-three patients （67 males,156 females） fitted the radiographic and follow-up （average 24.6 months） criteria.The average age was 77.2 years.The average lateral migration with telescoping was 4.8 mm.Twenty-one patients （9.4%） had excessive lateral migration with telescoping （≥10 mm）.The quality of calcar reduction （P=0.01） and unstable fracture patterns （P=0.006） were significant predictive factors of lateral migration with telescoping.The mean outcome scores （MHHS and HOS-ADL） were 80.1 points and 78.7 points,respectively.All subjects had no significant relationship to lateral migration with telescoping （P 〉0.05）.Of all the patients who developed lateral migration with telescoping,only one required removal of the blade for hip pain and all patients went on to uneventful union at an average time of 4.5 months.Conclusions Lateral migration with telescoping is a common mechanical complication of intertrochanteric hip fracture treated with the TFN procedure.It was predicted by the quality of calcar reduction and fracture type.However,this did not affect stable fixation and fracture healing,so rarely leads to clinical problems.
