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Vlachos C, Ampadiotaki MM, Papagrigorakis E, Galanis A, Zachariou D, Vavourakis M, Rodis G, Vasiliadis E, Kontogeorgakos VA, Pneumaticos S, Vlamis J. Distinctive Geometrical Traits of Proximal Femur Fractures-Original Article and Review of Literature. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2131. [PMID: 38138234 PMCID: PMC10744519 DOI: 10.3390/medicina59122131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/04/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023]
Abstract
Background and Objectives: The incidence of proximal femoral fractures is escalating rapidly, generating a significant challenge for healthcare systems globally and, carrying serious social and economic implications. The primarily object of this study was to discover potential distinguishing factors between fractures occurring in the femoral neck and trochanteric region. Materials and Methods: We performed a prospective cohort study of the radiographic images of 70 people over 65 years of age who were admitted to the orthopedic department with hip fracture and who fulfilled our eligibility criteria. Neck Length (NL), Offset Lenth (OL), Hip Axis Length (HAL), Neck Shaft Angle (NSA), Wiberg Angle (WA), Acetabular Angle (AA), Femoral Neck Diameter (FND), Femoral Head Diameter (FHD), Femoral Shaft Diameter (FSD), Femoral Canal Diameter (FCD) and Tonnis classification were recorded. For the comparison of the categorical variables, Pearson's χ2 criterion was used, while Student's t-test was applied for the comparison of means of quantitative variables across fracture types. Results: There were no statistically significant variances observed while comparing the selected geometric parameters of the proximal femur with the type of fracture. This finding was reaffirmed in relation to age, gender, and Tonnis classification. However, a moderate correlation was noted, revealing comparatively reduced values of HAL, FHD, and FND in women as opposed to men. Conclusions: The inability of our research to establish the differentiative geometric factors between femoral neck and trochanteric fractures underscores the need for further investigations, which would take into consideration the intrinsic characteristics of the proximal femur.
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Affiliation(s)
- Christos Vlachos
- 3rd Orthopedic Department, National and Kapodistrian University of Athens, KAT General Hospital, 14561 Athens, Greece; (E.P.); (A.G.); (D.Z.); (M.V.); (E.V.); (S.P.); (J.V.)
| | | | - Eftychios Papagrigorakis
- 3rd Orthopedic Department, National and Kapodistrian University of Athens, KAT General Hospital, 14561 Athens, Greece; (E.P.); (A.G.); (D.Z.); (M.V.); (E.V.); (S.P.); (J.V.)
| | - Athanasios Galanis
- 3rd Orthopedic Department, National and Kapodistrian University of Athens, KAT General Hospital, 14561 Athens, Greece; (E.P.); (A.G.); (D.Z.); (M.V.); (E.V.); (S.P.); (J.V.)
| | - Dimitrios Zachariou
- 3rd Orthopedic Department, National and Kapodistrian University of Athens, KAT General Hospital, 14561 Athens, Greece; (E.P.); (A.G.); (D.Z.); (M.V.); (E.V.); (S.P.); (J.V.)
| | - Michail Vavourakis
- 3rd Orthopedic Department, National and Kapodistrian University of Athens, KAT General Hospital, 14561 Athens, Greece; (E.P.); (A.G.); (D.Z.); (M.V.); (E.V.); (S.P.); (J.V.)
| | - George Rodis
- Department of Radiology, KAT General Hospital, 14561 Athens, Greece;
| | - Elias Vasiliadis
- 3rd Orthopedic Department, National and Kapodistrian University of Athens, KAT General Hospital, 14561 Athens, Greece; (E.P.); (A.G.); (D.Z.); (M.V.); (E.V.); (S.P.); (J.V.)
| | - Vasileios A. Kontogeorgakos
- 1st Orthopedic Department, National and Kapodistrian University of Athens, Attikon General University Hospital, 12462 Chaidari, Greece;
| | - Spiros Pneumaticos
- 3rd Orthopedic Department, National and Kapodistrian University of Athens, KAT General Hospital, 14561 Athens, Greece; (E.P.); (A.G.); (D.Z.); (M.V.); (E.V.); (S.P.); (J.V.)
| | - John Vlamis
- 3rd Orthopedic Department, National and Kapodistrian University of Athens, KAT General Hospital, 14561 Athens, Greece; (E.P.); (A.G.); (D.Z.); (M.V.); (E.V.); (S.P.); (J.V.)
