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Tang M, Zhou H, Xu G, Tong D, Xu C, Li J. Quantitative Analysis of Spatial Distribution of Medial Fracture Lines in Intertrochanteric Fractures. Appl Bionics Biomech 2025; 2025:6959877. [PMID: 40256441 PMCID: PMC12006714 DOI: 10.1155/abb/6959877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2025] [Accepted: 03/19/2025] [Indexed: 04/22/2025] Open
Abstract
The integrity of the medial wall of the proximal femur is crucial for maintaining mechanical homeostasis. However, the impact of intertrochanteric fractures on the medial wall and the optimal diagnostic methodology remain unclear. We retrospectively analyzed CT data from 205 patients with intertrochanteric fractures. The lowest point of the medial fracture line was marked, and a standard coordinate system was established to record its spatial position. The association between AO, Evans, or Tang classification and different types of medial wall disruption was analyzed using Spearman correlation. The lowest point of the fracture line was located in the first quadrant of the proximal medial wall in 20 patients, with spatial coordinates of (6.44 ± 5.47, 6.14 ± 2.71). In 21 patients, it was in the second quadrant, with coordinates of (-7.23 ± 5.86, 8.31 ± 6.59). In 122 patients, it was in the third quadrant, with coordinates of (-9.59 ± 4.32, -24.43 ± 15.79), and in 42 patients, it was in the fourth quadrant, with coordinates of (8.18 ± 4.56, -18.20 ± 12.92). The Tang classification showed a stronger correlation with fracture instability (r = 0.40, p < 0.001) compared to the AO (r = 0.32, p < 0.001) and Evans (r = 0.38, p < 0.001) classifications. The medial wall of the proximal femur is significantly compromised in intertrochanteric fractures, with varying mechanical stability depending on the fracture type. The Tang classification effectively differentiates these stability differences, providing valuable guidance for clinical practice.
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Affiliation(s)
- Miaotian Tang
- Department of Trauma and Orthopedics, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing 100044, China
| | - Hao Zhou
- Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, No. 51 Fucheng Road, Beijing 100048, China
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, No. 51 Fucheng Road, Beijing 100048, China
| | - Gaoxiang Xu
- Department of Orthopedics, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450042, Henan, China
| | - Dake Tong
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Cheng Xu
- Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, No. 51 Fucheng Road, Beijing 100048, China
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, No. 51 Fucheng Road, Beijing 100048, China
| | - Jiantao Li
- Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, No. 51 Fucheng Road, Beijing 100048, China
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, No. 51 Fucheng Road, Beijing 100048, China
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Zhang S, Wang R, Li J, Li C, Wang T, Yang Y, Guo H, Wu D, Zhu Y. Risk factors of excessive sliding in elderly patients with intertrochanteric fractures treated with PFNA-II: a retrospective observational study. BMC Musculoskelet Disord 2025; 26:255. [PMID: 40087659 PMCID: PMC11907781 DOI: 10.1186/s12891-025-08479-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2024] [Accepted: 02/28/2025] [Indexed: 03/17/2025] Open
Abstract
PURPOSE Excessive sliding of cephalic components of cephalomedullary nails has been established to be significantly associated with the development of mechanical failures and unfavorable results in the surgical treatment of intertrochanteric fractures. This study aims to elucidate the risk factors that contribute to excessive sliding in elderly patients treated with PFNA-II devices for the fixation of intertrochanteric fracture. METHODS We conducted a retrospective analysis of patients aged 65 and older who presented with intertrochanteric fractures and underwent surgical treatment using PFNA-II devices at a university teaching hospital between January 2020 and December 2021. All patients were subjected to a minimum of one year of follow-up. We collected data on patient demographics, as well as preoperative, perioperative, and postoperative radiographic information, identifying mechanical failures during routine follow-ups. Patients were categorized into an excessive sliding group and a normal sliding group based on the sliding distance, with the optimal cut-off determined by receiver operating characteristic (ROC) curve analysis. Binary logistic regression was employed to identify independent risk factors associated with excessive sliding. RESULT Among the 507 eligible patients, the mean postoperative sliding distance was 4.45 mm (SD, 5.39 mm; range, 0-31.67 mm). The cut-off for excessive sliding was determined as 6.75 mm, with 61 patients (12.0%) classified as hving excessive sliding, of whom 18 (29.5%) experienced mechanical failures. Binary logistic analysis indicated that poor reduction quality (OR = 11.493, 95% CI: 3.386-39.014, P < 0.001), and Subtype P in LAT reduction (OR = 15.621, 95% CI: 5.984-40.779, P < 0.001) were independently associated with excessive sliding distance. Their associations were robust across subgroup analyses. CONCLUSIONS Poor reduction quality and the Subtype P in LAT reduction were identified as independent risk factors for excessive sliding. It is essential for surgeons to be mindful of these two risk factors during preoperative assessment and intraoperative procedures.
