Suc Hyun Kweon; Jin Yeong Park; Seng Hwan Kook; Byung Min Yoo

doi:10.12671/jkfs.2016.29.3.171

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Radiologic Assessment of Postoperative Stability in Unstable Intertrochanteric Fracture Using Lateral Radiograph: Suc Hyun Kweon, M.D., Ph.D., Jin Yeong Park, M.D., Seng Hwan Kook, M.D., Byung Min Yoo, M.D.; Journal of the Korean Fracture Society 2016;29(3):171-177.
DOI: https://doi.org/10.12671/jkfs.2016.29.3.171
Published online: July 21, 2016

Department of Orthopedic Surgery, Wonkwang University School of Medicine, Iksan, Korea.

^*Department of Orthopedic Surgery, St. Carollo Hospital, Suncheon, Korea.

Address reprint requests to: Suc Hyun Kweon, M.D., Ph.D. Department of Orthopedic Surgery, Wonkwang University Hospital, 895 Muwang-ro, Iksan 54538, Korea. Tel: 82-63-859-1360·Fax: 82-63-852-9329, osksh@wonkwang.ac.kr

• Received: April 5, 2016 • Revised: May 23, 2016 • Accepted: May 23, 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Abstract
NOTES
REFERENCES

Abstract

Purpose
The purpose of this study was to compare the sliding distance of lag screw in patients with unstable femoral intertrochanteric fractures treated with intramedullary fixation using a cephalomedullary nail with a fixed angle between the neck and shaft of the femur in relation to reduction type by lateral radiographs.
Materials and Methods
Between January 2009 to October 2013, 86 cases (86 patients) with unstable femoral intertrochanteric fractures were treated with intramedullary fixation using a metal nail with a fixed neck-shaft angle and followed for at least 6 months. We used AO/OTA classification, and all cases were unstable fractures. Twenty cases were 31-A22, 54 cases were 31-A23, and 12 cases were 31-A3. There were 30 men and 56 women. Average patient age was 73.7 years (range, 47-97 years). We classified reduction types into three groups as postoperative lateral radiologic findings. Group 1 showed no displacement, group 2 showed anterior displacement of the femur neck, and group 3 showed posterior displacement of the femur neck. The radiological assessment compared the sliding distance of the lag screw between postoperative X-ray and last follow-up X-ray.
Results
Forty-two cases were in group 1, 22 cases were in group 2, and the other 22 cases were in group 3. There was no significant difference in the patient characteristics of each group. The sliding distances of the lag screw were 4.9±3.2 mm, 4.6±3.6 mm, and 8.5±4.9 mm, respectively, and group 3 showed a significant result (p<0.0001, p=0.024).
Conclusion
In cases treated with intramedullary fixation using a cephalomedullary nail with a fixed neck-shaft angle, appropriate reduction with a lateral radiograph before screw fixation is needed to prevent excessive lag screw sliding.
Key words: Femur, Intertrochantertic fracture, Intramedullary nailing

This paper was supported by Wonkwang University in 2015.

None.

REFERENCES

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Fig. 1

Classification of quality of fracture reduction based on postoperative lateral radiographs. (A) Group 1 (reducted). (B) Group 2 (anteriorly displaced proximal fragment). (C) Group 3 (posteriorly displaced proximal fragment).

Fig. 2

Extent of sliding distance. (A) Postoperative X-ray. (B) Last follow-up X-ray. L1 ⁺ : Postoperative screw length from the end of a lag screw to the center of a nail, L1 ⁺⁺ : Last follow-up length from the end of a lag screw to the center of a nail.