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Senra AR, Carvalho DR, da Silva MR, Sousa AN, Torres J. Proximal femur geometry: a major predictor of proximal femur fracture subtypes. Hip Int 2023; 33:1100-1106. [PMID: 36253960 DOI: 10.1177/11207000221129785] [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] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Proximal femur geometry (PFG) represents an important risk factor for the occurrence of hip fractures. There are currently few studies regarding the correlation between PFG and the occurrence of a specific fracture subtype, and those that exist have small cohorts and present with different methodologies and contradictory results. Therefore, there is no consensus in the literature regarding this topic. The present study aimed to establish the contribution of the PFG in the occurrence of different subtypes of proximal femur fractures (PFF): intertrochanteric, neck and subtrochanteric. METHODS Analysis of 1022 plain anteroposterior pelvic radiographs of patients consecutively admitted to the emergency room of a Level 1 Trauma Centre between 2013 and 2019 after low energy trauma who presented with PFF and underwent surgical treatment. Patients were analysed considering age, gender and subtype of PFF (intertrochanteric, neck or subtrochanteric). Radiological parameters including cervicodiaphyseal angle (CDA), horizontal offset (HO), femoral neck width (FNW), femoral neck length (FNL), great trochanter-pubic symphysis distance (GTPSD), acetabular teardrop distance (ATD) and width of the intertrochanteric region (WIR) were measured and compared between the different subtypes of fractures (7154 measurements). Statistical analysis was conducted recurring to absolute measurements and measurements ratios. The correlation was assessed using t-test. RESULTS There were statistically significant differences in proximal femur geometry between the different subtypes of fractures. Patients presenting with femoral neck fractures had greater CDA (132.5 ± 6.9 vs. 130.0 ± 7.3; p < 0.001) and lower HO (45.8 ± 7.4 vs. 49.0 ± 8.0; p < 0.001), HO/ATD (0.34 ± 0.068 vs. 0.37 ± 0.072; p < 0.001) and HO/GTPSD (0.26 ± 0.049 vs. 0.28 ± 0.039; p < 0.001) than patients with intertrochanteric/subtrochanteric fractures. CONCLUSIONS PFG represents an important contributor to the occurrence of different fracture subtypes. Femoral neck fractures are associated with greater CDA and lower HO, HO/ATD and HO/GTPSD when compared to intertrochanteric or subtrochanteric fractures.
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Affiliation(s)
| | - Diogo R Carvalho
- Department of Orthopaedics and Traumatology, Baixo Vouga Hospital Centre, Aveiro, Portugal
| | - Miguel R da Silva
- Department of Orthopaedics and Traumatology, Saint John's University Hospital, Porto, Portugal
| | - António N Sousa
- Department of Orthopaedics and Traumatology, Saint John's University Hospital, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine University of Porto, Portugal
| | - João Torres
- Department of Orthopaedics and Traumatology, Saint John's University Hospital, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine University of Porto, Portugal
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Wang Y, Liang W, Chen Y, Li S, Ji H, Feng Z, Ma D, Zhong S, Ouyang J, Qian L. Sex-specific bone and muscular morphological features in ischiofemoral impingement: A three-dimensional study. Clin Anat 2023; 36:1095-1103. [PMID: 36905221 DOI: 10.1002/ca.24036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 02/14/2023] [Accepted: 02/22/2023] [Indexed: 03/12/2023]
Abstract
The study aimed to investigate how hip bone and muscular morphology features differ between ischiofemoral impingement (IFI) patients and healthy subjects among males and females. Three-dimensional models were reconstructed based on magnetic resonance imaging images from IFI patients and healthy subjects of different sexes. Bone morphological parameters and the cross-sectional area of the hip abductors were measured. The diameter and angle of the pelvis were compared between patients and healthy subjects. Bone parameters of the hip and cross-sectional area of the hip abductors were compared between affected and healthy hips. The comparison results of some parameters were significant for females but not males. For females, the comparison results of pelvis parameters showed that the anteroposterior diameter of the pelvic inlet (p = 0.001) and intertuberous distance (p < 0.001) were both larger in IFI patients than in healthy subjects. Additionally, the comparison results of hip parameters showed that the neck shaft angle (p < 0.001) and the cross-sectional area of the gluteus medius (p < 0.001) and gluteus minimus (p = 0.005) were smaller, while the cross-sectional area of the tensor fasciae latae (p < 0.001) was significantly larger in affected hips. Morphological changes in IFI patients demonstrated sexual dimorphism, including bone and muscular morphology. Differences in the anteroposterior diameter of the pelvic inlet, intertuberous distance, neck shaft angle, gluteus medius, and gluteus minimus may explain why females are more susceptible to IFI.
