Intramedullary Fixation For The Treatment Of Intertrochanteric Fracture Reposition Techniques

Objective To explore the soft reduction technique of intramedullary fixation in the treatment of intertrochanteric fractures in order to achieve satisfactory reduction and restore an anatomical relationship between the neck of the femur and the trochanter area of the femur.Methods The data of 152 patients who received the treatment of intramedullary nailing with intertrochanteric fracture were analyzed from July 2015 to July 2017.There were 69 male patients and 83 female patients,the age range is 25-93 years old,mean age was 71 years old.All cases were unilateral closed injury,of which there were 67 cases of left closed injury and 85 cases of right closed injury.The fracture was caused by low-energy injury in 129 patients(fall down)and fall from standing height in seven cases,traffic accident in twelve cases and four bicycle accident.Of all,5 3 cases were type A1,85 cases were type A2 and 14 cases with type A3 fractures according to the AO classification.According to the Tronzo-Evans classification,48 cases were type 1,62 cases were typeⅡ,17 cases were typeⅢ,11 cases were typeⅣ and 14 cases were typeⅤ.Complications:osteoporosis in 85 cases,hypertension in 37 cases,coronary heart disease in 34 cases,diabetes in 8 cases,multiple lacunar infarction with hemiplegia sequela in 2 cases,renal insufficiency in 1 cases,and 1 cases after cardiac valve replacement.87 patients were treated by the close reduction and 65 patients were remedied by the Steinmann pin,"Gold-finger",bone-hook,clamp,intramedullary nail,segmental preset the intramedullary nail path and so on.Results The patients were treated by the simple traction bed with closed reduction in 87 cases,65 cases of simple closed reduction which is fail to complete the good reduction of femoral intertrochanteric fractures were treated by K-wire assisted reduction in 8 cases,"Gold-finger" poking reduction in 18 cases,reduction of bone hook traction in 15 cases,punctate reduction forceps assisted reduction of 4 cases,using the lever principle main nail assisted reduction in 7 cases,"sub preset screw" auxiliary reset in 13 cases.Anatomical reduction was achieved in 67 cases and the acceptable reduction was achieved in 85 cases.All the cases were followed up with 6-12 months,and it was founded that all patients with fracture were healed.There were no internal fixation loosening,nail breaking,infection,and coxa varus,2 cases of venous thrombosis of lower extremity were treated with anticoagulation until the patients returned to normal.According to the Harris score of hip joint function,118 cases were excellent,30 cases were good,and 4 cases were acceptable.Conclusion According to the intraoperative condition and the type of fracture,the use of several gentle reduction techniques to achieve satisfactory reduction as much as possible can reduce the incidence of complication and obtain a better result.