Unstable trochanteric fractures: Issues and avoiding pitfalls

Babhulkar, Sudhir

doi:10.1016/j.injury.2017.02.022

Cited by 52 publications

(58 citation statements)

References 33 publications

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“…Considering the complexity of the fracture morphology, a three-dimensional classification system originating from Evans' would be more pragmatic [16]. The principle from Babhulkar and Shoda's classifications of GT fracture [2,7] could be incorporated to further classify basicervical TF variants according to the morphology of the PLF.…”

Section: Discussionmentioning

confidence: 99%

“…Surgical intervention has been the preferred treatment for TF patients because of the benefits of effective pain control and the opportunity for early weight bearing. Compared to dynamic hip screw plates, INs are gaining more popularity and could provide superior stability to unstable TF patterns that are characterized by posteromedial comminution, reverse oblique configuration, lateral wall disruption, GT disruption and basicervical variants [2,3].…”

Section: Introductionmentioning

confidence: 99%

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Reverse wedge effect following intramedullary nailing of a basicervical trochanteric fracture variant combined with a mechanically compromised greater trochanter

Zhang

2020

BMC Musculoskelet Disord

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Background: To introduce an unreported intraoperative complication in intramedullary nailing (IN) of an anatomically reduced trochanteric fracture variant characterized by a basicervical fracture line and coronally disrupted greater trochanter (GT). Methods: A total of 414 trochanteric fractures (TF) treated with intramedullary nails from 2013 to 2017 were included in this study. After analysis of intraoperative fluoroscopy data, 33 cases, including 21 females and 12 males, with a mean age of 72.5 years (33 to 96 years) were identified for internal rotation of the cephalocervical fragment and inferior opening at the basicervical fracture line caused by nailing a satisfactorily reduced TF. The morphological features of this group of patients were analyzed on computed tomography (CT) scan. On radiograph, the magnitude of the displacement and final femoral neck-shaft angle (NSA) were measured. Results: CT analysis demonstrated that the basicervical fracture line and the posterolateral fragment (PLF) detached from the GT were the two dominant features of this cohort. They were classified according to the number of main fragments: a 3-fragmentary subgroup containing three consistent fragments (cephalocervical fragment, PLF and distal femoral shaft) and a 4-fragmentary subgroup embracing one additional fragment (lesser trochanter). The four subtypes were as follows: the 3-fragmentary S indicating a small PLF (6 cases), the 3-fragmentary M presenting a moderate PLF (3 cases), the 3-fragmentary L standing for the PLF involving whole lesser trochanter (LT) (4 cases) and the 4-fragmentary GL incorporating separated PLF and LT fragments (20 cases). Geological analysis demonstrated that the majority of the basicervical fracture lines (81.8%) just crossed the center of the piriformis fossa, while the others marginally involved the medial wall of the GT. Postoperatively, the mean width of the inferior opening at the basicervical region was 9.2 ± 4.6 mm. The mean NSA was 135.2 ± 7.8 degrees. The comparison between the 3-and 4-fragmentary subgroups revealed no significant differences in magnitude of displacement and NSA. (Continued on next page)Conclusion: This unreported intraoperative complication predominantly occurred in the intramedullary nailed basicervical trochanteric fracture variant combined with a PLF from the GT. The magnitude of the secondary displacement was substantial and resulted in a relative valgus reduction. This secondary displacement was caused by an impingement of the reamer with the superolateral cortex of the cephalocervical fragment and should be addressed during the operation. Level of evidence: Therapy IV.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Reverse wedge effect following intramedullary nailing of a basicervical trochanteric fracture variant combined with a mechanically compromised greater trochanter

Zhang

2020

BMC Musculoskelet Disord

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“…Anatomical reduction is of critical importance in young intertrochanteric femoral fractures. Surgical maneuvers require satisfactory reduction achieved [ 10 – 14 ]. It is always highlighted to not ream an unreduced fracture [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

A novel cerclage wiring technique in intertrochanteric femoral fractures treated by intramedullary nails in young adults

