Application of precise-guided temporary fixation assistive devices in proximal femoral nail antirotation fixation for femoral intertrochanteric fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

QU Wanming ¹ ,  ZHOU Hongbin ¹ , ZHANG Xiangwei ¹ , XIANG Qinghua ¹ , SHEN Wenbin ¹ , YU Xin ¹ , CHEN Wenyao ² , LI Xinzhi ³

1. Department of Orthopedics, Yiling People’s Hospital of Yichang City, Yichang Hubei, 443100, P. R. China;
2. Department of Orthopedics, Affiliated Renhe Hospital of China Three Gorges University, Yichang Hubei, 443001, P. R. China;
3. Hubei Key Labordtory of Tumor Microenvironment and Immunotherapy, Yichang Hubei, 443002, P. R. China;

Corresponding?author：

ZHOU Hongbin, Email: 723700839@qq.com

Keywords：

Femoral intertrochanteric fracture; proximal femoral nail antirotation; precise guidance; main nail guide pin; temporary fixation

DOI：

10.7507/1002-1892.202503125

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To investigate the feasibility and effectiveness of precise-guided temporary fixation assistive devices in assisting the main nail guide pin placement and precise temporary fixation in proximal femoral nail antirotation (PFNA) internal fixation of femoral intertrochanteric fractures. Methods A prospective randomized controlled study was conducted to analyze the clinical data of 60 patients with femoral intertrochanteric fractures over 65 years old who met the selection criteria between January 2020 and June 2022 and were treated with PFNA internal fixation. The patients were randomly divided into the trial group (auxiliary device guided main nail guide pin placement and temporary fixation) and the control group (conventional treatment), with 30 cases in each group. There was no significant difference in baseline data such as gender, age, cause of injury, time from injury to operation, fracture side, AO/Orthopaedic Trauma Association (AO/OTA) classification, and combined medical diseases between the two groups (P>0.05). The operation time, times of main nail guide pin placement, intraoperative fluoroscopy frequency, intraoperative blood loss, and perioperative blood transfusion were recorded and compared between the two groups. The quality of fracture reduction was evaluated by CHANG Shimin et al criteria. Harris score was used to evaluate the hip function at 1 year after operation. Results In the trial group, 2 temporary fixation needles were successfully placed 2-5 times, including 2 times in 13 cases (43.3%), 3 times in 8 cases (26.7%), 4 times in 7 cases (23.3%), and 5 times in 2 cases (6.7%). The operation time, times of main nail guide pin placement, intraoperative fluoroscopy frequency, and intraoperative blood loss in the trial group were significantly less than those in the control group, and the reduction quality score was significantly better than that in the control group (P<0.05). There was no significant difference in perioperative blood transfusion between the two groups (P>0.05). All patients were followed up 12-19 months (mean, 15 months). There was no complication such as incision infection, deep vein thrombosis, or internal fixation loosening. At 1 year after operation, the Harris score of the affected hip joint in the trial group was significantly higher than that in the control group (P<0.05). Conclusion The technique of main nail guide pin placement and temporary fixation under the guidance of auxiliary devices in PFNA internal fixation can achieve faster insertion of the main nail guide pin, accurate temporary fixation to maintain reduction, and avoid the subsequent operation space, so as to improve the effectiveness.

Citation： QU Wanming, ZHOU Hongbin, ZHANG Xiangwei, XIANG Qinghua, SHEN Wenbin, YU Xin, CHEN Wenyao, LI Xinzhi. Application of precise-guided temporary fixation assistive devices in proximal femoral nail antirotation fixation for femoral intertrochanteric fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2025, 39(6): 680-685. doi: 10.7507/1002-1892.202503125 Copy

