CT Evaluation of Rotational Malalignment after Intertrochanteric Fracture Fixation

Abstract

Background: Intertrochanteric fractures account for 60% of all proximal fractures of femur and most of these fractures occur in patients over 65 years of age and mostly affect females. They are fixed mostly either by proximal femoral nails (PFN) or dynamic hip screw (DHS) post reduction under C-arm images. Objective: To evaluation by CT the quality of reduction in the horizontal plane. Patients and methods: Prospective study including 20 patients operated for intertrochanteric fracture femur between April 2019 and December 2019. Thirteen fractures were treated using DHS plate and screw fixation and 7 with PFN. All these patients underwent postoperative CT of the pelvis and knee on the same day of the operation during their hospitalization with measurement of anteversion of the operated and healthy necks of femur compared with a tangent posterior condyles of femur. Results: There was malalignment greater than 15° on the operated side compared to the unoperated side at 30% of patients. Conclusion:The rate of rotational malreductions of operated trochanteric fractures is very high; 30%, with a majority of external over rotation occurred during reduction maneuvers. The criteria normally used for reduction of trochanteric fractures are insufficient to prevent rotational malalignment. The increase in the number of C-arm images seems to be an advantageous to avoid these reduction errors during pre-and intraoperative maneuvers.