Intramedullary nail fixation for femoral intertrochanteric fractures with lateral trochanteric wall injury

Objective To evaluate the clinical effect of intramedullary nail fixation for treatment of femoral intertrochanteric fractures with lateral trochanteric wall injury.Methods From February 2009 to February 2012,22 patients suffered from femoral intertrochanteric fractures with lateral trochanteric wall injury were treated by intramedullary nail fixation.The types of intramedullary nail included:reconstruction nail in 10 cases,PFN in 5,Gamma nail in 3,PFNA in 2,Inter Tan in 2.The neck shaft angle(NSA) and femoral neck long axis(FNLA) were measured on the X-ray films in the early postoperative period,at the3 rd month and 1.5 year postoperatively.The effect was evaluated according to the Harris score at the last follow-up.Results The operation duration was 70-150 min(mean,95 min),the blood loss was 50-250 ml(mean,120 ml),and the hospitalization time was 10-41 d(mean,21 d).All 22 cases were followed up,and the period was 19-28 months(mean,22.5 months).The fracture healing time was 9-15 weeks(mean,11.3 weeks).Distal locking failed by guide device in 2 cases,and succeeded under C-arm fluoroscopy by free hand.Femoral neck screw disengaged in 2 cases.Leg length discrepancy occurred in 3 cases,and the difference was 1.5 cm.External rotation of the affected limb occured in 2 cases,and the angle was 10°.A comparison concerning NSA and FNLA in the early postoperative period,at the 3rd month and 1.5 year postoperatively was performed,the difference was not significant(P 0.05).The mean Harris score at the last follow-up was 91.4(78-98).Conclusion In the treatment of femoral intertrochanteric fractures with lateral trochanteric wall injury,intramedullary nail fixation can provide durable and stable fixation,avoid the replacement,allow patients to do exercise early,and achieve an excellent clinical outcome.