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Suzuki M, Takegami Y, Tokutake K, Nakasima H, Mishima K, Kumagai H, Imagama S. Elderly trochanteric fracture outcomes: Unveiling the risks of excessive postoperative sliding - A retrospective multicenter (TRON group) investigation. J Orthop Sci 2024:S0949-2658(24)00185-4. [PMID: 39370317 DOI: 10.1016/j.jos.2024.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 08/04/2024] [Accepted: 09/04/2024] [Indexed: 10/08/2024]
Abstract
BACKGROUND Intramedullary nailing (IMN) for femoral trochanteric fractures (FTF) is the primary surgical intervention. Excessive lag screw sliding (ES) of the femoral neck screw sometimes occurs. This multicenter investigation sought to 1) determine the prevalence of ES, 2) evaluate the relationship between ES and postoperative complications, and 3) identify the factors of ES in elderly patients with FTF undergoing IMN. METHODS From 2016 to 2020, 1448 patients with FTF were treated using a short IMN across 11 institutions (TRON group). Upon applying exclusion criteria, 519 patients (127 men, 392 women; mean age, 84.4 years) were included. The postoperative sliding distance was measured immediately after surgery and at final follow-up. A sliding distance of ≥8 mm categorized patients as having ES. We identify the factors contributing to ES using the logistic regression analysis, with a p < 0.05 as statistical significance. RESULTS ES was observed in 116 patients (22.4 %). Patients with ES had a higher incidence of postoperative cut-out and peri-implant fracture. Logistic regression analysis showed that achieving optimal reduction in both AP and lateral views (odds ratio (OR) 0.48, p = 0.0012) and the use of a double screw system or twin screws with integrated locking mechanism significantly reduced the risk of ES (OR 0.27, 0.17; p = 0.0027, <0.001). CONCLUSIONS The incidence rate of ES was 22.4 %. ES was associated with a higher risk of postoperative complications. The surgeons should aim for optimal reduction and use a double screw or twin screws with an integrated interlocking mechanism as the implant of choice.
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Affiliation(s)
- Makoto Suzuki
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuhiko Takegami
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Katsuhiro Tokutake
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroaki Nakasima
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenichi Mishima
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroaki Kumagai
- Department of Orthopaedic Surgery, Nagoya Ekisaikai Hospital, Nagoya, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Maehara T, Hayakawa T, Mukouyama S, Anraku Y, Hamada T, Suzuki H, Doi T, Shimizu T, Yorimitsu M, Teramoto H, Mae T, Okamoto Y, Hara J, Mihara K, Kanekasu K. The effect of anterior support screw (AS2) in unstable femoral trochanteric fractures: A multicenter randomized controlled trial. Injury 2024; 55:111725. [PMID: 39096804 DOI: 10.1016/j.injury.2024.111725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 07/08/2024] [Accepted: 07/09/2024] [Indexed: 08/05/2024]
Abstract
OBJECTIVES This study was conducted to verify the effectiveness of Anterior Support Screw (AS2) for unstable femoral trochanteric fractures. DESIGN A multicenter, prospective, randomized controlled trial SETTING: This study was conducted across 15 academic medical centers in Japan PATIENTS/PARTICIPANTS: We enrolled 240 cases of femoral trochanteric fractures with posterior crushing and intramedullary displacement of proximal bone fragments across 15 institutions in Japan. INTERVENTION All patients were subjected to a reduction in which the anterior cortex was brought into contact. The patients were randomly assigned to the anterior support screw group (AS2 group) and the non-screw group (control group). MAIN OUTCOME MEASUREMENTS Two computed-tomography (CT) scans were taken immediately after surgery and early postoperative period (day 14-21) to investigate the reduction loss rate of the anterior cortex and sliding distances in the early postoperative period. RESULTS The reduction loss rate was 4.5 % in the AS2 group and 16.8 % in the control group, indicating a significantly lower reduction loss rate in the AS2 group (p = 0.003). The average sliding distance was 1.8 mm in the AS2 group and 2.8 mm in the control group, indicating a significantly shorter sliding distance in the AS2 group (p < 0.0001). CONCLUSION Adding a screw in front of the intramedullary nail significantly reduces reduction loss, and maintains anterior bony contact. This study also showed that these screws suppress the sliding distance during the postoperative period. LEVEL OF EVIDENCE Therapeutic Level I.
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Affiliation(s)
- Takashi Maehara
- Department of Orthopaedic Surgery, Kagawa Rosai Hospital, Japan.
| | - Takashi Hayakawa
- Department of Joint Orthopaedic Surgery, Niigata Central Hospital, Japan
| | | | - Yoshihisa Anraku
- Department of Orthopaedic Surgery, Saiseikai Kumamoto Hospital, Japan
| | - Takahiro Hamada
- Department of Orthopaedic Surgery, Kyushu Central Hospital, Japan
| | - Hiroyuki Suzuki
- Department of Orthopaedic Surgery, Kasugai Municipal Hospital, Japan
| | - Takeshi Doi
- Department of Orthopaedic Surgery, Okayama Red Cross Hospital, Japan
| | - Tomohiko Shimizu
- Department of Orthopaedic Surgery, Fujieda Municipal General Hospital, Japan
| | | | | | - Takao Mae
- Department of Orthopaedic Surgery, Saga-ken Medical Centre Koseikan, Japan
| | - Yasunori Okamoto
- Department of Orthopaedic Surgery, Hoshigaoka Medical Center, Japan
| | - Jun Hara
- Department of Orthopaedic Surgery, Kawasaki Saiwai Hospital, Japan
| | - Kazushi Mihara
- Department of Orthopaedic Surgery, Toyooka Hospital, Japan
| | - Koichi Kanekasu
- Department of Orthopaedic Surgery, Saiseikai Takaoka Hospital, Japan
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Mao W, Liu CD, Chang SM, Yang AL, Hong CC. Anteromedial Cortical Support in Reduction of Trochanteric Hip Fractures: From Definition to Application. J Bone Joint Surg Am 2024; 106:1008-1018. [PMID: 38683886 DOI: 10.2106/jbjs.23.01023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
➤ The concept of anteromedial cortical support (AMCS) serves as valuable guidance for the intraoperative reduction of trochanteric hip fractures.➤ Positive medial cortical support (MCS) and positive or neutral anterior cortical support (ACS) are desirable. Some evidence has suggested that positive MCS is potentially superior to neutral MCS.➤ Experimental studies underscore the vital importance of the anteromedial wall and reveal why positive MCS potentially outperforms neutral MCS.➤ Incorporating the AMCS concept, the Chang reduction quality criteria (CRQC) are a reliable alternative approach to evaluate the reduction quality of trochanteric hip fractures.
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Affiliation(s)
- Wei Mao
- Department of Orthopaedic Surgery, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, People's Republic of China
- Department of Orthopaedic Surgery, National University Hospital, National University Health System, Singapore
| | - Chen-Dong Liu
- Department of Orthopaedic Surgery, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, People's Republic of China
| | - Shi-Min Chang
- Department of Orthopaedic Surgery, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, People's Republic of China
| | - Ao-Lei Yang
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, People's Republic of China
| | - Choon Chiet Hong
- Department of Orthopaedic Surgery, National University Hospital, National University Health System, Singapore
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Kelley B, Lee C. Reply to Letter to the Editor: Strategies for Pertrochanteric Fracture Reduction and Intramedullary Nail Placement: Technical Tips and Tricks. J Am Acad Orthop Surg 2024; 32:e269-e273. [PMID: 37561945 DOI: 10.5435/jaaos-d-23-00439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 06/10/2023] [Indexed: 08/12/2023] Open
Affiliation(s)
- Ben Kelley
- From the Department of Orthopaedic Surgery, University of California Los Angeles, Los Angeles, CA
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Inui T, Watanabe Y, Suzuki T, Matsui K, Kurata Y, Ishii K, Kurozumi T, Kawano H. Anterior Malreduction is Associated With Lag Screw Cutout After Internal Fixation of Intertrochanteric Fractures. Clin Orthop Relat Res 2024; 482:536-545. [PMID: 37732692 PMCID: PMC10871777 DOI: 10.1097/corr.0000000000002834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 07/31/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND Lag screw cutout is a devastating complication after internal fixation of an intertrochanteric fracture. Although the tip-apex distance (TAD) is known to be associated with this complication, another factor we thought was potentially important-fracture reduction on an oblique lateral view-has not, to our knowledge, been explored. QUESTIONS/PURPOSES (1) Is a well-reduced fracture position on an oblique lateral view after internal fixation of intertrochanteric fracture associated with a lower odds of postoperative cutout, independently of the TAD? (2) Is postoperative sliding of the lag screw after fixation associated with postoperative cutout? METHODS Patients with intertrochanteric fractures who were at least 65 years old and who had been treated with internal fixation in one of six facilities between July 2011 and December 2017 were included. All patients in the study group had lag screw cutout, and controls were selected by risk-set sampling of age-matched and sex-matched patients using a ratio of 4:1 for patients from each hospital. Of the 2327 intertrochanteric fractures, there were 36 patients (0.02 per person-year), with a mean age of 85 years; 89% (32) were women. In the control group, there were 135 controls. There was no difference in age or sex between the two groups. Sagittal reduction was evaluated using an immediate postoperative oblique lateral radiograph (anterior malreduction versus anatomic reduction or posterior malreduction). The association between anterior malreduction and the odds of cutout was estimated by conditional logistic regression analysis with the TAD and interaction between the TAD and the reduced position as covariates. As a sensitivity analysis, we estimated whether sliding within 2 weeks postoperatively was associated with cutout. RESULTS After controlling for the potentially confounding variables of age and sex, we found that anterior malreduction was independently associated with a higher odds of cutout compared with anatomic reduction or posterior malreduction (adjusted OR 4.2 [95% CI 1.5 to 12]; p = 0.006). There was also an independent association between cutout and larger TAD (≥ 20 mm) (adjusted OR 4.4 [95% CI 1.4 to 14]; p = 0.01). However, the association between cutout and reduction was not modified by the TAD (adjusted OR of interaction term 0.6 [95% CI 0.08 to 4]; p = 0.54). Postoperative sliding ≥ 6 mm within 2 weeks was associated with higher odds of cutout after adjusting for age and sex (adjusted OR 11 [95% CI 3 to 40]; p < 0.001). CONCLUSION In patients older than 65 years with intertrochanteric fractures, anterior malreduction on a lateral oblique view was associated with much greater odds of postoperative cutout than anatomic reduction or posterior malreduction. Because anterior malreduction is within the surgeon's control, our findings may help surgeons focus on intraoperative reduction on an oblique lateral view to prevent cutouts. Although this factor is a reliable indicator, the results should be applied to cephalomedullary nails, because there was only one patient with cutout among those with sliding hip screws. Because this study was conducted in a homogenous Japanese population, future studies should focus on the association between anterior malreduction and cutout in people of different ethnicities, adjusting for confounding factors such as implant type and surgeon level. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Takahiro Inui
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
- Trauma and Reconstruction Center, Teikyo University Hospital, Tokyo, Japan
| | - Yoshinobu Watanabe
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
- Trauma and Reconstruction Center, Teikyo University Hospital, Tokyo, Japan
| | - Takashi Suzuki
- Trauma and Reconstruction Center, Teikyo University Hospital, Tokyo, Japan
| | - Kentaro Matsui
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
- Trauma and Reconstruction Center, Teikyo University Hospital, Tokyo, Japan
| | - Yoshiaki Kurata
- Division of Orthopaedic Trauma, Sapporo Tokushukai Hospital, Hokkaido, Japan
| | - Keisuke Ishii
- Trauma and Reconstruction Center, Teikyo University Hospital, Tokyo, Japan
| | | | - Hirotaka Kawano
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
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Cho YH, Kim S, Koo J, Byun SE. Failure after intramedullary nailing for geriatric trochanteric fracture: does quality of fracture reduction on the AP and lateral planes show the same results? Arch Orthop Trauma Surg 2024; 144:1233-1241. [PMID: 38167750 DOI: 10.1007/s00402-023-05176-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 12/05/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE This study aimed to investigate the failure of trochanteric fracture fixation according to the quality of fracture reduction on the anteroposterior (AP) and lateral views. METHODS Data from 340 female and 152 male patients ≥ 60 years of age who underwent intramedullary nailing for a trochanteric fracture between 2016 and 2020 were analysed retrospectively. The quality of fracture reduction was classified as type A, type E, and type I on the AP view and type N, type A, and type P on the lateral view according to the relative position of the proximal and distal fragments. The failure rate was evaluated and compared according to the quality of fracture reduction. The risk factors of the fixation failure were investigated by comparison of variables between patients with and without failure and by regression analysis. RESULTS Patients with poor reduction, type I and type P had higher failure rates. However, a statistically significant difference was found only for patients with poor reduction (type P) on the lateral view (p < 0.001). Patients with failure showed significantly higher rates of poor reduction on the lateral view and AO/OTA type A3 fractures. The regression analysis also showed that poor reduction on the lateral view (odds ratio [OR] 12.70; 95% confidence interval [CI] 4.0-40.6; p < 0.001) and AO/OTA type A3 fractures (OR 5.40; 95% CI 1.24-23.49, p = 0.025) were risk factors for failure. CONCLUSION Poor reduction such as type P reduction was associated with failure after intramedullary nailing for trochanteric fractures. Surgeons should check the quality of fracture reduction carefully with the proper fluoroscopic view to prevent failure in geriatric patients with trochanteric fractures.
