Treatment of irreducible intertrochanteric femoral fractures in elderly by novel bone hook combined with finger-guided technique_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANG Zenghui ¹ , HAN Tichao ¹ , LI Wei ¹ , ZHOU Yangyang ¹ , LIU Junjun ¹ , LI Nannan ¹ ,  REN Tiantian ²

1. Department of Orthopedics, People’s Hospital of Linquan County, Linquan Anhui, 236400, P. R. China;
2. Department of Orthopedics, the First Affiliated Hospital of Ningbo University, Ningbo Zhejiang, 315000, P. R. China;

Corresponding?author：

REN Tiantian, Email: 993722396@qq.com

Keywords：

Irreducible intertrochanteric femoral fracture; fracture reduction; novel bone hook; finger-guided technique; the elderly

DOI：

10.7507/1002-1892.202410006

Video：

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Objective To investigate the feasibility and effectiveness of the novel bone hook combined with finger-guided technique in the treatment of irreducible intertrochanteric femoral fractures in elderly. Methods Between January 2021 and August 2023, 23 elderly patients with irreducible intertrochanteric femoral fractures were treated with the novel bone hook combined with finger-guided technique. There were 10 males and 13 females; the age ranged from 68 to 93 years (mean, 76.2 years). The time from injury to operation ranged from 36 to 76 hours (mean, 51.2 hours). According to the classification standard proposed by TONG Dake et al in 2021, there were 10 cases of typeⅠA, 1 case of typeⅠB, 6 cases of type ⅡA, 4 cases of type ⅡB, and 2 cases of type ⅡC. The operation time, intraoperative blood loss, intraoperative fluoroscopy frequences, and quality of fracture reduction were recorded. The fracture healing time and occurrence of postoperative complications were observed during follow-up. At last follow-up, the Harris scoring system was used to evaluate the hip joint function. Results The operation time was 42-95 minutes (mean, 52.1 minutes). The intraoperative blood loss was 40-420 mL (mean, 126.5 mL). Intraoperative fluoroscopy was performed 14-34 times (mean, 20.7 times). According to the criteria proposed by Chang et al, the quality of fracture reduction was rated as good in 20 cases and acceptable in 3 cases. All patients were followed up 6-20 months (mean, 10.2 months). X-ray film showed that all fractures healed with the healing time of 3.0-5.5 months (mean, 4.0 months). At last follow-up, the Harris score of the hip joint ranged from 82 to 97 points (mean, 90.4 points). Among them, 14 cases were rated as excellent and 9 cases as good. No complication such as coxa vara, cutting of the cephalomedullary nail, nail withdrawal, or nail breakage occurred during follow-up. Conclusion The treatment of elderly patients with irreducible intertrochanteric femoral fractures by using the novel bone hook combined with finger-guided technique can achieve high-quality fracture reduction and fixation, and has a good effectiveness.

Citation： ZHANG Zenghui, HAN Tichao, LI Wei, ZHOU Yangyang, LIU Junjun, LI Nannan, REN Tiantian. Treatment of irreducible intertrochanteric femoral fractures in elderly by novel bone hook combined with finger-guided technique. Chinese Journal of Reparative and Reconstructive Surgery, 2025, 39(1): 53-58. doi: 10.7507/1002-1892.202410006 Copy

