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Distal locked and unlocked nailing for perthrochanteric fractures—a prospective comparative randomized study

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Abstract

Purpose

Intramedullary nailing is widely used in the treatment of stable pertrochanteric fractures. However, it remains controversial whether the distal locking with intramedullary nailing is necessary.

Method

In this study, 70 patients over the age of 65 with pertrochanteric fractures (AO/OTA 31-A1 and A2) were enrolled and randomly divided into two groups for treatment by intramedullary nails either with or without distal locking. Intra-operative variables such as operation time, volume of blood loss, total fluoroscopy time, total length of incision, postoperative complications and clinical outcomes were recorded and compared between the two groups.

Results

A total of 29 patients in the locking group and 30 patients in the unlocking group completed one year of follow up. Operation time (39.2 ± 7.6 min), blood loss (158.6 ± 63.6 ml), fluoroscopy time (53.7 ± 3.9 s), and total length of incision (13.1 ± 2.1 cm) in the unlocking group were significantly decreased compared with the locking group (48.5 ± 9.0 min; 194.3 ± 61.6 ml; 57.8 ± 4.3 s; 10.9 ± 1.7 cm) (p < 0.05). No significant differences in postoperative complications and fracture union were identified between the two groups. Most patients in the locking group (80.0 %) and the unlocking group (77.1 %) recovered to their pre-injury activity levels.

Conclusion

This study suggests that intramedullary nails without distal locking may be a reliable and acceptable option for treating stable pertrochanteric fractures (AO/OTA 31-A1 and A2) in elderly people. Distal unlocked nails showed subtle advantages in reducing blood loss, operation time, fluoroscopy exposure time, and size of the incision.

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Conflict of interest

The authors declare that they have no conflicts of interest.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, People’s Republic of China

    Xing Li, Zhiyong Hou, Wei Chen, Pengcheng Wang & Yingze Zhang

  2. Hebei Medical University, Shijiazhuang, People’s Republic of China

    Liping Zhang

  3. Department of Orthopaedics Surgery, Children’s Hospital of Hebei Province, Shijiazhuang, People’s Republic of China

    Zhao Meng

Authors
  1. Xing Li
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  2. Liping Zhang
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  3. Zhiyong Hou
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  4. Zhao Meng
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  5. Wei Chen
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  6. Pengcheng Wang
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  7. Yingze Zhang
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Correspondence to Zhiyong Hou.

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Li, X., Zhang, L., Hou, Z. et al. Distal locked and unlocked nailing for perthrochanteric fractures—a prospective comparative randomized study. International Orthopaedics (SICOT) 39, 1645–1652 (2015). https://doi.org/10.1007/s00264-015-2771-1

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  • DOI: https://doi.org/10.1007/s00264-015-2771-1

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