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European Journal of Trauma and Emergency Surgery

Erschienen in:

31.05.2021 | Original Article

Postoperative computed tomography assessment of anteromedial cortex reduction is a predictor for reoperation after intramedullary nail fixation for pertrochanteric fractures

verfasst von: Norio Yamamoto, Takahiro Imaizumi, Tomoyuki Noda, Tomoo Inoue, Keisuke Kawasaki, Toshifumi Ozaki

Erschienen in: European Journal of Trauma and Emergency Surgery | Ausgabe 2/2022

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Abstract

Purpose

Postoperative radiographs are routinely used to assess fracture reduction following intramedullary nail fixation for pertrochanteric fractures, even though computed tomography (CT) is a superior modality. We aimed to determine the association between reduction quality assessed by CT and rates of reoperation and to evaluate the association of reoperation and reduction quality according to the assessment modality (plain radiographs vs. CT).

Methods

A retrospective analysis of 299 consecutive patients treated with intramedullary nail fixation for pertrochanteric fractures was conducted. Fracture reduction measured by postoperative radiographs and CT was categorized as anatomical type, extramedullary type, or intramedullary type. Postoperative data for analysis included reduction status, tip-apex distance (TAD), screw position in the femoral head, sliding distance, and conditions associated with reoperation.

Results

Of the 299 patients included with a mean age of 83.1 ± 8.2 years, there were six patients who required reoperation (2.0%). According to the CT assessments, there were 42 intramedullary reductions (14.0%). Patients with a non-intramedullary reduction based on postoperative CT images were significantly more likely to have proper placement of the screw, a reduced TAD, a reduced sliding distance, and a lower reoperation rate than those with an intramedullary reduction (P < 0.05). The reduction quality assessed by postoperative CT was significantly associated with reoperation (95% CI, 1.45–29.31).

Conclusions

Intramedullary reduction assessed by CT was associated with reoperation. The reduction quality based on CT findings was more predictive for reoperation than that from plain radiographs.

Tsukada S, Okumura G, Matsueda M. Postoperative stability on lateral radiographs in the surgical treatment of pertrochanteric hip fractures. Arch Orthop Trauma Surg. 2012. https://doi.org/10.1007/s00402-012-1484-9.CrossRefPubMed

Kozono N, Ikemura S, Yamashita A, Harada T, Watanabe T, Shirasawa K. Direct reduction may need to be considered to avoid postoperative subtype P in patients with an unstable trochanteric fracture: a retrospective study using a multivariate analysis. Arch Orthop Trauma Surg. 2014. https://doi.org/10.1007/s00402-014-2089-2.CrossRefPubMed

Bojan AJ, Beimel C, Taglang G, Collin D, Ekholm C, Jönsson A. Critical factors in cut-out complication after Gamma nail treatment of proximal femoral fractures. BMC Musculoskelet Disord. 2013. https://doi.org/10.1186/1471-2474-14-1.CrossRefPubMedPubMedCentral

Ito J, Takakubo Y, Sasaki K, Sasaki J, Owashi K, Takagi M. Prevention of excessive postoperative sliding of the short femoral nail in femoral trochanteric fractures. Arch Orthop Trauma Surg. 2015. https://doi.org/10.1007/s00402-015-2200-3.CrossRefPubMed

Baumgaertner MR, Curtin SL, Lindskog DM, Keggi JM. The value of the tip-apex distance in predicting failure of fixation of peritrochanteric fractures of the hip. J Bone Joint Surg Am. 1995. https://doi.org/10.2106/00004623-199507000-00012.CrossRefPubMed

Yoon YC, Oh CW, Sim JA, Oh JK. Intraoperative assessment of reduction quality during nail fixation of intertrochanteric fractures. Injury. 2020. https://doi.org/10.1016/j.injury.2019.10.087.CrossRefPubMed

Yamamoto N, Tamura R, Inoue T, Noda T, Nagano H, Ozaki T. Radiological findings and outcomes of anterior wall fractures in pertrochanteric fractures. J Orthop Sci. 2020. https://doi.org/10.1016/j.jos.2020.02.020.CrossRefPubMed

Zhang W, Antony Xavier RP, Decruz J, Chen YD, Park DH. Risk factors for mechanical failure of intertrochanteric fractures after fixation with proximal femoral nail antirotation (PFNA II): a study in a Southeast Asian population. Arch Orthop Trauma Surg. 2020. https://doi.org/10.1007/s00402-020-03399-2.CrossRefPubMed

Turgut A, Kalenderer Ö, Karapınar L, Kumbaracı M, Akkan HA, Ağuş H. Which factor is most important for occurrence of cutout complications in patients treated with proximal femoral nail antirotation? Retrospective analysis of 298 patients. Arch Orthop Trauma Surg. 2016. https://doi.org/10.1007/s00402-016-2410-3.CrossRefPubMed

10.

Chang SM, Zhang YQ, Du SC, Ma Z, Hu SJ, Yao XZ, et al. Anteromedial cortical support reduction in unstable pertrochanteric fractures: a comparison of intra-operative fluoroscopy and post-operative three dimensional computerised tomography reconstruction. Int Orthop. 2018. https://doi.org/10.1007/s00264-017-3623-y.CrossRefPubMed

11.

Jia X, Zhang K, Qiang M, Chen Y. The accuracy of intra-operative fluoroscopy in evaluating the reduction quality of intertrochanteric hip fractures. Int Orthop. 2020. https://doi.org/10.1007/s00264-020-04533-w.CrossRefPubMed

12.

