Efficacy Analysis And Risk Observation Of Two Types Of Intramedullary Nail Fixation In The Treatment Of Intertrochanteric Fractures Of The Femur

Objective:Intertrochanteric Femur Fracture(IFF)is a fracture from the base of the femur to above the level of the lesser trochanter.The posterolateral wall risk type of IFF is a cis-rotor intertrochanteric fracture in which the fracture line involves the lesser trochanter and part of the greater trochanter,but not the anatomical location of the posterolateral wall.This type is prone to medically induced posterolateral wall rupture intraoperatively and postoperatively because of the weaker posterolateral wall.The purpose of this study was to analyze the efficacy and risk of intertrochanteric femoral nailing(PFNA)and interlocking intramedullary nailing(Intertan)fixation in the treatment of lateral wall risk intertrochanteric femur fractures(IFF)by observing the efficacy and To evaluate the efficacy of the two types of intramedullary nailing and the importance of the "intact lateral wall" in the treatment and prognosis of lateral wall-risk IFF;to further discuss the choice of surgical procedure for lateral wall-risk IFF and the measures that can effectively protect the "lateral wall" during surgery.Methods:This study retrospectively analyzed the clinical data and final follow-up hip function scores of 51 patients with lateral wall dangerous intertrochanteric femur fractures who visited the orthopedic department of Luliang People’s Hospital from January 2018 to June 2021,including 26 cases in the PFNA intramedullary nailing group(PFNA group),and 25 cases in the Intertan intramedullary nailing group(Intertan group).The operating time,intraoperative bleeding,postoperative complications(medically induced lateral wall fracture,postoperative screw excision),postoperative time to full weight bearing,and the FRS(functional recovery scale)functional score of the hip joint at the last follow-up were recorded in each case.Using these indicators,the efficacy of the two types of intramedullary nail fixation was evaluated;the FRS functional scores at the last follow-up were compared between patients with and without medically induced lateral wall fractures and correlation analysis was performed to determine the importance of the "intact lateral wall" for the treatment and prognosis of lateral wall risk type IFF.Results:1.51 patients with posterolateral risk IFF were included,including 26 cases in the PFNA intramedullary nailing group(PFNA group)and 25 cases in the Intertan intramedullary nailing group(Intertan group).Both groups were followed up for 9 to 45 months,with a mean of(27.5 ± 9.2)months.The differences in general data(gender,age,BMI,affected side,timing of surgery,ASA score)between the two groups were not statistically significant(P > 0.05)and were comparable.2.The operative time in the PFNA group was shorter than that in the Intertan group and the difference was statistically significant(P < 0.05),and the intraoperative bleeding was less than that in the Intertan group and the difference was statistically significant(P < 0.05).3.There was no statistically significant difference between the two groups in the postoperative time to full weight-bearing and the hip function score at the last follow-up(P>0.05).4.The incidence of medically induced posterolateral wall fracture in the Intertan group(8%)was similar to that in the PFNA group(7.7%),and the difference was not statistically significant(P>0.05).1 case(4%)of screw incision was reviewed in the Intertan group at three months,and 1 case(4%)of screw incision was reviewed in the PFNA group at one week postoperatively and 2 cases of screw incision were reviewed at three months postoperatively.The total incidence of postoperative complications in the Intertan group(12%)was lower than that in the PFNA group(19.2%),and the difference was clinically significant,but not statistically significant(P > 0.05).5.Patients with medically induced lateral wall fractures had a statistically significant decrease in the final hip score compared with those without(P < 0.05);the hip FRS score at the final follow-up was negatively correlated with medically induced lateral wall fractures and was statistically significant(r =-0.350,P = 0.12,< 0.05).Conclusion:1.In the treatment of lateral wall risk IFF,the duration of surgery and intraoperative bleeding of PFNA intramedullary nailing are less than those of Intertan;while the incidence of screw excision after Intertan intramedullary nailing is lower than that of PFNA,and the rate of excellent hip joint at the last follow-up is higher than that of PFNA intramedullary nailing.2.PFNA is suitable for patients who are in poor general condition and do not tolerate or cannot undergo prolonged surgery for other reasons;Intertan is suitable for patients who are in good general condition,can tolerate prolonged surgery and have high expectation for postoperative quality of life.3.Both PFNA and Intertan intramedullary nail fixation for posterolateral wall risk IFF may result in medically induced posterolateral wall fractures,and patients with medically induced posterolateral wall fractures have significantly reduced hip function.