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Huang X, Zuo Q, Zhou H, Lv T, Liu J. The use of intramedullary reduction techniques in the treatment of irreducible intertrochanteric femoral fractures with negative medial cortical support. Front Surg 2024; 11:1391718. [PMID: 38803548 PMCID: PMC11129679 DOI: 10.3389/fsurg.2024.1391718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 04/29/2024] [Indexed: 05/29/2024] Open
Abstract
Objective To explore the clinical efficacy of intramedullary reduction techniques for irreducible intertrochanteric femoral fractures with negative medial cortical support. Methods A retrospective analysis was conducted on 69 patients with irreducible intertrochanteric femoral fractures with negative medial cortical support treated in the Department of Orthopedics at Jiangsu Province Hospital (The First Affiliated Hospital of Nanjing Medical University) from July 2019 to December 2021. Patients were divided into Group A and Group B. Group A (experimental group) consisted of 36 cases with an average age of 76.2 ± 5.9 years, while Group B (control group) comprised 33 cases with an average age of 76.6 ± 6.3 years. Group A received treatment using intramedullary reduction techniques, while Group B received treatment using traditional extramedullary reduction techniques. Both groups achieved anatomic reduction of the medial cortex or slight positive support. Surgical duration, intraoperative fracture reduction time, intraoperative bleeding, intraoperative fluoroscopy time, fracture reduction quality, fracture healing, postoperative neck-shaft angle loss, femoral neck shortening, and hip joint functional recovery score (FRS) were compared between the two groups. Results All patients were followed up for an average of 13.8 months. Group A showed superior outcomes compared to Group B in surgical duration, intraoperative fracture reduction time, intraoperative bleeding, intraoperative fluoroscopy time, fracture reduction quality, fracture healing, postoperative neck-shaft angle loss, and femoral neck shortening (P < 0.05). Hip joint function assessed by functional recovery score was better in Group A than Group B at 1 and 3 months postoperatively (P < 0.05), with no significant statistical difference at other time points (P > 0.05). Conclusion For irreducible intertrochanteric femoral fractures with negative medial cortical support, intramedullary reduction techniques used during surgery demonstrated simplicity, significant reduction in surgical duration, decreased intraoperative bleeding, fewer amounts of intraoperative fluoroscopy, improved fracture reduction quality, and reduced surgical complexity. Further clinical research and application are warranted.
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Affiliation(s)
| | | | | | - Tianrun Lv
- Department of Orthopedics, First Affiliated Hospital of Nanjing Medical University (Jiangsu Provincial People’s Hospital), Nanjing, China
| | - Jiuxiang Liu
- Department of Orthopedics, First Affiliated Hospital of Nanjing Medical University (Jiangsu Provincial People’s Hospital), Nanjing, China
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Yurek JW, Doerr NA, Tang A, Kohring AS, Liporace FA, Yoon RS. Assessing the Necessity of Extra Reduction Aides in Intramedullary Nailing of Intertrochanteric Hip Fractures. Hip Pelvis 2023; 35:183-192. [PMID: 37727297 PMCID: PMC10505845 DOI: 10.5371/hp.2023.35.3.183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 07/21/2023] [Accepted: 07/21/2023] [Indexed: 09/21/2023] Open
Abstract
Purpose This study aims to determine which intertrochanteric (IT) hip fracture and patient characteristics predict the necessity for adjunct reduction aides prior to prep and drape aiming for a more efficient surgery. Materials and Methods Institutional fracture registries from two academic medical centers from 2017-2022 were analyzed. Data on patient demographics, comorbidities, fracture patterns identified on radiographs including displacement of the lesser trochanter (LT), thin lateral wall (LW), reverse obliquity (RO), subtrochanteric extension (STE), and number of fracture parts were collected, and the need for additional aides following traction on fracture table were collected. Fractures were classified using the AO/OTA classification. Regression analyses identified significant risk factors for needing extra reduction aides. Results Of the 166 patients included, the average age was 80.84±12.7 years and BMI was 24.37±5.3 kg/m2. Univariate regression revealed increased irreducibility risk associated with RO (odds ratio [OR] 27.917, P≤0.001), LW (OR 24.882, P<0.001), and STE (OR 5.255, P=0.005). Multivariate analysis significantly correlated RO (OR 120.74, P<0.001) and thin LW (OR 131.14, P<0.001) with increased risk. However, STE (P=0.36) and LT displacement (P=0.77) weren't significant. Fracture types 2.2, 3.2, and 3.3 displayed elevated risk (P<0.001), while no other factors increased risk. Conclusion Elderly patients with IT fractures with RO and/or thin LW are at higher risk of irreducibility, necessitating adjunct reduction aides. Other parameters showed no significant association, suggesting most fracture patterns can be achieved with traction manipulation alone.
