Feasibility study of Kirschner wire-fixation-cortical bone technique in treatment of intertrochanteric fracture_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

TIAN Kewei ¹ , LIU Chao ² , YAN Jiaxiang ³ , FAN Kejie ¹ , MA Wenlong ¹ ,  CHEN Ke ¹

1. No.1 Department of Hip Injury and Disease, Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital), Luoyang Henan, 471000, P.R.China;
2. Department of Pelvic Injury and Disease, Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital), Luoyang Henan, 471000, P.R.China;
3. Department of Geriatric Disease, Luoyang No.1 Hospital of Traditional Chinese Medicine, Luoyang Henan, 471000, P.R.China;

Corresponding?author：

CHEN Ke, Email: 29564557@qq.com

Keywords：

Kirschner wire-fixation-cortical bone technique; intertrochanteric fracture; minimally invasive; closed reduction

DOI：

10.7507/1002-1892.201904126

Video：

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Objective To explore the feasibility and effectiveness of maintaining the reduction of unstable intertrochanteric fractures by Kirschner wire-fixation-cortical bone technique. Methods Forty patients with intertrochanteric fracture [AO/Orthopaedic Trauma Association (AO/OTA) type 31-A2.2] admitted between May 2015 and January 2017 and requiring closed reduction and proximal femoral nail antirotation (PFNA) were randomly divided into trial group (intraoperative Kirschner wire-fixation-cortical bone technique group, 20 cases) and control group (conventional treatment group, 20 cases). There was no significant difference in general data of gender, age, side, body mass index, cause of injury, time from injury to operation between the two groups (P>0.05). The operation time, intraoperative blood loss, and intraoperative fluoroscopy times of the two groups were recorded; the reduction quality of fracture was observed according to the corresponding relationship between medial and anterior cortex (positive, neutral, and negative support) of intraoperative fluoroscopy proposed by ZHANG Shimin, and the stability of internal fixation and fracture healing were observed; Harris score was used to evaluate the recovery of hip function at 12 months after operation. Results In the trial group, 6 cases (30%) had 2 Kirschner wires implanted less than 4 times, 7 cases (35%) had 5-8 times, and 7 cases (35%) had 9 times or more. There was no significant difference in operation time and intraoperative blood loss between the two groups (P>0.05), but the blood transfusion volume and intraoperative fluoroscopy times in the trial group were significantly less than those in the control group (P<0.05). Both groups were followed up 13-21 months, with an average of 17 months. There was no complications such as wound infection, deep venous thrombosis of lower extremities, refracture, and internal fixation-related complications. The quality of intraoperative reduction in the trial group was significantly better than that in the control group (Z=–2.794, P=0.024). The Harris score of the trial group was significantly better than that of the control group at 12 months after operation (t=2.98, P=0.01). Conclusion The use of Kirschner wire-fixation-cortical bone technique during intertrochanteric fracture closed reduction and PFNA internal fixation surgery can effectively maintain the reduction effect, reduce the number of fluoroscopy, improve the reduction quality, reduce allogeneic blood input, obtain better hip function, and do not increase the operation time and intraoperative blood loss.

Citation： TIAN Kewei, LIU Chao, YAN Jiaxiang, FAN Kejie, MA Wenlong, CHEN Ke. Feasibility study of Kirschner wire-fixation-cortical bone technique in treatment of intertrochanteric fracture. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(10): 1239-1244. doi: 10.7507/1002-1892.201904126 Copy

