Femoral intertrochanteric fracture is a common injury in the elderly. The annual incidence is approximately 50 per 100,000, with a higher incidence in women. 90% of intertrochanteric fractures in the elderly are caused by falls alone. Increasing age makes the elderly prone to falls, and this is exacerbated by decreased vision, decreased muscle strength, unstable blood pressure, decreased responsiveness, vascular disease and coexisting musculoskeletal pathology.
Surgery is the treatment of choice for many patients with intertrochanteric fractures, as it allows for early recovery and ideal functional recovery. However, surgery also carries certain risks, and even some have a sometimes high mortality rate due to poor physical condition and inability to tolerate anesthesia and surgery. However, conservative therapies such as ambulatory traction have the same risks and high complications, such as pressure sores, urinary tract infections, pneumonia, thrombosis, and joint contractures.
Surgical procedures include incision and internal fixation, percutaneous or semi-closed internal fixation, and external fixation frames. There are two types of internal fixation: extramedullary and intramedullary fixation. The variety of fixation materials used in the surgery of intertrochanteric fracture is the largest, and there are still new fixation devices invented and applied so far.
I. Improvement of sliding hip screw
1.The first successful internal fixation implant is the angle fixed screw plate device (e.g. Jewett screw, Holt screw), which consists of a plate with an angle of about 133° and a triple-edged nail fixed on it.
2.Sliding screw plate device (e.g. Massie screw, Ken-Push screw), which consists of a pressurized screw that can fix the proximal fracture block and a slide-slotted plate, and the screw can move in the slide-slotted plate, and the pressure can make contact with the broken segment.
3.Sliding hip screw: such as DHS, is a more widely used and successful device.
4.Variable angle hip screw, such as VHS, is a sliding hip screw that conforms to different neck stem angles by adjusting the angle of the slide groove steel plate.
5.Talon compression hip screws: four reverse extension fork-like projections at the threads at the bottom of the screw, in order to better occlude the bone dense material below the femoral neck.
6.Rotor fixation plate and lateral support plate:The standard component to support the greater trochanter is added.
7.Medoff plate is a biaxial power pressurized plate, the component plate allows the built-in to slide along the femoral neck and femoral stem in both directions.
8, Percutaneous locking plate: Using a locking device, two or more locking thick screws can be used in the femoral neck. Now there are several types, but they are all similar.
Second, the intramedullary device
1.Gamma nail: nail shape like γ-shaped, currently more used.
2, short intramedullary hip screws: both IMMS.
3, rotor paralleling intramedullary nail: TAN.
4, proximal femoral intramedullary nail: PFN, and there are PFNA designed for Asian people, currently more widely used.
5, rotor fixation intramedullary nail: TFN is a kind of femoral reconstruction nail.
Third, external bone fixation: refers to the application of external fixation frame fixation
There are many types, such as: Orthofix fixation frame, combined external fixation frame, etc.
External fixation frame has short operation time, less blood loss, and can be handled by local anesthesia. It can be considered for some patients who have more risk of complications and cannot tolerate anesthesia or incisional surgery for internal fixation. However, there are also complications such as loosening of fixation pins, infection and hip inversion.
IV. Artificial joint replacement
The current standard indications regarding artificial femoral head or total hip replacement for treatment of intertrochanteric fracture are: patients with failed internal fixation. However, there is also a grasp of the application of over 75 years old, comminuted or unstable fractures, which should be taken with caution, and there are also reactionary views, but there is no consensus.