Therapeutic Effect Of Anterior Medial Cortical Positive Support Reduction And INTERTAN Fixation For Intertrochanteric Fractures

Objective:To explore the effect of anterior medial cortical positive support reduction combined with anterograde femoral intramedullary nail(INTERTAN)fixation on intertrochanteric fracture of femur.Methods:A retrospective analysis was made of 120 patients(AO/OTA 31A2)who met the diagnostic criteria of intertrochanteric fracture of femur and needed surgical treatment during the period from January 2015 to December 2017 in the Department of Orthopedics of the first Central Hospital of Baoding City.There were 38 males and 82 females with an average age of 72.51 years.According to the relationship between the anterior medial cortex of the femoral head and neck and the anterior medial cortex of the proximal femoral bone mass on the Positive X-ray films of the double hips after operation,they were divided into three groups: group A with positive support(80 cases),group B with neutral support(23 cases)and group C with negative support(17 cases).The differences of age,sex ratio and BMI were analyzed.The neck shaft angle and the femoral neck length were measured and compared immediately after surgery and 3 months after surgery.Also the time of first weight-bearing after operation and the difference of the Harris scores in 3 months and 6 months after operation were recorded and analyzed.Results:There was no statistical difference in general data among the three groups.On the basis of the imaging data,the results of immediate and three-month follow-up after operation were compared.The average loss of neck-shaft angle and femoral neck length in group A was 0.80°±0.11°and 2.00 ±0.30 mm,while that in group B was 3.31°±0.61°? 2.78±0.53 mm and group C was 4.47°±1.21°and 5.64 ±1.10 mm.The difference was statistically significant.The first time of part weight-bearing of group A was significantly shorter than that of group B and C.The Harris scores of the 6 months after surgery among the 3 groups were significantly higher than those of the 3 months after surgery.The Harris scores of group A were higher than those of group B and C at 3 months and 6 months after operation,and there was statistical difference.Conclusion:Positive support reduction of anterior medial cortex combined with INTERTAN fixation can fully contact bone fragments at both ends of the fracture,improve the stability of fracture,recover the force line and reduce postoperative complications,such as loss of neck shaft angle,shortening of femoral neck length,and so on.Patients can exercise in bed and on the ground as soon as possible.