Abstract:Objective To investigate the treatment of intertrochanteric femoral fracture nonunion with Gamma 3 combined with auto-iliac bone graft.Methods The clinical data of 7 cases of intertrochanteric fractures treated by the orthopaedic department of Wuhan Fourth Hospital were analyzed retrospectively from October 2014 to April 2016.There were 6 males and 1 female. Age 42-68, average 52 years old. All of the 7 patients were intertrochanteric fractures caused by trauma, and the fracture was AO typing, 2 cases 31A2.2, 4 cases 31A2.3 and 1 case 31A3.The initial operation was from 10 months to 3 years, with an average of 17 months. Gamma 3 fixation combined with atuo-iliac bone graft treatment was used in all 7 cases. operation time, blood loss, bone healing time and complications were observed, faction of hip joint was evaluated by Harris scores criteria 12 months after operation.Results Operation was performed successfully in all 7 patients, and the operation time was 1.7-2.2 h, with an average of 2 h. Intraoperative blood loss was 350-520 mL, with an average of 430 mL.The patient's incision was healed in the first stage.All 7 patients were followed up for 14-32 months, with an average of 21.7 months. All patients received bone healing, healing time 16.6-22.7 weeks, average 17.3 weeks. There were no complications such as deep venous thrombosis of the lower extremity, coxa vara, tension screw cutting femoral head and breakage. The function of hip joint was assessed by Harris scoring standard 12 months after surgery: 6 excellent cases and 1 good case.Conclusions The treatment of intertrochanteric femoral fracture nonunion with Gamma 3 combined with bone auto-iliac graft can get firm fixation and definite bone healing. It proves to be an effective revision method.
熊文, 陈明, 郑琼. Gamma 3髓内钉固定结合自体髂骨植骨治疗粗隆间骨折骨不连[J]. 中华解剖与临床杂志, 2018, 23(2): 121-125.
Xiong Wen, Chen Ming, Zheng Qiong. The treatment of intertrochanteric femoral fracture nonunion with Gamma 3 combined with auto-iliac bone graft. Chinese Journal of Anatomy and Clinics, 2018, 23(2): 121-125.
Xue D, Yu J, Zheng Q, et al. The treatment strategies of intertrochanteric fractures nonunion: An experience of 23 nonunion patients[J]. Injury, 2017, 48(3): 708-714. DOI:10.1016/j.injury.2017.01.042
[2]
Angelini M, McKee MD, Waddell JP, et al. Salvage of failed hip fracture fixation[J]. J Orthop Trauma, 2009, 23(6): 471-478. DOI:10.1097/BOT.0b013e3181acfc8c
[3]
Konstantinidis L, Papaioannou C, Blanke P, et al. Failure after osteosynthesis of trochanteric fractures. Where is the limit of osteoporosis?[J]. Osteoporos Int, 2013, 24(10): 2701-2706. DOI:10.1007/s00198-013-2392-8
[4]
Haq RU, Manhas V, Pankaj A, et al. Proximal femoral nails compared with reverse distal femoral locking plates in intertrochanteric fractures with a compromised lateral wall; a randomised controlled trial[J]. Int Orthop, 2014, 38(7): 1443-1449. DOI:10.1007/s00264-014-2306-1
[5]
Dhamangaonkar AC, Joshi D, Goregaonkar AB, et al. Proximal femoral locking plate versus dynamic hip screw for unstable intertrochanteric femoral fractures[J]. J Orthop Surg(Hong Kong), 2013, 21(3): 317-322. DOI:10.1177/230949901302100311
[6]
Azboy I, DemirtaŞA, Gem M, et al. A comparison of proximal femoral locking plate versus 95-degree angled blade plate in the treatment of reverse intertrochanteric fractures[J]. Eklem Hastalik Cerrahisi, 2014, 25(1): 15-20. DOI:10.5606/ehc.2014.04
[7]
Yin H, Pan Z, Jiang H. Is dynamic locking plate(Targon FN) a better choice for treating of intracapsular hip fracture? A meta-analysis[J]. Int J Surg, 2018, 52: 30-34. DOI:10.1016/j.ijsu.2018.01.044
[8]
Kanakaris NK, Tosounidis TH, Giannoudis PV. Nailing intertrochanteric hip fractures: short versus long; locked versus nonlocked[J]. J Orthop Trauma, 2015, 29(Suppl 4): S10-S16. DOI:10.1097/BOT.0000000000000286
Sidhu AS, Singh AP, Singh AP, et al. Total hip replacement as primary treatment of unstable intertrochanteric fractures in elderly patients[J]. Int Orthop, 2010, 34(6): 789-792. DOI:10.1007/s00264-009-0826-x
[12]
Biber R, Bail HJ, Stedtfeld HW. Lateral cortical notching in specific cases of delayed unions or nonunions after intertrochanteric and reversed fractures[J]. Arch Orthop Trauma Surg, 2013, 133(4): 495-501. DOI:10.1007/s00402-013-1683-z