Treatment of irreducible intertrochanteric femoral fracture in elderly by folding top technique combined with right-angle pliers prying and pulling under G-arm X-ray fluoroscopy_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

HAN Xiaoliang ¹ , LIU Xu ¹ , CHEN Gongqiang ¹ , CHEN Dongsheng ¹ , SUN Zhipeng ¹ , YUE Heng ¹ ,  LIU Jingsheng ² , HAN Xiaoliang ¹ , LIU Xu ¹ , CHEN Gongqiang ¹ , CHEN Dongsheng ¹ , SUN Zhipeng ¹ , YUE Heng ¹ ,  LIU Jingsheng ²

1. Department of Orthopedics, Dingxi People’s Hospital, Dingxi Gansu, 743000, P. R. China;
2. Department of Orthopedics, the Second Hospital of Lanzhou University, Lanzhou Gansu, 730000, P. R. China;

Corresponding author：

LIU Jingsheng, Email: 324376533@qq.com; LIU Jingsheng, Email: 324376533@qq.com

Keywords：

Irreducible intertrochanteric femoral fracture; G-arm X-ray fluoroscopy; folding top technique; right-angle pliers; proximal femoral nail antirotation

DOI：

10.7507/1002-1892.202401066

Video：

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Objective To explore the effectiveness of irreducible intertrochanteric femoral fracture in the elderly by treating with folding top technique and right-angle pliers prying and pulling under G-arm X-ray fluoroscopy. Methods The clinical data of 74 elderly patients with irreducible intertrochanteric femoral fracture admitted between February 2016 and December 2022 and met the selection criteria were retrospectively analyzed. Among them, 38 cases were treated with folding top technique combined with right-angle pliers prying and pulling under G-arm X-ray fluoroscopy and intramedullary nailing fixation (study group), and 36 cases were treated with limited open reduction combined with other reduction methods and intramedullary nailing fixation (control group). There was no significant difference in baseline data between the two groups, such as age, gender, cause of injury, affected side and classification of fractures, complicated medical diseases, and time from injury to operation (P>0.05). The operation time, intraoperative blood loss, hospital stay, fracture reduction time, fracture healing time, and complications of the two groups were recorded and compared. The quality of fracture reduction was evaluated by Baumgaertner et al. and Chang et al. fracture reduction standards. Results Patients in both groups were followed up 10-14 months, with an average of 12 months. The operation time and intraoperative blood loss in the study group were significantly less than those in the control group (P<0.05), there was no significant difference in hospital stay between the two groups (P>0.05). At 2 days after operation, according to the fracture reduction standards of Baumgaertner et al. and CHANG Shimin et al., the quality of fracture reduction in the study group was better than that in the control group, and the fracture reduction time in the study group was shorter than that in the control group, with significant differences (P<0.05). After operation, the fractures of the two groups all healed, and there was no significant difference in healing time between the two groups (P>0.05). During the follow-up, there was no complication such as incision infection, internal fixation failure, deep venous thrombosis of lower limbs, intramedullary nail breakage, spiral blade cutting, or hip varus in the two groups, except for 2 cases of coxa vara in the control group. Conclusion For the irreducible intertrochanteric femoral fracture, using folding top technique combined with right-angle pliers prying and pulling under G-arm X-ray fluoroscopy can obviously shorten the operation time, reduce the intraoperative blood loss, and improve the quality of fracture reduction.

Citation： HAN Xiaoliang, LIU Xu, CHEN Gongqiang, CHEN Dongsheng, SUN Zhipeng, YUE Heng, LIU Jingsheng. Treatment of irreducible intertrochanteric femoral fracture in elderly by folding top technique combined with right-angle pliers prying and pulling under G-arm X-ray fluoroscopy. Chinese Journal of Reparative and Reconstructive Surgery, 2024, 38(4): 398-404. doi: 10.7507/1002-1892.202401066 Copy

