Medial wall fragment involving large posterior cortex in pertrochanteric femur fractures: a notable preoperative risk factor for implant failure

Li, Pengfei; Lv, Yang; Zhou, Fang; Tian, Yun; Ji, Hongquan; Zhang, Zhishan; Guo, Yan; Yang, Zhongwei; Hou, Guojin

doi:10.1016/j.injury.2020.01.019

Cited by 10 publications

(10 citation statements)

References 18 publications

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“…Based on anteroposterior X-ray films in all included studies, three studies set up the concrete cut-off of displacement distance of LT (DDLT, measurement method depicted in Figure 5), including 5 mm (12), 10 mm (22), and 20 mm (3) (Table 1). Besides, two other studies set up the concrete quantity and sizes of displaced LT. One was that three groups were built up based on the new classification for a medial wall in trochanteric fractures (17); the other study was that all patients were divided into five groups according to the quantity of LT fragment (<2, =2, and >2) and range of LT fragment in the femoral posteromedial wall (<75, ≥75%) (42).…”

Section: Characteristics Of Lesser Trochantermentioning

confidence: 99%

“…Besides, most classifications, such as AO/OTA (1990) (13), revised AO/OTA(2018) (14), Evans (15), and Evans/Jensen (16), didn't investigated the stratification exclusive for LT fracturing degree. Recently, a novel classification (Figure 2) for medial wall fragments in trochanteric fractures has been proposed (17). It classified medial fragments into three types based on the degree of posterior cortex involvement: type 1: LT fragment with fracture line not exceeding base of the LT; type 2: a larger LT fragment and posterior cortex involved near the base of LT with fracture line not reaching the midline of the posterior wall; type 3: a much larger LT fragment and large posterior cortex involved with fracture line reaching or exceeding the midline of the posterior wall.…”

Section: Introductionmentioning

confidence: 99%

“…In the meanwhile, several studies (3,20,21) demonstrated that reducing and fixing LT or not would get similar outcomes. On the contrary, some studies (4,17,22) verified that severely displaced LT might increase the postoperative complications, from which they recommended that this kind of LT should be reduced and fixed. Moreover, it is noticed that orthopaedists paid more attention to the postoperative injury of surrounding vessels (23)(24)(25)(26)(27) especially potentially life and limb-threatening pseudoaneurysm (28)(29)(30)(31)(32)(33)(34)(35)(36)(37), caused by displaced LT.…”

Section: Introductionmentioning

confidence: 99%

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When to Reduce and Fix Displaced Lesser Trochanter in Treatment of Trochanteric Fracture: A Systematic Review

Dong

Mao

et al. 2022

Front. Surg.

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PurposeTo systematically evaluate the benefits of reducing and fixing displaced lesser trochanter (LT) of trochanteric fractures and when this procedure is worth the effect.MethodsFrom database establishment through March 2021, four online databases (PubMed, Cochrane, Embase, and Web of Science) were searched for relevant literature that investigated reduction and fixation for displaced LT of trochanteric fractures. The papers were then screened by two reviewers independently and in duplicate according to prior inclusion and exclusion criteria. Demographic data as well as data on fracture types, surgical protocols, and surgical outcomes were recorded, analyzed, and interpreted.ResultsTotal 10 clinical studies with 928 patients were included, in which 48 cases had intact LT and 880 cases involved the displaced LT, of which 196 (22.27%) cases underwent reduction and fixation for LT while the rest of 684 (77.73%) cases not. In these studies, complications were evaluated as a more applicable predictive parameter for operation than postoperative hip function.ConclusionIt was beneficial to reduce and fix the displaced LT when one of the conditions below occurred: displacement distance of LT ≥2 cm, quantity of comminuted LT fragments ≥2, and range of LT fragments in medial wall ≥75%; the fracture line of LT fragments reaching or exceeding the midline of the posterior wall.

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Section: Characteristics Of Lesser Trochantermentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

When to Reduce and Fix Displaced Lesser Trochanter in Treatment of Trochanteric Fracture: A Systematic Review

Dong

Mao

et al. 2022

Front. Surg.

