Okano Ichiro, Sawada Takatoshi, Kushima Nobumasa, Tachibana Tetsuya, Inagaki Katsunori
Department of Orthopaedic Surgery, Ohta Nishinouchi Hospital, Koriyama, Japan.
Department of Orthopaedic Surgery, Showa University, School of Medicine, Tokyo, Japan.
Geriatr Orthop Surg Rehabil. 2017 Dec;8(4):244-251. doi: 10.1177/2151458517743327. Epub 2017 Nov 28.
Basicervical proximal femoral fracture is a known subtype of extracapsular fracture and is mechanically unstable, especially for the rotational direction, which may lead to implant failure. A cephalomedullary nail (CMN) is widely used for the fixation of unstable extracapsular fracture; however, its application for basicervical fracture remains controversial. Helical blade CMN is proven to have more rotational stability than traditional lag screw implants and potentially advantageous in the treatment of basicervical fracture. The aim of this study is to assess the effectiveness of helical blade CMN for basicervical fracture in elderly patients.
We conducted a retrospective review of 500 consecutive extracapsular fracture patients treated surgically between January 2005 and February 2015. Patients who had trochanteric extension or multifragment fracture were excluded. Sixteen cases of 2-part basicervical proximal femoral fracture were identified. All patients were treated with the same single helical blade CMN system (DePuy Synthes PFNA-II). Implant-related complications were recorded.
Two patients dropped out during follow-up and 14 patients were included in the analysis. The average follow-up period was 21.9 months. No major complication was observed. The patients were subcategorized into 2 groups: nondisplaced (displacement <2 mm at any point of the fracture line) or displaced. Excessive telescoping was observed in 2 patients, both of whom were in the displaced fracture group. The overall implant-related complication rate was 14.2% (2/16).
Internal fixation with the helical blade CMN system can be considered as a treatment option for 2-part basicervical proximal femoral fracture in elderly patients.
股骨近端基底部骨折是一种已知的囊外骨折亚型，力学上不稳定，尤其是在旋转方向，这可能导致植入物失败。髓内钉广泛用于不稳定囊外骨折的固定；然而，其在基底部骨折中的应用仍存在争议。螺旋刀片髓内钉已被证明比传统拉力螺钉植入物具有更高的旋转稳定性，在治疗股骨近端基底部骨折方面可能具有优势。本研究的目的是评估螺旋刀片髓内钉治疗老年患者股骨近端基底部骨折的有效性。
我们对2005年1月至2015年2月期间连续手术治疗的500例囊外骨折患者进行了回顾性研究。排除转子间延伸或多段骨折的患者。确定了16例两部分股骨近端基底部骨折病例。所有患者均采用相同的单螺旋刀片髓内钉系统（DePuy Synthes PFNA-II）进行治疗。记录与植入物相关的并发症。
2例患者在随访期间退出，14例患者纳入分析。平均随访时间为21.9个月。未观察到重大并发症。患者分为两组：无移位（骨折线任何点移位<2 mm）或移位。2例患者出现过度缩短，均在移位骨折组。与植入物相关的总体并发症发生率为14.2%（2/16）。
对于老年患者的两部分股骨近端基底部骨折，螺旋刀片髓内钉系统内固定可作为一种治疗选择。
