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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

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          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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          Most cited references19

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          A new mobility score for predicting mortality after hip fracture.

          C. Palmer, Geoff Parker (1993)
          We assessed 882 patients presenting with a proximal femoral fracture by a new mobility score and by a mental test score, to determine which was of the most value in forecasting mortality at one year. Both scores gave a highly significant prediction, but the mobility score had a greater predictive value and is easier to perform.
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            The value of the tip-apex distance in predicting failure of fixation of peritrochanteric fractures of the hip.

            Kristaps J. Keggi, S Curtin, M Lindskog … (1995)
            Failure of fixation of peritrochanteric fractures that have been treated with a fixed-angle sliding hip-screw device is frequently related to the position of the lag screw in the femoral head. A simple measurement has been developed to describe the position of the screw. This measurement, the tip-apex distance, is the sum of the distance from the tip of the lag screw to the apex of the femoral head on an anteroposterior radiograph and this distance on a lateral radiograph, after controlling for magnification. To determine the value of this measurement in the prediction of so-called cutout of the lag screw, 198 peritrochanteric fractures (193 patients) were studied. The minimum duration of follow-up was three months (average, thirteen months), during which period all of the fractures either healed or had failure of the fixation. Of the nineteen failures that were identified, sixteen were due to the device cutting out of the femoral head. The average tip-apex distance was twenty-four millimeters (range, nine to sixty-three millimeters) for the successfully treated fractures compared with thirty-eight millimeters (range, twenty-eight to forty-eight millimeters) for those in which the screw cut out (p = 0.0001). None of the 120 screws with a tip-apex distance of twenty-five millimeters or less cut out, but there was a very strong statistical relationship between an increasing tip-apex distance and the rate of cutout, regardless of all other variables related to the fracture.(ABSTRACT TRUNCATED AT 250 WORDS)
            Article 0 comments Cited 177 times – based on 0 reviews     Review now
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              Nail or plate fixation of intertrochanteric hip fractures: changing pattern of practice. A review of the American Board of Orthopaedic Surgery Database.

              , John N Weinstein, J Anglen (2008)
              A new method of fixation for intertrochanteric hip fractures that involves the use of an intramedullary nail that interlocks proximally into the femoral head was introduced in the early 1990s. Anecdotal observation of practice patterns during the Part II (oral) American Board of Orthopaedic Surgery examination suggested that the use of this method had increased substantially in recent years in comparison with the more traditional sliding compression screw technique. A study of the Part II database was undertaken to detect changing patterns of care for intertrochanteric fractures. During the process of Board certification, candidates for the Part II (oral) examination submit a six-month surgical case list and patient data into a secure database. The database was searched for all intertrochanteric fractures (International Classification of Diseases, Ninth Revision, code 820.20 or 820.21) over a seven-year period (1999 through 2006). The cases were categorized by intramedullary nail or plate fixation on the basis of surgeon-reported Current Procedural Terminology codes. Relative utilization of the two devices was analyzed according to year and region, and the devices were compared in terms of complications and outcomes. A dramatic change in practice was demonstrated, with the intramedullary nail fixation rate increasing from 3% in 1999 to 67% in 2006. Regional variation was substantial. The highest rate of utilization of intramedullary nail fixation was recorded by candidates from the South, Southeast, and Southwest, who converted to the new technology faster than those in the Northeast, Northwest, and Midwest. Overall, patients managed with plate fixation had slightly less pain and deformity in comparison with those managed with intramedullary nailing, with no significant differences being identified in terms of function or satisfaction. Patients managed with intramedullary nailing had more procedure-related complications, particularly bone fracture. From 1999 to 2006, a dramatic change in surgeon preference for the fixation device used for the treatment of intertrochanteric fractures has occurred among young orthopaedic surgeons. This change has occurred despite a lack of evidence in the literature supporting the change and in the face of the potential for more complications.
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                Author and article information

                Contributors
                Peifu Tang:
                ORCID: http://orcid.org/0000-0003-4279-1704
                +86 10 01066938101 , pftang301@163.com
                Journal
                Journal ID (nlm-ta): Int Orthop
                Journal ID (iso-abbrev): Int Orthop
                Title: International Orthopaedics
                Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )
                ISSN (Print): 0341-2695
                ISSN (Electronic): 1432-5195
                Publication date (Electronic): 16 August 2018
                Publication date PMC-release: 16 August 2018
                Publication date (Print): August 2019
                Volume: 43
                Issue: 8
                Pages: 1951-1959
                Affiliations
                [1 ]ISNI 0000 0004 1761 8894, GRID grid.414252.4, Department of Orthopaedics, , Chinese PLA General Hospital, ; No. 28 Fuxing Road, Beijing, 100853 China
                [2 ]ISNI 0000 0004 0369 153X, GRID grid.24696.3f, Department of Orthopedics, Beijing Chaoyang Hospital, , Capital Medical University, ; No. 8 Gong Ren Ti Yu Chang Nan Lu Rd, Beijing, 100020 China
                [3 ]GRID grid.452517.0, Department of Orthopaedics, , Hainan Branch of Chinese PLA General Hospital, ; Sanya, 572013 Hainan China
                [4 ]ISNI 0000 0000 9878 7032, GRID grid.216938.7, Medical College, , Nankai University, ; No. 94 Weijin Road, Tianjin, 300071 China
                Author information
                http://orcid.org/0000-0003-4279-1704
                Article
                Publisher ID: 4098
                DOI: 10.1007/s00264-018-4098-1
                PMC ID: 6647079
                PubMed ID: 30116869
                SO-VID: c18ccd54-c408-493f-aaae-92898764cdc9
                Copyright © © The Author(s) 2018
                License:

                Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                Date received : 29 March 2018
                Date accepted : 6 August 2018
                Funding
                Funded by: the capital health research and development of special
                Award ID: shoufa 2016-1-5012
                Award Recipient :
                Categories
                Subject: Orignal Paper
                Custom metadata
                issue-copyright-statement © SICOT aisbl 2019

                ScienceOpen disciplines: Orthopedics
                Keywords: intertrochanteric fractures,intramedullary nail,reduction quality,outcomes,ct findings
                Data availability:
                ScienceOpen disciplines: Orthopedics
                Keywords: intertrochanteric fractures, intramedullary nail, reduction quality, outcomes, ct findings

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