Analyze The Complications And Influencing Factors With Femoral Intertrochanteric Fracture By The InterTAN Nail

Objective To analyze the complications and influencing factors with femoral intertrochanteric fracture by the InterTAN nail system and improve the clinical efficacy through the prevention of complications.Methods We retrospectively analyzed the clinical data of 482 patients who had been treated in the first affiliated hospital of dalian medical university from December 2008 to August 2015 for femoral intertrochanteric fracture with closed reduction and internal fixation with InterTAN nail,Male 196 cases,female 286 cases;age 19-103 years old(average,74.1 ± 15.6 years old).Left in 231 cases,right in 251 cases,including 9 cases of bilateral fracture of different time.The mechanism of injury: traffic accident in 58 cases,slip and fall falls in 363 cases,stair fall injury in 61 cases.According to AO/OTA classification[8],type A1.1 108 cases,type A1.2 78 cases,type A1.3 56 cases,type A2.1 91 cases,type A2.2 76 cases,type A2.3 26 cases,type A3.1 40 cases,type A3.2 2cases,type A3.3 5 cases.Combined internal medicine diseases in 253 cases(52.5%),including hypertension in 115 cases(23.9%),coronary atherosclerotic heart disease in 73 cases(15.1%),respiratory system diseases in 30 cases(6.2%),cerebral vascular diseases in 65 cases(13.5%),diabetes mellitus in 104 cases(21.6%),other complications in 94 cases(19.5%),had two or more complications in 120 cases(24.9%).Operation within 1-7 days after injury.we should clear of the operation time,blood loss and length of stay,intraoperative and postoperative complications.To record the X-ray measurement TAD value of internal fixation,postoperative neck stem Angle,and then observe presence of varus and shortening.By using SPSS21.0 statistical software.Results The operation time was 20-90 min,(average,43.1 ± 12.3 min),the amount of intraoperative bleeding was about 100-300 ml,(average,151.1 ± 34.5 ml).5-10 days of hospitalization days,(average,7.5 ± 2.2 days).Remove the incorrect insufficient due to burst into the open intraoperative complications occurred in 10 cases(2.1%),of which the lag screw reamed occurs when the guide wire wear in 1 cases(0.2%),pressurized cortical screw drill tip splitting in 1 case(0.2%);intramedullary nail and nail causing femoral shaft lateral wall in 2 cases(0.4%),intraoperative reamed and into the needle point leads to the main nail into the difficulty in 2 cases(0.4%);operation guided needle into the medullary cavity is too deep,auxiliary incision in 1 case(0.2%);postoperative review of distal locking screws did not enter the intramedullary nail locking holes in 3 cases(0.6%),postoperative adjustment screw,which resulted in a solid Dingyuan at the end of the femoral shaft fracture instead elongated type intertan re fixed in 1 case(0.2%).During the period of hospitalization occurred in patients with complications of 33 cases(6.8%),including lung infection in 10 cases(2.1%),pulmonary embolism in 2 patients(0.4%),20 cases of traumatic delirium(4.1%),1 cases of deep venous thrombosis of lower extremity(0.2%).Complications resulted in death in 3 patients(0.6%).Postoperative review X-ray measurement TAD measurement value is 14.8mm-31.9mm,(average,18.5 ± 5 mm).Patients with contralateral leg neck shaft angle of 122°-135°,(average,128.5 ± 7°);limb collodiaphyseal angle is 112-143°(average,127.1 ± 6.3°).No significant difference(P=0.078>0.05).206 of patients successful follow-up,the success rate was 42.7%,and the postoperative follow-up time is 3-80 months(average,35.8±15.8 months).We were found 97 patients who were measured according to the standard of Harris scores were great,good for 70 patients,general for 25 patients and poor for 14 patients,the satisfactory rate was 84%.After 3 months of fracture section no obvious callus formation after removed distal screws in promoting fracture healing in 2 cases(0.4%),After internal fixation of femoral head cut inline fixed adjustment in 3 patients(0.6%),with 6 weeks 1 year and 2 years after operation,including 2 case with internal fixation failure in femoral head necrosis and joint replacement,1 underwent internal fixation of adjustment,the above 3 cases were hip varus and shortening of the femoral neck,TAD value were 25.1 mm and 27.8 mm and 31.9 mm;Postoperative ipsilateral limb within 1 year of distal femoral fractures in 3 patients(0.6%),open reduction and internal fixation.2 years after cortical bone defect in 1 case(0.2%),if there are no special treatment.The other 9 cases(1.9%)after 3 months to 2 years of lateral femoral fractures parallel between rotor InterTAN intramedullary nail fixation treatment.There were 11 cases(2.2%)had thrombus after operation between 1 to 3 months,with clot formation of cerebral thrombosis in 3 patients(0.6%),8 cases of lower extremity deep venous thrombosis(1.6%).and 48 patients(10%)died in the last follow-up,5 cases(1%)died within 3 months after operation,6 c ases(1.2%)died within 1 years.Conclusions InterTAN intramedullary nail system design is reasonable and effective in the treatment of femoral intertrochanteric fractures.Through the active treatment of diseases in Department of internal medicine,preoperative treatment plan formulation,perfect fine operation,and postoperative individualized functional exercise is the key to avoid the intraoperative and postoperative complications.