Banding with lesser trochanter fragment using nonabsorbable tape in trochanteric femoral fractures

Abstract

Introduction: Trochanteric femoral fracture is one of the most common fractures in the elderly. Trochanteric femoral fracture with involvement of the lesser trochanter is considered unstable and recognized as having a poor prognosis. However, fixation of lesser trochanter fragment is scarce because of technical difficulties. In this study, we reported the simple surgical procedure and the effect of using nonabsorbable tape in lesser trochanter fixation. Methods: From January 2014 to December 2017, 114 patients treated with proximal intramedullary nailing for trochanteric fractures with the lesser trochanter fragment were reviewed. Among patients enrolled in this study, 73 were followed up until radiographic bone union, of which 26 were treated with lesser trochanter fragment banding (group B) and 47 without banding (group N). Radiographs and/or computed tomography images were used to evaluate bone union of the lesser trochanter fragment at three months postoperatively. Results: The bone union of the lesser trochanter fragment was achieved in 24 cases (92%) in group B and 30 cases (64%) in group N. Compared with group N, group B showed a significantly increased number of mild and moderate deformities but decreased number of severe deformity and nonunion (P < 0.001). Postoperative complications were not observed in both groups. Conclusions: From the viewpoint of increasing lesser trochanteric bone union ratio, fixation of the lesser trochanter fragment using nonabsorbable tape in the treatment of trochanteric fractures could be an effective procedure.

A novel computed tomography-based three-column MLP classification of intertrochanteric fracture

“…In recent literatures, it was reported that poor reduction and xation of LT fragment may be signi cantly associated with posterior sagging after operation [28]. Fixation with non-absorbable tape (Alfresa Pharma Co., Ltd., Japan), or twisted steel wires (Alfresa Pharma Co., Ltd., Japan) could be an effective procedure to improve early ambulatory ability [13,27,29]. Optimal management of posterior column fractures may need further research.…”

“…However, inadequate fracture reduction and xation is associated with high incidence of postoperative complications such as nonunion and cut out of the lag screw or blade [9][10][11]. Based on biomechanical characteristics of proximal femur and fracture patterns, various late-model internal xation devices have been designed for stability augmentation [12][13][14][15][16]. It remains confusing to use these classi cation systems to formulate optimal therapeutic option and sequential rehabilitation schedule [17].…”

A biomechanical analysis of the effect of hydroxyapatite augmentation for trochanteric femoral fractures

“…Open reduction and internal fixation using an intramedullary nail is the most commonly used operative method for fractures (4). Many implant designs and augmentation methods have been reported to increase the initial fixation strength (5,6). However, complications such as necrosis of the femoral head and cut-out of the lag screw are problematic due to lower bone mineral density (BMD) (7,8).…”

A novel computed tomography-based three-column MLP classification of intertrochanteric fracture

“…However, inadequate fracture reduction and fixation are associated with high incidences of postoperative complications such as nonunion and cut out of the lag screw or blade (9)(10)(11). Based on the biomechanical characteristics and fracture patterns of the proximal femur, various late-model internal fixation devices have been designed for stability augmentation (12)(13)(14)(15)(16). It remains confusing to use these classification systems to formulate optimal therapeutic options and sequential rehabilitation schedules (17).…”