Trochanteric fractures treated by internal fixation using short intramedullary nails: does the visual intraoperative estimation of the Tip-Apex Distance (TAD) concur with its digital postoperative measurement?

Intertrochanteric femur fractures are common in older patients and often have a significant impact on disability. The treatment aims to achieve a rapid return to the prior functional level with a low rate of complications and mortality. Surgical management by internal fixation is the mainstay of treatment for most of these fractures. Even when treated with intramedullary nails, the overall complication rates are high, especially for unstable or highly comminuted fractures or in the presence of poor bone quality. Hip arthroplasty is an alternative in older patients with intertrochanteric femur fractures at high risk of fixation failure or with concomitant intraarticular pathologies. Especially patients whose condition precludes prolonged bedrest and who are at risk of significant deterioration if their locomotor function cannot be restored rapidly are likely to benefit from hip arthroplasty. The choice of the surgical technique mainly depends on the surgeon’s preferences and the fracture characteristics. Bipolar hemiarthroplasty is the most common type of prosthesis used with primary or revision femoral stems. Compared with intramedullary nails, hip arthroplasty has a better early functional outcome and lower rates of surgical complications as well as reoperations. However, the functional outcome and the mortality rate in the longer term tend to favor intramedullary nails, even though the results are inconsistent, and a statistically significant difference cannot always be obtained. Currently, there are no guidelines that define the role of hip arthroplasty in the treatment of intertrochanteric femur fractures in older patients. The literature only offers an overview of the possibilities of the usage of hip arthroplasty, but methodological limitations are common, and evidence levels are low. Further studies are needed to identify the intertrochanteric fractures that are at high risk of internal fixation failure, the characteristics that determine which patients may benefit most from hip arthroplasty, and the optimal surgical technique.

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Tip-Apex Distance Is Most Important of Six Predictors of Screw Cutout After Internal Fixation of Intertrochanteric Fractures in Women

JBJS Open Access ◽

10.2106/jbjs.oa.16.00022 ◽

2017 ◽

Vol 2 (4) ◽

pp. e0022 ◽

Cited By ~ 6

Author(s):

Tatsuya Fujii ◽

Shun Nakayama ◽

Masahiko Hara ◽

Wataru Koizumi ◽

Takashi Itabashi ◽

...

Keyword(s):

Internal Fixation ◽

Intertrochanteric Fractures ◽

Tip Apex Distance

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Hip function and health-related quality of life in intramedullary and extramedullary internal fixation of trochanteric fractures

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh200301029m ◽

2020 ◽

Vol 148 (7-8) ◽

pp. 451-454

Author(s):

Milan Mitkovic ◽

Sasa Milenkovic ◽

Ivan Micic ◽

Igor Kostic ◽

Predrag Stojiljkovic ◽

...

Keyword(s):

Quality Of Life ◽

Internal Fixation ◽

Harris Hip Score ◽

Health Related Quality ◽

Trochanteric Fractures ◽

Component Score ◽

Related Quality ◽

Health Related ◽

Hip Function

Introduction/Objective. There are extramedullary and intramedullary methods of trochanteric fractures? internal fixation with implants having a lag screw. The objective of this study was to examine the difference in impact of these fixation types on final hip function and health-related quality of life. Method. There were 75 patients treated for a trochanteric fracture, using self-dynamisable internal fixator (SIF group), as an extramedullary method, or gamma nail (GN group), as an intramedullary method. These patients were called for the evaluation of Harris Hip Score (HHS) and SF-12 questionnaire at least two years after surgery. The SF-12 questionnaire has dual expression ? physical component score (PCS) and mental component score (MCS). Results. There were no significant differences between the SIF group and the GN group regarding HHS, PCS, and MCS. Positive correlation was confirmed between HHS, PCS, and MCS, with the strongest relation between HHS and PCS. Negative correlation was confirmed between age and HHS. Conclusion. There was no difference in final hip function and health-related quality of life between SIF and GN methods in trochanteric fractures treatment (p > 0.05). These parameters of outcome were confirmed to have positive interrelation (p < 0.05). Both submuscular presence of extramedullary implant with dimensions of SIF and the need for bone reaming in cephalomedullary fixation were considered not to have significant impact in HHS and SF-12 scores after trochanteric fractures treatment by internal fixation.

