Observation of the clinical efficacy of percutaneous reduction by leverage combined with intramedullary nail internal fixation in the treatment of irreducible femoral intertrochanteric fracture: a retrospective single-arm cohort study

BACKGROUND: There are few reports on the efficacy and safety of percutaneous lever reduction combined with intramedullary nailing in the treatment of irreducible functional intertrochanteric fracture. This study was designed to investigate the clinical effect of percutaneous reduction by leverage combined with intramedullary nail internal fixation in the treatment of irreducible femoral intertrochanteric fracture. METHODS: A total of 26 patients with irreducible femoral intertrochanteric fracture admitted to Qilu Hospital were included in this study, including 10 males and 16 females. All fractures were reduced through an incision made at the insertion point of the intramedullary nail head or the main nail with the aid of auxiliary equipment such as a periosteal dissector or a bone-holding forcep. Indicators such as operative time, blood loss, and complications were recorded, and the quality of fracture reduction was evaluated by the Baumgaetner modified method. All the patients were followed up regularly for 3 months, 1 year, and 2 years postoperatively, and the Zuckerman Functional Recovery Scale (FRS) for Hip Fracture was utilized to evaluate the hip function of the patients. The Euro-Quality of Life-5 Dimension (EQ-5D) was used to evaluate the quality of life of patients. Hip pain was assessed by the visual analog scale (VAS) at the last follow-up. RESULTS: According to the Evans-Jensen classification of fractures, 12 cases were classified as type III, 10 as type IV, and 4 as type V. The mean operation time was 67.9±16.4 min and the intraoperative blood loss was 165.8±58.3 mL. All fractures healed completely. In terms of fracture reduction quality, 14 cases were excellent and 11 cases were good. At the last follow-up, the FRS scores decreased from 93.3±5.7 preoperatively to 81.5±18.5 postoperatively, and the EQ-5D index decreased from 0.95±0.05 preoperatively to 0.86±0.14 postoperatively. CONCLUSIONS: With mini-incision assisted reduction combined with intramedullary nail internal fixation to treat of irreducible femoral intertrochanteric fracture, favorable clinical results can be obtained, and the walking ability and quality of life of the patients can be improved postoperatively.