Treatment of irreducible intertrochanteric femoral fracture in elderly by folding top technique combined with right-angle pliers prying and pulling under G-arm X-ray fluoroscopy_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

HAN Xiaoliang ¹ , LIU Xu ¹ , CHEN Gongqiang ¹ , CHEN Dongsheng ¹ , SUN Zhipeng ¹ , YUE Heng ¹ ,  LIU Jingsheng ² , HAN Xiaoliang ¹ , LIU Xu ¹ , CHEN Gongqiang ¹ , CHEN Dongsheng ¹ , SUN Zhipeng ¹ , YUE Heng ¹ ,  LIU Jingsheng ²

1. Department of Orthopedics, Dingxi People’s Hospital, Dingxi Gansu, 743000, P. R. China;
2. Department of Orthopedics, the Second Hospital of Lanzhou University, Lanzhou Gansu, 730000, P. R. China;

Corresponding?author：

LIU Jingsheng, Email: 324376533@qq.com; LIU Jingsheng, Email: 324376533@qq.com

Keywords：

Irreducible intertrochanteric femoral fracture; G-arm X-ray fluoroscopy; folding top technique; right-angle pliers; proximal femoral nail antirotation

DOI：

10.7507/1002-1892.202401066

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To explore the effectiveness of irreducible intertrochanteric femoral fracture in the elderly by treating with folding top technique and right-angle pliers prying and pulling under G-arm X-ray fluoroscopy. Methods The clinical data of 74 elderly patients with irreducible intertrochanteric femoral fracture admitted between February 2016 and December 2022 and met the selection criteria were retrospectively analyzed. Among them, 38 cases were treated with folding top technique combined with right-angle pliers prying and pulling under G-arm X-ray fluoroscopy and intramedullary nailing fixation (study group), and 36 cases were treated with limited open reduction combined with other reduction methods and intramedullary nailing fixation (control group). There was no significant difference in baseline data between the two groups, such as age, gender, cause of injury, affected side and classification of fractures, complicated medical diseases, and time from injury to operation (P>0.05). The operation time, intraoperative blood loss, hospital stay, fracture reduction time, fracture healing time, and complications of the two groups were recorded and compared. The quality of fracture reduction was evaluated by Baumgaertner et al. and Chang et al. fracture reduction standards. Results Patients in both groups were followed up 10-14 months, with an average of 12 months. The operation time and intraoperative blood loss in the study group were significantly less than those in the control group (P<0.05), there was no significant difference in hospital stay between the two groups (P>0.05). At 2 days after operation, according to the fracture reduction standards of Baumgaertner et al. and CHANG Shimin et al., the quality of fracture reduction in the study group was better than that in the control group, and the fracture reduction time in the study group was shorter than that in the control group, with significant differences (P<0.05). After operation, the fractures of the two groups all healed, and there was no significant difference in healing time between the two groups (P>0.05). During the follow-up, there was no complication such as incision infection, internal fixation failure, deep venous thrombosis of lower limbs, intramedullary nail breakage, spiral blade cutting, or hip varus in the two groups, except for 2 cases of coxa vara in the control group. Conclusion For the irreducible intertrochanteric femoral fracture, using folding top technique combined with right-angle pliers prying and pulling under G-arm X-ray fluoroscopy can obviously shorten the operation time, reduce the intraoperative blood loss, and improve the quality of fracture reduction.

Citation： HAN Xiaoliang, LIU Xu, CHEN Gongqiang, CHEN Dongsheng, SUN Zhipeng, YUE Heng, LIU Jingsheng. Treatment of irreducible intertrochanteric femoral fracture in elderly by folding top technique combined with right-angle pliers prying and pulling under G-arm X-ray fluoroscopy. Chinese Journal of Reparative and Reconstructive Surgery, 2024, 38(4): 398-404. doi: 10.7507/1002-1892.202401066 Copy