Table 1

Baseline and Demographic Characteristics of Patients

Characteristic	Group 1	Group 2	Group 3
Mean age (yr)	74.0	72.1	74.9
Sex (female:male)	27:15	13:9	16:6
Mean height (cm)	155.6	158.4	159.8
Mean weight (kg)	53.6	54.2	58.1
Mean body mass index (kg/m²)	21.9	21.5	22.6
ASA classification (1:2:3:4:5)	29:11:2:0:0	11:11:0:0:0	14:8:0:0:0
Gait ability preinjury (0:2:4:6:8:10)	3:5:8:10:3:13	2:1:2:6:3:7	1:1:5:12:1:2
AO/OTA classification (A22:A23:A3)	12:26:4	6:13:3	2:15:5
Mean tip-apex distance (mm)	18.3	20.6	19.4
Mean postoperative follow-up (mo)	12.5	11.9	10.7

Group 1 showed no displacement, group 2 showed anterior displacement of the femur neck, and group 3 showed posterior displacement of the femur neck. ASA: American Society of Anesthesiologists classification of physical status.

Table 2

Sliding Distance of Lag Screw

Variable	Group 1	Group 2	Group 3
L1 (postoperative)⁺	79.7	77.7	82.9
L1 (last follow-up)⁺⁺	74.8	73.1	74.4
L1⁺-L1^++* (mm)	4.9±3.2	4.6±3.6	8.5±4.9

Group 1 showed no displacement, group 2 showed anterior displacement of the femur neck, and group 3 showed posterior displacement of the femur neck. ^*Values are presented as mean± standard deviation. L1: Length from the end of a lag screw to the center of a nail, L1 ⁺ : Postoperative L1, L1 ⁺⁺ : Last follow-up L1.

Figure & Data

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Radiologic Assessment of Postoperative Stability in Unstable Intertrochanteric Fracture Using Lateral Radiograph

J Korean Fract Soc. 2016;29(3):171-177. Published online July 31, 2016

DOI: https://doi.org/10.12671/jkfs.2016.29.3.171

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Figure

We recommend

Radiologic Assessment of Postoperative Stability in Unstable Intertrochanteric Fracture Using Lateral Radiograph

Fig. 1 Classification of quality of fracture reduction based on postoperative lateral radiographs. (A) Group 1 (reducted). (B) Group 2 (anteriorly displaced proximal fragment). (C) Group 3 (posteriorly displaced proximal fragment).

Fig. 2 Extent of sliding distance. (A) Postoperative X-ray. (B) Last follow-up X-ray. L1 + : Postoperative screw length from the end of a lag screw to the center of a nail, L1 ++ : Last follow-up length from the end of a lag screw to the center of a nail.

Fig. 1

Fig. 2

Radiologic Assessment of Postoperative Stability in Unstable Intertrochanteric Fracture Using Lateral Radiograph

Table 1

Baseline and Demographic Characteristics of Patients

Characteristic	Group 1	Group 2	Group 3
Mean age (yr)	74.0	72.1	74.9
Sex (female:male)	27:15	13:9	16:6
Mean height (cm)	155.6	158.4	159.8
Mean weight (kg)	53.6	54.2	58.1
Mean body mass index (kg/m²)	21.9	21.5	22.6
ASA classification (1:2:3:4:5)	29:11:2:0:0	11:11:0:0:0	14:8:0:0:0
Gait ability preinjury (0:2:4:6:8:10)	3:5:8:10:3:13	2:1:2:6:3:7	1:1:5:12:1:2
AO/OTA classification (A22:A23:A3)	12:26:4	6:13:3	2:15:5
Mean tip-apex distance (mm)	18.3	20.6	19.4
Mean postoperative follow-up (mo)	12.5	11.9	10.7

Table 2

Sliding Distance of Lag Screw

Variable	Group 1	Group 2	Group 3
L1 (postoperative)⁺	79.7	77.7	82.9
L1 (last follow-up)⁺⁺	74.8	73.1	74.4
L1⁺-L1^++* (mm)	4.9±3.2	4.6±3.6	8.5±4.9

Table 1 Baseline and Demographic Characteristics of Patients

Table 2 Sliding Distance of Lag Screw