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 complications 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.

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.	张世民. 老年髋部转子间骨折. 2版. 北京: 科学出版社, 2023: 204-210.
3.	陈时益, 张世民, 熊文峰, 等. 股骨转子间骨折前方骨折线对髓内钉术后前侧皮质复位丢失的影响. 中国修复重建外科杂志, 2024, 38(4): 391-397.
4.	李翔, 王爱国, 时晓华, 等. 难复性股骨转子间骨折的新分型与复位策略研究. 中华创伤骨科杂志, 2023, 25(9): 762-769.
5.	黄晓文, 洪顾麒, 凡进, 等. 皮质内螺钉技术结合有限切开复位治疗老年31A3型难复性股骨粗隆间骨折. 中华医学杂志, 2020, 100(9): 674-678.
6.	佟大可, 丁文彬, 王光超, 等. 难复性股骨转子间骨折的临床分型与治疗. 中华创伤骨科杂志, 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.	韩晓亮, 刘旭, 陈功强, 等. G臂X线机透视下采用折顶技术联合直角钳撬拉治疗老年难复性股骨转子间骨折. 中国修复重建外科杂志, 2024, 38(4): 398-404.
9.	辛大江, 张成成, 李文亮, 等. 股骨转子间骨折中头颈骨块“鸟嘴样”向前翘起的形态特征及复位技巧. 中国修复重建外科杂志, 2024, 38(6): 710-715.
10.	姜刚强, 张军, 张亚弟, 等. 枪式复位钳在AO-A1.3型股骨粗隆间骨折PFNA内固定术中的应用. 中国骨与关节损伤杂志, 2018, 33(5): 551-552.
11.	佟大可, 丁文彬, 王光超, 等. 难复性股骨转子间骨折的2021分型与复位技巧研究. 中华创伤骨科杂志, 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.	张泽, 孙凤坡, 张统一, 等. 基于复位期及骨块位置的难复性股骨转子间骨折分型及复位技巧研究. 中华创伤骨科杂志, 2023, 25(9): 755-761.
15.	王跃挺, 张琳袁, 龚伟华, 等. 老年转子间骨折股骨近端防旋髓内钉内固定术后骨折断端阳性支撑与阴性支撑短期疗效比较. 中华骨与关节外科杂志, 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. 张世民. 老年髋部转子间骨折. 2版. 北京: 科学出版社, 2023: 204-210.
3. 陈时益, 张世民, 熊文峰, 等. 股骨转子间骨折前方骨折线对髓内钉术后前侧皮质复位丢失的影响. 中国修复重建外科杂志, 2024, 38(4): 391-397.
4. 李翔, 王爱国, 时晓华, 等. 难复性股骨转子间骨折的新分型与复位策略研究. 中华创伤骨科杂志, 2023, 25(9): 762-769.
5. 黄晓文, 洪顾麒, 凡进, 等. 皮质内螺钉技术结合有限切开复位治疗老年31A3型难复性股骨粗隆间骨折. 中华医学杂志, 2020, 100(9): 674-678.
6. 佟大可, 丁文彬, 王光超, 等. 难复性股骨转子间骨折的临床分型与治疗. 中华创伤骨科杂志, 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. 韩晓亮, 刘旭, 陈功强, 等. G臂X线机透视下采用折顶技术联合直角钳撬拉治疗老年难复性股骨转子间骨折. 中国修复重建外科杂志, 2024, 38(4): 398-404.
9. 辛大江, 张成成, 李文亮, 等. 股骨转子间骨折中头颈骨块“鸟嘴样”向前翘起的形态特征及复位技巧. 中国修复重建外科杂志, 2024, 38(6): 710-715.
10. 姜刚强, 张军, 张亚弟, 等. 枪式复位钳在AO-A1.3型股骨粗隆间骨折PFNA内固定术中的应用. 中国骨与关节损伤杂志, 2018, 33(5): 551-552.
11. 佟大可, 丁文彬, 王光超, 等. 难复性股骨转子间骨折的2021分型与复位技巧研究. 中华创伤骨科杂志, 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. 张泽, 孙凤坡, 张统一, 等. 基于复位期及骨块位置的难复性股骨转子间骨折分型及复位技巧研究. 中华创伤骨科杂志, 2023, 25(9): 755-761.
15. 王跃挺, 张琳袁, 龚伟华, 等. 老年转子间骨折股骨近端防旋髓内钉内固定术后骨折断端阳性支撑与阴性支撑短期疗效比较. 中华骨与关节外科杂志, 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.

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