Effectiveness of proximal femoral nail anti-rotation and cerclage fixation for complicated femoral subtrochanteric fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

HUANG Chenyi , GAO Yi , GAO Haiming , LIU Shigui , FU Zhijiang , CHEN Jingwen ,  LIU Zongchao

Department of Orthopedic Surgery, the Affiliated Hospital of Traditional Chinese Medicine, Southwest Medical University, Luzhou Sichuan, 646000, P.R.China;

Corresponding author：

LIU Zongchao, Email: 565409672@qq.com

Keywords：

Femoral subtrochanteric fracture; proximal femoral nail anti-rotation; cerclage; internal fixation

DOI：

10.7507/1002-1892.202103138

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To investigate the effectiveness of proximal femoral nail anti-rotation (PFNA) and cerclage fixation for complicated femoral subtrochanteric fractures.Methods A clinical data of 74 patients with complicated femoral subtrochanteric fractures, who were admitted between March 2016 and March 2019 and met the criteria, was retrospectively analyzed. Among them, 39 patients were treated with limited open reduction and PFNA combined with cerclage fixation (observation group) and 35 patients were treated with closed reduction and PFNA fixation (control group). There was no significant difference in gender, age, cause of injury, side and type of fracture, and the time from injury to operation (P>0.05). The ratio of postoperative hemoglobin (1, 3, and 5 days) to the preoperative hemoglobin, the operation time, the first weight-bearing time after operation, and the hospital stay were recorded. X-ray films were taken to observe fracture healing in the two groups and bone resorption around the cerclage in the observation group, and the fracture healing time was recorded. Hip function was evaluated by Harris scoring. Results The operation time of the observation group was significantly longer than that of the control group (P<0.05), but the first weight-bearing time and hospital stay were significantly shorter (P<0.05). All patients were followed up 12 months. There was no significant difference in the ratios of post- to pre-operative hemoglobin (1, 3, and 5 days) between the two groups (P>0.05). X-ray film reexamination showed that the fractures of the two groups healed smoothly, and the fracture healing time of the observation group was significantly shorter than that of the control group (t=−12.989, P=0.000). No bone resorption around the cerclage occurred in the observation group. The Harris scores of the observation group were better than those of the control group at 7 days and 1, 2, and 3 months after operation (P<0.05), and there was no significant difference between the two groups at 6 months after operation (t=1.329, P=0.180).Conclusion Compared with PFNA fixation, PFNA combined with cerclage fixation for the complicated femoral subtrochanteric fractures has a shorter operation time, and can obtain immediate stability after fixation, which can meet the needs of patients for early functional exercise.

Citation： HUANG Chenyi, GAO Yi, GAO Haiming, LIU Shigui, FU Zhijiang, CHEN Jingwen, LIU Zongchao. Effectiveness of proximal femoral nail anti-rotation and cerclage fixation for complicated femoral subtrochanteric fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(8): 956-960. doi: 10.7507/1002-1892.202103138 Copy