1.	Chun YS, Oh H, Cho YJ, et al. Technique and early results of percutaneous reduction of sagittally unstable intertrochateric fractures. Clin Orthop Surg, 2011, 3(3): 217-224.
2.	Chun YS, Oh H, Cho YJ, et al. Technique and early results of percutaneous reduction of sagittally unstable intertrochateric fractures. Clin Orthop Surg, 2011, 3(3): 217-224.
3.	佟大可, 丁文彬, 王光超, 等. 难复性股骨转子间骨折的临床分型与治疗. 中华创伤骨科杂志, 2017, 19(2): 109-114.
4.	佟大可, 丁文彬, 王光超, 等. 难复性股骨转子间骨折的临床分型与治疗. 中华创伤骨科杂志, 2017, 19(2): 109-114.
5.	Ma KL, Wang X, Luan FJ, et al. Proximal femoral nails antirotation, Gamma nails, and dynamic hip screws for fixation of intertrochanteric fractures of femur: A meta-analysis. Orthop Traumatol Surg Res, 2014, 100(8): 859-866.
6.	Ma KL, Wang X, Luan FJ, et al. Proximal femoral nails antirotation, Gamma nails, and dynamic hip screws for fixation of intertrochanteric fractures of femur: A meta-analysis. Orthop Traumatol Surg Res, 2014, 100(8): 859-866.
7.	王跃挺, 张琳袁, 龚伟华, 等. 老年转子间骨折股骨近端防旋髓内钉内固定术后骨折断端阳性支撑与阴性支撑短期疗效比较. 中华骨与关节外科杂志, 2021, 14(3): 205-209.
8.	王跃挺, 张琳袁, 龚伟华, 等. 老年转子间骨折股骨近端防旋髓内钉内固定术后骨折断端阳性支撑与阴性支撑短期疗效比较. 中华骨与关节外科杂志, 2021, 14(3): 205-209.
9.	孙凤坡, 刘湘雪, 张统一, 等. 顶棒支撑法复位在难复性股骨转子间骨折治疗中的应用效果分析. 中华创伤骨科杂志, 2021, 23(9): 782-787.
10.	孙凤坡, 刘湘雪, 张统一, 等. 顶棒支撑法复位在难复性股骨转子间骨折治疗中的应用效果分析. 中华创伤骨科杂志, 2021, 23(9): 782-787.
11.	邱卫华, 王剑玮, 黄磊, 等. 骨钩辅助闭合复位股骨近端防旋髓内钉内固定治疗较难复位的老年外翻型股骨粗隆间骨折. 中国骨与关节损伤杂志, 2022, 37(12): 1291-1293.
12.	邱卫华, 王剑玮, 黄磊, 等. 骨钩辅助闭合复位股骨近端防旋髓内钉内固定治疗较难复位的老年外翻型股骨粗隆间骨折. 中国骨与关节损伤杂志, 2022, 37(12): 1291-1293.
13.	黄淑明, 兰树华, 吴泉州, 等. 枪式钳辅助复位髓内固定治疗内外向难复性股骨转子间骨折. 中国基层医药, 2019, 26(9): 1037-1041.
14.	黄淑明, 兰树华, 吴泉州, 等. 枪式钳辅助复位髓内固定治疗内外向难复性股骨转子间骨折. 中国基层医药, 2019, 26(9): 1037-1041.
15.	梁志强, 孙俊明, 林永炀, 等. 经皮撬拨复位股骨近端防旋髓内钉内固定治疗闭合复位困难的股骨粗隆间骨折. 中国骨与关节损伤杂志, 2022, 37(2): 184-186.
16.	梁志强, 孙俊明, 林永炀, 等. 经皮撬拨复位股骨近端防旋髓内钉内固定治疗闭合复位困难的股骨粗隆间骨折. 中国骨与关节损伤杂志, 2022, 37(2): 184-186.
17.	赵益峰, 姜振, 李涛, 等. 前入路微创钳夹复位技术治疗难复性股骨转子间骨折. 中国修复重建外科杂志, 2021, 35(5): 544-549.
18.	赵益峰, 姜振, 李涛, 等. 前入路微创钳夹复位技术治疗难复性股骨转子间骨折. 中国修复重建外科杂志, 2021, 35(5): 544-549.
19.	佟大可, 丁文彬, 王光超, 等. 难复性股骨转子间骨折的2021分型与复位技巧研究. 中华创伤骨科杂志, 2022, 24(3): 238-246.
20.	佟大可, 丁文彬, 王光超, 等. 难复性股骨转子间骨折的2021分型与复位技巧研究. 中华创伤骨科杂志, 2022, 24(3): 238-246.
