Effectiveness of proximal femoral nail anti-rotation combined with minimally invasive percutaneous plate osteosynthesis versus Intertan intramedullary nail fixation in treatment of intertrochanteric fracture with incomplete lateral wall_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CHEN Zhangxin , HU Cuiyu , ZHENG Zhenhua , JIANG Huixiang , GAO Mingming , WU Benwen ,  HUANG Guofeng ,  DING Zhenqi

Military Orthopaedic Center, the 909th Hospital of Joint Service Support Force of PLA (the Affiliated Dongnan Hospital of Xiamen University), Zhangzhou Fujian, 363000, P.R.China;

Corresponding author：

HUANG Guofeng, Email: huangguofeng175@163.com; DING Zhenqi, Email: dingzhenqi175@163.com

Keywords：

Intertrochanteric fracture of femur; lateral wall; closed reduction; minimally invasive percutaneous plate osteosynthesis; proximal femoral nail anti-rotation; Intertan intramedullary nail; internal fixation

DOI：

10.7507/1002-1892.202001071

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Objective To compare the effectiveness of proximal femoral nail anti-rotation (PFNA) combined with minimally invasive percutaneous plate osteosynthesis (MIPPO) and Intertan intramedullary nail fixation by closed reduction in the treatment of AO/Orthopaedic Trauma Association (AO/OTA) type 31-A3.3 intertrochanteric fracture with incomplete lateral wall.Methods The clinical data of 54 patients with AO/OTA type 31-A3.3 intertrochanteric fracture who met the selection criteria and were admitted between January 2012 and January 2018 were retrospectively analyzed. According to different surgical methods, the patients were divided into group A (24 cases with lateral wall reconstruction by MIPPO combined with PFNA internal fixation) and group B (30 cases with Intertan intramedullary nail fixation by closed reduction only). There was no significant difference between the two groups (P>0.05) in terms of gender, age, side of injury, cause of injury, and combined medical diseases. The operation time, intraoperative blood loss, time to weight-bearing, fracture healing time, and postoperative complications were recorded and compared between the two groups. The tip apex distance (TAD) was measured at 2 days, 2 months, and 1 year after operation. At 12 months after operation, the hip joint function was evaluated according to Harris scoring standard, and the rate of conformity (Harris score were more than 70) was calculated.Results The wounds of the two groups healed by first intention, without infection, skin deformity, and other incision complications. The operation time and intraoperative blood loss of group A were significantly more than those of group B, and the time to weight-bearing and fracture healing were significantly shorter than those of group B (P<0.05). The patients were followed up 9-20 months (mean, 14.7 months) in group A and 9-19 months (mean, 13.8 months) in group B. There was no significant difference in TAD values at 2 days, 2 months, and 1 year after operation between the two groups (P<0.05), and there was also no significant difference in TAD values between the postoperative time points (P>0.05). There was 1 case of infection, 1 case of screw withdrawal, 2 cases of screw removal, and 1 case of bone nonunion in group B, the incidence of complications was 16.7%; there was only 1 case of screw withdrawal combined with screw blade withdrawal in group A, the incidence of complications was 4.2%; there was no significant difference between the two groups (χ²=2.109, P=0.146). At 12 months after operation, the Harris scores of pain, function, malunion, range of motion, and total score in group A were significantly better than those in group B (P<0.05). The rate of conformity of group A was 95.83% (23/24) and 76.67% (23/30) in group B, and the difference between the two groups was significant (χ²=3.881, P=0.049).Conclusion For the AO/OTA type 31-A3.3 intertrochanteric fracture with incomplete lateral wall, compared with the closed reduction Intertan intramedullary nail fixation, the incidence of internal fixation failure after MIPPO reconstruction with lateral wall combined with PFNA fixation was lower, the time to weight-bearing was earlier, and the postoperative function was better.

