Hook leverage technique for reduction of intertrochanteric fracture

Kim, Youngwoo; Dheep, Kunal; Lee, Jaeheon; Yoon, Young Wook; Shon, Won Yong; Oh, Chang Wug; Oh, Jong‐Keon

doi:10.1016/j.injury.2014.02.007

Cited by 43 publications

(57 citation statements)

References 14 publications

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“…After the nail was inserted, it can be used as a tool to separate the engaged head–neck fragment from the shaft. By lateral pull of the nail jig, the fragments were loosened and sagittal reduction was easily manipulated by leverage technique using a bone hook or a long forceps [ 18 ].…”

Section: Methodsmentioning

confidence: 99%

Fracture reduction with positive medial cortical support: a key element in stability reconstruction for the unstable pertrochanteric hip fractures

Chang

Zhang

et al. 2015

Arch Orthop Trauma Surg

166

150

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PurposeTo introduce the concept of fracture reduction with positive medial cortical support and its clinical and radiological correlation in geriatric unstable pertrochanteric fractures.MethodsA retrospective analysis of 127 patients (32 men and 95 women, with mean age 78.7 years) with AO/OTA 31A2.2 and 2.3 hip fractures treated with cephalomedullary nail (PFNA-II or Gamma-3) between July 2010 and June 2013 was performed. They were classified into three groups according the grade of medial cortical support in postoperative fracture reduction (positive, neutral, and negative). The positive cortex support was defined that the medial cortex of the head–neck fragment displaced and located a little bit superomedially to the medial cortex of the shaft. If the neck cortex is located laterally to the shaft, it is negative with no cortical buttress, and if the two cortices contact smoothly, it is in neutral position. The demographic baseline, postoperative radiographic femoral neck–shaft angle and neck length, rehabilitation progress and functional recovery scores of each group were recorded and compared.ResultsThere were 89 cases (70 %) in positive, 26 in neutral, and 12 in negative support. No statistical differences were found between the three groups among patient age, sex ratio, prefracture score of activity of daily living, walking ability score, ASA physical risk score, number of medical comorbidities, osteoporosis Singh index, fracture reduction quality (Garden alignments), and the position of lag screw or helical blade in femoral head (TAD). In follow-up, patients in positive medial cortical support reduction group had the least loss in neck–shaft angle and neck length, and got ground-walking much earlier than negative reduction group, with good functional outcomes and less hip–thigh pain presence.ConclusionFracture reduction with nonanatomic positive medial cortical support allows limited sliding of the head–neck fragment to contact with the femur shaft and achieve secondary stability, providing a good mechanical environment for fracture healing.

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Section: Methodsmentioning

confidence: 99%

Fracture reduction with positive medial cortical support: a key element in stability reconstruction for the unstable pertrochanteric hip fractures

Chang

Zhang

et al. 2015

Arch Orthop Trauma Surg

166

150

View full text Add to dashboard Cite

show abstract

“…Various techniques exist for reducing or maintaining the reduced status of an intertrochanteric fracture during cephalomedullary nailing, such as provisional pin fixation or hook leverage techniques. 7 - 9 Loss-of-reductions still occasionally are reported despite the adequate reduction achieved by those techniques. 7 …”

Section: Discussionmentioning

confidence: 99%

“…Anteromedial cortical reduction has been emphasized in intertrochanteric fractures, especially in cases of unstable nature, despite lack of a definite consensus for achieving adequate reduction. 6 Several surgical techniques have been introduced to establish these bone-to-bone contacts during surgery, 7 - 9 but some patients still experience loss-of-reduction (LOR) despite such efforts. We also experienced several cases of LOR as posterior sagging (PS) of the proximal fragment after obtaining adequate reduction during cephalomedullary nailing for intertrochanteric fractures.…”

Section: Introductionmentioning

confidence: 99%

Posterior Sagging After Cephalomedullary Nailing for Intertrochanteric Femur Fracture is Associated with a Separation of the Greater Trochanter

Kim

Kang

Lim

et al. 2020

Geriatr Orthop Surg Rehabil

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Introduction: Cephalomedullary nailing presents several biomechanical benefits for treatment of intertrochanteric fractures, but posterior sagging (PS) of the proximal fragment occurs postoperatively in some patients despite intraoperative achievement of an adequate reduction. We investigated the risk factors for PS in those patients, with specific attention to posterior split fragment involving the greater trochanter (GT separation) as a possible significant risk factor. Methods: We retrospectively reviewed 50 (12 males, 38 females) patients ≥50 years old at diagnosis of an intertrochanteric fracture after low-energy trauma who underwent cephalomedullary nailing between April 2015 and February 2017 and were not lost to follow-up within 12 months postoperatively. Results: Thirteen (26%) patients experienced PS postoperatively. Average time to bone union was significantly longer in the PS (9.5 months) than in the non-PS (4.8 months) groups ( P = .002). Three patients in the PS group experienced nonunion compared to none in the non-PS group ( P = .015). Significant difference was found in postoperative level of ambulatory ability (Koval score) and deterioration of the score after the injury between 2 groups (4.2 vs 2.8, P = .043 and 2.5 vs 0.8, P = .005). On multivariate logistic regression analysis, GT separation ( P = .010) was a significant risk factor for PS. Discussion and Conclusion: The presence of GT separation in cases of intertrochanteric fractures seems to weaken posterior stability in the proximal fragment, thus showing poor clinical outcomes.

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“…apex posterior angulation of the fragment can be corrected by application of a constant force directed from posterior to anterior with either a crutch, pusher or by direct levering of the distal and/or proximal fragments through small stab incisions. Intrafocal manipulation can also be performed [65,66]. In two-part basicervical fractures a pointed reduction clamp can be also be applied if the proximal fragment is tipped in varus ( Fig.…”

Section: Reduction/fixation Of Pertrochanteric Fracturesmentioning

confidence: 99%

Common complications in hip fracture surgery: Tips/tricks and solutions to avoid them

Tosounidis

Castillo

Kanakaris

et al. 2015

Injury

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Hook leverage technique for reduction of intertrochanteric fracture

Cited by 43 publications

References 14 publications

Fracture reduction with positive medial cortical support: a key element in stability reconstruction for the unstable pertrochanteric hip fractures

Fracture reduction with positive medial cortical support: a key element in stability reconstruction for the unstable pertrochanteric hip fractures

Posterior Sagging After Cephalomedullary Nailing for Intertrochanteric Femur Fracture is Associated with a Separation of the Greater Trochanter

Common complications in hip fracture surgery: Tips/tricks and solutions to avoid them

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