Morphology of the posteromedial fragment in pertrochanteric fractures: A three-dimensional computed tomography analysis (original) (raw)
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Outcomes of surgical management of per-trochanteric fractures: About 363 cases
The Journal of Orthopaedics Trauma Surgery and Related Research, 2019
Background: Per trochanteric fractures are undoubtedly the lesions most frequently encountered in traumatology, particularly in the elderly, where they retain a high mortality rate The aim of our study was to evaluate the functional and radiological results of the surgical management of per trochanteric fractures. Materials and methods: This was a retrospective study of 363 cases of per trochanteric fractures taken care of and followed from January 2012 to December 2016. The average age was 68.89 years (23-100 years) with 59.2% men and 40.8% women. 97.5% had support (protected or not) before trauma compared with 2.5% non-autonomous. The evolution of the consolidation and functional score of Parker and Palmer was evaluated at 1; 3; 6 and 12 months. Results: 99.2% consolidation at 3.8 months (3-8 months). The cervico-diaphyseal angle variation was 4.2° (0°17.2°) for the overall population (p=0.0057); 4.3° (0°-17.2°) for Gamma Nail (GN) And 4.2° (0°-17°) for Dynamic Hip Screw (DHS). 94...
Treatment of Pertrochanteric Fractures (OTA 31-A1 and A2)
Journal of Orthopaedic Trauma, 2013
Objectives: To retrospectively compare the clinical outcomes in patients with pertrochanteric femur fractures without subtrochanteric extension (OTA 31-A1 and A2) after treatment with short or long cephalomedullary nails.
SA Orthopaedic Journal, 2018
Background: The Schatzker classification is the most widely accepted system used to classify tibial plateau fractures. The presence of posteromedial fragments in the more severe fracture types is known, but the presence of posteromedial fragmentation in the less severe fracture types is unknown. The ability of the Schatzker classification to predict posteromedial fragmentation was evaluated. Methods: Two hundred patients were reviewed of which only 67 met the inclusion criteria. The X-rays were reviewed by three independent orthopaedic surgeons and classified according to the Schatzker classification. A radiologist reviewed the CT scans and noted the presence or absence of a posteromedial fragment and if present, the largest diameter of the fragment was measured. Results: The mean age of the sample was 44.79 (SD: 14.03) years. Seventy-five per cent of the females (n=33) presented with posteromedial fragmentation compared to 65.20% of the males (n=44) (chi²-test, P=0.399). The incidence of posteromedial fragmentation varied between 15.8 and 26.3% for Schatzker 1 and 2 fractures and 73.7 and 84.2% for Schatzker 3 to 6 (chi 2-test, p<0.001) based on the three independent assessments. The mean length of the posteromedial fragmentation ranged from 41.87 to 47.77 mm for Schatzker 1 and 2 fractures, and 44.74 to 46.12 mm for Schatzker 3 to 6 for the three assessors (statistically not significant [T-test, P=0.536, P=0.551 and P=0.652]). Conclusion: The Schatzker classification by itself is not adequate to identify all fractures with posteromedial fragmentation. There is a higher association of posteromedial fragmentation with fracture types 3 to 6. There is a high probability of missing a significantly sized posteromedial fragment in Schatzker type 1 and 2 fractures if a CT scan is not performed which might influence and compromise fracture stability, joint congruency and the ability to rehabilitate optimally.
Nailing unstable pertrochanteric fractures: does size matters?
Archives of Orthopaedic and Trauma Surgery, 2020
Introduction and objectives New generation cephalomedullary nails are, currently, widely used for the treatment of trochanteric proximal femoral fractures. This study aims to compare the midterm outcomes and complication rates in patients with unstable 31A2 fractures treated with two different lengths of nails. Materials and methods Retrospective study including 123 pertrochanteric proximal femoral fractures 31A2 treated with Gamma3 nail ® between January/2017 and January/2019. 19 patients were excluded, resulting in a total of 104 patients with a minimum follow-up of 1 year. Two groups, Long Dynamic Gamma3 Nail (LGN) and Short Static Gamma3 Nail (SGN), with 52 patients each were compared. Mean age was 81 years (range 50-99), being 78% female. Preoperative variables included: age, medical comorbidities, mobility, anesthetic risk, associated fractures, hemoglobin and hematocrit values. Postoperatively, functional and radiological results, quality of life, hemoglobin and hematocrit concentration, transfusion requirements, mobility, and pain were evaluated. Additionally, perioperative complications were also analyzed, such as malunion, non-union, infection rates, cutouts , and peri-implant fractures. Results A correct radiological fracture reduction was obtained in 73% of the cases (73% SGN/74% LGN). Two patients in LGN group had intraoperative complications (greater trochanter fractures). 38% of the patients with LGN presented nail tip impaction upon the distal anterior femoral cortex, associated with anterior knee pain. Blood loss and operative time was statistically different between groups. Despite the previous, no differences in clinical outcomes and quality of life were found. Conclusions The present study comparing two lengths of the Gamma3 Nail in 31A2 fractures showed no overall differences in clinical and radiological outcomes, and complication rates. However, the use of LGN was associated with a statistically significant higher blood loss and operative time, and a tendency for increased need for transfusion, and anterior knee pain and reoperation rate. Therefore, we recommend the use of locked SGN in the treatment of 31A2 fractures.
