Villano Marco, Innocenti Matteo, Civinini Roberto, Carulli Christian, Civinini Alessandro, Taha Zyad Ayman, Cozzi Lepri Andrea
Department of Health Sciences, Orthopedic Unit, University of Florence, C.T.O. Largo Palagi 1, 50139, Firenze, Italy.
J Orthop. 2022 Aug 17;34:94-99. doi: 10.1016/j.jor.2022.08.013. eCollection 2022 Nov-Dec.
Lesser trochanter (LT) fixation to restore the continuity of the posteromedial fragment using a cerclage wire has been reported to provide a more stable reduction in the treatment of unstable femoral neck fractures with LT involvement. However, LT fixation is not commonly performed due to the complications associated with the traditional monofilament cerclage metal wires. In this study, we investigate the clinical and radiological outcomes of a new technique for LT fixation in conjunction with Intramedullary (IM) fixation with nail and screws when compared to isolated IM fixation. The Sling Fixation Technique involves a new wiring technique and the use of a polymer-based cerclage cable characterized by iso-elastic properties that is hypothesized to provide better clinical and radiographic outcomes.
This prospective observational study included 30 patients who underwent proximal IM nailing from July 2019 to April 2020. Thirty consecutive patients (30) were assigned to 2 different treatment groups. Fifteen (15) patients were treated with the IM Nailing and Sling Fixation Technique and 15 with IM nailing only. Patients were comparable for demographic features, fracture pattern, age, gender and associated medical comorbidities. Clinical outcomes were analyzed in terms of time needed to achieve complete weight bearing, Harris hip score (HHS), Barthel Index (BI) and Radiographic Union Scale for Hip (RUSH). The follow-up period was one year.
Time for fracture healing and to achieve weight-bearing in the "Sling" group were shown to be significantly shorter than in the IM group. The Sling group showed furthermore better HHS, BI and RUSH scores when compared to the IM group at 1, 3, 6, and 12 months from the surgery. No complications such as wiring breakage, cut-outs, breakage or pullout of the fixation screws were observed; one case of heterotrophic ossification was reported.
In cases of unstable intertrochanteric fractures of the proximal femur with lesser trochanter involvement, the Sling fixation technique using an isoelastic polymer-based wire showed superior results in terms of stability and consequently better clinical and radiographic outcomes than IM nailing only.
据报道，使用环扎钢丝进行小转子（LT）固定以恢复后内侧骨折块的连续性，在治疗累及小转子的不稳定股骨颈骨折时能提供更稳定的复位。然而，由于传统单丝环扎金属丝相关的并发症，LT固定并不常用。在本研究中，我们探讨了一种LT固定新技术与髓内（IM）钉和螺钉固定相结合与单纯IM固定相比的临床和影像学结果。吊带固定技术涉及一种新的钢丝技术以及使用具有等弹性特性的聚合物基环扎缆线，据推测其能提供更好的临床和影像学结果。
这项前瞻性观察性研究纳入了2019年7月至2020年4月接受近端IM钉固定的30例患者。连续30例患者被分为2个不同的治疗组。15例患者采用IM钉和吊带固定技术治疗，15例仅采用IM钉固定。患者在人口统计学特征、骨折类型、年龄、性别和相关内科合并症方面具有可比性。从实现完全负重所需时间、Harris髋关节评分（HHS）、Barthel指数（BI）和髋关节影像学愈合量表（RUSH）方面分析临床结果。随访期为1年。
“吊带”组骨折愈合和实现负重的时间明显短于IM组。与IM组相比，吊带组在术后1、3、6和12个月时的HHS、BI和RUSH评分更高。未观察到诸如钢丝断裂、穿出、固定螺钉断裂或拔出等并发症；报告了1例异位骨化病例。
在累及小转子的近端股骨不稳定转子间骨折病例中，使用具有等弹性聚合物基钢丝的吊带固定技术在稳定性方面显示出更好的结果，因此在临床和影像学结果上优于单纯IM钉固定。
