Use of a Double Reverse Traction Repositor versus a Traction Table for the Treatment of Intertrochanteric Femur Fractures: A Comparative Study

Abstract

The aim of the present study was to compare the clinical results for unstable femoral intertrochanteric fractures treated with a double reverse traction repositor (DRTR) and those treated using a traction table with the Asia proximal femoral nail antirotation (PFNA-II).Methods: A retrospective study was performed including 95 patients with AO/OTA type 31-A2 and 31-A3 unstable femoral intertrochanteric fractures who underwent DRTR or traction table-facilitated PFNA-II nailing from April 2015 to December 2018 in our traumatic center. Demographics, duration of operation, blood loss, part loading time after surgery, fracture healing time, and early and late complications were assessed. Clinical and radiological outcomes were collected to compare the differences between the two groups.Results: A total of 95 unstable intertrochanteric fracture patients treated with the PFNA-II were analyzed. Of these cases, 56 patients were treated with a DRTR and the other 39 patients were treated using a traction table to achieve fracture reduction. No patients died during surgery and hospitalization. There were no significant differences in respect to demographics and fracture characteristics of cases enrolled. The total operative time was significantly longer in the traction table group than in the DRTR group (72.5 ± 6.1 min for the traction table and 63.0 ± 4.1 min for the DRTR group, P < 0.001). No significant differences were observed in intraoperative blood loss and duration of hospitalization. The periods of follow up ranged from 12 to 31 months among all patients. At the last follow up, the Harris hip score (HHS) in the DRTR group was excellent in 10 patients (17.9%), good in 36 (64.3%), fair in 8 (14.3%), and poor in 2 (3.6%). These scores were comparable to those in the traction table group, which were: excellent in 8 patients (20.5%), good in 24 (61.5%), fair in 6 (15.4%), and poor in 1 (2.6%). Regarding the radiological evaluation, excellent rates of reduction rate were achieved in 39 cases (69.6%) in the DRTR group, which was comparable to 19 cases (48.7%) in the traction table group. In addition, the mean fracture healing time after surgery was 20.6 ± 2.3 weeks in the DRTR group and 21.4 ± 3.4 weeks in the traction table group, which did not reach a significant difference (P = 0.18). During the follow up, 6 cases of thigh pain, 4 cases of deep vein thrombosis, and 1 case of fracture of the anterior superior iliac spine were reported in the DRTR group. In the traction table group, there were 2 cases of deep vein thrombosis and 3 cases of thigh pain. Conclusion:When using the PFNA-II for unstable intertrochanteric fractures, the DRTR was superior to the traction table in respect to operative time and duration of patient position, despite an additional ipsilateral anterior superior iliac spine (ASIS) incision and drilling of the ASIS and the femur condyle.

The clinical efficacy and safety of double reverse traction repositor and traction table in the reduction of unstable intertrochanteric fractures in elderly patients: a retrospective comparative study

“…This present study investigated the effects of invasive reduction with DRTR combined with PFNA internal fixation in the treatment of unstable femoral intertrochanteric fractures in the elderly and confirmed that the intraoperative reduction time and operation time were significantly shorter in patients who underwent minimally invasive reduction with DRTR compared to those who underwent conventional reduction with TT. However, there were no statistically significant differences in incision length, intraoperative blood loss, fracture healing time, nor Harris score of the hip joint function at one year after the operation, which was consistent with a previous study ( 10 ). The follow-up period of the study was 8–15 months, with a mean follow-up time of 12 months.…”

“…There were no other surgery-related complications in any other patient after the operation and during follow-up. Femoral intertrochanteric fractures usually occur in the elderly patients and are associated with poor prognosis and prolonged bed rest, which can consequently lead to high rates of disability and mortality (10). With the increased incidence of intertrochanteric fractures of the femur, there has been a focus on fracture fixation modalities, particularly intramedullary and extramedullary fixation.…”

“…Since this is highly consistent with the mechanical axis of the limbs, and the traction force of the joints and soft tissue and the natural axis of the human body are used for reduction, the reduction quality is significantly improved, and its traction force is also significantly enhanced ( 9 ). Current studies indicated that DRTR enjoyed significant advantages, such as its continuous and stable reduction effect and simple operation, compared with TT in treatment of unstable femoral intertrochanteric fractures ( 8 , 10 ), femoral shaft fractures ( 9 ), distal femur fractures ( 11 ) and tibial plateau fractures ( 12 ), which has attracted extensive attention from orthopedic doctors. However, the clinical safety and efficacy of DRTR in treatment of elderly patients with unstable intertrochanteric fractures remains unknown.…”

The clinical application of minimally invasive surgery for tibia fracture with traction reduction device on lower limb fracture

“…But it has some disadvantages,such as having more di culty in reduction, demanding higher technique. By the aid of assisted reduction device [11][12], the surgery is easy to get good reduction.…”

Implementation of Enhanced Recovery After Surgery (ERAS) protocol for elderly patients receiving surgery for intertrochanteric fracture: a propensity score-matched analysis

“…Surgical treatment has excellent advantages in relieving pain, restoring hip function early, improving quality of life, and avoiding complications such as cardiovascular accidents and lower limb venous thrombosis caused by long-term bed rest. Therefore, there is a clinical consensus on the surgical approach for ITF [3,4,12]. Currently, PFNA has the advantages of easy operation, more minor trauma, and stable fixation compared with other internal fixation, and is characterized by the addition of BO and the essence of minimally invasive surgery while maintaining the firm fixation and biomechanical stability of AO, which is suitable for all types of ITF and is currently one of the primary surgical modalities for clinical treatment of ITF [4,13].…”