Citation： CHEN Zhangxin, HU Cuiyu, ZHENG Zhenhua, JIANG Huixiang, GAO Mingming, WU Benwen, HUANG Guofeng, DING Zhenqi. Effectiveness of proximal femoral nail anti-rotation combined with minimally invasive percutaneous plate osteosynthesis versus Intertan intramedullary nail fixation in treatment of intertrochanteric fracture with incomplete lateral wall. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(9): 1085-1090. doi: 10.7507/1002-1892.202001071 Copy

1.	Yu X, Wang H, Duan X, et al. Intramedullary versus extramedullary internal fixation for unstable intertrochanteric fracture, a meta-analysis. Acta Orthop Traumatol Turc, 2018, 52(4): 299-307.
2.	Lee JH, Park KC, Lim SJ, et al. Surgical outcomes of simple distal femur fractures in elderly patients treated with the minimally invasive plate osteosynthesis technique: can percutaneous cerclage wiring reduce the fracture healing time? Arch Orthop Trauma Surg, 2020. [Epub ahead of print].
3.	李建涛, 张里程, 唐佩福. 股骨粗隆间骨折治疗理念与内固定器械的发展概述. 中国修复重建外科杂志, 2019, 33(1): 1-7.
4.	Díaz VJ, Cañizares AC, Martín IA, et al. Predictive variables of open reduction in intertrochanteric fracture nailing: a report of 210 cases. Injury, 2016, 47(Suppl 3): S51-S55.
5.	武建超, 师政伟, 李吉鹏, 等. 股骨粗隆间骨折外侧壁损伤的研究进展. 中国修复重建外科杂志, 2018, 32(12): 1605-1610.
6.	姜昊, 曹烈虎, 潘思华, 等. 有限切开钛缆捆扎辅助 PFNA 与单纯微创辅助 PFNA 治疗老年骨质疏松性 31-A3 型股骨粗隆间骨折的疗效对比. 中国骨与关节杂志, 2019, 8(3): 191-195.
7.	李尧, 胡传真, 茅凌洲, 等. 股骨近端防旋髓内钉联合小钢板重建外侧壁治疗 AO/OTA 31-A3 型股骨转子间骨折. 中国修复重建外科杂志, 2019, 33(10): 1223-1227.
8.	张金辉, 张科学, 张立海, 等. 老年股骨粗隆间骨折股骨近端抗旋髓内钉和股骨近端髓内钉 InterTAN 的选择和疗效评价. 中国修复重建外科杂志, 2015, 29(5): 538-541.
9.	Jiang L, Zheng Q, Pan Z. What is the fracture displacement influence to fracture non-union in intramedullary nail treatment in subtrochanteric fracture? J Clin Orthop Trauma, 2018, 9(4): 317-321.
10.	Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg (Am), 1969, 51(4): 737-755.
11.	Gotfried Y. The lateral trochanteric wall: a key element in the reconstruction of unstable pertrochanteric hip fractures. Clin Orthop Relat Res, 2004, (425): 82-86.
12.	Gotfried Y. Integrity of the lateral femoral wall in intertrochanteric hip fractures: an important predictor of a reoperation. J Bone Joint Surg (Am), 2007, 89(11): 2552-2553.
13.	Palm H, Jacobsen S, Sonne-Holm S, et al. Integrity of the lateral femoral wall in intertrochanteric hip fractures: an important predictor of a reoperation. J Bone Joint Surg (Am), 2007, 89(3): 470-475.
14.	Hao Y, Zhang Z, Zhou F, et al. Risk factors for implant failure in reverse oblique and transverse intertrochanteric fractures treated with proximal femoral nail antirotation (PFNA). J Orthop Surg Res, 2019, 14(1): 350.
15.	Haq RU, Manhas V, Pankaj A, et al. Proximal femoral nails compared with reverse distal femoral locking plates in intertrochanteric fractures with a compromised lateral wall; a randomised controlled trial. Int Orthop, 2014, 38(7): 1443-1449.
16.	朱新红, 黄飞, 于凤宾, 等. PFNA-Ⅱ联合外侧支撑钢板治疗股骨粗隆并外侧壁不稳定型骨折的疗效分析. 中国骨与关节杂志, 2018, 7(7): 506-509.
17.	于晨, 江龙海, 蔡大卫, 等. PFNA 与 InterTAN 髓内钉治疗老年股骨转子间骨折疗效的 Meta 分析. 中国骨伤, 2019, 32(2): 120-129.
18.	张舒. 髓内固定术对老年股骨粗隆间骨折患者股骨头旋转及固定钉滑脱的影响研究. 中国骨与关节杂志, 2019, 8(6): 465-469.

