Intertrochanteric fractures of the femur

　　Intertrochanteric fractures can be caused by indirect violence or direct violence, such as when the body rotates upon falling, landing in an excessive abduction or adduction position, or falling on the side, causing a direct impact on the greater trochanter, which can lead to intertrochanteric fractures. This is one of the common sites for bone cystic lesions, and pathological fractures can also occur here.

　　The onset age of intertrochanteric fractures of the femur is 7 to 8 years older than that of femoral neck fractures, with more and severe complications, and the postoperative mortality rate is 5% to 30%. The main reason is that the average age of patients with intertrochanteric fractures is about 76 years old, with poor physical condition and many complications, such as: Wang Fuquan reported in 106 cases of intertrochanteric fractures, 40 cases (38%) had more than 3 complications, mainly cardiovascular diseases, followed by diabetes, cerebrovascular diseases, which bring difficulties to anesthesia, surgery, and postoperative management.

　　First, preventive methods:The indications for surgery must be strictly controlled, and surgery should be selected according to the following criteria:

　　1. Cardiac function

　　(1) Myocardial infarction, the condition is stable for at least 3 months.

　　(2) Heart failure, the condition is stable for at least 6 months.

　　(3) No serious arrhythmia, arrhythmia

　　(4) Walking up the stairs before the injury.

　　2. Pulmonary function

　　(1) Hold breath time >30s.

　　(2) Blowing wax distance >50cm.

　　(3) No sputum, asthma, or shortness of breath.

　　(4) Arterial blood gas, P02>60mmHg, PCO2>45mmHg, FVTl

　　3. Hypertension:Blood pressure

　　4. Renal function:Urine protein 1ml/(kg·h), BUN

　　5. Alanine aminotransferase of liver function does not exceed 1 times the normal value.

　　6. Diabetes:Fasting blood glucose

　　7. Choose minimally invasive surgery and percutaneous pin fixation.

　　Second, the failure of internal fixation causes hip varus:The failure of internal fixation leads to the occurrence of hip varus deformity healing or non-union in intertrochanteric fractures of the femur. The success of internal fixation depends on stable bone union, the firm holding of the fixation of the proximal and distal ends of the fracture, and also depends on the type of fracture, the design of the fixation device, the correct use of the fixation device, the degree of osteoporosis, and reasonable postoperative functional exercise. The causes of internal fixation failure:

　　1. Related to the type of fracture:In stable fractures, the posterior medial support is intact or slightly comminuted, the collapse of the fracture fragments is extremely small, the contact of the varus or reconstruction of the medial cortex is good, and the fracture can be stable, then the failure of internal fixation is less, the incidence of hip varus is low. Conversely, in unstable fractures, there are large floating bone fragments in the posterior medial side, posterior comminution, and the fracture is still extremely unstable after reduction, which relies on internal fixation support to maintain stability, which is easy to cause failure of internal fixation and the occurrence of hip varus, accounting for about 80% of intertrochanteric fractures.

　　2. Related to the incorrect design and operation of internal fixation:Currently, the internal fixation methods for intertrochanteric fractures of the femur can be summarized into three types: nail-plate type, intramedullary fixation type, and multiple needle type.

　　The hip varus deformity in elderly patients generally does not require treatment. For young and middle-aged adults with severe hip varus deformity, the osteotomy can be performed with a trochanteric wedge osteotomy, and sliding compression screws, gamma nails, and internal fixation can be chosen postoperatively. For rare cases of non-union of intertrochanteric fractures, internal displacement and varus osteotomy can be used for treatment - intertrochanteric osteotomy, to internally displace the femoral shaft, fix the proximal bone fragment in a varus position, and graft bone around the fracture line.

　　The intertrochanteric region is a common site for osteoporosis. The speed of osteoporosis occurrence is faster in the trabeculae and slower in the femoral shaft. The junction of the fast-developing trabeculae and the slow-developing femoral shaft is the weakest part of the bone, so intertrochanteric fractures are prone to occur. After injury, the affected area will have pain, swelling, ecchymosis, and the lower limb cannot move. Examination shows intertrochanteric tenderness, marked lower limb external rotation deformity, up to 90 degrees, with axial clunking pain, and measurement can find shortening of the lower limb. X-ray film can clearly identify the type and displacement of the fracture.

　　Intertrochanteric fracture of the femur has a significant impact on the patient's daily life, so it should be actively prevented. However, there is currently no effective preventive method for this disease, so early detection and early treatment are of great significance for the treatment of the disease.

