The Surgical Treatment of Reverse Oblique Intertrochanteric Fractures
|Keywords||Reverse oblique intertrochanteric fracture Dynamic hip screw (DHS) Femur Proximal intramedullary nail (PFN) the dynamic condylar screw (DCS) the trochanter stabilizing plate in addition to the dynamic hip screw (DHS+TSP)|
Most of Intertrochanteric femoral fractures occur in the elderly, and their average age is 70 years old. Because many patients are elderly people, they easily lead to a variety of long-term complications of bed rest. Its fatality rate is 15%-20%. In recent years, with the aging of our society increases and the increasing elderly population, the quantity of the patients with intertrochanteric fracture is also rising. Simultaneously with the rapid development of medicine, the treatment of intertrochanteric fracture of femur methods are becoming more and more. Through our ongoing research of intertrochanteric fracture, many scholars had recognized the idea that depending on the type of fracture to take a different treatment in order to alleviate the suffering of patients and achieve better therapeutic. Reverse oblique intertrochanteric fracture is a special type of intertrochanteric fracture. Its fracture alignment and biomechanics are different from most of the intertrochanteric fracture. Its fracture ends are highly unstable, and it belongs to unstable fracture. Its reduction and internal fixation are difficult, so its surgical treatment has considerable difficulty. In this study, we did a review of research to 31 patiens who have the reverse oblique intertrochanteric fracture and were treated with DHS、DHS+TSP、PFN and DCS in our hospital since January 2002 to January 2008. And we analyzed the consequent in the treatment of reverse oblique intertrochanteric fracture that were treated with four different internal fixation methods.Objective To compare the consequent in the treatment of reverse oblique intertrochanteric fracture with DHS、DHS+TSP、PFN and DCS such as four internal fixation methods. To explore their own characteristics and provide a reference for the clinical treatment of reverse oblique interochanteric fractures.Methods To review retrospectively a series of 31 patients treated with internal fixations for reverse oblique intertrochanteric fractures between Januare 2002 and Janauary 2008 in our hospital. ALL the patiens are A3 which are typied by AO\OTA. And They are divided into dynamic hip screw (DHS), Femur Proximal intramedullary nail (PFN), the dynamic condylar screw (DCS) and the trochanter stabilizing plate in addition to the dynamic hip screw (DHS+TSP).Resluts Thirty patients were followed (range: 8 to 68months). Six patiens happened failure of internal fixation, four in DHS, one in PFN, and one in DHS+TSP. The failure rates of different internal fixation methods were compared by usingχ2 test method. we found DHS had a high failure rate (P <0.05) in the treatment of reverse oblique interochanteric fractures. We found P was less than 0.05, when we compared DHS’s failure rate with DCS and PFN’s failure rate, so this had statistical significance. Twenty-four patients achieve clinial healing. One patient who was treated with PFN happened screws loosening. After that it happened malunion and Coxa vara. One patient that was treated with DSH+TSP also happened screws loosening, malunion and Coxa vara. Four patients that were treated with DHS happened plates fracture, and they achieve clinial healing after replacing internal fixator. There were 14 post-operative complications. DHS group had four cases, the occurrence rate was 57.1%; DHS + TSP group had three cases, the occurrence rate was 50%; PFN group had five cases, the occurrence rate was45.5%; DCS group had two cases, the occurrence rate was 33.3%. DHS group occurred in a higher rate. The incidence of post-operative complications with different internal fixation methods were compared by usingχ2 test method. And we found that P was greater than 0.05, therefore the difference of post-operative complications in each group did not have statistical significance. The postoperative functions of hip were evaluated according to Sanders score. DHS group was 72.1, PFN group was 85.8, DHS+TSP group was 82.5, DCS group of excellent and good rate was 85.3. We compared the postoperative hip function scores of different internal fixation methods by using analysis of variance. And we found that P was greater than 0.05, therefore the difference of postoperative hip function scores in each group did not have statistical significance.Conclusion PFN has significant effect, so it should be to gived priority to applications when we want to treat the reverse oblique intertrochanteric fracture. DCS and DHS + TSP also achieved good efficacy, so they are also the right choice when we want to treat the reverse oblique intertrochanteric fracture. However, DHS + TSP is still questioned by some scholars, they still need our further study. DHS has high rate of fixation failure and poor efficacy,so it has become taboo.