The management of pertrochanteric fractures of the hip

Mokawem, Michael; Bobak, Peter; Aderinto, Joseph

doi:10.1016/j.mporth.2012.04.001

Cited by 10 publications

(7 citation statements)

References 35 publications

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“…Furthermore, MPC and Contact models predicted more variations than the most commonly used Linear model in terms of both stratification power and the location of the predicted high strains. That is in agreement with what was reported clinically in terms of fracture types resulted from falls (Cauley et al, 2009;Mokawem et al, 2012). Contact model has higher classification power than MPC model and is more computationally expensive.…”

Section: Discussionsupporting

confidence: 91%

The effect of boundary and loading conditions on patient classification using finite element predicted risk of fracture

Altai

Qasim

et al. 2019

Clinical Biomechanics

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Background: Osteoporotic proximal femoral fractures associated to falls are a major health burden in the ageing society. Recently, bone strength estimated by finite element models emerged as a feasible alternative to areal bone mineral density as a predictor of fracture risk. However, previous studies showed that the accuracy of patients' classification under their risk of fracture using finite element strength when simulating posterolateral falls is only marginally better than that of areal bone mineral density. Patients tend to fall in various directions: since the predicted strength is sensitive to the fall direction, a prediction based on certain fall directions might not be fully representative of the physical event. Hence, side fall boundary conditions may not be completely representing the physical event. Methods: The effect of different side fall boundary and loading conditions on a retrospective cohort of 98 postmenopausal women was evaluated to test models' ability to discriminate fracture and control cases. Three different boundary conditions (Linear, Multi-point constraints and Contact model) were investigated under various anterolateral and posterolateral falls. Findings: The stratification power estimated by the area under the receiver operating characteristic curve was highest for Contact model (0.82), followed by Multi-point constraints and Linear models with 0.80. Both Contact and MPC models predicted high strains in various locations of the proximal femur including the greater trochanter, which has rarely reported previously. Interpretation: A full range of fall directions and less restrictive displacement constraints can improve the finite element strength ability to classify patients under their risk of fracture.

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Section: Discussionsupporting

confidence: 91%

The effect of boundary and loading conditions on patient classification using finite element predicted risk of fracture

Altai

Qasim

et al. 2019

Clinical Biomechanics

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“…4,12 These fractures are biomechanically unstable. 2,13,14 Previous similar studies with larger sample sizes suggest that lateral wall fractures consistently have poor prognosis than intact lateral wall fractures. So we decided to study the prognosis of lateral wall fractures following surgical intervention regardless of the type of implant.…”

Section: Discussionmentioning

confidence: 94%

“…Lateral wall act as buttress to the proximal fragment during this process. 2,[13][14][15][16][17][18][19] However, in lateral wall fractures, line of fracture is parallel to the sliding vector of fragments (high shear forces). This disturbs the fracture healing process.…”

Section: Discussionmentioning

confidence: 99%

Prospective study of prognosis of intertrochanteric fractures with lateral wall involvement as compared to intertrochanteric fractures with intact lateral wall

Bansal

2019

Int J Res Orthop

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Background: Intertrochanteric fractures with fracture lateral wall (FLW) are biomechanically unstable fractures.Methods: 40 patients who met inclusion criteria underwent surgery. Post-operatively patients were followed up for a minimum period of 24 weeks. Radiological and functional assessment was done post-operatively. Endpoints of fracture were studied thoroughly.Results: Secondary lateral wall fractures were common than primary lateral wall fractures. Functional outcome was found to be poor in FLW than intact lateral wall (ILW) group (p=0.01). HHS of ILW fracture was 70, while in FLW it was 46. Displacement was found to be a better radiological parameter to assess reduction quality (p=0.02) than neck shaft angle. Implant position with Cleveland method was found to be a better predictor of fixation quality than tip apex distance. There were 6 (15%) mechanical failures. Screw cut out (3 cases) found to be most common mechanical complication (7.5%). There were four failures (33%) in FLW. Secondary lateral wall fractures were found to have poor prognosis than primary lateral wall fractures. A2.3 was found to have more chance of conversion to A3 due to thinned out lateral wall. Many of them happened when DHS was the implant of choice (60%).Conclusions: Functional outcome of FLW is poor than ILW. Secondary lateral wall fractures have worse prognosis than primary lateral wall fractures. Fragment specific fixation is difficult in secondary lateral wall fractures as compare to primary lateral wall fracture, due to higher comminution.

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“…In treating patients with fragility femoral neck fracture, especially for displaced fracture, arthroplasty is generally preferred over fixation [ 20 , 29 , 30 ]. By contrast, fracture fixation with intramedullary nailing is the mainstay in patients with pertrochanteric fractures [ 31 ]. During the post-operative period, patients who receive arthroplasty usually experience less pain and are able to ambulate and bear weight early [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Prognostic Factors of the Inability to Bear Self-Weight at Discharge in Patients with Fragility Femoral Neck Fracture: A 5-Year Retrospective Cohort Study in Thailand

Tangchitphisut

Khorana

Phinyo

et al. 2022

IJERPH

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An inability to bear self-weight is one of the unfavorable results in geriatric hip fracture, which needs to be prevented. This study determines pre-operative, intra-operative, and post-operative prognostic factors of the inability to bear self-weight at discharge in patients with fragility femoral neck fracture. This retrospective study was conducted at Chiang Mai University (CMU) hospital with an observational cohort design. Electronic medical records of patients aged ≥ 50 years old with fragility femoral neck fractures between 1 January 2015 and 31 December 2019 were reviewed. Pre-, intra-, and post-operative factors were collected. Ambulation status at discharge time was classified into either ability or inability to bear self-weight. Analysis of prognostic factors was done using multivariable risk ratio regression. In total, 269 patients were recruited in this study. Significantly prognostic factors of inability to bear self-weight at discharge were end-stage renal disease (ESRD), cirrhosis, cerebrovascular disease, pre-fracture ambulatory status, having associated fractures, increasing intra-operative blood loss, and having pressure sore. These prognostic factors could be used to predict patients’ outcomes at discharge. Proper management could then be offered to the patients by the multidisciplinary care team to enhance surgical outcomes.

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The management of pertrochanteric fractures of the hip

Cited by 10 publications

References 35 publications

The effect of boundary and loading conditions on patient classification using finite element predicted risk of fracture

The effect of boundary and loading conditions on patient classification using finite element predicted risk of fracture

Prospective study of prognosis of intertrochanteric fractures with lateral wall involvement as compared to intertrochanteric fractures with intact lateral wall

Prognostic Factors of the Inability to Bear Self-Weight at Discharge in Patients with Fragility Femoral Neck Fracture: A 5-Year Retrospective Cohort Study in Thailand

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