Effectiveness of proximal femoral nail anti-rotation and cerclage fixation for complicated femoral subtrochanteric fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

HUANG Chenyi , GAO Yi , GAO Haiming , LIU Shigui , FU Zhijiang , CHEN Jingwen ,  LIU Zongchao

Department of Orthopedic Surgery, the Affiliated Hospital of Traditional Chinese Medicine, Southwest Medical University, Luzhou Sichuan, 646000, P.R.China;

Corresponding?author：

LIU Zongchao, Email: 565409672@qq.com

Keywords：

Femoral subtrochanteric fracture; proximal femoral nail anti-rotation; cerclage; internal fixation

DOI：

10.7507/1002-1892.202103138

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Objective To investigate the effectiveness of proximal femoral nail anti-rotation (PFNA) and cerclage fixation for complicated femoral subtrochanteric fractures.Methods A clinical data of 74 patients with complicated femoral subtrochanteric fractures, who were admitted between March 2016 and March 2019 and met the criteria, was retrospectively analyzed. Among them, 39 patients were treated with limited open reduction and PFNA combined with cerclage fixation (observation group) and 35 patients were treated with closed reduction and PFNA fixation (control group). There was no significant difference in gender, age, cause of injury, side and type of fracture, and the time from injury to operation (P>0.05). The ratio of postoperative hemoglobin (1, 3, and 5 days) to the preoperative hemoglobin, the operation time, the first weight-bearing time after operation, and the hospital stay were recorded. X-ray films were taken to observe fracture healing in the two groups and bone resorption around the cerclage in the observation group, and the fracture healing time was recorded. Hip function was evaluated by Harris scoring. Results The operation time of the observation group was significantly longer than that of the control group (P<0.05), but the first weight-bearing time and hospital stay were significantly shorter (P<0.05). All patients were followed up 12 months. There was no significant difference in the ratios of post- to pre-operative hemoglobin (1, 3, and 5 days) between the two groups (P>0.05). X-ray film reexamination showed that the fractures of the two groups healed smoothly, and the fracture healing time of the observation group was significantly shorter than that of the control group (t=?12.989, P=0.000). No bone resorption around the cerclage occurred in the observation group. The Harris scores of the observation group were better than those of the control group at 7 days and 1, 2, and 3 months after operation (P<0.05), and there was no significant difference between the two groups at 6 months after operation (t=1.329, P=0.180).Conclusion Compared with PFNA fixation, PFNA combined with cerclage fixation for the complicated femoral subtrochanteric fractures has a shorter operation time, and can obtain immediate stability after fixation, which can meet the needs of patients for early functional exercise.

Citation： HUANG Chenyi, GAO Yi, GAO Haiming, LIU Shigui, FU Zhijiang, CHEN Jingwen, LIU Zongchao. Effectiveness of proximal femoral nail anti-rotation and cerclage fixation for complicated femoral subtrochanteric fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(8): 956-960. doi: 10.7507/1002-1892.202103138 Copy