21.	Baumgaertner MR, Solberg BD. Awareness of tip-apex distance reduces failure of fixation of trochanteric fractures of the hip. J Bone Joint Surg (Br), 1997, 79(6): 969-971.
22.	Baumgaertner MR, Solberg BD. Awareness of tip-apex distance reduces failure of fixation of trochanteric fractures of the hip. J Bone Joint Surg (Br), 1997, 79(6): 969-971.
23.	Chang SM, Hou ZY, Hu SJ, et al. Intertrochanteric femur fracture treatment in Asia: What we know and what the world can learn. Orthop Clin North Am, 2020, 51(2): 189-205.
24.	Chang SM, Hou ZY, Hu SJ, et al. Intertrochanteric femur fracture treatment in Asia: What we know and what the world can learn. Orthop Clin North Am, 2020, 51(2): 189-205.
25.	尚宏喜, 刘安庆, 丁强, 等. G型臂X线机监视下微创空心螺纹钉内固定治疗股骨颈骨折. 中华创伤骨科杂志, 2013, 15(2): 180-182.
26.	尚宏喜, 刘安庆, 丁强, 等. G型臂X线机监视下微创空心螺纹钉内固定治疗股骨颈骨折. 中华创伤骨科杂志, 2013, 15(2): 180-182.
27.	王华, 王先辉, 吴非, 等. G型臂与C型臂X线机在PFNA内固定治疗股骨粗隆间骨折中的应用对照研究. 中国骨与关节损伤杂志, 2019, 34(8): 826-828.
28.	王华, 王先辉, 吴非, 等. G型臂与C型臂X线机在PFNA内固定治疗股骨粗隆间骨折中的应用对照研究. 中国骨与关节损伤杂志, 2019, 34(8): 826-828.
29.	张红远. 瑞典Biplanar500G型臂技术优点及常见故障排除. 医疗卫生装备, 2012, 33(4): 145-146.
30.	张红远. 瑞典Biplanar500G型臂技术优点及常见故障排除. 医疗卫生装备, 2012, 33(4): 145-146.
31.	Klaber I, Besa P, Sandoval F, et al. The new AO classification system for intertrochanteric fractures allows better agreement than the original AO classification. An inter- and intra-observer agreement evaluation. Injury, 2021, 52(1): 102-105.
32.	Klaber I, Besa P, Sandoval F, et al. The new AO classification system for intertrochanteric fractures allows better agreement than the original AO classification. An inter- and intra-observer agreement evaluation. Injury, 2021, 52(1): 102-105.
33.	李翔, 王爱国, 时晓华, 等. 难复性股骨转子间骨折的新分型与复位策略研究. 中华创伤骨科杂志, 2023, 25(9): 762-769.
34.	李翔, 王爱国, 时晓华, 等. 难复性股骨转子间骨折的新分型与复位策略研究. 中华创伤骨科杂志, 2023, 25(9): 762-769.
35.	Moehring HD, Nowinski GP, Chapman MW, et al. Irreducible intertrochanteric fractures of the femur. Clin Orthop Relat Res, 1997(339): 197-199.
36.	Moehring HD, Nowinski GP, Chapman MW, et al. Irreducible intertrochanteric fractures of the femur. Clin Orthop Relat Res, 1997(339): 197-199.
37.	张泽, 孙凤坡, 张统一, 等. 基于复位期及骨块位置的难复性股骨转子间骨折分型及复位技巧研究. 中华创伤骨科杂志, 2023, 25(9): 755-761.
38.	张泽, 孙凤坡, 张统一, 等. 基于复位期及骨块位置的难复性股骨转子间骨折分型及复位技巧研究. 中华创伤骨科杂志, 2023, 25(9): 755-761.

