The Stability Score of the Intramedullary Nailed Intertrochanteric Fractures: Stability of Nailed Fracture and Postoperative Patient Mobilization

Abstract

BackgroundIntertrochanteric fractures of the femur are the most common type of fracture, and are an increasing occurrence due to the aging of the population. The objectives of our study are to predict the fate of intertrochanteric fractures treated with intramedullary hip nails by assessing the postoperative fracture stability utilizing the newly developed scoring system, and to help rehabilitate these patients.MethodsEighty-two patients with intertrochanteric fractures that were treated with intramedullary hip nails between December, 2004 and January, 2011 were subjected to this study. The patients who could be followed for a minimum of one year postoperatively were enrolled. The immediate postoperative conditions were determined by radiograms: reduction status (3 parameters/4 points: contact accuracy of posteromedial cortex, severity of angulation, and distraction), fixation status (3 parameters/3 points: tip-apex distance, location of tip of the lag screw, entry point of the intramedullary nail), and fracture type (1 parameter/1 point: stable or unstable type by the Kyle's classification). Postoperative reduction loss and fixation failure were checked by radiograms taken at a minimum 3 months postoperative.ResultsReduction loss and fixation failure were observed in 14 consecutive patients (17%). The fixation failure rate was 100% (2 patients) in score 1, 60% (3 out of the 5 patients) in score 2, 39% (3 out of the 8 patients) in score 3, and 50% (4 out of the 8 patients) in score 4 groups. There were fixation failures only in 1 out of 13 patients with score 5, and in 1 out of 18 patients with score 6. There was no fixation failure in 17 patients with score 7 and 11 patients with score 8.ConclusionsMaintenance of the fracture reduction by the stable fixation in the patient scores over 5 could be predicted by the postoperative radiograms.

Disorder-related risk factors for revision total hip arthroplasty after hip hemiarthroplasty in displaced femoral neck fracture patients: a nationwide population-based cohort study

“…Risk equations and risk functions have been widely applied for patient counseling, clinical diagnosis, risk stratification, treatment selection, and prognosis prediction; these have especially been useful in medical fields such as cardiovascular disease [ 31 ], hepatic disease [ 32 , 33 ], and cancer [ 34 , 35 ]. Most risk score systems used in orthopedic surgery are constructed according to the preoperative damage condition [ 36 , 37 ], bony destruction [ 38 ], or postoperative fixation status [ 39 ]. In preoperative assessment of displaced femoral neck fracture without complicated bony destruction, using demographic data and underlying comorbidity is an easy way to predict risk of revision.…”

Hüftgelenknahe Frakturen/Luxationen

“…Allerdings muss bemerkt werden, dass auch bei noch so großer Anstrengung die Repositionen nicht immer ideal gelingen. Auffällige postoperative Röntgenbilder sollten sauber analysiert und notwendige Repositionen verbessert werden [16]. Daraus resultiert immer eine neue Implantatposition (s. Fallbeispiel 5; ▶ Abb.…”

Comparison of radiological outcome of unstable Intertrochanteric femur fractures in elderly patients treated with Indian and Foreign Cephalomedullary nails

“…Tip apex distance of <25mm [16] for Indian implants and 20-30 mm for Foreign implants [15] was considered appropriate. Sliding length difference of 0-5mm between immediate and last follow up x rays for both implants was acceptable [19] . In the last follow up x rays, outcome was analysed for surgical fixation, union and complications.…”

“…Reduction was good (0-5degree), acceptable (5-10 degree), poor (>10 degree) [18] . Reduction also was found to be anatomical if there was adequate posteromedial cortical contact, angulation <5 degree, no distraction in fracture fixation [19] . Screw positioning was appropriate if screw was placed into the lower half of the neck AP view, centrally on a lateral view [18] and PFNA2 blade was placed in to the center of the neck AP view and centrally on a lateral view.…”