scholarly journals Comparison of Robot Versus Fluoroscopy-Assisted Pedicle Screw Instrumentation in Adolescent Idiopathic Scoliosis Surgery

2021 ◽  
Author(s):  
Canglong Hou ◽  
Yu Chen ◽  
Mingyuan Yang ◽  
Yilin Yang ◽  
Huan Yang ◽  
...  
Keyword(s):  
Blood Loss ◽  
Clinical Outcomes ◽  
Pedicle Screws ◽  
Operation Time ◽  
Scoliosis Surgery ◽  
Scoliotic Curve ◽  
Robot Assisted ◽  
Screw Insertion ◽  
Radiological Data ◽  
Transfusion Volume

Abstract The aim of this study is to explore whether robot-assisted technique has advantages over conventional fluoroscopy-assisted technique in clinical and radiological outcomes and whether it could decrease the incidence of mis-implantations of pedicle screws in AIS correction surgery.A total of 101 AIS patients were recruited (RA group: 45 patients underwent robot-assisted screw insertion; FA group: 56 patients underwent fluoroscopy-assisted screw insertion). When compared the radiological data between two groups, major and secondary curve were both corrected proficiently with no difference in the Cobb angle comparison at last follow-up, suggesting that both robot-assisted technique and fluoroscopy-assisted technique could lead to efficient radiographic correction and similar clinical outcomes (all, P<0.05). In RA group, operation time, blood loss and transfusion volume were significantly greater than those in FA group, while the accuracy of screw implantations in AIS patients with thoracic scoliotic curve in RA group was higher than that in FA group.In conclusion, both robot-assisted and fluoroscopy-assisted technique could reach proficient radiographic correction and similar clinical outcomes in AIS surgery. Compared with conventional fluoroscopy technique, robot-assisted technique might improve the accuracy of screw implantations in AIS patients with thoracic scoliotic curve, while the increased operation time, blood loss and transfusion volume might be the disadvantages due to preliminary stage of learning curve.

scholarly journals Microscopic extra-laminar sequestrectomy (MELS) for the treatment of hidden zone lumbar disc herniation: report of the surgical technique, patient selection, and clinical outcomes

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Chunxiao Wang ◽  
Yao Zhang ◽  
Xiaojie Tang ◽  
Haifei Cao ◽  
Qinyong Song ◽  
...  
Keyword(s):  
Blood Loss ◽  
Learning Curve ◽  
Clinical Outcomes ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Operation Time ◽  
Operation Duration ◽  
The Mean

Abstract Background The area which located at the medial pedicle, posterior vertebral body and ventral hemilamina is defined as the hidden zone. Surgical management of hidden zone lumbar disc herniation (HZLDH) is technically challenging due to its difficult surgical exposure. The conventional interlaminar approach harbors the potential risk of post-surgical instability, while other approaches consist of complicated procedures with a steep learning curve and prolonged operation time. Objective To introduce microscopic extra-laminar sequestrectomy (MELS) technique for treatment of hidden zone lumbar disc herniation and present clinical outcomes. Methods Between Jan 2016 to Jan 2018, twenty one patients (13 males) with HZLDH were enrolled in this study. All patients underwent MELS (19 patients underwent sequestrectomy only, 2 patients underwent an additional inferior discectomy). The nerve root and fragment were visually exposed using MELS. The operation duration, blood loss, intra- and postoperative complications, and recurrences were recorded. The Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and the modified MacNab criteria were used to evaluate clinical outcomes. Postoperative stability was evaluated both radiologically and clinically. Results The mean follow-up period was 20.95 ± 2.09 (18–24) months. The mean operation time was 32.43 ± 7.19 min and the mean blood loss was 25.52 ± 5.37 ml. All patients showed complete neurological symptom relief after surgery. The VAS and ODI score were significantly improved at the final follow-up compared to those before operation (7.88 ± 0.70 vs 0.10 ± 0.30, 59.24 ± 10.83 vs 11.29 ± 3.59, respectively, p < 0.05). Seventeen patients (81%) obtained an “excellent” outcome and the remaining four (19%) patients obtained a “good” outcome based the MacNab criteria. One patient suffered reherniation at the same level one year after the initial surgery and underwent a transforaminal endoscopic discectomy. No major complications and postoperative instability were observed. Conclusions Our observation suggest that MELS is safe and effective in the management of HZLDH. Due to its relative simplicity, it comprises a flat surgical learning curve and shorter operation duration, and overall results in reduced disturbance to lumbar stability.

scholarly journals Is It Necessary to Reduce Thoracolumbar Compression Fractures  with Intermediate Screws in the Fractured Vertebra?

