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

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

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, 李彥眉, 許紅生, 等. 股骨轉子下骨折植入物髓外及髓內固定治療的規范化. 中國組織工程研究, 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, 陳明, 鄭瓊. 加長 Gamma 3 釘結合鈦纜固定治療 Sein-sheimer Ⅲ型老年股骨轉子下骨折. 中華創傷骨科雜志, 2018, 20(1): 33-37.
4.	王杰, 馬信龍, 馬劍雄, 等. 生物力學分析四種內固定治療股骨轉子下骨折的差異. 中華骨科雜志, 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.	林燁澎, 何志明, 汪志中, 等. 股骨近端防旋髓內釘治療股骨轉子下骨折療效分析. 中華關節外科雜志 (電子版), 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.	孫哲, 劉紹靈, 鄧進. 股骨轉子下骨折的治療進展. 創傷外科雜志, 2018, 20(5): 396-398.
11.	陳松, 高悠水, 張長青. 股骨轉子下骨折的手術治療進展. 中國骨與關節雜志, 2015, 4(2): 147-150.
12.	王磊, 沈龍祥, 芮碧宇, 等. 長 Gamma 釘結合 Cable 環扎治療股骨轉子下粉碎性骨折. 生物骨科材料與臨床研究, 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.	李建濤, 張里程, 唐佩福. 股骨粗隆間骨折治療理念與內固定器械的發展概述. 中國修復重建外科雜志, 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.	王建偉, 姜朝來, 張長青, 等. InterTan 髓內釘與 Gamma 3 釘治療老年股骨轉子間骨折的療效比較. 中華創傷骨科雜志, 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.	劉偉軍, 王俊文, 黃玉成, 等. 小切口輔助復位髓內釘固定治療復雜性股骨轉子下骨折. 中華解剖與臨床雜志, 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.	劉兆杰, 胡永成. 微創鋼纜輔助加長頭頸型髓內釘治療股骨轉子下骨折. 中華骨科雜志, 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.	李國臣, 鄭聯合, 張弘韜, 等. 微創環扎輔助髓內釘固定治療長斜形股骨轉子下骨折臨床療效觀察. 創傷外科雜志, 2018, 20(10): 735-739.
30.	陳鵬, 傅德皓. 股骨近端防旋髓內釘治療老年股骨轉子間骨折內固定失敗原因分析. 中國修復重建外科雜志, 2019, 33(10): 1270-1274.
31.	湯旭日, 馬安軍, 付馳, 等. 髓內釘聯合微創環扎與單純髓內釘固定治療長斜形股骨轉子下骨折的療效比較. 中華創傷骨科雜志, 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.	胡金璽, 賀常仁, 劉芳, 等. 微創鋼絲導入器引導下的鋼絲復位技術在難復性股骨轉子間骨折治療中的應用. 中國修復重建外科雜志, 2019, 33(10): 1245-1249.

1. 孟位明, 李彥眉, 許紅生, 等. 股骨轉子下骨折植入物髓外及髓內固定治療的規范化. 中國組織工程研究, 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, 陳明, 鄭瓊. 加長 Gamma 3 釘結合鈦纜固定治療 Sein-sheimer Ⅲ型老年股骨轉子下骨折. 中華創傷骨科雜志, 2018, 20(1): 33-37.
4. 王杰, 馬信龍, 馬劍雄, 等. 生物力學分析四種內固定治療股骨轉子下骨折的差異. 中華骨科雜志, 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. 林燁澎, 何志明, 汪志中, 等. 股骨近端防旋髓內釘治療股骨轉子下骨折療效分析. 中華關節外科雜志 (電子版), 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. 孫哲, 劉紹靈, 鄧進. 股骨轉子下骨折的治療進展. 創傷外科雜志, 2018, 20(5): 396-398.
11. 陳松, 高悠水, 張長青. 股骨轉子下骨折的手術治療進展. 中國骨與關節雜志, 2015, 4(2): 147-150.
12. 王磊, 沈龍祥, 芮碧宇, 等. 長 Gamma 釘結合 Cable 環扎治療股骨轉子下粉碎性骨折. 生物骨科材料與臨床研究, 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. 李建濤, 張里程, 唐佩福. 股骨粗隆間骨折治療理念與內固定器械的發展概述. 中國修復重建外科雜志, 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. 王建偉, 姜朝來, 張長青, 等. InterTan 髓內釘與 Gamma 3 釘治療老年股骨轉子間骨折的療效比較. 中華創傷骨科雜志, 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. 劉偉軍, 王俊文, 黃玉成, 等. 小切口輔助復位髓內釘固定治療復雜性股骨轉子下骨折. 中華解剖與臨床雜志, 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. 劉兆杰, 胡永成. 微創鋼纜輔助加長頭頸型髓內釘治療股骨轉子下骨折. 中華骨科雜志, 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. 李國臣, 鄭聯合, 張弘韜, 等. 微創環扎輔助髓內釘固定治療長斜形股骨轉子下骨折臨床療效觀察. 創傷外科雜志, 2018, 20(10): 735-739.
30. 陳鵬, 傅德皓. 股骨近端防旋髓內釘治療老年股骨轉子間骨折內固定失敗原因分析. 中國修復重建外科雜志, 2019, 33(10): 1270-1274.
31. 湯旭日, 馬安軍, 付馳, 等. 髓內釘聯合微創環扎與單純髓內釘固定治療長斜形股骨轉子下骨折的療效比較. 中華創傷骨科雜志, 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. 胡金璽, 賀常仁, 劉芳, 等. 微創鋼絲導入器引導下的鋼絲復位技術在難復性股骨轉子間骨折治療中的應用. 中國修復重建外科雜志, 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

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content