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Affiliation(s)
- Young-Ho Cho
- Department of Orthopaedic Surgery, Daegu Fatima Hospital, Daegu, Republic of Korea
| | - Sangwoo Kim
- Department of Orthopaedic Surgery, Daegu Fatima Hospital, Daegu, Republic of Korea
| | - Jaewook Koo
- Department of Orthopaedic Surgery, Daegu Fatima Hospital, Daegu, Republic of Korea
| | - Seong-Eun Byun
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University, 59 Yatap-Ro, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 13496, Republic of Korea.
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Li B, Hu SJ, Chang SM, Wei Z, Du SC, Xiong WF. The remnant axial cortical length of the proximal femur in pertrochanteric fractures: a three-dimensional computed tomography study and its clinical implications. BMC Musculoskelet Disord 2023; 24:941. [PMID: 38053090 DOI: 10.1186/s12891-023-07059-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 11/24/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Cortical buttress are important factors for postoperative stable reconstruction of per/inter-trochanteric fractures. The study aimed to measure the remnant axial cortical length (RACL) of the proximal circumference of the femur, and to determine which part of the RACL can be used reliably to postoperatively sustain the head-neck fragment as a cortical support pattern. METHODS Eighty patients with trochanteric hip fractures admitted from January 2015 to January 2016 were included in a retrospective study. Their pre-operative computed tomography (CT) images were used to form 3D-CT reconstructions via Mimics software. After simulated rotation and movement for fracture reduction, the RACL, its three component parts-namely, the remnant anterior cortex (RAC), remnant lateral cortex (RLC), and remnant posterior cortex (RPC) -the γ angle between the anterior and posterior cortex, and the Hsu's lateral wall thickness (LWT) were evaluated. RESULTS Patients with an A1 fracture (21/80) had a longer RACL (88.8 ± 15.8 mm) than those with an A2 fracture (60.0 ± 11.9 mm; P < 0.01). The RAC, RLC, and RPC of the RACL in A1 fractures were also significantly longer than those in A2 fractures (P < 0.001). However, the most significant difference among the three components of the RACL was in the RPC, which was 27.3 ± 7.8 mm in A1 fractures and 9.2 ± 6.6 mm in A2 fractures. In addition, the coefficient of variation of the RAC was only 20.0%, while that of the RPC was 75.5%. The average γ angle in A1 fractures was 16.2 ± 13.1°, which was significantly smaller than that in A2 fractures, which was 40.3 ± 14.5° (P < 0.001). There was a significant statistical difference in the LWT between A1 and A2 fractures (P < 0.001). There were significant differences in the RACL, RAC, RLC, RPC, γ angle, and LWT among the five subtypes (P < 0.001). CONCLUSIONS The RAC is relatively stable in pertrochanteric fractures. Fracture reduction through a RAC buttress may help to enhance the postoperative stable reconstruction of per/inter-trochanteric fractures and make possible good mechanical support for fracture healing.
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Affiliation(s)
- Bo Li
- Department of Orthopedic Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, 200090, China
| | - Sun-Jun Hu
- Department of Orthopedic Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, 200090, China
| | - Shi-Min Chang
- Department of Orthopedic Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, 200090, China.
| | - Zhen Wei
- Department of Orthopedic Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, 200090, China
| | - Shou-Chao Du
- Department of Orthopedic Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, 200090, China
| | - Wen-Feng Xiong
- Department of Orthopedic Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, 200090, China
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Nakamura H, Jimbo K, Morito S, Haraguchi T, Kawasaki Y, Gotoh M, Shirahama M, Yoshida K, Shiba N. Postoperative Rotation Deformity of Head-Neck Fragments in Unstable Intertrochanteric Fractures Fixed with Intramedullary Nails. Kurume Med J 2023; 69:1-9. [PMID: 37793889 DOI: 10.2739/kurumemedj.ms6912007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
BACKGROUND Our purpose was to quantify the postoperative rotation deformity (RD) after osteosynthesis of unstable intertrochanteric fractures (ITFx) using 3D-CT / image processing software, and to clarify the clinical meaning of RD. METHODS Forty-six consecutive patients with unstable intertrochanteric fractures were enrolled in this study. All were fixed with Gamma 3 Trochanteric nail and RC Lag Screw® (Stryker). We performed 3D-CT evaluations for the rotational deformity of head-neck fragments, the medial cortex support (MCS) between main fragments and bone healing at 3 months postoperatively. RESULTS The RD was significantly larger in the patients without the MCS (5.1 ± 4.0°, N = 9) than those with the MCS (2.4 ± 2.6°, N = 37) (P = 0.006*). Delayed healing (N=3) was observed in patients without the MCS, and the association between RD and delayed healing was significant (P = 0.003*, cut-off value 6.4°, sensitivity 100% and specificity 90.7%, AUC 0.91). CONCLUSIONS This study proposed a novel method of measuring postoperative RD. Lack of MCS may lead to RD and consequent delayed healing in unstable ITFx fixed with intramedullary nails.
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Affiliation(s)
| | - Kotaro Jimbo
- Department of Orthopedic Surgery, St. Mary's Hospital
| | - Shinji Morito
- Department of Orthopedic Surgery, Kurume University School of Medicine
| | | | - Yuji Kawasaki
- Department of Orthopedic Surgery, St. Mary's Hospital
| | - Masafumi Gotoh
- Department of Orthopedic Surgery, Kurume University Medical Center
| | | | - Kenji Yoshida
- Department of Orthopedic Surgery, St. Mary's Hospital
| | - Naoto Shiba
- Department of Orthopedic Surgery, Kurume University School of Medicine
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Lim EJ, Kim JW, Lee J, Kim CH. Is Nail-Canal Diameter Discordance a Risk Factor for the Excessive Sliding of Cephalomedullary Nails in Geriatric Intertrochanteric Fracture Surgery? MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1035. [PMID: 37374239 DOI: 10.3390/medicina59061035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 05/22/2023] [Accepted: 05/25/2023] [Indexed: 06/29/2023]
Abstract
Background and Objectives:: There were limited studies which investigated nail diameter as a predictor for cephalomedullary nail (CMN) failure in intertrochanteric fracture (ITF). We aimed to evaluate the surgical outcomes of CMN in fragility ITF following nail-canal (N-C) diameter discordance. Materials and Methods: From November 2010 to March 2022, we retrospectively reviewed 120 consecutive patients who underwent CMN surgeries due to fragility ITF. We included patients with acceptable reduction and a tip-apex distance ≤ 25 mm. The N-C diameter differences both in anterior-posterior (AP) and lateral-view X-rays were measured, and we compared the number of excessive sliding instances and the rate of implant failure between the N-C concordance (≤3 mm) and discordance (>3 mm) group. Simple linear regression was used to determine the strength of the relationship between the N-C difference and sliding distance. Results: The sliding distance showed no differences between the groups in the AP (3.6 vs. 3.3 mm, p = 0.75) and lateral view (3.5 vs. 3.4 mm, p = 0.91). For analyses in the AP view, the AP-concordance and AP-discordance groups had 14 (25%) and 14 patients (22%) with a sliding distance of >5 mm (p = 0.69), while treatment failure occurred in 3 (5%) and 3 (3%) patients, respectively (p = 0.66). For analyses in the lateral view, the lat-concordance and lat-discordance groups had 8 (27%) and 20 patients (22%) with a sliding distance of >5 mm (p = 0.62), while treatment failure occurred in 1 (3%) and 4 (4%) patients, respectively (p = 1.00). Linear regression analyses showed that the N-C difference in either views was not a significant predictor of sliding distance in both the AP (R2 = 0.002, p = 0.60) and lateral views (R2 = 0.007, p = 0.35). Conclusions: If appropriate fracture reduction and fixation are achieved, the N-C discordance of short CMN does not affect treatment outcomes in ITF.
