Clinical study on reduction of difficult-reducing intertrochanteric fracture with ball head screw driver of proximal femoral nail antirotation_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHENG Zhanle ¹ , LIU Huan ¹ , YU Xian ² , LI Sheng ¹ ,  ZHANG Yingze ¹

1. Department of Trauma Emergency Center, Key Laboratory of Orthopaedics, the Third Hospital of Hebei Medical University, Shijiazhuang Hebei, 050051, P.R.China;
2. Department of Endocrinology, Hebei General Hospital, Shijiazhuang Hebei, 050051, P.R.China;

Corresponding author：

ZHANG Yingze, Email: yzling_liu@163.com

Keywords：

Intertrochanteric fracture; proximal femoral nail antirotation; reduction; internal fixation

DOI：

10.7507/1002-1892.201805002

Video：

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Objective To evaluate the effectiveness of the leverage reduction with proximal femoral nail antirotation (PFNA) ball head screw driver for difficult-reducing intertrochanteric fracture.Methods The clinical data of 8 patients with difficult-reducing intertrochanteric fractures between July 2015 and February 2018 were retrospectively analysed. There were 3 males and 5 females, aged 66-89 years, with an average age of 76.3 years. According to Evans classification, there were 3 cases of type Ⅲ and 5 cases of type Ⅳ. The time from injury to operation was 2-8 days (mean, 3.9 days). All patients were reducted with ball head screw driver leverage through PFNA proximal incision during operation. The operation time, intraoperative blood loss, reduction time, and fluoroscopy times were recorded. Harris hip function score was used to evaluate the effectiveness at last follow-up.Results The operation time was 52.5-83.7 minutes (mean, 68.1 minutes), the intraoperative blood loss was 49.8-96.4 mL (mean, 73.1 mL), the reduction time was 3.7-9.1 minutes (mean, 6.4 minutes), and the fluoroscopy times were 18.4-27.4 times (mean, 22.9 times). Patients were followed up 6-18 months (mean, 9.6 months). Postoperative X-ray films showed that the fracture obtained good reduction. No fracture displacement, fixation failure, and coxa vara occurred after operation. Fracture healing time was 3-6 months (mean, 4.6 months). At last follow-up, the Harris hip function score was 85-96 (mean, 91.6), with a result of excellent in 6 cases and good in 2 cases.Conclusion The reduction of difficult-reducing intertrochanteric fracture by using ball head screw driver can obtain good reduction and reliable fixation. The method has such advantages as no more incision, and less blood loss and soft tissue injury.

Citation： ZHENG Zhanle, LIU Huan, YU Xian, LI Sheng, ZHANG Yingze. Clinical study on reduction of difficult-reducing intertrochanteric fracture with ball head screw driver of proximal femoral nail antirotation. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(10): 1250-1253. doi: 10.7507/1002-1892.201805002 Copy

1.	田伟. 积水潭实用骨科学. 北京: 人民卫生出版社, 2008: 777-780.
2.	Yang X, Wu Q, Wang X. Investigation of perioperative hidden blood loss of unstable intertrochanteric fracture in the elderly treated with different intramedullary fixations. Injury, 2017, 48(8): 1848-1852.
3.	Xue D, Yu J, Zheng Q, et al. The treatment strategies of intertrochanteric fractures nonunion: An experience of 23 nonunion patients. Injury, 2017, 48(3): 708-714.
4.	李景光, 章平治, 徐名洪, 等. 侧卧位斯氏针撬拨、PFNA 内固定治疗不易复位的股骨粗隆间骨折. 创伤外科杂志, 2019, 21(6): 431-434.
5.	张英泽. 临床骨折分型. 北京: 人民卫生出版社, 2013: 374-385.
6.	Evans EM. The treatment of trochanteric fractures of the femur. J Bone Joint Surg (Br), 1949, 31B(2): 190-203.
7.	Ovre S, Sandvik L, Madsen JE, et al. Modification of the Harris Hip Score in acetabular fracture treatment. Injury, 2007, 38(3): 344-349.
8.	沈光银. 防旋股骨近端髓内钉与动力髋螺钉治疗老年股骨粗隆间骨折疗效比较. 中国修复重建外科杂志, 2012, 26(6): 671-674.
9.	石永新, 李富琴, 谭文甫, 等. 股骨近端防旋髓内钉与锁定加压接骨板治疗老年外侧壁薄弱型股骨粗隆间骨折疗效比较. 中国修复重建外科杂志, 2014, 28(10): 1199-1203.
10.	张舒. 髓内固定术对老年股骨粗隆间骨折患者股骨头旋转及固定钉滑脱的影响研究. 中国骨与关节杂志, 2019, 8(6): 465-469.
11.	方成, 赵文, 甘泉, 等. 侧卧位 PFNA 技术治疗 Evans Ⅱ 型股骨转子间骨折. 中国矫形外科杂志, 2019, (14): 1327-1329.
12.	房巍, 孙从府, 侯全运, 等. 髓内与髓外固定治疗老年股骨转子间骨折. 中国矫形外科杂志, 2019, 27(14): 1335-1337.
13.	李明东, 胡稷杰, 黎早敏, 等. 不同手术方式治疗老年股骨粗隆间骨折的疗效比较. 中国修复重建外科杂志, 2017, 31(6): 653-658.
14.	马坤龙, 王绚, 栾富均, 等. 股骨近端防旋髓内钉、动力髋螺钉、伽马钉治疗股骨转子间骨折的系统评价. 华西医学, 2013, 28(3): 345-351.
15.	Xu Z, Zhang M, Yin J, et al. Redisplacement after reduction with intramedullary nails in surgery of intertrochanteric fracture: cause analysis and preventive measures. Arch Orthop Trauma Surg, 2015, 135(6): 751-758.
16.	侯宇, 姚琦, 张亘瑷, 等. 第三代 Gamma 钉与防旋股骨近端髓内钉治疗股骨粗隆间骨折术后股骨近端短缩的比较研究. 中国修复重建外科杂志, 2018, 32(3): 338-345.
17.	施保华, 尹峰. 复杂股骨粗隆间骨折的复位策略与手术技巧. 中国骨与关节损伤杂志, 2013, 28(8): 769-770.
18.	Ulmar B, Simon S, Stratos I, et al. Repositioning, reduction and surgical approaches for subtrochanteric femoral fractures. Unfallchirurg, 2013, 116(12): 1115-1122.
19.	范永前, 梁承伟, 林伟龙, 等. 股骨粗隆间骨折复位过程中旋转控制策略. 中国骨与关节损伤杂志, 2012, 27(12): 1081-1083.
20.	Perez EA, Jahangir AA, Mashru RP, et al. Is there a gluteus medius tendon injury during reaming through a modified medial trochanteric portal? A cadaver study J Orthop Trauma, 2007, 21(9): 617-620.

