Hu Sun-Jun, Chang Shi-Min, Du Shou-Chao, Zhang Li-Zhi, Xiong Wen-Feng
Department of Orthopaedic Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, Republic of China.
Geriatr Orthop Surg Rehabil. 2023 Jan 22;14:21514593231153827. doi: 10.1177/21514593231153827. eCollection 2023.
To introduce the clinical features of and surgical techniques for a rare type of irreducible pertrochanteric femur fracture pattern with bisection of the lesser trochanter.
From January 2017 to December 2019, 357 patients with per/intertrochanteric femur fractures underwent surgery by closed reduction and internal fixation, of whom 12 patients were identified with rare preoperative imaging features, the lesser trochanter was almost equally bisected. The main fracture pathoanatomy of these cases included: The anterior fracture line passed along the intertrochanteric line to the medial lesser trochanter and bisected it into 2 equal parts from mid-level of the lesser trochanteric protrusion. The proximal part of the lesser trochanter connected to the head-neck fragment and attached by the psoas major tendon, while the distal part of the lesser trochanter connected to the femoral shaft and attached by the tendon of the iliac muscle. These fractures were irreducible by a closed maneuver and were reduced with limited assistance by some devices, and short intramedullary nails were used for fixation of these fractures.
All patients were followed up for an average of 14.2 ± 2.1 months. Clinical fracture union occurred at an average of 10.8 ± 1.5 weeks, while radiographic union occurred at an average of 12.7 ± 1.2 weeks. No cut out of the helical blade was visible on radiographs. The average Parker-Palmer score was 6.9 ± 1.3 (range, 5-9) at the last follow up, including 8 cases rated as excellent, 2 as good and 2 as fair.
Two-part pertrochanteric femur fractures with bisection of the lesser trochanter have an irreducible fracture pattern with cortical locking and soft tissue incarceration. Soft tissue release and short cephalomedullary nail fixation for this fracture pattern provide stable fixation and allow early exercise. This treatment appears to have excellent outcomes in the short and medium terms.
介绍一种罕见的小转子二分法的不可复位型股骨转子间骨折的临床特征及手术技术。
2017年1月至2019年12月，357例股骨转子间/转子下骨折患者接受了闭合复位内固定手术，其中12例患者术前影像学表现罕见，小转子几乎被均分为两部分。这些病例的主要骨折病理解剖包括：前骨折线沿转子间线至内侧小转子，并从小转子突出部中点将其均分为两等份。小转子近端与头颈骨块相连，由腰大肌腱附着，而小转子远端与股骨干相连，由髂肌肌腱附着。这些骨折无法通过闭合手法复位，需借助一些器械进行有限辅助复位，并用短髓内钉固定这些骨折。
所有患者平均随访14.2±2.1个月。临床骨折愈合平均发生在10.8±1.5周，而影像学愈合平均发生在12.7±1.2周。X线片上未见螺旋刀片穿出。末次随访时帕克-帕尔默评分平均为6.9±1.3（范围5-9），其中优8例，良2例，可2例。
小转子二分法的两部分股骨转子间骨折具有不可复位的骨折模式，伴有皮质锁定和软组织嵌顿。对于这种骨折模式，软组织松解和短头髓内钉固定可提供稳定的固定并允许早期活动。这种治疗在短期和中期似乎有良好的效果。