1.	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.
2.	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.
3.	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.
4.	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.
5.	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.
6.	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.
7.	王躍挺, 張琳袁, 龔偉華, 等. 老年轉子間骨折股骨近端防旋髓內釘內固定術后骨折斷端陽性支撐與陰性支撐短期療效比較. 中華骨與關節外科雜志, 2021, 14(3): 205-209.
8.	王躍挺, 張琳袁, 龔偉華, 等. 老年轉子間骨折股骨近端防旋髓內釘內固定術后骨折斷端陽性支撐與陰性支撐短期療效比較. 中華骨與關節外科雜志, 2021, 14(3): 205-209.
9.	孫鳳坡, 劉湘雪, 張統一, 等. 頂棒支撐法復位在難復性股骨轉子間骨折治療中的應用效果分析. 中華創傷骨科雜志, 2021, 23(9): 782-787.
10.	孫鳳坡, 劉湘雪, 張統一, 等. 頂棒支撐法復位在難復性股骨轉子間骨折治療中的應用效果分析. 中華創傷骨科雜志, 2021, 23(9): 782-787.
11.	邱衛華, 王劍瑋, 黃磊, 等. 骨鉤輔助閉合復位股骨近端防旋髓內釘內固定治療較難復位的老年外翻型股骨粗隆間骨折. 中國骨與關節損傷雜志, 2022, 37(12): 1291-1293.
12.	邱衛華, 王劍瑋, 黃磊, 等. 骨鉤輔助閉合復位股骨近端防旋髓內釘內固定治療較難復位的老年外翻型股骨粗隆間骨折. 中國骨與關節損傷雜志, 2022, 37(12): 1291-1293.
13.	黃淑明, 蘭樹華, 吳泉州, 等. 槍式鉗輔助復位髓內固定治療內外向難復性股骨轉子間骨折. 中國基層醫藥, 2019, 26(9): 1037-1041.
14.	黃淑明, 蘭樹華, 吳泉州, 等. 槍式鉗輔助復位髓內固定治療內外向難復性股骨轉子間骨折. 中國基層醫藥, 2019, 26(9): 1037-1041.
15.	梁志強, 孫俊明, 林永煬, 等. 經皮撬撥復位股骨近端防旋髓內釘內固定治療閉合復位困難的股骨粗隆間骨折. 中國骨與關節損傷雜志, 2022, 37(2): 184-186.
16.	梁志強, 孫俊明, 林永煬, 等. 經皮撬撥復位股骨近端防旋髓內釘內固定治療閉合復位困難的股骨粗隆間骨折. 中國骨與關節損傷雜志, 2022, 37(2): 184-186.
17.	趙益峰, 姜振, 李濤, 等. 前入路微創鉗夾復位技術治療難復性股骨轉子間骨折. 中國修復重建外科雜志, 2021, 35(5): 544-549.
18.	趙益峰, 姜振, 李濤, 等. 前入路微創鉗夾復位技術治療難復性股骨轉子間骨折. 中國修復重建外科雜志, 2021, 35(5): 544-549.
19.	佟大可, 丁文彬, 王光超, 等. 難復性股骨轉子間骨折的2021分型與復位技巧研究. 中華創傷骨科雜志, 2022, 24(3): 238-246.
20.	佟大可, 丁文彬, 王光超, 等. 難復性股骨轉子間骨折的2021分型與復位技巧研究. 中華創傷骨科雜志, 2022, 24(3): 238-246.
21.	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.
22.	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.
23.	Chang SM, Hou ZY, Hu SJ, et al. Intertrochanteric femur fracture treatment in Asia: What we know and what the world can learn. Orthop Clin North Am, 2020, 51(2): 189-205.
24.	Chang SM, Hou ZY, Hu SJ, et al. Intertrochanteric femur fracture treatment in Asia: What we know and what the world can learn. Orthop Clin North Am, 2020, 51(2): 189-205.
25.	尚宏喜, 劉安慶, 丁強, 等. G型臂X線機監視下微創空心螺紋釘內固定治療股骨頸骨折. 中華創傷骨科雜志, 2013, 15(2): 180-182.
26.	尚宏喜, 劉安慶, 丁強, 等. G型臂X線機監視下微創空心螺紋釘內固定治療股骨頸骨折. 中華創傷骨科雜志, 2013, 15(2): 180-182.
27.	王華, 王先輝, 吳非, 等. G型臂與C型臂X線機在PFNA內固定治療股骨粗隆間骨折中的應用對照研究. 中國骨與關節損傷雜志, 2019, 34(8): 826-828.
28.	王華, 王先輝, 吳非, 等. G型臂與C型臂X線機在PFNA內固定治療股骨粗隆間骨折中的應用對照研究. 中國骨與關節損傷雜志, 2019, 34(8): 826-828.
29.	張紅遠. 瑞典Biplanar500G型臂技術優點及常見故障排除. 醫療衛生裝備, 2012, 33(4): 145-146.
30.	張紅遠. 瑞典Biplanar500G型臂技術優點及常見故障排除. 醫療衛生裝備, 2012, 33(4): 145-146.
31.	Klaber I, Besa P, Sandoval F, et al. The new AO classification system for intertrochanteric fractures allows better agreement than the original AO classification. An inter- and intra-observer agreement evaluation. Injury, 2021, 52(1): 102-105.
32.	Klaber I, Besa P, Sandoval F, et al. The new AO classification system for intertrochanteric fractures allows better agreement than the original AO classification. An inter- and intra-observer agreement evaluation. Injury, 2021, 52(1): 102-105.
33.	李翔, 王愛國, 時曉華, 等. 難復性股骨轉子間骨折的新分型與復位策略研究. 中華創傷骨科雜志, 2023, 25(9): 762-769.
34.	李翔, 王愛國, 時曉華, 等. 難復性股骨轉子間骨折的新分型與復位策略研究. 中華創傷骨科雜志, 2023, 25(9): 762-769.
35.	Moehring HD, Nowinski GP, Chapman MW, et al. Irreducible intertrochanteric fractures of the femur. Clin Orthop Relat Res, 1997(339): 197-199.
36.	Moehring HD, Nowinski GP, Chapman MW, et al. Irreducible intertrochanteric fractures of the femur. Clin Orthop Relat Res, 1997(339): 197-199.
37.	張澤, 孫鳳坡, 張統一, 等. 基于復位期及骨塊位置的難復性股骨轉子間骨折分型及復位技巧研究. 中華創傷骨科雜志, 2023, 25(9): 755-761.
38.	張澤, 孫鳳坡, 張統一, 等. 基于復位期及骨塊位置的難復性股骨轉子間骨折分型及復位技巧研究. 中華創傷骨科雜志, 2023, 25(9): 755-761.

