Treatment of irreducible intertrochanteric femoral fracture with minimally invasive clamp reduction technique via anterior approach_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHAO Yifeng ¹ , JIANG Zhen ¹ , LI Tao ² , XU Chongyang ³ , HAN Liang ¹ , CHU Fenglong ¹ , WU Bin ¹ , GAO Ming ¹ ,  WANG Haibin ¹

1. Department of Traumatic Orthopedics, Affiliated Hospital of Jining Medical University, Jining Shandong, 272029, P.R.China;
2. Department of Orthopedics, Wenshang People’s Hospital, Jining Shandong, 272501, P.R.China;
3. Department of Imaging, Huaiyin People’s Hospital, Jinan Shandong, 250000, P.R.China;

Corresponding?author：

WANG Haibin, Email: wanghaibin99@163.com

Keywords：

Irreducible femoral intertrochanteric fracture; anterior approach; clamp reduction; minimally invasive technique

DOI：

10.7507/1002-1892.202012030

Video：

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Objective To explore the effectiveness of minimally invasive clamp reduction technique via anterior approach in treatment of irreducible intertrochanteric femoral fractures.Methods Between January 2015 and January 2019, 59 patients with irreducible intertrochanteric femoral fractures were treated with minimally invasive clamp reduction technique via anterior approach. There were 29 males and 30 females with an average age of 77.9 years (range, 45-100 years). The causes of injury included falling in 46 cases, traffic accident in 6 cases, smashing in 2 cases, and falling from height in 5 cases. The time from injury to operation was 1-14 days (mean, 3.8 days). The fractures were classified as AO type 31-A1 in 12 cases, type 31-A2 in 25 cases, type 31-A3 in 22 cases.Results All fractures were reduced well and the fracture reduction took 10 to 30 minutes, with an average of 19 minutes. All patients were followed up 13-25 months, with an average of 17.6 months. Among them, 2 cases of pronation displacement of proximal fracture segment died for infection or falling pneumonia after internal fixation failed. Six patients with reversed intertrochanteric femoral fractures experienced re-pronation and abduction displacement of the lateral wall after internal fixation, but the fractures all healed. The rest of the patients had no fracture reduction loss, and the fractures healed with an average healing time of 5.9 months (range, 3-9 months). Except for 2 patients who died, the Harris score of hip joint function of the remaining 57 patients was excellent in 49 cases and good in 8 cases at last follow-up.Conclusion The minimally invasive clamp reduction technique via anterior approach for irreducible intertrochanteric femoral fractures is simple and effective. For irreducible intertrochanteric femoral fractures related to lateral wall displacement, after clamp reduction and intramedullary nail fixation, the lateral wall should be reinforced in order to avoid reduction loss and internal fixation failure.

Citation： ZHAO Yifeng, JIANG Zhen, LI Tao, XU Chongyang, HAN Liang, CHU Fenglong, WU Bin, GAO Ming, WANG Haibin. Treatment of irreducible intertrochanteric femoral fracture with minimally invasive clamp reduction technique via anterior approach. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(5): 544-549. doi: 10.7507/1002-1892.202012030 Copy

1.	Kumar P, Rajnish RK, Sharma S, et al. Proximal femoral nailing is superior to hemiarthroplasty in AO/OTA A2 and A3 intertrochanteric femur fractures in the elderly: a systematic literature review and meta-analysis. Int Orthop, 2020, 44(4): 623-633.
2.	Moehring HD, Nowinski GP, Chapman MW, et al. Irreducible intertrochanteric fractures of the femur. Clin Orthop Relat Res, 1997, (339): 197-199.
3.	Said GZ, Farouk O, Said HG. An irreducible variant of intertrochanteric fractures: a technique for open reduction. Injury, 2005, 36(7): 871-874.
4.	Sharma G, kumar GNK, Yadav S, et al. Pertrochanteric fractures (AO/OTA 31-A1 and A2) not amenable to closed reduction: causes of irreducibility. Injury, 2014, 45(12): 1950-1957.
5.	Chandak R, Malewar N, Jangle A, et al. Description of new “epsilon sign” and its significance in reduction in highly unstable variant of intertrochanteric fracture. Eur J Orthop Surg Traumatol, 2019, 29(7): 1435-1439.
6.	Chun YS, Oh H, Cho YJ, et al. Technique and early results of percutaneous reduction of sagittally unstable intertrochateric fractures. Clin Orthop Surg, 2011, 3(3): 217-224.
7.	Hao YL, Zhang ZS, Zhou F, et al. Predictors and reduction techniques for irreducible reverse intertrochanteric fractures. Chin Med J (Engl), 2019, 132(21): 2534-2542.
8.	Ikuta Y, Nagata Y, Iwasaki Y. Preoperative radiographic features of trochanteric fractures irreducible by closed reduction. Injury, 2019, 50(11): 2014-2021.
9.	吳巍巍, 胡敏超, 于艷麗, 等. 難復性股骨轉子骨折術中的一種復位技巧. 中國骨傷, 2018, 31(9): 867-870.
10.	張世民, 胡孫君, 杜守超, 等. 小轉子二分型的難復位股骨轉子間骨折手術技巧及療效分析. 同濟大學學報 (醫學版), 2020, 41(6): 772-778.
11.	于沂陽, 常恒瑞, 鄭占樂, 等. 順勢互動復位技術治療難復性股骨頸骨折. 中華創傷雜志, 2017, 33(7): 596-601.
12.	劉月駒, 連曉東, 李晗, 等. 應用兩種股骨頭干三維互動技術治療難復性股骨頸骨折的療效比較. 中華骨科雜志, 2015, 35(6): 670-672.
13.	Baumgaertner MR, Solberg BD. Awareness of tip-apex distance reduces failure of fixation of trochanteric fractures of the hip. J Bone Joint Surg (Br), 1997, 79(6): 969-971.
14.	Kim Y, Dheep K, Lee J, et al. Hook leverage technique for reduction of intertrochanteric fracture. Injury, 2014, 45(6): 1006-1010.
15.	Zhang W, Antony Xavier RP, Decruz J, et al. Risk factors for mechanical failure of intertrochanteric fractures after fixation with proximal femoral nail antirotation (PFNA Ⅱ): a study in a Southeast Asian population. Arch Orthop Trauma Surg, 2020, 11: 1-7.
16.	Karayiannis P, James A. The impact of cerclage cabling on unstable intertrochanteric and subtrochanteric femoral fractures: a retrospective review of 465 patients. Eur J Trauma Emerg Surg, 2020, 46(5): 969-975.
17.	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.
18.	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): 350-357.
19.	Imerci A, Aydogan NH, Tosun K. The effect on outcomes of the application of circumferential cerclage cable following intramedullary nailing in reverse intertrochanteric femoral fractures. Eur J Orthop Surg Traumatol, 2019, 29(4): 835-842.

