The choice of internal fixator for fractures around the femoral trochanter depends on area classification

Kijima, Hiroshi; Yamada, Shin; Konishi, Noriaki; Kubota, Hitoshi; Tazawa, Hiroshi; Tani, Takao; Suzuki, Norio; Kamo, Keiji; Okudera, Yoshihiko; Sasaki, Ken; Kawano, Tetsuya; Miyakoshi, Naohisa; Shimada, Yasuhiro

doi:10.1186/s40064-016-3206-1

Cited by 4 publications

(4 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Based on their preoperative X-ray and computed tomography, including 3-dimensional computed tomography, the orthopedic surgeon at each hospital classified the PFF according to the Area Classification method. [12,15] Because of proven high inter-rater reliability, the Area classification for each case was not done by multiple orthopedic surgeons. [12] Incomplete proximal femur fractures that can only be detected by magnetic resonance imaging were excluded from this study, and only cases diagnosed by X-ray and computed tomography were analyzed.…”

Section: Methodsmentioning

confidence: 99%

Occurrence and clinical outcome of lateral wall fractures in proximal femoral fractures whose fracture line runs from femoral basal neck to subtrochanteric area

Suzuki¹,

Kijima

Tazawa³

et al. 2022

Medicine

Self Cite

View full text Add to dashboard Cite

Treatment methods for proximal femoral fractures, when the fractures run from the femoral basal neck to the subtrochanteric area, have not yet been fully reported. Thus, we aimed to clarify osteosynthesis methods based on the fracture frequency and clinical results. We classified the proximal femoral fractures using the Area classification method based on the location (area) of the fracture line. The proximal femur has 4 areas with 3 boundaries; the center of the femoral neck, the boundary between femoral neck and trochanter, and the plane connecting the lower ends of the greater trochanter and the lesser trochanter. Fractures occurring only in Area-1 (proximal from the center of the femoral neck) were classified as Type 1; those in both Areas 1 and 2 (base of the femoral neck) were classified as Type 1-2. Therefore, fractures running from femoral basal neck to the subtrochanteric area were classified as Type 2-3-4. We targeted 60 Type 2-3-4 cases (average age 81 years, 10 men, 50 women) out of 1042 proximal femoral fracture cases who visited 8 hospitals in 2 years. We investigated the presence or absence of lateral trochanteric wall fractures, the selection of internal fixator, and the proportion of poor results. The lateral trochanteric wall fracture was observed in 48% of subjects. Long nails were selected to treat 46% cases, and nails with 2 or 3 proximal lag screws were used in 58% cases. Long nails and those with 2 or 3 lag screws were also used in 59% and 69% of lateral trochanteric wall fractures. Poor results such as cutout or excessive telescoping of lag screw occurred in 11.7% of cases and 17.2% of lateral trochanteric wall fractures. Even in cases where long nails and multiple lag screws were used for femoral trochanteric fractures whose fracture line ran from the femoral basal neck to subtrochanteric area were used, the failure rate was high in the presence of a lateral wall fracture. Therefore, it is necessary to consider careful post-operative treatment for proximal femoral fractures with lateral wall fracture, whose fracture line runs from femoral basal neck to subtrochanteric area.

show abstract

Section: Methodsmentioning

confidence: 99%

Occurrence and clinical outcome of lateral wall fractures in proximal femoral fractures whose fracture line runs from femoral basal neck to subtrochanteric area

Suzuki¹,

Kijima

Tazawa³

et al. 2022

Medicine

Self Cite

View full text Add to dashboard Cite

show abstract

“…Their mean age was 82 years (range, 26-108 years). The type of fracture was retrospectively evaluated using the area classification [4, 5] based on X-ray films and 3D-CT images.…”

Section: Methodsmentioning

confidence: 99%

“…It is also possible to detect fractures involving the subcapital area to the trochanteric or subtrochanteric region by using this classification. In addition, this classification is reliable and useful for selecting therapeutic strategies [4, 5].…”

Section: Introductionmentioning

confidence: 99%

Incidence and Clinical Outcomes of Hip Fractures Involving Both the Subcapital Area and the Trochanteric or Subtrochanteric Area

