[Comparison of various kinds of internal fixations in unstable intertrochanteric femoral fracture].

OBJECTIVE: To explore the effects of various kinds of internal fixations on unstable intertrochanteric femoral fractures.

METHODS: From January 2000 to December 2004, 88 cases of unstable intertrochanteric femoral fractures were treated. There were 52 males and 36 females (aged 19-86 years). Twenty-two cases were caused by fall from height, 36 by motor vehicle accident and 20 by fall and 10 by tumble. They were divided into 4 groups according to 4 kinds of internal fixations: dynamic hip screw (DHS, group A, n=42), anatomical proximal femur bone plate (group B, n = 23), proximal femoral nail (PFN, group C, n = 8)and dynamic condylar screw (DCS, group D, n = 15). According to the modified Evan's classification, fractures were all unstable type and were classified as follow types: group A (15 type III, 8 type IV and 19 type V); group B (12 type III, 5 type IV and 6 type V); group C (3 type III, 2 type IV and 3 type V); and group D (10 type III, 3 type IV and 2 type V). The data of operative time, intra-operative blood loss, intra-operative complications, fluoroscopy exposures, clinical healing time of fracture, post-operative restored function and postoperative complications were recorded and analyzed statistically using the SPSS 12.0 software package.

RESULTS: All patients were followed up for 12-48 month (18 months on average). All patients achieved clinical healing. Coxa varus occurred in 3 cases of group A, in 1 case of group C and in 3 cases of group D. The differences were of no statistical significance in operative time and postoperative complications between 4 groups (P>0.05). The difference was of statistical significance in the blood loss between groups A, B and groups C, D (P<0.05) but no statistical significance between group C and group D (P>0.05). The difference was of statistical significance in the fluoroscopy exposures, clinical healing time of fracture and postoperative complications between group B and the other groups (P<0.05). The difference was of statistical significance in the post-operative restored functions between group D and the other groups (P<0.05).

CONCLUSION: The anatomical proximal femur bone plate is a useful device in the treatment of unstable intertrochanteric femoral fracture. The operative manipulation is simple and the hip functions recover well.