Selecting Arthroplasty Fixation Approach Based on Greater Trochanter Fracture Type in Unstable Intertrochanteric Fractures

Kim, Minwook; Chung, Young-Yool; Lim, Sung-An; Shim, Seung-Woo

doi:10.5371/hp.2019.31.3.144

Cited by 4 publications

(6 citation statements)

References 18 publications

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“…Obvious exposure of the GT is important when inserting the femoral stem on a special fracture table for placement of a retractor behind the GT and for elevating the femur using a femur elevation hook to prevent intraoperative fractures. However, in type D of the author’s classification of GT fracture type 13) , elevation of the proximal femur outside into the operation field is difficult. Thus use of the DAA is considered difficult only in this type of intertrochanteric fracture.…”

Section: Discussionmentioning

confidence: 99%

“…No statistically significant difference in age, sex, BMI, and BMD was observed between the two groups ( Table 1 ). Fractures of the greater trochanter (GT) were classified into four types according to the author’s classification criteria 13) ( Fig. 1 ), and no statistically significant difference was observed between the two groups ( Table 2 ).…”

Section: Methodsmentioning

confidence: 99%

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A Comparative Study of Bipolar Hemiarthroplasty for Intertrochanteric Fracture: Direct Anterior Approach versus Conventional Posterolateral Approach

Chung,

Shim,

Kim

et al. 2023

Hip & Pelvis

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Purpose The aim of this study was to compare short-term results from use of the direct anterior approach (DAA) and the conventional posterolateral approach (PLA) in performance of bipolar hemiarthroplasty for treatment of femoral intertrochanteric fractures in elderly patients. Materials and Methods A retrospective review of 100 patients with intertrochanteric fractures who underwent bipolar hemiarthroplasty was conducted. The PLA was used in 50 cases from 2016 to 2019; since that time we have used the DAA in 50 cases from 2019 to 2021. Measurements of mean operative time, blood loss, hospitalization period, and ambulation status, greater trochanter (GT) migration and stem subsidence were performed. And the incidence of complications was examined. Results Operative time was 73.60±14.56 minutes in the PLA group and 79.80±8.89 minutes in the DAA group ( P <0.05). However, after experiencing 20 cases using DAA, there was no statistically difference in operative time between two groups ( P =0.331). Blood loss was 380.76±180.67 mL in the PLA group and 318.14±138.51 mL in the DAA group ( P <0.05). The hospitalization was 23.76±11.89 days in the PLA group and 21.45±4.18 days in the DAA group ( P =0.207). In both groups, there were no progressive GT migration, intraoperative fractures or dislocations, although there was one case of infection in the PLA group. Conclusion Although use of the DAA in performance of bipolar hemiarthroplasty required slightly more time in the beginning compared with the PLA, the DAA may well be an alternative, safe surgical technique as a muscle preserving procedure in elderly patients with intertrochanteric fractures.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

A Comparative Study of Bipolar Hemiarthroplasty for Intertrochanteric Fracture: Direct Anterior Approach versus Conventional Posterolateral Approach

Chung,

Shim,

Kim

et al. 2023

Hip & Pelvis

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“…The mean bone mineral density T-score was –3.36±0.91 (range, –5.9 to –1.6) ( Table 1 ). Four types of classification criteria according to the previous work of Kim et al 11) were used for classifying fractures of the greater trochanter (GT). Five cases were type A, 21 cases were type B, five cases were type C, and three cases were type D.…”

Section: Methodsmentioning

confidence: 99%

Hemiarthroplasty through Direct Anterior Approach for Unstable Femoral Intertrochanteric Fractures in the Elderly: Analysis of Early Cases

et al. 2022

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Purpose The purpose of this study was to determine whether the direct anterior approach (DAA) can be applied to hemiarthroplasty for treatment of unstable femoral intertrochanteric fractures in elderly patients. Materials and Methods We conducted a retrospective review of 34 cases (34 patients) who underwent bipolar hemiarthroplasty using a DAA from February 2019 to April 2020. The mean age of the patients was 82.68 years (range, 67-95 years). A cementless distal fixation hip system was used in all cases. Operation time, total amount of blood loss, intraoperative and postoperative fractures, infections, and reoperations were measured. The patients performed weight-bearing walking as tolerated immediately after surgery. Measurement of migration of the greater trochanter (GT) and progressive subsidence of the femoral stem was performed using follow-up radiographs. Results The mean operative time was 83.50 minutes (range, 60-120 minutes). The mean amount of bleeding was 263.53 mL (range, 112-464 mL). Walking started a mean of 3-03 days (range, 3-4 days) after surgery. There was no case of progressive migration of the GT more than 5 mm even though it was not fixed. There were no cases of infection, dislocation, or reoperation. Conclusion Bipolar hemiarthroplasty using the DAA for treatment of unstable femoral intertrochanteric fractures could be considered a useful option that provides many advantages in elderly patients.

