Research progress of lateral wall injury of intertrochanteric fracture_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WU Jianchao , SHI Zhengwei , LI Jipeng , XU Shaoce , WANG Shiyao ,  WANG Yuliang

Department of Orthopedics, the Second Affiliated Hospital of Lanzhou University, Lanzhou Gansu, 730030, P.R.China;

Corresponding author：

WANG Yuliang, Email: wy160918@sina.com

Keywords：

Intertrochanteric fracture; fracture fixation; lateral wall

DOI：

10.7507/1002-1892.201806115

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To summarize the general concept of lateral wall, the causes of lateral wall injury, and surgical strategies in order to improve the understanding of lateral wall and reduce the complications of operation. Methods The related literature on lateral wall was extensively reviewed, summarized, and analyzed. Results The superior extent of the lateral wall is vastus lateralis ridge and the inferior extent is the intersection between the lateral femoral cortex and a line drawn at a tangent to the inferior femoral neck. The integrity of the lateral wall is important to prevent the failure of fixation and reoperation of intertrochanteric fractures. The main causes of injury are that there is no suitable typing criteria as a guide, the fracture pattern shown by X-ray does not match with the actual situation of the fracture, the type of fracture is special, and the operation is improper. The main treatment is to reconstruct the lateral wall and choose different reconstruction methods according to different fracture patterns. Conclusion The lateral wall is very important for the treatment of intertrochanteric fracture. Lateral wall fracture should be internal fixation in order to minimize the risk of reoperation.

Citation： WU Jianchao, SHI Zhengwei, LI Jipeng, XU Shaoce, WANG Shiyao, WANG Yuliang. Research progress of lateral wall injury of intertrochanteric fracture. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(12): 1605-1610. doi: 10.7507/1002-1892.201806115 Copy

