[Precise-surgical-opening intramedullary nail insertion in treating unstable femoral intertrochanteric fractures with...

To compare clinical efficacy of repositioning with precise-surgical-opening intramedullary nail insertion and traditional repositioning in treating unstable femoral intertrochanteric fractures with closed-reposition difficulty.

Clinical data of 58 patients with unstable femoral intertrochanteric fractures after closed-reposition difficulty (AO 31A2.2-3.3) were retrospective analyzed. Among them, 32 patients were treated with first open intramedullary nail and then reduction operation(modified reductuon group) including 9 males and 23 females with an average age of (80.9±11.1) years old ranging from 46 to 99 years old; and 26 patients were treated by traditional reduction(traditional reduction group) including 7 males and 19 females with an average of(78.1±13.9) years old ranging from 41 to 89 years old. The time of operation, the amount of bleeding, the length of hospital stay, the first weight-bearing time and the time of fracture healing, postoperative complications and Harris hip score were evaluated and compared between the two groups.

All patients were followed up for 12 to 24 months with an average of 17.3 months. The operative time(t=3.612, P=0.008 2) nd the blood loss(t=3.389, P=0.007 5) in the modified reduction group were lower than those in the traditional reduction group. There were no significant differences in hospitalization time(t=0.851, P=0.392), fracture healing time(t=0.640, P=0.531), and the first loading time(t=0.845, P=0.411) between two groups. There was no significant difference in the Harris score between two groups(χ²=0.66, P=0.831>0.05).

Traditional repositioning requires a repositioning of the fracture bone and a correct opening reaming before the insertion and fixture of the intramedullary nail, which is a complicated operation in unstable femoral intertrochanteric fractures after closed-reposition difficulty. On the other hand, the new method implements the insertion of the intramedullary nail before the repositioning of the fracture bone, greatly simplifying the operation procedure, shortening the total operation time and reducing the amount of intraoperative blood loss.