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“…Hip fractures are anatomically classified in relation to the hip capsule as intracapsular fractures (i.e., at the femoral neck) or extracapsular fractures (i.e., intertrochanteric or subtrochanteric fractures). Intertrochanteric fractures (ITFs) are one of the most common types of hip fractures, accounting for 45%–50% of total hip fractures, of which 35%–60% are unstable fractures. Intertrochanteric fractures in the elderly population are mostly osteoporotic fractures in the form of a comminuted fracture in which the bone has broken into 3–4 fragments in 30%–40% of cases.…”

Section: Introductionmentioning

confidence: 99%

“…Intertrochanteric fractures (ITFs) are one of the most common types of hip fractures, accounting for 45%–50% of total hip fractures, of which 35%–60% are unstable fractures. Intertrochanteric fractures in the elderly population are mostly osteoporotic fractures in the form of a comminuted fracture in which the bone has broken into 3–4 fragments in 30%–40% of cases. The treatment for intertrochanteric fractures of the femur can be divided into conservative treatment and surgical treatment.…”

Section: Introductionmentioning

confidence: 99%

Procedure for Femoral Intertrochanteric Fractures using the “Three‐Finger Method” Assisted by Proximal Femoral Nail Antirotation

Cheng

Lin

Zhu

et al. 2020

Orthopaedic Surgery

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Objective: To assess long-term follow-up evaluations for the treatment of femoral intertrochanteric fractures with the "three-finger method" assisted by proximal femoral nail antirotation (PFNA). , 123 patients were selected and followed for the treatment of femoral intertrochanteric fractures with PFNA assisted by the "three-finger method" (application of the index finger, middle finger, and ring finger in the process of surgery to assist PFNA). There were 56 male patients and 67 female patients aged 52-93 years with an average age of 75.6 years, and 88 cases were due to a fall and 35 due to a traffic accident injury. The femoral necks were fixed with PFNA assisted by the "three-finger method" applying the following procedure: traction reduction, determining the incision, inserting the needle, and placing screw. The Harris hip score, postoperative complications, hip pain and function status were statistically analyzed to evaluate the surgical efficacy and to discuss the surgical technique of the "three-finger method" assisted by PFNA.Results: According to the Harris scoring criteria, patients were followed for 1, 2, 4, 6, and 8 years, and the good outcomes of patients were recorded. The excellent and good rate of 87% was the highest in the second year of follow-up. Then, the rate decreased following the eighth year of follow-up. The excellent and good rate of 82.7% was the lowest. The patients with incisions healed well, there were no instances of fat liquefaction or infection. There were three cases of effusion, the rate was 2.4%. The secretions were cultured, and no bacterial growth was found. After treatment of the wound, it healed, and the spiral blade used for the femoral head did not wear out. There was one case of femoral head necrosis. There was no significant correlation between hip pain and sex and age (P > 0.05), and the function of the hip joint was significantly correlated with the age of the patients (P < 0.05). Conclusion:The "three-finger method" in the process of surgery to assist PFNA for the treatment of patients with intertrochanteric fractures of the femur simplified the operation steps, reduced the operation difficulty, shortened the operation time, improved the operation efficiency, and reduced the incidence of postoperative complications.

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Selecting Arthroplasty Fixation Approach Based on Greater Trochanter Fracture Type in Unstable Intertrochanteric Fractures

Cited by 4 publications

References 18 publications

A Comparative Study of Bipolar Hemiarthroplasty for Intertrochanteric Fracture: Direct Anterior Approach versus Conventional Posterolateral Approach

A Comparative Study of Bipolar Hemiarthroplasty for Intertrochanteric Fracture: Direct Anterior Approach versus Conventional Posterolateral Approach

Hemiarthroplasty through Direct Anterior Approach for Unstable Femoral Intertrochanteric Fractures in the Elderly: Analysis of Early Cases

Procedure for Femoral Intertrochanteric Fractures using the “Three‐Finger Method” Assisted by Proximal Femoral Nail Antirotation

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