The distribution of bone mineral density in the femoral heads of unstable intertrochanteric fractures

Uemura, Keisuke; Takao, Masaki; Otake, Yoshito; Hamada, Hirofumi; Sakai, Takashi; Sato, Yoshinobu; Sugano, Nobuhiko

doi:10.1177/2309499018778325

Cited by 8 publications

(4 citation statements)

References 23 publications

(43 reference statements)

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“…[ 28 ] On the contrary, some authors argued that the stability of the lag screw was correlated with the bone quality around the screw. [ 29 ] They measured the BMD with micro-computed tomography and found that it was higher in the center region of the femoral head than in the inferior region. Therefore, lag screws are recommended to be inserted into the center of the femoral head.…”

Section: Discussionmentioning

confidence: 99%

Comparison of helical blade versus lag screw in intertrochanteric fractures of the elderly treated with proximal femoral nail: A meta-analysis of randomized-controlled trials

Huang

Wei

2022

Jt Dis Relat Surg

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Currently, there are two surgical ways to treat intertrochanteric fractures among the elderly, including extramedullary or intramedullary fixation. [1,2] Although extramedullary fixation is the conventional treatment of intertrochanteric fractures, intramedullary fixation has become a more popular method with the development and progress of intramedullary instruments. [3] The optimal choice between the helical blade and lag screw is still controversial. [4][5][6] Some pieces of literature have reported that there is no difference in the clinical efficacy, excepted for the operation time that the lag screw is longer than that of the helical blade. [7] However, biomechanical studies have shown that the helical blade is superior to the conventional solid lag Objectives: In this review, we aimed to compare the radiological and functional outcomes between the helical blade and lag screw in treating intertrochanteric fractures among the elderly and to provide suggestions for clinical treatment. Materials and methods:Between January 1 st , 1990 and January 12 th , 2022, the literature search in document databases identified eligible randomized-controlled trials (RCT) studies directly comparing the helical blade and lag screws for treating hip fractures. The mechanical failure rates, the excellent and good rate of fracture reduction, Harris Hip Score (HHS), and postoperative hip pain of two intramedullary devices (helical blades versus lag screws) in patients with intertrochanteric fractures were analyzed using the RevMan software and Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The random-effects models were used for statistical analysis.Results: A total of 11 articles containing 1,146 patients for helical blade and lag screw comparison were included. Compared to the lag screws, the mechanical failure rate (odds ratio [OR]=0.71, 95% confidence interval [CI] 0.40-1.27, p=0.25), the excellent and good rate of fracture reduction (OR=1.33, 95% CI 0.61-2.90, p=0.48), HHS (mean differences 1.83, 95% CI -0.29-1.83, p=0.09), and postoperative hip pain (OR=0.41, 95% CI 0.14-1.21, p=0.11) were similar with the helical blades. There was no significant difference between the two implants in terms of the treatment outcomes. Conclusion:Both helical blades and lag screws are good choices for treating intertrochanteric fracture among elderly.

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Section: Discussionmentioning

confidence: 99%

Comparison of helical blade versus lag screw in intertrochanteric fractures of the elderly treated with proximal femoral nail: A meta-analysis of randomized-controlled trials

Huang

Wei

2022

Jt Dis Relat Surg

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“…(20) It was thought that this situation could be caused as a result of the relatively low bone mineral density of the anterior and posterior region of the femoral head reported in previous studies. (21) However, studies that investigated the relationship of the intramedullary position of the implant with cut-out are few and there are contradictions between the results of these studies.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Cut-Out after Fixation of Intertrochanteric Fractures with Two Cephalocervical Screwed Proximal Femur Nails

