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首页> 外文期刊>Hip international: the journal of clinical and experimental research on hip pathology and therapy >Comment on: 'Outcome of short proximal femoral nail antirotation and dynamic hip screw for fixation of unstable trochanteric fractures. A randomised prospective comparative trial'.
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Comment on: 'Outcome of short proximal femoral nail antirotation and dynamic hip screw for fixation of unstable trochanteric fractures. A randomised prospective comparative trial'.

机译：评论：“短近端股骨钉抗旋转和动力髋螺钉固定不稳定型转子粗隆骨折的结果。一项随机前瞻性比较试验”。

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摘要

We wish to comment on the above article by Garg et al published in Hip international 2011; 21(5): 531-6 (1). The authors performed a prospective, randomised, controlled trial to compare the outcome of treatment of unstable tro-chanteric fractures with either a short proximal femoral nail annotation (PFNA) or dynamic hip screw (DHS). To our knowledge, intramedullary implants are (biomechanically) superior for unstable fractures, and this type of fracture is a relative contraindication for DHS fixation due to loss of medial calcar continuity, DHS fixation tends to result in varus displacement and a high rate of failure (2). The DHS works by guiding the controlled collapse of the proximal fragment against the lateral femoral wall. As a result of the guided sliding, compression occurs across the fracture site and fracture healing occurs. Because the integrity of the lateral wall is compromised in A3 fractures, the lateral wall collapses when the proximal fragment slides down. Excessive sliding and in turn medialisation of the shaft occurs as the lateral wall fragment cannot retain the proximal fragment.
机译：我们希望评论Garg等人在《 Hip international 2011》上发表的上述文章; 21（5）：531-6（1）。作者进行了一项前瞻性，随机，对照试验，比较了使用短股骨近端股骨钉注释（PFNA）或动力髋螺钉（DHS）治疗不稳定型转子粗隆性骨折的结果。据我们所知，对于不稳定的骨折，髓内植入物（生物力学上）优越，并且由于内侧is骨连续性的丧失，这种类型的骨折是DHS固定的相对禁忌症，DHS固定往往会导致内翻移位和高失败率（ 2）。 DHS的工作原理是将近端碎片的受控塌陷引导至外侧股骨壁。作为引导滑动的结果，在整个骨折部位发生压缩，并且发生骨折愈合。由于在A3骨折中侧壁的完整性受到损害，因此当近端碎片向下滑动时侧壁会塌陷。由于侧壁碎块无法保留近端碎块，因此发生了轴的过度滑动，进而导致了中转。

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