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Affiliation(s)
- John W. Yurek
- Division of Orthopaedic Trauma and Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center – RWJBarnabas Health, Jersey City, NJ, USA
| | - Nikki A. Doerr
- Division of Orthopaedic Trauma and Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center – RWJBarnabas Health, Jersey City, NJ, USA
| | - Alex Tang
- Division of Orthopaedic Trauma and Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center – RWJBarnabas Health, Jersey City, NJ, USA
| | - Adam S. Kohring
- Division of Orthopaedic Trauma and Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center – RWJBarnabas Health, Jersey City, NJ, USA
| | - Frank A. Liporace
- Division of Orthopaedic Trauma and Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center – RWJBarnabas Health, Jersey City, NJ, USA
| | - Richard S. Yoon
- Division of Orthopaedic Trauma and Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center – RWJBarnabas Health, Jersey City, NJ, USA
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Qiu J, Jiang Z, Han L, Li X, Zhang R, Wu B, Zhu F, Zhao Y. Treatment of irreducible intertrochanteric femoral fracture with a minimally invasive clamp reduction technique via the anterior approach. J Orthop Surg Res 2023; 18:167. [PMID: 36871013 PMCID: PMC9985279 DOI: 10.1186/s13018-023-03641-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 02/23/2023] [Indexed: 03/06/2023] Open
Abstract
OBJECTIVE To investigate the efficacy of the minimally invasive clamp reduction technique via the anterior approach in the treatment of irreducible intertrochanteric femoral fractures. METHODS From January 2015 to January 2021, 115 patients (48 males and 67 females) with irreducible intertrochanteric femoral fractures were treated. The average age of the patients was 78.7 (45-100 years old). The types of injuries were falls (91 cases), traffic accidents (12 cases), smashing (6 cases), and high falling (6 cases). The duration between injury and surgery ranged from 1 to 14 days, with an average of 3.9 days. The distribution of AO classification was as follows: 31-A1 in 15 cases, type 31-A2 in 67 cases and 31-A3 in 33 cases. RESULTS All patients achieved good reduction, with fracture reduction times ranging from 10 to 32 min (mean of 18 min), and were followed up for 12-27 months after surgery (mean of 17.9 months). Two patients with pronation displacement of the proximal fracture segment died of infection or hypostatic pneumonia after internal fixation failure; one patient with failed internal fixation switched to joint replacement. After internal fixation, the lateral wall of six reversed intertrochanteric femoral fractures showed repronation and abduction displacement, but all fractures achieved bony healing. The rest of the patients did not lose fracture reduction, and all fractures achieved bony healing with a healing time ranging from 3 to 9 months (mean of 5.7 months). While two patients died and one patient exhibited failed internal fixation and thus switched to joint replacement, 91 of the remaining 112 patients had an excellent Harris score of the hip joint function at the final follow-up, while 21 patients had a good Harris score. CONCLUSION The minimally invasive clamp reduction technique via the anterior approach for the treatment of irreducible intertrochanteric femoral fractures is simple, effective and minimally invasive. In the case of irreducible intertrochanteric femoral fractures associated with lateral wall displacement, the lateral wall needs to be strengthened after clamp reduction and intramedullary nail fixation to avoid loss of reduction and failure of internal fixation.
