Comparison Of Three Kinds Of Internal Fixations For The Treatment Of Comminuted Subtrochanteric Fractures

Objectives To compare the clinical efficacy of proximal femoral locking compression plate,proximal femoral nail and proximal femoral nail combined with reconstruction plate in the treatment of subtrochanteric comminuted fractures.Methods The clinical data of 79 cases were collected from January 2010 to May 2016 in Department of orthopedics,Affiliated Hospital of North China University of science and technology and Second Hospital of Tangshan.75 cases were remained after a strict exclusion standard removal.The related medical records,X-ray,after the data of follow-up records were collected and analyzed retrospectively.According to the way of internal fixation,75 cases were divided into three groups.Among them,26 patients(group A)were treated with LCP,including 19 males(73.1%)and 7 females(26.9%),aged 23~62 years,with an average age of(41.27±10.62)years,and the time from injury to operation was 2~8 days,with an average of(4.85±4.85)days.25 patients(group B)were treated with PFN,including 17 males(68%)and 8 females(32%),aged 23~62 years,with an average age of(39.56±10.25)years.The time from injury to operation was 2~8 days,with an average of(4.76±1.56)days.24 cases(group C)were treated by PFN combined with reconstruction plate,15 males(62.5%),9 females(37.5%),the age was 23~60 years,the average age was(38.79±9.47)years old,and the time from injury to operation was 2~8 days,averaging(4.63±1.61)days.The operation time,intraoperative bleeding,healing time and Harris hip score were collected and analyzed to compare the clinical effect of three kinds of internal fixation for treatment of comminuted subtrochanteric fracture.Results All three groups of patients were followed up for 12~24 months,with an average of(16.09±2.88)months.The three groups were all healed.The three groups of operation time,intraoperative bleeding,healing time and Harris hip score were statistically significant(P < 0.05).The operation time of group B was(73.28±7.82)min.The group C was(94.33±7.76)min,and group A was(114.58±12.08)min.The difference was statistically significant(F = 120.37,P < 0.05).The intraoperative bleeding of group B was(399.88±95.77)ml.The group C was(607.75±110.22)ml,and group A was(731.73±121.20)ml.The difference was statistically significant(F = 59.31,P < 0.05).The difference between the three groups in fracture healing time was statistically significant(F = 63.44,P < 0.05).The group C was(6.50±0.89)months.The group B was(7.52±1.02)months,and the group A was(9.62±1.08)months.The difference between the three groups in the Harris hip score was statistically significant(F = 17.65,P < 0.05).The score of group C was(96.25±2.63).The the group B was(93.64±3.30),and the group A was(90.65±3.90).There were no complications such as soft tissue injury,fracture nonunion and internal fixation failure in the three groups.Conclusions 1 PFN group had the shortest operative time and the least intraoperative bleeding.2 PFN combined with reconstruction plate group had the shortest healing time and the shortest postoperative recovery period.The postoperative hip joint function and activity recovery were well.3 LCP group had the longest operative time,the most intraoperative bleeding and the lowest Harris hip score.