Reduction with Pre-Drilling Combined with a Finger Reduction Tool in Difficult-to-Reduce Intertrochanteric Fracture

Overview

Journal Orthop Surg

Specialty Orthopedics

Date 2022 Sep 3

PMID 36056594

Authors

Hongxin Hu

Guoli Chen

Xianwei Wu

Mei Lin

Haibin Lin

Affiliations

Soon will be listed here.

Abstract

Objective: To investigate the feasibility of pre-drilling combined with a finger reduction tool for the reduction of difficult-to-reduce intertrochanteric fractures.

Methods: Patients diagnosed with complicated intertrochanteric fractures during the period from July 2016 to May 2021 at the Affiliated Hospital of our College were enrolled in this study. All patients underwent reduction by pre-drilling combined with a finger reduction tool followed by fixing with proximal femoral nail antirotation. The outcome of reduction was evaluated by intraoperative fluoroscopy. The operation time, intraoperative fluoroscopy frequency, and incidence of postoperative complications (including infection in the incision area, coxa vara, nail withdrawal, nail breakage, blade cut-out, lower limb vein thrombosis, and pulmonary embolism) were recorded to evaluate the speed of the operation, the difficulty of the operation, and the prognosis of the patient, respectively. The Harris hip score at 9 months after surgery was used to evaluate the hip recovery.

Results: A total of 52 patients (17 men and 35 women), 61-88 (77.54 ± 7.40) years of age were included in the study. There were 14 patients with cardiovascular or cerebrovascular disease, ten patients with diabetes, three patients with Parkinson's disease, and three patients with respiratory diseases. The fractures included in the study were classified according to the Orthopedic Trauma Association 31 classification system as type A2.2 (n = 36) or type A2.3 (n = 16). The time from injury to surgery was 1-11 (3.35 ± 1.78) days, and the operation time ranged 31-101 (65.67 ± 14.17) min. The intraoperative blood loss ranged from 40 to 100 (67.69 ± 18.24) mL, and the number of intraoperative fluoroscopy images obtained was 12 to 32 (20.42 ± 5.27). The Harris hip score at 9 months after surgery ranged from 84 to 94 (90.06 ± 2.15). Patients were followed for 9-16 (10.63 ± 1.61) months. One patient died of acute myocardial infarction at 9 months after surgery. One patient suffered from nail withdrawal 5 months post-operation and thus underwent hemiarthroplasty.

Conclusions: Satisfactory reduction can be achieved using a pre-drilling femoral trochanter combined with a finger reduction tool for the management of difficult-to-reduce complex intertrochanteric fractures. This technique does not increase surgical trauma and also reduces the dose of radiation administered to the patient.

Citing Articles

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

Qiu J, Jiang Z, Han L, Li X, Zhang R, Wu B J Orthop Surg Res. 2023; 18(1):167.

PMID: 36871013 PMC: 9985279. DOI: 10.1186/s13018-023-03641-8.

References

Ahn J, Bernstein J . Fractures in brief: intertrochanteric hip fractures. Clin Orthop Relat Res. 2010; 468(5):1450-2. PMC: 2853662. DOI: 10.1007/s11999-010-1263-2. View

Marsh J, Slongo T, Agel J, Broderick J, Creevey W, DeCoster T . Fracture and dislocation classification compendium - 2007: Orthopaedic Trauma Association classification, database and outcomes committee. J Orthop Trauma. 2008; 21(10 Suppl):S1-133. DOI: 10.1097/00005131-200711101-00001. View

Hao Y, Zhang Z, Zhou F, Ji H, Tian Y, Guo Y . 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. PMC: 6842253. DOI: 10.1186/s13018-019-1414-4. View

Kim S, Park H, Lee D, Lee J . Short-term daily teriparatide improve postoperative functional outcome and fracture healing in unstable intertrochanteric fractures. Injury. 2019; 50(7):1364-1370. DOI: 10.1016/j.injury.2019.06.002. View

Chen P, Wu C, Chen W . Factors affect stability of intertrochanteric fractures when elderly patients fall. Biomed J. 2016; 39(1):67-71. PMC: 6138804. DOI: 10.1016/j.bj.2015.08.007. View

Yuan B, Abdel M, Cross W, Berry D . Hip Arthroplasty After Surgical Treatment of Intertrochanteric Hip Fractures. J Arthroplasty. 2017; 32(11):3438-3444. DOI: 10.1016/j.arth.2017.06.032. View

