Application of wire reduction technique guided by minimally invasive wire introducer in treatment of difficult-reducing intertrochanteric fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

HU Jinxi ¹ , HE Changren ¹ , LIU Fang ¹ ,  WEN Fei ²

1. Department of Orthopaedics, the Second People’s Hospital of Yueyang City, Yueyang Hunan, 414000, P.R.China;
2. Department of Orthopaedics, the Rongchang District People’s Hospital, Rongchang Chongqing, 402460, P.R.China;

Corresponding?author：

WEN Fei, Email: 214707603@qq.com

Keywords：

Intertrochanteric fracture; intramedullary nail; minimally invasive wire introducer; reduction

DOI：

10.7507/1002-1892.201905025

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To investigate the application effect of wire reduction technique guided by minimally invasive wire introducer in the treatment of difficult-reducing intertrochanteric fractures.Methods Between April 2016 and April 2018, 30 patients with intertrochanteric fractures who had difficulty in closed reduction under the traction bed were treated. There were 17 males and 13 females, aged from 60 to 93 years (mean, 72 years). The causes of injury included falls in 22 cases and traffic accidents in 8 cases. The fractures were classified according to AO/Orthopaedic Trauma Association (AO/OTA) classification: 12 cases of type A1, 12 cases of type A2, and 6 cases of type A3. Intramedullary nail incision and self-made minimally invasive wire introducer were used to assist reduction of intertrochanteric fracture, and then intramedullary nail internal fixation was performed.Results The operation time was 30-70 minutes, with an average of 45 minutes. The intraoperative blood loss was 100-210 mL, with an average of 160 mL. One case died of cerebrovascular accident at 3 months after operation; the remaining 29 cases were followed up 6-18 months, with an average of 8.3 months. Postoperative DR reexamination showed that all patients had a good reduction in the fracture end, no retraction, fracture displacement, hip valgus deformity, and other serious complications occurred. The fracture was completely healed and the healing time was 3-8 months, with an average of 6 months. At 3 months after operation, the visual analogue scale (VAS) score was 1-3, with an averge of 1.7. According to Harris functional score of hip joint, 26 cases were excellent and 3 cases were good.Conclusion For the difficult-reducing intertrochanteric fractures, minimally invasive wire introducer is used to insert steel wire into the incision of head and neck nail for assisted reduction, which can achieve satisfactory reduction results and improve the effectiveness of intertrochanteric fracture.

Citation： HU Jinxi, HE Changren, LIU Fang, WEN Fei. Application of wire reduction technique guided by minimally invasive wire introducer in treatment of difficult-reducing intertrochanteric fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(10): 1245-1249. doi: 10.7507/1002-1892.201905025 Copy

1.	Stevens JA, Rudd RA. The impact of decreasing U.S. hip fracture rates on future hip fracture estimates. Osteoporos Int, 2013, 24(10): 2728-2728.
2.	Ma KL, Wang X, Luan FJ, et al. Proximal femoral nails antirotation, Gamma nails, and dynamic hip screws for fixation of intertrochanteric fractures of femur: A meta-analysis. Orthop Traumatol Surg Res, 2014, 100(8): 859-866.
3.	李建濤, 張里程, 唐佩福. 股骨粗隆間骨折治療理念與內固定器械的發展概述. 中國修復重建外科雜志, 2019, 33(1): 1-7.
4.	唐佩福. 股骨轉子間骨折的治療進展與策略. 中華創傷骨科雜志, 2017, 19(2): 93-94.
5.	Jia L, Zhang K, Wang ZG, et al. Proximal femoral nail antirotation internal fixation in treating intertrochanteric femoral fractures of elderly subjects. J Biol Regul Homeost Agents, 2017, 31(2): 329-334.
6.	Hélin M, Pelissier A, Boyer P, et al. Does the PFNA^TM nail limit impaction in unstable intertrochanteric femoral fracture? A 115 case-control series. Orthop Traumatol Surg Res, 2015, 101(1): 45-49.
7.	Boldin C, Seibert FJ, Fankhauser F, et al. The proximal femoral nail (PFN)--a minimal invasive treatment of unstable proximal femoral fractures: a prospective study of 55 patients with a follow-up of 15 months. Acta Orthop Scand, 2003, 74(1): 53-58.
8.	Cho SH, Lee SH, Cho HL, et al. Additional fixations for sliding hip screws in treating unstable pertrochanteric femoral fractures (AO Type 31-A2): short-term clinical results. Clin Orthop Surg, 2011, 3(2): 107-113.
9.	Kim GM, Nam KW, Seo KB, et al. Wiring technique for lesser trochanter fixation in proximal IM nailing of unstable intertrochanteric fractures: A modified candy-package wiring technique. Injury, 2017, 48(2): 406-413.
10.	張睿, 羅鵬, 胡煒, 等. 新型股骨近端內側支撐鋼板治療股骨反轉子間骨折的生物力學研究. 中國修復重建外科雜志, 2017, 31(2): 165-170.
11.	佟大可, 丁文彬, 王光超, 等. 難復性股骨轉子間骨折的臨床分型與治療. 中華創傷骨科雜志, 2017, 19(2): 109-114.
12.	Apivatthakakul T, Phaliphot J, Leuvitoonvechkit S. Percutaneous cerclage wiring, does it disrupt femoral blood supply? A cadaveric injection study. Injury, 2013, 44(2): 168-174.
13.	Winquist RA, Hansen ST Jr, Clawson DK. Closed intramedullary nailing of femoral fractures. A report of five hundred and twenty cases. J Bone Joint Surg (Am), 1984, 66(4): 529-539.
14.	楊偉, 魏文東, 王歡, 等. 骨鉤輔助 PFNA 治療不穩定股骨轉子間骨折. 重慶醫學, 2018, 47(12): 1675-1677.
15.	王亮. 股骨大粗隆外展肌復合體及其臨床意義. 中國骨與關節損傷雜志, 2015, 30(2): 223-224.

