Treatment of unstable intertrochanteric fracture with intramedullary nails

Abstract

Objective To summarize our clinical experience in treatment of unstable intertrochanteric fractures with intramedullary nails. Methods From July 2010 to January 2013, 32 unstable intertrochanteric fractures were treated at our department. They were 13 men and 19 women, aged from 54 to 89 years (average, 68.7 years). By AO classification, 18 cases were type 31-A2.3 and 14 type 31-A3.3. They were all treated with either proximal femoral nails anti-rotation (PFNA) or InterTAN intramedullary nails. The intro-operative blood loss, operation time, complications, healing time, tip-apex distance (TAD), Harris and SF-36 scores one year postoperation were recorded for analysis. Results In this series, the operation time averaged 63.3 minutes (range, from 42 to 93 minutes), and the blood loss 263 mL (range, from 137 to 646 mL). Thirty patients obtained an average follow-up of 16.7 months (range, from 12 to 38 months), and 2 died within 12 months postoperation. The 30 patients achieved bony union after an average of 8.2 months (range, from 6 to 12 months). The TAD averaged 19.8 mm (range, from 15 to 28 mm). The SF-36 scores one year postoperation for the 30 patients were significantly improved compared to the preoperation. The average Harris score one year postoperation for the 30 patients was 83.6 points (range, from 71 to 92 points). No such complications as implant failure, hip varus, collapse, femoral cut-off and nonunion occurred. Conclusions In dealing with complex unstable intertrochanteric fractures, it is advisable to make better understanding of the displacement mechanism of the fracture with the aid of CT scan and choose a suitable implant according to the anatomic parameters of the patient. A variety of instruments may help improve the quality of reduction, leading to better surgical outcomes. Key words: Hip fractures; Fracture fixation, intramedullary; Bone nails