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Affiliation(s)
- Yining Wang
- Department of Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Digital Medicine and Biomechanics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
- Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
- National Virtual and Reality Experimental Education Center for Medical Morphology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
- National Experimental Education Demonstration Center for Basic Medical Sciences, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
- National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China, Guangzhou, China
| | - Wenjie Liang
- Department of Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Digital Medicine and Biomechanics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
- Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
- National Virtual and Reality Experimental Education Center for Medical Morphology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
- National Experimental Education Demonstration Center for Basic Medical Sciences, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
- National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China, Guangzhou, China
| | - Yanjun Chen
- Department of Medical Imaging, The Third Affiliated Hospital, Southern Medical University, Guangzhou, China
| | - ShaoLin Li
- Department of medical imaging, The Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, Guangdong, China
| | - Hongli Ji
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhengkuan Feng
- Department of Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Digital Medicine and Biomechanics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
- Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
- National Virtual and Reality Experimental Education Center for Medical Morphology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
- National Experimental Education Demonstration Center for Basic Medical Sciences, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
- National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China, Guangzhou, China
| | - Dong Ma
- Department of Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Digital Medicine and Biomechanics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
- Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
- National Virtual and Reality Experimental Education Center for Medical Morphology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
- National Experimental Education Demonstration Center for Basic Medical Sciences, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
- National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China, Guangzhou, China
| | - Shizhen Zhong
- Department of Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Digital Medicine and Biomechanics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
- Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
- National Virtual and Reality Experimental Education Center for Medical Morphology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
- National Experimental Education Demonstration Center for Basic Medical Sciences, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
- National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China, Guangzhou, China
| | - Jun Ouyang
- Department of Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Digital Medicine and Biomechanics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
- Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
- National Virtual and Reality Experimental Education Center for Medical Morphology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
- National Experimental Education Demonstration Center for Basic Medical Sciences, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
- National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China, Guangzhou, China
| | - Lei Qian
- Department of Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Digital Medicine and Biomechanics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
- Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
- National Virtual and Reality Experimental Education Center for Medical Morphology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
- National Experimental Education Demonstration Center for Basic Medical Sciences, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
- National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China, Guangzhou, China
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Qiu F, Huang S. Effectiveness of nursing intervention in the operating room to prevent pressure ulcer and wound infection in patients undergoing intertrochanteric fracture: A meta-analysis. Int Wound J 2023; 21:e14434. [PMID: 37849027 PMCID: PMC10828731 DOI: 10.1111/iwj.14434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 09/27/2023] [Accepted: 10/02/2023] [Indexed: 10/19/2023] Open
Abstract
In this study, a meta-analysis was conducted to comprehensively assess the effectiveness of nursing intervention in the operating room to prevent pressure ulcers and wound infections in patients with intertrochanteric fractures. A computerised search of PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), VIP Database of Chinese Technical Periodicals, and Wanfang databases was performed to identify randomised controlled studies (RCTs) on the effectiveness of nursing intervention in the operating room for patients undergoing intertrochanteric fractures from the time of construction of the respective databases to June 2023. Two researchers independently searched and screened the literature, extracted information and performed quality assessments of the included literature. The meta-analysis was performed using RevMan 5.4 software. Eighteen studies were finally included, including 1517 patients, with 757 in the intervention group and 760 in the control group. The results showed that nursing intervention in the operating room significantly reduced the incidence of postoperative pressure ulcers in patients with intertrochanteric femoral fractures compared to the control group (1.69% vs. 6.01%, odds ratio [OR]: 0.32, 95% confidence interval [CI]: 0.18-0.57, p < 0.001) and reduced the incidence of surgical site wound infection (1.00% vs. 6.15%, OR: 0.23, 95% CI: 0.11-0.50, p < 0.001). Current evidence suggests that nursing intervention in the operating room is superior to routine care in reducing the incidence of pressure ulcers and wound infections in patients with intertrochanteric fractures and that such interventions should be promoted for clinical use.
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Affiliation(s)
- Fei‐Fei Qiu
- Department of AnesthesiologyThe Second Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
| | - Si‐Mei Huang
- Department of AnesthesiologyThe Second Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
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Çukurlu M, Karagoz B, Keceli O. The effect of pre-fracture proximal femur geometry on hip fracture type in elderly patients. Medicine (Baltimore) 2023; 102:e33622. [PMID: 37171316 PMCID: PMC10174388 DOI: 10.1097/md.0000000000033622] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
This study aimed to analyze the relationship between fracture type by determining data on the geometry of the proximal femur in the pre-fracture period in patients over 65 years of age who had hip fractures as a result of low-energy trauma. A total of 127 patients who were admitted to the hospital for reasons other than hip pathology within 1 year before the occurrence of hip fracture and who had an anterior-posterior pelvic X-ray were included in the study. Measurements were made to evaluate the proximal femur geometry, neck shaft angle, central edge angle, femoral head diameter, femoral neck diameter, femoral neck length, femoral offset length, femoral neck axial length, hip axis length, and femoral shaft diameter. As a result of these measurements, analyses were performed to determine the relationship between the control group and fracture types. The mean Neck shaft angle scores were significantly higher in both fracture types than in the control group (P = .034, P = .002). The mean Femoral offset length values of both fracture types were lower than those of the control group (P = .002, P = .011, respectively). Multiple logistic regression analysis revealed that the risk of collum femoris fracture increased as the Femoral head diameter value increased. (OD = 0.21, P = .002). The geometric parameters of the proximal femur play an important role in the formation of hip fracture types. Therefore, differences in proximal femur geometry in hip fracture types should be considered, and patient-focused choices should be made regarding the surgical procedures and implants to be used during fracture fixation.