2021 ◽  
Author(s):  
ZeJun Xing ◽  
Shuai Hao ◽  
XiaoFei Wu
Keyword(s):  
Blood Loss ◽  
Body Height ◽  
Pedicle Screws ◽  
Operation Time ◽  
Short Segment ◽  
Compression Fractures ◽  
Significant Difference ◽  
Before And After ◽  
Screw Group

Abstract PurposeTo compare the efficacy and safety of percutaneous short-segment pedicle screws fixation (PPSF) with or without intermediate screws (IS) for the treatment of thoracolumbar compression fractures.MethodsFrom January 2016 to March 2019, a retrospective study of 38 patients with thoracolumbar compression fractures conducted. The patients were divided into a 4-screw group (without IS) and a 6-screw group (with IS) according to whether pedicle screws were placed in the fractured vertebrae. Combined positional reduction effects with the technique of pre-contoured lordotic rods were used to reduce the fracture by lengthening the anterior column of the fractured vertebrae. The posterior structure of the fractured vertebrae was undertaken as the fulcrum point for both groups. The operation time, intra-operative blood loss, visual analogue scale (VAS), anterior vertebral body height (AVBH), segment kyphosis（SK）before and after operation and complications were recorded.ResultsAlthough the operation time and blood loss in the 6-screw group were higher than in the 4-screw group, difference was not significant (P＞0.05). There was no significant difference in VAS, AVBH and SK between the two groups (P＞0.05). Nevertheless, these results were significant differences between the preoperative and the immediate postoperative, between preoperative and follow-up groups (P < 0.001). No neurologic injury was observed in either groups. ConclusionsIn the treatment of thoracolumbar compression fractures, percutaneous short-segment pedicle screws fixation without intermediate screws in the 4-screw construct may obtain the same clinical effect as that in the 6-screw construct.

scholarly journals Does the application of Robotics improve outcomes of pedicle screw insertion in spine surgery compared to conventional fluoroscopy guidance? A protocol for Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Vishal Kumar ◽  
Vishnu Baburaj ◽  
Prasoon Kumar ◽  
Sarvdeep Singh Dhatt
Keyword(s):  
Systematic Review ◽  
Pedicle Screw ◽  
Clinical Outcomes ◽  
Spine Surgery ◽  
Meta Analysis ◽  
Pedicle Screws ◽  
Screw Placement ◽  
Screw Insertion ◽  
Pedicle Screw Insertion ◽  
Fluoroscopy Guidance

AbstractBackgroundPedicle screw insertion is routinely carried out in spine surgery that has traditionally been performed under fluoroscopy guidance. Robotic guidance has recently gained popularity in order to improve the accuracy of screw placement. However, it is unclear whether the use of robotics alters the accuracy of screw placement or clinical outcomes.ObjectivesThis systematic review aims to compare the results of pedicle screws inserted under fluoroscopy guidance, with those inserted under robotic guidance, in terms of both short-term radiographic outcomes, as well as long-term clinical outcomes.MethodsThis systematic review will be conducted according to the PRISMA guidelines. A literature search will be conducted on the electronic databases of PubMed, Embase, Scopus, and Ovid with a pre-determined search strategy. A manual bibliography search of included studies will also be done. Original articles in English that directly compare pedicle screw insertion under robotic guidance to those inserted under fluoroscopy guidance will be included. Data on outcomes will be extracted from included studies and analysis carried out with the help of appropriate software.