1. Kumar P, Rajnish RK, Sharma S, et al. Proximal femoral nailing is superior to hemiarthroplasty in AO/OTA A2 and A3 intertrochanteric femur fractures in the elderly: a systematic literature review and meta-analysis. Int Orthop, 2020, 44(4): 623-633.
2. Moehring HD, Nowinski GP, Chapman MW, et al. Irreducible intertrochanteric fractures of the femur. Clin Orthop Relat Res, 1997, (339): 197-199.
3. Said GZ, Farouk O, Said HG. An irreducible variant of intertrochanteric fractures: a technique for open reduction. Injury, 2005, 36(7): 871-874.
4. Sharma G, kumar GNK, Yadav S, et al. Pertrochanteric fractures (AO/OTA 31-A1 and A2) not amenable to closed reduction: causes of irreducibility. Injury, 2014, 45(12): 1950-1957.
5. Chandak R, Malewar N, Jangle A, et al. Description of new “epsilon sign” and its significance in reduction in highly unstable variant of intertrochanteric fracture. Eur J Orthop Surg Traumatol, 2019, 29(7): 1435-1439.
6. Chun YS, Oh H, Cho YJ, et al. Technique and early results of percutaneous reduction of sagittally unstable intertrochateric fractures. Clin Orthop Surg, 2011, 3(3): 217-224.
7. Hao YL, Zhang ZS, Zhou F, et al. Predictors and reduction techniques for irreducible reverse intertrochanteric fractures. Chin Med J (Engl), 2019, 132(21): 2534-2542.
8. Ikuta Y, Nagata Y, Iwasaki Y. Preoperative radiographic features of trochanteric fractures irreducible by closed reduction. Injury, 2019, 50(11): 2014-2021.
9. 吳巍巍, 胡敏超, 于艷麗, 等. 難復性股骨轉子骨折術中的一種復位技巧. 中國骨傷, 2018, 31(9): 867-870.
10. 張世民, 胡孫君, 杜守超, 等. 小轉子二分型的難復位股骨轉子間骨折手術技巧及療效分析. 同濟大學學報 (醫學版), 2020, 41(6): 772-778.
11. 于沂陽, 常恒瑞, 鄭占樂, 等. 順勢互動復位技術治療難復性股骨頸骨折. 中華創傷雜志, 2017, 33(7): 596-601.
12. 劉月駒, 連曉東, 李晗, 等. 應用兩種股骨頭干三維互動技術治療難復性股骨頸骨折的療效比較. 中華骨科雜志, 2015, 35(6): 670-672.
13. Baumgaertner MR, Solberg BD. Awareness of tip-apex distance reduces failure of fixation of trochanteric fractures of the hip. J Bone Joint Surg (Br), 1997, 79(6): 969-971.
14. Kim Y, Dheep K, Lee J, et al. Hook leverage technique for reduction of intertrochanteric fracture. Injury, 2014, 45(6): 1006-1010.
15. Zhang W, Antony Xavier RP, Decruz J, et al. Risk factors for mechanical failure of intertrochanteric fractures after fixation with proximal femoral nail antirotation (PFNA Ⅱ): a study in a Southeast Asian population. Arch Orthop Trauma Surg, 2020, 11: 1-7.
16. Karayiannis P, James A. The impact of cerclage cabling on unstable intertrochanteric and subtrochanteric femoral fractures: a retrospective review of 465 patients. Eur J Trauma Emerg Surg, 2020, 46(5): 969-975.
17. 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.
18. 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): 350-357.
19. Imerci A, Aydogan NH, Tosun K. The effect on outcomes of the application of circumferential cerclage cable following intramedullary nailing in reverse intertrochanteric femoral fractures. Eur J Orthop Surg Traumatol, 2019, 29(4): 835-842.

Chinese Journal of Reparative and Reconstructive Surgery

Treatment of irreducible intertrochanteric femoral fracture with minimally invasive clamp reduction technique via anterior approach

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