Reduction techniques in treatment of coronal femoral intertrochanteric fractures with proximal femoral nail antirotation

Objective To explore the reduction techniques in the treatment of coronal femoral intertrochanteric fractures with proximal femoral nail antirotation (PFNA).Methods A retrospective study was performed of the 45 patients with unstable coronal femoral intertrochanteric fracture who had been treated with reduction and osteosynthesis at our department from March 2008 to August 2012.Of them,22 cases received closed reduction,including 5 males and 17 females with a mean age of 81.1 ± 13.6 years; 23 cases received limited open reduction with Kirschner wire prying or forceps clamping,including 7 males and 16 females with a mean age of 78.6 ± 12.3 years.All the patients were fixated with PFNA.The 2 groups were compared in terms of operation time,blood loss,hospital stay,time of fracture healing,complications and Harris hip score at the last follow-up.Results Of this series,42 patients were followed up (21 in each group) for 12 to 40 months (average,19.6 months).The open reduction group had significantly greater blood loss (365.6 ± 89.1 mL),significantly longer operation time (64.5 ± 14.2 min) and a significantly lower rate of complications (0) than the closed reduction group (221.3 ± 105.0 mL,53.6 ± 6.5 min and 23.8％ respectively) (P ＜ 0.05).However,there were no significant differences between the 2 groups regarding hospital stay,time of fracture healing or Harris hip score at the last follow-up (P ＞ 0.05).Conclusions As it is difficult to perform closed reduction for coronal intertrochanteric fractures,limited open reduction may be preferable in most of the cases because it can improve reduction and decrease incidence of postoperative complications by effectively correcting displacements caused by varus and anterior or posterior angulation. Key words: Hip fractures;  Fracture fixation, intramedullary;  Bone nails