1.	贺丹, 刘厚莲. 中国人口老龄化发展态势、影响及应对策略. 中共中央党校 (国家行政学院) 学报, 2019, 23(4): 84-90.
2.	Xie Y, Dong Q, Xie Z. Proximal femoral nail anti-rotation (PFNA) and hemi-arthroplasty in the treatment of elderly intertrochanteric fractures. Acta Orthop Belg, 2019, 85(2): 199-204.
3.	Forward DP, Doro CJ, O’Toole RV, et al. A biomechanical comparison of a locking plate, a nail, and a 95° angled blade plate for fixation of subtrochanteric femoral fractures. J Orthop Trauma, 2012, 26(6): 334-340.
4.	袁春晓, 阿里木江·阿不来提, 李京, 等. 髓内固定与髓外钉板固定治疗成人股骨转子下骨折的 Meta 分析. 中国矫形外科杂志, 2014, 22(10): 886-891.
5.	吴克俭, 汤俊君. 准确理解股骨转子间骨折“外侧壁”. 中国修复重建外科杂志, 2019, 33(10): 1210-1215.
6.	张世民, 胡孙君, 杜守超, 等. 股骨转子间骨折的稳定性重建概念演化与研究进展. 中国修复重建外科杂志, 2019, 33(10): 1203-1209.
7.	张世民, 张英琪, 李清, 等. 内侧皮质正性支撑复位对老年股骨粗隆间骨折内固定效果的影响. 中国矫形外科杂志, 2014, 22(14): 1256-1261.
8.	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.
9.	孙哲, 刘绍灵, 邓进. 股骨转子下骨折的治疗进展. 创伤外科杂志, 2018, 20(5): 396-398.
10.	杨明辉, 李宇能. 当今股骨转子下骨折的治疗理念. 国际骨科学杂志, 2017, 38(4): 213-215.
11.	杨雷, 殷刚, 刘志元, 等. 股骨近端防旋髓内钉治疗股骨粗隆下骨折的效果. 实用临床医药杂志, 2015, 19(23): 102-103.
12.	Karayiannis P, James A. The impact of cerclage cabling on unstable intertrochanteric and subtrochanteric femoral fractures: a retrospective review of 465 patients. Eur J Trauma Emerg Surg, 2020, 46(5): 969-975.
13.	Codesido P, Mejía A, Riego J, et al. Subtrochanteric fractures in elderly people treated with intramedullary fixation: quality of life and complications following open reduction and cerclage wiring versus closed reduction. Arch Orthop Trauma Surg, 2017, 137(8): 1077-1085.
14.	李继川, 赵义荣, 余春生, 等. 微创 PFNA 髓内钉治疗老年转子间骨折术后隐形失血的因素分析. 中国医师杂志, 2019, 21(9): 1418-1420.
15.	Stacey J, Bush C, DiPasquale T. The hidden blood loss in proximal femur fractures is sizeable and significant. J Clin Orthop Trauma, 2021, 16: 239-243.
16.	Rehme J, Woltmann A, Brand A, et al. Does auxiliary cerclage wiring provide intrinsic stability in cephalomedullary nailing of trochanteric and subtrochanteric fractures? Int Orthop, 2020, 45(1): 1329-1336.
17.	Huang X, Zhang F, Zhang Y. Case series and finite element analysis of PFNA combined with cerclage wire for treatment of subtrochanteric fracture of femur. J Orthop Surg Res, 2021, 16(1): 70. doi: 10.1186/s13018-020-02187-3.
18.	Fauconnier S, Van Lieshout M, Victor J. Evaluation of cerclage wiring in the treatment of subtrochanteric fractures. Acta Orthop Belg, 2020, 86(1): 28-32.
19.	朱佳福, 徐卫星, 刘宏. InterTan 髓内钉治疗老年股骨转子间冠状位骨折的病例对照研究. 中国骨伤, 2016, 29(12): 1130-1134.
20.	Broos PL, Sermon A. From unstable internal fixation to biological osteosynthesis. A historical overview of operative fracture treatment. Acta Chir Belg, 2004, 104(4): 396-400.
21.	Bauer TW, Muschler GF. Bone graft materials. An overview of the basic science. Clin Orthop Relat Res, 2000, (371): 10-27.
22.	Kennedy MT, Mitra A, Hierlihy TG, et al. Subtrochanteric hip fractures treated with cerclage cables and long cephalomedullary nails: a review of 17 consecutive cases over 2 years. Injury, 2011, 42(11): 1317-1321.
23.	倪东馗, 郑道明, 庞小建, 等. 捆绑带对骨折愈合影响的实验研究. 天津医科大学学报, 2010, 16(3): 395-398.
24.	Grimsrud C, Monzon RJ, Richman J, et al. Cemented hip arthroplasty with a novel cerclage cable technique for unstable intertrochanteric hip fractures. J Arthroplasty, 2005, 20(3): 337-343.
25.	Old AB, McGrory BJ, White RR, et al. Fixation of Vancouver B1 peri-prosthetic fractures by broad metal plates without the application of strut allografts. J Bone Joint Surg (Br), 2006, 88(11): 1425-1429.
26.	庞小建, 倪东馗, 郑道明, 等. 不同宽度捆绑带对骨折愈合的影响. 中国组织工程研究与临床康复, 2011, 15(39): 7221-7225.
27.	叶添文, 李阳, 欧阳跃平, 等. 医用钛缆在髌骨粉碎性骨折治疗中的应用. 中国矫形外科杂志, 2009, 17(4): 268-271.

