Proximal femoral nail antirotation in the treatment of aged intertrochanteric fractures by an improved approach

CHEN Xiong; SHEN Feng; YU Zheng-xi; WANG Huai-yun; GUO Wen-rong; HONG Zhi-qun; LIN Guo-bing; XU Jian-ping; WANG Tao

doi:10.3969/j.issn.2095-252X.2017.01.014

Abstract：Objective To observe the therapeutic effects of proximal femoral nail antirotation ( PFNA ) in the treatment of intertrochanteric fractures in the aged patients by an improved approach when compared with the traditional approach described in the 11th edition of Campbell’s Operative Orthopaedics. Methods The data of 112 aged patients with femoral intertrochanteric fractures, who were hospitalized and followed up for more than 4 months ( average: 6 months ) were collected. In the improved approach group 56 cases were treated, and there were 56 cases in the traditional treatment group. The incision length, operative time, intraoperative blood loss, blood transfusion ratio, cumulative fluoroscopy time, hospitalization time, gluteus medius gait, complications such as infection, coxa vara, limited hip movement and cut-out and excellent and good rates were summarized and compared item by item. Results The differences in average incision length [ ( 2.13 ± 0.31 ) cm vs. ( 5.09 ± 1.97 ) cm ], operative time [ ( 29.73 ± 5.35 ) min vs. ( 39.21 ± 4.33 ) min ], intraoperative blood loss [ ( 31.09 ± 18.40 ) ml vs. ( 74.29 ± 27.41 ) ml ], cumulative lfuoroscopy time [ ( 20.05 ± 2.50 ) s vs. ( 29.39 ± 3.18 ) s ] and gluteus medius gait ( 3 cases vs. 6 cases ) between the improved approach group and the traditional treatment group were statistically signiifcant ( P<0.05 ). There were no statistically signiifcant differences in hospitalization time and fracture healing time ( P>0.05 ). At 6 months after the operation, the therapeutic effects were evaluated in both the improved approach group and the traditional treatment group, and the Harris hip scores were 94.64%and 92.28%. The differences in infection, coxa vara, limited hip movement, cut-out and other complications between the 2 groups were not statistically signiifcant ( P > 0.05 ). Conclusions The improved approach for the treatment of senile femoral intertrochanteric fractures has the advantages of simple method, short incision length, short cumulative lfuoroscopy time, short operative time,less operative bleeding, small trauma, less hidden blood loss, lower blood transfusion ratio and so on. PFNA by the improved approach is suitable for the treatment of intertrochanteric fractures in aged patients.