Prospective Study of Closed Reduction of Trochanteric Fractures via a Novel Intraoperative Femoral Fracture Reduction Device: Early Clinical Results

The Clinical Efficacy of Minimally Invasive Clamp-Assisted Reduction and Open Reduction with Wire Cerclage for Unstable Subtrochanteric Fractures

The purpose of this study was to compare the clinical effectiveness of minimally invasive clamp-assisted reduction and open reduction with wire cerclage and intramedullary nails for unstable subtrochanteric fractures. Between January 2016 and October 2019, 68 patients who had unstable subtrochanteric fractures experienced intramedullary nail surgery in this retrospective study. There were 41 cases in the minimally invasive clamp or closed reduction group (group A) and 27 cases in the open reduction with wire cerclage group (group B). There were 3 cases of complications in group A and 2 cases of complications in group B. Remarkable distinction was observed between the two groups in the operation time (p < 0.05), quality of reduction (p < 0.05), and union time (p < 0.05). For the successful surgical treatment of unstable femoral subtrochanteric fractures, an anatomical reduction is crucial. Reduction and wire cerclage are cut to give medial support for the anatomical reduction, which has a positive effect on fracture healing.

High risks of failure observed for A1 trochanteric femoral fractures treated with a DHS compared to the PFNA in a prospective observational cohort study

INTRODUCTION

Both the DHS and the PFNA are common and well-studied treatment options for stable trochanteric fractures. The aim of the current study was to compare the implant failure rates of these two implants in 31A1 type trochanteric femoral fractures.

MATERIALS AND METHODS

A single-centre observational cohort study was conducted in the Hip Fracture Unit of a multicentre level 1 trauma teaching hospital between December 2016 and October 2018. Patients with an AO/OTA type 31A1 fracture were included. Pathological fractures, bilateral fractures, high-energy traumas and patients younger than 18 years of age were excluded. Surgery was performed using either a DHS or PFNA. Both were used routinely for stable trochanteric fractures, and allocation was decided by the surgeon performing the operation. The primary outcome of this study was the implant failure rate in the first postoperative year. Secondary outcomes included the reoperation rate, functional recovery, pain and morphine use.

RESULTS

Data were available from 126 patients treated with a DHS (n = 32, 25.4%) or PFNA (n = 95, 74.6%). Minor differences were observed in the patient characteristics including the prevalence of cognitive impairment (18.8% vs 40.2%; P = 0.028), prefracture independence in activities of daily living (87.1% vs 67.4%; P = 0.034) and prefracture mobility (independently without aides: 61.3% vs 40.4%; P = 0.033). Fractures treated with a DHS showed 25% implant failures, compared to 1.1% for fractures treated with a PFNA (P = 0.004). No differences were observed in any of the secondary outcomes.

CONCLUSIONS

Significantly more implant failures were observed for the DHS compared the PFNA within 1 year after surgery. Despite the fact that this did not result in differences in revision surgery, we conclude that the PFNA, considering the minimal number of implant-related fractures is a viable implant for A1 type trochanteric fractures.

[Clinical application of lower extremity axial distractor in closed reduction and retrograde intramedullary nail fixation of distal femoral fractures]

Objective

To explore the efficacy and advantages of the lower extremity axial distractor assisted closed reduction and retrograde intramedullary nail internal fixation in the treatment of distal femoral fractures.

Methods

The clinical data of 49 patients with distal femoral fractures treated with retrograde intramedullary nail internal fixation between April 2016 and December 2018 were retrospectively analyzed. According to the different methods of intraoperative reduction, the patients were divided into trial group (29 cases, using lower extremity axial distractor to assist closed reduction) and control group (20 cases, using free-hand retraction reduction). There was no significant difference in general information between the two groups ( P>0.05), such as gender, age, side of injury, cause of injury, and fracture classification. The operation time, intraoperative blood loss, intraoperative fluoroscopy frequency, and callus formation time were recorded and compared between the two groups. The function of the affected limb was evaluated according to the Schatzker-Lambert standard at 1 year after operation.

