CT scans better assess lateral wall morphology of “stable appearing” intertrochanteric (IT) femur fractures and predict early failure of sliding hip screw (SHS) fixation

Abstract

Objectives: To compare the efficacy of plain x-ray images and computed tomography (CT) to assess the morphology of the lateral wall (LW) component of intertrochanteric (IT) femur fractures and determine predictors of early fixation failure.Design: Retrospective cohort study.Setting: Level-one trauma center.Patients/Participants: One hundred forty-two adult patients with IT fractures treated with either a sliding hip screw (SHS) or a cephalomedullary nail (CMN) who had both pre-op plain x-ray images and CT scans with at least 6 weeks of follow-up were reviewed.Intervention: Preoperative CT scan and plain radiographs of the affected hip.Main Outcome Measurements: Lateral wall assessment based on plain x-rays versus CT imaging in relation to implant failure.Results: One hundred forty-two patients met inclusion criteria, 105 patients treated with a CMN, and 37 with a SHS. There was a poor correlation between the assessment of the LW on plain x-ray images and CT scans. Failures in the SHS group were significantly associated with all CT measurements (P < .05) but not with plain film LW assessment (P = .66). Fifteen patients had an early implant failure (6 CMN, 9 SHS). There were no statistically significant associations between any radiographic measurement (plain images and CT) and CMN failures.Conclusions: Plain film images are not accurate for assessing lateral wall morphology/integrity and are not predictive of SHS implant failures. Our novel CT measurements were effective at detecting lateral wall patterns at risk for treatment failure with SHS implants.Level of Evidence: Level III

Bilgisayarlı Tomografi İntertrokanterik Kırık Tedavisinde X-ray’e göre avantaj sağlar mı?

“…23 Again, Hecht et al showed that CT provides better and more predictable fixation results in unstable intertrochanteric femur fractures aft er preoperative use. 24 In the present study, DHS, which was preferred to apply to stable fracture patterns, was preferred in 36.20% of patients compared to x-ray, and it was preferred in 26.20% compared to x-ray/CT. We think the CT evaluation and x-ray will be less critical in the treatment of imp-lant preference in groups other than 31A1 because implant preference is for intramedullary fixation in the 31A2 and 31A3 groups with unstable fracture patterns.…”

Relative lateral wall thickness is an improved predictor for postoperative lateral wall fracture after trochanteric femoral fracture osteosynthesis

“…However, the same applies to the already established aLWT measure. Evaluating rLWT in a three-dimensional aspect from a computed tomography (CT) scan should be more accurate but would come at a higher cost and radiation exposure 23 , 24 . Today's standard in diagnosing TFF does not imply a CT scan and that is why the latter cannot be used for rLWT definition 25 , 26 .…”

Accuracy of detecting burst of the lateral wall in intertrochanteric hip fractures with plain radiographs: Is postoperative CT necessary?

“…However, postoperative burst of the lateral femoral wall is the serious complication that is thought to be the main predictor of reoperation [ 8 , 9 ]. It is because that the lateral femoral wall is crucial for maintaining the stability of intertrochanteric fractures [ 10 ]. Therefore, early and accurate detection of lateral wall burst is important.…”