There are many clinical reduction approaches, such as pulling the distal fracture segment with a bone hook, clamping the fracture segment with reduction forceps, prying the cephalocervical fracture segment backward through the enlarged spiral blade entrance with the periosteal stripper, cutting the strangulated iliac muscle, and jacking the distal fracture segment with the bucking bar. These fractures are called “irreducible intertrochanteric femoral fractures" and account for 3–17% of all intertrochanteric fractures. Although the majority of fractures can be successfully reduced after abduction, external rotation, adduction and internal rotation of the hip with traction bed traction, a small proportion of closed reductions fail and require limited incision and auxiliary reduction. Traction bed closed reduction and intramedullary nail internal fixation have become the main treatment modalities. Intertrochanteric femoral fractures are common in traumatic orthopedics, and they mostly occur among elderly individuals. In the case of irreducible intertrochanteric femoral fractures associated with lateral wall displacement, the lateral wall needs to be strengthened after clamp reduction and intramedullary nail fixation to avoid loss of reduction and failure of internal fixation. The minimally invasive clamp reduction technique via the anterior approach for the treatment of irreducible intertrochanteric femoral fractures is simple, effective and minimally invasive. While two patients died and one patient exhibited failed internal fixation and thus switched to joint replacement, 91 of the remaining 112 patients had an excellent Harris score of the hip joint function at the final follow-up, while 21 patients had a good Harris score. The rest of the patients did not lose fracture reduction, and all fractures achieved bony healing with a healing time ranging from 3 to 9 months (mean of 5.7 months). After internal fixation, the lateral wall of six reversed intertrochanteric femoral fractures showed repronation and abduction displacement, but all fractures achieved bony healing. Two patients with pronation displacement of the proximal fracture segment died of infection or hypostatic pneumonia after internal fixation failure one patient with failed internal fixation switched to joint replacement. ResultsĪll patients achieved good reduction, with fracture reduction times ranging from 10 to 32 min (mean of 18 min), and were followed up for 12–27 months after surgery (mean of 17.9 months). The distribution of AO classification was as follows: 31-A1 in 15 cases, type 31-A2 in 67 cases and 31-A3 in 33 cases. The duration between injury and surgery ranged from 1 to 14 days, with an average of 3.9 days. The types of injuries were falls (91 cases), traffic accidents (12 cases), smashing (6 cases), and high falling (6 cases). The average age of the patients was 78.7 (45–100 years old). Methodsįrom January 2015 to January 2021, 115 patients (48 males and 67 females) with irreducible intertrochanteric femoral fractures were treated. To investigate the efficacy of the minimally invasive clamp reduction technique via the anterior approach in the treatment of irreducible intertrochanteric femoral fractures.
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