Effectiveness analysis of closed or limited open reduction and intramedullary nail fixation in treatment of Seinsheimer type Ⅴ subtrochanteric fracture_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YAO Xiaoke ¹ , WU Lingna ² , LI Jianhua ¹ , HUANG Wengang ¹ , DUAN Xin ¹ , GU Zuchao ¹ ,  WANG Yue ³

1. Department of Orthopedics, Chengdu First People’s Hospital, Chengdu Sichuan, 610041, P.R.China;
2. Department of Intensive Care Unit, Chengdu First People’s Hospital, Chengdu Sichuan, 610041, P.R.China;
3. Department of Orthopedics, Sichuan Academy of Medical Science·Sichuan Provincal People’s Hospital, Chengdu Sichuan, 610072, P.R.China;

Corresponding author：

WANG Yue, Email: wang669yue@163.com

Keywords：

Subtrochanteric fracture; hip joint; Seinsheimer type Ⅴ; closed reduction; limited open reduction; intramedullary nail; internal fixation

DOI：

10.7507/1002-1892.201908100

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Objective To investigate the effectiveness of closed or limited open reduction and intramedullary nail fixation in the treatment of Seinsheimer type Ⅴ subtrochanteric fracture.Methods Between May 2014 and July 2018, 36 patients with Scinsheimer type Ⅴ subtrochanteric fractures were treated with closed or limited open reduction and intramedullary nail fixation. There were 25 males and 11 females with an age of 23-86 years (mean, 55.8 years). The cause of injury included falling in 19 cases, traffic accident in 9 cases, falling from height in 7 cases, and heavy object injury in 1 case; all were fresh closed injuries. The interval between injury and operation was 1-14 days (mean, 6.8 days). There were 18 cases of closed reduction and 18 cases of limited open reduction during the operation. Seventeen cases were fixed with femoral reconstruction intramedullary nail, 5 with InterTan long nail, 14 with lengthened proximal femoral nail anti-rotation, and 7 cases were assisted with auxiliary steel wire binding. After operation, through X-ray film and clinical follow-up, the fracture reduction and maintenance status, internal fixation position, and fracture healing were judged; the range of motion, walking ability, and complications of hip joint were observed, and the function of hip joint was evaluated according to Merle d’Aubigne Postel hip joint scoring standard.Results All the incisions of medullary operation healed by first intention, and no vascular, nerve injury, or infection occurred. All patients were followed up 12-24 months, with an average of 14.2 months. Among the 36 patients, 1 patient received revision surgery due to varus displacement of femoral head and screw penetration at 2 months after closed reduction, with poor recovery of hip function. X-ray film re-examination showed that the fractures of the other 35 patients healed after 9-15 months, with an average of 11.5 months. During follow-up, there was no complication such as internal fixation failure, fracture redisplacement, bone nonunion or malunion, and deep vein thrombosis of lower extremity occurred. The function of hip joint recovered well, and the patients could walk and squat normally without affecting daily life or work. At last follow-up, according to Merle d’Aubigne Postel hip joint scoring standard, 28 cases were rated as excellent, 4 cases as good, 3 cases as fair, and 1 case as poor, the excellent and good rate was 88.9%.Conclusion C-arm X-ray fluoroscopic closed or limited open reduction and intramedullary nail fixation for the treatment of Seinheimer Ⅴ type subtrochanteric fracture, if necessary, with the aid of auxiliary steel wire binding, it has the advantages of less blood supply destruction at the fracture end, satisfactory reduction, firm fixation, and early rehabilitation training, with definite effectiveness.

Citation： YAO Xiaoke, WU Lingna, LI Jianhua, HUANG Wengang, DUAN Xin, GU Zuchao, WANG Yue. Effectiveness analysis of closed or limited open reduction and intramedullary nail fixation in treatment of Seinsheimer type Ⅴ subtrochanteric fracture. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(4): 457-462. doi: 10.7507/1002-1892.201908100 Copy

