Background

This study aims to compare therapeutic effects of two methods in complicated subtrochanteric femur fractures surgery: intramedullary nail fixation assisted with lateral monocortical locking plate versus intramedullary nail fixation assisted with supplementary cables.

Methods

From June 2015 to June 2020, seventy-seven patients with complex subtrochanteric fractures (i.e., Seinsheimer's classification type IV or V) were included in this study. Thirty-six patients (plate group) were operated using the intramedullary nail fixation assisted by lateral monocortical locking plate, and forty-one patients (cable group) were using the intramedullary nail fixation assisted by cables. The clinical information and demographic results were collected and compared.

Results

Operation time of plate group was shorter than cable group and the Incisions length of plate group was longer. The fluoroscopy times were 22.8 ± 8.2 in plate group and 33.0 ± 9.0 in cable group (p < 0.01). Compared with the cable group, patients in plate group used less cerclage cables (p < 0.01). Patients in the plate group has less medial cortex displacement compared with the cable group. (p = 0.038). As for the angular difference of neck shaft angle between operated hip and uninjured hip, plate group has less difference compared with the cable group. Time to union was 14.2 ± 3.1 weeks in plate group which is shorter than the cable group (17.9 ± 4.8 weeks). In terms of follow up period, number of malunion, Harris hip score, walking ability and traumatic hip rating scale, no significant differences were detected.

Conclusions

Our results suggest that using lateral monocortical plate as an auxiliary way may have a longer surgical incision and more intraoperative blood loss, however, the operation time is shorter, the fluoroscopy times is less, and the time to union is shorter. Intramedullary nail fixation assisted by lateral monocortical locking plate may be a new option for patients with complex subtrochanteric femur fractures.

中文翻译：

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锁定钢板辅助髓内钉内固定治疗复杂股骨粗隆下骨折的回顾性研究

背景

本研究旨在比较两种方法在复杂股骨粗隆下骨折手术中的治疗效果：外侧单皮质锁定钢板辅助髓内钉固定与辅助钢索辅助髓内钉固定。

方法

2015年6月至2020年6月，77例复杂股骨粗隆下骨折（即Seinsheimer分类为IV型或V型）患者纳入本研究。36例患者（钢板组）采用外侧单皮质锁定钢板辅助髓内钉内固定术，41例患者（缆索组）采用缆索辅助髓内钉内固定术。收集并比较临床信息和人口统计结果。

结果

钢板组手术时间较缆索组短，且钢板组切口长度较长。板组的透视时间为 22.8 ± 8.2，电缆组的透视时间为 33.0 ± 9.0 (p < 0.01)。与电缆组相比，钢板组患者使用的环扎电缆较少（p < 0.01）。与电缆组相比，钢板组患者的内侧皮质移位较少。（p = 0.038）。对于手术髋部和未受伤髋部的颈轴角的角度差异，钢板组与电缆组相比差异较小。钢板组的愈合时间为 14.2 ± 3.1 周，短于电缆组（17.9 ± 4.8 周）。随访时间、畸形愈合次数、Harris髋关节评分、步行能力及髋关节创伤评定量表均无显着性差异。

结论

我们的研究结果提示，采用外侧单皮质板作为辅助途径，手术切口较长，术中出血量较多，但手术时间较短，透视次数较少，愈合时间较短。外侧单皮质锁定钢板辅助髓内钉内固定可能成为复杂股骨粗隆下骨折患者的新选择。