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“…It is well known that reduction, particularly the medial cortex reduction, is the most important factor for preventing implant failures in ITF patients. 5 , 7 , 11 - 14 However, there are only three kinds of reductions of ITF (Figure 1): anatomical reduction ( Figure 1(a) ), positive medial cortex support reduction ( Figure 1(b) ), and negative medial cortex support reduction (NMCS reduction, Figure 1(c) ). Since anatomical reduction and positive medial cortex support reduction can result in better biomechanical effects and clinical outcomes, 7 , 11 we can consider these two kinds of reductions as acceptable reductions.…”

Section: Introductionmentioning

confidence: 99%

CalTAD is the Key Evaluation Tool for Measurement of Cephalic Fixation Position for Predicting Cut-Out in Geriatric Intertrochanteric Fracture Patients with Internal Fixations after Achieving Acceptable Reduction

Yang

Huang

Gao

2022

Geriatr Orthop Surg Rehabil

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Objective To discover the key evaluation tool of the cephalic fixation position for predicting implant failures in geriatric intertrochanteric fracture (ITF) patients treated with internal fixations after achieving an acceptable reduction. Methods We measured the geriatric ITF patients undergoing single-screw cephalomedullary nailing (CMN) fixation surgery after obtaining the acceptable reduction (including anatomical reduction and positive medial cortex support reduction) in our treatment group between September 2016 and March 2020 by using four kinds of cephalic fixation position evaluation tools including Cleveland zone system, Parker’s ratio index, tip–apex distance (TAD), calcar-referenced TAD (CalTAD), and analyzed which were the key evaluation tools for measurement of cephalic fixation position for prediction of implant failures in geriatric ITF patients with internal fixations. Results Seventy-four ITF patients treated with single-screw CMN fixation after obtaining the acceptable reduction were enrolled in this study. Of the 74 patients, nine cases were observed with implant failures. There were six cases of cut-out and three of pending cut-out. We found that TAD (odds ratio (OR)=1.149; 95% confidence interval (CI), 1.00–1.32; P=.046) and CalTAD (OR=1.140; 95% CI, 1.00–1.30; P=.037) were risk factors for implant failures by univariate analysis, while only CalTAD (OR=1.200; 95% CI, 1.032–1.395; P=.018) was the independent risk factor for implant failures by multivariate analysis. The Kappa coefficient (κ) of CalTAD was .976 (95% CI, .966–.984) by ICC analysis. The ROC analysis showed that the best cut-off value of CalTAD was 23.76 mm with a sensitivity of 77.8% and specificity of 72.3% (area under the curve, AUC =.775; P = .001). Conclusions CalTAD is the key evaluation tool for measurement of cephalic fixation position for predicting implant failures in geriatric ITF patients treated with single-screw CMN after obtaining the acceptable reduction.

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“…Unfortunately, the selection of the treatment method is burdened with uncertainties and, consequently, errors, leading to serious adverse events. The most notable adverse effect is an implant failure due to various reasons with a rate of occurrence of 0.5% in A1, 1.3% in A2, and 9.7% in A3 types of fractures (AO/OTA classification) [ 9 ]. Artificial intelligence (AI) that rapidly develops in the field of medicine holds promise to optimize the decision-making process in the perioperative stage.…”

Section: Introductionmentioning

confidence: 99%

In Silico Finite Element Modeling of Stress Distribution in Osteosynthesis after Pertrochanteric Fractures

Lorkowski

Pokorski

2022

JCM

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A stabilization method of pertrochanteric femur fractures is a contentious issue. Here, we assess the feasibility of rapid in silico 2D finite element modeling (FEM) to predict the distribution of stresses arising during the two most often used stabilization methods: gamma nail fixation (GNF) and dynamic hip screw (DHS). The modeling was based on standard pre-surgery radiographs of hip joints of 15 patients with pertrochanteric fractures of type A1, A2, and A3 according to the AO/OTA classification. The FEM showed that the stresses were similar for both GNF and DHS, with the medians ranging between 53–60 MPa and consistently lower for A1 than A3 fractures. Stresses also appeared in the fixation materials being about two-fold higher for GNF. Given similar bone stresses caused by both GNF and DHS but shorter surgery time, less extensive dissection, and faster patient mobilization, we submit that the GNF stabilization appears to be the most optimal system for pertrochanteric fractures. In silico FEM appears a viable perioperative method that helps predict the distribution of compressive stresses after osteosynthesis of pertrochanteric fractures. The promptness of modeling fits well into the rigid time framework of hip fracture surgery and may help optimize the fixation procedure for the best outcome. The study extends the use of FEM in complex orthopedic management. However, further datasets are required to firmly position the FEM in the treatment of pertrochanteric fractures.

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Medial wall fragment involving large posterior cortex in pertrochanteric femur fractures: a notable preoperative risk factor for implant failure

Cited by 10 publications

References 18 publications

When to Reduce and Fix Displaced Lesser Trochanter in Treatment of Trochanteric Fracture: A Systematic Review

When to Reduce and Fix Displaced Lesser Trochanter in Treatment of Trochanteric Fracture: A Systematic Review

CalTAD is the Key Evaluation Tool for Measurement of Cephalic Fixation Position for Predicting Cut-Out in Geriatric Intertrochanteric Fracture Patients with Internal Fixations after Achieving Acceptable Reduction

In Silico Finite Element Modeling of Stress Distribution in Osteosynthesis after Pertrochanteric Fractures

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