Morphology of the posteromedial fragment in pertrochanteric fractures: A three-dimensional computed tomography analysis

Sharma, Gaurav; Gn, Kiran Kumar; Khatri, Kavin; Singh, Rohit; Gamanagatti, Shivanand; Vp, Sharma

doi:10.1016/j.injury.2016.11.010

Cited by 39 publications

(38 citation statements)

References 17 publications

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“…The loading on the hip depends on a number of factors such as activities and body weight [ 17 ]. Bergmann et al studied the in vivo forces acting on the hip joint and found maximum gait loads (4 km/h) of 211–285% of the body weight and mean loads of 238% of the body weight [ 9 , 16 ]. By choosing 1800 N as a comparative point, we assumed full weight-bearing in patients corresponding to a clinically relevant load to simulate a one-leg stance for the hip, which is approximately 2.6 times the average body weight [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…Among the six paired specimens, each bone of the pair was randomly assigned to two groups, which were either in the medial wall group ( n med = 6) or lateral wall group ( n lat = 6), ensuring an equal number of left and right specimens in each group. Because only bone pairs were used, major differences in the bone quality among the groups were excluded [ 9 , 10 ]. During the preparation, instrumentation, and biomechanical testing, the specimens were intermittently sprayed with normal saline to maintain hydration.…”

Section: Methodsmentioning

confidence: 99%

“…The second axial loading test for the implant-femur constructs was performed using the same protocol as that of the first loading after the instrumentation. Failure was defined as a fracture in the femoral neck or shaft, and/or cutout/cut-through, and/or implant failure, and/or sudden drop in the load resistance observed in the load-displacement curve [ 9 ], or an axial displacement of the actuator of more than 20 mm [ 8 ].…”

Section: Methodsmentioning

confidence: 99%

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The medial femoral wall can play a more important role in unstable intertrochanteric fractures compared with lateral femoral wall: a biomechanical study

Nie

Chen

et al. 2017

J Orthop Surg Res

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BackgroundThe major objective of the present study is to investigate the differences in the load and strain changes in the intertrochanteric region of human cadaveric femora between the loss of medial or lateral wall and after treatment with proximal femoral nail antirotation (PFNA).MethodsAfter measuring the geometry of the proximal femur region and modeling the medial or lateral wall defect femoral models, six pairs of freshly frozen human femora were randomly assigned in the medial or lateral wall group. According to a single-leg stance model, an axial loading was applied, and the strain distribution was measured before and after PFNA implantation. The strains of each specimen were recorded at load levels of 350, 700, and 1800 N and the failure load. Paired t test was performed to assess the differences between two groups.ResultsThe failure mode of almost all defect model femora was consistent with that of the simulated type of intertrochanteric fractures. After the PFNA implantation, the failure mode of almost all stabilized femora was caused by new lateral wall fractures. The failure load of the lateral wall group for defect model femora was significantly higher than that of the medial wall group (p < 0.001). However, the difference disappeared after the PFNA was implanted (p = 0.990). The axial stiffness in all defect model femora showed the same results (p < 0.001). After the PFNA implantation, the axial stiffness of the lateral wall group remained higher than that of the medial wall group (p = 0.001). However, the axial stiffness of the lateral wall group showed that the femora removed from the lateral wall were higher than the PFNA-stabilized femora (p = 0.020). For the axial strain in the anterior wall after the PFNA implantation, the strain of the lateral wall group was significantly lower than that of the medial group (p = 0.003). Nevertheless, for the axial strain of the posterior wall after the PFNA implantation, the strain of the medial wall group was significantly lower than that of the lateral group (p < 0.001).ConclusionsIn summary, this study demonstrated that PFNA is an effective intramedullary fixation system for treating unstable intertrochanteric fractures. Compared with the lateral wall, the medial femoral wall is a more important part in the intertrochanteric region. We suggest that in treating intertrochanteric femoral fractures with medial wall fractures, the medial wall fragment should be reset and fixed as much as possible.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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The medial femoral wall can play a more important role in unstable intertrochanteric fractures compared with lateral femoral wall: a biomechanical study

Nie

Chen

et al. 2017

J Orthop Surg Res

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“…In our study and classi cation, we did not describe the lateral wall, because we believe that intertrochanteric fractures involving the lateral wall are a special type of femoral fracture, and their fracture patterns and prognosis are considerably different from other intertrochanteric fracture models. In addition, we believe that the posteromedial structure plays an important biomechanical role in ensuring the stability of the proximal femur 16,17,2 . The loss of support in the posteromedial side is an important cause of femoral head collapse, femoral neck shortening, and internal xation failure, and studies of the posteriormedial fracture line and fracture fragments have already been reported.…”

Section: Discussionmentioning

confidence: 97%

“…The posterior wall and medial wall are important biological structures of the femoral trochanter 16 . Previous studies have shown that the integrity of posterior-medial structure is closely related to its stability after fracture surgery and hip joint functional mobility 17,2 .…”

Section: Introductionmentioning

confidence: 99%

Morphological Analysis of Posterior-Medial Intertrochanteric Fracture Patterns Using Fracture-Mapping Technique

Ren

et al. 2020

Preprint

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Background: The purpose of this study was to analyze the fracture patterns of different posterior-medial wall types of intertrochanteric fractures by 3-D fracture-mapping technique and to further assess their clinical utility.Methods: In a retrospective analysis of interochanteric fractures treated in a large trauma center, fractures were classified into predesigned groups based on 3D-CT imaging techniques, and a 3-D template of the intertrochanteric region was graphically superimposed on the fracture line. Fracture characteristics were then summarized based on fracture-mapping. Finally, radiographic parameters, function, and range of motion were recorded in different fracture classification states.Results: A total of 348 intertrochanteric fractures were included. There were 111 patients (31.9%) in the posterolateral + posteromedial + medial group, with the most severe fracture displacement (typically characterized by fragmentation of the posteromedial wall into three isolated fragments). There were 102 cases (29.3%) in the posterolateral + posteromedial + simple medial group, and the most common fracture feature was a complete fragment posteromedially. A total of 81 cases (23.3%) were classified into the posterolateral + medial group, with the medial fracture line extending the anterior fracture line but leaving the lesser trochanter intact. In the isolated medial group of 33 cases (9.5%), the fracture type was similar to type IV, but the integrity of the greater trochanter was ensured. In the posteromedial + medial group of 12 cases (3.4%), the fracture was characterized by an interruption when the fracture line of the anterolateral wall extended to the posteromedial wall, often resulting in a complete isolated fragment posteromedially and medially. There were 9 patients (2.6%) in the isolated posterolateral group. In addition, we found significantly different radiographic scores and range of motion scores between groups.Conclusions: This morphometric study helps us to further characterize posterior-medial fracture patterns of intertrochanteric fractures, which may be closely related to different clinical outcomes. Further studies are needed to verify the reliability of this classification scheme in clinical application.Study Design: Crossover Study Design; Level of evidence, 3.

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Occult fracture propagation in patients with isolated greater trochanteric fractures: patterns and management

2021

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Morphology of the posteromedial fragment in pertrochanteric fractures: A three-dimensional computed tomography analysis

Cited by 39 publications

References 17 publications

The medial femoral wall can play a more important role in unstable intertrochanteric fractures compared with lateral femoral wall: a biomechanical study

The medial femoral wall can play a more important role in unstable intertrochanteric fractures compared with lateral femoral wall: a biomechanical study

Morphological Analysis of Posterior-Medial Intertrochanteric Fracture Patterns Using Fracture-Mapping Technique

Occult fracture propagation in patients with isolated greater trochanteric fractures: patterns and management

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