Feasibility study of Kirschner wire-fixation-cortical bone technique in treatment of intertrochanteric fracture_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

TIAN Kewei ¹ , LIU Chao ² , YAN Jiaxiang ³ , FAN Kejie ¹ , MA Wenlong ¹ ,  CHEN Ke ¹

1. No.1 Department of Hip Injury and Disease, Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital), Luoyang Henan, 471000, P.R.China;
2. Department of Pelvic Injury and Disease, Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital), Luoyang Henan, 471000, P.R.China;
3. Department of Geriatric Disease, Luoyang No.1 Hospital of Traditional Chinese Medicine, Luoyang Henan, 471000, P.R.China;

Corresponding author：

CHEN Ke, Email: 29564557@qq.com

Keywords：

Kirschner wire-fixation-cortical bone technique; intertrochanteric fracture; minimally invasive; closed reduction

DOI：

10.7507/1002-1892.201904126

Video：

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Objective To explore the feasibility and effectiveness of maintaining the reduction of unstable intertrochanteric fractures by Kirschner wire-fixation-cortical bone technique. Methods Forty patients with intertrochanteric fracture [AO/Orthopaedic Trauma Association (AO/OTA) type 31-A2.2] admitted between May 2015 and January 2017 and requiring closed reduction and proximal femoral nail antirotation (PFNA) were randomly divided into trial group (intraoperative Kirschner wire-fixation-cortical bone technique group, 20 cases) and control group (conventional treatment group, 20 cases). There was no significant difference in general data of gender, age, side, body mass index, cause of injury, time from injury to operation between the two groups (P>0.05). The operation time, intraoperative blood loss, and intraoperative fluoroscopy times of the two groups were recorded; the reduction quality of fracture was observed according to the corresponding relationship between medial and anterior cortex (positive, neutral, and negative support) of intraoperative fluoroscopy proposed by ZHANG Shimin, and the stability of internal fixation and fracture healing were observed; Harris score was used to evaluate the recovery of hip function at 12 months after operation. Results In the trial group, 6 cases (30%) had 2 Kirschner wires implanted less than 4 times, 7 cases (35%) had 5-8 times, and 7 cases (35%) had 9 times or more. There was no significant difference in operation time and intraoperative blood loss between the two groups (P>0.05), but the blood transfusion volume and intraoperative fluoroscopy times in the trial group were significantly less than those in the control group (P<0.05). Both groups were followed up 13-21 months, with an average of 17 months. There was no complications such as wound infection, deep venous thrombosis of lower extremities, refracture, and internal fixation-related complications. The quality of intraoperative reduction in the trial group was significantly better than that in the control group (Z=–2.794, P=0.024). The Harris score of the trial group was significantly better than that of the control group at 12 months after operation (t=2.98, P=0.01). Conclusion The use of Kirschner wire-fixation-cortical bone technique during intertrochanteric fracture closed reduction and PFNA internal fixation surgery can effectively maintain the reduction effect, reduce the number of fluoroscopy, improve the reduction quality, reduce allogeneic blood input, obtain better hip function, and do not increase the operation time and intraoperative blood loss.

Citation： TIAN Kewei, LIU Chao, YAN Jiaxiang, FAN Kejie, MA Wenlong, CHEN Ke. Feasibility study of Kirschner wire-fixation-cortical bone technique in treatment of intertrochanteric fracture. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(10): 1239-1244. doi: 10.7507/1002-1892.201904126 Copy

1.	张轩轩, 李宝丰, 章莹, 等. 股骨近端防旋髓内钉与髋关节置换术治疗高龄股骨粗隆间骨折 Meta 分析. 实用医学杂志, 2019, 35(6): 903-907.
2.	张世民, 胡孙君, 张立智, 等. 老年髋部转子间骨折. 北京: 科学出版社, 2019: 238.
3.	张世民, 余斌. AO/OTA-2018 版股骨转子间骨折分类的解读与讨论. 中华创伤骨科杂志, 2018, 20(7): 583-587.
4.	姜浩, 李忱, 孙树东. 30 例成人双侧股骨近端形态一致性的研究. 中国实验诊断学, 2018, 22(1): 97-98.
5.	皮益刚, 赵耀超, 王万春, 等. 500 例湖南地区股骨近端形态样本测量分析. 中南大学学报 (医学版), 2013, 38(9): 925-930.
6.	杜守超, 张世民, 张英琪, 等. 不稳定股骨转子间骨折前内侧皮质支撑复位的影像学研究. 中国矫形外科杂志, 2018, 26(18): 1633-1638.
7.	Cho MR, Lee JH, Kwon JB, et al. The effect of positive medial cortical support in reduction of pertrochanteric fractures with posteromedial wall defect using a dynamic hip screw. Clin Orthop Surg, 2018, 10(3): 292-298.
8.	Chang SM, Zhang YQ, Du SC, et al. Anteromedial cortical support reduction in unstable pertrochanteric fractures: a comparison of intra-operative fluoroscopy and post-operative three dimensional computerised tomography reconstruction. Int Orthop, 2018, 42(1): 183-189.
9.	张世民, 张英琪, 李清, 等. 内侧皮质正性支撑复位对老年股骨粗隆间骨折内固定效果的影响. 中国矫形外科杂志, 2014, 22(14): 1256-1261.
10.	Chang SM, Zhang YQ, Ma Z, et al. Fracture reduction with positive medial cortical support: a key element in stability reconstruction for the unstable pertrochanteric hip fractures. Arch Orthop Trauma Surg, 2015, 135(6): 811-818.
11.	李双, 张世民, 张立智, 等. 不同组合前内侧皮质支撑复位对股骨转子间骨折髓内钉术后稳定性影响的生物力学研究. 中华创伤骨科杂志, 2019, 21(1): 57-64.
12.	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): 342-343.
13.	王敬博, 于树军, 李辰, 等. 近侧骨折段向前成角移位的股骨粗隆间骨折治疗经验. 中国修复重建外科杂志, 2018, 32(9): 1163-1164.
14.	Carr JB. The anterior and medial reduction of intertrochanteric fractures: a simple method to obtain a stable reduction. J Orthop Trauma, 2007, 21(7): 485-489.
15.	Haidukewych GJ. Intertrochanteric fractures: ten tips to improve results. J Bone Joint Surg (Am), 2009, 91(3): 712-719.
16.	Yoon YC, Jha A, Oh CW, et al. The pointed clamp reduction technique for spiral subtrochanteric fractures: a technical note. Injury, 2014, 45(6): 1000-1005.
17.	Kim Y, Dheep K, Lee J, et al. Hook leverage technique for reduction of intertrochanteric fracture. Injury, 2014, 45(6): 1006-1010.
18.	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.
19.	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.
20.	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.

