Clinical study on reduction of difficult-reducing intertrochanteric fracture with ball head screw driver of proximal femoral nail antirotation_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHENG Zhanle ¹ , LIU Huan ¹ , YU Xian ² , LI Sheng ¹ ,  ZHANG Yingze ¹

1. Department of Trauma Emergency Center, Key Laboratory of Orthopaedics, the Third Hospital of Hebei Medical University, Shijiazhuang Hebei, 050051, P.R.China;
2. Department of Endocrinology, Hebei General Hospital, Shijiazhuang Hebei, 050051, P.R.China;

Corresponding?author：

ZHANG Yingze, Email: yzling_liu@163.com

Keywords：

Intertrochanteric fracture; proximal femoral nail antirotation; reduction; internal fixation

DOI：

10.7507/1002-1892.201805002

Video：

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Objective To evaluate the effectiveness of the leverage reduction with proximal femoral nail antirotation (PFNA) ball head screw driver for difficult-reducing intertrochanteric fracture.Methods The clinical data of 8 patients with difficult-reducing intertrochanteric fractures between July 2015 and February 2018 were retrospectively analysed. There were 3 males and 5 females, aged 66-89 years, with an average age of 76.3 years. According to Evans classification, there were 3 cases of type Ⅲ and 5 cases of type Ⅳ. The time from injury to operation was 2-8 days (mean, 3.9 days). All patients were reducted with ball head screw driver leverage through PFNA proximal incision during operation. The operation time, intraoperative blood loss, reduction time, and fluoroscopy times were recorded. Harris hip function score was used to evaluate the effectiveness at last follow-up.Results The operation time was 52.5-83.7 minutes (mean, 68.1 minutes), the intraoperative blood loss was 49.8-96.4 mL (mean, 73.1 mL), the reduction time was 3.7-9.1 minutes (mean, 6.4 minutes), and the fluoroscopy times were 18.4-27.4 times (mean, 22.9 times). Patients were followed up 6-18 months (mean, 9.6 months). Postoperative X-ray films showed that the fracture obtained good reduction. No fracture displacement, fixation failure, and coxa vara occurred after operation. Fracture healing time was 3-6 months (mean, 4.6 months). At last follow-up, the Harris hip function score was 85-96 (mean, 91.6), with a result of excellent in 6 cases and good in 2 cases.Conclusion The reduction of difficult-reducing intertrochanteric fracture by using ball head screw driver can obtain good reduction and reliable fixation. The method has such advantages as no more incision, and less blood loss and soft tissue injury.

Citation： ZHENG Zhanle, LIU Huan, YU Xian, LI Sheng, ZHANG Yingze. Clinical study on reduction of difficult-reducing intertrochanteric fracture with ball head screw driver of proximal femoral nail antirotation. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(10): 1250-1253. doi: 10.7507/1002-1892.201805002 Copy

1.	田偉. 積水潭實用骨科學. 北京: 人民衛生出版社, 2008: 777-780.
2.	Yang X, Wu Q, Wang X. Investigation of perioperative hidden blood loss of unstable intertrochanteric fracture in the elderly treated with different intramedullary fixations. Injury, 2017, 48(8): 1848-1852.
3.	Xue D, Yu J, Zheng Q, et al. The treatment strategies of intertrochanteric fractures nonunion: An experience of 23 nonunion patients. Injury, 2017, 48(3): 708-714.
4.	李景光, 章平治, 徐名洪, 等. 側臥位斯氏針撬撥、PFNA 內固定治療不易復位的股骨粗隆間骨折. 創傷外科雜志, 2019, 21(6): 431-434.
5.	張英澤. 臨床骨折分型. 北京: 人民衛生出版社, 2013: 374-385.
6.	Evans EM. The treatment of trochanteric fractures of the femur. J Bone Joint Surg (Br), 1949, 31B(2): 190-203.
7.	Ovre S, Sandvik L, Madsen JE, et al. Modification of the Harris Hip Score in acetabular fracture treatment. Injury, 2007, 38(3): 344-349.
8.	沈光銀. 防旋股骨近端髓內釘與動力髖螺釘治療老年股骨粗隆間骨折療效比較. 中國修復重建外科雜志, 2012, 26(6): 671-674.
9.	石永新, 李富琴, 譚文甫, 等. 股骨近端防旋髓內釘與鎖定加壓接骨板治療老年外側壁薄弱型股骨粗隆間骨折療效比較. 中國修復重建外科雜志, 2014, 28(10): 1199-1203.
10.	張舒. 髓內固定術對老年股骨粗隆間骨折患者股骨頭旋轉及固定釘滑脫的影響研究. 中國骨與關節雜志, 2019, 8(6): 465-469.
11.	方成, 趙文, 甘泉, 等. 側臥位 PFNA 技術治療 Evans Ⅱ 型股骨轉子間骨折. 中國矯形外科雜志, 2019, (14): 1327-1329.
12.	房巍, 孫從府, 侯全運, 等. 髓內與髓外固定治療老年股骨轉子間骨折. 中國矯形外科雜志, 2019, 27(14): 1335-1337.
13.	李明東, 胡稷杰, 黎早敏, 等. 不同手術方式治療老年股骨粗隆間骨折的療效比較. 中國修復重建外科雜志, 2017, 31(6): 653-658.
14.	馬坤龍, 王絢, 欒富均, 等. 股骨近端防旋髓內釘、動力髖螺釘、伽馬釘治療股骨轉子間骨折的系統評價. 華西醫學, 2013, 28(3): 345-351.
15.	Xu Z, Zhang M, Yin J, et al. Redisplacement after reduction with intramedullary nails in surgery of intertrochanteric fracture: cause analysis and preventive measures. Arch Orthop Trauma Surg, 2015, 135(6): 751-758.
16.	侯宇, 姚琦, 張亙璦, 等. 第三代 Gamma 釘與防旋股骨近端髓內釘治療股骨粗隆間骨折術后股骨近端短縮的比較研究. 中國修復重建外科雜志, 2018, 32(3): 338-345.
17.	施保華, 尹峰. 復雜股骨粗隆間骨折的復位策略與手術技巧. 中國骨與關節損傷雜志, 2013, 28(8): 769-770.
18.	Ulmar B, Simon S, Stratos I, et al. Repositioning, reduction and surgical approaches for subtrochanteric femoral fractures. Unfallchirurg, 2013, 116(12): 1115-1122.
19.	范永前, 梁承偉, 林偉龍, 等. 股骨粗隆間骨折復位過程中旋轉控制策略. 中國骨與關節損傷雜志, 2012, 27(12): 1081-1083.
20.	Perez EA, Jahangir AA, Mashru RP, et al. Is there a gluteus medius tendon injury during reaming through a modified medial trochanteric portal? A cadaver study J Orthop Trauma, 2007, 21(9): 617-620.