1. 贺丹, 刘厚莲. 中国人口老龄化发展态势、影响及应对策略. 中共中央党校 (国家行政学院) 学报, 2019, 23(4): 84-90.
2. Xie Y, Dong Q, Xie Z. Proximal femoral nail anti-rotation (PFNA) and hemi-arthroplasty in the treatment of elderly intertrochanteric fractures. Acta Orthop Belg, 2019, 85(2): 199-204.
3. Forward DP, Doro CJ, O’Toole RV, et al. A biomechanical comparison of a locking plate, a nail, and a 95° angled blade plate for fixation of subtrochanteric femoral fractures. J Orthop Trauma, 2012, 26(6): 334-340.
4. 袁春晓, 阿里木江·阿不来提, 李京, 等. 髓内固定与髓外钉板固定治疗成人股骨转子下骨折的 Meta 分析. 中国矫形外科杂志, 2014, 22(10): 886-891.
5. 吴克俭, 汤俊君. 准确理解股骨转子间骨折“外侧壁”. 中国修复重建外科杂志, 2019, 33(10): 1210-1215.
6. 张世民, 胡孙君, 杜守超, 等. 股骨转子间骨折的稳定性重建概念演化与研究进展. 中国修复重建外科杂志, 2019, 33(10): 1203-1209.
7. 张世民, 张英琪, 李清, 等. 内侧皮质正性支撑复位对老年股骨粗隆间骨折内固定效果的影响. 中国矫形外科杂志, 2014, 22(14): 1256-1261.
8. 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.
9. 孙哲, 刘绍灵, 邓进. 股骨转子下骨折的治疗进展. 创伤外科杂志, 2018, 20(5): 396-398.
10. 杨明辉, 李宇能. 当今股骨转子下骨折的治疗理念. 国际骨科学杂志, 2017, 38(4): 213-215.
11. 杨雷, 殷刚, 刘志元, 等. 股骨近端防旋髓内钉治疗股骨粗隆下骨折的效果. 实用临床医药杂志, 2015, 19(23): 102-103.
12. Karayiannis P, James A. The impact of cerclage cabling on unstable intertrochanteric and subtrochanteric femoral fractures: a retrospective review of 465 patients. Eur J Trauma Emerg Surg, 2020, 46(5): 969-975.
13. Codesido P, Mejía A, Riego J, et al. Subtrochanteric fractures in elderly people treated with intramedullary fixation: quality of life and complications following open reduction and cerclage wiring versus closed reduction. Arch Orthop Trauma Surg, 2017, 137(8): 1077-1085.
14. 李继川, 赵义荣, 余春生, 等. 微创 PFNA 髓内钉治疗老年转子间骨折术后隐形失血的因素分析. 中国医师杂志, 2019, 21(9): 1418-1420.
15. Stacey J, Bush C, DiPasquale T. The hidden blood loss in proximal femur fractures is sizeable and significant. J Clin Orthop Trauma, 2021, 16: 239-243.
16. Rehme J, Woltmann A, Brand A, et al. Does auxiliary cerclage wiring provide intrinsic stability in cephalomedullary nailing of trochanteric and subtrochanteric fractures? Int Orthop, 2020, 45(1): 1329-1336.
17. Huang X, Zhang F, Zhang Y. Case series and finite element analysis of PFNA combined with cerclage wire for treatment of subtrochanteric fracture of femur. J Orthop Surg Res, 2021, 16(1): 70. doi: 10.1186/s13018-020-02187-3.
18. Fauconnier S, Van Lieshout M, Victor J. Evaluation of cerclage wiring in the treatment of subtrochanteric fractures. Acta Orthop Belg, 2020, 86(1): 28-32.
19. 朱佳福, 徐卫星, 刘宏. InterTan 髓内钉治疗老年股骨转子间冠状位骨折的病例对照研究. 中国骨伤, 2016, 29(12): 1130-1134.
20. Broos PL, Sermon A. From unstable internal fixation to biological osteosynthesis. A historical overview of operative fracture treatment. Acta Chir Belg, 2004, 104(4): 396-400.
21. Bauer TW, Muschler GF. Bone graft materials. An overview of the basic science. Clin Orthop Relat Res, 2000, (371): 10-27.
22. Kennedy MT, Mitra A, Hierlihy TG, et al. Subtrochanteric hip fractures treated with cerclage cables and long cephalomedullary nails: a review of 17 consecutive cases over 2 years. Injury, 2011, 42(11): 1317-1321.
23. 倪东馗, 郑道明, 庞小建, 等. 捆绑带对骨折愈合影响的实验研究. 天津医科大学学报, 2010, 16(3): 395-398.
24. Grimsrud C, Monzon RJ, Richman J, et al. Cemented hip arthroplasty with a novel cerclage cable technique for unstable intertrochanteric hip fractures. J Arthroplasty, 2005, 20(3): 337-343.
25. Old AB, McGrory BJ, White RR, et al. Fixation of Vancouver B1 peri-prosthetic fractures by broad metal plates without the application of strut allografts. J Bone Joint Surg (Br), 2006, 88(11): 1425-1429.
26. 庞小建, 倪东馗, 郑道明, 等. 不同宽度捆绑带对骨折愈合的影响. 中国组织工程研究与临床康复, 2011, 15(39): 7221-7225.
27. 叶添文, 李阳, 欧阳跃平, 等. 医用钛缆在髌骨粉碎性骨折治疗中的应用. 中国矫形外科杂志, 2009, 17(4): 268-271.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of proximal femoral nail anti-rotation and cerclage fixation for complicated femoral subtrochanteric fractures

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content