1.	孟位明, 李彦眉, 许红生, 等. 股骨转子下骨折植入物髓外及髓内固定治疗的规范化. 中国组织工程研究, 2014, 18(22): 3587-3592.
2.	Seinsheimer F. Subtrochanteric fractures of the femur. J Bone Joint Surg (Am), 1978, 60(3): 300-306.
3.	熊文, 陈明, 郑琼. 加长 Gamma 3 钉结合钛缆固定治疗 Sein-sheimer Ⅲ型老年股骨转子下骨折. 中华创伤骨科杂志, 2018, 20(1): 33-37.
4.	王杰, 马信龙, 马剑雄, 等. 生物力学分析四种内固定治疗股骨转子下骨折的差异. 中华骨科杂志, 2013, 33(11): 1126-1134.
5.	Ulmar B, Simon S, Eschler A, et al. Subtrochanteric femoral fractures. Unfallchirurg, 2013, 116(12): 1097-1112.
6.	Liu P, Wu X, Shi H, et al. Intramedullary versus extramedullary fixation in the management of subtrochanteric femur fractures: a meta-analysis. Clin Interv Aging, 2015, 10: 803-811.
7.	Matta JM. Fractures of the acetabulum: accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury. J Bone Joint Surg (Am), 1996, 78(11): 1632-1645.
8.	林烨澎, 何志明, 汪志中, 等. 股骨近端防旋髓内钉治疗股骨转子下骨折疗效分析. 中华关节外科杂志 (电子版), 2016, 10(4): 449-455.
9.	Barquet A, Mayora G, Fregeiro J, et al. The treatment of subtrochanteric nonunions with the long gamma nail: twenty-six patients with a minimum 2-year follow-up. J Orthop Trauma, 2004, 18(6): 346-353.
10.	孙哲, 刘绍灵, 邓进. 股骨转子下骨折的治疗进展. 创伤外科杂志, 2018, 20(5): 396-398.
11.	陈松, 高悠水, 张长青. 股骨转子下骨折的手术治疗进展. 中国骨与关节杂志, 2015, 4(2): 147-150.
12.	王磊, 沈龙祥, 芮碧宇, 等. 长 Gamma 钉结合 Cable 环扎治疗股骨转子下粉碎性骨折. 生物骨科材料与临床研究, 2016, 13(4): 43-45.
13.	Afsari A, Liporace F, Lindvall E, et al. Clamp-assisted reduction of high subtrochanteric fractures of the femur. J Bone Joint Surg (Am), 2009, 91(8): 1913-1918.
14.	Haidukewych GJ, Berry DJ. Nonunion of fractures of the subtrochanteric region of the femur. Clin Orthop Relat Res, 2004, (419): 185-188.
15.	Velasco RU, Comfort TH. Analysis of treatment problems in subtraochanteric fractures of the femur. J Trauma, 1978, 18(7): 513-523.
16.	Burnei C, Popescu G, Barbu D, et al. Intramedullay osteosynthesis versus plate osteosynthesis in subtrochanteric fractures. J Med Life, 2011, 4(4): 324-329.
17.	李建涛, 张里程, 唐佩福. 股骨粗隆间骨折治疗理念与内固定器械的发展概述. 中国修复重建外科杂志, 2019, 33(1): 1-7.
18.	Riehl JT, Koval KJ, Langford JR, et al. Intramedullary nailing of subtrochanteric fractures-does malreduction matter? Bull Hosp Jt Dis, 2014, 72(2): 159-163.
19.	Kim Y, Dheep K, Lee J, et al. Hook leverage technique for reduction of intertrochanteric fracture. Injury, 2014, 45(6): 1006-1010.
20.	Herman A, Landau Y, Gutman G, et al. Radiological evaluation of intertrochanteric fracture fixation by the proximal femoral nail. Injury, 2012, 43(6): 856-863.
21.	Vidyadhara S, Rao SK. One and two femoral neck screws with intramedullary nails for unstable trochanteric fractures of femur in the elderly—randomised clinical trial. Injury, 2007, 38(7): 806-814.
22.	王建伟, 姜朝来, 张长青, 等. InterTan 髓内钉与 Gamma 3 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, 2013, 15(2): 107-112.
23.	Kanakaris NK, Tosounidis TH, Giannoudis PV. Nailing intertrochanteric hip fractures: short versus long; locked versus nonlocked. J Orthop Trauma, 2015, 29(Suppl 4): S10-S16.
24.	Finsen V. The effect of cerclage wires on the strength of diaphyseal bone. Injury, 1995, 26(3): 159-161.
25.	刘伟军, 王俊文, 黄玉成, 等. 小切口辅助复位髓内钉固定治疗复杂性股骨转子下骨折. 中华解剖与临床杂志, 2015, 20(3): 257-259.
26.	Beingessner DM, Scolaro JA, Orec RJ, et al. Open reduction and intramedullary stabilisation of subtrochanteric femur fractures: A retrospective study of 56 cases. Injury, 2013, 44(12): 1910-1915.
27.	刘兆杰, 胡永成. 微创钢缆辅助加长头颈型髓内钉治疗股骨转子下骨折. 中华骨科杂志, 2017, 37(22): 1392-1399.
28.	Tomás J, Teixidor J, Batalla L, et al. Subtrochanteric fractures: treatment with cerclage wire and long intramedullary nail. J Orthop Trauma, 2013, 27(7): e157-e160.
29.	李国臣, 郑联合, 张弘韬, 等. 微创环扎辅助髓内钉固定治疗长斜形股骨转子下骨折临床疗效观察. 创伤外科杂志, 2018, 20(10): 735-739.
30.	陈鹏, 傅德皓. 股骨近端防旋髓内钉治疗老年股骨转子间骨折内固定失败原因分析. 中国修复重建外科杂志, 2019, 33(10): 1270-1274.
31.	汤旭日, 马安军, 付驰, 等. 髓内钉联合微创环扎与单纯髓内钉固定治疗长斜形股骨转子下骨折的疗效比较. 中华创伤骨科杂志, 2017, 19(11): 994-998.
32.	Apivatthakakul T, Phaliphot J, Leuvitoonvechkit S. Percutaneous cerclage wiring, does it disrupt femoral blood supply? A cadaveric injection study. Injury, 2013, 44(2): 168-174.
33.	Lenz M, Perren SM, Richards RG, et al. Biomechanical performance of different cable and wire cerclage configurations. Int Orthop, 2013, 37(1): 125-130.
34.	Pazzaglia UE, Congiu T, Raspanti M, et al. Anatomy of the intracortical canal system: scanning electron microscopy study in rabbit femur. Clin Orthop Relat Res, 2009, 467(9): 2446-2456.
35.	Hoskins W, Bingham R, Joseph S, et al. Subtrochanteric fracture: the effect of cerclage wire on fracture reduction and outcome. Injury, 2015, 46(10): 1992-1995.
36.	Kim JW, Park KC, Oh JK, et al. Percutaneous cerclage wiring followed by intramedullary nailing for subtrochanteric femoral fractures: a technical note with clinical results. Arch Orthop Trauma Surg, 2014, 134(9): 1227-1235.
37.	胡金玺, 贺常仁, 刘芳, 等. 微创钢丝导入器引导下的钢丝复位技术在难复性股骨转子间骨折治疗中的应用. 中国修复重建外科杂志, 2019, 33(10): 1245-1249.

