Department of Orthopaedics and Traumatology, Medical Faculty, Celal Bayar University, Manisa, 45250, Turkey.
Clin Orthop Relat Res. 2013 Sep;471(9):2768-75. doi: 10.1007/s11999-013-2948-0.
Reverse obliquity fractures of the proximal femur have biomechanical characteristics distinct from other intertrochanteric fractures and high implant failure rate when treated with sliding hip screws. Intramedullary hip nailing for these fractures reportedly has less potential for cut-out of the lag screw because of their loadbearing capacity when compared with extramedullary implants. However, it is unclear whether nail length influences healing.
QUESTIONS/PURPOSES: We compared standard and long types of intramedullary hip nails in terms of (1) reoperation (fixation failure), (2) 1-year mortality rate, (3) function and mobility, and (4) union rate.
We conducted a pilot prospective randomized controlled trial comparing standard versus long (≥ 34 cm) intramedullary hip nails for reverse obliquity fractures of the proximal femur from January 2009 to December 2009. There were 15 patients with standard nails and 18 with long nails. Mean age was 79 years (range, 67-95 years). We determined 1-year mortality rates, reoperation rates, Parker-Palmer mobility and Harris hip scores, and radiographic findings (fracture union, blade cut-out, tip-apex distance, implant failure). Minimum followup was 12 months (mean, 14 months; range, 12-20 months).
We found no difference in reoperation rates between groups. Two patients (both from the long-nail group) underwent revision surgery because of implant failure in one and deep infection in the other. There was no difference between the standard- and long-nail groups in mortality rate (17% versus 18%), Parker-Palmer mobility score (five versus six), Harris hip score (74 versus 79), union rate (100% in both groups), blade cut-out (zero versus one), and tip-apex distance (22 versus 24 mm).
Our preliminary data suggest reverse obliquity fractures of the trochanteric region of the femur can be treated with either standard or long intramedullary nails.
反斜型股骨近端骨折具有与其他转子间骨折不同的生物力学特征，当使用滑动髋螺钉治疗时，植入物失败率较高。与髓外植入物相比，髓内髋钉据称由于其承载能力，发生拉力螺钉切出的可能性较小，可用于治疗此类骨折。但是，钉的长度是否会影响愈合尚不清楚。
问题/目的：我们比较了标准型和长型髓内髋钉在（1）再次手术（固定失败）、（2）1 年死亡率、（3）功能和活动度以及（4）愈合率方面的差异。
我们进行了一项前瞻性随机对照试验，比较了 2009 年 1 月至 2009 年 12 月期间标准型和长型（≥34cm）髓内髋钉治疗反斜型股骨近端骨折的情况。标准型髓内髋钉组 15 例，长型髓内髋钉组 18 例。平均年龄为 79 岁（范围，67-95 岁）。我们确定了 1 年死亡率、再次手术率、Parker-Palmer 活动度和 Harris 髋关节评分以及影像学发现（骨折愈合、刀片切出、尖端-顶点距离、植入物失败）。最低随访时间为 12 个月（平均 14 个月；范围，12-20 个月）。
我们发现两组之间的再次手术率没有差异。两名患者（均来自长钉组）因植入物失败（1 例）和深部感染（1 例）而接受了翻修手术。标准型和长型髓内髋钉组在死亡率（17%与 18%）、Parker-Palmer 活动度评分（5 与 6）、Harris 髋关节评分（74 与 79）、愈合率（两组均为 100%）、刀片切出（0 与 1）和尖端-顶点距离（22 与 24mm）方面均无差异。
我们的初步数据表明，股骨转子间区域的反斜型骨折可以使用标准型或长型髓内髋钉治疗。