1. 张轩轩, 李宝丰, 章莹, 等. 股骨近端防旋髓内钉与髋关节置换术治疗高龄股骨粗隆间骨折 Meta 分析. 实用医学杂志, 2019, 35(6): 903-907.
2. 张世民, 胡孙君, 张立智, 等. 老年髋部转子间骨折. 北京: 科学出版社, 2019: 238.
3. 张世民, 余斌. AO/OTA-2018 版股骨转子间骨折分类的解读与讨论. 中华创伤骨科杂志, 2018, 20(7): 583-587.
4. 姜浩, 李忱, 孙树东. 30 例成人双侧股骨近端形态一致性的研究. 中国实验诊断学, 2018, 22(1): 97-98.
5. 皮益刚, 赵耀超, 王万春, 等. 500 例湖南地区股骨近端形态样本测量分析. 中南大学学报 (医学版), 2013, 38(9): 925-930.
6. 杜守超, 张世民, 张英琪, 等. 不稳定股骨转子间骨折前内侧皮质支撑复位的影像学研究. 中国矫形外科杂志, 2018, 26(18): 1633-1638.
7. Cho MR, Lee JH, Kwon JB, et al. The effect of positive medial cortical support in reduction of pertrochanteric fractures with posteromedial wall defect using a dynamic hip screw. Clin Orthop Surg, 2018, 10(3): 292-298.
8. Chang SM, Zhang YQ, Du SC, et al. Anteromedial cortical support reduction in unstable pertrochanteric fractures: a comparison of intra-operative fluoroscopy and post-operative three dimensional computerised tomography reconstruction. Int Orthop, 2018, 42(1): 183-189.
9. 张世民, 张英琪, 李清, 等. 内侧皮质正性支撑复位对老年股骨粗隆间骨折内固定效果的影响. 中国矫形外科杂志, 2014, 22(14): 1256-1261.
10. Chang SM, Zhang YQ, Ma Z, et al. Fracture reduction with positive medial cortical support: a key element in stability reconstruction for the unstable pertrochanteric hip fractures. Arch Orthop Trauma Surg, 2015, 135(6): 811-818.
11. 李双, 张世民, 张立智, 等. 不同组合前内侧皮质支撑复位对股骨转子间骨折髓内钉术后稳定性影响的生物力学研究. 中华创伤骨科杂志, 2019, 21(1): 57-64.
12. 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): 342-343.
13. 王敬博, 于树军, 李辰, 等. 近侧骨折段向前成角移位的股骨粗隆间骨折治疗经验. 中国修复重建外科杂志, 2018, 32(9): 1163-1164.
14. Carr JB. The anterior and medial reduction of intertrochanteric fractures: a simple method to obtain a stable reduction. J Orthop Trauma, 2007, 21(7): 485-489.
15. Haidukewych GJ. Intertrochanteric fractures: ten tips to improve results. J Bone Joint Surg (Am), 2009, 91(3): 712-719.
16. Yoon YC, Jha A, Oh CW, et al. The pointed clamp reduction technique for spiral subtrochanteric fractures: a technical note. Injury, 2014, 45(6): 1000-1005.
17. Kim Y, Dheep K, Lee J, et al. Hook leverage technique for reduction of intertrochanteric fracture. Injury, 2014, 45(6): 1006-1010.
18. 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.
19. 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.
20. 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.

Chinese Journal of Reparative and Reconstructive Surgery

Feasibility study of Kirschner wire-fixation-cortical bone technique in treatment of intertrochanteric fracture

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