Gao

Guo

et al. 2018

BMC Musculoskelet Disord

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BackgroundIntertrochanteric femoral fractures (IFFs) in young adults, generally due to severe trauma, are increasingly presented. Different from IFFs in the geriatric population, these fractures in young adults are always comminuted and substantially displaced. Natural traction induced by musculature following IFFs determines closed reduction on a fracture table is extremely difficult.MethodsTo achieve anatomical reduction before intramedullary nail (IMN) fixation, we made an extended or a mini petrotrochantetic incision to facilitate temporary reduction using a pointed clamp. Subsequently, a curved and cannulated wire-passer was employed to pass through a multistrand cable to surround displaced fragments and strengthen intertrochanteric fixation. Afterward, a standard procedure was conducted to nail the fracture.ResultsWe used the surgical technique in 9 young patients with an age range of 28~ 48 years old. The fractures were categorized as AO/OTA 31-A2.2 (3 cases) and 31-A2.3 (6 cases). The injury-to-surgery interval was 2.5 days on average. Mean operation time was 55 min. All fractures achieved anatomical reduction and healed within 14 weeks postoperatively without cable breakage, implant irritation or deep infection.ConclusionsIn conclusion, the surrounding technique with cerclage wire in IFFs in young adults is an effective surgical technique with easily achieved anatomical reduction to facilitate operative maneuvers and fracture healing.

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“…Intertrochanteric fractures can be classi ed into stable and unstable according to their severity. The characteristics of unstable fractures include reverse obliquity, loss of posterior medial buttress, lateral wall comminution, and subtrochanteric extension [11]. These di cult patterns are associated with longer operative time, increased need for open reduction, hardware failure, head cutout, varus malunion, and nonunion [12,13].…”

Section: Introductionmentioning

confidence: 99%

Association of Serum Vitamin D and Calcium Levels With the Severity of Intertrochanteric Fractures in the Elderly: A Retrospective Study

Hwang

Kim³

2020

Preprint

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Background: Femur intertrochanteric fractures can be classified into stable and unstable fractures according to their severity. Postoperative complications and mortality were more common in patients with unstable intertrochanteric fractures. However, there has been little effort to evaluate the risk factors of the two fracture types. This study aimed to identify the possible differences in demographic and clinical characteristics of older patients with different types of intertrochanteric fractures.Methods: The medical records of patients aged ≥60 years who presented with intertrochanteric fractures from June 2018 to March 2020 were retrospectively reviewed. Fifty-seven patients were enrolled and divided into two groups according to severity: stable (21 patients) and unstable (36 patients). Demographic data, body mass index (BMI), ambulatory ability prior to fracture, pre-fracture residence, season at fracture, bone mineral density (BMD), and serum 25-hydroxyvitamin D [25(OH)D], osteocalcin, and calcium levels were compared between the two groups. Additionally, we analyzed the correlation among variables.Results: The stable group had significantly higher serum 25(OH)D and calcium levels than the unstable group (p = 0.010, p = 0.019). There were no statistically significant differences (p > 0.05) in age, sex, height, weight, BMI, ambulatory ability prior to fracture, pre-fracture residence, season at fracture, BMD, and serum osteocalcin level between the two groups. In addition, serum 25(OH)D and calcium levels were not correlated with any of the variables in all patients.Conclusion: Low vitamin D and calcium levels are associated with unstable intertrochanteric fracture in elderly patients. Maintaining adequate vitamin D and calcium levels could avoid an increase in the severity of intertrochanteric fractures.

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Unstable trochanteric fractures: Issues and avoiding pitfalls

Cited by 52 publications

References 33 publications

Reverse wedge effect following intramedullary nailing of a basicervical trochanteric fracture variant combined with a mechanically compromised greater trochanter

Reverse wedge effect following intramedullary nailing of a basicervical trochanteric fracture variant combined with a mechanically compromised greater trochanter

A novel cerclage wiring technique in intertrochanteric femoral fractures treated by intramedullary nails in young adults

Association of Serum Vitamin D and Calcium Levels With the Severity of Intertrochanteric Fractures in the Elderly: A Retrospective Study

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