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Affiliation(s)
- Eic Ju Lim
- Department of Orthopedic Surgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju 28644, Republic of Korea
| | - Ji Wan Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Jeuk Lee
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul 06973, Republic of Korea
| | - Chul-Ho Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
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Insufficient proximal medullary filling of cephalomedullary nails in intertrochanteric femur fractures predicts excessive postoperative sliding: a case-control study. BMC Musculoskelet Disord 2023; 24:156. [PMID: 36855090 PMCID: PMC9972673 DOI: 10.1186/s12891-023-06213-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 01/31/2023] [Indexed: 03/02/2023] Open
Abstract
OBJECTIVE Excessive postoperative sliding is a common complication of intramedullary nails in the treatment of intertrochanteric femur fractures. The aim of this study was to identify risk factors for excessive postoperative sliding in the intertrochanteric fractures treated with an intramedullary nail. METHODS A retrospective analysis of 369 patients with femoral intertrochanteric fractures treated with short intramedullary nails between February 2017 and September 2020 was performed. Patients were classified into an excessive sliding group (ES group) and a control group according to the sliding distance after 6 months of follow-up. The proximal medullary filling degree (MFD), fracture reduction patterns in the anteroposterior (AP) view and lateral view, and tip-apex distance (TAD) were evaluated and compared in each group. RESULTS Thirty-three cases were included in the ES group, and 336 cases were included in the control group. No significant differences in age, sex, fracture side, AO Foundation and Orthopaedic Trauma Association (AO/OTA) classification, Dorr classification, Singh Osteoporosis Index (SOI), American Society of Anesthesiologists classification (ASA), TAD or fracture reduction patterns in the AP view were noted between the two groups. The negative reduction pattern can strongly predict excessive postoperative sliding (OR 4.286, 95% CI 1.637-11.216, P = 0.003). The incidence of excessive postoperative sliding increased by 8.713-fold when the MFD decreased by 10% (OR 8.713, 95% CI 1.925-39.437, P = 0.005). CONCLUSIONS A low medullary filling degree and negative fracture reduction pattern in the lateral view were both independent risk factors for excessive postoperative sliding.
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Muacevic A, Adler JR, Fujiwara K. Measurement of Lag-Screw Anteversion With an iPhone During Trochanteric Fracture Surgery. Cureus 2022; 14:e33110. [PMID: 36721595 PMCID: PMC9884309 DOI: 10.7759/cureus.33110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2022] [Indexed: 12/31/2022] Open
Abstract
Introduction A useful way to easily evaluate femoral rotation during surgery for trochanteric fractures is not known. Hence, this pilot study aimed to develop an intraoperative indicator to evaluate anteversion in femoral trochanteric fractures. Material and methods Prospectively, from June 2021 to January 2022, all patients with femoral trochanteric fractures (Orthopaedic Trauma Association classification: 31A1-3) treated using a cephalo-medullary nail with a lag-screw neck-shaft angle of 125° were included in this study. During surgery, lag-screw anteversion (LS-AV) was measured using the goniometer application in an iPhone with the fractured femur table-top-plane level with the traction table floor. Accuracy was analyzed by comparing axial-projected lag-screw anteversion (AxP-LS-AV) and three-dimensional computed tomography lag-screw anteversion (3DCT-LS-AV) measurements after surgery. Results Fifty patients (14 males and 36 females) were included in the study. The mean age was 87 (range; 69-98) years; the Orthopaedic Trauma Association classifications were A1 (28 patients), A2 (18 patients), and A3 (4 patients). The mean LS-AV was 10.7° ± 6.9°, the mean AxP-LS-AV was 12.8° ± 8.3°, and the mean 3DCT-LS-AV was 13.1° ± 8.6°. The median difference between AxP-LS-AV and 3DCT-LS-AV was 3.0° (range: 0°-12°), and 40 (80%) patients had differences of ≤5° (Bland-Altman plot: inside of limit of agreement = 86%, paired t-test p = 0.7, Pearson correlation coefficient r = 0.817, p <0.001). Conclusion Femur malrotation is defined as a deformity of >15° relative to the normal contralateral limb. Intraoperative LS-AV iPhone measurement on table-top-plane standard had sufficient accuracy as an indicator of anteversion in femoral trochanteric fractures.
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Kim HS, Lee DK, Mun KU, Moon DH, Kim CH. What Is the Best Treatment Choice for Concomitant Ipsilateral Femoral Neck and Intertrochanteric Fracture? A Retrospective Comparative Analysis of 115 Consecutive Patients. J Pers Med 2022; 12:1908. [PMID: 36422084 PMCID: PMC9693868 DOI: 10.3390/jpm12111908] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 11/02/2022] [Accepted: 11/13/2022] [Indexed: 11/28/2023] Open
Abstract
PURPOSE Although a concomitant ipsilateral femoral neck and intertrochanteric fracture has been considered to be a rare type of injury, its incidence has been increasing, especially among elderly hip fracture patients. However, there is limited evidence on the optimal treatment option. This study surveys surgical outcomes of different implants in order to assist in selecting the best possible implant for a combined femoral neck and intertrochanteric fracture. METHODS The postoperative complications after the treatment of a concomitant ipsilateral femoral neck and intertrochanteric fracture via cephalomedullary nail (CMN), dynamic hip screw (DHS), and hip arthroplasty groups were analyzed by retrospectively reviewing the electronic medical records of 115 consecutive patients. RESULTS The patient demographics and perioperative details showed no significant discrepancies amongst different surgical groups, except for the operative time; a CMN had the shortest mean operative time (standard deviation) of 85.6 min (31.1), followed by 94.7 min (22.3) during a DHS, and 107.3 min (37.2) during an HR (p = 0.021). Of the 84 osteosynthesis patients, 77 (91.7%) achieved a fracture union. Only one (3.2%) of the 31 HR cases had a dislocation. The sub-analysis of the different osteosynthesis methods showed a higher incidence of excessive sliding and the nonunion of the fracture fragment in the DHS group than that in the CMN group (p = 0.004 and p = 0.022, respectively). The different surgical methods did not significantly vary in other outcome variables, such as the re-operation rate, mortality, and hip function. CONCLUSIONS For the surgical treatment of combined femoral neck and trochanteric fractures, osteosynthesis did not differ significantly from an HR in terms of the overall postoperative complications, reoperation and mortality rate, and hip function, however, the risk of nonunion and more mechanical complications should be considered when choosing a DHS. Our suggestion for the treatment of a femoral neck and ipsilateral trochanteric fracture is that a surgeon should choose wisely between an HR and a CMN depending on the patient's age, the displacement of the femoral neck, and one's expertise.
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Affiliation(s)
- Han Soul Kim
- Department of Orthopedic Surgery, Gachon University Gil Medical Center, Namdong-gu, Incheon 21556, Republic of Korea
| | - Dong Keun Lee
- Department of Orthopedic Surgery, Gachon University Gil Medical Center, Namdong-gu, Incheon 21556, Republic of Korea
| | - Ki Uk Mun
- Department of Orthopedic Surgery, Gachon University Gil Medical Center, Namdong-gu, Incheon 21556, Republic of Korea
| | - Dou Hyun Moon
- Department of Orthopedic Surgery, Gachon University Gil Medical Center, Namdong-gu, Incheon 21556, Republic of Korea
| | - Chul-Ho Kim
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul 06973, Republic of Korea
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Matsubara T, Soma K, Yamada I, Fujita H, Yoshitani J, Oka H, Okada H, Tanaka S. Offset nail fixation for intertrochanteric fractures improves reduction and lag screw position. PLoS One 2022; 17:e0276903. [PMID: 36383515 PMCID: PMC9668128 DOI: 10.1371/journal.pone.0276903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/17/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Surgery for intertrochanteric fractures using intramedullary hip nails (IHNs) is among the most common surgical procedures in the orthopedic field. Although IHNs provide good overall outcomes, they sometimes cause complications, such as loss of reduction and cut-out. Here, we investigated the usefulness of IHNs with an anterior offset (Best Fit Nail® [BFN]) in maintaining fragment reduction and ensuring proper lag screw position compared with conventional non-offset nails (Proximal Femoral Nail Antirotation® [PFNA]), using postoperative computed tomography (CT). METHODS Fifty consecutive patients with intertrochanteric fractures who underwent surgery with BFNs (BFN group) and 50 patients who underwent surgery with PFNAs (PFNA group) were retrospectively analyzed. Indices evaluated by postoperative CT were displacement distance of proximal fragment relative to distal fragment, reduction status (intramedullary, anatomical, and extramedullary types), lag screw direction, and angle between lag screw and femoral neck axis (deviation angle). RESULTS Median [interquartile range] displacement distance was significantly smaller in the BFN group (0 [0, 0] mm) compared with the PFNA group (5.2 [3.6, 7.1] mm) (p<0.001). Reduction status was significantly better in the BFN group (anatomical type, 40 cases; intramedullary type, in 9 cases, and extramedullary type in 1 case) than in the PFNA group (anatomical type, 6 cases; intramedullary type, 43 cases; extramedullary type, 1 case) (p<0.001). Deviation of lag screw direction was observed in significantly fewer cases in the BFN group (20 cases; 40%) compared with the PFNA group (36 cases; 72%). Lag screw deviation angle was significantly smaller in the BFN group (-0.71°±4.0°) compared with the PFNA group (6.9°±7.1°). No adverse events related to surgery were observed in either group. CONCLUSIONS Intertrochanteric fracture surgery using offset BFNs exhibited significantly smaller displacement distance, better reduction status, and higher frequency of no deviation with central lag screw position, compared with surgery using non-offset PFNAs.
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Affiliation(s)
- Takehiro Matsubara
- Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | | | - Ikufumi Yamada
- Fushimi Momoyama General Hospital, Fushimi-ku, Kyoto, Japan
| | - Hiroshi Fujita
- Hip Joint Center of Rakuyo Hospital, Sakyo-ku, Kyoto, Japan
| | | | - Hiroyuki Oka
- Faculty of Medicine, Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical and Research Center, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Hiroyuki Okada
- Center for Disease Biology and Integrative Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
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Effectiveness of Cement Augmentation on Early Postoperative Mobility in Patients Treated for Trochanteric Fractures with Cephalomedullary Nailing: A Prospective Cohort Study. J Pers Med 2022; 12:jpm12091392. [PMID: 36143177 PMCID: PMC9501313 DOI: 10.3390/jpm12091392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 08/26/2022] [Accepted: 08/26/2022] [Indexed: 11/16/2022] Open
Abstract
Fixation using cephalomedullary nails (CMNs) with additional cement augmentation (CA) was developed as a novel treatment option for the osteosynthesis of osteoporotic trochanteric fractures, though the effectiveness of CA on early postoperative mobility remains uncertain. This multicenter prospective cohort study aimed to estimate the effectiveness of CA on early postoperative mobility in patients with trochanteric fractures. We enrolled patients with femoral trochanteric fractures aged >60 years who were able to walk independently before the injury. The primary outcome was the postoperative 3-day cumulated ambulation score (CAS); the secondary outcome was the visual analog scale (VAS) pain score at rest and during movement on postoperative days 1−3. The outcomes of the patients treated using CMNs with or without CA were compared. Sixty-three eligible patients were categorized into CA (n = 32) and control (n = 31) groups. In univariate analysis, the CA group had significantly higher CAS values, lower VAS scores at rest on day 1 postoperatively, and lower VAS scores during movement on day 3. In multivariable linear regression analyses, the CA group had significantly higher CAS values (beta, 2.1; 95% confidence interval, 0.5 to 3.6; p = 0.01). The CA group had a negative adjusted beta value in their VAS scores during movement. This study indicated that CA was associated with a high CAS value in patients with geriatric trochanteric fractures. However, CA was not associated with pain reduction at rest and during movement during the initial postoperative days.
