![]() 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. The trochanteric fractures are extracapsular injuries.To investigate the efficacy of the minimally invasive clamp reduction technique via the anterior approach in the treatment of irreducible intertrochanteric femoral fractures. Extracapsular fracturesįractures outside the capsule do not cause the same degree of vascular damage as intracapsular fractures and therefore can be treated differently. They usually occur secondary to femoral head dislocation. Femoral neck fractures must therefore be diagnosed and treated appropriately in order to reduce the morbidity from the consequences of devascularisation.įemoral head fractures are rare intracapsular injuries but are very different from femoral neck fractures in that they do not cause disruption to the vessels that supply blood to the femoral head. Intracapsular fractures are important because of their propensity to damage the small intracapsular vessels that provide the majority of the blood supply to the femoral head. whether they are intracapsular or extracapsular. Proximal femoral fractures are therefore divided into groups based on their location with regard to the capsule, i.e. When a fracture of the femoral neck occurs, disruption to these blood vessels can occur result in devascularisation of the femoral head and resulting avascular necrosis. ![]() first perforating branch of the profunda femoris.medial circumflex artery (main supply of blood to the femoral head).The trochanteric anastomosis 1 consists of the following vessels: There are two sources of blood supply: the trochanteric and cruciate anastomoses 1. ![]() Blood supply for the femoral head is derived from vessels within the hip capsule. The anatomy of the region is important when considering fractures of the proximal femur. In this group of patients, the fracture is usually the result of low-impact trauma although, in younger patients they are usually victims of high-impact trauma, usually during a car accident. They tend to occur in older patients, and in those who have osteoporosis. Proximal femoral fractures are a subset of fractures that occur in the hip region. ![]()
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