1.	張軒軒, 李寶豐, 章瑩, 等. 股骨近端防旋髓內釘與髖關節置換術治療高齡股骨粗隆間骨折 Meta 分析. 實用醫學雜志, 2019, 35(6): 903-907.
2.	張世民, 胡孫君, 張立智, 等. 老年髖部轉子間骨折. 北京: 科學出版社, 2019: 238.
3.	張世民, 余斌. AO/OTA-2018 版股骨轉子間骨折分類的解讀與討論. 中華創傷骨科雜志, 2018, 20(7): 583-587.
4.	姜浩, 李忱, 孫樹東. 30 例成人雙側股骨近端形態一致性的研究. 中國實驗診斷學, 2018, 22(1): 97-98.
5.	皮益剛, 趙耀超, 王萬春, 等. 500 例湖南地區股骨近端形態樣本測量分析. 中南大學學報 (醫學版), 2013, 38(9): 925-930.
6.	杜守超, 張世民, 張英琪, 等. 不穩定股骨轉子間骨折前內側皮質支撐復位的影像學研究. 中國矯形外科雜志, 2018, 26(18): 1633-1638.
7.	Cho MR, Lee JH, Kwon JB, et al. The effect of positive medial cortical support in reduction of pertrochanteric fractures with posteromedial wall defect using a dynamic hip screw. Clin Orthop Surg, 2018, 10(3): 292-298.
8.	Chang SM, Zhang YQ, Du SC, et al. Anteromedial cortical support reduction in unstable pertrochanteric fractures: a comparison of intra-operative fluoroscopy and post-operative three dimensional computerised tomography reconstruction. Int Orthop, 2018, 42(1): 183-189.
9.	張世民, 張英琪, 李清, 等. 內側皮質正性支撐復位對老年股骨粗隆間骨折內固定效果的影響. 中國矯形外科雜志, 2014, 22(14): 1256-1261.
10.	Chang SM, Zhang YQ, Ma Z, et al. Fracture reduction with positive medial cortical support: a key element in stability reconstruction for the unstable pertrochanteric hip fractures. Arch Orthop Trauma Surg, 2015, 135(6): 811-818.
11.	李雙, 張世民, 張立智, 等. 不同組合前內側皮質支撐復位對股骨轉子間骨折髓內釘術后穩定性影響的生物力學研究. 中華創傷骨科雜志, 2019, 21(1): 57-64.
12.	侯宇, 姚琦, 張亙璦, 等. 第三代 Gamma 釘與防旋股骨近端髓內釘治療股骨粗隆間骨折術后股骨近端短縮的比較研究. 中國修復重建外科雜志, 2018, 32(3): 342-343.
13.	王敬博, 于樹軍, 李辰, 等. 近側骨折段向前成角移位的股骨粗隆間骨折治療經驗. 中國修復重建外科雜志, 2018, 32(9): 1163-1164.
14.	Carr JB. The anterior and medial reduction of intertrochanteric fractures: a simple method to obtain a stable reduction. J Orthop Trauma, 2007, 21(7): 485-489.
15.	Haidukewych GJ. Intertrochanteric fractures: ten tips to improve results. J Bone Joint Surg (Am), 2009, 91(3): 712-719.
16.	Yoon YC, Jha A, Oh CW, et al. The pointed clamp reduction technique for spiral subtrochanteric fractures: a technical note. Injury, 2014, 45(6): 1000-1005.
17.	Kim Y, Dheep K, Lee J, et al. Hook leverage technique for reduction of intertrochanteric fracture. Injury, 2014, 45(6): 1006-1010.
18.	Hsu CE, Shih CM, Wang CC, et al. Lateral femoral wall thickness. A reliable predictor of post-operative lateral wall fracture in intertrochanteric fractures. Bone Joint J, 2013, 95-B(8): 1134-1138.
19.	Hsu CE, Chiu YC, Tsai SH, et al. Trochanter stabilising plate improves treatment outcomes in AO/OTA 31-A2 intertrochanteric fractures with critical thin femoral lateral walls. Injury, 2015, 46(6): 1047-1053.
20.	張世民, 馬卓, 杜守超, 等. 股骨近端外側壁的解剖學研究及其對轉子間骨折內固定的意義. 中國臨床解剖學雜志, 2016, 34(1): 39-42.