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Affiliation(s)
- Jinya Qiu
- Department of Clinical Medicine, Jining Medical University, 133 Hehua Road, Taibai Lake New District, Jining, 272067, Shandong, People's Republic of China
| | - Zhen Jiang
- Department of Traumatic Orthopedics, Affiliated Hospital of Jining Medical University, 129 Hehua Road, Taibai Lake New District, Jining, 272007, Shandong, People's Republic of China
| | - Liang Han
- Department of Traumatic Orthopedics, Affiliated Hospital of Jining Medical University, 129 Hehua Road, Taibai Lake New District, Jining, 272007, Shandong, People's Republic of China
| | - Xingwei Li
- Department of Orthopedics, Wenshang People's Hospital, 1, Dehui Road, Wenshang County, 272501, Shandong, People's Republic of China
| | - Rui Zhang
- Department of Traumatic Orthopedics, Affiliated Hospital of Jining Medical University, 129 Hehua Road, Taibai Lake New District, Jining, 272007, Shandong, People's Republic of China
| | - Bin Wu
- Department of Traumatic Orthopedics, Affiliated Hospital of Jining Medical University, 129 Hehua Road, Taibai Lake New District, Jining, 272007, Shandong, People's Republic of China
| | - Fenghua Zhu
- Department of Traumatic Orthopedics, Affiliated Hospital of Jining Medical University, 129 Hehua Road, Taibai Lake New District, Jining, 272007, Shandong, People's Republic of China.
| | - Yifeng Zhao
- Department of Traumatic Orthopedics, Affiliated Hospital of Jining Medical University, 129 Hehua Road, Taibai Lake New District, Jining, 272007, Shandong, People's Republic of China.
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The effect of cerclage wiring with intramedullary nail surgery in proximal femoral fracture: a systematic review and meta-analysis. Eur J Trauma Emerg Surg 2022; 48:4761-4774. [PMID: 35618854 DOI: 10.1007/s00068-022-02003-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 05/07/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE The aim of this study was to evaluate the utility of cerclage wiring with intramedullary nail surgery in the treatment of proximal femoral fractures. METHODS MEDLINE, Embase, and Cochrane Library were systematically searched for studies that evaluated the impact of cerclage wiring on proximal femoral fractures published up to September 20, 2021. Pooled analysis identified differences in the (1) fracture healing profile, (2) perioperative variables, (3) complications, and (4) clinical outcome score between cerclage wiring and non-cerclage wiring. RESULTS Fourteen studies involving 1,718 patients with proximal femoral fractures who underwent cephalomedullary nailing surgeries were included. The pooled analysis revealed a longer fracture union time in the non-cerclage wiring group than in the cerclage wiring group (mean difference [MD] = - 1.03 months; 95% confidence interval [CI]: - 1.47 to - 0.59; P < 0.001), and there was no difference in the nonunion rate. The operation time was longer in the cerclage wiring group (MD = 14.32 min; 95% CI: 6.42-22.22; P < 0.001), but there were no differences in blood loss and the rate of poor quality of reduction. Superficial and deep infection rates showed no difference between the groups, and the readmission rate also showed no difference. The cerclage wiring group had a higher Harris hip score than the non-cerclage wiring group (MD = 2.13; 95% CI: 0.77-3.49; P = 0.002). CONCLUSIONS Intramedullary nailing with cerclage wiring is considered a useful treatment method for proximal femoral fractures. It enables anatomic reduction and stable fixation, thereby reducing union time and facilitating rapid functional recovery.
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Guobin C, Cui Y, Maoquan Z, Qishu X. A comparison between proximal femoral nail antirotation (PFNA) and inter Tan nail for the surgical treatment of unstable intertrochanteric fracture: A case series. Asian J Surg 2021; 44:1095-1096. [PMID: 34119387 DOI: 10.1016/j.asjsur.2021.05.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 05/17/2021] [Indexed: 12/01/2022] Open
Affiliation(s)
- Chen Guobin
- Department of Orthopaedics, Neijiang Hospital of Traditional Chinese Medicine, Neijiang, 641000, China.
| | - Yu Cui
- Department of Orthopaedics, Neijiang Hospital of Traditional Chinese Medicine, Neijiang, 641000, China
| | - Zhao Maoquan
- Department of Orthopaedics, Neijiang Hospital of Traditional Chinese Medicine, Neijiang, 641000, China
| | - Xiao Qishu
- Department of Orthopaedics, Neijiang Hospital of Traditional Chinese Medicine, Neijiang, 641000, China
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