1.	Tan WL, Low SL, Shen L, et al. Osteoporotic hip fractures: 10-year review in a Singaporean hospital. J Orthop Surg (Hong Kong), 2015, 23(2): 150-154.
2.	Kanakaris NK, Noviello C, Saeed Z, et al. Preliminary results of the treatment of proximal femoral fractures with the AFFIXUS nail. Injury, 2015, 46(Suppl 5): S12-S17.
3.	Gotfried Y. The lateral trochanteric wall: a key element in the reconstruction of unstable pertrochanteric hip fractures. Clin Orthop Relat Res, 2004, (425): 82-86.
4.	Haidukewych GJ. Intertrochanteric fractures: ten tips to improve results. J Bone Joint Surg (Am), 2009, 91(3): 712-719.
5.	Palm H, Jacobsen S, Sonne-Holm S, et al. Integrity of the lateral femoral wall in intertrochanteric hip fractures: an important predictor of a reoperation. J Bone Joint Surg (Am), 2007, 89(3): 470-475.
6.	Abram SG, Pollard TC, Andrade AJ. Inadequate ‘three-point’ proximal fixation predicts failure of the Gamma nail. Bone Joint J, 2013, 95-B(6): 825-830.
7.	张世民, 马卓, 杜守超, 等. 股骨近端外侧壁的解剖学研究及其对转子间骨折内固定的意义. 中国临床解剖学杂志, 2016, 34(1): 39-42.
8.	Haq RU, Manhas V, Pankaj A, et al. Proximal femoral nails compared with reverse distal femoral locking plates in intertrochanteric fractures with a compromised lateral wall; a randomised controlled trial. Int Orthop, 2014, 38(7): 1443-1449.
9.	Ma Z, Chang SM. Letter to the editor: where is the lateral femoral wall. Int Orthop, 2014, 38(12): 2645-2646.
10.	Haq UI R, Manhas V, Pankaj A, et al. Authors response: the lateral femoral wall. Int Orthop, 2015, 39(3): 613-614.
11.	戴骏琪. 一种评估髓内钉治疗股骨粗隆间骨折所致外侧壁破裂风险的影像学指标. 苏州: 苏州大学, 2015.
12.	张英琪, 张世民, 熊文峰, 等. 股骨近端外侧壁的骨折特征地图研究. 中国临床解剖学杂志, 2017, 35(2): 121-125.
13.	Gao Z, Lv Y, Zhou F, et al. Risk factors for implant failure after fixation of proximal femoral fractures with fracture of the lateral femoral wall. Injury, 2018, 49(2): 315-322.
14.	Hsu CE, Shih CM, Wang CC, et al. Lateral femoral wall thickness. A reliable predictor of post-operative lateral wall fracture in intertrochanteric fractures. Bone Joint J, 2013, 95-B(8): 1134-1138.
15.	Hsu CE, Chiu YC, Tsai SH, et al. Trochanter stabilising plate improves treatment outcomes in AO/OTA 31-A2 intertrochanteric fractures with critical thin femoral lateral walls. Injury, 2015, 46(6): 1047-1053.
16.	Pradeep AR, KiranKumar A, Dheenadhayalan J, et al. Intraoperative lateral wall fractures during Dynamic Hip Screw fixation for intertrochanteric fractures-Incidence, causative factors and clinical outcome. Injury, 2018, 49(2): 334-338.
17.	Sun LL, Li Q, Chang SM. The thickness of proximal lateral femoral wall. Injury, 2016, 47(3): 784-785.
18.	Sharma G, Singh R, Gn KK, et al. Which AO/OTA 31-A2 pertrochanteric fractures can be treated with a dynamic hip screw without developing a lateral wall fracture? A CT-based study. Int Orthop, 2016, 40(5): 1009-1017.
