A comparative study on effectiveness of closed reduction and internal fixation of intertrochanteric fracture assisted with skeletal tractor and traction table_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

DU Gangqiang ,  WANG Zhigang , YANG Shuye , JIA Long , LI Peng , ZHANG Kai , JIANG Jianhao

Department of Orthopedics Trauma, Binzhou Medical University Hospital, Binzhou Shandong, 256603, P.R.China;

Corresponding author：

WANG Zhigang, Email: wangzgyh@sina.com

Keywords：

Intertrochanteric fracture; skeletal tractor; traction table; closed reduction; internal fixation

DOI：

10.7507/1002-1892.201908120

Video：

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Objective To investigate the effectiveness and advantages of skeletal tractor in closed reduction and proximal femoral nail antirotation (PFNA) internal fixation of intertrochanteric fracture compared with traction table.Methods The clinical data of 86 patients with intertrochanteric fractures, who were treated with closed reduction and PFNA internal fixation between October 2016 and March 2018 and met the selection criteria, was retrospectively analysed. Among them, 44 cases were treated with skeletal tractor (trial group) and 42 cases were treated with traction table (control group). There was no significant difference between the two groups in gender, age, cause of injury, fracture side, AO classification, and degree of osteoporosis (P>0.05). The preoperative position time, operation time, intraoperative fluoroscopy times, intraoperative blood loss, fracture healing time, intraoperative and postoperative complications, and postoperative Harris score were compared between the two groups.Results The operation was successfully completed in both groups. Compared with the control group, the patients in the trial group had shorter preoperative position time and operation time, fewer intraoperative fluoroscopy times, and less intraoperative blood loss (P<0.05). The patients were followed up 12-21 months in trial group (mean, 14.2 months) and 12-22 months in control group (mean, 14.3 months). Venous thrombosis of lower extremity occurred in 8 patients (3 cases of trial group and 5 cases of control group) after operation. Internal fixation failure occurred in 5 patients (2 cases of trial group and 3 cases of control group) during 1 year after operation. All fractures healed except for those with internal fixation failure, the fracture healing time was (11.6±2.9) weeks in trial group and (12.4±3.6) weeks in control group; and there was no significant difference between the two groups (t=1.250, P=0.214). At 1 year after operation, Harris score of the trial group was 86.2±5.9 and that of the control group was 84.1±6.1. There was no significant difference between the two groups (t=1.768, P=0.080).Conclusion Compared with traction table, skeletal tractor in closed reduction and PFNA internal fixation of intertrochanteric fracture can significantly shorten the preoperative position time and operation time, reduce the intraoperative fluoroscopy times, improve the operation efficiency, and have similar effectiveness.

Citation： DU Gangqiang, WANG Zhigang, YANG Shuye, JIA Long, LI Peng, ZHANG Kai, JIANG Jianhao. A comparative study on effectiveness of closed reduction and internal fixation of intertrochanteric fracture assisted with skeletal tractor and traction table. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(4): 469-474. doi: 10.7507/1002-1892.201908120 Copy

1.	Güven M, Kocadal O, Akman B, et al. Proximal femoral nail shows better concordance of gait analysis between operated and uninjured limbs compared to hemiarthroplasty in intertrochanteric femoral fractures. Injury, 2016, 47(4): 1325-1331.
2.	Radaideh AM, Qudah HA, Audat ZA, et al. Functional and radiological results of proximal femoral nail antirotation (PFNA) osteosynthesis in the treatment of unstable pertrochanteric fractures. J Clin Med, 2018, 7(4): E78.
3.	万乾, 张擎柱, 张义, 等. 股骨近端防旋髓内钉与锁定加压钢板治疗老年脑梗死偏瘫侧股骨转子间骨折的疗效比较. 中国修复重建外科杂志, 2018, 32(11): 1411-1416.
4.	Makki D, Matar HE, Jacob N, et al. Comparison of the reconstruction trochanteric antigrade nail (TAN) with the proximal femoral nail antirotation (PFNA) in the management of reverse oblique intertrochanteric hip fractures. Injury, 2015, 46(12): 2389-2393.
5.	李尧, 胡传真, 茅凌洲, 等. 股骨近端防旋髓内钉联合小钢板重建外侧壁治疗 AO/OTA 31-A3 型股骨转子间骨折. 中国修复重建外科杂志, 2019, 33(10): 1223-1227.
6.	马金龙, 吾路汗·马汉, 罗雪, 等. 特殊体位下非牵引床复位股骨近端防旋髓内钉固定治疗股骨转子间骨折. 中华创伤骨科杂志, 2018, 20(3): 258-262.
7.	Sambandam SN, Chandrasekharan J, Mounasamy V, et al. Intertrochanteric fractures: a review of fixation methods. Eur J Orthop Surg Traumatol, 2016, 26(4): 339-353.
8.	Kumar S, Chadha GN. Dynamic hip screw fixation of intertrochanteric fractures without using traction table. Acta Orthopaedica Belg, 2016, 82(2): 346-350.
9.	王志刚, 王兆林, 刘栋, 等. 新型股骨撑开复位装置在股骨干骨折闭合复位顺行髓内钉固定术中的应用. 中华创伤骨科杂志, 2017, 19(2): 164-168.
10.	Krettek C, Miclau T, Grün O, et al. Intraoperative control of axes, rotation and length in femoral and tibial fractures. Technical note. Injury, 1998, 29(Suppl 3): C29-39.
11.	谢添, 马彬彬, 李荥娟, 等. 加速康复外科在老年髋部骨折的研究现状. 中国修复重建外科杂志, 2018, 32(8): 1038-1046.
12.	Chen W, Zhang T, Wang J, et al. Minimally invasive treatment of displaced femoral shaft fractures with a rapid reductor and intramedullary nail fixation. Int Orthop, 2016, 40(1): 167-172.
13.	王娟, 李升, 臧砚超, 等. 应用四肢长骨骨折快速复位器治疗股骨骨折. 河北医科大学学报, 2014, 35(2): 220-221, 249.
14.	芮云峰, 鲁攀攀, 李荥娟, 等. 老年股骨转子间骨折患者术后死亡危险因素分析. 中国修复重建外科杂志, 2019, 33(12): 1538-1542.
15.	Nunes JC, Braz JR, Oliveira TS, et al. Intraoperative and anesthesia-related cardiac arrest and its mortality in older patients: a 15-year survey in atertiary teaching hospital. PLoS One, 2014, 9(8): e104041.
16.	Tan L, Qi B, Yu T, et al. Incidence and risk factors for venous thromboembolism following surgical treatment of fractures below the hip: a meta-analysis. Int Wound J, 2016, 13(6): 1359-1371.
17.	Jaffer AK, Barsoum WK, Krebs V, et al. Duration of anesthesia and venous thromboembolism after hip and knee arthroplasty. Mayo Clin Proc, 2005, 80(6): 732-738.
18.	DePalma AA, O’Halloran K, Shenoy K, et al. A novel technique for reducing intertrochanteric hip fractures. Am J Orthop (Belle Mead NJ), 2014, 43(2): 402-404.