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Affiliation(s)
- Mustafa Çukurlu
- Adiyaman University Training and Research Hospital Department of Orthopaedics and Traumatology, Adiyaman, Turkey
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Jia X, Zhang K, Qiang M, Han Q, Zhao G, Wu Y, Chen Y. Design of well-matched end-structure of anatomical proximal femoral locking plate based on computer-assisted imaging combined with 3D printing technology: a quality improvement study. Int J Surg 2023; 109:1169-1179. [PMID: 37026794 PMCID: PMC10389635 DOI: 10.1097/js9.0000000000000300] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 02/13/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND The extramedullary locking plate system was the common internal fixation method for hip fractures. However, common plates were poorly matched to femur, which was because they were designed based on anatomical parameters of the Western populations. Therefore, the aim was to design an end-structure of the anatomical proximal femoral locking plate that closely matched the anatomy of the Chinese population. MATERIALS AND METHODS From January 2010 to December 2021, consecutive patients aged 18 years and older who underwent a full-length computed tomography scan of the femur were included. The end-structure (male and female model) of the anatomical proximal femoral locking plate was designed based on anatomical parameters of femurs that were measured in three-dimensional space using computer-assisted virtual technology. The match degree between the end-structure and femur were evaluated. Inter-observer and intra-observer agreement for the evaluation of match degree was assessed. The matching evaluation based on a three-dimensional printing model was regarded as the gold standard to assess the reliability. RESULTS A total of 1672 patients were included, with 701 men and 971 women. Significant differences were seen between male and female for all parameters of the proximal femur (all P <0.001). All match degree of end-structure was over 90%. Inter-observer and intra-observer agreement was almost perfect (all kappa value, >0.81). The sensitivity, specificity, and percentage of correct interpretation of matching evaluation in the computer-assisted virtual model was all greater than 95%. From femur reconstruction to completion of internal fixation matching, the process takes about 3 min. Moreover, reconstruction, measurement, and matching were all completed in one system. CONCLUSIONS The results showed that based on the larger sample of femoral anatomical parameters, a highly matching end-structure of anatomical proximal femoral locking plate for Chinese population could be designed with use of computer-assisted imaging technology.
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Affiliation(s)
- Xiaoyang Jia
- Department of Orthopedic Surgery, Changzheng Hospital, Naval Medical University (Second Military Medical University)
| | - Kun Zhang
- Department of Orthopedic Trauma, East Hospital, Tongji University School of Medicine
| | - Minfei Qiang
- Department of Orthopedic Surgery, Zhongshan Hospital, Fudan University, Shanghai
| | - Qinghui Han
- Department of Orthopedic Trauma, East Hospital, Tongji University School of Medicine
| | | | - Ying Wu
- Department of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangdong, Guangzhou, China
| | - Yanxi Chen
- Department of Orthopedic Surgery, Zhongshan Hospital, Fudan University, Shanghai
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Yang YF, Huang JW, Gao XS, Xu ZH. Standardized Tip-Apex Distance (STAD): a modified individualized measurement of cephalic fixator position based on its own femoral head diameter in geriatric intertrochanteric fractures with internal fixation. BMC Musculoskelet Disord 2023; 24:189. [PMID: 36915071 PMCID: PMC10009924 DOI: 10.1186/s12891-023-06286-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 03/02/2023] [Indexed: 03/16/2023] Open
Abstract
OBJECTIVE To design a standardized Tip-Apex Distance (STAD) and analyze the clinical significance of STAD in predicting cut-out in geriatric intertrochanteric fractures with internal fixation. METHODS Firstly, we designed STAD according to the rule of TAD. We measured the STAD individually based on its own femoral head diameter (iFHD) instead of the known diameter of the lag screw in calculating TAD, resulting in that the STAD is simply the relative quantitation relationship of iFHD (the times of iFHD). In this study, we assumed that all the iFHD was 6D (1iFHD = 6D, or 1D = 1/6 of iFHD) in order for complete match of the Cleveland zone system, easy comparison of the STAD, and convenient identification for artificial intelligence. Secondly, we calculated and recorded all the STAD of cephalic fixator in 123 eligible ITF patients. Thirdly, we grouped all the ITF patients into the Failure and Non-failure groups according to whether cut-out or not, and analyzed the correlation between the cut-out and the STAD. RESULTS Cleveland zone, Parker's ratio (AP), TAD, and STAD were associated with the cut-out in univariate analysis. However, only STAD was the independent predictor of the cut-out by multivariate analysis. No cut-out was observed when STAD ≤ 2D (1/3 of iFHD). The Receiver Operating Characteristic (ROC) curve indicated that STAD was a reliable predictor of cut-out, and the best cut-off value of STAD was 2.92D. Cut-out rate increased dramatically when STAD increased, especially when STAD > 3D (1/2 of iFHD). CONCLUSION Essentially, the STAD is a relative quantitation relationship of iFHD. The STAD is a reliable measurement of cephalic fixator position in predicting cut-out in geriatric ITF patients with single-screw cephalomedullary nail fixations. For avoiding cut-out, the STAD should be no more than a half of iFHD. LEVEL OF EVIDENCE Level III, Prognostic Study.
