Chinese Journal of Tissue Engineering Research ›› 2021, Vol. 25 ›› Issue (21): 3337-3342.doi: 10.3969/j.issn.2095-4344.3856

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Proximal femoral nail antirotation combined with posteromedial wall reconstruction for the treatment of type A2 intertrochanteric fracture in the elderly

Tian Kechao, Wang Lei, Tao Yong, Yao Tao   

  1. Department of Traumatic Orthopedics, Third Affiliated Hospital (Hefei First People’s Hospital) of Anhui Medical University, Hefei 230061, Anhui Province, China
  • Received:2020-09-15 Revised:2020-09-17 Accepted:2020-10-22 Online:2021-07-28 Published:2021-01-23
  • Contact: Tao Yong, Master, Associate chief physician, Department of Traumatic Orthopedics, Third Affiliated Hospital (Hefei First People’s Hospital) of Anhui Medical University, Hefei 230061, Anhui Province, China
  • About author:Tian Kechao, Associate chief physician, Department of Traumatic Orthopedics, Third Affiliated Hospital (Hefei First People’s Hospital) of Anhui Medical University, Hefei 230061, Anhui Province, China
  • Supported by:
    the Medical and Health Science and Technology Development Research Center Project of National Health and Family Planning Commission, No. W2015QJ062 (to TKC)

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Abstract: BACKGROUND: Elderly with femoral intertrochanteric fractures experienced more adverse events after surgical treatment, such as such as coxa vara, screw penetration, and hip pain. In recent years, study on the posterior medial wall of intertrochanteric femur has been deepened. The reconstruction and fixation of the posteromedial wall have gradually been used in clinical work. 
OBJECTIVE: To investigate the application characteristics and efficacy of posteromedial wall reconstruction in surgical treatment of A2 type intertrochanteric fractures of the elderly.
METHODS: The medical records of 75 patients with type A2 intertrochanteric fractures who were treated with proximal femoral nail antirotation in Third Affiliated Hospital of Anhui Medical University from March 2016 to March 2020 were retrospectively analyzed. Patients undergoing posteromedial wall and fixation served as trial group (n=32) and those without reconstruction as control group (n=43). After long-term follow-up, the Harris function score, fracture healing time, full weight bearing time, and adverse events of the two groups were compared.
RESULTS AND DISCUSSION: (1) Operation time and intraoperative blood loss had no significant difference in both groups (P > 0.05). (2) Compared with the control group, the fracture healing time was early; Harris hip function scores were high at postoperative 1, 3, and 6 months; complications were less in the trial group; and the above differences were statistically significant (P < 0.05). (3) Follow-up data were obtained from both groups for more than 12 months. One case of sciatic nerve injury occurred in the trial group. In the trial group, there was one case of sciatic nerve injury, which was numb on the back of the foot on the same side after injury, and returned to normal after oral medication. In the control group, there were six cases of coxa vara, three cases of screw penetration, and one case of heterotopic ossification. (4) The results showed that after the reconstruction and fixation of the posteromedial wall, the patients could get down to the ground early and experience effective recovery of the hip function, with less postoperative adverse events and satisfactory clinical effect. 

Key words: intertrochanteric fracture, posteromedial wall, bone hook, proximal femoral nail antirotation, internal fixation, hip fracture

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