Abstract Objective To investigate the treatment of femoral cricoid fractures. Methods 105 cases of femoral cricoid fractures were fixed with the combination of DHS plus hollow thread nail, and the stability after treatment was observed. The fractures were all healed without hip inversion deformity and bone discontinuity, and the hip joint function was normal. Conclusion The combination of DHS and hollow screw fixation of cricoid fracture is an ideal method.
Keywords DHS; hollow screw; intertrochanteric fracture of femur, Siping Central Hospital, Department of Orthopaedics, Chen Xiaoming
DHS and cannulated compressive for intertrochanteric fracture
Chen Xiaoming, Wang Dapeng, Ye Xiangiang, Chen Yuan. Department of Orthopaedics, The center of Hospitol of Siping 136000.
Abstract Objective To investigate the treatment for intertrochanteric fracture.
Methods 105cases with intertrochanteric fracture were fixed with DHS and cannulated screws then abserved the fixation of treatment.Results All of the cases were cured after followed up 12-24 months. without happeness of coax vara and nonunion. hip joint function normal.Conclusions DHS and cannulated compressive screws is the ideal treatment for intertrochanteric fracture.
Key words DHS; cannulated compressive screws; intertrochanteric fracture
DHS is currently the most widely used standard surgical method for the treatment of intertrochanteric fractures [1], but it is particularly prominent in cisfemoral trochanteric fractures because of its short fixation distance to the proximal end of the fracture and its lack of resistance to rotation. The author has explored this problem by using DHS with hollow screws in 105 cases from January 2000 to May 2005. They are described as follows.
1. Materials and methods
1.1 Case data In this group of 105 cases, 63 males and 42 females, aged 28-79 years, with simple cis
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~Department of Orthopedics, Siping Central Hospital, Jilin Province, China 136000
There were 54 cases of coarctation fracture of femur and 49 cases of comminuted fracture of cis coarctation.
Causes of injury: 59 cases of car accident injury, 38 cases of walking and slipping and falling, and 8 cases of bed fall injury. The time from injury to surgery was Q3 days in 29 cases, >5 days in 79 cases, combined with cardiopulmonary hypertension in 19 cases, diabetes in 16 cases, liver and kidney damage in 11 cases, sequelae of cerebrovascular disease in 24 cases, osteoporosis in 28 cases, and others were normal.
1.2 Selected materials 74 cases of domestic stainless steel L317 type DHS, 29 cases of domestic titanium type, and 2 cases of AO type DHS.
1.3 Treatment After admission, after routine preoperative examination, there were no contraindications, and those with cardiopulmonary, hepatic and renal insufficiency and diabetes mellitus, after adjustment, appropriate DHS and several hollow screws were selected and sterilized according to the fracture type and physique. The surgery was performed after continuous epidural anesthesia. The patient is placed supine on the traction bed, the healthy limb is fixed, and the affected limb is slowly tractioned, gradually changing from the externally rotated position to the neutral position to the internally rotated 15° position. cm from the femoral moment. After the C-arm fluoroscopy is appropriate, first screw a hollow screw of appropriate length with padding along the upper guide pin to fix it, remove the upper guide pin, then drill and tap through the lower guide pin, screw a coarse threaded nail to place the DHS staple plate to fix it, and place a drainage suture to close the incision (Figure 1 and 2).
1.4 Postoperative treatment After surgery, antibiotics were routinely applied and comorbidities were actively prevented and treated without traction or other external fixation.
2. Results
105 patients were followed up from 12 to 24 months, with a mean of 15 months. Among them, there were 2 cases with delayed healing, mainly due to severe osteoporosis and combined with diabetes mellitus, but all the rest healed without displacement or hip inversion.
According to the following criteria.
Excellent: no pain in the affected hip, no claudication, normal hip function, 86 cases.
Good: discomfort in the affected hip, basically normal function, basically no claudication, 12 cases.
OK: slight pain in the affected hip, fair function, 5 cases.
Poor: the affected hip had pain, the range of motion of the hip joint became smaller, the neck stem angle was less than normal, and the walking limp was observed in 2 cases.
The excellent rate of this group was 93.33%.
3. Discussion
3.1 Disadvantages of DHS fixation alone Cis-femoral trochanteric fractures occupy an important part in the whole trochanteric fracture, and DHS treatment is more suitable for this fracture type, and generally can achieve good clinical treatment results. However, for a portion of the fracture line near the base of the femoral neck and close to the femoral neck, the disadvantages of simple DHS fixation are prominent: (1) the fracture between the femoral neck and the trochanter is borderline, and simple DHS fixation cannot resist rotation, so the proximal end of the fracture is not firmly fixed; (2) the distal part of the fracture through the screw is short, and the fixation holding force is small and not stable enough; (3) the single nail is often located in the center of the femoral neck, and the surrounding (3) the single nail is often located in the center of the femoral neck, around which there is a lot of cancellous bone, and it is easy to produce loosening in the cancellous bone, which is unfavorable to DHS fixation.
3.2 Advantages of adding hollow screws
3.2.1 Two nails, one thick and one thin, form a mother and father nail, which are positioned at the upper and lower edges of the femoral neck, and the span of fixation of the two nails is large and the effective fixation area is increased.
3.2.2 Double nail fixation with two holding points to make up for the shortcomings of shallow fixation screws and short force distance.
3.2.3 It has obvious anti-rotation and avoids shear force, which is beneficial to the stability and healing of the fracture.
3.3. Since the hollow screw its unthreaded part passes through the fracture line, it does not affect the sliding function of the DHS sleeve and does not lose its dynamic effect.
Through clinical application, we believe that DHS plus hollow screw fixation has obvious advantages over simple DHS fixation for cis femoral ramus type fractures, and the addition of a hollow screw to fix the fracture line in an attempt to control the occurrence of hip inversion showed that the incidence of hip inversion and limb shortening decreased and was statistically significant [2]. It provides a reliable guarantee for controlling the rotation of the fracture end and preventing the complications of proximal femur fracture due to the nail end, which is an effective method for treating cisfemoral trochanteric fractures.
References
1 Yin Chengzhong, Cai Xianhua, Ren Jian et al. Evaluation of the efficacy of DHS in the treatment of unstable intertrochanteric fractures of the femur. Journal of Bone and Joint Injury,2003,18(4):275
2 He Y Ma Z Z Xun S Huai et al. Comparison of DHS alone and DHS combined with trochanteric tension screws in the treatment of intertrochanteric fractures of the femur. Chinese Journal of Bone and Joint Injury,2006,21(1):62