Effectiveness of proximal femoral nail anti-rotation combined with minimally invasive percutaneous plate osteosynthesis versus Intertan intramedullary nail fixation in treatment of intertrochanteric fracture with incomplete lateral wall_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CHEN Zhangxin , HU Cuiyu , ZHENG Zhenhua , JIANG Huixiang , GAO Mingming , WU Benwen ,  HUANG Guofeng ,  DING Zhenqi

Military Orthopaedic Center, the 909th Hospital of Joint Service Support Force of PLA (the Affiliated Dongnan Hospital of Xiamen University), Zhangzhou Fujian, 363000, P.R.China;

Corresponding?author：

HUANG Guofeng, Email: huangguofeng175@163.com; DING Zhenqi, Email: dingzhenqi175@163.com

Keywords：

Intertrochanteric fracture of femur; lateral wall; closed reduction; minimally invasive percutaneous plate osteosynthesis; proximal femoral nail anti-rotation; Intertan intramedullary nail; internal fixation

DOI：

10.7507/1002-1892.202001071

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Objective To compare the effectiveness of proximal femoral nail anti-rotation (PFNA) combined with minimally invasive percutaneous plate osteosynthesis (MIPPO) and Intertan intramedullary nail fixation by closed reduction in the treatment of AO/Orthopaedic Trauma Association (AO/OTA) type 31-A3.3 intertrochanteric fracture with incomplete lateral wall.Methods The clinical data of 54 patients with AO/OTA type 31-A3.3 intertrochanteric fracture who met the selection criteria and were admitted between January 2012 and January 2018 were retrospectively analyzed. According to different surgical methods, the patients were divided into group A (24 cases with lateral wall reconstruction by MIPPO combined with PFNA internal fixation) and group B (30 cases with Intertan intramedullary nail fixation by closed reduction only). There was no significant difference between the two groups (P>0.05) in terms of gender, age, side of injury, cause of injury, and combined medical diseases. The operation time, intraoperative blood loss, time to weight-bearing, fracture healing time, and postoperative complications were recorded and compared between the two groups. The tip apex distance (TAD) was measured at 2 days, 2 months, and 1 year after operation. At 12 months after operation, the hip joint function was evaluated according to Harris scoring standard, and the rate of conformity (Harris score were more than 70) was calculated.Results The wounds of the two groups healed by first intention, without infection, skin deformity, and other incision complications. The operation time and intraoperative blood loss of group A were significantly more than those of group B, and the time to weight-bearing and fracture healing were significantly shorter than those of group B (P<0.05). The patients were followed up 9-20 months (mean, 14.7 months) in group A and 9-19 months (mean, 13.8 months) in group B. There was no significant difference in TAD values at 2 days, 2 months, and 1 year after operation between the two groups (P<0.05), and there was also no significant difference in TAD values between the postoperative time points (P>0.05). There was 1 case of infection, 1 case of screw withdrawal, 2 cases of screw removal, and 1 case of bone nonunion in group B, the incidence of complications was 16.7%; there was only 1 case of screw withdrawal combined with screw blade withdrawal in group A, the incidence of complications was 4.2%; there was no significant difference between the two groups (χ²=2.109, P=0.146). At 12 months after operation, the Harris scores of pain, function, malunion, range of motion, and total score in group A were significantly better than those in group B (P<0.05). The rate of conformity of group A was 95.83% (23/24) and 76.67% (23/30) in group B, and the difference between the two groups was significant (χ²=3.881, P=0.049).Conclusion For the AO/OTA type 31-A3.3 intertrochanteric fracture with incomplete lateral wall, compared with the closed reduction Intertan intramedullary nail fixation, the incidence of internal fixation failure after MIPPO reconstruction with lateral wall combined with PFNA fixation was lower, the time to weight-bearing was earlier, and the postoperative function was better.

Citation： CHEN Zhangxin, HU Cuiyu, ZHENG Zhenhua, JIANG Huixiang, GAO Mingming, WU Benwen, HUANG Guofeng, DING Zhenqi. Effectiveness of proximal femoral nail anti-rotation combined with minimally invasive percutaneous plate osteosynthesis versus Intertan intramedullary nail fixation in treatment of intertrochanteric fracture with incomplete lateral wall. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(9): 1085-1090. doi: 10.7507/1002-1892.202001071 Copy

