To compare the clinical efficacy of PFNA internal fixation for the treatment of femoral intertrochanteric fracture in the lateral position without traction table and supine position with traction table. To explore the surgical techniques of fixation using PFNA in lateral supine without traction table.

A retrospective study was conducted on 173 patients with intertrochanteric fracture fixed with PFNA in Fuzhou Second Hospital from January 2010 to January 2017. In the lateral position group, 106 were operated in lateral position without the use of a traction table, including 42 males and 64 females, with the age range of 65~98 years (the median age was 78 years); and In the supine position group, 67 were operated in supine position with a traction table, including 32 males and 35 females, with the age range of 66-101 years (the median age was 76 years). The anesthesia time, operative time, length of hip incision, intraoperative dominant bleeding loss, the rate of bone hook assisted reduction, hospitalization days, fracture reduction effect, fracture healing time, and postoperative complications were analyzed and compared, and the function of hip joint was evaluated according to the Harris score system.

The anesthesia time was 59.3±8.7 min, operative time was 46.6±6.5 min, length of hip incision was 2.9±0.9 cm, intraoperative dominant bleeding loss was 76.4±15.6 ml, and the rate of bone hook assisted reduction was (25.4%, 17/67) in the lateral position group, while the anesthesia time was 62.6±7.4 min, operative time was 51.4±9.7 min, length of hip incision was 4.2±1.1 cm, intraoperative dominant bleeding loss was 105.3±17.4 ml, and the rate of bone hook assisted reduction was (25.4%, 17/67) in the supine position group. These of the lateral position group were less than those of the supine position group, and the difference was statistically significant (P<0.05). The overall incidence of complications was 24.53% (26/106), lateral cortical disruption of the greater trochanter accompanied with extravasation of the nail point was 3.77% (4/106), the incidence of deep venous thrombosis was 4.72% (5/106) and the incidence of skin contusion was 0.94% (1/106) in the lateral position group, while those of the supine position group were 56.71% (38/67), 11.94% (8/67), 10.45% (7/67), and 10.45% (7/67). Numerical analysis of the lateral position group was less than those of the supine position group, and the difference was statistically significant (P<0.05). The hospitalization days (t=1.75, P=0.081) and the effect of fracture reduction (χ²=0.202, P=0.042), fracture healing time (t=-1.47, P=0.145) and Harris score of hip function (t=1.03, P=0.305) were not statistically different (P>0.05) between the two groups.

Fixation of intertrochanteric fractures using PFNA in the lateral position without a traction table has more advantages than those of in supine position with traction table and is worthy of promotion and application in basic hospitals.

Hip fractures; Fracture fixation, intramedullary; Posture; Case-control studies