Choice Of Different Internal Fixation Of A Type Proximal Femoral Fractures

Objective: To compare the advantage and disadvantage of extramedullary and intramedullary fixation of proximal femur fracture of type A to provide clinical guidance to therapy selection of such fractures.Methods: 133 Cases of Type A proximal femur fracture cured in our hospital from February 2003 to December 2007 by extramedullary and intramedullary fixation are reviewed. out of 133 cases,103 were treated by extramedullary fixation and the other 30 were treated by intramedullary fixation. The follow up time of extramedullary fixation range from 8 to 57 months and the time of intramedullary fixation range from 6 to 54 months. Average follow up time of all 133 cases is 34 months. The average inpatient time, surgery method, rates of complications, and function of contracted hip joint of the 2 different groups were compared and analized.Results: the average inpatient time of those treated with extramedullary fixation is 21.15 days, longer than 20.25 days of cases fixed intramedullarily. The difference is not statistically meaningful(p>0.05). The ratio of excellent hip function of patients fixed by extramedullary implant is 90.29%, which is not significantly different from 90% of those fixed intramedullarily(p>0.05). However, among cases older than 65 years, The ratio of excellent hip function of extramedullary group is 86.2%, which is significantly less than 90.91% of intramedullary group(p<0.05, according to X2 check).Conclusion: 1. extramedullary and intramedullary fixation are both good alternation of relatively stable type A fracture of proximal femur. 2. According to unstable complex A3 type proximal femoral fracture, anti-transtrochanteric fracture and cases older than 65 years, the therapy decision should be made on general evaluation of cases'conditions, and intramedullary method should be prefered.