Analysis of pertrochanteric fractures managed by intramedullary or extramedullary fixation
International Journal of Orthopaedics Sciences, 2020
Fractures of the proximal femur are relatively common fractures seen in elderly with trivial trauma. These fractures are associated with substantial morbidity and mortality. There are various forms of internal fixation devices used for peritrochanteric Fractures. The most commonly used device is the Dynamic Hip Screw with Side Plate assemblies. This is a collapsible fixation device, which permits the proximal fragment to collapse or settle on the fixation device, seeking its own position of stability. The latest implant for management of trochanteric fractures is proximal femoral nail, which is also a Centromedullary and collapsible device with added rotational stability. In view of these considerations, the present study of Surgical Management of peritrochanteric fractures was taken up. This prospective comparative present study was carried out in People's College of Medical Sciences and Research Centre, Bhopal from September 2011 to September 2013. The study consisted a total of 61 patients with pertrochanteric fractures of femur satisfying the inclusion criteria, who are treated with Proximal Femoral nail (30 cases) and Dynamic Hip Screw (31 cases). The advantage with Proximal femoral nail is that a smaller exposure, lesser blood loss, shorter operating time, shorter screening time and less morbidity. (minimizes the jeopardy to the vascularity). It gives a biomechanically sound fixation. In osteoporotic bones Proximal femoral nail fixation carries definitive advantage over Dynamic Hip Screw fixation devices. The incidence of wound infection was found to be lower with PFN which resulted in early ambulation of the patients and lesser duration of antibiotics. The screening time with the help of image intensifier was much lesser in the cases operated by PFN. The implant related complications were much lesser in the patients treated with Dynamic Hip Screw (DHS). However, the rate of union was similar in two groups. (PFN & DHS). Both the implants in their own right are excellent modalities in the management of pertrochanteric fractures of the femur.
Open Journal of Orthopedics, 2013
Background: Unstable pertrochanter femur fractures are common in orthopedic practice. They pose a surgical challenge in both reduction and fixation. The fixation devices used are based on hip intramedullary nailing with femur head lag screw or blade. The aim of this paper is to compare different types of unstable pertrochanter fractures. Materials & Methods: We retrospectively reviewed 386 unstable pertrochanter femur fractures surgically treated in our hospital from 2000 to 2009. These included 62 (16.1%) unstable pertrochanter fractures with fractured lesser trochanter (31.A2-2, 31.A2-3); 63 (16.3%) reverse oblique fractures (31.A3-1), 51 (13.2%) transverse fractures (31.A3-2), 145 (37.6%) comminuted fractures (31.A3-3) and 65 (16.8%) subtrochanter fractures. We compared survival rates between fracture types. The clinical characteristics, surgery immediate outcome (e.g., tip apex distance, reduction quality), and long term results, i.e., complications were also compared between fracture types. Results: Survival analysis showed that the fracture types can be grouped into low and high risk fracture types. The former group included, reverse oblique and comminuted fractures. Lesser trochanter, transverse and subtrochanter fractures were included in the high risk group. The survival estimates for five years were 64.6% and 49.3% for the low and high risk fracture types, respectively (p value = 0.008). Multivariate survival analysis showed that the hazard ratio for the high risk fracture group was 1.9 (95% CI = 1.37-2.67). No differences were found between unstable pertrochanter femur fractures with regards to clinical and epidemiology characteristics. Optimal tip apex distance (TAD) of less than 25 mm was found in 66.7%, 57.1% and 66.7% of lesser trochanter, reverse oblique and sutrochanter fractures, respectively. TAD of less than 25 mm was found in 81.2% of both transverse and comminuted fractures (p value = 0.032). No statistically significant difference was found between fracture types, in regards to complication or revision rates. Conclusions: Survival rates were higher in patients suffering from reverse oblique or comminuted pertrochanteric fractures. No differences were found between fracture types, in regards to clinical and other outcome parameters.