1. Güven M, Kocadal O, Akman B, et al. Proximal femoral nail shows better concordance of gait analysis between operated and uninjured limbs compared to hemiarthroplasty in intertrochanteric femoral fractures. Injury, 2016, 47(4): 1325-1331.
2. Radaideh AM, Qudah HA, Audat ZA, et al. Functional and radiological results of proximal femoral nail antirotation (PFNA) osteosynthesis in the treatment of unstable pertrochanteric fractures. J Clin Med, 2018, 7(4): E78.
3. 万乾, 张擎柱, 张义, 等. 股骨近端防旋髓内钉与锁定加压钢板治疗老年脑梗死偏瘫侧股骨转子间骨折的疗效比较. 中国修复重建外科杂志, 2018, 32(11): 1411-1416.
4. Makki D, Matar HE, Jacob N, et al. Comparison of the reconstruction trochanteric antigrade nail (TAN) with the proximal femoral nail antirotation (PFNA) in the management of reverse oblique intertrochanteric hip fractures. Injury, 2015, 46(12): 2389-2393.
5. 李尧, 胡传真, 茅凌洲, 等. 股骨近端防旋髓内钉联合小钢板重建外侧壁治疗 AO/OTA 31-A3 型股骨转子间骨折. 中国修复重建外科杂志, 2019, 33(10): 1223-1227.
6. 马金龙, 吾路汗·马汉, 罗雪, 等. 特殊体位下非牵引床复位股骨近端防旋髓内钉固定治疗股骨转子间骨折. 中华创伤骨科杂志, 2018, 20(3): 258-262.
7. Sambandam SN, Chandrasekharan J, Mounasamy V, et al. Intertrochanteric fractures: a review of fixation methods. Eur J Orthop Surg Traumatol, 2016, 26(4): 339-353.
8. Kumar S, Chadha GN. Dynamic hip screw fixation of intertrochanteric fractures without using traction table. Acta Orthopaedica Belg, 2016, 82(2): 346-350.
9. 王志刚, 王兆林, 刘栋, 等. 新型股骨撑开复位装置在股骨干骨折闭合复位顺行髓内钉固定术中的应用. 中华创伤骨科杂志, 2017, 19(2): 164-168.
10. Krettek C, Miclau T, Grün O, et al. Intraoperative control of axes, rotation and length in femoral and tibial fractures. Technical note. Injury, 1998, 29(Suppl 3): C29-39.
11. 谢添, 马彬彬, 李荥娟, 等. 加速康复外科在老年髋部骨折的研究现状. 中国修复重建外科杂志, 2018, 32(8): 1038-1046.
12. Chen W, Zhang T, Wang J, et al. Minimally invasive treatment of displaced femoral shaft fractures with a rapid reductor and intramedullary nail fixation. Int Orthop, 2016, 40(1): 167-172.
13. 王娟, 李升, 臧砚超, 等. 应用四肢长骨骨折快速复位器治疗股骨骨折. 河北医科大学学报, 2014, 35(2): 220-221, 249.
14. 芮云峰, 鲁攀攀, 李荥娟, 等. 老年股骨转子间骨折患者术后死亡危险因素分析. 中国修复重建外科杂志, 2019, 33(12): 1538-1542.
15. Nunes JC, Braz JR, Oliveira TS, et al. Intraoperative and anesthesia-related cardiac arrest and its mortality in older patients: a 15-year survey in atertiary teaching hospital. PLoS One, 2014, 9(8): e104041.
16. Tan L, Qi B, Yu T, et al. Incidence and risk factors for venous thromboembolism following surgical treatment of fractures below the hip: a meta-analysis. Int Wound J, 2016, 13(6): 1359-1371.
17. Jaffer AK, Barsoum WK, Krebs V, et al. Duration of anesthesia and venous thromboembolism after hip and knee arthroplasty. Mayo Clin Proc, 2005, 80(6): 732-738.
18. DePalma AA, O’Halloran K, Shenoy K, et al. A novel technique for reducing intertrochanteric hip fractures. Am J Orthop (Belle Mead NJ), 2014, 43(2): 402-404.

Chinese Journal of Reparative and Reconstructive Surgery

A comparative study on effectiveness of closed reduction and internal fixation of intertrochanteric fracture assisted with skeletal tractor and traction table

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