Abstract
Background: Accurate percutaneous guide wire insertion for the treatment of intertrochanteric fractures with proximal femur nail anti-rotation(PFNA) can be a technical challenge. It is critical for the surgeon to place the implant accurately during the procedure; however, the muscles and soft tissues in the hip often make accurate guide wire insertion difficult, especially in overweight and obese patients.Purposes: The purpose of this study was to evaluate a series of patients who underwent percutaneous guide wire puncture and PFNA fixation to determine the influence of this technique on soft-tissue trauma and accuracy of guide wire placement.Methods: From June 2015 to June 2018,forty-five consecutive patients with a minimally displaced or displaced intertrochanteric fracture were treated with percutaneous guide wire puncture technique and PFNA fixation in two trauma centers. Six patients were lost to follow-up. The remaining thirty-nine patients were followed until union or a minimum of twelve months. There were thirty female and fifteen male patients with a mean age of 78.5 years old. Radiographs were used to evaluate the quality of fracture union. Intraoperative fluoroscopic views of the first puncture attempt were evaluated for the accuracy of percutaneous puncture technique.The number of puncture attempts used was recorded.Incision lengths of nail insertion were measured and recorded.Results: All fractures united. The length of the incisions ranged from 2.0 cm to 3.1 cm,with a mean of 2.5 cm.The angles between the guide wire and the axis of the proximal femur were within 3°in lateral fluoroscopic view,and ranged from 4°to 8°with a mean value of 6.3°in anteroposterior(AP) fluoroscopic views.The number of punctures in every patient were less than 2.Among forty-five patients, forty-three patients(95.6%) were punctured successfully with one pass. No complications were observed.Conclusions: Percutaneous guide wire puncture for the treatment of intertrochanteric fractures with PFNA fixation can lead to excellent outcomes, by virtue of accurate implant placement, less trauma,and fewer complications.Level of Evidence: Therapeutic level IV
A clinical study of functional outcome of unstable intertrochanteric fractures treated with proximal femur nail anti rotation system II