1.	Yu X, Wang H, Duan X, et al. Intramedullary versus extramedullary internal fixation for unstable intertrochanteric fracture, a meta-analysis. Acta Orthop Traumatol Turc, 2018, 52(4): 299-307.
2.	Lee JH, Park KC, Lim SJ, et al. Surgical outcomes of simple distal femur fractures in elderly patients treated with the minimally invasive plate osteosynthesis technique: can percutaneous cerclage wiring reduce the fracture healing time? Arch Orthop Trauma Surg, 2020. [Epub ahead of print].
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.	Díaz VJ, Ca?izares AC, Martín IA, et al. Predictive variables of open reduction in intertrochanteric fracture nailing: a report of 210 cases. Injury, 2016, 47(Suppl 3): S51-S55.
5.	武建超, 師政偉, 李吉鵬, 等. 股骨粗隆間骨折外側壁損傷的研究進展. 中國修復重建外科雜志, 2018, 32(12): 1605-1610.
6.	姜昊, 曹烈虎, 潘思華, 等. 有限切開鈦纜捆扎輔助 PFNA 與單純微創輔助 PFNA 治療老年骨質疏松性 31-A3 型股骨粗隆間骨折的療效對比. 中國骨與關節雜志, 2019, 8(3): 191-195.
7.	李堯, 胡傳真, 茅凌洲, 等. 股骨近端防旋髓內釘聯合小鋼板重建外側壁治療 AO/OTA 31-A3 型股骨轉子間骨折. 中國修復重建外科雜志, 2019, 33(10): 1223-1227.
8.	張金輝, 張科學, 張立海, 等. 老年股骨粗隆間骨折股骨近端抗旋髓內釘和股骨近端髓內釘 InterTAN 的選擇和療效評價. 中國修復重建外科雜志, 2015, 29(5): 538-541.
9.	Jiang L, Zheng Q, Pan Z. What is the fracture displacement influence to fracture non-union in intramedullary nail treatment in subtrochanteric fracture? J Clin Orthop Trauma, 2018, 9(4): 317-321.
10.	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.
11.	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.
12.	Gotfried Y. Integrity of the lateral femoral wall in intertrochanteric hip fractures: an important predictor of a reoperation. J Bone Joint Surg (Am), 2007, 89(11): 2552-2553.
13.	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.
14.	Hao Y, Zhang Z, Zhou F, et al. Risk factors for implant failure in reverse oblique and transverse intertrochanteric fractures treated with proximal femoral nail antirotation (PFNA). J Orthop Surg Res, 2019, 14(1): 350.
15.	Haq RU, Manhas V, Pankaj A, et al. Proximal femoral nails compared with reverse distal femoral locking plates in intertrochanteric fractures with a compromised lateral wall; a randomised controlled trial. Int Orthop, 2014, 38(7): 1443-1449.
16.	朱新紅, 黃飛, 于鳳賓, 等. PFNA-Ⅱ聯合外側支撐鋼板治療股骨粗隆并外側壁不穩定型骨折的療效分析. 中國骨與關節雜志, 2018, 7(7): 506-509.
17.	于晨, 江龍海, 蔡大衛, 等. PFNA 與 InterTAN 髓內釘治療老年股骨轉子間骨折療效的 Meta 分析. 中國骨傷, 2019, 32(2): 120-129.
18.	張舒. 髓內固定術對老年股骨粗隆間骨折患者股骨頭旋轉及固定釘滑脫的影響研究. 中國骨與關節雜志, 2019, 8(6): 465-469.

1. Yu X, Wang H, Duan X, et al. Intramedullary versus extramedullary internal fixation for unstable intertrochanteric fracture, a meta-analysis. Acta Orthop Traumatol Turc, 2018, 52(4): 299-307.
2. Lee JH, Park KC, Lim SJ, et al. Surgical outcomes of simple distal femur fractures in elderly patients treated with the minimally invasive plate osteosynthesis technique: can percutaneous cerclage wiring reduce the fracture healing time? Arch Orthop Trauma Surg, 2020. [Epub ahead of print].
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. Díaz VJ, Ca?izares AC, Martín IA, et al. Predictive variables of open reduction in intertrochanteric fracture nailing: a report of 210 cases. Injury, 2016, 47(Suppl 3): S51-S55.
5. 武建超, 師政偉, 李吉鵬, 等. 股骨粗隆間骨折外側壁損傷的研究進展. 中國修復重建外科雜志, 2018, 32(12): 1605-1610.
6. 姜昊, 曹烈虎, 潘思華, 等. 有限切開鈦纜捆扎輔助 PFNA 與單純微創輔助 PFNA 治療老年骨質疏松性 31-A3 型股骨粗隆間骨折的療效對比. 中國骨與關節雜志, 2019, 8(3): 191-195.
7. 李堯, 胡傳真, 茅凌洲, 等. 股骨近端防旋髓內釘聯合小鋼板重建外側壁治療 AO/OTA 31-A3 型股骨轉子間骨折. 中國修復重建外科雜志, 2019, 33(10): 1223-1227.
8. 張金輝, 張科學, 張立海, 等. 老年股骨粗隆間骨折股骨近端抗旋髓內釘和股骨近端髓內釘 InterTAN 的選擇和療效評價. 中國修復重建外科雜志, 2015, 29(5): 538-541.
9. Jiang L, Zheng Q, Pan Z. What is the fracture displacement influence to fracture non-union in intramedullary nail treatment in subtrochanteric fracture? J Clin Orthop Trauma, 2018, 9(4): 317-321.
10. 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.
11. 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.
12. Gotfried Y. Integrity of the lateral femoral wall in intertrochanteric hip fractures: an important predictor of a reoperation. J Bone Joint Surg (Am), 2007, 89(11): 2552-2553.
13. 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.
14. Hao Y, Zhang Z, Zhou F, et al. Risk factors for implant failure in reverse oblique and transverse intertrochanteric fractures treated with proximal femoral nail antirotation (PFNA). J Orthop Surg Res, 2019, 14(1): 350.
15. Haq RU, Manhas V, Pankaj A, et al. Proximal femoral nails compared with reverse distal femoral locking plates in intertrochanteric fractures with a compromised lateral wall; a randomised controlled trial. Int Orthop, 2014, 38(7): 1443-1449.
16. 朱新紅, 黃飛, 于鳳賓, 等. PFNA-Ⅱ聯合外側支撐鋼板治療股骨粗隆并外側壁不穩定型骨折的療效分析. 中國骨與關節雜志, 2018, 7(7): 506-509.
17. 于晨, 江龍海, 蔡大衛, 等. PFNA 與 InterTAN 髓內釘治療老年股骨轉子間骨折療效的 Meta 分析. 中國骨傷, 2019, 32(2): 120-129.
18. 張舒. 髓內固定術對老年股骨粗隆間骨折患者股骨頭旋轉及固定釘滑脫的影響研究. 中國骨與關節雜志, 2019, 8(6): 465-469.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of proximal femoral nail anti-rotation combined with minimally invasive percutaneous plate osteosynthesis versus Intertan intramedullary nail fixation in treatment of intertrochanteric fracture with incomplete lateral wall

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