Microscopic extra-laminar sequestrectomy (MELS) for the treatment of hidden zone lumbar disc herniation: report of the surgical technique, patient selection, and clinical outcomes

2020 ◽  
Author(s):  
Chunxiao Wang ◽  
Yao Zhang ◽  
Xiaojie Tang ◽  
Haifei Cao ◽  
Qinyong Song ◽  
...  
Keyword(s):  
Blood Loss ◽  
Learning Curve ◽  
Clinical Outcomes ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Operation Time ◽  
Operation Duration ◽  
The Mean

Abstract Background Surgical management of lumbar disc herniation in the hidden zone is technically challenging due to its difficult surgical exposure. The conventional interlaminar approach harbors the potential risk of post-surgical instability, while other approaches consist of complicated procedures with a steep learning curve and prolonged operation time. Objective To introduce a safe and effective technique named microscopic extra-laminar sequestrectomy (MELS) for treatment of hidden zone lumbar disc herniation and present clinical outcomes within a two year follow-up period. Methods Between Jan 2016 to Jan 2018, twenty one patients (13 males) with hidden zone lumbar disc herniation were enrolled in this study. All patients underwent MELS (19 patients underwent sequestrectomy only, 2 patients underwent an additional inferior discectomy). The nerve root and herniated fragment were visually exposed using this extra-laminar approach. The operation duration, blood loss, intra- and postoperative complications, and recurrences were recorded. The Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and the modified MacNab criteria were used to evaluate clinical outcomes. Postoperative stability was evaluated both radiologically and clinically. Results The mean follow-up period was 20.95 ± 2.09 months, ranging from 18 to 24 months. The mean operation time was 32.43 ± 7.19 min and the mean blood loss was 25.52 ± 5.37 ml. All patients showed complete neurological symptom relief after surgery. The VAS and ODI score were significantly improved at the final follow-up compared to those before operation (7.88 ± 0.70 vs 0.10 ± 0.30, 59.24 ± 10.83 vs 11.29 ± 3.59, respectively, p < 0.05). Seventeen patients (81%) obtained an “excellent” outcome and the remaining four (19%) patients obtained a “good” outcome based the MacNab criteria. One patient suffered reherniation at the same level one year after the initial surgery and underwent a transforaminal endoscopic discectomy. No major complications and postoperative instability were observed. Conclusions Our observation suggest that MELS is a safe and effective method in the management of hidden zone lumbar disc herniation. Due to its relative simplicity, it comprises a flat surgical learning curve and shorter operation duration, and overall results in reduced disturbance to lumbar stability.

Impact of an Ultrasonically Activated Device in Robot-Assisted Distal Gastrectomy

2017 ◽  
Vol 12 (6) ◽  
pp. 453-458
Author(s):  
Makoto Hikage ◽  
Masanori Tokunaga ◽  
Rie Makuuchi ◽  
Yutaka Tanizawa ◽  
Etsuro Bando ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Blood Loss ◽  
Surgical Outcomes ◽  
Distal Gastrectomy ◽  
Operation Time ◽  
Patient Characteristics ◽  
Clinicopathological Characteristics ◽  
Robot Assisted ◽  
Estimated Blood Loss ◽  
Device Use

Objective Robot-assisted gastrectomy is increasingly used for the treatment of gastric cancer, although it remains a time-consuming procedure. An ultrasonically activated device might be useful to shorten operation times. This study therefore assessed the effect of ultrasonically activated device use on procedural times and on other early surgical outcomes. Methods Consecutive patients (N = 42) who underwent robot-assisted distal gastrectomy for gastric cancer were included. Clinicopathological characteristics and early surgical outcomes were compared between robotic-assisted gastrectomy procedures using an ultrasonically activated device (U group, n = 21) and those without it (NU group, n = 21). Results There were no significant differences in patient characteristics between the groups; however, the median operation time was significantly less in the U group than in the NU group (291 vs 351 minutes, P = 0.006). In detail, the median duration of console time until dividing the duodenum was less in the U group (70 vs 102 minutes, P < 0.001). Estimated blood loss, incidence of postoperative morbidity, and duration of postoperative hospital stay were not different between the groups. Conclusions An ultrasonically activated device reduced the operation time of robot-assisted gastrectomy without increasing blood loss and morbidity.

scholarly journals Accuracy of robot-guided versus freehand fluoroscopy-assisted pedicle screw insertion in thoracolumbar spinal surgery