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Affiliation(s)
- Yun-Fa Yang
- Department of Orthopaedic Surgery, the Second Affiliated Hospital, School of Medicine, Guangzhou First People's Hospital, South China University of Technology, 1 Panfu Road, 510180, Guangzhou, Guangdong, China.
| | - Jian-Wen Huang
- Department of Orthopaedic Surgery, the Second Affiliated Hospital, School of Medicine, Guangzhou First People's Hospital, South China University of Technology, 1 Panfu Road, 510180, Guangzhou, Guangdong, China
| | - Xiao-Sheng Gao
- Department of Orthopaedic Surgery, the Second Affiliated Hospital, School of Medicine, Guangzhou First People's Hospital, South China University of Technology, 1 Panfu Road, 510180, Guangzhou, Guangdong, China
| | - Zhong-He Xu
- Department of Orthopaedic Surgery, the Second Affiliated Hospital, School of Medicine, Guangzhou First People's Hospital, South China University of Technology, 1 Panfu Road, 510180, Guangzhou, Guangdong, China
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Yu Y, Wang Y, Hou X, Tian F. Recent advances in the identification of related factors and preventive strategies of hip fracture. Front Public Health 2023; 11:1006527. [PMID: 36992874 PMCID: PMC10040558 DOI: 10.3389/fpubh.2023.1006527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 02/27/2023] [Indexed: 03/14/2023] Open
Abstract
Hip fracture is the most devastating type of osteoporosis-related fracture, and is a major worldwide public health problem with a high socioeconomic burden, morbidity rate, and mortality rate. Thus, it is crucial to uncover the risk factors and protective factors to create a hip fracture prevention strategy. In addition to a briefly review of some well accepted risk and protective factors of hip fracture, this review mainly summarized the recent advances in the identification of emerging risk or protective factors for hip fracture, in terms of regional differences in medical services, diseases, drugs, mechanical load, neuromuscular mass, genes, blood types, cultural differences. This review provides a comprehensive review of the associated factors and effective prevention measures for hip fracture, and discusses issues that need further investigation. These issues include the determination of the influencing mechanism of risk factors triggering hip fracture and their interlinked correlation with other factors, as well as the confirmation or correction of emerging factors associated with hip fracture, particularly those that are still controversial. These recent findings will aid in optimizing the strategy for preventing hip fracture.
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Hu H, Zhang J, Xie XG, Dai YK, Huang X. Identification of risk factors for surgical site infection after type II and type III tibial pilon fracture surgery. World J Clin Cases 2022; 10:6399-6405. [PMID: 35979296 PMCID: PMC9294882 DOI: 10.12998/wjcc.v10.i19.6399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/05/2022] [Accepted: 05/17/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND High-energy tibial pilon fractures are complex and severe fractures that are associated with a high risk of infection following open reduction and internal fixation. Infection can negatively impact patient outcomes.
AIM To compare risk factors for postoperative infection after open reduction and internal fixation for a pilon fracture.
METHODS Among the 137 patients included, 67 developed a surgical site infection. Demographic, clinical, and surgical factors were compared between the two groups. A binary logistic regression analysis was used to determine the odds ratio (OR) and corresponding 95%CI for significant risk factors for postoperative infection.
RESULTS The distribution of pathogenic bacteria among the 67 patients who developed a surgical site infection was as follows: Gram-positive, 58.2% (n = 39); Gram-negative, 38.8% (n = 26); and fungal, 2.9% (n = 2). The following factors were associated with postoperative infection (P < 0.05): a Ruedi–Allgower pilon fracture type III (OR = 2.034; 95%CI: 1.109–3.738); a type III surgical incision (OR = 1.840; 95%CI: 1.177–2.877); wound contamination (OR = 2.280; 95%CI: 1.378–3.772); and diabetes as a comorbidity (OR = 3.196; 95%CI: 1.209–8.450).
CONCLUSION Infection prevention for patients with a Ruedi–Allgower fracture type III, surgical incision type III, wound contamination, and diabetes lowers the postoperative infection risk after surgical management of tibial pilon fractures.
