New classification focusing on the relationship between the attachment of the iliofemoral ligament and the course of the fracture line for intertrochanteric fractures

Futamura, Kentaro; Baba, Tomonori; Homma, Yasuhiro; Mogami, Atsuhiko; Kanda, Akio; Obayashi, Osamu; Satō, Kazuo; Ueda, Yasuhisa; Kurata, Yoshiaki; Tsuji, Hideki

doi:10.1016/j.injury.2016.05.015

Cited by 41 publications

(20 citation statements)

References 23 publications

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“…In almost all 26 patients, at least one observer identified one of the respective technical deviations. In other words, all potential deviations on the guideline were seen by at least one surgeon in each patient; even conflicting potential technical deviations like scoring both intramedullary Kirschner wires and Kirschner wires protruding radially in the same TBW construct by different surgeons exemplifies the fact that surgeons mostly agree with themselves (good to excellent intra-observer reliability), but not so much with each other (poor interobserver reliability) in most studies [ 4 , 7 , 16 ].…”

Section: Resultsmentioning

confidence: 99%

Tension band wiring for simple olecranon fractures: evaluation of surgical technique

et al. 2017

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BackgroundIn some settings, specific techniques for open reduction and internal fixation are preferred based on the eminence of a surgeon or professional organization. An emphasis on technical aspects of surgery that are not proved superior and vary substantially from surgeon to surgeon can be confusing for trainees. This study applied a numerical grading of the technical aspects of tension band wire (TBW) fixation for olecranon fracture; assessed the interobserver agreement of each criterion; and measured the correlation of the technical grading and objective and subjective long-term outcomes.Materials and methodsForty observers were invited to rate the technical aspects of TBW fixation of the olecranon on 26 post-operative radiographs. The interobserver reliability of the rating was measured using the intra-class correlation coefficient. The correlation between the rating and motion, Mayo elbow performance index, and disabilities of the arm, shoulder and hand score was tested with the Spearman’s rank correlation test.ResultsNone of the figure-of-eight TBW constructs were considered perfect according to the numerical grading: the majority of observers found three deviations per fixation. The interobserver agreement was only fair for the total number of deviations and no correlation between the number of deviations and long-term objective and subjective outcome was found.ConclusionsA rating of the technical aspects of TBW for olecranon fractures was unreliable and did not correlate with subjective and objective outcomes. Emphasis on specific technical aspects of fixation might be confusing for trainees and could distract them from the principles of effective treatment.Level of evidenceLevel IV diagnostic study.

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Section: Resultsmentioning

confidence: 99%

Tension band wiring for simple olecranon fractures: evaluation of surgical technique

et al. 2017

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“…In clinical practice, trochanteric fractures with severe displaced lesser trochanter were usually complex types of fractures and caused by severe violence [ 25 ]. In our study, the surgical time was also significantly longer in Group C compared with Groups A and B.…”

Section: Discussionmentioning

confidence: 99%

The Influence of Position of the Displaced Lesser Trochanter on Clinical Outcome of Unstable Trochanteric Femur Fractures in the Elderly

Sun

et al. 2018

BioMed Research International

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Purpose This study aimed to evaluate whether position of the displaced lesser trochanter affected clinical outcome in the treatment of unstable trochanteric fractures with intramedullary fixation. Patients and Methods Patients with unstable trochanteric fractures and displaced lesser trochanter who received intramedullary fixation were retrospectively reviewed in this study. Based on displacement distance of the lesser trochanter and whether the lesser trochanter was reduced operatively, patients were divided into three groups: patients with the displaced lesser trochanter less than 1cm (Group A), those with the displaced lesser trochanter more than 1 cm without operative reduction (Group B), or those with operative reduction (Group C). The surgical time, reduction quality, Harris Hip Score (HHS), Visual Analog Score (VAS), and complication rate were reviewed. Results There were 42 patients in Group A, 33 in Group B, and 36 in Group C with comparable demographic characteristics. The surgical time was significantly longer in Group C (P=0.009), compared with Groups A and B. Fracture reduction quality was comparable with over 85% good reduction among the three groups. The VAS score was significantly higher in Group B (P=0.023) without significant difference between Groups A and B. The HHS score was slightly lower in Group B, but it did not reach significant difference. The complication rate was statistically higher in Group B (p=0.043) than Groups A and C. Conclusion The severe displaced lesser trochanter may increase postoperative complications and postoperative pain in the treatment of unstable trochanteric femur fractures. However, the displaced lesser trochanter may not affect hip function.

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“…For example, a very small number of fracture lines in zones 2, 3, and 4 are an inverted “V” shape. The different types of fracture lines aside, it is not easy to perfectly reduce an anterior fracture [ 18 , 20 ] because the iliofemoral ligament restrains the anterior displacement of the femoral neck [ 21 ]. The lines in Type A3 fractures have the same features as in Type A1 and A2 fractures, but their range is larger in the lateral femur, affecting the femoral shaft.…”

Section: Discussionmentioning

confidence: 99%

Three-Dimensional Computed Tomography (CT) Mapping of Intertrochanteric Fractures in Elderly Patients

Liu

Zhao

et al. 2020

Med Sci Monit

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Background The complex anatomy of the trochanter and the diversity in mechanisms of injury to it complicate intertrochanteric fracture patterns. Using digital technology, we created three-dimensional (3D) computed tomography (CT) mapping to show the relevant characteristics of intertrochanteric fractures in elderly patients. Material/Methods This was a retrospective analysis of a case series of closed intertrochanteric fractures in patients older than age 60 years who had sustained single-sided injuries less than 1 week previously. High-quality CT scans of the cases were used to create a 3D reconstruction fracture model, and fracture maps of the proximal femur were created by overlapping the fracture lines. Results A total of 115 patients were enrolled in this study, with mean age of 78 years (SD 7.98 years; range, 60 to 96 years). The essential features of the fracture lines were recorded in each case. Fracture maps revealed that the fracture lines were mainly concentrated in the area of the lesser and greater trochanter, intertrochanteric line, and intertrochanteric crest. As for fracture subtypes, results between patients were similar for Types A1 and A2 fractures, and differed for Type A3 fractures. Conclusions Detailed analysis of essential features of fracture lines revealed fracture fragments, some of which may be difficult to see using traditional imaging methods. Fracture maps composed of interindividual fracture lines revealed the relevant characteristics of intertrochanteric fractures in elderly patients. The resulting information about characteristics of distribution of fracture lines may be helpful in clinical practice.

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New classification focusing on the relationship between the attachment of the iliofemoral ligament and the course of the fracture line for intertrochanteric fractures

Cited by 41 publications

References 23 publications

Tension band wiring for simple olecranon fractures: evaluation of surgical technique

Tension band wiring for simple olecranon fractures: evaluation of surgical technique

The Influence of Position of the Displaced Lesser Trochanter on Clinical Outcome of Unstable Trochanteric Femur Fractures in the Elderly

Three-Dimensional Computed Tomography (CT) Mapping of Intertrochanteric Fractures in Elderly Patients

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