Purpose: To define the unique radiographic features, operative treatment, and complications of pertrochanteric fractures (AO/OTA 31-A1 and A2) which are not amenable to the usual closed reduction manoeuvres. Methods: During a 2-year period (from August 2011 until December 2013), 212 patients with pertrochanteric fractures were treated at our level I trauma centre. A retrospective review was undertaken to determine which of these fractures were not reducible via the routine closed reduction manoeuvres and required some form of open reduction. These fractures were assessed for radiographic markers of irreducibility, surgical findings, reduction techniques, and perioperative complications. Results: Twenty-four patients had fractures, which were not amenable to closed reduction and underwent open reduction. These fractures could be grouped into four patterns. A preoperative CT scan was available for at least two cases of each pattern, which provided further insights into the cause of irreducibility by closed means. These included a variant where the proximal fragment is locked underneath the shaft fragment (3 cases), bisected lesser trochanter with a locked proximal fragment (3 cases), irreducibility due to entrapped posteromedial fragment at the fracture site (6 cases) and a variant where the proximal fragment is flexed passively by the underlying lesser trochanter (12 cases). Conclusions: Pertrochanteric fractures, which are not amenable to closed reduction, are uncommon, but are heralded by unique radiographic features. These patients warrant special consideration in terms of recognition and management. The specific radiographic markers should alert the surgeon to this injury pattern and its related difficulty encountered during closed reduction. Once reduction is achieved, however, these fractures follow an uneventful course.
Pertrochanteric Fractures: Is There an Advantage to an Intramedullary Nail?
Journal of Orthopaedic Trauma, 2002
Objectives: To compare the results between a sliding compression hip screw and an intramedullary nail in the treatment of pertrochanteric fractures. Design: Prospective computer-generated randomization of 206 patients into two study groups: those treated by sliding compression hip screw (Group 1; n ס 106) and those treated by intramedullary nailing (Group 2; n ס 100). Setting: University Level I trauma center. Patients: All patients over the age of fifty-five years presenting with fractures of the trochanteric region caused by a lowenergy injury, classified as AO/OTA Type 31-A1 and A2. Intervention: Treatment with a sliding compression hip screw (Dynamic Hip Screw; Synthes-Stratec, Oberdorf, Switzerland) or an intramedullary nail (Proximal Femoral Nail; Synthes-Stratec, Oberdorf, Switzerland). Main Outcome Measurements: Intraoperative: operative and fluoroscopy times, the difficulty of the operation, intraoperative complications, and blood loss. Radiologic: fracture healing and failure of fixation. Clinical: pain, social functioning score, and mobility score. Results: The minimum follow-up was one year. We did not find any statistically significant difference, intraoperatively, radiologically, or clinically, between the two groups of patients. Conclusions: There is no advantage to an intramedullary nail versus a sliding compression hip screw for low-energy pertrochanteric fractures AO/OTA 31-A1 and A2, specifically with its increased cost and lack of evidence to show decreased complications or improved patient outcome.
International Journal of Orthopaedics Sciences, 2021
The main objective of the study is to emphasizes the importance of the postero-medial fragment in the management of the tibial plateau fractures and study the functional outcome in Proximal tibia fracture treated with buttress plating. So accurate reduction and buttressing the fragment is essential for excellent functional outcome. Materials and Methods: It was a single center Retrospective and prospective study. 60 patients, with mean age 50.53 + 13.47, presenting with traumatic fractures of proximal tibial having posteromedial fragment treated with buttress plating via posteromedial approach were included in the study and were followed up for the period of 1-year post-surgery. Anatomical and functional evaluation was done using the modified Rasmussen's clinical and radiological criteria. Results: Mean Rasmussen's Clinical Outcome score was 26.63 ± 2.63 with 53.33% (32 patients) showed excellent clinical outcome and 30% (18 patients) showed good outcome. Mean Rasmussen's Radiological Outcome score was 8.3 ± 0.95 with 60% (36 patients) showed excellent radiological outcome and 33.33% (20 patients) showed good outcome. The correlation between Rasmussen's Clinical and Radiological Score was found to be strongly positive (R=0.76) which was a statistically significant finding (p<0.05). The correlation between Rasmussen's Clinical and Radiological Score with Age of patients was found to be negative (p=0.03). There was a significant difference in Mean Clinical and Radiological Scores of Patients between different classification groups, Highest score were seen in patients with One Column involvement followed by Two column (p <0.05). Conclusion: The study emphasizes the importance of the postero-medial fragment in the management of the tibial plateau fractures. Accurate reduction and buttressing the fragment is essential for excellent functional outcome. The goal of treatment of these fractures aims at stability and perfect articular reduction, both of them are not possible without reduction and fixation of the posteromedial fragment.