1. 田偉. 積水潭實用骨科學. 北京: 人民衛生出版社, 2008: 777-780.
2. Yang X, Wu Q, Wang X. Investigation of perioperative hidden blood loss of unstable intertrochanteric fracture in the elderly treated with different intramedullary fixations. Injury, 2017, 48(8): 1848-1852.
3. Xue D, Yu J, Zheng Q, et al. The treatment strategies of intertrochanteric fractures nonunion: An experience of 23 nonunion patients. Injury, 2017, 48(3): 708-714.
4. 李景光, 章平治, 徐名洪, 等. 側臥位斯氏針撬撥、PFNA 內固定治療不易復位的股骨粗隆間骨折. 創傷外科雜志, 2019, 21(6): 431-434.
5. 張英澤. 臨床骨折分型. 北京: 人民衛生出版社, 2013: 374-385.
6. Evans EM. The treatment of trochanteric fractures of the femur. J Bone Joint Surg (Br), 1949, 31B(2): 190-203.
7. Ovre S, Sandvik L, Madsen JE, et al. Modification of the Harris Hip Score in acetabular fracture treatment. Injury, 2007, 38(3): 344-349.
8. 沈光銀. 防旋股骨近端髓內釘與動力髖螺釘治療老年股骨粗隆間骨折療效比較. 中國修復重建外科雜志, 2012, 26(6): 671-674.
9. 石永新, 李富琴, 譚文甫, 等. 股骨近端防旋髓內釘與鎖定加壓接骨板治療老年外側壁薄弱型股骨粗隆間骨折療效比較. 中國修復重建外科雜志, 2014, 28(10): 1199-1203.
10. 張舒. 髓內固定術對老年股骨粗隆間骨折患者股骨頭旋轉及固定釘滑脫的影響研究. 中國骨與關節雜志, 2019, 8(6): 465-469.
11. 方成, 趙文, 甘泉, 等. 側臥位 PFNA 技術治療 Evans Ⅱ 型股骨轉子間骨折. 中國矯形外科雜志, 2019, (14): 1327-1329.
12. 房巍, 孫從府, 侯全運, 等. 髓內與髓外固定治療老年股骨轉子間骨折. 中國矯形外科雜志, 2019, 27(14): 1335-1337.
13. 李明東, 胡稷杰, 黎早敏, 等. 不同手術方式治療老年股骨粗隆間骨折的療效比較. 中國修復重建外科雜志, 2017, 31(6): 653-658.
14. 馬坤龍, 王絢, 欒富均, 等. 股骨近端防旋髓內釘、動力髖螺釘、伽馬釘治療股骨轉子間骨折的系統評價. 華西醫學, 2013, 28(3): 345-351.
15. Xu Z, Zhang M, Yin J, et al. Redisplacement after reduction with intramedullary nails in surgery of intertrochanteric fracture: cause analysis and preventive measures. Arch Orthop Trauma Surg, 2015, 135(6): 751-758.
16. 侯宇, 姚琦, 張亙璦, 等. 第三代 Gamma 釘與防旋股骨近端髓內釘治療股骨粗隆間骨折術后股骨近端短縮的比較研究. 中國修復重建外科雜志, 2018, 32(3): 338-345.
17. 施保華, 尹峰. 復雜股骨粗隆間骨折的復位策略與手術技巧. 中國骨與關節損傷雜志, 2013, 28(8): 769-770.
18. Ulmar B, Simon S, Stratos I, et al. Repositioning, reduction and surgical approaches for subtrochanteric femoral fractures. Unfallchirurg, 2013, 116(12): 1115-1122.
19. 范永前, 梁承偉, 林偉龍, 等. 股骨粗隆間骨折復位過程中旋轉控制策略. 中國骨與關節損傷雜志, 2012, 27(12): 1081-1083.
20. Perez EA, Jahangir AA, Mashru RP, et al. Is there a gluteus medius tendon injury during reaming through a modified medial trochanteric portal? A cadaver study J Orthop Trauma, 2007, 21(9): 617-620.

Chinese Journal of Reparative and Reconstructive Surgery

Clinical study on reduction of difficult-reducing intertrochanteric fracture with ball head screw driver of proximal femoral nail antirotation

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