The Application Of On-off Technique, Prizeing-reduction With Internal Fixation By LCP On Comminuted Femoral Inter-trochanteric Fracture

Intertrochanteric fracture is a common clinical fracture with a relationship to osteoporosis, occurring mostly in the elderly, and the incidence accountes for 3% to 4% in fractures of the body, with the aging of our society, its incidence has been rising. The elderly patients generally consolidate with cardiovascular and cerebrovascular diseases, diabetes and other diseases, while the previous conservative treatments such as skeletal traction required bedding for a longer time, therefore, the complications of conservative treatment were more, mortality were higher with the rate of 6.1%～34.6%. Clinical study confirmed that surgical treatment in patients with early functional exercise can reduce pain, complications and mortality, but mortality rate is as high as 8.5% within one year. Due to osteoporosis, the inter-trochanteric fracture is usually comminuted as to the elderly, so the surgical demand is relatively high, while the combined medical disorders further increase the difficulty of surgery and surgical risk. Therefore, to explore the anatomic reduction, solid internal fixation, shorter operative time, protecting the soft tissue and postoperative good functional recovery, etc, thereby reducing the postoperative short-term and long-term complication is the goal of current treatment of such fractures.Objective:For the surgery of comminuted intertrochanteric fracture, anatomic reduction is the prerequisite, solid internal fixation is the basic requirement, the both are indispensable and mutually reinforcing to each other. Reduction effects and the stability of fixation are the two key factors to determine the success or failure of surgery. At present, locking compression plate (Locking compression plate, LCP)has been generally used as the fixation materials of comminuted intertrochanteric fracture, the fixed effect is good, but the research of the reduction techniques of carrying out anatomical reduction is still little. In view of this, this issue mainly discusses the skill and theory of reduction with fixation of on-off technique, prizeing-reduction with internal fixation by LCP on comminuted femoral inter-trochanteric fracture, and thus improves the clinical effect, simultaneously, introduces and popularizes this clinical surgical experience to the medical workers, and ultimately reaches the purpose of reducing the incidence of complications of the comminuted intertrochanteric fracture effectively.Methods:Retrospective analysis of 35 patients using on-off technique, prizeing-reduction with internal fixation by LCP on comminuted femoral inter-trochanteric fracture in Hubei hospital of TCM from 2007.7 to 2009.10.35 patients were divided into 3 groups, including twelve of A2.1 type, ten of A2.2 type and thirteen of A2.3 type, being equal for closed fractures. Recorded operation time and the times of using C-arm x-ray engine, evaluated reduction effect by the C-arm x-ray engine as well as union instance after six months, and assessed functional recovery instance through sander-grades.Results:The average operation time was fifty-five minutes, the average times of using C-arm x-ray engine was four, the medial and posterior cortical bone were returned to the integrity by the C-arm x-ray engine, with the neck-shaft angle basically controlled at 135°and the former angle maintained at 12°or so, moreover, the incidence of angle loss was very low after reduction, indicating that all of the fractures were reached anatomic reduction. All of the fractures are healing in a half year follow-up, the superior is 10, the better is 22, the inferior is 3 according to sander-grades.Conclusion:The reduction effect of using on-off technique, prizeing-reduction with internal fixation by LCP on comminuted femoral inter-trochanteric fracture is exact, the operation time is shorter, the number of using C-arm x-ray engine is decreasing, the clinical effect is better, reduction skill is fascinate and suitable. This reduction technique is designed directly based on the characteristics of fracture deformity and displacement, integrating the bone-setting techniques of traditional Chinese medicine with the reduction techniques of Western medicine characterized by limited open effectively, is a kind of technique worthy of promotion that can guide the clinical.