Causation And Influence Of Intraoperative Iatrogenic Lateral Wall Fracture In Intertrochanteric Fracture Of Femur

ObjectiveAt present,dynamic hip screw(DHS)and proximal femoral nail anti-rotation(PFNA)are the mutual therapies,since femoral intertrochanteric fracture is divided into A1 and A2 types according to Association for the Study of Internal Fixation(AO/ASIF).To provide a theoretical basis for the clinical treatment on this type of iatrogenic lateral wall fractures,the paper analyzes the risk factors for the complication and investigate the effect of intraoperative effusion lateral wall fractures on fracture healing and long-term function of hip based on statistics of the incidence of patients' intraoperative iatrogenic lateral wall fracture with femoral intertrochanteric fracture treated by DHS and PFNA.MethodsClinical case analysis.Analyze 55 cases of femoral intertrochanteric fracture treated with PFNA or DHS internal fixation from March 2013 to August 2015.These femoral intertrochanteric fracture cases were of complete data and of conformance to requirements.Both groups were followed by more than 1 year.There are one group of 32 cases treated with PFNA internal fixation,and another group of 32 cases with DHS fixation.Count the odds of occurrence of intraoperative effusion lateral wall fractures using the observational research method,and analyze the relationship between the possible factors(gender,age,type of fracture,treatment methods and occurrence of neurological complications)and the occurrence of intraoperative effusion lateral wall fractures by binary logistic regression.At the same time use the t test to compare the second-time treatment with conservative treatment(the patients with the occurrence of intraoperative effusion lateral wall fracturesdidn't accept second-time treatment)on patients who suffered with intraoperative iatrogenic lateral wall fracture for indicators such as overall fracture healing and hip long-term function,etc.ResultsThe incidence of intraoperative iatrogenic lateral wall fracture was 17% in patients with femoral intertrochanteric fractures treated by PFNA or DHS internal fixation.There was no statistically significance between intraoperative iatrogenic lateral wall fracture and gender,age,type of fracture,treatment methods and occurrence of neurological complications of the patients(P>0.05),but there were statistical differences between intraoperative iatrogenic lateral wall fracture and fracture classification(P=0.018),the higher fracture classification,the higher risk of intraoperative iatrogenic lateral wall fracture.There was no statistically significance of overall fracture healing time and Harris hip scores between second-time treatment with conservative treatment of the patients with intraoperative iatrogenic lateral wall fracture.ConclusionsThere is a risk of intraoperative iatrogenic lateral wall fracture on patients with femoral intertrochanteric by operative(DHS or PFNA).And fracture classification is a risk factor for intraoperative iatrogenic lateral wall fracture.Second-time treatment and conservative treatment are both effective treatment methods for patients of intraoperative iatrogenic lateral wall fracture.