1.	賀丹, 劉厚蓮. 中國人口老齡化發展態勢、影響及應對策略. 中共中央黨校 (國家行政學院) 學報, 2019, 23(4): 84-90.
2.	Xie Y, Dong Q, Xie Z. Proximal femoral nail anti-rotation (PFNA) and hemi-arthroplasty in the treatment of elderly intertrochanteric fractures. Acta Orthop Belg, 2019, 85(2): 199-204.
3.	Forward DP, Doro CJ, O’Toole RV, et al. A biomechanical comparison of a locking plate, a nail, and a 95° angled blade plate for fixation of subtrochanteric femoral fractures. J Orthop Trauma, 2012, 26(6): 334-340.
4.	袁春曉, 阿里木江·阿不來提, 李京, 等. 髓內固定與髓外釘板固定治療成人股骨轉子下骨折的 Meta 分析. 中國矯形外科雜志, 2014, 22(10): 886-891.
5.	吳克儉, 湯俊君. 準確理解股骨轉子間骨折“外側壁”. 中國修復重建外科雜志, 2019, 33(10): 1210-1215.
6.	張世民, 胡孫君, 杜守超, 等. 股骨轉子間骨折的穩定性重建概念演化與研究進展. 中國修復重建外科雜志, 2019, 33(10): 1203-1209.
7.	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.
8.	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.
9.	孫哲, 劉紹靈, 鄧進. 股骨轉子下骨折的治療進展. 創傷外科雜志, 2018, 20(5): 396-398.
10.	楊明輝, 李宇能. 當今股骨轉子下骨折的治療理念. 國際骨科學雜志, 2017, 38(4): 213-215.
11.	楊雷, 殷剛, 劉志元, 等. 股骨近端防旋髓內釘治療股骨粗隆下骨折的效果. 實用臨床醫藥雜志, 2015, 19(23): 102-103.
12.	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.
13.	Codesido P, Mejía A, Riego J, et al. Subtrochanteric fractures in elderly people treated with intramedullary fixation: quality of life and complications following open reduction and cerclage wiring versus closed reduction. Arch Orthop Trauma Surg, 2017, 137(8): 1077-1085.
14.	李繼川, 趙義榮, 余春生, 等. 微創 PFNA 髓內釘治療老年轉子間骨折術后隱形失血的因素分析. 中國醫師雜志, 2019, 21(9): 1418-1420.
15.	Stacey J, Bush C, DiPasquale T. The hidden blood loss in proximal femur fractures is sizeable and significant. J Clin Orthop Trauma, 2021, 16: 239-243.
16.	Rehme J, Woltmann A, Brand A, et al. Does auxiliary cerclage wiring provide intrinsic stability in cephalomedullary nailing of trochanteric and subtrochanteric fractures? Int Orthop, 2020, 45(1): 1329-1336.
17.	Huang X, Zhang F, Zhang Y. Case series and finite element analysis of PFNA combined with cerclage wire for treatment of subtrochanteric fracture of femur. J Orthop Surg Res, 2021, 16(1): 70. doi: 10.1186/s13018-020-02187-3.
18.	Fauconnier S, Van Lieshout M, Victor J. Evaluation of cerclage wiring in the treatment of subtrochanteric fractures. Acta Orthop Belg, 2020, 86(1): 28-32.
19.	朱佳福, 徐衛星, 劉宏. InterTan 髓內釘治療老年股骨轉子間冠狀位骨折的病例對照研究. 中國骨傷, 2016, 29(12): 1130-1134.
20.	Broos PL, Sermon A. From unstable internal fixation to biological osteosynthesis. A historical overview of operative fracture treatment. Acta Chir Belg, 2004, 104(4): 396-400.
21.	Bauer TW, Muschler GF. Bone graft materials. An overview of the basic science. Clin Orthop Relat Res, 2000, (371): 10-27.
22.	Kennedy MT, Mitra A, Hierlihy TG, et al. Subtrochanteric hip fractures treated with cerclage cables and long cephalomedullary nails: a review of 17 consecutive cases over 2 years. Injury, 2011, 42(11): 1317-1321.
23.	倪東馗, 鄭道明, 龐小建, 等. 捆綁帶對骨折愈合影響的實驗研究. 天津醫科大學學報, 2010, 16(3): 395-398.
24.	Grimsrud C, Monzon RJ, Richman J, et al. Cemented hip arthroplasty with a novel cerclage cable technique for unstable intertrochanteric hip fractures. J Arthroplasty, 2005, 20(3): 337-343.
25.	Old AB, McGrory BJ, White RR, et al. Fixation of Vancouver B1 peri-prosthetic fractures by broad metal plates without the application of strut allografts. J Bone Joint Surg (Br), 2006, 88(11): 1425-1429.
26.	龐小建, 倪東馗, 鄭道明, 等. 不同寬度捆綁帶對骨折愈合的影響. 中國組織工程研究與臨床康復, 2011, 15(39): 7221-7225.
27.	葉添文, 李陽, 歐陽躍平, 等. 醫用鈦纜在髕骨粉碎性骨折治療中的應用. 中國矯形外科雜志, 2009, 17(4): 268-271.