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Affiliation(s)
- Hao Hu
- Department of Orthopaedics, Huai’an Second People’s Hospital, Huai’an 223300, Jiangsu Province, China
| | - Jian Zhang
- Department of Orthopaedics, Huai’an Second People’s Hospital, Huai’an 223300, Jiangsu Province, China
| | - Xue-Guan Xie
- Department of Orthopaedics, Huai’an Second People’s Hospital, Huai’an 223300, Jiangsu Province, China
| | - Yan-Kun Dai
- Department of Orthopaedics, Huai’an Second People’s Hospital, Huai’an 223300, Jiangsu Province, China
| | - Xu Huang
- Department of Orthopaedics, Huai’an Second People’s Hospital, Huai’an 223300, Jiangsu Province, China
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PFNA-II Internal Fixation Helps Hip Joint Recovery and Improves Quality of Life of Patients with Lateral-Wall Dangerous Type of Intertrochanteric Fracture. BIOMED RESEARCH INTERNATIONAL 2021; 2021:5911868. [PMID: 34859101 PMCID: PMC8632387 DOI: 10.1155/2021/5911868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 10/13/2021] [Accepted: 10/18/2021] [Indexed: 11/21/2022]
Abstract
Objective To analyze the effect of PFNA-II internal fixation on hip joint recovery and quality of life (QOL) in patients with lateral-wall dangerous type of intertrochanteric fracture. Methods One hundred and twelve patients with lateral-wall dangerous type of intertrochanteric fracture who underwent surgical treatment in our hospital from May 2017 to May 2019 were selected as the participants of the study. Based on the treatment method, all the enrolled patients were divided into two groups: proximal femoral nail antirotation (PFNA group; n = 59) who received closed reduction and minimally invasive PFNA internal fixation and dynamic hip screw group (DHS; n = 53) who received internal fixation. The clinical indicators, curative effect, hip function score, pain degree, postoperative QOL score, and complications were compared between the two groups. Results The operation time, intraoperative blood loss, postoperative drainage volume, and the incidence of postoperative complications in PFNA group were statistically lower than those in DHS group (P < 0.05). The curative effect in PFNA group was notably better than that in DHS group. There were no significant differences in scores of hip function, visual analogue scale (VAS), and QOL between the two groups before operation (P > 0.05). However, the hip function score and QOL score increased in both groups after surgery, and the increase was more significant in the PFNA group, while the VAS score decreased in both groups, and the decrease in PFNA group was more significant (P < 0.05). Conclusion PFNA internal fixation for the treatment of lateral-wall dangerous type of intertrochanteric fracture has the advantages of short operation time, less intraoperative blood loss, effective improvement of hip joint function, and fewer postoperative complications, which is worthy of clinical application.
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Thalmann BH, Latz D, Schiffner E, Jungbluth P, Windolf J, Grassmann J. CCD angle & hip fractures - Predictor of fracture symmetry? J Orthop 2021; 24:1-4. [PMID: 33679019 DOI: 10.1016/j.jor.2021.02.012] [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: 11/19/2020] [Accepted: 02/07/2021] [Indexed: 11/18/2022] Open
Abstract
Background Hip fracture caused by fall is a common injury of the elderly. The risk of sustaining a contralateral hip fracture has been reported to be 5-10%. Aging society heightens the need of efficient prevention tools. To be able to cope with this demand, understanding of biomechanics of hip fractures are mandatory. Previous studies suggest that geometry of the proximal femur could play an important role for fracture probability and fracture type. Thus, analysis of hip geometry could play an important role in the prediction and prevention of bilateral hip fractures. Aim of this study was to elucidate the influence of caput collum diaphyseal angle on the fracture type of proximal femur. Material and methods In a retrospective analysis, data of patients with an acute hip fracture who underwent surgical treatment within five years were included. Data was separated into two groups: (I) intra capsular femur fracture (femoral neck fractures) and (II) extra capsular femur fracture (inter- and subtrochanteric femur fractures). Occurrence of a bilateral fracture, age, gender, weight, height and caput collum diaphyseal angle (standardized measurement of the opposite joint on preoperative digital x-rays) of each group were further analyzed. Results Data of 448 patients were included ((I): 250 vs. (II): 198 patients). Group (I) showed a significant higher mean caput collum diaphyseal angle of 133.9 ± 7.0° (mean ± standard deviation) compared to group (II) with 127.6 ± 6.1° (F (1, 451) = 106.5, p = 0.00). In group (I) 0 patients had a caput collum diaphyseal angle <120° (varus), 214 patients (86%) 120°-140° and 35 patients (14%) angle>140° (valgus). In contrast, in group (II) 21 patients (10%) had a caput collum diaphyseal angle <120° (varus), 175 patients (86%) 120°-140° and 7 patients (4%) >140° (valgus). 52 patients had a bilateral hip fracture. 36 patients (69%) sustained a bilateral hip fracture of the same fracture type. Conclusion Patients with an intra capsular proximal femur fracture showed a significantly higher caput collum diaphyseal angle compared to patients with an extra capsular proximal femur fracture. Moreover, intra capsular femur fractures are correlated with an indifferent (120-140°) or valgus (>140°) femoral neck configuration. Extra capsular femur fractures correlate with an indifferent (120-140°) or varian femoral neck configuration (<120°). The results support the assumption that the caput collum diaphyseal angle has an influence on fracture type of the proximal femur. This could possibly be a predictor for the fracture type of the contralateral hip (second fracture). Based on this, present data may benefit prosthetists in developing new and more efficient hip protectors. Level of evidence Level III. Retrospective comparative study.
