Osteossíntese minimamente invasiva de fraturas transtrocantéricas com Dynamic Hip Screw (DHS)

Guimarães, José André Melo Barreto; Machado, Marcos Cezar Feitosa de Paula; Galvão, Pauliana Valéria Machado; Lima, Jéssika Cristina de; Gomes, Lucas dos Santos; Guimarães, Pedro Ferreira Barreto

doi:10.1055/s-0040-1716758

Cited by 7 publications

(3 citation statements)

References 7 publications

(16 reference statements)

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“…Consequently, it becomes imperative for surgeons to bestow due diligence upon the application of a precise preoperative imaging classification system, as it profoundly impacts postoperative outcomes. The precision in classifying these fractures is paramount, first, influencing the selection of optimal implants, such as dynamic hip screws (DHS) for stable pertrochanteric fractures and intra-medullary nails (IMN), a modified DHS for unstable fractures, or hemiarthroplasty [2][3][4]. In cases where stability is elusive, femoral locking compression plates, rather than DHS, have been advocated as an alternative device [5].…”

Section: Introductionmentioning

confidence: 99%

Inter-observer Agreement and Reproducibility of Pertrochanteric Fracture Classification Using Plain Radiograph Versus Computed Tomogram Images: A Study of 523 Patients

Noda,

Takahara,

Inui

et al. 2023

Cureus

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BackgroundA precise preoperative imaging classification system for pertrochanteric fractures is imperative due to the reported unreliability of the current classification system, which relies solely on plain radiographs. This study aims to achieve two primary objectives: (i) elucidate the reproducibility of pertrochanteric fracture evaluation based on the Revised Arbeitsgemeinschaft für Osteosynthesefragen/Orthopedic Trauma Association (AO/OTA) Classification, comparing plain radiographs and computed tomography (CT) scan images, and (ii) investigate the consistency of fracture classification between both imaging modalities. MethodsA total of 523 patients (112 males and 411 females, mean age 85 years) who had both preoperative plain radiographic and three-dimensional CT images were enrolled in this study. Following the Revised AO/OTA Classification, three individual observers initially classified the fractures in plain radiograph images as either Stable (A1) or Unstable (A2). Subsequently, they further categorized them into five sub-categories (A1.1, A1.2, A1.3, A2.2, and A2.3). The same classification system was applied to the CT scan images. Interobserver agreement and consistency of fracture classification between plain radiographs and CT scan images were assessed. ResultsThe inter-observer agreement for fractures classified as stable or unstable using only plain radiographs was found to be fair among the three observers, with a mean κ of 0.397 (95% CI: 0.316-0.478). However, interobserver agreement improved significantly when using CT scans, with a mean κ of 0.590 (95% CI: 0.518-0.662). Our results demonstrated a consistency level between two graphical modalities ranging from fair to moderate, with κ values of 0.581, 0.383, and 0.335, respectively. It's worth noting that plain radiographic classification occasionally resulted in underestimations, with each observer identifying 16.1%, 34.0%, and 37.9%, respectively, of cases as A1 in plain radiographs that were classified as A2 in CT scans. ConclusionsThis study reveals a moderate to substantial level of inter-observer agreement for fracture classification when using CT scan images, in contrast to plain radiographs. Fracture evaluation relying solely on plain radiographs sometimes underestimates fracture classification and exhibits less consistency compared to using CT scan images.

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Section: Introductionmentioning

confidence: 99%

Inter-observer Agreement and Reproducibility of Pertrochanteric Fracture Classification Using Plain Radiograph Versus Computed Tomogram Images: A Study of 523 Patients

Noda,

Takahara,

Inui

et al. 2023

Cureus

View full text Add to dashboard Cite

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“…It poses a public health problem due to the high morbidity and mortality that it causes. [1] The treatment of these fractures is generally surgical. They are broadly classifed into stable and unstable fractures depending on the fracture pattern.…”