1.	楊冬松, 王瓊, 欒中豪, 等. 股骨近端仿生髓內釘治療老年股骨轉子間骨折的療效研究. 中國修復重建外科雜志, 2023, 37(10): 1198-1204.
2.	Zhou Y, Zhang X, Wei Y, et al. Different surgical interventions for unstable intertrochanteric fracture of the femur: Network meta-analysis. Medicine (Baltimore), 2024, 103(37): e39676. doi: 10.1097/MD.0000000000039676.
3.	田可為, 劉超, 嚴嘉祥, 等. 經骨皮質臨時固定技術在股骨轉子間骨折術中維持復位的可行性研究. 中國修復重建外科雜志, 2019, 33(10): 1239-1244.
4.	張鵬, 鄭青山, 廖明輝, 等. 手法復位聯合克氏針臨時固定下PFNA內固定治療股骨粗隆間骨折. 中國骨與關節損傷雜志, 2019, 34(6): 604-606.
5.	Meinberg EG, Agel J, Roberts CS, et al. Fracture and dislocation classification compendium-2018. J Orthop Trauma, 2018, 32 Suppl 1: S1-S170.
6.	中華人民共和國國家衛生健康委員會醫政司. 老年髖部骨折診療與管理指南(2022年版). 骨科臨床與研究雜志, 2023, 8(2): 77-83.
7.	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): 811-818.
8.	李世杰, 杜守超, 張世民. 股骨轉子間骨折復位質量判斷標準的研究進展. 中華創傷骨科雜志, 2022, 24(9): 793-798.
9.	宋偉, 吳永東, 李祎, 等. 聯合加壓交鎖髓內釘與股骨近端防旋髓內釘內固定治療骨質疏松性股骨粗隆間骨折療效比較. 中國骨與關節損傷雜志, 2025, 40(2): 178-181.
10.	Baral P, Chaudhary P, Shah AB, et al. Outcome of proximal femoral nail antirotation Ⅱ fixation of peritrochanteric fracture of femur. J Nepal Health Res Counc, 2020, 18(2): 301-306.
11.	Esen E, Dur H, Atao?lu MB, et al. Evaluation of proximal femoral nail-antirotation and cemented, bipolar hemiarthroplasty with calcar replacement in treatment of intertrochanteric femoral fractures in terms of mortality and morbidity ratios. Eklem Hastalik Cerrahisi, 2017, 28(1): 35-40.
12.	Wang B, Liu Q, Liu Y, et al. Comparison of proximal femoral nail antirotation and dynamic hip screw internal fixation on serum markers in elderly patients with intertrochanteric fractures. J Coll Physicians Surg Pak, 2019, 29(7): 644-648.
13.	Müller F, Doblinger M, Kottmann T, et al. PFNA and DHS for AO/OTA 31-A2 fractures: radiographic measurements, morbidity and mortality. Eur J Trauma Emerg Surg, 2020, 46(5): 947-953.
14.	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.
15.	馬騰, 黃強, 許毅博, 等. 經皮雙改錐微創與切開復位治療難復性股骨粗隆間骨折的比較. 中華老年骨科與康復電子雜志, 2021, 7(6): 326-332.
16.	王建華, 林艷, 吳永東, 等. 經皮撬撥復位內固定技術對難復性股骨粗隆間骨折老年患者NE、AngⅡ水平及髖關節功能的影響. 中華老年骨科與康復電子雜志, 2021, 7(1): 9-14.
17.	張增輝, 韓體超, 李偉, 等. 新型骨鉤結合手指引導技術治療老年難復性股骨轉子間骨折. 中國修復重建外科雜志, 2025, 39(1): 53-58.
18.	Chang SM, Zhang YQ, Du SC, et al. Anteromedial cortical support reduction in unstable pertrochanteric fractures: a comparison of intra-operative fluoroscopy and post-operative three dimensional computerised tomography reconstruction. Int Orthop, 2018, 42(1): 183-189.
19.	Mallya S, Kamath SU, Annappa R, et al. The results of unstable intertrochanteric femur fracture treated with proximal femoral nail antirotation-2 with respect to different greater trochanteric entry points. Adv Orthop, 2020, 2020: 2834816. doi: 10.1155/2020/2834816.
20.	吳健, 金紹林, 焦慶豐, 等. C臂機引導下徒手置入導針在股骨近端防旋髓內釘固定術中的應用. 臨床骨科雜志, 2024, 27(2): 252-256.
21.	嚴純, 曹勇. 股骨近端防旋髓內釘治療老年股骨轉子間骨折. 臨床骨科雜志, 2024, 27(6): 852-855.
22.	吳獻民, 李廣峰, 何國云, 等. 網格定位器輔助植入防旋股骨近端髓內釘治療老年股骨轉子間骨折. 中國修復重建外科雜志, 2019, 33(6): 666-670.
23.	趙非凡, 曹玉凈. 股骨近端防旋髓內釘治療股骨轉子間骨折內固定失效的危險因素與應對策略. 中國組織工程研究, 2025. doi: 10.12307/2025.868.
24.	張卓. InterTAN與PFNA治療老年AO/OTA 31-A2型股骨轉子間骨折的療效分析. 唐山: 華北理工大學, 2022.
25.	董方, 李廣義, 劉德強, 等. 股骨粗隆間骨折PFNA內固定術中應用骨科牽引床的利弊分析. 中國骨與關節損傷雜志, 2017, 32(2): 141-143.

