The Universal Definition and Classification of Heart Failure consensus has proposed the universal definition, classification and staging criteria of heart failure. The prevalence of heart failure is still increasing, and the phenotype of heart failure with preserved ejection fraction (HFpEF) is becoming more and more common. Neuro-endocrine antagonists are effective in treating patients with heart failure with reduced ejection fraction (HFrEF). However, there is no effective drug that can improve the clinical prognosis of patients with HFpEF. The pathophysiological mechanism of HFpEF involves metabolic-inflammatory mechanism disorders, epicardial fat tissue accumulation, and coronary microvascular dysfunction. The exploratory treatment of these mechanisms requires further research to confirm whether it is beneficial to patients with HFpEF. In addition, the improvement of ejection fraction and the recovery of cardiac function in patients with HFrEF after treatment cannot interrupt the drug treatment of heart failure.
ObjectiveTo summarize the research progress of posterior coronal banana-shaped fragments in the treatment of intertrochanteric femoral fracture with cephalomedullary nail, provide valuable reference for clinical practice. Methods Relevant domestic and foreign literature was extensively reviewed to summarize the history, anatomical structure, the need for reduction and fixation, the influence on the stability of cephalomedullary nail, and the remedies of posterior coronal banana-shaped fragments. Results With the wide application of three-dimensional-CT in clinical practice, the posterior coronal fragments were more comprehensively understood, and the banana-shaped fragments accounted for about 20% in A2 type pertrochanteric femur fractures. According to whether the fracture line involves the entry portal of head-neck implants or not, the coronal fragments were divided into two types: small and large. The large fragment involving the posteromedial wall (lesser trochanter) will increase the difficulty of the medial cortical contact reduction; or involving the posterolateral wall and resulting in rupture of the entry portal (type A2.4), which will cause sagittal swing of the nail in the femoral marrow cavity, thereby affecting the stability of the nail. There is no effective technique for reduction and fixation of the banana-shaped fragment nowadays. However, the adverse effects of posterior banana-shaped fragment can be compensated by improving the quality of fracture reduction and choosing high filling cephalomedullary nail. ConclusionThe extension of the posterior coronal fracture line on the lateral wall may affect the entry portal of head-neck implants, which will impair the bone-nail integral stability in the sagittal plane. Whether the entry portal will rupture or not and its risk factors still need further clinical and basic research.