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Affiliation(s)
- Shian Zhang
- Musculoskeletal Research Laboratory, Department of Orthopaedics and Traumatology, Shatin, New Territories, Hong Kong, 999077, P. R. China
- Innovative Orthopaedic Biomaterial and Drug Translational Research Laboratory of Li Ka Shing Institute of Health, Shatin, New Territories, Hong Kong, 999077, P. R. China
- Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, 999077, P. R. China
| | - Rui Wang
- Department of Orthopaedic Surgery, Huai'an Hospital of Huai'an City, Huai'an, Jiangsu, 223200, P.R. China
| | - Jingqiao Li
- Department of Orthopedic Surgery, Hebei Jing-Xing Xian Hospital, Shijiazhuang, Hebei, 050051, P.R. China
| | - Chengsi Li
- Department of Orthopedic Surgery, Hebei Medical University Third Hospital, Shijiazhuang, Hebei, 050051, P.R. China
- Hebei Orthopedic Research Institute, Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, P.R. China
| | - Tianyu Wang
- Department of Orthopedic Surgery, Hebei Medical University Third Hospital, Shijiazhuang, Hebei, 050051, P.R. China
- Hebei Orthopedic Research Institute, Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, P.R. China
| | - Yanjiang Yang
- Department of Orthopedic Surgery, Hebei Medical University Third Hospital, Shijiazhuang, Hebei, 050051, P.R. China
- Hebei Orthopedic Research Institute, Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, P.R. China
| | - Haichuan Guo
- Department of Orthopedic Surgery, Hebei Medical University Third Hospital, Shijiazhuang, Hebei, 050051, P.R. China
- Hebei Orthopedic Research Institute, Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, P.R. China
| | - Dongwei Wu
- Department of Orthopedic Surgery, Hebei Medical University Third Hospital, Shijiazhuang, Hebei, 050051, P.R. China.
- Hebei Orthopedic Research Institute, Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, P.R. China.
| | - Yanbin Zhu
- Department of Orthopedic Surgery, Hebei Medical University Third Hospital, Shijiazhuang, Hebei, 050051, P.R. China.
- Hebei Orthopedic Research Institute, Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, P.R. China.
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Richa P, DeFrancisis JS, Young VL, Habib F, Danahy P. Exploring the Efficacy of Computer-Assisted Navigation in Improving Lag Screw Placement and Preventing Cut-Out in Intramedullary Nail Fixation of Femoral Fractures: A Meta-Analysis. Cureus 2025; 17:e77724. [PMID: 39981447 PMCID: PMC11841961 DOI: 10.7759/cureus.77724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2024] [Accepted: 01/20/2025] [Indexed: 02/22/2025] Open
Abstract
Femoral neck fractures are a common complication treated by orthopedic surgeons. Exploring the role of computer-assisted orthopedic programs in femoral fracture treatment is of particular interest given the technological advances in computer-assisted programs in the medical field. Notably, systems such as Stryker's Adaptive Positioning Technology (ADAPT) may allow for more precision in determining the tip-apex distance (TAD) when treating intertrochanter femur fractures. Such innovations hold the potential to reduce complication rates, including the incidence of lag screw cut-out, which could improve clinical outcomes in intertrochanter femur fracture treatment. This meta-analysis aims to evaluate the effectiveness of computer-assisted orthopedic systems in improving lag screw placement, as determined by the TAD and, ultimately, screw cut-out. Three studies were compared that reported continuous data for TAD in groups that did and did not use Stryker's ADAPT computer-assisted system. A random effects model was utilized to identify heterogeneity between studies. This was determined by variation and calculated through Cochran's Q-test, I2 statistic, and Tau2. Operative time was also reported in these studies and was evaluated as a secondary outcome. Each study analyzed showed that ADAPT had a statistically significant improvement in TAD with an overall effect size of -5.06. However, with an I2 value of 89% (p<0.01), there was notable heterogeneity between the three studies compared in this meta-analysis. While it is clear that there are benefits to using computer-assisted technology for internal femur fixation, more research is needed to understand the implications, including operative time and possible improvements in screw position.