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Yamamoto N, Tsujimoto Y, Yokoo S, Demiya K, Inoue M, Noda T, Ozaki T, Yorifuji T. Association between Immediate Postoperative Radiographic Findings and Failed Internal Fixation for Trochanteric Fractures: Systematic Review and Meta-Analysis. J Clin Med 2022; 11:4879. [PMID: 36013114 PMCID: PMC9409751 DOI: 10.3390/jcm11164879] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/11/2022] [Accepted: 08/17/2022] [Indexed: 11/17/2022] Open
Abstract
Failed internal fixations for trochanteric fractures have a strong negative impact owing to increased postoperative mortality and high medical costs. However, evidence on the prognostic value of postoperative radiographic findings for failed internal fixations is limited. We aimed to clarify the association between comprehensive immediate postoperative radiographic findings and failed internal fixation using relative and absolute risk measures. We followed the meta-analysis of observational studies in epidemiology guidelines and the Cochrane handbook. We searched specific databases in November 2021. The outcomes of interest were failed internal fixation and cut-out. We pooled the odds ratios and 95% confidence intervals using a random-effects model and calculated the number needed to harm for each outcome. Thirty-six studies involving 8938 patients were included. The certainty of evidence in the association between postoperative radiographic findings and failed internal fixation or cut-out was mainly low or very low except for the association between intramedullary malreduction on the anteromedial cortex and failed internal fixation. Moderate certainty of evidence supported that intramedullary malreduction on the anteromedial cortex was associated with failed internal fixation. Most postoperative radiographic findings on immediate postoperative radiographs for trochanteric fractures were uncertain as prognostic factors for failed internal fixations.
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Affiliation(s)
- Norio Yamamoto
- Department of Orthopedic Surgery, Miyamoto Orthopedic Hospital, Okayama 773-8236, Japan
- Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8530, Japan
- Scientific Research Works Peer Support Group (SRWS-PSG), Osaka 541-0043, Japan
| | - Yasushi Tsujimoto
- Scientific Research Works Peer Support Group (SRWS-PSG), Osaka 541-0043, Japan
- Departments of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto 606-8501, Japan
- Oku Medical Clinic, Osaka 573-0164, Japan
- Cochrane Japan, Tokyo 104-0044, Japan
| | - Suguru Yokoo
- Department of Orthopedic Surgery, National Hospital Organization Okayama Medical Center, Okayama 701-1192, Japan
| | - Koji Demiya
- Department of Orthopedic Surgery, Tsuyama Chuo Hospital, Okayama 708-0841, Japan
| | - Madoka Inoue
- Scientific Research Works Peer Support Group (SRWS-PSG), Osaka 541-0043, Japan
| | - Tomoyuki Noda
- Department of Orthopedic Surgery and Traumatology, Kawasaki Medical School General Medical Center, Okayama 700-8505, Japan
| | - Toshifumi Ozaki
- Department of Orthopedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama 700-8530, Japan
| | - Takashi Yorifuji
- Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8530, Japan
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Sivakumar A, Edwards S, Millar S, Thewlis D, Rickman M. Reoperation rates after proximal femur fracture fixation with single and dual screw femoral nails: a systematic review and meta-analysis. EFORT Open Rev 2022; 7:506-515. [PMID: 35900199 PMCID: PMC9297051 DOI: 10.1530/eor-21-0067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose Methods Results Conclusion
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Affiliation(s)
- Arjun Sivakumar
- Centre for Orthopaedic & Trauma Research, University of Adelaide, Adelaide, South Australia, Australia
| | - Suzanne Edwards
- Adelaide Health Technology Assessment, University of Adelaide, Adelaide, South Australia, Australia
| | - Stuart Millar
- Centre for Orthopaedic & Trauma Research, University of Adelaide, Adelaide, South Australia, Australia
| | - Dominic Thewlis
- Centre for Orthopaedic & Trauma Research, University of Adelaide, Adelaide, South Australia, Australia
| | - Mark Rickman
- Centre for Orthopaedic & Trauma Research, University of Adelaide, Adelaide, South Australia, Australia
- Department of Orthopaedics & Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Goto K, Murakami T, Saku I. Postoperative subtype P as a risk factor for excessive postoperative sliding of cephalomedullary nail in femoral trochanteric fractures in old patients: A case series of 263 patients using computed tomography analysis. Injury 2022; 53:2163-2171. [PMID: 35260246 DOI: 10.1016/j.injury.2022.02.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/29/2022] [Accepted: 02/27/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Although excellent results of cephalomedullary nailing for femoral trochanteric fractures have been reported, excessive sliding has recently been noted as a cause of lag screw cut-out. Excessive sliding is reported as sliding of ≥8mm, which occurs in approximately 40%of cases. This study aimed to evaluate the risk factors for excessive sliding. PATIENTS AND METHODS Overall, 551 patients who underwent cephalomedullary nail surgery between 2016 and 2021 were recruited. Patients aged ≥65 years who underwent preoperative computed tomography (CT), experienced low-energy trauma, and received follow-up for >4 months were included. Cases were retrospectively reviewed for their postoperative sliding distance and the percentage of excessive sliding (>8 mm). 3D-CT classification, reduction pattern (subtypes A, N, and P) in the lateral view, medullary mismatch, and implant type (short/long Gamma3 nail and INTERTAN) were investigated fortheirimpact on sliding distance andtheincidence of excessive sliding. Complication rates (lag screw cut-out and non-union) were also assessed. RESULTS Overall, 263 patients (mean age, 84.0±7.4; 186 women) were recruited. The median (range) sliding distance was 3.5 (0-20) mm, and 42 cases (16.0%) had excessive sliding. Sliding distance was significantly smaller in the 2-fragment group than in the 3-fragment group (GP+GA and GP+L) (p=0.02); however, there were no significant differences between the 2-fragment and other fracture-type groups, including the 3-fragment group (GP, GA, GP ± GA, GP ± L), 4-fragmentgroup(GP/L, GP ± L/GA, GP±GA/L), and 5-fragmentgroup. There was no significant difference in sliding distance according to postoperative reduction type between the groups (p=0.83) and no correlation between medullary mismatch and sliding distance. The amount of sliding and rate of excessive sliding were significantly lower in the INTERTAN group than in the Gamma3 nail groups (p<0.01). Logistic regression analysis with excessive sliding as the variable revealed reduction type P as the only risk factor (p=0.024, odds ratio 2.99). There were three lag screw cut-out (1.1%) cases and one non-union (0.4%) case. CONCLUSIONS Postoperative subtype P is a risk factor for excessive sliding; there was significantly less sliding in the INTERTAN nail group. It is necessary to avoid reduction to subtype P to prevent postoperative excessive sliding. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Kazumi Goto
- Department of Orthopaedic Surgery, Yaizu City Hospital, Yaizu-Shi, Shizuoka, Japan.
| | - Tomoki Murakami
- Department of Orthopaedic Surgery, Yaizu City Hospital, Yaizu-Shi, Shizuoka, Japan
| | - Isaku Saku
- Department of Orthopaedic Surgery, Yaizu City Hospital, Yaizu-Shi, Shizuoka, Japan
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Risk factors for over-telescoping in reverse oblique intertrochanteric fractures. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2022; 33:1101-1107. [PMID: 35403907 DOI: 10.1007/s00590-022-03263-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 03/28/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Postoperative over-telescoping (OT) with lag screws is often observed in reverse oblique intertrochanteric fractures. This study aimed to clarify the risk factors of OT in patients with reverse oblique intertrochanteric fractures. METHODS Electronic medical records of patients diagnosed with reverse oblique intertrochanteric fractures using plain radiography who underwent operative fixation with an intramedullary nail between August 2013 and December 2019 were reviewed. Patients were classified into two groups according to the Futamura classification: lateral wall pattern (LW) and reverse oblique pattern (RO). The incidence of OT in the LW and RO groups was compared. Also, we compared the incidence of OT for each reduction type in the LW group. RESULTS Twenty patients had LW, and nine had RO. OT was observed in eight fractures (42.1%) in the LW group but not in the RO group. The incidence of OT was significantly higher in the LW group than in the RO group (P = 0.0261). Among the 19 fractures with LW, OT was observed in 7 of 10 and 1 of 9 fractures with postoperative reduction in the intramedullary and extramedullary or anatomical types, respectively. In the LW group, the incidence of OT was significantly higher in fractures with postoperative reduction in the intramedullary type than in those of the extramedullary or anatomical type (P = 0.0198). CONCLUSION Our study showed that the incidence of OT was significantly higher in LW than in RO and that postoperative reduction in the intramedullary type in LW was a risk factor for OT.
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Fuse Y, Zenke Y, Okimoto N, Yoshioka T, Yamanaka Y, Kawasaki M, Terayama H, Sakai A. Biomechanical comparison of lag screw and non-spiral blade fixation of a novel femoral trochanteric nail in an osteoporotic bone model. Sci Rep 2022; 12:782. [PMID: 35039574 PMCID: PMC8764022 DOI: 10.1038/s41598-022-04844-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 01/03/2022] [Indexed: 12/05/2022] Open
Abstract
There is no consensus regarding the advantages of the lag screw type over the blade type for treating femoral trochanteric fractures. We aimed to investigate whether non-spiral blade (Conventional-Blade, Fid-Blade) nails provide better biomechanical fixation than lag screws in a severe osteoporotic bone model. Different severities of osteoporotic cancellous bone were modelled using polyurethane foam blocks of three densities (0.24, 0.16, and 0.08 g/cm3). Three torsional tests were performed using each component for each density of the polyurethane block, and the maximum torque was recorded; subsequently, the energy required to achieve 30° rotation was calculated. Using a push-in test, the maximum force was recorded, and the energy required to achieve 4-mm displacement was calculated. For 0.08-g/cm3 density, the peak torques to achieve 30° rotation, energy required to achieve 30° rotation, peak force to achieve 4-mm displacement, and energy required to achieve 4-mm displacement were significantly greater for Conventional-Blade and Fid-Blade than those for Lag Screw. The fixation stability of the blade-type Magnum nail component is better than that of the lag screw type under any test condition. The blade-type nail component may have better fixation stability than the lag screw type in a severe osteoporotic bone model.
