Twenty-one patients with Jensen type III intertrochanteric comminuted fractures were treated with DHS plus internal fixation with tension bands. The average operative time was 2 h, with intraoperative bleeding of 200 ml. 21 cases had postoperative bony healing, and 2 cases had complications. It was concluded that Jensen type III comminuted intertrochanteric fracture is a complex fracture that is difficult to manage, and the results of DHS with tension band internal fixation were satisfactory for this type of fracture. Comminuted intertrochanteric fracture of the femur is a common type of hip fracture, and the fracture is comminuted, which is difficult to treat and has many postoperative complications, especially the treatment of type III comminuted intertrochanteric fracture combined with large trochanteric fracture is difficult, and the use of single internal fixation often cannot achieve satisfactory results. From June 2005 to February 2008, 21 patients with Jensen type III intertrochanteric comminuted fractures were treated with DHS plus tension band internal fixation with satisfactory results. The results are reported as follows. 1. Data and methods 1.1 Clinical data There were 21 cases in this group, including 12 males and 9 females, aged 51-78 years, with an average age of 66 years, all of whom had Jensen type III comminuted intertrochanteric fracture of the femur. Among them, 19 cases were caused by inadvertent fall injury and 2 cases were traffic accident injury. 1.2 Treatment Preoperative tibial tuberosity traction was performed for 3 d. The traction weight was 1/7 of the patient’s body mass, and preoperative radiographs showed that the fracture had been basically reset. Procedure: After epidural anesthesia, the patient’s affected limb was placed on an orthopedic surgical traction bed, and traction was performed under C-arm X-ray machine fluoroscopy. After repositioning, the affected limb was abducted by 30° and slightly internally rotated, and a certain amount of traction was maintained on the traction support to maintain the fracture in a repositioned state and avoid intraoperative displacement and shortening. Under C-arm fluoroscopy, the guide pin is inserted 2-3 cm below the apex of the greater trochanter with a 135° DHS positioner, and since the fracture line of the greater trochanter is often at or near the entry point, the fracture can be repositioned with two large cloth towel clamps before inserting the guide pin. The guide pin is then inserted. The orthotropic position is along the long axis of the femoral neck, parallel to the femoral moment, and laterally in the middle of the long axis of the femoral neck, with the tip of the guide pin reaching under the cartilaginous surface of the femoral head. The length of the guide pin into the femoral neck segment is measured, the corresponding length of hip screw is selected (minus 0.5 cm), and after reaming and tapping with a triple DHS reamer (no tapping is required for obvious osteoporosis), the screw is screwed in, the guide pin is dialed out, and the DHS plate is screwed to the femoral stem. Then, two Kirschner pins were driven in parallel from the greater trochanter to the lesser trochanter, respectively, through the front and back of the screw, and the wire was tightened with pressure around the end of the Kirschner pin and the end of the screw to form a tension band, and the fracture of the trochanter was gradually reset while the wire was tightened. The wound is irrigated, a negative pressure drainage tube is placed, and the incision is closed sequentially. Postoperative management: functional exercise of the quadriceps muscle and dorsiflexion and plantarflexion of the ankle joint were performed after the anesthesia effect disappeared. Functional exercise with CPM of the lower extremity was started 1 week after surgery. After 4 weeks, bedside activities and non-weight-bearing exercises with double crutches or walking frames were performed. Premature weight-bearing was strictly prohibited in patients with osteoporosis. 2. Results The average operation time of this group was 2 h, with intraoperative bleeding of 200 ml. The follow-up time of this group was 6 to 18 months, with an average of 9 months, of which 90.4G obtained satisfactory results. Complications occurred in two cases, one case combined with pneumonic pneumonia and one case with hip inversion. All the cases in this group had bony healing with an average healing time of 2.5 months. According to the efficacy assessment criteria of Huang Gongyi et al [1], 14 cases were excellent, 6 cases were good, with an excellent rate of 95.2% and 1 case was poor, accounting for 4.8%. The pre- and postoperative radiographs are shown in Figure 1. 3. Discussion There are various methods to classify intertrochanteric fractures [2], and the commonly used ones are the AO, Evans and Jensen typing, etc. Jensen improved the Evans typing by dividing the fracture into five types based on the involvement of the large and small trochanter and the stability of the fracture after repositioning, and the Jensen type III intertrochanteric comminuted fracture is a more common Jensen type III intertrochanteric comminuted fracture is a more common type of severe injury, combined with fracture of the greater trochanter. It is highly prevalent in elderly patients and is often combined with varying degrees of osteoporosis. The patients selected in this group were all patients with type III intertrochanteric comminuted fracture, with obvious fracture misalignment and relatively free large trochanteric bone mass due to the tension of the gluteus medius muscle pulling, which is difficult to treat clinically and difficult to fix by repositioning with separate internal fixation. Because the greater trochanter is attached by the abductor muscles (especially the gluteus medius), a firm fixation of the greater trochanter during surgery is important for early weight bearing and maintenance of normal standing posture of the patient. It can also reduce complications and improve the long-term treatment outcome. Most scholars prefer surgical treatment for comminuted intertrochanteric fractures. Commonly used are nail plate internal fixation systems, such as Jewett nail plate, pressurized sliding screw, proximal femoral anatomic plate, etc., and intramedullary fixation systems, such as Ender nail, Gamma nail, proximal femoral intramedullary nail, etc. For the treatment of Jensen type III intertrochanteric comminuted fractures, the use of DHS internal fixation alone may not achieve firm fixation of both the intertrochanteric fracture and the large trochanteric bone mass. Also, because DHS internal fixation makes the head and neck relative to the femoral stem slippery, it may not fix the bone mass firmly. If the greater trochanteric fracture is not treated, postoperative bed rest plus external fixation with traction is still necessary, thus increasing the complication rate. We have found that the use of DHS internal fixation combined with multiple fixation of the greater trochanteric fracture with a tension band has resulted in a unified fracture of the trochanteric comminuted fracture with an ideal repositioning, and the use of a tension band not only fixes the greater trochanteric fracture better against the tension of the gluteus medius muscle, but also allows compression in the vertical direction, which promotes fracture healing while maintaining stability, The patient can also move to the floor earlier after surgery. It is easy to place the kyphotic pin and the wire tension band during the operation, and it is convenient for the patient to remove the internal fixation after the operation. (2) The fracture end of the greater trochanter is clearly exposed and repositioned under direct vision, and is fixed with two large cloth towel clamps with up and down pressure; (3) The guide pin is then drilled under fluoroscopy, and the entry point of the guide pin may be just past the fracture line at this time, and after the position of the guide pin is satisfactory, the reaming drill should be drilled with ④In case of osteoporotic patients, the screws can be screwed in directly without the use of the wire; ⑤The Kirschner pin for fixing the greater trochanter should be passed from the upper and lower sides of the screw, and the tension band wire should be passed under the sleeve plate, and the wire should be tightened and pressurized after the plate is fixed (6) The angle of the Kirschner needle should be changed according to the position of the fracture line, and the angle with the femoral distance should be reduced under the premise of striving for stable fixation, and the pressure effect should be good.