Comparison of a New Minimally Invasive Reduction Technique Using Open Wiring in the Treatment of Subtrochanteric...

Minimally invasive reduction and intramedullary nailing (IMN) are the most common strategies used to treat subtrochanteric femur fractures (SFF). We report a new minimally invasive surgical technique for the successful reduction of SFF and maintenance of fragmental position after longitudinal traction. This study compared the radiological and clinical effects of these two reduction techniques when using IMN to treat SFF.

All 43 patients who underwent SFF at our hospital were included in this retrospective study. Twenty-two patients were treated using the conservative method (CM) from March 2016 to January 2018. Between May 2019 and March 2022, 21 patients with SFF were treated using this new technique (NT). All the patients completed the entire follow-up period. Details of both groups were obtained and analyzed from electronic medical records. Postoperative complications, fracture reduction quality, and fracture healing times were recorded and compared.

There were no statistically significant differences after comparing both groups in terms of patient demographics or the incidence of complications. The mean operating time was 68.2 min (range, 54-85 min) in the group NT, shorter than 78 min (range, 65-103 min) in the group CM (p = 0.005). Compared to 275.6 mL average blood loss using NT, that using CM was 329.5 mL (p = 0.021). Three patients (14.2%) experienced deep venous thrombosis of the affected lower limb; however, no other postoperative complications occurred in the NT group, similar to those in the CM group. Compared to the uninjured side, the average fracture displacement was corrected to 2.7 mm (range, 2-4 mm) in the anterior-posterior view, and the mean anterior angulation was restored to 2.0° (range, 0°-10°) in the lateral view in group NT. All fractures in the NT group achieved consolidation healing within a mean time of 4.7 months (range, 4-8 months). The lower-extremity functional scale (LEFS)score of all patients was 60.4 (range, 47-71) in the NT group at the last follow-up. Similar results were observed for fracture reduction quality, time to bone union, and the LEFS in the CM group.

The soft tissue rebalancing technique utilizes hemostatic forceps as a lever and soft tissue around the fracture end as fulcrums to successfully overcome deforming forces in the proximal femoral fragment. Compared to CM, it is a minimally invasive, time-saving method for closed reduction and maintenance of the fragment position before opening and reaming.