The Study Of Six Part Fracture Classification Of Femoral Trochanteric Fractures And Trauma Scoring System (KNXW)

Objective:According to the femoral trochanteric fractures in anatomic areas,combinedwith CT three-dimensional reconstruction techniques, six part fracture classification offemoral trochanteric fractures is put forward. Which can provide accurate, intuitive, simpleguidance for clinical diagnosis and treatment.Methods: Cases of femoral trochanteric fractures surgery patients were analysised fromJan.2008to Mar.2013.The patients were randomized to six part fracture classification offemoral trochanteric fractures, improved Evans and AO classification. To compare andanalysis the above three different classifications of injury in patients with operative time,length of hospital stay, operative time, blood loss, load time, fracture healing time, Harrisscore and the incidence of postoperative complications, etc.Results: A total of320patients were followed up with the rate of90.1%for12-22months (average13.5months).Cases of femoral trochanteric fractures classificationrs werecompared with gender，age, degree of osteoporosis, injury from the operating time,therewere of no statistical significance (P>0.05). Six part fracture classification and the othertwo were compared in stable femoral trochanteric fractures: in DHS group：Six partfracture classification were shorter operation time, less blood loss, shorter fracture healingtime,higher Harris score than AO classification and improved EVANS classification(P<0.05).There were of no statistical significance in hospitalization time and loadtime(P>0.05). In Gamma nail,and PFNA group, the length of hospital stay, operative time,blood loss, load time, fracture healing time, Harris scoring were of no statistical significance(P>0.05). In the unstable femoral fractures: in Gamma nail group and PFNAgroup,hip replacement group: six part fracture classification was shorter hospitalizationtime, load time,operation time, fracture healing time,and less blood,higher Harris scorethan AO classification and improved EVANS classification.(P<0.05). In the comparation ofthe postoperative complications: six part fracture classification was lower incidence ofcomplications than AO classification and improved EVANS classification(P<0.05).Conclusion:1.Six part fracture classification of femoral trochanteric fractures moreaccurately reflect the anatomy of femoral trochanteric fractures trauma than improvedEVANS classification and AO classification.2.In guiding clinical surgery,six part fracture classification of femoral trochantericfractures has more help to guide clinical to choose operation method than improvedEVANS classification and AO classification，especially the choice of internal fixation.3.Six part fracture classification of femoral trochanteric fractures helps to evaluate thedegree of disease and treatment prognosis of fracture after injury, which has scientificguiding function exercise. Objective: Based on the femoral trochanteric fractures patient’s age, cardiovascularsystem, respiratory system, urinary system, renal function,etc.And in combination withsurgical risk degree.Then established a new fractures of femoral trochanteric fracturestrauma scoring system in order to reduce and prevent the perioperative risk and improvethe curative effect.Methods:Femoral trochanteric fractures patients623cases were retrospectively analyzedfrom Jan.2000to Dec.2010.The preoperative auxiliary examination, the type of surgery,blood loss, operation rate and other factors were seen as the risk factors when the patientsadmitted to hospital. Single factor analysis and multivariable analysis with logisticregression were performed for the selected risk factors.Then established risk factors andrespectively gave scores to them.And set up the femoral trochanteric fractures operationrisk score system. Using this scoring system conducted a prospective studiey about148patients with femoral trochanteric fractures in our hospital from Sep.2011to Jan.2014，andverified the feasibility and practicability.Results: Age,blood pressure, heart function, electrocardiogram (ecg), and the degree ofCOPD, lung infection, albumin, electrolyte, creatinine, blood sugar, white blood cells,hemoglobin, immune damage, Glasgow coma scale, trochanteric fractures stability degreeand the degree of osteoporosis, blood loss estimation, operation time, infection, surgerysize, times of surgery in one month, operation opportunity and the doctor proficiency,smoking history, these risk factors were the elderly postoperative complications mainlyrelated risk factors.148cases of femoral trochanteric fractures patients were retrospectively analyzed. Instable group,there were48cases patients.5cases were predicted to havecomplications,while the actual number was4and no mortality was reported in their duration of hospital. In relatively stable group,there were36cases patients.8cases werepredicted to have complications,while the actual number was7and no mortality wasreported in their duration of hospital. In risk group,there were19cases patients.10caseswere predicted to have complications,while the actual number was8and no mortality wasreported in their duration of hospitall.In High risk group,there were18cases patients.13cases were predicted to have complications,while the actual number was14and1cases ofdeaths were reported in their duration of hospital. In very high risk group,there were27cases patients.21cases were predicted to have complications,while the actual number was19and2cases of deaths were reported in their duration of hospital.Conclusion: The patients of femoral trochanteric fractures were applied to (KNXW)trauma scoring system for the quantitative rating of trauma in hospital, which can helporthopedic surgeons comprehensively and correctly to evaluate patient’s condition,so as toprevent and reduce perioperative risk. For high risk or high risk group of patients, doctorscan apply medical treatment accurately and timely to reduce the surgical risk, creatingconditions for the operation, thus it can improve the effect of surgical treatment.