EFFECTIVENESS COMPARISON OF PROXIMAL FEMORAL NAIL ANTI-ROTATION AND LOCKING COMPRESSION PLATE FOR INTERTROCHANTERIC FRACTURES WITH LATERAL UNSUBSTANTIAL FEMORAL WALL IN ELDERLY PATIENTS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 SHIYongxin ¹ , LIFuqin ² , TANWenfu ¹ , LIUJinhua ¹

1. Department of Orthopedics, Second Affiliated Hospital, South China University, Hengyang Hunan, 421001, P. R. China;
2. Hunan Polytechnic of Environment and Biology, Hengyang Hunan, 421001, P. R. China;

Corresponding?author：

SHIYongxin, Email: shiyongxinshi@126.com

Keywords：

Intertrochanteric fracture with lateral unsubstantial femoral wall; Locking compression plate; Proximal femoral nail anti-rotation; Internal fixation; Elderly patient

DOI：

10.7507/1002-1892.20140260

Video：

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Objective To compare the effectiveness of the proximal femoral nail anti-rotation (PFNA) and locking compression plate (LCP) in the treatment of intertrochanteric fractures with the lateral unsubstantial femoral wall in elderly patients. Methods Between May 2009 and August 2012, 69 elderly patients with intertrochanteric fractures with the lateral unsubstantial femoral wall were treated. Fractures were fixed with PFNA in 36 patients (PFNA group), and with LCP in 33 patients (LCP group). There was no significant difference in gender, age, injury cause, side of fracture, and fracture AO type between 2 groups (P > 0.05). The incision length, operation time, intraoperative blood loss, total blood loss, fluoroscopy frequency, time for ambulation, and early (within 3 months) and late (more than 12 months) complications were compared. Fracture healing was assessed according to X-ray reexamination, the function of the hip joint was assessed according to the Harris hip scoring system. Results The incision length, operation time, intraoperative blood loss, and time for ambulation of PFNA group were significantly less than those of LCP group (P < 0.05), but the fluoroscopy frequency of PFNA group was significantly more than that of LCP group (P < 0.05). There was no significant difference in total blood loss between 2 groups (t=-1.686, P=0.096). The patients were followed up 12-24 months in PFNA group and 15-30 months in LCP group. The X-ray reexamination revealed fracture healing at (12.667±2.527) weeks in patients of PFNA group, and at (13.364±1.194) weeks in the others of LCP group except 1 case of nonunion, showing no significant difference (t=-1.443, P=0.154). There was no significant difference in Harris hip score between PFNA group (84.611±7.076) and LCP group (81.785±7.500) at 12 months after operation (t=1.626, P=0.109). The early complication rate and late complication rate were 16.7% (6/36) and 5.6% (2/36) in PFNA group and were 9.1% (3/33) and 9.1% (3/33) in LCP group, all showing no significant difference between 2 groups (χ²=0.871, P=0.481; χ²=0.320, P=0.665). Conclusion Both PFNA and LCP have good effectiveness in the treatment of intertrochanteric fractures with the lateral unsubstantial femoral wall in the elderly patients. Each has its own advantages and disadvantages.

Citation： SHIYongxin, LIFuqin, TANWenfu, LIUJinhua. EFFECTIVENESS COMPARISON OF PROXIMAL FEMORAL NAIL ANTI-ROTATION AND LOCKING COMPRESSION PLATE FOR INTERTROCHANTERIC FRACTURES WITH LATERAL UNSUBSTANTIAL FEMORAL WALL IN ELDERLY PATIENTS. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(10): 1199-1203. doi: 10.7507/1002-1892.20140260 Copy

