Effects of femoral macrotrochanteric bone block separation on the therapeutic effect of internal fixation of intertrochanteric fractures
GUO Jian
GUO Yue-chao
WANG Zhe
ZHANG Yu-jian
Abstract：Objective To investigate the effects of internal fixation on intertrochanteric fracture of the femur with separated greater trochanter.Methods Review and analyse 82 patients treated with proximal femoral intramedullary nailing for intertrochanteric fractures associated with posterior separation of the greater trochanter from May 2021 to May 2023.Patients were divided into Group A(satisfactory healing position)with 38 cases and Group B(unsatisfactory healing position)with 44 cases based on the satisfaction of the healing location.The Harris hip score(HHS)for hip joint function,pain(Visual Analog Scale,VAS)scores,and external rotation range of the affected hip joint at one year post-surgery were compared between the two groups.Results Eighty-two patients underwent surgical treatment,and postoperative imaging showed good internal fixation.Some patients had separation or discontinuity of the bone cortex behind the greater trochanter of the femur.Eighty-one patients had good fracture healing 3 to 4 months after surgery,with one patient healing 6 months postoperatively.The average healing time was 3.9 months.One year after surgery,14.6%of patients had poor healing of the bone mass behind the greater trochanter of the femur,but no failure of internal fixation was observed.Fifteen patients had mild distal femoral varus deformity.There was no statistically significant difference in HHS and VAS scores between the two groups one year after surgery(P>0.05),but the hip joint abduction range of motion in Group B was significantly smaller than in Group A[(26.11±5.09)° vs.(30.22±5.12)°],with statistically significant differences(P<0.05).The neck-shaft angle in Group A was significantly larger than Group B postoperatively[(135.6±5.8)° vs.(130.5±6.1)°],while the anteversion angle was smaller[(10.3±2.9)° vs.(14.2±3.5)°],with statistically significant differences(P<0.001).Postoperative improvement of the neck-shaft angle in A3-type fractures(8.2±3.1)° was significantly lower than that in A1-type(12.1±2.8)° and A2-type(10.5±3.3)°,with statistically significant differences(P=0.003,P=0.021).The anteversion angle deviation was the greatest in A3-type at(4.3±1.9)°,which was significantly higher than in A1/A2-type(2.1±0.8)° with statistically significant differences(P<0.05).Compared with Group B,Group A still maintained a better neck-shaft angle[(133.8±6.2)° vs.(128.7±5.9)°]and a smaller anteversion angle deviation[(1.8±0.7)° vs.(3.9±1.5)°],with statistically significant differences(t=2.17,P=0.013;t=5.02,P<0.001).Conclusions The separation of bone fragments behind the greater trochanter of the femur affects the internal fixation outcome of fractures.There is no significant difference in postoperative HHS and VAS scores for hip joint function,but patients with poor healing positions experience limited hip abduction.The healing position of bone fragments impacts postoperative functional recovery,especially in abduction activities.When performing intramedullary nail fixation,it is important to emphasize the reduction and fixation of bone fragments to improve functional recovery.
Keywords：Hip fracturesFracture fixationinternalSeparated bone fragment
Publication Date：2025-09-19
Online Publishing Date：2025-09-29(First online date of this platform, not the publication date of the document)
Pages：7( 775-781 )