Comparative study of radiological outcomes of intertrochanteric fractures managed with intra medullary nailing with or without intraoperative temporary K-wire’s stabilization
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20234040Keywords:
K-wire stabilization, Intertrochanteric fractures, Intramedullary nailingAbstract
Background: Inter-trochanteric fractures are one of the most common hip fractures, occurring in both young adults and the elderly, as a result of high-energy trauma or low-energy trauma. These fractures are three to four times more common in elderly women with osteoporosis. The primary concern with Intertrochanteric fractures is the 20% to 30% mortality risk in the first year after the fracture.
Methods: Various methods of fracture fixation have been used in treating this fracture with intramedullary nailing has been the most favoured. In this modality maintenance of reduction during and after fixation remains a concern. The temporary stabilization of fracture with K-wires for minimally invasive fixation of Intertrochanteric fracture with an intramedullary nail is advocated and aids in keeping the fracture reduction in place while proximal reaming and nail introduction.
Results: In this study a total of 80 patients with intertrochanteric fractures were included, of which 45 patients operated with temporary K-wire, 43 patients reduction was maintained and loss of reduction was noted in 2 patients (4.4%) and 35 patients operated without K-wire, 29 patients reduction maintained and lost in 6 patients (17.1%).
Conclusions: There was no statistically significant, difference in the 2 groups with respect to intra/post-operative loss of reduction. Having a larger study group the results may have a statistically significant outcome.
References
Kokoroghiannis C, Aktselis I, Deligeorgis A, Fragkomichalos E, Papadimas D, Pappadas I. Evolving concepts of stability and intramedullary fixation of intertrochanteric fractures-a review. Injury. 2012;43(6):686-93.
Hoffmann MF, Khoriaty JD, Sietsema DL, Jones CB. Outcome of intramedullary nailing treatment for intertrochanteric femoral fractures. J Orthop Surg Res. 2019;14(1):360.
Ruecker AH, Rupprecht M, Gruber M, Gebauer M, Barvencik F, Briem D, et al. The treatment of intertrochanteric fractures: results using an intramedullary nail with integrated cephalocervical screws and linear compression. J Orthop Trauma. 2009;23(1):22-30.
Huusko TM, Karppi P, Avikainen V, Kautiainen H, Sulkava R. Randomised, clinically controlled trial of intensive geriatric rehabilitation in patients with hip fracture: subgroup analysis of patients with dementia. BMJ. 2000;321(7269):1107-11.
Kaplan K, Miyamoto R, Levine BR, Egol KA, Zuckerman JD. Surgical management of hip fractures: an evidence-based review of the literature. II: intertrochanteric fractures. J Am Acad Orthop Surg. 2008;16(11):665-73.
Boyd HB, Griffin LL. Classification and treatment of trochanteric fractures. Arch Surg (1920). 1949 Jun;58(6):853-66.
Ahn J, Bernstein J. Fractures in brief: Intertrochanteric hip fractures. Clin Orthop Relat Res. 2010;468(5):1450-2.
Balathithyan R, Venkatachalam K. Analysis of outcome of proximal femoral nailing inunstable trochanteric fractures: A prospective study. Int J Orthop Sci. 2019;5(2):661-9.
Gong J, Liu P, Cai M. Imaging evaluation of the safe region for distal locking screw of proximal femoral nail anti-rotation in patients with proximal femoral fracture. Med Sci Monit. 2017;23:719-24.
Wang F, Meng C, Cao XB, Chen Q, Xu XF, Chen Q. Hemiarthroplasty for the treatment of complicated femoral Intertrochanteric fracture in elderly patients. Zhongguo Gu Shang. 2018;31(9):818-23.
Sharma A, Sethi A, Sharma S. Treatment of stable Intertrochanteric fractures of the femur with proximal femoral nail versus dynamic hip screw: a comparative study. Rev Bras Ortop. 2018;53(4):477-81.
Attum B, Pilson H. Intertrochanteric Femur Fracture. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2020.
Tian K, Liu C, Yan J, Fan K, Fan K, Ma W, et al. Feasibility study of Kirschner wire-fixation-cortical bone technique in treatment of intertrochanteric fracture. Chin J Reparat Reconstr Surg. 2019;33(10):1239-44.
Kulkarni SG, Babhulkar SS, Kulkarni SM, Kulkarni GS, Kulkarni MS, Patil R. Augmentation of intramedullary nailing in unstable intertrochanteric fractures using cerclage wire and lag screws: a comparative study. Injury. 2017;48:18-22.
Paul O, Barker JU, Lane JM, Helfet DL, Lorich DG. Functional and radiographic outcomes of intertrochanteric hip fractures treated with calcar reduction, compression, and trochanteric entry nailing. J Orthop Trauma. 2012;26(3):148-54.
Koval KJ, Zuckerman JD. Hip fractures: II. Evaluation and treatment of intertrochanteric fractures. J Am Acad Orthop Surg. 1994;2(3):150-6.
Gao YS, Guo YJ, Yu XG, Chen Y, Chen C, Lu NJ. A novel cerclage wiring technique in intertrochanteric femoral fractures treated by intramedullary nails in young adults. BMC Musculoskelet Disord. 2018;19(1):359.
Kregor PJ, Obremskey WT, Kreder HJ, Swiontkowski MF. Evidence-based orthopaedic trauma working group. Unstable pertrochanteric femoral fractures. J Orthop Trauma. 2005;19(1):63-6.
Siddiqui YS, Khan AQ, Asif N, Khan MJ, Sherwani MKA. Modes of failure of proximal femoral nail (PFN) in unstable trochanteric fractures. MOJ Orthop Rheumatol. 2019;11(1):7-16.
Gu-Hee J. Treatment of the intertrochanteric femoral fracture with proximal femoral nail: nailing using the provisional k-wire fixation. JKFS. 2011;24(3):223-9.
Bhat TA, Butt MF, Beigh IA, Mantoo SA, Ahmad MN, Ganie IA. Comparative study of intramedullary nailing in reverse obliquity intertrochanteric fractures with or without cerclage wire augmentation. Int J Orthop Sci. 2019;5(4):192-5.
Duan X, Tong D, Zhang H, Ji F. Intramedullary nailing of intertrochanteric fractures-minimal invasive techniques for reduction. Res Squa. 2021:1-11.
Maraskolhe DS, Chawla AB, Harne NM. An alternate method to maintain reduction in proximal femur nailing of intertrochanteric femur fracture: temporary k wire fixation. Paripex-Ind J Res. 2020;9(8).