1. 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.
2. 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.
3. 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.
4. 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.
5. 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.
6. 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.
7. 王躍挺, 張琳袁, 龔偉華, 等. 老年轉子間骨折股骨近端防旋髓內釘內固定術后骨折斷端陽性支撐與陰性支撐短期療效比較. 中華骨與關節外科雜志, 2021, 14(3): 205-209.
8. 王躍挺, 張琳袁, 龔偉華, 等. 老年轉子間骨折股骨近端防旋髓內釘內固定術后骨折斷端陽性支撐與陰性支撐短期療效比較. 中華骨與關節外科雜志, 2021, 14(3): 205-209.
9. 孫鳳坡, 劉湘雪, 張統一, 等. 頂棒支撐法復位在難復性股骨轉子間骨折治療中的應用效果分析. 中華創傷骨科雜志, 2021, 23(9): 782-787.
10. 孫鳳坡, 劉湘雪, 張統一, 等. 頂棒支撐法復位在難復性股骨轉子間骨折治療中的應用效果分析. 中華創傷骨科雜志, 2021, 23(9): 782-787.
11. 邱衛華, 王劍瑋, 黃磊, 等. 骨鉤輔助閉合復位股骨近端防旋髓內釘內固定治療較難復位的老年外翻型股骨粗隆間骨折. 中國骨與關節損傷雜志, 2022, 37(12): 1291-1293.
12. 邱衛華, 王劍瑋, 黃磊, 等. 骨鉤輔助閉合復位股骨近端防旋髓內釘內固定治療較難復位的老年外翻型股骨粗隆間骨折. 中國骨與關節損傷雜志, 2022, 37(12): 1291-1293.
13. 黃淑明, 蘭樹華, 吳泉州, 等. 槍式鉗輔助復位髓內固定治療內外向難復性股骨轉子間骨折. 中國基層醫藥, 2019, 26(9): 1037-1041.
14. 黃淑明, 蘭樹華, 吳泉州, 等. 槍式鉗輔助復位髓內固定治療內外向難復性股骨轉子間骨折. 中國基層醫藥, 2019, 26(9): 1037-1041.
15. 梁志強, 孫俊明, 林永煬, 等. 經皮撬撥復位股骨近端防旋髓內釘內固定治療閉合復位困難的股骨粗隆間骨折. 中國骨與關節損傷雜志, 2022, 37(2): 184-186.
16. 梁志強, 孫俊明, 林永煬, 等. 經皮撬撥復位股骨近端防旋髓內釘內固定治療閉合復位困難的股骨粗隆間骨折. 中國骨與關節損傷雜志, 2022, 37(2): 184-186.
17. 趙益峰, 姜振, 李濤, 等. 前入路微創鉗夾復位技術治療難復性股骨轉子間骨折. 中國修復重建外科雜志, 2021, 35(5): 544-549.
18. 趙益峰, 姜振, 李濤, 等. 前入路微創鉗夾復位技術治療難復性股骨轉子間骨折. 中國修復重建外科雜志, 2021, 35(5): 544-549.
19. 佟大可, 丁文彬, 王光超, 等. 難復性股骨轉子間骨折的2021分型與復位技巧研究. 中華創傷骨科雜志, 2022, 24(3): 238-246.
20. 佟大可, 丁文彬, 王光超, 等. 難復性股骨轉子間骨折的2021分型與復位技巧研究. 中華創傷骨科雜志, 2022, 24(3): 238-246.
21. 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.
22. 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.
23. Chang SM, Hou ZY, Hu SJ, et al. Intertrochanteric femur fracture treatment in Asia: What we know and what the world can learn. Orthop Clin North Am, 2020, 51(2): 189-205.
24. Chang SM, Hou ZY, Hu SJ, et al. Intertrochanteric femur fracture treatment in Asia: What we know and what the world can learn. Orthop Clin North Am, 2020, 51(2): 189-205.