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Affiliation(s)
- Peter Richa
- Orthopedic Surgery, Lake Erie College of Osteopathic Medicine, Bradenton, USA
| | - Jason S DeFrancisis
- Orthopedic Surgery, Lake Erie College of Osteopathic Medicine, Bradenton, USA
| | - Victoria L Young
- Orthopedic Surgery, Lake Erie College of Osteopathic Medicine, Bradenton, USA
| | - Feross Habib
- Orthopedic Surgery, Lake Erie College of Osteopathic Medicine, Bradenton, USA
| | - Paul Danahy
- Orthopedic Surgery, Lake Erie College of Osteopathic Medicine, Bradenton, USA
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Xie W, Shi L, Zhang C, Cui X, Chen X, Xie T, Zhang S, Chen H, Rui Y. Anteromedial cortical support reduction of intertrochanteric fractures-A review. Injury 2024; 55:111926. [PMID: 39388744 DOI: 10.1016/j.injury.2024.111926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Revised: 09/19/2024] [Accepted: 09/21/2024] [Indexed: 10/12/2024]
Abstract
The intertrochanteric fracture is a common fragility fracture typically resulting from low-energy falls. The functional outcome of intertrochanteric fractures is closely linked to the patient's underlying physical condition, intraoperative procedures, and postoperative complications. In terms of surgery, while timely surgery and appropriate internal fixation have demonstrated favorable outcomes, attention to intraoperative reduction is crucial. In recent years, there have been further developments in the evaluation of reduction of intertrochanteric fractures, particularly in the anteromedial cortical reduction, and these advances have been further scientifically elucidated in terms of their ability to provide stable fracture reduction and resist loss of reduction. In order to gain a comprehensive understanding of the anteromedial cortex theory, this article reviewed the anatomy, related theoretical progress, and controversies in recent years.
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Affiliation(s)
- Wenjun Xie
- Department of Orthopaedics, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, China; Trauma Center, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, China; Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing, Jiangsu, 210009, China; Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management Zhongda Hospital, School of Medicine Southeast University, Nanjing, Jiangsu, China.
| | - Liu Shi
- Department of Orthopaedics, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, China; Trauma Center, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, China; Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing, Jiangsu, 210009, China; Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management Zhongda Hospital, School of Medicine Southeast University, Nanjing, Jiangsu, China.
| | - Cheng Zhang
- Department of Orthopaedics, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, China; Trauma Center, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, China; Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing, Jiangsu, 210009, China; Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management Zhongda Hospital, School of Medicine Southeast University, Nanjing, Jiangsu, China.
| | - Xueliang Cui
- Department of Orthopaedics, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, China; Trauma Center, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, China; Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing, Jiangsu, 210009, China; Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management Zhongda Hospital, School of Medicine Southeast University, Nanjing, Jiangsu, China.
| | - Xiangxu Chen
- Department of Orthopaedics, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, China; Trauma Center, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, China; Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing, Jiangsu, 210009, China; Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management Zhongda Hospital, School of Medicine Southeast University, Nanjing, Jiangsu, China.
| | - Tian Xie
- Department of Orthopaedics, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, China; Trauma Center, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, China; Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing, Jiangsu, 210009, China; Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management Zhongda Hospital, School of Medicine Southeast University, Nanjing, Jiangsu, China.
| | - Sheng Zhang
- Department of Orthopaedics, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, China; Trauma Center, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, China; Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing, Jiangsu, 210009, China; Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management Zhongda Hospital, School of Medicine Southeast University, Nanjing, Jiangsu, China.
| | - Hui Chen
- Department of Orthopaedics, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, China; Trauma Center, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, China; Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing, Jiangsu, 210009, China; Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management Zhongda Hospital, School of Medicine Southeast University, Nanjing, Jiangsu, China.
| | - Yunfeng Rui
- Department of Orthopaedics, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, China; Trauma Center, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, China; Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing, Jiangsu, 210009, China; Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management Zhongda Hospital, School of Medicine Southeast University, Nanjing, Jiangsu, China.
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Yu X, Li YZ, Lu HJ, Liu BL. Treatment of a femoral neck fracture combined with ipsilateral femoral head and intertrochanteric fractures: A case report. World J Orthop 2024; 15:973-980. [DOI: 10.5312/wjo.v0.i0.973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 09/01/2024] [Accepted: 09/19/2024] [Indexed: 10/11/2024] Open
Abstract
BACKGROUND This article presents a rare case of a complex hip fracture involving the ipsilateral femoral neck, trochanter, and femoral head, that was accompanied by hip dislocation. Currently, there is no established standard treatment method for this specific type of fracture. Therefore, it is crucial to comprehensively consider factors such as patient age, fracture type, and degree of displacement to achieve a successful outcome.
