Radiographic Analysis of Preoperative and Postoperative 3DCT Images of Trochanteric Femoral Fractures

Abstract

: The present study compared a 3-dimensional computed tomography 3DCT classi cation Nakano classi cation with conventional x-ray classi cations Jensen classi cation and AO classi cation in 44 patients with trochanteric femoral fractures, and evaluated the patterns of fracture lines using 3DCT images. The concordance rate between the Jensen and 3DCT classification, and between the AO and 3DCT classification was 65.9 and 75.0 , respectively. 3DCT scans enabled the creation of detailed images of fracture lines. The anterior fracture line was found to run along the intertrochanteric crest in 90.9 of patients, while the location of the posterior fracture line was in the same approximate position in all patients, including those with comminuted fractures 34.1 . Posterior destruction along lateral fracture lines was present in 63.6 of patients. Furthermore, the preoperative and postoperative CT images of 33 patients with fractures treated via insertion of short femoral nails demonstrated that there was dif culty reducing greater trochanteric fractures. This included reducing fracture sites separated by nail insertion 42.4and greater trochanteric fracture sites displaced after surgery 54.5 , suggesting that the use of short femoral nails is limited.

A tomografia computadorizada melhora a reprodutibilidade na classificação das fraturas transtrocanterianas?

“…When analyzing CT scans, Ito et al 36 obtained a 75% concordance with the complete AO classification, and a 65.9% concordance with the Evans-Jensen classification. Van Embden D. et al 33 did not observe a higher reproducibility for the simplified AO classification when adding CT to the radiographic study, obtaining kappa values of 0.70 (strong) not using CT, and of 0.68 (strong) using CT images.…”

“…Ao analisar a TC, Ito et al 36 evidenciaram concordância de 75% com a classificação AO completa e de 65,9% com a classificação de Evans-Jensen. Van Embden D. et al 33 não apresentaram maior reprodutibilidade para a classificação AO simplificada ao acrescentar a TC ao estudo radiográfico, demonstrando valores kappa de 0,70 (forte) sem o uso da TC e de 0,68 (forte) com a TC.…”

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

“…Some studies have reported on GT separation in intertrochanteric fractures, 11 , 22 but to our knowledge none has evaluated its clinical relevance, such as the association with postoperative PS. Ito et al 22 especially reported the increased AP diameter of the GT at 2 weeks postoperatively if there was preoperative GT separation. This seems to support our results ( Figure 6 ).…”