Simple guidelines for evaluating intraoperative alignment after the reduction of intertrochanteric fractures

Yoon, Yong-Cheol; Kim, Jin-Il; Cho, Jae-Woo; Cho, Won-Tae; Kim, Hyungjin; Oh, Jong-Keon

doi:10.1016/j.asjsur.2020.10.010

Cited by 5 publications

(2 citation statements)

References 27 publications

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“…The incidence of intertrochanteric fractures (ITF) has rapidly increased with the population ages, and most intertrochanteric fractures can be effectively treated with internal fixation, 1 , 2 nevertheless, previous studies have reported that the failure rate of internal fixation has reached up to 1.2% to 9.6%, 3 , 4 manifests in coxa vara, internal fixation loosening or fracture, serious hip pain, and loss of hip function; and often requires reoperation. The surgery of failed internal fixation includes re‐osteosynthesis or conversion hip arthroplasty (CHA).…”

Section: Introductionmentioning

confidence: 99%

Conversion Hip Arthroplasty Using Standard and Long Stems after Failed Internal Fixation of Intertrochanteric Fractures

Shi

Fang

Huang

et al. 2022

Orthopaedic Surgery

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Background: Failed internal xation of intertrochanteric fractures is often treated by conversion hip arthroplasty (CHA). This study aimed to evaluate the results and complications of using long and standard femoral stems in this operation.Methods: This retrospective, multi-center study enrolled 31 total hip arthroplasty (THA) and 23 hemiarthroplasty (HA) cases (30 women, 24 men; mean age 76 years) after FIF-ITF between 2012 and 2019, divided into 2 groups: standard stem group (n = 20) and long stem group (n = 34). The initial internal xation includes 38 cases of proximal femoral nail anti-rotation (PFNA), 8 cases of the dynamic hip screw (DHS), and 8 cases of locking proximal femoral plate (LPFP). The indications for CHA included 38 cases of failure of xation, 7 cases of nonunion, and 9 cases of avascular necrosis or posttraumatic osteoarthritis. Perioperative data and complications related to fracture and operation were collected, and preoperative and postoperative clinical and radiological data were analyzed.Results: At an average of 5.6 years with a minimum of 2 years follow-up. A signi cant overall surgeonrelated complication rate was detected (27.8% [15/54]), ve cases had an intraoperative femur fracture, one case had a late periprosthetic femoral fracture, one case had a stem penetration, one case had a cement leakage, and two patients had an early postoperative dislocation, one infection and three cases of stem loosening or subsidence. Long stems had an increased risk of complication (13/34) compared to standard stems (2/20) (P= 0.031). The operation time and blood loss in the long stem group were higher than those in the standard stem group (P= 0.002;0.017). Harris Hip Score (HHS) and SF-36 significantly improved in both groups from preoperative to the final follow-up, and did not present significant differences at the nal follow-up (P>0.05).Conclusion: A high complication rate was detected in CHA following failed internal xation of intertrochanteric fractures, and long stem arthroplasty should be approached with caution to the risks of complications, especially intraoperative femur fractures.

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Section: Introductionmentioning

confidence: 99%

Conversion Hip Arthroplasty Using Standard and Long Stems after Failed Internal Fixation of Intertrochanteric Fractures

Shi

Fang

Huang

et al. 2022

Orthopaedic Surgery

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“…Treatment selection depends on fracture-related conditions, a patient’s demographic profile, personal preferences, and a surgeon’s training and skill level. 6 7 8 9 10) The mechanical strength of the femoral neck is determined primarily by bone density, bone geometry, and thickness of the cortical bone. 11) Bone defects in FNFs are strongly associated with the prognosis after internal fixation.…”

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confidence: 99%

Bone Grafting Can Promote the Prognosis of Displaced Femoral Neck Fractures: A Follow-up of the Clinical Significance of Bone Defects

et al. 2023

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Background Femoral neck fractures (FNFs) comprise a large proportion of osteoporotic fractures in Asia. However, the full range of prognostic variables that affect prognosis remains unclear. Here, we aimed to determine whether the severity of bone defects at the fracture site and other variables impact the prognosis of displaced FNFs. Methods We evaluated the incidence of FNF internal fixation failures at regular intervals after surgery in data collected retrospectively. Digital Imaging and Communications in Medicine (DICOM) magnetic resonance imaging data of the displaced FNFs of 204 patients (> 20 years old; mean age, 52.3 years; men, 55.4%) who underwent internal fixation were used to construct three-dimensional (3D) virtual models of the femoral neck region. We calculated the position and volume of bone defect (VBD) using our independently developed algorithm and Mimics software. Each participant was followed up for at least 24 months; complications were noted and correlated with VBD and demographic and clinical variables. Results On the basis of VBD values calculated from virtual reduction models, 57 patients were categorized as having a mild defect, 100 as having a moderate defect, and 47 as having a severe defect. Age ( p = 0.046) and VBD ( p < 0.001) were significantly correlated with internal fixation failure. Multivariate analysis revealed that severe bone defects were associated with internal fixation failure (adjusted odds ratio [aOR], 23.073; 95% confidence interval [CI], 2.791–190.732) and complications (aOR, 8.945; 95% CI, 1.829–43.749). In patients with a severe defect, bone grafting was inversely associated with internal fixation failure (aOR, 0.022; 95% CI, 0.002–0.268) and complications (aOR, 0.023; 95% CI, 0.002–0.299). Conclusions Bone defect severity was associated with internal fixation failure and other complications. For young adults with large VBDs, bone grafting of the defect can reduce the risk of internal fixation failure. These results provide useful new quantitative information for precisely classifying displaced FNFs and guiding subsequent optimal treatments.

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A rare case of coronal hip fracture with the fracture line involving ipsilateral femoral neck and the trochanter

Zhang,

Liu,

Wen

2024

Asian Journal of Surgery

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Simple guidelines for evaluating intraoperative alignment after the reduction of intertrochanteric fractures

Cited by 5 publications

References 27 publications

Conversion Hip Arthroplasty Using Standard and Long Stems after Failed Internal Fixation of Intertrochanteric Fractures

Conversion Hip Arthroplasty Using Standard and Long Stems after Failed Internal Fixation of Intertrochanteric Fractures

Bone Grafting Can Promote the Prognosis of Displaced Femoral Neck Fractures: A Follow-up of the Clinical Significance of Bone Defects

A rare case of coronal hip fracture with the fracture line involving ipsilateral femoral neck and the trochanter

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