1.	Hsueh KK, Fang CK, Chen CM, et al.Risk factors in cutout of sliding hip screw in intertrochanteric farctures:an evaluation of 937 patients.Int Orthop, 2010, 34(8):1273-1276.
2.	張逸凌, 沈景, 毛智, 等.股骨粗隆間骨折內固定手術隱性失血的相關因素分析.中國修復重建外科雜志, 2014, 28(5):610-614.
3.	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.
4.	張世民.股骨粗隆間骨折中外側壁的概念及其臨床意義.中國矯形外科雜志, 2010, 18(17):1489-1492.
5.	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.
6.	Im GI, Shin YW, Song YJ.Potentially unstable intertrochanteric fractures.J Orthop Trauma, 2005, 19(1):5-9.
7.	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.
8.	沈光銀.防旋股骨近端髓內釘與動力髖螺釘治療老年股骨粗隆間骨折療效比較.中國修復重建外科雜志, 2012, 26(6):671-674.
9.	李必奎, 陳周兵, 徐富生.股骨近端鎖定鋼板治療股骨轉子間骨折.中國修復重建外科雜志, 2011, 25(10):1273-1275.
10.	Xu Y, Geng D, Yang H, et al.Treatment of unstable proximal femoral fractures:comparion of the proximal femoral nail anti-rotation and gamma nail 3.Orthopedics, 2010, 33(7):473.
11.	李興鑫, 姚一民, 張聰, 等.PFNA治療高齡外側壁危險型股骨粗隆間骨折的療效分析.實用骨科雜志, 2012, 18(12):1079-1081.
12.	侯志勇, 尹英超, 張英澤.PFNA置入術中主釘與螺旋刀片冷焊接三例.2013中華骨科年會論文匯編.北京:中華醫學會骨科學分會, 2013.
13.	秦暉, 安智全.InterTan治療股骨粗隆間骨折的療效評估.中國修復重建外科雜志, 2010, 24(12):1424-1427.
14.	[1 Brunner A, J?ckel JA, Babst R.The PFNA proximal femur nail in treatment of unstable proximal femur fractures-3 cases of postoperative perforation of the helical blade into the hip joint.J Orthop Trauma, 2008, 22(10):731-736.
15.	韋旭明, 孫振中, 宋驍軍.經皮加壓鋼板與股骨近端防旋髓內釘治療外側壁危險型股骨粗隆間骨折的病例對照研究.中國骨傷, 2013, 26(12):981-984.
16.	崔勇, 湯威, 吳立文, 等.鎖定加壓板(LCP)治療股骨近端骨折失敗原因分析.中國矯形外科雜志, 2010, 18(22):1910-1912.
17.	Baumgaertner MR, Curtin SL, Lindskog DM, et al.The value of the tip-apex distance in predicting failure of ixation of peritrochanteric fractures of the hip.J Bone Joint Surg (Am), 1995, 77(7):1058-1064.

1. Hsueh KK, Fang CK, Chen CM, et al.Risk factors in cutout of sliding hip screw in intertrochanteric farctures:an evaluation of 937 patients.Int Orthop, 2010, 34(8):1273-1276.
2. 張逸凌, 沈景, 毛智, 等.股骨粗隆間骨折內固定手術隱性失血的相關因素分析.中國修復重建外科雜志, 2014, 28(5):610-614.
3. 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.
4. 張世民.股骨粗隆間骨折中外側壁的概念及其臨床意義.中國矯形外科雜志, 2010, 18(17):1489-1492.
5. 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.
6. Im GI, Shin YW, Song YJ.Potentially unstable intertrochanteric fractures.J Orthop Trauma, 2005, 19(1):5-9.
7. 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.
8. 沈光銀.防旋股骨近端髓內釘與動力髖螺釘治療老年股骨粗隆間骨折療效比較.中國修復重建外科雜志, 2012, 26(6):671-674.
9. 李必奎, 陳周兵, 徐富生.股骨近端鎖定鋼板治療股骨轉子間骨折.中國修復重建外科雜志, 2011, 25(10):1273-1275.
10. Xu Y, Geng D, Yang H, et al.Treatment of unstable proximal femoral fractures:comparion of the proximal femoral nail anti-rotation and gamma nail 3.Orthopedics, 2010, 33(7):473.
11. 李興鑫, 姚一民, 張聰, 等.PFNA治療高齡外側壁危險型股骨粗隆間骨折的療效分析.實用骨科雜志, 2012, 18(12):1079-1081.
12. 侯志勇, 尹英超, 張英澤.PFNA置入術中主釘與螺旋刀片冷焊接三例.2013中華骨科年會論文匯編.北京:中華醫學會骨科學分會, 2013.
13. 秦暉, 安智全.InterTan治療股骨粗隆間骨折的療效評估.中國修復重建外科雜志, 2010, 24(12):1424-1427.
14. [1 Brunner A, J?ckel JA, Babst R.The PFNA proximal femur nail in treatment of unstable proximal femur fractures-3 cases of postoperative perforation of the helical blade into the hip joint.J Orthop Trauma, 2008, 22(10):731-736.
15. 韋旭明, 孫振中, 宋驍軍.經皮加壓鋼板與股骨近端防旋髓內釘治療外側壁危險型股骨粗隆間骨折的病例對照研究.中國骨傷, 2013, 26(12):981-984.
16. 崔勇, 湯威, 吳立文, 等.鎖定加壓板(LCP)治療股骨近端骨折失敗原因分析.中國矯形外科雜志, 2010, 18(22):1910-1912.
17. Baumgaertner MR, Curtin SL, Lindskog DM, et al.The value of the tip-apex distance in predicting failure of ixation of peritrochanteric fractures of the hip.J Bone Joint Surg (Am), 1995, 77(7):1058-1064.

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EFFECTIVENESS COMPARISON OF PROXIMAL FEMORAL NAIL ANTI-ROTATION AND LOCKING COMPRESSION PLATE FOR INTERTROCHANTERIC FRACTURES WITH LATERAL UNSUBSTANTIAL FEMORAL WALL IN ELDERLY PATIENTS

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