19.	Kellam JF, Meinberg EG, Agel J, et al. Introduction: fracture and dislocation classification compendium-2018: international comprehensive classification of fractures and dislocations committee. J Orthop Trauma, 2018, 32(Suppl 1): S1-S10.
20.	侯宇, 姚琦, 张亘瑷, 等. 第 3 代 Gamma 钉拉力螺钉钉尾距股骨外侧皮质距离与术后拉力螺钉移位或切出关系研究. 中国修复重建外科杂志, 2018, 32(1): 40-44.
21.	顾海伦, 杨军, 王维, 等. 不稳定型股骨转子间外侧壁骨折的治疗策略. 中华创伤骨科杂志, 2016, 18(8): 679-684.
22.	Futamura K, Baba T, Homma Y, et al. New classification focusing on the relationship between the attachment of the iliofemoral ligament and the course of the fracture line for intertrochanteric fractures. Injury, 2016, 47(8): 1685-1691.
23.	Ma Z, Yao XZ, Chang SM. The classification of intertrochanteric fractures based on the integrity of lateral femoral wall: Letter to the editor, Fracture morphology of AO/OTA 31-A trochanteric fractures: A 3D CT study with an emphasis on coronal fragments. Injury, 2017, 48(10): 2367-2368.
24.	Shoda E, Kitada S, Sasaki Y, et al. Proposal of new classification of femoral trochanteric fracture by three-dimensional computed tomography and relationship to usual plain X-ray classification. J Orthop Surg (Hong Kong), 2017, 25(1): 2309499017692700.
25.	Cho JW, Kent WT, Yoon YC, et al. Fracture morphology of AO/OTA 31-A trochanteric fractures: A 3D CT study with an emphasis on coronal fragments. Injury, 2017, 48(2): 277-284.
26.	张世民, 祝晓忠, 黄轶刚, 等. 外侧壁危险型股骨粗隆间骨折 DHS 与 PFNA 治疗的回顾性对比研究. 中国矫形外科杂志, 2010, 18(22): 1868-1872.
27.	Tan BY, Lau AC, Kwek EB. Morphology and fixation pitfalls of a highly unstable intertrochanteric fracture variant. J Orthop Surg (Hong Kong), 2015, 23(2): 142-145.
28.	Sharma G, Gn KK, Khatri K, et al. Morphology of the posteromedial fragment in pertrochanteric fractures: A three-dimensional computed tomography analysis. Injury, 2017, 48(2): 419-431.
29.	Joshi D, Dhamangaonkar AC, Ramawat S, et al. Predictors of iatrogenic lateral wall fractures while treating intertrochanteric fracture femur with the dynamic hip screw system in Indian patients. Eur J Orthop Surg Traumatol, 2015, 25(4): 677-682.
30.	Boopalan PR, Oh JK, Kim TY, et al. Incidence and radiologic outcome of intraoperative lateral wall fractures in OTA 31A1 and A2 fractures treated with cephalomedullary nailing. J Orthop Trauma, 2012, 26(11): 638-642.
31.	Zhou F, Zhang ZS, Yang H, et al. Less invasive stabilization system (LISS) versus proximal femoral nail anti-rotation (PFNA) in treating proximal femoral fractures: a prospective randomized study. J Orthop Trauma, 2012, 26(3): 155-162.
32.	Gadegone WM, Shivashankar B, Lokhande V, et al. Augmentation of proximal femoral nail in unstable trochanteric fractures. SICOT J, 2017, 3: 12.
33.	Kim Y, Bahk WJ, Yoon YC, et al. Radiologic healing of lateral femoral wall fragments after intramedullary nail fixation for A3.3 intertrochanteric fractures. Arch Orthop Trauma Surg, 2015, 135(10): 1349-1356.