1. 張軒軒, 李寶豐, 章瑩, 等. 股骨近端防旋髓內釘與髖關節置換術治療高齡股骨粗隆間骨折 Meta 分析. 實用醫學雜志, 2019, 35(6): 903-907.
2. 張世民, 胡孫君, 張立智, 等. 老年髖部轉子間骨折. 北京: 科學出版社, 2019: 238.
3. 張世民, 余斌. AO/OTA-2018 版股骨轉子間骨折分類的解讀與討論. 中華創傷骨科雜志, 2018, 20(7): 583-587.
4. 姜浩, 李忱, 孫樹東. 30 例成人雙側股骨近端形態一致性的研究. 中國實驗診斷學, 2018, 22(1): 97-98.
5. 皮益剛, 趙耀超, 王萬春, 等. 500 例湖南地區股骨近端形態樣本測量分析. 中南大學學報 (醫學版), 2013, 38(9): 925-930.
6. 杜守超, 張世民, 張英琪, 等. 不穩定股骨轉子間骨折前內側皮質支撐復位的影像學研究. 中國矯形外科雜志, 2018, 26(18): 1633-1638.
7. Cho MR, Lee JH, Kwon JB, et al. The effect of positive medial cortical support in reduction of pertrochanteric fractures with posteromedial wall defect using a dynamic hip screw. Clin Orthop Surg, 2018, 10(3): 292-298.
8. Chang SM, Zhang YQ, Du SC, et al. Anteromedial cortical support reduction in unstable pertrochanteric fractures: a comparison of intra-operative fluoroscopy and post-operative three dimensional computerised tomography reconstruction. Int Orthop, 2018, 42(1): 183-189.
9. 張世民, 張英琪, 李清, 等. 內側皮質正性支撐復位對老年股骨粗隆間骨折內固定效果的影響. 中國矯形外科雜志, 2014, 22(14): 1256-1261.
10. Chang SM, Zhang YQ, Ma Z, et al. Fracture reduction with positive medial cortical support: a key element in stability reconstruction for the unstable pertrochanteric hip fractures. Arch Orthop Trauma Surg, 2015, 135(6): 811-818.
11. 李雙, 張世民, 張立智, 等. 不同組合前內側皮質支撐復位對股骨轉子間骨折髓內釘術后穩定性影響的生物力學研究. 中華創傷骨科雜志, 2019, 21(1): 57-64.
12. 侯宇, 姚琦, 張亙璦, 等. 第三代 Gamma 釘與防旋股骨近端髓內釘治療股骨粗隆間骨折術后股骨近端短縮的比較研究. 中國修復重建外科雜志, 2018, 32(3): 342-343.
13. 王敬博, 于樹軍, 李辰, 等. 近側骨折段向前成角移位的股骨粗隆間骨折治療經驗. 中國修復重建外科雜志, 2018, 32(9): 1163-1164.
14. Carr JB. The anterior and medial reduction of intertrochanteric fractures: a simple method to obtain a stable reduction. J Orthop Trauma, 2007, 21(7): 485-489.
15. Haidukewych GJ. Intertrochanteric fractures: ten tips to improve results. J Bone Joint Surg (Am), 2009, 91(3): 712-719.
16. Yoon YC, Jha A, Oh CW, et al. The pointed clamp reduction technique for spiral subtrochanteric fractures: a technical note. Injury, 2014, 45(6): 1000-1005.
17. Kim Y, Dheep K, Lee J, et al. Hook leverage technique for reduction of intertrochanteric fracture. Injury, 2014, 45(6): 1006-1010.
18. Hsu CE, Shih CM, Wang CC, et al. Lateral femoral wall thickness. A reliable predictor of post-operative lateral wall fracture in intertrochanteric fractures. Bone Joint J, 2013, 95-B(8): 1134-1138.
19. Hsu CE, Chiu YC, Tsai SH, et al. Trochanter stabilising plate improves treatment outcomes in AO/OTA 31-A2 intertrochanteric fractures with critical thin femoral lateral walls. Injury, 2015, 46(6): 1047-1053.
20. 張世民, 馬卓, 杜守超, 等. 股骨近端外側壁的解剖學研究及其對轉子間骨折內固定的意義. 中國臨床解剖學雜志, 2016, 34(1): 39-42.

Chinese Journal of Reparative and Reconstructive Surgery

Feasibility study of Kirschner wire-fixation-cortical bone technique in treatment of intertrochanteric fracture

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