Dynamic hip screw for the treatment of intertrochanteric fractures in the elderly

1 Chen Decai. Geriatrics and health care. First Edition. Southeast University Press, 1993: 02 2 Xu evaluation. Pay attention to the monitoring and treatment of perioperative period of abdominal surgery in the elderly. Outside the abdomen 3 Qi Chunlian, Lu Junqing, Wang Shubao and so on. Clinical and pathological features of elderly patients with gastric cancer were analyzed in 44 cases. Chinese Journal of Practical Surgery 1995; 15: 294 dynamic hip screw treatment of intertrochanteric fractures in the elderly. Nantong City First People's Hospital (226001) when Xin Yan Jianjun Zhu Xinhui results: 70 cases were followed up, an average of 11 months, satisfactory results. Conclusion: Early intertrochanteric fractures of the femur should be treated with early surgery. DHS is a better method for the treatment of intertrochanteric fractures in the elderly.

Intertrochanteric fractures are one of the most common fractures in the elderly. In our hospital from 1995 to 2001, the application of dynamic hip screw (DHS) in the treatment of 76 elderly patients with intertrochanteric fractures, 70 cases of follow-up, satisfactory results, the report is as follows.

1. Clinical data ~91 years old, with an average of 74.9 years old, all fractures were caused by trauma, including 57 cases of falls and 19 cases of car accidents. The fracture type was 21 cases according to Tionzo and Evans1 type, 25 cases of type 1 type, 18 cases of type 111, 7 cases of type W, and 5 cases of type V. Among them, 58 cases (77%) had more than one medical disease, 28 cases of coronary heart disease, 15 cases of hypertension, 35 cases of arrhythmia, 5 cases of cerebral vascular hemiplegia, 1 case of senile dementia and 16 cases of type 1 diabetes.

Preoperative preparation for admission to the hospital, skin traction or tibial tuberosity traction, routine liver and kidney function, blood glucose, blood biochemistry, electrocardiogram, total chest radiographs, etc., to understand the functional status of the main organs of the patient, with the assistance of the physician consultation Treat comorbidities. The blood pressure of hypertensive patients is controlled at the level of critical hypertension, and the blood glucose is controlled below 10nmol/L. According to the blood biochemistry and hemoglobin, supportive treatment is given. Among them, 200~400ml of fresh blood is given before surgery to support the posterior lateral incision of the hip. The outer side of the upper trochanter of the femur and the upper part of the femoral shaft are drilled into the 1-2 needles under the guidance of the angle guide 2 to 3 cm below the greater trochanter. Under the fluoroscopy, the guide needle is in the center of the head or neck or slightly below the femoral head joint. 1cm rotating C-arm X-ray under the surface, the lateral perspective guide pin should be located in the center of the neck, select the guide needle with the best position and depth, and use the combined cutter to ream and tap the guide needle, and select the appropriate according to the needle depth. DHS lag screw, screw into the lag screw, and align the tip to the tip of the femoral head joint 1cm to install the appropriate length of the casing steel plate, the steel plate and the lateral femur cortex, the bone screw fixed steel plate, screw the tail compression screw, Rinse the incision, carefully stop bleeding, and close the incision layer by layer.

Postoperative postoperative routine ECG monitoring, anti-inflammatory symptomatic support, attention to the treatment of preoperative complications and prevention of postoperative complications. On the second day after surgery, the lower limbs were exercised on the bed. On the fourth day, the patient was encouraged to sit on the bedside. For patients with better physical condition, the patients could not carry weight-bearing activities after 4-6 weeks. Unstable fractures were accompanied. In patients with severe osteoporosis, X-rays were taken 10 to 12 weeks after surgery. After seeing the formation of osteophytes, they could gradually lose weight-bearing activities.

2 Results 4 cases, surgery under 4 to 12 days after injury, continuous epidural anesthesia or general anesthesia, C-arm X-ray fluoroscopy, the group was discharged after treatment, 3 of them died after discharge from other diseases, Seventy patients were followed up for 6 to 14 months, with an average of 10 months.

Yu Fei was dragging and pulling the lower limbs and rehabilitating limbs. The nfMb is run according to Wang f. 3. Discussion of surgical indications The choice of intertrochanteric fracture is a frequently-occurring disease in the elderly. In the past, bed-pulling traction was used. The patient suffered from pain, complications, nursing difficulties and high mortality. Surgical treatment has significant advantages (2), can shorten bed rest, fractures achieve a good reduction, is conducive to fracture healing and early functional exercise, sequelae and mortality are significantly reduced, currently advocated surgical treatment at home and abroad. The dysfunction of the organs in the elderly over 70 years old is often accompanied by a variety of complications. Whether or not surgery is performed depends on the self-care ability of the patient before the injury, the severity of the complications, and the effect after treatment. The surgical indications we chose were: 1 self-care before injury, can be active outdoors or indoors; 2 cardiopulmonary function is basically normal, blood oxygen partial pressure is above 70mmHg, urea nitrogen is less than 25mmol/dl3 blood pressure is controlled below 16C/10QnmHg; 4 anemia or hypoproteinemia, through blood transfusion or plasma, so that Hb is higher than 10g / dl; 5 diabetes patients subcutaneous insulin, blood sugar below 10nmd / L, urine sugar + ~ + +; 6 months without myocardial infarction Heart failure and arrhythmia. Our experience, advanced age is not a surgical contraindication, as long as the above conditions can be achieved, and surgery should be actively carried out.

Surgical points Preoperative reduction and placement of the femoral neck lead are the key to this procedure. After the anesthesia was stabilized, the traction was pulled under C-ray fluoroscopy. For Ul and iV fractures, the affected posterior medial cortex is fully contacted by pulling and rotating the affected limb. The posterior lateral incision is selected. The proximal incision is slightly forward and outward, and enters from the posterior edge of the lateral femoral muscle. Only the large trochanter and the lower femur should be exposed. It is not necessary to separate the femur before and after the femoral trochanter, thus reducing Intraoperative hemorrhage, the needle insertion point on the lateral axis of the femur 2~3cm under the trochanter, using the 135T positioner to drill the lead needle, through the C-arm X-ray arm lateral side perspective, can shorten the operation time. For those with small-rotor fractures, we agree with Zhang Jianmin's point of view that it is considered that the reduction of the small-rotor fracture will not lead to nonunion and hip dysfunction, so it is considered that the small rotor can be fixed.

With the continuous improvement of the power hip screw matching device, the application of the C-arm X-ray machine in the lateral side perspective, the orthopaedic surgeon's skill in operation, can make the DHS surgery easier and the operation time shorter. The internal fixation is strong and stable, which can enable early limb movement and systemic exercise and effective treatment of postoperative complications. Therefore, we believe that hip-powered screws are currently a satisfactory method for the treatment of advanced intertrochanteric fractures.

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