34.	Ciufo DJ, Zaruta DA, Lipof JS, et al. Risk factors associated with cephalomedullary nail cutout in the treatment of trochanteric hip fractures. J Orthop Trauma, 2017, 31(11): 583-588.
35.	王志钢, 徐晓峰, 陈奇, 等. 股骨近端外侧壁重建对 A3 型股骨转子间骨折手术疗效的影响. 华中科技大学学报(医学版), 2017, 46(3): 332-335.
36.	Matre K, Vinje T, Havelin LI, et al. TRIGEN INTERTAN intramedullary nail versus sliding hip screw: a prospective, randomized multicenter study on pain, function, and complications in 684 patients with an intertrochanteric or subtrochanteric fracture and one year of follow-up. J Bone Joint Surg (Am), 2013, 95(3): 200-208.
37.	Reindl R, Harvey EJ, Berry GK, et al. Intramedullary versus extramedullary fixation for unstable intertrochanteric fractures: a prospective randomized controlled trial. J Bone Joint Surg (Am), 2015, 97(23): 1905-1912.
38.	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.
39.	Langford J, Pillai G, Ugliailoro AD, et al. Perioperative lateral trochanteric wall fractures: sliding hip screw versus percutaneous compression plate for intertrochanteric hip fractures. J Orthop Trauma, 2011, 25(4): 191-195.
40.	顾家烨, 周正明, 殷小军, 等. 经皮加压钢板与股骨近端防旋髓内钉治疗老年股骨转子间骨折的疗效比较. 中华创伤骨科杂志, 2015, 17(8): 730-733.
41.	唐天华, 谭文成, 唐三元, 等. 经皮加压钢板与动力髋螺钉治疗股骨转子间骨折的 Meta 分析. 中国矫形外科杂志, 2015, 23(16): 1454-1460.
42.	李晓彬, 郭建邦, 刘展亮, 等. 股骨近端锁定加压接骨板与 Gamma 钉固定治疗老年稳定型股骨转子间骨折的疗效比较. 中华创伤骨科杂志, 2014, 16(11): 1004-1006.
43.	唐佩福. 股骨转子间骨折的治疗进展与策略. 中华创伤骨科杂志, 2017, 19(2): 93-94.
44.	张世民. 股骨粗隆间骨折中外侧壁的概念及其临床意义. 中国矫形外科杂志, 2010, 18(17): 1489-1492.
45.	向川, 郝耀, 杨宇君, 等. 人工髋关节置换术与内固定术治疗老年股骨粗隆间骨折的 META 分析. 中国矫形外科杂志, 2013, 21(14): 1384-1391.
46.	梅汉尧, 索鹏, 周永顶, 等. 人工股骨头置换术治疗高龄股骨转子间骨折. 中华创伤骨科杂志, 2006, 8(8): 725-729.
47.	Yang S, Liu Y, Yang T, et al. Early clinical efficacy comparison study of Gamma3 nail, percutaneous compression plate (PCCP) and femoral head replacement (FHR) treatment on senile unstable fractures. J Invest Surg, 2018, 31(2): 130-135.
48.	Díaz VJ, Cañizares AC, Martín IA, et al. Predictive variables of open reduction in intertrochanteric fracture nailing: a report of 210 cases. Injury, 2016, 47(Suppl 3): S51-S55.
49.	Kulkarni SG, Babhulkar SS, Kulkarni SM, et al. Augmentation of intramedullary nailing in unstable intertrochanteric fractures using cerclage wire and lag screws: a comparative study. Injury, 2017, 48(Suppl 2): S18-S22.
50.	Babhulkar S. Unstable trochanteric fractures: Issues and avoiding pitfalls. Injury, 2017, 48(4): 803-818.
51.	Lilly RJ, Koueiter DM, Graner KC, et al. Computer-assisted navigation for intramedullary nail fixation of intertrochanteric femur fractures: A randomized, controlled trial. Injury, 2018, 49(2): 345-350.
52.	Zheng SN, Yao QQ, Mao FY, et al. Application of 3D printing rapid prototyping-assisted percutaneous fixation in the treatment of intertrochanteric fracture. Exp Ther Med, 2017, 14(4): 3644-3650.