1. 孟位明, 李彦眉, 许红生, 等. 股骨转子下骨折植入物髓外及髓内固定治疗的规范化. 中国组织工程研究, 2014, 18(22): 3587-3592.
2. Seinsheimer F. Subtrochanteric fractures of the femur. J Bone Joint Surg (Am), 1978, 60(3): 300-306.
3. 熊文, 陈明, 郑琼. 加长 Gamma 3 钉结合钛缆固定治疗 Sein-sheimer Ⅲ型老年股骨转子下骨折. 中华创伤骨科杂志, 2018, 20(1): 33-37.
4. 王杰, 马信龙, 马剑雄, 等. 生物力学分析四种内固定治疗股骨转子下骨折的差异. 中华骨科杂志, 2013, 33(11): 1126-1134.
5. Ulmar B, Simon S, Eschler A, et al. Subtrochanteric femoral fractures. Unfallchirurg, 2013, 116(12): 1097-1112.
6. Liu P, Wu X, Shi H, et al. Intramedullary versus extramedullary fixation in the management of subtrochanteric femur fractures: a meta-analysis. Clin Interv Aging, 2015, 10: 803-811.
7. Matta JM. Fractures of the acetabulum: accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury. J Bone Joint Surg (Am), 1996, 78(11): 1632-1645.
8. 林烨澎, 何志明, 汪志中, 等. 股骨近端防旋髓内钉治疗股骨转子下骨折疗效分析. 中华关节外科杂志 (电子版), 2016, 10(4): 449-455.
9. Barquet A, Mayora G, Fregeiro J, et al. The treatment of subtrochanteric nonunions with the long gamma nail: twenty-six patients with a minimum 2-year follow-up. J Orthop Trauma, 2004, 18(6): 346-353.
10. 孙哲, 刘绍灵, 邓进. 股骨转子下骨折的治疗进展. 创伤外科杂志, 2018, 20(5): 396-398.
11. 陈松, 高悠水, 张长青. 股骨转子下骨折的手术治疗进展. 中国骨与关节杂志, 2015, 4(2): 147-150.
12. 王磊, 沈龙祥, 芮碧宇, 等. 长 Gamma 钉结合 Cable 环扎治疗股骨转子下粉碎性骨折. 生物骨科材料与临床研究, 2016, 13(4): 43-45.
13. Afsari A, Liporace F, Lindvall E, et al. Clamp-assisted reduction of high subtrochanteric fractures of the femur. J Bone Joint Surg (Am), 2009, 91(8): 1913-1918.
14. Haidukewych GJ, Berry DJ. Nonunion of fractures of the subtrochanteric region of the femur. Clin Orthop Relat Res, 2004, (419): 185-188.
15. Velasco RU, Comfort TH. Analysis of treatment problems in subtraochanteric fractures of the femur. J Trauma, 1978, 18(7): 513-523.
16. Burnei C, Popescu G, Barbu D, et al. Intramedullay osteosynthesis versus plate osteosynthesis in subtrochanteric fractures. J Med Life, 2011, 4(4): 324-329.
17. 李建涛, 张里程, 唐佩福. 股骨粗隆间骨折治疗理念与内固定器械的发展概述. 中国修复重建外科杂志, 2019, 33(1): 1-7.
18. Riehl JT, Koval KJ, Langford JR, et al. Intramedullary nailing of subtrochanteric fractures-does malreduction matter? Bull Hosp Jt Dis, 2014, 72(2): 159-163.
19. Kim Y, Dheep K, Lee J, et al. Hook leverage technique for reduction of intertrochanteric fracture. Injury, 2014, 45(6): 1006-1010.
20. Herman A, Landau Y, Gutman G, et al. Radiological evaluation of intertrochanteric fracture fixation by the proximal femoral nail. Injury, 2012, 43(6): 856-863.
21. Vidyadhara S, Rao SK. One and two femoral neck screws with intramedullary nails for unstable trochanteric fractures of femur in the elderly—randomised clinical trial. Injury, 2007, 38(7): 806-814.