1. Yu X, Wang H, Duan X, et al. Intramedullary versus extramedullary internal fixation for unstable intertrochanteric fracture, a meta-analysis. Acta Orthop Traumatol Turc, 2018, 52(4): 299-307.
2. Lee JH, Park KC, Lim SJ, et al. Surgical outcomes of simple distal femur fractures in elderly patients treated with the minimally invasive plate osteosynthesis technique: can percutaneous cerclage wiring reduce the fracture healing time? Arch Orthop Trauma Surg, 2020. [Epub ahead of print].
3. 李建涛, 张里程, 唐佩福. 股骨粗隆间骨折治疗理念与内固定器械的发展概述. 中国修复重建外科杂志, 2019, 33(1): 1-7.
4. Díaz VJ, Cañizares AC, Martín IA, et al. Predictive variables of open reduction in intertrochanteric fracture nailing: a report of 210 cases. Injury, 2016, 47(Suppl 3): S51-S55.
5. 武建超, 师政伟, 李吉鹏, 等. 股骨粗隆间骨折外侧壁损伤的研究进展. 中国修复重建外科杂志, 2018, 32(12): 1605-1610.
6. 姜昊, 曹烈虎, 潘思华, 等. 有限切开钛缆捆扎辅助 PFNA 与单纯微创辅助 PFNA 治疗老年骨质疏松性 31-A3 型股骨粗隆间骨折的疗效对比. 中国骨与关节杂志, 2019, 8(3): 191-195.
7. 李尧, 胡传真, 茅凌洲, 等. 股骨近端防旋髓内钉联合小钢板重建外侧壁治疗 AO/OTA 31-A3 型股骨转子间骨折. 中国修复重建外科杂志, 2019, 33(10): 1223-1227.
8. 张金辉, 张科学, 张立海, 等. 老年股骨粗隆间骨折股骨近端抗旋髓内钉和股骨近端髓内钉 InterTAN 的选择和疗效评价. 中国修复重建外科杂志, 2015, 29(5): 538-541.
9. Jiang L, Zheng Q, Pan Z. What is the fracture displacement influence to fracture non-union in intramedullary nail treatment in subtrochanteric fracture? J Clin Orthop Trauma, 2018, 9(4): 317-321.
10. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg (Am), 1969, 51(4): 737-755.
11. Gotfried Y. The lateral trochanteric wall: a key element in the reconstruction of unstable pertrochanteric hip fractures. Clin Orthop Relat Res, 2004, (425): 82-86.
12. Gotfried Y. Integrity of the lateral femoral wall in intertrochanteric hip fractures: an important predictor of a reoperation. J Bone Joint Surg (Am), 2007, 89(11): 2552-2553.
13. Palm H, Jacobsen S, Sonne-Holm S, et al. Integrity of the lateral femoral wall in intertrochanteric hip fractures: an important predictor of a reoperation. J Bone Joint Surg (Am), 2007, 89(3): 470-475.
14. Hao Y, Zhang Z, Zhou F, et al. Risk factors for implant failure in reverse oblique and transverse intertrochanteric fractures treated with proximal femoral nail antirotation (PFNA). J Orthop Surg Res, 2019, 14(1): 350.
15. Haq RU, Manhas V, Pankaj A, et al. Proximal femoral nails compared with reverse distal femoral locking plates in intertrochanteric fractures with a compromised lateral wall; a randomised controlled trial. Int Orthop, 2014, 38(7): 1443-1449.
16. 朱新红, 黄飞, 于凤宾, 等. PFNA-Ⅱ联合外侧支撑钢板治疗股骨粗隆并外侧壁不稳定型骨折的疗效分析. 中国骨与关节杂志, 2018, 7(7): 506-509.
17. 于晨, 江龙海, 蔡大卫, 等. PFNA 与 InterTAN 髓内钉治疗老年股骨转子间骨折疗效的 Meta 分析. 中国骨伤, 2019, 32(2): 120-129.
18. 张舒. 髓内固定术对老年股骨粗隆间骨折患者股骨头旋转及固定钉滑脱的影响研究. 中国骨与关节杂志, 2019, 8(6): 465-469.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of proximal femoral nail anti-rotation combined with minimally invasive percutaneous plate osteosynthesis versus Intertan intramedullary nail fixation in treatment of intertrochanteric fracture with incomplete lateral wall

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