2021

GMJ

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Objective: To identify the factors of predicting cut-out development about implant position after fixation of proximal femoral fractures with two cephalocervical screwed femoral nails and to calculate the position-related failure risk. Methods: Retrospective analysis of clinical and radiographic data were performed on hospital records and 20 cases with implant cut-out were included in the study group. 31 cases from a similar epidemiological group who completed the second year without failure were included as a control group. Tip-apex distance (TADAP-TADL), calcar tip apex distance (CalTAD) were measured using radiographs, and Parker ratio was calculated for anteroposterior (ParkerAP) and lateral (ParkerLat) views. Advanced analysis was performed for each statistically significant variable to determine the cut-off point of the predictors for implant cut-out. Results: TADAP-L (p:<0.001), CalTAD (p:0.001) and ParkerLat ratio (p:0.001) calculated were found to have prognostic significance to estimate implant cutout. ParkerLat was found to be the most significant to estimate implant cut-out (p:0.001). The risk of implant cut-out development increased by 7.3 fold in TADAP, 5.7 in TADLat, and 8.6 in CalTAD, and the greatest risk was calculated in ParkerLat, and this increase was 11.5 fold (Cut-off:≥0.58, p:<0,001) Conclusion: Current study confirmed the significant relationship between implant cut-out and inadequate TAD and ParkerLat. The importance of predictors identified to prevent the development of this phenomenon has been demonstrated in this study for two cephalocervical screwed proximal femur nails. It has been shown that the central positioning of the proximal screw inserted while providing osteosynthesis in both anterior-posterior and lateral views was important in preventing cut-out development.

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“…Usually, lumbar vertebral or proximal femoral BMD is quantified using dual-energy X-ray absorptiometry-the procedure recommended by the World Health Organization and by several guidelines [1][2][3]. Yet, BMD assessment in other specific regions is also important as it can be used for surgical planning to achieve good clinical results; to this end, studies have used quantitative computed tomography (CT) images to determine local BMD in the proximal femur [4], femoral head [5,6], and the distal radius [7].…”

Section: Introductionmentioning

confidence: 99%

Automated segmentation of an intensity calibration phantom in clinical CT images using a convolutional neural network

et al. 2021

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To apply a convolutional neural network (CNN) to develop a system that segments intensity calibration phantom regions in computed tomography (CT) images, and to test the system in a large cohort to evaluate its robustness. MethodsA total of 1040 cases (520 cases each from two institutions), in which an intensity calibration phantom (B-MAS200, Kyoto Kagaku, Kyoto, Japan) was used, were included herein. A training dataset was created by manually segmenting the regions of the phantom for 40 cases (20 cases each). Segmentation accuracy of the CNN model was assessed with the Dice coefficient and the average symmetric surface distance (ASD) through the 4-fold cross validation. Further, absolute differences of radiodensity values (in Hounsfield units: HU) were compared between manually segmented regions and automatically segmented regions. The system was tested on the remaining 1000 cases. For each institution, linear regression was applied to calculate coefficients for the correlation between radiodensity and the densities of the phantom. ResultsAfter training, the median Dice coefficient was 0.977, and the median ASD was 0.116 mm. When segmented regions were compared between manual segmentation and automated segmentation, the median absolute difference was 0.114 HU. For the test cases, the median correlation coefficient was 0.9998 for one institution and was 0.9999 for the 4 other, with a minimum value of 0.9863. ConclusionsThe CNN model successfully segmented the calibration phantom's regions in the CT images with excellent accuracy, and the automated method was found to be at least equivalent to the conventional manual method. Future study should integrate the system by automatically segmenting the region of interest in bones such that the bone mineral density can be fully automatically quantified from CT images. The source code and the model used for segmenting the phantom are open and can be accessed via https://github.com/keisuke-

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The distribution of bone mineral density in the femoral heads of unstable intertrochanteric fractures

Abstract: The BMD was higher in the center region of the femoral head than in the inferior region. Therefore, lag screws are recommended to be inserted into the center of the femoral head.

Cited by 8 publications

References 23 publications

Comparison of helical blade versus lag screw in intertrochanteric fractures of the elderly treated with proximal femoral nail: A meta-analysis of randomized-controlled trials

Comparison of helical blade versus lag screw in intertrochanteric fractures of the elderly treated with proximal femoral nail: A meta-analysis of randomized-controlled trials

Predictors of Cut-Out after Fixation of Intertrochanteric Fractures with Two Cephalocervical Screwed Proximal Femur Nails

Automated segmentation of an intensity calibration phantom in clinical CT images using a convolutional neural network

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