1. Chun YS, Oh H, Cho YJ, et al. Technique and early results of percutaneous reduction of sagittally unstable intertrochateric fractures. Clin Orthop Surg, 2011, 3(3): 217-224.
2. Chun YS, Oh H, Cho YJ, et al. Technique and early results of percutaneous reduction of sagittally unstable intertrochateric fractures. Clin Orthop Surg, 2011, 3(3): 217-224.
3. 佟大可, 丁文彬, 王光超, 等. 难复性股骨转子间骨折的临床分型与治疗. 中华创伤骨科杂志, 2017, 19(2): 109-114.
4. 佟大可, 丁文彬, 王光超, 等. 难复性股骨转子间骨折的临床分型与治疗. 中华创伤骨科杂志, 2017, 19(2): 109-114.
5. Ma KL, Wang X, Luan FJ, et al. Proximal femoral nails antirotation, Gamma nails, and dynamic hip screws for fixation of intertrochanteric fractures of femur: A meta-analysis. Orthop Traumatol Surg Res, 2014, 100(8): 859-866.
6. Ma KL, Wang X, Luan FJ, et al. Proximal femoral nails antirotation, Gamma nails, and dynamic hip screws for fixation of intertrochanteric fractures of femur: A meta-analysis. Orthop Traumatol Surg Res, 2014, 100(8): 859-866.
7. 王跃挺, 张琳袁, 龚伟华, 等. 老年转子间骨折股骨近端防旋髓内钉内固定术后骨折断端阳性支撑与阴性支撑短期疗效比较. 中华骨与关节外科杂志, 2021, 14(3): 205-209.
8. 王跃挺, 张琳袁, 龚伟华, 等. 老年转子间骨折股骨近端防旋髓内钉内固定术后骨折断端阳性支撑与阴性支撑短期疗效比较. 中华骨与关节外科杂志, 2021, 14(3): 205-209.
9. 孙凤坡, 刘湘雪, 张统一, 等. 顶棒支撑法复位在难复性股骨转子间骨折治疗中的应用效果分析. 中华创伤骨科杂志, 2021, 23(9): 782-787.
10. 孙凤坡, 刘湘雪, 张统一, 等. 顶棒支撑法复位在难复性股骨转子间骨折治疗中的应用效果分析. 中华创伤骨科杂志, 2021, 23(9): 782-787.
11. 邱卫华, 王剑玮, 黄磊, 等. 骨钩辅助闭合复位股骨近端防旋髓内钉内固定治疗较难复位的老年外翻型股骨粗隆间骨折. 中国骨与关节损伤杂志, 2022, 37(12): 1291-1293.
12. 邱卫华, 王剑玮, 黄磊, 等. 骨钩辅助闭合复位股骨近端防旋髓内钉内固定治疗较难复位的老年外翻型股骨粗隆间骨折. 中国骨与关节损伤杂志, 2022, 37(12): 1291-1293.
13. 黄淑明, 兰树华, 吴泉州, 等. 枪式钳辅助复位髓内固定治疗内外向难复性股骨转子间骨折. 中国基层医药, 2019, 26(9): 1037-1041.
14. 黄淑明, 兰树华, 吴泉州, 等. 枪式钳辅助复位髓内固定治疗内外向难复性股骨转子间骨折. 中国基层医药, 2019, 26(9): 1037-1041.
15. 梁志强, 孙俊明, 林永炀, 等. 经皮撬拨复位股骨近端防旋髓内钉内固定治疗闭合复位困难的股骨粗隆间骨折. 中国骨与关节损伤杂志, 2022, 37(2): 184-186.
16. 梁志强, 孙俊明, 林永炀, 等. 经皮撬拨复位股骨近端防旋髓内钉内固定治疗闭合复位困难的股骨粗隆间骨折. 中国骨与关节损伤杂志, 2022, 37(2): 184-186.
17. 赵益峰, 姜振, 李涛, 等. 前入路微创钳夹复位技术治疗难复性股骨转子间骨折. 中国修复重建外科杂志, 2021, 35(5): 544-549.
18. 赵益峰, 姜振, 李涛, 等. 前入路微创钳夹复位技术治疗难复性股骨转子间骨折. 中国修复重建外科杂志, 2021, 35(5): 544-549.
19. 佟大可, 丁文彬, 王光超, 等. 难复性股骨转子间骨折的2021分型与复位技巧研究. 中华创伤骨科杂志, 2022, 24(3): 238-246.
20. 佟大可, 丁文彬, 王光超, 等. 难复性股骨转子间骨折的2021分型与复位技巧研究. 中华创伤骨科杂志, 2022, 24(3): 238-246.
21. Baumgaertner MR, Solberg BD. Awareness of tip-apex distance reduces failure of fixation of trochanteric fractures of the hip. J Bone Joint Surg (Br), 1997, 79(6): 969-971.