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Stable Trochanteric Fractures. A Comparative Analysis of four Methods of Internal Fixation

Acta Orthopaedica Scandinavica ◽

10.3109/17453678008990878 ◽

1980 ◽

Vol 51 (1-6) ◽

pp. 811-816 ◽

Cited By ~ 36

Author(s):

J. Steen Jensen ◽

E. Tøndevold ◽

S. Sonne-Holm

Keyword(s):

Comparative Analysis ◽

Internal Fixation ◽

Trochanteric Fractures

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Fracture Fixation

Musculoskeletal Imaging Volume 1 ◽

10.1093/med/9780190938161.003.0027 ◽

2019 ◽

pp. 130-133

Author(s):

Jack Porrino ◽

Alvin R. Wyatt

Keyword(s):

Internal Fixation ◽

External Fixator ◽

Fracture Fixation ◽

Surgical Intervention ◽

Operative Intervention ◽

Intramedullary Nails ◽

Early Mobility ◽

Fast Healing ◽

And Function

Chapter 27 discusses fracture fixation. Although many fractures are managed nonoperatively, others require various forms of surgical intervention. Fracture fixation can be conservative or surgical. The goal is to stabilize the fractured bone, enable fast healing, and return early mobility and function of the injured extremity. Orthopedic hardware permits stabilization of the fractured bone, expediting healing and early mobility. Percutaneous pins and wires can be used to apply traction to a fracture. External and internal fixation are used when more advanced operative intervention is required and encompass external fixator devices, pins/wires, screws, plates, and intramedullary nails/rods. Hardware is unfortunately susceptible to complication, including loosening, migration, fracture, and infection.

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Comparison of Baumgaertner and Chang reduction quality criteria for the assessment of trochanteric fractures

Bone and Joint Research ◽

10.1302/2046-3758.810.bjr-2019-0032.r1 ◽

2019 ◽

Vol 8 (10) ◽

pp. 502-508 ◽

Cited By ~ 1

Author(s):

Wei Mao ◽

Haofei Ni ◽

Linli Li ◽

Yiqun He ◽

Xujun Chen ◽

...

Keyword(s):

Univariate Analysis ◽

Quality Criteria ◽

Clinical Information ◽

Trochanteric Fractures ◽

Receiver Operating Characteristic Curves ◽

Mechanical Complications ◽

Full Analysis ◽

Tip Apex Distance ◽

American Society ◽

American Society Of Anesthesiologists

Objectives Different criteria for assessing the reduction quality of trochanteric fractures have been reported. The Baumgaertner reduction quality criteria (BRQC) are relatively common and the Chang reduction quality criteria (CRQC) are relatively new. The objectives of the current study were to compare the reliability of the BRQC and CRQC in predicting mechanical complications and to investigate the clinical implications of the CRQC. Methods A total of 168 patients were assessed in a retrospective observational study. Clinical information including age, sex, fracture side, American Society of Anesthesiologists (ASA) classification, tip-apex distance (TAD), fracture classification, reduction quality, blade position, BRQC, CRQC, bone quality, and the occurrence of mechanical complications were used in the statistical analysis. Results A total of 127 patients were included in the full analysis, and mechanical complications were observed in 26 patients. The TAD, blade position, BRQC and CRQC were significantly associated with mechanical complications in the univariate analysis. Only the TAD (p = 0.025) and the CRQC (p < 0.001) showed significant results in the multivariate analysis. In the comparison of the receiver operating characteristic curves, the CRQC also performed better than the BRQC. Conclusion The CRQC are reliable in predicting mechanical complications and are more reliable than the BRQC. Future studies could use the CRQC to assess fracture reduction quality. Intraoperatively, the surgeon should refer to the CRQC to achieve good reduction in trochanteric fractures. Cite this article: Bone Joint Res 2019;8:502–508. DOI: 10.1302/2046-3758.810.BJR-2019-0032.R1.

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