Application of reconstruction of medial and lateral structures combined with hypothermic tranexamic acid in PFNA internal fixation for type A3 elderly intertrochanteric fractures
WU Lang
LIU Weinan
ZHANG Zhenqing
XING Yuegang
HAO Chengjun
WANG Shoubao
Abstract：Objective To investigate the application effect of reconstruction of medial and lateral structures combined with hypothermic tranexamic acid in the treatment of proximal femoral nail anti-rotation(PFNA)internal fixation for elderly patients with type A3 femoral intertrochanteric fractures.Methods A retrospective analysis was conducted on the clinical data of 28 elderly patients with type A3 intertrochanteric fractures of the femur admitted to Huai'an Hospital Affiliated to Yangzhou University from January 2018 to February 2023.All patients were treated with PFNA plus locking titanium plate fixation for internal and external femoral wall reconstruction combined with local application of hypothermic tranexamic acid.Results The number of fluoroscopic times during the operation,operative time,intraoperative blood loss,postoperative ambulation time and hospital stay was(15±5)times,(80±30)min,(260±90)mL,(8±7)d and(9±3)d respectively.Tip-apex distance at 1 d after the surgery was(26.5±4.3)mm.The quality of fracture reduction was evaluated according to Kim grading standard,there were 23 cases of grade Ⅰ and 5 cases of grade Ⅱ.All 28 patients achieved bony healing,and the fracture healing time was(9±3)months.Patients were followed up for(11±3)months.Harris score was(64.73±4.32)points at 1 d after surgery and(84.86±9.57)points at the last follow-up,which improved significantly compared with preoperative(38.28±2.11)points(P<0.05).Harris score at the last follow-up showed that 10 cases were excellent,16 cases were good,and 2 cases were fair,with an excellent and good rate of 92.86%.During the follow-up period,no complications such as internal fixation loosening,rupture or cutting,coxa valgus or varus,infection,neurovascular injury,deep vein thrombosis,pulmonary embolism occurred.Conclusion Application of reconstruction of medial and lateral structures combined with hypothermic tranexamic acid in PFNA internal fixation for type A3 elderly intertrochanteric fractures can effectively control intraoperative bleeding and provide strong internal fixation for rapid postoperative recovery,with satisfactory clinical results.
Keywords：Bone reconstructionFracture fixationintramedullaryTranexamic acidFemoral fractureElderly
Publication Date：2024-12-15
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：5( 405-409 )