[Treatment of intertrochanteric fractures with forwardly and angularly displaced proximal part]

To explore the characteristics and treatment of intertrochanteric fracture, which the proximal part displaced forwardly and angularly.

Between March 2015 and March 2016, 40 patients with intertrochanteric fracture with forwardly and angularly displaced proximal part were treated with open reduction and intramedullary nailing fixation. There were 11 males and 29 females with the age of 56-87 years (mean, 75.7 years). The causes of injury included traffic accident in 1 case and fall in 39 cases. The body mass index was 18.9-33.8 (mean, 24.3). The time from injury to admission was 2-360 hours. The type of fracture according to AO-OTA classification was A1.2 type in 7 cases, A1.3 type in 1 case, A2.1 type in 6 cases, A2.2 type in 9 cases, A2.3 type in 12 cases, A3.2 type in 2 cases, and A3.3 type in 3 cases. The haemoglobin (Hb) value at admission and the lowest values before and after operation were recorded; the amount of the transfused-blood during hospital stay and visible blood loss around operation were recorded. The short-form 36 health survey scale (SF-36) before injury and at 12 weeks after operation were recorded for evaluating the quality of living; the visual analogue scale (VAS) score at admission and 2 days after operation were recorded for evaluating the reduction of pain, the union after operation were evaluated by X-ray film and clinical examination, and the Harris hip scale at 12 weeks were used to evaluate the injuried hip function.

The lowest Hb value before operation was (99.10±16.48) g/L, which was significantly lower than that at admission ［(114.33±14.93) g/L］ ( t=9.134, P=0.000). Eleven cases were treated with blood transfusion about (520.00±269.98) mL before operation. The amount of transfused blood during operation was (569.23±207.94) mL, and intraoperative blood loss was (373.08±154.68) mL. The lowest Hb value was (105.41±13.36) g/L after operation, and 8 cases were treated with second blood transfusion at amount of (500.00±185.16) mL. The reduction of fracture was rated as excellent in 16 cases, good in 18 cases, and poor in 6 cases according to the modified Baumgaertner criterion at 3 days after operation. Forty cases were followed up 12-15 weeks (mean, 12.8 weeks). No infection occurred in all cases. The VAS score at 2 days after operation was 3.2±0.5, which was significantly improved when compared with the value at admission (8.2±0.5) ( t=37.500, P=0.000). At 12 weeks after operation, all the fractures healed; the Harris score was 82.5±6.9; and the SF-36 score was 51.4±11.5, which was significantly decreased when compared with the score before injury (54.89±11.5) ( t=18.901, P=0.000). Delirium occurred in 4 cases, pneumonia in 8 cases, urinary infection in 5 cases, and venous thrombosis in 4 cases after operation, which were all cured after corresponding treatment.

Intertrochanteric fracture with forwardly and angularly displaced proximal part is a type of unstable fracture, and it is difficult to reduction. It is necessary to achieve a good fracture reduction by means of auxiliary instrument. The anatomical alignment is the primary condition for the good effectiveness, and the anemia before and after the operation must be corrected.