1. Stevens JA, Rudd RA. The impact of decreasing U.S. hip fracture rates on future hip fracture estimates. Osteoporos Int, 2013, 24(10): 2728-2728.
2. Ma KL, Wang X, Luan FJ, et al. Proximal femoral nails antirotation, Gamma nails, and dynamic hip screws for fixation of intertrochanteric fractures of femur: A meta-analysis. Orthop Traumatol Surg Res, 2014, 100(8): 859-866.
3. 李建濤, 張里程, 唐佩福. 股骨粗隆間骨折治療理念與內固定器械的發展概述. 中國修復重建外科雜志, 2019, 33(1): 1-7.
4. 唐佩福. 股骨轉子間骨折的治療進展與策略. 中華創傷骨科雜志, 2017, 19(2): 93-94.
5. Jia L, Zhang K, Wang ZG, et al. Proximal femoral nail antirotation internal fixation in treating intertrochanteric femoral fractures of elderly subjects. J Biol Regul Homeost Agents, 2017, 31(2): 329-334.
6. Hélin M, Pelissier A, Boyer P, et al. Does the PFNA^TM nail limit impaction in unstable intertrochanteric femoral fracture? A 115 case-control series. Orthop Traumatol Surg Res, 2015, 101(1): 45-49.
7. Boldin C, Seibert FJ, Fankhauser F, et al. The proximal femoral nail (PFN)--a minimal invasive treatment of unstable proximal femoral fractures: a prospective study of 55 patients with a follow-up of 15 months. Acta Orthop Scand, 2003, 74(1): 53-58.
8. Cho SH, Lee SH, Cho HL, et al. Additional fixations for sliding hip screws in treating unstable pertrochanteric femoral fractures (AO Type 31-A2): short-term clinical results. Clin Orthop Surg, 2011, 3(2): 107-113.
9. Kim GM, Nam KW, Seo KB, et al. Wiring technique for lesser trochanter fixation in proximal IM nailing of unstable intertrochanteric fractures: A modified candy-package wiring technique. Injury, 2017, 48(2): 406-413.
10. 張睿, 羅鵬, 胡煒, 等. 新型股骨近端內側支撐鋼板治療股骨反轉子間骨折的生物力學研究. 中國修復重建外科雜志, 2017, 31(2): 165-170.
11. 佟大可, 丁文彬, 王光超, 等. 難復性股骨轉子間骨折的臨床分型與治療. 中華創傷骨科雜志, 2017, 19(2): 109-114.
12. Apivatthakakul T, Phaliphot J, Leuvitoonvechkit S. Percutaneous cerclage wiring, does it disrupt femoral blood supply? A cadaveric injection study. Injury, 2013, 44(2): 168-174.
13. Winquist RA, Hansen ST Jr, Clawson DK. Closed intramedullary nailing of femoral fractures. A report of five hundred and twenty cases. J Bone Joint Surg (Am), 1984, 66(4): 529-539.
14. 楊偉, 魏文東, 王歡, 等. 骨鉤輔助 PFNA 治療不穩定股骨轉子間骨折. 重慶醫學, 2018, 47(12): 1675-1677.
15. 王亮. 股骨大粗隆外展肌復合體及其臨床意義. 中國骨與關節損傷雜志, 2015, 30(2): 223-224.

Chinese Journal of Reparative and Reconstructive Surgery

Application of wire reduction technique guided by minimally invasive wire introducer in treatment of difficult-reducing intertrochanteric fractures

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content