Clinical Analysis Of The Effect Of Medial Cortical Reduction Status On The Efficacy Of PFNA Internal Fixation In Unstable Intertrochanteric Fractures

Objective: To analyze the clinical analysis of the effect of medial cortical reduction status on the efficacy of proximal anti-rotational intramedullary nail(PFNA)in the treatment of unstable intertrochanteric fractures(IFF).Methods: A retrospective analysis was conducted on the clinical data of PFNA surgery for patients with unstable IFF from September 2020 to March 2023.Based on preoperative DR plain radiographs and CT-3D imaging data to judge unstable IFF,all cases were randomly divided into two groups,namely medial cortical reduction group and medial cortical non-reduction group(including iatrogenic medial cortical injury).Cases were screened according to inclusion and exclusion criteria,and relevant data were collected for final inclusion in this study,including sex,age,height,weight,underlying diseases(hypertension,diabetes),and apical distance(TAD);Intraoperative data include intraoperative blood loss,operation time,incision length;Postoperative data include bed complications(DVT of the lower extremities),bedsores,respiratory or urinary tract infections),loss of neck shaft angle,change in femoral neck length,spiral blade incision or withdrawal,delayed healing,hip varus;The discharge followup data included Harris hip function score(HHS)at 1,3,6 and 12 months and HHS excellent rate at 6th and 12 months,and statistically analyzed the differences in relevant data between the two groups,and explored the relationship between different reduction states of medial cortex and the effect of PFNA surgery.Results: In the end,a total of 81 patients entered the study,including 43 cases in the medial cortex reduction group and 38 cases in the medial cortex non-reduction group.Compared with the baseline data and statistical analysis of TAD between the two groups,the P value was > 0.05,and the difference was not statistically significant.The P value was > 0.05 and the difference was not statistically significant.The two groups had a statistically <significant difference in the loss of neck shaft angle,change of femoral neck length,spiral blade incision or exit,delayed healing,and hip varus.The statistical analysis of HHS at 3,6 and 12 months after surgery between the two groups showed that the P value was < 0.05,and the difference was statistically significant.The excellent rate of HHS 6 months after surgery was 97.67% in the medial cortical reduction group and 68.42% in the medial cortex non-reduction group,and the statistical analysis resultsχ~2=12.81,P <0.05,the difference was statistically significant.The excellent rate of HHS at 12 months after surgery was 97.67% in the medial cortical reduction group and 78.95%in the medial cortex unreduced group,and the statistical analysis results χ~2=4.20,P<0.05,the difference was statistically significant.Conclusion: When PFNA treats unstable IFF,the reduction of the medial cortex can increase fracture stability,reduce the incidence of complications such as neck trunk angle change,femoral neck length change,and internal fixation failure(including spiral blade incision or exit,delayed healing,hip varus),and improve hip joint function,so effective reduction of the medial cortex should be performed as much as possible during surgery.When the medial cortex of the proximal femur is poorly reduced,auxiliary tools such as hook prying and point reduction forceps can be used to reset,and if necessary,steel wire and other bundles can be used to fix the medial cortex.