1. Tan WL, Low SL, Shen L, et al. Osteoporotic hip fractures: 10-year review in a Singaporean hospital. J Orthop Surg (Hong Kong), 2015, 23(2): 150-154.
2. Kanakaris NK, Noviello C, Saeed Z, et al. Preliminary results of the treatment of proximal femoral fractures with the AFFIXUS nail. Injury, 2015, 46(Suppl 5): S12-S17.
3. Gotfried Y. The lateral trochanteric wall: a key element in the reconstruction of unstable pertrochanteric hip fractures. Clin Orthop Relat Res, 2004, (425): 82-86.
4. Haidukewych GJ. Intertrochanteric fractures: ten tips to improve results. J Bone Joint Surg (Am), 2009, 91(3): 712-719.
5. Palm H, Jacobsen S, Sonne-Holm S, et al. Integrity of the lateral femoral wall in intertrochanteric hip fractures: an important predictor of a reoperation. J Bone Joint Surg (Am), 2007, 89(3): 470-475.
6. Abram SG, Pollard TC, Andrade AJ. Inadequate ‘three-point’ proximal fixation predicts failure of the Gamma nail. Bone Joint J, 2013, 95-B(6): 825-830.
7. 张世民, 马卓, 杜守超, 等. 股骨近端外侧壁的解剖学研究及其对转子间骨折内固定的意义. 中国临床解剖学杂志, 2016, 34(1): 39-42.
8. Haq RU, Manhas V, Pankaj A, et al. Proximal femoral nails compared with reverse distal femoral locking plates in intertrochanteric fractures with a compromised lateral wall; a randomised controlled trial. Int Orthop, 2014, 38(7): 1443-1449.
9. Ma Z, Chang SM. Letter to the editor: where is the lateral femoral wall. Int Orthop, 2014, 38(12): 2645-2646.
10. Haq UI R, Manhas V, Pankaj A, et al. Authors response: the lateral femoral wall. Int Orthop, 2015, 39(3): 613-614.
11. 戴骏琪. 一种评估髓内钉治疗股骨粗隆间骨折所致外侧壁破裂风险的影像学指标. 苏州: 苏州大学, 2015.
12. 张英琪, 张世民, 熊文峰, 等. 股骨近端外侧壁的骨折特征地图研究. 中国临床解剖学杂志, 2017, 35(2): 121-125.
13. Gao Z, Lv Y, Zhou F, et al. Risk factors for implant failure after fixation of proximal femoral fractures with fracture of the lateral femoral wall. Injury, 2018, 49(2): 315-322.
14. Hsu CE, Shih CM, Wang CC, et al. Lateral femoral wall thickness. A reliable predictor of post-operative lateral wall fracture in intertrochanteric fractures. Bone Joint J, 2013, 95-B(8): 1134-1138.
15. Hsu CE, Chiu YC, Tsai SH, et al. Trochanter stabilising plate improves treatment outcomes in AO/OTA 31-A2 intertrochanteric fractures with critical thin femoral lateral walls. Injury, 2015, 46(6): 1047-1053.
16. Pradeep AR, KiranKumar A, Dheenadhayalan J, et al. Intraoperative lateral wall fractures during Dynamic Hip Screw fixation for intertrochanteric fractures-Incidence, causative factors and clinical outcome. Injury, 2018, 49(2): 334-338.
17. Sun LL, Li Q, Chang SM. The thickness of proximal lateral femoral wall. Injury, 2016, 47(3): 784-785.
18. Sharma G, Singh R, Gn KK, et al. Which AO/OTA 31-A2 pertrochanteric fractures can be treated with a dynamic hip screw without developing a lateral wall fracture? A CT-based study. Int Orthop, 2016, 40(5): 1009-1017.
19. Kellam JF, Meinberg EG, Agel J, et al. Introduction: fracture and dislocation classification compendium-2018: international comprehensive classification of fractures and dislocations committee. J Orthop Trauma, 2018, 32(Suppl 1): S1-S10.
20. 侯宇, 姚琦, 张亘瑷, 等. 第 3 代 Gamma 钉拉力螺钉钉尾距股骨外侧皮质距离与术后拉力螺钉移位或切出关系研究. 中国修复重建外科杂志, 2018, 32(1): 40-44.
21. 顾海伦, 杨军, 王维, 等. 不稳定型股骨转子间外侧壁骨折的治疗策略. 中华创伤骨科杂志, 2016, 18(8): 679-684.
22. Futamura K, Baba T, Homma Y, et al. New classification focusing on the relationship between the attachment of the iliofemoral ligament and the course of the fracture line for intertrochanteric fractures. Injury, 2016, 47(8): 1685-1691.
23. Ma Z, Yao XZ, Chang SM. The classification of intertrochanteric fractures based on the integrity of lateral femoral wall: Letter to the editor, Fracture morphology of AO/OTA 31-A trochanteric fractures: A 3D CT study with an emphasis on coronal fragments. Injury, 2017, 48(10): 2367-2368.
24. Shoda E, Kitada S, Sasaki Y, et al. Proposal of new classification of femoral trochanteric fracture by three-dimensional computed tomography and relationship to usual plain X-ray classification. J Orthop Surg (Hong Kong), 2017, 25(1): 2309499017692700.
25. Cho JW, Kent WT, Yoon YC, et al. Fracture morphology of AO/OTA 31-A trochanteric fractures: A 3D CT study with an emphasis on coronal fragments. Injury, 2017, 48(2): 277-284.
26. 张世民, 祝晓忠, 黄轶刚, 等. 外侧壁危险型股骨粗隆间骨折 DHS 与 PFNA 治疗的回顾性对比研究. 中国矫形外科杂志, 2010, 18(22): 1868-1872.