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Affiliation(s)
- Yoshifumi Fuse
- Department of Orthopaedic Surgery, Saka Midorii Hospital, 6-28-1, Midorii, Asaminami-Ku, Hiroshima Shi, Hiroshima Ken, 731-0103, Japan.
| | - Yukichi Zenke
- Department of Orthopaedic Surgery, University of Occupational and Environmental Health, 1-1, Iseigaoka, Yahatanishi-ku, Kitakyusyu-shi, Fukuoka, 807-8555, Japan
| | - Nobukazu Okimoto
- Okimoto Clinic, 185-4, Yutakamachi Kubi, Kure Shi, Hiroshima Ken, 734-0304, Japan
| | - Toru Yoshioka
- Department of Orthopaedic Surgery, Shimura Hospital, 3-13, Funairimachi, Naka Ku, Hiroshima Shi, Hiroshima Ken, 730-0841, Japan
| | - Yoshiaki Yamanaka
- Department of Orthopaedic Surgery, University of Occupational and Environmental Health, 1-1, Iseigaoka, Yahatanishi-ku, Kitakyusyu-shi, Fukuoka, 807-8555, Japan
| | - Makoto Kawasaki
- Department of Orthopaedic Surgery, University of Occupational and Environmental Health, 1-1, Iseigaoka, Yahatanishi-ku, Kitakyusyu-shi, Fukuoka, 807-8555, Japan
| | - Hiroshi Terayama
- Department of Orthopaedic Surgery, Saka Midorii Hospital, 6-28-1, Midorii, Asaminami-Ku, Hiroshima Shi, Hiroshima Ken, 731-0103, Japan
| | - Akinori Sakai
- Department of Orthopaedic Surgery, University of Occupational and Environmental Health, 1-1, Iseigaoka, Yahatanishi-ku, Kitakyusyu-shi, Fukuoka, 807-8555, Japan
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Momii K, Fujiwara T, Mae T, Tokunaga M, Iwasaki T, Shiomoto K, Kubota K, Onizuka T, Miura T, Hamada T, Nakamura T, Itokawa T, Iguchi T, Yamashita A, Kikuchi N, Nakaie K, Matsumoto Y, Nakashima Y. Risk factors for excessive postoperative sliding of femoral trochanteric fracture in elderly patients: A retrospective multicenter study. Injury 2021; 52:3369-3376. [PMID: 34373108 DOI: 10.1016/j.injury.2021.07.039] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 07/26/2021] [Accepted: 07/28/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The application of a load on the internal fixation of a trochanteric fracture exerts a moment along the lag screw, causing the proximal bone fragment to slide along the lag screw, allowing contact between the proximal and distal bone fragments, which promotes healing. However, excessive sliding is related to poor postoperative outcomes. We aimed to identify the risk factors for excessive sliding. MATERIALS AND METHODS We conducted a multicenter retrospective study including 115 trochanteric fractures sustained through low-energy trauma in 19 male and 96 female patients aged 60 years or older (mean age: 82.9 years) between September 2013 and December 2014. We measured the postoperative sliding distance after osteosynthesis using a sliding hip screw or intramedullary nailing, and classified participants with ≥8 mm of sliding into the excessive sliding group (ESG) and with <8 mm into non-ESG. Finally, we investigated the risk factors of excessive postoperative sliding. RESULTS Fifty participants were classified into the ESG and 65 participants into the non-ESG. Female sex (p = 0.0264), an A3 fracture type (p = 0.0003), greater tip-apex distance (p = 0.0250), and poor reduction in either the anteroposterior or lateral radiographic views (p = 0.0156) were identified as risk factors for excessive sliding by multivariate regression analysis. CONCLUSIONS Female sex, an unstable fracture type, a greater tip-apex distance, and a poor reduction, in either the anteroposterior or lateral views, are associated with excessive postoperative sliding. Therefore, surgery should aim to achieve good reduction and stabilization from both radiographic views.
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Affiliation(s)
- Kenta Momii
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan
| | - Toshifumi Fujiwara
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan.
| | - Takao Mae
- Department of Orthopaedic Surgery, Saga Prefectural Hospital Koseikan, 400, Ohaza Nakabaru, Kase-Town, Saga, Japan
| | - Masami Tokunaga
- Department of Orthopaedic Surgery, Fukuoka Orthopaedic Hospital, 2-10-50 Yanagouchi, Minami-ku, Fukuoka, Japan
| | - Takeshi Iwasaki
- Department of Anatomic Pathology, Graduate School of Medical Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan
| | - Kyohei Shiomoto
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan
| | - Kensuke Kubota
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan
| | - Toshihiro Onizuka
- Department of Orthopaedic Surgery, Kyushu Rosai Hospital, 1-1 Sone north town, Kokura Minami-ku, Kitakyushu city, Japan
| | - Tatsuhiko Miura
- Department of Orthopaedic Surgery, Iizuka Hospital, 3-83 Yoshio town, Iizuka city, Fukuoka, Japan
| | - Takahiro Hamada
- Department of Orthopaedic Surgery, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, 3-23-1 Shiobaru, Minami-ku, Fukuoka, Japan
| | - Tetsuro Nakamura
- Department of Orthopaedic Surgery, Japan Community Healthcare Organization Kyushu Hospital, 1-8-1 Kishinoura, Yahata Nishi-ku, Kitakyushu, Japan
| | - Takashi Itokawa
- Department of Orthopaedic Surgery, Fukuoka City Hospital, 13-1 Yoshizukamotomachi, Hakata-ku, Fukuoka, Japan
| | - Takahiro Iguchi
- Department of Orthopaedic Surgery, Hamanomachi Hospital, 3-3-1 Nagahama, Chuo-ku, Fukuoka, Japan
| | - Akihisa Yamashita
- Department of Orthopaedic Surgery, Shimonoseki City Hospital, 1-13-1 Kouyouchou, Shimonoseki, Yamaguchi, Japan
| | - Naoshi Kikuchi
- Department of Orthopaedic Surgery, Miyazaki Prefectual Miyazaki Hospital, 5-30 Kitatakamatsu town, Miyazaki, Japan
| | - Kazutoshi Nakaie
- Department of Orthopaedic Surgery, National Hospital Organization Fukuoka-higashi Medical Center, 1-1-1 Chidori, Koga city, Fukuoka, Japan
| | - Yoshihiro Matsumoto
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan
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Comparison of sliding distance of lag screw and nonunion rate according to anteromedial cortical support in intertrochanteric fracture fixation: A systematic review and meta-analysis. Injury 2021; 52:2787-2794. [PMID: 34417003 DOI: 10.1016/j.injury.2021.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 07/07/2021] [Accepted: 08/05/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION We compared the sliding distance of the lag screw, change in neck-shaft angle (NSA), and nonunion rates according to the anteromedial cortical support on anteroposterior (AP) and lateral view radiographs post intertrochanteric fracture reduction. MATERIAL AND METHODS In this systematic review and meta-analysis, MEDLINE, Embase, and Cochrane Library databases were searched systematically for studies published before September 26, 2020. We performed synthetic analyses of the amount of lag screw sliding, change in NSA, and incidence of nonunion following reduction of intertrochanteric fractures by extramedullary reduction (EMR), neutral reduction (NR), and intramedullary reduction (IMR). The combined data of EMR and NR comprised the non-IMR group. RESULTS Our study enrolled eight studies, representing 1,363 patients who underwent surgery for intertrochanteric fractures. A pooled analysis showed a larger sliding distance in the IMR group than in the non-IMR group (standard mean difference [SMD] = 1.47, 95% confidence interval [CI]: 0.73-2.20; P < 0.0001 and SMD = 1.27, 95% CI: 0.56-1.99; P = 0.0005, respectively) in both AP and lateral views. The pooled mean difference of change in NSA in the IMR group was -3.11° and differed significantly from that of the non-IMR group (95% CI: -4.07 to -2.16; P < 0.0001). In the lateral view, the nonunion rate was significantly higher in the IMR group than in the non-IMR group (odds ratio [OR] = 11.61; 95% CI, 3.32-40.62; P = 0.0001). In the subgroup analysis, the NR group showed a larger sliding distance than that of the EMR group in the AP view (SMD = 0.40, 95% CI: 0.04-0.76; P = 0.03); however, the reverse was true in the lateral view (SMD = 0.68, 95% CI: 0.38-0.97; P < 0.00001). CONCLUSION In the current meta-analysis, larger sliding distances, more varus in NSA, and higher nonunion rates were observed in the IMR group than the non-IMR group, in both AP and lateral views. However, in the comparison between EMR and NR, it was difficult to conclude which of them was the ideal reduction method because of inconsistent results.
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Kim CH, Kim HS, Moon DH. Additional Reduction Screw Fixation Technique for Pertrochanteric Hip Fractures: A Novel Method to Prevent Excessive Sliding in Cephalomedullary Nail Surgery. Hip Pelvis 2021; 33:162-166. [PMID: 34552894 PMCID: PMC8440134 DOI: 10.5371/hp.2021.33.3.162] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 03/31/2021] [Accepted: 04/01/2021] [Indexed: 11/24/2022] Open
Abstract
Extramedullary (EM) reduction, defined as the medial cortex of the head-neck fragment located outside the medullary canal of the distal shaft fragment, has been introduced to prevent excessive postoperative sliding or failure of the lag screw in pertrochanteric fracture surgeries. Favorable EM reduction results have recently been reported in several clinical and biomechanical studies. Despite these efforts, maintaining the head-neck fragment in an EM position is periodically a difficult and challenging problem. Herein, the technique for reduction and maintenance of the head-neck fragment was introduced in an EM position using a Kirschner wire and partially threaded cannulated screw fixation via screw fixation from EM to the head-neck fragment, which was positioned inferior to the lag screw on the femoral calcar, also called the reduction screw. The authors utilized this reduction screw in 34 pertrochanteric fracture surgeries using a cephalomedullary nail and fracture union was acheive in all cases by a minimum one-year follow-up period without surgical complications.
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Affiliation(s)
- Chul-Ho Kim
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Han Soul Kim
- Department of Orthopedic Surgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Dou Hyun Moon
- Department of Orthopedic Surgery, Gachon University Gil Medical Center, Incheon, Korea
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Shon OJ, Choi CH, Park CH. Factors Associated with Mechanical Complications in Intertrochanteric Fracture Treated with Proximal Femoral Nail Antirotation. Hip Pelvis 2021; 33:154-161. [PMID: 34552893 PMCID: PMC8440130 DOI: 10.5371/hp.2021.33.3.154] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 01/11/2021] [Accepted: 01/19/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose Although proximal femoral nail antirotation (PFNA; Synthes, Switzerland) has demonstrated satisfactory results when used for the treatment of intertrochanteric fractures, mechanical complications may occur. To better quantify the risk of mechanical complications when proximal femoral nail antirotation is used to treat intertrochanteric fractures, this study aimed to: (1) characterize the frequency of mechanical complications and extent of blade sliding and their correlation with reduction quality and (2) identify factors associated with mechanical complications. Materials and Methods A review of medical records from 93 patients treated for intertrochanteric fractures with a minimum of 6-months of follow-up between February 2014 and February 2019 was conducted. Blade position was evaluated using Tip-apex distance (TAD) and Cleveland index. The extent of blade sliding was evaluated using the adjusted Doppelt's method for intramedullary nailing. Individuals were classified as having or not having mechanical complications, and reduction quality and radiologic outcomes were compared between the two groups. Results Mechanical complications occurred in 12 of 94 hips (12.8%), with 11 out of 12 being from the intramedullary reduction group. There was no significant difference in TAD between groups; however, there were significant differences were noted in Cleveland index, AO/OTA classification, reduction quality and extent of blade sliding. The mean blade sliding distance was 1.17 mm (anatomical group), 3.28 mm (extramedullary group), and 6.11 mm (intramedullary group), respectively (P<0.001). Data revealed that blade sliding was an associated factor for mechanical complications (odds ratio 1.25, 95% confidence interval 1.03–1.51). Conclusion The extent of blade sliding determined using the adjusted Doppelt's method was significantly associated with mechanical complications suggesting that prevention of excessive sliding through proper intraoperative reduction is important to help achieve satisfactory treatment outcomes.
