Three-Dimensional Computed Tomographic Analysis for Comminution of Pertrochanteric Femoral Fracture: Comminuted Anterior Cortex as a Predictor of Cutting Out

Abstract

Background:Fixed angle sliding hip screw devices allow controlled impaction between the head neck fragment and the femoral shaft fragment in the surgical treatment of pertrochanteric fractures. This study was performed to evaluate the frequency and pattern of comminution at the fracture site, which may prevent the intended impaction.Materials and Methods:Three-dimensional computed tomography was used to investigate 101 pertrochanteric fractures treated with fixed angle sliding hip screw devices, with emphasis on the comminuted cortex. A comminuted fracture was defined as a fracture that had a third fracture fragment at the main fracture line.Results:There were 40 fractures without comminution and 61 with comminution. All 61 comminuted fractures had a comminuted posterior cortex, and 3 of 61 fractures also had comminution at the anterior cortex. The prevalence of cutting out of the implant from the femoral head was significantly higher in cases involving comminution at both the posterior and anterior cortices than in cases involving comminution only at the posterior cortex (66.7 % and 3.4 %, p < 0.0001).Conclusion:The posterior cortex was comminuted in 60.4% of pertrochanteric fractures and the anterior cortex in 3.0%. Intended impaction at the fracture site could not be obtained at any cortex in cases with comminution at both the anterior and posterior cortices; comminution at the anterior cortex may be a predictor of cutting out.

[Retracted] Three‐Dimensional Mapping of Medial Wall in Unstable Pertrochanteric Fractures

“…Pertrochanteric femoral fractures constitute a significant proportion of hip injuries, which continues to be a challenge for orthopedic trauma surgeons in daily practice. The integrity of the medial cortex has gained increasing focus to address issues concerning the stability of reconstructions after fracture fixation [1,2]. It affects internal fixation stability and fracture prognosis [3].…”

A novel three-dimensional classification system for intertrochanteric fractures based on computed tomography findings

“…The final limitation is that the study did not include a clinical evaluation of the fragment-based classification system. Tsukada et al investigated comminution at the intertrochanteric fracture site and found that comminution at the anterior cortex may predict cutout after osteosynthesis (28). Similar clinical studies including the present classification system are necessary.…”