1. 賀丹, 劉厚蓮. 中國人口老齡化發展態勢、影響及應對策略. 中共中央黨校 (國家行政學院) 學報, 2019, 23(4): 84-90.
2. Xie Y, Dong Q, Xie Z. Proximal femoral nail anti-rotation (PFNA) and hemi-arthroplasty in the treatment of elderly intertrochanteric fractures. Acta Orthop Belg, 2019, 85(2): 199-204.
3. Forward DP, Doro CJ, O’Toole RV, et al. A biomechanical comparison of a locking plate, a nail, and a 95° angled blade plate for fixation of subtrochanteric femoral fractures. J Orthop Trauma, 2012, 26(6): 334-340.
4. 袁春曉, 阿里木江·阿不來提, 李京, 等. 髓內固定與髓外釘板固定治療成人股骨轉子下骨折的 Meta 分析. 中國矯形外科雜志, 2014, 22(10): 886-891.
5. 吳克儉, 湯俊君. 準確理解股骨轉子間骨折“外側壁”. 中國修復重建外科雜志, 2019, 33(10): 1210-1215.
6. 張世民, 胡孫君, 杜守超, 等. 股骨轉子間骨折的穩定性重建概念演化與研究進展. 中國修復重建外科雜志, 2019, 33(10): 1203-1209.
7. 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.
8. 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.
9. 孫哲, 劉紹靈, 鄧進. 股骨轉子下骨折的治療進展. 創傷外科雜志, 2018, 20(5): 396-398.
10. 楊明輝, 李宇能. 當今股骨轉子下骨折的治療理念. 國際骨科學雜志, 2017, 38(4): 213-215.
11. 楊雷, 殷剛, 劉志元, 等. 股骨近端防旋髓內釘治療股骨粗隆下骨折的效果. 實用臨床醫藥雜志, 2015, 19(23): 102-103.
12. 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.
13. Codesido P, Mejía A, Riego J, et al. Subtrochanteric fractures in elderly people treated with intramedullary fixation: quality of life and complications following open reduction and cerclage wiring versus closed reduction. Arch Orthop Trauma Surg, 2017, 137(8): 1077-1085.
14. 李繼川, 趙義榮, 余春生, 等. 微創 PFNA 髓內釘治療老年轉子間骨折術后隱形失血的因素分析. 中國醫師雜志, 2019, 21(9): 1418-1420.
15. Stacey J, Bush C, DiPasquale T. The hidden blood loss in proximal femur fractures is sizeable and significant. J Clin Orthop Trauma, 2021, 16: 239-243.
16. Rehme J, Woltmann A, Brand A, et al. Does auxiliary cerclage wiring provide intrinsic stability in cephalomedullary nailing of trochanteric and subtrochanteric fractures? Int Orthop, 2020, 45(1): 1329-1336.
17. Huang X, Zhang F, Zhang Y. Case series and finite element analysis of PFNA combined with cerclage wire for treatment of subtrochanteric fracture of femur. J Orthop Surg Res, 2021, 16(1): 70. doi: 10.1186/s13018-020-02187-3.
18. Fauconnier S, Van Lieshout M, Victor J. Evaluation of cerclage wiring in the treatment of subtrochanteric fractures. Acta Orthop Belg, 2020, 86(1): 28-32.
19. 朱佳福, 徐衛星, 劉宏. InterTan 髓內釘治療老年股骨轉子間冠狀位骨折的病例對照研究. 中國骨傷, 2016, 29(12): 1130-1134.
20. Broos PL, Sermon A. From unstable internal fixation to biological osteosynthesis. A historical overview of operative fracture treatment. Acta Chir Belg, 2004, 104(4): 396-400.
21. Bauer TW, Muschler GF. Bone graft materials. An overview of the basic science. Clin Orthop Relat Res, 2000, (371): 10-27.
22. Kennedy MT, Mitra A, Hierlihy TG, et al. Subtrochanteric hip fractures treated with cerclage cables and long cephalomedullary nails: a review of 17 consecutive cases over 2 years. Injury, 2011, 42(11): 1317-1321.
23. 倪東馗, 鄭道明, 龐小建, 等. 捆綁帶對骨折愈合影響的實驗研究. 天津醫科大學學報, 2010, 16(3): 395-398.
24. Grimsrud C, Monzon RJ, Richman J, et al. Cemented hip arthroplasty with a novel cerclage cable technique for unstable intertrochanteric hip fractures. J Arthroplasty, 2005, 20(3): 337-343.
25. Old AB, McGrory BJ, White RR, et al. Fixation of Vancouver B1 peri-prosthetic fractures by broad metal plates without the application of strut allografts. J Bone Joint Surg (Br), 2006, 88(11): 1425-1429.
26. 龐小建, 倪東馗, 鄭道明, 等. 不同寬度捆綁帶對骨折愈合的影響. 中國組織工程研究與臨床康復, 2011, 15(39): 7221-7225.
27. 葉添文, 李陽, 歐陽躍平, 等. 醫用鈦纜在髕骨粉碎性骨折治療中的應用. 中國矯形外科雜志, 2009, 17(4): 268-271.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of proximal femoral nail anti-rotation and cerclage fixation for complicated femoral subtrochanteric fractures

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