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Affiliation(s)
- Oog-Jin Shon
- Department of Orthopedic Surgery, Yeungnam University Medical Center, Daegu, Korea
| | - Chang Hyun Choi
- Department of Orthopedic Surgery, Yeungnam University Medical Center, Daegu, Korea
| | - Chan Ho Park
- Department of Orthopedic Surgery, Yeungnam University Medical Center, Daegu, Korea
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Yamamoto N, Ogawa T, Banno M, Watanabe J, Noda T, Schermann H, Ozaki T. Cement augmentation of internal fixation for trochanteric fracture: a systematic review and meta-analysis. Eur J Trauma Emerg Surg 2021; 48:1699-1709. [PMID: 34223912 DOI: 10.1007/s00068-021-01746-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 06/29/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE This study aimed to determine the efficacy and safety of cement augmentation for internally fixed trochanteric fractures through a systematic review and meta-analysis of randomized controlled trials (RCTs). METHODS We searched the MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov databases to identify RCTs, published until July 2020 that examined the effects of cement augmentation of internal fixation of trochanteric fractures. The primary outcomes were reoperation and Parker Mobility Score, whereas the secondary outcomes were 1-year mortality rate, EuroQol 5 Dimension, fixation failures, and adverse events. We conducted meta-analyses of the outcome measures using the random-effects models. We evaluated the certainty of evidence based on the Cochrane risk-of-bias tool and the Grading of Recommendations, Assessment, Development, and Evaluation approach. RESULTS We included three RCTs (326 participants). No significant effect was observed in favor of cement augmentation on all these outcomes. The certainty of evidence for fixation failures was very low and that for the other outcomes was low. The overall risk of bias for each outcome was high or of some concern in all included studies. CONCLUSIONS The effect of cement augmentation of internal fixation of trochanteric fractures was uncertain for the clinical outcomes due to the low certainty of evidence. Further RCTs with a low risk of selection bias may present convincing conclusions on the efficacy and safety of cement augmentation. LEVEL OF EVIDENCE Level 1.
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Affiliation(s)
- Norio Yamamoto
- Department of Orthopedic Surgery, Kagawa Prefectural Central Hospital, 1-2-1, Asahi-machi, Takamatsu, Kagawa, 760-8557, Japan. .,Systematic Review Workshop Peer Support Group (SRWS-PSG), Osaka, Japan.
| | - Takahisa Ogawa
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masahiro Banno
- Systematic Review Workshop Peer Support Group (SRWS-PSG), Osaka, Japan.,Department of Psychiatry, Seichiryo Hospital, Tsurumai 4-16-27, Showa-ku, Nagoya, 466-0064, Japan.,Department of Psychiatry, Nagoya University Graduate School of Medicine, Tsurumai-cho 65, Showa-ku, Nagoya, 466-8560, Japan
| | - Jun Watanabe
- Systematic Review Workshop Peer Support Group (SRWS-PSG), Osaka, Japan.,Department of Surgery, Tottori Prefectural Central Hospital, 730 Ezu Tottori City, Tottori, 680-0901, Japan.,Center for Community Medicine, Jichi Medical University, 3311-1, Yakushiji Shimotsuke City, Tochigi, 329-0498, Japan
| | - Tomoyuki Noda
- Department of Musculoskeletal Traumatology, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Haggai Schermann
- Department of Orthopedics, Foot and Ankle Research and Innovation Laboratory, Massachusetts General Hospital, Boston, USA
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Dentistry and Pharmaceutical Science, Okayama University Graduate School of Medicine, Okayama, Japan
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Yamamoto N, Imaizumi T, Noda T, Inoue T, Kawasaki K, Ozaki T. Postoperative computed tomography assessment of anteromedial cortex reduction is a predictor for reoperation after intramedullary nail fixation for pertrochanteric fractures. Eur J Trauma Emerg Surg 2021; 48:1437-1444. [PMID: 34057554 DOI: 10.1007/s00068-021-01718-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 05/26/2021] [Indexed: 12/20/2022]
Abstract
PURPOSE Postoperative radiographs are routinely used to assess fracture reduction following intramedullary nail fixation for pertrochanteric fractures, even though computed tomography (CT) is a superior modality. We aimed to determine the association between reduction quality assessed by CT and rates of reoperation and to evaluate the association of reoperation and reduction quality according to the assessment modality (plain radiographs vs. CT). METHODS A retrospective analysis of 299 consecutive patients treated with intramedullary nail fixation for pertrochanteric fractures was conducted. Fracture reduction measured by postoperative radiographs and CT was categorized as anatomical type, extramedullary type, or intramedullary type. Postoperative data for analysis included reduction status, tip-apex distance (TAD), screw position in the femoral head, sliding distance, and conditions associated with reoperation. RESULTS Of the 299 patients included with a mean age of 83.1 ± 8.2 years, there were six patients who required reoperation (2.0%). According to the CT assessments, there were 42 intramedullary reductions (14.0%). Patients with a non-intramedullary reduction based on postoperative CT images were significantly more likely to have proper placement of the screw, a reduced TAD, a reduced sliding distance, and a lower reoperation rate than those with an intramedullary reduction (P < 0.05). The reduction quality assessed by postoperative CT was significantly associated with reoperation (95% CI, 1.45-29.31). CONCLUSIONS Intramedullary reduction assessed by CT was associated with reoperation. The reduction quality based on CT findings was more predictive for reoperation than that from plain radiographs.
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Affiliation(s)
- Norio Yamamoto
- Department of Orthopedic Surgery, Kagawa Prefectural Central Hospital, 1-2-1, Asahi-machi, Takamatsu, Kagawa, 760-8557, Japan.
| | - Takahiro Imaizumi
- Department of Orthopedic Surgery, Kagawa Prefectural Central Hospital, 1-2-1, Asahi-machi, Takamatsu, Kagawa, 760-8557, Japan
| | - Tomoyuki Noda
- Department of Orthopedic Surgery, Kagawa Prefectural Central Hospital, 1-2-1, Asahi-machi, Takamatsu, Kagawa, 760-8557, Japan
| | - Tomoo Inoue
- Department of Orthopedic Surgery, Kagawa Prefectural Central Hospital, 1-2-1, Asahi-machi, Takamatsu, Kagawa, 760-8557, Japan
| | - Keisuke Kawasaki
- Department of Orthopedic Surgery, Kagawa Prefectural Central Hospital, 1-2-1, Asahi-machi, Takamatsu, Kagawa, 760-8557, Japan
| | - Toshifumi Ozaki
- Department of Orthopedic Surgery, Kagawa Prefectural Central Hospital, 1-2-1, Asahi-machi, Takamatsu, Kagawa, 760-8557, Japan
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Yamamoto N, Tamura R, Inoue T, Noda T, Nagano H, Ozaki T. Radiological findings and outcomes of anterior wall fractures in pertrochanteric fractures. J Orthop Sci 2021; 26:247-253. [PMID: 32241602 DOI: 10.1016/j.jos.2020.02.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 02/18/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Anterior wall fractures with comminution at the anterior cortex in pertrochanteric fractures are relatively rare. We aimed to investigate the prevalence and clinical findings of anterior wall fractures in this comparative cohort study. METHODS We reviewed 516 consecutive patients who underwent internal fixation. Anterior wall fractures were classified into three types: proximal, distal, and proximal/distal. Outcome measures included demographic data, residual anterior cortex length, fracture reduction, tip-apex distance (TAD), sliding distance, bone union, and revision surgery. We compared radiological outcomes between patients with anterior wall fractures and posterior comminuted fractures without an anterior wall fracture. The groups were matched for age and sex. RESULTS Anterior wall fractures were noted in 44 patients (8.5%). Residual anterior cortex length was shorter for the proximal/distal type. The distal type was the most common, was the most difficult to achieve an acceptable reduction status for, and was associated with the longest sliding distance. The proportion of unacceptable reduction status was higher for anterior wall fractures. However, there were no statistically significant differences between anterior wall fractures and posterior comminuted fractures without an anterior wall fracture in terms of TAD, sliding distance, bone union, and revision rate. CONCLUSIONS This study suggests that anterior wall fracture is not a significant predictor of over-sliding distance.
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Affiliation(s)
- Norio Yamamoto
- Department of Orthopaedic Surgery, Unnan City Hospital, Shimane, Japan.
| | - Ryu Tamura
- Department of Orthopaedic Surgery, Kochi Health Sciences Center, Kochi, Japan
| | - Tomoo Inoue
- Department of Orthopaedic Surgery, Kagawa Prefectural Central Hospital, Kagawa, Japan
| | - Tomoyuki Noda
- Department of Musculoskeletal Traumatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hiroshi Nagano
- Department of Orthopaedic Surgery, Kagawa Prefectural Central Hospital, Kagawa, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
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27
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Chen SY, Chang SM, Tuladhar R, Wei Z, Xiong WF, Hu SJ, Du SC. A new fluoroscopic view for evaluation of anteromedial cortex reduction quality during cephalomedullary nailing for intertrochanteric femur fractures: the 30° oblique tangential projection. BMC Musculoskelet Disord 2020; 21:719. [PMID: 33153440 PMCID: PMC7643444 DOI: 10.1186/s12891-020-03668-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/24/2020] [Indexed: 11/10/2022] Open
Abstract
Background Anteromedial cortex-to-cortex reduction is a key parameter for stable reconstruction of the fracture fragments during the intertrochanteric fracture fixation. This paper introduces the oblique fluoroscopic projection as a novel method to evaluate the quality of anteromedial cortical apposition. Methods Three proximal femur specimens were marked with steel wires along five anatomic landmarks: Greater trochanter, Lesser trochanter, Intertrochanteric line, Anterolateral tubercle and the Anteromedial cortical line. After obtaining the standard femoral neck AP and lateral fluoroscopic images, the C-arm was rotated by every 5°increments until a clear tangential view of the antero-medial-inferior corner cortex was observed. 98 cases of intertrochanteric hip fractures were enrolled from April 2018 to October 2019. After fixation with the nails, the intra-operative anteromedial cortex reduction quality was evaluated from the AP, the true lateral, and the new anteromedial oblique fluoroscopic images. The fluoroscopic results were compared with the post-operative 3D-CT reconstruction images. Results The specimen study showed that internal rotation of the C-arm to approximately 30 ° can remove all the obscure shadows and clearly display the antero-medial-inferior cortical tangent line. Clinically,the positive, neutral and negative apposition of different cortices via intra-operative fluoroscopic images showed79, 19 and 0 cases of medial cortical apposition in AP views; 2, 68 and 28 cases of anterior cortices in lateral views;and 22, 51 and 25cases of anteromedial cortical apposition in oblique views respectively. The post-operative 3D-CT reconstruction images revealed that the final anteromedial cortical contact was noted in 62 cases (63.3%), and lost in 36 cases (36.7%). The overall coincidence rate between intra-operative fluoroscopy and post-operative 3D-CT was 63.3% (62/98) in AP view,79.6% (78/98) in lateral view, and 86.7% (85/98) in oblique view(p < 0.001). Negative cortical apposition in oblique view was highly predictive of a final loss of cortical support on 3D CT (24/25 cases, 96%).And non-negative cortical apposition in oblique view was highly associated with true cortical support on 3D CT images (61/73 cases, 83.6%) (p < 0.001). Conclusions Besides the AP and lateral projections, an anteromedial oblique view of 30° certifies to be a very useful means for evaluation of the fracture reduction quality of anteromedial cortical apposition.