2017 ◽  
Vol 42 (5) ◽  
pp. E14 ◽  
Author(s):  
Granit Molliqaj ◽  
Bawarjan Schatlo ◽  
Awad Alaid ◽  
Volodymyr Solomiichuk ◽  
Veit Rohde ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Spinal Instrumentation ◽  
Pedicle Screws ◽  
Screw Placement ◽  
Robotic Assistance ◽  
Anatomical Landmarks ◽  
Pedicle Screw Placement ◽  
Robot Assisted ◽  
Screw Insertion ◽  
Freehand Technique

OBJECTIVEThe quest to improve the safety and accuracy and decrease the invasiveness of pedicle screw placement in spine surgery has led to a markedly increased interest in robotic technology. The SpineAssist from Mazor is one of the most widely distributed robotic systems. The aim of this study was to compare the accuracy of robot-guided and conventional freehand fluoroscopy-guided pedicle screw placement in thoracolumbar surgery.METHODSThis study is a retrospective series of 169 patients (83 women [49%]) who underwent placement of pedicle screw instrumentation from 2007 to 2015 in 2 reference centers. Pathological entities included degenerative disorders, tumors, and traumatic cases. In the robot-assisted cohort (98 patients, 439 screws), pedicle screws were inserted with robotic assistance. In the freehand fluoroscopy-guided cohort (71 patients, 441 screws), screws were inserted using anatomical landmarks and lateral fluoroscopic guidance. Patients treated before 2009 were included in the fluoroscopy cohort, whereas those treated since mid-2009 (when the robot was acquired) were included in the robot cohort. Since then, the decision to operate using robotic assistance or conventional freehand technique has been based on surgeon preference and logistics. The accuracy of screw placement was assessed based on the Gertzbein-Robbins scale by a neuroradiologist blinded to treatment group. The radiological slice with the largest visible deviation from the pedicle was chosen for grading. A pedicle breach of 2 mm or less was deemed acceptable (Grades A and B) while deviations greater than 2 mm (Grades C, D, and E) were classified as misplacements.RESULTSIn the robot-assisted cohort, a perfect trajectory (Grade A) was observed for 366 screws (83.4%). The remaining screws were Grades B (n = 44 [10%]), C (n = 15 [3.4%]), D (n = 8 [1.8%]), and E (n = 6 [1.4%]). In the fluoroscopy-guided group, a completely intrapedicular course graded as A was found in 76% (n = 335). The remaining screws were Grades B (n = 57 [12.9%]), C (n = 29 [6.6%]), D (n = 12 [2.7%]), and E (n = 8 [1.8%]). The proportion of non-misplaced screws (corresponding to Gertzbein-Robbins Grades A and B) was higher in the robot-assisted group (93.4%) than the freehand fluoroscopy group (88.9%) (p = 0.005).CONCLUSIONSThe authors’ retrospective case review found that robot-guided pedicle screw placement is a safe, useful, and potentially more accurate alternative to the conventional freehand technique for the placement of thoracolumbar spinal instrumentation.

scholarly journals Clinical Application of a Neurosurgical Robot in Intracranial Ommaya Reservoir Implantation

2021 ◽  
Vol 15 ◽  
Author(s):  
Huan-Guang Liu ◽  
De-Feng Liu ◽  
Kai Zhang ◽  
Fan-Gang Meng ◽  
An-Chao Yang ◽  
...  
Keyword(s):  
Blood Loss ◽  
Minimally Invasive ◽  
Operation Time ◽  
Hole Diameter ◽  
Drainage Tube ◽  
Ommaya Reservoir ◽  
Implantation Technique ◽  
Intraoperative Blood Loss ◽  
Robot Assisted ◽  
Robot Assisted Surgery