CASE SUMMARY A 38-year-old man sustained a comminuted fracture of his right hip as a result of a car accident. The injuries included a fracture of the femoral head, a fracture of the femoral neck, an intertrochanteric fracture of the femur, and a posterior dislocation of the hip on the same side. We opted for a treatment approach combining the use of a proximal femoral locking plate, cannulated screws, and Kirschner wires. Following the surgery, we developed an individualized rehabilitation program to restore patient limb function.
CONCLUSION For this complex fracture, we selected appropriate internal fixation and formulated individualized rehabilitation, which ultimately achieved good results.
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Affiliation(s)
- Xiang Yu
- Department of Orthopedics, Shanghai Seventh People's Hospital, Shanghai 200000, China
| | - Yu-Zhi Li
- Department of Orthopedics, Shanghai Seventh People's Hospital, Shanghai 200000, China
| | - Hai-Jian Lu
- Department of Orthopedics, Shanghai Seventh People's Hospital, Shanghai 200000, China
| | - Bing-Li Liu
- Department of Orthopedics, Shanghai Seventh People's Hospital, Shanghai 200000, China
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Yu X, Li YZ, Lu HJ, Liu BL. Treatment of a femoral neck fracture combined with ipsilateral femoral head and intertrochanteric fractures: A case report. World J Orthop 2024; 15:973-980. [DOI: 10.5312/wjo.v15.i10.973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 09/01/2024] [Accepted: 09/19/2024] [Indexed: 10/11/2024] Open
Abstract
BACKGROUND This article presents a rare case of a complex hip fracture involving the ipsilateral femoral neck, trochanter, and femoral head, that was accompanied by hip dislocation. Currently, there is no established standard treatment method for this specific type of fracture. Therefore, it is crucial to comprehensively consider factors such as patient age, fracture type, and degree of displacement to achieve a successful outcome.
CASE SUMMARY A 38-year-old man sustained a comminuted fracture of his right hip as a result of a car accident. The injuries included a fracture of the femoral head, a fracture of the femoral neck, an intertrochanteric fracture of the femur, and a posterior dislocation of the hip on the same side. We opted for a treatment approach combining the use of a proximal femoral locking plate, cannulated screws, and Kirschner wires. Following the surgery, we developed an individualized rehabilitation program to restore patient limb function.
CONCLUSION For this complex fracture, we selected appropriate internal fixation and formulated individualized rehabilitation, which ultimately achieved good results.
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Affiliation(s)
- Xiang Yu
- Department of Orthopedics, Shanghai Seventh People's Hospital, Shanghai 200000, China
| | - Yu-Zhi Li
- Department of Orthopedics, Shanghai Seventh People's Hospital, Shanghai 200000, China
| | - Hai-Jian Lu
- Department of Orthopedics, Shanghai Seventh People's Hospital, Shanghai 200000, China
| | - Bing-Li Liu
- Department of Orthopedics, Shanghai Seventh People's Hospital, Shanghai 200000, China
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Maehara T, Hayakawa T, Mukoyama S, Anraku Y, Hamada T, Suzuki H, Doi T, Shimizu T, Yorimitsu M, Teramoto H, Mae T, Okamoto Y, Hara J, Mihara K, Kanekasu K. The effect of anterior support screw (AS2) in unstable femoral trochanteric fractures: A multicenter randomized controlled trial. Injury 2024; 55:111725. [PMID: 39096804 DOI: 10.1016/j.injury.2024.111725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 07/08/2024] [Accepted: 07/09/2024] [Indexed: 08/05/2024]
Abstract
OBJECTIVES This study was conducted to verify the effectiveness of Anterior Support Screw (AS2) for unstable femoral trochanteric fractures. DESIGN A multicenter, prospective, randomized controlled trial SETTING: This study was conducted across 15 academic medical centers in Japan PATIENTS/PARTICIPANTS: We enrolled 240 cases of femoral trochanteric fractures with posterior crushing and intramedullary displacement of proximal bone fragments across 15 institutions in Japan. INTERVENTION All patients were subjected to a reduction in which the anterior cortex was brought into contact. The patients were randomly assigned to the anterior support screw group (AS2 group) and the non-screw group (control group). MAIN OUTCOME MEASUREMENTS Two computed-tomography (CT) scans were taken immediately after surgery and early postoperative period (day 14-21) to investigate the reduction loss rate of the anterior cortex and sliding distances in the early postoperative period. RESULTS The reduction loss rate was 4.5 % in the AS2 group and 16.8 % in the control group, indicating a significantly lower reduction loss rate in the AS2 group (p = 0.003). The average sliding distance was 1.8 mm in the AS2 group and 2.8 mm in the control group, indicating a significantly shorter sliding distance in the AS2 group (p < 0.0001). CONCLUSION Adding a screw in front of the intramedullary nail significantly reduces reduction loss, and maintains anterior bony contact. This study also showed that these screws suppress the sliding distance during the postoperative period. LEVEL OF EVIDENCE Therapeutic Level I.