Lee S, Chen I, Li Y, Fan Chiang C, Chang C, Hsieh P . Incidence of second hip fractures and associated mortality in Taiwan: A nationwide population-based study of 95,484 patients during 2006-2010. Acta Orthop Traumatol Turc. 2016; 50(4):437-42. PMC: 6197401. DOI: 10.1016/j.aott.2016.06.008. View

Hao Y, Zhang Z, Zhou F, Ji H, Tian Y, Guo Y . Predictors and reduction techniques for irreducible reverse intertrochanteric fractures. Chin Med J (Engl). 2019; 132(21):2534-2542. PMC: 6846246. DOI: 10.1097/CM9.0000000000000493. View

Hongku N, Woratanarat P, Nitiwarangkul L, Rattanasiri S, Thakkinstian A . Fracture fixation versus hemiarthroplasty for unstable intertrochanteric fractures in elderly patients: A systematic review and network meta-analysis of randomized controlled trials. Orthop Traumatol Surg Res. 2021; 108(1):102838. DOI: 10.1016/j.otsr.2021.102838. View

10.

Nie B, Wu D, Yang Z, Liu Q . Comparison of intramedullary fixation and arthroplasty for the treatment of intertrochanteric hip fractures in the elderly: A meta-analysis. Medicine (Baltimore). 2017; 96(27):e7446. PMC: 5502185. DOI: 10.1097/MD.0000000000007446. View

11.

Guobin C, Cui Y, Maoquan Z, Qishu X . A comparison between proximal femoral nail antirotation (PFNA) and inter Tan nail for the surgical treatment of unstable intertrochanteric fracture: A case series. Asian J Surg. 2021; 44(8):1095-1096. DOI: 10.1016/j.asjsur.2021.05.025. View

12.

Chun Y, Oh H, Cho Y, Rhyu K . Technique and early results of percutaneous reduction of sagittally unstable intertrochateric fractures. Clin Orthop Surg. 2011; 3(3):217-24. PMC: 3162202. DOI: 10.4055/cios.2011.3.3.217. View

13.

Aktselis I, Kokoroghiannis C, Fragkomichalos E, Koundis G, Deligeorgis A, Daskalakis E . Prospective randomised controlled trial of an intramedullary nail versus a sliding hip screw for intertrochanteric fractures of the femur. Int Orthop. 2013; 38(1):155-61. PMC: 3890147. DOI: 10.1007/s00264-013-2196-7. View

14.

Nherera L, Trueman P, Horner A, Watson T, Johnstone A . Comparison of a twin interlocking derotation and compression screw cephalomedullary nail (InterTAN) with a single screw derotation cephalomedullary nail (proximal femoral nail antirotation): a systematic review and meta-analysis for.... J Orthop Surg Res. 2018; 13(1):46. PMC: 5834859. DOI: 10.1186/s13018-018-0749-6. View

15.

Sbiyaa M, El Alaoui A, Admi M, Lahrach K, Marzouki A, Boutayeb F . Intertrochanteric fracture non-unions with implant failure of the gamma nail. Pan Afr Med J. 2016; 23:57. PMC: 4862775. DOI: 10.11604/pamj.2016.23.57.7965. View

16.

Baumgaertner M, Solberg B . Awareness of tip-apex distance reduces failure of fixation of trochanteric fractures of the hip. J Bone Joint Surg Br. 1997; 79(6):969-71. DOI: 10.1302/0301-620x.79b6.7949. View

17.

Wu H, Chang C, Wang G, Lai K, Chen C . Biomechanical investigation of dynamic hip screw and wire fixation on an unstable intertrochanteric fracture. Biomed Eng Online. 2019; 18(1):49. PMC: 6482576. DOI: 10.1186/s12938-019-0663-0. View

18.

Sun D, Wang C, Chen Y, Liu X, Zhao P, Zhang H . A meta-analysis comparing intramedullary with extramedullary fixations for unstable femoral intertrochanteric fractures. Medicine (Baltimore). 2019; 98(37):e17010. PMC: 6750238. DOI: 10.1097/MD.0000000000017010. View

19.

Ma K, Wang X, Luan F, Xu H, Fang Y, Min J . 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):859-66. DOI: 10.1016/j.otsr.2014.07.023. View

20.

Makki D, Matar H, Jacob N, Lipscombe S, Gudena R . Comparison of the reconstruction trochanteric antigrade nail (TAN) with the proximal femoral nail antirotation (PFNA) in the management of reverse oblique intertrochanteric hip fractures. Injury. 2015; 46(12):2389-93. DOI: 10.1016/j.injury.2015.09.038. View