Section: Introductionmentioning

confidence: 99%

Intravesical Migration of a Screw during Hip Osteosynthesis: A Case Report

Montassar,

Hamdi,

Wael

et al. 2023

EAS J Orthop Physiother

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The incidence of fractures of the upper extremity of the femur continues to increase as the population ages. Dynamic hip screw (DHS) is the treatment of choice for stable fractures. We report the case of an 80-year-old man with no notable pathological history presenting with a pertrochanteric fracture. Intraoperatively, the cephalic screw migrated unexpectedly into the pelvis. Several attempts were made to remove it, but the screw had penetrated deep into the pelvis, making removal impossible through the femoral neck. An emergency abdominal CT scan was performed showing that the screw had penetrated into the bladder. The urological surgeon was called in to remove the screw via a medial abdominal approach, which was fnally removed without any further complications. Intravesical migration of a DHS screw is a rare complication. Compliance with the DHS surgical technique, especially in very old osteoporotic patients, can avoid this complication.

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“…Obtaining a precise characterization of these fractures holds the potential to alleviate burdens across various clinical scenarios. Firstly, accurate differentiation between stable and unstable fractures significantly influences the choice of implant for procedures such as dynamic hip screwing (DHS), intra-medullary nails (IMN), or a modified DHS [2][3][4]. Noteworthy reports indicate that opting for IMN over DHS in unstable cases may result in improved functional outcomes [5,6].…”

Section: Introductionmentioning

confidence: 99%

Posterior Protrusion Measures (PPM) for Three-Dimensional (3D) CT Classification of Pertrochanteric Fractures

Noda,

Takahara,

Inui

et al. 2023

Cureus

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IntroductionWe introduced a novel numerical index known as posterior protrusion measures (PPM), derived from lateral plain radiograph images, which effectively serves to distinguish stable from unstable pertrochanteric fractures. The present study aims to scrutinize PPM values among two classified fracture patterns, stable and unstable, within the three-dimensional (3D) CT classification system, establishing a numeric threshold for PPM to differentiate between these groups; explore the potential relationship between the PPM index and unclassified categories; investigate how groups divided by the PPM threshold value can predict fracture stability based on 3D CT. Materials and methodsIn this study, three observers were tasked with measuring PPM on a single occasion. The chi-square test assessed the association between each demographic parameter on a categorical scale and stable/unstable groups. Continuous variables were also subject to examination. Receiver operating characteristic (ROC) analysis was employed to determine optimal cut-off points of PPM for predicting the presence of stable versus unstable groups. Additionally, the chi-square test examined the linear relation between separated groups based on the defined threshold PPM value and the stable/unstable groups. ResultsA total of 106 pertrochanteric fractures were identified using CT scan images and plain radiographs in the 3D CT classification system, revealing the stable group of 35 patients and the unstable group of 71 patients. The PPM values for stable/unstable fractures were, on average (± standard deviation), 0.34±0.25/0.50±0.29 for observer 1, 0.31±0.23/0.57±0.31 for observer 2, and 0.41±0.29/0.57±0.26 for observer 3, respectively (p<0.01). We established 0.3 as the cut-off value for PPM. The average PPM value among three observers represented each patient to assess fracture stability. The group with PPM <0.3 included 27 patients (16 stable and 11 unstable), and the group with PPM ≥0.3 group comprised 79 patients (19 stable and 60 unstable; p<0.005). ConclusionThe present study revealed a significant difference in PPM values among stable and unstable 3D CT classification groups. Additionally, a threshold PPM value of 0.3 suggests a pivotal point for differentiating fracture stability. This innovative methodology makes a substantial contribution to clinical endeavors, potentially circumventing the necessity for 3D CT scanning.

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Osteossíntese minimamente invasiva de fraturas transtrocantéricas com Dynamic Hip Screw (DHS)

Cited by 7 publications

References 7 publications

Inter-observer Agreement and Reproducibility of Pertrochanteric Fracture Classification Using Plain Radiograph Versus Computed Tomogram Images: A Study of 523 Patients

Inter-observer Agreement and Reproducibility of Pertrochanteric Fracture Classification Using Plain Radiograph Versus Computed Tomogram Images: A Study of 523 Patients

Intravesical Migration of a Screw during Hip Osteosynthesis: A Case Report

Posterior Protrusion Measures (PPM) for Three-Dimensional (3D) CT Classification of Pertrochanteric Fractures

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