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Affiliation(s)
- Takashi Maehara
- Department of Orthopaedic Surgery, Kagawa Rosai Hospital, Japan.
| | - Takashi Hayakawa
- Department of Joint Orthopaedic Surgery, Niigata Central Hospital, Japan
| | | | - Yoshihisa Anraku
- Department of Orthopaedic Surgery, Saiseikai Kumamoto Hospital, Japan
| | - Takahiro Hamada
- Department of Orthopaedic Surgery, Kyushu Central Hospital, Japan
| | - Hiroyuki Suzuki
- Department of Orthopaedic Surgery, Kasugai Municipal Hospital, Japan
| | - Takeshi Doi
- Department of Orthopaedic Surgery, Okayama Red Cross Hospital, Japan
| | - Tomohiko Shimizu
- Department of Orthopaedic Surgery, Fujieda Municipal General Hospital, Japan
| | | | | | - Takao Mae
- Department of Orthopaedic Surgery, Saga-ken Medical Centre Koseikan, Japan
| | - Yasunori Okamoto
- Department of Orthopaedic Surgery, Hoshigaoka Medical Center, Japan
| | - Jun Hara
- Department of Orthopaedic Surgery, Kawasaki Saiwai Hospital, Japan
| | - Kazushi Mihara
- Department of Orthopaedic Surgery, Toyooka Hospital, Japan
| | - Koichi Kanekasu
- Department of Orthopaedic Surgery, Saiseikai Takaoka Hospital, Japan
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张 世, 孙 贵, 王 振, 张 立, 田 可, 刘 涛, 王 欣, 芮 云. [Standard radiographic images in cephalomedullary nailing fixation for intertrochanteric femoral fractures]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2024; 38:1130-1137. [PMID: 39300890 PMCID: PMC11440158 DOI: 10.7507/1002-1892.202405004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 08/24/2024] [Indexed: 09/22/2024]
Abstract
OBJECTIVE To review and summarize the projections of radiographic images during cephalomedullary nailing fixation for intertrochanteric femoral fractures, and to propose a set of three projections as standard requirement in immediate postoperative fluoroscopy. METHODS Papers on intertrochanteric femoral fractures treated with cephalomedullary nailing fixation that published in a three-year period of 2021-2023 in four leading English orthopedic trauma journals were searched in PubMed. The presented radiographic pictures were identified and scrutinized as whether they were in standard anteroposterior and/or lateral projections of the implanted nails. The nonstandard presence percentage was calculated. Combined with clinical experience, the standard anteroposterior and lateral perspective images of femoral neck, the current situation of radiographic imaging in the operation of cephalomedullary nails, the literature analysis of nonstandard images, the impact of limb rotation on image interpretation, and the characteristics of anteromedial 30° oblique perspective were summarized and analyzed. RESULTS The presence of nonstandard radiographic pictures is 32.1% in anteroposterior view and 69.2% in lateral view in leading orthopedic trauma journals. In cephalomedullary nailing fixation operation of intertrochanteric femoral fractures, it is reasonable to use the radiographic images of the implanted nails to represent the fractured head-neck, as the head-neck implant (lag screw or helical blade) is aimed to put into centrally in femoral head in lateral projection. Limb rotation or nonstandard projections produced distortion of images, which interfers the surgeons' judgement of fracture reduction quality and the measurement of implant position parameters in femoral head (such as neck-shaft angle and tip-apex distance), and finally lead to a meaningless comparison with the accurate normal value. The 30° anteromedial oblique view from the true lateral (set as 0°) is a tangential projection of the cortices at the anteromedial inferior corner, which gives a clear profile for the determination of cortical apposition status and mechanical support. It is essential to get firstly the true standard lateral fluoroscopy of the nail (shown as a line), then rotate the C-arm to 90° and 30° to get anteroposterior and anteromedial oblique views, and use these three immediate postoperative radiographies as the baseline for evaluation of operative quality and follow-up comparisons. CONCLUSION As for real-time monitoring of surgical steps, intraoperative fluoroscopy follows the "Enough is Good" principle, but as for immediate postoperative data storage and basis for operative quality evaluation and baseline for follow-up comparison, it is recommended to obtain a set of three standard radiographic pictures in anteroposterior, true lateral, and 30° anteromedial oblique fluoroscopic projections.