Results

All patients successfully completed the operation. In the control group, there was 1 case with open reduction and internal fixation, and the rest of the two groups were closed reduction. There was no significant difference in operation time, intraoperative blood loss, and intraoperative fluoroscopy frequency between the two groups ( P>0.05). There was no complication such as vascular or nerve injury and iatrogenic fracture, etc. during and after operation, and the incisions healed by first intention. Except for 2 patients in the trial group who were lost to follow-up at 3 months after operation, the rest of the patients were followed up 12-36 months, with an average of 16.0 months. There was no significant difference in the callus formation time between the two groups ( t=2.195, P=0.145). During the follow-up, postoperative knee joint stiffness occurred in 1 case in the control group, which improved by strengthening the knee joint function exercise and removing the internal fixator; the rest were not found to be associated with delayed or nonunion fractures, knee stiffness, and internal fixation complication. The function of the affected limb was evaluated according to the Schatzker-Lambert standard at 1 year after operation, the trial group achieved excellent results in 22 cases, good in 4 cases, and fair in 1 case, with an excellent and good rate of 96.3%; in the control group, the results were excellent in 16 cases, good in 3 cases, and fair in 1 case, with an excellent and good rate was 95.0%; showing no significant difference in the excellent and good rate between the two groups ( χ ²=0.451, P=0.502).

Conclusion

The lower extremity axial distractor assisted closed reduction and retrograde intramedullary nailing for the treatment of distal femoral fractures is convenient, which has satisfactory efficacy.

Use of a Double Reverse Traction Repositor versus a Traction Table for the Treatment of Intertrochanteric Femur Fractures: A Comparative Study

OBJECTIVE

The aim of the present study was to compare the clinical results for unstable femoral intertrochanteric fractures treated with a double reverse traction repositor (DRTR) and those treated using a traction table with the Asia proximal femoral nail antirotation (PFNA-II).

METHODS

A retrospective study was performed including 95 patients with AO/OTA type 31-A2 and 31-A3 unstable femoral intertrochanteric fractures who underwent DRTR or traction table-facilitated PFNA-II nailing from April 2015 to December 2018 in our traumatic center. Demographics, duration of operation, blood loss, part loading time after surgery, fracture healing time, and early and late complications were assessed. Clinical and radiological outcomes were collected to compare the differences between the two groups.

RESULTS

A total of 95 unstable intertrochanteric fracture patients treated with the PFNA-II were analyzed. Of these cases, 56 patients were treated with a DRTR and the other 39 patients were treated using a traction table to achieve fracture reduction. No patients died during surgery and hospitalization. There were no significant differences in respect to demographics and fracture characteristics of cases enrolled. The total operative time was significantly longer in the traction table group than in the DRTR group (72.5 ± 6.1 min for the traction table and 63.0 ± 4.1 min for the DRTR group, P < 0.001). No significant differences were observed in intraoperative blood loss and duration of hospitalization. The periods of follow up ranged from 12 to 31 months among all patients. At the last follow up, the Harris hip score (HHS) in the DRTR group was excellent in 10 patients (17.9%), good in 36 (64.3%), fair in 8 (14.3%), and poor in 2 (3.6%). These scores were comparable to those in the traction table group, which were: excellent in 8 patients (20.5%), good in 24 (61.5%), fair in 6 (15.4%), and poor in 1 (2.6%). Regarding the radiological evaluation, excellent rates of reduction rate were achieved in 39 cases (69.6%) in the DRTR group, which was comparable to 19 cases (48.7%) in the traction table group. In addition, the mean fracture healing time after surgery was 20.6 ± 2.3 weeks in the DRTR group and 21.4 ± 3.4 weeks in the traction table group, which did not reach a significant difference (P = 0.18). During the follow up, 6 cases of thigh pain, 4 cases of deep vein thrombosis, and 1 case of fracture of the anterior superior iliac spine were reported in the DRTR group. In the traction table group, there were 2 cases of deep vein thrombosis and 3 cases of thigh pain.

CONCLUSION

When using the PFNA-II for unstable intertrochanteric fractures, the DRTR was superior to the traction table in respect to operative time and duration of patient position, despite an additional ipsilateral anterior superior iliac spine (ASIS) incision and drilling of the ASIS and the femur condyle.