Chinese bone injury, stenosis, stenosis, and fixation of the elderly patients with femoral subtrochanteric fractures. Han Kaijin Affiliated Hospital of Nanjing University of Traditional Chinese Medicine. The Nanjing 210029 femoral subtrochanteric fracture was a fracture of the upper femur in the lower 5 of the small trochanter. Often coincide with femoral intertrochanteric fractures. Clinically, it is often used in elderly patients. Because of the comminuted fracture of the common femoral trochanter and the complication of the patient's own senile internal medicine, the treatment is more difficult. In the past 3 years, our hospital used dynamic é« plate screw 0 to treat 18 cases of this fracture. Satisfactory results were obtained, 1 clinical data-like data in this group of 18 patients. There were 13 males and 5 females, aged 6782 years. The average is 724 years old. All are fresh fractures. According to 3; also, 4 cases of subtrochanteric fracture type 14 type, 3 cases of this type, 8 cases of Chinese type, 3 cases of type. Among them, 8 patients had hypertension. 2 cases of diabetes. All fractures were fixed with 008.
Conventional iliac bone grafting is performed on those with defects on the medial side. The small trochanter free bone block is larger or displaced significantly. After the reduction, the screws and the wire were fixed; after the operation, the affected limb was placed on the elbow and the hip was raised. Knee joint function exercise; 4 weeks later, the crutches practice gradually walked down the weight. However, the limb is not allowed to be fully loaded before the fracture is healed.
1.2 Treatment results 18 patients in this group were followed up. The follow-up time was May 2 years, with an average of 8 months. Of these, 16 patients achieved bone healing, no hip varus occurred, and functional activities were good; 2 cases were fractured. The fracture sites of the steel plate are in the cleft palate of the intertrochanteric fracture. The distal end of the plate was 86, type, and the fracture time of one plate was 4 months after operation. The total weight was 2.5 months after surgery; the other plate fracture time was 8 months after operation, and the full weight was 3 months after operation. The healing time of fracture in 16 cases of healing was 3.57 months. The average is 4.7 months. There is no wound infection in the hip varus and internal fixation damage. 2 Discussion 2.1 The role of internal fixation in elderly patients The femoral subtrochanteric fracture is different from the intertrochanteric fracture. It is characterized by a rotor. Characteristics of inter-fracture and femoral shaft fractures. In particular, elderly patients often have comminuted fractures due to osteoporosis, resulting in complication of the posterior cortex in the upper end of the femur, which is an unstable fracture. Therefore, it is considered that the use of surgical internal fixation therapy is more conservative than simple treatment. The benefits outweigh the disadvantages. Conservative traction therapy has often been used in the past for the age characteristics of this fracture. It was found that it was difficult to achieve a satisfactory reduction by traction therapy alone, because the support of the posterior cortex was lost. After traction, the distal end of the fracture often shifts inward, and the elderly are often accompanied by cardiovascular and cerebrovascular diseases, old chronic bronchitis and other diseases. Long-term bed rest is prone to acne pneumonia and urinary tract infection. In patients with heart failure and other diseases, the high mortality rate of patients also brings great difficulties to clinical and home care work. Since early leave is an important means of reducing comorbidities and restoring function, surgical treatment is necessary to perform early functional exercise. Reduce bed rest time and effectively prevent complications. Although there is a risk of surgical trauma to the patient. However, the risk factors for medical complications in relatively long-term bed rest are much smaller. From the surgical cases of this group, through active treatment and nursing, no cases are caused by serious complications of internal medicine, and the principle and advantages of 6 are based on the principle of tension band fixation. , the support of the cortex. It has a supporting force to withstand the axial pressing force of the steel sheet. The tensile stress experienced by the steel sheet is converted into a compressive stress. The eccentricity of the sliding nail is pressurized. The trochanter stress is transferred to the lateral cortex. The stress transmitted on the inside is reduced. This helps to reduce the large amount of stress stimulation of the medial cortical bone. Promotes healing and completes the stability of the inside. Another aspect. The internal fixation of 008 causes the fractured lateral cortex to pressurize due to the tension band of the steel plate. The pressure can be obviously increased, and the overall stability is 12. This is also the advantage of 003 compared to the dynamic hip screw plate 01, and why the 0 internal fixation device is used. And when there is absorption at the fracture end. The internal fixation screw can be shortened in the sleeve to maintain the fracture end and has high strength characteristics. The role of supporting the steel plate plays an important role in maintaining the stability of the fracture end. This can be confirmed from 16 cases of healing in this group. .
2.3 Analysis of the causes of fracture of steel plate 2.3.1 Osteoporosis factors Comminuted subtrochanteric fractures of the femur are often found in elderly patients with osteoporosis. The sliding screw is pressed ten times to break the loose trabecular bone in the femoral neck, so that the sliding pressure is insufficient. 008 only plays a role in supporting the steel plate; on the other hand, the elastic modulus of the steel plate is much higher than that of the bone tissue. The resulting stress shielding enhances the progression of osteoporosis and bone atrophy, causing incomplete loosening of the internal solution due to osteoporosis leading to greater strain conditions at the fracture end. The fracture is healed slowly, which causes the steel plate to fatigue fracture. In this group, 2 cases of instrument fracture occurred, and the incidence rate was. 1. The author believes that the patient's own osteoporosis is the main reason. Therefore, it is necessary to protect the elderly patients with osteoporosis after skin traction, because osteoporosis is an unavoidable senile hip fracture itself. 2.3.2 patients with premature weight bearing for patients with femoral subtrochanteric fractures 003 Fixation does not shorten the healing time of the fracture. On the outer side of the upper part of the femur, the 08 steel plate is eccentrically fixed on the tension side. The effect of nail plate fixation depends on the degree of recovery of the medial cortical continuity. 3. Elderly patients have problems in balance coordination.
Premature weight bearing without protection, the fracture end stress is improved, plus; and premature weight bearing. The posterior cortical bone epiphysis grows slowly. The broken end is constantly moving, and the steel plate cannot be lifted to improve its performance. 2 The steel plate breaks inevitable. Do, make the screw cut the femoral head. neck. A series of complications have occurred. Therefore, patients should not be allowed to fully load in the early stages. Two patients in this group were not obvious because of their symptoms. Failure to follow the doctor's advice. Premature weight-bearing walking, even tourism climbing, coupled with osteoporosis factors, caused 0 to break the steel plate, Rong Guowei Wei Gui Liu Wei, and so on. Internal fixation in orthopedics. Third edition. Beijing People's Medical Publishing House, 1995. Zhou 1.
Zhao Dinglin. New theories and new technologies in orthopedics. Shanghai Shanghai Science and Technology Education Press,
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