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. 2019 Aug;43(8):1951-1959.
doi: 10.1007/s00264-018-4098-1. Epub 2018 Aug 16.

Effect of reduction quality on post-operative outcomes in 31-A2 intertrochanteric fractures following intramedullary fixation: a retrospective study based on computerised tomography findings

Jiantao Li  1 , Licheng Zhang  1 , Hao Zhang  1 , Peng Yin  2 , Mingxing Lei  3 , Guoqi Wang  1 , Song Wang  4 , Peifu Tang  5
Affiliations

Effect of reduction quality on post-operative outcomes in 31-A2 intertrochanteric fractures following intramedullary fixation: a retrospective study based on computerised tomography findings

Jiantao Li et al. Int Orthop. 2019 Aug.

Abstract

Purpose: To determine how the reduction of medial and anteromedial cortices using CT findings in 31-A2 intertrochanteric fractures treated with the intramedullary nail could affect the clinical outcomes and complication rates of the fractures.

Methods: We retrospectively analyzed the data of 43 patients with 31-A2 intertrochanteric fractures who underwent closed reduction and intramedullary internal fixation (CRIF) between January 2010 and December 2013. Patients were classified into two groups based on the post-operative CT scans taken from the sagittal and coronal planes, respectively. Five radiographic parameters and three clinical parameters were used to evaluate the post-operative functional states and mobilization levels in this study. Post-operative complications were also recorded.

Results: The mean loss of the femoral neck-shaft angle (FNSA) was significantly smaller in Group C1 than that in Group C2. There were significant differences in the sliding distance of the cephalic nail and the loss of femoral head height between the two groups. In terms of the reduction conditions shown on the sagittal planes, the FNSA, sliding distance of the cephalic nail, and the loss of FHH were significantly different, although differences in TCD were not significant. Patients in groups C1 (3.6%) and S1 (0.0%) had lower complication rates compared to patients in groups C2 (26.7%) and S2 (27.8%).

Conclusion: Patients with good reduction quality of the medial and anteromedial sustainable cortices had better clinical outcomes and lower complication rates. The sustainable stability and anti-rotational function of these validated reductions might play a critical role in maintaining the fragment positions and reducing the incidence of complications in patients.

Keywords: CT findings; Intertrochanteric fractures; Intramedullary nail; Outcomes; Reduction quality.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart for inclusion and exclusion of patients
Fig. 2
Fig. 2
a The first point. b The second point. c The third point. d New coronal planes through three points were created
Fig. 3
Fig. 3
a The femoral neck was reduced medially to the distal fragment. b Medial cortices were integrated to each other. c The femoral neck was reduced laterally to the distal fragment. d Large gaps was wider than 4 mm within the medial cortices. e The anteromedial cortices of proximal fragment were anteriorly reduced. f The cortices were without displacement. g The anteromedial cortices were posteriorly reduced to the distal fragment. h Large gaps within the anteromedial cortices were wider than 4 mm
Fig. 4
Fig. 4
The constructed sphere fitted the contour of the femoral head properly and the cross-section of the sphere could be visualized on images in the three views
Fig. 5
Fig. 5
a L1 was the chord of the circle O and L2 was treated as the axis of the femoral neck. L3 was the axis of the femoral shaft. The angle formed between L2 and L3 was FNSA. b The distance between the point A and L4 was measured and designated as the FHH. c The green arrow marked was the Lmcn. dLmtc (marked by the orange arrow) was overlapping Lmcn and extending to the femoral head cortex. The difference between Lmtc and Lmcn was TCD
See this image and copyright information in PMC

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