Case Control Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 6, 2023; 11(25): 5863-5869
Published online Sep 6, 2023. doi: 10.12998/wjcc.v11.i25.5863
Application of lesser trochanteric reduction fixator in the treatment of unstable intertrochanteric fractures
Yao-Min Hui, Guang Zeng, Pei-Yi Liu, Bin Chai
Yao-Min Hui, Guang Zeng, Pei-Yi Liu, Bin Chai, Department of Orthopedics, Tong Ren Hospital, School of Medicine Shanghai Jiao Tong University, Shanghai 200336, China
Author contributions: Liu PY designed the study, wrote the main manuscript text, and prepared the figures; Hui YM prepared the utility model patents tool for surgery; Zeng G prepared the surgery; Chai B collected the data and performed the statistical analysis; all authors have read and approved the final manuscript.
Institutional review board statement: The Institutional Review Board of the TongRen Hospital, School of Medicine Shanghai Jiao Tong University approved this study, and it was conducted in accordance with the Declaration of Helsinki. All participants provided written informed consent before their data were stored in our hospital database and used for study purposes.
Informed consent statement: All participants provided written informed consent before their data were stored in our hospital database and used for study purposes.
Conflict-of-interest statement: The authors declare no competing interests for this article.
Data sharing statement: The generated and analysed datasets are available from the corresponding author upon reasonable request.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Pei-Yi Liu, MD, PhD, Academic Research, Attending Doctor, Department of Orthopedics, Tong Ren Hospital, School of Medicine Shanghai Jiao Tong University, No. 1111 Xianxia Road, Shanghai 200336, China. liupeiyi_sjtu@163.com
Received: March 30, 2023
Peer-review started: March 30, 2023
First decision: July 3, 2023
Revised: July 5, 2023
Accepted: August 3, 2023
Article in press: August 3, 2023
Published online: September 6, 2023
Processing time: 154 Days and 19.2 Hours
ARTICLE HIGHLIGHTS
Research background

We invented a new device for better treatment of femoral intertrochanteric fractures. During the treatment of intertrochanteric fractures, we fully realize the significance of trochanteric reduction and fixation, namely, reconstruction of structures under pressure.

Research motivation

As long as the general condition of patients is suitable and they are willing to undergo surgery, fixation should be carried out at the main fracture end and the lesser trochanter should be reduced and fixed at the same time. Some foreign scholars have proposed another method for performing nail fixation through a medial incision. However, as a medial incision causes larger trauma, we advocate that the lateral intramedullary nail incision shall be appropriately lengthened and the soft tissue shall be properly stripped from the anterior and posterior aspects of the greater trochanter, followed by placement of the newly developed lesser trochanteric reduction fixator.

Research objectives

We aimed to focus on how to avoid displacement of the lesser trochanter in unstable intertrochanteric fractures.

Research methods

IBM SPSS 26 was used for data analyses. An independent samples t-test was used for comparison of means between groups. A P value of < 0.05 was considered statistically significant.

Research results

The postoperative Harris hip score in patients who were treated with the lesser trochanteric reduction fixator was significantly higher than that in patients who were treated without the lesser trochanteric reduction fixator (P < 0.05), which indicated that the lesser trochanteric reduction fixator had a positive impact on rehabilitation of the hip joint after surgery and could significantly improve the quality of life of patients. In addition, the proximal incision in patients who were treated with the lesser trochanteric reduction fixator was larger than that in patients who were treated without the lesser trochanteric reduction fixator (P < 0.05).

Research conclusions

We fully realize the significance of trochanteric reduction and fixation, namely, reconstruction of structures under pressure, in the treatment of intertrochanteric fractures. As long as the general condition of patients is favorable and they are willing to undergo surgery, fixation should be carried out at the main fracture end and the lesser trochanter should be reduced and fixed at the same time. Some foreign scholars have proposed another method for performing nail fixation through a medial incision. However, as a medial incision causes greater trauma, we advocate that the lateral intramedullary nail incision should be appropriately lengthened and the soft tissue should be properly stripped from the anterior and posterior aspects of the greater trochanter, followed by placement of the newly developed lesser trochanteric reduction fixator.

Research perspectives

This newly developed lesser trochanteric reduction fixator has some advantages: (1) After reliable reduction and fixation, this fixator can be introduced into the loop plate through the customized holes, and the loop plate can pass through the muscle space of the lesser trochanter, which can achieve reduction and fixation of the lesser trochanter; and (2) This fixator can improve the quality of reduction of the lesser trochanter, and the loop plate can achieve elastic fixation. There is no risk of nail breakage caused by nail fixation.