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Affiliation(s)
- 世民 张
- 同济大学附属杨浦医院骨科（上海 200090）Department of Orthopedic Surgery, Yangpu Hospital, Tongji University, Shanghai, 200090, P. R. China
| | - 贵新 孙
- 同济大学附属杨浦医院骨科（上海 200090）Department of Orthopedic Surgery, Yangpu Hospital, Tongji University, Shanghai, 200090, P. R. China
| | - 振海 王
- 同济大学附属杨浦医院骨科（上海 200090）Department of Orthopedic Surgery, Yangpu Hospital, Tongji University, Shanghai, 200090, P. R. China
| | - 立 张
- 同济大学附属杨浦医院骨科（上海 200090）Department of Orthopedic Surgery, Yangpu Hospital, Tongji University, Shanghai, 200090, P. R. China
| | - 可为 田
- 同济大学附属杨浦医院骨科（上海 200090）Department of Orthopedic Surgery, Yangpu Hospital, Tongji University, Shanghai, 200090, P. R. China
| | - 涛 刘
- 同济大学附属杨浦医院骨科（上海 200090）Department of Orthopedic Surgery, Yangpu Hospital, Tongji University, Shanghai, 200090, P. R. China
| | - 欣 王
- 同济大学附属杨浦医院骨科（上海 200090）Department of Orthopedic Surgery, Yangpu Hospital, Tongji University, Shanghai, 200090, P. R. China
| | - 云峰 芮
- 同济大学附属杨浦医院骨科（上海 200090）Department of Orthopedic Surgery, Yangpu Hospital, Tongji University, Shanghai, 200090, P. R. China
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Barra AE, Barrios C. Predictive value of tip-apex distance and calcar-referenced tip-apex distance for cut-out in 398 femoral intertrochanteric fractures treated in a private practice with dynamic intramedullary nailing. Front Surg 2024; 11:1438858. [PMID: 39205795 PMCID: PMC11349698 DOI: 10.3389/fsurg.2024.1438858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Accepted: 07/22/2024] [Indexed: 09/04/2024] Open
Abstract
Introduction Cut-out, a biomechanical complication, is one of the most common causes of internal fixation failure of trochanteric hip fractures. The tip-apex distance (TAD) and the calcar-referenced tip-apex distance (CalTAD) have been suggested as the radiographic parameters that most predict the risk of cut-out. The purpose of this study was to check whether these two factors could predict implant cut-out in a series 398 of intertrochanteric hip fractures, treated by dynamic intramedullary nailing with the Trigen Intertan short nail. Methods We reviewed 398 consecutive intertrochanteric fractures included in a prospective study and treated in a single private hospital by the same surgeon. The radiographic parameters were obtained from anteroposterior (AP) and axial hip plain radiographs before surgery, immediately postoperatively, and every 3 weeks after surgery until 3 months postoperatively, and every month until the 6-month follow-up. The concept of medial cortex support (MCS) was also analyzed as a criterion for evaluating the quality of fracture reduction. Results The overall cut-out rate was 2.3% (9/398). The significant parameters in the univariate analysis were AO fracture type, quality of fracture reduction (p = 0.02), TAD (p < 0.001), CalTAD (p = 0.001), and quality of reduction. No statistically significant relationships were observed between the occurrence of cut-out and sex, age, fracture side, and American Society of Anesthesiologists type. Varus collapse and cut-out were only found in cases of negative MCS (22.2% and 77.8%, respectively). Multivariate analysis showed that only TAD showed an independent significant relationship to cut-out (p < 0.001). In this study, CalTAD has no predictive value in the multivariable analysis. Conclusions Our findings differed from those in previous reported studies suggesting that CalTAD is the best predictor of cut-out. According to our data, careful optimal reduction ensuring stable fixation with TAD >25 mm reduced the occurrence of cut-out after dynamic intramedullary nailing of intertrochanteric fractures.
