Agedness; Intertrochanteric fracture; Replacement of artificial femoral head
Objective To investigate the effect of treatment with proximal femoral nail (PFN) on femur intertrochanteric fractures in the old. Methods A retrospective study of 62 patients with femur intertrochantericfractures treated with PFN from October 2001 to September 2003 was carried out.The data of operative time, blood loss, intraoperative complications, wound drainage, postoperative complications, healing time, and hip function were recordedand compared with previous literature so as to evaluate the effect. Results All patients were followed up for 8-22 month(13.6 months on average). Intraoperative fracture occurred again in 2 cases. Two patients died of brain embolism and pulmonary infection respectively. Heterogeneous ossification occurred in 2 cases. Hip varus occurred in 1 case. Extra hip anteversion occurred in 1 case. The effect of other cases was satisfactory. The operative time was 76.5±29.1 min, the mean blood loss was 385.7±98.4 ml, the wound drainage was 45.5±21.7 ml, and the healing time was 13.2±3.8 weeks. According to the Sanders post-trauma hip function assessing system, the excellent and good rate was 89.6%. Conclusion The application of PFN is characterized by short operative time, less blood loss, stable fixation, so it is an effective way to treat femur intertrochanteric fracture in the old.
Objective To study the technique and effect of adjunctive cancellous screw in treatment of intertrochanteric fractures with dynamic hi p screw (DHS) fixation. Methods Between April 2004 and August 2007, 33 patients with intertrochanteric fracture were treated with DHS fixation and adjunctive cancellous screw. There were 13 males and 20 females, aging 43-82 years with an average age of 67 years. Fractures were caused by traffic accident in 7 patients, by fall ing from height in 11 patients, by sprain in 15 patients. All fractures were closed. The patients were operated 3-12 days after injury. According to Evans classification, there were 12 cases of type II, 15 cases of type III, and 6 cases of type IV. Twenty-twocases had osteoporosis. Weight bear time and compl ication were recorded. Fracture heal ing and neck-shaft angle were observed on radiogram. Hip functions were evaluated using Radford criterion. Results Thirty-three patients had no intraoperative compl ications with incision heal ing by first intension. All patients were followed up from 14 months to 38 months, with an average of 21 months. Fracture heal ing was achieved within 14 weeks to 21 weeks, with an average of 17 weeks after operations. The neck-shaft angles were (134.2 ± 13.7)° 3 days after operation, (128.6 ± 8.9)° 8 weeks after operation, and (128.5 ± 9.3)° after fracture heal ing, showing no significant difference when compared with that of the third day after operation (P gt; 0.05). According to the Radford criterion at last follow-up, the excellent and good rate of hi p function was 93.9% (excellent in 21 cases, good in 10 cases, and poor in 2 cases). Compl ications such as loosening, breakage, or grievous migration of hardware were not observed. Conclusion The adjunctive cancellous screw in treatment of intertrochanteric fractures with DHS fixation can provide counteraction of tension and rotation, promote fixation stabil ity, enhance fracture heal ing and decrease compl ication.
ObjectiveTo compare the clinical effect of proximal femoral nail antirotation (PFNA) and locking proximal femoral plate (LPFP) for femoral intertrochanteric fracture in elderly patients. MethodsWe respectively analyzed the clinical data of 116 senile patients with femoral intertrochanteric fracture treated between October 2008 and March 2014. Among them, 60 were treated with PFNA, and 56 were treated with LPFP. We compared the two groups of patients in terms of operating time, surgical blood loss, surgical complications, walking exercise time, fracture healing time and joint function recovery. ResultsA total of 115 patients had regular follow-up from 12 to 24 months (averaging 15.7 months). One patient died. The operating time was (83.26±14.81) minutes in PFNA group and (102.58±15.31) minutes in LPFP group. The surgical blood loss was (202.16±33.14) mL in PFNA group and (255.80±45.92) mL in LPFP group. The walking exercise time was (1.80±0.91) weeks in PFNA group and (3.48±3.03) weeks in LPFP group. The fracture healing time was (11.80±2.26) weeks in PFNA group and (12.14±2.21) weeks in LPFP group. The postoperative Harris score for hip joint was 84.56±9.55 in PFNA group and 82.47±9.22 in LPFP group. There were statistical differences in operating time, surgical blood loss and walking exercise time (P<0.05), while no statistical differences were found in fracture healing time and postoperative Harris score for hip joint (P>0.05). ConclusionPFNA and LPFP are effective methods for femoral intertrochanteric fracture in elderly people, but PFNA has a shorter operating time, less surgical blood loss and earlier walking exercise time.
ObjectiveTo compare the effectiveness of proximal femoral nail anti-rotation (PFNA) in the treatment of intertrochanteric fracture of femur in traction bed supine position and non-traction bed lateral position.MethodsA retrospective analysis of 102 elderly patients with intertrochanteric fracture of femur who met the selection criteria between January 2013 and April 2018 was made. According to the different operative positions, the patients were divided into two groups: group A (50 cases, PFNA internal fixation in traction bed supine position) and group B (52 cases, PFNA internal fixation in non-traction bed lateral position). There was no significant difference in age, gender, fracture side, cause of injury, AO classification, complications, and time from injury to operation between the two groups (P>0.05). The preoperative preparation time, incision length, operation time, intraoperative blood loss, intraoperative X-ray fluoroscopy times, fracture healing time, and complications were recorded and compared between the two groups, and the effectiveness was evaluated by Harris hip score at 1 year after operation.ResultsThere was no significant difference in incision length between groups A and B (t=1.116, P=0.268). In addition, the preoperative preparation time, operation time, intraoperative blood loss, and intraoperative X-ray fluoroscopy times in group A were significantly greater than those in group B (P<0.05). Both groups were followed up 12-14 months, with an average of 13 months. There were 3 postoperative complications in group A and group B respectively. In group A, there were 2 cases of hip joint pain and 1 case of local fat liquefaction (healed after dressing change); in group B, there were 2 cases of hip joint pain and 1 case of deep vein thrombosis in lower extremity; there was no significant difference in the incidence of postoperative complications between the two groups (P=0.642). The patients of the two groups had a good result of fracture reduction and the internal fixation quality, and there was no main nail loosening, screw fracture, spiral blade cutting, withdrawal, and the nail breakage occurred, and no nonunion of bone, coxa vara, and other complications occurred. X-ray showed that the fracture healed in both groups, and there was no significant difference in fracture healing time between the two groups (t=1.515, P=0.133). There was no significant difference in Harris hip score between the two groups at 1 year after operation (t=0.778, P=0.438).ConclusionCompared with the traction bed supine position, PFNA internal fixation for intertrochanteric fracture of femur in the non-traction bed lateral position has the advantages of short preparation time, short operation time, less intraoperative blood loss, less X-ray fluoroscopy times, and satisfactory postoperative recovery effect.