Objective: To analyse the imaging characteristics of the irreducible femoral intertrochanteric fracture and evaluate the operative effect of closed poking reduction and intramedullary nail fixation.
Methods: From December 2011 to October 2015, 28 patients with irreducible femoral intertrochanteric fracture were treated by closed poking reduction and intramedullary nail fixation including 12 males and 16 females with an average age of 72 years old ranging from 58 to 89 years old. According to AO classification: 5 cases were type A2.1, 10 cases were type A2.2, 13 cases were type A3.3. The postoperative complications were observed, and the postoperative X ray were used to evaluate the fracture healing, and the Harris score was used to evaluate the hip joint function.
Results: Preoperative X rays for determine irreducible femoral intertrochanteric fracture was difficult, but dimensional CT had characteristic performance: the fracture near the end displaced forward rotation. Operation time was 45 to 100 minutes with an average of 65 minutes. Intraoperative bleeding was 80 to 300 ml with an average of 160 ml. Two cases died within 3 months after operation, 26 patients were followed up for 6 to 12 months with an average of 8.4 months. Fracture healing time was 12 to 16 weeks with an average of 13.6 weeks. Two cases occurred inversion deformity.There were no wound infection, nonunion and fracture fixation failure. Hip Harris score was 86.7±5.3 at the last follow up, the result was excellent in 14 cases, good in 12 cases.
Conclusions: Dimensional CT can be very good to predict the fracture of the irreducible femoral intertrochanteric fracture. Closed poking reduction and intramedullary nail fixation for the treatment of the irreducible femoral intertrochanteric fracture has satisfactory clinical result.
Keywords: Femoral fractures; Fracture fixation, intramedullary; Surgical procedures, operative.