Morphology and Fixation Pitfalls of a Highly Unstable Intertrochanteric Fracture Variant

Tan, Bien-Keem; Lau, Adrian Cheng Kiang; Kwek, Ernest Beng Kee

doi:10.1177/230949901502300204

Cited by 28 publications

(23 citation statements)

References 12 publications

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“…Helin et al reported that intramedullary nailing provides poorer stabilization of unstable fractures compared to stable fractures (16). In some previous reports, relatively high complication rates were noted in patients with unstable intertrochanteric fractures (3,17). From the viewpoint of treatment methods, Chun et al introduced a unique reduction technique using a 4.2-mm Steinmann pin for unstable intertrochanteric fractures (18).…”

Section: Discussionmentioning

confidence: 99%

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A novel three-dimensional classification system for intertrochanteric fractures based on computed tomography findings

et al. 2019

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A novel three-dimensional fragment-based classification system based on computed tomography findings was established to characterize femoral intertrochanteric fractures. The intertrochanteric bone fragments were defined as follows : neck, posterior portion of the greater trochanter, anterior portion of the greater trochanter, lesser trochanter, and shaft. Each type of fracture was classified as 2-, 3-, 4-, or 5-fragment according to the number of floating bone fragments. Following the description of the fracture type, each floating bone fragment was appended, with the exception of a fragment involving the shaft. Ninety-five intertrochanteric fractures were classified by the same surgeon. The fractures occurred in 14 men and 81 women with a mean age of 84.7 years. The frequency of each type of fracture was investigated. Thirty-one fractures (32.6%) were 2-fragment and 64 (67.4%) were ≥ 3-fragment. A fragment of the anterior portion of the greater trochanter, which cannot be classified using conventional systems, was included in 29 cases (30.5%). A 5-fragment fracture was detected in two cases (2.1%). Using this fragment-based classification system, intertrochanteric fractures can be evaluated in more detail than is possible using conventional classification systems.

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Section: Discussionmentioning

confidence: 99%

“…Osteosynthesis has been widely used for intertrochanteric fractures (2). However, it is not always possible for elderly patients with unstable fractures to have good outcomes after osteosynthesis (3,4). To address this problem, both improvement of surgical technique and advances in implant technology have been promoted (5)(6)(7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

A novel three-dimensional classification system for intertrochanteric fractures based on computed tomography findings

et al. 2019

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“…If starting point is placed lateral to the tip of the trochanter it may result in varus malreduction (Figure 13) [4][5][6][7].…”

Section: If Too Lateral Entry Pointmentioning

confidence: 99%

Proximal Femur Nail in Intertrochanteric Fractures Indications and Tips/Tricks

Panchanadikar¹

2016

MOJOR

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A. Advanced versions of both nails offer spiral blade instead of head screws, lesser mediolateral angle of 5 degrees, and flat lateral surface at proximal end, long nail options. B. Surgical technique remains the same. C. Features change from manufacture to manufacturer; hence we need to study the design of chosen nail carefully (Table 1). Table 1: Comparison between Proximal femur nail (PFN) and Trochanteric femoral nail /Trochanteric fixation nail (TFN) PFN TFN Length 240 mm. Length 170 mm. Less anterior cortex impingement. Proximal diameter around 17 mm. Smaller proximal diameter around 15 mm. In narrow canals less possibility of impingement/ fracture extension during nail insertion. PFN Biomechanically stronger than DHS A. Intramedullary. Nearer axis of deforming force. B. Resists excessive collapse by buttress effect. C. Replaces comminuted lateral wall. D. Often has 2 Screws in head. Lag screw and hip pin. Controls rotation well (Figures 2 & 3). Factors that Ensure Success in PFN A. Maintaining the proper neck shaft angle. B. Placing the Lag screw (Compression Screw) in the centre of hip (or sight inferior). C. Compression screw first. (inferior lag screw). D. Hip pin should be shorter by at least 15mm.

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“…Some studies have reported better results with the use of SHS in intertrochanteric fracture treatment and others have stated that CMN give better results (6)(7)(8). However, the current approach to the treatment of unstable intertrochanteric fractures is the use of CMN (9)(10)(11). It has been reported that basicervical fractures could also be evaluated as unstable fractures (12).…”

Section: Introductionmentioning

confidence: 99%

Comparison of Intramedullary and Extramedullary Fixation of Basicervical Fractures of the Femur in the Elderly: A Prospective Randomized Study

Ecevız¹,

Çevi̇k²,

Bulut³

2020

Haseki

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Basicervical fractures of the femur are a unique type of unstable hip fracture, usually treated with sliding hip screw (SHS) or cephalomedullary nail (CMN). The aim of this randomized, prospective study was to evaluate the outcomes and complications of the two different treatment methods, SHS and CMN, in the management of basicervical fractures of the femur in the elderly osteoporotic bones. Methods: Patients aged over 65 years, who presented to our clinic with basicervical fracture of the femur between January 2016 and January 2018, were included in the study. The permuted block randomization method was used to randomize the participants into groups. The patients were allocated to one of two groups treated via CMN (n=29) or SHS (n=27). Functional and radiological evaluations included mobility score, Harris Hip score, modified Barthel index, Singh index, tip-apex distance, and fracture settling. Results: Continuous improvement in the Barthel index was seen over the 12-month period in either group (p<0.05). The average mobility score was found to be decreased at the 6 th week follow-up visits in either group (p<0.05). The fracture settling measurements in SHS group was higher than in CMN group (p<0.01). Conclusion: The clinical and radiological outcomes of both CMN and SHS groups showed no superiority of one technique over the other in the treatment of basicervical fractures of the femur.

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Morphology and Fixation Pitfalls of a Highly Unstable Intertrochanteric Fracture Variant

Cited by 28 publications

References 12 publications

A novel three-dimensional classification system for intertrochanteric fractures based on computed tomography findings

A novel three-dimensional classification system for intertrochanteric fractures based on computed tomography findings

Proximal Femur Nail in Intertrochanteric Fractures Indications and Tips/Tricks

Comparison of Intramedullary and Extramedullary Fixation of Basicervical Fractures of the Femur in the Elderly: A Prospective Randomized Study

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