[Finite element analysis of InterTan for the treatment of femoral intertrochanteric fractures].

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose. 10. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2019 Oct 15;33(10):1270-1274. doi: 10.7507/1002-1892.201905071. [Failure analysis of proximal femoral nail antirotation in treatment of geriatric intertrochanteric fractures]. [Article in Chinese; Abstract available in Chinese from the publisher] Chen P(1), Fu D(2). Author information: (1)Department of Orthopaedics, West Campus, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan Hubei, 430056, P.R.China. (2)Department of Orthopaedics, West Campus, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan Hubei, 430056, P.R.China.49899555@qq.com. OBJECTIVE: To analyze the failure factors of proximal femoral nail antirotation (PFNA) in the treatment of geriatric intertrochanteric fractures. METHODS: The clinical data of 136 cases of intertrochanteric fracture treated with PFNA internal fixation between May 2015 and June 2017 were retrospectively analyzed. There were 106 males and 30 females, aged from 60 to 80 years, with an average age of 75.5 years. According to Evans-Jensen classification, there were 45 cases of type Ⅰ, 50 cases of type Ⅱ, 23 cases of type Ⅲ, 13 cases of type Ⅳ, and 5 cases of type Ⅴ. The time from injury to operation was 2-4 days, with an average of 3 days. According to the X-ray films before and after operation, the fracture types (stable and unstable), reduction quality (according to Baumgaertner's criteria), integrity of lateral wall and posteromedial cortex of the patients with failure of PFNA internal fixation were summarized, and the causes of failure were analyzed. RESULTS: All the 136 patients were followed up 7-18 months (mean, 13.6 months). There were 17 cases (12.5%) of PFNA internal fixation failure after operation, including 3 cases of stable fracture and 14 cases of unstable fracture; the quality of fracture reduction was excellent in 2 cases, good in 5 cases, and poor in 10 cases; 10 cases with complete lateral wall and 7 cases with defect; 9 cases with complete posteromedial cortex and 8 cases with defect. Reasons for failure of internal fixation: ① There were 8 cases of coxa varus at 12 weeks after operation due to the loss of posteromedial cortex of femoral intertrochanteric, 7 of them continued non-weight-bearing observation and fracture healed at 6 months after operation; 1 case underwent total hip arthroplasty with spiral blade excision after operation. ② There were 7 cases of internal fixation failure caused by lateral wall defect, including 2 cases of screw blade retraction, continued non-weight-bearing observation, and removed the internal fixator after fracture healing; 2 cases of malunion of rotation with the rotation of no more than 15°, fracture healed at 6 months after operation without special treatment; and 3 cases of rupture of lateral intertrochanteric wall during operation, continued non-weight-bearing observation and fracture healed at 6 months after operation. ③ The distal locking of the main screw was deviated in 2 cases during operation. One of them was found and replanted in time during operation, and 1 case was found with fracture of femoral shaft on 3 days after operation, following 1 year of non-weight-bearing observation and fracture ending healing. CONCLUSION: The types of intertrochanteric fractures (especially unstable fractures), the integrity of the proximal lateral wall of femur, and the defect of the posteromedial cortex are the internal risk factors for the success or failure of PFNA in the treatment of geriatric intertrochanteric fractures. The effective protection of the lateral wall during operation and the good quality of fracture reduction are the external factors that must be paid attention to. Publisher: 目的: 分析股骨近端防旋髓内钉（proximal femoral nail antirotation，PFNA）内固定治疗老年股骨转子间骨折的失败原因。. 方法: 回顾分析 2015 年 5 月—2017 年 6 月采用 PFNA 内固定治疗的 136 例股骨转子间骨折患者临床资料。其中男 106 例，女 30 例；年龄 60～80 岁，平均 75.5 岁。骨折按 Evans-Jensen 分型，Ⅰ型 45 例，Ⅱ型 50 例，Ⅲ型 23 例，Ⅳ型 13 例，Ⅴ型 5 例。受伤至手术时间 2～4 d，平均 3 d。根据手术前后 X 线片，总结 PFNA 内固定失败患者的骨折类型（稳定型和不稳定型）、骨折复位质量（根据 Baumgaertner 等的标准评定）、外侧壁及后内侧骨皮质完整性，分析失败原因。. 结果: 136 例患者术后均获随访，随访时间 7～18 个月，平均 13.6 个月。术后发生 PFNA 内固定失败 17 例（12.5%），其中稳定型骨折 3 例、不稳定型骨折 14 例；骨折复位质量优 2 例、良 5 例、差 10 例；外侧壁完整 10 例、缺损 7 例；后内侧骨皮质完整 9 例、缺损 8 例。内固定失败原因分析：① 股骨转子间后内侧骨皮质缺失致术后 12 周出现髋内翻 8 例，其中 7 例继续非负重观察，术后 6 个月骨折愈合；1 例术后发生螺旋刀片切出，行人工全髋关节置换术。② 外侧壁缺损致内固定失败 7 例，其中 2 例术后发生螺旋刀片退钉，非负重观察，于骨折愈合后取出内固定物；2 例发生旋转畸形，旋转均不超过 15°，未作特殊治疗，术后 6 个月骨折端愈合；3 例术中致股骨转子间外侧壁破裂，非负重观察，术后 6 个月骨折愈合。③ 术中主钉远端螺钉锁偏 2 例，其中 1 例为术中及时发现并重新植钉，1 例于术后 3 d 摄片发现并伴股骨干裂隙骨折，均非负重观察，术后 1 年后骨折端愈合。. 结论: 股骨转子间骨折类型（尤其是不稳定型骨折）、股骨近端外侧壁完整性、后内侧骨皮质是否缺损是 PFNA 治疗老年股骨转子间骨折成败的内在危险因素，术中对外侧壁有效保护及良好的骨折复位质量是术者必须重视的外在因素。. DOI: 10.7507/1002-1892.201905071 PMCID: PMC8337626