1. 田伟. 积水潭实用骨科学. 北京: 人民卫生出版社, 2008: 777-780.
2. Yang X, Wu Q, Wang X. Investigation of perioperative hidden blood loss of unstable intertrochanteric fracture in the elderly treated with different intramedullary fixations. Injury, 2017, 48(8): 1848-1852.
3. Xue D, Yu J, Zheng Q, et al. The treatment strategies of intertrochanteric fractures nonunion: An experience of 23 nonunion patients. Injury, 2017, 48(3): 708-714.
4. 李景光, 章平治, 徐名洪, 等. 侧卧位斯氏针撬拨、PFNA 内固定治疗不易复位的股骨粗隆间骨折. 创伤外科杂志, 2019, 21(6): 431-434.
5. 张英泽. 临床骨折分型. 北京: 人民卫生出版社, 2013: 374-385.
6. Evans EM. The treatment of trochanteric fractures of the femur. J Bone Joint Surg (Br), 1949, 31B(2): 190-203.
7. Ovre S, Sandvik L, Madsen JE, et al. Modification of the Harris Hip Score in acetabular fracture treatment. Injury, 2007, 38(3): 344-349.
8. 沈光银. 防旋股骨近端髓内钉与动力髋螺钉治疗老年股骨粗隆间骨折疗效比较. 中国修复重建外科杂志, 2012, 26(6): 671-674.
9. 石永新, 李富琴, 谭文甫, 等. 股骨近端防旋髓内钉与锁定加压接骨板治疗老年外侧壁薄弱型股骨粗隆间骨折疗效比较. 中国修复重建外科杂志, 2014, 28(10): 1199-1203.
10. 张舒. 髓内固定术对老年股骨粗隆间骨折患者股骨头旋转及固定钉滑脱的影响研究. 中国骨与关节杂志, 2019, 8(6): 465-469.
11. 方成, 赵文, 甘泉, 等. 侧卧位 PFNA 技术治疗 Evans Ⅱ 型股骨转子间骨折. 中国矫形外科杂志, 2019, (14): 1327-1329.
12. 房巍, 孙从府, 侯全运, 等. 髓内与髓外固定治疗老年股骨转子间骨折. 中国矫形外科杂志, 2019, 27(14): 1335-1337.
13. 李明东, 胡稷杰, 黎早敏, 等. 不同手术方式治疗老年股骨粗隆间骨折的疗效比较. 中国修复重建外科杂志, 2017, 31(6): 653-658.
14. 马坤龙, 王绚, 栾富均, 等. 股骨近端防旋髓内钉、动力髋螺钉、伽马钉治疗股骨转子间骨折的系统评价. 华西医学, 2013, 28(3): 345-351.
15. Xu Z, Zhang M, Yin J, et al. Redisplacement after reduction with intramedullary nails in surgery of intertrochanteric fracture: cause analysis and preventive measures. Arch Orthop Trauma Surg, 2015, 135(6): 751-758.
16. 侯宇, 姚琦, 张亘瑷, 等. 第三代 Gamma 钉与防旋股骨近端髓内钉治疗股骨粗隆间骨折术后股骨近端短缩的比较研究. 中国修复重建外科杂志, 2018, 32(3): 338-345.
17. 施保华, 尹峰. 复杂股骨粗隆间骨折的复位策略与手术技巧. 中国骨与关节损伤杂志, 2013, 28(8): 769-770.
18. Ulmar B, Simon S, Stratos I, et al. Repositioning, reduction and surgical approaches for subtrochanteric femoral fractures. Unfallchirurg, 2013, 116(12): 1115-1122.
19. 范永前, 梁承伟, 林伟龙, 等. 股骨粗隆间骨折复位过程中旋转控制策略. 中国骨与关节损伤杂志, 2012, 27(12): 1081-1083.
20. Perez EA, Jahangir AA, Mashru RP, et al. Is there a gluteus medius tendon injury during reaming through a modified medial trochanteric portal? A cadaver study J Orthop Trauma, 2007, 21(9): 617-620.

Chinese Journal of Reparative and Reconstructive Surgery

Clinical study on reduction of difficult-reducing intertrochanteric fracture with ball head screw driver of proximal femoral nail antirotation

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