Kartal Dr. Lutfi Kirdar City Hospital, Department of Orthopaedics and Traumatology, 34865, İstanbul, Turkey.
Diskapi Yildirim Beyazit Training and Research Hospital, Department of Orthopaedics and Traumatology, 06110 Ankara, Turkey.
Orthop Traumatol Surg Res. 2021 May;107(3):102863. doi: 10.1016/j.otsr.2021.102863. Epub 2021 Feb 20.
Although one of the optimal treatment methods for fixing intertrochanteric femur fractures (ITFF) is the proximal femoral nail (PFN) that still has some complications, during implantation of PFN, there might be a V-effect on the trochanteric fracture line, which leads to hinging from the inferior of the femoral neck of the fracture and consequently, fixation of the hip in a varus position. The aim of this study was to identify the causes of the V-effect, and possible preventative solutions.
The V-effect is seen at a considerable rate and is an important iatrogenic complication with a high re-operation rate.
A retrospective review of ITFFs treated with PFN was conducted. Fractures were classified from the injury films using the Arbeitsgemeinschaft für Osteosynthesefragen/Orthopedic Trauma Association (AO/OTA) classification, and quality of reduction, rate of complication and re-operation, and the V-effect was evaluated on the initial postoperative films.
A total of 667 patients met the inclusion criteria. The overall rate of complications was 19.8% and re-operation was 5.1%. According to the AO/OTA fracture classification, 393 (58.9%) fractures were stable, and 274 (41.1%) were unstable. The reduction was good in 538 patients (80.7%), acceptable in 14 (2.1%) and poor in 115 (17.2%) patients. The V-effect was detected in 9.4% (n=63) of all patients, and re-operation was required in 19.1% (n=12) of these.
The V-effect is an iatrogenic complication during fixation of ITFF with PFN. To avoid complications of the V-effect, either constant anatomic reduction should be provided during and before implantation of PFN, or a more suitable instrument should be selected.
III; retrospective study.
虽然股骨转子间骨折（ITFF）的最佳治疗方法之一是股骨近端髓内钉（PFN），但它仍存在一些并发症。在 PFN 植入过程中，可能会在转子骨折线上出现 V 效应，从而导致骨折股骨颈的下侧铰链，并因此将髋关节固定在旋内位置。本研究旨在确定 V 效应的原因和可能的预防措施。
V 效应的发生率相当高，是一种重要的医源性并发症，其再手术率很高。
对采用 PFN 治疗的 ITFF 进行回顾性研究。使用 Arbeitsgemeinschaft für Osteosynthesefragen/Orthopedic Trauma Association（AO/OTA）分类法从损伤影片中对骨折进行分类，并评估初始术后影片中的复位质量、并发症发生率和再手术率以及 V 效应。
共有 667 名患者符合纳入标准。总体并发症发生率为 19.8%，再手术率为 5.1%。根据 AO/OTA 骨折分类，393 例（58.9%）骨折为稳定型，274 例（41.1%）为不稳定型。538 例（80.7%）复位良好，14 例（2.1%）可接受，115 例（17.2%）较差。所有患者中有 9.4%（n=63）出现 V 效应，其中 19.1%（n=12）需要再手术。
V 效应是 PFN 固定 ITFF 的医源性并发症。为避免 V 效应的并发症，应在 PFN 植入过程中和植入前提供恒定的解剖复位，或选择更合适的器械。
III；回顾性研究。