22. Baumgaertner MR, Solberg BD. Awareness of tip-apex distance reduces failure of fixation of trochanteric fractures of the hip. J Bone Joint Surg (Br), 1997, 79(6): 969-971.
23. Chang SM, Hou ZY, Hu SJ, et al. Intertrochanteric femur fracture treatment in Asia: What we know and what the world can learn. Orthop Clin North Am, 2020, 51(2): 189-205.
24. Chang SM, Hou ZY, Hu SJ, et al. Intertrochanteric femur fracture treatment in Asia: What we know and what the world can learn. Orthop Clin North Am, 2020, 51(2): 189-205.
25. 尚宏喜, 刘安庆, 丁强, 等. G型臂X线机监视下微创空心螺纹钉内固定治疗股骨颈骨折. 中华创伤骨科杂志, 2013, 15(2): 180-182.
26. 尚宏喜, 刘安庆, 丁强, 等. G型臂X线机监视下微创空心螺纹钉内固定治疗股骨颈骨折. 中华创伤骨科杂志, 2013, 15(2): 180-182.
27. 王华, 王先辉, 吴非, 等. G型臂与C型臂X线机在PFNA内固定治疗股骨粗隆间骨折中的应用对照研究. 中国骨与关节损伤杂志, 2019, 34(8): 826-828.
28. 王华, 王先辉, 吴非, 等. G型臂与C型臂X线机在PFNA内固定治疗股骨粗隆间骨折中的应用对照研究. 中国骨与关节损伤杂志, 2019, 34(8): 826-828.
29. 张红远. 瑞典Biplanar500G型臂技术优点及常见故障排除. 医疗卫生装备, 2012, 33(4): 145-146.
30. 张红远. 瑞典Biplanar500G型臂技术优点及常见故障排除. 医疗卫生装备, 2012, 33(4): 145-146.
31. Klaber I, Besa P, Sandoval F, et al. The new AO classification system for intertrochanteric fractures allows better agreement than the original AO classification. An inter- and intra-observer agreement evaluation. Injury, 2021, 52(1): 102-105.
32. Klaber I, Besa P, Sandoval F, et al. The new AO classification system for intertrochanteric fractures allows better agreement than the original AO classification. An inter- and intra-observer agreement evaluation. Injury, 2021, 52(1): 102-105.
33. 李翔, 王爱国, 时晓华, 等. 难复性股骨转子间骨折的新分型与复位策略研究. 中华创伤骨科杂志, 2023, 25(9): 762-769.
34. 李翔, 王爱国, 时晓华, 等. 难复性股骨转子间骨折的新分型与复位策略研究. 中华创伤骨科杂志, 2023, 25(9): 762-769.
35. Moehring HD, Nowinski GP, Chapman MW, et al. Irreducible intertrochanteric fractures of the femur. Clin Orthop Relat Res, 1997(339): 197-199.
36. Moehring HD, Nowinski GP, Chapman MW, et al. Irreducible intertrochanteric fractures of the femur. Clin Orthop Relat Res, 1997(339): 197-199.
37. 张泽, 孙凤坡, 张统一, 等. 基于复位期及骨块位置的难复性股骨转子间骨折分型及复位技巧研究. 中华创伤骨科杂志, 2023, 25(9): 755-761.
38. 张泽, 孙凤坡, 张统一, 等. 基于复位期及骨块位置的难复性股骨转子间骨折分型及复位技巧研究. 中华创伤骨科杂志, 2023, 25(9): 755-761.

Chinese Journal of Reparative and Reconstructive Surgery

Treatment of irreducible intertrochanteric femoral fracture in elderly by folding top technique combined with right-angle pliers prying and pulling under G-arm X-ray fluoroscopy

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