27. Tan BY, Lau AC, Kwek EB. Morphology and fixation pitfalls of a highly unstable intertrochanteric fracture variant. J Orthop Surg (Hong Kong), 2015, 23(2): 142-145.
28. Sharma G, Gn KK, Khatri K, et al. Morphology of the posteromedial fragment in pertrochanteric fractures: A three-dimensional computed tomography analysis. Injury, 2017, 48(2): 419-431.
29. Joshi D, Dhamangaonkar AC, Ramawat S, et al. Predictors of iatrogenic lateral wall fractures while treating intertrochanteric fracture femur with the dynamic hip screw system in Indian patients. Eur J Orthop Surg Traumatol, 2015, 25(4): 677-682.
30. Boopalan PR, Oh JK, Kim TY, et al. Incidence and radiologic outcome of intraoperative lateral wall fractures in OTA 31A1 and A2 fractures treated with cephalomedullary nailing. J Orthop Trauma, 2012, 26(11): 638-642.
31. Zhou F, Zhang ZS, Yang H, et al. Less invasive stabilization system (LISS) versus proximal femoral nail anti-rotation (PFNA) in treating proximal femoral fractures: a prospective randomized study. J Orthop Trauma, 2012, 26(3): 155-162.
32. Gadegone WM, Shivashankar B, Lokhande V, et al. Augmentation of proximal femoral nail in unstable trochanteric fractures. SICOT J, 2017, 3: 12.
33. Kim Y, Bahk WJ, Yoon YC, et al. Radiologic healing of lateral femoral wall fragments after intramedullary nail fixation for A3.3 intertrochanteric fractures. Arch Orthop Trauma Surg, 2015, 135(10): 1349-1356.
34. Ciufo DJ, Zaruta DA, Lipof JS, et al. Risk factors associated with cephalomedullary nail cutout in the treatment of trochanteric hip fractures. J Orthop Trauma, 2017, 31(11): 583-588.
35. 王志钢, 徐晓峰, 陈奇, 等. 股骨近端外侧壁重建对 A3 型股骨转子间骨折手术疗效的影响. 华中科技大学学报(医学版), 2017, 46(3): 332-335.
36. Matre K, Vinje T, Havelin LI, et al. TRIGEN INTERTAN intramedullary nail versus sliding hip screw: a prospective, randomized multicenter study on pain, function, and complications in 684 patients with an intertrochanteric or subtrochanteric fracture and one year of follow-up. J Bone Joint Surg (Am), 2013, 95(3): 200-208.
37. Reindl R, Harvey EJ, Berry GK, et al. Intramedullary versus extramedullary fixation for unstable intertrochanteric fractures: a prospective randomized controlled trial. J Bone Joint Surg (Am), 2015, 97(23): 1905-1912.
38. 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.
39. Langford J, Pillai G, Ugliailoro AD, et al. Perioperative lateral trochanteric wall fractures: sliding hip screw versus percutaneous compression plate for intertrochanteric hip fractures. J Orthop Trauma, 2011, 25(4): 191-195.
40. 顾家烨, 周正明, 殷小军, 等. 经皮加压钢板与股骨近端防旋髓内钉治疗老年股骨转子间骨折的疗效比较. 中华创伤骨科杂志, 2015, 17(8): 730-733.
41. 唐天华, 谭文成, 唐三元, 等. 经皮加压钢板与动力髋螺钉治疗股骨转子间骨折的 Meta 分析. 中国矫形外科杂志, 2015, 23(16): 1454-1460.
42. 李晓彬, 郭建邦, 刘展亮, 等. 股骨近端锁定加压接骨板与 Gamma 钉固定治疗老年稳定型股骨转子间骨折的疗效比较. 中华创伤骨科杂志, 2014, 16(11): 1004-1006.
43. 唐佩福. 股骨转子间骨折的治疗进展与策略. 中华创伤骨科杂志, 2017, 19(2): 93-94.
44. 张世民. 股骨粗隆间骨折中外侧壁的概念及其临床意义. 中国矫形外科杂志, 2010, 18(17): 1489-1492.
45. 向川, 郝耀, 杨宇君, 等. 人工髋关节置换术与内固定术治疗老年股骨粗隆间骨折的 META 分析. 中国矫形外科杂志, 2013, 21(14): 1384-1391.
46. 梅汉尧, 索鹏, 周永顶, 等. 人工股骨头置换术治疗高龄股骨转子间骨折. 中华创伤骨科杂志, 2006, 8(8): 725-729.
47. Yang S, Liu Y, Yang T, et al. Early clinical efficacy comparison study of Gamma3 nail, percutaneous compression plate (PCCP) and femoral head replacement (FHR) treatment on senile unstable fractures. J Invest Surg, 2018, 31(2): 130-135.
48. Díaz VJ, Cañizares AC, Martín IA, et al. Predictive variables of open reduction in intertrochanteric fracture nailing: a report of 210 cases. Injury, 2016, 47(Suppl 3): S51-S55.
49. Kulkarni SG, Babhulkar SS, Kulkarni SM, et al. Augmentation of intramedullary nailing in unstable intertrochanteric fractures using cerclage wire and lag screws: a comparative study. Injury, 2017, 48(Suppl 2): S18-S22.
50. Babhulkar S. Unstable trochanteric fractures: Issues and avoiding pitfalls. Injury, 2017, 48(4): 803-818.
51. Lilly RJ, Koueiter DM, Graner KC, et al. Computer-assisted navigation for intramedullary nail fixation of intertrochanteric femur fractures: A randomized, controlled trial. Injury, 2018, 49(2): 345-350.
52. Zheng SN, Yao QQ, Mao FY, et al. Application of 3D printing rapid prototyping-assisted percutaneous fixation in the treatment of intertrochanteric fracture. Exp Ther Med, 2017, 14(4): 3644-3650.

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