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Affiliation(s)
- Shi-Yi Chen
- Department of Orthopaedic Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China
| | - Shi-Min Chang
- Department of Orthopaedic Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China.
| | - Rujan Tuladhar
- Department of Orthopaedic Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zhen Wei
- Department of Orthopaedic Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China
| | - Wen-Feng Xiong
- Department of Orthopaedic Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China
| | - Sun-Jun Hu
- Department of Orthopaedic Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China
| | - Shou-Chao Du
- Department of Orthopaedic Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China
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Li C, Zhao D, Xu X, Ding J, Guo Y, Liao L, Li G. Three-Dimensional Computed Tomography (CT) Mapping of Intertrochanteric Fractures in Elderly Patients. Med Sci Monit 2020; 26:e925452. [PMID: 33041321 PMCID: PMC7566228 DOI: 10.12659/msm.925452] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background The complex anatomy of the trochanter and the diversity in mechanisms of injury to it complicate intertrochanteric fracture patterns. Using digital technology, we created three-dimensional (3D) computed tomography (CT) mapping to show the relevant characteristics of intertrochanteric fractures in elderly patients. Material/Methods This was a retrospective analysis of a case series of closed intertrochanteric fractures in patients older than age 60 years who had sustained single-sided injuries less than 1 week previously. High-quality CT scans of the cases were used to create a 3D reconstruction fracture model, and fracture maps of the proximal femur were created by overlapping the fracture lines. Results A total of 115 patients were enrolled in this study, with mean age of 78 years (SD 7.98 years; range, 60 to 96 years). The essential features of the fracture lines were recorded in each case. Fracture maps revealed that the fracture lines were mainly concentrated in the area of the lesser and greater trochanter, intertrochanteric line, and intertrochanteric crest. As for fracture subtypes, results between patients were similar for Types A1 and A2 fractures, and differed for Type A3 fractures. Conclusions Detailed analysis of essential features of fracture lines revealed fracture fragments, some of which may be difficult to see using traditional imaging methods. Fracture maps composed of interindividual fracture lines revealed the relevant characteristics of intertrochanteric fractures in elderly patients. The resulting information about characteristics of distribution of fracture lines may be helpful in clinical practice.
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Affiliation(s)
- Cong Li
- Department of Trauma Surgery, East Hospital Affiliated to Tongji University, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Dongyang Zhao
- Department of Trauma Surgery, East Hospital Affiliated to Tongji University, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Xian Xu
- Department of Trauma Surgery, East Hospital Affiliated to Tongji University, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Jiajun Ding
- Department of Trauma Surgery, East Hospital Affiliated to Tongji University, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Yangping Guo
- Department of Trauma Surgery, East Hospital Affiliated to Tongji University, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Lili Liao
- Department of Pediatric Intensive Care Unit, Xinhua Hospital Affiliated to Shanghai Jiaotong University of Medicine, Shanghai, China (mainland)
| | - Guang Li
- Department of Trauma Surgery, East Hospital Affiliated to Tongji University, Tongji University School of Medicine, Shanghai, China (mainland)
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Cheung ZB, Selverian S, Barbera J, Forsh DA. The effect of nail diameter on proximal femoral shortening after internal fixation of pertrochanteric hip fractures with short cephalomedullary nails. J Orthop 2020; 22:358-361. [PMID: 32952326 DOI: 10.1016/j.jor.2020.08.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/04/2020] [Accepted: 08/26/2020] [Indexed: 10/23/2022] Open
Abstract
Objective Investigate the effect of distal nail diameter on proximal femoral shortening (PFS) after cephalomedullary nailing of hip fractures. Methods A retrospective cohort study of 80 patients aged 50 years and older with pertrochanteric hip fractures treated with a 10 or 11 mm short cephalomedullary nail (CMN) was performed. We measured abductor lever arm shortening, femoral height shortening, and PFS. Results There was no difference in abductor lever arm shortening (p = 0.09), femoral height shortening (p = 0.86), and PFS (p = 0.34) between the 10 and 11 mm groups. Conclusions Our results suggest that distal nail diameter does not affect PFS. Level of evidence III.
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Affiliation(s)
- Zoe B Cheung
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, NewYork, NY, 10029, USA
| | - Stephen Selverian
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, NewYork, NY, 10029, USA
| | - Joseph Barbera
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, NewYork, NY, 10029, USA
| | - David A Forsh
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, NewYork, NY, 10029, USA
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Hsu KH, Chang CH, Su YP, Chang MC. Radiographic risk factors for predicting failure of geriatric intertrochanteric fracture treatment with a cephalomedullary nail. J Chin Med Assoc 2019; 82:584-588. [PMID: 30893256 DOI: 10.1097/jcma.0000000000000042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The cephalomedullary nail is the most common device used to treat unstable intertrochanteric fractures (ITFs) (AO/OTA 31-A2 and A3) in the geriatric population. However, there is lack of radiological parameter to evaluate the entry point; hence, this study reports a new radiological parameter to evaluate the entry point of the nail. Besides, other risk factors were also examined. METHODS A retrospective study on the geriatric population with unstable ITFs was conducted from July 2011 to December 2014. A total of 136 patients were enrolled in this study; they received treatment with Gamma-3 nails (Stryker, Mahwah, NJ, USA) and were followed for at least 1 year. Demographic data, radiological parameters, and side-difference of the distance from the piriformis fossa to the greater trochanteric tubercle in the anteroposterior view (dPG) were compared between the union and failure groups. Student's t test, χ test, and multiple logistic regression were used in the statistical analyses. RESULTS The overall failure rate was 13.23% (18 patients). Sex, tip-apex distance (TAD), and dPG were significantly different between the failure and union groups in multivariate analyses. Using a dPG > 6 mm as a reference, patients with a dPG > 6 mm had an odds ratio of 7.64 for failure relative to a dPG < 6 mm. CONCLUSION This study provides additional evidence demonstrating that sex and TAD have significant effects on the outcomes of unstable ITFs after nailing. Moreover, the newly reported radiological parameter, dPG, can be used to predict the failure of ITFs treated using cephalomedullary nails.
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Affiliation(s)
- Kuei-Hsiang Hsu
- Department of Orthopedics & Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Orthopedics, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Chun-Hung Chang
- Department of Orthopedics & Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Orthopedics, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Yu-Ping Su
- Department of Orthopedics & Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Orthopedics, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Ming-Chau Chang
- Department of Orthopedics & Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Orthopedics, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
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31
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A New Joystick Technique for the Reduction of Unstable Trochanteric Hip Fractures: Especially With Rotational Deformity. Tech Orthop 2018. [DOI: 10.1097/bto.0000000000000355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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32
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Effect of reduction quality on post-operative outcomes in 31-A2 intertrochanteric fractures following intramedullary fixation: a retrospective study based on computerised tomography findings. INTERNATIONAL ORTHOPAEDICS 2018; 43:1951-1959. [PMID: 30116869 PMCID: PMC6647079 DOI: 10.1007/s00264-018-4098-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 08/06/2018] [Indexed: 11/30/2022]
Abstract
Purpose To determine how the reduction of medial and anteromedial cortices using CT findings in 31-A2 intertrochanteric fractures treated with the intramedullary nail could affect the clinical outcomes and complication rates of the fractures. Methods We retrospectively analyzed the data of 43 patients with 31-A2 intertrochanteric fractures who underwent closed reduction and intramedullary internal fixation (CRIF) between January 2010 and December 2013. Patients were classified into two groups based on the post-operative CT scans taken from the sagittal and coronal planes, respectively. Five radiographic parameters and three clinical parameters were used to evaluate the post-operative functional states and mobilization levels in this study. Post-operative complications were also recorded. Results The mean loss of the femoral neck-shaft angle (FNSA) was significantly smaller in Group C1 than that in Group C2. There were significant differences in the sliding distance of the cephalic nail and the loss of femoral head height between the two groups. In terms of the reduction conditions shown on the sagittal planes, the FNSA, sliding distance of the cephalic nail, and the loss of FHH were significantly different, although differences in TCD were not significant. Patients in groups C1 (3.6%) and S1 (0.0%) had lower complication rates compared to patients in groups C2 (26.7%) and S2 (27.8%). Conclusion Patients with good reduction quality of the medial and anteromedial sustainable cortices had better clinical outcomes and lower complication rates. The sustainable stability and anti-rotational function of these validated reductions might play a critical role in maintaining the fragment positions and reducing the incidence of complications in patients. Electronic supplementary material The online version of this article (10.1007/s00264-018-4098-1) contains supplementary material, which is available to authorized users.
