A total of 210 patients with femoral intertrochanteric fractures who underwent surgical treatment were selected from January 2015 to December 2019. Inclusion criteria is as follows: the diagnosis of all patients was confirmed via imaging and a clear medical history of hip joint trauma. Exclusion criteria were patients with pathological fractures, blood disorders or immune system diseases. According to the operation mode, they were divided into groups. Group A was comprised of patients who underwent compression interlocking intramedullary compression nailing (INTERTAN) (n=69). In group A, 33 males and 36 females aged 40-85 years had an average age of (63.72 ± 6.28) years. Group B had patients who had γ-III interlocking intramedullary nailing (γ-III) done (n=73). In group B, there were 35 males and 38 females, aged 35-84 years, with an average age of (62.61 ± 6.38) years. Group C contained patients who had proximal femoral anatomical locking plate (PFLP) surgery (n=68). In group C, there were 33 males and 35 females, aged 34-94 years, with an average age of (64.49 ± 6.79) years. There were no significant differences in the general data of the three groups of patients (P > 0.05), indicating that the general data of the three groups of patients were comparable.
This study was approved by the Ethics Committee of Affiliated Zhongshan Hospital of Dalian University and monitored by an independent experimental center. All patients who participated in the study gave their voluntary written informed consent.
Methods: Three groups of patients fasted with water 6 hours before operation. Antibiotics were intravenously injected 30 minutes before operation. Continuous epidural anesthesia or general anesthesia was given. Routine disinfection and paving were carried out, and fracture reduction was done under the guidance of a C arm.
Group A (INTERTAN): The patients were reset with traction, adduction and internal rotation in the supine position. A straight incision was made at the proximal end of the top of the ectotrochanter to cut the muscle fibers, and a rhombus awl was applied to cut the top bone to expose the medullary cavity. After the guide needle was inserted into the medullary cavity, the medullary cavity was enlarged, and the main needle was implanted under X-ray, where a Kirschner wire was positioned. When satisfactory results were obtained under the guidance of a C arm, the interlocking nail was placed in the femoral neck, and the distal femur was locked.
Group B (γ-III): The patients were reset with traction, adduction and internal rotation in the supine position. A straight incision was made at the proximal end of the top of the greater trochanter to cut the muscle fibers, and a rhombus awl was used to cut the top bone to expose the medullary cavity. After the guide needle was inserted into the medullary cavity, the medullary cavity was enlarged, the main needle was implanted under X-ray, and the Kirschner wire was positioned. When satisfactory results were obtained under the guidance of a C arm, the screw was pressed into the femoral neck, and the distal femoral end was locked.
Group C (PFLP): The patient was in the supine position, and the hip joint was slightly elevated. The proximal femur and greater trochanter were exposed through a lateral incision of the hip joint. After traction reset of the fracture, the steel plate and Kirschner wire were placed from the neck of the femoral head. When satisfactory results were obtained under the guidance of a C-arm, the pressure screw was fixed and tightened after installing the sleeve plate.
Antibiotics were intravenously injected 72 hours after operation to prevent infection, and low molecular weight heparin was given to prevent thrombosis for 7 days. Moreover, hip joint functional exercise was started 3 - 7 days after the operation. The operation time, bleeding volume, time to leave bed, fracture healing time, incidence of complications, and discharge time at 1, 3 and 6 months after operation were observed, and the hip joint function was evaluated via Harris scoring. All data were processed with SPSS 22.0 and tested with t-test expressed by (x ± s). P < 0.05 was designated to be statistically significant.