Tani¹,

Kijima

Konishi³

et al. 2019

Advances in Orthopedics

Self Cite

View full text Add to dashboard Cite

Purpose. Proximal femoral fractures involving both the subcapital area and the trochanteric or subtrochanteric area have rarely been reported, but they are not uncommon. However, few studies have reported the incidence or clinical outcomes of such fractures. This study investigated such fractures. Methods. In area classification, the proximal femur is divided into 4 areas by 3 boundary planes: the first plane is the center of femoral neck; the second plane is the border between femoral neck and femoral trochanter; and the third plane links the inferior borders of greater and lesser trochanters. A fracture only in the first area is classified as a Type 1 fracture; one in the first and second areas is classified as a Type 1-2 fracture. Therefore, proximal femoral fractures involving both the subcapital area and the trochanteric area are classified as Type 1-2-3, and those involving both the subcapital area and the subtrochanteric area are classified as Type 1-2-3-4. In this study, a total of 1042 femoral proximal fractures were classified by area classification, and the treatment methods and the failure rates were investigated only for Types 1-2-3 and 1-2-3-4 cases. The failure rate was defined as the incidence of internal fixator cut-out or telescoping >10 mm. Results. Types 1-2-3 and 1-2-3-4 fractures accounted for 1.72%. Surgical treatment was performed for 89%. Of these, 56% underwent osteosynthesis, but the failure rate was 33%. The other patients (44%) underwent prosthetic replacement. Fracture lines of all these fractures were present along trochanteric fossa to intertrochanteric fossa in posterior aspect and just below the femoral head in anterior aspect. Conclusion. Fracture involving the subcapital area to the trochanteric or subtrochanteric area was found in approximately 2%. In patients for whom prosthetic replacement was selected, good results were obtained. However, 1/3 of patients who underwent osteosynthesis had poor results.

show abstract

“…[2,3] Long IMNs have advantages over short nails for treating unstable fracture types. Kijima et al [4] investigated failure rates according to area classifications, and they found that short nails should be considered for fractures extending above the trochanter, while long nails should be considered when fractures extend to the subtrochanteric part. The use of long IMNs is a standard technique for treating femoral diaphysial fractures, [5] where a nail must be inserted from the proximal cavity into the distal medullary cavity.…”

Section: Introductionmentioning

confidence: 99%

An innovative method for measuring the femoral arch

Ren

Wang

et al. 2019

Medicine

View full text Add to dashboard Cite

A mismatch between the femoral bow and intramedullary nails causes a series of complications. Previous investigations have sought to determine the curvature of the femur using the radius of the femoral bow. However, the radius of the curvature is affected by femur length. To eliminate the influence of femur length, we instead used an angle to indicate femoral curvatures.Forty patients with intertrochanteric fractures who underwent a surgical procedure at our institution were enrolled in this study. We conducted a lateral X-ray of the contralateral femur before operation. We drew a triangle in the X-ray images using Digimizer software. The tangent values of the acute angle were used to indicate femoral curvature. The tangent values were then compared with the dimensions of currently used nails.The average tangent value of the femurs was 0.0835 ± 0.0147, as measured from the inner cortex and 0.0798 ± 0.0150, as measured from the outer cortex. The tangent values were related to sex, with males having straighter femurs than females, and there was no obvious correlation between tangent values and age or femur length. Tangent value is a reliable method with a high intersurveyor consistency; femur curvatures were significantly greater than the curvatures of currently used nails.

show abstract

The choice of internal fixator for fractures around the femoral trochanter depends on area classification

Cited by 4 publications

References 8 publications

Occurrence and clinical outcome of lateral wall fractures in proximal femoral fractures whose fracture line runs from femoral basal neck to subtrochanteric area

Occurrence and clinical outcome of lateral wall fractures in proximal femoral fractures whose fracture line runs from femoral basal neck to subtrochanteric area

Incidence and Clinical Outcomes of Hip Fractures Involving Both the Subcapital Area and the Trochanteric or Subtrochanteric Area

An innovative method for measuring the femoral arch

Contact Info

Product

Resources

About