25. 尚宏喜, 劉安慶, 丁強, 等. G型臂X線機監視下微創空心螺紋釘內固定治療股骨頸骨折. 中華創傷骨科雜志, 2013, 15(2): 180-182.
26. 尚宏喜, 劉安慶, 丁強, 等. G型臂X線機監視下微創空心螺紋釘內固定治療股骨頸骨折. 中華創傷骨科雜志, 2013, 15(2): 180-182.
27. 王華, 王先輝, 吳非, 等. G型臂與C型臂X線機在PFNA內固定治療股骨粗隆間骨折中的應用對照研究. 中國骨與關節損傷雜志, 2019, 34(8): 826-828.
28. 王華, 王先輝, 吳非, 等. G型臂與C型臂X線機在PFNA內固定治療股骨粗隆間骨折中的應用對照研究. 中國骨與關節損傷雜志, 2019, 34(8): 826-828.
29. 張紅遠. 瑞典Biplanar500G型臂技術優點及常見故障排除. 醫療衛生裝備, 2012, 33(4): 145-146.
30. 張紅遠. 瑞典Biplanar500G型臂技術優點及常見故障排除. 醫療衛生裝備, 2012, 33(4): 145-146.
31. Klaber I, Besa P, Sandoval F, et al. The new AO classification system for intertrochanteric fractures allows better agreement than the original AO classification. An inter- and intra-observer agreement evaluation. Injury, 2021, 52(1): 102-105.
32. Klaber I, Besa P, Sandoval F, et al. The new AO classification system for intertrochanteric fractures allows better agreement than the original AO classification. An inter- and intra-observer agreement evaluation. Injury, 2021, 52(1): 102-105.
33. 李翔, 王愛國, 時曉華, 等. 難復性股骨轉子間骨折的新分型與復位策略研究. 中華創傷骨科雜志, 2023, 25(9): 762-769.
34. 李翔, 王愛國, 時曉華, 等. 難復性股骨轉子間骨折的新分型與復位策略研究. 中華創傷骨科雜志, 2023, 25(9): 762-769.
35. Moehring HD, Nowinski GP, Chapman MW, et al. Irreducible intertrochanteric fractures of the femur. Clin Orthop Relat Res, 1997(339): 197-199.
36. Moehring HD, Nowinski GP, Chapman MW, et al. Irreducible intertrochanteric fractures of the femur. Clin Orthop Relat Res, 1997(339): 197-199.
37. 張澤, 孫鳳坡, 張統一, 等. 基于復位期及骨塊位置的難復性股骨轉子間骨折分型及復位技巧研究. 中華創傷骨科雜志, 2023, 25(9): 755-761.
38. 張澤, 孫鳳坡, 張統一, 等. 基于復位期及骨塊位置的難復性股骨轉子間骨折分型及復位技巧研究. 中華創傷骨科雜志, 2023, 25(9): 755-761.

Chinese Journal of Reparative and Reconstructive Surgery

Treatment of irreducible intertrochanteric femoral fracture in elderly by folding top technique combined with right-angle pliers prying and pulling under G-arm X-ray fluoroscopy

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