Postoperative stability on lateral radiographs in the surgical treatment of pertrochanteric hip fractures

Abstract

Excessive sliding occurs in surgical treatment for pertrochanteric fractures with posterior displacement of the head and neck fragment. In such cases, we recommend appropriate reduction prior to internal fixation.

Direct reduction may need to be considered to avoid postoperative subtype P in patients with an unstable trochanteric fracture: a retrospective study using a multivariate analysis

“…Type I: undisplaced 2-fragment fracture; Type II: displaced 2-fragment fracture; Type III: 3-fragment fracture without posterolateral support, owing to displacement of the greater trochanter fragment; Type IV: 3-fragment fracture without medial support, owing to a displaced lesser trochanter or femoral arch fragment; Type V: 4-fragment fracture without posterolateral and medial support (combination of type III and type IV). B Diagrams showing the classification of the postoperative subtype on the lateral view of radiographs [8,9]. Subtype A: anteriorly displaced proximal fragment (arrow).…”

“…2B). The radiographic magnification and rotation of the hip joint were corrected during measurement based on the screw length [9]. Regarding the position of the lag screw in the femoral head, the femoral head was divided into six areas as a grid, which included superior and inferior areas (S, I) in the AP view, and anterior, middle and posterior areas (A, M, P) in the lateral view (Fig.…”

“…The 136 patients were divided into two groups based on the direction of proximal head and neck fragment displacement relative to the distal femoral shaft fragment on the postoperative lateral radiographs at the final follow-up [8,9]. Cases with the femoral neck reduced anteriorly to the distal fragment (subtype A = anterior) or cases with the reduced neck and distal fragment with increased integrity of the anterior cortex (subtype N = normal) were classified as belonging to the subtype A or N group.…”

“…Ikuta first focused on the correlation between the fracture reduction in the lateral view of radiographs and the postoperative outcome [8]. He concluded that the posterior displacement of the head and neck fragment (subtype P = posterior) had the potential to slide excessively because most of the impaction during sliding would occur on the fragile posterior cortex [4,8,9]. Recently, Tsukada et al [9] reported that excessive sliding occurs following the surgical treatment for peritrochanteric fractures with displacement of postoperative subtype P. However, to the best of our knowledge, there have been no reports that have assessed the factors that may correlate with the postoperative subtype N. Kozono Á S. Ikemura (&) Á A. Yamashita Á T. Harada Á T. Watanabe Á K. Shirasawa Investigation performed at the Department of Orthopaedic Surgery, Shimonoseki City Hospital, 1-13-1 Koyo-cho, Shimonoseki 750-8520, Japan e-mail: saikemura@gmail.com on the lateral view of radiographs.…”

The Antero-medial Cortex Overlapped Reduction of Unstable Intertrochanteric Fractures

“…그러나 많은 저자들은 전•후면상 중앙과 하방에 위치하는 것이 이상적이라고 하였다 [17][18][19] . 또한 측면 상 중앙에 위치하는 것이 강조되었다 12,17,20) . Kuzyk 22,23) .…”