| Objective: Intramedullary nailing is widely used in the treatment of stable pertrochanteric fractures. Distal locking is routinely utilized in the course of nailing the fractures. However, it remains controversial whether the distal locking with intramedullary nailing is necessary. This study prospectively compared the clinical outcomes and prognosis of the elderly people with stable pertrochanteric fractures(AO/OTA 31-A1 and A2) treated by the intramedullary nails with distal locking or not, to confirm the hypothesis that the distal locked nails won’t provide better results relatively, and the distal unlocked nails is a reliable and acceptable option.Methods: In this study, 70 patients over age 65 with pertrochanteric fractures(AO/OTA 31-A1 and A 2) were enrolled and randomly divided into two groups treated by intramedullary nails with distal locking or not. There were 49 women and 21 men, with an average age of 78.2 years(range, 65–93). Overall, there were 36 fractures of the right femur and 34 fractures of the left. Based on the AO/OTA classification, there were 18 A1-type fractures and 52 A2-type fractures. There were no statistically significant differences between the two groups with respect to gender, age, side of fractures, OTA classification, co-morbidity and ASA scores. All the intramedullary nails came from a single manufacturer, yielding a similar proximal blade design for all implants. The rehabilitation protocol was identical to each group. The follow-up period was at least 12 months. Fracture healing was assessed for each patient using the Harris hip score and radiographic examinations during follow up. The intra-operative variables such as operation time, volume of blood loss, total fluoroscopy time, total length of incision and the prospective complications and clinical outcomes were recorded and compared between the two groups.Results: Eventually, 29 patients in locking group and 30 patients in unlocking group completed the one year followed-up. No significant differences were found with respect to the mortality between the locking group(11.4%) and unlocking group(5.7%). The operation time(39.2±7.6 minutes), blood loss(158.6±63.6 ml), fluoroscopy time(53.7±3.9 seconds), and total length of incision(13.1±2.1 cm) in the unlocking group was significantly decreased compared with the locking group(48.5±9.0 minutes; 194.3±61.6 ml; 57.8±4.3 seconds; 10.9±1.7 cm)(P < 0.05). The incidence of postoperative complications was the same in both groups. Cutting out, migration of blade, varus collapse, breakage of the implant, distal tip fracture, infection or non-union was not found in any cases. No significant differences were founded as to the average time of fracture union between the locking group(8.8±2.2 weeks) and the unlocking group(8.5±2.4 weeks). At the time of final follow-up, 21 patients(72.4%) in the locking group were fully weight- bearing and recovered to their pre-injury activity levels, 5 patients(17.2%) walked with a walking aid and 3 patients(10.3%) used a wheel chair; while in the distal unlocking group, 19 patients(63.3%) were fully weight- bearing and recovered to their pre-injury activity levels, 7 patients(23.3%) walked with a walking aid and 4 patients(13.3%) used a wheel chair. Fracture union occurred in all patients. The mean Harris hip scores and shortening of the femur in the locking group were not significantly different from that in the unlocking group(P < 0.05).Conclusion: No significant differences in the complication rate and the fracture healing were found between the two groups in our study. Relatively, unlocked intramedullary nails showed subtle advantages in reducing blood loss, operation and fluoroscopy exposure time as well as the length of incision. Intramedullary nails without distal locking could be a reliable and acceptable option for stable pertrochanteric fractures(AO/OTA 31-A1 and A 2) in the elderly people. |
PDF Full Text Request