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High-energy caused intertrochanteric fractures in adult patients

摘要


Background: Although intertrochanteric fractures (IF) are common, the majority of IF occur in elderly patients with low-energy injuries. Highenergy caused IF are uncommon and the outcomes after treatment have few been reported. Following far advancement of modern medicine and technology, the prognosis may be quite different. Purpose: The purpose of this retrospective study intended to report the treatment outcomes of high-energy caused IF at our institution. A guide for treating such uncommon but potentially difficultly managed injuries might be established. Methods: For the 3.5-year period, 655 IF were treated. Thirty-six IF occurred due to high-energy injuries (5.5%, 36/655). Patients aged from 18-59 years (average, 32 years) with a male to female ratio of 6 to 1. Associated injuries were common (non-skeletal injury, 27.8%; skeletal injury, 47.2%). Three patients died before surgical treatment started (8.3%, 3/36). Thirty-three IF were surgical treated after an average of 4.5 days (range, 1.5-15.0 days). Three types of internal fixators were used: sliding hip screws (SHS), reconstructive locked nails, and dynamic condylar screws (DCS). In principle, stable IF was treated with SHS and unstable IF, nailing or DCS. Postoperatively, early ambulation with protected weight bearing was encouraged. The Harris Hip Score (HHS) was used to evaluate the subjective hip function. Results: Twenty-seven patients were followed for an average of 1.8 years (range, 1.1-4.2 years). Twenty-six IF healed with a union rate of 96% and an average union time of 3.7 months (range, 2.5-6.0 months). One aseptic nonunion was treated with cancellous bone grafting and healed uneventfully. Two deep infections occurred and repeated debridement was performed. Satisfactory hip function (by HHS) was achieved in 89% of patients (24/27). Conclusion: High-energy caused IF is uncommon. When it occurs, multiple associated injuries may co-exist concomitantly. Current techniques with various internal fixators for IF may achieve a high success rate and a low complication rate. Referring to the current and previously reported studies, the prognosis after surgical treatment is normally satisfactory.

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