ObjectiveTo formulate the classification criteria of femoral intertrochanteric fractures based on irreducibility or not in order to predict the difficulty of fracture recovery.MethodsA clinical data of 244 patients with closed femoral intertrochanteric fractures admitted between January 2017 and March 2020 was retrospectively analyzed. There were 116 males and 128 females with an average age of 77.9 years (range, 45-100 years). The cause of injury included falling in 190 cases, traffic accident in 36 cases, smashing in 13 cases, and falling from height in 5 cases. The time from injury to operation was 1-14 days (mean, 3.6 days). According toAO/Orthopaedic Trauma Association (AO/OTA) classification, the fractures were classified as type 31-A1 in 38 cases, type 31-A2 in 160 cases, and type 31-A3 in 46 cases. According to whether the recovery difficulty occurred after intraoperative closed traction reset, the patients were divided into reducible-group and irreducible-group; combined with the literature and preoperative imaging data of two groups, the classification criteria of femoral intertrochanteric fractures was formulated based on the irreducibility or not. The 244 fractures were classified by the doctors who did not attend the operation according to the classification criteria, predicted the difficulty of fracture reduction, and compared with the actual intraoperative reduction situation.ResultsThe 244 patients were divided into reducible-group (n=164, 67.21%) and irreducible-group (n=80, 32.79%) according to the intraoperative difficulty of reduction. Comparing the imaging data and characteristics of the two groups, and formulating the classification criteria of femoral intertrochanteric fractures based on irreducibility or not, the fractures were mainly divided into two categories of irreducibility and reducibility. The fractures of irreducibility category was divided into typesⅠ-Ⅴ, among which type Ⅲ was divided into subtypes 1-4; the fractures of reducibility category was divided into typesⅠand Ⅱ. Compared with the actual intraoperative evaluation results, the total accuracy rate of the doctors who did not attend the operation was 81.15% (198/244) based on the classification criteria of femoral intertrochanteric fractures. The accuracy rate of irreducibility category was 65.74% (71/108), and the reducibility category was 93.38% (127/136). All patients were followed up 13-25 months, with an average of 17.6 months. All fractures healed except 2 cases died of infection.ConclusionThe classification criteria of femoral intertrochanteric fractures based on irreducibility or not can accurately predict the reducible cases preoperatively, and most of the irreducible cases can be correctly predicted in a wider way. But the classification criteria still need to be further improved and supplemented.
ObjectiveTo investigate the clinical characteristics of deep branch of the ulnar nerve injuries at the wrist and hand and to summarize the classification criteria. MethodsA retrospective analysis was conducted on 12 patients with deep branch of the ulnar nerve injuries at the wrist and hand admitted between November 2016 and September 2025, including 7 males and 5 females with an average age of 42.2 years (range, 17-69 years). The duration of injury ranged from 0.3 to 4.0 months (mean, 1.85 months). Two point discrimination (2-PD) of the little finger was 12 (4, 15) mm. The muscle strength of little finger abduction was rated as grade 3 in 1 case, grade 4? in 6 cases, and grade 5 in 5 cases. Pinch strength between the thumb and index finger was (2.88±0.49) kg. Wartenberg sign was positive in 10 cases and negative in 2 cases. The index-middle finger crossing test was positive and claw-hand deformity was present in all patients. Ten patients underwent surgical treatment, whereas 2 patients received conservative treatment. ResultsBased on the anatomical characteristics of the deep branch of the ulnar nerve, clinical manifestations, and intraoperative exploration findings, injuries to the deep branch of the ulnar nerve at the wrist and hand were classified into three types. Type Ⅰ injuries were located proximal to the pisohamate hiatus; type Ⅱ injuries were located between the pisohamate hiatus and a point 17 mm distal to the hook of the hamate; and type Ⅲ injuries were located distal to a point 17 mm distal to the hook of the hamate. Among the 12 patients, 7 were rated as type Ⅰ injuries, 3 as type Ⅱ injuries, and 2 as type Ⅲ injuries. All patients were followed up 6-108 months after treatment (median, 15.5 months). At last follow-up, 2-PD of the little finger improved to 6 (4, 6) mm; the muscle strength of little finger abduction improved to grade 5? in 3 patients and grade 5 in 9 patients; and pinch strength between the thumb and index finger increased to (6.53±1.12) kg. All differences between pre- and post-treatment were significant (P<0.05). Wartenberg sign, the index-middle finger crossing test, and claw-hand deformity were all negative. The all outcome indicators in the 7 patients with type Ⅰ injuries significantly improved when compared with those before treatment (P<0.05). Conclusion Based on the clinical characteristics and injury location, injuries to the deep branch of the ulnar nerve at the wrist and hand can be classified into three types. The pisohamate hiatus and the point 17 mm distal to the hook of the hamate on the palmar aspect are key anatomical landmarks for this classification. This classification system may facilitate accurate localization of deep ulnar nerve branch injuries and provide guidance for surgical planning.