The Analysis Of Integrity Of Lateral Trochanteric Wall In The Surgery Of The Intertrochanteric Fractures

ObjectiveTo discuss the implant options for the treatment of intertrochanteric fractures of the hip by evaluating the lateral trochanteric wall integrity of the femur.MethodRetrospectively analyze 298 cases of intertrochanteric fracture patients which treated by internal fixation in our department from October 2011 to May 2016.including 87 cases of type A1,179 cases of type A2 and 32 cases of typeA3.To conduct the relations between the lateral femoral trochanteric wall integrity and internal fixation choice.ResultThe data of 298 cases were followed up for a period of from 6 to 34 months,with an average follow-up time of 21 months.Type A1 fractures with dynamic hip screw in treatment of 76 cases and with cephalomedullary nail in the treatment of 11 cases;and Type A2.1 fractures 53 cases total,treated with dynamic hip screw in 31 cases and with cephalomedullary nail of in 22 cases,there's no fracture of the lateral trochanteric wall,no significant internal fixation failure or fragment displacement postoperatively.Type A2.2 and Type A2.3 fractures treated with dynamic hip screw in 52 cases and 74 cases of cephalomedullary nail.But in dynamic hip fixation cases,ruptures of the lateral trochanteric wall were total of 18 cases,11 cases of coxa vara,lag screw withdrawal and the screw cut-out were total of 5 cases,2 cases underwent revision.In intramedullary nail cases,fractures of the lateral trochanteric wall were total of 7 cases,1case of coxa vara intra-operatively because of conduct of intramedullary nail laterally,no changes in follow-up.Type A3 fractures in 32 cases,4 cases were treated with dynamic hip screw,proximal femoral locking plate in the treatment of 2 cases,26 cases were treated with cephalomedullary nail.Dynamic hip screw and proximal femoral locking plate internal fixation were failed in 3 cases of coxa vara,2 cases of screw withdrawal,1case of cut-out.conclusionThe lateral trochanteric wall of type A1 and Type A2.1 fractures are intact.Dynamic hip screw fixation through controlled impaction between fragments,promote bone healing,the technical challenge is relatively small and the cost is cheap.And the use of cephalomedullary nail fixation for type A3 fractures which lateral wall fractures preoperatively has no controversy.However,in type A2.2 and A 2.3 intertrochanteric fractures,which the lateral wall were vulnerable,when using extramedullary fixation device such as dynamic hip screw or proximal femoral locking plate should pay more attention to maintain the integrity of the lateral wall of the proximal femur.to avoid intra-operative or postoperative iatrogenic lateral wall fractures.When patients have severe osteoporosis and low intertrochanteric fractures with the proximal end of fracture exiting near the vastus ridge,we should use intramedullary fixation system such as Gamma3 or PFNA,so as to avoid the lateral femoral wall ruptures which maybe result in fracture collapse and coxa vara or screw withdrawal.