Results of sagittaly unstable intertrochanteric fractures managed by dual reduction technique

Authors

  • Anoop Kalia Department of Orthopaedics, Max Super Speciality Hospital, Mohali, Punjab, India
  • Gaurav Saini Department of Orthopaedics, Max Super Speciality Hospital, Mohali, Punjab, India
  • Isha Sharma Department of Anaesthesia, Fortis Hospital, Amritsar, Punjab, India
  • Sagar Kadam Department of Orthopaedics, Max Super Speciality Hospital, Mohali, Punjab, India

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20192562

Keywords:

Intertrochanteric, Nail, Reduction

Abstract

Background: We evaluated the functional and radiological outcome of sagittally unstable intertrochanteric fractures reduced by dual technique consisting of a crutch placed posteriorly over distal fragment and pushing the flexed proximal fragment by ramrod anteriorly over a period of 12 months.

Methods: A fracture was defined as sagittally unstable intertrochanteric fracture when posterior sagging of distal fragment and flexion of proximal fragment worsens after routine maneuvers for closed reduction. Out of the 80 intertrochanteric fractures treated from February 2018 to April 2019, 16 hips had sagittal instability and after reduction were treated with proximal femoral nail (Stryker Trauson) in some patients and DePuy Synthes proximal femoral nail PFNA in remaining patients. These 16 patients were followed up for a period of 1 year and functional and radiological outcome was noted.

Results: Out of the 16 patients, 10 were males and 6 were females. The mean age was 68.2 years. According to the A.O classification out of the 16 patients, 7, 5 and 4 patients were classified as A1.3, A2.1, and A2.2 or more. The mean time from injury till surgery was 4.6 days. The mean surgical time was 45.8 minutes. The mean time for radiological union was 22.4 weeks. The mean pre injury activity level was 4.2 while the mean final activity level was 3.8 (1-5) according to modified Koval activity index.

Conclusions: Anatomical reduction followed by rigid internal fixation is the key to success in intertrochanteric fractures. 

References

Hornby R, Evans JG, Vardon V. Operative or conservative treatment for trochanteric fractures of the femur: a randomized epidemiological trial in elderly patients. J Bone Joint Surg Br. 1989;71(4):619-23.

Lorich DG, Geller DS, Nielson JH. Osteoporotic pertrochanteric hip fractures: management and current controversies. Instr Course Lect. 2004;53:441-54.

Barquet A. Proximal IM nailing of unstable trochanteric fractures: minimally invasive reduction aids- a review. J Clin Exper Traumatol. 2016;1(1):4-5.

Desjardins AL, Roy A, Paiement G, Newman N, Pedlow F, Desloges D, et al. Unstable intertrochanteric fracture of the femur: a prospective randomized study comparing anatomical reduction and medial displacement osteotomy. J Bone Joint Surg Br. 1993;75(3):445-7.

Said GZ, Farouk O, Said HG. An irreducible variant of intertrochanteric fractures: a technique for open reduction. Injury. 2005;36(7):871-4.

Chun LYS, Oh H, Cho YJ, Rhyu KH. Technique and Early Results of Percutaneous Reduction of Sagittally Unstable Intertrochateric Fractures. Clin Orthop Surg. 2011;3(3):217–24.

Riehl JT, Widmaier JC. Techniques of obtaining and maintaining reduction during nailing of femur fractures. Orthopedics. 2009;32(8):581.

Koval KJ, Zuckerman JD. Hip fractures: II. Evaluation and treatment of intertrochanteric fractures. J Am Acad Orthop Surg. 1994;2(3):150-6.

Schlickewei CW, Ruger JM, Ruecker AH. Nailing of displaced intertrochanteric hip fractures. Tech Orthop. 2015;30:70-86.

Aktselis I, Papadimas D, Fragkomichalos E. Intramedullary nailing of trochanteric fractures-operative technical tips. Injury. 2012;43:961-5.

Carr JB. The anterior and medial reduction of intertrochanteric fractures: a simple method to obtain a stable reduction. J Orthop Trauma. 2007;21(7):485-9.

Koval KJ, Skovron ML, Aharonoff GB, Meadows SE, Zuckerman JD. Ambulatory ability after hip fracture: a prospective study in geriatric patients. Clin Orthop Relat Res. 1995;(310):150-9

Evans EM. The treatment of trochanteric fractures of the femur. J Bone Joint Surg Br. 1949;31(2):190-203.

Boyd HB, Griffin LL. Classification and treatment of trochanteric fractures. Arch Surg. 1949;58(6):853-66.

Moehring HD, Nowinski GP, Chapman MW, Voigtlander JP. Irreducible intertrochanteric fractures of the femur. Clin Orthop Relat Res. 1997;(339):197-9.

Pape HC, Tarkin IS. Intraoperative reduction techniques for difficult femoral fractures. J Orthop Trauma. 2009;23(5 suppl):S6-S11.

Langford J, Burgess A. Nailing of proximal and distal fractures of the femur: limitations and techniques. J Orthop Trauma. 2009;23(5):22-5.

DePalma AA, O'Halloran K, Shenoy K, Gruson KI, Sharan AD. A novel technique for reducing intertrochanteric hip fractures. Am J Orthop (Belle Mead NJ). 2014;43(9):402-4.

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Published

2019-06-27

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Original Research Articles