Intramedullary nail fixation assisted by locking plate for complex subtrochanteric femur fractures: A retrospective study

Kaihang Xu; Guangchao Wang; Lingyu Lu; Chen Ding; Yun Ding; Xinyu Chang; Dake Tong; Fang Ji; Hao Zhang

doi:10.1016/j.jos.2022.06.015

Intramedullary nail fixation assisted by locking plate for complex subtrochanteric femur fractures: A retrospective study

J Orthop Sci. 2023 Sep;28(5):1105-1112. doi: 10.1016/j.jos.2022.06.015. Epub 2022 Jul 19.

Authors

Kaihang Xu¹, Guangchao Wang², Lingyu Lu³, Chen Ding², Yun Ding², Xinyu Chang², Dake Tong⁴, Fang Ji⁵, Hao Zhang⁶

Affiliations

¹ Department of Orthopedics, Changhai Hospital Affiliated to Navy Military Medical University, Shanghai, China; Hospital Affiliated to 71217, Yantai, China.
² Department of Orthopedics, Changhai Hospital Affiliated to Navy Military Medical University, Shanghai, China.
³ Faculty of Anesthesiology, Changhai Hospital Affiliated to the Navy Military Medical University, Shanghai, China.
⁴ Department of Orthopaedics, Shanghai Ninth People's Hospital Affiliated to Shanghai JiaoTong University School of Medicine, Shanghai, China.
⁵ Department of Orthopaedics, Shanghai Ninth People's Hospital Affiliated to Shanghai JiaoTong University School of Medicine, Shanghai, China. Electronic address: doctorjif@126.com.
⁶ Department of Orthopedics, Changhai Hospital Affiliated to Navy Military Medical University, Shanghai, China. Electronic address: zhanghsmmu@126.com.

PMID: 35864029
DOI: 10.1016/j.jos.2022.06.015

Abstract

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.

Keywords: Intramedullary nailing; Locking plate; Open reduction; Subtrochanteric femur fractures.

MeSH terms

Bone Nails
Femur
Fracture Fixation, Intramedullary* / methods
Hip Fractures* / diagnostic imaging
Hip Fractures* / surgery
Humans
Retrospective Studies
Treatment Outcome