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Affiliation(s)
- Ben Hannes Thalmann
- Department of Trauma and Hand Surgery, University Hospital, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - David Latz
- Department of Trauma and Hand Surgery, University Hospital, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Erik Schiffner
- Department of Trauma and Hand Surgery, University Hospital, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Pascal Jungbluth
- Department of Trauma and Hand Surgery, University Hospital, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Joachim Windolf
- Department of Trauma and Hand Surgery, University Hospital, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Jan Grassmann
- Department of Trauma and Hand Surgery, University Hospital, Moorenstrasse 5, 40225, Düsseldorf, Germany
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Chen J, Zheng S, Song Q, Liu A. Diagnostic Value of Magnetic Resonance (MR) Combined with Computed Tomography (CT) in Patients with Stress Injury of Femoral Neck. Med Sci Monit 2020; 26:e922170. [PMID: 32887868 PMCID: PMC7491231 DOI: 10.12659/msm.922170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The purpose of this research was to study and analyze the diagnostic value of magnetic resonance (MR) combined with computed tomography (CT) in patients with stress injury of the femoral neck. MATERIAL AND METHODS The 58 patients with stress injury of the femoral neck who were treated in our hospital from July 2017 until July 2019 were selected as subjects on the basis of clinical pathology and surgery, MR and CT examination, and related imaging data retrospectively analyzed. We observed all patients using different diagnostic methods to determine the value of diagnosis and treatment of disease. RESULTS The patients selected for this study were confirmed by clinicopathology and surgery; the positive rate of CT diagnosis was 65.5%, the positive rate of MR diagnosis was 74.1%, and the positive rate of combined diagnosis was 91.4%. Through statistical analysis, CT and MR showed no significant difference in the detection of stress lesions in different femoral necks, indicating no statistical significance (P>0.05). However, the amount of stress lesions detected in the combined diagnosis was higher than that in the two separate detection methods, with statistically significant difference (P<0.05). The grading of stress lesions in all patients examined through MR showed that there was no proportion of grade 0, whereas grades 3-4 were the highest, accounting for 20.7% and 32.8% respectively. In CT scanning of all patients, fracture lines were observed in 35 patients, of which 25 were transparent lines and 10 were strip dense shadows; Periosteal reaction was observed in 34 patients, of whom umbilical concave was observed in 18 patients. Osteoporosis was observed in 30 patients, and the lesion showed a zone of reduced density in the cortical bone, with a stripelike shape and unclear boundary. The density tended to increase in the cavum medullare of 32 patients, with porosis being visible. Compared with CT diagnosis, the accuracy, sensitivity, and specificity of MR detection were not significantly different (P>0.05). The accuracy, sensitivity, and specificity of the combined detection were higher than that of CT and MR detection alone, with statistically significant differences between groups (P<0.05). CONCLUSIONS The application of MR combined with CT in early clinical diagnosis and treatment of femoral neck stress injury will improve the diagnosis rate; the imaging signal is obvious, which is helpful to further evaluate the severity of disease.
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Affiliation(s)
- Jing Chen
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China (mainland)
| | - Shaowei Zheng
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China (mainland)
| | - Qingwei Song
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China (mainland)
| | - Ailian Liu
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China (mainland)
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Geographic Variations in Intertrochanteric Femoral Fractures in China. BIOMED RESEARCH INTERNATIONAL 2019; 2019:8396723. [PMID: 31772937 PMCID: PMC6854944 DOI: 10.1155/2019/8396723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 09/05/2019] [Indexed: 11/17/2022]
Abstract
Background Hip fracture is one of the major risk factors of global mortality and disability. The aim of this study was to map the pattern of intertrochanteric femoral fractures in China, providing a pilot national dataset and basis for medical policy proposals. Methods A multistage probability sampling strategy was applied in the national baseline survey. Thirty provinces in mainland China were included in this survey. A standardized questionnaire survey was conducted to collect information about basic characteristics such as age, working seniority, hospital level, and residence, with two other parts including perioperative and postoperative treatment parameters. Odds ratios and 95% confidence interval were used to determine essential statistical differences. The proportion of the options in each region was compared using the chi-square (χ 2) test. The histogram and choropleth map of the monthly number of admissions were created using Excel 2016 to show the distribution characteristics. Results In total, 1065 valid responses were included, representing a 96.7% survey capture rate. Perioperative treatment and postoperative care distinctly varied across regions and hospital levels. The monthly number of admissions was relatively lower in the Northern region, with higher proportion of hospitalizations to secondary hospitals compared with the Eastern region. The patients in the Eastern region or tertiary hospitals had shorter preoperative waiting time and hospitalization period. Conclusions We found apparent geographic variations in intertrochanteric femoral fractures in this study, and the data can be used for drafting national healthcare plans and medical policies.