Li J, Zhang L, Zhang H, Yin P, Lei M, Wang G, et al. Effect of reduction quality on post-operative outcomes in 31–A2 intertrochanteric fractures following intramedullary fixation: a retrospective study based on computerised tomography findings. Int Orthop. 2019. https://doi.org/10.1007/s00264-018-4098-1.CrossRefPubMed

13.

Meinberg EG, Agel J, Roberts CS, Karam MD, Kellam JF. Fracture and Dislocation Classification Compendium-2018. J Orthop Trauma. 2018. https://doi.org/10.1097/BOT.0000000000001063.CrossRefPubMed

14.

Chang SM, Zhang YQ, Ma Z, Li Q, Dargel J, Eysel P. Fracture reduction with positive medial cortical support: a key element in stability reconstruction for the unstable pertrochanteric hip fractures. Arch Orthop Trauma Surg. 2015. https://doi.org/10.1007/s00402-015-2206-x.CrossRefPubMedPubMedCentral

15.

Hsueh KK, Fang CK, Chen CM, Su YP, Wu HF, Chiu FY. Risk factors in cutout of sliding hip screw in intertrochanteric fractures: an evaluation of 937 patients. Int Orthop. 2010. https://doi.org/10.1007/s00264-009-0866-2.CrossRefPubMed

16.

Lechler P, Frink M, Gulati A, Murray D, Renkawitz T, Bücking B, et al. The influence of hip rotation on femoral offset in plain radiographs. Acta Orthop. 2014. https://doi.org/10.3109/17453674.2014.931196.CrossRefPubMedPubMedCentral

17.

Koo H, Leveridge M, Thompson C, Zdero R, Bhandari M, Kreder HJ, et al. Interobserver reliability of the Young-Burgess and tile classification systems for fractures of the pelvic ring. J Orthop Trauma. 2008. https://doi.org/10.1097/BOT.0b013e31817440cf.CrossRefPubMed

18.

Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–74.CrossRef

19.

Doros G, Lew R. Design based on intra-class correlation coefficients. Am J Biostatistics. 2010;1:1–8.

20.

Rubio-Avila J, Madden K, Simunovic N, Bhandari M. Tip to apex distance in femoral intertrochanteric fractures: a systematic review. J Orthop Sci. 2013. https://doi.org/10.1007/s00776-013-0402-5.CrossRefPubMed

21.

Bojan AJ, Jönsson A, Granhed H, Ekholm C, Kärrholm J. Trochanteric fracture-implant motion during healing - a radiostereometry (RSA) study. Injury. 2018. https://doi.org/10.1016/j.injury.2018.01.005.CrossRefPubMed

22.

van Embden D, Stollenwerck GA, Koster LA, Kaptein BL, Nelissen RG, Schipper IB. The stability of fixation of proximal femoral fractures: a radiostereometric analysis. Bone Joint J. 2015. https://doi.org/10.1302/0301-620X.97B3.35077.CrossRefPubMed

23.

Toogood PA, Skalak A, Cooperman DR. Proximal femoral anatomy in the normal human population. Clin Orthop Relat Res. 2009. https://doi.org/10.1302/0301-620X.97B3.35077.CrossRefPubMed

24.

Carr JB. The anterior and medial reduction of intertrochanteric fractures: a simple method to obtain a stable reduction. J Orthop Trauma. 2007. https://doi.org/10.1097/BOT.0b013e31804797cf.CrossRefPubMed

25.

Verbeek DO, van der List JP, Villa JC, Wellman DS, Helfet DL. Postoperative CT is superior for acetabular fracture reduction assessment and reliably predicts hip survivorship. J Bone Joint Surg Am. 2017. https://doi.org/10.2106/JBJS.16.01446.CrossRefPubMed

26.

Qiang M, Chen Y, Jia X, Zhang K, Li H, Jiang Y, et al. Post-operative radiological predictors of satisfying outcomes occurring after intra-articular calcaneal fractures: a three dimensional CT quantitative evaluation. Int Orthop. 2017. https://doi.org/10.1007/s00264-017-3577-0.CrossRefPubMed

27.

Verbeek DO, van der List JP, Helfet DL. Computed tomography versus plain radiography assessment of acetabular fracture reduction is more predictive for native hip survivorship. Arch Orthop Trauma Surg. 2019. https://doi.org/10.1007/s00402-019-03192-w.CrossRefPubMedPubMedCentral

28.

Gordon M, Berntsson PO, Sjölund E, Demir Y, Hedbeck CJ, Stark A, Sköldenberg O. Loss of offset after pertrochanteric hip fractures affects hip function one year after surgery with a short intramedullary nail. A prospective cohort study. Int Orthop. 2016. https://doi.org/10.1007/s00264-015-2815-6.CrossRefPubMed

Titel: Postoperative computed tomography assessment of anteromedial cortex reduction is a predictor for reoperation after intramedullary nail fixation for pertrochanteric fractures
verfasst von: Norio Yamamoto
Takahiro Imaizumi
Tomoyuki Noda
Tomoo Inoue
Keisuke Kawasaki
Toshifumi Ozaki
Publikationsdatum: 31.05.2021
Verlag: Springer Berlin Heidelberg
Erschienen in: European Journal of Trauma and Emergency Surgery / Ausgabe 2/2022
Print ISSN: 1863-9933
Elektronische ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-021-01718-9

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Postoperative computed tomography assessment of anteromedial cortex reduction is a predictor for reoperation after intramedullary nail fixation for pertrochanteric fractures

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