Background: The Ommaya reservoir implantation technique allows for bypass of the blood-brain barrier. It can be continuously administered locally and be used to repeatedly flush the intracranial cavity to achieve the purpose of treatment. Accurate, fast, and minimally invasive placement of the drainage tube is essential during the Ommaya reservoir implantation technique, which can be achieved with the assistance of robots.Methods: We retrospectively analyzed a total of 100 patients undergoing Ommaya reservoir implantation, of which 50 were implanted using a robot, and the remaining 50 were implanted using conventional surgical methods. We then compared the data related to surgery between the two groups and calculated the accuracy of the drainage tube of the robot-assisted group.Results: The average operation time of robot-assisted surgery groups was 41.17 ± 11.09 min, the bone hole diameter was 4.1 ± 0.5 mm, the intraoperative blood loss was 11.1 ± 3.08 ml, and the average hospitalization time was 3.9 ± 1.2 days. All of the Ommaya reservoirs were successful in one pass, and there were no complications such as infection or incorrect placement of the tube. In the conventional Ommaya reservoir implantation group, the average operation time was 65 ± 14.32 min, the bone hole diameter was 11.3 ± 0.3 mm, the intraoperative blood loss was 19.9 ± 3.98 ml, and the average hospitalization time was 4.1 ± 0.5 days. In the robot-assisted surgery group, the radial error was 2.14 ± 0.99 mm and the axial error was 1.69 ± 1.24 mm.Conclusions: Robot-assisted stereotactic Ommaya reservoir implantation is quick, effective, and minimally invasive. The technique effectively negates the inefficiencies of craniotomy and provides a novel treatment for intracranial lesions.

scholarly journals CT-to-fluoroscopy registration versus scan-and-plan registration for robot-assisted insertion of lumbar pedicle screws

2022 ◽  
Vol 52 (1) ◽  
pp. E8
Keyword(s):  
Pedicle Screw ◽  
Lumbar Fusion ◽  
Pedicle Screws ◽  
Retrospective Chart Review ◽  
Robot Assisted ◽  
Registration Method ◽  
Screw Insertion ◽  
Pedicle Screw Insertion ◽  
Radiology Reports ◽  
Lumbar Pedicle

OBJECTIVE Pedicle screw insertion for stabilization after lumbar fusion surgery is commonly performed by spine surgeons. With the advent of navigation technology, the accuracy of pedicle screw insertion has increased. Robotic guidance has revolutionized the placement of pedicle screws with 2 distinct radiographic registration methods, the scan-and-plan method and CT-to-fluoroscopy method. In this study, the authors aimed to compare the accuracy and safety of these methods. METHODS A retrospective chart review was conducted at 2 centers to obtain operative data for consecutive patients who underwent robot-assisted lumbar pedicle screw placement. The newest robotic platform (Mazor X Robotic System) was used in all cases. One center used the scan-and-plan registration method, and the other used CT-to-fluoroscopy for registration. Screw accuracy was determined by applying the Gertzbein-Robbins scale. Fluoroscopic exposure times were collected from radiology reports. RESULTS Overall, 268 patients underwent pedicle screw insertion, 126 patients with scan-and-plan registration and 142 with CT-to-fluoroscopy registration. In the scan-and-plan cohort, 450 screws were inserted across 266 spinal levels (mean 1.7 ± 1.1 screws/level), with 446 (99.1%) screws classified as Gertzbein-Robbins grade A (within the pedicle) and 4 (0.9%) as grade B (< 2-mm deviation). In the CT-to-fluoroscopy cohort, 574 screws were inserted across 280 lumbar spinal levels (mean 2.05 ± 1.7 screws/ level), with 563 (98.1%) grade A screws and 11 (1.9%) grade B (p = 0.17). The scan-and-plan cohort had nonsignificantly less fluoroscopic exposure per screw than the CT-to-fluoroscopy cohort (12 ± 13 seconds vs 11.1 ± 7 seconds, p = 0.3). CONCLUSIONS Both scan-and-plan registration and CT-to-fluoroscopy registration methods were safe, accurate, and had similar fluoroscopy time exposure overall.

Robot-assisted transthoracic first rib resection for venous thoracic outlet syndrome

Vascular ◽  
2021 ◽  
pp. 170853812199733
Author(s):  
Frank Hoexum ◽  
Vincent Jongkind ◽  
Hans ME Coveliers ◽  
Kak K Yeung ◽  
Willem Wisselink
Keyword(s):  
Blood Loss ◽  
Functional Outcomes ◽  
Thoracic Outlet Syndrome ◽  
Operation Time ◽  
Minimal Invasive ◽  
Robot Assisted ◽  
Rib Resection ◽  
First Rib ◽  
First Rib Resection