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Affiliation(s)
- Amariel E. Barra
- School of Doctorate, Valencia Catholic University, Valencia, Spain
| | - Carlos Barrios
- Institute for Research on Musculoskeletal Disorders, Valencia Catholic University, Valencia, Spain
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辛 大, 张 成, 李 文, 吴 成, 赵 勇, 尚 衍, 王 振. [Morphological characteristics and reduction techniques of sagittal beak-like deformity of head-neck fragment in femoral intertrochanteric fractures]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2024; 38:710-715. [PMID: 38918192 PMCID: PMC11190693 DOI: 10.7507/1002-1892.202402004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 05/22/2024] [Accepted: 05/22/2024] [Indexed: 06/27/2024]
Abstract
Objective To summarize the morphological characteristics of sagittal beak-like deformity of head-neck fragment in femoral intertrochanteric fractures and to investigate the technical skills in fracture reduction. Methods A clinical data of 31 patients with femoral intertrochanteric fractures between May 2021 and April 2023 was retrospectively analyzed. The fractures had sagittal beak-like deformity of head-neck fragment in all patients. There were 13 males and 18 females, with an average age of 76.2 years (range, 68-83 years). The time from injury to operation was 36-76 hours (mean, 51.2 hours). Fractures were classified as type A1.2 in 10 cases, type A1.3 in 11 cases, type A2.2 in 6 cases, and type A2.3 in 4 cases according to the AO/Orthopaedic Trauma Association (AO/OTA)-2018 classification; and as type A1.3 in 10 cases, type A2.1 in 11 cases, type A2.2 in 6 cases, type A2.3 in 2 cases, and type A2.4 in 2 cases according to a novel comprehensive classification for femoral intertrochanteric fractures proposed by the "Elderly Hip Fracture" Research Group of the Reparative and Reconstructive Surgery Committee of the Chinese Rehabilitation Medical Association. Based on preoperative X-ray films, CT scan and three-dimensional reconstruction, the fractures were classified into two types: type 1 (14 cases), with uncomplicated fracture morphology, severe bone interlocking and (or) soft tissue incarceration; type 2 (17 cases), with severe fracture crushing, obvious dissociation between bone blocks, and severe soft tissue hinge destruction. After the failure of the closed reduction, all patients underwent fracture reduction assisted with instrument via anterior minimal incision and proximal femoral nail antirotation nails internal fixation. The operation time, intraoperative fluoroscopy, intraoperative visible blood loss, length of hospital stay, and incidence of complications were recorded. The fracture reduction quality and stability score were assessed at immediate after operation under fluoroscopy. The fracture healing was evaluated and healing time was recorded by X-ray films. The pain visual analogue scale (VAS) score was performed at 48 hours after operation and Parker-Palmer activity score at 3 months after operation for function evaluation. Results The operation time was 39-58 minutes (mean, 46.3 minutes); fluoroscopy was performed 13-38 times (mean, 23.5 times) during operation; the intraoperative visible blood loss was 45-90 mL (mean, 65.3 mL). The fracture reduction quality and stability score were rated as good in 29 cases and acceptable in 2 cases. The pain VAS score was 2-6 (mean, 3.1) at 48 hours after operation. Eleven patients developed deep vein thrombosis of the lower limbs after operation. Patients were hospitalized for 6-10 days (mean, 7.3 days). All patients were followed up 5-8 months (mean, 6.5 months). All fractures healed at 3.5-8.0 months after operation (mean, 4.5 months). Parker-Palmer activity score at 3 months after operation was 9 in 28 cases and 6 in 3 cases. Conclusion The femoral intertrochanteric fracture with sagittal beak-like deformity of head-neck fragment is difficult to manually reduce. The pin combined with cannulated screw insertion to the neck cortex can hold the fragment and assist fracture reduction, which is a simple and effective technique.