1.	Cha YH, Ha YC, Yoo JI, et al. Effect of causes of surgical delay on early and late mortality in patients with proximal hip fracture. Arch Orthop Trauma Surg, 2017, 137(5): 625-630.
2.	張世民. 老年髖部轉子間骨折. 2版. 北京: 科學出版社, 2023: 204-210.
3.	陳時益, 張世民, 熊文峰, 等. 股骨轉子間骨折前方骨折線對髓內釘術后前側皮質復位丟失的影響. 中國修復重建外科雜志, 2024, 38(4): 391-397.
4.	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.
5.	黃曉文, 洪顧麒, 凡進, 等. 皮質內螺釘技術結合有限切開復位治療老年31A3型難復性股骨粗隆間骨折. 中華醫學雜志, 2020, 100(9): 674-678.
6.	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.
7.	Hao YL, Zhang ZS, Zhou F, et al. Predictors and reduction techniques for irreducible reverse intertrochanteric fractures. Chin Med J, 2019, 132(21): 2534-2542.
8.	韓曉亮, 劉旭, 陳功強, 等. G臂X線機透視下采用折頂技術聯合直角鉗撬拉治療老年難復性股骨轉子間骨折. 中國修復重建外科雜志, 2024, 38(4): 398-404.
9.	辛大江, 張成成, 李文亮, 等. 股骨轉子間骨折中頭頸骨塊“鳥嘴樣”向前翹起的形態特征及復位技巧. 中國修復重建外科雜志, 2024, 38(6): 710-715.
10.	姜剛強, 張軍, 張亞弟, 等. 槍式復位鉗在AO-A1.3型股骨粗隆間骨折PFNA內固定術中的應用. 中國骨與關節損傷雜志, 2018, 33(5): 551-552.
11.	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.
12.	Chang SM, Zhang YQ, Ma Z, et al. Fracture reduction with positive medial cortical support: a key element in stability reconstruction for the unstable pertrochanteric hip fractures. Arch Orthop Trauma Surg, 2015, 135(6): 811-888.
13.	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.
14.	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.
15.	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.
16.	Cho YH, Kim S, Koo J, et al. Failure after intramedullary nailing for geriatric trochanteric fracture: does quality of fracture reduction on the AP and lateral planes show the same results? Arch Orthop Trauma Surg, 2024, 144(3): 1233-1241.
17.	Liu J, Ge Y, Wang Y, et al. Sagittal support rather than medial cortical support matters in geriatric intertrochanteric fracture: A finite element analysis study. Heliyon, 2024, 10(7): e28606. doi: 10.1016/j.heliyon.2024.e28606.
18.	O’Malley MJ, Kang KK, Azer E, et al. Wedge effect following intramedullary hip screw fixation of in tertrochanteric proximal femur fracture. Arch Orthop Trauma Surg, 2015, 135(10): 1343-1347.

1. Cha YH, Ha YC, Yoo JI, et al. Effect of causes of surgical delay on early and late mortality in patients with proximal hip fracture. Arch Orthop Trauma Surg, 2017, 137(5): 625-630.
2. 張世民. 老年髖部轉子間骨折. 2版. 北京: 科學出版社, 2023: 204-210.
3. 陳時益, 張世民, 熊文峰, 等. 股骨轉子間骨折前方骨折線對髓內釘術后前側皮質復位丟失的影響. 中國修復重建外科雜志, 2024, 38(4): 391-397.
4. 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.
5. 黃曉文, 洪顧麒, 凡進, 等. 皮質內螺釘技術結合有限切開復位治療老年31A3型難復性股骨粗隆間骨折. 中華醫學雜志, 2020, 100(9): 674-678.
6. 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.
7. Hao YL, Zhang ZS, Zhou F, et al. Predictors and reduction techniques for irreducible reverse intertrochanteric fractures. Chin Med J, 2019, 132(21): 2534-2542.
8. 韓曉亮, 劉旭, 陳功強, 等. G臂X線機透視下采用折頂技術聯合直角鉗撬拉治療老年難復性股骨轉子間骨折. 中國修復重建外科雜志, 2024, 38(4): 398-404.
9. 辛大江, 張成成, 李文亮, 等. 股骨轉子間骨折中頭頸骨塊“鳥嘴樣”向前翹起的形態特征及復位技巧. 中國修復重建外科雜志, 2024, 38(6): 710-715.
10. 姜剛強, 張軍, 張亞弟, 等. 槍式復位鉗在AO-A1.3型股骨粗隆間骨折PFNA內固定術中的應用. 中國骨與關節損傷雜志, 2018, 33(5): 551-552.
11. 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.
12. Chang SM, Zhang YQ, Ma Z, et al. Fracture reduction with positive medial cortical support: a key element in stability reconstruction for the unstable pertrochanteric hip fractures. Arch Orthop Trauma Surg, 2015, 135(6): 811-888.
13. 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.
14. 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.
15. 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.
16. Cho YH, Kim S, Koo J, et al. Failure after intramedullary nailing for geriatric trochanteric fracture: does quality of fracture reduction on the AP and lateral planes show the same results? Arch Orthop Trauma Surg, 2024, 144(3): 1233-1241.
17. Liu J, Ge Y, Wang Y, et al. Sagittal support rather than medial cortical support matters in geriatric intertrochanteric fracture: A finite element analysis study. Heliyon, 2024, 10(7): e28606. doi: 10.1016/j.heliyon.2024.e28606.
18. O’Malley MJ, Kang KK, Azer E, et al. Wedge effect following intramedullary hip screw fixation of in tertrochanteric proximal femur fracture. Arch Orthop Trauma Surg, 2015, 135(10): 1343-1347.

Chinese Journal of Reparative and Reconstructive Surgery

Treatment of irreducible intertrochanteric femoral fractures in elderly by novel bone hook combined with finger-guided technique

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