1. 楊冬松, 王瓊, 欒中豪, 等. 股骨近端仿生髓內釘治療老年股骨轉子間骨折的療效研究. 中國修復重建外科雜志, 2023, 37(10): 1198-1204.
2. Zhou Y, Zhang X, Wei Y, et al. Different surgical interventions for unstable intertrochanteric fracture of the femur: Network meta-analysis. Medicine (Baltimore), 2024, 103(37): e39676. doi: 10.1097/MD.0000000000039676.
3. 田可為, 劉超, 嚴嘉祥, 等. 經骨皮質臨時固定技術在股骨轉子間骨折術中維持復位的可行性研究. 中國修復重建外科雜志, 2019, 33(10): 1239-1244.
4. 張鵬, 鄭青山, 廖明輝, 等. 手法復位聯合克氏針臨時固定下PFNA內固定治療股骨粗隆間骨折. 中國骨與關節損傷雜志, 2019, 34(6): 604-606.
5. Meinberg EG, Agel J, Roberts CS, et al. Fracture and dislocation classification compendium-2018. J Orthop Trauma, 2018, 32 Suppl 1: S1-S170.
6. 中華人民共和國國家衛生健康委員會醫政司. 老年髖部骨折診療與管理指南(2022年版). 骨科臨床與研究雜志, 2023, 8(2): 77-83.
7. 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): 811-818.
8. 李世杰, 杜守超, 張世民. 股骨轉子間骨折復位質量判斷標準的研究進展. 中華創傷骨科雜志, 2022, 24(9): 793-798.
9. 宋偉, 吳永東, 李祎, 等. 聯合加壓交鎖髓內釘與股骨近端防旋髓內釘內固定治療骨質疏松性股骨粗隆間骨折療效比較. 中國骨與關節損傷雜志, 2025, 40(2): 178-181.
10. Baral P, Chaudhary P, Shah AB, et al. Outcome of proximal femoral nail antirotation Ⅱ fixation of peritrochanteric fracture of femur. J Nepal Health Res Counc, 2020, 18(2): 301-306.
11. Esen E, Dur H, Atao?lu MB, et al. Evaluation of proximal femoral nail-antirotation and cemented, bipolar hemiarthroplasty with calcar replacement in treatment of intertrochanteric femoral fractures in terms of mortality and morbidity ratios. Eklem Hastalik Cerrahisi, 2017, 28(1): 35-40.
12. Wang B, Liu Q, Liu Y, et al. Comparison of proximal femoral nail antirotation and dynamic hip screw internal fixation on serum markers in elderly patients with intertrochanteric fractures. J Coll Physicians Surg Pak, 2019, 29(7): 644-648.
13. Müller F, Doblinger M, Kottmann T, et al. PFNA and DHS for AO/OTA 31-A2 fractures: radiographic measurements, morbidity and mortality. Eur J Trauma Emerg Surg, 2020, 46(5): 947-953.
14. 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.
15. 馬騰, 黃強, 許毅博, 等. 經皮雙改錐微創與切開復位治療難復性股骨粗隆間骨折的比較. 中華老年骨科與康復電子雜志, 2021, 7(6): 326-332.
16. 王建華, 林艷, 吳永東, 等. 經皮撬撥復位內固定技術對難復性股骨粗隆間骨折老年患者NE、AngⅡ水平及髖關節功能的影響. 中華老年骨科與康復電子雜志, 2021, 7(1): 9-14.
17. 張增輝, 韓體超, 李偉, 等. 新型骨鉤結合手指引導技術治療老年難復性股骨轉子間骨折. 中國修復重建外科雜志, 2025, 39(1): 53-58.
18. Chang SM, Zhang YQ, Du SC, et al. Anteromedial cortical support reduction in unstable pertrochanteric fractures: a comparison of intra-operative fluoroscopy and post-operative three dimensional computerised tomography reconstruction. Int Orthop, 2018, 42(1): 183-189.
19. Mallya S, Kamath SU, Annappa R, et al. The results of unstable intertrochanteric femur fracture treated with proximal femoral nail antirotation-2 with respect to different greater trochanteric entry points. Adv Orthop, 2020, 2020: 2834816. doi: 10.1155/2020/2834816.
20. 吳健, 金紹林, 焦慶豐, 等. C臂機引導下徒手置入導針在股骨近端防旋髓內釘固定術中的應用. 臨床骨科雜志, 2024, 27(2): 252-256.
21. 嚴純, 曹勇. 股骨近端防旋髓內釘治療老年股骨轉子間骨折. 臨床骨科雜志, 2024, 27(6): 852-855.
22. 吳獻民, 李廣峰, 何國云, 等. 網格定位器輔助植入防旋股骨近端髓內釘治療老年股骨轉子間骨折. 中國修復重建外科雜志, 2019, 33(6): 666-670.
23. 趙非凡, 曹玉凈. 股骨近端防旋髓內釘治療股骨轉子間骨折內固定失效的危險因素與應對策略. 中國組織工程研究, 2025. doi: 10.12307/2025.868.
24. 張卓. InterTAN與PFNA治療老年AO/OTA 31-A2型股骨轉子間骨折的療效分析. 唐山: 華北理工大學, 2022.
25. 董方, 李廣義, 劉德強, 等. 股骨粗隆間骨折PFNA內固定術中應用骨科牽引床的利弊分析. 中國骨與關節損傷雜志, 2017, 32(2): 141-143.

Chinese Journal of Reparative and Reconstructive Surgery

Application of precise-guided temporary fixation assistive devices in proximal femoral nail antirotation fixation for femoral intertrochanteric fractures

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