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Affiliation(s)
- 大江 辛
- 烟台市烟台山医院创伤骨科（山东烟台 264000）Department of Orthopedic Trauma, Yantaishan Hospital, Yantai Shandong, 264000, P. R. China
| | - 成成 张
- 烟台市烟台山医院创伤骨科（山东烟台 264000）Department of Orthopedic Trauma, Yantaishan Hospital, Yantai Shandong, 264000, P. R. China
| | - 文亮 李
- 烟台市烟台山医院创伤骨科（山东烟台 264000）Department of Orthopedic Trauma, Yantaishan Hospital, Yantai Shandong, 264000, P. R. China
| | - 成波 吴
- 烟台市烟台山医院创伤骨科（山东烟台 264000）Department of Orthopedic Trauma, Yantaishan Hospital, Yantai Shandong, 264000, P. R. China
| | - 勇 赵
- 烟台市烟台山医院创伤骨科（山东烟台 264000）Department of Orthopedic Trauma, Yantaishan Hospital, Yantai Shandong, 264000, P. R. China
| | - 衍亮 尚
- 烟台市烟台山医院创伤骨科（山东烟台 264000）Department of Orthopedic Trauma, Yantaishan Hospital, Yantai Shandong, 264000, P. R. China
| | - 振海 王
- 烟台市烟台山医院创伤骨科（山东烟台 264000）Department of Orthopedic Trauma, Yantaishan Hospital, Yantai Shandong, 264000, P. R. China
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Mao W, Liu CD, Chang SM, Yang AL, Hong CC. Anteromedial Cortical Support in Reduction of Trochanteric Hip Fractures: From Definition to Application. J Bone Joint Surg Am 2024; 106:1008-1018. [PMID: 38683886 DOI: 10.2106/jbjs.23.01023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
➤ The concept of anteromedial cortical support (AMCS) serves as valuable guidance for the intraoperative reduction of trochanteric hip fractures.➤ Positive medial cortical support (MCS) and positive or neutral anterior cortical support (ACS) are desirable. Some evidence has suggested that positive MCS is potentially superior to neutral MCS.➤ Experimental studies underscore the vital importance of the anteromedial wall and reveal why positive MCS potentially outperforms neutral MCS.➤ Incorporating the AMCS concept, the Chang reduction quality criteria (CRQC) are a reliable alternative approach to evaluate the reduction quality of trochanteric hip fractures.
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Affiliation(s)
- Wei Mao
- Department of Orthopaedic Surgery, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, People's Republic of China
- Department of Orthopaedic Surgery, National University Hospital, National University Health System, Singapore
| | - Chen-Dong Liu
- Department of Orthopaedic Surgery, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, People's Republic of China
| | - Shi-Min Chang
- Department of Orthopaedic Surgery, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, People's Republic of China
| | - Ao-Lei Yang
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, People's Republic of China
| | - Choon Chiet Hong
- Department of Orthopaedic Surgery, National University Hospital, National University Health System, Singapore
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张 雅, 付 宇, 吴 斗. [Research progress on weak state of lateral wall in intertrochanteric fractures]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2024; 38:363-367. [PMID: 38500432 PMCID: PMC10982047 DOI: 10.7507/1002-1892.202401005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 02/15/2024] [Accepted: 02/18/2024] [Indexed: 03/20/2024]
Abstract
Objective To review the research progress of the weak state of the lateral wall in intertrochanteric fracture, in order to provide clinical references. Methods The relevant research literature on the lateral wall of intertrochanteric fracture at home and abroad in recent years was summarized and analyzed in terms of morphology, fracture line in coronal plane, and bone density. Results Assessment of weak state of the lateral wall is particularly important in the treatment of intertrochanteric fractures. Lateral wall thickness is the main way to assess the weak state of the lateral wall, but there are still problems. Many scholars at home and abroad have studied various aspects such as width, height, and length of the anterior cortex, but there is a lack of a comprehensive assessment method. Coronal fractures affect lateral wall morphology and are difficult to detect on X-ray films, requiring vigilance on the part of the clinician. Further research is needed to clarify the correlation between bone density and the weak state of the lateral wall. The femur lesser trochanter fractures interacts with the latertal wall, and the lesser trochanter fracture exacerbates the weak state. The soft tissue around the lateral wall also affects the weak state, so attention must be paid to protecting the soft tissues during operation. Conclusion There are more methods for assessing the weak state of the lateral wall, but none of them has formed a unified standard. Most of the current studies assess the weak state from a single perspective and lack a comprehensive assessment of all aspects affecting the lateral wall. Fewer studies have been conducted to assess the residual lateral wall function after a partial fracture of the lateral wall, and further research is needed.
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Affiliation(s)
- 雅淳 张
- 山西医科大学第三医院（山西白求恩医院 山西医学科学院 同济山西医院）骨科 （太原 030032）Department of Orthopedic Surgery, Third Hospital of Shanxi Medical University (Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital), Taiyuan Shanxi, 030032, P. R. China
| | - 宇捷 付
- 山西医科大学第三医院（山西白求恩医院 山西医学科学院 同济山西医院）骨科 （太原 030032）Department of Orthopedic Surgery, Third Hospital of Shanxi Medical University (Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital), Taiyuan Shanxi, 030032, P. R. China
| | - 斗 吴
- 山西医科大学第三医院（山西白求恩医院 山西医学科学院 同济山西医院）骨科 （太原 030032）Department of Orthopedic Surgery, Third Hospital of Shanxi Medical University (Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital), Taiyuan Shanxi, 030032, P. R. China
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