22. 王建伟, 姜朝来, 张长青, 等. InterTan 髓内钉与 Gamma 3 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, 2013, 15(2): 107-112.
23. Kanakaris NK, Tosounidis TH, Giannoudis PV. Nailing intertrochanteric hip fractures: short versus long; locked versus nonlocked. J Orthop Trauma, 2015, 29(Suppl 4): S10-S16.
24. Finsen V. The effect of cerclage wires on the strength of diaphyseal bone. Injury, 1995, 26(3): 159-161.
25. 刘伟军, 王俊文, 黄玉成, 等. 小切口辅助复位髓内钉固定治疗复杂性股骨转子下骨折. 中华解剖与临床杂志, 2015, 20(3): 257-259.
26. Beingessner DM, Scolaro JA, Orec RJ, et al. Open reduction and intramedullary stabilisation of subtrochanteric femur fractures: A retrospective study of 56 cases. Injury, 2013, 44(12): 1910-1915.
27. 刘兆杰, 胡永成. 微创钢缆辅助加长头颈型髓内钉治疗股骨转子下骨折. 中华骨科杂志, 2017, 37(22): 1392-1399.
28. Tomás J, Teixidor J, Batalla L, et al. Subtrochanteric fractures: treatment with cerclage wire and long intramedullary nail. J Orthop Trauma, 2013, 27(7): e157-e160.
29. 李国臣, 郑联合, 张弘韬, 等. 微创环扎辅助髓内钉固定治疗长斜形股骨转子下骨折临床疗效观察. 创伤外科杂志, 2018, 20(10): 735-739.
30. 陈鹏, 傅德皓. 股骨近端防旋髓内钉治疗老年股骨转子间骨折内固定失败原因分析. 中国修复重建外科杂志, 2019, 33(10): 1270-1274.
31. 汤旭日, 马安军, 付驰, 等. 髓内钉联合微创环扎与单纯髓内钉固定治疗长斜形股骨转子下骨折的疗效比较. 中华创伤骨科杂志, 2017, 19(11): 994-998.
32. Apivatthakakul T, Phaliphot J, Leuvitoonvechkit S. Percutaneous cerclage wiring, does it disrupt femoral blood supply? A cadaveric injection study. Injury, 2013, 44(2): 168-174.
33. Lenz M, Perren SM, Richards RG, et al. Biomechanical performance of different cable and wire cerclage configurations. Int Orthop, 2013, 37(1): 125-130.
34. Pazzaglia UE, Congiu T, Raspanti M, et al. Anatomy of the intracortical canal system: scanning electron microscopy study in rabbit femur. Clin Orthop Relat Res, 2009, 467(9): 2446-2456.
35. Hoskins W, Bingham R, Joseph S, et al. Subtrochanteric fracture: the effect of cerclage wire on fracture reduction and outcome. Injury, 2015, 46(10): 1992-1995.
36. Kim JW, Park KC, Oh JK, et al. Percutaneous cerclage wiring followed by intramedullary nailing for subtrochanteric femoral fractures: a technical note with clinical results. Arch Orthop Trauma Surg, 2014, 134(9): 1227-1235.
37. 胡金玺, 贺常仁, 刘芳, 等. 微创钢丝导入器引导下的钢丝复位技术在难复性股骨转子间骨折治疗中的应用. 中国修复重建外科杂志, 2019, 33(10): 1245-1249.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness analysis of closed or limited open reduction and intramedullary nail fixation in treatment of Seinsheimer type Ⅴ subtrochanteric fracture

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