Proximal Femoral Shortening after Operation with Compression Hip Screws for Intertrochanteric Fracture in Patients under the Age of 60 Years

Abstract

PurposeWe aimed to quantify proximal femoral shortening after operation with compression hip screws for intertrochanteric fracture in patients under the age of 60 years.Materials and MethodsWe followed 37 consecutive patients with intertrochanteric fractures treated with compression hip screws from March 2005 to February 2014. We designated the aspect of the fracture, a defect of the postero-medial wall, a defect of the lateral wall, and the degree of reduction as four potentially important factors we assumed would strongly affect proximal femoral shortening. We quantified proximal femoral shortening and compared the effects of above factors. We divided femoral shortening into two plane vectors; femoral offset in the horizontal plane and leg length discrepancy in the vertical plane. We measured shortening separately during two periods: during operation and after weight bearing (called dynamic compression).ResultsAfter bone union, the average femoral offset shortening was 5.45 mm. Patient groups with anatomic reduction and intact postero-medial wall showed lower femoral offset shortening than the respective opposite groups. As to functional score using modified Harris hip score, low femoral offset shortening group showed more 2.35 scores than high groups. None of the factors significantly affected leg length shortening.ConclusionWe found that a stable medial buttress is involved in lower femoral offset shortening. Thus, surgeons need to attempt to recover the defect of the medial wall and to reduce anatomically when operating intertrochanteric fractures with compression hip screws.

The medial femoral wall can play a more important role in unstable intertrochanteric fractures compared with lateral femoral wall: a biomechanical study

“…It started at the bottom level of the lesser trochanter superomedially run and terminated at the middle of the diaphysis. The other line was created from the top of the lateral wall [ 4 ] and terminated at the intersection of the first osteotomy line. The wedge of the lateral wall was removed (Fig.…”

“…The defect in the intertrochanteric medial wall has been proven to be due to the hinge, which postoperatively causes coxa vara and proximal femoral shortening after intertrochanteric fractures occur. The lateral femoral wall was defined for the first time in 2004 by Gotfried [ 3 ] as a proximal extension of the femoral shaft, whereas Palm [ 4 ] defined it as the lateral femoral cortex distal to the vastus ridge. In recent clinical studies, the lateral femoral wall has been recognized as an important predictor of stability in intertrochanteric fractures [ 3 – 6 ].…”

Effects of Teriparatide on Clinical and Radiologic Long-Term Outcomes after Fixation of Pertrochanteric hip Fractures

“…Femoral shortening is a common complication after the operation with DHSs for pertrochanteric hip fractures. [ 8 28 29 ] teriparatide (Forteo ® ) is reported to have an important role in decreasing femoral shortening. [ 17 ] Similarly, in this study the magnitude of femoral shortening was significantly less in those treated with Cinnopar ® .…”

“…[ 7 ] On the other hand, because of osteoporosis, there is a potential shortage of femoral neck during the healing process of the fracture site which will cause shortening of abductor lever arm and functional impairment. [ 8 ]…”

CT-measurement predicts shortening of stable intertrochanteric hip fractures

“…SHS and CMN devices were designed to allow fracture sliding to improve union rates, and even substantial settling of the fracture may not be considered a mal-union. 11 However, too much settling may cause a diminished abductor level arm and a limb length discrepancy (LLD) which are associated with worse https://doi.org/10.1016/j.jor.2018.08.044 Received 11 June 2018; Accepted 25 August 2018 T functional outcomes, albeit no decrease in survival. 12,13 A symptomatic threshold of shortening has not been defined for the ambulatory hip fracture population, but LLDs have been extensively studied for the similarly-aged hip arthroplasty population.…”