Clinical classification and strategies for irreducible femur intertrochanteric fractures

Abstract

Objective To explore clinical classification and strategies for irreducible femur intertrochateric fractures. Methods A retrospective study was conducted of the 96 patients with irreducible intertrochanteric fracture who had been treated from January 2012 through December 2014 at our department. They were 47 men and 49 women, aged from 48 to 97 years (average, 78.5 years). We classified the fractures according to location of fracture line and mechanism of fracture displacement into 5 types: 13 cases of type Ⅰ (sagittal irreducible fracture), 7 cases of type Ⅱ (coronal irreducible fracture), 72 cases of type Ⅲ(sagittal plus coronal irreducible fracture), zero of type Ⅳ (irreducible fracture involving the lesser trochanter), and 4 cases of type V (irreducible fracture involving the greater trochanter). All the patients were managed using different techniques for closed reduction and fixation with proximal femoral nails antirotation Ⅱ. Results Of this series, limited open reduction was eventually conducted in 7. The operation time averaged 40 min; the amount of intraoperative blood loss averaged 200 mL. Fracture reduction was rated as grade Ⅰ in 78 cases and as grade Ⅱ in 18. The follow-up time averaged 16.6 months (from 12 to 24 months). All the fractures got united after an average of 5.8 months (from 3 to 9 months). The function of the affected hip was rated at the final follow-up using Harris scoring system as excellent in 79 cases and as good in 17, with an excellent to good rate of 100%. Refracture happened in one patient due to striking injury, urinary infection occurred in 2 patients and no wound infection was observed. Conclusion According to the classification and reduction strategy proposed by us, satisfactory reduction and fracture fixation can be achieved in management of irreducible intertrochanteric fractures. Key words: Hip fractures; Fracture fixation, internal; Classification; Reduction