Background Venous thoracic outlet syndrome (vTOS) is caused by external compression of the subclavian vein at the costoclavicular junction. It can be subdivided in McCleery Syndrome and Paget-Schroetter Syndrome (PSS). To improve the venous outflow of the arm and to prevent recurrent thrombosis, first rib resection with venolysis of the subclavian vein can be performed. Open transaxillary, supraclavicular, infraclavicular or combined paraclavicular approaches are well known, but more recent robot-assisted techniques are introduced. We report our short- and long-term results of a minimal invasive transthoracic approach for resection of the anteromedial part of the first rib using the DaVinci surgical robot, performed through three trocars. Methods We analyzed all patients with vTOS who were scheduled to undergo robot-assisted transthoracic first rib resection in the period July 2012 to May 2016. Outcomes were: technical success, operation time, blood loss, hospital stay, 30-day complications and patency. Functional outcomes were assessed using the “Disability of the Arm, Shoulder and Hand” (DASH) questionnaire. Results Fifteen patients (8 male, 7 female; mean age 32.9 years, range 20–54 years) underwent robot-assisted transthoracic first rib resection. Conversion to transaxillary resection was necessary in three patients. Average operation time was 147.9 min (range 88–320 min) with a mean blood loss of 79.5 cc (range 10–550 cc). Mean hospital stay was 3.5 days (range 2–9). In three patients, complications were reported (Clavien-Dindo grade 2–3a). Patency was 91% at 15.5 months’ follow-up. DASH scores at one and three years showed excellent functional outcomes (7.1 (SD= 6.9, range 0–20.8) and 6.0 (SD= 6.4, range 0–25)) and are comparable to the scores of the normative general population. Conclusion Robot-assisted transthoracic first rib resection with only three trocars is a feasible minimal invasive approach for first rib resection in the management of vTOS. This technique enables the surgeon to perform venolysis under direct 3D vision with good patency and long-term functional outcome. Studies with larger cohort size are needed to compare the outcomes of this robot-assisted technique with other more established approaches.

scholarly journals Intracortical Screw Insertion Plus Limited Open Reduction in Treating Type 31A3 Irreducible Intertrochanteric Fractures in the Elderly

2021 ◽  
Author(s):  
Xiao-wen Huang ◽  
Gu-qi Hong ◽  
Qiang Zuo ◽  
Chen Qun
Keyword(s):  
Blood Loss ◽  
Elderly Patients ◽  
Open Reduction ◽  
Operation Time ◽  
The Elderly ◽  
Fracture Reduction ◽  
Intertrochanteric Fractures ◽  
X Rays ◽  
Intraoperative Blood Loss ◽  
Screw Insertion

Abstract Objective: To discuss the clinical efficacy of intracortical screw insertion plus limited open reduction in treating type 31A3 irreducible intertrochanteric fractures in the elderly. Methods: A retrospective analysis was performed for 23 elderly patients with type 31A3 irreducible intertrochanteric fractures (12 males and 11 females, aged 65-89 years old, with an average of 75.6±5.1 years old) who received treatment at the orthopedics department of our hospital from September 2017 to August 2019. After type 31A3 irreducible intertrochanteric fractures were confirmed by intraoperative C-arm, all of these cases received intracortical screw insertion plus limited open reduction in the broken end with intramedullary screw internal fixation. The basic information of surgery, reduction effects, and FRS scores of the hip joint were assessed. Results: All patients were followed up for an average of 13.8 months. The operation time was 53.8±13.6min (40-95min). The intraoperative blood loss was 218.5±28.6ml (170-320ml). The average number of intraoperative X-rays was 22.8±4.6 (18-33). The average time to fracture union was 4.8±0.7 months. The reduction effect was assessed using Kim's fracture reduction evaluation. 20 cases achieved grade I fracture reduction and 3 cases grade II fracture reduction. All of them achieved excellent or good fracture reduction. Upon the last follow-up, the FRS score was 83.6±9.8, which was not significantly different from the FRS score (84.8±10.7) before the fracture (t= 0.397, P= 0.694). Conclusion: With careful preoperative preparation, intracortical screw insertion plus limited open reduction could achieve high-quality fracture reduction and fixation in elderly patients with type 31A3 irreducible intertrochanteric fractures. Good clinical outcomes were achieved without increasing operation time and intraoperative blood loss.

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