PDF(Pubmed)
Abstract：
OBJECTIVE: Reverse oblique (RO) and transverse intertrochanteric fracture patterns constitute a challenge for the operating surgeon. Currently, no gold standard fixation method exists. This study aimed to retrospectively compare proximal femoral nail (PFN) to dynamic condylar screw (DCS) plating in the treatment of RO and transverse intertrochanteric fractures.
METHODS: A total of 61 patients fixated by PFN or DCS were included. Of these, 36 were treated with PFN (21 females and 15 males; mean age: 65.52 years), and 25 were treated with DCS (12 females and 13 males; mean age: 59.36 years). The mean follow-up time was 33.8 and 42.6 months (range: 24-108). Radiological evaluation included the quality of fracture reduction, neck-shaft angle change, posteromedial support presence, and bone union time. Complications such as mechanical failure, nonunion, and infection were noted.
RESULTS: The only significant differences between the fixation methods were the superiority of DCS over PFN in earlier fracture union time (mean values: 8.9 versus 14.1 weeks) and the superiority (p=0.007) of PFN in shorter hospital stay (3.4 days versus 5.1 days). No significant difference was observed in radiological parameters. While similar mechanical complication rates were found, a significantly higher nonunion rate was detected with the DCS.
CONCLUSIONS: The most crucial disadvantage of DCS was the high rate of nonunion. Closed fracture reduction in PFN seems to be the most critical parameter to prevent severe complications. The open reduction using DCS showed no advantages over closed reduction and PFN fixation in providing a more anatomical alignment in AO/Orthopaedic Trauma Association (OTA) 31-A3 fractures. However, we recommend PFN application in this type of fracture, since nonunion is more common in DCS.
METHODS: A total of 61 patients fixated by PFN or DCS were included. Of these, 36 were treated with PFN (21 females and 15 males; mean age: 65.52 years), and 25 were treated with DCS (12 females and 13 males; mean age: 59.36 years). The mean follow-up time was 33.8 and 42.6 months (range: 24-108). Radiological evaluation included the quality of fracture reduction, neck-shaft angle change, posteromedial support presence, and bone union time. Complications such as mechanical failure, nonunion, and infection were noted.
RESULTS: The only significant differences between the fixation methods were the superiority of DCS over PFN in earlier fracture union time (mean values: 8.9 versus 14.1 weeks) and the superiority (p=0.007) of PFN in shorter hospital stay (3.4 days versus 5.1 days). No significant difference was observed in radiological parameters. While similar mechanical complication rates were found, a significantly higher nonunion rate was detected with the DCS.
CONCLUSIONS: The most crucial disadvantage of DCS was the high rate of nonunion. Closed fracture reduction in PFN seems to be the most critical parameter to prevent severe complications. The open reduction using DCS showed no advantages over closed reduction and PFN fixation in providing a more anatomical alignment in AO/Orthopaedic Trauma Association (OTA) 31-A3 fractures. However, we recommend PFN application in this type of fracture, since nonunion is more common in DCS.
摘要：
目的：反向斜（RO）和横向股骨转子间骨折模式对手术外科医生构成了挑战。目前,不存在金标准固定方法。本研究旨在回顾性比较股骨近端髓内钉（PFN）与动力髁螺钉（DCS）钢板治疗RO和股骨转子间横置骨折的疗效。
方法：共纳入61例PFN或DCS固定患者。其中,36例接受PFN治疗（21名女性和15名男性；平均年龄：65.52岁），25例接受DCS治疗（女性12例，男性13例；平均年龄：59.36岁）。平均随访时间为33.8和42.6个月（范围：24-108）。放射学评估包括骨折复位的质量，颈轴角度变化，后内侧支撑存在，和骨结合时间。并发症，如机械故障，骨不连,并注意到感染。
结果：固定方法之间唯一的显着差异是DCS在较早的骨折愈合时间（平均值：8.9对14.1周）优于PFN，而在较短的住院时间（3.4天对5.1天）内优于PFN（p=0.007）。在放射学参数中没有观察到显着差异。虽然发现了类似的机械并发症发生率，DCS检测到不愈合率明显较高.
结论：DCS最关键的缺点是骨不连的发生率高。PFN的闭合性骨折复位似乎是预防严重并发症的最关键参数。在AO/骨科创伤协会（OTA）31-A3骨折中，使用DCS进行的切开复位与闭合复位和PFN固定相比没有优势。然而,我们建议在这种类型的骨折中应用PFN，因为骨不连在DCS中更常见。
方法：共纳入61例PFN或DCS固定患者。其中,36例接受PFN治疗（21名女性和15名男性；平均年龄：65.52岁），25例接受DCS治疗（女性12例，男性13例；平均年龄：59.36岁）。平均随访时间为33.8和42.6个月（范围：24-108）。放射学评估包括骨折复位的质量，颈轴角度变化，后内侧支撑存在，和骨结合时间。并发症，如机械故障，骨不连,并注意到感染。
结果：固定方法之间唯一的显着差异是DCS在较早的骨折愈合时间（平均值：8.9对14.1周）优于PFN，而在较短的住院时间（3.4天对5.1天）内优于PFN（p=0.007）。在放射学参数中没有观察到显着差异。虽然发现了类似的机械并发症发生率，DCS检测到不愈合率明显较高.
结论：DCS最关键的缺点是骨不连的发生率高。PFN的闭合性骨折复位似乎是预防严重并发症的最关键参数。在AO/骨科创伤协会（OTA）31-A3骨折中，使用DCS进行的切开复位与闭合复位和PFN固定相比没有优势。然而,我们建议在这种类型的骨折中应用PFN，因为骨不连在DCS中更常见。