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Lan H, Tan Z, Li KN, Gao JH, Liu TH. Intramedullary Nail Fixation Assisted by Orthopaedic Robot Navigation for Intertrochanteric Fractures in Elderly Patients. Orthop Surg 2019; 11:255-262. [PMID: 31004410 PMCID: PMC6594474 DOI: 10.1111/os.12447] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 02/18/2019] [Accepted: 02/24/2019] [Indexed: 12/14/2022] Open
Abstract
Objective To compare the clinical efficacy of intramedullary nail fixation for intertrochanteric fractures assisted by orthopaedic robot navigation and the traditional intramedullary nail fixation in elderly patients, and to investigate the application advantages of intramedullary nail fixation for femoral intertrochanteric fractures assisted by orthopaedic robot navigation in the elderly. Methods Among the 51 patients with intertrochanteric fractures who were selected from April 2015 to September 2017 in the Affiliated Hospital of Chengdu University, 25 patients underwent the intramedullary nail fixation assisted by orthopaedic robot navigation (orthopaedic robot navigation surgery group) and 26 patients underwent the traditional intramedullary nail fixation (traditional surgery group). The operation time, the number of intraoperative fluoroscopy images taken, the frequency of guide pins inserted into the femoral marrow cavity, the amount of intraoperative bleeding, and the one‐time success rate of the guide pin inserted into the femoral marrow cavity were recorded. Fracture healing and internal fixation were observed. The Harris score was used to evaluate hip joint function 1 year after surgery. Results All patients were followed up for 12–24 months. The operation time was 65.44 ± 8.01 min in the orthopaedic robot navigation surgery group and 77.50 ± 16.64 min in the traditional surgery group. The number of intraoperative fluoroscopy images taken was 10.28 ± 0.61 in the orthopaedic robot navigation surgery group and 13.23 ± 1.75 in the traditional surgery group. The frequency of guide pins inserted into the femoral marrow cavity was 1.00 ± 0.00 times in the orthopaedic robot navigation surgery group and 2.46 ± 1.10 times in the traditional surgery group. The one‐time success rate of intramedullary pin puncture was 100% (25/25) in the orthopaedic surgical robot navigation surgery group and 19.23% (5/26) in the traditional surgery group. The amount of surgical bleeding was 90.80 ± 14.98 mL in the orthopaedic robot navigation surgery group and 118.46 ± 32.21 mL in the traditional surgery group. Compared with the traditional surgery group, the operation time of the orthopaedic surgical robot navigation surgery group was shorter (P < 0.05), the number of intraoperative fluoroscopy images taken was fewer (P < 0.05), the frequency of guide pins inserted into the femoral marrow cavity was lower (P < 0.05), the one‐time success rate of intramedullary pin puncture was higher (P < 0.05), and the amount of surgical bleeding was less (P < 0.05). One year after surgery, fracture healing occurred in both groups without failure of internal fixation or fracture displacement. The Harris score of hip function in the orthopaedic robot navigation surgery group was 86.68 ± 6.23 and that in the traditional surgery group was 82.69 ± 6.85. It was higher than that in the traditional surgery group (P < 0.05). The fine rate of hip joint function in the orthopaedic robot navigation surgery group was 84.00% (21/25) and that in the traditional surgery group was 73.07% (19/26). There was no significant difference between the two groups (P > 0.05). Conclusion Intramedullary nail fixation for intertrochanteric fractures assisted by orthopaedic robot navigation in elderly patients is an ideal method, offering a short operation time, minimal surgical trauma, less radiation, and good recovery of hip function.
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Affiliation(s)
- Hai Lan
- Department of Orthopaedics, Affiliated Hospital of Chengdu University, China
| | - Zhe Tan
- Department of Orthopaedics, Affiliated Hospital of Chengdu University, China
| | - Kai-Nan Li
- Department of Orthopaedics, Affiliated Hospital of Chengdu University, China
| | - Jin-Hua Gao
- Department of Orthopaedics, The First People's Hospital of Anqing, Anqing, China
| | - Tian-Hu Liu
- Department of Orthopaedics, Pidu District People's Hospital, Chengdu
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