　　The X-ray film of intertrochanteric fracture of the femur should include anteroposterior and lateral views, and it must include the adjacent joints. Sometimes, oblique, tangential, or corresponding部位的x光片 may need to be taken. After carefully reading the X-ray film, the following points should be identified:

　　1. Whether the fracture is traumatic or pathological.

　　2. Whether the fracture is displaced, and how it is displaced.

　　3. Whether the reduction of the fracture is satisfactory, and whether it needs to be reduced.

　　4. Whether the fracture is fresh or old.

　　5. Whether there is injury to the adjacent joint or bone injury.

　　1. Food therapy for intertrochanteric fracture of the femur

　　1, Early stage

　　10 grams of Sanqi, 10 grams of Danggui, and 1 pigeon, boil until tender, consume the soup and meat together, once a day, for 7-10 days consecutively.

　　2, Middle stage

　　10 grams of Danggui, 15 grams of Suanzaoren, 10 grams of Xuanduan, and 250 grams of fresh pork chop or beef chop, simmer for more than 1 hour, consume the soup and meat together, and use it for 2 weeks consecutively.

　　3, Late stage

　　10 grams of Chinese wolfberry, 15 grams of Suanzaoren, 10 grams of Xuanduan, 50 grams of Job's tears. First decoct Suanzaoren and Xuanduan to remove the dregs, then add the remaining two ingredients to cook porridge for consumption.

　　4, Other food therapy recipes

　　(1) Appropriate amount of red bean, decoct and add a little red sugar, take it warm. This recipe is suitable for the stage of activating blood and removing blood stasis.

　　(2) 1000 grams of pork bones and 250 grams of soybeans, add water and simmer over low heat until tender. Season with salt and ginger and consume as food.

　　(3) One set of pork spinal bones, wash clean, add 120 grams of red dates, 90 grams of lotus seeds, 9 grams of Jiangxiang, and 9 grams of raw licorice root, add water and simmer over low heat until tender. Add ginger and salt for seasoning and drink in several doses.

　　(4) 2 fresh lake crabs, remove the meat (with the yolk), add the crab meat to the cooked sticky rice, and serve with a moderate amount of ginger, vinegar, and soy sauce. Consume regularly.

　　(5) 1 male chicken (about 500 grams), skin, feathers, and internal organs removed, wash clean, slice 5 grams of Sanqi, stuff it into the chicken's stomach, add a small amount of yellow wine, steam until tender, and serve with soy sauce after cooking. Consume regularly.

　　(6) 30 to 60 grams of raw Huangqi, decoct to obtain a concentrated juice, add 100 grams of sticky rice, and cook to make porridge for consumption in the morning and evening.

　　(7) 20 grams of Danggui, 100 grams of Huangqi, and 1 tender hen, boil in water to make a soup for consumption.

　　(8) 50 grams of purple Danshen, wash clean, boil in water, strain the juice, and then boil the juice with 1000 grams of pork long bones and 250 grams of soybeans until tender. Add a small amount of cassia bark and salt and it is ready.

　　(9) Fresh crab 500 grams, pounded, served with 250 grams of hot yellow wine, the remaining residue applied to the affected area, about half a day 'each' sound is good. Used for fracture healing.

　　Second, what is best to eat for intertrochanteric femoral fracture

　　1, Early stage

　　The principle of diet coordination is to focus on light and delicious food, such as vegetables, eggs, soy products, fruits, fish soup, lean meat, etc.

　　2, Middle stage

　　Bone soup, Cordyceps chicken stew, animal liver.

　　3, Late stage

　　Old hen soup, pork bone soup, lamb bone soup, deer tendons soup, stewed fish, etc., those who can drink can choose Eucommia ulmoides and bone broken wine, chicken mallow wine, tiger bone papaya wine, etc.

　　Third, what not to eat for intertrochanteric femoral fracture

　　Early avoidance of sour and spicy, dry and hot, and greasy foods, especially not to apply greasy tonifying substances prematurely, such as bone soup, fatty chicken, stewed fish, etc. In addition, fruit juice and sugar are also not suitable.

　　After traction reduction of intertrochanteric femoral fracture, absolute bed rest and strong external fixation with plaster and braces are required, with a fixation time of about 8 weeks. Alternatively, open reduction and internal fixation can be used, which is more effective and can reduce the occurrence of complications.

　　The treatment of complications: a comprehensive and systematic examination of the elderly, the discovery of complications, and the corresponding treatment is the key to reducing surgical complications and improving the success rate of surgery. The treatment of elderly internal medicine complications involving multiple systems is more complex, and it is best to cooperate with relevant departments to quickly and effectively control complications to prevent the occurrence of complications effectively.

　　The timing of surgery: although some patients with intertrochanteric femoral fracture still have self-care ability, if they remain in bed for a long time after the fracture, it will reduce the patients' opportunities for physical exercise, further worsen the existing chronic diseases, increase the risk of surgery, and even lose the opportunity for surgery. Therefore, for elderly patients with intertrochanteric femoral fracture, surgery should be performed as soon as possible to shorten the preoperative preparation time.

　　The choice of anesthesia method should be the one with minimal impact on the respiratory and circulatory systems, short-acting, and highly controllable. Continuous epidural anesthesia is more suitable for elderly patients, and local anesthesia can also be chosen.