SymbolStandardization of extramedullary and intramedullary fixations for subtrochanteric fracture

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BACKGROUND:The classification and treatment of subtrochanteric fracture experienced a long process of development. Surgical treatment was currently used popularly, including extramedullary and intramedullary fixation. It should be selected according to the type of fracture and clinical practice, and it is inconclusive in the clinic.OBJECTIVE:To summarize the study and present application of intramedullary and extramedullary fixation in the subtrochanteric fracture in recent years.METHODS:The first author researched two books, and retrieved PubMed, Wanfang Database, and Chinese Journal Full-text Database for articles about clinical trials on fixation for subtrochanteric fractures, and the safety and efficacy of fixation for subtrochanteric fractures published until March 2014. A total of 42 clinical studies on type, intramedullary and extramedullary fixations were selected.RESULTS AND CONCLUSION:With the progress of fixation methods of subtrochanteric fracture, there was a great progress in improving the rate of fracture healing and reducing hip malunion, and limited mobility. Whether extramedullary fixation, intramedullary fixation or arthroplasty, clinical reports have achieved satisfactory results at present. The intramedullary fixation was still dominated among various therapeutic methods. However, the type of fracture, age and osteoporosis fractures were different in patients. There was no uniform standard of the specific choice of surgical approach, which still should be further studied. Authors believed that when fracture line was below the lesser trochanter, interlocking intramedullary nail could be used. High subtrochanteric fracture could utilize proximal femoral nail anti-rotation. However, if the medullary cavity was narrow, the fracture was involved in the greater trochanter or piriformis fossa area, locking proximal femoral plate or less invasive stabilization system could be employed. No matter intramedullary or extramedullary fixation, minimal invasion and biological fixation were the present trend of development. The new minimally invasive techniques and internal fixation are still the goal. Although intramedullary fixation has advantages, but cannot completely replace the current extramedullary fixation. It is important to have a perfect surgery plan, standardized surgical approach and long-term postoperative follow-up, in order to achieve better clinical outcomes.Subject headings:femoral fractures; internal fixators; fracture fixation, intramedullary; arthroplasty, replacement, hip

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