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The Effects of Extramedullary Reduction in Unstable Intertrochanteric Fracture: A Biomechanical Study Using Cadaver Bone. ACTA ACUST UNITED AC 2018. [DOI: 10.12671/jkfs.2018.31.3.79] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Fujii T, Nakayama S, Hara M, Koizumi W, Itabashi T, Saito M. Tip-Apex Distance Is Most Important of Six Predictors of Screw Cutout After Internal Fixation of Intertrochanteric Fractures in Women. JB JS Open Access 2017; 2:e0022. [PMID: 30229226 PMCID: PMC6133149 DOI: 10.2106/jbjs.oa.16.00022] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Six risk factors for screw cutout after internal fixation of intertrochanteric fractures have been reported. The purpose of the present study was to evaluate and compare the impact of the 6 risk factors of screw cutout to clarify the most important one. Methods We enrolled 8 consecutive patients who had screw cutout and 48 random control subjects after internal fixation of intertrochanteric fractures treated with proximal femoral nail antirotation systems at our institution. All of the patients were female. The group that had screw cutout and the control group were retrospectively evaluated and compared with respect to the OTA/AO classification, presence of a posterolateral fragment, types of reduction pattern on anteroposterior and lateral radiographic images, position of the screw, and the presence of a tip-apex distance (TAD) of ≥20 mm. The impact of each factor on screw cutout was assessed using backward stepwise multivariable logistic regression analysis with the Akaike information criterion. Risk stratification was assessed using classification and regression tree (CART) analysis. Results Among 6 risk factors, only a TAD of ≥20 mm had a significant impact on screw cutout, with an adjusted odds ratio of 12.4 (95% confidence interval, 1.6 to 129.0; p = 0.019). CART analysis also demonstrated that a TAD of ≥20 mm was the most important risk stratification factor (p < 0.001). Conclusions Among the 6 previously reported screw cutout-related factors, only a TAD of ≥20 mm was associated with screw cutout after internal fixation of intertrochanteric fractures with proximal femoral nail antirotation systems. Level of Evidence Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Tatsuya Fujii
- Department of Orthopedics, Narita Red Cross Hospital, Narita, Japan.,Department of Orthopedics, Sanno Hospital, Chiba, Japan
| | - Shun Nakayama
- Department of Orthopedics, Narita Red Cross Hospital, Narita, Japan.,Department of Orthopedics, Sanno Hospital, Chiba, Japan
| | - Masahiko Hara
- Department of Clinical Investigation, Cloud Clinic, Takarazuka, Japan
| | - Wataru Koizumi
- Department of Orthopedics, Narita Red Cross Hospital, Narita, Japan
| | - Takashi Itabashi
- Department of Orthopedics, Narita Red Cross Hospital, Narita, Japan
| | - Masahito Saito
- Department of Orthopedics, Narita Red Cross Hospital, Narita, Japan
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Anteromedial cortical support reduction in unstable pertrochanteric fractures: a comparison of intra-operative fluoroscopy and post-operative three dimensional computerised tomography reconstruction. INTERNATIONAL ORTHOPAEDICS 2017; 42:183-189. [PMID: 28891021 DOI: 10.1007/s00264-017-3623-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 08/15/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Anteromedial cortical support reduction is favourable for secondary stability after limited sliding in unstable pertrochanteric fractures. The aim of this study was to compare the accuracy and agreement between intra-operative fluoroscopy and post-operative 3D reconstruction. MATERIALS AND METHODS A retrospective analysis of 28 patients (mean 81.6 years) treated with short cephalomedullary nails was performed. All patients had full sets of intra-operative fluoroscopy and post-operative 3D CT images. Observation was focused on the position of the anteromedial cortices of the inferior corner between the head-neck fragment and femoral shaft, and their relationship was categorised into three types: positive, neutral and negative. The percentage of subsequent changes in cortical reduction quality between fluoroscopy and 3D CT was calculated and compared. RESULTS There were 24 positive (85.7%), four neutral and no negative positions in the anteroposterior (AP) view and one positive, 20 neutral (71.4%) and seven negative positions in the lateral view from fluoroscopy. On post-operative 3D CT images with a full range of rotation, definitive anteromedial cortical contact (positive and neutral support) was observed in 18 cases (64.3%). Ten cases lost the anteromedial cortical buttress. With the posteromedial region of the lesser trochanter detached, a positive AP cortical position combined with a positive/neutral lateral position on fluoroscopy (17 cases) was highly predictive of reliable, definitive cortical support (15 cases, 88.2%) on 3D CT. A negative lateral position on fluoroscopy (seven cases), regardless of the combination in the AP view, was likely to predict the final loss of cortical support (six cases, 85.7%) on 3D CT; a positive/neutral lateral position (21 cases) was only associated with loss of support in four cases (19.1%) (p < 0.05). CONCLUSIONS A lateral negative position of the anterior cortex on fluoroscopy for unstable pertrochanteric fractures may be highly predictive of post-operative final loss of the anteromedial cortical buttress, which should be avoided during operation.
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Futamura K, Baba T, Homma Y, Mogami A, Kanda A, Obayashi O, Sato K, Ueda Y, Kurata Y, Tsuji H, Kaneko K. New classification focusing on the relationship between the attachment of the iliofemoral ligament and the course of the fracture line for intertrochanteric fractures. Injury 2016; 47:1685-91. [PMID: 27242330 DOI: 10.1016/j.injury.2016.05.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 04/24/2016] [Accepted: 05/09/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE There are various types of intertrochanteric fractures that are unstable pertrochanteric fractures of the hip. The aim of this study was to develop a systematic and comprehensive classification of intertrochanteric fractures. MATERIALS AND METHODS This study enrolled 74 patients with intertrochanteric fractures treated by us between 2012 and 2015. The fractures were classified using 3D-CT images taken immediately after the fractures occurred based on the course of the lateral fracture line (LFL) that extends through the lateral femoral cortex distal to the vastus ridge of the greater trochanter in the intertrochanteric area. Furthermore, the presence or absence of additional typical fractures was also studied. Then, 4 orthopedic specialists examined the 3D-CT images of 20 patients randomly selected from the 74 patients to evaluate both the inter-rater and intra-rater agreement levels. RESULTS Intertrochanteric fractures were classified into three types according to the LFL patterns. Type I (41.9%), the Lateral Wall Pattern, has a LFL that extends towards the lateral fiber bundle attachment area of the iliofemoral ligament. Type II (24.3%), the Transverse Pattern, has a LFL that extends towards the medial bundle attachment area. Type III (33.8%), the Reverse Oblique Pattern, has a LFL that extends between the lateral and medial fiber bundle area of the iliofemoral ligament. Each type showed characteristic displacement and was associated with various combinations of typical fractures (fracture across the intertrochanteric line, posteromedial fragment, including the lesser trochanter, posterolateral fragment posterior to the femoral greater trochanter, and banana-shaped big fragment, including both the greater trochanter and the lesser trochanter). The mean κ values for the interobserver and intraobserver agreement levels were 0.77 (0.70-0.85) and 0.76 (0.70-0.85), respectively, which were considered substantial agreement levels. CONCLUSION We believe our new classification is a useful communication tool for medical professionals in the diagnosis of fractures.
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Affiliation(s)
- Kentaro Futamura
- Department of Orthopedic Surgery, Juntendo University Shizuoka Hospital, 1129 nagaoka, Izunokuni-shi, Shizuoka, Japan
| | - Tomonori Baba
- Department of Orthopedic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan.
| | - Yasuhiro Homma
- Department of Orthopedic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Atsuhiko Mogami
- Department of Orthopedic Surgery, Juntendo University Shizuoka Hospital, 1129 nagaoka, Izunokuni-shi, Shizuoka, Japan
| | - Akio Kanda
- Department of Orthopedic Surgery, Juntendo University Shizuoka Hospital, 1129 nagaoka, Izunokuni-shi, Shizuoka, Japan
| | - Osamu Obayashi
- Department of Orthopedic Surgery, Juntendo University Shizuoka Hospital, 1129 nagaoka, Izunokuni-shi, Shizuoka, Japan
| | - Kazuo Sato
- Orthopedic Trauma Center, Sapporo Tokushukai Hospital, 1-1-1Oyachihigashi, Atsubetsu-ku, Sapporoshi, Hokkaido, Japan
| | - Yasuhisa Ueda
- Orthopedic Trauma Center, Sapporo Tokushukai Hospital, 1-1-1Oyachihigashi, Atsubetsu-ku, Sapporoshi, Hokkaido, Japan
| | - Yoshiaki Kurata
- Orthopedic Trauma Center, Sapporo Tokushukai Hospital, 1-1-1Oyachihigashi, Atsubetsu-ku, Sapporoshi, Hokkaido, Japan
| | - Hideki Tsuji
- Orthopedic Trauma Center, Sapporo Tokushukai Hospital, 1-1-1Oyachihigashi, Atsubetsu-ku, Sapporoshi, Hokkaido, Japan
| | - Kazuo Kaneko
- Department of Orthopedic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan
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Tsukada S, Wakui M, Yoshizawa H, Miyao M, Honma T. Three-Dimensional Computed Tomographic Analysis for Comminution of Pertrochanteric Femoral Fracture: Comminuted Anterior Cortex as a Predictor of Cutting Out. Open Orthop J 2016; 10:62-70. [PMID: 27347234 PMCID: PMC4897036 DOI: 10.2174/1874325001610010062] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 01/06/2016] [Accepted: 02/04/2016] [Indexed: 11/30/2022] Open
Abstract
Background: Fixed angle sliding hip screw devices allow controlled impaction between the head neck fragment and the femoral shaft fragment in the surgical treatment of pertrochanteric fractures. This study was performed to evaluate the frequency and pattern of comminution at the fracture site, which may prevent the intended impaction. Materials and Methods: Three-dimensional computed tomography was used to investigate 101 pertrochanteric fractures treated with fixed angle sliding hip screw devices, with emphasis on the comminuted cortex. A comminuted fracture was defined as a fracture that had a third fracture fragment at the main fracture line. Results: There were 40 fractures without comminution and 61 with comminution. All 61 comminuted fractures had a comminuted posterior cortex, and 3 of 61 fractures also had comminution at the anterior cortex. The prevalence of cutting out of the implant from the femoral head was significantly higher in cases involving comminution at both the posterior and anterior cortices than in cases involving comminution only at the posterior cortex (66.7 % and 3.4 %, p < 0.0001). Conclusion: The posterior cortex was comminuted in 60.4% of pertrochanteric fractures and the anterior cortex in 3.0%. Intended impaction at the fracture site could not be obtained at any cortex in cases with comminution at both the anterior and posterior cortices; comminution at the anterior cortex may be a predictor of cutting out.
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Affiliation(s)
- Sachiyuki Tsukada
- Department of Orthopaedic Surgery, Nekoyama Miyao Hospital, Niigata, Japan
| | - Motohiro Wakui
- Department of Orthopaedic Surgery, Nekoyama Miyao Hospital, Niigata, Japan
| | - Hiroshi Yoshizawa
- Department of Orthopaedic Surgery, Nekoyama Miyao Hospital, Niigata, Japan
| | - Masunao Miyao
- Department of Orthopaedic Surgery, Nekoyama Miyao Hospital, Niigata, Japan
| | - Takeshi Honma
- Department of Rehabilitation, Nekoyama Miyao Hospital, Niigata, Japan
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Increased Fracture Collapse after Intertrochanteric Fractures Treated by the Dynamic Hip Screw Adversely Affects Walking Ability but Not Survival. BIOMED RESEARCH INTERNATIONAL 2016; 2016:4175092. [PMID: 26955637 PMCID: PMC4756143 DOI: 10.1155/2016/4175092] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 01/11/2016] [Indexed: 12/03/2022]
Abstract
In osteoporotic hip fractures, fracture collapse is deliberately allowed by commonly used implants to improve dynamic contact and healing. The muscle lever arm is, however, compromised by shortening. We evaluated a cohort of 361 patients with AO/OTA 31.A1 or 31.A2 intertrochanteric fracture treated by the dynamic hip screw (DHS) who had a minimal follow-up of 3 months and an average follow-up of 14.6 months and long term survival data. The amount of fracture collapse and shortening due to sliding of the DHS was determined at the latest follow-up and graded as minimal (<1 cm), moderate (1-2 cm), or severe (>2 cm). With increased severity of collapse, more patients were unable to maintain their premorbid walking function (minimal collapse = 34.2%, moderate = 33.3%, severe = 62.8%, and p = 0.028). Based on ordinal regression of risk factors, increased fracture collapse was significantly and independently related to increasing age (p = 0.037), female sex (p = 0.024), A2 fracture class (p = 0.010), increased operative duration (p = 0.011), poor reduction quality (p = 0.000), and suboptimal tip-apex distance of >25 mm (p = 0.050). Patients who had better outcome in terms of walking function were independently predicted by younger age (p = 0.036), higher MMSE marks (p = 0.000), higher MBI marks (p = 0.010), better premorbid walking status (p = 0.000), less fracture collapse (p = 0.011), and optimal lag screw position in centre-centre or centre-inferior position (p = 0.020). According to Kaplan-Meier analysis, fracture collapse had no association with mortality from 2.4 to 7.6 years after surgery. In conclusion, increased fracture collapse after fixation of geriatric intertrochanteric fractures adversely affected walking but not survival.
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