Published online Nov 16, 2021. doi: 10.12998/wjcc.v9.i32.9752
Peer-review started: May 12, 2021
First decision: June 15, 2021
Revised: June 28, 2021
Accepted: August 24, 2021
Article in press: August 24, 2021
Published online: November 16, 2021
Processing time: 181 Days and 18.3 Hours
In most elderly patients with intertrochanteric fractures, satisfactory fracture reduction can be achieved by closed reduction using a traction table. However, intertrochanteric fractures cannot achieve satisfactory reduction in a few patients, which is called irreducible intertrochanteric fractures. Especially for type 31A3 irreducible intertrochanteric fractures, limited open reduction of the broken end with different intraoperative reduction methods is required to achieve satisfactory reduction and fixation.
To discuss clinical efficacy of intracortical screw insertion plus limited open reduction in type 31A3 irreducible intertrochanteric fractures in the elderly.
A retrospective analysis was performed on 23 elderly patients with type 31A3 irreducible intertrochanteric fractures (12 males and 11 females, aged 65-89-years-old) who received treatment at the orthopedics department. After type 31A3 irreducible intertrochanteric fractures were confirmed by intraoperative C-arm, all of these cases received intracortical screw insertion plus limited open reduction in the broken end with intramedullary screw internal fixation. The basic information of surgery, reduction effects, and functional recovery scores of the hip joint were assessed.
All patients were followed up for 13.8 mo on average. The operation time was 53.8 ± 13.6 min (40-95 min). The intraoperative blood loss was 218.5 ± 28.6 mL (170-320 mL). The average number of intraoperative X-rays was 22.8 ± 4.6 (18-33). The average time to fracture union was 4.8 ± 0.7 mo. The reduction effect was assessed using Kim’s fracture reduction evaluation. Twenty cases achieved grade I fracture reduction and three cases grade II fracture reduction. All of them achieved excellent or good fracture reduction. Upon the last follow-up, the functional recovery scores score was 83.6 ± 9.8, which was not significantly different from the functional recovery scores score (84.8 ± 10.7) before the fracture (t = 0.397, P = 0.694).
With careful preoperative preparation, intracortical screw insertion plus limited open reduction contributed to high-quality fracture reduction and fixation. Good clinical outcomes were achieved without increasing operation time and intraoperative blood loss.
Core Tip: Intertrochanteric fractures are common hip fractures in elderly patients with osteoporosis. Most of them achieve satisfactory fracture reduction with closed reduction using a traction table. However, for type 31A3 fractures, limited open reduction of the broken end with different intraoperative reduction methods is usually required to achieve satisfactory reduction and fixation. Here a retrospective analysis was performed on 23 elderly cases with 31A3 type irreducible intertrochanteric fractures, who were treated by intracortical screw insertion plus limited open reduction at our hospital in the past 2 years. The clinical efficacy of this treatment approach was assessed.